Hazardous drugs such as antineoplastic agents pose occupational risks to healthcare workers, making appropriate chemotherapy spill management essential for workplace safety. Hands-on training opportunities in pharmacy education are often limited by safety concerns and resource constraints. Virtual reality (VR) simulation may provide immersive, guided rehearsal without hazardous-drug exposure, but comparative evidence remains limited. This study examined changes in pharmacy interns' self-perceived knowledge, understanding, and ability following VR simulation-based training and traditional instructor-led instruction and explored whether short-term changes differed between the two cohort-defined instructional orders. This cohort-allocated crossover quasi-experimental study included 37 pharmacy interns at a tertiary medical center in Taiwan. Instructional order was assigned by training cohort rather than by individual randomization and was completely confounded with cohort and calendar period. Cohort 1 (n = 17) received instructor-led instruction followed by VR training; Cohort 2 (n = 20) received the reverse order. Four single-item domains-knowledge of spill-kit contents, understanding of spill-management procedures, ability to independently don personal protective equipment (PPE), and ability to independently manage a spill-were assessed using a 5-point response scale at baseline, after the first intervention, and after crossover. Non-parametric tests were used. After the first session, self-perceived scores increased significantly across all four items in both cohorts (all p < 0.001). The instructor-led-first cohort showed greater first-phase changes than the VR-first cohort in self-perceived knowledge of spill-kit contents (p = 0.006) and ability to independently don PPE (p = 0.047); differences in the other two items were not statistically significant. These findings could not be attributed to instructional modality alone. Following crossover, second-phase change scores did not differ significantly between the cohort-defined orders (p = 0.221-0.956). All participants met the prespecified satisfaction criterion for the VR training (37/37, 100.0%; rating ≥ 4/5); 27 (73.0%) identified instructor-led explanation combined with VR as the most helpful option, and 28 (75.7%) indicated that VR could not replace instructor-led explanation. Both first-session instructional approaches were followed by short-term increases in pharmacy interns' self-perceived knowledge, understanding, and ability. Because instructional order was completely confounded with cohort and calendar period, the absence of significant second-phase differences neither establishes equivalence between the orders nor rules out an instructional-order effect. VR may serve a complementary rather than competing instructional role and provide a safe approach for rehearsing hazardous-drug spill-management procedures. These conclusions are limited to short-term self-perceived outcomes and post-training learner perceptions.
Breast cancer (BC) is the most frequently diagnosed cancer among women worldwide. Growing evidence highlights the role of overall dietary patterns, rather than individual foods or nutrients, in modulating cancer risk. Among these, the EAT-Lancet diet, developed to promote both human and planetary health, has recently gained attention for its potential in preventing non-communicable diseases. However, its association with BC risk remains understudied, particularly in low-and middle-income countries. We conducted a population-based matched case-control study in Morocco, including 2,800 women (1,400 incident BC cases and 1,400 matched controls by age and place of residence). Cases were newly diagnosed, histologically confirmed BC patients recruited from major oncology centers across Morocco between 2019 and 2023. Dietary intake was assessed using a validated Food Frequency Questionnaire, and an EAT-Lancet diet index (ELD-I) was developed based on the available data. Multivariable logistic regression models were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for BC risk according to levels of adherence to the ELD-I with adjustments made for relevant confounding factors. Further analyses were conducted by stratifying participants according to menopausal status and body mass index (BMI) category. Higher adherence to the ELD-I was significantly associated with reduced BC risk, for each one-point increment in adherence to the ELD-I, the odds of BC decreased by 21% overall (OR = 0.79; 95% CI: 0.77-0.82, p < 0.001). This inverse association remained consistent across subgroups defined by menopausal status and body mass index. In this large Moroccan case-control study, greater adherence to the EAT-Lancet dietary pattern was associated with a lower risk of BC, regardless of menopausal status or BMI category. These findings support the potential role of sustainable, plant-based diets in cancer prevention and emphasize the importance of dietary recommendations adapted to local contexts.
Menstrual health plays a crucial role in health-related quality of life (HRQoL). However, there is a gap addressing HRQoL in relation to broader aspects of menstrual health definition. This study aims to analyse the relationship between menstrual health and self-reported health-related quality of life in women and people who menstruate (PWM) ≥ 18 years in five regions of Spain (Andalusia, Basque Country, Canary Islands, Catalonia, and Galicia). A cross-sectional survey-based study with gender perspective was conducted. Thirty-two healthcare centres took part in the study across five regions of Spain between May and September 2023. Participants were women and PWM aged 18 or over with at least one menstruation in the last 6 months. Self-reported sociodemographic, menstrual health and HRQoL variables (using EQ-5D-5 L scale) were collected. Descriptive statistics and linear regression models were performed. EQ-VAS scale was employed to perform sensitivity analyses. A total of 1,381 women and PWM were included (Mean age = 34.63, SD = 10.06). The mean of EQ-5D-5 L index was 0.88 (SD = 0.13) and EQ-VAS was 73.63 (SD = 22.60). Several menstrual health variables were significantly associated with lower HRQoL. The strongest associations were observed for high frequency of premenstrual symptoms (β= -0.144; 95%CI= -0.139 to -0.090), high impact of premenstrual symptoms (β= -0.071; 95%CI= -0.102 to -0.040), high impact on social participation during menstruation (β= -0.104; 95%CI= -0.128 to -0.080), moderate frequency of menstrual poverty (β= -0.054; 95%CI= -0.078 to -0.029) and menstrual pain intensity (β= -0.047; 95%CI= -0.068 to -0.025). These findings highlight the substantial impact of menstrual health on HRQoL, particularly in some EQ-5D-5 L domains (usual activities, anxiety/depression, and pain/discomfort). From a public health perspective, it is important to recognise menstrual health as a relevant component of overall well-being of women and PWM. Specifically paying greater attention to menstrual health relation to general pain, emotional health and participation in daily activities when designing health promotion and primary healthcare interventions.
Pertussis remains a clinically significant vaccine-preventable respiratory infection, with the greatest morbidity concentrated in young infants who are not yet eligible for, or have not yet completed, the primary pertussis-containing vaccine series. Despite established immunization programs, hospitalizations continue to occur, and locally generated evidence is needed to describe clinical severity, complications, and healthcare utilization among admitted children. To describe the clinical characteristics, in-hospital management, and outcomes of children hospitalized with PCR-confirmed pertussis at King Saud Medical City (KSMC), Riyadh, and to explore unadjusted associations between pertussis vaccination status and severity-related outcomes. A retrospective exploratory chart review was conducted among children aged 0-14 years hospitalized with PCR-confirmed pertussis between 2023 and 2025. Disease severity was classified using an operational Pertussis Severity Score (PSS), with PSS > 5 indicating severe disease. Descriptive statistics summarized demographic characteristics, clinical presentation, laboratory findings, management, and outcomes. Unadjusted exploratory analyses were performed to assess associations between vaccination status and categorical severity-related outcomes using Pearson's chi-square test or Fisher's exact test, as appropriate. Effect estimates were reported with 95% confidence intervals where applicable. The study included 50 children with a median age of 2.0 months (IQR 1.0-3.0); 50.0% were male. Common clinical features included cough (94.0%), paroxysms (88.0%), cyanosis (70.0%), recurrent apnoea (64.0%), vomiting (64.0%), hypoxemia (58.0%), and pneumonia (40.0%). Most patients had no documented pertussis-containing vaccine dose at admission (86.0%). Severe pertussis (PSS > 5) was identified in 52.0% of cases; 58.0% required oxygen therapy and 54.0% required ICU admission. In-hospital mortality occurred in 20.0% of admissions, reflecting the high-acuity tertiary referral setting. In unadjusted exploratory Fisher's exact analysis, severe pertussis occurred in 25 of 43 children with no documented pertussis-containing vaccine dose before admission compared with 1 of 7 children with at least one documented dose (58.1% vs. 14.3%; OR = 8.33, 95% CI: 0.92-75.36; p = 0.045). This association was borderline and imprecise, as reflected by the wide confidence interval. Hospitalized pertussis at KSMC primarily affected very young infants and was characterized by substantial clinical severity, high ICU utilization, and notable in-hospital mortality within this tertiary referral setting. Children with no documented pertussis-containing vaccine dose were over-represented among severe cases; however, this unadjusted exploratory finding should be interpreted cautiously because age and vaccination eligibility were closely related in this very young admission sample. Larger prospective studies are needed to clarify vaccination-related predictors of pertussis severity while accounting for age eligibility and other potential confounders.
Social media addiction is common among university students and may have consequences for their physical activity. This study examines the relationship between nursing students' social media addiction and both their engagement in physical activity and their perceptions of the benefits and barriers of exercise. This cross-sectional study involved 346 nursing students enrolled at three universities in different regions of Türkiye. Participants completed a demographic questionnaire, the Social Media Addiction Scale (SMAS), and the Exercise Benefit/Barrier Scale (EBBS), which measure social media addiction and perceptions of exercise benefits and barriers, respectively. Data were analyzed with t tests, one-way ANOVA, Pearson correlation, and linear regression, with sex, year of study, and body mass index treated as comparison or control variables. A weak but statistically significant negative correlation was found between social media addiction and exercise benefit perception (r = - 0.188, p < 0.01), and this association persisted after adjusting for age, sex, year of study, and BMI (β = -0.164, p = 0.001). Longer daily social media use was associated with higher addiction scores (heaviest-use group 107.30 ± 35.26; p < 0.001), and students who exercised regularly scored lower than those who did not (p = 0.046). No significant difference in social media addiction was found between female and male students. Because the design is cross-sectional, these findings reflect an association rather than a causal link: higher social media addiction was weakly related to a less favorable perception of exercise benefits. Approaches that encourage physical activity may be worth evaluating in future longitudinal and interventional studies.
High-throughput sequencing has transformed clinical diagnostics of rare diseases (RD), cancer and infectious diseases by enabling the identification of disease-causing genetic alterations and facilitating individualised treatment and care. In response to these advances, Genomic Medicine Sweden (GMS) was established in 2017 as a national collaborative effort to accelerate implementation of genomics-based precision medicine within Sweden's regionally organized, publicly funded healthcare system. GMS brings together the seven university healthcare regions and their associated medical faculties, in collaboration with healthcare regions across Sweden, Science for Life Laboratory, patient organizations, industry and governmental agencies. Activities are coordinated through national disease-specific expert groups, supported by cross-cutting functions in bioinformatics, health economics, ethics, education and patient engagement. At the operational level, seven Genomic Medicine Centres, embedded at university hospitals, develop and deliver harmonised genomic diagnostics nationwide. The National Genomics Platform provides secure infrastructure for large-scale data storage, analysis, and national and international data sharing. Following initial project-based funding, GMS now receives long-term governmental support. This review describes the national implementation of genomic-based precision diagnostics, discusses challenges and lessons learnt, and highlights key milestones across disease areas, including whole-genome sequencing in RD and paediatric cancer, comprehensive genomic profiling of haematological malignancies and solid tumours, pathogen genomics in microbiology, pharmacogenomic testing and emerging applications of polygenic risk scores in complex diseases. Collectively, these efforts have contributed to more than 500,000 genomic tests being performed within Swedish healthcare between 2017 and 2025. Finally, we outline future diagnostic needs and priority areas to ensure sustainable, scalable and equitable access to precision medicine.
Professional volleyball demands high-level neuromuscular control, yet frequent physical exhaustion during competition can compromise postural stability. While balance training is often utilized in athletic training programs, its specific efficacy in mitigating fatigue-induced deficits among elite athletes remains under-investigated. The aim of this study was to determine whether 12 weeks of supplementary balance training, integrated into a routine athletic schedule, improves fatigue-induced postural sway in professional female volleyball players. Twenty-three professional female volleyball players from two professional teams participated in this non-randomized, controlled study. One team implemented supplementary balance training in addition to routine practice, whereas the other team continued their standard seasonal program. Eleven players were in the training team, and twelve were in the control team. Postural sway was assessed using the Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI), and Medial-Lateral Stability Index (MLSI) with the Biodex Balance Systems SD device. Measurements were taken at baseline and multiple time points (0, 10, 20, 30 min) after Bruce protocol, both before and after the 12-week intervention. Data were analyzed using a robust rank-based, non-parametric method and by estimating relative treatment effects (RTEs) with 95% confidence intervals (CIs). Post-intervention analysis revealed no significant group-by-time interaction for OSI (p = 0.303), APSI (p = 0.397), or MLSI (p = 0.113). These results indicate that the trajectory of balance loss and recovery following high-intensity exercise was statistically similar for both groups. While a significant main effect of time was observed (p < 0.001), confirming that high-intensity exercise impaired stability, the supplementary balance training did not provide a statistically superior resistance to fatigue compared to routine training alone. Consistent with the non-significant group-by-time interaction tests (p > 0.05 for all stability indices), the 95% CIs of the RTEs overlapped substantially at all post-exercise time points; however, inferential conclusions are based on the interaction test results. Supplementary balance training did not provide a statistically significant advantage in mitigating fatigue-induced postural instability compared to routine training in this sample.
Superior sinus venosus atrial septal defect (SVASD) is an uncommon congenital anomaly frequently associated with partial anomalous pulmonary venous drainage (PAPVD). Surgical repair has traditionally been the standard treatment; however, transcatheter strategies have recently emerged as viable alternatives in selected patients. We describe a 22-year-old Persian male with SVASD and PAPVD who underwent a staged transcatheter intervention. Initially, two PTFE-covered stents were deployed at the superior vena cava-right atrial junction to redirect pulmonary venous flow and exclude the defect. Due to residual shunting and persistent symptoms, a second procedure was performed, during which a septal occluder device was implanted to close the residual SVASD and a concomitant secundum ASD. The combined approach achieved effective defect closure and symptomatic improvement. This case illustrates the feasibility of a minimally invasive, staged endovascular strategy for complex SVASD with PAPVD. In carefully selected patients, this approach may represent an alternative to surgery.
Patients with a history of cerebrovascular disease may be at an increased risk for postoperative complications following knee arthroplasty; however, previous studies have been limited by small sample sizes and insufficient adjustment for confounding variables. This study aimed to evaluate whether cerebrovascular disease is associated with postoperative complications using a nationwide Japanese database. A retrospective cohort study was conducted using Japan's Diagnosis Procedure Combination database from April 2016 to March 2023. Patients who underwent total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) were identified, and postoperative complications-including deep vein thrombosis, pulmonary embolism, cerebrovascular events, surgical site infection, cognitive-related complications, and periprosthetic fractures-were evaluated. Cerebrovascular disease was defined using ICD-10 codes I60-I69. Propensity score matching (1:1) was performed using demographics, comorbidities, anesthesia type, and surgical procedure. Multivariate logistic regression was conducted to account for residual confounding. Among 259,319 eligible patients, 8298 had cerebrovascular disease. After matching, 8269 pairs were analyzed. Before matching, patients with cerebrovascular disease showed higher rates of thromboembolic and infectious complications, longer hospital stays, and greater transfusion volume. After matching, only cognitive-related complications remained significantly more frequent in the cerebrovascular disease group. Cerebrovascular disease was associated with postoperative cognitive-related complications (odds ratio (OR) 1.70; 95% confidence interval (CI) 1.28-2.26; p = 0.0003), with a risk difference of 0.62% (95% CI 0.28-0.95). Sensitivity analyses excluding patients with preoperative dementia or cognitive impairment and analyses limited to TKA cases demonstrated directionally consistent findings, although these associations did not reach the prespecified stringent significance threshold. Cerebrovascular disease does not increase the risk of recurrent cerebrovascular events after knee arthroplasty; however, it elevates the risk of postoperative cognitive-related complications, despite a low absolute incidence. Although the overall incidence was low, this finding may have implications for postoperative recovery and functional outcomes. III (retrospective cohort study).
Climate change increases the frequency and intensity of heat events. Previous studies have established a correlation between heat exposure and adverse pregnancy outcomes, including preterm birth, stillbirth, and other maternal and fetal health complications. However, evidence on the physiological pathways underlying heat strain during pregnancy and on whether heat adaptation strategies can modify these responses remains limited, particularly in low-resource settings. This study aims to assess the effects of environmental heat exposure on maternal and fetal physiological responses among pregnant women exposed and unexposed to a heat adaptation strategy. Physio-HeMAB is an interventional, cluster-randomized study hosted by the Health and Demographic Surveillance System in Navrongo, Ghana. This study integrates: (i) high-resolution environmental monitoring including Wet-Bulb Globe Temperature at household level and Universal Thermal Climate Index environmental data at regional level; (ii) continuous maternal physiological assessment via wearable devices measuring heart rate, heart rate variability, core body temperature, physical activity, and sleep; and (iii) fetal health assessments, including fetal heart rate and Doppler indices. This multimodal framework supports detailed assessment of how varying levels of environmental heat exposure relate to maternal physiological changes and fetal health indicators. Descriptive and multivariable statistical methods will be used to analyze the data. A better understanding of the physiological mechanisms of heat strain during pregnancy, and an evaluation of whether targeted adaptation strategies can mitigate its effects, are essential for protecting maternal and neonatal health. This Physio-HeMAB study integrates individual-level physiological responses to environmental heat exposure and heat adaptation strategies. This approach strengthens the evidence for developing context-specific and gender-responsive public health interventions. This study was registered in the Pan African Clinical Trials Registry as PACTR202601761543866 on 05 January 2026.
Health literacy is a critical social determinant of health (SDH) that can influence the professional performance of healthcare workers. However, evidence from randomized controlled trials (RCTs) on the effectiveness of structured health literacy training on self-efficacy and occupational well-being among primary health workers is limited. This study aimed to evaluate the effectiveness of a multi-component educational intervention (integrating health literacy fundamentals, self-efficacy theory, communication skills, and stress management) on perceived self-efficacy and occupational well-being. This RCT employed a pretest-posttest design with a control group. A total of 88 health workers were randomly allocated to either an intervention group (n = 44) or a control group (n = 44) using two-stage random sampling. The intervention group received an 8-session health literacy training program (60 min per session, two sessions per week), while the control group received no training. Data were collected using the Ansari Self-Efficacy Questionnaire (20 items, three dimensions: perseverance, self-regulation, effort) and the Zheng Occupational Well-being Questionnaire (18 items, three dimensions: personal life well-being, work well-being, psychological well-being). Data were analyzed using repeated measures ANOVA and MANCOVA in SPSS-26. No significant differences were found between the two groups at baseline (p > 0.05). MANCOVA results showed a significant effect of the intervention on the combined dependent variables (self-efficacy and occupational well-being) (P < 0.001, η² = 0.247, power = 0.998). In the intervention group, mean self-efficacy scores increased from 75.40 to 82.00 (P = 0.001), and mean occupational well-being scores increased from 87.75 to 91.72 (P = 0.004), while no significant changes were observed in the control group. Additionally, a strong positive correlation was found between self-efficacy and occupational well-being in the post-test phase (r = 0.518, P < 0.001). A structured multi-component educational intervention significantly improves perceived self-efficacy and occupational well-being among health workers. Based on these findings, such training may be considered for integration into in-service education programs, particularly in similar primary healthcare settings. However, further research in larger and more diverse samples is needed before widespread policy recommendations can be made. Not applicable.
The community epidemic prevention in the post COVID-19 requires the prevention to respond quickly to changes in the epidemic and immediately initiate on-site isolation. A system for rapid prevention and control of infectious diseases is built systematically, forming a comprehensive epidemic prevention method, and to achieve the application of the system by proposing a new architecture scheme (isolation wards). The paper starts from the theoretical framework of epidemic prevention across preventive medicine, architecture, and mechanical engineering. Through interviews with medical staff in healthcare institutions and preventive medicine experts in public health institutions, the Grounded theory is used to deeply analyze the composition system and key factors. The architectural blueprint is composed of community epidemic prevention as the core, consisting of physical realization & supply system, preventive medicine system, and spatial & functional system. The study identified eight major influencing factors related to the isolation and epidemic prevention system, including the application scenarios and management considerations of isolation wards within communities, the relationship between isolation wards and surrounding community environments and facilities, as well as key aspects of manufacturing and implementation technologies for isolation wards. The small foldable isolation ward will serve as the core material carrier of the prevention system, mainly composed of three key elements: support structure, use unit, and equipment support. The realization criteria, multi-unit combinations, application scenarios and distribution models of isolation wards are also explored. The proposed plan of interdisciplinary collaboration significantly boosts the overall performance of the isolation program and overcomes challenges that community epidemic prevention and control face. Not applicable.
Chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) remains a major global public health problem, as many infected individuals remain undiagnosed. Emergency departments (ED) represent a strategic setting for opportunistic screening. This study aimed to evaluate implementation strategies of opportunistic screening in ED within the Girona Health Region in Spain. A prospective observational study was conducted in the ED of the Hospital Universitari de Girona Dr. Josep Trueta (HUGJT) and the Hospital Santa Caterina (HSC) between October 2023 and January 2024. Adults older than 18 years who required blood testing for clinical reasons were screened. In HUGJT screening was automated within the electronic system (opt-out strategy), while in HSC it was performed following a specific request from the attending physician. Comparisons of screening outcomes between hospitals and patient characteristics were evaluated using non-parametric tests. A total of 1695 patients from HUGJT (54.3% coverage) and 303 patients from HSC (6.9% coverage) with valid screening results were included. In HUGJT, antibodies to HCV were detected in 37 individuals (2.2%); while active infection was confirmed in 9 patients (0.5%) (50.0% were previously undiagnosed), being more frequent among individuals with a history of heroin (20.0%). Hepatitis B surface antigen was detected in 11 patients (0.6%) (60.0% had no prior diagnosis), being more common among individuals born outside Spain, particularly those from South-Saharan Africa (7.1%), North Africa (3.2%), and Eastern Europe (2.2%). Opt-out opportunistic screening in ED is effective for identifying undiagnosed infections and facilitating linkage to care.
This study aimed to develop a CT-based delta-radiomics model for personalized prediction of postoperative prognosis in bladder cancer patients and identification of differentially expressed genes associated with tumour recurrence. This retrospective study included 316 patients with bladder cancer from Wuhan Union Hospital who underwent preoperative unenhanced and arterial-phase CT before surgical resection. Patients were randomly divided into training and internal validation cohorts at an 8:2 ratio. Radiomic features were extracted from tumor volumes of interest on both CT phases, and delta-radiomic features were calculated as arterial-phase features minus unenhanced-phase features. Feature selection was performed within the training cohort using statistical filtering, correlation analysis, and LASSO regression. Multiple machine-learning classifiers were evaluated, and a combined clinico-radiomic model was constructed by integrating the delta-radiomics score with selected clinical predictors. Model performance was assessed using ROC analysis, calibration, decision curve analysis, DeLong testing, and repeated stratified random splitting. An additional TCIA cohort of 33 patients was used for exploratory transcriptomic analysis. After feature selection, nine delta-radiomic features derived from paired unenhanced and arterial-phase CT images were retained for model construction. The LightGBM-based delta-radiomics model achieved AUCs of 0.837 and 0.822 in the training and validation cohorts, respectively. The combined clinical-radiomics model, constructed by integrating the delta-radiomics Rad-score with muscle invasion as a clinical predictor, achieved the best discrimination, with AUCs of 0.860 and 0.861 in the training and validation cohorts, respectively, and showed stable validation performance in 100 repeated splits. High radiomics scores were associated with significantly shorter recurrence-free survival. Exploratory transcriptomic analysis showed enrichment of immune-related pathways in the low-risk radiomic subgroup. Multiphasic CT-based delta-radiomics provides a non-invasive approach for predicting postoperative recurrence and stratifying prognosis in bladder cancer. A combined clinico-radiomic model incorporating delta-radiomics and muscle invasion achieved superior predictive performance and may support individualized postoperative risk assessment.
Metabolic reprogramming is a fundamental hallmark of cancer and provides essential biochemical support for malignant progression. In lung cancer, aberrant fatty acid metabolism not only fuels cancer cell growth but also influences regulatory T cell (Treg) differentiation through altered lipid availability. Krüppel-like factor 5 (KLF5) has been implicated in lung cancer progression; however, its role in coordinating cancer fatty acid metabolism and Treg differentiation remains insufficiently defined. We combined clinical lung cancer specimens, genetically modified lung cancer cell models, Treg differentiation systems, and mouse tumor models to define the metabolic function of KLF5. Gain- and loss-of-function approaches were used to determine how KLF5 affects lipid storage, fatty acid synthesis, extracellular free fatty acid production, and tumor growth. Conditioned-medium transfer experiments, fatty acid uptake assays, fatty acid oxidation measurements, and flow cytometry were applied to evaluate the impact of cancer cell-derived lipid output on Treg differentiation. Mechanistically, promoter-binding assays, transcriptional reporter analysis, protein-interaction experiments, molecular docking, and TAZ depletion were used to dissect how KLF5 regulates FASN-dependent fatty acid synthesis. KLF5 was highly expressed in lung cancer tissues and cells and showed positive associations with lipogenic markers and Treg-related indicators. Suppression of KLF5 markedly weakened the fatty acid metabolic phenotype of lung cancer cells, as reflected by reduced lipid droplet accumulation, decreased free fatty acid release, and downregulation of FASN, SCD1, DGAT2, and PLIN5. In vivo, KLF5 knockdown restrained tumor growth and reduced fatty acid synthesis-related molecular features. Mechanistically, KLF5 bound directly to the FASN promoter and cooperated with TAZ to enhance FASN transcription. KLF5 promoted nuclear accumulation of TAZ, whereas TAZ silencing attenuated KLF5-induced FASN expression, lipid accumulation, and free fatty acid production. Functionally, fatty acids released from KLF5-overexpressing lung cancer cells enhanced CD36-associated fatty acid uptake and fatty acid oxidation in Tregs, thereby promoting Treg differentiation. Conversely, KLF5 depletion reduced this lipid-associated differentiation process both in vitro and in tumor-bearing mice. This study reveals a KLF5-driven fatty acid metabolic program in lung cancer. KLF5 cooperates with TAZ to activate FASN transcription, thereby increasing lipogenesis and free fatty acid release. The resulting lipid output promotes CD36-dependent fatty acid uptake and oxidation in Tregs and supports their differentiation. These findings identify the KLF5-TAZ-FASN axis as a cancer metabolism-centered mechanism linking lung cancer lipogenesis to Treg differentiation, highlighting this pathway as a potential metabolic vulnerability for interfering with fatty acid-supported lung cancer progression.
Prescribing patterns are highly influenced by national healthcare structures. This study aimed to investigate the current antidepressant prescribing patterns, associated diagnoses, and the impact of financial barriers on clinical decision-making in Thailand. We conducted a multicenter national survey on psychotropic drug prescribing across 25 Thai hospitals from December 2023 to March 2024. Utilizing the Research on East Asia Psychotropic Prescription Patterns (REAP-AD3) protocol for antidepressant data, we integrated country-specific modules assessing patient economic burden and physician preferences. Data from 604 patients were analyzed. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed class (70.2%), followed by tricyclic antidepressants (TCAs) (13.9%) and serotonin antagonist and reuptake inhibitor (SARI) trazodone (12.7%). Most common antidepressant users' diagnoses were depressive disorders (55.0%), followed by substance use (15.2%) and psychotic disorders (13.7%). A substantial number of psychiatrists reported feeling restricted by financial and reimbursement limitations related to each prescription, specifically citing limited drug availability (21.9%, n = 131), the patient's reimbursement scheme (36.3%, n = 217), and the patient's financial status (33.9%, n = 203). In addition, 34.3% (n = 205) indicated that they wanted to change the current prescription if there were not any financial barriers, especially for patients currently on TCAs (49.4%, χ2 = 10.16, p = 0.001). Indirect costs per visit (transportation and opportunity costs) frequently exceeded direct monthly medication expenses. SSRIs were the most commonly prescribed antidepressant in Thailand. However, financial constraints may have contributed to the use of TCAs against clinician preference. Policy revisions addressing both medication access and indirect costs are essential to allow psychiatrists to prescribe antidepressants according to clinical needs, which may sustainably optimize mental health outcomes in Thailand.
To explore the long-term therapeutic effect of capsular tension ring (CTR) suture fixation in patients with lens subluxation. A retrospective analysis was conducted on 29 (29 eyes) patients with lens subluxation who underwent phacoemulsification, in-the-bag intraocular lens (IOL) implantation, and ciliary sulcus suture fixation of the CTR at Qingdao Eye Hospital Affiliated to Shandong First Medical University from October 2019 to July 2024. The patients' postoperative best-corrected visual acuity (BCVA), refraction, intraocular pressure (IOP), complications, and IOL position were observed. All patients were followed up for at least 12 months (range: 12-48 months). Postoperative BCVA was significantly improved compared with preoperative values (t=-7.43, P < 0.001). The average postoperative residual refractive error was 0.42 ± 0.39D (range: 0-1.25 D). Postoperative IOP was significantly lower than preoperative IOP (t = 2.42, P = 0.023). Postoperatively, 2 eyes developed dislocation of the IOL-CTR-capsular bag complex and underwent complex suspension surgery; 1 eye had transient high IOP; 1 eye had a small amount of nasal vitreous hernia; and 1 eye developed posterior capsular opacification (PCO) during follow-up, which was treated with YAG posterior capsulotomy. CTR suture fixation can effectively improve visual acuity, maintain stable IOP, and has a low complication rate in patients with lens subluxation. It provides a safe and effective treatment method for lens subluxation.
Cameroon lacks a national screening algorithm for Human papilloma virus (HPV) infection. In order to standardize HPV screening using molecular detection tools in Cameroon, this study aimed to evaluate the concordance of HPV detection via two multiplex systems and profile the epidemiology of High-risk oncogenic HPV (HR-HPV) circulating locally. A cross-sectional study was conducted on endocervical samples collected among women in Cameroon. HR-HPV detection and genotyping was done using Abbott and Sacace kits simultaneously. Discordant results were retested using Anyplex II HPV28 kit. Of 364 participants enrolled (median-age: 42 [IQR:34-50] years), overall HR-HPV positivity was 21.4% (78/364) versus 15.4% (56/364) using Abbott and Sacace, respectively. Detection concordance between the test kits was strong (kappa-value = 0.8). Of 22 samples with discordant results, 86.36% (19/22) were further confirmed with Anyplex II HPV28; yielding an overall HR-HPV positivity prevalence of 20.6% (75/364), with 12 genotypes circulating. The most prevalent genotypes were HR-HPV_16 (18.8%), HR-HPV_18 (16.0%), HR-HPV_39 (16.0%), and HR-HPV_58 (13.0%). Discrepancy in the detection of different and/or same genotype was more prominent for HPV 18 (6/9). Though Sacace is suitable to further discriminate among genotypes, cost-analysis showed that Abbott was 50.6% cheaper in reagents per test. This study revealed a strong concordance between Abbott and Sacace kits for HR-HPV detection, demonstrating interoperability of these two multiplex systems available locally.
Anaemia is prevalent during pregnancy in Fiji. In many countries, inadequate nutrient intake is associated with anaemia during pregnancy. We aimed to describe the relationship between dietary patterns and anaemia amongst pregnant women in Fiji. A hospital-based, age-matched case-control study was conducted in the Antenatal Clinic at the main hospital in Suva, Fiji. Anaemia was defined as a haemoglobin concentration of less than 11.0 g/dL in trimesters 1 and 3, and less than 10.5 g/dL in trimester 2. Dietary variables were assessed using a semi-quantitative food frequency questionnaire, primarily reflecting late-pregnancy intake. Reduced-Rank Regression was employed to identify dietary patterns. Hierarchical multivariable conditional logistic regression models were used to assess the relationship between dietary patterns and anaemia in pregnancy. We enrolled 52 cases and 52 controls. The adjusted odds of anaemia decreased among women who were employed (aOR = 0.20, 95% CI: 0.11-0.37), had at least four antenatal visits (aOR = 0.30, 95% CI: 0.01-0.60), or did not drink milk with main meals (aOR = 0.04, 95% CI: 0.01-0.63). As the intake of vitamin B9 (aOR = 0.85, 95% CI: 0.76-0.98), vitamin B12 (aOR = 0.40, 95% CI: 0.17-0.95), or iron (aOR = 0.42, 95% CI: 0.22-0.80) increased, the odds of anaemia decreased. The odds of anaemia were reduced (aOR = 0.35, 95% CI: 0.10-0.96) for women with high intakes of fruit, vegetables, fish, and nuts, along with a low intake of organ meats, and increased (aOR = 1.21, 95% CI: 1.03-4.02) for women with high intakes of fruit but low intakes of green leafy vegetables, nuts, cereals, and animal protein. In Fiji, both non-dietary and dietary factors are associated with the risk of anaemia during pregnancy. Preventing anaemia in pregnancy should focus on improving employment opportunities, promoting antenatal care visits, and encouraging nutrient-rich dietary habits.
Membranous nephropathy (MN) is an antibody-mediated podocytopathy in which subepithelial immune deposits and complement activation lead to podocyte injury and proteinuria. Short-chain fatty acids (SCFAs) are microbiota-derived metabolites with immunomodulatory properties, but their therapeutic potential and mechanisms in MN remain incompletely defined. We evaluated acetate, propionate, and butyrate in a passive Heymann nephritis (PHN) rat model (n = 6/group). Rats received 150 mM sodium acetate, propionate, or butyrate in drinking water from day 0 to day 42. Proteinuria and biochemical indices were monitored; glomerular immune deposition and ultrastructure were assessed by immunofluorescence and transmission electron microscopy. Antigen-specific antibodies were quantified by ELISA. Glomerular expression of synaptopodin and WT1 was detected by immunohistochemistry. Splenic CD4+ T-cell subsets were analyzed by flow cytometry. In vitro, conditionally immortalized human podocytes were exposed to plasma from patients with primary MN, with or without acetate and the GPR43 antagonist GLPG0974, migration, synaptopodin expression, reactive oxygen species (ROS), apoptosis, and viability were assessed, and SCFA receptor expression was examined. All three SCFAs significantly reduced proteinuria in PHN rats compared with disease controls and ameliorated ultrastructural injury, including GBM thickening and podocyte foot-process effacement. Acetate and propionate reduced subepithelial immune-complex deposits. Acetate selectively decreased antigen-specific anti-sheep IgG responses without altering total IgG. PHN was associated with decreased Tregs and increased Th1/Th17 polarization; acetate increased the Treg proportion in splenocytes. Acetate protected podocyte cytoskeletal integrity and viability in vivo. Acetate acted through GPR43, as the GPR43 antagonist GLPG0974 partially or completely blocked acetate's effects on ROS reduction, migration improvement, and synaptopodin mRNA upregulation. Acetate treatment reduced HDAC activity in both renal cortex and podocytes while increasing HAT activity. Acetate mitigated primary MN plasma-induced dysfunction by improving migration and synaptopodin signal, reducing ROS, limiting apoptosis, and restoring cell viability. Acetate ameliorates experimental MN through coordinated immunomodulatory effects and amelioration of podocyte foot process effacement. These findings support targeting acetate pathways as a mechanistically plausible adjunct strategy with low potential toxicity for MN.