The Sarajevo ion accelerator (SARAI) benefits from the successful transfer of the CERN’s 750 MHz radiofrequency quadrupole (RFQ) technology, adapted for societal and medical applications. SARAI incorporates an industrial electron cyclotron resonance supernanogan ion source operating at 14.5 GHz, designed to generate alpha particles and ions that can be used for ion beam analysis and experimental and applied physics research. The system is equipped with a 4-electrode extraction subsystem capable of extracting and focusing multiple ion species at voltages up to 30 kV. The source is being optimized at CERN for injection into a 750 MHz RFQ, initially with protons, followed by helium and carbon ions. This paper reports on the progress of a novel idea of integrating a supernanogan ECR ion source with the RFQ to get higher currents than currently achievable in the emerging domain of compact linacs for societal applications. The project is in its infancy, so this paper focuses on the source commissioning preparation, reports on the initial high voltage holding tests on the source extraction system in vacuum, and discusses further plans and applications.

This study investigates early‐age carbonate mineralization in cementitious systems using in situ Raman microspectroscopy. In the presence of dissolved CO 2 , clinker phases undergo accelerated dissolution, decomposing to form various calcium carbonate polymorphs and a transient amorphous silica gel network. Once the available CO 2 is consumed, clinker hydration resumes, leading to delayed calcium–silicate–hydrate (C–S–H) and portlandite (Ca(OH) 2 ) formation. The precipitation of portlandite through the pore network triggers a localized pozzolanic reaction at the silica gel–portlandite interface, yielding a distinct calcium–silicate–hydrate (C–S–H*). This templated mechanism produces a homogeneous and highly polymerized binder, leading to improved 24‐h compressive strength compared to reference samples. Correlation function analysis confirms that the evolution of silica gel, portlandite, and C–S–H follows a three‐stage sequence— mineralization , transition , and stabilization— quantitatively demonstrating a strong spatial anticorrelation between silica gel dissolution and portlandite precipitation. These findings establish a new chemomechanical framework for CO 2 mineralization in cement, highlighting transient silica gel as a critical intermediate for engineering sustainable, high‐performance concrete.

This translational synthesis highlights the potential role of obesity-induced low-grade chronic inflammation in modulating clinical outcomes among patients with spondyloarthritis (SpA). Obesity transforms adipose tissue into a pro-inflammatory endocrine organ, where hypertrophic adipocytes release adipokines such as leptin alongside cytokines including TNF-α and IL-6, potentially contributing to macrophage polarization toward an M1 phenotype and activating NF-κB signaling pathways. This systemic immunometabolic priming may lower activation thresholds at the enthesis—the primary pathological site in SpA—potentially amplifying IL-23/IL-17 axis activity via Th17 bias, innate-like lymphocyte responses, and stromal–immune crosstalk under mechanical stress. Clinically, patients with SpA and obesity have been reported to demonstrate heightened disease activity (BASDAI, ASDAS), impaired function (BASFI), accelerated radiographic progression (syndesmophytes, enthesophytes), and diminished biologic response rates, potentially attributable to pharmacokinetic alterations (e.g., subtherapeutic TNF inhibitor levels) and pharmacodynamic resistance. Multisystem comorbidities, including non-alcoholic fatty liver disease, cardiovascular events, metabolic syndrome, sleep disturbances, and depression, further exacerbate morbidity and diminish quality of life. Therapeutic implications emphasize obesity as a modifiable disease modifier. Weight loss interventions, including hypocaloric diets, anti-inflammatory regimens (e.g., Mediterranean diet), multicomponent exercise, GLP-1 receptor agonists, and bariatric surgery, have been associated with reductions in inflammatory biomarkers, improved remission rates (MDA, DAPSA), and prolonged drug survival by restoring adipokine balance and disrupting mechano-inflammatory loops. Future randomized controlled trials should prioritize long-term evaluations of integrated multidisciplinary strategies that combine metabolic optimization with immunomodulatory therapies, addressing adherence challenges through psychological support and patient-tailored protocols, while elucidating dose–response relationships for GLP-1RAs and exercise in diverse SpA subtypes to establish precision management paradigms that mitigate cardiometabolic burden and improve holistic outcomes.

Spinal muscular atrophy (SMA) therapies that restore SMN expression improve survival and motor function but often fail to fully stabilize distal motor units or sustain endurance. We propose a hypothesis-driven adjunctive approach, intended to complement SMN-restoring therapies, in which localized nanotube-enabled interfaces acting at or near the distal motor unit and neuromuscular junction enhance neuromuscular transmission reliability in surviving, remodeled motor units. The model predicts a temporal cascade: improved junctional reliability and reduced activity-dependent failure, followed by consistent motor unit output across repeated activation, and ultimately, enhanced endurance and functional reserve. Phenotype-specific responsiveness identifies patients most likely to benefit, specifically those with preserved-but-limited residual motor unit substrate accompanied by measurable neuromuscular junction instability. Drawing on shared mechanisms from ALS, spinal cord injury, and other neuromuscular disorders, we discuss mechanistic, translational, safety, regulatory, and ethical considerations. This framework links objective physiological constructs to functional outcomes, offering a mechanistically grounded path for adjunctive therapy development in SMA and related conditions.

Global reporting of obesity is commonly based on comparisons over multiple decades1 and lacks a granular and systematic analysis of its dynamics. We used 4,050 population-based studies with measured height and weight data on 232 million participants to assess the worldwide dynamics of obesity from 1980 to 2024. The rise in obesity decelerated in school-aged children and adolescents throughout the 1990s in many high-income countries, and subsequently plateaued in most at age-standardized prevalences spanning 20 percentage points, from 3–4% for girls in Japan, Denmark and France to 23% for boys in the USA. There were indications of a small decline in obesity in children and adolescents in some high-income western countries (for example, Italy, Portugal and France) since the 2000s. Similar trends were seen in some countries in Central and Eastern Europe. In adults, the rise in obesity slowed down in high-income western countries about a decade after children, followed by a plateau or possibly a small reversal of the rise in some countries (for example, Spain). In most low-income and middle-income countries, the annual absolute change in prevalence has remained stable or increased over time, even though prevalence has surpassed that of high-income countries. These highly varied dynamics suggest that the social, economic and technological trends that influence the availability, affordability and use of different foods may have helped control the rise in obesity in high-income countries, but require policy interventions in low-income and middle-income countries. Global analysis of obesity trends from 1980 to 2024 in 200 countries and territories using data from 4,050 population-based studies reveals that framing obesity as a single global epidemic masks the highly varied dynamics across countries and age groups.

Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine tumor that typically arises centrally in individuals with a significant smoking history. It is characterized by rapid progression and early metastatic spread, most commonly to the mediastinal lymph nodes, liver, bones, adrenal glands, and brain.1 SCLC is also known to be associated with several paraneoplastic syndromes, including Cushing’s syndrome, Lambert-Eaton myasthenic syndrome, and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Metastasis to the breast from SCLC is exceedingly rare, especially as an isolated site of metastases. Only sporadic cases have been reported in the literature, particularly as an isolated site of spread2. A 45-year-old female with a 30-pack-year smoking history presented with dyspnea. CT chest showed a right lower lobe mass measuring 5.7 cm and an adjacent right hilar component measuring 4.8 x 4.2 x 5.6 cm, with extensive hilar lymphadenopathy and bronchovascular encasement, concerning for malignancy. Bronchoscopy with endobronchial ultrasound-guided biopsy and partial debulking of the right main bronchus mass confirmed SCLC. Staging imaging revealed a suspicious mass in the left breast. Ultrasound of the left breast showed an irregular, hypoechoic, solid lesion with lobulated margins measuring 2.5 x 2.4 cm, without associated axillary lymph node involvement. MRI of the brain showed no additional sites of metastases, indicating the breast as an isolated extrathoracic site of disease. Core needle biopsy of the breast lesion confirmed metastatic small cell carcinoma, with immunohistochemical staining positive for TTF-1, synaptophysin, and chromogranin, supporting lung origin. The patient was subsequently started on systemic chemotherapy. This case highlights a rare instance of isolated breast metastasis from SCLC. Given the unusual site, new breast lesions in patients with lung cancer should raise the suspicion for metastases, even in the absence of widespread disease. Early biopsy is essential to delineate a (second) synchronous primary vs unusual site of metastases to help guide therapy, preventing misdiagnosis as a primary breast malignancy. This abstract is funded by: None

OBJECTIVES Community-acquired bloodstream infections (CA-BSIs) are a major cause of mortality in older adults, yet prospective international data are limited. This study evaluated clinical features, microbiology, and mortality predictors in older patients with CA-BSI. METHODS This prospective, observational study was conducted in 72 referral centers across 16 countries between June 1 and September 1, 2024. Patients aged ≥65 years with confirmed CA-BSI were included. Demographic, clinical, laboratory, and treatment data were collected. The primary outcome was 30-day all-cause mortality. Univariate and multivariate logistic regression was used to identify predictors. RESULTS 574 patients were enrolled (median age 74 years; 48.1% female), and 30-day mortality was 26.3%. Urinary tract infection was the most common source (33.7%), and 30.5% had no identifiable origin. Gram-negative organisms predominated (58.6%). Independent mortality predictors included SOFA score ≥5, thrombocytopenia (<50,000/µL), Staphylococcus aureus bacteremia, pneumonia, bacteremia of unknown origin, and higher Charlson Comorbidity Index. Higher Katz Activities of Daily Living scores were protective. CONCLUSION CA-BSI in older adults is associated with high mortality. Outcomes are driven by comorbidity burden, functional status, infection severity, and causative pathogen, highlighting the need for early risk stratification and tailored management.

BACKGROUND The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. METHODS Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. FINDINGS We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. INTERPRETATION A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. FUNDING Gates Foundation, Queensland Health, and University of Queensland.

OBJECTIVES Transsphenoidal surgery for the resection of pituitary neoplasms has evolved over the years. The current study sought to summarize visual outcomes following transsphenoidal surgery for sellar and parasellar lesions and evaluate how these outcomes are reported across the literature. METHODS A systematic review was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, Scopus and Cochrane Library database were searched from inception through October 2023. Studies were included if they reported pre- and post-operative visual outcomes for patients undergoing transsphenoidal resection of sellar or parasellar lesions. Reviews, abstracts, and non-English studies were excluded. Rates of pre- and postoperative visual loss, visual field defects, and visual acuity impairment were collected. Postoperative outcomes were categorized as improved, normalized, unchanged, or worsened. RESULTS Of 3828 studies identified, 236 met inclusion criteria and were included in the analysis. Pituitary adenomas accounted for 80% of cases, followed by craniopharyngiomas (14%) and meningiomas (4%). Preoperative visual loss, visual field defects, and visual acuity impairment were present in 55%, 51%, and 37% of patients, respectively. Postoperative improvement occurred in 76% of patients with visual loss, 73% with visual field defects, and 64% with visual acuity impairment, while 2%-11% experienced worsening of symptoms. Reporting completeness varied across studies, with fewer than half of studies reporting both pre- and post-operative outcomes. CONCLUSIONS Across all studies, approximately 76% of patients with preoperative visual impairment experienced postoperative improvement following transsphenoidal surgery. Reporting of visual outcomes remains highly variable, underscoring the need or standardized definitions and outcome measures in future research.

BACKGROUND Obstructive hydrocephalus caused by a membranous or synechial occlusion at the level of the superior medullary velum (SMV) is likely under-recognized and may be mislabeled as aqueductal stenosis. We aimed to describe the anatomical pattern of these "velar obstructions" and discuss their surgical targeting implications. METHODS We retrospectively rereviewed 94 patients previously classified as primary aqueductal stenosis (1995-2015) and identified 5 cases (5%) with an obstruction caudal to the aqueductal tectum, at the SMV. A targeted literature search retrieved 18 additional reports with midline sagittal magnetic resonance imaging compatible with a velar-level occlusion. In the primary series, morphometrics were obtained from calibrated imaging. Literature cases were used for qualitative/topographic assessment. The SMV was segmented into A (externally free) and B (covered by the lingula), and the occlusion site was classified as A, AB junction, or B. RESULTS In the combined cohort (n = 23), the AB junction was the most frequent site (12/23). In the primary series (n = 5; mean age: 34 years; range: 14-47), the sagittal depth of the dilated cavity averaged 24 mm (range: 17-33) and consistently exceeded the length of the aqueductal tectum. Morphometric patterns were heterogeneous. Across cases with reported treatment (20/23), endoscopic third ventriculostomy was the most common strategy, alone or combined with transaqueductal fenestration. CONCLUSIONS Velar occlusion is a distinct imaging-anatomical pattern that may influence endoscopic planning. Any endoscopic fenestration at the SMV level ("velarplasty") should be framed as investigational and must explicitly account for the nearby trochlear nerve decussation and vermian/lingular relationships.

Abstract Objectives Rescue stenting (RS) has emerged as a bailout strategy after failed reperfusion during endovascular treatment (EVT). Optimal blood pressure (BP) management after RS remains unclear. Our aim is to evaluate the association of BP levels and blood pressure variability (BPV) during the first 24 h after RS with short-term and long-term patient outcomes. Methods We performed a retrospective analysis of an international registry where data from adult patients who underwent either RS or rescue angioplasty after failed EVT were collected. Patients who received RS with large vessel occlusion and at least 4 BP measurements in the first 24 h were included. Results RS was performed in 437 patients (40.5% female, mean age 67.1 ± 13 years). Admission median National Institutes of Health Stroke Scale score was 12 (IQR 7–18) and history of hypertension was present in 74.2% of patients. Μean Systolic BP (SBP) in the first 24 h was 137.4 ± 14.6 mmHg. Higher values of BPV (coefficient of variation, standard deviation, average real variability and successive variation) were associated with lower odds for Modified Rankin Scale score 0–2 at 90 days (adjusted odds ratio ranging 0.55 [0.38, 0.79] to 0.99 [0.98, 0.99] per 10 units increase). No associations were found between any SBP measure and death, sICH as well as neurological deterioration at 24 h. Conclusion In our study, higher BPV was associated with worse clinical outcomes in stroke patients treated with RS as bailout therapy after failed reperfusion. No association was shown between mean, maximum, minimum and delta SBP and clinical outcomes.

Abstract Introduction Endovascular therapy (EVT) has become an increasingly important part of acute stroke management. However, the lack of trained neurointerventionalists represents a key barrier in expanding availability of EVT in Europe. This project aimed to investigate the association between the number of neurointerventionalists and overall EVT rates. Patients and methods A cross-sectional analysis was conducted using publicly available data from the Global Burden of Disease Report 2021 and the Stroke Action Plan for Europe (Stroke Service Tracker). Data on the number of neurointerventionalists across 35 European countries were surveyed through a structured survey distributed via the Resident and Research Fellow Section (RRFS) of the European Academy of Neurology (EAN). Correlation analyses were performed to estimate the association between neurointerventionalist density per served population, EVT rates and stroke-related mortality and morbidity. Results Survey response rate was 71% (25/35 countries). The proportion of acute ischaemic stroke patients treated with EVT ranged from 0.05% to 14.96% of people with ischaemic stroke, and the number of neurointerventionalists ranged from 9 to 137 per country and from 0.3 to 7.5 per million inhabitants. There was a positive correlation between the number of neurointerventionalists per population served and EVT rates (Spearman coefficient ρ = 0.507; 95% CI, 0.209–0.719). Greater availability of trained neurointerventionalists was moderately associated with lower national ischaemic-stroke mortality (ρ = −0.473; 95% CI, −0.746 to −0.065) and lower overall disability-adjusted life years (ρ = −0.444; 95% CI, −0.729 to −0.027). Discussion and conclusion The number of neurointerventionalists correlates positively with the annual volume of EVT across European countries; higher EVT rates were also associated with lower stroke-related mortality and disability; however, these associations are unadjusted for other important confounders and causality cannot be inferred. These data suggest an urgent need to increase neurointerventional capacity in Europe, for example, by expanding dedicated national training programmes and enhancing support from national and international professional societies.

In conditions where information and communication technologies (ICT) dictate the “rules” of the market, the strong promotion and development of innovation-oriented small and medium-sized enterprises (SMEs) are essential. The transition from a traditional, linear system of waste management and fleet management in utility companies to a digital and circular-oriented system represents not only a significant challenge

Highlights What are the main findings? Quantitative 2D and 3D morphometric descriptors, combined with LLM-based interpretation, enable a structured and informed assessment of pediatric foreign-body aspiration risk. Object morphology, including shape, sharpness, and orientation, substantially influences both where an aspirated foreign body lodges in the pediatric airway and the severity of the resulting injury, beyond traditional size-based criteria. What are the implications of the main findings? For practicing pediatricians, incorporating shape-related metrics into hazard assessment may complement existing size-based safety standards and improve the bedside identification of high-risk objects. The proposed framework offers a basis for developing interpretable tools to support prevention strategies, product design, caregiver education, and clinical risk assessment. Abstract Background/Objectives: Foreign-body aspiration (FBA) is a common and largely preventable pediatric emergency, yet current safety standards and risk assessments rely predominantly on object size and on anecdotal descriptions and bronchoscopy findings. We propose a clinically oriented proof-of-concept workflow that combines high-resolution three-dimensional (3D) scanning and calibrated two-dimensional (2D) imaging of retrieved objects with radiomic shape descriptors and large language model (LLM) reasoning to support aspiration risk assessment and guide prevention. Methods: Objects were obtained from the Susy Safe registry and historical series from the University Clinical Centre Tuzla. Each object was digitized with 3D scanning and photographed with a ruler. Morphometric descriptors—including volume, surface area, sphericity, elongation, flatness, curvature and convexity—were computed from stereolithography (STL) meshes; silhouette area, perimeter and Feret diameters were extracted from 2D photographs. Normative airway dimensions from radiographic and computed tomography (CT) studies provided anatomical context. A sharp, irregular metallic object recovered from a child’s laryngo-tracheal tract served as an illustrative case. Results: The object’s major axis approximated the anteroposterior glottic diameter, suggesting potential traversal when longitudinally oriented, whereas its irregular shape increased the likelihood of mucosal laceration and lodging. LLM-based synthesis provided a structured narrative interpretation consistent with a high-risk profile and highlighted preventive implications. Conclusions: Combining 2D/3D morphometry with LLM reasoning provides objective assessment of FBA hazards and may support safer product design, injury-prevention policies, and caregiver education.