Health literacy and fear of disease progression can predict quality of life, yet the underlying mechanisms among these three factors remain poorly understood. This study aimed to investigate the hypothesis that health literacy among patients with ischemic stroke is associated with fear of disease progression and both directly and indirectly influence quality of life through the mediating role of fear of disease progression. Between December 2023 and June 2024, questionnaires were distributed to 300 in-patients with ischemic stroke selected by convenience sampling from the neurology departments of three tertiary general hospitals in the Xiangxi region of Hunan Province. Assessments were conducted using the General Information Questionnaire, the Medical Outcomes Study Short Form 36 (SF-36), Health Literacy Management Scale (HeLMS) and Fear of Progression Questionnaire-Short Form (FoP-Q-SF). Pearson correlation analysis was employed to examine the correlations between variables; AMOS 24.0 statistical analysis software was used to explore the pathways and effect sizes of fear of disease progression and health literacy on quality of life. Health literacy was positively correlated with quality of life (r = 0.412, p < 0.01), while fear of disease progression was negatively correlated with quality of life (r = -0.445, p < 0.01). Fear of disease progression partially mediated the relationship between health literacy and quality of life, accounting for 41.3% of the total effect. Findings support the development of targeted psychosocial intervention strategies aimed at enhancing patients' health literacy to effectively alleviate disease-related fear, ultimately improving quality of life and optimizing care outcomes for stroke patients.
People living with inflammatory bowel disease (IBD) frequently experience abdominal pain, fatigue and faecal incontinence that persist despite optimal medical treatment. This study aimed to assess the cost-effectiveness of IBD-BOOST, a digital, interactive, facilitator-supported self-management intervention targeting these symptoms. A cost-effectiveness analysis was conducted alongside the IBD-BOOST trial, which randomised people with IBD experiencing fatigue, pain and/or faecal incontinence to the IBD-BOOST intervention (N=391) or care as usual (N=389) over 12 months. While the IBD-BOOST intervention did not significantly improve the primary trial outcome measures (UK Inflammatory Bowel Disease Questionnaire and global rating of symptom relief), trends towards benefit were observed across study outcomes. Therefore, this analysis focuses on secondary health economic outcome measures. The cost of the intervention, including its development, facilitation and delivery, was assessed. Participants reported their health service use, out-of-pocket expenses and time off work over the previous 3 months and their health-related quality of life at baseline, 6-month and 12-month follow-up. Participants' costs (2023 UK£) and quality-adjusted life years (QALYs) over the 12 months were compared between study arms using mixed effects models. The IBD-BOOST intervention resulted in additional per participant 0.016 QALYs (95% CI 0.002 to 0.030) over the 12 months in the study and cost savings of -£304.66 (-803.51 to 194.18) for healthcare and -£39.48 (-388.09 to 309.12) for out-of-pocket costs and time off work over months 4-6 and 10-12. This resulted in cost savings of -£28 633 (95% CI -51 555 to 18 764) and -£33 568 (-64 421 to 26 198) per QALY gained with IBD-BOOST from health services and societal perspectives, respectively, and high probability of cost-effectiveness. The IBD-BOOST intervention is highly likely to be cost-effective for the self-management of pain, fatigue and faecal incontinence in people living with IBD. ISRCTN71618461.
The coronavirus disease 2019 (COVID-19) pandemic highlighted the influence of behavioral and environmental factors on the risk of infection, as well as on disease progression and severity. Therefore, it is critical to improve public health knowledge regarding the factors influencing disease outcomes. This study describes the development and validation of the "Cuban population environmental and lifestyle factors Questionnaire" (CELF-Q), a tool designed to evaluate the impact of environmental and lifestyle factors on COVID-19 outcomes in the Cuban population. Based on an existing lifestyle questionnaire developed for the Latin American population, a thorough process of modification, cross-cultural adaptation, and iterative desk review was conducted to generate the CELF-Q. Pre-test analysis was performed to assess face and content validity. To evaluate content validity, a panel of 15 experts was selected. Test-retest reliability was assessed in 60 participants, while internal consistency was evaluated by administering the questionnaire to 309 individuals with SARS-CoV-2 infection. Confirmatory factor analysis (CFA) was performed to assess the fit of the CELF-Q's factor structure. The content validity of the questionnaire was deemed "acceptable" across several dimensions, based on the results of the content validity ratio (CVR), content validity index (CVI), and Aiken's validity (V). Only a few items were identified for revision using these quantitative measures. Additionally, the experts supplemented the evaluations with qualitative comments for the modification of the questions. The test-retest reliability analysis showed an overall mean kappa coefficient of 0.89 [standard deviation (SD): 0.21] and a mean overall correlation coefficient of 0.99 (0.02), indicating high to almost perfect agreement. An internal consistency analysis showed that the majority of the dimensions had acceptable Cronbach's alpha values. In particular, the self-care behavior, socioeconomic restrictions, and diet and nutritional habits dimensions achieved respectable Cronbach's alpha values (between 0.7 and 0.8). The generated CELF-Q is a comprehensive, valid, and reliable tool for obtaining information on environmental/lifestyle factors associated with SARS-CoV-2 infection, as well as the development and severity of COVID-19, in the Cuban population.
Meningococcal infections represent a significant public health concern due to their high mortality and morbidity rates. In Turkey, meningococcal vaccines are not included in the routine immunization schedule, and families increasingly seek health-related information through digital platforms. YouTube, as a widely used video-sharing platform, has the potential to influence public attitudes toward vaccination; however, concerns remain regarding the reliability and quality of its content. This study aimed to evaluate the characteristics and quality of YouTube videos related to meningococcal vaccines in Turkey. This cross-sectional study analyzed 158 YouTube videos retrieved using the keywords "meningococcal vaccines" and "private vaccines." Videos were evaluated according to uploader type, content features, message tone, and audio-visual quality. The Global Quality Scale (GQS) and the Journal of the American Medical Association (JAMA) benchmark criteria were used for quality assessment. Of the videos, 55.7% were uploaded by physicians and 92.4% were intended for patient education. Most videos (86.7%) conveyed positive messages about vaccination. Physician-produced videos demonstrated significantly higher quality scores, while videos uploaded by pharmaceutical companies were more up-to-date and had higher view counts. Overall, a considerable proportion of the videos were of moderate or low quality. The quality and reliability of YouTube content on meningococcal vaccines vary substantially. Increasing the availability of evidence-based, high-quality content and encouraging greater involvement of healthcare professionals in digital media are essential to support informed vaccination decisions and reduce vaccine hesitancy.
Property of traditional Chinese medicine (TCM) is the core of the basic theories of TCM. Especially, the cold and hot properties are considered as closely related to the clinical medication and have the guiding significance. Driven by the ongoing advances of modern analytical technology, studies on the ancient theory of TCM cold and hot properties are flourishing recently; however, the review focusing on the applied research methods is insufficient. This review, by the bibliometric analysis of 996 associated publications, discloses the methodological evolution in researching the cold and hot properties of TCM from the traditional temperature-based methods (e.g., cold/hot plate differentiating and infrared thermography technologies) to modern elucidation that relies on the material basis-oriented strategies (multi-omics and gut microbiomics). The analytical techniques that are appliable to the in vitro/in vivo characterization of TCM decoction, analysis of effects on endogenous substances, and use of machine learning models for predicting properties, are systematically summarized. In addition, a review on the principles, characteristics, and applications of these analytical methods is conducted, to highlight the important research ideas and key results. It is thus expected to provide valuable reference for the in-depth analysis and better understanding of the theory of TCM properties.
Financial ties between healthcare professionals and the medical-device industry raise conflict-of-interest and transparency concerns; despite Japan's 2012 self-regulatory guidelines, device-related payments receive less scrutiny than pharmaceutical payments globally, including in Japan. To provide the first detailed analysis of honoraria from medical device companies to Japanese physicians in 2019, offering a baseline before the COVID-19 pandemic. We retrospectively examined 2019 payment data from the Yen for Docs database, compiled from disclosures by 118 companies affiliated with the Japan Medical Devices Network and other major firms. The analysis focused on honoraria-lecture, consulting, and writing fees-because these are the only categories disclosed with individual healthcare professionals names. Payments were standardized, cleaned, and aggregated at company and recipient levels. Descriptive analyses identified overall volume, company distribution, and top-earning specialties. In 2019, 66 companies disclosed 60,161 honorarium payments totaling USD 46.0 million. Most funds (66.7%) were lecture fees, followed by consulting (28.8%) and writing (4.5%). Payments were highly concentrated: the top 10 companies accounted for 63.3% of the total, led by Medtronic, Terumo, and Johnson & Johnson. Among 24,434 recipients, 66.1% received less than USD 1,000, while only seven physicians received more than USD 100,000. Cardiologists (48.0%) and cardiovascular surgeons (24.0%) dominated the top 50 earners. Honoraria from Japan's device industry were modest in scale compared with pharmaceutical companies but highly concentrated among a few firms and cardiovascular specialists. These findings highlight the need for more comprehensive and legally enforceable transparency frameworks to safeguard clinical integrity and public trust.
This study aimed to retrospectively evaluate the demographic, toxicological, and pathological characteristics of individuals aged 65 and older who died due to carbon monoxide (CO) poisoning and underwent autopsy. Cases aged 65 years and older who were determined to have died from carbon monoxide poisoning at autopsy were analyzed in terms of age, gender, time of death, place of death, source of CO exposure, carboxyhemoglobin levels, toxicological findings, and accompanying chronic diseases. The mean age of the 115 cases included in the study was 74.6 ± 7.03 years, and 58.3% were male. Sixty percent of deaths occurred during winter months, and 84.3% occurred in domestic settings. The most common source of CO exposure was stoves, accounting for 71.3%. Carboxyhemoglobin levels were mostly in the range of 40-79%, while only 4.3% of cases had carboxyhemoglobin levels above 80%. Various pharmaceutical agents were detected in 43.5% of cases, and ethyl alcohol alone was detected in 4.3% of cases. Among accompanying chronic diseases, cardiovascular system diseases (69.6%) were the most common. Carbon monoxide poisoning remains an important cause of death among older adults. Fatal cases were predominantly associated with domestic exposure, stove use, and winter months. Cardiovascular and pulmonary comorbidities were common among the victims, highlighting the vulnerability of older populations to fatal carbon monoxide exposure.
The co-administration of Dapagliflozin and Sitagliptin has attracted considerable interest in the management of type 2 diabetes mellitus due to their complementary therapeutic effects. However, their simultaneous determination is analytically challenging because of the significant overlap in their native fluorescence spectra. In this study, a selective and sensitive first-derivative synchronous spectrofluorimetric method was developed for the simultaneous determination of both drugs without prior separation. The proposed approach enabled efficient spectral resolution through zero-crossing points at 348 nm and 289 nm for dapagliflozin and sitagliptin, respectively, using a constant wavelength difference (Δλ = 30 nm). The method exhibited excellent linearity over the concentration ranges of 50-1000 ng/mL and 100-2000 ng/mL for dapagliflozin and sitagliptin, respectively, covering concentration levels relevant to their reported maximum plasma concentrations (Cmax), with low limits of detection (16.02 and 31.07 ng/mL, respectively), indicating high sensitivity. The proposed method demonstrated satisfactory accuracy (mean recoveries of 100.67% and 99.86%) and precision (%RSD < 2%). The method was successfully applied to the analysis of pharmaceutical dosage forms and spiked human plasma, showing reliable recoveries. To the best of our knowledge, this is the first validated spectrofluorimetric method for the simultaneous determination of these co-administered drugs, offering a simple, cost-effective, and efficient alternative to conventional analytical techniques.
To assess healthcare professionals' knowledge, attitudes, and practices (KAP) towards deprescribing. A facility-based cross-sectional study was conducted from May to June 2025. Two public hospitals in Gondar, Ethiopia. A total of 389 healthcare professionals participated in this study with a 92.2% response rate. We assessed healthcare professionals' KAP towards deprescribing as the primary outcomes. These were measured using a structured, self-administered questionnaire. The majority of participants were female (54.2%), and the largest age group was 21-28 years (46.0%). The study revealed that most of the study participants were nurses (65.6%), with most (88.7%) graduating from government institutions. The overall proportion of participants with good knowledge of deprescribing was 32%, while 51.7% had a positive attitude and 27.2% demonstrated good practice. The multivariable analysis revealed that male participants (AOR=2.866, 95% CI 1.734 to 4.737), graduating from a governmental institution (AOR=2.895, 95% CI 1.244 to 6.736) and being a pharmacist (AOR=4.115, 95% CI 1.678 to 10.090) were also positively associated with good knowledge. Among the participants, nearly half (49%) of healthcare providers demonstrated poor knowledge of deprescribing, while more than half (53.3%) showed poor practice. Overall, the study highlights that healthcare professionals have limited awareness of deprescribing. Therefore, deprescribing should be incorporated into undergraduate curricula and training should be provided for healthcare professionals.
Organophosphate esters (OPEs) are a class of additive flame retardants that exhibit persistence, toxicity, and bioaccumulative potential. These compounds can persist in environmental media for extended periods and may enter the human body through multiple exposure pathways, thereby posing significant risks to human health. In this research, a novel analytical method for the simultaneous determination of trace amounts of 14 hydrophilic and hydrophobic OPEs (log Kow=1.53-8.90) in water samples is developed by using magnetic zwitterionic covalent organic framework (COF) based on magnetic solid-phase extraction prior to UHPLC-MS/MS analysis. Inspired by the amphiphilic molecular architecture of phospholipid bilayers, we rationally designed and synthesized a phosphoester-functionalized COF anchored onto magnetite nanoparticles (Fe3O4@P-ZCOF). The effects of various extraction parameters, including Fe3O4@P-ZCOF dosage, solution pH, extraction time, eluent type, elution duration, and ionic strength, on the extraction efficiency of the target analytes were systematically investigated. Under the optimized extraction conditions, 14 OPEs were successfully pretreated within only 6 min. The limits of detection (LOD, S/N = 3) for wastewater, reservoir water and tap water range from 0.01 to 1.50 ng/L, 0.01 to 1.00 ng/L and 0.01 to 2.00 ng/L, respectively. The method presents some merits such as quick and simple sample pretreatment procedure, and being able to simultaneously determine the hydrophilic and hydrophobic properties of OPEs. The method was successfully used to detect OPEs in the effluent and influent of 6 sewage treatment plants.
To estimate the effect of hospital-physician vertical integration on utilization-driven annual healthcare spending for an all-payer cohort of patients with multiple chronic conditions. We used a quasi-experimental difference-in-differences with staggered adoption approach to estimate the effect of hospital-physician vertical integration on total annual utilization-driven spending per patient (primary outcome). We also examined changes in annual inpatient, outpatient, professional, and pharmaceutical utilization-driven spending (secondary outcomes). Using 2016-2021 Virginia all-payer administrative claims data, we conducted a retrospective analysis of 77,248 patients aged 45-99, with Medicare, Medicaid, and/or commercial insurance, and at least two qualifying chronic conditions at the beginning of the study period. The treatment group included patients of physicians who began the study period independent and became integrated in 2018, 2019, 2020, or 2021, respectively. The control group included patients of physicians who remained independent during the entire study period. While we found no significant difference in utilization-driven spending after integration overall ($1063, CI: $-364 to $2414), meaningful heterogeneity emerged across the staggered integration cohorts. Notably, when excluding the 2021 integration cohort (which exhibited significantly lower total annual utilization-driven spending), we found evidence of substantially higher annual total ($1750, CI: $207 to $3739) and inpatient ($898, CI: $65 to $2293) spending after integration among the earlier integration cohorts, driven by inpatient utilization. These findings held when limiting our analyses to patients of primary care physicians. This study provides evidence that the timing of hospital-physician vertical integration (pre-pandemic versus pandemic-era), particularly among primary care physicians, drove heterogeneous treatment effects in utilization-driven spending for the growing population of adults living with multiple chronic conditions.
A ratiometric fluorescence platform for sensing arsenate with high-performance has been developed with Cu2+-functionalized Zr metal organic framework (Cu@Zr-MOF) fluorescent nanozyme. The doping of Cu2+ provides the catalytic active site to decompose O2 into •OH and 1O2, which oxidizes non-fluorescent substrate o-phenylenediamine (OPD) into product (oxOPD) with yellow fluorescence. When As(V) is present, the intrinsic blue fluorescence of Zr-MOF enhances remarkably by weakening the ligand-to-metal charge transfer (LMCT) accompanied by the fluorescence decrease of oxOPD owing to inner filter effect (IFE). Furthermore, the solutions present a distinguishable color tonality from yellow to blue, which is converted to digital value by smartphone, achieving visual detection of As(V) with a low LOD of 0.67 μM. The specific recognition of Zr-O clusters toward As(V) enables this sensor high selectivity. Compared to other MOF-based ratiometric fluorescence assays for As(V), this method is portable and cost-effective owing to the direct coordination of Cu@Zr-MOF nanozyme instead of fragile and high-cost natural enzyme with As(V). This work not only develops a portable method for sensing As(V) but also expands the potential application of functionalized MOF in on-site monitoring.
Epinastine used in treatment and management of allergic conjunctivitis. The development of a simple, sensitive, and cost-effective analytical method for its quantification is essential for pharmaceutical quality control and study. Green (eco-friendly) spectrofluorimetric method for the determination of epinastine in ophthalmic preparations and aqueous humor samples was developed. The method involves converting the cited drug into a fluorescent derivative through a one-pot condensation reaction with fluorescamine, which serves as a detection probe. Fluorescamine is a reagent that reacts specifically with the primary amine moiety of epinastine, forming a highly fluorescent product. In borate buffer (pH 8.5), the reaction yielded a fluorescent product with maximum emission intensity at 483 nm upon excitation at 390 nm. The fluorescence intensity showed a linear response within the concentration ranges of 60-400 ng/mL and 65-350.0 ng/mL for standard epinastine and spiked aqueous humor samples, respectively. The method demonstrated high sensitivity, with limits of detection (LOD) of 19.5 and 20.60 ng/mL and limits of quantification (LOQ) of 59.11 and 62.50 ng/mL for standard epinastine and aqueous humor samples, respectively. The greenness profile of the method was evaluated using four smart metric tools.
Insomnia and obstructive sleep apnea (OSA) comorbidity is prevalent and leads to worse outcomes. While zolpidem may improve sleep in OSA, existing trials report inconsistent results on safety and efficacy. We aimed to perform a meta-analysis to systematically evaluate the effect of zolpidem in OSA patients. We systematically searched PubMed, Medline, Embase, Cochrane's Library, Web of Science, and other online sources for related trials. Data were pooled using a random-effects model, and mean differences with 95% confidence intervals were calculated. The effects of zolpidem on sleep efficiency and severity of sleep apnea were analyzed. 5 controlled trials (4 randomized and 1 nonrandomized) were included. All studies claimed all participants were diagnosed with OSA. Treatment with zolpidem significantly improved total sleep time compared to placebo or no-drug (MD: 0.78, 95% confidence interval: 0.19-1.37, P = .009; I2 = 38%). However, zolpidem did not alter OSA severity as shown by no systematic changes in the Apnea-Hypopnea Index (AHI). Total AHI, supine AHI, and AHI during non-rapid eye movement sleep or rapid eye movement sleep were unaltered on the drug night compared to the control group. Next-day sleepiness was measured in 4 studies, and the results showed no statistical difference, indicating that zolpidem was generally well tolerated with no major adverse events. Zolpidem can substantially increase sleep duration in OSA patients without worsening AHI or overnight hypoxemia, and appears well-tolerated without a next-day hangover. These findings are limited by the small number of studies, small sample sizes, and short-term nature of interventions. Further large-scale RCTs are warranted to confirm long-term safety and efficacy.
Many individuals with diabetes have compromised immune systems and reduced peripheral sensation, making them susceptible to infections. As a result, combination therapy involving antidiabetic drugs and antibiotics has become essential. A newly introduced combination of the antidiabetic drug linagliptin (LIN) and the third-generation cephalosporin antibiotic cefixime (CEF) has been recommended to combat infections in diabetic patients.To optimize therapeutic efficacy and minimize adverse effects associated with this combination therapy, a reliable analytical method was essential for pharmacokinetic analysis and therapeutic drug monitoring. This study present, for the first time, a green high-performance liquid chromatographic method with photodiode array detection (HPLC-PDA) for the simultaneous determination of LIN and CEF in plasma samples. Chromatographic separation was achieved using a Symmetry C18 column (250 mm × 4.6 mm, 5 μm particle size) under isocratic elution with a mobile phase consisting of 20 mM sodium phosphate (pH 4.3, adjusted with orthophosphoric acid) and methanol (50:50, v/v). The flow rate was set at 0.8 mLmin- 1, with a total run time of 12 min. The injection volume was 20 µL and the detection was performed at 230 nm. The method demonstrated linearity over a range of 50-2000 ng mL-1for both LIN and CEF, with limits of detection (LOD) of 24 and 21 ngmL⁻¹ and limits of quantitation (LOQ) of 43 and 45 ngmL⁻¹ for LIN and CEF, respectively. Validation parameters complied with ICH M10 bioanalytical guidelines. Additionally, the method was successfully applied to a pharmacokinetic study comparing drugs efficacy when administered alone versus concurrently. The results demonstrated that co-administration of LIN and CEF significantly altered their bioavailability: LIN Cmax increased by 63.2% and AUC increased by 134.2%, while CEF Cmax decreased by 27.3% and AUC decreased by 23.3%, indicating a bidirectional pharmacokinetic interaction, and underscoring the need for careful monitoring during combination therapy.The greenness of the proposed HPLC-PDA method was evaluated using four metric tools and the findings confirmed the method's minimal environmental impact. In conclusion, the developed HPLC-PDA method not only provides a reliable tool for therapeutic drug monitoring in clinical practice but also establishes a robust framework for future investigations into drug-drug interactions in human therapeutics.
Sensitive detection of microRNA-204 (miR-204) is critical for the early diagnosis and management of osteoarthritis (OA). This work presents a novel surface-enhanced Raman scattering (SERS) biosensor for the ultrasensitive and specific detection of OA-associated miR-204. The platform integrates a self-amplifying nucleic acid circuit with DNAzyme-catalyzed etching of a plasmonic nanoprobe. At its core is a single, rationally designed overhang-containing hairpin probe (O-HP) that functions as both the recognition element and amplification initiator. Upon binding to miR-204, the O-HP triggers polymerase-mediated extension, generating G-quadruplex structures. These structures bind hemin to form DNAzymes that catalyze the localized production of reactive oxygen species (ROS), which subsequently etch the silver shell of the gold nanostars core with silver shell and 4-aminothiophenol (AuNS/Ag@4-ATP) SERS nanoprobe. This etching causes the desorption of Raman reporters and a quantifiable 'signal-off' response. This biosensor achieves a remarkably low detection limit of 8.13 fM with a broad dynamic range from 10 fM to 150 nM, and exhibits high specificity, capable of discriminating single-nucleotide variants. Furthermore, it successfully quantified miR-204 in clinical cartilage samples, showing a strong correlation with real-time quantitative polymerase chain reaction results. The modular design of the O-HP also facilitated the adaptation of the platform for detecting miR-21, demonstrating its generalizability. This work provides a robust and versatile biosensing strategy with significant potential for clinical miRNA diagnostics.
The 2019 medication regimen complexity-intensive care unit (MRC-ICU) score is associated with patient outcomes, ICU complications, and critical care pharmacist workload. This score was developed using heuristic component selection and validated in a single-center cohort of 130 ICU patients. We sought to apply data-driven reweighting methodology in a large, multicenter cohort of ICU adults to improve the predictive capabilities of MRC-ICU. This was a retrospective, observational cohort study of adults admitted to an ICU between 2015 and 2023 at two academic health systems. Machine learning-based methods, including Principal Component Analysis and Random Forest, were used to create an updated MRC-ICU score optimized to predict three outcomes: hospital mortality, ICU fluid overload (FO) occurrence, and invasive mechanical ventilation (IMV) use. MRC-ICU 2.1 used average mortality, FO, and IMV use; MRC-ICU 2.2 used average mortality and FO and adjusted for prolonged IMV use. Data from one center were used for training and testing, and data from the other for validation. The predictive abilities of MRC-ICU 2.1 and 2.2 for each outcome were compared to MRC-ICU 1.0 and to severity of illness scores (i.e., Acute Physiology and Chronic Health Evaluation [APACHE] II and Sequential Organ Failure Assessment [SOFA]). A total of 19,117 patients across training, testing, and validation datasets were included. MRC-ICU 2.0 scores outperformed MRC-ICU 1.0 for predicting most outcomes, with improvements in Area Under the Receiver Operating Characteristic (AUROC) ranging from +0.03 to +0.08 across datasets. MRC-ICU 2.1 and 2.2 did not consistently outperform APACHE II and SOFA in predicting mortality. The addition of MRC-ICU 2.0 scores to models including APACHE II or SOFA resulted in statistically significant improvements in discrimination in several settings (DeLong p < 0.05), with AUROC increases generally ranging from approximately +0.01 to +0.13 depending on outcome and dataset. The updated MRC-ICU 2.0 score (MRC-ICU 2.1 and 2.2) demonstrated consistently improved discrimination compared with the original MRC-ICU 1.0 across outcomes and datasets. The performance of MRC-ICU 2.0 (MRC-ICU 2.1 and 2.2) was generally comparable to established severity-of-illness scores (SOFA and APACHE II), although it did not consistently outperform these measures. When incorporated into combined models, MRC-ICU 2.0 provided additional predictive value, indicating that it captures information complementary to traditional severity-of-illness scores. Overall, these findings suggest that MRC-ICU 2.0 represents an improved and clinically interpretable measure of medication regimen complexity that is useful as a complementary predictor.
Tetracycline (TC) compounds, which Metal-organic frameworks (MOFs), a class of porous crystalline materials with designable structures and fluorescence properties, have become ideal candidate materials for constructing ratiometric fluorescent sensors. To enable rapid and convenient detection of tetracycline (TC), we developed a novel CAU-1-on-EuMOF heterostructure, in which EuMOF nanoparticles grow on the surface of blue-emitting CAU-1. This unique architecture achieves efficient dual-emission ratiometric sensing through the synergistic effect of the antenna effect and the inner filter effect, significantly improving selectivity and self-calibration capability. The ratiometric fluorescence sensing platform constructed from this composite material exhibits a limit of detection (LOD) for tetracycline as low as 200 nM. The platform also demonstrated excellent selectivity for TC over other substances. The sensing platform was further tested on real samples, including tap water, milk, and fish. In these tests, the recoveries ranged from 93.53% to 112.07%. These findings highlight the substantial potential of the MOF-on-MOF hybrid material for advanced sensing applications.
A rapid, sensitive, and selective LC-MSMS method was developed and validated for the quantification of dextromethorphan (DXM), pseudoephedrine (PSE), olanzapine (OLA), and fluoxetine (FLU) in human plasma. Mixture 1 (DXM/PSE) and mixture 2 (OLA/FLU) are fixed-dose combinations commonly misused at high doses for their euphoric effects. The proposed method employed a simple protein precipitation technique for sample preparation, using a cost-effective cross-over internal standard strategy; OLA for mixture 1 and DXM for mixture 2. Chromatographic separation was achieved on a Hypersil GOLD column (100 × 3 mm, 1.9 µm) using an isocratic mobile phase consisting of acetonitrile and 0.1% formic acid (70:30, v/v) at a flow rate of 0.3 mL/min. The short runtime of 2.5 min enables high-throughput analysis. Detection was performed in positive ionization mode using multiple reaction monitoring (MRM). The method exhibited linearity over concentration ranges of 0.05-25.0 ng/mL for DXM, 2.0-1000.0 ng/mL for PSE, 0.2-20.0 ng/mL for OLA, and 0.5-50.0 ng/mL for FLU with lower limits of quantification (LLOQs) of 0.05, 2.0, 0.2, and 0.5 ng/mL, respectively. The method was successfully validated in accordance with FDA and ICH bioanalytical method validation guidelines, demonstrating satisfactory selectivity, accuracy, and precision. The validated method demonstrated high extraction recovery (> 90%), limited, reproducible matrix effects (IS-normalized matrix factor CV ≤ 15%). This study represents a novel application of artificial intelligence (AI)-assisted evaluation, utilizing a universally accessible model to assess the greenness and whiteness of the proposed LC-MS/MS method through the Auto-AGREE and Auto-RGB 12 frameworks. The AI-generated assessments demonstrated high agreement with traditional metrics, highlighting the potential of AI tools to provide rapid and objective holistic sustainability evaluations for the global analytical community.
Marketed cream formulations contain fatty acids as core constituents, required for its texture, uniformity, shelf life, and skin penetration. Given their importance in the cosmetic and pharmaceutical industries, real-time quantification and analysis of these compounds are crucial for assessing authenticity and ensuring compliance with regulatory specifications. In the present analysis, we employed gas chromatography with flame ionization detection (GC-FID) due to its sensitivity, robustness, and quantitative reliability. Overcoming the traditional method for fatty acid determination, we analyzed the sample without derivatization to fatty acid methyl esters (FAMEs). The derivatization step was initially omitted to simplify sample preparation, reduce analysis time and reagent consumption, and minimize the potential errors associated with incomplete esterification or degradation of unstable fatty acids during derivatization. Direct analysis was performed by dissolving the extracted sample in isopropyl alcohol and then filtering and injecting it into the GC-FID system under optimized chromatographic conditions. The optimized method was used for the concurrent quantification of lauric, myristic, palmitic, oleic, and stearic acids. The validation of the present work was executed in alignment with ICH Q2(R1) requirements. The method was further expanded to analyze real cream samples, thereby validating the accuracy of fatty acid profiling for routine quality control.