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In internal medicine (IM), an increasing number of chief residents (CRs) are serving while still in training, but their responsibilities and workload remain poorly characterized, leaving program leaders without clear guidance on how to structure or support the role. To describe the demographics, responsibilities, and experiences of IM CRs serving during residency in the United States. This was a national cross-sectional survey of IM CRs serving during residency in the 2024-2025 academic year. The 42-item instrument included multiple-choice, Likert-scale, and open-ended items. Because no centralized database of CRs serving during training exists, the number of eligible participants was unknown. The survey was disseminated using a 2-step nonrandom sampling strategy: contacting leaders at 476 potentially eligible programs identified through national directories and distributing the survey through Association of Program Directors in Internal Medicine listservs. Descriptive statistics, chi-square tests, and Cochran-Mantel-Haenszel tests were used. Of 165 respondents, 142 confirmed they were IM CRs serving during residency. Most were postgraduate year 3, non-White, and international medical graduates. Most trained in community-based programs and carried full clinical schedules. Weekly chief work varied, with 38% reporting 2 to 5 hours, 35% reporting 6 to 10 hours, and 14% reporting more than 10 hours. Common duties included enforcing program rules, coordinating backup coverage, and resident well-being support. Although 68% felt prepared for the role, less than half received written expectations (41%) or internal faculty-led training (39%). IM CRs serving during residency commonly maintain full clinical schedules while performing substantial administrative and educational responsibilities, with variable preparation and role expectations.

Coronary artery calcium score (CACS) quantifies calcification to assess coronary artery disease (CAD), but it provides insufficient warning for low-attenuation non-calcified plaques. This study proposes and validates an automated pipeline that combines deep learning and radiomics for efficient detection of non-calcified plaques in the left anterior descending artery (LAD) and right coronary artery (RCA) using non-contrast CACS. Patients undergoing coronary CT angiography for suspected CAD from two medical sites were retrospectively enrolled and categorized into lesion and control groups. LAD and RCA vessels on CACS images from the development set were manually annotated to train deep learning-based segmentation models for automated coronary segmentation and subsequent pericoronary adipose tissue (PCAT) extraction. Radiomics models were built for LAD and RCA using three regions of interest-coronary artery, PCAT, and their combination-based on the training set. Model performance was evaluated across all datasets using receiver operating characteristic analyses, and DeLong tests were applied for pairwise comparisons. The SegResNet models achieved optimal performance in coronary segmentation. Radiomics models for predicting non-calcified plaques demonstrated moderate to good vessel-level diagnostic performance, with areas under the curve (AUCs) ranging from 0.700 to 0.855 across datasets, encompassing separate LAD and RCA models and all ROI strategies. The coronary artery and combined-region models generally outperformed or matched the PCAT model, with comparable AUCs between them in most settings. The automated pipeline enables efficient detection of non-calcified coronary plaques in CACS, with combined-region models showing promise for future use. The approach may facilitate further research and support the clinical translation of chest CT for large-scale CAD screening.

To evaluate the influence of different irrigation regimens on the sealability and push-out bond strength of Biodentin used for furcal perforation repair in mandibular molars. Fifty-six extracted human mandibular molars with standardized 1.6 mm furcal perforations were divided into seven groups according to the irrigation protocol: (1) 1% sodium hypochlorite (NaOCl) +17% ethylenediaminetetraacetic acid (EDTA), (2) 1% NaOCl + 7% maleic acid, (3) 1% NaOCl + 9% HEDP, (4) 2% chlorhexidine (CHX) +17% EDTA, (5) 2% CHX + 7% Maleic Acid, (6) 2% CHX + 9% HEDP, and (7) saline (control). Biodentin was placed to seal the perforation and allowed to set for 24 h. Pushout bond strength was measured using a universal testing machine, and marginal sealability was analyzed under the scanning electron microscopy. Statistical analysis was performed using the one-way analysis of variance and post hoc Tukey tests. Group 3 (1% NaOCl + 9% HEDP) showed the highest bond strength (31.33 ± 25.89 MPa) and the least marginal gap (1.28 ± 0.45 μm), indicating superior adhesion and sealing. The irrigation regimen of 1% NaOCl combined with 9% HEDP enhances Biodentin's bonding and sealing ability in furcal perforation repair, suggesting its clinical advantage over other protocols.

A seizure is a neurological disorder in the brain that is caused by changes in the function of brain neurons. Caffeic acid phenetyl ester (CAPE), as a polyphenol, has antioxidant, anti-inflammatory, and anticancer effects. Since the effects of CAPE on the neurotoxins and neurotoxic medicinal agents have not been widely investigated, this study aimed to investigate the effect of CAPE on the nicotine (NIC)-induced seizures in mice. Thirty-three male mice were divided into five groups of 6-8 as follows: sham group (normal saline), NIC group (5 mg/kg single dose on day 7), treatment groups (CAPE at 4 and 8 mg/kg for 7 days), and diazepam group (1 mg/kg single dose on day 7). At the end, the animals were anesthetized, and mortality, convulsive behavior, total thiol, thiobarbituric acid reactive substances (TBARS), catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), nitric oxide (NO), tumor necrosis factor-alpha (TNF-α), and the expression of nuclear factor kappa B (NF-kB) protein in the brain frontal cortex were measured, and histological studies were performed. Treatment with CAPE decreased the levels of TBARS, TNF-α, and NO and increased the levels of total thiol, CAT, SOD, GPx, and NF-kB protein expression compared to the NIC group. Seizure behavioral tests and histopathological investigations confirmed these results. According to the antioxidant effects of CAPE in various studies, it seems that CAPE can improve seizures by reducing inflammation and inhibiting oxidative stress.

Severity assessment of human immunodeficiency virus (HIV)-associated Pneumocystis jirovecii pneumonia (PJP) is clinically important because arterial blood gas indices are standard but may not fully capture the heterogeneity of lung involvement on chest computed tomography (CT). We aimed to develop and internally validate a CT radiomics model for classifying severity in adults with confirmed HIV-associated PJP. This retrospective single-center study included 96 adult patients with confirmed HIV-associated PJP who underwent chest CT at presentation. Disease severity was classified as mild or moderate-to-severe according to room-air arterial blood gas criteria, with moderate-to-severe disease defined as arterial partial pressure of oxygen (PaO2) <70 mmHg or an alveolar-arterial oxygen gradient (A-aDO2) &#x2265;35 mmHg. Clinical variables were retrospectively collected from medical records. Patients were randomly divided into training and test cohorts at a ratio of 7:3. Radiomics features were extracted from the bilateral lung parenchyma. After least absolute shrinkage and selection operator regression, features with non-zero coefficients were included in the final radiomics model. In parallel, a clinical logistic model incorporating serum lactate dehydrogenase, &#x3b2;-D-glucan, and CD4 count was developed in the training cohort and tested in the test cohort. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs), calibration analysis, decision curve analysis, and pairwise DeLong test comparisons. Of the 96 patients, 38 were classified as mild and 58 as moderate-to-severe. Patients with moderate-to-severe disease had a higher frequency of dyspnea, higher levels of inflammatory markers, and lower CD4 count. The final radiomics model included 10 features. In the training cohort, the radiomics model achieved an AUC of 0.92 (95% CI: 0.85-0.97), compared with 0.65 (95% CI: 0.51-0.78) for the clinical logistic model. In the test cohort, the radiomics model showed a numerically higher AUC of 0.89 (95% CI: 0.72-1.00), followed by the clinical logistic model at 0.84 (95% CI: 0.68-0.97). Using their respective classification thresholds, the radiomics model yielded a sensitivity of 0.778 (95% CI: 0.548-0.910) and a specificity of 0.818 (95% CI: 0.523-0.949) in the test cohort, while the clinical logistic model yielded a sensitivity of 0.722 (95% CI: 0.491-0.875) and a specificity of 0.909 (95% CI: 0.623-0.984). Pairwise DeLong tests in the test cohort showed no statistically significant difference between the radiomics model and the clinical logistic model. In this small single-center study, the CT radiomics model showed promising discrimination for severity classification in HIV-associated PJP, but these findings are preliminary and require external multicenter validation before clinical use.

Voice analysis, a non-invasive and cost-effective approach, shows potential for improving heart failure (HF) management. Previous studies mainly focused on non-Chinese voice features, and speech tasks tailored to Chinese HF patients remain lacking. This study aimed to design and optimize speech tasks for Chinese HF patients and establish a foundation for a Chinese HF voice database. A total of 203 participants (101 HF patients and 102 healthy controls) were recruited from The Affiliated Taizhou People's Hospital of Nanjing Medical University. Based on Chinese phonetics, 12 speech tasks were developed, including vowels, sentences, numbers, and the paragraph. Voice recordings were obtained for all participants. Binary logistic regression was used to analyze factors associated with task completion. Differences in voice features between groups were assessed using independent t-tests (P<0.05), and classification performance was evaluated using a fully connected neural network (FNN) based on the ComParE 2016 and eGeMAPSv02 feature sets. Among all participants, 105 (51.7%) completed all tasks (Group A), whereas 98 (48.3%) failed due to reading (75.5%) or execution problems (67.3%). Regression analysis revealed that age [middle-aged, odds ratio (OR) =3.716; young, OR =27.28], education (college or higher, OR =6.919), and task difficulty (easy, OR =14.185) significantly influenced completion rates (P<0.05). After removing six low-completion tasks (tasks 2, 3, 6, 8, 10, and 12), an optimized six-task set (Group B) increased the completion rate to 92.1%, particularly for participants with lower education (6.9% to 35.5%) and older age (15.3% to 50.7%). The ComParE 2016 feature set extracted 1,617 (task "i") to 3,039 (task "mm") features, while the eGeMAPSv02 feature set extracted 19 (task "i") to 53 (task "mm") features. Tasks "pg", "mm", and "1" demonstrated greater discriminative capacity (F-values are 67.5, 54.4, and 49.4, respectively) and superior classification performance (F1 scores are 0.817, 0.813, and 0.774, respectively). FNN models based on ComParE 2016 achieved higher performance than those based on eGeMAPSv02 (P<0.05), but there was no significant difference in the FNN models based on two datasets after demographic adjustment (P=0.16). This study developed standardized Chinese speech tasks for HF patients, identified factors influencing task completion, and demonstrated the feasibility of voice-based classification using both ComParE 2016 and eGeMAPSv02 feature sets. These findings support the development of large-scale voice databases and artificial intelligence models for early detection and management of HF in Chinese populations.

Treatment of teeth with immature apices is difficult to manage by conventional endodontics. Apical barrier formation using bioceramic materials offers a biologically favorable solution, providing a hermetic seal that supports periapical healing and facilitates successful root canal treatment. The aim is to evaluate and compare the sealing ability of NeoPutty, Biodentine, and Bio-C repair used as apical plugs in teeth with immature apex using radioactive isotopes. Sixty-nine extracted single-rooted human teeth were decoronated at the CEJ, leaving a root segment of 15 mm. Further, 3 mm of the apex was resected. Standardizing 12 mm root length, biomechanical preparation was carried out, and a divergent retrograde preparation using a NeoEndo orifice opener (30/08) was done to simulate an immature root apex. Samples were randomly distributed into 3 experimental groups (n = 23): Group 1 (NeoPutty), Group 2 (Biodentine), and Group 3 (Bio-C Repair) with an apical plug of 4 mm and two controls, Group 4 (Negative) and Group 5 (Positive). After 4 days, the teeth were immersed in 99TcNaO4 for 4 h, and microleakage was assessed using a gamma-ray spectrometer. Data normality was assessed using the Shapiro-Wilk test, which showed a nonnormal distribution. Therefore, nonparametric tests were applied: Kruskal-Wallis ANOVA for intergroup comparisons and Mann-Whitney U test for pairwise analysis. The highest percentage of radioactivity was observed in Group 5: 71%, followed by Group 2: 55%, Group 3: 53%, Group 1: 48%, and Group 4: 4%. Neoputty exhibited the best apical sealing ability.

Suboptimal reactive oxygen species (ROS) production in photodynamic therapy (PDT) and chemodynamic therapy (CDT) due to tumor antioxidants and H2O2 constraints poses a challenge to their therapeutic efficacy. To address this, our study introduces GOx@MPN@Gel, a novel PDT/CDT platform that integrates glucose oxidase (GOx), luteolin, iron ions, a traditional Chinese medicine-inspired metal-phenolic network (MPN), and hydrogel (Gel) carriers to enhance ROS generation. Experimental results demonstrate GOx@MPN@Gel enhanced acid sensitivity, robust GOx activity, and significant ROS production. Both in vitro and in vivo tests validate its therapeutic potential. Within the tumor microenvironment, GOx@MPN@Gel effectively elevates H2O2 levels for CDT, producing cytotoxic hydroxyl radicals (&#x2d9;OH), and upon near infrared (NIR) light exposure, its porphyrin component triggers potent PDT effects, generating additional ROS. This synergistic approach significantly enhances antitumor efficacy. The platform's unique design, combining acid-responsive degradation and PDT/CDT synergy, offers a promising personalized treatment strategy for breast cancer.

Early diagnosis of invasive fungal diseases (IFD) remains a major clinical challenge due to pathogen diversity and nonspecific symptoms. This study used metagenomic next-generation sequencing (mNGS) technology to comprehensively characterize fungal profiles across various clinical specimens and the demographic characteristics (sex and age) of the patient population. The results provide laboratory evidence to support the diagnosis and treatment of fungal infections. A total of 11,161 mNGS reports from clinical specimens collected at the Renmin Hospital of Wuhan University between March 2022 to August 2024 were retrospectively analyzed. Fungal spectra and patient demographics were comprehensively profiled and compared across different specimen types. The highest fungal detection rate was observed in bronchoalveolar lavage fluid (36.85%, 1,985/5,387), followed by urine (22.76%, 264/1,160), blood (13.38%, 380/2,840), pleural and peritoneal fluid (12.91%, 174/1,348), cerebrospinal fluid (CSF) (13.82%, 17/123), and wound exudates (12.87%, 39/303). Candida species were the most frequently detected fungi across all specimen types except CSF, wherein Aspergillus predominated. Overall fungal detection rates were significantly higher in male patients than in female patients (26.76% vs. 23.84%, P&#xa0;<&#xa0;0.01) and in individuals aged > 60 years compared with those aged &#x2264; 60 years (33.04% vs. 20.02%, P&#xa0;<&#xa0;0.001), although this trend varied by specimen type. Multivariate logistic regression analysis confirmed that male sex (adjusted odds ratio [aOR]=0.893,95% confidence interval: 0.824-0.967, P&#xa0;=&#xa0;0.006) and advanced age (&#x2265;80 years: aOR=14.77,95% confidence interval: 12.08-18.06, compared with minors) were independent risk factors for fungal detection. Among fungal-positive specimens, 68.28% (1,952/2,859) were co-detected with bacteria, and 15.63% (447/2,859) showed polyfungal detection (&#x2265; 2 fungal species). In conclusion, our findings highlight the predominance of Candida and Aspergillus, identify elderly male patients as a high-risk population, and underscore the high frequency of bacterial-fungal co-detection. Overall, Clinicians should combine mNGS results with imaging, conventional fungal tests (G/GM assays, culture), and clinical presentation for a more accurate diagnosis of IFD.

Background The detection of the second mesiobuccal (MB2) canal in maxillary first molars remains a major challenge in endodontic practice because of complex root canal anatomy and frequent calcification. This controlled experimental study evaluated the diagnostic performance of magnification and ultrasonic troughing, applied alone or in combination, for MB2 canal detection. Methods A total of 208 extracted human maxillary first molars were randomly allocated into four groups (n = 52 each): direct visual method (DVM) without troughing, DVM with troughing, dental operating microscope (DOM) without troughing, and DOM with troughing. A two-factor experimental design was used to assess the independent and combined effects of magnification and ultrasonic troughing. After standardized access preparation, MB2 detection was evaluated clinically and verified by root cross sections. Detection rates were compared using chi-square tests with post hoc pairwise comparisons, and multivariable binary logistic regression was performed. Results MB2 canal detection rates differed significantly among groups (p < 0.001). The lowest detection rate was observed with the DVM without troughing (21/52, 40.4%), whereas the highest rate was observed with the DOM with troughing (46/52, 88.5%). Intermediate detection rates were observed with troughing alone (30/52, 57.7%) and magnification alone (35/52, 67.3%). Magnification (OR = 3.90, p < 0.001) and ultrasonic troughing (OR = 2.54, p = 0.003) were independently associated with improved MB2 detection. Conclusions Magnification and ultrasonic troughing independently improved MB2 canal detection in maxillary first molars, with the highest diagnostic performance achieved when both techniques were combined. These findings may improve clinical decision-making during the detection of MB2 canals in routine endodontic practice.

The role of surgery in limited-stage small cell lung cancer (LS-SCLC) remains controversial and has traditionally been limited to early-stage disease. This study aimed to evaluate whether neoadjuvant immunochemotherapy (NIC) followed by surgery is associated with survival outcomes compared with definitive radiotherapy in patients with LS-SCLC. We conducted a single-center retrospective cohort study of 64 patients with stage I-IIIB LS-SCLC who received NIC between April 2020 and July 2024. Patients subsequently underwent surgery (n=23) or definitive radiotherapy (n=41) based on multidisciplinary evaluation and patient preference. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Survival was estimated using the Kaplan-Meier method and compared via log-rank tests. Multivariable Cox proportional hazards regression was employed to identify independent predictors of PFS. Baseline demographic, clinical, and tumor characteristics were generally comparable between groups. The objective response rate (ORR) to NIC was 91.3% in the surgery group and 85.4% in the radiotherapy group (P=0.70). Median OS was significantly longer in the surgery group (45 vs. 20 months; P=0.048; 2-year OS: 73.9% vs. 40.4%). Median PFS was also significantly prolonged after surgery (30 vs. 9.5 months; P=0.002; 2-year PFS: 55.2% vs. 23.2%). Multivariable analysis confirmed surgical treatment as an independent favorable factor for PFS [hazard ratio (HR): 0.31, 95% confidence interval (CI): 0.15-0.64; P=0.001]. In exploratory subgroup analyses, the PFS benefit appeared most pronounced in patients with stage II-IIIA disease (median: 32.0 vs. 8.1 months; P=0.004). In this cohort, NIC followed by surgery was associated with improved survival outcomes compared with radiotherapy. These findings suggest that surgical consolidation after effective systemic induction is a viable strategy for selected patients with LS-SCLC, particularly those with intermediate disease burden, warranting further prospective validation.

This study aimed to evaluate changes in photophobia using the Turkish version of Utah Photophobia Symptom Impact Scale-12 (UPSIS-12) in patients with episodic (EM) and chronic migraine (CM) treated with galcanezumab, and to examine the relationship between photophobia, migraine outcomes, disability, and treatment response. Photophobia is one of the most bothersome symptoms (MBS) of migraine and may persist during both ictal and interictal periods, leading to substantial impairment in daily functioning. Despite the clear clinical relevance of photophobia, the specific effects of galcanezumab, a CGRP monoclonal antibody, on photophobia have not yet been fully elucidated. This retrospective study, included patients with EM and CM treated with galcanezumab (240&#x202f;mg loading dose followed by monthly 120&#x202f;mg) for 3&#x202f;months. Patients completed headache diaries and validated patient-reported outcome measures (PROMs) at baseline and monthly follow-up visits. Non-parametric tests, correlation analyses, and multivariable linear regression were performed. A total of 77 patients were enrolled, of whom 47 (89.3% female; mean age 39.5&#x202f;&#xb1;&#x202f;10.6&#x202f;years) completed all study visits and were included in the final analysis. Over the study period, monthly headache days (MHDs) decreased from a median of 15 to 4&#x202f;days by month 3 (p&#x202f;<&#x202f;0.001), with 74.5% of patients classified as responders (&#x2265;50% reduction). UPSIS-12 scores declined significant (median 22.6%; p&#x202f;<&#x202f;0.001). Although baseline UPSIS-12 scores were similar between responders and non-responders, responders demonstrated a notable reduction in ictal photophobia (p&#x202f;=&#x202f;0.010). Significant improvements were also observed in ictal phonophobia, osmophobia, and cutaneous allodynia, whereas interictal sensory symptoms remained largely unchanged. In addition, headache intensity, attack duration, acute medication use, disability (HIT-6, MIDAS), and comorbid depression (BDI) and anxiety (BAI) scores all improved. Treatment was well tolerated, with no serious adverse events reported. Galcanezumab was associated with clinically important reduction not only in migraine frequency, severity, disability, and psychological comorbidities, but also in ictal photophobia, highlighting its responsiveness to CGRP-targeted preventive therapy. These findings suggest that photophobia as a potentially modifiable outcome that warrants systematically evaluation in future studies, with larger cohorts and long-term follow-up.

Thrombotic Thrombocytopenic Purpura (TTP) is a rare but potentially life-threatening thrombotic microangiopathy that presents significant diagnostic and therapeutic difficulties during pregnancy due to overlap with conditions like HELLP syndrome and preeclampsia. We present the case of a previously healthy 28-year-old woman at 34&#xa0;weeks of gestation presenting with fatigue, headache, and petechiae. Laboratory tests indicated anemia, thrombocytopenia, increased lactate dehydrogenase levels, and the presence of schistocytes in the peripheral smear. Low ADAMTS13 activity (<10%) confirmed TTP. The patient showed significant improvement after receiving corticosteroids and undergoing daily plasma exchange. For maternal stability, an elective caesarean section was performed at 36&#xa0;weeks, resulting in good maternal and neonatal outcomes. Early detection requires the timely diagnosis of unexplained thrombocytopenia, hemolysis, and neurologic symptoms in the absence of hypertension or abnormal coagulation, which should prompt immediate ADAMTS13 testing. Diagnosis and treatment were guided by multidisciplinary management and ADAMTS13 testing, resulting in complete remission without relapsing at the six-week follow-up.

The Fe/FeCl2-graphite battery is an intermediate-temperature molten salt electrochemical system. It employs the solid Fe/Fe2+ redox couple as the negative electrode and a graphite positive electrode based on the intercalation/de-intercalation of AlCl- 4, offering high safety, low material cost and a moderate operating temperature range of 110-150 &#xb0;C. However, the poor electronic conductivity and high nucleation barrier of the FeCl2 material result in limited electrochemical reversibility and reaction kinetics. Here, we demonstrate that the Fe-FeCl2 contact interface effectively enhances the redox reversibility and electrode kinetics by providing favorable sites for Fe0 nucleation and improving electronic conductivity. The prepared Fe-FeCl2-CR electrode delivers a low voltage hysteresis of 0.09 V and exhibits excellent electrochemical reversibility in the Fe/FeCl2-graphite molten salt battery, achieving a specific capacity of 162.6 mAh g-1 at 3 mA cm-2 and retaining 93% of its capacity after 200 cycles. Compared with the pure FeCl2 electrode, the Fe-FeCl2-CR electrode shows lower direct-current pulse resistance and negligible nucleation overpotential, which are primarily attributed to the Fe-philic nucleation interface. This mechanism is further confirmed by density functional theory (DFT) calculations, revealing that the (110) crystal plane of nano-Fe possesses the highest binding energy (-55.94 eV) during charging, thereby serving as the potential dominant interface for Fe0 nucleation. Additional self-discharge and capacity expansion tests further confirm the electrochemical reaction stability of the Fe-FeCl2-CR electrode in Fe/FeCl2-graphite molten salt batteries.

Connective tissue disease-associated interstitial lung disease (CTD-ILD) is a severe complication, yet early objective detection of pulmonary structural and microvascular alterations remains challenging. This study aimed to quantitatively compare pulmonary structural alterations between connective tissue disease (CTD) patients with and without interstitial lung disease (ILD) and to identify independent computed tomography (CT)-derived discriminators for ILD diagnosis by means of quantitative computed tomography (QCT). Fifty-one CTD patients with ILD (median age, 51 years; 66.7% female) and thirty-three CTD patients without ILD (median age, 33 years; 69.7% female) who underwent paired inspiratory and expiratory non-contrast chest computed tomography (CT) scans and pulmonary function testing were retrospectively collected. The lung density, functional small airway and pulmonary vessel parameters were analyzed using computer software. Differences in these CT quantitative parameters between the patients with CTD-ILD and those with CTD without ILD were compared using Mann-Whitney U tests. Furthermore, univariable and multivariable logistic regression analyses were used to establish nomograms to identify the independent predictors associated with the presence of ILD in patients with CTD. The calibration curve evaluates the predictive accuracy, while the decision curve analysis (DCA) evaluates clinical applicability. The forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), diffusing capacity of the lungs for carbon monoxide corrected for alveolar volume (DLCO/VA) and diffusing capacity of the lungs for carbon monoxide (DLCO) of the CTD with ILD group were significantly lower than those of the CTD without ILD group (all P<0.05). CTD with ILD group had higher percentages of high-attenuation area on inspiratory and expiratory CT (HAA%-IN and HAA%-EXP) (both P<0.05), and lower percentage of low-attenuation area on expiratory CT (LAA%-EXP), functional air trapping (fAT) volume, functional small airway disease (fSAD) volume and fSAD volume ratio (all P<0.001). Additionally, pulmonary vascular parameters including No. vessels, No. vessels cross-sectional area (CSA) <5 mm2 at 6, 12 and 24 mm depth from the pleural surface, BV1, BV5, BV10 and total blood volume (TBV) were significantly decreased in CTD-ILD patients (all P<0.001). Multivariate Ridge regression identified age, sex, DLCO%, FEV1%, EXP HAA%, fSAD ratio, and No. vessels_12mm as independent diagnostic predictors associated with the presence of ILD (all P<0.05). The combined diagnostic model achieved an area under the curve (AUC) of 0.963 [95% confidence interval (CI): 0.920-0.998], with an accuracy of 0.893, sensitivity of 0.941 and specificity of 0.818. The calibration curve demonstrated high consistency between predicted probabilities and actual outcomes. QCT can serve as a crucial and highly promising imaging biomarker for the diagnosis and assessment of CTD-ILD.

The hypothesis of allopatric speciation suggests that spatial separation is the major driver to speciation. The ecological niche theory suggests that differentiations in niche dimensions allow more species to co-exist in ecological communities. It is thus predicted that, (1) species from the same genus will tend to appear in different ecological communities due to the strong force of exclusion between them; (2) sibling genera may co-occur in communities without direct spatial associations (i.e., with indirect spatial associations); and (3) when they are directly associated, the genera will be different in some ecological features to avoid resource competitions. In this study, we used infrared camera trap data and statistic techniques to set up species association networks in four national nature reserves (NNRs) in central China, and the data of mitochondrial cytochrome b (cytb) gene sequences downloaded from the National Center for Biotechnology Information (NCBI) database to test the predictions based on the phasianids (order Galliformes) appearing in the networks. We found 14 phasianid species belonging to 12 genera, resulting in 91 potential species pairs and 45 potential genus pairs. A total of 12 associations were identified between species, accounting for 13.2% of the potential species pairs; and 11 associations identified between genera, accounting for 24.4% of the potential genus pairs. The chi-square goodness-of-fit test results showed that the spatial separation existed extensively between the phasianids at levels of species (86.8% of potential species pairs) and genera (75.6% of potential genus pairs). There were 2 genera each containing 2 species; i.e., the Crossoptilon (containing the white-eared pheasant C. crossoptilon and the blue-eared pheasant C. auritum) and the Chrysolophus (the golden pheasant C. pictus and the Lady Amherst's pheasant C. amherstiae). These congeneric species appeared in different ecological communities. The other 10 genera each contained only one species in community, although they have more species in taxonomy. This monotypicalness in community makes them effectively avoid competition within genera. The Spearman rank-order correlation coefficient tests showed no general correlation between the phylogenetic distance and the spatial association coefficient of the genera of Phasianidae, but the correlation existed in Liancheng, which may be attributed to the difference in evolutionary history between Palearctic and Indomalayan realms. Discussions suggested that the genus pairs of Tetraophasis-Ithaginis and Ithaginis-Crossoptilon are associated in a way that is consistent with beneficial interactions. The genera in symmetric associations may differentiate in diets. It is thus concluded that the spatial separation may play a major role in promoting and maintaining the diversity of Phasianidae, and the differentiation in ecological features play a supplementary role.

Patients with gastroesophageal reflux disease (GERD) often experience typical or atypical symptoms accompanied by depression, anxiety, and low quality of life (QoL). In patients with various diseases, having a Type D personality has been linked to an elevated risk of developing symptoms such as depression and anxiety, as well as reduced QoL. The objectives of this study were to examine the influence of Type D personality on GERD symptoms, depression and anxiety, and QoL and to identify the causal relationships among the variables influencing QoL in patients with GERD. A cross-sectional correlational design and convenience sampling were used, and 149 patients with GERD were enrolled as study participants from the gastroenterology outpatient clinic of a university hospital in the Republic of Korea. Data were collected using structured questionnaires and tested using SPSS 28.0 and Amos 23.0. Approximately 46% of the participants met the criteria for inclusion in the Type D personality group. This group exhibited higher levels of depression and anxiety and diminished QoL than the non-Type D personality group. In the multiple regression model, GERD symptoms, depression and Type D personality were found to have a significant influence on QoL. In the structural equation model, GERD symptoms, depression, and Type D personality were shown to affect QoL, explaining 51.7% of the total variance in QoL. Two factors, namely depression and GERD symptoms, were identified as mediators of the association between Type D personality and QoL. The results of this study indicate a relatively high frequency of Type D personality among patients with GERD. When assessing QoL in patients with GERD, it is essential to consider the influence of Type D personality in conjunction with symptom experience and the presence of depression and anxiety. In particular, managing depression and symptoms in patients with GERD and a Type D personality may offer an effective approach to improving QoL in this patient group.

This study aimed to investigate the infection distribution, drug resistance, and risk factors associated with carbapenem-resistant Pseudomonas aeruginosa (PA) in children, and to construct a risk prediction model. Two retrospective cohorts were established based on the Children's Hospital Affiliated to Shandong University. The derivation cohort included 1397 children with Pseudomonas aeruginosa infection hospitalized from January 2020 to December 2024, divided into the carbapenem-resistant PA (CRPA) group and the carbapenem-sensitive PA (CSPA) group based on antimicrobial susceptibility testing. LASSO regression was used for feature selection, and an XGBoost model was constructed to predict CRPA infection, with internal validation performed using a randomly split test set. Subsequently, an independent temporal validation cohort of 431 children (January 2025 to March 2026) was used to evaluate model generalizability. SHapley Additive exPlanations (SHAP) was employed to interpret variable importance. Among the 1397 PA isolates, 1177 were CSPA and 220 were CRPA. Children in the CRPA group were younger, had longer hospital stays, and were more prevalent in the NICU and PICU than those in the CSPA group. Among CRPA isolates, 88.2% met multidrug-resistant criteria and 46.4% met extensively drug-resistant criteria, while maintaining high sensitivity to amikacin (95%). The XGBoost model, incorporating 10 key variables, achieved an AUC of 0.848 (95% CI, 0.783-0.912) on the internal test set and 0.715 (95% CI, 0.622-0.807) on the temporal validation cohort. SHAP interpretability analysis showed that length of hospital stay, CD8+ T cells, ventilator use, and pre-infection carbapenem exposure were important risk factors for CRPA infection. CRPA infection in children is closely associated with prolonged hospitalization, immune dysregulation, invasive procedures, and prior carbapenem exposure. The XGBoost prediction model demonstrated good discrimination in internal validation, and its performance remained stable on temporal validation, suggesting potential utility in identifying high-risk children for early clinical intervention.

Carbapenemase-producing Enterobacterales (CPE) constitute a critical public health concern due to multidrug resistance and limited available treatment options. This study aimed to assess the in vitro susceptibility of CPE isolates to colistin, fosfomycin, and mecillinam. Prospective study was conducted in 2023 at Mohammed VI University Hospital, Marrakech. A total sample of 180 non-duplicate CPE isolates were collected and identified by standard microbiological methods. Antimicrobial susceptibility testing was performed following recommended guidelines. Among the isolates, Klebsiella pneumoniae (60%) and Escherichia coli (14%) predominated. The most common carbapenemase was NDM (62%), followed by OXA-48 (26%) and co-producers (11%). Most isolates were obtained from intensive care (32%), plastic surgery (13%), and neonatology (12%) units. Skin and soft tissue (43%) and bloodstream (21%) were the predominant infected sites. Resistance rates were 25% for colistin, 48% for fosfomycin, and 64% for mecillinam, with frequent co-resistance to fluoroquinolones, aminoglycosides, and cotrimoxazole. The high prevalence of NDM-producing Klebsiella pneumoniae and significant resistance to last-line agents suggest the urgent need for antimicrobial stewardship, optimized therapeutic strategies, and strengthened regional surveillance.