Search Results (8,585)

Two-dimensional antimonene has recently emerged as a promising electrocatalytic platform; however, its oxygen reduction reaction (ORR) activity and modulation strategies remain largely unexplored. Herein, density functional theory (DFT) calculations are employed to systematically investigate ORR catalysis on antimonene co-doped with transition metal (TM) and nonmetal (C, P) dual atoms. The results reveal that Pd@C–Sb, Pt@C–Sb, and Pd@P–Sb exhibit remarkably enhanced ORR activity, delivering low overpotentials of 0.31 V, 0.32 V, and 0.38 V, respectively, significantly outperforming their single-atom-doped counterparts. Mechanistic analyses demonstrate that nonmetal dopants induce strong synergistic interactions with TM centers, leading to charge redistribution and effective regulation of the TM d-band center, which optimizes the adsorption energetics of key ORR intermediates. Notably, the number of d-electrons of TM atoms is identified as a reliable electronic descriptor governing intermediate binding strength and catalytic activity. Furthermore, ab initio molecular dynamics simulations confirm the excellent thermodynamic stability of the optimized dual-atom catalysts. This work elucidates the atomic-scale origin of synergistic enhancement in dual-atom-doped antimonene and provides a rational design strategy for high-performance ORR electrocatalysts based on two-dimensional main-group materials. Full article

Background: Adolescent obesity and depressive symptoms have increased concurrently, often presenting as co-occurrence. However, evidence on the timing of physical activity (e.g., weekday vs. weekend) and adherence to planetary health diets remains limited. This study examined these associations among adolescents in Zhejiang Province from 2022 to 2024. Methods: A total of 261,495 adolescents aged 11–18 years were included. Physical activity (PA) and dietary behaviors were assessed through the China Common Disease and Risk Factor Surveillance among Students questionnaire (reliability: Cronbach’s α = 0.84, validity: RMSEA = 0.07). The plant-based Planetary Health Diet Index (PHDI-green) adherence was defined as consuming at least one daily serving of both vegetables and fruits. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CES-D) scale, and co-occurrence was defined as the coexistence of obesity and depressive symptoms. Temporal trends were tested using χ² tests. Sex-stratified logistic regression, restricted cubic spline analyses, and population attributable fraction (PAF) analyses were applied. Results: From 2022 to 2024, obesity (p for trend = 0.013) and depressive symptoms (p for trend = 0.003) increased significantly, while co-occurrence remained stable (p for trend = 0.058). Boys had higher obesity and co-occurrence, whereas girls showed higher depressive symptoms (all p < 0.001). Higher weekly PA, greater weekend PA and PHDI-green adherence were associated with reduced odds of obesity in both sexes (all p < 0.001). Weekend PA showed stronger associations with depressive symptoms among girls, while PHDI-green showed stronger inverse associations in boys (p for sex difference < 0.001). PAF analyses suggested that low weekend PA accounted for substantial proportions of cases (girls: obesity 10.17%, depressive symptoms 31.30%, co-occurrence 35.64%). Joint adherence to adequate PA and PHDI-green conferred the lowest odds of co-occurrence (boys: OR = 0.40, 95% CI: 0.34–0.46; girls: OR = 0.33, 95% CI: 0.26–0.43). Conclusions: Adherence to the Planetary Health Diet may be particularly relevant for boys, whereas PA—especially weekend PA—may be more strongly associated with health outcomes among girls. These findings suggest the importance of sex-specific and time-targeted behavioral strategies for obesity, depressive symptoms, and their co-occurrence in adolescents. Full article

Background: Pancreatic adenocarcinoma (PAAD) is a highly malignant cancer posing severe clinical challenges. Although the dual role of pyroptosis in tumor progression is increasingly recognized, the prognostic value of its molecular heterogeneity in PAAD remains underexplored. Methods: We integrated multi-omics data and applied interpretable machine learning to construct a predictive framework centered on pyroptosis heterogeneity. Using non-negative matrix factorization (NMF) on pyroptosis-related genes (PRGs), patients were classified into distinct molecular subtypes. Evaluating 117 machine learning combinations, we employed random survival forest (RSF) to build the final model, followed by comprehensive internal and external validation. SHapley Additive exPlanations (SHAP) analysis provided global and local interpretability. Clinical potential was assessed via nomogram, drug sensitivity prediction, single-cell analysis, and immunohistochemical validation. Results: We identified two biologically distinct pyroptosis subtypes and developed a ten-gene pyroptosis subtype-associated gene signature (PSAGS). PSAGS demonstrated robust performance across training, test, and multiple external validation cohorts, outperforming most published models. Multivariate analysis confirmed its independent prognostic value, and a PSAGS-based nomogram exhibited clinical utility. PSAGS-stratified subgroups showed differential responses to immunotherapy, chemotherapy, and targeted agents. Single-cell analysis revealed cell type-specific links between PSAGS scores and pyroptosis activity, indicating that high-PSAGS malignant cells foster an immunosuppressive microenvironment through extracellular matrix (ECM)-mediated signaling. Protein-level validation confirmed upregulation of signature genes in PAAD tissues. Conclusions: This work presents a biologically reliable prognostic model for personalized PAAD management and elucidates how pyroptosis heterogeneity drives tumor progression through cellular interactions. Full article

Arsenic contamination, mainly in the arsenate (As(V)) form, continues to pose a serious threat to groundwater quality worldwide due to its long-term stability and toxicity at very low levels. Herein, we demonstrate, for the first time, a three-dimensional graphene oxide-based nanocomposite composed of Cu nanoparticle-doped, amino-functionalized UiO-66 (Cu/UiO-66-NH₂) anchored on a graphene oxide framework (Cu/UiO-66-NH₂@GO) as a novel and efficient nanosorbent for the rapid removal of As(V) in groundwater-like solutions. The nanocomposite was characterized by SEM and HRTEM to confirm the hybrid structure and by XRD, N₂ adsorption–desorption isotherms, and XPS to investigate crystallinity, porosity, and surface chemistry. The derived material exhibited a highly dispersed morphology and performed rapid arsenate solid-phase extraction to attain equilibration within 10 min and was effective for a wide pH range of 2–11. The best fit for the kinetic profiles was provided by the pseudo-second-order model. Interestingly, the maximum adsorption capacity of 747.9 mg g⁻¹ at pH 6.8 was achieved, demonstrating the benefits of the complementary pairing of dispersive GO sheets and Zr-MOF adsorption domains with Cu-derived active sites. Mechanistically, the enhanced uptake is ascribed to a combination of effects, including electrostatic pre-concentration, ligand exchange, and inner-sphere complexation at metal-oxo nodes; spectroscopic analysis (XPS and FTIR) suggests that the majority of arsenate is immobilized via a strong Zr-O-As bond at coordinatively unsaturated Zr centers, which is in line with t-ZrO₂-like surface domains formed within the nanocomposite. The embedded GO support inhibits further framework interpenetration and enhances active site availability and mass transport, leading to fast and high-capacity arsenate capture in groundwater samples with related conditions. Taken together, this work presents a powerful design concept that integrates unique GO-supported, Cu-modified UiO-66-NH₂ with Zr-O binding motifs to afford high-rate remediation nanocomposites, providing an excellent platform for next-generation arsenate remediation materials. Full article

Well-defined, small-molecule, platinum-centered coordination compounds are of continued interest in both basic and applied research, particularly in medicinal chemistry and pharmaceuticals (i.e., cisplatin). Organoplatinum(IV) complexes have been reported to exhibit substantial in vitro cytotoxicity across a range of cancer cell lines. Compared with coordinatively unsaturated platinum(II) species, electronically and coordinatively saturated platinum(IV) complexes are generally more inert, reducing undesirable side reactions in plasma and cellular environments and potentially improving their safety profiles as chemotherapeutic agents. In addition, the presence of organic ligands can enhance lipophilicity, facilitating passive diffusion across cell membranes. Here, we report the synthesis, structural characterization, and in vitro anticancer activity of a series of organoplatinum(IV) complexes of the general formula Pt(CH₃)₂I₂{n,n′-dimethyl-2,2′-bipyridine} (n,n′ = 4,4′; 5,5′; 6,6′). The 5,5′- and 6,6′-dimethyl isomers were characterized by single-crystal X-ray diffraction. All three dimethyl-substituted complexes, along with the parent compound, Pt(CH₃)₂I₂{2,2′-bipyridine}, were evaluated for cytotoxic activity against a panel of 60 human cancer cell lines. Whereas Pt(CH₃)₂I₂{2,2′-bipyridine} and the 4,4′- and 5,5′-dimethyl derivatives displayed limited cytotoxicity, the 6,6′-dimethyl isomer exhibited notable activity, particularly against the colon cancer cell line HCT-116 (LC₅₀ = 8.17 μM) and the ovarian cancer cell line OVCAR-3 (LC₅₀ = 7.34 μM). The enhanced cytotoxicity of the 6,6′-dimethyl derivative is attributed, at least in part, to the relatively facile dissociation of the 6,6′-dimethyl-2,2′-bipyridine ligand from the platinum(IV) center, suggesting that sterically induced ligand lability plays an important role in modulating biological activity in this particular compound, giving new structural activity impetus for potential drug molecules. Full article

Background: Technology such as telerehabilitation, virtual reality, robotics, and wearable systems are reshaping pediatric physiotherapy. While evidence remains fragmented, there is little guidance on how these approaches can be integrated into coherent, family-centered care pathways. Objective: To develop the Digital Pediatric Physiotherapy Framework (DPPF) based on a systematic review of randomized evidence on digital interventions in pediatric physiotherapy. Methods: Several databases were searched for randomized trials published after 1 January 2020, including PubMed, Web of Science Core Collection, and Google Scholar. The included studies assessed the results of physiotherapist-delivered or physiotherapist-supervised digital interventions in children and adolescents aged 18 and younger. Population, intervention, outcome, implementation, and safety data were extracted. Considering the substantial heterogeneity of the findings, they were synthesized narratively. Cochrane RoB 2 was used to assess risk of bias, and GRADE was used to evaluate certainty of evidence. Results: Twenty-nine trials involving 1196 participants were included. Most studies examined virtual reality and gaming-based interventions, with fewer evaluating telerehabilitation/tele-exercise and robotic or wearable technologies. Digital interventions were most often directed at body-function and activity-level outcomes, while participation outcomes were less frequently studied. The strongest evidence supported short-term benefits in balance, gross motor function, upper-limb activity, pain, and selected fitness outcomes, particularly in children with cerebral palsy. Evidence for telerehabilitation and robotic or wearable approaches was more limited but generally promising. Implementation, equity, cost, and long-term outcomes were rarely reported. No eligible trial directly evaluated electronic patient-reported outcome measures, digital triage, or clinical decision support as stand-alone interventions. Conclusions: Digital interventions have the potential to strengthen pediatric physiotherapy, particularly for short-term motor and functional outcomes. The proposed DPPF provides an implementation-informed structure to guide future research, pathway design, and more purposeful integration of digital health into pediatric rehabilitation practice. Full article

Introduction: Caffeine is the most widely consumed psychoactive stimulant worldwide and acts primarily through antagonism of adenosine A1 and A2A receptors, thereby reducing sleep pressure and promoting wakefulness. Although its alerting and performance-enhancing effects are well established, its influence on sleep-related electroencephalography (EEG) has been investigated across diverse paradigms with substantial methodological heterogeneity. This systematic and mechanistic review aimed to synthesize human evidence on how caffeine affects sleep architecture, quantitative sleep EEG, and neurophysiological markers of sleep homeostasis, and to interpret these findings within current models of adenosine-mediated sleep–wake regulation. Materials and methods: A systematic search of PubMed/MEDLINE, Web of Science, Scopus, Embase, PsycINFO, ResearchGate, and Google Scholar was conducted for studies published between January 1980 and January 2026, with the final search performed on 10 January 2026. Eligible studies were original human investigations examining caffeine exposure or administration and reporting sleep-related EEG outcomes, including polysomnographic sleep staging, spectral EEG analyses, or other EEG-derived sleep metrics. Two reviewers independently screened records and assessed eligibility, with disagreements resolved by consensus. Data on study design, participant characteristics, caffeine interventions, EEG methodology, and outcomes were extracted using a predefined form. Risk of bias was evaluated using the RoB 2 and ROBINS-I tools. Owing to marked heterogeneity across studies, findings were synthesized narratively within a mechanistic interpretive framework. Results: Thirty-two studies were included. Across highly heterogeneous paradigms—including acute bedtime or evening dosing, daytime or repeated caffeine use before nocturnal sleep, administration during prolonged wakefulness followed by recovery sleep, withdrawal protocols, and ambulatory/home EEG monitoring—the most consistent finding was suppression of low-frequency NREM EEG activity, particularly slow-wave activity and the lowest delta frequencies. Caffeine frequently increased faster EEG activity, including sigma/spindle and beta ranges, producing a lighter, more aroused, and more wake-like sleep EEG profile. These effects were especially prominent during early-night NREM sleep and in recovery sleep after sleep deprivation, where caffeine attenuated the expected homeostatic rebound in low-frequency power. REM-related effects were less consistent, but some studies reported delayed REM timing and subtler alterations in REM EEG. Emerging evidence further suggests that caffeine increases EEG complexity and shifts sleep dynamics toward a more excitation-dominant state. Several studies indicated that quantitative EEG measures were more sensitive than conventional sleep-stage variables in detecting caffeine-related sleep disruption. Dose, timing, habitual caffeine use, withdrawal state, age, circadian context, and adenosinergic genetic variation, particularly involving ADORA2A, moderated the magnitude of effects. We also highlighted the connection between current results and sports and sports science. Conclusions: Caffeine reliably alters the neurophysiological architecture of human sleep in a direction consistent with reduced sleep depth and weakened homeostatic recovery. The overall evidence supports a mechanistic model centered on adenosine receptor antagonism, attenuation of sleep-pressure build-up and expression, and a shift toward greater cortical arousal during sleep. Sleep EEG appears to be a sensitive marker of these effects, often revealing physiological disruption even when conventional sleep architecture changes are modest. Future research should prioritize larger and more diverse samples, pharmacokinetic and pharmacogenetic characterization, and ecologically valid high-resolution sleep monitoring to clarify the real-world and functional consequences of caffeine-induced EEG changes. Full article

Diabetic cardiomyopathy (DCM) features progressive fibrotic remodeling, but the shared molecular circuitry connecting diabetes mellitus (DM) to cardiomyopathy (CM) remains unclear. We integrated three DM- and three CM-related Gene Expression Omnibus (GEO) datasets and corrected batch effects with sva, verified by violin plots, principal component analysis (PCA), and silhouette coefficients computed on all common genes (DM: 0.9489 to −0.1016; CM: 0.9693 to −0.045; PC1/PC2 inter-batch differences abolished after normalization). Differential expression analysis identified 2562 DM Differentially expressed genes (DEGs) and 1414 CM DEGs, and their intersection yielded 91 common DEGs (51 upregulated, 40 downregulated). Protein–protein interaction (PPI) analysis prioritized 25 hub genes, whose enrichment profiles implicated insulin resistance/insulin signaling and adrenergic signaling in cardiomyocytes. TRRUST-based inference further defined a regulatory network centered on seven key genes (HIF-1α, ACTN4, ABCB1, LTBP1, CLU, TIMP2, and MYH11). To nominate a candidate target of oxymatrine (OMT), we performed docking and molecular dynamics (MD) simulations for representative complexes; OMT showed the most stable interaction with LTBP1, maintaining a consistently short pocket distance (~0.2 nm), the highest contact frequency, and the lowest MM/PBSA binding free energy (−15.32 kcal/mol), with favorable contributions dominated by van der Waals and nonpolar solvation terms. In primary cardiac fibroblasts (CFs), high glucose (HG, 30 mM glucose) induced proliferative and profibrotic activation, whereas OMT (0.4–0.8 mM) reduced HG-driven proliferation without detectable toxicity below 1.2 mM, suppressed FN, collagen I/III, and α-SMA expression, and inhibited migration. OMT also normalized HG-induced cell-cycle skewing by restoring G0/G1-phase occupancy and reducing S-phase entry, with effects comparable to metformin. Finally, HG increased LTBP1 expression and upregulated SMAD3/SMAD4, while OMT attenuated LTBP1 induction and suppressed downstream TGF-β/SMAD activation. Together, these data integrate cross-dataset transcriptomics with mechanistic validation to position LTBP1 as a putative antifibrotic node targeted by OMT, supporting inhibition of the LTBP1/TGF-β/SMAD axis as a candidate strategy to counter DCM-associated fibrosis. Full article

Empathy is fundamental to patient-centered care but frequently diminishes during clinical training. To inform medical education, we conducted a systematic review (PRISMA-2020-compliant) of interventions aimed at augmenting empathy in healthcare learners. We searched the PubMed, EMBASE, PsycINFO, CINAHL, ERIC, and Cochrane CENTRAL databases from the beginning of time until January 2026 for trials and pre- and post-studies that looked at empathy outcomes. Two reviewers evaluated the studies (κ = 0.86) and extracted data regarding participants, intervention format, and outcomes. Our initial search yielded 2056 records. After removing duplicates, 1250 titles and abstracts were screened, resulting in the inclusion of 43 studies from 2010 to 2026. The majority of studies reported improvements in empathy post-intervention, based on both self-report measures and observational assessments. Interventions that included active learning methods like role-playing, standardized patient encounters, narrative medicine, art workshops, and mindfulness led to much better improvements in empathy than passive, lecture-based methods. Long-term, multimodal programs that included communication skills training, reflective exercises, and patient contact were better than classes that only met once. Nonetheless, many studies used different, sometimes untested, empathy measures, and the follow-up period was often short. Our review demonstrates that empathy can be imparted through evidence-based curricular approaches. We advocate for the incorporation of prolonged, experiential empathy training into health professions education, alongside the standardization of outcome assessment. These results make it clear which teaching methods work best and point out areas where more research is needed. Full article

The integration of high-penetration distributed photovoltaics (PV) into distribution networks triggers frequent voltage limit violations, fluctuations, and increased network losses. To address the limited communication infrastructure inherent in medium-voltage distribution networks, this paper employs PV inverters as fast-response voltage regulation devices and proposes a real-time distributed voltage control strategy specifically for such networks. Firstly, a distribution network communication topology and voltage regulation architecture based on adjacent asynchronous communication are established. A reactive power-voltage tracking regulation method at PV grid connection points is introduced, utilizing the division and equivalence of voltage regulation feeder segments. By partitioning the distribution network into feeder segments centered around individual PV units, rapid reactive power-voltage tracking regulation based on local and neighboring information is achieved. Secondly, a three-stage cascaded real-time distributed voltage control strategy integrating both reactive power regulation and active power curtailment is designed. Within each regulation stage of this strategy, a voltage estimation process is embedded, enabling dynamic evaluation of the regulation effectiveness and adaptive determination for transitioning between stages. Finally, the proposed strategy is applied to modified IEEE 33-node and IEEE 69-node test systems. Simulation results verify the effectiveness and superiority of the proposed method in improving voltage quality and reducing network losses. Full article

Background: Last-mile logistics is one of the most complex and cost-intensive segments of supply chains, particularly in densely populated urban environments where rising customer expectations, sustainability requirements, and operational constraints increasingly intersect. Despite growing academic interest, empirical evidence remains limited regarding how convenience-related last-mile service attributes influence customer satisfaction, while the sector is undergoing a revolutionary transformation. Methods: This study applies a refined Kano model to classify last-mile convenience services according to their differentiated effects on customer satisfaction. Data were collected through a structured questionnaire administered to active e-commerce users in a metropolitan area. The methodological approach modifies and extends the traditional Kano framework. Results: The findings reveal clear patterns among last-mile service attributes. Online tracking and preferred payment options function as One-dimensional attributes, proportionally influencing customer satisfaction. Time-based delivery, flexible pickup options, and sustainability-oriented service features appear as Attractive attributes, generating additional increases in service value. In contrast, advanced technological solutions such as drone or autonomous vehicle delivery were perceived as Indifferent attributes. These interpretations are further nuanced by the fuzzy approach. Conclusions: The results provide important insights and validation for consumer-centered service design and support the prioritization of investments aimed at developing sustainable and customer-oriented last-mile logistics systems. Full article

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent urological disorder characterized by persistent pelvic pain, urinary symptoms, and significant impact on quality of life. In addition to its clinical symptoms, CP/CPPS is frequently associated with psychiatric comorbidities, such as anxiety and depression, indicating complex neurobiological mechanisms. This review explores the mechanisms linking CP/CPPS with affective disorders, emphasizing central nervous system alterations, dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, and neuroimmune interactions. Evidence in-dicates that central sensitization, microglial and astrocytic activation, and elevated proinflammatory cytokines (IL-1β, IL-6, TNF-α) contribute to maladaptive painemotion network interactions. Additionally, dysregulation of hormones and neurotransmitters may exacerbate both pain perception and mood disorders. Psychosocial factors, including stress, coping strategies, and cognitive-emotional processes, further modulate symptom severity and treatment outcomes, highlighting the importance of a biopsychosocial approach. Gaining a deeper understanding of the neurobiological and psychosocial mechanisms behind anxiety and depression in CP/CPPS can lead to more effective, multidimensional management strategies and enhance patient-centered care. Full article

Indoor air pollution, listed by the World Health Organization (WHO) as one of the top 10 environmental risk factors for human health, significantly elevates the risk of respiratory diseases, cardiovascular diseases, and cancers upon long-term exposure. Traditional indoor air purification technologies dominated by physical adsorption and filtration have inherent limitations, including mere pollutant phase transfer, easy saturation, and secondary pollution, while chemical purification centered on pollutant mineralization and degradation is the core development direction for radical elimination of indoor air pollution. Novel nanomaterials, featuring ultra-high specific surface area, precisely tunable active sites and electronic structures, and excellent room-temperature catalytic activity, have become the research focus in this field. This review systematically summarizes the characteristics of typical indoor air pollutants and purification scenario requirements, clarifies the core advantages of chemical purification technologies, details the research progress of novel nanomaterial systems in indoor air chemical purification, and dissects the reaction mechanisms and material optimization strategies of core pathways (photocatalysis, room-temperature thermal catalysis, electrocatalysis, plasma catalysis). We also outline the engineering application status and bottlenecks of these nanomaterials, propose systematic future development directions targeting existing challenges, and aim to provide a reference for fundamental research and industrial application of novel nanomaterials in indoor air purification. Full article

This study examines how perceived tourist comfort in museum agglomerations influences tourist satisfaction, museum agglomeration vitality, and the cultural sustainability of urban tourism, focusing on Jongno-gu, Seoul, based on the experiences of Chinese tourists. Moving beyond facility-centered evaluations of individual museums, the study conceptualizes museum agglomerations as continuous tourism environments shaped by movement, guidance, congestion, waiting, rest, and overall usability. Four latent constructs—Tourist Comfort, Tourist Satisfaction, Museum Agglomeration Vitality, and Cultural Sustainability of Urban Tourism—were tested using structural equation modeling. The results show that Tourist Comfort significantly enhances both Tourist Satisfaction and Museum Agglomeration Vitality, while Tourist Satisfaction further strengthens Museum Agglomeration Vitality. In addition, both Tourist Satisfaction and Museum Agglomeration Vitality have significant positive effects on the Cultural Sustainability of Urban Tourism. Tourist Comfort also exerts an indirect influence on cultural sustainability through the mediating pathways of Tourist Satisfaction and Museum Agglomeration Vitality. These findings contribute a demand-side, cluster-level explanation of how museum districts become experientially activated for tourists, while also indicating that the results should be interpreted as case-based evidence for Chinese tourists in Jongno-gu rather than as a universally generalizable model. Full article