Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is sig...Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.展开更多
Background:Amid the global rise in adolescent sedentary behavior and psychological distress,extant research has largely focused on variable-level associations,neglecting symptom-level interactions.This study applies n...Background:Amid the global rise in adolescent sedentary behavior and psychological distress,extant research has largely focused on variable-level associations,neglecting symptom-level interactions.This study applies network analysis,aims to delineate the interconnections among sedentary time,social support,social exclusion,and psychological distress in Chinese students,and to identify core and bridge symptoms to inform targeted interventions.Methods:This study employed a cross-sectional design to investigate the complex relationships among sedentary behavior,social support,social exclusion,and psychological distress among Chinese students.The research involved 459 high school and university students,using network analysis and mediation models to examine these relationships.Results:Network analysis revealed that the network had a density of 58.33%and an average edge weight of 0.11.In terms of centrality,stress had the highest expected influence(EI=1.135),acting as the core amplifier in the network.Sedentary behavior demonstrated the highest bridging expected influence,functioning as a critical bridge for cross-community transmission.Conversely,friend support showed the lowest bridging EI with a negative value,indicating its effectiveness in blocking cross-community diffusion and alleviating symptoms.Conclusion:With stress acting as the most influential“core engine”within the symptom network and sedentary behavior serving as the key“bridge”for cross-community transmission,interventions should first target stress to weaken the overall symptom cascade,followed by reducing sedentary behavior or enhancing friend support to disrupt cross-community pathways,thereby achieving a core-bridge dual blockade.展开更多
Interferon-related genes are involved in antiviral responses,inflammation,and immunity,which are closely related to sepsis-associated acute respiratory distress syndrome(ARDS).We analyzed 1972 participants with genoty...Interferon-related genes are involved in antiviral responses,inflammation,and immunity,which are closely related to sepsis-associated acute respiratory distress syndrome(ARDS).We analyzed 1972 participants with genotype data and 681 participants with gene expression data from the Molecular Epidemiology of ARDS(MEARDS),the Molecular Epidemiology of Sepsis in the ICU(MESSI),and the Molecular Diagnosis and Risk Stratification of Sepsis(MARS)cohorts in a three-step study focusing on sepsis-associated ARDS and sepsis-only controls.First,we identified and validated interferon-related genes associated with sepsis-associated ARDS risk using genetically regulated gene expression(GReX).Second,we examined the association of the confirmed gene(interferon regulatory factor 1,IRF1)with ARDS risk and survival and conducted a mediation analysis.Through discovery and validation,we found that the GReX of IRF1 was associated with ARDS risk(odds ratio[OR_(MEARDS)]=0.84,P=0.008;OR_(MESSI)=0.83,P=0.034).Furthermore,individual-level measured IRF1 expression was associated with reduced ARDS risk(OR=0.58,P=8.67×10^(-4)),and improved overall survival in ARDS patients(hazard ratio[HR_(28-day)]=0.49,P=0.009)and sepsis patients(HR_(28-day)=0.76,P=0.008).Mediation analysis revealed that IRF1 may enhance immune function by regulating the major histocompatibility complex,including HLA-F,which mediated more than 70%of protective effects of IRF1 on ARDS.The findings were validated by in vitro biological experiments including time-series infection dynamics,overexpression,knockout,and chromatin immunoprecipitation sequencing.Early prophylactic interventions to activate IRF1 in sepsis patients,thereby regulating HLA-F,may reduce the risk of ARDS and mortality,especially in severely ill patients.展开更多
BACKGROUND:Individualized positive end-expiratory pressure(PEEP)titration is a crucial technique in mechanical ventilation therapy for acute respiratory distress syndrome(ARDS)patients with intra-abdominal hypertensio...BACKGROUND:Individualized positive end-expiratory pressure(PEEP)titration is a crucial technique in mechanical ventilation therapy for acute respiratory distress syndrome(ARDS)patients with intra-abdominal hypertension(IAH).This study aimed to evaluate the eff ectiveness of electrical impedance tomography(EIT)-guided PEEP titration in this population.METHODS:This prospective study enrolled 36 ARDS patients,including 22 patients with IAH and 14 without IAH.All the patients underwent EIT-guided PEEP titration at the intersection point between alveolar overdistension and collapse during a decremental PEEP trial.The changes in pulmonary ventilation distribution,respiratory mechanics and hemodynamics during the titration process were observed.RESULTS:After EIT-guided PEEP titration was performed,the PEEP,peak inspiratory pressure and plateau pressure increased significantly(P<0.05).Furthermore,no significant differences were observed in respiratory system compliance,tidal volume,driving pressure,or the 4*DP+RR index between the two groups(P>0.05).The mechanical power increased in the non-IAH(NIAH)group after PEEP titration(P<0.05).Ventilation in gravity-dependent lung regions significantly increased(P<0.05),and the oxygenation index(PaO2/FiO2)improved signifi cantly(P<0.05)in both groups.However,blood pressure,heart rate,respiratory rate,central venous pressure,and lactate levels did not signifi cantly change.In the IAH group,the PaO2/FiO2 ratio improved less than that in the NIAH group did(P<0.05).CONCLUSION:In our study,individualized PEEP titration guided by EIT improved oxygenation in ARDS patients with concomitant IAH without signifi cantly aff ecting hemodynamics.The presence of IAH may limit the improvement of oxygenation during EIT-guided PEEP titration.展开更多
Acute respiratory distress syndrome(ARDS)is a life-threatening condition that is characterized by high mortality rates and limited therapeutic options.Notably,Zhang et al demonstrated that CD146+mesenchymal stromal ce...Acute respiratory distress syndrome(ARDS)is a life-threatening condition that is characterized by high mortality rates and limited therapeutic options.Notably,Zhang et al demonstrated that CD146+mesenchymal stromal cells(MSCs)exhibited greater therapeutic efficacy than CD146-MSCs.These cells enhance epithelial repair through nuclear factor kappa B/cyclooxygenase-2-associated paracrine signaling and secretion of pro-angiogenic factors.We concur that MSCs hold significant promise for ARDS treatment;however,the heterogeneity of cell products is a translational barrier.Phenotype-aware strategies,such as CD146 enrichment,standardized potency assays,and extracellular vesicle profiling,are essential for improving the consistency of these studies.Further-more,advanced preclinical models,such as lung-on-a-chip systems,may provide more predictive insights into the therapeutic mechanisms.This article underscores the importance of CD146+MSCs in ARDS,emphasizes the need for precision in defining cell products,and discusses how integrating subset selection into translational pipelines could enhance the clinical impact of MSC-based therapies.展开更多
Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU...Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU)patients is approximately 10%,with mortality rates ranging from 35%to 45%and exceeding 50%in severe cases.[1]Identifying and controlling risk factors for ARDS is critical for early prevention.Smoking remains a significant global public health issue,affecting one-third of adults and 40%of children through exposure to secondhand smoke.[2]In an animal study,cigarette smoke impaired lung endothelial barrier function through oxidative stress and exacerbated lipopolysaccharide-induced increases in vascular permeability in vivo.This finding is consistent with the pathological changes observed in ARDS.[3]Although many observational studies have suggested a potential link between smoking and ARDS,the causal relationship remains unclear.This study uses Mendelian randomization(MR)to explore whether smoking behavior causally influences ARDS and investigates the mechanisms by which smoking may contribute to ARDS development through transcriptomic analysis of the Gene Expression Omnibus(GEO)database.展开更多
Purpose:This study aimed to determine the nurses’profile characteristics that are associated with moral distress among nurses in selected government hospitals in Shangdong,China.Methods:This is a descriptive-correlat...Purpose:This study aimed to determine the nurses’profile characteristics that are associated with moral distress among nurses in selected government hospitals in Shangdong,China.Methods:This is a descriptive-correlational study.A total of 185 clinical registered nurses who met the eligibility criteria from different departments in two tertiary governmental hospitals in Jinan city were purposively selected to participate in this study.The instruments included the general demographic characteristics and Chinese version of Moral Distress Scale-Revised(MDS-R).Correlation technique,specifically Spearman’s rho,was utilized to determine the significant correlation between the selected nurse’s characteristics and moral distress.Ethical considerations were given by the Far Eastern University ethics review committee(FEU-ERC Code:2020-2021-079).Results:The number of patients nurses handled per shift(rs=0.650,p=0.032)and the type of patients that nurses handled(rs=0.718,p=0.020)are the nurses’profile factors that are significantly correlated with nurses’moral distress(p-value<0.05).As there is an increase in the number of patients handled every shift and the patients are becoming unstable,requiring complex care,the frequency and intensity of moral distress increase as well.Conclusion:The nurses’moral distress was registered at a low level in this study.Characteristics related to patients,such as the number and type assigned to nurses,are correlated to moral distress.The main source of the high frequency and intensity of moral distress among nurses is“futile care”and“false hope”.Educational learning program is recommended to manage and alleviate the moral distress of nurses.展开更多
Objectives This study aimed to develop and preliminarily assess the quality of a Mindfulness Breast Care(MBC)App to reduce body image distress and stigma among breast cancer survivors(BCSs).Methods The development pro...Objectives This study aimed to develop and preliminarily assess the quality of a Mindfulness Breast Care(MBC)App to reduce body image distress and stigma among breast cancer survivors(BCSs).Methods The development process of the MBC App involved:1)establishing a research group;2)determining of the content of the MBC App based on Mindfulness-Based Cognitive Therapy and 3)technical exploitation and maintenance.A mixed-methods study was conducted.We selected ten BCSs by a convenience sampling method.After using the APP for three months,five assessed the quality using the Mobile App Rating Scale:User Version(uMARS)and another five were interviewed for process evaluation.Results The MBC App was developed with three modules:1)Library to provide health education information on body image,stigma,mindfulness,recovery and etc;2)Mindfulness Yoga to offer 12 Hatha yoga videos for daily practice;and 3)Mindfulness Practices to have 12 sessions of mindfulness videoconferences.Based on the uMARS data,the MBC App received high ratings for functionality(4.10±0.34),aesthetics(3.93±0.55),information quality(4.10±0.72),and perceived impact(4.03±0.96),as well as moderate ratings for engagement(3.72±0.94)and subjective quality(3.87±0.77).Participants indicated that the MBC App provided reliable knowledge,information,and emotional support.Recommendations from participants included categorizing knowledge in the Library Module,recording videoconferences of mindfulness practice,and adding discussion sessions in the videoconference.Afterward,we optimized the MBC App to enhance the user experience accordingly.Conclusions The MBC App offers online mindfulness interventions specifically for BCSs in China.The preliminary quality assessment indicates that the MBC App may be a promising tool for delivering mindfulness interventions to BCSs.展开更多
Variation in the vocal behavior of nonhuman vertebrates includes graded transitions and more dramatic changes.Wapiti males produce a reproductive bugle that has a fundamental frequency that surpasses 2,000 Hz with evi...Variation in the vocal behavior of nonhuman vertebrates includes graded transitions and more dramatic changes.Wapiti males produce a reproductive bugle that has a fundamental frequency that surpasses 2,000 Hz with evidence of biphonation and other nonlinear phenomena.Here,we analyze the acoustic structure of captive wapiti vocalizations to compare the male bugle with 3 categories of distress vocalizations:neonate distress(capture)calls,calf isolation calls,and adult female isolation calls.These 4 high-arousal call categories serve a common general function in recruiting conspecifics but occur in different behavioral contexts(capture,isolation,reproduction).Our goal was to distinguish characteristics that vary in graded steps that may correspond to an animal’s age or size from characteristics that are unique to the bugle.Characteristics of the high and loud fundamental(G0)varied in an age/size-graded manner with a decrease in minimum G0,an increase in the maximum and range of G0,with no evidence of sex differences.The nonlinear phenomena of deterministic chaos,biphonation,and frequency jumps were present in all 4 call categories and became more common from the distress vocalizations of neonates to calves to adult females to the male bugle.Two temporal characteristics sharply distinguished the bugle from the 3 categories of distress vocalizations:these included a prolonged call duration and a maximum G0 that occurred much later in the call for the bugle than for distress vocalizations.Our results suggest that distress vocalizations of different age groups and the reproductive bugle of wapiti share a high G0,with age/size-graded changes in G0 and nonlinear phenomena,but differ sharply in temporal characteristics.展开更多
BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifi...BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifies ARDS severity based on the partial pressure of arterial oxygen/fractional inspired oxygen fraction ratio.Despite various treatment strategies,ARDS remains a significant public health concern with high mortality rates.AIM To evaluate the implications of driving pressure(DP)in ARDS management and its potential as a protective lung strategy.METHODS We conducted a systematic review using databases including EbscoHost,MEDLINE,CINAHL,PubMed,and Google Scholar.The search was limited to articles published between January 2015 and September 2024.Twenty-three peer-reviewed articles were selected based on inclusion criteria focusing on adult ARDS patients undergoing mechanical ventilation and DP strategies.The literature review was conducted and reported according to PRISMA 2020 guidelines.RESULTS DP,the difference between plateau pressure and positive end-expiratory pressure,is crucial in ARDS management.Studies indicate that lower DP levels are significantly associated with improved survival rates in ARDS patients.DP is a better predictor of mortality than tidal volume or positive end-expiratory pressure alone.Adjusting DP by optimizing lung compliance and minimizing overdistension and collapse can reduce ventilator-induced lung injury.CONCLUSION DP is a valuable parameter in ARDS management,offering a more precise measure of lung stress and strain than traditional metrics.Implementing DP as a threshold for safety can enhance protective ventilation strategies,po-tentially reducing mortality in ARDS patients.Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.展开更多
BACKGROUND Frailty has become a significant public health issue.The recent increase in the number of frail older adults has led to increased attention being paid to psycho-logical care services in communities.The soci...BACKGROUND Frailty has become a significant public health issue.The recent increase in the number of frail older adults has led to increased attention being paid to psycho-logical care services in communities.The social isolation of pre-frail older adults can impact their psychological distress.AIM To explore the mediating effect of health literacy between social isolation and psychological distress among communitydwelling older adults with pre-frailty.METHODS This descriptive cross-sectional study was conducted with 254 pre-frail older individuals aged 60 years and over.Social isolation,health literacy,and psycholo-gical distress were comprehensively measured using the Lubben Social Network Scale-6,12-item Short-Form Health Literacy Questionnaire,and the Kessler Psy-chological Distress Scale-10.Data were evaluated using the SPSS 27.0 package program and the PROCESS macro tool.Descriptive statistical analyses,correlation analyses,and bootstrap mediation tests were used to assess associations between the variables.RESULTS The results showed that social isolation had an effect on health literacy among pre-frail older adults(β=0.240,P<0.001),social isolation impact on psycho-logical distress pre-frail older adults(β=-0.415,P<0.001);health literacy was identified effect on psychological distress among pre-frail older persons(β=-0.307,P<0.001).Health literacy partially mediated the relationship between social isolation and psychological distress among community-dwelling older adults with pre-frailty,with a mediation effect of-0.074,accounting for 17.83%of the total effect.展开更多
Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major...Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.展开更多
Background:Acute respiratory distress syndrome(ARDS)is the major therapeutic dilemma associated with significant inflammation and severe pulmonary dysfunction.Liriodendrin is a bioactive compound extract from traditio...Background:Acute respiratory distress syndrome(ARDS)is the major therapeutic dilemma associated with significant inflammation and severe pulmonary dysfunction.Liriodendrin is a bioactive compound extract from traditional Chinesemedicine,historically utilized formodulating inflammatory responses and alleviating symptoms in multiple diseasemodels.Methods:At present,BALB/c mice to explore the effects of liriodendrin on lipopolysaccharide(LPS)-induced ARDS.Before LPS was administered,the mice were treated with either liriodendrin or dexamethasone.Leukocyte infiltration,lung edema,and alveolar-capillary barrier integrity were evaluated in the bronchoalveolar lavage fluid(BALF)and pulmonary parenchyma.The expression of adhesion molecules and proinflammatory cytokines in BALF was evaluated by enzyme-linked immunosorbent assay.Western blotting assay facilitated the analysis of the expression or phosphorylation of inducible nitric oxide synthase(iNOS),cyclooxygenase-2(COX-2),NOD-like receptor family pyrin domain-containing 3(NLRP3),apoptosis-associated speck-like protein containing a CARD(ASC),cleaved caspase-1(CL-csapase-1),nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),inhibitor of kappa B(IκB),mitogen-activated protein kinase(MAPK),and protein kinase B(Akt)in the lungs.In addition,the anti-inflammatory effects of liriodendrin were evaluated in LPS-stimulated RAW264.7 macrophages.Before LPS was administered,the RAW264.7 macrophages were treated with either liriodendrin or dexamethasone.Nitric Oxide(NO)production was measured using the Griess reaction assay,while ELISA assessed IL-1β,IL-6,and TNF-αlevels.Western blot analysis evaluated NF-κB phosphorylation and the expression of NLRP3,ASC,and CLcaspase-1.Results:These outcomes revealed that liriodendrin intervention markedly ameliorated the pathological features of LPS-induced ARDS,including leukocyte infiltration,lung edema,and alveolar-capillary barrier disruption.Liriodendrin also reduced the LPS-induced secretion of intercellular adhesion molecule-1(ICAM-1)and vascular cell adhesionmolecule-1(VCAM-1),expression of iNOS and COX2,and production of proinflammatory cytokines.Finally,we further discovered that the concentration trend of liriodendron amelioration ofARDSwas similar to those ofNLRP3 formation,NF-κB pathway activation,and p38 MAPK,c-Jun N-terminal kinase(JNK),and Akt phosphorylation but not to that of extracellular signal-regulated kinase(ERK)phosphorylation.Liriodendrin inhibited LPS-induced inflammatory responses in RAW264.7 macrophages.It markedly reduced NO production,propro-inflammatorytokines,NF-κB phosphorylation,and NLRP3 formation.Conclusions:In summary,liriodendrin effectively ameliorated the pathological features of LPS-induced ARDS inmice,demonstrating significant anti-inflammatory properties attributed to NLRP3 formation through NF-κB pathway activation by p38MAPK,JNK,and Akt phosphorylation.In LPS-treated RAW264.7 macrophages,liriodendrin reduced NO production,pro-inflammatory cytokines,and NLRP3 formation,suggesting its potential as an agent for ARDS and relative inflammation.展开更多
Thyroid cancer is a common endocrine malignancy with a rising incidence.Pa-tients often suffer from mental pain due to concerns about recurrence,treatment-related side-effect,and body image changes.Demographic factors...Thyroid cancer is a common endocrine malignancy with a rising incidence.Pa-tients often suffer from mental pain due to concerns about recurrence,treatment-related side-effect,and body image changes.Demographic factors like age,gender,physiological factors such as somatic symptoms and disease stage,co-gnitive-regulatory factors including negative and positive thinking,and social factors like work,economy,education level,and social support all influence their mental state.Existing interventions,including nursing,psychological,and tra-ditional Chinese medicine-based methods,have some benefits but face limitations like short-term effectiveness and lack of standardization.Future research should focus on creating better-defined,long-term,and widely applicable intervention programs and explore positive psychology-based approaches to improve patients'mental well-being and quality of life.展开更多
Objectives:The study aimed to examine the severity of moral distress and intention to leave among ICU nurses in the United Arab Emirates(UAE),and explore the influencing factors of intention to leave.Methods:The study...Objectives:The study aimed to examine the severity of moral distress and intention to leave among ICU nurses in the United Arab Emirates(UAE),and explore the influencing factors of intention to leave.Methods:The study utilized a cross-sectional research design.A convenience non-probability sample of 341 nurses from various private and government hospitals across different emirates in the UAE participated in June 2022.Data were collected using a self-administered questionnaire comprising demographic information,the Moral Distress Scale–Revised.Multivariable logistic regression was used to identify factors associated with intention to leave.Results:The study found that a large majority(71.9%)of ICU nurses experienced severe moral distress,and more than 35%had intention to leave.Futile end-of-life interventions emerged as the most distress-provoking aspect of practice[16.0(0,16.0)].Multivariable analysis revealed nurses experiencing severe moral distress had 3.73 times the odds of intending to leave their job compared with those experiencing mild distress(95%CI:1.81,7.69;P<0.001)and being aged 31–40 years(OR=2.02;95%CI:1.23,3.33;P=0.005)was independently associated with a higher intention to leave.Conclusions:Severe moral distress was prevalent among ICU nurses in the UAE and strongly associated with intention to leave,and also those aged 31–40 years.Promoting ethical support,shared decision-making,and nurse empowerment is vital to improving retention and care quality.展开更多
Background:Communication barriers are a critical yet underexplored determinant of psychological well-being in oncology care,particularly among rural Chinese patients treated in urban hospitals.This study examined how ...Background:Communication barriers are a critical yet underexplored determinant of psychological well-being in oncology care,particularly among rural Chinese patients treated in urban hospitals.This study examined how Mandarin proficiency influences emotional distress and identified implications for mental health promotion.Methods:A sequential mixed-methods design was adopted.Quantitative data were collected from 180 rural cancer patients using the Putonghua Proficiency Test(PSC),the Hospital Anxiety and Depression Scale(HADS),and the Distress Thermometer(DT).Multiple linear regressions estimated covariate-adjusted associations between Mandarin proficiency and distress outcomes,controlling for demographic and clinical factors.Semi-structured interviews with 20 patients explored communication experiences and psychosocial impacts.Quantitative and qualitative findings were integrated for triangulated interpretation.Results:Lower Mandarin proficiency was significantly associated with higher anxiety(β=−0.30,p=0.001),depression(β=−0.25,p=0.01),and distress(β=−0.28,p=0.003),with an adjusted R^(2)=0.18(F=7.4,p<0.001).Each 10-point increase in PSC corresponded to a 0.5-point reduction in DT score(B=−0.05,p=0.003).Qualitative themes revealed confusion,stigma,isolation,and reliance on family interpreters,confirming that linguistic inequity functions as an independent psychosocial stressor in oncology care.Conclusion:Language barriers significantly heighten distress among rural Chinese cancer patients.Addressing these barriers through interpreter services,culturally responsive staff training,and inclusive educational materials should be recognized as a core strategy for mental health promotion and equitable cancer care.展开更多
BACKGROUND Diabetes distress(DD),an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management,is common among patients with type 2 diabetes(T2D).South Asi...BACKGROUND Diabetes distress(DD),an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management,is common among patients with type 2 diabetes(T2D).South Asia has a high T2D burden,and many studies have reported varying prevalence rates of DD in this area.AIM To estimate the pooled prevalence of DD among patients with T2D in South Asia,as it is crucial for developing effective therapeutic strategies.METHODS This systematic review and meta-analysis included cross-sectional studies conducted in South Asian countries involving adults with T2D and reported the prevalence of DD.The studies were identified by searching multiple electronic databases and registries from the inception of each database to January 30,2025,using prespecified search terms.Four authors screened and extracted data independently.Meta-analyses were conducted using RStudio software with a random-effects model.The primary outcome was the pooled prevalence of DD.RESULTS Thirty-seven cross-sectional studies(28 from India,five from Bangladesh,and two each from Pakistan and Sri Lanka)with mostly high methodological quality involving 11500 subjects were included.The pooled prevalence of DD was 44%(95%confidence interval:35-53,I2=97.4%).The prevalence of DD was highest in Pakistan(85%),followed by India and Bangladesh(42%each),and Sri Lanka(25%).Emotional burden was the most prevalent form of DD(60%),followed by treatment regimen-related distress(51%),interpersonal distress(31%),and physician-related distress(17%).Meta-regression analysis revealed no significant associations between the prevalence of DD and publication year,sample size,proportion of females,age,duration of diabetes,insulin usage,glycated hemoglobin levels,or diabetic complications.CONCLUSION South Asians with T2D seem to experience a relatively high burden of DD,and the emotional burden is the most common form of DD in this area.Larger studies utilizing unique tools and involving a broader participant base from the region would provide better epidemiological data for effectively planning high-quality diabetes care in South Asian countries.展开更多
Pavement distress detection plays a pivotal role in ensuring roadway safety,serviceability,and cost-effective infrastructure management.With rapid advancements in intelligent transportation systems,computer vision,and...Pavement distress detection plays a pivotal role in ensuring roadway safety,serviceability,and cost-effective infrastructure management.With rapid advancements in intelligent transportation systems,computer vision,and sensing technologies,non-contact detection approaches based on images and point clouds have become increasingly prominent due to their efficiency,objectivity,and scalability.This review systematically examines both image-based and point cloud-based methodologies,structured along the complete detection pipeline encompassing data acquisition,preprocessing,distress extraction,and geometric quantification.Image-based techniques rely on visual cues,such as texture,color,and edge continuity,to identify surface-level anomalies efficiently,benefiting from mature deep learning frameworks for classification,object detection,and pixel-level segmentation.In contrast,point cloud-based methods capture rich three-dimensional geometric and structural information,enabling detailed modeling of crack depth,rutting deformation,and surface irregularities.Although each modality can independently achieve satisfactory performance,their complementary strengths have driven a growing trend toward hybrid frameworks,combining image-based rapid screening with point cloud-based precision modeling,to enhance detection accuracy,robustness,and adaptability across varying conditions.Furthermore,this paper highlights persistent challenges,including multimodal data fusion,high equipment and labeling costs,computational complexity,and the need for standardized benchmarks.By synthesizing current progress and identifying key technical bottlenecks,this review provides a comprehensive foundation and forward-looking perspective for developing intelligent,efficient,and scalable pavement distress detection systems.展开更多
Acute respiratory distress syndrome(ARDS)is a severe and life-threatening manifestation of acute lung injury,characterized by widespread pulmonary inflammation and edema,ultimately resulting in acute respiratory failu...Acute respiratory distress syndrome(ARDS)is a severe and life-threatening manifestation of acute lung injury,characterized by widespread pulmonary inflammation and edema,ultimately resulting in acute respiratory failure.Despite advancements in mechanical ventilation and lung-protective strategies,targeted therapies aimed at modulating dysregulated inflammation and promoting tissue repair remain elusive.Extracellular vesicles(EVs),critical mediators of intercellular communication,have emerged as a promising research focus due to their dual regulatory roles in ARDS pathogenesis.Pro-inflammatory EVs,derived from pathogens or injury-stressed cells,exacerbate alveolar macrophage activation and increase endothelial permeability,thereby aggravating pulmonary damage.In contrast,anti-inflammatory EVs originating from mesenchymal stem cells facilitate alveolar barrier restoration and tissue repair by delivering reparative molecular cargo.This review systematically evaluates the dualistic functions of EVs in ARDS from three key perspectives:Molecular mechanisms,clinical translation,and technical challenges.We further discuss the complexities associated with EV heterogeneity,pathogen interactions,and standardization in EV production.Additionally,we propose future directions that integrate engineered EV modifications and multi-omics approaches to address current therapeutic limitations and enhance ARDS management.展开更多
Financial distress prediction(FDP)is a critical area of study for researchers,industry stakeholders,and regulatory authorities.However,FDP tasks present several challenges,including high-dimensional datasets,class imb...Financial distress prediction(FDP)is a critical area of study for researchers,industry stakeholders,and regulatory authorities.However,FDP tasks present several challenges,including high-dimensional datasets,class imbalances,and the complexity of parameter optimization.These issues often hinder the predictive model’s ability to accurately identify companies at high risk of financial distress.To mitigate these challenges,we introduce FinMHSPE—a novel multi-heterogeneous self-paced ensemble(MHSPE)FDP learning framework.The proposed model uses pairwise comparisons of data from multiple time frames combined with the maximum relevance and minimum redundancy method to select an optimal subset of features,effectively resolving the high dimensionality issue.Furthermore,the proposed framework incorporates the MHSPE model to iteratively identify the most informative majority class data samples,effectively addressing the class imbalance issue.To optimize the model’s parameters,we leverage the particle swarm optimization algorithm.The robustness of our proposed model is validated through extensive experiments performed on a financial dataset of Chinese listed companies.The empirical results demonstrate that the proposed model outperforms existing competing models in the field of FDP.Specifically,our FinMHSPE framework achieves the highest performance,achieving an area under the curve(AUC)value of 0.9574,considerably surpassing all existing methods.A comparative analysis of AUC values further reveals that FinMHSPE outperforms state-of-the-art approaches that rely on financial features as inputs.Furthermore,our investigation identifies several valuable features for enhancing FDP model performance,notably those associated with a company’s information and growth potential.展开更多
文摘Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.
文摘Background:Amid the global rise in adolescent sedentary behavior and psychological distress,extant research has largely focused on variable-level associations,neglecting symptom-level interactions.This study applies network analysis,aims to delineate the interconnections among sedentary time,social support,social exclusion,and psychological distress in Chinese students,and to identify core and bridge symptoms to inform targeted interventions.Methods:This study employed a cross-sectional design to investigate the complex relationships among sedentary behavior,social support,social exclusion,and psychological distress among Chinese students.The research involved 459 high school and university students,using network analysis and mediation models to examine these relationships.Results:Network analysis revealed that the network had a density of 58.33%and an average edge weight of 0.11.In terms of centrality,stress had the highest expected influence(EI=1.135),acting as the core amplifier in the network.Sedentary behavior demonstrated the highest bridging expected influence,functioning as a critical bridge for cross-community transmission.Conversely,friend support showed the lowest bridging EI with a negative value,indicating its effectiveness in blocking cross-community diffusion and alleviating symptoms.Conclusion:With stress acting as the most influential“core engine”within the symptom network and sedentary behavior serving as the key“bridge”for cross-community transmission,interventions should first target stress to weaken the overall symptom cascade,followed by reducing sedentary behavior or enhancing friend support to disrupt cross-community pathways,thereby achieving a core-bridge dual blockade.
基金supported by the National Natural Science Foundation of China(Grant No.82220108002 to F.C.and Grant No.82273737 to R.Z.)the U.S.National Institutes of Health(Grant Nos.CA209414,HL060710,and ES000002 to D.C.C.,Grant Nos.CA209414 and CA249096 to Y.L.)+1 种基金the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)supported by the Qing Lan Project of the Higher Education Institutions of Jiangsu Province and the Outstanding Young Level Academic Leadership Training Program of Nanjing Medical University.
文摘Interferon-related genes are involved in antiviral responses,inflammation,and immunity,which are closely related to sepsis-associated acute respiratory distress syndrome(ARDS).We analyzed 1972 participants with genotype data and 681 participants with gene expression data from the Molecular Epidemiology of ARDS(MEARDS),the Molecular Epidemiology of Sepsis in the ICU(MESSI),and the Molecular Diagnosis and Risk Stratification of Sepsis(MARS)cohorts in a three-step study focusing on sepsis-associated ARDS and sepsis-only controls.First,we identified and validated interferon-related genes associated with sepsis-associated ARDS risk using genetically regulated gene expression(GReX).Second,we examined the association of the confirmed gene(interferon regulatory factor 1,IRF1)with ARDS risk and survival and conducted a mediation analysis.Through discovery and validation,we found that the GReX of IRF1 was associated with ARDS risk(odds ratio[OR_(MEARDS)]=0.84,P=0.008;OR_(MESSI)=0.83,P=0.034).Furthermore,individual-level measured IRF1 expression was associated with reduced ARDS risk(OR=0.58,P=8.67×10^(-4)),and improved overall survival in ARDS patients(hazard ratio[HR_(28-day)]=0.49,P=0.009)and sepsis patients(HR_(28-day)=0.76,P=0.008).Mediation analysis revealed that IRF1 may enhance immune function by regulating the major histocompatibility complex,including HLA-F,which mediated more than 70%of protective effects of IRF1 on ARDS.The findings were validated by in vitro biological experiments including time-series infection dynamics,overexpression,knockout,and chromatin immunoprecipitation sequencing.Early prophylactic interventions to activate IRF1 in sepsis patients,thereby regulating HLA-F,may reduce the risk of ARDS and mortality,especially in severely ill patients.
基金PEEP titration in ARDS patients using EIT combined with lung ultrasound,Key Laboratory of Emergency Trauma Research,Ministry of Education (KLET-202201)airway clearance protocol in ICU mechanically ventilated patients based on electrical impedance imaging technology,Natural Science Foundation of Hunan Province (2024JJ9148)effects of end expiratory positive pressure on lung re-expansion in patients with ARDS and intra-abdominal hypertension monitored using lung ultrasound,Natural Science Foundation of Hunan Province (2023JJ60308)
文摘BACKGROUND:Individualized positive end-expiratory pressure(PEEP)titration is a crucial technique in mechanical ventilation therapy for acute respiratory distress syndrome(ARDS)patients with intra-abdominal hypertension(IAH).This study aimed to evaluate the eff ectiveness of electrical impedance tomography(EIT)-guided PEEP titration in this population.METHODS:This prospective study enrolled 36 ARDS patients,including 22 patients with IAH and 14 without IAH.All the patients underwent EIT-guided PEEP titration at the intersection point between alveolar overdistension and collapse during a decremental PEEP trial.The changes in pulmonary ventilation distribution,respiratory mechanics and hemodynamics during the titration process were observed.RESULTS:After EIT-guided PEEP titration was performed,the PEEP,peak inspiratory pressure and plateau pressure increased significantly(P<0.05).Furthermore,no significant differences were observed in respiratory system compliance,tidal volume,driving pressure,or the 4*DP+RR index between the two groups(P>0.05).The mechanical power increased in the non-IAH(NIAH)group after PEEP titration(P<0.05).Ventilation in gravity-dependent lung regions significantly increased(P<0.05),and the oxygenation index(PaO2/FiO2)improved signifi cantly(P<0.05)in both groups.However,blood pressure,heart rate,respiratory rate,central venous pressure,and lactate levels did not signifi cantly change.In the IAH group,the PaO2/FiO2 ratio improved less than that in the NIAH group did(P<0.05).CONCLUSION:In our study,individualized PEEP titration guided by EIT improved oxygenation in ARDS patients with concomitant IAH without signifi cantly aff ecting hemodynamics.The presence of IAH may limit the improvement of oxygenation during EIT-guided PEEP titration.
基金the Scientific and Technological Research Council of Türkiye(TÜBİTAK)Under the International Postdoctoral Research Fellowship Program(2219),No.1059B192400980the National Postdoctoral Research Fellowship Program(2218),No.122C158.
文摘Acute respiratory distress syndrome(ARDS)is a life-threatening condition that is characterized by high mortality rates and limited therapeutic options.Notably,Zhang et al demonstrated that CD146+mesenchymal stromal cells(MSCs)exhibited greater therapeutic efficacy than CD146-MSCs.These cells enhance epithelial repair through nuclear factor kappa B/cyclooxygenase-2-associated paracrine signaling and secretion of pro-angiogenic factors.We concur that MSCs hold significant promise for ARDS treatment;however,the heterogeneity of cell products is a translational barrier.Phenotype-aware strategies,such as CD146 enrichment,standardized potency assays,and extracellular vesicle profiling,are essential for improving the consistency of these studies.Further-more,advanced preclinical models,such as lung-on-a-chip systems,may provide more predictive insights into the therapeutic mechanisms.This article underscores the importance of CD146+MSCs in ARDS,emphasizes the need for precision in defining cell products,and discusses how integrating subset selection into translational pipelines could enhance the clinical impact of MSC-based therapies.
基金funded by the Hunan Provincial Natural Science Foundation of China(2024JJ2038,2024JJ9161)the Central Government Guides Local Science and Technology Development Fund Projects(2024ZYC031)+4 种基金the Hunan Health High-Level Talent Project(R2023073)the National Key Clinical Specialty Scientific Research Project(Z2023114)the Young Doctor Foundation of Hunan Provincial People’s Hospital(BSJJ202209)the Key Cultivation Project of Hunan Provincial People’s Hospital(RS2022A06)the Clinical Research Center for Emergency and Critical Care in Hunan Province(2021SK4011).
文摘Acute respiratory distress syndrome(ARDS)is a severe clinical condition characterized by acute respiratory failure due to widespread pulmonary inflammation and edema.The incidence of ARDS among intensive care unit(ICU)patients is approximately 10%,with mortality rates ranging from 35%to 45%and exceeding 50%in severe cases.[1]Identifying and controlling risk factors for ARDS is critical for early prevention.Smoking remains a significant global public health issue,affecting one-third of adults and 40%of children through exposure to secondhand smoke.[2]In an animal study,cigarette smoke impaired lung endothelial barrier function through oxidative stress and exacerbated lipopolysaccharide-induced increases in vascular permeability in vivo.This finding is consistent with the pathological changes observed in ARDS.[3]Although many observational studies have suggested a potential link between smoking and ARDS,the causal relationship remains unclear.This study uses Mendelian randomization(MR)to explore whether smoking behavior causally influences ARDS and investigates the mechanisms by which smoking may contribute to ARDS development through transcriptomic analysis of the Gene Expression Omnibus(GEO)database.
文摘Purpose:This study aimed to determine the nurses’profile characteristics that are associated with moral distress among nurses in selected government hospitals in Shangdong,China.Methods:This is a descriptive-correlational study.A total of 185 clinical registered nurses who met the eligibility criteria from different departments in two tertiary governmental hospitals in Jinan city were purposively selected to participate in this study.The instruments included the general demographic characteristics and Chinese version of Moral Distress Scale-Revised(MDS-R).Correlation technique,specifically Spearman’s rho,was utilized to determine the significant correlation between the selected nurse’s characteristics and moral distress.Ethical considerations were given by the Far Eastern University ethics review committee(FEU-ERC Code:2020-2021-079).Results:The number of patients nurses handled per shift(rs=0.650,p=0.032)and the type of patients that nurses handled(rs=0.718,p=0.020)are the nurses’profile factors that are significantly correlated with nurses’moral distress(p-value<0.05).As there is an increase in the number of patients handled every shift and the patients are becoming unstable,requiring complex care,the frequency and intensity of moral distress increase as well.Conclusion:The nurses’moral distress was registered at a low level in this study.Characteristics related to patients,such as the number and type assigned to nurses,are correlated to moral distress.The main source of the high frequency and intensity of moral distress among nurses is“futile care”and“false hope”.Educational learning program is recommended to manage and alleviate the moral distress of nurses.
基金supported by the National Natural Science Foundation of China(No.71974162 and No.7231101009).
文摘Objectives This study aimed to develop and preliminarily assess the quality of a Mindfulness Breast Care(MBC)App to reduce body image distress and stigma among breast cancer survivors(BCSs).Methods The development process of the MBC App involved:1)establishing a research group;2)determining of the content of the MBC App based on Mindfulness-Based Cognitive Therapy and 3)technical exploitation and maintenance.A mixed-methods study was conducted.We selected ten BCSs by a convenience sampling method.After using the APP for three months,five assessed the quality using the Mobile App Rating Scale:User Version(uMARS)and another five were interviewed for process evaluation.Results The MBC App was developed with three modules:1)Library to provide health education information on body image,stigma,mindfulness,recovery and etc;2)Mindfulness Yoga to offer 12 Hatha yoga videos for daily practice;and 3)Mindfulness Practices to have 12 sessions of mindfulness videoconferences.Based on the uMARS data,the MBC App received high ratings for functionality(4.10±0.34),aesthetics(3.93±0.55),information quality(4.10±0.72),and perceived impact(4.03±0.96),as well as moderate ratings for engagement(3.72±0.94)and subjective quality(3.87±0.77).Participants indicated that the MBC App provided reliable knowledge,information,and emotional support.Recommendations from participants included categorizing knowledge in the Library Module,recording videoconferences of mindfulness practice,and adding discussion sessions in the videoconference.Afterward,we optimized the MBC App to enhance the user experience accordingly.Conclusions The MBC App offers online mindfulness interventions specifically for BCSs in China.The preliminary quality assessment indicates that the MBC App may be a promising tool for delivering mindfulness interventions to BCSs.
基金The University of Winnipeg and The University of Winnipeg Foundation contributed funding to this research.
文摘Variation in the vocal behavior of nonhuman vertebrates includes graded transitions and more dramatic changes.Wapiti males produce a reproductive bugle that has a fundamental frequency that surpasses 2,000 Hz with evidence of biphonation and other nonlinear phenomena.Here,we analyze the acoustic structure of captive wapiti vocalizations to compare the male bugle with 3 categories of distress vocalizations:neonate distress(capture)calls,calf isolation calls,and adult female isolation calls.These 4 high-arousal call categories serve a common general function in recruiting conspecifics but occur in different behavioral contexts(capture,isolation,reproduction).Our goal was to distinguish characteristics that vary in graded steps that may correspond to an animal’s age or size from characteristics that are unique to the bugle.Characteristics of the high and loud fundamental(G0)varied in an age/size-graded manner with a decrease in minimum G0,an increase in the maximum and range of G0,with no evidence of sex differences.The nonlinear phenomena of deterministic chaos,biphonation,and frequency jumps were present in all 4 call categories and became more common from the distress vocalizations of neonates to calves to adult females to the male bugle.Two temporal characteristics sharply distinguished the bugle from the 3 categories of distress vocalizations:these included a prolonged call duration and a maximum G0 that occurred much later in the call for the bugle than for distress vocalizations.Our results suggest that distress vocalizations of different age groups and the reproductive bugle of wapiti share a high G0,with age/size-graded changes in G0 and nonlinear phenomena,but differ sharply in temporal characteristics.
文摘BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifies ARDS severity based on the partial pressure of arterial oxygen/fractional inspired oxygen fraction ratio.Despite various treatment strategies,ARDS remains a significant public health concern with high mortality rates.AIM To evaluate the implications of driving pressure(DP)in ARDS management and its potential as a protective lung strategy.METHODS We conducted a systematic review using databases including EbscoHost,MEDLINE,CINAHL,PubMed,and Google Scholar.The search was limited to articles published between January 2015 and September 2024.Twenty-three peer-reviewed articles were selected based on inclusion criteria focusing on adult ARDS patients undergoing mechanical ventilation and DP strategies.The literature review was conducted and reported according to PRISMA 2020 guidelines.RESULTS DP,the difference between plateau pressure and positive end-expiratory pressure,is crucial in ARDS management.Studies indicate that lower DP levels are significantly associated with improved survival rates in ARDS patients.DP is a better predictor of mortality than tidal volume or positive end-expiratory pressure alone.Adjusting DP by optimizing lung compliance and minimizing overdistension and collapse can reduce ventilator-induced lung injury.CONCLUSION DP is a valuable parameter in ARDS management,offering a more precise measure of lung stress and strain than traditional metrics.Implementing DP as a threshold for safety can enhance protective ventilation strategies,po-tentially reducing mortality in ARDS patients.Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.
基金Supported by the Scientific Research Fund of Zhejiang Provincial Education Department,No.Y202351104and Huzhou Science and Technology Plan Project,No.2023GZ67。
文摘BACKGROUND Frailty has become a significant public health issue.The recent increase in the number of frail older adults has led to increased attention being paid to psycho-logical care services in communities.The social isolation of pre-frail older adults can impact their psychological distress.AIM To explore the mediating effect of health literacy between social isolation and psychological distress among communitydwelling older adults with pre-frailty.METHODS This descriptive cross-sectional study was conducted with 254 pre-frail older individuals aged 60 years and over.Social isolation,health literacy,and psycholo-gical distress were comprehensively measured using the Lubben Social Network Scale-6,12-item Short-Form Health Literacy Questionnaire,and the Kessler Psy-chological Distress Scale-10.Data were evaluated using the SPSS 27.0 package program and the PROCESS macro tool.Descriptive statistical analyses,correlation analyses,and bootstrap mediation tests were used to assess associations between the variables.RESULTS The results showed that social isolation had an effect on health literacy among pre-frail older adults(β=0.240,P<0.001),social isolation impact on psycho-logical distress pre-frail older adults(β=-0.415,P<0.001);health literacy was identified effect on psychological distress among pre-frail older persons(β=-0.307,P<0.001).Health literacy partially mediated the relationship between social isolation and psychological distress among community-dwelling older adults with pre-frailty,with a mediation effect of-0.074,accounting for 17.83%of the total effect.
文摘Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.
基金supported by Chung Shan Medical University and Changhua Christian Hospital(CSMU-CCH-111-08)supported by research grants from the Chung Shan Medical University Hospital,Taichung,Taiwan(CSH-2023-C-023)the National Science and Technology Council,Taiwan,for financially supporting this research under Contract Nos.NSTC 112-2320-B-040-017,NSTC112-2314-B-040-009,and NSTC 112-2320-B-040-011.
文摘Background:Acute respiratory distress syndrome(ARDS)is the major therapeutic dilemma associated with significant inflammation and severe pulmonary dysfunction.Liriodendrin is a bioactive compound extract from traditional Chinesemedicine,historically utilized formodulating inflammatory responses and alleviating symptoms in multiple diseasemodels.Methods:At present,BALB/c mice to explore the effects of liriodendrin on lipopolysaccharide(LPS)-induced ARDS.Before LPS was administered,the mice were treated with either liriodendrin or dexamethasone.Leukocyte infiltration,lung edema,and alveolar-capillary barrier integrity were evaluated in the bronchoalveolar lavage fluid(BALF)and pulmonary parenchyma.The expression of adhesion molecules and proinflammatory cytokines in BALF was evaluated by enzyme-linked immunosorbent assay.Western blotting assay facilitated the analysis of the expression or phosphorylation of inducible nitric oxide synthase(iNOS),cyclooxygenase-2(COX-2),NOD-like receptor family pyrin domain-containing 3(NLRP3),apoptosis-associated speck-like protein containing a CARD(ASC),cleaved caspase-1(CL-csapase-1),nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),inhibitor of kappa B(IκB),mitogen-activated protein kinase(MAPK),and protein kinase B(Akt)in the lungs.In addition,the anti-inflammatory effects of liriodendrin were evaluated in LPS-stimulated RAW264.7 macrophages.Before LPS was administered,the RAW264.7 macrophages were treated with either liriodendrin or dexamethasone.Nitric Oxide(NO)production was measured using the Griess reaction assay,while ELISA assessed IL-1β,IL-6,and TNF-αlevels.Western blot analysis evaluated NF-κB phosphorylation and the expression of NLRP3,ASC,and CLcaspase-1.Results:These outcomes revealed that liriodendrin intervention markedly ameliorated the pathological features of LPS-induced ARDS,including leukocyte infiltration,lung edema,and alveolar-capillary barrier disruption.Liriodendrin also reduced the LPS-induced secretion of intercellular adhesion molecule-1(ICAM-1)and vascular cell adhesionmolecule-1(VCAM-1),expression of iNOS and COX2,and production of proinflammatory cytokines.Finally,we further discovered that the concentration trend of liriodendron amelioration ofARDSwas similar to those ofNLRP3 formation,NF-κB pathway activation,and p38 MAPK,c-Jun N-terminal kinase(JNK),and Akt phosphorylation but not to that of extracellular signal-regulated kinase(ERK)phosphorylation.Liriodendrin inhibited LPS-induced inflammatory responses in RAW264.7 macrophages.It markedly reduced NO production,propro-inflammatorytokines,NF-κB phosphorylation,and NLRP3 formation.Conclusions:In summary,liriodendrin effectively ameliorated the pathological features of LPS-induced ARDS inmice,demonstrating significant anti-inflammatory properties attributed to NLRP3 formation through NF-κB pathway activation by p38MAPK,JNK,and Akt phosphorylation.In LPS-treated RAW264.7 macrophages,liriodendrin reduced NO production,pro-inflammatory cytokines,and NLRP3 formation,suggesting its potential as an agent for ARDS and relative inflammation.
文摘Thyroid cancer is a common endocrine malignancy with a rising incidence.Pa-tients often suffer from mental pain due to concerns about recurrence,treatment-related side-effect,and body image changes.Demographic factors like age,gender,physiological factors such as somatic symptoms and disease stage,co-gnitive-regulatory factors including negative and positive thinking,and social factors like work,economy,education level,and social support all influence their mental state.Existing interventions,including nursing,psychological,and tra-ditional Chinese medicine-based methods,have some benefits but face limitations like short-term effectiveness and lack of standardization.Future research should focus on creating better-defined,long-term,and widely applicable intervention programs and explore positive psychology-based approaches to improve patients'mental well-being and quality of life.
文摘Objectives:The study aimed to examine the severity of moral distress and intention to leave among ICU nurses in the United Arab Emirates(UAE),and explore the influencing factors of intention to leave.Methods:The study utilized a cross-sectional research design.A convenience non-probability sample of 341 nurses from various private and government hospitals across different emirates in the UAE participated in June 2022.Data were collected using a self-administered questionnaire comprising demographic information,the Moral Distress Scale–Revised.Multivariable logistic regression was used to identify factors associated with intention to leave.Results:The study found that a large majority(71.9%)of ICU nurses experienced severe moral distress,and more than 35%had intention to leave.Futile end-of-life interventions emerged as the most distress-provoking aspect of practice[16.0(0,16.0)].Multivariable analysis revealed nurses experiencing severe moral distress had 3.73 times the odds of intending to leave their job compared with those experiencing mild distress(95%CI:1.81,7.69;P<0.001)and being aged 31–40 years(OR=2.02;95%CI:1.23,3.33;P=0.005)was independently associated with a higher intention to leave.Conclusions:Severe moral distress was prevalent among ICU nurses in the UAE and strongly associated with intention to leave,and also those aged 31–40 years.Promoting ethical support,shared decision-making,and nurse empowerment is vital to improving retention and care quality.
文摘Background:Communication barriers are a critical yet underexplored determinant of psychological well-being in oncology care,particularly among rural Chinese patients treated in urban hospitals.This study examined how Mandarin proficiency influences emotional distress and identified implications for mental health promotion.Methods:A sequential mixed-methods design was adopted.Quantitative data were collected from 180 rural cancer patients using the Putonghua Proficiency Test(PSC),the Hospital Anxiety and Depression Scale(HADS),and the Distress Thermometer(DT).Multiple linear regressions estimated covariate-adjusted associations between Mandarin proficiency and distress outcomes,controlling for demographic and clinical factors.Semi-structured interviews with 20 patients explored communication experiences and psychosocial impacts.Quantitative and qualitative findings were integrated for triangulated interpretation.Results:Lower Mandarin proficiency was significantly associated with higher anxiety(β=−0.30,p=0.001),depression(β=−0.25,p=0.01),and distress(β=−0.28,p=0.003),with an adjusted R^(2)=0.18(F=7.4,p<0.001).Each 10-point increase in PSC corresponded to a 0.5-point reduction in DT score(B=−0.05,p=0.003).Qualitative themes revealed confusion,stigma,isolation,and reliance on family interpreters,confirming that linguistic inequity functions as an independent psychosocial stressor in oncology care.Conclusion:Language barriers significantly heighten distress among rural Chinese cancer patients.Addressing these barriers through interpreter services,culturally responsive staff training,and inclusive educational materials should be recognized as a core strategy for mental health promotion and equitable cancer care.
文摘BACKGROUND Diabetes distress(DD),an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management,is common among patients with type 2 diabetes(T2D).South Asia has a high T2D burden,and many studies have reported varying prevalence rates of DD in this area.AIM To estimate the pooled prevalence of DD among patients with T2D in South Asia,as it is crucial for developing effective therapeutic strategies.METHODS This systematic review and meta-analysis included cross-sectional studies conducted in South Asian countries involving adults with T2D and reported the prevalence of DD.The studies were identified by searching multiple electronic databases and registries from the inception of each database to January 30,2025,using prespecified search terms.Four authors screened and extracted data independently.Meta-analyses were conducted using RStudio software with a random-effects model.The primary outcome was the pooled prevalence of DD.RESULTS Thirty-seven cross-sectional studies(28 from India,five from Bangladesh,and two each from Pakistan and Sri Lanka)with mostly high methodological quality involving 11500 subjects were included.The pooled prevalence of DD was 44%(95%confidence interval:35-53,I2=97.4%).The prevalence of DD was highest in Pakistan(85%),followed by India and Bangladesh(42%each),and Sri Lanka(25%).Emotional burden was the most prevalent form of DD(60%),followed by treatment regimen-related distress(51%),interpersonal distress(31%),and physician-related distress(17%).Meta-regression analysis revealed no significant associations between the prevalence of DD and publication year,sample size,proportion of females,age,duration of diabetes,insulin usage,glycated hemoglobin levels,or diabetic complications.CONCLUSION South Asians with T2D seem to experience a relatively high burden of DD,and the emotional burden is the most common form of DD in this area.Larger studies utilizing unique tools and involving a broader participant base from the region would provide better epidemiological data for effectively planning high-quality diabetes care in South Asian countries.
基金supported in part by the National Natural Science Foundation of China(52378431,52408454)Fundamental Research Funds for the Central Universities,Chang’an University(300102210302,300102210118)+1 种基金111 Project of Sustainable Transportation for Urban Agglomeration in Western China(B20035)the 111 Project of Low Carbon Smart Road Infrastructure Construction and Maintenance Discipline Innovation and Talent Introduction Base of Shaanxi Province.
文摘Pavement distress detection plays a pivotal role in ensuring roadway safety,serviceability,and cost-effective infrastructure management.With rapid advancements in intelligent transportation systems,computer vision,and sensing technologies,non-contact detection approaches based on images and point clouds have become increasingly prominent due to their efficiency,objectivity,and scalability.This review systematically examines both image-based and point cloud-based methodologies,structured along the complete detection pipeline encompassing data acquisition,preprocessing,distress extraction,and geometric quantification.Image-based techniques rely on visual cues,such as texture,color,and edge continuity,to identify surface-level anomalies efficiently,benefiting from mature deep learning frameworks for classification,object detection,and pixel-level segmentation.In contrast,point cloud-based methods capture rich three-dimensional geometric and structural information,enabling detailed modeling of crack depth,rutting deformation,and surface irregularities.Although each modality can independently achieve satisfactory performance,their complementary strengths have driven a growing trend toward hybrid frameworks,combining image-based rapid screening with point cloud-based precision modeling,to enhance detection accuracy,robustness,and adaptability across varying conditions.Furthermore,this paper highlights persistent challenges,including multimodal data fusion,high equipment and labeling costs,computational complexity,and the need for standardized benchmarks.By synthesizing current progress and identifying key technical bottlenecks,this review provides a comprehensive foundation and forward-looking perspective for developing intelligent,efficient,and scalable pavement distress detection systems.
基金Supported by National Natural Science Foundation of China,No.82374400Heilongjiang Province“Double First-Class”New Round of Construction Disciplines Collaborative Innovation Achievements Construction Project,No.LJGXCG2022-097.
文摘Acute respiratory distress syndrome(ARDS)is a severe and life-threatening manifestation of acute lung injury,characterized by widespread pulmonary inflammation and edema,ultimately resulting in acute respiratory failure.Despite advancements in mechanical ventilation and lung-protective strategies,targeted therapies aimed at modulating dysregulated inflammation and promoting tissue repair remain elusive.Extracellular vesicles(EVs),critical mediators of intercellular communication,have emerged as a promising research focus due to their dual regulatory roles in ARDS pathogenesis.Pro-inflammatory EVs,derived from pathogens or injury-stressed cells,exacerbate alveolar macrophage activation and increase endothelial permeability,thereby aggravating pulmonary damage.In contrast,anti-inflammatory EVs originating from mesenchymal stem cells facilitate alveolar barrier restoration and tissue repair by delivering reparative molecular cargo.This review systematically evaluates the dualistic functions of EVs in ARDS from three key perspectives:Molecular mechanisms,clinical translation,and technical challenges.We further discuss the complexities associated with EV heterogeneity,pathogen interactions,and standardization in EV production.Additionally,we propose future directions that integrate engineered EV modifications and multi-omics approaches to address current therapeutic limitations and enhance ARDS management.
基金China Postdoctoral Science Foundation(No.2023M740237,2024M750254)Postdoctoral Fellowship Program of CPSF(No.GZB20230934)+1 种基金National Natural Science Foundation of China(No.71801113,72401029,72431003)China Scholarship Council(No.202006060162).
文摘Financial distress prediction(FDP)is a critical area of study for researchers,industry stakeholders,and regulatory authorities.However,FDP tasks present several challenges,including high-dimensional datasets,class imbalances,and the complexity of parameter optimization.These issues often hinder the predictive model’s ability to accurately identify companies at high risk of financial distress.To mitigate these challenges,we introduce FinMHSPE—a novel multi-heterogeneous self-paced ensemble(MHSPE)FDP learning framework.The proposed model uses pairwise comparisons of data from multiple time frames combined with the maximum relevance and minimum redundancy method to select an optimal subset of features,effectively resolving the high dimensionality issue.Furthermore,the proposed framework incorporates the MHSPE model to iteratively identify the most informative majority class data samples,effectively addressing the class imbalance issue.To optimize the model’s parameters,we leverage the particle swarm optimization algorithm.The robustness of our proposed model is validated through extensive experiments performed on a financial dataset of Chinese listed companies.The empirical results demonstrate that the proposed model outperforms existing competing models in the field of FDP.Specifically,our FinMHSPE framework achieves the highest performance,achieving an area under the curve(AUC)value of 0.9574,considerably surpassing all existing methods.A comparative analysis of AUC values further reveals that FinMHSPE outperforms state-of-the-art approaches that rely on financial features as inputs.Furthermore,our investigation identifies several valuable features for enhancing FDP model performance,notably those associated with a company’s information and growth potential.
