Conectar
by Jingwen Ji, Xiangyuan Wu
Heavy metal pollution in coastal agricultural soils poses significant threats to food security, human health, and marine ecosystems. Effective prevention and control require systematic analysis of their spatial distribution and sources. This study integrated geostatistics, principal component analysis (PCA), positive matrix factorization (PMF), and finite mixture modeling (FMM) to comprehensively analyze the spatial variability and sources of five heavy metals (Cr, Pb, Cd, Hg, As) across 877 sampling sites in the coastal area of eastern Zhejiang. The results indicate that overall soil quality is good, though enrichment occurs at some sites due to anthropogenic activities. Pollution displays a spatial pattern of lower levels in the south and higher levels in the north. Pb is widely distributed, while Cd, Hg, and As are concentrated in agricultural plain areas. PMF-based source apportionment revealed that mobile sources (traffic) contributed the most (52.5%), followed by industrial sources (30.4%) and agricultural sources (17.1%). The consistency of multi-model results validated the reliability of source identification. By implementing precise management strategies based on pollution source contributions, it is expected to effectively curb the further deterioration of heavy metal pollution in agricultural soils in Zhejiang Province, gradually improve soil environmental quality, and ensure the safety of agricultural products and the sustainable development of agriculture.by Jingwen Gao, Yasushige Shingu, Ryota Azuma, Satoru Wakasa
BackgroundInflammatory response plays a pivotal role in myocardial injury and post-infarction remodeling after acute myocardial infarction (AMI). Mechanical unloading (UL) of the left ventricle (LV) has been proposed as a potential therapeutic strategy to preserve cardiac function; however, its effects on myocardial inflammation remain incompletely understood.
MethodsWe employed a rat model of partial UL using heterotopic heart-lung transplantation following AMI. RNA sequencing (RNA-seq) was performed to evaluate transcriptomic changes, with a specific focus on inflammatory pathways in the non-infarcted remote area. Immune cell abundance was estimated using deconvolution analysis (QUANTISEQ). Quantitative PCR was performed to analyze some inflammatory cytokines, and macrophage polarization was evaluated by immunohistochemistry.
ResultsAMI significantly impaired cardiac function, which was mitigated by UL. RNA-seq analysis revealed marked activation of inflammatory pathways and identified several hub genes involved in cytokine signaling following AMI, while these transcriptional changes were not significantly altered in UL groups after AMI. Immune cell profiling demonstrated an increase in M2 macrophages after AMI, while UL preserved M2 macrophage levels. Histological analysis further supported UL’s modulatory effect on macrophage polarization. Pro-inflammatory cytokines TNFα and IL1β were upregulated after AMI but showed attenuation with UL.
ConclusionPartial UL potentially attenuates cardiac functional deterioration after AMI while exerting substantial effects on inflammatory gene expression and macrophage polarization. These findings suggest that the cardioprotective effects of UL may be correlated with the modulation of inflammatory pathways in the remote area after AMI.
by Zijing Wang, Liyuan Ma, Zhanyuan Sun, Hengyi Lv, Ruxue Ma, Mengqi Ding, Hai Li, Tao Jiang
BackgroundDiethyl phthalate (DEP), a widely used plasticizer with endocrine-disrupting properties, has raised concerns regarding its potential carcinogenic effects. However, its precise role in colorectal cancer (CRC) development remains poorly understood.
MethodsThe chemical structure of DEP was obtained from the PubChem database. Potential targets of DEP were identified through ChEMBL and STITCH databases and intersected with known CRC-related genes to screen for candidate biomarkers. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore the biological functions and signaling pathways involved. Molecular docking was conducted to predict the binding affinities between DEP and core targets. Finally, 200-ns molecular dynamics (MD) simulations using GROMACS were employed to evaluate the binding stability and dynamic behavior of the DEP–target complexes.
ResultsA total of 62 overlapping genes were identified between DEP targets and CRC-associated genes. GO and KEGG enrichment analyses indicated enrichment in epigenetic regulation, chromatin remodeling, and cancer-related signaling pathways, including Notch, TGF-β, and FoxO. Protein–protein interaction analysis identified EP300, EZH2, HDAC1, HDAC2, and KDM1A as key epigenetic regulators. Molecular docking predicted moderate binding affinities between DEP and these targets (−6.6 to −5.7 kcal·mol ⁻ ¹). Subsequent 200-ns MD simulations suggested that DEP formed stable complexes with HDAC1, KDM1A, and EZH2, moderate stability with EP300, and partial dissociation with HDAC2, consistent with hydrophobic and hydrogen-bonding interactions at the binding interfaces.
ConclusionThis study provides a theoretical framework for exploring the molecular mechanisms through which DEP may contribute to CRC development, emphasizing the value of network toxicology in cancer research. These findings may inform future investigations into the risks of DEP exposure and support public health policy and the development of targeted therapeutic strategies.
To systematically review published studies on fall risk prediction models for inpatients.
A systematic review and meta-analysis of prognostic model studies.
A literature search was carried out in Web of Science, the Cochrane Library, PubMed, Embase, CINAHL, SinoMed, VIP Database, CNKI and Wanfang Database. The search covered studies on risk prediction models for falls in inpatients from inception to March 9, 2024.
The research question was formulated using the PICOTS framework. Data extraction was performed following the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The quality of studies related to risk prediction models was evaluated with the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was conducted using STATA 18.0 software.
A total of 15 studies were included, with 13 eligible for meta-analysis. Only 2 of these 15 studies had external validation. The reported AUC values ranged from 0.681 to 0.900. The overall risk of bias was high, mainly attributed to inappropriate data sources and improper processing in the analysis domain. The pooled AUC from the meta-analysis was 0.799. After reviewing the predictors included in various models, FRIDs, fall history, age, gait, mental status, gender and incontinence were relatively common.
The fall risk prediction model for inpatients performs well overall, but it has a high risk of bias. Future development of risk prediction models should strictly adhere to the PROBAST, combine clinical reality, optimise study design and improve methodological quality.
This study provides medical professionals with a clear overview of constructing fall risk prediction models for inpatients. The fall-related predictors in these models help healthcare providers identify high-risk patients and implement preventive strategies. It also offers valuable insights for the development of future prediction models.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore the experiences and perceptions of Singaporean parents in managing feeding difficulties among children with developmental disabilities.
A descriptive qualitative study design was used.
Twenty parents were recruited via convenience sampling from a paediatric feeding clinic in a public hospital in Singapore between July and October 2024. One-to-one interviews were conducted using a semi-structured interview guide. Thematic analysis was used to analyse the data.
Four themes were identified: (1) Feeding as a ‘guessing’ game; (2) mutual understanding within the family and community; (3) beliefs regarding developmental disabilities and feeding difficulties; and (4) challenges in accessing adequate support. There were a total of nine subthemes supporting these themes.
This study revealed that parents of children with developmental disabilities faced challenges in adjusting to their child's feeding preferences, dealing with conflicting views on feeding practices among caregivers, and accessing adequate support. Parents also valued instrumental support from grandparents and domestic helpers, as well as emotional support from online peers. Additional research and targeted interventions are needed to better support parents of children with developmental disabilities in managing feeding difficulties.
Policies should facilitate the provision of feeding-specific resources, treatment, and education for parents. Additionally, healthcare providers should proactively assess feeding-related concerns and address misconceptions to enhance parental awareness of feeding difficulties and how they can improve the feeding practices of their children with developmental disabilities. Future research should obtain a more in-depth understanding of how differing beliefs in feeding difficulties between parents can impact the child's developmental outcomes, as well as the support and resources that may address feeding needs in these children.
This study followed the reporting guidelines outlined by the Consolidated criteria for Reporting Qualitative (COREQ) research checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
Labour companionship is a recommendation by WHO that health authorities enable women to choose a companion during labour to ensure a safe and dignified labour experience for the birthing woman. However, most healthcare facilities in low- and middle-income countries do not necessarily consider this maternal need, which hampers a positive maternal experience during labour.
This study aims to examine midwives' perception towards the involvement of male partners in labour companionship.
An exploratory phenomenological approach was chosen and semi-structured interviews were used for this study.
The four main themes identified in this study include ‘Understanding of male partners' involvement in labour companionship’, ‘Involvement of midwives in decision-making’, ‘Barriers to male partners' involvement in labour companionship’ and ‘Facilitators of male partners' involvement in labour companionship’.
This study found a lack of understanding among midwives of the significance of male partners' involvement in labour companionship; and the identification of hierarchical and authoritarian leadership as a barrier to midwives' participation in decision-making highlights the need for transformational leadership styles to empower midwives. Overall, the findings of this study can inform maternity care policy as well as resource development, education and professional training in the field of midwifery.
To clarify the role performance of gerontological nurse specialists (GNSs) and identify associated factors.
A cross-sectional survey.
A self-designed questionnaire based on the Donabedian model was developed to assess structure, process, and outcome variables using a 5-point Likert scale. The questionnaire was administered to 230 GNSs. Descriptive statistics (e.g., means, standard deviations, frequencies) were calculated in SPSS to summarise GNSs' role performance, and multiple regression analysis identified factors influencing GNSs' role performance.
Ninety-six GNSs (response rate of 44.3%) scored 3.15 to 3.81 out of 5 in GNSs' role performance, including clinical practice, education and guidance, consultation, research, leadership and coordination. High self-ratings were observed in clinical practice and consultation, whereas research and leadership scored lower. Education and guidance, as well as consultation, were primarily performed among hospital nurses, with GNSs' role performance largely confined to the hospital. Multiple regression revealed that GNSs' role performance was significantly associated with factors such as GNS competency, identification of stakeholder needs and perceived social recognition of GNS.
To enhance the role performance of GNSs, it is necessary to expand their activities outside the hospital, improve gerontological nursing competency, and promote the social recognition of their role. The results also suggest that it is important for GNSs to understand the needs of patients, nurses, and other related healthcare workers, and enhance collaboration with multiple professionals.
Clarifying the role performance of GNSs in China enables future outcome evaluations. Identifying influencing factors provides insights for effective support, which will further contribute to the success and development of GNSs.
No public or patient involvement.
Skin temperature, including absolute temperature (at bony prominence areas under long-term compression) and relative temperature (the difference between bony prominence and adjacent control area), may serve as early warning indicators for PI. However, the optimal indicator remains unclear. This meta-analysis therefore synthesises evidence on their association with PI risk to identify the best indicator and evaluate its early-warning accuracy.
Systematic review and meta-analysis.
We included prospective cohort studies of adult patients investigating longitudinal associations between skin temperature and subsequent PI development. We pooled standardised mean difference (SMD) and odds ratios, complemented by summary receiver operating characteristic (SROC) curve analysis. The overall quality of evidence was evaluated using the GRADE method.
We researched PubMed, Embase, CINAHL, Cochrane Library (CENTRAL), Wanfang and CNKI databases from inception to September 25, 2024.
After screening 1354 titles and abstracts, ten studies comprising 1742 participants were included in the final synthesis. No significant difference in absolute temperature (combined SMD) was found between the PI and non-PI groups (seven studies included). In addition, decreased relative temperature (< −0.1°C) was associated with a 16-fold increased likelihood of PI (95% CI 6.38–40.19, I 2 = 79.4%) (three studies included), with the SROC curve analysis showing an AUC of 0.776. According to GRADE, the evidentiary certainty was very low for AT and low for RT.
Relative temperature is significantly related to the risk of PI, supporting its role as a promising early warning indicator. Future studies should establish a standardised measurement protocol to facilitate its clinical application.
Monitoring skin temperature changes holds promise as a non-invasive tool for early warning of PI risk. However, the amount and quality of available evidence limit our confidence in these findings, underscoring the need for further research before a definitive conclusion can be drawn.
This study followed PRISMA guidelines.
No patient or public contribution.
PROSPERO CRD42024550099
by Achilleas Livieratos, Maria Kudela, Yuxi Zhao, All-shine Chen, Xin Luo, Junjing Lin, Di Zhang, Sai Dharmarajan, Sotirios Tsiodras, Vivek Rudrapatna, Margaret Gamalo
BackgroundNetwork meta-analysis (NMA) can compare several interventions at once by combining head-to-head and indirect trial evidence. However, identifying, extracting, and modelling these often takes months, delaying updates in many therapeutic areas.
ObjectiveTo develop and validate MetaMind, an end-to-end, transformer-driven framework that automates NMA processes—including study retrieval, structured data extraction, and meta-analysis execution—while minimizing human input.
MethodsMetaMind integrates Promptriever, a fine-tuned retrieval model, to semantically retrieve high-impact clinical trials from PubMed; a multi-agent LLM architecture--Mixture of Agents (MoA)-- pipeline to extract PICO-structured (Population, Intervention, Comparison, Outcome) endpoints; and GPT-4o–generated Python and R scripts to perform Bayesian random-effects NMA and other NMA designs within a unified workflow. Validation was conducted by comparing MetaMind’s outputs against manually performed NMAs in ulcerative colitis (UC) and Crohn’s disease (CD).
ResultsPromptriever outperformed baseline SentenceTransformer with higher similarity scores (0.7403 vs. 0.7049 for UC; 0.7142 vs. 0.7049 for CD) and narrower relevance ranges. Promptriever performance achieved 82.1% recall, 91.1% precision and an F1 score of 86.4% when compared to a previously published NMA. MetaMind achieved 100% accuracy on a limited set of remission endpoints regarding PICO (Population, Intervention, Comparator, Outcome) element extraction and produced comparative effect estimates and credible intervals closely matching manual analyses.
ConclusionsIn our validation studies, MetaMind reduced the end-to-end NMA process to less than a week, compared with the several months typically needed for manual workflows, while preserving statistical rigor. This suggests its potential for future scaling of evidence synthesis to additional therapeutic areas.
To evaluate the research capability of clinical nurses in China and identify the determinants associated with their capability.
As nursing evolves into an increasingly independent discipline, the research capability of clinical nurses has become critical for the development of the profession, advancing evidence-based practice and improving patient care quality.
A multicentre cross-sectional survey was conducted using convenience sampling from September 2023 to February 2024, among clinical nurses in tertiary hospitals across three provinces in China. The Nursing Research Capability Self-Assessment Scale was used to assess the research capability of the nurses. Chi-square tests, one-way analysis of variance and multiple linear regression were used to examine factors associated with research capability. The Strengthening the Reporting of Observational Studies in Epidemiology was followed.
A total of 1074 clinical nurses participated. The mean research capability score was 89.11 ± 27.69, reflecting a moderate level of research capability. However, two dimensions of research questions and literature review received lower scores. Multiple linear regression analysis identified that education level, professional title, administrative position and nursing job title (all p < 0.05) were independent predictors of research capability.
Clinical nurses exhibit moderate research capability, with notable deficiencies in formulating research questions and conducting literature reviews. Key factors influencing research capability include education, professional title, administrative position, and job title. Targeted training and development programmes should address these factors to enhance nurses' research competence and advance nursing science.
This study aims to explore the trajectories and co-occurrence of perceived control and caregiver self-efficacy among patients with heart failure (HF) and their caregivers within 3 months post-discharge and identify associated risk factors.
A prospective cohort design.
A prospective cohort study was conducted from March to June 2024 in Tianjin, China. Information on perceived control and caregiver self-efficacy was collected 24 h before discharge, 2 weeks, 1 month, and 3 months after discharge. Group-Based Dual Trajectory Modelling (GBDTM) and logistic regression were used for analysis.
The study included 203 dyads of patients with HF and their caregivers (HF dyads). Perceived control identified three trajectories: low curve (15.3%), middle curve (57.1%) and high curve (27.6%). Caregiver self-efficacy demonstrated three trajectories: low curve (17.2%), middle curve (56.7%) and high stable (26.1%). GBDTM revealed nine co-occurrence patterns, with the highest proportion (36.7%) being ‘middle-curve group for perceived control and middle-curve group for caregiver self-efficacy’, and 16.7% being ‘high-curve group for perceived control and high-stable group for caregiver self-efficacy’. Age, gender, household income, NYHA class, symptom burden and psychological resilience were identified as risk factors for perceived control trajectories; marital status, regular exercise and psychological resilience were identified as risk factors for caregiver self-efficacy trajectories.
We identified distinct trajectories, co-occurrence patterns and risk factors of perceived control and caregiver self-efficacy among HF dyads. These findings help clinical nurses to better design and implement interventions, strengthening the comprehensive management and care outcomes for HF dyads.
These findings highlighted the interactive relationship between perceived control and caregiver self-efficacy trajectories, suggesting that interventions should boost both to improve personalised treatment plans and outcomes for HF dyads.
This study adhered to the STROBE checklist.
Patients and their caregivers contributed by participating in the study and completing the questionnaire.
To systematically identify and appraise existing risk prediction models for EN aspiration in adult inpatients.
A systematic search was conducted across PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biomedical Literature Database (CBM) and VIP Database from inception to 1 March 2025.
Systematic review of observational studies.
Two researchers independently performed literature screening and data extraction using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and the clinical applicability of the included models.
A total of 17 articles, encompassing 29 prediction models, were included. The incidence of aspiration was 9.45%–57.00%. Meta-analysis of high-frequency predictors identified the following significant predictors of aspiration: history of aspiration, depth of endotracheal intubation, impaired consciousness, sedation use, nutritional risk, mechanical ventilation and gastric residual volume (GRV). The area under the curve (AUC) was 0.771–0.992. Internal validation was performed in 12 studies, while both internal and external validation were conducted in 5 studies. All studies demonstrated a high risk of bias, primarily attributed to retrospective design, geographic bias (all from different parts of China), inadequate data analysis, insufficient validation strategies and lack of transparency in the research process.
Current risk prediction models for enteral nutrition-associated aspiration show moderate to high discriminative accuracy but suffer from critical methodological limitations, including retrospective design, geographic bias (all models derived from Chinese cohorts, limiting global generalisability) and inconsistent outcome definitions.
Recognising the high bias of existing models, prospective multicentre data and standardised diagnostics are needed to develop more accurate and clinically applicable predictive models for enteral nutrition malabsorption.
Not applicable.
PROSPERO: CRD420251016435
by Chao Feng, Guodong Chen, Yan Shu, Jing Chen, Wenxin Ye, Ligang Ren
IntroductionGiven the high recurrence rate of bladder cancer (BCa) and the significant adverse effects associated with conventional treatments, it is urgent to search for new clinical therapeutic targets and safer natural-derived compounds. Resveratrol (Res) has been demonstrated to exhibit cytotoxicity against various tumors. However, the signaling pathways and targets involved in inhibition of BCa cells still need further exploration. This study aims to investigate the mechanism of Res in Bca via suppression of the AURKA/STAT3 axis, providing important theoretical basis for subsequent further researches on Res for treating BCa.
MethodsDifferentially expressed genes were identified through bioinformatics methods and the binding sites of resveratrol were also identified. The cell survival rate was detected by the CCK8 method to calculate the concentrations of Res for 30% inhibition and for 50% inhibition. Then, flow cytometry was used to detect the cell cycle and apoptosis after treatment with different concentrations of Res. Immunofluorescence staining was used to detect the effects of Res and MLN8237 on the expression of STAT3. Western blot and qPCR analyses were used to verify the reliability of the effects of Res and MLN8237 on target proteins.
ResultsAURKA was identified as the potential target of Res by computational analysis. Further validation through CCK8 assays and flow cytometry demonstrated that Res could inhibit BCa cells and their cell cycle in a time- and dose-dependent manner. Immunofluorescence staining revealed both Res and MLN8237 suppressed STAT3 expression in BCa cells. Additionally, western blot and qPCR analysis confirmed that Res and MLN8237 inhibited the expression of AURKA and known target genes (VEGF, Bcl-2, and Cyclin D1).
ConclusionOur findings suggest that Res may regulate BCa cell expression through the AURKA/STAT3 axis, providing a theoretical foundation for the structural optimization of Res and the development of multi-target drugs for clinical application.
To explore the concurrent trajectories of depressive symptoms and insomnia among adolescents and to analyse the individual, familial and social predictors of the concurrent trajectories.
This study tracked depressive symptoms and insomnia in eight secondary schools annually from 2021 to 2023. We also collected data on individual, familial and social factors that may influence these conditions. Group-based multi-trajectory (GBMT) modelling was used to categorise adolescents into depressive–insomnia severity subgroups.
This study included 2822 adolescents, who were categorised into four groups, including the no symptom group, mild symptom group, symptom relief group and symptom increase group. Compared with the no symptom group, predictors of the mild symptom group were gender (OR = 1.30), academic performance (OR = 1.57), subjective well-being (OR = 0.78), anxiety (OR = 1.14), economic status (OR = 1.23) and relationship with teachers (OR = 1.46). Predictors of the symptom relief group were personality (OR = 1.75), academic performance (OR = 2.28), subjective well-being (OR = 0.69) and anxiety (OR = 1.25). Predictors of the symptom-increasing group were personality (OR = 2.45), academic performance (OR = 1.96), subjective well-being (OR = 0.69), anxiety (OR = 1.20), maternal education level (OR = 1.58), family function (OR = 0.93), parental relationship (OR = 2.07) and relationship with teachers (OR = 1.54).
This study provided a comprehensive understanding of the concurrent trajectories of depressive symptoms and insomnia among adolescents, revealing distinct subgroups and identifying predictors across individual, familial and social levels.
This study emphasises the importance of a multi-faceted approach involving family, school and society to promote adolescent mental health and also highlights the need for conducting precise interventions according to adolescents' features.
The identification of four distinct symptom trajectories and their predictors advances the understanding of adolescent mental health development, informing precision prevention strategies.
STROBE checklist.
None.
To examine the relationship among leadership, clinical teaching competencies, and structural empowerment of nursing clinical instructors in China.
A cross-sectional study.
A total of 152 nurses who come from three Grade A tertiary hospitals located in Beijing, Kunming, and Liaoning Province, China, completed an online questionnaire that included general information, clinical teaching information, the Conditions of Work Effectiveness Questionnaire-II, nurse leadership, and structural empowerment. SPSS 26.0 and AMOS 26.0 were used for normality test, descriptive statistics, correlation analysis, regression analysis, and structural equation model.
The study revealed that nurse leadership (r = 0.402) and structural empowerment (r = 0.568) both positively correlated with clinical teaching competencies. Specifically, the level of nurse leadership exhibited a low but direct positive effect on these competencies (β = 0.22), while the level of structural empowerment demonstrated a moderate direct positive effect (β = 0.56).
Enhancing nurse leadership and structural empowerment positively influence the clinical teaching competencies of nursing instructors.
Constructing a structural equation model to describe the relationship between leadership, structural empowerment, and teaching ability can provide the most intuitive direction for future research, so as to better improve the teaching ability of clinical nursing teachers.
No patient or public contribution.
The aim of this study was to innovatively utilise the BERTopic model for topic modelling in order to comprehensively identify and understand the factors contributing to bed falls.
Retrospective study.
The study collected 241 reports of bed fall accidents recorded by nurses from Peking University Third Hospital Nursing Department from 2014 to 2024. Among them, 102 reports met the inclusion and exclusion criteria.
This study follows the Minimum Information for Medical AI Reporting (MINIMAR). It collected patient bed fall reports from Peking University Third Hospital between 2014 and June 2024, preprocessed the texts, utilised the BERTopic library in Python for topic modelling, and manually aggregated secondary topics by combining visualisation results and professional knowledge.
We utilised cluster bar charts to visually display the distribution of the 22 secondary topics and further consolidated them into five core topics through the use of a topic distribution diagram and a topic similarity matrix diagram. These topics were related to patient factors, ward equipment and surroundings factors, medication risk factors, caregiver factors, and nursing practice factors. The study highlights the environment's specificity in bed falls, especially bedside safety and patient-bed rail interaction.
The innovation of this study lies in the successful utilisation of BERTopic technology to identify topics of risk factors for bed falls through alternative data sources, providing a scientific basis for formulating preventive measures. The findings aim to optimise nursing processes, improve ward environments and enhance educational training, ultimately reducing patient bed falls and enhancing medical safety, nursing quality and patient experience.
This study not only helps nurses identify risk factors for patient bed falls, but also provides important guidance for developing effective prevention strategies.
No patient or public contribution applied.
FreshRSS 