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Interest in the potential of population-based genomic sequencing is growing. However, integrating a large-scale screening program into an already complex healthcare system is challenging. The implementation of gNBS needs a thorough understanding of the process. The purpose of this study is to investigate how gNBS can be integrated into the Australian health system and delivered at scale. Embedded within the BabyScreen+ study, we utilised a research design informed by process mapping and phenomenology. Fifty-one semi-structured interviews with parents (n = 33), healthcare providers (n = 15), and BabyScreen+ study team members (n = 8) were conducted. Additionally, we analysed the operational team meeting minutes. A baseline process map, developed in consultation with team members, consisted of six stages: 1. Raising awareness of the screening program; 2. Offer; 3. Participant enrolment and consent; 4. Sample collection; 5. Testing; and 6. Result disclosure and management. We recorded changes made over the study period to inform the post-implementation process map. Most changes occurred at stages: 1. Raising awareness, 4. Sample collection and 5. Testing. Lastly, a process map to inform the scale up of screening, was developed. Four key aspects of the gNBS process needing modification are: (1) growing awareness of screening amongst the public and HCPs; (2) building flexibility and accessibility into the consent process; (3) developing automation capabilities and infrastructure for large-scale sequencing and analysis, and (4) dedicated referral processes for infants who receive high-chance results. These findings demonstrate key system-level considerations and provide a foundation for implementing genomic newborn screening at scale within existing healthcare systems.

Individuals with very late-onset schizophrenia-like psychosis (VLOSLP) experience a persistent mortality gap compared to the general population, yet no validated prognostic tools tailored to this growing population exist. We aimed to develop and validate a 3-year all-cause mortality prediction model (VALOR-m) for individuals with VLOSLP. We developed VALOR-m with LASSO-penalised Cox regression. To evaluate temporal drift and geographic generalisability, we employed a two-stage approach: 1)temporal validation stratified by two time periods (period 1: 2002-2013; period 2: 2014-2024), and 2)temporal recalibration with internal-external cross-validation (IECV) stratified by seven catchment areas in period 2. Discrimination was assessed by time-dependent AUC and Harrell's c-statistic; calibration by calibration slope and observed-to-expected ratio (O/E ratio). Using a population-based electronic health record cohort from Hong Kong (2002-2024), we identified 33,594 older adults (aged≥60 years) with VLOSLP. Of 33,594 individuals included (16,262[48·4%] male; mean age of onset 76·4 years), 11,272 (33·6%) died within 3 years. VALOR-m retained 11 predictors and demonstrated good discrimination (pooled time-dependent AUC:0·772 95%CI[0·765-0·779]; Harrell's c-statistic 0·734 95%CI[0·728-0·741]) and satisfactory calibration (calibration slope 0·885 95%CI[0·859-0·911]; O/E ratio 0·972 95%CI[0·908-1·041]) in IECV. VALOR-m provides the first validated individualised mortality risk estimates for individuals with VLOSLP, applicable to real-world clinical practice using routinely collected data. VALOR-m achieved comparable discrimination to conventional comorbidity indices with fewer predictors, suggesting that it better captures the unique mortality profile of VLOSLP, and supporting its use to guide antipsychotic treatment decisions, personalised healthcare management in this understudied yet growing population.

Antimicrobial resistance (AMR) in Helicobacter pylori is increasingly compromising eradication therapies worldwide. Despite growing concern, comprehensive global genomic analyses integrating resistance determinants, geographic distribution, and evolutionary patterns remain limited. A total of 6876 high-quality H. pylori genomes collected from 85 countries between 1900 and 2024 were analyzed. Resistance determinants were identified using AMRFinderPlus, followed by lineage profiling, geographic mapping, temporal trend analysis, and resistome characterization. The distribution of virulence-associated genes and resistance gene presence patterns was also evaluated. Twenty-two AMR determinants were identified, predominantly chromosomal mutations. The most prevalent mutation was pbp1a S543R, associated with amoxicillin resistance, detected in 24.03% (1652/6876) of genomes across 63 countries since 1983. Fluoroquinolone resistance-associated gyrA N87K demonstrated a marked temporal increase, reaching approximately 50% prevalence by 2023. Additional gyrA and pbp1a variants were widely distributed globally. Acquired resistance genes, including blaTEM,aph(3')-IIIa, and catA1, were rare and primarily confined to sequence type 181. Among 2877 resistant isolates, 103 distinct resistance profiles were observed, with single-mutation patterns predominating. Geographic analysis revealed pbp1a S543R prevalence exceeding 40% in multiple Asian and African countries, while gyrA N87K exceeded 30% in parts of Asia and South America. The resistome exhibited an open structure, whereas 134 virulence-associated genes remained highly conserved. This large-scale global genomic study demonstrates the extensive dissemination and ongoing evolution of AMR in H. pylori, particularly against amoxicillin and fluoroquinolones. The findings indicate that empirical treatment strategies based on these agents are becoming increasingly unsustainable worldwide. Implementation of susceptibility-guided therapy, rapid molecular diagnostics, and international genomic surveillance programs is urgently required to preserve eradication efficacy and limit further resistance expansion.

Mining and e-waste recycling release trace elements (TEs) that can accumulate in aquatic organisms and impair their vital functions. Predicting whether an element will biomagnify or biodilute in food webs is challenging, as it depends on the element, species, and environment. This is especially true for technology-critical elements (TCEs), including most rare earth elements (REEs), which remain largely unstudied and are currently unregulated in most countries despite growing environmental releases. To address the gaps in understanding pollution fate and ecological implications of these elements, we quantified concentrations of understudied TCEs (Ti, Sr, Co, Tl, REEs (La, Ce)), alongside conventional TEs (Cu, Zn, As, Se, Cd, Pb), in six organism groups spanning multiple trophic levels (Ephemeroptera, Diptera-Chironomidae, Amphipoda, zooplankton, Yellow perch, and Walleye) from six boreal lakes at varying distances from mining and e-waste recycling activities. We then examined biomagnification and biodilution patterns of these elements across food webs using stable isotope δ15N to determine trophic position (TP). TCEs, including Ti, Co, La, and Ce, consistently biodiluted across all lakes, similarly to the better-known TEs (Cu, Zn, As, Cd, Pb). Selenium was the only element to show significant biomagnification, and this pattern was observed exclusively in two remote lakes. Tl also showed a variable pattern, characterized by significant biodilution in some lakes and non-significant trophic relationships in others. The variability for Se and Tl suggests their trophic transfer depends on lake-specific ecological factors rather than exposure alone. Zooplankton consistently showed the highest concentrations within the food web for multiple elements (e.g., Ti, Co, Tl, La, Ce, Cu and Zn), making them a key contaminant entry point. This study provides needed evidence on TCEs trophic dynamics in boreal lakes. These results inform pollution monitoring and ecosystem protection for freshwater environments across boreal regions impacted by mining and e-waste recycling worldwide.

Fibromyalgia (FM) is a chronic widespread pain syndrome affecting 2%-4% of the population whose pathophysiology remains incompletely understood. Growing evidence implicates gut microbiota dysbiosis as a contributing factor, acting through immune, neuroendocrine, and metabolic pathways that may reinforce central sensitization. Consistent findings of reduced microbial diversity and altered metabolite profiles-including short-chain fatty acids, bile acids, and tryptophan derivatives-suggest mechanistic links between the gut and FM symptoms. Microbiota-targeted interventions such as probiotics, dietary modification, and fecal microbiota transplantation have shown preliminary benefits, though evidence remains limited by small sample sizes and methodological heterogeneity. This review synthesizes current knowledge on the role of the gut microbiota in FM within the broader context of rheumatic diseases and discusses future research directions.

Alternaria toxins (ATs) are mycotoxins of increasing relevance in food safety risk analysis, as they are widely detected in plant foods. Tomato and tomato-based products represent major contributors to ATs dietary exposure due to their high consumption and susceptibility to Alternaria spp. contamination. Matrix properties, combined with industrial processing, can further promote toxin accumulation. Despite the growing scientific interest in these fungal metabolites, an integrated assessment on tomato products is lacking. In this context, this review systematically examines twenty liquid chromatography-mass spectrometry studies published between 2011 and 2025, covering a range of tomato-based matrices. Data extraction focused on analytical performance, sample preparation, validation parameters, matrix effects and occurrence levels. Across processed matrices, tenuazonic acid (TeA) is the most prevalent toxin, with substantial enrichment in concentrated products, whereas alternariol (AOH) and alternariol monomethyl ether (AME) frequently co-occur and, in several instances, exceed the indicative levels currently set in the European Union (EU). Occurrence data were integrated with international and national consumption datasets to support risk assessment. The analysis indicates that exposures to TeA and tentoxin (TEN) generally remain below the Thresholds of Toxicological Concern (TTCs), whereas estimated intakes of AOH and AME frequently exceed the TTC, particularly among sensitive subgroups. Finally, this review examines the global regulatory framework, indicating that, apart from the EU recommendation, no formal maximum levels for ATs currently exist worldwide. This integrated assessment spotlights data gaps and the need for harmonized monitoring and refined toxicological evaluation. Tomato products are proposed as a model matrix for refining future risk assessment and management strategies for ATs.

Broilers are highly susceptible to heat stress (HS), which can impair bone growth and metabolism. Supplementation with n-3 polyunsaturated fatty acids (PUFA) may affect the metabolism of mineralized tissues, whereas antioxidants can mitigate these effects. The aim was to investigate the combined effects of HS (thermoneutral conditions vs. cyclic HS) or dietary oxidative stress induced by supranutritional n-3 PUFA (control feed without PUFA vs. feed supplemented with 5% linseed oil) with two levels (lower and higher) of dietary antioxidants and minerals on bone properties. The morphology and geometry of the proximal tibiotarsal growth plate, biomechanical behavior, and mineral composition of 42-day-old male Ross 308 broilers were evaluated. HS and high PUFA levels decreased bone size and mass, whereas supplementation with high antioxidant levels had the opposite effect. High PUFA supplementation induced histopathological changes in the growth plate that resembled tibial dyshondroplasia; these effects were attenuated by supplementation with high levels of antioxidants. Additionally, HS had a negative effect on the biomechanics and reduced the crude ash content. High levels of antioxidants increased the bone ash content, fat content, Ca content and Ca:P ratio. Our results suggest that HS and PUFA impair the growth of bones, hindering the overall growth of fast-growing broilers. The incidence of dyshondroplasia appears to be related to diet rather than to environmental changes. High antioxidant levels mitigate the negative effects of both stressors to some extent, suggesting that antioxidants have positive effects on bone growth and functionality, especially under nonoptimal environmental conditions and dietary stress.

Interest in surgical careers is shaped by personal and contextual factors. Although women represent a growing proportion of medical students, they remain underrepresented in surgical specialties. This study evaluated factors influencing interest in General Surgery among medical students, with a particular focus on discouragement and sex differences. A cross-sectional survey was conducted among Brazilian medical students using an anonymous electronic questionnaire distributed through social media. Students who reported General Surgery as their initial specialty choice were included. Sociodemographic characteristics, experiences of discouragement, sources and reasons for discouragement, and factors influencing specialty choice were analyzed. Among 706 respondents, 82 students (11.6%) reported General Surgery as their initial specialty choice. Overall, 65.9% reported experiencing discouragement regarding a surgical career. Women were significantly more likely to report discouragement than men (78.2% vs 40.7%, p&#x202f;<&#x202f;0.001), and female sex remained independently associated with discouragement after adjustment for age, type of medical school, and having a physician in the family (adjusted odds ratio 5.62, 95% CI 1.96-16.09, p&#x202f;=&#x202f;0.001). Among women who reported discouragement, 62.8% indicated that at least one discouraging message was explicitly related to their sex. Family members or friends were the most frequently reported sources of discouragement (70.4%). Extracurricular activities were the only factor influencing specialty choice that differed significantly between sexes (p&#x202f;=&#x202f;0.040). Interest in General Surgery is frequently accompanied by discouragement, particularly among women. Positive exposure to surgery through extracurricular experiences may represent an important avenue for supporting sustained interest in surgical careers.

The presence of organic micropollutants in highly modified lowland rivers is a growing concern for the environment and human health. This study employs both target and non-target analysis over two years with high spatiotemporal resolution in the M&#xfc;nstersche Aa River which is influenced by both agricultural and urban land use to identify major stressors, their input pathways and the impact of low-flow conditions. Treated wastewater is the major input pathway for pharmaceuticals, illicit drugs as well as for pesticides and biocides. Moreover, urban and agricultural non-point sources contribute to the input of organic micropollutants. Database search identified sartans as a therapeutic class of pharmaceuticals of interest in the river and spatiotemporal analysis for two years showed wastewater treatment plants as the major input source with highest concentrations of >1&#xa0;&#x3bc;g/L in summer at low-flow conditions for the sartans. Thereby, mean concentrations of candesartan and valsartanic acid as well as the carbamazepine metabolite 10,11-dihydro-10,11-dihydroxycarbamazepine exceeded health orientation values. For the first time, the UV protection agent 2-[4-(Diethylamino)-2-hydroxybenzoyl] benzoic acid (DHHB) was tentatively identified in a river. Fold change analysis at Lake Aasee, which is a small, shallow reservoir lake in the M&#xfc;nstersche Aa River system, stagnant at low and flowing at high discharge, revealed that elimination and associated formation processes are responsible for the changing occurrence of features at the inflow and outflow of the lake. The exact mechanisms need to be further evaluated. The present study provides valuable insights to stressors in high modified water bodies and shows that fold change analysis after non-target data processing is a valuable tool to gain insights into transformation processes in lakes and rivers which can aid in prioritizing research in the future.

Soil-transmitted helminths (STHs) are intestinal parasitic worms that present a significant global health challenge. Traditionally, the diagnosis of STH infections has relied on microscopy; however, molecular tests such as quantitative PCR (qPCR) are now widely adopted for their greater sensitivity, increasingly reduced cost and higher throughput. Recent evidence highlights genetic diversity in both coding and non-coding DNA regions of STHs routinely targeted by molecular diagnostics. Most qPCR assays have been developed using a limited selection of parasite isolates, thus likely overlooking the substantial genetic variation present within and among STH populations worldwide. Such genetic diversity can significantly impact the diagnostic targets of molecular tests, potentially reducing their sensitivity and leading to false-negative results. Therefore, there is growing recognition of the need to develop diagnostic tools that account for this genetic variation. In this Chapter, we outline current advances in STH genomics and review recent work on the assessment of genetic diversity directly from fecal samples, especially as access to adult worms becomes increasingly difficult. These studies emphasize the importance of thoroughly evaluating current and future diagnostic methods prior to their implementation to effectively guide control measures and policy decisions regarding the cessation of STH deworming. Together, these findings lay the groundwork for genomic epidemiology and the sustainable control of STHs as a public health issue.

Obesity-related metabolic imbalance represents a growing health concern, and increasing attention has been directed toward mild metabolic regulatory interventions based on plant-derived phytochemicals before progression to more severe metabolic disorders. Raspberry ketone (RK), a naturally occurring phytochemical with reported metabolic regulatory activity, exhibits limited gastrointestinal accessibility due to its high crystallinity and poor aqueous solubility. In this study, a chitosan-based cinnamaldehyde-raspberry ketone integrated carrier system (CS-CA/RK) was developed as a surfactant-free oral delivery platform for mild metabolic regulation. The resulting CS-CA/RK system formed a stabilized interfacial carrier architecture with improved dispersion stability and gastrointestinal compatibility for RK. Structural characterization by FTIR, XRD, TEM, and DOSY NMR supported the formation of a unified CS-CA-associated framework and the structural confinement of RK within the carrier architecture. The CS-CA/RK system exhibited enhanced gastrointestinal stability and improved oral bioavailability compared with bulk RK. In a high-fat diet-induced metabolic imbalance model, CS-CA/RK attenuated body weight gain, adipose expansion, hepatic steatosis, and glucose-insulin dysregulation. These results demonstrate that integrating metabolically active phytochemical components into a carbohydrate-based carrier architecture enables the construction of a phytochemical-integrated oral delivery platform that combines structural stabilization with complementary metabolic regulatory functionality within a single system.

Transcutaneous fluorescein isothiocyanate (FITC)-sinistrin fluorescence enables convenient, minimally invasive estimation of the glomerular filtration rate (GFR) in rodents. However, the commonly used fixed-factor conversions (i.e., GFR/BW conversion factor (21.33)/HL, where HL is sinistrin half-life and BW is body weight) assume the volume of distribution scales proportionally with BW. This assumption can bias GFR estimates when body composition shifts with growth or when extracellular fluid volume expands under high-salt intake. Here, we quantified these errors and developed improved HL-to-GFR conversion methods. Male and female Dahl salt-sensitive rats with chronically implanted venous catheters underwent simultaneous measurements of serum and transcutaneous FITC-sinistrin fluorescence. Serum clearance provided reference GFR and serum-derived HL, and the transcutaneous signal provided transcutaneous HL. In separate cohorts, body composition and extracellular fluid were assessed by Nuclear Magnetic Resonance-Bioimpedance Spectroscopy. A regression of GFR&#xd7;HL was performed using BW, age, sex, and salt intake. In low-salt fed rats, sex-specific BW-based models explained much of the variability in GFR&#xd7;HL (females: 97.81&#xd7;BW0.385; males: 203.0&#xd7;BW0.855; BW in kg). Separately, using data from all rats across salt conditions, we derived a salt-dependent conversion to allow for temporal salt effects. The corrected model detected the transient increase in GFR on high salt day 3 that was missed by a fixed factor. GFR scaled sub-linearly with BW (exponent 0.744). Allowing the sinistrin HL-to-GFR conversion to vary with BW and salt condition moderately improves the accuracy of HL-based FITC-sinistrin GFR estimates compared with a single fixed conversion factor and captures the transient GFR increase after salt loading. Sub-linear scaling of GFR supports allometric size adjustment (BW0.744) to reduce size dependent bias and better reflect true GFR in growing rats.

Immunoglobulins are key effector molecules in humoral immunity and play&#xa0;fundamental roles in human health and disease through their complex structure-function relationships. Dysregulation of immunoglobulin production or function underlies numerous conditions, including inflammatory disorders, autoimmune diseases, and metabolic diseases. In the context of cancer, immunoglobulin G (IgG) is frequently enriched within tumor tissue and displays aberrant glycosylation, where it correlates with cancer progression, and its functional impact within the tumor microenvironment is drawing growing interest. Furthermore, recent studies have collectively identified as a novel aging-associated factor involved in multi-organ aging processes. Understanding the role and the mechanisms of immunoglobulins in both physiological and pathological conditions remain a major priority for researchers. Elucidating the underlying pathophysiology and mechanisms of IgG may therefore provide valuable insights for the development of new therapeutic strategies. In&#xa0;this&#xa0;review, we summarize recent progress in the study of IgG in aging and cancer and discuss its potential roles in the future landscape of immunology and biomedical research.

The development and dissemination of improved agricultural technologies are crucial for enhancing productivity and the welfare of smallholder farmers. Although there is growing empirical evidence on the impact of improved agricultural technologies on various economic and social outcomes, some studies often overlook potential biases. Stemming from both observable and unobservable characteristics, these biases can result in misleading conclusions. To fill the gap, this study examined the impact of the adoption of improved cassava varieties (ICV) on farm performance and household welfare using a sample of 608 households from 14 rural communities in Ghana. To account for potential biases, the study used appropriate matching algorithm, local average treatment effects and endogenous treatment effects regression. The findings show that ICV adoption has a positive impact on cassava yields, whole-farm land productivity, and household crop incomes. We also show that adopters have significantly lower total annual per capita and food expenditures than non-adopters. Furthermore, adopters were found to spend more on children's education. Thus, policies and strategies aimed at increasing ICV adoption rates could lead to increased land productivity and crop incomes, as well as enhanced food security and higher investment in children's education, particularly for female-headed farm households.

Endogenous endophthalmitis (EE) is a rare but potentially devastating intraocular infection resulting from hematogenous seeding of an intraocular pathogen from a distant infectious focus. Klebsiella pneumoniae&#xa0;is an increasingly recognized causative agent, classically associated with hepatic abscesses, particularly in Asian populations, but with a growing incidence worldwide. Despite adequate treatment, late inflammatory complications may occur; cystoid macular edema (CME) as a delayed sequela of treated EE has been rarely described in the literature. We report a 64-year-old woman with no prior ophthalmic history and a documented penicillin allergy who presented with bilateral EE secondary to K. pneumoniae&#xa0;hepatic abscesses. At presentation, visual acuity (VA) was counting fingers at one meter in the right eye (RE) and no light perception in the left eye (LE). Treatment included intravenous (IV) imipenem, ciprofloxacin, and metronidazole, combined with bilateral intravitreal injections of vancomycin and ceftazidime. Microbiological analysis of hepatic drainage fluid confirmed K. pneumoniae&#xa0;on day 5. At discharge, RE VA recovered to 8/10, while the LE required evisceration due to irreversible functional loss. Two months later, the patient presented with a sudden drop in RE VA to 1/10. Macular optical coherence tomography (OCT) revealed confluent cystic intraretinal spaces with a central macular thickness (CMT) of 620 &#x3bc;m and a macular volume of 11.35 mm&#xb3;, consistent with inflammatory CME. After confirming infection control, two posterior sub-Tenon injections of triamcinolone acetonide (40 mg/1 mL each), spaced one month apart, resulted in significant edema regression (CMT: 408 &#x3bc;m, average thickness: 341 &#x3bc;m) with VA improvement to 6/10. This case illustrates the occurrence of delayed CME as a late complication of treated EE, likely sustained by persistent subclinical inflammation mediated by pro-inflammatory cytokines (vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-&#x3b1;)), disrupting the blood-retinal barrier (BRB). Sub-Tenon triamcinolone acetonide proved effective and well-tolerated. Prolonged ophthalmologic follow-up with systematic macular OCT is warranted after treated EE to enable early detection and management of late inflammatory complications such as CME.

Phytobacter spp. have recently emerged as opportunistic pathogens in vulnerable patients and are increasingly recognized as carriers of clinically relevant carbapenemase genes, particularly bla KPC-2. Phytobacter diazotrophicus is the most frequently recovered species from clinical specimens in cases of infections. Despite this growing clinical importance, little is known about the presence, genomic characteristics, and environmental dissemination of Phytobacter spp. outside clinical settings. Hospital effluent is recognized as an important environmental pollutant and source of antimicrobial-resistant bacteria carrying resistance genes. However, the occurrence and genomic context of carbapenemase-producing P. diazotrophicus in hospital wastewater remain largely unexplored, particularly in Brazil, where bla KPC-2 is endemic. Therefore, this study aimed to isolate and characterize carbapenem-resistant P. diazotrophicus from the effluent of a pediatric hospital in Brazil. Wastewater samples were collected at Pequeno Pr&#xed;ncipe Hospital, Curitiba Brazil. Phytobacter diazotrophicus isolates were isolated and identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Whole-genome-based analysis was performed to confirm the identity of P. diazotrophicus isolates, and their antimicrobial susceptibility was tested using antimicrobial assays. Expression of the bla KPC gene was confirmed via polymerase chain reaction. MALDI-TOF MS revealed 345 microorganisms, and whole-genome comparisons supported the assignment of five strains to P. diazotrophicus. The resistance phenotypes determined via antimicrobial assays were consistent with the genomic antimicrobial resistance profiles, and two isolates (PHY1 and PHY5) exhibited resistance to carbapenems. Genomic analysis revealed the presence of bla KPC-2 in these two isolates. To the best of our knowledge, this study provides the first evidence of bla KPC-2 harboring P. diazotrophicus in hospital effluent in Brazil. The detection of carbapenemase-producing bacteria in hospital wastewater underscores the importance of effluent surveillance as a strategy to monitor and mitigate the environmental dissemination of antimicrobial resistance.

This review highlights that integrating physiological, molecular, imaging, and AI-based approaches enables early and reliable detection of graft incompatibility, improving rootstock-scion selection, orchard sustainability, fruit productivity, and long-term tree performance. One of the most serious problems in fruit growing is the breaking, weakening, or dying of the tree at the graft union, either within a short period of time or after 10-15&#xa0;years. This condition is often triggered by environmental factors; however, it is certainly not solely caused by environmental conditions. This problem is defined as graft incompatibility. Graft incompatibility refers to the failure of successful anatomical and physiological integration between a rootstock and a scion, primarily due to biochemical, molecular, and genetic mismatches that impair vascular reconnection and long-term stability of the graft union. Graft incompatibility remains a significant constraint in fruit tree production, resulting in reduced longevity, yield, and quality of orchards. This review integrates recent advancements in physiological, molecular, and technological approaches for the early detection of graft incompatibility, with special emphasis on Prunus species such as sweet cherry. Physiological and biochemical markers, including phenolic accumulation, antioxidant enzyme activities, and isozyme patterns, serve as early indicators of incompatibility. At the molecular level, transcriptomic, metabolomic, and epigenetic analyses have revealed differentially expressed genes (DEGs) and post-translational modifications associated with stress signaling, vascular reconnection, and callus formation. Imaging-based non-destructive technologies such as micro-CT, MRI, terahertz, and hyperspectral imaging now allow real-time visualization of graft-union structures without damaging plant tissues. The integration of artificial intelligence and machine learning with multi-omics datasets and imaging tools offers unprecedented potential for predictive diagnosis and compatibility assessment. Collectively, these multidisciplinary advances are reshaping the detection and management of graft incompatibility, enabling faster, more reliable, and sustainable rootstock-scion selection in fruit tree breeding.

The implementation of screening endoscopy and the increasing availability of image-enhanced endoscopy (IEE) has significantly improved the detection of superficial non-ampullary duodenal epithelial tumors (SNADETs). At the same time, growing experience with advanced endoscopic resection (ER) techniques throughout the gastrointestinal (GI) tract has recently extended to the duodenum-an organ traditionally regarded with caution by endoscopists due to its substantial risk of major treatment related complications. These advances have made it possible to achieve successful endoscopic managements of duodenal superficial neoplasms, allowing organ-preservation and reducing the need for highly invasive surgical procedures. Despite this progress, a comprehensive global statement dedicated specifically to the diagnosis and management of duodenal neoplasms has been lacking. Current approaches remain heterogeneous, with substantial geographic variability. To address this gap, we developed an international position statement to guide the diagnosis and management of SNADETs. Nine position statements were formulated regarding the role of endoscopy in diagnosing SNADETs, highlighting the importance of a routine inspection of the first and second part of the duodenum, the role of high-definition endoscopy in the identification of SNADETs, and the increasing role of IEE in the characterization of duodenal neoplasms. In addition, seven statements were developed emphasizing that ER is the preferred approach to manage SNADETs, but it carries a substantial risk of complications, thus complete wound closure after ER should be routinely adopted. A thorough understanding of the current endoscopic strategies and advances to address duodenal neoplastic lesions will ensure a safe, minimally invasive, and effective management of SNADETs globally.

Phyllodes tumors of the breast are rare fibroepithelial neoplasms accounting for 0.3%-1.0% of all primary breast tumors. They are classified into benign, borderline, and malignant subtypes, with borderline and malignant tumors associated with an increased risk of local recurrence and distant metastasis. Giant phyllodes tumors, defined as tumors larger than 10 cm in diameter, are uncommon, and reports of tumors exceeding 20 cm are extremely rare. We report a case of a rapidly growing giant benign phyllodes tumor with skin ulceration, along with a review of the relevant literature. A 48-year-old Asian woman presented with rapid enlargement of the left breast and active bleeding from an ulcerated mass. Clinical findings and imaging studies revealed a well-circumscribed giant tumor measuring 24 cm that occupied the entire left breast, without evidence of distant metastasis. Core needle biopsy suggested a fibroepithelial tumor, and a benign phyllodes tumor was most strongly considered. A left mastectomy was performed. Skin grafting had been considered preoperatively, as the skin defect would be large. However, as sufficient skin flaps were obtained intraoperatively, due to the skin being stretched by the tumor, only mastectomy was done without a reconstructive procedure. Histopathological examination confirmed a benign phyllodes tumor with negative surgical margins. The postoperative course was uneventful. We experienced a rare case of a giant breast tumor and tumor resection. Although rapid breast tumor growth and skin breakdown suggested malignancy, the pathological diagnosis was a benign phyllodes tumor. This highlights the importance of considering phyllodes tumors in the differential diagnosis of rapidly enlarging breast masses and the need for timely surgical intervention. This case is particularly noteworthy because it demonstrates an unusual combination of clinical features-giant tumor size, rapid growth, and skin ulceration-that are generally associated with malignant disease, despite the final diagnosis being benign.