Service members are routinely deployed to geographical locations where arthropod-borne diseases are endemic. Force health protection relies on integrated vector management methods to reduce service member exposure to disease vectors. The United States Department of Defense relies heavily on personal protective measures that include proper uniform wear, on-skin application of topical repellents, and insecticidal treatment of working uniforms with permethrin. The objective of this study was to evaluate the effectiveness of topical N,N-diethyl-3-methylbenzamide (DEET) application, permethrin-treated U.S. Army Combat Uniforms (ACUs) with operational camouflage pattern, and their combination for protecting service members from the bite of Aedes aegypti (L.) mosquitoes in a semi-field environment. Volunteers wearing treated or untreated ACUs, with or without DEET on exposed skin, stood stationery in outdoor cages containing 100 unfed Ae. aegypti females. The data recorded included number of mosquito bites identified on the volunteer, the number of blood fed mosquitoes, and post-exposure mosquito mortality rates 24 hours following trials. Results demonstrated that properly worn ACUs prevented mosquito bites from occurring on covered body parts, even when untreated. However, bites were common on exposed skin when DEET was not applied. The combination of DEET and a properly worn uniform provided nearly 100% protection from bites. Permethrin-treated uniforms alone did not prevent mosquitoes from biting exposed skin but resulted in significant mosquito mortality 24 hours after exposure. These results show that the combination of proper uniform wear, uniform treatment, and use of topical repellent provides holistic protection including bite reduction and focal mortality of exposed mosquitoes.
Military service is one of the most consistent risk factors for the development of amyotrophic lateral sclerosis (ALS), but little is known about what aspects of military service matter. Understanding the distribution of ALS risk in military personnel may help identify key risk factors. We aimed to ascertain the association of United States (US) military branch and rank with incident ALS. We conducted a longitudinal cohort study including all veterans with a Veterans Health Administration encounter from January 1, 2000, through October 1, 2024, and more than 2 years of follow-up. Incident ALS was identified through medical records. Exposures included military branch (Army, Navy, Air Force, Marine Corps, Coast Guard, or multiple branches), military rank (officer, enlisted, or both), and length of service. Risk was estimated with Cox proportional hazards models, controlled for age, adjusted for race/ethnicity, and stratified by sex. The analytic sample comprised 9,157,938 men (13,935 incident ALS cases, mean age = 56.9 years) and 784,941 women (484 cases, mean age = 42.4 at start of follow up). Among men, compared with service in the Army, service in the Air Force (hazard ratio [HR] = 1.29, 95% CI 1.23-1.35), Navy (HR = 1.15, 95% CI 1.10-1.20), and Coast Guard (HR = 1.26, 95% CI 1.06-1.50) was associated with higher rates of ALS and service in the Marines a lower rate (HR = 0.78, 95% CI 0.68-0.88). Officers had higher rates than enlisted personnel (men, HR = 1.64, 95% CI 1.53-1.74; women, HR = 1.72, 95% CI 1.31-2.27). Longer service was associated with lower rates of ALS. In age-stratified models, differences in hazard rates between Army veterans and Air Force, Navy, and Coast Guard veterans were greatest for the youngest men (17-61 years, HR range = 1.26 to 1.51) and smallest for the oldest (>75-104 years, HR range = 0.99 to 1.12). ALS rates varied considerably by branch and rank in the US military, with larger differences among younger veterans. Officers and those serving in the Air Force, Navy, or Coast Guard may incur exposure to military environments that increase risk of ALS. It is imperative to identify relevant exposures to reduce harm to service members and, potentially, civilians with similar exposures.
Bisphenol A (BPA), a phenolic endocrine-disrupting compound (EDC) usually found in food containers and other plastic components, can interfere in the mechanisms performed by the endocrine system. To predict the occurrence and concentration of BPA in the Pampanga River Basin, a contaminant transport model was generated using the Water Quality Analysis Simulation Program (WASP) by the US Environmental Protection Agency (EPA). The surface water flow values in the Main Pampanga River (MPR) were approximated using the Hydrologic Engineering Center - Hydrologic Modeling System (HEC-HMS) by the US Army Corps of Engineers. The concentrations of BPA in selected locations along the MPR were determined by gas chromatography-mass spectrometry. Calibration and validation of the transport model of BPA revealed that the model is acceptable with Nash-Sutcliffe Efficiency (NSE) greater than 0.5; and since the R-squared value is greater than 0.8, the model is considered to have a good fit. The model also met the criteria for model accuracy with PBIAS values between -25 and + 25. Through the contaminant transport model, the concentration of BPA can be predicted in certain locations in the MPR whenever there are changes in the sources of BPA in the area. Such model can support the environmental monitoring, assessment, and management of critical areas and provide key information to stakeholders and policymakers for evidence-based planning and policymaking.
Objective: To introduce an acetabular reconstruction technique for total hip arthroplasty (THA) in patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH), and report its mid-term clinical outcomes. Methods: This is a retrospective case series study. Clinical data of 231 patients (310 hips) with Crowe type Ⅳ DDH who consecutively underwent THA via the posterolateral approach at the First and the Fourth Medical Centers of the Chinese People's Liberation Army General Hospital from August 2018 to April 2024 were retrospectively analyzed, and all patients had complete surgical and follow-up records. There were 17 males and 214 females, with an age of (43.9±9.8) years (range:18 to 60 years) and a body mass index of (24.0±3.1) kg/m² (range:17 to 30 kg/m²). Intraoperatively, the "ABCDE" method for true acetabulum identification (A: acetabular capsule; B: bone ridge; C: ligamentum capitis femoris; D: detect with index finger; E: exploration via ligamentum transversum) was adopted to precisely locate the true acetabulum, together with standardized operative essentials for acetabular reaming and acetabular cup implantation. All patients were followed up for no less than 1 year postoperatively. Preoperative and postoperative Harris Hip Score (HHS) and leg length discrepancy were measured and recorded, and perioperative complications were documented. The paired-sample t-test was used to compare preoperative and postoperative indicators. Results: All patients successfully received the surgery and completed follow-up. Among all hips, 223 were treated with robotic or navigation-assisted THA, and 87 with conventional THA. The operative time was (131.7±27.5) min (range:91 to 170 min). Intraoperatively, ceramic-on-ceramic bearing surfaces were used in 195 hips, ceramic-on-highly cross-linked polyethylene in 114 hips, and metal-on-polyethylene in 1 hip. Modular femoral stems were implanted in all hips, and subtrochanteric osteotomy was performed in 205 hips. The postoperative hospital stay was (5.2±2.8) d (range:3 to 9 d). The follow-up period was (28.8±14.2) months (range:12 to 46 months). Acetabulum-related complications occurred in 6 hips, including 3 cases of hip dislocation and 3 cases of acetabular fracture; secondary open reduction surgery was performed in 3 hips due to postoperative dislocation. The HHS significantly increased from preoperative (60.0±14.1) points (range:40 to 74 points) to postoperative (95.9±3.1) points (range:88 to 99 points) (t=32.45, P<0.01). The absolute value of postoperative leg length discrepancy was (6.5±3.3) mm (range:0 to 18 mm), which was significantly lower than the preoperative value of (17.6±11.2) mm (range:1 to 50 mm) (t=9.152, P<0.01). Conclusion: The true acetabulum localization and acetabular reconstruction technique adopted in this study can accurately identify the native acetabulum, improve the stability of the acetabular component, and significantly restore hip function, which provides certain clinical references for acetabular reconstruction in patients with Crowe type Ⅳ DDH. 目的： 探讨全髋关节置换术（THA）中Crowe Ⅳ型发育性髋关节发育不良（DDH）髋臼重建技术的中期临床疗效。 方法： 本研究为回顾性病例系列研究。回顾性分析2018年8月至2024年4月解放军总医院第一医学中心和解放军总医院第四医学中心连续收治的行后外侧入路THA的231例（310髋）Crowe Ⅳ型DDH患者的临床资料。男性17例，女性214例，年龄（43.9±9.8）岁（范围：18~60岁），体重指数（24.0±3.1）kg/m2（范围：17~30 kg/m2）。术中采用髋臼识别“ABCDE”法（A：髋关节囊；B：骨嵴；C：圆韧带；D：食指探查；E：横韧带）定位真实髋臼位置，并采用髋臼磨锉和髋臼杯植入的髋臼重建技术。患者术后随访1年以上，记录手术前后髋关节Harris评分（HHS），测量下肢长度差异，并记录并发症情况。手术前后各指标的比较采用配对样本t检验。 结果： 所有患者顺利完成髋臼重建。其中机器人或导航辅助手术223例，传统手术87例，手术时间（131.7±27.5）min（范围：91~170 min）。术中195髋使用陶瓷对陶瓷假体界面，114髋使用陶瓷对高交联聚乙烯假体界面，1髋使用陶瓷对高分子聚乙烯假体界面。所有髋关节的股骨侧均使用组配式假体，其中205例行粗隆下截骨。术后住院时间（5.2±2.8）d（范围：3~9 d）。术后随访时间为（28.8±14.2）个月（范围：12~46个月）。共6髋发生髋臼处手术并发症，其中脱位3髋，髋臼骨折3髋；二次手术3髋，均为术后脱位行切开复位手术。患者HHS由术前的（60.0±14.1）分（范围：40~74分）升至（95.9±3.1）分（范围：88~99分），差异有统计学意义（t=32.45，P<0.01）。术后双下肢长度差的绝对值为（6.5±3.3）mm（范围：0~18 mm），小于术前的（17.6±11.2）mm（范围：1~50 mm），差异有统计学意义（t=9.152，P<0.01）。 结论： 本研究采用的髋臼识别方法可精准定位真实髋臼，髋臼重建技术可提升髋臼杯稳定性，改善髋关节功能，为Crowe Ⅳ型DDH患者的髋臼重建提供了一定的临床参考。.
First, to describe the development of a novel postconcussive symptom (PCS) code set for identifying symptoms via medical records. Second, to apply it to a population-based cohort of service members with a history of mild traumatic brain injury (mTBI) per Military Health System (MHS) records, to identify distinct subgroups based on patterns of risk for specific PCS. MHS. Population-based sample of service members with mTBI who served in the Army, Air Force, Navy, and Marine Corps and received a diagnosis within the MHS (n = 148 293). Retrospective cohort study using medical record data from the MHS spanning 2002 to 2021. In collaboration with clinical experts, we iteratively refined a novel PCS code set comprised of ICD-9/10 codes based on Neurobehavioral Symptom Inventory categories, when possible. We used latent class analysis (LCA) with a split-sample cross-validation procedure to identify subgroups of service members with mTBI based on probability of receiving each PCS diagnosis. The final PCS code set included 20 symptoms, spanning vestibular, sensory, cognitive, and mood/behavioral-related symptoms. The LCA supported 5 distinct subgroups, the most prevalent being the Minimal subgroup (59%), characterized by low probability of all PCS. The next most common class was the Headache class (16%), followed by the Mood-Behavioral (15%), Headache-Sleep (6%), and Headache-Mood-Sleep (5%) classes. Using a novel PCS code set leveraging routinely collected data, we identified 5 clinically meaningful and statistically distinct subgroups based on symptom patterns in a population-based cohort of service members with a history of mTBI. These subgroups provide a nuanced, person-centered understanding of symptoms among those with a history of TBI and can inform targeted interventions and policies aimed at meeting the needs of these service members. Further, findings establish a foundation for investigating risk factors and outcomes across subgroups, informing prognostication.
High-capacity anodes are desirable for high-energy lithium-ion batteries but suffer from limited cycle life due to large volume changes during cycling. The LiF-based solid-electrolyte interphase (SEI) has led to prolonged cycling stability. However, current LiF-forming electrolyte designs require anions to enter the Li+ solvation sheath, which inherently reduces the electrolyte's ionic conductivity, limiting both fast-charging and low-temperature performance. Here we develop solvent-bridged electrolytes composed of LiPF6 dissolved in a cosolvent system comprising a bridging cyclic ether that solvates both PF6- and Li+ to form a LiF-rich SEI, and a structural linear ether that governs the electrolyte liquid range. By mitigating direct Li+-anion interactions, the electrolytes maintain high ionic conductivity, enabling stable cycling of micrometre-sized silicon anodes under extreme conditions involving high rates (>4 C), low temperatures (down to -55 °C) and Li plating. Solvent-bridged electrolytes address the intrinsic trade-offs between LiF-rich SEI formation and electrolyte ionic conductivity, offering a promising approach for high-capacity anodes operating under demanding conditions.
Time in moderate-to-vigorous intensity activity (MVPA), light intensity activity (LPA), and sleep are critical for bone health in older adults but are often considered separately despite being inherently co-dependent. We examined cross-sectional associations between compositions of accelerometry-derived MVPA, LPA, inactivity, and sleep with bone microarchitecture and strength (High-Resolution Peripheral Quantitative Computed Tomography; HR-pQCT) in community-dwelling older men (n=119) and women (n=177), mean age 76.3±4.6 yrs. Participants wore an ActiGraph GT9X on their non-dominant wrist for 7 consecutive 24hr periods during the Study of Muscle, Mobility and Aging (SOMMA) baseline visit. The primary outcomes were distal radius (DR) and tibia (DT) estimated failure load, and secondarily, total volumetric bone mineral density (vBMD), and cortical (Ct) and trabecular (Tb) vBMD, area (Ar), and thickness (Th) from HR-pQCT. Compositional data analysis methods evaluated proportions of time in one behavior relative to the remaining behaviors. Sex-stratified multiple linear regression estimated associations between 24hr composition with sex-specific standardized HR-pQCT parameters. Compositional isotemporal substitution methods estimated hypothetical changes in continuous HR-pQCT measures if 10-60 min in one behavior was displaced by another. On average, women spent 90.2 min/day (6.3%) in MVPA, 346.1 min/day (24.0%) in LPA, 556.4 min/day (38.6%) in inactivity, and 447.4 min/day (31.1%) in sleep; men spent 93.6 min/day (6.5%) in MVPA, 309.5 min/day (21.5%) in LPA, 596.7 min/day (41.4%) in inactivity, and 440.2 min/day (30.6%) in sleep. Compared to the average sex-specific 24hr composition, higher proportions of MVPA were associated with higher DR and DT failure load in women; higher DR Tb.vBMD and Tb.Th in men; and higher DR Tt.vBMD, Ct.Ar, and Ct.Th, and DT Ct.vBMD, Ct.Ar, and Ct.Th in women. Hypothetically displacing 10-60 min in inactivity for MVPA resulted in more favorable HR-pQCT parameters. These data support the importance of MVPA for a healthy skeleton in older men and women. Time spent in all 24hr activities impacts bone strength. We evaluated associations between moderate-to-vigorous intensity physical activity, light intensity physical activity, inactivity, and sleep together with measures of bone strength. In women, 10 minutes of moderate-to-vigorous intensity physical activity instead of inactivity may increase bone strength. In men, higher amounts of time in any activity beyond the average were not associated with bone strength. These results support the importance of moderate-to-vigorous intensity physical activity for a healthy skeleton.
Breast cancer immunity depends on more than the number of immune cells in a tumor. It is also shaped by where those cells sit, which neighbors they contact, and what functional states they adopt locally. Tumor-associated macrophages (TAMs) and T cells are a key pairing in this setting. Depending on tissue context, their crosstalk may support cytotoxic immunity, reinforce immune exclusion, promote T-cell exhaustion, or weaken therapeutic response. Spatial technologies now allow these states to be examined in intact tumor sections rather than inferred from dissociated or bulk samples. Antibody-based imaging approaches, including imaging mass cytometry, MIBI, and CODEX, together with high-plex transcriptomic platforms such as MERFISH, Xenium, CosMx, Visium, GeoMx, and related methods, have revealed inflamed, excluded, myeloid-rich, stromal-barrier, and tertiary lymphoid structure-associated niches in breast cancer. However, spatial maps alone cannot establish mechanism. Cells that lie close together may not necessarily interact, and computational tools, including ligand-receptor scoring, graph-based neighborhood modeling, and spatial biomarker prediction, can only prioritize candidate macrophage-T cell programs. Functional validation remains essential. In this mini review, we discuss how spatial omics, computational modeling, organoid and explant cultures, microfluidic models, perturbation assays, and therapeutic testing can be linked to study macrophage-T cell crosstalk. We highlight a practical workflow in which spatial maps generate hypotheses, experimental systems test causality, and post-treatment profiling determines whether candidate interactions are remodeled by therapy.
Future large-scale combat operations, high-impact domestic disasters, and infrastructure-disrupting crises will generate casualty volumes and system stress far exceeding those experienced during the conflicts occurring during the previous two decades. These threats will transcend the traditional distinctions between military and civilian healthcare systems. They will necessitate an integrated national response capable of absorbing sustained casualty surges and preserving access to care for the civilian population. At the 2026 Eastern Association for the Surgery of Trauma Annual Scientific Assembly, a multidisciplinary short course entitled "Forging the Frontlines at Home: Integrating Military-Civilian Systems for National Readiness and Resilience" convened military, civilian, academic, and policy leaders to examine readiness gaps and propose actionable pathways to facilitate military-civilian integration. This article synthesizes key themes from that program across three domains: (1) defining the operational problem space, (2) coordinating a synchronized national response, and (3) understanding the financial and administrative consequences of large-scale casualty care. Together, these perspectives highlight that national casualty readiness for combat casualty care needs to be a core component of domestic resilience.
Identifying synergies between dietary fibers and beneficial bacteria holds promise for precision interventions that optimize gut health, yet these interactions remain largely unexplored. Here we integrate machine learning, Bayesian optimization and high-throughput community construction to investigate how dietary fibers shape health-relevant functions of human gut microbial communities. To efficiently navigate the landscape of fiber-microbiome interactions, we implemented a design-test-learn cycle to identify fiber-species combinations that maximize a multiobjective function capturing beneficial community properties. Our model-guided approach revealed a highly butyrogenic and robust ecological motif characterized by the copresence of inulin, Bacteroides uniformis and Anaerostipes caccae and a higher-order interaction with Prevotella copri. Human fecal communities invaded with model-designed species-fiber combinations displayed predictable gut-beneficial outputs. In sum, we demonstrate a framework for designing synthetic microbial communities with desired functions in response to key nutrients.
The COVID-19 pandemic has substantially affected college students' mental health worldwide. Although daily life has gradually returned to normal, less is known about whether the underlying structure of psychological symptoms-and their associations with personality traits-has shifted in the post-pandemic period. Addressing this gap, the present study applied network analysis to psychological and personality data from 51,305 college freshmen to compare pre-pandemic and post-pandemic cohorts. Using the Eysenck Personality Questionnaire (EPQ) and the Symptom Checklist-90 (SCL-90), networks based on EPQ dimensions and SCL-90 subscale scores were estimated and compared across pre-pandemic and post-pandemic cohorts. Results indicated that anxiety and depression remained central symptom domains across both periods; however, the network-structure invariance test was significant. Specifically, the expected influence (EI) of both interpersonal sensitivity (ΔEI = 0.058, p = 0.007) and paranoia (ΔEI = 0.059, p = 0.007) showed a significant increase. The regularized partial associations between symptoms and personality traits also changed, with the negative correlation between extraversion and interpersonal sensitivity weakening, and the positive correlation between neuroticism and obsessive-compulsive symptoms strengthening. These findings suggest that although overall mental health showed no substantial deterioration compared to the pre-pandemic period, the underlying symptom network and its associations with personality traits differ between cohorts, highlighting the potential value of considering personality-related information in future research on post-pandemic mental health among university students.
Background: Lymphoma is the most common hematologic malignancy diagnosed in active-duty service members (ADSMs). Service members treated for lymphoma often face uncertainty regarding their fitness for duty, which carries implications for individual careers and force readiness. In this retrospective, exploratory study we aimed to (1) determine the proportion of previously deployed ADSMs who deployed after a lymphoma diagnosis, and (2) characterize those deployments. Methods: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) cases diagnosed between 2001 and 2022 were identified from the Defense Health Agency Cancer Registry using International Classification of Diseases for Oncology, Third Edition histology codes. Deployment variables were obtained from the Defense Manpower Data Center. Analysis was restricted to service members who were on active duty at diagnosis and had a history of deployment; those who had never deployed were excluded. This study was exempt from full institutional review board review. Results: A total of 866 previously deployed ADSMs with lymphoma were identified (455 HL, 411 NHL). Of these, 119 (13.7%; 95% CI 11.6-16.2) deployed after their lymphoma diagnosis, including 86 of 455 with HL (18.9%; 95% CI 15.6-22.8) and 33 of 411 with NHL (8.0%; 95% CI 5.8-11.1). HL survivors were significantly more likely than NHL survivors to deploy after diagnosis (p < 0.001). The mean interval from diagnosis to deployment was 5.1 years (SD 3.7) for HL and 4.5 years (SD 2.3) for NHL. As of 2022, all 119 individuals were alive at last follow-up. Conclusions: Among previously deployed ADSMs with lymphoma, roughly one in six deployed after their diagnosis and treatment, typically within five years. These findings indicate that deployment after lymphoma treatment is achievable for a significant subset of service members, highlighting both the success of cancer care in military treatment facilities and the favorable impact of modern oncologic care on operational readiness.
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National patterns of frostbite injury and severity in the U.S. remain poorly characterized. We aimed to describe the epidemiology, mechanisms, and severity of frostbite injuries presenting to U.S. emergency departments (EDs). We analyzed 2005-2024 National Electronic Injury Surveillance System (NEISS) data. Cases were identified via combined diagnosis- and narrative-based searches. Weighted national estimates and logistic regression examined factors associated with serious emergency department disposition (admission, transfer, or observation), used as a pragmatic indicator of resource-intensive care. Of 1096 identified cases (42,054 weighted), injuries peaked in January, with December-February accounting for 54.7%. Environmental cold (41.1%) and contact cold (36.6%) were primary mechanisms. Males comprised 61.6% of cases; the 18-34 age group was largest (28.1%). Overall, 11.3% of cases resulted in serious disposition. Higher odds of serious disposition were associated with male sex (OR 2.91, 95% CI 1.75-4.84), age ≥ 65 years (OR 7.91, 95% CI 3.62-17.3), and social exposure (OR 3.57, 95% CI 1.89-6.77). Contact injuries were associated with lower odds of serious disposition (OR 0.47, 95% CI 0.27-0.81). Frostbite injuries in the United States are seasonal, mechanistically heterogeneous, and more likely to require serious emergency department disposition among older adults, males, and individuals with social exposure. These findings suggest that exposure burden and clinical severity follow different patterns and support prevention strategies that address both environmental risk and social vulnerability.
Lysozyme-loaded antibacterial wound dressings hold great promise for wound healing. Herein, we propose a simple yet powerful method of loading antibacterial lysozyme into calcium alginate (CaAlg) hydrogel films for wound healing. This method presents a controlled strategy to modulate the surface roughness of CaAlg hydrogel films by tailoring their thickness, thereby enhancing the lysozyme loading efficiency on the film surface. We fabricated CaAlg hydrogel films with gradient thicknesses by adjusting the copper wire diameters. Morphological characterization confirmed that the surface of the thin CaAlg film is rougher than that of the thick ones. This enhanced surface roughness conferred a larger specific surface area, which effectively promoted the adsorption of lysozyme and, thus, improved the enzyme loading capacity. The release of lysozyme after adsorption and the interactions between lysozyme and alginate were also investigated, and the results showed that approximately 7.5 mg/g lysozyme can be released from the film. Therefore, the lysozyme-loaded CaAlg film (CaAlg-lysozyme) exhibited excellent antibacterial properties. In vivo results showed that the CaAlg-lysozyme film could promote wound healing. The percentages of wound healing of the untreated group, gauze, and CaAlg-lysozyme film were 65.36, 77.78, and 91.43% on day 10, respectively, indicating the great potential of CaAlg-lysozyme film as a practical wound dressing.
Post-traumatic stress disorder (PTSD) often follows a chronic trajectory, with many patients failing to respond to first-line psychotherapy and SSRIs/SNRIs. This case series explores clozapine for treatment-resistant PTSD (TR-PTSD) without psychosis. Seven soldiers showed improved function and reduced aggression at doses of 125-300 mg, suggesting that clozapine warrants further investigation.
This study applies Buysse's sleep health framework to examine sleep in children and adolescents with neurofibromatosis type 1 (NF1). By examining sleep timing, daytime sleepiness, sleep quality, sleep behavior, sleep duration, and sleep efficiency together, this framework captures the multidimensional nature of sleep and its relationship with biopsychosocial factors and health-related quality of life (HR-QoL) in NF1. This multi-site, prospective, cross-sectional study included 131 children and adolescents with NF1 and 71 typically developing (TD) controls aged 6 to 16 years. A sleep health composite was derived from carer rating scales and 7 days of actigraphy. A biopsychosocial framework was used to examine factors associated with sleep health in NF1, including sociodemographic, cognitive, psychopathology, and biological variables. Independent predictors of QoL were examined to assess the unique contributions of sleep quality, sleep duration, and previously established predictors of HR-QoL in NF1. Poorer sleep health was evident in children with NF1. Compared with TD controls, children with NF1 were five times as likely to have poor sleep quality, with almost 78% demonstrating impaired sleep efficiency and nearly half not obtaining sufficient sleep at night. The strongest risk factors were being male, elevated pain, and having greater levels of ADHD and autism spectrum disorder traits. Findings suggest sleep health in NF1 is interconnected with multiple biopsychosocial factors. A better understanding of these relationships will help identify early risk markers, improve prediction of clinical trajectories, and guide the development of targeted multimodal interventions for sleep disruption in NF1.
After a century of development, hip arthroplasty has evolved into a classic surgical procedure with high recognition worldwide. The volume of hip arthroplasty surgeries has rebounded steadily both domestically and internationally, while relevant technologies are advancing toward personalization, digitalization and intellectualization. Restricted by medical registration systems, regulatory policies and uneven resource distribution, notable disparities in clinical quality and outcomes of hip arthroplasty exist across regions and between different areas. This systemic reviews summarize research advances in hip arthroplasty over the past five years. High-quality clinical trials and consensus guidelines were integrated to guide clinical decision-making. Updates regarding prosthesis safe zone, hip-spine relationship, prosthesis design and enhanced recovery were particularly introduced, and objectively evaluation were presented on surgical approaches, reconstructive techniques and digital technologies. Prospectively priorities of hip arthroplasty were also outlined including: national joint replacement registry, ambulatory surgery guided enhanced recovery pathway, translational research on prosthesis-host interaction, and enabling and expanding of digital technologies. This comprehensive review is beneficial to optimize clinical concepts and standardize practice for hip surgeons, and shed lights on the high-quality and sustainable development of hip arthroplasty in China. 历经百年发展，髋关节置换术已成为被临床高度认可的经典术式，且手术技术逐渐向个性化、数字化、智能化方向发展。受医疗登记、监管认证、资源分布等因素影响，国内外及我国不同地区间髋关节置换术的手术质量与临床结局存在明显差异。本文系统梳理近五年本领域研究进展，结合高质量研究及指南共识更新手术决策理念及假体安全区、髋脊适应、假体设计、加速康复等方面的相关理论，对手术入路、重建技术及数字化、智能化技术等临床关注点进行梳理与评价。结合行业现状，展望髋关节置换术的未来发展重点领域，包括国家关节置换登记系统、日间手术牵引加速康复、假体-机体互作转化科研和数字化技术赋能拓展等。希望本文可为髋关节外科专业人员提供最新的诊疗理念和技术规范，为国内该术式的高质量、可持续发展提供参考。.
Chagas disease, also known as American Trypanosomiasis, is a parasitic infectious disease that is primarily transmitted by infected kissing bugs belonging to the subfamily Triatominae. Military personnel that conduct deployment operations (field training, patrols, combat, physical training and sustainment) in kissing-bug infested habitats are at risk. Transmission of disease to humans occurs by contact of skin and mucous membranes with infected kissing bug's feces. Additionally, transmission can result from blood transfusion, and ingestion of infected insects. However, the exact route of infection for military personnel (including military working dogs) remains elucidated. In this laboratory study, Trypanosoma cruzi-infected triatomine bugs collected from the field were used to evaluate various oral exposures in rats. Treatment groups included: 1) ingestion of T. cruzi-positive insect excreta; 2) ingestion of T. cruzi-infected insect digestive tract; 3) oral exposure via mucosal scraping; and 4) ingestion of a live infected kissing bug. Rats were monitored for 12 weeks. An indirect immunofluorescent assay to detect parasite-specific immunoglobulin (Ig) M and IgG was used to estimate the rate of infection. At necropsy, heart, spleen, kidney, and stomach were collected to assess histopathology. Trypanosoma cruzi infection was established through various oral exposures. This resulted in the development of anti-T. cruzi antibodies. Rats exposed via ingestion of whole insect or oral mucosa were comparable to the positive control group in that 86% and 100%, respectively, of animals developed a T. cruzi-specific IgM response by 14 days post infection (dpi). By 21 dpi, a significant number of rats that ingested T. cruzi-infected insect digestive tract (100%) or T. cruzi-positive insect excreta (57%) had developed a parasite-specific IgM response. Amongst all groups receiving oral exposures, a significant number of rats (85.7%) exhibited a T. cruzi-specific IgG response by 35 dpi. We identified a few histopathological differences between groups; nonetheless, we did not observe a consistent statistical trend that would suggest that the histopathology of an oral exposure group was markedly different from another. Collectively, these data suggested that the rate of infection was notably higher than other studies using similar administration routes. As laboratory-raised organisms may not retain the same virulence factors, that data generated in this study may be a better representative of transmission rates occurring naturally. Nonetheless, valuable data is expected to emerge from future studies that assess host susceptibility factors and the vehicle of exposure.
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique that uses magnetic fields to stimulate or inhibit specific populations of neurons in the brain. rTMS targeting the cortex has emerged as an effective treatment for chronic pain. It is established that stress can heighten pain sensitivity, a condition termed stress-induced hyperalgesia (SIH). However, neither direct evidence for rTMS treatment of SIH nor a clear understanding of its therapeutic mechanisms has been established. In this article, we studied the effectiveness of rTMS in SIH using a rat CFA (complete Freund's adjuvant) + SPS (single-prolonged stress)-induced model. Following SPS + CFA treatment, a significant enhancement in both medial prefrontal cortex (mPFC) microglia activation by immunohistochemistry and Western blot analyses and mechanical allodynia was observed, as compared with the application of SPS or CFA alone. Compared to the untreated SPS + CFA model group, 10 Hz rTMS treatment significantly elevated the paw withdrawal threshold. This effect was also significantly greater than that observed in the group receiving 1 Hz rTMS. Moreover, the application of 10 Hz rTMS inhibited microglial activation in the SPS + CFA model, along with alleviating associated anxiety-like behaviors. These results suggest that rTMS might have an effect on the treatment of SIH.