Intravenous thrombolysis is the standard early treatment for acute ischaemic stroke (AIS), yet a substantial proportion of patients, particularly those with mild disabling deficits, do not achieve favourable functional recovery. Tenecteplase (TNK), a fibrin-specific thrombolytic agent administered as a single bolus, and butylphthalide (NBP), a multi-mechanism neuroprotective agent, have each shown benefit in AIS. However, whether their combination confers additional benefit in mild disabling AIS remains unknown. This trial aims to determine whether adding NBP to TNK improves functional outcomes in patients with mild disabling ischaemic stroke treated within 4.5 hours of symptom onset.

A woman in her 20s presented with neck pain and was diagnosed with a primary giant cell tumour (GCT) involving the C5 vertebral body and encasing the left vertebral artery (VA). Denosumab therapy was initiated to reduce tumour vascularity and facilitate resection. After preoperative embolisation of the left VA, total en bloc resection of the tumour was performed. Postoperatively, the patient experienced transient left upper extremity weakness, which improved significantly over time. Follow-up imaging showed successful bony fusion and no recurrence. This case highlights the importance of multidisciplinary planning in managing cervical spine GCTs involving critical neurovascular structures. Combined denosumab therapy and VA embolisation can enable safe and complete tumour resection, potentially improving outcomes and reducing recurrence risk, especially in young patients.

Sarcopenia involves progressive muscle weakness driven by neuromuscular junction (NMJ) degradation, axonal injury, and diminished neurotrophic support. Electromyography (EMG) and plasma biomarkers can reveal these mechanisms, but integrated analyses remain scarce. We examined associations between EMG parameters and plasma biomarkers in older men with and without sarcopenia. We studied 146 men aged ≥60 years, classified as sarcopenic (n=72) or controls (n=74) using standardized criteria. Intramuscular EMG of the biceps brachii and vastus lateralis measured motor unit potential (MUP) amplitude, duration, and recruitment. Plasma C-terminal agrin-fragment 22 (CAF22), neurofilament light-chain (NfL), and brain-derived neurotrophic factor (BDNF) were quantified. Sarcopenic men exhibited higher amplitude and longer MUP duration with reduced recruitment in vastus lateralis. Plasma CAF22 and NfL were elevated, while BDNF was reduced. CAF22 was positively associated with MUP amplitude and duration, whereas NfL with prolonged duration, reflecting NMJ degradation and axonal damage. BDNF showed a negative association with amplitude but a positive association with recruitment, indicating its neuroprotective role. Integrated EMG and biomarker profiling identifies a convergent signature associated with NMJ instability, axonal degeneration, and reduced neurotrophic support in sarcopenia. These findings suggest links between electrophysiological and molecular alterations in sarcopenia.

BackgroundAdvance care planning (ACP) is important for older people with frailty but is inconsistently delivered in Hospital at Home. Baseline staff survey and interview work identified low confidence, documentation uncertainty, time pressure, limited mentorship and organisational barriers.ObjectiveTo evaluate whether a theory-informed multicomponent strategy improved emergency care-planning documentation and nurse confidence, and whether the 30-day emergency department reattendance rate changed.MethodsA quality improvement project was implemented from June 2025 in a UK Hospital at Home service. Interventions included education, simulation, champions, peer mentorship, documentation redesign and co-design. Monthly Recommended Summary Plan for Emergency Care and Treatment (ReSPECT)/Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) documentation and 30-day emergency department reattendance were analysed from January 2024 to June 2026 using run charts and baseline-centred statistical process control p-charts. Nurse confidence was assessed immediately before and after ACP training and analysed using a paired t-test.ResultsAcross 10 950 admissions, new ReSPECT/DNACPR documentation increased from 2.55% (160/6266) before intervention to 5.57% (261/4684) during intervention. Baseline-centred statistical process control showed an eight-point upward shift in documentation rate from November 20252 to June 2026. Nurse confidence increased from 4.71 to 7.43/10 (mean paired increase 2.71, 95% CI 1.86-3.57; P < .001). Thirty-day emergency department reattendance decreased from 22.25% to 21.26%, with an eight-point downward shift over the same period.ConclusionMulticomponent implementation was associated with improved emergency care-planning documentation and nurse confidence. A sustained downward shift in 30-day emergency department reattendance was also observed, although causal attribution is not possible in this uncontrolled service-level evaluation.

In 2014, Uganda was identified as a high-risk country for Ebola Virus Disease (EVD), with a series of outbreaks recorded since 2000. In 2007, the second outbreak in Bundibugyo district resulted in 149 reported cases and 37 confirmed Ebola deaths. Through the outbreak response, a new strain of the Ebola virus (Bundibugyo ebolavirus) was discovered. Although much is known about the nature of Ebola, including disease signs and symptoms, transmission and management, there is limited understanding of the short and long-term sociocultural impacts of the disease in communities. The study team conducted a focused ethnography in Bundibugyo District 10 years after the 2007 outbreak. Data collection included a review of archival data, participant observation, field notes and 19 in-depth interviews with survivors and affected families. Results underscored short and long term social, cultural and economic disruptions caused by the outbreak. We interpreted findings through an Eco-health framework with an emphasis on ways that underlying stigma accentuated detrimental long-term effects of the outbreak. Affected women, particularly widows, experienced social exclusion, and economic strain, and acknowledged loss of opportunity for a better life for their orphaned children. Deepening fear of the possible recurrence of Ebola resulted in ethnic tension driven by speculations on the 2007 outbreak source. Survivors reported varying persistent health effects including impaired vision and general body weakness. Community members reported positive changes in health seeking behaviors. Health care workers described high levels of alert for early clinical signs of Ebola, a critical factor for early outbreak detection at the community level. Our findings can inform future research, Ebola response, and recovery interventions, particularly those targeting community re-integration and mitigation of the fear and stigma associated with survivorship.

Frailty is characterised by a loss of function across several domains but is not an inevitable aspect of ageing and can be reversed with intervention. Determining those who are more likely to become frail before physical deficits become manifest will allow earlier intervention. One promising indicator of the potential for frailty is allostatic load, a physiological status associated with prolonged stress that is characterised by multisystem dysfunction. Previous research has sought to understand the links between allostatic load and frailty, but has not yet explored whether allostatic load may be a predictive factor at younger ages. The present study examined whether allostatic load can be used as a predictive indicator of frailty. Using data from four waves of the English Longitudinal Survey on Ageing (ELSA) collected over 12 years with a sample of 3248 people between 50 and 89 years old at baseline, discrete time event history analysis was used to determine if allostatic load is associated with the onset of pre-frailty and frailty. The findings indicate that allostatic load was a significant contributor to the occurrence of (pre-)frailty. Age and sex did not interact with allostatic load and frailty predictions, whilst in particular social support was identified as a possible modifiable factor. Allostatic load determination should be considered as a possible screening tool for future frailty risk in currently non-frail individuals.