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Fourteen species of monopisthocotyls were reported from the gills of Triportheus albus Cope (Characiformes: Triportheidae) collected from the Itaya River, Peru. Nine species belonged to Anacanthorus Mizelle & Price, 1965: seven previously described species: Anacanthorus acuminatus Kritsky, Boeger & Van Every, 1992, Anacanthorus alatus Kritsky, Boeger & Van Every, 1992, Anacanthorus bellus Kritsky, Boeger & Van Every, 1992, Anacanthorus euryphallus Kritsky, Boeger & Van Every, 1992, Anacanthorus quinqueramus Kritsky, Boeger & Van Every, 1992, Anacanthorus formosus Kritsky, Boeger & Van Every, 1992, and Anacanthorus ramulosus Kritsky, Boeger & Van Every, 1992, and two new species described herein. Three species belonged to Ancistrohaptor Agarwal & Kritsky, 1998: Ancistrohaptor falciferum Agarwal & Kritsky, 1998, Ancistrohaptor falcunculum Agarwal & Kritsky, 1998, and Ancistrohaptor forficata Diniz, de Sousa, Yamada & Yamada, 2025; and two to Jainus Mizelle, Kritsky & Crane, 1968: Jainus iquitensis Morey, Viana, Chota & Chero, 2025 and Jainus sardinae Morey, Viana, Chota & Chero, 2025. Anacanthorus itayensis n. sp. is characterized by a long sclerotized sigmoid male copulatory organ (MCO) with submedial cirral "feather" and by a four-branched accessory piece in which the second branch terminates in a fish-like fin, the others bifurcate into sub-branches with pointed tips. Anacanthorus ypsiloniformis n. sp. is characterized by an elongate, slightly conical MCO curving ventrally and terminating in a rounded, slightly tapered distal tip bearing a dense crown-like cluster with submedial small spines, and by a distinctively Y-shaped accessory piece with two divergent arms arising proximally: one broader and blunt-ended with a comb-like denticulate distal margin, the other narrower and more rounded distally. This study constitutes the first comprehensive record of monopisthocotyls from T. albus in Peru and documents one of the most species-rich dactylogyrid assemblages reported from a single host species of Triportheus Cope in the Neotropical region.
Correctional climate-the perceptions staff and incarcerated people hold about their institution-can influence well-being for everyone living and working in prison. This study explores differences in perceptions of safety, quality of sleep, psychological and emotional wellness, physical health, and overall life outlook among 1,148 security staff, non-security staff, and incarcerated individuals across five Minnesota Department of Corrections facilities. Results indicate that both staff groups report significantly greater safety and sleep quality outcomes than incarcerated people, while security staff also reported better emotional wellness than the incarcerated population. No differences emerged across groups regarding perceived psychological wellness, physical health, or life outlook. These findings highlight both shared experiences and key disparities within correctional environments, underscoring opportunities to improve conditions, support workforce well-being, and advance institutional policies that benefit all people in prison settings. How Prison Staff and Incarcerated People View Safety, Health, and Life in PrisonPrisons are environments where both staff and incarcerated people live or work every day. How people feel about safety, health, and well-being in these settings, often called the correctional climate, can affect everyone inside the facility. Understanding these perceptions can help improve conditions for both staff and incarcerated individuals. This study examined how people in five prisons in Minnesota view their safety, sleep quality, emotional and psychological well-being, physical health, and overall outlook on life. The study included responses from 1,148 people: correctional security staff, non-security staff, and incarcerated individuals. The results showed some important differences. Both security staff and non-security staff reported feeling safer and said they slept better than incarcerated people. Security staff also reported better emotional well-being than incarcerated individuals. However, the three groups reported similar levels of psychological well-being, physical health, and general outlook on life. These findings suggest that people in prisons share some similar experiences but also face different challenges. Understanding these similarities and differences can help correctional leaders develop policies and programs that improve safety, well-being, and working and living conditions for everyone in prison facilities.
The Cuckoo Catfish Optimizer (CCO) is a recent swarm method with four built-in movement strategies. Its weakness is not the moves themselves but the way it chooses among them: a fixed chain of random-versus-threshold (rand>C) tests that ignores how each agent is actually doing and keeps no memory of which move has been paying off. On harder, higher-dimensional problems, this rigidity drains diversity and the search stalls. We propose CCO-RL, which hands the choice of move to a small tabular Q-learning controller. For every agent at every iteration, the controller reads a 48-state summary of the agent's crowding, its recent stagnation and how far the run has progressed, then picks one of the four moves. A bounded reward and a decaying ε-greedy rule let it learn a policy online with no extra function evaluations. We test CCO-RL against the original CCO and eight popular metaheuristics on CEC2017 (D=30,50) and CEC2022 (D=20): 70 instances, 30 runs each. CCO-RL earns the best overall Friedman rank (1.69) and significantly beats every external competitor according to the Nemenyi test. It also finds the best mean design in three engineering problems.
SSGJ-608 is an anti-interleukin-17A monoclonal antibody with high specificity and high affinity and has shown promising efficacy in treatment of moderate-to-severe psoriasis in preliminary trials. This multicenter, randomized, open-label, phase 3 trial aimed to further evaluate SSGJ-608 at different dosing intervals (80mg every two weeks and 160mg every four weeks) in patients with moderate-to-severe plaque psoriasis. A total of 770 patients with moderate to severe plaque psoriasis were randomly assigned (1:1) to receive subcutaneous injections of 80mg of SSGJ-608 every two weeks (Q2W) after a starting dose of 160mg at week 0(608A group), or 160mg of SSGJ-608 every four weeks (Q4W) (608 B group) for 12 weeks. Efficacy was assessed by PASI75 and sPGA 0 or 1 response rates at week 12 as co-primary endpoints, and proportion of patients who achieved PASI90, PASI100 or sPGA score of 0 at week 12 as secondary endpoints. The safety profile was also evaluated. At week12, the proportions of patients achieving PASI75 (92.7% vs. 95.1%) and sPGA 0/1 (80.3% vs. 79.0%) were comparable between the two SSGJ-608 dose regimens. The PASI90, PASI100 and sPGA 0 response rates were 81.0% vs.82.3%, 49.4% vs. 47.5%, and 49.4% vs.47.3% in the 608A group and the 608B group, respectively. In the subgroup of patients previously treated with anti-IL-17 therapy, SSGJ-608 also achieved high clinical response rates at week12. The most common TEAEs were hypertriglyceridemia, upper respiratory tract infection, hyperuricemia, increased alanine aminotransferase and hypercholesterolemia. Both treatment groups demonstrated a favorable safety profile and no new safety signals were identified. SSGJ-608 was highly effective for treating patients with moderate-to-severe plaque psoriasis at 80mg Q2W and 160mg Q4W in a larger population, especially in patients previously treated with anti-IL-17 therapy, and exhibited a favorable tolerability profile in Chinese patients with moderate-to-severe plaque psoriasis. https://clinicaltrials.gov/, identifier NCT06299982.
To observe and evaluate the clinical efficacy of acupuncture combined with estazolam on chronic insomnia, so as to provide an effective intervention protocol for patients with chronic insomnia. Sixty-four patients with chronic insomnia were randomized into a treatment group and a control group, with 32 cases in each group. Patients in the control group received estazolam orally at bedtime every day and for consecutive 4 weeks according to the dosage recommended by experts. In the treatment group, on the basis of the treatment as the control group, acupuncture was delivered once every 2 days, 3 times a week and for consecutive 4 weeks. Before and after treatment, the scores of Pittsburgh sleep quality index inventory (PSQI) and self-anxiety scale (SAS), the objective sleep indicators (total sleep duration, sleep latency, and sleep efficiency), and the scores of Wechsler memory scale (WMS-RC) and traditional Chinese medicine (TCM) symptoms were evaluated in two groups. The clinical efficacy was assessed in each group. The total effective rate of the treatment group was 87.10%, higher than that of the control group (67.74%, P<0.05). In the intra-group comparison, compared with before treatment, the score of each item and the total score of PSQI, sleep latency, SAS score and TCM symptom score decreased (P<0.05);the total sleep duration, sleep efficiency, scores of long-term memory, transient memory, short-term memory, and memory quotient increased (P<0.05) after treatment in both groups. When compared with the control group after treatment, in the treatment group, sleep onset time score, the total score of PSQI, sleep latency, SAS score and TCM symptom score decreased (P<0.05) and the total sleep duration, sleep efficiency, scores of long-term memory and transient memory were elevated (P<0.05). Acupuncture combined with estazolam can remarkably improve the overall sleep quality, anxiety status, memory level, and TCM symptoms in patients with chronic insomnia. The combined treatment protocol is more superior to estazolam alone for chronic insomnia. 目的: 观察和评价针刺联合艾司唑仑治疗慢性失眠的临床疗效，为慢性失眠患者提供有效的临床干预方案。方法: 将64例慢性失眠患者随机分成治疗组和对照组，每组32例。对照组患者根据专家建议剂量每日睡前口服艾司唑仑，连续服用4周。治疗组在对照组的基础上加用针刺治疗，每周3次，隔日1次，治疗4周。评价两组治疗前后匹兹堡睡眠质量指数（PSQI）、焦虑自评量表（SAS）、客观睡眠指标（睡眠总时长、入睡潜伏期、睡眠效率）、韦氏记忆量表（WMS-RC）、中医症候量表的积分，并评价临床疗效。结果: 治疗组总有效率（87.10%）显著高于对照组总有效率（67.74%，P<0.05）。与同组治疗前比较，治疗后治疗组和对照组患者PSQI各因子评分及总分、入睡潜伏期、SAS评分、中医症候积分均显著降低（P<0.05），睡眠总时长和睡眠效率，长时记忆、瞬时记忆、短时记忆、记忆商数得分升高（P<0.05）;与对照组比较，治疗后治疗组患者入睡时间评分、PSQI总分、入睡潜伏期、SAS评分、中医症候评分显著降低（P<0.05），睡眠总时长、睡眠效率及长时记忆、瞬时记忆评分显著升高（P<0.05）。结论: 针刺联合艾司唑仑治疗慢性失眠可以明显改善患者整体睡眠情况、焦虑状态、记忆力水平及中医症候指标。针刺联合艾司唑仑疗法治疗慢性失眠症疗效优于单纯使用艾司唑仑。.
Shared immersive environment sports venues, virtual classrooms, and collaborative workspaces require multiple users to stream 360° videos simultaneously over the same edge network, yet every existing adaptive bitrate system optimises each viewer in isolation. This self-interested behaviour triggers a bandwidth auction that chronically starves the most uncertain viewers: Jain's Fairness Index for ten independently optimised agents routinely falls below 0.85. We present FairEdge360, a hierarchical multi-agent reinforcement learning framework that reformulates multi-user 360° streaming as a Decentralised Partially Observable Markov Decision Process (Dec-POMDP) and proves, formally, that fairness and quality are complementary rather than competing objectives. Three tightly coupled innovations make this possible. First, a Lightweight Uncertainty Estimator (LUE) a compact 8385-parameter four-layer MLP evaluates per-device viewport prediction confidence cti=σ(w4⊤h3) in under approximately 2.1 ms on commodity smartphones (95th percentile, iPhone 12 A14 Bionic), enabling selective edge offloading that reduces device energy consumption by 38.9%. Second, a variational Graph Neural Network compresses each agent's 256-dimensional GRU state into a 32-byte INT8 latent, transmitted over a dynamic RTT-gated neighbourhood graph at 96 bytes per agent per 500 ms 75% less overhead than competing approaches. Third, the edge coordinator maximises the Nash social welfare objective NSW=(∏i=1NQi)1/N, whose gradient ∂NSW/∂Qi∝1/Qi automatically prioritises the most disadvantaged viewer; a formal proof guarantees that every Pareto-optimal policy satisfies Qi/∑jQj≥1/N. Counterfactual advantage estimation correctly attributes each agent's marginal contribution to the global reward, eliminating the credit-assignment ambiguity inherent in standard multi-agent baselines. Evaluated on 284 users, 52 omnidirectional videos, and 10,000 real network traces spanning 4G LTE, 5G mmWave, HSDPA, and campus WiFi, FairEdge360 raises Jain's Fairness Index from 0.934 to 0.976 (+4.5%), improves worst-case user quality-of-experience from MOS 2.54 to MOS 3.21 (+26.4%), and halves rebuffering rate from 2.1% to 1.1%, all within a 20 ms motion-to-photon budget on a commodity smartphone.
While most ophthalmologists and medical oncologists are aware of the excessive tearing and canalicular and lacrimal duct blockage associated with docetaxel, there is lack of deeper understanding of the appropriate management of this side effect and what clinical settings justify surgical intervention as opposed to conservative management. In this review, we summarize the findings in the seminal original research studies that document the association between the frequency of administration of docetaxel and treatment duration and the frequency of excessive tearing as a subjective symptom versus canalicular and lacrimal duct blockage as anatomic findings seen during probing and irrigation. Based on the published literature to date, we note that excessive tearing is a common and important side effect of docetaxel and can be seen in breast cancer patients who are receiving docetaxel either weekly or every three weeks in metastatic or adjuvant settings. However, the anatomic findings of canalicular and lacrimal duct stenosis are almost exclusively seen in patients receiving weekly docetaxel or in patients with metastatic breast cancer who are treated with docetaxel for prolonged periods. Lacrimal duct blockage is much less commonly reported in patients with early breast cancer who are receiving docetaxel every three weeks for short durations and, to our knowledge to date, have not been reported in the literature in breast cancer patients receiving docetaxel in the adjuvant setting.
Fibrous dysplasia is one of the most common skeletal lesions. The wide spectrum of clinical manifestations ranges from asymptomatic conditions (typical of monostotic forms) to severe skeletal diseases with deformity and fractures for polyostotic fibrous dysplasia. The classical radiological features include: an osteolytic geographic pattern, ground-glass bone matrix, cortical thinning/cortical scalloping, bone deformities and enlargement, concavity of margins (evaluated with MRI), and cystic areas (MRI). All the bones can be affected, and the proximal femur is the most common one (about 30% of cases). Nonetheless, the disease can also affect cranio-facial bones, leading to compression of neural structures, as well as deformation and enlargement of facial bones, leading to the so-called "leontiasis ossea" or "facies leonine". The polyostotic forms of fibrous dysplasia can be associated with multiple soft-tissue myomas (Mazabraud syndrome) or several endocrine diseases (McCune-Albright syndrome). In every diagnostic step of the disease, as well as in different fibrous dysplasia forms, imaging plays a key role. Indeed, radiology is fundamental to assess the suspicion of fibrous dysplasia in classical monostotic forms, representing the sole diagnostic tool needed in many cases. Imaging is also fundamental to staging and following up on more severe polyostotic forms, as well as for detecting complications. In this comprehensive updated review article, we examine every aspect of the disease, with a main focus on imaging presentation. The indications for biopsy are discussed as well. Most importantly, the article details the potential risk of malignant transformation (osteosarcoma, fibrosarcoma, chondrosarcoma, and other rarer sarcomas, all accounting for <1% of cases) underlying the radiological patterns of these conditions. The occurrence of aneurysmal bone cyst-like changes on fibrous dysplasia is also analyzed in the article. This review article aims to be a comprehensive guide for radiologists and clinicians involved in the care of patients affected by various forms of fibrous dysplasia, and a starting point for future research. Many classical and atypical cases are collected as an iconographic comprehensive representation.
Evaluate the test-retest reliability of quadriceps corticospinal excitability and intracortical excitability using transcranial magnetic stimulation (TMS). A test-retest observational cohort study. Twelve healthy adults attended two laboratory sessions, seated with their knee at 90 degrees and fitted with electrodes on the rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM). TMS was used to assess the active motor threshold (AMT), motor evoked potential (MEP) amplitude, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF). Individual results were calculated as the mean and median of the 10 trials of each measure for MEP, SICI and ICF. Intraclass correlation coefficients were calculated. All muscles showed good or excellent reliability for the mean and median measures of the MEP amplitude (ICC ≥ 0.820) as well as the AMT of the RF (ICC = 0.991). SICI showed good reliability in the mean and median measures of the RF and the mean measure of the VL (ICC ≥ 0.809), moderate reliability in both measures of the VM (ICC ≥ 0.655) and was not significant for the median measure of the VL (ICC = 0.513). ICF showed excellent reliability in the mean measure of each muscle and median measure of the RF (ICC ≥ 0.906), with good reliability in the median measure of the VL (ICC = 0.888) and moderate reliability in the median measure of the VM (ICC = 0.719). The mean of an individual's quadriceps corticospinal excitability and intracortical excitability have good or excellent reliability for every TMS measure, in every muscle (except SICI of the VM). With the previous reliability of TMS measures mostly investigating the upper limbs, these results offer important context for neurophysiological research in the quadriceps.
The Dynamic Economic Dispatch (DED) problem underpins the cost-efficient and reliable operation of modern power systems, yet valve-point loading, ramp-rate coupling, and the growing share of intermittent wind, photovoltaic, and pumped-storage hydro (PSH) resources render it highly non-convex. Metaheuristic methods typically require large computational budgets and hand-crafted constraint-handling rules, whereas deep reinforcement learning agents rarely guarantee the feasibility of the schedules they produce. To address both limitations, this paper proposes a Two-Stage PPO-RLMPA framework that couples data-driven policy learning with a biomimetic metaheuristic search inspired by marine predator-prey dynamics. In the first stage, a Proximal Policy Optimization (PPO) agent is trained on a Markov Decision Process reformulation of DED in which a deterministic Safety Layer projects every raw action onto the feasible set defined by capacity, ramp-rate, and power-balance constraints, so the policy only observes physically viable transitions. In the second stage, the PPO dispatch is refined by the RLMPA module, a Marine Predators Algorithm (MPA) whose exploration-exploitation balance, Lévy-flight foraging, and Fish Aggregating Devices (FADs) attraction mechanisms emulate strategies documented in marine ecosystems; its step-size factor and FADs probability are further adapted online by a Deep Q-Network. This biomimetics-informed refinement translates predator-prey foraging intelligence into economically efficient thermal dispatch under valve-point non-convexity. Across 30 independent runs on ten- and twenty-unit benchmark systems with wind, PV, and PSH integration, the framework attains best costs of USD 368,763 and USD 737,348 on Test Systems 1 and 2, corresponding to reductions of approximately 1.1% and 4.4% over the CFCEP baseline, with zero post-repair constraint violations in every run.
Background/Objectives: Dynamic navigation and robot-assisted implant workflows depend on robust intraoral perception. Marker-based tracking introduces workflow complexity and is sensitive to occlusions, motivating markerless alternatives. This study evaluates whether a single-stage YOLO instance segmentation model (YOLO-seg) can provide a practical markerless perception layer for dental navigation, combining accurate per-tooth delineation with low, predictable inference latency. Methods: YOLO-seg was trained end to end on an intraoral RGB corpus of 400 training, 20 validation, and 100 testing images, combining a public source and a partner-hospital in-house set. A two-stage YOLO + SAM baseline was implemented for comparison. Segmentation quality was evaluated on a 50-image held-out clinical test set at three complementary levels (per-instance matching, per-class union, and global union), with paired Wilcoxon signed-rank tests, Cliff's delta effect sizes, and 95% bootstrap confidence intervals. Runtime was assessed under matched inference-only and end-to-end conditions on N = 100 frames at a 640 × 640 resolution on an NVIDIA RTX A2000 GPU. Results: YOLO-seg significantly outperformed YOLO + SAM across all primary metrics, with very large effect sizes (Cliff's delta: 0.76-0.94; Wilcoxon p < 10-8 on every metric except precision at IoU ≥ 0.5). YOLO-seg reached AP50 = 0.716 and recall = 0.973 versus 0.383 and 0.398 for YOLO + SAM. Under matched inference-only timing, YOLO-seg ran at 27.08 ms per frame (36.9 FPS) versus 1302.78 ms (0.77 FPS), an approximately 48-fold latency gap intrinsic to the two-stage forward pass. Conclusions: YOLO-seg shows strong potential as a 2D perception module for dental navigation, balancing per-instance segmentation fidelity with real-time feasibility under the tested conditions. These results support its use as a 2D perception front-end for future integration with stereo-based 3D reconstruction and robot-assisted navigation; 3D registration accuracy, implant-placement error, and robotic execution remain outside the scope of the present study.
Respiratory syncytial virus (RSV) causes millions of lower respiratory tract infections (LRTIs) in young children, older adults, and immunocompromised populations every year. RSV infection initiates in the upper respiratory tract and can progress to the lower airways, resulting in bronchiolitis, pneumonia, and even death. RSV primarily infects epithelial cells apically, but we hypothesized that basolateral exposure of the respiratory epithelium could provide an alternative mechanism of infection that contributes to LRTI development. Using a human nose organoid-air-liquid interface (HNO-ALI) model, we performed apical and basolateral inoculations with contemporaneous RSV strains (RSV/A/Ontario [RSV/A/ON] and RSV/B/Buenos Aires [RSV/B/BA]) representing the two RSV subgroups (A and B) in both adult- and infant-derived HNO-ALIs. Basolateral RSV exposure resulted in delayed viral replication and apical release compared to apical infection. A statistically significant difference in basolateral infection frequency was observed between RSV/B/BA and RSV/A/ON (81.3% versus 25%). Basolateral infection selectively targeted a rare basal cell population, while preserving epithelial integrity. Using undifferentiated HNO-ALIs, we determined for the first time that Krt23+ activated basal cells are uniquely susceptible to RSV infection, a finding we confirmed in fully differentiated HNO-ALIs. Together, our findings show that RSV can infect the respiratory epithelium from the basolateral side by initially targeting a rare subset of basal cells before spreading apically to ciliated cells. Moreover, RSV/B/BA may have an advantage over RSV/A/ON in utilizing the basolateral infection route. These findings highlight an alternative RSV infection pathway and could be a potential mechanism for RSV spread to the lower airways.IMPORTANCEUnderstanding the pathogenesis of respiratory syncytial virus (RSV) is essential to understanding and preventing acute and long-term sequelae from infection. The canonical understanding of RSV infection is that the virus infects and is restricted to the apical ciliated cells upon inhalation or fomite exposure. We demonstrate that an alternative route of infection-the basolateral route-can be utilized by RSV to infect the apical ciliated cells of the respiratory epithelium. We also show for the first time a novel difference in infectivity between the two contemporaneous RSV strains (RSV/A/Ontario and RSV/B/Buenos Aires). In addition, we describe a rare basal subset-the Krt23+ activated basal cells-that are uniquely susceptible to RSV, expanding the known cellular tropism of RSV. Infection of basal cells can impact airway differentiation, homeostasis, and remodeling. Overall, our findings expand on RSV pathogenesis and indicate there are alternative mechanisms of infection and cell populations that are susceptible to RSV.
Human papillomavirus infection is one of the most prevalent sexually transmitted infections worldwide. Women living with HIV are at increased risk of acquiring and developing persistent infection with high-risk HPV genotypes, leading to higher rates of cervical dysplasia and cancer. However, limited data are available regarding the timing and determinants of HPV clearance in this population. This is a retrospective, single-center study including women living with HIV with confirmed high-risk HPV infection, followed at an Italian university hospital between 2019 and 2024. Clinical, virological, and immunological data were collected, including HIV viral load, CD4+ T-cell count, and adherence to antiretroviral therapy. HPV persistence, clearance, and time to clearance were assessed over a 5-year follow-up period. Statistical analyses were performed using SPSS version 29, with p < 0.05 considered significant. Seventy-seven women living with HIV were recruited, and fifty-one met the inclusion criteria for analysis. Most participants (92%) were adherent to ART. HR-HPV clearance occurred in 76.5% of patients, with a mean clearance time of 2.08 years. No significant correlation was observed between HPV clearance time and HIV viremia, CD4+ T-cell count, or cytological/colposcopic findings at baseline. However, baseline positivity for the high-risk HPV pool was significantly associated with longer clearance time (p = 0.011). Women living with HIV showed a high-risk HPV clearance time of approximately 2 years under ART. Our findings suggest that HPV screening every 2 years may represent an appropriate interval in this population, potentially increasing adherence and optimizing healthcare resources. Larger multicenter prospective studies are needed to confirm this observation.
The donor selection criteria are developed to identify and defer the blood donors at risk of infections for an appropriate duration of time to allow time for the infectious agent to elicit an immune response for the purpose of diagnostic detection. This was an observational study to compare the prevalence of markers of hepatitis B and hepatitis C in 1000 donors deferred on hepatitis-related risk factors, with 62,328 donors selected for donations on quality-assured enzyme-linked immunosorbent assay and individual unit nucleic acid testing (NAT). In 1000 deferred donors, 8 (0.8%), 10 (1%), and 17 (1.7%) were reactive for hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV) antibodies, and initial NAT; 8 (0.8%) and 7 (0.7%) discriminated against hepatitis B virus (HBV) and HCV, respectively. In 62,328 selected donors, 260 (0.4%), 267 (0.4%), and 76 (0.12%) were reactive for HBsAg, anti-HCV antibodies, and initial NAT; 26 (0.04%) and 8 (0.01%) discriminated against HBV and HCV, respectively. NAT yield was 4 (0.4%, n = 982) in deferred donors and 76 (0.1%, n = 62253) in selected blood donors. The deferral could exclude 1-2 HBV and/or HCV-reactive blood donors from entering the quarantine blood supply for every 100 donors with a history of hepatitis-related risk factors. The history of high-risk behavior was a statistically significant risk factor for the presence of markers of hepatitis B and C in deferred donors. The study highlights the need for surveillance of hepatitis-related risk factors in the potential blood donor population to generate evidence for periodic updates to the donor selection criteria.
Active case finding (ACF) can improve tuberculosis (TB) diagnosis in high-burden populations. Many programmes rely on symptom evaluation as the first screening step; however, symptom reporting may vary according to the context of evaluation. We performed a cross-sectional analysis of persons deprived of liberty (PDL) diagnosed with TB in an ACF programme conducted in two male Brazilian prisons from February 2023 to February 2025. Every 4 months, participants underwent sputum testing by GeneXpert Ultra (Xpert) and culture. Study nurses administered symptom questionnaires during the initial evaluation. Individuals with positive results were interviewed by a physician. We compared characteristics of individuals with microbiologically confirmed TB according to their symptom reporting at initial screening and medical consultation, which was used to define four groups (e.g., combinations of symptomatic/asymptomatic at each of the two symptom assessments). Among 6919 PDL screened, 448 (6.4%) had microbiologically confirmed TB. We included 292 (65.1%) individuals in the analysis, after excluding those with missing clinical information and consults >15 days after screening. 113 (38.7%) reported symptoms at initial screening, while 192 (65.8%) reported symptoms at medical consultation (p<0.001). Compared with individuals asymptomatic at both evaluations, those who reported symptoms at the two instances were more likely to have medium or high semiquantitative Xpert results (45.0% vs 11.4%, p<0.001), report symptomatic cellmates (61.0% vs 25.2%, p<0.001), have higher LunitTB scores (95.1 vs 91.9; p=0.037) and lower body mass index (19.4 vs 21.4, p<0.001). There was a trend of more cavitary lesions (60.9% vs 50.0%, p=0.073) and bilateral disease (56.7% vs 45.0%, p=0.056) in chest X-ray of participants with symptomatic than asymptomatic TB at medical consultation. More than half of individuals who reported no TB symptoms at initial screening endorsed symptoms at first medical consultation. Clinical severity and contextual factors can influence TB symptom reporting during ACF.
To observe the effect of refined mode of acupuncture and moxibustion for synkinesia of facial paralysis sequelae based on surface electromyography (sEMG). Sixty patients with synkinesia of facial paralysis sequelae were randomized into a special manipulation group and a basic manipulation group in a ratio of 1∶1, with 30 cases in each group. Acupoints such as Yangbai (GB14), Cuanzhu (BL2), Touwei (ST8) and Taiyang (EX-HN5) on the affected side,as well as bilateral Sibai (ST2), Quanliao (SI18) were selected in the two groups. Conventional acupuncture was applied in the basic manipulation group, while point-to-point needling with long needle, stuck needling by lifting and dragging, and balance needling on the healthy side were delivered in the special manipulation group. The needles were retained for 30 min, once every other day, 3 times a week, for 30 sessions in total in the two groups. The Sunnybrook facial grading system (SFGS) score and the facial paralysis fine graduation scale grading were observed before and after treatment in the two groups; sEMG was performed before and after treatment, and the ratios of root mean square (RMS) on the affected side to the healthy one of frontalis, orbicularis oculi, buccinator, nasalis, orbicularis oris, and the integrated electromyography (IEMG) of orbicularis oculi were calculated; the correlation analysis was conducted between the total score of SFGS and facial paralysis fine graduation scale grading, and the clinical efficacy and safety were evaluated in the two groups. After treatment, the total scores of SFGS were increased and the synkinesia scores were decreased compared with those before treatment in both groups (P<0.001); in the special manipulation group, the total score of SFGS was higher and the synkinesia score was lower than those in the basic manipulation group (P<0.01, P<0.05). After treatment, the ratios of RMS on the affected side to the healthy one of orbicularis oculi, nasalis and orbicularis oris were increased compared with those before treatment in the special manipulation group (P<0.01, P<0.001), and those of orbicularis oculi, buccinator and nasalis were increased compared with those before treatment in the basic manipulation group (P<0.05, P<0.01); in the special manipulation group,the ratio of RMS on the affected side to the healthy one of nasalis was higher than that in the basic manipulation group (P<0.05). After treatment, the IEMG of orbicularis oculi was decreased compared with that before treatment in the two groups(P<0.001), and the IEMG of orbicularis oculi in the special manipulation group was lower than that in the basic manipulation group (P<0.05). After treatment, the grading of angulus oris drooping and eyelid closure was decreased compared with that before treatment in the two groups (P<0.01, P<0.05, P<0.001), and the grading of angulus oris drooping and eyelid closure in the special manipulation group was lower than that in the basic manipulation group (P<0.01,P<0.05). The total score of SFGS was negatively correlated with the grading of angulus oris drooping and eyelid closure (P<0.001). The total effective rate was 93.3% (28/30) in the special manipulation group, which was higher than 70.0% (21/30) in the basic manipulation group (P<0.01). No adverse events occurred during the trial. Refined mode of acupuncture and moxibustion contributes to the recovery of facial muscle strength, regulates oculofacial synkinesia, corrects angulus oris deviation and promotes eyelid closure in patients with synkinesia of facial paralysis sequelae. 目的：基于表面肌电图观察精细化针灸对面瘫后遗症联带运动的影响。 方法：将60例面瘫后遗症联带运动患者按1∶1比例随机分为特色手法组和基本手法组，每组30例。两组均穴取患侧阳白、攒竹、头维、太阳及双侧四白、颧髎等，基本手法组采用常规针刺治疗，特色手法组使用长针透经穴刺法、滞针提拉刺法、健侧平衡对刺法治疗，留针30 min，隔日1次，每周3次，共30次。观察两组患者治疗前后Sunnybrook面神经评定系统（SFGS）评分、安中面瘫精细分度量表分级；于治疗前后行表面肌电图（sEMG）检测，计算额肌、眼轮匝肌、颊肌、鼻肌、口轮匝肌患健侧均方根振幅（RMS）平均值比值，眼轮匝肌肌电图活动指数（IEMG）；对SFGS总分和安中面瘫精细分度量表分级进行相关性分析，并评定临床疗效和安全性。 结果：治疗后，两组患者SFGS总分均较治疗前升高（P<0.001），联动评分较治疗前降低（P<0.001）；特色手法组SFGS总分高于基本手法组、联动评分低于基本手法组（P<0.01，P<0.05）。治疗后，特色手法组眼轮匝肌、鼻肌、口轮匝肌患健侧RMS平均值比值较治疗前升高（P<0.01，P<0.001），基本手法组眼轮匝肌、颊肌、鼻肌患健侧RMS平均值比值较治疗前升高（P<0.05，P<0.01）；特色手法组鼻肌患健侧RMS平均值比值高于基本手法组（P<0.05）。治疗后，两组患者眼轮匝肌IEMG均较治疗前降低（P<0.001），且特色手法组低于基本手法组（P<0.05）。治疗后，两组患者口角下垂分级、眼睑闭合程度分级较治疗前降低（P<0.01，P<0.05，P<0.001），且特色手法组低于基本手法组（P<0.01，P<0.05）。SFGS总分与口角下垂分级和眼睑闭合程度分级均呈负相关（P<0.001）。特色手法组总有效率为93.3%（28/30），高于基本手法组的70.0%（21/30，P<0.01）。治疗过程中未发生安全性事件。 结论：精细化针灸治疗面瘫后遗症联带运动有助于恢复患者面部肌力，调节口眼联动，纠正口角歪斜，促进眼睑闭合。.
To evaluate the feasibility of using the acoustic change complex (ACC) as an objective cortical marker of continuous speech sound discrimination using connected Ling-six stimuli. Cortical auditory evoked potentials were recorded from 10 young adults with normal hearing using a continuous, pause-free sequence of the six Ling phonemes (/u-a-i-ʃ-s-m/). ACC responses were recorded in a passive listening paradigm with minimal electrodes. Reproducibility was assessed in a subset of participants retested 1 year later. Robust ACC responses were elicited for all six phonemic transitions in every participant, indicating reliable cortical discrimination within the continuous speech stream. Although response morphology varied across listeners, within-subject responses demonstrated strong reproducibility over a one-year interval (mean cross-correlation = 0.95). Continuous Ling-six stimuli reliably evoke ACC responses reflecting cortical speech sound discrimination. This efficient and repeatable paradigm shows promise as an objective verification tool for auditory learning and sound discrimination, particularly in populations for whom behavioral assessment is unreliable.
The loss of Royal Mail Ship (RMS) Titanic has been examined extensively through the lenses of engineering failure, maritime law, and social history, yet little attention has been paid to the conduct and professional identity of her medical officers. This surgical history examines the lives and final hours of the ship's 2 surgeons, Dr. William Francis Norman O'Loughlin and Dr. John Edward "Jack" Simpson, situating their actions within the evolving practice of maritime medicine in the early 20th century. Drawing on contemporary newspaper accounts, official inquiries, archival records, personal correspondence, and genealogical sources, this article reconstructs their careers, responsibilities, and conduct during the disaster. O'Loughlin, a senior surgeon with decades of maritime experience, and Simpson, a younger assistant surgeon at the outset of his career, represented 2 generations united by a shared professional ethic. Both remained at their posts, assisting passengers and crew, maintaining calm, and declining opportunities for self-preservation. Their actions exemplify the unwritten code of the surgeon: composure under pressure, disciplined and methodical judgment, and a steadfast respect for the dignity of every human life. Beyond documenting individual bravery, this article demonstrates that their conduct reflects enduring principles of surgical professionalism that transcend era, technology, and setting. In a tragedy remembered primarily for its scale, the surgeons' story highlights how judgment, humanity, and moral responsibility remain central to the identity of the surgeon, whether practiced in a modern operating room or a rolling hospital at sea.
To observe the clinical therapeutic effect and effect mechanism of regulating-yinyang moxibustion therapy for primary dysmenorrhea (PD) of cold induced blood stasis, and conduct cost-effectiveness analysis. Sixty-six patients with PD of cold induced blood stasis were randomly divided into an observation group (33 cases, 1 case dropped out) and a control group (33 cases, 3 cases dropped out). The patients in the observation group received regulating-yinyang moxibustion therapy. Centered at Mingmen (GV4) and Guanyuan (CV4), moxibustion therapy for warming yang and benefiting kidney and for warming kidney and uterus was operated within an 8 cm to 10 cm radius separately. Moxibustion therapy for warming yang and benefiting kidney was delivered 10 days before menstruation (60 min), and that for warming kidney and uterus was performed 2 days before menstruation (40 min). One course of regulating-yinyang moxibustion therapy consisted of 1 operation for warming yang and benefiting kidney and 1 for warming kidney and uterus, and the treatment for 3 menstrual cycles was required. In the control group, gentle moxibustion therapy was operated at Guanyuan (CV4), Shenque(CV8), and bilateral Sanyinjiao (SP6), for 20 min at each acupoint. The intervention began 10 days before menstruation, once every other day; 1 course of treatment consisted of 5 interventions, and the treatment for 3 menstrual cycles was required.Before and after treatment, as well as in follow-up for 3 menstrual cycles after treatment, the scores of visual analogue scale(VAS) for pain, Cox menstrual symptom scale (CMSS), and traditional Chinese medicine (TCM) clinical syndromes were observed in the two groups. Before and after treatment, the contents of nerve growth factor (NGF) and prostaglandin F2α(PGF2α) in serum were detected. After treatment, the clinical therapeutic effect was compared, the cost-effectiveness analysis performed, and the sensitivity analysis conducted to verify the reliability of the results in the two groups. After treatment and in follow-up, the VAS scores for pain were reduced in comparison with those before treatment in each group (P<0.05), and the scores in the observation group were lower than those of the control group (P<0.05). The scores for the severity and duration in CMSS were lower than those before treatment in the observation group (P<0.05), and lower when compared with those in the control group (P<0.05). When compared with the score before treatment, the TCM syndrome scores in the observation group were reduced after treatment and in follow-up (P<0.05), and the score in the control group was lower after treatment (P<0.05). In follow-up, the TCM syndrome score in the observation group was lower than that in the control group (P<0.05). After treatment, the serum contents of NGF and PGF2α decreased in comparison with those before treatment (P<0.05), and the contents in the observation group were lower than those in the control group (P<0.05).After treatment, the total effective rate was 81.3% (26/32) in the observation group and was 73.3% (22/30) in the control group, without statistical significance (P>0.05). The cost-effectiveness analysis showed that the cost-effectiveness ratio(CER) in the observation group was lower than that in the control group. The sensitivity analysis found that there was no significant fluctuation of CER in either group. Regulating-yinyang moxibustion therapy effectively alleviates pain and TCM syndromes in patients with PD of cold induced blood stasis, which may be related to the decrease of the contents of NGF and PGF2α in serum. This therapy shows its advantages in terms of health economics compared with the conventional gentle moxibustion therapy. 目的：观察阴阳调理灸治疗寒凝血瘀型原发性痛经（PD）的临床疗效及效应机制，并进行成本-效果分析。 方法：将66例寒凝血瘀型PD患者随机分为观察组（33例，脱落1例）和对照组（33例，脱落3例）。观察组采用阴阳调理灸法，分别以命门、关元穴为中心，在半径8～10 cm的圆形范围内施温阳益肾灸与温肾暖宫灸，月经来潮前10 d行温阳益肾灸（施灸时间60 min），月经来潮前2 d行温肾暖宫灸(施灸时间40 min)，1次温阳益肾灸和1次温肾暖宫灸为一疗程，共治疗3个月经周期；对照组于关元、神阙、双侧三阴交行温和灸治疗，每穴施灸时间20 min，月经来潮前10 d开始治疗，隔日1次，5次为一疗程，共治疗3个月经周期。分别于治疗前、治疗后及治疗后随访3个月经周期，观察两组患者疼痛视觉模拟量表（VAS）评分、COX 痛经症状量表（CMSS）评分、中医证候评分；于治疗前、治疗后，检测两组患者血清神经生长因子（NGF）、前列腺素F2α（PGF2α）含量；治疗后比较两组临床疗效，进行成本-效果分析以及敏感性分析验证结果可靠性。 结果：治疗后及随访时，两组患者疼痛VAS评分较治疗前降低（P<0.05），观察组低于对照组（P<0.05）；观察组患者CMSS症状严重程度和症状持续时间评分较治疗前降低（P<0.05），观察组低于对照组（P<0.05）。与治疗前比较，观察组患者治疗后及随访时中医证候评分降低（P<0.05），对照组患者治疗后中医证候评分降低（P<0.05）；随访时，观察组患者中医证候评分低于对照组（P<0.05）。治疗后，两组患者血清NGF、PGF2α含量较治疗前降低（P<0.05），观察组低于对照组（P<0.05）。治疗后，观察组总有效率为81.3%（26/32），对照组为73.3%（22/30），差异无统计学意义（P>0.05）。两组进行成本-效果分析，观察组成本效果比值（CER）低于对照组；进行敏感性分析，两组患者CER值无明显波动。 结论：阴阳调理灸能有效减轻寒凝血瘀型PD患者疼痛，改善中医证候，其作用途径可能与降低血清NGF、PGF2α水平有关，较常规温和灸在卫生经济学上存在一定优势。.