Search Results (37,739)

Accurate measurement of serum uric acid (UA) is critical for disease assessment and therapeutic monitoring; however, numerous factors can compromise the accuracy of UA detection. This study describes a novel circulating immunoglobulin M (IgM)-involved protein complex that interferes with the uricase method and reduces serum UA measurement accuracy. A total of 24 serum samples were collected from 18 patients, and complete clinical information and laboratory data were obtained. Samples were divided into three groups according to their UA reaction curves. Optical density values were extracted to analyze differential insoluble properties, serum viscosity was measured, coimmunoprecipitation was performed for IgM complex detection, and three additional clinical methodologies were used for UA measurement and comparison. All samples exhibiting unique reaction curves showed simultaneous elevations in IgM and complement component 4 (C4) levels. Circulating IgM formed a protein complex with C4d without significantly increasing serum viscosity. The insolubility of the IgM–C4d complex was attributable to the particular alkaline component of the uricase reagent. Inaccurate UA measurements could only be corrected by mass spectrometry. This study represents the first report of the circulating IgM–C4d protein complex. Given that serum UA serves as a crucial therapeutic indicator for specific patient populations, mass spectrometry is the preferred analytical method for accurate UA quantification in these individuals. Full article

The aim of the present study was to evaluate the bioavailability and associated bioactivity of p-coumaric (p-COA), caffeic (CA), and ferulic (FA) hydroxycinnamic acids (HCAs) isolated from an aqueous extract of plant material. An aqueous extract is more applicable in practice because this form is the most commonly used for oral administration. The p-COA, CA, and FA acids were evaluated for their behavior in the processes of absorption, distribution, metabolism, and excretion (ADME) using modern methods for assessing their functional groups according to Lipinski’s Rule of Five and the Rule of Nines. Given the available data on extensive metabolism of hydroxycinnamic acids during the first pass through the liver, it is necessary to consider an alternative route of administration, namely the sublingual route. Sublingual delivery of exogenous molecules obtained from plant material by extraction may represent a preferable alternative to oral administration, as first-pass hepatic metabolism is bypassed when dosage forms are administered sublingually. Full article

The article examines how India and Pakistan have interpreted the Indus Water Treaty (IWT) in the broader context of their preference, needs, and constraints. Rather than treating the IWT as a static legal instrument or as a case of institutional resilience, the analysis conceptualizes the Treaty as a performance-based regime, where treaty stability emerges from how states perform their obligations over time rather than from institutional design alone. Adopting a qualitative process-tracing approach grounded in treaty interpretation as operationalized through state practice, this article advances three interrelated arguments: first, the durability of the IWT cannot be explained solely by institutional design, but must be understood as a “performance-based equilibrium” sustained through state practice. Second, this stability historically relied on a pattern of “compliance asymmetry,” in which India, as the upper riparian, exercised restraint well beyond minimal entitlement while Pakistan consolidated downstream dependence through infrastructural development. Third, the growing juridification of dispute resolution since the 2000s, driven by escalating infrastructural friction, has altered the political meaning of compliance, narrowed interpretive flexibility, and reshaped reciprocal expectations. The article contributes to the scholarship of international legal theory and hydro-politics, particularly by reconceptualizing treaty resilience as a function of material and political performance, rather than the formal text alone. Full article

Background: Linear growth during childhood is a key indicator of health status and child development, and liquid cow’s milk has been proposed as a potentially relevant dietary component for this outcome. In this systematic review, we aimed to synthesize the available evidence on the association between liquid cow’s milk consumption and linear growth outcomes in infants and children aged 6 months to 12 years. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Observational and experimental studies published in peer-reviewed journals, with no language restrictions, were included if they assessed habitual liquid cow’s milk consumption as the main exposure and reported linear growth outcomes such as height, growth velocity, or height-for-age z-scores. Searches were performed in PubMed (MEDLINE) and Scopus from database inception to 15 January 2026. Study selection, data extraction, and risk-of-bias assessment were carried out systematically. Due to methodological heterogeneity among the included studies, results were synthesized narratively. Results: Twelve studies conducted across diverse geographic and socioeconomic contexts were included. Most studies reported positive associations between liquid cow’s milk consumption and indicators of linear growth, including greater height, higher growth velocity, or improved height-for-age z-scores. Experimental studies showed significant increases in linear growth among children who received milk regularly, whereas some observational studies reported non-significant associations or results dependent on statistical adjustment. One study assessing complete cow’s milk exclusion observed deceleration in linear growth. Overall, the risk of bias was predominantly moderate. Conclusions: Habitual consumption of liquid cow’s milk during childhood appears to be predominantly associated with favorable linear growth outcomes, although variability exists according to study design, age at exposure, milk type, and exposure assessment. Further research using more robust designs is warranted to clarify the magnitude of the association, potential mechanisms, and implications for weight-related outcomes. Full article

Diffusion-based generative models achieve high-fidelity image synthesis; however, controlling internal representations for abstract visual concepts remains challenging due to the ambiguity of textual descriptions. In this work, we propose a prompt-guided concept-vector learning framework for the controllable manipulation of such concepts without requiring external human-annotated image pairs, segmentation masks, identity labels, or manually annotated editing targets. The method introduces a learnable concept vector optimized in the bottleneck (mid-block) feature space of a pretrained Stable Diffusion U-Net, while keeping all pretrained model parameters frozen. A multi-prompt data generation strategy based on paired positive and neutral prompts provides weak semantic guidance for capturing the target concept direction and reducing dependence on a single prompt formulation. The learned vector is further applied in an image-to-image setting through controlled noise injection and concept-guided denoising, enabling the semantic modification of real images while preserving structural content. The concept strength is controlled by a scaling parameter $\gamma$, while the image-to-image noise strength is controlled by $\beta$, allowing for a practical balance between semantic modification and structural fidelity. Experiments are conducted on two main abstract concepts, perfect skin and peaceful lake, with additional qualitative analysis on subjective portrait-level concepts. Quantitative evaluation using SSIM, LPIPS, and CLIP similarity demonstrates that the proposed method improves semantic alignment while maintaining structural preservation compared with Stable Diffusion image-to-image baselines. A human preference study further shows that concept-injected outputs are preferred in 76.0% of responses for perfect skin and 85.7% for peaceful lake. Ablation studies further demonstrate the controllability and robustness of the proposed framework. Overall, the method provides a simple and parameter-efficient approach for interpretable concept-level manipulation in diffusion models. Full article

Background: Post-traumatic growth (PTG) refers to positive psychological changes resulting from the struggle with highly challenging or traumatic life events. Psychosocial interventions have demonstrated efficacy in promoting psychological well-being in the aftermath of traumatic experiences. Cognitive Behavioral Therapy (CBT) is among the most extensively studied such interventions, aligning with the PTG model’s prerequisites for growth. Objective: The aim of this systematic review was to assess the efficacy of CBT and CBT-based interventions in promoting PTG. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Scopus, and Google Scholar databases from inception to December 2024. Eligibility criteria included: (a) the inclusion of a CBT or CBT-based intervention, (b) measurement of PTG using the Post-Traumatic Growth Inventory (PTGI), (c) study participants having experienced traumatic life events, and (d) articles written in English. Risk of bias was assessed independently by two reviewers. Due to the heterogeneity of included studies, a qualitative narrative synthesis approach was adopted. Risk of bias was assessed using the RoB-2 tool for RCTs, ROBINS-1 for quasi-experimental studies and Newcastle–Ottawa scale for cohort studies. Certainty of evidence, assessed using the GRADE framework, is considered low. Results: A total of 19 studies were included (13 randomized controlled trials, 3 quasi-experimental, and 3 longitudinal studies). While traditional CBT produced mixed results in fostering PTG, CBT-based therapeutic protocols—particularly those explicitly designed to target PTG or incorporating structured cognitive–emotional techniques—demonstrated more consistent benefits. Limitations of the included studies include measurement of PTG as a secondary outcome, small sample sizes, and the presence of confounding variables. Conclusions: Further high-quality, multicenter randomized controlled trials with standardized protocols are needed to clarify the role of CBT in promoting growth after trauma. Full article

With increasing residential electricity demand, hybrid energy systems capable of simultaneously improving affordability, reliability, and environmental performance have become increasingly important. This paper develops an integrated techno-economic and environmental assessment framework for grid-connected residential energy systems under unreliable grid conditions and applies it to a real-world residential case study in Fayoum, Egypt. In the proposed framework, the utility grid is treated as the primary electricity source, while PV, diesel generation, and battery storage are evaluated as backup/support options. Six grid-connected hybrid configurations, namely Grid/Diesel, Grid/PV/Diesel, Grid/PV/Diesel/Battery, Grid/Diesel/Battery, Grid/PV/Battery, and Grid/Battery, were evaluated under identical load, solar resource, and economic conditions to identify the minimum net present cost (NPC)configuration capable of satisfying a specified service level, expressed in terms of the maximum allowable unmet load ratio. The optimization problem was formulated as a single-objective model that minimizes NPC, subject to technical constraints and a service level constraint represented by a zero unmet load requirement in this study. Additional indicators, including levelized cost of energy (LCOE), renewable fraction, CO₂ emissions, and electricity purchased from the grid, were used for comparative performance evaluation. The candidate systems were simulated and optimized under frequent grid outage conditions using HOMER Pro. The results identify the Grid/PV/Battery configuration as the preferred base case backup/support configuration among the evaluated alternatives, achieving the lowest NPC of USD 8949, the lowest LCOE of USD 0.135/kWh, the highest renewable fraction of 55.1%, and the lowest annual CO₂ emissions of 2333 kg/yr, while satisfying the zero unmet load requirement. Compared with the base Grid/Diesel system, the optimal configuration reduces annual operating cost from USD 1204/yr to USD 648.19/yr and lowers emissions by approximately 50%, despite requiring a higher initial capital investment. Sensitivity analysis shows that the preferred solution remains robust across most of the examined financing parameter space. The PV derating factor analysis further indicates that the Grid/PV/Battery configuration remains optimal at higher PV derating levels of 70–80%, whereas the preferred solution shifts toward Grid/Diesel at lower derating levels of 50–60%. Overall, the results demonstrate that combining service-level-constrained NPC minimization with comparative techno-economic and environmental evaluation provides a robust basis for identifying suitable backup-supported grid-connected residential energy solutions under unreliable grid conditions. Full article

Pediatric phlebotomy is a common invasive procedure frequently associated with pain, anxiety, and fear, which may negatively affect children’s cooperation and overall healthcare experiences. Virtual reality (VR) has emerged as a promising non-pharmacological intervention capable of providing immersive distraction and emotional engagement during painful medical procedures. The aim of this systematic review was to evaluate the effectiveness of immersive VR in reducing pain perception and anxiety-related outcomes among pediatric patients undergoing phlebotomy procedures. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research question was developed using the PICO framework. Randomized controlled trials and comparative controlled studies published between January 2020 and September 2025 were identified through systematic searches of PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies involving children and adolescents aged 4–17 years undergoing phlebotomy or venipuncture procedures were eligible for inclusion. A total of six studies comprising 557 pediatric participants were included in the review. The VR interventions involved immersive and interactive environments, including educational simulations, animated scenarios, and game-based experiences delivered through head-mounted displays. Four studies reported statistically significant reductions in pain and/or anxiety among participants exposed to VR compared with control groups, whereas two studies found no significant differences. Across the included studies, VR interventions were generally well accepted by children, parents, and healthcare professionals, with only mild and transient adverse effects reported. However, substantial heterogeneity was observed regarding clinical settings, VR technologies, intervention protocols, and outcome assessment methods. The current evidence suggests that immersive VR is a promising adjunctive strategy for reducing pain and anxiety during pediatric phlebotomy procedures. Nevertheless, the available evidence remains limited by methodological heterogeneity and relatively small sample sizes. Future research should focus on larger, well-designed randomized controlled trials using standardized intervention protocols and outcome measures to support evidence-based implementation of VR in pediatric clinical practice. Full article

Rapid demographic change across countries, with people from diverse ethnic backgrounds and preferences, mandates new nectarine (Prunus persica var. nucipersica) cultivars with varying skin and flesh colors and times of availability. After a 4-year initial screening with 21 cultivars, long-term phenological characteristics, yield, and fruit quality attributes of several cultivars of yellow- and white-fleshed nectarine, harvested at two intervals (Harvest 1 and Harvest 2) and stored for two storage durations (Period 1 and Period 2), were studied over four years. ‘Royal Bright’ consistently exhibited the latest bloom (higher Julian day) and, together with ‘Giant Pearl’, required greater cumulative growing degree days (GDD) than other cultivars to reach both Harvest 1 and Harvest 2 each year. Fruit GDD differences at Harvest 2 as compared to Harvest 1 in ‘Candy Pearl’ were the longest, and those of ‘Giant Pearl’, ‘BN7’, and ‘Royal Bright’ were shorter among all cultivars. ‘Burnectseven’ (‘BN7’), ‘Flame’, and ‘Royal Bright’ always had higher yield, while all “Pearl” series (‘Giant Pearl’, ‘Majestic Pearl’, ‘Candy Pearl’) were in the low-yielding cultivars. ‘Candy Pearl’, ‘Majestic Pearl’, and ‘BN7’ nectarines often had larger fruit than other cultivars. Fruit picked at the second harvest had lower firmness than that picked at the first harvest in all cultivars every year. Fruit of ‘Candy Pearl’ often had higher firmness, but those of ‘BN7’ and ‘Royal Bright’ had lower firmness, at the times of both Harvest 1 and Harvest 2. Fruits of ‘BN7’ and ‘Candy Pearl’ often had higher soluble solids concentrations at Harvest 1 and Harvest 2, and after keeping the fruit in storage for Period 1 and Period 2. According to this study, ‘Candy Pearl’ is recommended as a good choice for the early market, as the fruit in this cultivar was mild with high flavor and attractive red skin and white flesh. Also, ‘Majestic Pearl’, ‘BN7’, and ‘Flame’ can be grown for the mid-to-late August market. ‘Majestic Pearl’ and ‘Flame’ had large fruit with a moderate level of russet and a split pit in some years, and thus, any cultural practices that may contribute to fruit russet and split pit should be avoided. Details on recommendations for suitable cultivars, harvest stages, and storage durations are provided in this study. Full article

Visual programming using blocks and diagrams facilitates understanding of fundamental programming concepts, which is particularly important for children with special educational needs because it reduces their cognitive load and encourages interactive learning. This study aimed to develop and apply a hybrid multi-criteria framework to evaluate, rank, and select visual programming software solutions intended for children with special educational needs. Based on an analysis of the educational context and the target population’s needs, a set of criteria was defined to evaluate and select the most suitable software solution. Data for the analysis were collected using a structured questionnaire, from which a decision matrix was developed. Within the proposed hybrid multi-criteria decision-making (MCDM) framework, criterion weights were determined using the Rank Order Centroid (ROC) method, and the ranking of alternatives was performed using the Preference Ranking Organization Method for Enrichment Evaluation (PROMETHEE II). Additionally, a sensitivity analysis was conducted to assess the stability and robustness of the obtained rankings in relation to changes in the criterion weights. The results indicate a stable ranking of alternatives and the identification of the most favorable solution in the majority of scenarios. The projection quality of 91.1% in the Geometrical Analysis for Interactive Aid (GAIA) plane confirmed the reliability of the visual interpretation of the results. The proposed framework improves the decision-making process and provides a foundation for further research in educational software evaluation. Full article

The research analysed the space-use and habitat-preference characteristics of red deer (Cervus elaphus) in the Sopron Mountains, Hungary, utilising high-resolution Global Positioning System (GPS) telemetry data and two distinct land-cover databases. Hourly location data from 10 individuals were processed using the minimum convex polygon (MCP) and kernel home range (KHR) methods. Additionally, a relative stability index (RSI) was developed to describe seasonal shifts in area use. Significant sexual dimorphism was identified in the extent of annual home ranges: the mean space use of stags (3381 ha) significantly exceeded that of hinds (1391 ha). Geomatical analyses highlighted the seasonality of space use: the smallest extent was recorded in June, and shifts in home ranges within a single year were significant, while the winter period exhibited the least seasonal variation. Regarding habitat selection, significant seasonality was observed in hinds, reflecting temporal changes in resource availability, whereas this pattern was not observed in stags. The study concluded that the applied methods are appropriate for gathering baseline information; however, integrating high-precision databases is essential for accurate modelling of deer–forest interactions. Full article

Cancer patients receiving systemic therapy experience substantial treatment-related symptoms. Nurse-led digital health interventions, e.g., interactive voice response systems, web platforms, mobile apps, and telehealth, have emerged as strategies to strengthen supportive care. To evaluate its effectiveness, this systematic review summarizes evidence exclusively from randomized controlled trials (RCTs). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, four databases were searched from inception to January 2025 for eligible RCTs involving adults undergoing anticancer therapy; evaluating nurse-led or nurse-co-led interventions using digital or telecommunication technologies; reporting validated symptom or health-related quality of life (HRQoL) outcomes. Risk of bias was assessed. Nine RCTs (N = 3344) met criteria; seven had low risk of bias. Interventions using telephone systems, web portals, mobile apps, or videoconferencing reduced symptom burden and improved HRQoL. The Symptom Care at Home system reduced symptom burden by ~43%, with greatest effects from combined automated monitoring and nurse practitioner follow-up. Additional benefits included improved anxiety, self-efficacy, patient participation, fewer severe toxicities and hospitalization days. In conclusion, nurse-led digital interventions effectively reduce symptom burden and support HRQoL during systemic therapy. Multicomponent models integrating automated monitoring with structured nursing follow-up and decision support appear most beneficial. Full article

Background: Lychee fruits are sweet and juicy, yet mitochondrial genomic data for this species remains scarce, limiting in-depth studies of its genetic and evolutionary characteristics. To address this gap, in this study, the abortive-seeded cultivar ‘Xianjinfeng’ (XJF) and the large-seeded cultivar ‘Xinqiumili’ (XQML) were selected for analysis. Using third-generation sequencing technology, we sequenced, assembled, and annotated their mitochondrial genomes, and compared their structural characteristics and evolutionary relationships. Results: Assembly revealed mitochondrial genome sizes of 579,270 bp for XJF and 579,261 bp for XQML, both with 45.41% GC content. The mitogenomes contain 396 repetitive sequences, including 47 tandem repeats and 165 dispersed repeats, with SSR loci primarily 10–14 bp in length. Each genome encoded 62 genes, comprising 22 tRNAs, 3 rRNAs, and 35 protein-coding genes. Further analysis revealed 15 homologous sequences originating from chloroplasts in both mitochondrial genomes, totaling 12,194 bp (2.11% of the mitochondrial genome). These included 9 tRNA genes, 4 rRNA genes, and partial protein-coding sequences. Additionally, 184 simple sequence repeats (SSRs) were identified in both cultivars, whereas 564 and 563 potential RNA editing sites were predicted by computational tools in XJF and XQML, respectively, indicating subtle genetic differences between the cultivars. This study also analyzed codon usage preferences, nucleotide diversity, and chloroplast-to-mitochondria gene transfer events. Collinearity and comparative genomics results indicate that lychee is closely related to Nephelium lappaceum L. and Xanthoceras sorbifolium Bunge within the Sapindaceae family. Conclusions: In this study, two high-quality lychee mitochondrial genomes were successfully assembled and annotated, enriching the mitochondrial genome resources of Sapindaceae plants and laying a foundation for future lychee phylogenetic and evolutionary studies of closely related species. Full article

The surgical management of distal tibia fractures in the elderly is increasingly complex due to the rising prevalence of osteoporosis and the unique anatomical constraints of the region. While autologous bone graft remains the gold standard, its limitations have led to the widespread adoption of synthetic and biological substitutes. This narrative review explores the current trends in bone grafting for osteoporotic distal tibia fractures, focusing on pure β-tricalcium phosphate (β-TCP) and demineralized bone matrix (DBM). We specifically examine the biological mechanisms, resorption kinetics, and clinical outcomes of these materials. Furthermore, we highlight the emerging clinical preference for powder-type pure β-TCP (Neobone™) due to its superior surface area and packing efficiency in irregular metaphyseal voids. Powder-type pure β-TCP demonstrates superior packing efficiency and predictable resorption kinetics for metaphyseal void filling, while DBM remains a context-dependent biological supplement. Ion-substituted TCP formulations, pharmacological augmentation, and hybrid scaffolds are highlighted as future directions. Full article

Tit species (Paridae) are an important part of urban settlements during winter. We counted wintering tit species from 31 urban settlements along a 920 km latitudinal gradient in Finland during four winters between 1991 and 2020. We observed a total of five tit species, the Great Tit (Parus major), Eurasian Blue Tit (Cyanistes caeruleus), Coal Tit (Periparus ater), Willow Tit (Poecile montanus), and Crested Tit (Lophophanes cristatus) during the surveys. The most common and abundant species were the deciduous forest preferring Great Tit and Eurasian Blue Tit, whereas the coniferous forest preferring species exhibiting a hoarding behavior, the Coal Tit, Willow Tit, and the Crested Tit, were seldom observed, and no Siberian Tits were detected. These results indicated that food-hording coniferous preferring tit species avoided urban areas. The numbers of Great Tit and Eurasian Blue Tit were greater at the end of the study period than in the first two winters studied. The average growth rate (λ) of the Great Tit and Eurasian Blue Tit increased during the winters studied. Our data indicated a greater increase rate of the Great Tit and Eurasian Blue Tit than the Finnish winter bird monitoring work, probably because we only surveyed tits within human settlements. There was a positive correlation between the average growth rate of the Great Tit and the latitude. There was a negative correlation between the changes in average growth rate (λ) of the Eurasian Blue Tit and the changes in built-up area cover within the study areas between winters 1991/1992 and 2019/2020, and vice versa, indicating that the Eurasian Blue Tit population suffered from the increase in built-up area cover. Despite the fact that the total number of winter-feeding sites decreased during the study period, changes in their numbers were not associated with the growth rates of any tit species. The abundance of the Great Tit was negatively associated with building cover and positively associated with winter temperature. The abundance of the Eurasian Blue Tit was negatively associated with building cover and negatively associated with latitude. When controlling for the latitude, the growth rate of the Great Tit increased with the temperature in winter months, indicating that the Great Tit populations have increased in colder study sites. Our results indicated that population trends of tit species may differ regionally, and that changes in urban settlements may modify the abundance of tit species during winter. We did not detect any correlation in population growth rates between species. We recommend conducting more long-term tit research both during the winter and breeding seasons to understand the population dynamics and population trends of tit species across diverse types of habitats in more detail. Full article