Background: Several interventions have been developed for carotid artery plaque-related ischemic stroke risk reduction; carotid endarterectomy (CEA) remained the gold standard. If longitudinal arteriotomy was used, patch angioplasty is recommended for closure. Different types of synthetic and autologous venous patches are in use for the purpose. The aim of this study was to compare the early and long-term outcome between autologous everted, hence double layer, external jugular vein (DL-EJVP), and Dacron patches (DPs). Methods: Retrospective cohort comparison design identified patients who underwent CEA between 2006 and 2023. Two cohorts were built based on patch type: DL-EJVP and DP closures were included. Primary closure, shortening with resection, or posterior plication, other types of patches, and eversion endarterectomies were excluded. Demographics, relevant conditions, shunt use, utilization of intraoperative imaging were collected. Short-and longterm outcome measures included need for re-exploration, postoperative ischemic event, nerve injury, wound problems, length of stay, perioperative death, significant restenosis, pseudoaneurysm development, recurrent ipsilateral ischemic stroke, need for reintervention, and long-term survival. Results: In total, 134 CEA (34 DL-EJVP, 100 DP) met inclusion criteria. The cohorts were comparable in demographics and CEA-relevant conditions. More DL-EJVP pt. was evaluated with intraoperative duplex ultrasound after patch closure (P = 0.19). The mean imaging follow-ups were similar (DL-EJVP: 51, DP: 60 months). There was no difference between the cohorts in the early outcomes, including hemispheric ischemic events. Early death, nerve injury, wound problems, length of stay, and late outcomes, including >50% restenosis, pseudoaneurysm formation, ipsilateral neurologic events, need for reoperation or intervention, and overall survival. Conclusion: Both DL-EJVP and DP closure of the longitudinal arteriotomy after CEA are durable solutions with similar complication profile. When surgeon's preference, cost reduction or other circumstances would require autologous vein material for CEA closure DL-EJVP can be safely considered.
This cross-sectional study examined the network structure and centrality of clinically meaningful psychopathology constructs across adolescence (14-17 years; N = 895), emerging adulthood (18-29 years; N = 717), and established adulthood (30-45 years; N = 381) in a Brazilian sample. Using the clinical scales of the Personality Assessment Inventory (PAI) and PAI-Adolescent (PAI-A), we applied exploratory graph analysis (EGA) and estimated centrality and bridge centrality metrics to identify communities and structurally connected constructs within each age group. Across all three age groups, EGA revealed a three-community structure partially consistent with dimensional models of psychopathology, identifying internalizing, externalizing, and severe dysregulation clusters. Borderline features were the most central across all networks and served as the dominant bridge in emerging and established adulthood groups, whereas somatic complaints played this role in the adolescent group. A notable difference across age groups was observed for mania, which clustered with the severe dysregulation community in adolescents but with the externalizing community in emerging and established adults. These findings highlight both similarities and cross-sectional age-related differences in the organization of broad psychopathology domains across age groups. The use of a large Brazilian sample contributes to addressing geographic inequities in mental health research.
The practice of individuals listing their pronouns in their email signatures, Zoom salutations, as well as social media and other profiles containing biographical information has gained popularity in the last several years. As this behavior has become more routine, the frequency of cisgender individuals using she/they or he/they rolling pronouns has also increased, particularly among the Gen Z cohort. This practice is often intended to signal acceptance and inclusivity regarding gender. However, research has yet to examine the implications of this social shift as well as whether the impact on gender expansive communities is as intended. Given the emergent nature of the phenomena, qualitative research is needed to understand the multifaceted perspectives from gender expansive voices on these social shifts. Our study participants consisted of 60 emerging adults between ages 18 and 29 who identified as Black, Indigenous People of Color (BIPOC); Two-Spirit, lesbian, gay, bisexual, trans, queer, and intersex+ (2SLGBTQI+); and were assigned female at birth. Participants' open-ended online survey question responses were examined using conventional qualitative content analysis. Emergent themes include affective opinions about the phenomena that range from positive (finding the behavior important and even necessary) to negative (considering it appropriative), emphases on individual intention behind pronoun use, and hypotheses about social implications. Our findings from the lived experiences of BIPOC gender expansive emerging adults provide novel insights and valuable recommendations for institutional and individual best practices around listing and use of pronouns, recognizing the importance of cultural humility and inclusivity in these evolving social shifts.
The examination of molecular markers confirms hidden diversity and reveals a new species within the Nyctixalus pictus (Peters, 1871) complex. Three genetically distinct clades were recovered: one from the Thai-Malay Peninsula; one from Sumatra, Indonesia; and one from Sarawak, Borneo, East Malaysia. Voucher specimens from each region were compared, and significantly different mean values were found through morphological analyses. The populations also differ significantly in morphospace, as determined by PCA, DAPC, and MFA analyses. The Thai-Malay Peninsula individuals have a distinct, rounded and slightly elongated snout shape compared to the other two clades. Based on these combined data, these three clades are recognized as distinct species. The name N. anodon is reinstated for those from Sumatra, Indonesia. The type locality of Sarawak, East Malaysia for N. pictus restricts the distribution of the species to Borneo. The type specimen of N. pictus was lost (pers. communication, G. Doria), and no lectotype or syntypes were described; thus, a specimen from Sarawak, Borneo, in the collection of the Field Museum of Natural History, Chicago (FMNH), is designated here as the neotype of N. pictus.
