Microorganisms are fundamental components of terrestrial ecosystems, acting not only as symbionts or pathogens but also as key nutritional resources for invertebrates. Despite their ubiquity, their role in shaping early-life survival and phenotypic variation in terrestrial animals remains poorly understood. Here, we investigated how microbial resource regimes act as early-life ecological filters influencing survival, growth, and reproductive morphology in the phally polymorphic wetland microsnail Vertigo antivertigo. Using eggs and early juveniles, life stages characterized by high natural mortality, we conducted a series of laboratory experiments manipulating access to the species' fecal- and litter-associated bacteria, soil and litter fungi, and the cyanobacterium Limnothrix sp. Survival emerged as the most consistent response variable across treatments. Fungal supplementation combined with plant litter supported growth and survival to sexual maturity, whereas bacterial resources alone did not compensate for the absence of intact litter-associated microorganisms. Exposure to Limnothrix sp. resulted in severe growth suppression and complete juvenile mortality, irrespective of bacterial supplementation. Disrupted microbial conditions were also associated with shifts in reproductive morphology, including reduced or absent male copulatory organs. Our findings demonstrate that microbial resource regimes can function as strong early-life ecological filters, shaping survival, growth and reproductive morphology.

Benign paroxysmal positional vertigo (BPPV) generally responds well to canalith repositioning procedures (CRPs), although some patients require repeated interventions. In this study, we evaluated refractory BPPV based on the number of CRP attempts required in 171 patients with acute BPPV and investigated clinical factors associated with treatment resistance, with particular emphasis on serum 25-hydroxyvitamin D [25(OH)D] levels and BPPV subtype. Kaplan-Meier analysis showed that cumulative resolution increased substantially during the first three CRP attempts but plateaued thereafter, indicating limited additional benefit beyond three sessions. Refractory BPPV was therefore defined as requiring three or more CRP attempts, and 47 patients (27.5%) met this criterion. In the multivariable model without interaction terms, BPPV subtype and prior vestibular neuritis were the strongest predictors of treatment resistance, and lower serum 25(OH)D levels were independently associated with refractoriness. However, inclusion of an interaction term between 25(OH)D and subtype revealed a significant subtype-dependent effect, attenuating the main effect of 25(OH)D. Subgroup analysis demonstrated that lower 25(OH)D levels were associated with treatment resistance only in typical BPPV. These findings suggest that 25(OH)D may serve as a supplementary prognostic marker reflecting metabolic vulnerability of the otolith system, particularly in typical BPPV.

Osteolipoma is an uncommon benign lipomatous tumor characterized by the presence of mature adipose tissue intermixed with lamellar bone. We present a unique case of a 22-year-old female with an osteolipoma in the upper cervical paraspinal region, closely associated with the vertebral artery. The patient exhibited atypical symptoms, including intermittent dizziness and numbness around the right eye, which were previously unreported in similar spinal cases. Diagnosis was confirmed through multimodal imaging and CT-guided biopsy. Surgical excision was performed without complications, and the patient experienced complete symptom resolution at follow-up. This report contributes novel clinical and anatomical insights to the limited literature on spinal osteolipomas, emphasizing the importance of individualized evaluation and multidisciplinary management for optimal outcomes.

This narrative review explores recent advances in the study of migraine with an emphasis on its complex polygenic aetiology, pathogenesis, clinical presentation, and the potential for new specific mechanism-based treatments in children and adolescents. The polygenic aetiology and complex pathogenesis of migraine make its clinical presentation subject to the influences of intrinsic physiological and psychological factors as well as extrinsic environmental and lifestyle factors. In addition to variation in the clinical presentation of migraine in children, several disorders, such as abdominal migraine, cyclical vomiting syndrome, benign paroxysmal vertigo, benign paroxysmal torticollis, and infantile colic, are considered under the wide umbrella of childhood migraine syndrome. Advances in the study of migraine pathophysiology have identified the important roles of several neurotransmitters and opened the way for the development of new specific medication to treat migraine episodes and for prevention. In the absence of reliable biomarkers, clinical assessment remains the backbone for the diagnosis and assessment of migraine. With better understanding of the complexity of migraine pathophysiology comes the realization that no single drug will solve all the problems of the disease for all patients.

Exposure to high altitude can cause acute mountain sickness (AMS) characterized by headache, gastrointestinal symptoms, dizziness and fatigue, which may progress to life-threatening conditions like high-altitude cerebral edema (HACE). Although the pathophysiology and development of AMS have been intensely investigated, the risk factors and underlying mechanisms remain incompletely understood. In addition, objective criteria for the diagnosis of AMS and reliable biomarkers are missing. Here we provide an overview of the molecular and pathophysiological foundations of AMS and review which potential biomarkers have been suggested and in combination with which physiological and psychological correlates of AMS they could improve diagnosis. Moreover, we point out current knowledge gaps and discuss which future research is required to enable AMS diagnosis based on more objective biomedical and psychophysical criteria. Emphasizing the apparent heterogeneity in AMS pathogenesis, we support the classification of different AMS subtypes according to etiological parameters. We propose the hypothesis that both insufficient and excessive hypoxia responses can cause AMS and that the differentiation according to these divergent mechanisms might allow the identification of AMS subtypes that can be characterized better using biomarkers and correlates of AMS.

NF2-Related Schwannomatosis (NF2-SWN) is a rare tumor predisposition syndrome characterized by heterogeneous clinical manifestations that substantially impact quality of life (QOL). In this diverse patient population, a disease-specific QOL instrument is essential for both research and clinical decision-making. Insight into factors associated with QOL may further facilitate the tailoring of management strategies to individual patient needs. This study aimed to validate the Dutch version of the NF2 Impact on Quality of Life questionnaire (NFTI-QOL) and to identify factors associated with QOL in Dutch patients with NF2. Following forward‑ and backward‑translation, the NFTI-QOL was administered to NF2-SWN patients alongside the SF‑36, EQ‑5D and PANQOL. The NFTI-QOL was repeated after one week. Demographic and clinical data were extracted from medical records. To provide clinical context, questionnaires were also administered to patients with sporadic vestibular schwannoma (sVS). 64 NF2-SWN and 51 sVS patients completed the questionnaires. The NFTI-QOL demonstrated good validity and reliability. In multivariate linear regression, dizziness (β = 2.533, p = 0.027) and facial weakness (β = 4.064, p = 0.008) were significantly associated with QOL, whereas hearing complaints were not. Surprisingly, overall QOL did not differ between NF2-SWN and sVS patients, whereas patients with sVS even reported poorer hearing-related QOL. The Dutch NFTI-QOL is a reliable instrument for assessing QOL in NF2-SWN patients. Dizziness and facial weakness were associated with lower QOL, while hearing problems were not.