Search Results (48,868)

Background: Vitamin B12 deficiency is a recognized but frequently under-integrated cause of global developmental delay (GDD) in infancy and early childhood. Early diagnosis is critical because neurological impairment may be partially or completely reversible with timely treatment. Objective: This narrative review aims to synthesize current evidence on the role of vitamin B12 deficiency in the diagnostic evaluation of GDD, with a focus on clinical phenotype, risk factors, biomarkers, treatment outcomes, and practical integration into contemporary diagnostic algorithms. Methods: A structured, non-systematic search of PubMed/MEDLINE, Embase, and Web of Science was performed to identify clinical studies, case series, reviews, and guideline documents addressing pediatric vitamin B12 deficiency and neurodevelopmental delay. Results: Vitamin B12 deficiency in early childhood is most commonly associated with maternal deficiency and exclusive breastfeeding without adequate supplementation. Evidence from recent clinical and observational studies indicates that vitamin B12 deficiency may present with nonspecific neurological symptoms, including developmental regression, hypotonia, and feeding difficulties. Incorporating vitamin B12 assessment—using serum vitamin B12, holotranscobalamin, methylmalonic acid, and homocysteine—into early diagnostic algorithms for GDD may facilitate timely identification of a treatable cause of neurodevelopmental impairment. The proposed diagnostic framework emphasizes early biochemical evaluation in infants with unexplained developmental delay, thereby supporting prompt treatment during a critical window of neurological reversibility. Conclusions: Targeted assessment of vitamin B12 status in children with GDD, together with evaluation of maternal status, represents a clinically relevant approach to identifying a potentially preventable and treatable cause of neurodevelopmental impairment. Integration of functional biomarkers into diagnostic pathways and the development of pediatric-specific reference standards are key priorities for future research and clinical practice. Full article

Quantifying dynamic urban resilience is critical for climate adaptation. This study assesses the spatiotemporal resilience of 6838 flood-affected communities across 39 Chinese cities using high-resolution human activity data. By establishing a multi-phase framework, we extract six metrics characterizing resistance and recovery trajectories. Results reveal a distinct resilience paradox: coastal cities, despite suffering deeper instantaneous shocks from typhoons, exhibit superior adaptive capacity compared to inland cities, which face chronic recovery deficits under rainstorm stress. Unsupervised clustering identifies 12 distinct resilience phenotypes, ranging from brittle collapse to adaptive growth. Structural analysis confirms a Matthew Effect where functional diversity and economic vitality enable resource-rich communities to bounce forward, while peripheral areas remain trapped in vulnerability. These findings underscore the need for resilience-based regeneration policies that prioritize spatial justice and resource optimization over static engineering standards. Full article

Background and Objectives: To assess the reliability and construct validity of the Functional Rating Index (FRI) in Italian-speaking individuals with chronic non-specific low back pain (CLBP), in order to improve assessment and clinical management in this population. Materials and Methods: This cross-sectional study consecutively enrolled 75 individuals with CLBP (52 females; mean age 48.71 ± 19.18 years; mean pain duration 298.64 ± 427.52 weeks). Internal consistency and test–retest reliability were evaluated using Cronbach’s α and the intraclass correlation coefficient [ICC_2,1], respectively, while measurement error was estimated through the minimum detectable change (MDC). Construct validity was examined by testing a priori hypotheses through correlations (Pearson’s r) between the FRI and disability measures (Roland–Morris Disability Questionnaire, RMQ; Oswestry Disability Index, ODI), pain intensity (Numerical Rating Scale, NRS), and quality of life (Short-Form Health Survey, SF-36). Results: Cronbach’s α was 0.88, and test–retest reliability showed an ICC_2,1 of 0.86 (95%CI: 0.82–0.93). The MDC was 18.05, corresponding to approximately 20% of the total score. The Italian FRI demonstrated strong correlations with the RMQ (r = 0.70) and ODI (r = 0.77), and a moderate correlation with the NRS (r = 0.60). The physical and social domains of the SF-36 showed stronger negative correlations with the FRI than the mental and emotional domains. Conclusions: The Italian version of the FRI is a reliable and valid instrument for individuals with CLBP and is recommended for both clinical practice and research applications. Full article

Background/Objectives: To investigate whether chronic cosmetics use near or directly on the eyelid margin contributes to tear film instability and meibomian gland dysfunction. Methods: Subjects were enrolled in one of three groups: those who rarely wear makeup (No-M), those who wear it frequently but only outside the eyelid margin (Min-M), and those who wear it frequently and directly on the eyelid margin (W-M). Subjects were assessed for dry eye signs and symptoms by a masked examiner. Lipid layer thickness (LLT), tear meniscus height, meibomian gland excreta grade, number of glands secreting, corneal and conjunctival staining and tear breakup time were assessed. Results: 10 No-M, 18 Min-M, and 21 W-M subjects completed the study. Average fluorescein breakup time was 4.6 s in each group (p = 0.839, 1-way ANOVA). There were higher scores (worse findings) in the marginal eyeliner sample for symptoms (modified Schein, OSDI, SPEED), Oxford and total NEI staining and lower lid meibomian secretions. The W-M group demonstrated a statistically significant increase in the meibomian gland excreta grade (a worsening) compared to the No-M group (mean grades 1.2 and 0.55 respectively; Tukey test, adjusted p < 0.05, 95% CI 0.055–1.187). LLT, tear breakup time, eyelid marginal signs, and meibomian gland dropout had no differences among groups. Conclusions: Eyeliner wear both outside and on the eyelid margin demonstrated increased ocular staining and decreased gland excretion quality, compared to non-makeup users. The meibomian gland excreta decrement may lead to worsening meibomian gland function and potentially glandular atrophy over time. Full article

Rapid urbanization-induced extreme rainstorms severely disrupt social functions. Previous research often focused on “de-densification” strategies, which are difficult to adapt to high-density Sponge City Stormwater Management Units (SMUs) that carry core development functions. This study uses Shenzhen as a case study, utilizing Keep movement big data as a “social sensor” for system function perception and introducing the Socio-Ecological-Technological Systems (SETS) theory to construct a “recovery (RCN)–resistance (MI)” binary assessment framework. Through systematic clustering and hierarchical regression models, the driving mechanisms of blue landscape patterns, topography, road networks, and the built environment on social behavioral resilience are systematically parsed. The results show: (1) Road network morphology dominates resistance, while multi-dimensional elements collaborate for recovery. Resistance (MI) is primarily dominated by macro road network detour resistance (TPD2000, β = 0.956), while recovery depends on the synergistic support of blue space interspersion (Blue_IJI), topography, and micro-circulation road networks. (2) Green infrastructure fails in the model due to efficiency bottlenecks, empirical evidence of weakened regulation caused by green space fragmentation in ultra-high-density environments. (3) Low-density, eco-centric built environments provide dual synergistic gains for resilience. Based on this, a “Bidirectional Socio-Ecological Resilience Needs Pyramid” model is constructed, identifying four governance types such as the “Synergistic Balanced Type”. This study provides a quantitative basis for the transition from administrative control to precise morphological governance in high-density cities. Full article

Background: Traditional functional mobility assessments often fail to detect subclinical postural decline in active aging populations. This study introduces the Head–Sternum Dissociation Index as a novel digital biomarker to identify latent sensorimotor deficits before macroscopic balance failure occurs. Methods: Ninety-four participants (Young, Middle-Aged Civil, Middle-Aged Dancers, and Older Adults) performed instrumented limits of stability tasks, specifically functional and lateral reach tests, utilizing a three-sensor inertial measurement unit configuration. Postural strategies were quantified via the Head–Sternum Dissociation Index and the peak ratio of corrective micro-movements, validating the sensor output against a gold-standard force platform. Results: A significant kinematic breakpoint in postural control was identified at age 55 (p < 0.001). However, Middle-Aged Civilians exhibited early kinematic divergence despite maintaining normal Timed Up and Go test performance. Receiver operating characteristic analysis revealed distinct, sex-specific physiological limits: aging males predominantly adopted a rigid “Stiffness” strategy (peak ratio ≤ 1.15, head–sternum dissociation threshold > 0.63°), while females utilized a broader, more permissive “Continuous” strategy (head–sternum dissociation threshold > 0.31°). Notably, recreational rhythmic training (dance) completely neutralized this age-related decay, with middle-aged dancers maintaining highly efficient, youthful stabilization profiles (Cohen’s d = 2.20). Conclusions: The Head–Sternum Dissociation Index, combined with relative corrective frequency, successfully phenotypes early sensorimotor erosion. These findings advocate for the integration of sex-specific kinematic screening into primary care, allowing clinicians to prescribe targeted interventions well before clinical fall risk manifests. Full article

Background/Objectives: Patients with severe hemophilia A on prophylaxis with emicizumab exhibit a mild/moderate bleeding phenotype that requires the use of either recombinant FVIII (rFVIII) or bypassing agents (BPAs) in patients with inhibitors, in the case of breakthrough bleeding or surgery. Since factor IX (FIX) limits the formation of the FIXa–emicizumab–FX complex, exogenously added FIX might enhance complex formation and thrombin generation. This study aimed to compare the procoagulant effects of various FIX concentrates with recombinant activated FVII (rFVIIa), activated prothrombin complex concentrate (aPCC), and rFVIII in SHA patients with and without inhibitors under emicizumab prophylaxis. Methods: Hemostatic changes were monitored using two optimized global coagulation assays: rotational thromboelastometry and calibrated automated thrombin generation. Tubes containing corn trypsin inhibitor (CTI) were used during blood collection to prevent activation. Low concentrations of tissue factor (TF) were used to trigger coagulation in both assays. Results: Ex vivo addition of recombinant FIX concentrates significantly increased the procoagulant activity of emicizumab, achieving levels comparable to therapeutic doses of rFVIIa or rFVIII, and the proportion of active FIXa within the concentrates is a major contributor to their procoagulant function. We assessed the influence of FVIII inhibitors on the hemostatic efficacy of rFIX concentrates and BPAs, finding that rFIX-induced thrombin generation increased in the presence of inhibitors, and no significant differences were observed with BPAs. Conclusions: These findings suggest that FIX concentrates could be an effective alternative to BPAs for emicizumab-treated patients, particularly those with inhibitors. Further studies are needed to confirm their in vivo efficacy and to evaluate thrombotic risk. Full article

Brosimum alicastrum Swartz is a forest species with substantial potential for animal and human nutrition. However, its nutritional attributes and commercial applications are poorly disseminated and structurally underdeveloped. This study examines the relationship between scientific research and the commercialization of Brosimum alicastrum products in Mexico, integrating bibliometric analysis with a value network approach to identify market constraints and opportunities. Scientific publications indexed in Scopus from 1961 to 2024 were analyzed to characterize research trends, documented uses, and the geographic distribution of knowledge production. In parallel, companies commercializing Brosimum alicastrum-based products in Mexico were surveyed during 2024 using a value network approach (suppliers, customers, complementors, and competitors). A SWOT analysis was conducted to assess the structural strengths and vulnerabilities affecting market development. The results show that research in Mexico has primarily focused on the species’ properties as a functional food. At the same time, limited attention has been given to silviculture, commercialization strategies, and value-chain governance. Although Brosimum alicastrum products are currently positioned within premium market segments, business continuity is constrained by unstable supply systems that rely almost exclusively on seasonal wild collection from natural distribution areas. Both the value network and the SWOT analysis identified supply instability as the main factor limiting market expansion. Therefore, advancing research on the silviculture of Brosimum alicastrum is essential to support the establishment of managed production systems and commercial plantations capable of ensuring a stable, year-round supply of raw material. These developments would facilitate access to new market niches and enhance the biocultural and ethnobotanical value of Brosimum alicastrum as a functional and medicinal food resource within Mexico’s emerging bioeconomy. Full article

Background: Arterial hypertension in childhood is an increasing health concern, often associated with structural and functional cardiovascular or renal alterations. This study aimed to investigate the prevalence and type of non-stenotic renal artery anatomical variants in children with systemic hypertension and to assess their possible association with cardiac involvement. Methods: A total of 107 children and adolescents with hypertension (mean age 15.4 ± 2.7 years) were evaluated. Hypertension was defined as blood pressure persistently above the 95th percentile for over one year, confirmed by 24 h ambulatory blood pressure monitoring. Patients with known secondary causes were excluded. All underwent renal vascular imaging by CT or MRI and echocardiographic assessment of left ventricular morphology and function. Results: Renal artery anatomical variants were found in 69 of 107 patients (65%), mainly unilateral or bilateral accessory polar arteries. Other anomalies found (left renal vein narrowing or duplication, severe left renal artery stenosis) were excluded from the statistical analysis. Normal renal vasculature was observed in only 32%. Left ventricular hypertrophy was detected in 41%, highlighting a significant prevalence of target-organ involvement. No statistically significant differences were found in terms of hypertension or hypertrophy between patients with renal artery anatomical variants and those without. However, patients with renal anomalies more frequently required dual antihypertensive therapy (p = 0.025). Conclusions: Renal artery anatomical variants, even in the absence of overt stenosis, may contribute to the pathogenesis of pediatric hypertension and complicate its management. Systematic evaluation of renal vasculature should be considered in the diagnostic workup to improve risk stratification and guide management strategies. Full article

Background: Sarcopenia is the age-related, progressive loss of strength, function, and skeletal muscle mass, which can be assessed with specific tests. The Growth differentiation factor 15 (GDF-15) has been proposed as a key biomarker of aging, and it has been associated with mitochondrial dysfunction, cachexia, and physical impairment. Methods: The cohort of this study comes from the SardiNIA study, an ongoing longitudinal survey focused on the identification of genetic and phenotypic variants associated with aging. We assessed hand grip strength, gait speed, and GDF-15 in all samples. Linear multivariate analysis was used to assess the correlation after adjusting for a range of potential confounders. Results: The sample consisted of 4842 subjects (57.5% female) with a median age of 48.6 years. Levels of GDF-15 were comparable between males and females and showed a strong positive association with aging (rho 0.617, p < 0.001). Linear multivariate regression analyses showed that GDF-15 was negatively associated with gait speed and grip strength in both hands (respectively, Beta −0.09, Beta −0.07, and Beta −0.08, p < 0.001 for all). Conclusions: GDF-15 was negatively associated with physical function. GDF-15 may be considered a proxy for reduced physical performance. Future research is needed to understand the pathogenetic role of GDF-15 in the reduction in skeletal muscle in aging people. Full article

Background: Postpartum depression (PPD) is a clinically significant condition shaped by emotional regulation processes and close relational contexts. Anxiety is often theorized as a mediating mechanism linking relational vulnerabilities to depressive symptoms, yet empirical findings remain mixed. Objectives: This study examined whether state anxiety mediates the association between insecure attachment styles and PPD symptoms or whether its effects depend on relational context, specifically perceived partner support. Methods: In this cross-sectional study, a sample of 249 women assessed within 12 months postpartum completed self-report measures of attachment styles in the intimate relationship, state and trait anxiety, perceived partner support, and PPD symptoms. Hypotheses were tested using multiple regression analyses with heteroskedasticity-consistent standard errors, including mediation and moderation models. Results: Both anxious–ambivalent and avoidant attachment styles were associated with greater PPD symptom severity. State anxiety was neither an independent predictor nor a mediator of the attachment–PPD relationship. Instead, its association with PPD symptoms was conditional: anxiety was positively related to depressive symptoms only when perceived partner support was insufficient. Conclusions: Anxiety may function as a context-sensitive amplifier rather than a universal mechanism of postpartum depressive risk. These findings highlight the potential importance of relational context in understanding emotional vulnerability and depressive symptoms during the postpartum period. Full article

Background/Objectives: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure; however, successful return to sport (RTS) remains a major challenge influenced by both physical and psychological factors. Kinesiophobia and psychological readiness are crucial yet inadequately studied components of rehabilitation that may change across distinct phases. This study aimed to examine longitudinal, phase-specific changes in kinesiophobia, psychological readiness, and patient-reported knee function across standardized ACLR rehabilitation phases. Methods: A retrospective longitudinal cohort design was employed. Data were extracted from 45 patients who completed ACLR rehabilitation at a specialized musculoskeletal center in Riyadh, Saudi Arabia. Participants were assessed across four rehabilitation phases: Phase One (0–1 month), Phase Two (>1–3 months), Phase Three (>3–6 months), and Phase Four (>6 months post-ACLR). Outcomes included the Tampa Scale of Kinesiophobia (TSK-17), the ACL–Return to Sport after Injury scale (ACL-RSI), and the International Knee Documentation Committee subjective knee form (IKDC), administered using validated Arabic versions. Linear mixed-effects models with Bonferroni-adjusted pairwise comparisons were used to evaluate phase-related changes. Results: Significant fixed effects of rehabilitation phase were observed for all outcomes (p < 0.001). Kinesiophobia declined substantially from Phase One (mean 51.5) to Phase Three (34.7), with the greatest reduction between Phases Two and Three, followed by stabilization in Phase Four. Psychological readiness increased progressively across all phases (ACL-RSI: 37.1 to 61.8). Knee function demonstrated the greatest improvement during late rehabilitation (IKDC: 37.6 to 75.8). Conclusions: Psychological and functional recovery following ACLR follow distinct temporal trajectories rather than improving synchronously. Kinesiophobia declines most markedly during mid-rehabilitation, while functional gains peak in late rehabilitation. These findings support integrating structured psychological screening into phase-specific ACLR rehabilitation protocols. Full article

Land use change has direct human impacts and profoundly alters the structure and function of terrestrial ecosystems. Numerous studies have explored land use change dynamics in the context of socio-economics, often overlooking the influence of climate change on the potential suitability of land use. To address this gap, we propose an integrated framework combining CLUE-S and MaxEnt models to analyze how land use in Tai’an City, Shandong Province, China, responds to future socio-economic and climate change scenarios. The CLUE-S model, based on land demand, and the MaxEnt model, based on suitability assessment, can effectively explore the trends of land change under the influence of human activities and global warming. This study maps the spatial distributions of land use under socio-economic development and four climate change pathways. Overall, the AUC values of the CLUE-S model were all greater than 0.7, and those of the MaxEnt model were all greater than 0.5, indicating that the results of both are relatively reliable. Our study reveals that, within the baseline development (BL) scenario, cultivated land, forest land, grassland, and unused land are projected to decrease between 2020 and 2040. Conversely, the expansion of water bodies and built land will keep growing. In addition, climate change is expected to enhance the suitability of cultivated land between 2020 and 2040, while reducing that of forest land, grassland, unused land, and built land, with only minimal effects on water bodies. Finally, our framework projected that the most widespread priority areas are cultivated land, followed by forest, grassland, water, built land, and unused land. These priority areas are largely determined by human activities, while the influence of climate change is relatively small. Our research framework has broad applicability to the other regions. Considering the MaxEnt model within the framework is beneficial for excluding unsuitable distribution areas of land use types in the CLUE-S model, which will provide new insights for the sustainable use of land resources. Full article

Background and Objectives: Physiotherapeutic Scoliosis-Specific Exercises (PSSE) are recognized treatment methods for idiopathic scoliosis, focused on correcting three-dimensional postural abnormalities. Objective indices such as Angle of Trunk Rotation (ATR), Anterior Trunk Symmetry Index (ATSI), and Posterior Trunk Symmetry Index (POTSI) enable precise assessment of clinical changes, while the Trunk Appearance Perception Scale (TAPS) reflects the patient’s subjective perception of their posture. Combining these data allows for a comprehensive assessment of the effects of therapy after intensive 5-day inpatient rehabilitation. We aimed to assess the improvement in the patients’ clinical appearance and compare objective and subjective trunk assessment indicators after intensive 5-day inpatient rehabilitation, treated by PSSE, according to the Functional Individual Therapy of Scoliosis (FITS) Method. Materials and Methods: This retrospective study included 75 patients with idiopathic scoliosis who participated in a 5-day inpatient rehabilitation, treated by FITS Method. The average age was 13.5 years, and 63% of the girls were after menarche. The mean Cobb angle was 27.41° in single-curve scoliosis and 31.03° in double-curve scoliosis (31.24° in the thoracic spine, 30.82° in the lumbar spine), Risser test 2, and ATR was 7.1° in the thoracic spine and 4.6° in the lumbar spine. Forty-nine patients wore a brace. At the beginning and end of inpatient care, objective assessments were performed, including ATR at the peak of the scoliosis using the Adams test and photoregistration of the trunk in the front and back standing positions—ATSI and POTSI. A subjective assessment was also performed using the TAPS. Results: A statistically significant difference was demonstrated after therapy in the ATSI (p < 0.001) and POTSI (p = 0.008) values. A reduction in the ATR in the thoracic spine was observed (p < 0.001). The TAPS questionnaire demonstrated a statistically significant difference in the values of all indicators measured before and after therapy: in the frontal plane SET 1 (p = 0.002), in the transverse plane SET 2 (p = 0.042), and in the frontal plane SET 3 (p = 0.028). A statistically significant negative correlation was demonstrated between objective and subjective indicators after therapy: ATR Th vs. TAPS-SET 2 (−0.45) (p < 0.001) and ATSI vs. SET 3 (−0.29) (p = 0.011). Conclusions: The subjective assessment of trunk appearance correlates with the objective assessment, except for SET 1 vs. POTSI. Patients who noticed a change in their posture can expect confirmation in objective clinical tests. FITS Method positively influences the improvement of subjective and objective assessments of idiopathic scoliosis patients during the short term of intensive care. Full article

Plant growth-promoting microorganisms (PGPMs) and microbial biocontrol agents have emerged as key tools for improving crop productivity while maintaining environmental sustainability. However, central questions remain regarding which factors determine their consistent field performance and how these factors interact under real agronomic conditions. Previous research has demonstrated that PGPMs enhance nutrient acquisition, regulate phytohormone balance, improve stress tolerance, and suppress plant pathogens through diverse biochemical and ecological mechanisms. Advances in omics technologies, genome mining, and synthetic microbial communities have further expanded understanding of their functional potential. Nevertheless, many studies rely on laboratory-scale experiments or short-term trials, with limited multi-season and cross-regional validation. This gap contributes to inconsistent field outcomes and restricts large-scale agricultural adoption. Long-term multi-season validation and reproducibility assessment remain essential priorities for improving reliability of microbial agricultural products. This review synthesizes recent advances in PGPM-based biofertilizers and microbial biocontrol technologies, critically examining their mechanisms of action, scalability constraints, formulation challenges, and regulatory limitations. It identifies major translational barriers, including context dependency, mechanistic uncertainties, reproducibility gaps, and insufficient systems-level integration. Full article