Browse Articles

Correction: Spatio-temporal patterns, trends, and oceanographic drivers of whale shark strandings in Indonesia

The shared biomarkers and molecular mechanisms of systemic lupus erythematosus and type 2 diabetes

Systemic lupus erythematosus (SLE) and type 2 diabetes mellitus (T2DM) share inflammatory and metabolic disturbances, yet the molecular mechanism of their overlap remains unclear. This study used integrated bioinformatics to identify transcriptomic signatures and potential biomarkers common to both conditions. Gene expression profiles from publicly available datasets (SLE: 38 patients/32 controls; T2DM: 6 patients/6 controls; validation cohorts: 79/30 and 41/15, respectively) were analyzed to detect shared differentially expressed genes and co-expression modules. Functional enrichment, protein-protein interaction networks, and immune-cell composition analyses were performed. Diagnostic gene panels were constructed using random forest feature selection and logistic regression and evaluated through receiver operating characteristic analysis with external validation. A total of 551 shared differentially expressed genes were identified, enriched predominantly in type I interferon signaling, Toll-like/NOD receptor pathways, TNF signaling, necroptosis, and neutrophil extracellular trap formation. Across analytical methods, a 10-gene interferon-related hub (STAT1, IRF7, OAS1, OAS2, ISG15, MX2, IFI35, RSAD2, SAMD9, SAMD9L) genes demonstrated strong discriminative performance in both SLE and T2DM. A three-gene model further showed potential clinical utility (AUC 0.872–1.00 in discovery; 0.665–0.928 in validation).These signatures align with therapeutic axes in SLE (IFN/JAK-STAT) and intersect inflammatory-metabolic pathways in T2DM, supporting assayable biomarkers and compact diagnostic models that warrant validation in larger, medication-annotated cohorts.

Rheological characterisation of clay-cement sealing suspensions with fractionated coal fly ashes

Abstract This study investigates the rheological behaviour of clay–cement sealing suspensions modified with dry size-fractionated coal fly ashes of contrasting chemical composition. High-calcium S1 ashes and siliceous S2 ashes were separated into ultrafine (< 10 μm), fine (5–20 μm), and middle (20–100 μm) fractions to isolate size-dependent reactivity. Rotational and oscillatory rheometry demonstrate that Ca-rich fractions induce rapid structuration: at 20wt% ash addition, the Bingham yield stress rises from ~ 20–30 Pa in reference suspensions to > 150 Pa, and exceeds 400 Pa at 30wt% S1 loading, accompanied by steep increases in storage modulus (G′ up to 10⁷–10⁸Pa for ultrafine fractions). In contrast, S2 ashes disperse the clay–cement network, lowering yield stress to ~ 15–60 Pa even at 40 wt% replacement and maintaining moderate viscoelastic stiffness (G′~10⁴–10⁵Pa). Particle fineness amplifies these trends: S1.UF promotes early hydration products precipitation and slip-layer formation, whereas S2.UF preserves fluidity. Sodium-silicate activation introduces a distinct threshold—at 1.0–1.5wt% Na₂SiO₃ the S1 systems undergo a sol–gel transition, with τ₀ surging above 200 Pa, while S2 systems respond gradually. These results quantitatively shows how ash chemistry and granulometry govern early yield stress, viscosity, and G′/G″ ratios, and identify composition windows for either rapid sealing (Ca-rich, fine fractions) or long-distance pumpability (Si-rich, fine fractions). The work demonstrates that fractionated fly ash provides an effective design tool for tailoring rheology of low-cement, sustainable sealing slurries for hydraulic and geotechnical applications.

Direct measurement of free glucocorticoids in small volumes of mouse and rat serum using ultrafiltration and liquid chromatography-tandem mass spectrometry

Glucocorticoids are critical steroid hormones secreted from the adrenal glands. In mice and rats, over 90% of circulating corticosterone is bound to proteins such as corticosteroid-binding globulin and albumin, and the rest is unbound (free). Only free glucocorticoids can enter cells and bind receptors, so it is crucial to measure free glucocorticoids. Some studies have estimated free glucocorticoid levels, but such estimates might be inaccurate as they do not take temperature and protein binding by competing steroids into account. Far fewer studies have directly measured free glucocorticoid levels in serum, and current methods to do so are time-consuming and require sample volumes (200 + µl) that are difficult to obtain from mice. Here, we developed a method to directly measure free glucocorticoids in a small volume of rodent serum using ultrafiltration and liquid chromatography-tandem mass spectrometry. We validated this method to measure free 11-deoxycorticosterone (corticosterone precursor), corticosterone, and 11-dehydrocorticosterone (corticosterone metabolite) in as little as 30 µl of mouse and rat serum. Ultrafiltration produces results that are qualitatively similar to those from equilibrium dialysis, an established method that requires a much larger sample volume (200 + µl). We then applied our novel method to examine the effects of lipopolysaccharide (LPS), an immune stressor that is known to increase total corticosterone levels, free corticosterone levels, and percent free corticosterone. We administered saline vehicle or LPS to adult male and female mice, collected blood 4 hr later, and measured total and free glucocorticoid levels in serum from individual mice. As expected, LPS increased total and free corticosterone levels and percent free corticosterone. This simple, robust, and rapid method allows direct measurement of free corticosterone and other steroids in 30 µl of rodent serum.

Mimicking opioid analgesia in cortical pain circuits

Distinguishing microplastics from microplastic-like particles in the marine fish from Qatar

Physical exercise and academic performance among students in the medical field at Jordanian Universities

Background The literature emphasizes multiple factors that affect academic performance, including emotional and physical well-being, motivation, and physical exercise. University students, especially medical students, usually lack time and experience high levels of stress, leading to neglect of a healthy lifestyle. This study aimed to assess the association between physical activity patterns and academic performance (cumulative grade point average (cGPA)) among medical students at Jordanian universities. Methods This is an online survey study that was conducted in Jordan between 28/12/2023 and 30/07/2025. A multivariate logistic regression analysis was performed to identify sociodemographic and physical activity items associated with academic performance, while sociodemographic characteristics were analyzed to predict the probability of engaging in physical activities among participating students. Results A total of 1,209 university students participated in this study. Around 54.8% reported engaging in physical activity. Vigorous exercises such as running or football were practiced by 61.8%, and moderate activities such as brisk walking or swimming by 74.8%. Nearly half of the participants (45.9%) had been exercising for over a year, and 42.7% exercised more than 2.5 hours weekly. The main motivations for physical activity included maintaining health (39.9%) and stress relief (31.8%), while barriers included a lack of time (33.1%) and energy (26.9%). Students aged 22–24 were significantly less likely to have cGPA > 3.5 compared to those aged 18–21 (adjusted odds ratio (aOR) = 0.6, 95% confidence interval (CI): 0.4–0.9; p = 0.021). Additionally, non-Jordanian students had a lower likelihood of achieving a cGPA > 3.5 compared to Jordanian students (aOR = 0.3; 95% CI: 0.2–0.5; p < 0.001). Conclusion In this study sample, medical students exercise moderately. Health improvement and stress relief were the main motivators, whereas a lack of time and energy were barriers. Significant cGPA variances were seen according to age, university, and nationality, revealing sociocultural and institutional impacts within this study population. Although physical activity was not significantly associated with academic performance, females showed lower odds of participating in physical activity, highlighting the importance of promoting physical activity among women to improve overall student health and well-being.

Digital coding metamaterials with multi-modulation schemes and beam steering for intra-chip millimeter-wave connectivity

Abstract In modern wireless communication systems, data transmission is achieved through the collaboration of digital modulation circuits and antennas. Digital baseband signals are first modulated in terms of amplitude, frequency, and phase of the carrier wave and then transmitted directionally via antennas. However, in intra-chip environments, the performance of on-chip antennas is fundamentally constrained by micro-fabrication and integration requirements. As a result, these antennas often exhibit low gain and efficiency and are susceptible to interference among closely spaced transmission channels. To address these limitations, we propose a digital coding metamaterial for direct signal modulation within intra-chip wireless channels, providing an alternative solution to achieve directional signal delivery without depending on the antenna’s intrinsic radiation pattern. The proposed metamateiral can directly convert digital control inputs into discrete phase shifts of a 70 GHz TE-mode surface wave, enabling post-radiation modulation as the electromagnetic wave propagates through the metamaterial. When combined with a single broadcast antenna, multiple metamaterial units can perform simultaneous, multi-directional modulation and transmissions. The proposed metamaterial supports various phase shift modulation schemes, including BPSK, QPSK, and 8-PSK. Furthermore, it enables hybrid modulation and beam steering modes, offering a beam steering range of up to $$\pm 28^{\circ }$$ . The proposed metamateiral presents an innovative method for information routing in intra-chip transmission, helps reduce signal crosstalk under parallel transmission, and expands wireless channel capacity and spectral efficiency.

Stratifying cardiometabolic risk in urban Chinese children with obesity: Study protocol of the Shenzhen Children Cohort Study (SCCS)

Background Cardiovascular risk factors often begin in early childhood, with obesity being a major contributor. However, not all children with obesity share the same risk profile. The Shenzhen Children Cohort Study (SCCS) is a prospective, multimodal cohort designed to follow overweight and obese children aged 5–11 years, aiming to identify subgroups with elevated long-term cardiometabolic risk. The study will longitudinally track the evolution of cardiometabolic risk by integrating anthropometric, biochemical, imaging, behavioral, and psychosocial data. In addition to profiling child-level risk trajectories, SCCS will examine how parental beliefs, health behaviors, and family environments shape the development and progression of obesity-related cardiovascular risks. By capturing interactions between family-level determinants and biological markers, the study aims to support individualized risk stratification and inform early-life prevention frameworks in urban China. Methods The Shenzhen Children Cohort Study (SCCS) will enroll 3,363 overweight and obese children aged 5–11 years from Longgang District, Shenzhen, through public recruitment campaigns. Participants will undergo annual follow-up visits over a five-year period. At each visit, standardized clinical examinations, laboratory tests, and caregiver-completed questionnaires will be conducted to assess cardiovascular, behavioral, and environmental risk factors. All data will be centrally managed and analyzed using longitudinal statistical models to characterize cardiometabolic risk trajectories and to evaluate how family-level factors interact with child health indicators over time. Discussion This study follows overweight and obese children aged 5–11 years over five years to document changes in physical measurements, biochemical indicators, imaging results, and questionnaire data on household structure, parental health history, and child routines. The aim is to build a multi-domain risk profile that moves beyond body mass index and simple metabolic categories. Prior studies often grouped children by BMI percentile or defined metabolically healthy and unhealthy types based on a few biomarkers. These methods overlook transitions, internal variation, and context. By applying repeated measurements and multiple modeling approaches, this study aim to identify subgroups based on shared risk trajectories, biomarker shifts, and family conditions. Risk is not treated as a single threshold but as a process shaped by exposures and responses. Although this cohort is located in one district, its structure may guide future work on pediatric risk classification under precision medicine frameworks.

Supramolecular aggregation of aquaporin-4 shapes astrocyte collective migration and mechanics

Abstract Aquaporin-4 (AQP4), the main astrocytic water channel, assembles into supramolecular structures known as Orthogonal Arrays of Particles (OAPs). While AQP4-mediated water fluxes are known to influence cytoskeletal dynamics at the single-cell level, their role in collective migration remain unclear. Using primary WT and OAP-deficient (OAP-null) astrocytes, we investigated cell migration under control and proinflammatory conditions. In wound healing assays, control OAP-null astrocytes exhibited greater migratory capacity, while inflamed cells were largely immotile. Particle Image Velocimetry revealed genotype and condition-specific migration patterns, with OAP-null astrocytes displaying more linear trajectories. Cytokine treatment also reduced AQP4 and Connexin-43 expression and impaired gap-junctional communication in both genotypes. Calcein-AM quenching assays showed reduced water permeability in OAP-null cells, independently of treatment. These findings highlight the supramolecular organization of AQP4 as a key determinant of astrocyte collective migration and suggest that chronic inflammation induces a poorly coordinated phenotype through dysregulation of AQP4 and gap-junctional networks.

The mechanism of mammalian peroxidase destruction of invasive microbes

We calculated the internal energies (ΔE) for the breakdowns of HOI, HOBr and HOCl for the first time using the principles of molecular orbital theory. The release of atomic oxygen (ATOX) from all three molecules was estimated being from 43.3 (HOCl) to 64.1 (HOI) kcal mol −1 . These internal energies are much less than the inputs required for hydroxyl anion and cationic halide productions which range from 315.0 (HOI) to 381.1 (HOCl) kcal mol −1 . These results answer the puzzle concerning the fates of the products from the halide oxidations by peroxidases. The active species were thought to be the hypohalous acids themselves or the cationic halide but ATOX has never been considered. ATOX is an electron pair accepter and an incredibly destructive species which is observed only in high energy systems. Our results have implications for mammalian immunology because the final steps for microbe disposal in mammals are destructions by one of three peroxidases; lactoperoxidase (LPO), eosinophil peroxidase (EPO) or myeloperoxidase (MPO). These all utilize H 2 O 2 and one of the halide ions; I − (LPO), Br − (EPO) or Cl − (MPO) to biosynthesize HOI, HOBr and HOCl, respectively. The low energies required for ATOX liberation from hypohalous acids explains why these are the preferred products of important mammalian peroxidases. For example, LPO is an integral enzyme of mammalian airway defence and enhanced nutritional iodine intake encourages liberal biosynthesis of HOI, which is immediately lethal to all microbes tested in vitro and in vivo.

Increased cervical spinal cord signal intensity corresponds to specific cerebellar and cerebral functional changes in degenerative cervical myelopathy patients

Allostatic load in thyroid cancer is higher than that of other cancers: A secondary analysis using NHANES

Background To compare the levels of allostatic load score (ALS) between thyroid cancer patients and patients with other types of cancer and explore whether ALS mediates the association between thyroid cancer and alterations in physiological function. Methods This cross-sectional study conducted a secondary analysis of 181 cancer patients using NHANES data from 2007 to 2020, including 91 individuals with thyroid cancer. Generalized linear regression, logistic regression, and sensitivity analysis were used to analyze the association between thyroid cancer and ALS in three different models. Receiver operating characteristic (ROC) curve analysis and feature importance analysis were utilized to assess the clinical predictive value of thyroid cancer. We also conducted a series of mediation analyses to examine the mediating role of ALS. Results The ALS in thyroid cancer patients was higher than that in other cancer types ( P  < 0.05). Thyroid cancer was significantly associated with ALS even after adjusting for demographic variables (β = 0.770, 95%CI: 0.315–1.480; OR=2.255, 95%CI: 1.111–4.575). This association remained robust to missing data (all P  < 0.05) and was not confounded by drinking, diabetes, or thyroid disease (all P  > 0.05). Although thyroid cancer had limited predictive value on ALS, it exerted strong explanatory power. The mediation analysis conducted with imputed data and adjusted for confounding variables revealed that ALS fully mediated the effect of thyroid cancer on red cell distribution width (RDW) (IE: β = 0.103, P  = 0.008; DE: β = 0.389, P  = 0.056), with a mediation proportion of 20.93%. Conclusion Our findings revealed that thyroid cancer condition were associated with elevated AL. AL mediated the relationship between thyroid cancer and RDW.

Dietary patterns and emotion dysregulation in borderline personality disorder and eating disorders as a shared mechanism underlying symptom severity

A cost-effectiveness analysis comparing pembrolizumab combined with chemotherapy versus chemotherapy alone for advanced biliary tract cancer: US and China perspectives

Objective In the KEYNOTE-966 study, the clinical benefits of pembrolizumab plus chemotherapy were demonstrated for patients with advanced biliary tract cancer (BTC). At this point, it is unknown whether this expensive therapy is cost-effective. The purpose of this study was to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy in treating BTC. Methods We constructed a partitioned survival model form the perspectives of US and Chinese payers. KEYNOTE-966 was used to obtain the baseline characteristics of the patients as well as their clinical data. Local databases and published literature were used to collect costs and utilities. Costs, life years, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net health benefits (INHB), and incremental net monetary benefits (INMB) were measured and compared. We conducted sensitivity analyses in order to assess the robustness of the model. Subgroup analyses were also performed. Results Pembrolizumab plus chemotherapy is not cost-effective in China at the willingness to pay (WTP) thresholds of $38,258 and $84,866. However, it yielded an additional 0.137 QALYs and an additional $63,864 (ICER $466,340) over chemotherapy alone. In the US, this treatment was not cost-effective, resulting in an improvement in effectiveness of 0.144 QALYs and an increase in overall cost of $141,000 (ICER of $976,925). There were INHBs of −0.616 QALYs and INMBs of -$52,237 for pembrolizumab plus chemotherapy in China if the WTP threshold for QALYs was set at $84,866, and INHBs of −0.796 QALYs and INMBs of -$119,400 when the WTP threshold was set at $150,000 for the US. Through sensitivity analyses, it was demonstrated that the results were stable. The results of the subgroup analysis indicate that better survival properties subgroups were more likely to be cost-effective, although pembrolizumab plus chemotherapy may not be cost-effective for all subgroups. Conclusions In the US and China, pembrolizumab plus chemotherapy may not be a cost-effective treatment option. This study provides evidence-based pricing strategies that may benefit decision makers and clinicians as they make clinical decisions. For a better understanding of the impact on budgets and the affordability of care for patients, more evidence is required.

Strategic foliar nutrition with Sorbitol, Mannitol, and Boron improves physiological performance and yield in Faba beans on reclaimed sandy soil

Abstract Under natural field stress conditions in newly reclaimed sandy soils characterized by extreme diurnal temperature fluctuations (ΔT > 20 °C, peak temperatures 42 °C), limited water retention, and moderate salinity, faba bean cultivation faces significant yield stability challenges. This study evaluated whether combined foliar applications of sugar alcohols (sorbitol, mannitol) and boron could synergistically enhance stress tolerance and yield stability in faba bean under these conditions. A two-season field experiment (2023/2024, 2024/2025) at Sadat City, Egypt, tested three cultivars (Nobaria3, Misr1, Giza717) under seven foliar treatments: control (CK, distilled water), individual applications of sorbitol (40 g L⁻¹), mannitol (40 g L⁻¹), boron (50 mg L⁻¹), and binary combinations (S + M, S + B, M + B) administered at four critical growth stages (30, 40, 50, 60 days after planting) arranged in a factorial randomized complete block design with three replications. Combined treatments demonstrated superior efficacy, with sorbitol + boron (S + B) producing maximum improvements: plant height increased 31% (111.91 vs. 85.38 cm in control, p  < 0.01), leaf area expanded 85% (1275.92 vs. 689.93 cm², p  < 0.001), and chlorophyll content increased 17% (40.56 vs. 34.78 mg L⁻¹, p  < 0.05). The S + B treatment enhanced grain quality with 30.6% higher protein content (31.87% vs. 24.40%, p  < 0.001) and 39% increase in 100-grain weight (112.48 vs. 80.67 g, p  < 0.01). Nobaria3 exhibited superior treatment responsiveness, achieving peak yield stability of 5.24 t ha⁻¹ (Season 1) and 3.70 t ha⁻¹ (Season 2). Treatment effects remained consistent across contrasting seasons (Season × Treatment interaction was non-significant for 9 of 12 parameters, p   ≥  0.05), demonstrating robust stress-mitigation mechanisms applicable to variable production conditions in newly reclaimed arid lands. The strategic foliar application of combined sorbitol and mannitol enhances osmoregulation, stabilizes cellular membranes, and improves photosynthetic efficiency, thereby ensuring sustained reproductive development. Consistent treatment effects across seasons demonstrate reliable stress alleviation mechanisms appropriate for climate-resilient production systems in newly reclaimed soils.

Uptake of cervical cancer screening and its associated factors among women of reproductive age in Kericho County

Cervical cancer is a public health issue among reproductive-aged women worldwide. It is the second most common cancer among females and contributes to 12.9% of new cancer cases and 11.84% of all cancer deaths annually. Early detection and treatment can prevent and cure the disease. Screening among women has gained global attention since it’s a crucial step in early detection. This study investigated the level of uptake of cervical cancer screening and factors associated with the cervical cancer screening among women aged 18–49 years in Bureti Constituency, Kericho County. The study adopted an institution-based cross-sectional study design. The study used systematic random sampling technique to select 328 women aged 18–49 who attended maternal and child health clinic at Kapkatet Sub-County Hospital during study period. Data was collected using structured questionnaires, including sociodemographic, awareness and knowledge and screening uptake sections. The data was analyzed using SPSS version 26.0. Descriptive analyses were performed to all the variables. Binary logistic regression analyses were conducted to assess factors associated with cervical cancer screening. The uptake of cervical cancer screening was 16.2% (n = 53, 95% CI: 10.5–23.4). We found that being 34 years and above (aOR = 1.43, 95% CI: 1.11–2.52, p < 0.001), having a primary education (aOR = 3.20, 95% CI: 1.50–7.00, p = 0.003), being self-employed (aOR = 5.20, 95% CI: 2.40–10.70, p < 0.001), or unemployed (aOR =7.50, 95% CI: 2.45–25.00, p < 0.001), and having a family history of cervical cancer (aOR = 2.10, 95% CI: 0.80–6.00, p = 0.015) significantly increased the odds of screening uptake. In contrast, earning an income of Ksh. 2,001–5,000 (aOR = 0.38, 95% CI: 0.10–0.90, p = 0.016) or> Ksh. 10,000 (aOR = 0.15, 95% CI: 0.06–0.33, p < 0.001) significantly decreased the odds of screening. Additionally, poor knowledge on risk factors (aOR = 0.50, 95% CI: 0.28–0.65, p < 0.001), signs and symptoms (aOR = 0.40, 95% CI: 0.10–0.70, p < 0.001), and groups at risk (aOR = 0.35, 95% CI: 0.15–0.60, p < 0.001) were all associated with lower odds of screening. Uptake of cervical cancer screening was influenced by multiple factors including socio-demographics and economic factors, awareness, and knowledge related factors. Thus, there is urgent need for intensified health education to enhance awareness and knowledge of women on cervical cancer and its screening.

Horizontal saccade bias results from combination of saliency anisotropies and egocentric biases

Abstract Saccadic eye movements shift the fovea between objects of interest to build a visual percept. In humans, saccades are predominantly executed along the cardinal axes, particularly in the horizontal direction. It is unknown how this horizontal saccade bias could arise mechanistically, though previous work suggests contributions from neural, image-based, and ocular motor factors. Here we used two publicly available eye movement datasets to first investigate which image features–spatial frequency, saliency, and structural content–relate to the horizontal saccade bias. Among the three image features, we found that orientation anisotropies in saliency content best predicted the strength of the horizontal saccade bias. Based on this result, we next implemented a saccade target selection model combining allocentric biases aligned with image orientation and egocentric biases aligned with eye or head orientation, independent of image content. As in prior work, this combination successfully replicated human saccade distributions during free viewing of upright images. When applied to tilted images, the model produced effects of image tilt and saccade size that were correlated with prior empirical findings, though with reduced amplitude, suggesting that current saliency models do not fully capture image effects. Taken together, these results suggest that saccade generation reflects both the allocentric biases present in the structure of natural scenes and the egocentric biases present in the saccade generation system itself. An open question is why the egocentric saccade bias exists, but our results suggest that it is adaptive in response to regularities in the world and our typical upright orientation.

Optimizing expanded carrier screening for China: Multi-center study establishes 202-gene panel with optimal cost-effectiveness in preconception and prenatal care

Objective To evaluate the cost-effectiveness of different expanded carrier screening (ECS) panels for couples in China during preconception and early pregnancy (≤12 +6 weeks) based on a multi-center cohort study. Methods A multicenter, population-based study was conducted across 22 prenatal diagnosis centers in China from August 2022 to June 2023, enrolling 2,996 participants. Geographical distribution and at-risk gene frequencies were analyzed, categorizing the 222-gene panel into three groups: Panel A (222 genes), Panel B (188 genes, compliant with international guidelines), and Panel C (202 genes, optimized for the Chinese population). Decision-tree models assessed cost-effectiveness in two clinical scenarios: Preconception and During Pregnancy. Additionally, two distinct outcomes were employed: payoff 1 was defined as the number of necessary medically termination, while payoff 2 was the number of newborns free of recessive monogenic disorders. Results As anticipated, European screening recommendations demonstrated limited applicability to the Chinese population. Panel A incurred the highest total cost in both the Preconception (US $5,214) and During Pregnancy (US $990) models. In the Preconception model, the incremental cost-effectiveness ratio for Panel C was US $74,869 per necessary termination and US $23,999 per additional healthy newborn without genetic disorders, compared to Panel B. In the During Pregnancy model, Panel B was the most cost-effective, yielding savings of US $580 per necessary termination and US $2,052 per healthy newborn compared to Panel C. Conclusion For Chinese couples, the 202-gene panel (Panel C) is the most cost-effective option in both preconception and prenatal settings. However, for couples prioritizing comprehensive screening over cost, the 222-gene panel (Panel A) provides greater clinical value at a higher cost.

A hybrid federated learning framework with generative AI for privacy-preserving and sustainable security in IOT-enabled smart environments