Future large-scale combat operations will produce casualty volumes and injury patterns that exceed current military surgical capacity, particularly in contested, resource-limited environments requiring prolonged, autonomous care. Concurrently, the Military Health System (MHS) faces the "peacetime effect" or "Walker Dip," with declining exposure to high-acuity trauma and reduced operative experience during residency, contributing to gaps in combat readiness. Despite this, no standardized Military Unique Curriculum (MUC) exists for surgical trainees. In this commentary, we describe a comprehensive, longitudinal MUC at the Uniformed Services University (USU) and Walter Reed National Military Medical Center (WRNMMC) designed to develop expeditionary surgical capability throughout residency. This model integrates four core domains: (1) military-civilian partnerships to ensure exposure to complex trauma and surgical pathology; (2) military-specific didactics and mentorship grounded in operational experience; (3) a robust simulation-based curriculum focused on austere, open surgical care; and (4) mission-aligned research and graduate education. While descriptive, this model demonstrates a feasible approach to embedding combat-relevant training within residency rather than relying solely on pre-deployment courses. The USU/WRNMMC MUC offers a scalable framework to standardize expeditionary surgical training across the MHS and better prepare surgeons for future conflict.
Stress fractures frequently occur in athletes and military personnel due to their rigorous training and are typically treated conservatively with immobilization and rehabilitation. However, a displaced distal third stress fracture of the fibula that requires surgical intervention is a rare occurrence. A 20-year-old male military recruit under training for 1 month presented with a week-long history of pain and swelling in his right ankle and difficulty in walking. A plain radiograph revealed a transverse fracture of the fibula with a minimal displacement, consistent with a Kaeding-Miller type III stress fracture. Although considered low-risk, the fracture was treated surgically with open reduction and internal fixation using a one-third tubular plate due to the rigorous demands of military training and the extended recovery time associated with conservative management. Postoperatively, nonweight bearing with structured rehabilitation was done, and the fracture healed early without complications. A minimally displaced stress fracture of the distal fibula managed operatively is a rare entity with very limited literature published which poses diagnostic and therapeutic challenges. This case demonstrates that minimally displaced fibular stress fractures can be diagnosed using plain radiographs and may necessitate operative reduction and fixation, especially in high-demand athletes and military personnel.
The study aims to substantiate the development of an oral dosage form for military medicine based on the API dimethylammonium 3-methyl-2-(2-((E)-styryl)quinazolin-4-ylthio)butanoate, which demonstrates antioxidant and hepatoprotective activity. The molecule's physicochemical properties and dissociation constant were evaluated. Computer modelling was used to assess lipophilicity, physicochemical parameters, and ADME characteristics via the SwissADME service. Drug-likeness was evaluated according to Lipinski's Rule of Five. Conductometric studies of API solutions (0.0625-0.5 M) were performed with a Konduktometr N 5721 M to determine χ, λv, λ∞, α, and the dissociation constant (7.45 × 10-8-9.2 × 10-8). The ionization constant was used to calculate pK = 7.13, indicating the pH range of optimal absorption. ADME analysis showed high gastrointestinal absorption and suitable solubility, supporting the feasibility of an oral dosage form. Conductometric data confirmed the API to be a weak electrolyte with increasing dissociation at lower concentrations. The pK value suggests preferential absorption in the neutral to slightly alkaline environment of the small intestine. Considering its pharmacological activity, the API is promising for further development of tablets or capsules for military and clinical use. The findings justify designing a gastro-resistant oral dosage form ensuring API stability in gastric acid and efficient intestinal absorption. Such a form is particularly valuable for military medicine due to its stability, portability, and suitability for emergency and rehabilitation settings.
The perinatal period is a window of exacerbated vulnerability for eating disorder symptoms. Moreover, US military servicewomen represent a population at increased risk for eating disorder psychopathology relative to civilians. However, no study has evaluated changes in eating disorder symptoms across the perinatal period in servicewomen. Active-duty servicewomen (N = 192, ages 20-41), between 12- and 27-weeks' gestation at study enrollment (between 2023 and 2024), completed questionnaires assessing binge-eating, avoidance of eating/dietary restraint, eating concerns, and body dissatisfaction at three time points: second trimester, third trimester, and postpartum. A series of general estimating equations and linear mixed models were used to evaluate eating disorder symptoms over the three time points. Mean frequencies of past-month binge-eating episodes were high (~9-10 across time points) and did not change across pregnancy and the postpartum period (p = 0.452). Similarly, eating concerns did not significantly change over time (p = 0.078). Avoidance of eating/dietary restraint did not change from second to third trimester (p = 0.593) but significantly increased during the postpartum period (ps < 0.001). Body dissatisfaction decreased from second to third trimester (p = 0.008), followed by a significant increase in the postpartum window (ps < 0.008). Risk for binge-eating and eating concerns among servicewomen was not significantly different across the time points during the perinatal period, whereas body dissatisfaction and avoidance of eating/dietary restraint were highest postpartum. Findings are consistent with military culture and policies requiring Service women to return to meeting specific fitness and anthropometric standards after giving birth. Results support postpartum screening for eating disorder symptoms in the military.
Elite acrobatic military parachutists are exposed to extreme repetitive axial loads and high gravitational forces, and low back pain (LBP) is common; however, the relationship between LBP and trunk neuromuscular function in this population remains unclear. This study aimed to explore whether lumbar multifidus (LM) activation and the lumboabdominal strength ratio differ between parachutists with and without LBP. This exploratory cross-sectional study assessed nine male elite Spanish Air Force acrobatic parachutists (mean age 31.2 ± 5.5 years; 3527.89 ± 2973.92 lifetime jumps). Participants were classified into two groups: those without LBP and those with current LBP or a history of LBP within the previous 6 months. LM activation was measured with surface electromyography (mDurance). Trunk flexor and trunk extensor isometric strength were measured with handheld dynamometry (HHD) (Lafayette Manual Muscle Tester), and the lumboabdominal strength ratio was calculated as abdominal strength divided by lumbar extensor strength. Between-group comparisons used Mann-Whitney U tests for continuous variables and Fisher's exact tests for categorical variables with Bonferroni correction; a two-sided probability value less than 0.05 was considered statistically significant. LBP prevalence was 44.4% (4/9), and no sick leave due to LBP was reported. Groups did not differ in age, anthropometrics, lifetime jumps, daily energy expenditure, or sitting time (all probability values greater than 0.05). In the total sample, mean LM activation was 0.57% and 0.79% of the maximum voluntary isometric contraction (MVIC) at rest (left and right, respectively), and 34.34% and 34.47% of the MVIC during the functional task. The mean lumboabdominal strength ratio was 0.90. Effect sizes were negligible for basal multifidus asymmetry and the lumboabdominal strength ratio (δ = 0.00) and small-to-moderate for functional multifidus asymmetry (δ = 0.30), with no statistically significant between-group differences after Bonferroni correction. In this homogeneous cohort of elite acrobatic military parachutists, low back pain was not associated with altered LM activation or lumboabdominal strength ratio as assessed by field surface electromyography and HHD. These findings are hypothesis-generating given the small sample size and support larger multicenter longitudinal studies incorporating dynamic and imaging-based assessments to clarify mechanisms and readiness implications.
Combat has been related to suicidal thoughts and behaviors via increased PTSD and depression in prior work; however, such studies have been limited by sample size, reliance on self-report, failure to account for other disorders, and a limited focus on ideation and attempts. The objective of this study was to overcome these limitations by examining the association between combat and suicide ideation, attempts, and deaths in a large and diverse sample of veterans (N = 324,510) using survey data, electronic health records, and National Death Index data. As expected, combat was positively associated with PTSD and depression, which were, in turn, positively associated with suicide ideation, attempts, and death. Combat was indirectly associated with all three outcomes via PTSD-depression after accounting for the influence of other psychiatric disorders, although the effects were small in magnitude. Combat exposure, PTSD-depression, and other psychiatric disorders collectively accounted for 30-35% of the variance in suicide attempts and suicidal ideation, respectively. In contrast, combat exposure, PTSD-depression, and other psychiatric disorders collectively accounted for only a small fraction of the variance (2%) in suicide deaths. Taken together, our findings suggest that combat is primarily associated with suicidal ideation and suicide attempts (as opposed to suicide deaths) via PTSD and depression (as opposed to other psychiatric conditions). More research is needed to identify predictors of suicide death among military veterans. Combat was primarily associated with suicidal ideation and suicide attempts (as opposed to suicide deaths) via PTSD and depression (as opposed to other psychiatric conditions).The presence of PTSD and depression diagnoses partially explained the association between combat exposure and suicide ideation, attempts, and deaths.Whereas combat and PTSD-depression had significant associations with all three suicide-related outcomes, they appeared to play a comparatively modest role in risk for suicide deaths in this study of military veterans.
Leptospirosis is a global zoonosis with varying severity that remains underreported due to diagnostic limitations. We analyzed the burden, epidemiology, and clinical characteristics of leptospirosis diagnoses in the Military Health System, which includes care to more than 1.3 million active-duty service members and 6.5 million retirees and dependents worldwide. Potential diagnoses were identified by leptospirosis-specific ICD-9 and ICD-10 codes or laboratory tests between January 1, 2013 and December 31, 2021. Upon chart review they were classified per U.S. CDC case definitions. Of 296 identified potential leptospirosis cases, there were 11 confirmed, 134 probable, and 53 possible cases. The majority of cases were young adult males. Japan, Guam, and Hawaii were the most common areas of exposure. Most cases were associated with freshwater exposures, both from recreational and occupational exposures (including a significant number associated with jungle warfare training in Okinawa). Confirmed cases were statistically more likely to be diagnosed in Hawaii. This study from a worldwide distributed unified health system reaffirms the global distribution and wide range of clinical severity of leptospirosis. It highlights the relatively few confirmed diagnoses in the setting of diagnostic limitations even in a population already presumed to be at elevated risk. Strategies and improved diagnostics are needed to shift clinician practice to pursue confirmatory testing, particularly in cases with a high suspicion or high-risk of exposure. Recent improvements in availability and performance of various testing methodologies (multiplex polymerase chain reaction based-assays and serological testing) may further define the epidemiology of this global disease.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
This narrative describes the journey of a disabled veteran who experienced homelessness before ultimately becoming a physician. Early life instability, including a federal raid on the family home and subsequent homelessness, led to military service as a means of escape and structure. After 10 years of active duty in the Air Force, musculoskeletal injuries and force reduction resulted in an unexpected separation, loss of stability, and a return to homelessness. Despite these challenges, the author pursued higher education using the GI Bill and ultimately entered medical training. During residency, a clinical encounter with an active duty service member facing a potentially career-altering injury highlighted the continuity between patient and physician experiences. This perspective underscores the unique value that physicians with lived military experience bring to veteran care. This story reflects resilience, identity reconstruction, and the importance of shared experience in the care of military populations.
Personality dysfunction is increasingly conceptualised dimensionally, yet evidence for the occupational validity of contemporary personality disorder models in military settings remains limited. This study examined psychometric validity and applied utility of the PID-5-BF+M in a naval sample (N = 1874) using archival occupational health data. Structural validity was evaluated using confirmatory factor analysis and gender-based measurement invariance testing, while internal consistency, construct validity, and associations with resilience, borderline personality indicators, and real-world adjustment outcomes were also examined. The six-domain structure of the PID-5-BF+M was supported, with acceptable internal consistency for the total score and most domains. Negative affectivity and disinhibition showed expected associations with borderline personality indicators, while higher personality dysfunction was moderately associated with lower resilience. Notably, negative affectivity and detachment independently predicted probable ICD-11 Adjustment Disorder, explaining approximately 30% of variance. Algorithm-based identification of possible personality disorder yielded markedly different prevalence estimates depending on facet- versus domain-level thresholds, highlighting risks of false-positive classification in occupational samples. Elevated anankastia traits were common but largely unrelated to maladjustment, suggesting contextual adaptiveness in structured naval environments. Findings support the PID-5-BF+M total score as a pragmatic global index of personality dysfunction severity for use in occupational health screening, while underlining the necessity of context-sensitive, multi-method interpretation. Personality assessment in military settings should prioritise functional impairment over trait elevation per se.
Adjustment disorder is the most common mental health diagnosis in the U.S. military and one of the most common globally, yet its patterns and predictors are rarely studied. Identifying career phases and characteristics associated with increased risk of first adjustment disorder (AD) diagnosis among U.S. Army soldiers can inform targeted prevention and intervention efforts. This longitudinal, retrospective cohort study analyzed data from the Study to Assess Risk and Resilience in Servicemembers-Longitudinal Study (STARRS-LS). Administrative medical and personnel records from active duty Regular Army enlisted soldiers (2015-19) were used to identify all 118,735 person-months with a first AD diagnosis and a representative, stratified probability sample of control person-months with no history of AD diagnosis (n = 316,275). Risk of first AD diagnosis was estimated as function of time in service, stratified by sex and occupation. Logistic regression examined socio-demographic, service-related, and mental health risk factors for first AD diagnosis during periods of greatest risk. This study was approved by the Institutional Review Boards of STARRS-LS collaborating institutions. AD cases were 77.2% male, 54.9% ≤24 years old, and 51.0% White Non-Hispanic. For 63.7% of cases, AD was their first documented mental disorder during service. Of those, 25.5% had been diagnosed with a stressor or marital problem in the previous 12 months. Risk of first AD by time in service was bimodal, with elevated risk during the first 1-4 years ("early-career") and years 17-20 ("late-career"). This pattern was consistent across sex and occupational groups. Based on a sample size-adjusted alpha level, 12 of 13 multivariable risk factors were associated with early-career AD, whereas 7 of 13 were associated with late-career AD. Notable risk factors among early- and late-career soldiers were female sex (early-career: OR = 2.0; 95% CI = 1.9-2.0; late-career: OR = 1.4; 95% CI = 1.3-1.5), deployment status (early: never-deployed, OR = 2.0; 95% CI = 1.9-2.2, previously-deployed, OR = 1.6; 95% CI = 1.4-1.8; late: previously-deployed, OR = 1.7; 95% CI = 1.5-2.0), and recency of previous mental health diagnosis (early: past-month, OR = 3.7; 95% CI = 3.6-3.8; late: past-month, OR = 4.2; 95% CI = 3.9-4.5), stressor/marital problems (early: past-month, OR = 5.7; 95% CI = 5.5-5.8; late: past-month, OR = 4.1; 95% CI = 3.8-4.6), and postconcussive syndrome (early: past-month, OR = 3.0; 95% CI = 2.6-3.5; late: past 2-3-months, OR = 2.7; 95% CI = 1.5-4.8). Magnitudes of other significant ORs were more modest. Interactions indicated that associations of 9 risk factors differed for early versus late career soldiers. First AD risk is highest among soldiers either beginning their Army careers or approaching retirement eligibility. Differences in risk factors across groups highlight the importance of considering distinct military and life experiences/stressors when attempting to target and tailor interventions for those at risk of AD.
The ability to predict cardiometabolic risk is essential to support efforts to prevent future onset of disease. Biomarkers that assess biological aging-the rate of decline in physiological functioning that occurs across the systems of the human body-have the potential to support this goal. We investigated the extent to which Dunedin Pace of Aging Calculated From the Epigenome (DunedinPACE), an epigenetic measure of biological aging, predicted cardiometabolic disease onset in a cohort of 2062 US military veterans free of disease at baseline and followed for an average of 14.1 years via electronic health records. Other clinical biomarkers included hemoglobin A1C, blood pressure, pulse, and body mass index. DunedinPACE predicted incident cardiometabolic disease onset (hazard ratio [HR]=1.82 [95% CI, 1.64-2.04]; P<0.001) and remained associated with cardiometabolic disease onset when accounting for hemoglobin A1C, blood pressure, pulse, and body mass index (HR=1.38 [95% CI, 1.23-1.55]; P<0.001). DunedinPACE increased prediction of cardiometabolic disease (area under the receiver operating characteristic [AUROC] curve=0.76, ΔAUROC=0.04) compared with demographics alone and increased prediction when combined with clinical biomarkers, demographics, smoking, and alcohol use (AUROC=0.81, ΔAUROC=0.01, ΔΧ2 = 27.81, df=1, P<0.001). These results suggest that DunedinPACE improves prediction of cardiometabolic disease compared with other clinical biomarkers and could help identify individuals who would benefit from preventative interventions that delay the onset of cardiometabolic disease.
While most concussion research focuses on sports or military injuries, most emergency department-diagnosed concussions result from other forms of trauma, highlighting a gap in understanding concussion prevalence among admitted trauma patients. To assess the prevalence of concussion in admitted trauma patients using systematic screening, and to evaluate associated symptoms, screening tool performance, and cognitive deficits within this population. A single-center, prospective cross-sectional study was conducted over 3 months (April-June 2023) at a southeastern US Level I Trauma Center that examined concussion prevalence in admitted trauma patients using systematic screening. The Standardized Assessment of Concussion (SAC) was completed within 48 hours for eligible patients, and the Cognistat evaluation was used to assess concussion-related deficits; 3 additional questions assessed amnesia. A total of 1077 patients were evaluated for study inclusion, with 285 meeting criteria. The age range was 14-95 years, with a mean of 46.5 (SD 18.4). Males were the largest group, accounting for 184 (64.6%). The median Injury Severity Score was 16. Using the Standardized Assessment of Concussion for concussion screening, 122 (42.8%) were diagnosed with concussions. Further testing with the Cognistat showed 54 patients (44.2%) had moderate to severe cognitive deficits. Our study showed that systematic screening of trauma patients helps identify underappreciated, subtle diagnoses, which can potentially cause long-term negative effects if not treated promptly.
Femoroacetabular Impingement Syndrome (FAIS) is a prominent source of non-arthritic hip pain and is highly prevalent in young active populations. Decisions to undergo surgery are significant in nature and require proper understanding of potential benefits and risks. To develop and user-test a patient decision aid comparing non-surgical management and hip arthroscopy for FAIS with an additional military-related section. Mixed-methods. The initial draft of the decision aid was developed by a multidisciplinary steering group. An iterative process of semi-structured interviews, re-drafting and further interviews provided feedback on the decision aid. The interviews were analysed reflexively using thematic analysis for qualitative findings. Acceptability questionnaires were analysed using descriptive statistics for quantitative findings. We interviewed 27-participants; 13 clinicians (6 physiotherapists, 3 orthopaedic surgeons, 2 general practitioners, 1 sports medicine doctor, 1 anaesthesia pain physician) and 14 patients. Most participants rated the decision aid's acceptability as good-to-excellent. Participants agreed on most aspects of the decision aid including the introduction, treatment options, comparison of outcomes and questions to consider asking a health professional. Participants agreed on including more information on the treatment options and provide more long-term outcomes comparing the options. Our decision aid met all 6 of the International Patient Decision Aid Standards qualifying criteria. Our decision aid was considered a useful tool that may help patients choose an appropriate treatment option for the management of FAIS. A clinical trial evaluating the impact of the decision aid on decision making for patients considering surgery for FAIS is needed.
Contemporary crises increasingly draw health systems, humanitarian access, medical supply chains, and civilian protection into security-oriented governance. While the health consequences of war and economic coercion, and geopolitical rivalry are widely documented, less attention has been paid to the discursive processes through which such consequences are rendered legitimate, unavoidable, or politically peripheral. This paper addresses this gap by applying a critical geopolitics framework and critical discourse analysis to examine how geopolitical narratives may structure health-relevant governance during crises. Drawing on a purposive, illustrative corpus - (i) a primary corpus of institutional and policy discourse (state communications, United Nations and World Health Organization documents, sanctions guidance, and international non-governmental organizations' reports) and (ii) a secondary corpus of scholarly literature, the study identifies three recurring discursive mechanisms: securitization, exception-making, and displacement of responsibility. Across five illustrative case contexts-US-China geopolitical rivalry, the Russia-Ukraine war, the Israel-Palestine/Gaza crisis, Iran-related sanctions and protest governance, and US-Venezuela sanctions governance-the analysis suggests how security narratives can condition humanitarian access, reshape the practical meaning of civilian protection, and diffuse accountability for health harms. Rather than arguing that discourse alone causes health outcomes, the paper treats discourse as one governance condition among others: it influences what becomes politically thinkable and institutionally actionable while interacting with military, economic, legal, and health-system factors. The findings advance critical health geopolitics and peace and security scholarship by showing how health inequities can function as a diagnostic lens through which norm erosion and the normalization of exceptional governance become empirically visible.Clinical trial numberNot applicable.
Post-traumatic stress disorder (PTSD) screening and prediction tools are widely used in veteran and trauma-exposed populations, yet methodological practices show substantial gaps. Rigid threshold application, inconsistent calibration reporting and limited attention to sex-based performance differences, comorbid conditions including traumatic brain injury (TBI) and moral injury and cultural context may introduce inequities and reduce clinical utility. PTSD screening programmes miss cases in some groups while over-referring in others, yet lack practical guidance for addressing these disparities. We provide an implementation framework that operationalizes existing standards (TRIPOD-AI, PROBAST-AI) with concrete, PTSD-specific procedures for calibration assessment, sex-stratified analysis and comorbidity integration. We conducted a systematic scoping review of PTSD screening and prediction studies (2019-2024, n = 75 studies) and synthesized published meta-analytic evidence on TBI-PTSD associations as a worked exemplar of comorbidity integration. We developed a tiered implementation framework (Tier 1: minimum standards; Tier 2: recommended practices; Tier 3: excellence standards) addressing observed heterogeneity. Technical feasibility was demonstrated using synthetic data explicitly matching published PTSD parameters from landmark veteran studies. The scoping review of 75 studies (2019-2024) found that only three studies (4.0%) reported calibration metrics, and only 10.7% provided sex-disaggregated performance metrics. Current reporting practices inadequately address TBI-PTSD comorbidity heterogeneity, moral injury (0% of studies) and cultural adaptation. These findings document substantial methodological gaps and demonstrate framework recommendations target empirically observed heterogeneity. The framework organizes recommendations into three tiers based on feasibility and resource requirements. Tier 1 standards (achievable by all studies) include: precise population definition, pre-specified thresholds, calibration slope reporting, sex-disaggregated performance and missing data documentation. Tier 2 recommendations (feasible for most studies) include: bootstrap internal validation, formal sex-stratified calibration testing with specified interaction thresholds (|β3| > 0.10), decision curve analysis, comorbidity integration and multiple imputation (m ≥ 20). Tier 3 excellence standards (aspirational for well-resourced studies) include: rigorous multi-site external validation, annual calibration monitoring and cultural adaptation for refugee contexts. Synthetic data demonstration (n = 850, matching Bovin 2016 and Wortmann 2016 published parameters: PTSD prevalence = 33%, PCL-5 distributions, TBI prevalence = 35%) confirmed technical feasibility using standard statistical software. Bootstrap validation (500 iterations) yielded optimism-corrected AUC = 0.969 with negligible optimism. Sex-stratified analysis detected meaningful calibration differences (|Δ| = 0.14, exceeding threshold). Comorbidity analysis revealed prevalence stratification (40.4% vs. 30.6%) despite minimal discrimination improvement (ΔAUC = +0.003), clarifying comorbidity's dual role in prediction versus case-finding. Published meta-analyses demonstrate consistent TBI-PTSD associations (2.68× risk overall; 4.18× in military populations) alongside substantial prevalence heterogeneity (I2 = 96%) that current reporting practices inadequately address. Using TBI as a worked exemplar of comorbidity integration alongside sex-stratified validation, moral injury assessment and cultural adaptation, the tiered framework provides PTSD-specific operational guidance for implementing established methodological standards, designed for incremental adoption based on study resources. All Tier 2 components are implementable with standard methods and moderate sample sizes. Prospective validation studies are needed to assess whether framework implementation improves calibration stability, subgroup equity and clinical outcomes compared to standard practice.
The widespread presence of per- and polyfluoroalkyl substances (PFAS) at industrial and military sites threatens subsurface environments and human health. Conventional barrier materials, such as those used in cutoff walls and compacted clay liners, retain PFAS poorly due to their low adsorption affinity. To address this, we engineered a robust functionalized clay (DMOAP-Kao) by covalently grafting dimethyloctadecyl[3-(trimethoxysilyl)propyl]ammonium onto kaolinite. This grafting strategy ensures superior stability compared to modification by cation exchange. The resulting DMOAP-Kao exhibited a high PFAS adsorption capacity and sustained strong adsorption performance under various aqueous chemistry conditions. Permeation tests further confirmed that incorporating DMOAP-Kao as an amendment into soil-bentonite barrier materials enhances PFAS retardation performance. Molecular dynamics simulations identified three distinct PFAS adsorption morphologies, corresponding to their binding with the outer organosilane shell, the inner organosilane shell, and the kaolinite surface. Free energy calculations revealed a three-stage adsorption process synergistically governed by electrostatic attraction and hydrophobic interactions. The positively charged quaternary ammonium groups of the grafted DMOAP enable long-range electrostatic attraction, effectively "capturing" anionic PFAS species from water and drawing them toward the modified clay surface for subsequent binding. This study establishes a conceptual framework for designing high-affinity clay adsorbents by selecting functionalized organosilanes based on the specific physicochemical properties of target contaminants and grafting them via condensation with the hydroxyl groups on clay surfaces and edges.
Differentiating pediatric medulloblastoma (MB) from ependymoma (EA) in the fourth ventricle remains challenging due to overlapping clinical and imaging features. This study aimed to identify distinctive semantic features and develop a feature-based model for differentiating MB from EA using conventional MRI. This multi-center retrospective MRI study enrolled 295 pediatric patients, including 184 MB and 111 EA cases, allocated to the training, internal validation set, and external testing set. Subsequently, 13 semantic features were extracted. After feature selection, quantitative parametric models and mixed parametric models were constructed and evaluated. Finally, three junior and three senior radiologists completed independent and model-assisted assessments. MB showed significantly greater left-right/upper-lower (0.98 vs. 0.76) and anterior-posterior/upper-lower (0.88 vs. 0.66) diameter ratios compared to EA (both p < 0.001). The pathognomonic "sea anemone sign" (100% specific for MB) occurred in 38.60% of MB cases. The support vector machine (SVM) model achieved optimal performance, with areas under the receiver operating characteristic curves (AUCs) of 0.946/0.921/0.915 and accuracies of 0.906/0.907/0.832 across training/internal validation/external testing sets. With SVM model assistance, diagnostic performance improved for both senior and junior radiologists across all datasets. In the external testing set, the AUCs increased to 0.849-0.893 for junior radiologists and 0.893-0.913 for senior radiologists, with the accuracies of 0.832-0.858 and 0.850-0.867, respectively. The sea anemone sign is highly specific for MB. The SVM model using conventional MRI semantic features achieved robust discrimination between MB and EA, significantly augmenting the diagnostic accuracy of radiologist assessment.
The significant variation in treatment strategies among breast cancer subtypes establishes precise early subtyping as a critical prerequisite for effective therapy. While molecular profiling offers accurate classification, developing a rapid and reliable detection method remains challenging. Hence, we constructed an integrated platform by integrating a DNA tetrahedral probe (DTP) and surface antiadhesive magnetic micro/nanorobots (MNRs), enabling rapid contact between the MNR-DTP system and target analytes. The probe enhances fluorescence via target-triggered strand displacement and CHA-mediated signal amplification, allowing breast cancer subtypes to be identified through distinct dual-color fluorescence patterns. Furthermore, magnetically driven MNRs improve detection efficiency by enhancing mass transfer, promoting mixing, and accelerating probe-target interactions. Experimental results demonstrate that this strategy markedly enhances fluorescence output, enables rapid detection of dual-miRNA signatures in different breast cell lines, and distinguishes expression heterogeneity at the single-cell level. The system shows high specificity and improved sensitivity, with limits of detection of 1.5 pM for miR-21 and 1.17 pM for miR-31. The biocompatibility and stability of the proposed MNR-DTP system make it a promising tool for early breast cancer subtype discrimination and multiplexed target recognition in complex biological settings.