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  • India conflict fires up Pakistan’s Independence Day fervor, boosts flag sales

    India conflict fires up Pakistan’s Independence Day fervor, boosts flag sales

    Pakistan to cut auto tariffs over 5 years, eyes car exports after tractors and motorcycles


    ISLAMABAD: Pakistan will gradually cut tariffs on the auto sector over the next five years and work on a strategy to expand exports, Commerce Minister Jam Kamal Khan told industry representatives on Wednesday, as the government seeks to strengthen the local market and boost overseas sales.


    Khan met auto industry stakeholders in Islamabad and announced the formation of a committee, comprising officials from the Commerce Ministry, the Federal Board of Revenue and the Ministry of Industries, to address sector challenges. The minister invited the industry to participate in the upcoming industrial policy and said healthy competition was increasing in Pakistan’s auto market.


    “After tractors and motorcycles, we will now also export cars,” Khan said, adding that the government would prepare “a strategy for the development and exports of the auto sector” and that tariffs “will be gradually reduced over the next five years.”


    Khan said imported used cars should meet quality and environment-friendly standards and linked new export prospects to a recently signed US tariff reduction agreement. Under the deal, Washington has cut import duties on Pakistani goods to 19 percent, a move the government says will improve competitiveness for products including automobiles. 


    “The tariff reduction agreement with the US has created new opportunities for auto exports,” the minister said.


    Industry representatives told the meeting that new technologies had increased production costs, and urged protection for local manufacturers from the import of used vehicles.


    Pakistan’s automobile industry is one of the fastest-growing sectors, contributing around 7 percent of Large Scale Manufacturing (LSM) and accounting for 7–16 percent of the manufacturing GDP depending on the metric used. It employs millions, and local assembly is dominated by established players like Honda, Toyota, Suzuki, Hyundai, Kia, and newcomers such as MG and Haval.


    The market includes motorcycles, tractors, cars, and commercial vehicles, but remains highly concentrated among a few brands.


    The fiscal year 2025–26 budget introduced several changes impacting the auto industry. A new Green Tax was applied to internal combustion engine vehicles, ranging from 1 percent to 3 percent of vehicle value depending on engine size and origin .


    The industry also flagged an imbalance in GST rates — 8.5 percent on hybrid electric vehicles versus 18 percent on fully electric vehicles — raising concerns over a policy disconnect with the Automotive Industry Development and Export Policy (AIDEP) 2021–2026 provisions.


    Experts warn that high taxes, policy uncertainty, and weak industrial support were curbing demand. Recent vehicle sales dropped 49 percent month-on‑month in July 2025, partly due to pre-budget rushes and subsequent tax adjustments  .


    The sector also faces structural challenges including limited localization of parts, high production costs, and fragile capacity utilization (around 24 percent). Policy instability, particularly regarding tariff reductions and fiscal incentives, risks discouraging investment, and experts say long-term industrial support is necessary to prevent local manufacturing decline.


    Inflation, currency volatility, and macroeconomic uncertainty further weigh on consumer demand and financing.

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  • Myrkur Games Releases Iceland-Inspired ‘Echoes of the End’ – Iceland Review

    1. Myrkur Games Releases Iceland-Inspired ‘Echoes of the End’  Iceland Review
    2. Echoes of the End reviews highlight strong puzzles, visuals and some technical issues  The Express Tribune
    3. Echoes of the End – Official Launch Trailer  MSN
    4. Echoes of the End Review  Gamereactor UK
    5. Echoes of the End review — Vestige of hope  GamingTrend

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  • UNRWA Commissioner-General on Gaza: No one should stay silent when children die – ReliefWeb

    1. UNRWA Commissioner-General on Gaza: No one should stay silent when children die  ReliefWeb
    2. UNRWA says loss of education risks creating ‘lost generation’ in Gaza  Dawn
    3. ‘My studies, my life’: War leaves Gaza students hungry and out of school  Al Jazeera
    4. Gaza students trade lofty dreams for bare-knuckle fight to find food | Daily Sabah  Daily Sabah
    5. Race against starvation  The News International

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  • Oligoclonal Bands as Predictors of Disease Severity and Prognosis in A

    Oligoclonal Bands as Predictors of Disease Severity and Prognosis in A

    Introduction

    Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, caused by GluN1 subunit-targeting antibodies, ranks among the most prevalent forms of autoimmune encephalitides.1 Anti-NMDAR encephalitis is characterized by multiple clinical manifestations, including seizure, cognitive impairment, psychiatric symptoms, movement disorders, autonomic dysfunction, and disturbance of consciousness.2 Intrathecal oligoclonal bands (OCBs) synthesis is identified by the presence of immunoglobulin bands in cerebrospinal fluid (CSF) without corresponding detection in paired serum samples,3–5 a process driven by clonally expanded B-cell populations in the central nervous system (CNS).6 The OCBs testing offers significant advantages as it can be conducted even with a suspected anti-NMDAR encephalitis diagnosis. Approximately 50–70% of individuals suffering from anti-NMDAR encephalitis exhibit positive OCBs.7–9 The positive OCBs indicate an immune response within the CNS. The ongoing intrathecal humoral immune response may be related to the severity and prognosis of anti-NMDAR encephalitis. Currently, there is limited research on the role of OCBs in anti-NMDAR encephalitis, and their clinical significance in anti-NMDAR encephalitis remains poorly understood.

    Previous studies have demonstrated that OCB-positive status may correlate with disease activity levels and serve as a prognostic factor in certain neurological disorders. For example, in autoimmune encephalitis, OCB-positive patients have been shown to exhibit significantly worse clinical outcomes than OCB-negative patients.10 Similarly, in multiple sclerosis (MS), OCB positivity occurs more frequently in progressive disease phenotypes, suggesting a possible association between OCBs and the severity of MS.11 In myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), patients with OCB positivity exhibit significantly higher relapse rates, highlighting the potential prognostic utility of OCBs in neuroinflammatory disorders.12 However, despite these findings, evidence on the role of OCBs in anti-NMDAR encephalitis remains limited and inconclusive. Prior investigations were constrained by the inclusion of relatively small sample sizes and heterogeneous cohorts comprising different types of autoimmune encephalitis, which complicates the interpretation of results. Consequently, the clinical significance of OCBs in anti-NMDAR encephalitis, particularly their potential impact on disease severity and clinical outcomes, remains unclear and requires further investigation in well-defined, larger patient cohorts.

    This research aimed to explore the impacts of OCBs regarding clinical features, disease severity, as well as prognosis in anti-NMDAR encephalitis by systematically comparing OCB-positive and OCB-negative patients. Additionally, this study sought to identify biomarkers that could facilitate risk stratification, guide personalized treatment strategies, and improve prognostic prediction in anti-NMDAR encephalitis.

    Materials and Methods

    Study Design and Participants

    This retrospective cohort study enrolled a total of 136 patients diagnosed with anti-NMDAR encephalitis at the First Affiliated Hospital of Guangxi Medical University between June 2017 and January 2024. After a thorough screening process, 9 patients were excluded due to incomplete medical records. Additionally, 4 patients were excluded because they had other diseases that could affect their neurological status, thereby confounding the study results. Furthermore, 38 patients were excluded as they did not undergo OCBs testing, which was essential for the analysis, as shown in Figure 1. To assess selection bias, baseline characteristics were compared between the OCBs-tested (n=85) and untested groups (n=38). No significant differences were observed in demographics, clinical manifestations, complications, immunotherapy regimens, laboratory findings, or short-term outcomes (all P>0.05; see Supplementary Table S1).

    Figure 1 Flow chart of study patients.

    Abbreviation: NMDAR, N-methyl-D-aspartate receptor.

    Ultimately, the study enrolled 85 patients, all of whom met the 2016 diagnostic criteria for autoimmune encephalitides, including typical medical symptoms and detection of anti-NMDAR antibodies within CSF. To assess the possible influence of OCBs on disease advancement, patients were categorized into OCB-positive (n=47) and OCB-negative (n=38) groups.

    This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2025-E0217). Written informed consent was obtained from all participants or their legal guardians. Patients data were fully anonymized and used solely for scientific analysis in strict compliance with the ethical principles of the Declaration of Helsinki.

    Data Collection

    Our study systematically collected essential clinical data from medical records, encompassing demographic data (such as age and gender), clinical features (including memory deterioration, cognitive impairment, speech dysfunction, mental behavior disorders, epileptic seizure, movement disorders, autonomic nervous dysfunction, and disturbance of consciousness), and comorbidities (such as urinary tract infection and pulmonary infection). Additionally, data included hospital stays, intensive care unit (ICU) admission, laboratory findings (including CSF and peripheral blood analyses), magnetic resonance imaging (MRI) results, and details of immunotherapy. The severity and prognosis of the disease were assessed using standardized tools, including the modified Rankin Scale (mRS) and Clinical Assessment Scale for Autoimmune Encephalitis (CASE), ensuring an objective evaluation of patient condition. To ensure comprehensive follow-up, all patients were monitored for at least 12 months post-discharge. For OCB analysis, CSF samples were collected at the time of the patient’s first admission for anti-NMDAR encephalitis. OCB detection was performed via isoelectric focusing followed by immunoblotting. Positivity was strictly defined as the presence of one or more discrete immunoglobulin bands in the CSF that were absent in the corresponding serum sample. Qualitative results (positive/negative) were used for analysis. This thorough data collection and analysis framework allowed for a detailed comparison of OCB-positive and OCB-negative populations, aiming to elucidate OCBs’ role in anti-NMDAR encephalitis.

    Statistical Analysis

    Statistical analysis was performed using IBM SPSS 27.0, and figures were created using GraphPad Prism 10. Continuous variables were described as mean±standard deviation (SD) for data that followed a normal distribution, or as the median with interquartile range (IQR) for data that followed a non-normal distribution. Categorical data were described as counts (percentages) [n (%)]. For comparisons, categorical variables were analyzed using the chi-square test. As for continuous variables, the independent t-test was utilized for normally distributed data, while the Mann–Whitney U-test was used for non-normally distributed data. Candidate variables with P<0.05 in univariate analyses were included in the multivariable regression analysis, which was then used to identify the prognostic factors for anti-NMDAR encephalitis. Additionally, the predictive performance of prognostic factors was evaluated using receiver operating characteristic (ROC) curve analysis. A P-value<0.05 was considered statistically significant.

    Results

    Clinical Features of Research Participants

    In this research, 47 (55.3%) patients were classified as OCB-positive, and 38 (44.7%) as OCB-negative. The demographics and clinical traits of both groups were analyzed, as presented in Table 1.

    Table 1 Demographic Details and Clinical Features of Anti-NMDAR Encephalitis Between OCB-Positive and OCB-Negative Groups

    Notable disparities were identified between OCB-positive and OCB-negative patients, such as disturbance of consciousness, movement disorders, ICU admission, and the time to second-line immunotherapy initiation. Specifically, OCB-positive patients demonstrated a markedly increased probability of experiencing disturbance of consciousness compared with OCB-negative patients (61.7% vs 23.7%, P<0.001). Similarly, a higher incidence of movement disorders was observed among the OCB-positive patients (78.7% vs 50.0%, P=0.005). Additionally, ICU admissions were markedly elevated in OCB-positive individuals (36.2% vs 10.5%, P=0.006), indicating greater disease severity in this group. Furthermore, the median time to second-line immunotherapy initiation was shorter in OCB-positive patients at 24 days (IQR: 17.0, 35.0) compared to 32.5 days (IQR: 24.5, 62.5) in OCB-negative patients (P=0.032), suggesting a more aggressive disease course requiring earlier escalation of treatment in the OCB-positive cohort.

    Figure 2A illustrates the classification of seizure severity in OCB-positive and OCB-negative patients. OCB-positive patients exhibited a significantly higher prevalence of severe seizure type, including drug-resistant epilepsy and status epilepticus, compared to OCB-negative individuals (P=0.011).

    Figure 2 Comparison of the percentage of the severity of seizures (A) and distribution of consciousness (B) between OCB-positive and OCB-negative groups. *p < 0.05.

    Abbreviations: OCB+, positive oligoclonal bands; OCB−, negative oligoclonal bands.

    Figure 2B showed significant differences in the phenotypic disturbance of consciousness between the two groups, including somnolence, stupor, and coma. Notably, compared to OCB-negative individuals, OCB-positive patients exhibited a significantly higher prevalence of disturbance of consciousness, particularly coma (P=0.022).

    No significant distinctions were identified in gender, age, prodromal symptoms, memory deterioration, cognitive impairment, speech dysfunction, mental behavior disorder, autonomic nervous dysfunction, urinary tract infection, pulmonary infection, hospital stays, tumor presence, relapse, or time to first line immunotherapy between two groups (P>0.05).

    Auxiliary Examination Results

    The abnormal MRI, CSF findings, peripheral blood findings and NMDAR antibody titer of both groups were analyzed, as illustrated in Table 2.

    Table 2 Auxiliary Examination Results of Anti-NMDAR Encephalitis Between OCB-Positive and OCB-Negative Groups

    OCB-positive patients demonstrated an increased prevalence of abnormal MRI findings compared to the OCB-negative group (55.3% vs 31.6%, P=0.029). Regarding CSF findings, the median CSF protein levels increase in the OCB-positive group (349.6 mg/L; IQR: 264.9, 497.7), whereas the OCB-negative group was lower (242.6 mg/L; IQR: 196.2, 403.4) (P=0.022). Regarding peripheral blood findings, the OCB-positive group showed a higher median neutrophil percentage (77.9%; IQR: 66.9, 83.9) than the OCB-negative group (66.5%; IQR: 54.5, 76.2) (P=0.004). Conversely, the median lymphocyte percentage was lower in the OCB-positive group (14.6%; IQR: 11.0, 22.6) than in the OCB-negative group (22.7%; IQR: 14.4, 32.9) (P=0.004).

    The analysis revealed no notable variations in QAlb, CSF cell count, CSF albumin, CSF LDH, CSF NMDAR antibody titers, serum NMDAR antibody titers, serum IgG, or serum albumin when comparing the two groups (P>0.05).

    Comparison of Disease Severity and Prognosis Between OCB-Positive and OCB-Negative Groups

    The mRS and CASE scores were used to evaluate disease severity and prognosis in both groups.

    In terms of mRS scores, at admission, OCB-positive patients showed notably elevated median mRS scores (4; IQR: 3, 5) relative to OCB-negative patients (3; IQR: 2, 3), with statistical significance (P<0.001). This trend persisted at discharge, where the OCB-positive patients’ median mRS score (3; IQR: 2, 4) still surpassed that of the OCB-negative patients (2; IQR: 1, 2) (P<0.001). At 12 months post-discharge, the OCB-positive patients maintained a higher median mRS score (1; IQR: 0, 1) than the OCB-negative patients (0; IQR: 0, 1) (P=0.006). Remarkably, during the last follow-up, the OCB-positive patients continued to exhibit elevated median mRS scores (0; IQR: 0, 1) relative to the OCB-negative patients (0; IQR: 0, 0) (P=0.021), as shown in Figure 3A.

    Figure 3 Comparison of mRS (A) and CASE (B) scores between OCB-negative and OCB-positive patients with anti-NMDAR encephalitis at admission, discharge, 12 months post-discharge, and last follow-up. *p < 0.05, **p < 0.01, and ***p < 0.001.

    Abbreviations: mRS, modified Rankin Scale; CASE, Clinical Assessment Scale for Autoimmune Encephalitis; OCB+, positive oligoclonal bands; OCB−, negative oligoclonal bands.

    In terms of CASE scores, at admission, OCB-positive patients showed notably elevated median CASE scores (10; IQR: 6, 15) relative to OCB-negative patients (4.5; IQR: 3, 7) (P<0.001). This trend continued at discharge, with the OCB-positive group having higher scores (5; IQR: 3, 10) than the OCB-negative group (2; IQR: 1, 3) (P<0.001). At 12 months post-discharge, OCB-positive patients still had higher median CASE scores (1; IQR: 0, 1) relative to the OCB-negative patients (0; IQR: 0, 1) (P=0.002). At the last follow-up, the OCB-positive patients continued to show elevated median CASE scores (0; IQR: 0, 1) than the OCB-negative patients (0; IQR: 0, 0) (P=0.03), as shown in Figure 3B.

    Comparison of Clinical Characteristics in Anti-NMDAR Encephalitis Patients with Different Short-Term Prognosis

    Based on the mRS scores at discharge, the 85 patients were stratified into mild-moderate (mRS<3; n=45) and severe (mRS≥3; n=40) groups. Table 3 compares the clinical manifestations of the two groups.

    Table 3 Comparison of Clinical Data in Anti-NMDAR Encephalitis with Different Levels of Severity Upon Discharge

    The results revealed statistically significant differences between the two groups in age, disturbance of consciousness, movement disorders, pulmonary infection, urinary tract infection, OCBs, CSF protein levels, neutrophil percentage, and lymphocyte percentage (P<0.05).

    A significantly increased median age was observed in the severe group (22; IQR: 15, 43) compared to the mild-moderate group (17; IQR: 14, 26) (P=0.037). The severe group demonstrated a higher prevalence of disturbance of consciousness (80.0% vs 13.3%, P<0.001), movement disorders (85.0% vs 48.9%, P<0.001), pulmonary infection (70.0% vs 33.3%, P<0.001), and urinary tract infection (20.0% vs 2.2%, P=0.008) than those in the mild-moderate group. Additionally, compared to the mild-moderate group, the severe group exhibited a higher prevalence of oligoclonal bands (77.5% vs 35.6%, P<0.001). Regarding CSF findings, the median protein level was notably elevated in the severe group (342.9 mg/L; IQR: 262.9, 474.1) compared to the mild-moderate group (244.2 mg/L; IQR: 196.2, 449.2) (P=0.034). In terms of peripheral blood findings, the severe group showed a higher median neutrophil percentage (77.7%; IQR: 66.1, 86.0) than the mild-moderate group (68.9%; IQR: 58.4, 78.7) (P=0.021). Conversely, the median lymphocyte percentage was lower in the severe group (14.4%; IQR: 10.5, 24.1) in contrast to the mild-moderate group (20.0%; IQR: 13.9, 32.4) (P=0.017).

    No substantial differences were evident in gender, prodromal symptoms, memory deterioration, cognitive impairment, speech dysfunction, mental behavior disorder, epileptic seizure, autonomic nervous dysfunction, tumor, relapse, abnormal MRI, QAlb, CSF cell count, CSF albumin, CSF LDH, serum IgG, serum albumin, or immunotherapy between the two groups (P>0.05).

    Prognostic Factors for Short-Term Outcomes in Anti-NMDAR Encephalitis Patients

    In the univariate analysis, factors showing statistical significance (P<0.05) were subsequently subjected to multivariable regression analysis to identify prognostic factors of poor short-term outcomes in anti-NMDAR encephalitis. Notably, OCBs (OR: 3.741, 95% CI: 1.026–13.637; P=0.046) and disturbance of consciousness (OR: 11.481, 95% CI: 2.633–50.057; P=0.001) were regarded as prognostic factors of poor short-term outcomes, as shown in Table 4.

    Table 4 Multivariable Regression Analysis: Predictors of Anti-NMDAR Encephalitis Patients’ Short-Term Prognosis

    The predictive value of OCBs and disturbances of consciousness for short-term outcomes in anti-NMDAR encephalitis was evaluated through ROC curves, with the area under the curve (AUC) being 0.873 (95% CI: 0.792–0.954), as illustrated in Figure 4, indicating strong predictive accuracy for these factors.

    Figure 4 Receiver operating characteristic (ROC) curve for predicting the value of oligoclonal bands and disturbances of consciousness in evaluating the prognosis of anti-NMDAR encephalitis.

    Abbreviation: AUC, area under the curve.

    Discussion

    Anti-NMDAR encephalitis is the most prevalent among autoimmune encephalitides, which are potentially life-threatening.13,14 Early evaluation of disease status and prognosis, combined with timely therapeutic interventions, can help minimize disability and enhance outcomes.15,16 Nevertheless, specific prognostic biomarkers to measure disease severity and predict outcomes in anti-NMDAR encephalitis are still lacking.17 OCBs are regarded as markers of chronic immune activation within the CNS and are commonly detected in some chronic inflammatory diseases.18,19 Notably, the presence of OCBs has been reported as a prognostic indicator in several neurological disorders, including autoimmune encephalitis, MS, and radiologically isolated syndrome (RIS).10,20–22 These findings indicate that OCBs may contribute to the pathogenesis and progression of anti-NMDAR encephalitis, offering potential as an indicator for evaluating disease severity and forecasting clinical outcomes.

    Positive OCBs have been reported in 50–70% among anti-NMDAR encephalitis patients.7–9,23 In this research, 47 (55.3%) patients exhibited positive OCBs, aligning with prior research findings. Our investigation demonstrated a significant correlation between OCBs and CSF protein levels, with OCB-positive patients showing markedly higher CSF protein concentrations compared to their OCB-negative counterparts. This observation can be attributed to the fact that the presence of OCBs is linked to increased blood-brain barrier (BBB) permeability,24 which may lead to elevated CSF protein levels.25 In anti-NMDAR encephalitis, NMDA receptor activation mediates the disruption of BBB permeability through the Rho/ROCK signaling pathway.26 The detection of OCBs in the CSF is mainly due to this enhanced BBB permeability,24 which facilitates the transudation of plasma proteins into the CSF compartment. Moreover, our research revealed that OCB-positive patients exhibited elevated neutrophil percentage and a lower lymphocyte percentage in peripheral blood compared to OCB-negative patients, likely reflecting a more heightened neuroinflammatory state in the OCB-positive group. Prior research has demonstrated that the severity of anti-NMDAR encephalitis correlates positively with neutrophil counts and negatively with lymphocyte counts.27 These results indicate that OCBs may act as an indicator of neuroinflammation and BBB disruption, potentially clarifying their link to poorer clinical outcomes in anti-NMDAR encephalitis. Together, these results underscore the involvement of OCBs in the pathophysiology of the disease, linking immune dysregulation, BBB impairment, and disease severity.

    Furthermore, our study indicated that OCB-positive patients displayed a more common incidence of abnormal MRI findings than OCB-negative patients. This observation aligns with findings in other neuroinflammatory conditions, such as MS, one research found that OCB positivity has been linked to increased cortical lesions and intrathecal inflammation.28 Another study showed that among MS patients, OCB positivity was linked to the number of periventricular lesions.29 The presence of OCBs may indicate a chronic inflammatory state in the CSF,30,31 potentially contributing to an increased incidence of cortical lesions and more severe clinical manifestations in OCB-positive groups. These findings are consistent with our observations that OCB-positive patients showed a greater tendency to display severe clinical manifestations in anti-NMDAR encephalitis, including severe seizure type, disturbance of consciousness, and movement disorders. Our results align with prior research indicating that OCB positivity is associated with more severe clinical features in autoimmune encephalitis.10,20 Prior studies have shown that OCBs detected at disease onset in anti-NMDAR encephalitis patients are connected to a more severe disease course, resulting in ICU admission, severe seizure type, and worse clinical outcomes.32 Our results further underscore this connection, revealing that OCB-positive patients had an elevated risk of ICU admission. In addition to this observed association with severe seizure types, the implications of refractory epilepsy are particularly important. Studies report that a subset of anti-NMDAR encephalitis patients develop seizures poorly responsive to first-line immunotherapy or antiepileptic drugs, often necessitating second-line immunotherapies or prolonged ICU support,33,34 these patients frequently experience prolonged disease courses, delayed recovery, and greater long-term disability. Collectively, these observations imply that the presence of OCBs may assist in recognizing individuals at increased risk of severe disease manifestations, including refractory epilepsy, thereby underscoring the potential role of OCBs in informing early clinical decisions and interventions aimed at mitigating poor outcomes.

    A significant finding is that anti-NMDAR encephalitis patients with positive OCBs showed increased disease severity and worse outcomes, demonstrated by elevated mRS and CASE scores at admission, discharge, 12 months post-discharge, and last follow-up assessments. These findings highlight that OCB-positive patients consistently demonstrated more severe initial symptoms, slower recovery, and poorer functional outcomes compared to their OCB-negative counterparts. This analysis reveals that OCB positivity is related to heightened inflammatory responses and greater central nervous system involvement, which contribute to poorer clinical outcomes.

    In this research, the OCB-positive patients exhibited a significantly higher mRS score at discharge than OCB-negative patients (P<0.001). To further investigate predictors of short-term prognosis in anti-NMDAR encephalitis, we performed multivariable regression analysis. Based on disease severity, patients were stratified into two groups: a mild-moderate group (mRS<3) and a severe group (mRS≥3).

    The results of our multivariable regression analysis indicated that the presence of OCBs and disturbance of consciousness were independent risk factors for unfavorable prognosis in anti-NMDAR encephalitis patients. ROC analysis demonstrated that the AUC values for OCBs and disturbance of consciousness in predicting prognosis were 0.873, indicating its good reference value. These results suggest that OCBs and disturbances of consciousness were identified as potential indicators of poor prognosis, highlighting their potential clinical utility in risk stratification and guiding treatment decisions for anti-NMDAR encephalitis patients. Previous researches have demonstrated that the presence of OCBs may be related to increased disease severity and worse outcomes in some neurological disorders. For instance, in autoimmune encephalitis, OCB positivity was markedly related to a reduced likelihood of achieving good clinical outcomes relative to those who were OCB-negative.10 In patients with MOGAD, those who were OCB-positive faced a greater risk of relapse, especially within the first year.35 In individuals with MS, the presence of OCBs in the CSF was correlated with a higher risk of poor prognosis.36–38 OCBs indicate a sustained intrathecal humoral immune response, reflect clonal B-cell expansion within the CNS.39 Thus, the presence of OCBs in anti-NMDAR encephalitis may arise from sustained and prolonged antigen exposure within the CNS, driving a persistent immunological response. This ongoing immune activation exacerbates neuroinflammation, leading to increased BBB permeability, neuronal injury, and cortical dysfunction, ultimately contributing to more severe neurological deficits. Consequently, in anti-NMDAR encephalitis, OCBs could serve as an early biomarker of disease severity, aiding clinicians in identifying patients who may require more intensive therapeutic interventions and closer monitoring.

    Limitations

    There are certain limitations that need to be addressed in our study. Firstly, the retrospective design employed may introduce selection bias. Therefore, further validation of the findings through larger-scale prospective cohort studies is necessary. Secondly, the underlying mechanism linking OCBs to the severity of anti-NMDAR encephalitis remains unclear, requiring future research to clarify it.

    Conclusion

    In conclusion, our results suggest that the detection of OCBs in CSF is linked to more severe clinical symptoms, a more aggressive disease progression, and poorer prognostic outcomes in anti-NMDAR encephalitis patients. OCB-positive patients showed an increased likelihood of severe symptoms, ICU admission, and worse functional outcomes. These findings highlight the potential value of OCBs as a biomarker for assessing disease severity and predicting prognosis in anti-NMDAR encephalitis.

    Acknowledgments

    The authors would like to thank the participants and their families.

    Funding

    This study was supported by the National Natural Science Foundation of China (82060236, 82460254) and the Natural Science Foundation of Guangxi Province (CN) (2023GXNSFAA026247).

    Disclosure

    The authors report no conflicts of interest in this work.

    References

    1. Michalski K, Abdulla T, Kleeman S, et al. Structural and functional mechanisms of anti-NMDAR autoimmune encephalitis. Nat Struct Mol Biol. 2024;31(12):1–12. doi:10.1038/s41594-024-01386-4

    2. Josep D, Francesc G. Antibody-mediated encephalitis. New Engl J Med. 2018;378(9):840–851. doi:10.1056/NEJMra1708712

    3. Zeman A, McLean B, Keir G, Luxton R, Sharief M, Thompson E. The significance of serum oligoclonal bands in neurological diseases. J Neurol Neurosurg. 1993;56(1):32–35. doi:10.1136/jnnp.56.1.32

    4. Willis MD, Kreft KL, Dancey B. Oligoclonal bands. Pract Neurol. 2024;24:400–406. doi:10.1136/pn-2023-003814

    5. Jorge C, María DLMBM. Oligoclonal bands and antibody responses in multiple sclerosis. J Neurol. 2002;249(4):375–389. doi:10.1007/s004150200026

    6. Cabrera CM. Oligoclonal bands: an immunological and clinical approach. Adv Clin Chem. 2022;109:129–163.

    7. Marc D, Gunnar N, Wolfram SK, et al. CSF findings in acute NMDAR and LGI1 antibody–associated autoimmune encephalitis. Neurology. 2021;8(6):e1086.

    8. Blinder T, Lewerenz J. Cerebrospinal fluid findings in patients with autoimmune encephalitis—a systematic analysis. Front Neurol. 2019;10:804. doi:10.3389/fneur.2019.00804

    9. Tobias Z, Romana H, Isabella W, Thomas B, Paulus R, Stefan M. Longitudinal CSF findings in autoimmune encephalitis—a monocentric cohort study. Front Immunol. 2021;12:646940. doi:10.3389/fimmu.2021.646940

    10. Xue H, Guo X, Jiang Y, et al. Comparing clinical features, severity and prognosis of autoimmune encephalitis and with and without oligoclonal bands. Front Neurol. 2024;14:1281276. doi:10.3389/fneur.2023.1281276

    11. Sara C, Diana F, Sergio F, Chiara B, Sara M. Oligoclonal bands: clinical utility and interpretation cues. Crit Rev Clin Lab Sci. 2022;59(6):11–14.

    12. Yuji T, Yasunobu H, Ryota K, Davide C, Kazumasa Y, Nobutaka H. Comparing clinical and imaging features of patients with MOG antibody-positivity and with and without oligoclonal bands. Front Immunol. 2023;14:1211776. doi:10.3389/fimmu.2023.1211776

    13. Restrepo-Martínez M, Espinola-Nadurille M, López-Hernández JC, et al. Neuropsychiatric aspects of anti-NMDA receptor encephalitis. Rev Alerg Mex. 2021;68(4):251–263. doi:10.29262/ram.v68i4.953

    14. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10(1):63–74. doi:10.1016/S1474-4422(10)70253-2

    15. Margherita N, Michael E, Erika M, et al. Use and safety of immunotherapeutic management of N-Methyl-d-Aspartate receptor antibody encephalitis: a meta-analysis. JAMA Neurol. 2021;78(11):1333–1344.

    16. Titulaer MJ, McCracken L, Gabilondo I, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12(2):157–165. doi:10.1016/S1474-4422(12)70310-1

    17. Dalmau J, Armangué T, Planagumà J, et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol. 2019;18(11):1045–1057. doi:10.1016/S1474-4422(19)30244-3

    18. Deisenhammer F, Zetterberg H, Fitzner B, Zettl UK. The cerebrospinal fluid in multiple sclerosis. Front Immunol. 2019;10:726. doi:10.3389/fimmu.2019.00726

    19. Freedman MS, Thompson EJ, Deisenhammer F, et al. Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis: a consensus statement. Arch Neurol. 2005;62(6):865–870. doi:10.1001/archneur.62.6.865

    20. Rozenberg A, Shelly S, Dembinsky AV, et al. Cognitive impairments in autoimmune encephalitis: the role of autoimmune antibodies and oligoclonal bands. Front Immunol. 2024;15:1405337. doi:10.3389/fimmu.2024.1405337

    21. Rojas JI, Tizio S, Patrucco L, Cristiano E. Oligoclonal bands in multiple sclerosis patients: worse prognosis? Neurological Res. 2012;34(9):889–892. doi:10.1179/1743132812Y.0000000088

    22. Matute-Blanch C, Villar LM, Álvarez-Cermeño JC, et al. Neurofilament light chain and oligoclonal bands are prognostic biomarkers in radiologically isolated syndrome. Brain. 2018;141(4):1085–1093. doi:10.1093/brain/awy021

    23. Qiao S, Li H, Cui C, et al. CSF findings in Chinese patients with NMDAR, LGI1 and GABABR antibody-associated encephalitis. J Inflamm Res. 2024;17:1765–1776. doi:10.2147/JIR.S383161

    24. JinLing W, Lei L, YanBing Z, PeiChang W. The interpretation of mirror pattern bands during oligoclonal immunoglobulin isoelectric focusing electrophoresis: a retrospective study. Lab Med. 2022;54(4):380–387.

    25. Caroline L, Elisa P, David J, et al. Fluid proteomics of CSF and serum reveal important neuroinflammatory proteins in blood–brain barrier disruption and outcome prediction following severe traumatic brain injury: a prospective, observational study. Critical Care. 2021;25(1):103. doi:10.1186/s13054-021-03503-x

    26. Yachun Y, Yu W, Junxiang W, et al. NMDA mediates disruption of blood-brain barrier permeability via Rho/ROCK signaling pathway. Neurochem Int. 2022;154(prepublish):105278. doi:10.1016/j.neuint.2022.105278

    27. Huang X-X, Zhang S, Yan -L-L, Tang Y, Wu J. Influential factors and predictors of anti-N-methyl-D-aspartate receptor encephalitis associated with severity at admission. Neurol Sci. 2021;42:1–7.

    28. Gabriele F, Roberta M, Marco P, et al. Increased cortical lesion load and intrathecal inflammation is associated with oligoclonal bands in multiple sclerosis patients: a combined CSF and MRI study. J Neuroinflammation. 2017;14(1):40. doi:10.1186/s12974-017-0812-y

    29. Akaishi T, Takahashi T, Nakashima I. Oligoclonal bands and periventricular lesions in multiple sclerosis will not increase blood-brain barrier permeability. J Neurol Sci. 2018;387:129–133. doi:10.1016/j.jns.2018.02.020

    30. Haiqiang J, Qianshuo L, Feng G, Hongjun H. Application of oligoclonal bands and other cerebrospinal fluid variables in multiple sclerosis and other neuroimmunological diseases: a narrative review. Ann Transl Med. 2023;11(7):282. doi:10.21037/atm-21-3073

    31. Xiang Z, Hongjun H, Tao J, et al. Cerebrospinal fluid oligoclonal bands in Chinese patients with multiple sclerosis: the prevalence and its association with clinical features. Front Immunol. 2023;14:1280020. doi:10.3389/fimmu.2023.1280020

    32. Bin HS, YongWon S, Jangsup M, WooJin L, Kon C, Kun LS. Initial cerebrospinal fluid-restricted oligoclonal bands associate with anti-N-methyl-D-aspartate receptor encephalitis severity: a pilot study. Encephalitis. 2021;1(1):7–13.

    33. Uchida Y, Kato D, Adachi K, et al. Passively acquired thyroid autoantibodies from intravenous immunoglobulin in autoimmune encephalitis: two case reports. J Neurol Sci. 2017;383:116–117. doi:10.1016/j.jns.2017.11.002

    34. Uchida Y, Kato D, Toyoda T, et al. Combination of ketogenic diet and stiripentol for super-refractory status epilepticus: a case report. J Neurol Sci. 2017;373:35–37. doi:10.1016/j.jns.2016.12.020

    35. Ramdani R, Pique J, Deschamps R, et al. Evaluation of the predictive value of CSF-restricted oligoclonal bands on residual disability and risk of relapse in adult patients with MOGAD: MOGADOC study. Mult Scler. 2025;31:13524585241311435.

    36. Noon GB, Vigiser I, Shiner T, Kolb H, Karni A, Regev K. Reinforcing the evidence of oligoclonal bands as a prognostic factor in patients with Multiple sclerosis. Mult Scler Relat Disord. 2021;56:103220. doi:10.1016/j.msard.2021.103220

    37. Gasperi C, Salmen A, Antony G, et al. Association of intrathecal immunoglobulin G synthesis with disability worsening in multiple sclerosis. JAMA Neurol. 2019;76(7):841–849. doi:10.1001/jamaneurol.2019.0905

    38. Mar T, Àlex R, Jordi R, et al. Defining high, medium and low impact prognostic factors for developing multiple sclerosis. Brain. 2015;138(Pt 7):1863–1874. doi:10.1093/brain/awv105

    39. Cheryl B, Timothy V, Michael G, Xiaoli Y. The complex relationship between oligoclonal bands, lymphocytes in the cerebrospinal fluid, and immunoglobulin G antibodies in multiple sclerosis: indication of serum contribution. PLoS One. 2017;12(10):e0186842. doi:10.1371/journal.pone.0186842

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  • An ethical guide to last-chance tourism

    An ethical guide to last-chance tourism

    In recent years, a growing number of tourists have started seeking similar experiences as they journey to see landmarks, landscapes and even entire destinations that may soon disappear forever because of climate change. Known as last-chance tourism, this “see-it-before-it’s-gone” practice is controversial. Research indicates that the amount of fuel it takes to travel to these far-flung destinations could accelerate their very decline. But advocates say that, done responsibly, it can also inspire travellers to protect the very places they came to see. 

    Increasing tourism demand to places that are rapidly submerging, melting or diminishing often exceeds the destination’s capacity – and Iceland is a prime example. Since Duroux’s first visit, half a million tourists now descend on the 400,000-person nation every year for glacier tours. Research at six glacier sites in Europe found that roughly half of visitors were driven by the desire to see the ice before it melted. While tourism at these places doesn’t necessarily lead to preservation, a tourist’s attachment to that place can help lead the way towards meaningful change.

    Robin Kundis Craig, a professor at the University of Kansas School of Law, studies the legal challenges of ecological preservation. As more people travel to see disappearing coral reefs, glaciers and archipelagos, she warns that without education and careful limits, “millions of people are trampling over an already fragile landscape that’s trying to cope with climate change”, as has happened in parts of Yosemite National Park. 

    The negative impacts of visitors travelling en masse to fragile ecosystems are well documented. As the seas warm and gas-powered boats bring more people to the Great Barrier Reef, the massive ecosystem recently experienced its worst coral bleaching on record. Coral reefs in Indonesia and Hawaii have also been damaged by tourists, and seafloors can take years to recover from the anchors of expedition boats. Venice has been sinking under the weight of overtourism for a decade. And as more tourists now venture to Antarctica every year, they have introduced invasive species and the avian flu, which devastated local seal populations.

    Alamy The Great Barrier Reef recently experienced its worst coral bleaching on record (Credit: Alamy)Alamy

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  • ‘Crowning Glory’: An intimate look at Black hair

    ‘Crowning Glory’: An intimate look at Black hair

    For many Black women, the relationship with their hair is complicated.

    It can be a source of joy, frustration, creativity and power. It can even foster community.

    Curator Myca Williamson explores all of this and more in her exhibition Crowning Glory: An Ode to Black Hair. It’s currently on view at the South Dallas Cultural Center.

    So, this is a multimedia show. Can you tell us a little bit about what we’ll see when we visit Crowning Glory?

    Yes, so the exhibit features photography, it features poetry, and it also features a film. I collaborated with two of my really good friends, photographer Hakeem Adewumi and videographer Nitashia Johnson.

    The photography really is this visual display of our Black hair moments, and our memories and our rituals… just some of those really relatable memories and moments.

    And then the poetry really is kind of my protest and my expression of some of my different hair experiences.

    …The film is also where I just wanted to bring in voices from my community.

    The exhibition has several what we call “texture shots” or close-ups that highlight the subject’s hair texture. What role does texture play in this story?

    So, I’m going through, like, my own hair struggle right now. I got some really bad hair color, and so I’m trying to grow my hair out and so it’s been frizzy, it’s breaking off…

    So, the conversation around texture, is there at the forefront without really being talked about. Because as Black women, I feel like we go through many different phases of our hair. And sometimes those phases are on purpose, right? Like, we do a big chop or we color it… But sometimes they aren’t on purpose. Like, we had a bad hair experience or we’re dealing with some health issues…

    Across those different moments in our life, our hair texture might change. And that also requires our relationship… our feelings and the emotions that we have around our hair also change too.

    I think that conversation is kind of woven throughout the entire exhibit that we’re all experiencing different types and textures of our hair. And that’s okay. That’s part of the journey.

    So, your exhibition not only features your hair story, but those of other women and girls… There’s also an interactive component. Why do you think it was important to collect other women’s hair stories?

    There is a part in the project that’s called “Dear, Crown.” And “Dear, Crown” is an invitation for you to write a letter to your younger self about really what it means to accept your hair.

    I thought that was important because throughout the exhibit over the last couple of weeks…[I’ve seen] the visceral and, like, emotional response to the film and to the photos and to poems. They see themselves in it. They’re like, “oh, this is my story too.” I didn’t just want them to feel that or have that moment. I wanted them to be able to express that. And the goal is that the project will be a living and breathing body of work.

    In putting together Crowning Glory, what did you learn about hair and hair culture?

    What I learned about hair, and I guess about our hair, particularly, is that it isn’t just hair. Our hair represents so much. For me especially, it represents the resilience of my ancestors. It represents the creativity of my people, as a whole.

    I also learned throughout this process — not even just about hair, but about creative expression and art in general– is that there are not a lot of art spaces that invite our stories, or that welcome us as a people to experience elevated storytelling. The amount of gratitude that I have gotten — people just expressing thanks for creating the space for us to go and see ourselves and see our hair in such a beautiful way — lets me know that there’s not enough of that.

    What do you want people to learn about Black hair when they come to view Crowning Glory?

    For Black women, I want them to feel seen, and celebrated and empowered by this exhibit. And I hope that they take something away from it that they can pass on to another woman to help her see and celebrate herself.

    And then on the flip side, I think for folks outside of our community, I really do hope that they become more curious, become more educated… have a new level of respect for our culture.

    Of course [this show] was for us, but the other purpose of this was to invite others into the conversation, so that we’re not always having to explain ourselves, right? Or we’re not always having to educate others. Like you come and do the work and when you do the work it’s not always messy or uncomfortable. Like, sometimes it’s artistic.

    “Crowning Glory: an Ode to Black Hair” is on view at the South Dallas Cultural Center through August 16th.


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  • China’s moon lander passes key test photo of the day for Aug. 13, 2025

    China’s moon lander passes key test photo of the day for Aug. 13, 2025

    Recently, China conducted a critical test of its new lunar lander, Lanyue (“Embracing the Moon”), running the vehicle through a landing on and takeoff from a simulated lunar surface.

    What is it?

    Lanyue is China’s first crewed lunar landing vehicle, purpose-built to ferry astronauts between lunar orbit and the moon’s surface.

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  • Sea star killer unmasked. Next step recovery. – Anthropocene Magazine

    1. Sea star killer unmasked. Next step recovery.  Anthropocene Magazine
    2. Mystery of billions of sea-star deaths solved at last  nature.com
    3. How scientists solved one of the greatest ocean mysteries  The Independent
    4. Mystery of why sea stars keep turning into goo finally solved — and it’s not what scientists thought  Live Science
    5. Bacteria that’s melting starfish alive has finally been identified  Earth.com

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  • Mycoplasma pneumoniae Infections After COVID Restrictions

    Mycoplasma pneumoniae Infections After COVID Restrictions

    TOPLINE:

    Post-COVID Mycoplasma pneumoniae infections in children were associated with increased frequencies of obstructive diseases and pleural effusions but no change in severe outcomes vs the pre-COVID period.

    METHODOLOGY:

    • Researchers conducted a retrospective, comparative cohort study in Zurich to assess evolving features of M pneumoniae infections in children since its delayed re-emergence after COVID non-pharmaceutical interventions (NPIs).
    • The study included 321 children (age range, 0 to < 18 years) with polymerase chain reaction (PCR)-detected M pneumoniae infection: 83 were included in the pre-NPI period (April 2015 to March 2020), two in the NPI period (April 2020 to March 2022), and 236 in the post-NPI period (April 2022 to March 2025).
    • Clinical features were compared between periods using the Kruskal-Wallis rank sum or Fisher’s exact test; hospitalisation and ICU admission rates were analysed using generalised linear models adjusted for age, sex, and underlying diseases, with patients stratified by NPI period.
    • Primary outcomes focused on comparing changes in clinical features and disease severity between the pre- and post-NPI periods; secondary outcomes included rates of hospitalisation and ICU admission.

    TAKEAWAY:

    • Patients included in the post-NPI period were older (median age, 9.05 vs 8.20 years; P = .30) and presented with significantly more chest pain (8.9% vs 2.4%; P = .05) and pleural effusions (45.7% vs 28.9%; P = .02) than those in the pre-NPI period.
    • The frequency of obstructive diseases was higher post-NPI than pre-NPI (18.6% vs 9.6%; P = .059), whereas extrapulmonary manifestations (18.6% vs 30.1%; P = .043), particularly dermatologic (15.7% vs 25.3%) and neurologic (1.3% vs 4.8%) manifestations, were less frequent post-NPI than pre-NPI.
    • Although hospitalisation rates were similar post-NPI and pre-NPI (38.6% vs 43.9%), generalised linear models showed a trend towards fewer hospitalisations post-NPI (odds ratio [OR], 0.72; 95% CI, 0.42-1.23; P = .22); a similar trend was seen for ICU admissions (5.1% vs 4.9%; OR, 0.90; 95% CI, 0.29-3.34; P = .86).
    • Disease severity remained unchanged, with no deaths and comparable rates of long-term sequelae (6.3% post-NPI vs 6.0% pre-NPI; P = 1.00).

    IN PRACTICE:

    “Concerns about a more severe disease course of re-emerging infections were not confirmed. However, the observed changes in the clinical characteristics of M pneumoniae infections highlight the need for continuous monitoring of these clinical phenotypes,” the authors of the study wrote.

    SOURCE:

    This study was led by Elena Robinson, Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, University of Zurich in Zurich, Switzerland. It was published online on August 07, 2025, in European Journal of Pediatrics.

    LIMITATIONS:

    The study was restricted to a single Swiss centre, which may have limited its generalisability. Although the targeted testing strategy remained consistent throughout, the shift from singleplex to multiplex PCR testing after October 2020 could have affected co-detection rates.

    DISCLOSURES:

    The study was supported by open access funding provided by the University of Zurich. The authors declared no competing interests.

    This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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  • EV drivers set to pay road user charges as record number of electric cars selling in Australia | Electric vehicles

    EV drivers set to pay road user charges as record number of electric cars selling in Australia | Electric vehicles

    Labor is set to overhaul road user charging rules to cover electric vehicles, with Anthony Albanese all but confirming the long-delayed reform will be thrashed out at next week’s productivity roundtable in Canberra.

    As data from the Australian Automobile Association showed EVs accounted for nearly one in 10 new car sales in the June quarter – a new record – the prime minister said the new rules would be worked through in this term of parliament.

    In recent years the federal budget has been affected by declining fuel excise revenue – collected via petrol prices at a rate of 51.6 cents per litre – as drivers shift to battery-powered vehicles.

    But a 2023 high court ruling delayed progress on taxing drivers after it found the Victorian government’s attempt to impose a tax on EVs was unconstitutional – because only the federal government had the power to impose excise taxes on consumption.

    Since then, state and federal treasurers have discussed ways to tax EV drivers and maintain budget revenue.

    After the treasurer, Jim Chalmers, signalled road user charging was likely to be considered earlier this week, Albanese said on Wednesday a solution to the growing problem was needed.

    He said Labor had sought to be constructive when the Morrison government considered introducing new charges, plans which fell through before Labor came to power in 2022.

    “What I believe is that we need money to ensure that roads are adequate and that is a long held belief,” Albanese said.

    “What we need to do is to work those issues through and to come up with a realistic plan that can be implemented. And we’ll await those discussions.”

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    The AAA’s quarterly EV Index showed Australians bought 29,244 new battery electric vehicles in the June quarter – up 63% from the nearly 18,000 registered in the previous three months.

    Chalmers said Labor had flagged plans for new EV rules before the 3 May election, working in concert with the states and territories.

    “We haven’t settled on a model or on timing when it comes to that change,” he said.

    “Clearly a government of either political persuasion will need to make changes there because the excise take on petrol will come down as petrol vehicles exit the fleet and as EVs take up a bigger and bigger proportion in the decades ahead.

    Polestar Australia’s managing director, Scott Maynard, said the summit should instead commission a review of the whole transport ecosystem, ensuring it is fit for purpose.

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    The Chinese-backed Swedish carmaker has sold about 1,400 vehicles in Australia in 2025.

    “Motorists are already paying stamp duty, registration, fuel excise, luxury car tax, fringe benefits tax, and tolls,” Maynard told Guardian Australia.

    “You’re going to place this on top, and that doesn’t make sense.

    “We would call for a road user charge to be part of a broader review of the current fees and taxes paid by Australian motorists to reconcile that and set it out more sensibly.”

    The Productivity Commission has previously called for action on road user charging, saying road infrastructure around the country should be funded through user charges reflecting “the efficient cost of providing and maintaining that infrastructure”.

    “By giving drivers a clear signal about the cost of infrastructure, they would have an incentive to use it more efficiently,” the commission said.

    “Moreover, there will be a signal to infrastructure providers where changes in road capacity are warranted.”

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