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Description of the subject. To boost the development of the national palm oil sector, one of the most promising moves for the Cameroonian government would be to improve partnerships between agro-industries and smallholders in order to increase the latter’s plantation yields and oil extraction rates.Objectives. Drawing on successful experiences in Southeast Asia, this paper examines the conditions for establishing a win-win partnership between agro-industrial companies and smallholders in the Cameroonian palm oil sector. Method. The study was carried out in three production basins in the Centre and the Southwest regions of Cameroon where such partnerships were initiated before the collapse of the National Aid Fund for Rural Development (FONADER) in the 1970s. In participatory workshops involving at least twelve stakeholders (palm oil producers, artisanal and industrial millers, intermediaries and agricultural extension services), the participants' knowledge was integrated together through individual and collective reflection, with a guarantee of equal expression and consideration of views. Two workshops followed a strict adaptation of Participatory Prospective Analysis (PPA); a third followed a semi-directed participatory approach. Interactions between participants produced definitions of the systems studied and the variables involved, different plausible future scenarios, and recommendations for decision making. Results. Access to technical and managerial capacity building, terms of the contract, access to shareholding in the company by smallholders, and legalization of the terms of the contract emerged as the major items that would influence a sustainable partnership between agro-industries and smallholders.Conclusions. Participatory derived recommendations show that long-term partnerships between agro-industry and smallholders depend on a negotiated contract agreement between the partners to ensure transparency and trust. In addition, a dedicated smallholder department in charge of village plantations within agro-industrial companies can facilitate communication between partners. Co-construire des partenariats gagnant-gagnant entre agro-industries et planteurs dans la filière huile de palme au CamerounDescription du sujet. Afin de développer le secteur de l’huile de palme au Cameroun, une des voies les plus prometteuses pour le gouvernement consiste à améliorer les partenariats entre agro-industries et petits planteurs afin d’augmenter les rendements et les taux d’extraction en huile des plantations villageoises. Objectifs. S’inspirant de l’expérience du développement du secteur de l’huile de palme dans les pays d’Asie du Sud-Est, cet article examine les conditions de mise en œuvre de partenariats gagnant-gagnant entre les entreprises agro-industrielles et les exploitations familiales de la filière. Méthode. L'étude a été menée dans trois bassins de production des régions du Centre et du Sud-Ouest du Cameroun où ces partenariats avaient été initiés dans les années 1970 avant l'effondrement du Fonds National d'Aide au Développement Rural (FONADER). Lors d’ateliers participatifs regroupant au moins douze participants (producteurs d’huile de palme, moulins artisanaux et industriels, intermédiaires et services de vulgarisation agricole), les connaissances des participants sont intégrées, partant d’une réflexion individuelle puis collective, garantissant une expression et une considération égales des points de vue. Deux ateliers ont été organisés suivant une stricte adaptation de la méthode d'Analyse Prospective Participative (PPA) et un troisième atelier suivant une approche participative semi-dirigée. Les interactions entre les participants se focalisent sur la délimitation du système étudié, les énoncés de variables, les différents scénarios plausibles, et des recommandations pour la prise de décision. Résultats. L'accès au renforcement des capacités techniques et managériales, les termes du contrat, l’accès des petits planteurs à l’actionnariat des agro-industries et la légalisation des termes du contrat ressortent comme les éléments majeurs d'un partenariat durable entre les agro-industries et les petits exploitants. Conclusions. Les recommandations élaborées de façon participative montrent qu’un partenariat de long terme entre l'agro-industrie et les petits planteurs dépend d'un accord contractuel négocié entre partenaires susceptible d’assurer la transparence et la confiance. De plus, la création au sein des agro-industries d’un département en charge des plantations villageoises faciliterait la communication entre partenaires.

The Mediterranean diet (MD) has shown to reduce the occurrence of several chronic diseases. To evaluate its potential protective role on dementia incidence we studied 16,160 healthy participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain Dementia Cohort study recruited between 1992–1996 and followed up for a mean (±SD) of 21.6 (±3.4) years. A total of 459 incident cases of dementia were ascertained through expert revision of medical records. Data on habitual diet was collected through a validated diet history method to assess adherence to the relative Mediterranean Diet (rMED) score. Hazard ratios (HR) of dementia by rMED levels (low, medium and high adherence levels: ≤6, 7–10 and ≥11 points, respectively) were estimated using multivariable Cox models, whereas time-dependent effects were evaluated using flexible parametric Royston-Parmar (RP) models. Results of the fully adjusted model showed that high versus low adherence to the categorical rMED score was associated with a 20% (HR = 0.80, 95%CI: 0.60–1.06) lower risk of dementia overall and HR of dementia was 8% (HR = 0.92, 0.85–0.99, p = 0.021) lower for each 2-point increment of the continuous rMED score. By sub-types, a favorable association was also found in women for non-AD (HR per 2-points = 0.74, 95%CI: 0.62–0.89), while not statistically significant in men for AD (HR per 2-points = 0.88, 0.76–1.01). The association was stronger in participants with lower education. In conclusion, in this large prospective cohort study MD was inversely associated with dementia incidence after accounting for major cardiovascular risk factors. The results differed by dementia sub-type, sex, and education but there was no significant evidence of effect modification.

Scar outcomes are traditionally evaluated at 12 months post‐surgery, yet early prediction of long‐term scar characteristics may facilitate timely interventions, enhance treatment strategies, shorten clinical trial durations, and improve patient outcomes. This study evaluates whether 3‐month scar assessments reliably predict 12‐month outcomes using validated scar assessment scales and interrater reliability measures. Two surgeons evaluated a prospective cohort of 40 surgical patients using standardised scar assessment tools. Logistic regression assessed the predictive value of 3‐month classifications for 12‐month binary outcomes (‘good’ vs. ‘poor’ scar quality), while linear regression evaluated continuous scar scores. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values quantified predictive accuracy. Scars classified as ‘good’ at 3 months were significantly more likely to remain ‘good’ at 12 months (p < 0.001), with strong predictive performance (AUC = 0.763). Linear regression demonstrated significant predictive accuracy for width, height, and overall opinion. However, vascularity predictions were weak, and depth was not significantly associated with long‐term outcomes. Interrater reliability was moderate to good across measures, with intraclass correlation coefficients values ranging from 0.215 (depth) to 0.714 (width), and Cohen's Kappa for binary scar classifications of 0.505 (p < 0.001). Early 3‐month scar assessments reliably predict 12‐month outcomes for width, height, and overall opinion, while vascularity and depth remain less predictable. Scars rated as ‘good’ at 3 months are unlikely to worsen, while ‘poor’ scars rarely improve without intervention. These findings highlight the utility of early scar evaluations in guiding postoperative management and patient counselling. Key Points Three‐month scar assessments can meaningfully predict 12‐month outcomes, though predictive value varies considerably by feature. Scar width was the strongest and most reliable early predictor, with the highest regression coefficient, explained variance, and inter‐rater agreement of all assessed features. The binary “good/poor” gestalt classification achieved 100% sensitivity and negative predictive value, meaning scars judged poor at 3 months reliably remained poor at 12 months. Vascularity and depth showed weak predictive associations and poor inter‐rater reliability, cautioning against early intervention decisions based on these parameters alone. The cohort's limited racial and ethnic diversity underscores the need for larger, more representative studies given the elevated risk of pathological scarring in patients of color.

Population aging poses significant public health challenges in China. Emerging studies have linked air pollution to physiological aging, yet evidence regarding particulate matter with an aerodynamic diameter ≤ 1 μm (PM 1 ) remains sparse. This two-wave panel study included 5391 Chinese adults aged 45–80 to explore the effects of long-term exposure to PM 1 on biological aging acceleration. The Klemera−Doubal method (KDM) was employed to estimate biological aging acceleration (KDM-BAA) using 11 clinical biomarkers at both the 2011 baseline and the 2015 follow-up survey. Multivariate linear models with natural cubic splines were performed to estimate the association between PM 1 exposure and KDM-BAA changes from baseline to follow-up. Sensitivity analyses and stratified analyses were also performed. The exposure–response curve indicated that exposure to ambient PM 1 was significantly positively associated with changes in KDM-BAA, with the association becoming substantially stronger when PM 1 exposure exceeded the median exposure level of 32.5 μg/m 3 . Per 10 μg/m 3 increment in PM 1 exposure was associated with an acceleration of 1.55 (95% CI: 0.79, 2.31) years in KDM-BAA. Elderly adults over 60 years and smokers demonstrated greater susceptibility to the aging effects of ambient PM 1 exposure, whereas leisure engagement was observed to have a beneficial effect in mitigating the aging response of PM 1 exposure. Long-term exposure to ambient PM 1 may accelerate biological aging among middle-aged and older adults in China, especially in the elderly. These findings highlight the urgency for policies aimed at mitigating PM 1 pollution to promote healthy aging within an increasingly aging population.

The concept and application of nature-based solutions (NBS) have been rapidly progressing in Europe and Latin America, reflecting a transition in the way that urban governance is perceived. There is a large call for the collaborative, polycentric, and interdisciplinary governance of NBS. However, research on options for operationalising these governance processes in different contexts is still insufficient. This study explores and analyses the operationalisation of NBS adaptive governance in Europe and Latin America. Seven cities that are part of the project EU-H2020 CONEXUS have been selected as case studies: Barcelona, Bogotá, Buenos Aires, Lisbon, Santiago de Chile, São Paulo, and Turin. This contribution aims to (i) understand how NBS governance processes are managed; (ii) identify the main positive and negative factors that influence NBS adaptive governance; and (iii) understand common factors and relationships that can hinder or drive forward adaptive governance for NBS in the investigated contexts. The results revealed common priorities indicating a shared pathway for Europe and Latin America; however, context-dependent specificities were also observed. These findings can be used to support cities in both European and American contexts in developing plans and actions for the more efficient enabling of NBS implementation and governance through adaptive governance.

Aims/hypothesisMitochondrial dysfunction, which can be approximated by blood mitochondrial DNA copy number (mtDNA-CN), has been implicated in the pathogenesis of type 2 diabetes mellitus. Thus far, however, insights from prospective cohort studies and Mendelian randomisation (MR) analyses on this relationship are limited. We assessed the association between blood mtDNA-CN and incident type 2 diabetes using multivariable-adjusted regression analyses, and the associations between blood mtDNA-CN and type 2 diabetes and BMI using bi-directional MR.MethodsMultivariable-adjusted Cox proportional hazard models were used to estimate the association between blood mtDNA-CN and incident type 2 diabetes in 285,967 unrelated European individuals from UK Biobank free of type 2 diabetes at baseline. Additionally, a cross-sectional analysis was performed to investigate the association between blood mtDNA-CN and BMI. We also assessed the potentially causal relationship between blood mtDNA-CN and type 2 diabetes (N=898,130 from DIAGRAM, N=215,654 from FinnGen) and BMI (N=681,275 from GIANT) using bi-directional two-sample MR.ResultsDuring a median follow-up of 11.87 years, 15,111 participants developed type 2 diabetes. Participants with a higher level of blood mtDNA-CN are at lower risk of developing type 2 diabetes (HR 0.90 [95% CI 0.89, 0.92]). After additional adjustment for BMI and other confounders, these results attenuated moderately and remained present. The multivariable-adjusted cross-sectional analyses showed that higher blood mtDNA-CN was associated with lower BMI (−0.12 [95% CI −0.14, −0.10]) kg/m2. In the bi-directional MR analyses, we found no evidence for causal associations between blood mtDNA-CN and type 2 diabetes, and blood mtDNA-CN and BMI in either direction.Conclusions/interpretationThe results from the present study indicate that the observed association between low blood mtDNA-CN and higher risk of type 2 diabetes is likely not causal.

Purpose This study investigates potential failure modes and conducts failure mode and effects analysis (FMEA) and fault tree analysis (FTA) on the administration of 177Lu $^{177}{\\rm Lu}$DOTATATE (LUTATHERA) and 177Lu $^{177}{\\rm Lu}$PSMA‐617 (PLUVICTO). The quality management (QM) process in radiopharmaceutical therapies (RPTs) requires collaboration between nuclear medicine (NM) and radiation oncology (RO) departments. As part of a multi‐institutional study, we surveyed various departments to identify and analyze failure modes, leading to a proposed comprehensive QM program. RPT teams in RO or NM clinics can benefit from this study by continually improving their practice. Methods We reviewed the literature to investigate the administration of Pluvicto and Lutathera, focusing on prospective procedural failures and potential failure modes (PFMs) and their outcomes. We distributed an FMEA survey to multiple experienced centers in 177Lu $^{177}{\\rm Lu}$ ‐based RPTs and calculated risk priority number (RPN) for various PFM. We conducted an FTA using this information to pinpoint the root causes of potential failures. Results The findings from the literature review and survey responses on the prospective study have identified several critical areas at risk of failure. These areas include non‐optimized treatment delivery, inadequate patient monitoring, and lack of safety training, leading to radiation contamination from the dose excreted by the patients after treatment administration. A segmented FTA was created based on the FMEA results, focusing on radiation contamination with a high RPN value. Conclusion By identifying the root causes of failures and proposing targeted improvements to the existing QM measures, this analysis enhances safety in treatment delivery of 177Lu $^{177}{\\rm Lu}$ ‐based RPTs. Given the limited number of prospective risk analysis studies in RPTs, our research addresses the necessity for more such studies and recommends methods to apply this study to other RPTs.

Purpose Topoisomerase II alpha (TOP2A) has been identified as a proliferation marker, of which the most common method for detection is immunohistochemistry (IHC). However, the optimal cut-off of TOP2A expression regarding prognostic value remains controversial. This study was to identify the optimal cut-off value of TOP2A expression and its correlation with clinicopathological variables and prognosis in early stage breast cancer in China. Methods Between January 2013 and January 2015, a total of 1084 early breast cancer patients were enrolled. The optimal cut-off of TOP2A expression was assessed using the minimum P value approach. Correlations between TOP2A expression and clinicopathological characteristics were explored by the Spearman’s correlation analysis, while the impact of TOP2A expression on disease-free survival (DFS) and overall survival (OS) was evaluated by the Kaplan–Meier methods. Univariate and multivariate Cox regression analyses were executed to identify statistically significant prognostic factors. Results The optimal cut-off value of TOP2A was recommended as 15%. Overall, 603 (55.6%) patients were TOP2A over-expression and 481 (44.4%) patients were TOP2A low expression. TOP2A over-expression was in positive associations with a higher Ki67 index ( r  = 0.83, P  < 0.001), HER2 positive ( r  = 0.26, P  < 0.001), a larger tumor size ( r  = 0.14, P < 0.001), and a higher histologic grade (r = 0.59, P  < 0.001), and in a significantly negative correlation with hormone receptor (HR) positive expression ( r  =  − 0.40, P < 0.001) in early breast cancer. TOP2A over-expression significantly associated with worse DFS ( P  = 0.001) and OS ( P  < 0.001) and was an independent prognostic factor for both DFS (hazard ratio [HR] = 2.04; 95% confidence interval [95% CI] 1.30–3.18, P  = 0.0018) and OS (HR = 3.54; 95%CI 1.53–8.23, P  = 0.003) in stage I-II breast cancer patients. Conclusion To our knowledge, this is the first study to recommend the optimal cut-off value of TOP2A expression in breast cancer. The TOP2A expression is significantly correlated with HER2 status, Ki67 index, tumor size, histologic grade and HR status, and could be a surrogate indicator for poor prognosis of early breast cancer.

Background: The necessity of a pre-therapeutic biopsy for soft tissue tumors is assessed differently depending on imaging. We examined the concordance of histopathological and radiological imaging-based diagnoses of soft tissue tumors in a monocentric, multidisciplinary sarcoma board. Methods: From October 2022 to December 2024, we prospectively included 184 patients presenting with preoperative imaging but without prior histology who are presented at the multidisciplinary sarcoma board of the University Hospital of Erlangen. We evaluated tumor dignity (benign/malignant) and most probable tumor subtype based on cross-sectional imaging assisted by the demographic and anatomic characteristics of individual cases. This assessment was then compared with the final pathological results. Results: We classified 75 tumors as benign and 109 tumors as malignant. Of the 75 patients with a suspected benign tumor, 66 (88%) had a benign diagnosis confirmed by pathological assessment, while two (2.7%) had a malignant tumor and seven (9.3%) an intermediate biology tumor. Of the 109 patients with suspected malignant tumors, 69 (63.3%) had a malignant pathology, while 30 (27.5%) had a benign pathology, and 10 (9.2%) an intermediate tumor. Matching the multidisciplinary sarcoma board’s assessment with the pathological results revealed significant sensitivity and a negative predictive value for malignant tumors, as well as a significant positive predictive value and specificity for benign tumors. Conclusions: The study shows that, despite the high degree of predictability at an experienced sarcoma center, imaging cannot completely replace biopsies and caution should be exercised when deciding against a biopsy. It is emphasized that the decision not to perform a biopsy can only be made in cases where lipomatous tumors appear benign in imaging procedures, and only in an experienced center.

Background and Objectives: Metabolic syndrome (MetS) progresses gradually as individual components accumulate. However, there is limited understanding regarding whether the sequence of component appearance influences disease progression. This study sought to determine the most frequent initial MetS component and evaluate whether this component influences the subsequent risk of developing full MetS. Materials and Methods: We examined data from 6137 participants in the Korean Genome and Epidemiology Study (KoGES), free of MetS at baseline (2001–2002), followed until 2011–2012. Participants were stratified by the first emerging MetS component: abdominal obesity, elevated blood pressure, high fasting glucose, high triglycerides, or low HDL cholesterol. The primary endpoint was progression to full MetS, defined as the development of three or more components. We also assessed transition probabilities between components and sex-specific sequence differences. Results: Abdominal obesity was the most frequent initial metabolic abnormality (31.0%), followed by elevated blood pressure (26.3%), low HDL cholesterol (15.3%), high triglycerides (13.7%), and high fasting glucose (4.9%). Over a median 8.2-year follow-up, participants with initial abdominal obesity exhibited the greatest progression rate to full MetS (44.4%), significantly higher than those with elevated blood pressure (24.8%), high triglycerides (23.0%), high fasting glucose (21.6%), or low HDL cholesterol (9.3%) (all p < 0.001). After controlling for age, sex, smoking status, and baseline BMI, initial abdominal obesity was associated with a 4.77-fold increased risk (95% CI: 3.68–6.18) of developing full MetS compared to initial low HDL cholesterol. Distinct transition patterns were observed: high triglycerides frequently transitioned to low HDL cholesterol (78.1%), while abdominal obesity most often led to elevated blood pressure (52.1%). Marked sex-related differences were also found: abdominal obesity was more common initially among women (41.7% vs. 25.2%), whereas elevated blood pressure was predominant among men (37.6% vs. 21.2%). Conclusions: The initial MetS component strongly predicts progression to full syndrome, with abdominal obesity conferring the highest risk. Early identification and targeted interventions addressing abdominal obesity may effectively prevent MetS and its subsequent complications.