Community College of Baltimore County

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive intracranial arterial stenosis, which can lead to ischemic or hemorrhagic stroke. However, its pathogenesis remains poorly understood, limiting advances in the diagnosis and treatment of MMD. We perform data-independent acquisition (DIA) proteomics on serum samples from 40 MMD patients and 20 healthy controls, followed by ELISA validation of an additional 45 cohort. Vascular organoids are generated from induced pluripotent stem cells (iPSCs) derived from the peripheral blood, and analyzed using histological staining, transcriptomics, and single-cell RNA sequencing (scRNA-seq). Histological examination of the temporal superficial artery (STA) in MMD patients reveals abnormal accumulation of vascular smooth muscle cells (VSMCs). DIA proteomics identify significant upregulation of TUBA4A and TUBB4B in MMD serum. In vitro assays demonstrate that these tubulin proteins promoted VSMC proliferation, migration, and contractile-to-synthetic phenotypic switching through the GJA1/PI3K/AKT/KLF4 signaling pathway. Single-cell RNA sequencing of MMD vascular organoids shows an increased proportion of synthetic VSMCs with upregulated TUBA4A and TUBB4B expression. Our findings suggest that overexpression of TUBA4A and TUBB4B contributes to pathological vascular remodeling in MMD through the GJA1/PI3K/AKT/KLF4 pathway, as well as therapeutic targets for intervention in MMD vascular remodeling. Organoid modeling and single-cell profiling reveal TUBA4A and TUBB4B tubilin proteins-driven vascular smooth muscle cell migration and contractile-to-synthetic phenotypic switching via GJA1/PI3K/AKT/KLF4 pathway in Moyamoya disease.

PURPOSE:This study aimed to adapt international clinical practice guidelines for the rehabilitation of acute spinal cord injury (SCI) in Iran. METHODS:This study was conducted based on guideline adaptation methods (the ADAPTE (ADaptation and eVALuation of a prE-existing guideline) framework). After an organizing committee was created and health topics selected, we searched PubMed, Scopus, and Cochrane Library from January 2011 to April 2021 to find guidelines regarding acute/subacute rehabilitation of SCI patients. The quality of the clinical practice guidelines was examined using the Appraisal of Clinical Guidelines for Research & Evaluation II. Recommendations were made by the committee and categorized according to population, intervention, professions, outcomes, and health care setting. The decision-making process was based on a systematic evaluation of each recommendation, utilizing a combination of quality for supporting evidence or against each recommendation, as well as consideration of feasibility, acceptance, and adoptability for the healthcare context of Iran. RESULTS:Our selection yielded 1 high-quality guideline containing 4 recommendations that underwent an adaptation process. Rehabilitation should be implemented as soon as patients are hemodynamically and neurologically stable and can tolerate the intensity. We suggest establishing specialized rehabilitation centers with trained personnel and proper equipment, providing tele-rehabilitation, education, and encouraging caregivers to help with early rehabilitation. Negotiating with insurance companies is imperative to cover the cost of long-term occupational therapy and rehabilitation. We suggest conventional over-ground training rather than treadmill training due to the lack of facilities. Individuals with acute/subacute cervical SCI should be offered functional electrical therapy. We find that additional training in unsupported sitting has no clear benefit associated with it when compared to the current standard rehabilitation. CONCLUSIONS:Implementation of international guidelines for SCIs and rehabilitation is a process that involves feasibility, acceptability, relevance, and adaptability when considering developing countries. The recommendations presented in this study have the potential to significantly improve the care provided to patients with SCI, not only in Iran but also could help guide developing countries in the healthcare arena.

Ethiopia has numerous vibrant prehistoric rock art sites that showcase ancient paintings, engravings, and carvings on natural rock surfaces. The Subha Sa’esie and Tsa’eda Emba districts in Northeastern Tigrai, Ethiopia, have some of the highest concentrations of rock art sites in the region. However, these invaluable cultural assets are vulnerable to deterioration due to various natural and anthropogenic factors. Weathering and disintegration of the rock substrate, loss of pictorial details, blurring, fading, flaking off, erasure, and disfiguration of paintings, distortion of images, and dissolution of pigments are common forms of deterioration. A thorough assessment of the rock mass properties of the rock art sites proved to be crucial to determine the factors that cause deterioration of the artworks and to propose effective protection and mitigation measures against the threats. This study evaluated the rock mass properties of eight rock art sites in northeastern Tigrai, using standard rock mass classification schemes: Rock Mass Rating (RMR), Quality Index (Q), Geological Strength Index (GSI), and Continuous Slope Mass Rating (CSMR). The eight sites were selected based on their high archaeological and historical significance, as well as the level of visible damage on them. The findings revealed that the rock masses hosting the rock art sites have fair to good rock quality, weak to medium strength, and partially stable to stable slopes. Structural discontinuities, water inflow, infiltration, seepage, and weathering are the major factors contributing to the deterioration of the rock substrates and the artworks. Long-term preservation of the rock art sites can be ensured by implementing effective protective measures, including the installation of light-weight shelters, managing and controlling water inflow, stabilization and reinforcement of structural discontinuities based on detailed structural assessments, and establishing monitoring systems. Evidence-based conservation, restoration, and preservation guidelines should also be established and implemented to safeguard these precious cultural assets for future generations.

Abstract Background Moyamoya disease (MMD) is a progressive cerebrovascular disorder characterized by steno-occlusive lesions and intimal hyperplasia. Although vascular smooth muscle cell (VSMC) phenotypic switching is implicated in its pathogenesis, the precise spatial interplay between extracellular matrix (ECM) remodeling and local metabolic alterations within the distinct vascular microenvironments remains unknown. Methods Superficial temporal artery (STA) samples from patients with MMD and controls were analyzed by histology, immunofluorescence, spatial transcriptomics, spatial proteomics, and spatial metabolomics. Single cell RNA sequencing was used to profile the cellular landscape of STA tissues. To functionally validate the identified pathway, human brain vascular smooth muscle cells (HBVSMCs) were stimulated with fibronectin 1 (FN1), and patient derived induced pluripotent stem cell smooth muscle cells (iPSC-SMCs) were generated for migration and protein expression assays following ITGA5 silencing or focal adhesion kinase (FAK) inhibition. Results MMD STA samples exhibited marked intimal hyperplasia with medial thinning and intimal accumulation of α-SMA positive cells. Spatial transcriptomic and proteomic analyses identified an intimal remodeling program characterized by increased FN1, EFEMP1, fibronectin, ITGA5, and FAK, together with reduced MYH11. FN1 stimulation promoted smooth muscle cell migration, ECM associated protein expression, and FAK phosphorylation, whereas ITGA5 knockdown or FAK inhibition attenuated these effects. Patient derived MMD iPSC-SMCs showed similar abnormalities, including enhanced migration, increased FAK activation, reduced contractile markers, and increased ECM associated proteins. Spatial metabolomics and integrated multi-omics analyses further revealed that these changes were coupled to a metabolically depleted intimal niche enriched for reduced acyl-CoA related metabolites. Conclusions Integrated spatial multi-omics identifies coupled ECM remodeling and metabolic alteration in the hyperplastic intima of MMD. Within this context, the FN1-ITGA5-FAK axis emerges as a plausible mediator of smooth muscle remodeling that warrants further validation. Graphical Abstract

This study examines the implications of economic recessions for workers, organizations, and policymakers in the Dominican Republic, with a focus on resilience, labor market dynamics, and business vulnerability. Drawing on literature review, cultural immersion observations by living in the country, and qualitative insights from the survey of 12 subject-matter experts with over 300 years of combined work experience, the research explores how external shocks such as global downturns, inflation, and disruptions affect the Dominican economy. Findings indicate that recessions disproportionately impact small and medium-sized enterprises, informal workers, and tourism-dependent industries, often resulting in job insecurity, reduced consumer demand, and constrained business operations. The study highlights how individual experiences of economic hardship shape long-term attitudes toward equity, government intervention, and social welfare policies. It further emphasizes the importance of adopting a long-term, multilevel perspective that considers individual, organizational, and societal responses to economic stress. Key resilience strategies identified include workforce upskilling, digital transformation, business diversification, and proactive financial planning. Expert insights reveal that while recessions present significant challenges, they also create opportunities for innovation and structural reform. The findings underscore the need for coordinated efforts between public and private sectors to strengthen institutional capacity, support vulnerable populations, and promote inclusive growth. This research contributes to a deeper understanding of how the Dominican Republic can better prepare for, navigate, and recover from economic downturns in an increasingly interconnected global economy.