Aging is associated with progressive cognitive decline and reduced neurobiological resilience that increase vulnerability to anxiety-related dysfunction. Although aerobic exercise is known to support brain health, whether different exercise modalities exert distinct behavioral and neurobiological effects remains unclear. This study aimed to investigate the effects of moderate continuous and extensive interval aerobic exercise on behavioral outcomes and underlying neurobiological mechanisms in aged male rats. Thirty-two male Sprague Dawley rats (24 aged, 8 young adults) were randomly assigned to four groups (n = 8 per group): moderate continuous exercise (MCE; 0.5 km/h, 0° incline, 30 min), extensive interval exercise (EIE; alternating 5 min at 0.5 km/h and 1 min at 1.0 km/h, 30 min total, 0° incline), aged control, or young control. Following treadmill acclimatization, exercise was performed three days per week for six weeks. Anxiety-like behavior was assessed using the open field and elevated plus maze tests, and spatial learning and memory were evaluated with the Morris water maze. Serum, hippocampal, and gastrocnemius muscle samples were analyzed for brain-derived neurotrophic factor (BDNF), superoxide dismutase (SOD), glutathione peroxidase (GPx), and interleukin-10 (IL-10). Statistical analyses were conducted using one-way and repeated-measures ANOVA with Bonferroni post-hoc tests. Compared with aged controls, EIE reduced thigmotaxis in the open field test p = 0.035, d = 1.20), while no differences were observed in the elevated plus maze. Both exercise groups accelerated spatial learning across Morris water maze training days (p < 0.001). EIE was associated with improved memory retention, reflected by increased target quadrant time during the probe trial (p = 0.013, d = 1.35). Biochemically, EIE increased BDNF, IL-10, and SOD levels in serum and hippocampus (p < 0.05), whereas MCE selectively enhanced hippocampal GPx activity. Both exercise modalities elevated GPx levels in muscle and serum compared with aged controls (p < 0.05-0.001). Aerobic exercise was associated with changes in behavioral performance and neurobiological markers in aging rats. Interval-based training was associated with more pronounced changes in certain cognitive and biochemical parameters compared to moderate continuous exercise. These findings suggest that different exercise modalities may differentially influence selected cognitive and redox-related outcomes during aging.
Readmission is considered as a surgical quality indicator. More data regarding predictors of readmission and outcomes after surgery for colorectal liver metastasis are needed. Using a propensity score match to create a 1:2 match of cases:controls for 90-day. Readmission, the matching variables used for balance included age, tumor size, estimated blood loss, and type of resection (minor or major). T-tests were used for continuous measures, Fisher's exact test was used for categorical data, and the Kaplan-Meier method was used to estimate survival. p < 0.05 was considered significant. Retrospectively examined 935 patients with CLM from 2000 to 2018. Using a propensity score match to create a 1:2 match of cases:controls for 90-day. Readmission, the matching variables used for balance included age, tumor size, estimated blood loss, and type of resection (minor or major). T-tests were used for continuous measures, Fisher's exact test was used for categorical data, and the Kaplan-Meier method was used to estimate survival. p < 0.05 was considered significant. 935 patients were included in the initial sample with 896 eligible for inclusion in the propensity matching. The average age of the population was 59% and 59% male. Overall readmission rate was 8.0%. Median time to readmission was 14 days. In the propensity score matched sample, readmitted patients had higher rates of organ space infection (28% vs 2% and p < 0.0001), bile leak (26% vs 1% and p < 0.0001), and liver failure (9% vs 2% and p = 0.042). There was no difference in LOS (7 days versus six days and p = 0.40), overall survival (median 39.7 vs 41.0 months and p = 0.79), or rate of adjuvant therapy (68% for both and p > 0.99). Patients readmitted for intermediate and late complications after surgery for CLM can recover and receive adjuvant therapy with no adverse effect on overall survival. Organ space infection, bile leak, and liver failure are highly associated with readmission.
Gout is a metabolic disorder caused by abnormalities in purine metabolism and/or impaired uric acid excretion. It is characterized by the deposition of monosodium urate crystals in joints or connective tissues, leading to recurrent episodes of acute arthritis. Gout can be categorized into two major types based on its etiology: primary and secondary. The majority of gout cases are associated with impaired uric acid excretion. The natural course of gout can be divided into three stages: (1) asymptomatic phase; (2) acute arthritis phase and intercritical phase; (3) chronic gouty arthritis and tophaceous phase. Acute gouty arthritis typically presents with sudden, severe joint pain, accompanied by redness, swelling, warmth, and tenderness of the affected joint and surrounding soft tissues. When large joints are involved, joint effusion may occur. Acute gouty arthritis often develops at night or in the early morning, is self-limiting, and usually resolves within two weeks. The most common site of acute gout flare-ups is the first metatarsophalangeal joint, followed by the midfoot, ankle, knee, wrist, fingers, and elbow joints. Acute gout attacks rarely affect the axial joints. Pain in these affected areas is often accompanied by limited function, significantly impacting a patient' s daily activities and quality of life. Uncommon sites of gout involvement, as well as gout with normal serum uric acid levels, can easily lead to misdiagnosis. Therefore, a comprehensive diagnosis requires a detailed medical history, physical examination, laboratory tests, and imaging studies. This case report describes a 19-year-old male who was admitted with recurrent anterior chest pain. The diagnosis at another hospital suggested ankylosing spondylitis. Physical examination revealed significant tenderness, redness, and swelling of the bilateral sternoclavicular joints, with local warmth and mildly restricted movement. MRI of the sacroiliac joints showed no significant abnormalities, and serum uric acid levels were normal. Chest dual-energy CT scans revealed multiple tophi in the sternum, bilateral clavicles, scapulae, multiple ribs, and along the edges of the sternum. Based on the patient' s medical history, physical findings, and imaging studies, a diagnosis of gout was confirmed. Treatment included urate-lowering therapy, pain management, and dietary adjustments. During a two-year follow-up period, the patient did not experience recurrent anterior chest pain, and multiple serum uric acid tests consistently showed levels below 300 μmol/L. Repeat chest dual-energy CT scans indicated significant reduction of tophi in the sternoclavicular joints and other affected areas.
Parkinson's disease (PD) is a chronic neurodegenerative disorder that leads to motor and non-motor challenges, significantly impacting the quality of life. Research highlights body's antioxidant systems role in mitigating PD. This study investigated neuroprotective capabilities of Tinospora sinensis stem extract (TSSE) in a rat model of PD induced by rotenone. PD was induced in rats by subcutaneous rotenone injections (2 mg/kg/day) for 35 days. TSSE was administered orally at 100, 200, and 400 mg/kg doses, with levodopa-carbidopa as the standard reference. Motor impairments were assessed through catalepsy, locomotor activity, and rotarod tests. Biochemical evaluations included oxidative stress markers, antioxidant enzymes (glutathione, superoxide dismutase, and catalase), and dopamine levels, and monoamino oxidase-B (MAO-B). Histopathological examination of brain assessed neuronal integrity. Rotenone administration led to significant motor impairments, increased oxidative stress, reduced dopamine levels, and neuronal damage. Treatment with TSSE resulted in notable, dose-dependent enhancements in motor abilities and restored antioxidant enzyme activities, while also reducing lipid peroxidation, as indicated by decreased malondialdehyde levels. Additionally, TSSE decreased MAO-B level and increased brain dopamine level and maintained neuronal structure. The TSSE 400 mg/kg exhibited neuroprotective effects comparable to those of standard. TSSE shows significant neuroprotective effects, likely by enhancing endogenous antioxidant defenses and restoring dopaminergic neurotransmission. These findings suggest, TSSE could serve as a complementary therapeutic approach that targets oxidative and neurodegenerative mechanisms in PD.
Ice recrystallization is a key factor limiting the storage stability of ice cream. Although tamarind seed polysaccharide (TSP) is recognized for its thickening and ice recrystallization inhibition (IRI) capabilities, its specific mechanism of action in frozen dairy systems remains underexplored. This study aimed to elucidate the stabilizing mechanism of TSP (0%, 0.2%, and 0.5% w/w) in ice cream formulations. Rheological analysis revealed that TSP significantly modified the flow properties of the mixes. The consistency coefficient (K) increased from 0.4451 to 1.1593 Pa·sn, and the flow behavior index (n) increased from 0.2876 to 0.6445, confirming the characteristic shear-thinning behavior of the mixes. Oscillatory tests confirmed the formation of a weak gel-like network (storage modulus (G') > loss modulus (G″)), imparting viscoelastic stability to the mix. At the microstructural level, TSP promoted the formation of a finer, more monodisperse emulsion and effectively inhibited Ostwald ripening, reducing the mean ice crystal area from 221.69 μm2 to 135.78 μm2. Furthermore, TSP retarded crystallization kinetics and reduced freezable water content, leading to a prolonged phase transition. These microstructural changes translated to enhanced cohesiveness (rising from 5.835 to 7.121) and substantially reduced hardness in the final product, although this was accompanied by an increase in the melting rate. These findings demonstrate that TSP is a potent cryostabilizer that optimizes the microstructural integrity and textural quality of ice cream. This research provides a robust theoretical foundation for utilizing TSP as a functional ingredient in the frozen dessert industry. © 2026 Society of Chemical Industry.
ObjectiveTo evaluate the efficacy and safety of simultaneous antegrade-retrograde endoscopic rendezvous procedure for thermo-expandable metallic stent (Memokath 051) placement in treating post-kidney transplantation ureteral stenosis.MethodsA retrospective single-arm cohort study was conducted in six female patients with distal ureteral strictures after kidney transplantation treated between 2022 and 2024. A dual-endoscope technique was used for stent deployment. Surgical parameters, laboratory indicators, and complications were recorded, with a follow-up period of 1-20 months. Paired t-tests or Wilcoxon tests were applied for statistical analyses.ResultsAll stents were successfully placed, with a mean operative time of 173.0 min and mean hospital stay of 8.8 days. Hydronephrosis was significantly relieved in all patients. Postoperative estimated glomerular filtration rate was significantly higher than the preoperative rate (p = 0.04), whereas no significant differences were found between the pre- and postoperative creatinine levels or leukocyte counts. A mild but clinically insignificant hemoglobin drop occurred on postoperative day 1 (p = 0.02). One patient experienced stent migration that was successfully repositioned, and another developed recurrent urinary tract infections that were controlled using antibiotics. All stents remained patent at the final follow-up.ConclusionThe simultaneous antegrade-retrograde endoscopic approach for Memokath 051 placement appears to be a safe and effective minimally invasive option for post-transplant ureteral stenosis; this finding warrants confirmation in further large-scale multicenter studies.
Although clinical evaluation, radiological findings, and supplementary tests are routinely used to diagnose idiopathic normal pressure hydrocephalus (INPH), the large variability in surgical outcomes raises the question of whether diagnostic radiological markers truly reflect the typical clinical gait impairment. Gait disorder (GD) and ventriculomegaly (VM) are both common in older adults and may coincide by chance, potentially contributing to this inconsistency in results. This study aimed to determine the prevalence of typical INPH-related higher-level gait disorder (HLGD), diagnosed independently of imaging, and assess its association with VM and other MRI features. In this case-control study, 6467 individuals age 65-84 years were screened for GD per questionnaire. Physicians with experience of neurological GD identified cases with HLGD and matched controls without GD through clinical evaluation of 1047 of these individuals. Subsequently, brain MRI (n = 909) or CT (n = 98) was performed. After exclusions, 81 with HLGD and 192 controls remained. Radiological hydrocephalus features were compared between the groups. The prevalence of HLGD in the general older population was 5.8%. For HLGD combined with Evans Index (EI)>0.3, it was 3.7%, and 1.7% had HLGD with Disproportionately Enlarged Subarachnoid space Hydrocephalus (DESH). The estimated prevalence of asymptomatic VM, i.e. EI > 0.3 without GD, was 24%, and 4.1% had asymptomatic VM with DESH. Individuals with HLGD were older and performed worse on cognitive tests. Radiology revealed higher ventricular volumes and EI, and a more acute callosal angle in HLGD versus controls. DESH was also more frequent in HLGD (29% vs 7%, p < 0.001). Despite group-level differences, individual overlap was substantial. MRI markers showed poor to moderate ability to discriminate HLGD (AUC 0.614-0.765) from normal gait. In this population-based case-control study, both HLGD and EI > 0.3 were common. EI > 0.3 occurred more frequently with HLGD, but it was also common in asymptomatic individuals, indicating that ventriculomegaly is not specific to HLGD. Most MRI biomarkers showed limited ability to distinguish HLGD from normal gait, although lateral ventricular volume divided by total intracranial volume (relative ventricular volume) was the most informative. The frequent occurrence of EI > 0.3 and DESH in asymptomatic individuals highlights the need for longitudinal studies to clarify prognosis in these individuals.
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is characterized by persistent inflammation, microbiota dysbiosis, and excessive neutrophil extracellular trap (NET) formation. Rosavin, a natural phenylpropanoid glycoside, exhibits anti-inflammatory and immunomodulatory activities, but its therapeutic potential in COPD remains unclear. A COPD rat model was induced by intratracheal lipopolysaccharide instillation combined with chronic passive cigarette smoke exposure. Rosavin (50 or 100 mg/kg) or the NF-κB inhibitor BAY 11-7082 (3 mg/kg) was administered for treatment. Pulmonary function tests (FEV1/FVC, PEF, and airway resistance), histopathological evaluation (HE and PAS staining), bronchoalveolar lavage fluid (BALF) inflammatory cell counts, ELISA-based cytokine assays, and oxidative stress markers (MDA, MPO, and SOD) were systematically assessed. NET formation was evaluated using MPO-DNA ELISA, Western blotting, and immunofluorescence for CitH3 and MPO/IL-17 colocalization. In addition, lung microbiota composition was analyzed by 16 S rRNA gene sequencing. Cigarette smoke extract (CSE)-stimulated BEAS-2B cells were used to assess the direct effects of Rosavin on NF-κB activation in vitro. Rosavin significantly inhibited NF-κB activation, improved lung function, and reduced structural damage, oxidative stress, and inflammatory cytokines in COPD rats. It also suppressed NET formation, including IL-17-enriched NETs, by downregulating MPO, NE, and CitH3. In BEAS-2B cells, Rosavin similarly reduced CSE-induced NF-κB activation and cytokine release. Microbiota profiling showed decreased diversity and enrichment of Fusobacterium nucleatum in COPD rats, whereas Rosavin restored beneficial taxa such as Lactobacillus spp. BAY 11-7082 produced comparable effects, supporting NF-κB inhibition as a key mechanism. Rosavin ameliorates COPD-associated pathology through integrated mechanisms involving NF-κB inhibition, reduction of IL-17-enriched NET formation, and modulation of lung microbiota composition. These findings identify Rosavin as a promising multi-target therapeutic candidate for COPD.
Pneumoconiosis patients have a higher prevalence of chronic obstructive pulmonary disease (COPD). While age is a known associated factor, its impact across different populations is unclear. We included 9,964 pneumoconiosis patients from 27 Chinese provinces. Factors were identified using multivariable logistic regression, and the non-linear age-COPD association was examined with restricted cubic spline (RCS) modelling. Stratified analysis and interaction tests assessed sociodemographic heterogeneity. Sensitivity analyses comprised RCS models with varying knots and propensity score matching. The prevalence of COPD among patients with pneumoconiosis was 24.1%. Each additional year of age was associated with a significant increase in the odds of COPD (adjusted odds ratio [aOR] = 1.03, 95% confidence interval [CI]: 1.03-1.04). RCS analysis revealed a significant nonlinear relationship, with the odds increasing more steeply at older ages (P for overall < 0.001; P for nonlinear = 0.002). Subgroup analyses showed substantial heterogeneity in these associations. Among urban residents and individuals covered by work-related injury insurance (WRII), the odds of COPD increased sharply and then gradually plateaued in later life. In contrast, among rural residents and those without WRII, the odds increased steadily with advancing age. Sensitivity analyses confirmed the robustness of these findings. The nonlinear relationship between age and COPD in pneumoconiosis in patients with pneumoconiosis is significantly modified by sociodemographic factors.
Children with type 1 diabetes mellitus (T1DM) have an increased risk of developing celiac disease (CD), frequently without typical symptoms. However, the optimal screening strategies and diagnostic threshold for tissue transglutaminase antibody immunoglobulin A (tTG-IgA) remain controversial. This study aimed to assess the performance of CD screening tests and identify optimal serological thresholds in children with T1DM. This 12-year retrospective single-center cohort study from Türkiye included 282 newly diagnosed T1DM children without prior CD. Patients with <2 CD screenings performed ≥ 6 months apart or incomplete records were excluded. Among the remaining cohort, 206 patients had longitudinal screening for CD. Of them, only 24 patients who had seropositivity constituted the main analytical sample for assessing the diagnostic performance of tTG-IgA levels using receiver operating characteristic (ROC) analysis. Among the 206 patients with longitudinal CD screening, tTG-IgA positivity was observed in 24 patients (11.6%), either at T1DM diagnosis (70.8%) or during follow-up (29.2%). Biopsy-confirmed CD was diagnosed in 4.8% of the cohort. The remaining patients had fluctuations in tTG-IgA level; 50% became seronegative, but two-thirds became positive again. ROC analysis identified an optimal tTG-IgA threshold of ≥7.3× the upper limit of normal (ULN), yielding an area under the curve of 0.81, sensitivity of 70%, and specificity of 100%. Notably, 8.3% of biopsy-confirmed CD cases had tTG-IgA levels < 3×ULN. Although tTG-IgA level ≥7.3×ULN is highly predictive of CD in children with T1DM, lower levels may also be noteworthy. Continuous long-term monitoring and a multi-dimensional approach are crucial for early and accurate CD diagnosis in this high-risk group.
To evaluate the clinical role, durability, anatomical response, and safety for suprachoroidal triamcinolone acetonide (SCTA) (Xipere) in routine clinical practice. Data were manually extracted from health records at a high-volume retina practice in Cleveland, Ohio. All patients with noninfectious inflammatory macular edema undergoing SCTA (≥1 billing code) between October 25, 2021, and July 17, 2025, were included. Patients with known systemic autoimmune or infectious associations were excluded. Unique eyes were defined by MRN + laterality, with "OU" entries split into OD/OS. Patient demographics, underlying diagnosis categorization, time between first and second injection (for eyes with ≥2 injections) were summarized. Pre- versus post-treatment central retinal thickness (CRT) and intraocular pressure (IOP) were compared via paired t-tests. A total of 177 patients (195 eyes) received 340 SCTA injections for macular edema associated with an underlying diagnosis of intermediate uveitis (10%), pseudophakic cystoid macular edema (31%), and posterior uveitis (59%). The time between first and second injection was approximately 5 months [SD ± 72.5; median 144 (min 35, max 427)]. From baseline to follow-up, mean CRT decreased by 103 µm [95% CI: (-122,-83.2), P < 0.001], while IOP increased minimally [mean difference 0.7 mmHg, 95% CI: (-0.02, 1.43), P = 0.057]; and was medically managed when elevated. In this real-world cohort, findings suggest that SCTA achieves robust anatomical improvement, a favorable IOP profile, and prolonged durability across patients with inflammation-related macular edema.
Usutu virus (USUV) is an emerging arbovirus transmitted predominantly by mosquitoes of the genus Culex, although several other genera, including Aedes, Culiseta, Mansonia, Anopheles, and Coquillettidia, have also been implicated as potential vectors. The virus was originally found in sub-Saharan Africa but is increasingly detected in Europe. While human infections are often asymptomatic, USUV has been linked to neuroinvasive disease. In temperate regions, where mosquito activity is seasonal, mechanisms enabling virus persistence are poorly understood. Vertical transmission has been proposed as a route for interepidemic maintenance, but experimental evidence remains limited. To determine whether USUV can be vertically transmitted between mosquito generations and assess the effect of temperature on the vertical transmission rate in Cx. pipiens bioform molestus. Laboratory-reared Cx. pipiens bioform molestus were provided with a bloodmeal infected with USUV and maintained at either 27°C or 23.5°C. Infected females (F0) were allowed to oviposit, and two successive generations (F1 and F2) were reared. Individuals from all life stages were screened for USUV RNA using RT-qPCR. Infection prevalence and relative viral RNA quantification were compared between temperature conditions and generations. At 27°C, the vertical transmission rate was high, with 94% (n = 30) of F1 and 100% (n = 11) of F2 adult mosquitoes testing positive, although USUV RNA was also detected in immature stages (eggs, larvae, and pupae). At 23.5°C, only one F1 adult mosquito (1.25%) tested positive, with no infection detected in larvae or other immature stages and no F2 infection was detected. Temperature had a significant effect on vertical transmission rate (p < 0.001), while differences between generations were not statistically significant. These findings demonstrate that vertical transmission of USUV in Cx. pipiens bioform molestus occurs at significantly higher rates at 27°C (94-100%) compared to 23.5°C (1.25%), suggesting temperature-dependent mechanisms specifically affecting vertical inheritance. While temperature effects on viral acquisition and dissemination are well-established, our experimental design specifically tests vertical transmission by examininginfection in F1 and F2 offspring that had no direct exposure to the virus, allowing us to distinguish vertical inheritance from horizontal transmissionprocesses.
Transcranial direct current stimulation (tDCS) has been proposed as a non-invasive neuromodulatory strategy to enhance motor performance and modulate inflammatory responses. However, its effects on strength capacity and physiological stress markers during complex resistance exercises in elite athletes remain underexplored. In this exploratory, randomized, sham-controlled pilot study, ten elite male weightlifters (n = 10; active tDCS = 5, sham = 5) received either a single 20-min session of anodal tDCS (2 mA) over the motor cortex or sham stimulation immediately before performing high-load back squats (85% 1RM). Outcomes included repetition number, barbell kinematics, Borg Rating of Perceived Exertion (Borg-RPE), Visual Analogue Scale (VAS) measures, and metabolic and oxy-inflammatory biomarkers (blood glucose, lactate, antioxidant capacity; salivary ROS; urinary IL-6, 8-iso-PGF2α, 8-OH-dG, creatinine, and neopterin). Given the exploratory design and small sample size, intervention effects were analyzed using Mann-Whitney U tests. For outcomes assessed both before and after stimulation, between-group comparisons were performed on change scores (Δ = post - pre). In contrast, mechanical exercise-related variables, which were only collected after stimulation, were directly compared between the active and sham groups. Athletes receiving active tDCS performed a significantly higher number of back squat repetitions and exhibited shorter lift times compared with the sham group (p = 0.024 and p = 0.011, respectively). No significant between-group differences were observed in Borg-RPE, VAS-based subjective measures, or biochemical markers (all p > 0.05). No significant differences were found for the remaining mechanical parameters (all p > 0.05). A single session of anodal tDCS applied before high-load back squat exercise may be associated with improvements in repetition capacity and lifting efficiency in elite weightlifters. No significant effects were observed on perceived exertion, biomechanical stability measures, or metabolic, oxidative, inflammatory, and renal biomarkers. These preliminary findings suggest that tDCS may represent a promising neuromodulatory adjunct to strength training, warranting confirmation in larger and methodologically powered studies. None (pilot study).
Drawing on self-determination theory, this study develops a dynamic predictive framework to examine how basic psychological need satisfaction prospectively predicts subjective well-being among Chinese undergraduates and how self-determined motivation operates as a boundary condition. Five waves of panel data were collected from 547 students at four eastern Chinese universities across one academic year, with measurements spaced approximately ten weeks apart. Latent growth curve modeling combined with cross-lagged panel analysis revealed that need satisfaction at one wave reliably forecast subsequent well-being beyond autoregressive carryover, with autonomy exerting the strongest contemporaneous influence and relatedness contributing more enduring lagged effects. The interaction between lagged need satisfaction and the relative autonomy index was statistically reliable, and Johnson-Neyman analysis localized a non-significance interval of [-2.81, 1.93], outside which the predictive association held for roughly 71% of participants. Conditional slopes rose from 0.092 at low motivation to 0.418 at high motivation, suggesting that self-determined regulation statistically conditions, rather than uniformly amplifies, the need-well-being association. Robustness checks across alternative measures, estimators, and demographic strata supported the stability of these patterns. Because the design is observational, we read these patterns as temporally ordered associations rather than causal effects; traditional and random-intercept cross-lagged specifications, together with longitudinal measurement invariance tests, converged on the same qualitative picture. The findings add a dynamic, within-academic-year perspective to self-determination theory and inform mental health practice in Chinese higher education by suggesting that need-supportive interventions are most effective when paired with attention to motivational quality.
The psychosocial stress experienced by families with young children during the pandemic raised concerns about developmental risks, particularly for preterm infants, who are highly sensitive to environmental influences. This study examined the association between parent-reported pandemic burden and cognitive, language and motor development of preterm children. Between 2022 and 2023, a total of 69 children (median corrected age: 21.59 months) were assessed, 62.3% of whom were born prematurely. A subset of these preterm children (n = 31), restricted to improve age alignment, was compared to a pre-pandemic cohort (n = 40; median age: 22.2 months). Development was measured using the Bayley Scales of Infant and Toddler Development (Second and Third Edition). The pandemic burden was quantified using the Corona-Index, which was based on a standardised parental questionnaire. Multiple linear regressions were conducted with the Corona-Index as the main predictor and sex, gestational age, socioeconomic status and parental stress as moderators. Group differences were analysed using Mann-Whitney-U-Tests. Cognitive and motor scores did not differ significantly between cohorts, whereas language scores were significantly lower in the pandemic group (p = 0.001). The overall regression models for cognitive and language development did not reach statistical significance, and their sub-analyses should be interpreted with caution. Within the pandemic cohort, a significant interaction between the Corona-Index and sex was found for motor development (p = 0.022). Exploratory interaction effects suggested possible sex-related differences. Overall, preterm children assessed during the pandemic showed differences in language scores compared to the pre-pandemic control group, which may theoretically be linked to altered social environments. However, instrument-related variability and residual clinical confounding cannot be excluded. Exploratory analyses highlighted the importance of examining sex-specific patterns in the context of environmental disruptions.
Somalia lacks empirical data on routine infection prevention and control (IPC) monitoring at the health-facility level, despite ongoing gaps in IPC worldwide. Reducing healthcare-associated infections, preventing antibiotic resistance, and safeguarding healthcare personnel, especially in fragile health systems, all depend on effective IPC systems. This study examines IPC monitoring practices and associated facility-level determinants in Somalia using nationally representative data from the 2024 Harmonized Health Facility Assessment (HHFA). 1,219 health facilities were evaluated using a cross-sectional analytical approach. Data were collected using the standardized WHO. Harmonized Health Facility Assessment (HHFA) instrument, including facility-reported evaluations of standard IPC monitoring procedures using structured questionnaire items. The data were verified using field supervision and digital quality standards. To investigate relationships between IPC monitoring and facility characteristics, descriptive statistics and chi-square tests were applied, with a significance level of p < 0.05. Routine IPC monitoring based on standardized monitoring approaches in the preceding six months was reported in only 6.6% of facilities. While there was no significant variation by the state level, monitoring varied considerably by managing authority (p = 0.047) and facility type (p < 0.001). Primary health units, private clinics, TB centers, and privately run facilities demonstrated the lowest levels of monitoring performance, whereas higher-level facilities and those run by the government or non-governmental organizations showed higher monitoring levels. There was no significant correlation found between facility ownership and IPC monitoring. The IPC system in Somalia is still limited by managerial, structural, and capacity-related issues. It is crucial to prioritize resources for lower-tier and privately run facilities, strengthen governance, and standardize audit-feedback systems. To lower healthcare-associated infections and support antimicrobial resistance control, these findings provide practical evidence for national IPC scale-up, targeted oversight, and policy. Building capacity in privately run, primary-level facilities needs to be a top priority for the national IPC scale-up. Not applicable.
For identification of this new local poly-γ-glutamic acid (γ-PGA) bacteria and partial purification of γ-PGA, the bacterium was studied and identified as Bacillus cereus. Sixty isolates of Bacillus spp. were collected from 28 sources (agricultural soil, local market vegetables, and fruits). Preliminary screening was performed on selective plates; 37 strains were selected on the basis of their ability to form a slimy mucoid colony. All isolates were studied for morphological and microscopic characters and identified by biochemical tests; a test for the production of γ-PGA was conducted with spectrophotometric determination of the polymer concentration at 216 nm. The best local strain B3, causing 2.54 g/mL of polymer, was chosen. Isolated strain was designated ARM24 and was published elsewhere with 99% identity as B. cereus ARM24 under the GenBank accession number. Optimization studies indicated that the optimum conditions for γ-PGA production were 37°C, pH 7, inoculum size 2 mL, shaking speed 200 rpm, and fermentation time 48 h using grape pomace juice as carbon source and soybean meal with salting out as nitrogen source. The polymer was precipitated from cold 99% ethanol with a recovery rate of 3:1, purified by dialysis bags (10,000 Da), and characterized by Fourier transform infrared (FT-IR), thin-layer chromatography (TLC), 1H-NMR, and high-performance liquid chromatography (HPLC).
Heart failure (HF) is a clinical syndrome characterized by impaired cardiac diastolic and systolic function due to structural or functional damage to the myocardium. HF represents the end-stage manifestation of many cardiac diseases. Therefore, early identification of high-risk patients is crucial. This study aims to utilize machine learning (ML) methods to develop and validate a model to predict major adverse cardiovascular and cerebrovascular events (MACCE) in patients with HF and identify its key predictive features. This study is a retrospective cohort study. We enrolled a total of 271 patients, who were divided into training and testing sets. Baseline data, including cardiopulmonary exercise testing (CPET) parameters and laboratory tests, were collected for all participants. Based on the presence or absence of MACCE during follow-up, they were categorized into a No-event group and MACCE group. We developed seven ML models to predict the incidence of MACCE in patients with chronic heart failure (CHF) using CPET parameters. The predictive performance of these models was systematically compared, and model interpretability was evaluated using Shapley Additive exPlanations (SHAP). Subsequently, retaining only those with HF with preserved ejection fraction (HFpEF) for a sensitivity analysis. Additionally, a subgroup analysis was conducted between No-event group and Worsening HF (WHF) group. We used Boruta feature selection, four important predictive features were identified. Among the ML models constructed with these features, the Categorical Boosting (CatBoost) model demonstrated the best performance. SHAP analysis was applied to interpret the optimal model, revealing that lower values of heart rate recovery at 1 min (HRR1), as well as a higher carbon dioxide ventilation equivalent slope (VE/VCO2 slope), were associated with higher SHAP values-indicating greater importance in predicting adverse outcomes. HRR1 and VE/VCO2 slope can serve as independent predictors for the incidence of MACCE in patients with CHF. Both impaired HRR1 and an elevated VE/VCO2 slope serve as significant independent predictors of MACCE in the CHF population.HRR1 is an independent predictor of WHF in patients with CHF.
To evaluate the impact of international pooled procurement mechanisms, which are primarily represented by the United Nations Children ' s Fund (UNICEF) and the Pan American Health Organization (PAHO), on the procurement prices of vaccines. Based on 14 497 vaccine procurement transaction records collected from 188 different countries spanning the period from 2013 to 2024, this research employed a high-dimensional fixed effects model along with an event study metho-dology to accurately identify the price effects and dynamic temporal trends, while simultaneously conducting a multidimensional heterogeneity analysis. (1) The baseline model demonstrated that, when compared to the independent self-procurement conducted by individual nations, utilizing pooled procurement through the UNICEF significantly reduced the average vaccine prices by 27.6% (β=-0.323, P < 0.01). The PAHO mechanism similarly exhibited an initial price reduction potential of approximately 30.9% (β=-0.370, P=0.052). (2) The event study method strictly validated the parallel trend assumption (joint significance test of pre-treatment coefficients: F=0.27, P=0.845). Dynamic tracking revealed that a price reduction of approximately 30.0% (β=-0.356, P < 0.01) was achieved exactly in the year of transitioning from self-procurement to pooled procurement, and this reduction effect remained persistently stable in subsequent years. (3) Heterogeneity tests revealed a significant "pro-poor" effect of pooled procurement: the price reduction margin obtained by small-scale buyers (38.5%, β=-0.487, P < 0.01) was significantly higher than that of large-scale buyers (22.5%, β=-0.255, P < 0.01). The marginal price reduction coefficient for non-Global Alliance for Vaccines and Immunization (GAVI) eligible countries (β=-0.418, P < 0.01) was substantially larger than that for GAVI eligible countries (β=-0.118, P < 0.05). The high-income country group experienced the most substantial price drop (β=-0.475, P < 0.01). (4) The supply-side moderating effect analysis indicated that UNICEF' s collective bargaining power maintained robustness across diverse market structures, showing no statistically significant attenuation despite increases in market concentration (interaction term β=0.095, P>0.10). Institutionalized pooled procurement mechanisms are capable of significantly reducing vaccine prices. For those countries that are currently in the immunization financing transition period, as well as those facing high self-procurement benchmark prices, participating in an efficient international pooled procurement platform serves as a critical institutional arrangement to replace external financial aid and to effectively maintain the long-term affordability of vaccines.
Increasing physician turnover poses challenges to healthcare institutions worldwide. Patient-centered communication (PCC), which increases patient-physician communication quality and physician work experiences, is considered a potential solution. Nonetheless, little is known about its actual effects and underlying mechanisms on healthcare providers themselves. Drawing on an integrated framework based on affective event theory and affect theory of social exchange, this study proposes and tests a pathway model linking PCC and physician turnover intention. Analyzing survey data collected from Chinese physicians (N = 600) with the structural equation model technique, the findings show that PCC is negatively associated with turnover intention. Particularly, this association is sequentially mediated by 1) receipt of patient gratitude, positive affect after consultations and positive work rumination (β = -.002, 95%CI[-.006, -.0002]), 2) receipt of patient gratitude, positive affect after consultations and negative work rumination (β = -.003, 95%CI[-.007, -.0004]), 3) receipt of patient gratitude, negative affect after consultations and positive work rumination (β = -.003, 95%CI[-.007, -.0004]), and 4) receipt of patient gratitude, negative affect after consultations and negative work rumination (β = -.002, 95%CI[-.006, -.0002]). On this basis, this study contributes to the literature by elucidating how PCC benefits physicians through their active elicitation of positive affective events.