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The journal retracts the article titled "Therapeutic Potential of Mesenchymal Stem Cells versus Omega n - 3 Polyunsaturated Fatty Acids on Gentamicin-Induced Cardiac Degeneration" [...].

Softer means stickier for solid adhesives, because material compliance facilitates close contact between nonconformal surfaces. Recent discoveries have revealed that soft materials can exhibit a rich array of new physics arising from competing effects of continuum elasticity, fluid-like surface mechanics, and internal poroelastic flows, all of which can directly impact interfacial interactions. In this work, we investigate this complex interplay across several orders of magnitude of elastic stiffness by measuring the complete adhesive contact geometry between compliant silicone gel microspheres and flat, rigid substrates. We observe a continuous elastocapillary transition in adhesion mechanics, revealed by both the breadth of data and the detailed contact geometries. Importantly, soft gel spheres exhibit a remarkably broad range of near-equilibrium contact morphologies and their contact line deformation is always mediated by a fluid contact zone that phase separates from the gel. To explain this, we develop a model incorporating elastocapillary and poroelastic mechanics that predicts the complete range of adhesive behavior and elucidates energetic tradeoffs. The data and model together reveal a shallow energy landscape that may contribute to the robustness of everyday adhesives.

The Phase 3 TRANSFORM-1 study (NCT04472598) evaluated ruxolitinib (RUX) in combination with navitoclax (NAV) or placebo (PBO) in Janus-kinase-inhibitor-na&#xef;ve adults with intermediate-2 or high-risk myelofibrosis and Eastern Cooperative Oncology Group performance status &#x2264;2. Patients were randomized 1:1 to NAV (200 mg/day starting dose or 100 mg escalated to 200 mg/day) or PBO, with RUX dosed per label. The primary endpoint was &#x2265;35% spleen volume reduction (SVR) at Week 24 (SVR35W24). Secondary endpoints included change from baseline in Total Symptom Score (TSS) at Week 24 and SVR35 at any time. A total of 252 patients (NAV+RUX, n=125; PBO+RUX, n=127; median follow-up 20.3 months) were randomized; >80% had intermediate-2 risk and nearly 50% were high-molecular risk (HMR). SVR35W24 was achieved by 63.2% with NAV+RUX versus 31.5% with PBO+RUX (P<0.0001). Mean change in TSS at Week 24 was not significantly different between NAV+RUX and PBO+RUX (-10.2 vs -11.6; P=0.2852). SVR35 at any time was achieved in 76.8% with NAV+RUX versus 44.1% with PBO+RUX (nominal P<0.0001). A &#x2265;20% variant allele frequency reduction (exploratory endpoint) occurred in 58.5% (95% CI: 49.0-67.5) with NAV+RUX and 45.5% (95% CI: 36.4-54.8) with PBO+RUX. NAV+RUX showed higher hematologic toxicity versus PBO+RUX (Grade 3/4 thrombocytopenia: 54.0% vs 19.2%; Grade 3/4 neutropenia: 40.3% vs 8.8%); diarrhea (any grade: 41.9% vs 16.8%) was also more common. Cytopenias were generally manageable and reversible with dose adjustments.

Desensitization strategies for highly sensitized kidney transplant candidates remain limited in efficacy. Tocilizumab, an interleukin-6 receptor antagonist, has been proposed as an adjunct to IVIg to reduce HLA antibody burden. In this prospective controlled cohort study, highly sensitized candidates (median calculated panel reactive antibody [cPRA], 98.0%) were (n&#x2005;=&#x2005;19) or were not (n&#x2005;=&#x2005;15) treated with tocilizumab and IVIg. All tocilizumab-treated patients had failed &#x2265;3 mo of IVIg-based desensitization. We assessed changes in cPRA, unacceptable antigens (U/As), transplant rates, and posttransplant outcomes. Tocilizumab-treated patients were more likely to demonstrate any reduction in cPRA during the study period (84.2% versus 33.3%; P&#x2005;=&#x2005;0.002). Median cPRA change at nadir was -0.9% versus 0.0% (P&#x2005;=&#x2005;0.02), although end-of-study differences were not statistically significant. Treated patients more frequently achieved removal of high-impact U/As (median cPRA of removed U/As 31.7% versus 0.0%; P&#x2005;=&#x2005;0.004), and 3 underwent transplantation across antigens previously listed as unacceptable. Transplant rates (89.5% versus 73.3%; P&#x2005;=&#x2005;0.4) and early posttransplant outcomes-including rejection, graft loss, BK viremia, renal function, de novo donor-specific antibody, and donor-specific antibody rebound-were similar between groups. In this controlled cohort, tocilizumab combined with IVIg was associated with greater reductions in HLA antibody burden without an apparent increase in early posttransplant immunologic risk. These findings support further evaluation of interleukin-6 (IL-6) blockade as an adjunctive desensitization strategy, particularly in candidates with limited transplant access despite high allocation priority.

Pediatric caregiver stress specific to autism spectrum disorder (ASD) is associated with adverse outcomes, including reduced mental and physical well-being and family functioning. The Pediatric Inventory for Parents, short-form (PIP-SF), is a self-report measure of pediatric stress in caregivers of children with chronic health conditions. This study aims to fill a gap in the empirical literature by evaluating the psychometric properties of the PIP-SF within the previously excluded pediatric population of caregivers of children with ASD. Participants were a national sample of 363 female caregivers of children diagnosed with ASD. They completed the PIP-SF and measures related to general stress, anxiety, gratitude, perceptions of child vulnerability, and ASD characteristics. The PIP-Frequency and PIP-Difficulty demonstrated good to excellent internal consistency. Concurrent and convergent validity were evidenced by statistically significant positive correlations between the PIP-SF and key scales. Supporting discriminant validity, the scales evidenced nonsignificant correlations with a scale measuring gratitude. Scores on both scales did not significantly differ between caregivers of younger versus older children; caregivers of children with higher ASD characteristics. reported statistically significantly higher PIP-SF scores than those with lower characteristics. A unidimensional model for both scales met criteria for good fit. Results of the current study provide preliminary evidence supporting sufficient validity and reliability of the PIP-SF among female caregivers of children with ASD.

Real-world studies have demonstrated the effectiveness of automated insulin delivery systems in managing people with type 1 diabetes (T1D) worldwide. However, data on the effectiveness of such systems in the management of people with T1D in Greece have previously been lacking. This retrospective analysis sought to address this by providing real-world insights into the impact of the MiniMed 780G system on the glycemic control of people with T1D in Greece. Data from MiniMed 780G systems, uploaded to the CareLink Personal Software program between January 2024 and January 2025 by 2284 users with T1D in Greece, were collected and analyzed. Outcomes considered included glycemic control measures such as time spent in target ranges, glucose management indicator (GMI), and international glycemic control targets. Data were analyzed across different age groups (&#x2264;&#x2009;15&#xa0;years, 16-55&#xa0;years,&#x2009;&#x2265;&#x2009;56&#xa0;years), with additional analyses of cohorts using recommended optimal settings (ROS), users with data from before and after the initiation of the advanced hybrid closed-loop system, and users with 12&#xa0;months of data. Across the overall cohort, the mean (standard deviation [SD]) time in range (TIR) was 75.4% (9.5%), and 59.3% of users achieved a combined target of a GMI&#x2009;<&#x2009;7%, TIR&#x2009;>&#x2009;70%, time below 70&#xa0;mg/dl&#x2009;<&#x2009;4%, and time below 54&#xa0;mg/dl&#x2009;<&#x2009;1%. These findings were consistent across age groups and stable over a 12-month period, but were found to be better among users with ROS. Comparing data obtained before and after the initiation of the system, mean (SD) TIR was found to increase from 65.1% (13.9%) to 74.9% (9.6%), while the proportion of users achieving a TIR of&#x2009;>&#x2009;70% increased from 36.1 to 72.8%. These data demonstrate that most users of the MiniMed 780G system achieve the recommended glycemic control targets.

Thyroidectomy is a fundamental therapeutic intervention for various thyroid disorders, yet it entails significant risks, including iatrogenic hypoparathyroidism. Since 2019, our institution has implemented a standardized post-thyroidectomy protocol using parathyroid hormone (PTH) and calcium measurements to stratify hypocalcemia risk and guide calcium and alfacalcidol supplementation. This study aimed to assess the effectiveness of this structured approach in reducing unscheduled referrals due to hypocalcemia within three weeks after total thyroidectomy and evaluate the utility of early postoperative PTH levels in predicting permanent hypoparathyroidism (PhP). A retrospective observational cohort study was conducted at Radboud UMC Nijmegen, including 373 adult patients who underwent total/completion thyroidectomy between January 2014 and April 2025. Patients were assigned to either the post-protocol cohort (PPC) (N&#x2009;=&#x2009;154) or the historic cohort (N&#x2009;=&#x2009;219), depending on whether surgery occurred after or before protocol implementation, and subsequently compared. Unscheduled referrals were significantly more frequent in the historic cohort than in the PPC (19.2% vs. 11% respectively, p&#x202f;=&#x202f;0.034), and the introduction of the protocol was associated with a significant reduction in the odds of these referrals. Early postoperative PTH levels were a significant predictor of unscheduled referrals (p&#x2009;=&#x2009;0.003), postoperative hypocalcemia (p&#x2009;<&#x2009;0.001) and PhP (p&#x2009;<&#x2009;0.001). A postoperative PTH cutoff of 1.7&#x2005;pmol/L was identified as a clinically meaningful threshold for PhP prediction, demonstrating 100% sensitivity. Subject to assay availability and workflow efficiency, implementation of this protocol may reduce post-thyroidectomy emergency consultations and readmissions, improving healthcare resource utilization and optimizing follow-up.

Attitudes toward death and dying are central to intensive care unit (ICU) culture, influencing communication, ethical decision-making, moral distress and professional identity. Yet how these attitudes are measured in adult ICU clinicians, and the robustness of available instruments, remains unclear. We systematically reviewed tools used to assess attitudes toward death and dying in adult ICU staff. This systematic review followed PRISMA 2020 guidance and was registered on PROSPERO (CRD420250527706). Medline, PsycINFO, CINAHL and Scopus were searched from January 1980 to December 2024. Original peer-reviewed studies using named quantitative instruments in adult ICU clinicians were included. Study selection was undertaken independently by three reviewers. Measurement properties were appraised using COSMIN criteria, and methodological quality using the Mixed Methods Appraisal Tool (MMAT). Given substantial heterogeneity in constructs and outcomes, findings were synthesised narratively. Fourteen studies reporting eleven primary instruments were included, predominantly involving ICU nurses and cross-sectional designs. Instruments addressed diverse constructs, including caring attitudes, perceived barriers to end-of-life care, ethical sensitivity, organisational values and treatment decision-making. Several tools demonstrated acceptable internal consistency and construct validity. Overall methodological quality was moderate to high, although sampling representativeness and non-response bias were frequently unclear. Current instruments provide fragmented and conceptually divergent assessments of ICU clinicians' attitudes toward death and dying. Limited cross-cultural validation and poor evidence of responsiveness constrain their usefulness for evaluating interventions or supporting improvement. More coherent, implementation-ready measurement tools are needed to strengthen end-of-life culture in intensive care.

The growing complexity of clinical trials, particularly in oncology, has significantly increased the operational burden on research staff. However, standardized and validated instruments to measure trial-related workload remain scarce. This study aimed to adapt and validate the Italian version of Ontario Protocol Assessment Level (I-OPAL) tool for the Italian context, providing a reliable framework for workload planning and feasibility assessment. A cross-sectional, multicenter study was conducted across Italian research institutions. The OPAL tool was translated and culturally adapted following established validation procedures. Content validity was assessed using the Content Validity Ratio (CVR), while inter-rater reliability was evaluated with the intraclass correlation coefficient (ICC). Discriminant validity was examined through non-parametric tests, effect size measures, and multiple correspondence analysis. A total of 513 clinical trials were included. The OPAL tool showed excellent inter-rater reliability (ICC&#x2009;=&#x2009;0.93) and all items met the minimum CVR threshold (0.78-1.00). Significant differences in OPAL scores were observed across study type, clinical setting, sample size, and duration (all p&#x2009;<&#x2009;0.001), with large effect sizes (&#x3b5;2 up to 0.645). Higher OPAL scores were positively correlated with greater allocation of research staff, particularly nurses and data managers. Sensitivity analyses confirmed the robustness of findings, and internal consistency checks revealed full alignment with the model's classification rules. The Italian validation of OPAL confirmed its reliability, validity, and practical relevance as a tool for standardized workload assessment in clinical research. Its integration into feasibility analyses and trial planning could enhance resource allocation, regulatory compliance, and sustainability of research activities in Italy.

The emergency capacity of primary healthcare institutions is critical to the effectiveness of grassroots emergency management. This study examines the relationships among organizational culture, social capital, and the emergency capacity of primary healthcare institutions using a structural equation modeling approach. A questionnaire survey was conducted among healthcare professionals, yielding 983 valid responses for analysis. The results indicate that organizational culture, as well as structural, relational, and cognitive dimensions of social capital, are significantly associated with the emergency capacity of primary healthcare institutions within the model. In addition, social capital demonstrates mediating roles in the relationship between organizational culture and emergency capacity. Multi-group structural equation modeling further reveals variations across community types: relational social capital shows stronger associations with emergency capacity in ordinary communities, whereas structural social capital is more prominent in older communities. These findings provide empirical evidence on how organizational culture and social capital are linked to emergency capacity in primary healthcare settings, highlighting the importance of both internal cultural development and external social resources in different phases of emergency management.

Inborn Errors of Immunity (IEI) display increased susceptibility to infections among which cryptosporidiosis is an opportunistic infection poorly characterized in this population. We report cases of Cryptosporidium spp. infections in French patients with IEI based on data from the registry of the French National Reference Center for IEI (CEREDIH). Patients diagnosed with an IEI between 1986 and 2025 and who experienced proven cryptosporidiosis were included. Of the 10,004 patients in the CEREDIH registry, 149 were identified with at least one episode of parasitic infection (&#x2248;1.4%). Forty-one patients (27.5%) had cryptosporidiosis (0.41% of the cohort) and had the following diagnoses: Combined immunodeficiency (CID, n=25 including 8 Hyper IgM (HIGM) syndromes, 9 other CID, 4 HLA class II deficiency), Hyper IgE syndrome (n=2), Diaphanous related formin 1 mutation (n=1), Signal transducer and activator of transcription 1 (STAT1) gain-of-function (GOF) (n=1), Activated PI3K-delta syndrome (n=6), Common variable immunodeficiency disorders (CVID, n=3) and 7 miscellaneous.. The male-to-female ratio was 1.92 and the mean age at onset of cryptosporidiosis was 16.6&#xb1;17.5 years. Twenty (50%) patients had cholangitis and 23 (63%) had an indication for hematopoietic stem cell transplantation, which was performed in 15 (38%). Seventeen (41.5%) patients died. Cryptosporidiosis is a serious comorbidity in patients with IEI with a high mortality rate reaching more than one third of the patients. CID including HIGM syndrome and other CID were the most represented underlying condition in this study with the highest morbidity and mortality (cholangitis and its complications).

The coexistence of nontuberculous mycobacterial pulmonary disease (NTM-PD) and chronic obstructive pulmonary disease (COPD) represents a severe clinical phenotype. This study aimed to investigate the factors associated with COPD comorbidity in patients with NTM-PD and evaluate the discriminatory performance of novel composite inflammatory-nutritional indices, specifically the C-reactive protein-to-albumin ratio (CAR) and the neutrophil-to-lymphocyte ratio-to-albumin ratio (NAR). In this single-center, retrospective, cross-sectional study, we reviewed the clinical records of 153 patients with NTM-PD diagnosed between January 2019 and December 2024. Eligible patients were categorized into the NTM-PD alone group and the NTM-PD with comorbid COPD group based on postbronchodilator pulmonary function testing. A clinically driven multivariable logistic regression model was used to identify factors associated with COPD comorbidity after adjustment for potential confounders, including smoking index, comorbidity score, and NTM species. Discriminatory performance was assessed using receiver operating characteristic analysis, with internal validation by 1000-resample bootstrapping. Model calibration was evaluated using the Brier score and calibration plot, and clinical utility was explored using decision curve analysis. Of the 153 included patients, 75 (49.0%) had NTM-PD alone, and 78 (51.0%) had comorbid COPD. In the multivariable model, male sex (odds ratio [OR] = 4.93, 95% confidence interval [CI]: 2.01-12.09, P < 0.001), the presence of computed tomography (CT) cavities (OR = 3.82, 95% CI: 1.57-9.30, P = 0.003), and a higher NAR level (per 0.1-unit increase, OR = 1.85, 95% CI: 1.16-2.93, P = 0.009) were independently associated with COPD comorbidity. CAR and NAR showed similar discriminatory performance, with area under the curves (AUCs) of 0.768 and 0.767, respectively. The multivariable model showed good discrimination after internal validation by 1000-resample bootstrapping (bootstrapped AUC = 0.858, 95% CI: 0.796-0.910) and acceptable calibration (Brier score = 0.164). Male sex, the presence of CT cavities, and elevated NAR were independently associated with COPD comorbidity in patients with NTM-PD. In addition, CAR and NAR showed acceptable discriminatory performance as potential adjunctive screening markers for identifying patients who may warrant further evaluation for concurrent COPD. However, external validation is still required before broader clinical application.

This JAMA Clinical Guidelines Synopsis summarizes the 2025 Infectious Diseases Society of America (IDSA) updated recommendations on antiviral treatment for mild to moderate COVID-19 in adults.

Much remains unknown about the genetics of immune system changes during pregnancy. We used SNP data in a pregnancy cohort to genetically investigate 47 immune biomarkers at two timepoints, along with change between timepoints (&#x394;). We identified 19 biomarkers with significant SNP-based heritability and 34 with genome-wide significant signals, demonstrating genetic regulation. The same biomarkers measured in early- and mid-pregnancy shared about half of significant associations across timepoints, with enrichment for immune pathways. In contrast, &#x394; showed enrichment in transcription factors and developmental processes. About half of suggestive associations overlapped with non-pregnancy associations. However, these data leave a substantial fraction of potentially timepoint-specific and pregnancy-unique findings. Nearby genes were enriched for high expression in decidual cells at the maternal-fetal interface, reinforcing the novelty of our results. We additionally explored the relationship between immune genetic associations and prior GWAS of pregnancy complications. Overall, we present the first two-timepoint genetic study of immune profile in pregnancy.

Gestational diabetes mellitus (GDM) is one of the most frequent pregnancy complications. Investigating clinical risk factors for adverse pregnancy outcomes in women with GDM would help predict and prevent neonatal complications. We developed a machine learning model to discover risk factors for adverse pregnancy outcomes. Women with GDM from tertiary hospitals in Korea were included (n&#x2009;=&#x2009;305, discovery cohort; n&#x2009;=&#x2009;911, validation cohort). Supervised machine learning classification models, including ExtraTree, RandomForest, GradientBoosting, AdaBoost, Bagging, XGBoost, and Light Gradient Boosting Machine (LGBM), were developed to predict adverse pregnancy outcomes. Outcomes included large for gestational age (LGA), small for gestational age (SGA), low Apgar score, and preterm delivery. The top-ranked risk factors identified through feature importance were further validated using binary logistic regression analysis. In predicting LGA, the RandomForest model achieved the highest AUROC of 0.726 on the validation cohort. For SGA, the RandomForest model achieved the highest AUROC of 0.628. For low Apgar score and preterm delivery, the ExtraTree model showed the best performance with AUROCs of 0.689 and 0.616, respectively. This study presents machine learning models as a foundational tool for identifying factors associated with adverse pregnancy outcomes in women with GDM. These models may serve as a foundation for future development of clinical decision support tools.

Extrinsic lower limb muscle activity is often studied using simplified segmental models that overlook distinct kinematics of individual joints within the ankle joint complex and its associated articulations. This study provides a joint-level characterization of how individual muscle groups influence talocrural, subtalar, and midtarsal joint kinematics under an unweighted condition. Six fresh-frozen cadaveric specimens were mounted to a tendon force actuator system to independently actuate six functional muscle groups: tibialis anterior (TA), extensors (EXT), peroneals (PER), flexors (FLX), tibialis posterior (TP), and Achilles. Individual stepwise loading trials were performed for the five muscle groups other than the Achilles. Each muscle group was tested in 20&#xa0;% force increments while the Achilles was held at a constant 10&#xa0;% baseline tension. Three-dimensional rotations at the tibiotalar (TT), talofibular, tibiofibular, subtalar (ST), talonavicular (TN), and calcaneocuboid joints were measured. Parallel coordinate plots revealed distinct muscle-specific and shared joint coordination patterns, with consistent ST/TN coronal and transverse coupled motions across muscle groups. Principal component analysis showed that the first principal component strongly reflected force-dependent motion (R2&#xa0;=&#xa0;0.75-0.90). TA primarily drove TT dorsiflexion and ST/TN inversion and internal rotation. EXT produced ST/TN eversion and external rotation. PER and FLX contributed greater midtarsal motions in the coronal and transverse planes, consistent with common hindfoot-midfoot stabilization strategies. FLX and TP did not generate strong TT plantarflexion, likely due to the initial plantarflexed alignment and baseline Achilles activation, but TP showed strong ST/TN inversion and internal rotation. Findings highlight the influence of initial foot posture, hindfoot-midfoot coupling, and the value of joint-level analysis for understanding muscle function, refining musculoskeletal models, and evaluating surgical interventions.

Cupuassu (Theobroma grandiflorum) is a fruit native to the Amazon, whose pulp is the most economically valuable product due to its unique sensory and nutritional properties. Knowledge of its thermophysical properties, particularly thermal diffusivity, is essential for designing effective heat treatments. The objective of this study was to determine the thermal diffusivity of cupuassu pulp from experimental data using an inverse method. Experiments were conducted by heating the pulp in an aluminum capsule from 10&#x2005;&#xb0;C to 80&#x2005;&#xb0;C in a thermostatic water bath, with a thermocouple positioned at the center of the sample. The Biot number of heating process exceeded 50, indicating dominant internal conductive resistance and justifying the adoption of a first-kind (Dirichlet) boundary condition in the two-dimensional transient heat conduction model. Thermal diffusivity (&#x3b1;) was estimated by solving the model using the finite difference method and fitting the predicted temperatures to the experimental data through Root Mean Square Error (RMSE) minimization via an exhaustive parameter search. To avoid solving a nonlinear partial differential equation, &#x3b1; was treated as locally constant within each time step and iteratively updated based on the temperature field from the previous time step. Four models were evaluated to describe the temperature dependence of the diffusivity: constant, square-root, linear, and power-law. Temperature-dependent models provided superior predictive performance, with the power-law model: &#x3b1;(T)&#x2009;=&#x2009;A&#x2009;+&#x2009;BT3/2, yielding the best fit (RMSE &#x2248; 0.1&#x2005;&#xb0;C) and randomly distributed residuals. In addition, the &#x3b1; model was validated using two independent datasets, confirming its robustness for predicting heat transfer during thermal processing of cupuassu pulp.

High insulin prices are a major barrier to diabetes management in the U.S. Since 2019, several states have implemented legislation to mitigate high out-of-pocket (OOP) costs for commercially insured individuals by setting caps on monthly OOP payments for insulin. In this study, we examine the reach of these policies. We identified insulin OOP cap legislation enacted through 2026 for each state and Washington, DC. Using public data on diabetes prevalence and health insurance coverage, we identified the population eligible and exposed to OOP caps legislation: adults aged 18-64 years with diabetes, using insulin, enrolled in state-regulated commercial plans, and residing in states that enacted OOP caps legislation. We then estimated the number of commercially insured individuals using insulin still left unprotected due to 1) enrolled in federally regulated plans, regardless of state of residence; or 2) enrolled in state-regulated plans but living in states without OOP cap legislation. By 2026, 29 states and Washington, DC, had enacted OOP caps on insulin, covering an estimated 0.99 million individuals with diabetes, using insulin, and enrolled in state-regulated commercial plans. Despite these gains, policy reach remains uneven: 0.67 million adults with diabetes using insulin and insured by state-regulated plans live in states without an insulin OOP cap, and 2.2 million more are insured by federally regulated commercial plans that fall outside of state jurisdiction. State OOP caps have the potential to reduce OOP insulin costs for many commercial plan enrollees but have limited reach. Legislative efforts to contain costs at the federal level are therefore needed to decrease the financial burden of insulin therapy.

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