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Children must feel seen, safe, and supported! Laura Gould, MS, joins host, Raisa Amiruddin, MBBS, to discuss the value of soft language, gentle validation, and impacts from giving children a voice in their own care. Discover how simple human connection transforms imaging suites into warm safe spaces for kids.
Background/Objectives: This study aimed to compare the visualization rates of fetal anatomical structures with standard 2D ultrasound examination versus a single 3D volume acquired during the first trimester. Methods: This multicenter prospective study was performed in nine tertiary referral centers, by experienced sonographers. A standard protocol was adopted in both 2D and 3D modalities to assess the 17 anatomical structures listed in the national and international guidelines. The included cases were non-anomalous fetuses from women booked for combined screening test between 11 + 0 and 13 + 6 weeks. Results: Two hundred and thirty-nine women were included in the study. The mean gestational age at ultrasound examination was 12 weeks ± 5 days (±5.4 SD). All the 17 structures were seen in 155/239 fetuses (64.85%) at 2D evaluation and in 84/239 (35.15%) at 3D evaluation (p = 0.001). Comparing 2D and 3D visualization, the following anatomical structures showed a statistical difference: posterior fossa (92% vs. 74%, p < 0.005); neck (94.2% vs. 87.2%, p < 0.001); orbits (93% vs. 85.6%, p < 0.001); nasal bone (93% vs. 88.8%, p = 0.016); lung fields (99.5% vs 96.7%, p = 0.046); cardiac axis (99.5% vs. 83.9%; p < 0.001); bladder (97.5% vs. 91.7%, p < 0.001); abdominal wall (98.7% vs. 94.2%, p < 0.001). For the other anatomical portion, no statistically significant differences were found. Conclusions: Our study demonstrates that a full assessment of fetal anatomy is best performed using 2D ultrasound, while 3D ultrasound showed lower overall visualization rates, with comparable performance for selected structures, suggesting a potential supplementary use in specific clinical contexts.
Biologics have transformed the management of severe asthma, establishing clinical remission as a realistic treatment objective. Moreover, they offer the potential to reduce background treatment with inhaled corticosteroids (ICS). Although guidelines recommend ICS dose reduction in patients achieving disease control, they provide limited guidance on how to implement tapering. In this context, we developed Step-DAWN (De-escalation of ICS in Asthma With a Novel algorithm), a consensus-based protocol that guides ICS tapering in adults with severe asthma receiving biologic therapy. Step-DAWN was ideated through a modified Delphi process; a Steering Committee consisting of two Italian specialists and two pharmaceutical Medical Affairs professionals drafted 30 statements, which were voted on by an Expert Panel comprising 12 specialists. Consensus was reached on 21 of 30 statements in the first round; three other statements reached consensus in the second round; six statements did not reach consensus. The Step-DAWN protocol was designed based on 24 statements that achieved consensus. Patients eligible for Step-DAWN should have maintained the four criteria of complete clinical remission (cCR) for at least 6 months. ICS dose should be reduced gradually, with follow-up assessments not exceeding 6 months. In case of loss of eligibility criteria, potential causes should be addressed before reattempting tapering. Fractional exhaled nitric oxide (FeNO) and blood eosinophil count (BEC) were identified as key biomarkers for monitoring airway inflammation. Step-DAWN is the first consensus-based protocol designed by Italian specialists to provide guidance for ICS tapering in patients with severe asthma treated with biologics.
This study reports a proteomic investigation of historical leather from four Japanese Samurai armors (16th-20th century) from the Morigi Collection (Lugano, Switzerland), with the aim of identifying the animal species used and gaining insight into historical craftsmanship, material selection, and later restoration practices. A bottom-up proteomic workflow combining MALDI-ToF-MS and RPLC-ESI-MS/MS was applied to six leather micro-samples. Initial analyses showed that conventional enzymatic digestion was ineffective for part of the dataset, likely because vegetable tanning agents formed stable insoluble complexes with collagen and hindered protein extraction. To overcome this limitation, an extraction protocol was optimized on modern vegetable-tanned leather using alkaline de-tanning, dialysis, and filter-aided sample preparation (FASP) prior to tryptic digestion. This workflow enabled the taxonomic assignment of all six historical specimens, including three samples that initially failed under conventional digestion and were only resolved after the optimized NaOH/FASP protocol. Deer hide was identified in one sample from the oldest armor, consistent with historical accounts of pre-modern Japanese leather use, whereas bovine leather was found in three samples and sheepskin in two others. The occurrence of sheepskin in a component associated with a 16th-century armor is difficult to reconcile with the documented history of animal exploitation in Japan and more plausibly suggests later undocumented restoration rather than original manufacture. Overall, the results demonstrate that bottom-up proteomics provides an effective and minimally invasive approach for the taxonomic identification of tanned historical leather and offers a robust analytical strategy for the study of culturally significant armor collections.
The Lancet Oncology Commission on Global Cancer Surgery recommended that access to and the quality of surgical care be improved. This study aimed to understand differences in surgical quality between emergency and elective resection among patients with potentially curative colorectal cancer. This preplanned secondary analysis included patients undergoing only curative-intent surgery for colorectal cancer from three contemporary global prospective cohort studies (GlobalSurg-3, 5506 patients; CovidSurg-Cancer, 6719 patients; APOLLO, 876 patients) registered from 2018 to 2023. Hierarchical multilevel logistic regression models quantified associations between the urgency of surgery (elective versus emergency) and surgical quality, measured by margin-positive resection, adjusting for patient, disease, and health system factors. Bootstrap multivariable simulations evaluated effect modification by country income level, cancer stage, and location. Of the 45 699 patients registered, 13 101 across 95 countries were included in this analysis. Overall, 678 patients (5.4%) had margin-positive resections, with higher rates in the emergency than elective surgery group (13.7 versus 4.5%; P < 0.0001). In adjusted multilevel models, emergency surgery was associated with increased odds of margin-positive resections (adjusted odds ratio 2.45, 95% confidence interval (c.i.) 1.86 to 3.22), consistent across all country income groups and robust to alternative health system indicators. Bootstrap-derived absolute risk differences revealed the greatest disparities in patients with stage III-IV rectal cancers, with absolute differences of 12.6% (95% c.i. 10.2 to 15.7) in high-income countries, 19.0% (95% c.i. 13.6 to 23.9) in upper middle-income countries, and 14.1% (95% c.i. 10.9 to 16.5) in lower middle- and low-income countries. Variance decomposition demonstrated that hospital- and country-level factors accounted for 76% of the explained variation in surgical quality. Emergency surgery was associated with a two- to threefold increase in the risk of margin-positive resections globally, independent of resource availability, highlighting a neglected area of global surgical practice. These findings challenge the assumption that poorer outcomes after emergency surgery are due to advanced disease stage. For patients presenting as an emergency with potentially curative resection, enhanced decision-making around resectability, ensuring specialist surgeon availability, and developing bridge-to-surgery pathways represent immediate, low-cost strategies to improve global cancer outcomes.
Chronic inflammatory bowel disease (IBD) is a common illness, with a number of cases constantly rising. Pulmonary involvement is rarely described in children with IBD. This national survey aims to describe the clinical, biological, and therapeutic data of IBD children with pulmonary involvement followed from January 2017 to April 2023 in a rare respiratory diseases center. This was a retrospective, observational, descriptive, multicenter study conducted within the French RespiRare network. Socio-demographic characteristics, previous events, clinical and paraclinical data, treatment, and evolution were collected via an anonymous secure questionnaire. Seven IBD children with pulmonary involvement were reported (four girls and three boys, median age 10 years, 4 with Crohn's disease and 3 with ulcerative colitis). For 2 patients, the discovery of pulmonary involvement was concomitant with the diagnosis of Crohn's disease. Pulmonary symptoms were non-specific or absent. Chest computed tomography scans revealed condensation (n = 5), mosaic appearance (n = 2), excavated (n = 2) or non-excavated (n = 3) nodules or micronodules. Bronchoalveolar lavage revealed hypercellularity with hyperlymphocytosis in 4 patients among 6. Biopsies (n = 5) showed inflammation or granulomas. Organized pneumonia was diagnosed in 5 patients, granulomatosis in 1, and necrotizing pneumonia in 1. Most patients were treated with oral corticosteroids, with a favorable outcome. This is the first nationally reported cohort of IBD children with pulmonary involvement. They are discussed in regard to the 29 previously published cases we found in the same period.
Ecdysone, the major steroid hormone in insects, coordinates developmental progression by coupling systemic hormonal pulses to tissue-specific cellular responses. In this review, we explore its multifaceted roles in regulating organ growth and patterning, highlighting how a single hormone can elicit diverse - and sometimes opposing - outcomes depending on cell type, developmental stage, and hormone concentration. These context-dependent responses are shaped by cell-specific chromatin landscapes, stage-specific transcription factors, and dynamic changes in cellular competence over time, ensuring that successive ecdysone pulses trigger appropriate developmental programs across tissues and life stages. Understanding how such precise spatial and temporal control is achieved remains a central and fascinating question, providing key insight into how a single hormonal signal can orchestrate the remarkable complexity of animal development.
Robotic surgery offers technical advantages for minimally invasive procedures, but standardized clinical training pathways for junior surgeons remain poorly defined. This prospective study evaluated the feasibility and safety of integrating supervised robotic training into routine clinical practice and explored early operative performance patterns. Consecutive patients undergoing elective robotic cholecystectomy or transabdominal preperitoneal (TAPP) inguinal hernia repair between May 2025 and March 2026 were prospectively included in a structured supervised robotic training program. Procedures were performed by three junior surgeons after simulations and bedside robotic experience under direct senior supervision. Primary outcomes included perioperative safety and console takeover rates. Secondary outcomes included operative time and cumulative sum (CUSUM) analysis. A total of 126 patients were included: 103 cholecystectomies and 23 TAPP repairs. In the cholecystectomy cohort, mean operative time was 68.1 ± 18.6 min. No intraoperative complications, conversions, surgery-related postoperative complications, or 90-day mortality occurred. Console takeover occurred in 3 cases (2.9%), corresponding to autonomous completion in 97.1% of procedures. Median hospital stay was 1 day. CUSUM analysis showed heterogeneous operative performance trajectories across junior surgeons, with progressive approximation toward the predefined benchmark. TAPP repair was completed safely without adverse events. Robotic cholecystectomy appears to be a feasible and safe model for total practice-oriented training under structured supervision. Performance optimization and alignment with senior-level efficiency are safely achieved during supervised console exposure. Robotic TAPP repair showed exploratory feasibility as an adjunct training procedure.
The effects of surface functionalization and metal ordering on the structural, mechanical, and electrochemical properties of two-dimensional transition metal carbide MXenes remain insufficiently understood, particularly for double-metal systems. Nb2TaC2 and Ta2NbC2 monolayers, in bare and oxygen-functionalized forms, are studied using density functional theory to determine how these factors affect lithium adsorption, diffusion, and storage performance. Oxygen functionalization increases in-plane stiffness (Young's modulus up to 384.7 N/m) and stabilizes Poisson's ratios, while lithium preferentially adsorbs at metallic sites on bare MXenes and at carbon sites on O-functionalized surfaces, with adsorption energies reaching -3.70 eV. Nudged elastic band calculations show that oxygen functionalization slightly increases diffusion barriers, from 0.05 to 0.21 eV for Nb2TaC2 and from 0.06 to 0.24 eV for Ta2NbC2, while fast Li-ion mobility is maintained. Open-circuit voltage analysis indicates average voltages of 0.74 to 0.95 V with capacities up to 412 mAh/g. These results provide design guidelines for tuning surface chemistry and metal ordering in double-metal MXene anodes for Li-ion batteries.
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Nanoplastics are emerging contaminants of increasing concern in marine ecosystems, yet their in vivo biodistribution and biological effects in benthic organisms remain poorly understood. In this study, we provide an integrated, multi-level assessment of the uptake, translocation, and biological effects of polyethylene terephthalate nanoplastics (PET-NPs) in the brittle star Ophiactis virens, an ecologically relevant benthic invertebrate with high regenerative capacity. Individuals were exposed for 14 days to environmentally relevant (0.05 and 0.5 mg/L) and worst-case (5 mg/L) concentrations of PET-NPs. A multidisciplinary approach combining confocal and electron microscopy, behavioural assays, regeneration analysis, and biochemical biomarkers was applied. Imaging analyses revealed a dose-dependent accumulation of PET-NPs on the body surface and within the vestibulum and digestive systems, demonstrating particle ingestion. Notably, PET-NPs were detected also within internal tissues and intracellular vesicles, providing in vivo evidence of translocation across epithelial barriers and cellular internalization. At the organismal level, the highest tested concentration resulted in increased mortality, impaired righting behaviour and reduced arm regeneration. The latter was significantly reduced also at 0.5 mg/L, dose at which a significant decrease in superoxide dismutase activity was observed as well. This suggests a partial, although dose-independent, modulation of antioxidant homeostasis which however is not accompanied by a clear oxidative damage. Overall, this study provides one of the first integrated in vivo demonstrations of nanoplastic translocation from external exposure to intracellular compartments in a burrowing echinoderm, linking biodistribution to functional impairment. The observed effects on behaviour and arm regeneration highlight the potential ecological consequences of PET-NP exposure for benthic organisms, particularly for species whose fitness depends on locomotor performance and regenerative capacity. These findings underscore the ecological risks associated with PET-NP accumulation in sediment-associated fauna and identify arm regeneration as a sensitive ecotoxicological endpoint for nanoplastic risk assessment.
Assisted reproduction methodologies are essential to protect species from extinction. But to improve reproductive outcomes, we need to understand gamete quality. Gamete quality assays are powerful functional endpoints for comparative endocrinology, especially when they are integrated with hormone measurements and experimental manipulations. However, the methodologies for assessing amphibian gamete quality do not have published validation or comparisons within the literature. In this study we analysed sperm samples from two bell frog species, looking at morphology (measuring sperm head and sperm tail length) using both wet mounts and dry mounts of three different stains (unstained mounts, Coomassie blue and eosin nigrosin). We also assessed viability in the same sperm samples using three different preparations (eosin nigrosin dry mount, eosin nigrosin wet mount, and fluorescent SYBR-14 propidium iodide). We found that the methods varied in mean morphological measurements. For example, sperm tail lengths were measured longer when the slides were dry mounts, and when the eosin nigrosin stain was used. There were differences among species as well, where, for example, sperm head length was influenced by stain type in one species, but not in the other species. Importantly, all methods had similar variance, indicating that all staining techniques are suitable given methods are consistent within a study. For viability methods, the dried eosin nigrosin staining method showed lower viability, while the wet mount of eosin nigrosin and the fluorescent SYBR-14 propidium iodide stain were statistically equivalent. These results indicate that there are a wide range of methodologies that can be used for sperm quality assessment of amphibian sperm, and researchers must choose the methodology best suited for the study.
High throughput metabolomic assays offer a huge opportunity to quantify the cellular processes underlying disease and intervention pathways. However, the multi-dimensional inter-relatedness between these processes coupled with the complex noisy measurement environment create a need for generation of new methods that move beyond simple pairwise associations. To evaluate the utility of a simple, multivariate, relational comparison method called CLARITY in the context of metabolomics data. Nuclear magnetic resonance (NMR)-derived metabolomics data collected from the same individuals (N = 125) before and after a weight management intervention in By-Band-Sleeve (BBS), a clinical trial of metabolic and bariatric surgery, were used. First a traditional (univariate) linear mixed model approach was taken to identify metabolites that were changed post-intervention. The CLARITY method was then used to generate a covariance-based relational anomaly score with a view to increasing classification performance of the underlying cause of changes to the levels of and covariances between metabolites. CLARITY enabled further characterisation of metabolites identified in univariate linear regression analyses, differentiating those that exhibited covariance changes from those with mean changes only. An additional cluster of metabolites were identified as undergoing a relational change that would not have been detected using traditional methods. Gathering insights about biological pathways from large-scale metabolomics data has the potential to inform the future design of modelling and laboratory experiments aimed at capturing the underlying biological processes relevant to disease.
Systemic barriers may affect identification, emergency transportation (EMS), and care coordination for people with stroke. We assessed patient- and hospital-level factors for associations with pre-hospital and emergency department care. We compared trends for patients presenting to an academic medical center (AMC) versus community hospitals (CHs). We conducted a retrospective cohort study at an AMC (Tufts Medical Center) with 542 patients aged ≥18 years hospitalized with acute ischemic stroke or transient ischemic attack between 1/1/2018-12/31/2020 who presented directly to AMC or presented to AMC as a transfer from initial contact CHs. Primary outcomes were EMS use, stroke code activation, door-to-CT time, and door-to-needle time. AMC patients identifying as non-Hispanic Asian (odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.13-0.47) and Hispanic (OR = 0.19; 95% CI = 0.05-0.72) and CH non-Hispanic Black/African-American patients (OR = 0.17; 95% CI = 0.05-0.62) were less likely to use EMS compared to non-Hispanic white patients. Patients with non-English primary language were less likely to use EMS (OR = 0.38; 95% CI = 0.23-0.63) compared to English-speaking patients in both hospital settings. CH Hispanic patients were less likely to have stroke code activation (OR = 0.24; 95% CI = 0.05-0.86) compared to non-Hispanic white patients. CH patients were less likely to have stroke code activation (OR = 0.12; 95% CI = 0.07-0.19), had 31% shorter door-to-CT time (95% CI = 15-43% shorter), and had 29% longer door-to-needle time (95% CI = 5-58% longer). Patient-level factors and hospital setting were associated with differences in acute care suggesting opportunities for community outreach on EMS use, interventions to alleviate language barriers, and a need to address systemic biases.
Upward migration of plant species is a widespread phenomenon in mountain ecosystems under current global warming. Mount Teide (Canary Islands) offers a unique opportunity to study it because of its harsh environment and longstanding botanical studies. Since 1800, current distribution of two endemic species of its summit-ecosystem has shifted very distinctly, more strongly in the case of the generalist Pterocephalus lasiospermus than in the case of the summit specialist Viola cheiranthifolia. In this study we compared the physiological and biochemical responses to environmental stresses (particularly high UV and visible radiation) at two elevations where they currently coexist (2300 and 3500 m). Both species showed different composition of UV-absorbing foliar compounds, but a similar high photosynthetic efficiency at elevated radiation, with no symptoms of photoinhibition even at high irradiance. At high elevation, V. cheiranthifolia showed higher chlorophyll content and remarkable carbon assimilation, with elevation-related changes in physiology but not in leaf mass area (LMA). By contrast, P. lasiospermus showed stress symptoms at higher elevation: higher photoprotection demand in terms of visible and UV radiation and a higher predawn-to-midday responsivity. These results reveal contrasting strategies for coping with extreme mountain environments: high specialization to summit conditions in the endemic violet and greater, but less effective, physiological plasticity in the recent colonizer.
Mass casualty incidents (MCIs) involving pediatric burn patients are rare, high-impact events that can rapidly overwhelm rural emergency departments (EDs), particularly critical access hospitals with limited pediatric and subspecialty resources. We report a pediatric burn MCI involving three critically injured children presenting within minutes of each other to a rural ED following an enclosed structural fire. Pre-arrival EMS notification enabled early activation of institutional MCI protocols and immediate telemedicine consultation with regional pediatric and burn specialists. This facilitated rapid mobilization of multidisciplinary personnel, anticipatory airway planning, and coordination of critical care transport. Upon arrival, patients required simultaneous resuscitation under conditions of limited staffing and constrained transport availability. All three patients were stabilized and transferred to a regional pediatric burn center. Two patients survived to hospital discharge while the third was compassionately extubated at the receiving facility days later. To our knowledge, this is among the first descriptions of telemedicine-supported simultaneous pediatric burn MCI resuscitations in a critical access ED. This case highlights the importance of early MCI activation, and telemedicine-enabled operational and clinical coordination in rural disaster response systems.
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Hearing aids (HAs) can alleviate hearing loss; however, HA rehabilitation is frequently hampered by delayed diagnosis, suboptimal fitting and lack of systematic follow-up. Although the association between hearing loss and cognitive decline has been identified, evidence from randomised controlled trials remains limited. Addressing these gaps is essential for reducing hearing loss-related experiences and evaluating whether effective HA use could reduce the risk of cognitive decline. The healthy hearing for healthy ageing study is a proof-of-concept, single-site, two-arm parallel-group 12-month randomised controlled trial with a 12-month extended follow-up. Up to two hundred participants with hearing loss and without cognitive decline referred for an initial HA rehabilitation are recruited and randomised 1:1 to either data-driven hearing rehabilitation or standard care. The primary outcome is the change in two speech perception in noise tests validated for the Finnish language: the Finnish matrix sentence test and the digits-in-noise test. The secondary outcomes are patient-reported outcomes (eg, Hearing in Real-Life Environment and Speech, Spatial and Quality questionnaires), quality of life (eg, 15D-questionnaire), cognitive (eg, Consortium to Establish a Registry for Alzheimer's Disease test) and psychosocial measures. Exploratory outcomes include event-related responses, cortical auditory evoked potentials, structural brain imaging and vision-related measures. Ethical approval has been obtained from the Regional Medical Research Ethics Committee of the well-being Services County of North Savo (approval no. 697/2023). Findings from this study will be disseminated through peer-reviewed publications, conference presentations and relevant clinical and patient communities. NCT06495268.
Developmental screening can assist in identifying children 'at-risk' of developmental delay. The childcare setting may be the ideal location for screening most children for developmental delay. Therefore, our aim was to determine the feasibility of early childhood educator-led Targeted Motor Control (TMC) screening to identify 4-year-old children 'at-risk' of motor delay. In this study, conducted in Australia, we used a mixed methods convergent design. Educators attended a 2-h in-person TMC training, which included education, and a demonstration and scoring video that educators watched and scored, respectively. Educators then screened a minimum of four children each aged between 3 years 9 months to 4 years and 5 months, using the TMC. The final TMC that each educator performed was coscored by an experienced TMC-trained physiotherapist. Feasibility of the training and use of the TMC was evaluated using an online survey completed by all educators that covered five feasibility themes: acceptability, demand, practicality, implementation and integration. The survey, comprising closed and open-ended questions, was completed by educators after performing all TMC screening. Thirteen educators screened four children each and completed the survey. In terms of major findings, merging of quantitative and qualitative data demonstrated convergence for the themes of acceptability, demand and implementation with 100% agreement between educator and physiotherapist scoring on the TMC. However, there was divergence of findings for the feasibility themes of practicality and integration. It can be concluded that it may be feasible for early childhood educators to perform TMC screening, but we recommend modifications to the training and resources to enable educators to perform screening with greater success.
Mapping vegetation phenology in the high Arctic is critical for understanding ecosystem responses to rapid warming, but persistent cloud cover and low solar angles pose substantial challenges for optical satellite monitoring. We evaluated whether Landsat 8 can successfully map the start of growing season (SOS) at 78°N in Svalbard by developing spectral-based cloud detection algorithms tailored to Arctic conditions. From 17 images during the 2014 growing season, we generated cloud-free NDVI time series and extracted SOS dates at 30-m resolution across Adventdalen (Advent Valley). Validation against six field plots equipped with phenocameras demonstrated strong agreement (R² = 0.884, RMSE = 4.1 days, NSE = 0.869). The resulting SOS map revealed systematic spatial patterns ranging from late May to early August, with elevation explaining 6.6% of variance as the strongest single predictor. Combined topographic models (elevation, slope, distance from sea) explained 14.6% of variance, indicating that unmeasured factors particularly aspect, snow distribution, and vegetation composition exert dominant controls on phenological timing. These results confirm the viability of Landsat-based phenology mapping in the high Arctic. Critically, by establishing a validated processing framework this study provides the methodological foundation for application to the historical Landsat archive (Landsat 4/5 TM and Landsat 7 ETM+), subject to cross-sensor radiometric calibration. This opens unprecedented opportunities for reconstructing 30-m resolution phenological time series extending back to 1984, enabling quantification of four decades of vegetation responses to Arctic warming in regions experiencing some of Earth's most rapid climate change.