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Active control of multi-mode light-matter interactions is crucial for advancing quantum photonic technologies. Although triple-mode plasmon-exciton systems involving two distinct excitonic transitions offer a pathway to multi-level polaritonic states, achieving reversible electrical tuning at room temperature remains challenging. Here, we numerically investigate an electrically tunable triple-mode strong-coupling system comprising a J-aggregate-coated Au@Ag nanorod coupled with monolayer WS2. The simulated spectra show a UPB-LPB energy separation of approximately 239 meV near the zero-detuning condition. A modest gate voltage (2.0 V to 3.8 V) selectively modulates the middle and lower polariton branches over ∼46 meV, while the upper branch remains largely unaffected. This selective control is elucidated via a triple-mode coupled-oscillator model and Hopfield coefficient analysis, linking the polariton response to the excitonic composition. These results establish a framework for electrically reconfigurable multi-level polaritonic devices, offering potential for ultracompact optical modulators, high-sensitivity multiplexed sensors, and programmable quantum photonic circuits.

Paraleyrodes minei is an invasive alien species in China, representing a new record for Yunnan Province and a new sugarcane pest. The mitochondrial genome of P. minei was sequenced using the Illumina NovaSeq 6000 sequencing platform. The genome sequence was assembled and annotated, and its structural characteristics and nucleotide composition were analyzed. A phylogenetic tree of 18 species in the family Aleyrodidae was constructed using maximum likelihood (ML) and Bayesian inference (BI) methods to analyze the phylogenetic relationship of P. minei within the family Aleyrodidae. The results indicated that the mitochondrial genome of P. minei was 18,774 bp in length and contained 13 protein-coding genes (PCGs), 22 transfer RNA (tRNA) genes, 2 ribosomal RNA (rRNA) genes, and 1 non-coding control region. The A+T content of the mitochondrial genome of P. minei was 80.93%, indicating a marked A+T preference. ATN was used as the start codon for the PCGs, and TAA, TAG, TA, and T were used as the stop codons. In the secondary structure of tRNA, the TΨC arm was missing in trnA, trnC, and trnG, and the DHU arm was missing in trnS1 and trnS2, with G-U base mismatches present. The phylogenetic tree revealed that the 18 species of 10 genera in the two subfamilies of the family Aleyrodidae clustered into two major branches: the subfamilies Aleyrodinae and Aleurodicinae. All 10 genera were monophyletic groups; among them, the genus Paraleyrodes and the genus Aleurodicus formed a sister relationship, and both belonged to the subfamily Aleurodicinae. This study represents the first successful sequencing of the mitochondrial genome of P. minei, as well as the first mitochondrial genome of the genus Paraleyrodes, laying the foundation for the control of P. minei and the analysis of phylogenetic relationships among various genera of the family Aleyrodidae.

P. massoniana is an important native economic and ecological tree species in southern China, where seasonal drought has emerged as a critical factor limiting its productivity. The SAUR gene family, recognized as core early auxin-responsive genes, plays a crucial role in balancing plant growth, development, and stress adaptation; however, research related to this family in conifers remains limited. Utilizing the chromosome-level genome of P. massoniana, this study identified 73 SAUR genes (PmSAUR1~73) through bioinformatics methods, systematically analyzing the physicochemical properties of the encoded proteins, chromosomal localization, phylogenetic relationships, gene structures, and cis-acting elements. Combined with transcriptome sequencing and molecular experiments, the drought stress response patterns of these genes were further elucidated. The results indicated that PmSAUR genes predominantly encode alkaline proteins, primarily localized in mitochondria and nuclei, with an uneven distribution across nine chromosomes, where tandem duplication serves as the primary mechanism driving family expansion. Phylogenetic analysis classified these genes into seven subfamilies, which include both conserved clades homologous to angiosperms and branches specific to P. massoniana. All members contain the Auxin_inducible conserved domain, with motif1 identified as the core essential motif. Promoter regions were enriched with MeJA (methyl jasmonate)-responsive (56%), ABA-responsive, and drought stress-related cis-elements. Under drought stress, 38 PmSAUR genes exhibited diverse temporal expression patterns. Four key genes (PmSAUR14, PmSAUR28, PmSAUR54, and PmSAUR73), which are localized in the nucleus and exhibit high expression specifically in male cones or roots, were identified. These genes exhibit an expression pattern consistent with an auxin-negative response (i.e., repressed by IAA and induced by drought) and display a distinctive response pattern characterized by drought-induced upregulation coupled with IAA-mediated downregulation. This mechanism may contribute to the drought adaptation strategies of P. massoniana, involving regulatory processes for aboveground reproduction and adaptation of the underground root system. This study represents the first effort to elucidate the evolutionary characteristics and drought response patterns of the SAUR gene family in P. massoniana, thereby addressing the existing research gap regarding the functions of SAUR genes in coniferous trees. Furthermore, it offers candidate gene resources and theoretical support for the molecular breeding of stress resistance in P. massoniana. In addition, two auxin-induced SAUR genes (PmSAUR22 and PmSAUR37) were identified as contrasting examples, but the main focus of this study is on the four auxin-repressed genes.

Cervical fusion alters regional biomechanics and increases load transmission through adjacent facet joints, which may produce facet-mediated pain. Cervical medial branch blocks (MBBs) and radiofrequency ablation (RFA) remain highly useful diagnostic and therapeutic interventions, yet surgical approaches used in cervical fusion frequently disrupt the cervical medial branch nerves (MBNs) at treated levels. Identifying which MBNs remain anatomically intact is essential for accurate diagnostic and therapeutic targeting of relevant nerves (and sensate facet joints), and for avoiding unnecessary procedure levels or procedures altogether. To present an approach to determining which cervical medial branches require management after fusion, drawing upon surgical approach, anatomic landmarks, implant trajectory, and cross-sectional imaging. Technical Note. Cervical radiofrequency ablation following spinal fusion surgery. A systematic, anatomy-based method improves diagnostic precision, reduces unnecessary procedures, and helps identify patients most likely to benefit from interventions. Posterior cervical fusion using modern screw and rod instrumentation will essentially always result in denervation of the MBN at the operated level(s). Anterior surgical approaches reliably preserve the MBNs, making them viable targets for cervical RFA.

Fourteen species of monopisthocotyls were reported from the gills of Triportheus albus Cope (Characiformes: Triportheidae) collected from the Itaya River, Peru. Nine species belonged to Anacanthorus Mizelle & Price, 1965: seven previously described species: Anacanthorus acuminatus Kritsky, Boeger & Van Every, 1992, Anacanthorus alatus Kritsky, Boeger & Van Every, 1992, Anacanthorus bellus Kritsky, Boeger & Van Every, 1992, Anacanthorus euryphallus Kritsky, Boeger & Van Every, 1992, Anacanthorus quinqueramus Kritsky, Boeger & Van Every, 1992, Anacanthorus formosus Kritsky, Boeger & Van Every, 1992, and Anacanthorus ramulosus Kritsky, Boeger & Van Every, 1992, and two new species described herein. Three species belonged to Ancistrohaptor Agarwal & Kritsky, 1998: Ancistrohaptor falciferum Agarwal & Kritsky, 1998, Ancistrohaptor falcunculum Agarwal & Kritsky, 1998, and Ancistrohaptor forficata Diniz, de Sousa, Yamada & Yamada, 2025; and two to Jainus Mizelle, Kritsky & Crane, 1968: Jainus iquitensis Morey, Viana, Chota & Chero, 2025 and Jainus sardinae Morey, Viana, Chota & Chero, 2025. Anacanthorus itayensis n. sp. is characterized by a long sclerotized sigmoid male copulatory organ (MCO) with submedial cirral "feather" and by a four-branched accessory piece in which the second branch terminates in a fish-like fin, the others bifurcate into sub-branches with pointed tips. Anacanthorus ypsiloniformis n. sp. is characterized by an elongate, slightly conical MCO curving ventrally and terminating in a rounded, slightly tapered distal tip bearing a dense crown-like cluster with submedial small spines, and by a distinctively Y-shaped accessory piece with two divergent arms arising proximally: one broader and blunt-ended with a comb-like denticulate distal margin, the other narrower and more rounded distally. This study constitutes the first comprehensive record of monopisthocotyls from T. albus in Peru and documents one of the most species-rich dactylogyrid assemblages reported from a single host species of Triportheus Cope in the Neotropical region.

Radiologic findings associated with SARS-CoV-2 infection have been well described since its emergence. However, long-term clinical and radiologic complications of pediatric SARS-CoV-2 infection are less defined, including radiologic findings in children following recovery. This study compares chest radiographic (CXR) and low-dose chest computed tomography (CT) findings in pediatric participants; a longitudinal cohort of children who have recovered from SARS-CoV-2 infection and uninfected controls. Eight hundred forty-six children (700 laboratory confirmed SARS-CoV-2-infected children and 146 uninfected controls) completed a radiologic exam at the baseline visit, which occurred 9.8 months (mean) post-infection. CXR (n=485) and CT (n=362) images were evaluated by three radiologists for known radiologic manifestations of COVID-19 including various patterns of opacities (ground glass, reticular, consolidation), nodules, perihilar thickening, effusions, and/or cystic changes. Comparisons were made using generalized estimating equations with cohort (infected vs. uninfected) as the predictor. Overall, the incidence of radiologic abnormalities detected at baseline was 32.1% in the infected cohort and 24.0% in the uninfected cohorts. Infected participants were more likely to have CXR abnormalities than uninfected (21.2% vs. 12.4%; OR 2.44; 95% CI 1.19-5.02; P=0.016). This was primarily due to an increased incidence of perihilar peribronchial thickening (17.4% in infected vs. 10.1% in noninfected). There were no statistically significant differences between cohorts for CT abnormalities (46.2% vs. 42.1%; OR 1.24; 95% CI 0.71-2.16; P=0.46). Radiologic abnormalities were not statistically significantly associated with presence of pulmonary symptoms after recovery. At the baseline visit, infected participants were more likely than uninfected controls to have chest radiographic abnormalities, limited to perihilar peribronchial thickening. There was no significant difference in CT abnormalities between the two cohorts. There was no increased frequency of radiographic findings in children with underlying asthma, nor in children who experienced pulmonary symptoms following recovery at the baseline visit.

For the first time, a race survey of Puccinia graminis f. sp. tritici (Pgt) population was conducted on Triticum durum in the Altai region of Western Siberia, Russia. A total of 34 single-pustule isolates with different virulence phenotypes were identified on durum wheat (Triticum durum) in 2025 and compared with Pgt from bread wheat (Triticum aestivum). The UPGMA-based clustering separated Pgt isolates into two distinct groups, suggesting the host-driven differentiation that was further proven using population genetics tools. The pathogen isolates from durum showed a wider range of virulence complexity, higher variability, and greater average singularity. Virulence frequencies of Pgt on T. durum and T. aestivum differed markedly for Sr6, Sr7b, Sr9e, Sr17+13, and several other genes, while Sr24 and Sr31 remained effective independently of the pathogen origin. Two races, PKCSF and NFMSF, were detected on both the hosts, indicating a shared pathogen gene pool between bread and durum wheat. Even assuming host-specific divergence of Pgt in the Altai region, there is a need for the deployment of the same resistance genes into both T. aestivum and T. durum cultivars to prevent an outbreak of stem rust in the event of favorable conditions for inoculum exchange between crops.

Optimal phase selection in coronary computed tomography angiography (CCTA) is crucial. While the mid-diastolic slow-filling (SF) phase is typically predicted using a conventional formula based on heart rate and atrioventricular conduction time, its validity in complete left bundle branch block (CLBBB)-where pronounced QRS prolongation induces severe mechanical dyssynchrony-remains unclear. We evaluated the impact of bundle branch block on cardiac-phase selection and validated a QRS-corrected predictive model. We retrospectively analyzed 94 patients (sinus rhythm, n = 40; complete right bundle branch block [CRBBB], n = 36; CLBBB, n = 18). Measured SF at the proximal right coronary artery was compared against predictions from the conventional formula (SF = -362 + 0.742 × [RR - PQ]) and a proposed QRS-corrected formula incorporating a "-(QRS - 100)" subtraction. To test the necessity of a novel model, regression analyses were reconstructed exclusively for the CLBBB cohort. In CLBBB patients, the conventional formula critically overestimated SF by an average of 37.9 ms (RMSE 42.5 ms). Reconstructing simple and multivariate regression models exclusively for the CLBBB group yielded coefficients remarkably similar to the conventional formula, indicating that the fundamental physiological dependency on RR and PQ intervals remains intact despite the bundle branch block. Crucially, the simple proposed QRS-corrected formula successfully eliminated the overestimation bias (mean error -6.9 ms; p = 0.176) and demonstrated the highest predictive accuracy (RMSE 21.2 ms). A completely new predictive regression model is unnecessary for CLBBB patients. Simply incorporating a theoretical subtraction of pathological QRS prolongation optimally corrects the diastolic resting phase.

Widespread exposure to per- and polyfluoroalkyl substances (PFAS) is a growing public health concern, but its link to muscle damage remains largely unexplored. As PFAS exposure is associated with liver dysfunction, which is an established risk factor for muscle damage, we examined their associations and potential mediating pathways. A total of 1261 participants were recruited from Guangdong province, China, from November 2018 to August 2019 and examined for muscle mass, strength, serum PFAS levels, and biomarkers of liver function. The key results demonstrated significant positive associations between serum PFAS exposure and sarcopenia risk. Specifically, a per ln ng/mL increase in linear perfluorooctane sulfonate (PFOS), branch PFOS, and perfluorooctanoic acid (PFOA) was associated with adjusted odds ratios of 2.32 (95% CI: 1.77 to 3.00), 2.18 (95% CI: 1.67 to 2.90) and 3.01 (95% CI: 1.96 to 4.70), respectively. Analysis of PFAS mixtures via the BKMR model revealed a linear dose-response relationship of sarcopenia, with PFOS and PFOA being the primary contributor. Importantly, mediation analyses showed that liver function biomarkers served as significant mediators of the PFAS-sarcopenia association. Notably, liver synthesis function markers (albumin and globin) mediated a substantial proportion of the association, ranging from 3.48% to 82.42%, whereas liver injury markers (aspartate aminotransferase and gamma-glutamyl transferase) accounted for only 1.54% to 15.44%. This study underscores the need to be aware of the increased risk of muscle damage associated with PFAS exposure, which may primarily operate through liver function abnormalities.

The coronary arteries are a pair of arteries that branch off from the aorta and encircle the heart, providing oxygenated blood to the myocardium. Although coronary artery atherosclerosis remains a main cause of morbidity and mortality worldwide, coronary artery anomalies (CAAs) are increasingly recognized as a clinically relevant cause of ischemic events and can be subdivided into origin, course, or termination anomalies. The aim of this narrative review is to summarize the cross-sectional diagnostic imaging and clinical background of CAAs.

Invasive Haemophilus influenzae type b (Hib) infection in children has become rare following the introduction of highly effective conjugate vaccines under national immunisation programmes. However, breakthrough invasive infections in fully immunised individuals can still occur. We report a case of invasive Hib infection presenting as epiglottitis and bacteraemia in a fully vaccinated 5-year-old boy in regional Queensland, Australia. The child, with no history of immunodeficiency, presented with a 3-day history of fever, progressive throat pain and reduced oral intake. Subsequent investigations revealed leukocytosis with left shift, markedly elevated C-reactive protein, and radiographic features consistent with epiglottitis. Blood culture grew H. influenzae type b. He was treated with intravenous cefotaxime and made a full recovery without complications. Immunological evaluation demonstrated Hib-specific IgG levels consistent with prior vaccinations, with normal immunoglobulin and lymphocyte profiles supporting the absence of immunodeficiency. Whole-genome sequencing of the isolate identified sequence type 6, a known circulating strain, and duplication of the capsule (cap-b) locus which has been associated with increased capsular polysaccharide production and reduced susceptibility to immune-mediated clearance. This case demonstrates that invasive Hib disease can occur in fully vaccinated, immunocompetent individuals and highlights the need for continued clinical vigilance. Pathogen-related factors, such as cap-b locus duplication, may reduce the effectiveness of the immune response. Despite this, immunisation can still confer partial protection, potentially contributing to the relatively mild clinical course. Ongoing surveillance and detailed microbiological investigation are essential to better understand and monitor vaccine breakthrough infections.

Endotoxins, specifically lipopolysaccharides (LPS), are components of the outer membrane of Gram-negative bacteria. Due to the fact that even extremely low concentrations of endotoxins can trigger the human body's inflammatory cascade, there is an urgent need to develop highly sensitive detection technologies for accurate identification and quantitative analysis of trace amounts of endotoxin. This study, based on an electrochemical sensing platform constructed using AuNPs/NH2-UiO-66/PEI/MCNs functionalized nanocomposite materials, has successfully achieved efficient detection of endotoxins in food. Given the complex food matrix and numerous interfering substances, this sensor enhances its anti-interference capability through a multi-level cooperative interface design. It uses polyethyleneimine-modified mesoporous carbon nanospheres (PEI/MCNs) as the substrate and integrates the directional loading capability of NH2-UIO-66 with the conductivity-enhancing effect of gold nanoparticles (AuNPs), thereby significantly improving signal stability. This biosensor achieves a remarkable detection limit as low as 40 fg/mL, enabling trace-level identification of LPS. Additionally, it exhibits excellent selectivity against common foodborne interferents, facilitating rapid and accurate LPS detection.This study presents a novel, portable detection solution for the rapid screening of microbial contamination in food. The nanocomposite interface construction strategy employed herein provides significant guidance for developing trace-level hazard detection technologies in complex matrices.

Background/Objectives: Type II endoleaks (T2ELs) remain one of the most frequent causes of aneurysm sac enlargement following endovascular abdominal aortic aneurysm repair (EVAR). While embolization may be effective in typical T2ELs with a clearly identifiable feeding vessel, management becomes more challenging when no visible communication with a side branch can be demonstrated. Emerging evidence suggests that hypertrophic vasa vasorum may contribute to aneurysm sac expansion in these atypical cases. We present a case of refractory atypical T2EL treated by open conversion and discuss the potential role of the vasa vasorum network in its pathophysiology. Case Presentation: A 77-year-old man presented with lumbar pain ten years after EVAR for a symptomatic abdominal aortic aneurysm. Computed tomography angiography demonstrated progressive aneurysm sac enlargement to 8.5 cm despite three previous translumbar embolization procedures. Multiple areas of contrast pooling were identified within the aneurysm sac, but no clear communication with a feeding side branch was observed. Owing to persistent sac expansion and symptoms, open conversion was performed with partial endograft explantation and reconstruction using a bifurcated PTFE graft. Results: After opening the aneurysm sac and evacuating the thrombus, diffuse bleeding was observed from numerous small vascular orifices distributed throughout the inner sac surface. These findings were considered consistent with a prominent vasa vasorum network. Hemostasis was achieved using a combination of figure-of-eight sutures and electrocautery. The postoperative course was uneventful, and the patient was discharged on postoperative day five. Follow-up imaging demonstrated normal graft patency without complications. Conclusions: This case supports the hypothesis that an extensive vasa vasorum network may contribute to aneurysm sac expansion in atypical T2ELs and possibly endotension after EVAR. In patients with refractory sac enlargement, open conversion remains a definitive treatment option. Further research is needed to clarify the underlying mechanisms and to explore targeted therapeutic strategies aimed at modulating angiogenesis and vascular remodeling.

The aim of this study is to identify the anatomical location of the emergence point of the zygomaticotemporal nerve (EP) in the lateral orbital margin with reference to the marginal tubercle of zygomatic bone (MT), and to determine whether the MT can serve as a consistent landmark for zygomaticotemporal nerve (ZTN) block procedures. Thirty-six hemifaces from 20 cadavers were dissected. The spatial relationships of the EP with the MT and the lateral canthus (LC) were the main outcomes. Facial proportions were recorded as covariates. Cross-sectional relationships of the ZTN with the middle temporal vein (MTV) and the frontal branch of the facial nerve (FN) in fascial planes were also examined. The EP was consistently identified near the lateral orbital margin, located 4.5±1.6 mm superior to the MT and 17.6±2.7 mm lateral and 9.5±2.9 mm superior to the LC. The vertical distance to the MTV was 7.3±2.3 mm, with both structures positioned within the same fascial plane. In contrast, the FN coursed through a more-superficial layer. Correlation analyses indicated that while the facial proportions affected the absolute location of the ZTN, they did not alter its spatial relationship to the MT. The MT serves as a consistent palpable landmark for locating the EP, facilitating more-accurate regional nerve blocks for anesthesia, postoperative pain control, and neuralgia treatment. When the MT is not palpable, the LC can serve as an alternative landmark. Understanding their spatial relationships with surrounding structures-including the MTV and FN-may help prevent vascular injury and inadvertent FN blockade.Levels of Evidence: Basic science and clinical study.

Neurodegenerative disorders, including Parkinson's and Alzheimer's diseases, are hallmarked by the progressive degeneration of neuronal networks. Given the lack of disease-modifying cures, current therapies are limited to symptomatic relief. Here, we investigated the neurotrophic potential of the skin secretion (SS) from Rhinella schneideri, its polar fraction (PF) and nonpolar (NPF) fraction, and respective subfractions on the morphology of neuron-like cells. Following initial H2O-CH2CL2 partitioning, PF and NPF subfractions were isolated via RP-HPLC. Chemical characterization using LC-MS-IT-TOF identified eight distinct molecules, notably bufotenine and marinobufagin. Cytotoxicity screening established safe working concentrations (100-250 ng/mL for SS/PF; 250-500 ng/mL for NPF and subfractions) for downstream morphological evaluations using High Content Screening (HCS). The subfraction polar 5 (SfP5) elicited a robust neurotrophic response, significantly enhancing all assessed morphometric parameters: total neurite outgrowth (+72%), branching points (+120%), maximum process length (+60%), and total number of processes (+35%). Our data show that Rhinella schneideri SS contains molecules that improve in vitro neuronal networks, serving as a promising source for preliminary screening of neuroprotective effects.

In the treatment of high-salinity wastewater, the removal of nitrogen and organic pollutants remains a challenge, while the production of value-added compounds, such as ectoine from halophilic bacteria, offers a promising resource recovery pathway. In this study, halophilic activated sludge enriched with Thauera as the dominant strain was cultivated in a sequencing batch reactor (SBR) to treat synthetic high-salinity wastewater (30 g/L NaCl) under different sludge retention times (SRTs). The optimal nitrogen and organic carbon removal performances were achieved at an SRT of 10 days, with an ammonia nitrogen removal rate of 77.67% and a total organic carbon (TOC) removal rate of 72.51%. Ectoine production was strongly SRT dependent, as volumetric ectoine concentration was ~2 mg/L at 5 d SRT, almost undetectable at 10 d SRT, ~10 mg/L at 16 d SRT, and peaked at 21.5 mg/L at 22 d SRT. Short SRTs favored dynamic ectoine utilization for osmoprotection and metabolic stability, whereas long SRTs led to passive ectoine accumulation and deteriorated treatment performance. The system realized stable short-cut heterotrophic nitrification with negligible nitrite and nitrate accumulation, indicating direct conversion of ammonia to gaseous nitrogen. These results demonstrate that SRT regulation effectively balances ectoine synthesis and pollutant removal, providing a feasible strategy for resource-oriented treatment of high salinity wastewater.

Thirteen new decaline polyketides, namely, zosteropenillines T-W (1-4), 8-hydroxypallidopenilline A (5), 13-epi-zosteropenilline P (6), 11-epi-zosteropenilline N (7), 15-hydroxyzosteropenilline M (8), 8-hydroxyzosteropenilline M (9), 11-epi-zosteropenilline M (10), and zosteropenillines X-Z (11-13), along with 17 known related compounds (14-30) were isolated from the ethyl acetate extract of the marine-derived fungus Penicillium yezoense KMM 4679 cultivated on MgCl2-containing nutrient medium. The structures of the isolated compounds were established based on spectroscopic methods. The absolute configurations of zosteropenillines T (1) and V (3) were determined using time-dependent density functional theory (TD-DFT) calculations of the ECD spectra. X-ray diffraction analysis data were obtained for the known zosteropenilline S (28). A biogenetic pathway for 1-13 was proposed. The effects of the compounds on Staphylococcus aureus and Candida albicans growth and biofilm formation were observed. Zosteropenillines U (2), Y (12) and Z (13) with higher activity against C. albicans biofilms were nontoxic for normal cardiomyocyte H9c2 cells, making them promising anti-candidal agents. Moreover, zosteropenillines U and Y demonstrated cardioprotective effects in acute ischemia/reperfusion and CoCl2-mimicking hypoxia in vitro models.

Dysregulation of the c-Myc oncogene is a pivotal event in leukemia pathogenesis and therapy resistance. This review synthesizes current evidence, illustrating that c-Myc drives leukemogenesis by enhancing proliferation, inhibiting apoptosis, and upregulating immune checkpoints like PD-L1. Its overexpression is linked to poor treatment outcomes across various leukemia subtypes. Directly targeting c-Myc remains challenging; however, indirect epigenetic modifiers (BET inhibitors), transcriptional disruption (CDK9 inhibitors), and combination therapies emerge as promising strategies to suppress its oncogenic activity and overcome resistance, paving the way for improved clinical management.

Endovascular treatment planning for intracranial aneurysms requires integrating vascular geometry, branch preservation, device feasibility, and patient-specific risk tolerance. Because multiple strategies may be clinically acceptable for the same anatomy, treatment selection reflects expert heuristics rather than a single deterministic solution. Whether multimodal large language models (LLMs) can reproduce such expert decision patterns from angiographic inputs remains incompletely characterized. In this retrospective single-center study, 59 patients with unruptured intracranial aneurysms treated with endovascular therapy were analyzed. Four decision agents reviewed each case: (i) the multidisciplinary neurovascular board that performed the index procedure (contextual clinical reference), (ii) an independent interventional neuroradiologist (>&#x2009;10&#xa0;years EVT experience), (iii) a multimodal LLM (GPT-5), and (iv) a first-year neurointerventional fellow included as a trainee-level comparator. All evaluators received identical clinical summaries and 6-10 standardized 3D-DSA projections. The blinded expert scored all non-reference proposals on a 4-point ordinal scale that reflects procedural feasibility and alignment with heuristic preferences rather than clinical correctness. Agreement with board decisions for modality-level strategies (SAC/BAC/FD) was quantified using Cohen's kappa (&#x3ba;). GPT-5 demonstrated moderate concordance with board-selected treatment modalities (&#x3ba;&#x2009;=&#x2009;0.64), within the range of expert-level variability reported in intracranial aneurysm management and higher than agreement observed for the trainee-level comparator (&#x3ba;&#x2009;=&#x2009;0.15). Expert preference-based scoring indicated that most GPT-5 proposals were judged as either preferred strategies or clinically acceptable alternatives (median score 4 vs 3 for the fellow; p&#x2009;<&#x2009;0.001). Divergence between evaluators occurred primarily at the strategic planning level, whereas similar performance was observed for rule-based subtasks such as device sizing and landing-zone estimation. In this retrospective case series, a multimodal LLM generated endovascular treatment strategies that frequently aligned with expert heuristic decision-making patterns when evaluated in a real-world clinical decision-making context. Rather than representing autonomous clinical reasoning, the model appears to reproduce codified expert heuristics embedded in neurointerventional practice. Multimodal LLMs may therefore serve as adjunct tools for standardizing decision patterns and supporting trainees. Prospective multicenter validation incorporating full DICOM workflows and human-in-the-loop oversight is required before clinical integration.