Medical graduates must integrate new scientific findings into clinical practice requiring strong scientific training. In Germany, scientific education in medical curricula is often undervalued, necessitating curricular changes. This study evaluates medical students' current scientific training, perceived and objective knowledge, and their preferences for curricular organisation. A nationwide cross-sectional study was conducted using an online survey distributed to medical students across 45 German medical schools. The survey, conducted from March to May 2023, covered scientific education aspects including self-assessment of scientific skills and an optional 25-item knowledge competency test. Data were collected from 3005 students, with 1319 completing the full competency test. Only 53.8% of students were aware of their scientific curriculum, and over 60% reported no evaluation of their scientific skills at their universities. In their final year, 52.7% felt competent in literature search, and 44.1% in scientific writing. However, only 19.9% felt competent in study design, 25.7% in developing research projects, and 19.8% in applying findings to patient care. The average competency test score for final-year students was 16 out of 25, with notable deficiencies in empirics and practical applications. At least 62.2% of students expressed a desire for more scientific training, and 71.3% favoured mandatory scientific courses. German medical students are dissatisfied with their current scientific education with 75% expressing dissatisfaction. They feel unprepared to apply scientific knowledge in clinical settings. The study highlights the need for urgent curricular reforms to enhance practical scientific training and better prepare future physicians for modern medical practice and research.
As third-year medical students transition into high-stakes, high-stress clinical environments like the emergency department (ED), they may experience significant personal trauma. However, little is known about how this trauma is experienced early in their training - specifically during the transition from preclinical to clinical learning environments. This study addresses that gap by exploring third-year medical students' experiences of trauma during the emergency medicine (EM) clerkship through the lens of Trauma-Informed Care (TIC) and identifies workplace factors and intersectional demographics influencing these experiences. This qualitative study used the critical incident technique to explore emotionally-significant events encountered by third-year medical students immediately after completing the EM clerkship as their first core clerkship at a single academic institution. We conducted a thematic analysis using the Substance Abuse and Mental Health Services Administration's six TIC principles. Data were triangulated with quantitative demographic data, and data saturation was confirmed through constant comparison and reflexive team discussions. Seventeen students participated, describing 19 critical incidents of trauma. The most common trauma types involved lack of peer support and lack of empowerment or voice. Intersectional factors such as race, gender, and age shaped both the type and nature of trauma. Clinical uncertainty, power differentials, and unprofessional behavior emerged as frequent triggers. Applying a trauma-informed framework to medical education reveals how structural and interpersonal factors contribute to student trauma when they transition to the clinical learning environment. These findings highlight opportunities for trauma-informed clerkship design and structured support to create safer, more inclusive learning spaces. Not applicable.
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.
Severe acute malnutrition (SAM) affects millions of children globally, and treatment coverage remains below 30% in many settings, including Ethiopia. Although the Community-Based Management of Acute Malnutrition (CMAM) program has expanded nationwide, persistent service gaps remains, partly due to insufficient evidence for accurate cost estimation and budgeting. To address this gap, this study estimated the total economic cost, including provider-side financial and caregiver costs, of treating SAM through the CMAM program in two operational areas of Action Against Hunger, Ethiopia, and identified major cost drivers. A cross-sectional cost analysis was conducted in Girawa district (Oromia Region) and Adadle district (Somali Region) in 2024 from a societal perspective, including both provider-side financial and caregiver costs. Provider-side financial costs include personnel, medical supplies, therapeutic foods, equipment, transport and storage, and training and supervision. Caregiver costs include both direct costs (transport, food, and hospitalization-related expenses) and indirect costs (lost income and coping strategies). Provider-side financial costs were extracted and estimated using the FANTA CMAM costing tool. The tool automatically generated total cost per district, and the provider-side financial cost per SAM child was calculated by dividing total annual provider-side financial expenditure by the number of SAM cases treated. Caregiver costs were collected through structured exit interviews, analyzed using Excel, and summarized as mean cost per treatment episode. The mean caregiver cost was added to the provider-side financial cost to estimate the total economic cost per SAM child. The total annual provider-side financial cost for SAM treatment was USD 386,598 in Girawa district and USD 289,433 in Adadle district. Supplies, particularly RUTF and therapeutic milk, constituted the largest cost category in Girawa (57.7%), whereas repeated SAM-specific training and supervision represented the major share in Adadle (40.9%). The average provider-side financial cost per SAM child was USD 171.1 in Girawa and USD 325.2 in Adadle. The average caregivers incurred cost per SAM episode was USD 53.55. The total economic cost per SAM child, including caregiver expenses, was USD 224.65 in Girawa and USD 378.75 in Adadle. There is substantial variation in the cost of delivering SAM treatment across districts, highlighting the importance of context-specific district-level cost analyses. SAM-specific supplies and training intensity were the primary cost drivers. The incorporation of the household economic burden highlights an important but often overlooked dimension of treatment costs. These findings provide realistic district-level unit costs that can directly guide partners and governments in estimating resource needs for annual response plans while strengthening CMAM budgeting, planning, scaling up in Ethiopia.
Multiple Choice Questions (MCQs) remain the most widely used written assessment format in health professions education due to their efficiency and reliability; however, their susceptibility to cueing raises concerns regarding their authenticity in assessing true knowledge. Very Short Answer Questions (VSAQs) have emerged as a promising alternative that reduces cueing effects and requires learners to generate responses with greater cognitive engagement, while retaining the logistical advantages of computer-marked assessments. This systematic review and meta-analysis evaluates the comparative performance, discrimination, reliability, and practice effects of VSAQs versus MCQs. Following PRISMA guidelines (31), a systematic search identified studies comparing VSAQs and MCQs in undergraduate and postgraduate health professions education. Data extraction and risk of bias assessment were conducted independently by two reviewers, with disagreements resolved through consensus. Mean scores, standard deviations, discrimination indices, and reliability coefficients were extracted. Standardized Mean Differences (SMD) were pooled using a random-effects model. Psychometric indices were transformed using Fisher's z-scores. Heterogeneity was quantified using the I² statistic, and sensitivity and subgroup analyses were performed to explore the impact of outliers. Six cohorts (n = 1,191) derived from three included studies contributed data for score comparisons. The initial pooled analysis showed no significant difference between VSAQs and MCQs (SMD = - 0.52; 95% CI - 1.34 to 0.30), with extreme heterogeneity (I² = 98%). Sensitivity analysis identified Dhok et al. (2023) as an outlier. Excluding this dataset yielded a significant effect favoring MCQs (SMD = - 0.86; 95% CI - 1.01 to - 0.70; p < 0.00001) with markedly reduced heterogeneity (I² = 4%). Meta-analysis of psychometric properties demonstrated strong discrimination (pooled Fisher's z = 1.45) and acceptable reliability (pooled Fisher's z = 0.43) for VSAQs. Evidence on practice effects was mixed, with no consistent advantage for either format. VSAQs exhibit strong psychometric integrity and are designed to reduce the cueing effect observed in MCQs. Although associated with lower student scores, VSAQs likely provide a more accurate reflection of independent knowledge and clinical reasoning ability. Their integration into medical assessment systems may enhance the authenticity and validity of written examinations.
The China-ASEAN regional medical procurement platform was launched in early 2025. However, the scope and operational mechanisms of the platform remain unclear. This study aims to assess medicine prices and affordability in China and ASEAN countries, explore potential implementation challenges of the platform, provide policy suggestions. We selected commonly used medicines from four ATC categories (alimentary tract and metabolism, cardiovascular system, anti-infective for systemic use, nervous system). Prices were standardized to WHO defined-daily-dose (DDD) prices and converted into median price ratio (MPR) using Management Sciences for Health (MSH) international reference prices (IRP). All prices data were collected from official public sources and converted to US dollars using the official 2024 annual average exchange rate. Affordability was estimated the number of days' statutory gross daily minimum wages required to purchase one DDD, with wage data obtained from the International Labor Organization (ILO). Descriptive statistics were performed. A total of 68 medicines were included, with 68, 68, 60, and 59 available in China, Thailand, Indonesia, and the Philippines, respectively. Median MPRs were 0.88 (IQR:0.46-3.49), 0.97 (IQR:0.50-2.20), 1.69 (IQR:0.77-3.16), 1.86(IQR:0.72-5.03), respectively, and 45.6%, 45.6%, 61.7%, and 67.8% of medicines were priced above the IRPs. Prices varied widely across and within countries. For cardiovascular medicines, median MPRs exceeded the IRPs in China 1.72(IQR:0.53-6.30), Indonesia 1.79(IQR:0.78-2.80), the Philippines 2.85(IQR:1.31-6.43), while Thailand achieved a lower price of 0.78(IQR:0.31-1.37). The overall affordability was higher in China, Indonesia and Thailand, where one DDD of medicine required less than 6% of a day's wage, with median values of 4.8% (IQR:2.5%-19.3%), 5.1% (IQR:2.3%-9.6%), and 3.6% (IQR:1.8%-8.1%), respectively, compared with 14.0% (IQR:5.4%-37.7%) in the Philippines. Sensitivity analysis excluding extreme affordability values yielded similar results. Our findings suggest that understanding cross-country disparities in medicine prices and affordability may help inform the design of future regional purchasing strategies. Realizing the benefits of such joint procurement will require strong political commitment to establish a legal framework, enhance price transparency, harmonize regulations, and strengthen supply chains to ensure the platform's effectiveness and sustainability.
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.
Adolescents living with HIV demonstrate suboptimal adherence to antiretroviral therapy compared with adults. This significantly impedes progress toward achieving the UNAIDS 95-95-95 targets. Understanding the relationship between self-reported adherence and virological outcomes among this population is essential for guiding treatment monitoring strategies and intervention development in resource-limited settings. A cross-sectional study was conducted among 515 adolescents aged 10 to 19 years living with HIV and receiving ART at seven health facilities in the Ashanti Region of Ghana between August and November 2023. Self-reported adherence was measured using the adapted AIDS Clinical Trials Group 4-day recall questionnaire combined with items from the LifeWindows Information-Motivation-Behavioral Skills adherence questionnaire. Viral load data were extracted from medical records. Spearman's rank correlation was used to examine the relationship between adherence rates and viral load outcomes. The mean adherence rate was 92% (SD = 18.93). Males comprised 49.5% of participants and females 50.5%, with a mean age of 15.44 years (SD = 2.62). Most participants (67.9%) lived with parents, and 98% had low to middle economic status. The mean number of missed doses showed an ascending pattern across the four-day recall period: 0.056 (Day 1), 0.075 (Day 2), 0.077 (Day 3), and 0.093 (Day 4). Spearman's rank correlation revealed a weak negative correlation between adherence rate and viral load (rs = -0.052, p = 0.235, 95% CI: -0.141 to 0.037), which was not statistically significant. Among participants, 323 (62.7%) achieved viral suppression, while 192 (37.3%) did not. Despite high self-reported adherence levels, the weak and non-significant correlation with virological outcomes raises important validity concerns regarding self-reported adherence as a proxy measure for viral suppression among adolescents in this setting. The temporal mismatch between four-day adherence recall and longer-term viral load measurements may partly explain this discordance. Findings underscore the need for objective adherence measures, routine viral load monitoring, and adolescent-specific interventions that address psychosocial barriers affecting both adherence behavior and its biological impact.
The association between preoperative peripheral nerve block (PNB), major adverse cardiovascular events (MACE), and postoperative length of hospital stay (LOS) in elderly patients who underwent major thoracic and abdominal surgery remains unclear. This study aims to explore the potential mediating effect of MACE on the association between preoperative PNB and postoperative LOS using a statistical mediation framework. In this retrospective cohort study, perioperative data were collected from elderly patients (aged over 65 years) who underwent major thoracic and abdominal surgery. Mediation analysis was employed to examine the relationships between PNB, MACE, and postoperative LOS. A total of 1915 patients were included in the analysis, with 68.7% (1316/1915) receiving preoperative PNB. Compared to patients who did not receive PNB, those who did had a significantly lower incidence of MACE (P < 0.001) and a shorter postoperative LOS (P < 0.001). The adjusted total and direct associations of PNB with postoperative LOS were - 0.809 days (95% confidence interval [CI], -1.236 to -0.390; P < 0.001) and - 0.661 days (95% CI, -1.077 to -0.250; P = 0.003), respectively. A statistically significant indirect association via MACE was observed (adjusted β=-0.149 days; 95% CI, -0.271 to -0.060; P < 0.001), indicating that 18.1% (95% CI, 6.7% to 41.0%) of the total association was statistically attributable to the indirect pathway through MACE under the model assumptions. A sensitivity analysis excluding postoperative covariates yielded consistent results (proportion mediated: 25.3%). Our findings suggest that the observed association between preoperative PNB and reduced postoperative LOS in elderly patients following major thoracic and abdominal surgery may be partly explained by a statistically significant indirect pathway through a reduction in MACE, potentially accounting for approximately 18% of the total effect. These findings are hypothesis-generating and represent statistical associations rather than demonstrated causal mechanisms. ChiCTR2400087610; https://www.chictr.org.cn.
To investigate the current status and dyadic mechanism of maternal and spousal role adaptation for postpartum anxiety and depression. Convenience sampling was employed to select 276 pairs of mothers and their spouses from October 2023 to October 2024 as study participants. Binary analyses were conducted using the actor-partner interdependence model (APIM) and the mediation model. The prevalence rates of anxiety and depression during the first postpartum year were 38.5% and 14.5% among mothers, and 36.9% and 12.9% among their spouses, respectively. The APIM revealed that maternal and spousal role adaptation significantly and negatively predicted their own postpartum anxiety (maternal actor effect: β = -0.120; spousal actor effect: β = -0.081) and depression (maternal actor effect: β = -0.165; spousal actor effect: β = -0.113), and that role adaptation similarly predicted each other's anxiety (maternal partner effect: β = -0.115; spousal partner effect: β = -0.059) and depression (maternal partner effect: β = -0.129, spousal partner effect: β = -0.064). Mediation analyses suggest that future time insight and parenting competence mediate this process. Postpartum anxiety and depression serve as a dyadic phenomenon, where maternal and spousal role adaptation significantly affects mental health outcomes. Future time insights and feelings of parenting competence serve as mediating variables in the relationship. Not applicable.
Home environments shape children's dietary habits, but which factors are most influential is unclear. The study purpose was to identify factors in the home environment associated with child intake of fruit and vegetables (FV) and sugar-sweetened beverages (SSBs) using a national dataset collected in 2013-2015 in the U.S. Data from 5,138 school-aged children (4-15 years old) from 130 U.S. communities were collected in 2013-2015. Parents and/or children completed a dietary screener and additional survey questions to assess household socioeconomic status (SES), grocery shopping sources, home food availability, social support for healthy eating, eating out frequency, and other home eating and related behaviors. Other child characteristics included breastfeeding history, intake of school foods, and participation in other nutrition programs. Community variables included predominant race/ethnicity and SES. Classification and regression trees (CART) identified key predictors of intake. The FV and SSB CARTS had 14 and 12 terminal groups, respectively. Children with the highest FV intake (0.54 SD from mean cups/day; 13% of sample) had fruit more often available at home, dark green vegetables more often available at home, ate dinner with family more often, had SSBs less often available at home, and were breastfed longer. Conversely, children in the two groups with the lowest FV intake either had fruit less often available at home, and family never complimented their eating (-0.86; 2%), or they had family that rarely or sometimes complimented their eating, and perceived school lunches as unhealthy (-0.87; 1%). For SSB intake, the lowest consumers (-0.63 SD from mean tsp/day sugar; 17%) never or rarely had SSBs available at home, and lived in higher SES communities. Children in the two groups with the highest SSB intakes had SSBs available at home more often, and lived in a SNAP-participating household and either ate out less often, used a phone/computer for social networking, and had SSBs available at home very often (1.3; 1%), or they ate out more often, and were breastfed for a shorter duration (1.1; 5%). Home availability of FV and SSBs were the most salient predictors of intake of both FV and SSBs, while other predictors differed between FV and SSB intake. Study findings highlight several actionable home-environment strategies to test in future studies to improve school-aged children's diets.
This study investigates how emotional intelligence mediates the link between future temporal orientation and depressive symptoms in university students and explores whether physical activity moderates this connection. Data were collected from 1,014 undergraduate students (490 males and 524 females) across three universities in Fujian Province, China, between 1 March and 5 July 2024. Participants were selected via random sampling and completed the Future Time Perspective Scale, Emotional Intelligence Scale, Physical Activity Rating Scale, and Epidemiologic Studies Depression Scale. Statistical analyses included Pearson's correlation, linear regression, and moderated mediation analysis (PROCESS Model 7) using SPSS 22.0. (1) Future time perspective significantly and negatively predicted depression (β = -0.32, p < 0.001). (2) Emotional intelligence partially mediated the association between future time perspective and depression (indirect effect = -0.11, SE = 0.02, 95% CI [-0.15, -0.08]). (3) Physical exercise moderated the first-stage path of the mediation model (FTP → EI). Simple slope analyses showed that the FTP-EI association was significant at both low (M - 1 SD) and high (M + 1 SD) levels of physical exercise, but was stronger at high physical exercise (simple slope: β = 0.41, p < 0.01) than at low physical exercise (simple slope: β = 0.25, p < 0.01). Future time perspective influences depression both directly and indirectly through emotional intelligence. Additionally, physical exercise enhances the predictive effect of future time perspective on emotional intelligence, suggesting that active individuals exhibit a stronger link between future-oriented thinking and emotion regulation.
Tanzania has adopted artificial intelligence (AI)-assisted chest X-ray screening for tuberculosis (TB), including the use of CAD4TB version 6, which is registered by the Tanzania Medicines and Medical Devices Authority (TMDA). While GeneXpert, practical reference standard used in routine practice, remains the primary bacteriological confirmatory test in routine practice, there is currently no established national threshold for CAD4TB use in either active case finding (ACF) or passive case finding (PCF) settings. This study evaluates the implementation and operational use of CAD4TB version 6 within mobile TB screening units in Tanzania and highlights challenges affecting its effective use. We conducted a retrospective analysis of screening data from 11,923 individuals collected from mobile clinics equipped with digital X-ray, CAD4TB version 6, and GeneXpert systems. Comparisons were made between manual chest X-ray interpretation, CAD4TB scores, and GeneXpert results within the subset of individuals who underwent confirmatory testing. The findings reveal substantial inconsistencies in screening workflows, including non-uniform use of CAD4TB prior to GeneXpert testing, missing radiological records, and deviations from intended protocols across sites. Descriptive analysis showed that CAD4TB scores generally aligned with GeneXpert-positive cases within the tested subset; however, due to selective application of GeneXpert and incomplete data, these observations cannot be interpreted as measures of diagnostic accuracy. This study should be interpreted as an implementation and operational assessment of AI-assisted TB screening rather than a diagnostic accuracy or threshold-setting study. The findings highlight important gaps in protocol adherence, data completeness, and workflow standardization, underscoring the need for prospective, protocol-driven studies to establish validated national thresholds for CAD4TB use in Tanzania.
Traumeel (Tr14) and diclofenac gels are commonly prescribed topical treatments for Grade I-II acute lateral ankle sprain (LAS). A meta-analysis of two multi-center trials was performed to compare their clinical efficacy and supplement the evidence in support of topical treatments. Data from two Phase III prospective, randomised, double-blind, reference-controlled clinical trials, TAASS (2013) and TRAUMED (2024) were examined. An Individual Patient Data (IPD) meta-analysis was performed on those with an initial pain VAS (Visual Analogue Scale) score ≥ 50 mm, using the statistical analysis plan from the latter to ensure methodological consistency. A total of 628 patients underwent meta-analysis (mean baseline pain VAS = 72.3, mean age = 32.5). The primary endpoint of the IPD meta-analysis, Area Under the Curve (AUC) of pain VAS scores, indicated beneficial effects of Tr14 gel compared with diclofenac gel, statistically significant on Days 4, 7, and 14 (Day 4 mean difference MDAUC-META = -6.9 [95%CI -13.7 to -0.1], PAUC-META = 0.05; Day 7 MDAUC-META = -26.3 [95%CI -40.4 to -12.2], PAUC-META = 0.0003; Day 14 MDAUC-META = -63.6 [95%CI -92.3 to -34.8]), PAUC-META < 0.0001). A robust Wilcoxon-Mann-Whitney (WMW) analysis revealed percent changes from baseline in pain and function that were significantly superior for Tr14 gel in the pre-planned method of synthesis, compared to diclofenac gel, on all days (all PMETA < 0.05). Finally, translational effect sizes indicated less than "small" superiority on Day 4 (SMD 0.15, OR 0.78, NNT 23), and "small-medium-sized" superiority on Days 7 and 14 (Day 7: SMD 0.31, OR 0.59, NNT 12; Day 14: SMD 0.37, OR 0.53, NNT 10) for pain measured by VAS, as compared to diclofenac gel. The IPD meta-analysis of the TAASS and TRAUMED trials confirms the efficacy of Tr14 gel. In-depth analysis reveals it is a statistically favourable treatment with respect to pain, and function, compared to the gold-standard diclofenac gel. Taking this together, Tr14 gel represents a statistically favourable treatment option for Grade I-II ankle sprain within the context of the analysed endpoints.
Acute Coronary Syndromes (ACS) remain a major cause of morbidity and mortality, particularly in resource-limited settings where access to advanced diagnostics may be constrained. This study aimed to evaluate the utility of routine hematological indices and leukocyte morphometric parameters-volume, conductivity, and scatter (VCS)-as low-cost adjuncts for identifying ACS and differentiating its subtypes. This cross-sectional study included 291 adults (151 ACS patients and 140 healthy controls) evaluated between January 2022 and August 2023. Compared with controls, ACS patients had significantly higher total leukocyte counts, lower hemoglobin levels, increased mean platelet volume (MPV), reduced neutrophil conductivity (MN-C-NE), and increased monocyte scatter parameters (MN-LALS-MO, MN-AL2-MO) (all p < 0.01). On L1-regularized multivariable logistic regression, elevated WBC count, reduced hemoglobin, increased MPV, decreased neutrophil conductivity, and increased monocyte scatter indices independently predicted ACS. The combined model demonstrated excellent discriminatory performance (AUC 0.98 ± 0.02). However, discrimination between ACS subtypes was limited, with poor performance for differentiating STEMI from unstable angina and NSTEMI (AUC 0.63-0.65, p > 0.05). These findings suggest that hematological and VCS parameters are effective for identifying ACS but have limited utility in subtype differentiation.
Prostate cancer mortality trends and spatial clustering in Kazakhstan over the last two decades require detailed national and regional assessment using time-trend and spatial statistics.​ METHODS: A nationwide population-based observational study evaluated prostate cancer deaths (ICD-10 C61) among men in Kazakhstan from 2005 to 2024, calculating crude and age-standardized mortality rates, assessing temporal changes using joinpoint regression, and identifying spatial hot spots/cold spots using Getis-Ord Gi* across five predefined periods (2005-2012, 2013-2017, 2018-2019, 2020-2021, 2022-2024). A total of 7,411 deaths were recorded; the overall crude mortality rate (CMR) was 4.44 per 100,000 men and the age-standardized mortality rate (ASMR) was 6.54 per 100,000 men, with deaths concentrated in ages 65-79 (65-69: 19.2%; 70-74: 22.3%; 75-79: 18.9%) and age-specific mortality peaking at 103.04 per 100,000 in ages 80-84. National joinpoint analysis identified a statistically non-significant, essentially stable trend from 2005 to 2019 (annual percent change [APC] 0.7%, p = 0.397), followed by a statistically significant accelerated decline from 2019 to 2024 (APC =-8.4%, p < 0.001), with an overall average annual percent change (AAPC) of -2.8% (p=0.004) for 2005-2024. Regional ASMR varied substantially (3.1 per 100,000 in Kyzylorda to 10.5 per 100,000 in Almaty city), and mean regional ASMR decreased from 6.57 (2005-2012) to 4.30 (2022-2024) with shifting hot spot/cold spot patterns across periods. Prostate cancer mortality in Kazakhstan declined significantly over 2005-2024, but substantial and evolving geographic disparities persisted, supporting the need for continued surveillance and targeted regional cancer-control actions.
Direct anterior approach total hip arthroplasty (DAA THA) has become increasingly popular due to its muscle-sparing nature, but it remains technically challenging due to patient-specific anatomical variability. A comprehensive classification system for assessing surgical difficulty in DAA THA is lacking. This study aimed to develop a simple radiograph-based hip anatomic classification to estimate the difficulty of DAA THA. This retrospective cohort study analyzed primary, unilateral DAA THA performed by a single surgeon from January 2021 to December 2024. On preoperative radiographs, the horizontal offset distance (HOD) and the vertical offset distance (VOD) between the lateral-most iliac crest and the lateral-most greater trochanter were measured. Restricted cubic splines and receiver operating characteristic curves were used to determine HOD and VOD cutoffs for difficult DAA THA and defined four subtypes (Type A: low VOD/low HOD, Type B: low VOD/high HOD, Type C: high VOD/high HOD, Type D: high VOD/low HOD). Perioperative, radiographic, inflammatory, functional, and complication outcomes were compared using one-way analysis of variance, chi-square and other statistical methods. Subgroup analyses were performed to assess generalizability. HOD and VOD showed weak, nonlinear inverse associations with operative time. Four subtypes were defined using the optimal cutoffs (HOD = 6.25 mm; VOD = 126.95 mm). Type A had the longest operative time and a less favorable perioperative profile, whereas Type C had the shortest operative time, less total blood loss, more frequent cups within Lewinnek safe zones, and better early functional recovery. This novel iliofemoral classification stratifies DAA THA technical difficulty and early outcomes and may support preoperative risk stratification and surgical planning.
Strengthening professional identity is crucial to mitigate nursing students' attrition and ensure a sustainable workforce. While the hidden curriculum and learning engagement are believed to influence this identity, their interrelationships remain unclear. This study aims to explore the relationship between hidden curriculum and professional identity and examine whether learning engagement mediates the relationship between hidden curriculum and professional identity. A cross-sectional study was conducted among 623 undergraduate nursing students from two medical colleges in China. The general information questionnaire, Hidden Curriculum Evaluation Scale in Nursing Education, Utrecht Work Engagement Scale-Student, and Professional Identity Scale for Nursing Students were used for data collection, and IBM SPSS 26.0 and PROCESS macro (Model 4) were used for statistical analysis. Hidden curriculum, learning engagement, and professional identity were significantly positively correlated. Learning engagement partially mediated the relationship between hidden curriculum and professional identity, accounting for 44.13% of the total effect. Nursing educators should proactively develop the hidden curriculum and implement strategies to boost learning engagement, thereby fostering students' professional identity and reducing future workforce attrition.
To evaluate the safety, etiological diagnostic value, and impact on clinical treatment decisions of transjugular liver biopsy (TJLB) and percutaneous liver biopsy (PLB) in patients with liver failure. This retrospective study included patients with liver failure who underwent liver biopsy between January 1, 2017, and November 30, 2025. Demographic characteristics, clinical data, post-procedural adverse events, and pathological diagnoses were collected and subjected to statistical analysis. A total of 53 patients with liver failure were included, comprising 40 patients with acute-on-chronic liver failure (ACLF) and 13 patients with acute or subacute liver failure. 13 patients received TJLB, all of whom had ACLF. Compared with the PLB, patients in the TJLB group had a higher international normalized ratio (INR) [1.61 (1.32, 1.98)], a lower platelet count (PLT) [89.00 (73.00, 129.00) × 10⁹/L], and were more frequently complicated by moderate to large ascites. Both PLB and TJLB were successfully performed, with a low overall complication rate and no serious adverse events. Even among patients with marked coagulation abnormalities or concomitant ascites, TJLB demonstrated acceptable safety. Histopathological examination following liver biopsy enables reclassification of both chronic liver disease etiologies and acute precipitating factors in patients with ACLF, as well as etiological diagnoses in patients with acute liver failure (ALF) or subacute liver failure (SALF). A substantial proportion of drug- or toxin-related acute liver injury was identified by histopathological examination (n = 32, 60%), leading to a decreased proportion of liver failure with unclear etiology. Based on the pathological diagnosis, treatment strategies were modified in 11% of patients, including the initiation or continuation of specific therapeutic regimens. In patients with liver failure, liver biopsy provides crucial information for determining the etiology and guiding clinical decision-making. With appropriate selection of the biopsy approach and patient population, TJLB can serve as a safe and feasible option, particularly for patients with coagulation disorders or severe ascites.
Deep learning methods have made great progress in the automatic segmentation of nasopharyngeal carcinoma, but challenges remain. Computer-aided automatic segmentation of nasopharyngeal cancer primary area is of great significance for automatic outlining of nasopharyngeal cancer target areas and accurate prediction of responsiveness and prognosis of metastatic lymph nodes in the neck after radiotherapy. In this paper, we use deep learning methods to construct an automatic segmentation network for gross target volume of nasopharynx, combine clinical factors and radiomics features to establish a radiomics nomogram model, which will then predict the final outcome of metastatic lymph nodes that have not achieved complete remission after radical radiotherapy. Clinical and IMRT radiotherapy plan CT data were retrospectively collected from 69 patients who received intensity-modulated radiation therapy between July 2014 and December 2016. These patients exhibited residual metastatic lymph node lesions without residual primary lesions on the first follow-up MRI and had continuous follow-up records. The median follow-up was 53 months (IQR 39.75-62.37), with 30 patients eventually regressing and 39 patients persisting or progressing. The ct images of 69 radiotherapy plans were randomly divided into training and test sets according to 8:2, and a fusion attention-based model was trained for automatic nasopharyngeal carcinoma segmentation. Based on the unet framework, a fusion attention model was proposed, and a 2·5 d convolutional neural network was used to deal with the anisotropy. An improved channel and spatial attention module is fused in the codec 4 layer to enable the network to focus on small targets. 2d interlaced sparse self-attention module is extended to 3d to better extract the feature information of the tumor target area and solve the problem of low contrast between the target area and the surrounding soft tissues, thus optimizing the overall segmentation effect. The performance of the segmentation model was evaluated using the mean dice coefficient, relative volume error (RVE), average symmetric surface distance (ASSD) and hausdorff distance (HD), using the target area of the primary lesion of nasopharyngeal carcinoma manually outlined by a senior radiation therapy specialist as the gold standard. Radiomics features were extracted using the pyradiomics package, and the classification performance of the radiomics model was assessed by the area under the curve of the receiver operating curve (ROC). The average dice coefficient, RVE, ASSD and HD of our model for nasopharyngeal carcinoma were 75.05%, 14.63%, 2.224 mm, and 8.75 mm, respectively, which were 11.01%, 26.34%, 3.101 mm, and 52.58 mm better than the baseline 3dunet model. The radiomic features were an effective predictor of tumor outcome in nasopharyngeal carcinoma, with the highest area under the receiver operating characteristic curve (AUC) of 0.892 for the radiomic nomogram in the training set and 0.825 for the radiomic model in the test set. The fused attention-based segmentation network for nasopharyngeal carcinoma can effectively and reliably segment the region of the primary nasopharyngeal carcinoma, and the radiomic nomogram can effectively predict the response after treatment.