Late‐Onset Spondyloarthritis Presenting as Glucocorticoid‐Resistant Polymyalgia Rheumatica: A Hitherto Underappreciated Entity in Which Tumor Necrosis Factor or Interleukin ‐17 Blockade May Have a Therapeutic Role

Objective Polymyalgia rheumatica (PMR) is an age‐related inflammatory disease with shoulder/hip girdle involvement. Magnetic resonance imaging (MRI) reveals extracapsular/entheseal soft tissue involvement in both PMR and spondyloarthritis (SpA), with sacroiliac joint and perientheseal spinal bone marrow edema (BME) being characteristic of SpA. Therefore, some shared anatomic topography might be expected to result in similar clinical features. Herein, we describe the clinical and imaging features of SpA initially diagnosed as PMR. Methods Patients observed at Leeds Teaching Hospitals NHS Trust with a diagnosis of psoriatic arthritis (PsA) or axial SpA were screened to identify those initially diagnosed with PMR from 2002 to 2024. Only those patients who retrospectively fulfilled the 2012 EULAR/American College of Rheumatology classification criteria or the Bird et al criteria for PMR were included. Clinical data relevant to initial PMR diagnosis, imaging features, follow‐up, and treatment data were collected, as well as radiographic or MRI features that established the final diagnosis. Results Thirty‐one patients (median age 62 [interquartile range (IQR) 58–69] years; 17 women and 14 men) presenting with typical PMR shoulder/hip girdle pain were subsequently classified as having SpA spectrum disorders. The SpA diagnosis was made in 12 patients within three months of presentation and in 19 patients during the remaining follow‐up period (median 3 [IQR 1–4] years). Four of 27 tested patients were HLA–B27 positive. BME on MRI was detected in the spine and/or sacroiliac joints in 20 of 25 patients (80%) who underwent imaging (sacroiliac joint: 17 patients [68%]; spine: 15 patients [60%]). Clinical resolution with C‐reactive protein (CRP) level normalization occurred in 21 of 31 patients following initial glucocorticoid (GC) therapy, but 7 of these 21 initial responders experienced disease flares or elevations in CRP levels. Therapy‐wise, disease‐modifying antirheumatic drugs (DMARDs) were used in 21 of 31 patients: 8 received conventional synthetic DMARDs, and 11 received biologic agents (8 anti–tumor necrosis factor agents, 3 interleukin‐17 inhibitors), whereas the remaining 10 patients were treated with ≤10 mg/day of GCs. Conclusion Late‐onset SpA with PMR clinical presentations is characterized by failure to respond to or taper GC therapy and is often identified by SpA‐specific osteitis patterns on MRI. We propose that a PMR–SpA overlap may account for biologic therapy efficacy in steroid‐refractory PMR.

Targeting Brain Plasticity: Vagal Nerve Stimulation as a Therapy for Autism‐Like Symptoms in a Valproic Acid Mouse Model

ABSTRACT Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental condition defined by social deficits, stereotypical or repetitive behaviors, and anxiety. This study evaluates the therapeutic potential of transauricular vagal nerve stimulation (tVNS) in a valproic acid (VPA)‐induced mouse model of ASD. The study comprised three groups: the control + sham (saline‐treated offsprings receiving sham stimulation), the autistic + sham (VPA‐treated offspring receiving sham stimulation), and the autistic + tVNS (VPA‐treated offsprings receiving tVNS). Male C57BL/6 mice exposed to VPA on embryonic day 12.5 were evaluated for behavioral and neurobiological alterations. tVNS was applied twice weekly for 3 weeks to investigate its effects on sociability, anxiety‐like behaviors, neurogenesis markers, and apoptosis pathways. Behavioral testing, including the three‐chamber test, mirrored chamber test, open field test, and elevated plus maze, revealed that tVNS significantly improved sociability and social preference indices, reduced social anxiety, and decreased general anxiety‐like behaviors in VPA‐induced mice. Histological and immunohistochemical analyses have shown a decrease in neuron density, brain‐derived neurotrophic factor (BDNF), and doublecortin (DCX) expression in the hippocampus, amygdala, and prefrontal cortex of VPA‐induced mice. Additionally, the increase in caspase‐3 immunoreactivity indicates increased apoptosis. tVNS treatment restored BDNF and DCX levels, promoting neurogenesis and synaptic plasticity while significantly reducing caspase‐3‐mediated apoptosis in affected brain regions. These findings suggest that tVNS may counteract the neural and behavioral deficits associated with ASD by modulating neurogenesis, neuronal plasticity, and apoptosis. The study highlights tVNS as a potential therapeutic intervention for ASD, emphasizing its role in targeting both behavioral alterations and underlying neurobiological mechanisms.

Boron‐mediated regulation of productivity, pomology and nutritional composition across sequential harvests in high‐tunnel‐cultivated ‘ Rubygem ’ strawberries

Abstract BACKGROUND Strawberries are a high‐value fruit with increasing global demand, owing to their flavor and rich content of biochemicals beneficial to health. Fruit quality and yield are influenced by micronutrients, particularly boron (B) that is vital for sugar transport, membrane stability and phenolic metabolism. Yet, few studies have explored how different B application methods interact with the harvest period to affect fruit quality and yield. This study evaluates the effects of soil, foliar and combined B applications across three harvest periods (March, April and May) on yield and diverse quality attributes of ‘Rubygem’ strawberries under Mediterranean high‐tunnel conditions. RESULTS Combined B application resulted in the highest average fruit weight (24.2 g fruit −1 ) and cumulative yield (810 g plant −1 ), significantly exceeding the control (21.1 g fruit −1 and 757 g plant −1 ). March‐harvested fruits were heaviest (36.0 g), while sugars (fructose: 3.19 g (100 g) −1 ; glucose: 3.06 g (100 g) −1 ) and anthocyanin content (328 mg kg −1 ) peaked in May and April, respectively. Pelargonidin‐3‐glucoside (96.9 mg kg −1 ) and ellagic acid (26.5 mg kg −1 ) both reached their highest concentrations under combined B application. Citric acid reached its highest concentration (8.81 mg g −1 ) in May under foliar B application. Additionally, total flavonoid content tended to increase in later harvests, particularly under foliar and combined B applications. CONCLUSION Combined B application improved yield and certain biochemicals, though greater productivity may reduce overall phytochemical richness due to dilution linked with fruit enlargement. Later harvests enhanced sugar and pigment accumulation via senescence‐driven biosynthesis. Integrating combined B application with optimal harvest timing may ensure both productivity and quality. © 2025 Society of Chemical Industry.

High‐Mobility and Low Carrier Concentration Transparent Conducting Oxide Rear Contact for Bifacial CIGS Solar Cells

ABSTRACT The power conversion efficiency of bifacial Cu (In, Ga)Se 2 (CIGS) solar cells under rear illumination is limited by low short circuit current density (Jsc) values. This study investigates the potential of high‐mobility, low carrier concentration transparent conducting oxides (TCOs) as transparent rear contacts (TBCs) to enhance the performance of CIGS solar cells under rear illumination. We first show by optical simulations that TCO with high carrier mobility and low carrier concentration reduces parasitic absorption and improves light coupling into the CIGS absorber, respectively. Then, CIGS solar cells are realized by implementing In 2 O 3 :Sn (ITO) and the higher performing In 2 O 3 :H (IOH) and In 2 O 3 :Zr (InZrO) as TBC. These TBCs significantly improve the optical coupling of rear‐side illumination into the CIGS absorber, improving the rear external quantum efficiency maximum value from about 50% to above 80%. The optical transparency of IOH and InZrO TBC remains relatively unaffected after the CIGS growth process, outperforming ITO on this aspect as well. The observed poor rear EQE at short wavelength is ascribed to a strong rear interface recombination. Finally, a prospective analysis of realistically achievable rear Jsc gains is provided when introducing a steeper Ga gradient at the rear interface and a passivated rear contact.

Henry Levison, a Giant of Pediatric Respiratory Medicine

Sustainability in Small and Medium‐Sized Enterprises ( SME ): Integrated Research Framework and Future Research Agenda

ABSTRACT Over the past two decades, the concept of sustainability in the context of small and medium‐sized enterprises (SME) has gained significant attention within both business practice and academic research. This has resulted in a rapid and multidisciplinary proliferation of scholarly literature, which has led to an increasing fragmentation of the research field, calling for an integrative overview. Against this background, this paper aims to identify the main thematic clusters of the literature on sustainability in SMEs, using two science mapping techniques (co‐citation analysis and bibliographic coupling), and a cluster‐wise review identifying major determinants and antecedents of SME's sustainability, SME's sustainability efforts, and their outcomes, as well as contextual factors, applied theories, and research methods. Additionally, it seeks to reveal nascent subfields and research gaps. This research contributes to the literature by complementing and extending existing literature reviews in a quantitative approach and proposing an integrative overview. Moreover, implications for SMEs and future research directions are suggested.

Device Simulation Analysis of the Perovskite/Perovskite/Silicon Triple Junction Solar Cell Structure

In recent years, the development of perovskite/perovskite/silicon triple junction solar cells has received considerable attention, aiming to exceed the efficiency of perovskite/silicon dual junction solar cells. Various challenges must be addressed to reach these efficiencies and justify the additional complexity. This article outlines a simulation‐based roadmap for improving the structure of these cells. It discusses critical issues and estimates potential improvements for perovskite/perovskite/silicon solar cells based on device architectures developed at Fraunhofer ISE and EPFL. The article describes potential challenges related to thickening the middle perovskite absorber to achieve current matching. It explains the observed losses in fill factor in the top cell with a high bandgap, which arise from an insufficient hole barrier caused by unfavorable valence‐band alignment between the perovskite and the electron transport layer. These aspects are examined through numerical device simulations.

Breed Distribution of the Superoxide Dismutase 1 Gene Polymorphism Associated With Degenerative Myelopathy in a Canine Population From Different Geographical Regions of Türkiye

ABSTRACT Background and Objective Canine degenerative myelopathy (CDM) is a progressive neurodegenerative condition that impacts the spinal cord, resulting in paralysis in dogs. CDM is linked to a missense mutation in the superoxide dismutase 1 ( SOD1 ) gene. This study aimed to examine the presence of the SOD1:c.118G>A mutation in the German Shepherd, Golden Retriever, Pomeranian, Toy Poodle and native Kangal Shepherd dog breeds in Türkiye. Methods Blood samples ( n  = 161) from five breeds, collected from six provinces across five geographic regions of Türkiye, were tested for the prevalence of the mutant allele associated with CDM. All dogs were clinically healthy and sampled for genetic testing. Genotyping was performed using the PCR‐RFLP method and gel electrophoresis. Results Genotyping of dogs revealed that 141 had the homozygous wild‐type genotype (GG), 20 were heterozygous carriers (AG), and there were no homozygous mutant (AA) individuals. The mutant A allele was determined in Kangal Shepherd, German Shepherd and Toy Poodle dog breeds. The frequency of the mutant allele in the investigated population was identified as 0.062. It was determined that the mutant allele, which was not previously reported in the Kangal Shepherds, was present, and the mutant allele frequency revealed 0.057. Conclusions The SOD1:c.118G>A mutation is present in dog breeds in Türkiye, and is also detected in the Kangal Shepherd, an ancient breed. This finding underscores the importance of genetic testing in dogs, as it is crucial to prevent the spread of mutations in different canine populations. Carrier dogs can be clinically identified to prevent breeding and reduce CDM incidence.

Angiopoietin‐1, Angiopoietin‐2 and Vascular Endothelial Growth Factor Levels in Canine Leishmaniosis

ABSTRACT Background Canine leishmaniosis (CanL) is a zoonotic vector–borne disease and is primarily associated with systemic inflammation, endothelial dysfunction and immune dysregulation. Although angiopoietins (Ang) and vascular endothelial growth factor (VEGF) are key regulators of vascular homeostasis, their roles in CanL have remained unclear. Objectives The present study aimed to evaluate Ang‐1, Ang‐2 and VEGF levels in CanL, in relation to disease severity and inflammatory markers. Methods The study included 74 dogs (52 with CanL and 22 healthy controls). The dogs with CanL were categorized into four groups based on disease severity. Plasma levels of Ang‐1, Ang‐2 and VEGF were measured with commercial ELISA kits. The correlations of these parameters with disease progression and inflammatory markers, such as C‐reactive protein (CRP) and ferritin, were statistically analysed. Results Ang‐1 and VEGF levels were significantly elevated in advanced stages of CanL, suggesting a compensatory response to vascular damage and chronic inflammation. Ang‐2 levels increased in both early and late stages, indicating endothelial destabilization and inflammatory progression. VEGF correlated with disease severity and aligned with enhanced vascular permeability. CRP and ferritin levels increased with disease severity and reflected systemic inflammation. Conclusions This study highlights the potential role of VEGF, Ang‐1 and Ang‐2 in CanL progression. High levels of VEGF and Ang‐2 suggest enhanced vascular permeability and inflammation, whereas elevated Ang‐1 may indicate a compensatory response. Overall, these parameters have the potential to be used as biomarkers for monitoring disease progression and as targets for therapy. Additional studies with larger cohorts and advanced imaging techniques are needed to validate these findings.

Mapping Health Workforce Inequality: A Global Spatial and Temporal Assessment, 2000–2023

ABSTRACT Although international efforts to strengthen health systems have intensified over the past two decades, the global distribution of health personnel remains deeply uneven. This study examines physician density trends across 199 countries from 2000 to 2023, using data from the WHO Global Health Workforce Statistics. Annual Theil indices are calculated, and a decomposition analysis is conducted to distinguish between‐region and within‐region disparities. The global Theil index declined from 0.42 in 2000 to 0.32 in 2023, reflecting gradual but incomplete progress. On average, 55% of the observed disparity stems from differences between regions, while 45% arises within them. To explore spatial patterns, Global Moran's I and Local Indicators of Spatial Association (LISA) analyses are applied. The results reveal persistent clusters of physician shortages in Sub‐Saharan Africa and South Asia, contrasted by sustained concentrations of physician abundance in Europe and Central Asia. These geographic imbalances highlight the limitations of relying solely on regional coordination. Achieving more equitable health workforce distribution will require country‐specific strategies that address structural disadvantages and reduce the loss of health professionals from underserved areas. Policy options include regional training partnerships, cross‐border mobility frameworks, and integrated workforce planning mechanisms responsive to local capacity and need.