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Military-civilian partnerships (MCPs) have served as a cornerstone of U.S. medical readiness. Active-duty surgeon case volumes have dramatically decreased over the last two decades, making these relationships more crucial than ever. A review of formal partnership agreements between Madigan Army Medical Center (MAMC) and regional civilian health systems from 2019 to 2024 to further characterize MCPs. Eighteen agreements were identified, comprising three administrative structures: Medical Training Agreements (MTAs, n = 14), External Resource Sharing Agreements (ERSAs, n = 3), and one National Defense Authorization Act (NDAA). These agreements supported ten disciplines, with general and trauma surgery most frequently represented. Separate GME MCPs provided complex surgical volume in 15 surgical specialties. MCPs in the South Puget Sound region form a comprehensive readiness network bridging military and civilian healthcare systems. Expansion of MCPs through improved interoperability, standardized evaluation, and additional partnerships remains essential for a resilient, dual-use healthcare infrastructure.

West Point aims to develop cadets into future leaders of character. With this end in mind, the academy exposes cadets to a demanding 47-month experience meant to challenge and develop their resilience. Empirical studies have demonstrated a link between spirituality and resilience, including in military populations, and Army doctrine acknowledges this connection. However, the mechanisms behind this link remain unclear, and no work to date has examined this relationship among members of a service academy population. Across two studies with West Point cadets (N = 187, N = 282), we sought to address these gaps. In particular, we examined the potential mediating role that emotional integration - taking an interested stance toward one's emotional experience - may play in the link between daily spiritual experiences as a connection with a higher power and resilience. Across both studies, statistically significant positive correlations were found among spirituality, emotional integration, and resilience. A cross-sectional statistical mediation model showed that emotional integration significantly partially mediated the relationship between spirituality and resilience. Overall, these findings suggest that daily spiritual experiences of a connection with a higher power were positively associated with resilience and that emotional integration statistically accounts for part of this association. Limitations of the study include the cross-sectional design, with future longitudinal and experimental work therefore being important. Implications for leader development programs and future directions are shared.

This study assessed organ and effective doses in routine diagnostic radiography by combining measured entrance surface air kerma (ESAK) values with Monte Carlo-derived conversion coefficients. A total of 50 adult patients who underwent chest, abdominal, skull, and pelvic x rays at the Federal Teaching Hospital Jos were included. ESAK values were measured using a calibrated solid-state detector, and corresponding organ and effective doses were calculated using conversion factors derived from PCXMC simulations and International Commission on Radiological Protection (ICRP) guidelines. Effective doses ranged from low values for chest PA projections to higher doses for pelvic examinations, all within internationally accepted diagnostic reference levels (DRLs). The findings emphasize that while doses remain within safe thresholds, ongoing optimization of exposure parameters and adherence to ALARA (as low as reasonably achievable) principles are necessary to balance diagnostic benefit with radiation detriment.

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To compare the clinical efficacy and perioperative outcomes of arthroscopy-assisted uniportal spinal surgery (AUSS) and unilateral biportal endoscopy (UBE) for the treatment of adjacent two-segment lumbar disc herniation (AT-LDH). In this retrospective cohort study, we analyzed the data of 59 patients with AT-LDH admitted to our department between January 2020 and May 2025. Of these, 33 patients underwent AUSS and 26 underwent UBE. The primary outcome measures were the visual analog scale (VAS) for low back and leg pain and Oswestry disability index (ODI). Secondary outcomes included operative time, number of intraoperative fluoroscopies, incision length, length of hospital stay, perioperative hemoglobin change, complications, facet joint preservation, and serum inflammatory markers. Both the AUSS and UBE groups exhibited significant postoperative improvements in VAS and ODI compared with baseline (p&#x2009;<&#x2009;0.05). No significant between-group differences in clinical efficacy were observed at any time point (p&#x2009;>&#x2009;0.05). The excellent-to-good rates were 87.9% for AUSS and 88.5% for UBE. No significant between-group differences in complication and facet joint preservation rates were found (AUSS: 6.1% vs. UBE: 7.7% and AUSS: 81.6% vs. UBE: 83.2%, respectively). However, the AUSS group showed shorter incision length and operative time, fewer fluoroscopic exposures, smaller postoperative hemoglobin decreases, and lower levels of inflammatory markers on postoperative day 3 (all p&#x2009;<&#x2009;0.05). Both AUSS and UBE provided satisfactory short-term clinical outcomes for AT-LDH. AUSS offers advantages of reduced invasiveness, greater surgical efficiency, and lower inflammatory response, supporting its broader clinical application.

Tumor cells rely heavily on vascular nutrient supply and glucose metabolism to sustain proliferation, while maintaining redox homeostasis through reprogrammed antioxidant systems, making it difficult for single starvation therapy or chemodynamic therapy (CDT) alone to achieve durable and effective antitumor efficacy. To address these limitations, we developed a cancer cell membrane (CMC)-coated core-shell biomimetic nanoplatform, termed ACuA@CMC, for synergistically enhanced dual-starvation therapy and CDT. The nanoplatform consisted of a gold nanoparticle (Au NPs) core and a Cu2O shell. The Au NPs exhibited glucose oxidase-like (GOx-like) activity, enabling continuous glucose depletion and in situ H2O2 generation within tumor cells, while the Cu2O shell further catalyzed H2O2 into highly reactive &#xb7;OH under the tumor microenvironment, thereby amplifying oxidative stress. Meanwhile, the loaded apatinib (Apa) inhibited tumor angiogenesis and nutrient supply, which synergized with Au NPs-mediated glucose consumption to establish a dual-starvation therapeutic strategy. In addition, CMC coating endowed ACuA@CMC with favorable homologous targeting ability and enhanced cellular uptake efficiency. Experimental results demonstrated that ACuA@CMC possessed favorable physicochemical properties, stability, and hemocompatibility. Moreover, ACuA@CMC significantly enhanced the uptake of nanodrugs by A549 cells, effectively inhibited cell viability, induced apoptosis, elevated intracellular ROS levels, and triggered oxidative stress. Furthermore, the nanoplatform markedly suppressed tumor cell migration and downregulated VEGF expression, exhibiting synergistic anti-migration and anti-angiogenic effects. In summary, this study proposes a synergistic therapeutic strategy for lung cancer based on dual-starvation therapy and cascade CDT-mediated ROS amplification. This work provides a new approach for the development of multifunctional synergistic antitumor nanotherapeutic systems with potential clinical translational value.

Neutrophil extracellular traps (NETs) form a spatiotemporally heterogeneous defensive architecture within the tumor microenvironment (TME), representing a newly identified multi-dimensional biological barrier system. Particularly in hepatocellular carcinoma (HCC), this system drives the heterogeneous evolution of the TME through the integration of mechanical stress transduction (YAP/TAZ activation) and protease-mediated signaling network remodeling (reconfiguration of intercellular signaling via proteolytic enzymes like MMP9, e.g. the MMP9/TGF-&#x3b2; axis). The NET-driven heterogeneous evolution of the HCC TME is characterized by region-specific epithelial-mesenchymal transition (EMT) progression, metabolic reprogramming of tumor cells, and the formation of immunosuppressive niches within the TME. These changes collectively reshape the TME's biological properties, alter the energy landscape of tumor cells (a framework describing dynamic metabolic/functional states of tumor cells shaped by microenvironmental cues), and maintain their stem cell properties, ultimately contributing to therapeutic heterogeneity and cross-regional drug resistance. Existing targeted therapeutic strategies against NETs in HCC and their clinical translational potential are analyzed herein. This review systematically synthesizes the spatiotemporal heterogeneity of NETs in the HCC microenvironment and their functional roles, providing new insights into HCC treatment.

Minimally invasive surgery has transformed colon cancer care, with robotic colectomy emerging as a safe evolution of laparoscopy. This article reviews epidemiology, staging, multimodality therapy, and Level 1 evidence comparing robotic, laparoscopic, and open colectomy. Technical details for right, left, sigmoid, and total colectomies are outlined, emphasizing port placement, key landmarks, and intracorporeal anastomosis. Robotic surgery achieves equivalent oncologic outcomes with lower conversion and faster recovery, though with longer operative times and higher costs. Its role continues to expand with enhanced recovery and fluorescence imaging.

This study aimed to assess the diagnostic value of 18F-FDG PET/CT radiomics in distinguishing adenocarcinoma from inflammatory lesions in pulmonary solitary solid nodules (solid pulmonary nodules). A total of 222 patients with Solid pulmonary nodules were retrospectively analyzed and randomly divided into two groups: a training set (n&#xa0;=&#xa0;155) and a validation set (n&#xa0;=&#xa0;67). Radiomic features were extracted from positron emission tomography/computed tomography (PET/CT) images, and optimal features were selected from the training set. Three model groups were created (CT, PET, and PET+CT) using six machine learning classifiers: Support Vector Machine (SVM), Random Forest (RF), Stochastic Gradient Descent (SGD), K-Nearest Neighbors (KNN), Extreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM). The performance of the models was evaluated using the area under the receiver operating characteristic curve (ROC). A total of eleven, nine, and fourteen optimal features were identified for the CT, PET, and PET+CT groups, respectively. In the validation set, the Area Under the Curve (AUC) values for the CT models ranged from 0.731 to 0.831, for the PET models from 0.746 to 0.810, and for the PET+CT models from 0.800 to 0.847. Among these, the PET+CT model developed using the Random Forest (RF) classifier demonstrated the best diagnostic performance, with an AUC of 0.847, sensitivity of 0.804, and specificity of 0.821. Decision curve analysis (DCA) confirmed that the model has favorable clinical utility, while calibration curves showed a good agreement between predicted and observed outcomes. The PET+CT radiomics models outperformed the single-modality models in distinguishing Solid pulmonary nodules adenocarcinoma from inflammatory lesions. Overall, the RF-based PET+CT model achieved the highest diagnostic efficacy and indicates promising potential for clinical application.

Menke-Hennekam syndrome (MKHK) is a rare autosomal dominant disorder caused by mutations in the CREBBP and EP300 genes. The absence of established diagnostic criteria and non-specific clinical manifestations complicate timely diagnosis and management. This report presents a case of MKHK in which early diagnosis and intervention were achieved through the application of rapid whole-genome sequencing (rWGS), a tool that offers superior speed and genomic coverage compared to whole-exome sequencing (WES). This case report describes a male Han Chinese neonate who presented at birth (0&#xa0;days) with intrauterine growth restriction, respiratory distress, and feeding difficulties. During follow-up, he developed hearing loss and demonstrated global developmental delay. Clinical examination revealed craniofacial dysmorphism. Trio rWGS was performed in the neonatal period, with results returned within 72&#xa0;h of sample submission at 23&#xa0;days of age. Trio rWGS identified a de novo missense variant in the CREBBP gene (c.5570A&#x2009;>&#x2009;C, p.His1857Pro). Sanger sequencing confirmed its absence in both parents, and the variant was classified as likely pathogenic despite no prior documented cases. Based on integrated genetic and clinical findings, a neonatal diagnosis of MKHK-ID4 was established. Following this diagnosis, early targeted interventions were initiated, including hearing aid fitting, enrollment in a comprehensive rehabilitation program, and planning for necessary surgical corrections. Significant developmental improvement was observed at the 15-month follow-up assessment. In this case, rWGS facilitated a neonatal diagnosis of MKHK-ID4 and enabled early multidisciplinary intervention during a critical neurodevelopmental window. This experience suggests that such an approach may contribute to improved developmental outcomes in this rare disorder, though further studies are required to confirm its broader applicability and long-term benefits.

Although the neuroprotective potential of remote ischemic postconditioning (RIPC) has been reported, the efficacy and safety of ultra-early RIPC administered after endovascular treatment (EVT) in patients with acute ischemic stroke remain unclear. This study evaluated the efficacy and safety of ultra-early RIPC in patients with acute ischemic stroke undergoing EVT. The EnTRIPS trial (Endovascular Treatment Combined with Remote Ischemic Postconditioning in Patients with Acute Ischemic Stroke) was a multicenter, randomized, controlled, outcome assessor-blinded, prospective clinical trial. The trial was conducted at 8 hospitals in China between April 12, 2021, and March 26, 2025. Eligible patients were adults with acute ischemic stroke due to large vessel occlusion who presented within 24 hours of symptom onset, underwent EVT, and achieved successful recanalization. A total of 270 eligible patients were randomized within 6 hours after EVT to receive either RIPC plus guideline-based therapy (n=135) or guideline-based therapy alone (n=135). RIPC was administered for 7 days using pneumatic devices consisting of 5 cycles of bilateral upper-arm cuff inflation (5 minutes at 180 mm&#x2009;Hg) followed by deflation (3 minutes). The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale score of 0 to 2 (range, 0 [no symptoms] to 6 [death]). Safety outcomes included the incidence of RIPC-related adverse events within 7 days. Among 270 randomized patients, a total of 268 (99.3%) participants completed the trial, including 133 in the RIPC group and 135 in the control group (mean [SD] age, 65.5 [16.8] years; 171 [63.8%] men). At 90 days, functional independence was achieved in 81 (60.9%) patients in the RIPC group and 78 (57.8%) patients in the control group (adjusted risk ratio, 1.07 [95% CI, 0.89-1.30]; P=0.46). RIPC-related adverse events occurred in 10 of 133 (7.5%) patients, and no intervention-related adverse events occurred in the control group. Ultra-early RIPC is safe for patients with acute ischemic stroke treated with EVT, but it does not significantly improve the 90-day functional outcomes. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04581759.

Assessing the severity of diabetic foot ulcers (DFU) is critical for prognosis and treatment. While the Wagner classification is widely used, it lacks systemic inflammatory and nutritional assessment. Composite markers like the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and C-reactive protein-to-albumin ratio (CAR) may fill this gap. Furthermore, regional data on pathogen distribution in China are essential for guiding antibiotic therapy. To investigate the correlation of MHR and CAR with Wagner grades in Chinese DFU patients, identify independent predictors for severity, and analyze pathogen distribution and drug resistance patterns across different grades. A retrospective analysis was conducted on 136 DFU patients hospitalized from January 2022 to May 2024. Patients were categorized into three groups based on Wagner grades: Grade 1-2 (n=17), Grade 3 (n=42), and Grade 4-5 (n=77). Clinical data, MHR, and CAR were analyzed. Spearman correlation and ordinal logistic regression determined associations with severity. Receiver operating characteristic (ROC) curves evaluated the predictive value of MHR and CAR for severe infection (Wagner 4-5). Pathogen profiles were analyzed per group. MHR (r=0.451, P<0.001) and CAR (r=0.521, P<0.001) were significantly and positively correlated with Wagner grades. Logistic regression identified serum albumin (OR=0.88, 95% CI: 0.82-0.95, P=0.002) and HDL-C (OR=0.11, 95% CI: 0.02-0.68, P=0.017) as independent protective factors against higher Wagner grades. For predicting severe infection, the optimal cut-off values were 0.775 for MHR (AUC=0.760) and 2.04 for CAR (AUC=0.777). Among 183 isolated strains, Staphylococcus aureus (24.59%) was predominant. Notably, as Wagner grades increased, the prevalence of Gram-negative bacteria (e.g. Escherichia coli, Pseudomonas aeruginosa) and mixed infections rose significantly (P<0.01). MHR and CAR are valuable biological markers for assessing DFU severity in the Chinese population. Albumin and HDL-C serve as independent protective factors. The study reveals a grade-dependent shift in pathogen spectra toward Gram-negative bacteria and mixed infections, providing region-specific evidence for optimizing empirical antibiotic strategies.

This is a multicenter, randomized, double-blind, placebo-controlled interventional clinical study to evaluate the efficacy and safety of pronase in improving visibility in colonoscopy and to evaluate whether pronase can increase the detection rate of intestinal lesions and the colonoscopist's satisfaction. From June 2023 to December 2023, a total of 1942 patients undergoing air insufflation colonoscopy in 10 hospitals (The First Medical Center, Chinese PLA General Hospital, et al) were selected as the study subjects. They were randomly divided into two groups: (1) the experimental group (n = 969) was given pronase for flushing in colonoscopy; and (2) the control group (n = 973) was given physiological saline for flushing in colonoscopy. The improvement of the visibility at the target site (region of interest) in colonoscopy was evaluated in two groups to verify the efficacy of pronase in improving visibility in colonoscopy. The safety of pronase for flushing in colonoscopy was evaluated by comparing the incidence of adverse events between the two groups. After the use of pronase in colonoscopy, the patient's vital signs remained stable, without serious adverse reactions. The improvement rate of visibility in the pronase group was significantly higher than that in the physiological saline group (97.21% [942/969] vs. 86.74% [844/973], P <0.0001), and the subgroup analysis (Boston Bowel Preparation Scale &#x2265;6 points) showed similar results to the overall ones. The physician's satisfaction score in the pronase group was significantly increased. There was no significant statistical difference in the detection rates of adenoma, colorectal cancer, minimal lesions, non-polypoid colorectal lesions, polyps, and precancerous lesions between the two groups. Pronase can improve the visibility in colonoscopy and help physicians observe the lesions better. Pronase demonstrates good safety in colonoscopy, with no significant difference compared to physiological saline.

Emergency airway management (EAM) is a core competency in emergency medicine (EM), yet no standardized national curriculum exists for EM residency training. The Accreditation Council for Graduate Medical Education (ACGME) currently mandates only 35 endotracheal intubations (ETIs) for graduation, which represents a narrow component of EAM. We sought to define a comprehensive, consensus-based list of EAM competencies for all graduating EM residents. We conducted a modified Delphi study to identify essential EAM competencies. An initial list of topics was developed through a structured PubMed literature search, review of existing educational frameworks, and input from EM airway educators. Thirteen national experts in emergency airway management and education participated in iterative rounds of electronic surveys to rate and refine proposed competencies. Topics achieving >&#x2009;80% agreement were included in the final list. Descriptive statistics were used to summarize agreement across rounds. The first-round survey included 215 proposed topics spanning nine domains: principles of airway management, oxygen delivery, basic airway management, tracheal intubation, pharmacology, pediatric airway management, ventilator management, special clinical circumstances, and education. Consensus was achieved after two Delphi rounds and final included topics were narrowed to 148. Through a modified Delphi process, we developed a comprehensive, expert-derived list of EAM competencies for EM residency graduates. This framework provides a foundation for standardized, competency-based airway education and assessment in emergency medicine and may reduce variability across residency programs nationally and thus ensure preparedness for independent practice in one of the most critical skill domains in our discipline.

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To investigate the mediating roles of personal electronic health record usage and health literacy in the relationship between patient-centred communication and chronic diseases. The study was conducted at Chongqing, China from September 2024 to December 2024, and used secondary data from the Health Information National Trends Survey related to adults aged 18 and above. Guided by the conceptual framework from patient-centred communication pathway models, the sequential mediating roles of behavioural and cognitive factors in the relationship between PCC and chronic disease were examined. Data was analysed using SPSS 27. A negative association was found between the individual's patient-centred communication scale and chronic diseases (p<0.001). Furthermore, patient-centred communication was negatively associated with chronic diseases through the serial mediation of personal electronic health record usage and health literacy (bp=-0.001, 95% confidence interval: - 0.002--0.0004). Both personal electronic health record usage and health literacy sequentially mediated the relationship between patient-centred communication and chronic disease, highlighting the importance of these factors in enhancing health outcomes.

Extreme cold environments impose unique constraints on the delivery of image-guided and interventional care due to hypothermia-associated coagulopathy, altered drug metabolism, impaired operator performance, and temperature-sensitive imaging and device systems. These challenges are particularly relevant to military operations in polar and austere settings, where evacuation may be delayed, and medical capability must be delivered with limited infrastructure. This work presents an operationally focused review of the physiologic effects of cold exposure, imaging system limitations, and device performance considerations relevant to image-guided and interventional care. Available evidence regarding portable imaging platforms, material behavior at low temperatures, and procedural feasibility in cold environments was synthesized to assess realistic capability sets for austere and expeditionary settings. Portable ultrasound emerged as the most reliable imaging modality for diagnosis and procedural guidance in low-temperature environments. Cold exposure was associated with stiffening of medical polymers, increased glove failure, and accelerated battery degradation, emphasizing the need for insulated storage, device warming strategies, and adapted workflows. Frostbite represents the clearest clinical scenario in which angiography and catheter-directed therapy may influence outcomes, particularly when evacuation or surgical intervention is delayed. Hypothermia-associated coagulopathy, altered sedation pharmacokinetics, and operator performance degradation together create a compounded procedural risk environment. Operational frameworks for image-guided and interventional care in extreme cold must integrate shelter capability, power management, telemedicine support, and training that accounts for cold-related cognitive and motor impairment. Although significant gaps remain in interventional radiology-specific device testing, sedation pharmacology, and workflow optimization, existing evidence supports a focused, capability-based approach to expanding image-guided and minimally invasive care in extreme cold environments relevant to future military operations.

Radiation resistance poses a significant challenge in clinical cancer therapy. Ferroptosis, an iron-dependent form of cell death, plays an important role in the efficacy of radiotherapy. However, cancer cells often activate defense systems to survive this process. Moreover, interventions targeting only a single defense pathway often yield limited effects. To overcome radioresistance, we have developed a reactive oxygen species (ROS)-responsive nanosystem named PRBP. This system employs a siderophore-based framework PCN(Fe) as the core, loaded with two specific drugs: RAS-selective lethal compound 3 (RSL3) to block the glutathione peroxidase 4 (GPX4) pathway, and brequinar (BQR) to inhibit the dihydroorotate dehydrogenase (DHODH) pathway. The surface is coated with a diselenide bond-linked polyethylene glycol (PEG-Se-Se-PEG) layer that dissociates in a ROS-rich environment. Upon X-ray irradiation, the system rapidly degrades and releases the drugs, while iron ions trigger the Fenton reaction. RSL3 and BQR synergistically suppress the ferroptosis defense system, inducing a potent "ferroptosis storm." Through in vitro and in vivo experiments, we systematically evaluated the physical properties, magnetic resonance imaging (MRI) capability, and therapeutic efficacy of this platform. PRBP exhibits a uniform morphology and undergoes responsive degradation under X-ray irradiation, releasing Fe2+ to catalyze the Fenton reaction, leading to DNA damage and glutathione (GSH) depletion. Meanwhile, RSL3 and BQR inhibit the GPX4 and DHODH pathways, respectively, blocking multiple ferroptosis defense targets and thereby inducing robust ferroptosis. PRBP demonstrates favorable T1-weighted magnetic resonance imaging performance, significantly inhibits tumor cell proliferation in vitro, effectively suppresses 4T1 tumor growth in vivo, and exhibits good biosafety. PRBP induces ferroptosis through multiple targets, providing a potent strategy to overcome radiotherapy resistance.

Dopamine (DA) is a key neurotransmitter that regulates neuropsychological behaviors, including movement, emotion, motivation, and cognition. Dysregulation of dopaminergic signaling is linked to psychiatric and neurodegenerative disorders, including Parkinson's disease, depression, and schizophrenia. The dopamine transporter (DAT) controls DA levels by facilitating its reuptake from the synaptic cleft, terminating dopaminergic signaling. Here, we report structures of full-length human DAT (hDAT) in its apo state and in complexes with substrates and antidepressant compounds. The antidepressant compounds bupropion and vanoxerine bind to the central site of hDAT and inhibit substrate transport. Integration of structural analysis with functional assays and molecular dynamics simulations further suggests a role for potassium ions in regulating hDAT conformational transitions. Our findings reveal the molecular mechanisms governing DA reuptake and the specific ways in which hDAT interacts with antidepressant compounds. These insights provide a structural basis for the design of therapeutic agents targeting hDAT.