Conectar
Ample evidence has shown the benefit of high-fidelity simulation (HFS) in promoting learning in pre-licensure nursing students, but the evidence for practising registered nurses has not been synthesised.
To evaluate the effects of HFS training on learning outcomes and satisfaction in practising registered nurses.
In this systematic review and meta-analysis, we searched PubMed, CINAHL, ERIC, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for studies published in English or Chinese from database inception to 31 May 2023 (updated on 20 April 2025). All randomised controlled trials (RCT) or quasi-experiments that compared HFS training with traditional methods (e.g., lecture) for practising registered nurses and reported learning outcomes and satisfaction were included. Risk of bias was assessed by the Cochrane risk-of-bias tool for randomised trials (RoB 2) and non-randomised trials (ROBINS-I). Inverse-variance random-effect models were used to calculate standardised mean differences (SMDs) with 95% confidence interval (CI). We followed the PRISMA 2020 guideline.
Of 1404 records, eight eligible studies (five RCTs and three quasi-experiments) involving 275 practising nurses were identified. Two RCTs had high risk of bias, while others showed some concerns or moderate risk of bias. Meta-analyses showed that HFS could promote knowledge acquisition (SMD = 0.65, 95% CI, [0.35, 0.95], p < 0.01, I2 = 0%), professional skills (SMD = 0.72, 95% CI, [0.41, 1.04], p < 0.01, I2 = 0%) and learning satisfaction (SMD = 1.24, 95% CI, [0.35, 2.13], p < 0.01; I2 = 67%), compared with traditional methods. The pooled effect on self-confidence was marginally insignificant (SMD = 0.59, 95% CI, [−0.04, 1.22], p = 0.07; I2 = 67%).
Compared with traditional training methods, HFS is effective in promoting knowledge acquisition, professional skills and learning satisfaction and may enhance self-confidence among practising nurses. To strengthen the evidence base, more rigorous RCTs with larger sample sizes, adequate reporting of HFS design, and standardised outcome measures are warranted.
PROSPERO (CRD42022358717). No Patient or Public Contribution.
Intimate partner violence (IPV), encompassing physical, sexual, emotional and economic abuse, remains a pervasive global health concern. Traditional prevention efforts face obstacles such as underreporting, delayed detection and limited personalised support. Emerging artificial intelligence (AI) approaches offer new opportunities to enhance IPV prevention.
This systematic review maps and synthesises evidence on AI-driven tools in IPV prevention based on studies published between 2004 and 2024.
Following PRISMA 2020 guidelines and PROSPERO registration, we searched PubMed, Embase, CINAHL, PsycINFO, IEEE Xplore and Web of Science. Eligible studies explicitly evaluated AI technologies targeting IPV prediction, screening, intervention or support delivery. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT).
Of 1304 records initially identified, 41 studies met eligibility criteria. AI applications ranged from machine learning (ML) for risk prediction and natural language processing (NLP) for IPV detection in clinical and social media data, to image analysis for forensic evaluation and chatbot-based support. Predictive modelling demonstrated strong discriminative performance, while NLP-based screening detected IPV with notable sensitivity. Chatbots showed feasibility and user acceptability, but evidence of their direct impact on reducing IPV incidence was limited, with one randomised controlled trial showing a modest reduction. Key challenges identified included algorithmic bias, data privacy risks and barriers to integration across health and social care systems.
AI-informed interventions show promise for improving IPV detection, risk assessment, and scalable support, but questions remain about long-term effectiveness, ethical fairness, transparency and equitable implementation. Future interdisciplinary research should address these concerns to responsibly deploy AI in IPV prevention.
The findings highlight the importance of trauma-informed, culturally responsive care and provider training in AI applications. Nurse-led innovation and policy advocacy will be crucial for safe, equitable integration of AI in IPV prevention.
by Tianyu Zhang, Yu Yuan, Chunli Lin, Chao Song, Tianrong Liao, Yuewen Sun, Hongzhen Tang
BackgroundPerfluorooctanoic acid (PFOA), a pervasive environmental pollutant, has been implicated in hepatic injury and metabolic dysfunction. However, its role as an environmental risk factor in the pathogenesis of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains incompletely understood, particularly from a systems biology perspective.
MethodsThis study employed an integrative approach combining computational toxicology, multi-omics data analysis, and machine learning. Public databases were utilized to identify PFOA-related targets and MASLD-associated genes. A comprehensive machine learning framework comprising 113 model combinations was applied to transcriptomic datasets (GSE66676, GSE89632, GSE164760) to identify hub genes. Single-cell RNA sequencing (scRNA-seq) analysis delineated cell type-specific expression patterns. Molecular docking and dynamics simulations assessed the binding stability between PFOA and core targets, which was further validated in vitro using an FFA-induced MASLD HepG2 cell model.
ResultsWe identified 17 shared targets between PFOA and NAFLD. Machine learning pinpointed six hub genes (NR4A2, BCL6, CASP1, SHBG, FABP4, IL10) with high diagnostic accuracy (AUC up to 0.996). scRNA-seq revealed distinct expression patterns of these genes across liver cell subtypes in MASLD. Molecular docking and dynamics simulations demonstrated stable binding of PFOA to SHBG and FABP4. In vitro experiments confirmed that PFOA exposure significantly altered the mRNA and protein expression levels of these core genes in the MASLD model.
ConclusionOur findings suggest a potential mechanistic association between PFOA exposure and MASLD pathogenesis, characterized by disruption of lipid metabolism, inflammatory responses, and immune homeostasis. While these results identify biologically plausible pathways, they do not establish epidemiological causation, and further prospective studies with quantified PFOA exposure are required to confirm causality in humans.
by Siyi Song, Jinfeng Du, Huangkun Wei, Muhamad Shamsul Ibrahim, Hamedi Mohd Adnan
As social media platforms increasingly influence contemporary understandings of health and the body, fitspiration—a blend of “fitness” and “inspiration”—has become a widespread visual genre that promotes exercise, discipline, and culturally idealized physiques. Recent research has linked fitspiration content to negative body image among women, yet most studies focus on Western populations. Cultural differences in beauty ideals suggest that findings from Western contexts may not fully apply to Asian women. However, research on fitspiration in Asia, particularly China, remains limited. To address this gap, this study conducted an online experiment with 414 Chinese women aged 18–26, randomly assigned to view thinspiration, fitspiration, or neutral scenery images. Body appreciation and functionality appreciation were measured before and after exposure. Results showed that fitspiration images significantly reduced both body and functionality appreciation compared to neutral images. Thinspiration images produced even lower body and functionality appreciation than fitspiration. This study underscores the need to recognize and critically examine the potential risks of fitspiration content within the Chinese cultural context.To identify the types of nurses' perceptions regarding safety management for patients with dementia in acute care hospitals.
A Q-methodological study.
Data were collected between 31 July and 30 September 2025. A total of 161 statements were generated through individual in-depth interviews with eight registered nurses from general wards at a tertiary acute care hospital in South Korea and through a literature review. Subsequently, 34 statements were selected for Q-sorting and 22 nurses completed the procedure. Data were analysed using PQMethod with principal component analysis and varimax rotation, followed by interpretive analysis.
Four types of nurses' perceptions of safety management for patients with dementia were identified: physical control, relational collaboration, sceptical conformity and adaptive flexibility.
Safety management for patients with dementia in acute care requires a context-dependent, multidimensional approach encompassing physical, emotional, environmental and organisational aspects.
Understanding nurses' distinct perceptual orientations can inform type-specific practice interventions and support efforts towards safer, more person-centred care for patients with dementia in acute care settings.
This study offers insights for moving beyond uniform approaches and designing tailored, type-specific safety strategies in acute care by showing that similar safety behaviours may carry different meanings across nurses' perceptual orientations.
This study followed the Standards for Reporting Qualitative Research and Q-methodology conventions.
No patient or public contribution.
Children discharged after in-hospital treatment for severe anaemia or severe malaria in sub-Saharan Africa remain at high risk of readmission and death, particularly in malaria-endemic settings where recurrent infections are common. Post-discharge malaria chemoprevention (PDMC) has demonstrated substantial reductions in mortality and hospital readmissions and is now recommended by the WHO. However, optimal PDMC delivery strategies, via existing health systems, that optimise adherence remain unclear, particularly in West Africa where implementation and evidence of impact on clinical outcomes are limited. This trial aims to determine the effectiveness of different PDMC delivery strategies and adherence support mechanisms in optimising completion of PDMC courses. Secondary objectives include assessing clinical outcomes (readmissions, outpatient visits, mortality), evaluating health system linkage mechanisms and examining the acceptability and feasibility of the different delivery approaches.
A cluster-randomised implementation trial will be conducted in central and southern Benin across urban and rural settings. Clusters, defined as villages within the catchment areas of two referral hospitals, will be randomly allocated (1:1:1) to one of three arms: (A) facility-based drug distribution (all courses) at discharge with community health worker (CHW) home visit reminders; (B) monthly community-based drug delivery by CHWs combined with phone reminders; and (C) dispensing all courses to caregivers at discharge without adherence support (control). Eligible participants are children under 10 years hospitalised with severe anaemia or severe malaria and clinically stable at discharge. All participants should receive three courses of dihydroartemisinin–piperaquine at weeks 2, 6 and 10 post-discharge and will be followed for 14 weeks. The primary endpoint is incomplete adherence to the full PDMC regimen (3 courses/9 doses). Secondary endpoints include all-cause and malaria-specific readmissions, outpatient visits and mortality. Quantitative outcomes will be analysed using mixed-effects regression models under an intention-to-treat approach. Qualitative methods will assess acceptability and feasibility among caregivers, providers and policymakers.
Ethical approval was received from the institutional review boards of the Benin Institute of Applied Biomedical Sciences and Liverpool School of Tropical Medicine. Trial findings will be disseminated to national and international stakeholders through meetings, peer-reviewed publications and major conferences to inform PDMC policy, implementation guidelines and global malaria scale-up efforts, particularly through engagement with the World Health Organization and major malaria funding partners
Kashin–Beck disease (KBD) is a chronic, endemic osteoarthropathy that imposed a heavy financial burden on patients and their households. This study aimed to measure the incidence of catastrophic health expenditure (CHE), and compare its differences between KBD-suffered households with and without access to the Free Surgery Policy in China.
A cross-sectional survey was conducted between 2023 and 2024 in Shaanxi Province of China.
The study was carried out in four KBD-endemic counties (Linyou, Qishan, Huanglong and Yongshou) of Shaanxi Province, China.
A two-stage probability sampling method was used to select 709 households having at least one patient diagnosed with KBD. Households were divided into policy recipients and non-recipients.
The primary outcome was incidence of CHE, defined as out-of-pocket health expenditures accounting for 40% or more of a household’s capacity to pay.
The overall incidence of CHE was 38.93% among KBD households. A statistically significant difference in CHE incidence was observed between policy recipients and non-recipients, with the former presenting a lower incidence (35.35% vs 45.04%, p=0.011). After coarsened exact matching, the odds of CHE in policy-recipient households were 0.651 times that of non-recipient households (p
KBD households experience high CHE incidence. Policy-recipient households demonstrate a lower incidence of CHE compared with non-recipient households, with the comparative advantage of the Free Surgery Policy being more pronounced in low-income and middle-income groups. These comparative findings provide empirical support for healthcare providers and policymakers to consider expanding the coverage of the policy and optimising its reimbursement process, thereby mitigating CHE incidence in their households.
The DEVT and DIRECT-MT trials showed that endovascular thrombectomy (EVT) alone is non-inferior to intravenous thrombolysis (IVT) followed by EVT in achieving 90-day functional independence for stroke patients with large-vessel occlusion (LVO). However, it is unclear whether EVT alone is non-inferior to IVT followed by EVT among patients with acute basilar artery occlusion (BAO). Therefore, additional studies are needed to explore the potential benefits of EVT alone in these patients.
The ATTENTION IV trial is a prospective, multicentre, non-inferiority, blinded endpoint assessment, randomised controlled clinical trial to assess the effect of EVT alone compared with IVT plus EVT in acute BAO patients within 4.5 hours of symptom onset. Patients will be randomised in a 1:1 ratio to either the EVT-alone group or the IVT-plus-EVT group. A score of 0–2 on the 90-day modified Rankin Scale (mRS) was designated as the primary outcome for this study. Primary analysis will follow the intention-to-treat principle with a 15% non-inferiority margin. Secondary outcomes encompass functional status (mRS shift, excellent/good/fair outcomes), quality of life, early neurological recovery and radiological outcomes alongside safety endpoints of intracerebral haemorrhage and mortality.
This study has been approved by the Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (2023KY-055) and will be conducted following the Declaration of Helsinki. Study results will be published in peer-reviewed academic journals.
ClinicalTrials.gov (NCT05827042).
Pregnancy and childbearing immediately after marriage are often viewed as an indication of womanhood and parenthood within the African context. This study explored the psychosocial impacts of infertility among women in Southern Ghana, seeking to answer the research question: ‘How do women in Southern Ghana experience the psychosocial impacts of infertility?’
A qualitative exploratory descriptive design was employed. Data were collected at a designated hospital using a semi-structured interview guide.
The study was conducted in the obstetrics and gynaecology outpatient department of one of the public district hospitals in the Weija-Gbawe subdistrict in Ghana, where 20 women diagnosed with either primary or secondary infertility were interviewed for 45 min to 1 hour each. With all participants completing the study, interviews were audiotaped with consent, transcribed verbatim and analysed using content analysis.
The findings indicate that women experiencing infertility faced multiple psychosocial challenges, including depression, anxiety, reduced sexual desire, stigma, marital instability and deliberate social isolation.
Infertility significantly compromises women’s psychosocial well-being, leading to pervasive negative experiences across social and personal contexts. These challenges adversely affect quality of life and overall well-being, with potential implications for their reproductive outcomes.
To investigate the differences in pathogenic bacterial profiles between ventilator-associated pneumonia (VAP) and non-ventilator-associated hospital-acquired pneumonia (NV-HAP) and to provide data to support clinical infection prevention and control.
A retrospective observational study using surveillance data, accompanied by a statistical analysis of pathogen-related variables between the two study cohorts.
Sixty-one secondary and tertiary healthcare institutions in a single city. Data were extracted from the city’s regional healthcare-associated infection surveillance platforms.
Inpatients (≥18 years old) diagnosed with confirmed hospital-acquired pneumonia (HAP), including VAP and NV-HAP, at the aforementioned 61 healthcare institutions during the study period. Patients with community-acquired pneumonia (CAP) were excluded.
(1) Pathogen distribution in patients with VAP and NV-HAP; (2) temporal trends in pathogen isolation rates (January 2020–December 2024) in both groups; (3) antimicrobial resistance
characteristics of major pathogens, including detection/composition ratios of key multidrug-resistant organisms (MDROs): carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Escherichia coli (CREC), carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Pseudomonas aeruginosa (CRPA); (4) susceptibility of major pathogens to antimicrobials.
Pathogen distribution differed between the two groups, with Gram-negative bacteria being predominant in both groups (73.72% vs 80.98%). Among patients with NV-HAP, the isolation rates of K.pneumoniae, Burkholderia cepacia and Candida albicans showed a decreasing trend, whereas A.baumannii exhibited a slow increase. In patients with VAP, the isolation rates of K.pneumoniae and B.cepacia decreased, whereas Stenotrophomonas maltophilia increased. The proportion of drug-resistant bacteria was higher in patients with VAP than in those with NV-HAP (28.12% vs 19.74%). CRAB showed higher detection and composition ratios in the former group (77.37% and 48.05%, respectively). The MRSA detection rates were approximately 50% in both groups, whereas the CREC detection rate was below 6%. CRPA detection increased in patients with VAP, whereas CRKP and CRPA detection rates decreased in patients with NV-HAP. The antimicrobial resistance profiles of major pathogens were similar between the two groups. K.pneumoniae and E.coli remained susceptible to most antimicrobials, whereas CRKP and CREC were susceptible to only a few agents, such as tigecycline and polymyxin B. A.baumannii exhibited high resistance rates, with both A.baumannii and CRAB being susceptible only to tigecycline, minocycline and polymyxin B. P.aeruginosa and CRPA were largely susceptible to most antimicrobials. S.maltophilia exhibited a ceftazidime resistance rate exceeding 36%, and B.cepacia exhibited ticarcillin/clavulanate and cefoperazone/sulbactam resistance rates exceeding 67%. The resistance rates of S.aureus and MRSA to penicillin, erythromycin and clindamycin ranged from 41.83% to 98.72%. The resistance rates of C.albicans to commonly used antifungal agents were below 8%.
The two groups differed in the distribution and antimicrobial resistance of the pathogens and MDROs, and these profiles fluctuated over time. Patients with VAP have a higher percentage of drug-resistant bacteria, requiring special attention to CRAB and CRPA. Local microbiological epidemiological surveillance should be strengthened to improve infection prevention, control strategies and guide empirical antibiotic therapy.
by Dongrun Liu, Qixu Zhou, Shiwei Ma, Song Zhang, Yang Liu, Huanhuan Zhang, Kaige Li, Chaoran Chen
PurposeYoung nurses represent the primary workforce for the future of the nursing industry. However, they often experience a heightened sense of overqualification, which can easily lead to silence behavior, negatively impacting personal well-being, organizational development, and the quality of nursing care. The purpose of this study is to explore the relationship between perceived overqualification and silence behavior among young nurses, as well as the mediating role of surface acting and the moderating role of perceived organizational support.
MethodThe Scale of Perceived Overqualification, the surface acting dimension of the Emotional Labor Scale, the Employee Silence Scale, and the Perceived Organizational Support Scale were used to conduct a cross-sectional survey of 1,095 young nurses from six general hospitals in China. A moderated mediation model was constructed, and data were analyzed using Hayes’ PROCESS macro (Models 4 and 59).
ResultsThere are significant correlations among perceived overqualification, surface acting, silence behavior, and perceived organizational support (p Conclusion
Reducing young nurses’ perceived overqualification, decreasing surface acting, and enhancing perceived organizational support may help reduce the occurrence of silence behavior. Nursing managers should provide young nurses with appropriate career development opportunities, offer training in emotional regulation and stress management, and foster an open, psychologically safe communication environment and supportive organizational climate. These strategies may effectively intervene in silence behavior and contribute to improving team vitality and the quality of nursing services.
by Xiang Lyu, Yue Yu, ChengLei Song
The intelligent identification of tea diseases is crucial for ensuring tea quality and reducing economic losses in the tea industry. However, the deployment of deep learning models on edge devices remains challenging due to the conflict between detection accuracy and computational overhead. To address this, we propose CA-YOLOv8n, a lightweight object detection model tailored for tea disease diagnosis. Specifically, we introduce a Path-Decoupling strategy to streamline the network structure and integrate the Coordinate Attention (CA) mechanism to enhance the model's spatial awareness of subtle pathological features. Experimental results demonstrate that the proposed model achieves a mean Average Precision (mAP@50) of 98.89% while reducing the parameter count by 32.6% and FLOPs by 24.1% compared to the baseline YOLOv8n. The model was integrated into a diagnostic platform with an automated reporting interface, demonstrating that real-time tea disease identification is feasible on commodity CPU hardware in resource-constrained agricultural environments.Type 2 diabetes remission is an achievable, evidence-based therapeutic goal, yet its integration into routine care remains at an early stage. In China, where leading institutions are pioneering remission-oriented practice, healthcare professionals play a pivotal role in shaping its clinical implementation. Nevertheless, how healthcare professionals perceive, interpret, and enact remission-oriented care remains understudied.
To explore healthcare professionals' perceptions and experiences regarding type 2 diabetes remission implementation and to develop a constructivist grounded theory explaining how remission-oriented care is supported and advanced in clinical practice.
A grounded theory study.
Using constructivist grounded theory methodology, we conducted semi-structured interviews between March and November 2025. Participants were recruited from healthcare settings that implemented type 2 diabetes remission services in Hunan Province, China, including tertiary hospitals, community hospitals, and healthcare companies. Coding proceeded through three iterative phases: initial coding, focused coding, and theoretical coding, combined with constant comparative methods and reflective memo-writing.
We recruited 23 healthcare professionals, including physicians, nurses, dietitians, and healthcare service managers. The core category of the substantive theory, ‘sustaining development towards remission’, captured the process of remission-oriented care from its conceptual introduction to clinical implementation. This process comprised four interrelated phases: germination, emergence, branching, and flourishing. The theory illustrates how healthcare professionals navigate cognitive adaptation and behavioural transformation in implementing remission-oriented care, highlighting the developmental trajectory of type 2 diabetes remission within routine diabetes management.
The findings emphasise that achieving type 2 diabetes remission holds significant practical implications for promoting proactive health globally, while also representing a challenging process. It advocates that this approach be incorporated into routine diabetes care pathways to support remission-oriented management of type 2 diabetes, improve patient health outcomes, and optimise the professional contribution of nurses in sustainable diabetes management.
This study contributes to global understanding of remission-oriented diabetes care by illustrating healthcare professionals' implementation experiences and highlighting the contribution of nurses in supporting remission-oriented management of type 2 diabetes.
The COREQ guidelines for qualitative research reporting were followed.
No patient or public contribution.
Body mass index (BMI) changes dynamically during early life, but whether BMI at specific developmental stages is associated with adult regional fat distribution remains uncertain. We evaluated age-specific associations of genetically predicted childhood BMI with adult MRI-derived BMI-adjusted fat depots and examined whether these associations were independent of adolescent BMI.
Two-sample Mendelian randomisation study using univariable Mendelian randomisation (UVMR) and multivariable Mendelian randomisation (MVMR).
Publicly available genome-wide association study summary statistics for BMI at 12 early-life time points from birth to 8 years, adolescent BMI from the Early Growth Genetics Consortium and adult MRI-derived adipose depot traits from UK Biobank.
Genetically predicted BMI at birth; 6 weeks; 3, 6 and 8 months; and 1, 1.5, 2, 3, 5, 7 and 8 years.
Adult abdominal subcutaneous adipose tissue adjusted for BMI (ASATadj), gluteofemoral adipose tissue adjusted for BMI (GFATadj) and visceral adipose tissue adjusted for BMI (VATadj).
UVMR showed age-specific heterogeneity. Higher genetically predicted BMI at 1.5 and 2 years was associated with higher adult ASATadj, whereas GFATadj showed no consistent pattern. VATadj showed the clearest signal: higher genetically predicted BMI at 5 and 7 years was associated with lower adult VATadj, with a nominal inverse association at 8 years. After conditioning on adolescent BMI, most early-life associations attenuated, but inverse associations of BMI at 5 and 7 years with VATadj remained nominally significant.
Genetically predicted early-life BMI showed stage-specific associations with adult BMI-adjusted fat distribution. Most associations appeared to reflect continuity of body size across the life course, whereas later childhood may warrant further investigation as a possible developmental period related to adult visceral fat partitioning.
by Huan Song, Yueyu Shu, Ping Ren
ObjectivesBased on the Compensatory Internet Use Model and the I-PACE framework, the present study develops a serial mediation model grounded in a cognition-emotion-behavior pathway. Specifically, this study examined whether difficulties in emotion regulation and problematic social media use were associated with the relationship between rumination and subjective well-being among a sample of vocational college students within the context of increasingly digitalized everyday life.
MethodsA survey was conducted among 402 vocational college students using the Ruminative Responses Scale, the Brief the Version of the Difficulties in Emotion Regulation Scale, the Problematic Social Media Use Questionnaire, the Satisfaction with Life Scale and the Positive and Negative Affect Schedule.
ResultsRumination was positively associated with difficulties in emotion regulation and problematic social media use, whereas subjective well-being was negatively associated with all three variables. Difficulties in emotion regulation were also positively correlated with problematic social media use. Mediation analyses identified three significant indirect pathways: the mediating role of difficulties in emotion regulation, accounting for 35.49% of the total effect; the mediating role of problematic social media use, accounting for 22.35%; and the serial mediating role of difficulties in emotion regulation and problematic social media use, accounting for 12.16%.
ConclusionsThe findings suggest that difficulties in emotion regulation and problematic social media use are associated with the relationship between rumination and subjective well-being among the sampled vocational college students. These findings may provide preliminary implications for interventions targeting emotion regulation and problematic social media use among vocational college students.
by Xiaolan Meng, Yubin Li, Miao He, Chen Wang, Haoran Shengsong, Jiacheng Guo, Jiayu Zhang, Shuang Zhao, Yulei Zhu, Bowen Li, Yuqiang Li, Hongzhi Sun
Liver cancer, a prevalent and aggressive malignancy globally, is associated with high morbidity and mortality rates. Butyrate, a metabolite produced by intestinal microbiota, is capable of restricting cancer initiation and progression. However, the precise mechanisms underlying its effects on liver cancer remain poorly understood. This study utilized a CCK-8 cytotoxicity assay to demonstrate that sodium butyrate (NaB) suppresses liver cancer cell proliferation through ferroptosis and apoptosis. The involvement of ATF4/SLC7A11 signaling and mitochondrial dysfunction in NaB-induced ferroptosis and apoptosis was further investigated. Results revealed a decrease in ATF4 and SLC7A11 expression, an elevation in the levels of malondialdehyde (MDA) and reactive oxygen species (ROS), and a reduction in glutathione (GSH) in NaB-treated liver cancer cells. These ferroptosis-related alterations could be reversed by an ATF4 activator. Additionally, NaB-treated liver cancer cells presented a decrease in mitochondrial membrane potential (MMP), accumulation of mitochondrial ROS, and mitochondrial damage. These cellular changes disrupted the BAX/BCL-2 balance, leading to cytochrome C release, which subsequently activated caspase9 and caspase3, initiating mitochondrial pathway apoptosis. In vivo, NaB treatment resulted in increased iron content in liver cancer tissues, along with upregulated cytochrome C, activated caspase9, and caspase3 expression; these effects were counteracted by ferrostatin-1 (Fer-1). Collectively, this study elucidates that NaB induces mitochondrial damage via ferroptosis mediated by ATF4/SLC7A11, ultimately triggering mitochondrial pathway apoptosis in hepatoma cells. These findings may offer novel insights into therapeutic strategies for hepatoma.Trauma, obstetric haemorrhage and severe anaemia lead to millions of deaths every year. Many of these deaths occur in regions known as ‘blood deserts’ where there is virtually no access to blood transfusions. A community or civilian walking blood bank (CWBB) is a low-resource strategy that can provide just-in-time, point-of-care tested blood transfusions in blood deserts when banked blood is not readily available and the alternative is almost-certain death. This protocol is designed to evaluate the effectiveness and implementation of a CWBB at Lodwar County Referral Hospital located in a blood desert in rural north-west Kenya.
We will use a mixed-methods approach relying on an implementation science design to evaluate effectiveness, acceptability, applicability and impact of a CWBB. The study will be conducted over 1 year in two parts: pre-emergency and post-emergency transfusion protocol (ETP) implementation. First, a previously developed ETP will be validated and finalised by key hospital stakeholders. Effectiveness will be assessed quantitatively and qualitatively. Prospective laboratory-based data collection will measure changes in blood ordering practices. We expect a sample size of approximately 140 (20/month) unmet blood transfusion requests, with 40 (5/month) of those being emergent (requiring blood in less than 2 hours). These cohorts will be compared pre-implementation and post implementation. Qualitatively, key informant interviews of hospital staff and the community will explore clinical blood demand and general understanding and perceptions about blood donation and transfusion. Lastly, we will determine the adaptability and scalability of a CWBB to other low-resource settings with in-depth interviews and a modified Delphi approach to achieve consensus regarding key components of a CWBB and its transferability to other settings.
Ethical approval was granted by the Strathmore University Institutional Scientific and Ethics Review Committee (SU-ISERC2234/24) and the Mass General Brigham (MGB) Hospital’s Institutional Review Board (#2024P001878; #2024P001879; #2024P001885; #2024P001887). The study team also secured a research licence from the National Commission for Science, Technology and Innovation (#168094) before initiating the study. Interviews will be voluntary and consent will be obtained prior to participation. Blood transfusion consent will be collected as per standard hospital process. The findings will be disseminated through academic publications, conference presentations and workshops, contributing valuable insights into emergency blood transfusion protocols. These findings will also be conveyed to Lodwar County Referral Hospital in order to facilitate quality improvement.
Most patients undergoing renal transplantation experience moderate to severe postoperative pain, which may induce physiological stress, exacerbate preexisting complications and impair functional recovery of the transplanted kidney. Although opioids are commonly used for postoperative analgesia, they are associated with various opioid-related adverse events (ORAEs). Oliceridine, a novel G protein-biased ligand μ-opioid receptor agonist, has been shown to provide effective analgesia while reducing the incidence of ORAEs without adversely affecting renal function. Therefore, oliceridine may represent a promising analgesic option for patients after renal transplantation, and clinical validation is warranted to evaluate its safety, efficacy and impact on immune function in these patients.
This single-centre, randomised, double-blind, positive-controlled clinical trial is being conducted in China. A total of 212 renal transplant recipients requiring patient-controlled intravenous analgesia (PCIA) will be randomly assigned in a 1:1 ratio to receive either oliceridine or sufentanil for postoperative pain management. The oliceridine group will receive oliceridine at 0.3–0.6 mg/h, whereas those in the sufentanil group will receive sufentanil at 1–2 μg/h. Rescue analgesia will be provided if pain is inadequately controlled. The primary outcome is analgesic effective rate 24 hours after surgery. Secondary outcomes will include the (1) numerical rating scale (NRS) scores, cumulative AUC and maximum pain intensity at six time points within 48 hours postoperatively, time to first PCIA, number of effective PCIA presses and dosage of rescue analgesic within 48 hours; (2) occurrence of ORAEs within 48 hours; (3) dosage of antiemetic drugs within 48 hours; (4) satisfaction evaluation with analgesia at 48 hours; (5) renal function assessment at 1–7 days postoperatively, changes in inflammatory factors and postoperative immune indicators; and (6) recovery quality assessment at first day and third day postoperatively.
Ethics approval was provided by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (XJTU1AF2024LSYY-348) prior to study commencement. Written informed consent will be obtained from all participants before enrolment. Results will be published in peer-reviewed journals and presented at academic conferences.
ChiCTR2400091724 (chictr.org.cn).
To analyse changes in the prevalence of suspected scoliosis among children and adolescents in Heqing County, South-West China, over different periods and to identify risk factors for its progression.
A mixed-methods study, including a cross-sectional survey and longitudinal follow-up.
Single-centre study. An angle of torso rotation (ATR) ≥5° was defined as a positive screening result and progression was defined as an increase in ATR ≥2°.
In November 2021, 22 740 students aged 6–18 years were screened; in May 2023, 28 009 students aged 6–18 years were screened. A total of 350 students with suspected scoliosis identified in 2021 were enrolled for longitudinal follow-up.
The prevalence of suspected scoliosis was 2.47% in 2021 (22 740 students) and 3.14% in 2023 (28 009 students). Among 4468 students screened in both years, 109 (2.44%) tested positive in 2021 and 124 (2.78%) in 2023. Prevalence was significantly higher in girls (2.92% in 2021; 4.36% in 2023) than in boys (2.01% in 2021; 1.94% in 2023) and higher in the 10–18 years age group (3.38% and 4.11%) than in the 6–10 years age group (0.59% and 0.83%; both p
The prevalence of suspected scoliosis in children and adolescents in Heqing County was higher in 2023 than in 2021. Approximately 10.6% of individuals with suspected scoliosis progressed over 1.5 years. BMI may serve as a protective factor against scoliosis progression.
FreshRSS 