Search Results (42,044)

Background/Objectives: Significant heterogeneity in the treatment response to peroxisome proliferator-activated receptor γ (PPARγ) agonists exists, and predictive factors for their efficacy remain unclear. We aimed to assess the relationships between routinely available clinical features and the efficacy of PPARγ agonists and pan-PPAR agonists by meta-regression analysis. Methods: We searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) and included randomised controlled trials involving type 2 diabetes patients with 12-week or longer treatment durations with PPARγ agonists or pan-PPAR agonists published before 11 November 2023 (PROSPERO registration number: CRD42024578987). We conducted mixed-effect meta-regression analyses between baseline variables and treatment response. Moreover, we developed a machine learning-based meta-forest model and ranked the relative importance of each variable. Results: In 147 studies involving 29,250 participants, PPARγ and pan-PPAR agonists significantly reduced HbA1c (mean difference(MD) = −0.8876 [95% confidence interval (CI): −0.8999, −0.8754]; p < 0.0001, I² = 96.0%) and FPG = (MD = −1.7900 [95% CI: −1.9137, −1.6663]; p < 0.0001, I² = 92.0%). Multivariable association analysis suggested that a greater proportion of female participants (β = 0.0066 [95% CI: 0.0012, 0.0121]; p = 0.017), younger age (β = −0.0314 [95% CI: −0.05, −0.0129]; p = 0.0009) and lower HDL-C levels (β = −0.9304 [95% CI: −1.5176, −0.3431]; p = 0.0019) were significantly associated with a greater decrease in HbA1c. A greater proportion of female participants (β = 0.0112 [95% CI: 0.0019, 0.0205]; p = 0.0178) and lower baseline HDL-C levels (β = −1.8722 [95% CI: −2.812, −0.9323]; p < 0.0001) were significantly associated with a greater decrease in FPG. These variables also ranked among the top five most important predictors of drug response in the meta-random forest models. Conclusions: Our study demonstrated that female sex, younger age, and lower HDL-C levels were associated with greater glycaemic lowering effect from PPARγ and pan-PPAR agonists. Full article

Kabaddi is a contact sport that demands high physical fitness and specific technical skills. Although multiple training programs have been designed to improve performance, no systematic review had previously synthesized their effects on physical, physiological, and performance-related outcomes. This systematic review of randomized controlled trials aimed to evaluate the impact of different training interventions on physical fitness, physiological parameters, and sport performance in kabaddi players. A systematic review was performed in the Web of Science, PubMed, and Scopus databases up to May 2025. Randomized controlled trials analyzing training interventions in kabaddi players were included. Ten studies with a total of 458 participants were included. Interventions lasted between 6 and 12 weeks and comprised modalities such as strength training, plyometrics, combined training, circuit training, SAQ (speed, agility, and quickness), and Tabata. Nine studies reported significant within-group improvements in variables such as strength, speed, agility, and flexibility. In studies with between-group comparisons, training interventions could be more effective than control conditions. One study also reported improvements in physiological and hematological parameters. Overall, training interventions in kabaddi players may improve physical fitness, sport-specific performance, and certain physiological and hematological parameters. However, the evidence should be interpreted with caution given the predominantly fair methodological quality of the included trials. PROSPERO (CRD420251272758). Full article

The limitations of conventional diabetes management are increasingly evident. As a result, both type 1 and 2 diabetes in pediatric populations have become major global health concerns. As new technologies emerge, particularly artificial intelligence (AI), they offer new opportunities to improve diagnostic accuracy, treatment outcomes, and patient self-management. A PRISMA-based systematic review was conducted using PubMed, Web of Science, and BIREME. The research covered studies published up to February 2025, where twenty-two studies met the inclusion criteria. These studies examined machine learning algorithms, continuous glucose monitoring (CGM), closed-loop insulin delivery systems, telemedicine platforms, and digital educational interventions. AI-driven interventions were consistently associated with reductions in HbA1c and extended time in range. Furthermore, they reported earlier detection of complications, personalized insulin dosing, and greater patient autonomy. Predictive models, including digital twins and self-learning neural networks, significantly improved diagnostic accuracy and early risk stratification. Digital health platforms enhanced treatment adherence. Nonetheless, the barriers included unequal access to technology and limited long-term clinical validation. Artificial intelligence is progressively reshaping pediatric diabetes care toward a predictive, preventive, personalized, and participatory paradigm. Broader implementation will require rigorous multiethnic validation and robust ethical frameworks to ensure equitable deployment. Full article

This comprehensive review examines pathogens affecting adult anadromous Pacific salmon (Oncorhynchus spp.) during their terminal freshwater migration and spawning across populations from California through Alaska, including Oregon, Washington, and British Columbia. We systematically reviewed selected pathogens based on their significance to adult salmon health or role in epizootiology, categorizing them by their impact on prespawn mortality (PSM), disease severity, and maternal or ‘egg-associated’ transmission risks to progeny. Our analysis encompasses macroparasites, microparasites, bacteria, and viruses affecting anadromous Pink (O. gorbuscha), Chum (O. keta), Coho (O. kisutch), Sockeye (O. nerka), and Chinook Salmon (O. tshawytscha) and Steelhead Trout (O. mykiss), integrating extensive literature analysis with direct field observations and case studies from representative geographic regions. Understanding pathogen impacts during the spawning life stage is crucial for salmon population sustainability, as the unique semelparous nature of Pacific salmon makes this terminal phase critical for reproductive success and the continuation of these ecologically, economically, and culturally vital species. Full article

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023–2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice. Full article

Hilly and mountainous areas are important agricultural production regions globally. Their dramatic topography, dense fruit tree planting, and steep slopes severely restrict the application of traditional plant protection machinery. Pest and disease control has long relied on manual spraying, resulting in high labor intensity, low efficiency, and pesticide utilization rates of less than 30%. Plant protection UAVs, with their advantages of flexibility, high efficiency, and precise application, provide a feasible technical approach for plant protection operations in hilly and mountainous areas. However, steep slopes and dense orchard environments place higher demands on key technologies such as drone positioning and navigation, attitude control, trajectory planning, and terrain following. Achieving accurate identification and adaptive following of the undulating fruit tree canopy while maintaining a constant spraying distance to ensure uniform pesticide coverage has become a core technological bottleneck. This paper systematically reviews the key technologies and research progress of plant protection UAVs in hilly and mountainous operations, focusing on the principles, advantages, and limitations of core methods such as multi-sensor fusion positioning, intelligent SLAM navigation, nonlinear attitude control and intelligent control, three-dimensional trajectory planning, and multimodal terrain following. It also discusses the challenges currently faced by these technologies in practical applications. Finally, this paper discusses and envisions the future of plant protection UAVs in achieving intelligent, collaborative, and precise operations on steep slopes and in dense orchards, providing theoretical reference and technical support for promoting the mechanization and intelligentization of mountain agriculture. Full article

The integration of flexible electronics and machine learning (ML) algorithms has become a revolutionary force driving the field of intelligent sensing, giving rise to a new generation of intelligent devices and systems. This article provides a systematic review of core technologies and practical applications of ML in flexible electronics. It focuses on analyzing the theoretical frameworks of algorithms such as the Long Short-Term Memory Network (LSTM), Convolutional Neural Network (CNN), and Reinforcement Learning (RL) in the intelligent processing of sensor signals (IPSS), multimodal feature extraction (MFE), process defect and anomaly detection (PDAD), and data compression and edge computing (DCEC). This study explores the performance advantages of these technologies in optimizing signal analysis accuracy, compensating for interference in high-noise environments, optimizing manufacturing process parameters, etc., and empirically analyzes their potential applications in wearable health monitoring systems, intelligent control of soft robots, performance optimization of self-powered devices, and intelligent perception of epidermal electronic systems. Full article

Bone tissue engineering, as an important branch of regenerative medicine, integrates multidisciplinary knowledge from cell biology, materials science, and biomechanics, aiming to develop novel biomaterials and technologies for functional repair and regeneration of bone tissue. Hydrogels are among the most commonly used scaffold materials; however, conventional hydrogels exhibit significant limitations in physical properties such as strength, tensile strength, toughness, and fatigue resistance, which severely restrict their application in load-bearing bone defect repair. As a result, the development of high-strength hydrogels has become a research hotspot in the field of bone tissue engineering. This paper systematically reviews the latest research progress in this area: First, it delves into the physicochemical characteristics of high-strength hydrogels at the molecular level, focusing on core features such as their crosslinking network structure, dynamic bonding mechanisms, and energy dissipation principles. Next, it categorically summarizes novel high-strength hydrogel systems and different types of biomimetic hydrogels developed based on various reinforcement strategies. Furthermore, it provides a detailed evaluation of the application effects of these advanced materials in specific anatomical sites, including cranial reconstruction, femoral repair, alveolar bone regeneration, and articular cartilage repair. This review aims to provide systematic theoretical guidance and technical references for the basic research and clinical translation of high-strength hydrogels in bone tissue engineering, promoting the effective translation of this field from laboratory research to clinical application. Full article

The synchronization between nitrogen sources and carbohydrate fractions represents a critical factor for optimizing microbial protein synthesis and overall ruminant performance. This systematic review, conducted according to PRISMA 2020 guidelines, comprehensively evaluated the interactions between different nitrogen sources (true protein, urea, controlled-release urea, and bypass amino acids) and carbohydrate fractions (rapidly degrading soluble, slowly degrading soluble, fibrous, non-fibrous, and Van Soest fractions) in ruminant nutrition. A comprehensive search across PubMed, ScienceDirect, Web of Science, and Scopus databases identified 1855 records, of which 164 studies met the eligibility criteria for qualitative synthesis and 89 for quantitative meta-analysis. The review reveals that synchronization effectiveness varies significantly depending on the nitrogen source–carbohydrate combination, with controlled-release urea showing superior synchrony with slowly degrading carbohydrates, while conventional urea performs better with rapidly degrading sources. Meta-analytical results indicate that optimal nitrogen–carbohydrate synchronization can improve microbial protein synthesis by 18–34%, reduce urinary nitrogen excretion by 12–28%, and enhance feed efficiency by 8–15%. These findings provide evidence-based recommendations for precision nutrition strategies in ruminant production systems. Full article

China’s traditional courtyard drainage systems have evolved over millennia, embodying distinctive wisdom in sustainable rainwater management. This study aims to clarify the evolutionary logic of these systems, which shifted from relying on surface runoff to adopting more systematic drainage approaches. This addresses a gap in existing research on the systemic evolution of micro-scale units. From a sustainability perspective, the study also explores the relevance of traditional drainage practices to contemporary sponge city development. This research examines traditional courtyard drainage systems through a comprehensive methodology that integrates literature reviews, historical evidence analyses, and comparative historical research. The results reveal an evolutionary trajectory from localized and passive interventions to more holistic and systematic regulation. This process was driven by three interrelated factors: the natural environment, socio-technical conditions, and ritual–cultural systems. Based on this analysis, the study elucidates the logical connections between historical experiences and contemporary practice across three dimensions of sustainability: environmental, technological, and sociocultural. The findings offer both theoretical and practical insights for improving modern urban stormwater management. Full article

Maritime transportation accounts for approximately 80 percent of global trade volume, with modern vessels increasingly reliant on Software-Defined Radio (SDR) technologies for communication and navigation. However, the very flexibility and reconfigurability that make SDRs advantageous also introduce complex radio frequency vulnerabilities exposing ships to threats that jeopardize vessel security, and this disrupts global supply chains. This survey paper systematically examines the security landscape of maritime SDR systems through a threat modeling lens. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we analyzed 84 peer-reviewed publications (from 2002 to 2025) and applied the STRIDE framework to identify and categorize maritime SDR threats. We identified 44 distinct threat types, with tampering attacks being most prevalent (36 instances), followed by Denial of Service (33 instances), Repudiation (30 instances), Spoofing (23 instances), Information Disclosure (24 instances), and Elevation of Privilege (28 instances). These threats exploit vulnerabilities across device, software, network, message, and user layers, targeting critical systems including Global Navigation Satellite Systems, Automatic Identification Systems, Very High Frequency or Digital Selective Calling systems, Electronic Chart Display and Information Systems, and National Marine Electronics Association 2000 networks. Our analysis reveals that maritime SDR threats are multidimensional and interdependent, with compromises at any layer potentially cascading through entire maritime operations. Significant gaps remain in authentication mechanisms for core protocols, supply chain assurance, regulatory frameworks, multi-layer security implementations, awareness training, and standardized forensic procedures. Further analysis highlights that securing maritime SDRs requires a proactive security engineering that integrates secured hardware architectural designs, cryptographic authentications, adaptive spectrum management, strengthened international regulations, awareness education, and standardized forensic procedures to ensure resilience and trustworthiness. Full article

Mindful hypnotherapy is an intervention that integrates hypnotic induction and direct suggestions (hypnosis) to increase mindfulness and reduce distress. In the present study, a systematic review and meta-analysis were conducted to investigate the effects of mindful hypnotherapy on psychological distress and mindfulness in adults. Further, the study evaluated the methodological quality of the included studies. A total of five publications of randomized controlled trials were identified. This meta-analysis found that, when compared to both waitlist and active control groups, mindful hypnotherapy had a large effect on the reduction in psychological distress (Hedges’ g = 0.79, 95% CI [0.39, 1.19]; z = 3.87, p < 0.0001) and stress (Hedges’ g = 0.90, 95% CI [0.50, 1.31]; z = 4.38, p = 0.0001). Further, results also found mindful hypnotherapy had a large effect on increasing mindfulness (Hedges’ g = 1.42, SE = 0.28; 95% CI [0.88, 1.97]; z = 5.11, p < 0.001). Recommendations include conducting research examining mindful hypnotherapy in a wider range of clinical problems (i.e., generalized anxiety disorder, depression, post-traumatic stress). In addition, clinical trials of mindful hypnotherapy should include active controls and measures of hypnotizability. Further research is also needed with diverse populations. Full article

Over the past two decades, Building-Integrated Photovoltaics (BIPV) has become a core technology in the green building sector, driven by global carbon-neutrality goals and the growing demand for sustainable design. This review adopts a scalability-oriented perspective and systematically examines 82 peer-reviewed articles published between 2001 and 2025. The results indicate that existing research is dominated by studies on electrical and thermal performance, with East Asia and Europe—particularly China, Japan, and Germany—emerging as the most active regions. This dominance matters for scalability because real projects must satisfy comfort, compliance, buildability, and operation/maintenance constraints alongside energy yield; limited evidence in these dimensions increases delivery risk when transferring solutions across regions and building types. Accordingly, we interpret the observed distribution as an evidence-maturity pattern: performance gains are increasingly well characterized, whereas deployment-relevant uncertainties (e.g., boundary-condition sensitivity and validation depth) remain less consistently reported. Multidimensional integration of thermal, optical, and electrical functions is gaining momentum; however, user-centered performance dimensions remain underexplored. Simulation-based approaches still prevail, whereas large-scale empirical studies are limited. The review also reveals extensive interdisciplinary collaboration but also identifies a notable lack of architectural perspectives. Using Biblioshiny, this study maps co-authorship networks and research structures. Based on the evidence, we propose future research directions to enhance the practical scalability of BIPV, including strengthening interdisciplinary integration, expanding empirical validation, and developing product-level design strategies. Full article

Introduction: Temporary non-tunneled catheters are necessary in patients with chronic kidney disease requiring acute hemodialysis care, and complications associated with these catheters, such as infection and thrombosis, represent the most important sources of morbidity. There are no studies available that suggest the optimum duration of their use before catheter exchange or removal. This study aimed to explore the duration of temporary catheter insertion before the occurrence of catheter-related infection and mechanical complications in hemodialysis patients. Methods: Systematic searches were conducted according to the PRISMA 2020 guidelines on four databases up to 1 May 2025 (PROSPERO: CRD420251069657). The study outcome was the occurrence time to catheter-related infection and mechanical complications (thrombosis, obstruction, and kinking, causing dysfunction, failure, or insufficient blood flow) in days, pooled using a single-arm meta-analysis. Mean and 95% confidence interval (CI) were used as the summary statistics. Results: Nine studies involving 1448 participants undergoing hemodialysis using temporary catheters were included. Incidence of infection ranged from 0.7 to 13.58 per 1000 catheter-days. The most common bacterium identified was Staphylococcus aureus and Pseudomonas aeruginosa. The pooled mean time to catheter-related infection from 298 catheters was 15.98 days (95% CI 10.47–21.50; I² = 97.73%). We also found that the pooled mean time to mechanical complications from 507 catheters was 6.69 days (95% CI 2.49–10.90; I² = 98.03%). Conclusion: Among patients who developed complications, the mean time from temporary catheter insertion was approximately two weeks to the occurrence of catheter-related infection and one week to mechanical complications. Our finding was consistent with the recommendation of the KDOQI guideline, which suggests limiting catheter duration to typically less than two weeks. Full article

Electron transfer (ET) is a foundational biogeochemical process in paddy soils, distinctively molded by alternating anaerobic-aerobic conditions from flooding-drainage cycles. Despite extensive research on heavy metal(loid) (denoted as “HM”, e.g., As, Cd, Cr, Hg) dynamics in paddies, ET has not been systematically synthesized as a unifying regulatory mechanism, and the trade-offs of ET-based mitigation strategies remain unclear. These critical gaps have drastically controlled HMs’ mobility, which further modulates bioavailability and subsequent accumulation in rice (Oryza sativa L., a staple sustaining half the global population), posing substantial food safety risks. Alongside progress in electroactive microorganism (EAM) research, extracellular electron transfer (EET) mechanism delineation, and soil electrochemical monitoring, ET’s role in orchestrating paddy soil HM dynamics has garnered unparalleled attention. This review explicitly focuses on the linkage between ET processes and HM biogeochemistry in paddy ecosystems: (1) elucidates core ET mechanisms in paddy soils (microbial EET, Fe/Mn/S redox cycling, organic matter-mediated electron shuttling, rice root-associated electron exchange) and their acclimation to flooded conditions; (2) systematically unravels how ET drives HM valence transformation (e.g., As(V) to As(III), Cr(VI) to Cr(III)), speciation shifts (e.g., exchangeable Cd to oxide-bound Cd), and mobility changes; (3) expounds on ET-regulated HM bioavailability by modulating soil retention capacity and iron plaque formation; (4) synopsizes ET-modulated HM accumulation pathways in rice (root uptake, xylem/phloem translocation, grain sequestration); (5) evaluates key factors (water management, fertilization, straw return) impacting ET efficiency and associated HM risks. Ultimately, we put forward future avenues for ET-based mitigation strategies to uphold rice safety and paddy soil sustainability. Full article