Kombucha is a fermented beverage rich in bioactive compounds. This beverage has demonstrated high antioxidant capacity in vitro and experimental animal studies. In this sense, this study aimed to evaluate the effect of daily consumption of green tea kombucha on oxidative stress and endothelial health in individuals with excess body weight. This is a randomized controlled clinical trial, lasting 10 weeks, during which the control group followed a healthy -500 kcal/day energy-restricted diet. In contrast, the kombucha group, in addition to the energy-restricted diet, consumed 200 mL of kombucha green tea daily. This study included men and women aged 18 to 45 years without chronic diseases. At the beginning and end of the study, fasting blood was collected, and colorimetric assays and immunoassay protocols evaluated markers of oxidative stress and endothelial health. Compared to the control group, kombucha consumption significantly reduced hydrogen peroxide (H₂O₂) levels (p=0.007). Initial and final values were as follows: Control group (16.5 vs. 15.09 µmol/mL; n=29) and Kombucha group (18.14 vs. 14.67 µmol/mL; n=30). The other markers that were evaluated did not change after the kombucha consumption. In conclusion, daily consumption of 200 mL of green tea kombucha for 10 weeks reduces one pro-oxidant marker, without altering other markers of oxidative stress and endothelial health in individuals with excess body weight. Reducing a pro-oxidant marker suggests that kombucha is an antioxidant beverage with promising implications for human health. However, further studies are needed to elucidate other possible beneficial effects on health.

Background: Trofinetide is approved for the treatment of Rett syndrome (RTT) in patients aged ≥2 years. Here, we present the benefits and tolerability of trofinetide in the treatment of RTT with the 12-month follow-up of LOTUS. Methods: Caregivers of patients who are prescribed trofinetide under routine clinical care are eligible to participate. Assessments include the Behavioral Improvement Questionnaire (BIQ), the Quality-of-Life Inventory-Disability (QI-Disability) Questionnaire, and the Gastrointestinal Health Questionnaire. Due to ongoing enrollment, data are reported to 9 months since the initiation of trofinetide. Results: In total, 192 patients were included. The median dose reported at week 1 was 45.0% of the target weight-banded label dose; by week 9 onwards, the median dose was at least 80.0% of the target weight-banded label dose. Behavioral improvements reported with the BIQ were nonverbal communication (49–62%), alertness (43–62%), and social interaction/connectedness (32–52%). The QI-Disability Questionnaire median total scores indicated overall improvement in quality of life (QoL) with trofinetide. Caregivers reported that patients were most likely to void normal stools over the follow-up; most reports of diarrhea were contained inside the patient’s diaper. Conclusions: Caregivers of patients with RTT in LOTUS reported behavioral improvements of RTT symptoms and improvement in patients’ QoL.

Background: Stroke is a leading cause of disability worldwide, resulting in long-term impairments requiring rehabilitation. Frailty, characterized by reduced physiological reserve and vulnerability to stressors, is associated with poor health outcomes. When assessed using the Clinical Frailty Scale (CFS), frailty has been linked to adverse outcomes; however, its role in stroke rehabilitation remains underexplored. This study investigates the impact of pre-stroke frailty on functional recovery during inpatient stroke rehabilitation. Methods: A retrospective cohort study was conducted on 206 stroke patients admitted between 2020-2022. Pre-stroke frailty was assessed using the CFS, and rehabilitation outcomes were measured using Functional Independence Measure (FIM) gain and efficiency. Differences across CFS categories, stroke location, age, and sex were statistically analyzed. Results: Among these patients, 42.7% were female, and 75.7% were aged 60 or above. There were no significant differences in FIM gain or efficiency across CFS categories (p > 0.05). Frailty was associated with lower admission (p = 0.041) and discharge (p = 0.032) FIM scores. Conclusions: Pre-stroke frailty, assessed retrospectively using the CFS, does not predict functional improvement or efficiency during inpatient rehabilitation. However, frailty was associated with poorer functional status at admission and discharge. All patients meeting the admission criteria benefited from rehabilitation, regardless of frailty level.

Background: This scoping review investigates factors influencing local control in patients with metastatic brain disease undergoing adjuvant stereotactic radiosurgery (SRS) to surgical cavities. Methods: Seven databases (Ovid Medline, PubMed, Web of Science, EMBASE, BIOSIS, Scopus, Global Health, Cochrane) were searched up to August 2, 2021, using terms related to radiosurgery and brain metastasis. A three-level screening identified relevant studies. Data extraction included study type, population, SRS details, and outcomes. Variables recorded were histopathology, resection degree, number of metastases, SRS platform, dose parameters, cavity volume, margin, time to SRS, local control at 12/24 months, overall, and progression-free survival. Significant predictors were noted. Results: From 10,633 articles, 22 studies with 1,749 cavities. Local control at 12 months was 50–100% (median 82%, IQR 73–84.4%). Distant progression at 12 months was 36–64% (median 45.5%, IQR 38–51%) and at 24 months 39–76% (median 53%, IQR 46–55%). Histology, radiation dose, tumor size, extent of resection, treatment timing, tumor depth, and dural/pial attachment impacted local control, whereas primary disease status, surgical corridor coverage, and tumor location did not. Conclusions: Modifiable SRS treatment and patient selection factors need further investigation. This review emphasizes the necessity for consensus and guides future trials and guidelines to enhance metastatic brain disease management outcomes.

Background: Ischemic stroke often results in long-term motor impairments due to disrupted corticospinal pathways. Transcranial magnetic stimulation (TMS) motor mapping is a non-invasive technique used to assess corticospinal integrity by measuring motor evoked potentials (MEPs). This study investigates whether MEP amplitudes can predict impairment severity and functional performance in chronic stroke. Methods: Four non-human primates (NHPs) with chronic stroke (> six months) following transient right middle cerebral artery occlusion underwent TMS motor mapping using neuronavigation under ketamine anesthesia. Single pulses of TMS (50-70% of maximum stimulator output) were applied to the affected and contralesional primary motor cortices to elicit MEPs and assess cortical excitability. Intramuscular electromyography recorded muscle responses from the biceps, extensor digitorum longus, and abductor pollicis brevis. Neurological dysfunction was evaluated daily for three weeks using the NHP Stroke Scale, NHP Upper Extremity Motor Dysfunction Scale, and the primate Rankin Scale. Results: MEPs were present in NHP1, NHP3, and NHP4 but absent in NHP2. Stronger MEPs correlated with lower impairment severity and better functional performance, while NHP2 exhibited higher impairment and poorer performance. Conclusions: MEP presence and strength can serve as biomarkers of motor recovery potential, highlighting their role in assessing corticospinal integrity and functional outcomes.

Background: Neck vessel imaging is often performed in hyperacute stroke to allow neurointerventionalists to estimate access complexity. This study aimed to assess clinician agreement on catheterization strategies based on imaging in these scenarios. Methods: An electronic portfolio of 60 patients with acute ischemic stroke was sent to 53 clinicians. Respondents were asked: (1) the difficulty of catheterization through femoral access with a regular Vertebral catheter, (2) whether to use a Simmons or reverse-curve catheter initially, and (3) whether to consider an alternative access site. Agreement was assessed using Fleiss’ Kappa statistics. Results: Twenty-two respondents (7 neurologists, 15 neuroradiologists) completed the survey. Overall there was slight interrater agreement (κ=0.17, 95% CI: 0.10–0.25). Clinicians with >50 cases annually had better agreement (κ=0.22) for all questions than those with fewer cases (κ=0.07). Agreement did not significantly differ by imaging modality: CTA (κ=0.18) and MRA (κ=0.14). In 40/59 cases (67.80%), at least 25% of clinicians disagreed on whether to use a Simmons or reverse-curve catheter initially. Conclusions: Agreement on catheterization strategies remains fair at best. Our results suggest that visual assessment of pre-procedural vessels imaging is not reliable for the estimation of endovascular access complexity.

Background: Hemifacial spasm (HFS) is a disorder of unilateral facial myoclonus that can be psychosocially debilitating. It is generally caused by microvascular compression of the facial nerve and is amenable to potentially curative surgery. Unfortunately, many patients receive delayed surgical referrals and are instead managed with injections of botulinum toxin to varying benefit. The reason behind late referrals is unclear, but one factor may be misleading diagnostic information; specifically, MRI reports that indicate incorrect or absent neurovascular conflict. The goal of this study was to explore the association between MRI reports and operative findings in HFS patients, with the hopes of identifying opportunities for improved diagnosis and treatment. Methods: We performed a single-center, retrospective chart review of 30 consecutive patients who underwent surgery for HFS between January 2019 and January 2020. Descriptive data were extracted from pre-operative MRI reports and operative notes, then coded for statistical analysis. Results: Pre-operative MRIs were reported by radiologists from 6 provinces. Across all MRIs (n = 45), a positive finding was only identified in 51.1%. All 30 patients had clear neurovascular conflict noted in surgery. Conclusions: There is a need for improved diagnostic accuracy in HFS, with the goal of expediting surgical referrals and possible cure.

Background: Late-onset Pompe disease (LOPD) is caused by a deficiency of acid α-glucosidase (GAA), leading to progressive muscle and respiratory decline. Cipaglucosidase alfa (cipa), a recombinant human GAA naturally enriched with bis-mannose-6-phosphate, exhibits improved muscle uptake but is limited by inactivation at near-neutral blood pH. Miglustat (mig), an enzyme stabiliser, binds competitively and reversibly to cipa, enhancing its stability and activity. Methods: In dose-finding studies, Gaa-/- mice were treated with cipa (20 mg/kg) +/- mig (10 mg/kg; equivalent human dose ~260 mg). Clinical study methodologies have been published (Schoser et al. Lancet Neurol 2021:20;1027–37; Schoser et al. J Neurol 2024:271;2810–23). Results: In Gaa-/- mice, cipa+mig improved muscle glycogen reduction more than cipa alone and grip strength to levels approaching wild-type mice. LOPD patients (n=11) treated with cipa alone showed dose-dependent decreases in hexose tetrasaccharide (Hex4) levels by ~15% from baseline, decreasing another ~10% with added mig (260 mg). In a head-to-head study, cipa+mig had a similar safety profile to alglucosidase alfa. Among 151 patients (three trials), mig-related adverse events occurred in 21 (13.9%), none serious. Conclusions: Mig stabilised cipa in circulation, improving cipa exposure, further reducing Hex4 levels and was well tolerated in clinical studies in patients with LOPD. Sponsored by Amicus Therapeutics, Inc.

Over the years, cultural and linguistic diversity in schools across Europe has significantly increased due to migration and refugee flows. In response, international organizations, such as the Council of Europe and the European Commission, advocate intercultural education as both an educational strategy and a social policy tool to foster inclusion, address inequality, and build cohesive societies. This study contributes to the intercultural education literature by addressing an underexplored area: the process of translating intercultural policies into school practices. Using Street-Level Bureaucracy theory and qualitative research in Trento, Italy, it highlights the mechanisms and challenges shaping teachers’ practices and the extent of the policy–practice gap. Furthermore, the research also contributes to the Street-Level Bureaucracy theory. It shows that teachers can act as innovators in the policy implementation process. By engaging civil society members, notably students and members of migrant communities, as co-implementers, teachers reshape policy ecosystems through participatory and bottom-up approaches.

Five species of monorchiids are known from fishes of the family Gerreidae, of which one is from Australian waters. Here, we report it and two new monorchiids from three species of Gerres Quoy & Gaimard, 1824 from off Lizard Island, northern Great Barrier Reef, and Moreton Bay in south-eastern Queensland: Gerres oyena (Forsskål), Gerres oblongus Cuvier and Gerres subfasciatus Cuvier. One of the new species, found only in G. oblongus at Lizard Island, conforms most closely to the concept of Proctotrema Odhner, 1911. However, it differs from species of Proctotrema in oral sucker shape and location of intestinal bifurcation and termination. It is phylogenetically distinct from two sequenced species of Proctotrema; thus, we propose Obscuromonorchis ranae n. g., n. sp. The second new species infects all three gerreids, occurs at both Lizard Island and Moreton Bay, and is morphologically most similar to the concept of Monorchicestrahelmins Yamaguti, 1971. However, the combination of the length of the caeca, size of the testis and post-testicular region, and the form of spination in the genital atrium presents a clear genus-level distinction that warrants proposal of a new genus. There are no molecular data for the three recognised species of Monorchicestrahelmins. We propose Argenticola shuyinae n. g., n. sp. for this species. New specimens of Gerricola queenslandensis Wee, Cutmore & Cribb, 2021 were collected from off Lizard Island and Moreton Bay. The three species form a well-supported clade but with internal branch lengths and topology consistent with genus-level differentiation.

Background: Infundibular lesions are rare entities with variable clinical manifestations. Their detection during workup for endocrinologic abnormalities represents a decision-making challenge. We present a patient with ACTH-dependent hypercortisolemia found to have a stalk lesion, which was treated surgically. Methods: Information was gathered from electronic medical records. Results: A 57F underwent workup for Cushing’s syndrome, demonstrating evidence of ACTH-dependent hypercortisolemia. Imaging demonstrated a 4.7mm infundibular nodule. We elected to proceed with endoscopic endonasal approach for resection of the infundibular lesion with goal of biochemical cure. A satisfactory technical and radiographic resection of the infundibular lesion was achieved. However, the patient’s hypercortisolemia failed to resolve. Histopathologic analysis identified the lesion as a granulocytoma. Inferior petrosal sinus sampling further demonstrated evidence of ACTH-dependent central hypercortisolemia. She then underwent bilateral adrenalectomy for management of her persistent hypercortisolemia. Conclusions: This demonstrates a complex clinical picture in which our patient presented with biochemical results suggesting central ACTH-dependent hypercortisolemia with no identifiable glandular lesion. The presence of an infundibular lesion led to surgical intervention which unfortunately did not result in biochemical cure despite adequate technical results. The authors believe this case illustrates a challenging clinical conundrum which emphasizes the uncertainty that should be associated with management of stalk lesions.

Background: Transcranial doppler ultrasound (TCD) in a pediatric neurocritical setting can determine cerebral hemodynamics by assessing the blood flow velocity in main cerebral arteries. In large vessel occlusions (LVO) that require endovascular thrombectomy (EVT), TCD can monitor recanalization and arterial re-occlusion. We describe one case in a previously healthy 13-year-old girl with a right M1 middle cerebral artery occlusion. Methods: Analysis was done via a retrospective case review. Results: Our patient underwent a successful endovascular thrombectomy (EVT) six hours after symptom onset. Follow up TCDs done at 4, 8, and 24 hours showed stable peak systolic velocities (PSV) on the narrowing of right M1 ranging from 245 to 270 cm/s with stable pre-stenotic PSV around 110 cm/s, indicating focal and stable narrowing of M1 without reocclusion. No high transient signals (HITS) were identified on sub 10 minute TCDs. An urgent echocardiogram revealed a bicuspid aortic valve with vegetations, with later confirmation of infective endocarditis. The patient made an impressive recovery with only mild deficits. Conclusions: TCD can be an effective tool in a pediatric neurocritical setting in guiding initial recanalization after EVT and monitoring for arterial re-occlusion, HITS and hyperperfusion. TCD monitoring also decreases the amount of radiation exposure via CTA.

Background: Spinal cord injury (SCI) is a central nervous system injury that often leads to motor, sensory and autonomic dysfunction. Non-invasive trans-spinal electrical stimulation (ts-ES) has been shown to activate neural networks below the injury and improve motor function recovery after SCI. The objective of this study was to compare changes in motor and autonomic function attributable to ts-ES in individuals with incomplete SCI after 4 weeks of personalized training. Methods: Participants received 4 weeks of treadmill training with personalized step-cycle based PNS and FES with and without non-invasive lumbar ts-ES. Clinical outcome measures of motor function (2-minute walk test, Berg Balance and modified SCIM-Mobility) and metabolic analysis (heart rate and rate of oxygen consumption (VO2 sub-max)) were assessed before and after training. Non-invasive electromyography (EMG) and kinematic data assessed motor function. Results: Based on participant feedback and data, ts-ES with PNS/FES during training was tolerable, improved leg movement and facilitated muscle activity in knee extensors with 10-25% increased RMS amplitude of pre-training EMG activity during both forward and backward walking. Moreover, ts-ES tended to increase HR and VO2 sub-max within one session. Conclusions: Personalized rehabilitation strategies combining ts-ES with traditional physiotherapy exercises and locomotor training have the potential to improve recovery after SCI.

Background: CIDP is a rare immune-mediated demyelinating neuropathy that has significant phenotypic variability. A unifying immunopathological mechanism remains elusive, likely due to etiological heterogeneity among the variant presentations. This is best exemplified by the identification of nodal/paranodal antibodies, such as neurofascin 155, in a subgroup of CIDP patients who present with a distinct phenotype. Methods: We present the case of a 39-year-old male who presented with a 2-year history of progressive stocking-glove sensory loss and sensory ataxia. Electrodiagnostics confirmed an acquired demyelinating neuropathy, with serum anti-NF155 IgG4. His case was refractory to standard immunomodulatory therapy, including adequate trials of IVIG, steroids, azathioprine, and rituximab. He also had a non-therapeutic trial of PLEX, methotrexate, and tacrolimus. Results: After cessation of all immunomodulatory therapy for 2 years, he had spontaneous remission of his CIDP and near-complete resolution of electrodiagnostic/clinical abnormalities. Conclusions: This case provides insights into the natural history of NF155 “paranodalopathy” and highlights a unique case of supra-refractory CIDP which underwent spontaneous remission with near-complete resolution. Delayed effect from rituximab was posited as a contributor, however, the patient had no clinical or electrophysiological improvement 20-months after initiation of anti-CD20 therapy. Current data suggests the majority of CIDP patients respond to rituximab within 6-12 months.

Background: Giant olfactory groove meningiomas (OGMs), though rare, pose challenges due to their size. These slow-growing tumors often remain asymptomatic until exceeding 6 cm in diameter. While surgery has advanced, understanding long-term outcomes remains crucial. Methods: This retrospective study at a major medical center included all patients with giant OGMs (>6 cm) undergoing resection from 2000-2022.Data on visual status, recurrence, and functional status were collected. Multivariable logistic regression identified predictors of recurrence and functional outcome. Results: Thirty-two patients met the inclusion criteria for this study, with a mean age of 55.8years.The mean follow-up period was 62months. The majority of giant OGMs were classified as WHO grade 1(84.4%).Postoperatively, 19patients demonstrated improvement in visual acuity and visual field deficits.Radiological recurrence was observed in nine patients(28.1%) at a mean follow-up of 56months, with only three requiring reoperations for tumor resection.One patient developed a brain abscess, necessitating reoperation.Multivariable analysis identified patient age, Simpson grade of excision, and WHO grade as significant predictors of recurrence rate. Conclusions: This study demonstrates that surgery can improve visual deficits and functional outcomes. Postoperative outcomes were strongly predicted by age, resection extent, and histological grade. Developing a new predictive scale based on these parameters appears to strongly predict the Giant OGMs Long-Term outcome.

Coral reefs have been rapidly deteriorating, worldwide, due to global warming, ocean acidification, bleaching, diseases, and various local anthropogenic stressors, such as coastal development, habitat destruction, overfishing and eutrophication, all of which have significantly impacted the metabolic functions of corals and other marine organisms. Global warming has been identified as the main culprit in the decline of coral reefs. In response, we assessed the metabolic responses of one of the most iconic Caribbean corals to elevated temperatures. Accordingly, the proteomic profile of Acropora palmata was investigated during the cool dry and hot wet seasons of 2014 and 2015 in Puerto Rico using a combination of two-dimensional gel electrophoresis (2D-GE) and mass spectrometry. The study revealed that the average number of differentially abundant proteoforms between seasons was 527 in the inner-shelf reef at Enrique and 1,115 in the mid-shelf reef at San Cristobal, both located on the insular shelf of southwestern Puerto Rico. Our results show significant changes in A. palmata’s proteome, inducing alterations in key metabolic, enzymatic, translational, and apoptotic processes, between the cool dry and hot wet seasons. Quantitative real-time reverse transcription PCR (qRT-PCR) was used to validate the variation in the expression of five candidate stress-related genes under different seasonal temperatures. The findings highlight key proteoforms whose abundance varied with temperature, offering insight into A. palmata’s metabolic capacity to acclimate and respond to seasonal temperature fluctuations.

Background: Seronegative autoimmune encephalitis (SAE) in children is associated with cognitive deficits, particularly executive dysfunction. However, the relationship between cognitive impairment, disease severity, and lesion burden remains unclear. Identifying these associations could improve patient management and outcomes. This study characterizes neuropsychological symptoms in pediatric SAE and compares patients with and without formal neuropsychological assessments to determine factors influencing cognitive impairment. Methods: A retrospective review was conducted on 155 pediatric autoimmune encephalitis cases, including 80 with SAE. Eleven had neuropsychological evaluations. Statistical analyses assessed differences in age, disease severity, lesion characteristics, hospitalization, and treatment needs. Results: Executive dysfunction was present in 75% of SAE cases. Patients with neuropsychological evaluations were older (median: 8 vs. 3 years, p = 0.0115) and had more severe encephalitis at admission (p = 0.0391) and one year later (p = 0.0011). Lesion burden did not differ (p > 0.05), but patients with assessments had longer hospitalizations and required more intensive treatments (p < 0.005). Conclusions: Executive dysfunction in pediatric SAE is linked to disease severity rather than lesion burden. Systematic neuropsychological assessments should be integrated into patient care. Deeper phenotyping of cognitive profiles and identifying risk factors for poor prognosis will help personalize care in order to improve outcomes.

Background: Referrals to the Stroke prevention clinic with incomplete preliminary investigations decrease clinic capacity due to additional workload and the need for follow-ups. We aimed to improve the efficacy of the initial visit by increasing the completion rate of vascular imaging. Methods: Pre-post quasi-experimental study with three phases: Phase 1: Surveillance; Phase 2: Stakeholder feedback-informed intervention development (physicians and clinic staff); and Phase 3: Implementation. Interventions included a new referral order within the provincial EMR; a specific physician triage form listing required investigations (brain imaging, vascular imaging, cardiac tracing); and a nurse-led pre-visit via telephone. The primary outcome measure was the completion of vascular imaging - assessed with multivariable logistic regression Results: The study’s inclusion criteria were met by 383 patients, mean age of 67.6±13.2 years; 49% were female, 62.5% were diagnosed with vascular events. An increase in vascular imaging before the initial visit was found in Phase 3 (139/184, 75.5%) compared to Phase 1 (121/198, 61.1%, Odds ratio 1.96 95% CI 1.3-3.1; p=0.003). Fewer follow-up visits were required in Phase 3 (22.8%) compared to Phase 1 (31.8%, p=0.049). Conclusions: A uniform referral process, a standard triage process, and a nurse-led pre-visit may improve the completion of essential investigations before the patient visit.