Conectar
Colorectal cancer (CRC) is the third leading cause of new cancer cases and the second leading cause of cancer-related deaths worldwide. Current therapeutic modalities for CRC include surgical resection, intravenous chemotherapy (IVC), radiotherapy, immunotherapy, targeted therapy and their combinations. As a mainstream systemic treatment for CRC, IVC leads to widespread drug distribution but relatively low intratumoural drug accumulation. Compared with IVC, transarterial infusion chemotherapy (TAIC) involves selective arterial catheterisation to deliver chemotherapeutic agents directly to the tumour feeding vessels. Hepatic tumours receive their blood supply predominantly through branches of the hepatic artery. Hepatic artery infusion chemotherapy (HAIC) yields significantly superior outcomes compared with IVC and is currently widely employed for the treatment of primary and secondary hepatic malignancies. HAIC in combination with IVC can offer long-term durable disease control in the clinical treatment of liver cancer compared with IVC. CRC is also predominantly grown through angiogenesis. Therefore, we raise the question whether sequential IVC administered after intensive TAIC achieves better clinical efficacy than IVC alone for the treatment of unresectable CRC (uCRC). However, no prospective clinical trials have been conducted to compare the efficacy of these two strategies. This prospective study was therefore designed to fill this clinical knowledge gap.
This is a prospective, multicentre, randomised, open-label clinical trial. The uCRC is defined as inability to achieve an R0 resection owing to locally advanced CRC with clinical T4 disease confirmed by MRI or CT and/or synchronous liver metastases. This study only includes microsatellite stable or proficient mismatch repair uCRC. A total of 50 eligible patients will be randomly assigned to either the IVC group or the TAIC group. Patients in the IVC group will receive FOLFOX (fluorouracil, leucovorin, oxaliplatin)-based IVC every 2 weeks for a total duration of 8 weeks. Patients in the TAIC group will receive FOLFOX-based TAIC at week 0 and week 4 and receive FOLFOX-based IVC at week 2 and week 6. For patients with colorectal liver metastases, cetuximab or bevacizumab will be administered according to the RAS and BRAF status and the primary tumour site. The primary endpoint is the objective response rate. This study is scheduled to commence on 10 January 2026, and complete follow-up on 31 December 2027. The first subject was enrolled on 20 March 2026. To date, one subject in the IVC group and six subjects in the TAIC group have been enrolled.
The present study protocol has been approved by the Medical Ethics Committee of Guang’anmen Hospital, China Academy of Chinese Medical Sciences (ethical approval number 2025-268 KY). On completion of the study, data cleaning and analysis will be performed, and the results will be disseminated at academic conferences and in international peer-reviewed journals. This trial has been registered at ClinicalTrials.gov. The statistical analysis plan will be finalised and approved before the database lock. The final version is retained in the study documentation and will be made available to support the transparency and interpretation of the study results.
To describe antibacterial consumption (ABC) in four paediatric inpatient facilities in Sri Lanka in 2023.
Descriptive cross-sectional study, adapted from the WHO Global Antimicrobial Resistance and Use Surveillance System methodology.
Paediatric inpatient facilities in two tertiary and two secondary care government hospitals located across three provinces.
Data on antibacterials for systemic use, J01 in the Anatomical Therapeutic Chemical (ATC) classification issued to these paediatric inpatient facilities in 2023 by their respective hospital pharmacies.
(1) ABC at ATC third and fifth levels expressed as defined daily doses (DDDs)/100 admissions, (2) ABC as per WHO ‘Access, Watch and Reserve’ category, (3) choice of antibacterials within a class, (4) DU 75% for oral and parenteral dosage forms, (5) quality indicators such as amoxicillin index and broad:narrow spectrum ratio.
In 2023, total antibacterial (J01) consumption across the four paediatric inpatient facilities was 94.49 DDDs/100 admissions. Together, non-penicillin beta-lactams, penicillins and macrolides/lincosamides/streptogramins accounted for 90–98%. Co-amoxiclav was the most consumed antibacterial, and six agents (co-amoxiclav, cefotaxime, clarithromycin, azithromycin, cefuroxime and meropenem) collectively accounted for 70–90%. Aminoglycosides, tetracyclines, sulfonamides and trimethoprim, and quinolones contributed minimally. Access and Watch group antibacterials accounted for 34 and 65%. Quality indicators demonstrated disproportionately higher use of broad-spectrum and Watch group antibacterials.
High use of broad-spectrum and Watch-group antibacterials was observed across the four paediatric inpatient facilities. The findings highlight targets for antibacterial stewardship programmes and demonstrate the feasibility of ABC surveillance in Sri Lanka.
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.
To assess perceived patient safety competencies among nursing students and to examine their associations with their perceptions regarding clinical learning environment and unfinished nursing care.
An international comparative cross-sectional study.
A total of 1442 nursing students from the Czech Republic, Italy, Slovakia, and Türkiye participated between February and December 2025. Data were collected using the Health Professional Education in Patient Safety Survey, the Clinical Learning Environment, Supervision and Nurse Teacher scale, and the Unfinished Nursing Care Survey for Students. Descriptive statistics, non-parametric tests, Spearman correlations, and multivariate general linear modelling were applied.
Students reported significantly higher patient safety competencies in clinical compared with academic settings (p ≤ 0.001). Significant cross-country differences were observed across all competency domains (p ≤ 0.001). Perceived patient safety competencies were positively correlated with the overall quality of the clinical learning environment (r = 0.356–0.420; p < 0.001) and negatively correlated with unfinished nursing care (r = −0.107 to −0.171; p < 0.001). Multivariate analysis demonstrated that pedagogical atmosphere, premises of nursing care, supervisory relationship, and particularly the role of the nurse teacher were significant predictors of patient safety competencies.
The development of nursing students' patient safety competencies is closely linked to the quality of clinical learning environments. Strengthening educational and organisational conditions within clinical placements may play an important role in preparing future nurses for safe clinical practice.
Improving the quality of clinical learning environments, strengthening supervision, and addressing unfinished nursing care may support the development of nursing students' patient safety competencies and contribute to safer patient care.
The study was carried out according to the STROBE checklist.
No Patient or Public Contribution.
by Ya-Ling Hsieh, Chia-Jung Chiang, Tsung Yu
BackgroundAs cancer survival improves, increasing numbers of women diagnosed during their reproductive years face potential fertility impairment. However, population-based evidence on post-cancer childbearing remains limited in Asian settings.
MethodsWe conducted a nationwide cohort study in Taiwan by linking the Cancer Registry, Birth Reporting Registry, and Death Registry. A total of 72,929 females diagnosed with cancer at age ≤ 39 years were followed to identify subsequent livebirths. The cumulative incidence of first post-diagnosis livebirth was estimated using competing-risk methods. Predictors were evaluated using cause-specific Cox models. Standardized birth ratios (SBRs) were calculated by comparing observed births with expected births in the general population, standardized by age and calendar year.
ResultsOverall, 9.8% of female cancer survivors had at least one livebirth after diagnosis. The 5-, 10-, and 15-year cumulative incidences were 6.4%, 10.7%, and 13.9%, respectively. Compared with the general population, survivors had approximately half the expected number of births (SBR = 0.50; 95% CI, 0.49–0.51). Substantial heterogeneity was observed across cancer types: childbirth was most preserved among survivors of thyroid and skin cancers, whereas those with cervical, uterine, breast, leukemia, and central nervous system cancers had markedly reduced childbirth. Older age at diagnosis and receipt of chemotherapy were strongly associated with lower likelihood of childbirth.
ConclusionsIn this large, nationwide study, female cancer survivors in Taiwan experienced substantially reduced childbirth rates, with pronounced variation by cancer type, age at diagnosis, and treatment. These findings provide robust population-level evidence from an Asian context and highlight the need for early fertility counseling and improved access to oncofertility care.
by Christian Anker-Hansen, MirNabi Pirouzifard, Jan Sundquist, Kristina Sundquist, Bengt Zöller
ObjectiveOsteoporosis (OP) is a common degenerative disorder. This is the first real-world nationwide study aimed to determine the familial risks of hospital treated OP and fractures in first-, second- and third-degree relatives.
DesignThe Swedish Multigeneration register was linked to the National Patient Register to investigate the familial risks of OP between 1997 and 2018. Offspring born to Swedish parents were included. The adjusted familial hazard ratios (afHRs) with 95% confidence interval (CI) were determined for hospital treated OP and fractures at common osteoporotic fracture sites among twins, full-siblings, half-siblings, and cousins. There was no information about zygosity of the twins. Adjustments were made for birth year, sex, educational level, and comorbidities.
Results6,548,562 individuals (48.77% women) were included with a mean age of 41 years (range 0−87 years) at the end of follow-up. 57,869 (0.88%) individuals were affected with hospital treated OP, and 403,660 (6.16%) individuals with fractures. The afHRs were increased for both OP and fractures in twins, full-siblings, half-siblings, and cousins. The afHR for OP were for twins 2.92 (95%CI 2.32–3.67), full-siblings 2.22 (95%CI 2.14–2.31), half-siblings 1.74 (95%CI 1.55–1.94), cousins 1.81 (95%CI 1.55–2.11). Age-stratified analysis showed age-dependent familial associations with highest afHR in young individuals (<20 years): among full-siblings afHR was 125.70 (95%CI 59.44–265.84) for OP and 2.34 (95%CI 2.28–2.39) for fractures.
ConclusionsHeredity is associated with risk of hospital treated OP and fractures in the Swedish population. The familial risk of hospital treated OP or fractures is related to the genetic closeness of the affected relative(s).
by Felistar Mwakasungura, Alfateresia Mwasangama, Davis Amani, Elias Bukundi, Bruno Sunguya
Co-occurrence of HIV and Hepatitis B Virus (HBV) in sub-Saharan Africa, although less prevalent, is often more serious and exhibits rapid clinical deterioration even with appropriate treatment, jeopardizing efforts to reach regional and global targets. Evidence varies in the region and not reported in some countries. We used data from the nationally representative survey to characterize the burden and determinants of HIV and HBV co-occurrence in Tanzania. This secondary data analysis of the Tanzania HIV Impact Survey (THIS) involved 33,263 individuals aged 15 years and above, randomly selected from 14,966,262 households from 31 regions of Tanzania. The main outcome variable was HIV and HBV coinfections. Analyses were conducted using descriptive analysis, to estimate prevalence of co-occurrences, while Chi-square test used to characterize the burden. Through bivariable and multivariable binomial logistic regression models, we could estimate the associations between different independent variables with HIV-HBV co-occurrence. The burdens of HIV and HBV in the general population were 4.4% and 3.5% respectively. The prevalence of dual HIV and HBV infections was 0.3%. Among people diagnosed with HIV, 6.2% had HBV co-occurrence. After adjusting for confounder and other variables, age was significantly associated with coinfection (aOR = 1.02; 95% CI: 1.01–1.03; p < 0.001). Participants who were not in union had significantly higher risk of coinfection compared with those in union (aOR = 1.56; 95% CI: 1.01–2.41; p = 0.047). Having one lifetime sexual partner remained strongly protective factor against HIV-HBV coinfection (aOR = 0.19; 95% CI: 0.09–0.42; p < 0.001). Although the burden of HIV/HBV coinfection remains as low as 0.3% in the general population in Tanzania, the risk remains high among older adults and those with multiple sexual partnerships. Integrating HBV screening in all opportunities presented in the successful HIV program may help addressing the dual burden. For effectiveness, more efforts should target people with high-risk sexual behaviors and those with advanced age.Schools are key settings to intervene for the purpose of health promotion in children. However, the effectiveness of school-based interventions remains limited, potentially related to the obesogenic behaviours observed during holidays as posited by the structured days hypothesis. This study aims to evaluate the feasibility, process evaluation and preliminary efficacy of the keep moving in a structured summer (KEMOSS) intervention among Chinese children.
The KEMOSS intervention is an 8-week hybrid programme comprising two digitally supported home-based phases (weeks 1–2 and 7–8) and a structured school-based phase (weeks 3–6). The school-based phase will be a full-day scheduled programme that replicates the routine of regular school days, with a coach-led structured physical activity lesson and a free-play lesson embedded in the morning and afternoon, respectively. During the home-based phases, participants will be encouraged to complete prescribed exercises independently with support from mHealth reminders and instructional materials and to achieve a minimum of 10 000 steps per day. Feasibility, process evaluation and preliminary efficacy outcomes will be assessed using a mixed-methods approach. Quantitative data will be analysed using SPSS, while qualitative data from interviews and focus groups will be analysed thematically using NVivo.
Ethical approval has been obtained from the Ningbo University Ethics Committee (TY2026028). Findings will inform the refinement of the intervention and the design of a future definitive trial. Results will be disseminated through peer-reviewed publications and conference presentations.
ChiCTR2600126738.
by J. Richard T. Korecki, Diana Winston, Elizabeth Ko, Sun Yoo, Joshua Khalili, Julienne E. Bower
IntroductionNearly 80% of healthcare providers experience adverse psychological symptoms (e.g., depression, burnout, sleep disturbance) stemming from workplace stressors. Elevated levels of stress have been associated with unfavorable occupational, patient, and provider-related outcomes, imposing a heavy burden on a strained system. Given the impact of stress on both employee and patient health, effective interventions are urgently needed to reduce distress and promote well-being among healthcare professionals. Mindfulness-based interventions show promise for addressing these challenges. We developed a six-week, remotely delivered mindfulness intervention, the Building Emotional Strength Training (BEST) program, based on the Buddhist Four Immeasurables practice to cultivate the distinct emotional qualities of loving-kindness, compassion, joy, and equanimity. The present study aims to evaluate the feasibility and efficacy of a Four Immeasurables-based mindfulness intervention on perceived stress (primary outcome), burnout, depressive symptoms, and inflammatory biomarkers, while enhancing psychological well-being and sleep quality (secondary outcomes) in physicians. We will also investigate potential mediators of intervention effects, including compassion, positive affect, equanimity, and mindfulness.
MethodWe will enroll 90 full-time physicians in a remote, two-arm randomized controlled trial with 1:1 allocation to either the meditation intervention or waitlist control. Participants will complete self-report questionnaires and provide blood samples at baseline, mid-course, and post-intervention to assess outcomes and mediators.
DiscussionThe project aims to advance the study of mindfulness-based interventions that reduce distress and promote well-being through practices that cultivate prosocial and altruistic feelings toward oneself and others. While mindfulness interventions have gained considerable interest, none have specifically drawn from the Four Immeasurables practice to target loving-kindness, compassion, joy, and equanimity. This novel investigation could expand our understanding of practices that foster kindness and compassion to reduce distress in an at-risk population.
Trial registrationClinicalTrials.gov NCT07283744, registered on 2025/10/14. The Open Science Framework, registered on 2026/06/26.
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 Kyungsup Kwon, Choi Young Jang, Woori Kim, JuYeon Son, Euijin Chang, Sung-Han Kim
BackgroundThe post‑acute sequelae of SARS‑CoV‑2 infection (PASC, “Long COVID”) remain difficult to evaluate because standardized diagnostic tools are limited. We applied the recently proposed PASC index (score ≥ 12) to describe the 12‑month trajectory of Long COVID symptoms.
MethodsIn this prospective cohort, adults with laboratory‑confirmed COVID‑19 were consecutively enrolled from November 2022 to February 2025. Long COVID was defined by a PASC index of ≥12 across 12 symptom domains persisting for at least 30 days post-infection. Symptom questionnaires were completed at 1, 3, 6 and 12 months after infection.
ResultsAmong 183 participants, 48 (26.2%) met Long COVID criteria. Symptom assessments indicated that the proportion of participants meeting the Long COVID threshold declined from 27% at 1 month to 18% at 12 months, although this change was not statistically significant (p = 0.16). Participants classified as having Long COVID had consistently higher PASC index values across follow-up, while pairwise within-person comparisons showed no significant temporal changes in either the Long COVID or non-Long COVID group. These findings suggest that the overall symptom burden remained relatively stable over time, despite fluctuations in threshold status.
ConclusionDuring 12 months of follow-up, approximately one quarter of participants met the PASC index threshold at least once. Among participants with repeated assessments, PASC index scores showed limited within-person change, although differential non-response limits the interpretation of temporal prevalence estimates.
We examined the utility of quality indicators (QIs) for transcatheter aortic valve implantation (TAVI) in the assessment of TAVI care quality and variation in practice.
We performed a retrospective population-level cohort study in Ontario, Canada, where all residents receive publicly funded universal medical care. We examined the association between QI attainment and outcomes using multivariable hierarchical logistic models. We used median ORs to understand if variation in clinical outcomes between hospitals was attributable to variation in QI attainment.
We used all-comer registry data from the provincial CorHealth registry in Ontario, with linkage to administrative datasets using unique patient encoded identifiers.
TAVI recipients between 2018 and 2023 in Ontario, Canada.
We derived a unique set of QIs from internationally agreed ones.
The primary endpoint was a composite of all-cause mortality or rehospitalisation at 1 year from the date of TAVI.
Data from 9748 TAVI procedures were included between 2018 and 2023. We identified five feasible QIs, the majority of which had high compliance and minimal variation; the lone exception was the performance of transfemoral TAVI without general anaesthesia (median 0.87; IQR 0.78–0.93). Adherence to QIs was associated with a reduction in the composite endpoint. The strongest association was observed with multidisciplinary heart team involvement (defined as the presence of an interventional cardiologist and a cardiac surgeon) in the TAVI procedure (OR 0.67, 95% CI 0.50 to 0.90, p=0.007), the performance of transfemoral TAVI without general anaesthesia (OR 0.80, 95% CI 0.71 to 0.91, p<0.0004) and the utilisation of the transfemoral access (OR 0.84, 95% CI 0.69 to 1.04, p=0.10). However, variation in clinical outcomes following TAVI between hospitals was not attributable to variation in QI attainment. Falsification analysis suggests substantial residual confounding.
We developed a feasible set of QIs for TAVI and validated these QIs using routinely collected data from a large all-comer registry in Ontario. We have identified overall high quality of care for TAVI, but with some variation in practice, which in part is attributable to differences in patient factors. Our work suggests that QIs can inform quality improvement efforts by prompting future work into discretionary versus non-discretionary variation.
by Hidetaka Onda, Yuma Kuramatsu, Toyoaki Yamamoto, Atsunori Nishimatsu, Mami Kaneko, Daichi Tsutsui, Mizuki Kojima, Shinya Higuchi, Shinya Takeuchi, Kingo Nishiyama, Masato Miyauchi
BackgroundIdentifying patients at risk of very early emergency department revisits may help support discharge decision-making, but the extent to which routinely available index‑visit data can predict unplanned returns within 24 h remains unclear. Prior studies suggest that revisits are heterogeneous and influenced by factors beyond the initial encounter, underscoring the need to clarify—not overstate—the predictive value of simple, pragmatic tools.
MethodsWe conducted a single‑center retrospective study of 2,774 emergency department discharge visits in 2024 in which blood tests were performed. The primary outcome was an unplanned revisit within 24 h to the same emergency department. Two physicians independently adjudicated revisits using administrative and chart data. Candidate predictors included arrival mode, initial vital signs, and routinely available laboratory variables. Continuous variables were screened across prespecified percentile‑based cutoffs, and a simple additive score was constructed from dichotomized items. Internal validation used 2,000 bootstrap resamples with full repetition of item selection and cutoff search. Calibration was assessed using the calibration slope, intercept, and Brier score.
ResultsThere were 91 unplanned revisits (3.28%). Five dichotomized variables were retained: no ambulance use, C‑reactive protein ≥0.39 mg/dL, lymphocyte percentage ≤13.7%, red cell distribution width ≥13.5%, and mean corpuscular volume ≤87 fL. The odds ratio for revisit per 1‑point increase was 1.55 (95% confidence interval, 1.32–1.82). Apparent discrimination was modest (area under the curve, 0.651; 95% confidence interval, 0.592–0.711), with an optimism‑corrected area under the curve of 0.633. Apparent calibration in the derivation cohort was acceptable (slope 1.000; intercept 0.000; Brier score 0.0313). At a ≥ 4‑point threshold, specificity was 92.77% and sensitivity 20.88%.
ConclusionsA five‑item score based on index‑visit information showed a graded association with 24‑h revisit risk but modest predictive performance. This highlights the limitations of prediction using discharge‑time data alone and emphasizes the need for external validation and prospective evaluation before clinical implementation.
Acute wounds with high exudate output, such as split-thickness skin-graft donor sites, require dressings that effectively manage fluid, reduce pain, and support timely epithelialization. Foam dressings are widely used, but superabsorbent materials may provide advantages in exudate handling. This study compared the absorption performance, wound healing, and pain outcomes of foam versus superabsorbent dressings in donor-site wounds. Thirty patients undergoing split-thickness skin grafting were enrolled, with no exclusions or loss to follow-up. Each donor site was divided into two equal zones, with one receiving a foam dressing and the other a superabsorbent dressing according to randomized allocation. Data were collected using coded identifiers. Clinical outcomes, including absorption capacity, wound epithelialization, pain scores, and complications, were evaluated at 3-day intervals through postoperative day 15. Experimental testing showed that a 10 × 10 cm foam dressing weighed 7.5 g and absorbed 75 mL of saline, whereas the superabsorbent dressing weighed 5.5 g and absorbed 93 mL. Clinically, absorption power was significantly higher with the superabsorbent dressing on day 3 (104.09 vs. 71.87 mg/cm2/day; p = 0.034), day 6 (84.45 vs. 40.91 mg/cm2/day; p < 0.001), and day 9 (76.59 vs. 19.74 mg/cm2/day; p = 0.022). Pain scores tended to be lower with the superabsorbent dressing on days 6 and 9, although the differences were not statistically significant. Wound epithelialization was comparable between groups, with no allergic reactions, infections, or other complications observed. Superabsorbent dressing demonstrated superior absorption capacity compared with foam dressing, while achieving comparable epithelialization and healing outcomes. Pain scores tended to be lower with the superabsorbent dressing during the early postoperative period, although the differences were not statistically significant.
1.
by Shili Yang, Huaiquan Liu, Haiyang Kou, Lingyan Lai, Xinyan Zhang, Yunling Xu, Yu Sun, Bo Chen
Ochratoxin A (OTA), a food-borne mycotoxin, has been implicated in hepatotoxicity and potential carcinogenic processes, yet the molecular links between OTA exposure and hepatocellular carcinoma (HCC) remain incompletely understood. This study used an integrated computational workflow to prioritize candidate targets and pathways potentially linking OTA exposure with HCC. OTA-related and HCC-related targets were collected from public databases, intersected, and subjected to functional enrichment analysis. Transcriptomic data from the GSE36376 discovery dataset were analyzed to identify differentially expressed genes, followed by LASSO and SVM-RFE feature selection, immune-cell deconvolution, molecular docking, and molecular dynamics simulation. A total of 214 overlapping OTA-HCC-associated targets were identified and were enriched in pathways related to signal transduction, apoptosis, metabolism, and immune regulation. In GSE36376, 443 differentially expressed genes were identified using p 1, and overlap analysis yielded 13 shared target genes. Five candidate targets, CYP3A4, KIFC1, AKR1C3, CA2, and TTR, were further prioritized. KIFC1 and AKR1C3 were upregulated in HCC samples, whereas CYP3A4, CA2, and TTR were downregulated. These genes showed apparent discriminatory ability within the discovery dataset, with AUC values ranging from 0.866 to 0.958. Molecular docking predicted favorable OTA-target interactions, with docking energies ranging from −7.4 to −10.8 kcal/mol. CYP3A4 showed the lowest predicted docking energy (−10.8 kcal/mol) and was further evaluated by molecular dynamics simulation, with a protein-fitted OTA RMSD of 1.435 ± 0.097 nm and complex Rg of 2.308 ± 0.010 nm during the equilibrated 20–100 ns trajectory. Overall, this study provides a reproducible hypothesis-generating framework for exploring potential metabolic, genomic-instability-related, and immune-microenvironment links between OTA exposure and HCC. Future validation in independent datasets and experimental models will be important to further assess the biological relevance of these candidate targets and pathways.by Grace Kyule, Samuel Iddi, Noreen Dadirai Mdege, Lyagamula Kisia, Terefe Gelibo Argefa, Olatunbosun Abolarin, Didier M. Mirindi, Retselisitsoe Pokothoane, Boscow Okumu, Nelson Mbaya, Franklin Koech, James Kavai, Akinsewa Akiode, Thompson Ademola, Uche Okezie, Fakorede J.I, Christelle Tchoupé, Damazo T. Kadengye, Shukri F. Mohamed
Tobacco use often begins during adolescence, increasing the risk of lifelong nicotine dependence and future non-communicable diseases. In sub-Saharan Africa, concerns are rising due to aggressive tobacco industry marketing and expanding nicotine product markets, yet nationally representative data covering both in-school and out-of-school adolescents remain limited. Understanding tobacco use patterns during early and mid-adolescence, a critical period for experimentation and initiation, is essential for informing prevention strategies. We conducted nationally representative cross-sectional household surveys between March and June 2024 using harmonized tools and multistage stratified cluster sampling in Democratic Republic of Congo (DRC), Nigeria and Kenya. Adolescents aged 10–17 years completed standardized face-to-face interviews with response rates of 96% in DRC, 94% in Nigeria and 96% in Kenya. The outcomes were current use of any tobacco, smoked tobacco and smokeless tobacco. Current tobacco use was defined as self-reported use in the past 30 days of any tobacco product including cigarettes, cigars, shisha/waterpipe and smokeless-tobacco (snuff/chewing). Analyses incorporated sampling weights to estimate prevalence, assessed subgroup differences using Rao-Scott chi-square tests, and multivariable logistic regression models were fitted separately for each country and outcome. Among 18,612 adolescents (4,675 in DRC, 7,502 in Nigeria, 6,435 in Kenya), 6·5% (95% CI: 4·9–8·6) reported current tobacco use, with variations across countries (11·9% in DRC, 3·6% in Nigeria, and 2·5% in Kenya). Similar patterns were observed for smoked and smokeless tobacco use. Tobacco use was higher among boys, older adolescents, and those engaged in work. In adjusted analyses, being a boy and older was associated with higher odds of use. Being enrolled in school was linked to lower odds of use in DRC and Kenya, while having both parents alive reduced odds of use in DRC and Nigeria. Higher parental education was associated with lower odds of tobacco use in Kenya but higher odds of use in DRC and Nigeria. Overall, adolescents’ tobacco use remains a critical public health challenge and observed cross-country differences highlight the need for tailored, context-specific interventions and strengthened tobacco control efforts.Inadequately managed postoperative pain remains a significant clinical challenge, often leading to delayed mobilisation and increased complications. While intravenous patient-controlled analgesia (PCA) is a mainstay of treatment, conventional fixed-rate basal infusion modes may not align with the fluctuating biphasic nature of postoperative pain. This often results in either insufficient analgesia or unnecessary opioid overexposure. Advanced network-integrated PCA pumps now allow for ‘variable-rate feedback infusion,’ which dynamically adjusts the background rate based on real-time patient demand. This study aims to determine whether a variable-rate feedback infusion mode reduces total cumulative opioid consumption at 48 hours postoperatively while providing non-inferior analgesic efficacy compared with a fixed-rate basal infusion mode.
This is a multicentre, randomised, double-blind, controlled trial to be conducted at three hospitals in China. A total of 1170 patients (aged 18–65 years, American Society of Anaesthesiologists I-III) undergoing elective mixed surgery under general anaesthesia, including thoracic, abdominal, spinal, orthopaedic and cranial procedures performed using either minimally invasive or open approaches, will be recruited and randomised in a 1:1 ratio to either the fixed-rate basal infusion group or the variable-rate feedback infusion group. Both groups will receive a standardised PCA solution of sufentanil. In the variable-rate feedback infusion group, the background infusion rate will automatically increase by 0.5 mL/hour on demand boluses during lockout intervals and decrease by 0.5 mL/hour after 1 hour of inactivity. The primary outcome is the total cumulative opioid consumption at 48 hours postoperatively, including sufentanil delivered via PCA and opioid-equivalent rescue analgesics. Key secondary outcomes include resting and movement pain scores, cumulative PCA volume consumption, number and dosage of additional rescue analgesia and postoperative quality of recovery. Exploratory outcomes include sleep quality, sedation and agitation levels, and the degree of nausea and vomiting, patient’s satisfaction with PCA. These outcomes are assessed at predefined postoperative time points.
The study has been approved by the Institutional Review Board of Beijing Tiantan Hospital (KY2025-387-02) and the Affiliated Hospital of Youjiang Medical University for Nationalities (YYFY-LL-2026-006), and the Second Affiliated Hospital of Hainan Medical University (2026-K140-01). The study will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Written informed consent will be obtained from all participants before enrolment. Findings from this study will be disseminated through peer-reviewed journals and at scientific conferences. A summary of the findings will also be made available to participants on request.
Lung cancer is the leading cause of cancer-related death worldwide, with substantial variations in incidence, stage at diagnosis and outcomes across regions. High-quality, standardised diagnosis and treatment are essential to improving survival and quality of life. Multidisciplinary care (MDC) is a cornerstone of cancer care; however, its implementation faces barriers such as limited resources, uneven policy support and inequitable access to specialised care, particularly in low- and middle-income countries. To date, no global scoping review has systematically mapped lung cancer MDC—covering implementation models, facilitators, barriers, policy frameworks, technology integration and evidence gaps. This review seeks to fill that gap and inform the optimisation of MDC models.
The Joanna Briggs Institute methodological framework, underpinned by the framework of Arksey and O’Malley and enhanced by Levac and colleagues, will be used for this scoping review. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR). We will perform a comprehensive search of six electronic databases (PubMed, CINAHL, Scopus, CNKI, VIP and WanFang) and grey literature sources (ClinicalTrials.gov). In addition, we will screen the reference lists of included studies for further relevant publications. Two review authors will independently conduct the screening and data extraction processes; discrepancies will be resolved through consensus or discussion with a third review author. Findings will be presented graphically and tabularly, together with a narrative description.
We will collect all data from published and grey literature, meaning ethical approval is not necessary. To disseminate our findings, we plan to use diverse means, such as publishing in peer-reviewed journals and presenting at academic conferences.
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.
FreshRSS 