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.
Pediatric sepsis is a leading cause of global morbidity and mortality, yet high-resolution, granular subnational assessments remain scarce. Chile and Mexico are the only countries in Latin America that possess robust vital registration systems and open access databases with marginal levels of missing cases. This offers a unique opportunity to quantify the subnational burden of pediatric sepsis, identify healthcare system constrictions, and guide targeted public health interventions. This retrospective longitudinal study analyzed official hospital discharge and non-fetal death records of pediatrics (< 10 years old) from Chile and Mexico between 2014 and 2024. Age-standardized incidence (ASIR) and mortality (ASMR) rates, standardized ratios, and the mortality-to-incidence ratio (MIR), were calculated to assess mortality relative to subnational hospital output. A novel dynamic risk stratification matrix was developed to classify ICD-10 sepsis-related causes into four risk/severity quadrants based on year-specific ASIR and MIR indicators. A total of 656,234 discharges and 2,035 deaths in Chile, and 964,452 discharges and 77,252 deaths in Mexico were analyzed. Subnational trends were highly heterogeneous. Chile exhibited a predominantly low pediatric MIR (median < 1%) with isolated hotspots with significant structural deviations to the North. High-severity sepsis causes in Chile were relatively rare. Conversely, Mexico displayed an alarmingly high MIR (median 7.2%), with systemic persistency in States such as Chiapas and Nuevo León. Strikingly, high-severity causes in Mexico (e.g., unspecified septicaemia, bacterial meningitis) were highly frequent, accounting for 88-97% of pediatric sepsis deaths. Furthermore, systemic instances of code-specific MIR > 1.0 in Mexico suggest significant health system fragmentation and decoupling of hospital discharge from vital statistic registries. Pediatric sepsis in Latin America encompasses distinct realities, ranging from localized critical care gaps to high-lethality persistency. One-size-fits-all national policies may be inadequate. These findings advocate for precision public health, urging the deployment of decentralized, data-driven interventions and specialized resource allocation based on high-risk subnational hotspot identification.
Limb salvage centers have increased in number over time, but lack standardized defining criteria. This systematic review aimed to assess organizational features of limb salvage centers and determine whether orthoplastic centers, in comparison to vascular limb salvage centers, represent a distinct care model that may benefit from standardization. We conducted a systematic review of publications related to limb salvage centers by searching MEDLINE, Embase, Web of Science, and Cochrane databases from their inception through 2024. We quantified binary data extraction as a reporting score of 26 organizational features across six structural care domains for limb salvage centers, based on a validated quality measurement framework. Organizational features differentiating distinct center types were identified to establish a quality framework for orthoplastic centers. Statistical comparisons between center types were performed using appropriate tests (p < 0.05). Of 118 included studies, orthoplastic (n = 43) and vascular (n = 48) centers represented 77% of all studies. Recent increases in orthoplastic publications show substantial variability in organizational features. Orthoplastic center literature more frequently reported plastic surgery consultation criteria (p < 0.001), surgical outcomes (p < 0.001), and centralized network integration (p ≤ 0.006), highlighting acute reconstructive approaches. Vascular center studies documented significantly more organizational team features (p < 0.001) and quality systems (p = 0.033), reflecting established care frameworks for chronic disease management. Six organizational features characterized orthoplastic centers with > 70% prevalence, providing a benchmark framework with standardization priorities. Orthoplastic limb salvage centers demonstrate distinct care paradigms that benefit from standardization. Our findings suggest structural benchmarks to support the need for standardized development of orthoplastic limb salvage centers.
Soft skills correspond to intrapersonal and interpersonal abilities related to how individuals interact, make decisions, and manage their activities. In the context of undergraduate nursing education, their development is fundamental to the preparation of professionals capable of acting in an ethical, critical, and relational manner, making it relevant to understand how these competencies are incorporated into the teaching and learning process. In this context, the objective of this study is to understand how faculty members in undergraduate nursing programs incorporate soft skills into their pedagogical approaches and practices, identifying the competencies considered essential and the challenges to their implementation. A qualitative study was conducted with 26 nursing faculty members from four federal public universities in southern Brazil. Data were collected between June and September 2025 through semi-structured interviews, following the criteria of the Consolidated Criteria for Reporting Qualitative Research checklist. The interviews were processed using IRaMuTeQ software and analyzed in light of Discursive Textual Analysis. Three analytical categories emerged: faculty understanding of soft skills in nursing education; pedagogical approaches and strategies for the development of these competencies; and perceived difficulties in their promotion within teaching. The faculty members recognize the relevance of soft skills and report the use of active methodologies and reflective strategies for their development. However, most had not received specific training, and the teaching of these competencies occurs predominantly in an implicit manner. The findings demonstrate that, although soft skills are widely valued in nursing education, their promotion still lacks pedagogical systematization and institutional support. Challenges such as the subjectivity of these competencies, the prioritization of technical skills by students, and distractions associated with the use of technologies limit their intentional development. These results contribute to the international literature in nursing education by highlighting the need for structured institutional strategies for faculty development and for the explicit integration of soft skills into nursing curricula.
Congenital anomalies and genetic disorders contribute substantially to perinatal morbidity and mortality, particularly in low- and middle-income countries. Prenatal healthcare providers play a key role in identifying affected pregnancies and referring to patients for genetic counselling; however, referral practices remain suboptimal. To assess the utilisation of genetic counselling services and perceptions of genetic counselling among prenatal healthcare providers in Gauteng Province, South Africa. An electronic survey was distributed to prenatal healthcare providers working in public and private healthcare sectors in Gauteng. The survey assessed access to genetic counselling services, referral practices, knowledge of referral indications, understanding of the genetic counsellor's role, and perceived barriers to referral. Fifty-four respondents were included. Seventy-four percent of participants reported being able to refer to patients for genetic counselling, but only 57% had utilised the service. No participant correctly identified all appropriate referral indications, and only 24% understood the scope of practice of genetic counsellors. Only 6% felt confident in their knowledge of genetic counselling. Although genetic counselling services are available and utilised in Gauteng, they are not accessed to their full potential. Improved education and clearer referral guidance are required to optimise prenatal genetic care in this setting.
The growing proportion of women in veteran communities internationally highlights a rising need for veteran support services tailored to their unique experiences. Despite this, support services remain predominantly designed for men, leading to underutilization and dissatisfaction among women veterans. This scoping review aimed to provide a comprehensive international review of the current state of knowledge regarding the experiences of women veterans in accessing and engaging with veteran-specific support services. This study followed the Joanna Briggs Institute scoping review methodology. Five databases were searched for papers published from 2000 onwards. Studies reporting on barriers and/or facilitators to access and experiences of engaging with veteran-specific support services reported by women veterans were included. There were no limitations on study methodology or country of origin, and all publications reporting primary research were included. A total of 117 studies were included in the review. This research originated predominantly from the US (n = 109), with seven UK papers, and one Canadian. Eleven themes were identified across the literature, highlighting gendered barriers and facilitators of accessing veteran-specific support for women. Women veterans report feelings of discomfort, exclusion, and discrimination within veteran services, which are perceived as being set up and designed for men. Women report experiencing stigma in help-seeking compounded by a perception of feminine weakness experienced during military service. Some women didn't want to access services they saw as military-adjacent, due to gendered adverse experiences during military service, including discrimination, harassment, and sexual violence. A lack of identification with the term 'veteran' further hinders women's engagement with veteran-specific services. Enablers of access include care that is sensitive to women's needs, trauma-informed service user-provider relationships, and peer support. The reviewed evidence suggests women experience unique challenges and needs in accessing veteran-specific services. Support services should focus on developing care that is, culturally competent, trauma-informed and sensitive to the needs of women, to address gendered barriers to engagement. More research is needed to confirm these research findings outside of the US context, and incorporating an intersectional lens in future research will be essential for improving the support systems for women veterans internationally.
Lung cancer is one of the most common malignancies and the leading cause of cancer-related mortality worldwide, posing a major public health challenge. Flavonoids, a large and diverse group of plant metabolites, exhibit various anticancer properties, making them promising candidates for therapeutic applications. This study evaluated the anticancer efficacy of methoxy flavonoids and elucidated their underlying mechanisms of action in A549 lung cancer cells. A549 cells were treated with various flavonoids (AKC1-AKC5), and their effects were analyzed using an MTT assay, DAPI staining, mitochondrial membrane potential (MMP), reactive oxygen species (ROS) production, colony formation, and wound scratch tests. Molecular docking was also performed to confirm the binding of AKC1 and AKC3 to EGFR, BCL-2, and CDK-2 proteins. AKC1 and AKC3 prevented the growth of A549 lung cancer cells with IC50 of 64.57 and 19.80 μM among 5 methoxy flavonoids. AKC1 and AKC3 triggered notable alterations in the shape and reduced the colony-forming potential of A549 cells. The DAPI staining experiment demonstrated that AKC1 and AKC3 impede the growth of cancer cells through activation of apoptotic cell death. Moreover, the anticancer properties of AKC1 and AKC3 were attributed to significant inhibition of MMP and a notable ROS enhancement in a dose-related pattern. The wound scratch assay demonstrated that AKC1 and AKC3 suppressed A549 lung cancer cell migration, suggesting their anti-metastatic properties. Molecular docking studies confirmed that AKC-1 and AKC-3 bind strongly to EGFR, BCL-2, and CDK2, suggesting a multi-target mechanism that underlies their anti-proliferative and pro-apoptotic effects in A549 cells. AKC1 and AKC3 exhibited significant anticancer activity against A549 cells and may serve as promising therapeutic drugs for lung cancer treatment.
Peptic ulcer disease (PUD) remains a significant public health concern globally, particularly in regions with high prevalence of risk factors such as Helicobacter pylori infection and Non-Steroidal Anti-Inflammatory Drug (NSAID) use. This study aimed to investigate the prevalence of PUD and its associated risk factors among hospitalized patients in a tertiary hospital in southwest Iran. A mixed-methods design was employed, including a comprehensive literature review, checklist development and validation via a modified Delphi process, a cross-sectional prevalence study, and a hospital-based case-control study. Data were collected from 43,324 patient records (2019-2023) at Abadan University Teaching Hospital. Risk factors were assessed using a validated 21-item checklist, and multivariate logistic regression was used to identify independent predictors of PUD. Among all admissions, 6,874 cases of PUD were identified, indicating a point prevalence of 15.9% (95% CI: 15.6-16.2). NSAID use (75.3%), H. pylori infection (70.1%), smoking (46.9%), and corticosteroid use (30.2%) were highly prevalent among PUD patients. Significant independent risk factors included age ≥ 60 years (AOR: 1.65), NSAID use (AOR: 2.58), H. pylori positivity (AOR: 2.41), smoking (AOR: 1.45), and ulcer size ≥ 5 mm (AOR: 2.19). Despite the high rate of NSAID use, only 26.4% received gastroprotective therapy. The findings underscore the high burden of PUD in hospitalized patients in southwest Iran, with modifiable risk factors such as NSAID use, H. pylori infection, and smoking playing a critical role. Targeted interventions, including Proton Pump Inhibitor (PPI) co-prescription, H. pylori eradication, and lifestyle modifications, are essential to reduce PUD incidence and its complications.
In numerous cases of Moyamoya disease (MMD), the middle meningeal artery (MMA) develops as a spontaneous collateral prior to surgery, providing an extracranial-intracranial compensatory pathway. However, the MMA is vulnerable to iatrogenic injury during surgery. There is a lack of literature regarding managing iatrogenic injuries to the MMA which has collateral supply to the cerebral hemisphere. We report a case of a 61-year-old woman with MMD with collateral flows from the MMA. During a right-sided direct revascularization surgery, the MMA was inadvertently ruptured. After the bleeding is controlled, a salvage bypass was created by anastomosing the frontal branch of the superficial temporal artery (STA) end-to-end to the MMA, while the parietal branch of STA branch was anastomosed to a cortical middle cerebral artery (MCA) branch in an end-to-side fashion. Intraoperative indocyanine green video angiography (ICG-VA) confirmed good patency of the bypasses. Follow-up cerebral computed tomography angiography (CTA) confirmed the patency of the STA-MMA and STA-MCA anastomosis. Magnetic resonance imaging (MRI) showed no cerebral infarction. A remedial STA-MMA anastomosis can be a technically feasible salvage strategy when the MMA with collateral flow to the brain is injured intraoperatively. This approach preserves cortical collateral flow and expands the surgical options for complex revascularization cases.
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.
Although roles of CD44 in the genetic predisposition for bronchopulmonary dysplasia (BPD) has been recognized, the immune characteristics of CD44+ monocytes in BPD are unclear. We aimed to (1) compare the expression and function of CD44 on monocytes in BPD and non-BPD infants; (2) explore the roles of CD44 on monocytes in hyperoxia-induced inflammation. Flow cytometry assessments of the expression pattern and cytokine-secreting response upon LPS stimulation of CD44+ monocytes were conducted using peripheral blood samples from BPD infants (n = 80) and non-BPD infants (n = 106). The role of CD44 on monocytes was validated in hyperoxia exposure. CD44 expression and inflammatory cytokine secretion ability increased with postmenstrual age. The ability of CD44+ monocytes to secrete IL-6 and TNF-α was significantly greater than that of CD44-monocytes. Compared with those of non-BPD infants, the response capacity of the monocytes in BPD infants to secret IL-6 and TNF-α, especially TNF-α sourced from CD44+ intermediate monocytes, was greater upon LPS stimulation. CD44 expression significantly increased in hyperoxia, and CD44 knockdown significantly ameliorated the inflammation induced by hyperoxia. CD44+ monocytes played important roles in mediating the hyper-inflammatory response in BPD. One specific subpopulation, TNF-α+/CD44+intermediate monocytes, might be a valuable marker for identifying BPD. 1. This study revealed the key role of an immune cell subtype-CD44+ monocytes-in hyperoxia-induced bronchopulmonary dysplasia (BPD) and characterized the expression and function of CD44+ monocytes between premature infants with BPD and those without BPD. 2. CD44 was closely associated with the proinflammatory cytokine secretion capacity of monocytes. A specific subpopulation-TNF-α+/CD44+ intermediate monocytes- might serve as a valuable marker for the identification of BPD in the future. 3. Our findings added new evidence of the association between CD44+ monocytes and BPD pathogenesis, which provided new insights into the immune mechanisms for BPD.
Osteosarcoma typically arises during adolescence, posing a significant challenge. Despite comprehensive treatment strategies encompassing surgery, radiation therapy, and chemotherapy, which can notably enhance long-term survival rates among osteosarcoma patients, the 5-year survival rate for metastatic cases remains discouragingly low. Consequently, early diagnosis and prompt intervention are paramount in improving the prognosis of patients afflicted with this condition. Metabolic reprogramming holds paramount significance in the initiation and progression of tumors. In this meticulous investigation, we devised a risk prediction model that encompasses seven pivotal nucleotide metabolism-related genes: MYC, MUC1, IMPDH1, SAMHD1, NUDT13, UCK2, and NUDT16. This model was formulated leveraging six advanced machine learning algorithms. The results demonstrated that the risk prediction model exhibited robust prognostic predictive capability. Notably, patients identified with a high-risk phenotype exhibited a significantly lower long-term survival rate, coupled with elevated expression of immunosuppressive genes, highlighting the importance of metabolic reprogramming in influencing both survival outcomes and immune status. The multivariate Cox regression analysis confirmed that our model serves as an independent prognostic indicator, significantly impacting the long-term prognosis of osteosarcoma patients. Subsequently, we developed and validated a nomogram, which accurately predicts 1-, 3-, and 5-year survival rates for these patients. Furthermore, we compared chemosensitivity between high- and low-risk groups, gaining valuable insights into potential therapeutic differences. In conclusion, this model demonstrates superior prognostic predictive capability and holds promise in guiding chemotherapy treatment strategies for osteosarcoma patients, thereby enhancing treatment outcomes.
The co-occurrence of mirror-image dextrocardia and tetralogy of Fallot (TOF) is a rare congenital condition. Reoperative multivalve surgery in such patients, especially after repaired TOF, presents exceptional challenges due to the mirrored cardiac anatomy and altered surgical field. This case highlights the surgical strategy for concomitant tricuspid, mitral, and pulmonary valve replacement in this unique setting. A 14-year-old male patient with a history of corrected TOF and mirror-image dextrocardia presented with progressive heart failure due to severe regurgitation of the tricuspid, mitral, and pulmonary valves. Preoperative imaging confirmed the complex anatomy, with the atria positioned posteriorly, rendering the atrioventricular valve orifices near-vertical during surgery. The patient successfully underwent triple valve replacement under cardiopulmonary bypass. Key technical adaptations were made to select the valve model and position. The postoperative course was uneventful, with significant symptomatic and echocardiographic improvement at discharge and during the two-month and six-month follow-up. This case demonstrates that concomitant triple valve replacement is feasible in patients with mirror-image dextrocardia and a history of TOF repair, despite the profound technical challenges posed by the anatomical distortions. Success hinges on meticulous preoperative planning using advanced imaging and the development of an individualized surgical approach. This report provides a valuable reference for managing such complex, high-risk reoperations in the setting of congenital situs inversus.
Myasthenia Gravis (MG) is divided into ocular (OMG) and generalized (GMG) subtypes. While clinical diagnosis is well-established, understanding the underlying biochemical mechanisms and metabolic shifts during disease progression remains challenging; untargeted metabolomics offers a novel perspective to explore these systemic alterations. To characterize the serum metabolic landscape of MG patients and identify potential metabolic signatures associated with disease subtypes (OMG and GMG) via untargeted metabolomics. 91 participants (41 GMG, 22 OMG, 28 healthy controls [HC]) were enrolled. Fasting serum samples were analyzed by LC-MS/MS. Multivariate analyses (PCA, PLS-DA/OPLS-DA), differential metabolite screening (VIP > 1.0, p < 0.05), and KEGG pathway enrichment were performed. HC and MG groups showed distinct metabolic profiles. MG had 515 (175 up, 340 down) and 368 (146 up, 222 down) differential metabolites in positive/negative ion modes, respectively. Key perturbed pathways included glycerophospholipid, sphingolipid metabolism, and unsaturated fatty acid biosynthesis. Ten representative metabolites (e.g., ubiquinone, cortisol) differed significantly among groups; clustering analysis revealed distinct metabolite abundance trajectories across HC, OMG, and GMG. MG is associated with notable systemic metabolic dysregulation, particularly in lipid-related pathways. Rather than serving as immediate diagnostic tools, these integrative metabolic signatures provide a crucial biochemical framework for understanding disease pathogenesis and offer valuable clues for future hypothesis-driven research and prospective validation.
In this study, we have optimized a stabilizer formulation using native corn starch (A: 0-2%), acetylated distarch phosphate (B: 0-2%), and gelatin (C: 0.1-0.4%) via a D-optimal mixture design approach. The study aimed to quantify main and interaction effects and identify an optimum formulation under predefined quality targets. Physicochemical, textural, and sensory characteristics were monitored during storage at 4 °C. Syneresis after 28 days was predominantly influenced by ingredient type and concentration; gelatin significantly reduced syneresis, whereas native and modified starches contributed to increased syneresis. Gelatin showed a softening effect on texture immediately post-production but induced hardness during storage. Both starch types increased hardness throughout storage. Gelatin improved overall acceptability and a significant positive interaction was observed among all three ingredients (ABC). Conversely, binary interactions (AB and AC) negatively impacted sensory scores. Two optimized formulations with highest desirability were optimum 1 (0.998% A, 0.872% B, and 0.129% C) and optimum 2 (1.116% A, 0.526% B, and 0.358% C). After the experiments, observed values for optimum 1 closely matched the predicted values, confirming model accuracy and it was recommended for stirred yogurt formulation.
Wilson disease (WD) is a rare autosomal recessive disorder of copper metabolism presenting with acute liver failure, cirrhosis, or neurologic involvement. Liver transplantation (LT) is the definitive treatment; however, data remain limited, particularly from regions reliant on living donor LT (LDLT). We retrospectively analyzed a prospectively collected transplant database, identifying all patients (≥ 14 years) who underwent LT for WD between January 2001 and December 2023. Data on demographics, LT indications, disease characteristics, pre-transplant therapy, complications, and outcomes were collected. Survival was assessed using Kaplan-Meier methods, and neurologic outcomes from clinical documentation. Forty-one patients underwent LT for WD (median age: 23 years; 51.2% female). Ascites was present in 68.4%, encephalopathy in 32.4%, and hepatocellular carcinoma in 5.1%. Acute liver failure was the initial presentation in 17.9%. LDLT comprised 53.7%. Acute cellular rejection occurred in 29.7% but was manageable; no patient required re-transplantation. Neurologic involvement was present in 17.1%, with 71% improving post-LT. One-, five-, and ten-year survival rates were 94%, 94%, and 82%. LT for WD yields excellent long-term survival. Neurologic improvement occurred in most Neuro-Wilson patients, supporting LT even in neurologically affected cases. LDLT plays a crucial role in regions with limited deceased donors.
Childhood obesity is common and associated with adverse health outcomes. Fetal programming via epigenetics is a potential mechanism underlying its pathogenesis. We conducted an epigenome-wide association study (EWAS) on cord blood DNA to identify DNA methylation sites that may mediate the association of maternal body mass index (BMI) with offspring adiposity using data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study and its follow-up study (HAPO FUS). HAPO was a prospective, multicenter, international observational study that recruited pregnant women between 2000 and 2006 for glucose tolerance testing; cord blood was collected at delivery and newborn anthropometrics were obtained. The HAPO FUS was conducted from 2013 to 2016, where the 10-14 year-old offspring underwent measures of body composition, anthropometrics, and a fasting glucose tolerance test. Eligibility for HAPO FUS included gestational age at delivery ≥ 37 weeks without major neonatal malformations. There were 3,243 samples with cord blood DNA methylation (cbDNAm) data; mean child age at follow-up was 11.5 years. The present study used cord blood DNA to conduct methylation profiling using the Infinium MethylationEPIC 850 K BeadChip. Linear regression models were used to test the association between maternal BMI and cbDNAm levels adjusting for population substructure, cell count, maternal and child co-variates; multiple testing was accounted for using Bonferroni correction. Mediation analysis tested if cbDNAm CpG sites that were associated (Bonferroni P < 0.05) with maternal BMI explained the known association between maternal BMI and child BMI. This analysis included 3,116 mother-child pairs, 48% White, 21% Asian, 19% Black, 12% Hispanic and < 1% other race/ethnicity self-identified by the mother; 36% of mothers and 28.3% of children had an overweight or obese BMI. Maternal BMI was associated with DNAm at 7 CpG sites following adjustment including: cg00579423, cg07138793, cg12188424, cg19345626, cg20020844, cg02988288 and cg26974062. The 2 CpG sites on the TXNIP gene have been identified in previous EWAS of glucose metabolism and diabetes. Cord blood DNA methylation at cg20020844 (SP6) demonstrated mediation of 1.2% of the association between maternal BMI and child BMI z-score. Exposure to maternal obesity in utero and subsequent differential methylation present at birth may contribute to the prenatal programing of childhood obesity.
Postoperative gastrointestinal (GI) bleeding is a serious complication after hip fracture surgery in older adults, yet perioperative risk stratification remains limited because commonly used GI-bleeding scores are not tailored to orthopedic settings. This study aimed to develop and internally validate an interpretable model to predict postoperative GI bleeding risk in elderly hip fracture patients, using data routinely available during the perioperative period. We retrospectively included 342 elderly patients who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January to December 2023. The outcome was GI bleeding within 1 month after surgery, confirmed by medical records and/or telephone follow-up. Patients were randomly split into a training set (n = 242) and a validation set (n = 100). Predictors were screened using LASSO with 10-fold cross-validation, followed by multivariable logistic regression to identify independent risk factors. Ten prediction algorithms were trained and compared. Model performance was assessed by AUC, calibration, and decision curve analysis, and interpretability was evaluated using SHAP. GI bleeding occurred in 38 patients (11.1%). Multivariable analysis identified four independent predictors: alcohol consumption history (OR 8.109, 95% CI 2.463-26.69), glucocorticoid use (OR 4.922, 95% CI 1.055-22.97), NSAID use (OR 6.851, 95% CI 1.811-25.915), and higher systemic immune-inflammation index (SII) (OR 1.001, 95% CI 1.000-1.002). Among the tested models, LightGBM showed the best overall performance, with AUCs of 0.843 (training) and 0.817 (validation), good calibration, and the highest net benefit on decision curve analysis. SHAP results ranked feature importance as SII, NSAID use, alcohol consumption history, and glucocorticoid use, consistent with regression findings. We developed and validated an interpretable LightGBM model that predicts postoperative GI bleeding risk in elderly hip fracture patients using routinely available clinical data. The final model incorporates only preoperative variables, systemic inflammation, NSAID use, alcohol history, and glucocorticoid use, supporting its application for early risk stratification prior to surgery.
Chitin is the second most abundant polysaccharide in nature, and its degradation by marine microorganisms plays a critical role in the global carbon and nitrogen cycles. This study investigated the marine bacterium Microbulbifer harenosus CGMCC 1.13584T to elucidate its chitin metabolic pathway through genomic and transcriptomic analyses. When cultured with chitin as the carbon source, the strain exhibited an extended lag phase and enhanced extracellular chitinase activity. Genome sequencing revealed the presence of genes involved in both hydrolytic and oxidative chitin degradation pathways. Transcriptomic analysis showed that genes associated with the hydrolytic pathway were significantly upregulated upon chitin induction. In contrast, within the oxidative degradation pathway, only early-stage response genes (such as those encoding LPMOs) were markedly upregulated, while genes involved in subsequent metabolic steps (converting GlcNAc1A to KDG-6-P) did not show significant upregulation. Furthermore, a gene encoding a GH10 domain-containing protein was found to be substantially upregulated during growth on chitin. These findings indicate that Microbulbifer harenosus CGMCC 1.13584T utilizes a coordinated chitin degradation mechanism, where the hydrolytic pathway dominates carbon flux during active growth, while the oxidative pathway (via LPMOs) likely provides critical initial structural disruption.
Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors composed of cells exhibiting an epithelioid morphology. These cells typically arrange around small blood vessels (perivascular spaces) and display dual differentiation characteristics of smooth muscle cells and melanocytes. Diagnosis is challenging due to the absence of specific symptoms or tumor markers. This case features a young male patient with a large hepatic PEComa, whose imaging findings resemble those of hepatocellular carcinoma. We have detailed the entire process from diagnosis to treatment to aid in differential diagnosis and surgical planning. A 31-year-old male patient with no prior medical history underwent a routine health examination 20 days prior to presentation. Although the patient was asymptomatic, ultrasound revealed an incidental hepatic lesion measuring 58 × 50 × 45 mm (maximum diameter 58 mm, or 5.8 cm). The screening center suspected a hemangioma. Subsequently, he presented to our hospital. Comprehensive imaging studies, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), revealed a 58 mm-diameter space-occupying lesion in segments V and VIII of the right hepatic lobe. Imaging findings initially raised suspicion for hepatocellular carcinoma. To minimize surgical trauma and preserve liver function, our team discussed surgical approaches and ultimately decided on a laparoscopic partial hepatectomy. During the procedure, we obtained a specimen for pathological examination. The final histopathological analysis confirmed the diagnosis of a PEComa with undetermined malignant potential. The patient recovered smoothly postoperatively and was successfully discharged. PEComa has an insidious onset and is rare. Early diagnosis is often challenging, and imaging studies typically show no highly specific findings. Clinical diagnosis frequently relies on biopsy. In terms of treatment, radical resection (R0 resection, i.e., negative margins) represents the definitive therapeutic approach.