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In April 2023, Saudi Arabia and Iran announced the normalisation of diplomatic ties with China's mediation. Notably, Saudi Arabia sought China's mediation during Xi Jinping's visit in December 2022. Why did Saudi Arabia seek reconciliation while maintaining hostility with Iran? This study aims to uncover this puzzle using a case study approach. It examines the case through two mechanisms: reconciliation with one's enemy and reconciliation with a friend's enemy. According to the first approach, Saudi Arabia had to manage external threats to achieve the objectives of Vision 2030, an economic and social reform initiative implemented in response to political and economic shocks in the region. The second approach highlights Saudi Arabia's complex relationship with the United States. Through reconciliation, Saudi Arabia could attain considerable leverage in this relationship. Its approach to Iran serves as an effective example of foreign policy amid escalating tensions between the United States and China. [ABSTRACT FROM AUTHOR]

Purpose: Spinal fusion is the standard treatment for severe forms of adolescent idiopathic scoliosis (AIS). However, with the lowest instrumented vertebra that is usually located at L3 or L4, patients are prone to develop adjacent segment degeneration in the long term. Vertebral body tethering (VBT) as motion preserving technique has become an alternative for select patients with AIS. Several studies have presented the outcome after thoracic VBT but no study has analyzed the outcome after VBT for Lenke type 6 curves. Methods: This is a retrospective single center data analysis of patients who have had bilateral VBT for Lenke type 6 curves and a minimum follow up of 24 months. Radiographic analysis was performed on several time points. Suspected tether breakages were additionally analyzed with respect to location and time at occurrence. Results: 25 patients were included. Immediate thoracic curve correction was 55.4% and 71.7% for TL/L curves. Loss of correction was higher for TL/L curves and resulted in a correction rate of 48.3% for thoracic curves and 48.9% for TL/L curves at 24 months post-operatively. 22 patients were suspected to have at least one segment with a tether breakage. Three patients required a re-VBT but no patient received posterior spinal fusion. Conclusion: Bilateral VBT for Lenke type 6 curves is feasible and shows a significant curve correction for thoracic and TL/L curves at a minimum of 24 months post-operatively. Tether breakage rate and loss of correction remain an unfavorable observation that needs to be improved in the future. [ABSTRACT FROM AUTHOR]

Biological macromolecules, encompassing proteins, nucleic acids, lipids, and carbohydrates, have garnered increasing attention as tethering excipients within the realms of pharmaceuticals and biotechnology. This concise appraisal offers a comprehensive overview of their multifaceted role, highlighting the latest advancements in their applications. Biological macromolecules, long regarded as fundamental components of life, have transitioned into pivotal agents that contribute significantly to drug development, drug formulation stability and the optimization of pharmacokinetic profiles. This review delineates how these macromolecules serve as integral players in the enhancement of drug delivery systems, enabling controlled release, targeted delivery, and improved bioavailability. Furthermore, they play a critical role in the stabilization of sensitive compounds, preserving their efficacy and extending their shelf life. Additionally, the interactions between macromolecules and therapeutic agents are pivotal in mitigating issues of solubility and bioavailability, further propelling their utility as excipients. Despite these promising attributes, challenges such as immunogenicity, scalability, and regulatory compliance persist. Navigating these hurdles necessitates a concerted effort from researchers, engineers, and regulatory bodies alike. In conclusion, biological macromolecules stand as formidable contenders in the field of tethering excipients. Their versatile applications in drug delivery, formulation stability, and pharmacokinetic enhancement hold the promise of revolutionizing the pharmaceutical and biotechnological landscapes. To realize this potential fully, the scientific community must continue to probe their intricacies, address challenges proactively, and foster collaborative efforts to ensure their seamless integration into the future of healthcare and therapeutics. Ultimately, the enduring impact of biological macromolecules on patient care is poised to be transformative and far-reaching. [ABSTRACT FROM AUTHOR]

Introduction: Vertebral body tethering (VBT) has become an alternative option for select patients with idiopathic scoliosis. However, studies have shown a high number of tether breakages, specifically after thoracolumbar (TL) VBT, that can have a negative impact on the outcome, when the breakage occurs within the first year after surgery. In order to overcome this problem, we have started to apply an apical fusion (AF) in combination with TL VBT for select patients. This study aims to analyze the outcome after AF plus VBT. Methods: This is a retrospective single surgeon's data analysis. All patients were included who have had TL VBT after January 2022 and a follow-up of 12 months. Patients were grouped based on whether they only had VBT or VBT + AF. Results: Twenty-five patients were analyzed (15 VBT, 10 VBT + AF). Both groups showed a significant curve correction for thoracic and TL curves. Minor loss of correction was observed in both groups. A significant difference was seen regarding early tether breakages, which were found in 60% of VBT patients and 10% of VBT + AF patients. Conclusion: The preliminary data shows a significant reduction of early tether breakages when TL VBT is applied in combination with AF. [ABSTRACT FROM AUTHOR]

The emergence of antibiotic-resistant bacteria is a serious threat to public health. Antimicrobial peptides (AMP) are a powerful alternative to antibiotics due to their low propensity to induce bacterial resistance. However, cytotoxicity and short half-lives have limited their clinical translation. To overcome these problems, AMP conjugation has gained relevance in the biomaterials field. Nevertheless, few studies describe the influence of conjugation on enzymatic protection, mechanism of action and antimicrobial efficacy. This review addresses this gap by providing a detailed comparison between conjugated and soluble AMP. Additionally, commonly employed chemical reactions and factors to consider when promoting AMP conjugation are reviewed. The overall results suggested that AMP conjugated onto biomaterials are specifically protected from degradation by trypsin and/or pepsin. However, sometimes, their antimicrobial efficacy was reduced. Due to limited conformational freedom in conjugated AMP, compared to their soluble forms, they appear to act initially by creating small protuberances on bacterial membranes that may lead to the alteration of membrane potential and/or formation of holes, triggering cell death. Overall, AMP conjugation onto biomaterials is a promising strategy to fight infection, particularly associated to the use of medical devices. Nonetheless, some details need to be addressed before conjugated AMP reach clinical practice. Covalent conjugation of antimicrobial peptides (AMP) has been one of the most widely used strategies by bioengineers, in an attempt to not only protect AMP from proteolytic degradation, but also to prolong their residence time at the target tissue. However, an explanation for the mode of action of conjugated AMP is still lacking. This review extensively gathers works on AMP conjugation and puts forward a mechanism of action for AMP when conjugated onto biomaterials. The implications of AMP conjugation on antimicrobial activity, cytotoxicity and resistance to proteases are all discussed. A thorough review of commonly employed chemical reactions for this conjugation is also provided. Finally, details that need to be addressed for conjugated AMP to reach clinical practice are discussed. [Display omitted] [ABSTRACT FROM AUTHOR]

The indication for surgery for tricuspid regurgitation (TR) has reached a major turning point. It has become clear that the presence of moderate or severe TR alone worsens the prognosis of life, and the previous guidelines of Japanese Circulation Society, in which the indication for surgery was recommended at the timing of "right heart failure difficult to treat medically," now recommends surgery with a trigger of "repeated right heart failure" in the 2020 edition. In addition, a new repair technique targeting at subvalvular structure has been developed for end-stage TR to overcome a high TR recurrence rate that is associated with severe right ventricular enlargement and leaflet tethering. This review focuses on the spiral suspension technique, in which the papillary muscles are spirally suspended towards the septal leaflet annulus to correct tethering and enhances the understanding of its application in the context of TR management. [ABSTRACT FROM AUTHOR]

Despite seawalls becoming ubiquitous coastal features, and having some physical similarities to natural rocky shores, it remains unclear how these urban habitats influence predator–prey interactions. Predators can affect intertidal mobile prey densities through two pathways: (1) successful predation directly influences prey mortality rates, and (2) direct and indirect effects of predation can scare and induce motile prey to seek safer areas. In this study, we investigated whether intertidal predators affect the density of the marine gastropod, Nerita undata, at four seawall sites in Singapore. Using a tethering method that we developed, we monitored the mortality and other evidence of predation (shell state) of tethered N. undata. Field experiments revealed high (22.5%–82.5%) predation potential of N. undata across the four sites, with significantly higher predation risk at lower shore heights and for snails with mixed shell coloration. Observations and analysis of the shell state after 3 days showed that predation on seawalls was primarily by crushing predators such as fish. Other predators of N. undata include predatory snails, with various feeding methods that left behind different predator signatures. Our results add substantially to the limited knowledge on predator–prey interactions on seawalls, particularly for Nerita undata, and suggest that seawall systems are more dynamic than previously thought. This further highlights the role of these artificial structures as important habitats and feeding grounds in urban coastal ecosystems. [ABSTRACT FROM AUTHOR]

Study Design/setting. Retrospective Objective. Evaluate the surgical technique that has the greatest influence on the rate of junctional failure following ASD surgery. Summary of background data. Differing presentations of adult spinal deformity(ASD) may influence the extent of surgical intervention and the use of prophylaxis at the base or the summit of a fusion construct to influence junctional failure rates. Materials and Methods. ASD patients with two-year(2Y) data and at least 5-level fusion to the pelvis were included. Patients were divided based on UIV: [Longer Construct: T1-T4; Shorter Construct: T8-T12]. Parameters assessed included matching in ageadjusted PI-LL or PT, aligning in GAP-relative pelvic version or Lordosis Distribution Index. After assessing all lumbopelvic radiographic parameters, the combination of realigning the two parameters with the greatest minimizing effect of PJF constituted a good base. Good s was defined as having: (1) prophylaxis at UIV (tethers, hooks, cement), (2) no lordotic change(under-contouring) greater than 10° of the UIV, (3) preoperative UIV inclination angle<30°. Multivariable regression analysis assessed the effects of junction characteristics and radiographic correction individually and collectively on the development of PJK and PJF in differing construct lengths, adjusting for confounders. Results. In all, 261 patients were included. The cohort had lower odds of PJK(OR: 0.5,[0.2-0.9];P=0.044) and PJF was less likely (OR: 0.1,[0.0-0.7];P=0.014) in the presence of a good summit. Normalizing pelvic compensation had the greatest radiographic effect on preventing PJF overall (OR: 0.6,[0.3-1.0];P= 0.044). In shorter constructs, realignment had a greater effect on decreasing the odds of PJF(OR: 0.2,[0.02-0.9];P=0.036). With longer constructs, a good summit lowered the likelihood of PJK(OR: 0.3, [0.1-0.9];P=0.027). A good base led to zero occurrences of PJF. In patients with severe frailty/osteoporosis, a good summit lowered the incidence of PJK(OR: 0.4,[0.2-0.9]; P= 0.041) and PJF (OR: 0.1,[0.01-0.99];P=0.049). Conclusion. To mitigate junctional failure, our study demonstrated the utility of individualizing surgical approaches to emphasize an optimal basal construct. Achievement of tailored goals at the cranial end of the surgical construct may be equally important, especially for higher-risk patients with longer fusions. [ABSTRACT FROM AUTHOR]

Populations of the non-native Asian shore crab, Hemigrapsus sanguineus, now dominate the rocky intertidal of southern New England, USA. High abundances suggest the recent invader may have experienced enhanced success as a result of enemy release. While larvae and juveniles may serve as a food source for ecologically important species, little is known about predation of mature H. sanguineus or the influence of habitat on predation pressure. To assess natural predation rates of adult H. sanguineus, crabs were tethered in the intertidal at Clarks Cove in New Bedford, MA. Crabs were left in situ for half of a tidal cycle then observed for signs of predation. Results of separate high and low tide trials showed that adult crabs were preyed upon at both high and low tide, though at a significantly higher rate during high tide during both daytime and nighttime, suggesting predation by aquatic species is greater than that by terrestrial species. To investigate the role of habitat as refuge from predation, a laboratory experiment manipulated the complexity of habitat provided to crabs in the presence of a native fish predator. Results indicate better refuge is provided by more complex shelter. Together, findings suggest that fish, crabs, and/or diving birds are important predators for H. sanguineus in the invaded range and that habitat refuge acts to reduce predation pressure. [ABSTRACT FROM AUTHOR]

Abstract Despite seawalls becoming ubiquitous coastal features, and having some physical similarities to natural rocky shores, it remains unclear how these urban habitats influence predator–prey interactions. Predators can affect intertidal mobile prey densities through two pathways: (1) successful predation directly influences prey mortality rates, and (2) direct and indirect effects of predation can scare and induce motile prey to seek safer areas. In this study, we investigated whether intertidal predators affect the density of the marine gastropod, Nerita undata, at four seawall sites in Singapore. Using a tethering method that we developed, we monitored the mortality and other evidence of predation (shell state) of tethered N. undata. Field experiments revealed high (22.5%–82.5%) predation potential of N. undata across the four sites, with significantly higher predation risk at lower shore heights and for snails with mixed shell coloration. Observations and analysis of the shell state after 3 days showed that predation on seawalls was primarily by crushing predators such as fish. Other predators of N. undata include predatory snails, with various feeding methods that left behind different predator signatures. Our results add substantially to the limited knowledge on predator–prey interactions on seawalls, particularly for Nerita undata, and suggest that seawall systems are more dynamic than previously thought. This further highlights the role of these artificial structures as important habitats and feeding grounds in urban coastal ecosystems.

Populations of the non-native Asian shore crab, Hemigrapsus sanguineus, now dominate the rocky intertidal of southern New England, USA. High abundances suggest the recent invader may have experienced enhanced success as a result of enemy release. While larvae and juveniles may serve as a food source for ecologically important species, little is known about predation of mature H. sanguineus or the influence of habitat on predation pressure. To assess natural predation rates of adult H. sanguineus, crabs were tethered in the intertidal at Clarks Cove in New Bedford, MA. Crabs were left in situ for half of a tidal cycle then observed for signs of predation. Results of separate high and low tide trials showed that adult crabs were preyed upon at both high and low tide, though at a significantly higher rate during high tide during both daytime and nighttime, suggesting predation by aquatic species is greater than that by terrestrial species. To investigate the role of habitat as refuge from predation, a laboratory experiment manipulated the complexity of habitat provided to crabs in the presence of a native fish predator. Results indicate better refuge is provided by more complex shelter. Together, findings suggest that fish, crabs, and/or diving birds are important predators for H. sanguineus in the invaded range and that habitat refuge acts to reduce predation pressure.

Purpose: Pubic symphysis disruption is common in pelvic trauma. Open reduction and internal fixation with a plate is the gold standard technique. Despite increasing interest in an endoscopic approach, the challenges of specific endoscopic instrumentation, reduction and fixation remains. In this feasibility cadaveric study, we aimed to describe a novel endoscopic technique of fixation of pubic symphysis disruption with a spinal vertebral tethering system., Methods: Endoscopic pubic symphysis fixation with the tethering method was performed on a female cadaver specimen as well as an artificial pelvic model., Results: We describe a step-by-step technique where three abdominal portals were utilized in order to insert screws in the pubic body and superior pubic ramus under endoscopic visualization. The synthetic tether ligament was introduced through a lateral portal and fixed and tensioned to reduce and compress the pubic symphysis., Conclusions: While open plate fixation is the current gold standard of pubic symphysis disruption there is increasing interest in the minimally invasive endoscopic approach. In this feasibility cadaveric study, we present a new minimally invasive endoscopic fixation method to treat pubic symphysis disruption with a synthetic ligament., Competing Interests: 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., (© 2024 The Authors. Published by Elsevier Ltd.)

Red king crab, Paralithodes camtschaticus , was commercially important around Kodiak, Alaska, USA, in the 1960s and 1970s; however, the stock crashed in the late 1970 s and has remained closed since 1983. The lack of recovery inspired consideration of stock enhancement through the release of hatchery-reared juveniles as a means to bolster the wild population. We examined the effects of release timing on in situ survival of hatchery-reared red king crab by releasing juveniles in June, August, and September 2015 in Trident Basin, Kodiak. We monitored densities inside and outside of release plots for six months using quadrat counts to determine loss and emigration rates. Relative predation risk was determined using tethering experiments performed after each release, and predator densities were quantified using quadrat counts and predator transect counts. Initial mortality over the first 24 h was approximately 53%, and subsequent mortality rates decreased with month-of-release, likely due to a combination of larger size-at-release and seasonal changes in predation. Although predator density was consistent over time, relative predation risk of tethered crabs decreased with season, suggesting later releases may be beneficial. However, the extended hatchery rearing period needed for later releases presents other challenges, including cannibalism, and the potential for developing maladaptive traits. Stock enhancement programs must balance these trade-offs to maximize overall success. Early releases of small juveniles immediately after settlement may be optimal if large-scale hatchery communal rearing results in significant juvenile production loss and/or hatchery conditioning is impractical. • We performed a field experiment examining stock enhancement in red king crab. • Crab were released at three different times/sizes and tracked post release. • Crab survived best when released later and at a larger size. • However, account for holding mortality, earlier release times are more effective. [ABSTRACT FROM AUTHOR]

Fibrous materials may undergo an internal reorganization, which turns out in the emergence of preferential directions. This is a peculiar behavior of many biological tissues, which drive reorientation by external stimuli at chemo-mechanical levels. In particular, it is detected that contractile cells can reorganize fibrous extracellular matrices and form dense tracts of aligned fibers (tethers), that guide the development of tubular tissue structures and may provide paths for the invasion of cancer cells. Tether formation is caused by buckling instability of network fibers under cell-induced compression. We present a simple mechanical model, within a variational framework, that captures the essential aspects of these phenomena. The model qualitatively describes: (i) the emergence, induced by local compressive strain, of anisotropy, where fibrous materials exhibit directional preferences; (ii) the occurrence of micro-buckling, which leaves a lasting plastic deformation in the material; and (iii) the formation of localized field patterns, which contribute to the overall behavior of the material. By considering these fundamental aspects, our model provides insights into the mechanical response of fibrous materials and sheds light on the underlying mechanisms driving their behavior. [Display omitted] • A variational model to capture anisotropy, micro-buckling, localized field patterns • Homogeneous problem: analytical insights on micro-buckling and its plastic effects • Numerical investigations aligned with experiments on cell clusters in ECM [ABSTRACT FROM AUTHOR]