Conectar
by Qingyuan Li, Yousong Yue
ObjectiveTo assess long-term trends in height, weight and body mass index (BMI) among children and adolescents from 2005 to 2020 in Macao Special Administrative Region (SAR), China.
MethodsHeight, weight and BMI data for Macao children and adolescents aged 6–18 years were obtained from the Physical Fitness Reports of Macao SAR Residents in 2005, 2010, 2015, and 2020. Sex-specific two-way analysis of variance was used to estimate the differences in means. The Bonferroni post hoc test was used for multiple comparisons.
ResultsDuring the entire period, the average height, weight and BMI increased by 2.1 cm (95% confidence interval (CI): 1.6 to 2.6 cm), 4.0 kg (95% CI: 3.2 to 4.8 kg), and 1.1 kg/m2 (95% CI: 0.8 to 1.3 kg/m2) for boys and 2.4 cm (95% CI: 1.9 to 2.9 cm), 2.6 kg (95% CI: 1.9 to 3.3 kg), and 0.5 kg/m2 (95% CI: 0.3 to 0.8 kg/m2) for girls, respectively (p Conclusion
There were positive long-term trends in growth among Macao children and adolescents since 2005. Sex differences in changes of weight and BMI over the past five years may be related to the pandemic, and efforts are needed by governments and public health departments.
by Jung-Bin Park, Youmin Shin, Jihun Kim, Yoon Jung Kim, Seung-Bo Lee, Eun-Hee Kim, Joo Whan Kim, Seung-Ki Kim, Hee-Soo Kim, Young-Gon Kim
BackgroundPostoperative cerebrovascular events, including transient ischemic attacks, infarctions, and hemorrhages, remain a significant concern in pediatric patients with Moyamoya disease (MMD)undergoing surgical revascularization. This study aimed to develop an explainable deep learning-based classification model using intraoperative arterial blood pressure (ABP) waveform analysis for postoperative cerebrovascular events in pediatric patients undergoing surgery for MMD, with exploratory analysis of associated waveform-derived physiologic features.
MethodsThis retrospective study included 181 pediatric patients (≤18 years) who underwent revascularization surgery for MMD, with an independent temporal holdout cohort of 79 patients reserved for validation. ABP signals were preprocessed using detrending, pulse segmentation, and normalization, then converted into image representations for deep learning classification. Various convolutional neural network (CNN) models, including ResNet50, ResNet34, DenseNet121, VGG16, and VGG19, were evaluated against Vision Transformer (ViT) architectures. Multiple image transformation methods were tested, and Grad-CAM analysis and statistical comparisons of waveform-derived physiologic features were conducted between patients with and without postoperative cerebrovascular events.
ResultsThe optimal model configuration achieved the best performance using raw pulse waveforms with three consecutive pulses per image. CNN-based models outperformed ViT-based models, with the highest internal classification performance observed using raw pulse waveforms (AUROC = 0.772, SD = 0.070).In the independent temporal validation cohort, the model achieved an AUROC of 0.738 ± 0.011 at the patient level. Grad-CAM visualization highlighted the diastolic runoff phase as a region of interest for classification. Four waveform-derived features related to arterial compliance were significantly associated with postoperative cerebrovascular events (p Conclusions
In this study, CNN-based deep learning models demonstrated the feasibility of predicting postoperative cerebrovascular events from intraoperative ABP waveforms, with diastolic runoff dynamics emerging as a potentially relevant physiologic pattern. These findings are exploratory and require prospective multi-center validation before clinical application.
by Eui Jun Lee, Jae Yun Jung, Do Kyun Kim, Joong Wan Park, Young Ho Kwak
Pediatric emergency triage is a safety-critical task, and recent studies have explored whether artificial intelligence, including language models, can support triage decision-making; however, evidence on fine-tuned open-weight language models remains limited. We conducted a retrospective benchmark study using de-identified triage records from a tertiary pediatric emergency department in Korea collected from January 2020 to April 2025. After exclusions, 74,170 encounters were included. Each encounter was reconstructed into a case-level text sequence from triage-time structured variables and nurse-authored narratives. Qwen3-8B-Base was fine-tuned with Low-Rank Adaptation and Group Relative Policy Optimization using a safety-oriented reward design and was compared with a structured-data XGBoost model on a common evaluable test subset of 14,832 encounters. The fine-tuned model achieved an accuracy of 58.60%, a macro-F1 score of 0.417, and a quadratic weighted kappa of 0.535. Within-one-level agreement was 97.13%, and strict under-triage, defined as true Korean Triage and Acuity Scale levels 1 or 2 predicted as levels 4 or 5, occurred in 0.65% of cases. The structured-data comparator showed higher overall performance, with an accuracy of 69.40%, a macro-F1 score of 0.618, and a quadratic weighted kappa of 0.651. However, the fine-tuned model showed fewer extreme errors and lower strict under-triage in selected high-acuity groups, at the cost of higher over-triage. In this real-world pediatric benchmark, the fine-tuned language model did not surpass the structured-data comparator in overall performance but showed a distinct safety-oriented error profile. These findings support its potential role as a decision-support aid for human triage review rather than an autonomous triage system. External and prospective validation will be necessary before clinical implementation.
by Parya Jangipour Afshar, Vahid Yazdi-Feyzabadi, Zahra Abdolahinia, AliAkbar Haghdoost, Jaason M. Geerts, Reza Goudarzi, Katayoun Tayeri, Babak Eshrati, Hamid Sharifi
BackgroundIntegrating clinical programs and services is a cost-effective approach that can improve health and system outcomes. This review aimed to provide an overview of the benefits and challenges of integrated programs for HIV, hepatitis B and C, and STI services worldwide and provide recommendations for research and practice.
MethodsThis scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched electronic databases PubMed, Scopus, and Web of Science until May 2025 to extract relevant studies. Additionally, we reviewed reputable grey literature sources, such as WHO and UNAIDS, and references from included publications for further relevant articles. Studies that had eligible criteria were included. We applied a narrative approach to report the findings through an inductive approach.
ResultsOut of 19,516 initially identified studies, 118 were selected. The benefits and challenges of integration were classified into six categories: integrated service delivery, medical information and technology, human resources, health outcomes, collaboration and partnerships, and financial/physical resources. The significant benefits of these classifications include improved health outcomes, cost-effectiveness, enhanced efficiency, prevention of transmission, use of comprehensive care, reduction of time for receiving necessary services, increased knowledge and awareness, and improved cooperation. However, integration has some challenges, including the need for sufficient infrastructure, budget, human resources, and the potential for increased stress and work pressure on employees.
ConclusionsPrioritizing health is key to national development, requiring policies and resources for cost-effective patient and community benefits. This scoping review highlights the feasibility and advantages of integrating services for HIV, hepatitis B and C, and STIs. Our findings strongly support policymakers in prioritizing the planning and implementation of these integrated programs. An evidence-informed integration framework is needed to guide these actions effectively.
by Woong Sik Jang, Young Lan Choe, Soo Young Yoon, Chae Seung Lim, Min-Chul Cho
BackgroundCandida auris is an emerging multidrug-resistant yeast associated with invasive infections, healthcare-associated outbreaks, and high mortality, and is often misidentified by conventional diagnostic methods. Rapid, accurate, and scalable screening tools are essential for effective infection control, particularly in high-risk settings.
Materials and methodsWe developed a multiplex loop-mediated isothermal amplification (LAMP) assay that combines a broad-range Candida Pan target with a C. auris–specific target in a single isothermal reaction. Assay conditions were optimized for primer ratio and temperature, and analytical sensitivity was evaluated using serial dilutions of culture-derived C. albicans and C. auris DNA, as well as contrived specimens consisting of urine, swab, and whole-blood matrices. Clinical performance was assessed using 35 Candida-positive clinical specimens (blood, urine, ear swabs) and 94 non-infectious controls. Results were compared with Candida Pan qPCR and C. auris qPCR. Cross-reactivity was tested against common bacterial isolates.
ResultsUnder optimized conditions (1:1 primer ratio, 64 °C), the assay allowed species-level discrimination, with C. auris positive for both Pan and auris channels and C. albicans positive only for the Pan channel. The C. auris-specific LAMP probe detected approximately 10²–10³ cells/mL in culture-derived and contrived specimens, showing a 1–2 log improvement over C. auris qPCR (10⁴–10⁵ cells/mL), while the Pan LAMP channel detected C. auris at around 10⁵ cells/mL. In clinical specimens, Pan LAMP detected Candida spp. in 34/35 cases (97.14%) versus 32/35 (91.14%) for Pan qPCR. All C. auris–positive specimens (9/9) were detected by the multiplex LAMP assay, compared with 6/9 (66.7%) by Pan qPCR. All 94 non-infectious controls and all bacterial isolates tested negative, indicating 100% clinical specificity and absence of cross-reactivity.
ConclusionThe multiplex Candida Pan/auris LAMP assay provides a rapid, highly sensitive, and specific alternative to qPCR for C. auris screening, while preserving broad Candida detection in a single isothermal reaction. Its improved analytical and clinical sensitivity suggests strong potential for use in active surveillance and infection-control programs, particularly in settings where timely identification and containment of C. auris are critical.
by Min Jung Kim, Eun-Gee Park, Changyoung Kim, Dong Yoon Kang, Borim Ryu, Kichul Shin
BackgroundA treat-to-target strategy involving treatment modification improves outcomes in gout, but evidence remains limited regarding the optimal approach when initial urate-lowering therapy (ULT) fails. This study aimed to investigate real-world ULT sequence patterns and evaluate treatment retention based on the initial agent, modification type, and comorbidities.
MethodWe analyzed electronic health record data collected from 2010 to 2022 from the common data model databases of two hospitals. Adults aged 18 years or older diagnosed with gout who initiated ULT and were followed for at least 2 years were included. Outcomes included the frequency and sequence of ULT prescriptions. Treatment modification, defined as switching to another ULT or adding an additional agent, was considered the end of retention for the previous regimen. Subgroup analyses were performed based on comorbidity.
ResultsAmong 2220 patients, febuxostat was the most common first-line agent (51.4%), with 90.9% maintaining therapy. Among those who modified febuxostat therapy, switchers and add-on users continued treatment similarly (91.5% vs. 86.8%, P = 0.33). Of allopurinol initiators, 55.8% changed therapy, mainly switching to febuxostat or benzbromarone rather than adding another agent (51.4% vs. 4.1%, P vs. 86.8%, P = 0.33). Among benzbromarone initiators, 57.2% changed therapy (switchers, 56.7%; add-on users, 0.5%; P P = 1.00). Chronic kidney disease was associated with low variability in ULT sequence.
ConclusionsULT demonstrated durable retention when used as first- or second-line treatment, with switching being more common than add-on therapy and maintaining similar retention rates.
by Hongjun Park, Beechui Koo, Jungwook Shin, Byoung Hyuck Kim, James J. Sohn
Approximately one-third of US adults have tattoos, yet the dosimetric impact of intradermal tattoo pigments during radiation therapy remains uncharacterized. Commercial tattoo inks contain unregulated metallic impurities including chromium, lead, and nickel, raising concerns about dose perturbations in tattooed skin. This work quantifies radiation dose perturbations induced by high-atomic-number (Z) tattoo pigments under clinically relevant radiotherapy conditions. Monte Carlo simulations (TOPAS) modeled layered skin phantoms with a 0.3-mm intradermal tattoo layer embedded at 1.25–1.55 mm depth. Three commercial inks were evaluated: carbon-based (black) and metal-containing (Fe-rich brown, Al-containing orange) at pigment loadings of 5–100 vol% within the tattoo layer, to establish upper-bound effects. Electron (6, 18 MeV) and photon (6, 18 MV) beams were simulated with standard clinical geometry (1 × 1 cm² field, SSD = 100 cm). Photon irradiation produced pronounced, depth-localized dose enhancement, with peak dose enhancement factor (DEF) reaching 2.5 for brown ink at 18 MV, a 62% mean increase relative to non-tattooed skin driven by high-Z–mediated secondary electron production. Electron beams exhibited energy-dependent behavior: 6 MeV produced modest enhancement (peak DEF ~ 1.07), while 18 MeV unexpectedly generated dose deficits (DEF
by Hyun Ju Kim, Kyung-Ah Cho, So-Youn Woo
Skin inflammation arises from complex interactions among immune cells, particularly T cells and neutrophils. Mesenchymal stem cells (MSCs) exhibit potent immunomodulatory properties, but the specific roles of tonsil-derived MSCs (T-MSCs) in regulating neutrophil extracellular trap (NET) formation and cell death, as well as T cell migration in inflammatory skin conditions, remain poorly defined. In this study, the therapeutic effects and mechanisms of T-MSCs were investigated in a 2,4-dinitrochlorobenzene (DNCB)-induced skin inflammation model, with a focus on NET formation and T cell migration. T-MSCs were intravenously administered to mice with DNCB-induced skin inflammation; inflammation severity and immune cell dynamics were evaluated using histological analysis, flow cytometry, immunostaining, microarray profiling, NET assays, and T cell migration assays. T-MSC treatment reduced DNCB-induced skin inflammation, as demonstrated by decreased epidermal thickness and neutrophil infiltration. Although T-MSCs enhanced NET formation in vitro, they suppressed neutrophil accumulation in vivo. T-MSCs also modulated the distribution and activation of T cell subsets in the skin and secondary lymphoid organs. Gene expression profiling revealed that T-MSCs regulated pathways associated with inflammation and neutrophil activity, including those involved in immune cell trafficking and NET formation. Moreover, T-MSCs promoted T cell migration, although this effect was influenced by neutrophil presence, indicating complex interplay among immune cells. These findings demonstrate that T-MSCs exert anti-inflammatory effects in DNCB-induced skin inflammation by modulating NET formation and T cell migration, revealing a novel immunoregulatory mechanism and supporting their therapeutic potential for inflammatory skin diseases.
by Anas Ismail, Moatasem Salah, Mads Gilbert, Yousef H. Abu Alreesh, Craig Jones
BackgroundGaza has faced numerous military attacks that resulted in mass casualty incidents (MCIs). The ongoing genocide in Gaza has destroyed much of the health system, including killing and injuring of hundreds of health care workers (HCWs). Current thinking on the health system reconstruction lacks empirical data and local HCWs’ perspectives. The study analyses locally driven innovations and lessons learned by HCWs who responded to MCIs between 2018 and 2021 to guide current and future planning of the reconstruction of the health system in Gaza.
MethodsThis was a qualitative study using online and face-to-face interviews with HCWs who responded to the Great March of Return and the 2021 Israeli military attacks. Transcripts and extensive notes from the interviews were recorded and analyzed on NVivo using thematic content analysis. We used the health system building blocks as themes for deductive analysis with a seventh place-based theme (Gaza-specific) to account for the context of Gaza and the MCIs.
ResultsProblems faced by HCWs mostly related to the nature and complexity of traumatic injuries, shortages in HCWs, particularly specialist doctors, poor coordination among actors, duplication of services, and shortages of supplies and equipment. Locally driven innovations and solutions included establishing new services centers, opening and expanding training programs, starting new coordination bodies, and task shifting of staff and facilities. Lessons learned included strengthening training and employment opportunities for staff, enhancing emergency preparedness and capacities, maintaining coordination bodies, enhancing community engagement and strengthening the governance of the Ministry of Health.
ConclusionReconstruction of Gaza’s health system needs to be grounded in its political context and in the experiences of HCWs who have worked in and managed the system. Locally driven solutions and lessons learned can ensure that reconstruction serves as a vehicle for self-determination and sovereignty, rather than entrenching dependency.
by Chanseo Lee, Jaihyoung Lee, Kimon-Aristotelis Vogt, Muhammad Munshi
BackgroundAccurate intraoperative detection of nociceptive events is essential for optimizing analgesic administration and improving postoperative outcomes. Although deep learning approaches promise improved modeling of complex physiologic dynamics, their added computational and operational complexity may not translate into clinically meaningful benefit, particularly in small, high-resolution perioperative datasets.
MethodsWe performed a head-to-head evaluation of classical supervised models (L1-regularized logistic regression and 50-, 200-tree Random Forests, with and without drug dosing features) against a Temporal Convolutional Network (TCN) transfer-learning framework for intraoperative nociception detection. Using 101 adult surgical cases with 30 physiologic and 18 drug dosing features sampled in 5-second windows, models were assessed under leave-one-surgery-out cross-validation using AUROC and AUPRC. We further examined probability calibration, multiple ensemble strategies, permutation importance features, and computational cost in terms of inference operations and memory footprint.
ResultsDrug-aware Random Forests of various trees (50 trees vs. 200 trees) achieved the highest discrimination (AUROC 0.716; AUPRC 0.399), outperforming the TCN transfer-learning model (AUROC 0.649; AUPRC 0.311). However, increasing personalization windows in the TCN yielded inconsistent and modest gains (p > 0.05). Isotonic calibration substantially improved probability calibration but did not affect discrimination. No ensemble method surpassed the standalone Random Forest; the gated network consistently assigned >84% weight to the classical model. Computational analysis revealed that while the TCN was more compact in total memory footprint, the smaller, 50-tree Random Forest inference required two orders of magnitude fewer operations, with faster training and lower operational complexity.
ConclusionsIn this clinically realistic benchmark, interpretable classical models operating on well-engineered features without personalization matched or exceeded the performance of a personalized deep learning approach while remaining computationally cheaper and simpler to deploy. These findings underscore the importance of rigorously justifying model complexity in perioperative machine learning and suggest that, for intraoperative nociception monitoring, classical approaches may offer a more favorable balance of accuracy, interpretability, and operational efficiency.
by Riham M. Hamadouk, Esra D. Albashair, Einass M. Alshareif, Ali Awadallah Saeed, Bashir A. Yousef
BackgroundToday, community pharmacists’ responsibilities have expanded beyond the traditional role to include the management of minor ailments. Acute uncomplicated cystitis is one of the most prevalent medical conditions seen in primary healthcare and can be managed by community pharmacists (CPs).
ObjectivesTo evaluate community pharmacists’ history-taking practice when responding to patients with acute uncomplicated cystitis.
MethodsA cross-sectional simulated patient study was conducted from November 2022 to January 2023 in Khartoum locality targeting only pharmacists. Six trained female students played the simulation in which they pretended to have the clinical symptoms of acute uncomplicated cystitis and requested treatment for their condition. The Interactions during the simulation were documented immediately in a data collection form after each visit. Descriptive statistics were used to report the study outcomes.
ResultsA total of 238 community pharmacies were visited. The majority of the pharmacists were female. The mean of the number of questions that were asked by the pharmacists was 1 (SD = 1.6) questions. Among the studied pharmacists, 45.4% asked at least one question during patient assessment. The most asked question was if the patient has a fever, representing 61 (25.6%) CPs, followed by if there is vaginal discharge, representing 38 (16%) CPs. In response to scenario 47 (19.7%) CPs decided to refer the patient to a physician, and 45 (18.9%) of the CPs advised the patient to increase water intake.
ConclusionsThe study has revealed a poor history-taking practice towards acute uncomplicated cystitis during patient assessment. Further studies exploring pharmacists’ involvement in patient assessment are required. Strategies to improve community pharmacists’ practice, like continuing pharmacy education and providing a national guideline regarding patient assessment should be considered seriously.
by Boyoung Jeon, Boyoung Jung, Yun-Kyung Song
BackgroundMusculoskeletal surgery imposes extended recovery periods and significant financial burdens that can undermine individual and system-level health security. Patients undergoing musculoskeletal surgery often face prolonged recovery and substantial post-discharge costs, yet longitudinal evidence on their healthcare use remains limited.
MethodsThis study quantified two-year post-discharge utilization and identified predictors of high expenditure among Korean musculoskeletal surgery patients. A retrospective cohort was constructed from the 2019–2021 Korea Health Panel. Adults (n = 182) hospitalized for spinal, knee, shoulder or other musculoskeletal disorders between July 2019 and June 2020 were followed for 24 months. Outcomes were total healthcare expenditure (log-transformed) and in the top 25% cost group (“high-expenditure”) in the second post-discharge year.
ResultsAmong 182 adults hospitalized for musculoskeletal surgery, first-year post-discharge spending averaged US $848 but fell to US $487 in the second year. Readmission fell from 19.2% to 7.1%, and Western-medicine outpatient visits declined from 18.3 ± 25.9 to 13.6 ± 22.9 per person. By contrast, Traditional Korean Medicine (TKM) visits rose from 2.3 ± 6.5 to 3.3 ± 10.0. In multivariable models, metropolitan residence, obesity, additional chronic conditions, and heavier first-year inpatient and outpatient use independently predicted higher second-year costs. Lower household income was associated with lower spending. Index diagnoses were pivotal: spinal disorders and shoulder disorders markedly increased the odds of falling into the top-cost quartile. Among the first-year TKM, frequent chuna/manual therapy sessions were marginally associated with higher costs, suggesting these rehabilitative modalities may serve as proxies for underlying health complexity during the stabilization phase.
ConclusionsSpinal and shoulder disorders, metropolitan residence, obesity, multimorbidity, heavy inpatient and outpatient use during the first post-discharge year, and frequent TKM sessions, albeit marginally, jointly predicted the highest second-year expenditures. These findings highlight the value of early risk stratification and tightly coordinated Western-and-traditional care pathways that facilitate the shift from structural repair to functional restoration. From a policy perspective, these results suggest the need for integrated post-discharge care models and targeted financial support strategies to reduce avoidable costs and enhance equity in musculoskeletal rehabilitation.
by Hongfei Yang, Chao Sun, Ya Li, You Zhou, Rui Wang, Yingxue Li
ObjectiveThe triglyceride-glucose index and estimated glucose disposal rate serve as notable surrogate markers of insulin resistance, demonstrating established links to cardio-cerebrovascular disease. However, their combined prognostic value in predicting cardio-cerebrovascular disease outcomes remains unexplored. The current investigation examined the interaction between the TyG (triglyceride–glucose index) index and eGDR (estimated glucose disposal rate) concerning the danger of cardiovascular disease within a clinical population.
MethodsThis investigation employed data sourced from the China Health and Retirement Longitudinal Study (CHARLS). The median TyG index and eGDR scores were used to stratify the participants into 4 categories: low TyG/high eGDR, high TyG/high eGDR, low TyG/low eGDR, and high TyG/low eGDR. Clinical characteristics across groups were systematically compared. Cox proportional hazards regression models evaluated the distinct and interconnected associations of the TyG index and eGDR with the risk of cardio-cerebrovascular disease, with multiplicative and additive interaction effects subsequently assessed through formal interaction analysis.
ResultsThe final study cohort comprised 7,330 participants, with 1,336 individuals (18.2%) developing cardio-cerebrovascular disease during the 9-year follow-up. Stratification using median thresholds (TyG: 8.59; eGDR: 10.55 mg/kg/min) yielded four groups: low TyG/high eGDR (n = 2,991), high TyG/high eGDR (n = 1,375), low TyG/low eGDR (n = 1,372), and high TyG/low eGDR (n = 2,292). Multivariable-adjusted Cox regression analyses revealed markedly increased risks of cardio-cerebrovascular disease among the various exposure groups when contrasted with the low TyG/high eGDR reference: high TyG/high eGDR (HR: 1.31, 95%CI: 1.10–1.57, ppp Conclusion
The TyG index and eGDR demonstrate independent associations with cardio-cerebrovascular disease risk, while their combined assessment reveals synergistic predictive capacity. Combined assessment of the two allows for further accurate stratification of the population based on insulin resistance and improved prediction of cardio-cerebrovascular disease.
by Farhan R. Chowdhury, M. Ismail Hossain, Tangerul A. Jepu, Nusrat U. A. Saleh, Fatema T. Zohora, Tasmim A. Saleh, Mrinmoy Sarker, Al Numan, Zainab Yousuf, M. Aftab Uddin, Muktadir S. Hossain
Pneumococcal diseases caused by the human pathogenic bacterium Streptococcus pneumoniae are a major public health concern worldwide. In this study, we examined the pathogenicity of a clinical isolate of S. pneumoniae in the silk moth, Bombyx mori, larvae infection model. The whole genome sequencing of a clinical isolate of S. pneumoniae, Spn1 identified the presence of genes responsible for its virulence and antibiotic resistance. Spn1 infection of Bombyx larvae resulted in death within 24 h concomitant with an increase of phenoloxidase activity in the hemolymph. The bacterial load increased in the hemolymph within 9 h post-infection (p.i.) Ampicillin, ceftriaxone, tetracycline, imipenem, and erythromycin showed therapeutic effect in infected larvae, although the bacterial strain was resistant to erythromycin in vitro. The Bombyx homologs of mammalian TLR2 and TLR4, known as BmToll2 and BmToll9 (BmToll9−1 and BmToll9−2 isoforms), were upregulated in both the fat body and trachea. The antimicrobial peptide (AMP) genes, BmdefensinA and BmdefensinB, known to be regulated by the Toll signaling pathway, were significantly upregulated in both fat body and trachea after S. pneumoniae infection through hemolymph. Our data indicate that the Bombyx larvae can be a suitable infection model to study the pathogenicity of S. pneumoniae.
by Elizabeth Youens, Dan G. O’Neill, Zoe Belshaw, Johanna Neufuss, Mickey S. Tivers, Rowena M. A. Packer
Extreme conformation and reduced genetic diversity are recognised to lead to severely reduced health, welfare and longevity in certain dog breeds. There is growing interest in applying strategic crossbreeding to promote more moderate conformations and greater genetic diversity within currently problematic breeds. Crossbreeding could therefore lead to more rapid and effective improvements in welfare compared to current practices of within-breed selection. Deliberate crossbreeding between distinct different dog breeds is not a new concept; it was historically commonly used to create the current pure breeds, to increase genetic diversity and to bring new physical and/or temperament traits into existing breeds. However, a recent surge in the popularity of ‘designer crossbreeds’ (intentional crosses between established purebreds) has elicited fresh interest around the potential positives and negatives of crossbreeding practices. Further research on crossbred brachycephalic dogs is urgently required for a greater understanding of the motivators and barriers to their acquisition. An online survey explored factors that motivate dog breed choice and acquisition of both crossbreed and purebred dogs. In addition, the survey used both closed and open questioning to explore the UK public’s perceptions of crossbreeding, specifically (i) between a brachycephalic breed and a non-brachycephalic breed, and (ii) between two non-brachycephalic breeds. Free-text results were analysed using content analysis and subsequently quantified. Results from 4,899 participants identified that key motivators to acquire a brachycephalic crossbreed vs a brachycephalic purebred included perceptions of improved health, including the reduction in risk of breed and conformation-related disorders, and increased genetic diversity. However, the desire to acquire a purebred dog, or even a specific breed, remained a significant barrier to crossbreed acquisition, alongside concerns surrounding the ethics of crossbreeding. Other barriers included perceived negative changes to appearance and temperament of the offspring from crossbreeding. The current study identified a common set of acquisition decision-making factors across all ownership groups, including desiring a dog who the owner perceives to enjoy being loved and to enjoy physical affection, but further demonstrated that good health is of motivational low priority to some dog owners, particularly to owners of purebred brachycephalic dogs. The mix of positive and negative public perceptions and beliefs around crossbreeding and crossbreed dogs demonstrate the need for further research into the health, temperament and appearance of brachycephalic crossbreed dogs. The suitability of crossbreed dogs as an alternative to certain current purebred breeds with high risk of genetic or conformational disorders depends on both public desire and on evidence-based selection of suitable breeds to encourage crosses which maximise canine welfare.
by Jessica Liu, Sameer Pandya, Andreas Coppi, H. Patrick Young, Harlan M. Krumholz, Wade L. Schulz, Guannan Gong
BackgroundNear real-time electronic health record (EHR) data offers significant potential for secondary use in research, operations, and clinical care, yet challenges remain in ensuring data quality and stability. While prior studies have assessed retrospective EHR datasets, few have systematically examined the integrity of real-time data for research readiness.
MethodsWe developed an automated benchmarking pipeline to evaluate the stability and completeness of real-time EHR data from the Yale New Haven Health clinical data warehouse, transformed into the OMOP common data model. Twenty-nine weekly snapshots of the EHR collected from July to November 2024 and twenty-two daily snapshots collected from April to May 2025 were analyzed. Benchmarks focused on (1) clinical actions such as patient additions, deletions, and merges; (2) changes in demographic variables (date of birth, gender, race, ethnicity); and (3) stability of discharge information (time and status). A synthetic dataset derived from MIMIC-III was used to validate the benchmarking code prior to large-scale analyses.
ResultsBenchmarking revealed frequent updates due to clinical actions and demographic corrections across consecutive snapshots. Demographic changes were most frequently related to race and ethnicity, highlighting potential workflow and data entry inconsistencies. Discharge time and status values demonstrated instability for several days post-encounter, typically reaching a stable state within 4–7 days. These findings indicate that while near real-time EHR data provide valuable insights, the timing of data stabilization is critical for accurate secondary use.
ConclusionsThis study demonstrates the feasibility of automated benchmarking to assess the integrity of real-time EHR data and identify when such data become analysis ready. Our findings highlight key challenges for secondary use of dynamic clinical data and provide an automated framework that can be applied across health systems to support high-quality research, surveillance, and clinical trial readiness.
by Eneida Yuri Suda, Cristina Dallemole Sartor, Anice de Campos Passaro, Ricky Watari, Eunice Young Docko, Isabel C. N. Sacco
BackgroundThis study aimed to identify the predictive effects of different aspects of diabetic peripheral neuropathy (DPN) and other already known risk factors for falls through a comprehensive logistic model within community-dwelling older adults with diabetes and DPN. This paper also provides a model that estimates the probability of a fall occurring in a real-world clinical scenario.
MethodsThis cross-sectional retrospective study analyzed data from subjects that had never fallen (non-fallers, n = 534) and that had fallen at least twice in the previous year (fallers, n = 101). The logistic regression analysis was performed on a training sample randomly extracted from the original sample (non-fallers: n = 85; fallers: n = 81). The model was validated by checking the performance parameters using a test sample comprised of 10% of fallers (n = 16) and a proportionate subsample of non-fallers (n = 85) from the original dataset.
ResultsThree predictive models were developed. The best model (0.762 receiver operating characteristic[ROC] curve area, 60.4% accuracy, 68.8% sensitivity, 58.8% specificity) identified age (odds ratio[OR]=1.06[95%CI: 1.02, 1.10], P = 0.002), Michigan Neuropathy Screening Instrument score (OR=1.23[95%CI: 1.08, 1.40], P = 0.001), and self-reported balance problems (OR=2.65[95%CI: 1.29, 5.45], P = 0.008) as predictors of falls. A second model with good performance parameters (0.750 ROC curve area, 62.4% accuracy, 62.5% sensitivity, 62.4% specificity) showed that age (OR=1.04[95%CI: 1.01, 1.07], P = 0.015), balance problems (OR=3.29[95%CI: 1.64, 6.59], P = 0.001), and DPN severity (OR=1.18[95%CI: 1.03, 1.34], P = 0.018) were predictors of falls.
ConclusionsWe showed the potential of a predictive model for recurrent falls based on commonly evaluated variables in community-dwelling individuals with diabetes for use in clinical practice. Even for individuals who are not at a high risk for falls, it is crucial to assess the combination of DPN signs, symptoms, and severity and the perception of balance problems, as these are more relevant in people with diabetes than the traditional physical impairments associated to aging.
by Osman Yimer Mohammed, Kerstin Erlandsson, Tewodros Seyoum, Solomon Hailemeskel, Lemma Derseh, Helena Lindgren
BackgroundWork-related musculoskeletal disorder is a limiting, painful condition that affects the muscular, skeletal, articular, and nervous tissues of the body. The condition is mainly associated with poor working conditions and awkward body positions. Health professionals, including midwives, are among the most affected workforce globally. The condition affects the health of the professionals and the quality of care that professionals are expected to provide. However, there is a scarcity of information on the magnitude of the condition, its effect on midwifery practice, and associated factors. Objectives: This study aimed to assess the magnitude of work-related musculoskeletal disorder, its effect on midwifery practice, and associated factors among midwives in North Shoa Zone, Amhara Regional State, Ethiopia.
MethodAn institution-based cross-sectional study assessed the magnitude of work-related musculoskeletal disorder (WRMSD), the effect on midwifery practice, and associated factors. The Nordic Musculoskeletal Disorder Scale was used to assess the presence of WRMSDs in the nine regional body parts and its effect. A stepwise backward elimination logistic regression model was used, and significant association was declared at a p-value of less than 0.05.
ResultsA total of 473 (252 (53.3%) female and 221 (46.7%) male) midwives participated in this study. Overall, in the last 12 months, 355 (75.05%, 95% CI: 71.15% − 78.95%) midwives were affected by WRMSD, which was seen in any one of the nine regional body parts. About 45% (162) of them reported being unable to perform their daily tasks while they were affected, and 27% (96) of them sought treatment for their condition. The lower back was the most affected axial body part, reported by 300 (63.4%, 95% CI: 59% − 68%) midwives. Working in awkward or uncomfortable positions was significantly associated with the development of WRMSD (AOR: 1.81, 95% CI: 1.15–2.87). Similarly, awkward positions significantly affected the development of area-specific WRMSD in the lower back, upper back, neck, and limbs. Working in the same position for a longer time, seeing clients daily, and moving heavy objects were among the risk factors associated with developing area-specific WRMSD among midwives.
ConclusionThe magnitude of work-related musculoskeletal disorders is high among midwives, and a significant number of them were unable to perform their daily tasks. The lower and upper back are the most commonly affected areas. Working in uncomfortable positions and attending to large clients daily were common risk factors. Therefore, training midwives about safe working positions and reducing the workload is commendable.
by Yun-Jin Hwang, So-Young Park, Jung-Hyun Park, Du-Hyong Cho
Vascular smooth muscle cells (VSMCs) plays an important role in maintaining vascular function by responding to various vasoactive stimuli within blood vessels. Far-infrared (FIR) rays has been shown to possess a variety of physiological effects including vasodilation, while the underlying molecular mechanism remains elusive. Here, we explored the molecular mechanism by which FIR irradiation suppresses vascular contraction using rat VSMCs and aortas. FIR irradiation enhanced the transport of intracellular Ca2+ from the cytosol to the sarcoendoplasmic reticulum (SER) via activation of sarcoendoplasmic reticulum Ca2+-ATPase (SERCA), which accompanied a decrease in intracellular ATP levels. Pretreatment with thapsigargin (TG), a specific SERCA inhibitor, or knockdown of SERCA2 gene expression reversed FIR irradiation-induced translocation of Ca2+ into the SER. Notably, FIR irradiation promoted the dissociation of SERCA2 and phospholamban (PLN), an endogenous SERCA inhibitor, without altering their total protein expression levels. The array of effects elicited by FIR irradiation was not observed under hyperthermic conditions (39°C). Moreover, FIR irradiation, but not hyperthermal condition, decreased the phosphorylation of myosin light chain (MLC) at Ser19, which was restored by pretreatment with TG or the knockdown of SERCA2 gene expression. FIR irradiation attenuated phenylephrine-induced vessel contraction in endothelium-deprived rat aortas. Consistent with the in vitro results, the reduction in MLC phosphorylation caused by FIR irradiation was reversed following pretreatment with TG in isolated aortas. Additionally, FIR irradiation increased blood flow in the carotid arteries of mice. Collectively, these results suggest that FIR irradiation activates SERCA2 by promoting its dissociation from PLN, independent of hyperthermic effects. This activation lowers cytosolic Ca²⁺ and ATP levels, reducing MLC phosphorylation and vascular smooth muscle contraction. These findings provide scientific evidence for the therapeutic potential of FIR therapy in the treatment and prevention of arterial narrowing conditions such as pathological vasospasm, and peripheral artery disease.
by Jin-Hwa Kim, Ji-Soo Jeong, Jeong-Won Kim, Eun-Hye Chung, Su-Ha Lee, Je-Won Ko, Youn-Hwan Hwang, Tae-Won Kim
Moutan Cortex (MC), the dried root bark of Paeonia suffruticosa, is used in traditional Chinese and Korean medicine to treat enteritis for its anti-inflammatory properties. This study compared the pharmacokinetic (PK) profiles of paeonol and paeoniflorin in normal and dinitrobenzene sulfonic acid (DNBS)-induced colitis rats, and to determine how repeated low-dose MC [MC(L), 0.5 g/kg] or high-dose MC [MC(H), 2.5 g/kg] alters PK and disease severity. Using ultra-performance liquid chromatography–tandem mass spectrometry, we found that DNBS modestly increased paeonol AUClast (NC: 247.8 ± 63.7 vs DNBS: 337.0 ± 120.8 hr*ng/mL) and decreased paeoniflorin (NC: 474.1 ± 11.7 vs DNBS: 463.7 ± 106.8 hr*ng/mL) compared to controls (ns). After repeated dosing, the maximum plasma concentration (Cmax) of paeonol was higher in the MC(H) than that in the MC(L) group (MC(L): 63.81 ± 29.74 vs MC(H): 4221.5 ± 1579.2 ng/mL, p max in the MC(H) group was also higher than MC(L) group (MC(L): 60.5 ± 15.3 vs MC(H): 164.7 ± 74.7 ng/mL, p
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