Nursery pollination systems face an inherent conflict: pollinator larvae consume seeds or floral tissues. Known conflict-resolution mechanisms, including host sanctions, selective abortion, chemical defences, and third-party suppression, operate in systems where larvae feed on seeds. How mutualisms are stabilised when larvae feed on vegetative tissues remains unclear. We investigated a novel nursery pollination involving the dioecious aquatic plant Ottelia jingxiensis, combining field observations, exclusion experiments, floral manipulation, and chemical and colour analyses. We tested whether spatial decoupling of oviposition and larval feeding eliminates the conflict (conflict avoidance), or whether herbivory tolerance is required (conflict resolution). Shore flies (Hydrellia sp.) are primary pollinators; rewardless female flowers attract them via imperfect Bakerian mimicry. Shore flies oviposit on persistent female calyces, but larvae migrate to submerged leaves. Foliar herbivory is substantial (c. 62% of leaves with > 30% area consumed) yet uncorrelated with seed set (R[2] < 0.001), consistent with substantial tolerance. A parasitoid wasp (Chaenusa naiadum) parasitises 67.5-80.1% of pupae and provides supplementary pollination but does not reduce within-generation herbivory or seed predation. Spatial decoupling and herbivory tolerance jointly resolve the pollination-herbivory conflict without requiring host sanctions or biotic regulation, representing a previously unrecognised stabilisation mechanism in nursery pollination.

Acute disseminated encephalomyelitis (ADEM) is an autoimmune inflammatory disease of the central nervous system that typically presents with headache, fever, altered consciousness, and seizures. Diagnosis is made clinically and radiologically, supported by the exclusion of mimics. Delayed treatment can lead to severe neurological impairment, including a persistent vegetative state. A 69-year-old Asian female with rheumatic heart disease and prior transverse myelitis presented with hypoxic respiratory failure. On hospital day (HD) 4, she developed a rapid decline in mental status, progressing to a vegetative state with electroclinical seizures. Brain MRI showed diffuse, symmetric T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities involving subcortical white matter, which is an atypical finding for classic ADEM. Extensive infectious and autoimmune testing was unrevealing. Lumbar puncture on HD 11 (prior to steroids) showed no pleocytosis. She remained vegetative for 39 days without response to high-dose corticosteroids. Following a five-day course of intravenous immunoglobulin (IVIG), she showed marked neurological recovery. At discharge, she returned to her baseline functional status. This case illustrates the diagnostic challenges of suspected ADEM in an older adult with atypical symmetric imaging, prolonged vegetative state, and delayed response to immunotherapy. The case adds to the limited literature on extended encephalopathy in suspected ADEM and underscores the role of IVIG when steroid response is unclear.

Objective: To investigate the occurrence trends, distribution characteristics, and contributing factors of medical damage liability disputes in Chongqing from 2012 to 2024, thereby providing data support for risk prevention and control in regional medical institutions and for health policy formulation. Methods: A retrospective study design was employed. Adjudication documents pertaining to medical damage liability disputes in Chongqing, spanning from January 2012 to December 2024, were retrieved from the China Judgments Online database. A total of 1761 eligible cases were selected based on standardized criteria. Statistical analysis was conducted on core case variables. Results: The number of cases exhibited a fluctuating upward trend from 2012 to 2024, peaking in 2019 (276 cases) before subsequently declining. The average actual compensation amount demonstrated a steady increase, reaching its highest level in 2023 (259,200 ± 53,900 CNY). Deficiencies in diagnostic and therapeutic procedures constituted the predominant cause of disputes (50.37%). Surgical departments (46.05%) and orthopedics departments (22.60%) were identified as high-risk specialties. Tertiary public hospitals accounted for the highest proportion of disputes (48.89%) and the highest average actual compensation (216,100 ± 10,600 CNY). Regarding the apportionment of liability, secondary liability attributed to the medical provider was the most frequent (29.59%). Patient death was the most common adverse outcome (37.14%). The highest average compensation amount was associated with persistent vegetative state outcomes (777,500 ± 157,200 CNY). Statistically significant differences in actual compensation amounts were observed across all outcome categories (all p < 0.05). Conclusions: The situation concerning medical damage disputes in Chongqing remains severe. The etiologies of disputes are predominantly attributable to medical technical factors-particularly deficiencies in diagnostic and therapeutic procedures-and failure to fulfill a duty of care, both of which are associated with elevated compensation amounts. Given that this study employed a retrospective descriptive design, the aforementioned findings reflect associations among variables rather than causal relationships. Based on the identified risk hierarchy, it is recommended that priority be given to strengthening perioperative safety verification and re-certification of critical procedural skills in high-incidence departments, such as surgery and obstetrics and gynecology, enhancing informed consent and medical record quality management, and advancing the tiered healthcare delivery system, with a view to reducing medical risks and mitigating doctor-patient conflicts.

The withdrawal of clinically assisted nutrition and hydration (CANH) is a legally and ethically complex intervention governed by distinct frameworks across the world. In the UK, the British Medical Association (BMA) and Royal College of Physicians (RCP) guideline on CANH, formulated in 2018 after a Supreme Court ruling, provides a framework for decisions. In contrast, Islamic law treats nutritional support as basic care, and its withdrawal is prohibited unless it causes direct harm or there is the presence of an advance directive. Cross-jurisdictional cases where a patient moves between these legal frameworks are rarely described in published literature. We report the case of a 61-year-old woman with no co-morbidities who was in Qatar in November 2024 when she had an out-of-hospital cardiac arrest, resulting in a hypoxic brain injury and later a persistent vegetative state. Her family requested withdrawal of care, citing her wishes to avoid living with a disability. The hospital consulted its ethical and legal departments and concluded that they could not withdraw nutrition as there was no prior explicit directive from the patient. She was repatriated to her local hospital in the UK after eight weeks. She remained in a vegetative state, and her brain imaging was unchanged. Her care team followed the BMA/RCP CANH 2024 guidelines to assist with the process of withdrawing nutrition and hydration and obtained further specialist and legal team opinions. Letters of support from family and friends were also collected. Supportive treatment was withdrawn nine days after UK repatriation, and she died three weeks later with palliative team input. This case illustrates the practical challenges of applying CANH withdrawal guidelines across jurisdictions with different legal and ethical frameworks. It demonstrates the importance of a robust, workable framework like the BMA/RCP guideline on withdrawal of CANH. It highlights the value of advance directives, close family involvement, and legal framework in clinical decisions. Clinicians caring for Muslim patients should be aware of the Islamic bioethical perspective on CANH, which may shape family expectations and discussions in similar situations.

Mature pollen contains a vegetative nucleus with decondensed chromatin and two sperm cells engulfed within the vegetative cytoplasm. Chromatin decondensation in plants usually accompanies a decrease in heterochromatin markers such as H3K9me2, H3K27me1, and H2A.W. However, H3K9 methyltransferases are detected primarily in the vegetative nucleus. This finding raises two questions: whether heterochromatin persists in the vegetative nucleus, and by what mechanism it is regulated. Here, we show that the vegetative nucleus harbors a basal level of H3K9me2, and that ARID1, an integrator coordinating pollen mitosis and heterochromatin reprogramming during sperm cell formation, promotes the maintenance of this basal level via its C-terminal tail-mediated nuclear body formation. The heterochromatin nature of ARID1 nuclear bodies is further confirmed by their colocalization with H2A.W and H3K27me1. Domain truncation analysis reveals that nuclear body formation of ARID1 depends on its C-terminal forty-nine amino acids. Deletion of this short C-terminal region abolished nuclear body formation and inhibited the interaction with H3K9 methyltransferase SUVH6. Disrupting the nuclear body localization of ARID1 significantly impairs its recruitment to H3K9me2 target loci. Therefore, the ARID1 nuclear body is necessary for maintaining H3K9me2 in the vegetative nucleus, which ultimately influences the regulation of nuclear size. Our findings demonstrate that the vegetative nucleus, despite its decondensed state, maintains a basal level of H3K9me2 that is regulated by nuclear body-localized ARID1.

Bacterial endospores formed by Bacilli and Clostridia can persist for decades and survive a wide range of killing mechanisms but can rapidly germinate in permissive environments. SleB and CwlJ are partially redundant germination-specific lytic enzymes that degrade Bacillus spore cortex peptidoglycan, contributing to the transition to the vegetative state. SleB interacts with YpeB, which may hold it inactive until germination starts. YpeB is rapidly proteolyzed during germination, which may release SleB to degrade the cortex. HtrC cleaves YpeB, but YpeB is still degraded in the absence of HtrC, suggesting the contribution of other proteases that are associated with the inner membrane. We hypothesize that at least one additional protease serves a YpeB degradation role. A mutant strain lacking five spore-associated proteases had significantly delayed spore germination and YpeB degradation when compared to the wild type. It is hypothesized that delayed YpeB degradation might cause SleB to become active later during germination. To further characterize the role of YpeB stability on SleB activity, cortex muropeptides were analyzed using HPLC and mass spectrometry. A decrease in two SleB-associated muropeptides was seen in the protease mutant strain after 30 and 60 min of germination when compared to the WT, which might be the consequence of delayed SleB activity. Identifying protein-protein interactions during germination could guide manipulation of spores either to increase the germination efficiency, rendering the spores more susceptible to killing, or to prevent germination, making the spores inefficient in causing human disease.

The Supreme Court (SC) of India's judgment on March 11, 2026, in Harish Rana vs Union of India brought greater clarity on the complex issue of end-of-life decisions; specifically on withdrawal of care from persons in a "permanent vegetative state" [1]. In an earlier landmark judgment in Aruna Shanbaug vs Union of India in 2011, the Court had allowed petitions in favour of "withholding or withdrawal of life support" to allow "a dignified death", in very rare cases, following specific procedures outlined in that judgment [2]. In 2018, in Common Cause vs Union of India, the SC recognised the "right to die with dignity" as an extension of the fundamental "right to live with dignity" under Article 21 of the Indian Constitution. Patients who were terminally ill could refuse futile or burdensome treatment and could register Advance Directives, against unnecessary suffering caused by such treatment [3]. That judgment detailed the decision-making process to be followed for withdrawal of treatment, in order to protect vulnerable patients and prevent misuse. These procedural steps were later simplified by the SC in 2023 into what is termed "Common Cause Guidelines 2023" [4].

A 23-y-old female rhesus macaque (Macaca mulatta) from a long-term research colony developed progressive clinical decline, with lethargy, nasal discharge, and hematologic abnormalities, including persistent leukocytosis, neutrophilia, thrombocytopenia, and anemia. Despite treatment with enrofloxacin, deterioration led to euthanasia. Autopsy revealed severe vegetative endocarditis of the left atrioventricular (mitral) valve with intralesional gram-positive cocci, confirmed immunohistochemically as Staphylococcus aureus. Histologically, disseminated thromboembolic arterial disease was present in the lungs, tracheobronchial lymph node, kidneys, and spleen, with concurrent hepatic central vein thrombosis and coagulative necrosis of hepatocytes, supporting a concurrent hypercoagulable state. A PCR assay of the mitral valve tissue targeting the bacterial 16S ribosomal RNA gene was negative for S. aureus (interpreted as a false-negative result), acknowledging the limitation of PCR testing of formalin-fixed tissues caused by DNA damage and fragmentation. The absence of heart-failure cells and pulmonary edema made primary congestive heart failure unlikely and instead supported systemic inflammatory response syndrome with secondary multi-organ ischemic injury as the cause of death. In infective endocarditis, sustained bacteremia and inflammatory mediator release drive endothelial dysfunction, a hypercoagulable state, and widespread microvascular thrombosis, resulting in impaired tissue perfusion and organ failure.[8,22] Accordingly, the dominant life-threatening process in our case was not mechanical cardiac failure, but disseminated thromboembolic disease and ischemic injury to downstream organs. This pattern is well recognized in both human and veterinary literature; morbidity and mortality in infective endocarditis are frequently driven by septic embolization and systemic complications, rather than intrinsic cardiac dysfunction.

Brainstem auditory evoked potentials (BAEP) provide an objective assessment of brainstem functional integrity. However, their characteristic profiles and clinical significance in patients with prolonged disorders of consciousness (pDOC) remain to be fully elucidated, especially in small, well-characterized cohorts. This is an exploratory study that examines the characteristics of brainstem auditory evoked potential parameters in a small sample of patients with chronic disorders of consciousness and explores how these parameters correlate with the level of consciousness impairment. In this cross-sectional study, 29 patients with pDOC (16 with unresponsive wakefulness syndrome [UWS] and 13 in a minimally conscious state [MCS]) were enrolled. BAEP recordings, neurological assessments using the Coma Recovery Scale-Revised (CRS-R), and medical record reviews were performed. BAEP parameters (wave latencies, interpeak latencies [IPLs]) were compared between UWS and MCS groups using Mann-Whitney U tests. Effect sizes (r) were calculated to quantify the magnitude of observed differences. Spearman correlation was used to assess the relationship between BAEP parameters and CRS-R scores. No significant differences were observed in the latencies of wave I, wave III, the I-III interpeak interval (IPL), the III-V IPL, or the I-V IPL between the unresponsive wakefulness syndrome (UWS) group and the minimally conscious state (MCS) group (all p > 0.05). However, the study revealed a trend toward prolongation in the latency of wave V and the I-V IPL in the UWS group (wave V latency: p > 0.05; I-V IPL: p > 0.05). Both wave V latency (r = - 0.342) and I-V IPL (r = - 0.354) demonstrated moderate effect sizes, suggesting the presence of substantive differences in these measures between the two groups. Additionally, a moderate negative correlation was observed between the I-V IPL and the total score of the Coma Recovery Scale-Revised (CRS-R) (Spearman's ρ = - 0.447, p < 0.001). Although no significant differences were observed in the brainstem auditory evoked potential (BAEP) parameters between the two patient groups, the trend of prolonged I-V interpeak interval (IPL) in the unresponsive wakefulness syndrome (UWS) group, along with its moderate correlation with the Coma Recovery Scale-Revised (CRS-R) score, suggests that UWS patients may have more severe brainstem dysfunction. Therefore, BAEP remains a promising electrophysiological marker for assessing brainstem impairment in patients with prolonged disorders of consciousness (pDOC). Although these preliminary findings did not reach statistical significance in intergroup comparisons, they highlight the need for larger sample sizes in future studies to clarify the role of BAEP in the evaluation of consciousness disorders. If combined with EEG, functional neuroimaging, and other examinations, it would further enhance the accuracy of diagnosis and prognosis.