Falls are the leading cause of accidental injury among older adults, 30% of community-dwelling adults aged 65 and over fall each year, with nearly half occurring outdoors. These falls are complex, understudied, and insufficiently addressed in current age-friendly cities or walkability frameworks. This study aimed to build interdisciplinary consensus on risks, preventive actions, and barriers to fall prevention in outdoor public spaces through a Delphi process. A three-phase Delphi study was conducted with 64 participants in round 1, 60 in round 2, and 49 in round 3, including four expert groups: older adults who had fallen outdoors, health and research professionals, urban planners, and decision-makers (local and regional policy-makers, elected officials, and public-space managers involved in urban planning). Phase one collected open responses on risks, preventive actions (modification of physical layout, public-space management, and behavior-related factors), and barriers to these actions. Responses were synthesized using AI-assisted analysis with systematic human validation. In phases two and three, the relevance of 124 propositions were rated on a 10-point Likert scale. Consensus was defined as ≥ 70% of ratings ≥ 7/10 and interquartile range ≤ 2.5. Consensus was reached for key intrinsic factors such as gait and balance impairments, visual and vestibular deficits, cognitive decline, and polypharmacy, as well as for environmental factors including irregular or inappropriate surfaces, obstacles, or signage, and crowding. Highly relevant preventive actions included integrating fall prevention into street and sidewalk design, training urban planning professionals, awareness campaigns, systematic maintenance, safer crossings, participatory co-design public-space adaptations and urban design features involving older adults and local stakeholders, and improved data monitoring through surveillance, mapping, and sharing of fall-related and environmental risk information. Main barriers were insufficient budgets, high costs, limited integration of fall prevention into planning priorities, and lack of evaluation of the impact of implemented actions. Outdoor fall prevention is a transversal challenge requiring integration of public health and urban planning. This Delphi highlights actionable priorities to embed fall prevention in local and national strategies, in particular in rapidly aging regions.
Pain from dental caries is strongly linked to increased school absenteeism and poorer academic performance. This burden is pronounced in Saudi Arabia, where the prevalence of caries is double the global rate despite the availability of public dental services and various national oral health outreach programs, suggesting potential gaps in access to dental care. While the public health benefits of school-based oral health programs are well-documented, existing school-based caries prevention programs in Saudi Arabia are limited, episodic, and lack continuity, reducing long-term impact. This Theoretical Article addresses these limitations by proposing an innovative model of integrating dental hygienists as permanent providers of school-based preventive dental services. The integration of dental hygienists as permanent staff in schools is a needed intervention to address Saudi Arabia's high childhood caries prevalence. The proposed model promotes early, consistent, and equitable delivery of preventive dental services, reducing disparities and supporting long-term improvements in oral health equity. The integration of dental hygienists in schools would fill gaps in the current dental public health programs and offer a sustainable, equity-driven approach to reduce the prevalence of caries and oral health disparities.
Zoonotic diseases are common threats to global health. A large number of infectious diseases are transmitted from animals to humans. The current study aimed to assess the community's knowledge, attitudes, and practices (KAP) regarding common zoonotic diseases in the Arbaminch district. A cross-sectional survey was carried out between November 2024 and June 2025. A total of 384 participants were interviewed in the study. Participants residing in these areas were randomly chosen. Data were collected using a structured questionnaire. The collected data were analyzed using Stata 17, and the results were reported using descriptive statistics and the chi-square test. The findings of this study revealed that a majority (55%) of participants had good knowledge about zoonotic diseases. Respondents know several modes of transmission for zoonotic diseases, with animal bites (32.5%) being the most recognized, followed by direct contact (15.5%), ingestion of raw products (10%), and inhalation (10%). Regarding attitudes, 63.2% of respondents exhibited a positive attitude towards the importance of zoonotic disease prevention and control, and 67.4% of respondents followed relatively good hygiene and preventive behaviors. However, risky practices were still common. Knowledge score showed a significant association with age. Attitudes of participants were significantly associated with education, age, occupation, and income. Similarly, practices were significantly associated with gender, education level, occupation, and income, with all associations being statistically significant (p < 0.05). The overall community knowledge, attitudes, and practices regarding zoonotic diseases were relatively good.
School belonging is a key protective factor for socioemotional functioning during the preschool period. Counsellors working in preschool institutions play an important role in developing sense of school belonging by meeting their emotional and social needs and fostering a positive school environment. This study examined the views of school counsellors working in preschool education institutions in Türkiye regarding sense of school belonging and, to support these views and to reveal their reflection at the level of institutional practice, analysed routine guidance and counselling documents to identify how belonging-supportive practices are formally planned, implemented, and recorded over the school year. A phenomenological qualitative design was employed. Data were collected through structured interviews with school counsellors and complemented by document analysis of counselling artefacts to examine how belonging practices are formally planned, implemented, and documented across the school year. The document corpus comprised 186 written artefacts from 10 kindergartens. Data were analysed using computer-aided content analysis, and a hierarchical code-subcode model was utilised in MAXQDA 2020. Findings indicated that counsellors conceptualised school belonging as children's feelings of acceptance and security within the school community and described belonging-related differences in children's emotions, participation, and peer interactions. Counsellors also highlighted multi-level strategies targeting emotional safety, peer relationships, teacher practices, and family involvement. Complementing these findings, the document analysis yielded five practice-oriented domains through which counselling services may support school belonging: (1) emotional safety and adjustment to school routines, (2) support for peer relationships and social problem-solving, (3) cultivation of a positive classroom/school climate through teacher collaboration, (4) systematic family involvement and parent education, and (5) developmental monitoring and evaluation. Document analysis corroborated counsellors' reported perspectives by providing practice-level evidence of how belonging-supportive strategies were formally embedded in institutional plans and documented in artefacts. Preschool children's school belonging is supported through a year-long programme of practice spanning children, teachers, and families. Strengthening preventive counselling services that promote emotional safety, peer-inclusion, and family-school collaboration may improve school belonging in early childhood, as this phenomenon has far-reaching implications for children's educational trajectories, working lives, and broader societal and democratic engagement.
The role of diet in multiple sclerosis (MS) development is still a matter of debate and its impact on MS course is not well understood. We tried to investigate the possible role of adolescent diet in late-onset multiple sclerosis (LOMS) odds. LOMS patients were obtained from the National MS Registry of Iran. Controls were sex and age matched with no history of neurological disorders. We assessed dietary factors using a questionnaire based on multinational studies. Food consumption levels were classified into low, medium, and high for each item. Logistic regression models were used to evaluate diet's impact on LOMS odds. We included 83 LOMS cases and 207 matched healthy controls. The mean age for LOMS patients was 61.14, compared to 61.51 years for controls. The results showed that higher consumption of dairy as in the third tertile associated with 79% decline in LOMS odds (AOR: 0.21; 95%CI: 0.09-0.47). Higher seafood consumption, in the third tertile was associated with a decrease in the odds of LOMS (AOR: 0.32; 95%CI: 0.14-0.72). Furthermore, increased nut consumption, in the third tertile (AOR: 0.37; 95%CI: 0.18-0.77), decreased the odds of LOMS. Additionally, higher consumption of fruits (AOR: 0.22; 95%CI: 0.07-0.63) and vegetables (AOR: 0.26; 95%CI: 0.12-0.55) was linked to a reduced odds of LOMS. This research highlights the advantageous impact of dairy products, seafood, nuts, fruits, and vegetables in lowering the LOMS odds. Hence, advocating for nutrition role in development of LOMS could represent a preventive measure for people susceptible to MS.
There have been discussions as to the time of elective induction of labour to curb the continuation of pregnancy that might endanger the lives of both the mother and child. This research was conducted to assess foetal and maternal consequences of planned delivery at 40 and 41weeks in women with low-risk singleton pregnancy. A randomised controlled trial with equal allocation of participants (96 pregnant women in each arm) into 40weeks and 41weeks. Participants were randomised at the antenatal clinic at 39 weeks for induction of labour. The main outcome was the caesarean section rate. Secondary outcomes were maternal (genital tract laceration rate) and foetal (rates of meconium staining of amniotic fluid, SCBU admission, perinatal mortality, birth trauma, birth weight, and neonatal APGAR score at 1 and 5 minutes). Student t-test and chi-square test were used for inter-group comparison. Incidence of caesarean delivery (26.6% vs. 21.3%; p=0.406), and genital laceration (2.1% vs. 5.6%; p=0.268) did not differ between groups. Significantly higher birth weight was noted among women induced at 41weeks (3.41 ± 0.37kg) than 40weeks (3.28 ± 0.46kg) (p=0.043). Also, there was significant variation in meconium staining of amniotic fluid between 40weeks (11.7%) and 41weeks (25.8%) (p=0.014). Other foetal outcomes showed no significant difference. Inducing labour at 40weeks is safe for low-risk women as it does not significantly increase the cesarean delivery rate and adverse perinatal outcomes. Therefore, elective induction of labour at 40weeks should be recommended and introduced into obstetric practice without the fear of adverse outcomes.
The deltoid ligament (DL) is the primary stabilizer of the medial ankle, but its injury mechanisms remain poorly understood. This study aimed to investigate the injury risk and mechanisms of individual DL bundles under both acute and chronic conditions to inform prevention and treatment strategies. A validated finite element model of the human foot was used to examine peak stresses in DL bundles under four acute loading scenarios. Chronic loading was simulated by applying gait loads after transecting the lateral ligaments, and the resulting DL stresses were compared with those of the intact model. Additionally, thirty-nine rats were assigned to three groups: a lateral ligament rupture group (LR, n = 13), a tibialis posterior tendon rupture group (TPR, n = 13), and a sham group (n = 13). After 6 weeks of treadmill running, the mechanical properties and histological characteristics of the DL, along with ankle joint morphology and articular stresses, were evaluated to further verify the hypothesized mechanisms of chronic injury. Under acute loadings, the tibiocalcaneal ligament (TCL), anterior tibiotalar ligament (ATTL), and deep posterior tibiotalar ligament (dPTTL) showed the highest stress under pronation-external rotation loading. Lateral ligament rupture increased DL stress during gait. After 6 weeks of treadmill running, the LR and TPR groups showed roughened articular surfaces with osteophyte formation, increased articular stress, decreased talar bone volume fraction, lower failure load and stiffness ratios of the DL (p < 0.01), reduced fluorescence intensity of COL1, and elevated levels of COL3, MMP-2 and IL-1β compared with the sham group (p < 0.01). The TCL, ATTL, and dPTTL bundles are particularly susceptible to acute injury, with pronation-external rotation posing the greatest risk. Chronic degeneration of the DL occurs following rupture of the lateral ligament or tibialis posterior tendon, with a more pronounced effect after lateral ligament rupture.
With the popularity of short video platforms, Short Video Addiction has become a growing mental health concern. From a cognitive-emotional perspective, this study examined the association between Parental Neglect and Short Video Addiction among college students, focusing on the mediating role of Thought Suppression and the moderating effect of Thought Control Ability. A cross-sectional survey was conducted among 1,337 college students using the Parental Neglect Scale, Short Video Addiction Scale, White Bear Suppression Inventory, and Thought Control Ability Questionnaire. The results showed that Parental Neglect, Thought Suppression, and Short Video Addiction were all significantly and positively correlated with one another, while Thought Control Ability was significantly and negatively correlated with these three variables. Thought Suppression partially mediated the relationship between Parental Neglect and Short Video Addiction, and Thought Control Ability moderated the path from Thought Suppression to Short Video Addiction: for individuals with lower Thought Control Ability, Thought Suppression was a stronger positive predictor of Short Video Addiction; whereas for those with higher Thought Control Ability, this positive association was significantly attenuated. These findings suggest that enhancing individual Thought Control Ability may be associated with reduced negative influence of Thought Suppression on Short Video Addiction. This provides a theoretical and practical basis for cognitive-level interventions to help prevent excessive use of short video platforms among young adults.
Hydatid cyst disease is a parasitic disease induced by Echinococcus granulosus, which is still endemic in northern African countries. We report the case of a late-discovered pulmonary hydatid cyst in a four-year-old boy revealed by recent dyspnoea. The chest X-ray showed a complete white-out of the left hemithorax with mediastinal deviation, and the thoracoabdominal CT scan showed a giant pulmonary hydatid cyst encompassing the entire left lung associated with a hepatic cyst. An emergent superior pulmonary lobe resection was performed under deep general anaesthesia and selective intubation to prevent contralateral lung inundation. The evolution was favourable postoperatively.
Wild isolates of Toxoplasma gondii may exhibit different virulence characteristics and host adaptability compared with those of laboratory strains. In this study, we isolated a novel rodent-derived T. gondii strain, denoted TgRodGz1, and evaluated its pathogenic features. TgRodGz1 was isolated from T. gondii-positive wild rodents in Guangdong Province and compared with the RH and Me49 strains in C57BL/6 mice. Virulence and intestinal injury were evaluated by survival analysis, brain cyst quantification, histopathology, tight junction assessment and qPCR. Gut microbiota and metabolic alterations were analyzed by metagenomic sequencing and LC-MS/MS-based metabolomics. Compared with theT. gondii laboratory strains RH and Me49, TgRodGz1 was associated with more pronounced intestinal injury, including villus atrophy, barrier disruption and downregulation of tight junction proteins and increased gut permeability and inflammation. Metagenomic analysis revealed significant intestinal flora dysbiosis, with a marked reduction in beneficial bacteria and expansion of pathogenic bacteria. Metabolomic analysis revealed suppression of arachidonic acid (ARA) metabolism during TgRodGz1 infection. Supplementation with ARA did not directly inhibit parasite growth but significantly alleviated intestinal lesions, reduced brain cyst burden and attenuated inflammatory responses, including microglial activation. These findings suggest that TgRodGz1 represents a distinct T. gondii genotype associated with pronounced intestinal pathology and suggest that ARA supplementation may alleviate intestinal and neuroinflammatory changes associated with T. gondii infection.
Complex tissue architecture is achieved through multiple rounds of morphological transitions. Here, we analyzed cellular flows and tissue mechanics during avian skin development by employing chicken and transgenic quail skin explant models. We demonstrate how novel cellular flows initiate chemo-mechanical circuits that guide epithelial protrusion, folding, invagination, and spatial cell fate specification. During initial feather bud formation, stiff dermal condensates protrude vertically from the locally softened epithelial sheet. As the bud elongates, it stretches the epithelial cells at the base, thus mechanically activating YAP, which causes the epithelial sheet to fold downward and form a stiff cylindrical wall that invaginates into the skin. This stiff epithelial tongue is essential for the compaction and formation of the tightly packed dermal papillae. These topological transformational events are mechanically interconnected, and the completion of one circuit initiates the next. In contrast, during scale development, the rigid epithelial sheet restricts dermal cell flows, preventing further topological transformation. Based on these findings, we developed a topological transformation model describing how this process enabled the evolution of feather follicles from scales.
To investigate risk factors for early childhood caries (ECC) among 1-2-year-old children in Beijing and to assess the effect modification of baseline caries experience on the associations between other risk factors and subsequent caries outcomes. A 12-24-month prospective study was conducted from 2021 to 2023, a total of 919 participants with valid data were included in this study, with a follow-up rate of 76.9%. Oral health information and related factors were collected through parent-completed questionnaires and clinical dental examinations. Univariate analyses and a zero-inflated negative binomial (ZINB) regression model were used to identify risk factors. Caries incidence during follow-up was 29.8%, and the mean increase in decayed, missing, and filled primary teeth (Δdmft) was 0.94 ± 1.94. In the full-sample ZINB model, significant predictors of caries risk were frequency of snack intake, frequency of candy consumption, frequency of bedtime tooth brushing, frequency of bottle use at bedtime, and baseline caries status. In the baseline caries-free group, additional significant predictors of incident caries risk were parents' caries status, frequency of saliva-sharing behavior, frequency of post-meal mouth rinsing, and the presence of additives in daily drinking water. Interaction analyses showed that the effects of parents' caries status, saliva-sharing frequency, post-meal mouth rinsing frequency, presence of additives in daily drinking water, bedtime brushing frequency, and history of dental attendance on caries risk differed significantly between children with and without baseline caries. The risk of early childhood caries (ECC) among 1-2-year-old children in Beijing was associated with multiple oral health-related factors. Baseline caries experience was a strong predictor of subsequent caries risk and significantly modified the effects of other risk factors.
This study aims to evaluate the outcomes of a new PND initiative designed to optimize healthcare delivery in a highly consanguineous population. A descriptive study was conducted at a major tertiary referral center for genetic diseases in Saudi Arabia with a large scope objective to improve the existing prenatal diagnosis (PND) process. Consequently, a new prenatal workflow featuring a structured checklist, a dedicated prenatal board, and enhanced genetic counseling has been implemented since September 2023. The study included all prenatal cases with a documented autosomal recessive (AR) disease. The program processed 1128 cases, with 952 cleared by the prenatal checklist. In total, the board has discussed 160 variants of unknown significance (VUS), of which 122 (76%) were upgraded to likely pathogenic/pathogenic. Remarkably, the prenatal checklist enhanced patient safety and reduced serious harm incidents, while the prenatal board facilitated precision medicine by leveraging collective expertise in variant interpretation. This initiative significantly improved the healthcare, safety, and accessibility of PND services. The prenatal board and checklist streamlined decision-making, minimized errors, and enhanced patient outcomes. The model provides a cost-effective approach to preventing genetic diseases in highly consanguineous populations and serves as a replicable framework for similar settings worldwide.
Peritoneal fibrosis, driven by M2 macrophage polarization, limits the long-term application of peritoneal dialysis (PD). Although ADAM19 is known to mediate fibrosis in other organs, its specific role in PD-associated peritoneal fibrosis remains unclear. PD patients were enrolled in a single center and divided into three groups depending on the PD time. Demographic and clinical data were collected. We detected the expressions of ADAM19, Notch1, Fibrosis-associated protein, chemokines and inflammatory factors in the peritoneum dialysis effluent by real-time PCR and western-blot assays. Macrophages were identified through flow cytometry. Then we analysis the relationship between ADAM19 and clinical data in PD patients. Furthermore, we established mouse models for peritoneal fibrosis to verify the biological function of ADAM19 in regulating macrophage polarization. In the long-term group, the fibrotic proteins (Fibronectin, α-SMA) and inflammatory factors (IL-6, IL-10) and chemokines (CCL5, CCL2, CXCL16) were higher than short-term group and more macrophages polarized towards M2. ADAM19 expression was linearly correlated with dialysis time and Kt/v. The AUROC of ADAM19 was 0.738 to identify the predictive value for peritoneal dialysis adequacy. The cut-off of ADAM19 RNA level was 7.84. In logistic regression models, higher ADAM19 (≥ 7.84) was also independently associated with lower Kt/v (< 1.67). Additionally, the results revealed a moderate increment of M1 macrophage (CD86+) and enormous rise of M2 macrophage (CD206+) with high-glucose dialysis fluid in mice model. Furthermore, the 8-week G4.25% group showed significant growth of M2 macrophage compared to the 4-week G4.25% group, indicating that prolonged dialysis duration has a more pronounced effect on promoting M2 polarization of macrophages via ADAM19/Notch1 signaling pathway. Through stimulating chemokines and inflammatory factors, ADAM19 regulated macrophage polarization and was correlated to the progression of peritoneal fibrosis. ADAM19 is expected to be a novel indicator for detecting peritoneal ultrafiltration function in PD patients.
To synthesize and evaluate current evidence on the responsiveness, interpretability (MID/MIC), and clinical utility of validated health-related quality of life (HRQoL) patient-reported outcome (PRO) instruments used in adults with head and neck cancer (HNC). A systematic search of PubMed, Scopus, Web of Science, Embase, and Cochrane Library (Central) identified studies published from January 2015 to July 2025. The review was registered in PROSPERO (CRD420251128978) and followed PRISMA 2020 guidelines. Observational and interventional studies assessing HRQoL using validated HNC instruments (EORTC QLQ-C30, QLQ-H&N35/H&N43, UW-QOL, FACT-H&N or MDADI) were included. Eligible studies reported responsiveness (ability to detect meaningful change) or clinical applicability. Methodological quality was evaluated using the COSMIN Risk of Bias checklist, and results were narratively synthesized due to methodological heterogeneity. Thirteen studies involving 8,075 patients met the inclusion criteria. The EORTC QLQ-C30 and H&N35/43, UW-QOL, FACT-H&N, and MDADI exhibited consistent responsiveness, capturing expected HRQoL deterioration during treatment and partial recovery within 6-12 months. Reported minimal important difference (MID) and minimal important change (MIC) values typically ranged from 4 to 15 points for improvement and 10-20 points for deterioration, supporting the interpretability of change scores. Several patient-reported outcome measures (PROMs) also demonstrated prognostic relevance, with early HRQoL changes associated with survival or recurrence. Validated HRQoL questionnaires in HNC demonstrate robust responsiveness and meaningful clinical applicability, supporting their integration into routine oncology practice. Their use may enhance early detection of complications, guide rehabilitative interventions, and facilitate more individualized, patient-centered care.
This study investigates the identification of Benign Prostatic Hyperplasia (BPH) through a deep learning-based analysis of RGB prostate histopathological images. Adaptive Contrast Limited Adaptive Histogram Equalization (CLAHE) is selectively applied to the L-channel in the LAB color space to enhance tissue visibility while preserving chromatic fidelity. At the architectural level, Convolutional Neural Networks (CNNs) are integrated with Bidirectional Long Short-Term Memory (BiLSTM) layers, enhanced further through spatial and temporal attention mechanisms. This hybrid design facilitates both localized pattern recognition and the modeling of long-range contextual dependencies across tissue regions. To mitigate class imbalance and prevent overfitting, the training regime incorporates two key strategies: an adaptive focal loss function and a comprehensive image augmentation protocol. The proposed model achieved an AUC of 0.7220 on the validation set and an AUC of 0.73 on the test set. While the precision for normal tissue classification remained high, the recall for BPH detection highlighted the need for improvement in sensitivity. The proposed CNN-BiLSTM-Attention architecture demonstrates potential as a diagnostic aid in digital pathology, offering interpretable insights and forming a foundation for enhancing histological classification systems. Future work will focus on improving recall performance for BPH detection and expanding the architecture to support multi-class prostate disease grading frameworks. This study utilizes an RGB histopathological dataset consisting of 176 prostate images, each appropriately annotated. The model demonstrates moderate classification performance and a moderate true-positive rate for detecting Normal samples. The model, however, has a low sensitivity in the detection of the cases of BPH as indicated by the relatively low recall values.
Spectral features of the electroencephalogram (EEG) are essential for providing clinically relevant biomarkers in schizophrenia (SZ). Despite literature indicating altered short-scale neural dynamics in SZ, however, band-limited power (BLP) indices are rarely assessed in a time-resolved manner. To address this, here we evaluated static and dynamic BLP indices in a sample of 30 SZ patients and 31 healthy control (HC) individuals. Guided by recent findings on power spectral dynamics in SZ, we estimated total, and decomposed fractal and oscillatory BLP in a sliding window manner from resting-state EEG recordings collected in eyes-closed resting-state. The SZ cohort was characterized by elevated baseline of total fractal power (p = 0.0015, |r| = 0.4073), while its temporal variability was comparable between the two study groups. On the other hand, spectral power in the alpha (p < 10-4, d = 1.0503) and beta (p = 0.0022, |r| = 0.3925) regimes exhibited reduced fluctuation in SZ compared to HC, with no between-group differences in their baselines. Furthermore, alpha variability could be attributed to alterations in isolated oscillatory activity, while variability in beta-BLP over the dorsal attention network was found correlated with negative symptoms in SZ (Spearman r = -0.4994, p = 0.0055). Finally, surrogate data testing indicated altered phase dynamics in SZ as a potential mechanism for diminished BLP fluctuations.
Achondroplasia (ACH) is the most common skeletal dysplasia characterized by disproportionate short stature due to impaired endochondral ossification. One of the most critical and potentially fatal complications of ACH is foramen magnum and upper cervical canal stenosis. Compression at the cervicomedullary junction may lead to myelopathy, hypotonia, developmental delay, and central sleep apnea. Early detection and timely surgical intervention are essential to prevent permanent neurological injury. This retrospective study evaluated 15 pediatric patients with ACH (9 girls, 6 boys; age range 3-42 months, mean 17.2 months) who underwent foramen magnum decompression and C1 laminectomy at Marmara University Neurosurgery Department between 2016 and 2025. All patients underwent comprehensive neurological and radiological evaluation, including MRI and 3D CT of the craniovertebral junction, and were classified by the Achondroplasia Foramen Magnum Score (AFMS). Nine patients had AFMS level 4 stenosis and six had level 3. The anteroposterior diameter of the foramen magnum ranged from 4.03 to 11.03 mm, with an area between 17.40 and 105.16 mm2. Presenting symptoms included motor delay (n = 4), respiratory disturbances or central apnea (n = 4), and macrocephaly (n = 3). Postoperative imaging confirmed adequate decompression in all patients. Neurological and respiratory improvement occurred in all patients except one with persistent hypotonia. One patient died early postoperatively due to recurrent pneumonia and sepsis. Complications were minimal. Foramen magnum decompression with C1 laminectomy is a safe and effective procedure for infants and children with achondroplasia presenting with cervicomedullary compression. Early radiological and neurological evaluation, particularly with AFMS, facilitates accurate surgical decision-making and improves outcomes.
Aging and increased life expectancy generate growing challenges for end-of-life care in old age, particularly in rural contexts marked by territorial and health inequalities. From the perspective of gerontological geography and the notions of autonomy and agency of older adults, this study aims to generate an understanding of end-of-life as a lived experience from the subjective worlds of and with the people involved. To this end, a qualitative study, with an ethnographic approach and case study strategy, was conducted in the Los Lagos Region of Chile between 2022 and 2023. This included semi-structured interviews and ethnographic observation of rural older adults in the end-of-life stages, their caregivers, and rural health teams. The results show that remaining at home is a central desire and organizes care, sustained primarily by feminized family networks and rural primary care. The home becomes a space of care, and health teams play a key role in providing clinical and relational support at the end-of-life. It is concluded that end-of-life care in rural areas requires territorial approaches that recognize autonomy in old age and the structural inequalities of these processes. El envejecimiento y aumento de la esperanza de vida generan desafíos crecientes para los cuidados de fin de vida en la vejez, particularmente en contextos rurales marcados por desigualdades territoriales y sanitarias. Desde la geografía gerontológica, y las nociones de autonomía y agencia de las personas mayores, este estudio se propone generar una comprensión del fin de vida como experiencia vital desde los mundos subjetivos de y con las personas implicadas. Para ello, se realizó un estudio cualitativo, de enfoque etnográfico y estrategia de estudio de caso, en la Región de Los Lagos, Chile, entre 2022 y 2023, que incluyó entrevistas semiestructuradas y observación etnográfica a personas mayores rurales en etapas de fin de vida, las personas cuidadoras y los equipos de salud rural. Los resultados muestran que la permanencia en el hogar constituye un deseo central y organiza los cuidados, sostenidos principalmente por redes familiares feminizadas y por la atención primaria rural. El hogar se transforma en un espacio de cuidado y los equipos de salud cumplen un rol clave en acompañamiento clínico y relacional del fin de vida. Se concluye que los cuidados de fin de vida en la ruralidad requieren enfoques territoriales que reconozcan autonomía en la vejez y las desigualdades estructurales de estos procesos.
Although roles of CD44 in the genetic predisposition for bronchopulmonary dysplasia (BPD) has been recognized, the immune characteristics of CD44+ monocytes in BPD are unclear. We aimed to (1) compare the expression and function of CD44 on monocytes in BPD and non-BPD infants; (2) explore the roles of CD44 on monocytes in hyperoxia-induced inflammation. Flow cytometry assessments of the expression pattern and cytokine-secreting response upon LPS stimulation of CD44+ monocytes were conducted using peripheral blood samples from BPD infants (n = 80) and non-BPD infants (n = 106). The role of CD44 on monocytes was validated in hyperoxia exposure. CD44 expression and inflammatory cytokine secretion ability increased with postmenstrual age. The ability of CD44+ monocytes to secrete IL-6 and TNF-α was significantly greater than that of CD44-monocytes. Compared with those of non-BPD infants, the response capacity of the monocytes in BPD infants to secret IL-6 and TNF-α, especially TNF-α sourced from CD44+ intermediate monocytes, was greater upon LPS stimulation. CD44 expression significantly increased in hyperoxia, and CD44 knockdown significantly ameliorated the inflammation induced by hyperoxia. CD44+ monocytes played important roles in mediating the hyper-inflammatory response in BPD. One specific subpopulation, TNF-α+/CD44+intermediate monocytes, might be a valuable marker for identifying BPD. 1. This study revealed the key role of an immune cell subtype-CD44+ monocytes-in hyperoxia-induced bronchopulmonary dysplasia (BPD) and characterized the expression and function of CD44+ monocytes between premature infants with BPD and those without BPD. 2. CD44 was closely associated with the proinflammatory cytokine secretion capacity of monocytes. A specific subpopulation-TNF-α+/CD44+ intermediate monocytes- might serve as a valuable marker for the identification of BPD in the future. 3. Our findings added new evidence of the association between CD44+ monocytes and BPD pathogenesis, which provided new insights into the immune mechanisms for BPD.