Tag: pubmed

World J Surg Oncol. 2025 May 14;23(1):189. doi: 10.1186/s12957-025-03845-8.

ABSTRACT

BACKGROUND: Increasing evidence indicates that psychological factors play a role in tumor progression. This study aims to explore the impact of anxiety disorder on the prognosis of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) who underwent hepatic arterial infusion chemotherapy (HAIC).

METHODS: A propensity score-matching cohort study was conducted in 68 HCC patients with PVTT who underwent HAIC between January 2020 and December 2023. The anxiety situation was evaluated using the Hamilton Anxiety Rating Scale before HAIC. The objective response rate, overall survival (OS), progression-free survival, and adverse events were compared between the different anxiety score groups. Using Cox proportional hazards models for univariate and multivariate analysis to explore the risk factors of OS.

RESULTS: No statistical difference was found in the tumor response, treatment-related adverse events, and PFS between the two groups before and after PSM. Compared with low anxiety scores patients, the OS of obvious anxiety patients was shorter (hazard ratio [HR] = 1.606; 95%CI: 0.868-2.973; P = 0.116). The univariate and multivariate analysis showed that BMI (HR = 1.174, 95%CI: 1.044-1.320; P = 0.007), high anxiety score (HR = 2.769, 95%CI: 1.289-5.947; P = 0.007), and serum ammonia (HR = 1.059; 95%CI: 1.032-1.086; P < 0.001) were independent risk factors of OS.

CONCLUSIONS: Our study reveals that elevated anxiety scores in HCC patients with PVTT correlated with poor prognosis, indicating that it’s a potential prognostic marker. The high anxiety score, BMI, and serum ammonia were independent risk factors of OS.

PMID:40369614 | DOI:10.1186/s12957-025-03845-8

BMC Health Serv Res. 2025 May 14;25(1):697. doi: 10.1186/s12913-025-12749-y.

ABSTRACT

OBJECTIVES: This study aims to identify the dimensions and evolutionary pathways of China’s high-performing national healthcare system, as well as the interaction mechanisms between the digital and traditional healthcare dimensions.

METHODS: This study first constructs a high-performing healthcare evaluation index comprising four dimensions: digital healthcare, healthcare resource allocation, healthcare output, and healthcare effectiveness. It next presents a multilevel structural dynamic factor model to examine the evolutionary pathway of China’s national healthcare system. It then analyses the interaction mechanism of each healthcare dimension based on the impulse response function.

RESULTS: First, the upward trend in the overall performance of China’s high-performing national healthcare system demonstrates that it is significantly improving. Second, the overall performance of China’s high-performing national healthcare system has been most impacted by healthcare effectiveness and least impacted by healthcare output. The performance is trending upward for digital healthcare and healthcare resource allocation but downward for healthcare output and effectiveness. Third, increasing healthcare resource allocation and output promotes digital healthcare. The improvement in digital healthcare performance significantly and positively impacts healthcare effectiveness, while having weaker effects on healthcare resource allocation and healthcare output.

CONCLUSIONS: The performance of China’s high-performing national healthcare system is improving. However, healthcare resource allocation and health outcomes require further optimisation, and the integration capacity of traditional healthcare with digital healthcare must be strengthened.

PMID:40369605 | DOI:10.1186/s12913-025-12749-y

Exp Hematol Oncol. 2025 May 14;14(1):73. doi: 10.1186/s40164-025-00666-z.

ABSTRACT

Diagnosis-to-treatment interval (DTI) is an important prognostic factor in patients with newly diagnosed aggressive lymphomas, however the impact of DTI on outcomes in marginal zone lymphoma (MZL) is unknown. In this multicenter retrospective cohort study, we included adult patients with MZL who received first-line immunochemotherapy within 120 days of diagnosis at 10 US medical centers. Patients who received treatment within 60 days from their diagnosis were classified into the short DTI group and those who received treatment beyond 60 days into long DTI group. The primary objective was progression-free survival (PFS), while secondary objectives included overall survival (OS) and cumulative incidence of histologic transformation (HT) between the two groups. Of the 870 patients with newly diagnosed MZL, 177 patients met the inclusion criteria and were included in this analysis. Among these 144 (81%) were in the short DTI group and 33 (19%) in the long DTI group. In the univariable analysis, presence of B symptoms was associated with short DTI and remained significantly associated with short DTI in the multivariable analysis (OR = 11.91, p = 0.017). Short DTI was not associated with a statistically different PFS or OS compared to long DTI in the univariable or in multivariable analysis. The cumulative incidence of HT was not significantly different between the two groups. This is the first study to-date to report on the association of DTI on outcomes in MZL patients. This lack of prognostic utility of DTI in newly diagnosed MZL, in contrast to aggressive B-cell lymphomas, may be intrinsically linked to the underlying disease biology.

PMID:40369604 | DOI:10.1186/s40164-025-00666-z

BMC Nurs. 2025 May 14;24(1):526. doi: 10.1186/s12912-025-03201-x.

ABSTRACT

BACKGROUND: Nursing students often encounter ethical dilemmas throughout their professional training, which can pose challenges to their development. These dilemmas may lead to questioning professional values, hesitation during clinical practice, and even emotional fatigue. Therefore, reliable and valid tools are essential to assess and enhance their ethical decision-making abilities.

METHODS: Conducted as a methodological study, this research involved 233 nursing students from Manisa Celal Bayar University during November and December 2024. Data collection tools included the Ethical Decision-Making Competence Scale and the Inclination to Ethical Values Scale. Structural validity was analyzed using principal component analysis and confirmatory factor analysis, while internal consistency was assessed with Cronbach’s alpha.

RESULTS: The scale demonstrated acceptable model fit indices [χ2 (129) = 234.701, χ2/df = 3.295, GFI = 0.841, CFI = 0.900, IFI = 0.901, RMSEA = 0.096 (0.087-0.105)], with all factor loadings exceeding 0.4 and achieving statistical significance. Cronbach’s alpha values for the four dimensions were 0.865, 0.867, 0.868, and 0.886, indicating strong internal consistency. Furthermore, the test-retest analysis confirmed the scale’s stability over time, validating its use for repeated measurements.

CONCLUSION: Given its psychometric strengths, this tool can be effectively employed in future studies focusing on ethical decision-making competencies in nursing education.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40369595 | DOI:10.1186/s12912-025-03201-x

Reprod Biol Endocrinol. 2025 May 14;23(1):69. doi: 10.1186/s12958-025-01408-w.

ABSTRACT

BACKGROUND: The role of follicular fluid phosphate for reproductive health and oocyte maturation is unclear. This study investigates the relationship between follicular fluid vs serum phosphate concentrations and the possible link with sex steroids during in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at a Danish fertility clinic.

METHODS: A prospective cohort of infertile women who attended Danfert Fertility clinic (Copenhagen, Denmark) and received IVF or ICSI treatment between June 2015 and February 2017. Correlation analyses were performed with Spearman’s Rank or Pearson’s correlation, while categorical variables were analyzed with Chi-squared test.

RESULTS: In total, 110 participants were included in the study, and 33 of these achieved a live birth. Phosphate concentrations were higher in the follicular fluid compared to corresponding serum samples (1.16 mmol/L vs. 1.06 mmol/L, p = 0.002) and there was a positive correlation between serum and follicular fluid phosphate concentrations (r = 0.43, p = 0.007). A positive trend was also found for calcium concentrations, though not statistically significant (r = 0.31, p = 0.060). Correlation analysis also showed a positive correlation between concentrations of phosphate and calcium in follicular fluid (r = 0.41, p < 0.001). A positive correlation was observed between concentrations of phosphate and testosterone in follicular fluid (r = 0.34, p < 0.001). When stratified into tertiles, we found no significant differences between live birth rates in follicular fluid phosphate (p = 0.624), calcium (p = 0.207), or testosterone (p = 0.841).

CONCLUSIONS: This study found that follicular fluid phosphate concentrations are higher than serum phosphate concentrations, suggesting possible local regulation. However, no significant association was found between follicular phosphate and ART outcomes. Further research is needed to explore its potential role in reproductive physiology.

CLINICAL TRIAL: Clinicaltrials.gov (NCT02437578; registration date 2015/04/16).

PMID:40369590 | DOI:10.1186/s12958-025-01408-w

Cardiovasc Diabetol. 2025 May 14;24(1):209. doi: 10.1186/s12933-025-02770-0.

ABSTRACT

BACKGROUND: Recent basic biological research found that obesity accelerates biological aging and increases cardiovascular disease (CVD) risk. However, there is still a lack of real-world population evidence. This study aimed to explore the potential mediation roles of biological age acceleration in the associations between different dimensions of obesity characterization and incident CVD.

METHODS: This international multi-cohort study included participants aged over 45 years with 3 waves longitudinal data from China Health and Retirement Longitudinal Study (CHARLS). China Health and Nutrition Survey (CHNS) was used to develop Klemera-Doubal method-biological age (KDM-BA), and the validation analysis was performed in UK Biobank (UKB) and Hongguang Elderly Health Examination Cohort (HEHEC). Obesity indices including body mass index (BMI), waist circumference (WC), waist height ratio (WtHR), body roundness index (BRI) for body shape; Chinese visceral adiposity index (CVAI), lipid accumulation product (LAP) for visceral fat accumulation; triglyceride-glucose index (TyG) and its derivatives (TyG-BMI, TyG-WC, TyG-WtHR) for metabolic function were used to measure obesity across different dimensions. Biological age acceleration was evaluated by the classic KDM-BA acceleration (KDM-BAacc). Causal mediation analyses assessed the role of biological age acceleration in mediating obesity and incident CVD.

RESULTS: In CHARLS, the median follow-up period was 9.00 years, with a baseline age of 58 (52, 65) years. Obesity, KDM-BAacc, and CVD were all significantly associated with each other. For each 1-year increase in KDM-BAacc, the risk of incident stroke, heart disease and CVD increased by 68% (OR 1.68, 95% CI 1.35-2.09), 35% (OR 1.35, 95% CI 1.15-1.59), and 44% (OR 1.44, 95% CI 1.25-1.65), respectively. KDM-BAacc mediated the associations between BMI, WC, WtHR, BRI, CVAI, LAP, TyG-BMI, TyG-WC, TyG-WtHR, with CVD, with the mediation proportions ranging from 10.03 to 25.46%. However, the mediating effect was significant mostly in middle-aged individuals aged 45-65 years. Furthermore, sex differences existed in the mediation mechanisms. Biological age acceleration strongly mediated body shape indices and incident CVD in males, whereas in females, it predominantly mediated visceral fat accumulation and metabolic function dimensions with incident CVD. Similar main results were found in UKB and HEHEC.

CONCLUSIONS: Biological age acceleration partially mediates the relationship between obesity and incident CVD. This temporal evidence firstly validated the mediation pathway based on international cohorts, emphasizing the importance of addressing biological aging processes in population aged 45-65 years while providing sex-specific obesity intervention strategies to prevent CVD.

PMID:40369582 | DOI:10.1186/s12933-025-02770-0

BMC Health Serv Res. 2025 May 14;25(1):693. doi: 10.1186/s12913-025-12842-2.

ABSTRACT

BACKGROUND: Although Japan has successfully mitigated HIV infections, several issues related to the disease remain to be addressed. As the people living with HIV are aging, their medical care needs are expected to become more diversified and regionalized. Those residing beyond the boundaries of specialized hospitals will rely on general physicians for medical services. Hence, general physicians must have a non-discriminatory medical attitude toward people living with HIV and give more ethical consideration than for other diseases, such as privacy protection. Therefore, a nationwide survey was conducted to clarify the attitudes of general physicians, who do not specialize in HIV treatment, toward HIV and people living with HIV.

METHODS: An online questionnaire-based quantitative survey (February 14-16, 2022) yielded 212 valid responses. Questions covered proactivity in HIV care, attitudes toward ethical issues, and awareness of HIV in the context of stigmas. Although the sample size was small due to limited feasibility, similar populations were obtained in terms of distribution of mean age, gender, and type of practice, compared to official physician statistics.

RESULTS: Approximately 20% of respondents answered that refusing medical care due to HIV infection is acceptable. Younger physicians tended to be more negative toward HIV treatment, and, regardless of age, the negative attitude is correlated with aversion toward HIV infection itself.

CONCLUSIONS: The findings aligned with concerning situations in Japan highlighted by other studies. They also suggested that more careful attitudes may be needed regarding the protection of the privacy of people living with HIV. However, research has also suggested that some physicians could become more positive by providing specialist support for the treatment and prevention of HIV infection. Large-scale and ongoing surveys are imperative to continuously implement effective and reliable interventions that could change the attitudes of general physicians toward people living with HIV.

PMID:40369576 | DOI:10.1186/s12913-025-12842-2

Eur J Surg Oncol. 2025 Apr 12;51(8):110023. doi: 10.1016/j.ejso.2025.110023. Online ahead of print.

ABSTRACT

Axillary surgery for breast cancer has seen significant de-escalation in the past three decades. The ACOSOG Z0011 trial suggested that completion axillary clearance was not necessary in women with low disease burden after sentinel node biopsy (SLNB). Flaws in the design of the trial undermined confidence in its findings which delayed widespread adoption and caused practice heterogeneity globally. This systematic review evaluated the impact of Z0011 (and similar trials) on the rate and extent of axillary conservation in women with node-positive, low-risk early breast cancer. A search was conducted on the Ovid MEDLINE, Scopus, Web of Science and COCHRANE databases. Screening of titles and abstracts was undertaken according to eligibility criteria. Data were quality assessed using the ROBINS-1 and Robvis tools. The review retrieved 1362 papers, of which 30 papers were included, representing data from 290,754 women across nine countries. All articles were retrospective cohort studies. Included studies showed a statistically significant downward temporal trend in rates of ALND following the publication of the Z0011 trial but the extent of change ranged from a 5.6 %-73.4 % reduction in axillary clearance rates. This review demonstrated the Z0011 trial has been practice-changing. However, it also identified that few patients are eligible for de-escalation due to tight inclusion criteria. Finally, most articles were from Western countries, from research-focused hospitals, which limits generalizability. Further research across a wider range of settings is needed to understand the extent to which Z0011 has been implemented globally.

PMID:40367641 | DOI:10.1016/j.ejso.2025.110023

Child Abuse Negl. 2025 May 13;165:107492. doi: 10.1016/j.chiabu.2025.107492. Online ahead of print.

ABSTRACT

BACKGROUND: International evidence-based best practice for police interviewers of vulnerable groups, such as Indigenous populations, recommends encouraging interviewees to give a full uninterrupted account, followed by open-ended questions, to optimise memory and avoid contaminating information. However, most research examining the applicability of interview strategies on information gain has been conducted in western cultures.

OBJECTIVE: There is currently little extant quantitative research on questioning in police interviews with Indigenous complainants. The primary objective of this research was to examine whether international standards for interviewing vulnerable groups for legal purposes are transferable to an Indigenous population.

PARTICIPANTS AND SETTING: Police interviews with complainants reporting historical childhood sexual abuse [HCSA] as adults in a northern Canadian territory with an Indigenous population (N = 45 interviews) were examined.

METHODS: Interviews were coded for types of questions, answers, and investigation-relevant details reported. Frequency distributions were calculated for each dependent variable, and further inferential statistics were conducted using t-test, chi square, and one-way ANOVA analyses, to examine the possible effect of question types on the elicitation of certain answer and detail types.

RESULTS: Results showed a statistically significant difference in the mean number of overall details elicited (d = 0.29), with questions classed as productive eliciting more details compared to unproductive questions. Specifically, open-ended questions elicited the most details, including both overall details and abuse relevant details.

CONCLUSIONS: Although these results should be considered exploratory, the international guidance on interviewing vulnerable groups was found to be applicable to this Indigenous population.

PMID:40367620 | DOI:10.1016/j.chiabu.2025.107492

Ecotoxicol Environ Saf. 2025 May 13;298:118272. doi: 10.1016/j.ecoenv.2025.118272. Online ahead of print.

ABSTRACT

OBJECTIVE: Endocrine-disrupting chemicals (EDCs) can interfere with endocrine function and lead to neurological damage. Neurofilament light chain (NfL) is a protein released into the blood after neuroaxonal damage, and it has become a dependable biomarker for neurological conditions. The study aimed to investigate the associations between single or combined EDCs exposure and serum NfL levels in adults.

METHODS: The 1372 participants included in the study were from the 2013-2014 National Health and Nutrition Examination Survey. Due to the difference in types of EDCs, participants were divided into two populations. Multiple linear regression models were used to assess the association between 32 EDCs and NfL. The least absolute shrinkage and selection operator regression model was used for EDCs selection and the weighted quantile sum (WQS) regression was used for examining the association of EDCs mixture with NfL and identify the predominant exposure.

RESULTS: Levels of urinary bisphenol S, mono(2-ethylhexyl) phthalate, dibutyl phosphate, glyphosate, and 3,5,6-trichloropyridinol were positively associated with serum NfL levels, while benzophenone-3, methylparaben, and propylparaben showed negative associations. In the WQS regression model, the changes of NfL were 0.154 (95 % CI: 0.014-0.294) and 0.164 (95 % CI: 0.033-0.296) for each quartile increase in WQS index of EDCs mixture in the two populations, respectively. Analysis of the subgroup with gender stratification suggested that the association between EDCs mixture and NfL was only significant in men. The positive mixture β was 0.219 (95 % CI: 0.056-0.380) and 0.257 (95 % CI: 0.082-0.433) in the two population, respectively.

CONCLUSION: The study suggested a potential association between single or combined exposure to EDCs and NfL levels. High-level EDCs exposure might be associated with more severe neurological damage, particularly in men.

PMID:40367613 | DOI:10.1016/j.ecoenv.2025.118272