Publications

A rudimentary horn is a type of congenital uterine anomaly associated with a unicornuate uterus. Rudimentary horn pregnancies (RHPs) are extremely rare and the majority of cases result in second trimester rupture necessitating emergent laparotomy with associated high maternal morbidity and delivery of a previable fetus. We report the case of a 33-year-old G5P0131 female who presented at 15 weeks and 4 days gestational age with pelvic and back pain and imaging favoring an abdominal pregnancy. The patient underwent an exploratory laparotomy with left salpingectomy and excision of an unruptured extrauterine pregnancy that was confirmed to be an RHP on pathologic examination. Postsurgery review of the imaging demonstrated several features consistent with the diagnosis of an RHP that were not initially identified. Furthermore, the patient's medical and surgical histories were notable for several risk factors associated with congenital uterine anomalies that should have heightened the clinical suspicion for an RHP. This case emphasizes how increased familiarity with the risk factors and imaging findings associated with rudimentary horns and RHPs may lead to an earlier and more accurate diagnosis, more timely and appropriate treatment, and ultimately a reduction in maternal and fetal morbidity and mortality.

STUDY OBJECTIVES: While recovery sleep can ameliorate the negative impacts of total sleep deprivation (TSD) on cognitive functioning, the effects of post-TSD sleep on different forms of emotional functioning remain unknown. Here, we investigated the effects of TSD and post-TSD recovery sleep on emotional memory processing.

METHODS: Participants viewed scenes with negative or neutral central objects overlain on neutral backgrounds. The scene components were then presented separately for recognition testing. Participants in the TSD (n = 46) and Sleep (n = 22) conditions encoded the scenes the morning after the sleep manipulation ( 10:00) and recognition memory was tested for half of the scene components after a short delay (Recog_1,  10:45). Twenty of the TSD participants then received a 90-min nap opportunity (TSDNap). All participants then completed a second recognition test on the remaining images (Recog_2,  14:00).

RESULTS: At Recog_1, all TSD participants showed worse overall memory compared to sleep participants. Specifically, memory was significantly worse for every scene component except neutral objects during Recog_1. At Recog_2, while memory deteriorated further for all scene components in the TSDNoNap group, the TSDNap group showed no memory decline and had improved memory for negative objects, matching the sleep group at Recog_2.

CONCLUSIONS: Post-TSD recovery sleep preserves and restores memory functioning to the level seen in typically rested individuals. But extending TSD leads to continued memory deterioration, highlighting the importance of sleep in healthy emotional memory functioning. This paper is part of the Festschrift in honor of Dr. Robert Stickgold.

BACKGROUND: YouTube is an open-access platform increasingly used for both medical and patient education, but its user-generated content is not subject to peer review and shows wide variability in accuracy and quality. Celiac plexus blocks are technically complex procedures that are presented on YouTube, yet the educational quality of these instructional videos has not yet been systematically evaluated.

OBJECTIVE: To evaluate the educational quality of YouTube videos on celiac plexus blocks and to explore the utility of ChatGPT-4o as a secondary, adjunctive tool for assessing video quality.

METHODS: YouTube was searched on June 2nd, 2025 using the keywords "celiac plexus neurolysis," "celiac block for cancer pain," "celiac plexus block," and "celiac plexus injection." The 17 most-viewed videos were independently evaluated by two board-certified chronic pain physicians and by ChatGPT-4o using a modified DISCERN scale (mDISCERN), the Global Quality Scale (GQS), and a usefulness classification.

RESULTS: Based on human expert ratings, only 18 % of videos contained highly reliable information as assessed by the mDISCERN scale, and 24 % demonstrated moderate to excellent information quality on the Global Quality Scale. Overall, 65 % of videos were classified as useful. Inter-rater reliability between human experts ranged from poor to moderate across the three scales of evaluation, while agreement between human expert and ChatGPT-4o assessment was poor.

CONCLUSIONS: The educational quality of YouTube videos on celiac plexus blocks was generally poor. Unlike similar studies investigating other procedures, the quality of videos produced by physician and hospital sources was not better than that of videos by nonacademic sources. These findings highlight the need to improve the quality of educational content produced by physicians, hospitals, and professional societies.

BACKGROUND: Pleural mesothelioma (PM) represents an uncommon and exceptionally lethal malignancy. The sarcomatoid subtype constitutes the rarest histological variant, traditionally linked to the worst prognosis, while the advantages of operative intervention remain inadequately established. In this study, we present findings from a cohort of 34 sequential cases with sarcomatoid mesothelioma managed at a specialized high-volume center employing pleurectomy decortication (PD) within a comprehensive therapeutic strategy. We aim to identify patients in this cohort who may benefit from a multimodality approach.

METHODS: All patients diagnosed with sarcomatoid mesothelioma between 2007 and 2019 who received PD at our facility were enrolled, and relevant medical, histopathological, and operative data collected. Survival curves generated through Kaplan-Meier methodology alongside log-rank testing enabled comparison of longevity outcomes, while Cox proportional hazards modeling facilitated examination of predictive variables.

RESULTS: The cohort included 31 male subjects (91.2%), 24 procedures performed on the right side (70.6%), with a median patient age of 71.5 years (range, 51-85 years). Preoperative treatment was administered to 8 individuals (24.2%), while 23 participants (67.7%) underwent intraoperative heated chemotherapy (IOHC). Macroscopic complete resection (MCR) was accomplished in 22 cases (64.7%). Mortality at 30 and 90 days post-surgery stood at 2.9% and 14.7%, respectively. The median overall survival for the entire cohort reached 7.4 months, extending to 20.1 months among those with forced expiratory volume in 1 second (FEV1) at or above 80% predicted. In multivariate analysis, preoperative FEV1 ≥80% was associated with prolonged overall survival [P=0.01; hazard ratio (HR) =0.54].

CONCLUSIONS: As expected, the median survival for most patients with sarcomatoid histology who undergo surgery is under one year. However, a small subset of patients with FEV1 ≥80% do quite well using the multimodality approach.

BACKGROUND: Nails in the elderly undergo several structural changes related to aging with respect to surface, thickness, color, and growth pattern. The present study explores the potential association between nail alterations and zinc levels in this population.

METHODS: A total of 64 subjects aged ≥60 years with or without nail changes were recruited from the Dermatology and Venereology Outpatient Clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Their nail features were observed clinically and evaluated utilizing dermoscopy, and nail clippings weighing a total of 200 milligrams were collected from each subject for nail zinc concentration measurement. Appropriate statistical tests were employed to determine the relationship between nail zinc levels and the structural alterations, as well as the patients' comorbidities and medications, at a significance level of 0.05.

RESULTS: Most subjects in our study showed altered nail profiles in multiple digits (75.0%) with a predilection for toenails (62.3%), and the first toenail was primarily affected. The commonest dermoscopic features displayed in altered nails include nail plate pigmentation (n = 64), distal edge thickening (n = 39), and surface changes (n = 34). The average nail zinc concentration was lower in the elderly with nail changes than in those without, albeit with no statistically significant differences (p = 0.687). Subgroup analyses according to comorbidities (hypertension, diabetes mellitus type 2, and dyslipidemia) and medications (antihypertensives, antidiabetics, antidyslipidemic drugs, and anticonvulsants) also exhibited no discrepancies.

CONCLUSIONS: This study highlights the complex interactions among nail structural changes, zinc levels, comorbidities, and medications; hence, further research is warranted to obtain a deeper understanding.

Diffuse podocytopathy (DP) is a clinical and pathological entity, which comprises minimal change disease and primary focal segmental glomerulosclerosis (FSGS). It is characterized by diffuse podocyte foot process effacement resulting in nephrotic syndrome. Cumulative evidence supports that DP is a complex disease caused by circulating permeability factors. Following kidney transplantation, DP may recur and severely compromise graft survival. However, prior studies aiming to define immune and genetic factors implicated in disease recurrence have been limited by small cohorts and lack of utilizing stringent criteria to define DP. In this report, we briefly review the important advances made in understanding genomic and permeability factors involved in DP in the native kidney and in the transplant setting, focusing on anti-nephrin antibodies. We stress the importance of applying stringent criteria to define patients at risk of post-transplant recurrence and share our experience in a cohort of 281 consecutive kidney transplant recipients with native kidney failure attributed to FSGS or other forms of DP. Applying strict clinicopathologic criteria combining nephrotic syndrome and diffuse foot process effacement at the time of native kidney biopsy to define DP markedly increased recurrence rate from 9% to 36%. Excluding selected patients with monogenic forms of FSGS and those with high-risk APOL1 genotypes further increased recurrence rate to 54%. In conclusion, an accurate diagnosis of DP in the native kidney is crucial to further our understanding of genomic and immunologic predictors of DP recurrence and to ultimately support the development of prophylactic or therapeutic regimens to improve allograft outcomes.