Pediatric nurses carry heavy emotional and clinical demands that leave them vulnerable to burnout. Trauma-Informed Care (TIC) has helped ease burnout in the workplace, but psychological factors like Impostor Syndrome (IS) may weaken these benefits. Whether IS mediates the TIC-burnout link has not been well studied. To examine the mediating effect of impostor syndrome on the association of trauma-informed care with burnout in pediatric nurses. A descriptive cross-sectional study was conducted in six hospitals of Mansoura City, Egypt, between October 2024 and January 2025, with a sample size of 251 pediatric critical care nurses (96.5% response rate). Instruments included Trauma-Informed Care Scale, Maslach Burnout Inventory, and Clance Impostor Syndrome Scale. Data were analyzed by means of Pearson correlation, multiple linear regression, and mediation analysis through PROCESS macro with 5000 bootstrap samples. Impostor syndrome was the strongest predictor of burnout (β = 0.383, p < .001), followed by attitude toward TIC (β = 0.234, p = .047). Female nurses reported lower burnout, though only IS acted as a mediator. IS partially mediated the association of TIC with burnout (indirect effect = 0.15, 95% CI (0.06, 0.24)), with the model explaining 50.3% of burnout variance. Impostor syndrome has the potential to alter the work requirements of TIC into further vulnerability to burnout. Comprehensive support for pediatric nurses should incorporate trauma-informed practices alongside programs and strategies to ameliorate the experience of self-doubt, thus improving well-being and care quality.
Acute lymphoblastic leukemia (ALL) is the most common malignancy in pediatric populations and affects white blood cells. The solute carrier organic anion transporter family member 1B1 (SLCO1B1) gene encodes the organic anion transporting polypeptide 1B1 (OATP1B1), a transporter involved in drug metabolism, whereas methionine synthase reductase (MTRR) plays an essential role in DNA synthesis and methylation. This study investigated the association between pediatric ALL and genetic polymorphisms in the SLCO1B1 and MTRR genes in an Egyptian population. Tetra-primer amplification refractory mutation polymerase chain reaction (T-ARMS-PCR) was used to genotype the SLCO1B1 (521T > C, rs4149056) and MTRR (1049 A > G, rs162036) variants in 100 pediatric ALL patients and 100 healthy controls. Significant differences in genotype and allele frequencies were observed between cases and controls for both variants (SLCO1B1: p = 0.001; MTRR: p = 0.001 and p = 0.04, respectively). These findings suggest a possible association between SLCO1B1 and MTRR polymorphisms and susceptibility to pediatric ALL in the studied Egyptian population.
Uncontrolled and resistant hypertension continues to be a significant contributor to cardiovascular and renal risk. Baxdrostat is a selective aldosterone synthase inhibitor which has demonstrated a potential blood pressure-lowering effect in randomized controlled trials (RCTs). We performed a systematic literature search across PubMed, Scopus, Web of Science, and Cochrane from their inception to March 2026. The continuous outcomes were reported as mean differences (MDs), and dichotomous outcomes as relative risks (RRs), both with their corresponding 95% confidence intervals (CIs). In four RCTs involving 1481 participants, baxdrostat reduced mean sitting systolic and diastolic blood pressure significantly more than placebo (MD =  - 8.93 mmHg and MD =  - 3.79 mmHg, respectively), with no heterogeneity. Benefits were observed with both 1 mg and 2 mg daily doses. Baxdrostat was associated with a higher incidence of adverse events overall (RR = 1.24; 95% CI, 1.07 to 1.43), higher serum potassium levels (MD = 0.47 mmol per liter), and greater risks of hyperkalemia (RR = 8.64; 95% CI, 3.56 to 20.98) and potassium levels of more than 6 mmol per liter (RR = 6.06; 95% CI, 1.66 to 22.17), whereas serious adverse events were not significantly increased. In patients having uncontrolled or resistant hypertension, baxdrostat reduced sitting systolic and diastolic blood pressure compared to placebo. These results are based on a few RCTs, and the increased risk of hyperkalemia warrants caution. Further studies are required to provide enlightenment on long-term safety and general clinical benefit.
A one-step, in situ microwave-assisted procedure was used to prepare nitrogen- and sulfur-doped carbon quantum dots (N,S-CQDs) from Tilia tea bag waste. The resulting N,S-CQDs were characterized by microscopy and spectroscopic techniques and applied as a fluorescence "turn-off" probe for the anticancer drug entrectinib in aqueous samples. The fluorescence emitted by CQDs (λ em = 440 nm) decreased upon the addition of entrectinib due to the inner filter effect. The reduction in emission intensity exhibits a linear relationship across the concentration range of 1.0-25.0 µg mL-1 with a limit of detection of 0.27 µg mL-1. Method performance in spiked environmental waters showed mean recoveries above 97.5% under the tested conditions. The method's environmental and practical attributes were assessed using established multi-criteria tools. The metric outputs indicate favorable greenness, practicality, innovation potential, and analytical performance. This work demonstrates a practical route for converting an agro-waste stream into functional N,S-CQDs and their application for near-source screening of an emerging pharmaceutical contaminant in water.
This study evaluated the effects of quercetin nano-emulsion (QNE) and hesperidin-loaded chitosan nanoparticles (HLCN) supplementation on post-thaw semen quality, apoptotic markers, acrosomal integrity, oxidative stress, microbial load, and fertility of Egyptian buffalo bulls (Bubalus bubalis). Semen samples were collected via artificial vagina from seven fertile bulls (aged 5-6 years). The samples were cryopreserved using a Tris-based extender alone (control; CON) or supplemented with quercetin nano-emulsion at 5 µM (QNE5) or 10 µM (QNE10), or with hesperidin-loaded chitosan nanoparticles at 12.5 µM (HLCN12.5) or 25 µM (HLCN25). The results demonstrated that the QNE10, HLCN12.5, and HLCN25 achieved significantly higher post-thaw progressive motility, sperm viability, plasma membrane function, and acrosomal integrity compared to both the QNE5 and CON groups (P < 0.05). Notably, the HLCN25 group exhibited superior sperm kinematic parameters, which were significantly higher than those of all other treatment groups (P < 0.01). Total antioxidant capacity (TAC) and catalase (CAT) activity increased markedly in all nano-supplemented groups, peaking in the HLCN25 group (P < 0.05). Conversely, all treatment groups exhibited a significant reductions in oxidative stress markers (hydrogen peroxide and malondialdehyde) and total bacterial and coliform counts compared to the CON treatment (P < 0.05). Furthermore, HLCN25 significantly enhanced fertility, yielding a 40% increase in pregnancy rates compared with the CON treatment (P < 0.05). Molecular docking simulations demonstrated that both quercetin and hesperidin exhibit high binding affinities for the antioxidant proteins peroxiredoxin 3 (PRDX3) and cytochrome c. Notably, hesperidin displayed superior binding stability and lower free energy scores than quercetin, suggesting its enhanced therapeutic potential in mitigating oxidative stress. In conclusion, our findings suggest that QNE and HLCN are promising nano-antioxidants for the cryopreservation of buffalo semen. The 25 µM of HLCN dose, provided the most notable improvements in sperm quality and fertility outcomes, making it the most effective concentration for reducing cryodamage in buffalo spermatozoa.
Chromone derivatives are a large family of bicyclic six-membered oxygenated heterocycles. Also, they are bioactive, naturally occurring scaffolds with unique chemical and physical features. Additionally, chromone frameworks have been utilized in various applications, ranging from drug discovery to supramolecular chemistry. This review systematically summarizes the literature on synthetic methodologies for formylchromones, cyanochromones, chromene-3-carboxylic acids, and chromene-3-malononitrile derivatives, focusing on construction strategies involving Vilsmeier-Haack and palladium-catalyzed formylation. Moreover, this report outlines advancements in chromone chemistry, highlighting recent developments, discussing substrate scope, reaction conditions, and proposed mechanistic pathways, where available. Additionally, this review covers substantial common reactions involving Diels-Alder, Prins-Nazarov, aza-Friedel-Crafts, Biginelli, Mitsunobu-triggered, and Beckmann rearrangement. Correspondingly, this review focuses on ring opening, ring expansion, heteroannulation, and the ring-closing of chromone derivatives with various heterocyclic motifs, such as pyrroles, pyridines, pyrimidines, indoles, and pyran derivatives. These collective findings underscore the potential of chromone scaffolds as promising candidates for organic synthesis and therapeutic development. Accordingly, researchers in this domain will find this overview valuable for understanding the chemistry of chromone hybrids, as it covers the literature of the last two decades.
Antiphospholipid syndrome (APS) is a complex autoimmune thrombo-inflammatory disorder characterized by diverse clinical manifestations and heterogeneous antibody profiles. We aimed to characterize the demographic, clinical, laboratory features, and treatment patterns of primary (PAPS) and secondary antiphospholipid syndrome (SAPS) patients in Egypt. A total of 510 APS patients were recruited from 14 rheumatology centers. Data on demographics, clinical manifestations, serologic findings, and medications were analyzed. The cohort included 406 females and 104 males (mean age: 32.0 ± 8.7 years); 42.4% had PAPS and 57.6% SAPS. SAPS patients had an earlier disease onset (p = 0.008). Thrombotic events and pregnancy morbidity were more common in PAPS (40.7% and 83.8%) than SAPS (19% and 47.3%) (p < 0.0001). In contrast, mucocutaneous symptoms, arthritis, oral ulcers, gastrointestinal, pulmonary, renal, and cardiovascular involvement, as well as ANA, anti-dsDNA positivity, and complement consumption, were significantly more frequent in SAPS (p < 0.0001). Antiphospholipid (APL) antibodies positivity was more common in PAPS (p < 0.0001). Ocular and CNS manifestations, along with APL positivity, were notably higher in males (p = 0.002, p = 0.02, and p < 0.0001, respectively). A lupus like presentation was seen in 10.6% of PAPS, All ANA and anti dsDNA positive. Seronegative PAPS constituted 7.9% of cases and had higher thrombotic rates (p = 0.004). PAPS and SAPS share several key features but exhibit clinical and serological profiles. Male APS patients more frequently present with ocular, and CNS involvement, and are more likely to be APL positive. Subsets of PAPS, including lupus like and seronegative forms, require further investigation.
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This paper presents the design methodology, kinematic analysis, finite element structural validation, and closed-loop computational simulation of a novel 3-degree-of-freedom (3-DOF) ankle-foot rehabilitation exoskeleton. The proposed exoskeleton addresses the simultaneous rehabilitation of dorsiflexion/plantarflexion (DF/PF), abduction/adduction (AB/AD), and inversion/eversion (INV/EV) in a seated configuration suited to patients with weight-bearing restrictions. Three NEMA 23 stepper motors independently actuate each axis through custom two-stage spur gear transmissions, achieving positive torque margins of + 6%, + 35%, and + 25% and sub-degree angular resolution. Full kinematic decoupling between all three axes is established through two independent architectural strategies. A finite element analysis (FEA) conducted on all four critical Al 6061-T6 structural components confirms safety factors between 2.82 and 4.87 under worst-case loading. A closed-loop PID control framework with adaptive range-of-motion (ROM) regulation, simulated in MATLAB/SIMULINK, demonstrates tracking performance characterised by maximum overshoots of 0.02°-0.12°, settling times of 3.7-7.8 s, and steady-state errors below ± 0.04° across all nine simulation scenarios. The results confirm the mechanical feasibility, structural integrity, and control effectiveness of the proposed exoskeleton as a viable platform for multi-DOF seated ankle rehabilitation.
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Lead is a widespread environmental contaminant that induces multi-organ toxicity primarily through oxidative damage and inflammatory responses. Salivary glands particularly the parotid are increasingly recognized as vulnerable targets of metal-induced injury, with significant implications for oral and digestive health. This study investigated the protective effect of silymarin, a flavonolignan antioxidant extracted from milk thistle seeds, against lead acetate-induced parotid gland damage in rats. Forty adult male Wistar rats were allocated into four groups: untreated controls, silymarin only (100 mg/kg), lead acetate only (50 mg/kg), and a combined treatment group receiving silymarin (100 mg/kg) and lead acetate (50 mg/kg). Treatments were administered orally for six consecutive weeks. Parotid tissues were evaluated using histology, immunohistochemistry, ELISA, qRT-PCR, and transmission electron microscopy (TEM). Lead acetate exposure caused extensive tissue injury, including acinar vacuolation, ductal dilation, and vascular congestion, accompanied by elevated lipid peroxidation, depletion of endogenous antioxidant enzymes, activation of inflammatory signaling pathways, and upregulation of pyroptotic, apoptotic, and ferroptotic markers. TEM revealed swollen mitochondria with fragmented cristae in lead-exposed glands, hallmarks of ferroptosis. Fibrotic remodeling with collagen accumulation was also evident. Silymarin co administration was associated with significant attenuation of these pathological alterations, correlating with enhanced antioxidant defenses, reduced inflammatory mediators, lowered expression of markers linked to multiple programmed cell death pathways, and decreased fibrosis. TEM confirmed silymarin preserved mitochondrial cristae integrity. In summary, these findings suggest that silymarin may exert broad cytoprotective effects against lead induced parotid gland injury, potentially involving coordinated effects on oxidative stress, inflammation, cell death pathways, and fibrotic responses. This points to its potential therapeutic value in heavy metal toxicity, pending further validation.
This study introduces the Pray Optimization Algorithm (POA), a novel metaheuristic inspired by the procedural rituals of Islamic pray, designed to solve complex engineering and robotic manipulator problems. The mathematical model is structured into three distinct phases: Phase I simulates searching for a suitable mosque; Phase II models congregational alignment (lining up for pray); and Phase III implements a cumulative scoring system to drive convergence. The efficacy of the POA is initially validated on the CEC2017 benchmark suite through comparative analysis with six high-performing metaheuristic algorithms. The algorithm's statistical superiority is subsequently confirmed using the Wilcoxon rank-sum and Friedman tests. To verify its practical applicability, the POA is deployed to solve three classical real-world engineering optimization problems. Ultimately, the algorithm demonstrates superior performance when compared against five state-of-the-art methods in optimizing the trajectory planning of a 6-DOF industrial robotic arm. These findings substantiate the effectiveness of the proposed POA in navigating constrained, real-world engineering search spaces.
This study evaluates the efficacy and outcomes of endoscopic third ventriculostomy combined with choroid plexus cauterization (ETV + CPC) as a primary treatment for hydrocephalus associated with Chiari II malformation in infants. This retrospective study analyzed 53 infants, all under 12 months of age and post-myelomeningocele repair, who presented with hydrocephalus (Evans' Index > 0.3 or Frontal occipital horn ratio (FOHR) > 0.4). All patients underwent Endoscopic third ventriculostomy (ETV) and bilateral choroid plexus cauterization (CPC) using a rigid endoscope. Success was defined as shunt-free survival with clinical and radiological improvement over a 12-month follow-up period. The cohort of 53 infants (28 males, 25 females) had a mean age of 3.4 months, with 36% consanguinity. Patients were stratified into three age groups: < 3 months (n = 13), 3-6 months (n = 19), and 6-12 months (n = 21). The ETV + CPC success rate showed a positive correlation with age: 54% in the youngest group, 63% in the middle group, and 67% in the oldest group. Of the 20 failures, 14 required ventriculoperitoneal shunts (VPS), and 6 were managed with re-endoscopy for stoma closure. Meningitis was the most common complication (15%), with all affected patients eventually requiring a VP shunt. ETV + CPC offers an effective, safe, and durable alternative to traditional VPS for infants with Chiari II-associated hydrocephalus. It significantly reduces shunt dependency and its associated long-term complications. Success rates improve with advancing age, making it a viable first-line surgical option in pediatric neurosurgery, particularly in resource-limited settings.
This paper demonstrates that the nonlinear distortion of capacitive microphones, including the vast majority of micro-electromechanical systems, studio condenser designs, and laboratory measurement microphones, can be characterized and linearized in a simple laboratory environment. The proposed setup requires only two off-the-shelf loudspeakers, a low-cost amplifier, and a sound card to generate and analyze the signals. By driving each loudspeaker with a harmonic signal at a different frequency, the microphone's internal quadratic nonlinearity is isolated through second-order intermodulation products. This allows the characteristic parameter required for post-processing linearization to be calculated directly from the recorded signal without requiring proprietary manufacturer data, high-end laboratory speakers, or a specialized method for source linearization with a reference measurement microphone. The paper provides the mathematical derivation for this source-independent estimation, demonstrates its scale invariance for both analog and digital-output microphones, and validates the approach against high-precision laboratory standards. Results show that the identified parameter remains stable across a wide dynamic range, providing an accurate and robust solution for real-time microphone linearization in practical and field-testing environments.
Hantavirus infection is uncommon in many settings but can cause severe pulmonary or renal disease. Nursing students require disease-specific preparedness for exposure-history taking, safe prevention counselling and infection prevention during community and clinical learning. This study examined undergraduate nursing students' knowledge, risk perception and preventive practice toward hantavirus and identified associated factors. A descriptive analytical cross-sectional survey was conducted among 236 undergraduate nursing students in one nursing program in Ras Al Khaimah, the United Arab Emirates during the 2025-2026 academic year. Data was collected using the researcher-developed Hantavirus Knowledge, Attitudes and Preventive Practices Questionnaire for Nursing Students (HKAPP-NS). Descriptive statistics, Cronbach's alpha, Pearson correlations and multivariable linear regression with HC3 robust standard errors were used. Knowledge was low among the 236 complete-case respondents (mean 8.13/20, SD 5.84), with 59.0% classified as having poor knowledge. Attitude was moderate (mean 33.34/50, SD 7.78), and overall practice was higher (mean 42.98/64, SD 15.83). Internal consistency was strong across domains (alpha 0.886-0.967). Attitude correlated with overall practice (r = 0.569, p < 0.001), whereas knowledge did not (r = 0.101, p = 0.120). Previous hantavirus teaching, infection prevention and control training and environmental exposure predicted higher knowledge. Attitude was the strongest independent predictor of overall practice. Students reported comparatively frequent precautionary practice but had important disease-specific knowledge gaps, particularly regarding safe rodent-contamination cleanup, routine vaccine availability, specific antiviral treatment and person-to-person transmission. The finding that attitude, rather than knowledge, independently predicted practice suggests that scenario-based One Health education should combine factual teaching with risk appraisal, self-efficacy building, exposure-history taking and prevention counselling to strengthen future nurses' preparedness for rodent-borne zoonotic infections.
In the present study, samples (hepatopancreas and muscles) from 100 cultured shrimp (Penaeus indicus) were collected. The water samples (n = 30) were obtained from the same shrimp aquaculture farms located at Damietta Governorate in Egypt. An additional 30 samples of human stool were also taken from fish workers who consumed or handled shrimp in the farms. Traditional and regular molecular methods were used for the isolation of Vibrio spp. The investigation identified 165 (63.5%) Vibrio spp. with predominance of V. fluvialis (41.2%), V. alginolyticus (31.5%) and V. parahaemolyticus (7.9%). Findings of large-scale multidrug resistance (77.5% of isolates) and also of the presence of carbapenemase genes (blaKPC, blaNDM) and extended-spectrum beta-lactamase genes (blaCTX-M, blaTEM) were important discoveries. This strong resistance, due to the fact that a lot of pressure has been exerted on the aquaculture through the use of antibiotics, demonstrates the ineffectiveness of antibiotics in combating vibriosis in shrimp farming. The clinical signs observed in shrimps were red and fragile shells, and pale hepatopancreas. Histopathological analyses corroborated the presence of sloughed hepatopancreas epithelium, vacuolation, oedema and hemocytic infiltration. Regarding sequence similarity, the gyrB gene was sequenced, and all of the shrimp hepatopancreas isolates showed 100% sequence identity with the human stool isolates, which indicates potential genetic relatedness of V. fluvialis isolates. However, because of the conserved nature of gyrB, higher resolution tools are needed to verify transmission (e.g., MLST or WGS). The results of this study show that ecological management strategies and improved farm hygiene practices can be more effective intervention strategies than antibiotic use, providing valuable insights for sustainable shrimp aquaculture and public health interventions.
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[This corrects the article DOI: 10.1016/j.aicoj.2025.100016.].
Circulating cell-free epigenetic and epitranscriptomic modifications (epimarks) are emerging as minimally invasive biomarkers for cancer detection and therapeutic monitoring. Their clinical utility in non-small cell lung cancer (NSCLC), particularly in the context of EGFR-targeted therapies, remains to be fully established. Ten circulating epimarks encompassing cfRNA methylation, histone post-translational modifications on circulating nucleosomes, and cfDNA methylation were quantified in plasma samples from healthy donors and metastatic NSCLC patients with mutant or wild-type EGFR. Longitudinal analyses were performed in EGFR-mutant patients treated with tyrosine kinase inhibitors (TKIs). Functional relevance was assessed using in vitro and in ovo models of Osimertinib-sensitive and -resistant NSCLC cells combined with targeted epigenetic inhibitors. Distinct epimark signatures accurately discriminated healthy donors from NSCLC patients and distinguished EGFR-mutant from EGFR-wild-type tumors. cfRNA methylation marks (m1A, m6A, m5C, and m7G) showed excellent diagnostic performance, with a composite methyl-cfRNA score robustly distinguishing EGFR-mutant NSCLC. Disease progression under TKI therapy was characterized by increased m1A-cfRNA, H3K23Ac- and H4R3me2-circulating nucleosomes and decreased 5mC-cfDNA, with m1A-cfRNA alone reliably tracking progression. High m6A-cfRNA levels at diagnosis were strongly associated with shorter progression-free survival. Functionally, Osimertinib resistance promoted tumor growth and metastatic dissemination. Combination therapies targeting METTL3, KAT6A, or PRMT5 with Osimertinib reduced tumor burden and metastasis through miRNA-dependent regulation of histone acetylation and methylation. Circulating epimarks represent promosing diagnostic and prognostic biomarkers and provide a mechanistic basis for epigenetic combination therapies in EGFR-driven NSCLC.