公共卫生研究摘要 (2025-07-31)
共收录 54 篇研究文章
1. Three things we can do now to reduce the risk of avian influenza spillovers.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Aug-05 链接: PubMed
摘要
2. Temperature extremes impact mortality and morbidity differently.
期刊: Science advances 发表日期: 2025-Aug 链接: PubMed
摘要
Increased temperature-related mortality is expected to significantly contribute to future economic damages from climate change, with declines in cold-related deaths outweighed by increases in heat-related deaths. While temperature-mortality relationships are well-documented, the effects of climate change on morbidity are less understood. Using data on emergency department (ED) visits, hospital admissions, mortality, and daily temperatures across California from 2006 to 2017, we find distinct differences in the temperature-response functions of these health outcomes, influenced by age distribution and underlying causes of morbidity and mortality. These differential responses fundamentally shape the burden of future climate change: We project that while future warming will increase ED visits, mortality will decrease due to fewer cold extremes. These results underscore the need to quantify temperature-morbidity responses to fully understand and anticipate the health impacts of climate change and suggest that local declines in mortality due to warming can mask economically meaningful increases in temperature-driven morbidity and health care utilization.
3. Exercise That Feels as Good as Possible: Acceptability of an Affect-Based Exercise Prescription Among Stage 0-III Breast Cancer Survivors.
期刊: Psycho-oncology 发表日期: 2025-Aug 链接: PubMed
摘要
Leaders in the field have called for exercise counseling to become standard of care by 2029. An Affect-based exercise prescription (Affect-Rx) may be a viable strategy for supporting this effort. Guided by the ORBIT Model for developing behavioral treatments, this Phase 1b study evaluated breast cancer survivors’ perceived acceptability of Affect-Rx. Additionally, the feasibility of trial methods and opportunities for protocol refinements were assessed. Participants were 36 stage 0-III breast cancer survivors within 5 years of completing primary cancer treatment. Demographics were collected at baseline and via medical record review. Affect-Rx was delivered in conjunction with a low-touch, physical activity promotion intervention over videoconference call. At end-of-study, participants rated Affect-Rx using the Treatment Acceptability and Preferences (TAP) Measure. Participants responded to the Stanford L-Cat at baseline and end-of-study. ActiGraph wGT3X-BT accelerometers measured moderate-vigorous physical activity (MVPA) over 10-day periods at baseline and follow-up. Affect-Rx was rated acceptable (TAP overall M = 3.30, SD = 0.53). Study retention and accelerometer measurement completion was ≥ 80% across time. L-Cat scores were discordant from accelerometer-measured MVPA at baseline. Affect-Rx warrants further testing. The trial methods were feasible; however, physical inactivity verification procedures along with targeted recruitment efforts are needed to support future work. The field needs intervention strategies that can be deployed with limited resources and at low cost to offer survivors exercise counseling support in line with the new National Standards for Cancer Survivorship Care, the affect-based exercise prescription is designed to serve this mission. The study protocol was registered with ClinicalTrials.gov prior to the initiation of participant recruitment NCT04903249.
4. Workload, Work-Life Conflict, and Stress Amongst Mental Health Professionals: The Moderating Role of Segmentation Preference.
期刊: Stress and health : journal of the International Society for the Investigation of Stress 发表日期: 2025-Aug 链接: PubMed
摘要
The nature of the mental health profession inherently puts its workers at risk of heightened psychological stress. This raises the importance of understanding why some mental health professionals show greater resilience when faced with common work stressors than others. One work stressor that has been consistently linked with stress is workload. Research has found that higher workload generally leads to greater work-life conflict, which, in turn, leads to greater stress. The current study aimed to test this mediation model amongst mental health professionals and examined how individuals’ preference for segmentation versus integration of work and private life moderates the strength of the pathways in this mediation model. Research participants, consisting of 152 Australian mental health professionals aged 18-69 years (M = 37.58, SD = 12.12), voluntarily completed a 30-min survey capturing workload, work-life conflict, segmentation preference, and stress. In line with expectations, higher workload predicted greater stress via higher levels of work-life conflict. Furthermore, segmentation preference moderated the path between workload and work-life conflict as well as the path between work-life conflict and stress. Simple slopes analyses showed that a stronger (vs. weaker) preference for segmentation was associated with a stronger positive relationship between workload and work-life conflict as well as a stronger positive relationship between work-life conflict and stress. Segmentation preference may thus influence the workload-work-life conflict-stress relationship through two distinct mechanisms. Improving our understanding of such mechanisms facilitates creation of targeted strategies to reduce work-induced stress amongst mental health professionals.
5. Lifestyle change after initial colonoscopy screening and incidence of colorectal cancer and major chronic diseases.
期刊: The American journal of gastroenterology 发表日期: 2025-Jul-31 链接: PubMed
摘要
The impact of lifestyle changes following colorectal cancer (CRC) screening on risk of CRC and major chronic diseases remains unknown. Leveraging the repeatedly collected dietary, lifestyle, and screening data in the Nurses’ Health Study (NHS, 1988-2018), NHS II (1993-2019) and Health Professionals Follow-up Study (1988-2016), we assessed changes after initial colonoscopy screening in a healthy lifestyle score (0-5) based on smoking, body mass index, physical activity, alcohol intake, and diet. We used time-varying multivariable Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of CRC and major chronic diseases (including cancer, cardiovascular disease, and type 2 diabetes), among 118,396 and 88,558 individuals, respectively. During a median follow-up of 10.0 years (interquartile range, 6.2-12.6) and 9.6 years (interquartile range, 6.0-12.3 years), we documented 537 CRC and 14,165 major chronic diseases cases, respectively. Forty-eight percent of participants changed their lifestyle score with at least 1 point. One-unit increase in the lifestyle score was associated with 14% lower risk of CRC (HR=0.86, 95% CI, 0.77-0.95) and 11% lower risk of major chronic diseases (HR=0.89, 95% CI, 0.88-0.91). Similar associations were observed for proximal and distal CRC and individual chronic diseases. Changes in smoking and physical activity were associated with CRC and chronic diseases, while changes in weight, alcohol intake, and diet were associated with chronic diseases only. Adopting a healthier lifestyle after initial colonoscopy screening may reduce risk of CRC and chronic diseases, suggesting colonoscopy screening could be a teachable moment for health promotion.
6. Analysis of Social Media Perceptions During the COVID-19 Pandemic in the United Kingdom: Social Listening Study (2019-2022).
期刊: JMIR formative research 发表日期: 2025-Jul-30 链接: PubMed
摘要
Social media listening can be leveraged to obtain authentic perceptions about events, their impact, guidelines, and policies. There has been to date no research that has examined the experiences of patients with COVID-19 from diagnosis to treatment using social media listening in the United Kingdom. This study aimed to assess public perceptions, insights, and sentiments throughout the patient journey from diagnosis to treatment during the COVID-19 pandemic. A comprehensive search query was designed to retrieve social media data that referred to COVID-19 and treatment. The search was conducted using the social media monitoring tool, Synthesio (Ipsos). Data were retrospectively collected for the period covering September 2019 to September 2022 from Twitter (subsequently rebranded X), Facebook, Instagram, and YouTube as well as 126 public forums (including Health Unlocked, Mums Net, The Student Room, and Patient Forums UK). Available data in the United Kingdom expressed in the English language were collected and filtered, generating a final dataset consisting of 31,319 posts from an overall initial dataset of 706,634 posts. Complimentary Google trend analyses of search terms mentioning COVID-19 treatments were also performed. Social media posts related to COVID-19 symptoms accounted for 6% of overall posts, compared to 35% of posts related to testing, 25% of posts related to diagnosis, and 32% of posts related to treatment. Overall, the trend observed from social media posts relating to COVID-19 treatment extracted in Synthesio was largely congruent with the trend of COVID-19 searches on Google, indicating a potential relationship between public discourse and social media and internet search behavior. The findings from this study have the potential to inform decision-making regarding public health interventions, communication strategies, and health care policies in the United Kingdom during future public health emergencies.
7. Agreement Between TDK Silmee W22 and ActiGraph wGT3X-BT for Estimating Daily Step Counts and Moderate to Vigorous Physical Activity in Free-Living Adults: Comparative Study.
期刊: JMIR formative research 发表日期: 2025-Jul-30 链接: PubMed
摘要
Wearable Internet of Things (IoT) devices are powerful tools for remotely collecting intensive longitudinal data. The TDK Silmee W22, a wristband-type wearable IoT device with a built-in 3-axis acceleration sensor, provides minute-by-minute physical activity data such as estimated metabolic equivalents (METs) and step counts. These measurements can be aggregated to daily estimates; however, their accuracies have not been fully explored in adults under free-living settings. This study aims to assess the agreement between the TDK Silmee W22 and the research-grade activity monitor, ActiGraph wGT3X-BT, in estimating daily steps and time spent in moderate to vigorous physical activity (MVPA ≥3 METs) in adults under free-living settings. A convenience sample of young to older adults was recruited from communities across several prefectures in Japan. Participants concurrently wore a TDK Silmee W22 on their nondominant wrist and an ActiGraph wGT3X-BT on the left side of the waist during waking hours for 7 consecutive days. Data were aggregated to daily steps and time spent in MVPA (≥1952 vertical axis counts/minute for ActiGraph) for each participant. A valid day was defined as having ≥ 10 hours of accumulated ActiGraph wear time with ≥100 and <50,000 accumulated steps from both devices. Each valid day was classified as either an active day (≥10,000 steps/day or ≥21.4 minutes MVPA per day) or an inactive day. Bland-Altman plots combined with multilevel analysis and κ statistics were used to assess the agreement between physical activity estimates from the devices. A total of 129 participants (n=66, 51.2% women) aged 23-89 years provided the final dataset of 884 observations (5 to 7 daily observations/participant). The TDK Silmee W22 estimated an overall mean of 6369 (SE 242) steps/day and 40.3 (SE 1.9) minutes/day spent in MVPA. Although Bland-Altman plots suggested no obvious proportional bias, fixed biases were observed; the TDK Silmee W22 estimated -1203 steps/day (95% limits of agreement [LoA] -4202 to 1796) and +5 minutes/day (LoA-23 to 34) spent in MVPA compared with those estimated by the ActiGraph wGT3X-BT. TDK Silmee W22 and ActiGraph wGT3X-BT, respectively, classified 14% and 23.1% as active by daily step counts (κ=0.65, 95% CI 0.59-0.72), and 70.4% and 60.9% as active by daily time spent in MVPA (κ=0.64, 95% CI 0.59-0.69), both indicating moderate agreement. TDK Silmee W22 underestimated step counts and overestimated time spent in MVPA compared with the research-grade ActiGraph wGT3X-BT, which may lead to misclassification of active and inactive days. Caution is warranted when using TDK Silmee W22 data over relatively short periods, as discrepancies-particularly when compared with research-grade monitors-may affect feedback or goal setting.
8. Estimating the Population Size of People Who Inject Drugs in 3 Cities in Zambia: Capture-Recapture, Successive Sampling, and Bayesian Consensus Estimation Methods.
期刊: JMIR public health and surveillance 发表日期: 2025-Jul-30 链接: PubMed
摘要
Accurate population size estimates (PSE) of key populations-those disproportionately affected by HIV-are critical to forecast need and inform HIV prevention and treatment programs, though they can be difficult to ascertain due to low visibility of these groups. In Zambia, reliable estimates on the number of people who inject drugs are limited, inhibiting public health response. We sought to estimate the population size of people who inject drugs in 3 large cities in Zambia, assess how PSEs vary across different estimation methods, and explore the strengths and limitations of each approach. We applied 2-source capture-recapture (2S-CRC), 3-source capture-recapture (3S-CRC), and successive sampling population size estimation (SS-PSE) methods in Lusaka, Livingstone, and Ndola, Zambia. 3S-CRC methods included location-based 2S-CRC in combination with a respondent-driven sampling (RDS) survey. Data were collected from November 2021 to February 2022 and analyzed using a Bayesian nonparametric latent class model. SS-PSEs were produced using the RDS recruitment and network sizes. Kruskal tests and general linear models were used to examine sociodemographic and behavioral factors associated with being captured in 2S-CRC among RDS participants. Final city population estimates, incorporating 3S-CRC and SS-PSE with imputed visibility estimates, were generated using a Bayesian consensus estimator. Bayesian consensus PSEs ranged between 0.5% and 1.8% of the adult male population and were below 1% of the total adult population in each city. Consensus estimates were highest in Lusaka (3700, 95% credible interval [CRI] 1500-7500), followed by Ndola (2200, 95% CRI 1600-2900) and Livingstone (1200, 95% CRI 900-1,900). There was variability in estimates by method, with SS-PSE with imputed visibility generally providing the lowest estimates across cities, excluding Lusaka. Across methods, PSEs and uncertainty bounds (95% confidence interval [CI] or CRI depending on method) ranged from 1510 (95% CRI 1030-2070) to 4350 (95% CI 1410-18,890) in Lusaka, 360 (95% CI 290-530) to 2620 (95% CRI 1510-4680) in Livingstone, and 760 (95% CI 390-3060) to 4030 (95% CRI 960-5480) in Ndola. In all cities, fewer recaptures occurred in capture 3 (RDS) than with location sampling via 2S-CRC. Though results varied across cities, RDS participants captured through 2S-CRC differed from those captured solely through RDS in sociodemographic and behavioral risk factors, including housing, education, injection or needle sharing frequency, time since last injection, receipt of drug treatment, and experience with a peer educator in at least one city. This study used rigorous methods to produce PSEs in Zambia, and is the first to produce these for major geographies in the country. Through RDS, 3S-CRC reached people who inject drugs with distinct characteristics that were less accessible via location-based sampling (2S-CRC), yielding a PSE that may better reflect the population and informing the Bayesian consensus estimate. Findings from this study can guide program planning and future surveillance activities.
9. Teledentistry for Improving Access To, and Quality of Oral Health Care: Overview of Systematic Reviews and Meta-Analyses.
期刊: Journal of medical Internet research 发表日期: 2025-Jul-30 链接: PubMed
摘要
Digital interventions including teledentistry are promising approaches to address some of the inadequacies of health care systems. Despite existing systematic reviews (SRs) on the benefits, implementation challenges, accuracy, and effectiveness of teledentistry, a comprehensive synthesis of evidence on its impacts requires further analysis. The purpose of this overview of SRs is to summarize evidence on the impacts of teledentistry in promoting access to and enhancing the quality of oral health care. We searched electronic databases in MEDLINE (Ovid), Embase (Embase.com), CINAHL (EBSCO), Web of Science, Cochrane Library, and Epistemonikos from inception to March 2024, without date and language restrictions, to identify SRs and meta-analyses. Two independent reviewers performed data selection following the PICOSS (population, intervention, comparison, outcome, and study design) format, as well as the data extraction. We conducted quality assessments using both (A MeaSurement Tool to Assess Systematic Reviews-2) AMSTAR 2 and ROBIS (Risk Of Bias In Systematic reviews) tools. The certainty of evidence and the overlap of the primary studies included in the SRs were assessed. Results were presented in tables and graphs. A narrative synthesis was performed. The search yielded 1020 articles, of which 30 SRs were included in the overview. The number of participants across these reviews ranged from 130 to 7913 people. All dimensions of the quality of care were addressed to varying extents, with the domains of effectiveness (22/30, 73%), patient-centered care (14/30, 47%), and efficiency (11/30, 37%) being the most extensively studied. Teledentistry addressed public health challenges by improving access to oral health care and reducing inequities (9/30, 30%) for vulnerable people. The major teledentistry applications were teleconsultation (13/30, 43%), and telediagnosis (9/30, 33%). Teledentistry enhanced patient-clinician communication, quality of life, and care experiences for both patients and providers. However, multilevel barriers must be addressed to ensure its successful implementation (7/30, 23%). Meanwhile, patient safety (8/30, 27%) and equity (1/30, 10%) were the least explored domains, with few reviews addressing adverse outcomes, as well as concerns related to data privacy (3/30, 10%) and confidentiality (2/30, 6%). Several SRs exhibited a critically low to low methodological quality (25/30, 83%) and a high risk of bias (8/30, 27%). The overlap (corrected covered area) of the primary studies in all the SRs was slight (30/30, 2.3%), while it was moderate (11/30, 5.7%) for SRs with meta-analyses. The findings of this overview suggest that teledentistry is an effective and efficient alternative to in-person oral health care. However, significant concerns regarding the quality of the reviews highlight an urgent need for more methodologically rigorous studies to generate robust and reliable evidence. This is particularly essential to better understand teledentistry’s potential to enhance overall health outcomes and ensure equitable access to care, thereby providing a stronger foundation to guide clinical practices and inform policy decisions.
10. Short-Form Psychoeducation Videos: Process Development Study.
期刊: JMIR formative research 发表日期: 2025-Jul-30 链接: PubMed
摘要
Every year, around 1.8 million people in the United Kingdom are referred to NHS Talking Therapies, predominantly for cognitive behavioral therapy (CBT), which is the first-line treatment for common affective and anxiety disorders. However, more than a million of these do not complete their course. Supporting this “missing million” to attend and complete CBT is a policy priority. We aimed to coproduce a series of video resources to help patients better prepare for and complete their CBT sessions. We structured this project around a development cycle and documented outcomes against the Template for Intervention Description and Replication (TIDieR) checklist to ensure transparent intervention reporting. We assembled an interdisciplinary team to undertake an iterative video development process, composed of 3 subteams. An expert contributor subteam of 21 therapists shared their priorities and preferences for video content and style. A creative subteam of 4 members was responsible for scripting, filming, and editing video content. A project management subteam comprising 4 members (2 project managers, 1 designer, and 1 psychiatrist) distilled insights from the expert contributors and shared them with the creative team; they also presented video content to expert contributors and collected feedback. The process was terminated when expert contributors were satisfied that the videos developed could be shared with their patients. We conducted 2 development cycles over 7 months between February and August 2024. In total, we produced 12 short-form videos, each 1 minute 14 seconds to 4 minutes 46 seconds long, across 4 distinct presentation styles (animation, patient narrative, therapist vignette, and expert interview). Videos covered topics such as the format of CBT (eg, why there is work to do between therapy sessions) and the psychological content (the value of developing healthy habits). Between 4 and 11 expert contributors reviewed any given batch of videos. Based on early feedback, we removed checklist formats in favor of positive storytelling, slowed pacing, and added subtitles to ensure readability and reduce cognitive load. The termination condition was achieved; expert contributors agreed to share videos with their patients. We successfully collaborated to produce a series of psychoeducation videos. A major strength of this process was the large number of people from different professional backgrounds involved; this diversity boosted both the validity of the content and the creativeness of the videos. This approach was well-suited to the setting of psychotherapy, where therapists have a detailed understanding of the anxieties and uncertainties of their patients, but we would advise caution in fields where professionals are less attuned to their patients’ needs. Support to engage the “missing million” is urgently needed, and psychoeducational videos provide one suitable approach.
11. The Path Forward for Vaccine Policy in the United States.
期刊: The New England journal of medicine 发表日期: 2025-Jul-30 链接: PubMed
摘要
12. Progress Lost - The Unraveling of Medicaid and the Affordable Care Act.
期刊: The New England journal of medicine 发表日期: 2025-Jul-30 链接: PubMed
摘要
13. Fee-For-Service, Accountable Care Organizations, And Medicare Advantage: Why?
期刊: Health affairs (Project Hope) 发表日期: 2025-Jul-30 链接: PubMed
摘要
This Perspective discusses the fiscal challenge facing Medicare and how that challenge may be differentially met by fee-for-service, accountable care organization (ACO), and Medicare Advantage (MA) payment systems. The non-MA part of Medicare includes both fee-for-service and ACO payment systems and is sometimes referred to as traditional Medicare. Fee-for-service, although in need of reform, is inherently ill suited to improving the efficiency of care delivery. MA and ACOs offer more promise, but design issues related to MA payment policy and ACO program features have limited their ability to reduce program spending. In the case of MA, which is paid more by Medicare than would be spent if beneficiaries were in traditional Medicare, the core questions are how much value is created by the added benefits that higher payment helps finance, and what would be lost If MA payment were changed. In the case of ACOs, the key question is how program design can build on the demonstrated ability of some ACO models to provide care more efficiently and save money.
14. Recurrence and Emergence of New Primary Tumors in Patients with Resected Pathological Stage 1A Non-Small Cell Lung Cancer.
期刊: Annals of the American Thoracic Society 发表日期: 2025-Jul-30 链接: PubMed
摘要
Background Lung cancer screening has made early-stage non-small-cell lung cancer (NSCLC) more common and highly curable. However, evidence on post-treatment surveillance, new radiological findings, and distinguishing recurrence from new primary cancers remains limited. Our study aimed to assess outcomes in patients with post-surgical diagnosis of pathologic stage 0/1A first primary NSCLC, including overall survival, classification of new findings as second primaries or recurrence based on current algorithms, and propose potential improvements to these criteria. Methods We analyzed 653 patients with pathologic stage 0/1A NSCLC from the IELCART cohort (2016-2023). Radiological findings were reviewed to classify lung cancer diagnoses as second primaries or recurrences using a five-step approach based on histopathology, genetics, timing, and multidisciplinary discussions. Survival was analyzed with Kaplan-Meier curves and log-rank tests. Findings Among 653 patients (61.1% women, median age 69), 74 (11.3%) later had radiological findings confirmed as lung cancer, more frequent in men (15.7% vs. 8.5%), those with higher pack-years, and COPD. Malignancies were most common in current smokers (19.1%), followed by former (15.2%) and never smokers (1.6%) (p<.0001). Of these, 30 (5%) were second primaries, and 44 (7%) were recurrences. Non-solid cancers showed no recurrences. Recurrences peaked at 12-18 months, while second primaries occurred steadily at 0.6% annually. Overall survival differed significantly between patients groups (p < 0.0001), with overall survival of 58.2% with recurrences, 77.9% with new primaries, and 94.3% with no new cancer after a median follow-up of 3.5 years. Interpretation Among 653 patients, 7% had recurrences, while new primaries (5%) became more frequent after three years, occurring steadily at 0.6% per year, with distinct survival outcomes. New malignant events were more common in men, smokers, and those with COPD. Notably, all malignancies in non-solid cancers were new primaries. These findings emphasize the need for tailored surveillance strategies.
15. Prescribing Practices and Behaviours of Advanced Practice Nurses and Pharmacists: A Nationwide Cross-Sectional Survey.
期刊: Journal of advanced nursing 发表日期: 2025-Jul-30 链接: PubMed
摘要
To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors. Cross-sectional national survey. A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis. Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted. APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice. Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery. This study offers the first national insight into Singapore’s Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts. STROBE checklist. This study did not include patient or public involvement in its design, conduct, or reporting.
16. Re-envisioning the value proposition for investment in cancer care.
期刊: Journal of the National Cancer Institute 发表日期: 2025-Jul-30 链接: PubMed
摘要
Cancer’s place within broader health system development highlights key contradictions and distortions. While innovation in cancer care-spanning medicines, Articial Intelligence, and radiotherapy-advances rapidly, these technologies can be costly and often provide marginal benefits. Lower-cost approaches such as screening, patient navigation, and supportive care remain underutilized, especially in developing health systems. Simultaneously, cancer’s financial burden exacerbates inequities, driving patients into poverty and straining under-resourced systems. To address these contradictions, this paper calls for a re-envisioning of cancer care as a strategic investment within health systems by presenting four key transitions: 1) a shift in the predominant narrative of cancer control as a clinical problem to positioning it as a universal health system priority with far-reaching societal and economic benefits; 2) a greater emphasis on how cancer care supports health system strengthening across the full continuum of services involved in cancer control; 3) a view on cancer as a gateway for technology and systemic investments, showcasing its potential to generate and leverage cross-cutting improvements with benefits across clinical areas and; 4) the need to align cancer control with rigorous fiscal, economic, and operational planning to ensure that investments deliver broad and sustainable health system impacts. By embedding cancer control into health system development, governments can close equity gaps, optimize resources, and strengthen system resilience to address current and future health challenges.
17. Synergistic Toxicity in Alcohol-Associated Liver Disease and PFAS Exposure.
期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2025-Jul-30 链接: PubMed
摘要
Alcohol-associated liver disease (ALD) remains a leading contributor to global morbidity and mortality. Chronic ethanol intake drives hepatocellular damage through multiple mechanisms, such as acetaldehyde-induced cytotoxicity, dysregulated lipid metabolism, oxidative stress, and inflammation. Per- and polyfluoroalkyl substances (PFAS) have emerged as major environmental contaminants, characterized by their persistence, bioaccumulation, and capacity to disrupt hepatic function. PFAS share pathogenic pathways with ALD, including interference with mitochondrial function, oxidative stress induction, and steatosis promotion via altered lipid homeostasis. As exposure to PFAS becomes increasingly widespread and the burden of ALD continues to rise, understanding their potential synergistic impact on liver function is crucial. This review synthesizes current findings on the central mechanisms of ALD pathology, summarizes the hepatotoxic effects of PFAS, and explores their converging roles in exacerbating liver injury. Key pathways of interest include shared disruption of fatty acid oxidation, additive oxidative stress, and immunomodulation. The potential for concurrent exposure in high-risk populations (such as occupational groups with elevated PFAS exposure and higher-than-average alcohol use) warrants concern, particularly given these people often face more limited healthcare access. By identifying mechanistic convergences, this review underscores the need for targeted studies that address how common co-exposures to PFAS and alcohol may intensify liver pathology, the value of a systems biology approach for future investigations, and the importance of implementing strategies to mitigate these synergistic hazards.
18. Mobile Health Technology for Personalized Tobacco Cessation Support Among Cancer Survivors and Caregivers in Laos (Project SurvLaos): Protocol for a Pilot Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Jul-30 链接: PubMed
摘要
Tobacco use remains a major cause of preventable deaths and evidence suggests that smoking cessation offers considerable benefits for patients with and survivors of cancer. In the Lao People’s Democratic Republic (Lao PDR), approximately 60% of male patients and 15% of female patients with cancer smoke cigarettes. Nevertheless, there is no tobacco treatment program for this population. This pilot randomized controlled trial (RCT) aims to evaluate the feasibility and preliminary efficacy of our mobile health-based automated treatment (AT) program to help Lao cancer survivors and caregivers quit smoking cigarettes. We used an intervention mixed methods research design, which included a pilot 2-group interventional RCT and an embedded qualitative component to explain RCT outcomes. In the pilot RCT, cancer survivors or caregivers (n=80, no dyads) who smoked were recruited from national hospitals in Vientiane. Recruited participants were randomized to 1 of 2 treatment groups: standard care (SC) or AT. SC consisted of brief advice to quit smoking delivered by research staff, self-help written materials, and a 2-week supply of nicotine replacement therapy (transdermal patches). AT consisted of all SC components plus our fully automated, interactive, smartphone-based behavioral treatment program personalized and tailored to cancer survivors or caregivers and delivered by our Insight app. Feasibility outcomes of interest include the percentages of intervention messages delivered and viewed, and participant retention at the 3-month follow-up. The preliminary efficacy outcome is biochemically confirmed self-reported 7-day point prevalence abstinence at 3 months post study enrollment. During the interventional RCT and after the 3-month follow-up assessment, we used additional open-ended questions to explore why and how the participants did or did not successfully quit smoking and stay abstinent. Data collection occurred from April 2022 to May 2023. Outcome analyses are ongoing, and results are expected to be published in 2025. Our course of research will address the critical need of having a scalable and sustainable tobacco cessation treatment program for patients with cancer and their caregivers in Lao PDR. The preliminary data from this pilot project will lay a foundation for a subsequent fully powered RCT to evaluate the actual efficacy of our mobile health-based AT program. Ultimately, our course of research will contribute to reducing tobacco-related complications in cancer treatments, comorbidities, tobacco-related cancer recurrence, and mortality rates in Lao PDR. ClinicalTrials.gov NCT05253573; https://clinicaltrials.gov/study/NCT05253573. DERR1-10.2196/66517.
19. Cytomegalovirus (CMV), oxidative stress, and inflammation: implications for immunosenescence and age-related diseases in the MARK-AGE population.
期刊: Biogerontology 发表日期: 2025-Jul-30 链接: PubMed
摘要
Cytomegalovirus (CMV) drives immunosenescence, while its reactivation is associated with inflammation and oxidative stress. This study investigates the interplay between CMV, oxidative stress and inflammation in a cohort of 2065 age-stratified individuals randomly recruited from the general population (RASIG), as part of the MARK-AGE study, to better understand the role of CMV in immunosenescence and its potential impact on age-related diseases. CMV IgG titers were associated with oxidative stress, antioxidant, and inflammatory biomarkers. Stepwise-linear regression identified positive associations with age, BMI, apolipoprotein J (ApoJ/Clu), ceruloplasmin, α-2-macroglobulin, proteasome peptidase activity, and malondialdehyde, and negative associations with α-tocopherol, selenium, and vitamin D. Notably, the associations with ApoJ/Clu and proteasome peptidase activity represent novel findings that point to a potential involvement of proteostasis dysregulation and cellular stress responses in CMV-related immune alterations. Quartile-based analyses revealed significantly lower antioxidant levels (α-tocopherol, selenium, ascorbic acid and vitamin D) and higher oxidative stress markers (plasma 8-isoprostanes, malondialdehyde) in the highest quartile (Q4) compared to lower quartiles. Inflammatory markers (homocysteine, ceruloplasmin and α-2-macroglobulin) ApoJ/Clu and proteasome peptidase activity were elevated in Q4. This group also exhibited a higher prevalence of cardiovascular diseases, hypertension, and diabetes. This study highlights a link between CMV IgG titers, oxidative stress, inflammation, and the prevalence of cardiovascular and metabolic diseases. Our findings suggest that CMV may contribute to immunosenescence through mechanisms involving redox imbalance and dysregulation of protein degradation pathways. Further research is needed to explore the role of CMV reactivation in aging, and its impact on age-related metabolic and cardiovascular diseases.
20. Management of cushing's syndrome in patients with adrenocortical cancer: state of the art and future perspectives.
期刊: Reviews in endocrine & metabolic disorders 发表日期: 2025-Jul-30 链接: PubMed
摘要
Adrenocortical cancers (ACCs) are rare tumours, with up to 50% of cases associated with hypercortisolism. Cortisol-secreting ACCs are characterized by a worse prognosis, and in these patients, the normalization of hypercortisolism is mandatory and requires an urgent approach to avoid complications related to glucocorticoid excess. Clinical and biochemical parameters, including hormonal values, can be used to define cortisol normalization. However, in patients on concomitant mitotane treatment, serum cortisol and ACTH levels may be falsely altered and thus unreliable for defining cortisol normalization. Adrenal steroidogenesis inhibitors, alone or in combination, are the first-line treatment for severe hypercortisolism in ACC due to their rapid action, efficacy, and safety profile. Mitotane is the cornerstone of ACC treatment in both adjuvant and advanced settings. Similarly, glucocorticoid receptor antagonists also have a rapid onset of action, but their use is limited by challenges in monitoring efficacy and safety. This review aims to address the critical aspects of managing cortisol-secreting ACC, including the definition of hypercortisolism control, current therapeutic approaches and future perspectives for ACC, with a focus to the potential role of immune checkpoint inhibitors.
21. Fixating on a laser-projected point at a constant distance suppresses periodic eye movements and impairs balance control during cycling.
期刊: Experimental brain research 发表日期: 2025-Jul-30 链接: PubMed
摘要
The visual field is influenced by movements of the body, head, and eye movements during self-motion. Therefore, compensatory eye movements that stabilize the visual field are crucial for perceptual-motor control. In cycling, a type of eye movement known as optokinetic nystagmus may help prevent visual blur and support the use of retinal flow for maintaining dynamic balance. This study aimed to examine the impact of visual environmental manipulation on dynamic balance control in cycling by altering gaze behavior. Participants cycled under three conditions and were instructed to ride as slowly as possible while staying on the path. In the control condition, they cycled along a striped path. In the laser condition, they cycled on the same path while fixating on a laser point projected 4 m ahead of the bicycle. In the monochrome condition, participants cycled along a plain white path. Each condition consisted of five trials. The results showed that the amplitude at the peak frequency of eye movements was significantly lower in the laser condition compared to the control and monochrome conditions. In addition, the cycling distance and duration were significantly shorter in the laser condition compared to the control condition. There were no significant differences in eye movements or cycling performance between the control and monochrome conditions. These results suggest that fixating on a laser point projected at a constant distance ahead suppresses the amplitude of eye movements and impairs balance control during cycling. Natural gaze behavior is likely to be an important factor for cycling safely.
22. Urine Exposome-Metabolome Network Analysis Identifies Differential Chemical Connectivity Associated with Mild Cognitive Impairment.
期刊: Journal of proteome research 发表日期: 2025-Jul-30 链接: PubMed
摘要
Mild cognitive impairment (MCI) represents a transitional neurocognitive state vulnerable to environmental modulation, yet the exposomic underpinnings remain poorly characterized. In this study, we performed integrated urinary exposome and metabolome profiling in 30 MCI patients and 30 matched controls using a broad-spectrum targeted LC-MS/MS platform encompassing 239 xenobiotics and 688 endogenous metabolites. To characterize systemic environmental-metabolic interactions, exposome-metabolome (E × M) correlation networks were constructed through bootstrap-resampled Spearman analysis. Although total xenobiotic burdens were comparable between groups, MCI individuals exhibited significantly elevated chemical richness and E × M network hyperconnectivity, suggesting heightened metabolic reactivity to environmental stimuli. A core differential E × M network was delineated, identifying 1-hydroxypyrene, perfluorooctanoic acid, and NEtFOSAA as central environmental hubs, and acetylcholine, guanine, and l-methionine as key metabolic nodes associated with MCI status and AD8 cognitive scores. These molecules converge on oxidative stress, neuroinflammation, cholinergic dysregulation, and epigenetic perturbation pathways. Our findings underscore the pathophysiological relevance of chemical-metabolic crosstalk in early cognitive decline and advocate for exposome-informed precision neurology frameworks.
23. The multi-dimensional role of cancer epidemiology in cancer prevention: discovery science and beyond.
期刊: Journal of the National Cancer Institute 发表日期: 2025-Jul-30 链接: PubMed
摘要
The pivotal role of epidemiology in the identification of the causes of cancer is well recognised. However, after this identification the translation of those findings into cancer prevention typically requires further epidemiological research. The role of cancer epidemiology in these next steps and other aspects of cancer prevention, is perhaps, less well appreciated. Here we describe a framework for the multi-dimensional role of cancer epidemiology in cancer prevention including: 1) hazard identification 2) risk assessment 3) understanding natural history and 4) evaluating biological targets for prevention. The approaches required will vary depending on the type of prevention strategy. For example, primary prevention will usually require hazard identification and risk assessment and/or burden estimation, whereas secondary prevention will require studies of the natural history of disease. We describe the types of epidemiological study designs that are used to address these four dimensions and the role of novel methods in their success. We illustrate this with five examples: occupational radiation exposure, menopausal hormone therapy, per- and polyfluoroalkyl substances, obesity and lung CT screening. These examples show how the framework provides a systematic approach to define research questions and interpret results in the context of cancer prevention. This broader view of the field of cancer epidemiology also requires broader measures of success that go beyond the discovery of causes and estimates of population attributable fractions, through to reductions of harmful exposures and eventually lowering of cancer incidence and mortality in the affected populations.
24. Vaccination with mRNA-encoded membrane-anchored HIV envelope trimers elicited tier 2 neutralizing antibodies in a phase 1 clinical trial.
期刊: Science translational medicine 发表日期: 2025-Jul-30 链接: PubMed
摘要
mRNA technology might accelerate development of an urgently needed preventive human immunodeficiency virus (HIV) vaccine. We evaluated the safety and immunogenicity of three mRNA-encoded envelope trimers, including two doses of soluble and membrane-anchored forms, in a randomized, open-label, phase 1 clinical trial. Vaccines were generally well tolerated, although 6.5% (7 of 108) of participants developed urticaria, a higher proportion than seen with other mRNA vaccines. mRNA-encoded trimers induced strong envelope-specific B and T cell responses. Immunization with membrane-anchored trimers, intended to obscure epitopes at the trimer base targeted by nonneutralizing antibodies, reduced the frequency of base-binding serum antibodies in comparison with soluble trimers. Three immunizations elicited autologous tier 2 serum neutralizing antibodies in 80% of vaccinees receiving the membrane-anchored trimers, in contrast to only 4% receiving the soluble trimer. Thus, with demonstration of more favorable safety, mRNA-encoded membrane-anchored HIV envelope trimers represent a promising platform for HIV vaccine clinical development.
25. Impairment of stromal-epithelial regenerative cross-talk in Hirschsprung disease primes for the progression to enterocolitis.
期刊: Science translational medicine 发表日期: 2025-Jul-30 链接: PubMed
摘要
Hirschsprung disease (HSCR) is a congenital condition characterized by the improper migration of enteric neural crest cells, leading to aganglionosis most commonly in the rectosigmoid colon. This severe and life-threatening disorder often results in the development of Hirschsprung-associated enterocolitis (HAEC), which can occur either before or after surgical resection of the affected bowel segment. Using colonic tissue from patients with HSCR alongside the well-established endothelin receptor B knockout mouse model, we investigated epithelial regeneration dynamics and stromal-epithelial cross-talk in the distal ganglionic colon, a critical site for HAEC development. In individuals with HSCR but without epithelial damage, the distal ganglionic colon displayed impaired epithelial regeneration and alteration of intestinal stem cell dynamics, characterized by the reduction of leucine-rich repeat-containing G protein-coupled receptor 5 (LGR5+) epithelial stem cells. This phenomenon was consistent in the mouse model, where impaired regenerative ability preceded HAEC when epithelial damage occurred on site. Patients with HSCR also exhibited remodeling in stromal cells in this distal ganglionic colon region, with fewer primary sources of Wingless-related integration site (Wnt) signal-releasing stromal cells and the exclusive presence of proinflammatory (matrix metalloproteinase 1+) stromal cells. Stromal cells from the HSCR distal ganglionic colon failed to sustain the growth of colonic organoids. However, ibuprofen suppressed the proinflammatory stromal cells, leading to effective restoration of epithelial organoid growth. These observations underscore the crucial role of impaired stromal-epithelial cross-talk in HSCR and the pathogenesis of HAEC and suggest potential therapeutic targets for the prevention or treatment of the condition.
26. [Unmet Challenges in COVID-19 Prevention for Immunocompromised Individuals: A Consensus Analysis from Portugal].
期刊: Acta medica portuguesa 发表日期: 2025-Jul-30 链接: PubMed
摘要
The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulted in significant disease burden and mortality. Despite vaccination successes, new virus variants persist, affecting unvaccinated and immunocompromised individuals (ICI) severely. These high-risk groups face elevated mortality and hospitalization rates. Vigilance and targeted health measures remain crucial post-pandemic. The aim of this study was to develop consensus on the unmet needs in COVID-19 prevention among ICI. We performed a Delphi study involving 45 experts, including physicians, health managers, policymakers, public health experts, members of medical societies and patient organizations. Consensus was achieved at 65% for each identified strategy using a scale ranging from “strongly agree” to “strongly disagree.” Three Delphi rounds were conducted to address four key questions: identifying unmet needs in COVID-19 prevention for ICI; identifying the characteristics that distinguish ICI as a susceptible group; determining the main outcomes of COVID-19 in ICI; and indicating action plans for protecting ICI. The first round involved voting on pre-identified indicators. The second and third rounds involved analyzing the gathered information and voting on each indicator to achieve consensus. A retention rate of 80% was achieved. Out of 89 valid indicators analyzed, 23 achieved consensus. These included: eight indicators highlighting the importance of raising awareness about COVID-19 and vaccination outcomes, ensuring safety and understanding, and developing targeted immunization strategies for ICI; five indicators identifying susceptible groups within ICI, such as individuals undergoing chemotherapy or radiotherapy, those with primary immunodeficiencies, solid organ transplant recipients, patients with chronic kidney disease, and bone marrow transplant recipients; two indicators showing improvements in clinical outcomes and reduced hospitalizations; and eight indicators recommending the development of effective therapies, more immunogenic vaccines, and treatments for viral infections in ICI. The study emphasized the importance of targeted immunization strategies, monitoring, and tailored education to address diverse needs of ICI. These findings provide a foundation for future policies to effectively manage and protect ICI during and beyond the COVID-19 pandemic. Introdução: A pandemia de COVID-19, causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), resultou numa carga significativa de doenças e mortalidade. Apesar dos sucessos das vacinas, novas variantes do vírus persistem, afetando gravemente indivíduos não vacinados e imunocomprometidos (IIC). Estes grupos de alto risco enfrentam taxas elevadas de mortalidade e hospitalização. A vigilância e as medidas de saúde direcionadas permanecem cruciais após a pandemia. Este estudo teve como objetivo desenvolver um consenso sobre as necessidades não atendidas na prevenção da COVID-19 entre IIC. Métodos: Realizámos um Delphi envolvendo 45 especialistas, incluindo médicos, gestores de saúde, decisores políticos, especialistas em saúde pública, membros de sociedades médicas e organizações de doentes. O consenso foi alcançado em 65% para cada estratégia identificada, utilizando uma escala que varia de “concordo totalmente” a “discordo totalmente”. Foram realizadas três rondas Delphi para abordar quatro questões principais: identificar necessidades não atendidas na prevenção da COVID-19 para IIC; identificar as características que distinguem os IIC como um grupo suscetível; determinar os principais resultados da COVID-19 em IIC; e indicar planos de ação para proteger os IIC. A primeira ronda envolveu a votação de indicadores pré-identificados. As segunda e terceira rondas envolveram a análise das informações recolhidas e a votação de cada indicador para alcançar consenso. Resultados: Foi alcançada uma taxa de retenção de 80%. Dos 89 indicadores válidos analisados, 23 alcançaram consenso. Estes incluíram: oito indicadores que destacaram a importância de aumentar a conscientização sobre a COVID-19 e os resultados da vacinação, garantindo segurança e compreensão, e desenvolvendo estratégias de vacinação direcionadas para IIC; cinco indicadores que identificaram grupos suscetíveis dentro dos IIC, como indivíduos em quimioterapia ou radioterapia, aqueles com imunodeficiências primárias, recetores de transplantes de órgãos sólidos, pacientes com doença renal crónica e recetores de transplantes de medula óssea; dois indicadores que mostraram melhorias nos resultados clínicos e redução das hospitalizações; e oito indicadores que recomendaram o desenvolvimento de terapias eficazes, vacinas mais imunogénicas e tratamentos para infeções virais em IIC. Conclusão: O estudo enfatizou a importância de estratégias de vacinação direcionadas, monitorização e educação personalizada para abordar as diversas necessidades dos IIC. Estes resultados fornecem uma base para o desenvolvimento de políticas futuras que visem gerir e proteger eficazmente os IIC durante e após a pandemia de COVID-19.
27. Development of Ambulatory Oncology Clinical Pharmacy Key Performance Indicators Using a Modified Delphi Consensus Approach.
期刊: JCO oncology practice 发表日期: 2025-Jul-30 链接: PubMed
摘要
To develop evidence-based ambulatory oncology clinical pharmacy key performance indicators (AOcpKPIs). A systematic, modified Delphi process was used to reach consensus on AOcpKPIs. Following an environmental scan of current oncology pharmacy practices across Canada, a literature review identified critical activities linked to patient-centered outcomes. A panel of oncology pharmacists engaged in three Delphi rounds and a virtual live meeting, assessing and refining candidate AOcpKPIs on the basis of predefined criteria. A total of 17 candidate AOcpKPIs were evaluated. Consensus was achieved on 14 AOcpKPIs. These AOcpKPIs reflect critical pharmacist activities including clinical order review, patient education, medication adherence assessment, and management of drug therapy problems. This suite of AOcpKPIs provides a standardized approach for evaluating oncology pharmacist activities in ambulatory care, facilitating benchmarking and supporting evidence-based improvements in patient outcomes. This study represents a significant advancement in defining quality metrics for ambulatory oncology pharmacy practice. The consensus-based AOcpKPIs provide a foundation for enhanced patient care, professional accountability, and continuous quality improvement within oncology pharmacy. Implementing these AOcpKPIs has the potential to elevate oncology pharmacy practice, supporting pharmacists in meeting evolving health care demands and fostering evidence-based patient outcomes.
28. Investigating RND efflux pumps in Sphingobium yanoikuyae P4: the role of nonpathogenic bacteria in antibiotic resistance gene spread amid environmental contamination.
期刊: Journal of biomolecular structure & dynamics 发表日期: 2025-Jul-30 链接: PubMed
摘要
The widespread and inappropriate application of antibiotics across human and veterinary medicine has generated pressing global health threats, principally the emergence of antimicrobial resistance (AMR) and the contamination of the environment with antibiotics. A fundamental mechanism fueling environmental AMR is the proliferation and horizontal dissemination of antibiotic resistance genes (ARGs), with efflux transporter proteins functioning as central intermediaries. Surprisingly, nonpathogenic bacteria, which are usually regarded as harmless, now pose a substantial risk to society due to the presence of efflux transporters, which make them AMR contributors. In this study, the genomic analysis of the nonpathogenic soil bacterium Sphingobium yanoikuyae P4 revealed an RND (Resistance-Nodulation-Division) efflux pump containing the relevant domains responsible for antibiotic efflux. Molecular docking studies revealed high affinities between the efflux pump and various antibiotics, including fluoroquinolones, beta-lactams, and sulfonamides, raising the possibility of their efflux into the environment. Antibiotic susceptibility tests showed reduced susceptibility due to the action of this efflux transporter. Furthermore, the genome analysis suggested the presence of mobile genetic elements and plasmid-associated sequences, indicating possible horizontal gene transfer. The data highlights that both nonpathogenic and pathogenic bacteria are crucial for capturing and transmitting antibiotic-resistance genes. These results confirm the disregard for existing concerns over the substantial role of nonpathogenic environmental bacteria in the ecological resistome and warrant the need to consider such microorganisms in monitoring and controlling AMR.
29. Facile Control of a Tailed Virus Surrogate by Iron Conventional Coagulation and Electrocoagulation.
期刊: Environmental science & technology 发表日期: 2025-Jul-30 链接: PubMed
摘要
Both FeCl3 conventional coagulation and Fe(0) electrocoagulation were highly effective in mitigating the long-tailed somatic phage P1. We targeted enterobacterial coliphages because they are better than fecal indicator bacteria in tracking environmental persistence of viral pathogens and their fate in wastewater unit operations. Cryogenic electron microscopy (cryo-EM) of intact/damaged P1 and enumeration of infective virions by plaque assays demonstrated control via both removal and inactivation. Cryo-single particle analysis was coupled with cryo-electron tomography to generate 3-dimensional electron density maps to visualize and analyze untreated and coagulated capsids. To our knowledge, this is the first report of cryo-EM to visualize structurally damaged viruses with environmental relevance. Viruses were intrinsically enmeshed in precipitates consistent with sweep coagulation. Direct evidence of multiple inactivation mechanisms was obtained including (i) capsid breakage leading to leakage of viral genome and other components, (ii) deformation and thinning of capsid proteins, (iii) severance/damages to the neck region where the tail is attached to the capsid, (iv) removal, fragmentation, and splintering of tail sections, and (v) baseplate damage (including receptor-binding proteins). Conformational alterations to proteins, changes to secondary structures, and specific interactions with flocs were inferred from infrared spectroscopy for both coagulation approaches. However, only electrocoagulation oxidized proteins. Extremely facile reduction of P1 suggested that coliphages with myovirus morphology may not be conservative surrogates to measure log reduction values for regulatory purposes and public health protection by iron conventional coagulation and electrocoagulation.
30. Characterizing variability and uncertainty for parameter subset selection in PBPK models.
期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2025-Jul-30 链接: PubMed
摘要
Physiologically based pharmacokinetic (PBPK) models describe absorption, distribution, metabolism, and excretion of chemicals. Probabilistic PBPK models can be used to produce distributional estimates of human equivalent doses (HEDs), which are external measures of human exposure predicted to result in a target internal dose, generated with Monte Carlo sampling and reverse dosimetry calculations. Very low HED percentiles represent individuals that are more sensitive to possible adverse effects of chemical exposures and are therefore frequently used in risk evaluation. Details of the parameter distributions used in probabilistic PBPK models impact HED distributions, but obtaining precise distributional estimates for all the parameters would be challenging. Therefore, we sought to determine methods which can identify the extent of model parameter influence on extreme HED percentiles. We first analyzed published PBPK models for dichloromethane and chloroform (for inhalation and oral exposures given three internal target levels each) by identifying the overall relative importance of parameters using global sensitivity analysis (GSA) methods. Then, we used a novel yet computationally expensive method to analyze the stability and sensitivity of extreme HED percentiles to input parameter distributions. Applying the traditional GSA methods allowed us to identify subsets of parameters most influential for accurately determining 1st and 99th percentiles, but the specific parameters included in those subsets varied for different models and exposure scenarios. Our results demonstrate that better characterizing PBPK model uncertainty by using precise distributional details for influential parameters informed by GSA methods may improve confidence in estimates of extreme percentiles of HEDs.
31. Food Availability is a Critical Factor in Microplastic Toxicity Testing using Daphnia magna.
期刊: Environmental toxicology and chemistry 发表日期: 2025-Jul-30 链接: PubMed
摘要
Microplastics are ubiquitous in the environment and can have toxic effects on organisms. The effects of microplastics can include food dilution. This occurs when an animal feels full after consuming particles but does not gain nutrition from them. This satiety signal might limit further feeding, resulting in malnutrition. Environmental concentrations of microplastics and food are relevant to the risk of food dilution. The ratio of ingested microplastics to food by volume should determine the degree of food dilution and other toxicity pathways. To examine the possibility of a relationship between food availability and the effects of microplastics on animal health, we used a fully factorial design experiment exposing Daphnia magna to three concentrations of microplastic fragments (none, low, high). We exposed Daphnia to a mixture of three microplastic polymers (polyethylene, polyethylene terephthalate, polystyrene) and three levels of food availability (low, medium, high). We found that microplastics negatively affected survival only in the high exposure treatment and that food availability improved survival across all treatments. Higher survival of Daphnia in the high microplastics, high food treatment compared with the high microplastics, medium and low food treatments suggests that the two factors interact additively. Food availability also positively influenced reproduction and growth, whereas microplastic exposure did not. Future studies and the interpretation of past work should closely consider the relationship between food availability and microplastics, as the effect of microplastics on survival appears to be mediated by the abundance of food. Exposures to the same microplastic concentration across different levels of food will produce different experimental outcomes, which will affect the thresholds determined by risk assessments.
32. Single-Cell Multiome Impact of Prenatal Heavy Metal Exposure on Early Airway Development.
期刊: American journal of respiratory cell and molecular biology 发表日期: 2025-Jul-30 链接: PubMed
摘要
Prenatal exposure to cadmium (Cd) and arsenic (As) can severely impair fetal lung development, leading to lifelong adverse effects. As two of the most common and toxic heavy metals, Cd and As pose risks to many communities through food and water consumption. We have shown that prenatal co-exposure to Cd and As at levels relevant to human intake inhibits branching morphogenesis, yet cell-type-specific mechanisms remain elusive. Here we examined early embryonic lungs (E12) from mice exposed prenatally to either 0 (control) or 250 (treated) ppb of both Cd and As. Through single-cell multiome sequencing (scATAC-seq+scRNA-seq) and high-resolution metabolomics, we present a multifaceted landscape of Cd and As-induced molecular and cellular disruption. We identified 19 cell states exhibiting state-specific changes in gene expression related to cell proliferation and differentiation. Velocity analysis integrating RNA splicing and chromatin kinetics showed profound disruptions in cell fate, particularly affecting differentiation of Sox2+ proximal progenitors and Wnt2+ mesenchymal progenitors. Gene regulatory network analysis pinpointed the diminished function of Gata6 and Gli2 as central to these disruptions, which was further confirmed by their reduced protein expression in exposed E12, E14.5 and E17 lungs. Additionally, metabolomic alterations in polyamine, tyrosine and fatty acid biosynthesis correlated with changes in gene expression of catalytic enzymes. These findings demonstrate that Cd and As at levels relevant to human exposure impair early airway formation across multiple regulatory levels, including chromatin accessibility, transcription and cell metabolism, and provide insights into the factors central to cell resilience during this vulnerable stage of lung development.
33. Drilling with exoskeletons: effect of hand-arm vibration on neurological and muscular outcomes.
期刊: Ergonomics 发表日期: 2025-Jul-30 链接: PubMed
摘要
Exoskeletons can be used in workplaces where vibrating power tools are applied. The influence of these support systems on vibration exposure and impact remains unclear. In an experimental laboratory study, the influence of two passive exoskeletons for the upper body when working with a drill was compared to a task without exoskeletons. Vibration exposure, transmissibility to the wrist, feed force, muscle activity, muscle fatigue, posture and vibration perception thresholds were measured on 30 subjects. Vibration exposure at the machine handle was higher with both exoskeletons than without an exoskeleton. The vibration perception threshold at 125 Hz shifted less after using the exoskeletons than without using the exoskeletons. When wearing exoskeletons with a strong support torque, increased vibration exposure and higher abduction of the upper arm may occur. The results indicate that exoskeletons reduce the transmission of vibrations in the lower frequency range. An experimental study was conducted to investigate the effect of two passive exoskeletons for the upper body on the vibration exposure, feed force, muscle activity, posture and neurological impact of a drill. When wearing exoskeletons with strong support torque, increased vibration exposure may occur.
34. Enhancing predictive accuracy: Assessing the laparoscopic hysterectomy readmission score in a diverse endometrial cancer population.
期刊: Gynecologic oncology 发表日期: 2025-Jul-29 链接: PubMed
摘要
The laparoscopic hysterectomy readmission score (LHRS) was developed to identify patients at low risk for readmission following laparoscopic surgery. Its performance in patients with endometrial cancer (EC), a population increasingly undergoing laparoscopic hysterectomy, remains unassessed, particularly across racial and ethnic groups. This study evaluates LHRS discrimination and calibration in predicting readmission among patients with EC overall and by race and ethnicity. Using the National Surgical Quality Improvement Program database (2014-2020), we identified patients who underwent laparoscopic hysterectomy. The LHRS was calculated as previously described by Jennings et al. Model performance was assessed using the area under the receiver operating curve (AUC), true positive rate (TPR) and false positive rate (FPR). Logistic regression estimated 30-day readmission odds in the overall cohort and by race and ethnicity. The LHRS was analyzed as a continuous (0-8) and dichotomous (<3 vs. ≥3) variable. Among 27,981 patients with EC (Asian = 1367; American Indian/Alaska Native = 115; Black = 2120; Latine = 1676; Native Hawaiian/Pacific Islander = 305; White = 22,398), readmission rates were low (3.1 %). The LHRS demonstrated poor discrimination, with an AUC only marginally better than chance overall (0.52, 95 % CI = 0.51, 0.53) across all racial and ethnic groups. TPRs and FPRs were uniformly low. Patients with LHRS ≥3 has higher readmission odds (OR = 3.10, 95 % CI = 2.31, 4.15) with similar associations in race and ethnicity-stratified models. Although a higher LHRS was associated with increased readmission odds, the score failed to predict readmission better than chance in this EC cohort, underscoring the need for improved risk stratification tools for readmission in this population.
35. Real-world survival outcomes of immune checkpoint inhibitor therapy after standard treatment failure in EGFR-mutated NSCLC: A nationwide cohort study.
期刊: Lung cancer (Amsterdam, Netherlands) 发表日期: 2025-Jul-28 链接: PubMed
摘要
Immune checkpoint inhibitors (ICIs) have shown limited efficacy in EGFR-mutated NSCLC, and their role in later-line settings remains unclear. This study aimed to evaluate the real-world effectiveness of ICI monotherapy compared to chemotherapy in patients with EGFR-mutated NSCLC who had limited remaining treatment options. We conducted a target trial emulation using data from the Cancer Public Library Database under the K-CURE project, which integrates national cancer registry, mortality, medical check-up and health insurance claims data in Korea. Eligible patients were aged ≥ 18 years, had EGFR-mutated NSCLC with progression after both EGFR-TKI and platinum-based chemotherapy, and initiated ICI monotherapy or chemotherapy between August 2017 and December 2020. Propensity score matching was used to balance treatment groups. Overall survival was analyzed using time-dependent statistical methods to account for non-proportional hazards. Of 1,914 eligible patients, 663 matched pairs were analyzed. While standard Cox analysis showed no significant OS difference (HR 0.91, 95 % CI 0.80-1.03), time-dependent analyses revealed a late survival benefit for ICI beyond 6.8 months (HR 0.72, 95 % CI 0.59-0.88). Subgroup analyses revealed heterogeneous treatment effects, with greater long-term benefits in patients of older age, those with concurrent malignancies, and those without prior osimertinib exposure. Sensitivity analyses suggested a potential role for high PD-L1 expression as a biomarker of ICI response in this setting. ICI monotherapy may offer time-dependent survival benefits over chemotherapy in selected patients with EGFR-mutated NSCLC after standard treatment failure, supporting its consideration in later-line clinical decision-making.
36. Management of acute invasive fungal rhinosinusitis in immunocompromised children: a narrative review.
期刊: American journal of otolaryngology 发表日期: 2025-Jul-28 链接: PubMed
摘要
The aim is to review the current evidence for the management of acute invasive fungal rhinosinusitis (AIFR) in immunocompromised children. A systematic search of PubMed, Embase, and Cochrane Library was performed. Data regarding the epidemiology, clinical presentation, diagnostic instruments, and treatments of pediatric AIFR were narratively summarized and critically analyzed. The management of AIFR in immunocompromised children can be very challenging because of the paucity of symptoms and rapidly progressive disease. The following key concepts are crucial to optimize the management: 1) early diagnosis through clinical features (sinonasal, oral, ocular, neurological symptoms and fever) and instrumental exams (nasal endoscopy with biopsy, microbiological tests, CT and MRI); 2) vigorous medical antifungal therapy associated with surgical treatment (endoscopic/open); 3) treat the underlying immunosuppression by improving immunocompetence; 4) close follow-up and prompt intervention in case of recurrence. AIFR in immunocompromised children is a rare but serious condition that requires the use of fast and precise methods that can support clinicians in its management. In this perspective, a multidisciplinary diagnostic and therapeutic approach is essential. However, mortality is still high and further research is needed to improve knowledge in this field.
37. Blood Flow Restriction Training in People With Parkinson Disease: A Mixed-Methods Feasibility Study.
期刊: Journal of neurologic physical therapy : JNPT 发表日期: 2025-Jul-28 链接: PubMed
摘要
To determine the feasibility of low-load resistance blood flow restriction training (BFRT) in people with Parkinson disease (PD). This prospective cohort, convergent parallel mixed-methods design investigated the feasibility of 8 weeks of low-load resistance BFRT in people with PD. Feasibility was determined by enrolling 20 participants, ≥80% retention and adherence, and no serious intervention-related adverse events. Semistructured interviews and questionnaires evaluated acceptability and satisfaction. Changes in muscle strength and thickness, mobility, physical activity, and patient-reported outcomes were also assessed. Sixteen of 20 participants (80%) were retained at the postintervention assessment (68.1 ± 8.6 years old, 44% Female), completing 88% of visits with no serious adverse events. Qualitative analysis identified 3 themes: satisfaction and acceptability, functional capacity changes, and program feedback. Most participants were satisfied (88%), and lack of satisfaction was primarily related to pressure intolerance and exercise specificity. There were improvements in knee extension and ankle plantarflexion strength (18-22%), 30-Second Sit to Stand (+2.2 reps), Timed Up and Go (-2.1 seconds), and 10-Meter Walk Test (0.12 m/s). The average daily step count decreased (-476 steps/day) and sedentary time increased (21 minutes/day). There were minimal changes in elbow extension strength, rectus femoris muscle thickness, Parkinson’s Fatigue Scale, and Patient-Specific Functional Scale. BFRT was feasible and safe in people with PD, with promising improvements in muscle strength and mobility, warranting a future efficacy study. Clinicians considering BFRT should carefully evaluate tolerance and make sure BFRT aligns with patient goals. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A539).
38. Pan-cancer methylation analysis of circulating cell-free DNA.
期刊: Cancer genetics 发表日期: 2025-Jul-26 链接: PubMed
摘要
Universal cancer screening based on methylation analysis of circulating cell-free DNA (cfDNA) enables multi-organ cancer detection, thereby reducing all-cause mortality and preventing cancer misdiagnosed by guideline-based cancer-specific screening. This study aims to establish a gene methylation panel for blood-based multi-cancer early detection. Bioinformatics analysis and in-house DNA sequencing of various human cancer cell lines and blood from healthy persons were carried out to identify candidate pan-cancer methylation sites. Methylation-sensitive restriction enzymes-quantitative PCR (MSRE-qPCR) was then used for DNA methylation analysis. Blood cfDNA from 103 patients with diverse cancer types and 40 healthy subjects was extracted for methylation analysis. By bioinformatics analysis and in-house DNA sequencing, we identified two candidates pan-cancer methylation sites, HIST1H4F and CDO1. A long stretch of methylation was found on the promoters of HIST1H4F and CDO1 across various cancer cell lines, while these genomic regions are unmethylated in healthy persons. When tested with clinical samples, the detection sensitivity and specificity of our gene methylation panel in detecting pan-cancer were 47.57 % and 90.00 %, respectively. When analyzed by cancer subtypes, the detection sensitivity was the highest in lung cancer (76.92 %), followed by colorectal cancer (63.64 %) and gastric cancer (50.00 %). Our newly established gene methylation panel provides an alternative assay for multi-cancer screening tests. As no bisulfite conversion and invasive procedures are required, it can accelerate cancer diagnosis and streamline the operation for pan-cancer screening.
39. Impacts of a minimum pricing policy on high fat, sugar and sodium (HFSS) foods: Environmental, dietary and welfare analysis.
期刊: Economics and human biology 发表日期: 2025-Jul-22 链接: PubMed
摘要
Foods high in fat, sugar and salt (HFSS) are detrimental to people’s health, social well-being and the environment. Minimum unit pricing has shown potential to reduce cigarette and alcohol consumption, but it is unpopular in the food and drinks sectors. This research aims to simulate the shadow price or minimum price for HFSS that could potentially reduce demand by 10 %, and estimate the impacts on nutrition, climate and economic welfare in Scotland. The Linear Approximate Exact Affine Stone Index (LA/EASI) demand model was applied to household consumption data from Kantar Worldpanel (KWP) to derive elasticities that were used to simulate the minimum prices for the HFSS categories considered. Greenhouse gas emission estimates were derived from the SHARP Indicators Database (SHARP-ID) to estimate CO2-eq changes, and the log of living cost index was used to estimate the economic welfare effect of the policy. The expected minimum increment in prices with respect to the baseline price was approximately 28 % for edible ices and ice cream, 9 % for sugary drinks and 10-17 % for total puddings and desserts; biscuits and savouries; and confectionery, cakes, pastries and sugar morning goods. This had implications for non-targeted foods. For instance, the purchase of fruit and vegetables decreased by 0.47 % and 0.82 % respectively, whilst sugar and preserve purchases increased by 1.30 %, marginally discounting the benefits of the policy. On the positive side, purchases of meat, fish and alcohol decreased, and dairy product purchases increased. For the average per capita dietary carbon footprint, the policy reduced net average total CO2-eq emissions by 0.7 %. However, consumers would require a 12.3 % increase in expenditure to consume the same basket of food as before the price change. In summary, although the policy is expected to improve climate health, there will be negative unintended effects on non-targeted foods, as well as economic welfare loss if consumers decide not to change their consumption habits. It is recommended that policymakers consider the net total effect of the minimum pricing before introducing it in the food and drinks sector.
40. Adsorbent of bacteria and inflammatory Factors: Injectable dual-network hydrogel for osteomyelitis treatment.
期刊: Biomaterials 发表日期: 2025-Jul-21 链接: PubMed
摘要
Current treatments for osteomyelitis are often hampered by biofilm formation, the emergence of multidrug-resistant (MDR) bacteria, and limited antibiotic penetration into infected bone tissue, all of which impede bone regeneration and prolong the disease progression. Herein, based on the chlorogenic acid (CA)-Mg2+ coordination and covalent crosslinking of genipin (GP) with proteins, we proposed an injectable dual-network natural hydrogel named as CA-Mg/BSA-GP (CMBG) hydrogel. GP functions as a biological crosslinker, facilitating the adsorption and crosslinking exogenous bovine serum albumin (BSA) and polypeptide antibiotics, as well as endogenous inflammatory factors and bacterial surface proteins within the infection microenvironment. The CMBG hydrogel doped with polypeptide antibiotics (vancomycin and polymyxin B) effectively eradicates MDR strains (MRSA RJ011 and Escherichia coli RJ054) through the synergistic effect of CA and antibiotics. Additionally, CA released from the CA-Mg network, combined with the crosslinking of inflammatory factors and bacterial proteins, effectively inhibits inflammation and reduces local oxidative stress. Finally, the anti-infective environment, together with the bioactive release of CA and Mg2+, upregulates osteogenic protein expression and promotes bone repair. Collectively, the polypeptide antibiotics-doped CMBG hydrogel demonstrates potent antibacterial, anti-inflammatory, and osteogenic properties, offering a promising minimally invasive therapeutic strategy for MDR bacteria-associated osteomyelitis.
41. Influence of Age at Diagnosis on Clinical Disease Parameters in Wild-type Transthyretin Amyloid Cardiomyopathy.
期刊: JACC. Asia 发表日期: 2025-Jul-03 链接: PubMed
摘要
42. Prevention of Atopic Dermatitis: What Are We Missing?
期刊: Allergy, asthma & immunology research 发表日期: 2025-Jul 链接: PubMed
摘要
Atopic dermatitis (AD) is a prevalent chronic inflammatory disease that significantly burdens individuals and healthcare systems worldwide. The incidence of AD has risen sharply in both developed and emerging economies, necessitating an understanding of its complex etiological factors, including environmental influences and lifestyle changes. Generally, 2 primary preventive strategies for AD have been implemented so far: (1) the “Inside Out” approach that which involves allergen elimination, probiotic supplementation, fish oil supplementation, and vitamin D supplementation aim to regulate the immune system in pregnancy and early childhood and (2) the “Outside In” approach that focuses on improving skin barrier function through emollient use and environmental changes. Although current evidence suggests the potential benefits from these interventions, randomized controlled trials have revealed inconsistencies in their efficacy. It is imperative not only to explore the minute research gaps in existing studies, but also to develop novel interventional studies that consider individual and regional differences based on the epithelial barrier hypothesis, the biodiversity hypothesis, and the ‘old friends’ hypothesis evolved from the hygiene hypothesis. Ultimately, reversing the rising trend of AD prevalence will most likely require a multifaceted approach that integrates new scientific evidence and promote comprehensive lifestyle changes.
43. THE FREQUENCY AND IMPACT OF ENERGY DRINK CONSUMPTION ON BMI AMONG UNDERGRADUATE STUDENTS AT ALNOOR UNIVERSITY.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
Energy drink consumption has increased among college students, but its impact on health measures like body mass index (BMI) is not well understood, particularly in Iraqi populations. This study aimed to characterize energy drink intake patterns and investigate associations with BMI among undergraduate students at Alnoor University in Iraq. A cross-sectional survey of 270 students collected data on demographics, energy drink intake frequency, sleep duration, physical activity levels, and measured BMI. Descriptive statistics, chi-square tests, and Fisher’s exact tests analyzed relationships between variables. Over 45% of students consumed energy drinks, with 9.3% drinking them ≥4 times/week. Males consumed energy drinks more frequently than females (p<0.001). Energy drink intake frequency was not significantly associated with BMI categories (p=0.399) or sleep duration (p=0.632). Half of students slept ≤6 hours/night and 53.7% exercised <1 hour/week. Based on BMI, 35.9% were overweight, 13% obese, and 1.1% morbidly obese. Energy drink consumption was common in this Iraqi college population, especially among males, but was not significantly related to BMI or sleep duration. Students had high rates of overweight/obesity and insufficient sleep and physical activity. Universities should promote healthy lifestyles in this at-risk group.
44. IMPACT OF PHOTODYNAMIC THERAPY ON ORAL HEALTH IN PATIENTS UNDERGOING FIXED ORTHODONTIC TREATMENT: A RANDOMIZED CONTROLLED TRIAL.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
This study aimed to evaluate the effects of photodynamic laser therapy (PDT) on the condition of gingiva and dental plaque in patients with fixed orthodontic appliances (FOA) at various time intervals during orthodontic treatment. This research is a randomized controlled trial involving 60 patients with fixed orthodontic appliances, divided into two groups of 30 each. The first group served as the control, while the second group received the photodynamic treatment. Assessments of gingival and plaque conditions were conducted at two different time intervals. On the first day (T1), the gingival condition and dental plaque levels were evaluated using the gingival index (GI) and the dental plaque index (DPI) based on the Löe-Sillness and Sillness-Löe indexes. The test group was administered PDT with methylene blue, while the control group did not receive laser activation. On the 30th day (T2), gingival and plaque conditions were re-evaluated using the GI and DPI. Results were analyzed with SPSS, using independent samples t-tests and repeated measures ANOVA. In T1, the gingival condition according to GI in the test group was 50% mild inflammation, 36.7% normal, and 13.3% moderate inflammation. In T2, it shifted to 50% normal, 43.3% mild, and 6.7% moderate inflammation. Dental plaque at T1 according to DPI: 40% had film on the gingival margin, 36.7% moderate deposits in pocket, 16.7% no plaque, and 6.7% abundant soft matter. At T2: 56.7% film on margin, 30% no plaque, 13.3% moderate deposits in pocket. ANOVA revealed significant differences in GI and DPI (p<0.05). PDT with methylene blue demonstrates a statistically significant improvement in gingival health and reduction in dental plaque accumulation in patients undergoing FOA. This suggests that PDT could be a valuable adjunct to traditional oral hygiene practices for managing gingivitis and plaque-related issues in orthodontic patients.
45. ASSOCIATION BETWEEN ANTI-THYROID PEROXIDASE ANTIBODY LEVEL AND THYROID FUNCTION PROFILE IN TYPE 2 DIABETIC PATIENTS.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
Diabetes mellitus and thyroid dysfunction are the two most prevalent endocrine disorders. Patients with type 2 diabetes mellitus are more likely to experience both hypothyroidism and hyperthyroidism than nondiabetic. Uncontrolled T2DM can cause insulin resistance affecting thyroid. Thyroid autoimmunity is caused by autoantibodies. This research aims to evaluate the Association between Anti- Thyroid Peroxidase (ATPO) level and Thyroid function profile in Type 2 Diabetic Patients in Ajman-UAE. This cross-sectional study was conducted on patients at Thumbay Hospital, Ajman, UAE. FBG (Fasting Blood Glucose) sample collected in Fluoride oxalate anticoagulant, whole blood EDTA for HbA1c and Serum tube collected for A-TPO, Thyroid-stimulating hormone (TSH), Free T3(FT3), Free T4 (FT4). Glucose was measured spectrophotometrically and A-TPO, TSH, FT3, FT4 were analyzed based on Electrochemiluminescence technology. HbA1c was analyzed immunoturbidimetric method. A total of 250 individuals were participated in this study (125 males and females with type 2 diabetes mellitus disease compared to 125 males and females with non- diabetic). The results revealed a statistically significant difference in fasting blood glucose (FBG), HbA1c, thyroid-stimulating hormone (TSH), free T3 (FT3), and anti-thyroid peroxidase antibody (A-TPO) levels between type 2 diabetic patients and non-diabetic controls. Among diabetic participants, there was a significant difference in the mean values of HbA1c, FBG, TSH, and A-TPO between controlled and uncontrolled diabetic groups. Additionally, significant differences in HbA1c, FBG, TSH, and free T4 (FT4) levels were observed between male (43%) and female (57%) diabetic patients. A positive correlation was also identified between A-TPO levels and FBG, HbA1c, and TSH, indicating a potential link between thyroid autoimmunity and glycemic control. T2DM patients who have elevated anti-TPO antibodies are at risk of developing functional thyroid problems in the future. In summary, there is a noteworthy distinction between those with diabetes and those without, and the moderate positive association between serum TSH and A-TPO in T2DM patients suggests that autoimmunity plays a part in Type 2 diabetes. We conclude that patients with diabetes mellitus require regular thyroid disease screening.
46. "DERMATOLOGIC SURGERY (GNP) GROUND AND POUND"- EXTENDABLE PLASTIC SURGERY WITH PRIMARY WOUND CLOSURE AS OPTIMAL TREATMENT OPTION FOR MIDDLE-SIZED CONGENITAL DYSPLASTIC NEVUS OF THE BACK OF AN 8-YEAR-OLD BOY.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
Surgical treatment of congenital melanocytic nevi is a serious problem for the relatives and “small patients” as well as for dermatosurgeons. The responsibility of the medical team is enormous, analogous to the expectations of the parents themselves. The aggressive dermatosurgical approach is usually short-lasting but effective and depends on the size and localization of the nevus as well as the experience of the dermatosurgeon. In practice, it is the size and morphology of melanocytic nevi, assessed on the basis of clinical and dermatoscopic criteria, that are the main factors determining the need for possible future aggressive therapy. Although the literature suggests that advanced noninvasive drug options based on mutational status exist for congenital nevi, the outcomes of their use are generally or mostly unsatisfactory, as they do not result in complete regression of lesions. We report an 8-year-old child with a congenital medium-sized papillomatous mixed melanocytic nevus in the dorsal region, successfully treated dermatosurgically under intubation anesthesia using extendable plastic surgery.
47. IMMUNOMETABOLIC CORRELATIONS OF AUTOANTIBODIES IN LATENT AUTOIMMUNE DIABETES IN ADULTS PATIENTS: A CROSS-SECTIONAL STUDY.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
As a form of diabetes mellitus, latent autoimmune diabetes in adults (LADA) shares the features of both type 1 diabetes mellitus and type 2 diabetes mellitus, which can result in misdiagnosis at the early stage of insulin-independence. However, we have limited knowledge about the relations between immunological, anthropometric and clinical parameters in LADA, mainly in Sudanese subjects. We aimed to assess the prevalence of LADA in patients with T2DM and to investigate associations between autoantibodies, C-peptide, anthropometry, and clinical characteristics. A cross-sectional comparative study was conducted from April 2020 to January 2024 in Osman Degna Hospital and Ahmed Hassan Diabetic Center. A total of 250 patients with type 2 diabetes were included in the study: 150 on insulin treatment several years after diagnosis (study group) and 100 patients not using insulin (control group). Structured interviews were used to obtain demographic, clinical and lifestyle information. C-peptide, GADA, and IA-2A autoantibodies in serum were detected by the MAGLUMI-800 chemiluminescence immunoassay. The prevalence of LADA was 10.7%. The mean C-peptide level was significantly lower in patients with LADA as compared to non-LADA patients (0.50±0.18 vs. p0.7, p<0.001], whilst C-peptide levels negatively correlated with GADA concentrations [r=-0.65, p<0.001]. Inverted correlations were found for autoantibody titers and BMI, waist, weight (p<0.01), showing a link of autoimmune activity with leaner phenotypes and less preserved β cell function. LADA is under recognized with (10.7%), GADA as a significant early marker. Its close associations with C-peptide and anthropometric indices underline its autoimmune-metabolic profile.
48. GENES ENCODING HEAT-RESISTANT OBSCURE PROTEINS WITH CHAPERONE-LIKE ACTIVITIES-BBLN AND SERF2-ARE ASSOCIATED WITH CORONARY ARTERY DISEASE RISK: A PILOT STUDY.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
Coronary artery disease (CAD) is one of the main death causes around the world. Molecular chaperones (MCs) are heavily implicated in the pathogenesis of CAD. The role of recently discovered MCs called Hero-proteins in the CAD development is still unknown, hence we are set out to study the effect of genes encoding Hero proteins - BBLN and SERF2 - on the CAD risk. The research included 2164 unrelated Russians (836 patients with CAD and 1328 healthy controls). SERF2 SNP rs4644832 and C9orf16 SNP rs2900262 were genotyped using allele-specific probe-based PCR. Statistical analysis was done using PLINK v1.9.0-b.7.7 and R software. The analysis was carried out in the whole group and additionally in the groups stratified by sex and smoking status. The T allele of rs2900262 BBLN is a risk allele for females (OR=1.74, 95%CI 1.07-2.82, P=0.02), and, in contrast, has a protective effect in males (OR=0.56, 95%CI 0.36-0.88, P=0.01). The G allele of rs4644832 SERF2 is a risk allele for smokers (OR=1.34, 95%CI 1.004-1.79, P=0.047). Furthermore, in females the G allele is associated with a higher thrombocyte count (p=0.04) and a higher extent of left coronary artery damage (p=0.04). This study reveals the novel genetic association between rs2900262 BBLN, rs4644832 SERF2 and the risk CAD risk. It allows to suggest that both Hero-proteins are involved in the pathogenesis of CAD via regulation of proteostasis.
49. UNVEILING LADA: PREVALENCE AND CHARACTERISTICS AMONG TYPE 2 DIABETIC PATIENTS IN PORT SUDAN, SUDAN.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
The intermediate type of diabetes, known as latent autoimmune diabetes in adults (LADA), has traits in common with both type 1 and type 2 diabetic mellitus (T2DM). Initial insulin independence leads to misdiagnosis of type 2 diabetes. This study sought to ascertain the prevalence and features of LADA in patients with type 2 diabetes in Port Sudan, Sudan. A comparative cross-sectional study was conducted from April 2020 to January 2024 at the Osman Degna Hospital and Ahmed Hassan Diabetic Center, Port Sudan. A total of 250 T2DM patients were recruited: 150 insulin-requiring patients after years of diagnosis (study group) and 100 non-insulin-requiring patients (control group). Structured interviews were used to gather demographic and clinical information, and a fully automated chemiluminescence immunoassay (CLIA) was used to quantify the blood levels of C-peptide, GAD-65A (glutamic acid decarboxylase 65 autoantibody), and IA-2A (Insulinoma-Associated Protein 2 Autoantibody) autoantibodies. SPSS version 26 was used for statistical analysis, and p<0.05 was chosen as the significance level. 10.7% of patients with type 2 diabetes had LADA. Compared to the non-LADA group (1.47±0.04 ng/ml, p<0.0001), the C-peptide levels in the LADA group were significantly lower (0.50±0.18 ng/ml). Compared to non-LADA patients, GAD-65A and IA-2A autoantibody titers were higher in LADA patients (p<0.0001). Patients with LADA had lower waist circumferences (79.62±15.42 cm vs. 92.55±17.24 cm, p<0.0001) and BMIs (Body Mass Index) (21.02±4.21 kg/m2 vs. 24.02±3.48 kg/m2, p<0.0001). Furthermore, 68.75% of patients with LADA had a first-degree family history of diabetes, compared to 50% of non-LADA patients. LADA is underdiagnosed, with a prevalence of 10.7% among T2DM Sudanese patients. GAD-65A autoantibodies are the most sensitive biomarker. For prompt diagnosis and treatment, early screening is recommended.
50. CURRENT PERSPECTIVES ON THE ASSOCIATIONS BETWEEN GENERALIZED PERIODONTITIS AND SYSTEMIC DISEASES IN ELDERLY PATIENTS.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
The prevalence of generalized periodontitis increases with the age of patients. A thorough study of the associations between this inflammatory lesion of periodontal tissues and systemic diseases and conditions in older patients will allow the development of individualized strategies for the treatment and prevention of these pathologies, the establishment of new diagnostic criteria, and the improvement of the quality of life of such patients. The objective is to analyse possible associations between generalized periodontitis in elderly patients with general somatic diseases by analyzing data from scientific literature. Articles containing the results of cohort and randomized clinical trials, case-control studies, retrospective analyses, systematic reviews and meta-analyses on the associations between generalized periodontitis and systemic diseases in patients over 60 years of age were selected for the literature review. The data obtained were systematized according to the nosological forms of systemic diseases most commonly found in elderly patients. The article presents current scientific information on the bilateral relationships between generalized periodontitis and cardiovascular diseases, diabetes mellitus, neurodegenerative disorders, oncological diseases and ischaemic stroke in older patients. For all systemic diseases, the risks of their development in patients are presented and possible pathogenetic mechanisms linking somatic and dental pathology are highlighted. The associations between systemic diseases and generalized periodontitis in elderly people described in the scientific literature are often contradictory due to differences in research methodology and the neglect of a significant number of concomitant factors related to patients’ lifestyles, which requires further research to reveal in detail the characteristics of the bidirectional relationships between these pathologies.
51. HOW GENDER, LEARNING ATTITUDES, AND TEACHING EVALUATION AFFECT LEARNING OUTCOMES IN MEDICAL STATISTICS: AN EMPIRICAL STUDY.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
Medical statistics is a core competency for medical students, yet factors influencing learning outcomes remain understudied, particularly in resource-limited settings. This study examines how gender, learning attitudes, and teaching evaluations jointly shape learning outcomes in medical statistics education. A cross-sectional study design was employed to conduct a questionnaire survey and performance analysis among 243 medical students at a medical college in Anhui Province. Single-factor analysis, Pearson correlation, and multiple linear regression models were used to examine the effects of gender, learning attitude, and teaching evaluations on performance. The mean learning outcome score was 72.39±12.96. Female students demonstrated significantly better outcomes than males (74.23 vs. 60.67, p < 0.001). The total learning attitude score positively correlated with learning outcomes (r=0.192), with value judgment (r=0.208) and effort level (r=0.204) being significant contributors (both p<0.05). Multivariate regression identified female gender (β=0.349, 95% CI: 8.72-17.61), favorable course evaluations (β=0.137), and positive learning attitudes (β=0.147) as independent predictors of improved learning outcomes. Gender differences, learning attitudes, and teaching evaluations collectively influence learning outcomes in medical statistics. Targeted interventions for male students and enhanced emphasis on course value recognition may improve educational effectiveness.
52. DIAGNOSTIC AND PROGNOSTIC SIGNIFICANCE OF PINP AND Β-CROSSLAPS IN PEDIATRIC ACUTE HEMATOGENOUS OSTEOMYELITIS.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
Bone metabolism in children exhibits pronounced age-related characteristics. In acute hematogenous osteomyelitis (AHO), monitoring the synthesis marker PINP and the resorption marker β-CrossLaps is particularly valuable, as it enables assessment of disease phases and the adaptive capacity of bone tissue. We analyzed PINP and β-CrossLaps levels in 200 children with AHO across age groups and at four time points: Day 1, Day 7, 2 months, and 6-8 months post-operatively. ANOVA, the P/B index, and ROC analysis were employed to assess sensitivity and specificity. PINP exhibited a marked increase during the reparative phase in children aged 1-4 years (11.9-fold). β-CrossLaps rose predominantly in adolescents aged 15-19 years (10.5-fold). The P/B index proved the most sensitive, with diagnostic cut-offs of >1.2 for predominant osteogenesis and <0.8 for predominant resorption. ROC analysis of the combined model yielded an AUC of 0.84. The use of the P/B index enables individualized treatment, timely adjustment of mechanical loading and antibiotic therapy, and the prevention of complications. Integrating PINP, β-CrossLaps, and the P/B index into clinical practice improves diagnostic accuracy, enhances monitoring efficiency, and leads to better outcomes in children with acute osteomyelitis. A personalized monitoring algorithm covering all stages of the disease is proposed.
53. COMPARATIVE CHARACTERISTICS OF THE QUALITY OF LIFE OF STUDY PARTICIPANTS DEPENDING ON THEIR SOCIO-DEMOGRAPHIC CHARACTERISTICS AND LIFESTYLE.
期刊: Georgian medical news 发表日期: 2025-May 链接: PubMed
摘要
Research Rationale: Quality of life (QoL) is a critical public health concern, extending beyond clinical outcomes to encompass a wide range of social, psychological, and environmental factors. While the majority of QoL studies have focused on individuals with specific health conditions, it is now well-recognized that QoL is also significantly influenced by a variety of non-medical determinants. Тo evaluate the associations between socio-demographic characteristics, lifestyle factors, and quality of life among the adult population. Thе study was conducted as part of a scientific research project and included 180 male and female participants aged 16 to 60 years. Quality of life was assessed using a modified version of the Short Form-36 Health Survey (SF-36). Socio-demographic and lifestyle data were collected using a specially designed questionnaire. Statistical analysis was performed using SPSS version 22.0. To determine the significance of differences between two groups, the nonparametric Mann-Whitney U test was employed; for comparisons among three or more groups, the Kruskal-Wallis H test was used, followed by Dunn’s post hoc test for pairwise comparisons. The findings indicate that women reported lower QoL than men, and QОL declined with age. Lower QОL scores were significantly associated with severe stress exposure, lack of cold exposure practices, physical inactivity, absence of regular vacations, poor housing conditions, high levels of morbidity among family members, low or below-average financial status, widowhood, and inadequate nutrition (p<0.05). A tendency toward increased psychological vulnerability was observed. The most affected QОL domains, in descending order, were: mental health, vitality, general health, role emotional functioning, social functioning, role physical functioning, physical functioning, and bodily pain (p<0.05). The study highlights that socio-demographic disparities can introduce bias in population-based research and reduce the generalizability of findings. These factors should be carefully considered by public health and social care professionals to ensure accurate and equitable assessments.
54. Evaluation of health effect on workers exposed to methyl bromide with prefrontal event-related potential.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Methyl bromide (MB) is a potent fumigant used to control pests in soil and agricultural products. As an ozone-depleting substance, MB has been largely replaced by safer alternatives. MB is highly toxic to humans and has been shown to adversely affect asymptomatic workers’ central and autonomic nervous systems and vascular health. However, its impact on perceptual and cognitive abilities remains underexplored. In this study, we examined the effects of MB exposure on cognitive functions in asymptomatic workers. Event-related potential (ERP) indices, which reflect perceptual and cognitive processes, and urinary bromide ion (Br-) concentrations were assessed in 32 fumigators (study group) and 18 inspectors (control group) before and after fumigation. Post-work ERP latency and amplitude changes in inspectors were significant (P < 0.01), similar to those observed in healthy individuals. In contrast, ERP changes in fumigators were not significant compared to pre-work values; this suggests that MB negatively impacts cognitive health. Additionally, Br‑ levels in fumigators rose sharply after work (P < 0.001), while inspectors showed no such increase. The elevated Br- levels and nonenhanced ERP indices in fumigators after MB exposure indicate adverse health effects despite the absence of symptoms.