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Quantitative evaluation of therapeutic effect of silver needle thermal conduction therapy on myofascial trigger point
Background In clinical practice, silver needle thermal conduction therapy has a definite effect on myofascial pain syndrome (MPS). However, there is a lack of objective evidence to evaluate the efficacy of this therapy. This study aimed to assess the effectiveness of silver needle thermal conduction therapy on MPS rats by objective therapeutic index. Methods MPS model was established by blunt strick combined with centrifugal running training. MPS rats were divided into model and treatment groups, with a synchronized control group. The model group received no treatment, whereas the treatment group underwent silver needle thermal conduction therapy. The T2 value and stiffness values were evaluated by magnetic resonance imaging and sound touch elastography. The ultrastructure of muscle mitochondria was examined using transmission electron microscopy, and the Silent mating type information regulation 2 homolog 3 (SIRT3) expression level was evaluated by western blotting. Results T2 values and elastic modulus values in the treatment group were lower than those in the model group, and there was no difference between the treatment group and the control group. Mitochondrial damage was observed in the model group, and the degree of mitochondrial damage in the treatment group was less than that in the model group. SIRT3 expression in the treatment group was down-regulated compared with the normal group, but up-regulated compared with the model group. Conclusion The silver needle thermal conduction therapy demonstrates the ability to reduce muscle inflammation and stiffness and facilitate the repair of damaged muscle mitochondria.
Stability and physical compatibility of parenteral nalbuphine hydrochloride during continuous infusion in pediatrics
In pediatric practice, nalbuphine hydrochloride can be administered by continuous infusion through a multiport manifold or Y-site connection over 24 h in a 60 mL polypropylene syringe unprotected from light at concentrations ranging from 52.1 µg.mL-1 to 333.3 µg.mL-1 in normal saline (NS). To limit the need for multiple injections, nalbuphine hydrochloride may be co-administered with other drugs. Its stability and compatibility were already studied at concentration ranges equal or higher than 1.0 mg.mL-1. However, when nalbuphine hydrochloride needs to be diluted for a pediatric administration its stability in NS over 24 h of light exposure at ambient temperature and its compatibility with other drugs have never been studied before. A novel chromatographic method using high-performance liquid chromatography (HPLC) was validated by the International Council for Harmonisation (ICH) Q2 (R1) guidelines. The stability of nalbuphine hydrochloride and the appearance of degradation products under five experimental conditions (light, heat, oxidation, basicity, and acidity) were monitored by HPLC-UV for 24 h at ambient temperature at three concentrations administered in pediatric departments (52.1 µg.mL-1, 166.7 µg.mL-1 and 333.3 µg.mL-1). The physical compatibility of nalbuphine hydrochloride with 1:1 (v/v) mixtures of selected drugs used in pediatrics was evaluated by visual inspection and with a 10 µm and 25 µm sub-visible particle counter. Our nalbuphine hydrochloride quantification method has been validated and was stability-indicating. The stability of nalbuphine hydrochloride and the forced degradation assay (light, heat, oxidation, basicity, and acidity) studied for the three concentrations of nalbuphine hydrochloride diluted in 48 mL of NS and stored in a 60 mL polypropylene syringe unprotected from light were compliant for at least 24 h at ambient temperature. Nalbuphine hydrochloride in NS was found to be compatible with several drugs, but was incompatible with furosemide and amphotericin B. Nalbuphine hydrochloride can be administered in pediatric practice using a syringe pump for 24 h. However, drug-drug incompatibilities need to be considered when it is administered through a multiport manifold or Y-site connection.
Impact of COVID-19 on the awareness and interest in infectious disease specialization among Japanese medical students
Background The SARS-CoV-2 pandemic has highlighted the critical deficiency of infectious disease (ID) specialists, a subspecialty that remains underrepresented among Japanese medical students. Methods This nationwide cross-sectional survey was administered between April and August 2024 via an online questionnaire distributed to medical students throughout Japan. The survey assessed awareness of and interest in ID specialization, categorizing students by academic year: lower (first- and second-year students), middle (third- and fourth-year students), and upper grades (fifth- and sixth-year students). Results Of 502 respondents, data for 492 medical students were eligible, of whom 69.7% demonstrated awareness of ID specialists, with recognition rates increasing proportionally with academic progression. Regarding career aspirations, 9.8% of respondents expressed interest in pursuing ID specialization, with the highest proportion observed among upper-grade students (19.4%). Male students (14.8%) expressed greater interest in ID specialization than female students (5.2%). The pandemic positively influenced 5.5% of students to consider ID specialization as a future career, whereas only 0.6% reported a negative impact. Conclusions These findings underscore the necessity of enhanced educational initiatives to promote ID specialization among medical students, addressing current shortages and future infectious disease preparedness.
Retraction: National income accounting attributes and economic welfare. Evidence from Pakistan
Estimating braking and propulsion forces during overground running in and out of the lab
Accurately estimating kinetic metrics, such as braking and propulsion forces, in real-world running environments enhances our understanding of performance, fatigue, and injury. Wearable inertial measurement units (IMUs) offer a potential solution to estimate kinetic metrics outside the lab when combined with machine learning. However, current IMU-based kinetic estimation models are trained and evaluated within a single environment, often on lab treadmills. The transferability of these treadmill-trained models during overground running in and out of the lab is underexplored, and the individualization and validation of such models remain a challenge. Toward bridging this gap, we trained a generalized model on treadmill data of 15 recreational runners and evaluated braking and propulsion force estimates during overground running in and out of the lab. We explored fine-tuning with individual data from lab-based overground running to quantify model performance improvements with individualization. The generalized and fine-tuned models were extrapolated to outdoor running for a subset of five participants, and estimates were compared to lab-based overground measurements. Evaluating the generalized model with a leave-one-out cross validation yielded overground braking and propulsion force root mean squared error of 4.3 ± 1.1 % bodyweight (%BW). Fine-tuning this model with eight strides reduced error to 2.6 ± 0.5 %BW. Outdoor force predictions from the fine-tuned model better aligned with expected linear trends between braking/propulsion impulses and speed than the generalized model. These results provide insights into the accuracy and applicability of IMU data-driven models for braking and propulsion estimation during overground running, facilitating the development of practical, individualized biomechanical analysis tools for real-world use.
Immunotherapy using CAR T cells shows promising long-term outcomes for people with the blood cancer myeloma
A System dynamics analysis of the factors influencing the promotion of prefabricated decoration, based on a co-occurrence network
Prefabricated decoration effectively addresses resource waste, environmental pollution, and quality issues associated with traditional decoration methods. It also enhances the functionality of prefabricated buildings and offers promising market potential. Currently, insufficient attention from both the public and managers hinders prefabricated decoration development. To address this, this study analyzed 68 relevant documents from the China National Knowledge Infrastructure and Web of Science databases, identified 34 factors affecting the promotion of prefabricated decoration, and constructed a co-occurrence network model based on an adjacency matrix. The centrality index was used to identify four key factors related to the three core stakeholders: government support, technical level, developers’ willingness to use, and consumers’ willingness to use. Subsequently, the four key factors were simulated using Vensim software. The evolutionary trends of the system and the interactions between these factors were analyzed. The findings reveal that both developers and consumers show strong sensitivity to financial subsidies. As a result, the government can effectively increase subsidies to encourage adoption of prefabricated decoration. Additionally, enhancing the use of BIM technology throughout the project life cycle has been shown to promote synergy within the industrial chain, thereby improving promotion efficiency. Consumer feedback is essential for ensuring policy accuracy and plays a crucial role in advancing the industry's development. The novel contributions of this paper include the integration of co-occurrence network analysis with a system dynamics model, identifying key factors through the co-occurrence network, and uncovering the complex interactions between these factors via the system dynamics model. Based on the simulation results, this study predicts the development prospects of prefabricated decoration, offering both a theoretical foundation and practical guidance for policy formulation and promotion strategies.
Mating-induced neurogenesis and cell proliferation in male rats depend on opioid signaling
In the adult brain, neurogenesis primarily occurs in the dentate gyrus of the hippocampus (DG) and the olfactory bulbs, with new cells migrating from the subventricular zone. Additionally, small amounts of cell proliferation have been observed in the preoptic area (POA) and the amygdala (AMG), regions involved in the control of male sexual behavior. Sexual activity induces a reward state mediated by opioids, and our group previously demonstrated that neurogenesis induced by paced mating is opioid dependent in female rats. Therefore, in the present study, we examined whether naloxone hydrochloride could block the cell proliferation and neurogenesis induced by mating in male rats. We evaluated cell proliferation and neurogenesis in the DG, main (MOB) and accessory (AOB) olfactory bulbs, POA and AMG across 6 groups of male rats: without sexual contact injected with saline or NX, males that mated until they ejaculated once injected with saline or NX and males that mated until they ejaculated 3 times injected with saline or NX. Our findings indicated that the increase of cell proliferation and neurogenesis observed after 3 ejaculations was abolished by NX administration in the glomerular layer of both the AOB and MOB. The same effect was observed in the granular layer of the MOB. In contrast, NX did not reduce the cell proliferation induced by 3 ejaculations in the granular layer of the AOB, but significantly reduced neurogenesis. In the DG, cell proliferation and neurogenesis were increased by 3 ejaculations and NX blocked this effect. Finally, analyses of the AMG and POA revealed that NX blocked the cell proliferation induced by 3 ejaculations. This study highlights the central role of opioid signaling in mediating the effects of sexual behavior on cell proliferation and neurogenesis in both classical and non-classical neurogenic regions.
The role of emotional intelligence in shaping pre-service teachers’ cultural beliefs
Cultural beliefs and emotions have become recognised aspects of the teaching profession. This study examined the association between emotional intelligence (EI) and cultural beliefs using self-reported survey data collected from pre-service teachers at the beginning of their studies (N = 777). These pre-service teachers entered teacher education in 2021 and were studying in five different Finnish universities that geographically represent four regions in Finland. The results from the confirmatory factor analysis and the multiple linear regression suggested the four dimensions of EI positively predict the latent factors of both multicultural and egalitarian beliefs. The relationships between the constructs exhibited moderate effect sizes, with slightly stronger associations found for multicultural beliefs (β = 0.38) compared to egalitarian ones (β = 0.26). Moreover, the ‘using emotions’ dimension of EI significantly and positively predicted pre-service teachers’ multicultural beliefs; the use of emotions to guide thinking significantly predicted beliefs favouring cultural diversity. The study provides further empirical evidence for the influence of emotions on beliefs, and stresses the need to address topics pertaining to democratic education more explicitly and consistently in pre-service teacher education.
The association between adolescents’ independent food purchasing and dietary quality differs by socioeconomic status: Findings from a pilot study
During adolescence, many young people start to make more independent food purchases. Subsequently, these independent food choices will increasingly contribute to their overall diet quality; little is known, however, about this relationship. This pilot study aimed to examine the role adolescents’ independent food purchases play in their diet quality and assess if these relationships vary according to socio-economic status. A convenience sample of adolescents aged 11–18 years and attending secondary school or college in Hampshire, England, were recruited to participate in a one-week cross-sectional observational study. A validated 20-item Food Frequency Questionnaire assessed diet quality. Participants used an ecological momentary assessment mobile phone app to record food purchases. Over seven days, 552 food/drink items were purchased on 253 food purchasing occasions by 80 participants. The majority of purchases (n = 329, 59%) were coded as ‘not adhering’ to the UK Eatwell Guide, 32% were coded as ‘adhering’ and 9% fell between these categories being coded as ‘combination’. The healthfulness of food purchases did not differ between adolescents from low- and high-SES households. Across all adolescents, 39% reported that their food and drink purchases were snacks and these were less healthful than purchases made for main meals. Fully adjusted regression models showed that adolescents who made less healthy food purchases tended to have poorer quality diets (β 0.36, (95%CI −0.15, 0.87) p = 0.16). Interaction models showed that less healthy purchasing was more strongly associated with poorer diet quality among young people of lower SES than those of higher SES (p = 0.01). Future research should focus on identifying ways to support more healthful independent food choices by adolescents to reduce dietary inequalities and improve health and well-being among the next generation of adults.
Validation of plasma microRNAs as biomarkers in sepsis associated acute kidney injury upon first clinical presentation reveals limited diagnostic and prognostic performance
Background Sepsis is a life-threatening response to an infection, often complicated by sepsis-associated acute kidney injury (SA-AKI). Early recognition of SA-AKI is critical but challenged by the limited sensitivity of existing diagnostic markers. MicroRNAs (miRNAs), which regulate key SA-AKI pathways, have shown diagnostic promise, yet their clinical utility in early SA-AKI recognition remains unexplored. Moreover, validation in relevant clinical settings and populations remains limited. Therefore, this study aims to explore the potential of miRNAs for early recognition of SA-AKI at emergency department (ED) presentation, and explore the generalizability of findings by including a cohort of intensive care urine (ICU) patients with more advanced disease. Methods We conducted a post-hoc analysis of prospectively collected data from patients admitted to the ED and ICU. We performed a thorough literature review to select twelve miRNAs, previously implicated in kidney injury and sepsis or SA-AKI. MiRNAs were extracted from plasma and quantified using qPCR with and normalization to the global mean. We measured plasma levels of selected miRNAs upon ED arrival in 193 acutely ill patients (no infection, n = 65; sepsis, n = 67; SA-AKI, n = 61), and 47 critically ill patients (sepsis, n = 18; SA-AKI, n = 29). Statistical analyses included logistic and Cox regression adjusted for clinical variables, with correlations assessed between miRNA levels and disease severity markers. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results MiR-21-5p (OR 2.28, 95% CI [1.40–3.73]; p < 0.01) and miR-16-5p (OR 0.74, 95% CI [0.59–0.93]; p = 0.01) levels were associated with SA-AKI at ED presentation. Furthermore, miR-21-5p was independently associated with 30-day mortality after adjusting for age, illness severity, and comorbidities (adjusted OR 2.30, 95% CI [1.38–3.86]; p < 0.01). Similarly, in the ICU cohort with more advanced sepsis, miR-21-5p was associated with SA-AKI (OR 3.48, 95% CI [1.27–9.53]; P = 0.02), achieving an AUC of 0.74 (95% CI [0.58–0.89]), although it was not associated with 30-day mortality in this cohort. Conclusion We selected twelve miRNAs through literature review associated with kidney injury, sepsis or SA-AKI. Of these, only miR-21-5p was associated with SA-AKI and predicted 30-day mortality upon ED admission. This analysis effectively serves as a negative validation for most literature-derived miRNAs, challenging their clinical applicability identification of SA-AKI both at early presentation and in more advanced stages. Trial registration This study is embedded in the Acutelines data-biobank (www.acutelines.nl), registered in Clinicaltrials.gov (NCT04615065, November 3rd 2020) and the The Biobank Intensive Care Groningen registered in Clinicaltrials.gov (NCT04502511, August 6th 2020).
Retraction: Dynamic linkages between tourism development, renewable energy and high-quality economic development: Evidence from spatial Durbin model
Research on enhancing road apparent crack detection based on the improved YOLOv8n model
The improved YOLOv8n algorithm is proposed for the existing target detection algorithms to solve the issues of insufficient detection accuracy and leakage due to the target scale variability and complex background interference during road surface crack detection. This algorithm introduces the convolutional block attention module (CBAM) attention mechanism and integrates it with the cross-stage partial-feature fusion (C2f) module in the backbone network. The spatial pyramid pooling faster cross-stage partial channel (SPPFCSPC) module is introduced by integrating the spatial pyramid pooling (SPP) module with the Fully Cross-Stage Partial Convolution (FCSPC) module, which efficiently extracts multi-scale features. Then, the fine Slim-Neck paradigm is adopted to enhance the learning capability of the model while effectively reducing the number of model parameters. Ultimately, to mitigate the detrimental gradients produced by low-quality pictures, the weighted intersection over union (WIOU) loss function is employed instead of the complete intersection over union (CIOU), hence augmenting the bounding box regression efficacy of the network. After the aforementioned enhancements, the experimental outcomes on the road apparent crack dataset indicate that in comparison to the benchmark model YOLOv8n, the average precision (mAP@50), mean average precision (mAP@50–95), and recall of the enhanced algorithm have risen by 1.8%, 1.7%, and 1.8%, respectively. This indicates that the detection accuracy of road fractures is significantly enhanced by the enhanced YOLOv8n, which can more effectively accommodate the requirements of road maintenance.
An infrared night vision image enhancement algorithm based on cross-level feature fusion
Infrared night vision images are caused by color overflow and coloring discontinuity due to insufficient light at night, resulting in larger halo area and lower PSNR value after enhancement by single feature fusion method. For this reason, an infrared night vision image enhancement algorithm based on cross-level feature fusion is proposed. This method is used to denoise infrared night vision images, based on smooth wavelet decomposition. By labeling image edges and noise, and utilizing neighborhood based wavelet coefficient shrinkage algorithm, the noise interference in the image is effectively reduced; preliminary enhancement was performed on the denoised image, using Retinex algorithm combined with bilateral filtering method to estimate illuminance, and Sigmoid function was used to enhance the reflection area, improving the overall visual effect of the image. Based on the principle of cross-level feature adaptive fusion, a cross-level feature fusion network is constructed to further enhance the feature information of the infrared night vision image through the steps of multi-level feature extraction, feature reconstruction and adaptive cross-level feature fusion, and the output of the model is optimized by using the joint loss function, which realizes the high-quality enhancement of the infrared night vision image. The experimental results show that when the method is utilized for infrared night vision image enhancement, the PSNR is higher than 30dB, the SSIM is higher than 0.73, and the enhancement effect is good and the performance is high.
Impact of clinical pathways on enhancing compliance with evidence-based therapies for Heart failure with reduced ejection fraction–A retrospective cohort study
Background Heart failure (HF) mortality is rising despite robust evidence-based guidelines. Hospitalization presents an opportune time to optimize care. Inpatient care pathways (CP) embedded in the electronic health record (EHR) can enhance adherence to guidelines by providing real-time decision support. Objective To measure the impact of the heart failure reduced ejection fraction (HFrEF) CP on early diuretic use, goal-directed medical therapy (GDMT), and referral to comprehensive HF management (CHFM) on discharge. Methods A HFrEF CP embedded into the EHR was built by multidisciplinary providers across a large academic medical center. Providers could place orders and document notes directly from the pathway. We conducted a retrospective cohort study of all the HF hospitalizations two years after pathway implementation and further limited the cohort to those with ejection fraction (EF) ≤ 40%. We compared rates of early diuretic use, GDMT, and referral to CHFM between cohorts defined by pathway use. Results 1,639 patients contributed 2,062 hospitalizations. The pathway was opened in 362 (17.6%) hospitalizations. There were no significant clinical or sociodemographic differences between groups. Bivariate analyses revealed more GDMT (χ2 (1) = 3.651, p = 0.056); while multivariable analysis showed more early diuretics (OR = 1.58, 95% CI 1.19, 2.09, p = 0.002) and referrals to CHFM (OR = 3.24, 95% CI 2.54, 4.12, p < 0.001) in the pathway group. Conclusion Despite low utilization, pathway use was associated with more early diuretics and referrals to CHFM with a trend toward more GDMT on discharge. CPs are a feasible strategy to optimize care for hospitalized HF patients.
Cost-effectiveness of virtual emergency care models: A protocol for a systematic review
Background The COVID-19 pandemic has accelerated the adoption of virtual care models in emergency medicine. While virtual emergency care has the potential to expand access, improve efficiency, and reduce costs, rigorous evaluation of its cost-effectiveness compared with traditional in-person emergency care is needed. Objective This systematic review aims to comprehensively search the literature, critically appraise the evidence, and synthesize findings on the cost-effectiveness of virtual emergency care models compared to in-person emergency care. Methods We will search PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus from 2010 to February 2025 for economic evaluations that report both costs and effects comparing virtual and in-person emergency care models. Studies that compare multiple virtual interventions without an in-person care comparator will be excluded. Two reviewers will independently screen studies, extract data, and assess methodological quality and risk of bias using established quality assessment tools. Covidence software will be used to manage the screening and data extraction process. A narrative synthesis and quantitative meta-analysis of incremental cost-effectiveness ratios (ICERs) will be conducted if appropriate. Discussion This review will provide a comprehensive evidence synthesis on the cost-effectiveness of virtual emergency care to guide clinical implementation, health policy, and future research. Findings will be highly relevant as virtual care becomes increasingly integrated into emergency care delivery in the aftermath of the COVID-19 pandemic. PROSPERO registration CRD42025648218
The effect of gamification on the medication knowledge, performance and satisfaction of nurses in continued medical education: A quasi-experimental study
Background and objective One of the primary challenges within the health system is improving nurses’ motivation and attitude toward participation in the continuous education program. This study was conducted aim to investigate the effect of gamification on medication knowledge, performance and satisfaction of nurses in continued medical education (CME). Methodology The study was conducted as a quasi-experimental design from November 1, 2022, to February 1, 2024. Participants were 128 nurses with a minimum of 6 months of work experience who were randomly assigned to two groups, intervention and control groups via a colored card. Baseline assessments of medication knowledge and drug administration practices were conducted one week prior to the intervention. Education in both groups consisted of five 2-hour sessions. In the control group, education was delivered using the lecture method, while in the intervention group, the competitive software (Kahoot!) was used. One week after the completion of the training sessions, participants’ knowledge, drug administration skills, and satisfaction were evaluated. Results The participants’ average (standard deviation) age was 30.34 (5.34), with 49 male (38.35%) and 79 female (61.7%). Wilcoxon signed-rank test results demonstrated statistically significant difference in the knowledge and performance within both groups (p < 0.001). Mann-U-Whitney test findings revealed a significant difference between the two groups of participants in performance and satisfaction with the educational approach education (p < 0.001). Conclusion The gamification method enhanced nurses’ satisfaction and medication performance. Using Kahoot as a game-based competitive application has been shown to enhance nurses’ knowledge of pharmacology as well as increase participants’ satisfaction with educational programs. Therefore, it is recommended that nursing educators and administrators integrate gamified approaches and strategies—such as Kahoot!—to enrich learning experiences and motivate participation in ongoing professional development.