Objective To quantitatively analyze the volumetric characteristics of each subregion of the basal ganglia in patients with hepatolenticular degeneration （also known as Wilson disease ，WD） using brain magnetic resonance imaging （MRI） and brain segmentation technology， to explore the specific imaging findings of choreiform symptoms， and to assess the clinical value of caudate nucleus atrophy as an imaging indicator for this symptom. Methods A retrospective analysis was performed for 40 WD patients with choreiform symptoms and 40 patients without choreiform symptoms from June 2023 to June 2025， and clinical indicators were compared between the two groups. In addition， the two groups were compared in terms of the volume of the basal ganglia after estimated total intracranial volume （eTIV） correction， and the correlation between the volume of differential brain regions and the chorea subscale score of Unified Wilson's Disease Rating Scale （UWDRS） was explored. Results There were no significant differences in baseline data between the two groups. UWDRS scores showed that the choreiform group had a higher neurological function score （P=0.005）， a significantly higher chorea subscale score （P<0.01）， and a lower hepatic function score （P<0.01）. The choreiform group had a significantly smaller caudate nucleus volume than the non-choreiform group （P<0.001）， suggesting severe subregional atrophy， and in contrast， the choreiform group had a significant increase in thalamus volume （P=0.002）. Caudate nucleus volume ratio was significantly negatively correlated with chorea subscale score in the choreiform group （P<0.001）. Conclusion Caudate nucleus atrophy is a specific imaging finding of choreiform symptoms in WD patients， and a quantitative analysis of caudate nucleus volume is expected to become an objective imaging indicator for assessing the severity of choreiform symptoms and monitoring disease progression in WD.

Objective To investigate the cranial magnetic resonance imaging （MRI） features of patients with hepatolenticular degeneration （also known as Wilson disease，WD） and epilepsy， and to identify the neuroimaging risk factors for seizures in WD patients. Methods A total of 69 WD patients with epilepsy who were hospitalized in Affiliated Hospital of Neurology Institute， Anhui University of Chinese Medicine， from January 2018 to November 2025 were enrolled as study group， while 80 WD patients without seizures， matched for sex and age， during the same period of time were randomly selected as control group. Cranial MRI findings were compared between the two groups. Results There were 69 WD patients （43 male patients and 26 female patients） in the study group， with a mean age of （29.46±8.58） years at the time of attending the hospital， and all these patients had abnormal electroencephalogram （EEG） findings. There were no significant differences between the two groups in age of onset，disease duration， WD subtype， and serum copper. Cranial MRI showed that the putamen was the most common site of brain injury （47 patients， 68.1%）， followed by the frontal lobe （40 patients，58.0%） and the parietal lobe （31 patients，44.9%）， and there was a significantly higher probability of epilepsy in patients with abnormal lesions in the frontal， temporal， or parietal lobes （P<0.05）. Conclusion While the putamen is the most common site of brain injury in WD patients with epilepsy， frontal or temporal lobe injuries are neuroimaging risk factors for seizures in such patients.
Epilepsy, Frontal Lobe ; Putamen

Background: Patients with coarctation of the aorta (CoA) and an interrupted aortic arch (IAA) may present with small mitral valves (MVs) and a reduced left ventricular (LV) volume. Biventricular repair (BVR) in these patients is dependent on adequate size of the left cardiac structures.Purpose: This study evaluated the impact of the hemodynamic characteristics of atrial septal defects (ASDs) on MV growth following surgical repair. Methods: We retrospectively reviewed the data of patients diagnosed with CoA or IAA between 2007 and 2024. The z score for MV size measured 6 months postoperatively (Z2) was compared with the preoperative MV size (Z1). The factors associated with MV growth were also studied. Results: A total of 161 patients with CoA or IAA were included. Transthoracic echocardiography was used to assess the MV and LV dimensions preoperatively and 6 months postoperatively. Of the cohort, 155 (96.3%) underwent initial BVR and 6 underwent single-ventricle palliation. MV z scores significantly increased following BVR (mean change: +0.45±1.35; P<0.001) but decreased after single-ventricle repair (-0.56±0.49, P=0.04). Multivariate analysis identified the initial MV z score and ASD pressure gradient as independent predictors of MV growth (R2=0.39). Conclusion Annular growth of the MV was not observed in patients who underwent single-ventricle palliation. In contrast, among patients who achieved BVR, those with a small preoperative MV annulus and low ASD pressure gradient demonstrated subsequent catch-up MV growth, suggesting that adequate left-sided preload is essential for MV development.

OBJECTIVES: Acute diarrheal disease (ADD) remains a leading cause of morbidity and mortality in children under 5 worldwide. In Paraguay, the introduction of the rotavirus vaccine in 2010 aimed to reduce the burden of ADD in infants and young children. This study analyzed 31 years of public data on ADD morbidity and mortality in Paraguayan children under 5 and evaluated the impact of rotavirus vaccination. METHODS: Annual ADD incidence, total deaths, and mortality rates from 1993 to 2023 were obtained from public databases. Proportionate mortality due to ADD, cause-specific mortality rates, absolute risk reduction (ARR) and relative risk reduction (RRR), and joinpoint regression were calculated using EPIDAT 4.2 and Joinpoint 5.3.0 software, with data stratified by age group and vaccination period. RESULTS: Between 1993 and 2021, pediatric mortality in Paraguay declined steadily across all age groups. Following the introduction of Rotarix in 2010, infant mortality dropped from 2.36 to 0.19 deaths per 1,000 live births (ARR, 0.83; RRR, 81.4%). Joinpoint analysis showed a decline in under-5 mortality between 2009 and 2012 (annual percentage change=−35.2%, p<0.05), followed by stabilization. ADD incidence increased until 2019 and then declined, while vaccine coverage exceeded 70%. CONCLUSIONS Paraguay has sustained declines in infant and childhood mortality over 3 decades through improvements in healthcare and immunization, with the 2010 introduction of Rotarix reducing the mortality rate by 43 deaths per 100,000 infants under 12 months. These results underscore the impact of vaccination and health system strengthening, while highlighting the need to monitor emerging threats.

OBJECTIVES: Kudoa septempunctata has been identified as the causative agent of food poisoning following the consumption of raw farmed Paralichthys olivaceus. However, cohort studies providing robust evidence for an association between K. septempunctata and gastrointestinal symptoms remain limited. This prospective cohort study investigated the association between the consumption of K. septempunctata–infected farmed P. olivaceus and the occurrence of gastrointestinal symptoms. METHODS: Individuals who purchased raw farmed P. olivaceus between 2020 and 2021 were selected as the study population. Study data included 2 rounds of questionnaire surveys administered before and after consumption, 2 muscle specimens obtained from each purchased fish, and human biological specimens collected from individuals who developed gastrointestinal symptoms within 24 hours after consumption. Data were analyzed using the chi-square test and t-test, and the association between consumption of K. septempunctata–infected farmed P. olivaceus and gastrointestinal symptoms was evaluated using relative risk estimates between exposure groups. RESULTS: The relative risk of gastrointestinal symptoms associated with exposure to K. septempunctata–infected P. olivaceus ranged from 71.2 (95% confidence interval [CI], 27.0 to 178.6) to 124.5 (95% CI, 43.5 to 355.0) across the 2 case definitions. A strong and statistically significant association was observed between exposure to K. septempunctata–infected P. olivaceus and the development of acute gastrointestinal symptoms. CONCLUSIONS These findings indicate both an association and a causal relationship between consumption of K. septempunctata–infected farmed P. olivaceus and the onset of gastrointestinal symptoms.

Objective: The study was to develop the instrumental activities of daily living scale-ability and actual performance (IADL-AA) to assess the ability and actual performance constructs of instrumental activities of daily living (IADL). Methods: Eight experts reviewed the items of the IADL-AA. Additionally, 30 and 266 people with schizophrenia participated in cognitive interviews and validation analysis, respectively. Expert consultations and cognitive interviews were conducted to examine face validity and content validity, respectively. Construct validity was evaluated through Rasch analysis to ensure unidimensionality. Convergent validity was investigated using Pearson’s r, discriminative validity was examined through floor and ceiling effects, and internal consistency was assessed using Cronbach’s alpha (α). Results: The IADL-AA comprised 23 items showing the unidimensionality of each domain. The infit and outfit mean squares were 0.76–1.21 and 0.68–1.40, respectively. A moderate correlation was observed between ability and actual performance domains (r=0.63). No floor or ceiling effects were found for the two domains (0.0%–6.0% and 1.5%–3.0%, respectively). Cronbach’s α of the two domains was 0.83–0.90. Conclusion The IADL-AA demonstrates satisfactory psychometric properties, including face validity, content validity, construct validity, convergent validity, discriminative validity, and internal consistency. This measure can effectively identify the capacity and degree of independence of IADL function in people with schizophrenia.

Objectives: Helicobacter pylori is recognized as one of the most virulent microorganisms within the genus Helicobacter owing to its genomic characteristics. It has been associated with diseases, such as peptic ulcers and gastric cancer. This study aimed to evaluate Helicobacter pylori positivity in fecal samples using 16S rRNA gene polymerase chain reaction (PCR) in fecal samples. Methods: Fecal samples from patients with gastroduodenal symptoms were analyzed. Stool antigen test (SAT) was performed to identify H. pylori-positive cases. Subsequently, a pre-enrichment step was performed to increase the bacterial DNA yield and improve the molecular detection efficiency. Finally, PCR amplification, targeting a specific region of the H. pylori 16S rRNA gene, was performed to confirm the presence of the pathogen. Results: A 70% PCR positivity rate was observed among SAT-positive samples amplified for the 16S rRNA gene. Conclusions The positivity rate for H. pylori (70%) was confirmed by PCR, indicating that molecular testing of fecal samples is an effective non-invasive tool for detecting infection.

Introductions: Patients with primary podocytopathies such as minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) with nephrotic syndrome are at risk for adverse outcomes. This study reports on the long -term outcomes, specifically kidney failure and death among patients treated for primary podocytopathies in a tertiary centre in Singapore. Materials and Methods: This was a single -centre, retrospective cohort study of all adults aged ≥21 years old diagnosed between 2016 and 2020 with MCD and FSGS with nephrotic -range proteinuria. We excluded patients with membranous nephropathy and secondary glomerulonephritides (lupus nephritis, ANCA - associated vasculitis, membranoproliferative glomerulonephritis, and diabetic nephropathy). Sociodemographic, comorbidity, laboratory and pharmacotherapy data were retrieved from the electronic medical records. The outcomes assessed were incidence of death or kidney failure (estimated glomerular filtration function [eGFR]<15 ml/min/1.73 m2 or required kidney replacement therapy). Results: Sixty patients (Chinese 80%, Malay 6%, Indian 3% and other races 3%) with MCD (37 patients) and FSGS (23 patients) were included. The morphological lesions in FSGS included cellular (n=2), tip (n=2), perihilar (n=7), collapsing (n=3) and not otherwise specified (n=17). At a median follow -up of 26.3 (8.9, 50.3) months, 12 (20%) outcomes were recorded, 11 (47.8%; death 6 and kidney failure 5) in the FSGS group and 1 (2.7%; died) in the MCD group. The causes of death were attributed to kidney failure (n=1), cardiovascular disease (n=1), infection (n=3); and unknown (n=2). The Kaplan -Meier survival curve showed that patients with MCD had better patient and kidney outcomes than those with FSGS (log rank p<0.001). Cox regression analysis (adjusted for age) found that FSGS was significantly associated with death or kidney failure (adjusted hazard ratio 18.17, 95% confidence interval 2.28 -145.07, p=0.006), compared with MCD. Conclusion: Adults with severe primary podocytopathy due to FSGS had worse patient and kidney outcomes than MCD

Introductions: Patients with primary podocytopathies such as minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) with nephrotic syndrome are at risk for adverse outcomes. This study reports on the long -term outcomes, specifically kidney failure and death among patients treated for primary podocytopathies in a tertiary centre in Singapore. Materials and Methods: This was a single -centre, retrospective cohort study of all adults aged ≥21 years old diagnosed between 2016 and 2020 with MCD and FSGS with nephrotic -range proteinuria. We excluded patients with membranous nephropathy and secondary glomerulonephritides (lupus nephritis, ANCA - associated vasculitis, membranoproliferative glomerulonephritis, and diabetic nephropathy). Sociodemographic, comorbidity, laboratory and pharmacotherapy data were retrieved from the electronic medical records. The outcomes assessed were incidence of death or kidney failure (estimated glomerular filtration function [eGFR]<15 ml/min/1.73 m2 or required kidney replacement therapy). Results: Sixty patients (Chinese 80%, Malay 6%, Indian 3% and other races 3%) with MCD (37 patients) and FSGS (23 patients) were included. The morphological lesions in FSGS included cellular (n=2), tip (n=2), perihilar (n=7), collapsing (n=3) and not otherwise specified (n=17). At a median follow -up of 26.3 (8.9, 50.3) months, 12 (20%) outcomes were recorded, 11 (47.8%; death 6 and kidney failure 5) in the FSGS group and 1 (2.7%; died) in the MCD group. The causes of death were attributed to kidney failure (n=1), cardiovascular disease (n=1), infection (n=3); and unknown (n=2). The Kaplan -Meier survival curve showed that patients with MCD had better patient and kidney outcomes than those with FSGS (log rank p<0.001). Cox regression analysis (adjusted for age) found that FSGS was significantly associated with death or kidney failure (adjusted hazard ratio 18.17, 95% confidence interval 2.28 -145.07, p=0.006), compared with MCD. Conclusion: Adults with severe primary podocytopathy due to FSGS had worse patient and kidney outcomes than MCD

Introduction: Type 2 diabetes mellitus is a major healthcare problem worldwide, yet high percentage of patients are undiagnosed. There is a dire need for effective screening strategies. We examine the use of modified Asian FINDRISC (M-FINDRISC) and POCT random capillary blood glucose (rCBG) for the detection of dysglycemia Methodology: This cross-sectional, observational study included 151 adults aged ≥30 years without a prior history of diabetes in healthcare and community settings. Hemoglobin A1c of ≥6.3% was used for the diagnosis of diabetes, and 5.7– 6.2% for prediabetes. Areas under the receiver operating curve (ROC-AUC) for M-FINDRISC were analyzed. The sensitivity and specificity of the combined use of M-FINDRISC and rCBG for the detection of dysglycemia were evaluated. Results: The mean age of the participants was 44.6 ± 11.0 years. They had high body mass index (27.8 ± 4.9 kg/m²). Most were sedentary (only 25.2% reported physical activities of ≥30 min/day). A total of 52.3% had first-degree relatives with diabetes, but less than 12% were taking antihypertensive medication. Out of 151 participants, 3.3% (n = 5) were diagnosed with diabetes mellitus and 37.7% (n = 57) with prediabetes, giving an overall prevalence of 41.1% for dysglycemia. The mean age of participants with dysglycemia was significantly older (47.9 vs. 42.3 years, p-value 0.002). Other parameters were not statistically different for the two groups. Mean M-FINDRISC score was 9.7 ± 3.9 in the normal and 10.8 ± 4.0 in the dysglycemic group, while rCBG was 6.4 ± 1.1 mmol/L and 7.1 ± 3.1 mmol/L, respectively. ROC-AUC of M-FINDRISC for dysglycemia was 0.561. A combined screening strategy (M-FINDRISC score ≥7.5 and CBG ≥7.8 mmol/L) yielded high specificity (89.9%) but low sensitivity (17.7%) for dysglycemia. Conclusion While the combined screening strategy utilizing M-FINDRISC and POCT random CBG improves specificity, M-FINDRISC showed limited predictive value for dysglycemia in this specific cohort, making it a less ideal tool for screening.