Browse Articles

Dietary acid load and oxidative stress in relation to sleep quality and duration among Iranian adults

Differential role for hepatic glucuronidation and sulfonation in controlling the 24S-hydroxycholesterol ability to activate LXR

Puji Zhichuang suppositories alleviate acetic acid-induced hemorrhoid-like anorectal inflammation model may involve reduced the PI3K-Akt signaling pathway

Soft matrix promotes ciliogenesis in human retinal pigment epithelial cells

Abstract The primary cilium (PC) is a microtubule-based mechanosensory organelle involved in signal transduction. Although the signaling functions of PC have been well studied, its interaction with the cell´s mechanical environment remains unclear. Here, we used polyacrylamide hydrogels to investigate how extracellular matrix (ECM) stiffness influences ciliogenesis in human retinal pigment epithelial (RPE1) cells. We found that a soft hydrogel (1 kPa) induces cilia formation and elongation in RPE1 cells independent of serum starvation, a classical in vitro method to promote ciliogenesis. Transcriptome analysis of serum-fed RPE1 cells on soft matrix revealed cell cycle exit and alterations in ECM and cytoskeletal gene expression that favor ciliogenesis. Moreover, we observed that despite being very long, cilia formed on a soft substrate are functional, as they transduce Sonic hedgehog signal normally. Transcriptome and microscopy analysis of two cilia-inducing conditions (soft substrate and serum starvation) revealed upregulation of cilia-related genes and downregulation of proliferation markers on both conditions. Autophagy genes were more enriched in serum-starved cells, whereas upregulation of ECM genes and downregulation of actin-related genes were more pronounced on soft matrix. Our study demonstrates that PC biogenesis can be mechanically induced in RPE1 cells on soft substrates independent of external biochemical cues.

GIS-based fuzzy AHP multi-criteria assessment of concentrated solar power (CSP) potential in Timimoun, Algeria

Evaluation of a deep transfer learning-based ultrasound model for predicting HER2-positive breast cancer

Abstract This study aimed to evaluate the accuracy of an ultrasound imaging-based deep transfer learning model for predicting human epidermal growth factor receptor 2 (HER2)-positive breast cancer and to explore its potential advantages and clinical applications. This retrospective study included ultrasound images from 492 patients with breast cancer who were treated at Gongli Hospital (Shanghai, China) between December 2023 and January 2025. The dataset was randomly divided into a training dataset ( n  = 343), a validation dataset ( n  = 73), and an internal test dataset ( n  = 76) in a ratio of 7:1.5:1.5 for model development, parameter optimization, and internal evaluation. In addition, an independent external cohort consisting of 72 patients from another hospital (January 2025 to June 2025) was used as an external test dataset to evaluate the generalizability of the model. Based on a transfer learning framework, classification models were developed using six convolutional neural network backbone architectures, involving GoogLeNet, ResNet-18, ResNet-50, DenseNet-161, MobileNetV2, and EfficientNet-B0. Model performance was comprehensively evaluated using sensitivity, specificity, accuracy, positive predictive value, negative predictive value, the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). The model demonstrating the best overall performance in the internal test dataset was subsequently validated using the external test cohort to further assess its generalization capability. In the internal test dataset, the AUC values of the six models ranged from 0.913 to 0.989, with DenseNet-161 (AUC = 0.989) and EfficientNet-B0 (AUC = 0.987) demonstrating the strongest discriminative capacity. Among these architectures, EfficientNet-B0 achieved the most favorable overall performance, characterized by superior accuracy and specificity. When evaluated on the external test dataset, EfficientNet-B0 maintained excellent predictive performance, yielding an AUC of 0.972. DCA further indicated that this model provided a greater net clinical benefit across a wide range of threshold probabilities, while calibration analysis demonstrated good agreement between predicted probabilities and observed outcomes. In conclusion, ultrasound-based deep transfer learning model demonstrated remarkable potential for the noninvasive prediction of HER2-positive breast cancer. Among the evaluated architectures, EfficientNet-B0 exhibited the most robust overall performance and strong generalizability, indicating noticeable promise for future clinical translation in supporting precision diagnosis and individualized management of breast cancer. As a non-invasive preoperative auxiliary screening tool, this tool promotes the preliminary identification of high-risk, HER2-positive patient cohorts prior to tissue biopsy or surgical intervention, thereby establishing a substantive radiological basis to guide clinical decision-making.

OAHPE: occlusion-aware hybrid routing for efficient and robust 3D human pose estimation in mixed-occlusion videos

Prognostic value of epicardial adipose tissue distribution as a complementary risk marker for major adverse cardiovascular events in diabetes

Metabolic syndrome is associated with increased mortality in patients with breast or prostate cancer

Analyzing public sentiment during national healthcare system failures: A big data approach to emergency department experiences in South Korea

Background The 2024 healthcare crisis in South Korea, characterized by a mass resignation of medical residents and a subsequent “medical void,” has profoundly disrupted the healthcare landscape. This study aims to investigate the emotional responses and behavioral concerns of patients regarding emergency departments (EDs) during this period of systemic instability. Methods Utilizing AI-based text mining and sentiment analysis, we analyzed a comprehensive dataset of 1,359,146 unstructured data points harvested from major Korean online platforms between January 1, 2024, and December 31, 2024. The analysis focused on quantifying sentiment polarity and identifying core thematic stressors through keyword frequency and association mapping. Results The findings revealed a predominant negative sentiment (45.8%), significantly outweighing positive (32.4%) and neutral (21.9%) responses. Beyond clinical outcomes, specific terms such as “Medical Void,” “Emergency Room Runarounds,” and “Overtreatment” emerged as primary psychological stressors. Temporal and spatial analyses indicated that dissatisfaction spiked during holidays and nighttime, particularly concentrated in metropolitan areas like Seoul, reflecting critical bottlenecks in the emergency care network. Conclusions These results suggest that patient dissatisfaction during a national medical crisis transcends service-level issues, reflecting a deep-seated trust deficit and a perceived threat to psychological safety. This study provides a foundational evidence base for developing data-driven crisis communication systems and policy interventions aimed at restoring public trust and enhancing healthcare system resilience during national emergencies.

A unified machine learning framework for intelligent resource allocation toward 6G wireless communications

Is having a child with special needs a barrier to physical activity? A mixed design study

Having special needs is considered a difficult situation in society, but perhaps only families experiencing this situation know how challenging it is to be the parent of a child with special needs. Since families plan their entire lives around their children’s needs, they often neglect their own social lives and free time. The aim of this study is to investigate whether having a child with special needs constitutes a barrier to physical activity for parents, using a mixed methods approach. A total of 212 parents caring for individuals with special needs volunteered to participate in the study. The quantitative part of the study used a questionnaire to collect demographic information, as well as scales to measure perceived barriers to physical activity and care burden, and a shortened version of the international physical activity questionnaire. For the qualitative part of the study, a four-question interview form was used. It was observed that, as participants’ scores for physical activity barriers increased, so did their body mass index and care burden scores (p < 0.05). According to the results of the regression analysis, the model of physical activity barriers and care burden status of parents of children with special needs according to the participants’ metabolic equivalent classification was not significant (p > 0.05). However, the results of the qualitative data analysis revealed four barriers that parents indirectly associated with having a child with special needs hindering physical activity: responsibilities, having a child with special needs, psychological state and problems related to sports facilities. These results suggest that quantitative research methods alone may be insufficient for identifying factors hindering physical activity among individuals with special needs. Future studies may wish to conduct applied research projects on physical activity barriers among parents of children with special needs.

Exploratory study on the association between oral functions and nailfold capillary parameters

Abstract Extending life expectancy is a major public health priority. Oral frailty is closely associated with systemic health. However, the association between oral functions and systemic health, particularly nailfold capillary parameters, remains unclear. We analyzed data from 311 participants (mean age: 55.66 ± 12.54 years) to examine the associations between oral function parameters (number of remaining teeth, tongue pressure, and oral mucosal moisture) and nailfold capillary parameters (number, length, width, and turbidity). The results showed that the number of remaining teeth was significantly associated with capillary number. Additionally, oral mucosal moisture was significantly associated with capillary turbidity and width; notably, these two capillary parameters were moderately correlated with each other. These associations did not remain statistically significant after adjusting the P -values using the Holm–Bonferroni correction for multiple comparisons, and should therefore be interpreted as preliminary, hypothesis-generating findings. Overall, these findings may contribute to the growing body of evidence linking oral and systemic health and provide preliminary insights for future research on potential diagnostic applications. Examining oral functions and dental findings in the context of interconnected disease pathways, rather than individual diseases may improve our understanding of the relationship between oral and systemic health.

Patient safety management activities partially mediate nursing competences and patient safety culture in Vietnam

Background Patient safety culture is a key determinant of healthcare quality, yet evidence remains limited on how nurses’ person-centered care competence and patient safety competence relate to patient safety culture through patient safety management activities, particularly in low- and middle-income settings. Objective To describe levels of person-centered care competence, patient safety competence, patient safety management activities, and patient safety culture among nurses in central Vietnam, and to examine their direct and indirect relationships using a mediation model. Methods A multicenter cross-sectional study was conducted among 1,036 nurses from five tertiary hospitals in central Vietnam (response rate 99.6%). Person-centered care competence was measured using P-CAT, patient safety competence using H-PEPSS, patient safety management activities using PSMA, and patient safety culture using HSOPSC. Descriptive statistics, Pearson correlations, and multivariable linear regression analyses were performed. Mediation effects were examined using bias-corrected bootstrapping with 5,000 resamples. Results Mean scores indicated moderate-to-high levels of person-centered care competence (3.77 ± 0.36), patient safety competence (4.23 ± 0.36), and patient safety management activities (4.44 ± 0.35), while patient safety culture was moderate (3.93 ± 0.35). All variables were positively correlated, with the strongest association observed between person-centered care competence and patient safety culture (r = 0.49, p < 0.001). In adjusted regression analyses, person-centered care competence and patient safety competence were independently associated with patient safety management activities (β = 0.149 and β = 0.274; both p < 0.001). Patient safety management activities were significantly associated with patient safety culture (β = 0.102, p < 0.001). Bootstrapped analyses showed significant partial mediation through patient safety management activities for both person-centered care competence (indirect β = 0.0265, 95% CI 0.0143–0.0404) and patient safety competence (indirect β = 0.0497, 95% CI 0.0304–0.0711), suggesting that frontline safety behaviors may represent a pathway linking competencies to patient safety culture. Conclusions Higher person-centered care competence and patient safety competence were associated with stronger patient safety culture, partly through increased engagement in patient safety management activities. These findings highlight the potential role of patient safety management activities as a mechanism linking competencies to patient safety culture. However, causal relationships cannot be inferred due to the cross-sectional design.

Comprehensive investigation on an extraordinary-sized ocean sunfish (Mola mola L., 1758) stranded along the North Adriatic coastline of Italy

Instruments that measure evidence-based practice knowledge, skills, and attitudes among health professions students: A systematic review protocol

Background Evidence-based practice (EBP) is recognized as a foundational element of health professional education worldwide. The Sicily Statement is a five-step model for both clinical practice and teaching EPB: Ask, Acquire, Appraise, Apply, Audit (or evaluate) [Dawes M, et al. BMC Med Educ. 5(1):1 (2005)]. Evaluating EBP competence in health professions’ students is critical to develop strategies that build that competence and ultimately lead to optimal patient care. Rationale There are many EBP measurement instruments that have been identified in previous reviews, but none that were intended for the health professions student population [Tilson JK, et al. BMC Med Educ. 11:78 (2011)]. Objective This systematic review aims to summarize and evaluate the measurement properties of existing instruments that evaluate health professions students’ EBP competence including EBP knowledge, skills, and attitudes. Methods The systematic review was registered with PROSPERO under the identifier CRD42024564908. This systematic review will follow an adapted version of the eight-step process for systematic reviews for patient-reported outcome measures (PROMs)(3). The adaptations will align with the research question and EBP measurement instruments that are the primary target of this review. The search strategy will employ key words and phrases from the objective targeting following electronic databases: MEDLINE, CINAHL, SPORTDiscuss, and PsycINFO, all via EBSCO. Nine psychometric measurement properties will act as the foundation for data extraction and evaluation of the measurement instruments. Data will be extracted and risk of bias will be completed on an individual study basis and on an EBP measurement instrument basis. A unique GRADE reporting system will be employed that accounts for a single conclusion based on a composite of the nine measurement properties and synthesized results from all studies.

Effect of dietary counseling and dietary fiber on tolerability during weight management with EMP16 and conventional orlistat: a single-blind randomized pilot trial

Abstract The aim of this trial was to assess whether dietary counseling together with supplemental fiber improves gastrointestinal (GI) tolerability during dose escalation with controlled-release orlistat–acarbose (EMP16) in adults who had reported prior GI side effects. In this randomized, single-blind, phase 2 pilot trial, adults with obesity (BMI ≥ 30 kg/m² or ≥ 27 kg/m² with risk factors) and prior GI problems to conventional orlistat or EMP16 were randomized 1:2 to EMP16 plus psyllium-based fiber or conventional orlistat plus maltodextrin placebo for 39 days, both with diet counseling. The primary endpoint was the composite gastrointestinal tolerability events (GITE) area-under-the-curve (AUC) score (diarrhea, oily spotting, flatulence with discharge, fecal incontinence) from daily electronic diaries. Additional endpoints included investigator-assessed GI adverse events, anthropometry, and cardiometabolic markers. Thirty-six participants completed treatment. GI event rates were much lower than expected in both arms, and GITE AUC differences were not statistically significant. Total events and time to first GI event favored EMP16 plus fiber. Greater relative weight loss occurred with EMP16 plus fiber vs. conventional orlistat plus placebo (p = 0.026), with similar ~ 10% LDL-cholesterol reductions. Dietary counseling during treatment with EMP16 or conventional orlistat may mitigate GI side effects in adults with prior GI side effects and co‑administration of fiber might further enhance tolerability and efficacy.

Clinical efficacy of joint mobilization for shoulder impingement syndrome: a systematic review and meta-analysis

Background No systematic review has examined the clinical effectiveness of mobilization for shoulder impingement syndrome (SIS). We aimed to evaluate clinical effectiveness for the use of mobilization in SIS. Methods PubMed, Embase and the Cochrane Library were searched for studies published up to April 30, 2023. Randomized controlled trials that evaluated the effectiveness of mobilization for SIS were included. Literature was extracted using Endnote 20, and the risk of bias was assessed using the Cochrane risk-of-bias tool 2.0. A meta-analysis was conducted using RevMan 5.4. This study was conducted in accordance with the PRISMA guidelines. Results Nineteen randomized controlled trials (956 participants) were selected based on the inclusion criteria. Adding mobilization to traditional physical therapy reduced pain (mean difference [MD]=1.72, 95% confidence interval [CI]: 0.91 to 2.53, I 2  = 97%, p < 0.00001), increased active range of motion (MD = 14.49, 95% CI: 8.46 to 20.53, I 2  = 95%, p < 0.00001), and improved the disabilities of the arm, shoulder, and hand (MD = 5.95, 95% CI: 0.01 to 11.90, p = 0.05) and Constant-Murley scores (MD = 5.49, 95% CI: 0.78 to 10.19, p = 0.02). Joint mobilization was more effective in reducing pain (MD = 0.67, 95% CI: 0.15 to 1.19, p = 0.01) and increasing active range of motion (MD = 8.56, 95% CI: 2.31 to 14.82, p = 0.007) compared with sham mobilization. No statistically significant differences were found between physical therapy plus mobilization and physical therapy plus exercise. Conclusion Mobilization may offer adjunctive, short-term benefits in improving the clinical symptoms of SIS when added to conventional treatments. Future studies should focus on evaluating the effects of mobilization as a stand-alone intervention, incorporate larger sample sizes and long-term follow-up, and conduct high-quality comparative trials to identify the most effective specific mobilization techniques.

The challenges of self-management among patients with recurrent hypertriglyceridemic acute pancreatitis: a qualitative study

Mapping and appraising evidence syntheses of resuscitation training for healthcare professionals: Protocol for a systematic review of reviews

Background The number of systematic reviews on resuscitation training has grown rapidly, offering valuable evidence to guide healthcare decision-making. However, methodological shortcomings can compromise validity and yield biased or misleading conclusions. This systematic review aims to systematically map the distribution of published systematic reviews on resuscitation training interventions, evaluate their methodological quality, investigate contextual and methodological factors associated with systematic review quality, and delineate priorities for future systematic reviews. Methods This systematic review protocol follows the PRISMA-P guidelines. A comprehensive search from the inception to August 2025 will be conducted across eight major databases, comprising CENTRAL, EMBASE, MEDLINE, ProQuest, Scopus, Web of Science, CINAHL, and ERIC, to identify published reviews on resuscitation training interventions for healthcare professionals and students, excluding laypersons. All reviews that are appropriate for the inclusion criteria will be screened and selected independently by two reviewers, with disagreements resolved by a third reviewer. Data extraction will cover study characteristics and methodological features, and quality appraisal will be performed using the AMSTAR 2 tool. Findings will be synthesized narratively following the SWiM framework, focusing on methodological rigor and evidence gaps. Conclusion This study will systematically evaluate the methodological quality of published systematic reviews on resuscitation training using the AMSTAR 2 tool, providing key insights to promote higher standards in systematic review conduct and reporting within healthcare education.