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Light Filtering Lenses and Visual Photosensitivity in Individuals With Traumatic Brain Injury
No full textThe purpose of this study was to assess visual photosensitivity using the Ocular Photosensitivity Analyzer (OPA) with and without light filtering lenses in individuals with traumatic brain injury (TBI) and non-TBI controls.
This cohort study included 46 individuals with TBI (n = 46) and without TBI (n = 46) assessed from May 2021 to August 2023 at a large academic tertiary center. Visual photosensitivity thresholds (VPTs) were measured at two visits (≥1 month apart) under four lens conditions: no lens (NL), plano lenses (PLs), FL-41 lenses (FLs), and gray-filtering lenses (GLs). Lower VPTs indicate greater visual photosensitivity.
Participants with TBI had significantly lower VPTs compared with non-TBI controls across all lens conditions at the initial visit (TBI: PL = 1.6 ± 0.9, FL = 1.9 ± 0.9, and GL = 1.9 ± 1.0; and non-TBI: PL = 2.5 ± 0.9, FL = 2.8 ± 0.9, and GL = 2.8 ± 0.9 log lux, P 0.80 for all conditions).
Individuals with TBI consistently demonstrated greater visual photosensitivity compared with controls. FL and GL light filtering lenses improved light tolerance for both groups. These results highlight visual photosensitivity as a TBI sequela and suggest that these light filtering lenses may serve as effective treatment options
Wireless Federated Multi-Task LLM Fine-Tuning via Sparse-and-Orthogonal LoRA
No full textDecentralized federated learning (DFL) based on low-rank adaptation (LoRA) enables mobile devices with multi-task datasets to collaboratively fine-tune a large language model (LLM) by exchanging locally updated parameters with a subset of neighboring devices via wireless connections for knowledge integration.However, directly aggregating parameters fine-tuned on heterogeneous datasets induces three primary issues across the DFL life-cycle: (i) catastrophic knowledge forgetting during fine-tuning process, arising from conflicting update directions caused by data heterogeneity; (ii) inefficient communication and convergence during model aggregation process, due to bandwidth-intensive redundant model transmissions; and (iii) multi-task knowledge interference during inference process, resulting from incompatible knowledge representations coexistence during inference. To address these issues in a fully decentralized scenario, we first propose a sparse-and-orthogonal LoRA that ensures orthogonality between model updates to eliminate direction conflicts during fine-tuning.Then, we analyze how device connection topology affects multi-task performance, prompting a cluster-based topology design during aggregation.Finally, we propose an implicit mixture of experts (MoE) mechanism to avoid the coexistence of incompatible knowledge during inference. Simulation results demonstrate that the proposed approach effectively reduces communication resource consumption by up to73%and enhances average performance by5%compared with the traditional LoRA method
Eyelid Xanthelasma and Cardiovascular Outcomes: A Propensity-Matched Analysis
No full textXanthelasma palpebrarum (XP) is a common periocular lesion often regarded as benign. However, its potential association with systemic lipid dysregulation and cardiovascular disease remains controversial. This study aimed to evaluate the relationship between XP, dyslipidemia, and major cardiovascular outcomes using a large-scale, electronic health record dataset.
This retrospective propensity score-matched cohort study used de-identified electronic health record data from TriNetX, a global federated research network. Adults aged 20 to 85 years with and without XP were identified between August 5, 2005, and August 5, 2025. XP cases were matched 1:1 to controls without XP based on age, sex, comorbidities, and other covariates. Primary outcomes included the incidence of hyperlipidemia and major adverse cardiovascular events. Secondary measures included lipid profile values and use of lipid-lowering medications. Cox proportional hazards models estimated hazard ratios (HRs) for outcomes, adjusted for demographics and comorbidities.
A total of 40,096 patients (20,048 with XP; 20,048 controls) were included in the analysis. The mean age at index was 53.7 years in both groups. Male sex accounted for 28.3% of the XP cohort and 28.4% of the control group. Lipid profiles differed significantly between groups. Compared with controls, patients with XP had higher rates of hyperlipidemia (32.2% vs. 27.6%; p < 0.0001) and major adverse cardiovascular event (13.0% vs. 11.4%; p < 0.0001), while all-cause mortality was not significantly different in unadjusted comparisons (3.1% vs. 3.3%; p = 0.27). In Cox proportional hazards models, XP was associated with increased risk of hyperlipidemia (HR: 1.38; 95% CI: 1.35-1.41; p < 0.0001), major adverse cardiovascular event (HR: 1.26; 95% CI: 1.22-1.31; p < 0.0001), and a statistically significant but small elevation in all-cause mortality (HR: 1.09; 95% CI: 1.01-1.17; p = 0.0324).
XP is significantly associated with atherogenic lipid profiles, greater use of lipid-lowering medications, and increased risk of cardiovascular events. Recognition of XP during routine ophthalmic examinations may provide an opportunity for early cardiovascular risk stratification
Transposable Elements and Homotypic Niches Drive Immune Dynamics and Resistance in Melanoma Epigenetic-based immunotherapy
No full textMelanoma plasticity drives immune evasion and therapy resistance through dynamic cell-state transitions beyond genetic alterations. Although epigenetic remodeling is central to this process, its impact under therapeutic pressure remains unclear. We profiled longitudinal biopsies from melanoma patients treated in the phase Ib NIBIT-M4 epi-immunotherapy trial (NCT02608437, DNMT1 inhibitor plus anti-CTLA4) using single-cell multiome and spatial transcriptomics. Seven malignant meta-programs were identified, including a rare Wnt/β-catenin melanocytic state and a de-differentiated neural crest–like state enriched in non-responders. Spatial analyses showed that homotypic clustering stabilizes resistant programs, with neural crest–like cells forming compact niches. Responders displayed enrichment of antigen presentation/interferon programs and coordinated T and B cell expansion, whereas non-responders retained stable neural crest–like clusters. Epigenetic therapy reactivated transposable elements, priming innate immunity and enhancing immunogenicity. NFATC2 emerged as a master regulator of neural crest–like states and resistance; its perturbation promoted differentiation and immunogenicity. These findings define mechanisms of resistance and nominate β-catenin and NFATC2 as therapeutic vulnerabilities
Modified Osteotomies for Wing and Mini-Wing Genioplasty
No full textPatients with chin deficiency secondary to dentofacial deformity often present with aesthetic and functional complaints. Treatment of such deficiencies with conventional genioplasty may be limited when broader modification of the mandibular basilar contour is required. This retrospective case series reports the clinical and radiographic outcomes of 9 patients treated with wing (n = 8) or mini-wing (n = 1) genioplasty for anteroposterior and/or vertical chin deficiency, mandibular asymmetry, syndromic deformities, post-traumatic sequelae, or airway-related complaints. Wing osteotomy was indicated for the correction of the mandibular body and angle, whereas mini-wing osteotomy was reserved for deformities confined to the chin. Procedures were performed in combination with orthognathic surgery when indicated (n = 6). All patients demonstrated improved chin projection, mandibular contour, and lower facial harmony, with the additional benefits of transverse widening of the mandibular body, enhanced cervicomandibular angle definition, and improved symmetry. In one patient with obstructive sleep apnea, postoperative imaging showed enlargement of the pharyngeal airway space. Stable outcomes were maintained over the follow-up period (mean: 4.3 years; range: 1-9 years). Wing and mini-wing osteotomies represent reliable extensions of conventional genioplasty, allowing comprehensive modification of the mandibular basilar contour
Tele-delivered psychotherapeutic intervention for family members of patients in intensive care-a non-randomized pilot study
No full textFamily members of patients in intensive care units (ICU) experience psychological distress both during and after the ICU stay. Yet, past interventions are few and largely ineffective.
We developed a flexible, tele-delivered psychotherapeutic intervention based on contemporary cognitive therapeutic methods and tested its feasibility in a one-arm pilot study. Although evaluated in family members of patients with COVID-19, the intervention was developed to be broadly applicable to mental health problems in ICU family caregivers.
Adult family members of patients with COVID-19 in five ICUs across Denmark received weekly sessions with clinical psychologists during the ICU stay and on a needs basis for eight weeks post-discharge. The intervention manual specified a catalog of treatment principles and methods from contemporary cognitive therapies. Questionnaires evaluating peritraumatic distress, anxiety, depression, stress, rumination, worry, and tolerance of uncertainty were administered at pre-intervention, post-intervention, six-, and twelve-month follow-up. Mixed-effects models estimated the change in mental health symptoms over time. A subset of family members and psychologists completed in-depth interviews post-intervention analyzed with thematic analysis.
Of 43 eligible family members, 40 (93%) participated. Two withdrew consent during the intervention. On average, family members received 6 sessions (range: 0-15) over 9 to 118 days. Both the tele-delivery format and the intervention methods were found feasible and acceptable by family members as well as psychologists, and family members found the intervention beneficial in validating and addressing their evolving needs and helping them manage distress. Preliminary effects at post-intervention were large reductions in mental health symptoms for peritraumatic distress (Hedges' g = -0.86, 95% confidence interval (CI) = [-1.2 to -0.25]), anxiety (g = -2.46, [-2.36 to -1.51]), and depression (g = -1.77, [-2.5 to -0.88]), also seen at follow-up, together with medium improvements for perceived stress.
This tele-based psychotherapeutic intervention for family members of patients in ICUs was feasible and acceptable, and tele-delivered contemporary cognitive therapies present a promising approach for reducing peritraumatic distress, anxiety, and depression.
Clinicaltrials.gov (NCT04409821)
Acantholytic disorders: Update on pathophysiology, diagnosis, and management
No full textAcantholytic skin disorders without a primary immunological etiology are characterized by impaired intercellular adhesion between epidermal keratinocytes. Genetic acantholytic disorders include Darier disease (DD) and Hailey-Hailey disease (HHD); the pathogenesis of Grover disease (GD) is unknown. Since these conditions are not commonly seen in clinical practice, diagnoses may be missed and there are no standardized guidelines to direct treatment. Topical steroids and retinoids are typically utilized for mild disease, and oral retinoids, particularly acitretin, have often been used for more severe disease, but efficacy is not universal. There is emerging evidence for biologics and small molecular inhibitors, including dupilumab, tumor necrosis factor-α inhibitors, apremilast, and Janus kinase (JAK) inhibitors to treat refractory disease. Recent data and personal experience suggest potential efficacy of low-dose naltrexone as monotherapy or adjunctive treatment. Overactivity of the interleukin-17/23 and interleukin 4/13 axes or MAPK/ERK pathways may point to novel therapeutic strategies, including guselkumab. Direct SERCA activators may hold potential for treatment of DD. This clinical review aims to equip physicians to diagnose acantholytic disorders and provide expert treatment recommendations based on emerging evidence
Party Pressure and Representation
No full textI study how political parties affect representation in the U.S. House. To do so, I account for party pressure on the votes of members in an otherwise standard spatial model that uses roll call voting patterns to identify member ideologies. I simultaneously estimate voter ideologies from survey responses, leveraging their responses on issues before Congress to bridge voters and members into the same ideological space. I find that, relative to a model without party pressure, member ideologies and those of their constituents are much more closely aligned. The results imply that, in terms of actual votes, parties drive a wedge between members and those they represent. I provide evidence that parties do so strategically, balancing the need for legislative wins and the electoral concerns of their member
Chronic Corticosteroid Use Is Associated with Increased Postoperative Complications Following Lumbar Microdiscectomy
No full textRadiofrequency Ablation for the Treatment of Pain Related to Bertolotti's Syndrome: A Case Report
No full textBertolotti's syndrome is a congenital spinal disorder marked by back pain due to a lumbosacral transitional vertebra, often presenting with sacroiliac joint, groin, and hip pain. This condition results from the articulation of the lumbar 5 vertebra transverse processes with the sacrum, causing both radicular and pseudoradicular pain.
This is a case report of a patient with bilateral axial low back pain related to bilateral Bertolotti joints who received sustained pain relief after a radiofrequency ablation (RFA) targeting the bilateral L4 medial branch, L5 dorsal ramus, and S1 lateral branch.
Our case report demonstrates the complete resolution of chronic low back pain in a patient with bilateral Bertolotti's syndrome after an RFA targeting the L4 medial branch, L5 dorsal ramus, and S1 lateral branch