Cancer therapy-related cardiac dysfunction (CTRCD) is among the most important adverse effects of treatment of childhood cancer. In the EARLY study (Early detection of acute and early-onset cARdiovascuLar toxicity in children with cancer using a multiparametric approach), cardiac function in children treated for cancer was monitored during and shortly after treatment, using advanced echocardiography, electrocardiography, and cardiac magnetic resonance (CMR) techniques. In this prospective pilot study, 100 children newly diagnosed with childhood cancer receiving anthracyclines as part of their cancer treatment were included. A subgroup of 30 children was included in the CMR sub-study. Echocardiography, electrocardiography, and CMR were performed before (T0), three and a half months after (T1), and one year after (T2) start of anthracycline treatment. In this article, we focus on the methodological aspects of the EARLY study, including patient enrollment and characteristics of the study cohort, as well as the feasibility of advanced echocardiography. The last patient was included in August 2022. Follow-up for the last patient was finalized in August 2023. Follow-up was completed by 92% of the total study population and 97% of the CMR sub-study. Protocol adherence was high (92%-97%) and a full collection of data on each included individual was achieved. Advanced echocardiography, i.e., 4D ejection fraction and global longitudinal strain, was feasible in 76% and 69% of measurements, respectively. Cardiac outcomes during and shortly after treatment, as well as associations with known risk factors for CTRCD, such as anthracycline dose, dose of radiotherapy involving the heart, childhood cancer disease profile, age at diagnosis and sex will be reported in a future publication. The feasibility of the study allows for future insight into the correlation between early-onset CTRCD and heart failure during long-term follow-up of childhood cancer patients. ClinicalTrials.gov identifier: NL-OMON22737.
To systematically evaluate whether epilepsy duration is associated with glymphatic dysfunction as measured by diffusion tensor image analysis along the perivascular space (DTI-ALPS). A systematic review and correlation-based meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched from inception through January 20, 2026, for observational studies reporting correlations between epilepsy duration and DTI-ALPS values. Correlation coefficients were pooled using random-effects models after Fisher's z transformation. Subgroup analyses and meta-regression were performed to explore heterogeneity. Ten observational studies comprising 449 patients with epilepsy were included. Pooled analysis demonstrated a significant negative association between epilepsy duration and the DTI-ALPS index (r = -0.37, 95% confidence interval [CI]: -0.53 to -0.19), indicating lower glymphatic function with longer disease duration. A significant association persisted in temporal lobe epilepsy (r = -0.30, 95% CI: -0.54 to -0.02) and was stronger in late-onset epilepsy (r = -0.68, 95% CI: -0.79 to -0.54). Meta-regression identified age as a significant moderator of effect size, whereas mean disease duration did not significantly explain variability. Sensitivity analyses confirmed the robustness of findings, and no publication bias was detected. Longer epilepsy duration is associated with greater glymphatic dysfunction as measured by DTI-ALPS. Age significantly modulates this relationship, suggesting that seizure chronicity and aging-related vulnerability may synergistically influence perivascular clearance pathways. These findings support DTI-ALPS as a promising non-invasive marker of cumulative glymphatic burden in epilepsy and provide a quantitative framework for future longitudinal studies.
Existing models for stereo matching in minimally invasive surgery (MIS) require calibrated stereo images. Accurate calibration is however often unavailable intraoperatively. Training an uncalibrated stereo model is thus attractive but challenging owing to the lack of disparity-labelled surgical images. We leverage the wealth of non-medical stereo synthetic image datasets. These data were however generated in ideal conditions-rectified and with centred principal points-hence differ from real uncalibrated MIS images. We propose camera augmentation, a new type of image augmentation that augments a dataset by altering the camera's orientation and intrinsic parameters via geometric parameters. We augment the idealised existing datasets, sampling the geometric augmentation parameters from distributions estimated through an in-depth analysis and modelling of stereo laparoscopes. This forms the camera augmentation training strategy (CATS), with which we retrain RAFTStereo and IGEV++ for zero-shot uncalibrated stereo matching in MIS. We evaluated using the SCARED, StereoMIS, RIS2017, and an in-house datasets. In the uncalibrated setting on the SCARED dataset, CATS-RAFTStereo and CATS-IGEV++ achieved end-point errors (EPE) of 1.42 and 1.41 pixels. This is a successful result, as the reference pretrained models obtained 1.23 and 1.21 pixels in the calibrated setting and failed in the uncalibrated setting. Camera augmentation bridges the gap between ideally conditioned datasets and the real surgical conditions of uncertain or unavailable calibration, enabling the retraining of state-of-the-art architectures. Beyond stereo, the proposed CATS is applicable to tasks sensitive to camera geometry. Code and models will be released publicly.
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The search for high-efficiency antimicrobial nanomaterials has intensified due to the escalating threat of antibiotic resistance. In this study, titanium dioxide nanoparticles (TiO2 NPs) were synthesized using aqueous leaf extract of Pterolobium hexapetalum. Physicochemical characterization confirmed the formation of a pure nanocrystalline anatase phase (XRD) with a primary crystallite size of 10-15 nm and an optical band gap of 3.18 eV. While UV-Visible spectroscopy showed characteristic absorption bands at 209.5 and 270.5 nm, DLS and Zeta potential (+ 9 mV) measurements indicated that the nanoparticles exist as aggregated colloidal clusters with a hydrodynamic diameter of 399.2 nm. FTIR and SEM verified the presence of plant-derived functional groups and a clustered, rough surface morphology. Biological evaluation via agar well diffusion, MIC, and MBC assays demonstrated that the TiO2 NPs significantly outperformed the parent leaf extract. At a dose of 100 µg/well, the TiO2 NPs produced inhibition zones of 22.67 mm for Staphylococcus aureus and 27.67 mm for Escherichia coli, surpassing the absolute zones produced by the ciprofloxacin (5 µg/well) control. The MIC values (31.25-62.5 µg/mL) and an MBC/MIC ratio of 2 indicate a potent, primarily bactericidal mode of action, achieving a two- to four-fold increase in potency over the crude extract. These findings establish P. hexapetalum-mediated TiO2 NPs as a promising platform for antimicrobial applications in wound care and decontamination technologies.
Esophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy with a poor prognosis, characterized by early metastasis and high mortality rates. Cryptotanshinone (CTS), a diterpenoid quinone, has been extensively studied for its diverse pharmacological effects, particularly its anti-tumor properties, however, its therapeutic potential and mechanisms in the treatment of ESCC remain unclear. This study aimed to examine the impact of CTS on the polarization of TAMs and its subsequent role in inhibiting the metastasis of ESCC, both as a monotherapy and in combination with cisplatin. THP-1 cells were differentiated into M0, M2, and TAM-like macrophages using PMA, IL-4, and ESCC cell-conditioned medium. CTS's effects on macrophage polarization were analyzed via flow cytometry, RT-qPCR, Western blot, and ELISA. The impact of macrophage-conditioned media on ESCC cell migration and invasion was assessed through wound healing and transwell assays. Molecular mechanisms were confirmed using molecular docking, the cellular thermal shift assay (CETSA), and drug affinity responsive target stabilization assay (DARTS). An in vivo footpad xenograft model in nude mice, co-inoculated with KYSE150 cells and TAMs, tested the anti-metastatic effects of CTS with cisplatin. Within the tumor microenvironment of ESCC, TAMs are polarized into a pro-metastatic M2 phenotype. Our findings indicate that CTS disrupts this process by directly targeting the WNT2 protein, thereby interfering with the WNT2/STAT3/SOX4 signaling feedback loop. This disruption leads to a reduction in M2 polarization and a decrease in the secretion of pro-tumorigenic factors from TAMs. As a result, CTS attenuates the pro-tumorigenic effects of TAMs on ESCC cells and, when used in conjunction with cisplatin, synergistically inhibits ESCC metastasis. This study demonstrates that CTS reverses the M2 polarization of TAMs by inhibiting the WNT2/STAT3/SOX4 feedback loop, thereby suppressing ESCC metastasis. These findings underscore the potential of CTS as a therapeutic agent that mitigates the pro-tumoral tumor microenvironment and enhances the efficacy of conventional chemotherapy such as cisplatin.
In 2024, a catastrophic flood devastated Brazil's southernmost state, highlighting the need for tools to assess social capital. Yet, validated instruments for the Brazilian context are lacking. This study aimed to translate, culturally adapt, and validate the PSCS-8 for use in a Brazilian population after a climate event. This validation study used a sample from a longitudinal project assessing the mental health of residents of a flood-affected area. Participants (n=1057) responded to an online survey comprising the brPSCS-10, the PTSD Checklist for DSM-5 (PCL-5), and items on community resilience perception (CRP). The adaptation process involved expanding the scale to 10 items to enhance cultural relevance. Reliability was assessed using Cronbach's alpha, and a confirmatory factor analysis (CFA) tested the original two-factor structure. The brPSCS-10 demonstrated good internal consistency. The scoring model aligned with the original structure showed a good fit in the CFA. Social capital was higher among individuals with higher income and education levels, and associated with lower PTSD symptoms and higher CRP. The brPSCS-10 is a reliable instrument for measuring perceived social capital in Brazilian Portuguese. Its brevity makes it suitable for large-scale surveys in post-disaster and public health research.
The socio-economic situation in Lebanon has been dramatically deteriorating over the years affecting food insecurity (FI), psychological distress, and health-related quality of life (HRQoL). Therefore, the objectives of the study are to estimate the prevalence and severity of FI among Lebanese residents; evaluate the association between FI and psychological distress; and examine the association between FI and HRQoL. A cross-sectional study was conducted among residents of Lebanon aged 18 years or older in 2024. The final sample included 519 participants. The Food Insecurity Experience Scale, Beirut Distress Scale (BDS), and EQ-5D-5 L were used to assess FI, distress, and HRQoL levels, respectively. The questionnaire also included sociodemographic and general health-related questions. Regression analysis was applied to explore the association of FI with psychological distress and HRQoL after adjustment for relevant covariates. 14.3% of the participants exhibited moderate to severe FI. A moderate level of HRQoL was shown with a mean of 74.18 (SD = 19.0) for the EQ-VAS. Moreover, FI was significantly associated with HRQoL and psychological distress. FI (B = 5.183), age (B = 0.092), gender (B = 3.998), employment status (B = 0.558), and job loss (B = 6.021), were significant predictors of the BDS (p < 0.05). Whereas FI (B = - 8.490), age (B = - 0.461), job loss (B = - 4.659), and household income (B = 1.466) were significant predictors of EQ-VAS (p < 0.05). FI was associated with poorer mental health and lower HRQoL among Lebanese residents. This highlights the impact of the socio-economic crisis and provides data that could guide efforts to improve population health, especially for NGOs that are providing support to local communities. Lebanon has been facing severe socio-economic crises over the past years that have negatively affected food security, people’s mental health, and overall wellbeing, yet no population-based studies have been conducted to date to explore these issues. This study investigates the association of food insecurity with mental health, specifically psychological distress, and health-related quality of life. It aims to identify vulnerable groups that are most affected by the crises in order to develop targeted interventions. The study measures the prevalence of food insecurity among Lebanese residents and examines whether it is associated with higher psychological distress and lower health-related quality of life. Results revealed that about 14% of the participants were food insecure (moderate to severe FI) and it was linked to higher distress levels, and poorer health-related quality of life. Female, older individuals, unemployed, those who lost their jobs because of the crisis, those with lower educational attainment, and lower monthly income, showed worsened outcomes. The study revealed key dimensions of health that have been affected and provided data that could guide efforts to improve health of the population, especially for various NGOs that are providing support to local communities.
Proton pump inhibitor (PPI) use has been associated with metabolic dysfunction associated with steatotic liver disease (MASLD) in multiple studies. While the association is confounded by various risk factors, such as BMI and age, a potential mediating factor of the microbiome has been suggested. In this study, we aimed to identify bacterial clades with the highest mediating potential and evaluate the serially mediated path through microbially derived endogenous ethanol. Microbiome mediation analysis of PPI use and MASLD was conducted in two cohorts. In a bariatric surgery cohort (n = 122), liver biopsy-proven steatosis grade and postprandial ethanol concentrations were used as outcomes. In the HELIUS cohort (n = 2440), a general population cohort study, mediation was performed using the Fatty Liver Index (FLI) score. The strongest associations were validated in the FINRISK cohort (n = 7066). Several bacterial taxa, which are predominantly found in the small intestine, showed a potential role in mediating the effects of PPIs on MASLD, postprandial ethanol levels, and FLI score. The Lactobacillales order showed the strongest mediating potential across the outcomes tested in both discovery cohorts. A notable serial mediation pathway was identified, linking PPI use to MASLD via Lactobacillales abundance and postprandial plasma ethanol concentrations. The mediating role of Lactobacillales in the association between PPI use and FLI scores was confirmed in the final study cohort. Data from multiple cross-sectional cohort studies support a mediating potential of the microbiome in the association between PPI use and hepatic steatosis, independent of alcohol consumption. The effect of PPIs on MASLD appears to be mediated mainly by increased lactic acid bacteria abundance, and is potentially, in part, serially mediated by endogenous ethanol production.
Stage III non-small cell lung cancer (NSCLC) presents marked heterogeneity under evolving therapeutic paradigms. Real-world evidence on current treatment practices and outcomes remains limited. The MOOREA study aimed to evaluate real-world molecular testing, treatment patterns, and clinical outcomes of treatment-naïve Chinese patients with stage III NSCLC. MOOREA is a prospective, multicenter Chinese study enrolling patients with untreated stage III NSCLC (16 July 2019 to 28 February 2022) from 28 hospitals. Patients were consecutively enrolled. The primary endpoint was treatment pattern of cohort 1 (C1; unresectable stage III NSCLC), and the secondary endpoints included molecular testing pattern, progression-free survival (PFS), overall survival (OS) of C1, and treatment pattern of cohort 2 (C2; resectable stage III NSCLC). In total, 486 patients were analyzed (C1: 379; C2: 107). Molecular testing rates were: EGFR (20.0%), ALK (15.0%), and PD-L1 (13.0%). Of the 45.6% (173/379) of individuals in C1 who received chemoradiotherapy (CRT), 53.8% (93/173) underwent consolidation therapy, including 37.6% (35/93) who received immunotherapy (IO). In C2, lobectomy was the main surgical approach (85.8%, 91/106), whereas pneumonectomy was performed on 14.2% of patients (15/106). Adjuvant treatment was planned for 71.4% (75/105) of the patients in C2. For C1, the median follow-up was 27.5 months, with PFS and OS of 12.6 (95% CI: 11.0-14.0) and 33.3 months (95% CI: 29.6-not estimable), respectively. Subgroup analysis showed better OS and PFS for patients receiving CRT with IO consolidation versus CRT only, especially for those who underwent more than six IO consolidation cycles (24-month OS: 79.3% versus 66.4%; PFS: 49.6% versus 24.2%). MOOREA reveals the real-world management of stage III NSCLC in 20 provinces/cities in mainland China and Hong Kong SAR. Patients with unresectable tumors derived significant benefit from radiotherapy and consolidation after CRT. Substantial disparity persists between actual practice and guideline recommendations, necessitating efforts to enhance adherence to guideline-based care. NCT04023812.
Immunoglobulin A (IgA) nephropathy (IgAN) is a common clinical autoimmune disease, and the regulatory mechanism of Histone deacetylase 9 (HDAC9) in IgAN remains unclear. This study aims to elucidate the therapeutic value and potential mechanisms of HDAC9 in IgA nephropathy, offering potential new targets for clinical intervention and further research. An adeno-associated virus 9 (AAV9)-shHDAC9 vector was constructed and investigated the protective effect of HDAC9 knockdown in IgAN mouse. Transcriptome sequencing of renal tissues from IgAN mice was conducted, and immune infiltration analysis was quantified using transcriptomic data analyzed through the CIBERSORT deconvolution algorithm. Flow cytometry was employed to assess the expression of Th17 cell, B cell, and macrophage markers in the kidney tissues of IgAN mice. In vivo animal experiments indicate that HDAC9 knockdown ameliorates renal injury and suppresses the immune system to reduce inflammation in IgAN mice. Transcriptome sequencing results suggest that HDAC9 knockdown may exert therapeutic effects on IgAN by regulating immune-inflammatory responses. Through immune infiltration analysis and single-cell data, we found that HDAC9 may modulate immune cells, particularly T cells, B cells, and macrophages. Flow cytometry further confirmed that HDAC9 knockdown effectively inhibits Th17 cell and B cell activation, as well as macrophage polarization towards the M2 phenotype in IgAN mice. The graphical abstract of this study is shown in Fig. 1. HDAC9 knockdown modulates immune responses and alleviates pathological damage in IgAN mice. HDAC9 may serve as a potential therapeutic target for IgAN.
Patient-reported outcomes (PROs) after total knee arthroplasty (TKA) are well-documented in Western populations, but long-term recovery and its determinants in multiethnic Asian populations remain poorly understood. We aimed to characterise 5-year WOMAC recovery after TKA and to identify patient, clinical, and surgical factors associated with the odds of improvement at each consecutive postoperative interval in a multiethnic Asian cohort. This registry-based cohort study used prospectively collected data from a tertiary hospital in Singapore. We included 4964 consecutive cases with osteoarthritis undergoing primary TKA between December 1, 2008, and December 31, 2023. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total and subscale scores, measured at baseline and at 6 months, 1, 2, and 5 years postoperatively. The mean (SD) total WOMAC score improved from 38.6 (15.1) at baseline to 7.5 (9.2) at 5 years. The greatest improvement occurred within the first 6 months (mean change, 27.6 points; P value < .001). In multivariable interval-specific analyses, older age (≥ 75 years; OR 0.55, 95% CI 0.39-0.79) and the presence of one or more comorbidities (OR 0.83, 95% CI 0.71-0.96) were independently associated with lower odds of long-term improvement. Interval-specific associations with ethnicity were also observed for pain and stiffness. In this large, multi-ethnic Asian cohort, TKA was associated with substantial and durable WOMAC improvements, primarily within the first 6 months. Interval-specific predictors of improvement were dominated by patient-level factors, notably age, comorbidity, and ethnicity, while surgical variables showed limited association. These findings support the potential value of patient-centred risk stratification and culturally responsive perioperative care in optimising long-term outcomes.
Developmental dysplasia of the hip remains a preventable yet underdiagnosed condition. Conventional screening strategies that rely on physical examination demonstrate limited sensitivity and fail to achieve comprehensive population coverage. Although universal ultrasound screening has shown promise, evidence supporting scalable, sustainable, and nurse-led community-based implementation models within real-world public health systems remains limited. To evaluate a nurse-led community-based ultrasound hip screening program integrated into routine maternal and child health services in Japan using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. A prospective cohort study with a mixed-methods design. Three rural Japanese municipalities (February 2024 to August 2025). Public health nurses, midwives, infants, and their caregivers who underwent routine newborn home visits or child-rearing consultations in the participating municipalities. The existing maternal and child health services evaluated across the following dimensions: Reach (coverage rate); Effectiveness (the proportion and mean age of infants referred early to medical institutions, and caregiver-reported outcomes following referral); Adoption (nurse adoption rate); Implementation (the proportion of ultrasound images meeting Graf's criteria, examination time, operational challenges, and cost); and Maintenance (continuation and policy integration). Ultrasound images were uploaded to a secure encrypted cloud server and interpreted remotely by Graf-certified pediatric orthopedic surgeons, with structured feedback provided to nurses throughout the implementation process. A total of 818 examinations were performed in 349 infants. The estimated coverage rate was 95.6%, indicating a near-universal range. Standard-plane images meeting Graf's criteria were obtained in 85.8% of examinations. Non-Type I hips accounted for 8.7% of cases, and 7.0% of infants were referred for further evaluation. Of these referred infants, 97.6% visited medical institutions, 54.8% required continued follow-up, and 4.8% required treatment. Adoption was high, with 95.5% of trained nurses conducting screenings. Implementation challenges included infant positioning, data-upload errors, and limited digital integration; however, interprofessional feedback from orthopedic surgeons improved technical performance. Ultrasound visualization enhanced caregiver understanding and facilitated timely adherence to referral recommendations. All municipalities continued screening, demonstrating strong maintenance. Nurse-led ultrasound hip screening can be feasibly integrated into routine maternal and child healthcare systems. This model enables early identification of suspected developmental dysplasia of the hip without clinical signs, and offers an equitable approach in resource-limited settings from a precision public health nursing perspective. University Hospital Medical Information Network Clinical Trial Registry; UMIN000051929 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000059248). Registration date: September 16, 2023. Start of recruitment: November 01, 2023. Nurse-led community ultrasound hip screening achieved 95.6% coverage, and 8.7% of the screened infants had a suspected dislocation or hip dysplasia.
Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue malignancy with non-specific imaging features. We present a case of a 57-year-old woman with a right axillary mass to highlight the diagnostic value of advanced ultrasound techniques. Conventional ultrasound showed an irregular, vascularized hypoechoic mass. Contrast-enhanced ultrasound (CEUS) revealed early centripetal hyperenhancement and rapid washout, suggesting malignancy. Super-resolution ultrasound (SR-US) further characterized the lesion's disorganized microvascular architecture, providing insights beyond conventional imaging. The diagnosis was confirmed pathologically. This case underscores how integrating CEUS and SR-US aids preoperative assessment of LGFMS by delineating tumor vascular patterns unavailable through standard imaging.
Di(2-ethylhexyl) phthalate (DEHP) is a widely used industrial plasticizer, raising global concerns due to its potential endocrine-disrupting effects and environmental persistence. Human exposure to DEHP primarily occurs through the ingestion of contaminated food and water, inhalation of airborne particles, and dermal contact with products containing DEHP. Understanding the toxicological mechanisms of DEHP is essential for evaluating its health risks and developing effective strategies to mitigate its adverse effects. In this study, we conducted long-term exposure experiments to DEHP using both an animal model and in vitro system to investigate the complex interplay among DNA methylation, hyperactivation of macroautophagy/autophagy, mitochondrial dysfunction, and lipid accumulation induced by DEHP. The results revealed that DEHP exposure induced the degradation of DNMT1 (DNA methyltransferase 1) by enhancing its interaction with the autophagy-related protein SQSTM1 (sequestosome 1). DNMT1 degradation resulted in decreased methylation of the promoter regions of genes associated with autophagosome formation, subsequently increasing their expression. The resulting demethylation excessively activated autophagy, contributing to mitochondrial dysfunction and lipid accumulation in the liver. This study uncovered a previously unrecognized interplay among hyperactivation of autophagy, mitochondrial dysfunction, and lipid accumulation in the context of DEHP exposure. These findings enhanced our understanding of DEHP's toxicity and underscored concerns about the long-term health effects of environmental pollutants, particularly regarding metabolic diseases.
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The World Health Organization has identified ST23 carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) as a critical public health threat. Through China's national surveillance system (BRICS), we identified and characterized ST23 CR-hvKP bloodstream isolates from 2019-2023. Among 1069 CRKP bloodstream isolates, four ST23-K1 strains (0.37%) were detected across two hospitals, including a nosocomial transmission pair (differing by only 2 core SNPs). Clinical outcomes revealed that three of the four patients achieved recovery following appropriate antibiotic therapy, with one mortality case attributed to underlying comorbidities. All four ST23 isolates demonstrated resistance to multiple antibiotics, indicating a pattern of multidrug resistance. Genomic analysis uncovered diverse resistance mechanisms: the nosocomial transmission pair possessed conjugative IncFIIK2 NDM-1 plasmids, while the others harbored conjugative IncFIIK34 KPC-2 plasmids, which exhibited reduced carbapenem resistance attributed to the downregulation of blaKPC-2 expression. Conjugation assays revealed high transferability (10-5 for IncFIIK2 NDM-1; 10-4 for IncFIIK34 KPC-2). Whole-plasmid comparative genomics analysis suggested that the IncFIIK2 NDM-1 plasmids shared > 99% identity with historical IncFIIK2 plasmid backbones from Chinese K. pneumoniae isolates (2014-2022), suggesting local evolution. Notably, only 4.4% (26/590) of global IncFIIK2 plasmids carried blaNDM-1 and all IncFIIK2 NDM-1 plasmids maintain conjugative potential. All strains harbored conserved virulence plasmids and maintained hypervirulence, as indicated by a mouse infection model, with the exception of one strain that exhibited cps mutations. This study reports the first genomic evidence of a high-frequency conjugative IncFIIK2 NDM-1 plasmid in a hospital-transmitted ST23 CR-hvKP clone, highlighting the need for plasmid-focused surveillance to control this potential threat.
The coach-athlete relationship is central for the development and well-being of adolescent athletes, but the mechanisms underlying this relation are underexplored. Learning life skills may explain these underlying mechanisms; therefore, understanding this line of inquiry can help optimize the coaching process and life skill development. Given this context, this study aims to analyze how the interactions between coaches and adolescent athletes are associated with well-being, as well as understand the statistical mediating role of life skills. A total of 312 Brazilian adolescent athletes participated, completing measures assessing the coach-athlete relationship, life skills and well-being. The paths (coach-athlete relationship → life skills → well-being) were tested using structural equation modeling. As a result, life skills showed a statistical indirect association accounting for 45.7% of the variance explained in the association between the coach-athlete relationship with well-being. Among the dimensions associated with the coach-athlete relationship, commitment emerged as a significant correlate of all life skills. Moreover, complementarity showed a direct association with all three well-being domains. Additionally, closeness showed a specific direct association only with psychological well-being. With regards to life skills, goal setting was positively associated with all three well-being domains, whereas emotional skills showed a negative association, suggesting that they may function as a marker of prior adversity. Taken together, the coach-athlete relationship is not a monolithic construct; its dimensions show functional specificity in their associations. From an applied standpoint, sport-based programs should prioritize building a relationship of commitment as a foundational element to support the intentional teaching of skills.
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To examine sociodemographic, clinical, and healthcare-related factors associated with preoperative health-related quality of life (HRQoL) among patients undergoing surgery for degenerative lumbar spine conditions in a multi-ethnic Asian population. This cross-sectional study used baseline data from the Spine PROM Surgery Registry, including 1194 patients scheduled for surgery within a Singapore healthcare cluster between 2017 and 2022. HRQoL was measured using the EQ-5D-3L, with utility scores crosswalked to the EQ-5D-5L index using the van Hout crosswalk. Hierarchical linear regression assessed factors associated with HRQoL across three blocks: sociodemographic, clinical, and healthcare/lifestyle. Multivariable logistic regression identified factors associated with reporting problems within each EQ-5D dimension. Mean age was 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities problems (84.3%) were most commonly reported. Lower EQ-5D scores were independently associated with non-outpatient presentation (β = -0.37), non-Chinese ethnicity (e.g., Malay: β = -0.10), secondary education (β = -0.15), and accident/trauma history (β = -0.11). Dimension-level analyses showed secondary education was associated with higher odds of problems in mobility (OR = 2.72), self-care (OR = 1.87), usual activities (OR = 1.80), and anxiety/depression (OR = 1.97). Non-outpatient presentation was associated with markedly higher odds of self-care problems (OR = 2.98). Patients awaiting lumbar spine surgery appear to have impaired preoperative HRQoL. Although the modest explained variance limits robust risk prediction, preoperative profiles may still help inform clinical discussions and shared decision-making. Non-outpatient presentation may help identify patients who could benefit from enhanced preoperative support, although this requires prospective validation. Differences by ethnicity and education suggest opportunities for culturally tailored counselling. EQ-5D dimension profiles may indicate targets for prehabilitation and provide Singapore-based benchmark data for a lumbar spine surgery cohort for patient-centred care, service benchmarking, and health technology assessment. Low back pain is a common reason why people lose the ability to work, move, and take part in daily life. Many patients with long-lasting back problems eventually need surgery, but their quality of life before surgery can vary widely. Understanding how patients feel and function before surgery is important for planning care, setting expectations, and deciding who may need extra support. This study looked at how good or poor quality of life is in patients waiting for surgery for degenerative lumbar spine conditions, and which personal, social, and clinical factors are linked to worse quality of life. We studied over 1100 patients in Singapore using a standard health questionnaire that measures mobility, self-care, daily activities, pain, and mental wellbeing. This allowed us to examine both overall quality of life and specific problem areas. We found that patients had substantial problems before surgery, especially with pain and daily activities. Quality of life did not differ by diagnosis, but was worse in patients who entered care through emergency or inpatient routes, and in some ethnic and educational groups. These findings suggest that identifying patients with poorer preoperative quality of life may help clinicians tailor support and plan care before surgery.