搜索结果：Journal of internal medicine

Rheumatic heart disease (RHD) poses a significant global health challenge due to its high rates of premature morbidity, mortality, and disability, particularly in low-income countries. Existing risk scoring systems for valve replacement in cardiac surgery have primarily focused on non-RHD cases, making them less applicable to RHD patients due to the distinct pathology of valvular damage. This study aims to evaluate the Model for End-stage Liver Disease, including sodium (MELD-Na) score, as a predictive tool for pre-operative mortality risk assessment following cardiac surgery in RHD patients. This retrospective cohort study was conducted at Tenwek Hospital in Kenya and included 93 patients who underwent open heart valve replacement surgery between March 2022 and March 2023. Patients who underwent mechanical mitral valve replacement (MVR), mechanical aortic valve replacement (AVR), and tricuspid valve repair surgery (TVr) were included. Data were collected from Tenwek Hospital's electronic medical record system, and statistical analysis was performed using IBM SPSS Statistics 27.0, including Chi-square and binary logistic regression. Operative mortality was defined as all deaths occurring during the hospitalisation period of the operation and within 30 days post-discharge, unless unrelated to the procedure. The study included a cohort of 93 patients, comprising 36 (38.7%) males and 57 (61.3%) females, with a median age of 25. The majority of patients presented with mitral valve disease, 63 (67.7%), with varying degrees of mitral regurgitation, 32 (34.4%) and mitral stenosis, 31 (33.3%). Notably, 43 (46.2%) of patients exhibited an elevated MELD-Na score falling within the range of 9-15, while 20 (21.5%) had severely elevated scores exceeding 15. The overall mortality rate was 10 (10.8%), with a majority, six (60%), of deaths occurring in patients with severely elevated MELD-Na scores and the remaining 40% in the moderate category. Logistic regression analysis was employed to compare the predictive value of MELD-Na score with EuroScore II as a baseline indicator. Subsequently, the analysis was repeated, incorporating individual components of the MELD-Na score. The results indicated a significant link between the MELD-Na score and operative mortality (p = 0.003), showing an odds ratio (OR) of 1.17 (95% confidence interval (CI): 1.05-1.30). Additionally, both serum creatinine (p = 0.012, OR: 1.04, 95% CI: 1.02-1.09) and the international normalised ratio (INR) (p = 0.005, OR: 2.8, 95% CI: 1.38-6.0) emerged as notable predictors of operative mortality. Elevated MELD-Na scores are associated with an increased risk of operative mortality following RHD valve surgery, suggesting potential utility as a pre-operative risk stratification tool. Our findings underscore the utility of the MELD-Na score, particularly its components serum creatinine and INR, in predicting mortality risk following cardiac surgery in patients with RHD. Further prospective multicentre studies with larger sample sizes and longer durations are warranted to validate these findings.

Inherited epidermolysis bullosa comprises a heterogeneous group of skin fragility diseases, presenting with a range of manifestations and complications that profoundly affect quality of life (QoL). A disease-specific instrument, Quality of Life in EB (QOLEB), has been developed to assess the impact of epidermolysis bullosa signs and symptoms on QoL. The aim of this cross sectional study, conducted as part of a European project - BUR-EB, was to test the psychometric properties of the Italian version of the QOLEB and to assess QoL in Italian epidermolysis bullosa patients. Demographic, clinical, and QOLEB data of 56 Italian patients aged ≥11 years participating in the BUR-EB online survey were analysed. Principal component analysis showed excellent internal consistency of Italian QOLEB, and high convergent validity with the generic questionnaire EQ-5D. About 40% of patients reported severe to very severe disease burden, and a strong correlation was observed between disease severity and QOLEB scores. Independent variables associated with worse QoL were pain, chronic wounds, wheelchair use and patient organization membership. Our study confirms the good psychometric properties of the Italian QOLEB. In addition to depicting the major impact of epidermolysis bullosa on QoL, it identifies pain, chronic wounds and functional disability as major targets for therapeutic interventions.

Psychological problems among children and adolescents are increasing, and people with attention-deficit/hyperactivity disorder (ADHD) face varying degrees of stigma as they grow up. Such perceptions of stigma can prevent them from seeking psychological help and adhering to treatment. However, a standardized instrument for assessing ADHD-related stigma in Chinese populations is lacking. This study assessed the validity and reliability of a Chinese version of the Attention-Deficit/Hyperactivity Disorder Stigma Questionnaire (ASQ). A total of 508 adolescents with ADHD, mostly aged 11-13 years (mean age = 13.68 ± 2.12 years), participated in this study. Among them, 51.8% were junior high school students, and the distribution of male and female participants was relatively balanced. Data were collected from two Chinese hospitals between September 2023 and September 2024. The ASQ was translated and culturally adapted into Simplified Chinese. Psychometric evaluation included exploratory and confirmatory factor analyses, assessment of internal consistency, test-retest reliability, and examination of content and construct validity. Confirmatory factor analysis supported a three-factor structure for the study, demonstrating good model fit ( χ 2 /df = 1.325; goodness-of-fit index (GFI) = 0.900; comparative fit index (CFI) = 0.977; root mean square error of approximation (RMSEA) = 0.036). Convergent validity was supported by average variance extracted values above 0.50 and composite reliability values above 0.70. The scale showed excellent internal consistency (Cronbach's α = 0.951) and strong test-retest reliability (r = 0.958). The Chinese version of the ASQ is a valid and reliable measurement tool that can be used for assessing ADHD-related stigma in Chinese adolescents. This survey tool can assist healthcare professionals in this field in identifying and addressing stigma more effectively, thereby improving treatment adherence.

Statistics is a field that provides the methodological basis for modern scientific research, including data collection, analysis, and interpretation. The retraction procedure involves the official removal of a work from the literature due to substantial scientific concerns. Analysis of retracted publications is critical for identifying ethical violations and structural flaws in scientific publishing. This study performed a bibliometric and descriptive analysis of publications labeled as "retracted" in the Scopus database, retrieved via a search utilizing the term "statistics" on August 18, 2025. The analysis of documents was conducted based on year, country, journal, keyword, and reasons for retraction. Collaboration networks of countries and authors were displayed with VOSviewer software, and reasons for retraction were confirmed using the Retraction Watch Database. Temporal trends were assessed by linear regression analysis. A total of 680 retracted papers were examined. Retractions occurred between 2006 and 2025. A statistically significant upward trend was found in the number of retracted articles over time (P = 0.030). The most retracted publications came from China (n = 426), followed by India (n = 67), and the United States (n = 49). The Journal of Healthcare Engineering (n = 35) and Journal of Sensors (n = 25) stood out among the journals with the most retracted publications. The most common retraction reasons were investigation by journal/publisher (n = 297), unreliable results and/or conclusions (n = 189), and concerns/issues about referencing/attributions (n = 153). The number of retracted publications tagged with the keyword "statistics" has increased significantly over the years. This increase can be attributed to strengthening scientific oversight mechanisms and increased awareness of publication ethics. Increasing the involvement of statistical experts in the peer-review process, improving the statistical literacy of authors, and developing training and mentoring mechanisms to prevent ethical violations are crucial.

To develop and validate a Japanese version of the 26-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-J) for detecting dementia. In this cross-sectional study, consecutive outpatients attending a university memory clinic between 2019 and 2021 completed the IQCODE-J through informants. Dementia was diagnosed according to DSM-5 criteria, independent of IQCODE-J scores. Diagnostic accuracy was assessed using receiver operating characteristic analysis and bootstrap internal validation. Concurrent validity was examined by correlations with the Ascertain Dementia 8-item Informant Questionnaire (AD8-J), Clinical Dementia Rating (CDR-J), Mini-Mental State Examination (MMSE-J), and Frontal Assessment Battery (FAB), and by multivariable logistic regression. Of 166 participants, 93 had non-dementia and 73 had dementia. IQCODE-J scores were higher in the Dementia group (p&#x2009;<&#x2009;0.001). The apparent optimal cut-off in the development dataset was 4.06. Bootstrap internal validation showed an optimism-corrected area under the curve of 0.74, with sensitivity and specificity of 47.5% and 81.8%, respectively. The bootstrap median cut-off was 4.00. At cut-offs of 3.4-3.6, sensitivity ranged from 87.7% to 78.1%, and specificity from 33.3% to 54.8%. Each 1-point increase in IQCODE-J was associated with higher odds of dementia (adjusted odds ratio 7.55, 95% CI 3.31-18.74). IQCODE-J correlated with the AD8-J, CDR-J, MMSE-J, and FAB (rho&#x2009;=&#x2009;0.77, 0.45, -0.47, and -0.44, respectively; all p&#x2009;<&#x2009;0.001). IQCODE-J is a valid and feasible informant-based tool for assessing cognitive decline in Japanese patients. A cut-off around 4.0 may be practical when specificity is prioritized in referral-based settings.

We report the case of an 18-year-old previously healthy female who developed acute liver and kidney injuries with cytopenia and hyperinflammatory markers following cytomegalovirus (CMV) infection. Despite not meeting the hemophagocytic lymphohistiocytosis (HLH)-2004 or H-score criteria, her clinical and biochemical profiles suggested an HLH-like syndrome. Whole-exome sequencing revealed a heterozygous dominant stimulator of interferon genes (STING1) (c.841C>T; p. Arg281Trp) mutation. Although the patient lacked classic STING-associated vasculopathy with onset in infancy (SAVI)-associated skin or lung manifestations, immunological profiling revealed an inverted cluster of differentiation (CD)4/CD8 ratio and absolute CD4+ lymphopenia, supporting a state of underlying immune dysregulation that likely predisposed the patient to severe CMV infection. The patient showed partial clinical and biochemical improvements following antiviral and corticosteroid therapy, supporting our hypothesis of a genetically primed infection-triggered hyper-inflammatory response. This case broadens the STING1 disease spectrum and emphasizes the importance of genomic evaluation of unexplained hyperinflammation, even in apparently immunocompetent hosts. Conclusion: This case highlights a novel STING1 (p. Arg281Trp) gain-of-function mutation with a previously unreported autosomal dominant inheritance pattern identified in both the patient and her asymptomatic father, suggesting incomplete penetrance and variable expression rather than a fully penetrant autosomal dominant pattern. The patient's presentation was atypical compared with classical SAVI, manifesting as a CMV-triggered HLH-like syndrome with acute renal and liver cell injury in an adolescent with no prior evidence of immune deficiency or family history of genetic disease. Notably, this presentation lacked the characteristic cutaneous and pulmonary involvement. This case highlights a distinct phenotypic spectrum and expands our understanding of STING1-related interferonopathies.

Type 1 diabetes (T1D) results from T cell-mediated destruction of insulin-producing pancreatic beta-cells. Recently, the immune-provoking role of stress-related neoantigens has become evident. Neoantigens unlikely contribute to central tolerance and therefore hold strong immunogenic potential, but their role in peripheral immune regulation is unknown. Here, we sought proof of concept that Tregs can be generated against islet neoantigen INS-DRiP that results from stress-induced ribosomal misreads of insulin mRNA. Tregs were induced from na&#xef;ve CD4 T cells isolated from a healthy donor and co-cultured with monocyte-derived tolerogenic DCs either pulsed with neoantigen INS-DRiP or native autoantigen (proinsulin-peptide C19A3) that can induce Tregs in T1D patients. Their phenotypes, cytokine profiles and suppressive capacity were compared. Tregs induced against neoantigen completely inhibited proliferation of na&#xef;ve T cells upon cognate antigen-pulsed DC stimulation, which was indistinguishable from Tregs induced against C19A3. Phenotype and cytokine profiling showed co-clustering of native autoantigen- and neoantigen-specific Tregs, and distinction from T cells generated with antigen-pulsed proinflammatory instead of tolerogenic DCs. Na&#xef;ve T cells exist against islet neoantigen that can be primed to become Tregs despite the high immunogenic potential of neoantigen. Induction of immune regulation to neoantigens may be useful as immune intervention or prevention of T1D.

Cachexia, a complex multifactorial syndrome characterized by loss of skeletal muscle mass, is common in cancer and impacts treatment response, quality of life (QoL) and survival. No effective therapy is currently available. This report summarizes findings from the literature on the relationship between cachexia and physical function, activities of daily living and health-related QoL in patients with solid tumours. We conducted a systematic literature review by searching Embase, MEDLINE and Cochrane Library publications from 2018-2023 for relevant studies. After screening and data extraction, a narrative synthesis was performed to identify QoL and functional outcomes in relation to cachexia. Forty publications representing 37 unique studies and 52&#x2009;053 patients were identified, with 35 (94.6%) observational studies and two (5.4%) post hoc analyses of randomized trials ranging in sample size from 38 to approximately 17&#x2009;000 patients. Mean/median patient age ranged from 45 to 79.6&#x2009;years. Across the 40 publications, 11 different definitions of cachexia or body weight loss were used (with the most common, the Fearon et&#xa0;al. 2011 International Consensus criteria, used in 18 publications [45.0%]), revealing an overall lack of consensus on the most suitable diagnostic criteria for cachexia. Nineteen outcome types were reported, including physical function measures in 31 studies (77.5%), health-related QoL in 24 studies (60.0%), performance status in 16 studies (40.0%), pain and fatigue in 15 studies (37.5%) each, depression or anxiety in nine studies (22.5%) and activities of daily living in six studies (15.0%). Eleven outcome types were exclusively evaluated in univariate analysis; eight were evaluated in multivariate analysis. Many studies identified statistically significantly worse physical function, activities of daily living or health-related QoL in patients with cachexia or body weight loss compared with patients without these conditions. Of studies assessing physical function measures, 80.6% (25/31) identified a statistically significant association with cachexia or body weight loss in at least one outcome; for studies assessing health-related QoL, this was 91.7% (22/24); for performance status, 87.5% (14/16); for pain, 78.6% (11/14); for fatigue, 73.3% (11/15); for depression or anxiety, 55.6% (5/9); and for activities of daily living, 100% (6/6). This systematic literature review provides insights into functional outcomes and health-related QoL in predominantly real-world populations with cancer cachexia and can inform selection of cachexia clinical trial endpoints that reflect clinical benefits to patients. However, the wide range of methods, physical function metrics and patient-reported outcomes instruments used across studies support a call for standardization.

Despite decades of evidence demonstrating that cervical cancer screening prevents morbidity and mortality, approximately one in four eligible Americans remains overdue for screening. Screening gaps are unevenly distributed, disproportionately affecting uninsured individuals, those with lower income or educational attainment, rural residents, and racial and ethnic minority populations. In this commentary, we highlight that perceived out-of-pocket costs for cervical cancer screening-rather than actual costs-remain a salient and modifiable barrier to screening among low-income, underscreened women, even in the context of Affordable Care Act (ACA) provisions. Optimizing cervical cancer prevention requires attention not only to initial screening uptake but also to completion of the full screening continuum, including timely follow-up after abnormal results. Recent policy developments-including the US Supreme Court affirmation of the ACA preventive services mandate, elimination of cost-sharing for patient navigation beginning in 2026, expansion of coverage for diagnostic follow-up starting in 2027 for insured individuals, and endorsement of self-collected human papillomavirus testing-create an unprecedented opportunity to reduce financial and logistic barriers to completion of cervical cancer screening. However, realizing the population-level and equity benefits of these advances will require deliberate implementation strategies that emphasize transparent communication about patient out-of-pocket costs, integration of navigation services, and follow-up pathways. See related article by Isaacson et al., p. 1158.

ObjectiveThyroid disorders are among the most common endocrine conditions worldwide. However, in the Republic of North Macedonia, national level data on their prevalence and demographic distribution are lacking. This study aimed to determine the prevalence and demographic patterns of nonmalignant thyroid disorders using data from the National eHealth System.MethodsThis retrospective, population-based, cross-sectional study analyzed 269,690 anonymized records of patients diagnosed with nonmalignant thyroid disorders, derived from the National eHealth System as of 31 October 2024. Diagnoses were identified using the International Classification of Diseases, 10th Revision codes E00-E07.ResultsThe overall national prevalence of nonmalignant thyroid disorders was 14.68%. Prevalence was higher in women (24.36%) than in men (4.85%) and increased with age, with the highest prevalence of 21.9% among those aged 60-79 years. Women had significantly higher odds of thyroid disorders than men (odds ratio: 6.32; 95% confidence interval: 6.25-6.38; p&#x2009;<&#x2009;0.0001). Prevalence was higher in urban than in rural areas (17.1% vs. 10.9%). Hypothyroidism (E03) was the most common disorder, affecting 9.7% of the population.ConclusionThis is the first national level study to examine the epidemiology of nonmalignant thyroid disorders in the Republic of North Macedonia. The findings reveal marked variations in prevalence by sex, age, and place of residence, underscoring the need for targeted public health strategies and further investigation.

Perioperative morbidity in gastrointestinal (GI) cancers is closely associated with reduced physical fitness and impaired nutritional status. While prehabilitation has been shown to improve outcomes in patients with colorectal cancer (CRC), it is not yet standard of care and remains underexplored in other GI malignancies. This study evaluates the feasibility, safety, and preliminary effectiveness of a supervised moderate-to-high intensity exercise program combined with nutritional counseling in a cohort of GI cancer patients scheduled for surgery. In a prospective, two-arm, controlled trial, patients scheduled for GI cancer surgery were assigned to a prehabilitation program (2-3 sessions/week&#x2009;&#x2265;&#x2009;3&#xa0;weeks, endurance and resistance training with nutritional counseling) or usual care. Primary endpoints were feasibility (eligibility, recruitment, acceptance, retention, adherence) and safety (adverse events). Secondary endpoint was quality of life (QoL; EORTC QLQ-C30 global score, SF-36 physical and mental health component scores, PCS, MCS), assessed at baseline (t0), presurgery (t1), hospital discharge (t2), and 12-week follow-up (t3). Among the 400 patients assessed for eligibility, 36% met the eligibility criteria. Of those approached, 41% consented to participate, resulting in an overall recruitment rate of 27% (n&#x2009;=&#x2009;38). Of the recruited patients, 84% completed the study (n&#x2009;=&#x2009;32; prehabilitation&#x2009;=&#x2009;17; usual care&#x2009;=&#x2009;15; mean age 63.5&#xa0;years, range 38-85; ICD-10 C15-C26). Participants attended 95% of the planned sessions (8.1&#x2009;&#xb1;&#x2009;3.6) within a mean of 30&#xa0;days (SD&#x2009;&#xb1;&#x2009;16) and completed 59% at the target intensity. Nutritional counseling was provided to 94% of the patients. No intervention-related serious adverse events occurred. A modest improvement in PCS was observed in the prehabilitation group at t1 (+&#x2009;4.25 points), although this finding reached statistical significance only in the one-tailed analysis. No between-group differences were observed for global QoL or MCS. Multimodal prehabilitation combining supervised moderate-to-high intensity exercise with nutritional counseling is feasible and safe in a real-world GI cancer population. Recruitment and achievement of prescribed training intensity remain key challenges. Preliminary findings indicate short-term benefits for physical health, supporting further investigations in larger randomized trials. DRKS00028728; prospectively registered 05/05/2022.

This study aimed to compare the clinical and functional outcomes of Kirschner wire (K-wire) fixation versus volar locking plate (VLP) fixation for intra-articular distal radius fractures (DRFs). It also aimed to identify key patient- and fracture-related factors that influence the choice of surgical technique and to evaluate the responsiveness of specific patient-reported outcome measures in assessing recovery.&#xa0; Methods: A total of 201 consecutive patients with Arbeitsgemeinschaft f&#xfc;r Osteosynthesefragen/Orthopaedic Trauma Association-classified DRFs (Type A: n = 51; B: n = 90; C: n = 60) treated surgically between 2005 and 2022 were analyzed. Treatment allocation was based on fracture complexity and surgeon preference, resulting in a distribution where K-wire (n = 63) was primarily used for partial articular fractures (72.4% of K-wire cases were Type B), while VLP (n = 138) was preferred for complete articular fractures (83.6% of plate cases were Type C). Functional outcomes were assessed using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) (primary endpoint), Green-O'Brien, Gartland-Werley, and SF-12 at standardized intervals (6/12/24 months) during supervised physiotherapy.&#xa0; Results: Significant predictors of plate fixation included older age (58.1 &#xb1; 14.7 vs. 42.3 &#xb1; 12.1 years, P < .001), polytrauma (aOR: 2.4, 95% CI: 1.5-3.8), and complete articular fractures (83.6% Type C, P = .01). No statistically significant associations were found between injury type and fixation method (P = .20) or between complications and fixation method (4.8% vs. 2.2%, P = .41). Functional outcomes were comparable across all metrics, with no statistically significant differences observed: QuickDASH (34.9 &#xb1; 18.2 K-wire vs. 31.2 &#xb1; 16.8 plate, P = .146), Green-O'Brien (excellent-good: 76.2% vs. 82.6%, P = .552), Gartland-Werley (78.1% vs. 71.1% excellent-good, P = .591), and 12-Item Short Form Health Survey (SF-12) (100% vs. 99.3% good results, P = .32). Multivariable regression identified reduction quality (&#x3b2; = 0.81, P < .01), not implant type, as the primary outcome determinant.&#xa0; Conclusion: This study suggests that anatomical reduction quality-not fixation method-is the primary determinant of functional success in DRFs, with both K-wire and VLP achieving comparable outcomes (QuickDASH/Gartland-Werley P > .05). K-wires represent a cost-effective alternative for partial articular fractures (72.4% of cases), while plates were more frequently used in complex fractures and polytrauma cases (adjusted odds ratio [aOR] = 2.4). Early rehabilitation (median 4 days post-op) and condition-specific metrics (QuickDASH, Green-O'Brien) are critical for optimal recovery, whereas SF-12 proves less sensitive for wrist-specific assessment. These findings advocate for surgeon-tailored technique selection based on fracture pattern and emphasize the need for multicenter randomized controlled trials (RCTs) to evaluate long-term outcomes.&#xa0; &#xa0; Cite this article as: Yigit O, Kart H, Cat G, et al. Comparison of Kirschner wire versus volar locking plate fixation for distal radius fractures: clinical and functional outcomes. Acta Orthop Traumatol Turc. 2026; 60(2), 0585, doi: 10.5152/j.aott.2026.25585.

Exploring responses to everyday conflict scenarios is important for understanding the development of aggressive behavior in children and for clinical practice. Current research suggests that simulations within virtual reality (VR) improve traditional approaches. We expanded this research by developing a VR-based assessment (VR test) comprising three ambiguous and three hostile peer-related conflict scenarios. This pilot study examined the test's feasibility and psychometric properties in 8-12-year-old boys, including a clinical sample with aggressive behavior problems (n&#x2009;=&#x2009;42) and a non-clinical sample (n&#x2009;=&#x2009;40). During the VR test, behavioral responses were observed and social information processing (SIP) explored. Additionally, we collected reports of peer-related aggression and disruptive behavior symptoms from parents, children, and teachers. Good feasibility of the test was demonstrated by various indicators (e.g., session duration, appeal, immersion). Internal consistencies of the aggressive behavioral response and SIP scales suggested mostly good reliability of the VR test scales. Intercorrelations between scale scores indicated partial overlaps (r&#x2009;=&#x2009;.28-.84). Discriminant validity of the VR test scenarios was demonstrated by higher scale scores for hostile than for ambiguous scenarios and higher scores for ambiguous scenarios compared to a neutral scenario (all p&#x2009;<&#x2009;.001). Differences between the clinical and non-clinical sample revealed discriminant validity of VR test scales (d&#x2009;=&#x2009;0.57-1.76). With a few exceptions, correlations of the VR test scales with multi-informant ratings indicated convergent validity (r&#x2009;=&#x2009;.02-.71). Overall, these findings suggest feasibility and provide initial evidence of adequate psychometric properties. Further research is needed to ensure psychometric robustness and utility. Study registration: https://www.drks.de/ (Number&#x2009;=&#x2009;DRKS00032850, registration date&#x2009;=&#x2009;2024/01/30, retrospectively registered).

Oncocytic (H&#xfc;rthle cell) carcinoma of the thyroid (OCT) is characterized by widespread loss of heterozygosity (LOH), mitochondrial accumulation, and recurrent mitochondrial DNA mutations leading to impairment of complex I. Here, we establish and characterize a novel OCT cell line, UT946, which displays severe mitochondrial electron transport chain dysfunction and a Warburg metabolic phenotype. Using a series of cytoplasmic hybrids, we establish that the complex I defect in UT946 stems from a nuclear-encoded loss-of-function mutation in the complex I subunit NDUFS1. To our surprise, the mutation in NDUFS1 was inherited as a recessive germline allele that underwent LOH in the tumor to expose functional loss of complex I. A reanalysis of 91 OCT tumor genomes revealed that LOH-driven exposure of recessive germline mutations in complex I subunits was a recurrent mechanism underlying complex I inactivation in OCT. These findings unveil a previously unidentified germline-driven mechanism of complex I loss and metabolic reprogramming in cancer and provide further evidence of the selective pressure for complex I impairment in OCT.

ObjectiveThis systematic review and meta-analysis evaluates the diagnostic performance of machine learning-based radiomics models for predicting epidermal growth factor receptor mutation status in Chinese patients with lung adenocarcinoma.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251273027), a systematic search of PubMed, Embase, Web of Science, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wanfang, VIP, and Chinese Biomedical Literature Database was conducted from inception to 31 October 2025. Two reviewers independently screened studies, extracted data, and assessed bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effects model was used to synthesize the data. Subgroup analyses were conducted for three factors: (a) imaging modality (computed tomography vs. positron emission tomography-computed tomography); (b) algorithm type (deep learning vs. conventional machine learning); and (3) validation strategy (external vs. internal).ResultsThirteen studies encompassing 6628 patients were included. The pooled sensitivity was 71% (95% confidence interval: 68-74), the pooled specificity was 81% (95% confidence interval: 78-84), and the summary area under the curve was 0.85 (95% confidence interval: 0.82-0.88). Deep learning models significantly outperformed conventional machine learning models (area under the curve: 0.871 vs. 0.798; P&#x2009;=&#x2009;0.012). Computed tomography-based models yielded higher accuracy than positron emission tomography-computed tomography-based models (area under the curve: 0.879 vs. 0.828; P&#x2009;=&#x2009;0.038). Models validated on independent external cohorts demonstrated superior performance compared with those relying solely on internal validation (area under the curve: 0.922 vs. 0.841; P&#x2009;=&#x2009;0.006). Imaging modality was a significant source of heterogeneity (P&#x2009;<&#x2009;0.05). No threshold effect or publication bias was detected.ConclusionMachine learning-based radiomics models exhibit promising diagnostic accuracy for the noninvasive prediction of epidermal growth factor receptor mutations in Chinese patients with lung adenocarcinoma. Computed tomography-based deep learning models subjected to independent external validation represent the current optimal approach. However, the retrospective nature and substantial heterogeneity of the included studies necessitate large-scale, prospective, multicenter trials with standardized workflows before clinical translation.

Nonalcoholic fatty liver disease (now termed metabolic dysfunction-associated steatotic liver disease [MASLD]) is a leading cause of liver-related mortality worldwide, linked to the rising prevalence of metabolic syndrome. Despite prior analyses using earlier Global Burden of Disease (GBD) iterations, comprehensive trends incorporating post-2020 data remain limited. This study provides the first analysis utilizing the latest GBD 2023 release, examining global, sex-, and country-specific disparities in MASLD age-standardized mortality rates (ASMR) from 1990 to 2023 across 204 countries, highlighting the impact of recent events like the COVID-19 pandemic on metabolic health. MASLD ASMR data were extracted from the GBD 2023 database, defined by International Classification of Diseases, 10th Revision codes. Estimated annual percentage changes (EAPC) in ASMR were calculated using logarithmic linear regression. Analyses were stratified by sex and country, with 95% confidence intervals derived from the standard error of &#x3b2;. Globally, the mean EAPC was 0.152% (range: -3.079% in the Republic of Korea to 4.143% in Kazakhstan) for both sexes, 0.020% for females (-3.630% in Bermuda to 4.612% in the Russian Federation), and 0.291% for males (-2.970% in the Republic of Korea to 4.277% in Turkmenistan). Increases predominated in 111 countries (54.4%), with significance in 94; declines in 93, significant in 78. Pronounced rises occurred in Eastern Europe/Central Asia (e.g., Kazakhstan, Russian Federation) and the Middle East (e.g., Oman), while declines were evident in East Asia (e.g., the Republic of Korea) and Southern Europe (e.g., Italy). Males showed higher EAPC in 119 countries, with a mean sex difference of 0.271%; notable disparities included Cuba (males 3.296% vs females -0.172%). Country-specific trends revealed vulnerabilities in low- and middle-income countries, with mixed patterns in Africa. This inaugural GBD 2023 analysis reveals a modest global rise in MASLD mortality, with regional surges in transitioning economies and male-predominant disparities. Urgent, tailored interventions targeting metabolic risks are essential to mitigate this escalating burden.

Superior vena cava isolation (SVCI) is associated with complications such as sinus node (SN) and phrenic nerve (PN) injury or SVC stenosis. Our study assessed the electrophysiological properties of the SVC and use of high-density mapping for targeted SVCI by ablating preferential conduction sites to avoid these complications. Eighty-three consecutive patients, undergoing HD mapping of the SVC during AF re-ablation procedures were prospectively included. Conduction block (CB) lines between the right atrium and SVC, location of the sinus node (SN) and phrenic nerve (PN), and their spatial relationship to the ablation line (AbL) were assessed. CB lines were present in 98% of patients, with gaps identified in all SVC segments, most frequently posterior (73%), with a median gap width of 23.9 (14.3-37.8) mm. All gaps expressed decremental properties in the EP study. Ablation was performed in 35 (42%) patients and was achieved in all cases using targeted segmental ablation, closing the gaps between the CB lines.Median ablation duration was 88 (66; 161) seconds with a median of 8 (6-12) radiofrequency applications. SN was separated from SVC with CB line in 98% of cases, what excluded necessity to ablate in this area, distance from the AbL to the SN exit zone was 8.9 (6-14.7) mm. PN was located outside the areas of preferential conduction in all cases, distance from AbL to the PN was 10.4 (6.7-12.1) mm. No complications occurred. HD mapping-guided, targeted segmental SVCI using RF energy is feasible and safe.

This study aimed to validate the Caregiver Contribution to Self-Care of Chronic Illness Inventory (CC-SC-CII) and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC) in caregivers of patients with cancer. A multicenter, cross-sectional validation study was conducted involving a convenience sample of caregivers recruited from five Italian oncology centers. Confirmatory factor analysis (CFA) was used to assess structural validity, internal consistency was evaluated using factor score determinacy and McDonald's Omega, and construct validity was examined through correlations between caregiver and patient self-care scores. Test-retest reliability was assessed using the intraclass correlation coefficient. A total of 412 caregivers were included. CFA supported the three-factor structure of the CC-SC-CII and the bidimensional structure of the CSE-CSC, with adequate fit indices for all scales. Internal consistency was excellent across subscales. Construct validity was supported by positive associations between caregiver self-efficacy and caregiver contribution dimensions, while inverse associations emerged with patient self-care in selected domains. This study contributes to the limited evidence on caregiver support to self-care in cancer, offering validated tools to guide clinical assessment and research on this topic.

The Global Lung Function Initiative (GLI) has recently introduced race-neutral reference equations for pulmonary function tests, replacing traditional ethnic-specific equations. However, the clinical impact of this transition in Northeast Asian patients with idiopathic pulmonary fibrosis (IPF) remains unclear. We evaluated the implications of switching from the ethnic-specific equations to the race-neutral GLI equations in 903 Korean patients newly diagnosed with IPF between 2005 and 2020. Per cent predicted values of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) were calculated using both equations and used to derive the baseline gender-age-physiology (GAP) index scores. We then compared the prognostic performance of GAP staging derived from each equation in predicting all-cause mortality. Additionally, we assessed the clinical impacts of 1-year absolute declines in FVC and DLCO % predicted, as determined by each equation. The race-neutral GLI equations yielded higher FVC % predicted and lower DLCO % predicted values compared with the ethnic-specific equations, resulting in GAP stage reclassification in 203 of 903 patients (22.5%), predominantly toward lower stages. Despite these differences, the agreement in GAP staging between the two equations was substantial (Cohen's kappa 0.628) and their predictive performance for mortality did not significantly differ (C-index 0.686 vs 0.684; p=0.598). One-year absolute declines in FVC and DLCO % predicted were similarly associated with increased mortality, regardless of reference equation used. In Northeast Asian patients with IPF, race-neutral GLI equations resulted in reclassification of GAP stage for some patients but did not affect the overall prognostic performance of the GAP index in predicting mortality.