Objective To evaluate the causal relationship between air pollution and erectile dysfunction (ED). Methods This study was evaluated by the method of double sample Mendelian random grouping (MR). The exposure data were from the GWAS data set of British biological bank (n = 461). Results the data were integrated into three cohorts (223805 healthy controls and 6175 ED patients). Inverse variance weighted (IVW) analysis was mainly used, supplemented by Mr egger regression, weighted median and Cochran's Q test. One analysis was reserved for quality control, and Bonferroni correction was used for multiple tests. Results The increase of PM2.5 predicted by gene was significantly correlated with the increased risk of ED (IVW or = 1.65, 95% CI = 1.12 – 2.43, P = 0.010), which was still significant after Bonferroni correction (p < 1.67 × 10–2) After adjusting for confounding factors, multivariate MR analysis confirmed that PM2.5 had an independent causal effect on ed. Mr egger regression showed no horizontal pleiotropy (intercept P > 0.05), and no heterogeneity or abnormal single nucleotide polymorphisms were found. Conclusion This is the first genetic evidence that PM2.5 is an independent risk factor for ED. it is emphasized that air pollution control is the key public health strategy for global ed prevention.

ABSTRACT Introduction Corporoplasty is typically accompanied by circumcision to prevent complications such as phimosis, foreskin edema, and necrosis, yet supporting evidence is limited. We reassessed the need for concomitant circumcision by quantifying postoperative phimosis and exploring associated comorbidities. Methods In this single-centre retrospective cohort study, 69 of 191 men who underwent corporoplasty between 2010 and 2023 met predefined criteria. Patients with incomplete records, refusal to participate, or loss to follow-up were excluded. Data collection involved the administration of a questionnaire to patients, supplemented by data retrieved from medical databases. The median age was 55 years (range 17–70 years). Results 48 of 69 patients did not undergo circumcision either before or during the corporoplasty. Only 3 out of the 48 patients (6.25%) developed post-surgical phimosis. No post-surgical foreskin necrosis were reported. A relevant finding was type2 diabetes mellitus as a significant risk factor for post-surgical phimosis (p < 0.0038). Additionally, the negative impact of the degree of curvature on post-surgical glans penis sensitivity was identified (p = 0.027). Conclusion Our findings advocate against the obligatory practice of circumcision performing corporoplasty. Nonetheless, our results emphasize the importance of counseling patients with type2 diabetes mellitus due to their heightened susceptibility to post-surgical phimosis development.

Knowledge about dementia risk influences preventive behaviours, yet has been primarily explored as risk factor awareness. This study investigated the understanding of dementia prevention by systematically assessing general dementia risk knowledge and participants' capacity to recognise specific evidence-based dementia risk mitigation strategies and identify common misconceptions about purported mitigation strategies. This cross-sectional study used the Knowledge of Dementia Risk Reduction survey instrument to assess dementia literacy. The multi-component instrument assesses general knowledge about dementia risk, recognition of mitigation strategies for risk factors and the ability to appraise specific common misconceptions. Items were generated from a literature review and expert consultation. The instrument was administered to participants of an Australian online public health cohort study into dementia risk self-management. Participants numbered 3334 and had a median age of 62 years. Most (72.5%) identified as female; 44.5% had a university education, and 49.1% had a family history of dementia. Most participants (79.5%) agreed that you can reduce your chances of developing dementia. The most recognised mitigation strategies included increased physical activity, social activity and cognitive stimulation, with one-quarter of participants unsure about the management of cholesterol and adoption of a Mediterranean diet. Scores for general dementia risk knowledge and recognition of modifiable risk reduction were midrange and moderately correlated with each other. Correct appraisal of common misconceptions; for example, that aluminium exposure is a risk factor, was poor; only 5.0% of participants scored a midrange score (6/12) or higher, and only 0.2% of participants correctly identified all misconception items. The study highlights the additional insights offered by simultaneously assessing multiple components of dementia risk literacy. Participants in the study demonstrated some knowledge of dementia risk and risk factor mitigation strategies, but had a poor appraisal of common misconceptions. Such insights can inform risk reduction messaging and enable more effective public health campaigns for future risk mitigation.

NDUFAB1 promotes hepatocellular carcinoma progression by disrupting mitochondrial homeostasis and mitophagy pathway.

This study investigates early life trauma as a predictor of adverse outcomes in adult functioning, with specific attention to the moderating influence of social media. Using survey data from 102 participants, the research examines relationships between multiple trauma indicators such as verbal abuse, physical abuse, and neglect, and adult outcomes including self-reflection, emotional regulation, and perceptions of digital platforms. Descriptive analyses, correlation tests, and regression models are used to assess both direct effects and interactive patterns. Results suggest that verbal trauma and physical trauma differentially predict adult outcomes, with distinct pathways influencing reflection and emotional impact. Furthermore, social media engagement emerges as a critical factor, shaping how adults interpret and respond to earlier adverse experiences. These findings underscore the complex role of social media as both a risk factor and a protective factor. Implications highlight the need for trauma-informed care, emphasizing clinical sensitivity to diverse forms of early adversity. Additionally, the study points to the importance of digital literacy interventions, equipping individuals with skills to navigate online environments in ways that reduce harm and foster healthier psychosocial adjustment.

Multifunctional macrophage membrane biomimetic nanoparticles for targeted therapy of neovascular age-related macular degeneration.

Risk factors associated with hearing loss in neonates: A retrospective cross-sectional study from Qatar

A cross-sectional study on prevalence and risk factors of nutritional anemia in students of Bacha Khan University, Charsadda, Pakistan

To determine population attributable fractions (PAFs) of modifiable dementia risk factors by income, and independent and interactive associations of race-ethnicity and income with each risk factor and cumulative number of midlife risk factors. This nationally representative cross-sectional study of the 1999-2008, 2011-2014, and primarily the 2015-2018 National Health and Nutrition Examination Surveys comprised of individuals aged 18-44, 45-64, and 65+ years for early-life, midlife, and late-life analyses, respectively. Income was operationalized using the poverty-income ratio. The primary outcomes were PAFs and prevalence ratios (PR) of the 13 individual-level dementia risk factors and cumulative number of midlife risk factors. There were 13,145 individuals with risk factor data between 2015 and 2018 (51.1% aged 18-44, 31.0% aged 45-64, and 17.9% aged ≥65 years; 51.5% female after survey-weighting). Higher income was associated with lower prevalence of each dementia risk factor except obesity, high LDL, and TBI. The highest PAF for those with incomes <100% of the federal poverty level was late-life vision loss (20.9%, 95% CI 16.8%-25.2%). Higher income was associated with lower number of midlife risk factors (PR: 0.91, 95% CI 0.89-0.94). Race-ethnicity categories historically-underrepresented in dementia studies were associated with midlife diabetes, obesity, physical inactivity, and late-life vision loss. Lower income and historically underrepresented race-ethnicity categories are associated with many dementia risk factors. Dementia prevention efforts may be more successful by targeting modifiable risk factors in these higher-risk populations.

Patients with congenital heart disease (CHD) remain at high risk for morbidity and mortality when undergoing noncardiac procedures. Existing studies have utilized national databases focusing on mortality or are limited by small data sets from single institutions. Through a multi-institutional registry study, the primary aim was to describe the incidence of intraoperative cardiac events in patients with CHD undergoing noncardiac procedures. The secondary aim was to describe the risk factors associated with the events. Patients with CHD from birth to 21 yr undergoing noncardiac procedures between January and December 2021 were identified at all participating centers. The primary outcome was occurrence of an intraoperative cardiac event at each encounter, defined as the composite of intraoperative hemodynamic instability, cardiac arrest, and pulmonary hypertensive crisis. The final analysis involved 4,343 unique patients at 7 centers undergoing 6,455 procedures. Among the cohort, 335 of 6,455 procedures involved an intraoperative cardiac event (5.2%) in 296 unique patients. The most common event was hypotension (n = 315, 4.9%); there were 12 occurrences of cardiac arrest (0.2%). Univariate analysis showed multiple factors associated with an increased likelihood of intraoperative cardiac events including patient and procedure characteristics, cardiac disease severity, and anesthetic management. Examples of patient characteristics included prematurity (odds ratio, 1.34; 95% CI, 1.02 to 1.76; P = 0.038); gastrointestinal (odds ratio, 1.51; 95% CI, 1.15 to 1.99; P = 0.003) or respiratory (odds ratio, 2.12; 95% CI, 1.62 to 2.76; P < 0.001) chronic medical conditions; preoperative ventilatory support (odds ratio, 3.88; 95% CI, 2.8 to 5.38; P < 0.001); concurrent respiratory illness (odds ratio, 2.18; 95% CI, 1.47 to 3.2; P < 0.001); major CHD (odds ratio, 2.09; 95% CI, 1.54 to 2.83; P < 0.001); and severe CHD (odds ratio, 3.48; 95% CI, 2.47 to 4.91; P < 0.001). Pediatric patients with severe CHD, those undergoing emergency procedures, and those undergoing surgical interventions were at higher risk of not only mortality as shown previously but also hemodynamic instability. These are established risk factors for intraoperative cardiac events and should be considered when planning risk mitigation strategies.

Erdheim-Chester disease (ECD) is a rare systemic histiocytic neoplasm, with cardiac morbidities, including cardiovascular (CV) risk factors and cardiac conditions, playing a significant yet poorly understood role in the disease burden. This study evaluated the prevalence, characteristics, and prognosis of ECD in patients with (ECD-C) and without cardiac involvement (ECD-noC) and compared the burden of cardiac morbidities with matched controls. Patients diagnosed with ECD between 1990 and 2021 at a tertiary center were included, with cardiac involvement centrally assessed using radiographic studies. Cardiac morbidities were compared with a control group without ECD, matched for age, sex, body mass index, and smoking history. Among 104 patients with ECD, 39 (37%) had cardiac involvement. Patients with ECD-C had higher rates of hypertension (67% vs 46%), hyperlipidemia (67% vs 40%), heart failure (36% vs 8%), and pericardial effusion (28% vs 2%) than those with ECD-noC. Compared with the matched non-ECD cohort, patients with ECD had higher prevalence of coronary artery disease (20% vs 7%), heart failure (18% vs 4%), and antihypertensive drug use (55% vs 40%). Notably, patients with ECD-C had inferior progression-free survival (PFS) from frontline therapy compared with patients with ECD-noC (5-year PFS, 28.3% vs 70.5%). These findings highlight the burden of CV risk factors and cardiac conditions in ECD, even without a clinical diagnosis of ECD-C. Importantly, this cardiac morbidity burden is substantial for patients with ECD-C compared with ECD-noC. Our findings highlight the need for comprehensive cardiac risk assessment and management strategies to improve patient outcomes.

In pediatric patients, gallbladder polyps (GBPs) are lesions that are usually found incidentally on ultrasonography, which is the first-line modality for diagnosis. Though common in adults, GBPs are rare in children, and their prevalence remains unclear. Most GBPs in children are benign, and although the risk of malignancy is influenced by polyp size, growth rate, and morphology, specific criteria for the pediatric population are lacking. Management, therefore, is based on adult guidelines, with cholecystectomy being recommended only in symptomatic patients and for rapidly enlarging or 10-mm polyps and those with unfavorable morphology to avert the risk of malignant transformation, while surveillance is applied to asymptomatic patients with smaller polyps. Further research is needed to develop pediatric-specific guidelines for the management of GBPs. This review discusses the classification, diagnosis, risk factors, and management of pediatric GBPs.

BACKGROUND Traumatic brain injury (TBI) is the second most common presentation of trauma victims. Among the various non-neurological complications after TBI, acute kidney injury (AKI) is not uncommon. AIM To establish the incidence, risk factors, and predictors of AKI in TBI victims. The secondary aim was to study the impact of AKI development on the outcomes of patients with TBI. METHODS This was a single-center retrospective cohort study of TBI victims with a Glasgow coma scale (GCS) ≤ 11 in an apex trauma center in a metropolitan city. RESULTS The incidence of AKI after TBI was 11%. The risk factors for AKI after TBI were old age (P &lt; 0.001), comorbidities (P = 0.023), shock (P &lt; 0.001), blood transfusion (P = 0.016), consecutive neurosurgical intervention (P = 0.029), high intracranial pressure (ICP) (P &lt; 0.001), rhabdomyolysis (P &lt; 0.001), and diabetes insipidus (P &lt; 0.001). The predictors of AKI after TBI were, on point-biserial correlation: Lower GCS (rpb = -0.27, n = 331, P &lt; 0.001); and on multivariate logistic regression: (1) Shock (odds ratio [OR]: -11.94, P &lt; 0.001); (2) Rhabdomyolysis (OR: -7.33, P = 0.001); (3) High ICP (OR: -4.39, P = 0.018); (4) High Carlson comorbidity index (OR: -1.97, P = 0.001); and (5) High acute physiology and chronic health evaluation-2 (APACHE-2) score (OR: -1.13, P &lt; 0.001). The phenomenon of post-TBI AKI increased the extent of stay in intensive care unit (P = 0.008), demand for ventilators (P = 0.0170), ventilator days (P &lt; 0.001), incidence of brain death (P &lt; 0.001), and mortality (P &lt; 0.001). CONCLUSION Every tenth TBI victim suffers from AKI. AKI after TBI can be predicted by the patient's underlying comorbidities, on arrival low GCS, high APACHE-2 score, shock, rhabdomyolysis, and high ICP. The occurrence of AKI in TBI victims adversely affects outcome variables; however, this may be a reflection of the severe nature of TBI in the AKI group. New research is needed to understand the effects of AKI on outcome variables.

Heavy alcohol use (HAU) is a modifiable risk factor that may influence intracerebral hemorrhage (ICH) severity and cerebral small vessel disease (cSVD), but its role remains insufficiently understood. We aimed to investigate how HAU is associated with acute ICH characteristics and cSVD burden. In this cross-sectional study, we analyzed prospectively collected data from consecutive patients admitted with spontaneous, nontraumatic ICH to Massachusetts General Hospital between 2003 and 2019. HAU was defined as regular alcohol consumption of ≥3 drinks per day. Multivariable regression models assessed associations between HAU and acute ICH clinical and radiologic features and MRI markers of cSVD. Among 1,600 patients (851 male patients [53%]; median age 75 [interquartile range 64-82] years), 104 (7%) met criteria for HAU. Compared with the non-HAU cohort, patients with HAU were significantly younger at ICH onset (median 64 vs 75 years; p < 0.001) and had larger hematoma volume (1.7-fold increase, p = 0.005) and greater odds of deep hemorrhage location (adjusted odds ratio [aOR] 2.01; 95% CI 1.11-3.64; p = 0.021) and intraventricular extension (aOR 1.95; 95% CI 1.02-3.70; p = 0.045). Among 1,195 patients with MRI (75%), analysis of markers of cSVD showed that HAU was independently associated with severe white matter hyperintensities (aOR 3.04; 95% CI 1.43-6.49; p = 0.004) and a hypertensive cSVD pattern (aOR 1.82; 95% CI 1.04-3.20; p = 0.035). No other MRI markers of cSVD were associated with HAU. HAU was also associated with lower platelet counts (β = -17.73; 95% CI -32.75 to -2.72; p = 0.021) and higher admission blood pressure (β = 4.81; 95% CI 0.06-9.56; p = 0.047). HAU is associated with younger age at ICH onset, larger hematoma size, and imaging features consistent with more advanced hypertensive cSVD, including a greater burden of white matter hyperintensities. These findings suggest that HAU may exacerbate acute ICH severity and accelerate long-term cerebral small vessel pathology. Study limitations include the cross-sectional design, MRI availability restricted to a subset, and lack of detailed lifetime alcohol exposure. Future studies should clarify alcohol-related mechanisms underlying cSVD progression and ICH severity and inform prevention strategies.

Congenital hypothyroidism (CH) is a prevalent childhood endocrine disorder associated with irreversible neurological consequences. Its global incidence is on the rise. To estimate CH incidence in Jordan and assess the potential utility of incorporating (fT4) measurements into the screening process. This retrospective analysis examined thyroid function test results for infants born at our center between 2016 and 2020. Infants born before 28 weeks and those screened after 14 days of life were excluded. Screening occurred between days 3 and 7 of life, and thyroid-stimulating hormone (TSH) and T4 levels were measured concurrently from peripheral venipuncture blood samples. A TSH cutoff of < 5 mIU/L was considered normal. Values between 5 and 20 mIU/L were equivocal, requiring repeat tests. TSH levels exceeding 20 mIU/L were considered critical. A total of 10521 infants were included in the study, and 26 were diagnosed with CH, yielding an incidence of 1 in 400 live births. Females constituted 57.7% of CH cases. All CH cases had initial TSH values exceeding 5.0 mIU/L, with clustering above 20 mIU/L. Six CH infants had Down syndrome, accounting for 23.1% of CH cases. Our study revealed a high incidence of CH in Jordan, marking a significant increase from previously reported rates. We recommend a national study to investigate risk factors and underlying causes of CH in our population. Furthermore, we advocate for the use of TSH alone with a cutoff value of < 5 mIU/L for screening purposes.

Prevalence, Awareness, and Treatment of Hypertension in 37 African Countries: Trends From 2003 to 2022.

Giant coronary artery aneurysms (CAA), entailing thrombosis, myocardial infarction, and sudden death, are the most severe and life-threatening complications of Kawasaki disease (KD). Giant aneurysms rarely regress and can later transform into stenoses. Data on dynamic follow-up are scarce in the literature. To evaluate clinical features and long-term outcomes of giant CAA in children with KD. A single-center retrospective study included data from patients with KD and giant CAA in the Irkutsk region (2012-2023). CAA criteria according to the American Heart Association guidelines of 2017 were used: (1) Dilated coronary artery with diameter Z-score > 2 standard deviations (SD) but < 2.5 SD; (2) Small CAA with Z-score > 2.5 SD but < 5 SD; (3) Medium CAA with Z-score > 5 SD but < 10 SD; and (4) Giant CAA with Z-score > 10 SD or ≥ 8 mm. The mean age of children with coronary dilatation/aneurysms was 2.5 years, and the male-to-female ratio was 3:1. Patients with giant/medium CAA had symptoms of cerebral dysfunction more often compared with children with moderate (Z-score < 5 SD but > 2.0 SD) coronary dilatation (62.0% vs 21.0%, P = 0.019). Major cardiovascular events (myocardial infarction, coronary artery bypass grafting, acute coronary syndrome, ischemic cardiomyopathy, left ventricular aneurysm, and giant extracardiac aneurysm) occurred in 55.5% of patients who had giant CAA. At follow-up the complete regression of giant/medium CAA was observed in 58.0% and partial regression in 42.0% after a mean of 2.3 and 5.5 years, respectively. All thrombi detected by echocardiography, CT, and angiography in giant/medium CAA disappeared between 1 year and 5 years (mean: 15 months). All patients survived. Risk factors for giant CAA were male sex, early age, and cerebral dysfunction. Complete regression of giant coronary aneurysms occurred in 58.0% of patients after follow-up of 2.3 years.

Editorial: Hypertension – a major modifiable and undertreated risk factor

Contralateral hinge fracture is one of the most common complications of medial opening wedge high tibial osteotomy (HTO), however, this complication has been poorly investigated after closing-wedge HTO (CW-HTO). The primary aim of this study was to describe the incidence and characteristics and propose a classification system of medial hinge fracture (MHF) after CW-HTO. The secondary aim was to identify demographic and surgical factors that predispose to MHF. Consecutive patients who underwent CW-HTO for varus malalignment performed at a single institution were retrospectively screened for eligibility. Preoperative data were retrieved from medical charts, while incidence and type of MHF were evaluated on postoperative X-rays. To determine risk factors for MHF, a series of univariate logistic regression were performed using demographic and radiological data as independent variables, using a generalised linear mixed model (GLMM). Variables that demonstrated a significant difference (p < 0.1) in univariate analyses were defined as independent variables and were used as covariates in a multivariate analysis with the same dependent variables RESULTS: A total of 137 knees were included in the study. The incidence MHF fractures was 57% and three distinct types of fractures were identified. The most common fracture type was the two fragment one, with its subtypes "linear" (31%), "distal" (9%) and "proximal" (8%). A "third fragment" MHF was identified in 7% of cases, while "intra-articular" pattern was observed in 2%. Multivariate analysis showed that increased distance between the end of the osteotomy line up until the medial tibial plateau and decreased length of the osteotomy line were significantly associated with higher probability of MHF: respectively OR (odds ratio) 2.8 [1.20-6.78] (p = 0.018) for the former and OR of 0.35 [0.16-0.77] (p = 0.009) for the latter. MHF is a common complication after CW-HTO, and all the risk factors appear to be related to the osteotomy line: higher MHF incidence was associated with an increased distance from the medial plateau and reduced depth of the cut. Both these parameters are clinically relevant as they are modifiable. Level IV.

Infective endocarditis (IE) remains a prevalent and high-risk condition despite advances in cardiac care. Increasing attention has been directed toward sex-based differences in physiological presentation, disease progression, and surgical management. This review synthesizes evidence on sex-specific differences in IE, with an emphasis on diagnosis, risk factors, disease manifestations, medical management, surgical intervention, and postoperative outcomes. While the incidence of IE is more than twice as high in men, women consistently experience worse outcomes. Women present at an older age, with greater comorbidity burden and greater delays in surgical referral. Postoperatively, women are at higher risk of complications - including embolic events, extended ventilation time, and intensive care unit stays - and have significantly higher short-term mortality. Long-term survival is comparable between sexes, suggesting disparities largely influence short-term outcomes. Awareness of sex-specific differences in risk factors, clinical presentation, intervention bias, complications, and outcomes of IE is essential for optimizing management and equitable care. Further research into sex-based pathophysiology, comorbidity management, and tailored perioperative strategies is critical to advancing patient-centered treatment and optimizing clinical outcomes.