'I fit the category of the box, it just doesn’t describe me well.' Exploring the perspectives of autistic women and gender-diverse individuals on self-report autism measures

by Nora Uglik-Marucha, Serafina Show, Silia Vitoratou, Francesca Happé, Hannah Belcher

Psychological assessments play a significant role in both clinical decision-making and the interpretation of research findings, with the quality of these inferences depending on the validity of the measures used. Recent evidence suggests there are gender differences in the presentation of autism, raising concerns about the validity of existing autism tools to measure autistic traits in women and the subsequent implications for clinical inferences and research. This study explored the perspectives of autistic women on the relevance of existing autism questionnaires to their lived experience, alongside additional input from gender-diverse individuals assigned female at birth (AFAB). Through interviews, focus groups, and online surveys, 22 autistic women and AFAB gender-diverse individuals shared their experiences using and perspectives on the Autism Spectrum Quotient-10, 14-item Ritvo Autism & Asperger Diagnostic Scale, and Broad Autism Phenotype Questionnaire. The interview data were analysed using reflexive thematic analysis, identifying two overarching themes: (1) questionnaires measure only one way to be autistic, and not in an autism-friendly manner, and (2) enhancing questionnaires’ relevance for autistic women and individuals socialised as female: key missing experiences to include. The findings suggest that some of the most frequently used autism measures may not fully capture the experiences of autistic women and AFAB gender diverse individuals. Significant gaps were identified, indicating that important aspects of the participants’ lived experiences were missing. Furthermore, concerns were raised about the questionnaires’ lack of relevance to the autistic population as a whole. The findings underscore the non-satisfactory content validity of these tools for measuring autism in autistic women and AFAB gender-diverse individuals. This highlights the need for their refinement to better reflect contemporary understandings of different presentations of autistic traits, particularly the impact of gendered experiences, in a way that avoids the introduction of possible new biases and remains relevant and accessible to autistic individuals.

Mobile phone MIMO antenna array miniaturization-based low SAR research in the combined EMF

by Wen-Qi Hou, Yu-Xin Li, Ming-Fei Luo, Wen-Ying Zhou, Mai Lu

Due to the diversification of media functions of mobile phones, users can make calls and access the internet simultaneously, which has significantly increased the usage time of mobile phones. The exposure dose of the users in the combined electromagnetic fields (EMF) should be further quantified to better evaluate the public exposure safety. Different from most conventional EMF safety studies that only focus on a single frequency, this work not only discusses the mobile phone simultaneously operated in fourth-generation (4G) and fifth-generation (5G) mobile communications radiation impact on users, but also verifies that the miniaturized mobile phone multiple-input multiple-output (MIMO) antenna array can significantly reduce the specific absorption rate (SAR) absorbed by users. In this article, a miniaturized mobile phone MIMO antenna array is employed as the radiation source, and multi-pose human models are established to simulate the practical utilization of a smartphone. A systematic analysis of the SAR absorbed by the human model is conducted in both single and combined EMF scenarios. The results indicate that the peak SAR in various tissues under multi-frequency exposure is 1.02 to 15.85 times higher than that under single-frequency exposure.

Anal HPV shedding assessed by self-sampling and multiplex real-time PCR among men who have sex with men in N’Djamena, Chad: a feasibility and acceptability study

by Donato Koyalta, Zita Aleyo Nodjikouambaye, Jonathan Muwonga Tukisadila, Hachim Djamal Abdoulaye Bargo, Suitombaye Noubaramadji Yamti, Amine Akouya, Ralph-Sydney Mboumba Bouassa, Laurent Belec

Background

High-risk (HR) human papillomavirus (HPV) infection remains a great concern in sub-Saharan Africa in men who have sex with men (MSM). The prevalence of anal shedding of HPV and associated risk factors was estimated for the first time in a cross-sectional observational study covering MSM living in N’Djamena, the capital city of Chad.

Methods

MSM were recruited from the community in 21 sites in neighborhoods of 5 districts randomly selected in N’Djamena by respondent-driven sampling (RDS) method. Anal Collector V-Veil UP2™ device was used for anal canal self-sampling. Manual silica-extracted DNA was subjected for HPV detection and genotyping using BMRT Human Papillomavirus Genotyping Real Time PCR assay (Jiangsu Bioperfectus Technologies Co., Ltd., Taizhou, China). HIV serostatus was assessed using two rapid tests in series.

Results

A total of 70 MSM (mean age: 29.9 years; range, 18–50) were included. The overall acceptability to practice veil-based anal self-sampling was 95.9%. The usability of the veil collector device was high (92.3%), with easy understandable instructions for use and correct placement in the anal canal. Satisfaction questionnaire reported high overall feeling, intimacy respect and lack of shame. The majority of MSM (44/70, 62.8%) showed anal shedding of HPV DNA, with HR-HPV frequently detected (38,70, 54.3%), including HPV-33 (30/70, 42.9%) HPV-68 (16/70, 22.9%), HPV-18 (4/70, 5.7%), HPV-35 (3/70, 4.3%), HPV-58 (2/70, 2.9%), and HPV-45 (1/70, 1.4%). The distribution of genotypes in HR-HPV DNA-positive MSM revealed that HPV-33 (30/70; 42.9%) was the predominant genotype, followed by the HPV-68 (16/70; 22.9%), HPV-18 (4/70; 5.7%), HPV-35 (3/70; 4.3%), HPV-58 (2/70; 2.9%), and HPV-45, HPV-51 and HPV-56 (each type, 1/70;1.4%).Among all HPV detected, only 42 HPV (36.8%) were covered by Gardasil-9^® vaccine, including the HR-HPV-33, −18, −58 and −45, and the low risk-HPV-6 (5.7%) and HPV-11 (1.4%). The majority of detected HPV were non-covered by Gardasil-9^® vaccine (63.1%). Overall HIV prevalence was 5.7%.

Conclusions

Taken together, these observations point the MSM population in N’Djamena as a very particular core group of HIV and HPV transmission. HIV prevalence was higher than that of general adult population, but limited to only one MSM of twenty. The RDS method of recruitment allowed to include MSM likely belonging to the same sexual network of HPV transmission leading to the selection of an atypical and specific profile of anal HPV distribution. The potential efficacy of HPV prophylactic vaccination in this population can be estimated at relatively weak.

Faster but less accurate: An explorative study on the effects of three weeks of ketogenic diet on cognitive functions in undergraduate students

by Gianluigi Serio, Consiglia Pacelli, Claudia Piccoli, Nazzareno Capitanio, Giuseppe Cibelli, Anna Antonia Valenzano, Francesca Landini, Leonardo Carlucci, Paola Palladino

The ketogenic diet (KD) is a low-carbohydrate diet that induces and sustains a ketosis state and minimizes somatic glucose levels. Several psychological studies have described the positive effects of ketosis on cognitive functions for a wide range of neuropsychiatric conditions (e.g., Alzheimer’s disease; epilepsy), leading to greater interest in the KD today. However, the psychological and cognitive effects of inducing ketosis via diet remain unclear, especially in healthy people. From an initial pool of thirty participants, eight undergraduate students performed a cognitive assessment before (baseline) and after three weeks (follow-up) of an isocaloric ketogenic diet. Several neuropsychological measures and psychometric tests have been administered to investigate psychological chronotype, sleep quality, eating habits, anxiety and cognitive components of attention, inhibition, and memory. Non-parametric Bayesian analysis showed that the ketogenic diet affected cognitive functions. Participants performed cognitive tests faster at follow-up than at baseline, showing improvements in visual-motor cognitive and processing speed components. However, they were less accurate on working memory tasks, suggesting a decreasing performance of higher cognitive functions. Finally, no differences in anxiety levels were found between baseline and follow-up. The results could have significant implications for identifying specific cognitive models of students based on specific lifestyle habits and nutritional patterns, allowing the implementation of targeted interventions to improve university learning conditions.

“You could get the best of both breeds or the worst of both”: UK public attitudes towards crossbreeding in dogs - with a specific focus on brachycephalic dogs

by Elizabeth Youens, Dan G. O’Neill, Zoe Belshaw, Johanna Neufuss, Mickey S. Tivers, Rowena M. A. Packer

Extreme conformation and reduced genetic diversity are recognised to lead to severely reduced health, welfare and longevity in certain dog breeds. There is growing interest in applying strategic crossbreeding to promote more moderate conformations and greater genetic diversity within currently problematic breeds. Crossbreeding could therefore lead to more rapid and effective improvements in welfare compared to current practices of within-breed selection. Deliberate crossbreeding between distinct different dog breeds is not a new concept; it was historically commonly used to create the current pure breeds, to increase genetic diversity and to bring new physical and/or temperament traits into existing breeds. However, a recent surge in the popularity of ‘designer crossbreeds’ (intentional crosses between established purebreds) has elicited fresh interest around the potential positives and negatives of crossbreeding practices. Further research on crossbred brachycephalic dogs is urgently required for a greater understanding of the motivators and barriers to their acquisition. An online survey explored factors that motivate dog breed choice and acquisition of both crossbreed and purebred dogs. In addition, the survey used both closed and open questioning to explore the UK public’s perceptions of crossbreeding, specifically (i) between a brachycephalic breed and a non-brachycephalic breed, and (ii) between two non-brachycephalic breeds. Free-text results were analysed using content analysis and subsequently quantified. Results from 4,899 participants identified that key motivators to acquire a brachycephalic crossbreed vs a brachycephalic purebred included perceptions of improved health, including the reduction in risk of breed and conformation-related disorders, and increased genetic diversity. However, the desire to acquire a purebred dog, or even a specific breed, remained a significant barrier to crossbreed acquisition, alongside concerns surrounding the ethics of crossbreeding. Other barriers included perceived negative changes to appearance and temperament of the offspring from crossbreeding. The current study identified a common set of acquisition decision-making factors across all ownership groups, including desiring a dog who the owner perceives to enjoy being loved and to enjoy physical affection, but further demonstrated that good health is of motivational low priority to some dog owners, particularly to owners of purebred brachycephalic dogs. The mix of positive and negative public perceptions and beliefs around crossbreeding and crossbreed dogs demonstrate the need for further research into the health, temperament and appearance of brachycephalic crossbreed dogs. The suitability of crossbreed dogs as an alternative to certain current purebred breeds with high risk of genetic or conformational disorders depends on both public desire and on evidence-based selection of suitable breeds to encourage crosses which maximise canine welfare.

Health and lifestyle in the Iron Age Italian community of Pontecagnano (Campania, Italy, 7th-6th century BCE)

by Roberto Germano, Owen Alexander Higgins, Emanuela Cristiani, Alessia Galbusera, Carmen Esposito, Dulce Neves, Carmine Pellegrino, Alessandra Sperduti, Giorgio Manzi, Luca Bondioli, Alessia Nava

This study investigates health, dental development, diet, and human-environment interactions in individuals buried in the necropolises of Pontecagnano (Campania, Italy, 7th-6th century BCE), using an integrated approach merging dental histomorphometry and calculus micro-residue analysis. The sample consists of 30 permanent teeth (canines, first and second molars) from 10 individuals. Histomorphometric analysis of dental thin sections allowed the estimation of crown formation times, initial cusp formation, crown completion, and enamel extension rates. The prevalence of Accentuated Lines, marking physiological stress events, was analyzed chronologically across tooth classes. Dental calculus analysis was performed on five individuals, identifying plant micro-remains and fungal spores. Crown formation times varied by tooth class, with canines forming the longest (mean = 1,977 ± 295 days), followed by second molars (mean = 1,176 ± 179 days) and first molars (mean = 1,094 ± 154 days). Initial cusp formation values, estimated through chronological overlap between teeth, allowed for a more accurate reconstruction of crown completion timing. Accentuated Lines prevalence peaked at 12 and 44 months, likely reflecting early childhood dietary transitions and the differential recording of stress events across different crown regions. Calculus analysis identified starch granules from cereals (Triticeae) and legumes (Fabaceae), fungal spores (Saccharomyces), and plant fibers, indicating diverse dietary practices, food processing, and extra-masticatory activities. This interdisciplinary approach reinforces the validity of combining histomorphometric and micro-residue analyses to reconstruct childhood health, adult diet, and lifestyle. Our findings align with previous research while emphasizing population-specific variations. This study enhances understanding of Iron Age biocultural adaptations, offering insights into developmental and dietary behaviors in this ancient Italian community.

Human emotional odours influence horses’ behaviour and physiology

by Plotine Jardat, Alexandra Destrez, Fabrice Damon, Noa Tanguy-Guillo, Anne-Lyse Lainé, Céline Parias, Fabrice Reigner, Vitor H. B. Ferreira, Ludovic Calandreau, Léa Lansade

Olfaction is the most widespread sensory modality animals use to communicate, yet much remains to be discovered about its role. While most studies focused on intraspecific interactions and reproduction, new evidence suggests chemosignals may influence interspecific interactions and emotional communication. This study explores this possibility, investigating the potential role of olfactory signals in human-horse interactions. Cotton pads carrying human odours from fear and joy contexts, or unused pads (control odour) were applied to 43 horses’ nostrils during fear tests (suddenness and novelty tests) and human interaction tests (grooming and approach tests). Principal component analysis showed that overall, when exposed to fear-related human odours, horses exhibited significantly heightened fear responses and reduced interaction with humans compared to joy-related and control odours. More precisely, when exposed to fear-related odours, horses touched the human less in the human approach test (effect size: Rate Ratio(RR)=0.60 ± 0.24), gazed more at the novel object (RR = 1.32 ± 0.14), and were more startled (startle intensity – Cohen’s d = −0.88 ± 0.39; and maximum heart rate – Cohen’s d = 1.16 ± 0.47) by a sudden event. These results highlight the significance of chemosignals in interspecific interactions and provide insights into questions about the impact of domestication on emotional communication. Moreover, these findings have practical implications regarding the significance of handlers’ emotional states and its transmission through odours during human-horse interactions.

Assessment of microfungal contamination and enzymatic activity in ethnographic textile artifacts and museum environment

by Guven Ozdemir, Alev Haliki, Melike Çelebi

Ethnographic textile artifacts are highly susceptible to fungal biodeterioration due to their organic composition and continuous exposure to microfungi in museum environments. This study aimed to assess the extent of microfungal contamination in the exhibition and storage areas of the Ege University Ethnography Museum and to evaluate the enzymatic activities (cellulase and protease) of the isolated fungal species to determine their biodeterioration potential. Air and surface samples were collected from display halls, storage rooms, and outdoor reference points during two seasons (spring and autumn) using a portable air sampler on DG-18, PCA, and MEA media. Fungal isolates were identified through macroscopic and microscopic examination supported by standard mycological keys, and their enzymatic activity was assessed using CMC agar for cellulase and skim milk agar for protease production. Microclimatic influences and seasonal differences were statistically evaluated using a two-sample independent t-test. Fungal load ranged from 120–450 CFU/m³ on DG-18 and 300–1000 CFU/m³ on PCA, with the highest values recorded inside display cases and storage zones. A total of 58 fungal isolates were obtained, predominantly belonging to Aspergillus, Penicillium, Cladosporium, Alternaria, and Rhizopus. Enzymatic assays showed that several isolates exhibited strong cellulase and protease activities, particularly A. sydowii, P. citrinum, A. flavus, and P. chrysogenum, indicating a high biodeterioration risk for cellulose- and protein-based textiles. Seasonal differences were statistically insignificant, highlighting the greater importance of microclimatic conditions and ventilation patterns. These findings underscore the need for integrated biological risk management and continuous microbial monitoring to protect ethnographic textile heritage from fungal deterioration.

Sexual and reproductive health challenges among street adolescents in Sylhet city, Bangladesh: A cross-sectional study

by Yeahyea Ahmed, Md Abdullah Saeed Khan, Laila Afroz, Mohammad Nurunnabi, Md Golam Abbas

Background

Street adolescents often engage in early sexual activity, have multiple partners, and are at high risk of sexual abuse and exploitation. Despite the significance of this issue, there is a critical gap in understanding the sexual and reproductive health (SRH) needs, practices, and challenges of this marginalized population in Bangladesh, which this study aimed to explore.

Methods

A cross-sectional study was conducted from August to December 2023, involving 311 street adolescents aged 16–19 years in Sylhet City Corporation, Bangladesh. Data were collected through face-to-face interviews using a semi-structured questionnaire. The questionnaire covered sociodemographic characteristics, pubertal changes, SRH status, and SRH-seeking behaviors.

Results

Of all participants, 62.8% were males and 37.2% were females, with a mean age of approximately 17.3 years for both sexes. Sexual intercourse was reported by 32.56% of participants, with a significant gender disparity (76.79% females vs. 6.35% males, p  Conclusion

Street adolescents in Sylhet City face severe SRH challenges, including high rates of sexual abuse, low contraceptive use, and limited STD knowledge, with significant gender disparities, which should be addressed through appropriate and urgent interventions.

Placebo and nocebo in clinical practice: An online cross-sectional survey of healthcare professionals from European countries on views, practices and training needs

by Mary O’Keeffe, Nathan Skidmore, Arianna Bagnis, Przemysław Bąbel, Elżbieta A. Bajcar, Alessandra De Palma, Andrea W.M. Evers, Eveliina Glogan, Julia W. Haas, Stefanie H. Meeuwis, Marek Oleszczyk, Antonio Portolés, Johan W.S. Vlaeyen, Katia Mattarozzi, on behalf of PANACEA Consortium

Background

Placebo and nocebo effects significantly influence health outcomes, yet healthcare professionals receive limited training and guidance on their mechanisms and clinical application, creating a gap in education and practical understanding. Conducted within the European PANACEA Consortium, this study evaluated healthcare professionals’ knowledge, attitudes, and practices regarding placebo and nocebo effects, and assessed their needs in further education.

Methods

An online cross-sectional survey among a European multi-country convenience sample of healthcare professionals collected data assessing participants’ knowledge, perceptions, and experiences regarding placebo and nocebo effects; their application and ethical considerations in clinical practice; and investigated educational needs and interest in further training. Quantitative data were analyzed using descriptive statistics, and thematic analysis was applied to the free-text responses.

Results

Amongst 807 participants, 71.7% reported taking advantage of placebo effects in their practice, and over half of participants (55.8%) observing nocebo effects. Participants reported feeling somewhat confident (53.3%) in harnessing placebo effects with 47.5% feeling confident in preventing nocebo effects. The majority of respondents had not received formal training on placebo and nocebo effects, with most expressing an interest in further training in areas such as healthcare education, emphasizing communication skills to enhance placebo effects, and knowledge to recognize and reduce nocebo effects.

Conclusions

There is a significant need for more comprehensive training on placebo and nocebo effects, particularly in early health professional education. These findings informed the development of educational resources and best practice recommendations developed as part of the outcomes from the PANACEA Consortium, improving the understanding and application of these effects among healthcare professionals across Europe.

Monitoring the health of wolves (<i>Canis lupus</i>): Integrating conservation and public health

by Elisabetta Ferraro, Graziana Da Rold, Roberto Celva, Elisa Dalla Libera, Stefania Leopardi, Giulia Simonato, Paola De Benedictis, Nadia Cappai, Arianna Dissegna, Carlo Vittorio Citterio, Rudi Cassini, Federica Obber

The grey wolf (Canis lupus) population is expanding in parts of Europe due to legal protection and favorable ecological conditions. As wolves increasingly move into urban and suburban areas, interactions with domestic dogs become more frequent, raising the risk of pathogen transmission and posing potential threats to both wolf conservation and public health. This study investigated the health status of wolves in the Foreste Casentinesi National Park (Italy) using non-invasive fecal sampling conducted between May 2019 and March 2020. Samples were genetically analyzed to identify individuals and then screened for viral pathogens, Canine Coronavirus and Parvovirus, using PCR, Sanger sequencing, and phylogenetic analysis. Parasitological examinations were performed using flotation techniques on whole samples, and real-time PCR targeting Echinococcus granulosus and E. multilocularis was conducted on selected samples. Of the 260 samples collected, genetic analysis identified 80 individual wolves belonging to 8 packs. Only one sample tested positive for Coronavirus (1.2%), and none for Parvovirus. The detected sequence clustered with strains previously reported in wolves and foxes in Italy. Copromicroscopy revealed a high prevalence of veterinary-relevant endoparasites, including Eucoleus spp. (90.0%), Sarcocystis spp. (42.5%), Taeniids (28.7%), and Ancylostomatids (26.2%). Trichuris vulpis, Toxocara canis, and coccidia showed prevalence rates below 2%. All 104 samples tested for E. granulosus or E. multilocularis were negative. These findings suggest that while wolves in the FCNP commonly harbor several canine parasites, their role in the transmission of zoonotic pathogens appears limited. Although phylogenetic data suggest that coronavirus strains tend to cluster within wildlife species, molecular data on domestic dogs remain scarce. Nonetheless, the high prevalence of shared parasites highlights the need for ongoing surveillance in both wild canids and domestic carnivores. As wolves increasingly inhabit human-dominated landscapes, understanding disease dynamics at the wildlife–domestic interface is essential for effective conservation and public health strategies.

No pets allowed: Evidence that prolonged grief disorder can occur following the death of a pet

by Philip Hyland

Background

Prolonged grief disorder (PGD) is a psychiatric disorder in ICD-11 and DSM-5-TR that can only be diagnosed following the death of a person. Despite considerable evidence that people form strong attachments to their pets, and experience high levels of grief following their death, the current guidelines do not allow PGD to be diagnosed following the death of a pet. This study tested several hypotheses to determine if there is anything unique about grief that follows the death of a person versus grief that follows the death of a pet.

Methods

A nationally representative sample of adults from the United Kingdom (N = 975) provided information about different bereavements, their most distressing bereavement, and ICD-11 PGD symptoms.

Results

One-third (32.6%) of respondents experienced the death of a beloved pet, and almost all had also experienced the death of a human; 21.0% of these people chose the death of their pet as most distressing. The conditional rate of PGD following the death of a pet was 7.5%, similar to many types of human losses. The relative risk of PGD following pet bereavement was 1.27, and pet loss accounted for 8.1% of all PGD cases in the population, both of which were higher than many types of human losses. Full measurement invariance for PGD symptoms was found between people who reported symptoms for a human bereavement and for a pet bereavement.

Conclusions

People can experience clinically significant levels of PGD following the death of a pet, and PGD symptoms manifest in the same way regardless of the species of the deceased. Implications associated with excluding diagnosis following pet bereavement are discussed.

Transforming scholarly landscapes: The influence of large language models on academic fields beyond computer science

by Aniket Pramanick, Yufang Hou, Saif M. Mohammad, Iryna Gurevych

Large Language Models (LLMs) have ushered in a transformative era in Natural Language Processing (NLP), reshaping research and extending NLP’s influence to other fields of study. However, there is little to no work examining the degree to which LLMs influence other research fields. This work empirically and systematically examines the influence and use of LLMs in fields beyond NLP. We curate 106 LLMs and analyze ∼148k papers citing LLMs to quantify their influence and reveal trends in their usage patterns. Our analysis reveals not only the increasing prevalence of LLMs in non-CS fields but also the disparities in their usage, with some fields utilizing them more frequently than others since 2018, notably Linguistics and Engineering together accounting for ∼45% of LLM citations. Our findings further indicate that most of these fields predominantly employ task-agnostic LLMs, proficient in zero or few-shot learning without requiring further fine-tuning, to address their domain-specific problems. This study sheds light on the cross-disciplinary impact of NLP through LLMs, providing a better understanding of the opportunities and challenges.

Effects of breathing exercise and thoracic techniques on pain and disability in low back pain: A systematic review and meta-analysis

by Tahere Seyedhoseinpoor, Ramin Jafari, Zohreh Shafizadegan, Maryam Abbaszadeh-Amirdehi

Purpose

The objective of this study was to systematically review the effectiveness of thoracic-focused interventions, including breathing exercises and thoracic manual techniques (mobilization, high-velocity low-amplitude manipulation, and release techniques), on pain and disability in patients with low back pain (LBP).

Methods

PubMed, Scopus, Web of Sciences, ProQuest, Ovid, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and Google Scholar were searched without language restrictions. Clinical trials with control groups on pain and disability in low back pain patients focusing on the efficacy of breathing exercises or thoracic technique were included. In total, 31 studies contributed to the meta-analysis for pain and 24 for disability.

Results

Pooled analyses using Morris’ dppc demonstrated a statistically significant, small effect for pain reduction (dppc = −0.35, 95% CI = −0.46 to −0.23) and a large effect for disability improvement (dppc = −0.71, 95% CI = −0.86 to −0.57) when compared with control groups. Thoracic manual techniques showed larger effects on both pain and disability compare to breathing exercises. However, substantial statistical heterogeneity (I² > 85%) persisted in most analyses.

Conclusion

Breathing and thoracic manual techniques may be effective in reducing disability and, to a lesser extent, pain in patients with LBP, but the overall certainty of evidence is low. However, the quality of the evidence is low. Variability in treatment protocols, study quality, blinding, and outcome measures likely contributed to inconsistencies. Further high-quality trials with standardized protocols are needed to confirm these findings and inform clinical practice.

Identifying risk patterns for sudden cardiac death in athletes: A clustering and principal component analysis approach

by Giacinto Angelo Sgarro, Paride Vasco, Domenico Santoro, Luca Grilli, Marco Giglio, Natale Daniele Brunetti, Luigi Traetta, Giuseppe Cibelli, Anna Antonia Valenzano

Sudden Cardiac Death (SCD) is a critical and unexpected condition that occurs due to cardiac causes within one hour of the onset of acute cardiovascular symptoms or twenty-four hours in unwitnessed cases. Despite advancements in cardiovascular medicine, practical methods for predicting SCD are still lacking, and there are no standardized systems to identify individuals at risk, especially in seemingly healthy populations such as athletes. In this study, we employed hierarchical clustering and principal component analysis (PCA) on data from 711 competitive athletes, revealing distinct patterns and cluster distributions in PCA space. Specifically, Clustering revealed characteristic feature combinations associated with increased SCD risk in athletes. Notably, certain clusters shared traits, including participation in Class C sports, sinus tachycardia, ventricular pre-excitation, personal or family history of heart disease, T-wave inversions, and prolonged QTc intervals. PCA helped visualize these patterns in distinct spatial regions, highlighting underlying structures and aiding intuitive risk interpretation. These results enable scientists to derive cluster metrics that serve as reference points for classifying new individuals and visually representing risk patterns in a clear graphical format. These findings establish a foundation for predictive tools that, with additional clinical validation, could aid in the prevention of SCD. The dataset used in this study, along with the clustering and PCA results, is available to the scientific community in an open format, together with the necessary tools and scripts to enable independent experimentation and further analysis.

Food insecurity and the use of coping strategies on multimorbidity, anxiety and depression in South African adults: A nationally representative study

by Olatundun Gafari, Ashleigh Craig, Khuthala Mabetha, Duncan Hornby, Craig Hutton, Mary Barker, Shane A. Norris

Objective

To assess the associations between food insecurity, coping strategies, socio-economic status and anxiety, depression and multimorbidity in South Africa.

Methods

Data from a nationally representative cross-sectional survey conducted in April 2024 (n = 3171; weighted to 20,955,234 adults aged > 18 years) were used. Food insecurity was measured using the Community Childhood Hunger Identification Project (CCHIP) tool, a validated household-level measure commonly used in South Africa. Coping strategy, anxiety and depression were measured using the coping strategies index, Generalised Anxiety Disorder–7 scale and Patient Health Questionnaire–9, respectively. Multimorbidity was self-reported as ≥2 of 14 known chronic conditions. Multivariable logistic regression was used to test associations, and a generalised structural equation model examined the roles of socio-economic status and coping strategies.

Results

Being from a food-insecure household more than doubled the odds of experiencing multimorbidity (OR=2.17, 95% CI 2.17, 2.19), depression (OR=2.96, 95% CI 2.95, 2.97) and anxiety (OR=2.82, 95% CI 2.81, 2.83). Food insecurity accounted for approximately 60% of the total association between socio-economic status and depression, and about 88% of the association between socio-economic status and multimorbidity.

Conclusions

Food insecurity is significantly associated with adverse physical and mental health outcomes. Interventions to improve food security, especially in low socio-economic populations, should be prioritised given their associations with multimorbidity, anxiety and depression. Potential intervention effects will require longitudinal or experimental evaluation.

Phytochemical characterization, total phenolic and flavonoid content, antioxidant capacity, enzymatic profiling, and cytotoxicity of <i>Bidens pilosa</i> and <i>Croton</i> sp. from Colombia for applications in skin health

by Patricia Quintero-Rincón, Karina Caballero-Gallardo, Elkin Galeano, Oscar Flórez-Acosta

This study investigated the chemical and biological potential of Bidens pilosa and Croton sp., plants from megadiverse ecosystems in Colombia, collected in Santander de Quilichao (Cauca) and San Basilio de Palenque (Bolivar). The chemical profile was analyzed by UHPLC-ESI-Orbitrap-HRMS, and the total phenolic and flavonoid content was quantified using colorimetric methods. Antioxidant capacity was assessed using methods that evaluate reducing power and electron transfer mechanisms. The inhibition of key enzymes in skin aging, such as tyrosinase, hyaluronidase, and collagenase, was evaluated, as well as cytotoxicity in keratinocytes and human melanoma cells. Chemical characterization revealed distinctive phytochemical profiles: B. pilosa contained 21.1 mg GAE/g DT of phenolics and 64.6 mg RE/g DT of flavonoids, dominated by p-coumaric acid and rosmarinic acid, while Croton sp. exhibited higher levels of phenolics (169.4 mg GAE/g DT) and 54.1 mg RE/g DT of flavonoids, highlighting rosmarinic acid, p-coumaric acid and quercetin. Both extracts showed significant antioxidant capacity and enzyme modulation, including moderate collagenase inhibition (53.9–55.0%), high hyaluronidase inhibition (64.5–76.5%), and low tyrosinase inhibition (11.1–12.7%), suggesting protection of extracellular matrix and hyaluronic acid during skin aging. Sun protection factor was limited (SPF: 14.5 for B. pilosa and 11.6 for Croton sp.), with low ultraviolet absorption, consistent with low antityrosinase activity. Cytotoxicity assays demonstrated that B. pilosa was not toxic to HaCaT keratinocytes (IC₅₀ > 500 µg/mL) and displayed antimelanoma activity on A375 cells (IC₅₀ = 398.6 µg/mL), whereas Croton sp. showed moderate selectivity towards melanoma cells (IC₅₀ HaCaT = 329.5 µg/mL; IC₅₀ A375 = 189.0 µg/mL). The results suggest that both plants have potential in dermatological applications such as anti-melanoma agents, antioxidants, and modulators of skin aging enzymes, although highlight the importance of improving strategies to maximize their efficacy and safety.

“Kuchoka”: Investigation of research fatigue in Mosoriot, Kenya

by Felishana Cherop, Violet Naanyu, Juddy Wachira, Lukoye Atwoli

Background

Health research is key to the promotion of population and community health, however, conducting many research studies in a community can cause research fatigue.

Purpose

We determined the prevalence of research fatigue and associated factors in Mosoriot, Kenya.

Methods

We conducted a cross-sectional study in the Mosoriot community from Wednesday 28, May 2014, to Thursday 30, April 2015, involving (n = 327) community members who were randomly sampled to respond to self-administered and/or guided questionnaires. We analyzed descriptive statistics to summarise the data and used the Pearson Chi-Square test to assess the bivariate associations between the variables and conducted multivariate analyses using logistic regression models to test the hypotheses. The odds ratios and the corresponding 95% confidence limits were reported.

Results

Research fatigue prevalence was 56.3% and the factors associated included being >35 years (OR: 2.28, 95% CL: 1.27, 4.15), being male (OR: 2.80, 95% CL:1.59, 5.00), self-employment (OR: 2.05, 95% CL: 1.06, 4.01), participating in hospital-based studies (OR: 3.59, 95% CL:1.88, 7.09), involvement in multiple researches (OR: 3.86, 95% CL:1.87, 8.27), desire to drop out of a study (OR: 11.49, 95% CL: 3.69, 43.83) and being asked personal questions (OR: 6.23, 95% CL: 3.28, 12.23).

Conclusion

There is a high prevalence of research fatigue (56.3%) among community members in Mosoriot who have participated in repeated research, which is associated with age, gender, income source, research setting, frequency of research engagement, desire to drop out of studies, and discomfort with questions. Addressing research fatigue would enhance ethical research conduct and promote sustained community participation in research.

Inhibition of TREM1 attenuates myocardial ischemia-reperfusion injury-induced cardiomyocyte pyroptosis by suppressing the activation of the NF-κB signaling pathway

by Xiaohui Xu, Liang Cai, Xuan Dang, Jianbin Han, Yan Kou, Chunyan Rong, Junjie Kou

Background

Triggering receptor expressed on myeloid cells-1 (TREM-1) is a potent amplifier of inflammatory responses and plays a critical role in the pathogenesis of various infectious diseases. Notably, emerging evidence suggests that TREM-1 is also involved in the development and progression of cardiovascular diseases, such as atherosclerosis and atrial fibrillation. However, its role in myocardial ischemia/reperfusion (I/R) injury remains unclear. This study aimed to investigate the role of TREM-1 in myocardial I/R injury and to explore the potential underlying molecular mechanisms.

Methods

A hypoxia/reoxygenation (H/R) model was established using HL-1 cardiomyocytes subjected to 6 hours of hypoxia followed by 6 hours of reoxygenation. Pyroptosis levels were assessed by Hoechst-PI staining, lactate dehydrogenase (LDH) release assay, CCK-8 assay, and Western blot analysis. In vivo, a myocardial I/R injury model was established in C57BL/6 mice by subjecting them to 30 minutes of ischemia followed by 24 hours or 7 days of reperfusion. Evaluation was performed using TTC staining, Western blotting, echocardiography, histochemical staining, and immunohistochemistry.

Results

In this study, we found that TREM-1 expression was significantly upregulated in both in vitro and in vivo models of myocardial ischemia-reperfusion injury (MIRI). Pharmacological inhibition of TREM-1 by LR12 effectively reduced the levels of cardiomyocyte pyroptosis and suppressed activation of the NF-κB signaling pathway. In addition, LR12 treatment alleviated myocardial inflammation and fibrosis and improved left ventricular function in mice.Intervention experiments with MCC950, a specific NLRP3 inhibitor, confirmed that NLRP3 inhibition could mimic the anti-pyroptotic effect of LR12 and reduce the expression of pyroptosis-related proteins. Immunofluorescence experiments further verified that inhibition of NF-κB decreased NLRP3 expression, clarifying the association between TREM-1 downstream signals and NLRP3. Long-term follow-up experiments showed that LR12 treatment significantly reduced the area of myocardial fibrosis at 7 days after reperfusion.

Conclusion

Our findings indicate that inhibition of TREM-1 alleviates cardiomyocyte pyroptosis during MIRI by suppressing activation of the NF-κB signaling pathway. Therefore, TREM-1 may represent a promising therapeutic target for the treatment of myocardial ischemia-reperfusion injury.

Establishment of an amino acid metabolism related signature for prognostic and therapeutic sensitivity prediction in breast cancer by machine learning

by Xinrui Zhao, Jie Li, Nan Hu, Xiaoming Wu, Junbo Duan

Amino acid metabolism plays a critical role in tumor growth and immune regulation, yet its comprehensive function in breast cancer remains underexplored. We developed an amino acid metabolism–related gene signature (AAMRGS) to predict prognosis and therapeutic response in breast cancer. The AAMRGS was constructed using a machine-learning framework integrating ten algorithms and validated across multiple independent cohorts. It served as an independent prognostic factor and outperformed existing amino acid metabolism–related signatures and clinical variables. Moreover, the prognostic utility of AAMRGS was further validated across pan-cancer datasets, and an AAMRGS-based nomogram was constructed to facilitate clinical application. Functional enrichment and protein–protein interaction analyses revealed that AAMRGS genes were primarily involved in metabolic reprogramming and cell proliferation. Experimental validation confirmed the downregulation of key genes such as SAV1 and IGF2R in breast cancer cells. Integrative analyses revealed that the high-AAMRGS subgroup exhibited a greater copy number variation burden, higher tumor mutation burden (TMB), enrichment of immunosuppressive cell populations, and increased sensitivity to most chemotherapeutic drugs. In contrast, the low-AAMRGS subgroup displayed higher immune scores, stronger immune activation, enrichment of anti-tumor immune cells, and greater responsiveness to immunotherapy. Collectively, our findings establish AAMRGS as a reliable prognostic signature and a potential tool to guide individualized therapeutic strategies for breast cancer patients.