Assess the impact of anticoagulation or antiplatelet medications on endoscopic ear surgery visibility and procedural progress.

A case–control retrospective chart review of patients on anticoagulation/antiplatelet undergoing endoscopic ear surgery from April 2018 to April 2023 was conducted. Surgical videos were blindly rated by two surgeons utilising the Modena Bleeding Scale during clips of key operative steps; scores and outcomes were compared. Equivalence analysis was performed using two one-sided tests with an equivalence range of plus-or-minus 0.4 Modena Bleeding Scale points.

Fourteen cases were matched with 28 controls. Cases were more male (85.7 per cent; p < 0.01) and older (median: 54.9 years) than controls (median: 37.8; p < 0.01). Eleven cases (78.6 per cent) were on aspirin 81 mg, two (14.2 per cent) coumadin (4–6 mg) and one (7.1 per cent) aspirin 325 mg. No significant differences in Modena Bleeding Scale, blood loss, complications or outcomes were found.

This study revealed no significant difference in intra-operative visibility, progress, complications or outcomes with patients on anticoagulation/antiplatelet. Endoscopic ear surgery may be considered while on anticoagulation/antiplatelet.

This study aimed to compare the graft outcomes between endoscopic cartilage inlay myringoplasty with free perichondrial flap fold technique vs. raising the tympanomeatal flap technique for repairing large marginal perforation.

A total of 61 ears with marginal perforation were recruited and allocated to free perichondrial flap fold (n = 31) group and raising the tympanomeatal flap (n = 30) group using semi-random control trial. The graft success rate, hearing gain, operation time, visual analog scale score and post-operative complications were compared between the groups at six months.

The mean operation time was 26.4 plus-or-minus 3.1 minutes in the free perichondrial flap fold group and 50.7 plus-or-minus 2.6 minutes in the raising the tympanomeatal flap group (p < 0.001). The graft success rate was 93.5 per cent in the free perichondrial flap fold group and 96.7 per cent in the raising the tympanomeatal flap group (p = 0.977) at post-operative six months.

The free perichondrial flap fold technique may achieve similar graft success rate and hearing improvement as raising the tympanomeatal flap technique for repairing large marginal perforations; however, it is simple, time-saving and minimal invasive technique.

Despite the urgent need for support interventions for families facing parental life-threatening illness, research is limited – particularly in progressive neurological diseases. This scoping review aimed to systematically map existing interventions to inform the development of tailored support in the neurological context.

A scoping review was conducted, including articles published between 2013 and 2025, identified through searches in PubMed, CINAHL, PsycINFO, and Web of Science, along with manual screening of reference lists. Extracted data were systematically charted and descriptively summarized.

Of 5172 articles, 15 were included, describing 6 unique interventions aimed at supporting children (0–25 years) and/or parents in families where a parent had a life-threatening illness. While cancer was the predominant diagnosis among ill parents, progressive neurological diseases, such as amyotrophic lateral sclerosis (ALS) and Huntington’s disease, were represented to a limited extent. The interventions targeted children (n = 4), parents in their parenting role (n = 4), or the entire family (n = 7) and were primarily based on psychosocial, psychoeducational, or peer support. Overall, the interventions were positively received by both children and parents and perceived as helpful in navigating their challenging life situations in various ways.

This review confirms a particular lack of knowledge and tailored support for families affected by progressive neurological diseases. While support interventions for other life-threatening illnesses are also limited, those that exist may offer valuable insights to inform the development of support within neurological care contexts. The findings underscore the need for early, proactive, and accessible approaches that address both individual and family needs across the disease trajectory, aligning with core principles of high-quality palliative care.

There is currently no consensus on the optimal mapping technique for atrioventricular nodal re-entry tachycardia ablation.

This, the first of its kind, prospective randomised trial compared procedural characteristics and ablation outcomes between an anatomic approach for atrioventricular nodal re-entry tachycardia ablation and an approach guided by low voltage signals, local activation time, and the propagation wave collision.

A randomised, prospective, multi-centre clinical trial was performed at 5 paediatric cardiac centres. 3D mapping was used on all patients. After atrioventricular nodal re-entry tachycardia confirmation, patients were randomly assigned to either an anatomic-based approach or to a 3D mapping technique that assessed for low voltage, activation time, and propagation wave collision to select the initial ablation site. Patient and procedural characteristics were collected with up to a 2-year post-procedure follow-up.

In all, 70 patients were randomised: 37 within the voltage-propagation wave approach and 33 in the anatomic approach group. There was no significant difference between patient demographics or follow-up duration between groups. No significant difference was seen between duration of procedure, success rate, complications, or recurrences between techniques. There was a trend toward fewer ablation applications to initial success with the voltage-propagation technique (median of 2 vs 5). Conversely, there were significantly more total lesions placed for the voltage-propagation group. Typical atrioventricular nodal re-entry tachycardia trended towards fewer lesions to success and fewer recurrences than ablations for atypical atrioventricular nodal re-entry tachycardia or jump/echo.

Both techniques demonstrated an excellent acute success rate and a low recurrence rate. Voltage-propagation mapping trended toward fewer ablations to initial success and did not prolong the procedure time. This paediatric study suggests that both a traditional anatomical technique and a voltage-propagation technique can provide excellent clinical outcomes, especially for typical atrioventricular nodal re-entry tachycardia.

Neuropsychological (NP) tests are multi-domain in execution. Reliance on a single score representing specific domains obscures the detection of subtle cognitive changes and increases risk of inaccurate assessment. Rooted in the Boston Process Approach (BPA), the Framingham Heart Study (FHS) captures multi-dimensional errors and process features within and across NP tests. We examined these BPA variables in community-dwelling older adults.

We analyzed data from 2363 dementia-free participants aged 60 and above. Exploratory and confirmatory factor analyses used Kemeny covariance structures. Measurement invariance was estimated across age, sex, and education groups. We assessed the impact of demographics on latent factors, and the ability of these factors to predict future conversion to all-cause dementia. We trained machine learning (ML) models to compare NP and BPA data.

Participants were older adults (mean age 71.5 ± 8.7 years), primarily female (54.2%), and non-Hispanic White (96.5%). The bifactor model was the only model with adequate fit (CFI = 0.96, RMSEA = 0.03). General and specific factors captured ability for accurate and strategic responses, test-specific variance, and nuanced executive and semantic processes distributed across tests. Higher general ability and stronger verbatim story recall were associated with a reduced likelihood of developing all-cause dementia (general: OR = 0.15, 95% CI [0.12–0.86]; recall: OR = 0.24, 95% CI [0.23–0.90]) over a median of 5.2 years. With NP/BPA data, ML models identified >99% of 222 converters.

This study highlights the strengths of NP/BPA data. Multidimensional cognitive features may enhance sensitivity to early changes predictive of incipient dementia.

To evaluate left ventricular geometry, haemodynamic load, and inflammatory markers with multisystem inflammatory syndrome in children.

This retrospective study included paediatric patients with a prior diagnosis of multisystem inflammatory syndrome in children who underwent follow-up echocardiography, ambulatory blood pressure monitoring, and laboratory assessments.

Thirty patients (mean age 12.9 ± 5.0 years; 18 boys) were evaluated, including eight (26.7%) who had required an ICU stay during the acute phase. The median interval since the diagnosis of multisystem inflammatory syndrome in children was 48 months (interquartile range 47–50). Body mass index was positively correlated with left ventricular end-diastolic diameter (r = 0.577, p = 0.001), left ventricular end-systolic diameter (r = 0.522, p = 0.002), interventricular septal thickness (r = 0.565, p = 0.001), posterior wall thickness (r = 0.610, p < 0.001), and left ventricular mass (r = 0.594, p = 0.001). Body mass index z-score correlated with interleukin-6 (r = 0.415, p = 0.023), while lymphocyte count correlated inversely with left ventricular end-diastolic diameter (r = −0.559, p = 0.001) and left ventricular mass (r = −0.631, p < 0.001). Multivariate analysis identified lymphocyte count as the only independent predictor of left ventricular end-diastolic diameter [β = −0.492, 95% confidence interval = −0.589 to −0.078, p = 0.013].

Four years after multisystem inflammatory syndrome in children, ventricular enlargement appears to reflect physiological scaling rather than persistent hypertrophy, supporting the need for continued long-term surveillance in this population.

Assessment for children with acquired brain injury (ABI) often includes measures of preinjury functioning; however, there is limited understanding of how social determinants of health (SDOH) are associated with preinjury measures. This study investigated the association of the Area Deprivation Index (ADI) with measures of preinjury functioning.

196 caregivers of children with ABI completed the Adaptive Behavioral Assessment System-3rd Edition (ABAS-III), and 188 children with ABI completed the Wide Range Achievement Testing-4th Edition or 5th Edition word reading subtest (WRAT-Word Reading). Two linear regressions were performed: 1) ADI × WRAT-Reading and 2) ADI × ABAS-III.

The ADI demonstrated significant associations with the ABAS-III and WRAT-Reading scores. Children in lower deprivation areas demonstrated higher preinjury functioning and word reading scores.

These findings have implications for recovery from brain injury, considerations for incorporating social determinants of health into neuropsychological evaluations, and implications for clinician interpretation of a child’s testing.

Pneumocystis jirovecii pneumonia is a serious opportunistic infection in immunocompromised individuals. Despite recognized person-to-person transmission and healthcare-associated outbreaks, optimal infection control strategies remain unclear. The COVID-19 pandemic led to the implementation of universal masking and physical distancing in hospitals, providing a unique setting to observe P. jirovecii transmission under stringent “droplet precaution”-like conditions. This study investigated healthcare-associated P. jirovecii transmission between June 2020 and November 2021.

Retrospective cohort study.

One tertiary-care hospital in Montréal, QC, Canada.

All patients with P. jirovecii pneumonia at our institution during that period.

Cases were identified via laboratory data and chart review. P. jirovecii-positive samples underwent genotyping using multilocus sequence typing. A transmission map was constructed based on shared genotypes and spatiotemporal overlap of hospital visits within a defined window of potential exposure.

Twenty-eight P. jirovecii pneumonia cases were identified. Genotyping succeeded at providing a distinct sequence type (ST) in 21 cases, revealing 7 patients with shared genotypes (3 with ST52, 2 with STX7, 2 with ST19). The transmission map of 12 patients with shared or unknown genotypes revealed 34 same-day and 34 within-one-day contacts, exclusively within outpatient clinics and imaging facilities. Three spatiotemporal clusters of plausible healthcare-associated transmission were identified despite universal masking.

The occurrence of plausible healthcare-associated P. jirovecii transmission despite stringent universal masking suggests that traditional “droplet precautions” alone may be insufficient to prevent spread, supporting airborne transmission. Infection prevention strategies may need to be expanded in high-risk settings and should account for airborne transmission.

The Woven EndoBridge (WEB) device has emerged as a promising option for treating wide-neck bifurcation aneurysms. This multicenter study aimed to evaluate the impact of postoperative aspirin (ASA) use on clinical and angiographic outcomes in patients treated with the WEB device.

We conducted a retrospective multicenter study across 10 academic institutions, analyzing patients with ruptured or unruptured intracranial aneurysms treated with the WEB device.

A total of 225 patients were included, with 163 (72.4%) receiving postoperative ASA and 62 (27.6%) in the no antiplatelet (No AP) group. Before propensity score matching (PSM), the ASA group demonstrated significantly higher rates of excellent functional outcomes (mRS 0−1: 84% vs. 70%, p = 0.031) and lower mortality (3.3% vs. 13%, p = 0.014). Retreatment rates were also significantly lower in the ASA group (8.6% vs. 23%, p = 0.005). After PSM, 120 patients remained (74 ASA, 46 No AP). Retreatment rates remained significantly lower in the ASA group (5.4% vs. 24%, p = 0.003), whereas the other outcomes did not reach statistical significance after matching.

Postoperative aspirin use following WEB device treatment for intracranial aneurysms was associated with significantly lower retreatment rates, without compromising functional outcomes or mortality rates. These findings support the potential role of aspirin in enhancing aneurysm stability. Further prospective studies are needed to confirm.