Tympanic membrane perforation is a common condition with varying aetiology and clinical presentation. In this review, diagnosis, prognosis and management are outlined. Many perforations heal spontaneously, especially small traumatic ones without infection, while others may cause hearing loss and recurrent otorrhoea. Prognosis depends on size, aetiology and infection. Surgical treatment may be considered in cases with persistent symptoms.

Community resources are essential for supporting older adults with disabilities and chronic conditions, yet how these resources are conceptualized and evaluated across the empirical literature remains unclear. This scoping review synthesizes U.S.-based research on community resources for older adults with age-related disabilities and chronic conditions, guided by the PAGER framework. Following PRISMA-ScR guidelines, we searched MEDLINE, PsycINFO, CINAHL, and Web of Science, ultimately including 21 peer-reviewed studies. Findings reveal four primary resource domains: healthcare-based services, home- and community-based services (HCBS), behavioral health supports, and environmental or structural resources. Accessibility and utilization emerged as the most consistently examined dimensions, while quality and effectiveness received limited attention. Structural barriers-including geographic inequities, workforce shortages, financial constraints, and insurance gaps-persistently limit equitable access. Existing research remains fragmented, often treating health, social, and environmental domains in isolation. This review identifies critical gaps in integrated, participation-centered approaches and calls for theory-informed frameworks that account for the intersecting needs of older adults aging with disability.

Cervicogenic headache (CGH) is a secondary headache disorder arising from dysfunction of the C2-3 facet joint. First-line management options include conservative and multidisciplinary therapies including physical therapy, pharmacologic analgesic agents, and other noninvasive modalities. However, some patients experience persistent, refractory pain despite first-line management options. More invasive, interventional approaches including nerve blocks and steroid injections targeting the C2-3 joint have demonstrated relief, but their limited duration poses a challenge for managing chronic pain. Radiofrequency ablation (RFA) has emerged as a promising, minimally invasive, treatment for chronic pain relief in CGH. In this technical report, we describe the use of cooled RFA targeting the third occipital nerve (TON) and, when applicable, the C2 medial branch, for the treatment of chronic refractory CGH. We review relevant anatomy of the C2-3 facet joint implicated in CGH, as well as the anatomic variability of it is innervation, the TON and C2 medial branch, which can influence procedural efficacy. Compared with other RFA methods such as thermal or pulsed, cooled RFA allows for the creation of more precise treatment areas with the goal of improving efficacy and pain relief. A thorough understanding of anatomy, visualization, and procedural technique are important in optimizing outcomes and minimizing adverse effects. By generating more precise and effective lesion fields, cooled RFA may enhance treatment success. This report highlights cooled RFA as a promising treatment option for patients with CGH refractory to more conservative therapies and aims to provide a framework that promotes safe implementation and future research into its effectiveness.

BackgroundThis study compared treatment persistence of individuals newly initiating treatment with rimegepant or lasmiditan for the acute treatment of migraine.MethodsA retrospective cohort analysis was conducted on individuals from MarketScan (commercial and managed Medicare) newly initiating treatment with rimegepant or lasmiditan between March 2020 and December 2022. Treatment persistence was defined as the proportion of individuals with ≥1 medication refill within 12 months of the index prescription. Subgroups included individuals with chronic migraine, index lasmiditan dose (50 and 100 mg) and individuals with a history of two or more uses of controlled substances (prior repeated use of controlled substances [PRUCS] defined here as opioids, butalbital, nausea medications with central nervous system action). Treatment persistence was compared between inverse probability of treatment weighting (IPTW)-adjusted cohorts using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe primary analysis included 16,603 rimegepant and 716 lasmiditan users. A significantly higher proportion of individuals in the rimegepant cohort were treatment persistent compared with the lasmiditan cohort (OR 3.79 [95% CI 3.23-4.41]). This finding remained consistent across lasmiditan dosages (50 mg: 5.05 [3.87-6.60]; 100 mg: 3.33 [2.78-4.00]), chronic migraine diagnosis (3.89 [3.21-4.71]), or PRUCS (ORs ranged from 2.78 to 4.63; all statistically significant).ConclusionRimegepant users demonstrated higher treatment persistence over 12 months compared to lasmiditan users, which could reflect better real-world treatment satisfaction.

ObjectiveTo evaluate the long-term anatomical and functional efficacy of a hybrid surgical technique combining endoscopic dacryocystorhinostomy (En-DCR), endoscopic common canaliculotomy, and temporary bicanalicular silicone intubation in patients with severe common canalicular obstruction (CCO).MethodsThis retrospective case series analyzed 43 eyes of 43 patients (mean age: 55.4 ± 8.0 years) with severe CCO treated between February 2018 and July 2022. Severe CCO was confirmed intraoperatively by soft resistance to probing ≥10 mm from the punctum. The surgical technique included wide bony ostium creation, lacrimal sac marsupialization, direct endoscopic incision of the fibrotic common canaliculus, and bicanalicular silicone tube intubation (stent removed at 3 months). Outcomes were assessed at ≥12 months postoperatively using epiphora symptom resolution, lacrimal irrigation, nasal endoscopy, and fluorescein dye disappearance test. Anatomical success was defined as a patent ostium with unobstructed irrigation; functional success required anatomical patency plus complete epiphora resolution.ResultsAt a mean follow-up of 18.8 ± 6.9 months, anatomical success was achieved in 37 eyes (86.0%), and functional success in 35 eyes (81.4%). Failures included 5 cases of ostial fibrosis and 1 recurrent CCO; 2 patients reported persistent epiphora despite anatomical patency. No major complications (eg, orbital hemorrhage, sinusitis) occurred.ConclusionsIn carefully selected patients with isolated severe CCO, the hybrid technique of En-DCR with canaliculotomy and temporary intubation demonstrates promising success rates and a favorable safety profile while preserving physiological drainage. These findings suggest it may serve as a physiologically favorable alternative to conjunctivodacryocystorhinostomy, mitigating the long-term complications associated with permanent bypass tubes.

Migraine is a highly prevalent primary headache disorder that disproportionately affects women owing to the effects of sex hormones, particularly estrogen. Hyperestrogenism during early perimenopause, coupled with anovulatory cycles, is associated with an increased frequency and severity of migraine attacks and an increased prevalence of perimenstrual migraine. The natural decline in estrogen levels after menopause is generally associated with migraine improvement; however, this is variable and often complicated by chronic migraine, vasomotor symptoms, cardiovascular risk and use of menopause hormone therapy (MHT). Although there is a trend toward increasing the use of MHT during perimenopause, there are no research trials regarding migraine in this population, although it appears to have a negative clinical effect. This could be explained by the addition of MHT to the already high and fluctuating endogenous estrogen levels. More appropriate during perimenopause is hormone cycle control. This can be achieved using continuous combined hormonal contraception for women with migraine without aura, whereas progestogen-only regimens, with the option of additional transdermal estrogen, can be used in women with migraine with and without aura. For women choosing to use MHT postmenopause, continuous transdermal regimens are better tolerated than cyclical preparations.

Colorectal cancer (CRC) is one of the most commonly occurring malignancies worldwide, with incidence and mortality rising sharply in older adults. While aging is increasingly recognized as a key risk factor for CRC, the fundamental immunological mechanisms which underlie this risk remain incompletely understood. Two interconnected processes, namely inflammaging and immunosenescence, appear central to this association. On the one hand, inflammaging, which is characterized by chronic low-grade inflammation in older individuals, fosters a tumor-promoting microenvironment through oxidative stress, genomic instability, and persistent cytokine activation. On the other hand, immunosenescence diminishes immune surveillance, reducing the clearance of premalignant cells and weakening responses to tumor progression and therapy. Together, these processes create an immunological framework that predisposes the aging colon to malignant transformation. This review synthesizes current knowledge of the cellular and mechanistic impacts of inflammaging and immunosenescence in CRC pathogenesis, highlighting their roles in shaping disease susceptibility in the elderly. These insights may guide future endeavor in biomarker discovery, prevention, and therapeutic intervention to mitigate the burden of CRC in aging populations.

Radiopharmaceutical dosimetry is rapidly evolving from a physics-dominated calculation tool to a central pillar of precision nuclear medicine. As targeted radionuclide therapies expand across indications, there is a growing clinical imperative to personalize dose estimation, predict therapeutic efficacy and mitigate organ toxicity. This review critically examines the current landscape of dosimetry methods including organ level Medical Internal Radiation Dose (MIRD) schema, voxel-based S-values, Monte Carlo (MC) simulations and emerging artificial intelligence (AI)-assisted segmentation tools and their translational relevance. Through a comprehensive literature search of 177Lu peptide receptor radio nuclide therapy (PRRT) studies published between 2020 and 2025, we evaluate methodological heterogeneity and quantify dose variations across organs. Findings reveal persistent inconsistencies in absorbed dose estimates with reported kidney doses varying, 0.3-0.9 Gy/GBq and tumor doses ranging 1-10 Gy/GBq largely driven by differences in imaging protocol timing, segmentation strategy, and time-point sampling across studies. We also discuss regulatory trends, biologically informed dosimetry models incorporating relative biological effectiveness (RBE), and future integration with dose-point kernel (DPK) based and dose-volume histogram (DVH) driven computational frameworks. The field must now shift toward harmonized, reproducible standards that bridge physics, biology, and computation, transforming dosimetry into a predictive engine for individualized radiopharmaceutical therapy (RPT).

This study analyses the role of social capital in community resilience to disasters. Although there is broad consensus on its importance, there is still a need to distinguish the specific contribution of its different forms (bonding, bridging, and linking) throughout the phases of the risk management cycle (preparedness, response, recovery, and mitigation).