Study DesignCross-sectional survey study.ObjectivesTo provide a contemporary global overview of intra-operative neuromonitoring (IONM) practices, attitudes, and perceived barriers among spine surgeons.MethodsA web-based questionnaire was distributed to AO Spine surgeon members worldwide between April and May 2025 to collect data on surgeon demographics, access to and utilization of IONM, models of service delivery, intra-operative responses to neuromonitoring alerts, attitudes toward IONM, and perceived limitations. Attitudes were assessed using 13 Likert-scale statements. Logistic regression analysis was performed to identify factors associated with a positive attitude toward IONM. Significance was set at p<0.05.ResultsA total of 529 spine surgeons responded to the survey. Consistent access to IONM was reported by 55.5% of respondents, occasional access by 35.7%, and no access by 8.8%. External service providers were the most used IONM model (59.5%). Neuromonitoring technicians most frequently interpret intraoperative data (63.6%). In response to unexpected signal loss, most surgeons reported using a standardized checklist (76.3%). Overall attitudes toward IONM were predominantly positive, with most respondents agreeing that IONM improves patient outcomes, provides medicolegal protection, and offers surgeon reassurance. Economic constraints (38.2%), logistical challenges (27.4%), and lack of training (25.6%) were the most reported barriers. Multivariate analysis identified geographic region, specialty, and access to IONM as independent predictors of a positive attitude.ConclusionsThis global survey demonstrates widespread acceptance of IONM among spine surgeons, particularly for high-risk procedures. However, disparities in access and persistent economic and logistical barriers remain, highlighting the need for strategies to improve equitable implementation worldwide.
Kirsten rat sarcoma (KRAS) is an oncoprotein responsible for ∼ 20% of all human cancers. So far, only two covalent drugs are approved by the U.S. Food and Drug Administration (FDA) for the treatment of KRAS (G12C)-driven non-small cell lung cancer. However, their reliance on a covalent bond with cysteine at position 12 limits their effectiveness for treating other cancers driven by non-G12C KRAS mutations, and the emergence of resistance against allele-specific inhibitors means that considerable effort is being directed toward developing noncovalent KRAS inhibitors. Currently, multiple noncovalent inhibitors are in various stages of clinical trials. While some of these may eventually come to fruition, none has so far been approved for market use, underscoring the need for new inhibitors. Here, we report a set of small molecules obtained from virtual screening of a physiochemically tailored ligand library against multiple KRAS mutants. Initial binding and cell proliferation experiments show that some of the predicted hits exhibit high affinity (single digit nM) binding to KRAS and sub-to-low micromolar inhibitory activity in pancreatic cancer cell lines harboring G12D, G12V, or G12C KRAS mutations. Predicted to bind to the p2 (also called switch II) pocket of KRAS, these ligands harbor unique scaffolds compared to existing drugs or leads and may serve as useful starting points for the development of allele-specific or pan-KRAS inhibitors.
The ability to access atomically tailored complex peptides and proteins provides powerful opportunities for dissecting molecular functions and advancing applications in chemical biology, therapeutics, and (bio)-materials science. Robust precision-engineering strategies are essential to construct well-defined protein architectures while preserving native folding and activity. To do so, chemoselective bioconjugation techniques have been developed to modify specific side chains of amino acids. This allowed for the selective introduction of functionalities on predetermined amino acids. However, ultimate control can be achieved only through site-selective modifications that precisely define both the nature of the linkage and the exact position of conjugation on elongated peptide sequences or fully assembled proteins. Cysteine residues are of particular interest, as their highly nucleophilic thiols offer excellent chemoselectivity and typically occur in low abundance in their reduced form. Here, we examine chemoselective transformations targeting cysteine residues that have been further refined to occur exclusively at predefined positions within a peptide or protein, thereby achieving a high degree of site-selectivity. This review focuses exclusively on chemical strategies for cysteine modification, offering guidance for future synthetic developments within the field of precision chemistry. Achieving this level of precision requires advanced chemical strategies that exploit the local environment of the targeted cysteine. One approach involves leveraging neighboring functional groups, for example, engaging the thiol together with the α-amine or carboxylate to enable selective N- or C-terminal modification, respectively. In such designs, the cysteine side chain may contribute through transient interactions, direct incorporation into the covalent linkage, or the stabilization of the desired product. Recently, a promising strategy has attracted increasing attention in which site-selectivity is enabled by temporary interaction with a proximal amine, thus being applicable to differentiate also between internal cysteines. Together, these strategies highlight that site-selective protein modification has evolved into a powerful tool for the rational design and functional control of complex biomolecules, redefining what is achievable in chemical biology, therapeutics, and biomaterials science. We anticipate that increasingly routine or user-friendly approaches such as the programmable TriTEx method will further accelerate the adoption of precision biomolecule conjugates in both research and industrial settings.
Freeform 3D ice printing is emerging as a promising additive manufacturing method with potential applications in engineering, medicine, science, and art. Printing ice at the micrometer-millimeter scale is a challenging, high-frequency additive manufacturing process. Freeform ice 3D printing though is an early stage manufacturing process where complex geometries require significant time to design manually through an empirical trial-and-error approach, due to the nonlinear nature of droplet deposition and solidification along with unavoidable uncertainties and noise. This process would be tremendously improved with better understanding and harnessing the ability to visualize, analyze and adjust the printing process in real time. For this automation, using approaches such as closed loop control that have allowed tremendous advances in other fields like self-driving cars, plane autopilot, etc. would be very useful. In order to use closed loop control for this process, ice position and shape must be determined and transformed into in situ actionable data, which is complicated further by the transparency of ice and speed required for the phase transition from water to ice. We implemented vision techniques to build a data set to train a machine learning algorithm though an ice segmentation approach using a convolutional filter. We also implemented a hybrid optical flow algorithm (Farneback-FAST) to create a segmented video frame data set for training a neural network, Icenet. This approach was faster than the Farneback-FAST, segmenting frames in 25 ms, which allows for single and low multi droplet control. Our approaches will enable future closed loop control of the printing process and will be useful in a variety of areas including additive manufacturing, organ on a chip systems, and biomanufacturing.
Living kidney donation is considered the optimal treatment for patients with advanced kidney disease, but it carries risks for the donors. To assess these risks, data on donors' physical and mental health is needed. The German Living Donor Registry collects medical and psychosocial data from 32 transplant centers. The analysis provides a representative overview of the demographics, pre-operative physical and mental health, and psychosocial situation of accepted living kidney donors in Germany, accounting for gender-specific differences. From January 2020 to January 2025, 1,237 individuals aged 54.5 ± 10 years (range: 20-83 years) were examined pre-operatively. Most donors were women (63%), 56% reported at least one pre-existing disease or medication, and 13.5% had an eGFR <80 ml/min. Compared to the general German population, donors showed a higher quality of life and fewer psychological impairments and fatigue symptoms. Risk factors for impaired mental quality of life and fatigue included psychosocial stress and lower resilience. Living kidney donors in Germany do not represent a completely healthy population, but have a high quality of life. Careful, standardized medical and psychosocial evaluation is needed to identify donations with high medical or psychosocial risk and to ensure comprehensive education to protect donors.
暂无摘要(点击查看详情)
暂无摘要(点击查看详情)
Glioblastoma (GBM) represents the most aggressive primary brain tumor in adults, characterized by a profoundly immunosuppressive tumor microenvironment (TME) that systematically disables cytotoxic lymphocyte function and renders conventional immunotherapy largely ineffective. While exhaustion of CD8+ T cells and natural killer (NK) cells within solid tumors has been extensively studied in other cancer types, the CNS-specific architectural, metabolic, and molecular constraints that shape cytotoxic lymphocyte heterogeneity in GBM remain insufficiently characterized. Recent advances in single-cell RNA sequencing (scRNA-seq) and spatial multiomics have begun to reveal a rich landscape of cytotoxic lymphocyte subpopulations in GBM. These include TCF-1+ progenitor-exhausted T cells (Tpex), terminally exhausted CD8+ T cells (Tex), and dysfunctional natural killer (NK) cell subsets, each distributed across anatomically distinct immune niches. This review synthesizes current knowledge across three interconnected areas: the single-cell atlas of GBM-infiltrating cytotoxic lymphocytes; the spatial organization of their dysfunction within perinecrotic, perivascular, and infiltrative-edge niches; and the epigenetic and transcriptional programs that underlie GBM-specific cytotoxic failure, including dysregulation of the TOX/TCF-1 axis and IDH-mutation-driven silencing of NKG2D ligands. Critically, we compare CD8+ T cell and NK cell exhaustion mechanisms, highlighting their mechanistic divergence and therapeutic implications. We further discuss how these multiomics insights can be translated into neurosurgically relevant strategies, including intraoperative tumor profiling, progenitor T cell expansion via epigenetic priming, NKG2A/TIGIT dual blockade, and intracavitary delivery of engineered NK cells. Together, this review proposes a spatially and cellularly resolved framework for understanding cytotoxic immune failure in GBM and outlines precision immunotherapy approaches tailored to the unique immunobiology of the CNS tumor microenvironment.
Two pillar-layered MOF membranes, CALF-20 and CALF-15, were synthesized on polymeric substrates by in situ interfacial growth under mild conditions. Owing to the ultrasmall thickness of 60 nm and ultramicroporous lattice windows, the membranes exhibited ultrahigh H2 permeance of over 7000 GPU and H2/CO2 selectivity of 30-43.
In the context of unprecedented workforce age diversity, workplace ageism is increasingly reported. This review synthesizes empirical evidence on the relationship between workplace ageism and workplace wellbeing among workers aged 50 and older, focusing on how these effects unfold (mediation) and the conditions under which they are amplified or buffered (moderation). A systematic literature review was conducted following PRISMA guidelines. Searches were conducted in major academic databases, including Web of Science, Scopus, Pubmed, among others. Of the 3,378 records identified, 22 met the inclusion criteria. Across studies, ageism showed a consistently negative and statistically significant association with workplace wellbeing outcomes, even though ageism and wellbeing were measured with heterogeneous indicators. Findings also suggest spillover beyond work, for example, via decreases in life satisfaction or subjective wellbeing. Moderation evidence was limited; when tested, social support (supervisor and coworker support) emerged as the only moderator in this association. Mediation evidence was more developed and clustered around three pathways: (1) cognitive processes (e.g., appraisals and rumination); (2) affective processes (e.g., aging anxiety); and (3) job demands-resources mechanisms. By clarifying these moderators and mechanisms, the review points to leverage points for practices that foster inclusive, intergenerational workplaces and safeguard wellbeing.
The Cochrane Handbook's I 2 categorization system (0%-25% "low", 25%-75% "moderate", ≥ 50% "high" heterogeneity) defines the standard approach to interpreting heterogeneity in meta-analysis and informs thousands of systematic reviews each year. Despite its widespread use, its logical coherence and its role as an analytical decision tool have received limited formal examination. To examine whether the Cochrane Handbook's I2 categorization system includes overlapping category definitions that create ambiguous classification, and to propose context-specific frameworks that preserve I2 as a decision tool for heterogeneity exploration. We conducted a structured genealogical analysis of key methodological sources related to the Cochrane Handbook's I 2 categorization. We examined whether individual I 2 values can satisfy more than one category. We analysed the categorization using principles from formal logic, philosophy of science, and statistical theory. We traced the development of I2 interpretation from its original formulation to current Cochrane guidance. We developed context-specific frameworks based on patient-important outcome categories. The I 2 categorization system includes overlapping definitions in which identical values satisfy more than one category (e.g., I 2 = 50% corresponds to both "moderate" [25%-75%] and "high" [≥ 50%]). This structure assigns single values to multiple categories and departs from principles that require consistent and mutually exclusive classification. The primary literature provides limited explicit theoretical or empirical justification for the selected thresholds. The current approach uses I 2 as an interpretive endpoint rather than as a decision tool for heterogeneity exploration. These features reduce interpretive clarity and obscure the role of clinical context in heterogeneity assessment. The current I2 categorization system introduces ambiguity and leads to inconsistent analytical decisions across outcome contexts. Evidence synthesis requires context-specific frameworks in which interpretation reflects outcome type and expected variability. We propose the PIOHA framework to align heterogeneity assessment with clinical relevance while preserving I2 as an analytical decision tool. Systematic reviews inform clinical guidelines and patient care. Context-specific heterogeneity assessment supports analytical decisions that reflect the clinical importance and expected variability of patient-important outcomes.
Prey use a variety of anti-predator behavior, including alarm calling and approaching predators, and may adjust these behaviors by evaluating their benefits and costs. However, it remains unclear how prey expresses anti-predator behavior across seasons, when both breeding status or predator diet may influence perceived risk. We conducted nine-minute playback surveys (six-minute quiet period and subsequent three-minute playback) using calls of Collared Owlet (Glaucidium brodiei), a diurnal owl that preys on passerines, at 93 sites during breeding season and non-breeding season in Taiwan. We quantified whether the small passerine birds approach and make alarm call or not to quantify mobbing response. We found that probability of making alarm calls did not differ between seasons (30.88% and 29.15% in breeding and non-breeding season, respectively), whereas probability of approaching was higher in breeding (25.63%) than in non-breeding season (13.28%). To verify that responses were specific to predator cues rather than to loud vocalizations in general, we conducted supplementary playbacks using calls of a non-predatory species, Taiwan Barbet (Psilopogon nuchalis), which elicited markedly lower mobbing responses. Together, these results indicate that small passerine birds mob in both seasons but reduce the use of higher-risk behaviors against predators during the non-breeding season, consistent with seasonal variation in predation risk.
暂无摘要(点击查看详情)
暂无摘要(点击查看详情)
With increasing emphasis on patient-centric care, treatment goals for ulcerative colitis (UC) now include bowel urgency (BU), stool frequency, and rectal bleeding (RB) resolution, enhancement of overall well-being, and endoscopic remission (ER). This analysis evaluated the impact of adding BU improvement to clinical remission, defined by the modified Mayo score (RB, stool frequency, ER), on quality of life assessed by the Inflammatory Bowel Disease Questionnaire (IBDQ). The effect of mirikizumab on achieving combined clinical, BU, and IBDQ remissions was also evaluated in the LUCENT-1 and -2 trials. In LUCENT-1, patients were randomized 3:1 (mirikizumab to placebo) every 4 weeks. At Week 12, mirikizumab responders were re-randomized 2:1 (mirikizumab to placebo) for 40 additional weeks in LUCENT-2. BU improvement was assessed using clinically meaningful improvement (Urgency Numeric Rating Scale [UNRS] ≥3-point change) and BU remission (UNRS = 0 or 1). The impact of mirikizumab on achieving single and combined outcomes was determined at Weeks 12 and 52. Significant IBDQ improvement at both timepoints (P ≤ .01) was observed by achieving both BU improvement and clinical remission versus clinical remission alone. Significantly more mirikizumab-treated patients achieved single and combined endpoints of clinical, BU, and IBDQ remissions versus placebo (P ≤ .05). The addition of BU improvement in patients who had already attained clinical response or remission is associated with greater quality of life. Mirikizumab delivered comprehensive benefit for patients with UC by relieving BU symptoms, resolving endoscopic inflammation, and enhancing overall well-being concurrently.
Research investigating paedo-hebepho-ephebophilic sexual interests, a spectrum of atypical sexual interests toward minors under the age of 16 years old, has largely focused on men samples, while little is known about women. The present study aimed to contribute to this area by investigating the relationship between measures of experienced childhood trauma, empathy (dispositional as well as towards children), loneliness, intimacy, and paedo-hebepho-ephebophilic sexual interests or antisocial behaviour involving children in a community sample of 304 women - from the UK, Canada and USA - recruited through an online survey. Results revealed that between .7% (N = 2) and 4.6% (N = 14) reported different paedo-hebepho-ephebophilic sexual interests. Multiple regression analysis revealed that experiences of emotional abuse, physical abuse, sexual abuse, physical neglect, empathy towards victims, and empathic concern were significant predictors of paedo-hebepho-ephebophilic sexual interests. These results have several implications that will be discussed in this paper. Paedo-Hebepho-Ephebophilic Sexual Interests Among Women in a Community Sample from the UK, Canada and the USAThis study examines the prevalence and correlates of paedo-hebepho-ephebophilic sexual interests or antisocial behaviour involving children, a spectrum of atypical interests toward minors under the age of 16, in a community sample of 304 women from the UK, Canada and the USA. The majority of the existing literature within this field focuses on convicted or clinical samples. Therefore, little is known about women exhibiting these atypical sexual interests in the general population. We identified strong associations between these atypical sexual interests, previous childhood abuses and a lack of empathy. By examining these atypical sexual interests in a non-incarcerated and non-clinical sample, our work addresses a significant gap in the literature and offers insights into their prevalence and potential correlates.
This study aimed to explore undergraduate nursing students 'attitudes toward and needs regarding the use of generative artificial intelligence (AI) in professional learning, to provide a reference for the better integration of generative AI into nursing education. This study employed a qualitative research design. Guided by Colaizzi's seven-step method, semi-structured in-depth interviews were conducted with 18 undergraduate nursing students with experience in using generative AI. Participants were recruited through purposive sampling from three universities in China between January and March 2026. Two themes and six subthemes were identified: (1) undergraduate nursing students have a rational attitude toward generative AI, including broadening learning perspectives and improving learning efficiency, alleviating psychological anxiety, and existing concerns; (2) undergraduate nursing students 'needs regarding the use of generative AI in professional learning, including information accuracy, humanistic care, and external support. Undergraduate nursing students generally adopt a rational and accepting attitude toward generative AI. While recognizing its value as a learning aid, they maintain a clear understanding of its limitations and have expressed a pressing need for accurate information, humanistic care, and external support. Nursing institutions should strengthen the regulation, guidance, and integration of generative AI into teaching to promote the high-quality training of nursing professionals.
The aim was to analyze current orthodontic retention protocols in Croatia and their trend over a 10-year period. In a repeated cross-sectional survey, questionnaires were distributed to 150 orthodontists in Croatia in 2013 and 185 of them in 2023 (representing 69% and 85% of practicing orthodontists with response rates of 61% and 75%). Significant changes in retainer types across different malocclusions and treatment protocols were observed over a 10-year period. There was an increase in the use of VFR and a decrease in acrylic retention plates in both jaws (p≤0.001). Over the decade, the use of only fixed retention in the mandible declined from 20% to 7% (p=0.007), and the combination of fixed and removable retention in the maxilla dropped from 29% to 17% (p≤0.033). Increased use of removable retainers was noted in cases involving rotations, open bites, and extractions. Conversely, fixed-removable retainers were more frequently used in spacing cases (p≤0.001). There was a trend toward fewer check-ups (p=0.001) and toward increased patient self-monitoring (p=0.021). Personal experience as the primary reason for choosing a retention protocol increased from 39% to 62% (p<0.001). Additionally, the use of written information on retention rose from 39% to 69% (p<0.001). Retention practices in Croatia have evolved over the past decade, characterized by increased use of VFRs, more frequent implementation of dual retention in the mandible, and greater provision of written retention information. Additionally, follow-up protocols have shifted toward fewer scheduled visits, with increased emphasis on patient self-monitoring.
Patients with hemiplegia after stroke often suffer from motor dysfunction, and their recovery is frequently limited by the imbalanced interhemispheric competition and abnormal neural network reorganization. The combined application of transcranial magnetic stimulation (TMS) and functional near-infrared spectroscopy (fNIRS) has provided a novel closed-loop neuromodulation strategy for the assessment and intervention of post-stroke motor function. This systematic review aims to systematically synthesize clinical research evidence regarding the combined use of TMS and fNIRS in post-stroke motor function recovery, as well as to analyze its neurophysiological mechanisms, clinical efficacy, and methodological quality. By searching databases including PubMed, Web of Science, Embase and Cochrane Library, a total of 9 studies were finally included. The results showed that the TMS-fNIRS combined protocol was safe and feasible, with six of the nine interventional studies reporting statistically significant improvements in motor function (e.g., Fugl-Meyer Assessment scores), while the remaining three did not report clinical outcomes. At the neurophysiological level, effective TMS interventions (such as intermittent theta-burst stimulation (iTBS) or high-frequency repetitive transcranial magnetic stimulation (rTMS) could enhance the activation of the ipsilesional primary motor cortex, facilitate the restoration of interhemispheric balance (with the laterality index shifting toward the ipsilesional side), and improve local and interhemispheric functional connectivity as well as brain network efficiency. Two-thirds of the studies (6/9) found that changes in neurophysiological indicators were significantly correlated with improvements in clinical functions, providing preliminary, hypothesis-generating correlational support for the underlying intervention mechanisms. However, existing studies have limitations including small sample sizes, high protocol heterogeneity, and uneven methodological quality (especially the high risk of bias in non-randomized studies), resulting in a moderate to low level of evidence strength. In conclusion, the combined TMS-fNIRS technology demonstrates the potential to advance stroke rehabilitation toward individualization and closed-loop practice, but current evidence is still in the early stage. Future research needs to conduct large-scale, standardized, algorithm-driven clinical trials to achieve the transition from "proof-of-concept" to "precision therapy".
People with mental disorders (PMD) not only face difficulties related to their mental health problems, but also suffer from the stigma and discrimination associated with them. Research on social stigma in the educational setting has been mainly focused on health sciences students. The main objective was to compare the level of social stigma toward PMD among university students, categorized by their fields of study. Additionally, the analysis considered gender, knowledge about mental health, familiarity, and contact. A cross-sectional study was conducted among all first-year undergraduate students during the 2023-24 course at the University of Valencia, who were enrolled in five study fields: Engineering and Architecture (EA), Arts and Humanities (AH), Social and Legal Sciences (SL), Sciences (SC) and Health Sciences (HS). All students completed online an initial questionnaire with socio-demographic items, as well as the following questionnaires: The Mental Health Knowledge Schedule (MAKS), the Reported and Intended Behaviour Scale (RIBS), the Scale of Community Attitudes toward Mental Illness (CAMI), and the Attribution Questionnaire (AQ-27). The final sample comprised 2,693 students. The EA students scored highest in authoritarianism and social restrictiveness, and lowest in benevolence and CMHI. Students from SL had higher levels of public stigma than those from AH, SC and HS. Considering only women, EA had the highest scores in authoritarianism. EA men had lower benevolence and lower CMHI. These findings suggest that anti-stigma programs conducted at higher education institutions, in addition to traditional health sciences students, should target students from other study fields. This paper goes a step further by proposing that university curricula should include activities to improve understanding of mental health problems and reduce social stigma associated with PMD.