公共卫生研究摘要 (2026-05-18)

共收录 60 篇研究文章

1. Exploring the Social and Cultural Influences on Advance Care Planning Engagement for Patients Living With Cancer: A Hermeneutic Phenomenology Study.

期刊: Nursing inquiry 发表日期: 2026-Jul 链接: PubMed

摘要

Guided by Leininger’s Theory of Culture Care, this hermeneutic phenomenological study explored how social and cultural contexts shape engagement in advance care planning (ACP) among people living with cancer in Taiwan. Semi-structured interviews were conducted with 26 stakeholders, including 8 patients, 7 family caregivers, and 11 healthcare providers, recruited from oncology and ACP outpatient clinics, inpatient wards, and home care services at a tertiary medical center. Data were audio-recorded, transcribed verbatim, and analyzed using Naeem’s six-step approach. Six interrelated influences on ACP engagement were identified: socioeconomic circumstances, prior experiences and personal background, religious beliefs and life values, relational dynamics with family and significant others, wider social norms, and political and legal requirements. These factors shaped whether ACP was seen as acceptable, when it was introduced, who was involved in decision-making, and how discussions were negotiated within families and with healthcare professionals. The findings show that ACP engagement in Taiwan is a relational, culturally embedded process. Culturally congruent, nurse-led ACP approaches that address relational, socioeconomic, and legal structural influences are needed to support family-centered cancer care.

2. Are We in Control? How Best to Include a Control Group in Interrupted Time Series Designs: A Simulation Study.

期刊: Journal of evaluation in clinical practice 发表日期: 2026-Jun 链接: PubMed

摘要

While controlled interrupted time series (CITS) are commonly used to evaluate public health policies, how to incorporate control(s) into their statistical modelling has received limited attention. We aimed to compare the statistical performance of different model formulations for including control groups in various segmented regression model specifications (with a particular focus on CITS and Difference-in-Difference [DiD] designs) under conditions where their assumptions are met, as well as when they are violated. Based on a real-world dataset, we simulated and compared the statistical performance of four model formulations grounded on segmented regressions for including control groups in a pre- and post-evaluation. The compared model formulations were: (1) CITS segmented regression, (2) DiD segmented regression, (3) single ITS of the difference between control and intervention series, and (4) incorporating the control as a covariate in a single ITS. Models were tested across scenarios challenging assumptions around the control group (e.g., non-parallel trends -challenging DiD assumptions-, or inconsistent trend difference over time between groups -challenging CITS assumption-) or regression errors (e.g., heteroscedasticity or autocorrelation). We also included models, including restricted cubic splines of time, which may mitigate distortions from assumption violations. Additionally, we tested for detecting non-parallel trends. Standard DiD, CITS, and the ITS of the difference between series yielded the lowest bias whenever their design assumptions were satisfied. Overall, including time splines as covariates into ITS of the difference between series achieved the lowest bias and highest coverage also when design assumptions were violated. This makes it a valuable tool for causal inference in settings with parallel, non-parallel or inconsistent trend patterns between groups. Since violations of the trends assumption are often undetectable, methods robust to such violations are extremely valuable. Modelling CITS as an ITS of the difference between series is among the most robust methods to embed control series into model specifications. Incorporating time splines as model covariates within an ITS of the difference has the potential of reducing bias from assumption violations (including parallel trends) without negative impacts when assumptions hold.

3. Evaluation of Osteoprotegerin (OPG) and Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL) Biomarker Concentrations in the Saliva of Patients with Periodontitis and Depression.

期刊: Clinical and experimental dental research 发表日期: 2026-Jun 链接: PubMed

摘要

Periodontitis is a chronic inflammatory disease affecting tooth-supporting structures, while depression is a common mental disorder with emotional and behavioral disturbances. Previous studies suggest a potential association between the two conditions. This study aimed to evaluate salivary concentrations of Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL) and Osteoprotegerin (OPG)-key regulators of osteoclast activity and periodontal bone resorption-in patients with periodontitis and depression. In this cross-sectional study, 80 patients from Shahid Beheshti University Dental School were categorized into four groups based on the presence or absence of periodontitis and depression. Periodontitis was defined as having ≥ 2 teeth in ≥ 2 quadrants with bleeding on probing, pocket depth > 3 mm, and interdental clinical attachment loss ≥ 1 mm. Depression was assessed using the Persian PHQ-9, and individuals meeting criteria for major depressive disorder(MDD) were classified as depressed. Unstimulated saliva samples (1 mL) were collected, stored at -20°C, and analyzed for OPG and RANKL using ELISA kits. Statistical analyses included two-way ANOVA (SPSS v27; p < 0.05 significant). Among 80 participants (43 females, 37 males; mean age 45.3 years), RANKL, OPG, and the RANKL/OPG ratio were higher in depressed individuals, but differences were not statistically significant (p > 0.05). RANKL levels and the RANKL/OPG ratio were significantly higher in patients with periodontitis and increased with disease severity (p ≤ 0.05), while OPG showed no significant change. Periodontitis and its severity significantly influence salivary RANKL and the RANKL/OPG ratio, while depression does not. Within the limits of this cross-sectional design, no evidence was found that RANKL and OPG act as intermediary biomarkers linking depression and periodontitis.

4. Tooth Loss and Uncontrolled Diabetes Among Korean Adults With Type 2 Diabetes: Insights From the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2018.

期刊: Clinical and experimental dental research 发表日期: 2026-Jun 链接: PubMed

摘要

The relationship between tooth loss and glycemic control status in diabetes is inconclusive. Using data from the 2014-2018 Korean National Health and Nutrition Examination Survey (KNHANES), 2146 adults with diabetes aged ≥ 40 years were categorized by number of remaining teeth (0-19, 20-27, and ≥ 28). Uncontrolled diabetes and poorer glycemic control were defined as HbA1c ≥ 6.5% and ≥ 7.0%, respectively. Multivariable logistic regression models calculated the odds ratio (OR) for uncontrolled diabetes and poorer glycemic control according to the number of remaining teeth. No significant association was observed in men. In women, fewer remaining teeth were associated with higher odds of uncontrolled diabetes (per 1-tooth increase OR 0.961, 95% CI 0.937-0.986; p = 0.002), and compared with ≥ 28 teeth, OR were higher in the 0-19 teeth (OR 2.500, 95% CI 1.535-4.074) and the 20-27 teeth (OR 1.679, 95% CI 1.073-2.629) (all p = 0.002). Furthermore, among women, the associations persisted in both 40-59 years (per 1-tooth increase OR 0.878, 95% CI 0.780-0.988; p = 0.030) and ≥ 60 years (per 1-tooth increase OR 0.965, 95% CI 0.939-0.992; p = 0.011). Among women aged ≥ 60 years, those with 0-19 teeth had higher odds of uncontrolled diabetes (OR 1.994, 95% CI 1.041-3.818; p = 0.029) and poorer glycemic control (OR 2.498, 95% CI 1.321-4.723; p = 0.008) compared with those with ≥ 28 teeth. Fewer remaining teeth were associated with poorer glycemic control among women with diabetes, independent of periodontitis. This association was most pronounced in women aged ≥ 60 years. Large cohort studies are warranted to clarify causality and to evaluate the roles of periodontitis and dental caries in this relationship.

5. From conceptual site models to data-driven insights: Key controls on vapor extraction performance in dual-phase extraction systems.

期刊: Journal of environmental management 发表日期: 2026-May-17 链接: PubMed

摘要

Conceptual site models (CSMs) are commonly used to support remediation decision-making in dual-phase extraction (DPE) systems, but their application often relies on qualitative judgment and site-specific experience. This study developed a data-driven framework to translate CSM-based interpretation into a quantitative form for remediation adjustment support. A total of 421 records from five DPE systems across three contaminated sites were compiled, and 13 input features were used to predict off-gas PID concentration. Three nonlinear machine-learning models, multilayer perceptron (MLP), radial basis function network (RBFN), and kernel ridge regression (KRR), were compared with a multiple linear regression (MLR) baseline. The nonlinear models consistently outperformed MLR, with KRR achieving the best test performance in both the full-feature (R2=0.73) and SHAP-based Top-10 reduced-feature (R2=0.75) settings, whereas MLR yielded lower values (R2=0.50 and 0.48). SHAP analysis was further used to interpret feature importance and guide reduced-feature model development, from which KRR_SET3 was identified as the most informative five-feature structure. Leave-one-site-out (LOSO) evaluation showed that reliable quantitative generalization across sites was not achieved, with negative external-site R2 values for all three left-out sites. However, when KRR_SET3 and KRR_all were applied to two unseen-site cases, KRR_SET3 more clearly captured upward concentration trends under changed conditions. These results suggest that, although precise cross-site prediction remains difficult, interpretable machine learning can preserve trend-sensitive signals useful for field interpretation and action-oriented support.

6. Estimation of dynamic spinal loads during manual lifting using smartphone-based markerless motion capture.

期刊: Applied ergonomics 发表日期: 2026-May-17 链接: PubMed

摘要

This study evaluated the feasibility of dynamic spinal load estimation using kinematic data collected with a smartphone-based markerless motion capture system. Twenty-one participants performed various lifting tasks while marker-based and markerless kinematics were recorded simultaneously. Marker-based kinematics were used to drive a conventional optimization-based musculoskeletal (MSK) modeling workflow to obtain reference estimates of lumbosacral (L5/S1) compression and shear forces in OpenSim. Two markerless-driven approaches were then developed and evaluated against the conventional approach: (1) a markerless-driven MSK modeling workflow and (2) a machine learning model that uses intermediate outputs from MSK modeling (e.g., joint angles and moments) to directly predict L5/S1 compression and shear forces, removing the need for the time-consuming optimization step. Both approaches estimated compression forces with reasonable accuracy relative to reference values, with normalized root mean square error (nRMSE) of 12% for markerless-driven MSK modeling and 9% for the ML-based approach. However, larger errors were observed for shear force estimation, especially with markerless-driven MSK modeling. Overall, the findings support the feasibility of spinal load estimation during manual lifting using smartphone-based markerless kinematics and highlight the advantage of integrating data-driven predictive algorithms with conventional physics-based MSK modeling. Such a hybrid modeling framework, combined with the markerless system, can potentially enable fast, low-cost, and reasonably accurate spinal load estimation in field settings. Future studies should focus on improving the kinematic accuracy of the markerless system and enhancing the generalizability and accuracy of the ML model, especially for shear force prediction.

7. [Prevalence of direct oral anticoagulant users among patients with acute ischemic stroke].

期刊: Orvosi hetilap 发表日期: 2026-May-17 链接: PubMed

摘要

Despite the use of direct oral anticoagulants (DOACs), acute ischemic stroke can occur for several reasons. According to international data, 20% of patients with acute ischemic stroke take DOACs, but no comprehensive analysis of this occurrence has been available in Hungary to date. Our aim was to determine the prevalence of DOAC users in Hungarian ischemic stroke patients. We used retrospective analysis of the Semmelweis University stroke registry to evaluate DOAC use in patients with acute ischemic stroke treated consecutively between October 2020 and September 2024. Among the 2918 consecutive patients with acute ischemic stroke within 24 hours, 320 were taking DOAC (10,57%), of these, 276 (86,25%) had a history of atrial fibrillation. 183 patients (57%) were treated with apixaban, 72 (23%) with rivaroxaban, 38 (12%) with dabigatran, and 27 (8%) with edoxaban. Regarding thrombolysis time windows, 173 out of 1379 (12.54%) patients within the standard intravenous thrombolysis window (0-4.5 h) and 63 out of 656 (9.6%) patients within the extended thrombolysis window (4.5-9 h) were receiving DOAC treatment. Among acute ischemic stroke patients taking DOACs, the proportion of women was higher (56.7%), and the average age for was significantly greater (76 years) compared to the overall acute ischemic population (70 years). The 10.57% prevalence of DOAC use among acute ischemic stroke patients was significantly lower than the 20% observed in international data. This discrepancy may be attributable to the later introduction of DOACs in Hungary, differing reimbursement policies, and high drug costs. Further studies are needed to explore the factors explaining this difference and their impact on stroke prevention. The rate of DOAC use among Hungarian acute ischemic stroke patients was below the international average, which warrants targeted studies to optimize anticoagulation strategies. Orv Hetil. 2026; 167(20): 779-783. Bevezetés: A direkt orális antikoagulánsok (DOAC-ok) alkalmazása ellenére is kialakulhat úgynevezett áttöréses akut ischaemiás stroke. Nemzetközi adatok szerint az akut ischaemiás stroke betegek 20%-a szed DOAC-ot, hazai átfogó elemzés azonban erről az előfordulásról eddig nem állt rendelkezésre. Célkitűzés: Célunk a DOAC-ot szedők arányának meghatározása volt az akut ischaemiás stroke betegek körében. Módszer: Retrospektív elemzéssel értékeltük a 2020. október 1. és 2024. szeptember 30. között ellátott konszekutív akut ischaemiás stroke betegek adatait, DOAC-szedési szokásait. Az adatgyűjtést a Semmelweis Egyetem stroke-regiszteréből azonosított betegekről az eMedsol kórházi informatikai rendszerben végeztük. Eredmények: A 2918 akut ischaemiás stroke beteg közül 320 esetben volt dokumentálva DOAC-szedés (10,57%), közülük 276 beteg (86,25%) esetében az anamnézisben pitvarfibrilláció szerepelt. 183 beteg (57%) apixabánt, 72 beteg (23%) rivaroxabánt, 38 beteg (12%) dabigatránt, 27 beteg (8%) pedig edoxabánt szedett. Az intravénás thrombolysis időablakait tekintve a standard (0–4,5 h) időablakban 1379-ből 173 beteg (12,54%), míg a kiterjesztett időablakban (4,5–9 h) 656-ból 63 beteg (9,6%) szedett DOAC-ot a fenti betegpopulációból. A DOAC-ot szedő akut ischaemiás stroke betegek között nagyobb volt a nők aránya (56,7%), és magasabb volt az átlagéletkor (76 év), mint az akut ischaemiás stroke populáció egészében (70 év). Megbeszélés: A DOAC-szedés 10,57%-os előfordulása a hazai akut ischaemiás stroke betegek körében jelentősen kisebb arányú, mint a nemzetközi irodalomban dokumentált. Ennek hátterében állhat a DOAC-ok későbbi hazai bevezetése, az eltérő finanszírozás, a nagy gyógyszerköltség. A különbséget magyarázó tényezők feltárásához további vizsgálatok szükségesek. Következtetés: A hazai akut ischaemiás stroke betegek körében a DOAC-szedés aránya elmaradt a nemzetközi átlagtól, ami célzott vizsgálatokat indokol az antikoagulációs stratégiák optimalizálása érdekében. Orv Hetil. 2026; 167(20): 779–783.

8. Years of Life Lost in Patients with Muscle-Invasive and Metastatic Bladder Cancer.

期刊: Annals of surgical oncology 发表日期: 2026-May-17 链接: PubMed

摘要

Muscle-invasive and metastatic urothelial carcinoma of urinary bladder (UCUB) is associated with poor overall survival. However, individual years of life lost (YLL) according to detailed patient and disease characteristics have never been quantified. Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2021), muscle-invasive organ-confined (OC, T2N0M0), non-organ-confined (NOC, T3-4 and/or N1-3 M0), and metastatic (anyT, anyN, M1) UCUB patients aged 40-75 years were included. Relying on Social Security Administration (SSA) life tables, a 1:1 age, sex, and year of diagnosis matched control (Monte Carlo simulation) was simulated for each patient. Kaplan-Meier method was used to calculate average YLL truncated at the age of 75 years between SEER cases and SSA simulated controls. A total of 30,519 patients were included: 14,754 (48.3%) OC, 10,330 (33.8%) NOC, and 5435 (17.8%) metastatic. Compared with simulated population controls, average YLL was 3.7, 6.0, and 9.1 years for OC, NOC, and metastatic disease, respectively. YLL was most pronounced among patients diagnosed at younger ages (40-55 years: 9.2, 14.1, and 18.0 years for OC, NOC, and metastatic, respectively), decreasing with advancing age at diagnosis. Less pronounced YLL observations were recorded in most contemporary years (2017-2021: 2.7, 4.4, and 7.9 years for OC, NOC, and metastatic, respectively) across all stages compared with earlier periods. No clinically meaningful differences in YLL were observed between sexes. (male OC: 3.6, NOC: 5.9, metastatic: 9.0; female OC: 4.1, NOC: 6.6, metastatic: 9.5). UCUB is associated with substantial YLL, particularly in metastatic and younger patients. However, an YLL decrease over time was observed.

9. Life Expectancy in Chronic Obstructive Pulmonary Disease.

期刊: JAMA internal medicine 发表日期: 2026-May-17 链接: PubMed

摘要

Chronic obstructive pulmonary disease (COPD) is a leading cause of death and age-standardized COPD mortality has increased substantially over the past few decades. Robust estimates of life expectancy and years of life lost (YLL) from COPD, which are important to patient care and policy decisions, are lacking. To determine whether COPD is associated with lower life expectancy and whether the YLL are associated with disease severity. The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 8 US general population cohorts. Participants aged 17 to 98 years were enrolled from 1983 to 2011 and followed up longitudinally through 2020. Data analysis was conducted from January 1, 2025, to January 15, 2026. Presence of COPD, which was defined by a prebronchodilator forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio of less than 0.70 and disease stages per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. This study used a parametric proportional hazards model with a Gompertz baseline hazard function to estimate survival by GOLD stage from the time of initial spirometry. The multivariable hazards function was used to estimate life expectancy, adjusting for demographics, educational attainment, body mass index, smoking status, pack-years of smoking, diabetes, hypertension, and hypercholesterolemia. YLL was calculated in comparison with individuals with no airflow obstruction. Of 45 886 participants (mean [SD] age, 52.4 [15.8] years; 25 827 [56.3%] females), 13 869 (30.2%) died over a median follow-up of 15.2 (IQR, 9.7-27.1) years. COPD was present in 8058 participants (17.6%). In age-adjusted models, mean life expectancy for an individual aged 65 years was 21.5 (95% CI, 21.3-21.6) years without COPD, decreasing to 20.0 (95% CI, 19.7-20.4) years for GOLD stage 1, 16.4 (95% CI, 16.1-16.8) years for GOLD stage 2, 13.1 (95% CI, 12.5-13.8) years for GOLD stage 3, and 10.7 (95% CI, 8.9-12.6) years for GOLD stage 4. YLL were 0.71 (95% CI, 0.34-1.08) for GOLD stage 1, 2.58 (95% CI, 2.21-2.95) for GOLD stage 2, 5.07 (95% CI, 4.39-5.74) for GOLD stage 3, and 7.12 (95% CI, 5.21-9.04) for GOLD stage 4. Comparable decreases were noted for COPD in those who never smoked vs ever smoked. YLL for GOLD stages 2 to 4 were similar or greater than the YLL for hypertension (2.7; 95% CI, 2.4-3.0), diabetes (4.1; 95% CI, 3.7-4.4), obesity (0.5; 95% CI, 0.1-0.9), and cigarette smoking (5.5; 95% CI, 5.1-5.9). In this cohort study, COPD was associated with lower life expectancy, including in adults who never smoked.

10. Nutrition impact symptoms and the risk of malnutrition, frailty, and sarcopenia in adults with cancer: A cross-sectional latent class analysis.

期刊: JPEN. Journal of parenteral and enteral nutrition 发表日期: 2026-May-17 链接: PubMed

摘要

Malnutrition, frailty, and sarcopenia are common and interrelated in patients with cancer, yet their associations with nutrition impact symptom clusters remain unclear. This study examined the overlap of these conditions, and their relationships with symptom clusters in adults with cancer. Malnutrition was assessed using the Patient-Generated Subjective Global Assessment and Global Leadership Initiative on Malnutrition criteria, frailty using the FRAIL scale, and sarcopenia using the 2019 Asian Working Group for Sarcopenia consensus. Latent class analysis identified nutrition impact symptom clusters. Logistic regression models evaluated associations between symptom clusters and the three conditions. This cross-sectional latent class analysis included 28,377 hospitalized adults with cancer (median age 58 years; 55.3% male). Gastrointestinal (41.0%) and lung (23.1%) cancers were the most common diagnoses. The prevalence of malnutrition, frailty and sarcopenia was 56.4%, 37.7%, and 16.9%, respectively. Weight loss and low muscle mass represent key shared features of their coexistence. Five nutrition impact symptom clusters were identified and ranked by severity. Patients with severe multi-symptom cluster had 3.87-fold higher odds of malnutrition and 6.03-fold higher odds of frailty. Patients with the gastrointestinal-dominant symptom cluster were most likely to experience malnutrition, whereas those with the sensory-alteration symptom cluster were most likely to exhibit frailty. Maintaining stable body weight, particularly muscle mass, is crucial for cancer patients to reduce the risk of comorbidity among these conditions. Identifying nutrition impact symptom clusters and providing targeted interventions may help reduce the burden of these conditions and improve the efficiency of nutritional care.

11. Bridging bioenergy and circularity: Drivers, barriers, and pathways of biomass valorization in Indonesia.

期刊: Journal of environmental management 发表日期: 2026-May-17 链接: PubMed

摘要

Southeast Asia generates large volumes of biomass residues, yet most are managed through linear methods such as open burning rather than circular approaches. This study reviews biomass residue valorization research in Southeast Asia, using Indonesia as the primary case study. It investigated trends, conversion pathways, and factors that shape the implementation of biomass residue valorization. From a systematic review of 99 studies in Southeast Asia, 50 cases with country-level data were used to assess Indonesia’s valorization landscape. The results reveal that 74% of Indonesian research focused on energy recovery, positioned at R9 on the circularity hierarchy. Higher-value applications such as biochemicals and biochar receive limited attention, risking a technological lock-in that restricts circular material loops. The inductive thematic analysis identifies six categories of drivers: policy, environmental, energy security, human health, economic, and technological. However, two-level barriers constrained them: critical bottlenecks and operational challenges. To bridge this gap, the study proposes the Multi-Level Circular Biomass Residue Valorization (MCBV) framework, advocating for cascading utilization, high-value products before energy recovery, and decentralized pre-processing. These findings offer a pathway for Indonesia and lessons for developing bio-economies in the Global South, pursuing circular economy transition beyond single-purpose energy substitution.

12. Negotiating drug use and work: a poststructural analysis of construction workers who use drugs amid decriminalization.

期刊: The International journal on drug policy 发表日期: 2026-May-17 链接: PubMed

摘要

People who use drugs are embedded in complex systems and policy settings. In this study, we investigated how construction workers who use drugs negotiated their subject positions while navigating social and work demands in the context of British Columbia’s recent decriminalization policy, which aimed to reduce stigma and increase access to health and social services. Using poststructural interview analysis, we analyzed the ‘things said’ and the subject positions produced in 12 interviews with construction workers who use illicit drugs in British Columbia following the implementation of decriminalization. Throughout the interviews, participants produced and negotiated their subject position as people who use drugs alongside the position of the productive worker who aligned with the expectations of the responsible neoliberal subject. Within the existing decriminalization context, participants continued to be limited in how they positioned themselves and other people who use drugs by existing social and work policies and norms, which were not in line with decriminalization’s objectives. However, in small and local ways, some participants navigated these tensions by defying taken-for-granted assumptions about work and drug use. Our analysis highlights the complex social structures in which drug policies are implemented and which may limit how people who use drugs position themselves and others. Policy reforms must consider how changes may align with the existing local context in which they are implemented. It is critical that people who use drugs are not categorized only as drug users in research and policy reform but considered in full, beyond narrow categories.

13. A synthesis of human health and ecological risk assessment indicators for microplastics in Nigerian water systems.

期刊: International journal of environmental health research 发表日期: 2026-May-17 链接: PubMed

摘要

Microplastics contaminate water systems globally, posing risks to human and ecological health. This review synthesizes evidence from peer-reviewed studies (2021-2025) that report health, ecological, or pollution risk indices for microplastics in Nigerian waters. Studies from Nigeria’s six geopolitical zones were included alongside international studies for comparison of methodological approaches and polymer patterns. Concentrations are highest in surface waters (1.5-705 particles/L) and lowest in bottled water (1.4-44.6 particles/L). Health risks are consistently higher for children than adults; treated water and groundwater present medium risk for children. Ecological risks are high in several surface waters. Polyethylene, polypropylene, and polyethylene terephthalate are the dominant polymers. Methodological limitations include inconsistent risk indices, neglect of co-contaminants, and limited attention to vulnerable populations. Research coverage is uneven, with the Northeast and Northcentral underrepresented. Polymer composition mirrors global patterns, but Nigerian risk assessments are less diverse in methodology. The findings highlight the need for harmonized methods, expanded monitoring, and policy interventions aligned with Sustainable Development Goals 3, 6, 12, and 14 to protect water quality and public health in Nigeria. Synthesis of ecological and human health risk assessments for microplastics in Nigerian waters, revealing disparities in research coverage and risks.Nigerian rivers and lagoons show considerable to high ecological risk from polyethylene and polypropylene.Surface waters pose the highest health risk; treated water and bottled water present medium risk for children.Microplastic contamination presents challenges to achieving SDGs 3, 6, 12, and 14, with implications for policy and water management.Exposed inconsistencies in risk assessment methods, understudied co contaminants, and inadequate attention to vulnerable populations.Nigerian polymer profiles mirror worldwide trends, but risk quantification lags, requiring standardized global benchmarking.

14. Harnessing institutional knowledge: mixed methods evaluation of peer coaching in a multi-site EHR transition.

期刊: Journal of the American Medical Informatics Association : JAMIA 发表日期: 2026-May-17 链接: PubMed

摘要

Health systems undertaking electronic health record (EHR) transitions often struggle to prepare and support clinicians in learning and using the new system. We evaluated a national peer coaching program-the National EHRM Supplemental Staffing Unit (NESSU)-designed to support clinicians during the U.S. Department of Veterans Affairs’ (VA’s) transition to a new EHR. Our goal was to assess NESSU’s reach, perceived usefulness, and association with key EHR user outcomes, and to characterize how NESSU achieved its observed impacts. Using a convergent mixed-methods design, we surveyed EHR users at the most recent VA facility to implement the new EHR. Descriptive statistics summarized program reach and perceived helpfulness. Regression models assessed associations between NESSU participation and 3 outcomes: burnout, EHR-related stress, and EHR confidence. Qualitative data included 62 interviews with users and open-ended survey responses. We used structured coding and thematic analysis to identify themes. Among 385 respondents, 58.4% reported receiving NESSU support and 83.6% of those rated it as helpful. NESSU participation was associated with lower rates of burnout (29% vs 41%, P = 0.016) but not with differences in EHR confidence or EHR-related stress. Qualitative analysis yielded 4 themes describing how NESSU functioned (filling education gaps, providing responsive support, offering expert guidance, and drawing upon notable interpersonal skills) and one theme describing its overall impact. Findings demonstrate that peer coaching can address important support needs during EHR transitions. Scalable, clinician-led peer coaching may represent an essential component of large-scale EHR transitions, supporting both implementation and clinician well-being.

15. Integrating Equity in Topic Selection for Orphan Medicinal Products: Policy Implications for Health Technology Assessment in Rare Diseases.

期刊: Applied health economics and health policy 发表日期: 2026-May-17 链接: PubMed

摘要

Health technology assessment (HTA) informs evidence-based decision-making for resource allocation in healthcare; however, the topic selection phase that determines which technologies proceed to full assessment is underexplored and often lacks fairness and transparency, particularly disadvantaging orphan medicinal products (OMPs) for rare diseases. We drew on selectively identified literature and illustrative HTA experiences to advance an opinion-driven argument about equity in topic selection for OMPs, grouping insights into three domains: structural challenges, conceptual frameworks and policy strategies. Structural barriers in topic selection include a lack of institutionalised, participatory processes, overreliance on prioritisation criteria implicitly aligned with population-wide impact and minimal engagement with stakeholders representing the rare disease community, resulting in the systematic under-prioritisation of OMPs. Procedural and value frameworks, including multi-criteria decision analysis (MCDA), evidence-informed deliberative processes (EDPs), accountability for reasonableness (A4R), equity weighting and Health Equity Impact Assessment (HEIA), can help agencies incorporate social value and fairness before formal appraisal, but remain unevenly operationalised. Policy strategies such as equity-oriented horizon scanning, open nomination systems, and special pathways for OMPs are highlighted as feasible approaches to promote fairness. Achieving equity in HTA topic selection for OMPs requires both policy and cultural change, and embedding pluralistic value frameworks, engaging stakeholders and adopting specific policy tools are essential steps towards ensuring that rarity is met with heightened ethical attention rather than exclusion.

16. Clinical Outcomes in Concurrent Cohorts of Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA)-Treated versus ELX/TEZ/IVA-Ineligible Individuals with Cystic Fibrosis in the US during COVID-19.

期刊: Pulmonary therapy 发表日期: 2026-May-17 链接: PubMed

摘要

The initial US launch of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) coincided with the coronavirus disease 2019 (COVID-19) pandemic, altering healthcare-seeking behaviors and possibly resulting in decreased respiratory infection transmission. We evaluated real-world effectiveness of ELX/TEZ/IVA, accounting for potential impact of COVID-19 by comparing outcomes in people with cystic fibrosis (CF) treated with ELX/TEZ/IVA with ELX/TEZ/IVA-ineligible people with CF. This retrospective, observational study used US CF Foundation Patient Registry data (2017-2021) of people with CF aged ≥ 12 years initiating ELX/TEZ/IVA between Q4 2019 and Q3 2021 and a concurrent comparator cohort ineligible for ELX/TEZ/IVA. Primary outcomes (follow-up through 2021 or death) included change in percent predicted forced expiratory volume in 1 s (ppFEV1) from baseline over follow-up, annualized rate of ppFEV1 decline, rate of pulmonary exacerbations (PEx), time to lung transplantation, and overall survival. ppFEV1 increased in ELX/TEZ/IVA-treated individuals through follow-up but decreased in the comparator cohort (+6.20 versus -3.13 percentage points, respectively; mean difference 9.34, 95% confidence interval [CI] 8.84 to 9.85). The annualized rate of ppFEV1 change was -0.03 (95% CI -0.18 to 0.07) in the ELX/TEZ/IVA-treated cohort and -2.24 (95% CI -2.66 to -1.80) in the comparator cohort (relative reduction in rate of decline of 99%; 95% CI 92-103%). Rates of PEx requiring intravenous antibiotics or hospitalization were 0.17 and 0.77 among ELX/TEZ/IVA-treated and comparator cohorts, respectively (77% reduction, 95% CI 74-81%). Proportion undergoing lung transplant was 0.22% and 2.94% in ELX/TEZ/IVA-treated and comparator cohorts, respectively (90% reduction, 95% CI 29-98%). All-cause mortality was 0.76% and 3.45% in ELX/TEZ/IVA-treated and comparator cohorts, respectively (79% reduction; 95% CI 56-88%). During COVID-19, ELX/TEZ/IVA-ineligible people with CF experienced lung function decline and higher rates of PEx, lung transplant, and death versus the ELX/TEZ/IVA-treated cohort, despite infection prevention measures, suggesting ELX/TEZ/IVA’s benefits remain despite the potential bias from protective effects of the pandemic.

17. Activation-induced cytidine deaminase (AID) suppresses the activity of HBV EnhII/CP by downregulating FANCE expression.

期刊: Virus genes 发表日期: 2026-May-17 链接: PubMed

摘要

Activation-induced cytidine deaminase (AID) is a host restriction factor known to suppress hepatitis B virus (HBV) replication. However, the precise mechanisms underlying its antiviral activity remain incompletely understood. Combining RNA-Seq and functional assays, our study reveals a novel pathway by which AID inhibits HBV replication via downregulating the expression of Fanconi anemia complementation group E (FANCE). Our findings demonstrate that AID significantly reduces FANCE expression, and that FANCE promotes viral replication by specifically activating the HBV enhancer II/core promoter (EnhII/CP), a key transcriptional regulatory element. Combinatorial regulation experiments further confirm that FANCE is involved in AID-mediated HBV transcription. These results identify a novel downstream gene of AID, broaden the perspective on the host antiviral immune network against HBV, and provides a rationale for potential antiviral strategies targeting the FANCE regulatory axis.

18. Rapid Human Skin Barrier Disruption by Sodium Dodecyl Sulfate and Associated Molecular Mechanisms.

期刊: Allergy 发表日期: 2026-May-17 链接: PubMed

摘要

Epithelial barrier disruption is a hallmark of allergic skin diseases. Sodium dodecyl sulfate (SDS), a surfactant in household cleaning products, is known to impair the barrier. We used a physiologically relevant ex vivo human skin combined with real-time electrical impedance spectroscopy (EIS) to monitor barrier integrity after SDS exposure. Multi-omics analyses, including RNA sequencing and proximity extension-based proteomics, characterized molecular responses. Barrier permeability and oxidative stress were evaluated in primary keratinocytes, and the protective effects of N-acetylcysteine (NAC) and nicotinamide (NAM) were assessed in both air-liquid interface keratinocyte cultures and ex vivo skins. Even a 1-min SDS exposure caused a rapid EIS decline, indicating immediate barrier compromise. 5-min exposures produced dose-dependent EIS decline with broad suppression of barrier and immune mediators (e.g., CXCL11, MCP4, and HNMT), 6-h exposure sustained skin barrier loss and associated inflammatory and remodeling programs. Proteomic signatures highlighted AREG, JUN, and ITGA6 can track skin damage, while CST5 and PRDX1 correlated with the preservation. Transcriptomics corroborated these changes, showing up-regulation of stress and repair programs-endoplasmic reticulum stress, oxidative stress, sphingolipid biosynthesis, and epidermal differentiation pathways. NAC/NAM reduced SDS-induced reactive oxygen species, cytotoxicity, and permeability in primary keratinocytes, and restored EIS values in ex vivo skin. Short-term SDS exposure rapidly disrupts human skin barrier integrity through oxidative stress-driven suppression of structural/immune mediators and activation of stress/remodeling pathways. NAC and NAM effectively mitigated damages, highlighting antioxidants as preventive interventions for surfactant-induced skin barrier dysfunction.

19. Treatment of chronic insomnia in elderly adults with dual orexin receptor antagonists: A systematic review and meta-analysis.

期刊: Sleep 发表日期: 2026-May-17 链接: PubMed

摘要

Chronic insomnia (CI) is common among older adults, and its management is particularly challenging due to changes in sleep architecture, multimorbidity, and increased vulnerability to adverse drug effects. Dual orexin receptor antagonists (DORAs) have emerged as a novel therapeutic class with promising efficacy and tolerability profiles. However, evidence specific to older adults remains limited. Here, we performed the first systematic review and meta-analysis specifically evaluating the efficacy and safety of DORAs in elderly patients with CI (PROSPERO CRD42024565687). Randomized controlled trials were identified from MEDLINE, Scopus, and ClinicalTrials.gov. Objective polysomnographic outcomes, including Latency to Persistent Sleep (LPS), Total Sleep Time (TST), and Wake After Sleep Onset (WASO), as well as subjective sleep measures, were analyzed, along with safety outcomes. Ten studies met the inclusion criteria for the systematic review, with five studies contributing to the meta-analysis. The quantitative synthesis comprised 2235 patients in the experimental group and 1409 patients in the control group. Overall, compared with placebo DORAs reduced WASO and LPS while increasing TST after 1 month and 3 months of treatment. Importantly, DORAs increased sTST. Finally, daridorexant showed a favorable safety profile, whereas lemborexant and suvorexant were associated with higher rates of treatment-emergent adverse events than placebo, without an increase in serious adverse events. Despite limited evidence, DORAs appear effective and generally safe for treating CI in the elderly, supporting their role as a valuable therapeutic option.

20. Parent compounds and soil properties as primary drivers of neonicotinoid transformation products in surface soils from an intensive agricultural Basin in Central China.

期刊: Journal of environmental management 发表日期: 2026-May-17 链接: PubMed

摘要

Some transformation products of neonicotinoid insecticides (TPNNIs) exhibit ecological and potential human health risks comparable to or exceeding those of their parent neonicotinoids (pNNIs). Therefore, understanding their environmental occurrence and identifying the key factors governing their residues are essential for effective pollution control and prevention. In this study, we investigated the spatiotemporal distribution of TPNNIs in surface soils of the Shaying River Basin, a typical intensive agricultural region in central China, and assessed the key factors influencing their residues. TPNNIs were frequently detected in surface soils (detection frequency [DF] = 89.5%), with a mean concentration of 3.8 ± 3.5 ng/g, dominated by desnitro-imidacloprid (DN-IMI, 2.1 ± 2.0 ng/g), desmethyl-clothianidin (DM-CLO, 0.9 ± 1.1 ng/g) and imidacloprid-urea (IMI-UREA, 0.4 ± 1.6 ng/g). TPNNIs concentrations were comparable between the rainy and dry seasons but significantly higher in farmland soils (4.8 ± 3.4 ng/g) than in urban (1.0 ± 1.8 ng/g) and mountainous soils (0.1 ± 0.2 ng/g) (p < 0.01). Spatially, TPNNIs residues were higher in the central agriculturally intensive areas, whereas lower in the western mountainous and the northwestern urbanized area. Machine learning models identified pNNIs as the most important predictor of TPNNIs residues, while altitude, longitude, latitude, land-use type, total nitrogen content, and clay content were also influential variables. Partial least squares structural equation modeling (PLS-SEM) further revealed that pNNIs and soil physicochemical properties exerted significant direct positive effects on TPNNIs residues (p < 0.01). In contrast, geographic factors (longitude, latitude, altitude, and land-use type) indirectly exerted negative effects on TPNNIs residues by having significant direct negative effects on pNNIs and soil physicochemical properties (p < 0.01).

21. Simulating the impacts of ocean deoxygenation on coral reef resilience using adaptive ecosystem modeling.

期刊: Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering 发表日期: 2026-May-17 链接: PubMed

摘要

Adaptive ecosystem modeling provides a proactive approach to mitigating ocean deoxygenation and enhancing coral reef resilience. This study proposes an integrative framework that combines machine-learned dissolved oxygen (DO) reconstructions with a multispecies reef ecosystem model, augmented by Bayesian uncertainty quantification to identify intervention strategies that maximize ecological recovery. By explicitly linking oxygen dynamics with biological feedbacks and management actions, the framework addresses critical gaps in current hypoxia mitigation research. The approach is applied to the central Great Barrier Reef using long-term in situ measurements and satellite observations for model calibration. Simulation results indicate that targeted aeration, watershed nutrient reduction, and microbiome manipulation can reduce cumulative hypoxic stress by up to 43% over two decades, while increasing live coral cover by 28% relative to baseline projections. Sensitivity analyses reveal that model outcomes are particularly influenced by microbial acclimation rates and seasonal DO minima, highlighting the importance of fine-scale biogeochemical monitoring. Overall, the findings demonstrate the value of an adaptive, data-driven decision-support framework that integrates ecological processes, high-resolution environmental data, and management interventions, offering scalable guidance for hypoxia resilience planning in threatened coral reef systems.

22. Endometriosis and ovarian cancer: epidemiological evidence, molecular insights, and clinical decision-making.

期刊: Human reproduction update 发表日期: 2026-May-17 链接: PubMed

摘要

Endometriosis, particularly ovarian endometrioma, is associated with a 2-fold increased risk of ovarian cancer (OC), especially the clear cell and endometrioid subtypes. However, the absolute lifetime risk of OC in women with endometriosis remains relatively low, estimated at 1.9%. This review provides a focused overview of the relationship between these two conditions, addressing epidemiologic data, molecular links, advances in diagnosis, and clinical management. Somatic mutations in ARID1A, PIK3CA, and KRAS are shared between endometriosis and certain OC subtypes, and the nature of the environment typical of ovarian endometriomas suggests a context-specific oncogenic journey. Although advances in imaging, like transvaginal ultrasound and MRI, have improved endometriosis diagnosis, these modalities remain unreliable for identifying malignant transformation. Biomarkers, including CA-125 and HE4, provide additional diagnostic information, although their low specificity limits their role in clinical practice. Hormonal therapies, particularly the long-term use of combined oral contraceptives (COCs), have proven to be highly effective in reducing OC risk in women with endometriosis. This protective effect persists for more than a decade after discontinuation and has been associated with a risk lower than that of the general population. In addition, COC use has been linked to further protective effects against endometrial and colorectal cancers, highlighting its potential value as a cancer prevention strategy, especially for high-risk groups. Surgical management, particularly the excision of ovarian endometriomas, may also confer protection against OC, although this must be balanced against the risks of recurrence and ovarian reserve loss, especially in younger women. Prophylactic salpingo-oophorectomy is recommended for women with known genetic predispositions, but is not routinely indicated for those with endometriosis alone. Emerging evidence highlights the need for personalized risk prediction models that incorporate genetic, clinical, and environmental factors to guide care. Long-term studies are required to assess the impact of conservative versus surgical management on OC risk and overall survival. This review emphasizes the importance of a multidisciplinary approach to the management of endometriosis in relation to OC risk. While the link between endometriosis and OC is well-established, treatment strategies must be tailored to balance cancer prevention, fertility preservation, and quality of life.

23. Detection and Quantification of Antifouling Paint Particles in Marine Sediments by Pyrolysis-Gas Chromatography-Mass Spectrometry.

期刊: Environmental science & technology 发表日期: 2026-May-17 链接: PubMed

摘要

Antifouling paint particles (APPs), a form of microplastic pollution derived from the fragmentation of marine coatings, have emerged as a notable environmental concern due to their persistence and potential toxicity. However, the accurate extraction, detection, and quantification of the smallest APP size fraction (<500 μm) remain significant challenges. This study reports the development and application of a sensitive analytical method for the detection and quantification of rosin-based APPs in marine sediments using pyrolysis-gas chromatography-mass spectrometry (Py-GC/MS). Rosin, a biobased resin derived from pine sap and widely used as a primary binder or cobinder in antifouling coatings, was targeted as a chemical marker for APPs. The method combines accelerated solvent extraction with Py-GC/MS detection of derivatized rosin pyrolysis products. Recoveries exceeded 95%. The rosin content in commercial antifouling paints varied from 14.3 to 68% (m/m), reflecting formulation differences. Application to sediments from Australian marinas revealed an average rosin concentration of 0.32 mg g-1 sediment, estimated to be 0.47-2.2 mg g-1 of APPs. While rosin serves as a tracer for APP quantification, the environmental concern primarily relates to the overall paint particles, which contain biocides and other additives. This method provides a robust approach for the trace-level quantification of APPs in complex matrices.

24. Novelty to necessity: large language models in clinical practice-a call to action for physicians.

期刊: Internal and emergency medicine 发表日期: 2026-May-17 链接: PubMed

摘要

Large language models (LLMs) represent a rapidly advancing subset of artificial intelligence with significant potential to augment clinical practice. These tools can assist in literature synthesis, documentation, clinical reasoning, and patient communication. Despite demonstrated capabilities, adoption in healthcare remains limited due to barriers such as limited AI literacy, trust concerns, integration challenges, and generational disparities in digital proficiency. This review critically examines the role of LLMs as cognitive adjuncts in medicine, emphasizing the need for calibrated trust, human oversight, structured implementation strategies, and robust regulatory governance. Evidence suggests that stepwise integration of LLMs, beginning with low-risk tasks, may enhance physician efficiency, reduce cognitive burden, and may support high-quality care. Key limitations, including hallucinations, data currency, environmental impact, and data security, have to be addressed, alongside the need for continuous model refinement. Rigorous clinical trials are needed to establish the efficacy of LLMs. This includes the recognition that LLMs trained on vast web data may contain personal health information, creating a significant privacy risk. Responsible adoption of LLMs is essential to meet the demands of modern medicine while preserving clinical accountability and patient-centered care.

25. Modeling dispersion of dust caused by tailings and mining activities at Jajarm based on gradation analysis.

期刊: Environmental monitoring and assessment 发表日期: 2026-May-17 链接: PubMed

摘要

This study presents a novel application of source-specific particle size distribution (PSD) and moisture content-derived from laser gradation analysis of mining wastes-as explicit inputs to the AERMOD dispersion model, significantly improving its predictive realism for PM10 from complex mining operations at the Jajarm Alumina Plant in Iran. Sampling targeted key waste types, including bauxite crusher slime, red mud, and lime tailings, with laser diffraction (HORIBA LA-950) used to quantify PSD and ASTM D2216 for moisture determination. Emission rates were calculated using AP-42 methodologies and integrated into AERMOD with seasonal surface parameters and high-resolution meteorological data. Model validation against field measurements on 21 June 2018 showed excellent agreement (R2 = 0.88, RMSE = 127 µg/m3), confirming that incorporation of gradation-specific data enhances prediction accuracy compared to generic assumptions. The highest 24-h PM10 concentration reached 2087 µg/m3 near crushers, with an annual average of 542 µg/m3, far exceeding the air standards for particulate matter set by the EPA and the air quality standard in Iran (150 μg/m3). Results identify bauxite crusher slime (60% PM10) and red mud (50% PM10, 15.4% clay) as high-dispersion-potential wastes, and lime loading/unloading as the largest emission source (104 t/a). We recommend prioritizing dust suppression at lime/bauxite handling operations and surface stabilization of fine-grained tailings to mitigate air quality and public health impacts.

26. Long-term health-related quality of life in bereaved siblings of children with cancer: A cross-sectional study.

期刊: European journal of oncology nursing : the official journal of European Oncology Nursing Society 发表日期: 2026-May-16 链接: PubMed

摘要

Research on bereavement has mainly focused on risk factors linked to negative outcomes, while protective factors have been less evaluated. This study investigated the associations of resilience and perceived support from healthcare professionals with self-reported health-related quality of life (HRQoL) in young adults who had lost a sibling to cancer 2-10 years earlier. Additionally, the study explored gender differences in HRQoL, resilience, and perceived social support from healthcare professionals. Of 99 young adults who experienced the loss of a sibling to cancer between 2009 and 2014, 36 participants (response rate = 36.4%) were included in this nationwide Norwegian study. We measured HRQoL (Young Adult Version of the Pediatric Quality of Life), resilience (Resilience Scale for Adolescents), and perceived social support from healthcare professionals during the sibling’s illness, following the death, and during the past year. Participants were aged 18-26 years at the time of the survey, with the loss occurring 2.5-10 years prior. We did not detect statistically significant gender differences in HRQoL, resilience, or perceived social support. Analysis showed that higher resilience and greater perceived social support during the past year were significantly associated with higher HRQoL among bereaved siblings (adjusted R2 = 0.62; F(6, 35) = 14.7; p < 0.001). Young adults with higher resilience and stronger perceived social support during the past year reported better HRQoL 2-10 years after the loss of a sibling to cancer. These results underscore the need to enhance resilience and provide ongoing psychosocial care beyond early bereavement to promote long-term HRQoL among bereaved siblings.

27. Prenatal exposure to wildfire-related PM2.5 and birth outcomes: A population-based California statewide study.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-May-16 链接: PubMed

摘要

Wildfire frequency and intensity are increasing, yet impacts on birth outcomes remain unclear, particularly regarding patterns of exposure-response associations and developmental periods of susceptibility. We examined associations between wildfire-specific PM2.5 exposure during pregnancy and adverse birth outcomes, aiming to identify potential nonlinear relationships and susceptible gestational periods in a large population-based cohort. We linked 4.75 million California live birth records (2011-2020) to daily wildfire-specific PM2.5 exposure using geocoded maternal residential addresses to estimate weekly gestational exposure. Logistic regression estimated odds for preterm birth (PTB), very preterm (VPT), extremely preterm (EPT), low birth weight (LBW), term LBW, small for gestational age (SGA), and large for gestational age (LGA) adjusted for maternal, temporal and delivery characteristics; generalized additive models (GAMs) and discrete-time survival analysis assessed nonlinear patterns and cumulative exposure effects, respectively. Wildfire smoke PM2.5 was ubiquitous, affecting about 98% of pregnancies. Per 1 μg/m³ increase in pregnancy-average exposure, odds increased for PTB (OR=1.03, 95%CI: 1.02-1.03), VPT (OR=1.07, 95%CI: 1.06-1.08), and EPT (OR=1.10, 95%CI: 1.09-1.11). LBW showed modest positive associations that were amplified at high exposures (≥10 µg/m³; OR=2.21, 95%CI: 1.96-2.50), and odds for LGA were consistently elevated while SGA was inversely associated. Second-trimester exposure consistently related to greater odds of the adverse birth outcomes. GAMs indicated steeper risk increases at lower-to-moderate exposures that plateaued at higher exposure. These findings indicate that prenatal wildfire-specific PM2.5 exposure is associated with increased risks for adverse birth outcomes, underscoring the need to protect pregnant individuals during fire events.

28. From paediatric rebound to adult redistribution: changing the epidemiology of group A Streptococcus after COVID-19.

期刊: The Lancet. Microbe 发表日期: 2026-May-16 链接: PubMed

摘要

29. Trust-based healthcare communication with marginalized youth: A meta-ethnographic synthesis.

期刊: International journal of nursing studies 发表日期: 2026-May-16 链接: PubMed

摘要

Effective communication between healthcare providers and marginalized youth and adolescents is essential for promoting equitable care. However, existing models of care reinforce adult-centric and biomedical norms that overlook the diverse developmental and sociocultural realities faced by these youth. This review aimed to synthesize the perceptions and experiences of healthcare communication by marginalized youth and adolescents. We used Noblit and Hare’s meta-ethnographic approach. Six electronic databases were searched from their inception date till 31 December 2025. The included studies were assessed using the Critical Appraisal Skills Program tool. We synthesized findings from 42 included studies and identified four main findings: (1) Building trust in healthcare encounters is a relational process; (2) Shared agency in communication is key; (3) Marginalized youth construct a coherent sense of self through an iterative process; (4) Structural conditions shaping communication must not be overlooked. Drawing on the findings of this review, we developed a conceptual framework - the Culturally Safe and Relational Approach Tool (CARAT) - to support culturally safe, relational communication with marginalized youth. The framework positions marginalized youth as active agents and highlights the role of healthcare providers in either bridging bureaucratic health systems or functioning as gatekeepers to care. It underscores the importance of cultural safety, scaffolded autonomy, and relational continuity within healthcare systems. Reorienting communication practices to recognize youths’ strengths and lived realities, alongside policy and practice reforms that center marginalized youths’ voices, will strengthen trust and inclusivity across healthcare settings.

30. Evaluating the influence of promotional branding on consumer decision-making: A comparative study of product labels.

期刊: Acta psychologica 发表日期: 2026-May-16 链接: PubMed

摘要

Product labels have become an increasingly popular marketing tool, with promotional indicators like “buy one, get one free” or “20% off” gaining attention for their effectiveness. This study aimed to assess how these promotions impact consumer product selection behavior, employing the Theory of Planned Behavior. Through an online survey of 200 participants, the study explored shopping habits, preferences, and attitudes toward promotional labels. Results showed that consumers are more likely to choose products with promotional indications, perceiving them as higher in value. Price-sensitive consumers, in particular, were more influenced by these labels. The study further revealed that the type of product being promoted plays a role in the effectiveness of promotional cues. Key relationships were identified between promotional labels, perceived value, prudent behavior, and product selection behavior. The findings indicated that product selection behavior significantly influenced attitudes toward packaging and perceived behavioral control, both of which impacted the intention to select a product. Customer loyalty also emerged as a factor in the retention of products with promotional labels. This research provides valuable insights for researchers and marketers into how promotional labels drive consumer behavior.

31. Atmospheric pressure plasma-activated medium activates macrophages toward an antitumor M1 phenotype by modulating the SIRPα phagocytic checkpoint.

期刊: International immunopharmacology 发表日期: 2026-May-16 链接: PubMed

摘要

Macrophage-mediated tumor clearance is frequently restricted by the immunosuppressive tumor microenvironment. This study investigates the immunomodulatory effects of plasma-activated medium (PAM) on macrophage pro-inflammatory activation and antitumor function. Murine RAW264.7 and primary bone marrow-derived macrophages were treated with PAM generated by a helium atmospheric pressure plasma jet. Phenotypic changes and underlying signaling mechanisms were assessed. Functional enhancements in macrophage recruitment and tumor engulfment were quantified using chemotaxis and 3D confocal co-culture assays with Panc02 pancreatic cancer cells. Results show that PAM promotes macrophage activation by increasing spatial recruitment via pro-inflammatory chemokine secretion and enhancing tumor cell engulfment. Mechanistically, PAM drives this functional shift through hierarchical activation of the TLR4/NF-κB and PI3K/AKT signaling cascades. Furthermore, while hydrogen peroxide alone triggers a compensatory upregulation of the inhibitory SIRPα receptor, the reactive oxygen and nitrogen species (RONS) in PAM bypass this negative feedback to directly downregulate SIRPα. These findings demonstrate that PAM-mediated oxidative modulation effectively suppresses the “don’t-eat-me” signal and enhances innate antitumor immunity, providing a potential strategy for cancer immunotherapy.

32. Sequential soil application of bacterial siderophores and biosurfactants enhances Cu, Ni, Pb, and Zn accumulation and physiological performance in Brassica juncea L. Czern.

期刊: Ecotoxicology and environmental safety 发表日期: 2026-May-16 链接: PubMed

摘要

Achieving efficient plant uptake of potentially toxic elements (PTEs) for phytoremediation and agromining remains difficult due to limited metal bioavailability and metal-induced metabolic inhibition. In this proof-of-concept study, the uptake of PTEs by Brassica juncea (L.) Czern. was enhanced through sequential soil application of bacterial siderophores and biosurfactants synthesized by Pseudomonas sp. ANT_H12B and Bacillus sp. ANT_WA51, respectively. Siderophores were first applied to chelate and solubilize metals, followed by biosurfactants to disrupt their soil binding, thus improving PTE mobility and availability to plants. Experiments were conducted using soils with and without artificial contamination by copper (Cu), nickel (Ni), lead (Pb), and zinc (Zn). The combined treatment with both metabolites significantly increased metal bioavailability - particularly for Pb (up to 321%) and Zn (up to 618%) - promoting plant growth, chlorophyll synthesis, metal accumulation and translocation. PTE uptake efficiency was markedly improved: in shoots, siderophores and biosurfactant-based treatments increased the concentration of Cu by 59%, Ni by 75%, Pb by 272%, Zn by 89%, compared to the control (metabolite-untreated plants); in roots, the concentration of Cu increased by 73%, Ni by 105%, Pb by 101% and Zn by 101%. Moreover, in the metals-untreated soil, plants supplemented with both metabolites exhibited reduced oxidative stress and improved chloroplast ultrastructure, further supporting the biostimulant properties of metabolites. These findings demonstrate the potential of microbially derived metabolites as safe, sustainable agents that enhance PTE uptake while supporting soil and plant health, enabling ecotoxicologically sound phytoremediation and agromining.

33. Correlation analysis between serum 25-hydroxyvitamin D levels and thyroid peroxidase antibody positivity in preconception women.

期刊: BMC endocrine disorders 发表日期: 2026-May-16 链接: PubMed

摘要

Vitamin D insufficiency and TPOAb positivity frequently coexist in women planning pregnancy, yet their joint distribution and clinical correlates immediately before conception remain insufficiently characterized in routine preconception practice. This retrospective study aimed to examine the association between serum 25(OH)D concentrations and TPOAb positivity in preconception women, to assess whether low vitamin D status and TPOAb positivity were jointly associated with lower pregnancy rates, and to explore the robustness of these associations after adjustment for demographic, thyroid-related, reproductive, seasonal, and nutritional covariates. A total of 256 preconception women who underwent routine preconception evaluation in the Department of Premarital and Preconception Health Care between January 2021 and December 2023 were retrospectively enrolled. Serum 25(OH)D, TPOAb, TgAb, thyroid-stimulating hormone, free thyroxine, anti-Müllerian hormone, ferritin, fasting blood glucose, urinary iodine concentration, and season of blood sampling were recorded from existing clinical records. TPOAb reference range was 0-9 IU/mL; for the primary analysis, TPOAb positivity was prespecified as ≥ 34 IU/mL. Multivariable logistic regression and interaction analyses were used to evaluate factors associated with TPOAb positivity and retrospectively ascertained 12-month pregnancy outcomes. Among 256 participants (mean age 30.2 ± 4.1 years), 67 women (26.2%) were classified as TPOAb-positive. The TPOAb-positive group had lower serum 25(OH)D levels than the TPOAb-negative group (24.8 ± 9.6 vs. 31.4 ± 11.2 ng/mL, P = 0.003), and serum 25(OH)D was inversely correlated with TPOAb concentration (r = -0.287, P = 0.008). After adjustment for age, BMI, TSH, FT4, AMH, season, urinary iodine category, ferritin, and recent vitamin D intake, vitamin D deficiency remained independently associated with TPOAb positivity (adjusted OR 2.21, 95% CI 1.09-4.48, P = 0.028). In 218 women with follow-up, the 12-month pregnancy rate was 42.7% overall; women with concomitant TPOAb positivity and vitamin D deficiency/insufficiency had the lowest rate (28.6%), and the TPOAb-by-vitamin D interaction for pregnancy outcome was adverse (Pinteraction = 0.041). Lower serum 25(OH)D levels were independently associated with TPOAb positivity in preconception women. The coexistence of low vitamin D status and TPOAb positivity was associated with less favorable short-term pregnancy outcomes, although the observational design does not support causal inference. Not applicable.

34. Characteristics of gut microbiota changes in patients with nasopharyngeal carcinoma during radiotherapy.

期刊: Journal of translational medicine 发表日期: 2026-May-16 链接: PubMed

摘要

This study aimed to characterize the longitudinal and dynamic changes of gut microbiota in patients with nasopharyngeal carcinoma (NPC) during radiotherapy, to inform the development of strategies for maintaining gut microbiota homeostasis. Thirty-one newly diagnosed NPC patients were recruited from the Department of Radiotherapy, First Affiliated Hospital of Guangxi Medical University, and 31 age-matched healthy controls from the same Hospital Physical Examination Center between August and December 2023. Fecal samples were collected from NPC patients at three key time points, including days 1-3 pre-radiotherapy (T0), days 14-18 of mid-radiotherapy (T1), and days 28-32 at end of radiotherapy (T2). Meanwhile, fecal samples from healthy controls were collected on the morning of their physical examination. 16S rDNA sequencing, combined with bioinformatics and statistical analyses, was used to compare the structural characteristics and dynamic changes of gut microbiota in NPC patients during radiotherapy. Alpha diversity analysis showed significantly lower Shannon and Chao1 indices in NPC patients compared with healthy controls. Beta diversity analysis based on the Bray-Curtis distance revealed distinct gut microbial community structures between NPC patients and healthy controls. In this intergroup comparison, a total of 16 core differentially abundant taxa were consistently identified by two complementary analytical methods (LEfSe and ALDEx2). Linear mixed-effects models demonstrated that the Chao1 index at T0 was significantly lower than at T1 and T2 in NPC patients. Following adjustment for multiple confounding variables, mucositis grade was the only factor significantly associated with gut microbiota alpha diversity during radiotherapy. Radiotherapy time points, treatment regimen, and most clinical and demographic variables showed no such association. Beta diversity analyses based on the Bray-Curtis and unweighted Unifrac distances revealed significant compositional and structural differences linked to radiotherapy time points (T0/T1/T2) in the gut microbiota of NPC patients. This temporal variation was abrogated by stratification according to chemotherapy regimen. Beta diversity based on Bray-Curtis distance showed no significant differentiation across time points in either the concurrent chemotherapy (CCRT) alone cohort or the induction chemotherapy plus CCRT cohort. LEfSe and ALDEx2 concordantly identified seven core differentially abundant taxa across all NPC patients in the longitudinal T0 vs. T1 vs. T2 analysis. Stratification by chemotherapy regimen revealed such core taxa in the CCRT alone cohort, whereas no core differentially abundant taxa were detected by either method in the induction chemotherapy plus CCRT cohort. Our findings demonstrate that NPC patients exhibit significant gut microbial dysbiosis compared with healthy controls, characterized by reduced alpha diversity and altered genus-level composition. Longitudinal analyses further revealed that radiotherapy is associated with dynamic alterations in gut microbial diversity, composition, and structure in NPC patients. Notably, these temporal shifts in the gut microbiota are strongly stratified by chemotherapy regimen, with pronounced changes observed in patients receiving CCRT alone but a stable microbial profile in those receiving induction chemotherapy followed by CCRT. Collectively, these results highlight the profound impact of oncological treatment on the gut microbiome in NPC patients and identify treatment regimen as a critical modifier of microbial dynamics during radiotherapy.

35. Hydrogen-delivering biomaterial carriers for diabetic foot ulcer healing: a systematic review and meta-analysis of preclinical animal studies.

期刊: Diabetology & metabolic syndrome 发表日期: 2026-May-16 链接: PubMed

摘要

This study aimed to systematically evaluate the preclinical evidence on the therapeutic efficacy and underlying mechanisms of hydrogen-delivering biomaterial carriers in the treatment of diabetic foot ulcer (DFU). We conducted a comprehensive search across eight databases (PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, Wanfang, and VIP) to identify randomized animal studies investigating biomaterial-based hydrogen delivery for DFUs from database inception through November 2025. After screening, eleven studies met inclusion criteria and were included in the final meta-analysis. Data synthesis and statistical analyses were performed using RevMan 5.4; risk of bias was assessed using the SYRCLE’s tool for animal studies. The delivery of hydrogen via biomaterial carriers effectively promotes diabetic wound repair by enhancing wound closure rates, stimulating angiogenesis, and improving collagen deposition. Smart delivery systems, such as hydrogen-generating hydrogels, responsive microneedle patches, and photocatalytic dressings, enabled spatiotemporally controlled, sustained H₂ release. This modulation effectively attenuated oxidative stress and suppressed pro-inflammatory cytokine expression (e.g., TNF-α, IL-6). Collectively, biomaterial-mediated hydrogen delivery confers dual therapeutic actions: direct promotion of tissue regeneration and dynamic reprogramming of the impaired wound microenvironment, supporting its potential as a targeted, mechanism-informed intervention for DFUs. Biomaterial-based hydrogen delivery systems demonstrate multifaceted therapeutic benefits in preclinical DFU models, primarily through anti-inflammatory, pro-angiogenic, and collagen-enhancing mechanisms. The emergence of smart delivery systems enables localized, tunable, and prolonged hydrogen release, which improves bioavailability and therapeutic precision. Future research should prioritize optimization of release kinetics, pharmacokinetic-pharmacodynamic modeling in diabetic wound beds, and exploration of synergistic combinations (e.g., with growth factors or antimicrobial agents) to advance toward clinically translatable, precision wound therapeutics.

36. From polyetheretherketone to 3D‑printed composites: hydrothermal stability and cement‑dependent resin bonding of high‑performance polymers to pediatric restorations.

期刊: BMC oral health 发表日期: 2026-May-16 链接: PubMed

摘要

This study evaluated the water sorption/solubility, surface characteristics, and bonding performance of different high‑performance polymers intended for restorations and appliances used in pediatric dentistry, emphasizing their hydrothermal stability and cementation protocols for durable bonding. Disc‑shaped specimens of milled polyetheretherketone (PEEK), ceramic‑filled 3D‑printed composite resin, and milled polymethylmethacrylate (PMMA)‑based acrylic polymer were prepared. Water sorption and solubility were determined according to ISO 4049 after storage in distilled water and artificial saliva. Surface treatments included no treatment, airborne‑particle abrasion, and abrasion followed by application of a dimethacrylate/methyl methacrylate‑based primer. Surface microstructure, roughness, and wettability were evaluated. Shear bond strength was tested using either resin cement or glass ionomer cement under three aging conditions (24‑h water storage, thermocycling, and highly accelerated aging), and failure modes were classified. All materials showed very low water sorption (Wsp) and solubility (Wsl) below ISO 4049 limits (Wsp < 5 µg/mm³ and Wsl ~ 1 and 2 µg/mm³), with minor medium‑ and time‑dependent changes, indicating similar hydrolytic stability among the polymers. Airborne‑particle abrasion markedly increased surface roughness (from ~ 0.65 μm to 2.75-5.35 μm), whereas primer application reduced roughness while maintaining microroughness and significantly improved wettability; however, final roughness and contact angles remained material‑dependent. With resin cement, shear bond strength ranged from 17.07 to 23.26 MPa after 24‑h storage, decreased to 10.18-14.28 MPa after thermocycling, and increased up to 25.72 MPa after highly accelerated aging for the 3D‑printed and milled composites, with predominantly mixed or cohesive failures. Glass ionomer cement produced substantially lower bond strengths (0-8.70 MPa) and predominantly adhesive failures under all conditions. High‑performance polymers exhibited excellent resistance to water sorption and solubility and maintained favorable surface characteristics after clinically relevant pretreatments. Under the present in vitro conditions, resin cement combined with airborne‑particle abrasion and primer achieved more durable bonding than glass ionomer cement and may help guide material selection for pediatric‑oriented restorations and appliances.

37. Longitudinal trends and associations between housing and health among migrants in Australia: evidence from the Building a New Life in Australia study (2013-2023).

期刊: BMC public health 发表日期: 2026-May-16 链接: PubMed

摘要

Housing insecurity is a fundamental social determinant of migrant health. While the relationship between housing and health outcomes is well-documented, there is a paucity of longitudinal data examining this association among humanitarian migrants. Accordingly, we aimed to assess i) longitudinal trends in housing insecurity, psychological distress, post-traumatic stress disorder (PTSD), and self-rated health and ii) the longitudinal associations between housing insecurity and mental and physical health outcomes among humanitarian migrants over the period 2013/14 to 2023. Data were drawn from the Building a New Life in Australia Longitudinal Study (n = 6978) with repeated measures over six data waves from 2013/14 to 2023. Generalised Estimating Equations with logistic regression were used to test the association between housing insecurity and psychological distress, PTSD and self-rated health, adjusting for potential confounders and time-varying covariates. The adjusted odds ratios (AOR) and the 95% confidence interval were reported to determine the relationship between health and housing insecurity. A p-value < 0.05 was determined statistically significant. We found that the prevalence of housing insecurity decreased significantly, from 73.3% in Wave 1 (2013/14) to 39.7% in Wave 6 (2023). In contrast, psychological distress showed an alternating trend, increasing slightly from 17.2% in Wave 1 to 22.7% in Wave 6. Similarly, PTSD followed a fluctuating trend, decreasing from 34.12% in Wave 1 to 31.3% in Wave 6; self-rated health remained fairly consistent over time. After adjustment, housing insecurity was significantly related to increased odds for psychological distress (AOR = 1.66; 95% CI: 1.43, 1.93), PTSD (AOR = 1.41; 95% CI: 1.24, 1.60), and poor self-rated health (AOR = 1.42; 95% CI: 1.22, 1.66). While housing insecurity declined over time, our study presents strong evidence of the longitudinal associations between housing insecurity and (psychological distress, PTSD, and self-rated health) among humanitarian migrants. Addressing housing insecurity through targeted public health and housing policies may improve health outcomes for humanitarian migrants. These findings offer essential information for policymakers by demonstrating that housing insecurity is significantly associated with poorer mental and physical health outcomes among humanitarian migrants.

38. From Prevention to Progression: Can Belzutifan-Based Strategies Deliver Across the RCC Disease Continuum?

期刊: The oncologist 发表日期: 2026-May-16 链接: PubMed

摘要

HIF-2α signaling is a central driver of clear cell renal cell carcinoma (ccRCC) biology. With regulatory approval of the HIF-2α inhibitor, belzutifan, in the third- and fourth-line refractory setting, therapeutic targeting of this pathway has entered clinical practice. At the 2026 ASCO GU Cancer Symposium, two randomized phase III trials evaluated earlier integration of belzutifan: LITESPARK-022 (belzutifan plus pembrolizumab vs. pembrolizumab alone in the adjuvant setting) and LITESPARK-011 (belzutifan plus lenvatinib vs. cabozantinib in the post-PD-(L)1 setting). LITESPARK-022 demonstrated a disease-free survival (DFS) benefit (HR 0.72; 95% CI 0.59-0.87; p = 0.0003), with early and sustained curve separation, though grade ≥3 adverse events doubled and overall survival (OS) data remain immature. LITESPARK-011 enrolled patients after progression on prior PD-(L)1 therapy in the metastatic setting. The combination improved median progression-free survival (PFS; 14.8 vs. 10.7 months; HR 0.70), objective response rate (ORR; 52.6% vs. 40%), and duration of response (23 vs. 12 months), with a manageable toxicity profile. Together, these studies suggest that earlier targeting of HIF-2α biology may improve disease control and durability. However, patient selection, toxicity considerations, and the absence of mature OS data remain critical factors in determining the optimal role of belzutifan-based strategies across disease states.

39. Response to trastuzumab deruxtecan in postoperative recurrent lung adenocarcinoma harboring concurrent EGFR and HER2 mutations after progression on adjuvant osimertinib.

期刊: Respiratory investigation 发表日期: 2026-May-16 链接: PubMed

摘要

Epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) mutations are key molecular targets in non-small cell lung cancer (NSCLC). We report a rare case of postoperative recurrent lung adenocarcinoma in an 84-year-old woman harboring EGFR L858R and HER2 S310F mutations after progression on adjuvant osimertinib. After further progression on chemotherapy, she received trastuzumab deruxtecan (T-DXd), which induced metastatic regression and yielded disease control for approximately 6 months. This case highlights a therapeutic approach for NSCLC with multiple driver alterations and demonstrates the clinical activity of T-DXd in osimertinib-refractory EGFR-mutant disease with a concurrent HER2 alteration.

40. Accessing telehealth: Leveraging healthcare service-learning to promote confident use among older adults.

期刊: Gerontology & geriatrics education 发表日期: 2026-May-16 链接: PubMed

摘要

Telehealth offers increased access to healthcare services for older adults, yet this potential remains unrealized due to numerous barriers, including limited perceived competence to use technologies and older adult demographic factors. This study examined the impact of one training program embedded within a service-learning curriculum at a university medical center, which included didactic online training modules and subsequent live telehealth sessions with students. A quasi-experimental repeated measures design was employed to assess community participants’ (n = 59) confidence in using telehealth at baseline, post-didactic modules, and post-live telehealth sessions with students. We assessed participants’ perceptions through the Telehealth Competency Questionnaire - Consumer Version (TCQ-C) and the Usefulness subscale of the Telehealth Usability Questionnaire (TUQ-U) at each time point and the moderating effects of demographic factors. Significant increases (p < .001) in TCQ-C and TUQ-U occurred across the curriculum. Age and participant being of an underrepresented race/ethnicity had a significant influence on outcomes, though the median household income of the participant’s zip code did not. Outcomes suggest telehealth training may increase potential users’ perceptions of telehealth competency and usefulness. Participant demographics influenced their response to the curriculum. This suggests that targeted training may be critical to reducing disparate access to the promise of telehealth.

41. Inhibition of macrophage migration inhibitory factor attenuates bleomycin-induced murine pulmonary fibrosis via the MAPK pathway.

期刊: Respiratory research 发表日期: 2026-May-16 链接: PubMed

摘要

Idiopathic Pulmonary Fibrosis (IPF) is a chronic progressive disease marked by excessive extracellular matrix deposition and deteriorating lung function. Although macrophage migration inhibitory factor (MIF) has been implicated in pulmonary fibrosis, the downstream mechanisms-particularly whether MIF drives fibrosis through its receptor CD74-remain insufficiently understood. This study investigated whether MIF/CD74 signaling promotes fibroblast activation through specific downstream pathways that regulate proliferation and matrix production. Single-cell RNA sequencing and ELISA were used to characterize MIF-CD74 interactions and circulating MIF levels in IPF patients. Bleomycin-induced fibrosis models were established using C57BL/6J mice, Mif⁻/⁻ mice, and the MIF inhibitor 4-IPP. Macrophage-fibroblast co-culture systems were treated with bleomycin, 4-IPP, or CD74 shRNA. Lung injury, fibrosis, and signaling activation were assessed by histology, qRT-PCR, Western blotting, and functional assays. scRNA-seq identified MIF-CD74 as a dominant macrophage-fibroblast signaling axis in fibrotic lungs, and serum MIF levels were elevated in IPF patients. In mice, bleomycin markedly increased MIF and CD74 expression and activated MAPK signaling. Genetic deletion or pharmacologic inhibition of MIF attenuated collagen deposition, improved lung architecture, and reduced profibrotic and inflammatory signaling. In vitro, MIF promoted fibroblast proliferation, migration, and matrix synthesis, whereas CD74 knockdown or MIF inhibition significantly attenuated fibroblast profibrotic responses. MIF promotes pulmonary fibrosis by activating CD74-dependent MAPK signaling in fibroblasts, enhancing their proliferation and extracellular matrix production. Targeting the MIF/CD74 axis reduces tissue remodeling and represents a promising therapeutic strategy for IPF.

42. Association between premenstrual syndrome severity and musculoskeletal pain among nursing students: a cross-sectional study.

期刊: BMC nursing 发表日期: 2026-May-16 链接: PubMed

摘要

Musculoskeletal pain is highly prevalent among nursing students and may negatively affect their physical functioning and readiness for clinical practice. Premenstrual syndrome (PMS), characterized by physical and psychological symptoms, has been suggested to be associated with pain sensitivity and musculoskeletal discomfort. However, the relationship between PMS severity and musculoskeletal pain in nursing students has not been well established. This study employed a descriptive cross-sectional design and included 257 female nursing students. Data were collected using the Premenstrual Syndrome Scale (PMSS) to evaluate the presence and severity of PMS symptoms and the Extended Nordic Musculoskeletal Questionnaire (NMQ-E) to assess musculoskeletal complaints (pain, discomfort, or ache) across nine distinct body regions. Descriptive statistics, independent samples t-tests, chi-square tests, and logistic regression analysis were performed. All inferential statistical analyses were performed with a significance level set at p < 0.05. PMS was identified in 82.9% (n = 213) of participants, and 90.7% (n = 233) reported musculoskeletal pain. Students with pain had significantly higher PMSS scores (148.5 ± 28.5) than those without pain (90.5 ± 26.5; p < 0.001). Logistic regression analysis showed that PMS severity was independently associated with musculoskeletal pain (OR = 1.08, 95% CI: 1.05-1.11, p < 0.001). Chi-square analysis revealed that musculoskeletal pain in the neck, shoulder, lower back, and hips was significantly associated with increased healthcare utilization, medication use, and sick leave (p < 0.05). The lower back (75.9%, n = 195), upper back (42.0%, n = 108), and hip regions (39.3%, n = 101) were the most commonly affected regions. PMS severity is significantly associated with musculoskeletal pain in nursing students and may be linked to pain-related functional limitations. Early identification of students with severe PMS symptoms and incorporation of menstrual health considerations into musculoskeletal assessments may support preventive strategies aimed at reducing absenteeism, healthcare utilization, and pain-related disability, while improving the occupational health and clinical functioning of future nurses.

43. Clinical factors associated with severely reduced health status in patients with COPD and comorbid depression/anxiety: The Swedish PRAXIS study.

期刊: NPJ primary care respiratory medicine 发表日期: 2026-May-16 链接: PubMed

摘要

Patients with COPD and comorbid depression/anxiety are at risk of reduced health status. This study aimed to assess health status in COPD patients with depression/anxiety, the occurrence of severely reduced health status in this group, and to investigate associations between severely reduced health status and patient-related clinical factors. This cross-sectional study included 2245 randomly selected COPD patients from primary care and hospital outpatient clinics in Sweden. The COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ) were used to assess health status. Severely reduced health status was defined as CAT ≥ 20 or CCQ ≥ 2. The 524 patients (23.3%) who reported depression/anxiety had higher mean CAT scores (18.3 vs. 15.2, p < 0.001) and CCQ scores (2.37 vs. 1.83, p < 0.001) than patients without depression/anxiety. In this group, 48% had CAT ≥ 20 and 57% had CCQ ≥ 2. In patients with depression/anxiety, factors associated with CAT ≥ 20 were: onset of COPD symptoms before 60 years of age (OR = 2.62 [95% CI 1.37-5.04]), frequent symptoms of depression in the previous three months (2.59 [1.55-4.30]), one or more COPD exacerbations in the previous six months (2.37 [1.41-4.00]) and physical inactivity (1.89 [1.11-3.22]). Apart from physical inactivity, factors associated with CCQ ≥ 2 were the same as for CAT ≥ 20. Approximately half of the COPD patients with comorbid depression/anxiety reported severely reduced health status. Exacerbations, frequent depressive symptoms and physical inactivity were factors associated with severely reduced health status, and constitute important treatable and preventable traits of COPD.

44. "Remission doesn't always feel like remission": aligning disease evaluation with lived experience in systemic lupus erythematosus.

期刊: Rheumatology (Oxford, England) 发表日期: 2026-May-15 链接: PubMed

摘要

45. Cannabis surpasses tobacco among pregnant women: national trends and predictors of use in the U.S., 2015-2023.

期刊: Addictive behaviors 发表日期: 2026-May-15 链接: PubMed

摘要

Rapid cannabis legalization in the United States has heightened concern about prenatal exposure as social acceptance increases. While tobacco use during pregnancy has steadily declined, emerging evidence suggests cannabis use may be rising. We examined national trends in tobacco-only use, cannabis-only use, and co-use among pregnant individuals from 2015 to 2023 and identified associated sociodemographic factors. We analyzed nationally representative 2015-2023 National Survey on Drug Use and Health data restricted to pregnant women ages 15-44 (N = 6,099). Outcomes were self-reported past-30-day tobacco-only use, cannabis-only use, and co-use. Weighted prevalence was estimated for 2015-2019, 2020, and 2021-2023. Multivariable logistic regressions for 2015-2019 and 2021-2023 assessed predictors relative to non-use, reporting adjusted odds ratios and average marginal effects. Regressions were not estimated for 2020 due to limited sample size. Tobacco-only use declined from 12.0% in 2015 to 3.9% in 2023. Cannabis-only use more than doubled pre-pandemic and peaked at 6.3% in 2022, surpassing tobacco before converging in 2023. Co-use declined to 0.8% by 2023. Pre-pandemic, lower education, unmarried status, lower income, and public insurance were associated with higher tobacco-only use and co-use. Hispanic individuals had lower likelihoods of all use patterns relative to non-Hispanic White individuals. Post-pandemic, educational gradients in cannabis-only use emerged, while Medicaid and Medicare coverage remained associated with higher tobacco-only use and uninsured status became associated with higher cannabis-only use. Prenatal substance use patterns are shifting, with cannabis surpassing tobacco in recent years. Updated screening, counseling, and policy responses are needed to address evolving prenatal exposure risks.

46. Rethinking treatment effectiveness in the context of personalized care and environmental health.

期刊: Rheumatology (Oxford, England) 发表日期: 2026-May-15 链接: PubMed

摘要

47. GD3 synthase deficiency disrupts Na+/K+-ATPase and plasma membrane Ca2+-ATPase function in mouse brain.

期刊: Neurobiology of disease 发表日期: 2026-May-15 链接: PubMed

摘要

GD3 synthase (GD3S) is a key enzyme in the production of gangliosides, sialylated membrane glycosphingolipids with essential physiological roles in mammalian brains. To elucidate the molecular bases of neuropathological findings associated with GD3S deficiency, we performed a multilayered analysis focused on the functionality of ion transporters Na+/K+-ATPase (NKA) and plasma membrane Ca2+-ATPase (PMCA) in the cortex and cerebellum of GD3S-deficient mice (GD3S-/-). We examined global transcriptomes, NKA and PMCA gene and protein expression, the influence of membrane lipid composition on lipid raft integrity, and the activity of both ATPases, pairing them with an exploratory principal component analysis. Transcriptomic data reveal that sets of genes involved in ion transport and membrane dynamics are differentially expressed in the absence of GD3S, whereas qRT-PCR data confirm changes in gene expression of specific NKA and PMCA subunits or isoforms. Altered protein expression and significantly lower activity of both NKA and PMCA were found in the cerebral cortex of GD3S-/- mice. Analysis of membrane cholesterol content revealed segregation of cholesterol into lipid rafts, which may lead to disordered membrane lipid architecture in GD3S deficiency. Additionally, our results confirm that an imbalance in membrane ganglioside composition leads to significant alterations in ion transporter NKA and PMCA activity. Furthermore, we experimentally restored the activity of both ATPases in cortical homogenates by administering exogenous b-series gangliosides, a finding that may aid in developing therapeutic strategies targeting deficits in GD3S and other enzymes of ganglioside biosynthesis.

48. Investigating the comparability of wearable accelerometer methods in the association between physical activity and cardiovascular disease: a cohort study using UK Biobank.

期刊: Preventive medicine 发表日期: 2026-May-15 链接: PubMed

摘要

The selection of accelerometer processing methods may influence the shape of the dose-response association between wearable-measured physical activity and health outcomes. We aimed to compare the association of stroke and myocardial infarction with Moderate-Vigorous Physical Activity (MVPA) assessed by three accelerometer-generated metrics: Low-pass Filtered Euclidean Norm Minus One (LFENMO), machine-learning, and activity counts. We computed MVPA durations in the UK Biobank accelerometer sub-cohort recruited between 2013 and 2015 in the UK. The outcomes, incident stroke and myocardial infarction, were followed up until December 2022. We used Cox regression and a restricted cubic spline to estimate the dose-response association for each of the three MVPA metrics. There were 90,237 cardiovascular disease-free participants at baseline. We observed 1298 incident strokes and 2031 myocardial infarctions. For stroke, a linear decrease in hazard ratio was observed with machine-learning, but not with LFENMO and activity counts. For myocardial infarction, machine-learning and LFENMO showed a curvilinear decrease in hazard ratios, whereas activity counts showed a linear decrease. The dose-response associations between MVPA and cardiovascular disease varied markedly across the three accelerometer-derived MVPA metrics. Research using a single accelerometer metric may caution about the interpretation of the association.

49. Co-Exposure to PFAS, PFAS Alternatives, and Metals and Liver Function in Chinese Adults.

期刊: Environmental pollution (Barking, Essex : 1987) 发表日期: 2026-May-15 链接: PubMed

摘要

PER: and polyfluoroalkyl substances (PFAS) and their alternatives are recognized environmental hepatotoxins, yet their combined effects with metals on liver health in human populations remain underexplored. This study measured serum levels of 13 PFAS (including legacy and emerging alternatives such as Cl-PFESAs) and plasma levels of 25 metals, and evaluated their individual and joint associations with five liver function biomarkers (ALT, AST, ALP, GGT, and DBIL) among 1,263 adults in Guangzhou, China. Generalized additive models (GAMs) revealed that most individual pollutants were positively associated with liver function biomarkers, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and direct bilirubin (DBIL). Advanced Bayesian kernel machine regression (A-BKMR) analyses, employed to assess the joint associations of these complex mixtures, further demonstrated significant positive associations between the overall mixture of PFAS, alternatives, and metals and these biomarkers. Crucially, PFOS and PFHpS among the PFAS, alongside Pb, Cd, Tl, Zn, and Fe among the metals, were identified as the primary contributors to the observed mixture effect. These findings provide additional epidemiological evidence that co-exposure to PFAS (including emerging alternatives) and metals is adversely associated with liver health, highlighting the importance of assessing complex environmental mixtures. Further population-based studies are warranted, including studies measuring metals in matrices other than plasma, to validate these associations and elucidate underlying biological pathways.

50. EuroQol 5-Dimension 5-Level index value changes associated with clinically important functional improvement in individuals with traumatic spinal cord injury: insights from mean change analysis.

期刊: Archives of physical medicine and rehabilitation 发表日期: 2026-May-15 链接: PubMed

摘要

To quantify changes in the EuroQol 5-Dimension (EQ-5D) index value associated with clinically important functional improvement in patients with traumatic spinal cord injury (SCI). Secondary longitudinal analysis. SCI center in Japan using data from the Japan Single-Center Study for Spinal Cord Injury Database (JSSCI-DB). Patients with traumatic SCI registered in the JSSCI-DB between 2015 and 2024. Not applicable. The primary patient-reported outcome was the EQ-5D index value from the EuroQol 5-Dimension 5-Level questionnaire at two weeks and three months post-injury. As reference measures, we used previously reported minimal important change thresholds for the Spinal Cord Independence Measure version III (SCIM-III) subscale scores to compare EQ-5D index value changes between improvement and non-improvement groups. Patients were classified into improvement and non-improvement groups for the Walking Index for Spinal Cord Injury version II and for upper and lower extremity motor scores derived from the International Standards for Neurological Classification of Spinal Cord Injury motor score, based on established smallest real difference values; these were evaluated as supportive indices. Using these classifications, receiver operating characteristic analyses identified EQ-5D index value change thresholds. In patients with cervical SCI (American Spinal Injury Association Impairment Scale C/D), analyses using previously reported SCIM-III subscale MIC thresholds yielded EQ-5D index value change thresholds of 0.182 (95% confidence interval [CI]: 0.112-0.253) for “self-care” and 0.173 (95% CI: 0.107-0.284) for “respiration and sphincter management.” Other functional measures did not meet criteria for anchor validity and were not used to identify EQ-5D thresholds. In patients with cervical SCI with incomplete motor paralysis, this study quantitatively demonstrated the extent to which functional recovery is reflected in changes in EQ-5D index values. The findings provide reference thresholds to support clinical interpretation of EQ-5D index changes in the SCI field.

51. Novel polymyxin-resistant Klebsiella pneumoniae with ten resistance determinants and associated mutations drive localized outbreaks.

期刊: Journal of infection and public health 发表日期: 2026-May-14 链接: PubMed

摘要

To characterize the genomic features, resistance mechanisms and potential transmission chains of polymyxin-resistant Klebsiella pneumoniae (PR-KP). PR-KP isolates were retrospectively recovered from clinical specimens. Whole-genome sequencing (WGS) was performed, and transmission single-nucleotide polymorphism (SNP) profiling and core-genome phylogenetic analysis were used to reconstruct putative transmission chains. From June to October in 2023, among the 21 non-duplicate PR-KP isolates obtained from hospitalized patients (including ICU, with 96 beds), 85.71% (18/21) were derived from ICU patients, and 61.90% (13/21) were cultured from sputum samples. The KPC-2 phenotype was predominant, accounting for 85.71% (18/21) of the isolates, and was associated with near-pan-drug resistance. Core-genome alignment identified three clusters: cluster 1 (P7), cluster 2 (P15 and P18), and cluster 3 (comprising 18 highly homologous isolates). Multilocus sequence typing (MLST) further characterized these clusters, with cluster 3 identified as ST11. This genetic homology strongly indicates clonal transmission, suggesting horizontal spread and a localized hospital outbreak. Ten distinct genes associated with polymyxin resistance were identified, with mechanisms involving alterations in cell wall charge, proteins conferring antimicrobial resistance, and antimicrobial efflux pumps. Notably, acquired resistance in PR-KP was putatively acquired, including horizontally transferable genes such as MCR-3, basS-1, basS-2, basR, arnA-1, arnA-2, PmrE, PmrF, PmrC, and vanRF, which contributed to severe resistance phenotypes and significantly limited therapeutic options. Additionally, multiple non-synonymous mutations within these resistance genes resulted in 21 amino acid substitutions (e.g., Gly70Arg in basS-1). These mutations likely enhance the complexity of resistance development and dissemination. Genomic epidemiology confirmed an outbreak of ST11 PR-KP carrying multiple acquired resistance determinants. Horizontal gene acquisition and target-gene mutations drive high-level polymyxin resistance, underscoring the need for enhanced surveillance and infection-control interventions.

52. Identification and validation of cholesterol homeostasis and NK cell-associated predictive and therapeutic models for Coronary atherosclerotic heart disease patients with ST-elevated myocardial infarction: Insights from artificial intelligence and multi-omics.

期刊: Computational biology and chemistry 发表日期: 2026-May-14 链接: PubMed

摘要

Dysregulation of Cholesterol homeostasis(CH) and NK cells proportion can increase risk of ST-Elevated Myocardial Infarction(STEMI) for Coronary atherosclerotic heart disease(CAD) patients. Hence, it is necessary for the investigation of CH and MC in pathogenesis of STEMI for CAD patients, providing additional choice for the prevention of STEMI for CAD patients. By combining 5 peripheral blood bulk profiles of CAD patients with STEMI and integrative bioinformatic pipelines, such as ssGSEA, CIBERSORT, WGCNA, machine learning, consensus clustering, we first identified novel CH and NK cell(NCH)-associated molecular subgroup and hub genes for CAD patients with STEMI, and then estimated hub genes predictive performance for STEMI onset among CAD patients. Besides, the biological features of hub gene were estimated both in bulk and single-cell profiles of CAD patients with STEMI, especially in artificial intelligence(AI)-driven virtual cells. Indeed, AI-empowered therapeutic enrichment framework(DrugRefLector) and molecular docking were cross-performed for identification of optimal preventative agents targeting hub genes for CAD patients. Finally, in vitro study confirmed the differentially expressed level of hub genes. Integrated NCH can lead to the molecular stratification for CAD patients with AMI, which provides insights into the patient precision medicine. Besides, NAMPT and CLEC4D can be considered as up-regulated NCH-associated hub gene involved in STEMI pathogenesis of CAD patients with satisfied predictive efficacy, which was mainly distributed at NK cells. Novelty, BRD-K92455082 can be considered as optimal STEMI-preventative agent for the CAD patients by targeting NAMPT and CLEC4D. Our study provides integrative evidence suggesting a potential combined role of cholesterol homeostasis and NK cell-associated transcriptional programs of AMI for CAD patients, which offers novel insights into patient precision and personalized medicine.

53. Prevalence and predictors of bone density loss in men with low testosterone.

期刊: The journal of sexual medicine 发表日期: 2026-May-11 链接: PubMed

摘要

Low testosterone (T) is associated with several sequelae, including a high prevalence of bone density loss (BDL). We aimed to identify predictors of BDL in men with low T. The sample included (1) men ≥50 years old, (2) with low total T levels (<300 ng/dL using LCMS on 2 early morning blood draws), (3) who had dual-energy X-ray absorptiometry (DEXA) within 6 months of T measurement. Men with prior T therapy were excluded. On DEXA, osteopenia was defined as a T score between -1.0 and -2.5, and osteoporosis as a T score below -2.5. Additionally, demographics and comorbidity data were collected. We report BDL rates and identify predictors of any BDL using logistic regression. Bone density loss, which was defined as the presence of osteopenia or osteoporosis. Nine hundred ninety-seven men were analyzed, with a median age of 64 (IQR 59, 70) years. Median total T was 202 (IQR: 107, 256) ng/dL, median free T 5.8 (IQR: 4.3, 7.5) ng/dL. 24% had a total T ≤ 100 ng/dL. Thirty-three percent had ≥3 comorbidities. Seventy-four percent of our cohort had an oncological history; most of them had a history of prostate cancer. Bone density loss was present in 36% of the patients (89% osteopenia, 11% osteoporosis). On multivariable analysis, significant predictors of BDL were lower total T levels (OR = 1.09), older age (OR = 1.59), and the presence of ≥3 comorbidities (OR = 1.60). It is critical to be aware of the significant prevalence of BDL in men with low T. Early identification may enable targeted counseling, the initiation of preventive or therapeutic strategies to improve bone density outcomes, and the reduction of the risk of fractures and other serious skeletal complications. Limitations related to retrospective design, including selection bias and unmeasured confounding factors. Another limitation is that most cases had an oncological history. However, several strengths include the use of a large, systematically audited database; T labs were assessed using gold-standard methodology; and bone mineral density was assessed using a standardized scanning protocol. In our cohort of older men, most with oncological history and low T, around one-third had BDL, and around 10% of those with BDL had osteoporosis. Lower T levels, older age, and a greater number of comorbidities were significant predictors of BDL.

54. Perceived person-centered care and its association with outcomes in women with dyspareunia: a cross-sectional study.

期刊: The journal of sexual medicine 发表日期: 2026-May-11 链接: PubMed

摘要

55. 'Everywhere I turn, I'm blocked': a qualitative exploration of experiences of Charles Bonnet syndrome and its impact on physical activity and falls.

期刊: Age and ageing 发表日期: 2026-May-04 链接: PubMed

摘要

Charles Bonnet syndrome (CBS) refers to visual hallucinations that can occur following a decline in vision. Although vision loss increases fall risk and susceptibility to falls-related variables such as activity limitation, the potential contribution of CBS is unclear. The present study adopted a qualitative approach to explore experiences of CBS from different perspectives, including its impact on physical activity and falls. Semistructured interviews were conducted with 17 older adults living with CBS (mean age = 76 years) and 12 community falls and sight loss professionals. Reflexive thematic analysis guided data analysis. Themes represent the ‘CBS journey’ moving from symptom onset to living with CBS. Low CBS awareness, anticipated stigma and professionals’ failure to raise CBS had negative psychological impacts. While walking, recognisable images could evoke a behavioural response and delay insight. Falls occurred when CBS distracted attention from actual surroundings, automatic reactions led to a loss of balance, and panoramic hallucinations caused disorientation and obscured real hazards. CBS also contributed to concern about falling. While moving about, precipitating factors for CBS included fluctuations in light level and situational stress. Common relief techniques were least effective for people with intrusive symptoms. Instead, engaging in enjoyable multisensory activities or low to moderate physical activity for health provided relief. CBS adds an additional layer of complexity to the aetiology of sight-related falls. To reduce the risk of falls caused by CBS, a multifaceted strategy is indicated that addresses factors at the individual, organisational, educational and health care policy levels.

56. [Outcome Analysis of the Outpatient Pathway for Advanced Kidney Disease (MaReA): Focus on Dependent Patients].

期刊: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia 发表日期: 2026-Apr-30 链接: PubMed

摘要

Introduction. Chronic Kidney Disease (CKD) represents a global health challenge. The Advanced Kidney Disease Outpatient Program (MaReA) is an organizational model that prepares patients for renal replacement therapy (RRT), promoting informed choice and timely initiation of treatment. Peritoneal dialysis (PD) is a home-based therapy that offers greater autonomy, but its applicability depends on several factors. Objective. The purpose of this study is to analyze the outcomes of a MaReA program, with a specific focus on assessing suitability for PD, patient autonomy, and the role of the caregiver. Materials and Methods. A retrospective analysis was conducted on a cohort of patients with CKD stage 5 enrolled in the MaReA program. The analysis focused on suitability for PD, the outcome of the program for eligible patients, the degree of autonomy achieved, and the availability and type of caregiver for dependent patients. Results. The evaluation showed that 61.2% of patients were deemed eligible for PD. Among eligible patients who completed the program, a high rate of PD adoption was observed. For the proportion of dependent patients, the presence of a caregiver is essential. Conclusions. The MaReA program is an effective tool for identifying candidates for PD and adequately preparing them. Caregivers play a critical role in accessing home care for a subpopulation of frail patients. It is necessary to develop support strategies and implement telemedicine and assisted peritoneal dialysis programs to expand access to PD.

57. Salivary Bicarbonate Fails to Mirror Systemic Acid-Base Balance in Pediatric Patients at Risk of Metabolic Disturbances.

期刊: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia 发表日期: 2026-Apr-30 链接: PubMed

摘要

Introduction. The utility of salivary bicarbonate as a non-invasive marker of systemic acid-base status in pediatric patients remains unclear. This study investigated the possible correlation between salivary and blood gas analysis at risk for acid-base disturbances, including those with chronic kidney disease (CKD) or receiving acetazolamide. Methods. In a single-center cross-sectional study (July 2024-March 2025), 94 pediatric patients (6-18 years) underwent simultaneous blood and saliva sampling for gas analysis. Patients were stratified into metabolic acidosis (<22 mmol/L), normal (22-26 mmol/L), or metabolic alkalosis (>26 mmol/L) groups based on serum bicarbonate. Results. No relationship was observed between salivary and serum bicarbonate (r = 0.112, p = 0.281), pH, or base excess. However, strong correlations emerged within salivary parameters: bicarbonate was positively associated with salivary pH (r = 0.682, p < 0.001) and base excess (r = 0.865, p < 0.001). Patients with eGFR <30 ml/min/1.73m² had significantly higher salivary bicarbonate (13.6 mmol/L vs 6.8 mmol/L, p = 0.004), independently of bicarbonate supplementation. This was also negatively associated with calcium (β = -8.67, p = 0.004) and lactate (β = -0.82, p = 0.008). Dialysis status and underlying diagnosis were additional independent predictors. While patients with metabolic acidosis showed higher median salivary bicarbonate than those with normal or alkalotic profiles, this difference was not statistically significant (p = 0.545). Conclusions. Salivary bicarbonate does not reflect systemic acid-base balance but is elevated in advanced CKD, suggesting a local regulatory phenomenon worthy of further exploration.

58. Linguistic and Cultural Adaptation and Italian Validation of the Renal iNUT, a Nutrition Screening Tool for Hospitalized Patients with Chronic Kidney Disease.

期刊: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia 发表日期: 2026-Apr-30 链接: PubMed

摘要

Background/aim. Malnutrition is a frequent and serious issue among patients with chronic kidney disease (CKD), often leading to worse clinical outcomes. The Renal Inpatient Nutrition Screening Tool (Renal iNUT), originally developed in the United Kingdom, provides a quick and renal-specific method for screening hospitalized CKD patients. While a Spanish version has been adapted, no validated Italian translation is currently available. This study set out to translate and culturally adapt the Renal iNUT for application in Italian clinical contexts, as well as to evaluate its psychometric properties. Methods. The adaptation followed the methodological approach described by Sousa and Rojjanasrirat, proceeding through seven structured phases to secure conceptual, linguistic, and cultural equivalence. After a pilot phase with healthcare professionals, the tool was administered to hospitalized patients with CKD to assess both inter- and intra-rater reliability. Results. Feedback from the pilot testing indicated that the Italian Renal iNUT was clear, intuitive, and easy for clinicians to use in daily practice. Psychometric testing confirmed good intra-rater reliability [Intraclass Correlation Coefficients (ICC) = 0.83; 95% Confidence Interval (CI) 0.69 - 0.91] and excellent inter-rater reliability (ICC = 0.90; 95% CI 0.82-0.95). Total scores remained stable across repeated measurements [median = 2.0; Interquartile Range (IQR) 1.0 - 3.0/2.5]. Conclusions. Overall, the Italian version of the Renal iNUT demonstrated strong reliability and practical usability, supporting its use for nutritional screening in patients with CKD. Its implementation may help promote standardized nutritional screening and early nutritional interventions in Italian hospital settings, ultimately improving the quality of care and patient outcomes for individuals with CKD.

59. Fibronectin Glomerulopathy: A Case Report of Membranoproliferative Glomerulonephritis.

期刊: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia 发表日期: 2026-Apr-30 链接: PubMed

摘要

Background. Fibronectin glomerulopathy (FNG) is a rare autosomal dominant glomerulopathy characterized by proteinuria, hematuria, hypertension, and gradual progression to end-stage renal disease (ESRD) over 15-20 years. The disease is caused by mutations in the FN1 gene. Currently, there is no specific treatment for FNG. Case Report. A 22-year-old female presented with sub-nephrotic proteinuria and microscopic hematuria. Renal biopsy revealed mesangial expansion and electron-dense deposits consistent with FNG. Genetic testing confirmed a mutation in the FN1 gene (c.5773T>A, W1925R). No kidney disease was observed in patient’s parents; later genetic diagnosis was confirmed also in the patient’s brother. She was treated with conservative therapy. Three years later, her kidney function remained stable, with a serum creatinine of 0.5 mg/dL and proteinuria reduced to 0.7 g/24h. Discussion. FNG is caused by mutations in the FN1 gene, leading to abnormal fibronectin deposition in the kidneys. No specific treatment exists, but conservative therapy with ACE inhibitors may help slow disease progression. Steroid therapy is controversial, with limited success in preventing ESRD. Conclusion. Early diagnosis and conservative treatment are crucial for managing FNG. Further research is needed to explore effective therapies and better understand the disease’s progression.

60. Sodium Disorders in Multiple Myeloma: Beyond Pseudohyponatremia to Clinical Pitfalls and Mechanistic Insights.

期刊: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia 发表日期: 2026-Apr-30 链接: PubMed

摘要

Hyponatremia is a relatively frequent finding in multiple myeloma (MM) and may result from either pseudohyponatremia, due to marked hyperproteinemia, or true hyponatremia from genuine sodium-water imbalance. Differentiating between these two entities is essential, as they differ in pathogenesis, clinical relevance, and management. Pseudohyponatremia, observed in approximately 15-20% of MM patients, is a measurement artifact occurring with indirect ion-selective electrode techniques when plasma water fraction is reduced by high M protein levels. Serum osmolality remains normal, and no sodium correction is required. True hyponatremia (<135 mEq/L with hypo-osmolality) is less common but clinically significant, often associated with worse prognosis. Mechanisms include renal impairment (cast nephropathy, Fanconi syndrome, light chain deposition), hypervolemia from advanced renal failure, hypovolemia from gastrointestinal losses or diuretics, drug-induced effects (notably bortezomib, cyclophosphamide), and paraneoplastic SIADH. Alterations in electroneutrality and strong ion difference (SID) from highly cationic M protein may further lower sodium, usually mildly. Pseudohyponatremia is managed by controlling the underlying myeloma and reducing paraproteinemia. True hyponatremia treatment is etiology-specific: isotonic saline for hypovolemia, fluid restriction ± solute supplementation for SIADH, careful diuretic adjustment for hypervolemia, and withdrawal of causative drugs when possible. Optimal control of the plasma cell clone, through modern triplet or quadruplet regimens prevents recurrence. A structured diagnostic approach integrating volume status, laboratory evaluation, and medication review is critical to distinguish pseudo from true hyponatremia, prevent inappropriate interventions, and address the underlying disease.