Hidradenitis suppurativa (HS), an inflammatory skin disorder characterized by painful nodules and abscesses, has varying prevalence among different races/ethnicities. This study explored the social drivers of health, burden, and impact of HS among different racial and ethnic groups. An online, cross-sectional survey was conducted among adult patients with HS (September 2023-December 2023) in the USA. Patients were recruited through HS Connect (patient advocacy group) and AmeriSpeak (US national sample panel). Descriptive data were collected using patient-reported outcome measures and de novo questions about patients' disease knowledge and perception, healthcare access and utilization, impact on quality of life (QoL), and social impact. All analyses were descriptive and stratified by racial/ethnic groups. The study included 583 patients (mean age, 34.8 years; 95.5% female) representing a range of racial backgrounds: Black or African American (n = 273; 46.8%), white (n = 236; 40.5%), Two or More Races (n = 47; 8.1%), American Indian or Alaska Native (n = 18; 3.1%), Asian (n = 7; 1.2%), and Native Hawaiian and Other Pacific Islander (n = 2; 0.3%). Ethnic representation also varied (Hispanic/Latino = n = 76; 13.0%). Patients of all races and ethnicities reported considerable QoL impact (Dermatology Life Quality Index, EQ-5D-5L), with results for smaller subgroups (n < 10) included for descriptive completeness only and not intended for comparison with other groups. During flaring, most patients used over-the-counter products/medications (54.2%) or nonmedical intervention/home remedy (56.9%) Up to 36.5% of patients reported challenges in procuring food, utilities, medicine/healthcare, phone, clothing, or childcare when needed in the past year. Among those who paid out-of-pocket for their HS treatment, 55.6% reported that it stopped them from visiting a healthcare provider for treatment. The findings indicate a high burden and impact of HS across all races and ethnicities. Patients reported social drivers of health and challenges with healthcare utilization, indicating the need for integrating social workers and care management teams in dermatology practice, which could facilitate improved care of patients with HS. Hidradenitis suppurativa is a painful skin condition that causes lumps and abscesses. It affects people of all races and ethnicities but is more common in Black or African American individuals. This study surveyed 583 adults in the USA to understand how hidradenitis suppurativa affects people from different racial and ethnic backgrounds. Our focus was on how the disease impacts their daily lives, their ability to access healthcare, how often they visit doctors, their quality of life, and their mental and emotional well-being. Most people said that hidradenitis suppurativa lowers their quality of life and makes daily activities harder. During flaring, many used home remedies instead of seeing a doctor. People suffering from hidradenitis suppurativa also reported trouble getting basic needs such as food, medicine, and transportation. These challenges occurred among patients from different racial and ethnic groups; results for very small subgroups (Asian, Native Hawaiian/Other Pacific Islander) are reported descriptively only and should not be interpreted as representative of these groups or compared with other groups. The research underscores the importance of improving awareness and tailoring care for people with hidradenitis suppurativa, particularly those facing barriers to healthcare.
Group B Streptococcus (GBS) is a leading cause of early-onset neonatal sepsis (EOS). Intrapartum antibiotic prophylaxis (IAP) based on maternal GBS screening significantly reduces the incidence of neonatal GBS disease. We report a term neonate who developed early-onset GBS sepsis and meningitis despite a negative maternal GBS screening result obtained at 39 weeks of gestation. The infant presented with respiratory distress, poor feeding, and hypotonia shortly after birth. Blood culture confirmed GBS bacteremia, and cerebrospinal fluid (CSF) analysis supported concurrent meningitis. He was successfully treated with intravenous antibiotics, initially with penicillin and ceftazidime, then escalated to vancomycin for better central nervous system penetration following meningitis diagnosis, before de-escalation back to penicillin. Total antibiotic duration was 17 days. Cranial imaging revealed small hemorrhagic foci in the left centrum semiovale and periventricular area, which resolved on follow-up MRI. This case highlights the potential for false-negative maternal GBS screening and underscores the importance of clinical vigilance. Empirical antibiotic therapy for suspected neonatal sepsis should be considered based on clinical presentation, even when maternal screening is negative.
Pediatric femoral neck fractures require stable fixation to avoid complications. It remains unclear whether fixation with the Proximal Humeral Internal Locking System (PHILOS) can serve as an alternative to cannulated screw fixation. The purpose of this study was to compare the biomechanical properties of PHILOS and cannulated screws for stabilizing unstable pediatric femoral neck fractures using a synthetic bone model. Twelve fourth-generation synthetic composite femurs were randomly assigned to screw fixation (Group S) or PHILOS fixation (Group P) (n = 6 each). A standardized vertically oriented Delbet type II osteotomy was created in all specimens. Group S was fixed with three 6.5-mm cannulated screws, whereas Group P received a PHILOS plate with 3.5-mm locking screws. Each specimen underwent a standardized loading protocol using a universal testing machine. Axial stiffness, cyclic displacement, ultimate failure load, and failure modes were recorded and statistically compared between groups. No statistically significant difference was found in axial stiffness between Group P (746 ± 300 N/mm) and Group S (753 ± 256 N/mm) (p = 1.000). Displacement after cyclic loading was significantly greater in Group P (1.42 ± 0.3 mm) compared with Group S (0.57 ± 0.2 mm) (p = 0.004). The ultimate failure load was higher in Group S (2378 ± 513 N) than it was in Group P (1652 ± 206 N) (p = 0.025). Upon reaching ultimate load, all specimens in both groups failed at the femoral head region due to femoral head broken. The adult PHILOS plate with 3.5-mm locking screws demonstrated inferior biomechanical stability compared with three 6.5-mm cannulated screws in this synthetic composite femur model. Controlled laboratory study.
Diabetes is associated with a number of significant long-term effects. In this study we consider that purslane which possesses numerous of pharmacological properties, and metformin, an antidiabetic drug, may have a therapeutic effects on diabetes-induced memory impairments in rats. Forty male albino rats were randomly divided into five groups. Group I served as control group. The other four groups were first fed on HFD followed by a single interpretonial (i.p.) dose of STZ at a dose of (35) mg/kg then the groups were divided as following Group II diabetic group Group III, PEE group administered with oral dose of purslane ethanolic extract (100 mg/kg) for another four weeks. Group IV, MET group administered with oral dose of metformin (100 mg/kg) for another four weeks. Group V (PEE + MET) administered with oral dose of combination of both purslane ethanolic extract (50 mg/kg) and MET (50 mg/kg) for another four weeks. During the treatment rats were tested for memory and learning abilities (Morri's water maze test). Hippocampal samples were collected for biochemical, and histological measurements. Biochemical evaluation included (NO and TBARS) as an oxidative stress marker, (GSH, GPX, SOD, Catalase) as antioxidant, and inflammatory cytokines (tumor necrosis factor-α and interleukin-1β, interleukin-IL-6). Also, P-tau protein, (dopamine and GABA) as neurotransmitters, and for cholinergic system (acetylcholinesterase) were assessed, in addition to histological examinations of hippocampus. Diabetic rats showed a marked cognitive impairment in the Morris water maze test and alteration in the other biochemical and histological features. Intrestingly, PEE and MET treatments partially dramatically enhanced antioxidant levels. Also, reduced oxidative stress, pro-inflammatory mediators, and, phosphorylated tau levels. In addition, PEE and MET treatments partially modulated neurochemical profiles associated with memory function. The combined PEE + MET treatment showed the most pronounced improvement, reflecting synergistic effects. Individual data points highlighted consistent trends across animals. Also, it exhibited a significant restoration of normal hippocampal architecture, as confirmed by hematoxylin and eosin staining. The data obtained indicated that PEE, either alone or in combination with MET, has strong neuroprotective potential against STZ/HFD-induced diabetes. These safeguarding effects are probably because of its strong anti-inflammatory and antioxidant properties.
BACKGROUND This retrospective study aimed to radiographically compare injectable platelet-rich fibrin (I-PRF)-enriched bone graft matrix (sticky bone) with conventional particulate grafting during lateral sinus lift procedures performed simultaneously with implant placement in patients exhibiting insufficient posterior maxillary residual bone height. MATERIAL AND METHODS Twenty-four systemically healthy, non-smoking patients who underwent lateral sinus lift surgery between January 2014 and June 2023 were included. Patients were retrospectively allocated into groups according to grafting material: conventional particulate bone graft (group 1, n=12) and I-PRF-enriched bone graft matrix (sticky bone) (group 2, n=12). Radiographic bone height measurements were obtained using panoramic radiographs acquired preoperatively, immediately postoperatively, and at 6 months postoperatively. Measurements were conducted using calibrated digital software. Inter- and intragroup comparisons were analyzed via paired and independent samples t-tests, using a statistical significance threshold of P<0.05. RESULTS Immediate postoperative bone gain was significantly higher in group 1 than in group 2 (11.94 mm vs 10.15 mm; P<0.05). However, bone resorption at 6 months was significantly greater in group 1 than in group 2 (2.61 mm vs 1.07 mm; P<0.05). Bone loss percentage also was significantly higher in group 1 than in group 2 (16.50% vs 7.74%; P<0.05), indicating superior bone preservation in group 2. CONCLUSIONS Although conventional grafting resulted in greater initial bone gain, I-PRF-enriched bone graft matrix demonstrated significantly reduced bone resorption at 6 months. Sticky bone may provide a clinical advantage in bone preservation after sinus lift procedures.
The study presents experience in using a wound protector device named lap-protector during costal cartilage harvest in auricular reconstruction in order to improve outcomes, particularly final scar quality and length. The present study retrospectively comprised fifty-five patients who underwent costal cartilage harvesting for auricular reconstruction were admitted between June to August 2022. The author divided the patients into 2 groups according to whether the lap-protector was used or not: group 1 underwent costal cartilage with the minimal invasive conventional technique by using the lap-protector, while group 2 underwent the same procedure without. Patients were followed-up for a 6-months period. The time of surgery, the amount of blood loss during surgery, postoperative pain, donor-site scar quality and length were recorded and measured for both groups. Twenty-five patients with lap-protector were compared to thirty without. There were no significant differences between the two groups in the demographic of patient characteristics (P > 0.05). The score of pain dropped steadily over the 5 days in both groups, and patients in group 1 reported a lower level of pain in the following days compared with group 2 (P < 0.05), except the fifth day. In those without, the length of the scar on average was 5.43 ± 0.44 cm, which was longer than the average 3.61 ± 0.29 cm in group 1 (P < 0.05). Analysis of VSS results showed a better formation of the scar in the group1 (P < 0.05). The differences in postoperative pain, scar length and quality between the two groups were statistically significant(P < 0.05). There were no differences between the two groups in terms of the operation time and the amount of bleeding during the operation (P > 0.05). The application of lap-protector in costal cartilage harvest can optimize the scar formation and reduce postoperative pain without prolonging the operative time, which is a convenient and effective technique for achieving satisfactory results.
Depressive symptoms have been on the rise among young adults, with the transition to college, particularly the first year, being a critical period of vulnerability. Despite prior research on depression trajectories in college students, limited longitudinal studies have explored unique depressive symptom trajectory groups among first-year students and their associations with academic achievement (GPA), sleep patterns, and whether sociodemographic factors are associated with certain trajectories. This study analyzed a pre-existing dataset that was collected over two waves from a private university (spring semester 2017 and 2018). The final pooled sample resulted in first-year undergraduate students (N = 271) who reported on their depressive symptoms (CES-D scale) at the start and end of the semester, signed a release record for their fall and spring term GPA, and provided continuous sleep data across the academic spring term with Fitbits. K-means + + clustering was conducted to form depressive symptom trajectory groups. ANOVAs, Watson-Williams, and Dunnett's post hoc comparison tests were employed to examine how the resulting trajectory groups were associated with GPA and sleep outcomes (bedtime, waketime, total sleep time, time in bed). Associations between sociodemographic variables and trajectory groups were investigated using chi-square tests. K-means + + clustering identified four trajectory groups: low-stable (n = 109), increasing (n = 72), decreasing (n = 51), and high-stable depressive symptoms (n = 39). The low-stable and decreasing group had a higher spring term GPA (M = 3.44 and M = 3.39, respectively) compared to the increasing and high-stable groups (M = 3.22 and M = 3.18, respectively). The low-stable group generally had an earlier wake time and bedtime, greater total sleep time and time in bed, relative to the decreasing and increasing trajectory groups. Gender, ethnicity, international student status, and first-generation student status were not associated with trajectory groups. Consistent with prior work, there are unique depression trajectory groups among first-year college students that represent stability and change of depressive symptoms over the course of a spring semester. Favorable trajectories (low-stable and decreasing symptoms) are associated with better academic performance and sleep habits.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are severe complications following hemorrhagic shock, leading to significant morbidity and mortality. Direct peritoneal resuscitation (DPR) has been proposed to improve microcirculation and reduce organ damage, but its effects on lung injury have not yet been fully explored. Does direct peritoneal resuscitation with peritoneal dialysis fluid (PDF) reduce lung injury in a controlled hemorrhagic shock model in rats? In this randomized experimental study, 32 male Wistar albino rats were randomly assigned to four groups (n = 8 per group). Group I served as the control group, while Groups II, III, and IV underwent hemorrhagic shock. Group III received peritoneal resuscitation with saline, and Group IV received PDF. Lung tissue samples were harvested after 24 h to assess histopathological damage and inflammatory markers; Interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α) levels. DPR with PDF significantly attenuated lung injury compared to saline-treated or hemorrhagic shock-only groups. Interstitial polymorphonuclear leukocytes (PMNL) infiltration and alveolar septal thickening were reduced in the DPR group. Additionally, IL-6 levels were elevated in the DPR group, suggesting a potentially enhanced localized inflammatory response, while no significant differences were found in IL-10 and TNF-α levels. Direct peritoneal resuscitation with PDF was effective in reducing lung injury in rats subjected to hemorrhagic shock by improving microcirculatory function and modulating the inflammatory response. However, the elevated IL-6 levels suggest further investigation is needed to understand the long-term implications of this inflammatory response.
To compare perioperative outcomes between the 48-h short-stay pathway and traditional inpatient management for patients undergoing robot-assisted partial nephrectomy (RAPN), and to evaluate the feasibility, safety, recovery efficiency, and economic benefits of the 48-h short-stay pathway. This retrospective study included 175 patients who underwent RAPN between February 2022 and June 2024. Patients were assigned to a 48-h short-stay group (n = 60) or a traditional inpatient group (n = 115). A 1:1 propensity score matching (PSM) was conducted to balance baseline characteristics, including age, sex, BMI, comorbidities, tumor features, surgeon identity, and surgical year. Perioperative outcomes, recovery indicators, complications, and medical costs were compared. After PSM, 53 matched pairs were analyzed. The short-stay group showed significantly shorter operative time, less intraoperative blood loss, shorter warm ischemia time, earlier mobilization, earlier oral intake, faster bowel function recovery, and shorter bed rest (all P < 0.05). The short-stay group had 71.7% of patients discharged on postoperative day (POD) 1 and 100% within 48 h, while the traditional group had 22.6% on POD1, 33.96% on POD2, and 43.4% on POD ≥ 3 (P < 0.001). Both total and postoperative hospital stays were significantly shorter in the short-stay group (2.00 vs. 6.00 days, P < 0.001), with lower hospitalization costs (P < 0.001). Postoperative creatinine was lower in the short-stay group (P = 0.023), while creatinine change was comparable (P = 0.063). Complication rates, emergency department visits, and 30-day readmission rates were similar between groups (all P > 0.05). The short-stay group had a significantly lower drain placement rate (P = 0.002) without increased adverse events. The 48-h short-stay pathway for selected patients undergoing RAPN is feasible and safe. It accelerates postoperative recovery, shortens hospital stay, reduces medical costs, and optimizes healthcare resource utilization, without compromising safety or oncological early outcomes.
Clinical empathy refers to a healthcare professional's ability to understand a patient's experiences and emotions through cognitive and affective perspective taking, and to communicate that understanding through compassionate and appropriate professional behaviors. Aging simulation suits are experiential educational tools designed to replicate the sensory and physical limitations associated with aging. However, evidence regarding their effectiveness in enhancing clinical empathy among active healthcare professionals remains limited. This study aimed to evaluate the effects of an aging simulation suit on clinical empathy among healthcare professionals working in long-term care settings. A randomized controlled trial was conducted with 82 healthcare professionals from four nursing homes in Madrid and Asturias (Spain). Participants were randomly assigned to an experimental group (EG) (n=41) or a control group (CG) (n=41). Both groups received the same structured educational session on empathy and aging. The experimental group additionally participated in an immersive experience using the GERT aging simulation suit, whereas the control group did not receive the simulation component. Self-reported empathy were measured pre- and post-intervention using the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy-Health Professions version (JSPE-HPS). No significant differences were found between groups in IRI scores. However, the experimental group showed significant improvements in total JSPE-HPS scores and in the subscales Perspective Taking and Compassionate Care (p < 0.05), compared with the control group. These findings suggest that the immersive intervention enhanced both cognitive and affective components of clinical empathy. The use of an aging simulation suit was associated with improvements in specific dimensions of clinical empathy among healthcare professionals working in long-term care. This educational tool offers a valuable experiential approach that enhances understanding and compassion toward older adults. However, these findings are limited to short-term, self-reported measures, and no behavioral or patient outcome data were collected. Further longitudinal studies are needed to determine the long-term sustainability of these effects and their translation into clinical practice. ClinicalTrials.gov, Unique Protocol ID: 2711201916919; ClinicalTrials.gov ID: NCT07280689. Date of registration: 10/10/2025. Retrospectively registered.
Breast cancer patients often experience significant psychological distress. This study examined distress trajectories from diagnosis to 6 months post-treatment and explored differences across demographic, medical, and psychosocial subgroups. In this prospective cohort study, 528 patients with breast cancer were recruited between 1 December 2023 and 31 December 2024. Assessments were conducted at baseline (at diagnosis, T0), after the first treatment (T1), mid-treatment (T2), at treatment completion (T3), and at three (T4) and six months (T5) post-treatment. Growth mixture modeling (GMM) was used to identify distinct trajectories of psychological distress. Multinomial logistic regression analysis was performed to examine associations between patient-related factors and trajectory membership. Three psychological distress trajectories were identified: a high-distress remission group (17.05%), a moderate-stable distress group (11.93%), and a low-fluctuating distress group (71.02%). Multivariable analyses showed that higher educational attainment, breast-conserving surgery, early disease stage, partial self-management ability, and strong social support were associated with membership in the moderate-stable or low-fluctuating groups (p < 0.05). Employment, health insurance coverage, avoidant medical coping style, and higher baseline anxiety and depression scores were concurrently associated with membership in the high-distress remission group (p < 0.05). Although psychological distress generally decreased over time, 71.02% of patients followed a low-fluctuating trajectory, 11.93% maintained moderate distress with potential risk of persistence, and 17.05% showed high initial distress that remitted substantially within 6 months. Continuous monitoring and early psychosocial support are recommended, particularly for patients with moderate- or high-risk trajectories.
Swallowing and diaphragmatic functions share neural regulatory pathways and require synchronous assessment. Patients who have had a stroke are susceptible to many complications, of which dysphagia and diaphragmatic dysfunction are particularly common. To compare the distribution and severity of swallowing function in stroke patients with and without diaphragmatic dysfunction, and to explore the correlation between swallowing and diaphragmatic functions. This cross-sectional observational study among 102 Chinese stroke patients with hemiplegia was conducted in August 2022 to December 2024. Data collection was completed in the first 48 h following admission, including sex, age, post-stroke duration, stroke type, stroke region, hemiplegia side, nasogastric feeding, and pneumonia. The patients were stratified into two groups by the presence or absence of diaphragmatic dysfunction, which was assessed by diaphragmatic ultrasound with a threshold of diaphragm thickening fraction (TFdi) < 20%. We compared the distribution and severity of different swallowing functions using the Modified Barium Swallow Study Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS) by Videofluoroscopic Swallowing Study (VFSS) between the two groups. Significant differences were found between the two groups in the oral and pharyngeal phases of the MBSImP (p < 0.003), including hold position/tongue control, bolus preparation/mastication, bolus transport/lingual motion, oral residue, initiation of the pharyngeal swallow, anterior hyoid motion, pharyngeal stripping wave, and pharyngeal residue (p < 0.003). In contrast, there were no significant differences between the two groups in some components of the MBSImP including lip closure, soft palate elevation, laryngeal elevation, epiglottic movement, laryngeal closure, pharyngeal contraction, and tongue base retraction (p > 0.003). The severity of swallowing physiological impairment by MBSImP between the two groups, including the oral phase, pharyngeal phase and total MBSImP scores showed significant differences (p < 0.003). By contrast, the distribution and severity of penetration and aspiration risk by PAS showed no statistically significant difference between the two groups (p > 0.003). TFdi was negatively correlated with grades of Water Swallowing Test, the oral phase, pharyngeal phase and total MBSImP scores (rs = -0.327 to -0.300, p < 0.003). Whereas no significant correlations were found between TFdi and pneumonia, nasogastric feeding and the PAS scores (p > 0.003). Patients with diaphragmatic dysfunction exhibited a higher proportion of swallowing physiological impairment in the oral and pharyngeal phases, along with greater severity of such impairments. Diaphragmatic function was correlated with swallowing function, but the correlation was weak and of uncertain clinical significance.
The deltoid ligament (DL) is the primary stabilizer of the medial ankle, but its injury mechanisms remain poorly understood. This study aimed to investigate the injury risk and mechanisms of individual DL bundles under both acute and chronic conditions to inform prevention and treatment strategies. A validated finite element model of the human foot was used to examine peak stresses in DL bundles under four acute loading scenarios. Chronic loading was simulated by applying gait loads after transecting the lateral ligaments, and the resulting DL stresses were compared with those of the intact model. Additionally, thirty-nine rats were assigned to three groups: a lateral ligament rupture group (LR, n = 13), a tibialis posterior tendon rupture group (TPR, n = 13), and a sham group (n = 13). After 6 weeks of treadmill running, the mechanical properties and histological characteristics of the DL, along with ankle joint morphology and articular stresses, were evaluated to further verify the hypothesized mechanisms of chronic injury. Under acute loadings, the tibiocalcaneal ligament (TCL), anterior tibiotalar ligament (ATTL), and deep posterior tibiotalar ligament (dPTTL) showed the highest stress under pronation-external rotation loading. Lateral ligament rupture increased DL stress during gait. After 6 weeks of treadmill running, the LR and TPR groups showed roughened articular surfaces with osteophyte formation, increased articular stress, decreased talar bone volume fraction, lower failure load and stiffness ratios of the DL (p < 0.01), reduced fluorescence intensity of COL1, and elevated levels of COL3, MMP-2 and IL-1β compared with the sham group (p < 0.01). The TCL, ATTL, and dPTTL bundles are particularly susceptible to acute injury, with pronation-external rotation posing the greatest risk. Chronic degeneration of the DL occurs following rupture of the lateral ligament or tibialis posterior tendon, with a more pronounced effect after lateral ligament rupture.
This study aimed to examine 8th-grade students' views on the concepts of nanotechnology and nanoscience through the use of the Metaverse in science courses. The study group sample consists of five students from both the before- and after-experience groups, all of whom are in 8th grade. This study employed a qualitative research method with a case study design. Observation, interview, and document analysis were used as data collection tools. Necessary measures have been taken to ensure the validity and reliability of the research within its scope. The data were analyzed using a content analysis approach. As a result of the interviews, data were collected and analyzed. As a result of the textual examinations, code, category, and theme were determined. The findings were presented in categories through tables, and the participants' answers were included in direct quotations. Upon reviewing the literature, it becomes apparent that most studies in nanotechnology and nanoscience are conducted for informational purposes, typically presented as presentations or reports. Given the limited availability of nanotechnology and metaverse education, the study was divided into two groups: a before-experience group and an after-experience group. As a result of the survey, 8th-grade students experience the metaverse and have future expectations for nanotechnology and nanoscience. Their cognitive and affective interests have increased, as evidenced by their questioning why these applications cannot be applied to all courses and by their correct expression of the concepts. At the same time, it has been concluded that using rich materials to concretize abstract concepts, such as nanotechnology, facilitates their teaching. The study provides qualitative evidence that Metaverse-based instruction can enhance both cognitive and affective dimensions of science learning, offering design implications for integrating immersive technologies into middle school curricula to teach abstract concepts.
To compare the elastosonographic changes of the tibial nerve (TN) and Achilles tendon (AT) in patients with type 2 diabetes mellitus (T2DM) and explore their relationship and respective relevant factors. This case-control study enrolled 165 subjects, comprising 126 patients with T2DM and 39 healthy controls matched for age and gender. The patients were further divided into those with and without diabetic peripheral neuropathy (PN-DM and NPN-DM groups). Clinical and laboratory data were collected. Conventional ultrasound and elastography were performed to assess the changes in the morphology and elasticity of the bilateral TN and AT. Sonographic features were compared across the three groups, relevant factors affecting the stiffness of TN and AT were analyzed, respectively. Diabetic patients exhibited significantly higher levels of HbA1C and a higher rate of smoking than healthy controls (P < 0.01 and P = 0.02, respectively). Their levels of body mass index (BMI) and total cholesterol have a significant difference between the NPN-DM group and healthy controls (both P = 0.02). The incidence of other microvascular complications in the NPN-DM group was significantly lower among diabetic patients (P = 0.04). Compared with healthy controls, the cross-sectional area (CSA) and transverse diameter of TN in diabetic patients were significantly larger (both P < 0.01), and CSA and anteroposterior diameter of AT were notably greater (P = 0.02 and P < 0.01). Besides, the stiffness of TN in the longitudinal section was significantly higher (P < 0.01), and the stiffness of AT in the cross-section was remarkably lower (P < 0.01). There was no significant difference in the morphology or elastography of TN or AT between NPN-DM and PN-DM groups. Furthermore, the stiffness of TN was not linearly related to that of AT, but independently correlated with age, HbA1C, and other microvascular complications (P < 0.05). The stiffness of AT was only independent of age (P < 0.01). The size of both TN and AT in diabetic patients was significantly larger. The stiffness of TN increased, and that of AT decreased; however, these changes were independent of each other. Not applicable.
The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests. The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled). • Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health. • Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.
Proximal femoral fractures are highly prevalent in Japan, with over 200,000 cases annually and a rising trend. Fracture liaison service (FLS) interventions improve osteoporosis treatment initiation and reduce refracture rates. The content of FLS interventions varies by institution, and the effectiveness of our intervention remains unclear. The aim of this study was to evaluate the effectiveness of our FLS intervention in preventing fragility fractures within 1 year after proximal femoral fracture surgery. A retrospective case-control study was performed on patients aged ≥ 50 undergoing surgery for proximal femoral fracture between February 2021 and January 2024. Patients were divided into non-FLS (pre-August 2022) and FLS groups. Data including demographics, comorbidities, fracture type, medication initiation, and refracture occurrence within 1 year were extracted. Statistical analyses involved Mann-Whitney U, χ2 tests, and Cox proportional hazards modeling. Among 521 eligible patients, osteoporosis medication initiation within 3 months improved from 14% in the non-FLS group to 100% in the FLS group (p < 0.05). Time to medication initiation decreased from 20 to 12 days (p < 0.05). The refracture rate was significantly lower in the FLS group (1.8% vs. 5.7%, p < 0.05). Multivariate analysis showed FLS intervention significantly reduced refracture risk (HR 0.32, 95% CI 0.12-0.89, p = 0.03) and robust in sensitivity analyses for cognition, walking ability, and discharge destination. FLS intervention effectively reduced fragility fractures within 1 year postoperatively by enhancing early osteoporosis treatment initiation. Continued FLS programs and long-term follow-up are recommended to sustain benefits.
The pre-weaning period is critical because early-life nutrition and management influence growth, metabolic function and Rumen development, thereby affecting subsequent productivity in dairy calves. Zinc (Zn) supplementation plays a key role in supporting these processes through its involvement in enzymatic activity, antioxidant defense systems, and metabolic regulation, but conventional sources often have bioavailability limitations due to the formation of insoluble complexes in the gastrointestinal tract. This study addresses this challenge by evaluating three Zn forms (ZnO, Zn-lysine, and nano-ZnO) to identify the most effective source for enhancing growth rates, nutrient utilization, and metabolic health. Twenty-four newborn Holstein calves, each with an initial body weight of 40.5 ± 4.24 kg, were selected and randomly allocated to receive one of three treatments: ZnO, Zn-lysine, and nano-ZnO supplementation. Each calf received 80 mg of Zn daily. Supplementation with nano-ZnO increased dry matter intake (P < 0.01), average daily gain (P < 0.01), and hip width (P < 0.01) compared to Zn-lysine and ZnO. However, there were no differences in feed conversion ratio. The treatments did not affect apparent digestibility or rumen fermentation, except for a lower rumen ammonia nitrogen concentration in the nano-ZnO group compared to the other two treatments (P < 0.01). Regarding blood parameters, calves receiving Nano-ZnO showed higher blood triglyceride concentration (P = 0.04) and superoxide dismutase activity (P < 0.01), while blood D-lactate concentration was lower in the nano-ZnO and Zn-lysine groups than in the ZnO group (P = 0.01). Additionally, both fecal consistency (P = 0.02) and nasal discharge (P < 0.01) scores were significantly reduced in the nano-ZnO group. In summary, the study suggests that nano-ZnO is a more effective Zn source and an efficient additive for improving dairy calf performance.
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.
Effective patient education is critical for informed consent. Augmented Reality (AR) offers a novel approach to improving patient understanding and satisfaction, although current evidence is limited and of low quality. This study evaluated the added value of AR compared to traditional monitor-based 3D models for patient education and decision making for orthognathic surgery. A multicentre randomised controlled trial was conducted between August 2023 and June 2024 at three university medical centres in north-west Europe. Sixty referred patients were randomised to either the intervention group or the control group. Patient satisfaction and knowledge were assessed using two questionnaires. The study was registered at ClinicalTrials.gov(NCT06140043). Patient satisfaction was significantly higher in the control group (p = 0.04). No significant differences were found in knowledge acquisition (p = 0.74). Women showed a significant preference for the monitor-based consultation (p = 0.01), while men did not show a significant difference in satisfaction. Despite some centre heterogeneity, no clear added benefit of AR in satisfaction or knowledge was visible. Observed effect sizes (d = 0.76) and post-hoc power estimates (84%) are provided for context but should be interpreted cautiously. In the absence of clear evidence a monitor remain the most practical option for patient education.