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Vulvovaginal lichen planus (VVLP) is a chronic inflammatory mucocutaneous disease causing significant morbidity. Despite various available treatments, evidence regarding their effectiveness remains fragmented. To systematically evaluate the efficacy and safety of therapeutic interventions for VVLP with or without concomitant gingival involvement. We searched MEDLINE, Embase, CINAHL, and Scopus databases without date restrictions. We included randomized and non-randomized studies reporting treatment outcomes in adults with VVLP. Two reviewers independently screened studies and extracted data. Risk of bias was assessed. We analyzed 1417 patients across 66 studies. Monotherapy was used in 25.2% (357/1417), dual-component therapy in 12.0% (170/1417), triple-component therapy in 51.2% (726/1417), and complex therapy in 11.6% (164/1417) of cases. Among monotherapies, systemic corticosteroids demonstrated the highest complete resolution (CR) rate at 88.9% (24 of 27 patients), followed by biologics with tildrakizumab achieving 88.0% CR (22 of 25 patients), and JAK inhibitors with tofacitinib showing 75.0% CR (6 of 8 patients), and intravaginal corticosteroid suppositories at 55.7% (54 of 97 patients). Triple-component therapy combining systemic corticosteroids, topical calcineurin inhibitors, and antimetabolites (methotrexate or mycophenolate mofetil) was most commonly used (66.8%, 485/726), with 41.6% achieving CR. Adverse events were generally mild, including burning sensations with topical agents and gastrointestinal symptoms with systemic immunosuppressants. Recurrence rates varied widely: 84% for topical corticosteroids alone, 11.9% for methotrexate, and 3.2% for tildrakizumab. While corticosteroids remain the mainstay of VVLP treatment, newer therapies, including JAK inhibitors (75.0% CR, 6 of 8 patients) and biologics, show promising efficacy. Among biologic monotherapies, tildrakizumab achieved 88.0% CR (22 of 25 patients), while the overall CR rate across all 31 biologic-treated patients was 71.0% (22 of 31 patients). These findings are based on small patient numbers and require validation in larger controlled trials. Triple-combination therapy is frequently employed for resistant cases. High recurrence rates with monotherapy suggest combination approaches may be necessary for the long term.PROSPERO Registration: CRD42025101229. Which treatments work best for vulvovaginal lichen planus?Vulvovaginal lichen planus is a long-lasting inflammatory condition affecting the vulva and vagina that causes pain, burning, and scarring. We reviewed all available studies to understand which treatments work best.We found that placing steroid medication directly into the vagina using suppositories achieved better results (55.7% complete resolution) than applying stronger steroid creams to the external vulvar skin (14.8% complete resolution). However, most patients using suppositories had disease affecting both the vagina and vulva, so this finding primarily applies to combined vulvovaginal disease rather than vulvar-only disease.Newer medications like JAK inhibitors and biologics show promising results, with about 7 to 9 out of 10 patients achieving complete relief in small studies (6-25 patients per treatment). However, these findings need to be confirmed in larger studies. These medications work even in patients who haven’t responded to multiple other treatments. However, most patients need combination treatments using multiple medications together.The condition often comes back after stopping treatment and especially with steroid creams where most patients had ongoing disease. In contrast, only about 3% of patients on certain biologics had their disease return. This suggests some treatments might actually change the disease course rather than just controlling symptoms.An important finding was that mechanical treatments like vaginal dilators, when combined with medications, help prevent scarring and narrowing. While they don’t cure the disease, they significantly improve symptoms and function.

The volatility of individual species is a fundamental property governing the gas-particle partitioning of organic aerosols. However, in complex organic mixtures, a compound's apparent volatility may differ from its intrinsic volatility, depending on the matrix's chemical composition. Herein, we systematically investigate component-resolved, mixture-specific volatility for more than 1,500 individual species across 33 proxies and chemically complex mixtures representative of selected organic aerosol types. The results show that species in simplified proxies and reference mixtures with limited components follow a higher-volatility trend that approaches their intrinsic values, whereas species present in ambient and biomass-burning organic aerosols exhibit the opposite behavior, with systematically reduced apparent volatility attributable to matrix effects. Using levoglucosan (LG), a representative biomass-burning tracer, as an illustrative example, we find that its volatility in complex organic mixtures is reduced by 1 to 4 orders of magnitude relative to its intrinsic volatility in pure LG. This pronounced reduction underscores strong matrix effects that substantially suppress the apparent volatility of individual species in mixed systems. Machine-learning analysis further indicates that mixture-dependent molecular metrics are more predictive of apparent volatility than compound-specific molecular properties that define intrinsic volatility. Collectively, these findings highlight the critical role of intermolecular interactions in governing gas-particle partitioning in multicomponent systems. This study provides strong evidence that matrix effects significantly influence the apparent volatility of individual species in aerosols and other environmental organic mixtures and should be explicitly considered in volatility prediction frameworks and aerosol transport models.

Post-menopausal women frequently experience ocular dryness, with a notably greater severity of clinical symptoms and signs. Despite the high burden of dry eye disease in this population, limited evidence exists regarding the underlying nature and characteristics of this condition. In this cross-sectional comparative study, 319 participants were enrolled: 102 post-menopausal women, 105 age-matched men, and 112 younger healthy females. Assessments included the Ocular Surface Disease Index (OSDI), tear breakup time, corneal and conjunctival staining, Schirmer's test, and meibomian gland evaluations. Severity was classified using established clinical criteria. Multivariable logistic regression was performed to identify predictors of severe DED. Post-menopausal women exhibited significantly higher mean OSDI scores (24.1&#x2009;&#xb1;&#x2009;16.5) compared to age-matched men (20.2&#x2009;&#xb1;&#x2009;16.7) and younger females (19.8&#x2009;&#xb1;&#x2009;15.3; p&#x2009;=&#x2009;0.043). They also had notably shorter TBUT, greater ocular surface staining, and more pronounced meibomian gland dysfunction. Burning (20.6%) and itching were more frequent in this group (p&#x2009;<&#x2009;0.05). Severe DED prevalence was highest among post-menopausal women (24.5%), versus age-matched men (16.2%) and younger females (18.8%; p&#x2009;=&#x2009;0.047). Multivariable regression analysis identified burning symptoms as a significant predictor of severe DED (OR &#x223c; 2.40), while post-menopausal status (OR &#x223c; 1.19) and lid-margin changes (OR &#x223c; 1.42) showed weaker associations. DED in post-menopausal women is more severe and predominantly exhibits an evaporative profile, characterised by tear film instability and meibomian gland dysfunction.

Radioactive constituents of fine particulate matter (PM2.5) are an under-recognized dimension of urban air pollution, posing emerging challenges for sustainable public health management. In this study, we experimentally demonstrate a mechanistic link between particle radioactivity (PR) and oxidative potential in the urban atmosphere by integrating alpha and beta activity measurements of long-lived radon progeny (210Pb, 210Bi, 210Po) with dithiothreitol (DTT) assays. Using source apportionment, we present the first integrated evidence that biomass burning and industrial activity jointly drive both radiological activity and oxidative potential, highlighting a shared source-specific toxicity profile for PM2.5. Our results establish PR as an emerging, particle-bound radiological indicator of PM2.5 oxidative potential, offering source-specific insights with potential applications in air quality and health-relevant regulations. Recognizing the intrinsic coupling of radiological and chemical reactivities provides a new framework for evaluating synergistic health risks beyond conventional mass-based air quality metrics.

Exoplanets around massive young stars, including hot spectral-class B (B-type) stars, are rare but important for understanding how planets form and survive. Most known examples are either very distant companions found by direct imaging or extremely close-in planets found by transit surveys, leaving planets at intermediate orbital distances largely unexplored. Here, we show that this missing population can be revealed through evolved stars. Using space-based stellar oscillations and stellar-evolution models, we identify four known planet-hosting catalogue stars, HD 2952, HD 120084, HIP 65891, and HIP 67537 (Henry Draper and Hipparcos catalogue identifiers), as massive helium-burning giant stars. We reconstruct their birth properties and find that all four were originally B-type stars hosting giant planets at intermediate orbital distances. Orbital-evolution calculations show that the present systems can survive the expansion of their host stars after the main sequence. These systems uncover a hidden population of planets around B-type stars and extend tests of planet formation and survival into a previously inaccessible regime.

Agricultural insurance is rapidly expanding globally as a primary climate adaptation strategy. However, its implications for climate mitigation remain ambiguous. Shielding farmers from climate risks may inadvertently incentivize high-emission farming practices. This study unravels this adaptation-mitigation nexus. We investigate the causal impact of agricultural insurance on disaggregated greenhouse gases (CO2, N2O, and CH4) in China. To achieve this, we utilize a comprehensive panel dataset of 335 prefecture-level cities from 2001 to 2022 and employ an instrumental variable approach. Our empirical analysis reveals a striking asymmetry. Agricultural insurance acts as a potent mitigation tool for CO2 and N2O. It achieves this primarily by reducing defensive nitrogen fertilization and discouraging crop residue burning. However, these environmental co-benefits do not extend to CH4. Instead, insurance exhibits a neutral-to-positive effect on CH4 emissions. Furthermore, we observe significant CH4 emission increases in high-temperature and high-humidity regions, indicating a severe risk of maladaptation. These findings challenge the prevailing reliance on aggregated CO2-equivalent metrics. Such single-metric assessments completely mask these divergent trade-offs. Ultimately, agricultural insurance effectively synergizes climate adaptation with CO2 and N2O reduction. Nevertheless, policymakers must urgently design and implement complementary environmental regulations to prevent CH4 emissions, particularly in climate-vulnerable zones. &#xa9; 2026 Society of Chemical Industry.

The scanning electron microscopy (SEM) technique, coupled with energy dispersive X-ray spectrometry (EDS), is a key tool for characterizing particulate matter (PM), offering advantages such as in natura and non-destructive sample analysis. Published studies typically present SEM images alongside the elemental spectrum from EDS. Less commonly explored in the literature, the EDS elemental maps, performed with successive scans at appropriate resolution, can identify substances even when SEM analysis is compromised. In this present study performed PM analyses via SEM-EDS on samples collected using quartz and fiberglass filters during an environmental monitoring campaign across three regions of Rio de Janeiro, with no filter pre-treatment required. Blank filter characterization revealed that fiberglass filters contained Na, Ba, and Zn (~ 6%), while quartz filters is cleaner. The analysis enabled PM classification as organic/inorganic and natural/anthropogenic. Organic particles in the inland city included pollen and soot from biomass burning, while in the metropolitan area, clusters of small carbon spheres were linked to incomplete fuel combustion. Inorganic particles in the environmental reserve included aluminosilicates from crustal sources, while the inland city had iron-rich particles. Despite the long operation time, EDS elementary maps identified overlapping elements, enabling more accurate determination of PM's chemical composition.

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To evaluate the association between metabolic syndrome (MetS) and in-hospital mortality in sepsis patients and to determine whether this association varies according to disease severity and individual MetS-related components. Multicenter retrospective cohort study. Three tertiary hospitals in China. A total of 2,973 adult patients with sepsis admitted between September 2015 and May 2023. None. MetS was defined according to the criteria of the Chinese Diabetes Society. The primary outcome was in-hospital mortality. Multivariable Cox regression, subgroup analyses, interaction analyses, and Kaplan-Meier survival analyses were performed. MetS was present in 1,309 patients (44.0%). Patients with MetS had a higher in-hospital survival rate than those without MetS (78.4% vs. 72.8%, p = 0.001). After adjustment for potential confounders, MetS remained independently associated with lower in-hospital mortality. A significant interaction was observed between MetS and SOFA-defined severity strata, indicating a severity-dependent association. The survival advantage of MetS was mainly confined to patients with mild-to-moderate sepsis and was primarily driven by overweight and hyperlipidemia. In addition, these 2 metabolic features were associated with more favorable physiologic profiles, including lower inflammatory burden and better preservation of nutritional and cardiometabolic indices. MetS was associated with lower in-hospital mortality in sepsis, particularly in patients with mild-to-moderate disease severity. This association appeared to be largely driven by overweight and hyperlipidemia, supporting a stage-specific prognostic role of metabolic phenotypes in sepsis.

Persistent and repeated damage contribute to chronic kidney disease (CKD) progression, with repair responses diverging between successful resolution and failed repair. In the transition towards failed repair, renal tubules develop a maladaptive phenotype which establishes conditions that sustain chronic inflammation leading to fibrosis. To define regulators of this inflection point, we investigated the role of non-canonical NF-&#xf06b;B signaling, a persistent inflammatory pathway that is activated under chronic stress. Using CRISPR-Cas9 gene editing, we generated a novel Fn14 knockout (Fn14-KO) mouse, as Fn14 is one of a limited number of receptors identified that engages the non-canonical NF-&#xf06b;B pathway. Male and female wildtype and Fn14-KO mice underwent a repeated low-dose cisplatin regimen to model CKD. Post-treatment, we analyzed blood biochemistry, renal histopathology, and renal gene expression via the NanoString nCounter platform. Although renal injury was observed by histology and gene expression (KIM-1) in both wildtype and Fn14-KO mice following cisplatin treatment, transcriptional profiles suggested that Fn14-KO mice exhibited relative preservation of proximal tubule differentiation and survival markers. In contrast, wildtype kidneys displayed hallmark transcriptional features of maladaptive repair, including tubular dedifferentiation, apoptosis, complement activation, and fibrogenesis. Collectively, these findings suggest that Fn14-mediated non-canonical NF-&#xf06b;B signaling is a critical driver of the transition to maladaptive repair, positioning it as a potential therapeutic target to mitigate CKD progression.

Maintaining clinical readiness of military surgeons is essential for optimal combat casualty care, yet limited exposure to high-acuity trauma in military treatment facilities (MTFs) contributes to skill degradation during peacetime. Military-civilian partnerships (MCPs) have emerged as a key strategy to address this gap by embedding military surgeons within high volume civilian trauma centers. However, objectively measuring whether clinical experience translates into readiness remains challenging because of the disconnect between civilian billing-based documentation using current procedural terminology (CPT) codes and military readiness frameworks such as the United States (U.S.) Army General Surgeon Individual Critical Task List (ICTL). This study aimed to develop a CPT-to-ICTL mapping framework to quantify U.S. Army surgeon readiness within a long established MCP. A retrospective observational study was conducted at a single urban academic Level I trauma center MCP from May 2020 through September 2024. CPT codes from the CPT 2024 Professional Edition were categorized as definitively or potentially satisfying an individual critical task (ICT), with the latter requiring operative or procedural documentation review for confirmation. Billing logs for 2 MCP embedded U.S. Army surgeons (Surgeons A and B) were analyzed, excluding non-procedural and non-critical care codes. During the study period, Surgeon A contributed 48 months of clinical time while Surgeon B contributed 42 months because of periods of deployment and offsite military training. CPT codes were grouped by encounter, mapped to ICTs, and counted once per encounter to avoid duplication. Descriptive statistics were used to summarize ICT frequency. The study was approved by the local Institutional Review Board with a waiver of informed consent. The CPT-to-ICTL mapping framework identified 1,239 CPT codes corresponding to 1,772 CPT-to-ICT associations. Open abdominal and thoracic procedures accounted for the largest proportion of mapped codes. Surgeon A and Surgeon B completed 2,020 and 1,358 ICTs, respectively. The most frequently performed ICT was the Focused Assessment with Sonography in Trauma (FAST) examination, with laparotomy as the most common operative task. Additional commonly performed ICTs included tube thoracostomy, trauma resuscitation, and critical care management. This novel approach to quantifying military surgical readiness links administrative billing data to readiness-defined tasks. The findings support MCPs as effective environments for generating exposure to combat-relevant clinical activities while highlighting the feasibility of using CPT-based frameworks for objective readiness assessment. This framework has important implications for readiness reporting, program evaluation, and policy development within the Military Health System. Future work should validate this approach across diverse settings, incorporate non-procedural aspects of care, and align readiness metrics with clinical outcomes and deployment performance.

Conservation translocations are widely used to increase population size and redundancy, yet their genetic consequences are often uncertain, particularly for clonal species with unknown rates of sexual reproduction. Propagation through asexual reproduction is frequently employed in these systems, but its effectiveness for preserving genomic diversity remains poorly evaluated. We used genome-wide single nucleotide polymorphism (SNP) data to assess the genetic outcomes of translocation efforts in Pleuropogon oregonus, a critically endangered grass endemic to eastern Oregon, USA. We quantified genetic diversity, relatedness, and population structure across natural and introduced sites and used coalescent simulations to infer the divergence history between disjunct populations. Genetic analyses identified two divergent lineages corresponding to northern and southern regions, with divergence predating the last glacial period and limited subsequent gene flow. Within regions, natural populations exhibited high clonality but retained genetically distinct individuals. Introductions that used vegetative propagules from the northern region maintained heterozygosity and allelic diversity comparable to sources and captured multiple distinct genotypes, including alleles likely originating from an unsampled source, thereby increasing population redundancy. In contrast, the introduction derived from a low-diversity, southern region source reflected similarly limited clonal diversity. Our results demonstrate that vegetative propagation can effectively preserve genomic diversity in clonal species when propagules are sampled representatively, but that evolutionary history may inform sourcing and mixing decisions. More broadly, this study provides an empirical framework for integrating genomic data into conservation translocations, highlighting conditions under which vegetative propagation maintains evolutionary potential and when it may pose risks to long-term persistence.

Repeated measures designs are a common experimental setup in biology, from ecology to biomedical sciences. Traditional statistical techniques for analyzing such data, such as repeated measures ANOVA (RMANOVA), have limitations that prevent them from being used to answer many questions relevant to measurements taken over time. Response feature analysis (RFA) techniques can provide an ideal means for answering those questions by analyzing data based on a creatively chosen summary function of the individual subject's data. The process and rationale for the RFA is laid out in a step-by-step manner and is demonstrated on an example of behavioral data from a rodent spinal cord injury study. In the original analysis, a difference in average functional score was only found at one timepoint early in the study. Using RFA, we show that the female rats reached 90% of their peak recovery 15.3 days (95% CI 1.73, 28.86 days) earlier than the male rats. RFA enables answering the important question "do the two sexes differ in the speed at which they recovery functional ability?", and, by way of demonstration, illustrates its flexibility in answering questions that traditional repeated measures analyses cannot.