Abstract: Enhancing the soluble expression of heterologous proteins in chassis microorganisms is critical for fundamental biological research and synthetic biology-driven industrial ap-plications. Current methods for designing DNA sequences to ensure high soluble expres-sion often rely excessively on high-frequency codons while overlooking optimal codon context, leading to suboptimal outcomes. To address these limitations, we developed an integrated deep learning framework combining a synonymous codon generation (SCG) model and a gene expression level prediction (GELP) model. The SCG model captures co-don usage patterns in Escherichia coli using large-scale genomic data, whereas the GELP model leverages gene expression data to prioritize sequences with high soluble expression potential. We validated our approach by optimizing the DNA sequences of two industrial enzymes, α-glucan phosphorylase (αGP) and isoamylase (IA), achieving 20.52-fold and 3.05-fold increases in soluble expression, respectively, relative to the wild type. This study provides a powerful tool for designing DNA sequences that confer high soluble expression and for understanding the relationship between DNA sequence and protein expression. Notably, SCG-GELP reveals a protein surface-targeted codon optimization strategy that substantially enhances soluble protein yield. The framework is publicly accessible at https://scg-gelp.biodesign.ac.cn, and its open-source code and trained models are availa-ble on GitHub at https://github.com/yuddecho/SCG-GELP.

Abstract: Background and Objectives: GLP-1 receptor agonists (GLP-1 RAs) are effective weight-loss therapies, but data on body composition changes in pediatric obesity remain scarce. The primary objective was to evaluate the effects of GLP-1 RAs on body composition in children with obesity. Materials and Methods: We conducted a retrospective study of children with obesity evaluated at the National Institute for Mother and Child Health “Alessandrescu-Rusescu”, Bucharest, Romania, who initiated weekly injectable GLP-1 RA therapy (semaglutide) between January and December 2025. Patients were assessed at baseline and after a median follow-up of 5 months. Eight of ten participants with complete paired data were included in the final analysis; two were excluded because one was non-responder with weight gain and suspected non-compliance, while one responder could not maintain the standing position for bioimpedance measurement. Bioimpedance analysis and anthropometry were performed at both visits. Paired data were analyzed using Wilcoxon signed-rank tests. Results: Eight children (4 boys, 4 girls; mean age 14.9±1.8 years) completed the study. Significant Body Mass Index (BMI) Z-score improvements were observed (CDC: -0.14, p=0.012; WHO: -0.37, p=0.012), with median weight reduction of 4.75 kg (p=0.036). While absolute muscle mass showed non-significant change (-1.3 kg, p=0.362), predicted muscle mass percentage increased significantly (+1.9%, p=0.012), suggesting selective fat loss. Fat-free mass percentage increased (+2.0%, p=0.012) with reciprocal fat mass reduction (absolute: -3.85 kg, p=0.017; percentage: -2.0%, p=0.012). Fat-free mass index remained stable (-0.67 kg/m², p=0.161). No serious adverse events occurred. Sensitivity analysis (n=10) confirmed the robustness of the results, with BMI Z-score improvements remaining significant. Conclusions: GLP-1 RA therapy in children with obesity leads to notable improvements in BMI Z-scores and beneficial body composition changes, suggesting muscle mass preservation along with weight loss, even at submaximal doses. These findings support conducting a larger prospective study with body composition as the primary endpoint.

Abstract: Reflection is widely recognized as a pathway to deeper learning in higher education, yet many students struggle to engage in reflective tasks meaningfully. This study examined how student engagement and reflective performance developed across a seven-session structured reflective learning sequence in an undergraduate course. A longitudinal quantitative design was employed, including 59 students for participation data and 38 students for performance analysis. The instructional design incorporated teacher-led scaffolding, including exemplars, feedback, and structured prompts, with optional AI-supported assistance in later sessions. Results showed that engagement patterns were non-linear. Submission rates increased following the introduction of exemplars and feedback, declined when higher-order reflection was first introduced, and stabilized in later sessions, with the lowest participation observed in the final integrative task. Reflective performance also differed across stages. Step 1 (descriptive reflection) scores improved progressively, whereas Step 2 (analytical reflection) scores remained consistently high among students who completed substantive responses. The gap between attempted and completed Step 2 responses decreased over time. These findings suggest that reflective learning develops gradually and is sensitive to instructional conditions. The study highlights reflection as a staged developmental process and underscores the role of structured support in facilitating student engagement and performance.

Abstract: Background: Subcutaneous edema is a common condition seen on ultrasonography, characterized by thickening of the subcutaneous tissue with anechoic or hypoechoic fluid-containing spaces interspersed among fat lobules. The current descriptive term “cobblestone appearance” is used to describe this finding, but the metaphor lacks the vividness of the irregular, reticular pattern we have observed. Observation: We propose the “Cracked Earth Sign” as a novel sonographic sign to describe subcutaneous edema. The sign is defined by thickening of the subcutaneous tissue with irregular, reticular, or branching anechoic or hypoechoic clefts interspersed among fat lobules, resembling cracks in dry, sun-baked earth. Unlike the cobblestone sign, which focuses attention on individual fat lobules, the term “cracked earth sign” emphasizes the reticular network of clefts as a whole, offering a more intuitive visualization of edema distribution. Conclusion: The “Cracked Earth Sign” provides a simple, intuitive sonographic sign for recognizing subcutaneous edema. It may serve as a useful teaching tool for trainees.

Abstract: A descent sequence is a word π = π₁π₂ · · · πn of nonnegative integers satisfying π₁ = 0 and π_i ≤ 1 + des(π₁π₂ · · · π_i-1) for i = 2, 3, . . . , n, where des(π₁π₂ · · · π_m) denotes the number of indices j such that π_j > π_j+1. In this work, we study descent sequences subject to the additional restriction of avoiding a given pattern of length four. We analyze seven distinct avoidance classes and provide enumerative results for each of them. Our approach is based on the construction of generating trees with one or two labels, from which we derive succession rules and corresponding systems of recurrence relations. These recurrences are then used to compute explicit generating functions for the number of descent sequences of length n avoiding either 0001, 0010, 0011, 0012, 0021, 0110, 0112, 0123, or 0132.

Abstract: Chronic lung disease of prematurity (CLD) is a common complication of preterm birth with a com-plex pathology. Recent epidemiologic studies have identified a link between neonatal exposure to di(2-ethylhexyl) phthalate (DEHP), frequently used in medical equipment, and the development of CLD. We hypothesize that DEHP exposure in the early neonatal period contributes to lung injury in newborn rats. Newborn rat pups were raised in one of the following environments: room air (RA), RA + DEHP, hyperoxia (60% oxygen), and hyperoxia + DEHP. Ambient DEHP was inhaled in a dose of 25mg/m3 for 6 hours daily for 14 days. Lung tissue and blood samples were collected on day 14 of life. Independent exposure to DEHP and hyperoxia resulted in thicker pulmonary septal walls, fewer alveoli, increased pulmonary polymorphonuclear leukocytes and myeloperoxidase (MPO) activity and decreased expression of CD31 on endothelial cells in lung tissue. Additionally, DEHP-exposed rats showed higher serum malondialdehyde (MDA) levels and reduced vascular endothelial growth factor (VEGF) mRNA and protein levels compared to controls. Our experiments demonstrate that inhaled DEHP, with or without hyperoxia, resulted in a similar pattern of morphological lung injury and inflammation characteristic of CLD, and a causative link to CLD of prematurity.

Abstract: The increasing penetration of renewable energy sources demands dispatch strategies that balance technical reliability, environmental sustainability, and economic efficiency. While Hybrid Photovoltaic/Hydro/Diesel/Battery Energy Storage (BESS) systems have been studied, most existing works focus on single-objective optimization or genetic multi-objective trade-offs without explicit integration of global sustainability thresholds. This study introduces a novel policy-embedded Mixed Integer Nonlinear Programming (MINLP) dispatch framework that embeds policy-aligned constraints (losses ≤ 8%, CO₂ reduction ≥ 40%, and cost reduction ≥ 20%) directly into the optimization model of the IEEE 30-bus system. Unlike prior studies, the framework establishes a replicable benchmark for hybrid generator placement and sizing, combining renewable-first dispatch logic with explicit emission and cost caps.Results demonstrate that policy thresholds are achievable within technical feasibility, with losses halved, emissions reduced by over 40%, and costs lowered by 20%. Pareto frontier analysis reveals that global policy targets coincide with the frontier of achievable trade-offs, providing new evidence that sustainability agendas can be operationalized in dispatch optimization. This contribution advances hybrid system research by bridging technical modeling with global energy policy, offering actionable insights for grid operators, policymakers, and researchers. By systematically locating PV+BESS at Bus 19/30, Hydropower at Bus 6/11 and Diesel at Bus 2/5, the study provides a reproducible design logic that future researchers can adopt. This benchmark moves beyond abstract optimization to offer a practical system design contribution.

Abstract: Carbon-intensive firms face mounting pressure to develop substantive corporate climate risk management (CCRM), yet its firm-level and country-level antecedents remain unevenly understood. Drawing on stakeholder and institutional theory, we examine three drivers of CCRM: sustainability governance, voluntary climate-membership commitments, and regulatory quality. Our data cover 1,295 firm-year observations across 43 countries over 2018–2022. We estimate ordered logistic regressions with lagged regressors, with ordered probit, two-step system GMM, and sub-sample robustness checks. In the main specification, sustainability governance and regulatory quality are both positive antecedents (β = 2.441 and β = 1.676, p < 0.001); climate membership exerts a sector-conditional effect concentrated in energy and basic materials. Sub-sample analyses reveal that internal governance dominates among non-state-owned firms, while among state-owned firms (a sub-sample heavily concentrated in Chinese SOEs) regulatory quality dominates instead. We frame the latter as suggestive context-conditional substitution rather than a universal feature of state ownership. CCRM is highly persistent (system-GMM lagged coefficient = 0.693, p < 0.001), suggesting that climate risk management is best understood as a path-dependent organizational capability built incrementally over time. Firms strengthening CCRM should invest in integrated governance architecture; regulators should treat regulatory-quality reform as complementary to direct climate mandates.

Abstract: In dormant sunflower achenes, several structures -pericarp, seed coat and embryo- contribute to repress germination. Achene dormancy varies greatly among cultivated sunflowers, and how dormancy is transmitted to the hybrid progeny is relevant for hybrid seed production, but also to understand the role of these structures in achene dormancy. This work investigated how dormancy is transmitted to the F1 progeny with special focus on inhibition of germination at warm temperatures, or ther-mo-inhibition. Reciprocal crosses were performed using three oilseed inbred lines with varying dormancy phenotypes. Germination of achenes, seeds, and embryos was tested at 10 and 30°C at harvest and during postharvest, together with response to hormones (abscisic acid, ethylene and gibberellins) and measurements of endogenous ABA levels. Results show that expression of maternally inherited, pericarp-imposed ther-moinhibition is conditional to the level of dormancy displayed by the hybrid embryo, which follows a zygotic with incomplete dominance pattern. While embryo sensitivity to ABA related positively with thermo-inhibition, surprisingly, embryonic ABA content was inversely related to dormancy level across genotypes. Our results provide novel insight into physiological control of achene dormancy in sunflower while con-tributing to improve breeding for high quality hybrid seed.

Abstract: Adult plant resistance (APR) is widely used in wheat breeding, but its behaviour across genetic backgrounds remains poorly understood. In this study, we analysed the ex-pression of three APR loci (Lr34, Lr46, Lr67) following their introgression into elite winter wheat cultivars. BC2F1 populations derived from crosses between donor lines and com-mercial cultivars were evaluated under controlled infection with Puccinia triticina. Gene expression was assessed using RT-qPCR, and miRNA abundance was quantified by ddPCR at five time points (0–48 h post-inoculation). Expression patterns differed markedly between genetic backgrounds, affecting both the magnitude and timing of gene activity. Lr34 and Lr67 showed the highest expression prior to inoculation, with no consistent or sustained induction following infection. In contrast, the candidate gene Lr46-Glu2 displayed a clear tendency towards early induction, with peak expression typically observed at 6–12 h post-inoculation, although the amplitude of this response varied among genotypes. Levels of miRNA varied across genotypes and time points and did not consistently reflect mRNA expression, indicating additional layers of post-transcriptional regulation. The results indicate that APR loci do not operate as isolated genetic determinants, but as components of a background-dependent regulatory system. Distinct temporal expression patterns suggest that Lr34 and Lr67 contribute to constitutive defence layers, whereas Lr46 represents an inducible early-response component. These findings highlight the importance of genetic context in shaping APR gene behaviour and provide a framework for the effective deployment of durable resistance in wheat breeding.

Abstract: Human papillomavirus (HPV) has become a leading cause of oropharyngeal cancers, alongside well-known risk factors such as tobacco and alcohol use. Currently, HPV-positive oropharyngeal squamous cell carcinoma (HPV-OPSCC) has increased significantly in developed countries, with HPV-16 being the most common high-risk subtype. Clinically, HPV-OPSCC shows clear differences in prognosis compared to HPV-negative tumors, especially regarding survival rates and treatment responses. Patients with HPV-OPSCC tend to have notably better survival outcomes and a more favorable outlook. Strong evidence indicates that HPV-related oropharyngeal cancers form a distinct epidemiological, clinical, and molecular group, setting them apart from non-HPV-related cancers. As a result, treatment strategies for these subtypes should follow specific clinical protocols to achieve the best outcomes. Additionally, the viral oncoproteins E6 and E7, which systematically disrupt host tumor-suppressor networks, provide compelling reasons for targeted phytotherapeutic interventions. Therefore, there is growing interest in exploring plant bioactive compounds with promising anti-HPV and anticancer effects that target key oncogenic pathways. This review aims to compile the latest data on bioactive phytochemicals—such as polyphenols, flavonoids, carotenoids, glucosinolate derivatives, terpenoids, and alkaloids—with mechanistic evidence in HPV-OPSCC and to highlight their molecular interactions across oncogenic signaling pathways, focusing on research published from 2015 to 2025.

Abstract: Septic shock is a life-threatening condition characterized by a dysregulated host immune response to microbial infection, resulting in excessive inflammation, oxidative stress, and progressive multi-organ failure. Innate immune pathways are hyperactivated, resulting in overproduction of reactive oxygen and nitrogen species (RONS), amplification of cytokine signaling, and widespread tissue injury. Despite early administration of antibiotics, fluids, and vasopressors, treatment outcomes remain suboptimal due to infection-overwhelming defenses, delayed pathogen identification, and the growing prevalence of multidrug-resistant microorganisms. Such limitations emphasize the need for antibiotic-independent therapeutic strategies which directly target immune dysregulation. The unique architecture and tunable physicochemical properties of hollow nanoparticles make them a promising class of immunomodulatory therapies for septic shock. Early-generation empty lipid nanoparticles caused excessive immune activation and cytotoxicity, but advances in nanomaterial engineering now allow precise control of size, surface charge, and composition, enabling anti-inflammatory and cytoprotective effects. Rationally designed hollow nanoparticles are now known to exhibit intrinsic antimicrobial activity, scavenge RONS, suppress oxidative stress responses, reprogram macrophage polarization toward anti-inflammatory phenotypes, and neutralize immunogenic bacterial toxins and antigens. Lipid-based and biomimetic hollow nanoparticles show promise as immunomodulatory therapies through distinct mechanisms of immune modulation. Currently, VBI-S, a phospholipid-based nanoparticle colloid, is undergoing Phase III clinical evaluation for the management of hypotension in patients with septic shock. More broadly, hollow nanoparticle platforms can represent adaptable, antibiotic-independent therapeutic strategies with the potential to improve outcomes in complex inflammatory conditions.

Abstract: Mission diminishment and creep which is the gradual dilution of a faith-based organisation’s founding spiritual or theological purpose poses a defining challenge for faith-based organisations of many traditions navigating secular environments, leadership transitions, and the competing demands of contemporary governance. This paper reviews scholarship from theology, organisational studies, personnel psychology, and the sociology of religion, to examine the mechanisms through which faith-based identity erodes and to identify the structural factors that protect against it. Central to the analysis is the phenomenon of values camouflage, a term this paper introduces, where leaders adopt the language of faith for employability or cultural fit without necessarily embodying the spiritual, ethical, or pastoral commitments necessary to sustain organisational mission. The experience of Mary Aitkenhead Ministries (MAM) a Catholic mission-based organisation operating across health, education, and welfare in the tradition of the Religious Sisters of Charity is used to illustrate how founding charism, when institutionally sustained through Catholic Social Teaching, careful stewardship, and community engagement, can function as ways to navigate secular pressures rather than a liability to be concealed. Finally, the paper identifies four interconnected domains of protective action: engagement with modernity, recruitment integrity, the preservation of founding charism, and ongoing organisational formation. It also offers six evidence-based recommendations for boards, leaders, and chaplains across faith traditions committed to maintaining theological distinctiveness without sacrificing organisational effectiveness. Limitations and future research opportunities are also discussed.

Abstract: We present a fast time-domain simulator for optical cavities capable of reproducing non-linear dynamical regimes arising from ring-down effect during resonance crossings at high mirror velocities. The model is based on a recursive formulation of the intracavity electric field as a sum over round trips, preserving the cavity memory while maintaining high computational efficiency. The simulator is designed to achieve three main goals. First, the boundary conditions of the cavity can be modified at each simulation step, allowing arbitrary time-dependent variations of both mirror positions and input electric field. Second, the sampling frequency can be flexibly chosen by the user, however, it is internally adjusted before effectively executing the simulation to remain consistent with the cavity round-trip structure. Finally, high computational efficiency was obtained by avoiding the repeated evaluation of the full electric field history. The framework is validated through comparison with experimental data from the Virgo interferometer during a mechanical excitation experiment, showing good agreement in non-adiabatic regimes. Due to its efficiency and flexibility, the simulator provides a versatile tool for time-domain studies of optical resonators and future applications in real-time control and reinforcement-learning-based lock acquisition.

Abstract: We present AortaSeg-60, an open dataset of 60 real-world thoraco-abdominal CT-angiography scans of the aorta encompassing normal anatomy and pathological variations, designed for AI research, benchmarking, and educational purposes. The dataset is organized into six balanced categories: young normal, elderly normal, aortic aneurysms, aortic dissections, venous acquisition, and non-contrast acquisition, capturing realistic anatomical and pathological diversity. All scans are provided in NIfTI format with fully automated aortic segmentation masks generated using TotalSegmentator, without manual correction, enabling evaluation of typical algorithmic errors and testing of refinement strategies. Two radiologists performed a technical validation to ensure dataset curation and correct category assignment. AortaSeg-60 is publicly available on Zenodo under a CC0 license. By providing paired imaging and automated labels, the dataset facilitates reproducible research, algorithm development, and method comparison for vascular segmentation, while noting limitations of sample size, single-centre acquisition, and reliance on automated annotations.

Abstract: Soccer performance depends on multiple interacting factors, including physical, technical, tactical, and psychological components. Among the psychological factors associated with optimal performance are athletes’ emotional states, their regulation, and executive functions. These processes support attention to relevant external stimuli and enable players to plan, adapt, and regulate their behavior during gameplay. Although executive functions and emotional states have been widely studied in sport settings, research examining the relationship between these variables in athletes is limited, particularly in female soccer players. The aim of this study was to explore the relationship between emotional states, emotional regulation, and performance on cognitive tasks in female players from the Mexican soccer league. Twenty-eight players participated in two individual assessment sessions in which anxiety and depression levels, emotional regulation, and executive functions—planning, inhibitory control, working memory, and cognitive flexibility—were evaluated using psychological and neuropsychological tests. Results indicated a relationship between aspects of decision-making and players’ emotional regulation abilities, as well as between depression levels and onset latency in a working memory task. These findings support the existence of an association between emotional processes and cognitive functioning in female soccer players.

Abstract: Objectives: The Satisfaction With Life Scale (SWLS) generally operates as unidimensional but demonstrates invariance issues. This study aimed to examine the construct validity and stability of various SWLS across age and gender groups. Methods: Employing a convenience sample of community-dwelling European adults (N = 7531, median age = 26 (22-28) years, 51.1% females), this instrumental study investigated the structure and stability of SWLS through exploratory/confirmatory factor analysis (EFA/CFA) and multigroup CFA in SPSS and JASP. Results: EFA in 30% of the sample (n = 2246, KMO (0.86), Bartlett’s test of sphericity χ² (10) = 4561.84, p = 0.001) revealed a single factor with an eigenvalue of 3.12, which explained 62.35% of the variance. The unidimensional and two bidimensional structures (present/past life satisfaction; achievement/acceptance) expressed excellent fit (χ² (4-5) = 92.60-106.14, ps = 0.001; all CFIs = 0.994, ; TLI = 0.985-0.987, ; RMSEA = 0.052-0.056, ; SRMR = 0.013-0.014). Bifactor and second-order structures based on both two factor-structures did not converge. The three structures were invariant at the configural metric, scalar, and strict levels across age (<26, ≥26 years) while only the unidimensional SWLS was invariant at all levels across genders. Achievement/acceptance SWLS converged only in males while present/past life satisfaction converged only in females—the fit of both models was excellent, and the fit of the latter slightly improved when the errors of items 2 and 4 correlated. Conclusions: The findings support the use of the SWLS as a single-factor instrument for comparative purposes. SWLS components (cognitive or experiential) are interpreted uniformly among different age groups while gender-specific convergence patterns suggest meaningful gender-related nuances in its dimensional expression—males and females differently conceptualize SWLS components. Research should explore theoretical mechanisms underlying differential structuring of life satisfaction and examine whether these gender-specific dimensional patterns replicate across cultures and longitudinal designs.

Abstract: The Aral Sea crisis has severely impacted water resources in the Republic of Karakalpakstan, making groundwater a critical alternative source for drinking and irrigation. This study presents a hydroecological assessment of brackish groundwater in the Karauzyak district based on field investigations conducted in 2025. Results showed that groundwater mineralization ranges from 2.1 to 4.8 g/L (predominantly 2.2–3.8 g/L), classifying the water as brackish to highly brackish. The dominant hydrochemical type is sodium-chloride and mixed sodium-sulfate-chloride. Most samples exhibited pH values of 7.1–8.3, moderate to high hardness (6.5–26.5 mg-eq/L), and elevated sulfate and chloride levels. Concentrations of toxic microelements (Pb, Cd, As, Hg, etc.) remained below maximum permissible limits. However, the overall salinity significantly restricts direct use for drinking water supply and limits agricultural application without additional management. Piper diagram analysis revealed distinct hydrochemical facies, reflecting the influence of natural salinization processes, irrigation seepage, and evaporative concentration under arid conditions. The findings highlight both the potential and limitations of local groundwater resources and underscore the need for desalination technologies, improved drainage, and continuous monitoring to ensure sustainable use in the Aral Sea region.

Abstract: Introduction: Obesity is a chronic, multifactorial disease associated with significant metabolic and cardiovascular complications. Glucagon-like peptide-1 receptor ago-nists (GLP-1RAs) have emerged as effective pharmacological options for weight man-agement, demonstrating clinically relevant weight loss in controlled trials. However, real-world evidence is essential to assess their effectiveness and safety under routine clinical conditions and to verify if trial results are reproducible in diverse populations. Objective: To evaluate the effectiveness and safety of GLP-1RAs in terms of weight loss in real-world clinical practice and to compare outcomes among different available agents, focusing on their impact on obesity management. Method: A cross-sectional, observational pilot study was conducted in Spain. Adult patients receiving GLP-1RAs for at least four weeks were included. Data collected included sociodemographic vari-ables, treatment characteristics, anthropometric measurements, and adverse effects. Weight loss outcomes were analyzed using descriptive statistics, ANOVA for in-ter-drug comparisons, and multivariate ANCOVA to adjust for confounders. This pilot study also validated the protocol for a subsequent nationwide multicenter study. Re-sults: A total of 32 patients (62.5% women; mean age 58.2 years) were analyzed. Mean weight loss was 2.97 kg (3.17%). Significant differences between drugs were observed (p = 0.005), with semaglutide 2.4 mg (Wegovy) showing the greatest reduction (11.0 kg). Patients without diabetes achieved significantly greater weight loss than those with diabetes (5.0 vs. 0.8 kg; p = 0.021). Treatments were well tolerated, with 53.1% re-porting no adverse effects; most side effects were mild gastrointestinal symptoms. Conclusions: GLP-1RAs are effective and well-tolerated for obesity treatment in re-al-world clinical practice, although weight loss is more modest than in pivotal clinical trials. Differences between agents persist after adjustment, with specific formulations like semaglutide 2.4 mg showing superior effectiveness. These findings support the need for individualized treatment strategies in obesity care. This pilot study success-fully validated the methodology for an ongoing nationwide investigation

Abstract: Hard flaccid syndrome (HFS) is an emerging condition of male sexual dysfunction characterized by a persistent semi-rigid penis in the flaccid state, altered penile sensation, erectile dysfunction, and pelvic or perineal pain. Single-modality treatments have shown limited success, and multimodal protocols have been reported only in single-patient case studies. Our objective was to conduct a retrospective analysis of clinical outcomes from an integrative multimodal rehabilitation protocol in men with HFS. Thirty-two men with HFS completed a comprehensive protocol combining class IV laser therapy, dry needling, radial pressure wave shockwave therapy, therapeutic ultrasound, biofeedback training, manual therapy, therapeutic exercise, behavioral coaching, and oral tadalafil. Patient-reported outcomes were collected at treatment initiation and completion. The main outcome measures were Erection Hardness Scale (EHS), penile satisfaction, PROMIS Sexual Interest, and PROMIS Global Health Physical and Mental Component scores. In this case series, median EHS increased from 2 to 4 and median penile satisfaction increased from 2 to 5 (both P<0.01). All 32 patients achieved EHS ≥3 by treatment end, compared with 8 of 32 (25%) at baseline. PROMIS Sexual Interest, Physical Component, and Mental Component scores all improved significantly (P<0.01). Common comorbid features included low back pain (53%), hip or groin pain (38%), pelvic floor pain (31%), and urinary symptoms (28%). In this retrospective case series, multimodal treatment produced substantial improvements in erectile function and sexual quality of life in men with HFS, supporting an integrative model in which musculoskeletal and end organ pathologies initiate the syndrome and are amplified by central and peripheral nervous system contributions.