Split Learning (SL) represents a novel collaborative machine learning paradigm tailored for participants with private data and constrained computational capabilities. As with Federated Learning (FL) and other collaborative learning paradigms, SL is also vulnerable to security threats, including backdoor attacks. Although prior research has claimed that SL is highly resilient to backdoor attacks because attackers lack access to other participants' training data and models, this study reveals vulnerabilities in SL to such threats by analyzing smashed data from multiple clients. Based on our analysis and observations, we propose a novel Backdoor attack framework against split learning, termed Backspin, that leverages the similarity of smashed data from different clients to execute both client-side and server-side attacks. Our evaluations cover both Computer Vision (CV) and Natural Language Processing (NLP) tasks across six widely used datasets and six models in diverse split-learning settings to validate Backspin's effectiveness and robustness against prevalent privacy defenses. Remarkably, our method achieves an average Attack Success Rate (ASR) exceeding 90%, while incurring only a 1.5% reduction in Clean Data Accuracy (CDA) relative to centralized training, demonstrating the balanced nature of our approach for effective attack execution without significantly compromising data integrity.
Developing bioactive dressings to remodel pathological microenvironments is critical for diabetic foot ulcer management. Drawing inspiration from the traditional "smashed for external application" of Taraxacum mongolicum Hand.-Mazz., a biomimetic film (TH-EVLPs@CNF-) is engineered by integrating extracellular vesicle-like particles (TH-EVLPs) from fresh dandelion juice with carboxylated cellulose nanofibrils (TH-CNF-) derived from plant residues. The TH-CNF- matrix exhibits exceptional biocompatibility and multifunctionality: enhancing cell proliferation, dynamically reprogramming macrophage polarization from pro-inflammatory M1 to reparative M2 phenotypes, and promoting angiogenesis via VEGF signaling. Leveraging botanical homology, the anti-inflammatory TH-EVLPs are highly loaded in the CNF- films (109 particles/cm2) with on-demand release, synergistically accelerating diabetic wound closure by 96% within 14 days (vs 56% in untreated controls) through collagen reorganization and vascular regeneration. This work reveals the concept of integration of medicinal and adjuvant components embodied in the traditional application of dandelion, and meanwhile provides insights for the integrated forming process of medical dressings based on homologous bioactive substances.
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A healthy middle-aged man was treated for isolated scaphotrapeziotrapezoid joint osteoarthritis with implant arthroplasty using a Pyrocardan implant. We report implant breakage twice during tennis training, and the debut of squeaking after the first failure. The implant was revised and replaced both times. Revision of the implant resolved the squeaking. To our knowledge, this is the first report of a type of complication with this implant, indicating potential limitations for its future use.
Hearing loss (HL) is a prevalent condition that can substantially impact quality of life. Hearing aids can benefit people living with HL, yet many delay seeking treatment. This may be due to limited public awareness of HL and the stigma surrounding HL and hearing aids. The media can significantly shape public perceptions of HL and D/deafness, and there have been calls for improved media portrayals of HL and D/deafness. This study examined how British newspapers represent HL and D/deafness both visually and textually, and whether these representations reiterate and/or challenge stigma. This qualitative study used multimodal critical discourse analysis (MCDA) guided by stigma theory and the Visual Discourses of Disability framework. Public contributors living with HL or D/deafness were consulted. A Nexis database search retrieved 7,173 articles about HL or D/deafness from 2022-2023. A random sample, extracted from the 200 most relevant articles, was screened. Three key themes were identified: (1) representing social progress, including technological advancements and societal roles for people with HL or D/deaf people, (2) the lack of diverse narratives and perspectives, including the absence of older adults, and (3) the stigma and social barriers associated with living in a hearing-orientated world, including tensions regarding whether HL should be (in)visible. Combined, this suggests that the overall social progress narrative is challenged by continued stigmatisation and inadequate diversity. This research was a novel application of MCDA to representations of HL and D/deafness, which focused on British newspapers. Further efforts are needed to improve these representations, particularly representations of older adults. Future research should apply MCDA to representations of HL and D/deafness in other contexts. The findings have important implications for academics in discourse and disability studies, and for all those who communicate with the public about hearing loss, including researchers, clinicians, public health officials, charities, and the media.
Hemophilic arthropathy results from recurrent joint bleeding driven by impaired thrombin generation and a synovial environment favoring bleeding and chronic inflammation. Activated protein C (APC), abundant in hemophilic joints, may exacerbate cartilage degradation through enhanced matrix metalloproteinase activity. APC inhibition has emerged as a potential therapeutic strategy that may improve hemostasis and possibly protect joint tissues. The aim of the present work was to evaluate whether systemic inhibition of APC anticoagulant activity provides superior protection of cartilage compared with standard factor (F) VIII prophylaxis in a murine model of hemophilic arthropathy. FVIII-deficient mice underwent two induced knee hemarthroses. Animals received either extended-half-life FVIII, an APC-inhibitory peptide, or saline for three weeks. Plasma APC activity was measured using a chromogenic assay. Magnetic resonance imaging (MRI) scan assessed joint bleeding, and histopathology was evaluated using Valentino and standardized microscopic arthritis scoring of histologic sections (SMASH) scoring systems, with blinded analysis of synovitis, vascularity, and cartilage integrity. Both FVIII and APC inhibitor treatments reduced MRI scan-detected intra-articular bleeding compared with untreated controls. Histology confirmed synovial hypertrophy in all injured knees. Total Valentino and SMASH synovitis scores did not differ significantly between groups. Neither FVIII replacement nor APC inhibition resulted in measurable joint protection compared with untreated FVIII-deficient controls. Systemic inhibition of APC anticoagulant activity rebalanced coagulation but did not yield superior joint preservation. Differences from prior antibody-based APC inhibition studies likely reflect inhibitor design, dosing strategies, and the limited impact of systemic inhibition on synovial APC activity. Further work should explore targeted APC modulation within the joint microenvironment.
Brennan, A, Murray, A, Johansen, M, Couglan, D, Xu, J, Turner, A, and Bishop, C. Inclusion of lower-body and upper-body power exercises acutely improves distance-related measures in golf driving performance. J Strength Cond Res XX(X): 000-000, 2026-The aim of this study was to investigate the acute effects of including upper-body and lower-body power interventions on distance-related swing measures in high-level amateur golf players. Eighteen male golf athletes completed 2 acute interventions, separated by 1 week. Golf shot data were recorded at baseline, immediately postintervention, and at 15-, 30-, and 60-minute intervals. The upper-body intervention resulted in statistically significant, albeit trivial to small improvements in ball speed (g = 0.13-0.21), carry distance (g = 0.29-0.36), and smash factor (g = 0.14-0.27) across multiple time points, with no significant changes observed in clubhead speed (CHS). By contrast, the lower-body intervention demonstrated statistically significant improvements across all golf metrics, including CHS (g = 0.14-0.18), ball speed (g = 0.26-0.36), carry distance (g = 0.26-0.31), and smash factor (g = 0.16-0.35). In conclusion, both interventions elicited acute improvements in distance-related swing measures, with the lower-body intervention demonstrating a slightly superior influence on CHS. These findings suggest that low volume power exercises may be effectively integrated into prepractice or precompetition routines. However, practitioners should also consider the potential cumulative effects of combining both upper-body and lower-body power methods, as demonstrated by significant improvements in distance-related swing data across multiple time points. This suggests that practitioners can feel confident when implementing low volume power training interventions before golf practice or competition.
Controllable targeted protein degradation (controllable TPD) technologies, exemplified by proteolysis-targeting chimeras (PROTACs), have emerged as transformative tools in drug discovery and molecular biology research. With the endogenous cellular degradation machinery, controllable TPD platforms allow for the precise targeting and regulated elimination of specific proteins within cells. Recent advances have expanded the spectrum of controllable degradation strategies, including photosensitive degrons, opto-PROTACs, auxin-inducible degron (AID) systems, small molecule-assisted shut-off (SMASh) techniques, and engineered E3 ubiquitin ligases such as ΔTRIM21 with enhanced targeted protein degradation efficiency (ΔTRIM-TPD). These emerging methodologies provide unprecedented control over protein stability, facilitating targeted therapeutic interventions for diseases such as cancer and infectious diseases, and significantly advancing fundamental biological research. This review systematically summarizes recent breakthroughs in controllable TPD strategies, elucidates their distinct molecular mechanisms, and highlights their promising therapeutic applications. The rapidly evolving field of controllable TPD represents a powerful and adaptable technological frontier, opening new avenues in precision medicine and providing versatile tools for the future of biomedical research.
To evaluate retear rates, clinical outcomes, and complications of a consecutive series of full-thickness rotator cuff repair cases augmented with an autograft biceps patch. A retrospective review was performed of patients undergoing rotator cuff repair with autograft biceps patch augmentation. Patients underwent either magnetic resonance imaging or ultrasound to evaluate rotator cuff repair integrity at a minimum of 6 months postoperatively. Patient-reported outcomes including the American Shoulder and Elbow Surgeons Score and Single Assessment Numeric Evaluation score were also collected and evaluated for clinical significance at a minimum of 12 months postoperatively. Analysis of retear rates was performed by comparing observed retear rates to expected retear rates using the modified Rotator Cuff Healing Index score. The final cohort included 25 rotator cuff repair cases. Postoperative imaging was obtained by magnetic resonance imaging in 22 patients at a mean of 9 months postoperatively (range, 6.0-15.3 months) and ultrasound in 3 patients at a mean of 30.4 months (range, 28.8-32.2 months). The expected retear rate using the modified Rotator Cuff Healing Index score was 21.5% for the entire cohort. There was 1 retear, resulting in an actual retear rate of 4% at an average of 23.5-month follow-up (P = .0196). The average Single Assessment Numeric Evaluation score was 93 (standard deviation 9), and the average American Shoulder and Elbow Surgeons Score was 96 (standard deviation 6.3) at an average of 23.5-month follow-up (range 14-32). Patient acceptable symptomatic state was achieved by 96% of the cohort for the American Shoulder and Elbow Surgeons Score and 88% of the cohort for the Single Assessment Numeric Evaluation score. There were no cases of reoperation or complications. In this consecutive series, the biceps autograft "smash" patch for rotator cuff augmentation resulted in a low rate of retears, favorable patient-reported outcomes, and no complications. This augmentation option has the potential to be safe and effective for improving rotator cuff repair healing rates. Level IV, retrospective case series.
For competitive adolescent athletes, injury avoidance is a challenge, and causes of injury are complex and multifactorial. Despite an incidence of 8.2 shoulder injuries per 1,000 hours of tennis played, few studies have investigated the association between shoulder strength, range of motion (ROM), and injury. Eccentric and isometric shoulder muscle strength and/or shoulder ROM are associated with new shoulder complaints and/or injuries. Cohort study. Level 3. At baseline 301 adolescent competitive tennis players aged 13 to 19 years completed a questionnaire, were assessed with a shoulder protocol for strength and ROM and followed weekly (for shoulder complaint/injury) for 52 consecutive weeks. Outcomes were a first incidence of a tennis-related shoulder complaint or injury in the dominant arm, defined as a sum score of ≥20 or ≥40, respectively, on the Oslo Overuse Injury Questionnaire. Two cohorts were created for Cox regression analyses, adjusted for age, sex, and playing level: (1) shoulder complaints (n = 204), and (2) shoulder injuries (n = 252). The most definitive adjusted associations were a hazard rate ratio (HRR) of 1.3 (95% CI 1.0-1.8) for a shoulder complaint in eccentric external rotation (eccER) strength, and a HRR for shoulder injuries of 1.4 (95% CI 1.0-1.9) in isometric internal rotation (IIR) strength in the 90-90 position, and 1.5 (95% CI 1.1-2.0) in eccER normalized to body mass. Higher values of eccER shoulder strength, IIR strength at the 90-90 position, and eccER shoulder strength normalized to body mass, were associated with shoulder complaints/injuries in adolescent competitive tennis players. Incorporating a training program that takes volume and intensity into account in the daily oncourt sessions, to build resilience through a well-planned, long-term training and competition plan to minimize shoulder injury risk may be of importance.
This study aimed to characterize the clinical, laboratory, and neuroimaging profiles of hospitalized Brazilian patients with confirmed SARS-CoV-2 and acute cerebrovascular events. This retrospective multicenter study included 374 patients from 17 stroke centers between March and November 2020. Eligible events were ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and cerebral venous thrombosis. The stroke subtypes were further classified using the TOAST, Oxfordshire, and SMASH-U criteria. Demographics, National Institutes of Health Stroke Scale (NIHSS) scores, laboratory results, imaging findings, complications, and outcomes were analyzed. Multivariate logistic regression was used to assess the predictors of in-hospital mortality and good functional outcomes (modified Rankin Scale; mRS 0- 2). Ischemic stroke accounted for approximately 83% of all stroke cases. The median patient age and NIHSS score at admission were 66 years and 10, respectively. The major complications included pneumonia (61%), renal failure (35%), and sepsis (30%). The in-hospital mortality rate reached 31%, and only 28% of the patients achieved good functional outcomes. Higher NIHSS scores and D-dimer levels were independently associated with worse outcomes. Notably, the median time from stroke onset to admission (4.4 h) was shorter than the pre-pandemic average. In this national cohort, SARS-CoV-2-associated stroke was severe, predominantly ischemic, and commonly complicated by systemic organ dysfunction. D-dimer levels emerged as a significant prognostic biomarker of mortality and poor functional outcomes. Contrary to earlier assumptions, stroke admission delays were not prolonged during the pandemic. These findings highlight the need for integrated stroke care in patients with COVID-19 and inform future management strategies.
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This study aimed to investigate the effects of exercise-induced fatigue on the risk of tibial stress fractures by comparing biomechanical parameters during backhand-side smash landings in elite female badminton players before and after fatigue. Thirteen elite female badminton players performed smash-landing trials before and after fatigue. The AnyBody Modeling System was used for inverse dynamics analysis, and finite element analysis was conducted using the AnyFE2Abq plugin to compute tibial stress and strain. After fatigue, the backhand rearcourt jump smash (BRJS) and the backhand lateral jump smash (BLJS) landing movements showed significantly increased peak tibial acceleration (p = 0.003; p = 0.008), vertical average loading rate (p = 0.024; p = 0.040), and vertical instantaneous loading rate (p = 0.007; p = 0.029. Moreover, the simulated tibialis anterior muscle force significantly decreased after fatigue (p = 0.004; p = 0.046). Finite element analysis further revealed markedly increased tibial stress and strain after fatigue, with peak stress and strain reaching multiple times the pre-fatigue values (peak stress: BRJS anterior medial, 224.0%; BRJS posterior, 213.2%; BLJS anterior medial, 348.6%; BLJS posterior, 522.8%; peak strain: BRJS, 241.1%; BLJS, 243.7%). Exercise-induced fatigue increased tibial acceleration and vertical loading rates during smash landings in elite female badminton players. Tibial stress and strain also increased, suggesting a potentially higher risk of tibial stress fracture.
This study examined the effects of ballistic training (BT), blood flow restriction training (BFRT), and traditional resistance training (TRT) on the smash performance of adolescent badminton players. Thirty athletes were randomly assigned to BT, BFRT, or TRT groups and completed 12 training sessions over four weeks. Heart rate (HR) was continuously monitored to adjust intensity and rest intervals. After the intervention, data were analyzed using two-way mixed-design ANOVA. Smash speed significantly improved across all groups (F(1,27) = 22.34, p < 0.05, η²ₚ = 0.66), with a significant time by group interaction (F(2,27) = 6.71, p = 0.004, η²ₚ = 0.33). In the BFRT group, smash speed increased from 166.8 ± 9.7 to 202.0 ± 11.3 km·h⁻¹. Smash accuracy improved slightly without significant group differences (F(2,27) = 4.23, p = 0.026, η²ₚ = 0.24). Exercise heart rate and recovery showed significant time and time by group effects (Ex HR: F(2,27) = 7.08, p = 0.003; HRR: F(2,27) = 5.42, p = 0.010), while resting HR remained stable. In conclusion, both BT and BFRT increase smash speed in adolescent badminton players, suggesting that combining these methods can improve performance and training efficiency.
The Safe Medication Dashboard (known as SMASH), an intervention to reduce hazardous prescribing in general practice through a pharmacist-led intervention and web-based dashboard, was piloted in 2017. A rollout of SMASH by the regional health innovation network was funded in 2019. A longitudinal qualitative evaluation of the regional implementation effort was conducted over three years, including in-depth semi-structured interviews with relevant stakeholders (n = 18), non-participant observations (n = 42), and documentary analysis. Assumptions about the replicability and complexity of the intervention led to an implementation strategy and pace that were misaligned. The implementation of SMASH suffered from delays, diversions, and disruptions due to unanticipated infrastructure needs, regulatory changes in data sharing, and the health systems' response to the COVID-19 pandemic. The findings will be discussed alongside relevant implementation frameworks to highlight how interdependencies between wider policies, organisations, and technologies can significantly shape the trajectories and pace of implementation efforts.
The rising infection caused by Candida albicans and emerging multi-drug resistance necessitates the development of innovative antimicrobial discovery pipelines. To overcome high discovery rates from conventional sources, this study utilised a hazard-to-solution biotechnology paradigm, successfully transforming the sanitary pest Periplaneta americana into a sustainable bioresource for novel antifungal agents. Herein, an integrated multi-omics framework was established to systematically characterise the biosynthetic potential of Streptomyces sampsonii strain WA1-19, a symbiont of P. americana exhibiting potent activity against C. albicans. Whole-genome sequencing and anti-SMASH analysis revealed eight biosynthetic gene clusters of the strain, including one with 100% similarity to candicidin, providing a genomic rationale for its biocontrol capability. Subsequently, untargeted metabolomics coupled with GNPS analysis was employed to connect the genomic potential to the expressed chemistry of the strain, and several bioactive metabolites were identified such as surugamides, daizein and so on. Network pharmacology analysis predicted that the inhibitory effects of these metabolites against C. albicans might be associated with the core virulence pathways of the pathogen, particularly MAPK and PI3K-Akt signalling cascades. In summary, this study presents S. sampsonii strain WA1-19 as a promising biocontrol candidate and validates a multi-omics workflow that offers a powerful strategy for antimicrobial discovery from underexplored insect niches.
This study used one-dimensional statistical parametric mapping (SPM1d) to examine how exercise-induced fatigue affects lower limb biomechanics during landing from high-risk backhand smashes, including the backhand rear-court jump smash (BRJS) and backhand lateral jump smash (BLJS), in elite female badminton players. After fatigue, athletes showed increased hip coronal motion, knee valgus, and trunk lateral tilt, but reduced hip abduction, indicating weakened coronal control. These biomechanical changes suggest an increased risk of anterior cruciate ligament (ACL) injury. BRJS presented a sagittal plane dominant energy absorption strategy, while BLJS presented a coronal plane dominant balance strategy. Overall, exercise-induced fatigue reshapes landing control strategies and induces biomechanical alterations consistent with an elevated risk of ACL injury. In addition, BRJS exhibits biomechanical patterns potentially associated with ankle sprains, whereas BLJS displays loading patterns linked to ACL injury mechanisms, suggesting movement-specific potential injury risks.
Parallel importation (PI) is a TRIPS-recognized flexibility intended to improve access to medicines through price competition. In low- and middle-income countries, however, concerns persist regarding regulatory oversight, product quality, and patient safety. Empirical evidence on the real-world implementation of PI in Kenya remains limited. This study aimed to assess the regulatory compliance of selected parallel imported medicines marketed in Nairobi County, identify predictors of compliance, evaluate their market prevalence, and examine whether PI delivers the intended economic benefits for patients. Twenty-two medicines identified as parallel imports were evaluated against Kenyan regulatory requirements, including Pharmacy and Poisons Board (PPB) guidelines on labeling, packaging, patient information leaflets, storage conditions, and the Parallel Imported Medicinal Substances Rules (2019). A mystery-shopper survey covering 2348 retail pharmaceutical outlets across all 85 Nairobi wards estimated the prevalence of non-compliant PI products. Logistic regression was used to identify predictors of compliance, and independent t-tests compared retail prices of PI products with those supplied through authorized channels. Regulatory non-compliance was widespread. Ninety percent of PI products failed to meet labeling and package insert requirements, primarily due to foreign-language packaging that precluded verification of critical safety information. Forty-five percent displayed storage instructions inconsistent with Kenya's ICH climatic Zone IV requirements, indicating supply chains not adapted to tropical conditions. Overall, 90% of products violated key provisions of the PPB PI Rules. Nearly all PI medicines were off-patent and already had multiple generic alternatives registered in Kenya, undermining the TRIPS-based public health rationale for PI. Unauthorized PI products were identified in approximately 90% of surveyed outlets. Price analysis showed significant differences in 53% of comparisons, but nearly half of PI products offered no economic advantage over authorized equivalents. Parallel importation of medicines in Nairobi is characterized by extensive regulatory non-compliance, limited or absent price benefits, and significant risks to medicine quality and patient safety. In its current implementation, PI in Kenya operates largely outside its intended TRIPS scope and fails to deliver meaningful public health value. Strengthened regulatory enforcement, climate-appropriate packaging, mandatory language compliance, and a reassessment of PI policy are urgently required to protect patients and preserve trust in the pharmaceutical system.
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Biologic augmentation of rotator cuff repair continues to evolve as surgeons attempt to improve healing in an inherently biologically limited environment. Autograft options, particularly the long head of the biceps tendon, offer an attractive, readily available scaffold with theoretical advantages over allograft and synthetic patch technologies. This commentary discusses the emerging role of a compressed biceps autograft patch technique for rotator cuff augmentation and its potential to reduce structural failure while maintaining excellent patient-reported outcomes. Biologic augmentation must balance simplicity, cost, and reproducibility against theoretical improvements in tendon healing. The concept of using discarded native tissue as a structured biologic implant is particularly appealing because it avoids immunogenicity, reduces cost, and integrates seamlessly into the standard arthroscopic workflow. However, enthusiasm must be tempered by recognition of the limitations inherent to early, single-surgeon series and short-term imaging follow-up. Overall, the biceps autograft patch represents one of the more pragmatic biologic augmentation strategies currently described, but its true value will depend on reproducibility, comparative effectiveness, and longer-term outcomes. The key question is not whether it works in select hands, but whether it can be standardized and scaled.