Urethral complications remain a major source of morbidity following gender-affirming genital surgery, particularly in the setting of masculinizing procedures requiring urethral lengthening. This review summarizes recent advances in the epidemiology, prevention, and reconstructive management of urethral complications, with a focus on principles relevant to reconstructive urologists. Urethral complications are uncommon after feminizing genital surgery but occur frequently following masculinizing surgery, with pooled rates of strictures and fistulae approaching 50% after phalloplasty. Recent studies emphasize the heterogeneity of these complications, highlighting the importance of timing, anatomical location, and surgical technique. Improved classification systems, such as the Montréal classification, aim to standardize reporting. Preventive strategies - including careful patient selection, expectation management, hair removal protocols, optimized flap design, tissue interposition, and staged reconstruction - are increasingly recognized as critical but remain underreported. Reconstructive management must be individualized, as outcomes are influenced by tissue vascularity and prior interventions. Staged urethroplasty appears to offer the most durable results for complex strictures, while prolonged urinary diversion may allow conservative resolution of selected fistulae. Urethral complications after masculinizing gender-affirming genital surgery are common and complex. Emphasis on prevention, standardized reporting, and individualized reconstructive strategies is essential to improve long-term urinary outcomes.
Lichen sclerosus associated urethral stricture disease represents a complex and evolving reconstructive challenge due to its heterogeneous presentation, progressive course, and persistent long-term risk of recurrence. This review summarizes contemporary reconstructive strategies and adjunctive therapies, highlighting recent refinements and ongoing limitations in the available evidence. Recent data demonstrate a shift toward single-stage, anatomy-based urethral reconstruction in selected patients with lichen sclerosus, particularly using oral mucosa grafts, while emphasizing the need for segment-specific approaches for distal, penile, and panurethral strictures. Despite these advances, high-quality comparative evidence remains limited, with most studies being retrospective and heterogeneous in design and outcome reporting. A consistent finding across the literature is the clear contraindication to the use of genital skin grafts in lichen sclerosus. Advances in stricture classification systems, outcome assessment tools, and patient-reported measures have improved patient counseling and facilitated more standardized reporting. Topical therapies may play an adjunctive role, whereas systemic treatments remain investigational. Management of lichen sclerosus associated urethral stricture disease requires individualized, segment-specific reconstructive strategies and long-term surveillance. While recent refinements support selected single-stage approaches, further prospective, lichen sclerosus specific studies with standardized outcomes are needed to inform evidence-based recommendations.
This narrative review aims to summarize the most relevant literature published in 2024-2025 regarding the management of vesicourethral anastomotic stenosis (VUAS) and bladder neck contracture (BNC) after treatment of the prostate. We identified relevant articles focusing on novel treatment options regarding the management of VUAS and BNC, emphasizing patency rates and continence trade-offs. Vesicourethral anastomotic stenosis and bladder neck contracture represent distinct postoperative complications following radical prostatectomy and benign prostatic hyperplasia surgery, respectively. Endoscopic therapy continues to serve as first-line treatment, though reported success rates vary substantially across modalities. Emerging minimally invasive endoluminal techniques, such as transurethral incision with transverse mucosal realignment and drug-coated balloon dilation demonstrate promising early outcomes. For recalcitrant disease, reconstructive solutions including transperineal reanastomosis, buccal mucosal graft urethroplasty, and a growing spectrum of robot-assisted approaches offer encouraging patency rates with variable impacts on continence.
Limb salvage centers have increased in number over time, but lack standardized defining criteria. This systematic review aimed to assess organizational features of limb salvage centers and determine whether orthoplastic centers, in comparison to vascular limb salvage centers, represent a distinct care model that may benefit from standardization. We conducted a systematic review of publications related to limb salvage centers by searching MEDLINE, Embase, Web of Science, and Cochrane databases from their inception through 2024. We quantified binary data extraction as a reporting score of 26 organizational features across six structural care domains for limb salvage centers, based on a validated quality measurement framework. Organizational features differentiating distinct center types were identified to establish a quality framework for orthoplastic centers. Statistical comparisons between center types were performed using appropriate tests (p < 0.05). Of 118 included studies, orthoplastic (n = 43) and vascular (n = 48) centers represented 77% of all studies. Recent increases in orthoplastic publications show substantial variability in organizational features. Orthoplastic center literature more frequently reported plastic surgery consultation criteria (p < 0.001), surgical outcomes (p < 0.001), and centralized network integration (p ≤ 0.006), highlighting acute reconstructive approaches. Vascular center studies documented significantly more organizational team features (p < 0.001) and quality systems (p = 0.033), reflecting established care frameworks for chronic disease management. Six organizational features characterized orthoplastic centers with > 70% prevalence, providing a benchmark framework with standardization priorities. Orthoplastic limb salvage centers demonstrate distinct care paradigms that benefit from standardization. Our findings suggest structural benchmarks to support the need for standardized development of orthoplastic limb salvage centers.
Agricultural nitrogen (N) non-point source pollution is one of the major threats to water environmental safety. Although previous studies have shown that appropriate tillage practices can effectively reduce runoff and associated N loss, it remains unclear how N loss from sloping farmland responds to changes in microtopography and hydrological connectivity under different tillage practices. In this study, natural rainfall observations were conducted from August 2024 to August 2025 under three tillage treatments-flat tillage (FT), artificial digging (AD), and contour ridge tillage (RT)-in the red soil region of southern China. By combining high-resolution UAV-SfM topographic reconstruction with the Index of Connectivity (IC), we examined the dynamic evolution of hydrological connectivity under different tillage practices and its regulatory role in N loss. The results showed that conservation tillage treatments (AD and RT) initially disrupted hydrological flow pathways and reduced N export by >50 %; however, this mitigation effect was short-lived. Continued rainfall and the progressive attenuation of microtopography led to different IC evolution trajectories, which in turn increased N loss. Under RT, abrupt ridge failure during extreme rainfall events triggered a sharp increase in IC, causing runoff and N losses to temporarily exceed those under conventional FT. In addition, heavy rain and rainstorm events were the main drivers of system losses, contributing 36.61 %∼54.75 % of total runoff and 26.40 %∼51.34 % of total nitrogen export, respectively. Partial least squares structural equation modeling (PLS-SEM) further confirmed that IC acted as the primary mediating variable regulating N export through changes in runoff and transport intensity. These findings suggest that maintaining ridge structure after extreme rainfall events is critical to preventing abrupt increases in nitrogen loss caused by sudden shifts in structural connectivity. This study provides a theoretical basis for water and nitrogen loss control and tillage optimization on sloping farmland.
Autologous grafts remain the clinical gold standard for vascular reconstruction; however, their use is limited by donor site morbidity, poor availability, and long-term failure. Synthetic alternatives, while effective in large-caliber vessels, fail in small-diameter applications (<6 mm) due to thrombosis, intimal hyperplasia, and biomechanical mismatch. In this context, tissue-engineered vascular grafts (TEVGs) emerge as a solution, requiring biomaterials that closely replicate the structural, mechanical, and hemocompatible properties of native vessels. Aliphatic polyesters such as polylactic acid, polyglycolic acid, and poly(ε-caprolactone) are extensively studied but show poor endothelialization and mechanical deficiency. In contrast, poly(butylene trans-1,4-cyclohexanedicarboxylate) (PBCE) attracts interest for its biocompatibility, thermal stability, and processability. Its copolymerization with Pripol 1009, a commercial fatty diacid, enables modulation of mechanical properties and degradation rate, two of the key parameters for vascular engineering. In this work, electrospun scaffolds based on these copolymers are fabricated in flat and tubular formats and characterized in terms of morphology, mechanical behavior, hemocompatibility, and endothelialization potential. Certain formulations display mechanical properties comparable to native vessels, support endothelialization and smooth muscle cell adhesion, and do not trigger coagulation pathways in in vitro assays. These results identify PBCE/Pripol copolymers as promising candidates for next-generation TEVGs, bridging the gap between synthetic reliability and biological performance in small-diameter vascular applications.
This study examines the long-term variations in the water-level time series of Lake Uluabat, located in western Türkiye, over the past six decades. Despite the decline in lake water level in recent years, the scarcity of reliable information remains a major problem in understanding this phenomenon. To overcome this limitation, monthly water-level observations spanning from October 1960 to September 2019 (708 months) were analyzed to explore temporal dynamics in trend, homogeneity, stationarity, frequency, persistence, entropy, and the reconstructed phase-space geometry. The analyses were conducted for the entire period (1960-2019) and six decadal intervals (i.e., 1960-1969, 1970-1979, 1980-1989, 1990-1999, 2000-2009, and 2010-2019) to identify regime shifts and decade-scale variability. The so-called autocorrelation function, mutual information, probability distributions, return period, and dimensional analysis were performed. Also, the teleconnections between lake-level fluctuations and 19 large-scale atmospheric-oceanic oscillation indices were investigated. Results indicated a persistent but gradually descending downward trend, accompanied by a rise in system entropy and short-term dependencies. This indicates increased complexity and dependence on external factors. So in a nutshell, the recent lake water-level properties indicate reduced degree of functionality and self-dependency of the hydrological regime. Yet, the temporal teleconnection between lake water level and the climatic oscillations showed stability. This indicates that the climate and the anthropogenic factors have a direct effect on the lake water level states, although in this case, the latter seems to have the upper hand.
The study presents experience in using a wound protector device named lap-protector during costal cartilage harvest in auricular reconstruction in order to improve outcomes, particularly final scar quality and length. The present study retrospectively comprised fifty-five patients who underwent costal cartilage harvesting for auricular reconstruction were admitted between June to August 2022. The author divided the patients into 2 groups according to whether the lap-protector was used or not: group 1 underwent costal cartilage with the minimal invasive conventional technique by using the lap-protector, while group 2 underwent the same procedure without. Patients were followed-up for a 6-months period. The time of surgery, the amount of blood loss during surgery, postoperative pain, donor-site scar quality and length were recorded and measured for both groups. Twenty-five patients with lap-protector were compared to thirty without. There were no significant differences between the two groups in the demographic of patient characteristics (P > 0.05). The score of pain dropped steadily over the 5 days in both groups, and patients in group 1 reported a lower level of pain in the following days compared with group 2 (P < 0.05), except the fifth day. In those without, the length of the scar on average was 5.43 ± 0.44 cm, which was longer than the average 3.61 ± 0.29 cm in group 1 (P < 0.05). Analysis of VSS results showed a better formation of the scar in the group1 (P < 0.05). The differences in postoperative pain, scar length and quality between the two groups were statistically significant(P < 0.05). There were no differences between the two groups in terms of the operation time and the amount of bleeding during the operation (P > 0.05). The application of lap-protector in costal cartilage harvest can optimize the scar formation and reduce postoperative pain without prolonging the operative time, which is a convenient and effective technique for achieving satisfactory results.
Surface-mediated electron transfer with excellent resistance to salt interference has been widely applied in the pretreatment of high-salinity organic wastewater. However, traditional two-electron transfer process often forms polymers, resulting in additional economic cost for subsequent purification of salt with impurities. Herein, we proposed a chloride-induced dynamic diatomic reconstruction strategy to upcycle anti-salt interference into in-situ salt utilization for the treatment of high-salinity organic wastewater. The dynamic reconstruction system enabled an unprecedented surface-mediated three-electron transfer that efficiently mineralized refractory contaminants into low-toxicity small molecules, thus avoiding the formation of polymers and halogenated byproducts. By taking advantage of three-electron transfer, the diatomic reconstructor achieved a normalized rate constant k-value exceeding 259.0 min⁻ (Zhang et al., 2024) M⁻ (Zhang et al., 2024) for various typical contaminants, surpassing most of the state-of-the-art catalysts. Only US$0.30 per ton of treatment cost and low environmental impact confirmed scalability and practical applicability. This work developed a novel salt-driven dynamic wastewater treatment approach, enabling sustainable and cost-effective cleanup of high-salinity organic wastewater.
Shape-from-focus (SFF) is an economically efficient 3D shape recovery technology. As a core module of 3D digital microscopes, its primary goal is to acquire high-quality depth maps. However, the performance of such technology is highly dependent on the richness of image textures, which inevitably introduces noise into the generated depth maps and seriously impairs their quality. This has become a critical technical challenge in the field. To address this problem, this paper proposes a depth map filtering framework based on a hybrid network model. First, a depth reconstruction method combining the full width at half maximum (FWHM) and Gaussian fitting is designed to generate the initial depth map. Second, a hybrid network model for focus signal classification is constructed, which extracts the differential features of different signals to identify focus signals with noise patterns and generate a flag matrix. Finally, the initial depth map is filtered based on this flag matrix to obtain a high-quality depth map. Experimental results demonstrate that the proposed method can effectively distinguish the patterns of focus signals, filter out depth map noise caused by signal distortion, and simultaneously preserve the integrity of structural details in the depth map, exhibiting excellent filtering performance. In addition, the method proposed in this paper can serve as a general SFF framework, which is applicable to 3D shape measurement or high-end instrument design in different fields.
The optimal fixation method in total hip arthroplasty (THA) remains under debate. While cemented fixation has been associated with a lower risk of periprosthetic fracture, uncemented fixation predominates in Japan. This study aimed to compare early postoperative complications between cemented and uncemented fixation in elective THA using a nationwide inpatient database. We identified 198,102 patients aged ≥ 65 years who underwent primary THA for osteoarthritis, osteonecrosis, or rheumatoid arthritis between December 2011 and March 2023 from the Japanese Diagnosis Procedure Combination (DPC) database. After 1:1 propensity score matching for age, sex, body mass index (BMI), and Charlson Comorbidity Index, 36,859 patients were included in each fixation cohort. Surgical and medical complications, and in-hospital mortality were compared using multivariate logistic regression. Cemented fixation was associated with a significantly lower risk of periprosthetic fracture (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.53; p < 0.001), blood transfusion (OR, 0.76; 95% CI, 0.74-0.78; p < 0.001), and deep vein thrombosis (OR, 0.79; 95% CI, 0.74-0.84; p < 0.001). There were no statistically significant differences based on the predefined threshold (p < 0.001) in dislocation, infection, pulmonary embolism, cardiac or cerebrovascular events, or in-hospital mortality between fixation types, although a trend toward higher in-hospital mortality in the cemented group was observed. Cemented THA was associated with reduced rates of periprosthetic fracture, transfusion, and deep vein thrombosis without increasing other perioperative or medical complications. These findings suggest that cemented fixation may be associated with favorable short-term outcomes in selected patients.
Press-fit acetabular components achieve long-term fixation through osseointegration, yet the extent of bone ingrowth necessary for durable stability in well-functioning implants remains unclear. Postmortem retrievals provide a unique opportunity to directly assess the bone-cup interface in clinically successful total hip arthroplasties (THAs). This study evaluated osseointegration and biomechanical fixation strength in deceased-donor acetabular components to better define the characteristics of stable long-term fixation. Cadaver pelvis specimens containing uncemented THAs from a single institution were evaluated. There were 29 acetabular components that underwent axial pull-out testing using a universal testing machine. A total of seven of these were additionally processed for histologic evaluation, including dehydration, acrylic embedding, thin-sectioning, staining, and digital imaging. Osseointegration was quantified by bone-area fraction occupancy (%BAFO), representing the proportion of bone occupying the porous thread spaces of the cup. All 29 specimens failed through fracture of the ilium rather than at the bone-cup interface, indicating that the mechanical integrity of the osseointegrated construct exceeded that of the surrounding bone under axial tension. Among the seven histologically analyzed components, %BAFO ranged from 4.2 to 27.0% (mean 15.1%), despite all implants being clinically stable at the time of death. There were no significant linear correlations observed between %BAFO and time implanted, fracture load, or body mass index. A significant quadratic relationship between %BAFO and age was identified, peaking near 81 years. Cementless acetabular components exhibited strong fixation despite modest osseointegration, with failure occurring through host bone on axial testing. Durable biological fixation appears achievable with limited, but mechanically favorable bone ingrowth.
This study aimed to evaluate the effect of CAD/CAM milling and internal adjustment procedures, as well as subsequent intaglio surface polishing applied after both processes, on the internal/marginal adaptation and fatigue behavior of simplified zirconia crowns. Fifty 4YSZ crowns were subjected to five surface conditions (n = 10): CTRL- (milled without additional surface treatment), CTRL+ (milled with additional surface treatment), POL (milled + intaglio surface polishing + surface treatment), ADJ (internal adjustment + surface treatment), and ADJ + POL (internal adjustment + intaglio surface polishing + surface treatment). As surface treatment to enhance adhesion, the crowns were subjected to air-abrasion with 45 μm aluminum oxide. The only group that was not surface treated was the CTRL-. 4YSZ crowns thickness was measured before and after internal adjustment by grinding and intaglio surface polishing. Following the treatments, the internal/marginal adaptation of the 4YSZ crowns was assessed using the replica technique. After, the crowns were cemented onto epoxy resin substrates and the cyclic fatigue test started by 100 N for 10,000 cycles at 20 Hz, followed by load increments of 100 N every 10,000 cycles until reaching 500 N, after which the increment was reduced to 50 N per 10,000 cycles, until failure (crack). Changes in crown thickness before and after internal adjustment by grinding and intaglio surface polishing were evaluated using paired t-tests (α = 0.05). Internal/marginal adaptation, fatigue failure load and cycles for failure data were by Tukey's post-hoc test (α = 0.05) to compare the effects of different surface conditions. Internal adjustment by grinding significantly reduced crown thickness (P < 0.001), while intaglio surface polishing did not affect thickness (P = 0.168). Internal/marginal adaptation was assessed using the Kruskal-Wallis test, followed by pairwise comparisons, with POL showing the best adaptation, ADJ the highest misfit, and ADJ + POL demonstrating partially improved adaptation compared to ADJ, with intermediate to low discrepancy values depending on the evaluated region. Additionally, Kaplan-Meier survival analysis with log-rank (Mantel-Cox) tests (α = 0.05) was performed to evaluate the survival of each group under cyclic fatigue. POL exhibited the highest fatigue behavior, followed by CTRL+, ADJ, and ADJ + POL, while CTRL- showed the lowest performance. Internal adjustment by grinding increased internal/marginal discrepancies and showed intermediate fatigue behavior. Intaglio surface polishing after CAD/CAM milling improved both internal/marginal adaptation and fatigue behavior, whereas when performed after internal adjustment, it partially improved adaptation without enhancing fatigue behavior.
Osteoporotic fractures remain a major cause of morbidity and mortality worldwide. Current clinical assessment metrics (e.g., bone mineral density) are limited in their ability to identify fracture risk and bone strength. Statistical Shape and Appearance Modelling (SSAM) offers a method to quantify anatomical geometry and density patterns. This review examines advancements in SSAM for osteoporosis research. Recent literature demonstrates that SSAM can capture detailed bone geometry and internal density distribution. Increasingly, these models are combined with computational analytics, including finite element analysis and machine learning, to assess the mechanical and structural behavior of bone. SSAM provides a robust quantitative framework for bone research. Notably, SSAM is used to reconstruct 3D subjects from clinical 2D images for biomechanical evaluation. Although clinical adoption remains limited by generalizability, the advancement of deep learning and complex SSAM pipelines supports its potential for osteoporosis screening and fracture risk prediction.
Ileal ureter interposition is a well-established option for complex ureteral strictures. While minimally invasive approaches have evolved, the application of the single-port (SP) robotic platform for ileal ureter reconstruction has not been previously reported. This study presents the first clinical series evaluating the feasibility, technique, and early outcomes of SP robotic ileal ureter reconstruction. We retrospectively reviewed a prospectively maintained database of patients who underwent SP robotic ileal ureter substitution between September 2019 and November 2024 by a single surgeon. Demographic, perioperative, and functional data were analyzed. Surgical success was defined as freedom from reintervention, absence of radiographic obstruction, and stable renal function. Pre- and postoperative renal function was compared using paired statistical analysis. Seventeen patients underwent SP robotic ileal ureter reconstruction (29% male), with a mean age of 54 years. Radiation-induced strictures accounted for 70.6% of cases. Unilateral reconstruction was performed in 8 (47.1%), while 8 (47.1) required bilateral reconstruction with V-shaped or reverse-7 configurations, including bladder augmentation in selected cases. One patient (5.9%) underwent unilateral ileal ureter with bladder neck reconstruction. The median ileal segment length was 25 cm. Mean operative time was 308 min, and median blood loss was 70 mL. One intraoperative complication (5.9%) occurred. Postoperative complications were observed in 47%, with 11.8% classified as Clavien-Dindo grade IIIa. Renal function remained stable (preoperative eGFR 56.4 vs. postoperative 57.5 mL/min/1.73 m², p = 0.803). At a median follow-up of 20.5 months, the overall success rate was 94.1%. Single-port robotic ileal ureter reconstruction is a feasible and effective technique for complex ureteral strictures, achieving high early success with acceptable morbidity.
Deep neural networks have achieved remarkable success in various computer vision tasks, yet they remain vulnerable to adversarial examples-carefully crafted perturbations that are imperceptible to humans but cause misclassification. Detecting such adversarial inputs is crucial for deploying reliable AI systems, particularly in safety-critical applications such as medical diagnosis and autonomous driving. In this paper, we propose a novel adversarial detection method based on Hybrid Reverse Knowledge Distillation (Hybrid RKD). Our approach trains a multi-scale decoder to reconstruct intermediate feature representations of a frozen teacher encoder using only clean images. The key insight is that adversarial perturbations cause feature-level distortions that the decoder, trained exclusively on normal data, cannot accurately reconstruct. We further enhance detection performance by incorporating Mahalanobis-style statistical distance metrics that capture distribution-level anomalies. Extensive experiments on CIFAR-10 and ISIC2018 datasets demonstrate that our method achieves state-of-the-art detection performance against various adversarial attacks including FGSM, PGD, DeepFool, C&W, and AutoAttack, with average AUROC scores of 0.790 and 0.929 across five attack categories, respectively. Our hybrid approach consistently outperforms existing detection methods including LID, Mahalanobis, and ODIN, while requiring no adversarial examples during training.
Radioactive cesium-rich microparticles (CsMPs) released from the Fukushima Daiichi Nuclear Power Plant (FDNPP) in 2011 pose a persistent environmental concern, yet their initial atmospheric dispersion has remained poorly constrained. Here we quantify CsMP abundance and radioactive fraction (RF) in 100 surface soil samples collected across Fukushima Prefecture in July 2011 and integrate the results with WSPEEDI atmospheric simulations. CsMP abundance ranged from 0 to 52.3 particles g⁻¹ (dry weight), with RF values of 0-61.85%. The combined analysis identifies a major CsMP formation and release event at ∼03:00 JST on 15th March 2011, producing a plume strongly enriched in CsMPs. Plumes released after 00:00 JST on 16th March contained no detectable CsMPs, indicating that particle formation had ceased by that time. The widespread distribution of CsMPs across Fukushima is therefore attributed primarily to this single plume. Directional variations in CsMP abundance reflect temporal changes in plume composition, with peak concentrations of ∼2070 particles m⁻³ toward the southwest and ∼4700 particles m⁻³ toward the northwest. These findings constrain CsMP formation mechanisms and improve reconstruction of radiological dispersion relevant to the long-term environmental risk assessment of nuclear power plants.
Combining radiotherapy (RT) with immune checkpoint inhibitors (ICIs) offers potential synergy through RT-induced immunogenic cell death and enhanced systemic immunity. However, optimal RT dose, fractionation, and sequencing with ICIs remain unresolved. This meta-analysis evaluates the impact of biologically effective dose (BED), treatment timing, and ICI agents on progression-free survival (PFS) and safety in advanced cancers. A systematic search of PubMed, Embase, Web of Science, and Cochrane Library (2010-2024) identified 18 studies (727 patients). Pooled PFS and treatment-related adverse events (TRAEs) were analyzed using random-effects models. Subgroup analyses stratified outcomes by cancer type, RT regimen, BED (low: ≤50; moderate: 50-100; high: >100), treatment sequence (concurrent/sequential), and ICI agents. This study was registered on PROSPERO (CRD420251044176). The synthesis of PFS revealed extreme between study heterogeneity, with a wide 95% prediction interval ranging from 0.90 to 41.21 months. Despite this variance, reconstructed individual patient data suggested that moderate BED regimens between 50 and 100 showed a more favorable median PFS compared to low or high dose regimens. Concurrent administration of radiotherapy and immunotherapy demonstrated a longer reconstructed median PFS than sequential strategies. Furthermore, PD-1 and PD-L1 based regimens appeared to perform better than CTLA-4-only approaches. The pooled incidence of grade 3 or higher TRAEs was 0.22, indicating a manageable overall safety profile. This descriptive meta-analysis and reconstructed individual patient data synthesis provide hypothesis-generating insights into combined radioimmunotherapy. Concurrent administration of moderate BED radiotherapy with PD-1 and PD-L1 inhibitors suggests a plausible balance of efficacy and safety. However, extreme heterogeneity limits direct clinical application, underscoring the critical need for standardized dose protocols and rigorous sequencing in future randomized trials.
To reconceptualise becoming a nurse as a lifelong developmental journey that extends beyond the traditional focus on new graduate transition, and to inform policies and practices supporting recruitment, retention and career sustainability. The global nursing shortage persists, exacerbated by high attrition rates among new graduates and an aging workforce. While existing literature predominantly examines the transition from student to professional practice, we propose that 'becoming a nurse' begins earlier and extends beyond clinical roles into retirement. An analytical discursive paper. Key theoretical frameworks (Schlossberg's Transition Model, Kennedy's Integrated Transition Model, Benner's Novice-to-Expert framework and Duchscher's Stages of Transition Model) were integrated with empirical literature (1974-2025) on nursing career trajectories, clinical expertise development and professional identity across the lifespan, with emphasis on contemporary evidence from 2015 to 2025. Becoming a nurse is reconceptualised as a continuous, lifelong transition encompassing four interrelated phases: (1) early career interest, where nursing aspirations emerge during childhood and adolescence; (2) non-traditional entry, involving second-career entrants who undergo profound identity reconstruction as novices; (3) middle-career transition, characterised by sustained development from competence through proficiency toward expertise and clinical wisdom; and (4) late-career transition, where professional identity and contribution continue beyond retirement. Each phase presents distinct developmental demands requiring tailored educational, organisational and workforce responses. Together, these phases form a Lifespan Transition Framework that advances the field by proposing transition as a recursive developmental mechanism, where adaptive capacities built at each phase become foundational resources for subsequent phases, rather than separate, time-limited events. Understanding becoming a nurse as a lifelong transition provides a unifying conceptual foundation for more coherent, stage-sensitive workforce strategies. This perspective shifts policy and practice beyond short-term graduate retention toward lifespan-oriented workforce systems that strengthen recruitment, sustain expertise and preserve professional wisdom across the whole nursing career lifespan.
The global ocean carbon dioxide flux (air-sea) has shown a slow upward trend. Based on more than 160,000 quality-controlled measurements of surface ocean carbon dioxide fugacity from 2000 to 2020, a satellite-based ocean-atmosphere carbon dioxide fugacity (fCO2) retrieval algorithm was developed using machine learning methods. A comparative analysis was conducted among various machine learning methods, including XGBoost, random forest, light gradient boosting machine, feedforward neural network, convolutional neural network, and backpropagation neural network. Based on the best performance, the random forest algorithm was selected for model construction. Independent in situ validation showed that the model achieved a low root mean square error (RMSE = 14.35 µatm), a low mean absolute percentage error (MAPE = 2.61%), and a high coefficient of determination (R² = 0.86). The distribution of global air-sea carbon dioxide fugacity from 2000 to 2020 was reconstructed at a resolution of0.25° × 0.25°, and the air-sea carbon dioxide flux (FCO2) of the global ocean during the period of 2000-2020 was further estimated at a resolution of 0.25°×0.25°. During the period of 2000-2020, the global ocean CO2 uptake increased from 1.443 PgC/year in 2000 to 1.894 PgC/year in 2020, and the air-sea carbon dioxide flux in the entire study area increased by 31.2% over the 20 years. These comprehensive oceanic carbon sink datasets and new insights will support future research on ocean carbon sequestration and its climate regulation potential.