Kho-Kho is a high-intensity traditional sport characterized by rapid directional changes, relay-based movement patterns, and sustained postural demands, requiring well-developed agility, balance, and functional movement capacity. This study examined pre-post changes in functional movement, postural stability, and agility during a short-term camp-based functional strength and balance training period in male and female national-level Kho-Kho players. This single-arm, pre-post interventional trial included 60 national-level Kho-Kho players (30 males, 30 females) who participated in a two-week intensive functional strength and balance training program conducted during a training camp. No concurrent control group was included. Pre- and post-training assessments included the Functional Movement Screen (FMS), static balance under open- and closed-eye conditions, dynamic balance on both and single limbs, and agility performance using SEMO and Illinois tests. Linear sprint speed was assessed using a 40 m run test. Sex-based differences were examined using independent t tests, and two-factor ANOVA was used to examine differences according to time point, sex, and their interaction for selected performance outcomes. Significant pre-post changes were observed in FMS composite scores for both sexes (p ≤ 0.001, η2p = 0.66). Static balance scores changed favorably under both visual conditions (open eyes: p ≤ 0.001, η2p = 0.82; closed eyes: p ≤ 0.001, η2p = 0.76). Dynamic balance showed significant time-related changes in overall analysis for both-feet and single-limb conditions (p ≤ 0.001, η2p = 0.25 and 0.35, respectively), although within-sex analysis showed that the female single-foot condition did not change significantly. Agility test times showed significant pre-post reductions in SEMO and Illinois tests (p ≤ 0.001, η2p = 0.66 and 0.68), whereas the 40 m run test showed no significant changes (p = 0.28). Significant overall differences between male and female players were identified for dynamic balance on both feet (p = 0.007, η2p = 0.12) and agility outcomes (SEMO: p ≤ 0.001, η2p = 0.37; Illinois: p ≤ 0.001, η2p = 0.38). During the short-term structured camp-based functional strength and balance training period, favorable pre-post changes were observed in functional movement, postural stability, and agility among national-level Kho-Kho players. Because of the single-arm pre-post design, the absence of a concurrent control group, and possible agility-test familiarization effects, the findings describe changes observed over time and do not establish that the training program caused the observed changes. Controlled studies are required to determine the independent contribution of the training program.Trial registration: ClinicalTrials.gov, NCT06602895; retrospectively registered on 17 September 2024, after participant enrolment and commencement of the study.
This study aims to explore common challenges in self-management among patients with bladder cancer stoma during the first year post-surgery, providing reference for developing postoperative management and follow-up strategies. This was a descriptive qualitative study. Using purposive sampling, bladder cancer patients with urinary stomas from the Urology Departments of the Third Affiliated Hospital of Kunming Medical University and the Second Affiliated Hospital of Kunming Medical University were selected as participants between October 2024 and February 2025. Semi-structured interviews were conducted with patients at 1 month, 3 months, 6 months, and 12 months post-surgery. Thematic analysis was employed to identify themes. A total of 52 patients with urinary ostomies following bladder cancer surgery at different postoperative stages were included: 11 at 1 month post-surgery, 15 at 3 months, 14 at 6 months, and 12 at twelve months. Four main themes and nine sub-themes were identified: (1) constraints of physical and mental conditions (limited physical function, the fear of managing stoma care independently); (2) limitations in educational practice applications (lack of adequate and personalized education, application challenges in daily and nursing practice, inadequate health assessment capabilities); (3) perceptual and coping biases (tolerance and neglect of discomfort); (4) imbalance in multifaceted support systems (loss of autonomy with reliance on others' assistance, lack of access to specialized resources, negative impact of economic and policy constraints on self-management behaviors). Patients with urinary stomas face multiple postsurgical self-management challenges, including physical and psychological limitations, insufficient educational support, and constraints imposed by family, financial, and policy factors. These challenges hinder effective self-management to varying degrees. Therefore, enhancing pre- and post-discharge educational interventions is crucial to equip patients with the necessary skills and improve their health literacy. Concurrently, strengthening primary-level professional stoma care and reinforcing family and social support systems are essential. The comprehensive implementation of these measures may significantly improve self-management abilities and overall quality of life for patients with urinary ostomies, providing valuable implications for clinical practice and patient care strategies.
COVID-19 has been associated with adverse mental health outcomes in children. However, evidence regarding the long-term trajectories of post-acute symptoms remains limited. We examined long-term emotional and behavioral trajectories in children following COVID-19 infection. Eighty-four children (aged 6-16) with a confirmed COVID-19 were initially enrolled. Of these, 69 completed the three-year follow-up assessment and were included in the present analyses. Parents completed assessments approximately three months post-infection, retrospectively rating their child's behavior preceding infection and during the two weeks prior to the post-COVID assessment. An age- and sex-matched control group (n = 94) completed identical assessments. The COVID-19 group was reassessed approximately three years post-infection. Results showed that the COVID group showed significant impairments in school functions, internalizing problems, conduct problems, irritability and focus in post-COVID conditions compared to pre-COVID baseline. At three-year follow-up, most impairments resolved to pre-COVID levels. However, prosocial functioning among females remained impaired. Additionally, longer time since infection correlated with fewer school function problems (r = -0.26, p = 0.041) and lower levels of internalizing symptoms (r = -0.26, p = 0.038). In conclusion, post-COVID-19 children exhibited marked post-acute impairments in school functioning, increased emotional and behavioral problems followed by heterogeneous recovery trajectories.
To determine and compare the pain relief between Acetaminophen, Mefenamic Acid and Diclofenac Sodium in participants who had just had Implanon NXT® inserted. 129 healthy female participants were recruited from four clinics prior to Implanon NXT® insertion. They were randomized to receive either tablet Acetaminophen; tablet Mefenamic Acid; tablet Diclofenac Sodium; or no drugs. Post insertion, participants marked their pain score on a 100 mm Visual Analogue Scale (VAS) line during Lignocaine injection, Implanon NXT® insertion, 2 hours post insertion, 4 hours post insertion, and every day thereafter for 7 days; once in the morning before taking any analgesic, and once again after taking the prescribed analgesic. The Pain Intensity Difference (PID) and Sum of Pain Intensity Differences (SPID) were calculated for each drug. The Sum of Pain Intensity Differences (SPID) for Diclofenac Sodium group is 1009 mm VAS, for Mefenamic Acid group is 446 mm VAS, for Acetaminophen group is 296 mm VAS, and for Control group is 58 mm VAS. Kruskal Wallis ANOVA indicated that there were statistically significant differences between the Pain Intensity Differences on Day 2 (PID2) assigned to the "Mefenamic Acid" group and "Control" group (p = 0.021, adjusted significance (Bonferroni's) p = 0.013). The ANCOVA indicated that, after accounting for the effects of different baseline pain intensities at the beginning of the study, there was a statistically significant effect of drugs used on Pain Intensity Difference Day 2 (PID2), p = 0.024, partial ƞ2 = 0.07. Post-hoc testing revealed that the participants in the Mefenamic Acid group reported higher Pain Intensity Difference on Day 2 (PID2) than the Control group. All oral analgesics demonstrated a reduction in pain score. Based on this limited study, the most suitable analgesic for pain management post Implanon NXT® insertion is tablet Mefenamic Acid 250 mg twice daily for up to 2 days. More robust double-blinded studies using placebos as a control are needed to confirm this finding. This study was retrospectively registered with the Thai Clinical Trial Registry: TCTR20260331002 (https://www.thaiclinicaltrials.org/show/TCTR20260331002) on 31st March 2026.
The incidence and mortality of breast cancer are increasing year by year. Image-guided radiotherapy (IGRT) after breast cancer surgery is one of the important ways of comprehensive treatment of breast cancer, but the frequency of IGRT and additional radiation damage are one of the key problems of clinical attention. To investigate the impact of different orthogonal image-guided frequencies on positioning error correction, plan target volume (PTV) margin expansion, and dose distribution in postoperative radiotherapy for breast cancer patients, providing a reference for the optimal orthogonal image-guided frequency in clinical practice for post-surgical breast cancer radiotherapy patients. From January 2021 to January 2022, 61 patients undergoing postoperative intensity-modulated radiation therapy (IMRT) for breast cancer at Fujian Medical University Union Hospital were selected. Prior to each radiation session, initial setup errors were measured as the control group (Group A) using real-time orthogonal images aligned with digitally reconstructed radiographs (DRR). Automatic couch adjustments were then performed based on alignment results within specified error tolerances to determine residual setup errors. Data collected were categorized into experimental Groups B1 to B5 based on different verification frequencies (every 1 to 5 days). Statistical analysis was conducted on the grouped data to calculate PTV expansion margins under different error conditions and assess their impact on dose. In the study involving 61 patients, a total of 915 datasets were collected. The initial setup errors in three translational directions were (3.57 ± 3.48) mm, (2.76 ± 2.60) mm, and (2.65 ± 2.28) mm, respectively. With increasing verification frequency, residual setup errors gradually decreased. Under daily verification frequency, residual errors were (1.65 ± 0.90) mm, (1.60 ± 0.94) mm, and (1.56 ± 0.90) mm in the three translational directions. Pairwise comparisons between control and experimental groups indicated that differences were statistically significant except between B3 Vs B4, and B4 Vs B5. Based on setup error calculations under different verification frequencies, the reference PTV expansion margins decreased with increasing frequency. Specifically, under daily verification, the calculated PTV expansion reference values reduced from initial uncorrected setup errors of 6.53 mm, 5.07 mm, and 4.01 mm to 1.26 mm, 1.41 mm, and 1.29 mm, respectively. The differences between verification frequencies of every 3 days, 4 days, and 5 days were minimal. Finally, virtual error plans were designed in the treatment planning system based on average errors for each group of patients. Deviations in target area doses were statistically significant compared to the original plan across different imaging frequencies. Daily image-guided setup verification (including correction) effectively reduces setup errors in postoperative breast cancer IGRT. Variations exist in the efficacy of error correction and its impact on PTV expansion and dose among different verification frequencies. Higher frequencies exhibit more significant error correction effects, necessitating smaller PTV expansions. At the same time, daily image guidance can reduce the dose of the heart and left lung. Further follow-up studies are required to track the impact of these deviations on dose and clinical efficacy.
N6-methyladenosine (m6A) is a widespread internal modification of eukaryotic mRNA and is increasingly recognized as an important regulator of plant growth, development, and stress adaptation. However, its involvement in postharvest disease resistance of fruit is still poorly defined. In the present study, we identified an RNA demethylase, CsALKBH8, and investigated its function in citrus defense against green mold. We found that Penicillium digitatum infection significantly reduced global m6A levels in citrus peel, accompanied by rapid induction of CsALKBH8 expression. In vitro assays confirmed that CsALKBH8 possesses m6A demethylase activity. Transient overexpression of CsALKBH8 in citrus peel markedly alleviated disease development, as reflected by lower infection severity and smaller lesions after pathogen challenge. Transcriptome analysis revealed that CsALKBH8 overexpression induced extensive reprogramming of gene expression, with significant enrichment of defense-related pathways, including reactive oxygen species (ROS) metabolism, phenylpropanoid biosynthesis, and plant-pathogen interaction. Furthermore, CsALKBH8 reduced m6A levels on transcripts of multiple defense-related genes, including CsPR-1, CsPODs, CsRBOHF, CsGSTs, and lignin biosynthesis-associated genes, thereby enhancing their expression. This epitranscriptomic regulation promoted the activation of ROS metabolism and lignin accumulation, leading to increased enzyme activities (NOX, SOD, POD, APX, GST, and LAC) and elevated levels of H2O2, O₂-, and lignin, ultimately strengthening disease resistance in citrus fruit. Collectively, our findings demonstrate that CsALKBH8 enhances citrus resistance to P. digitatum through m6A-dependent post-transcriptional regulation of defense pathways, highlighting its potential as a molecular target for improving fruit storage quality and postharvest disease control.
Transcriptome analysis relies on intact RNA, and RNA integrity relies on intact cells. Death and cardiac arrest cause hypoxia and result in cell death and RNA fragmentation. Our study aims to systematically define the organ-specific post-mortem intervals (PMIs) at which RNA fragmentation has reached a level that hampers transcriptome analysis and at which apoptosis marker gene expression starts and reaches its maximum. A total of 453 biopsies were harvested from nine organs of seven body donors at 8, 10, 12, 18, and 24 hrs (h), and in four of them also at 6 h after confirmed death. From the livers, two biopsies were harvested. The material was used for calculating the percentage of RNA fragments > 200 nucleotides (DV200) and for determining the expression levels of marker genes of the intrinsic (BAX; CASP9) and extrinsic (FADD; FASLG; CASP8) apoptosis pathways. Additional material was collected from all organs and used for preparing histological sections. These were checked for pathologies. Detailed DV200 values and details of the expression levels of the selected genes of both apoptotic pathways are provided for each time point and organ. The DV200 and apoptosis marker expression levels of the different liver segments were almost identical. Our findings characterize post-mortem RNA fragmentation and the dynamics of apoptotic marker gene expression in nine organs. They define the time frame during which material harvested from these organs can be successfully used for transcriptomics projects, such as the Human Cell Atlas and similar programs.
Chronic odontogenic infections may represent overlooked infectious foci in patients with infection-related glomerulonephritis when conventional sources, such as skin or upper respiratory tract infections, are not identified. This manuscript first reports the case of a 36-year-old man who presented with nephritic syndrome and acute kidney injury requiring dialysis. Renal biopsy demonstrated infection-related glomerulonephritis with features compatible with post-streptococcal glomerulonephritis, although antistreptococcal serology was not available. Extensive medical investigation did not identify a conventional infectious source. A subsequent dental evaluation revealed an untreated chronic endodontic infection associated with pulpal necrosis, which was considered a plausible odontogenic infectious focus rather than a definitively proven causal source. After endodontic treatment, together with supportive medical care, the patient experienced progressive recovery of renal function and dialysis was discontinued. To contextualize this clinical observation, a scoping review was then conducted according to the Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR guidelines, aiming to map previously published cases in which oral or odontogenic infections were described as possible infectious foci associated with post-streptococcal or infection-related glomerulonephritis. Searches were performed in MEDLINE/PubMed, LILACS, SciELO, Web of Science, Scopus, Embase, Open Access Theses and Dissertations, and DANS Easy. Eligible reports were charted descriptively, focusing on patient characteristics, oral infectious source, renal diagnosis, treatment, and clinical outcome. The available evidence remains limited and predominantly descriptive, supporting hypothesis generation rather than causal inference. Nevertheless, both the present case and the mapped literature reinforce the importance of considering occult oral infectious foci in selected cases of infection-related glomerulonephritis of unclear origin. Interdisciplinary collaboration between nephrology and dentistry may contribute to more comprehensive diagnostic workup and management in these complex presentations.
There is limited real-world evidence on the safety and effectiveness of fremanezumab in South Korea. We aimed to evaluate the safety and effectiveness of fremanezumab as a preventive migraine treatment in adults with migraine in real-life clinical practice in South Korea. A 6-year, non-interventional, prospective, post-marketing surveillance study conducted in up to 60 clinics and hospitals in South Korea from July 2021 to 2027. Eligible participants are aged ≥ 18 years, have a formal migraine diagnosis, and are receiving fremanezumab for the first time. The primary endpoint is the proportion of new adverse events, including serious adverse events, from first administration of fremanezumab to the 12-week observation period or discontinuation. Secondary endpoints include the mean change from baseline to week 12 in average monthly migraine days (MMD), proportion of participants achieving a ≥ 50% reduction in MMD, and the Patient Global Impression of Change (PGIC) scale at week 12. We present an interim analysis of data collected up to the third year of this study. As part of the overall study, this 3-year interim analysis included data from 14 sites, with 1230 participants for safety and 1096 for effectiveness analyses (mean age: 46.1 years, standard deviation: 13.7; episodic/chronic migraine: 45.2%/54.8%; mean disease duration: 6.9 years [standard deviation 8.2]). Adverse events were reported by 17.6% of participants; the most common were injection-site reactions (5.7%); serious adverse events were infrequent (1.0%). After 12 weeks of treatment, mean change from baseline in MMD was - 7.8 ± 8.1 days (episodic migraine: - 3.4 ± 4.5 days, chronic migraine: - 11.4 ± 8.7 days), all p < 0.0001; 56.5% of participants (episodic migraine: 55.0%, chronic migraine: 57.7%) achieved a ≥ 50% reduction in MMD. Most participants (87.0%) rated treatment as effective on the PGIC scale. Fremanezumab was well tolerated and effective for migraine prevention in Korean adults in a real-world setting. These results support the use of fremanezumab in routine clinical practice across South Korea. This real-world study in South Korea assessed the safety and effectiveness of fremanezumab for preventing migraine in adults (aged ≥ 18 years). The main outcome was the proportion of new side effects reported during the first 12 weeks of treatment. Other study outcomes included the average change in the number of migraine days per month, the proportion of participants whose migraine days were reduced by at least half, and the patients’ overall perception of improvement in their migraine over the first 12 weeks of treatment. This interim analysis was based on data collected over a 3-year period from 14 of up to 60 sites participating in an ongoing multicenter study evaluating the safety and effectiveness of fremanezumab in adults with either episodic or chronic migraine across South Korea. Approximately 18% of participants experienced side effects, mostly mild reactions at the injection site, and serious side effects were rare (1%). On average, participants experienced nearly 8 fewer migraine days each month after receiving fremanezumab treatment compared with before receiving treatment, with those who had chronic migraine showing the greatest improvement. More than half (~ 57%) of the participants had their monthly migraine days reduced by at least half. Most participants (87%) felt their condition improved with treatment. Overall, fremanezumab was well tolerated and was effective in preventing migraine in Korean adults when used in everyday clinical practice. This study provides important real-world evidence supporting the use of fremanezumab in South Korea and helps healthcare professionals understand its benefits and risks in routine care.
To evaluate whether middle-latency-somatosensory evoked potentials (MLSEPs) can help to predict outcome in coma after cardiac arrest (CA). We conducted a retrospective evaluation of comatose patients after CA. MLSEPs were recorded during the first 12hs and after 72hs. No evolutionary analysis was done between these two patient groups. The outcome was evaluated using the cerebral performance category score achieved 6 months after CA. We retrospectively reviewed the records of 325 patients; of whom 248 were analyzed. Of these, 137 had SEP tests in the first 12 h, and 142 had them at 72hs. The two patient groups were analyzed separately and no evolutionary evaluation was made. At 12hs, the presence of MLSEPs associated with N20-P25 > 4.0 μV has a high prognostic value for predicting the recovery of consciousness (CPC1-3) (FPR:0.0%;-0.0-4.7;-95%ICs- and ACC:78.6-70.6-85.3;-95%ICs-). At 72 h, the absence of these components has high predictive value for severe disability (CPC 3-5), (FPR: 0.0%; 0.0-14.2; 95% CI and ACC: 73.6%; 64.8-81.2; 95% CI). At 12hs after CA, the presence of MLSEPs with cortical SEPs N20-P25 > 4 μV indicates a recovery of consciousness. Conversely, the absence at 72hs after CA, predicts severe disability. MLSEP incorporated into a multimodal prognostic pathway, may be a useful support tool in outcome prediction of post-anoxic coma.
Post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID syndrome (LCS), is characterized by persistent symptoms following SARS-CoV-2 infection and poses significant health challenges, particularly impacting pulmonary function in children. This study aims to evaluate the effect of COVID-19 vaccination on pulmonary function in children with PASC using standardized spirometry and impulse oscillometry (IOS). This prospective, observational study was conducted from July to September 2022, at the tertiary medical center of a children's hospital in Taiwan. Pediatric patients aged 6 to 18 years diagnosed with PASC were enrolled. Demographic data, vaccination status, and blood test results were collected. Pulmonary function was assessed using spirometry and IOS, measuring parameters such as respiratory resistance (R5, R20) and reactance (X5). Statistical analyses explored the association between IOS results and clinical symptoms, as well as vaccination status. Among 209 children, 78.7% were vaccinated. IOS detected abnormalities in 74.6%, with 12.0% diagnosed with obstructive lung disease (OLD) and 62.9% with small airway disease (SAD). Fatigue (56.0%) and dyspnea (52.0%) were most common in OLD, while chest pain (45.0%) and cough (41.7%) prevailed in SAD. Vaccinated children showed significantly lower respiratory resistance (R5, R20, p < 0.01) and improved reactance (X5, p < 0.001). Vaccination did not significantly reduce respiratory-related symptoms but it was associated with lower risks of decreased appetite (OR = 0.399) and sleep disturbance (OR = 0.345). COVID-19 vaccination may have a protective effect on pulmonary function in children with PASC, highlighting its mitigation of long-term respiratory complications. Further studies are needed to explore underlying mechanisms.
Although pain response has been associated with overall survival (OS) in palliative radiotherapy for bone metastases, the prognostic impact of integrating pain response with changes in performance status (PS) and treatment-related adverse events (AEs) remains unclear. This study aimed to investigate their combined effects on OS in this context. This study included 361 patients treated with palliative radiotherapy for bone metastases between January 2013 and October 2024, with 1-year OS as the primary endpoint. A composite score was developed by assigning weights to pain response, PS change, and AEs based on their respective 1-year OS rates (point = OS%/10). Internal validation used bootstrap resampling (1,000 iterations). Incremental prognostic value was assessed using Net Reclassification Improvement (NRI). The score (range, 4.8-15.8) significantly stratified OS (p < 0.001) with a C-index of 0.73. The composite model demonstrated superior discriminative performance compared with individual factor based on AUC comparisons (all p < 0.001). NRI analysis showed incremental prognostic value of the composite model over pain response (p = 0.017), PS change (p < 0.001), and AEs (p < 0.001). In conclusion, the scoring model incorporating pain response, PS changes, and AEs stratified OS-risk after palliative radiotherapy for bone metastases, providing incremental predictive value beyond pain response alone, but requires external validation before clinical application.
While adjacent segment degeneration (ASDeg) is a major complication following lumbar fusion, objective tools for preoperative risk prediction remain lacking. This study developed a model integrating clinical data, deep learning, and radiomic features from multisequence magnetic resonance imaging (MRI) to predict high-risk patients for ASDeg after lumbar fusion. This study included 305 patients who underwent lumbar MRI before surgery. The patients were randomly divided into a training cohort (n = 192) and an internal validation cohort (n = 83). An external test cohort (n = 30) was recruited from two additional centers. The Vision Transformer 3D model architecture was used for model development. Deep learning-based and handcrafted radiomic features were extracted from multisequence MR images of patients. A logistic regression model incorporating the least absolute shrinkage and selection operator was established, and both radiomic feature and deep learning radiomics (DLR) feature classification models were developed. ASDeg was defined as degeneration observed during radiological follow-up > 6 months after lumbar surgery and served as the reference standard. The performance of 14 machine learning classification models in predicting high-risk patients for ASDeg was evaluated using receiver operating characteristic (ROC) curves. A combined model was developed by integrating clinical baseline variables. After feature selection, 17 handcrafted radiomic features, 12 DLR features, and three clinical features were ultimately selected. The most effective machine learning algorithm for the radiomic feature model was the linear support vector machine, and AdaBoost was the best performing algorithm for the DLR feature model. By combining these features with clinical features, a combined model was developed, with the gradient boosting machine being the most effective machine learning algorithm. The AUCs for training, internal validation, and external test cohorts were 0.959, 0.818, and 0.895, respectively. Compared to the combined predictions of two spinal surgeons, the combined model also demonstrated superior performance. Calibration curves showed better calibration in the validation set. Decision curve analysis demonstrated greater net benefit for patients. The combined model effectively identified patients at high risk of ASDeg following lumbar fusion based on clinical characteristics and MRI, which may help reduce revision surgeries and alleviate the burden on the public healthcare system. Not applicable.
Post-intensive care unit (ICU) patients frequently fail to meet nutritional requirements during recovery on the hospital ward. Alterations in appetite, smell and taste perception in ICU survivors remain poorly understood. This study compared appetite and sensory perceptions between ICU survivors and general ward patients and assessed relationships with nutritional goal achievement during hospitalization and early recovery. In this single-center, observational prospective cohort study, 50 post-ICU patients (ICU stay ≥48 h) and 50 acutely admitted general ward patients were enrolled (June 2023-February 2024). Appetite, taste and smell perception were the primary outcome parameters and were assessed within 24 h of ward admission, after 7 days or at discharge, and at 6 weeks using visual analog scales. Multivariable linear regression and mixed-effect models analyzed associations between post-ICU status and outcome parameters at ward admission and during follow-up. No differences in appetite, taste, or smell were observed between post-ICU and general ward patients at ward admission or during follow-up (all P > 0.05). Post-ICU showed significant improvements in appetite, taste, and smell within 6 weeks (P < 0.001, P = 0.01, and P = 0.02, respectively), in contrast to general ward patients (all P > 0.05). Post-ICU patients achieved lower energy (48% ± 28% vs 72% ± 33%, P = 0.00) and protein adequacy (46% ± 29% vs 72% ± 39%, P = 0.00) versus general ward patients. We observed no differences in appetite, smell, or taste between post-ICU and general ward patients at ward admission or during recovery. Post-ICU achieved lower energy and protein adequacy by oral intake but barriers of reduced intake remain to be further investigated.
The mismatch negativity (MMN) has since decades become one of the most prominent phenomena in cognitive neuroscience, recognised as a brain response indexing automatic change-detection. While substantial work has characterized post-stimulus mismatch responses (MMRs), comparatively little is known about how prior information is represented before stimulus onset. 34 healthy human volunteers (12 females) underwent a somatosensory roving paradigm with EEG to investigate whether anticipatory brain activity reflects stimulus history accumulation. Post-stimulus analyses revealed canonical somatosensory MMRs, corresponding to a modulation of the N140 component (MMN), source localised in secondary somatosensory cortex, and a P300 MMR. Both were parametrically modulated by train length, with opposing direction for standard and deviant trials, decreasing over the course of the experiment. Pre-stimulus analyses revealed a stimulus-preceding negativity (SPN) that systematically varied as a function of stimulus history; longer trains of stimulus repetitions were associated with reduced anticipatory negativity. The SPN did not vary throughout the experiment, but its relationship with post-stimulus responses evolved, showing an initially negative correlation with the N140 that diminished over time, and an opposite pattern for the P300. Source reconstruction localized the SPN to a network involving inferior frontal, fronto-polar, and somatosensory cortices, suggesting a possible role in top-down gain modulation of upcoming sensory stimuli. These findings indicate that learning of statistical regularities is not only observable in the post-stimulus phase following violation of statistical regularities (i.e., prediction error signals), but also in neural activity preceding sensory inputs, thereby providing new avenues for investigating endogenous predictive processes.Significance Statement Research on unexpected sensory events has focused on post-stimulus neuronal responses, leaving the pre-stimulus representation of predictive information largely unexplored. Using a somatosensory roving paradigm, we show that stimulus history modulates pre-stimulus brain activity in addition to post-stimulus mismatch responses. The amplitude of the stimulus-preceding negativity (SPN) varies systematically with the number of preceding repetitions, indicating that anticipatory neural activity reflects the accumulation of prior information. These results provide evidence that endogenous predictive processes can be observed before sensory input arrives, complementing post-stimulus accounts of mismatch responses and advancing our understanding of anticipatory mechanisms in sensory processing.
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.
Excessive adiposity may alter dynamic postural control during functional tasks, but its influence on direction-specific acceleration during unilateral sit-to-stand transitions remains insufficiently understood. This study aims to examine the association between percent body fat and smartphone-derived direction-specific acceleration variables during the single-leg sit-to-stand test (SLSTST) in young adult females. Sixty young adult females, categorized by percent body fat as normal fat, overfat, and severe fat groups (n = 20 per group), performed the five-times SLSTST using the dominant leg. A smartphone positioned at the S2 level recorded linear acceleration in the mediolateral (ML), vertical (VT), and anteroposterior (AP) directions. Smartphone-derived acceleration variables were reported in cm/s², and task completion time was reported in seconds. Group differences were examined using one-way ANOVA with Bonferroni-adjusted post-hoc comparisons. The severe fat group exhibited greater direction-specific acceleration than the normal fat group, including posterior AP acceleration (-20.93 vs. -11.31 cm/s²), ML acceleration (5.85 vs. 1.38 cm/s²), and downward VT acceleration (-13.09 vs. -6.15 cm/s²). Task completion time was also longer in the severe fat group than in the normal fat group (18.21 vs. 11.72 s; p < 0.001). Total acceleration did not differ significantly among groups (p = 0.096). Severe adiposity was associated with altered direction-specific acceleration behavior and slower SLSTST performance. These findings suggest increased mechanical demand for dynamic postural control during unilateral functional transitions. Smartphone-based accelerometry may provide a feasible approach for detecting movement-control alterations, although future studies incorporating force plates, motion capture, electromyography, and segmental body composition assessment are required to confirm the underlying mechanisms.
Post-stroke impairments in attention and executive control are common and clinically relevant, whereas conventional neuropsychological tests mainly capture task outcomes and provide limited information about process-level task behavior. Eye tracking can quantify fixation behavior, saccadic activity, and visual sampling, but whether integrated eye-tracking features can reveal clinically interpretable heterogeneity after stroke remains insufficiently defined. This study examined whether integrated multi-paradigm eye-tracking features could identify exploratory eye-movement phenotypes in individuals with stroke and whether these phenotypes were associated with behavioral, clinical, lesion-related, and functional characteristics. In this single-center exploratory case-control study, 72 subacute stroke participants (14-90 days post-onset) and 36 matched healthy controls completed five tasks of attention and executive control and six eye-tracking paradigms. Group differences in behavioral and eye-tracking measures were examined with false discovery rate correction. Within the stroke group, K-means clustering was performed using four nonredundant integrated eye-tracking features: total fixation duration, first-fixation duration, number of fixations, and total saccade distance. Cluster stability and sensitivity analyses were conducted using bootstrap resampling, alternative feature sets, and combined clustering with healthy controls. Post-clustering comparisons and exploratory regression analyses were used to evaluate the clinical relevance of the identified phenotypes. Compared with healthy controls, participants with stroke showed lower performance across attention/executive-control tasks and altered eye-tracking metrics across paradigms. The most consistent eye-movement pattern was shorter total fixation duration and a higher number of fixations across the six paradigms, whereas total saccade distance differed most clearly during the antisaccade task. K-means clustering identified two exploratory eye-movement phenotypes: a High-Fixation/Low-Saccade phenotype and a Low-Fixation/High-Saccade phenotype. The two-cluster solution remained stable across bootstrap and sensitivity analyses. The Low-Fixation/High-Saccade phenotype showed poorer cognitive performance, greater neurological and functional impairment, higher emotional symptom burden, and more frequent frontal involvement and bilateral or multifocal involvement. In exploratory hierarchical regression, eye-movement phenotype explained additional variance in Barthel Index scores beyond demographic variables, post-stroke timing, neurological severity, and conventional attention/executive-control performance. Integrated multi-paradigm eye-tracking features identified two exploratory eye-movement phenotypes in individuals with subacute stroke. The Low-Fixation/High-Saccade phenotype was associated with broader clinical burden. These findings suggest that eye tracking may provide process-level information complementary to conventional assessment of post-stroke attention and executive-control dysfunction. Given the single-center and cross-sectional design, these preliminary phenotypes require validation in longitudinal and multicenter studies.
Meat quality is a critical determinant of the economic value in the broiler industry, with its foundational characteristics established during early post-hatch development. Skeletal muscles comprise a complex mixture of myofiber types, whose initial distribution and molecular signatures set the stage for post-mortem meat quality. However, the early regulatory landscapes governing these myofiber compositions remain to be fully elucidated. In this study, we employed high-resolution single-nucleus RNA sequencing (snRNA-seq) to characterize the transcriptomic divergence between broiler breast muscle (BM) and leg muscle (LM) at the neonatal stage (Day 1). Our panoramic atlas of muscle-resident cells revealed that neonatal LM already possesses a significantly higher proportion of oxidative fibers (Type I and Type IIA) and an enriched population of preadipocytes/adipocytes compared to BM. Functional enrichment analysis identified a prominent upregulation of the adipocytokine signaling pathway in D1 LM, suggesting an early molecular framework for the flavor and juiciness characteristics typically associated with leg meat. Furthermore, GSEA and KEGG analyses revealed a correlation between elevated FOS expression and apoptosis signatures in Type IIA and IIB myonuclei within LM, suggesting its potential involvement in shaping early myofiber type proportions. Additionally, PRKAG2 was identified as a candidate regulator linked to intramuscular lipid and fatty acid biosynthetic pathways. Our analysis indicated a regulatory link between the transcription factor EGR1 and its putative target PRKAG2, which coincides with initial lipid droplet accumulation in intramuscular adipocytes. Collectively, these findings provide a high-resolution genetic blueprint of early-postnatal muscle fiber characteristics and lipid deposition, offering novel developmental insights that may inform molecular breeding strategies aimed at predetermining the nutritional and sensory potential of broiler meat.
This study was to investigate the efficacy and safety of calcium hydroxylapatite (CaHA) filler injections combined with CO2 ablative fractional laser (AFL) for atrophic acne scars. A prospective, single-center, randomized controlled study was conducted on 160 participants, who were average randomly assigned to either an observation group (A) or a control group (B). Group A received two sessions of CaHA (1-month interval) after AFL 1 month, while Group B received AFL monotherapy. Efficacy was assessed by pre- and post-operation of standardized photographic images. Additionally, treatment-related adverse events (AEs) were documented. Compared with baseline, the quantitative global scarring grading system scores decreased significantly in both groups (p < 0.001), with greater reduction observed in group A (p < 0.001). The acne scar rating scale analysis revealed the combination therapy's effectiveness across all scar subtypes (p < 0.001) and demonstrated comparable efficacy for boxcar and rolling scars (p = 1.000), both of which showed superiority to icepick scars (p < 0.001). Mild AEs are occurred in both group, such as pain, edema, crusting, and transient post-inflammatory erythema (PIE), CaHA injection may pose a risk of ecchymosis. Nevertheless, long-term PIE (lasting over 4 weeks) (p < 0.001) and post-inflammatory hyperpigmentation (p = 0.002) in group A exhibited significantly shorter healing times, accelerated healing by an average of 3.8 weeks and 3.7 weeks. The combination of CaHA with AFL demonstrates both efficacy and safety for atrophic acne scars, particularly boxcar and rolling subtypes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .