OBJECTIVE:Remimazolam tosylate is an ultra‑short‑acting benzodiazepine sedative. This study aimed to determine a suitable intraoperative remimazolam dose for older adults undergoing hip arthroplasty with neuraxial anesthesia and to explore its association with postoperative delirium (POD) and perioperative stress responses. METHODS:In this randomized study, 153 older adults undergoing hip arthroplasty with neuraxial anesthesia were allocated to four groups: saline control (N), remimazolam 0.1 mg/(kg•h) (R1), 0.2 mg/(kg•h) (R2), and 0.3 mg/(kg•h) (R3). Primary outcomes were intraoperative sedation success (modified Observer's Assessment of Alertness/Sedation scale), plasma cortisol and norepinephrine concentrations at operating room entry and exit, and incidence of POD. RESULTS:In the R2 group, sedation success was 100%, and the mean awakening time was 6.82 ± 0.64 min, shorter than in the R3 group (8.16 ± 0.93 min), which exhibited deeper sedation and longer recovery. No statistically significant differences were observed in POD incidence across groups (2.86-6.00%; p = 0.922), and the study was underpowered to detect modest between‑group differences. Compared with saline, the remimazolam groups had lower cortisol and norepinephrine concentrations at operating room exit, whereas within‑group changes from entry to exit did not reach statistical significance (p > 0.05). CONCLUSION:Compared with saline, the remimazolam groups had lower cortisol and norepinephrine concentrations at operating room exit, whereas within‑group changes from entry to exit did not reach statistical significance (p > 0.05). Within the observed POD incidence range (2.86-6.00%), remimazolam did not appear to increase POD over the first 7 postoperative days compared with saline, although the study was not powered to detect modest differences.
OBJECTIVE:This study aimed to determine whether preemptive oliceridine reduces the half maximal effective concentration (EC₅₀) of remifentanil required to attenuate hemodynamic responses to tracheal intubation during propofol target‑controlled infusion anesthesia. METHOD:In this prospective randomized trial, 50 patients received either 1.5 mg intravenous oliceridine or an equivalent volume of saline (placebo) before anesthesia induction. All patients underwent induction with target-controlled infusion of propofol at an effect-site concentration of 3.0 μg/mL, in combination with remifentanil. The remifentanil concentration for each subsequent patient was determined using Dixon's up-and-down sequential allocation method, based on the preceding patient's hemodynamic response. The primary outcome was the remifentanil EC₅₀ required to prevent a tracheal intubation response, defined as a ≥20% increase in heart rate or blood pressure from baseline or the presence of tearing, muscle tremor, or coughing/choking, with EC₅₀ estimated using probit analysis. RESULTS:The remifentanil EC₅₀ was significantly lower in the oliceridine group (2.52 ng/mL; 95% CI: 2.19-2.80) than in the control group (3.52 ng/mL; 95% CI: 3.27-3.81), corresponding to an approximate 29% reduction in the target effect‑site concentration required to blunt the intubation response. This difference was accompanied by significantly lower induction doses of both remifentanil and propofol (p < 0.01). Additionally, patients who received oliceridine demonstrated lower pain scores immediately after extubation (p < 0.05). CONCLUSION:Preemptive oliceridine significantly reduced the remifentanil EC₅₀ for suppressing tracheal intubation responses, demonstrating an opioid‑sparing effect in this setting. This effect‑site reduction may support hemodynamic stability and help limit remifentanil exposure during anesthesia induction.
OBJECTIVE:To investigate whether genetically proxied educational attainment influences the risk of intracranial aneurysm. METHOD:We conducted a two-sample Mendelian randomization analysis using genome wide association study summary statistics from individuals of European ancestry. The inverse variance weighted method was the primary estimator, complemented by MR Egger, weighted median, weighted mode, and simple mode analyses, with years of schooling and college completion as educational exposures combined with intracranial aneurysm GWAS data. RESULTS:We selected two groups of genes associated with genetic susceptibility to education as exposure factors. When using years of education from the UK Biobank based GWAS as the exposure, the inverse variance weighted method indicated an inverse association between genetically proxied longer schooling and intracranial aneurysm risk. MR Egger regression suggested that directional pleiotropy was unlikely to strongly bias the results and yielded an inverse association between years of schooling and intracranial aneurysm. The weighted median estimator yielded a similar direction and magnitude of effect. When using college completion as the exposure, the inverse variance weighted method also indicated an inverse association with intracranial aneurysm risk, and sensitivity analyses produced estimates of similar direction and magnitude. MR-Egger regression intercept testing did not provide evidence of substantial directional pleiotropy. CONCLUSION:These Mendelian randomization findings are consistent with a potentially protective association of higher genetically proxied educational attainment with intracranial aneurysm risk in individuals of European ancestry.
OBJECTIVE:This study evaluated whether chlorhexidine gluconate (CHG) antimicrobial dressings reduce catheter‑related local infection and improve dressing stability in for subclavian central venous catheters (CVCs) in patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS:A total of 120 patients who underwent HSCT and received subclavian CVC placement in the laminar airflow ward of the Department of Hematology at the study hospital between November 2019 and November 2021 were enrolled. Participants were randomly allocated, using a random number table, to an intervention group or a control group (60 patients each). The intervention group received subclavian CVC fixation and maintenance with CHG antimicrobial dressings, whereas the control group used conventional transparent 3M dressings under the same standardized care protocol. Routine catheter maintenance was performed once weekly in both groups, with continuous intervention over a 5-week period. Outcomes assessed included the incidence of CVC-related local infection (manifested as redness, swelling, and pain at the puncture site), the frequency of dressing changes, and the number of cases of dressing loosening. RESULTS:The incidence of catheter‑related local infection was 46.67% in the control group and 23.33% in the intervention group. The mean number of dressing changes was 6.7 (range, 2-14) in the control group and 5.4 (range, 1-11) in the intervention group. Dressing loosening occurred in 19 control group patients and 9 intervention group patients. All between-group differences were statistically significant (p < 0.05), indicating fewer local infections, fewer dressing changes, and less dressing loosening with CHG antimicrobial dressings. CONCLUSION:In this randomized study, CHG antimicrobial dressings significantly reduced CVC‑related local infection, improved dressing fixation, and lowered the frequency of dressing changes in HSCT patients with subclavian CVCs. These findings support the use of CHG dressings to optimize catheter maintenance and may help reduce nursing workload in this high risk population.
OBJECTIVE:This cross-sectional study aimed to identify clinical factors associated with sarcopenia in adults with type 2 diabetes mellitus (T2DM) aged ≤ 65 years and to develop a preliminary nomogram-based risk scoring model using routinely collected clinical indicators. METHODS:We enrolled 81 patients with T2DM aged ≤ 65 years who were admitted to Huzhou Central Hospital between July 2023 and September 2025. Demographic characteristics, anthropometric measurements, and laboratory parameters were collected. Appendicular skeletal muscle mass, handgrip strength, and gait speed were measured, and sarcopenia was diagnosed according to Asian Working Group for Sarcopenia criteria. Univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariable logistic regression were used to identify independent risk factors and construct a nomogram-based prediction model. Model performance was evaluated using receiver operating characteristic (ROC) analysis, calibration plots, and decision curve analysis (DCA). RESULTS:Compared with patients without sarcopenia, those with sarcopenia had lower HDL-C and albumin levels and higher HbA1c concentrations (all p < 0.05). LASSO regression identified HDL-C, HbA1c, height, and BMI as key predictors, and multivariable analysis confirmed low HDL-C, high HbA1c, shorter height, and lower BMI as independent risk factors. The nomogram demonstrated good discrimination (AUC = 0.844) and calibration, and decision curve analysis indicated favorable clinical net benefit. CONCLUSION:Reduced height, lower BMI, elevated HbA1c, and decreased HDL-C are significant risk factors for sarcopenia in patients with T2DM. The developed risk scoring model demonstrated good discriminative ability within this single-center cohort and may serve as a preliminary tool for clinical risk stratification, but it requires validation in larger, independent samples.
OBJECTIVE:To develop a mechanism-oriented framework that specifies how narrative processes operate within schema therapy, detailing a core sequence of change (activation of emotionally salient autobiographical memories, shift in narrative position, emergence of corrective internal voices, and reconsolidation of meaning) through which narrative-based interventions support identity-level change in individual and group settings. METHODS:This paper adopts a theory-building approach combining a narrative review with an interpretive qualitative analysis of clinical case illustrations from schema therapy. Case material is used to model recurring mechanisms of narrative change rather than to evaluate treatment efficacy. RESULTS:Across imagery rescripting, chairwork, therapeutic letters, the River of Life, and the Inner House method, a consistent pattern of narrative change emerged. Core mechanisms included activation of emotionally salient autobiographical memories, a shift in narrative position from child-in-experience to adult author, emergence of corrective internal voices corresponding to the Healthy Adult and Kind Parent modes, and reconsolidation of meaning. These changes transferred into current identity and interpersonal functioning, with reduced dominance of punitive introjects, increased self-compassion, and greater narrative coherence. In group settings, corrective relational experiences were amplified through shared narrative processing. DISCUSSION:Narrative processes in schema therapy are discussed in relation to narrative identity research, trauma-related memory fragmentation, and emerging findings on memory reconsolidation, with neurobiological links framed as plausible but still tentative. Potential clinical risks, including emotional overactivation and narrative destabilization, highlight the need for careful pacing and integration with stabilization, cognitive-behavioral strategies, mindfulness, and resource-oriented interventions. CONCLUSION:Narrative processes constitute a central pathway through which schema therapy facilitates identity-level change beyond symptom reduction. A mechanism-based narrative framework may strengthen clinical formulation and inform future research on how and for whom narrative interventions are most effective.
BACKGROUND:Ventriculoperitoneal shunt (VPS) infection is a serious complication following shunt placement for hydrocephalus, particularly in patients with severe neurological impairment who require prolonged rehabilitation and invasive supportive devices such as tracheostomy and nasogastric feeding. OBJECTIVE:This study aimed to determine the incidence of VPS infection in a severely disabled adult hydrocephalus cohort and to evaluate the association between a modified surgical technique and VPS infection, alongside other potential risk factors. The findings were intended to guide the refinement and ongoing optimization of our department's standardized surgical protocols to further reduce infection risk. METHODS:We conducted a single centre retrospective before-after cohort study of 284 adults undergoing first time VPS between 2022 and 2024, comparing patients treated with the conventional technique (n = 168) and those treated after implementation of a modified, tracheostomy focused surgical protocol (n = 116). All patients were followed for 12 months, and predefined clinical, laboratory, and procedural variables were extracted from medical records. RESULTS:A total of 284 patients with hydrocephalus who were followed up for at least one year were included in the study. VPS infection occurred in 35 of 284 patients (12.3%), with 29 of 35 infections (82.8%) arising within 3 weeks of surgery. Infection rates were 17.9% (30/168) in the conventional group and 4.3% (5/116) in the modified protocol group (absolute risk reduction 13.6%), corresponding to approximately one infection prevented for every 7-8 patients treated with the modified technique (χ² = 11.654, p < 0.001). No other predefined patient related or shunt related factors showed a significant association with infection.
BACKGROUND:Neuromedin U (NMU) is a neuropeptide broadly expressed in the gastrointestinal (GI) tract and central nervous system (CNS), implicated in energy balance and glucose homeostasis. Recent studies have suggested that NMU may act as a "decretin" hormone by inhibiting glucose-stimulated insulin secretion (GSIS); however, in vivo findings remain inconclusive. This study evaluated plasma NMU responses during an oral glucose tolerance test (OGTT) and regional intestinal NMU expression in a monosodium glutamate (MSG)‑induced hypothalamic obesity (MHO) model in rats. METHODS:Thirty male Wistar rats were divided into control and MHO groups. MHO was induced by subcutaneous MSG injections during the neonatal period. After five months, metabolic parameters, oral glucose tolerance test (OGTT), plasma NMU levels, and NMU mRNA expression in the duodenum, jejunum, and ileum were analyzed using ELISA and RT-qPCR. RESULTS:The MHO group exhibited elevated fasting glucose, decreased basal insulin levels, and increased abdominal adiposity compared to controls, indicating a metabolically obese phenotype in this model. Basal plasma NMU levels were similar between groups. At 60 minutes post-glucose load, plasma NMU decreased significantly relative to baseline in both groups, with no difference between MHO and control rats. Intestinal NMU expression followed a proximal-to-distal declining pattern, consistent with previous reports, and did not differ between MHO and control rats. CONCLUSION:These findings suggest that NMU expression within the gastrointestinal tract remains regionally regulated and unaltered in experimental obesity. Furthermore, the significant decline in plasma NMU at 60 minutes is compatible with modulation during hyperglycemia but does not establish a causal role in glucose regulation. This pattern appears to be preserved in the MHO model despite metabolic dysfunction. Future studies employing receptor inhibition or NMU administration are warranted to elucidate its physiological role in insulin regulation.
BACKGROUND:Lipedema is a chronic adipose tissue disorder predominantly affecting women, often misdiagnosed as obesity or lymphedema. Emerging evidence points to microvascular dysfunction and chronic inflammation in its pathophysiology. This study aimed to compare complete blood count (CBC) parameters and derived inflammatory indices between women with lipedema and age-matched healthy controls, focusing on the potential diagnostic value of platelet indices such as PDW and MPV. METHODS:We conducted a retrospective observational study including 45 women with clinically confirmed lipedema and 40 age matched healthy controls. CBC parameters and derived inflammatory indices were compared between groups without adjustment for body mass index (BMI). RESULTS:The study included 45 women with lipedema and 40 healthy controls with similar age distributions. No statistically significant between group differences were observed in complete blood count parameters after correction for multiple comparisons, although PDW and MPV were numerically higher in the lipedema group. CONCLUSION:In this exploratory study, PDW and MPV were numerically higher in women with lipedema than in controls, but these differences lost statistical significance after correction for multiple comparisons. These findings argue against PDW or MPV as standalone diagnostic markers of lipedema and indicate that future research should prioritize larger, BMI-matched cohorts and multimodal approaches that integrate platelet indices with tissue-level or imaging markers.
OBJECTIVE:Emerging evidence suggests that low-grade systemic inflammation contributes to depressive symptoms; however, population-based longitudinal evidence, particularly from community samples, remains limited. This study examined the associations between serum cytokine levels and depressive symptoms among community-dwelling adults in Japan. PARTICIPANTS AND METHODS:Participants were drawn from the Shika Study cohort (N = 182; 98 men, 84 women; mean age: 62.2 ± 9.34 years for men, 60.9 ± 9.49 for women). They provided blood samples in 2017 and completed the Japanese versions of the Center for Epidemiologic Studies Depression Scale (CES-D) in 2017 and its revised version (CESD-R) in 2019. Serum TNFα, IL-6, IL-10 and IL-17A were quantified using a multiplex human immunoassay. RESULTS:Among men, serum IL-6 levels were positively associated with CES-D scores in 2017 after adjustment for age, visceral adiposity, smoking, and alcohol consumption (standardised regression coefficient (β) = 0.25, p = 0.024). Baseline TNF-α was significantly associated with higher CES-D-R scores in 2019 (β = 0.23, p = 0.026), whereas IL-17A showed only a non-significant trend (β = 0.13, p = 0.231). No significant associations were observed among women or for IL-10. CONCLUSION:In this exploratory community-based study, higher IL-6 levels were modestly associated with concurrent depressive symptoms in men, and baseline TNFα showed a similarly modest association with depressive symptoms two years later as measured by the CESD-R. IL-17A showed a tentative trend that requires replication. These findings suggest possible sex-specific links between peripheral inflammation and depressive symptoms, but the results should be interpreted as hypothesis generating.
To the Editor, In their review, Straka et al. (2026) discussed the role of Helicobacter pylori infection (Hp-I) in gastric and oral pathologies and highlighted the benefits of Hp eradication at both gastric and oral sites when combined with concomitant periodontal therapy (Straka et al. 2026). In this context, it is worth further emphasizing the broader impact of Hp and Porphyromonas gingivalis (Pg) in metabolic syndrome (MetS) and in bacteria-driven local and systemic disorders. Hp-I remains highly prevalent worldwide, affecting more than 4.4 billion individuals (Kountouras 2025). As a Group I carcinogen, Hp plays a central role in gastric carcinogenesis through Correa's cascade, namely the progression from chronic gastritis to atrophy, intestinal metaplasia, dysplasia, and ultimately gastric cancer (Kountouras et al. 2008). In addition, Pg and its virulence factors, particularly gingipains, have also been implicated in this carcinogenic sequence (Salazar et al. 2013). Beyond its primary colonization of the gastric mucosa, Hp may also inhabit the oral cavity, including dental plaque, saliva, periodontal pockets, and especially dental pulp, thereby acting as an important extragastric reservoir (Momtaz et al. 2012). This oral-gastric axis may contribute to persistent infection, reinfection after eradication, and enhanced transmission (Momtaz et al. 2012). Likewise, the oral cavity is a major reservoir for Pg, which can disseminate systemically through the bloodstream and influence distant organs (Farrugia et al. 2021). Hp-I, together with alterations in the oral-gut microbiota, may disturb the microecological balance of this axis. Both Hp and Pg are strongly associated with oral diseases, particularly periodontitis, a dysbiosis-driven inflammatory disorder. Periodontitis itself has been linked to the initiation and progression of malignancies, especially oral cancers (Farhad et al. 2024). Although Hp and Pg colonize different anatomical niches, they appear to share important pathogenic mechanisms (Doulberis et al. 2021). A major determinant of Pg virulence is the gingipain family, a group of cysteine proteases involved in tissue destruction, immune evasion, and bacterial invasion. Emerging evidence also suggests that Hp may express functionally similar proteolytic enzymes, indicating overlapping or complementary pathogenic strategies (Doulberis et al. 2021). Notably, co-incubation of Hp and Pg has been reported to enhance Pg virulence, supporting a synergistic interaction that may aggravate both local and systemic disorders (Doulberis et al. 2021). These shared features underline the potential value of targeting both pathogens in antimicrobial strategies.
OBJECTIVE:To identify and analyze differences in information and communication technology (ICT) knowledge and use between nurses and patients, and to examine how age and educational attainment are associated with these differences in the context of perioperative outpatient nursing care, based on data collected concurrently from both groups. MATERIAL AND METHODS:The tested group consisted of 81 nurses and 209 patients. The average age of the nurses was 41 years, and the average age of the patients was 36 years. This was a cross sectional, prospectively planned quantitative study. A self constructed questionnaire was used to assess levels of ICT knowledge and use. Data were analyzed using descriptive statistics and inferential tests (Chi square, Mann-Whitney U, and Wilcoxon tests) with a significance level of α = 0.05. RESULTS OF THE RESEARCH:We found statistically significant differences in the level of knowledge about ICT and social media between nurses and patients. Both groups considered ICT knowledge important, but patients rated it as more important than nurses (M = 2.78 vs 2.69; p < 0.001). This indicates a discrepancy between patients' expectations and nurses' perceptions within the same perioperative outpatient services. CONCLUSION OF THE RESEARCH:By comparing responses of nurses and patients within the same perioperative outpatient services, we showed that ICT and social media are perceived as important by both groups, but with different priorities. Education in the home environment using modern ICT, aligned with these distinct perspectives, has the potential to contribute to the prevention of postoperative complications.
OBJECTIVE:The objective of this study was to examine the relationship between handgrip strength (HGS) and the prevalence of type 2 diabetes mellitus (T2DM) among older adults residing in community settings in Nanjing, China. METHODS:In this cross-sectional study, 279 participants aged 60 years and older were assessed using a questionnaire, and T2DM diagnosis was confirmed through a review of medical records, defined as a documented physician diagnosis of type 2 diabetes and/or current use of antidiabetic medication. Participants were categorized into three groups based on HGS tertiles: low HGS group (< 12.0 kg, n = 92), middle HGS group (12.0-26.5 kg, n = 94), and high HGS group (> 26.5 kg, n = 93). Data analysis was conducted using analysis of variance, the χ² test, and multivariable logistic regression. RESULTS:The mean age of participants was 72.43 ± 6.38 years, and 38.0% were male (n = 106). The average body mass index (BMI) was 23.40 ± 3.14 kg/m², and the prevalence of T2DM, hypertension, and heart disease was 15.1%, 44.8%, and 19.8%, respectively. No significant differences were observed among the three groups in BMI, systolic blood pressure, diastolic blood pressure, or the prevalence of hypertension and heart disease, whereas the prevalence of T2DM was highest in the low HGS group (21.7%) and lowest in the high HGS group (8.6%). In the fully adjusted model, each 1 kg increase in HGS was associated with a 3.3% lower odds of T2DM (odds ratio 0.967, 95% confidence interval 0.944-0.989). CONCLUSIONS:Higher HGS was associated with a lower prevalence of T2DM among community dwelling older adults in Nanjing. These findings indicate that HGS may serve as a potential target for intervention and as a simple indicator for identifying older individuals at increased risk of T2DM in community settings. In Chinese community health centers, incorporating HGS into routine check ups for older adults could help prioritize individuals for further glucose testing and counseling about strength building physical activity.
BACKGROUND:Toxic masculinity has increasingly been discussed as a significant psychosocial factor affecting men's mental health, particularly in relation to depression, self-stigma, and low rates of help-seeking. In clinical practice, however, the concept remains ambiguous and may be applied in a reductive or pathologizing manner. This article aims to provide a clinically sensitive understanding of toxic masculinity within the framework of schema therapy. AIM:The aim of this article is to explore the relationship between toxic masculinity, early maladaptive schemas, and depressive symptomatology in men, and to demonstrate how schema therapy can facilitate long-term change without pathologizing male identity. METHOD:This paper is a narrative review complemented by systematized clinical experience of schema therapists. Four composite heuristic vignettes are presented. These vignettes do not represent individual patients but are composite cases reflecting common clinical patterns. Each vignette includes schema-therapeutic conceptualization, a discussion of transgenerational transmission of masculine norms, and examples of therapeutic interventions. CLINICAL ILLUSTRATIONS:Toxic masculinity is clinically expressed through specific early maladaptive schemas (e.g., emotional deprivation, unrelenting standards, emotional inhibition) and protective schema modes (Detached Protector, Overcontroller, Punitive/Demanding Critic). Depression in men often manifests through masked, externalizing, or somatic forms. Schema therapeutic interventions-including limited reparenting, imagery rescripting, chairwork, therapeutic letters, and transgenerational re-scripting-enable gradual access to unmet emotional needs and the strengthening of the Healthy Adult mode. CONCLUSION:Toxic masculinity is conceptualized as a learned and modifiable pattern embedded in early maladaptive schemas and schema modes rather than as a stable personality trait. Schema therapy provides an integrative clinical framework that links gendered social norms with early maladaptive schemas and schema modes, and offers clinically applicable strategies for promoting sustainable change without pathologizing male identity.
BACKGROUND:Pediatric cardiomyopathy (PCM) comprises a genetically heterogeneous, high risk group of myocardial disorders and is a leading cause of pediatric heart failure and transplantation. Genotype-phenotype correlations and outcome data remain limited, particularly in populations with high consanguinity. METHODS:We conducted a retrospective cohort study of 53 children with cardiomyopathy classified as hypertrophic (HCM), dilated (DCM), left ventricular noncompaction (LVNC), or restrictive cardiomyopathy (RCM). We analyzed demographics, consanguinity, echocardiographic parameters, genetic testing results (available in 26/53 patients, 49.1%), device therapy, transplantation, and mortality. RESULTS:The cohort included 20 HCM (37.7%), 17 DCM (32.1%), 13 LVNC (24.5%), and 3 RCM (5.7%) patients, with a median age at diagnosis of 6.5 years (interquartile range [IQR] 2.0-10.0). Consanguinity was documented in 24 of 53 patients (45.3%). A pathogenic or likely pathogenic (P/LP) variant was identified in 9 of 26 tested patients (34.6%), corresponding to 17.0% of the total cohort (9/53). When variants of uncertain significance (VUS) are included, 20 of 26 tested patients (76.9%) harbored at least one rare variant; however, 11 of these 20 findings (42.3% of tested patients) were VUS, which are not counted toward diagnostic yield and remain subject to reclassification. Baseline ejection fraction was markedly reduced in DCM (median 35%, IQR 28-37%), whereas HCM and RCM had preserved systolic function at diagnosis. During a median follow up of 3.0 years, 15 patients (28.3%) underwent implantable cardioverter defibrillator implantation, 6 (11.3%) underwent heart transplantation, and 18 (34.0%) died; mortality was highest in DCM (58.8%) and RCM (66.7%). CONCLUSION:Among the 26 of 53 patients who underwent genetic testing, PCM in this cohort showed a P/LP diagnostic yield of 34.6% (9/26) and substantial mortality, particularly in DCM and RCM phenotypes. High consanguinity was associated with a notable P/LP yield and a frequent VUS burden; whether consanguinity contributes to earlier or more severe disease requires confirmation in larger, prospective studies. These findings support offering comprehensive genetic testing to pediatric cardiomyopathy patients, especially in high consanguinity settings, to enable molecular diagnosis and structured family counseling. In this cohort, a substantial proportion of tested patients had P/LP variants, and many others carried VUS that will require ongoing re evaluation. Future prospective studies should assess how specific genetic findings, combined with imaging and functional parameters, can be incorporated into validated risk stratification and management algorithms. s.
OBJECTIVES:The objectives of our study are to explore the associations of uric acid to albumin ratio (UAR) with all-cause and cardiovascular mortality in stroke patients, and to examine whether UAR-mortality associations differ between stroke patients stratified by dietary antioxidant quality score (DAQS). METHODS:This cohort study included 1125 stroke patients from the NHANES 2007-2018. The DAQS was calculated based on the intake of six anti-oxidative nutrients. Multivariate Cox proportional hazards models were used to investigate the associations of UAR with all-cause and cardiovascular mortality in the total stroke cohort and within subgroups stratified by DAQS. RESULTS:UAR showed a positive linear association with all-cause mortality in unadjusted and adjusted models (HR = 1.49, p = 0.003). For cardiovascular mortality, the association with continuous UAR was significant before but not after adjustment (HR = 1.43, p = 0.108). Compared with low UAR (≤1.34), high UAR (>1.34) was associated with higher all-cause (HR = 1.37, = 0.030) and cardiovascular mortality (HR = 1.64, p = 0.040). In exploratory DAQS-stratified analyses, elevated UAR was related to higher all-cause (HR = 1.58) and cardiovascular mortality (HR = 1.83; both p < 0.05) only among patients with low DAQS, whereas associations in the high-DAQS subgroup were generally non-significant and imprecise. CONCLUSION:Higher UAR after stroke was robustly associated with increased all-cause mortality, with weaker and less consistent evidence for cardiovascular mortality. Exploratory DAQS-stratified analyses suggested excess risk with high UAR mainly among patients with low DAQS, while findings in the smaller high-DAQS subgroup were non-significant and imprecise; these subgroup and cardiovascular results are hypothesis-generating.
OBJECTIVES:This exploratory study examined changes in stress-related indicators, including subjective mood states, autonomic nervous system activity, and salivary biomarkers, during a 4-week period in which healthy young adults performed an instructed upright sitting posture. DESIGN:This study employed a single-arm, within-subject, repeated-measures observational design. MATERIALS AND METHODS:Eighteen healthy university students (10 males and 8 females) completed a 4-week upright sitting posture practice. Assessments took place at baseline (Week 0), mid-practice (Week 2), and end-of-practice (Week 4). At each visit, participants underwent a 10-minute seated rest; pre-session assessments using the Profile of Mood States, Second Edition (POMS2), autonomic indices, and salivary biomarkers; a 5-minute upright sitting period; and post-session assessments. Autonomic activity was indexed by heart rate (HR) and heart rate variability (HRV), and salivary cortisol, chromogranin A, oxytocin, and α-amylase were measured. RESULTS:Across assessment weeks, sessions that included the instructed upright sitting posture were accompanied by within-session pre-post improvements in most POMS2 mood indices, with large effects for several negative mood subscales and Total Mood Disturbance. Significant main effects of Week were observed for Confusion-Bewilderment, Tension-Anxiety, and Total Mood Disturbance, whereas other mood indices did not show consistent change. HR showed significant main effects of Measurement Timing and Week, while HRV indices and salivary biomarkers did not show consistent or statistically significant patterns. At Week 4, comfortable maintenance time-the self-reported maximum duration participants felt they could maintain the instructed posture-was positively associated with total practice time; this association was considered hypothesis-generating.
BACKGROUND:Hyperinsulinemia and insulin resistance promote acne pathogenesis through reduced Forkhead box protein O1 (FOXO1) signaling and increased mechanistic target of rapamycin (MTOR) and insulin-like growth factor-1 (IGF1) activity. While oral myo-inositol (MI) and D-chiro-inositol (DCI) supplementation may improve insulin sensitivity, evidence regarding direct pathway modulation in acne-involved skin remains limited. In this exploratory, single-arm, uncontrolled study, we sought to investigate the effects of oral MI/DCI (3.6:1 ratio) on cutaneous expression of these biomarkers in adults with acne and metabolic comorbidities (polycystic ovary syndrome or metabolic syndrome). METHODS:Forty-five adults with active inflammatory acne on the back were enrolled across three subgroups of 15 - including women with polycystic ovary syndrome (PCOS), women with metabolic syndrome (MetS), and men with MetS. All participants received oral MI/DCI (1100 mg + 300 mg daily) for 12 weeks in a single-arm, open-label, pre-post biopsy study. Paired punch biopsies of acne-involved skin were obtained before and after supplementation, and FOXO1, MTOR, and IGF1 mRNA expression was quantified by qRT-PCR. Clinical response was assessed by Investigator Global Improvement rating. RESULTS:Following the 12-week supplementation, FOXO1 expression increased (Cohen's d = +1.13; p < 0.001), whereas MTOR (Cohen's d = -3.46; p < 0.001) and IGF1 (Cohen's d = -1.62; p < 0.001) decreased significantly compared with baseline. Changes were directionally consistent across all subgroups. Clinical improvements were observed in 82.2% of participants. Plasma testosterone in men remained stable (p = 0.638). CONCLUSIONS:In this exploratory, uncontrolled study, 12 weeks of oral MI/DCI supplementation (3.6:1 ratio) was associated with significant changes in insulin resistance pathway gene expression in acne-involved skin. These findings provide preliminary mechanistic support for further randomized, controlled trials evaluating MI/DCI as a potential adjunctive strategy in acne associated with metabolic comorbidities.
OBJECTIVE:To evaluate first-trimester FBG category, pre-pregnancy BMI, and serial FBG trajectory as stratified predictors of GDM in a routine-care antenatal cohort. METHODS:Retrospective cohort of 771 women delivering at a single Chinese tertiary hospital (January-June 2013), with first-trimester FBG (<12 weeks) and 75-g OGTT at 24-28 weeks (Chinese IADPSG thresholds). GDM was diagnosed in 158 women (20.5%). Associations were analyzed by chi-square and Fisher's Exact Test (SPSS v19.0); all estimates are unadjusted. RESULTS:First-trimester FBG supported a two-tier, not three-tier, risk classification: GDM incidence in the ≤4.7 and 4.7-5.1 mmol/L strata was statistically indistinguishable (14.2% vs. 18.0%; Bonferroni-corrected p=0.188), while both were significantly lower than the ≥5.1 mmol/L stratum (45.9%; both P<0.001; overall χ²=58.835, p<0.01). The sole statistically supported triage cut-point is FBG ≥5.1 mmol/L. Non-decreasing FBG trajectory was the strongest predictor: 100% GDM incidence in the FBG ≥5.1 non-decreased subgroup (n=29; 95% CI: 88-100%; p<0.01) and 54.9% (95% CI: 43-67%) versus 4.2% in the FBG 4.7-5.1 stratum (n=71 vs. 190; p<0.01), yielding NPV 95.8% for a decreasing trajectory in this intermediate-risk group. BMI ≥24 kg/m² independently elevated GDM risk in women with FBG <5.1 mmol/L (p<0.01) but not in the FBG ≥5.1 stratum (p=0.075, n=34). CONCLUSION:Non-decreasing FBG trajectory identifies high-risk subgroups missed by a single threshold, using measurements already collected in routine prenatal care. FBG ≥5.1 mmol/L alone carries a 54.1% false-positive rate; the trajectory rule substantially refines this triage. RCTs are needed to assess early intervention benefit.
OBJECTIVE:This report documents the occurrence, clinical management, and outcome of a patient diagnosed with an atypical pulmonary embolism (PE) complicating subacute cerebral hemorrhage in a rehabilitation setting. By integrating the relevant literature, this study aimed to provide a clinical reference for the diagnosis and treatment of atypical PE in patients undergoing post-hemorrhagic rehabilitation. CASE:The medical history and imaging data from a patient diagnosed with atypical PE during the subacute phase after intracerebral hemorrhage in a rehabilitation setting were analyzed. After diagnostic confirmation, anticoagulation and symptomatic therapies were initiated. A literature review exploring anatomical factors underlying PE in this clinical context was performed. After multidisciplinary treatment, the patient's PE lesions disappeared and indicators, such as blood pressure and heart rate, returned to normal. CONCLUSION:Intracerebral hemorrhage complicated by atypical PE is a relatively uncommon occurrence in the rehabilitation ward. In this case, conservative low-dose nadroparin calcium anticoagulation was associated with marked biochemical improvement and complete bilateral pulmonary artery clearance on follow-up CTA, without recurrent intracranial hemorrhage. Although no domestic or international guidelines currently address intracerebral hemorrhage complicated by atypical PE, our experience suggests that early prevention, timely diagnosis, individualized anticoagulation, and multidisciplinary collaboration can enable safe and effective management in carefully selected patients.
