Stroke continues to impose a substantial economic burden globally. To mitigate escalating healthcare costs and enhance financial protection for patients, diagnosis-related group (DRG) payment systems have been widely implemented in China. Neurointerventional stroke care, characterized by its complexity and high costs, represents a critical area for evaluating the impact of such payment reforms. This study investigates the effects of the DRG payment system on hospitalization costs and patient out-of-pocket expenditures (OOPE) for neurointerventional stroke patients in a leading neurological hospital in China. We conducted a retrospective cohort study using 2024 administrative data from Beijing Tiantan Hospital, China. The study included 5,205 inpatient stroke patients who underwent neurointerventional procedures (BE2 codes). Patients were categorized into a DRG payment group (Beijing residents, 18.87%) and a Fee-For-Service (FFS) payment group (non-Beijing residents, 81.13%) based on their medical insurance payment method. Pearson χ² tests and Mann-Whitney U tests were employed to compare total direct hospitalization costs (TDHC) and OOPE between the two groups. Quantile regression analysis further explored the impact of DRG payment across different expenditure levels to assess the heterogeneity of its financial protective effects. Compared to the FFS group, patients in the DRG payment group demonstrated significantly lower median TDHC (RMB 86,268 vs. RMB 102,885; p < 0.001), representing a 16.15% reduction. Similarly, the median OOPE for DRG patients was significantly lower (RMB 19,851 vs. RMB 30,266; p < 0.001), a 34.41% reduction. Quantile regression analysis confirmed consistent cost reductions across all expenditure quantiles (TDHC: 3.84%-5.16%; OOPE: 14.49%-36.32%), with more pronounced financial protection for patients with higher OOPE levels. Notably, centrally procured medical supplies were associated with increased costs, while higher insurance reimbursement, non-centrally procured medications, ICU transfers, and prolonged length of stay independently predicted higher expenditures. This single-center study demonstrates a significant association between the DRG payment system and effective cost containment and enhanced patient financial protection for neurointerventional stroke care in a large Chinese neurological center. These findings underscore the necessity for future DRG payment policy development to include specialty-adjusted DRG weights and to ensure coordinated integration between payment reforms and medical supply procurement policies. Due to its single-center nature and reliance on single-year data, caution is warranted when generalizing these results to other institutions and policy contexts.
The emergence of Methicillin-resistance Staphylococcus aureus (MRSA) has posed a crucial threat in healthcare systems worldwide. Vaccination is ideal prevention against infection from antibiotic-resistance bacteria such as MRSA. Unfortunately, the development of S. aureus vaccine has faced tremendous challenges, suffering from repetitive failure of clinical trials. In this study, we formulated a panel of single polypeptide vaccines Sta-V5*1-3 based on a multi-valent S. aureus vaccine Sta-V5 previously developed by our team. The single polypeptide vaccines composed of antigen fragments induced robust humoral responses and protective immunity against MRSA infection in multiple animal disease models with indistinguishable efficacy when compared with Sta-V5 vaccine. We also attempted to formulate an epitope vaccine Sta-V5-EP based on T cell and B cell epitopes of antigens from Sta-V5. However, Sta-V5-EP failed to elicit sufficient protection in mouse model. Taken together, design of Sta-V5* vaccines represent a valuable S. aureus vaccine platform that avoids the laborious purification of multiple antigens and contamination with impurities.
Considering the importance of caregiver mental health for early childhood development, this study investigates risk and protective factors of mental health of mothers and grandmothers caring for infants and toddlers in rural China. Using survey data from 777 primary caregivers of children aged 5 to 25 months, we apply regression analysis and structural equation modeling to examine associations between social support, mental health literacy, parenting-related hardships, and mental health among mothers and grandmothers. The study finds that 33% of the caregivers report symptoms of mental health problems, with grandmothers experiencing more severe symptoms. Poor caregiver mental health is associated with lower child language (p < 0.05) and social-emotional development (p < 0.001). Social support and mental health literacy are associated with better mental health, but this association was not statistically significant among either the mothers or the grandmothers alone. Enhancing caregiver mental health is crucial for children's development. Social support and mental health literacy are predictors of mental health. Future research should examine the effect of improving social support and mental health literacy on the mental health of caregivers for young children.
The Mediterranean diet is widely recognized for its cardiovascular benefits, but its specific effects on atherogenic indices remain unclear, particularly in individuals seeking a weight-loss dietary program, where excess fat mass may mitigate the diet's protective effects. To explore this relationship, a cross-sectional study was conducted involving 10,286 participants enrolled in a weight-loss dietary program. Anthropometric and biochemical data were collected, and adherence to the Mediterranean diet was assessed using the 14-item Mediterranean Diet Adherence Screener questionnaire. Lipid profiles, including total cholesterol, LDL-C, HDL-C, and triglycerides, were analyzed to calculate the following atherogenic indices: atherogenic index of plasma, Castelli risk indices I and II, lipoprotein combine index, atherogenic coefficient, and atherogenic combined index. Multivariate linear regression models, adjusted for sex, age, body mass index, smoking, physical activity, sociodemographic factors, and use of lipid-lowering medications, showed that each one-point increase in the Mediterranean diet adherence score was significantly associated with reductions in the atherogenic index of plasma (- 0.003, 95%CI: 0.006, - 0.000), the atherogenic coefficient (- 0.013, 95%CI: - 0.024, - 0.001), Castelli risk index I (- 0.013, 95%CI: - 0.024, - 0.001), and the atherogenic combined index (- 0.004, 95%CI: - 0.007, - 0.000), with a marginal association observed for Castelli risk index II (- 0.009, 95%CI: - 0.019, 0.000). Significant associations were also observed for total cholesterol (- 3.453 mg/dl, 95%CI: -5.911, -0.995), LDL (- 3.225 mg/dl, 95%CI: -5.402, -1.048), and HDL-C concentrations (+ 0.255 mg/dl, 95%CI: 0.098, 0.412). However, except for HDL, these associations lost statistical significance after adjusting for body fat percentage. Significant interactions between Mediterranean diet adherence score and body fat percentage were observed for several atherogenic indices, including the atherogenic coefficient, Castelli risk index I, Castelli risk index II, and the atherogenic combined index as well as for total cholesterol and LDL, suggesting that the protective effects of the Mediterranean diet diminish as fat mass increases. Although adherence to the Mediterranean diet is associated with more favorable lipid profiles and atherogenic indices, these benefits are modulated by body composition, particularly fat mass. These findings highlight the importance of integrated dietary strategies that combine nutritional quality with body fat reduction to support cardiovascular prevention.
The genetic and environmental factors influencing an individual's susceptibility to develop Guillain-Barré syndrome (GBS) remain largely unidentified. This study aims to evaluate the genetically predicted associations between GBS and candidate autoimmune diseases using a Mendelian randomization (MR) framework. Genetic instruments for autoimmune diseases were extracted from large-scale genome-wide association study (GWAS) datasets. Following stringent quality control, seven autoimmune diseases were ultimately retained for the primary analysis. Summary statistics for GBS were obtained from the FinnGen consortium. We employed the inverse variance weighted (IVW) method as the primary approach, supplemented by sensitivity analyses to ensure robustness. Furthermore, a high-throughput two-step MR screening of 731 immune traits was integrated to explore potential biological mediators. Genetic liability to type 1 diabetes was suggestively associated with an increased risk of GBS [OR (95% CI) = 1.26 (1.04-1.52), p = 0.0176]. Conversely, genetic predisposition to psoriasis vulgaris showed a suggestive protective association [OR (95% CI) = 0.784 (0.623-0.986), p = 0.0375]. No significant or suggestive associations were observed for rheumatoid arthritis (p = 0.990), sarcoidosis (p = 0.993), systemic lupus erythematosus (p = 0.240), asthma (p = 0.906), or Graves' disease (p = 0.926). No circulating immune trait emerged as a significant mediator between these conditions. This study identifies suggestive genetically predicted associations between specific autoimmune diseases and GBS susceptibility, specifically a potential risk-increasing effect of type 1 diabetes and a protective effect of psoriasis vulgaris. The absence of significant peripheral immune mediators suggests that these neuro-immune interactions may be driven by more localized or complex tissue-resident mechanisms.
In the present study, novel amide derivatives of soybean oil fatty acids were synthesized via amidation of hydrolyzed fatty acids with aniline and benzylamine, yielding aromatic amides with structurally distinct amine moieties. These compounds were designed as potentially effective and biodegradable corrosion inhibitors. Comprehensive physicochemical characterization of the amides was performed using FT-IR and ¹H/¹³C NMR spectroscopy, while their thermal stability was assessed through thermogravimetric (TG) derivative thermogravimetric (DTG) and differential thermal analysis (DTA). The corrosion inhibition performance of the synthesized compounds was investigated using electrochemical techniques in CO₂-saturated 1 wt% NaCl solution. Linear polarization resistance (LPR) measurements were employed to study the time dependence of the corrosion rate, whereas potentiodynamic polarization (Tafel) curves were recorded to determine the electrochemical parameters of the corrosion process. The LPR results indicated that the inhibition efficiency of carbon steel increased with increasing inhibitor concentration, reaching 93-96% at 100 ppm. The inhibition mechanism was further elucidated by examining the surface morphology of mild steel using scanning electron microscopy (SEM). SEM images revealed that inhibitor-treated samples exhibited a smoother and less damaged surface compared to the uninhibited system, indicating the formation of a protective film. Adsorption behavior followed the Langmuir adsorption isotherm, and the calculated Gibbs free energy of adsorption (- 39 to - 42 kJ mol⁻¹) suggested strong and spontaneous adsorption with a dominant chemisorption contribution. The antimicrobial activity of the compounds was evaluated against sulfate-reducing bacteria (Desulfovibrio desulfuricans) as well as Gram-negative bacteria (Escherichia coli and coliforms). The benzylamine-derived fatty acid amide demonstrated the highest activity, achieving complete inhibition of D. desulfuricans growth at 50 mg L⁻¹. The results indicate that soybean oil fatty acid amides exhibit dual functionality, combining anticorrosive and antimicrobial properties, and may serve as promising environmentally friendly inhibitors for corrosion protection in oil-field environments affected by microbial activity.
Anthracyclines are widely used anticancer agents but are limited by dose-dependent cardiotoxicity. Ivabradine selectively reduces heart rate without negative inotropy and may offer cardio protection in cancer patients, though its efficacy in anthracycline-induced cardiotoxicity (AIC) remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ivabradine versus placebo in adult patients receiving anthracycline therapy. PubMed, Cochrane Central, Embase, Web of Science, Google Scholar, Scopus and ClinicalTrials.gov, and reference lists were searched through August 2025. Outcomes included left ventricular ejection fraction (LVEF), heart rate, blood pressure, NT-proBNP, and strain-based parameters. Risk of bias was assessed with the Cochrane RoB 2 tool. Three RCTs (n = 210) met inclusion criteria. Ivabradine showed no significant effect on LVEF (MD 0.32%, 95% CI - 0.90 to 1.54; p = 0.61) or NT-proBNP. Heart rate reduction was directionally favorable but not statistically significant (MD - 4.11 bpm, 95% CI - 8.69 to 0.46; p = 0.08). Systolic and diastolic blood pressure were unchanged. Strain-based outcomes were inconsistently reported, precluding pooled analysis. Given the limited sample size, heterogeneity, and variability in endpoint definitions, current evidence is insufficient to establish a definitive cardioprotective role for ivabradine in AIC. Larger, rigorously designed trials with standardized imaging and biomarker endpoints are needed to determine its role.
The increased intake of added sweeteners, such as high-fructose corn syrup, has been associated with a rise in metabolic dysfunctions in gut and brain. While different evidence showed that dietary fructose induces gut microbiota reshaping, the sugar impact on specific bacteria-derived metabolites remains an understudied topic. In this study, we identified secondary bile acids (sBAs) as molecules differentially represented in plasma of rats fed a fructose-rich diet compared to control animals, and hypothesized that these metabolites might be a target for probiotic-based strategies to counteract sugar-induced metabolic disorders. To this aim, we investigated whether probiotic spores of Shouchella clausii SF174 ameliorate fructose-induced cognitive and metabolic dysfunctions and prevent molecular alterations in hippocampus and frontal cortex. Wistar rats were fed a fructose-rich diet, alone or in combination with the daily administration of Shouchella clausii spores, for six weeks. At the end of treatment, behavioral, metabolomic and molecular analyses were performed. The probiotic spores exerted a protective effect on the memory function of fructose fed rats and prevented the decrease of markers of synaptic plasticity. This was associated with the maintenance of plasma and brain levels of the sBA deoxycholic acid and of its specific receptor Takeda G protein-coupled receptor 5. Further, spores beneficial modulation of fructose-induced peripheral and central inflammation was observed. Also, probiotic spores produced reshaping of the gut microbiota towards a composition exerting neuroprotective and anti-inflammatory effects. These results suggest that sBAs might act as a communication bridge along the microbiota gut-brain axis and suggest that their modulation, through probiotic administration, represents an effective strategy to counteract fructose-induced neuroinflammation and gut-brain dysfunction.
Pulmonary vein isolation (PVI) has become the cornerstone of atrial fibrillation (AF) treatment. Nevertheless, the efficacy of radiofrequency ablation remains limited by a substantial rate of recurrence. The selection of anesthesia, the surgeon's operative experience and medical expertise, as well as the ablation surgery strategy, all have an impact on the recurrence after atrial fibrillation surgery. Our research aims to explore a novel method for predicting atrial fibrillation (AF) recurrence. This study enrolled 148 patients with atrial fibrillation (AF) undergoing first-time radiofrequency ablation. Based on the data from the AIFV system (an artificial intelligence-based ablation quality analysis system that generates structured Vistag scores from CARTO3 mapping data), patients were divided into two groups: the high-score group(Vistag analysis scores ≥ V5) and the low-score group(scores < V5). Baseline characteristics, intraoperative parameters, and AIFV system-related data were collected. Multivariate logistic regression analysis was performed to identify factors associated with atrial fibrillation (AF) recurrence. Among the 148 enrolled patients, 84 were categorized into the high-score group and 64 into the low-score group. Patients in the low-score group had significantly higher Left Ventricular End-Diastolic Volume (LVEDV), Left Ventricular Ejection Fraction (LVEF), and Left Ventricular End-Systolic Volume (LVESV), as well as a higher prevalence of diabetes (29.5% vs. 9.5%, p = 0.002). During a minimum follow-up of 365 days, 11 patients (13.1%) in the high-score group experienced recurrence of atrial arrhythmia, compared to 19 patients (29.7%) in the low-score group. Kaplan-Meier analysis revealed a significantly higher atrial arrhythmia-free survival rate in the high-score group (log-rank test, P = 0.012). Multivariate logistic regression analysis revealed that being in the high-score group was an independent protective factor against AF recurrence (OR = 0.383, 95% CI 0.160-0.912, P = 0.030). The AIFV system was used to evaluate six procedural parameters in each atrial fibrillation procedure, which could play a crucial role in predicting the recurrence of atrial fibrillation.
Falls and physical inactivity are both linked to increased dementia risk, but their joint impact has not been well studied. It remains unclear whether physical activity can mitigate the elevated dementia risk after a fall and whether it also lowers the likelihood of future falls. We used data from 44,488 adults aged ≥ 60 years in three cohorts. Falls and physical activity were self-reported. Incident dementia was tracked during follow-up. Cox proportional hazards models estimated the associations of falls with dementia and physical activity with dementia and falls, stratified by fall history. Over a median follow-up of 5.9-7.9 years, 3,492 dementia cases were identified. Falls were associated with a 70% higher risk of dementia (pooled HR = 1.70, 95% CI: 1.57-1.84). In the no-fall group, compared with inactivity, low, moderate, and high physical activity were progressively associated with lower risks of dementia (HRs = 0.63, 0.53, 0.43) and falls (HRs = 0.77, 0.68, 0.58). These protective effects were consistent among fallers, with similar dose-response gradients. Falls substantially increased dementia risk. Higher levels of physical activity were linked to lower risks of both dementia and falls, regardless of fall history.
People with experiences of homelessness are at higher risk for suicide-related thoughts, behaviors, and deaths by suicide compared to those without homeless experience. This complex risk can be tied in part to extreme social need and multimorbidity. To meet these needs and reduce this risk, people with experiences of homelessness frequently require care from multiple providers. Continuity of care is protective against suicide risk, with care coordination playing a central role. Despite the importance of continuity of care in suicide prevention and the potential for mental health nurses to provide care coordination, few studies have explored this potential in relation to people with experiences of homelessness. Provide a potential practice application to illustrate the possible value of using the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) to measure and improve continuity of care as an important element of suicide prevention for people with experiences of homelessness. Using the U.S. Department of Veteran Affairs (VA) Homeless Patient-Aligned Care Team (HPACT) model and universal VA suicide risk screening protocol as a practice exemplar, we discuss the ACSS-MH subscales to illustrate a potential care delivery evaluation and way the psychiatric nursing community can optimize continuity of care, suicide risk detection and suicide prevention in this population. Innovative screening and practice models are needed to effectively prevent suicide in high-risk populations, like people with experiences of homelessness. This case study provides insight into the ACSS-MH measure and VA-based homeless-specific primary care as an example of how psychiatric nurses could similarly use this measure to impact the safety of patients with experiences of homelessness by intentionally fostering continuity related to suicide prevention. This discussion of a practice application shows how the use of a validated measurement tool could drive quality improvement and research that begins with the measurement of continuity related to suicide prevention for high-risk populations.
Caesarean section (CS) is a critical life-saving intervention when medically directed, yet its prevalence in Bangladesh has surged impulsively from approximately 4% in 2004 to nearly 45% in 2022, highlighting a distinctive South Asian pattern of widespread surgical overuse. This study examines the shifting socioeconomic and geographic determinants of CS, specifically investigating the private sector's role in widening inequalities and the transition of surgical birth from a targeted medical necessity to a routine practice dominated by private-sector utilization. We analyzed Bangladesh Demographic and Health Survey (BDHS) data of 26,845 ever-married women, covering the periods 2004-2007, 2011-2014, and 2018-2022. Variables were harmonized and administrative divisions grouped into broader regions to ensure comparability. Using survey-weighted multivariable logistic regression, we identified independent predictors of caesarean section, adjusting for sociodemographic, clinical, and geographic factors while accounting for complex survey design. Weighted CS prevalence increased sharply, rising from 6.8% in 2004-2007 to 39% in 2018-2022. This surge was largely driven by the private sector, where CS rates expanded from roughly 55% in the earliest period to 84% in the most recent. Longitudinal analyses also revealed a notable shift in key determinants: medical indications, initially strong predictors in 2004-2007 (e.g., Multiple Births AOR 9.55), had substantially weaker effects by 2018-2022 (AOR 2.93), indicating growing widespread saturation of CS beyond clinical necessity. The influence of frequent antenatal care similarly declined over time (AOR 9.62 to 4.62), though it remained a significant predictor. Socioeconomic patterns shifted as well; women in the "poorer" wealth quintile moved from having lower odds of CS in 2004-2007 (AOR 0.53) to higher odds in 2018-2022 (AOR 1.45), suggesting increased penetration of surgical delivery into lower-income groups. Geographically, residence in Coastal areas consistently remained protective relative to the Central region. Caesarean delivery in Bangladesh has shifted from a life-saving procedure to a highly prevalent practice, driven predominantly by the expansion of private-sector facilities. An unregulated private sector, rising healthcare contact, and socioeconomic disparities now fuel overuse, demanding stronger regulation, clinical audits, and expanded midwifery‑led care to ensure appropriate use.
Air pollution exposure is increasingly recognized as a risk factor for chronic kidney disease (CKD), but the underlying mechanisms, especially the complex gene-environment interactions as reflected in genetic susceptibility, transcriptomic, and proteomic signatures, remain to be elucidated. We conducted a large-scale prospective cohort study including 330,002 UK Biobank participants with an average follow-up of 13.0 years. Annual average concentrations of PM2.5, PM2.5-10, PM10, NO2, and NOX were assessed. Cox proportional hazards models were applied to estimate CKD risk associated with long-term air pollution exposure. We further evaluated non-linear relationships using restricted cubic splines (RCS), potential mediators via mediation analyses, and CKD susceptibility through additive interaction analyses with baseline comorbidities and polygenic risk scores (PRS). Additionally, transcriptome-wide association study (TWAS) and proteome-wide two-step Mendelian randomization (MR) were integrated to explore potential molecular pathways. Higher exposures to PM2.5 (HR: 1.36, 95% CI: 1.22-1.51, per 5 µg/m³), PM2.5-10 (HR: 1.25, 95% CI: 1.07-1.46, per 5 µg/m³), PM10 (HR: 1.20, 95% CI: 1.06-1.36, per 10 µg/m³), and NOX (HR: 1.04, 95% CI: 1.02-1.07, per 20 µg/m³) were significantly associated with increased CKD risk, whereas NO2 showed no significant association (HR: 0.98, 95% CI: 0.95-1.00, per 10 µg/m³). RCS revealed non-linear relationships for PM2.5-10 and PM10. Mediation analyses indicated that incident hypertension and type 2 diabetes mellitus (T2DM) acted as potential mediators in these associations. Crucially, additive interaction analyses revealed that participants with pre-existing hypertension or type 1 diabetes mellitus (T1DM) were significantly more vulnerable to specific pollution-driven CKD. Compared to individuals with low genetic risk and low air pollution exposure, those with both high genetic risk and high exposure exhibited the highest CKD risk, demonstrating a clear gradient effect across categories. TWAS identified shared genes potentially linking air pollutants with CKD, including upregulated transcripts (STX2, PHOSPHO2, NECAB3) and downregulated transcripts (CDK3, MEIOB, NDUFAF1, CRIPAK). Furthermore, proteome-wide MR analyses identified ALDH3A1, F12, and SNCG as potential risk proteins, and GNLY and MEGF10 as protective proteins. This study provides comprehensive evidence that long-term air pollution exposure is associated with increased CKD risk and offers exploratory insights into the potential molecular pathways underlying this association, advocating the incorporation of renal health considerations into air quality control policies.
To explore the influence of oral health-related knowledge, attitudes and practices on oral health risk-related behaviours of people in custodial settings. Integrative review. Scopus, ProQuest Central, Web of Science, Medline, CINAHL, Academic Search Complete, PsycINFO and Education Research Complete were searched in March 2024 and December 2025. Studies reporting on any individuals in custodial settings, at least one oral health-related knowledge, attitude or practice and at least one oral health risk-related behaviour (either smoking, alcohol, illicit substances or sugar consumption). Data related to custodial population's oral health knowledge, attitudes, or practices and oral health risk-related behaviour were extracted, synthesised narratively and reported thematically. Findings from the 26 studies reveal that people in custodial settings had a general lack of oral health knowledge, and oral health risk-related behaviours were prevalent. The most common risk-related behaviours reported were tobacco use and free sugar consumption. Oral health knowledge, attitudes and practices of this population were influenced by custodial healthcare systems and attitudes of dental professionals. This review highlights the influence custodial healthcare and dental professionals have on the knowledge, attitudes, practices and risk-related behaviours of people in custodial settings. Oral health targeted interventions and strategies are required to improve oral health-related knowledge and attitudes thereby encouraging oral health practices among people in custodial settings. This review will inform targeted oral health promotion programs that can improve oral health outcomes and experiences of this population. People in custodial settings experience a disproportionate burden of oral diseases. This review underscores the need for proactive interventions and systemic reform to improve correctional healthcare experiences globally. Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Extension for Scoping Reviews (PRISMA-ScR) 2018. No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Synthesises evidence on influencing factors contributing to poor oral health among people in custodial settings. Highlights impact of healthcare staff and custodial healthcare systems on population health. Highlights the necessity of oral health promotion programs to improve oral health knowledge and to promote oral health protective behaviours.
The increasing frequency and severity of natural hazards, such as floods, wildfires, land degradation, and ground displacement, pose significant challenges to the protection of urban areas worldwide. While traditional monitoring approaches based on a single-source satellite sensor have proved to be reliable, they often fail to provide a holistic representation of the complexity, scale, and rapid evolution of these phenomena. The recent advancement of artificial intelligence (AI), coupled with the unprecedented availability of multi-source satellite imagery, offers new perspectives for enhancing natural hazard monitoring and susceptibility mapping. In this study, we present a novel approach that leverages state-of-the-art Explainable AI (XAI) techniques, particularly SHAP (SHapley Additive exPlanations), to analyze multi-source satellite imagery for natural hazard monitoring and assessment in urban areas. The framework utilizes globally available, open-source satellite data (Sentinel-1/2, COSMO-SkyMed, SAOCOM) to ensure inherent scalability and transferability. XAI is chosen to move beyond black-box prediction, providing transparent attribution of susceptibility to underlying environmental and infrastructural parameters, which is essential for informed intervention. This interpretability is critical for building stakeholder trust and ensuring that automated predictions align with domain knowledge before deployment. Our approach was developed, applied, and validated in two distinct sites located in the Puglia region, southern Italy: the densely populated Bari Urban Region (BUR) and the diverse settlements and land uses within the Gargano Urban Region (GUR). We combined XAI-based models with optical imagery from Sentinel-2, SAR data from Sentinel-1, COSMO-SkyMed, and SAOCOM to extract the key features explaining the occurrence and magnitude of the following hazards: (1) sediment connectivity; (2) land displacement; (3) urban floods; and (4) urban wildfires. Our results demonstrate that the integration of multi-source satellite imagery through AI not only significantly enhances the accuracy and reliability of hazard detection (e.g., F1 scores consistently above 67.5% for three of the four hazards, and high Recall across all modules) but also enables the identification of subtle spatial patterns and crucial interrelationships.
Although transanal total mesorectal excision (TaTME) has been recognized as an important surgical method for low rectal cancer, optimal anastomotic techniques remain debated. This study compared short-term outcomes of hand-sewn coloanal anastomosis (CAA), single-stapled anastomosis (SSA), and two-stage Turnbull-Cutait pull-through coloanal anastomosis (TCA). A retrospective analysis of 147 patients who underwent TaTME for low rectal cancer (tumor distal margin ≤ 5 cm from anal verge) was conducted between July 2020 and July 2023. The patients were categorized into CAA, SSA, and TCA groups based on the anastomosis. The primary endpoint was anastomosis-related complications that included anastomotic leakage, anastomotic bleeding, and anastomotic stricture. The secondary endpoints included neorectal prolapse, pathological outcomes, perioperative outcomes, stoma-related outcomes, and functional outcomes assessed through the low anterior resection syndrome (LARS) scoring system. Among 147 patients with low rectal cancer, 42 patients underwent CAA, 69 patients underwent SSA, and 36 patients underwent TCA. Operative time was shortest in the SSA group and longest in the TCA group (p = 0.023). TCA demonstrated a lower protective stoma rate (p = 0.005), higher splenic flexure mobilization (SFM) rate (p = 0.014), and extended postoperative hospital stay (p < 0.001) compared to CAA and SSA. Pathologically, TCA resulted in longer length of resected bowel (p < 0.001), with similar distal resection margins and lymph node yield. The complication rates were similar among the three groups, although the TCA group had a higher incidence of neorectal prolapse (p < 0.001). LARS scores improved gradually in all groups postoperatively, with SSA potentially reducing its incidence. In TaTME, SSA may reduce the incidence of LARS, whereas TCA avoids the need for a stoma at the expense of longer bowel resection and an increased risk of neorectal prolapse. Patient-specific selection of the anastomotic technique remains recommended.
Accurate identification of dangerous driving behaviors is critical for accident prevention and occupant protection. However, most existing in-vehicle driver monitoring systems rely primarily on facial or head motion analysis, which fails to capture full-body driving behaviors and raises privacy concerns due to dependence on RGB or near-infrared imaging. In addition, these systems often exhibit limited robustness under low-light conditions. To address these limitations, this study proposes a comprehensive depth-based framework for in-vehicle 3D human pose estimation and dangerous driving posture recognition. First, a large-scale dual-view 3D pose dataset encompassing ten typical driving behaviors is constructed using a Time-of-Flight (ToF) camera. Based on this dataset, we develop a lightweight end-to-end pipeline in which an anchor-based regression model estimates the 3D poses of 16 driver keypoints, followed by an enhanced ST-GCN++ architecture for skeleton-based action recognition. By integrating pose estimation with graph-based temporal modeling, the proposed method effectively distinguishes visually similar hazardous behaviors. To facilitate real-world deployment, the algorithm is further integrated into a software system that enables closed-loop pose monitoring and hierarchical intervention. Experimental results verify that the proposed method achieves 96.02% accuracy in 3D pose estimation and 98.0% accuracy in behavior recognition. With a computational cost of only 1.49 G FLOPs and an inference latency of 0.0375 s per sample, the system achieves real-time performance (27-28 FPS) on an automotive embedded platform, making it well suited for practical in-vehicle safety applications.
Older adults remain highly vulnerable to serious influenza-related complications despite routine vaccination. Whether high-dose quadrivalent influenza vaccine (HD-QIV) offers greater protection than standard-dose quadrivalent influenza vaccine (SD-QIV) against clinically important outcomes remains an important question. We conducted a systematic review and pairwise meta-analyses of randomized controlled trials (RCTs) comparing HD-QIV with SD-QIV in adults aged 65 years or older. PubMed, Cochrane Library, Embase, Web of Science, and Scopus were searched up to February 2026. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models. Prespecified subgroup analyses were performed according to baseline cardiovascular disease (CVD) status. Four RCTs comprising 511,890 participants were included. HD-QIV was associated with significantly lower odds of cardio-respiratory hospitalization (OR 0.93, 95% CI [0.90-0.97]) and cardiovascular hospitalization (OR 0.93, 95% CI [0.89-0.98]), with no significant reduction in respiratory hospitalization (OR 0.90, 95% CI [0.80-1.01]). Significant reductions were also observed for hospitalization due to influenza (OR 0.61, 95% CI [0.50-0.74]), laboratory-confirmed influenza hospitalization (OR 0.69, 95% CI [0.56-0.86]), and heart failure hospitalization (OR 0.80, 95% CI [0.69-0.94]). No significant differences were found for all-cause hospitalization (P = 0.12), all-cause mortality (P = 0.413), myocardial infarction (P = 0.753), or serious adverse events (P = 0.419). No significant subgroup differences were observed according to baseline CVD status. In older adults, HD-QIV was associated with modest but significant reductions in cardio-respiratory and cardiovascular hospitalization, as well as influenza-related and heart failure hospitalizations, without an apparent safety penalty. These findings support preferential use of high-dose influenza vaccination in this population.
Severe pneumonia (SP) threatens the quality of life and well-being of children. This study aims to explore the serum NNT-AS1 expression in SP children and its impact on lipopolysaccharide (LPS)-induced injury in human embryonic lung fibroblasts. The study included 69 SP children, 62 mild pneumonia (MP) children and 75 healthy controls. A pneumonia cell model was constructed with LPS-induced MRC-5 cells. Loss-of-function experiments were performed using si-NNT-AS1 and miR-23a-3p inhibitor. The NNT-AS1 and miR-23a-3p expression was detected by real-time quantitative polymerase chain reaction. The diagnostic effect and prognostic value of NNT-AS1 were evaluated by receiver operating characteristics curves and Kaplan-Meier method. Cell viability and apoptosis were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and flow cytometry. Inflammatory factors were measured by enzyme-linked immunosorbent assay. The interaction between NNT-AS1 and miR-23a-3p was verified by luciferase reporter gene and RNA immunoprecipitation assays. Pearson correlation coefficient was used to analyze the correlation. NNT-AS1 was upregulated in SP children and showed good diagnostic efficacy (area under the curve (AUC) = 0.815). High NNT‑AS1 expression predicted a poorer survival. Silencing of NNT-AS1 increased cell viability, decreased apoptosis, and alleviated inflammatory responses. MiR-23a-3p was a target of NNT-AS1. Inhibition of miR-23a-3p partially reversed the protective effects of NNT-AS1 silencing on LPS-induced MRC-5 cell injury. Serum NNT-AS1 is upregulated in SP patients, and its expression is correlated with clinical prognosis. NNT-AS1 participates in LPS-induced cellular damage by regulating miR-23a-3p. These findings provide a new theoretical basis for understanding the pathogenesis of SP.
CHD8 is a chromatin remodeler implicated in autism spectrum disorders (ASD) and multiple neurodevelopmental disorders, yet heterozygous Chd8-mutant mouse lines often exhibit only mild ASD-related phenotypes, leaving its role unclear. Because a complete knockout of Chd8 causes embryonic lethality, we generated viable homozygous Chd8-mutant mice carrying the human CHD8-Asn2373LysfsX2 mutation using a hybrid (C57BL6/J × 129/Sv) genetic background. Compared to heterozygous Chd8+/N2373K mice, the homozygous Chd8N2373K/N2373K mice showed more robust phenotypes, including increased ASD-related behaviors and brain volume, decreased cerebral blood volume/flow, brain rhythms, and synaptic transmission, and ASD-related transcriptomic changes. Notably, while Chd8+/N2373K mice on a pure background predominantly displayed behavioral deficits in males, the homozygous mutants in the hybrid background exhibited more pronounced female phenotypes, suggesting the interaction of genetic background and mutation strength. A direct comparison of Chd8+/N2373K and Chd8N2373K/N2373K mice on the same hybrid background across brain volume, cerebral blood flow, neuronal firing, synaptic transmission, and transcriptome revealed a gene dosage-dependent attenuation of sexual dimorphic phenotypes that varied by developmental stage and brain region. Transcriptomic analyses further implicated pathways related to synaptic function, RNA splicing, and mitochondrial activity in mediating differences in male-female protection and susceptibility. Thus, a homozygous Chd8 mutation not only intensifies ASD-related traits but can also diminish typical sex-specific severity patterns, uncovering a novel link between mutation strength and sexual dimorphism in ASD.