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To evaluate the prevalence of hyperlipidaemia with respect to age and gender, and to assess future prospects. The retrospective study was conducted in October 2024 at Dr Abdul Rauf Laboratory, Gujrat, Pakistan, and comprised data from January 1, 2020, to September 30, 2024, of patients who had undergone lipid profile test. To assess prospects for the next 10 years, Seasonal Auto-Regressive Integrated Moving Average model was used by using Jupyter Notebook of Anaconda Navigator 1.9.12 that was installed in Microsoft window 7(32 bit). Of the 4,004 patients, 2,338(58.4%) were male and 1,666(41.6%) were female. The overall prevalence of hyperlipidaemia was 3286(82.1%). The prevalence of hyperlipidaemia among male patients was high throughout the time as 266(86.9%) in 2020, 384(84.4%) in 2021, 444(86.7%) in 2022, 500(83.8%) in 2023 and 408(87.2%) in 2024. In contrast, female patients exhibited comparatively lower prevalence rates as 146(81.1%) in 2020, 298(74.7%) in 2021, 279(74.8%) in 2022, 308(77.4%) in 2023 and 253(80.1%) in 2024. In males age group 41-50 years highly effected with 564(88.3%) while in females age group 51-60 years with 366(80.6%). The prevalence of high level of triglycerides, cholesterol, and low-density lipoprotein, and low level of high-density lipoprotein was 2364(59%), 1454(36.3%), 1172(29.3%) and 2022(50.5%) respectively. Level of triglycerides and high-density lipoprotein was higher in males 1454(62.2%), 1371(58.6%) compared to females 910(54.6%), 651(39.1%) while the level of cholesterol and low-density lipoprotein was higher in females 618(37.1%), 497(29.8%) compared to males 836(35.8%), 675(28.9%). The Seasonal Auto-Regressive Integrated Moving Average model suggested that hyperlipidaemia over the next 10 years in Gujrat will fluctuate between 80% and 90. All stakeholders need to play their role in controlling the spread of life-threatening hyperlipidaemia.

Knee osteoarthritis (OA) is a common musculoskeletal disorder characterized by the progressive degradation of articular cartilage, along with changes in surrounding soft tissues and bone structures. The knee joint is particularly susceptible to osteoarthritic changes, resulting in pain, functional impairment, and a significant decline in the quality of life for affected individuals. Plain radiography and MRI are considered the standards imaging modalities for diagnosis. This research aims to explore the correlation between soft tissue changes and the severity of knee OA, utilizing both traditional plain radiographs and advanced MRI techniques. The study also focuses on gender differences to provide insights into potential modifiable risk factors and therapeutic targets. A total of 232 patients underwent knee MRI and X-ray imaging for various clinical indications. Radiographs were classified according to the Kellgren-Lawrence scale, while MR images were used to assess body composition and degenerative changes in the knee. Among the 232 participants, 54.7% were female and 45.3% were male, with most aged 30-44 years and categorized as obese (44.8%). The data revealed that muscle thickness remained consistent across BMI categories, with males generally exhibiting higher values than females. Fat thickness increased with higher BMI categories, with females consistently showing greater values than males. The muscle-to-fat ratio decreased as BMI increased, with males having higher ratio in the normal BMI category compared to females. Pearson's correlation indicated that muscle to fat ratio has a weak negative correlation with soft tissue degenerative changes, and cartilage degenerative changes. Cohen's Kappa coefficient analysis revealed fair agreement between binary classifications derived from X-ray and MRI findings. The McNemar's test indicated a statistically significant difference in detection capabilities between the two techniques. The muscle-to-fat ratio and fat thickness significantly impact knee degenerative changes, particularly in females. This underscores the necessity for targeted interventions aimed at reducing fat thickness while preserving muscle thickness to enhance overall health outcomes. Although X-rays exhibit higher sensitivity, they have lower specificity compared to MRI; both diagnostic methods improve in accuracy as disease severity increases. The combination of MRI and X-ray further enhances the diagnostic accuracy for knee OA.

This study examines how digital stressors technostress, digital fatigue, and perceived AI ethical concerns impact foreign language learning anxiety (FLLA), digital burnout, and academic performance in English as a Foreign Language (EFL) classrooms, with implications for achieving Sustainable Development Goal (SDG) 4 on quality education. Employing a cross-sectional design, data were collected from 545 university-level EFL learners (domestic and international) in China. Partial least squares structural equation modeling (PLS-SEM) was used to test a serial mediation model with moderation. Results show that technostress (β = 0.41), digital fatigue (β = 0.33), and AI ethical concerns (β = 0.22) significantly increase FLLA, which in turn fully mediates the effects of these stressors on digital burnout (indirect effects: 0.10-0.19). Technology self-efficacy moderates the negative relationship between burnout and academic performance (β = 0.21), with this moderating effect being stronger for international students. Academic performance strongly predicts SDG-4 achievement (β = 0.53). By integrating control-value theory and the job demands-resources model, this study provides a robust framework for understanding digital stress dynamics in language learning. Practically, the findings underscore the urgency of embedding digital wellness training, culturally responsive onboarding for international students, and discipline-specific AI ethics guidelines into EFL curricula to safeguard learner well-being and advance equitable, sustainable education.

The journal retracts the article titled "Blockchain-Powered Healthcare Systems: Enhancing Scalability and Security with Hybrid Deep Learning" [...].

Paediatric controlled donation after circulatory determination of death (pcDCDD) is a well described pathway for deceased organ donation, but there has been wide variability in global uptake. There are substantial and differing barriers to pcDCDD across countries, including clinical, legal, and ethical issues. This process utilized a Delphi consensus methodology involving 30 international experts to develop recommendations to guide the development and operation of pcDCDD programs. Two survey rounds evaluated agreement on system requirements, donor identification, medical suitability, communication, end-of-life care, and ante-mortem interventions. Consensus recommendations emphasized the need for robust administrative and legal frameworks that explicitly support pcDCDD, multidisciplinary approaches for donor suitability assessment, and normalization of integrating donation into paediatric end-of-life care. The particularities of obtaining consent for both donation and antemortem interventions necessary for pcDCDD for patients that have never expressed a valid intent to donate were addressed. While our findings demonstrated international variability, strong consensus was obtained for multiple recommendations, suggesting the possibility of developing pcDCDD in varied international settings. The process also highlighted areas of knowledge gaps along the pcDCDD process that would benefit from sustained research.

The Damage Response Framework (DRF) is a conceptual model that evaluates the outcome of host-pathogen interactions (HPI) by assessing the total damage sustained by the host. The DRF emphasizes that disease results from cumulative host injury arising from the interplay between microbial virulence and the host immune response, rather than from the pathogen alone. HPI has been described as a "tug of war" between a pathogen and a host; the DRF improves this analogy by grounding it in reality, as both excessive immune activation and insufficient pathogen clearance can lead to host damage and disease. Acinetobacter baumannii is a Gram-negative pathogen known for its extensive drug resistance and immunomodulatory capacities. The interaction among isolate-specific virulence traits, antimicrobial resistance mechanisms, and host immune status determines the pattern and extent of damage, illustrating central tenets of the DRF. Different A. baumannii isolates may therefore produce varied clinical outcomes across different host conditions, depending on the extent of damage they cause. This narrative review discusses A. baumannii infections from the perspective of the DRF, highlighting how applying the DRF can inform our current understanding of A. baumannii pathogenesis by assessing A. baumannii HPI. We also provide brief insights into how the DRF can inform future research and treatment strategies that integrate host and microbial factors to minimize overall damage and improve host outcomes. A. baumannii infections are difficult to treat and can result in outcomes ranging from asymptomatic colonization to fatal disease. This narrative review examines these differences through the Damage Response Framework (DRF) to improve understanding of A. baumannii infections. The DRF emphasizes that disease results not only from the microbe but also from the interaction between microbial factors and the body’s immune response. When the total damage from the microbe and the immune response exceeds the body's ability to repair, hosts become sick. Hosts with weak immune responses can become very ill because their immune systems cannot control the infection effectively. Conversely, patients with strong immune responses can also become severely ill when their immune systems damage vital tissues and organs in an effort to eliminate the bacteria. This narrative review draws on existing literature to show that different A. baumannii isolates can cause varying levels of illness, depending on the host’s response to the infection. The review also briefly describes the importance of considering antimicrobial therapy as a potential source of host damage and the utility of the DRF in optimizing therapeutic strategies.

Although selenium nanoparticles (SeNPs) and arbuscular mycorrhizal fungi (AMF) are each known to enhance plant growth and stress tolerance, their combined application in medicinal herbs remains largely unexplored. This study evaluates how the concurrent action of applied SeNPs and AMF root colonization reprograms photosynthetic metabolism, antioxidant defense, and secondary metabolite pathways in sweet basil (Ocimum basilicum L.). In a factorial greenhouse experiment with four treatments (control, AMF, SeNPs, and AMF + SeNPs), the combined treatment markedly enhanced fresh and dry biomass accumulation by 72.8% and 96.2%, respectively. The treatments yielded strong additive benefits for gas exchange and pigment accumulation, where the combined application markedly enhanced net photosynthetic rate by 65.5% and chlorophyll level by 75.7%. This was in line with additively suppressed photorespiration, reflected in a 57.9% and 62.1% decline in glycolate oxidase and hydroxypyruvate reductase activity, respectively. The AMF-SeNPs interaction also enhanced phenylpropanoid-derived antioxidants (individual and total phenolic acid and flavonoids) amplifying total antioxidant capacity by 38.2%. By integrating biological and technological interventions, this study establishes an eco-efficient framework that maximizes both crop productivity and bioactive medicinal quality through improved redox homeostasis. While these greenhouse results are promising, future field trials with varied dosages remain essential to confirm the practical scalability of this combined approach.

Arthropod including ticks, fleas, and lice have been found to be infected with Rickettsia massiliae, a pathogenic member of spotted fever group, causing rickettsiosis. This comprehensive scoping review summarize the known facts about its transmission, diagnostic-methods, phylogenetic position, human-case-reports, preventive-measures, and distribution in Palearctic and Oriental regions. Three main steps were followed to compile this study: explanation of objective(s), identification of relevant literature, and retrieval of data determined by inclusion and exclusion criteria. Various databases, including Science Direct, Web of Science, PubMed, Scopus, Cochrane, and Google Scholar were screened for relevant literature. Our objectives were to collect data regarding transmission method(s) of R. massiliae, identification-assay(s), phylogenetic position, clinical-reports globally, and distribution via possible vectors & host animals surviving in Palearctic and Oriental regions. Descriptive analysis has been conducted to plot the frequency graphs of reported numbers in different countries and hosts. Findings presented that R. massiliae have been found across Palearctic and Oriental regions in 5 tick genera (Rhipicephalus, Hyalomma, Haemaphysalis, Ixodes, Amblyomma, and Dermacentor), 1 of louse (Haematopinus), 1 of sheep ked (Melophagus), and 1 of flea (Archaeopsylla), although their role as a vector(s) is still unknown. Dogs, sheep, cattle, and goats were recorded as epidemiologically important host animals for infected arthropods in 30, 23, 17, and 16 different studies, highlighting their role in its possible transmission. Additionally, Rh. sanguineus sensu lato (s.l) and Rh. turanicus were reported to infest the aforementioned animals, which is also being recognized as potential vector for its transmission. Highest number of R. massiliae reports (10) from different animals and vectors were recorded in China. Italy was recorded with highest (3) clinical cases of humans to-date. Moreover, transmission methods like transovarial via Rh. turanicus and horizontal/artificial-feeding via Rh. sanguineus s.l. and various diagnostic methods for R. massiliae have been documented. R. massiliae has been widely documented throughout Palearctic and Oriental regions, with human cases reported in about six countries. Rh. sanguineus and Rh. turanicus stands out the potential vectors, while further investigation into the implications of diverse range of arthropods in epidemiology of this bacterium.

Radiomics applied to two-dimensional breast ultrasound has emerged as a potential noninvasive approach for differentiating benign from malignant breast lesions; however, its diagnostic accuracy and methodological reliability remain uncertain. This PRISMA-DTA-compliant systematic review and meta-analysis (PROSPERO CRD420251149769) synthesized evidence from observational studies published between 2019 and 2026. A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library identified 27 eligible studies. Pooled sensitivity, specificity, and hierarchical summary ROC (HSROC) area under the curve were estimated using bivariate random-effects models; heterogeneity, threshold effects, and small-study effects were assessed with I2, Spearman correlation, and Deeks' funnel-plot asymmetry test. The meta-analysis pooled data from the validation or test sets of 9,627 histopathologically confirmed lesions (5,733 benign, 3,894 malignant). Pooled sensitivity and specificity were 0.85 (95% CI 0.82-0.88) and 0.87 (95% CI 0.83-0.91), with strong overall discrimination (HSROC AUC 0.92). Between-study heterogeneity was substantial (I2 74.0-85.5%), reflecting variability in study design, validation strategies, and ultrasound acquisition reporting. No evidence of small-study effects or publication bias was detected (Deeks' p = 0.5054; t = 0.676, df = 25); however, risk-of-bias assessment using QUADAS-2 revealed frequent high or unclear concerns in patient selection and index test domains. Although radiomics-based models demonstrate clinically meaningful diagnostic performance, pooled estimates likely represent upper-bound accuracy due to methodological limitations and optimism bias. Prospective, multicenter, multi-vendor validation, standardized acquisition and reporting frameworks, and evaluation of incremental clinical utility within BI-RADS-guided workflows are required to support safe clinical translation.

The Journal retracts the article "Influence of Compression Molding Process Parameters in Mechanical and Tribological Behavior of Hybrid Polymer Matrix Composites" [...].

The physical and sensory attributes of date palm fruits are crucial to consumer acceptance and their market value; however, relationship to microstructural morphometrics, which govern the texture stability and overall sensory perception of date fruits during postharvest handling and storage, is poorly understood. A combined methodology of morphometrics and statistical analysis was employed using two high-quality Pakistani date palm cultivars (cv), Aseel and Dhakki, to address this research gap. The mesocarp microstructure was quantified using Scanning Electron Microscopy (SEM) at 20, 50, and 100 μm scales and examined with ImageJ to determine porosity, cell equivalent diameter, wall thickness, edge density and collapse proxies. Cv. Dhakki exhibited significantly higher fruit length (5.03 cm) and flesh weight (14.65 g) compared to cv. Aseel (3.58 cm and 8.47 g, respectively). SEM analyses highlighted cultivar-specific variation in microstructural attributes, with cv. Dhakki fruits present larger cells and thinner walls associated with higher porosity (~ 25-30%) as a basis for the softer and juicier texture. While cv. Aseel had lower porosity (~ 10-15%), yet was superior in aromatic intensity, where more compact cells with thicker walls and denser fiber bundles explained its firmness and stronger aroma retention. The microstructural morphometries were positively correlated with fruit size and texture/mouthfeel but negatively correlated with odor/aroma and taste. This investigation integrates SEM-derived microstructural morphometrics with physical and sensory profiling of date palm fruits and contributes to understanding the relationship between these traits, with practical implications for cultivar selection, processing, and consumer-oriented quality improvement in the date palm sector.

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Resource-constrained medical sensing devices are increasingly expected to support local intelligence, privacy-preserving collaboration, and secure communication in Internet of Medical Things (IoMT) environments. However, deploying federated learning in ICU monitoring remains challenging because hospital data are often non-IID, model updates may be adversarially poisoned, and emerging quantum-security threats require stronger communication protection. This paper presents a federated TinyML framework with an edge-hosted patient-state Digital Twin layer for ICU monitoring. The Digital Twin component is implemented as a lightweight patient-state representation rather than a full physiological simulator. It maintains recent physiological observations, temporal risk trends, predicted status labels, and interpretable alert information at the hospital gateway. Patient-specific adaptation is therefore achieved through individualized temporal state tracking and risk-history synchronization, while the predictive model is collaboratively learned across hospitals. The suggested framework employs decision-tree ensembles due to their lightweight nature, efficient inference capabilities, and interpretability inherent to ESP32-class devices. As decision tree structures are not amenable to average aggregation like neural network parameters, the aggregation of local client models is done via the validation-based ensemble fusion. In order to enhance the resistance of the framework to attacks based on poisoning clients, the Performance-Based Filtering (PBF) method analyzes the performance of each local ensemble against a trusted validation set and excludes low-quality local ensembles from the subsequent global ensemble aggregation. The secure model exchange process utilizes ML-KEM-512 key encapsulation scheme in combination with AES-256-GCM authenticated encryption. The extra overhead of the crypto layer is 0.09 ms per update exchange. The framework is evaluated using a clinician-reviewed synthetic ICU monitoring dataset distributed across three non-IID hospital clients and externally benchmarked using a PhysioNet-based critical-care dataset constructed from shared physiological features. The prediction task uses five status categories: normal, mild, moderate, critical, and an outlier/anomaly category; these labels represent synthetic severity-status classes rather than prospectively validated ICU endpoints. Under a targeted label-flipping attack in which one client relabels critical cases as normal, the proposed PBF strategy achieves 86.79% accuracy, 0.782 macro-F1, 0.904 critical-class recall, 0.837 critical-class F1-score, 0.947 macro-AUROC, and 0.799 macro-AUPRC on the synthetic ICU evaluation. External benchmarking at [Formula: see text] achieves 98.04% accuracy, 0.959 macro-F1, 0.977 critical-class recall, 0.987 critical-class F1-score, 0.999 macro-AUROC, and 0.983 macro-AUPRC. Comparative evaluation against FedAvg, Krum, Trimmed Mean, and Coordinate Median shows that PBF provides stronger protection of critical-class recall under adversarial conditions, although full prospective clinical validation remains outside the scope of this study. Overall, the results indicate that a federated TinyML architecture with lightweight patient-state tracking, validation-based ensemble filtering, differential privacy, and post-quantum-secure communication can support privacy-aware and attack-resilient ICU monitoring experiments in resource-constrained IoMT settings. The study should be interpreted as a technical feasibility and robustness evaluation rather than a fully integrated clinical Digital Twin deployment.

Indeterminate biliary strictures present a diagnostic challenge with a differential ranging from benign conditions such as IgG4-related disease to cholangiocarcinoma. ERCP-guided brush cytology has been the long-standing tissue-sampling strategy, but its reported sensitivity for malignancy is limited, frequently falling below 50% in published series. Complementary and alternative approaches have been developed, including fluorescence in situ hybridization (FISH) of biliary brushings, intraductal biopsy (IDB), and single-operator cholangioscopy (SOC) with the SpyGlass DS platform. These modalities have been evaluated individually, but a unified comparative synthesis has not previously been undertaken. This network meta-analysis (NMA) was conducted to synthesize the available evidence across these five strategies and to provide comparative rankings of their diagnostic performance. We searched PubMed, EMBASE, the Cochrane Library, and Scopus from inception through 31 December 2024, without language restriction. Eligible studies enrolled adult patients with indeterminate biliary strictures and evaluated at least one diagnostic modality against a histopathological or follow-up reference standard. Reporting followed methodological guidance for network meta-analyses of diagnostic test accuracy, with relevant items from the PRISMA-NMA and PRISMA-DTA extensions used to structure the review. A Bayesian hierarchical random-effects model was used to pool diagnostic accuracy data. Primary endpoints were sensitivity and specificity for malignancy. Secondary endpoints included diagnostic odds ratio (DOR), area under the ROC curve (AUROC), tissue adequacy, and adverse events. Surface under the cumulative ranking curve (SUCRA) values were calculated to rank modalities. Heterogeneity, network consistency, publication bias, and pre-specified sensitivity analyses (including restriction to SpyGlass DS-era data and to studies with a uniform reference standard) were formally assessed. Thirty-eight studies enrolling 4,912 unique patients met our criteria, contributing 6,570 per-modality observations across five diagnostic strategies: brush cytology, FISH, intraductal biopsy, SOC (SpyGlass DS), and combined FISH + brush cytology. SOC achieved the highest pooled sensitivity at 82% (95% CrI: 76%-88%; SUCRA 92%), and brush cytology had the lowest at 45% (95% CrI: 38%-52%; SUCRA 30%). The pattern was inverted for specificity: brush cytology was highest at 97% (95% CrI: 94%-99%) and SOC was lowest at 89% (95% CrI: 84%-93%). For overall diagnostic accuracy, SOC ranked first (SUCRA 88%), followed by FISH + brush cytology (SUCRA 80%). Pairwise comparison showed SOC was statistically superior in sensitivity to brush cytology, FISH alone, and intraductal biopsy; the comparison between SOC and FISH + brush cytology did not reach statistical significance (OR 1.43; 95% CrI: 0.97-2.13). SOC was associated with a higher adverse-event rate than cytology-based sampling (6.8 vs. 2.1%; OR 2.3, 95% CrI: 1.2-4.6); no procedure-related deaths were reported. Network consistency was acceptable, and no material publication bias was detected. SOC (SpyGlass DS) demonstrated the highest pooled sensitivity for malignancy in indeterminate biliary strictures, but its interpretation should be guided by clinical context rather than statistical ranking alone. The sensitivity difference between SOC (SpyGlass DS) and combined FISH + brush cytology was not statistically significant in pairwise comparison, supporting FISH + brush cytology as a high-value, lower-morbidity alternative where SOC is unavailable or procedural risk is a concern. SOC was associated with a higher adverse-event rate than cytology-based sampling and showed lower specificity, which carries clinical implications for false-positive diagnoses. Choice of modality should therefore be considered in the context of local diagnostic capacity, patient-level pretest probability, and the relative consequences of false-negative and false-positive results. Comparative cost-effectiveness and the performance of these modalities in community-practice settings warrant further study.

The photothermal conversion of CO2 into selective multi-carbon hydrocarbons remains an unresolved challenge due to the instability of the key intermediates and the high barrier for C-C coupling. Here, we report an atomically integrated Cu-Au heteronuclear catalyst on carbon nitride (Cu-Au/CN) that converts CO2 to ethane (C2H6) with 87% selectivity at a rate of 30 mmol g-1 h-1, maintaining steady performance for over 200 hours and structural integrity for over one year. This catalyst surpasses the existing selectivity benchmarks for photothermal CO2 hydrogenation. The Cu-Au interface induces cooperative electronic asymmetry and charge redistribution, extending carrier lifetimes by over 160%. These effects stabilize the *CO and *CH3 intermediates, lower the C-C coupling barrier, and establish a durable and atomically precise platform for continuous C2 hydrocarbon production toward sustainable CO2 valorization.

Spleen tyrosine kinase (SYK), a critical non-receptor tyrosine kinase, is a significant target in therapy for cancer, autoimmune diseases, and inflammation. This study combines machine learning with molecular docking to overcome challenges related to activity and chirality cliffs in SYK inhibitors. A robust and statistically reliable multiple linear regression model (R2tr = 0.799, Q2LMO = 0.796) was developed, complemented by docking analyses of 1854 molecules. The findings reveal that inhibitory activity is governed by specific structural features, including the solvent accessible surface area of certain H-bond donors, the presence of sp2-C, and various nitrogen atom types. Crucially, the configuration of chiral centers significantly influences the activity profile. This dual approach effectively decodes the activity and chirality cliffs, offering valuable insights for the future optimization and development of potent SYK inhibitors.

Morel-Lavallée lesions (MLL) are closed degloving injuries caused by shearing forces that separate the skin and tissue from the deep fascia. This creates a space where blood and lymphatic fluid can collect if not found early. MLL often happen after high-energy trauma and may be missed when other injuries seem more urgent. A 35-year-old motorcyclist developed a swelling on his left thigh after an accident. At first, it was thought to be just a bruise. Over the next few months, the swelling grew and became more painful. Ultrasound and CT scans showed a large, multiloculated fluid collection, which matched a chronic MLL. Surgery drained about one liter of fluid through two incisions. After the wound was closed, the patient recovered fully without complications. This case shows that MLL can be missed, especially when the first injury seems minor. If the condition becomes chronic, surgery is often needed because a fibrous capsule forms around the fluid. If swelling lasts after an injury, clinicians should consider MLL. Early imaging and quick treatment can lower the risk of complications and help patients recover better.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by the accumulation of amyloid-β (Aβ) plaques and tau (τ) -related neurofibrillary tangles, often exacerbated by dysfunctional cellular clearance mechanisms. This manuscript explores the pivotal role of autophagy impairment in AD pathogenesis, with a specific focus on the AMPK/mTOR signaling axis as a primary regulatory pathway. Findings revealed that while mTOR overactivation suppresses autophagic flux and promotes the buildup of toxic protein aggregates, the activation of AMPK serves to restore homeostatic degradation processes. The review highlights that various pharmacological agent including rapamycin, metformin, trehalose, and curcumin, as well as repurposed drugs like lithium and statins can effectively enhance autophagy to ameliorate cognitive decline and neuroinflammation. Furthermore, herbal formulations such as Danggui Shaoyao San and phytoconstituents like Icariin demonstrate significant neuroprotective potential by modulating these same molecular pathways. Targeting autophagy represents a translationally viable approach for combating AD progression, with drug repurposing offering a time-efficient and cost-effective strategy. To advance these findings, future research should prioritize large-scale clinical trials to validate the efficacy of autophagy-inducing agents in human subjects. Additionally, investigating synergistic combinations of traditional bioactives with synthetic drugs and utilizing innovative delivery systems, such as intranasal nanotechnology-based platforms to bypass the blood-brain barrier, represents a promising frontier for developing effective, multi-targeted treatments against AD.

This study aimed to examine the level of test anxiety among nursing students in Saudi Arabia and to identify the coping strategies they use when facing pre-exam anxiety and uncertainty. A cross-sectional design was employed. Participants were recruited using convenience sampling. Data were collected from nursing students enrolled in regular and bridging programmes at a Saudi nursing college using a self-administered questionnaire. Test anxiety was assessed using the Westside Test Anxiety Scale (WTAS), and coping strategies were measured using the Coping with Pre-Exam Anxiety and Uncertainty (COPEAU) scale. Descriptive statistics and independent-samples t-tests were conducted to examine anxiety levels, coping patterns and differences between the regular and bridging programmes. A total of 199 nursing students participated in the study. Overall, students demonstrated a moderate level of test anxiety, with cognitive worry, memory concerns and post-exam performance anxiety emerging as the most prominent symptoms. Regarding coping strategies, students predominantly relied on task-oriented and preparation-focused approaches, reflecting strong engagement in planning, organisation and focused effort towards examinations. Seeking social support was also commonly utilised, indicating the importance of emotional and informational resources in managing exam-related stress. In contrast, avoidance strategies were less strongly endorsed. Nursing students in Saudi Arabia experience moderate test anxiety but predominantly adopt adaptive coping strategies, particularly task-oriented preparation and social support. These findings highlight the protective role of constructive coping behaviours in managing academic stress. Integrating structured exam preparation training, stress management programmes and accessible support services within nursing curricula is recommended to reduce cognitive worry and enhance students' academic resilience and psychological well-being. These study findings can directly inform nursing education and student support. Embedding structured exam-preparation and test-taking skills, evidence-based stress-management and relaxation training and routine screening for elevated test anxiety within the curriculum may help reduce cognitive worry and memory-related concerns. Peer-support services, accessible counselling and academic advising, can reinforce the adaptive, task-oriented and social-support coping that students already favour and strengthen their academic resilience and psychological well-being. No patient or public contribution.