Search Results (1,223)

Background: Trichosporon japonicum is a rare but highly lethal pathogen causing fungemia in immunocompromised patients. With the expanding use of chimeric antigen receptor T (CAR-T) cell therapy, the spectrum of opportunistic fungal infections is changing, yet data on T. japonicum infections in this setting remain scarce. Case Presentation: A 69-year-old man with diffuse large B-cell lymphoma developed catheter-associated fungemia after CAR-T cell reinfusion. He initially presented with neck pain and white oral mucosal patches, followed by fever four days later. T. japonicum was isolated from both peripheral blood and central venous catheter tip cultures, identified by microscopic examination, mass spectrometry, and molecular sequencing. Antifungal prophylaxis was initiated before fever onset based on close monitoring of white blood cell count, procalcitonin, interleukin-6, and C-reactive protein; treatment was subsequently adjusted according to species identification and antifungal susceptibility results. Infection was controlled within two weeks after catheter removal and immune recovery. The patient remained well at six-month follow-up. Conclusion: This case adds to the limited literature on T. japonicum fungemia in patients receiving CAR-T therapy. Our experience, together with a review of the literature, underscores that successful management requires prompt catheter removal, immune restoration, and combination therapy with voriconazole and amphotericin B, as echinocandin monotherapy should be avoided. Awareness of this pathogen in immunocompromised patients is critical. Full article

Slope aspect is the primary topographic factor controlling the surface thermal state in mountainous cold regions. By modulating the magnitude and timing of solar radiation on slopes, it systematically affects soil temperature, maximum frost depth, and freeze–thaw timing, and it drives differentiation of the coupled hydrothermal process between sunny and shady slopes. However, the quantitative patterns of slope aspect freeze–thaw dynamics in high-latitude seasonally frozen soils and their response mechanisms to climate warming have not been systematically revealed. Therefore, based on field monitoring, this study used the SHAW model to simulate the soil freeze–thaw process and designed multiple warming scenarios to evaluate the evolving trend of the aspect effect. The results showed that: (1) the SHAW model effectively simulated soil temperature dynamics (R² = 0.939, NSE = 0.913, RMSE = 1.71 °C); (2) the profile-mean soil temperature on sunny slopes was 3.10 °C higher than on shady slopes, with a maximum frost depth approximately 61.2 cm shallower, freezing onset about 18 days later, complete thawing 59–77 days earlier, and freezing and thawing rates approximately 28% and 50% higher, respectively; and (3) under the SSP2-4.5 scenario, various freeze–thaw differentiation metrics did not exhibit a systematic convergence trend, and the aspect effect remained robust against climate warming. These findings offer a quantitative basis for ecological and hydrological assessment, water-resource scheduling, and foundation-stability design in cold regions, thereby supporting ecosystem conservation, sustainable water-resource use, and climate-resilient infrastructure development, and informing sustainable development planning and policy-making in high-latitude regions under a warming climate. Full article

Background: Achondroplasia, the most common genetic dwarfism caused by the FGFR3 mutation (autosomal dominant, 80% de novo), results in a disproportionately short stature. Thoracolumbar kyphosis (TLK), combined with characteristic spinal canal stenosis, increases the risk of symptomatic compression, yet the literature lacks clear thresholds for symptom onset or progressive deformity angles. Methods: A 16-year-old female with achondroplasia presented with rapidly progressive kyphosis despite conservative management (bracing and therapy). Over six months, she developed neurogenic claudication; bilateral leg pain; weakness; and paresthesia that worsened with standing/walking, which was relieved by flexion/sitting. Imaging demonstrated surgical-threshold kyphosis with progressive spinal misalignment. Her symptoms indicated compressive myeloradiculopathy from lumbar stenosis, critical given achondroplasia’s congenitally narrowed canal and heightened neurologic vulnerability. Results: Staged surgery planned: Posterior fusion T6-L4 with pedicle screws and then extensive decompression (laminectomy/foraminotomy T11-L3), L1 corpectomy with expandable titanium cage, and Ponte osteotomies. Intraoperative complications included a malpositioned left T10 screw breaching the anterior/lateral cortex near the aorta, requiring urgent revision. Postoperatively: Neurogenic bladder, wound leakage, and E. coli urinary tract infection (UTI) with fever (treated with IV antibiotics). After infection resolution, definitive surgery removed the malpositioned screw and completed decompression, corpectomy, cage placement, bone grafting, and osteotomies, successfully resolving neurological symptoms. However, 13 cm trunk lengthening caused severe functional impairment—disproportionately short arms prevented independent toileting and dressing. Left arm lengthening via external fixation restored partial function. At 2.5-year follow-up, there was solid fusion, no neurological deficits, and improved quality of life. Conclusions: Surgery addresses severe TLK, vertebral wedging, and neurogenic claudication in achondroplasia. Vertebral column resection effectively corrects TLK and neurological deficits but carries a high complication risk. This should be reserved for severe TLK with hypoplastic vertebrae, performed by experienced surgeons. Critically, correction magnitude must preserve limb–trunk proportions to prevent functional disability, as excessive lengthening may necessitate additional limb procedures for independence restoration. Full article

Background: Post-exertional malaise (PEM), which is the cardinal feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is also reported in a proportion of patients with post-COVID-19 syndrome (PCS). Our objective was to identify determinants that may be linked to the emergence of PEM in PCS patients. Methods: Patients fulfilling the World Health Organization definition for PCS who attended the post-COVID unit of the Internal Medicine Department of Angers University Hospital, France, between June 2020 and December 2023 were included retrospectively. Their medical records were reviewed to extract information on COVID-19 infection history, characteristics of post-exertional malaise (PEM), fatigue severity, and relevant epidemiological variables. Results: The study included 220 patients, grouped according to whether post-exertional malaise was present (PCS/PEM+) or absent (PCS/PEM–). PEM was observed in 26.4% of patients and was significantly linked to earlier COVID onset in 2020/2021 (OR 5.68 (95% CI: 1.66–19.45), p = 0.006), as well as higher fatigue levels (OR 2.07 (95% CI: 1.22–3.50), p = 0.007). Conclusions: Patients who contracted COVID-19 during the pre-Omicron period reported PEM more frequently than those infected in later waves. This observation could reflect differences in viral characteristics following the emergence of the Omicron variant; however, alternative explanations—such as increasing vaccination coverage, accumulating post-infectious immunity, or other unmeasured factors—cannot be ruled out. Based on the observed link between PEM and symptom severity, PCS patients should be systematically assessed for the presence of PEM. Full article

Background: Paraneoplastic limbic encephalitis (PLE) with anti-Ma2 antibodies is a rare immune-mediated disorder associated with testicular cancer, particularly in young males. While neurological manifestations are well documented, hypothalamic–pituitary dysfunctions remain underreported. We present a case of anti-Ma2 PLE associated with testicular cancer together with a systematic review of PLE associated with testicular cancer, selectively restricted to anti-Ma2 positive cases and focusing on hypothalamic–endocrine involvement. Case presentation: We describe a 21-year-old male diagnosed with anti-Ma2 PLE and intratubular germ cell neoplasia of the right testis. He underwent orchifunicolectomy and immunosuppressive therapy with neurological improvement. Four years later, he developed new-onset temporal seizures, decreased libido, and a polyuria–polydipsia syndrome. Dynamic endocrine testing, including a water deprivation test and copeptin measurement, supported a diagnosis of partial central diabetes insipidus (CDI). Methods: A systematic literature review was performed in accordance with PRISMA guidelines. PubMed was searched using predefined keywords without time restriction. Studies reporting PLE associated with testicular tumors in humans with confirmed anti-Ma2 antibody positivity were included. Results: Eleven studies were included, reporting a total of 38 patients with anti-Ma2-associated PLE and testicular cancer. Hypothalamic or diencephalic involvement was described in 16 patients (42.0%), while endocrine manifestations were explicitly reported in four cases. Only two previous reports mentioned CDI, without detailed diagnostic evaluation. Conclusions: This study highlights the importance of recognizing hypothalamic-endocrine manifestations in PLE. In patients presenting with polydipsia and polyuria, CDI should be carefully differentiated from primary polydipsia using dynamic testing. Hypothalamic involvement may emerge years after tumor treatment, warranting long-term endocrine surveillance. Full article

Spring and autumn phenology jointly regulate terrestrial carbon, water, and energy exchanges, yet the mechanisms linking seasonal transitions remain debated under increasing hydroclimatic stress. Here, we integrate satellite-derived phenology with reanalysis-based indicators of land–atmosphere coupling to examine how spring onset interacts with growing season controlling factors and how these interactions shape autumn senescence at the global scale. Globally, start-of-season (SOS) and end-of-season (EOS) timings are positively coupled, with later SOS generally followed by later EOS, and this relationship becomes stronger when only later-SOS years are considered. However, SOS does not induce coherent global shifts in growing season climate limitation. Piecewise structural equation modeling reveals that SOS influences EOS primarily through a direct phenological pathway, with a mean path coefficient of ~0.4 day·day⁻¹ explaining approximately 26% of global EOS variability. In contrast, energy and water-mediated pathways contribute smaller but spatially heterogeneous effects, together accounting for ~5% of explained variance on average. SOS–EOS coupling is strongest in water-limited regimes, particularly in grasslands and shrublands. Managed croplands exhibit distinct and more heterogeneous responses, reflecting partial decoupling of phenology from natural hydroclimatic constraints. Collectively, our results indicate that spring phenology exerts a robust but spatially variable influence on autumn timing, dominated by direct effects rather than indirect mediation through growing season climate limitations, with regional modulation imposed by background hydroclimatic conditions. Full article

Background and Objectives: Very preterm infants are vulnerable to late-onset infection and prolonged NICU exposure, with potential downstream effects on caregiver health. We evaluated neonatal outcomes and caregiver psychosocial status across culture-confirmed infection phenotypes. Methods: We investigated a single-center prospective cohort (March 2023–December 2025) of 87 preterm infants assigned to one of three groups: no proven infection (n = 44), bacterial sepsis (n = 31), or candidemia (n = 12). Neonatal outcomes included a composite adverse endpoint (death or major morbidity) and resource utilization. Caregivers completed the SF-36, WHOQOL-BREF, HADS, PHQ-9, GAD-7, and Body Image Scale near discharge. Results: Candidemia occurred later than bacterial sepsis (day of life 17.8 ± 4.8 vs. 10.1 ± 3.9; p < 0.001) and had a longer time to effective therapy (23.3 ± 9.5 vs. 13.3 ± 5.3 h; p = 0.004). The composite adverse outcome was 27.3% in the no-infection group versus 54.8% in the bacterial group and 58.3% in the candidemia group (p = 0.025); ROP requiring treatment increased from 4.5% to 29.0% and 25.0% (p = 0.012). Length of stay rose from 39.7 ± 10.2 to 50.1 ± 11.9 and 60.9 ± 13.1 days (p < 0.001), and ventilation days from 15.7 ± 7.6 to 23.3 ± 7.5 and 34.2 ± 10.4 (p < 0.001). Caregiver SF-36 mental health (MCS) scores decreased from 44.7 ± 7.5 to 38.5 ± 6.0 and 36.7 ± 6.4 (p < 0.001), while PHQ-9 scores increased from 9.4 ± 3.9 to 11.6 ± 3.3 and 15.5 ± 4.6 (p < 0.001); NICU burden correlated with PHQ-9 scores (r = 0.52, p < 0.001). Conclusions: Culture-confirmed infection, particularly candidemia, was associated with higher neonatal morbidity, markedly greater resource use, and substantial caregiver distress at discharge. Full article

Lactiplantibacillus plantarum EL2, isolated from traditional fermented yak milk in the high-altitude Gannan Tibetan Autonomous Prefecture, produces the class IIb bacteriocin PlnJK. This study established three distinct cultivation models that critically influenced bacteriocin yield. Microbial co-culture was found to enhance the stress tolerance of EL2, significantly boosting PlnJK production. The optimal inducing strain, Enterococcus faecalis MH2, increased the bacteriocin inhibition zone diameter from 15.38 mm to 25.58 mm. Following optimization of key parameters—initial inoculum concentration (10⁷ CFU/mL), inoculation ratio (3:1, EL2:MH2), and initial pH (6.0)—the inhibition zone diameter reached 30.32 mm, representing a 1.97-fold increase over pure culture. Co-culture not only advanced the onset but also extended the duration of bacteriocin synthesis. Throughout the 24 h incubation, cell density, AI-2 autoinducer concentration, and the expression of key regulatory genes were significantly elevated in co-culture compared to monoculture, aligning with a cell-density-dependent, quorum-sensing (QS) regulatory paradigm. Bacteriocin production was co-regulated by two QS pathways: the AI-2/luxS system and the plnA-mediated autoinducing peptide (AIP). Gene expression analysis revealed differential temporal regulation: luxS expression was higher during the exponential phase (2.29 vs. 1.42 in stationary phase), while plnA exhibited the opposite pattern (1.42 in exponential vs. 2.21 in stationary phase). This indicates that the AI-2/luxS pathway drives strong induction during active growth, whereas plnA/AIP-mediated promotion becomes predominant later. The stationary-phase effect is likely triggered by the accumulation of specific MH2 metabolites, which impose an environmental stress on EL2, stimulating the pln-encoded regulatory system and further enhancing bacteriocin yield. This work provides an economically viable strategy and a novel theoretical framework for optimizing microbial cultivation, enhancing bacteriocin production, and elucidating the complex QS-mediated regulatory mechanisms involved. Full article

Numerosity can be represented in symbolic formats and non-symbolic dot arrays. How numerosity load unfolds across WM encoding/maintenance and test-stage comparison within a single paradigm remains unclear, especially within the tested 4–6 range. We used a delayed match-to-sample task manipulating numerosity (4–6) and match status, with two test blocks (dot–digit and dot–dot). Behaviorally, a higher numerosity reduced accuracy and increased RTs in both blocks, with larger costs in dot–dot; the mismatch reliably slowed RTs. At sample onset, occipital P1 and N1 amplitudes decreased with increasing numerosity, consistent with greater perceptual/processing demands at higher load, with the strongest differences at the high end of the range. During the delay, numerosity modulation was temporally specific, emerging in the 450–650 ms posterior window and remaining significant after FDR correction across the four consecutive delay windows. At the test, the mismatch elicited a more negative N2 in both blocks (larger in dot–dot), while numerosity also modulated N2 only in dot–dot, showing a monotonic increase in negativity with load. Controlling for condition-mean logRT did not eliminate these N2 effects. P3 showed no reliable modulation, whereas a later positive component was enhanced by mismatch selectively in dot–dot. Together, these results indicate stage-differentiated effects: numerosity load impacts early encoding and a circumscribed maintenance interval, whereas mismatch effects arise primarily during the test-stage comparison, with additional late evaluative activity when formats are aligned. Full article

Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by an impaired ventilatory response to hypercapnia and hypoxia, particularly during sleep, and frequently associated with autonomic dysfunction. It is caused by pathogenic variants in the PHOX2B gene. Although CCHS is typically diagnosed in the neonatal period, milder forms may present later in infancy or childhood, often triggered by respiratory infections. Case presentation: We report the case of 16-month-old male diagnosed with CCHS following an episode of hypoxemic–hypercapnic respiratory failure during respiratory syncytial virus (RSV) infection. His medical history included neonatal respiratory distress requiring oxygen therapy and recurrent wheezing. At 15 months, he developed acute respiratory distress with severe hypercapnia (PaCO₂ 70 mmHg), requiring admission to the Pediatric Intensive Care Unit and invasive mechanical ventilation. Persistent sleep-related hypercapnia and hypoxemia prompted evaluation for central hypoventilation, confirmed by means of transcutaneous capnography and nocturnal pulse oximetry. Genetic testing revealed a de novo nonsense mutation in exon 1 of PHOX2B (p.Tyr14Ter). Brain magnetic resonance imaging showed diffuse white matter changes suggestive of gliosis. Further investigations identified early-onset systemic hypertension, requiring antihypertensive therapy. The patient was discharged on nocturnal non-invasive ventilation and enrolled in a neurodevelopmental rehabilitation program. Conclusions: This case highlights the phenotypic variability of CCHS and the importance of considering this diagnosis in children presenting with unexplained hypercapnia and sleep-related hypoxemia. It underscores the need for comprehensive autonomic evaluation, including blood pressure monitoring. The p.Tyr14Ter variant may allow partial protein function, potentially accounting for the relatively mild phenotype. Full article

Background: Long-term glycemic control in type 1 diabetes (T1D) varies substantially among affected individuals, but the role of baseline characteristics at diagnosis and their association with later glycemic control remain incompletely understood. Identifying early predictors of glycemic control may facilitate timely, individualized therapeutic interventions. Methods: We retrospectively analyzed electronic health records of individuals with newly diagnosed T1D between 2001 and 2022 to assess anthropometric and metabolic parameters at the first presentation of the condition across age groups and determine predictors of glycated hemoglobin (HbA_1c) trajectories over 24 months. The multicentric cohort, which comprised people who were diagnosed with T1D in the Austrian federal state of Styria, was classified as children (<10 years), adolescents (10–18 years) or adults (≥18 years). Variables of interest included demographic and anthropometric data, positivity and titers of diabetes-specific autoantibodies, treatment setting (inpatient/outpatient), and presence and severity of diabetic ketoacidosis (DKA). Results: The cohort consisted of 281 individuals (23.1% were children, 41.3% were adolescents, and 35.6% were adults at T1D diagnosis; 46.6% were female). In the unadjusted analyses, younger age (age < 18 years), female sex, and receiving treatment in a general ward were associated with higher HbA_1c levels over 24 months. However, after adjustment for important covariates, only younger age remained a significant predictor of inferior glycemic control over 24 months, emphasizing the importance of structured, age-appropriate follow-up care. Conclusions: Younger age at T1D diagnosis independently predicts suboptimal glycemic trajectories over the first two years after T1D onset. Early identification may enable targeted, age-specific interventions to improve long-term outcomes. Full article

Background/Objectives: Childhood-onset Sjögren disease (cSjD) is a rare autoimmune disorder with heterogeneous manifestations and ongoing diagnostic challenges, as there are no validated paediatric criteria. Our study aims to characterise the clinical, laboratory, and imaging features of children diagnosed with cSjD at a single Romanian paediatric rheumatology centre between 2015 and 2025 and contextualise these findings within the most recent literature. Methods: A retrospective review of 15 consecutive cSjD patients was conducted, including clinical features, autoantibodies, imaging, biopsy findings, treatment, and outcomes. Results: Our cohort showed a significant female predominance (80%) and a broad age range at disease onset (3–15 years). Extraglandular manifestations were more common at presentation than glandular phenotypes (53.3% vs. 40%). Lupus-like extraglandular presentations frequently led to initial misdiagnosis as childhood-onset systemic lupus erythematosus (SLE) in our cohort. Sicca symptoms were present at diagnosis in only 3 of 15 patients (20%) and developed later during follow-up in an additional 4 patients (26.7%). Notably, the cohort included novel findings, such as an unprecedented presentation with acute exudative pericarditis complicated by cardiac tamponade. Anti-SSA antibodies and salivary gland ultrasound abnormalities were highly prevalent (86.7% and 100%, respectively). Anti-SSB antibodies were detected in seven patients (46.7%), with titres showing more variability than those of anti-SSA, ranging from just above the positivity threshold to mildly elevated levels. The association with macro-creatine kinase type I was another distinctive feature of this series. Chronic musculoskeletal pain and dryness were our patients’ most frequently reported symptoms at the last assessment, affecting up to 5/15 (33.3%) in each domain. One patient showed irreversible ocular damage during our study. Conclusions: Extraglandular presentations of cSjD are highly heterogeneous and diagnostically challenging, often occurring without glandular symptoms. Lupus-like systemic features—including facial vasculitic purpura, with or without arthralgia, and occasional pericarditis, as observed in our cohort—may contribute to frequent initial diagnostic misattribution to SLE. Early salivary gland ultrasonography, targeted autoantibody testing, and selective biopsy are essential for timely diagnosis, underscoring the urgent need for paediatric-specific validated classification criteria. Full article

Background/Objectives: Viper envenomation in Italy is uncommon but carries significant clinical and forensic implications: an average of 257 bites per year are estimated, with only one fatality. This epidemiological context necessitates careful consideration of the standard of care and professional liability The article aims to outline the clinical and medico-legal dimensions of viper bites within both national and international contexts. Methods: We report the case of a 40-year-old woman bitten by a viper in an urban environment. At the initial emergency department visit the presentation was classified as Grade 0 (“dry bite”) according to Boels and, after 21 h, was discharged in good condition. Three days later, she returned with worsening symptoms and CT imaging revealed intrafascial and subcutaneous edema. The subsequent onset of complications prompted a criminal malpractice investigation. Therefore, we performed a PubMed search which yielded 125 records; after applying eligibility criteria, 33 articles were included, supplemented by manual reference checking for a total of 60 sources reviewed. Results: Comparison with the Australian model suggests the need for more standardized care pathways in Italy, while accounting for local toxicological and epidemiological specificities. Conclusions: This case and the accompanying literature analysis highlight that, even in low-incidence settings, structured patient communication, multidisciplinary management, collaboration with Poison Control Centers, and adherence to good clinical practice are crucial for patient safety and for mitigating medico-legal risk. Full article

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis in which inflammation plays a central pathogenic role. Endovascular revascularisation may transiently amplify inflammation due to vascular injury, but successful restoration of perfusion could reduce inflammatory burden over time. This prospective, observational, single-centre pilot study aimed to characterise the temporal dynamics of inflammatory biomarkers during the first three months following endovascular revascularisation of the lower limbs. Consecutive patients with PAD who underwent successful percutaneous femoropopliteal revascularisation at the Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia, between January 2022 and January 2024 were enrolled. Venous blood was obtained one hour before the procedure, one day afterwards, and again approximately three months later. Concentrations of high-sensitivity C-reactive protein (hsCRP), interleukins (IL-6, IL-8, IL-10), and tumour necrosis factor-alpha (TNFα) were measured. Temporal changes in biomarker levels were analysed using Friedman and Wilcoxon signed-rank tests where appropriate. Clinical outcomes were evaluated at three months and one year post-procedure and were further verified through patient telephone interviews. The observed outcomes were worsening of PAD symptoms, newly diagnosed angina pectoris, myocardial infarction, stroke, transient ischaemic attack (TIA), or death. Twenty-eight patients (median age 69 years) completed all blood samplings. IL-6 concentrations increased significantly one day after revascularisation and decreased below preprocedural levels at three months, with significant differences observed across all time points (p < 0.001). IL-10 and TNFα decreased significantly between the postprocedural and three-month measurements (p = 0.012 and p = 0.016, respectively), but not below preprocedural levels. No significant changes were observed in hsCRP or IL-8. Over a median follow-up of 732 days, 9 patients experienced worsening PAD symptoms in the treated limb, 2 developed new-onset PAD symptoms in the contralateral limb, and 1 was newly diagnosed with angina pectoris. No myocardial infarction, stroke, TIA, or death occurred. To conclude, endovascular femoropopliteal revascularisation induces distinct short-term inflammatory responses, with IL-6 showing the most pronounced peri-procedural dynamics. The observed reductions in some inflammatory biomarker levels at three months suggest that restored limb perfusion may modulate systemic inflammation. Larger studies are warranted to clarify the prognostic relevance of these biomarkers. Full article

The earlier onset of vegetation phenology and longer growing seasons resulting from global warming are widely recognized as beneficial for enhancing the carbon sink function of terrestrial ecosystems. However, significant uncertainty remains regarding whether the increased growth during the early growing season can be sustained and converted into growth benefits during the later season or even throughout the entire year. This study focuses on vegetation in northern China. Based on solar-induced chlorophyll fluorescence (SIF) data from 2001 to 2020, it establishes an analytical framework for assessing the “seasonal stability” of vegetation growth. The framework quantifies the evolutionary characteristics of early growth enhancement signals during the late growing season. Furthermore, structural equation modeling (SEM) is employed to elucidate the underlying climate-driven mechanisms. The results indicate: (1) Vegetation growth season stability in northern China has long been dominated by the Strong stabilizing type (accounting for 87.4%), suggesting that early growth enhancement signals are mostly attenuated or suppressed during seasonal progression rather than continuously amplified. (2) This stable pattern exhibits a distinct spatial structure at the interannual scale. The expansive and Weak stabilizing types undergo event-driven expansions during specific climatic years, with different vegetation functional types adopting differentiated regulatory strategies during this process. Shallow-rooted grasslands demonstrate higher growth elasticity, while forest vegetation exhibits stronger ecological inertia. (3) Mechanistic analysis reveals that in water-limited zones, enhanced early growth accelerates transpiration processes, thereby disrupting seasonal soil moisture continuity and exacerbating water deficits during the late growing season. This inhibits late-season photosynthesis, constituting a core hydrological–physiological regulatory mechanism that maintains the dominance of Strong stabilizing in the region. Conversely, in energy-limited zones, late-season temperature emerges as the dominant factor constraining sustained growth. This study examines the transmission and modulation mechanisms of early growth signals to the later growing season from the perspective of intra-seasonal dynamics, providing a new analytical approach for incorporating interseasonal processes into assessments of vegetation growth and carbon sink stability in northern China. Full article