Browse Articles

Time lag between functional and structural lymphatic changes after lymphadenectomy: Insights from ICG lymphography and lymphatic ultrasound

Postoperative lower limb lymphedema is a common complication following pelvic or para-aortic lymphadenectomy for gynecologic cancers. Early detection of lymphatic dysfunction is crucial, but the temporal relationship between functional and structural changes remains unclear. This prospective observational study aimed to compare indocyanine green (ICG) lymphography and lymphatic ultrasound findings at multiple time points in the early postoperative phase. We enrolled 23 patients (46 lower limbs) who underwent pelvic and/or para-aortic lymphadenectomy for gynecologic malignancies. Each patient underwent ICG lymphography and lymphatic ultrasound preoperatively and at 1, 3, and 9 months postoperatively. ICG patterns were categorized as linear, splash, or stardust, while lymphatic vessel dilation ≥0.3 mm was defined as abnormal on ultrasound. At least one abnormal ICG finding was observed in 52.2% of limbs, and abnormal ultrasound findings were present in 65.2%. Among limb-timepoints with abnormal ICG findings, lymphatic dilation on ultrasound was observed in 32.6% overall, increasing to 52.6% at 9 months postoperatively, indicating increasing concordance between functional and structural abnormalities over time. Splash patterns on ICG were often not accompanied by lymphatic dilation, whereas stardust patterns were more likely to coincide with structural changes, especially at 9 months. Skin thickness increased significantly in the medial and lateral lower leg regions in limbs with stardust patterns. Our findings demonstrate a temporal dissociation between functional abnormalities detected by ICG and structural changes detected by ultrasound, suggesting that ICG lymphography may be more sensitive in the early phase. The combined use of both modalities may help capture the continuum from early functional disturbance to later structural remodeling and inform the optimal timing of intervention.

Enabling cross-indication protein expression analysis using a curated pan-cancer dataset and a tailored workflow

Abstract The National Cancer Institute’s Clinical Proteomic Tumor Analysis Consortium (CPTAC) recently generated harmonized genomic, transcriptomic, proteomic, and clinical data for over 1,000 tumors across 10 cohorts to facilitate pan-cancer discovery research. However, protein expression comparison across CPTAC cohorts remains challenging due to non-uniform missing data and varying protein expression distribution patterns across tumor types. To enable the cancer research community to conduct robust cross-cohort protein expression analysis, we present a curated and normalized pan-cancer protein expression dataset derived from the CPTAC pan-cancer study. Our workflow integrates systematic filtering, various missing data handling and normalization strategies. We developed a novel algorithm to select robustly expressed proteins in tumors within any CPTAC cohort; applied a cohort hybrid imputation approach to protein abundance values from FragPipe within each cohort, based on protein expression distribution patterns; and calculated intensity-based absolute quantification using protein abundance values and applied both global and smooth quantile normalization methods. Our analysis demonstrates that global quantile normalization surpasses both smooth quantile normalization and no normalization, as evidenced by its higher rank correlation across cancer cohorts between CPTAC and TCGA for selected proteins. The findings suggest that combining cohort hybrid imputation with global quantile normalization is an effective method for creating a normalized CPTAC pan-cancer protein dataset, which can facilitate the study of protein expression across different cancer types and accelerate cancer research.

Effects of GABAAR modulators CL218872 and MRK-016 on neural repair and synaptic plasticity in mice with Intracerebral hemorrhage

Background Intracerebral hemorrhage (ICH) is a devastating condition characterized by rapid onset, high rates of disability and mortality, and prolonged recovery. Dysregulated γ-aminobutyric acid type A receptor (GABAAR) signaling contributes to ICH-induced neurotoxicity, presenting a promising therapeutic target. Objective To assess the neurorestorative effects of the GABAAR α1-selective partial positive allosteric modulator (PAM) CL218872 and the α5-selective negative allosteric modulator (NAM) MRK-016 on synaptic plasticity and neural repair following ICH. Methods An ICH mouse model was constructed using collagenase IV, and ICH mice were administered the GABAAR modulators CL218872 or MRK-016. Differences in inflammation and neurological deficit score were compared between different groups of mice. Morphologic and functional changes in mouse neuronal cells were next determined by Nissl and Golgi-Cox staining. Synaptic structural changes in ICH mice were visualized by transmission electron microscopy, and changes in synaptic plasticity-related molecules were quantified to assess the effects of GABAAR modulators on synapses in ICH mice. Results Treatment with CL218872 resulted in a reduction in hemorrhage and improved neurobehavioral outcomes in ICH mice. Additionally, CL218872 mitigated inflammation by downregulating phospho-p65, IL-6 and TNF-α expression. Histological analysis revealed an increase in neuronal density, preservation of cell morphology, and enhanced synaptic connectivity following CL218872 treatment. Furthermore, synaptic structure was restored, and there was an upregulation of brain-derived neurotrophic factor (BDNF), growth-associated protein-43 (GAP-43), postsynaptic density protein 95 (PSD-95), and synaptophysin in ICH mice. However, treatment with MRK-016 yielded the opposite result. Conclusion The GABAAR α1-selective PAM CL218872 exerts neuroprotective and neurorestorative effects in ICH, suggesting its therapeutic potential for ICH management.

CFD and site analysis for optimizing indoor air quality in sustainable social housing via windcatcher integration

Abstract This study investigated the potential of integrating windcatchers into Egyptian social housing buildings to enhance natural ventilation and improve indoor thermal comfort, thereby reducing energy consumption used to enhance airflow inside residential spaces of residential communities, which is considered an important aspect of sustainable urban development that aims to counteract climate change. Computational Fluid Dynamics (CFD) simulations validated by site measurements were conducted on two distinctly oriented apartment models. The northwest-oriented apartment demonstrated a 7% improvement in natural ventilation rate with a single strategically placed windcatcher in the bedroom. The southwest-oriented apartment showed a remarkable 45.7% improvement when equipped with three windcatchers distributed across the living room and bedroom spaces. The results revealed that strategic windcatcher placement was more critical than quantity, with a dual-windcatcher configuration in the southwest-oriented apartment achieving a performance nearly comparable to that of a triple-windcatcher arrangement. Effectiveness relies on establishing appropriate pressure gradients through careful positioning to facilitate consistent airflow circulation. Configurations that enhance living room ventilation, the primary family gathering space, demonstrated the greatest potential for improving overall thermal comfort. Practical recommendations include orientation-specific design strategies, early integration of windcatchers into the architectural design process, and standardization of building codes for social housing projects. The implementation of passive cooling strategies offers multiple benefits, including reduced reliance on mechanical cooling, improved indoor air quality, connection to architectural heritage, and significant cumulative energy savings at scale. Future research directions encompass seasonal performance studies, combinations with other cooling strategies, and detailed analyses of windcatcher geometry.

Recombinant Potyvirus lilimaculae in asymptomatic Galanthus nivalis: Ecological and evolutionary implications

Snowdrops are economically important early-spring flowering geophytes. They are protected both in Hungary and across the European Union, and their international trade is regulated under the Washington Convention. Despite their importance, virological research on Galanthus species and cultivars remains limited. To date, only a single virus, Snowdrop virus Y, a tentative member of the genus Potyvirus within the family Potyviridae, has been identified in Galanthus . In this study, ten wild leaf samples and one cultivated, asymptomatic leaf samples were collected in accordance with the prescribed permit conditions. Both ELISA and RT-PCR tests were conducted, indicating infection by a Potyvirus. Direct sequencing of the PCR products revealed nucleotide heterogeneity in one sample, suggesting infection with multiple isolates of the same virus. In this case, the purified PCR product was ligated into pGEM®-T Easy vector. Individual clones were then sequenced to identify the distinct viral isolates present. A BLAST analysis of the sequences revealed that all three snowdrop isolates shared at least 96% identity in the complete coat protein region with the Potyvirus lilimaculae (lilí mottle virus, LMoV) isolate Handan (JF714974), previously identified in Narcissus tazetta var. chinensis from Hubei Province, China. To confirm pathogenicity, sap inoculation was performed on ELISA- and RT-PCR-negative snowdrops. One year later, these plants were re-tested via the same methods, which confirmed successful infection. Phylogenetic analysis revealed that all snowdrop isolates clustered within subgroup II and presented strong recombination signals. The detection of LMoV in asymptomatic wild plants has major implications for nature conservation, horticulture, virus reservoir identification, phytosanitary regulation, and our understanding of Potyviridae evolution.

Heterologous saRNA prime – multivalent protein boost strategy induces broad and durable immunity against SARS-CoV-2 and MERS-CoV

Assessing ecosystem service trade-offs and synergies in the rapidly urbanizing coastal region of Mangaluru Agglomeration, India

The steady growth of the cities alters the urban environmental pattern and functions, posing signs of danger mainly on the ecosystem services. Mangaluru is a coastal city, where rapid urbanization is seen presenting both opportunities and challenges for sustaining the vital ecosystem services. In this study, we utilized InVEST (Integrated Valuation of Ecosystem Services and Trade-offs) model, a widely spread, open-source tool employed to map and quantify the benefits of ecosystem services. Water yield, carbon sequestration and soil retention are the services assessed in this study. Furthermore, we applied Ecosystem Service Trade-offs and Synergies Degree Index (ESTD) to evaluate their relationships and analyzed how various policies affected land cover and ecosystem services of Mangaluru during 1980–2022. The results showed that built up area increased at the expense of wasteland/shrubland, and agricultural land. Notable increase in water yield is observed. Carbon storage and soil loss has reduced in the study area. Between these ecosystem services, water yield presented a clear trade-off relationship with soil loss, while carbon storage was synergistic with soil loss. Our findings show that different policies have diverse consequences on the environment and ecosystem services. Under economic policies, built-up areas developed dramatically, resulting in the loss of natural land and carbon storage. Ecological policies increased water yield, and a large amount of wasteland/shrubland land was transformed into forest. The study’s conclusions will help policymakers balance economic development and environmental conservation.

Validity, reliability and precision of a novel virtual reality rod and disk test to assess visual dependence

Abstract Visual dependence (VD) is heightened in pathologies where balance is compromised. It is measured using the Rod and Disk Test (RDT), traditionally delivered through a personal computer (PC). This restricts settings under which the test can be taken. This study aimed to evaluate validity, reliability and measurement precision of a novel virtual reality (VR) RDT. VD of 15 healthy participants and 15 people with symptomatic hypermobility was assessed using VR- and PC-based RDT to evaluate convergent validity. Assessments were conducted in three head positions. Intra-rater reliability was assessed by measuring VD of 15 healthy participants seven days apart. Convergent validity was evaluated using correlation analysis; intra-rater reliability using intraclass correlation coefficients. Bland-Altman plots assessed agreement, and measurement precision was reported as standard error of measurement (SEM) and minimal detectable change (MDC). Weak to moderate convergent validity was seen between VR- and PC-based tests, with coefficients of 0.3, 0.4 and 0.3. PC-based RDT showed poor to moderate ICCs; the VR-based RDT demonstrated poor ICCs. SEM and MDC for PC ranged from 0.44–0.47° and 1.23–1.30° respectively; for VR they ranged from 0.65–0.78° and 1.81–2.17° respectively. VR-based RDT demonstrated weak to moderate convergent validity and poor intra-rater reliability.

Time to initiate trophic feeding and predictors among preterm neonates admitted at General Hospitals in Tigray, 2025

Back ground Trophic feeding generally refers to providing small quantities of enteral feeding soon after birth. A study in Ethiopia highlighted substantial delays in starting therapeutic feeding (TF) for newborns. While guidelines recommend initiating TF within 24 hours of birth, an alarming 80–90% of infants did not begin feeding within 48 hours. Only 20% started TF within the advised timeframe. Furthermore, 29% of these infants did not survive until discharge, and 86.2% experienced extrauterine growth restriction. As a result, this study aims to assess the time to initiation of TF and its predictors among preterm neonates in the Tigray region. Method A prospective, institutional-based follow-up study was conducted on 193 preterm neonates admitted to the Neonatal Intensive Care Unit, with participants selected using systematic random sampling from a group of public hospitals.:The data collection period was from December 20, 2024, to February 30, 2025. Data was entered into Epi-Data version 4.7 and then exported to STATA version 14 for cleaning and analysis. To compare survival curves, Kaplan-Meier analysis and the log-rank test were used, bivariate and multivariate Cox regression analysis were used, all statistical tests were considered significant at a p-value of <0.05. Result A total of 193 neonates were followed for 8382 person-hours of risk time and 173 (89.6%) of neonates were initiated trophic feeding. The incidence rate of initiating trophic feeding was 2 per 100 person hours’ observations with a median time of 45 hours (95% CI: 42−56). Birth weight <1500 gram (AHR: 0.16,95% CI:0.075–0.35), APGAR score at first minute < 7 (AHR: 0.46,95% CI:0.26–0.76),APGAR score at fifth minute < 7 (AHR: 0.38,95%CI:0.21–0.68, having respiratory distress syndrome (AHR: 0.41,95% CI:0.25–0.66, and absence of Kangaroo mother care (AHR: 0.41,95% CI:0.21–0.77), were statistically Significant associated factors for the delay of initiation of trophic feeding. Conclusion In this study, a significant delay in the initiation time of trophic feeding. Therefore, health institutions should work on very low birth weight, APGAR scores below seven at one and five minutes, the presence of RDS, and the absence of KMC to shorten the initiation time and reduce complications associated with the delay.

A performance-optimized V2V task offloading framework for real-time vehicular communication

Redefining multi-target weather forecasting with a novel deep learning model: Hierarchical temporal convolutional long short-term memory with attention (HTC-LSTM-Attn) in Bangladesh

Bangladesh, being a country that relies on agriculture, has its agricultural sector contributing around 20% to the Gross Domestic Product (GDP) and providing employment opportunities for nearly 60% of the population. The study proposes a novel multi-step forecasting deep-learning framework designed to forecast the maximum temperature and humidity of 24 cities, called Hierarchical Temporal Convolutional Long Short-Term Memory with attention (HTC-LSTM-Attn). The model contains hierarchical temporal convolutions (HTC) for extracting multi-scale patterns, bidirectional LSTMs for sequential dependencies, and an attention mechanism for learning to weigh time steps differently, while parameters are optimized with Keras tuner. Using data from Bangladesh Agricultural Research Council (BARC) from 1961 to 2022 and rigorous preprocessing with seasonal features and lagged statistics, the model obtains temperature results for with a Mean Absolute Error (MAE) of 0.8178 °C, Root Mean Squared Error (RMSE) of 0.9718 °C, R-squared (R²) of 0.8527, and Mean Absolute Percentage Error (MAPE) of 2.8823% and humidity with MAE of 2.4693%, RMSE of 3.2442%, R² of 0.7228, and MAPE of 3.1757% values on a strict temporal test set (19 stations, 2016–2022). On a spatial hold-out test set (5 unseen stations, 2016–2022) performance remains robust, temperature with MAE of 0.9587 °C, RMSE of 1.1898 °C, R² of 0.8342, and MAPE of 3.1534% and humidity with MAE of 2.4796%, RMSE of 3.2119%, R² of 0.6561, and MAPE of 3.2045% consistently surpassing performance measures of models Gated Recurrent Unit (GRU), Long Short-Term Memory (LSTM), Convolutional Neural Network (CNN), Decision Tree Regression (DTR), Convolutional Neural Network – Long Short-Term Memory (CNN-LSTM) and latest transformer-based architectures (Autoformer, FEDformer, TimesNet, and Pyraformer). These results have shown robust spatial performance with the respective improvements needed in agricultural planning and disaster management in Bangladesh, in its vulnerable climate context.

Integrative structural and physicochemical characterization of chalcone synthase enzymes from medicinal plants using AlphaFold, molecular docking, and molecular dynamics

Coenrollment of critically ill patients in PROSPECT: A protocol and statistical analysis plan

Introduction The enrollment of a patient into more than one study (i.e., coenrollment) has risks which warrant exploration, particularly with respect to possible effects on trial outcomes. This pre-planned secondary analysis will examine the sensitivity of treatment effects to coenrollment in an international critical care trial (Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT). Objective(s) The primary objective is to evaluate the sensitivity of the effect of probiotics on the primary endpoint of VAP to patient coenrollment in at least one other study. The secondary objectives are to describe the characteristics of coenrolled patients and the studies they were coenrolled into; examine any differences in baseline traits; understand differences in center-level characteristics between coenrolling and non-coenrolling centers; identify factors associated with coenrollment; and explore the relationship between coenrollment status and the incidence of adverse events. Methods We developed a protocol and statistical analysis plan (SAP) for this secondary analysis involving the conduct of a Cox regression model, including treatment allocation, coenrollment status, and the interaction between the two as independent variables. We also describe our planned statistical analyses for the secondary objectives, involving descriptive statistics, univariable analyses, and multivariable analyses. Ethics and dissemination The results of this study will be published in a peer-reviewed journal focused on critical care research or trial methodology, and presented at local, national, and international conferences. As a secondary analysis, this study will not undergo secondary research ethics board approval. Data will be presented in aggregate and without patient identifiers.

Design, ecofriendly synthesis and spectroscopy of new pyrazolopyrimidine derivatives as potential candidates for dyeing and ultraviolet protection of wool fabrics

Abstract Pyrazolopyrimidine dyes are usually used as disperse dyes for coloring polyester (PET) fabrics due to lack of solubilizing groups. Herein, new water-soluble pyrazolopyrimidine dyes were synthesized and used as acid dyes for wool dyeing, which makes them suitable candidates for dyeing wool/PET blends. Designing and synthesizing a new pyrazolopyrimidine moiety via a one-pot multi-component reaction were reported using 4-((3,5-diamino-1H-pyrazol-4-yl)diazenyl)benzenesulfonic acid 1; its behavior and reactivity toward some 2-(aryl-diazenyl)malononitrile (ADM) derivatives was investigated. Both conventional and microwave heating were used in this investigation. The structures of the synthesized compoundswere confirmed using spectroscopic data. The synthesized compounds were used as potential candidates for dyeing and functional finishing of wool fabrics. The dyeing process was carried out by the exhaustion method at different dyeing conditions, including dye shade, pH, temperature, and duration. The color strength (K/S) of the dyed wool fabrics along with the dye absorption was measured, from which the dye exhaustion percentage, the dye fixation percentage, and the total dye fixation on the dyed fabrics were calculated. The colorimetric coordinates (L*, a*, b*) as well as the chromaticity (c) and hue (h°) of the dyed fabrics were monitored. The chemical structures of the dyed fabrics were examined by determining their urea-bisulfite solubility (U-BS) and base combining capacity (BCC). The effect of the dyeing on some inherent properties of wool was assessed. Results of this investigation proved that the synthesized dyes (SDs) are suitable candidates for dyeing wool fabrics.Results of this investigation revealed that the time consumed for synthesis of the said compounds were reduced from 4–10 h using the conventional heating to 1–4 min up on using microwave heating technique.The nature of the substituent of the ADM derivatives had significant influence on the K/S and the colorimetric data of the dyed fabric.The highest K/S (40.86) of the dyed fabrics was obtained when dyeing of wool was carried out using 3% of the synthesized dye-2 at pH 4 and 90 °C for 1 h. The ultraviolet protection factor of the dyed wool fabrics was immensely improved, with a very limited decrease in the tensile properties. The results of U-BS and BCC indicated dyeing wool with the SDs did not result in the formation of new crosslinks between the polypeptide chains of wool keratin macromolecules. Due to their sulfonic groups, the SDs bind to wool as acid dyes by forming salt links with the protonated amino groups in wool when in acidic media.

Ex vivo and in silico evaluations of (E)-5-((benzo[d]thiazol-2-ylimino)(methylthio)methylamino)-2-hydroxybenzoic acid as a β3-adrenoreceptor agonist exerting anti-obesity, anti-inflammatory and hepatoprotective effects on Zucker rats

Obesity increases oxidative stress and inflammation and thereby promotes liver damage and metabolic disorders, such as type 2 diabetes. Although exist anti-obesity treatments with employing anorexic drugs, antioxidants, and β3-adrenergic receptor (β3-ADR) agonists, their use adversely effects human health. Herein, the agonistic effect of 5-(((benzo[d]thiazol-2-ilimino)(methylthio)methyl)amino)-2-hydroxybenzoic acid ( C1 ) on β3-ADRs as well as its hepatoprotective and anti-inflammatory properties are investigated in obese Zucker rats. When compared to clobenzorex, C1 (12 mg/Kg bodyweight per day) intragastrically administered for 28 days significantly reduced the bodyweight and daily growth of the animals ( p  < 0.0001), as it stimulated thermogenesis by activating the uncoupling protein 1 (UCP-1) ( p  = 0.0090), which was mediated by the positive expression of β3-ADR ( p  = 0.0149). C1 -induced β3-ADR activation was attributed to the formation of conventional hydrogen bonds between the hydroxyl and secondary amine groups of C1 with ASP117, VAL121, and THR122 at the catalytic site on the receptor. In addition, C1 significantly decreased the levels of free fatty acid ( p  < 0.0001) and tumor necrosis factor alpha ( p  = 0.0073). Furthermore, C1 increased glutathione levels ( p  = 0.0245), and showed a tendency to decrease lipid oxidation and interleukin 6 levels. Therefore, these findings nevertheless suggested that C1 acted as a β3-ADR agonist and exerted hepatoprotective and anti-inflammatory effects on obese Zucker rats.

The impact of preimplantation genetic testing on the quality of life of people undergoing assisted reproduction treatment

Abstract Approximately 20% of infertility cases have a genetic origin. Preimplantation genetic testing (PGT) is an early prenatal diagnostic tool to prevent genetic disorders through embryo selection. Given its complexity, PGT requires a multidisciplinary approach, including psychosocial support, as infertility impacts mental health and overall well-being. Patients undergoing PGT often face prior miscarriages or IVF failures, elevating negative emotions and reducing quality of life. To compare affect levels, need for parenthood, and quality of life in IVF patients with and without PGT indications. This observational cross-sectional study included 375 patients divided into ‘PGT’ (n = 73) and ‘non-PGT’ ( n  = 302) groups. Participants completed the Positive and Negative Affect Schedule (PANAS), Need for Parenthood scale, and Fertility Quality of Life tool (FERTIQOL). Group comparisons were conducted. The groups did not differ in terms of gender, type and cause of infertility, and psychotropic medication use. The PGT group reported higher negative emotions, lower quality of life compared to the non-PGT group. Both groups showed high levels of need for parenthood. Patients indicated for PGT require greater support and monitoring, experiencing a significant emotional impact from the outset of treatment.

Correlation analysis and prediction models for loess compressibility in Ili region, Xinjiang

Loess compressibility is a crucial engineering parameter governing the deformation of loess foundations and the evolution of slope geohazards. Based on a comprehensive collection of physical, hydraulic, and mechanical parameters of loess in the Ili region, this study selected Huocheng, Nilka, and Xinyuan counties as typical study areas. Statistical methods were employed to a perform normality tests and necessary transformations on the data, followed by correlation analysis to identify key factors influencing the compression coefficient. Using Multiple Linear Regression (MLR) as a baseline, six machine learning models were constructed, including Random Forest (RF), Multilayer Perceptron (MLP), Radial Basis Function (RBF), Support Vector Machine (SVM), Classification and Regression Tree (CART), and XGBoost models. The results indicate that the compression coefficient is significantly positively correlated with the void ratio and negatively correlated with dry density and compressibility modulus. Consequently, compressibility modulus, dry density, and void ratio were selected as core input indicators. All constructed models successfully predicted the compression coefficient and its engineering classification. Under the evaluation principle of “error metrics priority, classification accuracy auxiliary,” the MLP model achieved the best overall performance across the three counties, followed by the Random Forest model. This study provides a methodological basis for the rapid estimation of loess compressibility parameters and engineering judgment in the Ili region.

Optimizing crop selection for sustainable agriculture: a compound ensemble approach integrating machine learning and IoT-based sensors

Beyond individual choice: Exploring pathways linking couple dynamics with Unintended Pregnancy and Birth in India

Couple power dynamics are known to influence sexual agency and reproductive health, yet this negotiation process within marital relationships remains empirically underexamined in India’s public health discourse. This study investigates Unintended Pregnancy and Birth (UPB) as an outcome associated with relational systems involving husbands’ sexual attitudes (normative context), wives’ health autonomy (negotiated agency), and Intimate Partner Violence (IPV; structural constraint). Using a sample of 19,896 couples from NFHS-5 (2019−21), we conducted bivariate and multivariate logistic regressions to identify patterns of UPB. Subsequently, a Generalized Structural Equation Model (GSEM) was used to test the mediating role of wives’ health autonomy on the pathway between husbands’ attitudes and UPB. To explore the moderating role of IPV between wives’ health autonomy and UPB, we used an interaction term. Findings show that overall, 8.30% of pregnancies and births are unintended. While wives’ health autonomy significantly reduces the risk of UPB, IPV act as the persistent structural constraint that elevates UPB. Furthermore, husbands’ regressive sexual attitudes, reflecting a normative climate of sexual entitlement, indirectly increased the likelihood of UPB by significantly restricting wives’ health autonomy. These findings highlight how intimate power asymmetries and normative constraints shape reproductive experiences. Addressing UPB, which reflects compromised autonomy and gender control, requires gender-transformative approaches that go beyond individual interventions to challenge inequitable norms, engage both partners and strengthen agency within intimate relationships to support reproductive well-being.

Impact of thiamin supplementation on thiamin pyrophosphate effect and cardiac function in pediatric heart disease patients on diuretics: a randomized controlled trial