Aim The long-term impact of different pain management strategies in older adults remains poorly understood. This population-based retrospective cohort study aimed to identify distinct trajectories of pain management utilization and examine their associations with adverse clinical outcomes in older adults, stratified by frailty status. Methods Using Taiwan’s National Health Insurance Database, we included older adults (≥65 years) who initiated NSAIDs in 2010 and followed them for 8 years. Group-based multi-trajectory modeling and Cox proportional hazards models were employed to assess associations between trajectory groups and subsequent clinical outcomes. Results Among 24,539 participants (mean age 72.7, 58.9% female), four distinct trajectories were identified: short-term (27.6%), mild (31.9%), moderate (21.7%), and extensive (18.9%) utilization. Compared to the short-term group, the extensive utilization group had significantly higher risks of unplanned hospitalization (adjusted HR: 1.36, 95% CI 1.24–1.48), all-cause hospitalization (aHR: 1.43, 95% CI 1.34–1.52), and incident dementia (aHR: 1.27, 95% CI 1.04–1.54). For dialysis, only the extensive group showed higher risk in the age-sex adjusted model (HR: 2.06, 95% CI: 1.00-4.22), but significance was lost after frailty adjustment. No significant differences in all-cause mortality were observed after full adjustment. Conclusion These findings highlight that extensive long-term utilization of pain management strategies in older adults is associated with increased risks of adverse outcomes, particularly hospitalizations and incident dementia, especially among fit older adults, emphasizing the need for careful monitoring and personalized approaches to pain management in older populations, balancing effective pain control with minimization of potential long-term risks.

Authors and affiliationsHaq, Tanveer; The Aga Khan University Hospital, RadiologyZafar, Burhan ; The Aga Khan University HospitalMuhammad Zohaib Uddin, Mallick; The Aga Khan UniversityYousaf , Muhammad ; The Aga Khan University HospitalFaheem, Muhammad ; Allama Iqbal Medical CollegeGulzar, Esha; King Edward Medical UniversityKhan, Faheemullah; Cleveland Clinic Main Campus HospitalZafar, Uffan; The Aga Khan University Hospital

This study introduces the first enzyme free molecular gender detection technique for the Asian houbara Chlamydotis macqueenii, utilizing and validating feathers and eggshell membranes (ESM) as novel genetic material sources. An established primer set (P2, P3) with enzyme MBoll was used to develop and validate the use of feathers and ESM as a suitable DNA source for sexing. 186 chicks, were sexed using ESM and 99 (53%) were male and 87(47%) were female. A further significant change in houbara sex identification was achieved by using a different primer set (CHD1 R and CHD1 F). This method separated the DNA fragments within the sexes with a gap of 450bp between the two chromosomes that unambiguously determined the sex within the gel electrophoresis image without the need for enzyme differentiation. Using this methodology to-date, 35 chicks have been sexed with 21 (58%) being male and 15(42%) being female. These advanced techniques provide significant benefits for non-invasive sexing, particularly in conservation and breeding programmes of the endangered Asian houbara.

This paper presents an event-triggered model predictive control scheme for distributed linear systems with additional disturbances. The subsystem states are coupled with each other and affected by unknown bounded disturbances. The communication among subsystems is assumed to be prompt and free from any information loss. A novel distributed event-triggered strategy is developed to balance communication resources and system control performance during asynchronous communication. This mechanism is meticulously designed to ensure optimal system performance while utilizing communication resources. The nominal system is introduced to construct a local optimization problem and a triggering mechanism considering the coupling influence is developed. To counter the additional disturbances, the dual-mode control approach has been implemented along with developing a robust terminal set. The terminal set is purposefully designed to maintain system stability in the presence of additive disturbances, achieved through a meticulously designed triggering mechanism. Then it is imperative to discuss the stability of the resulting closed-loop system and provide a proof process of the feasibility of the iterative optimization. Finally, the effectiveness of the proposed algorithm is validated through simulation results, thereby confirming its efficacy.

We aim to test hypotheses on the patterns of clade age of climbing plants under climatic variations along the latitudinal gradients in China. Specifically, we uncover their general patterns of mean family age (MFA) and their climatic drivers. We evaluate the extents to which both the tropical niche conservatism hypothesis (TNC) and the out of the tropics hypothesis (OTT) can account for the MFA of climbing plants respectively. A dataset including 2487 climbing species was used to quantify geographical patterns of MFA across China. Spatial regression analyses with information-theoretical multi-model selections were performed to estimate the importance of climatic variables. There were generally increasing trends of MFA from low to high latitudes for all types of climbers. For woody climbers, MFA was negatively correlated with minimum temperature, annual mean precipitation but positively with seasonal temperature and precipitation, and was mostly influenced by mean temperature of the coldest quarter. For herbaceous vines, MFA pattern showed relatively insignificant correlations with all the climatic variables. Our results highlight that the OTT hypothesis offers a promising explanation for the latitudinal MFA gradients of climbers in China (especially for woody climbers), which turn out to be contrary to the TNC predictions.

Target threat assessment is an important issue in command decision-making system. The naive Bayes, as an effective way to deal with uncertainty information, can be used to evaluate the target threat level. Unfortunately, most existing threat assessment methods base on naive Bayes have the main problem of ignoring the assumption of conditional independence under incomplete data, which does not meet the requirements of target threat assessment in complex battlefield situation. To solve this main problem, we propose a target threat assessment method using weighted naive Bayes under incomplete data. The core parts are each missing sample is replaced with the maximum weight fraction sample obtained from the E-step of expectation maximization algorithm and a weighted conditional log-likelihood function is constructed to learn the attribute weight of weighted naive Bayes. Additionally, an adaptive differential evolution is provided to solve the optimization problem of attribute weighting. The effectiveness of the proposed method has been validated through two types of experiments, including sample set test and specific case test. The results show that the proposed method is superior to the competitors, and can improve the accuracy and belief of target threat assessment.

Purpose This study aimed to conduct a comprehensive drug use evaluation (DUE) of injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) within Singapore’s largest healthcare cluster, focusing on the appropriateness of indication, efficacy in weight loss and glycemic control, and safety profile. Method A retrospective review of medical records was conducted for patients prescribed injectable GLP-1RAs (dulaglutide, liraglutide, or semaglutide) between July 2022 and June 2023 across SingHealth institutions. Appropriateness of indication was assessed against approved criteria. Efficacy was evaluated by changes in HbA1c for type 2 diabetes mellitus (T2DM) patients and body weight for those receiving treatment for weight loss. Safety was assessed by reviewing documented adverse events. Logistic regression analyses identified predictors of efficacy and safety. Results Among 915 patients included, the majority were female (53.3%), aged 35–64 years (74.4%), and had obesity (80%). Appropriate prescribing rates were 96.3%, primarily for weight loss (65.2%) and T2DM (31.0%). Efficacy analysis showed 51.3% of patients achieved ≥5% weight reduction, while 58.7% attained ≥1.0% HbA1c reduction. Adverse events were reported in 37.9% of patients, predominantly gastrointestinal symptoms. Factors influencing outcomes included treatment duration, GLP-1RA type, and baseline clinical parameters. Conclusion The DUE affirmed the appropriateness, efficacy, and safety of injectable GLP-1RAs for weight loss and T2DM management in a real-world setting. The findings provide actionable insights to optimise GLP-1RA utilisation and improve patient outcomes, emphasising the importance of patient selection, monitoring, and education in maximising therapeutic benefits.

Human monkeypox (MP) is a zoonotic disease caused by the monkeypox virus (MPV). It is considered one of the most significant orthopoxvirus infections after smallpox. MPV originated from the Congo Basin and West African clades, MP virus has spread globally, with recent outbreaks highlighting the need for predictive models in understanding its transmission. The aim of the study is to deploy machine learning models for monkeypox outbreak prediction across Africa. In this work, the most recent monkeypox dataset was evaluated and the significant instances were visualised. Feature extraction techniques like Recursive Feature Elimination (RFE), and Least Absolute Shrinkage and Selection Operator (LASSO) were deployed. These methods identify key predictors of monkeypox cases, including total cases, new cases smoothed, and total deaths, to improve model accuracy and interpretability. The various machine learning models employed are Random Forest, Decision Tree, Support Vector Machine, XGBoost, LightGBM, and CatBoost to evaluates their effectiveness in outbreak prediction. The results indicate that Random Forest and XGBoost performed best, achieving accuracy scores of 0.9696 and 0.8949, respectively, with R 2 values near 1.0 and low RMSE values of 1.29 and 5.51 for Random Forest and XGBoost respectively. The study showed that Random Forest and XGBoost are reliable tools for understanding monkeypox virus transmission dynamics across African countries. These models provide valuable insights for public health interventions and help to identify trends and factors influencing outbreaks.

Phyllosphere microbiota play an important role in plant growth and survival. The Dajiuhu wetland harbours a diverse range of plant species, but the composition and functions of the leaf microbiota remain poorly understood. We analysed the structures of the phyllosphere microbiota of twelve typical plants in this wetland via 16S rRNA sequencing and evaluated the determining factors and ecological role of the leaf bacterial community. The structure and diversity of the leaf bacterial community varied among plant species. Notably, the bacterial composition of Polytrichum significantly differed from that of the other plants. The specific leaf area was positively correlated with the Chao1 and Shannon indices, whereas the leaf thickness was negatively correlated with them. Plant type, geographical location and invasiveness affected the structure of the leaf bacterial community. The core community comprised mainly Sphingomonas, unclassified_f__Alcaligenaceae and Methylobacterium-Methylorubrum. Further analysis revealed that plant invasiveness influenced the species proportion and the network relationship of leaf-associated bacteria, with invasive plants hosting higher abundances of plant pathogens than noninvasive plants. Our results suggested that leaf microbiota contribute to the ecological functions of the host plants, offering a valuable basis for utilizing microbiota to enhance plant adaptability and ecosystem stability sustainably.

While clinically and academically important to highlight rare diseases in case reports, writing high-quality manuscripts requires great care in conducting a methodical literature review and in describing findings confirming a diagnosis to ensure trustworthiness and transparency—features readers should seek and expect.

It has been about 20 years since the discovery of Carbon dots (CDs), but new characteristics of CDs are knotted daily. Herein, we offer an alternative strategy using pollutant-detecting CDs as an oxygen vacant crafter in CoMoO4 (CM) cooked through a solid-state grinding synthesis process, and the materials were employed as high-performance supercapacitor applications. The functional moieties-rich CDs and their modified CM materials are confirmed with various sophisticated analytical methods. The core property of CDs fluorescence was used to detect Cr6+ ions and Doxycycline selectively in the aqueous medium against multiple interferences with a very good limit of detection values. Next, CoMoO4 with tuneable oxygen vacancy was prepared via a solvent-free grinding method with well-functionalized CDs without any solvents. Adding CDs into the solvent-free synthesis process of CoMoO4 effectively modulates the electronic, surface and structural properties, greatly enhancing the electrochemical performance. The modified CM-CDs (3) electrode exposes the specific capacitance of 781 F g-1 at the applied current density of 1 A g-1, which was two times greater than the pristine electrode and also retains 95.2 % of specific capacitance after successful completion of 2000 cycles. The asymmetric device was fabricated with CM-CDs (3) // AC, which results higher energy density of 34.75 Wh/kg at the power density of 749.1 W/kg and also accomplishes long cyclic stability. This research findings pave the way to develop an alternate strategy to improve conventional material synthesis through a non-conventional synthesis strategy using CDs along solvent-free preparation method.

Purpose To explore the ocular manifestations associated with mutations in key tumor suppressor genes mutations (RB1, NF1, NF2, VHL, TSC1/2) in children, emphasizing their significance in pediatric hereditary cancer syndromes. These mutations are associated with common pediatric ocular tumors, presenting as space-occupying lesions in the retina and uveal tract (including the choroid and iris). Method A review of 11 representative case reports, complemented by an analysis of existing literature, was conducted to examine the ocular presentations linked to these mutations. The study focused on the genetic mechanisms underlying these conditions and their distinct ocular symptoms. Results Unique ocular manifestations were identified for each gene mutation, underscoring the critical role of regular and thorough ophthalmic monitoring. Early detection of these ocular symptoms enables timely intervention, improving both visual and overall patient outcomes. Conclusions Mutations in pediatric tumor suppressor genes are often associated with systemic syndromes. Recognizing ocular symptoms is vital for early diagnosis and effective management, helping to preserve vision and support developmental progress. Pediatric ophthalmic evaluations should be prioritized for early detection and comprehensive care. Future studies should aim to include more cases, employ diverse research methodologies, and develop long-term observation strategies tailored to specific tumor suppressor genes.  

Letters to the editorSomato-cognitive coordination therapy in a brain tumor survivor with attention-deficit/hyperactivity disorder symptoms and motor coordination impairmentsMasanobu Takeuchi, MD, PhD 1，Ayumi Kato, MD, PhD2，Masahiko Hara, MD, PhD 3Department of Pediatrics, Yokohama City University Hospital, Yokohama, JapanDepartment of Diagnostic Radiology, Yokohama City University Hospital, Yokohama, JapanDepartment of Neurology and Clinical Rehabilitation, mediVR Rehabilitation Center Tokyo, Tokyo, JapanCorrespondenceMasanobu Takeuchi3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, JapanPhone: (+81)-45-787-2800Fax: (+81)-45-787-2800mtake@yokohama-cu.ac.jpTotal Word counts: 831 wordsFigure: 1 FigureReference: 10 ReferencesKey words: Somato-cognitive coordination therapy, Attention-deficit/hyperactivity disorder, brain tumor survivor, cerebral blood flow

Heavy anthropic pressures and rainfall crises have led to land degradation and increased the intensity of wind erosion in the Sahel. This erosion transports soil particles and associated nutrients and contributes to the degradation of cultivated and grazed land. The aim of this study is to assess the intensity of wind flux in relation to land use on the Namaro dune ridge, with sandy soils representative of south-western Niger. Its surface is essentially dominated by millet fields and rangelands. The methodological approach consisted in monitoring soil cover by vegetation on a rangeland and a millet field, meteorological parameters (rainfall, wind speed and direction) and associated erosion flux over two annual cycles. Precise, concomitant measurements of saltation and wind speed were used to determine wind erosion threshold velocity for both land uses. Wind erosion flux were measured using sand traps (BSNE) and saltation detectors: sensit and saltiphone. The potential wind erosion flux was also determined. It appeared that the millet field is at all times more covered by vegetation than the rangeland. The two land uses show the lowest land cover at the end of the dry and beginning of the rainy season when the winds are strongest. This difference can be explained by the high grazing pressure on the dune complex, which is maintained throughout the year. As a result, the threshold velocity, which is always lower on the rangeland, was 6.1 m.s -1 compared with 7.3 m.s -1 on the millet field. From July to December, as vegetation developed, threshold velocities increased, reaching 9.6 and 11.1 m.s -1 respectively on the grazing land and the field. In agreement with the vegetation cover, DUP and threshold velocities, horizontal erosion flux and saltation were at least 2 times greater on the rangeland than on the millet field. This is the first time in the Sahel that measurements have shown that rangelands can be more erodible than cultivated fields for the same weather conditions. This underlines the role of grazing pressure on Sahelian rangelands, particularly during the rainy season

Water conservation function is the core of ecosystem services, which has received great attention from governments and scholars around the world. The spatiotemporal variability of water conservation capacity under the joint activity of climate change and human activities resulted in great unbalance in the development of social economy in different regions. However, the previous methods have difficulty in accurately characterizing the interactions among driving factors of water conservation capability and can only be applied to areas with a single underlying surface, which dramatically reduces the reliability of global application. Therefore, this paper couples the water conservation index (WCI) and a complex mapping relationship exploration method (geographic detector) to evaluate the long-term dynamic changes of water conservation capacity from 1985 to 2022, and analyzes its driving factors in different periods, taking the Yellow River water conservation area of China with complex underlying surface and severe climate change, as the study area. This overcomes the shortcomings of previous methods and improves the reliability of large-scale water conservation capacity research. The results show that the trend of water conservation capacity in the area changes abruptly in 2000, first decreasing before and then rising after, which is consistent with the trend of climate change. The capacity is higher in the south and lower in the north, with the best capacity in the south and the worst in the north. The temporal and spatial variation of the capacity is similar to that of SWC. SWC determined the spatial distribution pattern of water conservation capacity, which had the greatest impact, followed by evapotranspiration (ET), land surface temperature (LST) and leaf area index (LAI). SWC was most affected by precipitation, lower in the northwest of the 400mm isoprecipitation line in the basin, and higher in the southeast of the isoprecipitation line. Moreover, two-factor interactions have a greater effect on water conservation than single-factor effects. The synergistic effect of SWC and ET had the greatest impact, while the synergistic effect of SWC and Slope had the lowest impact. We found that land use change, urban expansion, and GDP growth in the study area accelerated the growth rate of overall fractional vegetation cover (FVC), which directly increased the capacity after 2000. The above research methods and results can lay a solid theoretical and methodological foundation for the protection of water conservation function under complex underlying surface conditions, providing a scientific basis for the optimal allocation of water resources, the optimization of ecosystem structure, and the making of policies related to climate change adaption, for the purpose of sustainable development of China and other regions across the world.

Agarista (Ericaceae) is currently represented in Peru by three species. Here, we update this number to five, based on the description of one new species and the report of one new record of a species and variety. The new species Agarista eugeniifolia differs from all congeneric species by an abaxially sulcate midvein. It is only known from one location in the province of San Marcos in Cajamarca Department. We also report A. mexicana var. mexicana as a newly recorded species and variety for both South America and Peru, with remarkable similarity to the disjunct nominate variety from Mesoamerica and noteworthy differences regarding leaf shape and short inflorescences in comparison to the other Peruvian Agarista species. Along with morphological diagnosis, description, and risk assessment of the new species, we provide a key to identify the Agarista from Peru, a map with the geographic distribution of the five species occurring in the country, illustrations, and taxonomic notes.

A document by Sijia Liu. Click on the document to view its contents.

The popularisation of blockchain-based applications made evident a critical challenge, namely the inherent isolation of these decentralised systems, akin to the disconnected and technologically diverse local area networks of the 1970s. This lack of interoperability limits the potential for widespread adoption and innovation in the blockchain space. While various initiatives aim to bridge this gap, many remain nascent. This paper addresses this issue by proposing a robust architecture and practical implementation to interconnect two Ethereum-based blockchains, enabling seamless smart contract interactions across these chains, and facilitating the exchange of complex information beyond mere token transfers. Our work explores the emerging landscape of Inter-Blockchain Communication (IBC) protocols, highlighting their current maturity and potential, and providing insights on how to overcome the technical hurdles associated with these protocols, particularly in the context of transmitting complex data and executing cross-chain function calls. Additionally, we tackle the challenges posed by linking private blockchains with public ones, ensuring secure and efficient data exchange. This paper aims to inspire blockchain researchers and practitioners, presenting a foundational framework for enhancing blockchain interoperability, including detailed, practical steps for its implementation. By laying the groundwork for more connected blockchain ecosystems, we intend to support the continued evolution and widespread adoption of blockchain technology.

Drought is a significant environmental challenge, particularly in semi-arid regions like the Bidar district, where understanding its temporal dynamics and predictive modeling was crucial for effective water resource control. This study used predictive models to forecast SPI values and examined changes in Standardized Precipitation Index (SPI) at various timescales across five stations in Bidar to assess drought patterns. To find trends, the Mann-Kendall test was used. While ARIMA and ANN models were applied for predictive analysis. Trend analysis revealed no statistically significant patterns across stations and timescales, although Basavakalyan and Bhalki exhibited marginally significant positive trends at longer timescales, suggesting a potential improvement in drought conditions that requires further scrutiny. In the predictive modeling phase, ANN models demonstrated strong performance during training by effectively capturing the nonlinearities in the data. However, ARIMA models outperformed ANN during testing, achieving higher accuracy and reliability for unseen datasets. These findings underscore the utility of ARIMA models for robust SPI prediction while highlighting the potential of ANN models with further optimization. ”By combining these methods, the study offers a comprehensive understanding of the drought dynamics in the region. It highlights the significance of integrating trend analysis with predictive modeling to enhance drought monitoring, planning and mitigation efforts in vulnerable areas such as Bidar district.”

Essential Biodiversity Variables (EBVs) have emerged as a crucial tool for monitoring biodiversity change and provide a framework for standardized and integrated data that align with national and global conservation targets. While EBVs have static definitions, they offer considerable flexibility in their specific data products, allowing regions with diverse geographies, biota, and cultures to develop unique implementation strategies. To guide EBV data products for Japan, we compare data availability and gaps with Finland, a country with similar environments. We review the status of primary data for EBVs in terrestrial ecosystems in these two countries and then compare them with Europe. Phenology and model-based approaches have emerged as cost-effective methods covering multiple EBV classes and assessing changes across diverse biomes and temporal scales. We found that Japan had adequate or surplus data for many EBV classes, particularly for species distributions, phenology, and environmental disasters, and we also note additional data unique to Japan. However, we also identified gaps in Japan such as data for products in Genetic Composition, Species Traits, and Ecosystem Structure EBV classes relative to Finland and Europe. We then discuss how EBVs can contribute to calculate indicators for Japan, such as the “30 by 30,” and highlight the remaining data gaps to realize them. Lastly, we provide our perspectives on calculating EBVs at the national scale, focusing on Japan. As countries and regions develop EBV products, comparative regional analyses help elucidate key commonalities and differences that can inform more coordinated and effective responses to the global biodiversity crisis.

This research involved spectroscopic and computational investigations of a new charge-transfer complex (CTC) formed through hydrogen bonding between melamine ( MA) as the electron donor and 1,4-dinitrobenzene ( DNB) as the electron acceptor. The obtained CTC has the general formula C 9H 10N 8O 4 with a 1:1 acceptor: donor molar ratio. The structure and properties of the [MA(DNB)] complex were examined using 1HNMR, 13CNMR, FTIR, UV-vis techniques, and elemental analysis (CHN). The results confirm that this complex has been successfully produced and is stable. Density Functional Theory (DFT) studies, including FMO orbitals, quantum chemical parameter s, NLO, and spectral analysis, employed the B3LYP function with the 6-311G(d,p) basis sets for computational analysis. Additionally, the reduced density gradient (RDG), natural bonding orbital (NBO), and molecular electrostatic potential (MEP) surfaces were studied to understand intermolecular interactions in the gas phase of [MA(DNB)] complex molecules. Moreover, thermodynamic parameters, including Gibbs free energy change (ΔG 0), enthalpy change (ΔH 0), and entropy change (ΔS 0), were determined at room temperature.

Background: Atrial fibrillation (AF) is a prevalent arrhythmia in patients with Brugada Syndrome (BrS) and increases the risk of major arrhythmic events (MAE) and inappropriate ICD shock. The use of antiarrhythmic drugs (AAD) for rhythm control is often limited in this population. Objective: We aimed to assess the safety and efficacy of catheter ablation (CA) for AF in BrS patients with AF. Methods: A systemic search of databases, including PubMed, EMBASE, SCOPUS, Google Scholar, was conducted. Random effect model was used to evaluate pooled incidences of outcomes with 95% confidence interval (CI), including (1) freedom from atrial arrhythmias (AA) after index and last ablation, (2) patients requiring redo-ablation, (3) freedom from AAD, (4) inappropriate shocks, and (5) complications. Results: Five studies with a total of 58 BrS patients with AF undergoing AF ablation were analyzed (71% men, mean age 49.8±16.5 years, 76% with ICD, 98.3% paroxysmal AF, 25.9% spontaneous type-1, 33.3% positive SCN5A mutation, 13.8% with previous MAE). Prior to ablation, 65% of patients with ICD had experienced inappropriate shocks. At a mean follow-up period of 32.7 ± 21.5 months after the index ablation, the freedom from AA after the index and repeated ablation was 70% (95%CI 59-82%) and 92% (95%CI 82-100%), respectively. Redo-ablation was needed in 19% (95%CI 3-34%) of patients, with 73% of these cases involving pulmonary vein reconnection. Freedom from AAD use after the repeated ablation was 91% (95%CI 79-100%). No patients experienced inappropriate ICD shock after AF ablation (0%), and the procedural complication rate was 2.1% (95%CI 0-7.9%). Conclusions: Catheter ablation for AF in BrS patients is safe, highly effective, and associated with reduced inappropriate shocks and AAD use.

The scaling relationship of leaf dry mass (M) versus leaf area (A) is crucial for understanding the tradeoff between leaf construction cost and the photosynthetic area return across diverse environmental stresses. Because leaves at different spatial positions on a plant receive varying intensities of light, this can affect the overall assessment of leaf scaling; however, the impact has not been tested. We collected a total of 1,746 leaves from 217 Lamium barbatum plants and measured their M and A. These leaves were grouped based on vertical (upper layer and lower layer) and horizontal (east, south, west, and north) positions. Reduced major axis regression protocols were used to evaluate the scaling relationship between M and A, and the bootstrap percentile method was employed to determine the differences in scaling exponents across different positions. ANOVA with Tukey’s HSD test was utilized to compare the M, A, and leaf dry mass per unit area (LMA) across these spatial positions. The results showed that: (1) M, A, and LMA were not significantly different among horizontal positions; however, these traits in the lower layer leaves were significantly greater compared to the upper layer leaves; (2) The scaling exponents of M versus A were also not significantly different across horizontal positions, but the scaling exponents of the lower layer leaves were significantly smaller than those of the upper layer leaves. Although the leaf scaling of M versus A tends to be consistent horizontally, it is necessary to consider the impact of their longitudinal positions on biomass investment for the photosynthetic area when conducting experiments on leaves.

BACKGROUND Complete resection of the primary tumor is critical for the survival of children with hepatoblastomas. This prospective clinical study aimed to clarify the outcome of a chemotherapy regimen comprising cisplatin and doxorubicin (PLADO) followed by definitive surgery conducted at the appropriate time in patients with intermediate-risk hepatoblastoma. METHODS This study included patients with nonmetastatic hepatoblastomas who met any of the following criteria: age, ≥3 years; PRETEXT IV disease; or the presence of one or more of these PRETEXT annotation factors: E1, E1a, E2, E2a, F1, N1, P2, P2a, V3, or V3a positive. The study protocol consisted of four preoperative and two postoperative courses of PLADO. The appropriate surgeries were conducted at optimized timings via real-time central surgical reviews. RESULTS The 3-year progression-free and overall survival of the 33 intermediate-risk patients included were 78.7% and 87.9%, respectively. Preoperative PLADO resulted in a partial response in 83.9% of the patients. Microscopic complete resection was ultimately obtained in 31 (94%) patients. Surgery, including liver transplantation (LTx), was performed without significant delay, and none of the patients who underwent resection required more than six preoperative courses. Two patients never had surgery due to tumor progression. CONCLUSIONS The outcome for patients with intermediate-risk hepatoblastoma was satisfactory. PLADO, combined with surgery (including LTx) conducted at the optimal time, appeared to cure most patients in this study.