Accurate assessment of residual cognition in patients with disorders of consciousness (DoC) remains challenging due to their limited behavioral responsiveness. Statistical learning (SL), defined as the ability to extract regularities from sensory input, reflects neural processing associated with residual cognition. This study examined how SL is preserved across different levels of consciousness and whether neural markers of SL can inform diagnosis and prognosis in patients with DoC.

Pediatric gastrointestinal scintigraphy provides physiologic, quantitative, and clinically useful information for children with suspected motility disorders, feeding intolerance, reflux or aspiration, refractory constipation, and complex postsurgical anatomy. This review summarizes the role of esophageal transit scintigraphy, gastric emptying and gastroesophageal reflux scintigraphy, and small-bowel and colonic transit scintigraphy in children. These studies complement anatomic imaging, endoscopy, pH-impedance testing, and manometry by directly evaluating the movement of radiolabeled meals or boluses under relatively physiologic conditions. For each application, the review emphasizes practical patient preparation, meal and radiopharmaceutical selection, acquisition methods, quantitative analysis, interpretation patterns, reporting elements, and common pitfalls. Suggested pediatric protocols are provided in three tables, and representative examples are illustrated as figures. Because pediatric normative data are limited for several gastrointestinal transit applications, results should be interpreted in the context of patient age, symptoms, meal type, position, medication status, prior surgery, and institutional methodology. A structured and clinically oriented approach can improve the diagnostic value of pediatric gastrointestinal scintigraphy and help guide multidisciplinary management.

Physical functional limitations and sleep disturbances frequently co-occur in older adults, yet their joint mortality risks and the potential nonlinear dynamics of systemic inflammation remain unclear. This study investigated the joint associations of health behavior profiles (physical function and sleep) and the systemic immune-inflammation index (SII) with mortality, focusing on exploring nonlinear relationships. Data were obtained from 4548 individuals who participated in the National Health and Nutrition Examination Survey (2011-2014). Survey-weighted Cox proportional hazards models and restricted cubic splines with change-point diagnostics were used to characterize exposure-response relationships. Compared with healthy controls, participants with physical functional limitations exhibited >2-fold increases in the risks of all-cause mortality (hazard ratio: 2.44) and cardiovascular mortality (hazard ratio: 2.46). Concurrent sleep disturbances conferred minimal additional risk. The association of SII value with mortality was nonlinear. Risk remained stable at lower SII values but increased sharply beyond identified model-based turning points (SII ≈ 447-644 for all-cause mortality; SII ≈ 332-643 for cardiovascular mortality). Physical functional limitations are robustly associated with mortality, overshadowing the contribution of sleep disturbances. The identified model-based turning points reflect an inflection in mortality risk, suggesting a potential threshold effect in systemic inflammation. Specifically, the findings highlight a unique susceptibility of the cardiovascular system to low-level inflammation. Given the observational nature of this study, these turning points are exploratory and warrant external validation.

Intervertebral disc degeneration (IVDD) is frequently implicated in low back pain (LBP), yet the severity of degeneration on imaging often fails to parallel pain intensity or functional limitation. Modic changes capture abnormal marrow signal at the disc-vertebral interface, but they primarily describe subendplate marrow signal rather than lesion continuity across the disc, cartilaginous endplate, and adjacent marrow. The disc-endplate-bone marrow complex (DEBC) classification provides a complementary lesion-level imaging framework that integrates disc signal, endplate integrity, and adjacent marrow response. By incorporating short tau inversion recovery (STIR) sequences, DEBC may help identify imaging features suggestive of edema-like lesion activity; however, STIR hyperintensity should not be interpreted as direct proof of inflammation, pain generation, or a specific molecular program. This narrative and critical review synthesizes imaging, mechanistic, omics, and translational evidence to evaluate the biological plausibility and current limitations of the DEBC framework. We argue that DEBC should not replace Modic classification, assign pain causality, or guide treatment as a stand-alone criterion. Rather, its current value lies in generating testable hypotheses, improving lesion-level stratification, and supporting future imaging-to-molecular validation. Longitudinal imaging, histopathology, spatial omics, and clinical outcome studies are needed to determine whether DEBC types correspond to reproducible lesion ecologies, pain-associated phenotypes, or treatment-response patterns.

Canine integumentary mast cell tumors (CIMCTs) are common, and their clinical behavior can vary significantly. In an attempt to predict their biological behavior, veterinary pathologists utilize grading systems and assess specific histologic features, which are thought to carry prognostic significance. Assessment of interpathologist agreement with CIMCT grading systems has been investigated. However, for most individual histologic features that form the basis of these grading systems, there has been no investigation into how consistently they can be recognized and reported. This study evaluated the interpathologist agreement for morphologic diagnosis (ie, cutaneous vs subcutaneous mast cell tumors) and 31 histologic features commonly evaluated in CIMCTs by developing 2 surveys, without (survey 1) and with (survey 2) written definitions. Twenty-three veterinary anatomic pathologists located in 8 countries completed the surveys, which included 20 CIMCTs. Interpathologist agreement was calculated for each feature using Krippendorff's alpha values (α). The degree of agreement for morphologic diagnosis was moderate (α = 0.452) and substantial (α = 0.611) in surveys 1 and 2, respectively. In both surveys, there was suboptimal (α < 0.400) agreement among pathologists in evaluating most histologic features (21/31 in survey 1; 20/31 in survey 2). Ulceration, tumor depth and width, and deep histologic tumor-free distance had the best agreement (range = 0.597-0.929) in both surveys. The features with the worst agreement (α ≤ 0.100) in both surveys were cytoplasmic granularity, degree of demarcation, degree of infiltration, chromatin pattern, nucleolar number, and nucleolar prominence. Written definitions did not categorically change interpathologist agreement for most (24/31) histologic features.

In low-resource settings such as Ethiopia, where predictors of time to recovery from SAM remain understudied, identifying predictors and longitudinal weight patterns associated with time to recovery (TTR) from SAM is crucial for early and appropriate clinical interventions. Therefore, this study aimed to determine the incidence and predictors of recovery from SAM, as well as its association with longitudinal weight changes, among children aged 6-59 months in Ethiopia. An institution-based retrospective follow-up study was conducted among SAM children aged 6-59 months at Amhara Region Comprehensive Specialized Referral Hospitals (CSEHs), Northwest Ethiopia. Cox PH and linear mixed effect models were jointly used to evaluate the effects of time-dependent weight trajectories on the time to recovery from the SAM via the Bayesian approach. An adjusted hazard ratio (AHR) with a 95% credible interval (CrI) was used to determine statistically significant predictors. The data were entered into the Kobo toolbox and analyzed with R software version 4.5.1. A total of 480 children aged 6-59 months were followed for 4356 person-days of observation (PDO). At the end of the follow-up, 291 patients (291/480, 60.6%) had recovered, with an incidence density of 6.69 cases per 100 PDOs (95% CI: 5.93-7.47). The median recovery time from severe acute malnutrition was 10 days (IQR: 7-16). The time-dependent current value of weight was significantly positively associated with the time to recovery (AHR = 1.15 95% CrI: [1.04, 1.26]). Additionally, being HIV seropositive (AHR = 0.46, 95% CrI: [0.22, 0.90]), having edematous malnutrition (AHR = 0.48, 95% CrI: [0.32, 0.70]), vomiting at admission (AHR = 0.62, 95% CrI: [0.44, 0.87]), anemia at admission (AHR = 0.45, 95% CrI: [0.31, 0.64]), folic acid supplementation (AHR = 0.70, 95% CrI: [0.53, 0.94]), F-100 formula milk (AHR = 1.40, 95% CrI: [1.08, 1.80]), and antibiotic use (AHR = 1.58, 95% CrI: [1.04, 2.46]) were significant predictors of the time to recovery from severe acute malnutrition. The proportion of recovery reported in this study was lower than the minimum 75% threshold set by the national and international SPHERE standards. The median recovery time of 10 days was optimal. The unobserved true current value of weight change was significantly associated with the time to recovery from severe acute malnutrition. Additionally, HIV status, anemia, edema, vomiting at admission, folic acid supplementation, F-100 formula milk, and IV antibiotic use were significant predictors of the time to recovery from SAM. F-100 supplements and IV antibiotics should be used to improve and increase the recovery rate.

Over the past decade, the incidence of infectious syphilis has been on the rise in the general Chinese population. Consequently, Treponema Pallidum (TP) testing has been proposed as a surrogate marker for sexually transmitted pathogens and for monitoring risky sexual behaviors among blood donors globally. In addition, sexual contact with individuals chronically infected with hepatitis B virus (HBV) is recognized as one of the primary routes of HBV transmission. Blood donors may acquire HBV infection through sexual contact with chronically infected partners, particularly with occult hepatitis B infections (OBIs), which are characterized by intermittent and extremely low viral loads. Therefore, the prevalence of OBIs among syphilis-positive blood donations and the corresponding risks to blood safety require further investigation. This study aimed to investigate the prevalence of OBIs among syphilis-positive blood donors and assess the surrogate value of TP testing for evaluating OBI-related risks to blood supply. After routine screening using serological assays and nucleic acid testing (NAT), blood donation samples with positive anti-TP enzyme-linked immunosorbent assay (ELISA) results were collected and further confirmed by the Treponema Pallidum Particle Agglutination Assay (TPPA). For blood donations confirmed positive for syphilis, further tests were performed to characterize whether the donations had HBV co-infection, including electrochemiluminescence immunoassay (ECLI) for the detection of hepatitis B surface antigen (HBsAg), anti-hepatitis B surface antibody (anti-HBs), hepatitis B e antigen (HBeAg), anti-hepatitis B e antibody (anti-HBe), and anti-hepatitis B core antibody (anti-HBc). Additionally, quantitative real-time polymerase chain reaction (qPCR) was used for HBV DNA quantification, and nested PCRs for the S and basal core promoter/precore (BCP/PC) region were conducted in combination with high-volume nucleic acid extraction. Subsequently, molecular characterization of HBV DNA in these co-infected samples was carried out by DNA sequencing to analyze the viral genetic features. Of 252 anti-TP ELISA+ donations screened from 64,871 blood samples, 138 (138/250, 55.2%) donations were confirmed syphilis-positive but NAT-, among which 78 (78/138, 56.5%) were anti-HBc-positive, and 88 (88/138, 63.7%) had anti-HBs. Notably, seven donations (7/138, 5.1%) were diagnosed as OBI co-infections, and available sequence analysis revealed that three cases were genotype B and one case was genotype C. In addition, several mutations in the S region of the HBV genome were identified, including Q101R, K122R, Q129H, T131N, M133T, G145R, and Y161F mutations. Furthermore, nucleotide mutations such as T1719G, A1752T, G1896A, and A1762T/G1764A in the BCP/PC regions were also detected in these OBI donations. These mutations may contribute to the extremely low HBV viral loads and/or failure in HBsAg detection, collectively leading to OBIs. These data indicate that syphilis screening of blood donors has potential to serve as an additional safeguard measure for excluding donations co-infected with OBIs. The high prevalence of undetected OBIs in syphilis-positive blood donors further supports that syphilis screening has the potential to serve as a surrogate marker for HBV-related risks in the blood supply.

Background: Pain is a prominent and disabling manifestation of inflammatory bowel disease (IBD), including abdominal, pelvic, musculoskeletal, axial, and neuropathic pain phenotypes. Patients referred to pain clinics represent a selected subgroup with clinically meaningful, persistent, refractory, or diagnostically complex pain. Objective: To characterize pain phenotypes, treatment patterns, interventional pain-care exposure, and utilization burden among patients with IBD evaluated in tertiary pain-clinic settings and to explore differences between Crohn's disease and ulcerative colitis patients. Methods: We performed a retrospective electronic medical-record cohort study of patients with documented IBD who were evaluated in pain-clinic settings between 24 October 2010 and 14 May 2026. Repeated clinical entries were aggregated into unique visit dates and patient-level variables. IBD diagnosis, pain phenotypes, treatment documentation, interventional procedures, and pain-clinic utilization were summarized descriptively using counts, percentages, means, medians, interquartile ranges, and ranges as appropriate. Crohn's disease and ulcerative colitis subgroups were compared using univariable odds ratios with 95% confidence intervals and two-sided p-values. Because repeated clinical entries could belong to the same patient, the primary analytic unit was the patient rather than the individual note. Results: The source dataset included 19,615 clinical entries representing 7053 unique pain-clinic visits among 596 unique patients with IBD. The cohort included 314 patients with Crohn's disease (52.7%), 247 with ulcerative colitis (41.4%), and 35 with IBD-unclassified (5.9%). The mean number of pain-clinic visits per patient was 11.8, with a median of four visits (interquartile range, 1-11). The dominant patient-level pain phenotypes were limb or peripheral joint pain (395/596, 66.3%), back or axial spine pain (358/596, 60.1%), and abdominal or pelvic pain (246/596, 41.3%). Overall, 437 patients (73.3%) had documentation of at least one interventional pain procedure. Compared with ulcerative colitis, Crohn's disease was associated with higher documentation of abdominal or pelvic pain (148/314, 47.1% vs. 82/247, 33.2%; odds ratio, 1.79; 95% confidence interval, 1.27-2.53; p = 0.001) and fibromyalgia-like or widespread pain (83/314, 26.4% vs. 39/247, 15.8%; odds ratio, 1.92; 95% confidence interval, 1.25-2.93; p = 0.0027). In contrast, radiofrequency procedures (59/314, 18.8% vs. 78/247, 31.6%; odds ratio, 0.50; 95% confidence interval, 0.34-0.74; p = 0.0005) and facet or medial branch procedures (79/314, 25.2% vs. 87/247, 35.2%; odds ratio, 0.62; 95% confidence interval, 0.43-0.89; p = 0.012) were less frequently documented in Crohn's disease than in ulcerative colitis. Conclusions: Among patients with IBD referred to tertiary pain-clinic evaluation, pain was heterogeneous and predominantly musculoskeletal, axial, neuropathic, and procedurally targetable rather than exclusively visceral. These findings support structured, mechanism-based pain assessment integrated with gastroenterology, rheumatology, and pain-medicine care.

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with persistent disparities in stage at diagnosis. While transportation-related exposures are increasingly recognized as environmental health risks, the biological mechanisms linking these exposures to cancer progression remain unclear. This study evaluated whether tumor microRNAs (miRNAs), which regulate gene expression and tumor behavior, mediate the association between transportation burden and TNBC stage at diagnosis. Methods: We analyzed 434 TNBC cases from the Louisiana Tumor Registry (2009-2019). The transportation burden from the 2022 Environmental Justice Index reflects the residential proximity to high-volume roads, railways, and airports. miRNA expression was measured via high-throughput sequencing and normalized using the trimmed mean of M-values method. Three-phase analysis (screening, individual, and multiple mediation) was performed. KEGG pathway enrichment analysis assessed downstream biological pathways. Results: After adjusting for age, race, body mass index, marital status, primary payer, and concentrated disadvantage index (CDI), every 0.10 (10-percentile) increase in transportation burden rank was significantly associated with a 9% increase in the odds of late-stage TNBC diagnosis (Adjusted OR = 1.09, 95% CI: 1.01-1.17, p = 0.021). Five miRNAs significantly mediated this relationship: downregulated hsa-let-7c-5p, hsa-let-7b-5p, hsa-miR-30a-3p, and hsa-miR-92a-3p, and upregulated hsa-miR-151a-3p. Joint mediation analysis demonstrated complete mediation (indirect effect = 0.324; p = 0.027). hsa-let-7c-5p was the primary independent mediator. The enriched pathways included MAPK, PI3K-Akt, Wnt, and p53 signaling. Conclusions: These findings identified molecular pathways linking transportation-related environmental exposures to TNBC progression through dysregulation of miRNAs. By integrating environmental exposure assessment with tumor biology, this study advances our understanding of how the built environment contributes to cancer disparities.

Objectives: The aim of the study was to describe the graphical synovial cell distribution as LMNE matrix patterns in native knee aspirates and to explore their association with septic arthritis, crystal arthropathy, rheumatoid arthritis and haemarthrosis. Methods: In total, 117 patients with knee joint effusions of various origins underwent aspiration of the knee joint and the aspirate analysed using the Yumizen H500 automated cell counter. Microscopy of the aspirate was performed at the same time in cases with a cluster in the so-called noise field or previously unknown cell distribution. Results: The graphical type differentiation of automated synovial cell count analyses of native joints allowed 9 different types to be recognised: Type I as particle type, type II as infection type, type III as combination type of infection and particles, type IV as indifferent type, type V as haematoma type and type VI as combination type of infection and haematoma, type VII as particle type with haematoma, type VIII in rheumatoid arthritis and type IX as mixed type combining infection and rheumatoid arthritis. Differentiation of LMNE types into infection types (types II, III, VI and IX) and non-infection types (types I, IV, V, VII and VII) resulted in a sensitivity of 100%, a specificity of 93.9%, an accuracy of 96.6%, a positive predictive value (PPV) of 92.7%, a negative predictive value (NPV) of 100%, a positive likelihood ratio (LR+) of 16.5 and a negative likelihood ratio (LR-) of 0. Conclusions: Graphical LMNE matrix analysis of native knee aspirates identified reproducible patterns associated with septic arthritis, crystal arthropathy, rheumatoid arthritis, and haemarthrosis, which may be helpful in distinguishing these clinical entities, suggesting that graphical cell count interpretation may provide useful adjunctive information to the standard diagnostic work-up. The study is a preliminary descriptive study and requires validation using a larger number of patients.