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“Fate of pressure-bearing flaps: long-term observations”
Application and efficacy of the pubovesical complex-preserving technique in intrafascial laparoscopic radical prostatectomy: A propensity score-matched analysis
Purpose This study aimed to introduce the pubovesical complex preserving technique in intrafascial laparoscopic radical prostatectomy (PPLRP) and compare its efficacy with the conventional intrafascial laparoscopic radical prostatectomy (Intra-LRP). Materials and methods The clinical data of 475 cases who underwent PPLRP (n = 171) or Intra-LRP (n = 304) between 2012 and 2023 and were followed up for over 1 year were retrospectively analyzed. The baseline characteristics of the two groups were balanced using 1:1 propensity score matching. Lastly, Kaplan-Meier analysis and multivariable logistic regression were performed to assess survival rates and their influencing factors. Results After matching, 310 cases (155 cases each) were successfully matched. The median follow-up for the two groups was 45 and 47 months, respectively. The rate of positive surgical margins (PSM) was comparable between the two groups at 17.4% and 14.8% (p = 0.537), respectively. Moreover, Kaplan-Meier analysis revealed no significant difference in the biochemical relapse-free survival (bRFS) (p = 0.772), cancer-specific survival (CSS) (p = 0.507), and overall survival (OS)(p = 0.065) between the two groups. PPLRP was associated with earlier recovery of urinary control, as evidenced by higher continence rates 24 hours following catheter removal (p = 0.002), as well as at 1 month (p = 0.011), 3 months (p < 0.001), and 6 months (p = 0.020). Regarding sexual function, postoperative IIEF-5 scores were significantly higher in the PPLRP group compared to the intra-LRP group (p < 0.001), and the proportion of patients achieving satisfactory erections for sexual intercourse was 31.0% and 19.4%, respectively (p = 0.018). Finally, multivariate analysis identified surgical technique as the sole factor affecting urinary continence recovery (p = 0.001), while surgical technique (p = 0.042) and age (p = 0.050) were associated with sexual function recovery. Conclusion Compared with traditional Intra-LRP, PPLRP offered superior preservation of the pubovesical complex (PVC) and neurovascular bundle (NVB). Indeed, it facilitated early recovery of urinary continence and sexual function without increasing oncological risk. Besides, it can be feasibly implemented in hospitals equipped with conventional laparoscopic systems.
Preliminary ultrastructural analysis suggests phenotype-specific myofiber alterations in idiopathic inflammatory myopathies
Association between obesity and neurodevelopmental delay risk in children under five years: A study from Tumbes, Peru
Background Childhood obesity is an emerging public health concern in low- and middle-income countries and may be associated with early neurodevelopmental vulnerability. Evidence on this association during early childhood remains limited, particularly in Latin American settings. Objective To evaluate the association between childhood obesity and neurodevelopmental delay risk in children under five years of age attending public healthcare facilities in Tumbes, Peru, and to develop a multivariable nomogram for probabilistic risk estimation. Methods An analytical cross-sectional study was conducted between 2022 and 2024 among children aged 0–59 months receiving care at two EsSalud healthcare facilities in Tumbes. Neurodevelopment was assessed using the Evaluación del Desarrollo Infantil (EDI), classifying children as having normal development, developmental lag, or being at risk of developmental delay. Childhood obesity was defined using WHO weight-for-height standards. Sociodemographic, clinical, and behavioral variables were collected. Associations were evaluated using proportional odds ordinal logistic regression guided by a directed acyclic graph. A nomogram was developed based on the final model and internally validated using bootstrap resampling (1,000 iterations). Results The final analytical sample included 431 children; 27% were classified as obese and 19% had anemia. According to the EDI, 58% had normal development, 36% developmental lag, and 6% were at risk of developmental delay. Childhood obesity was independently associated with higher cumulative odds of neurodevelopmental delay risk (OR = 2.73; 95% CI: 1.66–4.51). Male sex and older age group were also associated with increased risk, while higher caregiver knowledge of complementary feeding showed a protective association. Physical activity compliance and anemia were not independently associated in the multivariable model. The nomogram demonstrated acceptable internal discrimination (AUC > 0.7). Conclusions Childhood obesity was associated with increased neurodevelopmental delay risk in children under five years of age. An explanation-informed nomogram using routinely available variables may support early risk stratification in primary care, although external validation is required before broader implementation.
Indirect screening for paternal perinatal depression independent of maternal factors using mother-reported EPDS-partner in a community-based cohort in Japan
Bovine mastitis epidemiology: Prevalence, risk factors, control program gaps and biosecurity recommendations to improve animal health in the Rwandan smallholder dairy farms
Bovine mastitis remains a significant challenge to dairy health management worldwide, with substantial economic and public health implications. In Rwanda, where traditional dairy farming is crucial for household livelihoods and the national economy, mastitis reduces milk yield and increases the risk for bacterial contamination, posing serious food safety concerns. This study, conducted in Rwanda’s North-Western region from January 2024 to April 2024, aimed to identify key mastitis risk factors, evaluate existing control gaps, and propose evidence-based interventions. This cross-sectional study collected data from 411 smallholder dairy farms in Rwanda, assessing one lactating cow per farm through clinical examination, California Mastitis Test, and structured farmer questionnaires on management and hygiene practices. Logistic regression analysis in R identified significant cow-related and farm-level risk factors, providing a basis for targeted mastitis control and biosecurity recommendations. The overall mastitis prevalence was 60.06% (95% CI: 53.57–66.55), with subclinical cases alone accounting for 56.9%. Poor cow hygiene emerged as the strongest predictor (OR = 85.47, 95% CI: 27.18–268.74; p < 0.001). Other associated factors included exotic pure breeds, late lactation stages, and multiparity. External contributors included inadequate milking practices and limited veterinary access. In zero-grazing systems, poor housing drainage (OR = 109, 95% CI: 26.46–507.18; p < 0.001) and infrequent bedding changes (OR = 6.36, 95% CI: 3.38–12.78; p = 0.014) significantly increased mastitis risk. Identified gaps included lack of farmer knowledge, insufficient access to affordable mastitis control supplies (e.g., disinfectants such as iodine or chlorine dioxide), inappropriate mastitis treatments, poor farm biosecurity, and inefficient quality control in the milk marketing chain. Strengthening farm biosecurity, implementing a national mastitis control program, and enhancing veterinary extension are essential to reduce mastitis and improve milk safety. Coordinated stakeholder action is vital for sustainable dairy development and public health.
Characteristics of patients diagnosed for acute myeloid leukemia before and during the 2020 COVID-19 pandemic: the DATAML population-based cohort
Editorial Note: Preclinical evaluation of 4-methylthiobutyl isothiocyanate on liver cancer and cancer stem cells with different p53 status
AI-guided surgical decision support system for corneal laceration repair: a prospective, non-randomized controlled feasibility study
Composition optimization of mastic in recycled asphalt mixtures based on pavement performance
Due to the depletion of natural sand and gravel resources and increasing environmental restrictions, the utilization of recycled asphalt pavement materials (RAP) has become a critical approach to mitigate the consumption of natural aggregates and reduce carbon emissions in highway construction. The performance of RAP-containing asphalt mixtures is closely associated with the properties of asphalt mastic, which consists of fine RAP (FRAP), fine natural aggregates, mineral filler, and asphalt binder. However, the interactions among these components, namely fine aggregate gradation (calculated via K value), mineral filler–binder ratio, and FRAP–fine aggregate ratio, are not yet fully understood, limiting the informed design of asphalt mastic. This study aims to investigate the compositional characteristics of asphalt mastic and propose an optimized gradation suitable for engineering applications. The results indicate that an asphalt mastic with a mineral filler–binder ratio of 1.4, a FRAP–fine aggregate ratio of 50:50, and a K value of 0.65 achieves optimal overall mechanical performance. An analysis of variance shows that the mineral filler–binder ratio is the dominant factor affecting mastic performance (p < 0.001), followed by the FRAP–fine aggregate ratio (p < 0.01), while the influence of the K value is comparatively weak. Building on these optimized mastic parameters, the effect of the coarse aggregate-to-asphalt mastic ratio was evaluated, with a ratio of 75:25 providing the most balanced mixture performance. Compared with the standard gradation, mixtures designed with the recommended gradation exhibited approximately 35% higher dynamic stability and 28% higher fracture toughness, indicating significantly improved resistance to rutting and cracking.
Enhancing solar PV efficiency in mining operations through optimized cleaning intervals and automated dust mitigation
Development of guidelines for managing unused and expired medications in local communities: An engaged stakeholder waste hierarchy approach
Objectives The management of unused and expired medications is essential to address environmental pollution, ensure public health safety, and optimize healthcare resources. Proper disposal of medications is especially challenging in areas where there is a lack of organized take-back programs. To bridge this gap, this study aims to develop inclusive guidelines through collaborative stakeholder engagement, while recognizing the absence of universally applicable solutions. Methods The study uses a mixed-methods approach, relying on surveys, in-depth interviews, and focus groups. First, 156 households were surveyed to measure the amount and economic value of unused and expired medications in their possession. Subsequently, in-depth interviews were conducted with 45 participants, including healthcare professionals, community leaders, citizens, and policymakers. These in-depth interviews provided rich insights about the roles, local contexts, and challenges regarding the management of unused and expired medications. Lastly, focus group discussions with 16 participants provided the basis for the development of a new set of guidelines aligned with waste hierarchy principles and founded on a holistic view of the medication cycle, from acquisition to disposal. Results The findings of the study have revealed that blood glucose lowering agents are the most common type of unused medication kept by households, while anti-hypertensive drugs are the ones that most frequently expire. In addition, the study has shown that medication wastage occurs at multiple stages across the system. Building on these insights, a set of guidelines and community-based management pathways were developed, offering a practical and scalable model in seven steps that can be applied to environments with no formal take-back systems. Conclusions The guidelines presented in this study offer a practical and effective framework for policymakers, researchers, and practitioners focused on regions that lack formal disposal mechanisms to guide community-based medication wastage reduction and disposal practices, supporting the sustainable production and consumption of medications.
Parental knowledge and practices and associated factors of dental caries in school-age children in Debark Town, Northwest Ethiopia
Integrated disease model considering mutation-induced infection waves with COVID-19 cases
COVID-19, an unprecedented global pandemic, has caused successive waves that pose unique challenges to public health and epidemiological research. Traditional Susceptible–Infected–Recovered (SIR) models often struggle to capture these complex dynamics, especially given that the virus has spawned multiple sub-variants. To tackle these challenges, we adopt an empirical modeling approach by integrating real-world data from Our World in Data (daily confirmed COVID-19 cases) and GISAID (variant prevalence) into a newly proposed integrated model. Specifically, we sum multiple sigmoidal (logistic) curves, each representing the cumulative infections of a distinct dominant variant, and recalibrate the model whenever a new variant emerges. By incorporating variant-specific parameters, our framework effectively captures the biological and epidemiological characteristics of COVID-19 in a dynamic, data-driven manner. Most importantly, we employ the Pruned Exact Linear Time (PELT) algorithm to provide rigorous mathematical justification for when separate variant models can be legitimately summed: specifically, when variant dominance reaches approximately 50%. This establishes the theoretical foundation that separate logistic models can be additively combined under specific dominance conditions. We evaluate our model using Mean Absolute Percentage Error (MAPE), Root Mean Square Error (RMSE), and Mean Absolute Error (MAE). Our empirical findings confirm that integrating dominant variants is associated with markedly improved accuracy compared to a single-strain approach, based on data from fourteen countries (including South Korea, the United States, and the United Kingdom) and global aggregates. We also provide theoretical motivation for approximating SIR dynamics via logistic functions and discuss how this integrated framework can be refined to enhance predictive performance. In doing so, we demonstrate the feasibility and advantages of iteratively updating epidemiological models in response to emerging variants, thereby offering actionable insights for ongoing and future pandemic management.
The microbiome of interstitial cystitis revealed by 2bRAD-M
Psychosocial hierarchies of modifiable risk for Alzheimer’s disease: A networks analysis
Thirty per-cent of multidomain risk reduction trials for Alzheimer’s disease and related dementias (ADRD) report limited efficacy. Identifying potential cascading influences between psychosocial ADRD risk factors is a promising strategy for increasing this efficacy rate. We aimed to identify relational hierarchies among modifiable ADRD risk factors to inform temporally optimized prevention strategies. We applied a dual network approach—regularized partial correlation network (RPCN) and a Bayesian directed acyclic graph (DAG) generated via a novel ensemble method—to cross-sectional data from 898 community-dwelling older adults enrolled in an ADRD prevention initiative. The RPCN revealed clustering among mental health domains. The DAG suggested directional associations from stress, anxiety, and coping to downstream factors including depression, social support, cognitive activity, and cardiometabolic domains (physical activity, BMI, blood pressure, and MIND diet adherence). This dual-network framework highlights upstream psychosocial factors statistically associated with multiple ADRD-related risks. Models suggest targeting stress and coping may offer broad, cascading, benefits for ADRD risk reduction. Further exploration of strategically staggered and/or needs-based individualization of future modifiable ADRD prevention initiatives is warranted.
A framework for impact based heat stress warning system for a coastal city in India
Abstract Urban Heat Islands (UHIs) pose a significant challenge to densely populated cities of India, intensifying heat stress and impacting public health, energy consumption, and urban sustainability. This study aims to identify Urban Heat Stress Risk in Mumbai (India) through the heat stress event of April-May 2024 using satellite data and by assessing thermal stress risk through a systematic approach combining urban weather modelling and in-situ observations along with vulnerability and exposure of the residents. Satellite-derived surface temperature data is analyzed to detect spatial patterns of UHI hotspots across the region. To deepen the understanding of thermal dynamics, the Weather Research and Forecasting Model with Urban Canopy Model (WRF-UCM) is employed, utilizing Local Climate Zone (LCZ) global data to simulate the Universal Thermal Climate Index (UTCI). A nested domain structure with spatial resolutions of 3*3 km, 1*1 km and 333*333 m are used to capture regional and localized variations of urban weather parameters. Validation of the WRF-UCM simulated meteorological variables is carried out using data from 36 Automatic Weather Stations across Mumbai (India). A correlation analysis between satellite-derived UHI hotspots and validated model results provides comprehensive insights into heat stress distribution. The findings highlight critical zones experiencing increased heat stress. The vulnerability and exposure index formulated through the Principal Component Analysis tool helped as additional overlaid layers to assess the risk over the study area, serving as an additional tool for urban planning interventions and policy recommendations related to heat stress risk.
Exploring the importance and preference of sugar feeding behaviour of malaria vectors in sugar plantations of southern Malawi
Background Reliable tools are needed to control opportunistic outdoor biting and resting malaria vectors that remain beyond the reach of indoor targeted interventions. The attractive targeted sugar baits (ATSBs) have demonstrated effectiveness in some settings but have shown limited impact in other areas, in part due to differences in mosquito species’ preferences and the presence of competing natural sugar sources. We evaluated the sugar-feeding preferences of Anopheles gambiae in Chikwawa, southern Malawi, to inform context specific sugar-based vector control interventions. Methods Using three collection tools, CDC Light traps; Prokopack aspirator and the barrier screen, we collected 187 adult anophelines from the Illovo sugar plantations. Collected mosquitoes were subjected to cold anthrone tests in the laboratory to assess the presence of plant sugars in their gut. Additionally, 810 adult Anopheles gambiae s.l., reared in the insectary from wild caught larvae, were exposed in an olfactory-driven choice experiment to identify the most attractive available sugar source in the area. Sugar sources included guavas, melon, bananas, mango, marula and sugarcane. Results Over 40% (n = 74) of the collected Anopheles mosquitoes- including An. gambiae s.l., An. funestus , An. coustani and An. tenebrous were found to have fed on natural sugar sources. For the sugar attractiveness tests for An. gambiae s.l., guava was found to be twice as attractive (IRR = 1.97, 95% CI: 1.49–2.62, p < 0.001) as sugarcane (our reference fruit), followed by banana (IRR = 1.68, 95% CI: 1.26–2.24, P < 0.001), then mango, and melon (IRR = 1.49, 95% CI: 1.11–2.01, P = 0.008) and (IRR = 1.45, 95% CI: 1.08–1.96, P = 0.014) respectively. Conclusion Sugar feeding is a key activity for Anopheles mosquitoes and presents a potential target for control. Understanding local sugar source preferences will help tailor novel mosquito control intervention strategies such as the ATSBs to specific ecological contexts.