公共卫生研究摘要 (2026-05-31)

共收录 60 篇研究文章

1. Maternal Immigrant Status and Mortality in Children With Congenital Heart Disease: A Population-Based Cohort Study.

期刊: Birth defects research 发表日期: 2026-Jun 链接: PubMed

摘要

This study examined the association between maternal immigrant status and survival of children with congenital heart diseases (CHD) in Ontario, Canada. A retrospective population-based cohort study of hospital live births between April 2002 to September 2020 in Ontario, Canada was conducted at the Institute for Clinical Evaluative Sciences. Multilevel Cox hazard regression models generated hazard ratios (HR) for the association between maternal immigrant status and child death while accounting for hospitals as a cluster factor and adjusting for maternal age at birth, neighborhood income and education quintiles, comorbidities, a composite of severe maternal morbidity, gestational age at birth, birth weight, infant sex and residential rurality among all CHD, severe CHD or single ventricle patients. Among children with any CHD, relative to children born to nonimmigrants, the adjusted HR was 1.17 (95% CI: 1.06-1.30) in children born to nonrefugee immigrants, and 1.33 (95% CI: 1.07-1.65) in those born to refugees. Similar patterns were observed in children with severe CHD, particularly within the single ventricle CHD subcohort, where the adjusted HR for children born to refugees was 2.01 (95% CI: 1.5-2.7) relative to those born to nonimmigrants. Health policy decision-makers should prioritize understanding the underlying causes of mortality in these populations to reduce health inequities.

2. Symptom Denial and Cultural Constraints: A Qualitative Exploration of Pre-Hospital Delay Determinants in Myocardial Infarction Patients in China.

期刊: Clinical cardiology 发表日期: 2026-Jun 链接: PubMed

摘要

To explore the pre-hospital delay experiences of myocardial infarction patients in China from a patient-centered perspective. Pre-hospital delay remains a globally prevalent issue, influenced by subjective and context-dependent factors that are not easily captured through quantitative methods. Traditional metrics may oversimplify the psychological processes involved and fail to account for individual variability and contextual influences. A descriptive qualitative study. Semi-structured interviews were conducted with MI patients at a tertiary hospital in Qingdao between November 18 and 30, 2024. Participants were selected through purposeful sampling. Thematic analysis was performed using MAXQDA software to code and analyze the qualitative data. The study followed the COREQ checklist. We interviewed 16 patients and conducted four core themes: (1) limited disease awareness, (2) inappropriate symptom response strategies, (3) constraints of traditional cultural beliefs and (4) family influence on decision-making, along with 12 subthemes. Patients’ pre-hospital delays frequently stem from cognitive limitations in symptom recognition coupled with maladaptive coping strategies contributes to treatment postponement. Notably, familial decision-making intervention demonstrates potential in mitigating such delays. And traditional Chinese culture exerts a profound influence on pre-hospital delays among elderly MI patients. Patients’ experiences of pre-hospital delay in myocardial infarction reveal its key determinants. Healthcare providers should develop targeted interventions tailored to patients’ cognition, culture, and family situations to enhance intervention effectiveness. Patients and family members contributed to the data collected.

3. Scientists' Warning to Humanity: Unnecessary Bureaucracy Is a Global Impediment to Productivity, Advancement of Human and Planetary Wellbeing, Science and Sustainability.

期刊: Microbial biotechnology 发表日期: 2026-Jun 链接: PubMed

摘要

Bureaucracies are essential to the proper functioning of almost all human activities. However, they are diverse in their quality and success-promoting potential. While many bureaucratic measures make sense and are necessary for the wellbeing and success of their organisations, some are unnecessary or ill-conceived/implemented, and yet others may harm system functioning and achievement. Unnecessary bureaucratic measures limit productivity, waste vital resources and drain workforces of engagement, enthusiasm, motivation, commitment and cohesion. (The term “unnecessary bureaucratic measures” used in this discourse is used in the sense of poor value and lacking a compelling basis-cost: benefit; see also GOV.UK 2020-but also includes poorly-conceived or -implemented measures, measures delegated to frontline and other workers that could/should be handled by the administrations, online tools promoted as reducing workloads but that in fact increase work and frustration because they are poorly designed and/or not subjected to adequate quality control.) They create frustration, anger and increased stress among those affected. Stress is considered by the World Health Organisation to be one of the foremost health crises of the 21st century. While the impact of unnecessary bureaucratic measures within an enterprise may go unnoticed by those not directly affected, the aggregate negative global impact on productivity, economic success and the wellbeing of workforces is concerning. Humankind is currently faced with a range of challenges, some existential, that urgently require solutions. Scientific research and discovery are generally considered to be major drivers of progress of humankind and a source of solutions to major problems and crises faced by society. Science innovation depends upon the creativity, originality and productivity of scientists. In the fields of biomedical sciences, the plant-agriculture-nutrition sciences, and the environmental sciences, progress in the past can be approximately quantified in terms of reduction in preventable human suffering, disease and premature death (as illustrated by the recent development of mRNA vaccines against the SARS-CoV-2 virus, which saved millions of lives), as well as the resulting socio-economic benefits. Unnecessary bureaucratic measures needlessly slow down research progress by diverting the time and effort of scientists from their essential tasks-creative thinking and research-to mundane tasks, and are responsible for delays in humanitarian improvements that translate into avoidable suffering and premature loss of life. Unnecessary bureaucracy is a global crisis of diversion from primary essential tasks, lowered human achievement and ensuing frustration, that is intertwined with and reinforces other problems, such as societal fragmentation. It requires a global response. A new, fit-for-purpose framework is needed that supports the functioning of bureaucracies and the necessary measures they impose, while constraining the imposition of unnecessary measures. Here, we consider some of the causes of unnecessary bureaucracy and measures needed to directly address these causes. These considerations lead us to propose an actionable solution strategy involving a Bureaucracy Charter and an implementation mechanism that will ensure best practice and adherence to the Charter. The rationale of this strategy incorporates key issues of benchmarking-best practice, transparency-accountability, oversight, stakeholder engagement-involvement, duty of care, Health in All Policies, and awareness and avoidance of cost externalisations.

4. Setting research priorities around the impact of COVID-19 control measures on people with dementia and caregivers living at home: A 14-country perspective.

期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2026-May-30 链接: PubMed

摘要

BackgroundThe global impact of COVID-19 restrictions on people with dementia (PWD) living at home and their informal caregivers has been described extensively. However, adoption of this knowledge into policy and practice is limited because of a lack of coordinated, inclusive, and regionally sensitive prioritization.ObjectiveTo establish key regional research priorities for Europe and the Global South.MethodsFollowing consensus-based prioritization methods, we applied a three-step approach: 1) a systematic literature review to derive a list of topics describing how PWD and caregivers were impacted by the COVID-19 restrictions; 2) an online survey distributed to PWD, caregivers and health care professionals (HCP) across 14 countries asking respondents to select the 10 most important topics; and 3) an iterative consultation process with stakeholders from each country to translate the top-ranked topics into a research agenda.ResultsWe identified 51 quantitative and 18 qualitative relevant publications, from which we derived 38 topics. 29 PWD, 110 caregivers and 117 HCP across 14 countries prioritized these topics, which largely overlapped across stakeholder groups and countries. The top ranked priorities cluster into four themes: daily routine and physical function, mental health, disease progression, and access to care. The consultancy process with stakeholders resulted in three lines of research to address these themes: understanding mechanisms, designing and improving education, and information access.ConclusionsThis research agenda offers a roadmap to guide future research and policy aimed at strengthening support for PWD and their caregivers in times of public health crises.

5. Compassion Fatigue and Spiritual Care Competence Amongst Palliative Care Nurses: A Moderated Mediation Model of Care Quality and Job Satisfaction.

期刊: Journal of clinical nursing 发表日期: 2026-May-30 链接: PubMed

摘要

To examine the association between compassion fatigue and spiritual care competence amongst palliative care nurses, investigate the mediating role of palliative care quality and determine the moderating effect of job satisfaction. Palliative care nurses face intense emotional demands and end-of-life stressors, increasing their risk of compassion fatigue and potentially affecting care delivery. Spiritual care competence is central to holistic palliative nursing; however, its association with compassion fatigue and the organisational factors shaping this relationship remain unclear. A cross-sectional, correlational study. Using a convenience sampling approach, 141 nurses working in palliative care units across hospitals in different regions of Türkiye were recruited. Data were collected between April and August 2024 via an online questionnaire including demographic variables and validated instruments measuring compassion fatigue, palliative care quality, spiritual care competence and job satisfaction. Data were analysed using SPSS and PROCESS macro. The mean spiritual care competence score was 107.9 ± 14.7. Compassion fatigue was negatively associated with palliative care quality and spiritual care competence, whereas palliative care quality was positively associated with spiritual care competence. Mediation analysis indicated a significant indirect association between compassion fatigue and spiritual care competence through palliative care quality. Moderated mediation analysis indicated that this indirect effect was significant only amongst nurses reporting higher job satisfaction. Compassion fatigue was negatively associated with palliative care nurses’ spiritual care competence. Mediation analysis suggested that this association was statistically explained by palliative care quality, whilst job satisfaction moderated the relationship between compassion fatigue and care quality. Addressing compassion fatigue as a critical occupational risk in palliative care nursing is essential. Organisational strategies that enhance job satisfaction and support high-quality care delivery may help sustain nurses’ spiritual care competence and promote high-quality palliative nursing practise. No patients or members of the public were involved in this study. Palliative care nurses participated by completing online questionnaires. This cross-sectional study was reported in accordance with the STROBE Statement.

6. Nurse and Social Worker Perceptions of Early Adoption of VA's Nationally Scaled Care Coordination Initiative.

期刊: Medical care research and review : MCRR 发表日期: 2026-May-30 链接: PubMed

摘要

Care coordination is increasingly evidenced to improve outcomes for patients with complex conditions. Accordingly, the Veterans Health Administration (VA) is expanding care coordination for ~1.5 million Veterans nationally at the highest risk for hospitalization and mortality. One large nationally mandated initiative, Care Coordination & Integrated Case Management (CCICM), provides a practice framework and structure for local facilities to adopt and accelerate care coordination efforts. We sought to characterize the experiences of lead coordinators (LCs) at VA sites during early adoption of CCICM. LCs expressed a common understanding and believed in the goals of CCICM, with wide agreement that Veterans benefit. The level of buy-in to the framework varied. When local CCICM leaders facilitated a collaborative approach, LCs more often embraced the role. Enthusiasm waned when a directive, top-down approach was taken. Providers often lacked awareness or understanding of CCICM, hindering coordination efforts. System-wide education about goals and potential gains of CCICM needs to be expanded.

7. Beyond epidemiology: Community, psychosocial and public health considerations in reducing asymptomatic Chlamydia trachomatis & Neisseria gonorrhoeae screening.

期刊: International journal of STD & AIDS 发表日期: 2026-May-30 链接: PubMed

摘要

Growing debate has emerged regarding the reduction of routine asymptomatic screening for gonorrhoea and chlamydia among gay, bisexual and other men who have sex with men (gbMSM), particularly within HIV pre-exposure prophylaxis (PrEP) populations. Existing evidence suggests that high-frequency screening may offer limited population-level benefit while contributing to antimicrobial exposure and resistance. Consequently, several authors and policy bodies have argued for more selective and stewardship-oriented approaches. This commentary argues that current debates remain dominated by epidemiological and microbiological framings of public health benefit, with insufficient attention to wider socioecological, psychosocial and community consequences. We highlight how asymptomatic STI screening functions not solely as a biomedical intervention, but also as a social practice embedded within community norms, healthcare engagement, reassurance and cultures of collective responsibility. Reductions in screening may therefore influence trust, stigma, healthcare-seeking behaviours and public health messaging in ways not captured through surveillance data alone. We argue that future screening policy changes should be developed through meaningful community engagement and evaluated using broader public health and socioecological frameworks alongside epidemiological evidence.

8. Prevention of heart failure.

期刊: European heart journal 发表日期: 2026-May-30 链接: PubMed

摘要

Heart failure (HF) remains a major cause of morbidity, mortality and costs for the healthcare systems worldwide, despite advances in diagnostic and therapeutic strategies. The enhancement of preventive measures is now a priority, but effective prevention requires a multidisciplinary strategy addressing a broad spectrum of comorbidities and risk factors. It must also consider the changes in the prevailing phenotype of the patients with HF with a lower impact of coronary artery disease and the increasing role of renal and metabolic conditions leading mostly to HF with preserved ejection fraction. Prevention of HF must take into consideration arterial hypertension, chronic kidney disease, diabetes mellitus, sedentary lifestyle, obesity, dyslipidemia, female-specific risk factors, as well as adverse effects of chemotherapy and radiotherapy. Other key factors include infections and the protective role of vaccination, and environmental and socio-economic determinants of health. In 2022, a position paper of the Heart Failure Association and the European Association of Preventive Cardiology of the ESC was published as a complete overview on this topic and as a compendium to the 2021 ESC Guidelines on HF. However, since then, significant evidence has emerged regarding the potential to prevent HF, particularly in the context of metabolic disorders, diabetes and kidney diseases. This scientific statement aims to provide an updated perspective, highlighting the importance of a holistic and tailored approach to managing the multifaceted contributors to this syndrome.

9. Comment on "Integrating preconception carrier screening into public health: lessons learned from a pilot implementation study".

期刊: Journal of assisted reproduction and genetics 发表日期: 2026-May-30 链接: PubMed

摘要

10. Multimodal machine learning for early risk stratification of post-stroke cognitive impairment.

期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2026-May-30 链接: PubMed

摘要

BackgroundPost-stroke cognitive impairment (PSCI) is a major vascular contributor to dementia, significantly impacting long-term recovery and quality of life. Developing accurate prediction models are essential for early identification and timely intervention in high-risk individuals.ObjectiveTo develop and validate a stacking-based multimodal machine learning model integrating clinical, demographic, and neuroimaging features for early PSCI prediction in acute ischemic stroke (AIS) patients.MethodsIn this retrospective cohort study, 1070 AIS patients admitted to Lianyungang First People’s Hospital from January 2020 to August 2023 were included. Demographic, clinical, and neuroimaging data were collected, and cognitive function was assessed 3-6 months post-stroke. PSCI was defined as a z-score ≤ -2.0 in at least one of four cognitive domains. A stacking ensemble model was developed, combining six base algorithms: XGBoost, Gradient Boosting Decision Trees, CatBoost, Support Vector Machine, Logistic Regression, and LightGBM. The final prediction was generated by a meta-model trained on base model outputs.ResultsOf the 1070 patients (mean age 67.4 ± 9.3 years, 61.5% male), 37.2% developed PSCI. The stacking model achieved 98.13% accuracy, 0.9972 AUC, and 0.9744 F1-score in internal validation. External validation showed 81.00% accuracy, 0.9049 AUC, and 0.8780 recall. Key predictors of PSCI included infarct volume, cortical lesions, medial temporal lobe atrophy, and baseline NIHSS score.ConclusionsThis stacking-based multimodal machine learning model demonstrates robust predictive performance for PSCI risk in AIS patients, serving as a reliable tool for early detection that may inform personalized intervention strategies to prevent progression to post-stroke dementia.

11. Bibliometric analysis of natural medicine in the treatment of Alzheimer's disease: Trends, hotspots, and emerging research fields.

期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2026-May-30 链接: PubMed

摘要

BackgroundAlzheimer’s disease (AD) is a progressive neurodegenerative disorder whose global prevalence continues to rise, yet treatment options are still limited. Natural medicines, with their potential for multi-target intervention, have become a key direction in AD drug development. However, a systematic overview of research trends in this field based on bibliometric methods is currently lacking.ObjectiveThis study aims to summarize research progress on natural medicines for AD treatment using bibliometric analysis and to identify future research hotspots and trends.MethodsRelevant publications were retrieved from the Web of Science Core Collection. Data visualization and analysis were conducted using VOSviewer, CiteSpace, and R.ResultsA total of 3800 publications were included, involving contributions from 108 countries/regions, 4024 institutions, 18,729 authors, and 706 journals. Publication output showed steady growth, with China and India as the leading contributing countries. Institutions such as the Chinese Academy of Sciences and Kyung Hee University demonstrated high productivity and influence. The research focus has shifted from initial clinical pharmacology and molecular pathology to exploring multi-target mechanisms of natural medicines through network pharmacology and molecular docking. Promising natural agents include Ginkgo biloba, ginseng, curcumin, resveratrol, and Centella asiatica.ConclusionsResearch on natural medicines for AD has progressed steadily over the past two decades, with current emphasis on elucidating multi-target mechanisms using emerging technologies. However, clinical evidence remains limited. Future studies should strengthen multi-omics integration and clinical translation to foster innovative AD prevention and treatment strategies.

12. UK Health Security Agency Syphilis Response Plan: Time for action.

期刊: International journal of STD & AIDS 发表日期: 2026-May-30 链接: PubMed

摘要

13. Recreational drug inhalation and socioenvironmental determinants of pulmonary infection in patients with HIV: a hospital-based case control study.

期刊: BMC public health 发表日期: 2026-May-30 链接: PubMed

摘要

Pulmonary infections cause substantial morbidity and mortality among people with HIV. Our objective was to evaluate common urban exposures among those living with HIV which may increase risk of pulmonary infection. We enrolled 75 adult patients infected with HIV and admitted to San Francisco General Hospital into a hospital-based case-control study: 38 cases with pulmonary infection and 37 controls admitted for diagnoses other than pulmonary infection. We administered questionnaires to assess inhaled drug exposures, outdoor and indoor pollution, and occupational exposures. We fit multivariable logistic regression models with pulmonary infection as the dichotomous outcome and each exposure as a primary predictor in separate models, including potential confounders based on biological plausibility and backward selection criteria. Participants were middle-aged (median age 48 years) and predominantly male (77%). Poverty was prevalent, with 79% unemployed and 27% unstably housed or homeless. Median CD4 count was lower in cases compared with controls (88 vs. 300 cells/µL, p = 0.005). Most cases were admitted with either bacterial pneumonia (76%) or Pneumocystis pneumonia (16%), and the most common admission diagnosis among controls was non-pulmonary infection (43%). 59% of participants had smoked tobacco cigarettes within the month prior to enrollment while 40% had recently smoked marijuana. In adjusted logistic regression models, tobacco smokers had six times higher odds of pulmonary infection (aOR 6.43, 95%CI 1.70-24.4) compared with non or former smokers, while those who had recently smoked marijuana experienced a 79% reduction in odds of pulmonary infection (aOR 0.21, 95%CI 0.06-0.78) compared with no recent marijuana smoking. Unstable housing or homelessness predicted a three-fold increased odds of pulmonary infection (aOR 3.22, 95%CI 1.01-10.3), whereas those sleeping on higher floors were at reduced odds of pulmonary infection, with each floor level above street-level predicting a 40% reduced odds of pulmonary infection (aOR 0.60, 95%CI 0.41-0.86). Finally, opening windows for ventilation was associated with reduced pulmonary infection odds (aOR 0.051, 95%CI 0.004-0.64). Pulmonary infection odds were increased with tobacco smoking and homelessness; and decreased among recent marijuana smokers, those sleeping on higher floors and opening windows for ventilation.

14. Weight Gain on Contemporary Integrase Strand Transfer Inhibitors and Tenofovir Alafenamide in Persons with HIV Starting Antiretroviral Therapy in the United States and Canada.

期刊: The Journal of infectious diseases 发表日期: 2026-May-29 链接: PubMed

摘要

Weight gain is common following antiretroviral therapy (ART) initiation. Integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) have been associated with greater weight gain, though prior analyses may have been confounded by the weight-suppressive effects of efavirenz (EFV) and tenofovir disoproxil fumarate (TDF). Treatment-naïve adults in the North American AIDS Cohort Collaboration on Research and Design initiating ART between 2007-2020 were analyzed. Predicted weight change was modeled using linear mixed effects models adjusted for demographic and clinical factors, and nucleoside reverse transcriptase inhibitor (NRTI) backbone, with sub-analyses excluding EFV and stratifying by INSTI agent, NRTI, sex, and race. 32,514 persons were included. At 2 years, INSTIs (4.9 kg, 95%CI 4.6-5.2) and protease inhibitors (PIs) (4.7 kg, 95%CI 4.4-5.1) were associated with greater mean predicted weight gain compared to non-nucleoside reverse transcriptase inhibitors (NNRTIs) (2.7 kg, 95%CI 2.4-2.9). Differences persisted when limiting analyses to TDF-containing regimens and excluding EFV. Among INSTIs, mean predicted weight gain was numerically highest with bictegravir (6.9 kg, 95%CI 5.8-7.9), followed by dolutegravir (5.3 kg, 95%CI 4.8-5.9), raltegravir (4.5 kg, 95%CI 3.8-5.3), and elvitegravir (4.0 kg, 95%CI 3.6-4.5). Participants receiving TAF with INSTIs gained more than those on TDF. Black females on bictegravir or dolutegravir with TAF had the highest gain at 2 years (10.0 kg, 95%CI 7.4-12.6). Weight gain with non-EFV NNRTIs was lower than with PIs and INSTIs, with the greatest increases observed among Black females starting TAF with contemporary INSTIs.

15. A Systematic Review on Classification, Exposure Pathways of Micropollutants in the Aquatic Environment, and Its Associated Human Health Risks.

期刊: Journal of applied toxicology : JAT 发表日期: 2026-May-29 链接: PubMed

摘要

Micropollutants are a diverse group of trace-level emerging contaminants present in different parts of the environment and causing notable risks to human health and aquatic life. They mainly originate from industrial, agricultural, pharmaceutical, and domestic sources, contaminating water bodies, where they induce toxicity in aquatic biota, bioaccumulate through food webs, and ultimately reach humans via ingestion, inhalation, and dermal exposure. Accumulating scientific research shows that exposure to micropollutants is associated with endocrine disruption, reproductive disorders, hormone-sensitive cancers, and dysfunction of the cardiovascular, respiratory, and immune systems. Their persistence, tendency to bioaccumulate, and chemically diverse modes of action further complicate their toxicological profiles. This systematic review evaluates findings from epidemiological, experimental, and molecular research published between 2000 and 2025 to provide a comprehensive perspective on micropollutant toxicity. Notably, it highlights critical research gaps, including inconsistent datasets, variation in defining chronic exposure, and limited investigation of combined or antagonistic effects of micropollutant mixtures. Addressing these gaps requires coordinated policy strategies, advances in remediation technology, and continuous scientific innovation to ensure public health protection and preserve the integrity of aquatic ecosystems. To bridge this gap, the present review proposes a systematic classification framework based on key sources, chemical nature, pathways, and ecotoxicological effects, while simultaneously elucidating their environmental dissemination in aquatic systems and characterizing their toxicological implications for both aquatic ecosystems and human health.

16. Sex-stratified epidemiological trajectories and predictive modeling of aortic aneurysm mortality in South Asia: A global burden of disease analysis (1990-2021) with advanced forecasting to 2050.

期刊: Medicine 发表日期: 2026-May-29 链接: PubMed

摘要

Aortic aneurysms are a growing public health concern in South Asia due to increasing cardiovascular risk factors and limited healthcare access. With South Asia experiencing rapid aging and limited cardiac care, forecasting aortic aneurysm mortality is critical for resource prioritization. This study analyzes historical mortality trends from 1990 to 2021 and projects future burdens to 2050, using data from 5 South Asian countries (Bangladesh, Bhutan, India, Nepal, and Pakistan), stratified by male and female subgroups, to guide evidence-based interventions. Using Global Burden of Disease 2021 data, age-standardized mortality rates (ASMR) for aortic aneurysms were extracted for South Asia (Bangladesh, Bhutan, India, Nepal, and Pakistan) from 1990 to 2021, stratified by sex. Joinpoint regression calculated average annual percent change (AAPC). Autoregressive integrated moving average models forecasted ASMR to 2030 and 2050. South Asia’s ASMR rose (AAPC: 1.9039%, 95% confidence interval [CI]: 1.7297-2.099). Country AAPCs: Bangladesh (1.2885%, 95% CI: 1.0986-1.4865), Bhutan (2.3303%, 95% CI: 2.2462-2.4155), India (2.1206%, 95% CI: 1.8661-2.4155), Nepal (2.2868%, 95% CI: 2.0628-2.5344), and Pakistan (1.5032%, 95% CI: 1.1631-1.8987). Male AAPCs higher (e.g., Nepal: 3.1369%, 95% CI: 2.9941-3.3051 and Bhutan: 3.0672%, 95% CI: 2.9625-3.1859) than female (e.g., Nepal: 1.5482%, 95% CI: 1.2213-1.9275). Peak annual percent change: 2012 to 2015 (South Asia: 4.0211%, 95% CI: 1.9534-4.462). ASMR 2021: South Asia 1.2204 (95% CI: 0.8788-1.7781). Projections 2050: South Asia 1.651 (95% CI: 1.367-1.934), males 2.284 (95% CI: 2.008-2.559), females 0.866 (95% CI: 0.457-1.276); Bhutan males 2.362 (95% CI: 1.1292-3.5942), and India females 0.8289 (95% CI: 0.3399-1.3179). Aortic aneurysm mortality is increasing, with male disparities driven by smoking and hypertension. Female stabilization reflects targeted interventions. Limitations include Global Burden of Disease data variability and forecasting assumptions. Recommendations: enhance diagnostics, male-focused smoking cessation, subnational studies. Policy action is critical by 2050.

17. Progress with accreditation and standards in the Middle east: the cases of the Jordanian Health Care Accreditation Council (HCAC) and Egyptian General Authority for Healthcare Accreditation and Regulation (GAHAR).

期刊: International journal for quality in health care : journal of the International Society for Quality in Health Care 发表日期: 2026-May-29 链接: PubMed

摘要

18. Diagnostic approach and management of patients with headache in Danish chiropractic practice.

期刊: Chiropractic & manual therapies 发表日期: 2026-May-29 链接: PubMed

摘要

Headache disorders are among the leading causes of disability globally. In primary care, including chiropractic practice, clinicians often serve as the first point of contact for patients seeking evaluation and management of headache. Despite this, limited evidence exists regarding how Danish chiropractors assess, diagnose, and manage headache in routine practice. This study aimed to examine how Danish chiropractors adopt a profession-specific clinical care standard, conduct clinical assessments, apply the ICHD-3 diagnostic criteria, and manage patients presenting with headache. A cross-sectional, questionnaire-based study was conducted between May 2022 and August 2022 among Danish chiropractors. The Danish Headache Questionnaire was used covering aspects such as diagnostic knowledge, clinical assessments and management. Descriptive statistics were used to characterise respondents and their clinical practices. A predefined threshold of ≥ 70% was applied to indicate acceptable adherence to the clinical care standard and sufficient familiarity with the ICHD-3 criteria. A total of 100 chiropractors completed the questionnaire, corresponding to a response rate of 14.4%. Self-reported data indicated that a larger percentage of Danish chiropractors demonstrate adequate knowledge of and adhere well to the clinical care standard. However, a proportion of respondents reported modest familiarity with specific elements of the standard and knowledge of red flags was limited. Overall familiarity with, and use of, the ICHD-3 diagnostic criteria was high. Management approaches largely aligned with guideline-supported strategies, with most chiropractors reporting the use of manual therapy, exercise, and patient education. In contrast, structured monitoring tools - such as headache diaries - were seldom used. Respondents generally appear to follow the profession-specific clinical care standard, demonstrate good familiarity with ICHD-3 criteria, and deliver guideline-aligned management for patients with headache. These findings suggest that chiropractors may play a meaningful role in primary-care headache management and potentially help reduce the burden on other health-care providers, although the low response rate warrants caution in generalising these findings. Identified gaps in knowledge and practice indicate a need for targeted postgraduate education, enhanced implementation strategies to support consistent use of clinical care standards and guidelines, and policy initiatives that facilitate the integration of chiropractors into interdisciplinary headache care pathways.

19. Technical and scale efficiency in health service production in Kenya: subnational analysis of 47 county governments.

期刊: Archives of public health = Archives belges de sante publique 发表日期: 2026-May-29 链接: PubMed

摘要

Kenya adopted a decentralized health system to improve access to care and accelerate progress toward universal health coverage (UHC). County governments now manage most health service delivery; however, the extent to which resources are used efficiently remains unclear. We compiled county-level data on health inputs, outputs, and contextual factors for 2022. Overall technical efficiency (OTE), pure technical efficiency (PTE), and scale efficiency (SE) were estimated using the single-step Simar and Wilson Data Envelopment Analysis (DEA) approach. Contextual determinants of efficiency were examined using truncated regression. Counties demonstrated moderate efficiency for child survival (OTE = 0.74; 95% CI: 0.70-0.78), indicating potential to improve outcomes by about 26% using existing resources. PTE averaged 0.85, suggesting that 15% of inefficiency stemmed from managerial factors, while SE averaged 0.87, reflecting a 13% loss attributable to suboptimal scale. For childhood immunization, the average OTE was 0.83 (95% CI: 0.81-0.87), implying that coverage could increase by 17% without additional inputs; uniformly high PTE points to strong managerial performance in immunization programs. Maternal survival showed the greatest inefficiency (OTE = 0.51; 95% CI: 0.48-0.55), with counties achieving only half of their potential. Efficiency for healthy life expectancy (HALE) was moderate (OTE = 0.83; 95% CI: 0.81-0.85), indicating scope for a 17% improvement without new resources. Substantial heterogeneity was observed across counties for all outputs. In 2022, maternal health services exhibited markedly lower efficiency than child health and immunization programs. The severe inefficiency in maternal service delivery, compared to child health and immunization programs, highlights an urgent need for targeted managerial strengthening in low-performing counties such as Kisii and Nyeri. Strengthening managerial capacity and optimizing scale of operations could yield major health gains without additional resources.

20. Pioneering leadership competencies for evidence-based nursing in China: a groundbreaking application of effective leadership theory.

期刊: BMC nursing 发表日期: 2026-May-29 链接: PubMed

摘要

Evidence-based nursing (EBN) is widely recognized as a cornerstone for improving the quality and safety of nursing care. Effective leadership is critical to the successful implementation of EBN; however, there is limited empirical understanding of the leadership competencies required to support EBN in complex healthcare systems, particularly in the Chinese context. This study aimed to identify and conceptualize the core competencies of effective leadership for EBN in China, drawing on leadership theory from the management sciences. A qualitative study design was employed using focus group discussions. Eight focus groups were conducted across multiple regions in China, involving nursing leaders, frontline nurses, and academic experts with experience in EBN practice, management, and education. Data were analyzed using thematic analysis, guided by an established leadership behavior framework encompassing task-oriented, relation-oriented, change-oriented, and external-oriented leadership behaviors. The analysis identified a comprehensive set of competencies required for effective EBN leadership across four interrelated dimensions. Task-oriented leadership competencies included defining EBN goals, planning context-sensitive initiatives, monitoring EBN implementation, and solving clinical problems with evidence. Relation-oriented leadership emphasized providing emotional support, fostering professional development, recognizing contributions, and empowering nurses to take ownership of EBN projects. Change-oriented leadership competencies focused on advocating for EBN integration, promoting innovation, and facilitating continuous learning within the team. Finally, external-oriented leadership involved networking with external experts, monitoring emerging evidence, and representing nursing in institutional decision-making. This study develops a theoretically grounded and context-sensitive framework of effective leadership competencies for evidence-based nursing in China. The findings demonstrate that effective EBN leadership extends beyond individual research knowledge to encompass relational, organizational, and system-level competencies. Although rooted in the Chinese healthcare context, the framework offers transferable insights for other countries facing similar organizational constraints and implementation challenges. The framework provides a practical foundation for nursing leadership development, education, and policy aimed at strengthening the implementation of EBN practice.

21. First molecular evidence of reptile-associated Borrelia spp. in tortoise bont ticks (Amblyomma marmoreum) collected in Zambia.

期刊: Medical and veterinary entomology 发表日期: 2026-May-29 链接: PubMed

摘要

Reptile-associated (REP) borreliae represent a distinct monophyletic lineage of spirochetes transmitted by hard ticks. These organisms have been reported in several regions worldwide, including South Africa, but had not been reported in ticks collected in Zambia until now. In this study, we screened for Borrelia spp. in Amblyomma marmoreum ticks collected from Leopard tortoises (Stigmochelys pardalis) in Southern Province, Zambia. Of the 87 tick DNA samples analysed, 74 (85.1%) were positive by Borrelia-specific real-time PCR. Subsequent BLASTn and phylogenetic analyses of flaB and 16S rDNA sequences confirmed that the detected Borrelia spp. belong to REP borreliae and are closely related to Borrelia sp. previously reported from South Africa. This study represents the first molecular confirmation of REP borreliae in A. marmoreum ticks collected in Zambia and expands the known distribution of these spirochetes. The findings underscore the need for further investigations on their ecology and epidemiology to better understand the public and animal health relevance and transmission dynamics of REP borreliae in reptile-associated tick populations.

22. Effects of different warming strategies on intraoperative hypothermia: a systematic review and network meta-analysis of randomized controlled trials.

期刊: BMC anesthesiology 发表日期: 2026-May-29 链接: PubMed

摘要

The purpose of this network meta-analysis was to assess the effect of different active warming strategies on intraoperative hypothermia (IH). Databases of PubMed, Web of Science, Embase, and Cochrane Library were searched for randomized controlled trials that were published from 1 January 2015 to 20 September 2025. The incidence of IH was the primary outcome. A total of 45 studies comprising 5317 patients were included in this study. Among the single warming strategies, both thermal suit [RR = 0.45, 95% CI (0.16, 1.27)] and irrigation fluid warming [RR = 0.95, 95% CI (0.27, 3.30)] demonstrated a numerically lower incidence of IH compared with forced-air warming (FAW). For FAW blanket type, the incidence of IH in FAW-Lower-body [RR = 1.54, 95% CI (1.17, 2.04)] and FAW-Surgical-access blanket [RR = 1.44, 95% CI (1.01, 2.06)] was significantly higher than that in FAW-Underbody. Compared with FAW alone, multiple combined warming strategies without prewarming exhibited numerically reduced IH incidence, such as irrigation fluid warming + intravenous fluid warming + FAW [RR = 0.44, 95% CI (0.04, 4.40)]. Compared with FAW alone, prewarming + FAW showed significantly lower IH incidence [RR = 0.66, 95% CI (0.45, 0.96)]. FAW remains the pragmatic standard for preventing IH, with the underbody type preferred whenever clinically feasible. We conditionally recommend combining FAW with prewarming and fluid warming in high-risk contexts (particularly for older patients and prolonged surgery), although wide prediction intervals suggest these added benefits should be interpreted cautiously. PROSPERO Registration Number: CRD420251148645.

23. Implementation of comprehensive genome analysis in clinical sequencing at an academic institution.

期刊: Journal of human genetics 发表日期: 2026-May-29 链接: PubMed

摘要

Given the increasing number of diseases for which causative genes have been identified, we are facing the need for implementing comprehensive genome sequence analysis as a molecular diagnostic system for patients with hereditary diseases in daily clinical practice. We established a laboratory-developed test (LDT) with the implementation of whole-exome sequence analysis (WES) as the clinical sequencing system at an academic institution. WES was conducted on 81 patients with suspected hereditary disorders referred from clinical departments in our hospital from 2021 to 2024. Target genes were selected on the basis of the clinical presentations of the patients and expanded when necessary. Additional analyses, including copy number and zygosity analyses, further improved the diagnostic accuracy. The overall diagnostic yield was 42.0%, excluding four patients with transthyretin cardiac amyloidosis confirmed as wild-type ATTR Amyloidosis (ATTRwt). High diagnostic yields were associated with the presence of family histories. Secondary findings were searched in 73 patients, and pathogenic or likely pathogenic variants were disclosed to three patients, leading to their subsequent clinical follow-up. Internal and external quality controls ensured analytical reliability. This study demonstrates that the implementation of LDT-based comprehensive genome analysis is highly useful in daily clinical practice, achieving a high diagnostic yield comparable to those in previous large-scale studies; furthermore, the clinical sequencing seamlessly harmonizes the research-level investigations, providing highly valuable results. Broader insurance coverage will be essential for expanding equitable access to the genetic tests based on comprehensive genome sequence analysis.

24. Author Correction: Attenuated fusogenicity and pathogenicity of SARS-CoV-2 Omicron variant.

期刊: Nature 发表日期: 2026-May-29 链接: PubMed

摘要

25. Rapid and reliable computational markers of decision-making for predicting daily smoking behavior and smoking cessation treatment outcomes.

期刊: Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology 发表日期: 2026-May-29 链接: PubMed

摘要

Addiction involves rapidly fluctuating affective and value-based decision-making processes that undermine cessation efforts, yet capturing these dynamics at clinically meaningful timescales remains challenging. Standard cognitive decision-making tasks are time-intensive and require many trials to achieve reliable parameter estimates, limiting their use longitudinally and in real-world settings. Here, we developed a rapid, smartphone-based framework that integrates ecological momentary assessment (EMA) with adaptive design optimization (ADO), a Bayesian method that enables reliable estimation of computational decision-making parameters from as few as 20-30 trials per task. We tested this framework in N = 79 individuals undergoing a 5-6-week smoking cessation program, who completed daily ADO-based delay discounting and risk/ambiguity tasks alongside EMA surveys assessing smoking behavior, craving, stress, mood, anxiety, and medication adherence. At the day-to-day level, elevated craving, depressive symptoms, and ambiguity tolerance predicted increased smoking the following day, whereas lower discounting rates and reduced craving and stress predicted cessation success at treatment completion. For the latter, models using data from the first week achieved meaningful predictive performance (mean AUC = 0.76), approaching the upper-bound performance observed in models incorporating both task and survey data from the full study period (mean AUC = 0.83). Together, these findings demonstrate that rapid, low-burden, ADO-based delivery of decision-making tasks via EMA can capture clinically relevant, dynamic vulnerability states during smoking cessation treatment. This methodology offers a promising approach for identifying cognitive markers that may facilitate or inhibit cessation success and informing personalized, time-sensitive intervention strategies for nicotine addiction and related psychiatric disorders.

26. Structural basis for auto-inhibition of the Rac1/Cdc42 guanine nucleotide exchange factor DOCK6 by oligomer formation.

期刊: Communications biology 发表日期: 2026-May-29 链接: PubMed

摘要

The guanine nucleotide exchange factor DOCK6 is important for neurite outgrowth, as well as cell migration and invasion, through the activation of Rac1 and Cdc42-members of the Rho family of GTPases that regulate the actin cytoskeleton. However, the precise molecular mechanisms by which DOCK6 regulates the intracellular GTPase signaling remain unclear. Here, we present cryo-electron microscopy structures of DOCK6 alone and in complex with Rac1 and Cdc42. The DOCK6-Rac1 and DOCK6-Cdc42 complexes exhibit similar homodimeric structures, with local differences in the catalytic domain of DOCK6 owing to distinct interactions with Rac1 and Cdc42. In contrast, apo-DOCK6 exhibits a closed auto-inhibited conformation in tetrameric and octameric assemblies, with the catalytic and membrane-binding domains contacting each other between two DOCK6 dimers. High-speed atomic force microscopy reveals transitions among multiple oligomers in solution. Biochemical and cellular functional analyses demonstrate that the N-terminal region of DOCK6 plays an auto-inhibitory role, supporting the structural findings. Overall, we propose a mechanism by which DOCK6 activity is spatiotemporally regulated within cells through oligomerization. These findings provide a framework for future studies of DOCK-family GEFs and their broader roles in cell regulation and human disease.

27. Evaluating the Impact of Surgeon Preference Card Age on Surgical Waste and Costs.

期刊: Surgical innovation 发表日期: 2026-May-29 链接: PubMed

摘要

BackgroundDisposal of unused surgical items exacerbates the environmental footprint and costs of hospitals. Surgeon preference cards (SPCs), which specify equipment needed for surgeries, impact inventory control and wasted supplies. This study assessed the effect of SPC age on surgical waste and costs, and examined staff attitudes towards SPC systems.MethodsA random selection of elective surgeries was observed in four operating theatres (March - October 2023) at a regional public hospital in New South Wales, Australia. Wasted items per procedure and the age of SPCs were recorded. Waste cost calculations were based on hospital records. An online survey measured perioperative nursing staff and surgeon attitudes. Data analysis involved simple linear regression, descriptive and summary statistics.ResultsData from 35 of 1456 (2.4%) elective surgical procedures showed that 285 single use items were unused (median 2 per procedure, IQR 7). Each year the SPC aged, 1.6 additional items were wasted (95% CI 1.3-1.9, P < 0.01). The total waste from unused single-use items amounted to 22.4 kg (18.7 kg general waste, 1.9 kg sharps waste, and 1.9 kg recycled) and purchase price totalled $3543.07 AUD. Survey respondents (n = 36) expressed mixed opinions about the current SPC system, with concerns about waste, cost, and environmental consequences. They favoured an electronic system for its potential to enhance efficiency and patient safety but noted barriers such as resource constraints and costs.ConclusionUpdating SPCs is an effective strategy to minimise surgical waste and costs. Hospitals using paper based SPCs should consider transitioning to electronic systems for better sustainability.

28. Machine learning identifies traffic-related pollutant mixtures as potential factors suggestive of association with osteoporosis in a cross-sectional analysis of NHANES.

期刊: Medicine 发表日期: 2026-May-29 链接: PubMed

摘要

The combined effect of traffic-related pollutant mixtures on osteoporosis (OP) remains unclear. This study aimed to evaluate such associations using machine learning and mixture modeling approaches. A cross-sectional analysis was conducted among 3053 participants from the National Health and Nutrition Examination Survey 2015 to 2018. Eighteen exposures were assessed, including heavy metals, polycyclic aromatic hydrocarbons, phthalates, per- and polyfluoroalkyl substances, volatile organic compounds, diesel exhaust, and behavioral factors. OP was defined by femoral neck bone mineral density T-score ≤-2.5. Weighted quantile sum regression and 5 machine learning models were applied, accounting for complex survey design. OP prevalence was 12.97%. Weighted quantile sum regression showed a positive but nonsignificant mixture odds ratio (odds ratio = 1.21; 95% confidence interval: 0.77-2.63; P = .412). The largest positive weights were daily outdoor work duration (0.240) and occupational diesel exhaust (0.136). Random forest identified female sex, age, vitamin D, blood lead, and body mass index as top predictors. Least Absolute Shrinkage and Selection Operator achieved the highest test area under the receiver operating characteristic curve (0.81) with the lowest cross-validation standard deviation (0.0167). Its coefficients highlighted occupational diesel exhaust (β = 0.40) as a notable environmental factor alongside female sex (β = 0.95) and age (β = 0.70). Traffic-related pollutant mixtures showed a cross-sectional association with OP in a nationally representative US population, with occupational diesel exhaust and prolonged outdoor work emerging as key contributors in mixture models. However, the nonsignificant overall mixture effect and potential for reverse causation warrant caution in interpretation. These findings support considering environmental and occupational factors in OP prevention, although the overall mixture effect did not reach statistical significance.

29. Co-occurrence of acute leukemia and type 1 diabetes among children: a detailed case-series.

期刊: Journal of medical case reports 发表日期: 2026-May-29 链接: PubMed

摘要

Leukemia is the most common malignancy in children, while type 1 diabetes mellitus (T1DM) is one of the most prevalent autoimmune diseases among children. The etiology of both conditions is still largely unexplained, yet emerging evidence suggests certain similarities in environmental exposures and genetic predispositions. In this case-series, we sought a new potential factor behind the co-occurrence of leukemia and T1DM by thoroughly reviewing the medical records of patients diagnosed with both diseases. We conducted a retrospective case series at Tampere University Hospital, Finland, by identifying pediatric patients diagnosed with both acute leukemia and T1DM from 1990 to 2023 using (International Classification of Diseases-10th revision) ICD-10 codes. Clinical and laboratory data, including leukemia subtype, age at diagnosis, treatments, comorbidities, and medical history, were collected, reviewed and analyzed descriptively. Study protocol was locally approved, and patient health data privacy was respected. Among 12 initially identified cases, seven met the inclusion criteria. Five cases were diagnosed with B-cell acute lymphoblastic leukemia (B-ALL), one with T-cell ALL (T-ALL), and one with acute myeloid leukemia. The mean age at leukemia diagnosis was 8.7 years (range from 0.7 to 15.3), while the mean age at T1DM diagnosis was 11.8 years (range from 7.5 to 17.8). In five cases, leukemia preceded T1DM, with two cases linked to asparaginase-induced pancreatitis. In two cases, T1DM developed before leukemia. Additional comorbidities included Down syndrome, Sotos syndrome, celiac disease, epilepsy, and Sweet’s syndrome. This case-series presents findings, which align with previous observations (e.g., Down syndrome, pancreatitis), though a less often reported finding, Sotos syndrome, was also observed.

30. Traumatic spinal cord injury in Jinan, China: A 10-year hospital-based retrospective observational study of 1134 cases.

期刊: Medicine 发表日期: 2026-May-29 链接: PubMed

摘要

Traumatic spinal cord injury (TSCI) imposes a substantial clinical and public health burden, yet contemporary epidemiological data from northern China are limited. This study aimed to describe the epidemiological characteristics of TSCI in Jinan, an urban-rural integrated city in northern China. We conducted a hospital-based retrospective observational study of patients with TSCI admitted to the 960th Hospital of the PLA and Qilu Hospital of Shandong University between 2015 and 2024. Medical records of 1134 patients were reviewed. Collected variables included sex, age, marital status, occupation, time of injury, etiology, neurological level of injury, American Spinal Injury Association grade, complications, concomitant injuries, treatments received, and length of hospital stay. Descriptive statistics were used to summarize the data. The mean (standard deviation) age was 62.0 (18.6) years (95% confidence interval, 60.9-63.1), and the male-to-female ratio was 3.69:1. Falls were the leading cause of injury (46.0%), including low-level falls (25.8%) and high-level falls (20.2%), followed by traffic accidents (40.7%). The cervical spine was the most frequently injured region. During hospitalization, 500 of 1134 patients (44.1%) developed complications, most commonly pulmonary infections (16.5%) and urinary tract infections (13.6%). Surgical intervention was performed in 88.9% (1009/1134) of patients. In this 10-year hospital-based series from Jinan, most patients with TSCI were older men, with 61 to 75 years being the most common age group. Falls and traffic accidents were the predominant etiologies. Farmers represented the highest-risk occupational group. Prevention strategies should particularly target fall risk among older adults and electric bicycle-related injuries among young men. These findings highlight the need for tailored injury-prevention measures and underscore the crucial role of rehabilitation in the long-term management of TSCI.

31. From 'droplet' to 'respiratory' precautions: implementation and adherence monitoring in a Swiss tertiary care center, 2023-2025.

期刊: Antimicrobial resistance and infection control 发表日期: 2026-May-29 链接: PubMed

摘要

Following updated 2023 guidance from the European Centre for Disease Prevention and Control (ECDC), and in parallel with recommendations from the Swiss Center for Infection Control, a tertiary care centre in Switzerland replaced droplet precautions with ‘respiratory precautions’ on 1 November 2023. A multifaceted strategy was implemented to facilitate the transition to this updated transmission-based precaution. We aimed to describe the implementation of and adherence to respiratory precautions between November 2023 and March 2025. From October 2023 to March 2024, a multifaceted, hospital-wide strategy was implemented to introduce changes in infection control policy with updated respiratory precautions, including standardized training, educational materials, a communication campaign, updated signage and prescription orders. Adherence to the updated respiratory precautions was audited during two periods: January-March 2024 and October 2024-March 2025. A total of 150 training sessions on infection control precautions were conducted for 1967/9410 (21%) healthcare workers and 2913 pocket cards summarizing updated precautions were distributed. Among 793 audits conducted, there was high adherence to recommended patient placement and signage (89-99%). Availability and suitability of placement for FFP2 respirators and eye protection were initially low but improved during the second audit (59% and 36%, respectively). FFP2 use was 76%, while use of eye protection remained low (38%), potentially due to limited availability and suitable placement. A structured, multifaceted strategy -combining training, audits, and feedback - supported the implementation of a change in respiratory precautions, achieving high adherence overall.

32. Seven-year surveillance of latent tuberculosis infection using interferon-gamma release assay among health workers at a large tertiary hospital in Thailand.

期刊: Journal of occupational medicine and toxicology (London, England) 发表日期: 2026-May-29 链接: PubMed

摘要

Despite ongoing TB control efforts, health workers (HWs) in Thailand remain at risk for latent tuberculosis infection (LTBI), yet the burden of LTBI in Thai HWs is insufficiently characterized. This study aimed to determine LTBI proportions across preplacement, post-exposure, and annual screening approaches, and to identify factors associated with LTBI among HWs. This retrospective analysis (2016-2022) utilized secondary data from an LTBI surveillance program at a large Thai tertiary hospital. HWs underwent LTBI screening with interferon-gamma release assays (IGRAs) through three surveillance approaches: preplacement, post-exposure, and annual screening in high-risk units (2021-2022). LTBI was defined as IGRA-positive in the absence of active TB. Demographic and exposure characteristics were recorded; associations were analyzed using chi-square and Mann-Whitney U tests. An exploratory restricted analysis using multivariable logistic regression was also performed to assess between-cohort patterns. Between 2016 and 2020, LTBI was detected in 198 of 1,823 HWs (10.9%; 95% CI: 9.5-12.4). Preplacement screening identified LTBI in 96 of 1,230 HWs (7.8%; 95% CI: 6.5-9.5), while post-exposure surveillance detected LTBI in 102 of 706 HWs (14.4%; 95% CI: 12.1-17.2). Annual surveillance (2021-2022) yielded 47 cases among 626 HWs (7.5%; 95% CI: 5.7-9.8). Among HWs diagnosed with LTBI in the preplacement and post-exposure cohorts, 40.9% of LTBI cases initiated TB preventive treatment. In post-exposure surveillance, older age and higher exposure-priority categories were associated with LTBI, although estimates for priority categories were imprecise because of sparse data. LTBI remains an important occupational health concern among HWs, with the highest detection proportion observed during post-exposure surveillance. These findings highlight the ongoing need for targeted, risk-based monitoring and efforts to enhance TB preventive treatment uptake in healthcare settings.

33. Long-term exposure to polystyrene microplastics exacerbates seizure symptoms via lipid metabolic disruption and ferroptosis: insights from multi-omics analyses.

期刊: Journal of nanobiotechnology 发表日期: 2026-May-29 链接: PubMed

摘要

As a consequence of global industrial growth, microplastics (plastic fragments < 5 mm) have become ubiquitous environmental contaminants, prompting serious questions about their impact on human health. Beyond the established risks of ingestion, the inhalation of these airborne particles is now a primary focus, especially regarding potential effects on the neurological system. Emerging evidence from laboratory and animal models shows that inhaled microplastics can penetrate the brain. Once there, they can trigger a cascade of harmful effects, including neuroinflammation, oxidative stress, and deficits in learning and memory. Among the general population, children are uniquely vulnerable to microplastic exposure due to their developing physiological systems, which are particularly susceptible to the chemical and physical hazards posed by these particles. Nevertheless, current scientific understanding of the health consequences of microplastic exposure remains limited, with a substantial knowledge gap concerning the long-term effects of respiratory microplastic exposure on pediatric populations, particularly those with pre-existing neurological conditions such as epilepsy. This study investigates the relationship between chronic respiratory exposure to polystyrene microplastics and seizure severity, with the aim of establishing a potential exposure-metabolite-gene regulatory network. We hypothesize that prolonged respiratory mciroplatsic exposure induces systemic oxidative stress and inflammation, which subsequently disrupts lipid metabolism, alters gene expression profiles, triggers ferroptosis, and ultimately exacerbates seizure manifestations.This study highlights three key findings. First, chronic respiratory microplastic exposure induces systemic oxidative stress and inflammation, posing substantial health risks. Second, integrated metabolomics and Mendelian randomization analyses reveal that this exposure disrupts lipid metabolism, with metabolic perturbations strongly associated with ferroptosis activation and increased seizure severity. Third, multi-omics approaches coupled with in vivo validation confirm that microplastics disrupt lipid homeostasis, dysregulate ferroptosis-related gene expression, and exacerbate seizure manifestations. Notably, our data identify melatonin as a promising therapeutic candidate for mitigating these adverse effects. Collectively, these findings substantially advance the understanding of microplastic-induced neurotoxicity and reveal actionable molecular targets for potential therapeutic interventions.

34. Out-of-hospital cardiac arrest in three EMS centers in northern and central Thailand: a mixed-methods call for a national data infrastructure.

期刊: BMC emergency medicine 发表日期: 2026-May-29 链接: PubMed

摘要

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality in Thailand, yet national response to the issue remains fragmented and under-prioritized. There is no centralized OHCA registry, neurological outcome data are almost entirely absent, and coordination between EMS and hospitals is weak. This limits Thailand’s ability to evaluate performance, guide investments, or improve survival. We conducted a convergent mixed-methods study combining retrospective analysis of OHCA registry data (n = 2,259) from three hospital sites participating in a regional OHCA registry (2017-2023) with in-depth qualitative interviews across EMS, hospital, and policy stakeholders. Quantitative data were analyzed for trends in bystander CPR, response and scene times, and outcome tracking. Qualitative data were thematically coded to identify structural and operational barriers to data use and system integration. Neurological outcome data were available for only 16.4% of patients who were alive at 30 days. EMS teams had limited access to in-hospital outcome information, and hospitals did not routinely track functional recovery. One suburban-capital hospital showed measurable improvement using internal data to reduce scene times and increase bystander CPR. However, systemic fragmentation undermined scalability. Across sites, EMS and hospital data systems were not interoperable, and OHCA care was inconsistently prioritized. Thailand’s OHCA system shows both promise and constraint. These findings highlight the need for improved data infrastructure, including standardized outcome tracking, better linkage between EMS and hospital systems, and clearer governance. Local successes can serve as models, but only with political will, shared infrastructure, and clear governance. A national OHCA data strategy is essential to improve survival and achieve equitable care.

35. Global and high-income regional burden and healthcare costs of musculoskeletal diseases, 1990-2023.

期刊: Annals of the rheumatic diseases 发表日期: 2026-May-29 链接: PubMed

摘要

This study aimed to clarify the latest epidemiologic trends, economic costs, and key drivers of musculoskeletal disorders (MSDs) in high-income regions, where the disease burden has increased despite high overall healthcare spending. Utilising data from the Global Burden of Disease 2023 database, we analysed the trends in incidence, prevalence, and years lived with disability (YLDs) for MSD across 36 high-income countries from 1990 to 2023. Bayesian meta-regression models were employed to quantify the burden attributable to major risk factors. A cross-national transfer model was used to estimate the direct healthcare economic costs associated with MSD in 2023. Spearman correlation analysis was applied to explore the relationship between the Sociodemographic Index (SDI) and disease burden, and trends in disease burden were forecasted for the period 2024 to 2050. Between 1990 and 2023, the total number of incident cases, prevalent cases, and YLDs for MSD in high-income regions increased by 36.75%, 54.28%, and 49.36%, respectively. Although the age-standardised incidence rate decreased by 4.07%, the standardised prevalence and YLD rates increased by 5.04% and 3.98%, respectively, indicating a continuously growing absolute disease burden. Low back pain and osteoarthritis accounted for the largest proportion of the disease burden. For all MSD subtypes except gout, the burden was higher in females than in males. In 2023, the direct medical costs associated with MSD reached as high as $327.68 billion, with the United States accounting for >45% of this amount. Regarding risk factors, the proportion of YLDs attributable to high body mass index increased from 8.3% in 1990 to 10.7% in 2023. The contribution of occupational ergonomic factors remained stable at approximately 7.7%, whereas the smoking-related burden decreased by 30%. Correlation analysis revealed no significant association between the SDI and the age-standardised burden rates of MSD. The burden of MSD in high-income regions continues to intensify, driven primarily by ageing, obesity, and occupational factors, and has not been alleviated by economic development. Future prevention and control efforts should focus on weight management and occupational ergonomic interventions to curb the growth of the disease and mitigate the substantial economic pressure.

36. "See What I Mean?" Linguistic Digital Markers of Cognitive Decline in Nursing Home Residents.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-26 链接: PubMed

摘要

Cognitive decline in nursing homes is often under-recognized. Access to specialized neuropsychological assessments, which involve detailed evaluations of how the brain influences behavior and thinking, is often limited. In this study, we examined the feasibility of administering an ecological reading task, involving reading activities that imitate real-life situations, in a real-world nursing home setting. We also explored whether reading-derived linguistic metrics and measures of language use during reading, along with an eye-tracking component that monitored participants’ eye movements, were associated with cognitive impairment. This cross-sectional observational pilot study included 60 nursing home residents aged 65 years or older, classified as either cognitively impaired (CI, n = 30) or healthy control (HC, n = 30) based on neuropsychological profiles and clinical evaluations. All participants completed the Mini-Mental State Examination (MMSE), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Frontal Assessment Battery (FAB), Geriatric Depression Scale (GDS), Barthel Index, and Cognitive Reserve Index questionnaire (CRIq). The reading task involved reading aloud a 177-word Italian passage followed by eight comprehension questions. Primary outcomes were total reading errors (TRE), total comprehension errors (TCE), and words per minute (WPM). Eye-tracking data (Gazepoint GP3, 60 Hz) were available for a subsample with usable calibration and validation data (CI: n = 26; HC: n = 24). Analyses included descriptive comparisons, covariate-adjusted generalized linear models, receiver operating characteristic (ROC) analyses, and partial Spearman correlations. All 60 participants completed the task. Usable audio recordings were obtained for everyone, and usable eye-tracking data were available for 50 participants. The CI group showed higher TRE and TCE, lower WPM, and longer reading times compared with the HC group. In models adjusted for gender, age, education, GDS, Barthel Index, and CRIq, TCE showed the strongest association with CI status (odds ratio [OR] = 11.108, 95% CI 2.662-246.186, p = 0.024), and TRE was also associated with CI status (OR = 1.238, 95% confidence interval [CI] 1.054-1.629, p = 0.045). ROC analyses showed high areas under the curve (AUCs) for TCE (0.982), TRE (≈0.95), and audio-based WPM (0.936). In the eye-tracking subsample, timing-related measures also showed good discrimination (AUC = 0.960 for eye tracking [ET]-WPM; 0.942 for ET-Total Reading Time), whereas conventional first-order oculomotor metrics did not differ significantly between groups. An ecological reading task was feasible within a nursing home setting. It generated reading-derived linguistic metrics linked to cognitive impairment and broader cognitive-functional status. Measures related to comprehension, overall reading error load, and reading speed were shown to be useful as digital linguistic markers.

37. Activation of the p62/Keap1/Nrf2 Pathway Protects Against Ferroptosis in Cerebral Ischemia-Reperfusion Injury.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-26 链接: PubMed

摘要

Protein p62 interacts with Kelch-like ECH-associated protein 1 (Keap1) competitively, triggering the oxidative stress response mediated by NF-E2-related factor 2 (Nrf2) and preventing ferroptosis in SH-SY5Y cells. Emerging evidence implicates that this regulatory axis may confer neuroprotection against cerebral ischemia-reperfusion injury (CIRI). The current investigation was designed to elucidate whether the p62/Keap1/Nrf2 signaling pathway contributes to the amelioration of CIRI through modulation of ferroptosis. In SH-SY5Y cells, we used an oxygen-glucose deprivation/reperfusion (OGD/R) paradigm. In Sprague-Dawley rats, we used a middle cerebral artery occlusion/reperfusion (MCAO/R) model. Through these models, we investigated the effects of p62/Keap1/Nrf2 pathway activation. Additionally, we used in vitro experiments to analyze ferroptosis markers, cell damage, and the expression of pathway proteins. We injected the p62-overexpressing lentivirus into SH-SY5Y cells and the lateral ventricle of rats subjected to MCAO/R. Finally, we investigated the effects of an Nrf2 activator and a ferroptosis inhibitor. Nrf2 negatively regulated OGD/R-triggered ferroptosis in SH-SY5Y cells by increasing glutathione peroxidase 4 (GPX4) expression and decreasing acyl-CoA synthetase long-chain family member 4 (ACSL4) levels. p62 overexpression in cells enhanced the interaction between Keap1 and p62, activating Nrf2 and protecting against OGD/R-triggered ferroptosis. Activating the p62/Keap1/Nrf2 signaling pathway in vivo reduced the brain injury area, decreased neuromotor functional impairment, and decreased the expression of ferroptosis markers in rats. Activation of the p62/Keap1/Nrf2 signaling pathway reduces ferroptosis and alleviates CIRI. This protective mechanism provides novel directions for investigating the pathological mechanisms of CIRI.

38. STING Mediates Necroptosis in Hippocampal Neurons of Mice With Sepsis-Associated Encephalopathy.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-26 链接: PubMed

摘要

Sepsis-associated encephalopathy (SAE) is a common and severe neurological syndrome induced by sepsis and characterized by brain dysfunction. The incidence of SAE is as high as 76%. After onset, the mortality rate is as high as 60%. Even if patients survive, about 20% have long-term cognitive impairment. At present, the exact pathogenesis of SAE remains unknown. Our results showed that necroptotic protein was obviously elevated in the hippocampus of SAE mice, but the internal mechanism was still unclear. The stimulator of interferon gene (STING) protein has been reported to be a key molecule in the regulation of programmed cell death. However, the critical role of STING in the progression of SAE remains elusive. We explored the mechanism by which STING regulates hippocampal neuronal necroptosis in SAE. A cannula was embedded into the lateral ventricle of mice, and mixed lineage kinase domain-like protein (MLKL) inhibitor necrosulfonamide (NSA) and STING inhibitor C-178 were injected. The motor ability and memory function of mice after cecal ligation and puncture (CLP) were assessed by the open field test (OFT) and barnes maze test (BMT), respectively. The expression and distribution of S345p-MLKL and S366p-STING proteins in the hippocampal region of SAE mice were analyzed, and the expression levels of S366p-STING/STING, S232p-receptor-interacting protein kinase 3 (RIPK3)/RIPK3, S345p-MLKL/MLKL, and S166p-RIPK1/RIPK1 proteins in the hippocampal tissue of SAE mice were examined. Co-immunoprecipitation (CO-IP) was used to detect the relationship between STING and RIPK3 protein. The surviving mice after CLP had cognitive dysfunction. The hippocampal tissues of SAE mice showed upregulated expression of S232p-RIPK3/RIPK3, S345p-MLKL/MLKL, and S166p-RIPK1/RIPK1 proteins. Mice in the CLP+NSA group showed better cognitive performance than the mice in the CLP+dimethyl sulfoxide (DMSO) group. The results showed that the expression of S366p-STING protein was elevated in neurons of the hippocampal cornu ammonis 1 (CA1) region in SAE mice, and there was an interaction between STING and RIPK3 proteins. STING inhibitor C-178 inhibited the protein expression level of S232p-RIPK3/RIPK3 and S345p-MLKL/MLKL and alleviated SAE mice with cognitive dysfunction. STING is implicated in the development of cognitive dysfunction in SAE by regulating necroptosis in hippocampal neurons. Inhibition of the STING pathway reduced necroptosis-related protein expression and partially improved BMT performance. This result provides a new potential therapeutic target for the prevention and treatment of SAE.

39. Influence of Gait Speed on Spatiotemporal Parameters in Advanced Parkinson's Disease Following Subthalamic Nucleus Deep Brain Stimulation.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-25 链接: PubMed

摘要

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a recognized treatment for advanced PD, yet its impact on gait parameters remains variable. The aim of this prospective study was to evaluate changes in spatiotemporal gait parameters following DBS-STN in patients with advanced PD. Thirty patients with advanced PD underwent bilateral DBS-STN. Gait assessments were performed preoperatively and three months postoperatively using a pressure-sensitive treadmill under three walking speed conditions (slow, optimal and fast). Spatiotemporal gait parameters (as walking speed, double-stance phase, cadence, step length, stance phase duration) and derived values, such as asymmetry of both step length and stance phase, were analyzed with respect to the clinically better and worse limbs defined in accordance with Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). No significant changes in walking speed, cadence, or double stance phase duration comparing gait characteristics pre- and postoperatively were found. Significant improvements were found in step length for the clinically worse limb at slow and optimal walking speeds and in stance phase duration for the clinically better limb at fast walking speed. Additionally, asymmetry in both step length and stance phase duration decreased at the fast walking speed after stimulation. For all other parameters evaluated in other walking speeds, the differences were not statistically significant. DBS-STN combined with medication had limited overall effects on spatiotemporal gait parameters in patients with advanced PD. However, when the clinically worse and better lower limbs were analyzed separately, selective improvements in step length and stance phase duration, along with reduced gait asymmetry at higher walking speeds were observed. These findings suggest that DBS may modulate specific components of gait control rather than global gait performance, highlighting the importance of individualized assessment in postoperative gait evaluation.

40. Comparison of the mNUTRIC Score and the PNI for Predicting 30-Day Mortality in Geriatric Patients in the ICU.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-22 链接: PubMed

摘要

Malnutrition represents a major clinical concern in geriatric populations and is strongly associated with adverse outcomes and increased mortality, particularly among patients admitted to the intensive care unit (ICU). This study aimed to compare the predictive performance of the modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the Prognostic Nutritional Index (PNI) for 30-day mortality in geriatric ICU patients. This retrospective study included 704 geriatric patients admitted to the ICU between December 2023 and June 2025 with a length of stay exceeding 24 hours. The mNUTRIC score and PNI were calculated using data obtained within the first 24 hours following ICU admission. Demographic and clinical characteristics were also evaluated and compared between groups according to these nutritional scoring systems. The primary outcome was 30-day mortality. Of the 704 patients, 301 (42.76%) died during ICU follow-up, and 257 patients (36.51%) died within 30 days. Both the mNUTRIC score and PNI differed significantly between survivors and non-survivors (p < 0.001 for both). Patients with high mNUTRIC scores demonstrated significantly higher rates of both 30-day mortality and ICU mortality compared with those with low scores (p < 0.001 for all comparisons). Receiver operating characteristic (ROC) curve analysis showed that the mNUTRIC score had an area under the curve (AUC) of 0.753, with a cut-off value of 5.5, sensitivity of 0.743, and specificity of 0.638. In contrast, PNI demonstrated the lowest predictive performance among the evaluated scores, with an AUC of 0.624 and a cut-off value of 36.175. Both the mNUTRIC score and PNI are useful for predicting 30-day mortality and clinical outcomes in geriatric ICU patients; however, the mNUTRIC score demonstrates superior predictive performance. Future research should further investigate their integration with established scoring systems and their utility in longitudinal trend monitoring.

41. Validation of Risk Factors and Assessment of Their Combined Predictive Efficacy for Perioperative Complications in Laparoscopic Radical Resection of Transverse Colon Cancer.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-22 链接: PubMed

摘要

Although laparoscopic surgery for colon cancer offers advantages over open surgery, such as minimal invasion and faster recovery, the transverse colon presents unique challenges due to its special anatomical location and complex vascular and lymphatic drainage. This study aimed to identify independent risk factors and to develop a corresponding combined predictor for perioperative complications following laparoscopic radical resection of transverse colon cancer. Retrospective clinical data from 170 patients with transverse colon cancer who underwent laparoscopic colectomy at The First People’s Hospital of Yongkang between January 2020 and July 2025 were analyzed. According to the Clavien-Dindo classification system, patients were divided into a complication group (Clavien-Dindo grade ≥I) and a non-complication group. Baseline demographics, surgical variables, and occurrence of perioperative complications were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for complications. The combination of these independent risk factors was then assessed as a composite predictor. Its predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. Among the cohort, 43 patients experienced complications (complication group) while 127 did not (non-complication group). Univariate logistic regression analysis revealed that age, presence or absence of comorbid diabetes mellitus, type of abdominal anastomosis, and operation time were associated with perioperative complications following laparoscopic colectomy for transverse colon cancer (p < 0.05). Multivariate logistic regression analysis revealed that comorbid diabetes mellitus (odds ratio [OR] = 4.656, 95% confidence interval [CI]: 1.715-12.640, p = 0.003), extracorporeal anastomosis (OR = 5.943, 95% CI: 2.497-14.142, p < 0.001), and an operation time exceeding 3 hours (OR = 4.520, 95% CI: 1.929-10.595, p < 0.001) were independent risk factors for perioperative complications. The area under the ROC curve (AUC) for the predictor combining these three factors was 0.825 (95% CI: 0.752-0.897, p < 0.001), demonstrating superior predictive efficacy compared to any single factor alone. Comorbid diabetes mellitus, extracorporeal anastomosis, and operation time >3 hours are independent risk factors for perioperative complications in patients undergoing laparoscopic resection of transverse colon cancer. The combination of these three risk factors shows good predictive value and holds promise for guiding targeted clinical interventions to improve patient outcomes.

42. Primary Ciliary Dyskinesia With Situs Inversus in Twin Premature Infants: Two Case Reports.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-22 链接: PubMed

摘要

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder characterised by structural or functional abnormalities of the cilia, which prevent proper oscillation. Patients typically present with symptoms such as chronic respiratory infections, bronchiectasis, and, in approximately half of the cases, inversion of internal organs. Due to its diverse clinical manifestations and lack of specificity, PCD is often misdiagnosed or underdiagnosed, and diagnosis in the neonatal period remains notably challenging. Therefore, this study aimed to analyse the clinical characteristics of the two cases, optimise PCD treatment, and improve the accuracy and timeliness of PCD diagnosis. This article reports two cases of twin sisters at 34+3 weeks of gestation who were diagnosed with PCD during the neonatal period. The patients, twin girls conceived naturally, were transferred to Department of Pediatrics after cesarean delivery at Pu’er People’s Hospital on 26 September 2024, at 11:24, due to cyanosis and shortness of breath after birth. Prenatal examination at 13 weeks revealed “dextrocardia with abdominal situs inversus” in both fetuses. Delivery was by emergency cesarean section due to premature rupture of membranes. After birth, the twins presented with respiratory distress symptoms, including cyanosis and shortness of breath. Bedside chest radiography revealed hyaline membrane disease, dextrocardia, and abdominal situs inversus. Treatments such as non-invasive ventilator-assisted ventilation and anti-infective therapy were initiated after admission. However, the patients repeatedly experienced breathing difficulties, alternating atelectasis in both lungs, difficulty weaning from the ventilator, and episodes of desaturation. Peripheral blood genetic testing confirmed a Dynein Axonemal Heavy Chain 5 (DNAH5) gene mutation as the cause of PCD. Following treatment with non-invasive ventilator-assisted ventilation, oxygen therapy in an incubator, nebulization (e.g., hypertonic saline), patting back and sputum aspiration, prone position ventilation, and postural drainage, both patients improved and were discharged. In neonates with unexplained respiratory distress, especially those with situs inversus, early refinement of diagnostic tools, including genetic testing, is crucial to confirm PCD promptly, enable timely intervention, and prevent irreversible lung injury.

43. Update on Investigation and Management of Dyslipidaemias and Cardiovascular Disease Risk.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-22 链接: PubMed

摘要

Despite accounting for a quarter of all UK deaths, atherosclerotic cardiovascular disease (ASCVD) is frequently undertreated in non-specialist hospital care due to the perceived complexity of modern lipid management. This review aims to bridge the gap between evolving guidelines and routine clinical practice. We examine the advances in lipid testing, including lipoprotein (a), apolipoproteins and genetic testing, which have allowed improved and personalised risk assessment. While statins remain the foundation of lipid-lowering therapy, the treatment options have expanded and we discuss the role of ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies, inclisiran, and bempedoic acid. We also look ahead to gene-editing strategies and lipoprotein (a) lowering therapies currently in clinical trials. By simplifying these recent advances, this review aims to provide hospital clinicians with a practical approach to identify high-risk patients, optimise their therapy and reduce cardiovascular disease burden.

44. Effects of Interdisciplinary Collaborative Nursing on Hemodialysis Compliance in Patients With Chronic Renal Failure: A Retrospective Analysis.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-22 链接: PubMed

摘要

Hemodialysis is the primary form of treatment for patients with chronic renal failure. The lengthy dialysis process and rigid treatment schedule often lead to poor patient adherence. This study aims to explore the effects of interdisciplinary collaborative nursing and routine nursing on hemodialysis compliance in patients with chronic renal failure. This retrospective analysis included clinical data of 136 patients with chronic renal failure who underwent hemodialysis in Zibo Central Hospital from April 2021 to January 2022. The patients were divided into a control group and an observation group according to the type of nursing care given. The control group received routine nursing, whereas the observation group received nursing intervention based on an interdisciplinary collaborative nursing model. Hemodialysis compliance, anxiety, awareness of disease, and health-related quality of life among the patients were evaluated. Compared to the control group, the observation group exhibited significantly higher levels of hemodialysis compliance and disease knowledge (p < 0.05). The anxiety level of the observation group was significantly lower than that of the control group (8.04 ± 5.06 vs. 12.49 ± 4.87; p < 0.001). In terms of quality of life, the observation group scored higher than the control group in physical, psychological, social, and environmental domains (p < 0.05). The interdisciplinary collaborative nursing enhances hemodialysis compliance in patients with chronic renal failure, ameliorates their anxiety, and improves their health-related quality of life. This research provides a theoretical basis for the design and selection of clinical management plans in the future.

45. The Microbiome Epoch: Cracking the Cardiovascular-Neurodegenerative Disorder Code.

期刊: Frontiers in bioscience (Landmark edition) 发表日期: 2026-May-22 链接: PubMed

摘要

Increasing evidence suggests that the gut microbiome (GM) may exert a seminal role in the maintenance of host health as well as in the pathogenesis of various illnesses, including cardiovascular disease (CVD) and neurodegenerative disorders (NDDs). GM influences host physiology by metabolizing dietary factors and host-derived substrates, thereby producing active molecules that trigger responses at local and systemic levels. The inflammatory process is characterized by a rapid “onset phase” followed by a “resolution phase”, which is essential to curtail inflammation and restore tissue homeostasis. Unique individual and environmental conditions may alter the GM equilibrium as well as impair the “resolution phase” leading to GM dysbiosis and chronic low-grade inflammatory conditions, which eventually promote the development of common/widespread human pathologies, such as inflammatory bowel and autoimmune diseases, cancer, CVD, and NDDs. This review describes the different components of the gastrointestinal tract, namely the enteroendocrine and enteric nervous systems, and the GM. Secondly, it discusses the connections among unresolved and sterile inflammation, GM and human illnesses, namely CVD and NDDs. Finally, we emphasizes the limitations of current evidence and the need for further research to fill the gap in establishing the causal link between the GM and the pathogenesis of both CVD and NDDs.

46. The Asian Burden of Urticaria in Adolescents and Young Adults: Estimates From 1990-2021 and Projections to 2036.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-20 链接: PubMed

摘要

Urticaria is a common inflammatory skin disease that significantly impairs the quality of life and mental health of adolescents and young adults. Despite its increasing impact, comprehensive long-term epidemiological data focusing specifically on the young population across diverse Asian regions remain limited. This study aimed to assess the burden of urticaria among adolescents and young adults in Asia from 1990 to 2021, and to project its changes through 2036. A repeated cross-sectional analysis using Global Burden of Disease (GBD) Study 2021 data was conducted to estimate the burden of urticaria prevalence, incidence, and disability-adjusted life years (DALYs) among Asian adolescents and young adults (ages 10-24) from 1990 to 2021. Data analysis was performed from November 2024 to April 2025. From 1990 to 2021, the prevalence, incidence, and DALYs for urticaria increased among Asian adolescents and young adults, with rates consistently higher in females. In 2021, there were 16,347,995 new cases (95% uncertainty interval [UI]: 12,625,370 to 21,681,388). The prevalence rose from 863.13 (95% UI: 761.99 to 983.08) to 877.84 (95% UI: 775.68 to 1000.20) per 100,000 population (average annual percent change [AAPC] = 0.055%, 95% confidence interval [CI]: 0.053% to 0.056%). The incidence increased from 1525.51 (95% UI: 1341.63 to 1728.55) to 1552.60 (95% UI: 1369.05 to 1758.22) per 100,000 population (AAPC = 0.057%, 95% CI: 0.055% to 0.057%). The DALY rate grew from 51.74 (95% UI: 34.15 to 74.31) to 52.78 (95% UI: 34.65 to 76.09) per 100,000 population (AAPC = 0.064%, 95% CI: 0.063% to 0.065%). Overall, Central Asia has the highest age-standardized prevalence, incidence, and DALYs. Health inequality assessments indicated that the disease burden has intensified in low socio-demographic index (SDI) regions due to unequal medical resources. The incidence is projected to continue rising over the next 15 years, reaching 1568.89 (95% prediction interval [PI]: 1552.24 to 1592.05) per 100,000 population by 2036. Over the past three decades, urticaria has shown significant increases in prevalence, incidence, and DALYs across the region, with females exhibiting higher morbidity rates than males. This trend is expected to persist through 2036. These findings underscore the urgent need for targeted public health interventions and more equitable distribution of medical resources to mitigate the escalating disease burden, particularly in high-burden, low-SDI regions.

47. Factors Associated With Glycemic Variability in Hospitalized Patients With Type 2 Diabetes Mellitus and Heart Failure.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-20 链接: PubMed

摘要

Patients with concomitant heart failure (HF) and type 2 diabetes mellitus (T2DM) are at high risk for adverse clinical outcomes. Glycemic variability (GV) has emerged as a crucial metric for assessing dysglycemia. However, its determinants in this specific patient population remain poorly characterized. This study aimed to investigate factors associated with GV in hospitalized patients with HF and T2DM. A total of 150 patients hospitalized with T2DM and HF were enrolled. Clinical and laboratory data were collected, and multiple linear regression analysis was performed to identify independent factors associated with four GV indices: standard deviation of blood glucose (SDBG), coefficient of variation (CV), mean of daily differences (MODD), and mean amplitude of glycemic excursions (MAGE). Multivariate analysis revealed that C-peptide level was significantly negatively associated with all four GV indices (SDBG: β = -0.219, p < 0.001; log(CV): β = -0.080, p < 0.001; MODD: β = -0.176, p < 0.001; MAGE: β = -0.284, p < 0.001). Age showed significant positive associations with SDBG (β = 0.020, p < 0.001), log(CV) (β = 0.009, p < 0.001), and MODD (β = 0.027, p < 0.001). Diabetes duration was significantly positively associated with SDBG (β = 0.028, p < 0.001), log(CV) (β = 0.011, p < 0.001), and MODD (β = 0.029, p < 0.001). Glycated hemoglobin (HbA1c) was significantly positively associated with SDBG (β = 0.062, p = 0.002), MODD (β = 0.125, p < 0.001), and MAGE (β = 0.196, p < 0.001). Log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) (log(NT-proBNP)) was significantly positively associated with all GV indices (SDBG: β = 0.085, p = 0.002; log(CV): β = 0.046, p = 0.002; MODD: β = 0.090, p = 0.009; MAGE: β = 0.162, p = 0.003). Additionally, family history of diabetes was positively associated with SDBG (β = 0.184, p = 0.001), log(CV) (β = 0.088, p = 0.004), and MODD (β = 0.175, p = 0.012). A history of cardiovascular disease was positively associated with MAGE (β = 0.265, p = 0.024). Body mass index (BMI) was negatively associated with MODD (β = -0.036, p < 0.001) but positively associated with MAGE (β = 0.037, p = 0.007). The regression models explained 34.9% to 49.6% of the variance across the different GV indices. Glycemic variability in hospitalized patients with T2DM and HF is influenced by multiple clinical and metabolic factors. C-peptide level, age, diabetes duration, HF severity (reflected by NT-proBNP), and overall glycemic control are primary factors associated with GV. These findings suggest that clinical management should adopt individualized strategies that account for the heterogeneity and distinct characteristics of different GV indices.

48. Establishment and Clinical Application of a Risk Prediction Model for Postoperative Complications of Arm Ports in Gynecological Oncology Patients.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-20 链接: PubMed

摘要

Long-term venous access is essential for administering chemotherapy in gynecological cancers, and the use of arm ports is becoming more common due to their practical advantages. However, postoperative complications remain a significant clinical concern. Currently, investigations specifically predicting the risk of arm port-related complications in gynecological oncology patients are limited. The advances of precision medicine warrant the development of individualized risk prediction tools to optimize clinical decision-making. This retrospective analysis enrolled 476 patients who underwent arm ports (APs) implantation in the Gynaecology Department, The Fourth Hospital of Hebei Medical University, between July 2022 and October 2024. Patients were randomly divided into a training set (n = 334) and a validation set (n = 142) using computer-generated random numbers. Univariate and multivariate logistic regression analyses were used to identify independent risk factors, and the significant variables were incorporated into a prediction model. A nomogram of the prediction model was generated. Furthermore, the prediction model was internally validated using the Bootstrap method. The model’s discriminative performance, calibration, and clinical utility were determined using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. The overall postoperative complication rate was found to be 12.18% (58/476). Multivariate logistic regression analysis identified preoperative neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.20-1.96), history of ipsilateral arm surgery (OR = 5.02, 95% CI: 2.06-12.23), and planned chemotherapy cycles (OR = 1.52, 95% CI: 1.26-1.85) as independent risk factors of postoperative complications (all p < 0.05). The nomogram prediction model constructed based on these factors demonstrated superior performance, yielding an area under the curve (AUC) of 0.819 (95% CI: 0.756-0.882) in the training set and 0.869 (95% CI: 0.793-0.945) in the validation set. The calibration curve showed good agreement between predicted probabilities and the actual observed incidence of postoperative complications. DCA indicated that the model showed greater clinical benefit than either treating all or treating no patients across a moderate range of threshold probabilities. The proposed prediction model demonstrates fair to good capability in assessing the risk of postoperative complications following AP implantation in gynecological oncology patients. It supports clinicians in identifying high-risk individuals before surgery and enabling the implementation of targeted preventive approaches.

49. Lactobacillus mucosae Reduces Neuronal Oxidative Stress in Alzheimer's Disease via the Regulation of CB2 Signaling.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-19 链接: PubMed

摘要

The probiotic Lactobacillus mucosae has been widely shown to have many positive effects. However, its neuroprotective effects and underlying mechanism in Alzheimer’s disease (AD) remain elusive. Male APP/PS1 mice were treated for 4 weeks with L. mucosae WMU007, followed by the evaluation of cognitive function, neuronal damage, amyloid-β (Aβ) deposition, and Tau phosphorylation. RNA-seq coupled with Gene Ontology (GO) enrichment analysis implicated L. mucosae WMU007 in modulating oxidative stress in this AD model. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and qPCR were performed to identify the specific mechanism by which this probiotic suppresses oxidative stress in the pathogenesis of AD. In addition, we quantified the levels of classical oxidative stress markers, such as superoxide dismutase 2 (SOD2) and glutathione peroxidase 4 (GPX4). We also examined the expression of cannabinoid receptor type 2 (CB2) and its key downstream regulators in the redox pathway, namely nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1), in both animal and cellular models. Our results showed that treatment with L. mucosae WMU007 significantly decreased cognitive impairment, neuronal damage, Aβ deposits, and Tau phosphorylation in APP/PS1 mice. Activation of CB2 was identified as the key mechanism by which L. mucosae WMU007 reduces oxidative stress in AD. In addition, L. mucosae WMU007 reduced oxidative stress and increased the levels of CB2 pathway-related proteins in vivo and in vitro. These results indicate that L. mucosae WMU007 confers neuroprotection in AD by targeting CB2-mediated oxidative pathways, highlighting its therapeutic potential as a novel probiotic intervention.

50. The Role of SGLT2 Inhibitors in the Management of Diabetic Retinopathy: A Literature Review.

期刊: Die Pharmazie 发表日期: 2026-May-19 链接: PubMed

摘要

Diabetic retinopathy (DR) remains a leading cause of blindness among individuals with diabetes mellitus (DM), with a continuously rising global prevalence. While anti-vascular endothelial growth factor (anti-VEGF) therapy, corticosteroids, laser photocoagulation, and vitreoretinal surgery have improved outcomes, none can permanently prevent disease progression. The complex pathophysiology of DR, which includes inflammation, oxidative stress, and neurodegeneration, highlights the need for additional systemic strategies. This narrative review was informed by a structured search of PubMed, Scopus, and Web of Science covering the period from January 2000 to September 10, 2025. Original studies, systematic reviews, and meta-analyses were included, whereas case reports and editorials were excluded. Findings were synthesized qualitatively. Preclinical models suggest that sodium-glucose cotransporter 2 (SGLT2) inhibitors exert neuroprotective, anti-inflammatory, and antioxidant effects on the retina, preserve the blood-retinal barrier, and reduce vascular endothelial growth factor (VEGF) expression. However, whether these retinal effects are only partially independent of glycemic control remains speculative, as clinical studies have not adequately controlled for changes in glycated hemoglobin (HbA1c) or for differences in concomitant glucose-lowering therapies. Observational clinical studies have associated SGLT2 inhibitor use with a lower risk of DR progression, a reduced incidence of proliferative DR, and fewer vision-threatening interventions compared with some other antihyperglycemic agents. Owing to the established indications in heart failure and chronic kidney disease associated with SGLT2 inhibitors, these agents appear promising for DR prevention and risk modification. However, current clinical evidence is based mainly on observational and retrospective studies and remains vulnerable to confounding and selection bias. Prospective randomized studies with ophthalmic endpoints are needed before firm conclusions can be drawn.

51. Comparative Evaluation of Functional Outcomes and Postoperative Complications After Minimally Invasive Fixation for Acromioclavicular Joint Injuries.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-18 链接: PubMed

摘要

Acromioclavicular (AC) joint dislocation is associated with severe pain, functional impairment, and postoperative complications. This study aimed to compare the efficacy and safety of TightRope with hook plate fixation for Rockwood type III injuries and to develop a postoperative complication prediction model. This retrospective study enrolled 178 patients with acute Rockwood type III AC joint dislocation who underwent surgical treatment at Tongliao People’s Hospital, China, between January 2020 and December 2023. Among them, 93 patients received arthroscopic TightRope fixation and 85 underwent conventional hook plate fixation. Perioperative parameters, radiographic outcomes, functional recovery, and complication rates were compared between the two groups. Linear regression was employed to identify factors influencing key recovery indicators, and a logistic regression model was constructed to predict complications. The TightRope group exhibited significantly less intraoperative trauma, as indicated by reduced blood loss and shorter incision length (both p < 0.001). Postoperative infection was less frequent with TightRope (2.15% vs. 10.59%). At 6 months postoperatively, radiographic parameters-including coracoclavicular distance (CCD), acromioclavicular distance (ACD), and acromioclavicular index (ACI)-and functional outcomes (American Shoulder and Elbow Surgeons [ASES], Constant-Murley, and University of California, Los Angeles [UCLA] scores) demonstrated improvement in the TightRope group, along with lower visual analog scale (VAS) pain scores (all p < 0.05). Linear regression analysis identified operation type, intraoperative blood loss, and implant displacement as independent predictors of recovery. Logistic regression revealed TightRope as an independent protective factor for complications (odds ratio [OR] = 0.42, p = 0.028), whereas blood loss (OR = 1.86, p = 0.017) and ACD (OR = 1.34, p = 0.042) were independent risk factors. The prediction model showed good discrimination in the training set (area under the curve [AUC] = 0.84, 95% confidence interval [CI]: 0.76-0.92) and validation set (AUC = 0.76, 95% CI: 0.64-0.89), with satisfactory calibration (Hosmer-Lemeshow p = 0.177, p = 0.477) and clinical utility demonstrated by decision curve analysis. Compared with hook plate fixation, the TightRope technique offers superior stabilization, improved functional recovery, and reduced complication rates in the management of acromioclavicular joint (ACJ) dislocations. The proposed predictive model provides a valuable tool for preoperative risk assessment and surgical decision-making.

52. A Systematic Review of Functional MRI Studies on Seasonal Modulation of Brain Functional Connectivity.

期刊: British journal of hospital medicine (London, England : 2005) 发表日期: 2026-May-18 链接: PubMed

摘要

Seasonal fluctuations in environmental conditions, particularly variations in photoperiod and ambient temperature, influence diverse physiological and behavioral processes. With advances in functional magnetic resonance imaging (fMRI), researchers have begun to investigate how such environmental factors modulate intrinsic brain activity. This review synthesizes current evidence on how seasonal, circadian, and environmental variations affect brain functional connectivity. A comprehensive search of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Web of Science databases was conducted for peer-reviewed fMRI studies published between 2010 and 2025. Eligible studies investigated the impact of environmental factors, such as photoperiod, temperature, and time of day, on brain functional connectivity. Due to methodological heterogeneity, a narrative synthesis approach was used in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review process is illustrated using a PRISMA flow diagram, and a checklist is provided as supplementary material. Sixteen original studies spanning cross-sectional and longitudinal designs met the inclusion criteria. Seasonal and environmental exposures modulated connectivity in major networks, particularly the default mode network (DMN), salience network (SN), and sensorimotor network (SMN). For the DMN and SMN, photoperiod consistently affected connectivity, with peaks in autumn and reductions in summer. Circadian and temperature effects were also observed. Methodological factors, including scanner stability, emerged as critical. Environmental rhythms significantly affect brain connectivity and should be considered in neuroimaging research and clinical practice. These effects are sometimes comparable to clinical conditions. Future work should enhance control of environmental exposures and incorporate physiological markers to improve reproducibility. PROSPERO (CRD420261390073).

53. Usefulness of Non-Contrast Electron Density Imaging for the Identification of Brain Tissue Changes in Large Vessel Occlusion Acute Ischemic Stroke.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-12 链接: PubMed

摘要

Electron density (ED) imaging has shown the ability to discriminate between different soft tissue components in preliminary studies. We hypothesized that ED might improve the identification of brain tissue abnormalities in patients with large vessel occlusion acute ischemic stroke (AIS). We retrospectively included a series of patients with large vessel occlusion AIS comprising the middle cerebral artery (MCA) territory. All patients underwent non-contrast brain computed tomography (CT) and CT angiography using a dual-layer spectral CT scanner. Using a multiparameter display including conventional CT images (Hounsfield units, HU), ED relative to water (%EDW), and effective atomic number (Zeff), we evaluated the brain tissue territory distal to the occlusion, and the contralateral hemisphere. Twenty-eight patients were included, with a mean age of 75.7 ± 10.9 years. The brain tissue distal to the MCA occlusion showed significant differences compared with the contralateral hemisphere only using conventional CT (25.0 ± 2.7 HU vs. 29.2 ± 2.4 HU, p < 0.0001) and ED imaging (102.2 ± 0.3 %EDW vs. 102.6 ± 0.2 %EDW, p < 0.0001), whereas the Zeff (7.37 ± 0.1 vs. 7.37 ± 0.1, p = 0.36) showed similar values. ED imaging was associated with a significantly higher diagnostic confidence for the identification of abnormal findings, both for the evaluation of the hyperdense MCA (conventional CT 3.46 ± 1.3 vs. ED imaging 4.79 ± 0.4 vs. Zeff imaging 2.07 ± 1.0, p < 0.0001) as well as for the subtended brain parenchyma (conventional CT 3.30 ± 1.3 vs. ED imaging 4.30 ± 0.8 vs. Zeff 1.44 ± 0.6, p < 0.0001). In this study, ED imaging enabled a more confident identification of brain tissue changes related to large vessel occlusion AIS compared with conventional CT imaging.

54. Molecular Mechanisms of Manganese Oxide Nanoparticles Toxicity in Brain and Other Tissues: An Overview.

期刊: Frontiers in bioscience (Landmark edition) 发表日期: 2026-May-12 链接: PubMed

摘要

The use of manganese oxide nanoparticles (MnOxNPs) in biomedicine increases the risk of their accumulation in the body, potentially leading to toxicity in various organs and tissues. In addition, occupational exposure to MnOxNPs-containing aerosols may also occur. MnOxNPs have been shown to accumulate in the brain and induce neurobehavioral alterations. However, the specific mechanisms of MnOxNPs toxicity in the brain and other tissues remain incompletely understood. Therefore, the objective of this review is to summarize existing data on the toxicity of MnOxNPs in the brain and other tissues, and to discuss the molecular mechanisms underlying their neurotoxic effects. It has been shown that MnOxNPs induce neuronal death through induction of mitochondrial dysfunction and subsequent apoptosis, and overaccumulation of tau protein and amyloid-β. Neurotoxic effects of MnOxNPs may also be mediated by blood-brain barrier disruption, and dysregulation of dopaminergic and glutaminergic signaling. Exposure to MnOxNPs induces neuroinflammation through activation of nuclear factor kappa B (NF-κB) and p38 mitogen-activated protein kinase (p38 MAPK) pathways in a reactive oxygen species-dependent manner. In vitro studies further demonstrate that MnOxNPs exhibit a dose-dependent cytotoxic effects in alveolar macrophages, as well as in respiratory, colonic, and other epithelial cells, through the promotion of oxidative stress and an inflammatory response. Overexposure to MnOxNPs has significant nephrotoxic, hepatotoxic, and immunotoxic effects, as well as affecting the reproductive system. Smaller particles exhibit more pronounced toxic effects in the brain and other tissues than larger nanoparticles or microparticles. However, the mechanisms underlying the different toxicities of MnOxNPs of different sizes, shapes, and surface modifications remain unclear. These observations highlight the potential of MnOxNP exposure to contribute to neurological disorders and dysfunction of other systems, underscoring the need for further mechanistic studies to ensure their safe application in biomedicine.

55. Tea Polyphenols Protect the Blood-Brain Barrier Structure in the Hippocampus of Early Diabetic Mice by Inhibiting the AGEs-RAGE Pathway.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-12 链接: PubMed

摘要

Diabetic encephalopathy is a prevalent complication of diabetes mellitus, which is primarily characterized by hippocampal injury and blood-brain barrier (BBB) dysfunction. This study investigates the neuroprotective effect of tea polyphenols (TP) on hippocampal tissue in early-stage diabetic mice. Sixty BALB/c mice were randomly assigned to the control group (C), the diabetes group (T0), and the TP-treated group (T1). After successful model induction, mice in group T1 received TP intragastrically (100 mg/kg/d). Hematoxylin and eosin (H&E), toluidine blue, and Hoechst 33342 staining, combined with polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), were used to assess the effects of TP on hippocampal histology, inflammation and oxidative stress, the advanced glycation end products (AGEs) - Receptor for Advanced Glycation End products (RAGE) pathway, and the expression of key proteins associated with the BBB. The contents of AGEs, RAGE, NF-κB, P-glycoprotein (P38), and oxidative stress factors in group T1 were lower than those in group T0 at 7, 14, and 21 days (p < 0.05). At the same time points, the mRNA expression levels of inflammatory factors in group T1 were lower than those in group T0 (p < 0.05). Moreover, compared with group T0, both P-glycoprotein (P-gp) protein expression and glucose transporters (Glut1) mRNA expression increased in group T1 (p < 0.05). The mRNA expression levels of key BBB-related molecules in group T1 also increased to varying degrees (p < 0.05). Histopathological analysis showed marked improvement in the hippocampal architecture of group T1 compared with group T0. Moreover, the expression levels of P38, NF-κB, IL-6, TNF-α, ROS, and Glut1 were significantly or highly significantly positively correlated with RAGE protein levels (p < 0.05 or p < 0.01). TP enhanced BBB structural integrity by inhibiting the AGEs-RAGE pathway, thereby attenuating hippocampal tissue damage.

56. Metabolic Brain Network Reorganization in Temporal Lobe Epilepsy With Aware or Impaired Awareness Seizures.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-09 链接: PubMed

摘要

Temporal lobe epilepsy (TLE) is increasingly recognized as a dysfunction of the brain network. However, the topological alterations of the metabolic brain network underlying impaired awareness seizures (IAS) remain unclear. In this study, we aimed to characterize metabolic network reorganization in patients with TLE and IAS (TLE-IAS) and to preliminarily investigate the specificity of these alterations by comparing the results with those of patients with TLE and aware seizures (AS). This retrospective study included a total of 193 TLE-IAS patients, 30 patients with TLE-AS, and 193 controls. Metabolic brain networks were constructed for all groups, and nonparametric permutation testing was applied to compare group differences in graph-theoretical metrics and hub node distribution. Compared with controls, both TLE patient groups exhibited globally weakened metabolic connectivity. Graph-theoretical analysis revealed that both groups demonstrated significant increases in characteristic path length and significant decreases in clustering coefficient (Cp). Furthermore, the TLE-AS group showed a significant decrease in local efficiency compared with controls. No statistically significant differences were found between the two patient groups across the four graph-theoretical parameters. Hub analysis revealed a convergent reorganization in both groups involving loss of default mode network hubs and a limbic/paralimbic shift, with the TLE-IAS group showing more limbic hubs, while the TLE-AS group exhibited more primary auditory hubs. This study revealed alterations in graph-theoretical parameters and hub distribution in patients with TLE-IAS and TLE-AS. These findings provide preliminary metabolic imaging evidence for the neural substrates underlying impaired awareness in TLE.

57. Longitudinal Reorganization of Local Brain Activity Following Acute Basal Ganglia Infarction: Combined Metrics of Amplitude and Dynamics Reveal Neural Substrates Underlying Motor Recovery.

期刊: Journal of integrative neuroscience 发表日期: 2026-May-09 链接: PubMed

摘要

In this study, we focused on exploring long-term trends and the clinical relevance of brain remodeling in acute basal ganglia cerebral infarction (BGCI) using percent amplitude of fluctuation (PerAF) and dynamic amplitude of low-frequency fluctuation (dALFF) from resting-state functional magnetic resonance imaging (rs-fMRI). rs-fMRI data were acquired from 28 acute BGCI patients and 34 healthy controls (HCs), with patient follow-ups conducted during the acute (days 1-7), early convalescent (day 30), and mid-convalescent (day 90) stages. One-way repeated-measures analysis of variance (ANOVA) was used to evaluate temporal changes in PerAF, while two-sample t-tests compared dALFF values between patient groups (days 1-7 and 90) and HCs. Pearson or Spearman correlation analysis was applied to examine relationships between significant neuroimaging metrics and clinical scores, including Fugl-Meyer Assessment (FMA) and Barthel Index (BI). PerAF abnormalities were mainly identified in the left precuneus, left cerebellum_4_5, and left precentral gyrus (PreCG). The cerebellar region exhibited a linear increase in PerAF over time. Patients showed altered dALFF in the right cerebellar crus II/I, right PreCG, and left precuneus compared with HCs. Acute-stage PerAF in the left PreCG negatively correlated with FMA and BI. In early and mid-convalescence, PerAF values in the left PreCG were further correlated with motor and lower-limb functional scores. Combined PerAF and dALFF analyses reveal distinctive patterns of dynamic brain functional remodeling following acute BGCI. These changes are closely associated with motor and daily living recovery, indicating that functional reorganization may represent a key neural mechanism supporting rehabilitation.

58. Adverse Childhood Experiences Underlie Race-Related Differences in Neural Reactivity to Stress.

期刊: Behavioural neurology 发表日期: 2026 链接: PubMed

摘要

Black individuals are disproportionately exposed to adverse childhood experiences (ACEs) in comparison to White individuals, including greater violence exposure, neighborhood disadvantage, and poverty. Neural circuitry that includes the amygdala, hippocampus, prefrontal cortex (ventromedial, dorsomedial, and dorsolateral), and inferior parietal lobule support stress-related emotional processes. ACEs may modify emotion-related activity within these brain regions, which, in turn, may modulate emotional behavior. However, the extent to which ACEs underlie race-related differences in emotional function remains to be determined. Therefore, this study investigated whether stress-elicited brain activity varies with race-related differences in ACEs. Functional magnetic resonance imaging (fMRI) data from 301 Black and White participants were acquired during the Montreal Imaging Stress Task. Violence exposure, neighborhood disadvantage, and family income were measured during adolescence to assess ACEs, whereas stress-elicited brain function was assessed in emerging adulthood. Behavioral (stress ratings) and psychophysiological data (skin conductance and heart rate) were collected alongside fMRI. Race-related differences were observed in behavioral (stress ratings), psychophysiological (heart rate), and neural (fMRI) responses to stress. Further, a significant relationship was observed between stress reactivity and ACEs. Importantly, adjusting for ACEs reduced race-related differences in stress reactivity (stress ratings and brain function), suggesting that the neurobehavioral response to stress may be shaped, in part, by ACEs. These findings provide new insight into the socioenvironmental factors that influence emotional function.

59. Racial and Ethnic Differences in Health Service Utilization Among Non-Hispanic Black and Non-Hispanic White Men: Findings From Medical Expenditure Panel Survey.

期刊: American journal of men’s health 发表日期: 2026 链接: PubMed

摘要

Persistent racial disparities underscore the disproportionate burden of poor health among Black men in the United States. Black men also use health care services less often, yet gaps remain in the literature on racial differences in health care utilization patterns. The objective of this study was to examine potential race differences in health care service utilization, specifically whether they had at least one office-based provider visit during the year between Black and White men. Data from the 2022 Medical Expenditure Panel Survey were used, consisting of a sample of 5,921 men (4,837 non-Hispanic White and 1,084 non-Hispanic Black). The dependent variable, health care utilization, was based on the aggregated 2022 annual total of office-based provider visits and was coded as a binary indicator of whether the respondent had at least one visit during the year. Race and ethnicity were based on respondents’ self-reported race and whether they identified as Hispanic, Latino, or of Spanish origin. Approximately 73 percent of the men had at least one office-based provider visit during the year, and 18 percent of the sample were NHB men. After adjusting for covariates, NHB men had a lower prevalence of having an office-based physical annual visit during the year (prevalence ratio = 0.83, 95% confidence interval [0.77, 0.88]) than NHW men. This difference may reflect medical mistrust and other health care system barriers rooted in historical and ongoing discrimination against Black men, which limits access to care. These findings underscore the need to address the root causes of barriers to health care utilization among Black men.

60. Morphogenesis of the Extraocular Muscles During the Human Embryonic and Early Fetal Periods.

期刊: Congenital anomalies 发表日期: 2026 链接: PubMed

摘要

Previous histological studies have shown that the extraocular muscles (EOMs) within the orbit are unique among skeletal muscles in both developmental origin and timing. However, three-dimensional (3D) morphological information and quantitative growth data remain limited. This study aimed to reconstruct 3D images of the EOMs during the human embryonic and early fetal periods (crown-rump length, 20-86 mm) using magnetic resonance imaging (MRI) data and quantify their growth. In specimens from the late embryonic period, all six EOMs controlling eye movement were recognizable on MRI and could be segmented for morphological analysis. The five EOMs originating from the common tendinous ring appeared to become closer as they widened during growth. Overall, the basic morphology of each EOM was broadly maintained from the late embryonic to early fetal period, with the most prominent change observed in the superior oblique muscle (SOM), whose bending angle at the trochlea changed from nearly rectangular at the end of the embryonic period to acute during the early fetal period. The lateral rectus muscle showed the largest volume and mean cross-sectional area among the EOMs in the early fetal period. Mean cross-sectional area increased at a similar rate among the four rectus muscles, but less in the inferior oblique muscle and much less in the SOM. Growth of each EOM strongly correlated with eyeball growth. These findings suggest that the four rectus muscles grow in a coordinated manner, whereas the oblique muscles follow distinct growth patterns during early orbital development.