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Folic acid (FA) has been reported to modify associations between air pollutants and autism, but no study has investigated whether air pollutants are associated with maternal folate status. We estimated associations between an air pollution mixture and maternal folate status among pregnant women in Canada. We enrolled pregnant women (n = 1983) in 10 cities in Canada from 2008 to 2011 in a prospective cohort. We estimated mean daily concentrations of nitrogen dioxide (NO2), ozone (O3), fine particulate matter (PM2.5), and sulfur dioxide (SO2) at maternal residences for 180 d preceding first and third trimester visits (ranges: 6-14 and 32-34 gestational weeks, respectively). At both visits, we measured plasma 5-methyltetrahydrofolate (5MTHF), unmetabolized FA (UMFA), and nonmethylated folate (NMF) concentrations and proportions (%5MTHF, %UMFA, %NMF). We used Bayesian weighted quantile sum regression to estimate expected differences in folate measures per 1-quartile difference in the air pollution mixture and weights for the mixture components. We stratified by fetal sex and FA supplementation. Among complete cases in the first and third trimesters (n = 927 and 838, respectively), median (interquartile range) plasma total folate was similar between the first trimester [96.9 (78.6, 119.0) nmol/L] and the third trimester [99.6 (76.0, 135.0) nmol/L]. In the third but not the first trimester, the mixture was positively associated with plasma total folate [12.0 nmol/L per one-quartile increase, 95% confidence interval (CI): 1.5, 22.7 nmol/L], negatively associated with %5MTHF (-2.8, 95% CI: -5.1, -0.70), and positively associated with %UMFA (13.4, 95% CI: 4.4, 23.0). O3 was the primary component (weights ≥0.4). Associations were stronger for women with female fetuses. Air pollution was positively associated with total folate concentrations and UMFA proportions and negatively associated with 5MTHF proportions. Associations were strongest in the third trimester and among pregnant women carrying female fetuses. Air pollution may influence maternal folate status during pregnancy.
The pseudocapsule (PC) status of clear cell renal cell carcinoma (ccRCC) is closely associated with tumor aggressiveness and surgical strategy, yet accurate preoperative non-invasive assessment remains challenging. This study aimed to develop and internally validate a contrast-enhanced ultrasound (CEUS)-based prediction model for assessing PC status in patients with ccRCC. This retrospective study enrolled 254 patients with pathologically confirmed ccRCC who underwent surgery at Shanghai General Hospital, between August 2021 and December 2024. All patients received preoperative conventional ultrasound and CEUS examinations. Independent risk factors for PC absence or penetration were identified using multivariable binary logistic regression analysis. These factors were then incorporated into a nomogram to construct a predictive model. The model's discriminatory performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). Internal validation was performed using bootstrap resampling to generate calibration curves and evaluate goodness-of-fit via the Hosmer-Lemeshow test. Finally, the clinical utility of the nomogram was determined using decision curve analysis (DCA). Three CEUS features-incomplete PC sign, peak hypoenhancement, and rapid washout pattern-were independent predictors in the final model. The nomogram showed acceptable discrimination [training AUC: 0.779, 95% confidence interval (CI): 0.692-0.867; validation AUC: 0.749, 95% CI: 0.600-0.898] and calibration (Hosmer-Lemeshow P>0.05). DCA supported its potential clinical utility. In conclusion, a CEUS-based nomogram was developed and internally validated to preoperatively predict PC status in ccRCC. This practical, non-invasive tool can guide and optimize surgical planning.
Nutritional status (NS) in children with cancer may impact a wide range of outcomes, and remediation of under and over-nutrition may potentially improve outcomes. Children with cancer at our centre were classified as undernourished (UN) body mass index (BMI Z-score ≤-2 standard deviations (SD) World Health Organisation (WHO) or mid-upper-arm circumference (MUAC) <12.5 cm for <5 years (WHO) or <25th percentile for >5 years (Frisancho)), well-nourished (WN) (BMI Z-score -1 SD to +1 SD or MUAC 12.5-13.5 cm for <5 years or 25-50th percentile for >5 years) and over-nourished (ON) (BMI Z-score ≥+1 SD or MUAC ≥75th percentile for >5 years). NS was assessed at three time-points: diagnosis, 3- and 6-month follow-up. Trends in NS and impact on outcomes (event-free survival (EFS) and overall survival) were analysed. At diagnosis (n = 2,086) and 6-month follow-up (n = 1,245), 30.9% and 41.7% were WN, 65.3% and 52.2% UN and 3.8% and 6.1% ON. During the course of treatment, 45.5% gained weight and 11.6% lost weight. The highest prevalence of undernutrition at diagnosis was seen in acute myeloid leukaemia (73.3%), lymphoma (68.8%) and bone tumours (68.7%). Two-year EFS was 71.3% ± 1.82% in WN children, 71.3% ± 5.19% in ON children and 68.4% ± 1.28% in children UN at diagnosis (p = 0.004). Children who gained weight between diagnosis and follow-up had a 2-year EFS of 82.8% ± 1.60% versus 76% ± 1.70% in those without weight gain (p = 0.022). Undernutrition at diagnosis as well as during treatment leads to increased relapse as well as mortality. Weight gain and improved NS appear to impact clinical outcomes, highlighting the need for targeted nutritional interventions in children with cancer.
Circulating tumor DNA (ctDNA) analysis is part of the current clinical practice for the management of hormone receptor (HR)-positive/HER2-negative metastatic breast cancer, particularly for detecting actionable alterations such as ESR1 and PIK3CA. Molecular testing reports commonly include variant allele fraction (VAF) as a contextual technical parameter, whose correct interpretation is increasingly important. Plasma VAF is influenced by multiple factors, including tumor fraction, metastatic site shedding, clonal architecture of the neoplasm, copy-number state, assay sensitivity, timing of sampling, and treatment pressure. In metastatic breast cancer, ESR1 and PIK3CA alterations represent different evolutionary events: PIK3CA mutations are early, clonal, and stable; ESR1 mutations are acquired under endocrine therapy and are often subclonal and dynamic. Consequently, VAF values across these biomarkers should be interpreted within their different biological contexts rather than as directly comparable indicators of therapeutic priority. Importantly, pivotal trials (EMERALD, PADA-1, SERENA-6, SOLAR-1, BYLieve, INAVO120, CAPItello-291) support mutation detection as the key evidence-based criterion for therapy selection. In this work, we discuss why, in metastatic breast cancer, the clinically relevant criterion for selecting ESR1-or PIK3CA-directed therapies remains the presence or absence of mutations, regardless of VAF.
Protection and restoration of ecosystems, ceasing human-induced extinctions and maintaining genetic diversity are key goals for the Global Biodiversity Framework. Molecular techniques can provide empirical data to understand all these goals and provide actionable conservation advice. Acacia araneosa, an endangered aridland shrub, has a restricted distribution in South Australia where it coexists sympatrically with the widespread Acacia rivalis. Evidence of hybridisation between the two challenges the A. araneosa species concept. Here, we examine the genetic distinctness between the two species and use a genomic approach to estimate population genetic structure and historical population size. We used SNP data to quantify species boundaries, population structure, demography, kinship and genetic diversity within and between populations of both A. araneosa and A. rivalis. We found that while A. araneosa and A. rivalis hybridise to produce F1 hybrids, further backcrossing and gene flow are limited, suggesting that a post-zygotic breeding barrier may exist and that the two species are distinct. Genetic structure within A. araneosa suggests limited gene flow between the two remaining populations occurring within its small range. Our results also reveal a major reduction in effective population size (Ne) in recent times, dropping from ~49,000 to ~51 (-99.9%) over the last 3200 years, coinciding with widespread climatic drying across southern Australia. Paleoclimatic data over the last 3000 years in arid Australia are uncertain; hence, we provide novel empirical support for continued drying in this region using molecular techniques. We recommend that A. araneosa be listed as Critically Endangered on the IUCN Red List, and that the remaining populations are actively conserved and managed to maintain (and ideally increase) population size and genetic diversity.
Older adults with influenza have an elevated risk of adverse clinical outcomes. Influenza vaccine effectiveness (VE) is generally lower in this age group due to several factors. Frailty has been identified as a potential modifier of VE, but the literature on this topic is fragmented. A systematic review of studies evaluating frailty and influenza VE in adults aged ≥ 50 years. Databases were searched from inception to September 2025. The primary outcomes were laboratory-confirmed influenza (LCI), influenza-related hospitalization, and influenza-associated mortality. Random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment were applied when pooling was appropriate. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Eight studies with 262,952 pooled participants were included. The prevalence of frailty ranged from 14.3% to 36.4%, with a pooled estimate of 24.3% (95% CI, 19.0%-30.4%; I²=99.8%). Four test-negative studies were pooled for LCI cases. Vaccination was associated with reduced odds of LCI (pooled OR, 0.53; 95% CI, 0.37-0.76; I²=4.0%), with a 95% prediction interval of 0.30-0.96. Stratified analyses showed pooled ORs of 0.43 (95% CI, 0.24-0.75) and 0.66 (95% CI, 0.35-1.25) in non-frail and frail individuals, respectively; no statistically significant effect modification was detected (p = 0.10). Hospitalization and mortality outcomes were not pooled because of heterogeneity. The certainty of evidence was low for LCI and very low for other outcomes. Influenza vaccination protected against LCI across frailty strata, though study heterogeneity requires cautious interpretation, and estimates were less precise for frail individuals. The elevated risk of adverse clinical outcomes in this age group supports immunization, and current data do not justify withholding vaccination.
Emerging evidence has underscored non-cell-autonomous roles of mutant p53 in reshaping the composition and functional state of tumour immune microenvironment (TIME). However, the impact of p53 status on the clinical relevance and functional differentiation of CD8+ T cells remains poorly understood in urothelial carcinoma (UC). Our study included 297 UC patients from two in-house cohorts and 871 UC patients from four public datasets to evaluate the impact of p53 status on the clinical implications of CD8+ T cells. Single-cell RNA sequencing, flow cytometry, immunohistochemistry, and bioinformatics analyses were performed to elucidate the role of p53 status in regulating CD8+ T cell polarisation and reshaping the TIME. High CD8+ T cell infiltration correlated with favourable prognosis and improved survival following chemotherapy and PD-(L)1 blockade exclusively in p53-WT UC, while its association with prognosis and therapeutic benefit was abrogated in p53-mutant UC. Moreover, p53-mutant UC exhibited predominant infiltration of TIM3+ exhausted CD8+ T cells, accompanied by increased Treg and M2 macrophage infiltration. The clinical significance and functional polarisation of CD8+ T cells in UC varied in a context-dependent manner according to p53 status. These findings provide novel insights to refine patient stratification and optimise personalised therapeutic strategies.
Smoking has been associated with disease risk; however, whether smoking is an independent predictor of long-term care (LTC) certification remains uninvestigated. Therefore, this study aimed to examine the association between smoking status and LTC certification. This prospective cohort study was conducted using data from the Yamagata cohort study in Japan. Participants were followed for a mean of 7.6 years (SD=1.8). Individuals with available baseline data on smoking status and relevant covariates were included. The main exposure was baseline smoking status (current, former, and never smokers), and the primary outcome was LTC certification incidence during follow-up. Associations between smoking status and LTC certification were evaluated using Cox proportional hazards models, with sequential adjustment for potential confounders, including demographic factors, lifestyle habits, and comorbidities. At baseline, the overall smoking prevalence rate was 12.4% (22.4% in men, 4.6% in women). At a mean follow-up of 7.6 years (SD=1.8), LTC certification was issued to 262 (2.6%) individuals: 137 men (3.0%), and 125 women (2.1%). Unadjusted analysis using a Cox proportional hazards model indicated a higher hazard ratio (HR) for current smokers (HR=1.44; 95% CI: 1.03-2.02), which remained significant after adjustment for sex and age (AHR=1.81; 95% CI: 1.23-2.66). This persisted even after adjusting for sex, age, physical activity, alcohol consumption, hypertension, diabetes, and dyslipidemia (AHR=1.83; 95% CI: 1.25-2.69), and after accounting for nine factors, including stroke and ischemic heart disease (AHR=1.86; 95% CI: 1.27-2.73). Never and former smokers showed no differences in adjusted models. A sensitivity analysis excluding patients with a history of cardiovascular disease yielded similar AHRs. Overall, current smokers had a higher risk of LTC certification than never smokers, suggesting that smoking may be an independent risk factor.
Psychological distress is prevalent among young adult (YA) patients with cancer, yet the role of couples' communication in this specific population remains underexplored. This study aimed to investigate the status of couples' communication and examine its independent association with depression and anxiety in YA patients with cancer. A cross-sectional survey was conducted among YA patients with cancer. Participants completed the Cancer-Related Communication Problems Scale, PHQ-9 (depression), and GAD-7 (anxiety). Hierarchical linear regression analyses were performed to determine the association between communication barriers and psychological outcomes after controlling for demographic and clinical variables. A total of 202 married YA patients with cancer participated in this study. The mean age was 34.69 ± 4.11 years (Range: 22-39 years). Participants reported a mild level of overall communication barriers (Total Score Mean ± SD: 13.41 ± 3.93; Range: 1-22). The mean anxiety and depression scores were 6.43 ± 5.16 (Range: 0-21) and 6.97 ± 5.47 (Range: 0-27). The top five specific barriers were difficulty with partner understanding of body image changes (Item 11, Mean ± SD = 1.46 ± 0.69), difficulty discussing worsening conditions (Item 13, Mean ± SD = 1.30 ± 0.68), difficulty sharing worries about treatment effectiveness (Item 9, Mean ± SD = 1.28 ± 0.71), avoidance of discussing sexual experience (Item 15, Mean ± SD = 1.11 ± 0.72) and selective disclosure to protect the spouse (Item 14, Mean ± SD = 1.07 ± 0.70). Univariate analysis indicated that unemployment and female sex were significantly associated with higher depression scores (P < 0.05), while no demographic variables were significantly associated with communication barriers. After adjusting for sex and unemployment status, communication barriers remained independently associated with depression (B = 0.26, 95% CI: 0.08, 0.44, P = 0.008), but not with anxiety (P > 0.05). Communication barriers were independently associated with depressive symptoms, but not anxiety, after adjustment for sex and employment status. These item-level findings suggest that body image and intimacy may be key topics for future dyadic communication interventions. Future psychosocial interventions may consider addressing open spousal dialogue about body image and sexual concerns in this population.
Chronic urinary retention (CUR) is a clinically relevant but poorly defined urological condition, often assessed in the clinic using postvoid residual (PVR) volumes. The lack of consensus on the PVR threshold that defines CUR limits diagnostic consistency, clinical decision-making, and comparability of research findings. This review aims to systematically examine how CUR is defined in the current literature, focusing on the reported PVR thresholds. In this systematic-narrative review, a search of five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, and Google Scholar) was conducted in August 2022 and December 2025. Eligible studies included randomized trials, observational studies, and systematic reviews that defined CUR using a PVR threshold in adult patients. A total of 4588 abstracts were screened across two searches, resulting in 14 inclusions. Eleven studies focused on patients with CUR due to benign prostatic hyperplasia. PVR thresholds for defining CUR varied between 150 ml and 1000 ml, with 300 ml being the most reported in 10 studies. Seven studies reported on patients who were able to void, three of which also reported on patients who were unable to void. The remaining seven studies did not report the voiding status of the participants. Four studies repeated the PVR measurements. Six studies used ultrasound or a bladder scan to measure PVR. This review highlights the inconsistency in the definitions and PVR thresholds used to define CUR in the literature. The available evidence was limited and heterogeneous, with substantial variation in study populations, voiding status, and measurement methods. Therefore, the current literature does not provide sufficient consistent evidence to support a single definitive PVR threshold for CUR.
Phase III clinical trials are essential for establishing the safety and efficacy of therapeutic interventions prior to regulatory approval. India has emerged as an important clinical research hub; however, long-term trends in phase III trials registered in the Clinical Trials Registry-India (CTRI) remain inadequately explored. A comprehensive analysis of phase III clinical trials registered in CTRI between 2007 and June 2025 was conducted. Trials were categorized into two periods, namely, 2007-2014 and 2015-2025, representing pre- and post-regulatory reform eras. Data regarding randomization, blinding, comparator type, intervention model, sponsorship, study site, intervention agents, geographic scope, and recruitment status were extracted and analyzed using descriptive statistics and chi-squared/Fisher's exact tests. A total of 1385 phase III clinical trials were analyzed. Randomized controlled trials significantly increased from 360 (88.7%) in 2007-2014 to 928 (94.8%) in 2015-2025 (p<0.001), while non-randomized studies declined. Active-controlled trials increased significantly (234 (57.6%) vs. 608 (62.1%); p=0.025), and parallel-group designs became more common (365 (89.9%) vs. 922 (94.2%); p=0.005). Industry-sponsored trials decreased from 374 (92.1%) to 799 (81.6%), accompanied by increased participation from educational and research institutions (p<0.001). Drug trials remained predominant, although vaccine and biologic/device-based studies increased significantly in the latter period. Recruitment status analysis demonstrated declining completed trials and increasing ongoing or "not yet recruiting" studies, likely reflecting stricter registration practices and pandemic-related disruptions. Phase III clinical trials registered in CTRI demonstrated substantial improvements in methodological rigor, comparator selection, intervention design, sponsorship diversity, and reporting characteristics during 2015-2025 compared with 2007-2014. These favorable trends are temporally associated with the major Indian and international regulatory reforms, including the New Drugs and Clinical Trials (NDCT) Rules 2019, International Council for Harmonisation's Guideline for Good Clinical Practice (ICH-GCP) updates, and strengthened ethical oversight. Nevertheless, persistent challenges related to trial completion and reporting transparency warrant continued regulatory strengthening.
Group living provides many potential benefits but can also incur important costs via competition for access to resources. Even in the absence of resource depletion, interference competition can reduce access to resources, and interference competition is not expected to affect all group members equally. In groups with dominance hierarchies, dominant individuals have priority access to resources and are therefore expected to experience lower costs of interference competition compared to subordinate individuals. Here, we assessed the effect of manipulating the number of feeders available with ad libitum food, which we assumed would affect competition intensity, on total daily feeder visits in a marked population of 126 black-capped chickadees (Poecile atricapillus). As predicted, we found strong evidence of interference competition: reducing feeder availability by 50% reduced average per capita daily visits to feeders in our population by circa 50%. Because chickadee flocks exhibit linear dominance hierarchies, with males being dominant over females, and at least in some populations, adults being dominant over immatures, we also investigated whether there was evidence for sex- and/or age-related differences in the strength of interference competition. We found that reductions in total daily feeder visits under lower manipulated food availability were similar for all age-sex categories, suggesting that females and immatures did not experience higher interference competition despite their subordinate status relative to males and adults. Post hoc analyses revealed that adult females expanded their foraging area, while immature females increased both the length of the foraging window and foraging area when the availability of feeders was reduced. We suggest that these results may indicate that females invest more to mitigate competition and manage unpredictable access to food due to their subordinate status.
This study aimed to characterize the shared genetic architecture and modifiable correlates between myopia and retinal-optic nerve diseases (RONDs). Genetic pleiotropy analysis and population-based cohort study. A total of 81 491 UK Biobank participants and summary statistics from large-scale genome-wide association studies were included. We examined associations between myopia and 5 common RONDs using population-based analyses of prevalent and incident outcomes, followed by cross-trait genetic analyses, locus-level annotation, colocalization, and enrichment analyses. Among myopic individuals, modifiable correlates and gene-environment interactions were evaluated, and Mendelian randomization was used as complementary evidence for selected associations. Myopia and RONDs. The primary findings were that, in baseline prevalent analyses, myopia was associated with higher risks of retinal detachment (RD) and primary open-angle glaucoma (POAG), but a lower risk of primary angle-closure glaucoma (PACG), with evident risk gradients across myopia severity, especially for RD. Diabetic retinopathy (DR) risk estimates were <1.0 across myopia severity categories but were not statistically significant. A U-shaped association was observed between refractive status and age-related macular degeneration, with elevated risk in both high myopia and hyperopia. Incident analyses during follow-up showed broadly consistent patterns. As supportive genetic evidence, cross-trait analyses revealed significant genetic correlations and overlaps between myopia and RONDs, identifying 66 pleiotropic loci and 115 candidate genes, with enrichment in immune-inflammatory, receptor-mediated signaling, and retinal developmental pathways. Among myopic individuals, exploratory analyses further showed that prevalent myopia-ROND comorbidity was associated with various modifiable correlates spanning health status, lifestyle, diet, mental health, sleep patterns, and medication use, and that 7 environmental factors interacted with 5 pleiotropic variants. Mendelian randomization analyses provided complementary and hypothesis-supporting evidence consistent with a positive association of myopia with RD and an inverse association with PACG, whereas findings for DR and POAG required more cautious interpretation because of pleiotropy or heterogeneity. This study reveals a shared genetic architecture and identifies modifiable correlates linking myopia to five common RONDs. These findings provide new insights into shared susceptibility patterns and offer a framework for future mechanistic, validation, and prevention-oriented research in myopic populations. The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.
healthcare inequalities have been widely documented, yet the COVID-19 pandemic may have altered their magnitude and direction. This study aimed to analyse the dynamics of healthcare inequalities in patients with type 2 diabetes mellitus (T2DM) before and after the pandemic using a real-world data approach. we conducted a real-world observational study including T2DM patients aged ≥ 45 from the CARhES cohort, a population-based dataset integrating clinical and administrative information from Aragón (Spain), between 2017 and 2022. Healthcare utilisation was assessed at two levels: Primary Care and specialist care. Socioeconomic, clinical, and healthcare variables were retrieved from electronic health records. We described healthcare utilisation patterns and trends across the study period and estimated adjusted prevalence ratios (PRs) for inequality axes (age, gender, migrant status, socioeconomic level, and rurality) using Poisson regression models at three time points (2017, 2020, 2022), adjusting for multimorbidity. A total of 86,407 T2DM patients were included. Almost all patients consulted a general practitioner (GP) each year and increased over time, while specialist consultations declined during the pandemic and had not recovered by 2022. Socioeconomic inequalities persisted or widened across most axes. After the pandemic, patients aged ≥ 80 were less likely to visit GP than younger patients, reversing pre-pandemic trends. Women continued to show higher GP use than men but fewer consulted with specialist, although the magnitude of the observed difference was small. Immigrants' access to specialists decreased relative to natives in 2022. active people with low socioeconomic status showed the lowest specialist consultations, while mutualists had the highest during the pandemic. Rural residents maintained greater reliance on Primary Care but fewer specialist visits post-pandemic. The explanatory power of socioeconomic variables declined in GP models, whereas multimorbidity gained influence during and after COVID-19. Healthcare inequalities among T2DM patients persisted and some patterns shifted after 2020. Although GP utilisation increased, nursing and specialist follow-up did not recover to pre-pandemic levels. These patterns underscore the need for targeted interventions to optimise care for older adults, women, migrants, rural residents, and low-income populations, with a focus on promoting digital inclusion and developing tailored healthcare pathways to advance health equity.
This study aimed to identify changes in body mass and hydration status, alongside rapid weight loss (RWL) methods, in elite Para judo athletes with visual impairment. Using a cohort repeated-measures design, twelve elite Para judo athletes with visual impairment (6 males, 6 females; age: 33.1 ± 4.3 years) were monitored. Measurements occurred at three distinct time points: one week before the competition (T1), at the official weigh-in (T2), and on competition day (T3). Body weight was measured using a calibrated digital scale, and hydration status was evaluated through midstream urine samples analyzed for urine specific gravity (USG). Hypohydration was defined as a USG ≥ 1.020. Athletes experienced a significant reduction in body weight, losing 3.89 ± 0.79 kg (5.2%) from T1 to the official weigh-in at T2. Following the weigh-in, athletes regained significant weight with a mean value of 3.44 ± 0.71 kg (4.8%) until the morning of the competition (T3). Hydration markers worsened alongside weight reduction; USG levels increased significantly from 1.023 ± 0.002 at T1 to 1.031 ± 0.002 at T2, indicating severe dehydration. Although USG values decreased significantly to 1.026 ± 0.001 by T3, they remained significantly higher than baseline levels. Notably, all of the athletes (100%) presented hypohydration one week before the competition, at the official weigh-in, and before the start of the competition. Elite Para judo athletes with visual impairment utilize aggressive RWL strategies, resulting in significant weight fluctuations and severe dehydration at the time of weigh-in. Despite experiencing substantial body weight regain during the recovery period prior to the match, the athletes fail to adequately rehydrate, starting the competition in a continuous state of hypohydration.
Cardiovascular diseases (CVDs) remain a leading cause of morbidity in Yemen. This study evaluates integrated lipid, renal, and hepatic function profiles in CVD patients to provide clinical insights into multi-organ metabolic associations in a resource-limited setting. This hospital-based, case-control study at Al-Gomhouri Hospital, Hajjah, Yemen, enrolled 320 participants (160 CVD patients and 160 age- and sex-matched controls). Assessments included lipid profiles, renal markers (uric acid, creatinine), and hepatic markers (albumin, total protein). Multivariate logistic regression identified factors associated with CVD status. CVD patients exhibited severe atherogenic dyslipidemia, with significantly higher Total Cholesterol (269.7 ± 43.83 mg/dL) and Triglycerides (246.0 ± 58.97 mg/dL) than controls (P < 0.001). Markers of organ stress were pronounced in the CVD group, notably higher Serum Uric Acid (7.59 ± 0.95 vs. 3.9 ± 0.63 mg/dL). Khat chewing was more prevalent among CVD patients (84.4%) versus controls (41.2%; P < 0.001), with longer duration and higher frequency in the disease group. After adjusting for confounders, multivariate logistic regression identified Stage 2 hypertension (OR: 4.15) and elevated creatinine (OR: 3.40) as prominent independent factors associated with CVD status (P < 0.001). Significant alterations in cardiorenal and hepatic biomarkers characterize CVD patients in Hajjah. Stage 2 hypertension, hyperuricemia, and elevated creatinine are critical metabolic factors, highlighting the necessity of integrated multi-organ biochemical screening over isolated lipid assessments for improved risk stratification in high-risk populations.
In this prospective controlled cohort study, we aimed to compare the safety and efficacy of Retrograde intrarenal surgery (RIRS) combined with high-power holmium:YAG laser and vacuum-assisted, flexible, navigable access sheaths (FANS) vs. mini-percutaneous nephrolithotomy (miniPCNL) in 2-3 cm kidney stones. Between June 2022 and June 2024, 60 patients with 2-3 cm in diameter kidney stones, aged 18 years or older, were prospectively included. Patients were classified into two groups based on their decision: RIRS (Group 1) and miniPCNL (Group 2). Patient demographic data, preoperative creatinine, and hemoglobin levels were recorded. Stone-related factors were evaluated using preoperative tomography. Creatinine and hemoglobin values were measured on the first postoperative day. Stone-free status (SFRs) was evaluated on the first postoperative day and at the first month. Hospital stays and complications were assessed. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026. Patient demographic data, preoperative creatinine levels, hemoglobin levels, and stone-related factors were comparable between the groups. The prestenting rate was higher in Group 1 (16.6%, 95% CI: 3.3-30) than in Group 2 (0%, 95% CI: 0-0, p = 0.02). The operative time and complication rates were comparable between the groups. The fluoroscopy time was lower in Group 1 (p < 0.001). The mean hemoglobin decrease was greater in Group 2 (p < 0.001). Stone-free status was comparable on the first day and first month. Hospital stay was shorter in Group 1 (p < 0.001). Retrograde intrarenal surgery combined with a high-power holmium:YAG laser and FANS shows comparable outcomes to miniPCNL for 2-3 cm kidney stones, yielding a similar SFRs with lower hemoglobin decrease, shorter hospitalization time, and reduced fluoroscopy exposure. However, increased prestenting rates should be considered. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026.
Maternal clinical phenotypes shape the neonatal gut microbiome and influence infant health outcomes, yet the microbial mechanisms linking maternal conditions to neonatal jaundice remain largely unknown. To investigate this, we characterized bacterial community profiling in prenatal maternal feces, meconium, and postnatal Day 3 neonatal feces from a mother-infant cohort, and integrated microbiota-phenotype association analyses and mediation models. We found that meconium microbiota showed slightly lower divergence from maternal fecal microbiota than neonatal fecal microbiota did. Canonical correspondence analysis (CCA) showed that maternal HbA1c consistently contributed to early-life gut microbial community structure, explaining 7% of the variation in meconium microbiota and 11% of the variation in neonatal fecal microbiota. Neonatal transcutaneous bilirubin levels on Day 3 were also associated with early-life microbial variation, with a stronger association observed in neonatal fecal microbiota than in meconium. In addition, maternal HbA1c significantly correlated with maternal urinary bacterial counts. The abundance distribution patterns of meconium ASVs related to maternal diabetes status and urinary bacterial detection status were also observed in the corresponding taxa of neonatal gut microbiota and were associated with subsequent neonatal jaundice. Notably, specific differentially abundant ASVs affiliated with Bifidobacterium, Clostridium_T, and Rothia mediated the interconnected rather than independent effects of maternal HbA1c and urinary bacterial counts on neonatal jaundice. The results suggest that meconium microbiota features associated with maternal diabetes-related phenotypes influence early neonatal gut microbial community structure and may contribute to neonatal jaundice. This study highlights the potential role of early-life gut microbiota shifts in mediating the effects of maternal physiological variation on neonatal health outcomes.
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke characterized by the formation of blood clots within the dural venous sinuses which has a high mortality rate. Despite its potential severity, cerebral venous sinus thrombosis secondary to nephrotic syndrome remains rarely reported and under-recognized in clinical practice. We described a 20-year-old male who presented with a relapse of minimal change disease, complicated by extensive CVST. On the basis of anticoagulant therapy, his neurological condition deteriorated rapidly, manifesting as altered mental consciousness, progressive limb weakness, and new-onset seizures. Given the failure of conventional medical management, endovascular therapy of catheter-directed thrombolysis was performed. The patient's neurological status improved dramatically within days. This case demonstrates that cerebral venous sinus thrombosis should be considered in nephrotic syndrome patients presenting with even subtle or non-specific neurological symptoms. Patients with focal neurological deficits, altered mental status, new-onset seizures, or unusual headache should undergo prompt neurological evaluation and appropriate brain imaging, including computed tomography venography (CTV) or magnetic resonance venography (MRV) when CVST is suspected. In the specific setting of nephrotic syndrome, clinicians should maintain a heightened index of suspicion for CVST, even when initial neurological findings are subtle or non-specific. As illustrated by this case, early recognition and timely escalation to endovascular therapy can be life-saving when conventional anticoagulation fails to prevent neurological deterioration. Our patient achieved complete neurological recovery and sustained remission of nephrotic syndrome, underscoring the value of multidisciplinary collaboration and individualized treatment strategies.
Retrievable inferior vena cava (IVC) filters are used in patients with acute venous thromboembolism (VTE) who have temporary contraindications to anticoagulation. Although guidelines recommend removing filters once anticoagulation is feasible, many filters remain in place. Long-term consequences of retention remain unclear. This study compared clinical outcomes in patients with VTE and retrievable IVC filters, according to filter status and anticoagulation use. We analyzed patients from the international RIETE (Registro Informatizado de Enfermedad TromboEmbólica) registry who received retrievable IVC filters. Outcomes from day 90 onward were stratified by filter status (removed vs retained) and anticoagulation (on vs off). Primary endpoints included VTE recurrence, major bleeding, and all-cause mortality. Filter-related complications were assessed. Among 1186 patients (mean age, 62 years; 51% male), 51.9% had filters removed by day 90. Patients with retained filters more often had active cancer and received longer anticoagulation, primarily low-molecular-weight heparin. VTE recurrence was higher with retained filters (4.5-6.5 vs 1.2-1.3 events per 100 patient-years), mainly as deep vein thrombosis; removal was associated with lower risk (adjusted incidence rate ratio, 0.29; 95% CI, 0.15-0.54). All-cause mortality was higher in patients with retained filters (7.3-17.7 vs 3.8-4.5; removal: adjusted odds ratio, 0.53; 95% CI, 0.34-0.81). Major bleeding was infrequent, with higher rates in patients with retained filters off anticoagulation. Filter-related complications were rare and did not differ significantly between groups after adjustment. In this large registry, retained IVC filters were associated with higher risk of VTE recurrence, even with extended anticoagulation. Findings support structured follow-up and timely filter retrieval.