Abortion aetiology is critically linked to increased myometrial contractions and maternal psychological stress. Given the limited efficacy of current therapies such as progesterone, investigating novel therapeutic interventions is essential. Melatonin exerts reproductive benefits. Agomelatine stands out as an agent that exerts antidepressant effects through serotonin receptor (5-HT2C) antagonism in addition to its potent melatonergic activity. Furthermore, agomelatine inhibits myometrial contractions. In this context, this study investigates agomelatine's therapeutic potential in an abortion model across behavioural, biochemical and histological parameters. Eighty female Sprague-Dawley rats were randomized into eight groups: control, sham, abortion, melatonin (M), agomelatine (A), progesterone (P) and combinations (MP, AP). Following pregnancy (Day 0), oral treatments were administered daily for 14 days. Abortion was induced via mifepristone on Day 11. Depressive-like behaviours were assessed using a forced swimming test on Day 13. The next day, rats were sacrificed for serum hormone analysis and uterine histological evaluation. The forced swimming test showed shorter immobility time in the AP group compared to the abortion group. An enzyme-linked immunosorbent Assay revealed lower serum prostaglandin F2α level in the AP group and lower serum oxytocin levels in the M, A, MP and AP groups versus the abortion group. Histologically, M, A, P, MP and AP groups exhibited higher scores for complete fetus, decidual congestion, decidual inflammation and cytotrophoblast-syncytiotrophoblast cells compared to the abortion group. Additionally, the abortion group showed higher decidual necrosis than controls. In conclusion, agomelatine-containing protocols demonstrated restorative effects in abortion across behavioural, biochemical and histological parameters. These effects of agomelatine provide a new perspective on the currently limited options for treatment of abortion.

BACKGROUND Hemodynamically stable penetrating neck trauma with retained deep foreign bodies can conceal functionally significant neural injury despite absence of major vascular findings on computed tomography angiography. In selected cases, early laryngoscopy may provide decisive functional evidence and help identify occult recurrent laryngeal nerve injury requiring timely surgical exploration. CASE REPORT A 45-year-old woman presented with penetrating neck trauma caused by multiple glass fragments, with Zone II entry wounds and a deep transcervical trajectory across zones. She was hemodynamically stable, without airway compromise. Computed tomography angiography demonstrated multiple retained glass foreign bodies in deep cervical compartments, without contrast extravasation, pseudoaneurysm, or hematoma. Flexible laryngoscopy demonstrated left vocal fold paralysis. Given the deep retained foreign bodies, proximity to critical structures, and laryngoscopy-confirmed vocal fold immobility, selective exploratory cervicotomy was performed. Forty glass fragments were removed. Intraoperatively, left recurrent laryngeal nerve transection was identified within the tracheoesophageal groove. After debridement of nonviable nerve ends, primary repair was not feasible; direct reinnervation was performed using the superior root of the ansa cervicalis under 3× surgical loupe magnification. The postoperative course was uneventful; the patient was discharged on postoperative day 5. At the 12-month follow-up, she demonstrated sustained functional voice recovery, with improvements in maximum phonation time, acoustic parameters, and videolaryngostroboscopic findings. CONCLUSIONS In selected stable penetrating neck trauma cases, hard sign absence does not exclude functionally important occult neural injury. Deep wound trajectories associated with retained foreign bodies may warrant early laryngoscopy with computed tomography angiography-this assessment can guide selective exploration and enable timely nerve reconstruction when technically feasible.

Adaptive stress coping involves flexible coordination of behavioral and neuroendocrine responses, yet how cortical regions orchestrate these outputs remains poorly understood. The insular cortex (IC) integrates interoceptive signals and projects to extended amygdala nuclei implicated in threat responses, including the anteroventral subdivision of the bed nuclei of the stria terminalis (avBST) and central amygdala (CeA). Here we used pathway-specific chemogenetics to bidirectionally manipulate IC-avBST projections in male rats during the shock probe defensive burying test (SPDB), which naturalistically measures active versus passive coping. Inhibition of avBST-projecting neurons resulted in a passive coping phenotype of increased immobility and elevated corticosterone levels. Excitation of these neurons unexpectedly shifted behavior in the same direction, reducing defensive burying without altering immobility or corticosterone responses. This convergence suggested that the effects might not be mediated by the avBST projection itself, prompting us to examine collateral targets. Anatomical tracing revealed that avBST-projecting IC neurons send dense collateral axons to CeA, and ex vivo recordings confirmed functional synaptic connectivity. Chemogenetic excitation of CeA-projecting IC neurons also reduced defensive burying, as did optogenetic stimulation of IC terminals in CeA but not avBST, implicating IC input to CeA. These findings suggest that reducing IC excitatory drive on avBST promotes behavioral and hormonal features of passive coping, consistent with avBST's established role in constraining stress responses. By contrast, excitatory influences operate through collateral CeA projections suppress active defensive behavior without engaging neuroendocrine output, indicating that a projection's collaterals, not its defining target, can determine its functional impact.Significance statement Adaptive stress coping requires coordinated behavioral and hormonal responses, yet the neural circuits orchestrating these outputs remain poorly understood. We show that insular cortex neurons projecting to the bed nuclei of the stria terminalis (BST) send dense collateral axons to the central amygdala, enabling distributed control of stress responses. Inhibiting these neurons increases both behavioral passivity and adrenocortical activation- hallmark features of passive coping. Conversely, exciting these neurons suppresses active defensive behavior without affecting hormonal output, an effect mediated by collateral projections to the amygdala rather than the projection to BST itself. These findings demonstrate that insular cortex regulation of stress coping operates through a collateral architecture rather than simple point-to-point connectivity.

The brain's ability to consolidate a wide range of memories while maintaining their distinctiveness across experiences remains poorly understood. Sharp-wave ripples, neural oscillations that occur predominantly within CA1 of the hippocampus during immobility and sleep, have been shown to play a critical role in the consolidation process. More recently, evidence has uncovered functional heterogeneity of pyramidal neurons within distinct sublayers of CA1 that display unique properties during ripples, potentially contributing to memory specificity. Despite this, it remains unclear exactly how ripples shift the activity of CA1 neuronal populations to accommodate the consolidation of specific memories and how sublayer differences manifest. Here, we studied interactions between the anterior cingulate cortex (ACC) and CA1 neurons during ripples and discovered a reorganization of their communication following learning. Specifically, using a generalized linear model decoder, we demonstrated the pre-existence of ACC-to-CA1 communication, which is weakened during post-training sleep following learning, suggesting that ACC activity reallocates the contribution of CA1 neurons during memory formation. Interestingly, the reorganization appeared unique for a subset of CA1 superficial (CA1sup) neurons that were task inactive, whereas communication between the ACC and CA1deep neurons remained largely stable across pre- and post-training sleep. Consistent with this sublayer-selective reorganization, we found that optogenetic stimulations of the ACC preferentially suppressed CA1sup neurons while activating a unique subset of CA1 interneurons. Overall, these findings highlight an important role of the ACC in rebalancing CA1 neuronal populations' contribution in learning and memory consolidation.

Catatonia is a heterogeneous and poorly defined entity. Akinetic catatonia shares core phenomenology with the adaptive freeze-to-tonic immobility response, a threat-defense system conserved across evolution. It has been suggested that catatonia may be the maladaptive counterpart of the freeze-to-tonic immobility response. While similar brain structures are implicated in both entities, no theory-driven synthesis of neuroimaging evidence has been conducted to provide mechanistic support for this hypothesis. In this critical review, we cross-referenced available neuroimaging studies in human freezing and catatonia studies across etiologies. Both independent literatures implicate failure of the orbitofrontal-medial prefrontal cortices, dysregulation of the salience network, and basal ganglia-midbrain mediated motor block. Based on this review's findings, we developed the freeze-arrest model of catatonia (FAMC), a unified mechanistic framework that integrates evolutionary, neurobiological, and clinical data. The three entry points into the FAMC are overwhelming emotions, toxic-metabolic network disruption, and subcortical short-circuiting. Neurodegenerative, neurodevelopmental, and structurally mediated catatonia represent a mechanistically distinct category. FAMC is a testable evo-neurobiological model that explains the heterogeneity of acute akinetic catatonia, proposes unified diagnostic criteria, and treatment implications per presentation.

Nutritional Support (NS) is essential for preserving or restoring nutritional status in clinical settings. Accurate nutritional prescription depends on selecting an appropriate Body Weight (BW), yet clinical factors such as edema, ascites, inflammation, immobility, and obesity can compromise the reliability of Current Body Weight (CBW). Although multiple guidelines exist for NS implementation, there is no clear consensus on which BW should be used across different clinical conditions. To map and summarize evidence regarding the types of BW recommended for nutritional prescription in adults receiving NS. A scoping review was conducted according to PRISMA-ScR guidelines. Four databases (PubMed, Embase, Scopus, Web of Science) were searched without date or language restrictions. Eligible documents included guidelines, consensus statements, reviews, and primary studies reporting BW types used to guide caloric or protein prescriptions for adult patients receiving enteral or parenteral nutrition. Four reviewers independently screened, selected, and extracted data, resolving disagreements through discussion. A total of 16 772 papers were identified and 41 publications met the inclusion criteria. Studies were most frequently conducted in Europe and North America. Ideal body weight (IBW) was the most frequently reported BW parameter (73.2%), especially for patients with obesity, fluid overload, or limited mobility. CBW was recommended primarily for individuals with normal weight and no edema or ascites. Considerable variability exists in BW selection for nutritional prescription. Standardized, pathology-specific guidance is needed to minimize heterogeneity in clinical practice and reduce the risk of inappropriate nutrient delivery.

Stroke remains a leading cause of death and acquired long-term disability worldwide, and the earliest days after onset frequently shape the safety, intensity, continuity, and person-centeredness of subsequent rehabilitation. Early rehabilitation is delivered by interprofessional teams, within which nurses make a distinctive contribution through continuous surveillance, repeated bedside implementation of agreed plans, prevention of avoidable complications, and coordination across shifts and settings. This comprehensive review synthesizes contemporary evidence relevant to early nursing contributions in post-stroke neurological rehabilitation for ischemic and hemorrhagic stroke. Guidelines, systematic reviews, randomized trials, and nursing-science sources were identified through structured searches of MEDLINE, CINAHL, Embase, the Cochrane Library, and named guideline and professional-society resources, then synthesized narratively using a transparent, criteria-based appraisal of evidence strength. Central themes include neurological surveillance, swallow safety, positioning and limb protection, readiness-based mobilization, prevention of immobility-related and iatrogenic complications, communication and cognitive support, mood and fatigue care, dignity-preserving continence rehabilitation, education, secondary prevention, and transitions of care. The strongest evidence supports organized stroke-unit care, timely swallow screening, protocolized management of fever, glycemia, and swallowing, appropriate mechanical venous thromboembolism prevention, and early supported discharge for selected patients. Evidence is more mixed for very early high-dose mobilization, routine splinting, several oral care protocols, and some digital interventions. Most included evidence was generated in high-resource stroke systems, and transferability to lower-resource settings requires contextual adaptation. Early nursing interventions are most effective when their nursing-led and shared components are clearly delineated within standardized yet individualized interprofessional pathways that preserve physiologic stability, dignity, equitable access, and long-term participation.

Endoscopic laser cordotomy, also known as Kashima operation, is used for the treatment of bilateral vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any stridor. The objective of the study was to assess outcome of unilateral transverse cordotomy (Kashima operation) for bilateral vocal cord immobility. This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangladesh Medical University, Dhaka, Bangladesh from January 2020 to June 2021 with 12 patients having bilateral vocal cord immobility with shortness of breath (SOB) or tracheostomized for SOB due to bilateral vocal cord immobility. The diagnosis was confirmed by fiberoptic laryngoscopy. Endoscopic assessment of subglottis and trachea was also done for assessment of any co-incidental pathology which may affect the outcome. Outcome of the surgery was evaluated by Flow volume loop Spirogram, Medical Research Council Dyspnoea Scale (MRCDS) 2007 and Voice Handicap Index (VHI) scores. All the information were recorded in a pretested questionnaire. The mean ±SD preoperative MRCDS was 4.33±0.49 and mean postoperative MRCDS was 1.75±1.06, 1.50±0.80 and 1.33±0.6 at 1st, 2nd and 3rd months of follow-up respectively. Mean ±SD preoperative total VHI score was 24.50±2.11 and postoperative score was 75.50±25.57, 44.17±31.50 and 37.33±22.86 at 1st, 2nd and 3rd months of follow-up respectively. MRCDS was significantly improved after Kashima operation (p<0.001). But no significant difference was observed in pre and at 3 months postoperative VHI score (p>0.05). In this study, preoperative mean of FVC, PEFR, PIFR, FEF50% and FIF50% were found 1.7±0.09 L, 2.5±0.12 L/S, 1.75±0.11 L/S, 0.84±0.06 and 2.08±0.38 respectively. Postoperative means of FVC, PEFR, PIFR, FEF 50% and FIF 50% were found 2.5±0.12 L, 4.5±0.12 L/S, 3.54±0.54 L/S, 1.84±0.40 and 3.54±0.69 at follow-up period of 2 months respectively. Statistically significant differences were observed in between pre and postoperative all the parameters of spirometry (p<0.001). In this study, only 2(16.67%) cases were developed complications after surgery. Vocal cord oedema in 1(8.33%) case and Fibrosis with granuloma in 1(8.33%) case. Kashima procedure is an effective surgery to reduce the severity of dyspnoea in bilateral vocal cord immobility without significant change of voice.

Chronic stress impairs quality of life by disturbing physical and psychological functioning, and increases susceptibility to a wide range of diseases. Lactobacillus reuteri ATG-F4 isolated from the fecal samples of a newborn baby alleviated chronic stress-induced anhedonia by altering the expression of neurometabolites and neurotransmitter receptors. In this study, we examined whether ATG-F4 can improve behavioral deterioration induced by chronic stress using the Laboratory Animal Behavioral Observation Registration and Analysis System (LABORAS). The continuous behavior of the mice was examined in the LABORAS cage without the intervention of the researchers. Mice exposed to chronic stress displayed significantly increased frequency of immobility compared with control mice, whereas the duration of immobility remained unchanged. Interestingly, mice treated with ATGF4 during stress treatment period and two weeks prior maintained immobility frequency at control level observed in control mice. Locomotor activity and exploratory behavior of mice exposed to chronic stress were significantly attenuated, but ATG-F4 treatment restored them at control levels. Stress is known to adversely affect sleep quality. Electroencephalography analysis revealed that sleep latency enhanced in stressed mice was reduced by ATG-F4 administration. RT-PCR analysis of brain tissues demonstrated that ATG-F4 intake modulated the expression of multiple genes including GABA receptor and serotonin receptor. Alterations in gut microbiota composition and bacterial diversity induced by chronic stress were restored to levels similar to controls by ATG-F4 treatment. Taken together, these results suggest that ATG-F4 can ameliorate chronic stress-induced behavioral impairments, potentially via its effects on gene expression and the composition of the gut microbiota.