Total factor productivity (TFP) serves as a critical indicator for measuring enterprise efficiency and technological progress. However, existing prediction methods often fail to distinguish genuine causal mechanisms from spurious correlations while neglecting inter-enterprise network dependencies. This study proposes a Causal-Temporal Graph Convolutional Network (CT-GCN) that integrates causal inference techniques with temporal graph convolutional networks for dynamic TFP prediction and optimization. The framework employs the Levinsohn-Petrin method for TFP estimation, double machine learning for causal effect identification, and constructs enterprise relationship graphs capturing supply chain linkages, geographic proximity, and technological similarity. Using panel data from 12,847 Chinese manufacturing enterprises spanning 2008-2022, empirical results demonstrate that CT-GCN achieves substantial prediction improvements over baseline models, with RMSE reductions exceeding 19%. The causal analysis identifies R&D investment, digital transformation, and human capital as genuine productivity drivers, with significant treatment effect heterogeneity across industry sectors, firm sizes, and regions. An optimization decision mechanism translates these insights into differentiated strategic recommendations. This research contributes a novel methodology bridging causal reasoning and deep learning for economic forecasting applications.
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Subjective well-being is a central component of physical and mental health and is increasingly recognized as a key indicator of quality of life. Despite the widespread use of the PERMA framework, no validated French version of the PERMA-Profiler is currently available. The aim of this study was to translate and culturally adapt the PERMA-Profiler into French and to examine its psychometric properties in a large sample of adults. A total of 612 French-speaking adults completed the French version of the PERMA-Profiler as well as measures of flourishing, anxiety and depression. The sample was randomly divided into two independent subsamples to conduct exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA suggested a parsimonious three-factor solution, while comparative model tests confirmed the theoretical five-factor structure of the PERMA model. The CFA conducted on an independent subsample strongly confirmed a correlated five-factor model, as well as a second-order hierarchical model reflecting a general well-being factor. The PERMA-Profiler demonstrated good to excellent internal consistency for most dimensions and for the total score, although the "engagement" dimension showed lower reliability, which is consistent with previous validation studies. Test-retest analyses indicated good temporal stability for the total score and most subscales. Convergent validity was confirmed by strong positive associations with flourishing and perceived happiness. Discriminant validity was evidenced by weaker associations with anxiety, depression, loneliness and negative emotions than with flourishing, although some correlations with HADS anxiety and depression scores reached moderate to strong magnitude. Overall, the French version of the PERMA-Profiler has robust psychometric properties and supports the multidimensional structure of psychological well-being proposed by the PERMA framework. This instrument is a reliable and theoretically grounded tool for assessing the well-being of French-speaking adult population, while highlighting the distinct psychometric behavior of the Engagement dimension.
Given concerns that screen time may impact dietary habits, this study investigated the association between screen time and dietary intake among adolescents in the United States. We analyzed a prospective cohort (N = 6485, 47.3% female, age: 12 ± 0.7 years) from the Adolescent Brain Cognitive Development (ABCD) Study, using data from Year 2 (2018-2020) and Year 3 (2019-2021). Multinomial logistic regression models estimated the associations between participant-reported screen time (watching television shows and videos, playing video games, socializing, browsing the internet, and total screen time (hours/day)) and parent/participant-reported intake of various food/nutrient categories 1 year later (Year 3). We adjusted for age, sex, race and ethnicity, household income, parent education, average daily kilocalorie intake, respective food or nutrient, and study site (Year 2). Each additional hour of most screen time modalities was prospectively associated with higher odds of consuming fewer fruits, vegetables, whole grains, legumes, fiber, and dairy, and higher glycemic index, and higher odds of consuming more added sugars and a higher polyunsaturated fats ratio 1 year later. These findings highlight the need for parental guidance and clinical interventions to support screen time habits and promote healthy dietary choices among adolescents. This study examines the association between contemporary screen time modalities and dietary intake 1 year later in a demographically diverse U.S. sample of early adolescents. Most screen time modalities, such as total screen time and watching television shows and videos, were prospectively associated with higher odds of consuming fewer fruits, vegetables, whole grains, legumes, and fiber 1 year later. Greater total screen time and time spent socializing were prospectively associated with higher odds of a higher polyunsaturated fats ratio 1 year later.
Sweet orange (Citrus sinensis L.) is a major fruit crop globally, but fungal pathogens have severely impacted its yield. Bilo Nopha, known for high-quality sweet oranges, has recently faced significant preharvest spoilage. This study aimed to isolate fungal pathogens associated with preharvest spoilage of sweet orange (Citrus sinensis L.) fruit in Bilo Nopha, southwestern Ethiopia. In the present study, a total of 240 symptomatic orange fruit samples were collected from six orchards of study area and fungi pathogens were isolated and characterized to genus level following standard microbiological techniques. A total of 430 fungal isolates were recovered. Pseudocercospora spp. were most prevalent (45.0%), followed by Colletotrichum spp. (42.1%). Alternaria spp. showed moderate prevalence (30.4%) with significant site variation (15.0-37.5%, P < 0.05). Rhizopus spp. were consistent across sites (20-30%, total 27.1%), while Fusarium and Phytophthora spp. had the lowest rates (17.5% each). Pseudocercospora spp., Colletotrichum spp., and Phytophthora spp. were identified as the primary fungal pathogens, whereas Alternaria spp., Rhizopus spp., and Fusarium spp. were involved as secondary or opportunistic pathogens. Species-level identification and targeted management are recommended to reduce losses and sustain production.
Aedes albopictus is a globally important mosquito species capable of transmitting a variety of viruses. In this study, a total of 440 Ae. albopictus individuals were collected from Fanchang, Anhui Province, and 22 tissue libraries were constructed for metagenomic sequencing. A total of 649,930,614 reads were obtained and assembled into 209,335 contigs, of which 18,339 showed similarity to known viral proteins, spanning 13 viral families including both DNA and RNA viruses. Because several DNA virus-related sequences were recovered from the dataset, we further focussed on CRESS-DNA virus-related sequences and members of the family Parvoviridae. Phylogenetic analysis showed that three CRESS-DNA virus-related sequences clustered within Smacoviridae and Genomoviridae, while two Parvoviridae genomes were assigned to Brevihamaparvovirus and Protoparvovirus. These findings provide a metagenomic overview of the Ae. albopictus-associated virome in Anhui Province and provide baseline information on mosquito-associated DNA virus-related sequences in this region.
The present study investigated the individual and combined effects of lactic acid and rosemary meal on growth performance, biochemical parameters, immune responses, the expression of growth and antioxidant-related genes, intestinal morphology, and oxidative status in Nile tilapia (Oreochromis niloticus). A total of 120 apparently healthy fish, with an average weight of 3.03 ± 0.02 g, were randomly assigned to four equal groups, each consisting of three replicates. Four experimental diets were formulated: a basal control diet (CON), a basal diet supplemented with 1 g of lactic acid per kg of diet (LA), a basal diet containing 10 g of rosemary per kilogram of diet (RM), and a basal diet that included both supplements (LA + RM). Fish were fed these diets for a duration of 60 days. The results indicated that either lactic acid or rosemary alone or in combination had a greater growth-stimulating impact than the CON group (P ≤ 0.05) with superiority to the combination group (LA + RM group). Activities of aspartate aminotransferase and alanine aminotransferase, along with creatinine and urea levels, were significantly reduced (P ≤ 0.05) in the groups of lactic acid and rosemary alone or in combination relative to the CON group. Total protein and albumin concentrations were elevated in the LA + RM group (P ≤ 0.05). Intestinal histology revealed normal morphology across groups, with increased villus height, intestinal villi spacing, and goblet cell density in LA + RM (P ≤ 0.05) without pathological lesions in the liver and spleen. Antioxidant, immune, and growth-related gene expressions were upregulated in RM and LA + RM groups. In conclusion, rosemary supplementation, alone or combined with lactic acid, enhanced fish health status and upregulated target genes without pathological lesions with superiority to the combination treatment.
Moyamoya angiopathy (MMA) is a cerebrovascular disease treated by surgical revascularization. This study aimed to present long-term outcomes of European MMA patients after surgical revascularization. MMA patients treated surgically between 1998 to 2023 were included. Follow-up comprised clinical and radiological examinations and electronic questionnaires. Patient data were analyzed retrospectively, and logistic regressions were performed to identify predictors of unfavorable outcomes. A total of 276 patients with 428 surgically treated hemispheres were included. The mean age was 35.0 ± 17.2 years, including 192 women and 84 men, predominantly of Caucasian ethnicity (88.0%). Ischemia (82.2%) and hemorrhage (10.1%) were the most common symptoms at onset. Most adults (80.9%) were treated with combined bypass surgery via mini-craniotomy. Within 30 days, complications occurred in 6.3% of surgeries, and the perioperative stroke risk was 2.6%. A total of 148 patients underwent in-house follow-up. No mRS scores ≥ 5 were observed, with 86.3% of patients achieving a score of 0-2, alongside a bypass patency rate of 95.7% and a stroke risk of 0.3% per patient-year. Preoperative stroke and silent ischemic MRI lesions were identified as predictors of an unfavorable outcome. Additionally, 201 patients were followed up electronically. No mRS scores ≥ 5 were observed, with 87.9% of patients achieving a score of 0-2. Moreover, 90.7% were independent in daily life, but only 50.5% returned to work or school. Combined bypass surgery yielded favorable outcomes with low complication and stroke rates. Patients with preoperative stroke require closer follow-up, and individualized strategies are needed to address persistent functional impairments.
The present study evaluated the influence of olive paste pH adjustment during malaxation on oil yield and quality parameters of virgin olive oil obtained from Olea europaea L. cv. Gemlik. The pH of olive paste was systematically adjusted to 2.7-6.7 using citric acid and NaOH solutions during malaxation. Oil yield, free fatty acidity (FFA), peroxide value (PV), total and individual phenolic compounds, DPPH radical scavenging activity, and color attributes (L*, a*, b*) were determined. Oil yield ranged from 28.67 to 45.11%, with the highest yield observed at pH 6.7. Total phenolic content(TPC)showed a clear pH-dependent pattern, reaching 678 mg GAE kg⁻¹ at pH 2.7 and decreasing to 281 mg GAE kg⁻¹ at pH 6.7. Moderately acidic conditions (pH 4.7) promoted elevated concentrations of secoiridoid derivatives, with oleacein (257 mg kg⁻¹) and oleocanthal (159.7 mg kg⁻¹) attaining their highest levels. Phenolic alcohols exhibited compound-specific pH responses, with tyrosol and hydroxytyrosol acetate reaching maximum levels at pH 4.7, while hydroxytyrosol peaked at pH 3.7 and declined thereafter. Flavonoids, such as apigenin, reached maximum concentrations (16.5 mg kg-¹) under mildly acidic conditions (pH 3.7). 3,4-DHPEA-EA decreased progressively with increasing pH, from 226 to 103 mg kg-¹, indicating that pH influences its stability and transformation pathways during malaxation. PV values were highest at pH 3.7 (8.4 meqO2kg⁻¹ oil) and 4.7 (7.2 meqO2kg⁻¹ oil). DPPH radical scavenging activity paralleled the phenolic profile, with oils obtained at lower pH exhibiting approximately twofold greater activity than those obtained at pH 5.7 and 6.7. Several quality parameters exhibited significant quadratic responses to pH variation. Color attributes were also influenced by pH, with acidic conditions producing brighter oils with reduced yellowness. These findings indicate that controlled pH modulation during malaxation can influence phenolic composition, antioxidant capacity, and visual characteristics of virgin olive oil, providing mechanistic insight into the pH sensitivity of its extraction and compositional changes.
Patients undergoing temporomandibular joint (TMJ) surgery can develop chronic postsurgical pain (CPSP). This study identifies patient factors and CPSP characteristics after TMJ surgery. Survey-based study of patients who underwent TMJ surgery at Massachusetts General Hospital between 08/1987-06/2024. Survey evaluates CPSP, comorbidities, and risk factors 6+ months postoperatively. Total of 104 patients responded. Male:female ratio 1:12; median follow-up 2.2 years. Total of 74.0% patients report ongoing TMJ pain since last surgery. CPSP noted in 77.3% patients who underwent minimally invasive TMJ surgery and 68.0% patients who underwent open surgery. CPSP is more prevalent in patients with bilateral TMJ surgery as opposed to unilateral surgery (P = .03). No significant difference noted in the mean preoperative pain score among patients with/without CPSP. Pain intensity is mild-moderate and common descriptors are aching, throbbing, and tender. Overall, 13% (n = 10/77) of patients with CPSP had a likely neuropathic component of the pain. Rates of pain interference (P < .001) and pain catastrophizing (P < .001) are higher in patients with CPSP. There is a high prevalence of CPSP after TMJ surgery; symptoms resemble myofascial pain, although neuropathic qualities may be present. Patients with CPSP are more likely to have undergone bilateral surgery and experience increased catastrophizing, pain interference, and disability.
Epirubicin (EPI) can cause metabolic side effects, including chemotherapy-related diabetes, partly through oxidative stress that disrupts zinc (Zn) homeostasis and impairs autophagy. This study investigated the effects of EPI on Zn regulation and autophagy in the pancreas, as well as the modulatory role of N-acetylcysteine (NAC). Rats received EPI (9.6 mg/kg) by intraperitoneal injection (i.p.) followed 1 h later by NAC (50 or 300 mg/kg, i.p.). Glucose homeostasis was assessed using the Homeostatic Model Assessment (HOMA-IR), and β-cell function was assessed using HOMA-β levels. Plasma insulin levels, as well as insulin, proinsulin, beclin, autophagy-related proteins (ATG5), Microtubule-Associated Protein 1 Light Chain 3 (LC3), phosphorylated Akt (p-Akt), mechanistic target of rapamycin complex 1 (mTOR1), cleaved caspase-3, Zrt/Irt-like Protein 10 (ZIP10), and the proliferation marker Ki-67 in pancreatic tissue, were measured using commercial ELISA kits. Total oxidant status (TOS) and total antioxidant status (TAS) were measured using commercial colorimetric assay kits, and the oxidative stress index (OSI) was calculated. Zn levels in pancreatic tissue and plasma samples were measured using a colorimetric method. Morphological changes in the pancreas were assessed by hematoxylin and eosin staining. As a result, in the EPI group, oxidative stress and ZIP10 levels increased, whereas Zn levels decreased, as well as pancreatic autophagy, proliferation, and insulin synthesis increased. Oxidative stress decreased in both the EN-50 and EN-300 groups, with a more pronounced decrease in the EN-300 group. Furthermore, in the EN-300 group, pancreatic Zn, ZIP10, autophagy, and proliferation levels decreased, whereas mTOR1 levels increased. The pancreatic insulin synthesis observed in the EN-50 group was not observed in the EN-300 group. In conclusion, the increased autophagy observed in the Epi group may reflect an adaptive response to oxidative stress. The effects of NAC on oxidative stress may be dose-dependent, and high-dose NAC administration may suppress EPI-induced autophagy via mTOR1-mediated signaling. Furthermore, the relationship among Zn levels, autophagy, and insulin synthesis observed in the experimental groups may contribute to a better understanding of EPI-associated diabetogenic alterations.
Rheumatoid arthritis (RA) is a systemic autoimmune disorder characterized by chronic inflammation and progressive joint destruction. Tenosynovitis is one of the early manifestations of RA. This study aims to develop a machine learning (ML)-based model using ultrasound (US) radiomics to objectively diagnosis tenosynovitis in RA patients, thereby facilitating accurate evaluation of RA. This study included a total of 1496 grayscale US images of the wrist extensor tendons, wrist flexor tendons, and finger flexor tendons from 152 patients with RA. Radiomic features were extracted from the US images. The radiomic features and a total of 10 clinically relevant features were selected to train machine learning model. To avoid data leakage, the dataset was partitioned at the patient level with 80% allocated to the training set and 20% to the test set. The model was trained for 100 epochs with an early stopping strategy (halted if no test set performance improvement was observed for 10 consecutive epochs) to prevent overfitting. Comparative experiments were conducted against two conventional ML methods: Support Vector Machine (SVM) and Random Forest (RF). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, accuracy, and the area under the receiver operating characteristic curve (AUC) of the model were calculated. Calibration curves and decision curve analysis (DCA) were employed to assess the model's clinical utility, and the average per-case processing time was measured to verify real-time applicability. The dataset comprised 1196 images for training and 300 images for testing. In the training set and the test set, the AUC reached 0.969 and 0.914 respectively. The model demonstrated robust performance on the test set, with a sensitivity of 0.881, specificity of 0.788, PPV of 0.505, NPV of 0.964, F1 score of 0.642 and accuracy of 0.807. The model also outperformed SVM (AUCs: 0.909 and 0.881) and RF (AUCs: 0.955 and 0.880) on the training and test sets, respectively. The average processing time per case was 0.8 s, which meets the real-time operational requirements of clinical settings. Calibration curves indicated excellent agreement between predicted and observed outcomes, while DCA confirmed the model's clinical applicability and predictive accuracy across both training and test datasets. The XGBoost-based machine learning model developed in this study could effectively diagnosed tenosynovitis on US imaging for RA patients, outperforming SVM and RF. Owing to its real-time processing capability, the model has potential to facilitate the accurate evaluation of RA.
To translate, culturally adapt, and evaluate the reliability and construct validity of the Korean version of the Haemophilia Activities List (HAL) in adult patients with hemophilia. This cross-sectional validation study included adult patients with hemophilia A and B. The HAL was translated into Korean using a standardized forward-backward translation process according to international guidelines. The participants completed the Korean HAL, the EuroQol Five-Dimension Five-Level Questionnaire (EQ-5D-5L), and the Routine Assessment of Patient Index Data 3 (RAPID3) questionnaire. Internal consistency was assessed using Cronbach's alpha, test-retest reliability was assessed using intraclass correlation coefficients (ICCs), and construct validity was assessed using Spearman's correlation analysis. A total of 87 adult patients completed the questionnaire. The mean age was 37 years (range, 18-62 years), and most participants had severe hemophilia. The Korean HAL demonstrated high internal consistency, with a Cronbach's alpha coefficient of 0.97 for the total score and domain-specific values ranging from 0.78 to 0.95. The test-retest reliability was excellent, with an overall ICC of 0.95. Construct validity was supported by strong correlations between the HAL and EQ-5D-5L overall scores (r = 0.78, p < 0.01) and strong correlations with RAPID3 physical function scores (r = -0.82, p < 0.01). The Korean version of the HAL demonstrated excellent reliability and good construct validity in adult patients with hemophilia. These findings support the use of the Korean HAL as a reliable and culturally appropriate patient-reported outcome measure to assess functional limitations in clinical practice and research.
A basal diet of low-quality forage (LQF) results in decreased forage utilization and animal performance. Protein and starch supplementation can ameliorate these effects by providing additional nitrogen and energy to ruminal microbes. However, the effect of protein and starch supplementation on ruminal microbial gene expression, specifically pathways involved in methanogenesis, is not well-documented. We aimed to evaluate the effect of supplement composition on ruminal microbial gene expression before and after supplementation in steers consuming a basal diet of LQF. Five ruminally-cannulated Angus steers (BW 375 ± 45 kg) were used in a 4 × 4 Latin square and fed a basal diet of King Ranch Bluestem Hay (3.5% CP, 73% NDF), and one of four isonitrogenous (130 mg nitrogen/kg BW) supplements. Ruminal samples collected from the steers provided the two most divergent supplements, 2% starch (43% CP; 100% soybean meal) and 56% starch (21% CP; 78% corn, 19% soybean meal, 2.4% urea) were used for metatranscriptomic analysis. Samples were collected via cannula prior to and 4h post-supplementation; total RNA was sequenced. Differentially expressed genes (DEG) were identified and functionally annotated; pathway enrichment analysis was completed. Sampling time exerted a greater effect than starch concentration (∼78 vs. 17% in both archaea and bacteria). All methanogenesis pathways were differentially regulated by time (P < 0.05) with upregulated genes primarily expressed by Thermoplasmata and downregulated genes primarily expressed by Methanobrevibacter. Acetoclastic and methylotrophic methanogenesis pathways were differentially regulated by starch supplementation (P < 0.05) with upregulated genes primarily expressed by Thermoplasmatales and downregulated genes primarily expressed by Methanomethylophilus alvus. The majority of bacterial DEG were expressed by Clostridia, but unclassified Bacteroidetes was the predominant bacteria responsible for expression of carbohydrate active enzymes (CAZymes). Time relative to feeding, rather than starch supplementation, resulted in a greater number of bacterial CAZymes expressed. Supplement composition elicited changes in the taxa involved in methanogenesis and carbohydrate metabolism, suggesting the potential for effects on CH4 emissions. Further research is needed to directly quantify CH4 emissions in response to supplementation to potentially optimize supplementation strategies and improve sustainability of beef cattle production. Intake of low-quality forage (LQF) in the absence of protein supplementation fails to meet ruminal microbial nitrogen requirements, decreasing forage utilization and animal performance. Supplementation of both protein and starch is used to ameliorate the negative effects of LQF; however, the effect of supplementation on ruminal microbial communities is not well-understood. This experiment evaluated the effect of protein (130 mg N/ kg BW) and starch supplementation (2 or 56% starch) on ruminal microbial gene expression in cattle consuming LQF (3.5% CP). Time of sampling, rather than concentration of starch, had a greater effect on microbial expression. At four hours post-supplementation, upregulated methanogenesis pathways were primarily expressed by Thermoplasmatales and downregulated methanogenesis pathways were principally expressed by Methanobrevibacter. Increased starch supplementation resulted in the differential regulation of methanogenesis pathways with upregulated genes mainly expressed by Thermoplasmatales and downregulated genes mostly expressed by Methanomethylophilus alvus. Sampling time affected the number of differentially expressed bacterial carbohydrate active enzymes, but concentration of starch supplementation did not. These results indicate that both time post-feeding and concentration of starch supplementation affect the microbial genes involved in methane and carbohydrate metabolism. Continued research in this area may help develop optimal supplementation strategies for beef cattle.
To illustrate the potential health risks to humans posed by heavy metals (HMs) through aquatic food webs magnification, a systematical research was performed at the mining-impacted subtropical river basin, Yuanjiang-Red River Basin. The As and Pb concentrations in multiple fish species exceeded national food safety limits. Meanwhile, Hg and Zn exhibited pronounced trophic biomagnification across the aquatic food web, collectively accounting for 32-84% of total dietary relative risk across the examined fishes. Elevated Hg and Zn levels in human hair samples were spatially consistent with their biomagnification profiles along food webs and hazard quotient indicated non-negligible noncarcinogenic risks from Hg exposure for both adults and children, supporting dietary fish consumption could serve as a plausible exposure pathway of these metals. Microbial profiles revealed both taxonomic and inferred functional compositions were significantly correlated with Hg and Zn levels in dietary organisms and variation in microbial community composition was statistically correlated with HM transfer from water into dietary organisms (path coefficient = 0.333, P = 0.049) according to partial least-squares-structural equation modeling. Therefore, microbial-associated trophic transfer of HMs may constitute an under-recognized health risk to humans in river systems affected by mining activities, even when aqueous HMs comply with national standards.
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by pain, sleep disturbance, and physical activity impairments, significantly impacting patients' quality of life (QoL). Biological therapies, targeting specific inflammatory pathways, have emerged as effective interventions for managing RA symptoms and disease progression. This integrative review explored the effects of biological therapies on pain management, physical activity, sleep quality, and QoL in adult patients with RA, emphasizing their role in improving patient outcomes. An integrative review was conducted as outlined by Whittemore and Knafl. This methodology allows for the inclusion of diverse study designs to comprehensively synthesize the literature. Data from all sources were analyzed thematically to identify consistent findings and overarching insights into the effects of biological therapies on RA-related outcomes. A total of 21 studies with diverse designs-including observational studies, cohort studies, randomized controlled trials, and reviews-were included, with sample sizes ranging from 33 to 1,651 participants. Biological therapies demonstrated significant benefits in reducing pain, improved joint function, and enhanced mobility by alleviating fatigue and stiffness. Sleep quality improved through reductions in nocturnal discomfort and disease activity. Overall, biological therapies produced marked improvements in health-related QoL across physical, psychological, and social domains by lowering disease burden and associated emotional distress such as anxiety and depression. Biological therapies represent a transformative advancement in RA management, providing targeted control of inflammation that alleviates pain, improves functional ability, enhances sleep quality, and elevates overall QoL. These findings underscore the essential role of nurses in delivering evidence-based, holistic care through assessment, education, and adherence support in order to optimize outcomes for patients receiving biologic therapy.
Interpreting pelvic floor imaging and planning management of pelvic organ prolapse (POP) require reliable, population-specific thresholds for levator hiatus evaluation. However, current reference data are largely drawn from Western populations and may not reflect East Asian pelvic anatomy, potentially leading to underdiagnosis and inconsistent risk assessment. This study aimed to define transperineal ultrasound normative measurements and cutoff points associated with clinically significant POP (stage II or higher) in Chinese women. This multicenter cross-sectional study initially enrolled 706 parous women who underwent urogynecologic assessment at three tertiary hospitals in China between November 2019 and October 2024. After application of the predefined exclusion criteria, 626 women were included in the final analysis. POP was staged with the Pelvic Organ Prolapse Quantification system. Blinded sonographers acquired three- and four-dimensional transperineal ultrasound volumes at rest, maximal contraction, and maximal Valsalva. They measured the levator hiatus area, anteroposterior and lateral diameters, and the levator urethra gap during contraction. Logistic regression examined factors associated with POP stage II or higher, and receiver operating characteristic (ROC) analysis determined optimal thresholds. Among the 626 women included in the final analysis, the median age was 45 y. A total of 330 participants had POP-Q stage ≥ II, representing 52.7% of the analyzed cohort. Women with advanced prolapse were typically older and had higher parity. Complete levator avulsion and greater levator urethra gap during contraction were more frequent in this group. They also showed larger increases in levator hiatus area and anteroposterior diameter from rest to maximal Valsalva, along with a greater proportional change in the lateral diameter (all p < 0.05). ROC analysis defined key thresholds for detecting POP stage II or higher: absolute LHA at maximal Valsalva ≥19.23 cm² (AUC 0.839), hiatus area change ≥4.85 cm² (AUC 0.805), anteroposterior diameter at maximal Valsalva ≥5.95 cm (AUC 0.798), hiatus area proportional change ≥27.18% (AUC 0.769), levator urethra gap at contraction ≥2.042 cm (AUC 0.696), and lateral diameter proportional change≥15.11% (AUC 0.705). Population-specific quantitative transperineal ultrasound parameters improved anatomic assessment, enabled earlier identification of high-risk women, and supported individualized surgical planning and conservative management.
Disclosure of conflict of interest (COI) is important for surgical societies to minimize bias. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) requires committee members to disclose potential COI to promote full transparency. This study investigates compliance with this requirement and quantifies the actual dollar amounts that ineligible companies, collectively "industry", give to committee members. All SAGES committee members were queried in the Centers for Medicare & Medicaid Services Open Payments database (OPD). The query results for 2023 and 2024 were compared to the actual self-reported disclosure statements submitted to SAGES in the spring of 2025. Due to the nature of the database, only US-based physicians were included. Only payments of $500 or more were recorded. Only committees whose rosters were available online were utilized. Incorrect disclosure was defined as a mismatch between the OPD and the member's disclosure. There were 930 individual committee members and 185 were excluded by OPD. Only 51% (382/745) of OPD queries matched disclosures. Correct disclosure occurred in 104/467 who had disclosable COI. Industry paid over $18,000,000 to committee members; one-third came from Intuitive Surgical. Members who received payments received an average of $38,992. The largest total amount to one individual was over $2,500,000. There was no difference in average payments received or appropriate disclosure rate by committee members on one committee versus those on multiple committees. Chair/co-chairs (n = 114) did not differ from other members (n = 631) in percent of appropriate disclosures (59 vs. 50%). However, chairs/co-chairs did receive larger payments ($37,501 vs. $22,021; p < 0.0035). SAGES has set policies for disclosing COI. Enforcement of these policies is challenging. Many committee members receive large payments from industry; thus the actual dollar amount should also be reported. Full and accurate reporting will allow for full transparency and reduce perception of bias.
Enteral nutrition feeding intolerance (ENFI) is a common complication in patients with sepsis and may compromise nutritional support and clinical recovery. This study aimed to develop and validate a risk stratification model incorporating serum lactate (LAC) and albumin (ALB) for predicting ENFI in patients with sepsis. A total of 258 patients were screened for eligibility according to predefined inclusion and exclusion criteria. The final complete-case cohort comprised 230 patients with sepsis who received enteral nutrition between December 2021 and June 2025, including 88 patients in the ENFI group and 142 in the non-ENFI group. Clinical variables and laboratory indicators obtained within 24 hours before enteral nutrition initiation were analyzed. Predictors were screened using least absolute shrinkage and selection operator regression and entered into multivariable logistic regression for model construction. Model performance was evaluated by receiver operating characteristic analysis, calibration analysis, bootstrap internal validation, and decision curve analysis. Lactate levels were significantly higher in the ENFI group than in the non-ENFI group (median [interquartile range], 2.70 [2.00-3.86] vs 1.82 [1.19-2.48] mmol/L; P < 0.001), whereas ALB levels were significantly lower (27.83 ± 5.02 vs 32.82 ± 4.33 g/L; P < 0.001). Least absolute shrinkage and selection operator regression identified 4 predictors: ALB, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, LAC, and mechanical ventilation. Multivariable analysis showed that decreased ALB (odds ratio [OR] = 0.80; 95% CI, 0.74-0.86), increased APACHE II score (OR = 1.09; 95% CI, 1.01-1.17), increased LAC (OR = 2.03; 95% CI, 1.50-2.85), and mechanical ventilation (OR = 2.52; 95% CI, 1.28-5.10) were independent predictors of ENFI (all P < 0.05). The 4-variable model achieved an area under the curve of 0.854 (95% CI, 0.803-0.905), outperforming single indicators. Bootstrap internal validation yielded a corrected area under the curve of 0.845, and the Hosmer-Lemeshow test indicated good fit (P = 0.299). Decision curve analysis reported a positive net clinical benefit across a threshold probability range of 10% to 70%. A 4-variable prediction model anchored by LAC and ALB and further incorporating APACHE II score and mechanical ventilation showed good discrimination for predicting ENFI in patients with sepsis. This model may provide a practical tool for early risk stratification and may help support individualized enteral nutrition monitoring in clinical practice.
To determine the incidence of placental chorangioma and evaluate its associated perinatal complications and mortality. A retrospective observational study was conducted at Fernandez Hospitals, Hyderabad, India, from March 2011 to March 2025. All singleton pregnancies with structurally normal fetuses diagnosed antenatally with placental chorangioma and delivered at our center, with postnatal confirmation by histopathological examination (HPE), were included in the study. The diagnosis was made using B-mode ultrasound examination and color Doppler flow imaging, demonstrating a well-circumscribed hypo or hyperechoic placental mass with a clearly identifiable vascular supply. Demographic details, prenatal sonographic findings, perinatal and neonatal outcomes were collected from electronic medical records. A total of 20 cases were included, with an incidence of 9.8 per 100 000 pregnancies. Large chorangiomas (≥ 4 cm) accounted for 90% of cases, while small chorangiomas (< 4 cm) accounted for 10%. The mean gestational age at diagnosis was 27.65 ± 5.27 weeks. Sixteen cases (80%) were managed conservatively, while four cases (20%) required prenatal intervention. Polyhydramnios was observed in 12 (60%) fetuses and cardiomegaly in 5 (25%). Fifteen fetuses (75%) were appropriate for gestational age, four (20%) had fetal growth restriction, and one (5%) was large for gestational age secondary to hydrops. Eleven pregnancies (55%) resulted in preterm birth. Nine neonates (45%) required admission to the neonatal intensive care unit (NICU), and eight (40%) experienced adverse neonatal outcomes. No neonatal deaths occurred despite the predominance of large chorangiomas in the study population. Serial ultrasound surveillance with meticulous fetal assessment enabled early identification of asymptomatic chorangiomas and timely intervention when required, resulting in favorable perinatal outcomes.