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How has the European Commission designed its new enlargement methodology in times of enlargement fatigue? Several studies have pointed out the French opposition to launching accession negotiation with North Macedonia and Albania in 2019 as a significant factor explaining the content of the new methodology. Traditionally, enlargement policy has been seen through the lenses of rational choice institutionalism: from this perspective, the new methodology would be resulting from such an external shock. This paper argues instead, using the discursive institutionalism framework and the concept of institutional bricolage, that the new methodology is the product of four different discourses on enlargement layered on top of each other. Une réaction au « non » français ? Ou un exemple de bricolage institutionnel ? Comment la Commission européenne a-t-elle conçu sa nouvelle méthodologie d'élargissement malgré une certaine lassitude face à ce processus ? Plusieurs études ont montré que l'opposition française au lancement des négociations d'adhésion avec la Macédoine du Nord et l'Albanie en 2019 expliquait le contenu de la nouvelle méthodologie. Traditionnellement, la politique d'élargissement a été vue à travers le prisme de l´institutionnalisme rationnel : de ce point de vue, la nouvelle méthodologie serait le résultat d’un tel choc externe. Cet article soutient au contraire, en utilisant le cadre de l'institutionnalisme discursif et le concept de bricolage institutionnel, que la nouvelle méthodologie est le produit de quatre discours différents sur l'élargissement superposés les uns sur les autres.

This study explored breed-specific differences in vertebral right heart index (VRHi) values and their accuracy in diagnosing right heart enlargement (RHE) in dogs. Certain breeds, particularly brachycephalic dogs, often exhibited higher VRHi values despite having a normal heart size. Right lateral thoracic radiographs were more reliable for VRHi measurements than ventrodorsal views. These results emphasize the importance of accounting for breed-specific factors when interpreting chest X-rays to assess heart size in veterinary practice.

Aortic root enlargement (ARE) is a variably performed during surgical aortic valve replacement (SAVR) to minimize patient-prothesis mismatch (PPM), but its impact on survival remains under-evaluated. We retrospectively analyzed Medicare beneficiaries (1999–2019) undergoing isolated SAVR with or without non-Konno ARE. Procedural details were doubly-adjudicated by ICD and CPT codes. Overlap propensity score weighting adjusted for confounders. Restricted mean survival times (RMST) at 30-days and 20-years were compared. Surgeons were stratified by ARE frequency, and survival was analyzed using risk-adjusted Kaplan-Meier estimates in both “as-treated” (SAVR vs SAVR+ARE) and “surgeon-preference” (never-ARE vs frequent-ARE surgeons) analyses. Of 214,266 beneficiaries undergoing isolated SAVR, 6,652 (3.1%) underwent SAVR+ARE. From 1999 to 2019, ARE utilization increased from 2.1% to 6.4% (Cochran-Armitage Z-statistic: 15.2). Among 3,018 surgeons, 1,513 never performed ARE (69,389 beneficiaries), 1,227 performed ARE in <10% of cases (128,258 beneficiaries), and 278 performed ARE in ≥10% of cases (16,619 beneficiaries). After risk-adjustment, survival was significantly lower in SAVR+ARE compared to SAVR recipients: 30-day RMST 28.73 (28.60,28.87) versus 29.35 (29.26,29.45) days (p = 0.013) and 20-year RMST 9.15 (8.96,9.35) vs 9.49 (9.30,9.69) years (p = 0.018). Similarly, beneficiaries treated by frequent-ARE surgeons experienced worse early risk-adjusted survival without any late survival benefit: 30-day RMST 29.19 (29.11,29.27) versus 29.33 (29.25-29.40) days (p = 0.013), 20-year RMST 9.04 (8.90,9.18) versus 9.13 (9.00,9.27) (p = 0.351). Landmark analysis of 1-year survivors showed no late survival difference (p = 0.456 “as-treated” analysis; p = 0.943 “surgeon-preference” analysis). Even among frequent-ARE surgeons, SAVR+ARE was associated with higher 30-day and reduced 20-year RMST relative to SAVR alone. In conclusion, ARE was associated with higher early mortality and no long-term survival advantage compared to SAVR alone (even among frequent-ARE surgeons), as was undergoing surgery by a frequent ARE surgeon. Further studies are required to assess the potential utility of ARE in younger patients, those with small annuli, and those at risk for PPM.

The extent to which water availability can be used to predict the enlargement and final dimensions of xylem conduits remains an open issue. We reconstructed the time course of tracheid enlargement in Pinus sylvestris trees in central Spain by repeated measurements of tracheid diameter on microcores sampled weekly during a 2 yr period. We analyzed the role of water availability in these dynamics empirically through time-series correlation analysis and mechanistically by building a model that simulates daily tracheid enlargement rate and duration based on Lockhart's equation and water potential as the sole input. Tracheid enlargement followed a sigmoid-like time course, which varied intra- and interannually. Our empirical analysis showed that final tracheid diameter was strongly related to water availability during tracheid enlargement. The mechanistic model was calibrated and successfully validated (R-2 = 0.92) against the observed tracheid enlargement time course. The model was also able to reproduce the seasonal variations of tracheid enlargement rate, duration and final diameter (R-2 = 0.84-0.99). Our results support the hypothesis that tracheid enlargement and final dimensions can be modeled based on the direct effect of water potential on turgor-driven cell expansion. We argue that such a mechanism is consistent with other reported patterns of tracheid dimension variation.

Background Prospective trials of active surveillance (AS) have shown low rates of progression in low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0). However, the significance of multifocality as a prognostic factor remains controversial. Methods Data from 571 patients (mean age, 53.1 years; 495 females) who underwent AS were reviewed. PTMC was unifocal in 457 patients (80.0%) and multifocal in 114 patients (20.0%), with 2–5 lesions each (261 tumors in total). Tumor progression was defined as tumor size enlargement ≥ 3 mm and/or development of clinically evident lymph node metastasis (LNM). Results After a mean duration of AS of 7.6 years, 53 patients (9.3%) showed tumor enlargement and 8 patients (1.4%) developed LNM. The 10-year progression rate was 13.1%. Age, sex, and calcification pattern did not differ significantly between uni- and multifocal diseases. However, anti-thyroglobulin antibody and/or anti-thyroid peroxidase antibody was more frequently positive with multifocal PTMCs (46.7%) than with unifocal disease (34.4%, p =  0.024). Patients with uni- and multifocal disease showed no significant differences in 10-year rate of tumor enlargement (11.4% vs. 14.8%), LNM development (1.1% vs. 2.4%), or progression (12.4% vs 15.9%). Multivariate analysis of predictors for progression showed multifocality was not a significant risk factor (odds ratio, 1.45; 95% confidence interval, 0.79–2.54; p =  0.22). Eventually, 9 patients (7.9%) with multifocal PTMCs underwent surgery and 7 needed total thyroidectomy, although 7 still showed T1N0M0 low-risk cancer. Conclusions Even patients with multiple PTMCs (T1amN0M0) are good candidates for AS. Many patients can avoid total thyroidectomy and subsequent surgical complications.

It has been reported that Ywhah (14-3-3[eta]) reduces glycolysis. However, it remains unclear about the downstream mechanism by which glycolysis is regulated by 14-3-3[eta] in cardiac hypertrophy. As an important regulator, Yes-associated protein (YAP) interacts with 14-3-3[eta] to participate in the initiation and progression of various diseases in vivo. In this study, the model of H9C2 cardiomyocyte hypertrophy was established by triiodothyronine (T3) or rotenone stimulation to probe into the action mechanism of 14-3-3[eta]. Interestingly, the overexpression of 14-3-3[eta] attenuated T3 or rotenone induced cardiomyocyte hypertrophy and decreased glycolysis in H9C2 cardiomyocytes, whereas the knockdown of 14-3-3[eta] had an opposite effect. Mechanistically, 14-3-3[eta] can reduce the expression level of YAP and bind to it to reduce its nuclear translocation. In addition, changing YAP may affect the expression of lactate dehydrogenase A (LDHA), a glycolysis-related protein. Meanwhile, LDHA is also a possible target for 14-3-3[eta] to mediate glycolysis based on changes in pyruvate, a substrate of LDHA. Collectively, 14-3-3[eta] can suppress cardiomyocyte hypertrophy via decreasing the nucleus translocation of YAP and glycolysis, which indicates that 14-3-3[eta] could be a promising target for inhibiting cardiac hypertrophy.