Sclerotherapy remains the standard for interventional treatment of slow-flow vascular malformations. However, bleomycin electrosclerotherapy (BEST) has shown promising results in the management of recurrent lesions. One notable adverse effect of BEST is the postinterventional development of skin hyperpigmentation. The aim of this study is the analysis of accidental skin hyperpigmentation after BEST of slow-flow vascular malformations.This retrospective study at our interdisciplinary vascular anomalies center investigated the occurrence of skin hyperpigmentation after bleomycin electrosclerotherapy of slow-flow vascular malformations over a period of 21 months documented clinically and in photographic findings, as well as related interventional treatment parameters with subsequent exploratory threshold analyses at 0.10 and 0.15 mg/kg. Subsequently, a comparison was made with recent publications reporting hyperpigmentation after bleomycin administration.During the observation period, 72 patients were included with a total of 80 BEST procedures. Bleomycin-related skin hyperpigmentation was documented in 4 of 7 lymphatic malformation (LMs), 20 of 44 venous malformation (VM)and in 16 of 29 combined venolymphatic vascular malformations associated with other anomalies. On average, 27.1 application series of reversible electroporation per intervention were performed (range 1-85).An average of 8.37 mg bleomycin was administered to LMs, 5.31 mg to VMs and 8.03 mg to the combined group in each session. Hyperpigmentation was more frequent with the hexagonal electrode: 33/56 (58,9 %); Needle-Foil Electrode (NFD) 6/19, Variable Geometry Device (VGD) 1/5. Rates were similar across entities (hexagonal: LM 3/5, VM 17/31, combined 13/20). Overall, bleomycin was administered intralesional 46 times with an average dose of 0.09 mg/kg bw (range 0.008-0.23) and intravenously 34 times, 0.22 mg/kg bw (range 0.13-0.5). Hyperpigmentation was more frequent after intravenous administration (61.8 %) than intralesional (41.3 %), likely reflecting higher dosing. A threshold dose of ≥0.10 mg/kg bleomycin was associated with a higher risk ratio for hyperpigmentation (RR 2.30, 95% CI 1.27-4.15).The frequency of skin hyperpigmentation following BEST seems to be analog to bleomycin-induced flagellate dermatitis and appears more frequently when using the hexagonal electrode and a higher bleomycin dosage per kg bodyweight (bw). · Puncture related skin hyperpigmentation is a frequent but often underestimated adverse effect of Bleomycin electrosclerotherapy (BEST) in slow-flow vascular malformations.. · Our findings suggest that electrode geometry and puncture-related trauma contribute substantially to this side effect.. · Recognizing these factors allows for more informed electrode selection and patient counseling to minimize the risk and improve cosmetic outcomes after BEST.. · Exploratory analyses suggest higher mg/kg dosing increases hyperpigmentation risk. When clinically feasible, consider dose minimization especially in cosmetically sensitive areas.. · Loeser JH, Schramm D, Cucuruz BR etal. Bleomycin Electrosclerotherapy and Skin Hyperpigmentation in Slow-flow Vascular Malformations: A Retrospective Monocentric Analysis. Rofo 2026; DOI 10.1055/a-2783-4420.

Abstract Atmospheric rivers are episodic events that can advect relatively large quantities of moisture to Antarctica, contributing to both disproportionate precipitation and melting events. The Year of Polar Prediction, an international effort to improve weather prediction over the southern polar region, presents an opportunity to study the clouds and precipitation associated with winter atmospheric river events. This study uses enhanced surface, profile, and remote‐sensing observations from the Antarctic Peninsula (AP) during a Targeted Observing Period around 16 May 2022, when an event occurred with local warming similar to a warm front. We compare regional atmospheric simulations with the polar‐optimized version of the Weather Research and Forecasting Model to various in situ and remote‐sensing observations. The study emphasizes data from three stations: Escudero, Vernadsky, and Rothera. Mixed‐phase clouds were simulated at the three stations, with the precipitation being primarily rain at Escudero and primarily snow at Vernadsky and Rothera. The model produced reasonable simulations of the clouds and precipitation. Furthermore, modeled longwave cloud forcing at Escudero had small errors compared to observed values. A sensitivity test enhancing secondary ice production indicates mixed‐phase cloud sensitivity to the Hallett‐Mossop process, especially at Rothera.

Low-temperature plasma (LTP) activation is increasingly used as a surface modification technique to enhance the wettability and biological performance of metallic implants. However, the stability of plasma-induced surface changes and their interaction with standard sterilisation procedures remain insufficiently understood. This study aimed to evaluate the effects of LTP activation, steam sterilisation, and their combination with the wettability of metallic implant materials, as well as the temporal stability of these effects. Samples manufactured from Ti6Al4V sheet, additively manufactured Ti6Al4V, and additively manufactured cobalt–chromium alloy were subjected to low-temperature plasma activation, steam sterilisation, or both procedures. Surface wettability was assessed by measuring the contact angle of canine blood droplets immediately after treatment and over a five-day observation period. Low-temperature plasma activation resulted in a substantial reduction in the contact angle for all tested materials, indicating a pronounced increase in surface wettability. However, this effect gradually diminished over time. Steam sterilisation alone moderately improved wettability and showed relatively stable effects. When steam sterilisation was applied after plasma activation, the plasma-induced enhancement was significantly attenuated and rapidly lost during storage. These findings demonstrate that while LTP activation effectively improves surface wettability, its benefits are highly time-dependent and strongly influenced by subsequent sterilisation. Plasma activation should therefore be performed immediately before implantation or combined with sterilisation and storage strategies that preserve surface modifications.

Background/Objectives: To investigate the rate of exudative progression over time in patients with non-exudative macular neovascularization (NE-MNV) associated with various acquired macular degenerations presenting with a double-layer sign (DLS) or triple-layer sign (TLS) on optical coherence tomography (OCT), and to identify potential predictors of this progression. Methods: Fifty-one eyes of fourty-nine patients with a DLS or TLS on OCT images were identified. OCT angiography (OCTA) was performed to detect NE-MNV, and only eyes with confirmed NE-MNV were included in the final analysis. Central macular thickness (CMT), choroidal thickness (CT), morphology of the abnormal vessels, the duration of follow-up, progression to active exudative MNV, and the status of the contralateral eye were assessed. Results: The final analysis included 32 eyes of 30 participants with NE-MNV. The median observation period was 46 months. The causes of NE-MNV were age- related macular degeneration (AMD) in 59.38% of eyes, pachychoroid epitheliopathy (PPE) in 37.50%, and other causes in 3.12%. Exudation developed in 15.62% of eyes (median time to onset: 24 months), predominantly in the AMD subgroup. Abnormalities in the fellow eye were present in 59.38% of cases. Neither age nor other factors, including sex, cause of MNV, CMT, CT, MNV morphology, or fellow eye status, were statistically significant predictors of progression to active MNV (p = 0.67, p > 0.99, p = 0.62, p = 0.09, p = 0.09, p = 0.2, p = 0.62, resp.). Conclusions: NE-MNV is an asymptomatic condition that may occur in the course of various retinal diseases. While DLS and TLS demonstrate high sensitivity and specificity for the diagnosis of NE-MNV, their presence does not always indicate concurrent MNV. Multimodal imaging is essential for accurate monitoring of these patients and detection of potential disease progression.

Abstract Feline panleukopenia virus (FPV) is a highly contagious parvovirus that causes acute gastroenteritis, leukopenia, and high mortality in felids. Although domestic cats are commonly vaccinated, FPV continues to threaten captive and wild felids because of its environmental stability, rapid progression, and potential antigenic drift. In June 2022, a one-year-old captive female cougar ( Puma concolor ) at Hongshan Forest Zoo, Nanjing, China, was found dead following a peracute course without prodromal signs. The animal had previously received a trivalent feline vaccine containing feline panleukopenia, herpesvirus, and calicivirus antigens. Postmortem examination revealed perianal fecal staining, oral discharge, pulmonary congestion with peripheral emphysema, a darkened liver, and intestinal mucosal sloughing with petechiae. Histopathology revealed crypt epithelial necrosis, mucosal sloughing, and lymphoid depletion, which was consistent with parvoviral enteritis. Fecal and intestinal samples tested positive for FPV according to the lateral-flow assay and PCR. Viral replication was confirmed in CRFK cells via indirect immunofluorescence, and FPV antigen was shown to be localized to the intestinal crypt epithelium via immunohistochemistry. VP2 gene sequencing (1,753 bp) revealed that the isolate clustered with field strains from domestic cats in Jiangsu and Shanghai, which share near-complete nucleotide identity but differ from the Felocell vaccine strain in three amino acid substitutions (A91S, I232V, and L562V), two of which lie in antigenic loops and may affect antigenicity. No further FPV cases were detected during or after the 14-day observation period, reflecting successful containment through disinfection, relocation, feral cat control, and movement restrictions. This represents the first confirmed fatal FPV infection in a captive cougar in China and highlights the potential for local spillover from domestic reservoirs. The case underscores the need for continuous molecular surveillance, vaccination evaluation, and One Health–based biosecurity to protect susceptible wildlife populations at the human–domestic–wildlife interface.

Cadavers are essential for anatomical education, but limited availability necessitates long-term preservation. While formalin is widely used, it is carcinogenic and alters muscle morphology and joint mobility, reducing anatomical accuracy. The modified Larssen solution (MLS) has shown promise in improving joint flexibility, yet its efficacy remains underexplored. This study aimed to evaluate muscle condition and joint range of motion in rat specimens preserved with 4% formalin followed by MLS immersion, compared to continuous 4% formalin preservation. Eighteen rat cadavers were allocated into three groups: intracardiac perfusion followed by 0.9% NaCl immersion, intracardiac perfusion and threemonth immersion in 4% formalin, and intracardiac perfusion with 4% formalin followed by three-month immersion in MLS. Statistical analysis included the t-test or Mann-Whitney test, depending on data distribution. Pearson correlation was used to assess the relationship between muscle fiber fragmentation and joint range of motion. Data from the NaCl group were excluded due to sample decomposition. The MLS group showed significantly redder muscle color (P<0.05), softer muscle consistency (P<0.05), and a non-significant increase in joint range of motion (P>0.05), without observable muscle fiber fragmentation. Correlation analysis could not be conducted due to the absence of fragmentation. MLS may serve as an effective alternative preservative by maintaining muscle color, texture, and structural integrity. Although the increase in joint mobility was not statistically significant, it was more pronounced than in the 4% formalin group. Future studies should explore longer observation periods and potential correlations with histological findings.

To investigate the safety of anagliptin/metformin combination tablets by evaluation of lactic acid levels in Japanese patients with type 2 diabetes and moderate renal impairment. The participants of type 2 diabetes with creatinine-based eGFR (eGFRcr) of ≥45 and <60 (mL/min/1.73 m2) (Group G3a) received anagliptin/metformin combination LD tablets (anagliptin: 100 mg, metformin hydrochloride: 250 mg/tablet) twice a day for 4 weeks. After 4 weeks, they received anagliptin/metformin combination HD tablets (anagliptin: 100 mg, metformin hydrochloride: 500 mg/tablet) twice daily until after 16 weeks. The participants (Group G3b) with baseline eGFRcr ≥30 and <45 (mL/min/1.73 m2) received anagliptin/metformin combination LD tablets twice daily for 16 weeks. The serum lactic acid levels were examined at weeks 4, 8, and 16 after receiving anagliptin/metformin combination tablets. The change in serum lactic acid levels from baseline to 16 weeks was -0.09 [-0.28, 0.10] mmol/L (mean [95% confidence intervals]), not exceeding the pre-specified non-inferiority margin (0.7 mmol/L). No significant differences occurred in the change in serum lactic acid levels during all observation periods. Serum lactic acid levels exceeded 2.5 mmol/L in four participants (10.5%) and 5.0 mmol/L in one participant (2.6%) during the observation period. No participant had a plasma metformin exceeding 2.5 μg/mL. This study demonstrates that the fixed-dose combination of anagliptin and metformin can be used safely in patients with type 2 diabetes complicated by moderate renal dysfunction. The advantage of this fixed-dose combination is also considered to be very large.

Background: The implantable miniature telescope is used to provide functional vision for patients with advanced AMD. However, despite the considerable cost of the device, there are strict criteria to be met for this procedure, since the patients require challenging neuroadaptation afterward, which sometimes fails and leads to the necessity of device explantation. Visual outcomes also depend on the stability of the microtelescope; tilts cause unwanted optical aberrations and can lead to device luxation, with sight-threatening complications. Case report: This case presents a novel technique for fixing the ophthalmic telescope device SING-IMT™. A 76-year-old female with pre-operative visual acuity of 15 letters on the ETDRS scale underwent surgery on her left eye. The superior haptic was fixed at the 12 o’clock position with a Prolene 5-0 suture, achieving good postoperative stability. The implant was stable throughout the entire observation period. Conclusions: Implant stability is crucial for maximizing visual potential in patients with advanced AMD selected for the procedure, since visual acuity in the peripheral retina, where the perceived image eventually lands, is much lower than the macula. Therefore, there is a need to standardize surgical approaches and use objective follow-up measures to assess long-term patient satisfaction.

Youth street violence known as klitih has become a persistent social problem in the Special Region of Yogyakarta, while access to structured and comprehensive official crime data remains limited. Online news portals frequently report klitih incidents and provide contextual information that can potentially support empirical crime analysis, yet such data are rarely utilized in systematic academic studies. This study aims to utilize online news articles as an alternative data source to identify patterns of youth criminality related to klitih in Yogyakarta, focusing on spatial distribution, temporal trends, and characteristics of actors and instruments involved. A quantitative descriptive approach was employed, using web scraping techniques to automatically collect relevant online news articles from a national news portal. The unit of analysis consisted of news articles reporting klitih incidents within the Yogyakarta region during a defined observation period. The collected data were pre-processed and analyzed using descriptive analytical techniques, including frequency analysis, categorical distribution, and temporal trend analysis. The results indicate that klitih incidents are predominantly concentrated in urban areas, occur mainly during nighttime and early morning hours, and involve youth actors using easily accessible instruments. These findings demonstrate that online news data can serve as a reliable alternative source for capturing empirical patterns of youth criminality and support data-driven approaches in criminological studies.

Football is the world's most popular sport, evoking strong physiological and emotional responses among its fans. Yet, the specific reactions to fan involvement have received little attention in the literature. In this paper, we quantify the resulting physiological responses through a unique case study from professional football: the 2025 cup final of the German Football Association (DFB) between first-division club VfB Stuttgart and third-division club Arminia Bielefeld. We collected high-resolution smartwatch data, including heart rate and stress level, from 229 Arminia Bielefeld fans over approximately 12 weeks, complemented by survey responses on identification with the club, match attendance, and personal characteristics from a subset of 37 participants. By combining physiological data with survey information, we analyse variations in emotional arousal across individuals and contexts, measured by physiological reactions to the cup final. This approach provides rare, data-driven insights into the football fever that captivates fans during high-stakes competitions. Furthermore, we compare the vital parameters recorded on the day of the match with baseline levels on non-matchdays throughout the entire observation period. Our findings reveal pronounced physiological responses among fans, beginning hours before the match and peaking at kick-off.

Background/Objectives: Epilepsy represents one of the most common chronic neurological disorders in children, with a considerable proportion of patients exhibiting resistance to pharmacotherapy despite the advent of novel antiseizure medications (ASMs) in recent decades. This retrospective study assesses the off-label administration of cenobamate—a newly approved antiseizure medication (ASM) for focal seizures in adults—in a cohort of paediatric patients with drug-resistant epilepsy at a single neurology centre. Methods: Clinical outcomes were reviewed retrospectively for 18 children who received cenobamate for at least 6 months. Results: Eighteen paediatric patients with drug-resistant epilepsy received cenobamate therapy at a neurology centre. The mean age was 164.6 months, and each patient had previously trialled an average of 8.7 antiseizure medications. During a follow-up period of up to 29 months, 39% of participants achieved complete seizure freedom, while five additional patients experienced a seizure reduction exceeding 80%. Concomitant clobazam use was common among the cohort. Adverse events were reported in 78% of patients, predominantly somnolence, though these were generally transient or manageable. One patient developed a temporary exacerbation of seizures, which resolved following a dosage adjustment. Many patients were able to reduce or discontinue other ASMs during the observation period. Conclusions: Cenobamate demonstrated acceptable tolerability in this paediatric cohort, and seizure improvements were observed in a subset of patients. Further clinical trials are warranted to comprehensively evaluate the efficacy and safety profile of cenobamate in this patient population.

Effect of extramedullary fixation under different biomechanical modes on osseointegration of short-stem intramedullary implants: an experimental study

To examine the prevalence of comorbidities and the use of psychiatric comedication among individuals in medical treatment for attention deficit hyperactivity disorder (ADHD), in comparison to a matched control group from the general population. This nationwide case-control study included 1,082,378 Danish individuals aged 7-64 of whom 98,398 had at least one prescription of ADHD medication during 2023. Data was collected over an observation period spanning from 2013 to 2023. Cases were matched to controls (1:10) from the general population on birth year and sex. Data were obtained and accessed through The Danish Health Data Authority. Associations were estimated using conditional logistic regression models. Somatic and particularly psychiatric comorbidities were more common among individuals in ADHD treatment across all age groups. Among those in ADHD treatment 46.7% had at least one comorbidity compared to 23.3% in the control group. The use of psychiatric comedications (besides ADHD medication) was likewise more common among individuals in ADHD treatment (32.7%) compared to the controls (7.2%). The association estimates from conditional logistic regression revealed a higher likelihood of somatic and psychiatric comorbidities among those in ADHD treatment in all age groups. Females in ADHD treatment had 4.48-4.50 times higher odds of comorbidities compared to females not in ADHD treatment (OR7 - 17 years = 4.48, 95% CI: 4.27-4.70; OR18 - 29 years = 4.50, 95% CI: 4.37-4.64). Similar patterns were observed for males but with slightly lower ORs (OR7 - 17 years = 2.35, 95% CI: 2.27-2.44; OR18 - 29 years = 3.38, 95% CI: 3.28-3.50). This study reveals that both prevalence of somatic and psychiatric comorbidities and the use of psychiatric comedication are significantly higher among individuals in ADHD treatment. The highest occurrence is seemingly among females aged 7-17 year and 18-29 years. The coexistence of ADHD with other somatic and psychiatric conditions can constitute a more complex disease burden, necessitating enhanced disease management strategies to reduce complications and enhance quality of life. Longitudinal studies are needed to confirm the temporal association of these results.

This study evaluates activity patterns and determines optimal observation periods for assessing the welfare of lowland tapirs (Tapirus terrestris L.) housed in the following two Danish zoological institutions: Aalborg Zoo and Randers Regnskov. The objectives were to identify the most efficient time window for welfare assessments, determine whether machine learning (ML) could support behavioral evaluations by providing automated estimates of activity, and examine whether automated pose-based tracking could serve as a proxy for manual ethogram observations. Behavioral data were collected using standardized ethograms from wildlife camera footage recorded over 72 h. Lowland tapirs were generally more active during daytime, with individuals at Aalborg Zoo showing peak activity between 07:00 and 14:00, while those at Randers Regnskov were most active between 12:00 and 18:00. Activity patterns differed between institutions, with Aalborg individuals displaying concentrated activity peaks and Randers individuals showing more evenly distributed activity. A preliminary ML analysis using the pose-estimation tool SLEAP demonstrated that movement-based activity estimates closely matched manually coded data, suggesting that automated tracking may offer an efficient and non-invasive tool for welfare monitoring. The findings highlight the potential for integrating automated analysis into routine welfare assessments of zoo-housed animals.

Respiratory syncytial virus (RSV) may trigger cardiorespiratory events in adults. To assess the risk of cardiorespiratory events in the 180 days following RSV-related hospitalization compared with a control period in adults. This self-controlled case series study had an observation period from January 1, 2017, through March 31, 2024. Data were obtained from the deidentified Optum Market Clarity Dataset, including RSV-related hospitalization and associated outcomes, which were identified based on diagnosis codes. Adults with 1 or more RSV-related hospitalizations and 1 or more cardiorespiratory events (myocardial infarction [MI], stroke, chronic obstructive pulmonary disease [COPD] exacerbation, congestive heart failure [CHF] exacerbation, and arrhythmia) were included. RSV-related hospitalization. A conditional Poisson regression model was fitted to compare the incidence of cardiorespiratory events during the risk period (ie, ≤180 days after RSV-related hospital index date) and control periods (ie, >21 days before or >180 days after the index date). Incidence rate ratios (IRRs) and 95% CIs were estimated and adjusted for time-varying covariates. A total of 11 887 patients (mean [SD] age, 69.4 [15.5] years; 7303 females [61.4%]) with RSV-related hospitalization were included. An increased risk was associated with each cardiorespiratory event during the first 14 days following RSV-related hospitalization, with the highest IRR estimates observed in the initial 7 days. For MI, the IRRs were 8.7 (95% CI, 6.7-11.2) during days 1 to 7, decreasing to 5.2 (95% CI, 3.7-7.2) during days 8 to 14 and 2.6 (95% CI, 1.6-4.3) during days 15 to 21. For stroke, the IRRs were 7.4 (95% CI, 5.5-10.1), 5.9 (95% CI, 4.2-8.3), and 3.7 (95% CI, 2.3-5.9) during the first 3 weeks with a similar pattern for CHF exacerbation (12.5 [95% CI, 10.5-14.8], 4.1 [95% CI, 3.1-5.5], and 2.4 [95% CI, 1.6-3.6], respectively). For COPD exacerbation and arrhythmia, the IRRs decreased during the first 3 weeks from 23.1 (95% CI, 20.2-26.5) through day 7 to 1.3 (95% CI, 0.8-2.4) during days 15 to 21 and from 16.5 (95% CI, 14.5-18.7) to 1.6 (95% CI, 1.1-2.5), respectively. This study demonstrated that RSV, similar to influenza and SARS-CoV-2, was associated with an increased risk of cardiorespiratory events 2 weeks following RSV-related hospitalization, and some conditions had significant risk elevations up to 180 days after admission. The findings reinforce the need to increase RSV immunization in adults.

Papaya ringspot virus watermelon strain (PRSV-W) is a member of the genus Potyvirus that infects Cucurbitaceae crops. The first occurrence of PRSV-W in Indonesia was reported in Bali in 2022. However, information regarding yield loss caused by PRSV-W infection in melon has not yet been reported. This study aimed to analyze yield loss and changes in fruit quality of melon resulting from PRSV-W infection. The research methods included individual and population level disease observations, assessment of agronomic variables and disease severity, yield loss estimation, and data analysis. Observations were conducted at the Pegok Experimental Farm, Faculty of Agriculture, Udayana University, covering an area of 1000 m². The observed plant ages ranged from 6 to 66 days after planting (dap). Mosaic disease development was observed from 18 dap until before harvest. The highest disease incidence and disease severity recorded at the end of the observation period were 58.4% and 61.8%, respectively. Actual yield loss, calculated by comparing mosaic symptomatic and asymptomatic melon plants, reached 49.45%. The most prominent quality defects were changes in fruit color and shape and fruit malformation, with values of 14.06% and 17.5%, respectively. The greatest economic loss occurred in plots with an AUDPC value of 751, resulting in a total yield loss of IDR 15,721,500. Yield loss showed strong correlations with disease incidence and disease severity, with correlation values of 95.41% and 96.19%, respectively. PRSV-W infection altered fruit skin color from yellow-orange to pale yellow with ringspot symptoms, and PRSV-W was detected in the skin tissues of infected fruits. In addition, PRSV-W infection reduced fruit sweetness to 9–12 °Brix, whereas healthy fruits exhibited sweetness levels of 14–17 °Brix.

This study evaluated and compared the effectiveness of Bacillus species probiotics and formalin-killed bacterin to control vibriosis caused by Vibrio anguillarium in European eel (Anguilla anguilla) elvers. Fish were allocated into four triplicate groups defined as follows: a control non-vaccinated (CON) group that fed on a basal diet without additives, two groups fed on diets supplied with Bacillus species probiotics (PRO; Sanolife PRO-F) in a dose of 0.5 g /kg diet (PRO-F1) and 1.0 g /kg diet (PRO-F2), and the fourth group was vaccinated with immersion formalin-killed bacterin and got a booster vaccination at 14th day (VACC). The experiment lasted for 28 days. In the end, the immune responses, including antibody titers, lysozyme activities (in serum and skin mucous), and bactericidal activity, were evaluated. The relative percent survival (RPS) after intraperitoneal challenge with V. anguillarium was calculated after an additional 10-day observation period. A one-way ANOVA followed by Dunnett’s multiple comparison test was used to compare the experimental groups (VACC, PRO-F1, and PRO-F2) with the CON group. The results revealed significantly higher antibody titers, lysozyme activities (in serum and skin mucous), and serum bactericidal activity in the VACC and PRO-treated groups over the CON group. Of interest, the lysozyme activities (in serum and skin mucous) and antibody titers were significantly higher in the VACC group over both PRO groups. After the experimental infection, it was noticed that both VACC and PRO significantly protected eel elvers against V. anguillarium compared to the CON group. In addition, the RPS were 41.67%, 29.17%, and 37.50% in the VACC, PRO-F1, and PRO-F2 groups, respectively. This study unveils the vital roles of PRO and VACC and their effective roles in enhancing innate and mucosal immunities and protecting European eel elvers against vibriosis caused by V. anguillarium. Based on our findings, immersion vaccination emerges as the superior strategy for managing vibriosis in eels. This approach offers greater protection than feed-based probiotics, underscoring its potential as a viable vaccination method in eel aquaculture.

Identifying high-cost patients in psychiatry: Optimal cut-off values for previous admissions and length of stay.

As the ambulatory care landscape shifts due to advances in medical technology and a rise in medically complex patients, health care systems must evolve by optimizing team-based care models and scope-of-practice utilization. This case study describes Northwell Health Physician Partners' policy-level initiative to expand the role of medical assistants (MAs) by permitting them to communicate normal laboratory results to patients. A structured, multiphase approach was used to evaluate and implement the policy change. This included a comprehensive review of clinical workflows, stakeholder engagement, assessment of patient safety implications, and alignment with regulatory and compliance standards. The initiative prioritized maintaining the integrity of the MA role while enhancing care delivery efficiency. Training, documentation protocols, and communication standards were developed to support safe execution of this expanded task. Following implementation, the organization observed improved care team efficiency and enhanced patient communication workflows. Clinicians reported a reduction in administrative burden, particularly in managing normal test results. MAs were successfully integrated into follow-up communication workflows, freeing licensed staff to focus on higher-acuity needs. This scope-of-practice enhancement not only empowered MAs but also fostered greater operational synergy across the care team, enabling more efficient task distribution among clinicians, registered Nurses, and MAs and improved overall workflow. This shift facilitated optimal utilization of licensed professionals within their scope of practice allowing them to fully leverage their training and expertise. No adverse events related to the expanded task were reported during the observation period. Expanding MA responsibilities to include the communication of normal laboratory results demonstrates how institutional flexibility in scope-of-practice policy can strengthen team-based care in ambulatory settings. Key lessons include the importance of stakeholder consensus, standardized training, and clear documentation protocols. This case highlights a replicable approach for other health systems seeking to address workforce challenges while ensuring patient safety and satisfaction. Future steps include ongoing evaluation of patient outcomes, expanded metrics tracking, and exploration of additional opportunities to optimize support staff roles across the ambulatory enterprise.

A biomimetic nano-suspension based on orthoester designed for the inhibition of postoperative tumor recurrence.