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Correction: Pooled prevalence and associated factors of traditional uvulectom among children in Africa: A systematic review and meta-analysis
Ultrasound-assisted green synthesis of 1,4-disubstituted 1,2,3-triazoles using natural polymer supports
Trends in public perceptions of patient safety during the COVID-19 pandemic: Findings from a repeated cross-sectional survey in Germany, 2019–2023
In recent years, public perceptions of patient safety have evolved significantly, driven by media coverage, healthcare reforms, and greater awareness during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to examine trends in public perceptions of patient safety, knowledge and self-efficacy in Germany during this pandemic between 2019 and 2023. A repeated cross-sectional study was conducted, using data from TK Monitor of Patient Safety. TK Monitor of Patient Safety in a nationwide survey assessing public perceptions of safety in medical treatment and diagnosis. Self-reported data were collected annually from a randomly selected sample of 1,000 different adults aged 18 and older residing in Germany. Statistical analyses included descriptive statistics, chi-square tests, and linear regressions for trend analyses. Our results revealed high perceived patient safety risk during the years of the study. Up to one third of respondents considered it very likely or somewhat likely that patients would be harmed when receiving medical treatment in hospital or ambulatory care, with lower perceived levels of risk before the COVID-19 pandemic. Regarding perceived prevalence of preventable adverse events, over half of respondents considered it very likely or somewhat likely that an illness of theirs would be diagnosed incorrectly, or that they would contract a nosocomial infection, at some stage in their lives. The majority of respondents considered themselves overall well informed about patient safety and reported higher levels of self-efficacy with regard to error prevention before and after the pandemic than during it. Given the facts that patient safety remains an important issue and that the German public perceives the level of patient safety risk but also of patient safety knowledge, and self-efficacy as high, actively involving patients in safety initiatives is essential for shaping positive public perception.
Resolvin D1 improves bleomycin-induced alveolar maturation arrest in newborn rats
Abstract Sustained, non-resolving inflammation is a fundamental mechanism that causes bronchopulmonary dysplasia (BPD). Specialized pro-resolving mediators (SPMs) are attracting attention as the new endogenous anti-inflammatory agents because they facilitate only the resolution phase of inflammation without affecting its acute phase, indispensable for the elimination of noxious microorganisms and damaged tissues. The preventive effects of resolvin D1 (RvD1), an SPM, were analyzed using bleomycin (Bleo)-induced BPD model of neonatal rats. Starting from the postnatal day (PD)-0, Bleo and RvD1 were administered simultaneously. At PD-14, morphological and immunohistochemical analyses, and the expression of key genes suspected to be involved in the Bleo-induced lung damage, were examined. Bleo injection successfully recapitulated the pathological features of BPD, such as alveolar enlargement and simplification with septal thickening. RvD1 effectively inhibited such alveolar dysmorphogenesis with attenuating macrophage infiltration and restoring the arrested capillary growth. It significantly suppressed the Bleo-induced upregulation of insulin-like growth factor-1 (IGF-1), tenascin-C, elastin, and anillin. The changes in IGF-1 protein expression in the bronchial and alveolar epithelia were confirmed by immunostaining. RvD1 effectively improves Bleo-induced model of alveolar maturation arrest of BPD. The supplementation of SPMs including RvD1 seems to be a promising treatment for the infants with BPD.
Machine learning-based predictive modeling of angina pectoris in an elderly community-dwelling population: Results from the PoCOsteo study
Background Angina pectoris, a comparatively common complaint among older adults, is a critical warning sign of underlying coronary heart disease. We aimed to develop machine learning-based models using multiple algorithms to predict and identify the predictors of angina pectoris in an elderly community-dwelling population. Methods Medical records of 2000 participants in the PoCOsteo study between 2018 and 2021 were analyzed. The Rose Angina Questionnaire was used to indicate angina pectoris. Preprocessing was performed using imputation and scaling methods. We developed the following models: logistic regression (LR), multilayer perceptron (MLP), support vector machine (SVM), k-nearest neighbors (KNN), linear and quadratic discriminant analysis (LDA, QDA), decision tree (DT), and two ensemble models: random forest (RF) and adaptive boosting (AdaBoost). To address model complexity and parameter uncertainty, we performed hyperparameter tuning and compared the trade-offs between model performance and interpretability, in addition to applying ten-fold cross-validation. To determine the importance of each feature as a measure of their contribution to the models’ performance, we conducted the permutation feature importance technique. Results With a mean age of 62.15 years (± 8.07) and 57.1% being female, 88.4% of the participants did not have angina, 3.6% had probable angina, and 8% had definite angina. The bivariate analysis revealed significant correlations between RAQ and several other variables. LDA, RF, and LR had the highest AUC values, averaging 0.772, 0.770, and 0.764, respectively. These three models outperformed QDA (AUC 0.752), SVM (0.733), AdaBoost (0.726), KNN (0.697), MLP (0.697), and DT (0.644). Permutation feature importance revealed a handful of features that implicated the role of thrombotic vascular diseases, congestive heart failure, renal failure, and anemia. Discussion Our study demonstrated that LDA, RF, and LR not only provided strong predictive performance but also balanced model complexity with interpretability. The superior performance of these models could be largely attributed to their ability to capture the relevant linear, nonlinear, and interaction effects inherent in the clinical data, as well as the clinical relevance of key predictors like thrombotic vascular diseases, congestive heart failure, renal failure, and anemia. Future studies could incorporate more direct diagnostic methods to test our findings further and enhance the robustness of the predictive models developed.
Acute cardiorespiratory physiological responses to functional electrically stimulated cycling in individuals with subacute phase traumatic cervical spinal cord injury
Trends in progress test performance of medical students at a university in Peru
Background Progress testing is a longitudinal assessment method used to monitor the acquisition and retention of knowledge throughout medical training. While progress tests (PTs) have been widely adopted internationally through collaborative networks of medical schools, in Peru, their implementation has been primarily institutional. This study aimed to evaluate longitudinal trends in PT scores at a Peruvian medical school. Methods We conducted a longitudinal analysis using data from PTs administered annually between 2017 and 2024. The PT assessed students’ knowledge based on the subjects completed at the time of testing. Scores ranged from 0 to 250 and were converted to a 20-point scale. Independent variables included number of PTs taken (1–7), year of entry into medical school (entry cohort; 2017–2024), year of test administration (2017–2024), and sex. Generalized estimating equations (GEE) were used to assess score trends over time, applying an identity link function with a Gaussian distribution and robust standard errors clustered by student ID. Results We included 1,899 test scores from 669 medical students. The mean score across all tests was 9.19 (standard deviation = 2.34). No consistent upward trend in PT scores was observed over the study period; scores decreased by 0.088 points per additional year (CI95% CI: −0.147 to −0.029, p = 0.003). Students who completed five PTs scored significantly higher than those who took four (β = 1.40; 95% CI: 0.79 to 2.01). When stratified by entry cohort, no sustained improvement in scores was observed within cohorts over time. Conclusion Over an eight-year period of administering a progress test at a Peruvian medical school, student performance remained stable, with an average of approximately 50% of questions answered correctly per test. Longitudinal analysis did not reveal a sustained increase in scores as students advanced through the curriculum. This pattern may be explained by the PT design, which assesses only the content covered by students at the time of each administration, in contrast to other PTs that measure end-of-curriculum knowledge across all cohorts. Nevertheless, an increase in median scores was observed during the transition from basic science to clinical subjects.
Temporal changes of hepatic drug-metabolizing enzymes mediated by hepatic ischemia-reperfusion injury and the protective effect of Oridonin
Nutritional deficiencies and abortions in sheep and goats: An in-depth study from East Azerbaijan Province, Northwest Iran
Vitamin and mineral levels in sheep and goat herds experiencing abortions in East Azerbaijan, northwest Iran, were studied. Between November 2023 and February 2024, 373 blood samples and 62 samples from aborted fetuses in various cities were collected. To find out whether a lack of selenium and copper in mothers led to heart and brain problems in their fetuses. Sheep and goats were mainly raised in a semi-intensive system, grazing from spring to mid-autumn and keeping indoors during winter. Sheep and goat flocks were categorized by size: small (1–100 sheep), medium (101–300 sheep), and large (over 300 sheep). The data show significant deficiencies in essential vitamins and minerals, affecting animal health and reproduction. A notable lack of vitamin A was observed in Bostan Abad. Widespread vitamin D deficiency was noted, especially severe in Jolfa, suggesting diet inadequacies despite enough sunlight. A slight deficiency of vitamin E was found, alleviated through farmers’ supplements helped some. Calcium and phosphorus deficiencies, particularly calcium, were also major concerns. Copper and zinc shortages were common across different cities. Aborted fetuses from copper-deficient mothers showed brain tissue damage, like Wallerian degeneration and neuronal necrosis. Severe iodine deficiency was observed in Marand and Khoda Afarin, risking thyroid and reproductive health and function. More than 87% of samples revealed significant selenium deficiency, indicating a need for supplementation. Pathological studies showed heart tissue damage in aborted fetuses from selenium-deficient mothers, including fragmentation, calcification, and necrosis. These results highlight the need for proper nutritional interventions and regular monitoring of vitamin and mineral levels to fix deficiencies. Proper nutrition in mothers is crucial for lowering abortion risks and fetal developmental issues. Our data highly recommend dietary changes and balanced vitamin and mineral supplements in the studied province, considering local factors such as soil quality, pasture, and crop residues.
Leisure activities indirectly affect depression in older chinese adults through activities of daily living and self-rated health
Registered nurse effect on long length of stay in the heart failure hospitalizations of African Americans
African Americans experience approximately 2.5 times more heart failure hospitalizations than Caucasians and the complexity of heart failure requires registered nurses to work in collaboration with other types of healthcare professionals. The purpose of this study was to identify care team configurations associated with long lengths of hospital stay in African Americans with heart failure hospitalizations and the related effect of the presence of registered nurses on their length of hospital stay. This study analyzed electronic health record data on the heart failure hospitalizations of 2,274 African American patients. Binomial logistic regression identified the association between specific care team configurations and length of stay among subgroups of African American patients. Of the significant team configurations, a Kruskal-Wallis H test and linear regression further assessed the team composition and the specific change in days associated with a one-unit change in the number of registered nurses on a patient’s care team. Six team configurations were associated with a long length of stay among all African Americans regardless of age, sex, rurality, heart failure severity, and overall health severity. The configurations only differed significantly in the proportion of registered nurses with respect to other care team roles. An increase in one additional registered nurse on a care delivery team was associated with an increase in length of stay of 8.4 hours (i.e., 504 minutes). Identifying the full range of social and technical care delivery tasks performed by RNs, and controlling for their effect on length of stay, may be a key strategy for reducing length of stay and explaining why these six configurations and RNs are associated with long LOS. The identification of these models can be used to support decision-making that optimizes the availability of patient access to high-quality care (e.g., clinical staffing and supplies).
Abacavir enhances the efficacy of doxorubicin via inhibition of histone demethylase KDM5B in breast cancer
Abstract KDM5B, a lysine-specific histone demethylase, is widely upregulated in breast cancer. The current study investigated the role of KDM5B in breast cancer and explored the repurposing potential of the antiviral drug abacavir (ABC). The cytotoxic effects and the effect of ABC sensitization on doxorubicin (DOX) efficacy were evaluated using 2-D and 3-D cell culture models. KDM5B expression was elevated in breast cancer tissues compared to normal breast tissues. In vitro studies demonstrated that ABC treatment reduced KDM5B expression in breast cancer cells and increased their sensitivity towards DOX. ABC induced late apoptosis and S-phase arrest, while the ABC + DOX combination led to S/G2 phase arrest, late apoptosis, and cell death. Data generated from patient-derived breast tumoroids corroborated the 2-D cell culture-based findings. Additionally, molecular docking studies indicated that the active drug metabolite carbovir triphosphate (CBV-TP) could interact with the DNA polymerase β-DNA complex, suggesting its potential mechanism to be incorporated into the DNA synthesis cycle, leading to cell cycle arrest in tumor cells. Our findings highlight the repurposing potential of ABC to target KDM5B in breast cancer. This approach enhanced the efficacy of DOX, which could allow further dose reduction and reduced side effects, offering a promising therapeutic strategy.
Evaluating the feasibility of study methods for a future trial-based economic evaluation of a multistage shared decision-making program for type 2 diabetes mellitus: Protocol for a cluster-randomized controlled pilot study
Introduction We developed a multistage shared decision-making program for type 2 diabetes that aims to support person-centered type 2 diabetes management in primary care. The program consists of an online patient decision aid, a preparatory consult for patients, and interprofessional training for healthcare professionals. The short- and long-term effectiveness of the multistage shared decision-making program needs to be researched in a trial-based economic evaluation. To evaluate the feasibility of study methods for such an evaluation, we will conduct a pilot study. In this article, we outline its protocol, which focuses on sample recruitment and retention, study management, and feasibility of outcome and cost measurements. Methods and analysis The multistage shared decision-making program will be pilot-tested in a cluster-randomized controlled trial in four primary care practices (located in the region of Gorinchem, the Netherlands) using a convergent parallel mixed-methods approach. The intervention practices will adopt the program, whereas the control practices provide usual care. Data collection will include recruitment, retention, and consent rates, patients’ sociodemographic and clinical characteristics, and the assessment of primary and secondary outcomes of the future trial-based economic evaluation. We will also collect data on the usage behavior of patients when completing questionnaires of the primary and secondary outcomes (i.e., time needed to complete questionnaires). Semi-structured interviews with patients will be conducted to obtain insights into the understandability and usability of measurement tools. Moreover, focus groups with healthcare professionals from participating practices will be organized to complement the quantitative data on sample representativeness and to assess the study management challenges of participating practices. Discussion The pilot will address uncertainties around the feasibility of a future trial-based economic evaluation, focusing on sample recruitment and retention, study management, and the feasibility of outcome and cost measurements. The results will guide the improvement of study procedures for the economic evaluation of our multistage shared decision-making program for type 2 diabetes. Trial registration The study is registered at ClinicalTrials.gov: NCT06410768.
A distinctive human fatty acid metabolism profile associated with osteoporotic patients
Disclosing disabilities: Barriers for medical school applicants
This study investigated the availability of accommodation request procedures for medical school admissions interviews and the accessibility of Technical Standards (TS) for candidates with disabilities (CWD) across Liaison Committee on Medical Education (LCME)-accredited institutions in the United States and Canada. Utilizing a cross-sectional study methodology, surveys were distributed to Deans of Admissions and Disabilities Resource Professionals (DRP) at all LCME-accredited US and Canadian MD programs. Surveys gathered data about interview formats, interview accommodation procedures, and TS accessibility during the 2018–2019 academic year. We received responses from 71 institutions (41.3%), with 56.3% survey completion rate (n = 40). Among respondents, interview formats varied: 26.8% (n = 19) Multiple Mini Interview, 32.4% (n = 23) Traditional Interviews, and 16.9% (n = 12) hybrid. 38% (n = 27) of respondents informed CWD of accommodation procedures before interviews. Ten institutions (14.1%) indicated they had updated their procedure since the 2018–2019 academic year, which demonstrated better overall outcomes. Statistical analyses showed significant differences between institutions with/without updated procedures in the total number of applicants who requested accommodations, were granted interviews, provided interview day accommodation, offered admission, and matriculated (p = 0.005). In 66.7% (n = 18) of respondent institutions, admissions staff were aware of initial interview accommodation requests and 44.4% (n = 12) involved admissions staff when communicating accommodation plans. Among 27 schools, 55.6% (n = 15) required no documentation to support the CWD’s need for accommodation; the rest required a form, clinician’s letter, past proof, or other methods. 56.3% (n = 40) responded questions about TS and confirmed posting them on their website, with 77.5% (n = 31) on their admissions webpage. 77.5% (n = 31) also reported including language in the TS that direct CWD to the institution’s disability office. This study reveals communication deficiencies about accommodations and TS requirements during the admissions process. Recommendations to enhance accessibility include informing candidates early about accommodation procedures and TS, and utilizing DRPs as CWD’s primary accommodation contact.
Association between the triglyceride-glucose index and major adverse cardiovascular events in patients with chronic kidney disease stages 3–4
Abstract The association between the triglyceride–glucose (TyG) index and the risk of major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) stages 3–4 has not been extensively studied. This study aims to investigate the relationship between baseline TyG index and MACE risk in a CKD stage 3–4 population. This study utilized data from the 2000–2022 China Renal Data System. Multivariate regression analysis models were constructed to explore the association between baseline TyG index and MACE. We employed restricted cubic splines to examine potential nonlinear correlations between these variables. Subgroup analyses were performed for different clinical endpoints. A total of 48,935 participants with CKD stages 3–4 were enrolled, with a mean TyG index of 8.88 [8.45, 9.38]. Participants were divided into quartiles based on TyG index values (quartile thresholds: 8.33, 8.78, 9.24). The overall prevalence of MACE was 15.90%. Multivariate Cox regression indicated a significant association between TyG quartiles and MACE occurrence, with hazard ratios (HR) of 1.08 (95% CI: 1.01–1.15, p = 0.016) for Quartile 1 and 1.12 (95% CI: 1.05–1.20, p = 0.001) for Quartile 4. Restricted cubic spline analysis revealed a nonlinear relationship between TyG index and MACE risk (P for nonlinearity < 0.001) among individuals with CKD stages 3–4. In patients with CKD stages 3–4, the TyG index shows a nonlinear association with the risk of MACE and all-cause mortality. These findings suggest that both elevated and reduced TyG index levels may increase the likelihood of MACE and all-cause mortality.
Prevalence and risk factors for Chlamydia trachomatis seropositivity and seropersistence among women: A prospective cohort study
Introduction Population-based Chlamydia trachomatis (CT) serology studies help evaluate the effectiveness of CT-control strategies. Determinants of CT seropersistence over time are largely unknown, but may include host genetic factors. This study aims to assess seropositivity, map antibody trajectories, and identify determinants of seropositivity and seropersistence. Methods We analyzed anti-chlamydial immunoglobulin G levels in serum of women of reproductive age who participated in a prospective cohort and CT screening study. CT history was determined using screening results and self-reported diagnoses from sexual debut onward. We assessed seropersistence for n = 1,405 participants with samples at baseline and after six years, and seropositivity for n = 2,997 participants with baseline samples. Multivariable logistic regression identified demographic, behavioral, and host single nucleotide polymorphism (SNP) factors associated with seropersistence and seropositivity. Results Among seropositive women at baseline, 42.0% (n = 118/281) were seropositive at follow-up. Seropersistence was more often found in women who reported treated asymptomatic and symptomatic CT infections as compared to those who did not (aOR: 3.74, 95%CI: 1.75–8.15 and 4.79, 95%CI: 2.42–9.47, respectively). Other associated factors were higher baseline antibody titers, carrying SNPs in TLR2 (aOR: 3.06, 95%CI: 1.31–7.36) and TLR9 (2.09, 95%CI: 1.09–4.08) genes and practical education (aOR: 3.16, 95%CI: 1.56–6.64). Seropositivity (24.9%, n = 748/2,997) was associated with a CCR5 deletion (aOR: 0.65, 95%CI: 0.42–0.99). Conclusions CT seropersistence was more often found in women who reported treated CT infections as compared to women who did not report having had a CT infection or receiving treatment for it. Genetic predisposition and behavioral factors are linked to diversity in seropersistence patterns.