The head-up tilt test (HUTT) is a primary diagnostic method for vasovagal syncope (VVS) in pediatric patients, yet conventional protocols are lengthy and may impose a substantial procedural burden on children and adolescents. Accordingly, this study aimed to characterize phase-specific time-to-positivity patterns and to identify candidate shortened protocol of each HUTT phase for future prospective validation. Between November 2023 and March 2025, 511 pediatric patients underwent HUTT. After excluding non-VVS cases and incomplete tests, 345 patients were included. Data on the baseline head-up tilt phase (BHUT) initiation to first positive response were collected. Temporal changes in diagnostic yield were analyzed using Kaplan–Meier analysis and tracking new positive cases in 5-min intervals. Bootstrap resampling was used to assess the internal stability of phase-specific thresholds and projected retention estimates. A total of 345 patients (aged 11.5 ± 2.5 years; 39.4
Autonomic dysfunction has been reported in myasthenia gravis (MG); however, its clinical relevance and relationship with sexual dysfunction (SD) remain unclear. This study aimed to evaluate autonomic dysfunction in MG and to investigate its association with SD using objective autonomic tests. A total of 44 patients with MG and 50 age- and sex-matched healthy controls (HCs) were included. Autonomic function was assessed with the Composite Autonomic Symptom Score-31 (COMPASS-31), sympathetic skin response (SSR), and R–R interval variability (RRIV). Ocular autonomic involvement was evaluated using the Schirmer test, noninvasive tear break-up time, pupillometry, and corneal confocal microscopy. Sexual function was assessed using the Female Sexual Function Index, International Index of Erectile Function, and Premature Ejaculation Profile. Depression and anxiety were evaluated with the Beck Inventories. Patients with MG showed prolonged SSR latencies, reduced amplitudes, and lower RRIV than HCs (p < 0.05). COMPASS-31 total scores were higher, especially in vasomotor, secretomotor, gastrointestinal, and bladder domains. Corneal nerve fiber density, length, and branching were significantly reduced in patients with MG (p < 0.05). SD scores were significantly worse and correlated with selected autonomic measures. After adjustment for age, depression, and anxiety, reduced corneal nerve fiber parameters were independently associated with SD. In male patients, RRIV during hyperventilation and gastrointestinal autonomic symptom burden were associated with ejaculatory function. Patients with MG exhibit evidence of autonomic dysfunction based on objective autonomic assessments. SD is common in patients with MG and appears to be associated with autonomic dysfunction beyond psychosocial factors alone.
The association between insular involvement identified on brain imaging and atrial fibrillation first detected after ischemic stroke remains uncertain. We evaluated this association and summarized prespecified neurocardiac outcomes. Seven databases were searched through April 5, 2026; six were searched from inception, and Wanfang Data was searched from January 2000. Eligible studies enrolled adults with ischemic stroke, assessed insular involvement on brain imaging, and reported atrial fibrillation or another prespecified neurocardiac outcome. Atrial fibrillation first detected after stroke was defined as atrial fibrillation identified after the index stroke in patients without previously known atrial fibrillation. Random-effects meta-analysis was performed when at least three studies were sufficiently comparable. Thirty-one studies were included; only three provided comparable adjusted estimates for the primary meta-analysis, totaling 2164 participants. Insular involvement was associated with higher odds of atrial fibrillation first detected after stroke (odds ratio 3.35, 95
