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Global and community-driven initiatives have recently achieved considerable success in overcoming key challenges that hinder the widespread adoption of advanced microscopy and bioimage analysis tools in under-resourced settings. To build upon this progress, we held a workshop in May 2025 at the University of York, UK to address the needs and barriers associated with implementing time-lapse imaging and machine learning-based phenotyping in low-resource research environments. We focussed on identifying the specific challenges faced by the existing networks represented at the meeting, emphasising how integrating combined imaging hardware and machine learning-based approaches can solve these problems. This article summarises the key observations and actionable strategies made at the workshop. These proposed steps aim to significantly increase the dissemination and uptake of these powerful technologies to advance biological research in low-resource settings globally.
Pathological risk stratification of prostate cancer (PCa) guides treatment decisions. Preoperative noninvasive assessment of PCa risk stratification holds promise for reducing unnecessary invasive biopsies. Elevated levels of iron and fat, along with metabolic disorders in PCa significantly correlate with tumor proliferation and aggressiveness, yet its predictive value in risk stratification remains unclear. We aimed to noninvasively measure fat content as well as iron deposition of PCa lesions by multiparametric magnetic resonance imaging (mpMRI) and investigate their effectiveness in predicting PCa risk. We prospectively collected patients suspected of PCa with preoperative MRI from 2019 to 2022, and ultimately included 109 pathologically confirmed PCa patients. The Gleason score (GS) and International Society of Urological Pathology grade group (ISUP GG) were determined by two uropathologists who evaluated independently and reached a consensus. Patients were stratified based on the ISUP GG, with 42 in the pathological low-risk (PL) group (ISUP GG ≤2; 69.9±6.08 years), 67 in the pathological high-risk (PH) group (ISUP GG ≥3; 71.82±5.86 years). We also collected clinical, pathologic, and imaging data from the patients. Based on the variables screened by Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis, an improved fusion (IF) model was established and visualized with a nomogram plot. The conventional fusion (CF) model was constructed by removing the non-conventional image variables in the IF model. Model performance was evaluated using 10-fold cross-validation, receiver operating characteristic (ROC) analysis, DeLong test, and decision curve analysis (DCA). P<0.05 was considered statistically significant. Significant differences were observed in the prostate-specific antigen (PSA), prostate volume (PV), Prostate Imaging Reporting and Data System (PI-RADS) scores, fat fraction (FF), T2*, and average apparent diffusion coefficient (ADC) values of the lesions between the two groups. These variables were selected to construct the IF model. The CF model was developed by removing FF and T2* values. The IF model demonstrated higher accuracy than the CF model [IF model: sensitivity =0.952, specificity =0.761, area under the curve (AUC) =0.920; CF model: sensitivity =0.762, specificity =0.761, AUC =0.819; DeLong test: P=0.002, <0.05]. mpMRI‑derived FF and T2* values were significantly associated with ISUP GG in PCa. Intergrating FF and T2* values with ADC, PI-RADS, PSA and PV may predict pathological risk classification more effectively.
Respiratory failure is a serious condition caused by impaired gas exchange, leading to hypoxemia or hypercapnia. Nasal high-flow therapy (NHFT) has emerged as an alternative to standard oxygen therapy (SOT). This meta-analysis evaluates the efficacy and safety of NHFT versus SOT by incorporating newly published trials to guide current clinical practice. This systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Randomized controlled trials (RCTs) comparing NHFT with SOT in acute respiratory failure were included. Primary outcomes were mortality and hospital stay. Data were pooled using a random-effects model in RevMan 5.4, and the certainty of evidence was assessed using GRADE. Sixteen RCTs (n = 5805) were included. NHFT showed no significant difference in 28-day mortality [risk ratio (RR) = 1.00; 95% confidence interval (CI): 0.85-1.17] or 90-day mortality (RR = 0.87; 95% CI: 0.58-1.29), length of hospital stay, length of ICU stay, or need for intubation. Oxygen saturation improved with NHFT after sensitivity analysis. Certainty of evidence ranged from moderate to very low using GRADE assessment, with heterogeneity addressed by removing outlier studies. NHFT shows comparable safety and efficacy to SOT in acute hypoxemic respiratory failure, with no significant differences in mortality, length of hospital stay, or intubation rates. Oxygen saturation improved with NHFT, reflecting its physiological advantages. Variability in study design limits generalizability. These findings support the individualized use of NHFT. Future research should explore patient-specific benefits, standardize protocols, and assess long-term outcomes.
School refusal behavior (SRB) is a prevalent and functionally heterogeneous problem among children and adolescents that can lead to serious academic, social, and psychological consequences. The School Refusal Assessment Scale-Revised (SRAS-R) is the most widely used instrument for identifying the functional motivations underlying school refusal, yet its psychometric properties have not been examined in Chinese clinical populations. The present study aimed to translate and culturally adapt the SRAS-R into Chinese and to evaluate its psychometric properties in a clinical sample of adolescents with depressive disorders. A total of 171 adolescent outpatients (age range 12-19 years; M = 15.5, SD = 1.90; 67.3% female) diagnosed with DSM-5 depressive disorders and meeting criteria for school refusal behavior completed both child and parent versions of the Chinese SRAS-R. Confirmatory factor analysis (CFA) using diagonally weighted least squares estimation was conducted. After removing Items 20 and 24, the four-factor model yielded strong CFI and RMSEA values for both parent (CFI = 0.99, RMSEA = 0.021, SRMR = 0.094) and child reports (CFI = 0.98, RMSEA = 0.028, SRMR = 0.097), although SRMR values were marginally above the prespecified threshold. Internal consistency reliability ranged from marginal to good across subscales (Cronbach's α: parent = 0.664-0.815; child = 0.700-0.864), with parent-reported Factor 4 showing the weakest reliability. Factor 1 (avoidance of aversive school situations) obtained the highest mean scores for both informants, consistent with the depression-related negative affectivity characteristic of this clinical sample. Cross-informant discrepancy analyses revealed that children reported significantly higher scores than parents on Factor 2 (escape from social/evaluative situations; p = .017, d = 0.18) and Factor 4 (pursuit of tangible reinforcement; p <.001, d = 0.27), suggesting that parents may underestimate internally driven motivations. Intraclass correlation coefficients indicated fair to good parent-child agreement (ICC = 0.45-0.62), with the highest agreement for Factor 1 and the lowest for Factor 4. The findings provide initial internal-structure and reliability evidence for the Chinese SRAS-R in this single-site clinical sample and underscore the need for multi-informant assessment, while future studies should examine convergent, discriminant, criterion-related, and predictive validity in more diverse samples.
The adaptive immune system monitors cellular integrity by recognizing short peptides from intracellular proteins presented on major histocompatibility complex class I (MHC-I) molecules, collectively termed peptide-MHC complexes (pMHC), enabling detection of foreign or mutated proteins. With the rising importance of immunotherapies targeting cancer neoantigens, accurately predicting which peptides bind to MHC alleles is critical. Current computational methods for pMHC-I binding prediction fall into sequence-based methods, which rely heavily on large training datasets, and structure-based methods that leverage structural modeling and pMHC binding energetics. Although sequence-based methods are widely used, their performance depends on the size and quality of the training data. Structure-based approaches, by contrast, can generalize better across diverse MHC alleles, but they traditionally depend on identifying a single global minimum-energy conformation, an assumption that may be inadequate for the promiscuous binding of MHC-I molecules. To address these limitations, we developed STRUMP-I (STRUcture-based pMHC Prediction for class I), a novel pMHC-I binding prediction tool that directly leverages a broad set of force-field-derived energy terms as machine learning features. In the standard benchmark set, STRUMP-I achieved performance comparable to state-of-the-art sequence-based models overall and showed a clear advantage for alleles with limited or imbalanced representation. Furthermore, STRUMP-I complemented sequence-based methods by removing method-specific false positives and improving precision, with a more favorable precision-recall tradeoff than AF-FT. These evaluations reinforced the value of STRUMP-I as a structure-informed prioritization method, particularly for underrepresented alleles and as a high-precision post-prediction filter.
The placenta serves as a vital channel for maternal-fetal substance exchange and is a crucial organ for maintaining pregnancy. Placental diseases can severely affect maternal health and fetal growth. Given the limitations of single-dimension segmentation models and traditional fusion strategies in meeting the demands of automatic placental magnetic resonance imaging (MRI) segmentation, this study developed an automatic placental MRI segmentation method based on a multi-dimensional interaction fusion network (MDIFN). This study included 267 placental MRI cases that met the inclusion criteria. After preprocessing steps, such as bias field correction, resampling, intensity normalization, and dimension matching, a dual-branch foundational architecture combining two-dimensional UNet (2D-UNet) and three-dimensional UNet (3D-UNet) was constructed. An interaction fusion bidirectional gated cross-dimension module was designed to achieve layer-wise synergistic fusion of two-dimensional (2D) detail features and three-dimensional (3D) contextual features. A global context recalibration module and a residual refinement module were introduced to optimize feature quality. A homoscedastic uncertainty-based multi-task weighted loss function was employed to balance the training process. Model performance was compared against six mainstream models using 10-fold cross-validation, and ablation studies were conducted to validate the contribution of core modules. The model achieved a Dice coefficient of 0.8749±0.0132 (P<0.05) on the test set, representing an improvement of 16.2% compared to pure 2D-UNet and 8.4% compared to pure 3D-UNet. The sensitivity was 0.8999±0.0172 (P<0.05), and the F1 score was 0.8749±0.0132, which were the optimal values among all models. The relative volume difference was 0.0301±0.0173, and the 95% Hausdorff distance was 7.67±1.04. Ablation experiments showed that removing the gating mechanism, global context module, or bidirectional interaction reduced the Dice coefficient to 0.8554, 0.8551, and 0.8566, respectively, confirming that each component contributes to performance improvement. This study addresses the limitations of single-dimension segmentation and traditional fusion models, providing an efficient and objective technical approach for automatic placental segmentation.
Large language models (LLMs) are increasingly deployed in decision-support systems for high-stakes domains such as hiring and university admissions, where choices often involve selecting among competing alternatives. While prior work has noted position biases in LLM-driven comparisons, these biases have not been systematically analyzed or linked to underlying preference structures. We present the first comprehensive study of position biases across multiple LLMs and two distinct domains: resume comparisons, representing a realistic high-stakes context, and color selection, which isolates position effects by removing confounding factors. We find strong and consistent order effects, including a quality-dependent shift: when all options are high quality, models favor the first option, but when quality is lower, they favor later options. We also identify a previously undocumented bias: a name bias, where certain names are favored despite controlling for demographic signals. To separate superficial tie-breaking from genuine distortions of judgment, we extend the rational choice framework to classify pairwise preferences as robust, fragile, or indifferent. Using this framework, we show that order effects can lead models to select strictly inferior options. These results indicate that LLMs exhibit distinct failure modes not documented in human decision-making. We also propose targeted mitigation strategies, including a novel use of the temperature parameter, to recover underlying preferences when order effects distort model behavior.
Stroboscopic visual training (SVT) is a perceptual-cognitive training paradigm that uses liquid-crystal eyewear to alternate between transparent and opaque states during sport-specific motor tasks, creating repeated cycles of vision and occlusion. By intermittently removing visual feedback, SVT compels the central nervous system to sustain internal predictions of moving targets rather than passively receiving real-time sensory input, placing concentrated and repeated demands on the predictive processing circuits that underpin performance in interceptive sports such as handball, volleyball, and soccer. Despite consistent behavioral evidence that SVT improves reaction speed, anticipatory skill, visuomotor performance, and sensorimotor balance control, the neural mechanisms driving these adaptations remain poorly characterized. This narrative review synthesizes evidence from SVT intervention studies, perceptual learning neuroscience, and sport neuroscience to propose a mechanistic account of how SVT may influence brain function. The review proposes that four neural systems may be engaged by SVT: the dorsal visual stream and MT/V5, which are repeatedly stressed by motion extrapolation demands during occlusion; the fronto-parietal attention network, which sustains predictive target representations across each occlusion cycle; the primary visual pathway, for which the only published SVT electrophysiology study demonstrated significantly reduced P100 latency following 6 weeks of stroboscopic training; and sensorimotor integration circuits, evidenced by SVT-induced changes in postural control and landing biomechanics. These findings are consistent with a proposed multi-level neuroplasticity model for SVT, though direct confirmation through concurrent EEG and fMRI designs remains an essential priority for future research.
Chronic obstructive pulmonary disease (COPD) poses a significant public health burden, particularly in China. This study mainly assessed the quality of clinical information and prevalent misinformation related to COPD-related short videos on TikTok, RedNote, and Bilibili. A cross-sectional observational study was conducted using videos collected on November 15, 2025. "Chronic obstructive pulmonary disease" was used as the search keyword on TikTok, RedNote, and Bilibili. After removing duplicate and irrelevant videos, 510 videos (167 from TikTok, 167 from RedNote, and 176 from Bilibili) were included in the analysis. Video characteristics, uploader types, and content categories were documented. The quality of information was assessed using the Global Quality Scale (GQS) and the modified Decision-Making Information Support Criteria for Evaluating the Reliability of Non-randomized Studies (mDISCERN) instrument. TikTok videos exhibited significantly higher user engagement (likes, comments, shares, and saves) than RedNote and Bilibili videos (P<0.001). However, regarding information quality, Bilibili videos achieved significantly higher GQS and mDISCERN scores than TikTok and RedNote videos (P<0.001). Content produced by professional institutions and individuals received significantly higher scores than that produced by nonprofessional institutions. A strong positive correlation was found among the popularity metrics, but no significant correlation was found between popularity indicators and quality scores. COPD-related short videos displayed uneven clinical information quality despite broad public exposure. Viral popular content cannot guarantee medical authenticity, and widespread misinformation may interfere with regular patient care. Sufficient professional participation and strict platform content supervision are therefore required to standardize online COPD health education and reduce clinical risks.
A data-driven and expert/patient consensus-based project to develop a revised Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) is under way supported by SLICC, ACR, and the Lupus Foundation of America. Our objective is to report the item generation and reduction phase results for a revised SDI. Item generation included a literature review by literature review groups and a Delphi exercise of international systemic lupus erythematosus experts and patients. Item reduction involved Delphi rounds in which items with a median appropriateness score of ≤4 of 9 were excluded. A 14-member item reduction committee assessed remaining items and removed those that did not reflect the damage construct, were rare, or were not feasible to assess. The clinical domain groups then refined the remaining items and their definitions. The Delphi panel included 146 individuals from 35 countries. The Delphi exercise nominated 2,256 items, and the literature review identified 117 items. After removing redundancies, 226 candidate items remained. Subsequent Delphi rounds, followed by review by the item reduction committee and clinical domain groups, resulted in 39 items across 13 domains. Eleven items from the original SDI, including proteinuria and cranial neuropathy, were removed and several new items were proposed, including growth failure/reduced final height and adrenal insufficiency. Severity-based subitems are proposed for 17 items (43.6%). This data-driven and expert/patient consensus-based process has proposed 39 candidate items, some with subitems, and definitions for a revised SDI. Weighting of items and subitems is underway to develop a clinical scoring system.
A 66-year-old man with acute coronary syndrome underwent emergency percutaneous coronary intervention (PCI) using Impella CP (Abiomed, Danvers, MA, USA) via the left common femoral artery (CFA). After PCI, he experienced shock and severe anemia. A computed tomography scan revealed a large retroperitoneal hematoma caused by femoral puncture-site bleeding. He was in hemorrhage and cardiogenic shock, so we needed to achieve hemostasis without removing Impella CP. We performed endovascular therapy (EVT) through the radial artery system. Angiography showed ongoing bleeding in the left CFA. Initially, we attempted balloon tamponade with an 8-mm semi-compliant balloon, but this was unsuccessful. We then performed percutaneous thrombin injections combined with balloon tamponade. Ultimately, we achieved hemostasis at the puncture site. Our case suggests that trans-radial EVT combined with percutaneous thrombin injection is a useful and safe method for controlling femoral puncture-site bleeding. Trans-radial endovascular therapy combined with percutaneous thrombin injection is a useful and safe method for controlling femoral puncture-site bleeding, even in patients requiring mechanical circulatory support.
Distributed arrays of wireless neural interfacing chips with 1-2 channels each, known as "neural dust," could enhance brain machine interfaces (BMIs) by removing wired connections through the scalp and increasing biocompatibility with their submillimeter size. Although several neural dust designs have emerged, currently reported procedures for implanting them in batches place the chips directly inside the brain, which can damage or displace large numbers of neurons. Therefore, a procedure for safely implanting neural dust in batches such that only ultrasmall microwire elements enter the brain is needed. Here, we demonstrate the feasibility of implanting batches of wireless motes that rest on the cortical surface and reach 1 mm brain depths via penetrating carbon fiber electrodes (6.8-8.4 μm diameter) without employing disruptive insertion shuttles. To simulate their implantation, we assembled over 230 mechanically-equivalent carbon fiber motes and affixed them to insertion tools with polyethylene glycol (PEG), a quickly dissolvable and biocompatible material. Then, we implanted batches into rat cortex in vivo and evaluated insertion success and their arrangement on the brain surface. When positioning motes for insertion, we discovered that they readily aggregated in molten PEG such that average array pitches were 5% longer than an individual mote's dimensions (240 × 240 μm). Overall, 187/214 (87%) motes tightly-packed in 4 × 4 (N = 4) and 5 × 5 (N = 6) square grid configurations successfully inserted into rat cortex. After implantation, measurements of how much motes tilted (22 ± 9°, X̄ ± S) and had been displaced from their original positions were smaller than those measured in the literature for devices implanted inside the brain. Collectively, these data establish the mechanical viability of assembling and safely implanting motes with ultrasmall electrodes and epicortically-situated chips, motivating the use of arrays with similar geometries in future BMIs.
Calcified materials in an opacified maxillary sinus often suggest fungal sinusitis, particularly aspergillosis. However, odontogenic maxillary sinusitis may rarely be associated with a bone-like calcified mass, creating diagnostic difficulty. We report a case of chronic odontogenic maxillary sinusitis with sequestrum-like bone formation that mimicked fungal sinusitis. An 88-year-old man was referred for mobility and occlusal pain of the maxillary left first molar. He had no nasal obstruction, rhinorrhea, headache, facial pain, or history of maxillary sinus surgery. Intraoral examination showed marked periodontal destruction, root exposure, tooth mobility, and percussion and occlusal pain. A hard structure was palpable through the periodontal pocket. Panoramic radiography showed increased opacity of the left maxillary sinus and a well-defined, horseshoe-shaped, bone-like radiopaque mass near the root apex. Computed tomography revealed a capsular calcified structure adjacent to the root apex within soft tissue occupying the left maxillary sinus, with extension toward the ethmoid sinus and thickening of the sinus wall. Fungal maxillary sinusitis was considered in the radiographic differential diagnosis. Under local anesthesia, extraction of the affected tooth, removal of the calcified mass, and maxillary sinus fenestration were performed. The mass, identified through the extraction socket, was not adherent to the tooth and was easily separated from the surrounding tissue. No fungal organisms, including Aspergillus species, were identified on histopathological examination. The excised specimen was a hard bone-like mass measuring approximately 20 × 15 mm. Histopathological examination revealed a sequestrum with areas suggestive of pre-existing lamellar bone and newly formed, incompletely mineralized bone. At one-year follow-up, maxillary sinus mucosal thickening had improved. This case illustrates that odontogenic maxillary sinusitis may be associated with a bone-like calcified mass and may radiographically mimic fungal sinusitis. When surgical treatment is clinically indicated, histopathological examination of the removed lesion can help establish a definitive diagnosis.
Protein-bound uremic toxins (PBUTs) such as 4-ethylphenyl sulfate (4-EPS) challenge kidney failure management due to strong binding to human serum albumin (HSA), thus limiting dialysis clearance. This study examined 4-EPS-HSA interactions using saturation transfer difference nuclear magnetic resonance spectroscopy (STD-NMR), isothermal titration calorimetry (ITC), in silico analysis via molecular docking, molecular dynamics (MD), and molecular mechanics Generalized Born surface area (MM/GBSA) simulations. STD-NMR qualitatively showed competitive binding with the site-specific ligands, warfarin and ibuprofen, indicating interaction with both Sudlow Sites I and II; competitive ITC results also showed competition between these molecules. ITC analysis using a two-component model indicated two distinct binding interactions with association constants Ka1 = 6.62 × 105 M-1 (entropically unfavorable) and Ka2 = 2.71 × 104 M-1 (enthalpically favorable), respectively. Docking models were used to analyze representative binding poses at Sudlow Sites I and II, while MD revealed hydrophobic stabilization at Site I and polar interactions at Site II. MM/GBSA per-residue decomposition identified key stabilizing residues. Circular dichroism measurements showed that the observed binding effects are not accompanied by gross protein unfolding. Comparisons with other PBUTs, including indoxyl sulfate and p-cresyl sulfate, indicated the role of electrostatic and hydrophobic forces involved in binding. These findings advance understanding of PBUT-HSA interactions and inform strategies for improved toxin removal in kidney failure treatments.
Ear, nose and throat (ENT) foreign body (FB) is common problem with significant morbidity and mortality. They are classified into organic or inorganic. Aerodigestive FBs are responsible for suffocation and death up to three years old with a 10% mortality up to 14 years old in Europe. Malaysia lacks local data that quantifies FB in dimensions to predict its risk. The study objectives were to determine the incidence of ENT FBs (paediatric and adult) in a Malaysian tertiary referral center; to determine the association between the FB types and factors contributing to its occurrence (largest dimension, volume, witnessed); to determine the treatment required; and association between hand dominance with ENT FBs. Prospective data of all children (<18 years old) and adults (≥18 years old) seen by the ENT physicians presenting with ENT foreign body were included over 12 months at Hospital Canselor Tuanku Muhriz (HCTM) from 1st February 2017 to 31st January 2018. All cases are seen by an ENT doctor (specialist and/or medical officer) during on-call, in hospital and outpatient's referrals. FB dislodged in the lower airways (trachea, bronchus and bronchiole) and upper gastrointestinal (GI) tract (oesophagus) were included. Exclusion criteria were FB dislodged in non-ENT orifices such as the stomach and beyond with no other ENT FBs. Bias was reduced by a proforma after obtaining an informed consent and taking the average of three measurements of FB dimensions. The incidence of ENT FB within HCTM was 3.5% (overall), 1.9% (organic), 1.6% (inorganic); 1.65% (children) and 1.85% (adults). Children have a mean age of 5.34 and adults 49.35 years. Among the patient factors; children FB are often inorganic (73.95%; plastic, metal, graphite), males predominant (56.5%), unwitnessed (66.67%), witnessed incidents were by adults (69.5%) at home (91.3%). Adult FB are often organic (77.1%; fish bone, cotton, tick), male to female ratio 1.4:1; not associated with occupation. Mackerel followed by red snapper and tilapia were common fish bones ingested. Common locations of FB among children and adults were throat (35.3%), ear (32.03%) and nose (26.14%). Less than one fifth required hospitalization due to aerodigestive FBs with 6 (72.7%) of hospitalised patients suffering complications of hypoxic brain injury, lung collapse, pneumonia, esophageal perforation and lacerations. Fifty-seven (37.25%) patients (adults predominant) required endoscopic removal under general or local anaesthesia. The side of ear and nose FB to hand dominance was significant (p<0.05). ENT FB are more common in the ear and nose in children; not witnessed, located in the oropharynx and occurred at home and during playtime. Organic FB and fish bones were common among adults in the Malaysian population. Aerodigestive FBs are associated with hospitalization, complications, requiring antibiotics and endoscopic intervention.
Bretziella fagacearum (formerly Ceratocystis fagacearum (Bretz)) Hunt is a vascular pathogen responsible for oak wilt disease, which affects various oak species in North America. Once established, management options include root disruption, removal of infected wood, and fungicide application, each with variable efficacy. This is the first study to assess three commercial biofertilizers against B. fagacearum in vitro, using Spectrum supplemented with Pepzyme Clear (SPC), EM-1, and Power Gelatinase and Chitinase-producing Microorganism (PGCM), as no biological methods currently exist. These biofertilizers were chosen for microbes associated with improved nutrient uptake and for their potential biocontrol activity. We conducted dual-culture plate assays, volatile organic compounds (VOCs) assays, and non-volatile metabolite assays. EM-1 and PGCM exhibited the strongest antagonistic effects for dual-culture plate assays (56% and 68%, respectively) and for VOCs assays (62% and 47%, respectively). After 15 days of exposure to non-volatile metabolites, microscopic analysis revealed severe hyphal distortions from EM-1 and PGCM. These preliminary in vitro findings suggest that PGCM and EM-1 suppressed mycelial growth of B. fagacearum and may be used as biological control. Further field studies are needed to understand how environmental factors and soil-tree-microbe interactions can affect their efficacy against oak wilt disease.
Intradural disc herniation (IDH) in the lumbar spine is an extremely rare condition, representing only a small percentage of all disc herniations. Despite advanced imaging techniques, IDH is often misdiagnosed as intradural tumor, disc herniation or migrated sequester. Definitive diagnosis is usually established intraoperatively and may be confirmed histologically. This case report describes an L1/2 IDH that was microsurgically removed with the assistance of intraoperative ultrasonography (IOUS) for localization of the lesion. The ventral dural tear, frequently occurring in IDH, was managed using a collagen pad, resulting in an uneventful postoperative course without evidence of cerebrospinal fluid (CSF) leak during follow-up. We present a 70-year-old female patient with acute back pain, radiating to inner thighs and paraparesis. Magnetic resonance imaging (MRI) showed intervertebral (IV) disc herniation in the L1/2 segment. Subsequent microdiscectomy assisted by IOUS revealed intradurally migrated fragments, which were carefully removed. The ventral dural tear was identified and treated using an absorbable collagen pad. At both 7-week and 18-month follow-up, the patient remained pain-free and showed no new neurological deficits or signs of CSF leakage. Lumbar IDH remains a rare diagnostic challenge, as preoperative imaging is often inconclusive. This case suggests that intraoperative ultrasound may aid localization of intradural pathology, while collagen-pad repair may provide a useful option for managing ventral dural defects when primary closure is technically challenging, although further research is necessary.
Severe complications following complex penile reconstructive surgery are uncommon but may be devastating, particularly when synthetic grafts are employed. Infection and progressive penile skin necrosis can rapidly compromise erectile structures and functional outcomes. Evidence guiding the optimal management of extensive necrosis after graft-based augmentation procedures remains limited. We report a case of severe penile skin necrosis following complex penile surgery with synthetic graft implantation, highlighting a staged salvage strategy aimed at infection control and preservation of erectile anatomy. A 36-year-old man presented with progressive penile skin necrosis and infection after undergoing corrective penile surgery at an external centre, including plaque excision, bilateral placement of Gore-Tex® grafts, suspensory ligament section, circumcision, and vasectomy. Clinical evaluation revealed extensive cutaneous necrosis with partial exposure of synthetic grafts. Urgent surgical exploration was performed, consisting of radical debridement and complete graft removal. The corpora cavernosa were exposed but viable and intentionally left uncovered as part of a staged reconstructive approach. Targeted antibiotic therapy and adjunctive hyperbaric oxygen treatment were initiated. After infection control and wound stabilization, definitive reconstruction was achieved using a split-thickness skin graft combined with a dermal regeneration template (Matriderm®). The postoperative course was uneventful, with excellent graft take and satisfactory cosmetic results. Extensive penile necrosis following synthetic graft-based surgery requires prompt recognition and aggressive management. Early removal of foreign material, radical debridement, and a staged reconstructive strategy are essential to prevent further tissue loss and preserve erectile structures. Multidisciplinary management and the use of dermal regeneration templates may facilitate reliable coverage and favourable functional recovery in complex salvage scenarios.
An item bank of cognitive items targeting the spectrum of cognitive function, with a focus on advanced dementia was developed with data from residents in long term services and supports (LTSS) settings. Latent variable models, including item response theory and factor analyses were applied to fifty items from multiple cognitive screening measures assessing memory, orientation, naming, attention, calculation, and following directions. Because the intent was to use the item bank to measure overall cognition, subdomains were not modeled. Factor analyses tested for essential unidimensionality, followed by application of an item response theory-based graded response model, including differential item functioning to examine measurement equivalence. The total sample size was 6,921, with 1,874 (27.1 %) males and 5,040 (72.9 %) females. The average age was 82.5 (SD = 11.0). There were 1,089 (16.2 %) Black, 498 (7.4 %) Hispanic, and 5,136 (76.4 %) White respondents. The average number of years of education was 9.1 (SD = 5.5). Estimates of reliability across age, education, race, and sex subgroups were high with most > 0.96. Cognitive function of the participants in the study varied from no to minimal impairment (552 or 8.0 %); mild (2,000 or 28.9 %); moderate (2,686 or 38.8 %); severe (1,328 or 19.2 %) to very severe impairment (355 or 5.1 %). Items with low information and substantial DIF were recommended for removal. The final recommended item bank includes 38 items. Future work with this item bank may include development of computerized adaptive tests and short-forms.
Semiconductor-based photocatalytic water splitting is a promising pathway for sustainable hydrogen production; however, the reported performance depends not only on the intrinsic properties of the photocatalyst but also on reactor configuration and operating conditions. This systematic technical review examines the interplay between nanostructured semiconductor photocatalysts and the principal engineering variables governing photocatalytic hydrogen evolution. Particular attention is given to particle size, morphology, surface area, defect density, heterojunction design, cocatalyst incorporation, aggregation, and catalyst immobilization, as well as their interaction with reactor geometry, optical path length, photon distribution, catalyst loading, working volume, pH, sacrificial agents, mixing, thermal control, gas purging, and product quantification. The reviewed evidence indicates that these material and reactor parameters jointly determine light absorption, charge-carrier separation and transfer, suspension turbidity, mass transport, catalyst recovery, stability, and the measured hydrogen evolution rate. Batch slurry reactors remain the most widely used laboratory configuration, whereas annular, flat-panel, microreactor, fixed-bed, continuous-flow, and photofluidized systems offer specific advantages for photon utilization, catalyst reuse, product removal, and scale-up. The review also emphasizes the need to distinguish overall water splitting from sacrificial-agent-assisted hydrogen evolution. Standardized reporting of photocatalyst properties, irradiance, spectral distribution, illuminated area, reactor dimensions, reaction atmosphere, and gas-analysis procedures is essential to improve reproducibility and enable reliable comparisons among nanostructured photocatalytic systems.