This article reviews the history, epidemiology, genetics, clinical presentation, multidisciplinary management, and established and emerging therapies for patients with spinal muscular atrophy.

Pulsed field ablation (PFA) has emerged as a novel non-thermal ablation modality with preferential myocardial selectivity. However, its effects on adjacent structures, including the sinus node and its arterial supply, remain incompletely understood.

Ischemia-reperfusion injury remains a major cause of mortality and disability worldwide, with limited therapeutic options. While reperfusion is essential for tissue salvage, it paradoxically triggers secondary damage, highlighting the need to better understand regulated cell death pathways. Traditionally, apoptosis was considered the dominant mechanism; however, incomplete protection by caspase inhibition revealed a substantial contribution of caspase‑independent death. Among these, necroptosis has emerged as a functionally purposeful process, eliminating compromised cells but simultaneously amplifying sterile inflammation through the release of damage‑associated molecular patterns. This review synthesizes current knowledge of necroptosis in ischemia-reperfusion injury. We first establish its functional relevance, then examine canonical and non‑canonical molecular pathways, including RIPK1-RIPK3-MLKL signaling, mitochondrial dysfunction, and CaMKIIδ‑mediated execution. We discuss mechanisms of CASP8 checkpoint weakening and bypass, emphasizing the roles of metabolic collapse, oxidative stress, and ZBP1‑mediated signaling. Finally, we highlight the cell‑type and temporal dynamics of necroptosis, as well as its translational implications. Recognizing necroptosis as a context‑dependent permissive state rather than a simple backup pathway provides a more comprehensive framework for understanding ischemic cell death and its tissue‑specific manifestations.

Thoracic segmental spinal anesthesia (TSSA) is an old neuraxial technique that has recently regained attention as a possible alternative to general anesthesia (GA) in selected surgical patients. Its segmental nature, low-dose local anesthetic requirement, and ability to preserve spontaneous ventilation may be particularly relevant in high-risk patients in whom airway manipulation, endotracheal intubation, positive-pressure ventilation, and systemic anesthetic exposure could represent an additional physiological burden. We report four selected high-risk patients undergoing procedures from different surgical specialties under TSSA: emergency videolaparoscopic adnexal detorsion in early pregnancy; retrograde intrarenal surgery (RIRS) in a patient with arthrogryposis multiplex congenita and restrictive ventilatory impairment; laparoscopic appendectomy in a patient with severe chronic obstructive pulmonary disease (COPD) and chronic cor pulmonale; and laparoscopic cholecystectomy in a morbidly obese patient with obstructive sleep apnea. In all cases, TSSA was tailored according to patient characteristics and surgical requirements through individualized selection of puncture level, local anesthetic baricity, adjuvants, sedation strategy, and respiratory support. All procedures were completed without conversion to GA, airway rescue, clinically relevant respiratory deterioration, or postoperative neurological complications. Quality of recovery was high in all patients. These cases suggest that TSSA may represent a versatile, physiology-preserving anesthetic strategy in carefully selected high-risk patients, provided that it is performed by experienced practitioners within a multidisciplinary plan and with a clear backup strategy.

Many α-herpesviruses, such as herpes simplex virus type 1 (HSV-1) and pseudorabies virus, possess GC-rich genomes prone to forming G-quadruplex (G4) structures. However, the impact of these G4 structures on viral genome maintenance is unknown. Here, we demonstrate that G4s impede lagging strand DNA synthesis in the viral genome, generating single-stranded DNA (ssDNA) gaps that activate an ATR-mediated replication checkpoint. To complete genome duplication, these viruses co-opt host ssDNA gap prevention pathways, including PARP-mediated backup Okazaki fragment maturation and post-replicative gap-filling mechanisms, to resolve G4-induced ssDNA gaps. Pharmacological G4 stabilization, combined with inhibition of these pathways, synergistically inhibits viral replication. In terminally differentiated neurons, only gap-filling pathways are essential for virus replication, and disrupting them or stabilizing G4s robustly impairs HSV-1 reactivation in trigeminal ganglion explants. Collectively, our findings identify G4-induced ssDNA gaps as key barriers to α-herpesvirus replication and reactivation and highlight host ssDNA gap prevention pathways as promising therapeutic targets.

As health services shift to digital delivery, older adults face practical online risks, including operational errors, difficulty interpreting clinical information, unclear privacy consent procedures, and telecommunications fraud. Existing empirical work mostly adopts questionnaire and interview designs to document older adults' real-world digital usage, yet few studies systematically analyze policy documents as an external intervention system and assess how they address four core usage barriers: limited digital proficiency, constrained service access, weak sustained participation, and individualized online safety threats. This paper analyzes 1008 policy records extracted from the Peking University Legal Database covering 2007-2025, and develops a four-dimensional analytical framework split into B1 (Digital Capacity and Age-Friendly Support), B2 (Digital Health Management Support), B3 (Home- and Community-Based Care Support), and B4 (Institutional Care and Risk Governance). The analytical toolkit combines a Capability-Opportunity-Motivation-Behavior (COM-B) diagnostic model, an M1-M4 intervention-mechanism coding protocol, Latent Dirichlet Allocation (LDA) topic modeling, and two indices: the Digital Adaptation Policy Orientation Index (DAPOI) and the Behavioral Intervention Diversity Index (BIDI). Coding outputs reveal a pronounced structural imbalance in policy allocation for older adults' digital health in China: community and institutional governance clauses (B3, B4) dominate the corpus, while person-centred support including one-on-one operational coaching, clinical data interpretation guidance and offline manual backup channels accounts for a marginal share of all coded entries (B1, B2). Age-friendly digital policies issued circa 2020 serve primarily short-term emergency adjustments instead of permanent institutional arrangements. Built on full-text policy coding outputs, this work defines policy-supported digital resilience as a holistic protective system formed by coordinated institutional clauses. Every result reported is sourced exclusively from supply-side policy records, which provides policy-level evidence for subsequent behavioral research on older adults' digital risk management and digital welfare construction.

Hurricane Dorian (2019, GLIDE TC-2019-000099-BHS) permanently destroyed decades of patient records in Grand Bahama, The Bahamas, exposing critical vulnerabilities in centralized health care information systems. This study proposes a distributed electronic medical record (EMR) architecture to maintain patient data availability during and after catastrophic hurricanes in small island states. The architecture connects The Bahamas' approximately 75 community health facilities through regional replication hubs, each maintaining a full local database replica with bidirectional synchronization, enabling autonomous operation when facilities are isolated. An external off-island backup site adds resilience against region-wide events, though site selection must weigh correlated hurricane risk. Critical information, including active medications and allergies, receives priority synchronization under bandwidth-limited conditions. Cost projections indicate feasibility for resource-constrained settings ($2.00 per capita capital cost; $0.59 per capita annual operating cost). Governmental support, including national patient identification infrastructure, would strengthen implementation. This proposed framework awaits pilot implementation and has not been deployed operationally.

Rapid urbanization and persistent reliance on fossil fuels in African cities have intensified ambient air pollution, posing significant public health and environmental challenges. This critical systematic review with policy synthesis, conducted in accordance with PRISMA 2020 reporting principles, synthesizes evidence on fossil fuel sources, urban air quality trends, health impacts, structural drivers, and policy responses while identifying evidence gaps and opportunities for integrated interventions. Diesel-powered road transport, backup generators, and household energy use emerge as dominant sources of particulate matter, nitrogen oxides, black carbon, and volatile organic compounds, disproportionately affecting children, the elderly, and low-income populations. Observed pollution levels often exceed World Health Organization guidelines, yet monitoring networks are sparse and unevenly distributed, limiting exposure assessment. Structural and institutional factors including urban sprawl, energy insecurity, weak fuel standards, and fragmented governance amplify emissions and health burdens. Policy synthesis indicates opportunities for co-benefits through transport electrification, clean cooking transitions, renewable mini-grids, and integrated urban planning, with interventions capable of simultaneously improving air quality, population health, and climate mitigation outcomes. Evidence-policy gaps highlight the need for cross-sectoral coordination, enhanced monitoring infrastructure, and health-informed energy and transport strategies. This review is intended to provide an evidence-informed policy synthesis for national and city governments, urban planners, environmental regulators, public health agencies, and development partners. By integrating evidence across energy, transport, health, and urban planning, it identifies practical pathways for reducing fossil-fuel dependence while improving air quality, population health, climate resilience, and sustainable urban development in rapidly growing African cities.