Effect of Transcutaneous Electrical Nerve Stimulation Based on Wrist-Ankle Acupuncture Theory for Pain Relief during Non-Anesthetic Colonoscopy: A Randomized Controlled Trial.

BACKGROUND: Colonoscopy is essential for diagnosing colorectal diseases but can cause pain during the procedure. This study explores the analgesic effects of Transcutaneous Electrical Nerve Stimulation based on Wrist-Ankle Acupuncture theory (TENS-WAA) in non-anesthetic colonoscopy. METHODS: This prospective study included 120 participants undergoing non-anesthetic colonoscopies. The trial group receiving low-frequency, high-intensity TENS-WAA adjusted to the maximum tolerable current, while the control group received minimal current. Primary outcome was the retrospective pain VAS score. Secondary outcomes included time, heart rate, and credibility/expectancy questionnaire (CEQ) scores (ChiCTR2300076524). RESULTS: Participants who received TENS-WAA intervention reported significantly lower pain VAS scores than the control group (estimated median difference -1.1, 95% CI: -2 to -0.4, P=0.002). Male participants in the trial group experienced significantly lower pain scores than the control group (mean difference -1.4, 95% CI: -2.41 to -0.39, P=0.008). Additionally, the trial group also had significantly lower heart rates (P<0.001) and higher CEQ scores (P=0.001) than the control group. No adverse events were reported. CONCLUSION: TENS-WAA effectively reduces pain during non-anesthetized colonoscopy, especially in male participants, providing a promising non-invasive analgesic method.

The role of amino acid metabolism alterations in acute ischemic stroke: From mechanism to application.

Acute ischemic stroke (AIS) is the most prevalent type of stroke, and due to its high incidence, disability rate, and mortality rate, it imposes a significant burden on the health care system. Amino acids constitute one of the most crucial metabolic products within the human body, and alterations in their metabolic pathways have been identified in the microenvironment of AIS, thereby influencing the pathogenesis, severity, and prognosis of AIS. The amino acid metabolism characteristics in AIS are complex. On one hand, the dynamic progression of AIS continuously reshapes the amino acid metabolism pattern. Conversely, changes in the amino acid metabolism pattern also exert a double-edged effect on AIS. This interaction is bidirectional, dynamic, heterogeneous, and dose-specific. Therefore, the distinctive metabolic reprogramming features surrounding amino acids during the AIS process are systematically summarized in this paper, aiming to provide potential investigative strategies for the early diagnosis, treatment approaches, and prognostic enhancement of AIS.

Association between oxidative balance score and resistant hypertension and arterial stiffness among US adults: A population-based study.

BACKGROUND AND AIMS: Prior studies have established the correlation between oxidative balance score (OBS) and hypertension (HTN). While the association between OBS and resistant hypertension (RHT) as well as arterial stiffness among individuals with hypertension remains undisclosed. METHODS AND RESULTS: In this study, total of 15,910 adults diagnosed with hypertension were enrolled from NHANES 2001-2018. OBS was calculated and categorized into quartiles. Weighted regression model, stratified analyses and restricted cubic spline (RCS) were employed to evaluate the association between OBS and RHT, major adverse cardiovascular events (MACEs) and arterial stiffness in individuals with hypertension. Among enrolled participants, high OBS quartiles consistently demonstrated a negative association with resistant hypertension across all models (all p < 0.05), indicating robust stability. Compared with the lowest OBS quartile, the risk of resistant hypertension in the highest OBS quartile was decreased by 30.8% (95%CI 0.471-0.995, p = 0.049). After dividing OBS into dietary OBS and lifestyle OBS, a significant inverse association with lifestyle OBS and RHT was observed. With regard to MACEs, the inverse association was also found in participants with high OBS. Besides, the potential relation between OBS and arterial stiffness was explored and we found OBS was significantly associated with decreased arterial stiffness (ß for ePWV, -0.014; 95%CI -0.026 to -0.001; p = 0.032). RCS analysis confirmed a nonlinear association between OBS and RHT, MACEs, cardiovascular death and nonfatal MI among participants with hypertension. CONCLUSION: Elevated OBS was negatively associated with the risk of RHT and arterial stiffness among US adults with hypertension.

Identification of the Key Gene DfCCoAOMT1 through Comparative Analysis of Lignification in Dendrocalamus farinosus XK4 and ZPX Bamboo Shoots during Cold Storage.

Dendrocalamus farinosus bamboo shoots, a species with rich nutritional value, are important in Southwest China. Lignin is an important factor affecting the postharvest flavor quality of bamboo shoots; however, the underlying mechanism of lignin deposition in D. farinosus bamboo shoots during cold storage is still not fully understood. In this study, the mutant D. farinosus XK4 with low lignin content at 3.11% and the cultivated variety ZPX at 4.47% were used as experimental materials. The lignin content of D. farinosus XK4 and ZPX, as well as the gene expression differences between them, were compared and analyzed during cold storage using transcriptomic and physiological methods. Our analysis revealed several key genes and found that D. farinosus CCoAOMT1 plays a key role in the regulatory network of bamboo shoots during cold storage. Tobacco heterologous transformation experiments demonstrated that overexpression of DfCCoAOMT1 significantly increases lignin content. This study provides a novel foundation for future research aimed at improving the postharvest quality and flavor of D. farinosus bamboo shoots through targeted genetic manipulation during cold storage.

Genome-Wide Identification and Expression Analysis of Dendrocalamus farinosus CCoAOMT Gene Family and the Role of DfCCoAOMT14 Involved in Lignin Synthesis.

As the main component of plant cell walls, lignin can not only provide mechanical strength and physical defense for plants, but can also be an important indicator affecting the properties and quality of wood and bamboo. Dendrocalamus farinosus is an important economic bamboo species for both shoots and timber in southwest China, with the advantages of fast growth, high yield and slender fiber. Caffeoyl-coenzyme A-O-methyltransferase (CCoAOMT) is a key rate-limiting enzyme in the lignin biosynthesis pathway, but little is known about it in D. farinosus. Here, a total of 17 DfCCoAOMT genes were identified based on the D. farinosus whole genome. DfCCoAOMT1/14/15/16 were homologs of AtCCoAOMT1. DfCCoAOMT6/9/14/15/16 were highly expressed in stems of D. farinosus; this is consistent with the trend of lignin accumulation during bamboo shoot elongation, especially DfCCoAOMT14. The analysis of promoter cis-acting elements suggested that DfCCoAOMTs might be important for photosynthesis, ABA/MeJA responses, drought stress and lignin synthesis. We then confirmed that the expression levels of DfCCoAOMT2/5/6/8/9/14/15 were regulated by ABA/MeJA signaling. In addition, overexpression of DfCCoAOMT14 in transgenic plants significantly increased the lignin content, xylem thickness and drought resistance of plants. Our findings revealed that DfCCoAOMT14 can be a candidate gene that is involved in the drought response and lignin synthesis pathway in plants, which could contribute to the genetic improvement of many important traits in D. farinosus and other species.

Patient-specific 3D printed models for enhanced learning of immediate implant procedures and provisionalization.

INTRODUCTION: This study aimed to describe the fabrication, implementation and evaluation of 3D-printed patient-specific models for unskilled students to enhance learning in immediate implant procedures and provisionalization. MATERIALS AND METHODS: The individualized simulation models were designed and processed based on CT and digital intraoral scanning of a patient. Thirty students performed simulation implant surgery and provisionalized the implant sites on the models and answered questionnaires to assess their perceptions before and after the training. The scores of the questionnaires were analysed using the Wilcoxon signed-rank test. RESULTS: Significant differences before and after training were found in the students' responses. Students reported better results in understanding of surgical procedures, knowledge in prosthetically driven implantology, understanding of minimally invasive tooth extraction, confirming the accuracy of surgical template, usage of the guide rings and usage of the surgical cassette after simulation training. The overall expenditure on the simulation training involving 30 students amounted to 342.5 USD. CONCLUSIONS: The patient-specific and cost-efficient 3D printed models are helpful for students to improve theoretical knowledge and practical skills. Such individualized simulation models have promising application prospects.

Distinct Composition and Assembly Processes of Bacterial Communities in a River from the Arid Area: Ecotypes or Habitat Types?

The composition, function, and assembly mechanism of the bacterial community are the focus of microbial ecology. Unsupervised machine learning may be a better way to understand the characteristics of bacterial metacommunities compared to the empirical habitat types. In this study, the composition, potential function, and assembly mechanism of the bacterial community in the arid river were analysed. The Dirichlet multinomial mixture method recognised four ecotypes across the three habitats (biofilm, water, and sediment). The bacterial communities in water are more sensitive to human activities. Bacterial diversity and richness in water decreased as the intensity of human activities increased from the region of water II to water I. Significant differences in the composition and potential function profile of bacterial communities between water ecotypes were also observed, such as higher relative abundance in the taxonomic composition of Firmicutes and potential function of plastic degradation in water I than those in water II. Habitat filtering may play a more critical role in the assembly of bacterial communities in the river biofilm, while stochastic processes dominate the assembly process of bacterial communities in water and sediment. In water I, salinity and mean annual precipitation were the main drivers shaping the biogeography of taxonomic structure, while mean annual temperature, total organic carbon, and ammonium nitrogen were the main environmental factors influencing the taxonomic structure in water II. These results would provide conceptual frameworks about choosing habitat types or ecotypes for the research of microbial communities among different niches in the aquatic environment.

Heavy metal(loid)s shape the soil bacterial community and functional genes of desert grassland in a gold mining area in the semi-arid region.

Gold mining can create serious environmental problems, such as soil pollution by heavy metal (loid)s. In this study, we assessed the ecological risk of Hatu gold mining activities and synchronously investigated the bacterial community structure, distribution of soil nutrient-element cycling genes (CNPS) and heavy metal resistance genes (MRG) in adjacent desert grassland soil. The study area was above the moderate risk level, with the ecological risk index (RI) of each sampling site greater than 150. Arsenic, mercury and copper were the main pollutants. Proteobacteria, Actinobacteria and Firmicutes dominated the phyla of the bacterial communities. Species turnover rather than nestedness accounted for the significant differences in community structure among various regions in the mining area. In addition, the bioavailable heavy metal (loid)s (AHM) content had a strong correlation with beta diversity and species turnover of the bacterial community (p < 0.05). No clear difference was found in the total abundance of CNPS genes among various functional regions, but eight specific functional genes were identified from downwind grasslands with lower pollution levels. Among the MRGs, Hg MRG had the highest average total relative abundance, followed by Cu, Co/Zn/Cd and As. The mercury resistance gene subtype hgcAB was positively related to the diversity of the bacterial community, and the bacterial community of grassland soil showed congruency with the MRGs in the Hatu mining area. Total Hg (THg) showed the highest influence affecting the bacterial community, while NH4+-N had the greatest effect on CNPS genes and MRGs. These results highlighted the role of heavy metal (loid)s in shaping the bacterial community and functional genes in arid and semiarid desert grassland soil in gold mining regions.

Dumbbell in the atrium: A rare case report of biatrial myxoma that crosses atrial septum diagnosed by multimodal echocardiography.

We reported a very rare case, a 59-year-old female whose heart myxoma was present in both atrium, the mass in biatrial was connected to each other at the oval foramen, resembling "dumbbell-like." By means of multimodality echocardiography techniques such as transthoracic echocardiography (TTE), contrast enhanced ultrasound (CEUS), and Real-time three-dimensional transesophageal echocardiography (RT-3D TEE), we have clarified the diagnosis. The patient underwent open-heart surgery to remove the biatrial myxoma which adhered to the oval fossa, with a slightly wider base and smooth lobulated surface. This case demonstrates the importance of multimodality echocardiography in the diagnosis of atypical myxomas.

Metagenomic binning and assembled genome analysis revealed the distinct composition of resistome and mobilome in the Ili River.

Rivers play an important role in receiving and transporting the resistome among different environmental compartments. However, the difference in resistome and mobilome between the water and sediment and their underlying mechanisms were still poorly understood. In this study, the Ili River, an important water source in the arid area of Central Asia, was selected as the studied target. The comprehensive profile of resistome and mobilome and their host in water and sediment were studied based on metagenomic binning and assembled genome (MAG) analysis. The relative abundance of resistome and mobilome in sediment were 28.0 - 67.8 × /Gb and 46.5 - 121.1 × /Gb, respectively, which were significantly higher than those in water (23.1 - 52.8 ×/Gb and 25.3 - 67.7 ×/Gb). Multidrug and macrolides-lincosamides-streptogramin (MLS) resistance genes were the main ARG types in both water and sediment from relative abundance. Transposases dominated the relative abundance of mobilome, followed by insert elements and integrases. Strong correlations were found between the relative abundance of resistome and mobilome (r > 0.6 and p < 0.01) in both water and sediment, indicating the mobilome played an important role in the propagation of resistome in the Ili River. The main hosts for multidrug resistance genes via MAG analysis differed in water (Alphaproteobacteria and Gammaproteobacteria) and sediment (Gammaproteobacteria). Distinct compositions of resistome and mobilome existed between water and sediment in the Ili River. Specificity-occupancy analysis of the differential resistome and mobilome showed that occurrence frequencies and habitat selections of the differential ARGs shaped the resistome of water and sediment. In contrast, habitat was the main driver that shaped the mobilome in the Ili River.

Covalent Amide-Bonded Nanoflares for High-Fidelity Intracellular Sensing and Targeted Therapy: A Superstable Nanosystem Free of Nonspecific Interferences.

A nanoflare, a conjugate of Au nanoparticles (NPs) and fluorescent nucleic acids, is believed to be a powerful nanoplatform for diagnosis and therapy. However, it highly suffers from the nonspecific detachment of nucleic acids from the AuNP surface because of the poor stability of Au-S linkages, thereby leading to the false-positive signal and serious side effects. To address these challenges, we report the use of covalent amide linkage and functional Au@graphene (AuG) NP to fabricate a covalent conjugate system of DNA and AuG NP, label-rcDNA-AuG. Covalent coating of abundant amino groups (-NH2) onto the graphitic shell of AuG NP efficiently facilitates the coupling with carboxyl-labeled capture DNA sequences through simple, but strong, amide bonds. Importantly, such an amide-bonded nanoflare possesses excellent stability and anti-interference capability against the biological agents (nuclease, DNA, glutathione (GSH), etc.). By accurately monitoring the intracellular miR-21 levels, this covalent nanoflare is able to identify the positive cancer cells even in a mix of cancer and normal cells. Moreover, it allows for efficient photodynamic therapy of the targeted cancer cells with minimized side effects on normal cells. This work provides a facile approach to develop a superstable nanosystem showing promising potential in clinical diagnostics and therapy.

Fungal transformation of selenium and tellurium located in a volcanogenic sulfide deposit.

Microbial reduction of soluble selenium (Se) or tellurium (Te) species results in immobilization as elemental forms and this process has been employed in soil bioremediation. However, little is known of direct and indirect fungal interactions with Se-/Te-bearing ores. In this research, the ability of Phoma glomerata to effect transformation of selenite and tellurite was investigated including interaction with Se and Te present in sulfide ores from the Kisgruva Proterozoic volcanogenic deposit. Phoma glomerata could precipitate elemental Se and Te as nanoparticles, intracellularly and extracellularly, when grown with selenite or tellurite. The nanoparticles possessed various surface capping molecules, with formation being influenced by extracellular polymeric substances. The presence of sulfide ore also affected the production of exopolysaccharide and protein. Although differences were undetectable in gross Se and Te ore levels before and after fungal interaction using X-ray fluorescence, laser ablation inductively coupled plasma mass spectrometry of polished flat ore surfaces revealed that P. glomerata could effect changes in Se/Te distribution and concentration indicating Se/Te enrichment in the biomass. These findings provide further understanding of fungal roles in metalloid transformations and are relevant to the geomicrobiology of environmental metalloid cycling as well as informing applied approaches for Se and Te immobilization, biorecovery or bioremediation.

Shell-Switchable SERS Blocking Strategy for Reliable Signal-On SERS Sensing in Living Cells: Detecting an External Target without Affecting the Internal Raman Molecule.

For SERS analysis in living cells, the inevitable desorption of Raman molecule on the substrate surface is a key challenge. To ensure high stability, SERS systems with Raman molecules protected inside the core-Raman molecule-shell (C-M-S) structures have been designed, but at the expense of sacrificed sensing performances. Here a shell-switchable SERS blocking strategy is developed for the reliable SERS analysis in living cells, relying on the shell blockers to regulate the SERS sensing signal without affecting the internal Raman molecules. After several C-M-S structures were investigated, the SERS blocking mechanism confirmed that thick shells (Au, Ag, ZnO, and MnO2) can cause a significant reduction in the internal SERS signal by obstructing the penetration of the laser or signal. The CAu-Mpy-SAu-SMnO2 nanoprobe is designed for the ratiometric SERS sensing in living cells, which retains sensing performances even though the Raman molecule is protected inside the nanostructure. This SERS strategy makes the turn-on sensing achievable in living cells with the MnO2 shell as a signal switch and a Raman reference. Additionally, it allows for accurate monitoring of the degradation of MnO2 carriers in living cells, even without fluorescent labels.

Sleep quality and military training injury during basic combat training: a prospective cohort study of Chinese male recruits.

OBJECTIVE: To examine the association between sleep quality and military training injury (MTI) in recruits during basic combat training (BCT). METHODS: Participants were new recruits undergoing 12-week military BCT in China. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI) . Participants were classified into two groups based on their sleep quality (group 1, good sleep, PSQI score <7; group 2, poor sleep, PSQI score ≥7) at the start of BCT. Logistic regression analysis was conducted to test whether baseline PSQI score was associated with MTI incidence during BCT. RESULTS: A total of 563 participants were included. The incidence of MTI was significantly lower in group 1 (48/203, 23.6%) than in group 2 (150/360, 41.7%) (p<0.001). Logistic regression analysis showed that the odds of MTI were 2.307 times higher in group 2 than in group 1 without adjusting for confounders: OR=2.307, p<0.001. When the model was adjusted for age, ethnicity, educational level and family income (OR=2.285) or for the previous confounders plus body mass index (OR=2.377), the results were similar (both p<0.001). Analysis of the types of initial MTI showed that group 2 had about 2.1 times higher odds of soft tissue injury than group 1 (p<0.001 in all the three models). CONCLUSION: Sleep quality before BCT influences the incidence of MTI, especially of soft tissue injury.

Influence of metals and metalloids on the composition and fluorescence quenching of the extracellular polymeric substances produced by the polymorphic fungus Aureobasidium pullulans.

Aureobasidium pullulans is a ubiquitous and widely distributed fungus in the environment, and exhibits substantial tolerance against toxic metals. However, the interactions between metals and metalloids with the copious extracellular polymeric substances (EPS) produced by A. pullulans and possible relationships to tolerance are not well understood. In this study, it was found that mercury (Hg) and selenium (Se), as selenite, not only significantly inhibited growth of A. pullulans but also affected the composition of produced EPS. Lead (Pb) showed little influence on EPS yield or composition. The interactions of EPS from A. pullulans with the tested metals and metalloids depended on the specific element and their concentration. Fluorescence intensity measurements of the EPS showed that the presence of metal(loid)s stimulated the production of extracellular tryptophan-like and aromatic protein-like substances. Examination of fluorescence quenching and calculation of binding constants revealed that the fluorescence quenching process for Hg; arsenic (As), as arsenite; and Pb to EPS were mainly governed by static quenching which resulted in the formation of a stable non-fluorescent complexes between the EPS and metal(loid)s. Se showed no significant interaction with the EPS according to fluorescence quenching. These results provide further understanding of the interactions between metals and metalloids and EPS produced by fungi and their contribution to metal(loid) tolerance. KEY POINTS: • Metal(loid)s enhanced production of tryptophan- and aromatic protein-like substances. • Non-fluorescent complexes formed between the EPS and tested metal(loid)s. • EPS complexation and binding of metal(loid)s was dependent on the tested element. • Metal(loid)-induced changes in EPS composition contributed to metal(loid) tolerance.

Biorecovery of cobalt and nickel using biomass-free culture supernatants from Aspergillus niger.

In this research, the capabilities of culture supernatants generated by the oxalate-producing fungus Aspergillus niger for the bioprecipitation and biorecovery of cobalt and nickel were investigated, as was the influence of extracellular polymeric substances (EPS) on these processes. The removal of cobalt from solution was >90% for all tested Co concentrations: maximal nickel recovery was >80%. Energy-dispersive X-ray analysis (EDXA) and X-ray diffraction (XRD) confirmed the formation of cobalt and nickel oxalate. In a mixture of cobalt and nickel, cobalt oxalate appeared to predominate precipitation and was dependent on the mixture ratios of the two metals. The presence of EPS together with oxalate in solution decreased the recovery of nickel but did not influence the recovery of cobalt. Concentrations of extracellular protein showed a significant decrease after precipitation while no significant difference was found for extracellular polysaccharide concentrations before and after oxalate precipitation. These results showed that extracellular protein rather than extracellular polysaccharide played a more important role in influencing the biorecovery of metal oxalates from solution. Excitation-emission matrix (EEM) fluorescence spectroscopy showed that aromatic protein-like and hydrophobic acid-like substances from the EPS complexed with cobalt but did not for nickel. The humic acid-like substances from the EPS showed a higher affinity for cobalt than for nickel.

Exercise training and dietary restriction affect PINK1/Parkin and Bnip3/Nix-mediated cardiac mitophagy in mice.

The aim of this study was to investigate the effects of exercise training and dietary restriction on cardiac PINK1/Parkin and Bnip3/Nix pathways involved in mitophagy. C57BL/6 mice were assigned to control (C), exercise training (T), dietary restriction (D) and exercise training + dietary restriction (TD) groups. T group undertook 10 weeks of swimming training. D group was subjected to 40% food reduction. TD group undertook the combination of exercise training and food reduction. Suspectable mitophagy autophagosomes can be observed in T and D groups and more autophagosomes appeared in TD group. In T group, both PINK1 mRNA and protein levels increased significantly (p < 0.01) but Bnip3 and Nix expressions decreased significantly (p < 0.05). Dietary restriction resulted in elevation of Drp1 (p < 0.01) and reduction and Nix (p < 0.05) in D group. The load in TD group resulted in serious mitochondrial abnormalities and myofibrillar damages accompanied by increases in PINK1 and Drp1 levels (p < 0.01) and decreases in Bnip3 and Nix levels (p < 0.05). The increase in PINK1 expression (exercise protocol) or Drp1 expression (diet protocol) contributes to cardiac activation of mitophagy, whereas Bnip3 and Nix are not implicated in this activation.

Uranium Bioreduction and Biomineralization.

Following the development of nuclear science and technology, uranium contamination has been an ever increasing concern worldwide because of its potential for migration from the waste repositories and long-term contaminated environments. Physical and chemical techniques for uranium pollution are expensive and challenging. An alternative to these technologies is microbially mediated uranium bioremediation in contaminated water and soil environments due to its reduced cost and environmental friendliness. To date, four basic mechanisms of uranium bioremediation-uranium bioreduction, biosorption, biomineralization, and bioaccumulation-have been established, of which uranium bioreduction and biomineralization have been studied extensively. The objective of this review is to provide an understanding of recent developments in these two fields in relation to relevant microorganisms, mechanisms, influential factors, and obstacles.

Cyclopentenone derivatives and polyhydroxylated steroids from the soft coral Sinularia acuta.

Four new polyhydroxylated steroids, 1-4, and the racemic form of cyclopentenone 9, together with four known steroids, 5-8, one known cyclopentenone derivative, 10, and one known butenolide derivative, 11, were isolated from the soft coral Sinularia acuta collected from Weizhou Island of Guangxi Province, P. R. China. Their structures were elucidated on the basis of spectroscopic analyses and by comparison of the corresponding data with those previously reported. The cytotoxicities of the isolates 1-11 in vitro against the selected tumor cell lines HL-60, HeLa, and K562 were evaluated. Compounds 2 and 5 showed potent cytotoxicities against HL-60 cell lines with IC50 values of 7.3 and 9.9 µM, respectively. Compounds 5 and 6 showed moderate activities against K562 cell lines with IC50 values of 10.9 and 11.7 µM, respectively, while compounds 1, 2, and 6 showed weak activities against HeLa cell lines with respective IC50 values of 44.8, 27.1, and 18.2 µM. This is the first report on chemical and bioactivity research of S. acuta.

Navigating the innovation policy dilemma: How subnational governments balance expenditure competition pressures and long-term innovation goals.

In the pursuit of economic growth, the role of innovation has become increasingly important, posing dilemmas for subnational governments as they navigate the balance between expenditure competition and long-term investments in innovation. This study aimed to investigate the intricate relationship between fiscal pressures and the pursuit of innovation goals faced by regional authorities. To achieve this, a systematic literature review was conducted, synthesizing more than 150 studies published within the past 15 years. Keyword searches were conducted across multiple databases, and additional scholarly articles were incorporated through citation tracking. Rigorous qualitative analysis techniques, including inductive coding and thematic analysis, were employed to distill conceptual insights from the literature. The analysis performed in this review reveals extensive discussions regarding the influence of competition on innovation outcomes, encompassing a wide range of perspectives. The potential advantages of localization are emphasized by some viewpoints, while others caution against the risks of inadequate investment. The effective coordination of policies across multiple levels of governance to maximize synergies between national and subnational innovation systems emerges as a complex yet crucial challenge. It is observed that collaborative networks, which facilitate knowledge exchange through industrial clustering and public-private linkages, play a significant role in leveraging regional innovation assets. Strategic approaches that successfully balance competition with long-term capacity development have been demonstrated by leading jurisdictions. These findings highlight the significance of tailored policy frameworks that account for the unique contexts of each region, providing opportunities to harness competitive motivations while sustaining investments in innovation. Ongoing coordination is essential to strike a balance between responsiveness and coherence across diverse territories. This study offers practical guidance and academic insights on strategies to align decentralized imperatives, aiming to optimize prosperity through knowledge creation within evolving multi-level innovation systems. By shedding light on these strategies, the research contributes to both practical and academic understandings of how to effectively navigate and capitalize on the dynamics of such systems.