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The development of low-potential plateau capacity in hard carbon (HC) negative electrodes is a key route toward enhancing the energy density of sodium-ion batteries. However, owing to the intrinsic structural complexity of HC, the microstructural origin of sodium storage in the low-potential region remains elusive. Here, a direct correlation between microstructure and electrochemical behavior is established, revealing that sodium storage proceeds via the formation of quasi-metallic Na+ clusters accommodated within closed pores and regulated by surface mesoporous architectures, thereby resolving longstanding mechanistic ambiguities associated with the low-potential plateau. In contrast, microporous-dominated surfaces fail to effectively activate plateau capacity, whereas mesoporous-dominated structures construct efficient Na+ diffusion pathways that enable rapid access to closed-pore storage sites. As a result, the plateau capacity is enhanced by 82.5% relative to microporous structures, accompanied by a pronounced increase in the initial discharge capacity from 168.4 to 347.7 mAh g-1. In situ electrochemical impedance spectroscopy combined with relaxation time distribution analysis further confirms the irreversible evolution of the solid electrolyte interphase and its role in stabilizing interfacial kinetics. Moreover, in situ Raman spectroscopy, integrated with multimodal structural characterizations, unambiguously verifies a multistep "adsorption-intercalation/filling" sodium storage mechanism. This work provides fundamental insights into the role of surface pore structures in HC, thereby guiding the rational design of high-performance HC negative electrodes.

To investigate whether tibiofemoral bone and meniscus morphology were associated with dynamic anterior tibial translation (ATTd) and internal tibial rotation (ITRd) during jump-landing tasks in anterior cruciate ligament (ACL)-reconstructed knees. Results may provide some guidance on the use of additional surgical procedures alongside (revision) ACL reconstruction (ACLR). Patients who underwent primary ACLR were included. Morphological features were measured using pre-surgery magnetic resonance images of the operated knee. Dependent variables included ATTd and ITRd during the landing of the single-leg hop for distance (SLHD) and side hop (SH), measured with three-dimensional optoelectronic motion capture. Univariate statistical parametric mapping regression analyses were conducted with morphological features as predictors. Thirty patients were included at 4.7 ± 1.8 years post-ACLR (age: 31.0 ± 4.8 years). Steeper sagittal-plane lateral posterior tibial slope and greater medial-lateral difference in posterior tibial slope were significantly associated with less ATTd (peak r = -0.75; p = 0.048) and greater ITRd (peak r = 0.75; p = 0.047) during the SLHD and SH, but only in ACL-reconstructed knees with a flat medial tibial plateau (-2° to +2°; n = 13 subgroup analysis). Steeper coronal-plane tibial slope was significantly associated with less ATTd during the SLHD (peak r = -0.45; p = 0.049), and with greater ITRd during the SH (peak r = 0.47; p = 0.047). Smaller lateral meniscal slope of the posterior horn was significantly associated with greater ITRd during the SLHD (peak r = -0.46; p = 0.047). Greater lateral femoral condyle ratio was significantly associated with greater ITRd during the SLHD (peak r = 0.46; p = 0.04) and SH (peak r = 0.56; p = 0.006). The observed associations with greater ITRd warrant further investigation into the potential role of anterolateral corner reconstruction alongside (revision) ACLR in patients with these morphological features. Since associations between posterior tibial slopes and ITRd depended on a flat medial plateau, the role of slope-reducing tibial osteotomy appears limited, as these procedures typically do not selectively target a single plateau. Level II.

Amsacrine is an antineoplastic agent for acute lymphoblastic leukemia. It contains methanesulfonamide group -similar to hERG/IKr inhibitors like E-4031 and dofetilide-therefore may exert cardiac arrhythmias. Although amsacrine inhibits expressed hERG channels, its effects on native cardiac electrophysiology remain unclear. We investigated the effects of 1 and 10 µM amsacrine on action potentials (APs) and underlying ionic currents in isolated canine ventricular cardiomyocytes. Amsacrine reduced phase 0 parameters: maximal upstroke velocity (∼50-60%), action potential amplitude (∼15%), and peak potential (∼55%), suggesting inhibition of sodium current. Moreover, the maximal rates of phase 1 and 3 repolarizations, and plateau potentials were reduced, suggesting effects on multiple ionic currents. Despite these, AP duration (APD20-APD90) remained unaffected. AP voltage-clamp analysis revealed a complex amsacrine-sensitive current consisting of an early inward component consistent with sodium current inhibition, a second early outward component suggesting transient outward current suppression, a mid-plateau inward component likely reflecting inhibition of inward plateau currents, and a late outward component compatible with IKr inhibition. 10 µM amsacrine reduced L-type calcium, transient outward potassium and expressed NaV1.5 channel currents by 22, 38, and 10%, respectively. Native IKr was also reduced in a concentration-dependent manner (152 nM IC50 and 1.21 Hill coefficient). These findings demonstrate that amsacrine modulates multiple cardiac ion currents. The lack of AP prolongation despite IKr inhibition can be due to concomitant suppression of inward currents. As the tested concentrations overlap with therapeutic plasma levels (3-18 µM), amsacrine may carry a non-negligible risk of cardiac electrophysiological effects, particularly in susceptible patients.

Extrapolated reference values (E-Ref) is a method to extract reference values (RVs) from a mixed data set (i.e., a data set containing normal and abnormal findings). This is an attractive way for any laboratory to develop their own RVs. Since its original description, we have made enhancements to the E-Ref method. Due to growing interest in this methodology, we describe our current version of the algorithm and interpretation of its results. The cumulative distribution function (CDF) is the foundation of E-Ref methodology. Computer simulations were used to generate "normal" and mixed data sets of conduction velocity. The E-Ref algorithm was revised based on the analysis of CDF in the simulation studies. Bootstrap analysis was performed to assess the variability of estimates and finalize the RV. Median motor nerve conduction parameters from patient studies were analyzed. The CDF shows a "plateau" that contains the majority of the normal data even in a mixed data set. The mean of data in the plateau approximated the mean of "normal" measurements. The difference between the maximum and minimum in the plateau was close to two standard deviations (SDs). The new algorithm establishes three ranges to define findings: definitely normal, definitely abnormal, and borderline. This is consistent with the customary clinical thought process where abnormalities are not "black and white." Bootstrap analysis must be performed for reliable estimates. This may be useful to assess the adequacy of the sample size.

Tc -99m -diethylenetriaminepentaacetic acid renal scintigraphy is a noninvasive method for assessment of graft function. Here, we evaluated the diagnostic accuracy of quantitative scintigraphy parameters in differentiating ischemic complications (acute tubular necrosis ) from nonischemic complications (acute rejection, tubulointerstitial nephritis ), using tissue biopsy as the reference standard. We retrospectively analyzed 63 kidney transplant recipients who underwent Tc -99m -diethylenetriaminepentaacetic acid renal scintigraphy followed by renal biopsy within 6 months posttransplant. Quantitative parameters derived from time -activity curves included delta peak, peak perfusion activity, plateau perfusion activity, peak perfusion activity -to -plateau perfusion activity ratio, peak function activity, peak perfusion activity -to peak function activity ratio, and the 20 /3 ratio. We compared scintigraphy findings with biopsy results categorized as ischemic, nonischemic, or normal. For statistical analysis, we used the Mann -Whitney test and receiver operating characteristic curve analysis. Of the 63 patients, 59 had abnormal biopsy findings (5 ischemic, 54 nonischemic ). Scintigraphy findings were concordant with biopsy results in 61 cases. Delta peak (P = .043 ) and peak perfusion activity -to peak function activity ratios (P = .015 ) differed significantly between ischemic and nonischemic groups. Receiver operating characteristic curve analysis showed that delta peak was a good predictor of nonischemic complications (area under curve = 0.772 ), whereas peak perfusion activity -to peak function activity ratio was a strong predictor of ischemic complications (area under curve = 0.822 ). A delta peak cutoff value of 6.5 seconds yielded 63 %sensitivity and 80 % specificity for identifying nonischemic complications, whereas a peak perfusion activity -to peak function activity ratio cutoff of 1.31 provided 80 % sensitivity and 82 % specificity for detecting ischemic complications. Quantitative parameters derived from Tc -99m -diethylenetriaminepentaacetic acid renal scintigraphy are useful for differentiating ischemic from nonischemic renal transplant complications and correlate well with biopsy findings. These parameters may aid in the early diagnosis and management of posttransplant graft dysfunction.

This study examined the association between non-restorative sleep (NRS) and functional limitation among US adults aged 25-74 years, assessed dose-response patterns, and estimated the population attributable fraction (PAF). This cross-sectional study used nationally representative Midlife in the United States Refresher 2 data from 2022-2024 (n=1,699). NRS was categorized as none or rare (never/rarely), intermediate (sometimes), or frequent (often/almost always). A secondary exposure quantified cumulative sleep burden as the count of 3 problems-trouble falling asleep, night waking, and feeling unrested-reported as often or almost always. Functional limitation comprised difficulty with basic or instrumental activities of daily living. Propensity score matching balanced 15 covariates. The PAF was estimated using a generalized Miettinen approach. Frequent NRS was associated with higher odds of functional limitation than no or rare NRS (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.61 to 3.18). Each 1-category increase was associated with 45% higher odds (OR, 1.45; 95% CI, 1.24 to 1.70). Odds also increased with cumulative sleep problems: 1 problem (OR, 1.66; 95% CI, 1.14 to 2.41), 2 problems (OR, 2.50; 95% CI, 1.63 to 3.81), and 3 problems (OR, 2.50; 95% CI, 1.51 to 4.11), suggesting a plateau at higher burden levels. Under causal assumptions, the PAF was 23.9% (95% CI, 14.3 to 34.3), corresponding to approximately 6.9 million affected US adults. RS and cumulative sleep problems were associated with functional limitation in graded patterns that plateaued at higher levels. Sleep disturbance may represent a scalable target for intervention when addressed in middle adulthood.

Achieving a high plateau capacity in hard carbon (HC) anodes is one of the most critical prerequisites for high-energy-density sodium-ion batteries (SIBs), yet it is fundamentally limited by inaccessible closed pores formed during conventional high-temperature annealing. Here, we propose a potentially scalable oxidation-reconfiguration strategy to unlock its latent capacity. By coupling controlled oxidative etching with subsequent thermal reconstruction, an interconnected closed-pore network is constructed. Oxidative pretreatment opens blocked channels and interconnects isolated voids, while reconstruction promotes void fusion, generating accessible internal reservoirs for the nucleation and storage of quasi-metallic sodium clusters. This structural evolution and storage mechanism are elucidated by total neutron scattering, SAXS, in situ techniques, and simulations. As a result, the optimized ICP-HC anode delivers reversible capacity 437 mAh g-1 with an initial Coulombic efficiency of 91.5%. It achieves an initial discharge plateau capacity of 399 mAh g-1 with fast kinetics (300 mAh g-1 at 2C), overcoming the capacity-rate trade-off. Furthermore, an NVP//ICP-HC full cell shows excellent rate capability (96 mAh g-1 at 5C) and stable cycling (95% retention over 200 cycles at 1C). This work provides a scalable strategy for advanced carbon anodes in high-energy-density SIBs.

Learning curves can quantify how trainees acquire complex clinical skills. We applied this concept to track pharmacists' proficiency in reviewing prescriptions for anesthetics and Schedule-I psychotropics-high-risk areas where workforce shortages are acute. Twenty pharmacy trainees enrolled in a tertiary-level hospital in 2025 completed a 10-step program; each step comprised 100 prescription reviews. Accuracy of review decisions, time to completion, and correct use of professional terminology were recorded for every trainee at every step. Cumulative-sum charts for binary outcomes were constructed for each metric, for the cohort overall, and for each individual. Pearson and Spearman coefficients tested associations between the step at which a trainee's curve flattened and baseline characteristics. Group-level curves plateaued at step 7 for overall proficiency, step 6 for terminology, step 7 for accuracy, and step 8 for speed. Individual curves began to flatten between steps 4 and 9. A strong negative correlation was found between years of prior front-line pharmacy experience and the number of steps required to reach plateau (r = -0.521, p = 0.018). Learning-curve analysis objectively identifies when pharmacists achieve consistent, timely, and accurate review of high-risk prescriptions. The cohort approached proficiency after approximately 600-700 reviewed prescriptions, with prior experience accelerating the process. Incorporating curve monitoring into training programs can guide individualized instruction and provide an evidence-based benchmark for competence.

The impact of polymer solution droplets on granular beds is relevant to powder processing, binder-jetting additive manufacturing, and environmental applications involving erosion control or spray deposition, yet most controlled studies of drop-grain interactions have focused on Newtonian liquids. In this study, we experimentally investigate the impact of viscoelastic polyethylene oxide (PEO) solution droplets on a dry granular bed and compare the resulting cratering dynamics with those of Newtonian liquids over a wide range of impact energies and Ohnesorge numbers. Crater morphology changes with impact energy, and this evolution occurs at lower energies for drops of polymer solution, consistent with their distinct liquid-grain interactions during impact. The crater diameter exhibits two distinct regimes: a low-energy plateau and a power-law increase at higher impact energies. We identify the transition between these regimes and show that, although the plateau size and the power-law scaling remain nearly unchanged, viscoelastic droplets reach the transition at a lower impact energy than Newtonian droplets. This suggests that the non-Newtonian response introduced by PEO modifies how the impact energy is partitioned among droplet deformation, liquid-grain coupling, and dissipation in the granular bed.

The interactions between indium and aquatic organisms are poorly documented despite indium increasing use. This study aimed to improve current knowledge of indium effects and intracellular fate in microalgae. The model green algae Chlamydomonas reinhardtii were thus exposed for 96 h to total indium concentrations ranging from 0.08 to 36.5 &#xb5;M and examined for their growth and subcellular parameters as well as for their indium subcellular distribution and speciation using differential ultracentrifugation and size-exclusion chromatography coupled with inductively coupled plasma mass spectrometry (SEC-ICP-MS), respectively. The strong adsorption of indium onto flask walls and its low solubility limited its stability and tested concentrations in the exposure media. Under these conditions of low bioavailability, indium did not have any significant effects on algal growth and subcellular parameters. Internalized indium was observed to plateau at a maximum value of 18.5 amol.cell-1 from 8 &#xb5;M total indium concentration. This internalized indium was mainly localized in granular (53%) and organelle fractions (33%), with only minor association with heat-stable or denatured proteins. Analysis of cytosol fraction by SEC-ICP-MS further revealed that indium was predominantly bound to biomolecules >470 kDa and to low-molecular-weight ligands <10 kDa. These results demonstrate for the first time that internalized indium could bind to sensitive sites in algal cells and that algae could employ intracellular granules to sequester part of the accumulated indium. Additional studies using molecular mass spectrometry based hyphenated techniques are needed to identify the biomolecules responsible for indium complexation in the cytosol in order to better understand indium reactivity within algal cells.

Plasma phosphorylated tau 217 (p-tau217) is a promising biomarker for monitoring treatment response in Alzheimer's disease (AD), but its longitudinal dynamics and clinical relevance remain unclear. In this prospective real-world study, 153 patients with early AD receiving lecanemab were analyzed. Longitudinal changes in plasma p-tau217 were assessed, and trajectory patterns were identified using clustering and slope-based approaches. Associations with baseline factors and cognitive outcomes were evaluated. Plasma p-tau217 levels decreased significantly from 3 months, with the greatest decline between 3 and 6 months, followed by a plateau. Two distinct trajectory groups were identified. Patients in the greater reduction group showed more favorable cognitive trajectories, particularly slower progression in Clinical Dementia Rating-Sum of Boxes (CDR-SB) scores. Hypertension was associated with a diminished biomarker response. These findings support plasma p-tau217 as an early pharmacodynamic biomarker and highlight its potential role in guiding individualized treatment strategies in routine clinical practice.

The Loess Plateau is a principal dryland winter wheat production region in China, where unreasonable sowing rate and fertilization management limit yield and quality. A two-factor split-plot experiment was conducted during 2019-2021 with three sowing rates (150&#xa0;kg ha-1, 180&#xa0;kg ha-1, 210&#xa0;kg ha-1) and three fertilization type (CK, OPT, OPT-N). Increasing sowing rate to 210&#xa0;kg ha-1 significantly improved population tiller, secondary root number, and canopy structure. OPT reduced N input by >&#x2009;50% but maintained plant growth and delayed leaf senescence. The 180&#xa0;kg ha-1 rate enhanced canopy light interception at anthesis, while 210&#xa0;kg ha-1 better sustained post-anthesis chlorophyll content, net photosynthetic rate, and stomatal conductance. Compared with OPT, OPT-N markedly restricted root growth, photosynthesis, and matter accumulation. 210&#xa0;kg ha-1 + OPT significantly increased 1000-grain weight by 5-11%, grain yield by 1.7-3.7%, total starch by 1.91-5.22%, and flour processing quality. The interaction significantly regulated growth, photosynthesis, yield, and quality. This study demonstrates that 210&#xa0;kg ha-1 + OPT realizes synchronous improvements in yield, quality, and resource efficiency under reduced N input, providing a green cultivation model for dryland wheat.

Rotator cuff tears (RTs) are among the most prevalent musculoskeletal conditions worldwide, imposing substantial burdens of chronic pain, functional limitation, and socioeconomic cost. The underlying pathophysiology is multifactorial, encompassing progressive mechanical attrition, tendon degeneration, and irreversible biological deterioration, including muscle atrophy, fatty infiltration, and altered glenohumeral kinematics that may ultimately culminate in cuff tear arthropathy. The central clinical challenge lies in stratifying patients appropriately and selecting the optimal treatment strategy before irreversible structural compromise renders either conservative or surgical intervention ineffective. This systematic review comprehensively synthesizes the available evidence on rotator cuff failure, evaluating its etiology, natural history, diagnostic accuracy of modern imaging modalities, and long-term functional outcomes, with direct comparison of conservative versus surgical management strategies and an assessment of emerging rehabilitation adjuncts. Adhering strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic search was performed across PubMed, Google Scholar, Scopus, and the Cochrane Library. Eligible studies included randomized controlled trials (RCTs) and cohort studies of adult patients with confirmed rotator cuff pathology diagnosed by MRI or high-resolution ultrasonography. Data extraction prioritized validated functional shoulder outcome scores. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias 2 (RoB2) tool for RCTs and the Risk of Bias-I (ROBINS-I) tool for non-randomized observational studies. Twelve studies meeting full eligibility criteria were included. Multi-center RCTs and cohort studies demonstrate equivalent functional outcomes between conservative care and surgical repair for small-to-medium degenerative tears. Longitudinal cohort data identify a critical dose-effect threshold at 16 physical therapy sessions, beyond which further functional benefit plateaus. Arthroscopic repair delivers outcomes equivalent to open techniques with substantially reduced surgical morbidity. Emerging adjuncts, including pulley exercises at six weeks post-repair, blood flow restriction training, ultrasound-guided dry needling, and asynchronous telemedicine, demonstrate significant improvements in pain modulation, range of motion, and therapeutic adherence. Optimal management of rotator cuff&#xa0;failure demands an individualized, milestone-driven approach. Structured conventional therapy constitutes an evidence-supported first-line intervention for chronic degenerative tears; however, patients who fail to achieve functional milestones after conservative treatment require a timely transition to arthroscopic evaluation to prevent irreversible structural decline. Surgical approach, suture anchor technique, tissue biology, and postoperative protocol adherence are each determinative of repair success. Integration of advanced biological, digital, and remote rehabilitation modalities further bridges the gap between radiographic severity and real-world patient functionality.

Soil total phosphorus (STP) is a key component of the terrestrial phosphorus cycle, and its spatial distribution pattern profoundly influences ecological security and the stability of food production. This study integrates 20,372 nationwide plot monitoring records and, based on the Random Forest algorithm, constructs a 1 km resolution layered spatiotemporal map of STP across China for the period 2000-2020. The results show that China's STP exhibits an overall "central high, northern-southern low" spatial pattern, with South China identified as a contiguous low&#x2011;phosphorus region (<0.4 g/kg). Vertically, STP decreases by approximately 25.8% with increasing soil depth. The study further reveals regional differentiation characteristics of STP variation: the mid&#x2011;temperate zone serves as the core area of phosphorus accumulation, while the middle&#x2011;lower Yangtze River region and the Sichuan Basin are identified as hotspots of phosphorus loss. Solar radiation (SR) is the main positive driver of phosphorus enrichment in plateau regions (affecting 29.1% of the national area, ca. 2.65 &#xd7; 106 km&#xb2;), whereas wind speed is the primary negative driver of phosphorus loss in arid regions (affecting 32.7% of the national area, ca. 2.98 &#xd7; 106 km&#xb2;). Temperature (Tmp) exhibits a bimodal regulatory pattern. This study systematically elucidates the integrated impacts of natural and anthropogenic factors on the spatiotemporal pattern of STP, proposes a multi&#x2011;scale analytical framework for soil phosphorus cycling, and provides both data support and scientific basis for the zonal management of phosphorus resources and sustainable agricultural development.