Search Results (18,149)

Background/Objectives: As part of China’s efforts to build a high-quality and efficient integrated healthcare delivery system, tightly knit urban medical groups (TKUMGs) have emerged as a key model for promoting inter-institutional collaboration. While existing studies have focused on organizational outcomes, limited empirical evidence is available regarding the personal benefits experienced by healthcare professionals within TKUMGs. Methods: This study evaluated 2200 healthcare professionals’ perceived benefits from TKUMG participation in six pilot medical groups across two Chinese cities to identify factors associated with variations in career development outcomes. Results: Three distinct latent classes were identified: (1) A Limited Growth Group (32.4%), with minimal improvement across all dimensions; (2) a Skill Recognition Group (35.6%), with improvements in recognition and expertise utilization but limited gains in compensation and promotion; and (3) a Comprehensive Growth Group (32.0%), with comprehensive improvements in all six areas. Higher levels of participation and more positive attitudes toward TKUMG construction were significantly associated with inclusion in the more advanced development groups. Other significant factors included age, educational attainment, institutional role (leading vs. member), and departmental affiliation. TKUMG construction has generated heterogeneous benefits for healthcare professionals. Active engagement and institutional environments play critical roles in shaping individual development trajectories. Conclusions: Despite limitations related to this study’s cross-sectional design and self-reported data, these findings offer valuable insights for policymakers aiming to design incentive mechanisms, optimize human resource allocation, and enhance the sustainability of integrated healthcare models in urban China. Full article

Background：In the bovine mammary gland, de novo fatty acid synthesis is a critical process for milk fat production, in which acetyl-CoA synthetase 2 (ACSS2) serves as a key enzyme by converting acetate into acetyl-CoA. This metabolic pathway is intricately regulated by non-coding RNAs, particularly through the competitive endogenous RNA (ceRNA) mechanism.Purpose: To elucidate the regulatory role and molecular mechanism of the circRNA-02213/miR-328/ACSS2 axis in the lipid metabolism of bovine mammary epithelial cells (BMECs). Methods: Bioinformatic prediction and dual-luciferase reporter assays were employed to verify the targeting interactions among circRNA-02213, miR-328, and ACSS2. In BMECs, qRT-PCR, Western blot, triglyceride/cholesterol quantification, Oil Red O staining, and cell proliferation assays were used to evaluate the effects of this axis on key lipid-metabolic indices and cellular phenotypes. Results: circRNA-02213 functioned as a molecular “sponge” that sequestered miR-328, thereby upregulating ACSS2 expression. Functionally, circRNA-02213 overexpression markedly promoted triglyceride and cholesterol synthesis, lipid droplet accumulation, and BMEC proliferation; whereas miR-328 exerted significant inhibitory effects on these lipid-metabolic processes and cell proliferation. Conclusion: This study demonstrates that circRNA-02213 acts as a ceRNA to relieve miR-328-mediated repression of ACSS2, constituting a critical network that regulates milk fat synthesis and metabolism. The circRNA-02213/miR-328/ACSS2 axis represents a potential molecular target for improving milk lipid quality in ruminants. Full article

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that substantially impairs health-related quality of life (HRQoL). Comorbid mental health conditions, particularly depression and anxiety, may further exacerbate this burden, yet evidence from large, population-based studies remains limited. Therefore, this study examined the association between comorbid depression and anxiety and HRQoL among adults with RA using nationally representative data from the United States. Methods: Data were drawn from the 2017–2022 Medical Expenditure Panel Survey. Adults aged ≥18 years with self-reported RA were included. HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12) physical (PCS) and mental (MCS) component summary scores. Multiple linear regression models were used to evaluate associations between depression, anxiety, and HRQoL, adjusting for sociodemographic, behavioral, and health-related covariates. Results: Comorbid depression and anxiety were significantly associated with lower HRQoL scores compared with RA alone. Participants with both conditions exhibited the poorest PCS and MCS scores, indicating a disease burden. Lower income, unemployment, and limited physical activity were also linked to poorer HRQoL, whereas better self-rated health and physical activity were positive predictors. Conclusions: Depression and anxiety independently and jointly contribute to poorer HRQoL among adults with RA, even after controlling for key confounders. These findings highlight the importance of integrated care models that address both psychological and physical health, alongside interventions promoting physical activity to enhance overall well-being. Full article

Transcranial direct current stimulation (tDCS) is being explored as an adjunct for diabetes-related symptoms grounded in diabetes-associated alterations in brain networks. We reviewed clinical trials of tDCS conducted in people with diabetes and summarized mechanistic findings relevant to metabolic control. Two reviewers searched PubMed/MEDLINE, Cochrane Library, Google Scholar, Scopus, and ResearchGate for studies published from 1 January 2008 to 31 August 2025. Forty-one records were identified; after screening and full-text assessment, 11 studies met the inclusion criteria. Across predominantly middle-aged adults with long-standing type 2 diabetes, protocols were low-intensity and well-tolerated. The most consistent clinical benefit was analgesia with primary motor cortex stimulation, with randomized comparisons favoring active tDCS over sham. Dorsolateral prefrontal stimulation paired with working-memory training improved cognition and reduced anxiety, while combined motor–prefrontal courses yielded gains in sleep quality and health-related quality of life; a small, randomized study in proliferative diabetic retinopathy reported short-term visual improvements after occipital stimulation. Safety was favorable, and no serious adverse events were reported. Objective metabolic endpoints in diabetic cohorts were scarce; early evidence for insulin-independent improvements in glucose handling and neurometabolic shifts derives mainly from non-diabetic or mixed samples and remains hypothesis-generating. Overall, tDCS appears to be a promising, well-tolerated adjunct for diabetes-related complications. Larger, rigorously sham-controlled trials that align targets with clinical phenotypes and include standardized metabolic outcomes are needed. Full article

Tomato is one of the most important vegetable crops worldwide, with about one quarter of the yearly production of fresh fruits dispatched to the processing industry. Paste, canned tomatoes, and sauces represent the three leading categories. Background/Objectives: The metabolic profile of processed tomatoes can be modified by several production steps, affecting the nutritional and sensory profile of the finished product. Despite this, a detailed metabolomic profiling of transformed tomatoes is currently missing. The goal of this investigation is to provide qualitative metabolomic profiling of tomato purees with two main advances: first, the use of a more sustainable analytical approach based on a single extraction protocol and one-shot analysis for multiple information retrieval on different compound classes; second, the achievement of a curated database consolidated over a wide collection of commercial samples representative of the Italian market. Methods: A non-selective ethanol extraction was applied to collect the main polar metabolites followed by untargeted high-resolution MS/MS analysis and software-based compound identification. Results: A list of more than five hundred features was collected and assigned to specific compounds or compound groups with different confidence levels. The results confirmed the persistence in processed tomatoes of the main primary and secondary metabolites already reported in fresh fruits, such as essential amino acids, sugar, organic acids, vitamins, fatty acyls, and phytohormones. Moreover, new insight on specific components never traced before in similar finished samples is provided. Bioactive compounds were detected in all samples, such as oligopeptides with ACE-inhibitor activity, ɣ-aminobutyric acid, alkaloids, and polyphenols (flavonoids, coumarins, and cinnamic acids). Many of these compounds have antioxidant activities, proving the relevance of transformed tomatoes as a source of health-promoting compounds for the human diet. Conclusions: A detailed metabolic profile of commercial tomato puree samples was obtained, and a curated database of metabolites was compiled, which can be useful for multiple purposes, for example, authentication, quality, or nutritional assessments. Full article

Background/Objectives: We aimed to evaluate the evidence regarding the effect of greater omentum flap transposition (OFT) on low anterior resection syndrome (LARS) in patients who undergo rectal resections. Methods: This study was conducted according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment was based on the ROBINS-I tool. Analyses were performed by utilizing the Random Effects (RE) model. Results: Overall, three retrospective studies and 100 patients were included in this meta-analysis. Pooled analysis confirmed that OFT did not improve postoperative LARS scores in 3 months (MD: −1.54; 95%CI: −7.30, 4.22; p = 0.6), 6 (MD: 3.75; 95%CI: −20.16, 27.66; p = 0.76) and 9 (MD: −4.86; 95%CI: −28.38, 18.66; p = 0.69) months postoperatively. Similarly, OFT did not impact the overall postoperative morbidity rate (p = 0.1), the pooled operation duration (p = 0.21), and the hospitalization duration (p = 0.21). Conclusions: Our preliminary results suggest that OFT does not influence postoperative LARS, morbidity, and perioperative efficiency. Given the limited available evidence and several study limitations, further randomized controlled trials are required. Full article

Background: Oral pemphigus is a rare autoimmune blistering disorder predominantly affecting the mucous membranes, particularly in older adults. Despite therapeutic advances, the chronic, painful, and recurrent nature of oral pemphigus vulgaris substantially impairs patients’ quality of life (QoL). Patient-reported outcomes (PROs) offer valuable insights into the subjective burden of the disease; however, data on PROs in older adults with oral pemphigus are scarce. Objective: To assess QoL in older adults diagnosed with oral pemphigus using validated PRO measures and to identify key clinical factors associated with QoL deterioration. Methods: A cross-sectional pilot study was conducted involving 10 participants aged 60 years or older with confirmed oral pemphigus vulgaris. Participants completed the Oral Pemphigus–Specific Quality of Life Questionnaire (OP-QoLQ) and the Dermatology Life Quality Index (DLQI). Clinical severity was evaluated using the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). Statistical analyses explored correlations between disease severity, treatment regimens, and QoL outcomes. Results: Most participants reported moderate to severe QoL impairment, with eating difficulties and emotional distress being the most frequently mentioned issues. Higher ABSISs and longer disease duration were significantly correlated with poorer OP-QoLQ and DLQI outcomes (Spearman’s ρ up to 0.80; p ≤ 0.021). Systemic corticosteroid therapy was more frequently reported among those with advanced disease, although treatment-related adverse effects may contribute to reduced QoL. Conclusion: Oral pemphigus substantially compromises QoL in older adults, with both disease- and treatment-related factors playing important roles. These findings support the integration of PROs into the multidisciplinary management of older adults with oral pemphigus vulgaris. Full article

Background/Objective: Cancer significantly impairs physical function and quality of life. Exercise has gained recognition as a therapeutic strategy; however, its long-term efficacy in terms of multidimensional outcomes in patients with cancer remains underexplored. This review aimed to evaluate and summarize the available evidence regarding the effects of multicomponent exercise programs on pain and psychosocial outcomes in individuals with cancer. Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42022321183). Comprehensive searches were performed in MEDLINE, OVID, LILACS, Scopus, PEDro, OTseeker, The Cochrane Library, EBSCO, and Google Scholar, without date restrictions. Search terms included “exercise” and “cancer.” Only randomized controlled trials (RCTs) were included. Methodological quality and risk of bias were assessed using the PEDro scale. Results: Sixteen randomized controlled trials met the inclusion criteria. Multicomponent exercise programs combining aerobic, resistance, and flexibility training significantly improved muscle strength, balance, and quality of life. Several studies reported meaningful reductions in pain intensity and interference, whereas others found no significant changes. Overall, exercise interventions demonstrated superior effects compared with usual care or educational controls across physical and psychosocial outcomes. Conclusions: Multicomponent exercise is a safe and feasible intervention for adults with cancer, including those with advanced disease or complex clinical profiles. Evidence supports consistent benefits in physical function and quality of life, with partially consistent yet favorable effects on pain. Programs integrating multiple exercise modalities appear most effective and should be considered as part of comprehensive oncological care to enhance therapeutic outcomes and long-term well-being. Full article

Intensifying urbanization in Central Europe is increasingly pushing flood retention areas onto private farmland, yet the agronomic and socio-economic trade-offs remain poorly quantified. We conducted a narrative review of published field data and post-event assessments from 2014–2023 along the transboundary Sava River. Information was collected from research articles, case studies, and environmental monitoring reports, and synthesized in relation to national and EU regulatory thresholds to evaluate how floods altered soil functions and agricultural viability. Water erosion during floods stripped up to 30 cm of topsoil in torrential reaches, while stagnant inundation deposited 5–50 cm of sediments enriched with potentially toxic elements, occasionally causing food crops to exceed EU contaminant limits due to uptake from the soil. Flood sediments also introduced persistent organic pollutants: 13 modern pesticides were detected post-flood in soils, with several exceeding sediment quality guidelines. Waterlogging reduced maize, pumpkin, and forage yields by half where soil remained submerged for more than three days, with farm income falling by approximately 50% in the most affected areas. These impacts contrast with limited public awareness of long-term soil degradation, raising questions about the appropriateness of placing additional dry retention reservoirs—an example of nature-based solutions—on agricultural land. We argue that equitable flood-risk governance in the Sava River Basin requires: (i) a trans-boundary soil quality monitoring network linking agronomic, hydrological, and contaminant datasets; (ii) compensation schemes for agricultural landowners that account for both immediate crop losses and delayed remediation costs; and (iii) integration of strict farmland protection clauses into spatial planning, favoring compact, greener cities over lateral river expansion. Such measures would balance societal flood-safety gains with the long-term productivity and food security functions of agricultural land. Full article

Treatment of aircraft with insecticide in a procedure referred to as ‘disinsection’ is recommended to prevent the conveyance of arthropod vectors internationally and to mitigate the globalization of vector-borne infectious diseases. However, the full spectrum of human-based outcomes related to disinsection of conveyances has not been recently synthesized. A systematic review was conducted to evaluate the human safety and toxicity of insecticides used during the process of disinsecting international aircraft, marine vessels, rail, and ground transportation of mosquitoes. The systematic review was conducted according to the PRISMA guidelines and was registered in PROSPERO (CRD42024543998). The certainty of the evidence was rated, and key primary outcomes, including human health effects of conveyance disinsection, were synthesized. A total of 21 studies that described human health effects of conveyance disinsection and reported outcomes of safety, toxicity, and tolerability were included, and were of generally limited quality and high risk of bias, with low to very low certainty of estimates of effect. No high-quality studies investigating the safety, toxicity, or tolerability of disinsection were identified. Human health effects, including morbidity, including work days lost, adverse events including hospitalization, objective measures of insecticide toxicity, detectable and elevated urinary metabolites, and subjective reporting of symptoms consistent with acute insecticide poisoning, were reported by the small number of uncontrolled observational studies and public health surveillance reports included. Given the reports of significant morbidity, adverse events, and toxicity putatively attributable to aircraft disinsection, well-designed studies in exposed populations investigating the full range of human health impacts of disinsection on passengers and crew are urgently needed. Full article

Background/Objectives: Long COVID (LC) causes persistent symptoms, including fatigue, musculoskeletal (MSK) pain, and a lower quality of life. It is hypothesised that chronic low-grade inflammation in LC could impact bone, joints, and muscle microcirculation, but evidence is limited. Our aim is to assess health-related quality of life (HRQoL) and circulating inflammation, bone turnover markers (BTM), and vitamin D in LC individuals to explore their potential association with MSK function. Methods: Prospective longitudinal cohort; LC n = 45, well-recovered (WR) n = 40; 12 ± 2 months follow-up. Baseline and follow-up assessments included evaluations of HRQoL and pain-rating questionnaires, and blood analysis of inflammatory and bone turnover markers (BTM). Results: More females were in the LC group. LC reported significantly lower HRQoL compared to WR, with no change over 12 months. LC had higher vitamin D levels at baseline, median 29.46 ng/mL (23.75; 35.06) compared to WR 20.36 ng/mL (15.995; 27.65) (p = 0.0021). Both groups experienced significant increases in vitamin D after 12 months: WR median from 21.4 ng/mL (16.34; 27.89) to 29.58 ng/mL (25.33; 41.74), (p =< 0.001) and LC median from 32.695 ng/mL (23.665; 35.1) to 35.89 ng/mL (30.1; 41.2), (p = 0.0023). Pain rating showed LC also experienced more hand pain at baseline median 1 (0; 5), (p = 0.003). There were no differences between groups in BTM or cytokines over time. Conclusions: This feasibility cohort showed that LC is associated with a reduction in HRQoL and joint symptoms; however, no significant changes were observed in the inflammatory markers, indicating the need for ongoing monitoring. Future studies should explore MSK, muscle function via imaging, and ways to enhance musculoskeletal health and well-being. Full article

Background/Objectives: The aging global population has led to a rising prevalence of type 2 diabetes mellitus (T2DM), in which biomedical outcomes alone fail to capture patients’ lived experiences. Patient-Reported Outcome Measures (PROMs) can provide insights into psychological, psychosocial, and quality-of-life (QoL) dimensions, yet their use—particularly among older adults—remains inconsistent. This AI-assisted rapid review aimed to map how PROMs are currently applied in adults with T2DM, with specific attention to studies involving older populations, focusing on their role in assessing well-being, distress, depression, and treatment satisfaction, as well as their implementation in clinical and organizational practice. Methods: A rapid review was conducted using Elicit, an AI tool designed to support systematic evidence synthesis. Studies published between 2015 and 2025 were identified from Semantic Scholar, complemented by manual searches for recent or unindexed papers. Eligibility criteria required inclusion of adults with T2DM and use of validated PROMs in real-world settings. Studies explicitly describing older or elderly subgroups were highlighted separately. After screening 504 records, 167 studies were included. Data extraction covered study design, instruments used, populations, outcomes, and implementation details. Results: The most frequently assessed outcomes were diabetes distress, depression, QoL, treatment satisfaction, and self-efficacy. Common instruments included PAID, DDS, PHQ-9, WHO-5, EQ-5D, SF-36, DTSQ, and GDS. Evidence showed PROMs effectively identified high-risk patients and informed tailored interventions, but integration into routine care remained limited. Barriers included workflow disruption, lack of provider training, heterogeneity of tools, and insufficient cultural validation. Facilitators included brief instruments, digital administration, and linkage with care planning. Conclusions: PROMs are valuable in capturing psychosocial and psychological burdens in adults with T2DM, including but not limited to older populations, but routine implementation is inconsistent. Broader adoption will require digital infrastructure, clinician training, and organizational integration, as well as the development of PROMs that capture experiences with emerging diabetes technologies. Methodologically, this study illustrates the feasibility of AI-assisted rapid reviews to generate timely, evidence-informed syntheses. Full article

Objectives: To identify patient-reported key disease-related challenges of macular and cone–rod dystrophies (MDs/CRDs) in a large consecutive cohort of individuals with molecularly confirmed diagnoses. Methods: Out of the 281 patients contacted, 194 (69.0%; 55.2% female) responded to an anonymized survey exploring the effects of MD/CRD on vocational training, professional careers, social participation, family life, personal well-being, and experience with ophthalmologic care. Results: While vocational training was generally less affected, professional careers were frequently disrupted, with 20.6% of patients aged ≥ 50 retiring early. A majority (54.7%) reported feeling restricted in public life. Financial constraints were noted by 20%. A negative impact on familial life (12.3%) was less frequently reported compared to anxiety (74.2%) and depression (15.8%). Diagnostic delays (≥2 years) were common (34.2%), along with a notable rate of initial misdiagnoses (22.1%). The lack of adequate psychological support was a major complaint in professional care. Conclusions: Compared to a previous study in retinitis pigmentosa, MD/CRD patients reported differing patterns of burden, especially in early retirement and family impact. Our findings underscore the need for ophthalmic and social care providers to accelerate the diagnostic process and enhance access to financial assistance and psychological support as key areas to improve patient care. Full article

As large language models (LLMs) are increasingly used to support learning, there is a growing need for a principled framework to guide the design of LLM-based tools and resources that are pedagogically effective and contextually responsive. This study proposes a framework by examining how prompt engineering can enhance the quality of chatbot responses to support middle school students’ scientific reasoning and argumentation. Drawing on learning theories and established frameworks for scientific argumentation, we employed a design-based research approach to iteratively refine system prompts and evaluate LLM-generated responses across diverse student input scenarios. Our analysis highlights how different prompt configurations affect the relevance and explanatory depth of chatbot feedback. We report findings from the iterative refinement process, along with an analysis of the quality of responses generated by each version of the chatbot. The outcomes indicate how different prompt configurations influence the coherence, relevance, and explanatory processes of LLM responses. The study contributes a set of critical design principles for developing theory-aligned prompts that enable LLM-based chatbots to meaningfully support students in constructing and revising scientific arguments. These principles offer broader implications for designing LLM applications across varied educational domains. Full article

Background: The COVID-19 pandemic disrupted healthcare systems, disproportionately affecting individuals with rare diseases. This study explores the health-related quality of life and financial burden in the post-pandemic context among children with Duchenne Muscular Dystrophy and their families in Greece, providing insights into health system performance. Methods: A multicenter, cross-sectional study was conducted in two neuromuscular clinics in Greece. Fifty families (response rate 67%) completed standardized quality of life instruments (PedsQL™ 4.0 Generic Core Scale; PedsQL™ 3.0 DMD Module) and a socioeconomic questionnaire. Descriptive and correlation analyses assessed associations between functional status, financial strain, and psychosocial indicators. Results: Children with Duchenne Muscular Dystrophy reported moderate-to-severe reductions in physical and emotional well-being, and substantial out-of-pocket expenditures. Families with greater financial strain or wheelchair-dependent children had significantly lower health-related quality of life scores. Insurance coverage was positively associated with emotional and psychosocial functioning. Conclusions: Greek families living with Duchenne Muscular Dystrophy continue to face significant financial and psychosocial challenges in the post-pandemic period. While the cross-sectional design does not allow causal attribute to COVID-19 pandemic, the results underscore the need to strengthen financial protection, coordinated multidisciplinary care, and equitable access to support services for rare disease management. Full article