Citations

Abstract Background Endoscopic placement of self-expandable metal stents (SEMS) is a minimally invasive intervention, aiming to restore luminal patency in GIT obstruction patients. As stent migration is considered a major sequela, techniques for its fixation have been established. This study aims to assess the efficacy of stent fixation using either endoscopic suture fixation or over-the-scope clips (OTSC). Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched available databases (PubMed, Scopus, and Web of Science) to identify eligible studies reported up to January 2025. Using RevMan 5.4, we reported outcomes as odds ratios (OR) and confidence intervals (CIs). A P-value ≤ 0.05 was considered statistically significant. Results Twelve studies were included in this meta-analysis, with a total of 1136 patients. The pooled OR for stent fixation is 0.32 (95% CI: 0.19–0.57; p < 0.001), with moderate heterogeneity (I² = 59%, P = 0.005). According to the subgroup analysis in relation to the fixation method, suture fixation yields a pooled OR of 0.37 (95% CI: 0.19–0.69; p = 0.002), and OTSC fixation yields a pooled OR of 0.25 (95% CI: 0.11–0.54; p = 0.0004). There is no statistically significant difference between these subgroups (p = 0.45, I² = 0%). There was no statistically significant difference in the rates of adverse events; with a pooled OR of 0.71 (95% CI: 0.33–1.54), and substantial heterogeneity (I 2 = 73%; P = 0.002). Conclusion Statistically significant lower stent migration rates were reported following either endoscopic suture fixation or OTSC, along with higher clinical success rates. Future clinical trials with longer follow-up durations are recommended to accurately update the guidelines.

Abstract Objective Gastrointestinal (GI) symptoms are common in systemic mastocytosis (SM). We hereby report the clinicopathologic and molecular features of GI mastocytosis. Methods The study includes 104 patients with suspected SM. Of 258 GI biopsy ­specimens, 33 (20 patients, 19%) were mastocytosis-positive, with 19 (16 patients) initially missed. Results Tryptase (n = 29) was weakly positive/negative in two-thirds of the mastocytosis-positive GI biopsy specimens. Additional immunohistochemistry (n = 23) showed positive mast cell expression for CD30 (n = 2), CD123 (n = 7), and PD-L1 (n = 12), as well as increased PD-1–positive cells (n = 4). Sixty patients had positive bone marrow (BM) for SM (SM-BM+), including 19 with positive GI biopsy specimens (SM-GI+). Almost all (43/44) SM-BM– patients were SM-GI–. The SM-GI vs SM-BM status showed high positive predictive value (95%) and specificity (98%). Patients with SM with mastocytosis-positive vs mastocytosis-negative GI biopsy specimens had higher serum tryptase levels (P = .04). KIT D816V mutation was detected in 7 of 13 and 12 of 13 mastocytosis-positive GI biopsy specimens using allele-specific polymerase chain reaction and droplet digital polymerase chain reaction (ddPCR), respectively. Conclusions GI mastocytosis is highly predictive of SM in BM; however, most SM-BM+ patients are SM-GI–. The SM-BM– patients are very unlikely to be SM-GI+. Because GI neoplastic mast cells are often tryptase negative, diagnostic evaluation should include CD117 and CD25 immunohistochemistry, as well as KIT D816V mutation analysis by ddPCR as needed.

Abstract Bone morphogenetic proteins ‐2 and ‐7 (BMP‐2 and BMP‐7) are effective in treating large bone defects, but the required doses are high, resulting in side effects and elevated costs. Previously, this work has demonstrated that a chemically modified messenger RNA (cmRNA) coding for BMP‐2 induced rapid and reliable healing until consolidation in a bone segmental defect in rats. Here, this work shows that the simultaneous transfer of BMP‐2 and BMP‐7 cmRNAs to stem cells leads to increased osteogenic gene expression, extracellular matrix deposition, and mineralization, compared to single or sequential delivery of these cmRNAs. Using a murine model of ectopic ossification, this work finds that dual BMP‐2/BMP‐7 cmRNA delivery using collagen‐hydroxyapatite scaffolds, designed specifically for bone repair, ensured local BMP‐2 and ‐7 expression with abundant osteogenesis in the absence of adverse effects. This confirms the superior osteogenic potency achieved by local, controlled dual delivery of cmRNAs encoding BMP‐2 and BMP‐7, further enhancing the potential of this highly translatable technology for promoting bone healing.

Clean water security demands autonomous systems that sense, reason, and act at scale. We introduce AquaSurveil, a unified multi-agent platform coupling mobile robots, fixed IoT nodes, and privacy-preserving machine learning for continent-scale water health surveillance. The architecture blends Gaussian-process mapping with distributed particle filtering, multi-agent deep-reinforcement Voronoi coverage, GAN/LSTM anomaly detection, and sheaf-theoretic data fusion; components are tuned by Bayesian optimization and governed by Age-of-Information-aware power control. Evaluated on a 2.82-million-record dataset (1940–2023; five countries), AquaSurveil achieves up to 96% spatial-coverage efficiency, an ROC-AUC of 0.96 for anomaly detection, ≈95% state-estimation accuracy, and reduced energy consumption versus randomized patrols. These results demonstrate scalable, robust, and energy-aware water quality surveillance that unifies robotics, the IoT, and modern AI.

ABSTRACT While BAG3 has been identified as a causative gene for dilated cardiomyopathy, the major pathological events in BAG3‐ related cardiomyopathy that could be targeted for therapeutic benefit remain to be discovered. Here, we aim to uncover novel pathological events through genetic studies in a zebrafish bag3 cardiomyopathy model. Given the known cardioprotective effects of mtor inhibition and the fact that transcription factor EB (tfeb ) encodes a direct downstream phosphorylation target of mTOR signaling, we generated a cardiomyocyte‐specific transgenic line overexpressing tfeb ( Tg[cmlc2:tfeb] ). This overexpression was sufficient to restore defective proteostasis and rescue cardiac dysfunction in the bag3 cardiomyopathy model. Importantly, we detected accelerated cardiac senescence in the bag3 cardiomyopathy model, which can be mitigated by Tg(cmlc2:tfeb) . We compared cardiac transcriptomes between the Tg(cmlc2:tfeb) transgenic fish and the mtor xu015/+ mutant and found that inhibition of the fatty acid binding protein a ( fabp7a ) gene exerts therapeutic effects. Consistent with this genetic evidence, we detected elevated fabp7a expression in the bag3 cardiomyopathy model, whereas cardiomyocyte‐specific overexpression of fabp7a induced dysregulated proteostasis, accelerated cardiac senescence, and cardiac dysfunction. To elucidate the functions of Fabp7a in normative cardiac aging, we turned to the African Turquoise Killifish. We noted elevated Fabp7a expression in the hearts of aged killifish, and pharmacological inhibition of Fabp7a mitigated the cardiac aging process. Together, this study uncovered accelerated cardiac senescence as a key pathological event in bag3 cardiomyopathy and reveals that manipulating the mTOR‐Tfeb‐Fabp7a axis can mitigate this pathology and confer cardioprotective effects.

Abstract The 2022 Supreme Court of the United States' decision in Dobbs v. Jackson Women's Health Organization eliminated federal abortion protections, returning abortion regulation to the states. However, in many states, abortion was already heavily restricted prior to this decision. This study aimed to assess the impact of dynamic restrictive legislation passed from 2020 to 2024 on the prenatal genetic counseling process and to describe similarities and differences between state policy environments by focusing on a group of neighboring states with different legislation. Twenty‐two genetic counselors practicing in Ohio, Kentucky, and Indiana participated in focus groups ( n = 6) and one individual interview. The research team conducted reflexive thematic analysis of qualitative data. We found that participants' perspectives on the effects of legislation varied depending on state abortion policy, patient population served, and institutional resources and directives under which they worked. Most participants expressed changes to the way they document patient visits, approach counseling appointments with patients, and provide patients with resources in lieu of referrals to abortion care. Additionally, many participants expressed feeling more motivation and less burnout in the wake of restrictive legislation—a change from previous study findings. This study provides insights into the ways in which federal case law and state regulations on abortion have impacted genetic counselors' approaches to healthcare practices, documentation, and referrals to abortion care in three states that have experienced dynamic abortion regulatory environments since 2020. Findings may be useful for guiding additional support from professional societies, healthcare institutions, and training programs.

The COVID-19 pandemic necessitated a triad of therapies for patients: oxygen, nutrition, and patient positioning. In the progressive care units, patients were placed in a prone position while receiving continuous enteral nutrition (EN) to optimize healing and oxygenation. The study aimed to identify the rate of aspiration pneumonia in non-ventilated COVID-19 patients placed in a prone position while receiving continuous EN. This was a single-group, descriptive retrospective study. The study was conducted at a two-time Magnet ® designated academic medical and health science center in the Southwestern United States. The sample included 97 electronic health records (EHRs) of patients diagnosed with COVID-19, receiving continuous EN, and placed in a prone position from March 15, 2020 to June 1, 2022. Data were extracted from EHRs using ICD-10 codes, including patient demographics, EN frequency, gastric tube placement, patient positioning, and incidence of aspiration pneumonia. Descriptive statistics and non-parametric tests were used. The Kruskal–Wallis rank sum test and Fisher’s exact test were employed for comparisons. Statistical significance was set at p ≤ .05. Out of 97 patients, 8 (8.25%) developed aspiration pneumonia. The majority of patients (75%) had post-pyloric feeding tubes. All patients who developed aspiration pneumonia had post-pyloric tubes. Placing COVID-19 patients in a prone position while receiving continuous EN may be a safe practice. Diligent nursing assessment is crucial to minimize aspiration risk and optimize patient outcomes.