Annexin A6 (ANXA6) regulates cholesterol transfer across membrane contact sites (MCSs) between late endosomes/lysosomes (LE/Lys) and the endoplasmic reticulum (ER) via the late endosomal StAR-related lipid transfer domain-3 (STARD3) transporter. Here, we describe a significant reduction of MCSs in ANXA6-depleted HeLa cells, which could be rescued by restoration of ANXA6 expression. Using AnxA6 as bait in BioID-based assays, we demonstrate that ANXA6 interacts with various tethers and bona fide MCS proteins that can modulate multi-organelle contacts. STARD3 interactors identified in BioID assays include the mitochondrial translocator protein (TSPO) and myosin heavy chain 9 (MYH9). Strikingly, reduced MCS formation in ANXA6-depleted cells was associated with changes in the STARD3 interactome that indicate altered MCS tethering functions of STARD3. Specifically, ANXA6 deficiency correlated with (1) altered positioning of STARD3-positive LE/Lys; (2) a new repertoire of cortical actin-binding proteins, including myosins interacting with STARD3; (3) and decreased microvillar structures and focal adhesions.
Purpose: There is limited literature on the functional outcomes of robotics-assisted (RA) superior transverse atraumatic reconstruction approach (STAR) in total hip arthroplasty (THA). This study compares the early functional outcomes, patient satisfaction, expectation fulfilment and complication rates between STAR RA-THA and direct anterior approach (DAA) RA-THA. Methods: We retrospectively analyzed all primary RA-THA performed between January 2022 and December 2024 at a high-volume tertiary centre. Patients undergoing either the DAA or STAR THA with available 6-month outcomes were included. There was a total of 123 patients (74 DAA and 49 STAR). Propensity score matching was used to account for baseline differences, generating 49 matched pairs based on age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) grade. Postoperative patient-reported outcome measures (PROMs) and the proportion achieving minimum clinically important difference (MCID) were compared between groups. PROMs included were the Oxford Hip Score (OHS), Western Ontario and McMaster University Arthritic Index (WOMAC), Short-Form 36 Health Survey (SF-36) subscale, patient satisfaction score and expectation fulfilment score. Results: The DAA group demonstrated significantly better postoperative day one (POD1) ambulation distance (p = 0.00390). No differences in PROMs, MCID, patient satisfaction and expectation fulfilment scores were noted at last follow-up. The RA-DAA group had a higher incidence of meralgia paresthetica (p = 0.00260). Conclusions: The STAR RA-THA demonstrated early functional recovery comparable to DAA RA-THA. Although POD1 ambulation distance was greater in the DAA group, at six months, both approaches had similar functional outcomes, patient satisfaction and low complication rates.
Theory predicts that a planet with a sufficiently strong magnetic field orbiting close to its host star could induce star-planet magnetic interactions. This is potentially observable as an optical or radio stellar activity signal synchronised with the planet's orbital period. We analyze 18 years of high-resolution optical spectroscopy of GJ 436, a low mass star orbited by a Neptune-sized exoplanet on a polar eccentric orbit. Stellar activity indicators show enhancements at a period corresponding to the exoplanet orbit, modulated by stellar rotation, and the star's 8-year magnetic cycle. We interpret this as a signal of star-planet magnetic interaction. Using a geometric model, we reproduce these periods if GJ 436 b has a magnetic field strength of 6 to 110 Gauss.
Background/Objectives: The Indian star tortoise (Geochelone elegans) is a protected species for which physiological and molecular health indicators remain poorly characterized. This study aimed to monitor and analyze plasma proteome profiles and biochemical parameters in captive adult Indian star tortoises and to identify potential diagnostic biomarkers. Methods: Plasma samples from nine clinically healthy adult Indian star tortoises (four males and five females) maintained in captivity were subjected to biochemical profiling and proteomic analysis. Sex-related differences in biochemical parameters were evaluated, and differentially expressed proteins were mapped to Homo sapiens Reactome pathways to identify significantly enriched biological processes. Results: Plasma biochemical profiling established baseline reference values, indicating stable hepatic and metabolic function in captive tortoises. Creatinine and urea concentrations were significantly higher in females than in males (p < 0.05), suggesting sex-related differences in protein metabolism or renal function. No significant sex-related differences were observed in hepatic enzymes (ALP, ALT, AST, and GGT), muscle-associated enzymes (CK and LDH), glucose, cholesterol, triglycerides, total proteins, albumin, or electrolyte concentrations (Na, K, Ca, Mg, Cl, P, and Fe). Proteomic analysis identified 12 differentially expressed proteins, including nine upregulated and three downregulated proteins. Functional pathway analysis revealed 90 significantly enriched Reactome pathways (FDR < 0.05). Upregulated proteins were primarily associated with cytoskeletal organization (KRT75, KRT5, and KRT17), lipid transport and remodeling (APOB), coagulation (F10), extracellular transport (TTR), immune response (WFDC3), transmembrane signaling (KCP), and gamete interaction (ZAN). Downregulated proteins (C7, SERPING1, and PZP) were linked to complement activation and acute-phase response pathways. Conclusions: Captive Indian star tortoises exhibited increased cytoskeletal remodeling and coagulation activity together with reduced complement activation. These findings provide novel insights into the plasma proteome of this species and identify candidate biomarkers that may support future health assessment, physiological monitoring, and diagnostic applications in Indian star tortoises.
Space situational awareness increasingly relies on optical observations to detect and track resident space objects and to estimate spacecraft attitude. Many existing resources are synthetic or restricted, and few provide on orbit, wide field of view imagery with joint labels for space objects and stars. We present a dataset of near-infrared images acquired by the Fast Auroral Imager on the CASSIOPE spacecraft between January and August 2023. The collection comprises 1,378 frames with astrometrically calibrated stars and 4,237 manually verified resident space object instances across 160 transits, accompanied by spacecraft ephemeris, attitude, and image quality metrics. We describe the acquisition conditions, calibration and annotation pipeline, and perform technical validation of pointing stability, astrometric accuracy, annotation reliability, and background characteristics. The dataset supports tasks such as resident space object detection in dense star fields, multi-object tracking under realistic orbital motion, and attitude estimation from star tracker class imagery, and is intended as a shared resource for space situational awareness and navigation studies.
The elegant hierarchical structures of biomacromolecules have promoted the pursuits of synthetic polymers with ordered monomer sequences and diverse topological architectures, which are in the initial stage. Here, a four-arm star-shaped segmented polyurethane (PU) with a controlled block sequence of amphiphilic seven-segment multifunctional arms containing a disulfide bond was prepared via a grafting-onto strategy, where the sequence-defined arms were synthesized by a diisocyanate-based liquid-phase iterative methodology and then conjugated onto four alkyne-functionalized pentaerythritol cores through click chemistry. The star-shaped PU can self-assemble into micelles in aqueous solution as the linear arm. Moreover, the four-arm star-shaped architecture endows self-assembled micelles with higher stability under various physiological conditions and enhanced redox-responsive performance, making them promising candidates for drug delivery. The experiments show that drug-loaded star-shaped PU micelles possess accelerated stimuli-responsive release profiles, optimized tissue distribution, and improved anticancer efficacy in vitro and in vivo in comparison with linear polymer micelles. This work demonstrates that advanced architectures of precise linear polymers hold tremendous potential for the structural regulation and performance adjustment of aggregation structures, opening the perspectives for the structural and functional design of next-generation materials.
Human activity recognition (HAR) using Wi-Fi channel state information (CSI) offers a privacy-preserving and contactless sensing modality suitable for smart homes, healthcare monitoring, and pervasive mobile Internet of Things (IoT) environments. However, existing CSI-based HAR approaches often suffer from computational inefficiency, high latency, and limited feasibility on resource-constrained embedded platforms. This work presents STAR (Sensing Technology for Activity Recognition), an edge AI-optimized framework that integrates lightweight temporal modeling, adaptive signal processing, and hardware-aware co-optimization to enable real-time, energy-efficient HAR on low-power embedded devices. STAR employs a streamlined three-layer Gated Recurrent Unit (GRU) architecture that reduces model parameters by 33% compared to conventional Long Short-Term Memory (LSTM) designs while maintaining strong temporal modeling capability. To enhance signal quality, STAR incorporates a multi-stage pre-processing pipeline consisting of median filtering, an eighth-order Butterworth low-pass filtering, and empirical mode decomposition (EMD) to denoise CSI amplitude measurements and extract stable spatial-temporal features. For on-device deployment, the system is implemented on a Rockchip RV1126 processor equipped with an embedded Neural Processing Unit (NPU) and interfaced with an ESP32-S3 CSI acquisition module. Experimental results demonstrate a mean recognition accuracy of 93.52% across seven activity classes and 99.11% for human-presence detection using a compact 97.6k-parameter model. INT8-quantized inference achieves a processing throughput of 33 MHz with only 8% CPU utilization, achieving a six-fold improvement in inference speed over CPU-based execution. With sub-second response latency and low power consumption, the system ensures real-time, privacy-preserving HAR, offering a practical, scalable solution for mobile and pervasive computing environments.
Accurate uplink channel estimation in high-mobility vehicular networks remains challenging due to rapid channel variations and Doppler effects, especially in systems assisted by simultaneously transmitting and reflecting reconfigurable intelligent surfaces (STAR-RIS). Most existing studies focus on limited user scenarios and static or low-mobility conditions, which restricts their applicability to realistic vehicular environments. This work proposes a Kalman-aided channel estimation framework for multi-user uplink vehicular STAR-RIS systems operating under high mobility. The proposed approach integrates least squares (LS) estimation with discrete Fourier transform (DFT)-based orthogonal pilot design to obtain initial channel estimates, followed by a Kalman filter to continuously track time-varying Rician fading channels modeled with Jakes temporal correlation. Path-loss scaling is incorporated to improve composite channel tracking accuracy. The framework effectively mitigates Doppler-induced estimation degradation and supports scalable multi-user operation. Simulation results show that the proposed estimator consistently outperforms conventional methods in high-mobility scenarios. In particular, the normalized mean square error is reduced by up to 25 dB for the time-switching protocol and approximately 22 dB for the energy-splitting protocol compared with the corresponding baseline estimation schemes. These results indicate that the proposed estimation and tracking framework maintains stable accuracy across a wide range of vehicular operating conditions.
CRISPR technology is a paradigm-shifting innovation in genome engineering, enabling precise gene editing in cell lines and model organisms. Robust protocols and troubleshooting strategies are essential for the successful application of CRISPR techniques in biological and clinical research. In this backstory, STAR Protocols authors and advisory board members share their advice on common questions related to CRISPR technologies, genome-editing strategies, and troubleshooting approaches.
Seawater zinc-air batteries (SZABs) stand out as promising candidates for marine and offshore energy supply. However, their practical implementation is greatly restricted by tardy oxygen reduction reaction (ORR) and oxygen evolution reaction (OER) kinetics at the air cathode, severe chloride ion-induced catalyst corrosion, and structural deterioration of traditional binder-containing electrodes in seawater media. Herein, we design and fabricate a binder-free integrated electrode consisting of carbon-supported iron phthalocyanine- modified star-like cobalt sulfide arrays directly grown on nickel foam. The optimal catalyst (0.3FePc-C/CoS) integrates the respective advantages of Fe single atoms and cobalt sulfide, exhibiting excellent ORR and OER activity, delivering a prominent half-wave potential of 0.89 V versus RHE, and exhibiting a low OER overpotential of 160 mV at 50 mA cm-2 and robust stability in seawater. As a self-supported air cathode, the 0.3FePc-C/CoS-based battery attains a favorable open-circuit voltage reaching 1.48 V, prominent peak power density (126.4 mW cm-2), small charge-discharge potential polarization (0.52 V), excellent energy efficiency (68.8%) and extraordinary long-term cycling durability (>360 h). This work not only discloses a feasible synergistic modulation strategy for constructing high-performance bifunctional electrocatalysts but also provides a valuable reference for developing corrosion-resistant integrated air electrodes toward practical marine energy storage applications.
Potted miniature roses are widely cultivated as popular indoor ornamental plants. Owing to increasing consumer demand, new varieties are introduced to the market each year. Cross-breeding remains the most prevalent method for developing potted miniature roses. In the present study, Rosa noisettiana Thory, a climber rose species, was used as the seed parent, while ten commercially popular miniature rose cultivars (Rosa White Star, Hot Jewel, Rosa Sweet Star, Rosa Bling Love Star, Orange Jewel, Rosa Shining Star, Rosa Lady Star, Orange Romance, Red Romance, and Sparkling Jewel) served as pollen donors. The success of hybridization was evaluated, and both quantitative and qualitative traits were analyzed in 861 F₁ hybrid individuals to assess the breeding potential of miniature roses. The percentage of pollen viability ranged from 17.71% to 46.79%, while the pollen germination rate varied between 10.33% and 21.68%. In total, 250 controlled pollinations were performed, all of which successfully developed into 250 fruits (hips). These fruits collectively contained 7,249 seeds. The results revealed that R. noisettiana × miniature rose combinations exhibited a 99.5% fruit set rate, with an average of 29.23 seeds per fruit and a seed germination rate of 20.53%. However, the recurrent blooming rate ranged between 15% and 34%, and many tall individuals were obtained from these crosses. Key commercial traits, such as flowering time, plant height, flower diameter, and petal number, were found to vary depending on the parental genotypes. In contrast, flower color did not exhibit as much variation as expected in the hybrid combinations. Based on these findings, further crosses should be conducted with different rose species to enhance genetic diversity in breeding programs and achieve more effective outcomes in the ornamental plant sector. Moreover, early selection methods utilizing genetic markers could be developed to increase the recurrent blooming rate and to obtain more compact plants.
Antibiotic-resistant Neisseria gonorrhoeae (Ng) is a WHO priority pathogen and represents a serious public health threat. This study reports the first Chilean Ng ST9363 isolate (GC11/23) exhibiting dual high-level resistance to azithromycin and fluoroquinolone, recovered from a urethral discharge sample in July 2023. Antimicrobial susceptibility was assessed using disk diffusion and MIC strip tests. Whole-genome sequencing (WGS) was performed using a hybrid approach, followed by annotation using the NCBI Prokaryotic Genome Annotation Pipeline (PGAP). In silico analyses included Staramr, MLST and NG-STAR. Phylogenetic analysis was performed on the core genome of 2,417 global ST9363 Ng isolates using IQ-TREE and visualized with TreeViewer. GC11/23 exhibited resistance to ciprofloxacin, tetracycline, penicillin, and azithromycin, while remaining susceptible only to ceftriaxone and spectinomycin. The isolate belonged to ST9363 and NG-STAR 3194. Mutations associated with fluoroquinolone resistance were identified in gyrA and parC, while high-level azithromycin resistance (HL-AziR) was linked to mutations in all four copies of the 23S rRNA gene, as well as in mtrD and mtrR. Additional resistance-associated alterations included an insertion (ins346D) in penA and a mutation in rpsJ, conferring resistance to penicillin and tetracycline, respectively. Phylogenetic analysis clustered GC11/23 with isolates from the USA and Europe collected in 2019. GC11/23 represents a multidrug-resistant Ng strain belonging to ST9363/NG-STAR 3194 and carrying mutations conferring resistance to fluoroquinolones, azithromycin, penicillin, and tetracycline. Its phylogenetic placement within a European lineage highlights the global dissemination of HL-AziR and fluoroquinolone-resistant strains.
The Forward Lunge is a representative squash-specific footwork movement involving rapid acceleration, braking, postural stabilization, and return propulsion. This study examined whether pre-competition neuromuscular electrical stimulation (NMES) combined with weighted squats was associated with differences in Forward Lunge performance and neuromuscular control in squash athletes. Thirty-six male squash athletes were randomly assigned to three groups: Weighted Squats, Fake Stimulation, and Real Stimulation, with 12 participants in each group. After the assigned acute intervention, all participants completed the squash-specific star test. Completion time was recorded using a Microgate Witty photocell timing system, while surface electromyographic (sEMG) signals from 14 right-side muscles were collected using a Delsys Trigno wireless electromyography system. High-speed video was used to identify the Forward Lunge movement cycle, and transistor-transistor logic (TTL) synchronization enabled temporal alignment among timing, video, and sEMG signals. Normalized root mean square (RMS), muscle co-activation index (CI), and non-negative matrix factorization (NMF)-based muscle synergy parameters were calculated. Between-group differences were analyzed using one-way analysis of variance (ANOVA) with Bonferroni post hoc comparisons, and false discovery rate (FDR) correction was applied to secondary neuromuscular outcomes. Star test completion time differed significantly among the three groups (F = 28.65, p < 0.001, η2 = 0.63). The Real Stimulation group showed a shorter completion time (10.35 ± 0.45 s) than the Weighted Squats group (11.80 ± 0.55 s) and Fake Stimulation group (11.55 ± 0.50 s). During the Forward Lunge movement cycle, normalized RMS values of the rectus abdominis (ABS; F = 18.56, p < 0.001, η2 = 0.55) and latissimus dorsi (LD; F = 13.42, p < 0.001, η2 = 0.44) were significantly higher in the Real Stimulation group. The gluteus maximus-biceps femoris (GLM-BF) co-activation index also differed significantly among groups (F = 58.42, p < 0.001, η2 = 0.78), with higher values in the Real Stimulation group. Muscle synergy analysis showed group differences in selected muscle activation weights and temporal activation parameters. In this parallel-group acute intervention study based on post-intervention measurements, real NMES combined with weighted squats was associated with shorter star test completion time and altered neuromuscular control during the Forward Lunge movement cycle. The integrated use of photocell timing, wireless sEMG, high-speed video, and TTL synchronization provided temporally aligned sensor-based evidence for evaluating acute pre-competition activation strategies. However, due to the absence of baseline measurements, the findings should be interpreted as post-intervention between-group differences rather than definitive evidence of individual improvement.
Recent growth in hospice has raised concerns about variability in access and quality. This study examines U.S. county-level presence of hospice providers. Quality was assessed using 2023 Centers for Medicare & Medicaid Services Consumer Assessment of Healthcare Providers and Systems Hospice Survey Star Ratings. County-level sociodemographic characteristics were obtained from the U.S. Census Bureau's American Community Survey 2023 five-year sample. Of 7024 hospice providers, 29.2% had publicly available ratings, of which 55.3% were high quality (>3 stars). Of 3222 counties, at least one hospice provider was located in 41.4%, and a high-quality provider was present in 23.6%. Counties with high-quality providers tend to be urban and have higher income, larger populations, higher education, and lower poverty and uninsurance rates. Many U.S. counties have no hospice providers. The presence of high-quality care is markedly lower in rural and poor counties. Missing star ratings limit the utility of public quality data for patient and family decision-making.
Interstellar objects provide the only directly observable samples of icy planetesimals formed around other stars, and can therefore provide insight into the diversity of physical and chemical conditions occurring during exoplanet formation1-3. Here we report isotopic measurements of the interstellar comet 3I/ATLAS, which reveal an elemental composition unlike any Solar System body. The water in 3I/ATLAS is enriched in deuterium, at a level of D/H = (0.98 ± 0.06)%, which is more than an order of magnitude higher than in known comets, while its range of 12C/13C ratios (141-191 for CO2 and 123-172 for CO) exceeds typical values found in the Solar System, as well as nearby interstellar clouds and protoplanetary disks. Such extreme isotopic signatures indicate formation at temperatures  ≲ 30 K in a relatively metal-poor environment. When interpreted with respect to models for Galactic chemical evolution, the carbon isotopic composition implies that 3I/ATLAS may have accreted as long ago as 12 billion years, following a period of intense, early star formation. 3I/ATLAS thus represents a preserved fragment of an ancient planetary system.
The presence of serum immunoglobulin E (IgE) antibodies to the oligosaccharide galactose-alpha-1,3-galactose (α-gal) was first recognized during the investigation of allergic reactions to the monoclonal antibody cetuximab. The availability of an assay for IgE to α-gal made it possible to show that the patients who reported delayed allergic reactions to meat also had IgE to α-gal. This syndrome of delayed reactions to meat in patients with IgE to an oligosaccharide that was present in nonprimate mammals represented a complete contrast to the other forms of food allergy. However, the realization that the sensitization resulted from bites of the lone star tick, Ambloymma americanum, provided an explanation for the increase in cases in an area of the United States where there had been a major increase in the deer population, which is the primary breeding host of this tick. In contrast to almost all other IgE-mediated reactions, there is no relationship between the delay after eating red meat and the severity of allergic reactions. There is also increasing evidence that serum tryptase in the range of 20-90 ng/mL can occur after severe reactions related to α-gal. In addition, a recently reported fatal anaphylaxis, which started 4 hours after the individual ate a hamburger, included a postmortem tryptase of >2000 ng/mL. A working hypothesis to explain the delay in reactions relates to the time taken to process glycolipids in food derived from mammals, first into chylomicrons and, finally, to low-density lipoproteins. However, the quantitative presence of α-gal that remains on these particles may have major individual differences. In contrast to the patients who have symptoms related to eating meat, there are many individuals who are sensitized and who are not aware of any symptoms. In addition, individuals who are sensitized to alpha-gal can react rapidly to intravenous injections to the monoclonal antibody cetuximab, or polyclonal antibodies to venom, or the newer antivenom digested to Fab or Fab'2.
The northern pike (Esox lucius) is an economically important cold-water fish species in northern China. It exhibits pronounced sexual dimorphism, yet the molecular mechanism underlying its sex differentiation remains unclear, which hinders the development of aquaculture. Whole-transcriptome sequencing is a powerful approach for screening sex-related genes; however, no such study has been reported for this species to date. In this study, gonadal tissues from three female and three male E. lucius were collected for whole-transcriptome sequencing. A total of 14,941 differentially expressed messengerRNAs, 119 differentially expressed microRNAs, 229 differentially expressed circularRNAs, and 2055 differentially expressed long non-codingRNAs were identified. Functional enrichment analysis revealed that the differentially expressed genes were significantly enriched in pathways closely associated with sex differentiation, such as steroid hormone biosynthesis and oocyte meiosis. Several key sex-biased genes were identified, including female-biased genes (FANCL, DDX5, SRSF5B) and male-biased genes (STAR, FDX1B, ITGA2B). Furthermore, a competing endogenous RNA (ceRNA) regulatory network involving dre-miR-107b was constructed, which may represent a candidate for further investigation into sex differentiation in E. lucius. This study provides the first comprehensive whole-transcriptome dataset of female and male gonads in E. lucius, identifies key sex-biased genes and core pathways involved in its sex differentiation, and thereby identifies the dre-miR-107b-centered ceRNA network and key sex-biased genes (FANCL, DDX5, SRSF5B, STAR, FDX1B, ITGA2B) as core molecular players in sex differentiation of this species.
Existing methods for hypergraph node classification usually rely on local message passing and use a unified strategy for topological modeling across hyperedges of different sizes. However, they have two limitations in semi-supervised settings. First, representation learning mainly depends on local neighborhoods, making it difficult to incorporate global topological information. Second, a unified structural modeling strategy cannot effectively handle both small and large hyperedges. Small hyperedges require modeling fine-grained local relations, while large hyperedges need sparse group-level structure. To address these issues, we propose S2-HGNN, a scale-aware hypergraph node classification framework with spectral inductive bias for semi-supervised learning. S2-HGNN first injects global topological information into the input features using complementary hypergraph spectral operators. It then constructs different auxiliary topologies based on hyperedge size. For small hyperedges, it uses Top-k constrained clique expansion to preserve representative local relations. For large hyperedges, it uses star expansion to reduce redundant connections while preserving sparse group-level structure. Finally, node representations are jointly learned from the original hypergraph backbone and the two auxiliary branches, and final predictions are obtained through node-level adaptive fusion. Experiments on multiple public datasets show that the proposed method consistently outperforms strong baselines and exhibits superior robustness under feature perturbations.
With the widespread adoption of neoadjuvant therapy in pancreatic cancer, the traditional surgery-centered treatment paradigm is undergoing a profound shift. Against the background of upfront systemic therapy, surgery no longer naturally occupies the starting point of the treatment sequence; instead, its indications, timing, and expected benefits must be re-evaluated and redefined within the new treatment framework. By improving completion of the entire treatment course, enabling biological selection, and optimizing patient selection for surgical intervention, neoadjuvant therapy has driven a shift in resectability assessment from a purely anatomical judgment toward a comprehensive decision-making model that integrates tumor biology and treatment response. Nevertheless, surgical practice faces multiple challenges, including blurred boundaries of surgical indications, greater complexity in determining the optimal timing of surgery, evolving technical difficulty and perioperative risk, and the limitations of traditional evaluation frameworks. On this basis, the role of surgeons is evolving from executors of surgical techniques to central decision-makers within multidisciplinary teams, accompanied by increasing refinement of surgical strategies and ongoing innovation in surgical techniques and assessment concepts. Overall, the reshaping of surgical strategies for pancreatic cancer in the era of neoadjuvant therapy is not centered on the binary question of whether to operate, but rather on determining for whom, when, and how surgery should be performed, with the ultimate goal of achieving precise surgical decision-making oriented toward long-term survival benefit for patients. 随着新辅助治疗在胰腺癌治疗中的广泛应用，传统以手术为中心的治疗范式正经历深刻转变。在系统治疗前移的背景下，外科手术不再占据治疗流程的起始环节，其适应证、实施时机及预期获益均需在新的治疗框架下重新审视与界定。新辅助治疗通过提高全程治疗完成度、实现生物学筛选及优化外科干预对象，推动可切除性评估由单纯的解剖学判断向融合肿瘤生物学行为与治疗反应的综合决策模式转变。然而，外科治疗亦面临适应证边界模糊、手术时机判断复杂化、技术难度与围手术期风险变化以及传统评价体系滞后等多重挑战。在此基础上，外科医师的角色正由手术技术执行者向多学科协作模式中的决策核心转变，手术策略趋于精细化，手术技术与评估理念不断创新。总体而言，新辅助治疗时代胰腺癌外科策略的重塑，并非围绕“是否手术”，而是聚焦于“为谁手术、何时手术、如何手术”，其核心目标在于实现以患者长期生存获益为导向的精准外科决策。.
We define guideline implementability as the characteristics of the guideline that reflect the extent to which it is likely to be adopted in clinical practice. Improving the intrinsic quality (e.g., context, format, language etc.) of clinical practice guidelines (CPGs) may be a cost-effective and broadly applicable approach. This study was aimed to develop the clinical practice guidelines implementability assessment tool (CPG-IAT) and test its psychometric properties. The study used the 2022 CPGs recorded in the STAR guideline repository as the evaluation sample. The evaluation team consisted of 60 members with clinical, guideline development, or prior rating experience, responsible for assessing the included guidelines. Guideline evaluation data were randomly assigned to be utilized for an exploratory factor analysis (n = 131) or for a confirmatory factor analysis (n = 130). Reliability and validity analyses were then conducted with the full sample. The exploratory factor analysis resulted in a 16-item tool with four dimensions representing Methodological Rigor and Transparency, Recommendation Clarity and Interpretability, clinical relevance and actionability. Confirmatory factor analysis supported a priori factor structure. The tool demonstrated excellent internal consistency reliability, convergent validity, construct reliability, split-half reliability, test-retest reliability, inter-rater reliability and pragmatic. The CPG-IAT provides a psychometrically validated instrument for assessing the intrinsic implementability of CPGs both during and after the guideline development process. The CPG-IAT contributes a systematically developed and empirically validated measure of guideline implementability, with potential to inform future research and practice aimed at enhancing the translation of evidence-based guidelines into clinical practice. China Clinical Trails Registry (ChiCTR2400086931); registered July 15, 2024. https://www.chictr.org.cn/.