Social vulnerability (SV) influences rehabilitation and postoperative care for patients with hip fracture. However, most previous work relies on area-level measures that overlook interindividual variation. The recent adoption of ICD-10 Z-codes allows clinical identification of patient-level SV and may offer a better understanding of its impact. This study aimed to evaluate healthcare utilization, including readmissions, discharge disposition, and length of stay (LOS) in surgically treated hip fracture patients with and without clinically acknowledged SV. Adults surgically treated for hip fracture between 2016 and 2020 were included from the Nationwide Readmissions Database. SV was defined as having at least one documented relevant ICD-10 Z-code. Primary outcome measures included complications, LOS, discharge disposition, and 30- and 90-day readmissions, stratified by SV and evaluated using chi-square analyses. Multivariable logistic regression assessed long LOS (≥ 5 days) and discharge to home, adjusting for age, insurance/income status, and substance use. Patients with SV were younger (35.6% with SV vs. 50.1% without SV were 81+), had a lower median household income (38.8% with SV vs. 25.7% without SV were in the lowest quartile), and were more often insured by Medicaid (19.3% vs. 3.8%). Alcohol/drug use disorders were significantly more prevalent in patients with SV (18.5% vs. 4.5%). SV was associated with 47% higher odds for long LOS (1.47, 1.41-1.54) and 23% higher odds for discharge to home (1.23, 1.16-1.30) but comparable 90-day readmissions (21.2% vs. 19.8%). Among surgically treated hip fracture patients, SV was associated with higher odds of long LOS and discharge to home but no meaningful difference in readmissions. The small number of patients with clinically documented SV highlights the limited reporting by healthcare workers. This analysis of a nationwide all-payer database highlights the need to identify these higher risk patients and implement appropriate care pathways to reduce healthcare utilization.
Periodontitis, a chronic inflammatory disease, is increasingly prevalent among young people and impairs their quality of life. Adverse childhood experiences (ACE), depressive symptoms, and suboptimal health status (SHS) are linked to health risks and chronic diseases, but their interrelationships with periodontitis in Chinese young adults remain unclear. This study aimed to explore associations among these factors. From December 2024 to May 2025, 2,888 participants (aged 18-35) from Tongji Hospital completed surveys on demographics, ACE, depressive symptoms, and SHS. Periodontitis was diagnosed according to the 2018 criteria. Simple, parallel, and chain mediation models were used, controlling for age, sex, marital status, and smoking. Periodontitis prevalence was 25.00% and higher in married individuals (P < 0.001) and smokers (P = 0.004). ACE correlated positively with depressive symptoms (r = 0.28, P < 0.001), SHS (r = 0.19, P < 0.001), and periodontitis (r = 0.16, P < 0.001). Mediation analyses showed: Simple model: Depressive symptoms and SHS partially mediated the effect of ACE on periodontitis (indirect effect = 0.011 for both). Parallel model: Only SHS significantly mediated the effect (indirect effect = 0.011). Chain model: ACE was related to periodontitis via "depressive symptoms → SHS" (indirect effect = 0.010), with significant direct and indirect effects. ACE associated with higher periodontitis risk in young people. This association included both a direct link between ACE and periodontitis, and an indirect link through the chain pathway of "depressive symptoms → SHS"; among these pathways, SHS was a key mediator. The study was registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2500103464. Childhood trauma can exert long‐term impacts on health, including oral health. This study involving 2,888 Chinese young adults aged 18‐35 found that 25% of the participants had periodontitis. Those who experienced childhood abuse, neglect, or family issues showed a higher association with the disease. The research revealed two pathways linking early trauma to periodontitis: a direct association and an indirect chain of “depressive symptoms → suboptimal health status (e.g., persistent fatigue).” While depressive symptoms played a role, suboptimal health status was the critical mediator. Higher periodontitis rates in married individuals and smokers may relate to stress or lifestyle factors. The findings suggested that early identification of childhood trauma, combined with interventions targeting mental health or overall well‐being (e.g., counseling, health management), could be more effective than oral care alone in prevention. This underscored the association between early‐life experiences and long‐term health and the need for integrated interventions.
To compare the elastosonographic changes of the tibial nerve (TN) and Achilles tendon (AT) in patients with type 2 diabetes mellitus (T2DM) and explore their relationship and respective relevant factors. This case-control study enrolled 165 subjects, comprising 126 patients with T2DM and 39 healthy controls matched for age and gender. The patients were further divided into those with and without diabetic peripheral neuropathy (PN-DM and NPN-DM groups). Clinical and laboratory data were collected. Conventional ultrasound and elastography were performed to assess the changes in the morphology and elasticity of the bilateral TN and AT. Sonographic features were compared across the three groups, relevant factors affecting the stiffness of TN and AT were analyzed, respectively. Diabetic patients exhibited significantly higher levels of HbA1C and a higher rate of smoking than healthy controls (P < 0.01 and P = 0.02, respectively). Their levels of body mass index (BMI) and total cholesterol have a significant difference between the NPN-DM group and healthy controls (both P = 0.02). The incidence of other microvascular complications in the NPN-DM group was significantly lower among diabetic patients (P = 0.04). Compared with healthy controls, the cross-sectional area (CSA) and transverse diameter of TN in diabetic patients were significantly larger (both P < 0.01), and CSA and anteroposterior diameter of AT were notably greater (P = 0.02 and P < 0.01). Besides, the stiffness of TN in the longitudinal section was significantly higher (P < 0.01), and the stiffness of AT in the cross-section was remarkably lower (P < 0.01). There was no significant difference in the morphology or elastography of TN or AT between NPN-DM and PN-DM groups. Furthermore, the stiffness of TN was not linearly related to that of AT, but independently correlated with age, HbA1C, and other microvascular complications (P < 0.05). The stiffness of AT was only independent of age (P < 0.01). The size of both TN and AT in diabetic patients was significantly larger. The stiffness of TN increased, and that of AT decreased; however, these changes were independent of each other. Not applicable.
Interleukin-33 (IL-33), an alarmin predominantly released by keratinocytes and endothelial cells, plays a pivotal role in type 2 immune responses and has been linked to the pathogenesis of autoimmune diseases, including systemic lupus erythematosus (SLE). This study aimed to explore the relationship between plasma IL-33 levels and clinical features in SLE patients. A cross-sectional study was conducted involving 133 SLE patients and 81 normal controls. Plasma IL-33 levels were measured via enzyme-linked immunosorbent assay. Clinical parameters, such as SLEDAI-2K scores, photosensitivity, skin lesion distribution, laboratory indices, immunofluorescence and immunohistochemistry results were collected. SLE patients demonstrated significantly higher circulating IL-33 levels compared to healthy controls (median 342.60 pg/ml vs. 56.77 pg/ml, p < 0.0001). IL-33 levels were positively associated with SLEDAI-2K scores (r = 0.279, p = 0.001), photosensitivity (p = 0.02), and facial skin lesions (p = 0.001). The expression levels of the IL-33 receptor (ST2) in head and face cutaneous tissues were markedly higher than those in other anatomical regions and in normal control subjects (p < 0.001). Multivariate analysis revealed negative correlations with complement C3 (β = - 0.303, p < 0.001) and positive correlations with IgA (β = 0.473, p < 0.001) and hs-CRP (β = 0.310, p < 0.001). Notably, IL-33 levels were higher in male patients (p = 0.002) and treatment-naïve patients (p = 0.03). Our data associate circulating IL-33 with SLE activity, photosensitivity, and specific serological markers. For the association between IL-33 and cutaneous photosensitivity, this study provides further histological evidence. This finding provides a novel perspective on the mechanism of photosensitivity in SLE, demonstrating the potential of IL-33 as a biomarker for patient stratification management.
The role of diet in multiple sclerosis (MS) development is still a matter of debate and its impact on MS course is not well understood. We tried to investigate the possible role of adolescent diet in late-onset multiple sclerosis (LOMS) odds. LOMS patients were obtained from the National MS Registry of Iran. Controls were sex and age matched with no history of neurological disorders. We assessed dietary factors using a questionnaire based on multinational studies. Food consumption levels were classified into low, medium, and high for each item. Logistic regression models were used to evaluate diet's impact on LOMS odds. We included 83 LOMS cases and 207 matched healthy controls. The mean age for LOMS patients was 61.14, compared to 61.51 years for controls. The results showed that higher consumption of dairy as in the third tertile associated with 79% decline in LOMS odds (AOR: 0.21; 95%CI: 0.09-0.47). Higher seafood consumption, in the third tertile was associated with a decrease in the odds of LOMS (AOR: 0.32; 95%CI: 0.14-0.72). Furthermore, increased nut consumption, in the third tertile (AOR: 0.37; 95%CI: 0.18-0.77), decreased the odds of LOMS. Additionally, higher consumption of fruits (AOR: 0.22; 95%CI: 0.07-0.63) and vegetables (AOR: 0.26; 95%CI: 0.12-0.55) was linked to a reduced odds of LOMS. This research highlights the advantageous impact of dairy products, seafood, nuts, fruits, and vegetables in lowering the LOMS odds. Hence, advocating for nutrition role in development of LOMS could represent a preventive measure for people susceptible to MS.
A history of prior cardiac surgery (PCS) determines treatment decision and long-term outcomes in patients requiring aortic valve replacement. This study examined patient profiles, treatment-decisions and long-term outcomes of patients under 75 years with PCS undergoing transcatheter and surgical aortic valve implantation/replacement (TAVI, SAVR) in the Netherlands. Data from 1,284 patients (ages 50-75 years) with PCS undergoing TAVI or SAVR between 2015 and 2020 were analyzed using data from the Netherlands Heart Registration. Logistic and cox regression identified determinants of treatment selection and long-term mortality. Determinants were considered impactful if they had an odds ratio (OR) or hazard ratio (HR) of ≥ 1.5 or ≤ 0.7 and a prevalence of ≥ 5%. Of 1,284 patients, 690 underwent TAVI (54%) and 594 SAVR (46%). Prior index surgery most frequently involved coronary artery bypass grafting (CABG) (57% in the TAVI group vs 40% in the SAVR group; p < 0.001) and previous aortic valve surgery (25% vs 51%; p < 0.001). TAVI patients were significantly older (median 71 vs. 67 years, p < 0.001) and had a higher EuroSCORE II (median 5.7 vs. 4.4, p = 0.003) than SAVR patients. SAVR was the preferred strategy for intermediate-risk patients (62%), while TAVI was favored in high- and prohibitive-risk patients (62% and 94%, respectively). In descending order of odds ratio, the strongest independent determinants of TAVI selection were left ventricular ejection fraction ≤ 30% ((OR: 4.8; 95% CI: 2.6-8.8), poor mobility ((OR: 3.4; 95% CI: 1.6-7.0) and obesity/cachexia (OR 2.7; 95% CI: 1.6-4.4); the key determinants of SAVR selection were pure native aortic regurgitation (OR: 0.1; 95% CI: 0.1-0.3) and failing surgical bioprosthesis (OR: 0.7; 95% CI: 0.5-1.0. Thirty-day, 1- and 5 year survival after TAVI and SAVR was 97% and 96%, 83% and 91%, and 56% and 83%, respectively (p-value < 0.001). Left ventricular ejection fraction ≤ 30% and chronic lung disease were important mortality determinants for both procedures, with higher odds ratios for mortality in SAVR as compared to in TAVI patients. In the Netherlands, TAVI and SAVR rates were comparable among patients < 75 years with PCS. Higher-risk patients were directed toward TAVI except for those presenting with pure native aortic regurgitation and bioprosthesis failure who mainly received SAVR. Severe left ventricular dysfunction and chronic lung disease were key mortality predictors for both procedures.
This study examined the prevalence of post-traumatic stress disorder (PTSD) diagnoses among pregnant women who delivered in hospitals in the United States between 2016 and 2020, and explored associations with adverse pregnancy outcomes, hospital length of stay, and hospital costs. This cross-sectional study utilised survey-weighted data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to estimate sample characteristics and prevalence trends. Logistic regression models were used to analyse associations between PTSD and adverse pregnancy outcomes. Length of hospital stay and hospital costs were examined using negative binomial and generalised linear models with log link and gamma distribution, respectively. PTSD prevalence increased from 236.3 to 545.8 per 100,000 delivery hospitalisations between 2016 and 2020 (p < 0.001; average annual percentage change [AAPC] 23.0%). PTSD was associated with a higher prevalence of comorbidity, increased odds of preterm delivery (adjusted odds ratio [aOR] 1.13; 95% CI 1.08-1.18), and increased odds of fetal growth restriction (aOR 1.09; 95% CI 1.01-1.17, p = 0.03). Longer hospital stays and higher costs were also observed among women with PTSD. These findings highlight a rising prevalence of PTSD among pregnant women who delivered in hospitals in the United States over the study period. PTSD was associated with higher prevalence of comorbidity, and increased length of stay and hospital cost. Further research is warranted to investigate the reasons behind the trend, and to clarify the temporal relationship between prenatal PTSD and adverse pregnancy outcomes.
Complications after pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) are associated with delays or omission of adjuvant chemotherapy (AC). Similar data for patients who undergo distal pancreatectomy (DP) are lacking. A retrospective cohort study was conducted using the SEER-Medicare database to identify patients who underwent upfront DP for PDAC (2010-2019). Multilevel logistic regression and Cox proportional hazards models were used to evaluate the association of postoperative complications with AC omission and delay as well as survival endpoints based on receipt of AC. Of 1029 patients identified, 613 (59.6 %) received AC. Patients with complications had lower rates of AC (50.0 % vs 61.1 %; p = 0.013) and multi-agent AC (25.0 % vs 28.2 %; p = 0.039) and higher rates of delays in AC (42.9 % vs 21.4 %; p < 0.001) than those without complications. In multivariable analysis, complications were associated with a lower rate of AC (hazard ratio [HR], 0.67; 95 % confidence interval [CI], 0.54-0.84; p < 0.001) and a higher rate of delayed AC (odds ratio [OR], 3.36; 95 % CI 1.92-5.91; p < 0.001). For survival, receipt of AC overall (HR, 0.56; 95 % CI 0.47-0.67; p < 0.001), even when delayed (HR, 0.72; 95 % CI 0.57-0.90; p = 0.005), was associated with better overall survival (OS) than no AC. However, delayed AC was associated with worse OS than timely AC (HR, 1.27; 95 % CI 1.01-1.62; p = 0.04). Patients who experienced a postoperative complication after DP for left-side PDAC had lower rates of AC overall and higher rates of delayed AC, both associated with worse OS.
The production of monoclonal antibodies (mAbs) in Chinese hamster ovary (CHO) cells is often affected by position-effect variegation and the gradual loss of transgene expression over time. Hence, we have designed a dual-promoter IgG expression vector and compared versions that either contained or lacked a CHO-derived matrix-attachment region (MAR). Stable CHO-S pools, cultured in serum-free conditions, revealed that the MAR-containing construct produced higher and more consistent antibody levels across ten passages, as confirmed by Western blot and Protein A Octet analysis. Product-quality analysis by size-exclusion chromatography and reducing SDS-PAGE confirmed formation of properly assembled, mainly monomeric antibodies in both cases. Quantitative PCR indicated greater transgene copy numbers in MAR pools (+ 48% for the light chain and + 71% for the heavy chain), and RT-qPCR showed roughly fourfold higher transcript levels for both chains relative to controls. Bioinformatic analysis revealed several SATB1 binding motifs within the MAR sequence, and ChIP-qPCR demonstrated SATB1 association with the MAR-linked transgene locus. Overall, the data suggested that a CHO-native MAR could enhance transgene dosage and transcriptional activity, while preserving product integrity, possibly through SATB1-mediated chromatin organization. Ongoing work includes chromatin-mark profiling and process-level productivity measurements to better define the impact of MAR-based vector design on biomanufacturing performance.
Portal hypertension (PH) is one of the major complications of liver cirrhosis, traditionally assessed using invasive methods such as the hepatic venous pressure gradient (HVPG). Soluble endoglin (sENG), a marker of endothelial dysfunction and fibrosis, has been proposed as a non-invasive biomarker of various liver diseases. This study aimed to evaluate serum sENG concentrations in cirrhotic patients with PH and investigate its relationship with PH severity, alcohol consumption, and smoking. Serum concentrations of sENG were measured in clinically well-examined patients with liver cirrhosis (n = 60, age range 24-82 years) with PH classified as mild, moderate, or severe according to the HVPG values measured invasively using the classical wedge technique. sENG concentrations were also compared to healthy controls (n = 54). Liver enzyme activities, alcohol consumption history, and smoking habits were also recorded to assess their association with sENG. sENG concentrations were significantly higher in patients with PH compared to healthy controls (6.31; 5.14-7.30 vs. 3.70; 3.24-4.20 ng/mL, p < 0.001) but did not correlate with the severity of HVPG-diagnosed portal hypertension. A moderately significant correlation was observed between sENG concentrations and GGT activities (p < 0.001). Alcohol consumption, but not smoking, was associated with higher serum sENG concentrations (p < 0.01). Based on our results, sENG appears to be a non-invasive marker of endothelial dysfunction/fibrosis in cirrhotic patients with PH, particularly in alcohol-related liver disease. Although it does not reflect PH severity and thus cannot be used as a diagnostic tool, it has the potential for early disease detection and risk prediction as a screening component in non-invasive approaches in clinical hepatology.
In the context of the aging of the global population, the prevalence of knee joint disorders continues to rise. Concurrently, the integration of robotic systems and intelligent implants represents an inevitable trend in orthopedic surgery. A comprehensive evaluation of the safety and effectiveness of robot-assisted total knee arthroplasty (RA-TKA) is therefore urgently needed to inform clinical decision-making. To explore the advantages of 9 RA-TKAs across 8 outcomes. A systematic literature search was conducted in the PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, Wanfang, and VIP databases from inception to December 1, 2025. The risk of bias and methodological quality were assessed via Review Manager (version 5.4). Network meta-analysis was performed via RStudio (version 4.4.1). A total of 36 studies involving 2841 patients were included. In direct comparisons, conventional TKA (C-TKA) yielded shorter operative times than MAKO, HURWA, SkyWalker, ROSA, and Brainlab Knee did. CORI also had a shorter operative time than Brainlab Knee did. Compared with the C-TKA, MAKO, HURWA, SkyWalker and TiRobot groups, the ROSA group presented higher KSS-knee scores. In addition, C-TKA, HURWA, and CORI presented higher KSS-knee scores than did SkyWalker. For the KSS-function scores, the C-TKA and ROSA scores were higher than the HURWA score. C-TKA demonstrated a greater postoperative ROM than HURWA did. For HKA angle deviation, C-TKA resulted in greater deviation than MAKO, HURWA, SkyWalker, TiRobot, and EPMEDBOT did. In the comprehensive best probability ranking, C-TKA (93%) ranked highest in terms of operative time. SkyWalker (87%) ranked highest in terms of blood loss. SkyWalker (91%) ranked highest in terms of the KSS-knee scores. HURWA (87%) ranked highest in terms of the KSS function scores. MAKO (85%) ranked highest for HSS. The YUANHUA (76%) ranked highest for the WOMAC. The CORI (69%) ranked highest for ROM. SkyWalker (87%) ranked highest for HKA angle deviation. Overall, RA-TKA demonstrated superior safety and effectiveness compared with C-TKA, with different robotic systems exhibiting distinct advantages across outcome measures. Nevertheless, C-TKA retains a significant advantage in reducing the operative time, highlighting an important area for further optimization of robotic-assisted TKA.
The aim of this study was to examine triceps surae neuromechanical function during cycling at a range of exercise intensities in endurance populations with different loading regimes, and to quantify differences in morphological properties. Kinematic and neuromuscular data were collected from 29 participants (10 cyclists, nine triathletes, and 10 controls) during cycling at four intensities (150, 200, 250, 300 W). Resting muscle and tendon morphology was assessed with ultrasound. During cycling, there were no differences between groups, despite triathletes possessing thicker Achilles' tendons. At higher intensities, ankle dorsiflexion increased (p < 0.001), leading to higher gastrocnemius medialis muscle-tendon unit range (p < 0.001), but no change in fascicle range or shortening velocity (p ≥ 0.919). Therefore, although there is evidence of some stretch-shortening cycle-like mechanism in the triceps surae during cycling, this does not happen at the muscle level, suggesting that energy storage and return could occur predominantly in the non-contractile series-elastic elements. Despite this, there were no differences detected between trained and untrained individuals in gastrocnemius medialis neuromechanical behavior at the exercise intensities tested, even though triathletes possessed a higher Achilles' tendon thickness.
Cold preservation is a critical logistical step in liver transplantation but induces ischemia-reperfusion injury (IRI), a key driver of early graft dysfunction. While bulk tissue assays capture global damage, they obscure the cell-type-specific transcriptional programs engaged during hypothermic storage. We utilized a multicellular human liver-on-chip model comprising Patient-Derived Organoids (PDOs), hepatic stellate cells (HSCs), liver sinusoidal endothelial cells (LSECs), and macrophages. Chips were exposed to 24-h static cold storage using either the clinical standard University of Wisconsin (UW) solution or a hyperbranched polyglycerol (HPG)-based formulation, followed by normothermic reperfusion. Single-cell RNA sequencing (scRNA-seq) was performed to map transcriptional trajectories across the preservation-reperfusion axis. We identified candidate solution-dependent transcriptional differences across cell types. PDOs from UW-preserved chips showed comparatively higher mean expression of inflammatory and oxidative stress-associated transcripts (IFI27, SAA1, HMOX1) and mitochondrially-encoded genes (MT-ND5) relative to HPG-preserved samples, which retained comparatively higher expression of homeostatic epithelial markers (EPCAM, KRT18). HSCs and LSECs in the UW group showed comparatively elevated expression of fibrosis-associated (COL1A1, TAGLN) and endothelial adhesion (ICAM1) transcripts. Ligand-receptor interaction modelling identified candidate inflammatory communication axes, including chemokine signaling interactions (CXCL1, CCL20) between macrophages and epithelial compartments, with higher predicted activity under UW preservation. This study provides an exploratory, high-resolution map of cell-type-specific transcriptional patterns associated with hypothermic preservation in a liver-on-chip model. Our findings suggest that preservation solution chemistry is associated with distinct transcriptional signatures spanning stress response, mitochondrial, and intercellular signaling pathways. Transcriptional patterns in HPG-preserved cells were consistent with comparatively attenuated injury responses; however, these observations are hypothesis-generating and require independent biological replication and functional validation, including metabolic flux assays and ROS production measurements before conclusions regarding mitochondrial protection or clinical preservation efficacy can be drawn.
BACKGROUND This retrospective study aimed to radiographically compare injectable platelet-rich fibrin (I-PRF)-enriched bone graft matrix (sticky bone) with conventional particulate grafting during lateral sinus lift procedures performed simultaneously with implant placement in patients exhibiting insufficient posterior maxillary residual bone height. MATERIAL AND METHODS Twenty-four systemically healthy, non-smoking patients who underwent lateral sinus lift surgery between January 2014 and June 2023 were included. Patients were retrospectively allocated into groups according to grafting material: conventional particulate bone graft (group 1, n=12) and I-PRF-enriched bone graft matrix (sticky bone) (group 2, n=12). Radiographic bone height measurements were obtained using panoramic radiographs acquired preoperatively, immediately postoperatively, and at 6 months postoperatively. Measurements were conducted using calibrated digital software. Inter- and intragroup comparisons were analyzed via paired and independent samples t-tests, using a statistical significance threshold of P<0.05. RESULTS Immediate postoperative bone gain was significantly higher in group 1 than in group 2 (11.94 mm vs 10.15 mm; P<0.05). However, bone resorption at 6 months was significantly greater in group 1 than in group 2 (2.61 mm vs 1.07 mm; P<0.05). Bone loss percentage also was significantly higher in group 1 than in group 2 (16.50% vs 7.74%; P<0.05), indicating superior bone preservation in group 2. CONCLUSIONS Although conventional grafting resulted in greater initial bone gain, I-PRF-enriched bone graft matrix demonstrated significantly reduced bone resorption at 6 months. Sticky bone may provide a clinical advantage in bone preservation after sinus lift procedures.
This study presents a detailed seismic fragility and collapse performance assessment of geometrically irregular continuous reinforced concrete rigid-frame (CRCR) bridges based on a representative bridge in Iran. A regular configuration was first established as the reference, after which a systematic set of bridge models was generated by varying the span-length ratio, pier-height ratio, and pier skew angle to investigate their individual and combined effects on seismic response. Detailed three-dimensional nonlinear finite element models were developed in OpenSees and analyzed under a comprehensive set of far-field and near-field earthquake ground motions. Seismic fragility curves were constructed based on pier drift demand corresponding to four damage states ranging from minor damage to collapse, defined by the attainment of the complete damage state. The results indicate that geometric irregularities significantly amplify seismic vulnerability, particularly at higher damage states. Across a range of span-length ratios, bridges with pronounced pier-height irregularity exhibit up to 50-60% higher probabilities of exceeding severe damage at the same intensity level compared to the regular configuration, while the median seismic intensity associated with collapse is reduced by approximately 55% in highly irregular cases. Among the investigated parameters, pier-height irregularity was identified as the most influential factor governing fragility and collapse behavior, followed by pier skewness, whereas span-length irregularity showed a comparatively smaller effect. The resulting fragility functions and collapse metrics provide quantitative insight into the seismic performance of CRCR bridges and support fragility-based assessment and performance-based seismic design in earthquake-prone regions.
Breast cancer patients often experience significant psychological distress. This study examined distress trajectories from diagnosis to 6 months post-treatment and explored differences across demographic, medical, and psychosocial subgroups. In this prospective cohort study, 528 patients with breast cancer were recruited between 1 December 2023 and 31 December 2024. Assessments were conducted at baseline (at diagnosis, T0), after the first treatment (T1), mid-treatment (T2), at treatment completion (T3), and at three (T4) and six months (T5) post-treatment. Growth mixture modeling (GMM) was used to identify distinct trajectories of psychological distress. Multinomial logistic regression analysis was performed to examine associations between patient-related factors and trajectory membership. Three psychological distress trajectories were identified: a high-distress remission group (17.05%), a moderate-stable distress group (11.93%), and a low-fluctuating distress group (71.02%). Multivariable analyses showed that higher educational attainment, breast-conserving surgery, early disease stage, partial self-management ability, and strong social support were associated with membership in the moderate-stable or low-fluctuating groups (p < 0.05). Employment, health insurance coverage, avoidant medical coping style, and higher baseline anxiety and depression scores were concurrently associated with membership in the high-distress remission group (p < 0.05). Although psychological distress generally decreased over time, 71.02% of patients followed a low-fluctuating trajectory, 11.93% maintained moderate distress with potential risk of persistence, and 17.05% showed high initial distress that remitted substantially within 6 months. Continuous monitoring and early psychosocial support are recommended, particularly for patients with moderate- or high-risk trajectories.
Healthcare-seeking behavior is a key factor in how well a health system performs and how fair it is. In Saudi Arabia, public healthcare services are free, yet many people still choose private healthcare, especially in cities like Riyadh. It is important to understand why people seek care from private clinics to help shape health policies, distribute resources better, and improve services across the healthcare system. This study aimed to examine the frequency of private healthcare use, defined as the reported usual or concurrent use of private healthcare services, and to identify sociodemographic, behavioral, and health-related factors associated with this choice among adults in Riyadh, Saudi Arabia. A cross-sectional study was carried out in Riyadh from March to July 2023 using a multistage cluster sampling method. We randomly selected 48 government primary healthcare centers and invited adults aged 18 and older who visited these centers to participate. We collected data electronically with a validated questionnaire that covered sociodemographic details, patterns of healthcare use, reasons for choosing private healthcare, behavioral risk factors, and existing health conditions. We used multivariate logistic regression analysis to find independent predictors of private healthcare use, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Of 14,239 participants, 72.4% reported using private healthcare services either as a usual source of care or alongside public services. The multivariable analysis revealed several factors to be positively related to private healthcare utilization. Those who were married were more likely to use private healthcare services (AOR 1.23, 95% CI 1.11-1.36). Those with insurance coverage were threefold higher odds of private healthcare use (AOR 3.51, 95% CI 3.13-3.94). Smokers were more likely to seek private healthcare (AOR 1.60, 95% CI 1.45-1.77) than non-smokers, and those who exercised reported increased utilization (AOR 1.83, 95% CI 1.67-2.00). Obesity was also positively related to private healthcare utilization (AOR 1.38, 95% CI 1.12-1.71), and those with heart disease had substantially higher odds of using private healthcare services (AOR 2.09, 95% CI 1.59-2.76). Private healthcare use in Riyadh is common and associated with insurance coverage, marital status, behavioral factors, and certain chronic conditions. These findings provide descriptive insights into factors related to private healthcare utilization among public PHC attendees in Riyadh, without implying causal effects or policy recommendations beyond the scope of the data.
Peritoneal fibrosis, driven by M2 macrophage polarization, limits the long-term application of peritoneal dialysis (PD). Although ADAM19 is known to mediate fibrosis in other organs, its specific role in PD-associated peritoneal fibrosis remains unclear. PD patients were enrolled in a single center and divided into three groups depending on the PD time. Demographic and clinical data were collected. We detected the expressions of ADAM19, Notch1, Fibrosis-associated protein, chemokines and inflammatory factors in the peritoneum dialysis effluent by real-time PCR and western-blot assays. Macrophages were identified through flow cytometry. Then we analysis the relationship between ADAM19 and clinical data in PD patients. Furthermore, we established mouse models for peritoneal fibrosis to verify the biological function of ADAM19 in regulating macrophage polarization. In the long-term group, the fibrotic proteins (Fibronectin, α-SMA) and inflammatory factors (IL-6, IL-10) and chemokines (CCL5, CCL2, CXCL16) were higher than short-term group and more macrophages polarized towards M2. ADAM19 expression was linearly correlated with dialysis time and Kt/v. The AUROC of ADAM19 was 0.738 to identify the predictive value for peritoneal dialysis adequacy. The cut-off of ADAM19 RNA level was 7.84. In logistic regression models, higher ADAM19 (≥ 7.84) was also independently associated with lower Kt/v (< 1.67). Additionally, the results revealed a moderate increment of M1 macrophage (CD86+) and enormous rise of M2 macrophage (CD206+) with high-glucose dialysis fluid in mice model. Furthermore, the 8-week G4.25% group showed significant growth of M2 macrophage compared to the 4-week G4.25% group, indicating that prolonged dialysis duration has a more pronounced effect on promoting M2 polarization of macrophages via ADAM19/Notch1 signaling pathway. Through stimulating chemokines and inflammatory factors, ADAM19 regulated macrophage polarization and was correlated to the progression of peritoneal fibrosis. ADAM19 is expected to be a novel indicator for detecting peritoneal ultrafiltration function in PD patients.
Seismic risk assessment is a probabilistic approach that evaluates the likelihood of earthquake occurrence, structural response, expected damage levels, economic losses, and potential casualties by incorporating the inherent uncertainties associated with seismic hazards and urban building characteristics. The primary objective of this study is to quantify and spatially characterize the distribution of damage states at the urban scale. Buildings were classified according to their structural system, age, and number of stories. The structures were initially modeled, analyzed, and designed in ETABS, and the beam and column section properties were extracted for each structural type. Finite element models were subsequently developed in OpenSees, and Incremental Dynamic Analysis, IDA, was performed to evaluate the seismic performance of building groups and large-scale seismic risk. The application of this approach to urban-scale seismic risk evaluation distinguishes this research from similar previous investigations. Given the considerable number of models, the extensive dataset, and the necessity for updating results under varying input conditions, a Bayesian Probabilistic Network was employed. In addition, GIS-based mapping was used to present the findings, including the exceedance probabilities of different damage states and the spatial distribution of collapse probability. The outcomes of this study identify areas that may exhibit relatively higher seismic vulnerability, emphasizing the potential need for targeted retrofitting strategies or, enhanced preparedness for post-earthquake emergency response and rescue operations.
Swallowing and diaphragmatic functions share neural regulatory pathways and require synchronous assessment. Patients who have had a stroke are susceptible to many complications, of which dysphagia and diaphragmatic dysfunction are particularly common. To compare the distribution and severity of swallowing function in stroke patients with and without diaphragmatic dysfunction, and to explore the correlation between swallowing and diaphragmatic functions. This cross-sectional observational study among 102 Chinese stroke patients with hemiplegia was conducted in August 2022 to December 2024. Data collection was completed in the first 48 h following admission, including sex, age, post-stroke duration, stroke type, stroke region, hemiplegia side, nasogastric feeding, and pneumonia. The patients were stratified into two groups by the presence or absence of diaphragmatic dysfunction, which was assessed by diaphragmatic ultrasound with a threshold of diaphragm thickening fraction (TFdi) < 20%. We compared the distribution and severity of different swallowing functions using the Modified Barium Swallow Study Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS) by Videofluoroscopic Swallowing Study (VFSS) between the two groups. Significant differences were found between the two groups in the oral and pharyngeal phases of the MBSImP (p < 0.003), including hold position/tongue control, bolus preparation/mastication, bolus transport/lingual motion, oral residue, initiation of the pharyngeal swallow, anterior hyoid motion, pharyngeal stripping wave, and pharyngeal residue (p < 0.003). In contrast, there were no significant differences between the two groups in some components of the MBSImP including lip closure, soft palate elevation, laryngeal elevation, epiglottic movement, laryngeal closure, pharyngeal contraction, and tongue base retraction (p > 0.003). The severity of swallowing physiological impairment by MBSImP between the two groups, including the oral phase, pharyngeal phase and total MBSImP scores showed significant differences (p < 0.003). By contrast, the distribution and severity of penetration and aspiration risk by PAS showed no statistically significant difference between the two groups (p > 0.003). TFdi was negatively correlated with grades of Water Swallowing Test, the oral phase, pharyngeal phase and total MBSImP scores (rs = -0.327 to -0.300, p < 0.003). Whereas no significant correlations were found between TFdi and pneumonia, nasogastric feeding and the PAS scores (p > 0.003). Patients with diaphragmatic dysfunction exhibited a higher proportion of swallowing physiological impairment in the oral and pharyngeal phases, along with greater severity of such impairments. Diaphragmatic function was correlated with swallowing function, but the correlation was weak and of uncertain clinical significance.