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Background/Objectives: Conventional Colour Doppler Ultrasonography (CDUS) is widely used to assess vascularity in focal intratesticular lesions, yet the influence of lesion size on flow detection and the diagnostic utility of vascular distribution patterns remain unclear. We evaluated (i) whether lesion size affects CDUS detection of intralesional vascularity and (ii) whether vascular patterns associated with disruption of normal intratesticular vascular architecture are linked to diagnostic groupings. Methods: This retrospective single-centre study screened 12,189 testicular ultrasound examinations (1999-2009) and included histologically confirmed focal lesions with archived greyscale and CDUS images. To avoid within-patient clustering, one lesion per patient (the largest if multiple) was analysed (99 patients/lesions). Two blinded radiologists assessed vascularity (present/absent) and, for vascularised lesions, peripheral vascularity and intralesional patterns (criss-cross; disordered/haphazard). A derived composite "disrupted" pattern comprised criss-cross or disordered/haphazard flow. Results: Intralesional vascularity was present in 85/99 (85.9%) lesions. Vascularity was more common in neoplastic vs. non-neoplastic lesions (78/82 [95.1%] vs. 7/17 [58.8%]; p < 0.001) and in malignant vs. benign lesions (64/68 [94.1%] vs. 21/31 [67.7%]; p = 0.001). Lesion size was not associated with vascularity (the smallest vascularised lesion was 2 mm; logistic regression was non-significant). Among vascularised lesions, the composite disrupted pattern was more frequent in neoplastic vs. non-neoplastic (OR 11.67) and malignant vs. benign lesions (OR 5.90). Four of 14 avascular lesions were malignant/neoplastic. Conclusions: With optimised settings, CDUS vascularity detection did not appear size-limited and was strongly associated with neoplasia and malignancy, although avascularity did not exclude malignancy. A composite disrupted vascular pattern may be a practical, reproducible reporting descriptor warranting prospective validation.

This study aimed to evaluate clinical outcomes, serologic changes, and immunologic effects induced by the bispecific B cell Maturation Antigen (BCMA)x Cluster of Differentiation (CD)3 T-cell-engaging antibody teclistamab in systemic sclerosis (SSc). Patients with severe and treatment-refractory SSc were treated with teclistamab as off-label therapy. Blood and tissue samples from skin and bone marrow were analysed with immunohistochemistry and flow cytometry, serum antibodies were quantified by enzyme-linked immunosorbent assay (ELISA). Clinical efficacy was assessed using the American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS) responses, among others. Ten patients with SSc (70% female; median age 51 years [IQR: 7]) completed 1 cycle of teclistamab. Two patients with advanced SSc heart involvement died shortly after treatment initiation. B-cells and plasma cells were almost completely eliminated from bone marrow and skin, accompanied by a median reduction of 70.6% (IQR: 39%) in antitopoisomerase antibody titres, decreases in serum IgG, and vaccination titres. After a median follow-up of 3.75 months (IQR: 2.5 months), 71% and 43% of patients achieved revised ACR-CRISS 25 and 50 responses, respectively. Among patients with interstitial lung disease, radiographic and functional improvement was observed by week 12 with a median increase in forced vital capacity of 7% (IQR: 15%). Skin fibrosis similarly improved, with a median decrease in the modified Rodnan skin score of 35.9% (IQR: 17.9%), accompanied by corresponding reductions in fibroblast activation protein (FAP)-alpha-positive fibroblasts in skin biopsy specimens. Teclistamab induced deep tissue depletion of B-cells and plasma cells and rapid clinical and serological responses, with evidence for resolution of inflammation and potential modification of fibrotic processes. These data suggest the potential of BCMA-directed therapies to promote immune modulation and tissue remodelling.

Assessment of disease activity in juvenile systemic sclerosis (jSSc) is essential for clinical care and trial readiness, yet no validated pediatric activity measures exist. Adult systemic sclerosis activity tools, including the Scleroderma Clinical Trials Consortium Activity Index, revised CRISS, and revised EUSTAR, provide conceptual frameworks but require adaptation for developmental, physiologic, and feasibility considerations for children. At the 17th Hamburg Symposium on JSSc, an international multidisciplinary panel reviewed adult indices, evaluated corresponding variables in the jSSc Inception Cohort and the NRCOS registry, and conducted a structured Delphi process to define organ-specific indicators of clinically meaningful activity in jSSc. Across skin, pulmonary, cardiac, vascular, musculoskeletal, gastrointestinal, renal, and global domains, the panel reached broad and often unanimous consensus on variables reflecting active, potentially reversible disease. Key endorsed measures included mRSS progression, new ILD on HRCT, &#x2265;10% declines in FVC or DLCO, new cardiac abnormalities, active digital ulcers, synovitis, myositis, nutritional decline, and physician global assessment. Patient-reported outcomes were strongly supported across domains. These consensus-derived indicators provide the first comprehensive pediatric-specific foundation for defining disease activity in jSSc and represent a critical step toward developing and validating a unified pediatric activity index suitable for future clinical trials.

Improving quality of care in pediatric cardiac surgery is complex. We describe using institutional The Society of Thoracic Surgery (STS) Congenital Heart Surgery Database (CHSD) data in real time to develop a quality framework with the aim of optimizing team performance and thus improving clinical outcomes. A single-center retrospective study was undertaken spanning 8 quarters: 3 quarters (Q) preimplementation (Q4 2022, Q1 2023, and Q2 2023), 2 quarters during implementation (Q3 2023 and Q4 2023), and 3 quarters postimplementation (Q1 2024, Q2 2024, and Q3 2024). STS CHSD data are abstracted from medical records, input into third-party software, and are used to create visual plots for each index procedure at weekly rounds called "Collaborative Multidisciplinary Assessment of Performance Rounds" (CMAP) and to create an STS Dashboard. STS CHSD unadjusted data and Pediatric Cardiac Critical Care Consortium (PC4) risk-adjusted clinical outcomes were compared preimplementation and postimplementation. CMAP were instituted in Children's Nebraska Criss Heart Center in July 2023. CMAP attendance median is 59 (interquartile range, 48-74). The case mix preimplementation and postimplementation is similar (17.7% The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery [STAT] Congenital Heart Surgery Mortality Categories 4 or 5 cases vs 18%). Postimplementation, 39 CMAP presented 223 index procedures. There were trends to decreased risk-adjusted PC4 outcomes postimplementation vs preimplementation, including failure-to-rescue, major complication, cardiac arrest, seizures, infection and unplanned reintervention. CMAP discussions have resulted in "CMAP Takeaways," which have informed quality care initiatives. Our data demonstrate the feasibility and power of using real-time STS CHSD unadjusted data to create a quality framework based on transparent data sharing and psychological safety to enhance team performance in congenital heart surgery.

The title compound, C29H24N2O3, was synthesized via a four-component Debus-Radziszewski reaction, involving benzil, amine, aldehyde and ammonium acetate. The OH group of the vanillin substituent forms both an intra-molecular and an inter-molecular hydrogen bond, the latter generating [010] chains. The extended structure is consolidated by weak C-H&#x22ef;O and C-H&#x22ef;&#x3c0; inter-actions, generating a criss-cross motif.

While antibiotics are routinely prescribed for cystic fibrosis (CF) pulmonary exacerbation (PEx) treatment, little evidence exists informing optimal antibiotic selection. This study aimed to determine whether broader-spectrum antibiotics were associated with improved clinical outcomes compared to narrower-spectrum antibiotics for PEx treatment. A secondary analysis of the Standardizing Treatment of Pulmonary Exacerbation-2 (STOP-2) clinical trial was completed. Antibiotic spectrum was defined using the CF antibiotic spectrum index (CF-ASI), a tool that classifies each antibiotic's expected spectrum of antibacterial activity, and was categorized into quartiles (<14, 14-17, 18-22, and >23). Multivariable generalized linear and inverse probability weighted models were constructed to describe the association between ASI and relevant clinical outcomes, including pre- to post-PEx changes in lung function, weight, and CF symptoms scores. A total of 982 people with CF with a mean age of 30.3 years (SD 9.7) were available for analysis. The median CF-ASI score for the entire cohort was 17 (IQR 13-22). The mean ppFEV1 (difference 0.4, 95% CI -1.4, 2.2, p = 0.80) and CRISS (difference 1.3, 95% CI -2.5, 2.5, p = 0.75) changes from baseline did not differ between the lowest and highest CF-ASI quartiles. In the multivariable analysis, a higher CF-ASI quartile score was not statistically significantly associated with improvements in lung function, symptom score or weight compared to a lower CF-ASI quartile score. Adverse events did not differ in frequency between CF-ASI quartiles. Opportunities exist to select narrower-spectrum antibiotics for PEx treatment in CF to minimize the risks of antibiotic toxicities.

We aimed to explore the potential effectiveness and safety of telitacicept in the treatment of systemic sclerosis (SSc) and to investigate mechanisms such as B cell immune phenotypes. This was a single-centre, single-arm, open-label study enrolling eight SSc patients inadequately responding to traditional immunosuppressants. All patients received telitacicept 160 mg weekly for 24 weeks in addition to their original stable immunosuppressive background treatment. The primary endpoint was changes in the median modified Rodnan skin thickness score (mRSS) at week 24. This study demonstrated that significant improvements were observed in the primary endpoints. Compared with the mean mRSS (18.9&#xb1;5.8) at baseline, mRSS declined to 12.5&#xb1;5.0 (p=0.008) and 10.8&#xb1;5.8 (p=0.003) at weeks 12 and 24, respectively. SCTC-DI score, ScleroID questionnaire score, and SF-36 physical score at week 24 also improved (p<0.05). The CRISS score was 0.75, indicating clinical improvement, with higher scores reflecting better outcomes. Telitacicept as an add-on treatment significantly decreased CD19+ B cells from 10.2% to 4.3% (p=0.006), decreased transitional B cells from 6.8% to 1.4 % (p=0.005), decreased naive B cells from 8.9% to 3.0% (p=0.001), and increased immature B cells from 0.10 % to 0.24% (p=0.03). Telitacicept add-on treatment also decreased serum levels of immunoglobulins (IgG, IgA, IgM) (p<0.05) at week 24 and increased haemoglobin (p=0.013) at week 12. HRCT score for pulmonary fibrosis showed a decline at week 24 (p=0.036). A decrease in titer of SSc-specific antibodies was observed in six out of eight patients. No serious adverse events occurred. Adverse effects were mainly hypogammaglobulinemia, respiratory tract infection, urinary tract infections, and rash. No deaths occurred. Telitacicept has the potential to be a safe and effective treatment for patients with SSc; however, further studies with larger sample sizes are needed to confirm these findings and to better understand long-term safety and efficacy.

The Critically Endangered endemic Wolkberg Zulu butterfly (Lycaenidae: Alaena margaritacea Eltringham, 1929) is known from only two colonies in the Wolkberg mountain range in north-east South Africa. An unusual behavior of this species was reported in 2020: the female climbs and criss-crosses grass blades while rubbing her abdomen against them and curling her abdomen. The function of the unusual behavior is unknown, but it might attract males by depositing a pheromone. Although long-range female sex pheromones are rare in butterflies (Papilionoidea), this conjecture is supported by a male flying to a tussock containing a female, where mating occurred directly. We used non-destructive micro-CT scanning and morphological analysis to uncover the potential abdominal and reproductive structures, including glands, that could explain the female's behavior. We illustrate the structures on A. margaritacea examined using micro-CT scanning, including rendered 2-D surface photos, rendered surface videos, a video showing the entire slide stack, video showing the density differences, and focus-stacked 2-D photos. We found a sclerotized area mid-ventrally on the 7th sternite, a ventral pouch-shaped opening on the 9th segment, and tiny, spherical, superficially gland-like structures inside the 7th abdominal segment. The sclerotized area on the 7th sternite may be associated with the observed behavior, and the gland-like structures may have a pheromone-producing function, but our data do not allow unambiguous confirmation of either of these explanations. However, we confirm the presence of a waxy mating plug sealing the ostium bursae, the first confirmation of this structure in a lycaenid. It corresponds to a protosphragis, extending into the posterior part of the ductus bursae and onto the ventral part of the 9th sternite. The mating plug could offer an alternative explanation for why the female rubs her abdomen against grass blades: she may be trying to remove the mating plug mechanically to allow remating. The closely related Alaena amazoula was also found to have a sclerotized area on the 7th sternite. We illustrate the female genitalia of A. margaritacea and A. amazoula using morphological analysis to explain their structures.

The genus Fagus, a key community-forming taxon in northern temperate forests, plays a vital role in maintaining biodiversity and ecosystem functions. However, natural Fagus forests are threatened by poor regeneration and community degradation, underscoring the need for precise and efficient monitoring techniques. Existing methods are constrained by the lack of public datasets and the limitations of standard architectures like U-Net in capturing fine-grained features within complex forest scenes. To address these challenges, we constructed a high-resolution UAV image segmentation dataset for Fagus and proposed the Environment Simulation-based Robust Data Augmentation Framework (ES-REF). By actively simulating realistic disturbances such as fog, local overexposure, and motion blur, ES-REF significantly enhances model generalization under complex conditions. Additionally, we developed ACG-Net, which uses VGG as the encoder backbone and incorporates SPConv, Criss-Cross Attention, and context-guided downsampling to improve multi-scale feature extraction, global context awareness, and spatial detail preservation. Experimental results demonstrate that ES-REF improves model robustness, increasing the mIoU of U-Net and ACG-Net by 0.71 and 2.18 percentage points, respectively. On the test set, ACG-Net achieved an mIoU of 89.55%, outperforming the U-Net baseline by 4.31 percentage points and surpassing models such as DeepLabv3+. This work establishes a data and methodological foundation for automated Fagus community mapping and provides a reliable framework for forest resource monitoring and smart forestry management.

Lane detection seeks to accurately identify the position and geometry of lane markings in real-world driving environments. However, existing models often struggle with robustness and accuracy due to insufficient integration of high-level semantic understanding and low-level geometric features. To tackle these limitations, we propose SR-LMamba, a novel lane detection framework built upon the Sketch-and-Refine paradigm of SRLane. At the core of our approach lies LMamba, a lightweight three-stage backbone network that accelerates inference while effectively capturing both geometric structures and sequential patterns through a synergistic combination of curvelet transform and the Mamba architecture. In the Refine stage, we introduce the Criss-Cross Lane Association Module (CLAM), which employs a multi-lane criss-cross attention mechanism to enhance feature interactions and applies polynomial regression to refine lane curve fitting. To further boost performance, we design tailored loss functions-angle loss and criss-cross attention loss-aligned with the model architecture. Experimental results show that SR-LMamba achieves an F1 score of 80.04%, outperforming current state-of-the-art models with similar parameter sizes, and demonstrating superior robustness across four challenging driving scenarios. In addition, we publicly release our code and models at https://github.com/chenml1/SR-LMamba.