Key Clinical MessageAggressive osteoblastoma with arterial hemangioma bone cysts in the lumbar spine are rare. In addition to the traditional en bloc technique for complete resection of the tumor, a transpsoas approach combined with a posterior approach may also be considered.

This paper considers the current and future use of magnetoencephalography (MEG) for assessing neural activity in children (birth to 18 years old), including the well-established use of SQUID (Superconducting QUantum Interference Device) MEG technology as well as the very rapidly developing Optically Pumped Magnetometry (OPM) technology. 1 A primary conclusion is that the changing landscape of pediatric neurophysiology studies foretells a revolution in electromagnetic neuroimaging. These changes will produce some discontinuity, progressing away from what once worked well enough, namely, examining neural activity at the level of the EEG or MEG sensor, but is not up to current and anticipated challenges. Given features intrinsic to MEG, including simpler mathematical models for source localization and higher-dimensional representation of neural activity, little effect of open fontanelles and sutures on infant neural measures, and reference-free neural measures, MEG will often be the preferred method for assessing neural activity in children. In particular, non-invasive, whole-brain MEG sensor data with source localization provide measures of neural activity in brain space that richly represent the structure and maturation of neural activity spanning both local and regional processes, as well as measures of connectivity within and between brain regions. Assessing neurophysiology in brain space is also essential for associating local neural activity with local brain structure (e.g., gray and white matter) and brain chemistry (e.g., magnetic resonance spectroscopy data). It is also highly likely that MEG data are more future-proof than EEG data (higher dimensionality, ease of source localization), especially for advanced source localization methods as well as advanced analysis methods yet to be developed and applied to previously collected data. The emergence of OPM-based MEG opens a new age of imaging for children and infants, such as translating the source localizing abilities of MEG in adults to wearable systems in young children. Looking forward, greater access to MEG and other advanced imaging technologies, the accessibility of greater computational power, and the rapid development of open-source software will combine to improve our methods and inform our research questions, all leading to a better understanding of how the human brain changes and supports behavioral development from birth to adulthood.

The Indian pangolin (Manis crassicaudata), an elusive and endangered species, remains understudied in Pakistan. This study presents a detailed ecological baseline of the spatial distribution, population density, burrow typology, vegetation associations, and threats to the species in District Buner, Khyber Pakhtunkhwa, from October 2022 to September 2023. Using stratified random sampling across 90 km², surveys along line transects and circular plots identified 127 burrows across four tehsils, with 63.8% of the burrows being active, 26.0% inactive, and 10.2% living/resting burrows. The most active burrows occurred between 300 and 700 m elevation, with a few found up to 1,300 m, and were absent above this range. Burrow activity was highest in Mandanr Tehsil, with a preference for north- and east-facing slopes, loamy soils, rocky substrates, moderate canopy cover (41–70%), and dense understory. Distance sampling estimated a low population density of 0.43 individuals/km², indicating a sparse and uneven distribution. The Phyto habitat associations linked living burrows to Lantana camara and Punica granatum, whereas feeding sites correlated with Dalbergia sissoo, Acacia modesta, and prey-rich substrates. Burrow concentration was highest in ecotones between scrub and subtropical pine forests, whereas areas dominated by Pinus roxburghii, Juglans regia, and Quercus incana lacked any signs of presence. Two direct sightings and physical remains confirmed the presence and local extirpation at some sites. The primary threats include poaching, illegal trade, habitat degradation, marble mining and unregulated development. These issues are exacerbated by weak law enforcement and low local awareness. This study provides the first fine-scale ecological baseline for M. crassicaudata in the Western Himalayas. Conservation recommendations include habitat restoration, zoning, anti-poaching enforcement and community-based monitoring. These findings serve as a foundation for developing integrated conservation strategies tailored to the region’s unique ecological and sociopolitical contexts.

Population genetic studies have traditionally relied on data from short tandem repeat (STR) markers, known as microsatellites, to produce individual genotypes used in population genetics research. However, size fragment analysis from traditional capillary electrophoresis presents scoring challenges and limits data comparisons among labs. Here, we present a new, cost-effective universal microsatellite genotype-by-sequencing assay for Canis species that allows for unambiguous allele calls, flags homoplasy for more accurate assignment tests and estimates of diversity and improves genotyping output from low-template DNA. We note size homoplasy in 18 of 26 loci with the number of alleles being 32% higher in the dataset that included sequence mutations (Namut=334) compared to the dataset based on size alone (Nalen=253). Assignment tests with Bayesian cluster analysis were similar for both datasets, although 64 of 84 samples had higher assignment values to their primary cluster when mutations were considered. We document and code a list of sequence mutations associated with each locus and propose a framework for building an accessible, universal STR dataset for wolves, coyotes, and dogs that improves cluster assignments and admixture estimates in a system with complex demography and hybridization patterns. Overall, the assay provides an improved microsatellite method of genetic monitoring to aid conservation of wolf populations.

Ageing, as a gradual and largely irreversible biological process, characterised by declining organismal vitality and multi-organ functional impairment. While research on ageing constitutes a major scientific focus, current efforts concentrate on two domains: elucidating fundamental mechanisms of ageing and developing anti-ageing strategies, and addressing the social management of ageing populations. A critical gap persists in the clinical understanding and management of ageing itself. Specifically, there is insufficient recognition and structured approach towards ageing within clinical practice. To address this, we propose a novel clinical staging system for ageing, which based on manifestations observed by distinct stages. For each stage, we delineate the clinical presentations, biological phenomena, theoretical underpinnings, and key management priorities. This framework aims to bridge the current void in the clinical conceptualization and stage-specific management of ageing, establishing a novel foundation for a structured, staged management model. We anticipate this framework will contribute significantly to advancing the goal of healthy aging.

Symbiotic relationships with microorganisms are fundamental to life on Earth, yet relatively little is known about how these interactions persist through time, how they co-evolve, and to which degree they are genetically constrained. In this study, three cardinalfish species in the genus Siphamia, S. tubifer, S. mossambica, and S. fuscolineata, from locations throughout the hosts’ broad Indo-Pacific distribution were analyzed for patterns of genetic divergence along with their luminous bacterial symbionts . Using whole genome sequencing (WGS) of the fish light organ, we investigated whether the specificity of the association is maintained across host species and over this geographic range and whether there are patterns of symbiont divergence associated with either host or geography. The results indicated that the light organ symbionts of all three Siphamia species examined were Photobacterium mandapamensis, suggesting high specificity of the symbiosis is conserved. There was evidence of biogeographic structure in the symbiont between the three sampling regions, but no co-diversification between the hosts and their symbionts (p = 0.92). However, an analysis of single nucleotide polymorphisms (SNPs) between two S. tubifer populations from Japan and the Philippines indicated genetic differentiation in the host (F ST = 0.043) with phylogenetically-distinct clades of symbionts. Overall, these findings indicate that the association between Siphamia hosts and P. mandapamensis is highly conserved, yet there is significant genetic diversity within the symbionts driven by geography and possibly host ecology.

Title: Multifactorial Lower Extremity Weakness in a Patient with NeurosarcoidosisAuthors: Helena H Kwon, MPH1; Kevin Batti, MD2; Brian Le, MD21Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 104612Department of Physical Medicine and Rehabilitation, Montefiore Einstein, 111 East 210th Street, Bronx, NY 10467Corresponding author email: hojeong.kwon98@gmail.comConsent: The patient provided informed consent for the publication of this anonymous case report.Conflict of Interest: The authors declare that there are no conflicts of interest.Author Contribution: Helena H Kwon contributed to conceptualization, formal analysis, the original draft preparation, and manuscript review and editing. Dr. Kevin Batti contributed to conceptualization, provided resources, supervised the project, and participated in manuscript review and editing. Dr. Brian Le provided supervision, contributed to validation of the case details, and participated in manuscript review and editing.Key Clinical Message : This case illustrates the interplay between disease progression, treatment-related adverse effects, and comorbid conditions in neurosarcoidosis. Rehabilitation plays a critical role in optimizing functional outcomes for patients with neurosarcoidosis. Even when initiated beyond the acute phase, a structured and individualized rehabilitation program can yield meaningful improvements in mobility and independence.Introduction : Neurosarcoidosis is a rare manifestation of systemic sarcoidosis, occurring in approximately 5–10% of patients, and can affect the brain, spinal cord, or peripheral nerves.1 Its presentation is heterogeneous, ranging from cranial neuropathies and encephalopathy to myelopathy and longitudinally extensive transverse myelitis (LETM). LETM is an uncommon but potentially debilitating complication that may mimic or coexist with other spinal pathologies.1 Diagnosis remains challenging due to the lack of definitive biomarkers and the frequent absence of histologic confirmation. Clinicians often rely on a combination of imaging findings, cerebrospinal fluid analysis, systemic biopsy results, and exclusion of alternative etiologies.2 Treatment typically involves corticosteroids and second-line immunosuppressive therapies, although treatment response is variable and long-term use may be complicated by toxicity and side effects.1, 2Case History/Examination : A 63-year-old male with a history of systemic sarcoidosis diagnosed in 2007 presented with progressive bilateral lower extremity weakness. His sarcoidosis was complicated by LETM extending from T6 to T12 (Figure 1). His medical history was also significant for cervical myelopathy, degenerative disc disease, deep vein thrombosis, osteoarthritis, hypertension, benign prostatic hyperplasia, and chronic venous insufficiency. He had previously undergone anterior cervical discectomy and fusion at C3–C6 for spinal stenosis (Figure 1). The patient reported recent worsening of lower extremity weakness and gait instability. On neurologic examination, upper extremity strength was intact. Lower extremity strength was reduced, particularly in hip flexors (3/5 right, 4/5 left), knee extensors (4+/5 bilaterally), and mild distal weakness including ankle dorsiflexors (4/5 right, 4−/5 left) and plantarflexors (4/5 right, 4−/5 left). Reflexes were decreased (1+ quadriceps bilaterally). His gait was crouched, and he required a rollator for ambulation.Differential Diagnosis, Investigations, and Treatment: Given the progression of weakness in a patient with known LETM, the differential diagnosis included neurosarcoidosis myelitis, baclofen-induced muscle weakness, and complications from chronic immunosuppression. Investigations included serial spinal imaging, review of immunosuppressive therapy response, and medication reconciliation focused on spasticity agents.The patient’s immunosuppressive treatment history included methotrexate, hydroxychloroquine, mycophenolate mofetil, and rituximab, with current therapy consisting of prednisone (5 mg daily) and infliximab infusions (480 mg in sodium chloride 0.9 % 250 mL). He also received intrathecal baclofen (104 mcg/24 hours) and oral baclofen 10 mg nightly for spasticity. Pain was managed with acetaminophen and NSAIDs. Given the recent worsening of lower extremity weakness, oral baclofen taper was initiated while maintaining spasticity control through the intrathecal pump at a minimal dosage. Referrals to physical therapy and orthotic evaluation were also placed.Conclusion and Results (Outcome and Follow-up): This patient’s worsening mobility was attributed to a multifactorial process involving chronic neurosarcoidosis, treatment-related adverse effects, and underlying spinal pathology. After adjusting his baclofen regimen and initiating targeted rehabilitation interventions, his functional strength and gait gradually improved. He remained independent in most ADLs, with walking as his primary limitation. Ongoing follow-up focused on monitoring spasticity, optimizing immunosuppression, and reinforcing long-term rehabilitation strategies to preserve mobility and quality of life.Discussion : Neurosarcoidosis presents a significant therapeutic challenge due to its heterogeneous presentation, variable progression, and limitations of available treatment. Long-term steroids and second-line immunosuppressive agents are commonly used as medical therapies in neurosarcoidosis, but their effectiveness is often limited by adverse effects, poor tolerability, and a lack of robust clinical evidence, as reflected in this patient’s history of multiple discontinued treatments. Symptom-targeted therapies, such as baclofen for spasticity, warrant particular attention as frequent reassessment of both efficacy and tolerability is essential for optimal dosing. While baclofen can effectively reduce spasticity, its dose-dependent side effects including hypotonia and muscle weakness may exacerbate functional impairment, especially when administered via both intrathecal and oral routes.3 In this patient, the multimodal regimen of baclofen likely contributed to his recent decline in mobility. The trade-off between spasticity reduction and preservation of functional strength should be evaluated in the context of the patient’s ability to perform key ADLs including transfers, ambulation, and stair navigation. Clinicians should employ targeted questioning such as inquiring about difficulty rising from a chair or changes in gait, alongside structured functional assessments for optimal dosing.Physical and occupational therapy are also integral components in the management of chronic neurosarcoidosis, especially when neurological deficits persist despite medical treatment. Physical therapy should be individualized to target specific functional impairments. Key interventions include gait and balance training, muscle strengthening, and evaluation for appropriate assistive devices or orthoses. These approaches are critical for enhancing mobility, reducing fall risk, and promoting patient independence. Complementing this, occupational therapy focuses on improving coordination, implementing adaptive strategies for ADLs, and recommending home modifications to maintain autonomy. Previous studies have demonstrated that patients with neurosarcoidosis can achieve rapid improvements in functional independence when managed with comprehensive acute inpatient rehabilitation alongside systemic therapy.4 Additionally, recent case report suggests that intensive rehabilitation initiated beyond the acute phase may still result in meaningful functional gains, provided that the underlying disease is adequately controlled medically.5 The role of supportive intervention such as physical and occupational therapy is critical but often underemphasized. These modalities can help address mobility limitations, prevent secondary complications, and enhance quality of life, especially when neurologic deficits are unlikely to fully reverse with medical therapy alone.References :1. Burns TM. Neurosarcoidosis. Arch Neurol. 2003; 60:1166-8.2. Tana C, Wegener S, Borys E, Pambuccian S, Tchernev G, Tana M, et al. Challenges in the diagnosis and treatment of neurosarcoidosis. Ann Med. 2015; 47:576-91.3. Brandenburg JE, Rabatin AE, Driscoll SW. Spasticity Interventions: Decision-Making and Management. Pediatr Clin North Am. 2023; 70:483-500.4. Nicolosi C, Carrera EJ, Heronemus M, Shivers J, Niehaus W. Neurosarcoidosis in acute inpatient rehabilitation: a case study. Spinal Cord Ser Cases. 2020; 6:99.5. Takeshima S, Furuya T, Yamamoto M, Noma M, Kawate N. Planning and effectiveness of intensive rehabilitation as a treatment for a patient with neurosarcoidosis: A case report. Medicine (Baltimore). 2023; 102:e34519.

Purpose: This study aimed to identify and synthesize published algorithms for identifying the initiation of a new line of therapy (LOT) for metastatic lung, breast, and colorectal cancer in real-world data (RWD). Methods: We conducted a scoping review of published, English-language studies describing algorithms for identifying any LOTs with systemic anti-cancer therapy (SACT) for either non-metastatic or metastatic lung, breast or colorectal cancer in RWD between January 1, 2014, and April 29, 2024. Dual reviewers independently screened titles, abstracts and full-text articles with disagreements resolved by a third reviewer. Data were extracted, categorized, synthesized, and summarized in narrative and tabular formats. Results: The review identified 25 studies, mainly from the U.S. (64%). Electronic health/medical records (EHRs) were the most frequently utilized (72%) RWD source. Twenty-four studies (96%) described RWD algorithms for identifying the initiation of a new LOT for metastatic lung, breast, or colorectal cancer. In 23 studies, algorithms required observing a new, adjuvant, SACT after an ‘incident’ metastatic diagnosis code, which had been preceded by a metastasis-free lookback period of varied duration. Three studies’ algorithms required observation of the completion of non-metastatic LOTs before initiation of a new LOT for metastatic cancer. Three studies validated their algorithms. Conclusions: Different algorithms are being used to identify LOT initiation for metastatic cancer. Most algorithms require an incident diagnosis of metastasis before considering subsequent SACT as newly initiated LOT for metastatic cancer. However, definitions of metastasis onset, and gap duration to therapy initiation, vary.

Author ResponseDear Dr. Papageorghiou, We welcome the letter from Garabedian et al. 1and their interest in our updated systematic review, comparing admission cardiotocography (CTG) and intermittent auscultation (IA) in low- risk term pregnancies2. While we focused on updating the meta-analysis, we agree that the results apply only to the settings and populations included in the original randomised controlled trials (RCTs). Clear limitations and challenges in interpreting the RCTs’ findings (discussed in Section 4.3,Research and Policy Implications 2) arise from methodological differences and poorly defined concepts, limiting the strength of the conclusions. Future work should ensure objective, consistent and reproducible definitions of the:target population;timing of CTG/IA administration;precise protocols for IA administration and admission CTG (including timing and duration);criteria for abnormal trace, directly linked to (6) and (7) below;clinical management guidelines for those with abnormal findings;precise study outcomes, based on the question/s the test is seeking to answer.Considering that classic two-arm RCTs are challenging to conduct for rare heterogeneous pregnancy outcomes (e.g. hypoxic-ischaemic enteropathy or perinatal mortality), routinely collected large datasets and/or innovative trial designs may play an important role in generating reliable evidence. We also agree that, the particular question “Is this fetus fit to undertake the journey of labour? ”3 is fundamental and future research could evaluate the utility of admission CTG and IA specifically for this. Moreover, the absence of accelerations and cyclicity may play a major role at admission, while current intrapartum CTG and IA protocols are typically focused on baseline and decelerations. This discrepancy drives the need for different interpretation criteria for admission CTG. In prior work, we analysed the data of 27,000 births4 and showed that the CTGs recorded within the first hour of admission were more likely to have baseline fetal heart rate ≥150bpm; non-reactive trace; reduced variability and decelerative capacity; and no accelerations4 in babies later born with severe complications (perinatal death, seizures, neonatal encephalopathy or need for intensive resuscitation). Given the complexity of labour and the nature of acute intrapartum events, a CTG at labour onset cannot foretell all causes of severe compromise at birth. However, identifying those with abnormal admission CTG is of particular interest because it provides an opportunity to prevent further deterioration, rather than discover compromise many hours later after the additional hypoxic stress of labour. Finally, the appropriate clinical response to an abnormal admission CTG findings, amongst other things, is determined by labour progression, parity, maternal and pregnancy-specific risk factors, patient preferences, and the clinical resources available within the unit. The meta-analysis indicated that concerns about increased caesarean deliveries are likely overstated2 and we believe that objective, evidence-based criteria to define abnormal admission CTG and clinical protocols could minimise false-positive findings and safely reduce unnecessary interventions. Given the inherent uncertainty and imprecision of current assessment tools, it is crucial to conceptualise risk as a continuum and to engage patients in informed, shared decision-making that carefully balances potential risks and benefits in light of the best available evidence. Yours sincerely, Mariana Tomé, Aimée A. K. Lovers, Lawrence Impey, Jane E. Hirst, Antoniya Georgieva Oxford Labour Monitoring Nuffield Department of Women’s & Reproductive Health University of Oxford, Oxford, United Kingdom

The Mediterranean diet (MedDiet) is among the most extensively studied dietary patterns and has been consistently associated with reduced risk of all-cause mortality, cardiovascular disease, metabolic disorders, cognitive decline, and several types of cancers. It is defined by a high intake of vegetables, fruits, legumes, nuts, (whole) grains, fish, seafood, and extra virgin olive oil, along with moderate consumption of red wine. Several physiological pathways may contribute to its beneficial effects, including favourable modulation of lipid profiles, enhanced insulin sensitivity, reduction of inflammatory and oxidative stress markers, improved endothelial function, and antithrombotic activity. These effects are largely attributed to bioactive compounds such as polyphenols, mono- and polyunsaturated fatty acids, and dietary fibre. This updated review summarizes the most recent evidence and discusses both established and emerging mechanisms of action related to individual dietary components within the MedDiet. It aims to provide a refined understanding of how this dietary pattern contributes to chronic disease prevention and overall health.

Reading directions vary across writing systems. Through long-term experience, readers adjust their visual systems to the dominant reading direction in their writing systems. However, little is known about the neural correlates underlying these adjustments because different writing systems do not just differ in reading direction, but also in visual and linguistic properties. Here, we took advantage of the fact that Chinese is read to different degrees in left-to-right or top-to-bottom directions in different regions. We investigated visual word processing in participants from Taiwan (both top-to-bottom and left-to-right directions) and from mainland China (only left-to-right direction). We used combined EEG/eye-tracking with a saccade-contingent parafoveal preview manipulation to investigate how the dominant reading direction shapes neural visual processing while participants read 5-word lists. Fixation-related potentials (FRPs) showed a reduced late N1 effect (preview positivity), but this effect was modulated by prior experience with a specific reading direction. Results replicated previous findings that valid previews facilitate visual word processing, as indicated by reduced FRP activation. Critically, the results provide the first neuroelectric evidence that this facilitation effect depends on experience with a given reading direction. The findings provide insight into how cultural experience shapes the way people process visual information and demonstrate how a person’s everyday visual experience can influence how the brain processes parafoveal information.

Protected areas are vital for preserving native biodiversity, yet invasive alien plant species (IAPS) pose significant threats to their conservation. This study investigates how IAPS diversity varies across their dispersal corridors, such as road verges, riversides, seasonal springs, fire lines, and trekking trails, and examines the relationship between tree canopy openness and IAPS richness. We sampled 156 plots (2m  5m) along these corridors, ensuring a minimum distance of 100 meters between plots. Out of 10 IAPS recorded during the study, road verges and riversides were invaded by 70% of the recorded species, while the walking trail had the lowest number of IAPS (30%). The most prevalent IAPS was Chromolaena odorata, followed by Mikania micrantha and Ageratum conyzoides. One-way ANOVA indicated significant differences in IAPS richness among dispersal corridors (p<0.001). Furthermore, IAPS richness increased with increasing tree canopy openness (R=0.8, p<0.001). Given that road verges and riversides appeared to be the major dispersal corridors of IAPS, it is imperative to prioritize these corridors for IAPS monitoring, early detection, eradication, and control. Such efforts can reduce the establishment probability of new IAPS and mitigate the impacts of the widespread IAPS on the native species and ecosystems.

Mature Gastric Teratoma in a 3-Month-Old Male Infant Presenting with Progressive Abdominal Distension: A Rare Pediatric Tumor with Complex Diagnostic and Surgical Considerations

A document by Zahra Sadin . Click on the document to view its contents.

Commentary to : Higny J, Benoît M, Clarembeau F, Henry J-P. An Electronic Device Floating in Hemothorax: When POCUS Helps to FOCUS. Clinical Case Reports. 2025;13:e71293.I read with great interest the report by Higny et al., presenting a remarkable case of rightventricular lead perforation resulting in massive hemothorax, in which Point-of-CareUltrasound (POCUS) enabled rapid diagnosis and timely intervention. The authors are to becommended for illustrating the critical clinical value of bedside ultrasound in anuncommon yet potentially fatal complication of cardiac device implantation.This case emphasizes several important considerations for physicians managing patientswith cardiac implantable electronic devices (CIEDs). First, it highlights the diagnosticstrength of POCUS in the evaluation of sudden cardiorespiratory deterioration during thepost-implant period. In contrast to conventional radiography, POCUS permits immediatedetection of simultaneous cardiac and pleural pathology, enabling real-time clinicaldecision-making when every minute is decisive.Second, this report reinforces the need to further integrate structured POCUS training intocardiology, intensive care, and emergency medicine curricula. While professional societiesadvocate competency in focused ultrasound, implementation remains heterogeneous.Systematic early post-implant POCUS, particularly among high-risk groups—older adults,recipients of active-fixation leads, and patients receiving anticoagulation—could allowdetection of subclinical lead migration prior to overt perforation or hemodynamiccompromise.Third, although computed tomography remains the reference standard for anatomicaldetail, this case elegantly demonstrates that POCUS is not only a diagnostic instrument butalso a procedural adjunct, supporting pleural decompression, characterizing effusions, andraising immediate suspicion of lead misplacement at the bedside. Future prospectivestudies comparing the diagnostic performance of POCUS against conventional imaging forlead-associated complications would be of significant clinical value.In summary, this important case further substantiates that POCUS has evolved beyond anadjunct modality to become a core component of acute cardiovascular and thoracicassessment. The work by Higny et al. strengthens the growing evidence base supportingroutine, early ultrasound evaluation in suspected CIED complications and contributesmeaningfully to improving patient safety in device medicine.I thank the authors for their insightful contribution and for highlighting the pivotal role ofPOCUS in time-critical cardiovascular care.Conflict of Interest: The author declares no conflict of interest.Funding: None.Sincerely,Sara Gonzalez Lastra, MDDepartment of Intensive Care MedicineRoyal Brompton and Harefield HospitalsLondon, United KingdomEmail: s.lastra@nhs.netReferences1. Higny J, Benoît M, Clarembeau F, Henry J-P. An Electronic Device Floating inHemothorax: When POCUS Helps to FOCUS. Clin Case Rep. 2025;13:e71293.2. Labovitz AJ, et al. Focused cardiac ultrasound in the emergent setting: A consensusstatement. J Am Soc Echocardiogr. 2010;23(12):1225–1230.3. Rajkumar CA, et al. Diagnosis and management of iatrogenic cardiac perforation causedby pacemaker and defibrillator leads. EP Europace. 2017;19(6):1031–1037.4. Vamos M, et al. Incidence of cardiac perforation with conventional and leadlesspacemaker systems: A systematic review and meta-analysis. J Cardiovasc Electrophysiol.2017;28(3):336–346.5. Soni NJ, et al. Ultrasound in the diagnosis and management of pleural effusions. J HospMed. 2015;10(12):811–816.

Strangler figs (Ficus spp.) typically establish as epiphytes on host trees before developing ground roots. Here we document abundant terrestrial establishment of strangler figs in burned tropical peat-swamp forests of Sumatra, Indonesia. Across 3.4 ha of transects in two post-fire sites, 97% of 138 strangler fig individuals (representing 10 species) germinated directly on the ground rather than epiphytically. Ficus sundaica dominated, comprising 22% of all trees and 67% of all figs. Our findings challenge the assumption that strangler figs require epiphytic establishment and reveal unexpected ecological flexibility in degraded peatlands where active planting efforts have largely failed. Given their abundance, flexible establishment mode, and role as keystone species supporting frugivore communities, naturally regenerating strangler figs may facilitate broader ecosystem recovery in fire-damaged peat-swamp forests.

¿p#1 Background and Purpose: Calcitonin gene-related peptide (CGRP) is a potent, clinically relevant endogenous vasodilator, but the precise intracellular signalling pathways remain unclear, particularly in small coronary arteries. Experimental Approach: This study used ex vivo myography and intracellular recording techniques to investigate α-CGRP-induced vasorelaxation and vascular smooth muscle cell (VSMC) hyperpolarization in myogenically-active rat isolated coronary arteries. Key Results: CGRP-induced vasorelaxation was not dependent on the endothelium, but relied heavily on K + channel activation. Immunohistochemistry indicated Kv7 and BK Ca channel expression in VSMC and endothelial cells (ECs). A combination of the K V7 channel inhibitor, linopirdine, and the BK Ca channel inhibitor, paxilline, significantly attenuated CGRP-induced vasorelaxation in endothelium-intact or denuded arteries. Electrophysiology confirmed that CGRP induced hyperpolarization and showed this was prevented by linopirdine and paxilline, also demonstrating a role for K V7 and BK Ca channels in suppressing depolarizing smooth muscle spikes. These spikes were also suppressed by NO• and HNO donors, resulting in hyperpolarization. Gβγ subunit inhibition with gallein markedly right-shifted CGRP-induced vasorelaxation in both endothelium-intact and denuded coronary arteries. Conclusion and Implications: α-CGRP stimulates robust vasorelaxation in the coronary microvasculature that relies on Gβγ subunit activated VSMC hyperpolarization involving K V7 and BK Ca channels. These data enhance understanding of coronary microvascular physiology and inform the design of future therapeutic strategies targeting coronary vascular dysfunction.

A document by Eduardo Xavier Porras Rosales. Click on the document to view its contents.