Pulmonary function and airway inflammation are key indicators of respiratory health. Dietary factors, particularly fat-soluble vitamins, may be related to these outcomes, yet their associations in general populations remain inadequately characterized. We analyzed data from the National Health and Nutrition Examination Survey 2007 to 2012, including 9328 adults. Fat-soluble vitamin intake (A, D, E, K) was assessed via 24-hour dietary recalls. Spirometry measures (forced vital capacity, forced expiratory volume in the first second [FEV1], forced expiratory flow between 25% and 75% of vital capacity) and fractional exhaled nitric oxide (FeNO) were used to assess pulmonary function and airway inflammation, respectively. Multivariable linear regression and generalized additive models were employed to evaluate associations, with adjustment for sociodemographic, lifestyle, and clinical factors. In fully adjusted models, vitamins A and D were positively associated with forced vital capacity (β = 0.04 mL and 3.72 mL per µg/day, respectively). Vitamins A and K were positively associated with FeNO (β = 1.1 ppb and 3.3 ppb per unit increase, respectively). Exploratory analyses using generalized additive models identified nonlinear inverted U-shaped relationships for vitamins A and D with FEV1, with threshold points at 958 µg/day and 11.95 µg/day. Below these thresholds, each unit increase in vitamin A and vitamin D intake was associated with an increase in FEV1 of 0.07 mL and 4.15 mL, respectively. These threshold values are exploratory and require validation in future studies. Subgroup analyses indicated significant interactions with body mass index, particularly among overweight individuals. Dietary intake of vitamins A and D is positively associated with lung function, while vitamins A and K are positively associated with FeNO in a cross-sectional analysis. These findings highlight the complex associations between fat-soluble vitamins and respiratory health indicators, providing population-level observational evidence for future research on nutritional factors and lung health. Exploratory analyses suggest inverted U-shaped relationships between vitamins A and D and FEV1, but these findings are hypothesis-generating and require validation. No causal or preventive implications can be drawn from this cross-sectional analysis.
Evidence suggests nurses in the United States experience disproportionate risk for suicide and additional research is important. Additional research is significant, in part, as there is variability across existing studies that have examined nurse suicide in the U.S. Specifically, there are differences with respect to nursing definitions and age parameters, and limited data on sex differences, race, ethnicity, and state details. The aim of this article is to explore how national databases may be used to examine suicide among nurses in an increasingly systematic manner. National Occupational Mortality Surveillance (NOMS), National Vital Statistics System (NVSS), and National Violent Death Reporting System (NVDRS) data codebooks were downloaded and reviewed in their entirety. Each supplemental data source was also reviewed in its entirety. Items of interest included variables that would address existing research gaps and facilitate increasingly systematic examination of suicide among nurses in the U.S. (i.e., manner of death, underlying cause of death, usual occupation, education, sex, age, race, ethnicity, and state details). Taken together, national databases may permit differentiated analyses of various nursing professionals with different levels of education and training. National databases may also allow customized age parameters, facilitating analyses of nursing professionals within a specified age criterion. National databases often also include data on sex, race, ethnicity, and state details, providing opportunities to increasingly address research gaps. However, only the NVDRS provides opportunities to differentiate between working and non-working nurses, though these distinctions may be difficult and may yield incomplete information. More generally, national databases include variables and coding procedures that may facilitate increasingly systematic examination of nurse suicide. While limitations persist, particularly regarding mortality data, systematic evaluations are vital for clarifying conflicting evidence, addressing research gaps, and building the evidence base.
Sustainable swine production hinges on optimizing sow reproductive efficiency, yet mechanisms driving healthy litter size and weak piglet rates remain unclear. This study categorized sows into high (group H) and low (group L) healthy litter size groups based on median performance. Multi-omics analyses (16S rRNA sequencing, metagenomics, and serum metabolomics) revealed distinct fecal microbiota and metabolic profiles between groups. The results showed significant differences in microbiota composition between groups L and H. Group H exhibited a marked increase in Bacteroidetes abundance (particularly Prevotella sp. CAG1092), concurrent with reduced Firmicutes populations. Metabolomic analysis identified 197 differentially abundant metabolites, with 85 metabolites significantly enriched in group H. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis indicated that the differentially abundant metabolites were mainly involved in amino acid synthesis and metabolism, and multiple amino acid metabolic pathways were associated with polyamine synthesis. The correlation results showed a significant correlation (P < 0.05) between these metabolites and litter size as well as litter weight. For instance, Prevotellaceae NK3B31 abundance positively correlated with L-alanine, urea, and securinine, while Prevotella sp. CAG1092 exhibited direct associations with reproductive performance. These findings suggest that gut microbiota dysbiosis may disrupt amino acid homeostasis and polyamine regulation, potentially serving as mechanistic links to reproductive efficiency. Reproductive performance dynamically shapes gut microbiota and systemic metabolism in gestating sows, with litter size influencing fecal metabolite diversity and microbial structure. This integrative analysis establishes a framework for improving both sow productivity and economic viability in pig farming. Optimizing sow reproductive efficiency is vital for sustainable swine production. This study identifies gut microbiota dysbiosis and metabolic imbalances as key drivers of litter size variability. Sows with lower productivity displayed marked reductions in Bacteroidetes (notably Prevotella spp.) and disrupted amino acid/polyamine metabolism, directly linking microbial shifts to poorer litter outcomes. Integrated multi-omics approaches revealed strong correlations between specific taxa (Prevotella sp. CAG1092), metabolites (L-alanine and urea), and reproductive metrics, underscoring the gut-reproductive axis. These findings elucidate mechanistic connections between microbial ecosystems and host physiology, providing a foundation for targeted strategies like microbiota modulation or dietary interventions to enhance metabolic homeostasis and farrowing success. By bridging microbial ecology with livestock productivity, this work advances practical solutions to improve both animal health and agricultural profitability within precision farming frameworks.
U.S. veterans experience chronic pain and physical and emotional stressors at a high rate. To inform intervention targets for chronic pain it is vital to understand the longitudinal associations of protective factors (e.g., distress tolerance and social support) with pain-related functioning among this population. This study assessed the longitudinal associations among distress tolerance (physical and emotional), social support, pain intensity, and pain-related disability in a sample of 345 U.S. post-9/11 combat veterans. Baseline and one-year follow-up assessments of self-reported pain intensity (numeric rating scale), pain-related disability (Pain Disability Inventory), physical and emotional distress tolerance (Distress Tolerance Inventory), pre- and post-deployment social support (Deployment Risk and Resilience Inventory), age, and education (in years) were collected (68.3% male, average age = 38.94 years [SD = 9.83]). Bayesian linear regression was used to predict pain intensity and pain-related disability at one year by age, education, pain intensity, social support, and physical and emotional distress tolerance reported at baseline. Results indicated baseline pain intensity, emotional (but not physical) distress tolerance, post-deployment social support, and age predicted follow-up pain-related disability (total R2 = 0.30, 95% CI: 0.21-0.39), while follow-up pain intensity was associated with baseline emotional distress tolerance only (R2 = 0.10, 95% CI: 0.05-0.16). These results suggest that emotional distress tolerance may be a promising target for intervention for both pain intensity and pain-related disability. Further, pain-related disability is impacted by a broader range of factors, including social support, and may therefore require a greater array of interventions than pain intensity.
Land plants have successfully colonized every terrestrial environment on Earth, and the evolution of root systems has played a vital role in this success. Root systems perform critical functions ranging from foraging in soil for water and nutrients to providing anchorage for shoot organs. Despite this organ's importance, the first land plants lacked roots, relying instead on fungal symbioses and root-hair-like rhizoids for foraging and anchorage functions. Root-axis formation in early land plants rapidly led to increased root- (and accompanying shoot-) system complexity. This review will chart the evolution of root systems, from simple bifurcating roots in lycophytes to complex root systems in flowering plants. We will highlight key innovations in root morphology and their regulatory mechanisms. We also discuss how the evolution of novel hormone regulators and gene-regulatory components has enabled root systems to adapt to myriad soil signals and stresses. These adaptive mechanisms have underpinned root plasticity, which has been critical for land plants to adapt to past and present climates and soil conditions. Root-plasticity traits are likely to be critical for maintaining yield stability in a warming world. We conclude by discussing how crop-breeding programs must account for future soil and climate conditions when defining desirable root traits, to ensure the right root system for the right soil and climate.
Mitochondrial dysfunction plays a crucial role in the pathogenesis of Parkinson's disease (PD). PINK1-Parkin-mediated mitophagy is a quality-control system for mitochondria that protects neurons by getting rid of damaged mitochondria. The OMA1-DELE1-HRI axis has recently been recognized as a vital regulatory checkpoint that limits excessive mitophagy and prevents metabolic failure during mitochondrial stress. The aim of this review is to analyze the mechanistic interplay between the PINK1-Parkin pathway and the OMA1-DELE1-HRI signaling axis. This study aims to synthesize current research on the influence of the stress-response pathway on the initiation of mitophagy, maintenance of mitochondrial homeostasis, and neuronal survival in PD. A comprehensive literature review was conducted of molecular, genetic, and pharmacological studies on OMA1, DELE1, and HRI. A thorough analysis of data from kinome-wide screening assays, genetic knockdown experiments, multi-omics profiling, and structural biology studies was performed to elucidate the regulatory interactions between HRI and PINK1 under mitochondrial stress conditions. The OMA1-DELE1-HRI pathway stops PINK1 from being stable by controlling how mitochondria make proteins and how they respond to stress. This inhibition serves as a metabolic safeguard that regulates mitophagy levels, preventing harmful overactivation. HRI seems to change PINK1-dependent mitophagy while having little effect on other pathways that clear things at the same time. This suggests that HRI has different substrate preferences and signaling specificity. The OMA1-DELE1-HRI axis is an important negative regulator of mitophagy that PINK1 and Parkin mediate. It stops too much mitochondrial clearance and metabolic failure in Parkinson's disease. This mechanism preserves bioenergetic homeostasis and promotes neuronal survival, suggesting that HRI is a promising therapeutic target. Inhibitors like ISRIB or heme mimetics may selectively restore mitophagy, thereby enhancing neuroprotection and enabling precision therapies guided by biomarkers such as phosphorylated eIF2. The OMA1-DELE1-HRI axis is a distinctive regulatory mechanism for mitochondrial quality control, significantly impacting neuroprotection in Parkinson's disease. Understanding its dual role in controlling mitophagy and maintaining bioenergetic homeostasis opens new possibilities for targeted drug development. Subsequent research should focus on structural and pharmacological modifications of HRI to enhance mitophagy while preventing mitochondrial depletion.
Horticultural crops, including fruits, vegetables, ornamental plants, and tea plants, are vital for economic and nutritional sustainability, yet their cultivation is severely hampered by abiotic stresses such as heat, cold, and salinity. The advent of the grapevine genome in 2007 initiated the genomic era for horticultural species. This milestone facilitated the use of genome-wide association studies (GWAS) to decode the complex phenotypic diversity of these crops. Unlike traditional methods, GWAS utilizes natural genetic diversity to identify quantitative trait loci linked to key traits, offering a high-resolution approach for dissecting traits such as stress resistance, quality, and yield. This review highlights the innovative workflows and technical advancements in GWAS applications for horticultural crops, covering aspects including population design, high-throughput phenotyping, sophisticated statistical modeling, and their applications in horticultural plants. Notably, the integration of multi-omics approaches has enhanced our understanding of the genetic mechanisms underlying critical horticultural traits. Future directions aim at harnessing technological innovations, cross-omics synthesis, and precision breeding strategies to optimize trait selection and expedite the development of resilient cultivars. Consequently, GWAS serves as a crucial bridge linking genomic variation to practical applications in horticultural improvement, enabling a paradigm shift toward predictive breeding and sustainable agricultural practices.
Parkinson's disease (PD) presents significant challenges due to its intricate symptoms and often delayed diagnosis. Therefore, early detection is vital for effective management and slowing the disease progression. Recently, machine learning based methods show high performance in this purpose. This research introduces a new machine learning approach that combines Residual-Shuffle Network (ResNet) with an advanced metaheuristic, the Improved Dandelion Optimizer (IDO) by integrating adaptive parameter control and enhanced exploration-exploitation balance, to provide an accessible and precise solution for automated PD detection. The proposed framework addresses previous limitations by effectively adjusting model hyperparameters and network weights without the need for expensive or sophisticated data collection devices. The proposed IDO-ResShuffle framework achieved strong performance on the HandPD dataset, obtaining 97.6% accuracy, 96.9% F1-score, 97.2% sensitivity, and 97.1% specificity. These results demonstrate the effectiveness of jointly optimizing the network architecture and hyperparameters through the Improved Dandelion Optimizer, enabling more reliable identification of Parkinson's disease from handwriting patterns. These enhancements empower healthcare professionals to make informed decisions about patient care sooner and potentially slow down the progression of symptoms. By enhancing accessibility and reliability, this approach can enhance clinical decision-making and support timely intervention in PD management.
Intracellular calcium signaling plays a vital role in regulating various cellular processes including gene regulation, motility, metabolism, and cell death. Inositol 1,4,5-trisphosphate receptors (IP3Rs) on the endoplasmic reticulum (ER) are a major cation channel that regulates stimulus-induced calcium release from the ER. While several molecular players regulate the activity of IP3R, its regulation by actin filaments was uncharacterized. Here, we show that actin filaments polymerized by the specific actin nucleator INF2 facilitate agonist-induced IP3R activity. Our results demonstrate that INF2-mediated actin filaments regulate the formation and/or stability of IP3R clusters on the ER that have been previously shown to be hotspots of ER calcium release. Using cell-biological and biochemical techniques, we further show that INF2 physically interacts with IP3R isoforms, often at IP3R clusters. While INF2-IP3R interaction is independent of INF2 activity, the ability of INF2 to mediate IP3R clusters is dependent on its actin polymerization activity. Finally, we demonstrate that in addition to its calcium mobilization activity, INF2 on the ER specifically regulates IP3R cluster positioning to mediate ER-mitochondrial contacts and facilitate ER-to-mitochondrial calcium transfer. Overall, these results reveal an actin-dependent step in the regulation of IP3R activity both in terms of ER calcium release and modulation of ER-mitochondrial contacts.
Biomass catalytic gasification studies often focus on either inherent metal catalysis or impregnated metal catalysis rather than their integrated roles. Thereby, this study focused on analyzing the integrated catalytic roles of inherent and impregnated metals of biochar on the steam gasification of grass biomass. Monometallic and bimetallic impregnations of nickel (Ni) and iron (Fe) on the biomass and char preparation at a pyrolysis temperature of 500 °C (i.e., Napier grass biochar (NGC500) were performed. Then the catalytic performance and synergistic effect on H2-rich syngas production from steam co-gasification with herbaceous biomass (i.e., Giant Miscanthus (GM)) were investigated, in which the reactions were basically conducted at 750 °C with 0.05 g/min steam flow and 1 h holding time in a vertical fixed bed gasifier. It is found that, by the addition of the bimetallic Ni-Fe-NGC500 into the co-gasification system, the highest H2-rich syngas yield was achieved with the maximum of 95 mmol/g-daf. The kinetic analysis based on time-resolved syngas profiles showed the highest H2 production rate with intermediate kinetic behavior. Also, the inherent K in NG plays a vital role in catalyzing the reactions in parallel with impregnated metals. Especially, the formation of Ni0.23Fe0.22 alloy in the bimetallic biochar sample is found to be favorable in achieving synergy effect during gasification whereas the inherent K in the NGC can easily react with CO2, H2O and silicates in the media yielding beneficial gaseous products, and ultimately forming K-aluminosilicates (KAlSi3O8) to reduce the catalytic effect.
Photocatalytic cracking of polystyrene (PS) into valuable aromatic chemicals presents a key route to plastic waste upcycling under mild conditions, in which CH2Cl2 is often used as an inert solvent. Represented herein is to report an unexpected cracking of PS to C6-C8 aromatic products in CH2Cl2 without any additional photocatalysts under an O2 atmosphere and 365-415 nm irradiation. Remarkably, this photocatalyst-free system achieves a maximum generation rate of 15.9 µmol/h for C6-C8 aromatic products, competitive with state-of-the-art systems that rely on external photocatalysts. Radical scavenging experiments and EPR spectra reveal that chlorine (Cl•) radicals generated from CH2Cl2 under irradiation contribute to the cleavage of C─H/C─C bonds in PS, leading to the formation of C6-C8 aromatic products. Under aerobic conditions, these Cl• radicals also promote the transformation of PS into carbonylated intermediates as the light-absorbing species with an absorption range of 300-500 nm, thereby accelerating the activation of PS and derivatives. Importantly, this work identifies, for the first time, CH2Cl2 as a vital photochemical reagent in PS conversion to value-added aromatics even under visible light irradiation.
Smart packaging plays a vital role in preserving fruit quality, reducing microbial spoilage, and mitigating postharvest losses. Real-time monitoring of relative humidity (RH), estimation of fruit storage time, and extension of fruit longevity are essential for delivering high-quality products to consumers. Triboelectric nanogenerators (TENGs) are a promising platform for developing self-powered smart packaging systems without external energy sources. In this work, a biodegradable cellulose nanofiber (CNF) was used as the triboelectric layer because of its biocompatibility. To enhance triboelectric output, the CNF was first composited with titanium dioxide (TiO2), titania nanotubes (TNTs), and titania nanotubes decorated with copper(I) oxide (TNT-Cu2O) at various weight ratios, and then patterned to increase contact area. These nanofillers have higher dielectric constants and electron affinities than pure CNF, improving charge induction efficiency while also providing moisture absorption and antibacterial activity to enhance fruit storage conditions inside the package. The optimized patterned CNF/TNT-Cu2O (10 wt%) TENG produced an open-circuit voltage of 377.4 V, a current of 37.6 μA, and a high power density of 7.8 W·m-2. As a self-powered humidity sensor, it demonstrated a maximum response of 1057% inside a sealed package. Additionally, electrical resistance variation was used to estimate fruit storage time, while antibacterial and moisture-absorbing properties of the film helped delay spoilage. This multifunctional platform offers a sustainable approach to smart food packaging and real-time postharvest monitoring.
This study develops a data-driven framework for early three-level maternal health risk prediction using routinely collected vital signs. The Maternal Health Risk Dataset, containing 1,014 anonymised records, was preprocessed through removal of clinically implausible values, SMOTE-based class balancing, Z-score normalisation, and second-order polynomial feature engineering. A soft-voting hybrid ensemble combining multi-layer perceptron, random forest, and XGBoost classifiers was then developed. Across repeated train-test partitions, the proposed model achieved approximately 0.98 accuracy and macro-F1, outperforming baseline models by about 10-11 percentage points. The framework shows strong potential for low-resource maternal health decision support.
Angiogenesis plays a vital role in cerebral tissue repair following ischemic stroke. Prior in vivo studies have identified astrocytic interleukin-17A (IL-17A) as a critical mediator of post-ischemic angiogenesis, associated with upregulation of interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF). However, the intracellular signaling mechanisms underlying these effects within astrocytes have not been fully elucidated. This study delineates a specific intracellular signaling mechanism through which astrocytic IL-17A promotes angiogenesis following an in vitro ischemia-like injury. Primary astrocytes were exposed to oxygen-glucose deprivation followed by reperfusion (OGD/R). Astrocyte viability was assessed using the Cell Counting Kit-8 assay. Brain microvascular endothelial cells (BMECs) were cultured with astrocyte-conditioned medium (ACM). Astrocytes were treated with recombinant IL-17A (rIL-17A), IL-17A-targeted small interfering RNA, a neutralizing antibody against IL-6, or the Janus Kinase 2/Signal Transducer and Activator of Transcription 3 (JAK2/STAT3) pathway inhibitor AG490. Protein levels were quantified, and angiogenic capacity was determined via tube formation assays and CD34 expression analysis. Exposure to OGD/R increased IL-17A secretion from astrocytes. Treatment with rIL-17A enhanced astrocyte viability and induced IL-6 production. Activation of the JAK2/STAT3 pathway by IL-6 was required for the subsequent VEGF upregulation. Consequently, ACM from rIL-17A-treated astrocytes significantly promoted angiogenic activity in BMECs, as evidenced by enhanced tube formation. These pro-angiogenic effects were significantly attenuated by IL-17A knockdown, IL-6 neutralization, or inhibition of JAK2/STAT3 signaling in astrocytes. This study delineates a specific intracellular signaling mechanism through which astrocytic IL-17A promotes angiogenesis following ischemia-like injury. The findings identify an IL-6-dependent activation of the STAT3-VEGF signaling axis as a key mediator of this process, underscoring the therapeutic potential of targeting astrocytic IL-17A signaling in post-stroke angiogenic repair.
Emergency departments are vital safety-net resources for adults seeking mental health treatment. Frequent mental health emergency department use has been associated with homelessness and alcohol use. However, little of this research has been conducted in rural settings, particularly in Northern Appalachia. Therefore, this program-level study aimed to describe the relationship between recent mental health emergency department use, homelessness, and alcohol use in intake survey data from one outpatient mental health clinic. Participants were 1,293 adults seeking treatment between June 2020 and August 2022. On average, participants reported using an emergency room for a psychiatric or emotional problem less than one time in the past 30 days. Nights spent homeless were statistically significantly positively associated with recent mental health emergency department use. Additionally, those who used alcohol daily or almost daily demonstrated a statistically significant greater frequency of mental health emergency department use compared with adults who did not use alcohol within the past 30 days. Future social work research should replicate this study with a larger, multisite, random sample of mental health treatment-seeking adults in rural Northern Appalachian settings.
Internuclear ophthalmoplegia (INO) is a distinct ocular motility disorder localizing to the medial longitudinal fasciculus (MLF). Because the MLF is a microscopic, highly myelinated tract, small inflammatory lesions can cause significant functional conduction blocks that fall below the resolution threshold of typical 1.5T or 3T MRI. This leads to clinical radiographic dissociation, resulting in a significant diagnostic challenge when pathognomonic physical findings are present despite negative neuroimaging. A 16-year-old female presented with acute binocular diplopia and bilateral INO. Physical examination revealed pathognomonic bilateral failure of adduction, dissociated nystagmus, and impaired convergence. While the brain MRI demonstrated periventricular white matter hyperintensities, it failed to reveal a distinct lesion within the MLF. Despite the lack of definitive radiological localization in the brainstem, the clinical findings were conclusive for a demyelinating process. The patient was treated empirically with high-dose intravenous methylprednisolone to facilitate blood-brain barrier stabilization and address suspected inflammatory demyelination. This case underscores the diagnostic hierarchy in neurology, where pathognomonic physical findings must supersede nonspecific imaging in highly localizing brainstem disorders. Early recognition is vital, especially in pediatric populations where bilateral INO serves as a "red flag" for multiple sclerosis or other central demyelinating events.
Self-monitoring of blood glucose (SMBG) is vital for diabetes self-care, but its uptake in Malaysia remains low. This study aimed to determine the prevalence, predictors, barriers and facilitators of SMBG among patients with type 2 diabetes in Malaysian primary care settings. A cross-sectional study was conducted from May to September 2024 across five urban, suburban and rural primary care clinics. Participants completed a validated questionnaire on sociodemographic characteristics, clinical characteristics and SMBG practices. Multivariable logistic regression was conducted to identify the predictors of SMBG. Among the 396 participants (mean age=53.6±10.9 years), the prevalence of SMBG was 59.3%. The participants aged 50-59 years (adjusted odds ratio [AOR]=2.80, 95% confidence interval [CI] = 1.03-7.62, P=0.045) and 60-69 years (AOR=3.43, 95% CI=1.25-9.38, P=0.017) were more likely to perform SMBG than those aged ≥70 years. Insulin use was strongly associated with SMBG (A0R=7.02, 95% CI=2.44-20.19, P<0.001), whereas the presence of diabetes complications was negatively associated with SMBG (A0R=0.57, 95% CI=0.33-0.98, P=0.043). The major barriers were the cost of test strips and lancets (59.6%) and frustration with high glucose readings (82.8%), while the facilitators included personal motivation (68.9%), family support (79.1%) and belief in the importance of SMBG (86.9%). The prevalence of SMBG is moderate but suboptimal. Enhancing structured diabetes education and addressing financial barriers are essential to improve SMBG practice and glycaemic control.
Tunneled cuffed catheters (TCCs) are vital haemodialysis access devices in chronic kidney disease (CKD), yet prone to significant dysfunction-related morbidity. To identify bedside patient-related predictors of TCC dysfunction and reduced patency in adult CKD patients undergoing haemodialysis at a single Indonesian center. Single-center retrospective cohort study at Rasyida Kidney Hospital, Medan, Indonesia, covering TCC insertions from 2021 to 2024. Primary outcomes were catheter dysfunction and patency. Variables were extracted from medical records. Multivariable logistic regression identified predictors of dysfunction; Cox proportional hazards regression assessed reduced patency. A total of 102 TCCs in 96 adult patients were included. Mean age was 62.7 ± 14.9 years and 62.7% were female. Dysfunction occurred in 30 catheters (29.4%) over a mean dwell time of 20.1 ± 13.1 months. Independent predictors of dysfunction were femoral insertion site (aOR 3.56, 95% CI 1.08-11.7, p = 0.036) and hypertension (aOR 3.34, 95% CI 1.01-11.1, p = 0.049). Cox regression confirmed femoral site (aHR 3.10, 95% CI 1.29-7.44, p = 0.011), hypertension (aHR 4.45, 95% CI 1.40-14.15, p = 0.011), and age ≥ 60 years (aHR 3.96, 95% CI 1.48-10.64, p = 0.006) as predictors of reduced patency. Femoral insertion site and hypertension were strong independent predictors of TCC dysfunction and shortened patency. Age ≥ 60 years additionally predicted reduced patency. These simple bedside factors support practical risk stratification in low-resource haemodialysis settings.
The urgent management of the patient with acute abdominal pain and other conditions comprises a rapid cardiorespiratory evaluation and resuscitation to maintain hemodynamic stability and obtain an elaborate and focused history and examination. Following the exclusion of life-threatening diagnoses, symptomatic improvement in patients with gastrointestinal conditions is vital. Vomiting causes mild to severe dehydration, leading to hypovolemia, electrolyte imbalances, and other consequences. This narrative review provides an overview of symptomatic care and antiemetic management in the acute setting. A systematic literature search was used to identify relevant articles. Consecutive trials in English published between 2005 and 2025 investigating the indications and use of antiemetic agents were abstracted from Google Scholar, PubMed, Scopus, and Web of Science. Case reports, editorials, and expert opinions were excluded from the analysis. Replacement of IV fluids combined with antiemetic agents is administered to patients with conditions causing intractable vomiting, such as pancreatitis, renal colic, hollow viscus obstruction, and appendicitis, based on the patient's clinical course. Emptying and decompression of the stomach contents with the nasogastric catheters may be necessary, as aspiration can often be encountered in patients with repeated vomiting. 5-Hydroxytryptamine 3 receptor antagonists are preferred as they act on central and peripheral receptors to prevent and treat vomiting. Patients with chief complaints of nausea and vomiting should prompt scrutiny for lifethreatening diagnoses initially, and then ruling out the other differential diagnoses, which need emergent interventions to prevent further deterioration. A `symptomatic` treatment not only ensures optimal cooperation and communication with the patient but also achieves physiological homeostasis. Measures to treat dehydration, pain, nausea, and vomiting should be individualized and implemented promptly with a multidisciplinary approach. Appropriate antiemetic agents should be selected to treat nausea and vomiting per evidence-based guidelines.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a vital therapy that bridges glycemic control and cardiovascular protection, fundamentally changing the way the Cardiovascular-Kidney-Metabolic (CKM) syndrome is managed. This review summarises the current evidence on the molecular mechanisms of SGLT2 inhibitors, ranging from haemodynamic regulation to metabolic reprogramming, and their clinical applications in various cardiovascular diseases. We critically discuss the pharmacological characteristics of different agents, as well as the debate surrounding glucose-dependent versus glucose-independent mechanisms. Furthermore, we summarise current guideline recommendations to provide clinicians with a reference for incorporating SGLT2 inhibitors into the treatment of heart failure and other cardiovascular conditions.