A fundamental yet unresolved issue in hydrothermal fluorite deposits is that initial 143Nd/144Nd ratios vary significantly among different veins, even among those with similar mineralization ages within the same region. This discrepancy likely reflects variations in the material sources of hydrothermal fluids, although the specific controlling factors and mechanisms remain unclear. To address this issue, this study analyses two types of fluorite veins on the southern margin of the North China Craton-both controlled by the same fault system and the same pluton-using Sm-Nd and C-O isotopes. The Baimiaogou fluorite veinlets represent conduit structures for hydrothermal migration, whereas the Yangshan fluorite veins represent host structures for ore precipitation. The results show that the Baimiaogou veinlets, which acted as fluid conduits, display highly variable isotopic compositions, with initial 143Nd/144Nd ratios of 0.511379 to 0.511757, εNd(t) values of -21.55 to -14.17, and TDM2 ages of 1.64 to 1.93 Ga. Associated calcite exhibits a pronounced oxygen isotope shift, with δ18OV-SMOW‰ values between 1.6‰ and 7.0‰. In contrast, the Yangshan veins, which served as host structures, show isotopic consistency, with tightly clustered initial 143Nd/144Nd ratios (0.511751-0.511799), εNd(t) values (-14.29 to -13.36), TDM2 ages (1.58-1.60 Ga), and associated calcite δ18OV-SMOW‰ values (7.5-8.5‰). Neodymium isotope mass balance calculations indicate that the variations in Nd isotope values reflect mixing between initial magmatic-hydrothermal fluids and the ancient Taihua Group metamorphic basement during fluid migration. Macro- and microstructural analyses reveal that the Baimiaogou veinlets experienced multiple tectonic pulses within an open system characterised by dynamically changing fluid flow paths, whereas the Yangshan veins formed during a single phase of large-scale extensional faulting, with fluid precipitation occurring in a relatively closed space. Thus, the nature and pulsatory behaviour of fault structures also control the variations in Nd isotope values. This model highlights the coupled control of magmatism and structural processes on the material sources of fluorite in hydrothermal deposits, providing new constraints for understanding the metallogenic mechanisms of hydrothermal fluorite systems.
Health literacy is crucial for pregnancy outcomes; yet, 15%-44% of pregnant women have low health literacy, negatively affecting maternal and fetal health. While pregnancy apps are increasingly used to support it, the psychological mechanisms through which they influence behavior remain unclear. Understanding these mechanisms is essential for designing effective interventions. Cognitive load theory (CLT) and the integrated model of cognitive-affective learning with media (ICALM) provide theoretical frameworks for understanding these digital interventions in pregnancy's emotionally intense context. This study aimed to understand the psychological and social-cognitive pathways through which engagement with pregnancy apps may enhance health literacy and behaviors. This cross-sectional survey study included 998 pregnant and early postpartum women aged 18-45 years from the United States and analyzed the data using Bayesian Network (BN) modeling informed by CLT and ICALM. Participants were stratified into Pregnancy+ (Royal Philips) users (n=362), other pregnancy app users (n=507), and nonapp users (n=129). We measured digital engagement, emotions, health literacy levels, support levels and sources, and health behaviors, including physical activity, nutrition, and stress management. The BN model underwent systematic refinement through bootstrap resampling (n=1000) to evaluate arc strength, followed by k-fold cross-validation (k=5) to assess model generalizability and predictive performance. In our study, pregnancy apps improve health literacy or behaviors, but not through direct pathways. Instead, they work through two indirect psychological pathways: (1) digital engagement related to positive emotions, which in turn is related to health literacy and stress management, and (2) digital engagement strengthened support networks, which in turn are related to health literacy. No direct pathways from digital engagement to health literacy or behaviors were retained. Pregnancy+ users demonstrated stronger adherence to these pathways compared with other app users and nonusers, by demonstrating more joyfulness (5.1 vs 4.7; P=.046), elevated support levels (4.1 vs 3.9; P=.03), and higher critical health literacy scores (8.4 vs 8.2 vs 7.7; P<.001). Pregnancy+ users also showed higher engagement frequencies (P<.001) and more frequently cited pregnancy apps as valuable information sources (78% vs 68%, P=.01) compared with users of other pregnancy apps. This study reveals that pregnancy apps may enhance health literacy by fostering positive emotions and strengthening support networks. This finding challenges assumptions about digital health interventions and demonstrates that apps function as psychological support systems rather than mere information sources. The findings validate CLT and ICALM within pregnancy contexts, showing that emotionally supportive apps reduce irrelevant emotional processing that consumes cognitive capacity, thereby enhancing information retention. For practice, app developers should prioritize emotional support and social connection over content volume, while health care providers should recommend apps that enhance emotional well-being. This study demonstrates BN's value for revealing complex psychological relationships in digital health contexts.
Abandoned mines are among the main sources of long-term soil contamination, often leaving behind persistent concentrations of potentially toxic elements (PTE) that pose environmental and health risks. Ribeiro da Serra Sb-Au mine, in Portugal, active from 1858 to 1890, has left a significant environmental legacy. This study mapped the spatial distribution of mine processing residues, elemental characterisation distinguishing between anthropogenic and natural enrichment by determining soil sample concentrations of PTE, Hg mobility, and Total Organic Carbon (TOC) quantification. Multivariate analysis, spatial interpolation and comparison with Enrichment Factor were employed with the aim of understanding the distributions and sources of PTEs in the soils. Mercury is still present at the site, revealing high mobile (18.72 mg kg-1) and semi-mobile (3.58 mg kg-1) concentrations accumulated in waste piles, a remnant of Au amalgamation processes. High Hg concentrations (20.75 mg kg-1) pose significant environmental risks, even after more than a century, such as bioaccumulation potential and soil toxicity. Also, there are high concentrations of Pb (449.03 mg kg-1) in the waste piles from the Sb processing. This study highlights the critical importance of interpreting natural enrichment values of elements of Hg (EF = 267) and Pb (EF = 18) to discern pollution pathways resulting from mining and processing activities. Interpretation of natural enrichment values leads to a more accurate evaluation of environmental contamination and its sources. The Enrichment Factor shows that Sb (EF = 133) and Hg (EF = 267) are the elements that present extremely high enrichment (EF > 40).
Robotic-assisted surgery (RAS) sees over six million procedures performed annually. Malpractice claims involving RAS increased by more than 250% between the periods 2006-2013 and 2014-2021 [1]. Understanding the legal landscape, risk profile, and evidence-based mitigation strategies is critical for all stakeholders. This scoping review aimed to: (1) map medicolegal cases involving RAS; (2) quantify complication incidence (3) characterise general and procedure-specific risks; and (4) synthesise interventions capable of reducing adverse events and litigation exposure. A structured search of PubMed/MEDLINE, EMBASE, the Westlaw legal database and FDA MAUDE was conducted for English-language sources from January 2000 to May 2026 [2]. Included sources reported medicolegal cases, adverse event rates, or human factors interventions in RAS. Sixty-one US malpractice cases were identified with 169 total liabilities claimed, most commonly negligent surgery, misdiagnosis, delayed treatment, and lack of informed consent [1]. Individual indemnity payments averaged $1,251,274. FDA MAUDE data (2000-2013) recorded 144 deaths, 1,391 injuries, and 8,061 device malfunctions across 1.75 million procedures [3]. Overall adverse event rates were 0.0834% [3]. Key modifiable risk factors include cognitive overload, loss of haptic feedback, team communication breakdown, and suboptimal ergonomics [4-7]. Medicolegal risk in RAS is rising but remains concentrated in a small number of procedure types and surgeon-experience brackets. The majority of claims relate to human error rather than device malfunction [1]. Severable actionable risk-reduction strategies such as structured training, governance, simulation-based competency are discussed [6, 8-10]. Adverse event registries and credentialing standards remain urgent legislative priorities.
Primates constitute an integral part of many African ecosystems. In some areas, primate species can be locally very abundant, while in others they are rare or absent. Our central question is: does the abundance of primate bones (or carcasses) reflect the abundance of local living populations? Past bone surveys in Amboseli National Park, Kenya, and Virunga National Park, Democratic Republic of Congo, revealed a positive correlation between carcass abundance and living mammal communities, with a notable exception: a low abundance or absence of primate carcasses when compared to other medium-sized and large mammals. Recent research conducted at Gorongosa National Park, Mozambique, revealed a similar discrepancy between the abundance of primate carcasses and mammalian live census data. This study aims to understand this mismatch between live and dead by examining the influence of ecological factors on primate carcass occurrence and bone distribution in the modern rift ecosystem of Gorongosa National Park. To address these issues, we investigated whether (1) landscape type, proximity to roads, and water sources (pans, rivers, and lakes) predict primate carcass occurrence relative to other mammal taxa, and (2) the accumulation of primate bones significantly differs from that of other mammals in annually flooding and non-annually flooding landscapes (broadly speaking, in the floodplain vs. higher areas). We analysed 26 bones from 18 chacma baboon individuals (Papio ursinus) and 255 bones from 20 other mammal species. Generalised Linear Model (GLM) outputs suggest that permanent water sources such as rivers and lakes are key drivers of primate bone accumulation (p < 0.05). A Fisher's Exact Test indicates that primate bones are deposited more frequently in Rift Valley Riverine & Floodplain landscapes (p < 0.05). Given that baboons regularly cross rivers in Gorongosa, these findings also suggest that crocodile predation may play an important role in determining where baboon carcasses ultimately accumulate, potentially contributing to the observed mismatch between living and dead communities. These findings have important implications for our understanding of primate bone accumulations in the African fossil record, where some palaeontological sites contain abundant primate fossils whereas others preserve few or none.
Methionine is a key limiting amino acid in poultry nutrition and plays an essential role in growth, metabolism, and antioxidant defence. This study aimed to evaluate the effects of different sources and combinations of methionine on performance, carcass traits, intestinal morphology, and blood biochemical parameters in broiler chickens. A total of 300 one-day-old male broiler chicks were randomly assigned to six dietary treatments with five replicates of 10 birds each. The treatments included a control diet without methionine (60-MET), 100% powder methionine (CONT), 100% liquid methionine (100-LM), and three combinations of powder and liquid methionine (50-LPM, 25-LPM, and 75-LPM). Body weight gain and feed conversion ratio were significantly improved in all methionine-supplemented groups, particularly in 100-LM and 50-LPM (p < 0.05) compared with the 60-MET group. Carcass yield did not differ significantly, but thigh and breast percentages increased in supplemented groups (p = 0.003 and p = 0.001, respectively) compared with the 60-MET group. Intestinal morphology analysis showed a significant increase in villus height with methionine supplementation (p = 0.001), while crypt depth and muscular thickness remained unchanged. Blood biochemical analysis showed that methionine supplementation significantly reduced serum urea, uric acid, AST, ALT, and MDA levels (p < 0.05), while increasing albumin, total protein, and total antioxidant capacity (p < 0.05) compared with the 60-MET group. In conclusion, both powder and liquid methionine sources, especially in the 100-LM and 50-LPM treatments, had positive effects on performance, gut morphology, and physiological health in broilers, indicating the efficiency of liquid form.
Objective: This study examined effects of exposure to a campus mental health promotion exhibit (Send Silence Packing®; SSP) on changes in college students' help-seeking intentions. Participants: College students (n = 576) from six campuses completed online surveys (baseline, 1-month, 6-month follow-up) assessing exposure to their campus' SSP exhibit (fall, 2022) and mental health help-seeking intentions, psychological distress, and service utilization. Methods: Fixed effects regression models examined associations between exposure to SSP (any vs. no) and changes in help-seeking intentions. Results: Relative to baseline, SSP exposure was associated with increases in intentions to seek help from informal sources (friend; family) at 1-month (B = 0.22, SE = 0.08, p = 0.006) and 6-month follow-up (B = 0.20, SE = 0.08, p = 0.01) but not from a mental health professional. Conclusions: Peer-informed campus mental health promotion exhibits may increase students' intentions to leverage informal sources of support when experiencing a mental health challenge.
Perinatal mental health concerns are common and may be heightened among immigrant populations because of migration-related stressors, social isolation, stigma, language barriers, and limited access to culturally safe care. Although previous reviews have examined perinatal mental health among immigrants broadly, evidence focused specifically on South Asian immigrant women in Canada across pregnancy and the postpartum period has not been comprehensively mapped. South Asian women represent one of the largest and fastest-growing immigrant populations in Canada and may experience unique cultural, familial, linguistic, and migration-related factors that shape perinatal mental health experiences and access to care. This scoping review will map the extent, range, and nature of evidence on perinatal mental health among South Asian immigrant women in Canada by examining reported mental health outcomes, associated risk and protective factors, help-seeking experiences, and barriers and facilitators to accessing support services, and identify gaps to inform future research, practice, and policy. This protocol was developed in accordance with Joanna Briggs Institute guidance for scoping review protocols and reported using the PRISMA-P checklist, where applicable (see S2 Checklist). The completed scoping review will be reported according to the PRISMA-ScR checklist. MEDLINE, Embase, PsycINFO, CINAHL, and Scopus will be searched for literature published from January 2000 to the date of the final search. Grey literature will be identified through targeted searches of government, public health, professional, and community organization websites. Eligible sources will include qualitative, quantitative, mixed-methods, and relevant grey literature addressing perinatal mental health during pregnancy and up to 12 months postpartum among South Asian immigrant women residing in Canada. Inclusion criteria are immigrant women of South Asian origin from counties such as India, Pakistan, Bangladesh, Sri Lanka, Afghanistan, Nepal, Bhutan, and Maldives residing in Canada during the perinatal period. Two reviewers will independently screen titles, abstracts with disagreements resolved through discussion or third-reviewer adjudication. Data will be extracted using a standardized charting form and summarized using descriptive mapping and narrative synthesis. Protocols and planned studies will be charted separately from completed studies. Consistent with scoping review methodology, formal exclusion of studies based on methodological quality will not be undertaken; however, study characteristics and reported methodological limitations will be charted to support interpretation of the evidence base. Ethics approval is not required because the review will use publicly available sources only. Findings will be disseminated through a dissertation, peer-reviewed publication, and conference presentations. The review will provide a comprehensive overview of existing evidence and knowledge gaps to support culturally responsive perinatal mental health research, policy development, and healthcare practice for South Asian immigrant women in Canada. This protocol has been preregistered on the Open Science Framework:10.17605/OSF.IO/FZN4S.
Despite global progress in reducing HIV incidence, adolescent girls and young women in sub-Saharan Africa remain disproportionately affected. Biomedical HIV prevention tools such as pre-exposure prophylaxis, condoms and HIV testing are effective but underutilized, especially within facility-based models. Schools represent consistent and scalable contact points for reaching adolescent girls and young women, yet evidence on the feasibility, accessibility and effectiveness of school-based biomedical HIV prevention interventions remains limited. This systematic review aims to synthesize evidence on how school-based programs implement, deliver and achieve outcomes in HIV prevention interventions involving pre-exposure prophylaxis, condom and HIV testing for adolescent girls and young women in sub-Saharan Africa. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Eligible studies will include randomized and non-randomized trials and qualitative research published between January 2015 and December 2025. Databases to be searched include PubMed, Embase, PsycINFO, CINAHL and the African Index Medicus, together with relevant grey literature sources (WHO, UNAIDS, UNICEF and PEPFAR). Two reviewers will independently screen titles, abstracts, and full texts, extract data, and assess risk of bias using appropriate tools. Quantitative data will be synthesized using meta-analysis where feasible, while qualitative findings will undergo thematic synthesis. Outcomes of interest include the feasibility, accessibility, and effectiveness of school-based HIV prevention interventions. This review will provide a comprehensive synthesis of evidence on biomedical HIV prevention interventions delivered in school settings for adolescent girls and young women in sub-Saharan Africa. Findings will highlight implementation process, barriers, facilitators and equity considerations. Trial registration number: PROSPERO CRD420251249595.
Soybean [Glycine max (L.) Merrill] is one of the most widely cultivated crops worldwide. Its seeds contain about 40% protein and 20% oil, serving as essential nutrient sources for humans. Given the nutritional importance of seed protein and oil, identifying genes that regulate their levels is crucial for improving soybean seed quality. This study aimed to identify genetic factors associated with seed protein and oil content using a genome-wide association study (GWAS). Seed protein and oil contents were quantified in 192 soybean mutant accessions in a mutant diversity pool (MDP), and GWAS was conducted using 17,631 SNPs filtered from genotyping-by-sequencing. Expression of a candidate gene was examined across seed developmental stages (R5 to R7), and a significant SNP was converted into a Kompetitive Allele-Specific PCR (KASP) marker for validation. GWAS detected significant SNPs associated with seed protein and oil content. Chr20_7635098 was identified as a nonsynonymous SNP located in the exon of Glyma.20g042400. This gene showed differential expression across seed developmental stages between mutant accessions with contrasting protein and oil contents. The KASP marker for Chr20_7635098 was validated using the MDP and six domestic soybean cultivars showing predictive accuracies of ≥ 80.50% for protein content and ≥ 61.18% for oil content. Overall, this study identified a candidate gene linked to both seed protein and oil content, providing valuable insights for molecular breeding strategies aimed at efficiently improving these nutritional traits.
Multidrug-resistant Gram-negative bacteria remain a major therapeutic challenge, highlighting the need for new antibacterial metabolites from underexplored microbial sources. This study investigated Streptomyces cavourensis strain BA1, isolated from the Zubaida fish farm southwest of Lake Burullus, Egypt, as a potential producer of antibacterial agents against multidrug-resistant Escherichia coli and Klebsiella pneumoniae. The isolate was characterized morphologically, microscopically, and molecularly, and its antibacterial activity was evaluated using culture filtrate and solvent fractions. Bioactive metabolites in the most active extract were analyzed by GC-MS and HPLC, while cytotoxicity against VERO cells and ultrastructural effects on bacterial cells were also assessed. Morphological and SEM observations showed branched mycelia and flexuous spore chains, and molecular analysis confirmed 100% similarity to S. cavourensis strain PES4. The culture filtrate exhibited marked bactericidal activity, whereas the ethyl acetate organic phase showed the strongest activity among solvent extracts, with MIC values of 0.125-0.5 µg/mL, exceeding the activity of ampicillin under the tested conditions. The extract showed a favorable in vitro safety profile, with a CC50 of 296.1 µg/mL against VERO cells. GC-MS revealed fatty acid derivatives, including 9,12-octadecadienoic acid and palmitic acid derivatives, while HPLC identified trans-ferulic acid, salicylic acid, and caffeic acid as antibacterial-associated phenolic/flavonoid compounds. SEM of treated bacteria demonstrated wrinkling, surface collapse, membrane damage, and cellular debris, suggesting disruption of cell envelope integrity. Overall, S. cavourensis BA1 represents a promising source of antibacterial metabolites, although genome sequencing, bioassay-guided purification, and mechanistic studies are required to confirm the active principles and therapeutic safety in vivo.
Robotic single-site and single-port gynecologic surgery has attracted increasing attention with the continued development of minimally invasive and robotic techniques, yet its overall research landscape has not been systematically characterized. This study aimed to evaluate the global publication landscape, knowledge structure, and evolving hotspots of this field using bibliometric and visualization methods. Publications related to robotic single-site and single-port gynecologic surgery were retrieved from the Web of Science Core Collection on April 23, 2026. Only English-language articles and reviews published up to December 31, 2025 were included. A full dataset of 308 publications was used for the main bibliometric analysis, and a field-specific sensitivity dataset of 264 publications was constructed after manual eligibility assessment to evaluate the influence of broadly related background literature. Because the literature in the full dataset spanned earlier robotic single-site/R-LESS approaches and more recent dedicated single-port platforms such as the da Vinci SP system, the retrieved literature was interpreted as a related technical spectrum rather than a completely homogeneous surgical field. Overall publication output showed a progressive upward trend over time. The USA was the leading contributor in both publication volume and citation impact, while Italy, Korea, and China also showed notable research activity. Several high-output institutions and core author groups contributed substantially to the development of this literature. The Journal of Minimally Invasive Gynecology and Journal of Robotic Surgery were among the most productive publication sources. Citation and co-citation analyses indicated that the knowledge base included both field-specific studies on robotic single-site/single-port gynecologic surgery and broader background literature on minimally invasive and robotic surgery. Keyword analysis suggested that research themes have shifted from early emphasis on feasibility, cervical cancer, lymphadenectomy, and surgical outcomes toward minimally invasive refinement and newer robotic platforms such as da Vinci SP. These findings provide an updated descriptive map of the publication landscape and thematic evolution of robotic single-site and single-port gynecologic surgery, while highlighting the need for standardized terminology, platform-specific evidence, and cautious interpretation of bibliometric trends.
Genetic testing is standard of care in Non-small Cell Lung Cancer(NSCLC). Few studies evaluate concurrent Endobronchial Ultrasound-Transbronchial Needle Aspiration(EBUS-TBNA) and liquid biopsy for Next Generation Sequencing(NGS). Compare diagnostic yield differences for detecting clinically relevant mutations via NGS in concurrent EBUS-TBNA and liquid biopsies. Prospective observational cohort study of NSCLC patients undergoing concurrent biopsies. Yield differences, receiver operating characteristic (ROC) and kappa statistics were calculated for clinically relevant mutations. Of 199 subjects, diagnostic yield for EGFR was 9.5% in EBUS-TBNA and 7.0% in blood with yield difference 2.5%(95% CI: 3.4%, 8.5%, p = 0.36). For clinically relevant targets, there were 79(39.7%) from EBUS-TBNA and 49(29.6%) from blood with yield difference 15.1%(95% CI: 5.5%, 24.2%, p = 0.001). ROC statistics for detection of clinically relevant mutations (where tissue results were the gold standard) included: sensitivity 0.53 (95% CI: 0.42, 0.64), specificity: 0.95(95% CI: 0.90,0.98), positive predictive value: 0.89 (95% CI: 0.77, 0.96), negative predictive value: 0.74 (95% CI: 0.65, 0.81), and kappa statistic: 0.51 (95% CI: 0.39, 0.63). There were 37 (18.6%) participants with mutations in tissue only and 7(3.5%) with mutations in blood only, while 42(21.1%) had mutations reported from both sources. EBUS-TBNA was more likely to detect mutations than blood. However, some patients had mutations in blood only, suggesting blood testing is complementary. Strategies are needed to improve NGS turnaround time(TAT) and QNS definition.
Lung cancer is the leading cause of cancer death in the United States and disproportionately affects Black adults. Lung cancer screening (LCS) remains narrowly focused on cigarette smoking, often excluding other tobacco use, and low provider referral rates continue to limit screening uptake. Addressing these gaps is critical to advancing screening equity. We surveyed 100 Black adults (aged 50 + years) with a 20 + year history of tobacco use who either currently used or had quit within the past 15 years. The survey assessed tobacco use characteristics, cessation intentions, tobacco product harm perceptions, LCS-related quit motivations, and LCS knowledge and beliefs. We compared characteristics, beliefs, and experiences by LCS status (56% screened) using a quasi case-control approach. LCS uptake varied by insurance status (p = 0.03), tobacco risk perceptions (p = 0.037), past-year quit attempts (p = 0.005), and lung cancer beliefs, including early detection knowledge (p < 0.001). Screening experiences were associated with health care discrimination and LCS-related risk perceptions. Among adults reporting past-year use of combustible tobacco products other than cigarettes, unscreened adults were more likely than screened adults to report current use (22.7% vs. 5.4%; p = 0.01). Participants most identified social media (48.0%), followed by magazines/newspapers (31.0%) and local news (29.0%), as trusted sources of information on early lung cancer detection. Expanding LCS eligibility to include non-cigarette combustible tobacco use-while addressing structural barriers, provider recommendations, gaps in screening knowledge, risk perception, and culturally responsive communication-are essential for improving the reach, implementation, and equity of LCS in Black communities.
IV thrombolysis (IVT) is the standard-of-care evidence-based treatment of eligible patients with acute ischemic stroke (AIS) within 4.5 hours of symptom onset. Emerging evidence supports its use beyond this time window, leading to expanded recommendations for selected patients presenting between 4.5 and 24 hours. We performed a systematic review and meta-analysis to evaluate IVT in the 4.5- to 24-hour window and to explore sources of between-study heterogeneity. We searched MEDLINE, Cochrane Library, and ClinicalTrials.gov from inception through February 2026. Eligible studies were randomized controlled trials (RCTs) or individual patient-data meta-analyses of RCTs comparing IVT with control in patients with AIS presenting beyond 4.5 hours from last known well. The primary outcome was excellent functional recovery, defined as a modified Rankin Scale (mRS) of 0-1 at 90 days. Secondary outcomes included functional independence (mRS of 0-2 at 90 days); change in mRS disability, quantified as the common odds ratio (OR) for a 1-point improvement across the full ordinal mRS distribution (ordinal analysis); and safety measures such as 90-day mortality and symptomatic intracranial hemorrhage (sICH). Risk ratios (RRs) with 95% CIs were pooled. Multivariable meta-regression simultaneously modeled thrombolytic agent, endovascular thrombectomy context, and territory to disentangle confounded predictors. Fifteen studies representing 18 RCTs and encompassing 5,168 patients were included in the primary analysis. Of the 18 included RCTs, 11 required advanced perfusion imaging (CTP or MRP mismatch) or diffusion-weighted imaging/fluid-attenuated inversion recovery mismatch to confirm salvageable tissue; the remaining 7 permitted noncontrast CT/CT angiography-based selection. IVT significantly improved excellent functional outcome at 90 days (mRS 0-1; 40.3% vs 33.2%, RR 1.21; 95% CI 1.13-1.30; p < 0.001; number needed to treat [NNT] = 14) and good functional outcome (mRS 0-2; 54.5% vs 50.1%, RR 1.09; 95% CI 1.04-1.15; p < 0.001; NNT = 23). IVT was associated with significantly greater odds of reduced disability across the full mRS spectrum (common OR 1.18; 95% CI 1.07-1.32; p = 0.004). IVT increased the risk of sICH (3.2% vs 1.4%; RR 1.90; 95% CI 1.28-2.84; p = 0.002; number needed to harm = 57) but did not increase 90-day mortality (13.7% vs 13.0% RR 1.04; 95% CI 0.92-1.18; p = 0.53). Meta-regression showed that thrombectomy (β = -0.275, p = 0.012 for mRS shift; β = -0.186, p = 0.032 for mRS 0-2) is the primary driver of between-study heterogeneity, explaining 66%-100% of intertrial variance. Extended-window IVT improves functional outcomes across a wider spectrum of stroke subgroups than previously recognized. The benefit seems greatest for patients with more severe strokes in settings where thrombectomy is unavailable, providing the evidence base for offering a critical reperfusion strategy for the substantial proportion of patients worldwide who lack timely access to thrombectomy. This study provides American Academy of Neurology Class I evidence that IVT administered 4.5-24 hours after moderate-to-severe AIS onset in patients with salvageable tissue, where thrombectomy is not readily available, improves functional outcome at 90 days without increasing mortality.
Human papillomavirus (HPV) infection poses a significant public health challenge, and HPV vaccination uptake among Chinese college students remains suboptimal. Therefore, it is essential to conduct ongoing, in-depth investigations into the psychological and cognitive mechanisms of HPV vaccination intention. This study aims to explore the associations among HPV vaccination intention, vaccine hesitancy, and health beliefs among Chinese medical college students. A cross-sectional survey was conducted from June 16 to July 16, 2024, to assess sociodemographic characteristics, vaccine hesitancy, and health belief model (HBM) among college students at Guangdong Medical University. Descriptive statistics, univariate analysis, and binary logistic regression were performed to identify factors associated with HPV vaccination intentions among unvaccinated students. Among 3,584 unvaccinated participants, 73.16% expressed willingness to receive the HPV vaccine. The key significant associations identified included gender (male) (OR: 0.26; 95% CI: 0.22 ~ 0.31; p  <  0.001), parental occupation (employees in enterprises, commercial, and service industries (including self-employed)) (OR: 1.43; 95% CI: 1.18 ~ 1.75; p  <  0.001), and information sources (hospitals or doctors) (OR: 1.37; 95% CI: 1.15 ~ 1.64; p  =  0.001). Vaccination intention was also directly associated with the perceived necessity (OR: 0.91; 95% CI: 0.88 ~ 0.94; p  <  0.001) and importance (OR: 1.07; 95% CI: 1.03 ~ 1.10; p  <  0.001) of vaccine hesitancy, as well as the perceived benefits of behavior for the HBM (OR: 1.21; 95% CI: 1.12 ~ 1.32; p <  0.001). In this sample, Chinese medical college students demonstrated a relatively high willingness to receive HPV vaccination. Willingness was positively associated with perceived necessity, importance, and benefits of vaccination. Integrating structured clinician-delivered counseling into curricula, using parental occupation data for targeted subsidies, and embedding classroom sessions comparing personal HPV risk with vaccine safety data may improve uptake. Government evaluation of gender-neutral vaccination policies and provision of male-inclusive campus services are also recommended.
The Hugo™ RAS system (Medtronic) is a modular four-arm robotic platform increasingly used in gynecologic surgery since its 2021 European approval. A first international Delphi exercise on docking was published in 2026, but whether published practice aligns with it, and how completely docking variables are reported, remains unmapped. We conducted a systematic scoping review (PRISMA Extension for Scoping Reviews, PRISMA-ScR) with structured analytical extensions of the gynecologic Hugo™ RAS literature published 1 January 2022-15 May 2026, searching PubMed, Embase, Scopus, Cochrane CENTRAL, ClinicalTrials.gov, WHO ICTRP, and grey literature. Two reviewers independently extracted seven in-depth sources; agreement used Cohen's weighted κ, with every disagreement reconciled against the source. Each recommendation was scored concordant, discordant, or not assessable against the conventional two-thirds (66.7%) Delphi threshold. Effect estimates were not pooled; the extensions are descriptive mapping tools, not a meta-analysis. Inter-rater agreement on coding was almost perfect for the proposed Hugo Docking Minimum Reporting Set (HuDoc-MRS; κ 0.927) and substantial for concordance (κ 0.808). Of recommendations crossing the 66.7% threshold, only the modified-bridge configuration (15/16, 93.7% panel) also exceeded 50% uptake across the six clinical cohorts and is therefore the only recommendation both consensus-supported and consistently reported. Two anthropometry-driven modifications (increased inter-port distance for body mass index > 30; cranial port displacement for an enlarged uterus; each 11/16, 68.7% panel) showed low uptake (≤ 22% and ≤ 8%), the principal translation gap. No included study formally codified external arm collisions; reporting was verbal only. In the gynecologic Hugo™ RAS literature to date, the modified-bridge configuration is the only recommendation both strongly endorsed by the 2026 Delphi panel and consistently applied across the included cohorts. Anthropometry-driven modifications are consensus-supported but rarely reported-an actionable translation gap, not evidence of disuse. External collisions remain uncodified; the HuDoc-MRS is proposed as a candidate minimum reporting set to improve future comparability.
Deep learning and computer vision are increasingly embedded in robotic surgery, yet the development and translational direction of this research domain remain incompletely characterized. We conducted a bibliometric and visualization analysis of publications retrieved from the Web of Science Core Collection using Bibliometrix/Biblioshiny, VOSviewer, and CiteSpace. A total of 1,186 documents published between 2010 and 2026 across 356 sources were included. Scientific output increased rapidly, with an annual growth rate of 16.09% and a peak of 216 publications in 2025. The field involved 5,296 authors, and international collaboration accounted for 30.69% of publications. IEEE Robotics and Automation Letters was the most productive and locally influential source. China and the United States were the leading contributors, with China showing the most rapid recent expansion and the United States retaining the highest citation impact. Citation-burst and keyword analyses identified U-Net, residual learning, transformer architectures, and foundation-model-enabled segmentation as major methodological drivers. The conceptual structure evolved from image guidance, registration, and navigation toward surgical video intelligence, instrument perception, workflow understanding, autonomous assistance, and clinical translation. Instrument perception emerged as a central link between algorithmic development and operative application. Future progress will require diverse multi-institutional datasets, external and prospective validation, integrated scene understanding, and rigorous evaluation of intelligent assistance within real robotic surgical workflows.
Removable orthodontic aligners are widely used due to their aesthetic appeal, removability, and perceived comfort. However, evidence regarding their potential adverse effects remains limited. To identify and synthesize the adverse effects associated with removable orthodontic aligner therapy. This systematic review with single-arm meta-analysis evaluated adverse effects related to removable orthodontic aligner therapy. Seven electronic databases (Cochrane, Embase, LILACS, Livivo, MEDLINE, Scopus, and Web of Science) and gray literature sources (ProQuest Dissertations and Google Scholar) were searched without language or date restrictions. Two calibrated reviewers independently selected studies. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Due to clinical and methodological heterogeneity, most outcomes were synthesized narratively; meta-analyses were conducted only for pain/discomfort, apical root resorption, and plaque. Thirty-four studies met the inclusion criteria, including 10 randomized controlled trials, 6 non-randomized clinical studies, and 18 cohort studies. Randomized trials were predominantly at low risk of bias, whereas most non-randomized and cohort studies were at moderate to high risk. Pain and apical root resorption were the most frequently reported adverse effects. Pain peaked within 24 hours, decreased by day 3, and was minimal by 1 week. Apical root resorption was generally small, with a mean linear loss of -0.33 mm (95% CI -0.55 to -0.11) and a volumetric loss of -4.37 mm³ (95% CI -5.51 to -3.24). Findings on plaque at 3 months were inconclusive. Other reported outcomes included periodontal changes, enamel demineralization, white spot lesions, speech alterations, halitosis, open gingival embrasures, temporomandibular symptoms, and awake bruxism. Short-term pain and minor apical root resorption appear to be the most frequently reported adverse effects of removable orthodontic aligners, although the certainty of evidence varies across outcomes. Speech alterations, discomfort, and white spot lesions have also been reported.
Perovskite/organic tandem solar cells (PO-TSCs) offer high photovoltage and solution processability, making them attractive power sources for bias-free photovoltaic-electrochemical (PV-EC) conversion. However, their integration into PV-EC systems requires minimizing interfacial losses and ensuring stable charge extraction at selective contacts. Herein, we report a simplified interfacial engineering strategy by incorporating Al2O3 into a MeO-4PACz self-assembled monolayer to form a mixed hole-selective layer (m-HSL) via a single-step deposition process. The resulting PO-TSC attains a power conversion efficiency of 22.85% with an exceptional open-circuit voltage (VOC) of 2.13 V. Exploiting this exceptional photovoltage, we directly couple the PO-TSC with a two-electrode nitrate electrolyzer to realize solar-driven nitrate-to-ammonia conversion without an external bias. The integrated device achieves a solar-to-ammonia efficiency of 3.7% with a faradaic efficiency of 82%. This work establishes a robust tandem-driven PV-EC framework for nitrate reduction and provides a foundation for solar-driven ammonia production.