Browse Articles

Congruence between preferred and actual place of death and its association with quality of death and dying in advanced cancer patients: A nationwide survey in Japan

Background Satisfying patients’ preferences is an important outcome in palliative care. Previous research has reported that a patient’s place of death was associated with quality of death and dying. Purpose This study aimed to evaluate the association between the congruence between a patient’s preferred and actual place of death and their quality of death and dying, as perceived by their family caregivers. Method Data were obtained from a nationwide cross-sectional questionnaire survey of bereaved family caregivers of patients with cancer in Japan. A total of 13,711 family caregivers participated. We evaluated the quality of death and dying using the Good Death Inventory. Results 9,123 responses were analyzed (effective response rate: 67%). Patients who died in their preferred place were categorized as the “achieved group,” whereas patients who died in a place that they did not prefer were classified as the “not-achieved group.” Good Death Inventory scores were significantly higher for the achieved group compared with the not-achieved group (48.8 ± 10.1 and 44.0 ± 9.5, respectively; p < 0.001). A multiple linear regression analysis indicated that congruence between the preferred and actual place of death was an independent determinant of good quality of death and dying (p < 0.001). Conclusion Congruence between a patient’s preferred and actual place of death may contribute to better quality of death and dying among terminally ill patients with cancer. Congruence between the preferred and actual place of death should be regarded as an essential component in end-of-life care.

Analyzing the effectiveness and safety of arthroscopic suture anchor repair for anterior talofibular ligament in patients with ankle instability

Background Ankle instability, often secondary to anterior talofibular ligament (ATFL) injury, poses significant challenges in orthopedic management. This study aimed to evaluate the effectiveness and safety of arthroscopic suture anchor repair for ATFL in patients with ankle instability. Methods This retrospective study spanned from January 2022 to February 2024 and involved 58 patients who underwent arthroscopic repair and 60 patients who underwent the open Broström procedure. Baseline characteristics, surgical outcomes, and functional assessments utilizing the Ankle Hindfoot Scale (AOFAS) were compared between the two groups. Additionally, talar tilt angle and anterior translation distance were measured using anteroposterior and lateral ankle radiographs. Results Both groups showed significant improvements in AOFAS scores post-treatment (p < 0.001). The observation group had shorter surgical durations, reduced blood loss, and quicker recovery times compared to the control group (p < 0.001). Talus tilt angle and anterior translation distance decreased significantly in both groups postoperatively (p < 0.001). Arthroscopic repair demonstrated superior outcomes in terms of AOFAS scores and surgical parameters. Conclusions Arthroscopic suture anchor repair is an effective and safe option for managing ankle instability, offering procedural efficiency, reduced blood loss, and favorable functional outcomes. Further research is needed to validate these findings and compare arthroscopic techniques with conventional open procedures.

Safety of outpatient non-upper airway surgery for patients with obstructive sleep apnea in ambulatory surgical centers: A systematic review

Objective The systematic review aims to determine the safety of conducting non-upper airway surgery in an ambulatory surgery center (ASC) for OSA patients. Data sources A comprehensive search was conducted from MEDLINE, Embase, CENTRAL, and Scopus from inception through February 2023. Review methods Studies including non-upper airway surgery done in ASC settings were identified. Risk of bias was assessed using the Murad Tool and Newcastle-Ottawa scale. Primary outcomes were 24 hour complications and unplanned admission rates. Results From 9313 studies, 13 non-OSA studies with 31,200 OSA participants and 318,709 non-OSA participants were identified. Severe complications were rare and tended to occur within the first 4 hours of the postoperative period. While a majority of smaller scale studies found no significant difference in unplanned admissions, large scale studies with multivariate analysis find OSA to be an independent risk factor for unplanned admission and 30-day complications. However, large scale ASC studies have found that with proper selection and perioperative interventions, OSA patients can undergo outpatient surgery at ASCs safely. Conclusions OSA patients with mild or controlled comorbidities can safely undergo ambulatory non-OSA surgery in ASCs. Other The protocol for this review was registered with the PROSPERO database (Registration number: CRD42023415162).

Influence of UHMWPE on the expansion characteristics of expansive soil: Experimental studies

This paper investigates the effectiveness of using Ultra-High-Molecular-Weight Polyethylene (UHMWPE) Fiber to improve expansive soil. The test results indicate that the amount and length of UHMWPE significantly affect the swelling pressure and free swelling ratio of the reinforced soil. The swelling pressure of reinforced expansive soil exhibits a significant negative correlation with both the UHMWPE content (p < 0.05) and its length. The free swelling ratio of reinforced expansive soil was significantly negatively correlated with both the content (p < 0.05) and length of UHMWPE. When the UHMWPE content exceeds 0.3% the weight of the soil, there is no significant decrease in the swelling pressure of the reinforced soil (p = 0.052, close to the threshold of significance). When the length of UHMWPE is greater than 9 mm, there is no significant decrease in the free swelling ratio of the reinforced soil (p = 0.165). Thus, it is recommended to use 0.3% UHMWPE with a length of 9 mm for optimal results. Swelling pressure, free swelling ratio and fiber content follow a quadratic polynomial relationship. While, the relationship between swelling pressure and fiber length is linear. The relationship between free swelling ratio and fiber length is a power function.

Exploring the factors influencing alarm fatigue in intensive care units nurses: A cross-sectional study based on latent profile analysis

Objective To identify potential categories of alarm fatigue among ICU nurses and to explore the differences in characteristics and influencing factors among different categories. Methods Using convenience sampling, 597 ICU nurses from 12 tertiary public hospitals across 8 cities in the Inner Mongolia Autonomous Region of China were recruited from September 2024 to December 2024. A cross-sectional survey was conducted using the General Information Questionnaire, ICU Nurses’ Alarm Fatigue Scale, Stanford Presenteeism Scale: Health Status and Employee Productivity, and Nurses’ Emotional Labor Scale. Potential profiles of nurse alarm fatigue were analyzed, and the influencing factors of different profiles were explored by univariate analysis and multivariate logistic regression analysis. Results The median alarm fatigue scale score was 26(IQR = 19.75–31), and the alarm fatigue of ICU nurses could be categorized into low fatigue-robust tolerance group (30.8%), moderate fatigue (54.4%), and high fatigue-negative coping group (14.9%). The regression analyses showed that the number of children, the frequency of night shifts, the health status and employee productivity score, and the emotional labor score were the main factors of the ICU factors influencing different potential categories of nurse alarm fatigue (P < 0.05). Conclusion ICU nurses alarm in Inner Mongolia exhibited moderate-to-high alarm fatigue with notable subgroup heterogeneity. Nursing managers should implement tailored interventions addressing profile-specific factors, such as workload adjustments and emotional support strategies, to mitigate alarm fatigue.

Association between inflammatory burden index and prognosis in patients with coronary heart disease: A retrospective study

Background Increasing evidences indicate that systemic inflammation plays a significant role of adverse prognosis in patients with coronary heart disease (CHD). The inflammatory burden index (IBI) is a novel biomarker that reflects systemic inflammation. The aim of this study was to investigate the association between IBI and prognosis of CHD patients. Methods In this retrospective analysis, data from 2453 CHD patients enrolled from December 2017 to December 2022.IBI was defined as neutrophil/lymphocyte*C-reactive protein, with patients categorized into four groups based on quartiles of baseline IBI levels. The primary outcome was adverse cardiovascular and cerebrovascular events (MACCEs) occurring during hospitalization, which included repeat revascularization, new-onset atrial fibrillation (NOAF), stroke, and all-cause in-hospital mortality. Multivariate logistic regression models and restricted cubic spline (RCS) analysis were used to investigate the association between IBI and prognosis of CHD patients. Results High levels of IBI were associated with higher risk of MACCEs, especially when IBI ≥ 45.68, patients exhibited a higher risk of MACCEs (P < 0.05). After adjusting for baseline confounders, multivariate logistic regression analysis demonstrated that baseline IBI was an independent predictor for NOAF (Odds Ratio (OR): 2.05; 95% confidence interval (CI): 1.30–3.24; P = 0.002) and contrast-induced nephropathy (CIN) (OR: 1.95; 95%CI: 1.16–3.28; P = 0.012) in CHD patients, mainly driven by the highest quartile. In addition, RCS confirmed a linear relationship between IBI and NOAF (P for non-linear = 0.425) and a nonlinear relationship with CIN (P for non-linear = 0.032). Conclusion IBI is a promising biomarker of systemic inflammation in CHD patients, where higher IBI levels are associated with adverse prognosis. These findings may aid clinicians in precise decision-making to improve outcomes in patients with CHD.

Mass spectrometry measurements of mercury isotope ratios support geochemical sourcing of archaeological cinnabar in the Andean region

Geochemical methods can identify the long-distance exchange of resources in the archaeological record. Cinnabar is a mineral with a limited number of geological sources; however, methods for determining the geological origin of cinnabar are constricted by the limited availability of comparative geological source materials. This study applies a multi-method approach to compare isotopic ratios of mercury and sulfur in archaeological specimens of cinnabar from museum collections and scientifically excavated materials from the Andes region of South America. We demonstrate that the δ202Hg to Δ199Hg relationship, assessed through Multicollector Inductively Coupled Plasma Mass Spectrometry (MC-ICP-MS), falls along a predictive slope, while Isotope Ratio Mass Spectrometry (IR-MS) for sulfur (S) was not a reliable proxy for determining ore source. Furthermore, Hg isotope ratios from similar sites and contexts tended to cluster, suggesting that most sites exploited cinnabar from the same ore source. Statistical analyses support the idea that the Huancavelica deposit served as the primary source of cinnabar pigment for pre-Hispanic societies, while also revealing some intriguing divergences that suggest alternate sources were exploited during certain periods on the North and South Coasts of Peru. These results demonstrate that MC-ICP-MS analyses of mercury can be used to geochemically trace cinnabar ore in the Andes and beyond.

Comparative study on eating habits and health of single-person and multi-person households

This study investigates the differences in health, dietary habits, and quality of life between single-person and multi-person households, with a specific focus on demographic subgroups such as gender and age. Data were drawn from the 2013–2021 Korean National Health and Nutrition Examination Survey, encompassing 40,839 participants aged 19 and older, and were analyzed using multivariate regression models. The results revealed significant disparities between the two types of households. Single-person male households exhibited poorer dietary quality and higher metabolic risk indicators, such as elevated waist circumference, low-density lipoprotein cholesterol, and blood pressure, compared to their multi-person counterparts. In contrast, single-person female households demonstrated slightly better metabolic profiles, including lower body mass index, triglycerides, and fasting glucose, relative to multi-person households. Quality of life, assessed using the EuroQol-5 Dimension, was significantly lower in single-person households, with women reporting higher rates of anxiety, depression, and mobility issues. Subgroup analyses identified pronounced vulnerabilities among single-person males aged 40–59 and single-person females aged 60 and older. These findings highlight the need for tailored public health policies and market strategies to address the distinct needs of diverse single-person household subgroups. Further research should prioritize well-designed studies exploring populations with unique characteristics, such as single-person households, to better understand their specific challenges and requirements compared to multi-person households.

Impact of body mass index on surgical and oncological outcomes after Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Background Complete cytoreductive surgery with Hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for patients with peritoneal metastases. In this retrospective observational two-center study, we assessed the impact of patient’s body mass index (BMI) on surgical and oncological outcomes. Methods Between 2017 and 2021, 144 patients with peritoneal metastases (all etiologies) were included. Morbi-mortality at day-30, overall survival and free-recurrence-survival were compared according to the patients BMI. The patients were divided into 2 groups (BMI < 25, and BMI ≥ 25). Results Median overall survival (OS) was 71.3 months [63–71.5], with significant differences observed between BMI groups (p = 0.015). Recurrence-free survival (RFS) averaged 26.8 months [20–35.3] and did not significantly differ between groups (p = 0.267). After stratification by histology, OS and RFS remained consistent. Cox multivariate analysis adjusted for Peritoneal Carcinomatosis Index (PCI) revealed BMI < 25 (HR = 2.53 [1.10–5.80]) and male sex (HR = 2.34 [1.11–4.92]) as predictors of poorer OS. 30-Day complication rates did not significantly differ (p = 0.094). The BMI ≥ 25 group experienced higher rates of digestive fistulas (p = 0.05) and 90-day readmissions (p = 0.007), although reintervention rates were comparable (p = 0.723). Conclusions Our study suggests a potential ‘obesity paradox’ in the context of HIPEC procedures. Morbidity at day-30 was similar for BMI < 25, and BMI ≥ 25 patients. Readmissions at day-90 were more frequent in high-BMI group. BMI < 25 is deleteriously associated with mortality. BMI and sex were related to OS.

Exploring the dynamics of a single vesicle induced by Fe₃O₄ nanoparticles using micropipette manipulation

Magnetite nanoparticles (MNPs, Fe3O4) have gained substantial interest for different biomedical and biochemical applications. Therefore, it is important to understand the mechanism of interaction between MNPs and cell membranes. As a model for cells, giant unilamellar vesicles (GUVs) are used in various research studies, providing valuable insights into the behavior of lipid bilayers and their interactions with MNPs. To understand the mechanism of interaction between MNPs and membranes, the dynamics of a ‘single GUV’ are explored using the micropipette technique under physiological conditions. The GUVs exhibited deformation upon adsorption of anionic MNPs into the membrane, with the degree of deformation (e.g., compactness) increasing over time. The addition of MNPs through a micropipette into the vicinity of a ‘single GUV’ induced various shape changes; for example, a prolate shape transformed into two spheres connected by a neck. The fraction of the shape changes of GUVs increased with the concentration of MNPs. These results indicated that MNPs were absorbed onto the outer monolayer, inducing an area mismatch between the outer and inner monolayers of the membrane. The change in membrane area upon MNP binding in a ‘single GUV’ was investigated using the micropipette aspiration technique. Initially, the membrane area increased at a faster rate until reaching a saturation point, then decreased at a slower rate back to the original point, followed by a slight increase at a very slow rate. These changes suggest rapid stretching, slower compression, and finally slow stretching in the membranes of the GUV. Based on these results, we discuss the interaction mechanism of anionic MNPs with a single GUV.

Air-ground collaborative multi-source orbital integrated detection system: Combining 3D imaging and intrusion recognition

With the rapid expansion of railway networks globally, ensuring rail infrastructure safety through efficient detection methods has become critical. Traditional inspection systems face limitations in flexibility, adaptability to adverse weather, and multifunctional integration. This study proposes a ground-air collaborative multi-source detection system that integrates 3D light detection and ranging (LiDAR)-based point cloud imaging and deep learning-driven intrusion detection. The system employs a lightweight rail inspection vehicle equipped with dual LiDARs and an Astro camera, synchronized with an unmanned aerial vehicle (UAV) carrying industrial-grade LiDAR. We propose an improved LiDAR odometry and mapping with sliding window (LOAM-SLAM) algorithm enables real-time dynamic mapping, while an optimized iterative closest point (ICP) algorithm achieves high-precision point cloud registration and colorization. For intrusion detection, a You Only Look Once version 3 (YOLOv3)-ResNet fusion model achieves a recall rate of 0.97 and precision of 0.99. The system’s innovative design and technical implementation offer significant improvements in railway track inspection efficiency and safety. This work establishes a new paradigm for adaptive railway maintenance in complex environments.

Nonlinear damage creep model of concrete considering the influence of temperature and its parameter variation law analysis

In order to study the creep characteristics of concrete under different temperatures, the uniaxial creep test of concrete is carried out. On this basis, the nonlinear creep model of concrete is established by using the fractal order derivative theory. According to the characteristics of the classical creep curve and the creep equation, the calculation method of creep parameters is determined. The variation law of each creep model parameter under different stress and temperature is analyzed. The results showed that the model can well reproduce the change trend of the curve during the creep process of concrete under different temperature conditions and stress levels, indicating that the model has strong adaptability and accuracy in capturing the creep law. In the later stage of concrete creep, the accelerated creep stage is often accompanied by complex situations such as rapid accumulation of internal damage and rapid deterioration of the structure. The traditional model has limitations in the accurate description of this stage, and the new model can effectively solve this problem. Undoubtedly, it enhances its value and advantages in practical applications. The elastic modulus of the elastomer controls the instantaneous strain. The elastic modulus, viscosity coefficient and fractal order of viscoelastic body control the viscoelastic creep and creep rate. Viscosity coefficient and fractal order of viscoplastic body control the viscoplastic creep and creep rate.

Comparative outcomes of image-guided percutaneous catheterization versus direct visualization catheterization for peritoneal dialysis: A meta-analysis

Introduction Debate persists on the optimal catheterization method for peritoneal dialysis (PD). This meta-analysis aimed to compare the outcomes of image-guided percutaneous catheterization (IGPC) versus direct visualization catheterization (DVC) for peritoneal dialysis. Materials and methods From the inception of the database until July 16, 2024, four databases (Medline, Embase, Web of Science, and the central database) were searched for literature comparing IGPC versus DVC for peritoneal dialysis. Meta-analyses were conducted on infectious complications, mechanical complications, one-year PD catheter survival, and catheter removal rates. Results Totally 11 studies were included in this meta-analysis, comprising a total of 8,981 patients, of which 2,518 patients received IGPC and 6,463 patients received DVC. IGPC exhibited lower rates of infection complications (OR = 0.73, 95% CI: 0.54-0.99, P = 0.04) mechanical complications (OR = 0.64, 95% CI: 0.42-0.99, P = 0.04) and catheter removal compared to DVC (OR = 0.63, 95% CI: 0.50-0.78, P < 0.0001). However, there was no significant difference in one-year PD catheter survival between the two groups (OR = 1.33, 95% CI: 0.78-2.27, P = 0.30). Conclusions This meta-analysis concluded that IGPC was a safe and effective catheterization method for PD. The results demonstrated that IGPC significantly reduced the incidence of infection complications, mechanical complications, and catheter removal compared to DVC. No notable disparity in one-year PD survival was detected between the two groups. Trial registration PROSPERO (CRD42024606795).

Saliency-enhanced infrared and visible image fusion via sub-window variance filter and weighted least squares optimization

This paper proposes a novel method for infrared and visible image fusion (IVIF) to address the limitations of existing techniques in enhancing salient features and improving visual clarity. The method employs a sub-window variance filter (SVF) based decomposition technique to separate salient features and texture details into distinct band layers. A saliency map measurement scheme based on weighted least squares optimization (WLSO) is then designed to compute weight maps, enhancing the visibility of important features. Finally, pixel-level summation is used for feature map reconstruction, producing high-quality fused images. Experiments on three public datasets demonstrate that our method outperforms nine state-of-the-art fusion techniques in both qualitative and quantitative evaluations, particularly in salient target highlighting and texture detail preservation. Unlike deep learning-based approaches, our method does not require large-scale training datasets, reducing dependence on ground truth and avoiding fused image distortion. Limitations include potential challenges in handling highly complex scenes, which will be addressed in future work by exploring adaptive parameter optimization and integration with deep learning frameworks.

Addressing global challenges: How does the integration of rural industries in China enhance agricultural resilience?

Promoting the integrated development of rural industries represents a crucial pathway for accelerating the modernization of the entire industrial chain and consolidating and enhancing agricultural resilience. This study constructs provincial-level panel data for China spanning 2012–2022 and employs a multidimensional, visualization-based, and spatial research paradigm to comprehensively examine the impact effects and mechanisms through which rural industrial integration empowers agricultural resilience in China. The findings reveal that, first, rural industrial integration can effectively enhance agricultural resilience levels, with stable economic returns and diversified functional development serving as key pathways for improving agricultural resilience. Second, the eastern and western regions have unleashed agricultural resilience potential through superior policy and environmental advantages, while the relatively homogeneous grain structure and path dependence in the central and northeastern regions have prevented agricultural industrial integration from effectively achieving expected outcomes. Third, structural rationalization has improved resource allocation efficiency, but industrial structure advancement and industrial structure sophistication have actually diminished the enhancement effects on agricultural resilience. Fourth, urbanization has led to adverse resource competition, reducing the positive impact of rural industrial integration on agricultural resilience levels. Fifth, the enhancement of agricultural resilience through rural industrial integration demonstrates geographically-distant resource spillover effects to neighboring regions. This research provides an important theoretical framework and practical paradigm for global agricultural transformation, offering particularly significant strategic guidance for developing countries in building resilient agricultural systems, addressing climate change impacts, and ensuring food security.

Tooth position prediction method based on adaptive geometry optimization

A multi-layer feature optimization Transformer-based tooth position prediction method is proposed to address the problems of difficult access to high-precision medical data and the difficulty of capturing and representing hierarchical features and spatial relationships among teeth by current methods. First, a geometric adaptive optimization strategy and a physiological adaptive reconstruction strategy are designed for real-time adaptation to the complexity of different clinical environments and enhanced pose invariance by integrating the physiological characteristics and anatomical structure of teeth. Then, a hierarchical feature tooth position prediction network was designed to solve the problems of weak ability of MLPs to process high-dimensional data and low accuracy of prediction transformation matrix by extracting hierarchical geometric features of teeth. Finally, a jointly supervised loss function is constructed, which can simultaneously capture the intrinsic differences, spatial relationships and uncertainties of the tooth position prediction disorder distribution, and can effectively supervise the tooth spatial structure relationships and prevent tooth collisions and misalignments. The experimental results show that the accuracy of the proposed method is improved by 2.87% and the rotation and translation errors are reduced by 28.28% and 37.53%, respectively, compared with the current method.

Vibration-based gearbox fault diagnosis using a multi-scale convolutional neural network with depth-wise feature concatenation

This article proposes a novel approach for vibration-based gearbox fault diagnosis using a multi-scale convolutional neural network with depth-wise feature concatenation named MixNet. In industrial environments where equipment reliability directly impacts productivity, safety, and operational efficiency, timely and accurate fault detection in gearboxes is of paramount importance. As critical components in manufacturing, energy production, transportation, and heavy machinery, gearboxes constitute major potential failure points, with malfunctions leading to costly downtime and, in severe cases, catastrophic incidents. The proposed method addresses these industrial challenges by integrating advanced signal processing techniques with deep learning architectures to enhance diagnostic accuracy and robustness. Specifically, MixNet utilizes multi-scale convolutional layers combined with depth-wise feature concatenation to extract discriminative features from spectrogram representations of vibration signals, generated via the Short-time Fourier transform (STFT). This approach offers several practical advantages for engineering applications, including non-invasive monitoring that eliminates the need for disassembly, early fault detection that facilitates condition-based maintenance strategies, automated diagnosis that minimizes reliance on domain-specific expertise, and robust performance under noisy and variable operating conditions. Experimental results on the Gearbox fault diagnosis dataset demonstrate that MixNet outperforms existing deep learning models, achieving a significantly higher accuracy of 99.32% with a relatively fast training time of only 4 minutes and 29 seconds. The combination of high accuracy and computational efficiency renders the proposed method well-suited for deployment in real-time monitoring systems across manufacturing plants, power generation facilities, and automotive applications, where it has the potential to reduce maintenance costs by up to 30% and improve equipment availability by enabling the detection of incipient faults before catastrophic failures.

Improved physical performance in obesity-resistant rats compared to obesity-prone rats: Effects of different diets and metabolic analysis

Animal models, such as high-fat diet-induced obese (DIO) rats, have been used to understand its pathophysiology. These models reveal differences between obesity-prone (OP) and obesity-resistant (OR) phenotypes. Thus, OR exhibit lower body mass gain and higher levels of physical activity, suggesting a more efficient energy metabolism. This study evaluated the metabolic adaptations and physical performance of OP and OR rats. Wistar rats (30 days old) were subjected to 23-week obesity exposure protocols. Initially, rats were randomized into two groups: a) SD: fed a standard diet (n = 39) and b) HFD: fed a high-fat diet (n = 39). Subsequently, animals were characterized as OP and OR on their respective diets: SD-OR (n = 13); SD-OP (n = 13); HFD-OP (n = 13); HFD-OR (n = 13). Nutritional, metabolic, and adiposity parameters were analyzed. Basal metabolism assessment was performed using indirect calorimetry. Physical performance and aerobic capacity were determined through treadmill exercise tests with gas analyzers for maximal oxygen consumption (VO2). OR animals had lower body mass compared to OP animals, despite consuming the same caloric intake under both diets. HFD-OP rats gained 30.5% more weight than HFD-OR rats, while SD-OP rats gained 19.5% more than SD-OR rats. SD-OR rats gained 20.5% more weight than HFD-OR. No significant differences in adiposity indices were observed among groups. HFD-OR rats showed 15.6% higher VO₂max than HFD-OP rats; SD-OR rats had 12.8% higher VO₂max and 20.3% longer time to exhaustion compared to SD-OP rats. Indirect calorimetry revealed higher energy expenditure in OR animals during the dark cycle. OP animals exhibited elevated insulin and HOMA-IR levels, while OR animals had higher leptin and glucagon levels. In conclusion, OR rats showed improved physical performance and aerobic capacity compared to OP rats, even on a high-fat diet, suggesting that OR rats have adaptive mechanisms that enhance energy metabolism and endurance.

Correction: Transcriptomic changes behind Sparus aurata hepatic response to different aquaculture challenges: An RNA-seq study and multiomics integration

Chikungunya masquerading as dengue infection in Sri Lanka uncovered by metagenomics

Introduction Dengue is a significant threat to human health in South and Southeast Asia where patients are treated without diagnostic confirmation during outbreaks. This approach, though cost-effective may miss important infections especially those caused by other arboviruses (e.g., Zika, Chikungunya and West Nile virus). This study aimed to diagnose missed infections mimicking dengue by using metagenomic next generation sequencing (mNGS). Methods and principal findings Total nucleic acid (DNA and RNA) was extracted and subjected to mNGS from acute infection plasma of 60 patients from a prospective cohort study in Sri Lanka in which patients with clinically suspected dengue fever were recruited but were later confirmed as dengue-negative by NS1 antigen testing and by dengue-specific reverse transcription and polymerase chain reaction (RT-PCR) analysis. mNGS data revealed missed chikungunya and dengue infections in five patients each, and a possible bacterial infection by Klebsiella pneumoniae in another patient. It was not possible to differentiate chikungunya infections from dengue infections based on clinical features or routine non-diagnostic laboratory tests conducted in early infection (e.g., full blood count, C-reactive protein level). Phylogenetic analysis showed that the chikungunya sequences from this study were closely related to those sequenced from Maldives, Malaysia, India and Singapore between 2015–2019. Conclusions Chikungunya infection may masquerade as dengue especially in low- and middle-income countries where dengue is treated based on clinical suspicion only – without confirmatory testing. As both infections are likely prevalent worldwide, but the complications and natural history of chikungunya and dengue infections are quite different, the addition of cheap and accessible diagnostics for both infections should be pursued in endemic countries.