To investigate the etiology and clinical characteristics of hospitalized secondary glaucoma (SG) patients in northwestern China. A cross-sectional study was conducted involving SG patients hospitalized between July 2024 and January 2025. Clinical data were collected, including medical history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, gonioscopic findings, and fundus examination. Demographic characteristics, etiological factors, and treatment modalities were analyzed. A total of 67 patients (82 eyes) were enrolled, aged 7 to 90y. Males accounted for 54.0% (36/67), and 22.4% (15/67) of patients had bilateral involvement. The predominant etiologies of SG were neovascular glaucoma (NVG; 25.4%), traumatic glaucoma (23.9%), uveitic glaucoma (20.9%), and lens-induced glaucoma (14.9%), collectively accounting for 85.1% of all cases. The peak age-specific incidence occurred in the 50-59 years age group (32.8%, 22/67), while NVG was prevalent across the 40-79 years age range. IOP of the 82 affected eyes was stratified into five severity tiers: 22-29 mm Hg (15 eyes, 18.3%), 30-39 mm Hg (14 eyes, 17.1%), 40-49 mm Hg (13 eyes, 15.9%), 50-59 mm Hg (20 eyes, 24.4%), and ≥60 mm Hg (20 eyes, 24.4%). The overall mean IOP was 45.2±12.3 mm Hg, indicating a significant pathological elevation. Surgical intervention was required in 46.3% of cases, predominantly for NVG, lens-induced glaucoma, and traumatic glaucoma-conditions prone to rapid IOP elevation. The etiologies with the highest surgical intervention rates were malignant glaucoma, pigmentary glaucoma, lens-induced glaucoma, and NVG. In contrast, uveitic glaucoma cases were primarily managed with targeted anti-inflammatory therapy, which effectively controlled IOP in the early disease stages and potentially obviated the need for surgery. This study identifies NVG, traumatic glaucoma, uveitic glaucoma, and lens-induced glaucoma as the four leading etiologies of SG in Northwestern China. These findings emphasize the critical need for targeted prevention strategies and evidence-based health education programs among high-risk populations. Implementation of such initiatives will improve early detection, enable ophthalmologists to deliver timely therapeutic interventions, and ultimately reduce preventable vision loss in this region.

To investigate the association between functional outcomes and postoperative patient satisfaction 5y after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). This is a cross-sectional study. The patients underwent basic ophthalmic examinations, axial length measurement, wide-field fundus photography, and accommodation function testing. Behavioral habits data were collected using a self-administered questionnaire, and visual symptoms were assessed with the Quality of Vision (QoV) questionnaire. Postoperative satisfaction was also recorded. Totally 410 subjects [820 eyes, 160 males (39.02%) and 250 females (60.98%)] who had undergone SMILE or FS-LASIK 5y ago were enrolled. The mean (standard deviation, SD) age of all patients was 29.83y (6.69). The mean (SD) preoperative manifest SE was -5.80 (2.04) diopters (D; range: -0.88 to -13.75). Patient satisfaction at 5y after undergoing SMILE or FS-LASIK was 91.70%. Patients were categorized into two groups: dissatisfied group and satisfied group. Significant differences were observed between the two groups in terms of age (P=0.012), sex (P=0.021), preoperative degree of myopia (P=0.049), postoperative visual symptoms (frequency, P=0.043; severity, P<0.001; bothersome, P=0.018), difficulty driving at night (P=0.001), and accommodative amplitude (AMP, P=0.020). Multivariate analysis confirmed that female sex (P=0.024), severity of visual symptoms (P=0.009), and difficulty driving at night (P=0.006) were significantly associated with lower satisfaction. The dissatisfied group showed higher rates of starbursts, double or multiple images, and high myopia, but lower age. The frequency, severity, and bothersome of distortion exhibited decreased with increasing age. Patient satisfaction 5y after SMILE and FS-LASIK is high and stable. Difficulty driving at night, sex, and severity of visual symptoms are important factors influencing patient satisfaction. Special attention should be paid to younger highly myopic female patients, particularly those with starbursts and double or multiple images. It is crucial to monitor postoperative visual outcomes and provide patients with comprehensive preoperative counseling to enhance long-term satisfaction.

The impact of adverse childhood experiences on emotional regulation in adult ED patients.

The hidden link under gender differences: How violence exposure fuels adolescents' cyber aggression through negative rumination.

The bidirectional relationship between hikikomori behavioral tendencies and depressive symptoms: A three-wave longitudinal study.

Area-level socioeconomic deprivation and suicide by restrictable method of death: Trends in Japan, 1995-2022.

Growing evidence suggests that the APOE ε4 allele, a genetic risk factor for Alzheimer disease (AD), influences the clinical-pathologic features of Parkinson disease (PD). APOE ε4 promotes brain amyloid accumulation, indicating a PD subtype more susceptible to late copathology. However, the early correlates of APOE ε4 carriers in PD are not known. In this study, we used a multimodal approach to define the clinical, neurochemical, and neurophysiologic profiles of APOE ε4 carriers in PD at onset. We conducted a single-center, cross-sectional study at Tor Vergata Hospital (Rome, Italy), enrolling newly diagnosed, drug-naïve PD participants and age-matched/sex-matched healthy controls (HCs). Patients with PD were stratified by APOE genotype into ε4 and non-ε4 carriers and evaluated through a comprehensive clinical assessment and the measurement of CSF amyloid peptides and tau protein levels. Group differences in high-density EEG-based functional connectivity (FC) were analyzed using network-based statistics to identify APOE ε4-modulated patterns. Clinical and biomarker associations with network metrics were tested using analysis of covariance and correlation analyses. The study included 66 PD participants (mean age 63.2 [10.1] years, 35% female, 52 ε4 noncarriers, 14 ε4 carriers) and 55 HCs (mean age 62.0 [15.2] years, 42% female). PD ε4, compared with PD non-ε4, demonstrated higher motor impairment, especially in bradykinesia (16.4 [7.6] vs 11.0 [5.6], p = 0.02) and gait disturbances (3.46 [2.23] vs 1.94 [1.46], p = 0.003) Movement Disorder Society-sponsored Unified Parkinson's Disease Rating Scale part III scores, and reduced CSF amyloid-β42 (Aβ42)/amyloid-β40 (Aβ40) ratio (0.09 [0.03] vs 0.13 [0.03], p < 0.001). Network analyses identified ε4-related FC alterations: decreased α-band connectivity (F = 3.9, p = 0.034) and increased β-band connectivity (F = 9.8, p < 0.001). In ε4 carriers, α-FC correlated inversely with gait disturbances (r = -0.62, p = 0.02) and positively with Montreal Cognitive Assessment (r = 0.57, p = 0.03) and CSF Aβ42/Aβ40 (r = 0.54, p = 0.04). β-FC correlated with bradykinesia in both groups, with stronger associations in ε4 carriers (r = 0.54, p = 0.04) than in non-ε4 (r = 0.28, p = 0.04). APOE ε4 defines a PD subtype characterized by greater motor impairment, reduced CSF Aβ42/Aβ40, and distinct FC abnormalities since the onset. An early amyloid-mediated network disruption thus emerges as the potential biological signature of ε4 carriers. Although limited by single-center and cross-sectional design, this study supports APOE ε4 as a stratification marker for early diagnostic and therapeutic strategies in PD.

The West Africa Ebola virus disease (EVD) outbreak resulted in over 28,000 individuals infected, primarily in Liberia, Guinea, and Sierra Leone. Data from previous outbreaks indicate lasting health problems in survivors. The long-term neurologic impact of EVD remains largely unknown. The aim of this study was to characterize the neurologic and neurocognitive sequelae of EVD in pediatric survivors of the 2015 outbreak in Liberia. In this cross-sectional observational study conducted in Monrovia, Liberia, pediatric survivors of acute EVD aged younger than 18 years at the time of infection and older than 2 years at the time of the visit, along with their asymptomatic close contacts as controls, were seen at a median of 18 months after EVD. The single clinic visit included a neurologic history and symptom questionnaire, neurologic examination, and neurocognitive testing. Seropositive survivors and seronegative controls were included in analyses, with the t test used for continuous variables and the χ2 or Fisher exact test used for categorical variables. The cohort included 31 EVD cases and 41 controls, with a median age of 11 years (44% female). Neurologic symptoms that were reported significantly more frequently in cases than in controls included arm/leg weakness (67.7% vs 4.9%, p < 0.0001); problems with sitting, standing, or walking (22.6% vs 4.9%, p = 0.031); difficulty seeing (38.7% vs 9.8%, p = 0.003); difficulty understanding speech (32.3% vs 0%, p < 0.0001); fecal incontinence (19.4% vs 0%, p = 0.0051); and lack of motivation (22.2% vs 0%, p = 0.0052). EVD cases more often demonstrated disability than controls on the modified Rankin Scale. EVD cases "either sometimes or often" faced consequences for poor behavior, became upset for unknown reasons, and had difficulty completing tasks independently more often than controls on executive function assessment. There was no significant difference between groups in individual neurologic examination components, frequency of uveitis, or cognitive test scores. Numerous neurologic symptoms were reported more commonly in EVD cases than in controls, suggesting that EVD may have a lasting effect on the nervous system. Limitations included small sample size and reliance on participant self-report. Our findings highlight the importance of long-term clinical monitoring of pediatric EVD survivors, given the potential impact on childhood development.

Sleep architecture, including spindles and slow oscillations, is disrupted in Alzheimer disease (AD). How changes in these sleep elements relate to cognitive decline is less clear. Our objectives were to examine changes in sleep macroarchitecture and microarchitecture in early clinical stages of AD compared with older adult controls (CTLs) and to investigate their associations with longitudinal cognitive change. This was both a cross-sectional and longitudinal study performed at Mass General Brigham Hospitals, where participants with early AD or CTLs underwent overnight ambulatory scalp EEG and longitudinal cognitive testing. We compared sleep microarchitectural features extracted from the EEG, including spindle activity, across the brain topography and between groups. We then performed longitudinal analyses using mixed-effects models to test the association of these sleep features with changes in cognition on the Montreal Cognitive Assessment (MoCA), collected annually for up to 7 years. AD (n = 47, mean age 74.1 years, 66% female) and CTL (n = 43, mean age 72.6 years, 56% female) groups spent a similar proportion of sleep time in each stage of sleep. Sleep efficiency, however, was lower in the AD group (mean: CTL 75.1% vs AD 70.9%; p = 0.034). We found a significant reduction in spindle range power (11-16 Hz) in patients with AD compared with CTLs, particularly in the temporal regions (mean normalized power at EEG channels T3/T4: CTL 3.13 ± 1.13 vs AD 2.48 ± 1.01; p = 0.005). In participants with longitudinal MoCA scores (AD = 26, CTL = 25), reduced temporal lobe spindle density (β = 0.61, 95% CI 0.35-0.87; false discovery rate [FDR]-adjusted p < 0.001) and temporal lobe spindle power (β = 0.56, 95% CI 0.22-0.88; FDR-adjusted p = 0.005) were each associated with a faster rate of cognitive decline. Temporal lobe sleep spindle activity is reduced in early clinical stages of AD and is associated with a faster rate of cognitive decline. Our results underscore the importance of including temporal lobe measurements when assessing sleep neurophysiology in AD, which is not standard in polysomnography. Future work examining the relationship between AD biomarkers and reduced spindle activity is needed to elucidate the potential mechanisms underlying these findings.

To evaluate brown adipose tissue (BAT) and white adipose tissue using Infrared Thermography (IRT) in children with different nutritional statuses and correlate findings with anthropometric variables. This cross-sectional observational study assessed body composition via bioelectrical impedance (BIA), skin temperature (supraclavicular and abdominal) through IRT, and anthropometric variables such as neck (NC), waist (WC), and hip (HC) circumferences. Calculations included waist-to-hip ratio (WHR) and conicity index (CI). Statistical analyses were performed in SPSS 20.0, with normality checked by the Shapiro-Wilk and homogeneity by Levene tests. Groups (eutrophic, overweight, obese) were compared using Pearson's Chi-square for categorical variables, Kruskal-Wallis, and ANOVA tests for quantitative data. Correlations were analyzed using Spearman's method. The significance level was set at p ≤ 0.05. Of 160 participants, 116 children were analyzed (eutrophic: N = 58; overweight: N = 26; obese: N = 32). Significant differences were noted between the eutrophic and obese groups. Supraclavicular temperature negatively correlated with BIA variables (total body water, fat-free mass, body fat percentage). IRT demonstrated inverse correlations between BAT temperature and BMI, NC, WC, and HC, underscoring its potential in obesity risk analysis. IRT also offers quantitative assessments of BAT activity and may estimate body fat percentages, suggesting its relevance for monitoring adipose tissue function and metabolic effects of physical exercise.

Introduction: type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by chronic hyperglycemia, associated with increased oxidative stress (OS), defined as the imbalance between the production of reactive oxygen species (ROS) and antioxidant capacity. Aim: to evaluate and compare serum concentrations of OS markers in patients with T2DM, differentiating between those with and without microvascular complications. Materials and methods: an observational, cross-sectional, and analytical study. Patients diagnosed with T2DM and an apparently healthy control group were included. All participants underwent anthropometric assessments, as well as biochemical and oxidative stress determinations. Results: statistically significant differences were observed between the T2DM group and the control group in terms of body mass index (BMI), glucose, triglycerides, LDL cholesterol, VLDL cholesterol, glycosylated hemoglobin, malondialdehyde (MDA), advanced protein oxidation products (PAOP), nitric oxide (NO), total antioxidant capacity (TAC), and oxidative stress index (OSI). When analyzing subgroups of patients with T2DM according to the number of microvascular complications, significant differences were detected in BMI, glucose, triglycerides, VLDL cholesterol, and glycosylated hemoglobin. Likewise, when comparing patients without complications with those who had one or two microvascular complications, a significant difference in CAT levels was identified. Conclusions: the biomarkers MDA and PAOP show particular clinical utility in monitoring the redox status in patients with T2DM, especially in the presence of microvascular complications, which supports their potential inclusion in personalized therapeutic and nutritional strategies.

Interstitial lung disease (ILD) encompasses pulmonary disorders characterised by varying degrees of inflammation and/or fibrosis. The presence and extent of these pulmonary abnormalities on (high-resolution) computed tomography (CT) have consequences for diagnosis and treatment; however, inter-observer assessment varies. Analysis of exhaled volatile organic compounds (VOCs) through gas chromatography-mass spectrometry (GC-MS) offers a noninvasive approach to biomarker discovery and pathophysiology understanding. Our study aims to explore the ability of GC-MS-driven exhaled breath analysis to differentiate ILD patients with predominant fibrotic, inflammatory, or a combination of fibrotic and inflammatory pulmonary abnormalities in a training and an external validation cohort. In a multicentre cross-sectional study, patients diagnosed with ILD were recruited. After central review of chest CT scans by independent radiologists, patients were categorised as fibrotic, inflammatory or mixed phenotype group based on the percentage of chest CT scan abnormalities. Breath samples were collected and analysed via GC-MS. Significantly different VOC fragments between groups were selected and used to differentiate groups in the training cohort with sparse partial least squares discriminant analysis. Analyses were validated with patients from an external cohort. 53 patients were included, 21 patients in the fibrotic, 14 in the inflammatory and 18 in the mixed phenotype group. Area under the curve (AUCs) for discrimination between groups ranged from 0.89-1.00 in training cohorts. An attempt to confirm these findings in our external validation cohort resulted in AUCs of 0.63-0.84. Re-evaluation of the training model led to an AUC of 0.78-0.83. This study shows that GC-MS driven exhaled breath analysis towards differentiation of ILD phenotypes is challenging. Current findings emphasise the importance of predefined validation steps during the process of biomarker discovery.

BackgroundThe emergence of artificial intelligence (AI) is driving digital transformation and reshaping medical education in China. Numerous medical schools and institutions are actively implementing AI tools for case-based learning, literature analysis, and lecture support. This expanding application is accelerating the adoption of localized AI platforms, which are poised to become integral components in the coming years.ObjectiveThe primary aim of this study was to investigate the current use of AI tools among medical students, including usage frequency, commonly used platforms, and purposes of use. The second aim was to explore students’ needs and expectations toward AI-powered medical education platforms by collecting and assessing student feedback, and to identify practical requirements across disciplines and academic stages to inform more effective platform design.MethodsBased on the task-technology fit model and 5 hypotheses, an anonymous online questionnaire was conducted to assess AI usage in learning, gather student feedback on AI-powered medical education platforms, and evaluate expected functionalities. The survey was conducted from March 1 to May 31, 2025, using a convenience sampling method to recruit medical students from various disciplines across Shanghai, China. The sample size was determined at 422, accounting for a 10% rate of invalid responses. The questionnaire was developed and distributed online via Wenjuanxing and promoted through WeChat groups and in-person interviews. Data analysis was conducted employing IBM SPSS Statistics (v 27.0).ResultsA total of 428 valid questionnaires were collected. The average frequency of AI-assisted learning among medical students was 5.06 (SD 2.05) times per week. Over 90% (388/428) of the students used more than 2 AI tools in their daily tasks. Students from different disciplines, educational stages, and academic systems demonstrated different usage patterns and expectations for AI-powered medical education platforms.ConclusionsAI technology is widely accepted by medical students and is extensively applied across various aspects of medical education. Significant differences are observed in usage patterns across disciplines, educational stages, and academic systems. Understanding the actual needs of students is crucial for the construction of AI-powered medical education platforms.

The Effects of Medicaid Payment and Payment-to-Cost Ratio on Nursing Home Five-Star Quality Ratings.

This study aimed to investigate the association between body composition and lung function. Metabolic body composition can independently predict the risk of poor lung function. Accordingly, this cross-sectional observational study included adults aged ≥18 years who attended annual health examinations at Xiamen Chang-Gung Hospital from 2013 to 2016. The study evaluated the association between lung function and metabolic body composition, after correcting for possible influencing factors. Males had a higher body mass index and waist-to-hip ratio and a higher prevalence of smoking and drinking histories. Additionally, men showed significantly higher mean arterial pressure, fasting blood glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, insulin, and homeostasis model assessment for insulin resistance values than those of women (all p < 0.001). The proportion of metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) was also higher in men than in women (17.91% vs. 25.20% and 11.28% vs. 13.67%, respectively). However, female participants demonstrated better pulmonary function. The prevalence of restrictive lung disease (RLD) was substantially higher in men than in women. The study findings suggest that MUO, and to a lesser extent, metabolic obesity with normal weight (MONW), are independent risk factors for RLD. These results imply that MUO, and to a lesser extent, MONW, may serve as potential screening markers for preclinical RLD in annual health checkups.

Delayed hospital arrival after 4.5 hours of stroke onset excludes patients from intravenous thrombolytic therapy. In the United States, prehospital triage is regulated by each state. Understanding race- and ethnicity-specific prehospital delays in each state could guide targeted interventions. This cross-sectional study examined adult patients treated at the GWTG (Get With The Guidelines)-Stroke participating hospitals from January 2021 to August 2023 for acute ischemic stroke. The outcomes, including onset-to-arrival >4.5 hours, onset-to-911 call >2.5 hours, and 911 call-to-arrival >1 hour by race and ethnicity and state, were examined using multivariable logistic regression analysis adjusting for patient and hospital-level characteristics. The study included 691 689 patients with a median age of 71 years and 48.6% women. Compared with White patients, risk-adjusted odds of onset-to-arrival >4.5 hours were higher in Asian patients (1.24 [95% CI, 1.20-1.28]), Black patients (1.18 [95% CI, 1.16-1.19]), and Hispanic patients (1.10 [95% CI, 1.07-1.12]); onset-to-911 call >2.5 hours was higher among Black patients (1.21 [95% CI, 1.16-1.26]); and 911 call-to-arrival >1 hour was lower among Asian (0.55 [95% CI, 0.49-0.63]), Black patients (0.67 [95% CI, 0.62-0.72]), and Hispanic patients (0.69 [95% CI, 0.63-0.75]). Relative to Texas, which has the highest racial and ethnic diversity index, the odds of onset-to-arrival >4.5 hours were higher in 20 states for non-White patients and 9 states for White patients. Delayed hospital arrivals are more prevalent among Asian, Black, and Hispanic patients, but emergency medicine service transportation times are shorter, suggesting the need for culturally tailored community stroke education. A few states have exceedingly high delayed arrival, highlighting an opportunity to improve state-wide stroke readiness and emergency medicine service triage.

Impact of 1 year of gender-affirming hormone therapy on bone mineral density in adults with gender incongruence: a cross-sectional study.

Motivators for sexual activity among women who are cancer survivors: a cross-sectional study.

BackgroundBiomedical research studies are increasingly using digital tools to enroll, recruit, and collect data from participants. However, variability in digital literacy and technological acceptance can be challenging for recruitment from groups traditionally underrepresented in research, including those served by Federally Qualified Health Centers.ObjectiveThis study aimed to (1) measure participant accessibility and comfort with digital platforms and (2) examine the interrelation of technology access, digital literacy, and support preferences during enrollment and data submission.MethodsA cross-sectional analysis was conducted using enrollment data from Federally Qualified Health Centers participating in the All of Us Research Program. Participants had the option of High-Touch (staff-assisted) or Low-Touch (self-directed) support for enrollment and survey completion. Survey items assessed internet access and technology comfort, while support type was recorded by the research staff based on participants’ actual selection. Logistic regression models evaluated relationships between technology access, comfort, and enacted support type, while controlling for age, consent language, and education, as well as race and ethnicity.ResultsThe analytic sample included 605 participants. The majority reported access to the internet (539/605, 89.1%) and felt comfortable with technology (448/605, 74.1%). In the group requesting High-Touch support (n=346), 14.5% (n=50) reported no internet access, and 31.5% (n=109) felt uncomfortable with technology. In the group requesting Low-Touch support (n=259), 6.2% (n=16) had no access to the internet, and 3.9% (n=10) reported feeling uncomfortable (P<.001). In the adjusted models, much greater comfort with technology was significantly correlated with reduced odds of requesting High-Touch support (comfortable: adjusted odds ratio 0.118, 95% CI 0.055‐0.255 and neutral: adjusted odds ratio 0.212, 95% CI 0.077‐0.587), but internet access was not significantly correlated.ConclusionsThe strongest predictor for support preference for digital enrollment among the participants was their comfort with technology rather than access alone. These findings illustrate the significance of participant-centric design methods coupling adaptive support paths, mixed enrollment strategies, and individualized onboarding methods aligned with digital confidence to promote equitable engagement in precision health research.

Heterogeneous Associations Between Community Social Capital and Loneliness: A Cross-sectional Study in 2019