bluuebunny/crossref_metadata_2025 huggingface dataset:
Childhood Adversity Is Not Related to Associative Memory for Emotional Stimuli
Authors: Wardell Victoria , Rho Kate , Stewardson Charlotte I. , Hunsche Michelle C. , Rights Jason D. , LeMoult Joelle , Palombo Daniela J. , Kerns Connor M.
Published: February 2025

Binding content together in memory (i.e., associative memory) is often impaired by negative emotion, and adults exposed to childhood adversity tend to show heightened emotional reactivity that may influence memory for emotional content. We tested whether childhood adversity augments the impairing effect of emotion on associative memory. In an online study, young adult participants ( N = 700) self-reported exposure to childhood adversity. Participants were then presented with images stratified by emotion (negative, neutral) that were paired with an image of a benign object. Twenty-four hours later, participants’ associative memory for image pairs was tested. Although childhood adversity was prevalent and negatively associated with psychological well-being, it was not associated with poorer associative memory regardless of stimuli valence ( b = −0.01, p = .175). Findings suggest that childhood adversity is not always related to associative memory despite theories positing that poor associative memory may drive mental-health concerns associated with childhood adversity.
The Preseason Functional Movement Screen as a Predictive Tool for Shoulder and Elbow Injuries in High School Baseball Pitchers: A Prospective Cohort Study
Authors: Shitara Hitoshi , Hamano Noritaka , Tajika Tsuyoshi , Ichinose Tsuyoshi , Sasaki Tsuyoshi , Kamiyama Masataka , Miyamoto Ryosuke , Nakase Kurumi , Ino Fukuhisa , Hatori Yuhei , Yanai Koichiro , Chikuda Hirotaka
Published: February 2025

Background:

The Functional Movement Screen (FMS) is used to evaluate fundamental movement patterns in patients. It is unknown whether the FMS can be used as a predictive tool for the occurrence of pitching injuries in baseball players.

Purpose:

To prospectively investigate the relationship between shoulder and elbow injuries and individual components of the FMS during the preseason in high school baseball pitchers and determine which components of the FMS can be used as screening tools to predict shoulder and elbow injuries.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Eligible participants comprised 133 male high school baseball pitchers aged 15 to 17 years who underwent a preseason medical examination in 2017. Included participants were right-handed pitchers who had been involved in preseason practices without restrictions in baseball activities. The physical examination included assessments of background factors, bilateral shoulder and elbow range of motion, and grip and shoulder strength as well as the FMS. A shoulder or elbow injury was defined as any condition causing the inability to pitch for ≥8 days. Injuries occurring in the season immediately after the preseason medical examination were recorded. Logistic regression analysis was performed to identify risk factors associated with an injury.

Results:

Overall, 90 high school baseball pitchers were enrolled in this study. The incidence of injuries was 22.2%. A comparison of FMS scores revealed significantly higher values for shoulder mobility on both sides (dominant side: P = .025; nondominant side: P = .034) and lower values for rotary stability on the dominant side ( P < .001) in the injured versus noninjured group. Logistic regression analysis identified poor rotary stability on the dominant side as a significant independent risk factor for baseball injuries (odds ratio, 5.30; P = .009).

Conclusion:

In right-handed high school baseball pitchers, a low FMS score for rotary stability on the dominant side during the preseason was a significant independent risk factor for injuries in the following season. The FMS score for rotary stability may be used as a predictive tool for the occurrence of pitching injuries in high school baseball pitchers.
Mechanisms of Severe Adductor Longus Injuries in Professional Soccer Players: A Systematic Visual Video Analysis
Authors: Jokela Aleksi , Pasta Giulio , Della Villa Francesco , Abrantes Arnaldo , Kalogiannidis Dimitrios , García-Romero-Pérez Alvaro , Marano Marco , Skibinskyi Dmitriy , Mazzoni Stefano , Pruna Ricard , Valle Xavier , Lempainen Lasse
Published: February 2025

Background:

Changing direction, kicking, reaching, and jumping have been found to be the primary mechanisms of adductor longus injury. No previous studies specifically analyzing severe adductor longus injury mechanisms using video analysis have been published.

Purpose:

To systematically analyze video footage to describe the mechanisms of severe acute adductor longus injuries in male professional soccer players.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 20 professional male soccer players (median age, 27 years; range, 18-35 years) who experienced an acute adductor longus injury during a match between October 2017 and December 2023 were included. All analyzed injuries were severe, either complete adductor longus tendon ruptures or partial lesions resulting in an absence from soccer competition of >28 days. Two authors independently reviewed the injuries based on a comprehensive injury causation model. Factors analyzed included playing situation, player/opponent behavior, and biomechanical descriptions encompassing whole-body and joint movements/positions.

Results:

Of the 20 included injuries, 13 (65%) were considered noncontact and 7 (35%) were indirect contact. A closed kinetic chain (CKC) injury mechanism was found in 14 injuries (70%), an open kinetic chain (OKC) mechanism was found in 3 injuries (15%), and the injury occurred during high-speed running in the remaining 3 cases (15%). Player actions at the time of injury included reaching with the uninjured leg (CKC stretching; n = 11 [55%]), reaching with the injured leg (OKC stretching; n = 2 [10%]), dribbling (n = 2 [10%]), and landing (n = 2 [10%]). In CKC injuries, hip extension, hip abduction, and external rotation were all found in 64% of the cases. All OKC injuries involved hip abduction, external rotation, and rapid change of movement from hip extension to flexion.

Conclusion:

Severe adductor longus injuries occurred predominantly during CKC actions, particularly when reaching for the ball with the uninjured leg. These injuries were consistently characterized by a combination of hip extension, abduction, and external rotation. A crucial aspect in these injuries appears to be the involvement of an eccentric muscle action, featuring rapid muscle activation during rapid muscle lengthening.
The Role of Crutches and Bracing in Preventing Secondary Meniscal Tears After Anterior Cruciate Ligament Injury in Pediatric Patients
Authors: Gupta Arjun , Badin Daniel , Lee R. Jay
Published: February 2025

Background:

Secondary meniscal tears are a well-described sequela of delay in anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL injury. This study aimed to evaluate whether preoperative conservative interventions (ie, crutches, bracing, and physical therapy) are associated with a reduced risk of secondary meniscal pathology in pediatric patients.

Hypothesis:

Preoperative conservative interventions of the ACL-deficient knee would be associated with fewer secondary meniscal tears in pediatric patients undergoing delayed (≥8 weeks postinjury) ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

All pediatric patients (age, <18 years) undergoing primary ACLR with a single surgeon between October 1, 2013, and January 31, 2022, were retrospectively identified. The exclusion criteria were as follows: previous ipsilateral knee injury; multiligamentous knee injuries; or time frommagnetic resonance imaging to surgery ≥52 weeks. Adherence to conservative management recommendations (ie, crutches, bracing, and physical therapy) was assessed through medical record review. Secondary meniscal injuries were defined as major tears that were discovered intraoperatively and required repair or substantial meniscectomy. Meniscal tears that occurred concomitantly with ACL rupture and were detectable on the initial (<3 weeks after injury) magnetic resonance imaging scans were not considered secondary. In total, 71 pediatric patients (35 girls; 36 boys) were included.

Results:

A total of 70 patients (99%) underwent ≥1 conservative interventions before ACLR—including 37 (52%) who used crutches, 47 (66%) who used bracing, and 69 (97%) who received physical therapy. There were no differences in use of conservative interventions between those who underwent early ACLR and those who had delayed ACLR ( P > .05). Delayed ACLR was associated with a greater risk of medial, but not lateral, meniscal tears compared with early ACLR ( P = .04). Overall, 15 secondary meniscal tears were observed intraoperatively in 14 patients—including 4 medial and 11 lateral tears. Knee bracing was associated with fewer lateral meniscal tears in patients undergoing early ACLR (6% vs 35%; P = .008), with multivariate regression analysis yielding an adjusted odds ratio of 0.06 (95% CI, 0.006-0.57; P = .015). The use of crutches was associated with fewer medial meniscal tears in patients undergoing delayed ACLR (0% vs 37%; P = .017). Since no new medial meniscal tears were observed in patients who used crutches, the adjusted odds ratio could not be calculated.

Conclusion:

Bracing and crutches were associated with the preservation of the menisci in the ACL-deficient knee in pediatric patients undergoing early and delayed ACLR, respectively. Surgeons should strongly encourage adherence to these conservative modalities in patients awaiting operative reconstruction to reduce the risk of secondary meniscal pathology.
Is Ulnar Collateral Ligament Strength Proportional to Height and Weight?
Authors: Beason David P. , Colberg Ricardo E. , Kimbrel Brandon K. , Rothermich Marcus A. , Slowik Jonathan S. , Fleisig Glenn S.
Published: February 2025

Background:

The rates of surgeries for ulnar collateral ligament (UCL) injuries continue to rise for baseball pitchers. The physical size of pitchers has also increased, bringing into question whether today’s larger pitchers have proportionally bigger and stronger UCLs able to withstand greater elbow varus torque. Furthermore, controversy exists in biomechanics literature regarding whether kinetics during pitching should be reported as torque (in N·m) or normalized torque (scaled by body weight and height).

Hypothesis/Purpose:

The purpose of this study was to quantify the relationships between body size and mechanical properties of the UCL measured directly on cadaveric specimens. It was hypothesized that greater body weight and height would correlate with greater UCL strength, stiffness, and cross-sectional area.

Study Design:

Descriptive laboratory study.

Methods:

UCL thickness and length were measured by ultrasound for 20 cadaveric right elbows from young adult (mean age, 33 ± 6 years) male donors. Each elbow was then dissected, potted, and placed into a mechanical test frame at 90° of flexion. The specimen was then tested to failure at a rate of 1° of valgus rotation per second. Correlations between geometric and biomechanical data were tested by linear regressions ( P < .05).

Results:

The mean UCL failure torque was 45.0 ± 10.5 N·m, and the mean stiffness was 2.72 ± 0.48 N·m/deg. Correlations between failure torque and height ( P = .25), weight ( P = .85), and height × weight ( P = .72) were nonsignificant. Similarly, stiffness showed no significant correlation with height ( P = .24), weight ( P = .21), or height × weight ( P = .18). UCL cross-sectional area did not significantly correlate with body height ( P = .34), height × weight ( P = .064), or weight ( P = .065).

Conclusion:

Body size is not correlated with UCL strength and stiffness.

Clinical Relevance:

Clinicians should not assume that bigger athletes have a stronger UCL. Furthermore, elbow varus torque during throwing for adult athletes should not be normalized by body weight and height.
Management of First-Time Anterior Shoulder Dislocation—A Systematic Review and Meta-analysis: Arthroscopy Association of Canada Position Statement
Authors: Abdel Khalik Hassaan , Dagher Danielle , Lameire Darius Luke , Gusnowski Eva , Kolpka Michaela , LeBel Marie-Eve , Matache Bogdan A. , Martin R. Kyle , Sommerfeldt Mark , Wong Ivan , Woodmass Jarret , Khan Moin
Published: February 2025

Background:

While surgical stabilization is typically recommended for patients with recurrent shoulder instability, the management of first-time shoulder dislocation (FTSD) presents a unique challenge for health care providers.

Purpose:

To assess the efficacy of arthroscopic Bankart repair (ABR) compared with nonoperative management for FTSDs.

Study Design:

Review.

Methods:

MEDLINE, EMBASE, and CENTRAL were searched from inception to December 26, 2023, for comparative studies assessing ABR versus nonoperative management of FTSDs. Outcomes of interest included rates of shoulder redislocation, cumulative shoulder instability (redislocation, subluxation, and/or subjective instability), subsequent shoulder stabilization surgery, return-to-sport rates, and patient-reported outcomes (Western Ontario Shoulder Instability [WOSI] score and Rowe score). Meta-analyses were performed on outcomes reported across a minimum of 3 comparative studies.

Results:

Eleven comparative studies with 694 patients (695 shoulders) were included in the final analysis. Patient demographics were comparable across arthroscopic stabilization (367 shoulders) and nonoperative management (328 shoulders) groups with a mean age of 21.6 ± 2.5 years across all studies, and 13.7% ± 13.6% of patients being female. The mean follow-up across all studies was 54.2 ± 28.5 months, with a mean loss to follow-up of 8.1% ± 10.3%. Meta-analyses demonstrated a reduction in the odds of cumulative instability in favor of the ABR group (odds ratio [OR], 0.04 [95% CI, 0.02 to 0.08]; P < .01), as well as reductions in the odds of shoulder redislocation (OR, 0.06 [95% CI, 0.02 to 0.17]; P < .01) and subsequent stabilization surgery (OR, 0.07 [95% CI, 0.03 to 0.14]; P < .01) in favor of ABR. Compared with the nonoperative group, patients in the ABR group were 3.87 times more likely to return to sport at the preoperative or higher level (OR, 3.87 [95% CI, 1.57 to 9.52]; P < .01). No differences were found across postoperative WOSI scores (mean difference, 8.08 [95% CI, –1.54 to 17.69]; P = .10). Subgroup analyses demonstrated similar outcomes between randomized controlled trials and observational studies.

Conclusion:

Early ABR of first-time anterior shoulder dislocations consistently demonstrated decreased subsequent rates of cumulative instability events, shoulder redislocations, and revision surgeries relative to nonoperative management.
Enhancing Business Communication: Comparing Teaching Styles in Supply Chain Education
Authors: Phan The Anh , Ninh Tran-Thuy-Duong
Published: February 2025

This study examines the impact of traditional lectures and guest speaker sessions on developing business communication skills in supply chain education. Focusing on green supply chain management practices (GSCMP) and sustainable development (SD), the research highlights the complementary strengths of these teaching methods. Traditional lectures excel in enhancing written communication and theoretical knowledge, while guest speaker sessions significantly improve verbal communication and practical skills. The findings provide actionable insights for educators to design balanced curricula that align with the dynamic communication needs of modern supply chain management professionals.
A genome-wide association study identified SNP markers and candidate genes associated with morphometric fruit quality traits in mangoes
Authors: Eltaher Shamseldeen , Li Jin , Freeman Barbie , Singh Sukhwinder , Ali Gul Shad
Published: February 2025

Background

Mangoes (Mangifera indica L.) are a widely grown fruit tree crop across the world, but breeding new varieties can take 15-20 years due to its long juvenile period and high heterozygosity. Marker-assisted selection can accelerate breeding new mango cultivars with desirable traits for fruit quality, storage, horticulture, pest and disease resistance, and nutrition.

Results

To achieve this, a genome-wide association study (GWAS) was conducted to discover molecular markers for 14 morphometric and economically important fruit traits of 161 mango accessions with diverse genetic backgrounds. These traits included pulp and brix; fruit weight, length, thickness, and width; stone weight, length, thickness, and width; and seed weight, length, thickness, and width. In this report, we employed the fixed and random model circulating probability unification (FarmCPU) model for conducting GWAS using 135,079 high-quality SNP markers. These analyses revealed 103 SNPs that were significantly associated with these traits. Of these markers, 7 were commonly associated with different traits, while 96 markers were uniquely associated with specific traits.

Conclusions

To choose the most promising mango accessions for future breeding and for closing genetic gaps among the accessions and increasing genetic diversity, a new selection method is suggested based on phenotypic traits such as high-yielding mango fruit cultivars, number of reference alleles, and genetic distance among the selected genotypes. Based on these criteria, 20 accessions were identified as the most promising parents for crossing to produce high mango yield. Gene annotation of the significant markers revealed candidate genes coding for important proteins, enzymes, and transcription factors associated with fruit development traits.
Enhancing salinity tolerance in cultivated rice through introgression of African rice genes and application of moringa leaf extract
Authors: Saleh Heba A. , Tourky Shaimaa M. N. , Ibraheem Farag , Abo-Hamed Samy A. , Shukry Wafaa M. , Elgamal Walid H. , Elghareeb Eman M.
Published: February 2025

Background

Salinity is a major threat to rice growth and productivity. Utilizing wild rice-derived genes and biostimulants with high growth promoting- and stress-alleviating potential can significantly improve salinity tolerance in cultivated rice. Herein, we investigated the vegetative growth and physiological responses of Giza 177 (Oryza sativa, salinity sensitive, high-yielding cultivar) and a promising introgression salt tolerant line (sativa/glaberrima; SG 65) from a population of Giza 177 × African rice (Oryza glaberrima) under low (2.75 mS/cm) and high (5.5 mS/cm) salinity stress. The possible ameliorative effects of priming rice seeds in moringa leaf extract (MLE) on these responses were also tested.

Results

The two salinity levels induced differential reduction in plant growth in both cultivars. In the MLE-unprimed plants, salinity induced 34–54% and 30–45% reductions in biomass accumulation in Giza 177 and SG 65, respectively. These responses were associated with significant differential reductions in relative water content, chlorophylls, carotenoids, and gas exchange parameters (transpiration rate, net photosynthetic rate, stomatal conductance, and intercellular CO2 concentration), ascorbic acid, and total protein. Conversely, salinity induced the accumulation of H2O2, malondialdehyde, proline, carbohydrate fractions, and membrane injury. MLE treatment mitigated the above salinity-induced adverse effects in both cultivars via reducing the salt-induced oxidative stress through the induction of non-enzymic (total phenols, and flavonoids) and enzymic antioxidants including ascorbate peroxidase, catalase, peroxidase, and polyphenol oxidase in both cultivars. SG 65 plants exhibited consistently higher salt tolerance and responsiveness to MLE than Giza 177.

Conclusions

This study reports significant differences in an array of critical physiological and biochemical indices that underpin the divergent responses between the two salinized cultivars. It demonstrates the potential of African rice-derived genomic fragments and MLE priming in mitigating salinity stress, highlighting their use as a sustainable strategy for increasing rice production in salt-affected soils.
Chromium "(VI)" phytoremediation using Azolla pinnata: effects on Vicia faba growth, physiology, cytogenetics, and gene expression profiling
Authors: Soliman Elham R. S. , Moustafa Kareem , Khamis Mohamed , Shedeed Zeinab A.
Published: February 2025

Background

One of the primary challenges that the expanding population faces is water scarcity. Thus, a global imperative has been established to safeguard extant water resources and optimize their utility through sustainable practices and efficient management. In the present investigation, Azolla pinnata, a pteridophyte (fern), was employed to phytoremediate Cr (VI) from chromium-polluted water. The potential of this treated water for agricultural purposes was verified through the use of Vicia faba plants.

Results

In vitro, A. pinnata effectively remediates Cr (VI) from an array of liquid concentrations (0.05 to 90 ppm) in a ratio of 25:1 {volume (mL): fresh weight of Azolla (g)} after 2 days incubation period at room temperature. At low concentrations (0.1 ppm), the phytoremediation capacity peaked at 70%, falling to 19.53% at a high concentration (90 ppm). Upon continuous irrigation with Cr-polluted water (0.05 to 50 ppm), the in vivo pot experiment on Vicia faba plants revealed high Cr accumulation in the roots reached 52.5 mg Kg-1 dry weight (Dwt) at the 50 ppm Cr treatment. Nevertheless, a reduced Cr content of 19.5 mg Kg-1 Dwt was observed when the plants were irrigated with 50 ppm Cr-polluted water that had been treated with Azolla. At 50 ppm of Cr, Azolla's treatment significantly increased shoot length, fresh weight, and Chl a content to 25.25 cm, 3.4 g, and 6.5 mg g-1 Dwt, respectively, up from 10.25, 1.8, and 4.7 in untreated plants. The chromosomal aberrations were significantly induced in the dividing cells of all Cr treatments, with the highest value of 4.8% at 50 ppm. This value was reduced to 2.88% at the same concentration when treated with Azolla. At a concentration of 10 ppm Cr, the mitotic index was significantly improved to 6.99% when combined with Azolla, as opposed to 3.63% when the same concentration was used without Azolla. The DNA degradation assay showed partial DNA degradation at 50 ppm Cr, which the Azolla treatment eliminated. Furthermore, the gene expression levels of both the PM H+-ATPase and the calcium-dependent protein kinase CDPK5 were upregulated in response to Cr, despite the fact that the expression level was altered in a dose- and concentration-dependent manner by Azolla treatment.

Conclusion

Azolla exhibits substantial potential for reducing the detrimental effects of chromium stress including oxidative stress on plants. It modulates stress-related gene expression, protects DNA integrity, enhances cell mitosis, and reduces chromosomal damage. These results indicate that Azolla has the potential to be a valuable asset in phytoremediation strategies for chromium-contaminated environments, and that it may enhance plant survival and growth under Cr stress conditions.

Key message

Azolla pinnata can be effectively utilized as an environmentally-friendly method to remediate chromium-contaminated water for agricultural usage.
Path model explaining the association between fear of falling and health-related quality of life in (pre-)frail older adults
Authors: Sattler Tjard , Gottschalk Sophie , König Hans-Helmut , Braun Tobias , Büchele Gisela , Denkinger Michael , Fleiner Tim , Nerz Corinna , Rapp Kilian , Schäufele Martina , Werner Christian , Dams Judith
Published: February 2025

Background

Fear of falling (FoF) is estimated to be prevalent in over 50% of older adults and several studies suggest that it negatively affects health-related quality of life (HrQoL). Unlike previous studies that examined only few mediating variables, this study aimed to develop a more comprehensive path model explaining the association between FoF and HrQoL.

Methods

A theoretical path model was developed based on existing evidence and expert feedback and fitted to cross-sectional baseline data on 385 community-dwelling (pre-)frail older adults from the PromeTheus randomized controlled trial using robust weighted least squares estimation. FoF and HrQoL were operationalized by the Short Falls Efficacy Scale International and EQ-5D Index, respectively. The model included potential explanatory pathways through physical activity (German Physical Activity Questionnaire for middle-aged and older adults), physical capacity (Short Physical Performance Battery), physical performance (Late-Life Function and Disability Instrument [LLFDI] function component), disability (LLFDI disability component – short form), and affect (visual analogue scales on ‘happiness’, ‘sadness’, ‘calmness’ and ‘tension’). Age, sex, education, and previous falls were considered as covariates.

Results

The model demonstrated good fit to the data and the remaining direct effect of FoF on HrQoL was small (β=-0.05). Physical capacity and physical performance were the most important mediators (combined indirect effect of β=-0.17, accounting for > 50% of the total effect). Pathways of minor individual relevance (e.g. through disability or affect) contributed considerably to the total indirect effect when combined. Controlling for sociodemographic data and previous falls only had minor effects on model fit and path coefficients.

Conclusion

Physical capacity and physical performance are particularly important levers for reducing the impact of FoF on HrQoL through interventions. However, the other pathways also had a considerable influence when taken together. Hence, research on the association of FoF and HrQol should acknowledge the complexity of causal pathways that may explain this association and not neglect minor pathways. The proposed model should be tested on an alternative sample, using longitudinal data, and extended to include additional explanatory factors (e.g. activity avoidance).

Trial registration

German Clinical Trials Register, ID: DRKS00024638, https://drks.de/search/en/trial/DRKS00024638, date of registration: March 11th 2021.
Key tips to shift student perspectives through transformative learning in medical education
Authors: Hart Efraim J. , de Heer-Koster Merel H. , van der Harst Maria , Browne Joyce L. , Scheele Fedde
Published: February 2025

Healthcare systems are increasingly complex, facing challenges such as rising costs, aging populations, and persistent health inequities. These challenges demand that medical education adapts, to equip health professionals with the competencies required to navigate and transform complex systems. This is where transformative learning theory can play a crucial role. This article offers twelve practical tips to integrate transformative learning in medical education, emphasizing the need for a shift from traditional educational approaches to more transformative methods. These tips focus on educating learners on the principles of transformative learning, encouraging critical reflection, fostering interdisciplinary collaboration, addressing the hidden curriculum, and creating a supportive learning environment. By implementing these tips, medical education can better prepare healthcare professionals to act as change agents, contributing to the long-term sustainability and effectiveness of healthcare systems. The potential impact of these tips on medical education is substantial, as they provide a pathway toward a more responsive, ethical, and sustainable future of healthcare. Clinical trial number: Not applicable.
Disparities in well-being outcomes among medical students: a comparative study between medical students with and without disability
Authors: Seaborne Henry J. , Chehab Lara Z. , Rajapuram Nikhil , Sammann Amanda
Published: February 2025

Background

The strenuous demands of medical education often lead to adverse mental health outcomes among students. Despite extensive research on medical student distress, the unique challenges faced by students with disabilities remain understudied. This study aims to investigate the well-being of medical students with and without disabilities, by comparing levels of distress, risk and protective factors, and modifiable variables’ impact on distress.

Methods

From September 2019 to February 2020, we implemented an exploratory observational study to survey medical students across the US, US territories, and Caribbean. Participants completed the Medical Student Wellbeing Survey (MSWS), which was used to assess well-being and capture extensive demographic data on these students. We retrospectively sorted participant data into cohorts based on disability status, then compared them using rates of well-being outcomes, logistic regression, and interaction analyses. We conducted logistic regression analyses to identify significant predictors of severe distress, burnout, and depression.

Results

Of the 3162 medical student participants, 277 identified as having a disability. Respondents with disabilities reported significantly higher rates of severe distress (65%) compared to their non-disabled peers (51.3%). Additionally, burnout and depression rates were higher among disabled students, with 80.41% experiencing burnout and 54.84% experiencing depression. Logistic regression revealed that certain identities, as well as high debt and tuition costs, were significant predictors of severe distress across cohorts. Uniquely, marital status emerged as a protective factor specifically for students with disabilities.

Conclusion

Medical students with disabilities exhibit higher levels of severe distress, burnout, and depression than their non-disabled counterparts. Current interventions and modifiable factors are insufficient in lessening severe distress for these students. These findings highlight the necessity for tailored support strategies and structural interventions to improve the well-being of medical students with disabilities, especially for those with intersecting vulnerable identities.

Trial registration

This study does not report the results of a health care intervention on human participants, so trial registration is not required.
High risk for life-threatening adverse events of fluoroquinolones in young adults: a large German population-based cohort study
Authors: Wicherski Julia , Peltner Jonas , Becker Cornelia , Schüssel Katrin , Brückner Gabriela , Schlotmann Andreas , Schröder Helmut , Kern Winfried V. , Haenisch Britta
Published: February 2025

Background

Fluoroquinolone antibiotics have a high potential for serious adverse drug reactions, but real-world evidence in European patient cohorts is lacking. Therefore, we aim to examine the association between fluoroquinolone exposure and potentially life-threatening adverse events stratified by age and gender in Germany.

Methods

We conducted an administrative cohort study using the active comparator new user design with a risk window up to 365 days between January 2013 and December 2019. Population-based longitudinal data from one of the largest German statutory health insurances were used. Episodes of newly dispensed fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, moxifloxacin, norfloxacin, and enoxacin) were compared to other antibiotics (amoxicillin, amoxicillin clavulanic acid, azithromycin, cefuroxime, cephalexin, clindamycin, sulfamethoxazole-trimethoprim, and doxycycline). Endpoints were defined by incident diagnoses of aortic aneurysm/dissection, cardiac arrhythmia, hepatotoxicity, and all-cause mortality. Adjusted hazard ratios were estimated from piece-wise exponential additive mixed models with smooth non-linear effects for person-time and age and adjusted for comorbidities, year and quarter at index.

Results

The cohorts comprised 15,139,840; 11,760,159; 11,027,175; and 15,305,757 antibiotic episodes. Patients during fluoroquinolone episodes were older (59 versus 51 years) and more often female (58% versus 54%). We counted 46,502; 446,727; 19,125; and 474,411 incident endpoints. Relative risk for all-cause mortality and hepatotoxicity was high for < 40-year- and 40–69-year-old females (aHR = 1.77, 95% CI 1.55–2.03 and aHR = 1.42, 95% CI 1.32–1.53), respectively. For aortic aneurysm/dissection a nominally increased relative risk for < 40-year-old females was found (aHR = 1.42, 95% CI 0.96–2.11), although 95% CI indicates that a small relative risk reduction is also supported by the data. Relative risk for cardiac arrhythmia was increased for men aged < 40 years (aHR = 1.14, 95% CI 1.08–1.20). High relative risks for each endpoint were also identified depending on choice of active comparator, and risks increased with higher defined daily doses and shorter follow-up.

Conclusions

This study contributes real-world evidence to endpoint-specific differences of risks in patient subgroups which need to be considered to improve fluoroquinolone drug safety.
Unlocking precision medicine: clinical applications of integrating health records, genetics, and immunology through artificial intelligence
Authors: Chen Yi-Ming , Hsiao Tzu-Hung , Lin Ching-Heng , Fann Yang C.
Published: February 2025

Artificial intelligence (AI) has emerged as a transformative force in precision medicine, revolutionizing the integration and analysis of health records, genetics, and immunology data. This comprehensive review explores the clinical applications of AI-driven analytics in unlocking personalized insights for patients with autoimmune rheumatic diseases. Through the synergistic approach of integrating AI across diverse data sets, clinicians gain a holistic view of patient health and potential risks. Machine learning models excel at identifying high-risk patients, predicting disease activity, and optimizing therapeutic strategies based on clinical, genomic, and immunological profiles. Deep learning techniques have significantly advanced variant calling, pathogenicity prediction, splicing analysis, and MHC-peptide binding predictions in genetics. AI-enabled immunology data analysis, including dimensionality reduction, cell population identification, and sample classification, provides unprecedented insights into complex immune responses. The review highlights real-world examples of AI-driven precision medicine platforms and clinical decision support tools in rheumatology. Evaluation of outcomes demonstrates the clinical benefits and impact of these approaches in revolutionizing patient care. However, challenges such as data quality, privacy, and clinician trust must be navigated for successful implementation. The future of precision medicine lies in the continued research, development, and clinical integration of AI-driven strategies to unlock personalized patient care and drive innovation in rheumatology.
Baseline atherogenic index of plasma and its trajectory predict onset of type 2 diabetes in a health screened adult population: a large longitudinal study
Authors: Sun Yongbing , Lin Xinbei , Zou Zhi , Zhao Caiwen , Liu Ao , Zhou Jing , Li Zhonglin , Wu Xiaoling , Dou Shewei , Zhu Jiadong , Li Tao , Lv Xue , Wang Yong , Li Yongli
Published: February 2025

Background

The Atherogenic Index of Plasma (AIP) is a novel biomarker for assessing the severity of atherosclerosis and has been shown to be closely associated with the risk of Type 2 Diabetes Mellitus (T2DM). However, no prospective cohort study has comprehensively evaluated both the immediate risk stratification through baseline AIP and the long-term risk assessment through multi-time point AIP trajectories in health screened adults in relation to T2DM risk.

Methods

This longitudinal study included data from 42,850 participants who underwent health check-ups at Henan Provincial People’s Hospital between January 2018 and August 2024. AIP was calculated as the logarithm of the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C). The Kaplan-Meier method was employed to analyze the incidence of T2DM across different AIP groups. A Cox model with restricted cubic splines assessed the dose-response relationship between AIP and T2DM risk, while latent class trajectory models (LCTM) evaluated the trends of AIP over multiple time points. Cox proportional hazards models were used to examine the relationship between baseline AIP quartiles, AIP trajectories, and T2DM risk.

Results

During an average follow-up of 47.95 months, 3,228 participants developed T2DM. Stratifying by baseline AIP quartiles revealed that higher AIP levels were associated with an increased risk of T2DM. Compared to the lowest quartile, the highest quartile had a hazard ratio (HR) of 2.10 (95% CI: 1.74, 2.53). The LCTM identified three trajectory patterns for AIP: with the low-stable group as the reference, the medium-stable and high-stable groups had HRs of 1.72 (95% CI: 1.50, 1.96) and 2.50 (95% CI: 2.06, 3.03), respectively, indicating a significantly elevated risk of T2DM (P < 0.05).

Conclusion

Elevated baseline AIP levels, medium stable trajectories and high stable trajectories are associated with an increased risk of T2DM in health screened adults.
Biogenesis, characterization, and applications of Spirulina selenium nanoparticles
Authors: Yassein Asmaa S. , Elamary Rokaia B. , Alwaleed Eman A.
Published: February 2025

Background

Nowadays, researchers are attracted to the phyco-synthesis of selenium nanoparticles (SeNPs) for biotechnological and medical applications as they possess many advantages such as safety, nutritional value, and easy biodegradation than gold, copper, and silver nanoparticles. Spirulina platensis is the preferred microalgae for SeNPs synthesis because it contains many compounds that increase their stability making them fit for biomedical treatments.

Results

The biosynthesized Spirulina platensis selenium nanoparticles (SP-SeNPs) were spherical and crystalline, with a diameter of 65 nm and a net charge of -16.7 mV. Furthermore, they were surrounded by active groups responsible for stability. The DPPH radical scavenging test assessed the antioxidant efficacy of SP-SeNPs and exposed scavenging inhibition of 79.234% at a 100 µM dosage. ABTS and H2O2 radical scavenging assay is dose-dependent recording IC50 of 50.69 and 116.18 µg/ml, respectively. The antibacterial efficacy was investigated against 13 G-negative & G-positive bacteria. The study demonstrated that SP-SeNPs had antibacterial and antibiofilm efficiencies against the tested strains with MBC of 286–333 µg/ml. The highest percentages of biofilm inhibition were recorded for Bacillus subtilis and Klebsiella pneumoniae, with ratios of 78.8 and 69.9%, respectively. The prepared SP-SeNPS efficiently suppressed the tested fungi growth with MIC (350 µg/ml) and MFCs (480–950 µg/ml). Most notably, biogenic SeNPs effectively extended the clot formation period recording 170.4 S for prothrombin time (PT) and 195.6 S for the activated partial thromboplastin time (aPTT). SP-SeNPs reduced the cell viability of breast adenocarcinoma (MCF-7) and ovarian cancer (SKOV-3) cell lines with a percentage of 17.6009% and 14.9484% at a concentration of 100 ug/ml, respectively. Moreover, SP-SeNPs could effectively alleviate the inflammation in RAW 264.7 macrophages with a reduction percentage of 8.82% in Nitric oxide concentration.

Conclusion

The investigation findings reveal that SP-SeNPs are a hopeful antimicrobial, anti-tumor, anticoagulant, antioxidant, and anti-inflammatory factor that can be applied in medical cures.
Promoting ER stress in a plasmacytoid dendritic cell line drives fibroblast activation
Authors: Ferreira Beatriz H. , Silva Inês S. , Mendes Andreia , Leite-Pinheiro Fátima , Paton Adrienne W. , Paton James C. , Duarte Iola F. , Pierre Philippe , Almeida Catarina R.
Published: February 2025

Background

Fibrosis remains a major complication in several chronic diseases, including systemic sclerosis (SSc). Plasmacytoid dendritic cells (pDCs) are innate immune cells that play a key role in the development of fibrosis in SSc patients, through still poorly defined mechanisms. Interestingly, endoplasmic reticulum (ER) stress signaling pathways are dysregulated in pDCs from patients with SSc, but their contribution to fibrosis remains unclear. Thus, this study aimed to unravel the mechanisms behind the involvement of pDCs and ER stress in fibrosis.

Methods

To address this question, we established an in vitro model designed to study the interactions between pDCs and fibroblasts. More specifically, IMR-90 fibroblasts were co-cultured with CAL-1, a pDC cell line. ER stress was then induced by the bacterial toxin SubAB. Extracellular matrix (ECM) production was assessed using immunoblotting, qPCR and confocal microscopy. The importance of cell-to-cell contact was investigated using conditioned media (CM) and transwell assays.

Results

Direct contact of CAL-1 and IMR-90 cells under ER stress conditions led to increased expression of fibronectin and alpha-smooth muscle actin (α-SMA). This effect required expression of the ER stress signaling sensor protein kinase R-like ER kinase (PERK) in pDCs and was observed only upon direct contact between both cell types.

Conclusions

Overall, our data suggest that ER stress induction in pDCs promotes fibroblast activation, which may contribute to the development of fibrosis in SSc.
Inhibition of tumour necrosis factor alpha by Etanercept attenuates Shiga toxin-induced brain pathology
Authors: Christ Robin , Siemes Devon , Zhao Shuo , Widera Lars , Spangenberg Philippa , Lill Julia , Thiebes Stephanie , Bottek Jenny , Borgards Lars , Pinho Andreia G. , Silva Nuno A. , Monteiro Susana , Jorch Selina K. , Gunzer Matthias , Siebels Bente , Voss Hannah , Schlüter Hartmut , Shevchuk Olga , Chen Jianxu , Engel Daniel R.
Published: February 2025

Infection with enterohemorrhagic E. coli (EHEC) causes severe changes in the brain leading to angiopathy, encephalopathy and microglial activation. In this study, we investigated the role of tumour necrosis factor alpha (TNF-α) for microglial activation and brain pathology using a preclinical mouse model of EHEC infection. LC–MS/MS proteomics of mice injected with a combination of Shiga toxin (Stx) and lipopolysaccharide (LPS) revealed extensive alterations of the brain proteome, in particular enrichment of pathways involved in complement activation and coagulation cascades. Inhibition of TNF-α by the drug Etanercept strongly mitigated these changes, particularly within the complement pathway, suggesting TNF-α-dependent vasodilation and endothelial injury. Analysis of microglial populations using a novel human-in-the-loop deep learning algorithm for the segmentation of microscopic imaging data indicated specific morphological changes, which were reduced to healthy condition after inhibition of TNF-α. Moreover, the Stx/LPS-mediated angiopathy was significantly attenuated by inhibition of TNF-α. Overall, our findings elucidate the critical role of TNF-α in EHEC-induced brain pathology and highlight a potential therapeutic target for mitigating neuroinflammation, microglial activation and injury associated with EHEC infection.

Graphical Abstract
Incidence and predictors of respiratory tract infections among birth cohorts in Ethiopia, 2023
Authors: Bayou Fekade Demeke , Arefaynie Mastewal , Mohammed Anissa , Tareke Abiyu Abadi , Keleb Awoke , Kebede Natnael , Tsega Yawkal , Mersha Bayu Hailemariam , Endawkie Abel , Kebede Shimels Derso , Abera Kaleab Mesfin , Abeje Eyob Tilahun , Enyew Ermias Bekele , Daba Chala , Asmare Lakew
Published: February 2025

Background

Respiratory tract infection (RTI) has been a predominant health problem worldwide, including Ethiopia. It is one of the major causes of under-five mortality in Ethiopia, accountable for 18% of total deaths. Nationwide studies on the incidence of respiratory infections and maternal risk factors are limited. Hence, this study was aimed to determine the incidence and predictors of respiratory infections among infants aged less than six months in Ethiopia, 2023.

Methods

This was a retrospective follow up study using data from Performance Monitoring for Action Ethiopia (PMA Ethiopia). A two-stage cluster sampling technique was used to select a total 2,246 eligible study participants from 206 enumeration areas. A Cox proportional hazards regression model was used to identify independent predictors of respiratory tract infection incidence. Hazard ratios with 95% confidence intervals and p value < 0.05 were used to declare statically significant associations between variables.

Results

The incidence rate of respiratory tract infections among birth cohorts was 22.99 per 1000 infant weeks of observation. Infants born from mothers who sustained convulsion during labor had nearly doubled [AHR = 1.65, 95%CI (1.20, 2.28)] hazard or risk of developing respiratory tract infections than their counterparts. Similarly, infants born from mothers having prolonged labor (more than 12 h) had one and half times [AHR = 1.48, 95%CI (1.13, 1.93)] increased risk of developing respiratory tract infections as compared to their counterparts.

Conclusion

The incidence of respiratory tract infections is a significant public health concern in Ethiopia. Infants born to mothers with prolonged labor and convulsions need closer monitoring for early signs of respiratory tract infections.
Drug response is related to NR3C1 and FAAH polymorphism in Chinese pediatric epilepsy patients
Authors: Wang Hongli , Li Chu , Li Qian , Li Ning , Qin Huiling
Published: February 2025

Background

Childhood epilepsy is a common neurological syndrome with complex etiology and recurrent seizures. It seriously affects the growth and development of child patients.

Methods

NR3C1 rs41423247 and FAAH rs324420 polymorphisms were detected by the polymerase chain reaction in 105 pediatric epilepsy patients. Patients were divided into the good response group and the poor response group after anti-seizure medications (ASMs) treatment. According to the results of the liver function test (LFT), patients were divided into the no LFT disturbance group and the LFT disturbance group. Hardy–Weinberg balance was applied to analyze the population representation. The correlations were calculated by logistic regression analysis.

Results

NR3C1 rs41423247 genotype and allele frequencies differed significantly between good response and poor response groups, while FAAH rs324420 did not. The CG genotype and C allele of NR3C1 rs41423247 were associated with good drug response, and the association was also detected in the dominant model. In addition, polymorphisms in NR3C1 and FAAH were not associated with liver damage induced by epilepsy medication.

Conclusion

The polymorphism of NR3C1 rs41423247 might influence the drug response of epilepsy children.