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Pension levels of chinese institutions during the transition period: A case study of universities
Background With China’s rapidly aging population, the combined effects of this demographic shift and a growing wave of retirements present significant challenges for the sustainability of the basic pension system. To address these issues, China initiated reforms to the basic pension insurance system for institutions, including universities, on October 1, 2014, establishing a ten-year transition period. As this period nears its end, it is essential to analyze changes in retirement benefits for institutional retirees over the past decade. Materials and methods This study used representative data from retired employees in various post categories at Jiangsu universities, covering two periods: before the transition (prior to September 30, 2014) and during the transition (October 1, 2014, to December 31, 2023). The dataset included 1,200 retirees before the transition and 3,720 retirees during the transition. Results The income of retired university employees rose significantly before and during the transition period, with transition incomes surpassing those from earlier phases and stabilizing afterward. This increase was mainly due to the introduction of the occupational annuity system. Factors such as gender, retirement year, retirement age, payment index, post category, and level affected pension payment levels to varying extents. Notably, cumulative years of payment influenced by gender and other factors had the greatest impact on these levels. Conclusions The implementation of the occupational annuity system during the transition period revealed certain shortcomings in the endowment insurance reform. The transitional pension from the Social Collective Fund represents a significant portion of total pension expenditure, creating a heavy financial burden on the fund. Additionally, extending and standardizing retirement age for men and women can help reduce gender income disparities. Delayed retirement alleviates pressure on social pension systems by increasing individual incomes and aligning pension levels with societal needs. This approach promotes social equity and provides adequate care for older adults.
Process optimization of modified sodium persulfate for the remediation of total petroleum hydrocarbon contaminated soil
Petroleum hydrocarbon (TPH) contamination at industrial sites poses severe ecological and health risks to humans. However, conventional persulfate oxidation suffers from low efficiency and high oxidant demand requirements. To address this limitation, we employed citric acid-FeSO₄-modified sodium persulfate (FNS) for soil remediation.In this study, the petroleum hydrocarbon (TPH)-contaminated soil of a chemically contaminated site was used as the test object, and sodium persulfate modified by citric acid-FeSO4 (FNS) was selected as the oxidant. Based on laboratory tests, quantifying TPH degradation efficiency, soil pH variation, and sulfate leaching concentrations, the effects of oxidant dosage, oxidant dosage times, and CaO dosage on the remediation effect of petroleum hydrocarbon-contaminated soil were systematically investigated. The results demonstrated that citric acicd-FeSO4 significantly enhanced sodium persulfate activation (p < 0.01), achieving within 28 days a 36% higher TPH degradation efficiency than unmodified persulfate at 2% dosage. This modification amplified oxidation intensity and efficiency by up to 2.3-fold over the remediation period.For the contaminated soil with a petroleum hydrocarbon content of 16524 mg/kg, after a 28-day remediation period,FNS amendment achieved significant TPH reductions of 76.9% (to 3820 mg/kg) at 4% dosage-below Class II construction land in China’s soil environmental quality standard (4500 mg/kg). At a 6% dosage, after the same 28-day remediation period,reduction efficiency reached 95.5% (to 750 mg/kg) lower than the screening value of soil contamination risk for Class I construction land in China’s Soil Environmental Quality Standard (826 mg/kg). The FNS agent can significantly improve the oxidation strength and efficiency of sodium persulfate, but it causes soil acidification and exceeds the SO42- leaching concentration standard, among other things. The restored soil needs to be conditioned with CaO neutralization. In addition, FNS must be applied at one time and cannot be applied separately.
Combinatorial effects of Zingiber officinale and Citrus limon juices: Hypolipidemic and antioxidant insights from in vivo, in vitro, and in silico investigations
The combined use of Zingiber officinale (ginger) and Citrus limon (lemon) has been traditionally recognized for its therapeutic potential, particularly in promoting cardiovascular health. However, the synergistic effects of these botanicals on hyperlipidemia and oxidative stress, two major contributors to cardiovascular disease, remain insufficiently characterized. This study employed an integrative approach involving in vivo , in vitro , and in silico methodologies to assess the hypolipidemic and antioxidant properties of ginger and lemon juices. In vivo experiments were conducted using a murine model of Triton WR-1339-induced hyperlipidemia. Antioxidant activity was evaluated through DPPH and ABTS assays, while molecular docking simulations were performed to assess interactions with HMG-CoA reductase, a key enzyme in cholesterol metabolism. Phytochemical profiling revealed high levels of bioactive compounds, with ginger juice containing 6-gingerol (15.54% peak area), and lemon juice rich in hesperidin (13.85%) and rutin (5.57%). These constituents likely contributed to the observed pharmacological effects. The combined formulation led to marked improvements in lipid parameters, including reductions in total cholesterol (−54.3%), triglycerides (−49.8%), and LDL-C (−58.1%), alongside an increase in HDL-C (+47.6%) compared to hyperlipidemic controls (p < 0.05). Antioxidant assays further demonstrated strong free radical scavenging activity, with IC₅₀ values of 30.92 ± 2.00 µg/mL (ABTS) and 44.94 ± 1.02 µg/mL (DPPH) for the combined formulation. Molecular docking confirmed high binding affinities of key compounds, with hesperidin and 6-gingerol displaying binding energies of −10.4 and −9.6 kcal/mol, respectively, against HMG-CoA reductase. In summary, the combination of Zingiber officinale and Citrus limon juices exhibited potent lipid-lowering and antioxidant activities, outperforming the effects observed with individual extracts. These findings underscore their potential as natural therapeutic agents for the management of hyperlipidemia and oxidative stress. Further clinical investigations are warranted to validate these preclinical results and to explore their future application in the development of nutraceuticals or functional foods.
Relationship between Sn elemental background values and regional longevity levels—Data from Yunnan, China
The relationship between the geographic environment and human health has been a long-standing focus of scientific inquiry. Sn as an essential trace element for the human body, play vital roles in individual health and may influence longevity. However, the extent to which the statistical characteristics of population longevity are associated with elemental geochemical background values at a regional scale remains an important question. Based on the geochemical survey data of Yunnan Province and Chinese census data, the article utilizes Arcgis spatial analysis and mathematical statistics to explore the relationship between ω(Sn) and regional longevity level. The results of the study show that: (1) There is a close correlation between ω(Sn) and regional longevity levels. Within Yunnan Province, regions with high ω(Sn) have higher levels of longevity index and Ultra-octogenarian Index. (2) Spearman’s correlation coefficient shows that ω(Sn) is significantly positively (P < 0.01) correlated with both the longevity index and the Ultra-octogenarian Index; Linear regression further reveals that ω(Sn) always has a significant positive influence on the longevity index. For the Ultra-octogenarian Index, although the strength of the influence of ω(Sn) is not as significant as that of the longevity index, its influence on the healthy longevity of the population cannot be ignored. At the county scale in Yunnan Province, there is a significant positive correlation between ω(Sn) and longevity index, which may be related to the exposure of Sn in the natural environmental background into the human body and thus affecting the incidence of cancer, but the biogeochemical cycling mechanism of its association with longevity still needs to be further investigated.
Effect of opaque porcelain on color and aesthetic outcomes of titanium-abutment implant restorations
Objective This study evaluated the effects of opaque porcelain (OP) on color parameters and aesthetic outcomes of all-ceramic implant restorations with varying abutment types and restoration thicknesses. Methods Four types of zirconia discs were fabricated:(A) 1.5 mm zirconia; (B) 1.4 mm zirconia + 0.1 mm OP; (C) 2.0 mm zirconia; (D) 1.9 mm zirconia + 0.1 mm OP. These discs were bonded to titanium (t) or all-ceramic (c) backgrounds to form At, Ac, Bt, Bc, Ct, Cc, Dt, and Dc specimens,to simulate the aesthetic results of implant restorations with or without OP on titanium or all-ceramic abutments. The assembled specimens were placed at the center of a dark backboard in a specialized constructed photography platform, and a professional camera was used to acquire images of the specimens. Eight regions of interest on the image were selected, and color parameters in the form of L*, a*, and b* values and variations determined via the CIELAB color measurement system were analyzed using Adobe Photoshop software.Color differences (ΔE) between samples were quantified. Statistical comparisons of color parameters were conducted using the Kruskal-Wallis H test and Welch’s t-test. Results There were significant differences in L*, a*, and b* between all-ceramic and titanium backgrounds in all types of zirconia specimens (p < 0.001). The application of OP influenced the brightness and chroma of zirconia restorations on titanium backgrounds. ΔE values between restorations with metal substrate and OP, and those with all-ceramic substrate but without OP, (△E (Ac/Bt)= 1.99 ± 0.86; △E(Cc/Dt)= 1.31 ± 0.83) indicated that OP effectively mitigated the color compromise caused by metallic implant abutments. The greater the thickness of the restoration, the smaller the color difference caused by the titanium background. Conclusion This study revealed that titanium abutments can affect the color of implant-supported restorations. The application of OP on restorations reduces the titanium abutment’s color impact, and this effect improves with increased zirconia thickness.
Resolution of physics and deep learning-based protein engineering filters: A case study with a lipase for industrial substrate hydrolysis
Computational enzyme design remains a powerful yet imperfect tool for optimizing biocatalysts, especially when targeting non-natural substrates. Using design tools we investigated Pseudomonas aeruginosa LipA, a lipase with a flexible lid domain crucial for substrate binding and turnover, aiming to enhance its hydrolysis of the industrially relevant substrate Roche ester. We generated an initial set of single-point mutations based on structural proximity to the active site and evaluated their effects using a computational pipeline integrating molecular dynamics (MD) simulations, density functional theory (DFT) calculations, and ensemble-based energy scoring. While we identified several active variants, attempts to rank them by activity using structural features, such as hydrogen bond formation or residue flexibility, failed. Deep learning models, applied post hoc for structural analysis via AlphaFold3, produced nearly identical active site geometries across variants, irrespective of activity. Reaction pathway analysis revealed energy barriers varying by 5–15 kcal/mol depending on substrate conformation, with the nucleophile addition step consistently rate-limiting. However, these small energetic shifts, likely critical for incremental activity changes, were indistinguishable by current computational or deep learning methods. Our results highlight the limitations of existing approaches in resolving subtle functional differences and underscore the need for improved benchmarks, reactive force fields, and more sensitive ranking metrics. Advancing these areas will be essential for designing enzymes with gradual, evolution-like activity improvements and for bridging the gap between structural prediction and catalytic function.
Everything, everywhere, all at once - Surveillance and molecular epidemiology reveal Melissococcus plutonius is endemic among Michigan, US beekeeping operations
European foulbrood (EFB) is a severe bacterial disease of honey bee brood often leading to significant declines in colony health and honey production. The dearth of data on this disease in the United States (US) complicates response efforts. In 2021 and 2022 we conducted a two-year cross-sectional surveillance study among Michigan beekeepers to establish baseline pathogen and disease prevalence. We combined this surveillance with molecular epidemiology to investigate genetic diversity, and transmission dynamics of Melissococcus plutonius, the causative agent of EFB, in US honey bee colonies. PCR screening detected M. plutonius in all 15 migratory and stationary beekeeping operations and in 6 of 14 hobby beekeeping operations. Infection and disease were found to be seasonal, with prevalence of both peaking in June when over half the colonies were infected, and over 20% had clinical EFB. Whole genome, single nucleotide polymorphism analysis revealed wide genetic diversity even within a single hive. Operations often had multiple genotypes present which varied from year to year, consistent with high rates of transmission and reinfection. Prevalence and whole genome data provided here will be critical in tracking the efficacy of mitigation efforts and underscore the necessity of additional epidemiological investigations.
Evaluation of statistical regression models in predicting factors influencing HBV and HIV among female sex workers in Ghana: A Bio-behavioural survey
Purpose This study aims to evaluate the effectiveness of parametric statistical methods—specifically logistic regression, Poisson regression, and Cox proportional hazards models—in identifying factors influencing Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) infections among female sex workers (FSWs) in Ghana. The primary focus is to assess infection prevalence and determine how well the Cox model identifies significant predictors. Methods A cross-sectional survey was conducted, recruiting 7,000 female sex workers (FSWs), with 5,990 completing both biological sampling and structured interviews, 5,052 for HBV and 5,426 for HIV variables. Time-location sampling ensured a representative sample. The prevalence of HBV and HIV was calculated, and a Cox proportional hazards model was employed to identify key risk factors. Hazard ratios (HRs) and p-values were used to evaluate the strength and significance of these associations. Result The prevalence of HBV among FSWs was found to be 6.53% (95% CI: 6.08%–7.01%), while the prevalence of HIV was 4.53% (95% CI: 3.46%–5.92%). Significant predictors for HBV included alcohol consumption during sex (HR = 1.34, p = 0.042) and avoidance of healthcare due to stigma (HR = 1.64, p = 0.023). For HIV, older age was a significant risk factor, with hazard ratios of 1.60 (p = 0.007) for individuals aged 25–35 and 2.20 (p = 0.001) for those over 35 years old. Education appeared to be a protective factor: secondary education reduced HIV risk by 67% (HR = 0.33, p < 0.001), and higher education reduced risk by 60% (HR = 0.40, p = 0.019). The Cox model outperformed both logistic and Poisson regression in its ability to discriminate between risk factors and predict infection outcomes. Conclusions The Cox proportional hazards model proved highly effective in identifying the key risk factors for both HBV and HIV. Behavioral factors like alcohol use, social determinants such as stigma, and demographic variables such as age and education played significant roles in influencing infection risks. These findings highlight the need for tailored public health interventions that address alcohol-related behaviors, reduce stigma, and improve health literacy among FSWs.
Transient vascular occlusions in a zebrafish model of mycobacterial brain infection
Mycobacterial brain infection, for example tuberculous meningitis (TBM), caused by Mycobacterium tuberculosis, is a severe manifestation of tuberculosis that occurs when the bacteria invade the brain. In addition to extensive inflammation, vascular complications such as stroke frequently arise, significantly increasing the risk of disability and death. However, the mechanisms underlying these vascular complications remain poorly understood, as current knowledge is derived exclusively from human studies. To date, no animal model has been established to investigate the onset and progression of vascular pathology in TBM. Here, we use transparent zebrafish larvae to investigate vascular pathology during the early stages of TBM, establishing a model for studying vascular complications from mycobacterial brain infection. We find that mycobacteria preferentially attach to the lumen of vessel bifurcations and induce vessel enlargement. These attached microcolonies are sufficient to occlude brain blood vessels in the absence of an organized thrombus. The majority of microcolony-associated occlusions are transient and contribute to global hypoperfusion of the brain. These vascular disruptions lead to accumulation of oxidative stress and cell death in both the vasculature and neurons. Taken together, these findings demonstrate the occurrence of ischemic events during the early stages of mycobacterial brain infection and establish an animal model for studying vascular complications in TBM.
Correction: Sarcopenic obesity in predialysis chronic kidney disease: Muscle strength is a predictor of mortality and disease progression in a six-year prospective cohort
A meta-analysis of the prevalence, genotype distribution and risk factors for human papillomavirus infection in Nepal
This systematic review and meta-analysis estimated the prevalence, genotype distribution, and risk factors for human papillomavirus infection among Nepalese women. A total of 8 cross-sectional studies with 6,082 participants were included in this review. For this review, the eligibility criteria included studies reporting HPV prevalence or genotype-specific rates among Nepalese women; thus, database sources were searched up to December 2024. The quality of the studies was assessed, and pooled estimates were computed via random effects models. The pooled prevalence of HPV infection among Nepalese women was 8.31%, with a genotype-specific prevalence of 2.62% for HPV-16 and 1.25% for HPV-18. HPV infection was significantly associated with those whose husbands had multiple sexual exposures. Other factors, including smoking status, educational status, and the use of contraceptives, were not significantly associated. Most analyses showed moderate to high heterogeneity. This review highlights the moderate burden of HPV infection in Nepal; hence, targeted public health intervention through vaccination and screening programs is recommended. Limitations include heterogeneity of studies and an inability to draw causal interference because all the data were cross-sectional. The findings highlight the need for region-specific strategies to combat HPV-related diseases in Nepal and underscore the importance of future research to address existing knowledge gaps. This review is registered in PROSPERO with registration number CRD42025632655.
Identifying the influencing factors for cataract surgery uptake in Malaysia
Background/Aims In 2014, Malaysia conducted National Eye Survey II (NES II) using the World Health Organization (WHO)-recommended Rapid Assessment of Avoidable Blindness (RAAB) methodology across six administrative regions. The survey revealed significant discrepancies in key national eye care indicators, including prevalence of blindness, cataract surgery outcome, and effective Cataract Surgical Coverage (eCSC). In response, the Ministry of Health (MOH) launched the Klinik Katarak Kementerian Kesihatan Malaysia (KK-KKM) initiative, which includes mobile cataract surgical services to improve equitable access in the underserved areas in Sarawak and the Eastern Region. Despite endorsement and consistent operational funds, variations in cataract surgery uptake between regions persisted. We postulate that this disparity could be due to community-related factors and their interactions. In 2023, follow-up surveys were conducted in both regions to compare outcomes over time. The eligible subjects were consecutively recruited for a questionnaire interview. This study aims to identify the factors influencing cataract surgery uptake in Malaysia, specifically in Sarawak and Eastern Region. Methods A cross-sectional survey was carried out in 2023 using RAAB methodology, targeting individuals aged 50 years and above. Subjects with operable cataract with Pinhole Visual Acuity worse than 6/18, or a history of cataract surgery, were interviewed using the validated 22-item CatSurg-U questionnaire focused on Knowledge, Perception, Attitude and Practice. A total of 1,119 respondents (Sarawak: 408; Eastern 711) were recruited from 203 clusters. Binary logistic regression was used to identify demographic, socioeconomic and other predictors associated with non-uptake of cataract surgery. Results The identified factors that influenced individuals with unilateral operable cataracts to have “no surgery” in Sarawak included their “perception to own sight” [AOR: 0.67, 95% CI (0.53, 0.84) P = 0.001] and “attitude towards treatment” [AOR:1.47, 95% CI (1.17, 1.85) P = 0.001]. Meanwhile, in the Eastern region, the factors were “perception to own sight” [AOR: 0.80, 95% CI (0.69, 0.92) P = 0.002], “attitude towards treatment” [AOR:1.15, 95% CI (1.03, 1.29) P = 0.016], and “practice towards information” [AOR: 1.23, 95% CI (1.01, 1.50) P = 0.042]. For subjects with bilateral operable cataract in Sarawak, the factors that influenced them to have “no surgery” were “knowledge on surgery” [AOR: 0.35, 95% CI (0.25, 0.50) P < 0.001], “perception to own sight” [AOR: 1.48, 95% CI (1.15, 1.89) P = 0.002], ethnicity (Chinese compared to Malays) [AOR: 0.19, 95% CI (0.04, 0.88) P = 0.033] and education level (primary school compared to secondary school or above) [AOR: 5.54, 95% CI (1.49, 20.69) P = 0.011]. Additionally, for the Eastern region, the factors identified were “knowledge on surgery” [AOR: 0.35, 95% CI (0.26, 0.48) P < 0.001] and “practice on surgery” [AOR: 0.72, 95% CI (0.62, 0.84) P < 0.001]. Conclusion “Perception to own sight”, “attitude towards treatment”, and “knowledge on surgery” were key factors in both regions. Additional barriers in Sarawak include ethnicity and education levels, while in the Eastern Region, “practice towards information” and “practice on surgery” were key factors. Addressing these factors through targeted strategies such as enhancement of mobile outreach programs, public education, and service capacity expansion is essential. Collaborative efforts are needed to improve eye care delivery and ensure equitable access nationwide.
Traumatic brain injury reprograms lipid droplet metabolism shaped by aging and diet in Drosophila brain
Traumatic brain injury (TBI) initiates secondary cellular damage such as mitochondrial dysfunction, oxidative stress, and neuroinflammation. In neurodegenerative disorders, these stressors are associated with accumulation of lipid droplets (LDs) – organelles that store neutral lipids to provide energy and protect cells from lipid toxicity. However, the regulation of LD metabolism following TBI remains poorly understood. Using a Drosophila melanogaster model, we investigated how TBI influences LD accumulation, particularly in relation to aging and diet, other LD modulatory factors. Confocal microscopy of fly brains at one day after injury showed increases in both LD size and number. The rise in LD number occurred only in flies fed a carbohydrate-rich diet and was absent in those given a ketogenic diet (KD) or water, suggesting that glucose availability is necessary for LD formation post-injury and potentially underlying why KD and water do not elicit the deleterious outcomes observed with carbohydrates. Lipidomic analysis of fly heads further revealed elevated levels of triacylglycerol (TG) species typically stored in LDs, indicating enhanced lipid synthesis post-injury. By seven days post-injury, LD size and number returned to baseline levels observed in uninjured flies and remained stable through 14 days post-injury. However, by 21 days post-injury, uninjured flies showed a marked increase in LD number that was not observed in injured flies, although LD size increased in both groups. These findings suggest that TBI selectively impairs age-dependent production of new LDs without affecting the growth of existing LDs. Importantly, TG levels remained elevated in heads of injured flies, indicating that the reduction in LD number was not due to limited lipid availability. Together, our findings indicate that TBI acutely induces LD formation as a protective response but chronically impairs LD biogenesis, disrupting lipid homeostasis in an age- and diet-dependent manner that may contribute to neurodegeneration.
An interpretable LightGBM model for predicting coronary heart disease: Enhancing clinical decision-making with machine learning
Background Coronary Heart Disease (CHD) is one of the major burdens of cardiovascular diseases worldwide. Traditional diagnostic methods, such as coronary angiography and electrocardiogram, face challenges including high costs, subjectivity, and high misdiagnosis rates. To address these issues, this study proposes a prediction framework for CHD based on the LightGBM algorithm, aiming to improve the accuracy and interpretability of CHD risk prediction. Methods This study utilized three publicly available datasets: BRFSS_2015, Framingham, and Z-Alizadeh Sani. The BRFSS_2015 dataset was used for model training, while the Framingham and Z-Alizadeh Sani datasets were employed for validation. Data preprocessing included cleaning, feature engineering, and handling missing values. The LightGBM model was selected for its efficiency and performance, and SHAP (SHapley Additive exPlanations) values were used to enhance model interpretability. Model performance was evaluated using metrics such as accuracy, precision, recall, F1-score, and AUROC. A CHD scoring system was developed based on the model’s predictions to assist clinicians in risk assessment. Results The LightGBM model demonstrated excellent performance, achieving an accuracy of 90.60% and an AUROC of 81.06% on the BRFSS_2015 dataset. After parameter tuning, the model’s accuracy improved to 90.61%, and the AUROC increased to 81.11%. On the Framingham dataset, the accuracy improved from 83.96% to 85.26%, and the AUROC increased from 62.86% to 67.37%. On the Z-Alizadeh Sani dataset, the accuracy improved from 78.69% to 80.33%, and the precision increased from 74.40% to 76.36%. Conclusions SHAP analysis revealed that age, smoking status, diabetes, hypertension, and high cholesterol were the most influential features in predicting CHD risk. The developed CHD scoring system provided a user-friendly tool for clinicians to assess patient risk levels effectively.
Childhood vaccines up for review in the US: what’s at stake
Region-specific variation and determinants of caesarean delivery among ever-married women in Bangladesh
Background The extensive use of caesarean delivery has adverse consequences for both maternal and neonatal health. This study aims is to investigate regional variation and identify region-specific determinants of caesarean deliveries among ever-married women in Bangladesh. Methods A total of 17,704 women aged 15–49 who had given birth to children within three years preceding each of the surveys were included in this study, based on the last four consecutive nationally representative surveys between 2011 and 2022. Various demographics and socio-economic variables were considered as exposure variables. Bivariate and multiple mixed-effects logistic regression models were used to draw inferences from the data. Results In Bangladesh, between 2011 and 2022, the percentage of caesarean deliveries increased threefold (15% to 46%). Additionally, more than half of the children born in Dhaka and Khulna were via caesarean deliveries. After adjusting for relevant covariates in each of the region-specific models, women with highly educated husbands had significantly higher odds of undergoing a caesarean delivery compared to those with less educated husbands in Barisal (OR: 4.48), Chattogram (OR: 2.69), and Rangpur (OR: 2.46) divisions. The likelihood of caesarean delivery was considerably higher among overweight or obese women in Dhaka and Sylhet (OR: 2.33 and 2.50), as well as among women living in households with higher wealth status than their counterparts in Sylhet and Khulna (OR: 2.95 and 2.22), respectively. Conclusion Policymakers can address the high rate of caesarean deliveries by targeting several key factors at various geographic levels. Raising family awareness about the benefits of normal delivery can encourage expectant parents to make informed choices. They should also ensure the quality of care provided in hospitals, ensuring that medical professionals follow evidence-based guidelines for childbirth. Furthermore, implementing a centralized or local pregnancy registration system may enhance the monitoring and access to maternal health services.
Comparative outcomes of laparoscopic lateral suspension, sacrocolpopexy, and transvaginal mesh for advanced apical prolapse: A retrospective cohort study
Objective To compare perioperative outcomes and long-term anatomical/functional efficacy of laparoscopic lateral suspension (LLS), laparoscopic sacrocolpopexy (LSC), and transvaginal mesh (TVM) procedures in women with POP-Q stage III–IV apical prolapse. Methods This retrospective cohort included 98 participants undergoing surgical repair between 1/1/2021 and 30/12/2021: 34 TVM, 35 LSC, and 29 LLS. Concomitant hysterectomy or uterine preservation was performed based on clinical indications. Anatomical outcomes were assessed via Pelvic Organ Prolapse Quantification (POP-Q) measurements, while functional outcomes and quality of life (QoL) were evaluated using Pelvic Floor Distress Inventory Questionnaire (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) questionnaires preoperatively and at 2-year follow-up. Multivariable regression adjusted for age, BMI, parity, and surgical approach. Results LLS demonstrated superior perioperative outcomes, including shorter operative time (3.07 ± 0.15 vs. 4.59 ± 0.13 hours for LSC, p < 0.05), reduced blood loss (64.48 ± 4.62 vs. 116.18 ± 8.10 mL for TVM, p < 0.05), and shorter hospitalization (5.17 ± 0.20 vs. 6.21 ± 0.27 days for TVM, p < 0.05). Groin pain incidence was higher in TVM (21% vs. 0% in LSC/LLS, p < 0.05). All groups achieved significant anatomical restoration (POP-Q points p < 0.001) and QoL improvements (PFDI-20: TVM 97.31 → 8.37, LSC 108.92 → 5.76, LLS 110.89 → 6.64; PFIQ-7: TVM 103.86 → 3.45, LSC 113.24 → 9.28, LLS 122.99 → 8.04; p < 0.001). No intergroup differences persisted after adjusting confounders. Notably, TVM participants with uterine preservation reported significantly better PFIQ-7 scores than hysterectomy subgroups (0.96 ± 0.52 vs. 6.60 ± 3.46, p < 0.05), whereas LSC/LLS showed no such disparity. Conclusion LLS, LSC, and TVM effectively restore anatomy and QoL in advanced apical prolapse, with LLS offering optimal perioperative safety. Uterine preservation during TVM enhances postoperative satisfaction, suggesting individualized surgical planning is critical. Long-term complications and durability require further investigation.
Maintenance
The increase in varus tilt of the joint line convergence angle under weight-bearing is correlated with medial meniscus extrusion in patients with knee osteoarthrosis
Background Increased medial meniscus extrusion (MME) in weight-bearing conditions is a critical factor associated with knee osteoarthritis (OA) progression and is not an alternative indicator in nonweight-bearing. This feature is related to mechanical stress. However, its correlation with varus knee alignment, reflecting the loading stress on the medial compartment, is still unknown. This study aimed to determine whether increased MME is associated with varus limb alignment. Method Seventy patients with knee OA were recruited for this cross-sectional study. The MME was assessed using ultrasonography. Knee alignments were determined by whole-leg radiography in the standing position, and factors related to the loading stress on the medial compartment of the knee joint were detected, such as the hip-knee-ankle angle, percentage of the mechanical axis, medial proximal tibial angle, and joint line convergence angle (JLCA). MME and JLCA were evaluated under two conditions: nonweight-bearing and weight-bearing, and the increased values were determined as the difference between the conditions (Δ values). Results MME and JLCA were significantly higher in the weight-bearing condition than in the nonweight-bearing. The described alignment for MME under nonweight-bearing in the liner model was HKAA, where the ΔMME was ΔJLCA. Conclusion The factors of increased MME in weight-bearing conditions differed from those of MME in nonweight-bearing conditions, as shown by the amount of change in JLCA under loading stress.