搜索结果：rebuild

Chronic wound management remains a significant clinical challenge, requiring adaptive therapeutic approaches to achieve wound closure that nonetheless frequently prove fruitless. Balancing the initial pro-inflammatory response with debris removal and tissue rebuilding remains elusive in most cases, leading to pain, drastic quality-of-life deterioration, and, eventually, amputation. Meanwhile, patient adherence is an overarching theme. Furthermore, non-surgical alternatives that effectively promote tissue rebuilding are essential for patients seeking to avoid further invasive procedures. We report a patient with a recalcitrant ulcer managed using human amniotic membrane dressing (hAM-pe) and a bovine collagen matrix (BCM) in spatially distinct areas as an intra-patient control. Methodology included clinical monitoring and ad hoc molecular and histological analyses to assess inflammatory markers and tissue architecture. Following 59 days of observation, the superior evolution of the hAM-pe-treated zone led to the clinical decision to extend hAM-pe treatment over the adjacent BCM area, resulting in total wound closure. The hAM-pe-treated site demonstrated accelerated closure and clinical resolution of inflammation without the presence of a granulomatous response. Molecular analysis revealed downregulated pro-inflammatory mediators (IL-1β, TNF-α, CXCL-10) and upregulated markers associated with angiogenesis (VEGF, CD34) and tissue repair (Arginase-1). In this case, the non-surgical hAM-pe treatment was associated with a favorable healing trajectory, characterized by superior inflammation resolution and enhanced tissue organization (collagen type I/III maturation). While these descriptive findings suggest the potential advantages of amniotic membrane dressings in promoting advanced tissue repair, they remain limited to this individual observation. Further research in larger cohorts is required to validate these mechanisms.

Internally displaced persons (IDPs) are individuals or groups forced to leave their homes due to conflict, violence, or other coercive circumstances. This study examined the effects of armed conflict on health service availability and outcomes for IDPs residing in designated centers in Adigrat City, Tigray region, Ethiopia. From a total of 13,315 households (HHs), a stratified random sample of 373 respondents was drawn across four zones of Tigray. Key informants were selected using purposive and simple random sampling. Data were collected through direct observation, structured questionnaires, and interviews with key informants. The study focused on key indicators of health service disruption, including destruction of health facilities, access to health extension services, and treatment for chronic diseases, as well as broader health outcomes such as maternal, infant, and elderly mortality. Findings revealed severe negative consequences of war, including widespread destruction and collapse of hospitals and health centers. Regression analysis indicated that approximately 69.8% of the disruption in health service delivery and infrastructure within IDP areas was associated with the combined effects of disrupted banking services and increased crime rates resulting from the conflict. Overall, the study underscores the urgent need for coordinated postwar reconstruction, restoration of critical systems, and targeted interventions to rebuild the health sector and improve the well-being of displaced populations in Tigray.

This paper offers a methodological critique of the study by AlShurman et al. that examined whether COVID-19 vaccine hesitancy (VH) and COVID-19-related factors interact to influence booster dose uptake among university students in Canada from a syndemic perspective. The original cross-sectional survey was conducted among 4453 students at the University of Waterloo in 2024. VH was measured retrospectively for primary doses and concurrently for booster doses, with a change score computed to capture shifts in hesitancy over time. Logistic regression models were used to assess the main effects and interactions on additive and multiplicative scales. While the original study provides a valuable application of syndemic theory, notable limitations warrant caution in interpretation. These include substantial recall bias in the retrospective VH change score, the inability of the cross-sectional design to establish temporal dynamics and bidirectional reinforcement required by syndemic theory, low response rate (approximately 11%) raising concerns about selection bias, dichotomization of key variables, untested linearity of the change score, and potential overinterpretation of statistical interactions as mechanistic syndemic synergy. Unmeasured factors such as student stressors, social media exposure, and psychological reactance may also influence the observed associations. The findings should be interpreted conservatively. Targeted interventions such as rebuilding trust and addressing misinformation remain important. However, stronger longitudinal studies with prospective measurement of hesitancy, mediation analyses, and sensitivity testing are needed to more robustly examine syndemic interactions in vaccine uptake.

This study analyses the role of social capital in community resilience to disasters. Although there is broad consensus on its importance, there is still a need to distinguish the specific contribution of its different forms (bonding, bridging, and linking) throughout the phases of the risk management cycle (preparedness, response, recovery, and mitigation). To address this gap, a multiple case study with a qualitative approach was developed, comparing three communities exposed to hydrometeorological risk in Colombia: Salgar and Mocoa, municipalities impacted by the country's deadliest flash floods in the last decade, and La Primavera, a community with high exposure to risk where a major disaster has not yet occurred. The findings confirm the centrality of social capital in community resilience throughout all phases of the risk cycle and broaden understanding of the phenomenon by identifying psychosocial processes, such as collective memory and social learning, that mediate this relationship. The analysis shows differentiated and complementary effects of each type of social capital evidencing that the sustainability of resilience depends on its dynamic articulation within collaborative risk governance frameworks. Likewise, the results suggest that, although disasters can weaken binding social capital, the bonds that persist constitute the basis for rebuilding the social fabric through solidarity practices and shared norms. The study shows that social capital is an important condition for community resilience, but not sufficient on its own, as resilience also depends on other types of capital and on institutional and governance factors. In this regard, limits and ambivalent effects of social capital on risk management are identified. Finally, the research contributes to the literature by highlighting its relevance in the mitigation phase, which has traditionally been less explored.

The key characteristics of the cornea, its transparency and avascularity, emerge from spatial organization of cell populations, extracellular matrix layers, biomechanical properties, and morphogenic cues. This review translates these organizing principles into contextual considerations for advancements in corneal regeneration therapies. We begin by outlining the development of the cornea, followed by how layer-specific microenvironments underpin homeostasis, and provide an outlook on current and future therapies. While full-thickness corneal transplantation remains the gold standard for global corneal blindness, definitive care is transitioning toward layer-specific procedures. These surgeries improve safety and recovery, yet remain limited by critical vulnerabilities such as donor supply scarcity and tissue rejection. Regenerative strategies are explored through full-thickness and layer-specific therapies with an ultimate goal to recapitulate native tissue by rebuilding the way it is patterned in vivo. Across the layers, successful corneal regeneration depends on reproducing where signals are presented, in what mechanical context, and with what architectural alignment. Cell-based therapies, from limbal epithelial stem cell transplantation to intrastromal keratocyte injection, require precise spatial control over the cellular microenvironment to ensure stemness, survival, and proper tissue integration. Scaffold-based therapies, by encapsulating these spatial rules into advanced fabrication platforms (such as additive manufacturing), biomaterials, and delivery schemes offers a path to long-term clarity, avascularity, and physiologic function, and exemplifies how spatial patterning drives the next generation of truly biomimetic corneal repair. Despite these advancements, achieving widespread clinical translation will require addressing key challenges, including standardizing safe cell therapies and overcoming technical limitations in the high-resolution, moderate-scale scaffold manufacturing.

Online sexual extortion, or "sextortion," describes a crime in which a victim is threatened with the public distribution of private, sexually explicit images unless they comply with the offender's demands. Current research and law enforcement data highlight the rapid growth of male victims of sextortion crimes, especially financial sextortion offenses, a variant in which the primary demand is financial payment in exchange for keeping material private. However, there is limited research on the psychological impacts of financial sextortion victimization on men. Using a theory-guided thematic analysis of open-ended survey responses from 169 male victims, this study examines how male victims experience, interpret, and manage their victimization using Shattered Assumptions Theory (SAT) as a framework. Results find that victims experience symptoms in a way that can be understood with SAT, such as a "shattering" of the core assumptions around their invulnerability, the predictability of the world, and their own positive self-regard, leading to intense anxiety, fear, shame, hopelessness, and concern for future victimization. In addition, participants illustrate evidence of active and cognitive coping strategies that resemble SAT's notion of "rebuilding assumptions" to reduce emotional distress, such as minimizing the impact, reducing online activity, and identifying as a victim. Considerations for future research on male victims of sextortion and implications for practice are discussed.

Black women in the United States experience inequities in perinatal and neonatal mortality, contributing to psychological stress during and after perinatal loss. This analysis drew on a subset of interviews from a larger qualitative dataset and explored the experiences of 22 Black women who experienced perinatal loss and were pregnant or had given birth after a loss, focusing on feeling unheard by healthcare providers. Semi-structured interviews were conducted, and data were analyzed using descriptive coding and inductive thematic analysis. Three themes emerged: unheard and dismissed concerns, biased and stratified care, and perinatal loss follow-up gaps driving self-advocacy. Women described how systemic racism intensified psychological distress, expressed as heightened anxiety and uncertainty in subsequent pregnancies after perinatal loss. Findings underscore the need for maternity settings to confront racial bias and strengthen cultural safety. Care environments that validate Black women's concerns and act on them may help rebuild trust and improve maternal and newborn outcomes. The study calls for changes in maternity and mental healthcare aimed at addressing systemic racism and strengthening culturally responsive, equitable care. These findings have implications for perinatal public health practice and policy, including surveillance, prevention, and community-responsive approaches to maternity care during and after perinatal loss.

Rebuilding functional neuronal circuits after injury in the adult central nervous system is unachievable for many vertebrates. In pro-regenerative models, it is unclear how regeneration and rewiring are achieved in the central nervous system over long distances. The size and opacity of the adult vertebrate brain make it difficult to study re-innervation patterns and dynamic cellular interactions during long-distance axon regeneration. Here, we harnessed the properties of the small and transparent adult Danionella cerebrum for longitudinal in vivo imaging of retinal ganglion cell axon regeneration, correlating cellular events with functional recovery. Our results suggest that, following optic nerve injury, the arborization pattern of reinnervation differs after regeneration, suggesting that new axon tracts are formed to restore functional vision. Additionally, myelin is not restored to pre-injury levels, even after functional recovery is achieved. The Danionella cerebrum model provides a unique opportunity to visualize and experimentally manipulate the spatial and temporal events during central nervous system regeneration in intact adult vertebrates.

The freebirth movement, planned birth without any qualified professional attendant, is expanding internationally, including in Scandinavia, where rising rates and incomplete outcome reporting have raised clinical and ethical concerns. A recent editorial in this journal emphasizes respectful engagement with women considering out-of-hospital birth and the importance of rebuilding trust through less coercive models of care. We argue that insufficient distinction between professionally attended home birth and planned unassisted birth risks conflating two distinct professional obligations: respecting patient autonomy and maintaining clinical neutrality in the face of preventable fetal and neonatal harm. These are not equivalent obligations. Respect for autonomy requires accurate, complete, evidence-based counseling and a clear professional recommendation when the evidence warrants one, while preserving the patient's right to decline. After viability, the fetus acquires patient status with corresponding beneficence-based obligations that planned unassisted birth forecloses entirely. Directive counseling against a practice associated with increased risk of preventable fetal and neonatal death is not coercion. It is what informed consent requires of the clinician. Professional responsibility does not ask clinicians to choose between compassion and clarity. It requires both.

As a prominent feature of the face, the nose is susceptible to a variety of traumatic or pathological defects. It is a challenge to restore the external nasal structures because of its delicate three-dimensional contours. For the defects involved in multiple subunits, the restoration procedures are difficult because of the requirements of sufficient skin cover, steady cartilage supporting and lining. In this study, the authors applied pre-expanded paramedian forehead flap combined with autologous cartilage framework and laser treatment to rebuild nasal structures and aesthetics. A retrospective analysis was performed on nine patients who underwent nasal reconstructions and followed up between January 2020 and July 2024. The clinical data and surgical procedures were recorded and analyzed. The staged surgeries were included: tissue expander implantation, nasal reconstruction and pedicle division. The laser hair removal was applied postoperatively. The aesthetic outcomes were evaluated by FACE-Q questionnaires. The scars were scored by Vancouver Scar Scale. A total of 9 patients (3 females and 6 males) were included, with a mean age of 28.33  ±  7.30 years. Seven flaps survived well without complication. Partial necrosis at the distal end of flap occurred in one case, and another case developed a postoperative wound infection. The scar quality was scored 2.78 ± 1.02 and 2.56 ± 0.88 in the donor and recipient sites by the Vancouver Scar Scale. The nasal appearance outcomes were scored 82.22 ± 6.65 by the Satisfaction With Nose Scale and 76.33 ± 11.30 by the Satisfaction With Nostrils. The donor sites of the forehead were scored 83.56 ± 5.46 by the Satisfaction With Forehead and Eyebrows. The pre-expanded forehead flap combining with autologous cartilage is a feasible method for nasal reconstruction. The expansion technique and autologous costicartilage could provide adequate skin cover and reliable supporting to complete the nasal reconstruction with good outcomes. Postoperative laser and anti-scar treatments are beneficial for the appearance. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Current AI tools for designing macromolecules have been struggling with DNA and RNA structure prediction and design as significantly less experimental training data are available for nucleic acids than for proteins. Therefore, developing alternative approaches remains of interest. MUMBO, a program for designing protein-protein interactions and protein-ligand-binding pockets, uses side-chain-packing algorithms to select from alternative amino acids and conformers generated on a fixed backbone with the help of rotamer libraries. MUMBO identifies the most favourable combinations based on the lowest overall energy. In order to extend the program's capabilities to designing nucleic acids, we developed NuConf, a discrete pseudorotational angle-dependent nucleoside-specific rotamer library. We derived NuConf by statistically analysing pseudorotational and dihedral angles of more than 175,000 nucleotides from experimental structures and validated it by rebuilding more than 20,000 nucleotides in a custom dataset. Strikingly, our approach predicts nucleotides at least as accurately as amino acids. We show that the implementation of the NuConf library in MUMBO enables modelling and designing DNA and RNA sequences on a fixed backbone together with protein-nucleic acid interaction interfaces. Because its approach and format are program agnostic, NuConf can be used by other molecular design frameworks as well.

Healing after attempted intimate partner homicide (IPH) is critical not only for women's psychological recovery but also for their ability to sustain parenting roles and rebuild family life in the aftermath of near-lethal violence. While existing research has examined women's survival of attempted IPH, little attention has been paid to their experiences as mothers and to the ways parenting may shape processes of healing. Drawing on narrative identity as a theoretical framework, this study explored the role of parenting in mothers' meaning-making and recovery following a near-lethal attack. Using interpretative phenomenological analysis methodology, in-depth, semi-structured interviews were conducted with eight mothers who had survived an attempted IPH. Four themes emerged: (1) Parenthood as a Healing Resource, (2) Parenthood as a Victory, (3) Parenting as a Barrier to Healing, and (4) What Does the Future Hold? The findings illuminate the ambivalent role of motherhood in the aftermath of attempted IPH, revealing how parenting can simultaneously foster resilience, purpose, and continuity while also intensifying emotional strain and constraining survivors' healing trajectories. These results point to the importance of trauma-informed, family- and parenting-sensitive interventions that recognize healing as a relational process embedded within ongoing caregiving responsibilities and family contexts.