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To evaluate the performance of machine learning models in predicting liver metastasis in colorectal cancer (CRC) patients using the SEER database and external validation from Ningbo No.2 Hospital. The data on patients with colorectal cancer were obtained from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2023. Patients were classified into training (n = 29017) and testing sets (n = 12437). The data were used to build eight machine learning models to predict liver metastasis in colorectal cancer patients. A total of 11 clinical variables were entered into these models. Model performance was measured with the area under the receiver operating characteristic curve (ROC) and area under precision-recall curve (AUPR). The models were visualized and interpreted using the SHAP method. In the SEER database cohort, the incidence of liver metastasis was 7.2% (2977/41,454). Of the eight machine learning models, Gradient Boosting (GB) had the best AUC (0.837) and AUPR (0.294). Upon external validation, the GB model achieved an AUC of 0.730 and an AUPR of 0.278. We explored the significance of features in the model through SHAP analysis. CEA, N stage and T stage were the heavily weighted factors used by the GB. An online calculator was developed for clinical use. The GB model demonstrates robust predictive performance for liver metastasis in CRC, validated internally and externally, and presents a potentially valuable tool for clinical decision-making.

A BigSMILES string encodes the structural connectivity of any polymer chemistry and topology as a linear string. However, multiple BigSMILES strings can encode the same ensemble, making string-based searches for polymers in digital databases challenging. This work presents a canonicalization algorithm that breaks the degeneracy of the BigSMILES language for both linear and branched polymers and can reverse-translate canonicalized structures back into BigSMILES. The algorithm was validated on broadly representative polymer chemistries and topologies from the literature. First, the BigSMILES string is mapped onto a tree automaton, a type of state machine that accommodates branch points and recognizes the same ensemble of molecules that BigSMILES encodes. The automaton can then be minimized into a unique graph with the fewest states through existing algorithms. Finally, a human-readable canonicalized BigSMILES is obtained upon translation of the state machine transition rules back into a string. This robust canonicalization algorithm allows polymers to be searched rapidly in large database systems, making data findable, accessible, interoperable, and reusable (FAIR) and enabling the development of novel data-driven approaches with BigSMILES.

Ferroptosis plays a significant role in pulmonary arterial hypertension (PAH), although its underlying mechanisms and key pathogenic genes remain unclear. Transcriptomic data from human PAH and control lung tissue were obtained from the Gene Expression Omnibus (GEO) database, whereas ferroptosis-related genes (FRGs) were sourced from the MsigDb and FerrDb databases. Differentially expressed FRGs (DE-FRGs) were identified through the intersection of FRGs with differentially expressed genes (DEGs). Functional enrichment analysis was performed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Key hub genes were identified through Least Absolute Shrinkage and Selection Operator (LASSO), support vector machine-recursive feature elimination (SVM-RFE), and weighted correlation network analysis (WGCNA). Gene set enrichment analysis (GSEA) was conducted to explore the functional roles and associated pathways of hub genes. The relationship between hub genes and immune infiltration was investigated. Expression levels of potential biomarkers were validated via Quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC) in two PAH animal models (monocrotaline-induced and Sugen5416 plus hypoxia-induced PAH). Finally, molecular docking was employed to screen potential therapeutic compounds. A total of 133 DE-FRGs were identified, with KEGG and GO analyses highlighting their involvement in intracellular iron homeostasis and ferroptosis. Hub genes, notably FZD7 and NFE2, were identified using LASSO, SVM-RFE, and WGCNA. Immune infiltration analysis suggested that monocytes and neutrophils play key roles in PAH pathogenesis. Validation in PAH animal models showed significant upregulation of Fzd7 and downregulation of Nfe2 in lung tissues of both MCT- and SuHx-induced PAH models. Molecular docking identified tetrachlorodibenzodioxin (TCDD) has good binding affinity. In summary, we investigated two ferroptosis-related biomarkers, FZD7 and NFE2, in PAH using transcriptomics, offering new insights into molecular mechanisms and potential targeted therapies for the disease.

This study is to systematically evaluate the efficacy of acupuncture for PHN and provide a visual overview of treatment landscape. A systematic search was conducted in PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang Database for systematic reviews (SRs) on acupuncture for PHN up to Apr 18, 2025. Studies were included if they were SRs of randomized controlled trials (RCTs) assessing traditional Chinese acupuncture interventions for PHN, and excluded if they involved non-traditional acupuncture, herpes zoster, or PHN prevention research. Two independent reviewers utilized Excel, EndNote 20, and R software for data analysis and assessed the quality of included studies using the AMSTAR2 tool. Of 351 identified records, 40 SRs met inclusion criteria, encompassing 926 RCTs, 63,493 patients, 13 types of acupuncture interventions and 29 outcomes. Acupuncture interventions, particularly fire needling, CPBLC, Fu's subcutaneous needling, plum-blossom needle, multi-acupuncture and multi-acupuncture + pharmacotherapy, showed the most robust benefits in improving effective rate, reducing visual analog scale (VAS) scores, and decreasing adverse reactions in PHN treatment. Despite most SRs reporting positive outcomes, the quality was generally low by AMSTAR2. Acupuncture could be a valuable adjunct to standard PHN treatment, offering benefits in overall efficacy, pain management and treatment safety. However, high-quality clinical trials and systematic reviews are needed to confirm these preliminary results and guide clinical practice.

Venous thromboembolism (VTE), which encompasses deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common preventable complication in hospitalized patients. Risk assessment tools allow for easy stratification of patient VTE risk and have been demonstrated to reduce incidence of VTE. However, risk assessment tools remain underutilized in clinical practice. This scoping review aims to explore barriers and facilitators to VTE risk assessment usage to improve rates of hospital-acquired VTE and provide recommendations for future implementation strategies. Four databases (PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews) were searched from January 1990 through December 2025, and 59 studies were included after selection by three independent reviewers. Themes related to 'decreased provider compliance' and 'difficulty of use' were the most commonly cited barriers. For facilitators, the majority of themes surrounded 'electronic medical record integration,' 'forcing functions,' and 'education.' A prevalence of barriers and a paucity of facilitators contribute to decreased VTE risk assessment usage. Hospital administrators and clinicians should address current barriers and promote facilitators during VTE risk assessment initiatives to maximize patient quality improvement outcomes. (Prospero ID: CRD42022360033).

Narrative medicine is defined as medicine practiced with the competence to absorb, interpret, and respond to narratives. We hereby present a resource compiling narrative medicine texts, aiming to make narratives created by patients and/or their families fully accessible to citizens, by developing a documentary database and describing its characteristics. Active bibliographic search, March-June 2022 for narratives in Spanish and/or Catalan written after the year 2000 by patients and/or their companions. Subsequently, narratives up to June 2024 were included. The compilation is available in a searchable and open-source web ( https://osf.io/pk9b3/ ). Three hundred seventeen narratives, 50.14% written by women, are showing an increase from 2020 onwards. Texts are related to cancer/hematological diseases (45.11%), mental illnesses (10.41%), neurodegenerative diseases (9.4%). Personal stories (28.7%), autobiographical (11.29%), companion stories (5%), children's or young adult stories/narratives (8.87%). There are studies, websites, and digital platforms that recognize the importance of narrative as part of the therapeutic process and how it improves the experience of illness (either one's own or that of a family member). Despite this, to date, no one had compiled a collection of patient texts in Spanish and Catalan. For this reason, we believe our database is innovative and can pave the way for improving the patient-professional relationship.

ObjectiveTo explore and describe the components and underpinning theories of nurse-initiated transitional (hospital-to-home) care and to evaluate the effects of interventions on activities of daily living (ADLs), quality of life (QoL), depression, anxiety, self-efficacy, stroke-related knowledge, patient satisfaction and healthcare service utilisation in older stroke survivors and self-efficacy, caregiver burden, QoL and satisfaction with care in caregivers.Data sourcesMEDLINE, CINAHL, Cochrane Library, Health and Medical Collection, Nursing and Allied Health, Web of Science, Health Source: Nursing/Academic Edition and Scopus databases were searched in February 2024 and updated in March 2026.Review methodsRandomised controlled trials (RCTs) and cluster-RCTs were included. Risk of bias was assessed using the Cochrane Risk of Bias tool, and evidence quality was rated with GRADE. Meta-analysis was undertaken using random-effects models.ResultsSeventeen trials were included. Transitional care interventions were guided by various theoretical frameworks and had multiple components. Interventions improved ADLs at 1 month (standardised mean difference (SMD) 0.54; 95% CI 0.12-0.97, four studies) and 3 months (SMD 0.43; 95% CI 0.12-0.74, seven studies), increased patient satisfaction and reduced hospital readmissions up to 3 months. Interventions may improve the Mental Component Score at 1 month, Role Limitations due to Physical Problems and General Health of QoL at 6 months. The certainty of evidence was low to very low.ConclusionNurse-initiated transitional care can improve ADLs and QoL, while reducing hospital readmissions among older stroke survivors during the hospital-to-home transition. Multicomponent interventions combining home visits and follow-up phone calls may enhance improvements in ADLs. High-quality studies are needed to clarify long-term effects.PROSPERO IDCRD42024517619.

Cerebral palsy (CP) frequently compromises postural control and balance in children. Ankle-foot orthoses (AFOs) are routinely prescribed to improve stability, yet the influence of specific design parameters-stiffness, alignment, and individualized tuning-on balance outcomes remains inadequately characterized. Adhering to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251170932), this systematic review searched six databases (PubMed, Scopus, Web of Science, Embase, CINAHL, and Cochrane Library) up to October 10, 2025. Two reviewers independently screened interventional and observational studies assessing AFO effects on balance or postural control in children with CP. Methodological quality was appraised using Joanna Briggs Institute tools, evidence certainty graded via GRADE, and findings synthesized qualitatively across AFO types, assessment methods, and outcome domains. A total of 15 studies (n = 390) were included, predominantly involving ambulatory children with spastic diplegia (GMFCS I-III). Overall evidence certainty was very low for static and dynamic balance. Ground-reaction AFOs consistently enhanced static stability versus solid AFOs. Hinged AFOs yielded inconsistent dynamic balance effects. Individualized tuning of the AFO-footwear interface emerged as pivotal for optimizing postural control. Conversely, isolated stiffness modifications and prescribed wearing schedules showed variable or detrimental impacts. AFOs may improve balance in children with CP, but evidence is constrained by methodological heterogeneity and very low certainty. Optimal outcomes appear contingent upon individualized configuration-integrating biomechanical tuning, stiffness modulation, footwear compatibility, and context-sensitive wearing protocols. High-quality, parameter-specific trials are imperative to advance precision orthotic prescription and maximize functional stability.

Safety-net hospital (SNH) status is associated with high perioperative morbidity in pulmonary resection. Multiple etiologies have been proposed, including delays in diagnosis and inefficient care pathways. In integrated health systems, surgical volume has been shown to improve outcomes in pulmonary resection. However, whether surgical volume can overcome the inherent challenges of SNHs is unclear. We hypothesize that surgical volume is associated with improved outcomes at SNHs. The 2016 to 2021 Nationwide Readmissions Database was queried for all adult (&#x2265;18 years) patients undergoing elective lobectomy for lung cancer. Centers in the top quartile of Medicaid or self-pay/uninsured admissions were defined as SNHs. SNHs were further stratified by lobectomy caseload as a low-volume hospital (<10 cases/y), medium-volume hospital (10-33 cases/y), or high-volume hospital (>33 cases/y). Multivariable regressions were built to consider the independent association of hospital volume on acute clinical and financial outcomes among patients treated at SNHs. Care at high-volume centers remained associated with significantly reduced likelihood of overall major morbidity (adjusted odds ratio [AOR], 0.81; 95% CI, 0.68-0.97), respiratory complications (AOR, 0.79; 95% CI, 0.65-0.96), need for blood transfusion (AOR, 0.67; 95% CI, 0.48-0.93), and nonhome discharge (AOR, 0.66; 95% CI, 0.48-0.88). Care at high-volume centers was also associated with a decrease in duration of hospitalization (&#x3b2; = -1.02 days; 95% CI, -1.48 to -0.54 days) and overall expenditures (&#x3b2; = -$4360; 95% CI, -$7020 to -$1700). Surgical volume is associated with improved outcomes in pulmonary resection at SNHs. Patients who are eligible for care only at SNHs can still benefit from undergoing pulmonary resection at a high-volume center.

Peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) is a highly aggressive and heterogeneous lymphoma subtype with a poor prognosis. This study aims to develop a machine learning-based model to predict early death (within 3 months of diagnosis) in PTCL-NOS patients using data from the SEER database (2016-2021). A total of 1,156 patients were included and randomly divided into training (n&#x2009;=&#x2009;809) and validation (n&#x2009;=&#x2009;347) sets. Key predictive factors were identified through Boruta and LASSO algorithms, including chemotherapy, radiotherapy, age, B symptoms, primary tumor site, Summary Stage, and Ann Arbor Stage. Seven machine learning models were constructed and evaluated using AUROC, AUPRC, calibration curves, Brier scores, and decision curve analysis. XGBoost demonstrated the best predictive performance (AUROC&#x2009;=&#x2009;0.842 in training and 0.774 in validation). This study provides a novel and interpretable predictive tool that can aid in early risk stratification and personalized treatment planning for PTCL-NOS patients, ultimately improving clinical outcomes.

In general practice, symptom diagnoses are commonly used when patients seek care for symptoms in which no specific disease or disorder can be diagnosed. These diagnoses are prevalent, yet little is known about how they evolve or how General Practitioners (GPs) manage them in daily practice. To explore the course of symptom diagnoses and compare GPs' management strategies, both for symptom diagnoses that persisted for more than a year or changed into disease diagnoses. A retrospective longitudinal cohort study was conducted using the Dutch Family Medicine Network (FaMe-Net) database. We included all episodes of care in which the diagnosis recorded at the first consultation was coded as a symptom diagnosis between 2008 and 2021. The course of each EoC was analyzed, comparing management strategies, such as GP contacts, interventions, referrals, and medication use, between symptom diagnoses that persisted and those that changed into disease diagnoses. Referrals to primary healthcare workers include referrals to nurses, social workers and therapists such as physiotherapists and occupational therapists. Out of the 12,532 EoC that started as symptom diagnoses, 9.4% changed into a disease diagnosis within a median of 22&#x2009;days [2-239], 85.8% resolved within one year, and 4.3% persisted as symptom diagnoses. Within the course of the first year of care, a significantly higher number of management strategies were found for EoC that changed into a disease diagnosis. Referrals to primary healthcare workers were lower for EoC that changed into disease diagnoses (OR = 0.80, 95% CI [0.74, 0.87], p&#x2009;<&#x2009;0.001). Symptom diagnoses are more likely to resolve within a year, and only a few will persist or change into disease diagnoses. GPs can rapidly diagnose diseases. Our findings highlight the importance of reassurance in patient care when discussing the prognosis of symptom diagnoses, as most of these symptoms tend to resolve.

Suicidality is often understood as an acute crisis, yet it can also present as a persistent condition. Chronic or persistent suicidality (PS) remains conceptually underdefined, and existing literature provides varied operationalisations, underscoring the need for conceptual clarity. To clarify the concept of PS, an evolutionary concept analysis of the available literature was conducted. Following a systematic search across six databases, surrogate and related terms, antecedents, attributes, and consequences were identified in 45 included sources (1974-2025) and narratively synthesised according to Rodgers' evolutionary framework. The literature characterises PS as an ego-syntonic, fluctuating phenomenon. Its core attributes include serving as a functional tool for psychological regulation. While frequently associated with personality pathology, the analysis reveals that PS manifests across various psychiatric diagnoses. The identified consequences include a discrepancy between acute risk protocols and clinical care tailored to the nature of PS, aiming to avoid potential iatrogenic risks. This study establishes the conceptual groundwork for viewing PS as a transdiagnostic phenomenon, providing a step toward a shared understanding. The findings support a shift from rigid diagnostic categories toward a dimensional perspective that captures the fluctuating severity and persistence of the patient's experiences.

Surgeon case volume has been linked with outcomes across many orthopaedic procedures, but its influence on distal radius fracture fixation remains uncertain. (1) For distal radius fracture surgery, at what surgeon annual case volume does the risk of complications plateau? (2) For distal radius fracture surgery, at what surgeon annual case volume does the risk of revision surgery plateau? A retrospective, population-based study was performed using administrative health databases in Ontario, Canada, accessed through the Institute for Clinical Evaluative Sciences, an independent, nonprofit research institute that houses linkable, individual-level health administrative data for Ontario's publicly funded healthcare system. Between 2010 and 2020, a total of 27,945 adult patients (&#x2265; 18 years of age) underwent surgical fixation for acute isolated distal radius fracture. After applying prespecified inclusion and exclusion criteria, including exclusion of patients with open fractures, polytrauma, compartment syndrome, neurovascular injury, emergent presentations, incomplete administrative records, or prior distal radius surgery, a final cohort of 13,389 patients (48% of the initial cohort) was included (71% [9533] females; mean &#xb1; SD age 56 &#xb1; 15 years). Surgeon annual case volume, defined as the number of distal radius fracture fixations performed in the preceding year, was the primary exposure. The primary outcome was a composite of complications, including postoperative complications or revision surgery up to 10 years after the index procedure; revision surgery was also analyzed separately. Cox proportional hazards models were adjusted for demographics, comorbidities, fracture type (intraarticular versus extraarticular), fixation method, and hospital type (teaching versus nonteaching). Restricted cubic spline models were used to assess nonlinearity and identify potential volume thresholds. Surgeons performing < 5 distal radius fracture fixations annually had the highest hazards of both composite complications and revision surgery. Complication hazards declined with increasing surgeon volume and stabilized after approximately 20 procedures per year; consistent with this threshold, surgeons performing 20 to 24 procedures annually demonstrated a 37% lower hazard of complications compared with surgeons performing < 5 procedures per year (HR 0.63 [95% confidence interval (CI) 0.49 to 0.81]; p = 0.004). Revision surgery hazards likewise declined with increasing surgeon volume but plateaued at a lower threshold of approximately 10 procedures per year; surgeons performing 10 to 14 procedures annually had a 56% lower hazard of revision surgery compared with surgeons performing < 5 procedures per year (HR 0.44 [95% CI 0.33 to 0.60]; p < 0.001). Surgeons who perform distal radius fracture fixation infrequently may benefit from focused strategies to support maintenance of procedural proficiency including continuing professional development and enhanced surgical training. At a systems level, the lower risk of complications observed among surgeons performing at least 20 procedures per year have implications for training programs, ongoing competence frameworks, and health-system planning, particularly in settings where referral options may be limited. Level III, prognostic study.

Indian mental health providers have suggested that the Hindu scripture the Bhagavad Gita ("Gita") could be a source for psychotherapeutic interventions. This raises questions about how mental health practitioners have interpreted relationships between the Gita and psychotherapy, how these interpretations construct selfhood, and how these interpretations of selfhood relate to commentaries from Hindu religious scholars. This paper answers these questions through a critical narrative review of studies on the Gita and psychotherapy, along with textual analyses of authoritative Gita commentaries, analyzed through the pattern theory of the self framework. An April 2025 search for studies that explored psychotherapy and selfhood in the Gita in five databases along with forward citation and backward bibliographic analyses uncovered 17 studies, all suggesting that principles of the Gita could be used within psychotherapy, with eight studies naming cognitive behavioral therapy. Thirteen drew on Hindu concepts of &#x101;tman, dharma, and karma to postulate an ideal self to help patients reflect on thoughts, emotions, and behaviors. Authoritative commentaries from &#x100;di &#x15a;a&#x1e43;kar&#x101;c&#x101;rya, Swami Vivekananda, and Swami Chinmayananda show that &#x101;tman as the eternal soul, dharma as morally prescribed behaviors, and karma as actions without expectations of results have religious connotations without equivalents in Euro-American forms of psychology. A post-colonial approach to psychiatry can read the Gita alongside its commentators-ancient and modern, religious and non-religious-to uncover ways of conceptualizing selfhood before assuming that religious concepts have direct correspondences with psychotherapy.

This study conducted a systematic literature review to answer the question: "What is the frequency of post-discharge complications in patients who had bacterial meningitis during childhood and adolescence?" Observational studies assessing post-discharge complications in patients aged 29&#x2009;days to 18&#x2009;years with bacterial meningitis were included. Studies on Mycobacterium tuberculosis meningitis or lacking clear diagnostic criteria were excluded. Searches were performed in July 2025 across seven databases (PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, LILACS, and BVS). Evidence certainty was assessed using GRADE. Data on events and total participants were synthesized quantitatively. Thirteen studies were included (sample size range: 51-3623 participants). Age at meningitis diagnosis ranged from 29&#x2009;days to 18&#x2009;years, with follow-up periods from 6&#x2009;months to 35&#x2009;years. The overall complication rate was 37.3% (95% CI 28.7-46.9). The most frequent sequelae were cognitive impairment (21.6%; 95% CI 13.2-32.8), emotional/behavioural problems (15.3%; 95% CI 8.1-26.8), and hearing loss (14.3%; 95% CI 7.7-25.1). Bacterial meningitis in childhood is associated with a significant and persistent impact on health and development. Despite heterogeneity across studies, a consistently high burden of auditory, motor, cognitive, and behavioural sequelae is observed, underscoring the need for long-term follow-up of affected individuals.

Atrial fibrillation (AF) has complex etiologies. This study aimed to investigate the clinical significance of long non-coding RNA (lncRNA) NPPA-AS1 in AF and the pro-AF mechanism of the NPPA-AS1/miR-302e/transforming growth factor beta receptor 2 (TGFBR2) axis. This study included 120 patients with AF and 120 healthy controls. An in vitro AF model was established by stimulating rat primary cardiac fibroblasts (CFs) with angiotensin II (AngII). RT-qPCR, Cell Counting Kit-8 (CCK-8) assay, flow cytometry, and enzyme-linked immunosorbent assay (ELISA) were utilized to assess gene expression, cellular function, and protein concentration, respectively. Molecular target regulation relationships were validated using RNA immunoprecipitation (RIP) and dual luciferase assays. Target genes predicted by multiple databases were selected for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis to investigate the biological functions and related signaling pathways of the NPPA-AS1/miR-302e axis. NPPA-AS1 was highly expressed in AF patients, serving as an independent risk factor for AF onset while demonstrating excellent diagnostic efficacy for AF. Its expression may be closely associated with cardiac structural remodeling, myocardial injury, and inflammatory responses in AF patients. Mechanistically, NPPA-AS1 was found to act as a molecular sponge to negatively regulate miR-302e, which directly suppressed TGFBR2 expression, forming the NPPA-AS1/miR-302e/TGFBR2 regulatory axis. In vitro, this regulatory axis was associated with Ang II-induced cellular proliferation, apoptosis imbalance, expression of fibrotic molecules, and inflammatory factor secretion (tumor necrosis factor alpha [TNF-&#x3b1;], interleukin 6 [IL-6]), suggesting a potential role in AF-related pathological processes. Specifically, interference with NPPA-AS1 reversed these pathological effects, while inhibition of miR-302e counteracted this reversal. Further interference with TGFBR2 could re-block the pathological process. In vitro findings suggest that NPPA-AS1 may amplify Ang&#x2161;-induced atrial fibrosis and inflammation by releasing TGFBR2 inhibition through "sponge-like" adsorption of miR-302e, indicating a potential contributory role in AF pathogenesis.

The aggressive and diverse subtype of breast cancer known as triple-negative breast cancer (TNBC) has poor clinical outcomes and few specific therapeutic choices. Tumor-infiltrating lymphocytes (TILs), T-cell receptor-engineered T cells, and chimeric antigen receptor T (CAR-T) cells are examples of adoptive cell therapy (ACT), which has become a promising immunotherapeutic approach. Its clinical application in TNBC is still difficult, nevertheless. This study used bibliometric techniques to thoroughly assess growing hotspots, intellectual structure, and worldwide research trends pertaining to ACT in TNBC. The Scopus database was searched for publications related to ACT in TNBC from 2011 to 2025. There were only original articles and reviews written in English. VOSviewer (version 1.6.20) and Microsoft Excel 2021 were used to analyse bibliometric indicators, such as annual publication output, country and institutional contributions, authorship patterns, citation characteristics, and keyword co-occurrence. To investigate thematic evolution and collaboration patterns, network visualisation and clustering analysis were carried out. With a compound annual growth rate of more than 60%, a total of 8,496 publications were found, indicating an exponential rise in research output, especially beyond 2020. Together, China and the US accounted for over 60% of all publications, dominating the world's research output. The core research network was made up of a few institutions and very productive writers. CAR-T cell therapy, tumor microenvironment manipulation, immunological checkpoint inhibition, metabolic reprogramming, and biomarker-driven methods were among the clinically orientated themes that emerged from foundational and preclinical investigations, according to keyword analysis. The literature shows ongoing translational difficulties with regard to tumor heterogeneity, antigen instability, immunosuppressive microenvironments, and safety concerns in solid tumors, despite increased research activity. Over the past ten years, research on ACT in TNBC has grown significantly, reflecting both unmet clinical need and growing scientific interest. However, continuous efforts to overcome biological and translational constraints are highlighted by the concentration of scientific leadership and the conceptual move towards combination methods and next-generation engineering approaches. This bibliometric analysis offers a thorough picture of the state of the field and could direct future research, teamwork, and the creation of more potent ACT tactics for TNBC.

Hypertension often remains inadequately controlled despite pharmacological therapy, indicating the influence of multidimensional factors on blood pressure regulation. Psychological and spiritual processes contribute to stress regulation and adaptive coping; however, quantitative synthesis of psychospiritual interventions within holistic nursing remains limited. This meta-analysis evaluated the effects of psychospiritual interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in adults with hypertension. A systematic review and meta-analysis of randomized controlled trials was conducted following PRISMA 2020 guidelines using databases covering 2000-2025. Twelve studies were included in the qualitative synthesis, with six studies analyzed for SBP and five for DBP. Psychospiritual interventions were associated with a significant reduction in SBP (SMD = -0.91; 95% CI: -1.54 to -0.29; p&#x2009;=&#x2009;.004), but not DBP (SMD = -0.20; 95% CI: -0.77 to 0.36; p&#x2009;=&#x2009;.48). Findings support psychospiritual interventions as complementary non-pharmacological strategies consistent with holistic nursing approaches to hypertension management.

Klebsiella quasipneumoniae is a Gram-negative, non-motile, capsulated, facultative anaerobic rod within the K. pneumoniae species complex (KpSC) and is increasingly recognized as an opportunistic pathogen associated with bloodstream infections, urinary tract infections (UTIs), and other clinically significant conditions. Because it shares many phenotypic characteristics with K. pneumoniae, accurate diagnosis remains challenging in routine clinical settings, particularly in low-resource laboratories lacking access to molecular identification tools. In this study, we characterized the antimicrobial resistance (AMR) profile of a K. quasipneumoniae subsp. quasipneumoniae isolate obtained from a UTI case in Peshawar, Pakistan. The isolate exhibited a multidrug resistant (MDR) phenotype, with resistance to &#x3b2;-lactams, carbapenems, fluoroquinolones, and colistin (MIC 4&#xa0;&#xb5;g/mL), while remaining susceptible to aminoglycosides (amikacin and gentamicin) and tigecycline (MIC 2&#xa0;&#xb5;g/mL). Whole-genome sequencing (WGS) identified chromosomally encoded AMR determinants, including blaOKP-A-8, oqxAB, and fosA6, with no identifiable plasmid replicons detected. Multiple nonsynonymous mutations were observed in mgrB, pmrA/B, phoP/Q, lpxM, ompK35/36, and gyrA/parC, which have been previously associated with resistance phenotypes; however, their functional contribution in this isolate was inferred from genomic data and not experimentally validated. Virulence-associated loci such as fim, ecp, entB, and fepC were present, consistent with a classical (non-hypervirulent) phenotype. Phylogenomic analysis positioned the isolate (Kq1223) on a distinct branch relative to publicly available genomes, but given that this study is based on a single isolate, no definitive conclusions regarding regional lineage or evolutionary patterns can be established. The allelic profile identified by multilocus sequence typing (MLST) has not been previously reported and may represent an unassigned sequence type pending formal database validation. The presence of chromosomally mediated MDR, including colistin resistance, highlights potential therapeutic challenges and underscores the importance of accurate species identification and expanded genomic surveillance of Klebsiella species in clinical microbiology, particularly in resource limited settings.