Conectar
Pressure ulcers represent a significant healthcare challenge among respiratory patients. This study aimed to develop and validate a predictive nomogram based on machine learning algorithms to identify patients at high risk for pressure ulcer development. We conducted a retrospective analysis of 263 respiratory patients (166 with pressure ulcers). Patients were randomly divided into training and testing cohorts at a 7:3 ratio. Potential risk factors were identified through univariate logistic regression. Least absolute shrinkage and selection operator (LASSO) regression selected 17 significant predictors, from which 10 variables with optimal predictive values were incorporated into a nomogram model. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration plots and decision curve analysis (DCA). The final nomogram incorporated 10 predictors: age, albumin, C-reactive protein, serum sodium, history of diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, urinary incontinence, length of hospital stay and Braden sensory perception score. The model demonstrated excellent discriminative ability with AUCs of 0.865 (95% CI: 0.816–0.914) in the training cohort and 0.837 (95% CI: 0.783–0.891) in the testing cohort. Calibration curves showed good agreement between predicted and observed probabilities (Hosmer–Lemeshow test: training cohort χ 2 = 4.257, P = 0.833; testing cohort χ 2 = 12.350, P = 0.142). DCA confirmed the nomogram's superior clinical utility compared to individual predictors across a wide range of threshold probabilities. The machine learning–derived nomogram provides a practical, noninvasive tool for early identification of respiratory patients at risk for pressure ulcers. Implementation of this model could facilitate timely intervention strategies, potentially reducing the incidence of pressure ulcers and improving patient outcomes.
by Yuzhong Feng, Jiazhen Cui, Xuan Huang, Yupeng Li, Haolong Dong, Xianghua Xiong, Gang Liu, Qingyang Wang, Huipeng Chen
Uricase-based drugs excel at treating refractory hyperuricemia and tumor lysis syndrome by directly degrading uric acid but are limited by immunogenicity. Here, we engineered RAW264.7 macrophages with ectopic co-expression of Aspergillus flavus uricase and murine urate anion transporter 1 (URAT1), forming a “transport-degradation” system: URAT1 actively transports uric acid into cells for intracellular degradation. Recombinant lentiviral vectors carrying target genes were transfected into RAW264.7 cells, followed by puromycin screening. In vitro assays showed that the engineered macrophages nearly completely degraded uric acid (from 556.0 ± 37.0 μmol/L to 0.7 ± 0.6 μmol/L) at 72 h. URAT1 inhibition with benzbromarone abolished uric acid degradation in URAT1-expressing cells. In both acute dietary-induced and chronic genetic hyperuricemic mouse models, RAW-afUri-URAT1 exerted robust and sustained uric acid-lowering activity, maintaining serum uric acid at 77.14 ± 37.48 μmol/L on day 16 in yeast extract gavaged mice and normalizing serum uric acid to 76.2 ± 15.9 μmol/L in liver uricase conditional knockout mice, both significantly superior to the rebound levels observed in mice treated with Rasburicase (143.19 ± 38.21 μmol/L and 142.4 ± 17.4 μmol/L, respectively; P
by Yuzhen Sun, Ziguang Zhou, Yu Mao, Niu Liu, Yanfeng Li, Weiyuan Fang
BackgroundPsoriasis, a chronic inflammatory skin disease affecting 2–3% of the global population, is driven by dysregulated immune responses. Despite advancements in biologic therapies, treatment challenges persist due to high recurrence rates. This study aimed to identify immune-related hub genes and elucidate their clinical implications in psoriasis pathogenesis and therapy.
MethodsMultiple microarray datasets from psoriasis patients (GSE30999, GSE106992, GSE14905, GSE78097, and GSE117468) were obtained to identify immune-key genes by differential gene analysis and Weighted Gene Co-expression Network Analysis (WGCNA). Subsequently, immune-related hub genes were identified using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and Protein-Protein Interaction (PPI) networks, with further validation through Gene Set Enrichment Analysis (GSEA) and Receiver Operating Characteristic (ROC) curves to assess exploratory within-sample discrimination. Pearson correlation analysis evaluated the relationship between hub genes, skin lesion severity, and treatment outcomes. The study also conducted immune infiltration by using the Cell-type Identification by Estimating Relative Subsets Of RNA Transcripts (CIBERSORT) algorithm and identified potential therapeutic targets by the Drug-Gene Interaction Database (DGIdb).
ResultsThirty-one immune-related key genes were identified, and six hub genes (CLEC7A, CXCL1, IRF1, S100A12, S100A8, S100A9) were validated as central players in immune signaling pathways. These genes exhibited within-sample discrimination (AUC > 0.9) and correlated with disease severity and biological therapy efficacy. Immune infiltration analysis revealed increased activated memory CD4+ T cells and M1 macrophages in lesional skin, which was strongly associated with hub gene expression. Additionally, drug-gene interaction analysis identified potential therapeutic agents targeting these genes.
ConclusionThis study identified six immune-related hub genes that were closely linked to the severity of psoriasis, the effectiveness of biological treatments, and infiltrated activated memory CD4+ T cells and M1 macrophages. Our findings elucidate a novel immune-related hub gene network in psoriasis and provide potential targets for the development and application of biologics.
by Yukari Hara, Aoi Nakagawa, Junko Omori
This study aimed to investigate changes in work values among Japanese nurses before and after pregnancy, their return to work while managing childcare responsibilities, and the multifaceted factors influencing these changes. A web-based survey of 199 female nurses assessed their work values before and after pregnancy, including retrospective questions and open-ended responses. Data were analyzed comprehensively using paired t-tests, generalized estimating equations, and inductive thematic analysis. Only prestige work values demonstrated a significant decrease after pregnancy, as revealed by paired t-tests. Generalized estimating equation analysis identified age at first child, social support from family and other sources, employment status, and educational background as the main factors influencing changes in work values. Qualitative findings indicated that this decline in prestige work values was due to a shift in nurses’ awareness that “their life became centered on their children and family,” alongside family roles and time constraints that limited career development. This study demonstrates that Japanese nurses experience significant changes in their work values during the transition from childbirth to work re-entry. These changes are intricately shaped by several factors, particularly individual life stage variables and social support from family and other sources. A nuanced understanding of these shifts in work values is essential for developing effective and individualized support systems to promote the retention and long-term career development of female nurses in Japan.
Deprescribing is important because inappropriate polypharmacy increases the risk of adverse drug events, treatment burden, reduced adherence and healthcare costs, while potentially compromising patient safety and quality of life. This study aimed to investigate the perceived barriers and enablers experienced by healthcare professionals (HCPs) in Indonesia regarding deprescribing in patients with type 2 diabetes (T2D) and polypharmacy.
A qualitative study using focus group discussions (FGDs) and thematic analysis.
Four FGDs were conducted with general practitioners, specialists (internists) and pharmacists from healthcare facilities in West Java Province, Indonesia. Each group included 3–4 participants from the same discipline, with one mixed group that included one participant of each profession. In total, 13 participants were included in the study.
HCPs across disciplines recognised the goals of deprescribing as optimising treatment, reducing polypharmacy risks and preserving treatment outcomes. However, implementation was hindered by the lack of clear guidelines, hierarchical dynamics, limited training and resource constraints, particularly in rural and high-volume settings. Enablers included clinical competence, effective communication, access to comprehensive clinical data and interprofessional collaboration. Patient education level, family support and community engagement were also key, underscoring the need for system-level support and shared decision-making to achieve effective deprescribing.
Deprescribing in T2D with polypharmacy is shaped by clinical competence, interprofessional collaboration, patient engagement and system-level resources. Improving practice in Indonesia requires clear guidelines, targeted HCP training, stronger interprofessional communication, better access to patient data and active involvement of patients and families. These strategies could provide context-specific insights to guide practice and policy on deprescribing initiatives.
766/UN6.KEP/EC/2024
Parenting concerns, stemming from cancer's projected impact on children, are a common and significant source of emotional distress for parents. A quantitative synthesis of existing data is critically absent, and the role of modulating factors (e.g., male sex, single parenthood, and the number of children) remains unclear.
This meta-analysis aims to quantify the association between parenting concerns and emotional distress in cancer patients, examining male sex, single parenthood, and number of children as key moderators.
This systematic review and meta-analysis followed PRISMA guidelines. Searches (PubMed, Embase, PsycINFO, Airiti Library; inception-November 2025) identified observational studies of adult cancer patients with minor children. Data on parenting concerns, anxiety, and depression were extracted and appraised using a modified JBI Checklist. Correlations were synthesized. Meta-regression addressed the quantitative void, examining male sex, single parenthood, and number of children as key moderators. Publication bias and sensitivity were assessed.
We included 12 studies (N = 3895). Our meta-analysis found significant positive associations (r = 0.50, p < 0.001) between parenting concerns and both anxiety and depression. Meta-regression, controlling for time since diagnosis, identified male sex, single parenthood, and fewer children as significant moderators for anxiety (p < 0.001), with similar trends for depression.
This meta-analysis highlights parenting concerns linked to distress in cancer patients, with fathers, single parents, and those with fewer children particularly vulnerable. Routine assessment and tailored, family-centered psychosocial interventions are urgently needed.
This systematic review was registered with the International Prospective Register of Systematic Reviews and Meta-analysis (PROSPERO; Registration No. CRD42024592899).
To identify different longitudinal trajectories of hypoglycaemia problem-solving ability in patients with diabetes mellitus (DM) and explore their predictive factors. To examine the impact of these heterogeneous trajectories on quality of life.
This study adopted a prospective longitudinal design.
A total of 272 patients who completed follow-up were longitudinally assessed for their hypoglycaemia problem-solving abilities over 6 months. Latent class growth modelling (LCGM) was used to identify heterogeneous trajectories of hypoglycaemia problem-solving ability. Multiple logistic regression was conducted to determine predictors, while univariate ANOVA and multiple linear regression analysis were applied to explore the effects of heterogeneous trajectories on quality of life.
The overall level of hypoglycaemia problem-solving ability in DM patients increased from hospitalisation to 1 month after discharge and gradually decreased from 3 to 6 months after discharge. LCGM identified three heterogeneous trajectories of hypoglycaemia problem-solving ability. Results of multinomial logistic regression analysis showed that employment status, monthly income, frequency of blood glucose monitoring, fear of hypoglycaemia, and social support were predictors of heterogeneous trajectories of hypoglycaemia problem-solving ability in DM patients. In addition, hypoglycaemia problem-solving ability positively predicts quality of life.
Our findings establish a critical theoretical foundation for designing and implementing effective interventions tailored to patients' distinct trajectories in diabetes management.
This study explores the trajectories and predictors of hypoglycaemia problem-solving abilities in DM patients, providing a theoretical basis for nurses to guide patients in diabetes management.
Research findings indicate that nurses should regularly assess the hypoglycaemia problem-solving abilities in DM patients, and use trajectory subgroups to identify distinct patient characteristics in hypoglycaemia problem-solving abilities in order to implement personalised interventions.
This study was based on the STROBE guideline.
No patient or public engagement.
Procedural pain and distress in children can result in severe short- and long-term consequences, including post-traumatic stress syndrome and needle phobia. While distraction techniques (e.g., toys, music) have been widely used, virtual reality (VR) offers a novel, immersive form of distraction. Despite the rapid development of VR technologies, there is a lack of comprehensive evidence regarding which paediatric patients and procedures benefit most from VR interventions.
We conducted a scoping review following the PRISMA-ScR guidelines. A systematic search across PubMed, Embase, Web of Science, Cochrane Library and Chinese databases (CNKI, Wanfang, VIP, SinoMed) identified studies from January 1, 2000 to November 15, 2025. Inclusion criteria were randomized controlled trials (RCTs) or quasi-experimental designs assessing VR for pain/anxiety management during medical procedures in paediatric patients, with outcomes including pain intensity, distress, feasibility, satisfaction or safety.
Of the 5458 original database citations, 201 were eligible for full-text evaluation. Of these articles, a total of 22 were included in the scoping review. RCTs comprised 81.8% (n = 18). The majority (86.4%) employed immersive VR and 27.3% utilized cost-effective smartphone-based systems. Procedures targeted included venipuncture, needle-related interventions, intravenous access, surgery and burn wound care. Approximately 86.4% of studies reported VR's superiority over standard care in reducing procedural pain and distress.
VR is an effective, non-pharmacological tool for managing procedural pain and distress in paediatric clinical settings, showing promise for integration into routine care. However, existing studies exhibit methodological heterogeneity and focus primarily on short-term outcomes. Future research should prioritize large-scale, rigorously designed RCTs with long-term follow-up, and focus on developing standardized, evidence-based VR protocols for diverse paediatric populations.
No patient or public contribution was required for this scoping review, as it only synthesized existing published literature without primary data collection.
by Weifeng Wang, Xianli Meng, Yan Zhao, Wei Gong, Xiaochen Jiang, Wenjuan Cao, Xueling Qiu, Chenxi Sun, Fan Sun, Yuchen Wang, Lu Tang
BackgroundTo alleviate pain in burn patients during dressing changes, it is necessary to identify an effective analgesic method. Conventional opioid analgesics have many limitations. Nitrous oxide is a fast-acting, safe and reversible inhaled analgesic gas. This systematic review will evaluate the effectiveness and safety of nitrous oxide in the treatment of pain during dressing changes in burn patients.
MethodThe protocol was developed according to the PRISMA-P checklist and registered on PROSPERO (CRD42024550197). A systematic search will be performed in the following databases: PubMed, EMBASE, Web of Science, Cochrane Library to identify clinical trials comparing nitrous oxide inhalation with standard care in pain management during dressing changes in burn wounds. The search of all databases will be conducted on October 15, 2025.Our search scope will include studies published between each database creation and search date.Two researchers will independently screen studies, extract data, and evaluate study quality using the Risk of Bias2 tool. Primary outcomes will include pain, anxiety, side effects, among others.R statistical software (version 4.3.1) and R studio will be used to perform meta-analyses.Effect size will be expressed by 95% confidence interval (Cl) of weighted mean difference (MD) and risk ratio (RR). Subgroup analyses and sensitivity analyses will be performed to explore sources of heterogeneity and assess the robustness of the results.Publication bias will be assessed using funnel plot and Egger test. We will use the Grading of Recommendation, Evaluation, Development and Evaluation (GRADE) to assess the quality of the evidence.
DiscussionOperative pain has always been a difficult problem for burn patients. This study will evaluate the analgesic effect of nitrous oxide on dressing change in burn patients through comprehensive search and rigorous methods, and provide evidence support for clinical decision-making.
by Gen Tsujio, Masakazu Yashiro, Yuichiro Miki, Kohei Matsuoka, Koji Maruo, Mami Yoshii, Tatsuro Tamura, Katsunobu Sakurai, Takahiro Toyokawa, Naoshi Kubo, Shigeru Lee, Tomohisa Okuno, Kishu Kitayama, Go Masuda, Masaichi Ohira, Kiyoshi Maeda
BackgroundOur group revealed that the combination of intra-operative stamp cytology and peritoneal lavage cytology (CY) improved the identification of individuals with high risk of peritoneal metastasis. In this exploratory Phase II study, we aimed to evaluate the effect on relapse-free survival (RFS) of extensive intraoperative peritoneal lavage (EIPL) for gastric cancer with positive peritoneal cytology (CY1) and/or stamp cytology positive (stamp+).
Materials and methodsThis study was a single arm, multi-institutional, exploratory phase 2 trial to assess the effects of EIPL after open gastrectomy for gastric cancer with CY1 and/ or stamp+. The primary endpoint was RFS. Secondary endpoints were overall survival (OS), postoperative recurrence site and incidence of postoperative adverse events.
ResultsBetween 2017 and 2021, 13 patients from 2 institutions were enrolled in this study. Because of the recent decline in open abdominal surgery, the number of cases did not increase and the trial was closed due to lack of applicants at 13 cases. Median 3-year RFS was 14.5 months (95% CI 5.4-NA), median 3-year OS was not reached (95% CI 14.5-NA) and median3-year peritoneal RFS was 16.0 months (95% CI 5.4-NA). Median 3-year peritoneal RFS rate was 83% in CY0 and stamp+ cases (n=6), and 0% in CY1 and stamp+/- cases (n=7). (Log-rank p=0.015).
ConclusionBecause of the slow accrual pace and early stop of the trial, we were not able to evaluate the prespecified endpoints thoroughly. However, EIPL might be effective to prevent perineal recurrence, especially in CY0 and stamp+ case.
by Dominika Buni, Áron Botond Kovács, Enikő Wehmann, Dénes Grózner, Krisztián Bányai, Eszter Zsófia Nagy, Janet Bradbury, Marco Bottinelli, Elisabetta Stefani, Salvatore Catania, Inna Lysnyansky, László Kovács, Miklós Gyuranecz, Zsuzsa Kreizinger
Mycoplasma iowae is an economically significant pathogen that causes reduced hatchability, late embryo mortality and leg deformities, chondrodystrophy and skeletal lesions in poults. While prevention is essential in the control of infection, the appropriate administration of antibiotics may reduce economic losses during outbreaks. As a first step in the exploration of antimicrobial resistance mechanisms in M. iowae, target modification and efflux pump activity were examined in the present study. Point mutations were analyzed in previously described antibiotic binding sites in the whole genome sequences of 99 M. iowae strains. Mismatch amplification mutation assays (MAMAs) were designed and validated for the differentiation of mutations corresponding to elevated minimum inhibitory concentration (MIC) values for fluoroquinolones. Broth microdilution assays were performed to evaluate the effect of efflux pump inhibitors. In the presence of orthovanadate (OV), MIC values were significantly lower than in the absence of OV for spiramycin, tilmicosin, tylosin and oxytetracycline, which may indicate the presence of an active efflux system in M. iowae. Putative promoter regions of efflux-related genes were predicted and characterized. Genetic mutations, previously described in other bacteria, were described to be associated with elevated fluoroquinolone, macrolide and lincomycin MICs in M. iowae, although certain resistant phenotypes remained unexplained, promoting future examinations for deeper insights. The developed MAMAs may support rapid identification of M. iowae strains with elevated MIC values for fluoroquinolones. The better understanding of the efflux pump mechanisms enables the development of alternative methods for the support of therapy against this pathogen.
by Yuting Wang, Jun Li, Zhongsu Yu, Shuyuan Li, Yuxia Chen, Yun Pan, Liangping Cheng, Guangyuan Yu
Acute pancreatitis (AP) is a severe inflammatory disorder in which pyroptosis—a pro-inflammatory form of programmed cell death—may contribute to pathogenesis. However, the complete transcriptional profile of pyroptosis-related genes (PRGs) in AP and their potential as diagnostic biomarkers remain underexplored. This study aimed to systematically characterize pyroptosis-associated transcriptional signatures and identify the reliable biomarkers for diagnostic purposes. Three transcriptomic datasets from murine AP models were integrated to identify pyroptosis-related differentially expressed genes (PRDEGs). Functional enrichment and immune cell infiltration analyses were conducted to elucidate the biological pathways and immune microenvironment alterations associated with these genes. mRNA-transcription factor (TF) and mRNA-microRNA (miRNA) regulatory networks were constructed to investigate underlying molecular interactions. Machine learning techniques, including support vector machine (SVM) and least absolute shrinkage and selection operator (LASSO), were applied for feature selection, leading to the identification of key diagnostic markers and the development of a logistic regression model. The regression model were then assessed using an independent cohort of human peripheral blood samples. Eleven PRDEGs were identified, with enrichment observed in processes such as cytoskeletal organization, cell-substrate adhesion, and critical inflammatory signaling pathways, including MAPK and NF-κB. Immune infiltration analysis revealed significant correlations between these PRDEGs and various immune cell subsets, particularly M1 macrophages, Treg cells, and monocytes. A four-gene diagnostic signature, comprising ANXA3, IQGAP1, RELA, and VTN, was established through SVM and LASSO analysis. In the independent human cohort, the fixed-coefficient four-gene model demonstrated reduced discrimination, which likely reflects interspecies and tissue-specific variations. However, after optimizing the model to exclude non-significant predictors, a refined two-gene signature (ANXA3 and IQGAP1) exhibited improved accuracy, with excellent calibration and clinical net benefit. This study offers a comprehensive transcriptomic analysis of the pyroptosis-mediated landscape and immune microenvironment in AP. An optimized two-gene signature, comprising ANXA3 and IQGAP1, was validated in a human cohort with superior accuracy, reflecting critical disruptions in inflammatory pathways and cytoskeletal organization. Notably, ANXA3 demonstrated potential for stratifying disease severity. Although these markers hold potential for molecular diagnosis, further prospective studies are essential to establish their clinical specificity and generalizability across diverse populations.
by Min Jung Kim, Eun-Gee Park, Changyoung Kim, Dong Yoon Kang, Borim Ryu, Kichul Shin
BackgroundA treat-to-target strategy involving treatment modification improves outcomes in gout, but evidence remains limited regarding the optimal approach when initial urate-lowering therapy (ULT) fails. This study aimed to investigate real-world ULT sequence patterns and evaluate treatment retention based on the initial agent, modification type, and comorbidities.
MethodWe analyzed electronic health record data collected from 2010 to 2022 from the common data model databases of two hospitals. Adults aged 18 years or older diagnosed with gout who initiated ULT and were followed for at least 2 years were included. Outcomes included the frequency and sequence of ULT prescriptions. Treatment modification, defined as switching to another ULT or adding an additional agent, was considered the end of retention for the previous regimen. Subgroup analyses were performed based on comorbidity.
ResultsAmong 2220 patients, febuxostat was the most common first-line agent (51.4%), with 90.9% maintaining therapy. Among those who modified febuxostat therapy, switchers and add-on users continued treatment similarly (91.5% vs. 86.8%, P = 0.33). Of allopurinol initiators, 55.8% changed therapy, mainly switching to febuxostat or benzbromarone rather than adding another agent (51.4% vs. 4.1%, P vs. 86.8%, P = 0.33). Among benzbromarone initiators, 57.2% changed therapy (switchers, 56.7%; add-on users, 0.5%; P P = 1.00). Chronic kidney disease was associated with low variability in ULT sequence.
ConclusionsULT demonstrated durable retention when used as first- or second-line treatment, with switching being more common than add-on therapy and maintaining similar retention rates.
by Shuanghong Jiang, Hongxia Yang, Ting Chen, Zhenyu Ji, Xixi Yan
ObjectiveThis study aimed to assess the incidence and risk factors for the development of steroid-induced ocular hypertension (SIOH) following 23-gauge (23G) pars plana vitrectomy.
MethodsThe clinical data of patients treated with 23G vitrectomy from January 2019 to March 2022 were reviewed retrospectively. The incidence and characteristics of SIOH post-operatively and treatment provided were recorded. The clinical risk factors for developing SIOH were analyzed using logistic regression analysis.
ResultsAmong the 540 eligible patients, 111 (20.56%) cases developed SIOH. The majority (83.78%) of the SIOH cases developed between the third and seventh day postoperatively. Among these cases, 65 (58.56%) patients had an intraoperative pressure (IOP) of 30 mmHg or higher, and 31 (27.9%) had an IOP of 40 mmHg or higher. The IOP of all SIOH patients returned to normal within 1 month following the discontinuation of steroid and IOP-lowering medicine treatment. The independent risk factors for SIOH (IOP ≥ 23 mmHg) were myopia (odds ratio (OR) 5.22) and silicone oil filling (OR 8.20). For severe SIOH (IOP ≥ 30 mmHg) myopia and silicone oil filling were also identified as risk factors with an OR of 3.23 and 12.86, respectively. After adjusting the steroid administration pattern, the incidence of all SIOH and severe SIOH decreased to 17.11% and 9.14%, respectively.
ConclusionsMyopia and silicone oil filling were identified as potential independent risk factors for the development of SIOH after vitrectomy. A shorter topical steroid therapy was associated with a lower incidence of SIOH particularly in high-risk patients.
by Chia-Ying Li, Hung-Yu Lin, En-Pei Isabel Chiang, Hung-Chang Hung, Feng-Yao Tang
Sucralose, a widely utilized non-caloric sweetener, is frequently added to food and beverage products as a sugar substitute aimed at lowering energy consumption and reducing obesity-related health risks. However, epidemiological studies have indicated a possible association between high intake of sucralose and increased prevalence of coronary artery disease (CAD). Prior research has demonstrated that diminished levels of circulating human endothelial progenitor cells (hEPCs) are linked to a higher risk of CAD. Although sucralose is broadly consumed, its direct biological impact on hEPCs has not been comprehensively characterized. In this study, we investigated the cellular effects of sucralose on hEPCs using a variety of in vitro techniques, including assays for viability, migration, capillary-like tube formation, lactate dehydrogenase (LDH) release-cytotoxicity assay, and protein expression profiling by Western blotting. Our results revealed that increased concentrations of sucralose significantly impaired hEPCs viability, motility, and neovasculogenic function, accompanied by increased expression of markers associated with apoptosis, inflammasome activation, and pyroptosis. Mechanistic analysis further demonstrated that sucralose strongly activated endoplasmic reticulum (ER) stress/PERK pathways in these cells. Inhibition of ER stress via 4-phenylbutyric acid (4-PBA) substantially attenuated sucralose-induced cell death and reduced the expression of pyroptosis-related proteins and inflammasome markers. Taken together, these findings suggest that sucralose disrupts hEPCs function in part by triggering ER stress, which promotes both apoptotic and pyroptotic cell death programs.
Metabolic syndrome (MetS) poses a significant public health challenge among employed adults. Lifestyle modifications have been shown to be effective in preventing the onset and progression of MetS in employed adults, and the widespread adoption of mobile and wearable technologies introduces an appealing approach to mHealth lifestyle interventions. When widely implementing smartphone-based interventions for employed adults, enhancing equitable access and promoting wearable device use for those with MetS is a more cost-effective way to reduce health disparities, particularly in resource-limited settings. However, relevant evidence is currently lacking.
This study aims to design an mHealth-based Healthy Lifestyle Promotion (MYLIFE) trial, a three-arm randomised controlled trial (RCT), to evaluate the effectiveness of a smartphone-based lifestyle intervention and a combined smartphone-based lifestyle intervention with intensive intervention for MetS individuals using wearable devices, in reducing MetS risk among employed adults.
This is a three-arm, parallel, single-blind, cluster RCT with a 12-week intervention and a total follow-up of 1 year. The trial will recruit 120 workplaces from the Chinese Cohort of Working Adults in a 1:1:1 ratio to either a control group or one of two intervention groups. Within these workplaces, a total of at least 348 eligible participants will be enrolled. The regular mHealth group will receive smartphone-based intervention. The intensive mHealth group will receive smartphone-based intervention for all participants, and an additional wearable device-intensive intervention for those with MetS. The primary outcome is the Chinese MetS Z score at 12 weeks. Secondary outcomes include MetS Z score, prevalence of MetS, specific MetS components, questionnaire-based indicators, and clinical outcomes at 12 weeks and 1 years. The main analysis will follow the intention-to-treat principle, using mixed-effects models to assess between-group differences in outcomes.
The protocol has been approved by the Ethics Committee of the West China School of Public Health and the West China Fourth Hospital, Sichuan University (Gwll2025024). The findings will be published in peer-reviewed journals and presented at scientific conferences.
ChiCTR2500101904.
To identify body temperature dynamic patterns and develop a machine learning model for the early detection of nosocomial infections.
A retrospective and observational study of patients hospitalised in the haematology department of the Chinese People's Liberation Army General Hospital between January 2014 and December 2023.
A latent class trajectory model was used to discover patterns in patients' body temperatures over time. Machine learning models were then built to predict nosocomial infections and evaluated using standard metrics (AUROC, sensitivity, specificity). SHAP (SHapley Additive exPlanations) values were used to interpret the final model.
Among 6989 patients, we identified four distinct body temperature trajectories. Bloodstream infections were most common in patients exhibiting either a slow rise followed by a gradual decrease or a rapid rise followed by a quick decrease in body temperature. The XGBoost model showed excellent predictive performance (AUROC = 0.801), with balanced sensitivity (0.718) and specificity (0.701). The top five predictors of nosocomial infections were elevated procalcitonin, neutropenia, prolonged central venous catheter use and two specific temperature trajectories: ‘stable and relatively high’ and ‘a rapid rise followed by a quick decrease’.
The XGBoost model effectively predicted nosocomial infections. Dynamic body temperature trajectories provided early, objective warning signs of infection. This predictive tool empowered nursing staff to proactively monitor nosocomial infection, allowing for timely, data-driven interventions in vulnerable hematologic patients.
The developed machine learning predictive tool can help clinical medical staff identify nosocomial infections as early as possible, facilitate personalised rehabilitation and health management plans, aligning with the philosophy of patient-centred precision nursing. Further, the four body temperature trajectory patterns identified provide nurses with objective, dynamic indicators for recognising potential infection subphenotypes, supporting a shift from experience-driven reactive care towards data-driven proactive nursing.
Previous studies suggested that body temperature could indicate the severity and prognosis of infections, but the pattern was unknown. In this study, we found that body temperature trajectories could signal infection subphenotypes, such as bloodstream infections being most common in patients with a slow rise followed by a gradual decrease in body temperature or with a rapid rise followed by a quick decrease. By integrating body temperature trajectories with key clinical biomarkers, the developed prediction model enables early and accurate identification of nosocomial infections in hematologic patients. The application of this tool may significantly shorten the time window between infection onset and intervention, potentially reducing infection-related complications, mortality and healthcare costs, thereby improving overall care quality and patient outcomes.
The study adhered to the relevant EQUATOR reporting guidelines, the TRIPOD Checklist for Prediction Model Development and Validation.
The research team included nursing staff and clinicians responsible for infection surveillance and control in the hospital, who contributed real-world insights into the definition of predictors, interpretation of temperature trajectories, clinical implications of the prediction model and preparation of the manuscript. Their expertise helped ensure that the study addressed relevant clinical questions and that the findings are interpretable and actionable in practice.
To systematically map the landscape of central venous access device research from 2014 to 2024, identifying critical gaps in evidence that may impact nursing practice and patient outcomes across the full device lifecycle from selection through to removal.
This review was conducted in accordance with the Guidance for producing a Campbell evidence and gap map and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.
PubMed, Cumulative Index to Nursing and Allied Health Literature Complete, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched with additional hand-searching of reference lists from included reviews.
We systematically reviewed literature published between 2014 and 2024, mapping 710 studies on central venous access device interventions and outcomes. Studies were categorised by design, population, setting, device characteristics, intervention types, and outcomes. Evidence was evaluated using the National Health and Medical Research Council levels of evidence framework.
Of 710 included studies, 89 were systematic reviews and 621 primary studies, of which 41.1% (n = 292) were randomised controlled trials. Research was primarily conducted in high-income countries (n = 405, 65.2%) and focused on adults (n = 370, 59.6%) in hospital inpatient settings (n = 588, 94.7%). Catheter insertion and infection prevention dominated the evidence base, while device selection and removal procedures were less studied. Infection outcomes were extensively reported (bloodstream infection: n = 455, 13.6% of 3349 outcomes), while patient-reported outcomes (n = 218, 6.5%) and cost (n = 60, 1.8%) were underrepresented.
This review reveals that central venous access device research is predominantly focused on insertion and infection prevention while other key parts of nursing practice are under-supported.
Future nursing research should address these gaps to improve evidence-based care across diverse populations and healthcare contexts, particularly focusing on understudied device types, settings, and vulnerable populations.
This review was conducted and reported in accordance with the Guidance for producing a Campbell evidence and gap map.
This study did not include patient or public involvement in its design, conduct, or reporting.
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