Search Results (3,671)

Background: Various controversial conclusions exist regarding the reproductive toxicity of cyclophosphamide, creating uncertainties about the recovery timeline of maternal reproductive capacity and offspring health. Methods: Using a mouse model with a clinically relevant cyclophosphamide dosing regimen, we examined the recovery of female reproductive function after exposure and the long-term survival and development of their offspring. Results: Our findings revealed that cyclophosphamide exposure shortened the maternal reproductive lifespan, characterized by early fertility impairment at one week (p < 0.05), transient recovery at two weeks (p > 0.05), a subsequent decline at four weeks with further deterioration, and eventual progression to infertility at six months (p < 0.01). F1 pups from the cyclophosphamide group exhibited growth restriction, higher mortality rates, delayed pubertal onset, and impaired neurodevelopment during long-term follow-up. Although some parameters transiently improved at 2 weeks post-withdrawal, these abnormalities persisted or recurred at 4 and 8 weeks, indicating that developmental defects were not lessened by prolonging the medication withdrawal period. Conclusions: These findings demonstrate irreversible gonadotoxicity and developmental toxicity following cyclophosphamide exposure in this mouse model. Full article

Background: Deep infiltrating endometriosis (DIE), particularly when involving the bowel, significantly impairs health-related quality of life (HRQoL) and gastrointestinal function. This study aimed to evaluate the short- and mid-term impact of minimally invasive excision on these parameters in a large multicenter cohort. Methods: A retrospective observational study was conducted on 837 patients treated for endometriosis in two tertiary referral centers between 2018 and 2024. All patients underwent laparoscopic or robotic-assisted excision. Quality of life was assessed preoperatively and at 6 months (VAS: n = 69; SF-36: n = 100; GIQLI: n = 98) and 12 months (VAS: n = 30; SF-36: n = 46; GIQLI: n = 44) postoperatively, using validated patient-reported outcome measures (PROMs): the Visual Analog Scale (VAS) for pain, the Short Form-36 (SF-36) survey, and the Gastrointestinal Quality of Life Index (GIQLI). Results: The study population presented with predominantly advanced disease (Stage III–IV in 83.4% of cases), with 39.7% of patients undergoing segmental bowel resection. Postoperatively, a statistically significant reduction was observed in dysmenorrhea (VAS 7.6 vs. 5.0, p < 0.001) and chronic pelvic pain. The SF-36 scores improved significantly across all eight domains at 6 months, with the most dramatic recovery seen in Role Physical (p < 0.001) and Bodily Pain (p < 0.001). Regarding digestive function, the mean GIQLI score showed a progressive increase, reaching statistical significance at 12 months compared to baseline (112.6 vs. 106.6, p = 0.027), indicating superior long-term functional outcomes. Conclusions: Multidisciplinary minimally invasive surgery for deep infiltrating endometriosis was associated with significant and sustained improvements in quality of life among patients with available follow-up. Gastrointestinal quality of life, as measured by GIQLI, improved significantly at 12 months postoperatively, including in patients who underwent segmental bowel resection. Systematic use of PROMs is essential for accurate patient counseling and outcome monitoring. Full article

Background: Uterine fibroids (leiomyomas) are the most common benign tumors in women of reproductive age and represent a significant cause of abnormal uterine bleeding, pelvic pain, infertility, and reduced quality of life. Contemporary management has evolved toward individualized, uterus-sparing approaches, incorporating pharmacological and minimally invasive strategies alongside traditional surgical methods. Methods: This narrative review was conducted based on a comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science databases for studies published between January 2010 and December 2025. The search strategy combined Medical Subject Headings (MeSH) and free-text terms related to uterine fibroids and their management. Eligible studies included clinical trials, systematic reviews, and meta-analyses focusing on pharmacological, minimally invasive, and surgical treatments in adult women. The review was prepared in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) recommendations to improve methodological transparency and quality of reporting. Results: A total of 97 studies were included in the qualitative synthesis. Minimally invasive techniques, including uterine artery embolization (UAE), radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU), demonstrate high efficacy in symptom control and improvement of quality of life, with shorter recovery times and lower complication rates compared to conventional surgery. However, their impact on fertility remains variable and requires careful patient selection. Pharmacological therapies, particularly GnRH analogues and antagonists, effectively reduce bleeding and fibroid volume, although their long-term use is limited by side effects. Conclusions: The management of uterine fibroids should be individualized, taking into account symptom severity, fibroid characteristics, patient age, and reproductive plans. Minimally invasive and pharmacological treatments represent effective alternatives to surgery in appropriately selected patients, while surgical approaches remain essential in advanced or refractory cases. Future research should focus on optimizing personalized treatment strategies and evaluating long-term outcomes, particularly regarding fertility and recurrence. Full article

The increasing demand for sustainable energy and efficient wastewater treatment has driven interest in single-chamber microbial fuel cells (SCMFCs) as integrated systems for bioelectricity generation and waste remediation. This study evaluates untreated agro-industrial byproduct olive mill wastewater (OMW) as a substrate in SCMFCs. It investigates the performance of activated biochar derived from olive pomace coated on stainless-steel mesh (ACB/SSM) as a low-cost cathode material. A synthetic media was used as a control. Electrochemical performance was assessed using voltage profiles, polarization analysis, power density, chemical oxygen demand (COD%) removal, and coulombic efficiency (CE%). The synthetic media achieved higher peak voltage (0.647 ± 0.026 V) and power density (46.05 mW m⁻²), whereas OMW showed more stable voltage output and lower internal resistance. OMW exhibited superior initial COD removal (74%) and a gradual increase in CE% up to 63% over successive cycles. In contrast, synthetic media exhibited a consistent COD% of 64%; its CE% removal improved to 61%. These results demonstrate that, despite lower peak power, OMW provides a more stable and sustainable substrate for long-term SCMFC operation. The use of waste-derived biochar cathodes further enhances system feasibility by reducing cost and supporting circular economy principles. This study highlights the potential of OMW-based SCMFCs as a practical approach for simultaneous wastewater treatment and renewable energy recovery. Full article

Siziwang Banner in Inner Mongolia is a typical arid and semi-arid grassland region where ecological environmental quality is highly sensitive to climate variability and land use and land cover change (LULCC). Clarifying the long-term coupling relationship between LULCC and ecological environmental quality is essential for regional ecological protection and sustainable land management. Based on the Google Earth Engine (GEE) platform, this study integrated multi-temporal Landsat imagery and CLCD-based land use datasets, including an updated 2024 land use layer, to construct a Remote Sensing Ecological Index (RSEI) using standardized and direction-corrected principal component analysis. land use transition matrix analysis, spatial autocorrelation analysis, ecological contribution rate calculation, and GeoDetector were further applied to reveal the spatiotemporal evolution patterns, ecological effects, and driving mechanisms of LULCC in Siziwang Banner from 2000 to 2024. The results showed that: (1) grassland was consistently the dominant land use type, accounting for more than 90% of the total area. The overall land use pattern was characterized by stable grassland dominance, decreasing farmland and unused land, and slight increases in grassland and construction land; forestland showed a high relative growth rate but remained very small in absolute area. (2) The regional ecological environmental quality remained at a lower-to-medium level, with mean RSEI values ranging from 0.27 to 0.47. RSEI showed a phased pattern of initial improvement, subsequent decline, and partial recovery; the marked decline around 2015 was associated with the combined effects of drought stress and land use degradation rather than a single driving factor. RSEI exhibited significant positive spatial autocorrelation, with Moran’s I values ranging from 0.898 to 0.993. High-value clusters were mainly distributed in the southern region, whereas low-value clusters were concentrated in the central and northern regions. (3) Different land use transitions produced differentiated ecological effects. The conversion of unused land to grassland contributed positively to ecological restoration, while grassland degradation and construction land expansion exerted negative effects. The positive RSEI response of some grassland-to-farmland transitions should be interpreted cautiously in relation to local irrigation and intensive farmland management. (4) GeoDetector results indicated that land use type and DEM were the dominant factors controlling the spatial differentiation of RSEI, with average q values of 0.7188 and 0.6178, respectively. The interaction between DEM and land use type showed the strongest explanatory power, indicating that ecological quality was jointly shaped by land use structure and natural background conditions. This study provides a scientific basis for grassland protection, unused-land restoration, farmland management, and spatially differentiated ecological restoration in Siziwang Banner and similar ecologically fragile arid and semi-arid grassland regions. Full article

Background: More than 750 million cases of COVID-19 have been reported worldwide. The respiratory system, particularly the lungs, is one of the main targets of SARS-CoV-2 infection. Although persistent pulmonary function abnormalities have been described in adults, evidence in pediatric populations remains limited and inconsistent. Children usually experience a milder course of COVID-19; however, the long-term impact of SARS-CoV-2 infection on respiratory function in this group is still unclear. Current studies report conflicting findings regarding persistent spirometric abnormalities and their relationship with disease severity and time since infection. Therefore, further research is needed to better characterize post-infectious respiratory sequelae in children and adolescents. The aim of this study was to evaluate spirometric abnormalities in a pediatric cohort following COVID-19 infection. Methods: This retrospective and prospective observational study included 109 children and adolescents aged 6–18 years with a history of asymptomatic, mildly symptomatic, or symptomatic COVID-19 infection. Spirometry was performed following recovery from infection, and pulmonary function parameters were analyzed according to clinical course and time since infection. Results: Spirometry was conducted at a mean of 4.3 ± 2.8 months after infection. Abnormalities in pulmonary function were identified in 23.85% of the study population, with reduced FVC being the predominant spirometric abnormality. No statistically significant association was observed between the severity of COVID-19 and spirometric impairments (p > 0.5). Abnormal spirometry findings were observed across all post-infection time intervals examined; however, no statistically significant differences were identified between the groups. Conclusions: Spirometric abnormalities, predominantly reduced FVC, were observed in a substantial proportion of pediatric patients following SARS-CoV-2 infection. Although no clinical predictors were identified, the absence of pre-infection measurements and a control group limits interpretation. Longitudinal studies are required to clarify the clinical relevance and persistence of these pulmonary function changes. Full article

Background: Fresh frozen tissues are considered the gold standard for proteomic analyses due to their superior preservation of protein integrity; however, their use is limited by the logistical and financial requirements of long-term cold storage. Formaldehyde-fixed paraffin-embedded (FFPE) tissues provide a practical alternative, owing to their stability and widespread availability in clinical settings. A critical step in FFPE proteomics is deparaffinization, which traditionally relies on organic solvents such as xylene, along with the efficient reversal of formaldehyde-induced crosslinks. Methods: In this study, we evaluated multiple FFPE protein extraction and digestion workflows including chaotropic, surfactant-based, and detergent-free approaches in combination with xylene-free deparaffinization strategies, using label-free data-independent acquisition (DIA) LC-MS/MS. Results: Among the tested methods, a chaotropic, reductant, and surfactant-free in-solution digestion workflow demonstrated robust protein and peptide recovery. A modified version of this protocol further improved peptide coverage while maintaining comparable protein depth. The applicability of the optimized workflow was assessed using FFPE needle biopsy samples from control, hepatic steatosis, and liver fibrosis groups. Exploratory proteomic patterns were observed across conditions, with hepatic steatosis associated with early activation of stress-response pathways, while fibrosis showed evidence suggesting altered lipid metabolism. Conclusions: Overall, this study presents a simple, xylene-free, and MS-compatible workflow for FFPE proteomics that is suitable for low-input clinical samples and may support broader application of archival tissues in proteomic research. Full article

Objective: This study aimed to compare the clinical and radiological outcomes between microscopic and unilateral biportal endoscopic (UBE) posterior cervical foraminotomy (PCF). Methods: This study included 73 patients who underwent microscopic PCF (n = 40) or UBE PCF (n = 33) for single-level cervical foraminal disc herniation or stenosis between January 2018 and December 2021. Clinical outcomes were measured using the Visual Analog Scale (VAS) and Neck Disability Index (NDI). Radiologic outcomes were evaluated with cervical range of motion (ROM) using computed tomography and flexion-extension dynamic radiography. Results: The mean follow-up period for microscopic and UBE PCF was 33.0 ± 7.6 months and 29.9 ± 5.9 months, respectively. The postoperative neck VAS until postoperative 2 weeks was significantly lower in the UBE PCF group than in the microscopic PCF group (p < 0.05). The estimated blood loss and operative time were significantly lower in the UBE PCF group than in the microscopic PCF group, while the length of hospital stay was numerically shorter but did not reach statistical significance. The two groups had no significant difference in the NDI on the preoperative and postoperative 3 months. The recurrence occurred in 1 patient (2.5%) of the microscopic PCF group and 1 patient (3%) of the UBE PCF group. The revision surgery was performed in 2 patients (5%) of the microscopic PCF group and in 1 patient of the UBE PCF group. There were no significant differences in motion and instability between the two groups. Conclusions: Both microscopic and UBE PCF are effective and safe procedures for treating cervical radiculopathy due to cervical foraminal disc herniation or stenosis. The UBE approach may provide advantages mainly in early postoperative recovery, including lower early postoperative neck pain, while long-term clinical and radiologic outcomes appear comparable to those of microscopic PCF. Full article

Multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) are pediatric inflammatory conditions which share overlapping clinical features, yet their long-term cardiovascular trajectories remain incompletely characterized. Understanding differences in myocardial strain evolution and coronary artery Z-score progression is essential for optimizing surveillance strategies and risk stratification. Aims of this review were to comprehensively compare the long-term evolution of myocardial strain parameters and coronary artery Z-scores in children with MIS-C versus KD through mid- and long-term follow-up assessment studies, and to identify clinical implications for monitoring and management. A comprehensive literature search was conducted in PubMed to identify studies evaluating myocardial strain and coronary artery Z-scores in MIS-C and KD. Publications from January 2020 to February 2026 were considered for MIS-C, with earlier key studies on KD included to contextualize established cardiac outcomes. Observational studies and cohort reports describing echocardiographic findings and follow-up data were reviewed. Available evidence indicates that MIS-C commonly presents with acute myocardial dysfunction, frequently characterized by reduced global longitudinal strain despite preserved or mildly reduced ejection fraction; in most cases, myocardial strain abnormalities substantially improve within weeks to a few months following treatment. In contrast, myocardial strain impairment in KD, which typically presents at less than 5 years of age, is less pronounced; coronary artery involvement shows an opposite trend, as KD is more frequently associated with coronary dilations and aneurysm formation, reflected by persistent elevations in coronary artery Z-scores, whereas coronary abnormalities in MIS-C are milder and often transient. Recovery patterns therefore differ, with MIS-C demonstrating rapid myocardial functional recovery, and KD carrying a greater risk of long-term coronary artery sequelae. MIS-C and KD exhibit distinct cardiovascular phenotypes: MIS-C is primarily characterized by reversible myocardial dysfunction, whereas KD remains a condition most strongly associated with a risk of persistent coronary artery abnormalities. Deciphering these differences may help guide disease-specific cardiac monitoring and long-term follow-up strategies in affected children. Full article

Health tourism represents a dynamic sector operating at the intersection of medical services, international patient mobility, and tourism development. Despite its growing prominence, the academic literature frequently conflates health tourism with medical and wellness tourism—a conceptual ambiguity that complicates the establishment of robust, sustainable legal frameworks. Addressing this gap, the present paper conceptualizes health tourism as an overarching framework that encompasses recovery, wellness, and medical sub-sectors. Within this comprehensive paradigm, we explore the contemporary landscape of health tourism in Northern Cyprus through a stakeholder-driven qualitative lens. Utilizing a qualitative case study design, data were gathered via semi-structured interviews with 40 key respondents representing healthcare, travel, public administration, academia, and related professional domains, and subsequently subjected to thematic analysis using NVivo 15 software. The findings reveal that the sector in Northern Cyprus is heavily skewed toward medical tourism, with a concentrated focus on in vitro fertilization (IVF), cosmetic surgery, dental care, and bariatric procedures. Conversely, wellness and rehabilitation tourism remain largely untapped strategic niches. The analysis further indicates that sectoral growth is constrained by structural bottlenecks, including fragmented governance, limited international recognition, transport and accessibility barriers, inadequate accreditation systems, lack of stakeholder synergy, and ethical concerns regarding advertising and patient safety. Moving beyond standard environmental sustainability, this research underscores that long-term destination resilience requires ethical governance, clinical quality controls, patient-rights advocacy, transparent legal frameworks, and community-level economic integration. Ultimately, this study proposes an integrated, stakeholder-centric paradigm tailored to the unique socio-political and structural realities of Northern Cyprus, offering actionable policy recommendations that enrich the discourse on sustainable medical tourism from a small-island perspective. Full article

This study investigates the cross-border consequences of large-scale military attacks on Ukraine’s critical energy infrastructure and their implications for European energy resilience. Unlike prior research focused primarily on national-level disruption, this paper conceptualizes wartime infrastructure destruction as a source of systemic spillover risk within interconnected electricity systems. We develop an analytical framework integrating three dimensions: shock probability, structural vulnerability, and recovery capacity. Using evidence from 2022–2026 and comparative assessment of selected European Network of Transmission System Operators for Electricity (ENTSO-E) countries, we identify substantial asymmetries in exposure and resilience. Moldova appears highly vulnerable due to structural dependence and limited flexibility, whereas Poland demonstrates stronger resilience supported by diversification and institutional capacity. The findings show that shocks originating in Ukraine propagate through electricity trade flows, balancing constraints, and price volatility. The results highlight that large-scale attacks on the energy system threaten not only immediate regional security but also the long-term energy sustainability of the interconnected European network. The paper contributes to the literature by linking war-induced infrastructure damage with sustainable energy governance and by proposing resilience tools such as digital twins and blockchain coordination. The results are relevant for policymakers, transmission operators, and crisis management institutions across Europe. Full article

Traumatic brain injury (TBI) is a global public health problem which causes long-term neurologic damage caused by both primary mechanical injury and secondary pathological processes. Extracellular vesicles (EVs) such as exosomes, microvesicles (MVs) and apoptotic bodies (ApoBDs) serve as critical vehicles mediating intercellular communication in the central nervous system (CNS) following TBI. The biogenesis and the content of EVs, including proteins, lipids and RNAs, are greatly changed and involved in the evolution of inflammation or tissue repairing after TBI. In this overview, we recapitulate the cellular origin of EVs and the function of EVs in the neuroinflammatory process after TBI, highlighting the dual regulatory roles of EVs in the biological response to TBI, whereby certain EV populations amplify secondary injury cascades, while others promote endogenous repair and recovery processes. We next investigate the progress in EV engineering and targeted delivery systems and report the potential mechanisms, emphasize the prospects and potential of engineered EVs for therapy, and comment on challenges and perspectives for clinical application in TBI. Full article

Qinghai Lake, the largest endorheic saline lake in China, has undergone a pronounced hydrological regime shift from a multi-decadal decline to a rapid post-2004 recovery, reflecting strong hydroclimatic non-stationarity in the northeastern Tibetan Plateau (TP). This paper supplements the current water level and lake area status of Qinghai Lake to provide basic background for future prediction. Reliable forecasting of such climate sensitive lake systems remains difficult because conventional statistical models often fail to capture non-linear fluctuations, whereas standalone deep learning models may overlook long-term deterministic evolution. To address this challenge, we developed a serial decomposition GeoAI framework that integrates autoregressive integrated moving average (ARIMA), one-dimensional convolutional neural networks (1D-CNNs), and long short-term memory (LSTM) networks for non-stationary water level forecasting. Using annual water level observations from 1960 to 2025, the ARIMA component was first used to extract the low-frequency deterministic trend, after which the CNN-LSTM module reconstructed the nonlinear residual variability. The model was trained on the 1960–2012 period and validated over 2013–2025, which represents the most dynamic expansion stage of Qinghai Lake. The hybrid framework outperformed the benchmark models, achieving a Root Mean Square Error (RMSE) of 0.2033 m, Mean Absolute Error (MAE) of 0.1727 m, and Mean Squared Error (MSE) of 0.0413 m² during validation. The decomposition strategy effectively reduced phase lag and amplitude attenuation, improving both predictive accuracy and process interpretability. Multi-step forecasting for 2026–2056 suggests that Qinghai Lake will continue to rise, reaching approximately 3204.08 m by 2056, although the growth rate is projected to slow as negative hydrological feedback strengthen. By explicitly separating deterministic climate scale signals from nonlinear short-term variability, the proposed framework provides a robust and transferable geoinformation based tool for forecasting water level dynamics and supporting adaptive management in climate sensitive, data scarce lake basins. Full article

Single-index greening trends can misrepresent post-mining recovery because they do not show whether disturbed surfaces are converging toward the spectral conditions of nearby stable vegetation. Here, we present a 22-year (2003–2024) Landsat-based assessment of the Nannihu molybdenum mine (Henan, China) by combining LandTrendr-based disturbance and recovery timing from annual NBR series with a benchmark-relative spectral recovery index (RSRI) and five-epoch random forest land-surface classification used as contextual support. The classifier was trained on 2024 samples and transferred to earlier epochs without independent validation at each epoch. Historical class labels should therefore be treated as approximate contextual support. A five-type recovery pathway typology showed that only 41.8% of mine-affected pixels followed vegetated recovery pathways, while 28.2% stabilized as non-vegetated surfaces and 25.0% remained under persistent disturbance. Even the combined vegetation recovery type had a mean RSRI of only 0.309 (SD = 0.143), suggesting that greening alone does not imply close benchmark-relative spectral proximity to the local stable-vegetation reference. Disturbance magnitude was the feature most strongly associated with RSRI variation (XGBoost SHAP mean, |SHAP| = 0.075). The RSRI quantifies benchmark-relative spectral proximity using local stable-vegetation benchmarks, and it does not measure species composition, biomass, or ecosystem function. This site-specific case study indicates that benchmark-relative spectral assessment can complement conventional greening metrics in retrospective mine monitoring using open-access Landsat archives, with field validation the natural next step toward linking these spectral findings to ecological or functional recovery. Full article

Background and Objectives: Pediatric keratoconus may progress rapidly, and treatment decisions are often made before prolonged observation is possible. This study evaluated 24-month visual, tomographic, pachymetric, and biomechanical outcomes after conventional epithelium-off corneal collagen cross-linking (CXL) using Pentacam tomography and Corvis ST dynamic Scheimpflug analysis. Materials and Methods: This single-center observational longitudinal cohort included 28 eyes of 23 patients aged 13–18 years treated at the OCULENS Clinic, Cluj-Napoca, Romania, between 2019 and 2023. Because the study had no untreated or alternative-treatment control group, postoperative changes were interpreted as associations after CXL rather than as proof of causality. Baseline, 6-, 12-, and 24-month values were analyzed for UCVA, BCVA, Kmax, thinnest pachymetry, SP-A1, deformation amplitude (DA), first and second applanation times (A1T and A2T), highest concavity (HC) radius, and BAD-D. Repeated-measures ANOVA was used after assessment of within-eye difference normality; findings were interpreted cautiously because the analysis was eye-based, the cohort was small, and multiple outcomes were examined. Results: UCVA improved from 0.53 ± 0.16 to 0.44 ± 0.16 logMAR and BCVA from 0.31 ± 0.11 to 0.25 ± 0.11 logMAR (both p < 0.001). Mean Kmax decreased modestly from 54.36 ± 3.11 D to 53.41 ± 2.79 D, while SP-A1 increased from 84.69 ± 4.75 to 97.39 ± 5.11 (both p < 0.001). Thinnest pachymetry showed early postoperative thinning followed by partial recovery by 24 months. DA decreased, A1T increased, A2T decreased, HC radius increased, and BAD-D decreased significantly. Kmax and SP-A1 were inversely correlated at all visits (r = −0.714 to −0.773; all p < 0.001), but these correlations were considered exploratory. Post-24-month retreatment and keratoplasty-related events were recorded descriptively and were not included in the formal 24-month model. Conclusions: Within the prespecified 24-month analytic window, conventional epithelium-off CXL was associated with stabilization, modest visual and tomographic improvement, and a concordant biomechanical stiffening signal. The results should be interpreted as cautious observational findings rather than definitive evidence of long-term stability, because of the small sample, eye-level analysis, absence of a control group, limited follow-up, and lack of formal repeatability testing. Full article