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Pooling of gastropod samples is frequently used in surveys of the neurotropic nematode Angiostrongylus cantonensis to reduce cost and processing time. Here we highlight a potential limitation of this technique using the snail Theba pisana as an example. Pooled samples tested negative using a high-sensitivity qPCR assay, whereas subsequent individual testing revealed positive cases. This pattern is consistent with a dilution effect, where low parasite DNA concentrations could lead to false-negative results. These findings suggest that pooling may reduce diagnostic sensitivity in regions where infection intensities are low and should be applied with caution.
Surgical management of perianastomotic venous collaterals during the creation of vascular access remains a critical yet often overlooked step. Traditionally, these branches are ligated to optimize hemodynamics and direct the entire flow into the primary venous outflow tract. However, pathophysiological analysis suggests that this practice may limit the overall resilience of the access. Perianastomotic collaterals serve a functional role as essential compensatory outflow pathways; in the presence of stenosis or obstruction of the primary venous segment, their patency maintains blood flow, reduces resistance, and prevents stagnation. Systematically preserving these branches, rather than ligating them, can significantly delay the onset of thrombotic events and ensure the functional survival of the access even if the main outflow fails. This "conservative" hemodynamic approach proposes a paradigm shift in surgical strategy, prioritizing vascular redundancy to improve long-term patency and minimize the need for complex salvage interventions.
Social isolation (SI) is associated with a higher risk of cardiovascular disease (CVD). One mechanism linking SI and CVD is accelerated biological ageing, which can be assessed using artificial intelligence-enabled electrocardiography (AI-ECG). We investigated whether longitudinal changes in SI status are associated with changes in biological ageing patterns. A retrospective longitudinal cohort study including 17 663 individuals without significant CVD who completed ≥2 Berkman and Syme Social Network Index and had paired ECGs within 1 year of each questionnaire. Longitudinal SI status was defined by comparing baseline and follow-up SI status. Ageing trends were assessed using Δage-gap, defined as the change in the gap between AI-ECG-predicted age and chronological age from baseline to follow-up. Linear regression models predicting Δage-gap and survival analyses with Kaplan-Meier and multivariable Cox regression for all-cause mortality were performed. Persistently connected individuals were older [63.1 (52.1, 70.6) years] and had a higher prevalence of hyperlipidaemia and hypertension, yet demonstrated more favourable ageing trajectories. Similarly, those who became connected showed a non-significant attenuation of accelerated ageing. In multivariable linear regression, being persistently isolated [β = +0.412 years, P < 0.001] or becoming isolated [β = +0.438 years, P = 0.012] was associated with accelerated ageing compared to being persistently connected. In survival analyses, becoming isolated (aHR = 1.94, 95% CI = 1.53-2.46, P < 0.001) and being persistently isolated (aHR = 1.66, 95% CI = 1.40-1.96, P < 0.001) were associated with significantly higher all-cause mortality, independent of chronological age and comorbidities. Persistent social connection is associated with slower biological ageing and lower mortality. The effects of SI on ageing and survival appear to be potentially reversible, calling for a prospective study to evaluate interventions aimed at improving both the social and biological burden of SI. Social isolation (SI) is a well-recognized yet underestimated risk factor for cardiovascular morbidity and mortality, and accelerated biological ageing is a key mechanism linking SI to cardiovascular disease. However, most studies rely on a single assessment of SI and of ageing, which fails to capture the dynamic nature of both entities. Our study showed that:Repeated measurements of SI provide greater insight into individual ageing trajectories than a one-time assessment.Persistent social connections over time are associated with slower ageing, whereas becoming isolated or being persistently isolated is linked to accelerated biological ageing.
The aquaculture industry is undergoing a critical transition from marine-based to plant-based and novel protein sources. However, the physiological impacts of these dietary shifts remain largely obscured when evaluated solely by traditional performance metrics such as Feed Conversion Ratio (FCR) and Specific Growth Rate (SGR). This 'Black Box' approach fails to detect sub-clinical metabolic disorders, gut dysbiosis, and molecular stress responses until phenotypic losses occur. This review provides a comprehensive synthesis of how omics technologies - nutrigenomics, proteomics, metabolomics, and metagenomics - are elucidating the molecular mechanisms underlying fish nutrition. We examine the capacity of transcriptomics to identify early markers of soybean meal-induced enteritis and the role of proteomics in assessing muscle quality beyond mere gene expression. Furthermore, we highlight the integration of these layers into a 'Systems Biology' approach, utilizing multi-omics and bioinformatics to unravel the complex diet-microbiota-host axis. Finally, the review discusses the transition towards 'Precision Aquafeed.' It identifies the current challenges in cost, data standardization, and bioinformatics that must be overcome to implement these high-throughput tools in commercial feed formulation.
With the expansion of high-speed road mileage and the aging of road networks, maintenance workloads have increased dramatically. Accurately forecasting preventive maintenance costs is a practical approach to rationally control maintenance expenditure, enhance capital utilization efficiency, and ensure the long-term stable operation of the road network. However, the current predictive model for preventive maintenance costs fails to adequately account for variations in types of preventive maintenance measures, limiting their ability to capture the actual cost variation patterns under different engineering conditions. Consequently, there remains scope for improvement in prediction accuracy. In this study, we developed three meta-heuristic-optimized hybrid models, each tailored to a specific asphalt pavement preventive maintenance measure: 1) the fruit fly optimization algorithm (FOA)-enhanced XGBoost model for crack filling; 2) the hiking optimization algorithm (HOA)-enhanced RF model for surface sealing; 3) the particle swarm optimization (PSO)-enhanced BPNN model for overlay. A case study demonstrates that FOA-XGBoost (R² = 0.8622, MAE = 0.0552) improved XGBoost's R² by 0.0526. In contrast, HOA-RF (MSE = 0.0032, RMSE = 0.0565) outperformed RF with lower error metrics. Furthermore, PSO-BPNN achieved the highest R² (0.9277) and the lowest MAE (0.0419) compared to BPNN. All models maintained MAPE below 5%. To further support the reliability of the results, the Wilcoxon signed-rank test was conducted to assess the statistical significance of model performance differences. In addition, nested cross-validation and sensitivity analysis were performed to evaluate the robustness and stability of the proposed models. These findings indicate that the optimized hybrid model has demonstrated improvements in both predictive accuracy and stability. Consequently, the developed models may provide useful support for maintenance cost estimation and resource allocation in expressway maintenance management.
Conventional imaging fails to quantify the true physical density and mass of organs. This study aims to develop a spectral CT-based physical modeling approach to quantify organ remodeling in type 2 diabetes mellitus (T2DM). A total of 97 subjects (46 T2DM patients and 51 non-diabetic controls) were evaluated. Organ regions (liver, pancreas, spleen) were automatically segmented using a V-Net neural network. A physical density model was constructed based on spectral parameters. We compared organ CT value, effective atomic number, mass, volume, and physical density between groups and analyzed their correlation with HbA1c levels. The physical density model showed high accuracy, with measured subcutaneous fat density aligning with standard physical references. In T2DM patients, pancreatic mass and physical density decreased significantly. Conversely, liver and spleen mass increased without significant changes in physical density. Pancreatic physical density showed a significant negative correlation with HbA1c, with rho = -0.411 and p < 0.001. The spectral physical density model provides a precise, non-invasive metric for assessing organ quality. The strong correlation between pancreatic density and glycemic supports its potential utility in evaluating functional reserve for artificial organ.
Superhydrophobic material design has predominantly relied on direct structural replication of singular natural archetypes, such as the lotus leaf. While this biomimetic strategy has driven significant progress, it fundamentally fails to translate the dynamic droplet super-repellency into universally applicable predictive models. Here, we report a biomimetic laboratory toolkit designed to overcome the variability of natural leaves and establish a standardized paradigm for herbicide formulation screening. By integrating the high-ridge architecture of C3 grasses with the dense-groove networks of C4 grasses, we engineered a structural test strip that serves as a conservative worst-case benchmark. This engineered platform, combined with kinetic contact tension (KCT) analysis, enables the precise prediction of droplet deposition kinetics, facilitating high-throughput adjuvant screening prior to field trials.
Aberrant phosphatidylinositol 3-kinase (PI3K) activation drives many cancers, but PI3K inhibitors like Pictilisib often induce cytostasis rather than cytotoxicity, limiting their therapeutic potential. Here we demonstrate that PI3K inhibition combined with nutrient stress triggers methuosis, a non-apoptotic form of programmed cell death characterized by dysregulated macropinosomes. This response occurs selectively in PI3K-aberrant cancer cells that maintain macropinocytic uptake despite PI3K inhibition. Methuosis-associated vacuoles originate from macropinosomes that retain endosomal markers but fail to undergo lysosomal fusion. Active macropinocytic uptake is essential for methuosis, as demonstrated by suppression with EIPA and Bafilomycin A1, whereas the AKT inhibitor MK2206 has no effect, establishing that direct PI3K inhibition, rather than AKT signaling, is required. Mechanistically, PI3K blockade prevents conversion of phosphatidylinositol (4,5)-bisphosphate (PI(4,5)P2) to phosphatidylinositol (3,4,5)-trisphosphate (PI(3,4,5)P3) causing PI(4,5)P2 to accumulate on internalizing macropinosomal membranes. This aberrant PI(4,5)P2 enrichment impairs ion channel function across multiple channel families, disrupting intracellular osmotic balance. Ion dysregulation triggers aquaporin-1-mediated water influx, driving catastrophic vacuolar expansion and cell death. Although Pictilisib activates pro-survival autophagy, this fails to prevent methuosis-mediated cytotoxicity. In xenograft models, dietary restriction synergizes with Pictilisib to suppress tumor growth, correlating with pronounced intratumoral vacuolization. These findings reveal that combining PI3K inhibition with nutrient restriction converts cytostatic responses into methuosis-driven cytotoxicity via PI(4,5)P2-dependent macropinocytic dysregulation, providing a rational pharmacologic-dietary strategy to enhance PI3K-targeted cancer efficacy.
The simulation of magnetic properties in strongly correlated systems remains a central challenge in electronic structure theory. The Difference-Dedicated Configuration Interaction (DDCI) method is widely regarded as a gold standard for computing magnetic exchange couplings, but its applicability is limited to small magnetic systems due to the steep growth of the configuration-interaction space with the number of correlated electrons and orbitals. Here, we introduce a stochastic formulation of DDCI based on Full Configuration Interaction Quantum Monte Carlo (FCIQMC) and the Generalized Active Space framework, which largely alleviates the computational bottleneck of conventional DDCI. The implementation is validated by comparison with conventional DDCI for the spin ladder of a trinuclear [Mn(IV)3O4]3+ cluster (Slocal = 3/2). Using a small CAS(9,9) reference, DDCI fails to reproduce the spin-state energy differences defined by a two-parameter (J = -76, J' = -11 cm-1) Heisenberg-Dirac-van Vleck Hamiltonian extracted from experimental measurements. In contrast, Stochastic-DDCI enables calculations with a much larger CAS(33,21) reference and reproduces the experimental spin ladder with remarkable accuracy, yielding deviations smaller than 33 cm-1 with respect to the spin ladder extracted from the experimental measurements. This development extends DDCI methodologies to substantially larger active spaces and opens the door to the study of more complex magnetic systems.
This work introduces reverse EXAFS analysis (REA), a novel, ab initio framework that transforms extended X-ray absorption fine structure (EXAFS) spectroscopy from a complementary local probe into a primary tool for de novo crystal structure determination. By integrating iterative FEFF simulations with a reverse-fitting algorithm, REA directly extracts full crystallographic parameters, lattice constants, space group and atomic positions, from EXAFS oscillations, without requiring the user to supply an initial structural model from X-ray diffraction; instead, candidate models are retrieved from crystallographic databases and evaluated against EXAFS data. Validated on LiCrO2 and CuFeO2, REA uncovered unexpected phase complexities in CuFeO2, identifying secondary CuFe2O4 and CuFe5O8 phases undetected by conventional methods. This paradigm shift enables accurate structure solving in disordered, nanostructured and novel materials where diffraction fails, establishing EXAFS as a stand-alone crystallographic technique.
Nitrate reductase (NR) is a key enzyme in nitrate assimilation, yet its function within nodules remains poorly understood. In Medicago truncatula, three NR genes, MtNR1, MtNR2, and MtNR3, exhibit distinct evolutionary origins and regulatory features. Phylogenetic analyses indicate that NR3-type genes, originated from a duplication of NR1 within Inverted Repeat-Lacking Clade (IRLC) legumes, have lost the conserved phosphorylation sites critical for post-translational regulation. To assess the functional significance of these isoforms, we characterized single and double nr mutants obtained through Tnt1 transposon insertion under nitrate nutrition and during symbiosis. MtNR1 is the primary contributor to total NR activity: with nr1 and nr2 mutants retaining around 10% and 30% of wild-type levels, respectively. The nr1/nr2 double mutant shows an almost complete loss of NR activity and fails to survive under nitrate supply, demonstrating the essential and non-redundant roles of both isoforms. Under symbiotic conditions, single mutants displayed normal nodulation, whereas nodule development was nearly abolished in the double mutant despite continued MtNR3 expression. In addition to its role in nitrogen assimilation, single nr mutants showed increased sensitivity to hypoxic stress and impaired recovery of nitrogen fixation, revealing a role for NR in nodule energy metabolism through the phytoglobin-NO respiration pathway. We propose that the combined loss of NR1 and NR2 disrupts NO cycling linked to mitochondrial electron transport, thereby compromising the energy balance required for symbiosis under microoxic conditions. This work provides a framework to investigate NR diversification in legumes and opens perspectives for improving nitrogen fixation under environmental constraints.
Patellar clunk syndrome is a complication of total knee arthroplasty. Surgical treatment with arthroscopic irrigation and debridement and lysis of adhesions is often required when conservative treatment fails. This study examines patient improvement following arthroscopic treatment of patellar clunk. This single-surgeon case series uses a posterior-stabilized implant design. We performed a retrospective review of all patients from September 2013 to November 2020 treated for patellar clunk syndrome with arthroscopic debridement. Patient variables analyzed included knee flexion/extension angle and symptoms, including pain and mechanical symptoms. Analysis used paired t-tests with an alpha level of 0.05. Fifty procedures were examined. Mean patient age was 61.4 years (standard deviation [SD] = 8.57 years), and 64% were female. Before arthroscopy, the mean maximum knee extension (KE) of the affected side was 0.85° (SD = 3°), and the mean maximum knee flexion (KF) was 120.5° (SD = 9.4°). At the last follow-up, the mean maximum KE was 0.36° (SD = 1.3°), and the mean maximum KF was 123.1° (SD = 9.4°). Paired t-tests comparing preoperative and postoperative KF and KE were P = .138 and P = .487, respectively. All patients reported less pain, and 90% (45/50) reported mechanical symptom improvement. Arthroscopic treatment of symptomatic patellar clunk syndrome is safe and effective: almost all included patients experienced symptom relief, with a slight improvement in KF. This was a retrospective cohort study with a level of evidence of III.
A persistent sciatic artery is a rare congenital vascular anomaly resulting from the failed regression of the sciatic artery during fetal development. It is associated with complications such as thrombosis, aneurysm formation, and acute limb ischemia. A 49-year-old female presented with acute limb ischemia of the left lower limb. Computed tomography angiography confirmed bilateral persistent sciatic arteries with thrombosis affecting only the left limb. She underwent successful endovascular balloon angioplasty and percutaneous thrombectomy, resulting in symptom resolution. Acute limb ischemia is the second most common presentation of persistent sciatic artery, occurring in 33.3% of cases. While computed tomography angiography is the gold standard for diagnosis, magnetic resonance angiography has been used in select cases. Management includes conservative treatment, endovascular intervention, or surgical repair. A bilateral persistent sciatic artery with unilateral thrombosis is rare. Early diagnosis and appropriate intervention, such as endovascular therapy, are essential to prevent complications. Long-term vascular surveillance is crucial for optimal patient outcomes.
There remains controversy regarding the risk factors for failed hydrostatic enema reduction; therefore, we aimed to identify additional factors associated with unsuccessful hydrostatic enema reduction in children with ileocolic intussusception. This study was conducted retrospectively in two tertiary centers. Data were collected from patient charts or electronic medical records and consisted of pediatric intussusception cases treated with hydrostatic reduction during January 2021 and January 2025. Univariate and multivariate analyses, incorporating stepwise logistic regression, were conducted. Two hundred thirty-one patients with ileocolic-type intussusception were included and treated by ultrasound-guided hydrostatic reduction at two different institutions. Hydrostatic reduction was successful in 199 patients (86.2%), failed in 32 (13.8%). All patients were successfully discharged with uneventful recoveries. On multivariate analysis, under 12-month-old(OR = 58.106,P < 0.001 95%CI,14.166-238.338),an Onset of symptoms>48 h (OR = 7.070,P = 0.014 95%CI,1.491-33.517), previous history of intussusception (OR = 42.721, P < 0.001 95%CI,5.729-318.572), constipation (OR = 31.488, P < 0.001 95%CI,5.597-177.137), and bowel Wall Thickening on US(OR = 8.177, P = 0.015 95%CI,1.513-43.553) were significantly associated with failed hydrostatic enema reduction. An age of under 1 year, previous history of intussusception, onset of symptoms, constipation, and bowel wall thickening on US were risk factors for failed hydrostatic reduction of ileocolic intussusception. Older children with long-term recurrent intussusception are at high risk of pathological leading points(PLPs) and hydrostatic reduction failure, requiring close pediatric surgical attention. Patients with these findings warrant early surgical consultation or transfer to a facility with pediatric surgical capabilities.
Oliver-McFarlane syndrome (OMCS) is an extremely rare autosomal recessive disorder caused by biallelic mutations in the PNPLA6 gene, characterized by retinal dystrophy, trichomegaly, neurodevelopmental impairment, and combined pituitary hormone deficiencies. Hypogonadotropic hypogonadism (HH) is a frequent endocrine manifestation; however, the long-term reproductive consequences and fertility potential in affected males have not been previously described. We report the case of a 33-year-old man with genetically confirmed OMCS who presented with primary infertility and non-obstructive azoospermia following prolonged testosterone replacement therapy initiated in childhood for pubertal induction. The patient exhibited congenital HH, evidenced by micropenis in infancy, absent spontaneous puberty, persistently low gonadotropins, and severely reduced testicular volume. After discontinuation of exogenous testosterone, prolonged combined gonadotropin therapy with human chorionic gonadotropin and recombinant follicle-stimulating hormone resulted in partial testicular growth and biochemical response but failed to induce sperm in the ejaculate. Following nearly two years of optimized hormonal stimulation, microdissection testicular sperm extraction (micro-TESE) was performed, revealing focal spermatogenesis with successful retrieval and cryopreservation of motile spermatozoa for intracytoplasmic sperm injection. This case represents, to our knowledge, the first report of fertility management and successful surgical sperm retrieval in a male patient with OMCS. It highlights the potential reversibility of infertility in syndromic congenital HH and underscores the critical impact of pubertal management strategies on long-term reproductive outcomes. Early consideration of gonadotropin-based therapy, multidisciplinary follow-up, and fertility-preserving approaches may be essential to optimize future reproductive potential in patients with OMCS and related disorders.
Benzodiazepines are widely used for sedation and anxiolysis but may also exert unrecognized beneficial effects on airway smooth muscle (ASM) tone in clinical settings where they are routinely administered. While their primary mechanism involves GABAA receptor (GABAAR) modulation in the central nervous system, their direct effects on peripheral airways remain poorly understood. Using mouse precision-cut lung slices (PCLS) and video phase-contrast microscopy, we show that diazepam, lorazepam, and midazolam induce robust, reversible, and dose-dependent relaxation of methacholine (MCh)-constricted peripheral airways with IC50 of 12, 22, and 23 µM, respectively. We selected diazepam to further investigate the cellular and molecular mechanisms underlying airway relaxation. GABAAR antagonists picrotoxin and flumazenil failed to block relaxation, and diazepam inhibited MCh-induced airway constriction even in the absence of extracellular Ca2+, consistent with a GABAAR-independent mechanism. Diazepam-induced relaxation correlated with strong inhibition of concurrent intracellular Ca2+ oscillations in ASM cells. Diazepam inhibited airway constriction and Ca2+ transients elicited by intracellular IP3 uncaging but not by caffeine, indicating specific modulation of IP3-receptor mediated Ca2+ signaling. Furthermore, low concentrations of diazepam (1 µM) significantly prolonged terbutaline-induced airway relaxation, mirroring the effects of selective phosphodiesterase 4 (PDE4) inhibitor rolipram. Diazepam inhibited purified PDE4D2 activity and potentiated forskolin-induced cAMP accumulation in human ASM cells. These findings indicate that diazepam produces bronchodilation at least in part through direct PDE4 inhibition and modulation of IP3 receptor-mediated Ca2+ oscillations in ASM. The synergistic interaction between benzodiazepines and β2-adrenoreceptor agonists at therapeutic concentrations has important clinical implications for bronchodilation in high-risk patients.
Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope. ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6 mg/kg) with remifentanil (4 μg/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120 s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80% and 99%, respectively, using a two-sided α of 0.025. Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice. As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027. ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.
Melatonin is a pineal hormone that regulates circadian rhythms primarily through melatonin receptors. We recently demonstrated that melatonin inhibits the voltage-gated potassium KV4.2 channel (IC50 = 479 μM) through a melatonin receptor-independent mechanism. However, it remains unclear whether this inhibitory effect is specific to melatonin or shared by structurally related compounds. In the present study, we examined the effects of melatonin-related compounds on KV4.2 channels using human embryonic kidney 293 cells stably expressing KV4.2 channels. Whole-cell patch-clamp recordings showed that luzindole, a melatonin receptor antagonist, inhibited KV4.2 currents (IC50 = 33 μM). Notably, ramelteon, a melatonin receptor agonist, also inhibited KV4.2 currents (IC50 = 177 μM). These results indicate that the inhibitory effects of luzindole and ramelteon are mediated by direct interactions with KV4.2 channels rather than through melatonin receptors. In addition, luzindole inhibited KV1.5 channels. In contrast, melatonin biosynthetic precursors failed to inhibit KV4.2 currents, suggesting that the indole or indole-like structural motif alone is insufficient for KV4.2 channel inhibition. Instead, specific structural features, including the methoxy group in melatonin and the furan ring in ramelteon, together with increased hydrophobicity, may be critical determinants of KV4.2 channel blockade. Collectively, these findings reveal previously unrecognized pharmacological properties of melatonin-related compounds.
Active screening for TB may help address the global TB burden, but the optimal screening strategies are not defined. We have reviewed the effectiveness of community-wide active screening programmes to assess the characteristics associated with a reduction in TB. We performed a scoping review of community-wide screening studies since 1945 and summarised those that either provided TB prevalence data at the start and end of screening or compared the screening programme to a control community where screening was not performed. Eight studies were identified in China, Czechoslovakia, Kenya, Malawi, South Africa, Uganda, Vietnam, Zambia, and Zimbabwe. Initial TB prevalence ranged from 84/100,000 to 1,014/100,000. Five studies demonstrated TB prevalence reductions from 44% to >80%, one showed evidence both for and against reduction, and two failed to demonstrate reduction. The successful studies were those that found, over the duration of the multi-year intervention, between 124% and 252% of the number of people with TB estimated to have been in the population at the beginning of the intervention, while unsuccessful studies found only 69%-83%. Reducing the force of infection can be accomplished by performing multiple cycles of community-wide screening to reach substantial numbers of community members with TB.
This study systematically reviewed randomized controlled trials (RCTs) of acupuncture for chronic atrophic gastritis (CAG) published over the past 25 years, aiming to analyze the current status of clinical research, with a focus on evaluating heterogeneity in outcome measures and methodological quality. A comprehensive search of major Chinese and English databases identified 55 RCTs involving 5,311 patients. Methodological quality was assessed using the Cochrane risk of bias tool. Outcome measures were categorized and analyzed by frequency. The results revealed notable methodological limitations in the current literature. Only 83.6% of the studies employed low-risk randomization methods, while very few implemented allocation concealment (3.6%) or blinding (1.8%). Furthermore, no study reported prospective registration, and 34.5% did not mention ethical approval. Regarding outcome measures, 57 different indicators were reported, with laboratory and imaging examinations accounting for the majority (55.4%). Notably, there was a severe lack of focus on patient-reported quality of life, health economic evaluation, and long-term disease prognosis. Considerable heterogeneity was observed in the naming, definition, and timing of outcome measurements, and most studies failed to clearly distinguish between primary and secondary outcomes. In conclusion, the absence of clear criteria hinders clinical translation and results in fragmented data in existing clinical studies on acupuncture treatment for CAG. Standardized clinical trial protocols and a core outcome set (COS) for this discipline are urgently needed. Building on this foundation, future research should conduct multicenter, large-sample, methodologically robust RCTs with long-term follow-up. Such efforts will scientifically advance the standardized development of acupuncture clinical practice and produce high-quality, generalizable, evidence-based conclusions.