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[This corrects the article DOI: 10.1055/a-2828-9572.].
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Demand for preventative health care is weak in low-income settings. In a field experiment in a low-income, high-risk setting, we evaluated whether demand for a new bio-medical preventative health product, offered free at public health clinics, responds to digital feedback-based intensive information on health risks and benefits of prevention along with a clinic referral enabling access to the product. In our sample of women aged 18-24 years, we find a large correction in risk beliefs sustained six months after the intervention. Against a background of very low baseline usage, within six months we find a 5.8 percentage point increase in take up of the prevention method, a level of uptake which is very large relative to the control group. Reassuringly, there is no meaningful difference in up-take amongst baseline high- risk and low-risk individuals.
Hypovitaminosis D is a global public health concern and is known to be prevalent worldwide including in tropical countries. Data on its prevalence and determinants are scarce in Bangladesh. The objective of this study was to determine the vitamin D status and its dietary and lifestyle determinants among adult people attending selected clinical laboratories. It was a descriptive cross-sectional study conducted among 221 people undergoing laboratory investigation for serum 25- hydroxy vitamin D in selected two laboratories during the period of January 2022 to March 2022 (three months). The association between vitamin D status & individual specific variables was statistically analyzed. Out of 221 respondents, 156(70.59%) were female and 65(29.41%) were male, with a mean age of 45.32±17.41 years. Regarding serum vitamin D level, only 12.2% of respondents had a sufficient level of vitamin D and hypovitaminosis D was prevalent among 87.8% of respondents with 49.3% deficiency and 38.5% insufficiency. Vitamin D deficiency was found more among females (55.80%) compared to males (33.80%). This study reveals no milk intake (p=0.015) and traveling by car and motorbike (p=0.042) was significantly associated with hypovitaminosis D. No significant associations of vitamin D deficiency and insufficiency were detected with sea fish/oily fish consumption, vitamin D supplementation, covering clothes of females, use of sunscreen, physical exercise and smoking habit of the respondents. The study findings recommend encouraging people to take vitamin D-containing foods to prevent hypovitaminosis D and related consequences.
Mitochondria act as dynamic signaling hubs, constantly adapting to tissue-specific metabolic demands to ensure cell homeostasis. Central to this role is their capacity to take up calcium (Ca2+) into the matrix, a process that regulates energy production, cell death pathways, and broader cellular signaling. For decades, mitochondrial Ca2+ (mt-Ca2+) uptake was firmly established at the physiological level, yet the identity of the proteins involved remained elusive. The breakthrough discovery of the mitochondrial calcium uniporter complex (MCUC) has finally enabled genetic dissection of mt-Ca2+ fluxes and revealed its pivotal role in health and disease. Here, we retrace the trajectory of the field from the pioneering observations of the 1960s to the molecular era of the MCUC, emphasizing the latest advances in its regulation, integration into cellular networks, and pharmacological targeting.
Determinants of telemedicine applications use by general practice patients with chronic respiratory diseases are not yet fully known. The aim of this study was twofold: (a) to assess facilitators and barriers for the use of digital home spirometers in primary care, and (b) to evaluate parameters for process quality in implementing guideline-recommended care in daily practice. The study was evaluated using a mixed-methods design. Patients with bronchial asthma or chronic obstructive pulmonary disease were instructed to take daily measurements using a digital home-spirometry device. Primary care physicians regularly controlled spirometry data using a digital monitoring portal. Telephone interviews were conducted with patients and healthcare professionals. Qualitative analysis of the transcripts was based on content analysis. Quantitative data included the assessment of quality indicators in the beginning (t0) and at the end (t1) of each individual's participation in the study, the Patient Assessment of Chronic Illness Care Short-Version (t0) and reasons for use/non-use of the spirometer (t1). Logistic regression was performed to determine predictors of use according to instructions. Altogether, 127 patients participated in the study; the average age was 59 years, 61% (n = 78) of participants were female. 21 telephone interviews with patients and healthcare professionals were conducted. Facilitators included: sense of obligation, habituation, visualization of progression, self-efficacy, physician contacts, remote treatment, and positive aspects of integration into daily practice. Barriers included: understanding of the disease, dyspnea, as well as project and technical requirements. Care providers considered time-consuming procedures and clinical assessability as barriers. At t0 and t1, approximately one third of respondents (33% resp. 36%) stated that they had received disease-specific training, and 57% stated in both cases that they had gotten the annual influenza vaccination. Logistic regression revealed that duration of disease (OR 0.96; CI 95% 0.93; 0.99), a daily measurement being too strenuous (OR 0.165; CI 95% 0.04; 0.076), and the fact that measurements could not be taken while away from home (OR 0.235; CI 95% 0.07; 0.75) to be negative predictors of use according to instructions. For the patients in the study, digital applications improved self-efficacy and self-control. However, a better understanding of these applications and additional medical feedback could be helpful for the patients using such digital applications. The evaluation of process quality parameters showed potential for improving rates of disease-related education and influenza vaccination.
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, yet their uptake in low- and middle-income areas is hindered by high prices and uneven distribution. Anhui Province, China-characterized by marked urban-rural economic contrasts-offers a critical setting to examine real-world access to these agents. The objective of this study was to assess the availability, price levels, and affordability of ICIs across Anhui Province and to identify policy levers that could narrow observed access gaps. We applied the World Health Organization/Health Action International (WHO/HAI) standardized survey methodology to evaluate the availability, price differentials, and economic burden of immune checkpoint inhibitors (ICIs) marketed in Anhui Province, China. The survey was conducted in 2025 across 199 public hospitals. Affordability was further assessed using a four-tier framework comprising the WHO/HAI standard indicator (defined as the number of days' wages required to afford 30 days of treatment), adjusted using local urban and rural per capita disposable income to account for China's socioeconomic heterogeneity, and incorporating insurance reimbursement scenarios on the basis of Anhui provincial policy (85% for urban employee insurance and 70% for urban-rural resident insurance) to estimate out-of-pocket expenditure. In addition, catastrophic health expenditure (CHE), defined as household out-of-pocket health spending exceeding 40% of non-food expenditure, was used to capture household-level financial risk beyond individual income-based measures. Availability was defined as the proportion of facilities stocking a medicine on the survey day. Prices were collected at unit level and summarized as medians across facilities, with affordability assessed using the median price ratio (MPR), calculated as median local unit price relative to the international reference price (IRP) from the MSH International Drug Price Indicator Guide, in line with WHO/HAI methodology. Surveying 199 hospitals, we found that domestic PD-1 inhibitors-sintilimab, camrelizumab, and tislelizumab-were stocked in roughly 4 out of 5 facilities, whereas 11 of the 15 mainly imported ICIs appeared in fewer than 16% of hospitals; although some imported agents had acceptable median-price ratios (0-2), their absolute prices remained several-fold higher than domestic alternatives; thus even after insurance (85% urban, 70% rural), a year's treatment with cadonilimab or durvalumab still exceeded the catastrophic-expenditure threshold by up to 40 times for rural households, while domestic sintilimab or camrelizumab stayed well below that line. Domestic ICIs are broadly available and relatively affordable, whereas imported brands remain scarce and financially out of reach; boosting reimbursement limits, expanding centralized procurement, and favoring cost-effective domestic options may help reduce Anhui's access gap, although their implementation should take budget constraints and opportunity costs into account.
The position paper of the Working Group "Cross-sectoral urological care" addresses the profound challenges currently facing urological healthcare. Demographic change, workforce shortages, increasing financial pressure, digital transformation, and the political shift toward outpatient care are placing growing strain on both hospitals and private practices. To maintain comprehensive, high-quality care, structural changes are essential. This paper outlines how such a transformation can succeed through coordinated, cross-sectoral collaboration-by developing integrated care networks, hybrid surgical centers linked to hospitals, specialized emergency structures, and flexible employment and training models. Guided by the principle "digital before outpatient before inpatient", the goal is to establish a patient-centered, efficient, and future-oriented care system. Achieving this requires stable conditions, sustainable investment, reduced bureaucracy, digital interoperability, and continuous scientific evaluation. Only through joint efforts between hospitals and outpatient providers can this transformation be successfully achieved and urological care be secured for the future. With its broad clinical spectrum, strong professional networking, and established organizational structures, urology is particularly well positioned to take a leading role in developing cross-sectoral models of care. Das Zukunftspapier der Arbeitsgruppe „Sektorenübergreifende fachärztliche Versorgung in der Urologie“ greift die tiefgreifenden Herausforderungen auf, vor denen die urologische Versorgung derzeit steht. Demographischer Wandel, Fachkräftemangel, steigender Kostendruck, Digitalisierung und der politische Wandel hin zur Ambulantisierung führen zu einer zunehmenden Belastung sowohl in den Kliniken als auch in den Praxen. Um die flächendeckende und qualitativ hochwertige Versorgung langfristig sichern zu können, sind strukturelle Veränderungen unvermeidlich. Das Papier zeigt Wege auf, wie diese Veränderungen durch gemeinsame, sektorenübergreifende Ansätze gelingen können – etwa durch vernetzte Versorgungsstrukturen, hybride OP-Zentren mit Klinikanbindung, spezialisierte Notfallstrukturen sowie flexible Beschäftigungs- und Weiterbildungskonzepte. Unter dem Leitprinzip „digital vor ambulant vor stationär“ soll eine patientenzentrierte, effiziente und zukunftsfähige Versorgung etabliert werden. Voraussetzung dafür sind verlässliche Rahmenbedingungen, Investitionen, Bürokratieabbau, digitale Interoperabilität und eine kontinuierliche wissenschaftliche Begleitung. Nur durch das gemeinsame Handeln von Klinik und Praxis kann der Wandel erfolgreich gestaltet und die urologische Versorgung auch künftig gesichert werden. Die Urologie ist aufgrund ihres breiten fachlichen Spektrums, ihrer starken Vernetzung und etablierten Strukturen prädestiniert, in der sektorenübergreifenden Versorgung eine Vorreiterrolle einzunehmen.
We would like to take this opportunity to thank all of Dalton Transactions' reviewers for helping to preserve quality and integrity in chemical science literature. We would also like to highlight the Outstanding Reviewers for Dalton Transactions in 2025.
Early intra-abdominal infections (EIAIs) are among the most frequent and life-threatening complications following liver transplantation (LT). Early identification of high-risk patients remains challenging, and no standardized risk stratification tool is currently available. To develop and externally validate interpretable machine learning (ML) models for preoperative and postoperative prediction of EIAIs after LT. A multicenter retrospective cohort study. A total of 363 adult LT recipients were included (Center 1: n = 285; Center 2: n = 78). EIAIs were defined as intra-abdominal infections occurring within 30 days after LT. From 120 candidate variables, predictors were selected using random forest, LASSO regression, and univariate logistic regression. Seven ML algorithms were evaluated, and stacking ensemble models were selected as the final preoperative (pre-liver transplantation early intra-abdominal infection forecast tool (LIFT)) and postoperative (post-LIFT) models. Internal testing and external validation were performed. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). The stacking models demonstrated superior performance. For pre-LIFT, the areas under receiver operator characteristic curve (ROC) curves (AUCs) were 0.995 ± 0.004 (training), 0.818 ± 0.056 (testing), and 0.796 ± 0.024 (external validation). For post-LIFT, AUCs were 0.996 ± 0.003, 0.847 ± 0.055, and 0.858 ± 0.026, respectively. Both models significantly outperformed model for end-stage liver disease and Child-Turcotte-Pugh scores (all p < 0.05). SHAP analysis revealed that baseline liver dysfunction, inflammatory markers, and immune status were key determinants in the pre-LIFT model, whereas perioperative factors such as intraoperative blood loss, ICU stay, and drainage duration predominated in the post-LIFT model. We developed and externally validated interpretable ML-based models (LIFT) for predicting EIAIs after LT. These models enable individualized risk stratification at both preoperative and postoperative stages and may support personalized infection surveillance and management strategies. Prospective validation is warranted. Using artificial intelligence to predict early abdominal infections before and after liver transplantation: a study developing easy-to-use computer models to help doctors prevent and manage postoperative infections Liver transplantation can save the lives of people with severe liver disease, but infections in the abdomen are a common and dangerous problem soon after surgery. These infections can be hard to detect early because symptoms are often unclear, and test results may take time. Doctors often use broad antibiotics to prevent infections, but this can lead to side effects and antibiotic resistance. In this study, we used artificial intelligence-based methods, known as machine learning, to help predict which patients are most likely to develop early abdominal infections after liver transplantation. We collected information from 285 transplant patients at Beijing Friendship Hospital between 2020 and 2024 and 78 patients from Tianjin First Central Hospital. The information included patient characteristics, blood test results, and details from the surgery and recovery period. Two artificial intelligence models were developed: one that predicts infection risk before the operation (called pre-LIFT) and one that predicts risk after surgery (post-LIFT). These models combined data from several advanced algorithms and showed high accuracy in identifying patients at risk. Important factors included whether the patient had a repeat transplant, blood albumin and bilirubin levels, lymphocyte count, and how long the surgical drain remained in place. By using these models, doctors can better identify high-risk patients before and after surgery. This will allow them to adjust antibiotic use, monitor patients more closely, and provide care that matches each patient’s needs. This study provides interpretable artificial intelligence models (LIFT) for predicting early abdominal infections after liver transplantation. It supports more personalized prediction and may help reduce complications and improve patient recovery.
Recently, both Clarivate and Scopus announced improved metrics for the European Journal of Translational Myology (EJTM), bringing its Impact Factor to 2.0 and its CiteScore to 4.1. I am proud of these achievements and share the credit with the entire PAGEpress staff. Furthermore, many organizers and moderators for the "Padua Days on Muscle and Mobility Medicine" 2027 (2027 Pd3m) have accepted their roles and proposed improvements for the event, which will take place at the Euganean Thermal Baths (Padua, Italy) from March 9 to 12, 2027. The program remains open to numerous additional speakers. On the downside, rising operating costs are affecting both digital publishing and event organization; it is hoped that these increases will not negatively impact the submission of contributions to the EJTM and the 2027 Pd3m conference. Those interested can find further information and forms for active participation (registration, accommodation, abstract template, and participation details) at the following address: www.paduamuscledays.it. Undoubtedly, the 2027 Pd3m promises to be an engaging event, on par with all previous editions of the "Padua Days on Muscle and Mobility Medicine."
Objective: To understand the distribution and associated factors of second-line antituberculosis drug concentrations in patients with multidrug-resistant or rifampicin-resistant tuberculosis (MDR/RR-TB), and to explore their association with treatment outcomes. Methods: A multi-center prospective cohort study was conducted at three designated tuberculosis hospitals in Nantong and Zhenjiang City, Jiangsu Province, and Jinhua City, Zhejiang Province. Patients with newly diagnosed MDR/RR-TB who received standard treatment between January 2022 and December 2024 were included. After 14 days of treatment, venous blood samples were collected at 2 and 6 hours post-dose to measure the plasma concentrations of linezolid, bedaquiline, clofazimine, levofloxacin, moxifloxacin, cycloserine, and pyrazinamide using a validated liquid chromatography-tandem mass spectrometry method. Demographic, clinical, and laboratory data were collected to investigate the factors associated with plasma drug concentrations, and the relationship between drug concentrations and treatment outcomes was further evaluated. Results: A total of 99 MDR/RR-TB patients were included in this study, with 73.7% being male and a median (Q1, Q3) age of 53.6 (37.2, 67.5) years. Pulmonary cavities were observed in 39.4% of patients at baseline. The regimen consisting of bedaquiline, linezolid, fluoroquinolones, cycloserine, and clofazimine was the most frequently prescribed one (44.4%, 44/99). Regarding the drugs, cycloserine (91.9%), linezolid (87.9%), and clofazimine (84.8%) were the most commonly prescribed agents. The median (Q1, Q3) values for peak drug concentration (Cmax) of linezolid, pyrazinamide, cycloserine, clofazimine, bedaquiline, moxifloxacin, and levofloxacin were 15.000 (11.801, 18.048), 25.988 (22.997, 31.000), 10.604 (7.480, 17.251), 0.662 (0.513, 0.844), 2.290 (1.445, 3.353), 2.591 (2.162, 3.371), 8.550 (6.844, 11.352) mg/L, respectively. Interindividual variability in Cmax was observed across all drugs, with cycloserine, bedaquiline, and moxifloxacin demonstrating particularly high coefficients of variation (all CV >70.0%). Correlation analysis revealed positive relationships between clofazimine and bedaquiline (ρ=0.487, P=0.006) and between levofloxacin and linezolid (ρ=0.571, P=0.004). The dose-to-weight ratio was found to be significantly associated with the concentrations of pyrazinamide (β=0.530, 95%CI: 0.120-0.940, P=0.010), linezolid (β=0.900, 95%CI: 0.250-1.550, P=0.007), cycloserine (β=1.080, 95%CI: 0.350-1.760, P=0.004), and fluoroquinolones (β=0.680, 95%CI: 0.200-1.160, P=0.005), while age was associated with the concentrations of cycloserine (β=0.190, 95%CI: 0.060-0.310, P=0.010), and fluoroquinolones (β=0.060, 95%CI: 0.015-0.105, P=0.009). In addition, hemoglobin levels were associated with the concentrations of cycloserine (β=0.110, 95%CI: 0.015-0.199, P=0.010) and fluoroquinolones (β=-0.050, 95%CI: -0.090--0.020, P=0.002). Although patients who responded to treatment had relatively higher concentrations of pyrazinamide and levofloxacin, these differences were not statistically significant. Conclusions: Plasma concentrations of second-line antituberculosis drugs showed inter-individual variability among patients with MDR/RR-TB. The dose-to-weight ratio was the major factor associated with the drug concentrations, supporting the rationale of weight-based dosing. When deciding the treatment regimen and drug doses, it is important to take into account the potential drug-drug interactions. Therapeutic drug monitoring may contribute to improved MDR/RR-TB treatment outcomes by precise adjustment of drug doses. 目的： 系统评估耐多药/利福平耐药结核病（MDR/RR-TB）患者治疗中二线抗结核药物的血药浓度水平及其影响因素，探讨其与治疗结局之间的关联。 方法： 采用多中心前瞻性队列研究设计，以2022年1月至2024年12月期间在江苏省南通市、镇江市及浙江省金华市3家结核病定点医院接受规范化MDR/RR-TB治疗的患者为研究对象，于治疗第14天采集患者服药后2 h和6 h的静脉血样本，通过液相色谱串联质谱法测定利奈唑胺、贝达喹啉、氯法齐明、左氧氟沙星、莫西沙星、环丝氨酸及吡嗪酰胺的血药浓度，结合患者人口学、临床及实验室资料分析血药浓度的影响因素，进而评估血药浓度与治疗结局之间的关联。 结果： 共纳入99例MDR/RR-TB患者，男性占73.7%，年龄M（Q1，Q3）为53.6（37.2，67.5）岁，入组时39.4%患者存在肺部空洞。以贝达喹啉、利奈唑胺、氟喹诺酮类、环丝氨酸、氯法齐明构成的药物组合方案使用率最高（44.4%，44/99），主要治疗药物依次为环丝氨酸（91.9%）、利奈唑胺（87.9%）及氯法齐明（84.8%）。血药浓度检测结果显示，利奈唑胺、吡嗪酰胺、环丝氨酸、氯法齐明、贝达喹啉、莫西沙星、左氧氟沙星药物峰浓度M（Q1，Q3）分别为15.000（11.801，18.048）、25.988（22.997，31.000）、10.604（7.480，17.251）、0.662（0.513，0.844）、2.290（1.445，3.353）、2.591（2.162，3.371）、8.550（6.844，11.352）mg/L。各药物血药浓度均呈现不同程度的个体间差异，其中环丝氨酸、贝达喹啉和莫西沙星的变异系数较高（均>70.0%）。药物间相关性分析显示，氯法齐明和贝达喹啉（ρ=0.487，P=0.006），以及左氧氟沙星和利奈唑胺（ρ=0.571，P=0.004）的血药浓度呈正相关。剂量/体重比值显著影响吡嗪酰胺（β=0.530，95%CI：0.120~0.940，P=0.010）、利奈唑胺（β=0.900，95%CI：0.250~1.550，P=0.007）、环丝氨酸（β=1.080，95%CI：0.350~1.760，P=0.004）及氟喹诺酮类（β=0.680，95%CI：0.200~1.160，P=0.005）等血药浓度水平；而年龄与环丝氨酸（β=0.190，95%CI：0.060~0.310，P=0.010）、氟喹诺酮类（β=0.060，95%CI：0.015~0.105，P=0.009）血药浓度相关，血红蛋白与环丝氨酸（β=0.110，95%CI：0.015~0.199，P=0.010）和氟喹诺酮类（β=-0.050，95%CI：-0.090~-0.020，P=0.002）血药浓度相关。尽管治疗成功组中吡嗪酰胺和左氧氟沙星等血药浓度相对较高，但差异无统计学意义。 结论： 本研究发现MDR/RR-TB患者二线抗结核药物的体内暴露存在个体差异。剂量/体重比值是影响血药浓度的主要因素，提示临床用药剂量应严格参照患者体重。同时，在确定方案和药物剂量时，应考虑部分药物间可能存在的相互作用，可通过治疗中的血药浓度监测来调整剂量，以改善MDR/RR-TB的治疗效果。.
Shilajit exists as a natural resin that contains fulvic and humic acids that provide antioxidant benefits and stress relief. The compounds help animals survive hot temperatures because they enable animals to preserve their metabolic equilibrium. The research project aims to study Shilajit effects on physiological responses and its impact on haematological and biochemical parameters and lamb growth development at two different dosage levels of 50 and 100 mg/kg BW. We separated 18 4-month-old female Awassi lambs into three groups. One group did not receive any Shilajit, whilst the other two groups received either 50 mg/kg BW or 100 mg/kg BW. Each group was given a specific diet and a daily dosage of Shilajit. We collected blood samples each month from June to August and looked at their health indicators. Shilajit has been demonstrated to increase bodies use of food and aid in weight management. For optimal results, take 100 mg/ kg BW Shilajit seems to lower cortisol levels and boost growth and thyroid hormones. Furthermore, it aids in the production of haemoglobin, haematocrit, and red and white blood cells. Also, increases in glucose, protein, hepatic enzymes, and cholesterol, alongside marked reductions in oxidative stress. The research shows that Shilajit supplementation at 100 mg/kg BW to Awassi lambs during summer months leads to better growth results and improved resistance against stress, which makes this natural substance a useful tool for farmers to boost their livestock production and health outcomes.
Although postmenopausal osteoporosis management has evolved in recent years, it nonetheless remains underdiagnosed and undertreated. Given that general practitioners (GPs) are the keystone of patient screening and referral in France, the present study was conducted to assess their professional positioning in the management of postmenopausal osteoporosis. This is a qualitative study based on semidirected interviews, carried out between July 2020 and February 2021. Alsatian GPs were randomly selected and interviewed until data saturation was achieved. The consolidated criteria for qualitative research reporting grid were used, as well as NVivo software to categorise the data. Twenty-three GPs were interviewed. Study participants recognised that the investigation and treatment of osteoporosis begin at a primary care level, typically with the GP. Although some initiated screening by prescribing bone mineral density assessments, only a few prescribed the associated laboratory assessment and spinal X-rays in search of curable osteoarthritis or vertebral fracture. For those GPs who do take the opportunity to initiate treatments for patients, there is an understanding that first-line options often include calcium and vitamin D, at a preventive level. The interviewed physicians interacted mainly with gynaecologists and rheumatologists. Fracture liaison services were widely acclaimed. Several barriers were identified in their care management. The absence of a defined role between specialists and the lack of communication between them were additional highlighted barriers. GPs were unevenly involved in the management of osteoporosis; numerous barriers to care were identified.
There is uncertainty about the ranking of effectiveness of the available medical expulsive therapies (MET) for ureteric stones, a common and painful urological condition. We comprehensively compared all currently available METs employing a novel evidence grading system to evaluate published network meta-analyses (NMA). Following prospective registration (PROSPERO CRD #42023472770), we conducted an umbrella review incorporating NMAs of randomized controlled trials (RCTs) evaluating various METs. Literature searches were performed in PubMed, Embase, and Google Scholar until January 2026. The primary outcome was the rate of ureteric stone expulsion. Calculated covered area (CCA) estimated the overlap of studies between NMAs. Evidence certainty was assessed using a novel modified GRADE methodology incorporating AMSTAR-2. Surface under the cumulative ranking curve (SUCRA) based on probability of being the best intervention was used for comparing METs. Eight NMAs, comprising 147 RCTs were selected. The CCA showed high (24.5%) overall overlap. Evidence certainty was high-moderate in 5 NMAs, and low in 3. The highest-ranked METs were Naftopidil plus corticosteroids (SUCRA 91.8% and 90.6% in 1 high and 1 moderate certainty NMA) and Silodosin (SUCRA 94.8% and 82.5% in 1 moderate and 1 low certainty NMA). Naftopidil plus corticosteroids was the most effective MET for stone expulsion based on evidence certainty assessment, followed by Silodosin. Clinical care and future research should take into account the ranking evidence collated in this umbrella review.
Potentially toxic elements (PTEs) pollution in the air and its sources and risks have become a major environmental problem faced by developing countries, especially plateau cities. This study determined the concentrations of seven PTEs in PM2.5 by Inductively Coupled Plasma Mass Spectrometry (ICP-MS), and comprehensively utilized methods such as geoaccumulation index (Igeo), enrichment factor (EF), principal component analysis (PCA), potential ecological risk index and health risk assessment to systematically analyze their pollution levels, sources and environmental risks. The results indicated that Cd pollution was the most severe (Igeo = 6.80 ± 0.49), while Tl pollution was the least (Igeo = 1.60 ± 0.53). The EF values of Cd and Ni are greater than 10, and the EF value of Cd even exceeds 100, indicating strong anthropogenic interference. PCA analysis indicates that traffic emissions, agricultural activities, industrial production, corrosion of building materials and combustion of fossil fuels are the main sources. The potential ecological risk assessment indicates that Cd has an extremely high single-element ecological risk (Ei = 5320.80 ± 1886.59). All non-carcinogenic health risks fall within the acceptable safety range (HQ < 1). However, the carcinogenic risk assessment reveals that Cr (Ⅵ) and As pose significant carcinogenic risks, and Ni exposure in adults should not be overlooked. This study provides multi-angle scientific evidence for PTE pollution in PM2.5 in plateau cities, emphasizing the need to take targeted intervention measures to reduce the risk of PTE exposure.
To explore the symptom clusters of heart failure (HF) patients, identify the sentinel symptom of each symptom cluster, and provide a basis for the implementation of precise symptom management. The study participants were recruited using convenience sampling from inpatients admitted to the cardiology department between November 2024 and January 2025, including patients admitted for acute HF, chronic HF, and acute decompensation of chronic HF. The General Information Questionnaire and the Memorial Symptom Assessment Scale were used for the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. A total of 354 HF patients participated in the study. Four symptom clusters were identified in HF patients: the nocturnal respiratory distress symptom cluster, the low perfusion symptom cluster, the upper airway irritation symptom cluster, and the gastrointestinal symptom cluster. Three sentinel symptoms were explored: waking up breathless at night, sweating and cough. HF patients have a variety of symptoms in the form of four symptom clusters, waking up breathless at night, sweating and cough are the sentinel symptoms. Medical staff can take sentinel symptoms as the focus of symptom cluster evaluation and targeted intervention, which can improve the efficiency of symptom cluster management and reduce patients' symptom burden.
Widespread electric vehicle use is a key step to tackling transportation emissions, but adoption has yet to take off beyond high-income communities. A lack of access to public charging stations can be a major barrier to adoption. In this paper, we analyze the distribution and typology of public charging stations found in low-, mid-, and high-income communities across the US. Our results describe a robust neighborhood advantage, where high income in the surrounding area coincides with higher numbers of public stations in lower income block groups. We further show that station types in lower income areas are associated with shorter stops, suggesting they are designed to serve pass-through demand. Future income-based policies for public charging infrastructure should consider how new stations fit local residents' mobility patterns and should use both local and neighborhood income to better target their support toward equal access for all future electric vehicle drivers.
The attachment of bacteria and subsequent biofilm formation is the first step toward the colonization of medical devices and implants by bacteria. Preventing the colonization of bacteria is key to averting infections. At the same time, the bacterial type Staphylococcus aureus (S.aureus) is the main pathology affecting infections on implant surfaces. The joint effects of natural selection and antibiotics have resulted in drug resistance. Reserving antibiotics and other antimicrobials is a promising way to combat these pathogens. Despite the antimicrobial surfaces that have been presented in the report having an intricate and prolonged synthetic process, their application is severely obstructed in practicality. For the new antibacterial nanocomposite, cerium metal-organic frameworks (Ce-MOF) that are ultrasmall in size, along with high stability, were developed as a vancomycin drug delivery system. The composite's pH-responsive synergistic antibacterial mechanism enables controlled release of vancomycin. According to the study, Ce-MOF@ Vanc can take advantage of its reversible Ce3 +/Ce4+ conversion to play a role in different physiological microenvironments, while exhibiting excellent biocompatibility. The Ce-MOF@ Vanc composite was strongly bonded to titanium alloy surfaces due to the adhesive properties of dopamine. This series of coatings exhibited highly effective antibacterial performance against S. aureus and E. coli, attributable to the synergistic action of Ce-MOF and vancomycin in membrane disruption and biochemical inhibition. The most effective coating was found to have an antibacterial efficiency of 96.62%. It showed excellent durability and corrosion resistance properties from wear and electrochemical tests. Also, the TCMV 3 coating had the highest corrosion inhibition efficiency, which was 93.22%. As a result of this research work, a new strategy was given, and an experimental basis was provided for the development of next-generation intelligent implant surfaces with the function of anti-bacteria, anti-corrosion, and biosafety.
The purpose of this study is to assess if the descriptor "non-compliant" negatively influences a physician's perception of and reaction to a patient. While the term "non-compliant" is often used in the medical record to describe a patient who does not follow prescribed recommendations, there is concern that its use may create a negative bias toward a patient and dissuade a provider from examining specific reasons for non-compliance. Current research evaluated whether the term creates a negative bias toward a patient in medical residents, who are at a pivotal point in their training and development of professional attitudes. Four fictitious scenarios of a patient admitted for diabetic crisis were created-identical except for gender and inclusion of the term "non-compliant." Internal medicine residents across a university-affiliated program were randomly assigned one scenario, and then asked to rate their perceptions of the patient from 0 (very negative) to 7 (very positive) on various parameters. Responses were categorized into "positive" (4-7) vs. "negative" (0-3) perceptions. Categorical variables, reported as numbers and percentages, were compared using the Chi-square test or Fisher's exact test. Continuous variables were reported as mean, standard deviation, and range, and were compared using the Student's t test. All reported P values were two-tailed. For the tests above, statistical significance was considered if P < 0.05. All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). No significant differences were found in perceptions of patients based on the presence of the term "non-compliance" nor gender of either patient or physician. Faculty members were less willing to take on non-compliant patients compared to residents. Contrary to the current literature, the term "non-compliant" did not significantly affect resident attitudes or perceptions toward patients. This may represent a shift in attitudes of younger trainees as they may be aware of the effect of bias when treating patients. Future research should include a larger, more diverse cohort.