This paper aims to understand the status quo of structural empowerment of clinical nurses and analyze its influencing factors to provide references for optimizing nursing management. A cross-sectional survey of 333 clinical nurses was conducted using the Chinese version of the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II) for Medical Staff and the Psychological Capital Scale. The total score of clinical nurses' structural empowerment was (57.45 ± 9.28), and the average score of structural empowerment was (3.02 ± 0.49). Multiple linear regression analysis showed that marital status, highest educational background, position, employment method, and mental health training experience were the main influencing factors of nurses' structural empowerment level (P < .05). Correlation analysis showed that the total score of structural empowerment was significantly positively correlated with the total score of psychological capital (r = 0.449, P < .001). The level of structural empowerment of clinical nurses is at a moderate level and is affected by many factors. Medical institutions and nursing managers should take effective improvement measures according to its influencing factors to improve the level of structural empowerment of clinical nurses, optimize nursing management, and help the development of the nursing career.
Ultrasound-guided suprascapular nerve block (SSNB) and subacromial injection (SI) are commonly used for chronic subacromial impingement syndrome (SIS), but the additional benefit of combining these interventions remains uncertain. This study evaluated whether adding ultrasound-guided SI to SSNB improves clinical outcomes in patients with chronic MRI-confirmed SIS who had failed conservative treatment. This retrospective cohort study included consecutive patients with chronic SIS treated between December 2021 and January 2025. Patients underwent ultrasound-guided SSNB alone or combined SSNB with SI according to routine clinical practice. SIS was classified by MRI as grade 1 (tendinopathy), grade 2 (partial-thickness rotator cuff tear), or grade 3 (full-thickness rotator cuff tear). The primary outcome was treatment success, defined as a ≥50% reduction in Numerical Rating Scale (NRS) score at 3 months. Secondary outcomes included pain intensity, patient satisfaction, and treatment outcomes according to MRI grade. Sixty-one patients were included (30 SSNB and 31 SSNB + SI). Both treatment groups demonstrated substantial pain reduction during follow-up. Treatment success rates were similar between the SSNB and SSNB + SI groups (86.7% vs 87.1%, P = .999), as were patient satisfaction rates (86.7% vs 87.1%, P = .946). No significant between-group differences were observed in NRS scores at 1 or 3 months. Treatment success was significantly higher in patients with grade 1 SIS than in those with grade 2 SIS (97.4% vs 80.0%, P = .044). All 3 patients with grade 3 SIS experienced treatment failure. Ultrasound-guided SSNB was associated with favorable short-term outcomes in patients with chronic SIS who had failed conservative treatment. Adding ultrasound-guided SI did not provide additional improvement in pain, treatment success, or patient satisfaction over 3 months. Higher treatment success was observed in patients with grade 1 SIS than in those with more advanced disease. Larger prospective randomized studies are needed to confirm these findings.
This study investigates the clinical and abdominal computed tomography (CT) characteristics of pneumatosis intestinalis (PI). This retrospective single-center study included 58 patients with PI. Clinical data and CT images were reviewed. CT findings included location, extent, and associated features, and PI was classified into 3 morphological patterns: bandlike, grapelike, and beadlike. Inter-observer agreement was evaluated, and subgroup analysis was performed using analysis of variance and chi-square tests. The mean age of the patients was 68 years. The most common comorbidities were diabetes (44.8%) and hypertension (42.4%). Abdominal pain (62.1%) was the predominant symptom. Inter-observer agreement for CT findings was excellent (kappa 0.88-0.95). The beadlike pattern was most frequent (48.3%), followed by bandlike (34.5%) and grapelike (17.2%). The surgical group (n = 10) was older and had more frequent abdominal pain, peritoneal signs, and ascites (60.0% vs 20.8%, P = .033) than the conservative group (n = 48). Overall prognosis was favorable (96.6% recovery), but both deaths were associated with concurrent portal and mesenteric venous gas. After treatment, a follow-up CT scan obtained 2 to 4 weeks later demonstrated resolution of PI. We propose a novel CT morphological classification method for PI. Clinical signs and specific CT findings (e.g., ascites and portomesenteric venous gas) guide management. While most patients recover with conservative care, concurrent portal and mesenteric venous gas signifies a high mortality risk. CT plays a key role in the follow-up of patients with PI.
Pre-eclampsia is a major cause of maternal and perinatal morbidity, and there remains a need for reliable and easily accessible biomarkers for early prediction. The Endothelial Leakage-Erythrocyte Stress (ELES) index is a novel composite biomarker derived from routine first-trimester red cell distribution width (RDW), aspartate aminotransferase (AST), and serum albumin, reflecting endothelial leakage and erythrocyte stress. This retrospective case-control study evaluated the predictive value of the ELES index for pre-eclampsia in singleton pregnancies undergoing routine laboratory assessment at 11-13 + 6 weeks who delivered at the same hospital. First-trimester ELES index values were significantly higher in women who later developed pre-eclampsia than in controls (6.36 ± 2.59 vs 4.75 ± 1.38, P < .001), with an AUC of 0.75 (95% CI: 0.65-0.85); at a cutoff of ≥5, sensitivity and specificity were 76.3% and 65.0%, respectively. After adjustment for maternal age and obstetric characteristics, ELES ≥ 5 remained independently associated with pre-eclampsia (OR 5.971, 95% CI: 2.427-14.688, P = .001); higher AST and lower albumin were also independently associated. Albumin alone yielded the highest AUC (0.775, 95% CI: 0.689-0.847), and the ELES index was not statistically superior to albumin alone (DeLong P = .698). Because first-trimester albumin is not part of routine national antenatal screening, only women in whom this measurement had already been requested could be analyzed, and BMI, aspirin prophylaxis, gestational age at diagnosis, and disease severity were not retrievable. These findings should therefore be regarded as preliminary and hypothesis-generating, requiring prospective validation in a broader obstetric population before clinical use.
RATIONALE:Prader-Willi syndrome (PWS) is a complex genetic disorder that affects multiple systems and results from loss of expression of paternally inherited genes in the 15q11.2-q13 region. It is characterized by severe hypotonia and feeding difficulties during infancy, followed by hyperphagia in later childhood and adolescence, which, without strict control of excessive eating behaviors, ultimately leads to severe obesity associated with type 2 diabetes mellitus. PATIENT CONCERNS:We present the case of a woman who was diagnosed with PWS and diabetes mellitus in adulthood. She had a history of hypotonia, developmental delay, intellectual disability, hyperphagia, and morbid obesity since childhood, with gonadal dysplasia emerging during puberty. She presented with long-term poorly controlled blood glucose levels. DIAGNOSES:Genetic testing revealed a heterozygous deletion in the 15q11.2-q13.1 region on chromosome 15, and DNA methylation analysis confirmed the diagnosis of PWS. INTERVENTIONS:The distinctiveness of this case lies in the patient's uncontrollable food-seeking behavior combined with PWS-related severe insulin resistance and β-cell dysfunction, which together resulted in refractory diabetes. Initial combination therapy using multiple glucose-lowering agents, including insulin, metformin, chiglitazar sodium, a glucagon-like peptide-1 receptor agonist, and a sodium-glucose cotransporter-2 inhibitor, demonstrated limited efficacy. OUTCOMES:Subsequent substitution of the glucagon-like peptide-1 receptor agonist with the dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide led to notable improvements in appetite suppression, body weight reduction, and glycemic control. LESSONS:This case underscores the importance of considering genetic syndromes in patients with diabetes presenting with early-onset severe obesity and developmental abnormalities and emphasizes the potential therapeutic value of novel antidiabetic agents such as tirzepatide for managing PWS-associated metabolic disturbances. These findings provide important insights into the diagnosis and treatment of diabetes complicated by PWS.
Rheumatoid arthritis (RA) is a chronic autoimmune systemic inflammatory condition that significantly damages bone and cartilage, leading to severe joint deformities. Matrix metalloproteinase(s) (MMP-9) plays a significant role in both the pathogenesis and management of RA, and its status as a biomarker and a target for inhibition is important in understanding and treating the disease. This work aims to examine the interactions between the molecules of MMP-9 and bioactive compounds derived from marine algae using molecular docking and absorption, distribution, metabolism, excretion, and toxicity investigations. Docking results were assessed using Glide gscore, the top 5 compounds (6,6-Bieckol, Dieckol, Lophocladine B, Sargachromanol E, and Porphyran) docked against protein receptors were chosen. The selected compounds had binding affinities that varied from -8.523 to -6.327 kcal/mol, and the selected compounds also had undergone absorption, distribution, metabolism, excretion, and toxicity analysis. Density functional theory analysis was conducted against finalized compound, Lophocladine B, with HOMO-LUMO gaps of 4.235 and 5.275 eV, respectively, confirming electronic stability and binding-relevant reactive sites consistent with its predicted MMP-9 inhibition. It was discovered that only Lophocladine B met the selection criteria, so this compound was subjected to molecular dynamics simulations for stability analysis. Moreover, the docking studies were supported by redocking validation of the native inhibitor, heavy-atom root mean square deviation, benchmarking with a known inhibitor, and molecular dynamics simulations along with a replication run. The results of the study imply that these substances might ultimately be employed to treat rheumatoid arthritis. Although this study only included computer validations, in vitro investigations are needed to convert these potential inhibitors into medicinal products.
RATIONALE:Chronic patellar tendon rupture with complete tendon loss is difficult to reconstruct when primary repair is impossible. We report reconstruction using an ipsilateral peroneus longus (PL) autograft in a 4-strand "M-shaped" configuration with suture-anchor fixation and temporary cerclage augmentation. PATIENT CONCERNS:A 17-year-old male had progressive anterior knee pain, instability, and inability to actively extend the left knee for 2 years after trauma. DIAGNOSES:Examination showed patella alta, a palpable infrapatellar gap, and complete loss of active extension. Radiographs showed an Insall-Salvati ratio of 1.28. Magnetic resonance imaging confirmed chronic complete patellar tendon rupture without a repairable stump. INTERVENTIONS:A 21-cm ipsilateral PL autograft was folded into a 4-strand construct and anchored to the inferior patella and tibial tubercle. Patellar height was deliberately overcorrected, and a transpatellar-tibial cerclage wire protected the reconstruction during staged rehabilitation. OUTCOMES:At 1 year, after wire removal, the Insall-Salvati ratio was 1.08. The patient regained full active extension without lag, near-full flexion, and recreational activity participation without pain or donor-site morbidity. Asymptomatic wire breakage occurred at 6 months. LESSONS:A multi-strand PL autograft with anchor fixation and temporary cerclage augmentation may restore patellar height and extensor function in chronic patellar tendon rupture with complete tendon loss.
Although severe depression and suicidal ideation among adolescents could be driven by excessive academic competition, research on this problem is still insufficient. Therefore, this study aims to analyze the relationship between academic achievement, depression, and suicidal ideation based on large-scale data. This study utilized data from the nationwide Korea Youth Risk Behavior Web-based Survey conducted from 2006 to 2022, investigating a total of 1,138,802 adolescents. Weighted proportions with 95% confidence intervals (CIs) and crude numbers and percentages were utilized to analyze and present the results in various formats. To accurately assess the association of academic achievement with depression and suicidal ideation, weighted odds ratios and their 95% CIs were calculated using weighted logistic regression analysis. Compared to students with high academic achievement, those with moderate achievement showed a 1.12 (95% CI = 1.11-1.13) times higher risk of depression, while those with low achievement had a 1.54 (1.52-1.56) times higher risk. Similarly, students with low academic achievement had a 1.49 (95% CI = 1.47-1.51) times higher risk of suicidal ideation. The prevalence of both depression and suicidal ideation decreased before the coronavirus disease 2019 pandemic but steadily increased during the pandemic. Females experienced higher rates of depression in each academic achievement group (high: weighted odds ratio = 1.49 [95% CI = 1.46-1.52]; middle: 1.59 [1.56-1.63]; low: 1.72 [1.69-1.75]) and suicidal ideation (high: 1.60 [1.57-1.64]; middle: 1.63 [1.59-1.68]; low: 1.82 [1.78-1.86]) than males. This study suggests that academic achievement can be associated with depression and suicidal ideation. Therefore, implementing mental health and educational programs targeting students with lower academic achievement may be crucial.
This study employed a bidirectional 2-step, two-sample Mendelian randomization approach to investigate the causal relationships between ferroptosis-related genes and juvenile idiopathic arthritis (JIA) and to explore the mediating role of immune cells. Ferroptosis genes were identified from the deCODE database and matched with protein quantitative trait locus data as exposures to evaluate their causal effects on JIA, while immune cell traits were similarly assessed. For genes showing positive Mendelian randomization results, further analyses were conducted to determine whether immune cells mediated the effects on JIA, with mediation analysis performed only in the presence of causal associations. Data were sourced from the GWAS, FerrDb, and other public repositories. Nine ferroptosis-related genes were found to have causal links with JIA: HSPB1, DECR1, LIFR, and CTSB increased JIA risk, whereas PIEZO1, DPP4, BID, and others were protective. Forty immune cell traits were also causally associated with JIA. Mediation analysis revealed that several immune cells, including CD127- CD8+ T cells, partially mediated the genetic effects, with mediation proportions reaching up to 18.6%. Collectively, these results point to a ferroptosis-immune-JIA axis, suggesting that ferroptosis-related genes contribute to JIA pathogenesis through immune cell mediation and offering new mechanistic insights and potential therapeutic targets.
We employed Mendelian randomization (MR) to explore causal relationships between gut microbiota (GM), coronary atherosclerotic heart disease (CAHD), and potential metabolic mediators. We utilized summary statistics from genome-wide association studies (GWAS), encompassing data on 473 GM traits from comprehensive microbiome GWAS, 61 lipoprotein-mediated cholesterol transport and distribution data from large-scale metabolic biomarker studies, and coronary atherosclerosis (CA) data from the GWAS catalog (study accession GCST90043957) involving 456,348 European participants. Bidirectional MR analyses were conducted to investigate the causal relationships between GM and CA. Two-sample Mendelian randomization analyses were performed to identify potential mediating metabolites and quantify the mediation proportion. Ultimately, the GM GCA-900066755, identified through MR as having a potential causal relationship, was selected to investigate its potential effects on CA by influencing cholesterol transport and distribution. Our results indicated that GCA-900066755 was positively associated with an increased risk of CA (odds ratio = 1.156). CA did not significantly affect the levels of GCA-900066755 (odds ratio = 1.009). GCA-900066755 was negatively correlated with total cholesterol levels in medium high-density lipoprotein, which reduced CA risk, and was positively correlated with total cholesterol levels in low-density lipoprotein (LDL), large LDL, medium LDL, and small LDL, which were positively associated with CA. Mediation analysis showed 7 data points mediating the association between GCA-900066755 and CA. Our MR study supports a causal relationship between specific GM groups and the risk of CAHD, highlighting that cholesterol traits are not merely outcomes associated with the relationship between GM and CAHD, but are important mediating factors. Understanding the biological mechanisms of these traits can provide a concrete foundation for future targeted interventions.
This study compares the clinical and radiological outcomes of volar plating alone and combined volar and radial column plating in the management of Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C2-C3 distal radius fractures. This retrospective cohort study included 80 patients with AO type C2-C3 distal radius fractures who were treated with either single volar plating (n = 50) or combined volar and radial column plating (n = 30). The patients were followed up for a minimum of 2 years. Outcome measures included the Patient-Rated Wrist Evaluation score, wrist range of motion, radiological parameters (radial height, inclination, volar tilt, ulnar variance), and pinch strength. Patients treated with dual plating demonstrated significantly better Patient-Rated Wrist Evaluation scores at all follow-up points (P < .05) as well as improved radial height, inclination, volar tilt, wrist flexion, and grip strength. Pronation values were more favorable in the single-plating group across all follow-up time points, while supination values differed only at the 6-month assessment; overall function and radiological alignment otherwise appeared more favorable in the dual-plating group. In AO type C distal radius fractures with radial styloid involvement or severe comminution, dual plate fixation demonstrated improved functional recovery and maintenance of radiographic alignment. Supplementary radial column fixation may therefore represent an effective treatment strategy for these challenging fracture patterns, warranting further prospective investigation.
Short-video platforms increasingly disseminate health information. This study evaluated the content, quality, reliability, and transparency of acute leukemia (AL)-related videos on Douyin and Bilibili. On August 27, 2025, algorithm-ranked search results were sequentially screened, and the first 100 eligible videos from each platform were included, reflecting prominently exposed eligible content rather than the full AL-related video population. Video characteristics, engagement metrics, uploader identity, and content categories were recorded. Quality, reliability, and transparency were assessed using the Global Quality Score (GQS), modified DISCERN, and Journal of the American Medical Association (JAMA) benchmark criteria. Group differences were analyzed using nonparametric tests, and associations between engagement and quality were examined using Spearman correlation and multivariable ordinal logistic regression. Inter-rater reliability was assessed using weighted and unweighted Cohen's kappa. A total of 200 videos were analyzed. Median scores were 3.00 for GQS, 1.50 for modified DISCERN, and 1.50 for Journal of the American Medical Association. Clinical manifestations and treatment were commonly covered, whereas prevention and etiology were underrepresented. Videos uploaded by blood disease-related experts had significantly higher quality and reliability scores. On Douyin, engagement metrics were negatively associated with GQS in correlation analyses, but this association was no longer significant after adjustment for uploader type, video duration, and days since upload (adjusted odds ratio = 0.97, 95% confidence interval: 0.92-1.02, P = .18). Inter-rater reliability was substantial to almost perfect. Algorithm-exposed AL-related videos on Douyin and Bilibili showed suboptimal quality and reliability. Uploader identity, rather than engagement, was more closely associated with information quality. Findings are limited to prominently exposed videos retrieved on one date.
Chemotherapy-induced neutropenia is a common adverse effect, with severe neutropenia associated with significant morbidity, mortality, and costs that require immediate evaluation and treatment. To identify the risk factors that may predispose adult patients with solid cancers to severe intravenous chemotherapy-induced neutropenia, we conducted a retrospective study. A study was performed by collecting data of solid cancer patients who received intravenous chemotherapy from January 2023 to May 2024 at Shanghai Sixth People's Hospital Affiliated to Shanghai JiaoTong University, South Campus. Patient data including age, sex, body mass index, Eastern Cooperative Oncology Group (ECOG) performance status, number of chemotherapy lines, number of chemotherapy drugs, radiotherapy history, and comorbidities were collected. We analyzed potential risk factors for severe neutropenia. In total, 343 patients were included in the analysis. Multivariate analysis showed that female sex (odds ratio [OR] 1.84; 95% confidence interval [CI] 1.06-3.18; P < .03), number of chemotherapy lines (OR 1.51; 95% CI 1.06-2.13; P < .02), and radiotherapy history (OR 2.53; 95% CI 1.04-6.19; P < .04) were independent predictors of severe neutropenia. Comorbidity (OR, 0.46; 95% CI 0.26-0.81; P < .007) was found to be an independent predictor of no severe neutropenia. In conclusion, we found that female sex, a larger number of chemotherapy lines, and a history of radiotherapy might be predictors of severe neutropenia. Comorbidity may be a protective factor against severe neutropenia.
Short-video platforms such as TikTok and Bilibili have become widely used sources of health information. This study assessed the informational content, quality, and reliability of videos related to cervical spondylotic myelopathy (CSM) on these platforms. A cross-sectional search was conducted on October 1, 2025, using the Chinese-language equivalent of "cervical spondylotic myelopathy" as the sole search term. For each eligible video, data on duration, user interaction metrics, uploader identity, and content themes were collected. Video quality and reliability were evaluated using the Global Quality Scale (GQS) and the modified DISCERN (mDISCERN) instrument. Group differences were analyzed using the Mann-Whitney U and Kruskal-Wallis tests, and correlations were examined using Spearman analysis. In total, 274 videos met the inclusion criteria. Most videos addressed diagnosis (76.28%) and treatment (74.82%), while prognostic information was scarce (16.06%). The median GQS score was 3.00 (interquartile range [IQR]: 2.00-3.00), and the median mDISCERN score was 4.00 (IQR: 3.00-4.00). TikTok videos achieved significantly higher GQS and mDISCERN scores than those on Bilibili (P < .001). Videos produced by specialized healthcare professionals (SHPs) obtained the best evaluation scores (P < .05). Engagement indicators showed no significant correlation with GQS or mDISCERN scores (P > .05). The overall educational value of CSM-related videos was suboptimal. Content created by SHPs demonstrated superior quality and reliability. Video engagement metrics were not associated with video quality or reliability. Greater professional involvement and preferential presentation of evidence-based content warrant further investigation as potential approaches to improving the dissemination of high-quality CSM information on these platforms.
RATIONALE:Purtscher-like retinopathy is an extremely rare, vision-threatening microvascular complication of systemic lupus erythematosus (SLE). To date, there is no standardized, unified treatment guideline for this condition worldwide, and conventional interventions including systemic glucocorticoids, immunosuppressants, and anti- vascular endothelial growth factor therapy often yield unsatisfactory visual outcomes. Additionally, the early ocular manifestations of SLE are easily overlooked due to atypical systemic symptoms, leading to delayed diagnosis and irreversible visual impairment. PATIENT CONCERNS:A 24-year-old female developed blurred vision after coronavirus disease 2019 infection, which was initially neglected. She subsequently presented with persistent fever, lymphadenopathy, recurrent seizures and altered consciousness, and was diagnosed with SLE complicated by neuropsychiatric lupus. Her visual loss progressively aggravated during systemic treatment. DIAGNOSES:Systemic workup confirmed active SLE with neuropsychiatric involvement. Serial ophthalmic examinations revealed bilateral Purtscher-like retinopathy characterized by venous tortuosity, extensive cotton-wool spots, retinal hemorrhages, macular edema, diffuse capillary non-perfusion, and foveal arteriovenous anastomosis, with secondary right eye vitreous hemorrhage. INTERVENTIONS:On the basis of standard SLE treatment with glucocorticoids and immunosuppressants, comprehensive interventions were implemented, including blood pressure optimization, anticoagulant discontinuation to mitigate bleeding risk, fractional panretinal photocoagulation for retinal ischemia, and adjunctive modified Ditan Decoction based on Traditional Chinese Medicine syndrome differentiation. OUTCOMES:During follow-up, blood pressure was gradually stabilized. Right eye vitreous hemorrhage resolved completely without recurrent bleeding. Retinal ischemia improved after photocoagulation, with partial regression of foveal arteriovenous anastomosis. Visual acuity improved modestly and remained stable at the final assessment. LESSONS:Ocular microvascular lesions may precede systemic disease flares in SLE, underscoring the necessity of routine ophthalmologic screening for newly diagnosed patients, particularly those with neuropsychiatric involvement. Adjunctive Traditional Chinese Medicine therapy may offer incremental benefit for refractory Purtscher-like retinopathy, representing a complementary strategy that warrants further investigation.
Observational studies suggest an association between lichen planus (LP) and Alzheimer disease (AD), but causality remains unclear due to confounding and reverse causation. In this study, we conducted a bidirectional two-sample Mendelian randomization (MR) analysis using Integrative Epidemiology Unit OpenGWAS database for LP (ID: finn-b-L12_LICHENPLANUS) and AD (ID: ebi-a-GCST90012877). The inverse-variance weighted (IVW) method was used as the primary analysis, complemented by MR-Egger, weighted median, simple mode, weighted mode, and sensitivity analyses to assess the robustness of the findings. Our analysis revealed a significant correlation between genetically predicted AD and an increased susceptibility to LP (P = .0001, odds ratio = 1.4326, 95% confidence interval = 1.1934-1.7196, IVW), providing genetic evidence supporting the oral-brain axis hypothesis. However, we did not detect any causal effect of genetic liability for LP on AD (P = .3749, odds ratio = 1.0147, 95% confidence interval = 0.9825-1.0476, IVW). This bidirectional MR study provides genetic evidence supporting a potential association between AD liability and increased susceptibility to LP, while no evidence was observed for an effect of LP on AD. These findings highlight the importance of further investigating immune-mediated mechanisms, including neuroinflammation and systemic immune dysregulation, that may connect neurodegenerative disorders with oral inflammatory diseases. Future studies are warranted to validate these findings and explore potential therapeutic implications.
A Body Shape Index (ABSI) is a composite metric designed to more accurately assess an individual's body size and associated health risks. This study aimed to explore the potential relationship between ABSI and constipation. A total of 11,336 participants from the National Health and Nutrition Examination Survey 2005 to 2010 were included. Multivariable logistic regression models were used to evaluate the association between ABSI and constipation after adjustment for potential confounders. Restricted cubic spline analysis was performed to explore potential nonlinear associations. Subgroup and interaction analyses were conducted to assess whether the association differed across demographic and clinical characteristics. The multivariate logistic regression analysis, fully adjusted for confounders, indicated that an increase in ABSI was associated with a decrease in the incidence of constipation when ABSI was below 0.082 (OR = 5.88, 95% CI: 2.17-9.59, P < .01). Subgroup analysis and interaction tests revealed a significant positive association between ABSI and constipation, particularly in males, individuals with a college education or higher, alcohol users, as well as those with hypertension and diabetes. This study identified a relationship between ABSI and the incidence of constipation, suggesting that a reduction in ABSI, within specific limits, is linked to a decreased risk of constipation.
Elevated serum uric acid is strongly associated with metabolic abnormalities and an increased risk of cardiovascular diseases. Endothelial dysfunction is considered a critical link in metabolic abnormalities. The Endothelial Activation and Stress Index (EASIX), a composite laboratory-based index, has not been systematically examined for its association with serum uric acid levels and endothelial function. This study utilized data from the 2007-2018 National Health and Nutrition Examination Survey (NHANES) with a cross-sectional design to assess the relationship between the EASIX index and serum uric acid levels. Multivariable linear regression analysis was conducted to evaluate their independent association, while restricted cubic splines (RCS) and piecewise regression models were employed to explore nonlinear dose-response trends. Subgroup and sensitivity analyses were performed to validate the robustness of the results. This study included 7602 participants, comprising those with normal and elevated serum uric acid levels. Regression analysis revealed a significant positive correlation between the EASIX index and serum uric acid levels after full adjustment for covariates (β = 0.26, 95% CI: 0.06-0.46). Quartile trend analysis demonstrated that serum uric acid levels increased with rising EASIX. RCS analysis revealed a nonlinear relationship, with serum uric acid levels plateauing at an EASIX value of approximately 1.31, suggesting a "threshold saturation" effect. Subgroup analyses confirmed consistent results across different demographic characteristics and disease statuses, and sensitivity analyses further validated the robustness of the findings. Among US adults, EASIX was positively and nonlinearly associated with serum uric acid levels. Exploratory analysis further suggested that higher EASIX quartiles were associated with increased odds of hyperuricemia. These findings indicate that EASIX may reflect systemic endothelial stress and metabolic burden related to uric acid variation. Further prospective and externally validated studies are needed to determine its clinical utility.
Thyroid cancer disproportionately affects women during their reproductive years, yet global trends, socioeconomic gradients, and health inequalities in this age group remain incompletely characterized. Using Global Burden of Disease Study 2021 estimates, we quantified incidence, prevalence, deaths, and disability-adjusted life years (DALYs) due to thyroid cancer among women aged 15 to 49 years in 204 countries and territories from 1990 to 2021. Temporal patterns were evaluated using estimated annual percentage change (EAPC) and joinpoint regression. Age-period-cohort models, decomposition analysis, Socio-demographic Index (SDI) analyses, slope and concentration indices of inequality, and Bayesian age-period-cohort projections to 2040 were also performed. From 1990 to 2021, the global age-standardized incidence rate increased from 2.18 to 3.37 per 100,000 (EAPC, 1.47%; 95% confidence interval [CI], 1.35-1.59%), and the age-standardized prevalence rate increased from 19.47 to 30.46 per 1,00,000 (EAPC, 1.51%; 95% CI, 1.39-1.64%). The age-standardized mortality rate declined from 0.18 to 0.16 per 1,00,000 (EAPC, -0.35%; 95% CI, -0.38% to -0.31%). The DALY rate was similar at the 2 endpoints (10.31 and 10.38 per 1,00,000), although the overall log-linear trend was slightly negative (EAPC, -0.05%; 95% CI, -0.08% to -0.02%). In 2021, high-SDI settings had the highest incidence and prevalence rates, whereas low- and low-middle-SDI settings carried the highest mortality and DALY rates. Incidence and prevalence were positively associated with SDI, while mortality and DALY rates were negatively associated. Epidemiologic change accounted for 46.35% and 47.03% of the global increases in incident and prevalent cases, respectively, whereas population growth was the principal contributor to increases in DALYs and deaths. By 2040, projected counts rose to 1,16,285 incident cases, 10,68,218 prevalent cases, 3,09,140 DALYs, and 4265 deaths, while model-based rate trajectories declined within the projection period. Among women aged 15 to 49 years, the global thyroid cancer burden is characterized by rising diagnosis and survivorship, comparatively favorable mortality trends, and persistent socioeconomic inequality in fatal and disabling outcomes. High-resource settings require strategies that limit unnecessary detection and overtreatment, whereas lower-resource settings need strengthened diagnostic, surgical, and long-term care pathways.
Neonatal hyperbilirubinemia is common in early neonatal life, and delayed recognition of high-risk infants may result in bilirubin-induced neurological injury. Prediction models based on routinely available maternal, perinatal, neonatal, and standardized laboratory variables may support early risk stratification as an adjunct to bilirubin measurement and clinical assessment. This single-center retrospective cohort included 986 neonates admitted between January 1, 2016, and March 1, 2026. The hemolytic-disease variable was excluded before preprocessing and model fitting. Admissions from 2016 through 2023 formed the development cohort (n = 776), and those from 2024 through 2026 formed a held-out temporal validation cohort (n = 210). Stability was assessed using repeated stratified 5-fold cross-validation repeated 5 times. The primary outcome was peak total bilirubin of at least 230 µmol/L during hospitalization. Only predictors documented by the predefined early-admission prediction time were used. Tabular prior-data fitted network (TabPFN) was compared with 5 conventional machine learning models. Performance included discrimination, calibration, Brier score, decision-curve analysis, bootstrap confidence intervals (CIs), and grouped permutation importance. The development and temporal validation cohorts included 468 and 54 events, respectively. Across 25 held-out development folds, TabPFN achieved a mean area under the receiver operating characteristic curve of 0.997 (standard deviation [SD], 0.002), mean area under the precision-recall curve of 0.998 (SD, 0.001), and mean Brier score of 0.023 (SD, 0.009). In temporal validation, TabPFN achieved an area under the receiver operating characteristic curve of 0.999 (95% CI, 0.997-1.000), area under the precision-recall curve of 0.997 (95% CI, 0.991-1.000), and Brier score of 0.013. At the development-derived threshold of 0.538, sensitivity was 1.000, specificity 0.981, positive predictive value 0.947, negative predictive value 1.000, and F1 score 0.973. Random forest had marginally higher temporal discrimination, whereas TabPFN had the lowest Brier score. Leading predictors were maternal disease count, abortion or preterm history, postnatal abnormality, and birth-weight category. After exclusion of the hemolytic-disease variable, TabPFN showed stable repeated-cross-validation performance and strong temporal discrimination, calibration, and clinical net benefit. These single-center findings support TabPFN as a candidate decision-support approach requiring independent multicenter validation and prospective benchmarking against standard-of-care bilirubin risk assessment.
