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Xianhua Zhang, Enqin Yan School of Education, Shandong Women’s University, Jinan, People’s Republic of ChinaCorrespondence: Enqin Yan, Email 15069198361@163.comObjective: This study investigates the impact of maternal childhood trauma on children’s problem behaviors, focusing on the mediating role of maternal depression and the moderating role of mindful parenting.Methods: The study used a convenience sampling method to survey 385 mother-child pairs from kindergartens in Jinan, China. Data were collected in two waves, and various validated questionnaires were used to assess maternal childhood trauma, depression, mindful parenting, and children’s problem behaviors.Results: Maternal childhood trauma positively predicted children’s problem behaviors. Maternal depression was found to mediate this relationship. Mindful parenting moderated the effects of maternal childhood trauma and depression on children’s problem behaviors, with high levels of mindful parenting mitigating these adverse effects.Conclusion: Maternal childhood trauma impacts children’s problem behaviors both directly and indirectly through maternal depression. Mindful parenting serves as a protective factor, reducing the negative impact of maternal childhood trauma and depression on children’s problem behaviors. These findings highlight the importance of interventions aimed at enhancing mindful parenting practices to improve child outcomes.Keywords: maternal childhood trauma, children’s problem behaviors, maternal depression, mindful parenting

This experiment employed viewing time methods to investigate the effects of individual differences in visuospatial working memory (VWM) on the processing of older adults' bridging inferences in the understanding of visual narratives. The results showed that older adults could make bridging inferences in visual narrative processing, and that VWM had no significant effect on the generation of older adults' bridging inferences in visual narrative comprehension. The findings of this study have the potential to enrich and advance the theories and models related to discourse comprehension and its inference processing, and they would have important implications for using visual media to facilitate training in inference processing.

Background and purpose: The baseline glucose-to-potassium ratio (GPR) is associated with poor outcomes in patients with acute brain injury and intracranial hemorrhage. However, the impact of serum GPR on clinical outcomes after endovascular thrombectomy (EVT) is unclear. This study aimed to evaluate the association between the GPR at admission and functional outcomes at 90 days after EVT. Methods: We retrospectively reviewed our database for patients with acute ischemic stroke involving an anterior circulation large-vessel occlusion who received EVT between October 2019 and December 2021. The baseline serum GPR was measured after admission. The primary outcome was a 90-day poor outcome, which was defined as a modified Rankin scale score of 3–6. Results: A total of 273 patients (mean age, 70.9 ± 11.9 years; 161 men) were finally included for analyses. During the 90-day follow-up, 151 patients (55.3%) experienced an unfavorable outcome. After adjusting for demographic characteristics and other potential confounders, the increased GPR was significantly associated with a higher risk of a 90-day poor outcome (odds ratio, 1.852; 95% confidence interval, 1.276–2.688, p = 0.001). Similar results were observed when the GPR was analyzed as a categorical variable. In addition, the restricted cubic spline observed a positive and linear association between the GPR and poor outcomes at 90 days (p = 0.329 for linearity; p = 0.001 for linearity). Conclusion: Our study found that ischemic stroke patients with the higher GPR at admission were more likely to have an unfavorable prognosis at 3 months, suggesting that GPR may be a potential prognostic biomarker for ischemic stroke after EVT. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes. Objectives: To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA. Design: A pilot randomized, double-blind, placebo-controlled trial. Setting: A tertiary university hospital in Beijing, China. Patients: One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28  mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022. Intervention: After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02  μg/kg/h) or placebo. We monitored polysomnogram from 9:00  pm to 6:00  am during the first night. Main outcome measures: Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0–100 score range, higher score better). Results: All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p  =  0.029); it also decreased the percentage of stage N1 sleep (median difference, −10%; 95% CI, −20% to −1%; p  =  0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p  =  0.060). Adverse events were similar between groups. Conclusion: Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events. [ABSTRACT FROM AUTHOR]

Background and purpose: The baseline glucose-to-potassium ratio (GPR) is associated with poor outcomes in patients with acute brain injury and intracranial hemorrhage. However, the impact of serum GPR on clinical outcomes after endovascular thrombectomy (EVT) is unclear. This study aimed to evaluate the association between the GPR at admission and functional outcomes at 90 days after EVT. Methods: We retrospectively reviewed our database for patients with acute ischemic stroke involving an anterior circulation large-vessel occlusion who received EVT between October 2019 and December 2021. The baseline serum GPR was measured after admission. The primary outcome was a 90-day poor outcome, which was defined as a modified Rankin scale score of 3-6. Results: A total of 273 patients (mean age, 70.9 ± 11.9 years; 161 men) were finally included for analyses. During the 90-day follow-up, 151 patients (55.3%) experienced an unfavorable outcome. After adjusting for demographic characteristics and other potential confounders, the increased GPR was significantly associated with a higher risk of a 90-day poor outcome (odds ratio, 1.852; 95% confidence interval, 1.276-2.688, p = 0.001). Similar results were observed when the GPR was analyzed as a categorical variable. In addition, the restricted cubic spline observed a positive and linear association between the GPR and poor outcomes at 90 days (p = 0.329 for linearity; p = 0.001 for linearity). Conclusion: Our study found that ischemic stroke patients with the higher GPR at admission were more likely to have an unfavorable prognosis at 3 months, suggesting that GPR may be a potential prognostic biomarker for ischemic stroke after EVT. [ABSTRACT FROM AUTHOR]

The detection algorithms of small objects in remote sensing images is often challenging due to the complex background and limited pixels. This can lead to reduced accuracy in detection and an increased number of missed small objects. So this paper introduces YOLOFNC, an enhanced network based on YOLOv7. To improve the model's ability to capture features of small objects, an enhanced C3-Faster module based on the C3 module is designed and integrated into the YOLOv7 network. This module helps extract more features related to small objects. Additionally, we employ Normalized Wasserstein Distance (NWD) fusion GIoU as a novel loss function to refine the accuracy of network optimization weights and the small object regression framework. Furthermore, a coordinated attention (CA) mechanism is incorporated at strategic locations in the model to reduce redundant information in the feature layer and prevent the loss of important small object features. we conduct comparison experiments between YOLO-FNC and other commonly used object detection algorithms on DIOR, AITOD, and VisDrone datasets. The experimental results show that YOLO-FNC achieves 84.4% mAP on the DIOR dataset, 35.9% mAP on the AI-TOD dataset, and 52.6% mAP on the VisDrone dataset. Compared to YOLOv7 and other remote sensing object detection models, YOLO-FNC demonstrates better performance in object detection. [ABSTRACT FROM AUTHOR]

This experiment employed viewing time methods to investigate the effects of individual differences in visuospatial working memory (VWM) on the processing of older adults' bridging inferences in the understanding of visual narratives. The results showed that older adults could make bridging inferences in visual narrative processing, and that VWM had no significant effect on the generation of older adults' bridging inferences in visual narrative comprehension. The findings of this study have the potential to enrich and advance the theories and models related to discourse comprehension and its inference processing, and they would have important implications for using visual media to facilitate training in inference processing. [ABSTRACT FROM AUTHOR]

Background and purpose: Caveolin‐1 (Cav‐1) is reported to mediate blood–brain barrier integrity after ischaemic stroke. Our purpose was to assess the role of circulating Cav‐1 levels in predicting symptomatic intracranial haemorrhage (sICH) amongst ischaemic stroke patients after endovascular thrombectomy (EVT). Methods: Patients with large‐vessel occlusive stroke after EVT from two stroke centres were prospectively included. Serum Cav‐1 level was tested after admission. sICH was diagnosed according to the Heidelberg Bleeding Classification. Results: Of 325 patients (mean age 68.6 years; 207 men) included, 47 (14.5%) were diagnosed with sICH. Compared with patients without sICH, those with sICH had a lower concentration of Cav‐1. After adjusting for potential confounders, multivariate regression analysis demonstrated that the increased Cav‐1 level was associated with a lower sICH risk (odds ratio 0.055; 95% confidence interval 0.005–0.669; p = 0.038). Similar results were obtained when Cav‐1 levels were analysed as a categorical variable. Using a logistic regression model with restricted cubic splines, a linear and negative association of Cav‐1 concentration was found with sICH risk (p = 0.001 for linearity). Furthermore, the performance of the conventional risk factors model in predicting sICH was substantially improved after addition of the Cav‐1 levels (integrated discrimination index 2.7%, p = 0.002; net reclassification improvement 39.7%, p = 0.007). Conclusions: Our data demonstrate that decreased Cav‐1 levels are related to sICH after EVT. Incorporation of Cav‐1 into clinical decision‐making may help to identify patients at a high risk of sICH and warrants further consideration. [ABSTRACT FROM AUTHOR]

Literature on integrated coastal zonal management (ICZM) for coastal sustainability from a legal perspective provided significant measures. Recently, sustainable development goals (SDGs) have become a focus in ICZM literature, which establishes coastal goals and connects these goals with other goals. Although integrating coastal goals into ICZM under international law challenges the existing models presented in the literature, the comprehensive literature review (CLR) methodology is appropriate for observing the current literature and provides a way-forward for coastal goals. Therefore, through this research, a CLR on ICZM literature is conducted to observe how far SDGs are integrated for coastal sustainability. The CLR identified that coastal city governance is a pertinent part of ICZM, and the coastal goals are devised in the form of environmental goals of SDG - 14 (life below water). This CLR examines the anthropogenic connections of waste, sanitation, and emissions management and urban planning with coastal ecosystems under the ICZM system. For such purposes, governance tools of science-policy integration under international law and policy for sustainable development are utilized to form an obligatory framework. The CLR further provided coordination, adaptivity, monitoring, and capacity-building tools, which were utilized thoroughly throughout the literature and can be incorporated with the SDGs in a multilevel governance framework of ICZM. Throughout the study, international law formulating SDGs is pivotal to be transplanted successfully into the ICZM governance processes. [ABSTRACT FROM AUTHOR]

Social distancing is an important non-pharmaceutical intervention tool (NPIs) to prevent the spread of COVID-19. However, it also created negative impacts of economic activities. Understanding the emotions and public opinions about social distancing are important for the future policy making of COVID-19 mitigation and the assessment of public health impacts. This study collected 77,627 number of Twitter messages (tweets) between February 1, 2020 and April 30, 2020 from five English-speaking countries (United States, the United Kingdom, India, Canada, and Australia) using the social distancing keywords. We adopted a multi-module hybrid convolutional neural network model sentiment analysis on social distancing related tweets with 85.95% accuracy. This paper conducts a sentiment analysis of tweets from the public on social distancing measures in five countries. Our findings show similar sentiments in tweets from these five countries, which is more positives than negatives about social distancing measures in the public. Additionally, when the daily number of new cases changes, public sentiment fluctuates with it. We believe that social distancing is effective in preventing the spread of coronavirus. [ABSTRACT FROM AUTHOR]

Sustainable Development Goal 14 (SDG 14) was launched in 2015 to provide an overarching governance framework for long-term sustainable ocean development. This research paper analyzes the extent to which global and regional organizations are coherent with SDG 14 under the existing frameworks of international law. This research paper further assessed Multilateral Environmental Agreements (MEAs) under the framework of the United Nations Convention on Law of the Sea (UNCLOS) and International Environmental Law (IEL) in the context of joint governance of ocean and fisheries as Large Marine Ecosystems (LMEs). According to its objectives, the research indicated that coherence across governing instruments should be increased for the governance of LMEs, leading to the development of a mechanism representing consistency with SDG 14. As a result, a mechanism that demonstrates the coherence of SDG 14 with Agenda—2030 is made, which indicates that, in order to govern fisheries and oceans as LMEs jointly, coherence among governing instruments must be increased. The conclusion followed SDG 14's recommended actions, which are sly in line with UNCLOS and IEL, although the current initiatives of the regional organizations should be updated. [ABSTRACT FROM AUTHOR]

Electric vehicles have become the first choice for products delivery in logistics, due to their environmental friendliness and low cost compared to the traditional fuel vehicles. This paper deals with an electric capacitated vehicle routing problem with variable energy consumption rate (ECVRP), which aims to minimize the total cost including vehicle fixed cost, traveled distance cost and energy cost. First, a mixed integer linear programming model is constructed based on the fact that the energy consumption is affected by the vehicle load. Second, a hybrid Max-Min Ant System (HMMAS) algorithm is proposed to solve this problem. Three neighborhood structures are introduced and executed in a Variable Neighborhood Descent (VND) algorithm to improve the current solution. In addition, an effective charging station adjustment strategy is adopted to further improve the solution obtained by the local search process. Finally, some experiments have been conducted on public instances, and the results demonstrate the effectiveness and stability of the algorithm. [ABSTRACT FROM AUTHOR]

Isostructural, pillar-layered metal–organic frameworks (MOFs) will provide an ideal structural model for studying the influence of functional groups on fluorescence sensing. Here, we study dipyridyl linkers to tune the detection of Fe3+ ions. Three isostructural analogues of pillar-layered frameworks were used as fluorescence sensors to quickly, sensitively, and selectively detect Fe3+ ions with good repeatability. Importantly, an increase in length of the pillars and accessible volumes may lead to an increase in the fluorescence quenching constants (Ksv(PL-1) = 1.58 × 104 M−1) < (Ksv(PL-2) = 1.72 × 104 M−1) < (Ksv(PL-3) = 2.47 × 104 M−1), which may be related to different dipyridyl ligands acting as pillars. [ABSTRACT FROM AUTHOR]

Berkembangnya kebutuhan masyarakat terhadap layanan telekomunikasi telah mengakibatkan persaingan yang semakin sengit di antara perusahaan-perusahaan di industri tersebut. Oleh karena itu, perusahaan-perusahaan ini dituntut untuk mencari strategi promosi guna meningkatkan penjualan produk mereka. SiDompul adalah aplikasi yang dikembangkan XL Axiata untuk membantu RO (Retail Outlet) dalam melakukan penjualan paket data XL Axiata. Di tahun 2022 terjadinya penurunan penjualan paket data XL Axiata dilihat dari transaksi penjualan Retail Outlet melalui aplikasi SiDompul mengalami penurunan 37% dan targetnya tidak tercapai. Penelitian ini bertujuan untuk membentuk dan menguji pemodelan klasterisasi dari data transaksi penjualan dengan metode K-Means dan metode Particle Swarm Optimization (PSO). PSO untuk optimasi penentuan pusat klaster atau centroid. Pada penelitian ini, Algoritma K-Means dan PSO terbukti dapat membentuk 2 klaster yang lebih baik dimana nilai quantization errornya dan nilai SSE lebih rendah yaitu quantization 2.920 dan SSE 17.255 sedangkan pada K-Means quantization 2.939 dan SSE 17.288.

Abstract Background The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR). Case presentation A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support. Conclusion We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits.

Introduction: Coronary artery disease (CAD) has caused more than a quarter of deaths in Indonesia and is found to be more prevalent in elderlies (≥60 years old). Treatment options include coronary artery bypass grafting (CABG), the most-performed cardiac surgery in Indonesia. This study aimed to determine the short-term and one-year postoperative success, morbidity, and mortality rates with their causes in Dr. Soetomo General Academic Hospital, Surabaya. Methods: This was a cross-sectional retrospective study using secondary data obtained from 85 medical records of CABG patients aged ≥60 years old in the Department of Thoracic, Cardiac, and Vascular Surgery Dr. Soetomo General Academic Hospital, Surabaya, from January 2018 to December 2020. Aside from descriptive statistics, logistic regression was conducted to assess the relationship between EuroSCORE II and the success of CABG in elderly patients. A probability (p) value < 0.05 was considered significant. Results: Patients were mostly male in their sixties with a mean of 65.5 ± 4.9 years old, had three-vessel disease, and predicted mortality of 1.6%. The average number of grafts used was 3.3 ± 0.7, and the average length of hospital stay was 7.4 ± 2.4 days. The morbidity rate was 71.8%, with bleeding as the most common complication, a 17.6% mortality rate, and a success rate of 82.4% (short-term) and 80% (one-year postoperative). Higher EuroSCORE II was found to significantly decrease the probability of both short-term (prevalence ratio [PR], 0.766; 95% CI, 0.604-0.971; p = .028) and one-year postoperative success (PR, 0.787; 95% CI, 0.624-0.993; p = .044). Conclusion: Surgical success in elderly patients is influenced by many factors, and old age should not deter physicians from referring patients for CABG. Despite the ability of EuroSCORE II to predict surgical success, both short-term and one-year survival, on elderly patients, there is a need for holistic and locally validated scoring systems to both evaluate and predict surgical success due to the unique healthcare context of Indonesia.

Monitoring the processes inside crystalline materials under their operating conditions is of great interest in optoelectronics and scientific instrumentation. Early defect detection ensures the proper functioning of multiple crystal-based devices. In this study, a combination of acoustic emission (AE) sensing and cross-polarization imaging is proposed for the fast characterization of the crystal’s structure. For the experiments, tellurium dioxide (TeO2) crystal was chosen due to its wide use in acousto-optics. Studies were performed under uniaxial compression loading with a simultaneous acquisition of AE signals and four polarized optical images. An analysis of the temporal dependencies of the AE data and two-dimensional maps of the light depolarization features was carried out in order to establish quantitative criteria for irreversible damage initiation and crack-like defect formation. The obtained results reveal the polarization image patterns and the AE pulse duration alteration specific to these processes, and they open up new possibilities for non-destructively monitoring in real-time the structure of optically transparent crystals under their operating conditions.

This paper introduces an multi-compartment open vehicle routing problem with time window (MCOVRPTW) arising in fresh products distribution, which doesn't require the finished service vehicles return to the distribution center. There are three types of fresh products to be delivered by the multi-compartment vehicles, and the objective aims to find the vehicles scheduling scheme with the lowest cost. For this problem, we established a mathematical model in which the capacity constraint of each compartment and time window constraint must be satisfied. Then, we proposed a hybrid genetic algorithm with some local search-based operators, called GA-LS, to solve it. Each individual in initial population was generated by the nearest neighborhood method to obtain highquality initial population. When a child population was built, the local search procedure was executed on each individual in the child population to enhance its quality. Finally, we carried out some experiments to evaluate the effectiveness of the proposed algorithm. According to the results, the proposed algorithm can yield better solutions compared with existing approaches. Meanwhile, the proposed algorithm reveals good stability and convergence. [ABSTRACT FROM AUTHOR]

Objectives: Infection by carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a serious clinical problem worldwide. However, the molecular epidemiology of the clinical isolates varies depending on the region. This study was conducted to analyse the resistance phenotype and clarify the genetic and epidemiological properties of CRPA clinical isolates from southeast Shanxi, China. Methods: Fifty-seven isolates of CRPA were collected from a hospital in this region. These isolates were reidentified by MALDI-TOF and subjected to whole-genome sequencing by next-generation sequencing. Phylogenetic trees were constructed based on single nucleotide polymorphisms (SNPs), after which multilocus sequence typing (MLST) was performed and antimicrobial resistance genes were identified. Results: All the 57 CRPA isolates carried at least one kind of gene encoding carbapenemase, such as blaIMP-1, blaIMP-10, blaOXA-10, blaOXA-395, blaOXA-396, blaOXA-485, blaOXA-486, blaOXA-488, blaOXA-494, and blaOXA-50. The isolates harboured AIM-1, CMY-51, mecD, and NmcR genes and carried one kind of Pseudomonas-derived cephalosporinase (PDC) β-lactamase-encoding gene, such as blaPCD-1 to blaPCD-3, blaPCD-5, or blaPCD-7 to blaPCD-10. Two isolates were found to harbour the aminoglycoside-modifying enzyme genes aadA1 and aadA7; however, no isolates were found to harbour genes encoding 16S rRNA methylase or quinolone resistance-related genes. These CRPA isolates belonged to various sequence types (STs), two of which, namely, ST235 and ST277, were high-risk types. Conclusions: Our findings indicate that CRPA isolates carrying resistance genes with unique regional characteristics are spreading in this region, with a high diversity of STs, especially in high-risk clones. These findings highlight the necessity for further measures to prevent CRPA spread in Shanxi.

Recurrence and metastasis of gastric cancer is a major therapeutic challenge for treatment. The presence of cancer stem cells (CSCs) is a major obstacle to the success of current cancer therapy, often leading to treatment resistance and tumor recurrence and metastasis. Therefore, it is important to develop effective strategies to eradicate CSCs. In this study, we developed a combined therapeutic strategy of photothermal therapy (PTT) and gastric cancer stem cells (GCSCs) inhibition by successfully synthesizing nanoliposomes loaded with IR780 (photosensitizer) and EN4 (c-Myc inhibitor). The nanocomposites are biocompatible and exhibit superior photoacoustic (PA) imaging properties. Under laser irradiation, IR780-mediated PTT effectively and rapidly killed tumor cells, while EN4 synergistically inhibited the self-renewal and stemness of GCSCs by suppressing the expression and activity of the pluripotent transcription factor c-Myc, preventing the tumor progression of gastric cancer. This Nano-EN-IR@Lip is expected to be a novel clinical nanomedicine for the integration of gastric cancer diagnosis, treatment and prevention.

Laminarin mainly consists of fucoidan, a unique, naturally active sulfate polysaccharide. Laminarin is known for its outstanding multiple bioactives, but its role in lactation remains largely unknown. Therefore, this study aimed to explore the influence of maternal intake of laminarin on lactation and infant health in a porcine model. A total of 20 sows of parity 6.85 ± 0.88 with similar comprehensive scores were randomly allocated to two dietary treatments to receive a basal diet with/without supplementary laminarin. We showed that maternal intake of laminarin improved the antioxidant capacity and intestinal barrier function of the offspring, alleviated the inflammatory response, and facilitated infant growth and health. Mechanistically, maternal consumption of laminarin significantly modified the metabolite profiles of colostrum and milk. We also demonstrated in a vitro study that coniferyl aldehyde, a representative differential milk metabolite, enhanced antioxidant capacity and tight junction protein expression levels in intestinal epithelial cells. In summary, maternal intake of laminarin facilitated offspring health and growth by fortifying milk metabolites.

Study Objectives: To (1) estimate the prevalence and trajectory of functional disability exceeding patient-acceptable and clinically significant levels in older surgical patients preoperatively and at 30, 90, and 180 days postoperatively, (2) identify risk factors associated with postoperative functional disability, and (3) compare adverse clinical outcomes between participants with and without functional disability., Design: Multicenter prospective study., Setting: Remote preoperative and postoperative assessments., Patients: 307 older patients aged ≥65 years undergoing non-cardiac surgery., Measurements: Functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 on an online survey, with a score ≥ 16 % exceeding a patient-acceptable symptom state and ≥ 35 % indicating significant, or at least moderate, severity., Main Results: We found that 133 (43 %) patients exhibited preoperative functional disability exceeding a patient-acceptable level, with 42 (14 %) experiencing clinically significant, or at least moderate, functional disability. The Functional Disability group showed greater improvement in function than the No-disability group. Specifically, over 60 % of participants in the Functional Disability group showed significant improvement at 90 and 180 days postoperatively, with 40 % being disability-free. However, 12 % of the Functional Disability group and 9 % of the No-disability group experienced a clinically important worsening in functional disability at 180 days postoperatively. Preoperative functional disability and depression were associated with nearly 6- and 4-fold higher odds of functional disability at 180 days, respectively., Conclusions: Patients with preoperative functional disability experienced greater postoperative improvement in functional disability than the No-disability group. Preoperative evaluation of functional disability informs perioperative care and recovery for patients and clinicians., Competing Interests: Declaration of competing interest EY reports research support from the Canadian Institutes of Health Research (CIHR) Canada Graduate Scholarships Doctoral Award (funding reference number: 195197). JW reports research support from the Ontario Ministry of Health and Long-Term CareInnovation Fund, Merck Inc. and is supported by a Merit Research Award from the Department of Anesthesiology and Pain Medicine, University of Toronto. LM reports grant funding from Brain Canada, Centre for Aging and Brain Health Innovation, and MOHLTC AFP Innovation Fund. FC reports research support from the Ontario Ministry of Health and Long-Term Care Innovation Grant, ResMed Foundation, University Health Network Foundation, Consultant to Takeda and Hasico Pharma, and STOP-Bang Questionnaire proprietary to University Health Network., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: Based on the Caregiving Stress Theory and Cognitive Theory of Stress and Coping, this study examined whether increase in caregiving stressors had an impact on subsequent increase in different forms of elder abuse. Additionally, this study evaluated how these relationships were influenced by caregiver (CG) coping strategies., Method: A group of 800 Chinese primary family CGs and their care recipients (CRs) with mild cognitive impairment or mild-to-moderate dementia were analyzed. Participatory dyads were assessed and followed for 2 years. Structural Equation Models were used to test the associations among caregiving stressors, CG coping strategies, and elder abuse., Results: Increase in caregiving stressors (ie CR decreased cognitive function, neuropsychiatric symptoms, and functional impairment) significantly increased the level of subsequent physical abuse, psychological abuse, and neglect. In addition, the associations between caregiving stressors and different forms of elder abuse as stated above was mediated by CG dysfunctional coping strategies., Conclusion: This study highlights the varying impact of caregiving stressors on different types of elder abuse and emphasizes the role of CG coping strategies in mediating these relationships. The findings provide valuable insights for the development of intervention protocols targeting both caregiving stressors and CG coping strategies to prevent elder abuse.

Extreme precipitation and flooding events are rising globally, necessitating a thorough understanding and sustainable management of water resources. One such setting is the Nile River's source areas, where high precipitation has led to the filling of Lake Nasser (LN) twice (1998-2003; 2019-2022) in the last two decades and the diversion of overflow to depressions west of the Nile, where it is lost mainly to evaporation. Using temporal satellite-based data, climate models, and continuous rainfall-runoff models, we identified the primary contributor to increased runoff that reached LN in the past two decades and assessed the impact of climate change on the LN's runoff throughout the twenty-first century. Findings include: (1) the Blue Nile subbasin (BNS) is the primary contributor to increased downstream runoff, (2) the BNS runoff was simulated in the twenty-first century using a calibrated (1965-1992) rainfall-runoff model with global circulation models (GCMs), CCSM4, HadGEM3, and GFDL-CM4.0, projections as model inputs, (3) the extreme value analysis for projected runoff driven by GCMs' output indicates extreme floods are more severe in the twenty-first century, (4) one adaptation for the projected twenty-first century increase in precipitation (25-39%) and flood (2%-20%) extremes is to recharge Egypt's fossil aquifers during high flood years., (© 2024. The Author(s).)

Background: Obstructive sleep apnea (OSA) is common in surgical patients and associated with worse perioperative outcomes., Objectives: To investigate the effect of mini-dose dexmedetomidine supplemented analgesia on postoperative sleep quality pattern in patients at high risk of OSA., Design: A pilot randomized, double-blind, placebo-controlled trial., Setting: A tertiary university hospital in Beijing, China., Patients: One hundred and fifty-two adult patients who had a STOP-Bang score ≥3 and a serum bicarbonate level ≥28 mmol/L and were scheduled for major noncardiac surgery between 29 January 2021 and 20 September 2022., Intervention: After surgery, patients were provided with high-flow nasal cannula and randomized in a 1:1 ratio to receive self-controlled opioid analgesia supplemented with either mini-dose dexmedetomidine (median 0.02 μg/kg/h) or placebo. We monitored polysomnogram from 9:00 pm to 6:00 am during the first night., Main Outcome Measures: Our primary outcome was the percentage of stage 2 non-rapid eye movement (N2) sleep. Secondary and exploratory outcomes included other postoperative sleep structure parameters, sleep-respiratory parameters, and subjective sleep quality (Richards-Campbell Sleep Questionnaire; 0-100 score range, higher score better)., Results: All 152 patients were included in intention-to-treat analysis; 123 patients were included in sleep structure analysis. Mini-dose dexmedetomidine supplemented analgesia increased the percentage of stage N2 sleep (median difference, 10%; 95% CI, 1 to 21%; p  = 0.029); it also decreased the percentage of stage N1 sleep (median difference, -10%; 95% CI, -20% to -1%; p  = 0.042). Other sleep structure and sleep-respiratory parameters did not differ significantly between the two groups. Subjective sleep quality was slightly improved with dexmedetomidine on the night of surgery, but not statistically significant (median difference, 6; 95% CI, 0 to 13; p  = 0.060). Adverse events were similar between groups., Conclusion: Among patients at high risk of OSA who underwent noncardiac surgery, mini-dose dexmedetomidine supplemented analgesia may improve sleep quality without increasing adverse events., Clinical Trial Registration: Clinicaltrials.gov, identifier NCT04608331., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sun, Liang, Chen, Ma, Zhang, Shen, Zhu and Wang.)

Background: There is a significant gap in research exploring changes in postoperative health-related quality of life (HRQoL) among patients aged 65 years and older undergoing hip or knee arthroplasty., Objectives: To investigate the variations in HRQoL improvement, as evaluated by patient-reported outcome measures following total hip arthroplasty, total knee arthroplasty, and partial knee arthroplasty between the young-old and old-old adults., Methods/design: We searched six online databases (including MEDLINE, Embase) from their inception dates to May 15, 2023. We included studies using a validated HRQoL assessment tool to evaluate changes in HRQoL in patients aged ≥65 years undergoing hip or knee arthroplasty. These include the EuroQol five-dimension (EQ-5D), Short Form 36 (SF-36) and Short Form 12 (SF-12). The primary outcomes were postoperative HRQoL changes between young-old (65-74 years) and old-old groups (≥75 years). The secondary outcomes included complications, length of stay, and mortality., Results: The search yielded 12,229 articles; twelve studies (n = 103,613) were included. Studies using EQ-5D found no significant differences between young-old and old-old patients after hip and knee arthroplasty. Analyses of SF-36 and SF-12 scales showed no significant age-related differences in postoperative improvements in physical and mental health. Our review of four studies that included multivariable analyses revealed inconsistent associations between age and EQ-5D. Comparisons between the young-old and old-old age groups in postoperative complications, hospital length of stay, and mortality revealed no associated age-related changes in HRQoL., Conclusions: The young-old and old-old patients exhibited comparable improvement in HRQoL following hip or knee arthroplasty. The older patients did not have higher postoperative complications rates, longer hospital length of stay, and increased mortality. While chronological age should be considered when planning hip and knee arthroplasty, greater emphasis should be placed on assessing the comorbidities and functional status of patients., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: FC reports research support from the Ontario Ministry of Health Innovation Grant, ResMed Foundation, University Health Network Foundation, Consultant to Takeda, and STOP-Bang Questionnaire proprietary to University Health Network. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Study Objective: Depression is a common cause of long-lasting disability and preoperative mental health state that has important implications for optimizing recovery in the perioperative period. In older elective surgical patients, the prevalence of preoperative depression and associated adverse pre- and postoperative outcomes are unknown. This systematic review and meta-analysis aimed to determine the prevalence of preoperative depression and the associated adverse outcomes in the older surgical population., Design: Systematic review and meta-analysis., Setting: MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) for relevant articles from 2000 to present., Patients: Patients aged ≥65 years old undergoing non-cardiac elective surgery with preoperative depression assessed by tools validated in older adults. These validated tools include the Geriatric Depression Scale (GDS), Hospital Depression and Anxiety Scale (HADS), Beck Depression Inventory-II (BDI), Patient Health Questionnaire-9 (PHQ-9), and the Centre for Epidemiological Studies Depression Scale (CESD)., Interventions: Preoperative assessment., Measurement: The primary outcome was the prevalence of preoperative depression. Additional outcomes included preoperative cognitive impairment, and postoperative outcomes such as delirium, functional decline, discharge disposition, readmission, length of stay, and postoperative complications., Main Results: Thirteen studies (n = 2824) were included. Preoperative depression was most assessed using the Geriatric Depression Scale-15 (GDS-15) (n = 12). The overall prevalence of preoperative depression was 23% (95% CI: 15%, 30%). Within non-cancer non-cardiac mixed surgery, the pooled prevalence was 19% (95% CI: 11%, 27%). The prevalence in orthopedic surgery was 17% (95% CI: 9%, 24%). In spine surgery, the prevalence was higher at 46% (95% CI: 28%, 64%). Meta-analysis showed that preoperative depression was associated with a two-fold increased risk of postoperative delirium than those without depression (32% vs 23%, OR: 2.25; 95% CI: 1.67, 3.03; I 2 : 0%; P ≤0.00001)., Conclusions: The overall prevalence of older surgical patients who suffered from depression was 23%. Preoperative depression was associated with a two-fold higher risk of postoperative delirium. Further work is needed to determine the need for depression screening and treatment preoperatively., Competing Interests: Declaration of competing interest Frances Chung: Reports research support from the Ontario Ministry of Health Innovation Fund, ResMed Foundation, University Health Network Foundation, Up-to-date royalties, consultant to Takeda Pharma, STOP-Bang proprietary to University Health Network. Linda Ma: Reports grant funding from Brain Canada, Centre for Aging and Brain Health Innovation, MOHLTC AFP Innovation Fund. Carmela Tartaglia: reports grand funding from NIH, Weston Brain Foundation, consultant to EISAI, Eli Lilly, and clinical trials work with Passage Bio, Janssen, Biogen, Avanex, Green Valley, Roche, GSK, BMS., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objective: To determine the diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment (CI) and assess the association of MoCA scores with adverse postoperative outcomes in surgical populations., Design: Systematic review and meta-analysis., Setting: Perioperative setting., Patients: Adults undergoing elective or emergent surgery screened for CI preoperatively using the MoCA., Measurements: The outcomes included the diagnostic accuracy of the MoCA in screening for CI and the pooled prevalence of CI in various surgical populations. CI and its association with adverse events including delirium, hospital length-of-stay (LOS), postoperative complications, discharge destination, and mortality was determined., Main Results: Twenty-six studies (5059 patients, 18 non-cardiac studies, 8 cardiac studies) were included. With a MoCA cut-off score of <26, the prevalence of preoperative CI was 48% (95% CI: 41%-54%). The MoCA had 0.87 (95% CI: 0.79-0.93) sensitivity, 0.72 (95% CI: 0.62-0.80) specificity, PPV of 0.74 (95% CI: 0.65-0.81), and NPV of 0.86 (95% CI: 0.77-0.92) when validated against Petersen criteria, the Diagnostic and Statistical Manual of Mental Disorders, or the National Institute on Aging and the Alzheimer's Association criteria to identify CI. Using the MoCA as a screening tool, the LOS was 3.75 (95% CI: -0.03-7.53, P = 0.05, not significant) days longer in the CI group after non-cardiac surgeries and 3.33 (95% CI: 1.24-5.41, P < 0.002) days longer after cardiac surgeries than the non-cognitively impaired group., Conclusions: MoCA had been validated in the surgical population. MoCA with a cut-off score of <26 was shown to have 87% sensitivity and 72% specificity in identifying CI. A positive screen in MoCA was associated with a 3-day longer hospital LOS in cardiac surgery in the CI group than in the non-CI group., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objectives: To determine the prevalence of suspected cognitive impairment using the Centers for Disease Control and Prevention (CDC) cognitive question, Ascertain Dementia Eight-item Questionnaire (AD8), Modified Telephone Interview for Cognitive Status (TICS-M), and Telephone Montreal Cognitive Assessment (T-MoCA), the agreement between each tool beyond chance, and the risk factors associated with a positive screen., Design: Multicenter prospective study., Setting: Remote preoperative assessments., Patients: 307 non-cardiac surgical patients aged ≥65 years., Measurements: Prevalence, Cohen's kappa (κ)., Main Results: The T-MoCA detected the highest prevalence of suspected cognitive impairment (28%), followed by the AD8 (17%), CDC cognitive question (9%), and TICS-M (6%). The four screening tools showed poor agreement beyond chance with one another, with the CDC cognitive question and AD8 approaching the threshold for weak agreement (κ = 0.39). Depression was associated with screening positive on the CDC cognitive question (OR: 2.81; 95% CI: 1.04, 7.68). Obstructive sleep apnea (OSA) (OR: 3.10; 95% CI: 1.26, 7.71) and functional disability (OR: 3.74; 95% CI: 1.34, 11.11) were associated with a positive AD8 screen. Older age (OR: 1.56; 95% CI: 1.01, 2.41), male sex (OR: 3.08; 95% CI: 1.09, 9.40), and higher pain level (OR: 1.21; 95% CI: 1.01, 1.47) were associated with a positive TICS-M screen. Similarly, older age (OR: 1.33; 95% CI: 1.03, 1.73), male sex (OR: 2.02; 95% CI: 1.09, 3.83), and higher pain level (OR: 1.15; 95% CI: 1.02, 1.30) were associated with a positive T-MoCA screen., Conclusions: The CDC cognitive question, AD8, TICS-M, and T-MoCA were easily implemented during preoperative assessment among older surgical patients. OSA, functional disability, and depression were associated with complaints on the CDC cognitive question and AD8. Older age, male sex, and higher pain level were associated with screening positive on the TICS-M and T-MoCA. Early remote cognitive screening may enhance risk stratification of vulnerable patients., Competing Interests: Declaration of competing interest EY reports research support from the Canadian Institute of Health Research (CIHR) Canada Graduate Scholarships Doctoral Award (funding reference number: FBD-195197). JW reports research support from the Ontario Ministry of Health and Long-Term CareInnovation Fund, Merck Inc. and is supported by a Merit Research Award from the Department of Anesthesiology and Pain Medicine, University of Toronto. LM reports grant funding from Brain Canada, Centre for Aging and Brain Health Innovation, and MOHLTC AFP Innovation Fund. MCT reports funding from NIH Clinical trials in AD: Janssen, Roche, Avanex, Merck, Green Valley, Biogen. FC reports research support from the Ontario Ministry of Health Innovation Grant, ResMed Foundation, University Health Network Foundation, Consultant to Takeda and Hasico Pharma, and STOP-Bang Questionnaire proprietary to University Health Network., (Copyright © 2024. Published by Elsevier Inc.)

Pulmonary artery pseudoaneurysms are rare but life-threatening vascular abnormalities. Only less than 10% hemoptysis cases are of pulmonary artery origin while most cases arise from bronchial arteries. When diagnosed, they are mostly found to accompany pre-existing cardiovascular disease, infection, (i.e. Tuberculosis or Aspergillosis), vasculitis, trauma and/or neoplastic conditions. There are rare reports of pulmonary artery pseudoaneurysms being caused by direct extension of invasive fungal infections. We report a case of a rapidly growing pulmonary artery pseudoaneurysm in a 20-year-old female with lymphoma involving the lung and mediastinum. The patient was hospitalized with complications, including hemoptysis in the setting of Aspergillus Pneumonia and respiratory failure requiring intubation. Interventional Radiology was consulted after multiple bronchoscopic interventions failed to stabilize the bleeding. Patient then underwent embolization of the left subsegmental pulmonary artery pseudoaneurysm, with resolution of hemoptysis the next day., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Individuals with systemic sclerosis (SSc) are particularly susceptible to SARS-CoV-2 infections, yet it remains to be determined if they generate humoral and cellular responses comparable to controls following SARS-CoV-2 vaccinations. Herein, we collected blood and serum after second, third, and fourth SARS-CoV-2 vaccinations in patients with SSc and controls. Following each dose, participants with SSc mounted comparable serum anti-RBD IgG, anti-RBD IgA, and spike-specific CD4 + and CD8 + T cell responses to those found in controls. At 3 months post dose 2, the frequencies of Th1, Th2, Th17, and Treg spike-specific CD4 + T cells in participants with SSc did not differ from controls. At 2-6 weeks post dose 3, participants with SSc displayed reduced frequencies, but not numbers, of Th17-polarized spike-specific CD4 + T cells. Thus, participants with SSc did not display significantly weaker humoral or cellular responses to SARS-CoV-2 vaccination than controls, enabling reassurance of vaccine immunogenicity in participants with SSc., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Maggie J. Larche reports financial support was provided by Scleroderma Canada. DMEB has received honorarium for consulting on the topic of vaccines from Pfizer-Canada and AstraZeneca. MJL is on the Advisory Boards/Speakers Bureaus for AbbVie, Actelion, Amgen, Astra-Zeneca, Boehringer-Ingelheim, BMS, Fresenius-Kabi, Gilead, GSK, Lilly, Mallinckrodt, Novartis, Pfizer, Sanofi, SOBI, UCB, and Scleroderma Society of Ontario/Canada. None of the other authors have competing interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Web archives offer researchers a promising source for large-scale longitudinal data collection; however, their complex social and technical infrastructures create an array of ethical concerns. In addition, there is a notable lack of guidance available for researchers hoping to conduct0 ethical research using web archives., Methods: We present an ethical decision-making case study based on an ongoing research project using the Internet Archive's Wayback Machine to study faculty appointments and mobility at Historically Black Colleges and Universities (HBCUs)., Results: This paper contributes to information ethics discourse by expanding on the Association of Internet Researchers' recommendations for ethical decision-making, and mapping ethical considerations for each stage of the project within existing conceptual frameworks for research using web archives., Conclusions: By utilizing internet research guidance and web archive research frameworks in a case study approach, we hope to aid future researchers conducting internet research of a similar nature by serving as a useful reference.

Study Rationale: Although the STOP-Bang questionnaire has been validated for its efficacy and diagnostic performance in various settings, there is no review that summarizes the pertinent evidence of the STOP-Bang questionnaire in the different populations. We aimed to review the evidence of the diagnostic performance of the STOP-Bang questionnaire, correlation between STOP-Bang scores and the probability of obstructive sleep apnea (OSA), and its clinical application in various populations., Study Impact: This review guides healthcare providers in the sleep medicine and perioperative medicine disciplines to be better informed when using the STOP-Bang questionnaire in the different populations. It provides a greater understanding for both patients and clinicians when making decisions regarding OSA screening for each population., Competing Interests: Declaration of competing interest FC reports research support from the Ontario Ministry of Health and Long-Term Care Innovation Fund, University Health Network Foundation, and ResMed Foundation, Up-to-date royalties, consultant to Takeda and Haisco Pharma, STOP-Bang proprietary to University Health Network. EY reports research support from the Canadian Institutes of Health Research (CIHR) Canada Graduate Scholarships Doctoral Award (funding reference number: 195197). TC declared no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The suitability of ambulatory surgery for patients with obstructive sleep apnea (OSA) remains controversial. This systematic review and meta-analysis aimed to evaluate the odds of perioperative adverse events in patients with OSA undergoing ambulatory surgery, compared to patients without OSA., Methods: Four electronic databases were searched for studies published between January 1, 2011 and July 11, 2023. The inclusion criteria were: adult patients with diagnosed or high-risk of OSA undergoing ambulatory surgery; perioperative adverse events; control group included; general and/or regional anesthesia; and publication on/after February 1, 2011. We calculated effect sizes as odds ratios using a random effects model, and additional sensitivity analyses were conducted., Results: Seventeen studies (375,389 patients) were included. OSA was associated with an increased odds of same-day admission amongst all surgery types (OR 1.94, 95% CI 1.46-2.59, I 2 :79%, P < 0.00001, 11 studies, n = 347,342), as well as when only orthopedic surgery was considered (OR 2.68, 95% CI 2.05-3.48, I 2 :41%, P < 0.00001, 6 studies, n = 132,473). Three studies reported that OSA was strongly associated with prolonged post anesthesia care unit (PACU) length of stay (LOS), while one study reported that the association was not statistically significant. In addition, four studies reported that OSA was associated with postoperative respiratory depression/hypoxia, with one large study on shoulder arthroscopy reporting an almost 5-fold increased odds of pulmonary compromise, 5-fold of myocardial infarction, 3-fold of acute renal failure, and 5-fold of intensive care unit (ICU) admission., Conclusions: Ambulatory surgical patients with OSA had almost two-fold higher odds of same-day admission compared to non-OSA patients. Multiple large studies also reported an association of OSA with prolonged PACU LOS, respiratory complications, and/or ICU admission. Clinicians should screen preoperatively for OSA, optimize comorbidities, adhere to clinical algorithm-based management perioperatively, and maintain a high degree of vigilance in the postoperative period., Competing Interests: Declaration of competing interest This research did not receive any grants or funding., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study examined the effects of exposure to resident aggression, self-efficacy, neuroticism, and attitudes toward dementia on burnout among direct care workers (DCWs) in nursing homes. A convenience sample of 800 DCWs from 70 randomly selected nursing homes in Hong Kong were recruited and individually interviewed. DCWs reported past-month experiences of resident aggression, levels of burnout, self-efficacy, neuroticism, attitudes toward dementia, and other personal and facility characteristics. Hierarchical multiple regression analysis revealed that, while physical environment of the facilities, and demographic background and self-efficacy of DCWs were not significant contributing factors, DCWs' exposure to resident aggression, insufficient experience and training in dementia care, negative attitudes toward dementia, and neurotic personality were associated with higher levels of staff burnout. Findings point to the importance of mitigating resident aggression and adequately screen and train staff to optimize their empathy and competence in minimizing the risk of burnout., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: KRAS mutations, particularly KRAS G12C , are prevalent in non-small cell lung cancer (NSCLC). Immune checkpoint inhibitors (ICIs) have been a frontline treatment, but recently developed KRAS G12C -selective inhibitors, such as sotorasib, present new therapeutic options. We conducted a multi-center retrospective cohort study to gain insights into real-world treatment patterns and outcomes in patients with KRAS G12C -positive advanced NSCLC receiving systemic therapy post-ICI treatment., Methods: From the CAnadian CAncers With Rare Molecular Alterations-Basket Real-world Observational Study (CARMA-BROS), a cohort of 102 patients with KRAS G12C -positive advanced NSCLC across 9 Canadian centers diagnosed between 2015 and 2021 was analyzed. Clinico-demographic and treatment data were obtained from electronic health records. Survival outcomes were assessed using Kaplan-Meier curves and Cox proportional hazards models., Results: The patients (median age 66 years; 58 % female; 99 % current/former tobacco exposure; 59 % PD-L1 ≥ 50 %), exhibited heterogeneous treatment patterns post-ICI. Most patients received ICIs as a first-line therapy, with varying subsequent lines including chemotherapy and targeted therapy. In patients receiving systemic therapy post-ICI, median overall survival was 12.6 months, and real-world progression-free survival was 4.7 months. KRAS G12C -selective targeted therapy post-ICI (n = 20) showed longer real-world progression-free survival compared to single-agent chemotherapy (aHR = 0.39, p = 0.012)., Conclusion: This study contributes valuable real-world data on KRAS G12C -positive advanced NSCLC post-ICI treatment. The absence of a standard treatment sequencing post-ICI underscores the need for further investigation and consensus-building in the evolving landscape of KRAS G12C -targeted therapies., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The study was supported by Amgen. The authors have no other conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Excessive backfat deposition lowering carcass grade is a major concern in the pig industry, especially in most breeds of obese type pigs. The mechanisms involved in adipogenesis and fat accumulation in pigs remain unclear. Lysine 2-hydroxyisobutyrylation (Khib), is a novel protein post-translational modification (PTM), which play an important role in transcription, energy metabolism and metastasis of cancer cells, but its role in adipogenesis and fat accumulation has not been shown., Results: In this study, we first analyzed the modification levels of acetylation (Kac), Khib, crotonylation (Kcr) and succinylation (Ksu) of fibro-adipogenic progenitors (FAPs), myogenic precursors (Myo) and mesenchymal stem cells (MSCs) with varied differentiation potential, and found that only Khib modification in FAPs was significantly higher than that in MSCs. Consistently, in parallel with its regulatory enzymes lysine acetyltransferase 5 (KAT5) and histone deacetylase 2 (HDAC2) protein levels, the Khib levels increased quadratically (P < 0.01) during adipogenic differentiation of FAPs. KAT5 knockdown in FAPs inhibited adipogenic differentiation, while HDAC2 knockdown enhanced adipogenic differentiation. We also demonstrated that Khib modification favored to adipogenic differentiation and fat accumulation by comparing Khib levels in FAPs and backfat tissues both derived from obese-type pigs (Laiwu pigs) and lean-type pigs (Duroc pigs), respectively. Accordingly, the expression patterns of KAT5 and HDAC2 matched well to the degree of backfat accumulation in obese- and lean-type pigs., Conclusions: From the perspective of protein translational modification, we are the first to reveal the role of Khib in adipogenesis and fat deposition in pigs, and provided new clues for the improvement of fat accumulation and distribution as expected via genetic selection and nutritional strategy in obese-type pigs., (© 2024. The Author(s).)

Stem cell therapy holds promise for tissue regeneration, yet significant challenges persist. Emerging as a safer and potentially more effective alternative, extracellular vesicles (EVs) derived from stem cells exhibit remarkable abilities to activate critical signaling cascades, thereby facilitating tissue repair. EVs, nano-scale membrane vesicles, mediate intercellular communication by encapsulating a diverse cargo of proteins, lipids, and nucleic acids. Their therapeutic potential lies in delivering cargos, activating signaling pathways, and efficiently mitigating oxidative stress-an essential aspect of overcoming limitations in stem cell-based tissue repair. This review focuses on engineering and applying EVs in tissue regeneration, emphasizing their role in regulating reactive oxygen species (ROS) pathways. Additionally, we explore strategies to enhance EV therapeutic activity, including functionalization and incorporation of antioxidant defense proteins. Understanding these molecular mechanisms is crucial for optimizing EV-based regenerative therapies. Insights into EV and ROS signaling modulation pave the way for targeted and efficient regenerative therapies harnessing the potential of EVs., (© 2024. The Author(s).)