Browse Articles

Prevalence of HIV infection and uptake of HIV/AIDs services among fishermen on the shores of Lake Victoria in Kagera region, Northwestern Tanzania

Introduction The Tanzania HIV Impact Survey (THIS) 2022–2023 showed that HIV prevalence among the general population stabilises but varies geographically across the country. Despite this, disproportionate burdens of HIV continue among specific subpopulations, such as fishermen. Fishermen are particularly vulnerable to HIV infection and have a low uptake of HIV prevention and treatment services. This study aimed to understand the prevalence of HIV infection, uptake of HIV/AIDs services, and associated risk factors of HIV Infection among fishermen residing along the shores of Lake Victoria in the Kagera region, Tanzania, in 2024. Methods A cross-sectional study among fishermen was employed from February to April 2024, using convenient sampling of 10 beach management units (BMUs) to obtain a robust sample of fishermen aged ≥15 years in Kagera. Participants were randomly selected across BMUs. Information was collected using an interviewer-administered questionnaire, and HIV testing was offered on-site according to national testing guidelines. Multivariable logistic regression was used to determine factors associated with HIV infection, adjusted for potential confounders. Results A total of 774 fishermen with a median age of 31 years (interquartile range: 25–38 years) were recruited. The study found an HIV prevalence of 11.3% (95% CI: 9.2–13.8). HIV prevalence varied across selected districts: 12.7% in Muleba District, 10.1% in Bukoba Rural District, and 8.6% in Bukoba Urban District. The HIV prevalence was highest among fishermen aged 20–24 years (14.7% (95% CI: 9.7–21.5). The majority, 60.9% (95% CI: 57.4–64.2), had tested for HIV in the past 12 months. Of those living with HIV, 77.6% (95% CI: 67.3–85.9) self-reported using anti-retroviral therapy. In adjusted analysis, using alcohol before sex (aOR = 2.32, 95 CI: 1.42–3.80), not testing for HIV in the last 12 months (aOR = 4.69, 95% CI: 2.79–7.88), and not using condoms (aOR = 1.94, 95% CI: 1.13–3.27) were significantly associated with HIV infection among fishermen. Conclusion HIV prevalence among fishermen was nearly twice as high as in the general population in Kagera. HIV programming should be strengthened to reduce new HIV infections. Hotspot mapping to expand HIV prevention and treatment services is pivotal for controlling the HIV epidemic.

Correction: Pregnant women with mild COVID-19 followed in community setting by telemedicine, and factors associated with unfavorable outcome

The relationship between vitamin A and myopia: A population-based study

Purpose We sought to evaluate the relationship between blood vitamin A levels and myopia in adults aged ≥20 years in Korea. Methods We collected data of 15,899 participants aged ≥20 years from the Korean National Health and Nutrition Examination Survey. Participants underwent refraction tests to identify myopia and high myopia, and their blood pressure and obesity levels were measured. Blood tests were conducted to assess vitamin A, fasting blood glucose, triglyceride, and total cholesterol levels. Blood vitamin A levels were classified into quartiles. Results After adjusting for confounding variables like age, sex, income, education, hypertension, diabetes, and obesity, the odds ratio (OR) of blood vitamin A in the second quartile for myopia was 0.66, while the OR in the fourth quartile was 0.74 (P for trend < 0.001). Among women, the ORs for myopia in the second and third quartiles of blood vitamin A levels were 0.48 (95% confidence interval [CI], 0.35–0.66) and 0.67 (95% CI, 0.49–0.90), respectively (P for trend < 0.001). In men, the ORs for high myopia in the second, third, and fourth quartiles of blood vitamin A levels were 0.05 (95% CI, 0.004–0.58), 0.15 (95% CI, 0.024–0.91), and 0.05 (95% CI, 0.008–0.364), respectively (P for trend < 0.001). Conclusion An inverse relationship was observed between higher blood vitamin A levels and the prevalence of myopia. Notably, higher blood vitamin A levels were associated with a lower prevalence of high myopia in men and a lower prevalence of myopia in women.

Is there a risk of developmental problems in infants born to mothers with gestational diabetes mellitus and/or pre-eclampsia?

Objective The aims of this study were (i) to describe the early spontaneous movements in 3-to 5-month-old infants in groups of infants born to mothers with GDM and/or PE, (ii) to compare them, and (iii) to analyze the differences between infants with these risk factors and typically developing infants born to mothers without GDM and/or PE and other risk factors. Methods This cohort study included 255 infants in 4 groups: (i) 96 infants born to mothers with GDM, (ii) 78 infants born to mothers with PE, (iii) 31 infants born to mothers with GDM and PE, and (iv) 50 typically developing infants. Early spontaneous movements, including not only fidgety movements but also concurrent movement and postural patterns, were assessed using the General Movements Assessment (GMA), which determines the Motor Optimality Score-Revised (MOS-R). Comparisons were made using one-way ANOVA for normally distributed continuous variables, Kruskal-Wallis test for non-normally distributed data, and Pearson chi-squared for categorical variables. Univariate logistic regression analyses were used to determine the odds ratios (OR) with 95% confidence intervals (CI). Results There were no differences between the three groups, which included infants whose mothers had at least one of these risk factors (p>0.05). Infants born to mothers with GDM, infants born to mothers with PE, and infants born to mothers with both GDM and PE had more aberrant fidgety movements, reduced age-adequate movement repertoire, and more abnormal postural patterns than typically developing infants (p<0.05), in addition to lower MOS-R. When looking at those with ≤24 in MOS-R, the odds ratios were ≥2.74. Conclusion Findings suggest that early spontaneous movements, GMA, may play a crucial role in understanding developmental outcomes of these infants and in determining infants who need early intervention.

Evidence of human exposure and associated risk factors to Rift Valley fever in selected districts of Central and Western Zambia

Rift Valley fever (RVF) is an important viral zoonotic disease that not only affects ruminants but causes serious morbidity and mortality in humans. In humans, its symptoms range from mild flu-like signs to a severe form such as retinal damage, meningoencephalitis to haemorrhagic fever. In this study, 202 human serum samples were collected from central and western parts of Zambia and tested for RVF-specific antibodies using a commercially available ELISA kit. A pre-tested semi-structured questionnaire was used to collect data for determining hypothesised risk factors for exposure to RVF. The participants enrolled in this study, were only those who are at high risk of RVF infection and were in close contact with animals and animal products. The study revealed an overall seropositivity of 9.90%, occupationally distributed as 16.67% among slaughter house workers, 14.41% among livestock farmers, and 0% among the others (i.e., students, butchery, and farm workers). The prevalence was highest (19.23%) in Sesheke district found in the western part of Zambia, while Chisamba district in central Zambia had the lowest prevalence (1.41). Movement of animals in search of greener pastures was identified as a risk factor to being RVF-seropositive. This suggests that there was silent circulation of the virus in the interepidemic period in the study areas. Therefore, this study recommends that public education of livestock farmers, public health workers, slaughterhouse workers, communities, livestock and veterinary staff needs to be enhanced to increase awareness and preparedness for RVF outbreak in Zambia.

Knowledge, attitudes, and practices (KAP) of animal health staff and farmers towards brucellosis control in sheep and goat in China: A cross-sectional study

Background In China, brucellosis has resurfaced recently with a discernible spatial distribution, particularly affecting dairy herds and small ruminant populations. However, limited dissemination of knowledge, attitudes, and practices (KAP) for brucellosis control exists among farmers and animal health staff. This study aimed to assess the KAP of brucellosis control and prevention in animal health staff and farmers, with the goal of educating the public regarding the application of efficient brucellosis control and prevention strategies. Methods We conducted a cross-sectional survey involving 1,468 participants, comprising farmers (n = 1,067) and animal health staff (n = 401) based on their significant density of sheep and goat population. They completed a questionnaire targeting a specific group of farmers and animal health staff through face-to-face interviews. The KAP scores were then categorized as either satisfactory or unsatisfactory based on a cutoff set at ≥80% of the total score for satisfactory. Binary logistic regression was used to identify the association between KAP and geographical information. Results The results indicated satisfaction with KAP among farmers (57.7%, 75.8% and 87.0%) and animal health staff (80.5%, 84.5%, and 78.3%) at ≥ 80% cut-off point of total score. The primary concern of farmers is involved in the understanding of the route of transmission and handwashing practices after contacting animals. Predictors of higher knowledge and positive attitude included province of residence and age. The factors linked to satisfactory practice levels consist of province of residence, educational level, and a history of family members’ infections (p < 0.05). Among animal health staff, the primary factor associated with KAP was province of residence, sex, level of education, and history of family members infection (p < 0.05). Additionally, brucellosis information primarily originated from traditional promotional materials and veterinarians. Conclusions This study emphasized that the KAP scores for both animal health staff and farmers were satisfactory, except for a suboptimal knowledge score among farmers. To proactively control future brucellosis outbreaks, it is imperative to develop targeted educational resources aimed at enhancing the understanding of brucellosis, particularly among farmers. Ensuring the availability and accessibility of informative materials for the effective prevention and control of brucellosis in livestock animals.

Distribution characteristics and pollution assessment of heavy metals in typical black soil profiles of Haicheng city, Liaoning province, China

In order to understand the spatial distribution, influencing factors, pollution level and sources of heavy metals in black soil profiles in Northeast China, black soil profile samples were collected from five sampling points in Haicheng City, Liaoning Province, with the deepest profile depth of 50m. The contents of heavy metals (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) in soil at different depths were analyzed, and the distribution characteristics and influencing factors of heavy metals in black soil profiles were analyzed. The pollution level of heavy metals in soil was evaluated based on the geo-accumulation index method and enrichment factor method, and the sources of heavy metals in soil were analyzed based on principal component analysis. The results show that the content ranges of As, Cd, Cr, Cu, Hg, Ni, Pb and Zn in the surface soil of the five profile sampling points are 7.74–16.5μg/g, 0.14–0.38μg/g, 75.4–104μg/g, 20.6–36.1μg/g, 0.031–0.20μg/g, 27.8–45.6μg/g, 28.5–45.6μg/g and 56.8–158μg/g, respectively. The Cd, Cr, Ni and Pb contents in the surface soil of the five profiles all exceeded the soil background values in Liaoning and China. Except for profile HCZK02, the contents of 8 heavy metals generally decrease with increasing depth. As the depth of profile HCZK02 increases, As, Hg and Pb show a decrease-increase-decrease change; Cd and Cr show a decrease change and Ni shows a zigzag change; Cu and Zn show a decreasing-increasing-decreasing-increasing trend. Corg, N, TC and TFe2O3 in the profile soil have a very significant impact on the vertical distribution characteristics of heavy metals. There are certain differences in the pollution degree of heavy metals in the surface soil of different profiles. Except for profile HCB01, where Cd and Hg in the surface soil are at moderate pollution levels, the heavy metals in the surface soil of the other profiles are at non-pollution to mild pollution levels. Principal component analysis results show that As, Cr, Cu and Ni belong to natural sources, Cd and Hg belong to anthropogenic sources from agricultural activities-atmospheric deposition, and Pb and Zn have both sources.

Factors associated with Catastrophic Healthcare Expenditure in communities of Lagos Nigeria: A Megacity experience

Background Each year, millions of people in low—and middle-income countries such as Nigeria are forced into poverty and financial ruin due to out-of-pocket (OOP) healthcare expenses. Our study assessed the prevalence and determinants of Catastrophic Healthcare Expenditure (CHE) experienced by households in Lagos, Nigeria. Methods A descriptive community-based cross-sectional survey was conducted on 2492 households in Lagos from December 2022 to March 2023 in 4 Local Government Areas (LGAs) using a multistage sampling technique. Data was collected using pre-tested semi-structured questionnaires, and analysis was performed using STATA 15.0 software. Univariate, bivariate, and binary logistic regression analyses were conducted with statistical significance set at p<0.05, and a 95% Confidence Interval was calculated for the adjusted odds ratio (OR). Results The study revealed that 15% of households experience catastrophic health expenditure (CHE). Gender, marital status, educational level, occupation, personal income, health perception, household location, and health insurance enrollment were significantly associated with CHE. Additionally, gender, religion, income, household location, and self-rated health status were significant predictors of household CHE, with adjusted odds ratios of 4.42, 2.45, 1.00, 1.07, and 1.69, respectively. Conclusion CHE is more prevalent among people with lower socio-economic status, urban residents, and those lacking health insurance. It is crucial to implement targeted initiatives to raise awareness about the benefits of health insurance and simplify the enrollment process for vulnerable groups, thereby alleviating the financial strain of healthcare expenses.

Evaluation of surgical treatment of gout—A retrospective study on 28 cases with tophi

Introduction The efficacy, safety, optimal timing, and urate-lowering effects of surgical interventions in gout management remain poorly understood. This study aims to fill this gap by evaluating the role of surgery in treating gout patients with tophi. Method A retrospective analysis was conducted on 28 gout patients presenting with tophi. Data were comprehensively retrieved from electronic medical records, including medical history, laboratory findings, surgical procedures, hospitalization duration, postoperative monitoring, and relevant variables. Results Postoperative improvements were observed in joint symptoms and functionality. Surgical intervention effectively reduced the frequency of gout flares, demonstrating short-term urate-lowering effects (STULE) and potential long-term urate-lowering effects (LTULE) when combined with urate-lowering treatments (ULT). Primary healing occurred in 65 out of 67 surgical sites (97.01%), with only 2 sites (2.99%) experiencing delayed healing, and minimal complications reported. Prolonged hospital stays were associated with elevated leukocyte counts, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) levels, as well as a higher number of surgical sites, rather than serum uric acid (SUA) levels. Conclusions Surgical intervention is a promising and safe therapeutic option for managing gout, particularly in cases with joint deterioration, functional impairment, or nerve involvement. Surgery not only reduces the frequency of gout flares but also provides STULE and potential LTULE when complemented with ULT. Patients with lower inflammatory indices and fewer incisions exhibit faster postoperative recoveries. Optimal timing of surgery, ideally during periods of disease remission, is crucial for minimizing complications and reducing hospitalization durations.

Correction: Characterization of an accessory plasmid of Sinorhizobium meliloti and its two replication-modules

Exploring shifts in values among urban Senegalese: The impact of global crises on social and cultural norms

The COVID-19 pandemic triggered social and economic stagnation worldwide, significantly impacting people’s lives. In addition, the Russia-Ukraine war that began in 2022 resulted in rising food prices globally, severely affecting low- and middle-income countries. This study aimed to examine the impact of these unprecedented crises on individual values, focusing on Senegal’s urban population. This study is the first to quantitatively assess changes in the values of urban Senegalese during this global crisis. Surveys were conducted in Saint-Louis, Senegal, in August-September 2018 and June-July 2022. The timing of these studies coincides with the onset of the COVID-19 pandemic in early 2020 and the outbreak of the Russia-Ukraine war in February 2022. The findings revealed a 19.9% decrease in the average monthly cost of living per capita between 2018 and 2022, attributed to the combined effects of rising food prices and unemployment. Furthermore, the proportion of households spending less than $3.50 per person per day—below the lower-middle-income class poverty line—increased by 11.05%. Our analysis indicates a decline in values such as benevolence, universalism, hedonism, and self-direction. In contrast, values related to power and achievement significantly increased following the pandemic. These results suggest that individual values are flexible and may change in response to external factors such as global crises.

The efficacy of acupuncture in relieving postoperative pain in patients with low simple anal fistula: Protocol of a prospective, randomised, controlled trial

Background Anal fistula surgery often leads to postoperative pain, which can hinder recovery and negatively impact patients’ quality of life. This prospective, randomised, controlled trial (RCT) aims to investigate the efficacy of acupuncture in alleviating postoperative pain and reducing the usage of analgesic medications following anal fistula surgery. Methods This single-centre, patient-blinded, assessor-blinded, placebo-controlled randomised controlled trial (RCT) will be conducted at a tertiary referral hospital. A total of 66 patients with low simple anal fistula will be randomised at a 1:1 ratio to receive either acupuncture or sham acupuncture. The primary outcome is the difference in the numerical rating scale (NRS) pain score before and after acupuncture at 6 hours post surgery. The secondary outcomes include postoperative analgesic usage (Day 0 to Day 7), complications (including infection, urinary retention, and bleeding from Day 0 to Day 7, as well as delayed wound healing and recurrence within 3 months post surgery), sleep quality (PSQI from Day 0 to Day 7), psychological state (SDS and SAS on Day 0, Day 1, and Day 7), and overall recovery quality (QoR-15 on Day 1, Day 3, and Day 7). The statistical analysis of this trial will be conducted using SPSS software, validating the normality of data and the homogeneity of variance, and employing t-tests, Mann-Whitney U tests, chi-square tests, and repeated measures ANOVA to analyze baseline data, primary and secondary outcome indicators. Discussion This study aims to contribute to the expanding evidence base regarding the role of acupuncture in postoperative pain management. Through a comprehensive assessment of pain relief, analgesic usage, and other recovery-related outcomes, our findings will establish a foundation for standardizing acupuncture protocols specifically tailored for anal fistula surgery patients. The strengths of this trial are rooted in its rigorous randomised controlled trial (RCT) design, comprehensive outcome measures, and focused examination of a clinically significant issue. Ultimately, the findings of this trial have the potential to offer valuable insights into the utility of acupuncture as an adjunctive therapy for postoperative pain management among anal fistula patients, thereby informing future clinical practice and research directions. Trial registration This study was registered in the China Clinical Trial Registry on June 1, 2024, with registration number: ChiCTR2400085178.

Exploring the dynamics of self-efficacy, resilience, and self-management on quality of life in type 2 diabetes patients: A moderated mediation approach from a positive psychology perspective

Objectives Type 2 diabetes mellitus (T2DM) significantly deteriorates patients’ quality of life (QOL). This study examined the dynamic interplay of factors that influence QOL in patients with T2DM, utilizing concepts from positive psychology and intrinsic mechanisms, to lay the groundwork for improving patient outcomes. Improving self-management behaviors is essential for effective disease management. Methods Using a cross-sectional design, this study incorporated 408 patients with T2DM from the endocrinology department of a public hospital in Urumqi, who were selected through convenience sampling from December 29, 2023 to June 30, 2024. Data collection tools included the General Data Questionnaire, Summary of Diabetes Self-Care Activities, Self-Efficacy for Diabetes Questionnaire, Connor-Davidson Resilience Scale, and Diabetes-Specific Quality of Life Scale. Structural equation modeling and Model 15 of Hayes’ SPSS-Process program facilitated the moderated mediation analysis. Results The findings demonstrated that self-efficacy significantly enhanced the QOL (β = -0.8557, p < 0.01), with resilience serving as a partial mediator, accounting for 43.1% of this effect. Interactions between self-efficacy and self-management, and resilience and self-management, were also significant predictors of QOL (β = -0.0751, p < 0.01 and β = -0.0073, p < 0.05, respectively). Conclusion These findings introduce a novel theoretical framework for T2DM from the perspective of positive psychology, which will be beneficial for intervention development. This study underscores the importance of promoting diabetes self-management as an effective strategy to enhance QOL. Additionally, healthcare providers must focus on fostering patients’ positive psychological traits and reliable self-management behaviors.

Correction: Import options for chemical energy carriers from renewable sources to Germany

Validation of the brief physical activity assessment tool: Comparison of telephone and in-person administration

We examined the reliability and validity of the Brief Physical Activity Assessment Tool (BPAAT) when administered by telephone interview compared to in-person administration. We analyzed data from the Epi-asthma study. Adult participants registered in the participating Portuguese primary health care centres (PCC) completed the BPAAT via telephone. After ~3 days (range 0–5 days), they had a face-to-face visit at their PCC and completed BPAAT using a tablet. The BPAAT classify individuals as "insufficiently active" (score 0–3) or "sufficiently active" (score 4–8). 355 subjects (60.8% female, 54[IQR 42–66] years) were included. The median BPAAT score was 2[0–4] for both methods, with a significant correlation (rho = 0.58, p<0.001). Test-retest reliability was moderate (ICC = 0.56, 95%CI 0.49–0.63). Agreement in physical activity classification was fair (71.5%, kappa = 0.31, 95%CI 0.21–0.41), with telephone administration classifying more individuals as "sufficiently active" (37.2%) than in-person (15.5%). Telephone administration of the BPAAT is a valid and reliable approach for monitoring of physical activity in the general population. However, it may slightly overestimate activity levels compared to face-to-face administration, particularly among subjects aged 65 years and older.

Genetic tracking of Crimean-Congo haemorrhagic orthonairovirus in Hyalomma population infesting cattle in Nigeria

Crimean-Congo haemorrhagic fever virus (CCHFV), a Biosafety level 4 pathogen transmitted by ticks, causes severe haemorrhagic diseases in humans but remains clinically silent in animals. Over the past forty years, Nigeria lacks comprehensive genetic data on CCHFV in livestock and ticks. This study aimed to identify and characterize CCHFV strains in cattle and their Hyalomma ticks, the primary vector, in Kwara State, Nigeria. Blood samples and Hyalomma ticks were collected from cattle, with ticks identified to species, pooled, and homogenized for RNA extraction. The CCHFV S-segment was detected using specific primers via reverse transcriptase polymerase chain reaction, followed by sequencing of amplicons. Among 318 cattle, 318 sera samples and 2855 Hyalomma ticks (H. dromedarii (49.0%), H. truncatum (44.5%), and H. rufipes (6.5%)) were obtained. Only two tick pools of H. truncatum tested (2/319 pools) were positive for CCHFV, with no positive cattle sera detected. The sequenced positive pools, denoted as CCHFV/NGR/ILN/2021/F22_S-segment (1228 bp) and CCHFV/NGR/ILN/2021/F101_S-segment (863 bp), showed 98.21% nucleotide identity with 15 variations. These strains shared 98.13% and 98.93% nucleotide identity with CCHFV IbAr10200/UCCR4401 isolated from Nigerian ticks, but only 93.88% and 93.63% similarity with CCHFV isolated in 2016 from humans in Nigeria. Additionally, compared to CCHFV isolate IbAr10200 (KY484036), sequences from this study exhibited 9–23 nucleotide variable positions with 3–4 non-synonymous amino acid replacements. Phylogenetic analysis revealed clustering of these strains around IbAr10200, suggesting ongoing circulation. This study underscores the need for broader surveillance to understand the full spectrum of CCHFV strains and clades circulating in Nigeria.

Community and familial dynamics influencing risk behavior for HIV acquisition among adolescent girls and young women in Uganda: Qualitative analysis using Protective Motivation Theory

Background In Uganda, adolescent girls’, and young women’s (AGYW-15-24 years) current HIV prevalence is fourfold compared with their male counterparts due to compounded social, economic, and environmental factors. Using the Protective Motivation Theory (PMT), we explored HIV-acquisition risk sources and perceived protective factors from AGYW and caregivers’ perspective. Materials and methods During 2018, we conducted a qualitative study guided by PMT to explore factors influencing HIV acquisition among AGYW. We purposively sampled two groups of key informants, AGYW at high-risk for HIV acquisition (uninfected) and AGYW living with HIV, varied by age and place of residence (urban/rural). We conducted 34 focus group discussions with AGYW, nine with AGYW parents, and 25 key informant interviews. Data were analyzed using the framework method based on the PMT and developed from participants’ narratives. Results AGYW were knowledgeable about HIV, HIV acquisition risk factors, and HIV prevention interventions. Nonetheless, few AGYW knew about pre-exposure prophylaxis (PrEP). Imbalance in power relations between the genders explained inability of AGYW making safe healthy decisions, with social norms giving men power over women. Parents modelling positively influenced HIV risk behavior. Many AGYW viewed staying in school a protective factor both while at school and further for life. AGYW identified alcohol use, desire for material possessions, discounting HIV disease severity, social norms, and poverty as barriers to engaging in self-protective behaviors. Several AGYW believed that access to AGYW-focused programs would facilitate healthy sex-positive, protective behaviors. Discussion While PMT focuses on individual factors confirmed by our findings, we found HIV risk behavior to be influenced by complex contextual factors including poverty, gender inequality and cultural norms. Distinct HIV risk factors among AGYW require policy and comprehensive targeted interventions addressing violence, alcohol consumption, increased economic opportunities, educational opportunities, safe-sex practices, and PrEP scale-up which may prevent HIV in AGYW and facilitate HIV epidemic control.

Low-profile double plating versus conventional single plating in midshaft clavicle fractures: A retrospective study and initial experience with this novel technique

Background Low-profile double plating seems a viable alternative to conventional single plating for fixation of midshaft clavicle fractures. This study aims to compare the two techniques regarding healing, complications, and removal rate. Methods This retrospective cohort study included all patients >16 years that underwent plate fixation for midshaft clavicle fractures between 2020 and 2022 at one trauma-center. Exclusion criteria encompassed pathological or open fractures, refractures and delayed presentation or treatment more than 14 days after the accident. Patients were categorized into two treatment groups: Single plating (Synthes 3.5mm LCP superior / anterior or Synthes 2.7mm VA-LCP superior) and low-profile double plating (2.0 superior combined with either 2.4 or 2.7mm anterior mini-plate). Treatment groups were compared regarding healing, complications, and removal rate. Results A total of 99 patients were included: 74 in the single plating and 25 in the double plating group. Implant failures within the first three months were comparable in both groups (4.0% double plating versus 2.7% single, p = 0.744, of which one was caused by infection). Low-profile double plating had a significantly lower operation duration (95 versus 111 minutes, p = 0.019). Long-term follow-up data was available in 60 patients in the single plating and 20 in the double plating group. The need for reintervention was significantly lower in the double plating group (n = 5, 25.0% vs. n = 31, 51.7%, p = 0.038). These reinterventions were predominantly caused by implant irritation in both groups (n = 4, 20% double plating versus n = 29, 48.3% single plating, p = 0.026). All fractures healed in both groups. Conclusion Low-profile double plating attains comparable healing rates as single plating and has a significantly lower risk for re-intervention as well as a shorter operation duration. The lower reintervention rate is mainly explained by a lower incidence of implant irritation in the double plating group.

Impact of mergers and acquisitions on firms’ performance adjusted to business cycle fluctuations in China

This research mainly explored the effects of mergers and acquisitions (M&As) on the financial performance of Chinese listed companies and the determinants of post-M&A financial performance of mergers by incorporating adjustments for business cycle fluctuations. The research was divided into two parts. The first part applied data envelopment analysis (DEA) models for the calculation of the financial performance scores of mergers and non-mergers in six major sectors before and after M&As. Comparative analyses of financial performance trends between mergers and non-mergers in similar sectors revealed that M&As often decrease financial performance scores of mergers compared with non-mergers. The second part adopted regression analyses and robustness test to evaluate the effects of listing duration, financial leverage level, free cash flow and target type on post-M&A financial performance. The results showed that mergers’ sufficient listing duration, high financial leverages, adequate free cash flow and asset as target had significant positive impact on the post-M&A performance of mergers. Opposite to the free cash flow hypothesis, this study revealed that free cash flow is beneficial for mergers in China. These findings emphasized that lack of experience and managerial hubris are the primary factors contributing to the underperformance observed within the Chinese M&A market.

Prognostic value of composite inflammatory markers in patients with chronic obstructive pulmonary disease: A retrospective cohort study based on the MIMIC-IV database

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease, and inflammation plays a key role in the pathogenesis of COPD. The aim of this study is to investigate the association between systemic immune inflammation index (SII), systemic inflammatory response index (SIRI),pan-immune inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) and all-cause mortality in patients with chronic obstructive pulmonary disease (COPD), and to evaluate the effect of composite inflammatory markers on the prognosis of COPD patients. We obtained data on COPD patients from the Medical Information Mart for Intensive Care (MIMIC) -IV database and divided patients into four groups based on quartiles of baseline levels of inflammatory markers, The primary outcomes were in-hospital and ICU mortality. We comprehensively explored the association between composite inflammatory markers and mortality in patients with COPD using restricted cubic splints (RCS), COX proportional hazards regression models, Kaplan-Meier curves, receiver operating characteristic (ROC), and subgroup analyses. A total of 1234 COPD patients were included in this study. RCS results showed that SII, SIRI, PLR, PIV and NLR were positively and non-linearly correlated with the increased risk of in-hospital mortality in COPD patients. Multivariate COX regression analysis showed that compound inflammatory markers were independent risk factors for in-hospital mortality in COPD patients. The KM curve results showed that COPD patients with higher SII, SIRI, PLR and PIV had a significantly lower survival probability. 5 kinds of compound between inflammatory markers and mortality in patients with COPD is related to nonlinear correlation, can increase the risk of mortality in patients with COPD is a risk factor for the prognosis of patients with COPD, and may serve as potential biomarkers for clinical COPD risk stratification and treatment management in critical patients.