The primary cause of revision of trapeziometacarpal arthroplasty limiting the implant survival has been aseptic cup loosening. Radiostereometry is a precise method to evaluate implant migration as a surrogate marker for aseptic implant loosening and later revision. The aim of this prospective single-centre cross-sectional cohort study was to evaluate fixation of trapeziometacarpal cups using radiostereometry, report clinical and patient reported outcomes at 5 year follow-up, and assess the complications and survival rate of the Moovis cup with up to 9 years of follow-up. Four-hundred and eighty-four conical press-fit dual-mobility Moovis trapeziometacarpal implants were inserted in 407 patients, with a mean age of 59 years (range 43-80). Tantalum beads were inserted in the trapezium during index surgery. Radiostereometric images at 3 weeks, 3 months, 1 year, 2 years and 5 years after the index surgery were used to measure cup migration. Clinical and patient reported outcomes were recorded for 5 years. The cumulative implant survival until 9 years was analysed using the Kaplan-Meier method. Cup migration was 0.28 mm (95% CI: 0.25 to 0.32 mm) total translation at the 3 month follow-up and remained stable until the 5 year follow-up. Females had 0.15 mm (95% CI: 0.06 to 0.24 mm) more cup migration (total translation) than males at the 5 year follow-up. Grip strength, resting and activity pain, and Quick DASH score showed clinically relevant improvement at 1 year and remained stable until the 5 year follow-up. Medium-term patient satisfaction was 96%, and willingness to repeat the procedure was 96%. The 9 year cumulative implant survival rate was 98% for cup removal owing to aseptic loosening and 87% for removal/exchange of any implant component. Stable cup fixation and high patient satisfaction until 5 years combined with good 9 year survivorship for Moovis press-fit cups favour its use in the treatment of trapeziometacarpal osteoarthritis. Although these results cannot be directly extrapolated to other trapezial cups, they suggest that similar press-fit conical trapezial cup designs may also provide good fixation and favourable clinical outcomes in the treatment of painful trapeziometacarpal joint osteoarthritis, in patients between the ages of 40 and 80 years. Level II.
A prospective randomized controlled trial of exclusive human milk nutrition (EHM) in infants with single-ventricle physiology (SVP) was previously published. This study evaluates growth and health outcomes at 3-6 months. Demographics, anthropometrics, and clinical outcomes were collected prospectively. Anthropometric z-scores were calculated using WHO standards. One hundred seven infants were randomized to EHM or control diet, with 23 infants meeting predefined exclusion criteria, 8 infants withdrawn/died, leaving 76 infants at discharge. At 3-6 months, 74 infants completed follow-up. Infants with hypoplastic left heart syndrome (HLHS) were similar (control 73%, EHM 86.5%; p = 0.24). Growth, z-scores, and hospitalization did not differ between groups up to 6 months. Median growth velocity was 25 (IQR: 20.24-30.99) and 22 (IQR: 18.76-23.94) g/day from birth to 3-6 months. Overall, 50-60% of infants achieved 100% PO intake by 3-6 months of age. Neonates with SVP receiving an EHM diet from birth to 30 days post-surgery had similar growth at 3-6 months of age compared to the control diet. Infants with SVP benefit from a protocolized nutritional approach, as evidenced by normal growth velocities in infancy. Centers may consider delaying gastrostomy tube placement until after the Glenn operation. This trial is registered with ClinicalTrials.gov ( www. gov , Trial ID: NCT02860702). This trial was approved by the Institutional Review Board of the University of Texas Health Sciences Center at San Antonio (ID: HSC20150779H). This multicenter RCT demonstrates the long-term benefits of exclusive human milk nutrition in infants with SVP, with improved growth and reduced necrotizing enterocolitis. A multidisciplinary approach and a well-thought-out nutritional algorithm can optimize growth in infants with complex congenital heart disease, similar to healthy term infants up to 6 months of age. The majority of infants with SVP requiring an operation within the first month of life are able to achieve 100% of their intake via PO by 6 months of age; therefore, delaying gastrostomy tube placement until after the Glenn operation may be considered.
Synaptic density is strongly correlated with cognitive function in many neurological disorders. All synapses contain synaptic vesicle glycoprotein 2 A (SV2A), making it a potential therapeutic target for neurodecline. ABBV-552, a high-affinity positive SV2A modulator, increases neurotransmitter release, improving synaptic efficiency. This Phase 1, open-label, mass balance study examined ABBV-552 safety, pharmacokinetics, metabolism, and elimination. Eight healthy males were orally administered 15 mg [14C]-ABBV-552. Safety was assessed via treatment-emergent adverse event (TEAE), vital sign, electrocardiogram, and laboratory value monitoring. Serial blood, urine, and fecal samples were collected pre-dose, Days 1-14, and daily until discharge. Sample radioactivity was measured with HPLC and metabolites characterized with mass spectrometry. Eight participants (30-49 years old) received 15 mg [14C]-ABBV-552 (~ 100 µCi) and were included in analyses (3 prematurely withdrew [personal reasons]). All TEAEs were Grade 1 in severity; euphoria (25.0%), dizziness (25.0%), and muscular weakness (12.5%) were deemed possibly-related to ABBV-552. No meaningful changes in laboratory values, vital signs, or ECGs were observed. Mean radioactive recovery was 78.8% (urine: 70.9%, feces: 7.83%), with < 1% parent drug in excreta. Parent and one metabolite (M2, mono-oxidized parent) accounted for 84% and 13%, respectively, of circulating drug-related material. M5, M9, and M33 were most prominent in urine (~ 13%, ~ 17%, ~ 11% of dose, respectively); M2/M36 (coeluted; 1.4% of dose) in feces. Orally-administered ABBV-552 was well absorbed and primarily recovered in urine as metabolites. M2 was the only major circulating metabolite. Therefore, ABBV-552 is primarily hepatically metabolized and metabolites are renally eliminated. These findings support further investigation of ABBV-552 in neurodegenerative disorders. ClinicalTrials.gov (NCT06278766) Date of registration: 26 February 2024.
Colorectal cancer (CRC) patients are immunocompromised, making them more susceptible to infection. The aim of this study was to estimate the prevalence of nosocomial infection among CRC patients at Prince Noora Oncology Centre in National Guard Health Affairs and to analyze the relationship between various pathogens and clinico-pathological characteristics of CRC. A cross-sectional study was carried out at PNOC from the period 2016 until 2024 and included CRC patients whose age was >18 and excluded others. Cancer patients' demographics, personal and family history, cancer characteristics, infection characteristics, and pathogens were collected from medical records. A total of 377 patients with CRC were included, and 222 (58.9%) of them were males. The mean age was estimated to be 62.1 (SD13.4) years. About 235 (62.3%) of these patients were infected. The total number of detected pathogens was 690, of which 222 (32.2%) were Escherichia coli, followed by Klebsiella pneumonia, 86 (12.5%), and candida species, 61 (8.8%). A significant relationship was found to be between the presence of infection and several variables like blood group (O +ve), cancer stage, and metastasis (P < 0.05). Two-thirds of CRC patients developed nosocomial infections. Gram-negative bacteria like Escherichia coli and Klebsiella pneumonia are the most involved. In addition, blood group, metastasis, and late-stage cancer were identified as significant risk factors for such infections.
A precise economic representation of the central emergency department (ZNA) is a challenge for most hospitals. Due to the complex interrelationship of revenues from various systems, internal service billing, costs associated with the German Association of Statutory Health Insurance Physicians (KV), and process indicators, there are currently no analytical models that provide full transparency regarding the economic reality of the ZNA, and, thus, there is no solid basis for differentiated management. In a retrospective, quantitative study based on routine data (n = 150 cases) from 2024 from the Charité - Universitätsmedizin Berlin emergency department, which was selected based on specific criteria, a cost and revenue analysis was performed. In addition, resource intensive formal "hybrid cases" that were billed formally as outpatients but with inpatient characteristics were defined and included in the analysis, which until now have not been adequately reflected in any renumeration system. The term "hybrid" describes formal outpatient but resource intensive processes with inpatient characteristics. Personnel costs were not analyzed based on each case due to lack of a reliable method to assign these to the individual cases. Remuneration was inadequate in nearly all outpatient cases (-242 to -346 €/case depending on the Charité site). Hybrid cases form an especially critical group (-205 to -290 € per case depending on the site) due to the longer hospital stay and higher costs in the internal cost allocation (ILV). In some cases, inpatient cases had more favorable remuneration ratios and thus appear to be more cost-effective due to internal splitting logic. However, because only about 22 % of cases are hospitalized, while 78 % remain outpatients, the inpatient minority can not compensate for the structural deficits of the outpatient majority. The economic outcome is also negatively affected by the about 10 % costs associated with the KV. The systematic integration of cost, revenue, and process data is feasible and generates new information for management, but it remains incomplete due to limitations in the routine data. The results show that the economic difficulties of the ZNA are not primary due to the inefficient provision of services, but are due to structural causes of renumeration logic in the German healthcare system. The internal establishment of specific management tools, especially the linking of ILV, hospital stay duration and case type ("hybrid flag"), can contribute to improvements, but can not overcome the structural deficit. This structural underfinancing of emergency preparedness exacerbates the already strained financial situation of hospitals and requires future reform that explicitly takes into consideration aspects of standby capacity components and the actual provision of services. HINTERGRUND: Die präzise ökonomische Abbildung zentraler Notaufnahmen (ZNA) stellt sich für die meisten Krankenhäuser als Herausforderung dar. Durch die komplexe Verknüpfung von Erlösen aus verschiedenen Systemen, interner Leistungsverrechnung, Absetzungen der Kassenärztlichen n Vereinigung (KV) und Prozesskennzahlen fehlen bisher Analysemodelle, die eine vollständige Transparenz über die ökonomische Realität der ZNA herstellen und damit die Grundlage für eine differenziertere Steuerung bilden. In einem retrospektiven, quantitativen Studiendesign auf Basis von Routinedaten von n = 150 Fällen des Jahrs 2024 aus den Notaufnahmen der Charité – Universitätsmedizin Berlin, die nach differenzierten Kriterien ausgewählt wurden, wurde eine Kosten- und Erlösanalyse durchgeführt. Zusätzlich wurden ressourcenintensive, formal ambulant abgerechnete „hybride Fälle“ mit stationären Merkmalen definiert und in die Analyse einbezogen, die bislang in keiner Abrechnungssystematik adäquat abgebildet sind. Der Begriff „hybrid“ beschreibt dabei formal ambulante, jedoch ressourcenintensive Verläufe mit stationären Charakteristika. Personalkosten wurden aufgrund der fehlenden Möglichkeit, diese einzelnen Fällen eindeutig zuzuordnen, nicht fallbezogen analysiert. Ambulante Fälle weisen nahezu durchgängig wirtschaftlich ungünstige Deckungswerte auf (−242 bis −346 €/Fall je nach Charité-Standort). Hybride Fälle bilden aufgrund langer Aufenthaltsdauern und hoher Kosten in der internen Leistungsverrechnung (ILV) ein besonders kritisches Segment (−205 bis −290 € pro Fall je nach Standort). Stationäre Fälle weisen in der internen Splitting-Logik teilweise wirtschaftlich günstigere Deckungswerte auf und erscheinen damit ökonomisch günstiger. Da jedoch nur rund 22 % der Fälle stationär sind, während 78 % ambulant verbleiben, kann die stationäre Minderheit die strukturellen Defizite der ambulanten Mehrheit nicht kompensieren. Das ökonomische Ergebnis wird zusätzlich durch etwa 10 %ige Absetzungen durch die Kassenärztliche Vereinigung belastet. Die systematische Verknüpfung von Kosten‑, Erlös- und Prozessdaten ist möglich und schafft neue Steuerungsinformationen, bleibt aber durch die Limitationen der Routinedaten unvollständig. Die Ergebnisse zeigen, dass die ökonomische Schieflage der ZNA nicht primär auf ineffiziente Leistungserbringung, sondern auf strukturelle Ursachen der Vergütungslogik im deutschen Gesundheitssystem zurückzuführen ist. Die interne Etablierung spezifischer Steuerungsinstrumente, insbesondere die Verknüpfung von ILV, Aufenthaltsdauer und Fallart („hybrid flag“), kann zur Verbesserung beitragen, aber das Strukturdefizit nicht überwinden. Diese strukturelle Unterfinanzierung der Notfallbereitschaft verschärft die ohnehin angespannte wirtschaftliche Lage der Krankenhäuser und erfordert eine künftige Reform, die Vorhaltekomponenten und die tatsächliche Leistungserbringung explizit berücksichtigt.
The tiny Allomerus ants utilise antibiotic producing bacteria to maintain the fungal monoculture that they grow to camouflage and reinforce the galleries that they build for the capture of insect prey. Until now, filipin complex was the only identified antifungal used in the trap ant system. Here we chemically identify the presence of the unusual and potent antifungal vD844. We identify the biosynthetic gene cluster responsible for its assembly and demonstrate its heterologous expression. With the full set of genes encoding vD844 in hand, we reveal further insight into the biosynthesis of this unusual compound.
To determine the prevalence of oral alterations among critical patients within the first 48 hours of intensive care unit admission, and their association with hospital-acquired pneumonia, bloodstream infections, and sepsis. This prospective cohort study was conducted from March 2018 to December 2021 in a Brazilian neurology intensive care unit. A single dental surgeon assessed oral conditions with follow-up until hospital discharge. Logistic regression analyzed the association between oral alterations and outcomes (hospital-acquired pneumonia, bloodstream infections, and sepsis), adjusting for confounders. We enrolled 248 patients (55.6% male; mean age, 67.2 years), of whom 97.6% had oral abnormalities. The most common were visible dental plaque (61.7%), gingival inflammation (60.9%), and five or more missing teeth (49.2%). Carious teeth were linked to pneumonia (OR 1.10; 95%CI 1.00 - 1.20; p = 0.047). Destroyed teeth (OR 1.12; 95%CI 1.02 - 1.23; p = 0.02) and visible plaque (OR 1.08; 95%CI 1.00 - 1.17; p = 0.04) were associated with bloodstream infections. No factors were linked to sepsis. Most patients exhibited oral alterations upon admission to the intensive care unit. Carious teeth may increase pneumonia risk, while destroyed teeth and visible plaque may raise bloodstream infection risk.
Rice kernel smut, caused by the fungus Tilletia horrida Tak., is an emerging disease of rice. The pathogen infects germ cells at the early flowering stage, yet the plant remains asymptomatic until maturity. The rice plant may recognize it as a stress-inducible factor, triggering the expression of various stress-responsive genes and pathways. However, researchers are attempting to identify kernel smut-resistant genes in cell-surface proteins (elicitors), secretory proteins, glycoside hydrolase family proteins, and effector proteins. Based on annotated effector proteins and integrated analyses of available gene-expression datasets, this study aims to identify allelic variation in a putative candidate gene to develop a functional marker for marker-assisted identification of both resistant and susceptible rice lines. The gene OsLAC11 was found to be strongly associated with kernel smut resistance and is expressed on the first day of flowering in rice, which aligns with the infection window and supports its role in resistance. Sanger sequencing of the OsLAC11 gene across ten rice germplasms with varying levels of kernel smut resistance identified two single nucleotide polymorphisms (SNPs) in intronic regions. The first SNP (G/T allele) was used to develop a functional marker using Polymerase Chain Reaction (PCR) with the Confronting Two-Pair Primers (CTPP). This marker effectively differentiated kernel smut-resistant rice lines from susceptible ones and was validated through phenotypic disease ratings. The molecular marker developed in this study represents a significant advancement in breeding for kernel smut resistance, providing a robust tool to accelerate genetic gains and streamline marker-assisted selection in rice improvement programs.
This study aimed to update the European Alliance of Associations for Rheumatology (EULAR) recommendations for management of polymyalgia rheumatica (PMR), giant cell arteritis (GCA), and Takayasu arteritis (TAK). Following EULAR standard operating procedures, systematic literature reviews identified data published since the previous versions for PMR (2015) and for GCA/TAK (2018). An international task force discussed the evidence, and following a structured voting process, created overarching principles, recommendations, and quality indicators. The task force agreed on 4 overarching principles, 12 recommendations, and 2 quality indicators. All patients with suspected PMR, GCA, or TAK should be referred for specialist assessment and those with suspected GCA within 24 hours. In patients with a strong clinical suspicion of GCA, treatment with glucocorticoids (GCs) should be commenced without delay, while waiting for the results of confirmatory investigations. For most patients with suspected PMR or TAK, treatment with GC can be delayed until the diagnosis is confirmed. For induction of remission, GC should be initiated at a dose of 15 to 25 mg/day prednisone-equivalent for PMR and 40 to 60 mg for GCA or TAK. Guidance on GC tapering is provided. Adjunctive therapy is recommended for selected patients with PMR or GCA using either interleukin (IL)-6 receptor inhibitors for PMR and GCA or upadacitinib for GCA. Methotrexate may be an alternative. GC-sparing agents should be given in combination with GC to all patients with TAK. All overarching principles and recommendations met with high levels of agreement. Updated guidance on management of PMR and large vessel vasculitis is provided in a single set of practical recommendations and algorithms.
Canadian population-based data show that sexually diverse youth face greater mental health challenges than their heterosexual peers. However, nuances within sexual diversity-particularly among mostly heterosexual persons-are overlooked, and psychotic-like experiences remain underexplored. We examined the mental health of sexually diverse young adults from Quebec, spanning indicators from well-being to psychotic-like experiences. Data were drawn from 1324 youth from the Quebec Longitudinal Study of Child Development-a representative cohort born in 1997/98 and followed up until age 23. Participants self-reported their sexual orientation and mental health across nine indicators: suicidality, depression, anxiety, binge drinking, cannabis, other drug use, psychotic-like experiences, well-being, and help-seeking. Standardized mean differences (SMD) assessed group differences, stratified by assigned sex at birth and sexual orientation. A total of 324 (24.47%) youth identified as non-heterosexual. These youth reported poorer outcomes across all indicators (SMDs ranged from 0.19 for cannabis use to 0.52 for suicidality) and had higher odds of seeking psychological help (OR = 2.09, 95% CI [1.52-2.89]). Sexually diverse females reported poorer outcomes across all indicators compared to heterosexual females. Sexually diverse males had elevated risks for suicidality, depression, anxiety, and reduced well-being compared to heterosexual males. Mostly heterosexual (N = 156, 48.15%) and bisexual persons (N = 85, 26.23%) reported more symptoms than heterosexuals. Despite Canada's inclusive stance on sexual diversity, sexually diverse youth-especially those identifying as mostly heterosexual and bisexual-continue to face significant mental health disparities. Our findings highlight the need for accessible, tailored mental health services to support this population. RéSUMé: OBJECTIFS: Les données canadiennes issues d’études populationnelles montrent que les jeunes issus de la diversité sexuelle présentent des problèmes de santé mentale plus importants que leurs pairs hétérosexuels. Cependant, les différences au sein de la diversité sexuelle, particulièrement chez les personnes majoritairement hétérosexuelles, demeurent peu étudiés, et les expériences de type psychotique sont négligées. Nous avons examiné la santé mentale de jeunes adultes québécois avec des orientations sexuelles diverses, en nous appuyant sur des indicateurs allant du bien-être aux expériences de type psychotique. MéTHODES: Les données proviennent de 1 324 jeunes issus de l’Étude longitudinale du développement de l’enfant au Québec — une cohorte représentative née en 1997/98 et suivie jusqu’à l’âge de 23 ans. Les participants ont déclaré leur orientation sexuelle et leur santé mentale à l’aide de neuf indicateurs : tendances suicidaires, dépression, anxiété, consommation excessive d’alcool, consommation de cannabis, consommation d’autres drogues, expériences de type psychotique, bien-être et recours à l’aide. Les différences moyennes standardisées (DMS) ont été utilisées pour comparer les groupes, stratifiées selon le sexe attribué à la naissance et l’orientation sexuelle.  RéSULTATS: 324 jeunes (24,47 %) se sont identifiés comme non hétérosexuels. Ces jeunes ont fait état de résultats moins favorables pour l’ensemble des indicateurs (les DMS variaient de 0,19 pour la consommation de cannabis à 0,52 pour les tendances suicidaires) et présentaient un risque plus élevé de rechercher de l’aide psychologique [rapport de cotes (OR) = 2,09 ; IC à 95 % [1,52–2,89]]. Les personnes de sexe féminin à orientation sexuelle diverse ont fait état de résultats moins favorables pour tous les indicateurs par rapport aux personnes de sexe féminin hétérosexuelles. Les personnes de sexe masculin à orientation sexuelle diverse présentaient des risques accrus de tendances suicidaires, de dépression, d’anxiété et démontraient leur bien-être réduit par rapport aux personnes de sexe masculin hétérosexuelles. Les personnes majoritairement hétérosexuelles (N = 156, 48,15 %) et bisexuelles (N = 85, 26,23 %) ont signalé davantage de symptômes que les personnes hétérosexuelles. CONCLUSION: Malgré les politiques canadiennes favorables à la diversité sexuelle, les jeunes issus de la diversité sexuelle — en particulier ceux qui s’identifient majoritairement hétérosexuels ou bisexuels — continuent de faire face à d’importantes inégalités en matière de santé mentale. Nos résultats soulignent la nécessité de mettre en place des services de santé mentale accessibles et adaptés pour soutenir cette population.
Adjusting limb movements when stepping over obstacles is essential to avoid tripping, especially in older adults among whom age-related physical decline increases the risk of falls. This study aimed to determine whether older adults modify their foot movements according to obstacle shape, particularly the presence of a vertical edge, and whether their responses differ from those of younger adults. Data from 12 younger and 13 older adults were analyzed. Participants stepped over obstacles placed 5 m away under four conditions that varied in shape and dimensions. Raised rectangular obstacles with clearly defined vertical edges and raised arch-shaped obstacles without vertical edges were presented in small (2.5 cm high × 8 cm deep) and large (5 cm high × 16 cm deep) sizes. Foot trajectories during the swing phase from toe-off to heel contact were compared using Statistical Parametric Mapping (SPM). Compared with raised arch-shaped obstacles, younger adults raised their leading foot higher when crossing both small and large raised rectangular obstacles, beginning at approximately 30% of the swing phase and continuing until immediately before the obstacle was crossed. By contrast, SPM did not reveal significant differences in foot trajectory patterns between raised rectangular and arch-shaped obstacles in older adults. However, discrete foot-clearance measures at obstacle crossing showed significant shape-related differences in both groups. These findings suggest that trajectory-level adaptation to obstacle shape was less clearly expressed in older adults than in younger adults under the examined conditions and that obstacle-shape effects may be detected differently by full-trajectory and discrete analyses.
We investigated the contribution of antecedent gestational diabetes mellitus (GDM) or gestational hypertensive disorder (GHTD) to the risk of cardiovascular disease (CVD) among women with Type 2 diabetes mellitus (T2DM). In a population-based cohort using the Ministry of Health of Ontario (Canada) healthcare administrative data, women without prior CVD with T2DM and a history of GDM or GHTD as of 1 January 2018 (n = 11 525, mean age: 43 years) were age-matched to three comparator cohorts (women with T2DM and no history of GDM or GHTD [n = 11 525], women without T2DM and without GDM or GHTD [n = 11 525] and men with T2DM [n = 11 525]). Incident CVD (coronary artery disease [CAD] and cerebrovascular disease) and heart failure (HF) were assessed until 31 December 2023. There were 1231 CVD events over a median follow-up of 6 years. Compared to women with T2DM but no history of GDM or GHTD, women with T2DM and a history of GDM or GHTD exhibited higher incident CVD (adjusted hazard ratio [aHR]: 1.19, 95% CI: 1.01, 1.41) and CAD (aHR: 1.35, 95% CI: 1.10, 1.66) risks. They also had higher CVD (aHR: 3.70, 95% CI: 2.79, 4.91), CAD (aHR: 4.96, 95% CI: 3.43, 7.19), cerebrovascular disease (aHR: 2.41, 95% CI: 1.54, 3.76) and HF (aHR: 4.95, 95% CI: 2.05, 11.94) risks versus women without T2DM and no history of GDM or GHTD. However, they had lower CVD, CAD, cerebrovascular disease and HF risks, compared to men with T2DM. Among women with T2DM, prior GDM or GHTD conferred a higher CVD risk.
The development of highly selective coordination complexes requires a precise understanding of how electronic structure dictates ligand affinity. We employ density functional theory (DFT) and conceptual DFT (cDFT) to elucidate the structural and redox-driven mechanisms of diruthenium paddlewheel complexes. Our analysis reveals a critical electronic-structural switch: the cationic Ru(III)Ru(III) core is paradoxically the softest Lewis acid among all accessible redox states. This finding contravenes simple electrostatic predictions of the Hard and Soft Acids and Bases (HSAB) principle, demonstrating that the significant Ru-Ru bond contraction upon oxidation (from 2.24 Å to 2.19 Å) dominates the electronic structure, creating a highly polarizable Lewis acid center. This unique structural property dictates a pronounced thermodynamic affinity for soft nucleophiles like cysteine (Cys) and selenocysteine (Sec), yielding highly exergonic substitution energies of -33.3 and -26.6 kcal mol-1, respectively. We characterize this mechanism as a redox-gated thermodynamic trap, where the complex remains in a lower-affinity state until localized oxidation "switches on" the maximally potent Ru(III)Ru(III) form. Detailed frontier molecular orbital analysis confirms that the lowering of the dz2 orbital energy and the availability of empty dπ orbitals in the oxidized state enable superior σ-donation and π-acceptance. These results provide quantitative structural design principles, demonstrating that tuning the equatorial ligands to control oxidation potentials is key to ensuring site-specific activation and irreversible binding to soft biological targets.
Management of patients over 50 years old with a rotator cuff tear (RCT), remains complex and individually driven. We assessed long-term clinical and radiological outcomes under conservative treatment and searched for any feature that would better define medical strategy. A prospective multicentric cohort. Ten participating tertiary level centers. We included 127 patients, aged 50 to 75, with a symptomatic RCT confirmed by MRI and not warranting surgical repair on the short term, according to current practice recommendations. 104 of them (82% retention rate) were evaluated at 2-year follow-up visit. Among those 104 patients,78 agreed to participate in an extension phase until 5-year final follow-up and 75 of them were evaluated at this time-point. The principal objective was to determine clinical outcome 2 years following diagnosis, using Constant score. Secondary objectives were to evaluate clinical outcomes at 5-year follow-up and radiological outcomes, centrally assessed by MRI, at baseline, 2 and 5-year follow-up visits. Among the 104 patients that remained in follow-up at 2 years, 8 had shoulder surgery and 8 reported a worsening clinical evolution at M24. Only 4 of the 78 enrolled in the extension phase had worsening of Constant score at 5-year follow-up visit. MRI evaluation was carried out in 94 patients at 2-year and 70 at 5-year follow-up. Among them, 70 % at 2-year and 60% at 5-year follow-up evaluation had no radiological worsening of their RCT, compared to baseline. We also observed a significant degradation of muscle status, including atrophy or fatty infiltration, in 54.3% of patients at 2-year and 71.4% at 5-year follow-up. No correlation was found between Constant score and this structural muscle evolution. Patients with RCT had a favorable clinical outcome under conservative treatment, while a majority of RCT remained stable in those who remained in a 5-year follow-up. However, progression of fatty muscle infiltration seems an inexorable process, independent of clinical evolution. NCT02510352.
Industry interference remains a major barrier to effective tobacco control. WHO Framework Convention on Tobacco Control (FCTC) Article 5.3 obliges Parties to protect public health policies from industry influence, yet systematic monitoring of interference is often lacking. The emergence of new nicotine products and actors further complicate implementation and monitoring. Within Joint Action PreventNCD, we assessed monitoring and information exchange practices related to tobacco and nicotine industry interference in five European countries (Belgium, Estonia, Finland, Iceland, and Slovenia). Partner organizations (n = 5) completed an online questionnaire (July-September 2024) and the responses were descriptively analysed. To supplement the questionnaire data, we continued and expanded the search for recent interference examples until January 2025, covering examples from 2019 to 2024 through a review of publicly available sources; these were categorized by known interference tactics. Although all partners acknowledged the importance of monitoring, most countries lacked protocols, designated entities, or registries for industry interference. While some disclosure measures existed, such as policies requiring disclosure of meetings with industry and potential conflicts of interest, comprehensive safeguards were rare. Interference examples underscored the need for stronger monitoring, as known interference tactics-lobbying, harm-reduction narratives, corporate social responsibility campaigns, and use of front groups-were consistently employed, particularly around regulatory blind spots and new nicotine products. Systematic monitoring of tobacco and nicotine industry interference is essential to safeguard public health policies under WHO FCTC Article 5.3. Building national capacity, fostering collaboration between governments and civil society, and using international benchmarking tools are important steps toward this goal.
To synthesise published literature to understand how, when and under what circumstances Intentional Rounding in acute hospital settings improves patient safety and make recommendations for implementation in real-world settings. Inpatient falls often result in injury due to complex interactions between the hospital environment and patient risk factors. Intentional Rounding (IR) is a structured process whereby nurses and care staff carry out regular checks with individual patients to address their needs in hospital. Realist Synthesis. Searches were conducted in six bibliographic databases until February 2026. A total of 34 studies were included, and 18 references from grey literature were appraised and included. Fourteen initial programme theories were identified and refined throughout the synthesis to identify five mechanisms which support implementation of IR in an acute hospital setting, with six programme theories developed. The mechanisms included motivation, accountability, engagement, consistency, comprehensiveness, and critical thinking. Contextual factors that may constrain the implementation of IR include the organisational support and availability of resources. Based on our findings, we have seven recommendations for consideration when designing and implementing an IR programme in the acute hospital setting. This synthesis has provided programme theories and recommendations that can guide research design when implementing an intervention at ward level. IR has been used in hospitals as an intervention to improve patient safety and reduce adverse events, such as falls. Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES-1). An in-person stakeholder engagement workshop was facilitated in March 2025, with patient representatives, hospital staff and members of the public. This engagement assisted the process of theory refinement to ensure research findings were clear and useful for those involved in providing and receiving IR in a hospital setting.
BackgroundImplantable venous access devices are widely used in oncology but introduce an additional risk of venous thromboembolism (VTE). Data on the incidence and temporal distribution of thrombotic events after port implantation remain limited and heterogeneous. This study aimed to evaluate the incidence and timing of VTE following implantable port placement in cancer patients.MethodsThis single-centre cohort study included consecutive adult oncology patients undergoing totally implantable venous access device placement between February 2024 and August 2024. Early catheter-related thrombosis (CRT) was assessed using ultrasound 10-12 days after implantation. Outcomes were obtained through chart review until February 2026. The primary endpoint was first objectively confirmed VTE event. Cumulative incidence functions accounting for death as a competing risk were used for time-to-event analyses.ResultsA total of 131 patients were included in survival analysis. Early CRT was detected in 2.29% of patients. During a median follow-up of 534 days, nine VTE events occurred (6.87%), corresponding to an incidence rate of 0.166 per 1,000 catheter-days. Six patients (4.58%) died during follow-up. The cumulative incidence of late VTE accounting for death as a competing risk was 3.26% at 90 days, 5.94% at 180 days and 8.05% at 365 days. No predictors of late VTE were identified in exploratory analyses.ConclusionsVTE following implantable port placement occurs with a modest cumulative incidence and was concentrated within the first six months after implantation. Early asymptomatic CRT was uncommon. These findings highlight a period of increased thrombotic vulnerability during early port use.
The concept of dignity in the context of nursing home care for older adults remains vague, hindering further research in this area. This systematic review aims to conceptualize the characteristics of dignity in nursing home care for older adults, with attention to Chinese cultural perspectives. The six international databases SCOPUS, PubMed, CINAHL, Embase, Ovid, and PsycInfo, and one Chinese database CNKI will be searched from inception to 31st August 2025, and eligible studies will be primarily evaluated. The literature selected will focus on primary studies that explore older adults' perceptions of dignity who have resided in the nursing home for at least one month, encompassing their experiences and the factors influencing dignity. This review will draw exclusively on peer-reviewed journal articles, with no language restrictions applied. Grey literature - including dissertations, theses, conference proceedings, and institutional reports - will not be considered for inclusion. The systematic review will adhere to the PRISMA 2020 guidelines and will be registered with PROSPERO. Three reviewers (a lead researcher, a graduate student assistant, and a non-nursing assistant) will primarily screen the titles and abstracts separately. And two professional reviewers (the lead researcher and the graduate student assistant) continue to select studies and extract data independently following the predesigned data extraction forms. Any discrepancies will be documented and resolved by a third external reviewer until consensus is reached. The quality of the included literature will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, and the findings will be synthesized using the meta-aggregation approach. This review is expected to identify key themes across two domains: inherent dignity (satisfying physical needs) and social dignity (individuality, identity and independence). It will also identify the key factors influencing dignity, including personal factors (functional status), organizational factors (staff attitudes, organizational ethical environment), and sociocultural factors (Chinese cultural norms such as collectivism). The results of the dignity in care will help healthcare providers implement dignified care in nursing homes.
Shift work is increasingly common in modern societies but is strongly associated with misalignments of natural circadian rhythms, which may negatively impact dietary behaviour and psychosocial well-being. Chronotype, an individual's natural sleep-wake preference, influences adaptation to shift work and its associated lifestyle challenges. This systematic review aimed to examine the relationship between chronotype on both eating behaviour and psychosocial well-being among shift workers. A systematic search was conducted in accordance with PRISMA 2020 guidelines. Literature searches were performed in Web of Science, Scopus, PubMed, and Cochrane from database inception until April 2026. Eligible studies included research involving adult shift workers reporting on chronotype in relation to eating behaviour and psychosocial aspects. Quality appraisal was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Twenty-nine studies met the inclusion criteria, comprising primarily nurses and healthcare workers, with additional representation from manufacturing and services sectors. Evening chronotypes consistently exhibited less healthy dietary habits, including irregular meal timing, skipping breakfast, delayed food intake, greater consumption of energy-dense foods, lower fibre intake, and higher alcohol use. Additionally, psychosocial outcomes showed similar patterns, with evening types reported significantly higher levels of depression, anxiety, stress, emotional exhaustion, and burnout compared to morning and intermediate types. Misalignment between chronotype and shift schedule further amplifies these effects, whereas alignment improved job satisfaction and well-being. Sleep disturbances, a contributing factor that can exacerbate psychosocial issues, were observed to be more common in evening types as compared to morning and intermediate types. Evening chronotype is a key vulnerability factor for both unhealthy eating habits and impaired psychosocial well-being among shift workers. Organisational strategies such as chronotype-sensitive scheduling, access to healthier food options, and tailored psychosocial support may mitigate these risks. Future longitudinal and interventional research is needed to establish causal pathways and to evaluate the effectiveness of chronotype-based workplace interventions.
Metastatic spinal tumors (MSTs) may cause pathologic burst fractures with severe pain and neurologic compromise, often requiring circumferential decompression and anterior column reconstruction. Traditional open corpectomy is associated with substantial surgical morbidity. Transpedicular intrabody augmentation has emerged as a minimally invasive alternative; however, an endoscopic approach using UBE for oncologic anterior reconstruction has not been well described. A 73-year-old man with polymetastatic colon cancer presented with debilitating axial back pain, bilateral lower-extremity weakness (motor grade 3), and radiculopathy due to an L2 metastatic burst fracture. He underwent percutaneous posterior screw fixation (T12-L4) followed by UBE-assisted transpedicular tumor resection and partial corpectomy. A transpedicular corridor was created through a unilateral laminotomy, enabling ventral tumor removal under direct endoscopic visualization. An expandable titanium cage was inserted and expanded for anterior support while preserving the posterior ligamentous complex. Ventral decompression and anterior column support were achieved through a posterior-only UBE-assisted transpedicular approach. The patient experienced immediate pain relief, ambulated on postoperative day 1 with motor strength improving to grade 4 + , and reported marked pain improvement by postoperative day 7 (NRS 1). Postoperative imaging confirmed satisfactory cage position; ambulation was maintained until death from systemic disease progression at 2 months. This case suggests that UBE-assisted transpedicular intrabody cage augmentation is technically feasible in a carefully selected patient with a metastatic pathologic burst fracture requiring ventral decompression and anterior support. Further experience and longer follow-up are needed to clarify its safety, durability, and role relative to established surgical approaches. Technical case report.