Characterizing distinct quitting trajectories may inform tailored behavioral smoking cessation interventions. We identified the quitting trajectories and associated characteristics in Hong Kong Chinese smokers. Data were from eight randomized controlled trials nested within the annual Smoking-free Community Campaign ('Quit-to-Win' Contest) from 2014 to 2021. The trials were two- or three-arm evaluating the effectiveness of behavioral smoking cessation interventions in 8300 adult daily smokers who were proactively recruited from communities across Hong Kong and followed-up at 1, 2, 3 and 6months. Daily cigarette consumption was collected at baseline and follow-ups for identifying quitting trajectories by group-based trajectory modeling based on relative changes in cigarette consumption (vs. baseline) over four follow-up assessment points. Multinomial logistic regressions were used to yield relative risk ratios (RRRs) for the trajectories by baseline smoking-related characteristics, adjusting for sex, age, economic status and education attainment. Four quitting trajectories were identified, including quitters (4.6%), relapsers (6.8%), reducers (54.8%) and persistent smokers (33.8%). Compared with persistent smokers, smokers in the other 3 trajectories were associated with having previous quit attempts, higher intention to quit and perceived higher importance and confidence in quitting (all P < 0.05). Quitters [adjusted RRR (aRRR) = 0.59, 95% confidence interval (CI) = 0.62-1.00] and relapsers (aRRR = 0.75, 95% CI = 0.61-0.91) reported lower nicotine dependence vs. persistent smokers, whereas reducers showed higher nicotine dependence (aRRR = 1.39, 95% CI = 1.25-1.55) at baseline. Relapsers and reducers perceived higher difficulty of quitting (all P < 0.05). When compared with quitters, relapsers had higher intention to quit within 7days (aRRR = 2.32, 95% CI = 1.64-3.28) and perceived higher importance (aRRR = 1.17, 95% CI = 1.09-1.25) and confidence (aRRR = 1.10, 95% CI = 1.04-1.17) in quitting, while reducers showed lower intention to quit within 7days (aRRR = 0.59, 95% CI = 0.45-0.77) and perceived lower confidence in quitting (aRRR = 0.91, 95% CI = 0.86-0.95). Subgroup analysis of different interventions showed similar trajectory shapes and group probabilities. Chinese smokers who joined behavioral smoking cessation trials in Hong Kong appear to have four quitting trajectories, each with associated characteristics, which may help predict the potential quitting trajectories and inform future interventions.

The decarbonisation of the electricity grid requires large scale deployment of renewable generation. Yet, most renewable generation is intermittent, and therefore large-scale energy storage may be needed to ensure supply availability. To guide future policies and system planning, it is important to know how much storage the future net-zero energy system will need. Previous attempts to estimate storage requirements have either focused on systems entirely supplied by renewables, or did not consider the increased demand due to expected electrification. In this work, we explore how much energy storage the future energy system in the United Kingdom may require and how much this requirement depends on future levels of demand, and the share of dispatchable generation in the grid, such as biomass or nuclear. We perform a simulation of energy flows for a typical year, for a range of energy mix scenarios, and two parameters – storage efficiency and renewable curtailment allowance. Our results anticipate a storage requirement for the UK ranging from 109 GWh to 9 TWh. Less storage is needed when a higher share of dispatchable generation is available, even if electricity demand is higher. Allowing for more renewable curtailment and less efficient storage may also reduce the requirements for storage capacity, at the expense of more energy dissipation. Highlights • We investigate energy storage requirements under energy transition pathways. • The UK will require 109GWh to 9TWh of energy storage depending on pathway. • The amount and type of dispatchable generation influence storage requirements. • Storage needs are much lower than in 100%-renewable scenarios. • VRE curtailment has a significant influence on storage requirements.

A compact perceptual space for natural textures emerges from natural image statistics.

Complex cryptoglandular anal fistulas present a treatment challenge, with many surgical options associated with recurrence, variable healing rates, and risk of incontinence. Freshly collected autologous adipose tissue (FCAAT) has been proposed as a minimally invasive, one-step alternative. This study aimed to assess clinical healing and clinical improvement and to evaluate the safety of the procedure. This prospective cohort study included 31 patients without inflammatory bowel disease (IBD) with complex single-tract cryptoglandular anal fistulas treated with FCAAT between May2019 and December 2023 and followed until August 2024. The surgical procedure involved liposuction, processing of adipose tissue,closure of the internal opening, and local injection along the fistula tract in a one-step procedure. Primary outcomes were clinical healing and clinical improvement; secondary outcomes were adverse events. The patient cohort presented with advanced disease. Median disease duration was 20months, and one-third of patients had undergone previous attempts at surgical closure. Clinical healing was achieved in 23 patients (74%), with an additional four patients (13%) demonstrating clinical improvement. Five of 27 responders (19%) healed more than 3months post-procedure. Common adverse events included proctalgia in 8 patients (22%), donor site pain 5 (14%), and minor graft site hematomas in 4 (11%). One Clavien-DindoIIIa event (graft site bleeding) was managed with a single suture; all other complications were minor and resolved conservatively. FCAAT is a safe and effective one-step treatment for complex anal fistulas in non-IBD patients, offering a high healing rate with predominantly minor complications. A delayed effect was observed in some patients.

A chimeric L1-L2 virus-like particle (VLP) vaccine targeting common cutaneous human papillomavirus type 1 (HPV1).

Cell envelope proteinases have long played a pivotal role in dairy science. However, as demand for alternative food sources grows, their application in plant-based food matrices is scarcely investigated. A deeper physiological and technological understanding of these enzymes requires efficient and effective tools tailored to this emerging sector. To date, plasmid-based recombination in Lactococcus spp. remains the most widely used and effective method. In this study, we engineered S. thermophilus LMD-9 as a host for heterologous expression of protease from Lc. cremoris. S. thermophilus LMD-9 offers several advantages, including its GRAS status, efficient chromosomal gene integration via natural competence, and native machinery for functional protease production, making it a highly versatile host. Previous attempts to employ this strain yielded inactive protease due to unresolved bottlenecks; here, we characterize and overcome those challenges to establish LMD-9 as a robust system for protease expression. Exploration of potential bottlenecks highlighted the availability of intrinsic peptidyl-prolyl cis/trans isomerase (PPIase; prtM/prsA) as a key factor influencing successful enzyme expression. Three recombinant strains with genotypes: LMD-9 ΔprtS::ermR, LMD-9 ΔprtS::ermR-ΩprtP, and LMD-9 ΔprtS::ermR-Ω (prtM-prtP), were generated to test the role of prtP-associated PPIase. Results demonstrated that inclusion of PrtP-specific PPIase from L. cremoris markedly enhances protease activity. In its absence, although partially compensated by the pleiotropic PPIase in S. thermophilus, we observed slower growth and reduced proteolytic activity. These findings establish S. thermophilus LMD-9 as a robust chassis and alternative host for heterologous expression of cell envelope proteinases. To our knowledge, this is the first work to heterologously express active CEP enzyme in this host, and it highlights the role of PPIase availability as a key determinant of successful enzyme expression. This then provides a suitable and robust host for studying the application of CEPs in both dairy and emerging plant-based food applications.

For decades inflammation has been postulated to play a key pathophysiological role in heart failure (HF), particularly in HF with preserved ejection fraction (HFpEF). Previous attempts to target inflammation in HF have been unsuccessful, possibly due to the choice of therapeutic target or the characteristics of the patient population studied. We hypothesized that targeting interleukin-6 (IL-6)-a cytokine central to NLRP3 inflammasome activation that is associated with both the onset and progression of HF-may be beneficial in patients with HF and circulating evidence of cardiovascular inflammation, but without overtly reduced ejection fraction (EF). We describe the rationale and design of two clinical trials (ATHENA and HERMES) investigating ziltivekimab, a human monoclonal antibody directed against the IL-6 ligand, in patients with HF and mildly reduced or preserved EF (HFmrEF/HFpEF) and cardiovascular inflammation. ATHENA (n=673) and HERMES (n=4900) are international, multicenter, double-blind, placebo-controlled trials randomising adults with HFpEF/HFmrEF and cardiovascular inflammation (hsCRP ≥2mg/L) to ziltivekimab 15 mg or placebo, administered subcutaneously once-monthly on top of standard of care. Eligible participants have a left ventricular ejection fraction >40%, elevated NTproBNP and serum high sensitivity C reactive protein ≥2 mg/L. The primary endpoint in ATHENA is the change in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score at 12 months. The primary endpoint in HERMES is time to first composite of cardiovascular death, hospitalisation for HF or urgent HF visit. ATHENA has a fixed duration of 12 months whereas the HERMES trial is event-driven (approximately 845 adjudicated primary events) with a minimum exposure of 6 months from randomisation to last treatment visit. ATHENA and HERMES will investigate the effect of ziltivekimab in HFpEF/HFmrEF and cardiovascular inflammation. ATHENA will determine the effect of ziltivekimab on health status. HERMES will determine the efficacy and safety of ziltivekimab on morbidity and mortality.

Cholera is highly climate sensitive, however previous attempts to model its future under climate change have been limited to statistical analyses. Mechanistic models are an essential addition because they permit a deeper understanding of the complex feedback loops involved in infectious disease transmission, allowing for better modelling of potential scenarios such as interventions or changes in pathogen dynamics. We compare four mathematical models with differing assumptions of climate sensitivity and fit them to a cholera dataset from Kolkata, India using MCMC. We then use bias-corrected climate projections of temperature and rainfall from 10 independent global climate models to produce climate-based cholera projections for the period 2080-2099. Using both temperature and rainfall as inputs, the best performing model recreates seasonal patterns highly effectively. Future projections suggest an average increase in cholera cases ranging from 81% - 150% due to climate change by 2080-2099 with earlier peaks in the infection cycle likely due to heightened transmission rates earlier in the year. Sensitivity analysis reveals that uncertainties in parameters related to the contact rate and water dynamics have the greatest impact on model projections, suggesting that these factors are critical for refining future predictions. While our mechanistic model demonstrates the potential to project cholera dynamics under future climate scenarios, projections remain sensitive to key knowledge gaps including epidemiological parameters and effects of temperature on bacterial growth. Addressing these limitations through improved environmental observations and more detailed process representation will be essential for refining future climate-cholera projections and informing long-term control strategies.

Acquired diaphragmatic hernias are rare, yet serious complications. This report details the unique case of a 2-year-old female who developed a right-sided diaphragmatic hernia following an omentum pull-up procedure, which occurred after a heart transplant for dilated cardiomyopathy. We present the case of a 2-year-old female patient who suffered from dilated cardiomyopathy, necessitating a heart transplant in her first year of life. Subsequently, an omentum pull-up was performed to manage a sternum that had dehisced with an infectious focus. Following this, she was exclusively on nasogastric (NG) tube feeding due to recurrent gagging and vomiting. She then presented with acute signs of pneumonia, vomiting, and cough. A chest radiograph and computed tomography scan revealed intestinal loops in the right thoracic cavity, suggesting a diaphragmatic defect. Surgical repair through median laparotomy successfully reduced the herniated transverse colon and primarily closed the anterior diaphragmatic defect. Postoperatively, the patient's respiratory status improved. However, despite consultations with the dietetics team and two previous rehabilitation attempts for tube weaning, she has not yet transitioned to oral nutrition and remains dependent on the NG tube, with a gastrostomy pending. Children who develop respiratory symptoms after undergoing a heart transplant followed by an omental pull-up should have an acquired diaphragmatic hernia ruled out.

Recurrent hard palate fistulas remain a challenging problem in cleft palate surgery, particularly after multiple failed local and regional flap attempts. Although free flaps provide reliable closure, excessive intraoral bulk and donor-site morbidity may compromise functional outcomes. The free medial femoral condyle (fMFC) flap offers thin, well-vascularized tissue with the option of vascularized bone, closely matching native palatal anatomy. This retrospective study included cleft palate patients who underwent reconstruction of recalcitrant hard palate fistulas using the fMFC flap between 2015 and 2025. Patient demographics, fistula characteristics, previous repair attempts, complications, and follow-up outcomes were analyzed. Nasal lining was reconstructed using bilateral hinge flaps prior to fMFC inset. Seven patients (mean age 19.5y) were included, all with a history of multiple failed fistula repairs (mean 2.2 previous surgeries). Six fistulas were located in the anterior hard palate and one in the mid-palate. The mean fistula size was 1.95cm², and the average follow-up period was 27 months. Complete closure was achieved in all but one patient, who developed partial bone exposure that healed with secondary granulation. No donor-site morbidity was observed. The fMFC flap is a reliable and effective option for reconstruction of small, recalcitrant hard palate fistulas. It provides excellent tissue compatibility, minimal intraoral bulk, and low donor-site morbidity, making it a valuable alternative when local and regional flaps are unsuitable.

Evaluation of factors associated with intentional non-pharmaceutical poisoning in Iran.

There is limited research examining the relationship between blood alcohol concentration (BAC) and other risk factors among suicide deaths in Finland. Our study aimed to investigate the relationship of an elevated (more than zero) blood alcohol concentration with medical history, including sociodemographic characteristics and disease diagnoses. Data was collected from suicide deaths in Finland from 2016 to 2024 and verified by official cause-of-death investigations, which included forensic autopsy, toxicology results, and other key information from death certificates and national healthcare registries. A condition recorded in both the death certificate (autopsy) and healthcare register was considered as confirmed diagnosis. BAC, as expressed as a percentage, was grouped into three categories: nil (BAC = 0.000), low-to-medium (BAC = 0.010%-0.099%), and high (BAC = 0.100%-0.500%). Descriptive statistics, correlation, and stepwise logistic regression to estimate odds ratios (ORs) for BAC categories were undertaken. The number of suicide deaths from 2016 to 2024 in Finland was n = 6892, with 5183 men (75.2%) and 1709 women (24.8%). BAC reports were available for n = 6835. Independent factors associated with a low-to-medium or high BAC at death were alcohol use (ORs: 41.80-275.27), longer than 1 day since last healthcare visit (ORs: 1.54-2.53), previous suicide attempt(s) (ORs: 1.42-1.65), and female gender (only for high BAC, OR: 1.30). There were reduced odds for schizophrenia spectrum diagnosis (OR: 0.17), bipolar disorder (OR: 0.29), age groups 10-19 (ORs: 0.30-0.65), 80 and over (ORs: 0.15-0.39), and 70-79 years (only for high BAC, OR: 0.43). Our findings show that individuals with documented habitual alcohol use, female gender, previous suicide attempts, and less frequent healthcare visits had higher odds of intoxication at suicide. Meanwhile, being aged under 20, over 70, or diagnosed with schizophrenia or bipolar disorders reduced the odds. The results highlight the need for proactive healthcare engagement and integrated alcohol-use interventions in suicide prevention strategies.

BackgroundSuicide is a critical public health issue, particularly among vulnerable populations of all ages living in slums. People residing in these environments often face unique psychosocial challenges that contribute to elevated rates of suicidal ideation and behavior. This study aims to consider the strategies and implementation considerations for suicide prevention programs in slums.MethodsA systematic scoping review was conducted according to Arksey and O'Malley's framework in 2024. Multiple electronic databases were searched systematically to identify studies focusing on suicide prevention strategies in slum populations. Studies were selected based on their relevance to suicide prevention, risk factors, and considerations for implementation. A narrative synthesis approach was applied to summarize the findings from the included studies.ResultsA total of 15 studies were included from an initial search of 3914 records screened. Synthesis of findings led to the identification of suicide control strategies for some target groups, including the general population, individuals at risk, and individuals with warning signs or previous suicide attempts. The strategies can be considered in the form of primary, secondary, and tertiary prevention. Strategies focus on enhancing mental health services access, promoting community awareness, reducing access to lethal means, and providing responsive crisis services.ConclusionAddressing suicide prevention in slum areas requires a multifaceted approach that considers the unique socio-economic contexts of these communities. Community-based interventions, enhanced healthcare access, and targeted mental health programs, adapted to the unique resource and structural constraints of slum environments, are crucial for reducing the incidence of suicidal ideation and behaviors.

Accurate subseasonal to seasonal (S2S) weather forecasts are critical for managing risks to society, yet improving forecast skill remains challenging. Ensemble forecasting mitigates atmospheric chaos but is limited by computational cost and by declining accuracy at longer lead times. Previous attempts to incorporate previous ensemble forecasts have yielded little improvement in the accuracy of the latest forecast because members from earlier initializations tend to degrade forecast quality. Here, we introduce a simple yet powerful postprocessing approach, lagged ensemble analog subselection (LEAS), which selectively chooses previous ensemble members that best predicted the most recent conditions. Using hindcasts of daily maximum 2-m air temperature over North America from four state-of-the-art S2S weather forecast models, we show that LEAS enhances both deterministic and probabilistic skill across multiple weeks, including for extreme heat events. The method reduces systematic bias as well as variance error, outperforming conventional lagged ensembles without requiring additional simulations or changes to model initialization. The improvement arises from filtering out poorly performing members and effectively emulating enhanced initialization of both atmospheric and land-surface states. LEAS combines principles of analog forecasting with lagged ensembles, extending their impact from short-term to multiweek predictions. Its simplicity and generality suggest broad applicability, not only to machine-learning-based weather forecasting but also to other predictive systems that rely on repeated initialization, such as hydrological, climate, and Earth system models. By extracting more value from existing forecast data, LEAS advances toward the upper limit of forecast skill achievable within current model frameworks while avoiding added computational burden.

Introduction: Suicide is a major global public health concern and the fourth leading cause of death among individuals aged 15-29. In Turkey, the crude suicide rate has shown a consistent increase in recent years. This study aimed to evaluate the sociodemographic and clinical characteristics of patients presenting to the pediatric emergency department following non-violent suicide attempts, and to identify associated risk factors. Methods: In this prospective study, patients under 18 years presenting with nonviolent suicide attempts were included. Data collected comprised demographic and clinical features, psychiatric history of children and families, family dynamics, and substance use. Standardized tools used included the Family Assessment Device-Communication subscale, Adolescent Friendship Attachment Scale, Parenting Style Scale, and Beck Scale for Suicide Ideation. Results: Of 101 patients (82.2% female; mean age 15.5 ± 1.3 years), 44.6% used their own medications, most frequently nonsteroidal anti-inflammatory drugs (19.6%). Psychiatric diagnoses were identified in 31.6%, prior suicide attempts in 43.6%, and tobacco/alcohol use in 35.5%. Poor family communication was observed in 73.3% of families, and authoritarian parenting in 35.6%. Substance use was found to predict recurrent suicidal ideation, while previous attempts and poor family communication predicted greater severity of suicidal ideation (OR = 3.093; p = 0.025), (OR = 4.267; p = 0.003), (OR = 3.218; p = 0.011). Conclusion: Adolescents with substance use, prior suicide attempts, and poor family communication are at significantly increased risk for severe or recurrent suicidal ideation.

Over the last two decades, there has been substantial development in the manufacturing of nano- and micro- tubes and wires as building blocks for electronic devices, such as field-effect transistors, to complement the conventional semiconductor transistors in electronic circuits. Previous attempts to improve device performance through the development of new materials have focused mostly on carbon or metal oxide-based semiconducting materials. Here, we report a flexible conducting polymer micro-wire grown from the vapor phase via an oxidative polymerization route. Electrical measurements show that the single micro-wires have relatively high conductivity and non-linear electrical characteristics. In addition, we demonstrate the fabrication of a flexible polythiophene micro-wire organic electrochemical transistor, in which the channel and gate are made of single micro-wires. These devices are fully compatible with conventional fabrication processes and operate in the sub-volt regime, and have the potential to be scaled to larger multi-micro-wire architectures and circuits. This study demonstrates the concept of self-assembly of organic molecules and simultaneous polymerization to generate complex, ordered, and functional structures resembling polymerized Bechgaard salts.

Metabolic dysfunction-associated fatty liver disease (MAFLD), recently redefined from non-alcoholic fatty liver disease (NAFLD), highlights the central role of metabolic dysfunction in its pathophysiology. The L-α-lysophosphatidylinositol/G protein-coupled receptor 55 (LPI/GPR55) axis, an element of the endocannabinoidome, has emerged as a key driver behind liver disease progression, leading to the progression of metabolic dysfunction associated steatohepatitis (MASH). Implicated in hepatic lipid accumulation, inflammation and fibrosis, this axis has detrimental effects in hepatocytes, Kupffer cells and hepatic stellate cells. Furthermore, recent evidence suggests that this axis induces de novo lipogenesis, promoting pro-inflammatory cytokine production, leading to fibrosis and the transition toward a steatotic liver. The enzyme membrane-bound O-acyltransferase domain-containing 7 (MBOAT7) modulates this axis by acylation of LPI, exacerbating hepatic steatosis and insulin resistance. Until recently, no pharmacologic treatments were approved for MAFLD. However, resmetirom received FDA approval in March 2024 for the treatment of MASH, and semaglutide (Wegovy) was granted accelerated FDA approval in August 2025 for MASH with moderate-to-advanced fibrosis. Additional agents such as tirzepatide and retatrutide remain in late-stage clinical development. We propose that targeting the endocannabinoidome, specifically the LPI/GPR55 axis, represents a promising therapeutic strategy for liver disease. Previous attempts to target GPR55 therapeutically have involved small-molecule agonists and phytocannabinoids with antagonistic activity. However, progress remains limited due to the context-specific roles of GPR55 across different tissues and signalling pathways. As such, future strategies involving the LPI/GPR55 axis must focus on hepatic-specific GPR55 modulation using selective ligands and advanced delivery systems, mitigating off-target effects. This review elucidates the mechanistic role of the LPI/GPR55 axis, combining the role of MBOAT7 in the pathophysiology of metabolic-associated liver disease.

Regional economic disparities in the United Kingdom lead to large differences in health. Previous attempts to address this issue have had limited success. Community Wealth Building is an economic strategy that aims to address these inequalities by redirecting wealth back into the local economy and increasing community control over the economy. The City of Preston initiated a Community Wealth Building strategy in 2012. We investigate the health impact of this approach in Preston up to 2019, a period during which their strategy largely focused on progressive procurement and the adoption of the Living Wage by employers within Preston. We estimate the impact of Community Wealth Building in Preston on mental health problems as measured by the Small Area Mental Health Index and its constituent components (antidepressants, depression diagnoses and mental health-related hospital attendances), self-reported life satisfaction, wages, employment and the number of non-profit enterprises. We use matching and difference-in-differences analysis to compare changes in outcomes in Preston before and after the intervention with changes in the outcomes in comparison areas. We use data on invoices and contracts issued by local authorities to compare procurement by Preston City Council with other similar local authorities, assessing the impact of local procurement on employment, wages and the cost of contracts. Finally, we use a combination of interviews and workshops to understand the process of change that has taken place in Preston and what has helped or hindered this. We found that, in Preston, the introduction of Community Wealth Building was associated with a reduction in mental health problems (-0.11 reduction in Small Area Mental Health Index, 95% confidence interval -0.16 to -0.06) alongside improvements in life satisfaction (0.06, 95% confidence interval 0.01 to 1.3), wages (£38 per week, 95% confidence interval £6.8 to £62.1), employment (4.1%, 95% confidence interval 2.3% to 5.8%) and a growth in non-profit enterprises (additional 20 enterprises 95% confidence interval 6 to 50). These economic improvements tended to be greatest among more disadvantaged groups, reducing inequalities. Preston City Council was much more likely to procure services from local suppliers compared to other similar local authorities, and this practice is likely to have contributed to these economic benefits. We found no evidence that procuring locally increased costs. Stakeholders in Preston highlighted that economic pathways to health impact were the most developed particularly in relation to procurement policy, while the community pathways to impact were less developed. Lack of widespread public involvement and engagement with smaller Voluntary, Community, Faith and Social Enterprise organisations in Preston had arguably limited the potential impact of Community Wealth Building in Preston. Despite this, appreciation for the approach and its aims remains strong. Community Wealth Building in Preston has led to economic gains that disproportionately benefited less advantaged groups, and this led to improvements in mental health and well-being. This seems to have been largely driven by changes in procurement practices of anchor institutions alongside policies to improve working conditions - such as the Living Wage. Future development should aim to shift the balance toward bottom-up civic engagement, which will help enhance sustainability of the approach. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR130808.

Robotic systems' mobility is fundamentally constrained by their power sources and wiring requirements. While electrical actuation systems have achieved autonomy through battery power and wireless control, pneumatic actuators remain tethered to air supply sources. Liquid-to-gas phase change actuators utilizing low-boiling-point liquids offer a potential solution, though they typically require substantial thermal input through heating elements that maintain electrical dependencies. External heat sources, particularly light energy, present an alternative for terrestrial applications. However, despite their optical transparency, silicone-based materials have a high volumetric heat capacity and low thermal conductivity, which limits efficient photothermal energy transfer. Previous attempts to address this issue through the incorporation of graphene or metallic powder have compromised material properties, including reduced transparency and altered elastic moduli. Inspired by the tapetum lucidum structure found in the eyes of nocturnal animals, which enables efficient light utilization in low-light conditions, this study proposes a novel anisotropic bilayer soft actuator incorporating Laser-Induced Graphene (LIG) on the inner surface of the light-irradiated silicone layer. This creates an anisotropic structure with enhanced photothermal conversion capabilities while maintaining the advantageous properties of silicone. Comparative analysis demonstrates that the proposed actuator exhibits significantly higher photo-induced bending efficiency than conventional silicone-based actuators. The response time improved by 54%, decreasing from 142 s for pure silicone to 65 s, with recovery response time showing a 48% improvement. This design maintains the silicone's transparency and flexibility while utilizing LIG, which can be fabricated under ambient conditions, facilitating manufacturing and diverse applications.

Objective: To investigate the relationship between the number of previous implantation failures (IFs) and embryo ploidy status, as well as subsequent clinical outcomes, in women with recurrent implantation failure (RIF) undergoing preimplantation genetic testing for aneuploidy (PGT-A). Methods: This retrospective cohort study included 422 women with RIF who underwent their first PGT-A cycle between 2017 and 2022. Participants were stratified by maternal age (<38 years, n = 292; ≥38 years, n = 130) and by the number of previous IFs, categorized as 3, 4, or ≥5. The primary outcomes were embryo ploidy rates (euploidy, aneuploidy, and mosaicism). Secondary outcomes included reproductive outcomes after single euploid blastocyst transfer (biochemical pregnancy, clinical pregnancy, ongoing pregnancy, live birth, and pregnancy loss) and neonatal birth weight. Results: Women aged ≥38 years had a significantly lower euploidy rate than those <38 years (24.8% vs. 47.3%, p < 0.001). Ploidy distribution did not differ significantly across IF categories. Among women aged <38 years with ≥5 IFs, a greater number of previous embryo transfer attempts was independently associated with higher odds of live birth after euploid embryo transfer (adjusted OR = 1.258, 95% CI: 1.051-1.505; p = 0.012). Neonatal weight did not differ significantly across IF categories. Conclusions: The number of previous IFs was not independently associated with embryo ploidy or clinical outcomes after euploid transfer, whereas advanced maternal age was strongly associated with a lower likelihood of obtaining euploid embryos. In younger women with ≥5 IFs, a greater number of previous embryo transfer attempts was associated with live birth after euploid transfer; however, this exploratory subgroup finding should be interpreted cautiously and requires prospective validation. Because this study did not directly evaluate therapeutic strategies, any potential role for individualized endometrial evaluation or optimization should be considered as hypothesis-generating rather than supported by the present data.