Pancreatic ductal adenocarcinoma (PDAC) grows within a highly fibrotic, pressurized microenvironment that collapses vasculature and restricts delivery of oxygen and circulating nutrients. To survive this metabolic stress, PDAC cells activate lysosome-centered nutrient acquisition and recycling programs, including macroautophagy, RAS-driven macropinocytosis, and receptor-mediated endocytosis, that traffic intracellular and extracellular cargo to lysosomes for degradation and metabolite export. These pathways are reinforced by oncogenic signaling and MiT/TFE-dependent lysosomal biogenesis, and they support core outputs of tumor metabolism such as iron bioavailability, amino acid and nucleotide pools, lipid homeostasis, and immune evasion. Lysosomal programs in nonmalignant compartments (fibroblasts, stellate cells, and immune cells) further shape nutrient exchange, matrix production, and whole-body metabolism, positioning the lysosome as a key node at the tumor-host interface. Although genetic and pharmacologic blockade of autophagy/lysosome function can produce potent antitumor effects in preclinical models, clinical trials with lysosomotropic agents have shown limited benefit, highlighting challenges in target engagement, biomarkers, and rational combination strategies. Here we review current tools and concepts for interrogating lysosomal flux in PDAC, integrate emerging insights from systemic metabolism and dietary interventions, and outline therapeutic opportunities for more effectively exploiting lysosome dependence in pancreatic cancer.
Toxic shock syndrome (TSS) caused by group A Streptococcus is uncommon but associated with high mortality. In this case report, a 17-year-old girl with influenza A presented with a rash, hypotension, parapneumonic effusion and multiorgan failure. Group A streptococci were identified in the pleural fluid. This case highlights the importance of early recognition of TSS, since treatment with clindamycin and immunoglobulin may improve the prognosis. As rates of meningococcal disease have decreased, TSS likely causes an increasing proportion of cases of septic shock among children in Denmark.
Clostridium perfringens (C. perfringens) spores pose a persistent food safety risk owing to their high resistance, yet the mechanisms governing their germination and outgrowth remain poorly understood. This study utilized ε-polylysine (ε-PL) as a model antimicrobial to systematically investigate its inhibitory effects and underlying mechanisms during the spore-to-vegetative cell transition. The results indicate that ε-PL had the least effect on early germination events; over 60 min, no significant differences were observed between the treatment and control groups in terms of OD₆₀₀ reduction or DPA release. In contrast, ε-PL significantly prolonged the lag phase and inhibited growth rates during the growth phase, suggesting a phase-dependent inhibitory effect. Mechanistic analyses revealed that the spore coat and cortex act as critical physical barriers during early germination, limiting antimicrobial access. As these outer layers progressively degraded, the inner membrane (IM) became exposed as the primary target. ε-PL disrupted IM lipid organization, significantly decreasing membrane order (GP value declined from 0.56 to 0.42), inducing membrane depolarization, and increasing permeability. These impairments led to intracellular protein leakage, ATP depletion, inhibition of Na+/K+-ATPase activity, and abnormal accumulation of pyruvate (0.3 g/L). Furthermore, excessive generation of reactive oxygen species (ROS) and DNA interference collectively signaled a collapse of energy metabolism and cellular integrity. The efficacy of ε-PL was validated in a ham sausage model, where microbial proliferation was significantly delayed. This study provides critical mechanistic insights into spore control and supports the application of ε-PL in food preservation.
To compare lower limb biomechanics during single-leg drop landings between individuals with low (2-4/year) and high (≥5/year) chronic ankle instability (CAI) recurrence frequencies. Cross-sectional study. Biomechanics laboratory. Sixty males with unilateral CAI, stratified into High-CAI (n = 30) and Low-CAI (n = 30) groups. Peak vertical ground reaction force (vGRF), time to peak vGRF, vertical loading rate (LR), leg stiffness, and lower extremity kinematics. High-CAI participants demonstrated greater peak vGRF, shorter time to peak vGRF, higher LR, and greater hip flexion, hip abduction, and ankle inversion at initial contact than the Low-CAI group (all p ≤ 0.048; ηp2 = 0.066-0.275). Group × side interactions occurred for knee flexion, ankle inversion, and LR (p = 0.005-0.033; ηp2 = 0.076-0.128). Simple-effects analyses showed the unstable side of the Low-CAI group exhibited less knee flexion than its stable side, whereas the unstable side of the High-CAI group exhibited greater ankle inversion and LR than both the unstable side of the Low-CAI group and its stable side (all p ≤ 0.040; d = 0.350-1.221). High-frequency CAI recurrence (≥5 times/year) induces a maladaptive landing strategy with altered proximal compensations and impaired shock absorption. Frequency-based stratification is essential for optimizing management.
Acute kidney injury (AKI) is common in patients treated with microaxial flow pumps (mAFP). Plasma-free haemoglobin (PFHb) due to haemolysis is known to increase kidney injury in a dose-dependent manner. Therefore, we aimed to identify the association between flow pump level, cumulative PFHb exposure, and AKI. In this retrospective observational study, we analysed consecutive patients aged ≥18 years with cardiogenic shock who underwent mAFP between December 2019 and March 2025 at Saiseikai Kumamoto Hospital, Japan. The primary outcome was AKI. A total of 160 patients were analysed separately: mAFP alone (n = 49) and veno-arterial extracorporeal membrane oxygenation (V-A ECMO) plus mAFP (n = 111). Among patients treated with mAFP alone, higher mAFP pump levels were significantly associated with higher PFHb levels (Adjusted P for spline <0.001). Higher cumulative PFHb exposure was significantly associated with an increased risk of AKI in the mAFP-alone subgroup (adjusted P for spline = 0.03). In contrast, these associations were not observed in patients treated with V-A ECMO plus mAFP. Multivariable analysis demonstrated that a high flow pump level ≥ P8 for 24 h or longer (adjusted RR 3.31; 95% CI 1.67-6.58; P < 0.001), as well as higher peak PFHb, longer duration of mAFP support, higher serum creatinine levels at mAFP initiation, and more severe shock status were significantly associated with an increased risk of AKI occurrence. Higher mAFP levels are significantly associated with higher PFHb levels, which may increase the risk of AKI in patients treated with mAFP alone. Keywords: microaxial flow pump, cardiogenic shock, acute kidney injury, plasma-free haemoglobin.
Adjunctive therapies targeting pathologic vasodilation in septic shock are increasingly used when standard vasoactive strategies fail. Although methylene blue (MB) and high-dose hydroxocobalamin (HC) have shown potential hemodynamic benefits, comparative data in sepsis are lacking. We compared outcomes among septic patients treated with MB or HC using a large multicenter electronic health record network. We conducted a retrospective cohort study using the TriNetX US network (65 health systems). Adults hospitalized with sepsis, severe sepsis, or septic shock from 2016 to 2025 who received MB or HC were included. Patients with nitroprusside exposure, methemoglobinemia, cardiogenic shock, or neither therapy were excluded. Propensity score matching (1:1) balanced 91 covariates. A total of 732 matched patients were analyzed (366 MB, 366 HC). Mortality and acute kidney injury rates were similar between groups. HC was associated with higher continuous renal replacement therapy initiation at 3-7 days and 7 days after treatment (both P < 0.001). Stroke and prolonged vasopressor use were more frequent with HC during days 3-7 but not by day 7. Other secondary outcomes were comparable. MB and HC demonstrated similar early mortality, but MB was associated with lower continuous renal replacement therapy use and fewer early strokes and prolonged vasopressor requirements. These findings suggest MB may be the more favorable adjunctive therapy, although prospective comparative studies are needed to confirm these observational results.
This poem captures the transformative journey of pregnancy, from the initial shock of discovery on an ordinary day to a profound shift in identity. It celebrates the simultaneous birth of a child and a mother, honoring the courage required to navigate the wait through doubt and hope.
Amid the ongoing opioid crisis, U.S. health systems have extended prescription monitoring interfaces with proprietary reports that provide clinicians with algorithmic risk scores to guide opioid decisions. However, little is known about how such tools shape clinical encounters, professional authority and accountability in everyday care. This article examines the case of NarxCare, a widely adopted risk-scoring system, through a multi-sited ethnographic study combining clinician interviews, interface walkthroughs, documentary analysis and clinic observation. We find that NarxCare operates through multiple opacities, presenting scores as authoritative yet unexaminable. It produces an amalgamated risk by collapsing diverse concerns-overdose, liability and societal harm-into a single number. Through its logic of contagion, physicians themselves become risk subjects, their reputations and careers tethered to the scores of patients they treat. These dynamics illustrate how this algorithmic automation recasts prescribers as governable agents of the opioid crisis; however, by unsettling established epistemic cultures of safety, it fails to completely enrol them as actuarial enforcers. In practice, clinicians respond by refusing, anticipating, or domesticating the scores, but cannot evade them fully. NarxCare thus reconfigures rather than resolves opioid risk, a dynamic with significant implications as algorithmic infrastructures expand across healthcare and scoring enters new domains.
Tethered cord syndrome (TCS) is a neurodevelopmental disorder associated with neural tube defects (NTD), yet its genetic underpinnings remain poorly characterized. To elucidate its molecular basis, we conducted whole-exome sequencing (WES) on 81 TCS patients. Our analysis revealed that MNX1 variants, including two microdeletions and a deleterious missense variant, accounted for 3.7% (3/81) of cases in this cohort. Furthermore, gene-based collapsing analysis against 5,000 healthy controls revealed eight genes significantly enriched for loss of function variants and nine genes with an excess burden of damaging missense variants in TCS patients. Additionally, TCS patients exhibited a significantly higher burden of damaging missense variants in NTD-related genes. We also identified a trigenic variant combination (AFDN/PCSK5/PRICKLE4) exclusively in TCS patients, suggesting potential oligogenic inheritance in TCS. Collectively, our findings expand the genetic architecture of TCS, highlight novel pathogenic mechanisms, and provide insights for future clinical surveillance.
In this study, we investigate the emergent dynamics of mixed populations of self-oscillatory and excitable Izhikevich neurons embedded in a random network topology and interacting through both first-order and second-order interactions. By gradually increasing the strength of second-order interactions, we analyze its impact on synchronization, bursting dynamics, and metastability at the network level. Our results reveal a sequence of dynamical transitions from synchronized regular spiking to synchronized chaotic bursting, followed by a regime of fast chaotic spiking. The transition to chaotic bursting occurs via a spike adding route, while the subsequent transition to fast chaotic spiking is associated with the loss of the bifurcation structure responsible for burst termination, leading to the collapse of silent phases. We demonstrate that weak second-order interactions support complete cluster phase synchronization in both excitable and self-oscillatory neuronal populations, whereas increasing higher-order coupling induces a second-order transition to partially synchronized dynamics. This partially synchronized regime is characterized by synchronized bursting and metastability. Further increase in second-order interactions drives the network into a fully incoherent state characterized by irregular fast spiking. Additionally, we show that network link density strongly influences the degree of synchrony among self-oscillatory neurons but has limited impact on excitable neurons in the partial synchrony regime due to their heterogeneous firing rate distributions.
Early recognition of haemorrhagic shock is critical in trauma care, particularly in low- and middle-income countries where delayed referral is common. Conventional vital signs may remain normal despite ongoing hypoperfusion. The Perfusion Index (PI), derived from pulse oximetry, is a non-invasive and continuously available marker of peripheral perfusion. This study evaluated the ability of PI to identify severe haemorrhagic shock in trauma patients and compared its performance with the Shock Index (SI) and Modified Shock Index (mSI). This prospective, single-centre study was conducted at a Level 1 trauma centre between January and May 2024. Adult Priority 1 trauma patients were enrolled and classified as having no/mild shock (ATLS grades 1-2) or severe shock (grades 3-4). PI was recorded during initial assessment. SI, mSI, lactate, injury severity, transfusion requirement, ICU admission, and 24-hour mortality were analysed. Receiver operating characteristic (ROC) analysis and multivariable logistic regression were performed. A total of 120 patients were included (mean age 40.4 ± 17.2 years; 90% male), predominantly with blunt trauma (85% road traffic injuries). Severe shock was present in 35 patients (29.2%). Median PI was significantly lower in severe shock compared with no/mild shock (0.54 [IQR 0.28-1.31] vs. 1.33 [0.71-2.16], p = 0.008). Mean SI (1.24 ± 0.47 vs. 0.72 ± 0.14, p < 0.001) and mSI (1.50 ± 0.49 vs. 0.96 ± 0.18, p = 0.001) were significantly higher in severe shock. On multivariable analysis, PI ≤ 0.78 independently predicted severe shock (OR 3.62, 95% CI 1.41-9.29), along with SI > 1.0, mSI > 1.3, and lactate > 4 mmol/L. PI demonstrated fair discrimination for severe shock (AUC 0.76; sensitivity 72%, specificity 66%) and 24-hour mortality (AUC 0.71). PI demonstrated moderate discriminatory ability and may serve as a useful non-invasive adjunct for identifying severe haemorrhagic shock. Its continuous, operator-independent measurement supports a potential role in early triage and resuscitation, particularly in resource-limited settings.
Trigeminal neuralgia (TN) has a prevalence ranging from 0.03% to 0.3%, with an annual incidence of approximately 4.7 cases per 100,000 individuals. Among these, around 11.4% are attributed to pure venous neurovascular conflict. The transverse pontine vein emerged as the predominant offending vein. There is no consensus on the best surgical technique for these cases. However, three principal surgical techniques have been described: coagulation and cut-off, interposition, and transposition. In this report featuring an operative video, we present the case of A 37-year-old woman with shock-like and burning pain in the V2 and V3 territory on the right side for four months, associated with lacrimation and triggered by brushing her teeth or drinking cold drinks. Her pain was refractory to oxcarbazepine (2400 mg/day). Her MRI showed a neurovascular conflict on the right. She subsequently underwent microvascular decompression (MVD) surgery. During the surgery, we found a purely venous conflict. We proceeded with Teflon interposition. The patient had an uneventful recovery, with complete initial pain relief and, at three months, a favorable early outcome (Barrow Neurological Institute (BNI) pain intensity score IIIb), with pain adequately controlled on a low dose of oxcarbazepine (300 mg/day). The patient consented to the procedure and to the publication of this report. Institutional ethics committee approval was not required because of the retrospective and fully anonymized nature of the case report.
Two-dimensional transition metal dichalcogenides (TMDCs) have recently emerged as promising defect qubit hosts due to their low nuclear spin density. Millisecond-scale spin coherence times were predicted for ideal model qubit systems under magnetic field strengths of a few teslas, where the magnetic noise due to the dilute nuclear spin bath was significantly suppressed. However, the effects of the specific defect structure and magnetic fields remain unexplored. Combining hybrid density functional theory and cluster correlation expansion, we investigate the spin decoherence of specific defect qubit candidates, which are a carbon radical ion (S = 1/2) and an antisite defect (S = 1), under varying magnetic field strengths. A key finding is that a spin in a TMDC undergoes early collapse of coherence (ECC) within a sub-microsecond timescale depending on the defect type, host material, and magnetic field. In particular, defect spins in a Mo-based TMDC show pronounced ECC over a broad range of magnetic field strengths, leading to a clear two-step decoherence process: (1) an initial sub-microsecond (TECC) decay driven by single nuclear spin dynamics, followed by (2) a slower millisecond-scale decay (T2) arising from nuclear spin flip-flop interactions. Notably, at specific magnetic field strengths, coherence associated with the slower T2 decay is completely suppressed due to enhanced nuclear spin modulation effects, leaving ECC as the dominant decoherence mechanism. These results identify ECC as a central feature of spin decoherence in TMDCs and highlight the interplay between defect characteristics and the nuclear spin environment in determining qubit coherence.
Kinematic alignment (KA) seeks to restore native, prearthritic alignment, including the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO). Advanced osteoarthritis may alter these parameters through erosion, subchondral collapse, or insufficiency fracture, potentially misrepresenting the native coronal plane alignment of the knee (CPAK) phenotype. Therefore, we sought to evaluate concordance in CPAK phenotype parameters between the severely arthritic knee and the contralateral healthy knee within the same patient. We performed a radiographic review of 578 patients with bilateral, weight-bearing, long-leg radiographs obtained prior to total knee arthroplasty. The inclusion criteria required a Kellgren-Lawrence grade 4 knee (arthritic) and a contralateral Kellgren-Lawrence grade 0 or 1 knee (healthy). Absolute side-to-side differences were calculated for aHKA, JLO, medial proximal tibial angle, and lateral distal femoral angle, with additional stratification based on the predominant compartment of arthritic degeneration (medial or lateral). Ninety patients met the inclusion criteria. The mean absolute differences between healthy and arthritic knees were 3.5° for aHKA, 2.3° for JLO, 2.4° for medial proximal tibial angle, and 1.7° for lateral distal femoral angle. CPAK concordance between healthy and arthritic knees was limited, with matching phenotypes in only 41% of patients with medial arthritis and 50% with lateral arthritis. Advanced knee osteoarthritis may lead to permanent bony changes that alter the measured CPAK phenotype. Replicating this pathologic alignment during kinematic alignment total knee arthroplasty could result in unintended component malposition. Careful preoperative radiographic assessment is essential to identify and account for these deformities.
Avascular necrosis (AVN) is a progressive bone disorder characterized by impaired blood supply, osteocyte death, and structural collapse, most commonly affecting the femoral head. In recent years, growing evidence has suggested that gut microbiota may influence skeletal health through immune, metabolic, and vascular pathways. This scoping review aimed to systematically map current evidence on the relationship between gut microbiota and AVN and to identify key knowledge gaps. Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a comprehensive search of PubMed, EMBASE, ScienceDirect, Web of Science Core Collection, ClinicalTrials.gov, and Cochrane CENTRAL was conducted. Thirteen eligible studies, including experimental, clinical, multi-omics, and Mendelian randomization analyses, were included. The available evidence indicates that AVN, particularly glucocorticoid- and alcohol-associated forms, is consistently associated with intestinal dysbiosis, reduced production of short-chain fatty acids, immune activation, vascular impairment, and altered bone remodeling. Animal and translational studies demonstrate partial reversal of pathological changes through microbiota-targeted interventions, while human studies reveal etiology-specific microbiota-metabolome signatures. Genetic analyses further support a potential causal contribution of selected microbial taxa and pathways. Overall, current data support the existence of a multidimensional gut-bone axis in AVN. However, most evidence remains indirect - derived from animal models, cross-sectional human studies, and genetic inference rather than from direct interventional testing in patients. Well-designed longitudinal and interventional investigations are needed to clarify causality and therapeutic potential.
Cold shock proteins (CSPs) play important roles in cellular adaptation to environmental stress. However, their characteristics and potential roles in yak (Bos grunniens), a species adapted to high-altitude environments, remain poorly understood. In this study, a genome-wide identification and comparative analysis of the CSP gene family was performed primarily using bioinformatics approaches based on publicly available genomic and transcriptomic datasets, along with a preliminary validation of their differential expression under cold and hypoxic stress. A total of 14 CSP genes were identified in the yak genome. Phylogenetic analysis across eight bovine species classified these genes into nine distinct clusters, revealing evolutionary conservation within the CSP family. Structural analyses showed variation in exon-intron organization and conserved motifs associated with stress responses. Protein-protein interaction (PPI) network analysis further suggested potential functional interactions between CSPs and key regulatory proteins. Tissue transcriptomic data indicated distinct expression patterns of CSP genes across multiple tissues. To provide experimental support for these findings, Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) analysis was conducted in yak preadipocytes exposed to cold and hypoxic stress, revealing significant upregulation of several CSP genes. Together, these results provide a comprehensive overview of the CSP gene family in yak and offer insights into their potential roles in high-altitude adaptation in bovine species.
Tracheal intubation and mechanical ventilation are frequently required for critically ill patients, yet mortality remains high despite appropriate management. This risk is particularly pronounced among elderly patients. To examine hospital disposition in a nationwide cohort of elderly emergency department (ED) patients who required endotracheal intubation. We performed a retrospective cohort study of ED encounters involving patients aged ≥ 65 years who were intubated in the ED or after admission from the ED using the Nationwide Emergency Department Sample from 2018 to 2022. Those who died in the ED or were transferred were excluded. The primary outcome was hospital disposition, including in-hospital death. Interactions between age, diagnoses, and comorbidities were analyzed. All counts and estimates were weighted, accounting for the complex survey design. We identified 2,127,000 encounters with a median age of 75 (interquartile range 70, 81) years old. 995,890 (46.8%, 95% confidence interval or CI 46.3-47.4) died in the hospital, 729,034 (34.3%, 33.7-34.9) were discharged to a facility (eg, skilled nursing facility), 224,479 (10.6%, 10.3-10.8) were discharged home with home health, and 177,598 (8.3%, 8.1-8.6) were discharged home without home health. With each additional year of age, the probability of in-hospital mortality increased by 0.65% (95% CI 0.62-0.67). Cerebral hemorrhage, shock, sepsis, and traumatic brain injury (TBI) increased the probability of in-hospital mortality. Heart failure and chronic obstructive pulmonary disease (COPD) had significantly positive interactions with age for in-hospital mortality. Nearly half of elderly ED patients who require intubation will die in the hospital. These results may inform decisions and expectations regarding hospital disposition of the acutely ill or injured and intubated elderly patient.
Accurately predicting optimal continuous positive airway pressure (CPAP) using traditional PSG parameters remains challenging. Respiratory endotypes derived from PSG can reflect the pathophysiological mechanisms of diseases to a certain extent and are expected to provide a novel perspective for individualized pressure prediction. 114 Chinese adults with obstructive sleep apnea (OSA) underwent two overnight in-laboratory PSG recordings. Optimal CPAP pressure was defined by standardized manual titration performed on the second night. The analysis incorporated three sets of variables: respiratory endotypes, anthropometric indicators, and PSG respiratory parameters. After initial correlation screening, significant variables were entered into a stepwise multiple linear regression model. The dataset was randomly split into training (80%) and validation (20%) sets to assess predictive performance. A total of 114 participants (15 mild, 38 moderate, 61 severe OSA) were included. The prediction model included loop gain (LG1), ventilation capacity (Vpassive, Vmin), BMI, apnea index (AI), mean respiratory event-related oxygen desaturation (RE-OD-Mean), longest apnea duration (Ap-Dur-Long), and respiratory-related arousal index (RR-ArI): CPAP = 0.708 + 1.804×LG1 + 0.023×Vpassive - 0.015×Vmin + 0.117×BMI + 0.003×AI - 0.074×RE-OD-Mean + 0.019×Ap-Dur-Long + 0.043×RR-ArI. The final model demonstrated acceptable predictive performance in the internal validation set (R² = 0.497; RMSE = 1.507 cmH₂O). Among the retained predictors, LG1 showed the largest effect size, with each 1-unit increase associated with an approximately 1.8 cmH₂O higher predicted CPAP pressure. Integrating respiratory endotypes with anthropometric indicators and PSG respiratory parameters provides a mechanism-based framework for CPAP pressure prediction. Collapsibility traits (Vpassive, Vmin) and ventilatory control stability (LG1) substantially enhance predictive accuracy, offering a more individualized approach to PAP therapy.
Heat shock protein 70 (HSP70) can assemble with other extracellular matrix proteins to form deoxycholate-insoluble aggregates in multiple sclerosis (MS) lesions, impairing oligodendrocyte (OLG) maturation and remyelination. However, soluble HSP70 supports myelination. HSP70 may also promote bone marrow-derived macrophages (BMDMs) toward classically and alternatively activated phenotypes, which may regulate OLG maturation. Given the roles of HSP70 in OLG maturation and in shaping microglial/BMDM phenotypes in MS lesions, we investigated how HSP70 in microglia/macrophages regulates OLG maturation in a toxin-induced demyelination model. Our results suggest that rrHSP70 may maintain HSP70 expression in microglia and BMDMs in vitro. Tandem mass tag (TMT)-labeled quantitative proteomic, post-translational modification, and phagocytosis analyses showed that rrHSP70 may induce Fc gamma R-mediated phagocytosis in microglia and BMDMs, enabling rrHSP70 engulfment and enhancing heat shock factor 1 (HSF-1) phosphorylation. Blocking or inhibiting CD45 activity reduced rrHSP70 phagocytosis and HSF-1 phosphorylation in microglia. These findings suggest that rrHSP70 may induce Fc gamma R-mediated phagocytosis in microglia and BMDMs, leading these cells to phagocytose rrHSP70 and enhance HSF-1 phosphorylation, thereby maintaining HSP70 expression in vitro. Furthermore, HSP70 levels increased during early demyelination in the animal model, suggesting that HSP70 may induce microglial/macrophage phagocytosis to remove factors that inhibit remyelination, thereby facilitating later remyelination. rrHSP70 likely promoted OLG maturation both in vivo and in vitro, as well as remyelination, possibly by enhancing myelin basic protein (MBP) expression and facilitating phosphorylated MBP redistribution. Overall, context-dependent HSP70 upregulation may be crucial for enhancing remyelination in MS lesions.
Reality shock among junior nurses is a significant issue that reflects the gap between expectations and reality, potentially associated with their professional identity. However, the distribution of reality shock patterns across subgroups and its correlation with professional identity remain unclear. To identify latent categories of reality shock among junior nurses using latent profile analysis, explore influencing factors of different profiles, and examine differences in professional identity across categories. A cross-sectional study was conducted from August to October 2025, enrolling 238 junior nurses ( ≤ 3 years of service) from a tertiary general hospital in Sichuan Province via convenience sampling. Data were collected using a demographic questionnaire, a reality shock scale, and a professional identity assessment scale. Latent profile analysis identified distinct reality shock categories; chi-square tests, independent-samples t-tests, and one-way ANOVA assessed demographic differences across categories; stratified linear regression determined the impact of reality shock on professional identity. Two latent categories were identified: "low reality shock" (n = 143, 60.1%) and "high reality shock" (n = 95, 39.9%). Employment type, average weekly overtime frequency, reasons for choosing nursing, and job satisfaction were associated factors of reality shock subtypes (P < 0.05). After controlling for demographic variables, high levels of reality shock are negatively associated with professional identity; passive career choice, low job satisfaction, and lack of education were also significant negative predictors. Junior nurses' reality shock exhibits significant within-group heterogeneity, and high levels of reality shock are negatively associated with professional identity. Nursing managers and educators should prioritize identifying high-risk groups and promoting smooth role transition by optimizing workload management, strengthening professional identity education, and establishing a multidimensional support system.