Internet use is deeply embedded in university life, but problematic internet use cannot be evaluated adequately by exposure time alone. Evidence suggests that maladaptive or compulsive patterns of internet use are associated with difficulty in emotion regulation, yet inconsistencies in questionnaire order, eligibility criteria, screening thresholds, scoring procedures, and analytic reporting continue to limit comparability across studies. This method's article presents a standardized questionnaire protocol for behavioral-science and psychological-assessment studies examining internet addiction and emotion-regulation difficulty among university students. The workflow includes a fixed questionnaire sequence, prespecified eligibility criteria, mandatory-response settings, pilot-based completion-time thresholds, sequential data-quality screening, standardized scoring of the Internet addiction test and the 16-item difficulties in emotion regulation scale, and reproducible descriptive, correlational, and multivariable regression analyses. The protocol also specifies archiving of raw returns, screening logs, README/codebook files, and the final analysis-ready dataset. A representative implementation is reported to demonstrate execution of the protocol rather than to validate the instruments or establish prevalence. In that implementation, 520 students were invited, and 480 questionnaires were returned. After sequential exclusion of duplicate submissions, speeded responses, failed attention checks, patterned responding, logical inconsistency, and missing core data, 452 valid questionnaires were retained. The predefined analytic demonstration examined the association between the Internet addiction test total score and the difficulties in emotion regulation scale total score. The retained sample showed a mean Internet addiction test total score of 51.94 and a mean Difficulties in emotion regulation scale total score of 35.95. Emotion-regulation difficulty increased across internet-addiction severity groups, and the association remained evident after adjustment for demographic and behavioral covariates. This protocol provides a transparent workflow that can be repeated, audited, and adapted for future cross-sectional, repeated-measure, or longitudinal studies in university populations.

Myocardial infarction (MI) remains a major cause of morbidity and mortality worldwide. This protocol describes a method for generating and characterizing a Cracd-deficient mouse line on the C57BL/6N background using CRISPR/Cas9 technology. Zygotes were co-injected with Cas9 mRNA, a gRNA construct, and a donor template designed to generate a 3153-bp genomic deletion. The edited allele was confirmed by PCR genotyping and Sanger sequencing. To assess the functional role of CRACD in post-MI remodeling, Cracd-deficient and wild-type (WT, C57BL/6N) mice underwent MI induced by permanent ligation of the left anterior descending coronary artery. On postoperative day 7, cardiac function and left ventricular wall motion were assessed using transthoracic echocardiography and speckle-tracking strain imaging, followed by histopathological evaluation with H&E and Masson's trichrome staining. Representative results showed that Cracd-deficient mice exhibited reduced ventricular dilation and preserved systolic function compared to WT controls. This protocol provides a reliable experimental platform for mechanistic studies of CRACD in cardiac pathophysiology.

Delayed cerebral ischemia (DCI) is an important cause of secondary neurological injury after aneurysmal subarachnoid hemorrhage (aSAH). This retrospective single-center study developed and evaluated prediction models for DCI using data from 680 adult patients with aSAH treated between July 2022 and December 2024. Patients were divided using an outcome-stratified 8:2 split into a training cohort of 544 patients and a hold-out internal-validation cohort of 136 patients. DCI occurred in 175 patients in the training cohort and 42 patients in the internal-validation cohort. Predictor selection was performed in the training cohort using least absolute shrinkage and selection operator regression with 10-fold cross-validation. Six variables were retained: age, cerebral edema, hypoalbuminemia, modified Fisher grade, Hunt-Hess grade, and World Federation of Neurological Surgeons grade. Logistic regression, extreme gradient boosting, light gradient boosting machine, support vector machine, and k-nearest neighbor models were compared. Logistic regression showed an area under the receiver operating characteristic curve of 0.832 (95% confidence interval, 0.758-0.906) in the internal-validation cohort. Its calibration slope, calibration intercept, and Brier score were 0.98, 0.02, and 0.168, respectively, although confidence intervals for these calibration estimates were unavailable. The findings represent preliminary performance in a single hold-out internal-validation cohort. Incomplete reproducibility records, the absence of the model intercept, the lack of resampling-based optimism correction, and the absence of external validation currently prevent patient-level probability calculation and clinical implementation.

Older adults remain at high risk for subsequent fragility fractures after hip fracture; however, post-discharge anti-osteoporosis therapy is frequently delayed, interrupted, or discontinued. This single-center, non-randomized longitudinal implementation study evaluated a nurse-led gastrointestinal (GI) tolerability-adapted osteoporosis care pathway for older adults following surgical treatment of hip fracture. A total of 147 participants were enrolled, including 73 in the nurse-led pathway group and 74 in the usual care group. The intervention incorporated discharge-time GI tolerability risk stratification, safety verification, tolerability-adapted regimen selection, standardized patient education, structured follow-up at 1 week and 1, 3, 6, 12, 18, and 24 months, and predefined criteria for treatment reassessment. Outcomes included implementation fidelity, timely treatment initiation, medication adherence measured by the proportion of days covered (PDC), treatment persistence, changes in bone mineral density (BMD), GI adverse events, and first confirmed subsequent fragility fracture. Compared with usual care, the nurse-led pathway achieved higher rates of GI risk stratification, education checklist completion, safety laboratory review, timely therapy initiation, follow-up completion, and dual-energy X-ray absorptiometry (DXA) assessment. Mean PDC and the proportion of participants achieving a PDC ≥0.80 were consistently higher in the intervention group throughout the 24-month follow-up. Lumbar spine and total hip BMD demonstrated greater improvements in the pathway group, whereas femoral neck BMD changes were smaller. Time-to-event analyses for subsequent fragility fractures favored the intervention group but should be interpreted with caution, given the limited number of events and the non-randomized study design. These findings demonstrate that a nurse-led GI tolerability-adapted osteoporosis care pathway is feasible and may improve treatment continuity following hip fracture. Larger multicenter randomized studies are warranted to confirm its effects on BMD and refracture outcomes.

Cardiovascular disease frequently coexists with anxiety and depression, creating a complex bidirectional relationship between mental and cardiovascular health. Anxiety and depression may increase cardiovascular risk, impair treatment adherence and self-management, and contribute to poorer long-term outcomes. Conversely, acute cardiovascular events, persistent physical symptoms, and functional limitations may trigger or exacerbate psychological distress. This narrative review focuses on coronary artery disease, acute coronary syndrome, and heart failure, and summarizes the epidemiological associations, clinical implications, potential mechanisms, and management strategies related to anxiety and depression. The mechanisms discussed include neuroendocrine and autonomic dysregulation, inflammation, mitochondrial dysfunction, gut microbiota alterations, and heart-brain communication. The review also examines integrated approaches involving cardiovascular treatment, psychological interventions, exercise rehabilitation, pharmacotherapy, social support, and digital management. Future research should standardize diagnostic criteria and outcome measures, clarify key mechanistic pathways, develop clinically meaningful phenotypic classifications, identify useful biomarkers, and evaluate comprehensive interventions in multicenter studies. These efforts may strengthen early detection, risk stratification, individualized treatment, and long-term management for patients with coexisting cardiovascular and mental health conditions.

The rapid evolution of smart biomaterials has opened new therapeutic avenues for complex bone defects, non-union fractures, and post-tumor resection reconstruction. Conventional bone substitutes often suffer from insufficient bioactivity, mechanical mismatch, and a lack of capacity to modulate the healing microenvironment. In contrast, smart biomaterials can dynamically adjust their physicochemical properties in response to external stimuli (light, electricity, magnetic fields, or mechanical forces) or internal cues (ROS, pH, or enzyme activity), enabling precise control over cellular behaviors and local microenvironmental dynamics. Recent advances in immuno-engineered materials, particularly those designed to polarize macrophages toward a pro-regenerative M2 phenotype, have shown promise in attenuating inflammation and accelerating osteogenesis. Concurrently, 3D/4D printing technologies enable programmable control of scaffold architecture, degradation profiles, and the spatial distribution of bioactive factors, thereby supporting personalized therapeutic strategies. Artificial-intelligence-driven material discovery and structural optimization further expand the design space for next-generation, high-performance bone repair biomaterials. This review provides a comprehensive synthesis of recent progress in smart biomaterials for bone regeneration, with emphasis on stimulus-responsive mechanisms, immune-modulatory strategies, advanced manufacturing technologies, and AI-enabled design, and highlights the key barriers and future directions for their clinical translation. In this review, smart biomaterial is used as an umbrella term; stimulus-responsive biomaterial denotes the subclass that responds to an external trigger (light, magnetic, electrical, mechanical, pH, ROS, or enzyme); and intelligent biomaterial is treated as synonymous with smart biomaterial. These terms are not used interchangeably.

Reduced circulating miR-197 was previously observed in preterm infants who later developed bronchopulmonary dysplasia (BPD), but its relationship with NLRP3 inflammasome signaling remains unclear. This study examined miR-197 expression, NLRP3 inflammasome-related markers, and the interaction between miR-197 and the NLRP3 3' UTR in a neonatal hyperoxia model. Neonatal C57BL/6J mice were exposed to 60% oxygen or room air from birth, and lung tissues were collected on postnatal days 1, 7, 14, and 21. Lung injury and alveolar development were assessed by histology, radial alveolar count, mean linear intercept, and lung wet-to-dry ratio. miR-197 and NLRP3 expression and NF-κB-, caspase-1-, and IL-18-related proteins were evaluated by RT-qPCR and Western blotting. A dual-luciferase reporter assay in MLE12 cells tested the interaction between miR-197 and the NLRP3 3' UTR. Hyperoxia increased lung wet-to-dry ratios and mean linear intercept, reduced radial alveolar count, and caused progressive alveolar simplification. miR-197 expression decreased, whereas NLRP3 mRNA increased, at all examined time points; NLRP3 protein and inflammasome-related protein changes were most evident from postnatal day 7 onward. The miR-197 mimic reduced luciferase activity in the wild-type but not mutant NLRP3 3' UTR reporter. These findings show that neonatal hyperoxia is associated with reduced miR-197 and increased NLRP3/inflammasome-related signaling and support a sequence-specific interaction between miR-197 and the NLRP3 3' UTR, although causal regulation in vivo requires further investigation.

Sport events are increasingly used to promote cultural heritage destinations, yet the mechanisms linking event image with tourist loyalty remain insufficiently understood. This field-based cross-sectional survey examined the associations among sport-event image, embodied experience, place attachment, and tourist loyalty. A structured Chinese-language questionnaire was administered to tourists attending a heritage-themed sport event. After data screening, 386 valid responses were retained from 412 collected questionnaires (valid-response rate among returned questionnaires, 93.7%). Each construct was measured using five reflective Likert-scale items. Partial least squares structural equation modeling showed positive associations between event image and embodied experience (β = 0.470, t = 10.82, p < 0.001, 95% confidence interval [CI] = 0.383-0.551), embodied experience and place attachment (β = 0.507, t = 11.36, p < 0.001, 95% CI = 0.421-0.589), and place attachment and tourist loyalty (β = 0.524, t = 10.74, p < 0.001, 95% CI = 0.430-0.611). The direct association between event image and tourist loyalty was weak and not statistically significant (β = 0.100, t = 1.88, p = 0.060, 95% CI = -0.004 to 0.203), whereas the sequential indirect association through embodied experience and place attachment was significant (β = 0.125, p < 0.001, 95% CI = 0.074-0.184). Because the data were cross-sectional, these estimates represent statistical associations rather than temporal causation. These findings are consistent with a sequential association in which a favorable sport-event image is linked to greater tourist loyalty through embodied experience and place attachment in a cultural heritage tourism context.

Endoscopic ear surgery (EES) is transforming contemporary otologic practice by enabling minimally invasive transcanal access and enhanced visualization of middle ear anatomy. This narrative review summarizes current technical considerations, clinical applications, and recent evidence regarding EES in tympanoplasty, ossiculoplasty, and cholesteatoma surgery. Technical factors influencing safety and efficacy include the use of angled endoscopes, the management of thermal risk from light sources, hemostasis, underwater endoscopic techniques, and emerging digital image enhancement systems. For type I tympanoplasty, endoscopic and microscopic approaches achieve comparable graft uptake and hearing outcomes, while EES may reduce operative time, postoperative pain, wound-related complications, and approach-related morbidity, particularly compared with postauricular microscopic surgery. Endoscopic ossiculoplasty also demonstrates audiological outcomes comparable to microscopic reconstruction, with potential benefits in operative efficiency and postoperative recovery in both adult and pediatric populations. In cholesteatoma surgery, EES provides wide-angle visualization and access to hidden recesses, and meta-analyses suggest lower residual or recurrent disease rates compared with traditional microscopic approaches. However, disease extension, particularly mastoid involvement, remains a key determinant of surgical strategy. Overall, EES is a safe, effective, and versatile technique for chronic middle ear disease, offering excellent clinical and audiological outcomes with minimal surgical morbidity.

The extensive integration of distributed renewable energy sources and the rapid expansion of low-voltage (LV) feeders have created operational challenges related to feeder acceptance and congestion coordination. Existing voltage-control and feeder-management approaches may have limited scalability and adaptability under intermittent renewable generation and changing network conditions. To address these limitations, this study proposes a Dynamic Orchestration Framework for Low-Voltage Feeder Acceptance based on intelligent-agent collaboration within a multi-agent reinforcement learning approach. Unlike voltage-control strategies focused primarily on voltage stabilization, the proposed framework supports dynamic feeder acceptance through the coordinated operation of agents responsible for feeder monitoring, congestion management, and voltage-sensitivity-based prioritization. The agents independently observed feeder states, evaluated congestion and voltage sensitivities, and collaborated on feeder-acceptance decisions. The framework was evaluated through simulations using the FeederBW dataset and the 236-bus low-voltage distribution-network dataset under varying renewable-integration levels and load conditions. The proposed framework achieved a Feeder Acceptance Rate of 97%, a Voltage Compliance Index of 98%, an orchestration latency of 98 ms measured as the wall-clock execution time of the orchestration algorithm on the reported hardware, and a convergence speed of 98.5%, outperforming the evaluated centralized coordination methods. The results also indicated improved adaptability, operational resilience, and decentralized decision-making efficiency under the simulated low-voltage distribution-network conditions.

Multimodal remote sensing classification plays an important role in applications such as urban mapping and environmental monitoring. However, heterogeneous feature distributions across sensing modalities can result in feature misalignment and semantic inconsistency, limiting the effectiveness of multimodal fusion. Existing multimodal fusion approaches, including convolutional, graph-based, attention-based, contrastive, transport-oriented, and sequence-based methods, can exploit complementary information but may not adequately align modality-specific feature distributions. This study proposes FlowErs, a two-stage multimodal classification framework that addresses this challenge through multimodal flow matching. The working hypothesis is that reducing paired feature-distribution discrepancies before feature fusion improves land-cover classification under fixed benchmark protocols. In the first stage, modality-specific MetaFormer encoders extract hierarchical representations from hyperspectral imaging (HSI) and light detection and ranging (LiDAR) data. A multimodal flow matching module then learns time-conditioned velocity fields to transport paired feature distributions toward a shared latent representation using a bidirectional mean-squared-error objective. In the second stage, the pretrained alignment module is reused to align multimodal representations before a lightweight fusion head performs pixel-wise classification. Evaluation on three public benchmark datasets demonstrated a maximum overall accuracy (OA) of 97.56% under fixed benchmark splits. Performance varied across individual land-cover classes, and the study discusses class-specific limitations and the influence of class imbalance on aggregate metrics. The current evaluation is limited to fixed-split experiments without repeated-run statistical analysis or computational profiling. Future work will investigate statistical robustness, computational efficiency, and cross-region generalization.

Esophageal squamous cell carcinoma remains difficult to diagnose early and to stratify accurately before treatment. Conventional tumor-node-metastasis staging provides essential anatomical information but does not fully reflect circulating biological heterogeneity. This two-center ambispective observational study developed and externally validated a combined serum biomarker panel incorporating carcinoembryonic antigen, squamous cell carcinoma antigen, and carbohydrate antigen 125 for diagnostic discrimination and prognostic risk assessment in esophageal squamous cell carcinoma. A total of 277 participants were enrolled from a tertiary hospital and a community healthcare center, including 167 patients with esophageal squamous cell carcinoma, 55 patients with benign esophageal disease, and 55 healthy controls. The tertiary hospital cohort was used for model development and internal validation, and the community center cohort was used for external validation. Pretreatment serum biomarkers were measured before initial treatment, logarithmically transformed, standardized using training-cohort parameters, and entered into diagnostic logistic regression and prognostic Cox proportional hazards models. The combined panel showed higher diagnostic discrimination than any individual marker, with an area under the receiver operating characteristic curve of 0.869 in the training cohort and 0.842 in the external validation cohort. A higher combined biomarker burden was associated with tumor length of at least 5 cm, pT3-4 disease, lymph node metastasis, and tumor-node-metastasis stage III-IV disease. In survival analysis, high combined biomarker burden independently predicted poorer overall survival and progression-free survival after adjustment for major clinicopathological factors. The integrated prognostic model, combining biomarker burden with clinicopathological variables, outperformed the tumor-node-metastasis stage alone, with a training-cohort C-index of 0.792 and an external-validation C-index of 0.761. These findings support the use of the serum carcinoembryonic antigen, squamous cell carcinoma antigen, and carbohydrate antigen 125 panel as a practical, noninvasive adjunct for pretreatment assessment and individualized risk stratification in esophageal squamous cell carcinoma.

University teachers participate in professional development under different institutional, disciplinary, and motivational conditions. Participation records alone cannot explain whether professional development translates into meaningful professional learning. This article presents a reproducible, anonymous, cross-sectional survey protocol for assessing psychological need satisfaction, autonomous and controlled motivation, teaching self-efficacy, professional development engagement, and reflective practice from a self-determination theory perspective. The protocol specifies eligibility screening, stratified convenience sampling, questionnaire construction, expert review, pilot testing, online administration, anonymization, response-quality screening, scale scoring, reliability estimation, correlation analysis, hierarchical regression, and sensitivity analyses. It also clarifies scale adaptation, permission verification, construct scoring, and the interpretation of highly reliable scales as potential indicators of item redundancy. Representative results were obtained from one completed implementation of the protocol, in which 326 submitted records were exported and 313 valid responses were retained after prespecified screening. The results showed that autonomy, competence, and relatedness need satisfaction were positively associated with autonomous motivation, and that autonomous motivation and teaching self-efficacy were associated with professional development engagement. The protocol is suitable for standardized, multi-institutional, survey-based studies of the motivational and professional belief correlates of professional development engagement. It is less suitable for causal inference, longitudinal change estimation, direct behavioral outcomes, or institution-level program evaluation unless repeated measurements, observation, qualitative inquiry, or administrative data are added.

To assess the impact of intimate partner violence (IPV) on postoperative psychological adaptation and nursing outcomes in female patients with enterostomy across multiple departments, a prospective cohort study was conducted. Between January and December 2024, 188 women who underwent enterostomy in the Departments of Obstetrics and Gynecology, Colorectal Surgery, and General Surgery were enrolled and followed for 11 months. IPV exposure was evaluated within 1 week after surgery, and participants were categorized as an IPV group (n = 54) or a non-IPV group (n = 134). The IPV exposure rate was 28.7%. Compared with the non-IPV group, the IPV group had higher anxiety and depression scores, persistently higher serum cortisol levels at each postoperative time point, and lower early stoma mucosal blood supply scores. By the end of follow-up, the IPV group showed higher rates of stoma complications (38.9%) and readmission (24.1%), alongside poorer stoma-care compliance, lower nursing compliance scores, and lower scores across quality-of-life domains. Multivariable logistic regression analysis indicated that IPV exposure was independently associated with stoma complications (OR = 3.764, 95% CI 1.133 - 12.505, p = 0.030). These findings suggest that IPV amplifies postoperative stress responses and undermines rehabilitation in female enterostomy patients. Clinically, a cross-departmental screening pathway and tailored postoperative support for IPV-exposed patients may help improve recovery and nursing outcomes.

This article presents a multimodal behavioral protocol for examining observable correlates of cognitive effort and strategic revision during English-Chinese written translation and sight interpreting. Keystroke logs and screen recordings are synchronized for written translation, whereas audio recordings and verbatim transcripts are used for sight interpreting. Revision and self-repair episodes are coded by type and by functional outcome (effective, neutral, or detrimental) independently of holistic output-quality ratings. In a demonstration with 62 participants assigned to novice and trained groups, both groups completed the two task conditions in counterbalanced order. Trained participants had higher mean output-quality scores in written translation (20.1 ± 2.1 vs. 16.8 ± 2.3) and sight interpreting (18.9 ± 2.4 vs. 15.4 ± 2.6), and a larger proportion of effective revisions or self-repairs. Because pauses, deletions, onset latency, and revision density are indirect and task-sensitive, they are interpreted as behavioral correlates that require triangulation rather than as direct measures of a unitary construct. The protocol is intended for controlled expository texts and can be adapted to other language pairs after recalibrating input-method handling, pause thresholds, text comparability, and scoring procedures.