Status Dystonicus in Children: Is it more Common than we Realize?

Abstract Background Status dystonicus (SD) is the most severe form of dystonia, affecting predominantly children. SD is thought to be rare, but the incidence is unknown. Objective We aimed to: (1) assess the number of admissions involving SD (2) describe complications/intensive care unit (ICU) transfers, and (3) evaluate whether these changed with implementation of a treatment pathway. Methods We retrospectively collected data for patients with SD admitted to the Hospital for Sick Children from January 2020 to June 2024. Results We identified 92 admissions among 48 patients with SD (20/year). Genetic/metabolic dystonia accounted for 45%. Triggers for SD were seen in 82%. The complication rate was 39%, with 27%/19% of individuals requiring ICU care pre/post‐pathway, respectively. Conclusions SD is common, especially in children with genetic/metabolic dystonia, often with identifiable triggers. More data are required to understand the impact of a clinical pathway. Awareness is necessary to mitigate complications.

Deep Brain Stimulation in a Child with Aicardi‐Goutières Syndrome‐7 ( AGS7 ): A Case Report and Literature Review

Movement Disorders after Dengue Virus Infection: A Scoping Review

Abstract Movement disorders after dengue virus (DENV) infection have been increasingly recognized. We aimed to synthesize the clinical and paraclinical characteristics, treatment responses, and outcomes of these neurologic complications. We systematically reviewed PubMed, Embase, Scopus, and LILACS databases up to September 2023 following a published protocol. We identified 73 cases of DENV‐induced movement disorders. Cerebellar ataxia was the most common, followed by parkinsonism, opsoclonus–myoclonus–ataxia syndrome, and dystonia. Movement disorders typically developed within 14 days of DENV infection and were associated with a range of neurological symptoms, including cognitive impairment and psychiatric disturbances. Neuroimaging studies frequently showed abnormalities in the basal ganglia and brainstem. Treatment varied depending on the specific movement disorder and included corticosteroids, intravenous immunoglobulin, and symptomatic medications. Whereas a handful of cases met the criteria for acute encephalitis, many lacked sufficient data to establish a definitive diagnosis. Para‐infectious and postinfectious immune‐mediated movement disorders were also reported. A rare case of chronic progressive panencephalitis due to DENV infection highlights the potential for long‐term neurological consequences. Other DENV‐related complications, such as stroke, pituitary apoplexy, subacute thyroiditis, and metabolic disturbances, can also cause movement disorders. We emphasize the importance of recognizing the diverse neurological manifestations of DENV infection and the need for further research to improve our understanding of the underlying mechanisms and optimize treatment strategies. We propose a more rigorous approach to determining the causality between infection and movement disorder, demanding stronger evidence beyond mere association and advocating for targeted research to fill the existing knowledge gaps. © 2025 International Parkinson and Movement Disorder Society.

Measuring Dopamine Transporter Availability and Synaptic Density in Parkinson's Disease: A Dual‐Tracer Positron Emission Tomography Imaging Study

Abstract Background 18 F‐FE‐PE2I is a highly selective dopamine transporter (DAT) positron emission tomography (PET) radioligand, whereas 11 C‐UCB‐J targets synaptic vesicle glycoprotein 2A (SV2A), enabling the assessment of synaptic density. Both tracers show significant alterations in Parkinson's disease (PD) in nigrostriatal regions. However, the extent of overlap between overall synaptic loss and dopaminergic denervation across different disease stages remains unclear. Objective To evaluate similarities and differences between patterns of DAT and SV2A binding in healthy controls (HC) and PD patients at different disease stages. Methods Thirty patients with PD (12 women, age: 65.8 ± 7.1 years) and thirteen HCs (7 women, age: 57.8 ± 5.4 years) underwent PET imaging with 18 F‐FE‐PE2I and 11 C‐UCB‐J on separate days. Patients with PD were also stratified by disease duration into two subgroups (<3 years, n = 10; >6 years, n = 11). Binding potentials ( BP ND ) were quantified in four regions of interest (ROIs): caudate, putamen, ventral striatum (VS), and substantia nigra (SN). Between‐group differences in BP ND were evaluated against HCs for each tracer, and correlations between 18 F‐FE‐PE2I and 11 C‐UCB‐J BP ND were evaluated. Results In HCs, significant correlations were observed between caudate 18 F‐FE‐PE2I and striatal 11 C‐UCB‐J BP ND (caudate, putamen, VS). In PD (full cohort and longer‐duration subgroup), significant correlations emerged between SN 11 C‐UCB‐J and striatal 18 F‐FE‐PE2I. Percent differences between patients with PD and HCs with 18 F‐FE‐PE2I and 11 C‐UCB‐J were similar only in the SN. Conclusions This study examined the relationship between DAT and overall synaptic density in nigrostriatal ROIs in PD using dual‐tracer PET imaging, and there were distinct patterns that vary across disease stages. Understanding the interplay between dopaminergic and presynaptic degeneration in PD could enhance our knowledge of its pathophysiology and contribute to improve diagnosis. © 2025 International Parkinson and Movement Disorder Society.

Advancing Temporomandibular Joint Reconstruction: A Cadaveric Study on the Design of the Fourth Chondrocostal Joint Flap

ABSTRACT Background The free fibula flap is the gold standard for reconstructing mandibular defects caused by trauma, tumors, dysplastic diseases, osteoradionecrosis, and atrophy. However, it has not yet been shown to be the ideal method for condylar reconstruction. This anatomical study proposes a surgically pragmatic approach to temporomandibular joint and condylar reconstruction by defining the vascularity of the chondrocostal joint. Methods One fresh frozen and six fixed cadavers were dissected to assess the suitability of the 4th rib for the planned procedure. Bilateral internal thoracic vessels and branches surrounding chondrocostal joints were identified. The 4th chondrocostal joint flap was dissected with care to preserve the joint surface and perichondral vascularity. Digital calipers were used for precise measurements of maximal flap and pedicle length. The vascular anatomy was further explored in a fresh frozen cadaver through fluoroscopic imaging by radiopaque latex injection. The flap's suitability for temporomandibular joint reconstruction was tested by surgically removing the original temporomandibular joint from the cadaveric skull and positioning the chondrocostal joint flap in the resultant defect. Results The dominant pedicle to the fourth chondrocostal joint was shown to be the perforators of the internal thoracic vessels. The mean pedicle length was 4.7 cm, which was sufficient to reach recipient vessels in the neck. The compatibility between the fourth chondrocostal joint and the glenoid fossa was confirmed. Conclusion This study demonstrates that the fourth chondrocostal joint flap is a promising free flap for temporomandibular joint and condylar reconstruction. It offers ideal pedicle positioning, length, and vascular size match at the anastomosis, making it a suitable technique for reconstructing the challenging temporomandibular region. This approach adds a new option to the reconstructive surgeon's armamentarium, addressing previous limitations in condylar reconstruction.

MicroRAG : Development of a Novel Artificial Intelligence Retrieval‐Augmented Generation Model for Microsurgery Clinical Decision Support

ABSTRACT Background Microsurgical decision‐making requires integration of diverse patient‐specific factors, advanced surgical techniques, and dynamic intraoperative insights. While artificial intelligence (AI), large language models (LLMs), and retrieval‐augmented generation (RAG) models have advanced significantly in various fields, no AI‐driven clinical decision support systems currently exist for microsurgery. We developed MicroRAG, the first AI‐powered clinical decision support system specifically designed for microsurgery, capable of instantly providing evidence‐based recommendations by searching and synthesizing the entire microsurgical literature. Methods We developed an AI clinical decision support system integrating 4876 peer‐reviewed microsurgical publications (2000–2024) using advanced retrieval‐augmented generation (RAG) technology. The system processes clinical queries through hierarchical document clustering and provides real‐time, evidence‐based recommendations with direct literature citations. We evaluated system performance using 10 standardized clinical scenarios covering common microsurgical decisions, measuring answer relevancy, faithfulness to source literature, and clinical accuracy. Results MicroRAG demonstrated exceptional performance with an average answer relevancy score of 0.953 (range: 0.857–1.000) and faithfulness score of 0.907 (range: 0.676–1.000). G‐Eval correctness averaged 0.88 with Semantic Evaluation Metrics showing an average similarity score of 0.75 and confidence score of 0.80. The system successfully provided comprehensive, immediately actionable guidance for complex scenarios including free flap monitoring protocols, vascular complication management, and surgical technique selection. All responses were grounded in peer‐reviewed literature with direct citations. Conclusion MicroRAG represents a technological innovation in microsurgical practice, providing instant access to evidence‐based recommendations that typically require hours of literature review. By delivering comprehensive, literature‐grounded guidance in real‐time, this system has the potential to standardize best practices, reduce decision‐making uncertainty, and ultimately improve patient outcomes across all levels of surgical experience.

Dynamical Analysis of an HIV Infection Model Including Quiescent Cells and Immune Response

ABSTRACT This research gives a thorough examination of a human immunodeficiency virus (HIV) infection model that includes quiescent cells and immune response dynamics in the host. The model, represented by a system of ordinary differential equations, captures the complex interaction between the host's immune response and viral infection. The study focuses on the model's fundamental aspects, such as equilibrium analysis, computing the basic reproduction numberℛ 0 }_0 $$ , stability analysis, bifurcation phenomena, numerical simulations, and sensitivity analysis. The analysis reveals both an infection equilibrium, which indicates the persistence of the illness, and an infection‐free equilibrium, which represents disease control possibilities. Applying matrix‐theoretical approaches, stability analysis proved that the infection‐free equilibrium is both locally and globally stable forℛ 0 < 1 }_0&amp;lt;1 $$ . For the situation ofℛ 0 > 1 }_0&amp;gt;1 $$ , the infection equilibrium is locally asymptotically stable via the Routh‐Hurwitz criterion. We also studied the uniform persistence of the infection, demonstrating that the infection remains present above a positive threshold under certain conditions. The study also found a transcritical forward‐type bifurcation atℛ 0 = 1 }_0&amp;amp;#x0003D;1 $$ , indicating a critical threshold that affects the system's behavior. The model's temporal dynamics are studied using numerical simulations, and sensitivity analysis identifies the most significant variables by assessing the effects of parameter changes on system behavior.

Preferential Therapeutic Potential of Ficus carica Against Monosodium Glutamate and Metanil Yellow‐Evoked Hepato‐Renal Injury: In Vivo and In Silico Approaches

ABSTRACT Food preservatives can break food safety worldwide; herein, we studied the mitigating effect of Ficus carica (FC) on hepato‐renal injury resulting from monosodium glutamate (MSG) or metanil yellow (MY) as a common food preservative. Rats were assigned into five groups; Control, MSG (400 mg/kg), MY (200 mg/kg), FC+MSG (received FC plus MSG), and FC+MY group (received FC plus MY). The antioxidant properties of FC were evaluated. The results revealed the antioxidant potency of FC leave extract. MSG/MY evoked a hepato‐renal injury indicated by marked elevations in their biochemical functions. Besides, oxidative damage was also initiated represented by significant increases in MDA levels and decreases in GSH content and SOD activity accompanied by apoptotic cascade (increases in Bax/Bcl2 ratio and caspase3 expression). The molecular docking ascertained the interaction between MSG/MY and cellular antioxidants. However, FC was able to reduce the MSG/MY‐induced oxidative stress, apoptosis, and histopathological alterations as well as improve the liver and kidney functions. In the molecular docking model, the natural bioactive compounds of FC explored high affinities for binding with Bax and caspase‐3 abrogating the induced apoptosis. The antioxidant potential of FC mitigated the hepato‐renal damage in rats caused by MSG or MY.

Resveratrol Improves Unilateral Nephrectomy/Amikacin‐Induced Oxidative Injury in Rat Kidney Tissue

ABSTRACT Chronic kidney disease (CKD) is characterized by progressive loss of kidney function and irreversible structural changes. Both kidney donation and amikacin exhibit nephrotoxic effects; however, polyphenols like resveratrol are known for their nephroprotective properties due to antioxidant capabilities. This study investigates the protective effects of resveratrol in a renal injury model involving unilateral nephrectomy and amikacin in Wistar rats. Male Wistar rats ( n  = 25) were divided into following five groups: (1) vehicle control, (2) resveratrol control, (3) kidney damage (unilateral nephrectomy plus amikacin), (4) resveratrol post‐treatment, and (5) resveratrol pre‐treatment. Renal function was assessed through serum creatinine and urea measurements. Oxidative stress was evaluated via malondialdehyde (MDA) levels, while antioxidant status was determined through total antioxidant capacity (TAC). Tissue analysis employed H&E, PAS, and Van Giesons trichrome staining. Data analysis was conducted using ANOVA and Tukeys post‐hoc test for parametric data and the Kruskal–Wallis test with Dunns post‐hoc for non‐parametric data, with significance set at p  < 0.05. Resveratrol treatment significantly improved body weight, renal compensatory growth, and several biochemical parameters. These results indicate that resveratrol may represent a promising nutritional strategy for safeguarding kidney function and architecture in renal injury contexts.

Shielding Human Adipocytes From Inflammation: The Protective Potential of Polyphenol‐Rich Opuntia ficus‐indica Cladode Extract

ABSTRACT Opuntia ficus‐indica (OFI) has attracted much attention as a source of antioxidant and antiinflammatory compounds. We hypothesize that the antioxidant content of OFI cladode extract may improve adipocyte dysfunction resulting from inflammatory stimulation of hypertrophic adipocytes. To this end, the properties of OFI cladode hydroalcoholic extract were evaluated in terms of antioxidant activity, regulation of adipocyte inflammation, and adipocyte/monocyte interaction in human adipocytes rendered dysfunctional by the proinflammatory cytokine tumor necrosis factor‐α (TNF‐α). The major phenolic compounds identified were isorhamnetin derivatives and phenolic acids, including piscidic and eucomic acids. Our results show that OFI cladode extract exhibits antiradical activities and reduces the adhesion and transmigration activity of monocytes to inflamed adipocytes by inhibiting various cytokines, chemokines, and adhesion molecules such as interleukin (IL)‐6 and IL‐8 by ∼80%, monocyte chemotactic protein (MCP)‐1, C‐X‐C motif chemokine ligand (CXC‐L)10, macrophage colony‐stimulating factor (M‐CSF) from 40% to 50%, and intercellular adhesion molecule‐1 (ICAM‐1) by 70% at the higher concentration. In structurally and mechanistically by protein–ligand docking profiling study, piscidic acid proved to be the best potential candidate for a regulatory interaction with the activities of nuclear factor erythroid 2‐related factor 2 (NRF‐2) and nuclear factor‐κB (NF‐κB). In summary, these data highlight the potential of OFI as a dietary supplement in nutritional treatments aimed at combating the inflammatory stigmata of obesity.