搜索结果：Warns

Rapid advances in stem cell science have generated stem cell-based embryo models (SCBEMs), multicellular structures derived from pluripotent stem cells that recapitulate key features of early human development without originating from fertilization. Although the literature also refers to these entities as "human embryo models" or "embryoids," this article adopts the term SCBEM to reflect their stem cell derivation and to maintain terminological precision. Originally presented as an alternative research platform to embryos, SCBEMs are increasingly exhibiting embryo-like structural and developmental organization. Their trajectory raises a familiar ethical warning about scientific creation outpacing responsibility and exposes significant gaps in legal definitions that rely on origin-based criteria (fertilization, cloning, parthenogenesis) instead of functional characteristics and demonstrated developmental potential. This article develops a South African-centred analysis within a comparative frame, arguing for a bespoke governance framework that is principled, proportionate, and adaptive. It proposes: (i) revised statutory definitions that are tethered to potential and organization; (ii) specialist oversight and a national register; (iii) a culture-limit policy that is aligned with resemblance (and distinct from the fourteen-day rule which applies in relation to embryos); (iv) bright-line prohibitions on any reproductive use or transfer into human or animal hosts; and (v) mechanisms for public trust, transparency, and cross-border harmonization. The aim is to enable socially valuable research while closing loopholes that could erode ethics oversight and public confidence. This article clarifies the legal-ethical problem through the lenses of potentiality and developmental resemblance, maps the comparative governance of SCBEMs with lessons for South Africa, and offers a model framework which includes definitions, oversight architecture, culture-limit policy, prohibitions, and transparency that are designed to be future-ready. A doctrinal analysis of primary law and authoritative guidance was adopted, supplemented by comparative review and governance design principles (proportionality, accountability, transparency). Where formal sources are silent, policy-ready rules were derived from best-practice codes and ethics literature.

Nicotiana glauca Graham (N. glauca) is an agricultural weed, environmental weed, and noxious weed, posing a significant threat to ecosystems and agricultural systems. To provide a basis for the early warning of N. glauca, the existing geographical distribution data and environmental variables of N. glauca were used to predict the potential invasion threat area under historical (1970-2000) and future (2061-2080) climate conditions through MaxEnt and ArcGIS in this study. The results showed that the isothermality (bio3), the max temperature of warmest month (bio5), the mean temperature of wettest quarter (bio8), and the mean diurnal range (bio2) were the key bioclimatic variables affecting the growth of N. glauca. The potential invasion threat area of N. glauca under historical climate conditions was mainly distributed in the central and southern parts of North America, the vast majority of South America, the northern coastal areas and the central and southern parts of Africa, the western and southern parts of Europe, the central and southern parts of Asia, and the vast majority of Oceania, among which the high-threat areas were mainly located in the southern regions of each land. Among the four scenarios of future climate, the centroid of the invasion threat area shifted southeastward and northeastward, and the total area of the invasion threat area was larger than that under historical climate conditions, suggesting the arduousness of the task of preventing the invasion of N. glauca. The results of this study provided valuable information and theoretical references for the early warning of N. glauca.

Colorectal cancer is a prevalent malignancy, with colon adenocarcinoma (COAD) representing its most common histological subtype. Although most stage I patients remain disease-free after treatment, a subset rapidly progresses to advanced disease with markedly reduced survival. Therefore, identifying early molecular warning signals in stage I patients is essential for timely intervention. In this study, integrated datasets from The Cancer Genome Atlas and Genotype-Tissue Expression projects were analysed using the landscape dynamic network biomarker (l-DNB) approach to identify progression biomarkers (PBs) for COAD. Twenty PBs were identified, among which succinate dehydrogenase complex flavoprotein subunit A (SDHA) was selected for further investigation. The L1000CDS2 database was subsequently queried utilizing these identified PBs, identifying Cucurbitacin I (CuI) as a promising therapeutic component against COAD. Molecular docking and molecular dynamics simulations demonstrated stable binding between CuI and SDHA, with a binding energy of -9.44 kcal/mol and an RMSD of 2.0 ± 0.3 Å. Subsequent in vitro experiments demonstrated that CuI treatment upregulated SDHA expression and inhibited activation of the NF-κB pathway. Collectively, these findings suggest that the identified PBs may serve as early-warning indicators for stage I COAD patients and that CuI suppresses COAD cell proliferation, potentially through the SDHA/NF-κB axis, highlighting its promise as a potential therapeutic candidate.

Local anesthetic systemic toxicity (LAST) is a preventable complication associated with regional anesthesia. When multiple local anesthetic (LA) agents are administered during dental procedures, calculating the cumulative fractional toxicity is cognitively demanding and error-prone. Studies have demonstrated that up to 87% of dental practitioners cannot correctly calculate the LA doses. The risk is amplified in pediatric patients, where fatal overdoses have been reported from dosing calculation errors. Despite the clinical importance of accurate dosing, no freely available peer-reviewed tool combines cartridge-based input, cumulative fractional toxicity calculations, and epinephrine dose tracking in dental practice. MaxSafe is a free open-source web application. The tool accepts patient weight, age (less than 1 year through 17 years or adult), and status (with independent cardiac and pregnant toggles). It provides five common dental LA formulations with multiple epinephrine concentration options, and uses dental cartridge counts as the input. It calculates the cumulative fractional toxicity in real-time and independently tracks the epinephrine dose against patient-specific limits. In the pediatric mode, the tool applies the American Academy of Pediatric Dentistry (AAPD) Conservative maximum recommended doses and visually restricts age-inappropriate drugs. Additional features include multi-concentration tracking per drug, advisory warnings for hepatic and renal impairments, and a verification summary panel to mitigate automation bias. The accuracy was validated against 23 manually calculated clinical test scenarios, including adult dosing, pediatric dosing, and alternative epinephrine concentration calculations. The app-calculated values matched the manual calculations exactly across all 23 test scenarios. In pediatric scenarios, the AAPD Conservative maximum recommended doses were substantially more restrictive than the Food and Drug Administration-labeled values; a single cartridge of lidocaine in an 8-kg infant produced 96.6% cumulative LA toxicity, and two cartridges of mepivacaine in an 18-kg child exceeded the safe threshold at 128.8%. MaxSafe is a validated, free, open-source clinical decision-support tool that automates fractional toxicity calculations and epinephrine dose tracking for multi-agent LA administration in both adult and pediatric dental practices. This tool is available as a progressive web application at https://thesorenc.github.io/maxsafe-local-anesthesia/.

Carboxyl/cholinesterases play important roles in detoxification of exogenous compounds in arthropods. In this study, the carboxylesterase gene PcCCE7 was upregulated in a spirodiclofen- and abamectin-resistant field population (ASR) and after exposure to each acaricide. Silencing PcCCE7 reduced CCE activity and increased the susceptibility of Panonychus citri to two acaricides. Molecular docking showed the stable binding of PcCCE7 to both compounds. In vitro assays confirmed that recombinant PcCCE7 can degrade spirodiclofen and abamectin, although only spirodiclofen metabolites were detected. Dual-luciferase assays revealed that transcription factors Snail, OVO-1, and OVO-2 enhance PcCCE7 promoter activity. These results indicate that Snail, OVO-1, and OVO-2 regulate PcCCE7, which contributes to cross-resistance to spirodiclofen and abamectin, providing valuable information for resistance management in P. citri.

Stevens-Johnson syndrome (SJS) is a rare but dangerous clinical condition characterized by extensive skin lesions and erosive mucosal lesions. SJS is typically caused by an allergic reaction to a medicine, and occasionally, infectious causes can provoke the syndrome. The illness is considered a medical emergency, and treatment varies based on symptoms, with a focus on lesion treatment, airway and hemodynamic stability, and opportunistic infection avoidance. We report a case of 10 years old female patient who presented with chickenpox accompanied by high-grade fever. Ibuprofen was used to relieve her fever, and then she experienced a worsening skin rash, mucosal ulcers, dysphagia, and eye symptoms. SJS was compatible with clinical findings. The temporal correlation raises the possibility of a medication-related side effect triggered during the course of viral infection or by the viral infection itself. Topical and oral corticosteroids were used to treat the patient, and the patient's symptoms significantly improved. SJS is a condition that requires multidisciplinary care and management. Our case demonstrates the possibility of SJS being caused by varicella zoster infection or after taking ibuprofen while having chickenpox. It highlights the significance of identifying warning symptoms early on, such as rash and mucosal involvement, and using drugs cautiously during viral diseases. Favorable results and the avoidance of serious complications can be achieved by promptly stopping the offending medication if present, and starting the proper therapy, including corticosteroids.

Brucellosis remains an important public health problem globally. Rapid and accurate diagnosis is crucial for the treatment of brucellosis. However, current diagnostic methods for brucellosis are limited, posing significant clinical challenges. Extracellular vesicles (EVs)-derived microRNAs (miRNAs) potentially offer a novel, non-invasive approach for accurate diagnosis of brucellosis. Small RNA sequencing was conducted to identify candidate miRNAs as potential diagnostic biomarkers in serum-derived EVs from patients with brucellosis and healthy individuals. These miRNA candidates were further validated in serum-derived EVs, serum free of EVs (EVs-free), and serum within an exploratory set and a preliminary validation set using a quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and a logistic regression model to establish and validate the diagnostic signature. The sequencing analysis initially screened and identified a panel of 52 overexpressed miRNAs in serum-derived EVs from patients with brucellosis. Subsequently, qRT-PCR demonstrated that 10 of the top 12 most differentially expressed miRNAs (miR-20a-5p, miR-320a-3p, let-7b-5p, miR-374a-5p, miR-93-5p, miR-186-5p, let-7d-5p, miR-151a-3p, miR-361-5p, and miR-98-5p), effectively distinguished patients with brucellosis from healthy individuals. Among single miRNAs, miR-361-5p (area under the curve [AUC], 0.917 [95% CI, 0.760 -1.000]) has the largest AUC. After logistic regression analysis and qRT-PCR, it was found that a miRNA signature (miR-20a-5p and miR-93-5p) in serum-derived EVs performed more robust in differentiating between patients with brucellosis and healthy individuals (exploratory set: AUC = 1.000; preliminary validation set: AUC = 0.988, 95% CI: 0.949 -1.000). Moreover, there was no significant difference in the expression levels of this miRNA signature in EVs-free and serum. EVs were enriched with miRNAs that are closely associated with Brucella infection. MiR-20a-5p and miR-93-5p in serum-derived EVs serve as highly accurate diagnostic biomarkers for brucellosis, offering a rapid and reliable alternative to conventional diagnostic methods.

This study aimed to develop and validate a clinically applicable predictive model for estimating the probability of intensive care unit (ICU) readmission within 48 hours following ICU discharge in patients with sepsis. The model's predictive performance was evaluated across development and validation cohorts. Clinical data from patients with sepsis-classified according to 48-hour ICU readmission status-were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database using structured query language. Propensity score matching was applied to balance baseline covariates and reduce confounding between comparison groups. Candidate variables were identified through univariate analysis and refined using least absolute shrinkage and selection operator regression. A logistic regression-based predictive model was subsequently constructed and validated using an independent dataset. The predictive model was developed using clinical data from 1,002 patients and validated in an independent external cohort of 100 patients. The final model incorporated 6 predictors, including the 24-hour serum albumin level at ICU admission, 24-hour activated partial thromboplastin time, antibiotic use, mechanical ventilation, heart rate within 24 hours prior to ICU discharge, and the Acute Physiology Score III. The model demonstrated robust predictive performance, with C-index values of 0.82 in the development cohort, 0.81 in the internal validation cohort, and 0.76 in the external validation cohort. The predictive model demonstrated reliable performance in estimating the probability of ICU readmission within 48 hours among patients with sepsis following ICU discharge. The variables incorporated into the model are routinely collected in clinical practice, supporting its feasibility for early risk stratification and targeted interventions aimed at reducing early ICU readmission rates.

Heart failure (HF) is a multifactorial syndrome, yet the dynamic processes through which physiological systems become unstable before HF remain incompletely understood. We analyzed longitudinal data from individuals undergoing health check-ups. In participants who developed HF, the date of first HF hospitalization was defined as the index date. All measurements were aligned to the index date. Using estimated glomerular filtration rate, systolic blood pressure, heart rate, and body mass index, we quantified dynamic indicators via rolling window analyses: resilience based on autoregressive [AR(1)] coefficients, irreversibility proxies, and multivariate instability assessed by the maximum eigenvalue (λ₁) of covariance matrices. Rather than formal hypothesis testing, we focused on the consistency of temporal patterns across analytical conditions. The HF group showed a progressive increase in AR(1) coefficients several years before HF, suggesting declining physiological resilience. Visual inspection of irreversibility trajectories suggested possible time-asymmetric patterns before HF onset, although formal quantification in the HF group was limited by sparse data. Multivariate analyses further demonstrated an increase in λ₁ as HF approached, indicating an increase in shared variance structure across multiple physiological markers. Before HF onset, physiological systems may undergo a dynamic loss of stability characterized by reduced resilience, emergence of irreversible dynamics, and breakdown of multivariate coordination, preceding marked changes in mean biomarker levels.

PurposeEvaluate trends and correlates of self-reported awareness of and responses to front-of-package warning labels (FoPWLs) on packaged Mexican foods among Mexican Americans (MAs) in the United States (US).DesignInternational Food Policy Study annual cross-sectional surveys (2021, 2022, 2023).SettingOnline survey.SampleMA adults in the US (n = 9662).MeasuresSelf-reported past-month frequency of buying food at Mexican-oriented stores (recoded: often/very often vs less often), awareness of Mexican FoPWLs (recoded: often/very often vs less often), and self-reported reductions in purchasing less healthy foods (yes vs no for eight foods) due to FoPWLs.AnalysisAdjusted logistic models regressed binary outcomes (above) on sociodemographics and survey year.ResultsMost participants bought food in Mexican-oriented stores (87.2%). Of those who noticed Mexican FoPWLs (67.6%), many reported that FoPWLs influenced them to reduce purchasing less healthy foods (range = 31.1% [snacks like chips] to 43.9% [cola]). In adjusted models, noticing FoPWLs often/very often (vs less often) increased over time (AOR2022 vs 2021 = 1.30; AOR2023 vs 2021 = 1.21), as did self-reported reductions in purchasing sweetened fruit drinks (AOR2022 vs 2021 = 1.27), and desserts (AOR2022 vs 2021 = 1.32). People with limited vs adequate health literacy reported higher awareness of FoPWLs (AOR = 1.21).ConclusionMAs' awareness and reported effects of Mexican FoPWLs were high and stable or increased over time, with greater awareness among those with limited health literacy.

Outdoor agricultural workers experience significant heat exposure, yet few studies have evaluated whether wearable sensors can reliably measure continuous physiological responses in real field conditions. This pilot study examined the feasibility and predictive utility of core temperature, hydration, heart rate, and movement data collected from commercially available wearables. Thirty farmworkers in eastern North Carolina wore three devices, the CALERA core temperature sensor, the Nix Hydration Biosensor, and the Garmin Vivoactive smartwatch, during one July work shift. 1 min, physiological and environmental data were aligned to compute the modified Physiological Strain Index, mPSI. Device reliability, physiological responses, and heat exposure were summarized. Multi-linear regression and machine learning, Random Forest (RF) and Gradient Boosting Regression (GBR), models were evaluated to predict mPSI, using raw and smoothed predictors to estimate mPSI. CALERA retrieved 100 percent of the data, Garmin retrieved 97 percent, and Nix retrieved 80 percent. WBGT remained consistently high, approximately 28 to 29 degrees Celsius, and 12.6 percent of core temperature measurements exceeded 38 degrees Celsius. mPSI ranged from minimal to high heat strain, with 8.3 percent of observations at or above 5. Heart rate showed the strongest association with mPSI. The RF model using 60-min moving averages achieved the highest predictive accuracy with an R2 of 0.96 and a root mean squared error of 0.25. Wearables captured meaningful physiological patterns that corresponded with environmental heat exposure, and WBGT-based risk levels consistently overestimated heat strain relative to mPSI. Multi-sensor wearable systems are feasible for continuous heat strain monitoring and can support accurate prediction of heat-related risk among agricultural workers. This study is the first to evaluate the CALERA, Nix, and Garmin devices combined for heat strain monitoring in outdoor agricultural workers. By combining all three wearables in a field-based feasibility assessment, it addresses a key gap in validating consumer-grade technology for occupational safety in this high-risk workforce. The findings of the study support the use of wearable devices for real-time heat strain alerts, individualized hydration and work-rest guidance, and early warning systems to help prevent heat-related illness in physically demanding outdoor occupations.

Mangroves are vital blue carbon ecosystems, yet the microbial drivers of carbon fixation in their soils remain poorly understood. Here, this study investigated the patterns of drivers carbon-fixing microbes and their functional genes across three representative mangrove bays in the Beibu Gulf of the South China Sea (Lianzhou Bay, Maowei Sea and Zhenzhu Bay) using an integrated geochemical and metagenomic approach. The findings showed that: (1) the distribution of total organic carbon (TOC) in mangrove soils was significantly influenced by tidal zonation and mangrove plants, with TOC content in the mid-tidal zone consistently exceeding that in adjacent mudflats by 1.5- to 2.3-fold (p&#xa0;<&#xa0;0.01); (2) potential dominant carbon fixation pathways inferred from soil microbial communities may vary significantly across different areas, including chemolithoautotrophic taxa (e.g., Nitrospira, Thiobacillus), phototrophic cyanobacteria (e.g., Synechococcus, Cyanobium), and mixotrophic assemblages. Correspondingly, the relative abundances of key functional genes (e.g., narH, narG, fabB, oadB) exhibited significant differences among these bays; (3) environmental factors including salinity, nutrients, and heavy metals jointly influenced the accumulation of carbon fixation genes and their microbial hosts, collectively explaining 63.9% of community variation at the species level. This study provides a mechanistic understanding of microbial functional diversity that underpins carbon cycling in mangrove soils, offering quantitative insights for the conservation and management of blue carbon ecosystems under anthropogenic pressures.

Predatory journals are unethical publications that exploit researchers by charging fees without providing proper peer review or editorial oversight. They pose a serious threat to the integrity of scholarly communication, prioritizing profit over scholarship and disregarding ethical standards, which results in the dissemination of research that lacks quality and credibility. This guide offers researchers a practical framework to identify and avoid such deceptive publications, thereby protecting academic integrity and professional reputation. Key indicators of predatory journals include poor visual design, questionable content, and unethical business practices. Common red flags include unprofessional websites, grammatical errors, generic stock photos, and fabricated editorial credentials. Operational warnings include aggressive email solicitations promising rapid or guaranteed acceptance, vague or hidden article processing charges (APCs), and journal names that closely mimic reputable titles. Predatory journals also make false claims about indexing in databases like Scopus or PubMed and display fabricated impact factors. Researchers in biomedical engineering are particularly vulnerable to these risks because of the interdisciplinary nature of the field, intense publication pressure, and the increasing use of AI tools in manuscript preparation. The consequences of predatory publishing extend beyond individual careers; unvetted research compromises the evidence base for clinical translation and healthcare innovation. To mitigate these risks, researchers must verify journal claims through official sources and consult trusted colleagues or mentors. Although publishing in legitimate journals requires more time, it ensures the quality, integrity, and credibility of research. Institutions play a crucial role by providing training and encouraging stakeholders to prioritize publication quality over quantity.

Technological-based early warning systems (EWS) in rural Indonesia have shown limited long-term adoption because centralised, top-down mechanisms fail to incorporate the contextual triggers trusted by local communities, resulting in a disconnect in how warnings are understood, leading to inappropriate responses. Field evidence reinforces this problem; the usage of Information and Communication Technology (ICT)-based disaster information systems remained below three-quarters of users and the perceived benefits were also limited. At the same time, Local Indigenous Knowledge (LIK) has long played a critical role in disaster preparedness in rural communities. Local Indigenous Knowledge demonstrated universal adoption and was consistently considered more useful in preventing loss of life, fishing gear, catch and boats. Although prior studies have attempted to integrate LIK into disaster technologies, existing frameworks rely heavily on expert-driven knowledge extraction from qualitative interviews. This approach produces expert systems with unvalidated rules, limiting their credibility and scalability. To address this gap, this study proposes a socio-technical integration framework that systematically incorporates LIK into EWS. The framework was developed through a qualitative inquiry involving 17 in-depth interviews with fishermen and a focus group discussion (FGD) with eight fishermen community leaders from three coastal provinces of Indonesia, and its contextual foundation was further validated using 438 fishermen survey across the same regions. The framework introduces three stages: (1) LIK acquisition from community experience, (2) validation through empirical community consensus and scientific explanation and (3) structured integration into EWS. This staged community validation approach reduces dependence on tacit expert judgement and supports future integration with data-supported decision processes.

To evaluate the short-term effects and lagged temporal patterns of air pollutants and meteorological factors on hematological exacerbation phenotypes in patients presenting to the emergency department with chronic obstructive pulmonary disease (COPD) exacerbation. Patients who presented to a tertiary emergency department with COPD exacerbation between April 2022 and April 2023 were retrospectively reviewed. Exacerbations were classified as eosinophilic, neutrophilic, or mixed-type based on admission complete blood counts. Daily air pollutant concentrations (PM&#x2081;&#x2080;, PM&#x2082;.&#x2085;, SO&#x2082;, NO&#x2082;, CO, O&#x2083;) and meteorological parameters were obtained from official monitoring stations. Day-level associations between environmental variables and phenotype-specific daily exacerbation counts were analyzed using quasi-Poisson distributed lag non-linear models (DLNM) and a time-stratified case-crossover design (lag 0-3 days). Of all exacerbations (n&#x2009;=&#x2009;354), 65.8% were neutrophilic, 20.3% mixed-type, and 13.8% eosinophilic. The neutrophilic phenotype was associated with the most severe clinical presentation. No significant environmental association was identified for the overall COPD exacerbation count. In the eosinophilic phenotype, same-day exposure to CO and SO&#x2082; was associated with increased exacerbation risk (RR&#x2009;=&#x2009;1.39, 95% CI: 1.06-1.82 and RR&#x2009;=&#x2009;1.21, 95% CI: 1.03-1.43, respectively). In the mixed-type phenotype, higher humidity was positively associated with exacerbation counts, whereas lower wind speed was associated with decreased counts. In the neutrophilic phenotype, an inverse association with O&#x2083; observed in the DLNM was not confirmed in the case-crossover analysis. COPD exacerbations do not appear homogeneous with respect to environmental triggers; the eosinophilic phenotype showed clearer associations with gaseous pollutants, whereas the mixed-type phenotype showed associations with meteorological conditions. The absence of associations in the overall population supports the value of phenotype-based environmental risk assessment. These findings may contribute to the development of phenotype-oriented environmental warning strategies in COPD management.

The species diversity of the families Peniophoraceae and Stereaceae (Russulales) in the high-altitude forests of southwestern China remains poorly explored. In this study, the detailed morphological characteristics and combined two-locus phylogenetic analyses based on the internal transcribed spacer (ITS) and large subunit (nLSU) regions of nuclear ribosomal DNA (rDNA) revealed four new wood-inhabiting species from southwestern China, belonging to the genera Baltazaria, Scytinostroma, Vararia, and Xylobolus. Their morphology and combined ITS + nLSU dataset showed that three of them grouped within Peniophoraceae, viz., Baltazaria yunnanensis, Scytinostroma sinense, and Vararia dehongensis, whereas Xylobolus yunnanensis clustered within Stereaceae. Descriptions, illustrations, and phylogenetic analysis results of the new taxa are provided. This study expands knowledge of Russulales diversity in China and provides baseline data for the conservation and sustainable utilization of fungal resources.

Percutaneous endoscopic lumbar discectomy (PELD) is a widely used minimally invasive spinal procedure. Rare but life-threatening complications related to irrigation-induced intraspinal hypertension have been reported, but cases under general anesthesia combined with metabolic acidosis and acute pulmonary edema are extremely rare and easily misdiagnosed. This case highlights a rare fatal complication and its clinical features to improve perioperative recognition and management. A 56-year-old ASA II woman without hypertension or heart disease underwent elective PELD for L5-S1 disc herniation. Intraoperatively, persistent tachycardia and hypertension occurred despite adequate anesthesia depth. Postoperatively, she developed agitation, severe lactic acidosis, acute pulmonary edema, and required re-intubation and ICU treatment, complicated by stress cardiomyopathy. After systematic supportive therapy, she recovered and was discharged on postoperative day 12, with no sequelae at 1-month follow-up. Spinal cord-like hypertension syndrome is a rare but catastrophic complication of PELD, especially under general anesthesia. Early warning signs include unexplained intraoperative tachycardia and hypertension. Perioperative strategies such as reducing irrigation volume/pressure, close surgeon-anesthesiologist communication, and early intervention can improve patient safety and prognosis.

En-bloc excision with limb salvage is the gold standard for aggressive bone tumors around the knee, but up to 15% of cases occur in skeletally immature patients, creating a risk of limb-length discrepancy. Growing distal femoral prostheses with passive sliding tibial components address this issue but introduce unique mechanical challenges and potential complications. This study aimed to evaluate the incidence of tibial pain and complications beneath extendable distal femoral endoprostheses, and to correlate clinical symptoms and revision surgery. The study comprised a retrospective review of 31 extendible distal femur endoprostheses from a single tertiary institution between 2008 and 2018. Measurements of radiographic parameters included coronal alignment, cortical thickness, cortical stem distances, stress shielding, and pedestal and periosteal reaction. The radiographic features were correlated with clinical evidence of tibial pain and the need for subsequent revision of the tibial component. 17 patients reported tibial pain during the follow-up period, with a mean time of onset of 62.2&#xa0;months (range, 27-132). There were 14 revisions in 12 patients, 4 revisions for tibial pain. Stress shielding and pedestal formation were seen in all patients after 28&#xa0;months following insertion. Lateral cortical hypertrophy was more prominent in the group with pain with a mean thickness of 5.8&#xa0;mm (range, 4-9.8). Varus shift of the tibial stem was radiographically evident during follow-up (n&#x2009;=&#x2009;18). 95% of the patients with tibial pain had radiographic evidence of stem migration, 88% showed a periosteal reaction, and 76% had varus malalignment. In 13 patients (76%) with pain, all three of these parameters were present. There is a strong correlation between radiographic evidence of tibial stem migration and periosteal reaction and the development of symptoms. Patients should be warned of the need for revision of the tibial component for pain during the lifetime of the implant. IV.

This study aimed to outline and evaluate three key implementation strategies undertaken by Humber River Health (HRH) nursing leadership to support the sustained implementation of the delirium, dementia & depression Best Practice Guideline (BPG). In 2017, HRH embarked on a high-reliability journey, prioritizing consistent quality and safe care delivery by implementing the Registered Nurses' Association of Ontario (RNAO) Best Practice Guidelines (BPGs). Based on the implementation guidelines, the hospital has also adopted three measures: the use of electronic medical records "DocOpt", embedding the content of delirium into staff training, and constructing health risk blocks with hierarchical early warnings, embedded within our Command Center. From 2019 to 2025, a retrospective longitudinal assessment of hospital inpatients was conducted using process indicators, outcome indicators, and patient satisfaction. Process and outcome metrics were evaluated pre- and post-implementation using Statistical Process Control Charts in Microsoft Excel QI Macros, in which Central Lines and Upper and Lower Lines were calculated. Further, segmented regression was conducted to evaluate key time periods during the implementation of the delirium BPG. Due to the implementation of specific recommendations for delirium, the process indicators of delirium in HRH patients improved from 2019 to 2025, and the incidence of delirium in elderly patients per 1,000 patient care days decreased accordingly, by 1.4 times (accounting for 23.3 %); more than 90 % of patients and their families were satisfied with the hospital. According to the segmented regression analysis, it indicates that from the third quarter of 2019 to the third quarter of 2020, and from the first quarter of 2021 to the first quarter of 2022, there was a transitional period, which marked the period when the "DocOpt" system and health risk blocks were applied. Long-term evaluation of process and outcomes data supported HRH to achieve improved patient delirium outcomes. Future research can rely on the regular, dynamic data-monitoring system to provide more empirical evidence for the localization adaptation, consistent implementation, and continuous quality improvement of BPGs.