Search Results (1,148)

Background: Renal cell carcinoma (RCC) is a common malignancy with a rising global incidence. While cytoreductive nephrectomy (CRN) was historically a cornerstone in the management of metastatic RCC (mRCC), its role has been questioned following pivotal trials such as CARMENA and SURTIME. With the advent of immune checkpoint inhibitors (ICIs) and targeted therapies, the contemporary relevance of CRN coupled with first-line immunotherapy and targeted therapy combination regimens warrants re-evaluation. Methods: This retrospective cohort study utilized the TriNetX research network to identify patients aged 18–90 years diagnosed with mRCC between 2005 and 2024 who received first-line systemic therapies. Patients were stratified into two cohorts based on receipt of CRN status within one year of diagnosis. Propensity score matching (1:1) was done to adjust baseline characteristics. Kaplan–Meier survival analysis and Cox proportional hazards modeling were used to compare five-year overall survival between the groups. Results: Among 5960 eligible patients, 1776 (888 CRN matched to 888 who did not) formed the cohort of analysis. The CRN group demonstrated significantly higher five-year survival (57.7% vs. 45.0%, p < 0.0001) with a hazard ratio of 1.56 (95% CI: 1.33–1.83). Subgroup analyses showed consistent survival benefits across all four NCCN-recommended first-line regimens—Axitinib + Pembrolizumab: 64.0% (CRN) vs. 53.3% (no CRN), p = 0.01; Cabozantinib + Nivolumab: 50.1% vs. 40.4%, p = 0.004; Lenvatinib + Pembrolizumab: 37.4% vs. 22.8%, p = 0.012; Nivolumab + Ipilimumab: 56.4% vs. 46.1%, p = 0.005. Conclusions: In the era of modern immunotherapy and targeted agents, CRN remains associated with improved survival in patients with mRCC receiving NCCN-recommended first-line regimens. These findings support the continued evaluation of CRN as a component of multimodal therapy, particularly in patients with favorable risk profiles. Full article

The Alevis of Anatolia and the Balkans and the Alawites of Syria and southeastern Turkey are two distinct ethnoreligious communities frequently conflated in both media and scholarly literature, despite their divergent historical origins, theological differences, and varying sociocultural formations. While their shared histories of marginalization and persecution, certain theological parallels, and cognate ethnonyms contribute to this conflation, it largely stems from a broader tendency within mainstream Islamic frameworks to homogenize so-called heterodox communities without sufficient attention to their doctrinal and cultural specificities. This paper, grounded in a synthetic analysis of current scholarship, maps the key historical, theological, and sociocultural intersections and divergences between Alawite and Alevi communities. Situated within the broader framework of intra-Islamic diversity, it seeks to move beyond essentialist and homogenizing paradigms by foregrounding the distinct genealogies of each tradition, rooted, respectively, in the early pro-Alid movements of Iraq and Syria and in Anatolian Sufism. In addition, the study examines the communities’ overlapping political trajectories in the modern era, particularly their alignments with leftist and secular–nationalist currents, as well as their evolving relationship—from mutual unawareness to a recent political rapprochement—prompted by the growing existential threats posed by the rise of Sunni-Salafi Islamist movements. Full article

In the modern era of smart grids, integrating advanced Geographic Information Systems (GISs) with protection coordination functionalities is pivotal for enhancing the reliability and efficiency of distribution networks. This paper presents an implementation of a web-based distribution network GIS platform that seamlessly integrates distribution system feeder GIS monitoring with the system model file layout, fault current analysis, and coordination simulation functions. The system can provide scalable and accessible solutions for power utilities, ensuring that protective devices operate in a coordinated manner to minimize outage impacts and improve service restoration times. The proposed GIS platform has demonstrated significant improvements in fault management and relay coordination through extensive simulation and field testing. This research advances the capabilities of distribution network management and sets a foundation for future enhancements in smart grid technology. Full article

In the modern era, the use of blockchain technology has been growing rapidly, where Ethereum smart contracts play an important role in securing decentralized application systems. However, these smart contracts are also susceptible to a large number of vulnerabilities, which pose significant threats to intelligent systems and IoT applications, leading to data breaches and financial losses. Traditional detection techniques, such as manual analysis and static automated tools, suffer from high false positives and undetected security vulnerabilities. To address these problems, this paper proposes an Artificial Intelligence (AI)-based security framework that integrates Generative Adversarial Network (GAN)-based feature selection and deep learning techniques to classify and detect malware attacks on smart contract execution in the blockchain decentralized network. After an exhaustive pre-processing phase yielding a dataset of 40,000 malware and benign samples, the proposed model is evaluated and compared with related studies on the basis of a number of performance metrics including training accuracy, training loss, and classification metrics (accuracy, precision, recall, and F1-score). Our combined approach achieved a remarkable accuracy of 97.6%, demonstrating its effectiveness in detecting malware and protecting blockchain systems. Full article

Low solar radiation, caused by climate change or dense planting patterns, now limits wheat production. Although wheat breeding has increased lodging resistance and yield potential through the introduction of dwarfing genes, it still reduces wheat yields. Few studies have been conducted to clarify the lodging sensitivity to shading of different-era wheat cultivars in China’s Huang-Huai-Hai region, as well as the characteristics of lodging resistance as affected by paclobutrazol under shading stress. To address this gap, the experiment included two wheat cultivars released in different decades, grown under shade and treated with or without paclobutrazol. The results showed that reductions in filling degree and lignin content, together with increases in length of the basal internode and gravity center height, markedly reduced the section modulus and breaking strength of shaded wheat culms. These changes impaired lodging resistance and raised lodging risk. However, paclobutrazol application effectively reduced lodging incidence and increased wheat yield under shading stress. Furthermore, these responses were more pronounced in the old cultivar (YZM) than in the modern cultivar (S28). This indicates that the culm mechanical parameters of the old cultivar were more shade-sensitive than those of the modern cultivar. Moreover, shading downregulated the relative expression levels of key genes associated with lignin biosynthesis to decrease the activities of key enzymes, thereby inhibiting the biosynthesis and deposition of lignin in culms to increase the risk of wheat lodging. Paclobutrazol application alleviated the inhibitory effects of shading on lignin biosynthesis, thereby strengthening culms and enhancing lodging resistance. These findings may provide a basis for exploring cultivation regulation methods to enhance wheat lodging resistance under overcast and low-sunshine conditions, and to offer guidance for the breeding of wheat cultivars with lodging resistance and shade tolerance. Full article

In an era of exponential data growth, ensuring high data quality has become essential for effective, evidence-based decision making. This study presents a structured and comparative review of the field by integrating data classifications, quality dimensions, assessment methodologies, and modern software tools. Unlike earlier reviews that focus narrowly on individual aspects, this work synthesizes foundational concepts with formal frameworks, including the Findable, Accessible, Interoperable, and Reusable (FAIR) principles and the ISO/IEC 25000 series on software and data quality. It further examines well-established assessment models, such as Total Data Quality Management (TDQM), Data Warehouse Quality (DWQ), and High-Quality Data Management (HDQM), and critically evaluates commercial platforms in terms of functionality, AI integration, and adaptability. A key contribution lies in the development of conceptual mappings that link data quality dimensions with FAIR indicators and maturity levels, offering a practical reference model. The findings also identify gaps in current tools and approaches, particularly around cost-awareness, explainability, and process adaptability. By bridging theory and practice, the study contributes to the academic literature while offering actionable insights for building scalable, standards-aligned, and context-sensitive data quality management strategies. Full article

Driven by industry–education integration and digital technology, higher vocational education textbooks are transitioning from traditional formats to an integrated “loose-leaf + digital” model. Combining the flexibility of loose-leaf textbooks with digital technology, these new materials enable real-time updates and align closely with industry practices. We explored the era connotations of integrated textbooks and proposed a development process based on cognitive psychology, interdisciplinary integration, and synergy theory. Continuous optimization through robust evaluation systems and digital platforms is required to provide modernized and informatized vocational education. Full article

Antimicrobial resistance (AMR) poses a critical global health threat by rendering existing antibiotics ineffective against infections, leading to increased mortality, prolonged illnesses, and higher healthcare costs. Developing new antibiotics is essential to combat resistant pathogens, safeguard modern medical procedures, and prevent a return to a pre-antibiotic era where common infections become untreatable. We report a series of chiral tricarbonyl rhenium(I) complexes incorporating enantiopure pinene-substituted bipyridine ligands (L#) of the general formula fac-[Re(CO)₃L#X] and fac-[Re(CO)₃L#Py]⁺ (where X = Cl or Br and Py = pyridine). These complexes were isolated as mixtures of two diastereomers, characterized by standard techniques, and evaluated for cytotoxic activity against methicillin-resistant and methicillin-sensitive Staphylococcus aureus (MRSA and MSSA). The results revealed notable antibacterial efficacy (MIC = 1.6 μM), reflected in high therapeutic indices (Ti > 10). In contrast, analogous complexes bearing non-chiral 2,2′-bipyridine ligands exhibited no activity, underscoring the critical role of chirality in modulating biological interactions at the molecular level. These findings highlight the potential of chiral Re(I) complexes as promising scaffolds for the development of more potent and selective antibacterial agents. Full article

The essay offers an expansive and multi-stratified investigation into the role of esoteric traditions within the development of Russian modernity, reframing occultism not as an eccentric deviation but as a foundational epistemological regime integral to Russia’s aesthetic, philosophical, and political evolution. By analyzing the arc from Petrine-era alchemical statecraft to the techno-theurgical aspirations of Russian Cosmism and the esoteric visual regimes of the avant-garde, this essay discloses the deep ontological entanglement between sacral knowledge and modernist radical experimentation. The work foregrounds figures such as Jacob Bruce, Wassily Kandinsky, and Kazimir Malevich, situating them within broader transnational currents of Hermeticism, Theosophy, and Rosicrucianism, while interrogating the role of occult infrastructures in both late-imperial and Soviet paradigms. Drawing on recent theoretical frameworks in the global history of esotericism and modernist studies, the long-read article elucidates the metaphysical substrata animating Russian Symbolism, Abstraction, Malevich’s non-Euclidian Suprematism and Moscow Conceptualism. This study contends that esotericism in Russia—far from marginal—served as a generative matrix for radical aesthetic innovation and ideological reconfiguration. It proposes a reconceptualization of Russian cultural history as a palimpsest of submerged sacral structures, where utopia and apocalypse, magic and technology, converge in a distinctively Russian cosmopoietic horizon. Ultimately, this essay reframes Russian and European occultism as an alternate technology of cognition and a performative semiotic universe shaping not only artistic modernism but also the very grammar of Russian historical imagination. Full article

The influence of social media personalities has grown significantly, especially among youth audiences who spend substantial time on platforms like TikTok. The emergence and popularity of different types of social media influencers accelerated during the COVID-19 pandemic in many countries, including South Africa. In turn, this period also saw a surge in youth audiences following these influencers. This rapid growth of influencer followings among young people is largely driven by specific types of content that resonate with them, thus encouraging continued engagement. However, the benefits that these young followers gain from engaging with various influencers and the factors driving their preferences for specific influencers remain underexplored, particularly within the context of South African students within higher education. Therefore, this study explores the types of social media influencers most followed by university students at a South African University and investigates the key factors that drive their preferences. A structured online questionnaire was distributed, gathering both multiple-choice and open-ended responses from students. The data were analyzed using categorical frequency counts and thematic analysis. The data highlight how students actively turn to influencers as emotional anchors, role models, and sources of practical guidance. Their engagement reflects a deep need for connection, inspiration, and identity formation in a challenging academic and social environment. These patterns show that influencer content is not just entertainment but plays a critical developmental role. Understanding these motivations helps educators, policymakers, and brands to align better with youth values. The significance of these results lies in how influencer content is now coming in to fill the emotional, cultural, and educational gaps left by traditional systems among the young South African university students in this modern era. Full article

The pursuit of sustainable construction practices has become imperative in the modern era. This paper delves into the research of the properties and application of a specific material called “red clay” from the locality “Crvena Mogila” in Macedonia. A series of laboratory tests were conducted to evaluate the physical, mechanical, and chemical properties of the material. The tested samples show that it is a porous material with low density, high water absorption, and compressive strength in range of 29.85–38.32 MPa. Samples of composite wall blocks were made with partial replacement of natural aggregate with red clay aggregate. Two types of blocks were produced with dimensions of 390 × 190 × 190 mm, with five and six holes. The average compressive strength of the blocks ranges from 3.1 to 4.1 MPa, which depends on net density and the number of holes. Testing showed that these blocks have nearly seven-times-lower thermal conductivity than conventional concrete blocks and nearly twice-lower conductivity than full-fired clay bricks. The general conclusion is that the tested red clay is an economically viable and sustainable material with favourable physical, mechanical, and thermal parameters and can be used as a granular aggregate in the production of composite ceramic blocks. Full article

Introduction: Obstructive sleep apnea syndrome (OSAS) is caused by anatomical and non-anatomical factors which lead to upper airway (UA) obstruction during sleep. Intrinsic UA collapse is the most frequent determinant of OSA. In the era of personalized medicine, adopting a tailored diagnostic approach is essential to rule out secondary causes of UA collapse, particularly those stemming from extrinsic anatomical factors. Although being rarely considered in the differential diagnosis, space-occupying lesions of deep cervical spaces such as the parapharyngeal space (PPS) may be responsible for airway obstruction and lead to OSAS. Objective: This study aimed to present an atypical case of OSAS caused by extrinsic PPS compression, outlining the relevance of modern personalized medicine in the diagnostic and therapeutic protocols, and to enhance understanding through a comprehensive literature review. Methods: A 60-year-old female presented with sleep-disordered complaints and was diagnosed with severe OSAS after polysomnography. At physical examination, a swelling of the right posterior oropharyngeal mucosa was noticed. Imaging confirmed the suspicion of a PPS tumor, and transcervical resection was planned. Case presentation was adherent to the CARE checklist. A comprehensive literature review was conducted using the most reliable scientific databases. Results: Surgery was uneventful, and the patient made a full recovery. The histopathology report was consistent with the diagnosis of pleomorphic adenoma. Postoperative outcomes showed marked improvement in polysomnographic parameters and symptom burden. Conclusions: Parapharyngeal space tumors are a rare, often overlooked cause of OSA. This case highlights the role of a personalized head and neck assessment in OSA patients, particularly in identifying structural causes and offering definitive surgical management when indicated. Full article

This study focuses on the impact of China’s digital economy on sustainable modernization from 2011 to 2021, using provincial panel data for empirical analysis. By applying threshold and mediation models, we find that the digital economy promotes modernization through industrial upgrading (with a mediating effect of 38%) and trade openness (coefficient = 0.234). The research reveals “U-shaped” nonlinear threshold effects at specific levels of digital development (2.218), market efficiency (9.212), and technological progress (12.224). Eastern provinces benefit significantly (coefficient ranging from 0.12 to 0.15 ***), while western regions initially experience some inhibition (coefficient = −0.08 *). Industrial digitalization (coefficient = 0.13 ***) and innovation ecosystems (coefficient = 0.09 ***) play crucial roles in driving eco-efficiency and equity, in line with Sustainable Development Goals 9 and 13. Meanwhile, the impacts of infrastructure (coefficient = 0.07) and industrialization (coefficient = 0.085) are delayed. Economic modernization improves (coefficient = 0.37 ***), yet social modernization declines (coefficient = −0.12 *). This study not only enriches economic theory but also extends the environmental Kuznets curve to the digital economy domain. We propose tiered policy recommendations, including the construction of green digital infrastructure, carbon pricing, and rural digital transformation, which are applicable to China and offer valuable references for emerging economies aiming to achieve inclusive low-carbon growth in the digital era. Future research could further explore the differentiated mechanisms of various digital technologies in the modernization process across different regions and how to optimize policy combinations to better balance digital innovation with sustainable development goals. Full article

The modern era of systemic treatment of urological cancers is definitely marked by checkpoint inhibitors. Over the past 30 years, checkpoint inhibitors have changed the oncological world, especially in chemoresistant malignancies. Multiple investigations focused on immunotherapy in urological cancers have carved new paradigms and changed clinical guidelines. However, some clinical trials have been blind alleys for systemic therapy. After a scrutinized review of electronic databases, we want to present the natural history and courses of clinical trials in urological malignancies. All of them contribute to expanding the knowledge and experience of clinicians, and some of them improve the prognosis and prolong the overall survival of oncological patients. In conclusion, checkpoint inhibitors open a new modern era in some urological cancers, but not overall. Future perspectives are focused on combination with targeted therapy and could be a new way forward in the systemic treatment of urological cancers. Full article

Inscribed trays, plates, mortars, and pestles made of beautiful green chert bearing formulaic administrative textual formulae were found during excavations at the Persepolis Treasury in the 1930s. These implements and the enigmatic formulae inscribed upon them present scholars with a complex and unique challenge whose correct interpretation holds important implications for the study of Achaemenid history, imperial administration, and relations between ancient Arachosia (roughly modern-day Afghanistan) and the centers of power, as well as—as I argue in this article—for the symbiosis between administration and cult in antiquity. They continue to be hotly debated ever since their inauspicious initial publication by Bowman in 1970, yet they have thus far remained obscure. By comparing these finds with material and textual data from across the Achaemenid empire and early Parthian sources, this article offers a new comprehensive study of these objects. My analysis suggests that these objects are to be considered as a more systematized and tightly controlled Arachosian form of “informal taxation”—namely, regulated gifts—which are comparable to similar imperial donations found in the Treasury at Persepolis. Specifically, they take part in an “economy of fealty” demonstrating loyalty to king and empire through the adherence to the era’s Mazdean ritual orthopraxy. Full article