Rotavirus is a major cause of acute gastroenteritis in children. This study assessed the frequency and clinical characteristics of rotavirus infection in children under five years old. This cross-sectional study was conducted in 2020 on children with acute gastroenteritis. Clinical and demographic data were collected, dehydration severity was assessed by a pediatrician, and stool samples obtained within 48 hours of admission were tested for rotavirus antigen using ELISA. A total of 301 children with acute gastroenteritis were included. Rotavirus antigen was detected in 34.6% of cases. Vomiting (81.2%) and diarrhea (96.1%) were significantly common among rotavirus-positive children (p = 0.01). Severe dehydration (>10%) and the need for parenteral rehydration were observed more frequently among rotavirus-positive children compared with rotavirus-negative cases (20.9% vs. 9.2%, p = 0.02 and 91.1% vs. 78.1%, p = 0.01, respectively). However, these findings should be interpreted cautiously, as clinical severity may also have been influenced by other demographic and clinical factors. Rotavirus was detected in a considerable proportion of children with acute gastroenteritis in southern Iran. Rotavirus-positive cases showed more frequent severe dehydration, although this finding should be interpreted cautiously. Early assessment and supportive care remain important.
The evidence linking blood pressure (BP) variability (BPV) to longitudinal lung function decline remains unclear. This cohort study aims to reveal the association between BPV and lung function decline among population over 45 years old. Participants were from the Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS). Lung function was assessed by peak expiratory flow (PEF), and was standardized using Z-score transformation. Variation independent of mean (VIM) was mainly used to assess BPV. A linear mixed model was conducted. Subgroup analyses across age, sex, body mass index (BMI), and hypertension status were employed. A meta-analysis was performed to pool results, with heterogeneity reported. A total of 6,930 and 5,119 eligible participants from HRS and CHARLS were included, respectively. With increment of VIM, participants' PEF decreased. Pooled analysis revealed that increased BPV was significantly associated with faster lung function decline [β for systolic BP: -0.224, 95% confidence interval (CI): -0.323 to -0.126; β for diastolic BP: -0.08, 95% CI: -0.011 to -0.005]. Compared with participants in the lowest tertile of VIM, those in the middle and highest tertiles showed greater declines. Subgroup analysis demonstrated that sex modified this association, with a more pronounced effect observed in males (pooled β for systolic BP: -0.347, 95% CI: -0.669 to -0.025; pooled β for diastolic BP: -0.012, 95% CI: -0.019 to -0.005). BPV is significantly associated with lung function decline in middle-aged and older adults, and this association is more pronounced in males. More early intervention for individuals with higher BPV is needed, particularly for males.
Advanced age is often associated with increased technical difficulty during lung resection; however, the mechanisms underlying age-related operative burden during segmentectomy remain unclear. This study aimed to evaluate age-related differences in pleural adhesion, operative complexity, and perioperative outcomes in patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy for lung cancer. Consecutive patients who underwent uniportal VATS segmentectomy were retrospectively reviewed. Patients were stratified into two groups according to age (<70 vs. ≥70 years). Baseline characteristics, radiologic and operative findings, pleural adhesion status, and postoperative outcomes were compared between the groups. Pleural adhesion was categorized as absent, partial, or whole. Continuous variables were compared using the Student's t-test or Wilcoxon rank-sum test, as appropriate. Multivariable logistic regression was performed to identify independent predictors of pleural adhesion. A total of 814 patients were included, of whom 683 were aged <70 years and 131 were aged ≥70 years. Pleural adhesion was significantly more frequent in patients aged ≥70 years than in those aged <70 years (26.7% vs. 8.8%, P<0.001), and whole pleural adhesion was also more common in the elderly group (5.3% vs. 1.8%, P=0.02). In multivariable analysis, age remained independently associated with pleural adhesion (adjusted OR 1.11 per year increase, 95% CI: 1.08-1.14, P<0.001). Patients aged ≥70 years demonstrated greater operative burden, with longer operative time (median 91 vs. 89 minutes, P=0.002) and longer postoperative chest tube duration {median [interquartile range]: 1 [1-3] vs. 1 [1-1] days, P<0.001}. The incidence of postoperative complications was significantly higher in the elderly group (12.2% vs. 3.8%, P<0.001), including a higher rate of prolonged air leak. Surgical margin distance was comparable between the two groups. Elderly patients undergoing uniportal VATS segmentectomy exhibited a significantly higher incidence of pleural adhesion and were associated with longer operative time and postoperative drainage, as well as higher complication rates. Nevertheless, acceptable postoperative outcomes can be achieved, supporting the feasibility of segmentectomy in carefully selected elderly patients.
Uterine fibroids are highly prevalent globally. However, evidence on the effects of menopausal hormone therapy (MHT) on fibroid growth during menopausal transition remains limited. This study explores the association between MHT and the size of uterine fibroids in women during the menopausal transition. This retrospective observational study enrolled women during menopausal transition with uterine fibroids who received sequential menopausal hormone therapy (estradiol combined with dydrogesterone) at Nanjing Women and Children's Healthcare Hospital from January 2016 to August 2023. Serial ultrasound examinations were performed to dynamically monitor changes in fibroid cross-sectional area during follow-up. A linear mixed-effects model was applied to explore the long-term impact of menopausal hormone therapy on fibroid size alterations over time. Furthermore, all adverse events occurring during hormone therapy were systematically recorded and summarized. A total of 83 patients were enrolled, with a maximum follow-up of 5 years post-treatment. Although statistically significant differences from baseline in fibroid cross-sectional area were observed during the first four years of follow-up, these changes were marginal and clinically unremarkable and undetectable at year 5. Most adverse events were transient and resolved spontaneously. The incidence rates of unexpected bleeding, breast discomfort and gastrointestinal symptoms were 18.07%, 10.84% and 2.41%, respectively. Findings suggest that women during menopausal transition that receiving MHT may experience transient, minor changes in fibroid size. These changes are not considered clinically meaningful, and MHT exhibits an overall favorable safety profile for this group. With regular surveillance and use of the lowest effective dose, MHT represents a safe and practical therapeutic choice. Additional prospective investigations are needed to characterize the long-term dynamic changes of fibroids associated with MHT. Uterine fibroids are the most common gynecological tumors in women worldwide. This retrospective study examined the association between MHT and fibroid size changes in women undergoing menopausal transition. A total of 83 patients received sequential MHT (estradiol plus dydrogesterone). Over 5 years of follow-up, a dynamic change in fibroid cross-sectional area was observed. Specifically, statistically significant differences from baseline were observed in the first four years and resolved by the fifth year. Given the modest magnitude of these variations, the effects of MHT on uterine fibroids are clinically acceptable. Most reported adverse events were transient and resolved without intervention. With appropriate monitoring and adherence to the lowest effective dose principle, MHT is a feasible option for women initiating MHT during the menopausal transition. Further prospective studies are needed to validate this dynamic change pattern and its clinical implications.
Marfan syndrome (MFS) is a heritable connective tissue disorder associated with a heightened risk of acute type A aortic dissection (ATAAD). The long-term impact of MFS on outcomes following total arch replacement with frozen elephant trunk (TAR with FET) remains poorly characterized. This study aimed to evaluate this impact in a large cohort from a single high-volume aortic center. Patients with ATAAD who underwent TAR with FET at Fuwai Hospital (2010-2018) were categorized into MFS and non-MFS groups. Long-term follow-up was complete for all surviving patients, with a median follow-up of 6.08 years (terminating in December 2023). Clinical characteristics and long-term follow-up outcomes were analyzed, with primary endpoints including survival, reoperation rates, and functional status. Multivariable logistic regression and competing risks Cox regression models were employed to identify independent predictors of outcomes. Among 1,086 patients with a mean age of 46.6 years (104 MFS, 982 non-MFS), Marfan patients were significantly younger (36.1 vs. 47.7 years, P<0.001) with higher rates of previous cardiovascular surgery (11.5% vs. 2.2%, P<0.001) and root replacement (76.0% vs. 22.7%, P<0.001). Overall operative mortality was 7.4% (80/1,086) with no significant between-group difference. At median follow-up of 6.08 years, 10-year survival was 80.6% and comparable between groups (P=0.22). Over 90% of survivors maintained complete self-care ability. Among 67 total reoperations, 25 occurred in Marfan patients. MFS remained an independent risk factor for reoperation (hazard ratio 2.06, 95% confidence interval: 1.18-3.59, P=0.01). While MFS does not compromise long-term survival in ATAAD patients undergoing TAR with FET, significantly elevated reoperation rates necessitate specialized long-term surveillance.
Lung transplantation (LT) remains a life-saving intervention for patients with end-stage lung disease, but recipient age continues to be a key determinant of long-term outcomes. As the candidate population ages and allocation policies shift, understanding how age and donor-recipient variables impact survival is increasingly critical. This study aimed to evaluate the association between recipient age and long-term survival after LT, and to characterize age-specific differences in mortality risk factors in a national cohort. We conducted a retrospective cohort study of 30,494 adult LT recipients using data from the Scientific Registry of Transplant Recipients (SRTR) from 2006 to 2022. Recipients were stratified by age at transplant into three groups: 18-64, 65-69, and ≥70 years. Primary outcome was all-cause mortality; secondary outcomes included graft dysfunction, rejection rates, and cause of death. Kaplan-Meier and Cox proportional hazards models were used to evaluate survival risk factors. Survival declined progressively with increasing age, with recipients aged ≥70 years showing significantly lower 5-year survival. Multivariable analysis identified treated rejection, low body mass index (BMI), pre-transplant intensive care unit (ICU) stay, and post-transplant dialysis as independent predictors of mortality. The impact of risk factors varied by age: rejection had less effect in older recipients, extracorporeal membrane oxygenation (ECMO) predicted mortality only in younger patients, and dialysis was significant mainly in the 65-69 years group. Importantly, donor age and sex did not significantly affect survival. Advanced recipient age is independently associated with reduced long-term survival after LT, and this association persists after adjustment for donor and procedural factors. The relative importance of risk predictors varies across age groups, highlighting distinct, age-dependent risk profiles that may inform candidate selection and counselling. Together, these findings underscore the need to further refine selection strategies to support the ethical and effective allocation of scarce donor lungs.
Early diagnosis of invasive fungal diseases (IFD) remains a major clinical challenge due to pathogen diversity and nonspecific symptoms. This study used metagenomic next-generation sequencing (mNGS) technology to comprehensively characterize fungal profiles across various clinical specimens and the demographic characteristics (sex and age) of the patient population. The results provide laboratory evidence to support the diagnosis and treatment of fungal infections. A total of 11,161 mNGS reports from clinical specimens collected at the Renmin Hospital of Wuhan University between March 2022 to August 2024 were retrospectively analyzed. Fungal spectra and patient demographics were comprehensively profiled and compared across different specimen types. The highest fungal detection rate was observed in bronchoalveolar lavage fluid (36.85%, 1,985/5,387), followed by urine (22.76%, 264/1,160), blood (13.38%, 380/2,840), pleural and peritoneal fluid (12.91%, 174/1,348), cerebrospinal fluid (CSF) (13.82%, 17/123), and wound exudates (12.87%, 39/303). Candida species were the most frequently detected fungi across all specimen types except CSF, wherein Aspergillus predominated. Overall fungal detection rates were significantly higher in male patients than in female patients (26.76% vs. 23.84%, P < 0.01) and in individuals aged > 60 years compared with those aged ≤ 60 years (33.04% vs. 20.02%, P < 0.001), although this trend varied by specimen type. Multivariate logistic regression analysis confirmed that male sex (adjusted odds ratio [aOR]=0.893,95% confidence interval: 0.824-0.967, P = 0.006) and advanced age (≥80 years: aOR=14.77,95% confidence interval: 12.08-18.06, compared with minors) were independent risk factors for fungal detection. Among fungal-positive specimens, 68.28% (1,952/2,859) were co-detected with bacteria, and 15.63% (447/2,859) showed polyfungal detection (≥ 2 fungal species). In conclusion, our findings highlight the predominance of Candida and Aspergillus, identify elderly male patients as a high-risk population, and underscore the high frequency of bacterial-fungal co-detection. Overall, Clinicians should combine mNGS results with imaging, conventional fungal tests (G/GM assays, culture), and clinical presentation for a more accurate diagnosis of IFD.
Robotic mitral valve (MV) repair has evolved as a minimally invasive surgical approach for mitral regurgitation (MR). However, evidence regarding its safety and clinical outcomes in octogenarians remains limited. This study was performed to evaluate the feasibility and early outcomes of robotic MV repair in octogenarians compared with younger patients. We retrospectively reviewed consecutive patients who underwent totally endoscopic robotic MV repair for MR between September 2019 and September 2024 at Osaka Metropolitan University Graduate School of Medicine. Both degenerative and functional MR were included. Patients were divided into two groups according to age: octogenarians (≥80 years) and younger patients (≤65 years). Preoperative characteristics, operative findings, and postoperative outcomes were compared. Postoperative physical function in older patients was evaluated using the Short Physical Performance Battery (SPPB). Among 170 robotic MV repair cases, 16 patients were aged ≥80 years and 101 patients were aged ≤65 years. Older patients had a higher prevalence of hypertension [14 (88%) vs. 51 (50%); P=0.006], dyslipidemia [6 (38%) vs. 14 (14%); P=0.03], respiratory disorders [4 (25%) vs. 2 (2%); P=0.003], and atrial fibrillation [9 (56%) vs. 13 (13%); P<0.001]. Preoperative echocardiography showed severe MR in all patients, and 10 older patients (63%) had more than moderate tricuspid regurgitation (TR). Concomitant procedures, including tricuspid valve repair [7 (44%) vs. 10 (10%); P=0.002], Maze procedure [7 (44%) vs. 10 (10%); P=0.002] and left atrial appendage closure [8 (50%) vs. 9 (9%); P<0.001], were performed more frequently in octogenarians. Echocardiography at 1 week after surgery and at the 1-year follow-up showed that MR and TR were reduced to no more than mild in all older patients. Comparison of preoperative and postoperative SPPB scores showed no significant differences in any component (balance, gait speed, or chair stand), and all older patients were discharged home without major complications. Robotic MV repair in carefully selected octogenarians was feasible and associated with favorable early clinical outcomes. Concomitant procedures could be safely performed without deterioration of postoperative physical performance. Robotic MV surgery may represent a reasonable treatment option for older patients.
The aim of the study is to identify perioperative predictors of positive resection margins in patients with non-small cell lung cancer (NSCLC) undergoing anatomical resections to improve perioperative risk stratification and ultimately, patient care. All patients with primary NSCLC admitted at the Bundeswehrkrankenhaus (Armed Forces Hospital) Ulm for anatomical resections between 01.01.2019 and 31.12.2024 were retrospectively included into the study. Based on resection margins, patients were categorized in two groups: Group 1 (with negative resection margins, R0) and Group 2 (with tumor involvement at the level of resection margins/ positive resection margins at bronchial level, or adjacent structures, R+). A comparative analysis of patients' demographics, topographical, pathological tumor characteristics and surgical approach was performed by Mann-Whitney U test, Chi-squared test, and Fisher test. A logistic regression model was performed to assess the independent predictive value of the selected variables. Of 232 NSCLC patients [median age 69.00 (63.00, 75.00) years, 22% aged >75 years, and 2.2% with an Eastern Cooperative Oncology Group (ECOG) >2] who underwent anatomical resections, 107 (46.1%) female patients were included. While R0 resections were observed in 214 (92.2%) patients, 18 (7.8%) patients had positive resection margins on histopathological evaluation. R+ was more frequently reported in male patients (83.3% vs. 16.7%, P=0.009), large tumors (>50 mm/> pT2, P<0.001), as well as in resection specimens with lymph node metastasis (pN1-2, P<0.001), lymphangiosis (L1, P=0.006), vascular invasion (V1, P=0.008) and squamous histology (P<0.001). No significant differences were observed between groups in terms of lobar distribution, tumor mutational status, regression grade upon neoadjuvant therapy, as well as surgical approach (open/minimally invasive). Multivariable analysis revealed male sex (P=0.042), squamous histology (P=0.02), and pT >2 (P<0.001) as independent predictors for R+. These predictors increased the risk of resection margin positivity by 4.1-, 3.7-, and 8.5-fold, respectively. T stage (pT >2), squamous histology and male sex predict positive resection margins in lung cancer patients undergoing anatomical resections. Consideration of these parameters could help in patients' stratification and care and thus, should be further evaluated in larger patients' cohorts.
Connective tissue disease-associated interstitial lung disease (CTD-ILD) is a severe complication, yet early objective detection of pulmonary structural and microvascular alterations remains challenging. This study aimed to quantitatively compare pulmonary structural alterations between connective tissue disease (CTD) patients with and without interstitial lung disease (ILD) and to identify independent computed tomography (CT)-derived discriminators for ILD diagnosis by means of quantitative computed tomography (QCT). Fifty-one CTD patients with ILD (median age, 51 years; 66.7% female) and thirty-three CTD patients without ILD (median age, 33 years; 69.7% female) who underwent paired inspiratory and expiratory non-contrast chest computed tomography (CT) scans and pulmonary function testing were retrospectively collected. The lung density, functional small airway and pulmonary vessel parameters were analyzed using computer software. Differences in these CT quantitative parameters between the patients with CTD-ILD and those with CTD without ILD were compared using Mann-Whitney U tests. Furthermore, univariable and multivariable logistic regression analyses were used to establish nomograms to identify the independent predictors associated with the presence of ILD in patients with CTD. The calibration curve evaluates the predictive accuracy, while the decision curve analysis (DCA) evaluates clinical applicability. The forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), diffusing capacity of the lungs for carbon monoxide corrected for alveolar volume (DLCO/VA) and diffusing capacity of the lungs for carbon monoxide (DLCO) of the CTD with ILD group were significantly lower than those of the CTD without ILD group (all P<0.05). CTD with ILD group had higher percentages of high-attenuation area on inspiratory and expiratory CT (HAA%-IN and HAA%-EXP) (both P<0.05), and lower percentage of low-attenuation area on expiratory CT (LAA%-EXP), functional air trapping (fAT) volume, functional small airway disease (fSAD) volume and fSAD volume ratio (all P<0.001). Additionally, pulmonary vascular parameters including No. vessels, No. vessels cross-sectional area (CSA) <5 mm2 at 6, 12 and 24 mm depth from the pleural surface, BV1, BV5, BV10 and total blood volume (TBV) were significantly decreased in CTD-ILD patients (all P<0.001). Multivariate Ridge regression identified age, sex, DLCO%, FEV1%, EXP HAA%, fSAD ratio, and No. vessels_12mm as independent diagnostic predictors associated with the presence of ILD (all P<0.05). The combined diagnostic model achieved an area under the curve (AUC) of 0.963 [95% confidence interval (CI): 0.920-0.998], with an accuracy of 0.893, sensitivity of 0.941 and specificity of 0.818. The calibration curve demonstrated high consistency between predicted probabilities and actual outcomes. QCT can serve as a crucial and highly promising imaging biomarker for the diagnosis and assessment of CTD-ILD.
Many adults with posttraumatic stress disorder (PTSD) related to childhood interpersonal trauma (CIT) face substantial barriers to care and limited access to trauma-specific treatment. We evaluated the efficacy of the Trauma PORTAL (Providing Online tRauma Therapy using an Asynchronous Learning platform), a trauma-focused hybrid therapy integrating self-paced psychoeducational and skills-based modules and virtual therapist-led group sessions, to reduce PTSD symptoms in adults with a history of CIT. This randomised, assessor-masked, controlled, parallel-group trial was conducted at a single site in Ontario, Canada. Participants (≥18 years) with a history of CIT were recruited within an ambulatory urban hospital and met criteria for PTSD based on the Mini-International Neuropsychiatric Interview (MINI). Participants were randomly assigned (1:1) to Trauma PORTAL (intervention; eight online modules and eight optional weekly 1-h virtual group sessions facilitated by two trauma therapists) or treatment as usual (control). The primary outcome was severity of PTSD symptoms assessed at 8 weeks relative to baseline, measured by self-report on the PTSD Checklist for DSM-5 (PCL-5). Outcomes were analysed in the intention-to-treat population using a linear mixed-effects model. Secondary outcomes included clinician-rated PTSD severity using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), emotion regulation, depression, anxiety, stress, and self-compassion. Individuals with lived experience of CIT were involved in the development of the Trauma PORTAL intervention, but not in the design of this trial. The trial was registered with ClinicalTrials.gov (NCT05670405). Between November 7, 2022, and October 6, 2023, 328 participants were screened for eligibility, and of these 183 (56%) provided consent and were enrolled. After 2 were lost to follow-up, 181 participants were randomly assigned to Trauma PORTAL (91 [50%]) or control (90 [50%]). At baseline, 147 (81%) participants were women, mean age was 40.8 years (SD 11.5), and 119 (66%) were White. Trauma PORTAL was superior to control in reducing PTSD symptoms, showing an adjusted mean difference (aMD) on the PCL-5 at week 8 of -7.08 (95% CI -11.55 to -2.61), corresponding to a moderate effect size (d = 0.44 [95% CI 0.12-0.76]). This effect was maintained at week 16 (aMD -7.00, 95% CI -11.83 to -2.18). No adverse events were reported. Trauma PORTAL reduced PTSD symptoms more than treatment as usual, supporting its potential as an effective and acceptable hybrid psychoeducation and skills-based therapy that may help expand access to trauma-focused care for adults with CIT. Further evaluation against established treatments is warranted. This project was supported by the WCHAMSG (Women's College Hospital Alternative Medical Staff Group) Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario, and the Department of Psychiatry, Women's College Hospital.
Medical education curricula may reinforce health inequities and bias, impacting clinical care. Interventions are needed to address these unintended consequences that contribute to health disparities. The Departmental Anti-Racism and Equity (DARE) educational initiative has been shown to improve the health equity-related content of residency educational conferences. This study evaluates the impact of DARE in sustaining equity-related content in medical education overtime. DARE was implemented in an internal medicine residency program's noon conferences in academic year 2021-2022 (AY22). A standardized rubric was used to evaluate lectures with the same topic and speaker pre-intervention (AY21), post-intervention (AY22), and 3 years post-intervention (AY25) to see if rubric scores for each session changed over time. Mean rubric scores across lectures were compared between AYs. The weighted rubric score was used to normalize total rubric scores between -1 and +1 (total score/number of rubric components scored) to account for different number of rubric components between conferences. All lectures with the same topic and speaker in AY21, AY22, and AY25 were evaluated. The weighted rubric score significantly improved from AY21 to AY22 in this subset of conferences (0.07 to 0.34 [+0.27]; P=.002; possible scores -1 to 1). Weighted rubric score remained higher in AY25 compared to AY21 (0.06 to 0.25 [+0.19]; P=.08) but was no longer statistically significant. The decrease in weighted score between AY22 and AY25 was also not statistically significant ([-0.06]; t9=-0.86; P=.41). Improvement in the health equity-related content of medical education curricula appeared to continue but was diminished 3 years after DARE.
Respiratory syncytial virus is the most common virus causing acute respiratory infections in children under 5 years old. We aimed to investigate the prevalence and circulating strains of RSV in hospitalized children in Isfahan. Between January and May 2024, children under 5 years of age were enrolled in this study. Nasal swabs were collected from 100 children with acute respiratory infections admitted to the referral pediatric ward at Imam Hossein Children's Hospital in Isfahan, Iran. The prevalence of circulating RSV was investigated using the RSV qPCR detection kit. The virus type was identified by RT-PCR using type A- and B-specific primers. A total of 51 (51%) samples tested positive for RSV. Among them, typing was done in 33 specimens, of which 66.6% (22/33 cases) were assigned as subtype B and 33.3% (11/33 cases) as subtype A. Infants under 6 months were most severely affected by RSV (47.1%, 24/51). RSV-positive samples peaked in February (43.1%), followed by January (29.4%). The results of the current study revealed a high prevalence of RSV and co-circulation of subtypes A and B, with subtype B more prevalent among children. This highlights the importance of ongoing surveillance of RSV.
Although trauma has been widely documented as a key risk factor for substance use among military personnel, there is a notable paucity of research on the factors that may mitigate trauma-related substance use in this population. The present study examined the moderating role of organizational trust in the relationship between psychological trauma and substance use among military personnel in Nigeria. Using a cross-sectional design, 250 military personnel aged between 26 and 60 years (mean age = 34.99 years, SD = 9.23; males = 187 [74.8%], females = 63 [25.2%]) were conveniently sampled from a military formation in South-eastern Nigeria. Participants completed relevant measures. Results indicated that psychological trauma was positively associated with substance use, whereas, organizational trust had a negative relationship with substance use, and also moderated the relationship between psychological trauma and substance use. Specifically, individuals with higher levels of organizational trust reported fewer issues with substance use due to their trauma, suggesting that the presence of organizational trust mitigated the impact of psychological trauma on the use of substance among military personnel. Thus interventions designed to reduce the negative impacts of psychological trauma should focus on fostering and reinforcing a sense of trust in the military while taking into consideration individual characteristics and experiences of military personnel in order to maximize the effectiveness of the intervention.
Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multi-spot dye-marking technique that utilizes virtual bronchoscopy images to aid in the resection of pulmonary nodules that are difficult to identify intraoperatively. In this study, we compared the long-term oncologic outcomes of VAL-MAP with those of historical computed tomography (CT)-guided percutaneous marking. This retrospective observational study included 213 consecutive patients who underwent curative pulmonary resection from 1998 to 2018 at our institute. Patients who underwent VAL-MAP were compared with those who underwent CT-guided localization. The local recurrence rate and local recurrence-free survival were evaluated. In total, 163 patients underwent sublobar pulmonary resection. Age and surgical procedure were significantly different between the VAL-MAP and CT-guided localization groups. The local recurrence rate was significantly lower in the VAL-MAP group than in the CT-guided localization group [2.9% vs. 11.1% at 5 years; subdistribution hazard ratio (HR) =0.22; 95% confidence interval (CI): 0.06-0.82; P=0.02]. Local recurrence occurred in three patients with metastatic lung tumors and in no patients with primary lung cancer in the VAL-MAP group. Among patients with metastatic lung tumors undergoing sublobar resection, VAL-MAP was associated with a lower local recurrence rate (subdistribution HR =0.23; 95% CI: 0.06-0.92; P=0.03) and higher local recurrence-free survival rate (65.5% vs. 36.4% at 5 years; P=0.04) compared with historical CT-guided localization. VAL-MAP demonstrated favorable long-term outcomes for both local recurrence and local recurrence-free survival compared with CT-guided percutaneous marking.
Non-specific psychological distress is closely associated with the risk of depression. Accordingly, assessing motivation on this distress can provide important information for preventing depression. In this study, we investigated the relationship between motivational state and non-specific psychological distress in participants with a 1-year follow-up. Two hundred and sixty-eight participants (117 men, 15.3-57.7 years, mean age = 23.7 years, SD = 7.8) were publicly recruited and administered a self-reported questionnaire. The 135 of all participants completed a 1-year follow-up. We translated and adapted the Perceived Locus of Causality Questionnaire (PLOCQ) into Japanese to be applicable to motivation for "study" (PLCQ-J-study) and for "most frequently performed activities" (PLCQ-J-time) and used them in the baseline survey. The Kessler 6 (K6), a 6-item scale assessing non-specific psychological distress, was administered in both surveys. In a hierarchical multiple regression analysis, K6 scores at 1-year follow-up were predicted by intrinsic motivation in the PLCQ-J-study (B [SE] = 0.259 [0.103], t = 2.51, p < 0.05), amotivation in the PLCQ-J-time (B [SE] = 0.287 [0.086], t = 3.33, p < 0.01), and K6 score at baseline (B [SE] = 0.436 [0.090], t = 4.83, p < 0.001). We identified the relationship between motivation in multiple domains as well as in non-specific psychological distress. Understanding multiple perspectives on motivation could reveal a new understanding of non-specific psychological distress.
Electronic cigarette (e-cig) use (vaping) has been associated with dysregulation of genes and molecular pathways in epithelial tissues. However, the relative contributions of dose and product characteristics to vaping-associated transcriptomic alterations have not been systematically evaluated. We performed RNA-sequencing of oral epithelial cells from e-cig users (vapers), cigarette smokers, and non-users. Differential gene expression was assessed using covariate-adjusted limma-voom modeling with false discovery rate control. We evaluated the extent to which exposure-specific dose metrics (including cumulative e-liquid, cumulative e-nicotine, years vaped, and plasma cotinine for vaping, and pack-years and plasma cotinine for smoking) explained transcriptional changes. Among vapers, we additionally examined whether device generation and flavor type contributed to variation in gene expression. Both vaping and smoking were associated with transcriptomic dysregulation relative to non-users, with partial overlap in differentially expressed genes (DEGs). Functional enrichment analyses revealed disruption of shared cancer- and signaling pathways, including RHO GTPase Cycle, as well as perturbation of pathways specific to vapers or smokers. Among vapers, 27.6% of DEGs showed concordant behavior across all dose metrics, indicating heterogeneous dose-response patterns for the remaining DEGs. Device generation and flavor type explained additional, largely non-overlapping components of gene expression variability. A much higher proportion of smoking-associated DEGs (54.1%) was consistently affected across dose metrics, reflecting more unified dose-dependent responses. These findings suggest that vaping-associated transcriptional dysregulation reflects combined influences of dose and product characteristics, highlighting structural differences in molecular perturbations between vaping and smoking. Incorporating multidimensional exposure metrics and product features into regulatory evaluation may better capture the biological complexity of e-cig exposure, thus informing clinical, public health practice, and regulatory decisions.
The mortality rate among patients in the intensive care units (ICUs) with severe community-acquired pneumonia (CAP) is high. Identification of severe CAP early in the course and transferring to appropriate setting seem favorable. This study aimed to identify clinical characteristics and the risk factors associated with mortality of severe CAP in the ICU (ICU-CAP). A multi-center, prospective study was conducted at 11 teaching hospitals in China from December 2017 to October 2021. Patients who met the inclusion criteria were assigned to the ICU group and the non-ICU group according to whether they were admitted to the ICU. A total of 170 patients with severe CAP were included, 111 patients were admitted to the ICU and 59 patients were admitted to the ward. Among patients in the ICU, 91.9% of patients were with respiratory failure, 65.8% of patients with consciousness disturbance, 23.4% were in shock state, and 73.0% (81/111) of patients had at least one comorbidity. In-hospital mortality for ICU-CAP was 34.2% (38/111), 28-day mortality was 27.9% (31/111), and 7-day mortality was 10.8% (12/111). Mortality in patients with pneumonia severity index class V (PSI-V) was 40.0% (18/45), mortality in patients with invasive mechanical ventilation was 40.2% (33/82). In the ICU subgroup, invasive mechanical ventilation [odds ratio (OR) =3.35; 95% confidence interval (CI): 1.14-9.81; P=0.02] and age ≥60 years (OR =2.64; 95% CI: 1.07-6.53; P=0.03) were independently associated with in-hospital mortality. In this multicenter prospective cohort, severe CAP patients admitted to the ICU exhibited substantial disease severity, with high rates of treatment failure and mortality. Invasive mechanical ventilation and age ≥60 years were associated with in-hospital mortality in the ICU subgroup.
The clinical features and prognosis of combined small cell lung cancer (C-SCLC) are not well understood. Given the unique histological heterogeneity of C-SCLC, the 8th tumor-node-metastasis (TNM) staging system has limited prognostic accuracy in this population, necessitating a dedicated prediction model. This study aimed to develop and internally validate dynamic nomograms incorporating combined subtypes and serum tumor markers to predict recurrence and survival in patients with resected C-SCLC. A total of 223 patients with resected C-SCLC were enrolled in this study between 2008 and 2021. Eligibility criteria were as follows: surgically resected and pathologically confirmed C-SCLC with complete clinical data. Due to the limited sample size, no training/validation split was performed; internal validation was conducted using 1,000 bootstrap resamples. All serum tumor markers including neuron-specific enolase (NSE) were measured within one week before surgery. Visceral pleural invasion (VPI) and combined histological components were independently reviewed by two professional pathologists. The independent prognostic factors were identified and integrated to build the nomograms for predicting 3- and 5-year disease-free survival (DFS) and overall survival (OS) based on stepwise Cox regression. The discrimination and predictive accuracy of the models were evaluated using the concordance index (C-index) and calibration curves. Decision curve analyses (DCAs) were performed to verify the clinical utility of the model compared with that of the 8th edition of the International Association for the Study of Lung Cancer (IASLC) TNM staging system. Based on the nomogram scores, the C-SCLC patients were divided into high- and low-risk subgroups. An online webserver was applied to facilitate the convenient use of the model. Ultimately, six independent prognostic factors, including tumor location, combined components, VPI, adjuvant chemotherapy, lymph node metastasis, and serum NSE level, were identified and incorporated into the nomograms. The median follow-up duration was 42.6 months. During follow-up, 101 patients developed recurrence or metastasis, and 121 died. The median age of the cohort was 64 years, with a predominance of male patients (89.7%). Among the patients, 27.8% were classified as stage I, and large cell neuroendocrine carcinoma (LCNEC) was the most common combined component (67.3%). The C-index values of the nomograms for predicting DFS [0.730, 95% confidence interval (CI): 0662-0.720] and OS (0.748, 95% CI: 0.682-0.734) were significantly higher than those of the TNM staging system (0.601, 95% CI: 0.574-0.628 and 0.615, 95% CI: 0.586-0.644 for DFS and OS, respectively; P<0.001). The calibration plots indicated good agreement between the model-predicted and observed survival. The DCA results showed that the developed nomograms demonstrated better predictive performance than the TNM staging system. Our internal validation suggests that the nomograms outperform the TNM staging system; however, these findings should be considered as hypothesis-generating. External validation with multicenter cohorts is essential before clinical implementation. The online tool is primarily intended to facilitate further research.
Politicized cyber shaming recodes adolescents' cultural interests as evidence of political loyalty or moral belonging. This study examines how such shaming is associated with longer-term identity tension in adolescence, focusing on public expression, peer belonging, and self-evaluation after politicized online controversy. Data were collected in China in 2023 using an event-anchored retrospective mixed-methods design. The study combines front-end data from Baidu Tieba, a Chinese topic-based online forum, during the 2012 Diaoyu/Senkaku Islands dispute and the 2016 Terminal High Altitude Area Defense (THAAD) controversy, with a retrospective survey of 84 participants exposed as adolescents and timeline interviews with 18 participants. At event exposure, participants were 14-18 years old (M = 16.06, SD = 1.40), and 63.1% were women. The controversy windows showed higher semantic hostility and first-screen nationalist dominance than historical baselines. Adaptation was organised into limited expression, circle contraction, and public silence. Public silence showed the highest long-term identity tension and perceived negative impact, circle contraction was intermediate, and limited expression was lowest. Peer support was associated with lower identity tension overall, behavioural visibility management with higher identity tension, and their interaction indicated joint association with adaptation. Politicized cyber shaming should be understood as an identity-relevant social-evaluative experience in adolescence. Support may reduce isolation, but it does not simply cancel harm when continued participation requires sustained visibility management.