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Vertebral Body Tethering (VBT) yields improving postoperative results. However, tether breakage remains a common complication, especially in thoracolumbar (TL) curves, and can negatively impact the outcome. The pathomechanism behind TL tether breakages is not well understood, yet this knowledge is essential for improving surgical planning. Therefore, the study aimed to investigate the timing and location of tether breakage in double-row (TL) revision cases. This study performed a descriptive analysis of consecutively explanted double-row implants in TL VBT patients who underwent revision due to tether breakage and for whom photographic documentation was available. A > 5° increase in the interscrew angle on consecutive radiographs suggested tether breakage. Data from 50 instrumented levels in ten patients were available. The UIV ranged from T9 to T11 and the LIV from L3 to L4. Revision surgery was performed, on average, 35 months after the index surgery. The study showed that the > 5° rule identified a higher percentage of segments with both tethers broken (68%) than segments with only one broken tether (54%). There was no difference in the occurrence of anterior (61%) and posterior (62%) tether breakage. The anterior tether broke in the distal segment in all ten cases, while the posterior tether broke in the distal segment in nine out of ten cases. This study showed that the distal segment of the lumbar spine is prone for tether breakage. Fewer breakages were observed in the thoracic segments. Additionally, no clear breakage pattern in relation to implant standing time was observed.

Venous thromboembolism (VTE) is a potentially life-threatening complication following orthopaedic surgery. While prophylaxis is well-established in joint arthroplasty, its role after Achilles tendon repair remains controversial. Despite being a soft-tissue procedure, prolonged postoperative immobilization increases VTE risk, with some studies reporting symptomatic rates as high as 7%. However, no prior studies have assessed whether pharmacologic VTE prophylaxis breaks-even in this population. A literature review and the TriNetX Research Network were used to identify symptomatic VTE rates within 30 days of primary Achilles tendon repair without pharmacologic prophylaxis. The cost of treating a symptomatic VTE was estimated from published data and adjusted to 2025 US dollars. Retail drug pricing was obtained from an online pharmacy database. A break-even analysis was conducted to determine the absolute risk reduction (ARR) and number needed to treat (NNT) required for aspirin (81 mg and 325 mg), warfarin (5 mg), enoxaparin (40 mg), and rivaroxaban (20 mg) to be cost-effective. A sub-analysis compared postoperative bleeding and transfusion rates in patients who received chemoprophylaxis versus those who did not. Among 8935 patients undergoing Achilles tendon repair without chemoprophylaxis, 47 developed a symptomatic VTE (0.526%). Aspirin and warfarin broke-even across all VTE rates, with NNTs ranging from 9217 to 10 547. Warfarin still broke-even when including international normalized ratio (INR) monitoring costs. Enoxaparin and rivaroxaban only broke-even at the highest VTE rate (7.2%), with NNTs of 131 and 390, respectively, and required higher VTE treatment costs to be justified. In this study, we found that aspirin 81 mg, aspirin 325 mg, and warfarin break-even for VTE chemoprophylaxis following Achilles tendon repair. Enoxaparin and rivaroxaban failed to break-even. Chemoprophylaxis decisions should be individualized, weighing patient risk and economic considerations.

SPINK5-syndromic epidermal differentiation disorder (also known as Netherton syndrome [NS]) is a severe chronic genetic disorder characterized by skin inflammation, severe atopy, and trichorrhexis invaginata (TI). Causative SPINK5 gene mutations result in defective serine protease inhibitor LEKTI, leading to unopposed serine protease activity and resulting in impaired skin barrier and type 2 inflammation. TI is the result of an intermittent keratinization defect of the hair cortex, a problem without specific treatment available to date. We diagnosed NS in a 67-year-old woman who had severe skin manifestations and a hair-growth defect since childhood. Scalp hair was sparse in the nuchal and temporoparietal regions. Trichoscopy of these areas showed numerous "bamboo" hairs that broke off during contact with the dermatoscope. We initiated treatment with dupilumab and optimized the topical therapy. At a 3-month follow-up, improvement of rash, pruritus, and quality of life was reported. Furthermore, the previously brittle short hair was replaced with longer hair and normal hair shafts in the previously affected areas. TI, as part of NS, has a variable presentation, biologics currently treating cutaneous inflammation, but little is known about their effects on hair biology. In this report, we show that dupilumab treatment not only proved efficient for control of skin inflammation and pruritus but was also associated with near-complete resolution of "bamboo" hair and promoted hair growth. Especially how alterations in the inflammatory response in NS can be linked to a structural defect have not been addressed in the current literature so far.

What is this summary about? This summary describes two studies in people with sickle cell disease, or SCD. Both studies looked at a medicine called voxelotor, also known as Oxbryta®, which was previously available for treating people with SCD. This is a summary of an article published in Blood Advances. What were the results of the studies? In the RETRO and PROSPECT studies, researchers looked at people with SCD taking voxelotor in everyday, real-world medical practice. In other words, they took voxelotor as part of their usual care when it was available for prescription in the United States. In RETRO, 216 participants were enrolled and the length of voxelotor treatment was about 1 year, on average. In PROSPECT, 265 participants were enrolled, and the length of voxelotor treatment was almost 3 years, on average. After taking voxelotor, participants had increases in hemoglobin, the protein in red blood cells that carries oxygen. Their red blood cells also broke apart less quickly when taking voxelotor. The most common symptom related to SCD was acute pain crisis, but participants did not experience it more often after starting voxelotor. What do the results mean? All medicines are tested in clinical trials before they are approved as treatments. However, it is always important to study a medicine in real-world medical practice as well. In RETRO and PROSPECT, the effects of voxelotor were like the effects seen in the clinical trials, and researchers did not see any unexpected symptoms related to SCD or unexpected side effects related to the study drug.

To address prominent problems such as repeated trips between departments, vertical movement across floors and repeated inquiries among outpatients, optimize medical treatment processes, and improve service efficiency and patient experience. Taking the East Campus of Quanzhou First Hospital in Fujian Province as the practice setting, this study constructed a four-dimensionally integrated one-stop outpatient service model covering space, function, personnel and system based on patient journey mapping, Patient healthcare management and service-dominant logic theory. Centering on patients' full-process medical experience, patient journey maps were drawn through semi-structured interviews, on-site process observations and satisfaction surveys to identify process breakpoints and service pain points. Spatial reconstruction, functional integration, personnel integration and system connectivity were implemented to establish an integrated medical service system featuring multi-department collaboration and multi-skilled positions. A pre-post self-controlled study was adopted to compare differences in outpatient process efficiency, patient experience and resource allocation before and after the intervention. The four-dimensionally integrated one-stop service model effectively broke down departmental barriers and significantly shortened patients' non-medical waiting time, with the average waiting time for comprehensive services reduced from 11.28 min to 7.56 min. Service continuity and convenience were notably improved, as outpatient satisfaction increased from 91.95 to 95.15 points, and the complaint rate dropped from 1.82 to 0.65 per 10,000 visits. Human resource allocation was optimized, with window staff reduced from 15 to 11, achieving staff reduction and efficiency improvement. The four-dimensionally integrated one-stop service model based on patient journey mapping can accurately match patient needs, significantly enhance outpatient service efficiency and medical experience, and provide replicable and scalable practical solutions for outpatient service reform in public hospitals. This model promotes the transformation of hospitals from function-centered to patient-centered care, effectively improves patient satisfaction and sense of gain, optimizes resource allocation, reduces operational costs and enhances hospital governance performance, which is consistent with the policy orientation of high-quality development of public hospitals in the new era (1).

This study examines a severe foehn event that occurred in winter on 19-20 February 2021 over the northern slope of the Middle Tianshan Mountains in Xinjiang, China, which produced extreme warming, gale-force winds, and heavy air pollution. By combining high-density surface observations, radiosonde data, microwave radiometer measurements, environmental monitoring records, reanalysis products, and WRF model simulations, we investigate the touchdown dynamics and the associated multi-phase environmental impacts. The main findings are as follows: (1) The foehn touchdown was not progressive but abrupt, triggered by intense mechanical turbulence from extreme vertical wind shear (150.1(m/s)/km between 850 and 890 hPa, with a Richardson number of 0.036). This shear broke through the low-level temperature inversion and drove a peak hourly warming of 20.9 °C. (2) WRF simulations reveal a distinct surface thermal structure during the mature stage, characterized by a warm core inside the canyon and cooler temperatures in the surrounding plains. Within the canyon, the convergence of southeasterly and northwesterly flows produced a micro-front, which was responsible for the pronounced local temperature fluctuations. (3) The foehn exhibited a phased dual effect on air quality. Before touchdown, the stable inversion layer trapped pollutants, allowing PM2.5 to build up to 224 µg/m³ at Urumqi Station. After touchdown, while strong winds enhanced particulate dispersion, the extreme warmth and intensified solar radiation concurrently accelerated photochemical ozone formation, with the maximum O₃-8 h reaching 158 µg/m³ at Miquan Station. This case study reveals the coupling among thermal, dynamic, and environmental effects during foehn events, providing a scientific basis for forecasting and combined pollution management over complex terrain.

The use of antibiotics is increasing and they enter water untreated. These antibiotics tendency to bioaccumulate and contribute to bacterial resistance. This study is designed to explore and optimize the potential of resistant bacteria for the treatment of norfloxacin (NOR) antibiotic spiked wastewater. The Alcaligenes faecalis ABR-14 was isolated from wastewater and sludge samples and was identified using 16S rRNA sequencing (Macrogen Inc. Geumchen-gu, South Korea). The 1515 bp was submitted in NCBI Genbank and the accession number of ‘PV364597.1’ was obtained. The results demonstrated that Alcaligenes faecalis ABR-14 efficiently broke down NOR reaching 96% degradation at 100 mg/L in 10 days under ideal circumstances such as 35 °C, pH 6.5, sodium acetate, NH4Cl and 105 CFU/mL. Two significate parameters (pH and Nitrogen (N) source), one less-significant parameter (inoculum density) and 3 non-significant parameters (antibiotic concentration, temperature and Carbon (C) source) based on Central Composite Design (CCD) and Response Surface Methodology (RSM) were revealed. The Hanes plot gives straight line, where R2 is 0.99, Vmax = 200.21, Km = 133.4. The plot between experimental and predicted values represent the best fit of the values based on straightness (R2 = 0.91). ANOVA for CCD present the p value below 0.05 which represents the significance and critically important factors. This study is among the first highlights the potential application of Alcaligenes faecalis ABR-14 for norfloxacin biodegradation. The generation of non-toxic metabolites makes this eco-friendly and sustainable. The abilities of such resistant microbes can be utilized in future to develop NOR contaminated wastewater treatment plant.

Phylogeographical patterns in North American freshwater fish are linked to the evolution of drainage configurations and have been shaped by the Pleistocene glaciations, especially throughout the Mississippi River drainage and eastern North America. This study investigated the recent phylogeographical history of Rhinichthys obtusus, Western Blacknose Dace, by integrating mitochondrial genomic DNA phylogenetics with geologic and paleoclimate data. This monophyletic species, recently determined to be genetically distinct from its sister species Rhinichthys atratulus, represents an important model to study the phylogeographic history of a North American stream fish in depth. Maximum-Likelihood and Bayesian analysis trees based on full consensus mitochondrial genomes resolved three major clades of R. obtusus: An Eastern Great Lakes clade, a Southeast clade, and an Upper Midwest clade. Our phylogenetic analyses suggested these three clades diverged 2-1.5 million years ago during the Pre-Illinoian glaciations, when the advancing ice sheet altered river systems and landscapes and broke up populations, constricting ancestral populations of R. obtusus to refugia in the Interior and Eastern Highland regions. Based on present and historical MaxEnt species distribution models as well as geologic evidence, recolonization into the Eastern Great Lakes and Upper Midwest regions may have primarily occurred from around 15 to 12 thousand years ago as glaciers retreated, habitat suitability increased, and river connections appeared. Our findings contribute to an understanding of the evolutionary history of Rhinichthys, and to a broader discussion of freshwater fish phylogeography in North America.

Polyvictimization, when children experience multiple forms of victimization, is a prevalent global health problem associated with multiple forms of negative developmental outcome. The paper argues that in conservative cultural contexts like that of Tunisia, school responsiveness to sexual harassment may be a critical indicator of a school's formal and informal interventions to protect children. Hence, in study 1 the paper develops and validates a measure of school social control of sexual harassment, and in study 2 tests the association between school-level social control of sexual harassment and child polyvictimization in schools. Study 2 also hypothesizes that school level social control of sexual harassment may weaken the link between polyvictimization at home and polyvictimization at school, and that individual secrecy about victimization exacerbates in-school polyvictimization. Examine a new measure of school social control of sexual harassment. Test for a relationship between school level social control of sexual harassment and in-school polyvictimization in a national sample of Tunisia. Test for an interaction between school-level social control of sexual harassment and polyvictimization at home. Test for individual and school-level relationships between victimization secrecy and in-school polyvictimization. The sample is a representative, stratified, random, four-stage probability proportional to size (PPS) cluster sample of 3098 preparatory and secondary students aged 12-18 in 40 schools, and 571 staff from the from the same 40 schools in Tunisia. Factor analysis and criterion validity are explored for the new social control of sexual harassment scale. The school staff sample was randomly divided into a training sample and a holdout sample. EFA and CFA models were run on the training sample; CFA was run on the holdout and full sample. Based on these analyses maximum likelihood factors were extracted from the CFA. Multilevel models are used to test the hypotheses, including relationships between dimensions of social control of sexual harassment and child polyvictimization in Tunisian schools. Survey weights are used to provide national prevalence estimates of school polyvictimization in Tunisia. Polyvictimization prevalence in Tunisian schools is high, with 63.8% of students reporting at least one victimization in school. The 8 item Social Control of Sexual Harassment Scale broke into two dimensions; one factor involving the school's local responses to sexual harassment and a second factor involving escalation and reporting to authorities responses. School-level local responses were associated with less in-school polyvictimization. Sensitivity analysis revealed that the main driver of the significant finding was staff reporting of sexual harassment to victims' parents. There was a positive interaction between reporting to parents and polyvictimization at home, indicating school reporting sexual harassment to parents appears to be more effective in protecting children who are not victimized at home. Individual secrecy about victimization was associated with more polyvictimization. Distance to school, attending an urban school, and attending a school with older staff were all risk factors for in-school polyvictimization. Female gender and attending a school with a higher percentage of female staff were protective factors. Social control of sexual harassment, particularly telling parents, may be at the forefront of protecting children from polyvictimization, both via direct intervention and signaling that violence against children will not be ignored. However, school responses appear to better protect children who are not victimized at home. Victimization secrecy is associated with more polyvictimization. Schools should work to improve local and reporting responses to all forms of polyvictimization, and help children to more readily disclose victimization.

Accurate disclosures from children are essential in child maltreatment investigations, yet many children are reluctant to disclose adverse experiences. Biologically sensitive children may experience stronger stress responses in morally or socially charged situations, potentially inhibiting disclosure. The present study examined whether stress, measured physiologically via autonomic nervous system (ANS) arousal and subjectively via self-reported stress, predicted children's disclosure of a transgression. Children (N = 337; ages 4-9 years) participated in a laboratory-based paradigm, during which two toys broke in their hands, and a confederate asked them to keep it a secret. Acute ANS arousal was indexed by heart rate during the minute following the secrecy instruction relative to baseline. Children also self-reported their stress and calmness at baseline and immediately post-transgression. Children were then interviewed using a NICHD-informed forensic-style interview protocol. Higher ANS arousal post-secrecy instruction predicted a lower likelihood of disclosure. In contrast, higher self-reported calmness post-transgression predicted a reduced likelihood of disclosure, while self-reported stress was unrelated. Age was positively associated with disclosure but did not moderate stress-disclosure associations. Findings highlight the value of assessing stress beyond self-report, with heightened ANS arousal capturing nondisclosure risk that children may strategically downplay or fail to recognize in self-reports.

This study compared the effects of static pressure (SP, 100/500 MPa) and dynamic pressure (DP, 10/50 MPa) treatments on the formation and properties of lotus seed starch-chlorogenic acid (LS-CA) non-inclusion (SP-NC-100, DP-NC-10) and inclusion (SP-IC-500, DP-IC-50) complex systems. SP broke the long chains of amylose, whereas DP preferentially sheared amylopectin, resulting in a higher inclusion rate for DP-IC-50 (26.01%) compared to SP-IC-500 (15.32%). All complexes reduced the system's viscoelasticity, with the inclusion complexes exhibiting a more pronounced suppressive effect due to the confined chain mobility within the helical cavities. Gel network stability analysis indicated that the non-inclusion complex primarily relied on hydrogen bonding, and its simulated binding energy (-4.983 kcal/mol) was significantly lower than that of the inclusion complex (-8.308 kcal/mol), which involved additional hydrophobic interactions. This study provided theoretical support for the design of starch-based polyphenol delivery systems at the levels of stress regulation and molecular interactions.

Many low- and middle-income countries are spending money on high-tech healthcare, such as simulation centres, pneumatic tube systems, and even robotic platforms. These upgrades are sold as a sign of modernisation and global parity. Yet, people in these places pay a lot out of pocket for basic care, and many end up broke from catastrophic healthcare costs. Notably, most of these technologies do not always deliver real patient-level benefits. They are often underused, incur substantial maintenance, and are usually installed in tertiary care hospitals, leaving the majority of the population behind. When governments spend a substantial amount on these advanced technologies, they have less left towards workforce expansion, creating allied jobs, or helping people actually afford care. Importantly, a significant portion of these investments goes underutilised, limiting their intended system-level impact. In the resource-constrained economies where every dollar counts, what matters more right now is setting the right priorities. Although the digital health and pursuit of high-quality healthcare remain essential, strategic emphasis on core services and investments that strengthen the workforce and generate employment opportunities is equally important for building resilient and sustainable health systems for all. It is not that advanced healthcare technologies are not of any value, but the adoption should be when patient-level value and system feasibility are demonstrated. Further frugal innovation plays a great role in the advancement of health technology and digital health implementation. Nevertheless, low cost does not necessarily mean low impact. Thus, in the absence of robust data on the patient-level long-term outcome benefits, its adoption should be context-sensitive and supported by good evidence on patient outcomes and survival, over and above safety. High-cost health technology investments should be assessed through the lens of cost-effectiveness. The present editorial argues a prioritisation framework balancing equity, evidence, and opportunity cost in the light of digital health, frugal technology adoption in place for high-cost health technologies where feasible, and employment generation.

Pressure ulcers present a serious clinical challenge due to their impaired healing processes and increased risk of infection, particularly for immobilized patients. This study aims to address the need for advanced wound dressings by developing a multifunctional polymeric hydrocolloid/film that blends zinc oxide (ZnO) nanoparticles, Cynodon dactylon extract, polyvinyl alcohol (PVA), and carboxymethyl chitosan (CMC). Composite hydrocolloids were fabricated via solvent casting and subsequently cross-linked with SA. We made four different formulations: pure CMC-PVA (H1), CMC-PVA/ZnO (H2), and CMC-PVA/C. dactylon (H3), and CMC-PVA/C. dactylon/ZnO (H4). The hydrocolloids were characterized using SEM, FTIR, and DLS, and their hemocompatibility, porosity, biodegradation, swelling, blood uptake, cell viability (MTT assay), potential anti-inflammatory-related effects based on protein denaturation inhibition, and in&#xa0;vitro release were all tested. The in&#xa0;vivo efficacy was assessed utilizing a Wistar rat model for pressure ulcers over a 14-day duration, incorporating histological examinations of the healed tissues. The H4 hydrocolloid had the best microstructure, was very porous (about 70%), broke down in a controlled way, and absorbed fluids very well. FTIR analysis confirmed that bioactive components were successfully added through hydrogen bonding and coordination interactions. The H4 formulation showed satisfactory hemocompatibility (<&#x2009;4% hemolysis), increased fibroblast growth (112% viability at 72&#x2009;h), and combined anti-inflammatory effects. The H4 hydrocolloid closed about 91% of the wounds in&#xa0;vivo, and it did a better job of epithelialization, collagen deposition, and reducing inflammation than the control groups. The CMC-PVA/C. dactylon/ZnO composite hydrocolloid demonstrates significant potential as a multifunctional wound dressing for the treatment of pressure ulcers, leveraging the synergistic effects of natural extracts and nanoparticles to promote expedited and structured tissue regeneration.

Hand dexterity assessments play a crucial role in informing the rehabilitative care of individuals with upper-limb hemiparesis. However, current assessments often struggle to evaluate the hand's ability to precisely control grip force, a skill vital for daily activities like handling fragile objects. Here we describe the design of the Electronic Grip Gauge (EGG), an adjustable-weight, instrumented "fragile" object that measures grip force, load force, acceleration, orientation, and relative position. Embedded sensors enable automatic segmentation and analysis of EGG transfers in various modes. In "Non-Fragile" mode, there is no break threshold; the EGG serves as an automated variant of the Box-and-Blocks test. In "Fragile" mode, the EGG simulates fragility by playing a "break" noise if grip force exceeds a set threshold, requiring grip control to prevent breaks. In "Fragile-Feedback" mode, audio-visual feedback is provided proportional to applied grip force to supplement potentially impaired tactile feedback. Demonstrating functionality, we evaluated sensorimotor differences between 26 hemiparetic and 26 age-matched healthy participants. In "Fragile" mode, paretic hands were significantly slower, applied excessive force, and broke the EGG more frequently than contralateral and healthy control hands. In "Fragile-Feedback" mode, a subset of paretic hands improved, transferring the EGG faster and/or with less force. This work demonstrates the EGG's utility in automatically quantifying sensorimotor deficits and that, for a subset of hemiparetic patients, audiovisual feedback could potentially coach and rehabilitate hand function. Collectively, this work showcases the EGG's potential as both an assessment and rehabilitation device for grip force control-a critical skill in hand therapy.