While many gymgoers do not experience psychological barriers to gym use, some feel anxious and intimidated there in the presence of other users. Qualitative research has suggested gyms can be places of unequal power leading to threats to one's adequacy of self, and privilege certain users based on demographics, masculinity, size, fitness, performance, competence, etc. Social comparison and trait social anxiety have been suggested as contributing to gym anxiety. However, a theoretical approach is needed to provide a coherent explanation of gym anxiety which can inform interventions; there is no current theory in use in the research literature. I argue that gym anxiety is not the same as social physique anxiety (a limited concern about physique evaluation) nor social anxiety (often conceptualized as a mental health "disorder" rather than a response to the norm-laden setting of the gym). I propose that the most suitable theoretical framework to explain gym anxiety is Johnstone and Boyle's Power-Threat-Meaning Framework (PTMF), designed to explain psychological problems or distress. Gym anxiety or intimidation does not represent a disorder or pathology but an understandable response among some users to the power differentials of the gym environment. The PTMF explains how the negative operation of social power, in combination with societal and personal meaning-making, can lead to a perception of subtle threats to one's psychological needs, such as exclusion, invalidation, or rejection; the resulting "symptoms" such as anxiety, shame, hypervigilance, and avoidance are conceptualized as coping strategies called threat responses. By addressing one or more of power imbalances, perception of threat, meaning-making and threat responses, interventions have the potential to make gym anxiety more manageable by addressing some of its root causes, either in individual interventions or at wider group level, including by changes that can be made to specific gym settings.
Hydrogen is one of the potential clean energy sources that might help to address two critical global issues: energy scarcity and environmental concerns. Using fossil fuels for hydrogen generation has drawbacks, such as increased greenhouse gas emissions throughout the process. As a result, finding clean, sustainable, and dependable hydrogen generation technology cheaply and with zero emissions has become critical. The purpose of this study is to analyze hydrogen generation from solar energy. Mainly focus on PEM electrolyzer as a source of hydrogen and solar energy as a source of power fed to electrolyzer, so it is necessary to ensure that PV operate at maximum power or close to it, so we used P&O MPPT technique with several controllers like fuzzy logic (FL), proportional integer (PI) and fraction order proportional integer (FOPI) controllers. To achieve optimal tuning for the final two controller parameters, differentiated creative search optimization algorithm (DCSO) is applied and compared to other algorithms such as PSO and GWO. When comparing the outcomes, it was revealed that PI-DCSO is the best, with 6987 W produced power, followed by FOPI-DCSO with 6767 W, and the FLC with 6296 W output power, as detailed in the result chapter, which also contains a comparison of PV production under varying conditions, and a comparison of PEM electrolyzer under different conditions.
This work presents a compact electronically switchable filtering power divider (FPD) for Sub-6 GHz wireless front ends requiring adaptive and spectrum-flexible RF hardware. Conventional multi-band receivers rely on separate narrowband and wideband chains, resulting in increased loss, complexity, and circuit footprint. To overcome these limitations, a miniaturized band-tuned FPD is developed by integrating a folded-resonator bandpass filter with a Wilkinson-based power-divider core through a coupled-line capacitive interface. The resonator employs inverted S-shaped and modified C-shaped elements to achieve size reduction, while four PIN diodes embedded in a step-impedance resonating structure enable electronic switching between wideband and narrowband modes. In the diode-OFF state, the proposed structure realizes wideband operation centered at 2.9 GHz with a 34.4% fractional bandwidth, insertion loss near 1.4 dB, return loss better than 15 dB, and isolation better than 10 dB. While for the diode-ON state, the circuit offers narrowband response centered at 2.35 GHz, realizing return loss better than 20 dB, isolation better than 10 dB, within an electrical size of only 0.14λ₀ × 0.18λ₀. The results confirm that the proposed FPD provides equal power division with high isolation, and electronically selectivity.
Drawing on social exchange theory, this study investigates the relationship between supervisors' psychological closeness and employees' taking charge at work. Furthermore, it examines the mediating role of trust in the supervisor and the moderating effect of employee power distance orientation. The study employs structural equation modeling in Mplus (version 8.6) to analyze multi-source data collected from a diverse sample of employees and supervisors, testing the proposed relationships. The findings indicate that supervisors' psychological closeness positively impacts employees' taking charge at work. Trust in the supervisor mediates this relationship, providing insights into the underlying psychological mechanisms. Additionally, employee power distance orientation moderates the link between psychological closeness and trust in the supervisor, thereby influencing the indirect effect of psychological closeness on taking-charge behaviors through trust. This study offers a deeper understanding of how relational and cultural factors, including supervisor closeness and power distance orientation, jointly influence proactive work behaviors. It contributes to the literature by highlighting the relationship between psychological and cultural factors in shaping employees' work behaviors.
To investigate the impact of empowerment-based health education combined with refined pain management in patients undergoing laparoscopic partial hepatectomy. Clinical data from 165 patients who underwent laparoscopic partial hepatectomy at The First Affiliated Hospital of Soochow University between March 2023 and March 2025 were retrospectively collected and analyzed. Based on documented nursing interventions, patients were assigned to an observation group (85 cases) or a control group (80 cases). The control group received routine nursing care, while the observation group received empowerment-based health education combined with refined pain management. Postoperative clinical indicators, postoperative pain intensity, quality of life, and the incidence of complications were compared between the two groups. The time to first ambulation, time to first flatus, and time to first defecation were significantly shorter in the observation group than in the control group (all p < 0.001). Postoperative pain scores at 12 h, 24 h, and 48 h were significantly lower in the observation group compared with the control group (Wald χ2 = 275.16, p < 0.001). At three months after the intervention, scores across all quality-of-life dimensions, including physical, psychological, social function, and material well-being, were significantly higher in the observation group than in the control group (p < 0.001). Additionally, the incidence of postoperative complications was significantly lower in the observation group (p < 0.05). Empowerment-based health education combined with refined pain management may facilitate early postoperative functional recovery and improve short-term quality of life in patients undergoing laparoscopic partial hepatectomy, while potentially reducing postoperative complications. These outcomes may be related to enhanced patient participation, optimized pain management, and improved adherence to rehabilitation protocols. This integrated nursing model may have potential value for clinical application. However, given the single-center retrospective design and the combined nature of the intervention, causal relationships cannot be established, and further validation through prospective, multicenter randomized controlled trials is warranted.
Decisions about limiting directives and Do Not Resuscitate orders in perianesthesia settings raise enduring ethical questions about power, responsibility, and compassion in clinical practice. This article advances the emancipatory theory of compassion for nursing by using these tensions to explore how the theory's core concepts operate within everyday clinical decision-making. The inquiry uses qualitative data from interviews, observations, and artifact reviews involving 27 participants, including patients, family members, and clinicians in a tertiary surgical services department. The results illustrate how distance, free-floating responsibility, and the zoe/bios dichotomy shape interactions between patients and clinicians. Together, these dynamics can normalize the suspension of limiting directives, rendering ethically troubling practices unspeakable within routine clinical work. At the same time, moments emerge when clinicians or family members insist that patient preferences be addressed, interrupting these patterns and creating space for more compassionate forms of practice. By demonstrating how these theoretical concepts illuminate the ethical dynamics of perianesthesia care, the analysis contributes to the continuing development of emancipatory nursing theory while highlighting how attention to relational power may help create more equitable and compassionate clinical encounters.
PlasticAnalytics provides an automated workflow that addresses key bottlenecks in vibrational spectroscopic analysis of microplastics by Raman spectroscopy and Fourier transform infrared spectroscopy (FTIR). The preprocessing framework integrates an iterative asymmetric penalized least-squares (i-arPLS) baseline correction algorithm optimized for spectra with complex environmental backgrounds, coupled with a hybrid rule-based and machine learning framework that automatically removes spurious peaks (cosmic rays and CO2) while handling resampling, normalization, and smoothing. A complementary machine learning module identifies and removes substrate spectra in spectral images, ensuring that downstream classification operates only on particulate-derived signals. The pipeline combines these steps with a deep residual network and an uncertainty-aware quality-control classifier trained on virgin, consumer, and environmentally weathered plastic spectra, achieving classification accuracies of 96.9% (Raman) and 97.9% (FTIR) and matching or exceeding existing architectures. For spectral imaging, automated background removal and high-speed inference reduced processing time by over 90%, from more than 200 min (Raman) and 800 min (FTIR) to under 7 min in both cases. PlasticAnalytics supports the major instrument platforms and file formats, providing a scalable, reproducible pipeline for environmental microplastic analysis.
The assessment of tumor-infiltrating lymphocyte (TILs), together with gene expression signatures (GES), has the potential to guide personalized breast cancer therapy. We included 262 patients from the phase III NSABP B-41 trial, which evaluated neoadjuvant HER2-targeted therapies in combination with chemotherapy. We conducted a manual and artificial intelligence (AI)-based analyses of TILs, as well as GES from RNA sequencing. Higher manual TILs as a continuous variable were associated with pathologic complete response (pCR) in patients with estrogen receptor (ER)-negative disease. AI-based TILs were associated with pCR regardless of ER status. Immune GES (iGES) were associated with pCR. Manual TILs were not associated with event-free survival (EFS), while AI-TIL showed a marginal association. These results support the use of TIL assessment, complemented by GES, as a prognostic biomarker in HER2-positive breast cancer. Future studies are needed to evaluate their predictive utility to guide treatment decisions.
Predicting how mutations affect protein stability and protein-protein binding affinity is crucial for protein engineering and drug development. Although several computational tools have been developed for these tasks, they often require specialized expertise and are difficult to integrate into unified workflows. Here, we present PythiaStudio (https://pythiastudio.wulab.xyz), a comprehensive web platform that integrates our recently developed Pythia, Pythia-PPI, and Pythia-Pocket models with complementary protein analysis tools. The platform enables users to predict mutational effects on protein stability and protein-protein binding affinity, ligand binding pocket, through an intuitive interface. Additional features include fitness and structure prediction. PythiaStudio provides interactive visualization tools, including mutation heatmaps, sortable result tables, and structure viewers. Importantly, the platform offers an integrated engineering workflow that combines stability and fitness predictions to guide rational protein design. We demonstrate the utility of this workflow through multiple cases, including different glycoside hydrolases and amidases. In these cases, the two-step computational redesign strategy successfully improved both thermostability and catalytic activity. PythiaStudio democratizes access to state-of-the-art deep learning-based protein engineering methods, enabling researchers without computational expertise to perform sophisticated protein engineering.
The integration of distributed generation (DG) into electrical networks offers technical and environmental benefits, including reduced power losses, improved voltage stability, and enhanced reliability. Improper DG placement or sizing, however, can degrade network performance. This study addresses optimal DG allocation under uncertainty, focusing on voltage profiles and stability indices in distribution networks. Variations in photovoltaic (PV) and wind turbine (WT) generation due to solar irradiance and wind speed are considered. Seven optimization algorithms-FVIM, SBO, SCSO, PSO, WOA, ALO, and Harmony Optimization-are applied and compared. Two DG types (active power only and active-reactive power) and a hybrid scenario with capacitor banks are analyzed. The IEEE-33 bus network is used as a test system. Results show reductions in total annual cost ($7.654 M → $2.614 M), voltage deviations (38.376 p.u. → 10.826 p.u.), and power losses (4043.462 kW → 2500.466 kW). Minimum voltage improved from 0.9065 to 0.9538 p.u. WOA achieves the lowest overall cost ($2,614,363), followed by PSO ($2,648,914) and FVIM ($2,699,308). FVIM demonstrates consistent technical performance, with total VDDT of 11.3144 p.u., VSIT of 730.6071, minimum bus voltage of 0.9527 p.u., and total active/reactive losses of 2789.703 kW and 2029.58 kVAr, maintaining a strong balance between economic and operational objectives.
Enterococcus faecalis can persist in root canal isthmuses and accessory canals despite conventional irrigation with sodium hypochlorite (NaOCl). Although high concentrations of NaOCl are effective, they pose safety risks. Therefore, strategies to enhance the efficacy of low-concentration NaOCl are clinically desirable. This study aimed to evaluate whether coating gold nanostars (AuNS) with chitosan (CS) to form a nanohybrid (AuNS-CS) can enhance the antibacterial efficacy of low-concentration NaOCl under low-power laser irradiation. The synthesis and comprehensive analysis of AuNS-CS nanohybrids were completed. Root canal models inoculated with E. faecalis were prepared. The antibacterial and antibiofilm capabilities of NaOCl (0.1-2.5%) alone or in combination with AuNS-CS and 810 nm diode laser irradiation (500 mW, 1 min), were evaluated using a colony-forming unit (CFU)·mL- 1 assay. Real-time temperature monitoring was performed. This nanohybrid enables efficient temperature elevation in NaOCl with low power laser irradiation (500 mW). AuNS-CS alone or under irradiation showed negligible antibacterial activity. NaOCl (0.1-2.5%) alone reduced planktonic E. faecalis viability by 1.74-3.71 log10 CFU·mL- 1 (p < 0.0001). The addition of AuNS-CS with 810 nm diode laser further reduced bacterial viability by 6 log10 CFU·mL- 1 (p < 0.0001), achieving complete eradication. In biofilm models, AuNS-CS combined with NaOCl (0.1-2.5%) under 810 nm diode laser irradiation reduced by 1.92-5.58 log10 CFU·mL- 1 (p < 0.0001). NaOCl (0.1-2.5%) alone resulted in a reduction of 0.16-3.68 log10 CFU·mL- 1, which was significantly lower than the combined treatment. The AuNS-CS nanohybrid enhances the antibacterial activity of low-concentration NaOCl under low-power laser irradiation, overcoming the limitations of conventional NaOCl treatment. This approach offers a promising strategy for more effective root canal disinfection and supports further exploration of nanoparticle-assisted endodontic therapies.
Waste energy recovery from mechanical systems represents a promising approach for improving energy utilization in transportation applications. In air brake systems used in heavy-duty vehicles and railway trains, a considerable amount of compressed air is released without being utilized for useful energy conversion. This study presents the design, fabrication, and experimental evaluation of a cost-effective Tesla turbine intended for recovering compressed air energy from such systems. A bladeless Tesla turbine prototype was manufactured using CNC machining and consisted of ten coaxially arranged discs. Two disc materials, aluminum and steel, were investigated in order to examine the influence of material type on turbine performance characteristics. The turbine was integrated into a compressed air system and experimentally tested under inlet pressures ranging from 2 to 10 bar under both no-load and electrical load conditions. The rotational speed of the turbine and the generated electrical parameters, including voltage, current, and electrical power output, were measured and analyzed. The experimental results indicate that increasing inlet pressure leads to a noticeable increase in turbine rotational speed and electrical power output for both disc materials. However, the turbine equipped with steel discs consistently produced higher rotational speeds and greater electrical power output compared with the aluminum configuration under the tested operating conditions. In addition, at lower inlet pressures, the turbine with aluminum discs was unable to generate measurable electrical output, whereas the turbine with steel discs maintained stable operation. Overall, the findings demonstrate the feasibility of using a low-cost Tesla turbine to recover compressed air energy that would otherwise be wasted in air brake systems. The proposed approach may contribute to improved energy utilization in transportation systems where low-pressure compressed air sources are available.
Atypical neurofibromatous neoplasm of uncertain biological potential (ANNUBP) lies between plexiform neurofibroma and malignant peripheral nerve sheath tumor (MPNST) in neurofibromatosis type 1 (NF1). Pediatric data are limited. We report two children with NF1 and rapidly enlarging peripheral nodules. Patient 1: a 13-year-old boy developed a lumbogluteal nodule despite prior selumetinib. Ultrasound showed a hypoechoic lesion with vascularity; magnetic resonance imaging confirmed interval growth. Excision revealed hypercellularity, architectural loss, cytologic atypia, and up to 2 mitotic figures/10 high-power fields. Immunohistochemistry showed S100/SOX10 positivity, focal CD34 loss, p16 loss, p53 wild-type pattern, and Ki-67 ≈1% overall, consistent with ANNUBP. Patient 2: a 15-year-old girl had a painful mass on the volar forearm. Resection disclosed a tumor embedded with a median-nerve fascicle. Histology showed hypercellularity, architectural loss, and 1 mitotic figure/10 high-power fields without necrosis; Immunohistochemistry showed S100, focal CD34/p16 reduction, and Ki-67 < 1%. Both patients remain recurrence-free under risk-adapted surveillance. ANNUBP is defined by ≥2 of atypia, hypercellularity, architectural loss, and low-level mitotic figures. Frameworks integrate morphology with CDKN2A/B and emphasize retained H3K27me3 to distinguish ANNUBP from MPNST. In children, ultrasound, magnetic resonance imaging, and positron emission tomograph support triage and biopsy. When feasible, complete excision is preferred; unresectable lesions need closer imaging. Early recognition widens cure opportunities and may refine risk stratification.
Chemotherapy is integral to many curative-intent regimens for HER2-positive breast cancer, but it contributes substantial toxicity and treatment burden, motivating interest in de-escalation strategies paired with HER2-targeted therapy. We conducted a systematic review and meta-analysis to quantify comparative effectiveness and safety of chemotherapy de-escalation approaches. PubMed, EMBASE, and Scopus were searched from inception to December 16, 2025 for English, peer-reviewed adult human randomized controlled trials (RCTs), cohort, or case-control studies evaluating chemotherapy omission, reduction, substitution, or shortening versus a contemporaneous comparator. Study selection, data extraction, and risk-of-bias assessment (Cochrane Risk of Bias 2 for RCTs; ROBINS-I for non-randomized studies) were performed by all authors with discrepancies resolved by discussion. Random-effects meta-analyses were performed in RevMan 5.4 using risk ratios (RR) for pCR, odds ratios (OR) for serious adverse events, and hazard ratios (HR) for time-to-event outcomes. Six studies (total N = 1,770) met inclusion criteria, largely in operable early to locally advanced settings with varied de-escalation backbones. Pooled estimates showed no clear differences in disease-free survival (HR 0.97, 95% CI 0.45-2.12; p = 0.95; I²=64%), recurrence-free survival (HR 0.85, 95% CI 0.30-2.39; p = 0.76; I²=75%), or pCR (RR 0.53, 95% CI 0.13-2.21; p = 0.19; I²=90%), while serious adverse events were reduced (OR 0.37, 95% CI 0.15-0.88; p = 0.03; I²=62%). The pooled overall survival estimate (HR 0.98, 95% CI 0.96-0.99; p = 0.004) was driven predominantly by a single large-sample study and should be interpreted with caution given sparse event counts and the exploratory nature of survival endpoints in most included trials. Chemotherapy de-escalation may reduce severe toxicity in selected patients with HER2-positive early breast cancer, but heterogeneity in de-escalation strategies, study designs, and outcome definitions and imprecision limit definitive inference. Most included trials were not powered for long-term survival endpoints, and pooled survival estimates should be regarded as hypothesis-generating rather than practice-defining. Adequately powered, randomized trials with prespecified non-inferiority margins and standardized endpoints are needed to establish the safety and efficacy of specific de-escalation approaches.
Predicting severe outcomes in acute pancreatitis (AP) remains a challenge. The interplay between endothelial dysfunction and systemic inflammation is pivotal in disease progression, but the combined prognostic value of their biomarkers is not well defined. The aims of this study were: 1) to define the interactions between endothelial dysfunction biomarkers and cytokines in patients with AP; 2) to evaluate the prognostic value of triple-marker model regarding prediction of survival in AP. In a prospective cohort of 100 AP patients, we serially measured biomarkers of endothelial dysfunction (vascular endothelial growth factor (VEGF), von Willebrand factor (vWF), endothelin, E-selectin) and inflammation (tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin) on admission (day 0), day 1, and day 7. We employed correlation analyses, logistic regression, and receiver operating characteristic (ROC) analysis to assess their individual and combined ability to predict mortality. A strong correlational network was observed, particularly among TNF-α, endothelin, E-selectin, CRP, and procalcitonin (all r > 0.75, P < 0.01). While VEGF correlated with TNF-α (P < 0.001), vWF did not show a significant bilateral correlation with it. Crucially, logistic regression revealed that the three-way interaction between vWF, TNF-α, and CRP was a significant predictor of mortality (P = 0.050). This triple-marker model demonstrated excellent predictive power for survival, with an area under the curve (AUC) of 0.861 in ROC analysis (P < 0.001). Kaplan-Meier analysis confirmed that patients with a high vWF-TNF-α-CRP interaction score had significantly lower survival rates (69.2% vs. 98.4%, P < 0.001). The combination of endothelial and inflammatory markers is a more powerful prognostic tool than any marker in isolation. The vWF-TNF-α-CRP interaction model effectively identifies AP patients at high risk of mortality, potentially enabling earlier targeted interventions. This underscores the critical role of the endothelial-inflammatory axis in determining AP outcomes.
The rapid growth of data-intensive artificial intelligence workloads has exposed data movement in conventional von Neumann architectures as a critical bottleneck to both enhanced energy efficiency and reduced latency. Among the materials investigated for resistive random-access memory, halide perovskites have garnered extensive attention owing to their tunable electronic properties and low-power operation, making them suitable for high-density memory applications. Although all-inorganic CsPbI3 offers high thermal stability, its reliability is compromised by mobile iodide vacancies causing stochastic switching. To address this limitation, this paper introduces a halide exchange-driven interface engineering strategy using CsPbBr3 quantum dots (QDs). Unlike conventional passivation, this approach enables spontaneous Br- diffusion into the CsPbI3 layer, passivating interfacial defects and promoting structural reorganization at the interface. The optimized device exhibits highly uniform switching and a considerable reduction in SET power consumption from 37.57 to 2.52 μW. Object-detection simulations demonstrate that while the control device suffers an accuracy loss of 17.9%, the QD-incorporated device maintains robust performance with only a 2.8% loss in accuracy over 2,000 cycles. These results establish QD-driven defect engineering as a robust pathway for developing reliable components for future neuromorphic systems.
Translating global climate targets into national decarbonization roadmaps is profoundly uncertain. To navigate this uncertainty for China, we employ a national-scale energy system model developed in the MESSAGEix framework─calibrated to China's energy balances─that uniquely combines provincial-level resolution for key sectors with a high-granularity representation of intra-annual (48 time slices) power system dynamics. Across three temperature targets (1.5, 1.6, 2.0 °C) and six allocation principles, our analysis reveals that wind and solar consistently emerge as "no-regret" pillars, CCS is essential for heavy-industry abatement, and hydrogen's sourcing shifts with budget stringency. A critical systemic codependency exists across scenarios with stringent emissions constraints: the power sector must transform into a net carbon sink to enable the decarbonization of heavy industry, creating stark path dependencies across technology choices. The 1.6 °C pathway under the Grandfathering principle presents a pragmatic alignment with China's 2060 neutrality pledge and offers a detailed blueprint for this transition. Our provincial-level analysis distinguishes high-stakes decisions from robust "no-regret" investments, offering a framework to guide China's journey to carbon neutrality.
The effects of elevated atmospheric carbon dioxide (CO2) on plant growth and productivity have received considerable attention. While CO2 capture agents have been generally reported to improve crop yield and quality, the underlying mechanisms remain unclear, particularly in rapeseed (Brassica napus L.). A field experiment was conducted to investigate the effects of different concentrations of a foliar-applied CO2-capturing agent on the growth, yield, and quality of Brassica napus cv. 'Xiangyou 15'. The results showed that 100× dilution of foliar-applied CO2-capturing agent was optimal, significantly increasing yield, leaf chlorophyll (SPAD), and seed oil content. Further transcriptomic analysis was conducted between the optimal foliar-applied CO2-capturing agent (T3) and control (T1), T3 up-regulated photosynthetic genes including PSAA, PSAB, rbcL and reshaped carbon metabolism, glucose, fructose, and sucrose contents increased by 40.6%, 32.0% and 10.5% respectively. Additionally, T3 significantly up-regulated INV (invertase) and G6PDH (glucose-6-phosphate dehydrogenase), supplying NADPH reducing power and carbon precursors for oil biosynthesis. Consequently, the total fatty acid content significantly increased from 44 059.02 to 62 909.80 μg g-1 under T3 treatment, representing a 42.8% rise. Taken together, this study provided the first integrated physiological and transcriptomic evidence that a CO2 capture agent boosted yield and increased the quality of Brassica napus L., highlighting its potential as an efficient and sustainable approach for crop productivity enhancement. © 2026 Society of Chemical Industry.
Graft selection is a key factor in anterior cruciate ligament reconstruction (ACLR), yet the statistical robustness of comparative outcomes remains unclear. Reliance on P values may overstate confidence in clinical differences. To assess the statistical fragility of dichotomous outcomes in randomized controlled trials (RCTs) comparing hamstring tendon (HT), bone-patellar tendon-bone (BPTB), quadriceps tendon (QT), and allograft ACL grafts. Systematic review and fragility analysis; Level of evidence, 1. A systematic search of PubMed, Embase, and Medline (June 2025) identified RCTs comparing 2 ACL graft types with >1 dichotomous outcome. Outcomes were analyzed for fragility index (FI), reverse FI (rFI), fragility quotient (FQ), and reverse FQ (rFQ); those with zero events in both groups were excluded. Median FI and rFI values were compared across graft types and outcome categories, and significant outcomes were stratified by graft type. A total of 29 RCTs (200 outcomes) were included; 179 outcomes (89.5%) were analyzed, and 21 (10.5%) showed significant results. Overall median FI and rFI were both 2.0 (interquartile range: FI 1.0-5.0, rFI 1.0-4.0). In 26 studies (89.7%), loss to follow-up exceeded or equaled the FI or rFI. HT versus BPTB was the most common graft pair comparison (72.1%). All graft comparisons had high fragility (FI ≤2.5). Radiographic complications and knee complications had relatively high FIs (6.5 and 4.5), whereas medical complications, revision ACL, and secondary surgery were most fragile (FI = 1.0). Among significant outcomes, HT had the highest FQ (0.034), followed by QT (0.026) and BPTB (0.016); none favored allografts. Many ACLR RCT findings were fragile, with most significant results reversible by altering 2 events. Loss to follow-up often exceeded fragility thresholds, raising reliability concerns. Although HT had the greatest number of significant outcomes and highest FQ, this likely reflects study volume rather than clinical superiority. High-powered RCTs with standardized outcomes and fragility reporting are needed to clarify graft effectiveness.
Cataracts and presbyopia affect millions worldwide, driving demand for advanced intraocular lenses (IOLs) to restore vision and reduce spectacle dependence. Extended depth of focus (EDoF) IOLs, such as Clareon Vivity and TECNIS PureSee, provide continuous vision with minimal disturbances. Given limited direct clinical comparisons, this research offers a head-to-head analysis of their visual performance and optical stability in cataract patients. This retrospective cohort study analyzed 106 eyes from 72 patients who underwent phacoemulsification with Clareon Vivity or TECNIS PureSee IOL implantation. Primary outcome measures were monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate VA (UIVA) at 66/80 cm, uncorrected near VA (UNVA) at 40 cm, and longitudinal internal higher-order aberrations (HOAs), specifically total coma. Refractive error (spherical/cylindrical powers [SPH/CYL], spherical equivalent [SE]) and defocus curve (+1.5 D to -3.5 D under mesopic/photopic conditions) were measured at 1 and 3 months postoperatively; HOAs (spherical aberration [SA], coma) and pupil size were assessed at 1 week, 1 month, and 3 months, and contrast sensitivity (CS; 1.5-18 cpd) at 1 month using standardized equipment. Both IOLs significantly improved UDVA (p < 0.05). Clareon Vivity showed superior monocular UIVA at 80 cm at 1 and 3 months (p = 0.0042 and p = 0.0711, respectively), comparable UIVA at 66 cm and UNVA at 40 cm, a broader defocus range (+0.5 D to -2.0 D), and lower total coma at 1 and 3 months (p = 0.001 and p = 0.0097) with reduced variability, emphasizing mid-range vision and optical stability advantages. TECNIS PureSee exhibited comparable refractive outcomes and CS, with initial superiority in monocular UNVA at 40 cm at 1 month (p < 0.05), providing robust early near vision. Clareon Vivity excels in intermediate vision, defocus tolerance, and coma stability, while TECNIS PureSee offers strong initial near focus. These differences suggest Clareon Vivity may be particularly suitable for patients prioritizing mid-range stability, while both IOLs provide excellent overall visual performance.