PLOS ONE Alerts: New Articles

Rates of childbirth in female cancer survivors: A population-based study in Taiwan

2026-09-11T14:00:00Z

by Ya-Ling Hsieh, Chia-Jung Chiang, Tsung Yu

Background

As cancer survival improves, increasing numbers of women diagnosed during their reproductive years face potential fertility impairment. However, population-based evidence on post-cancer childbearing remains limited in Asian settings.

Methods

We conducted a nationwide cohort study in Taiwan by linking the Cancer Registry, Birth Reporting Registry, and Death Registry. A total of 72,929 females diagnosed with cancer at age ≤ 39 years were followed to identify subsequent livebirths. The cumulative incidence of first post-diagnosis livebirth was estimated using competing-risk methods. Predictors were evaluated using cause-specific Cox models. Standardized birth ratios (SBRs) were calculated by comparing observed births with expected births in the general population, standardized by age and calendar year.

Results

Overall, 9.8% of female cancer survivors had at least one livebirth after diagnosis. The 5-, 10-, and 15-year cumulative incidences were 6.4%, 10.7%, and 13.9%, respectively. Compared with the general population, survivors had approximately half the expected number of births (SBR = 0.50; 95% CI, 0.49–0.51). Substantial heterogeneity was observed across cancer types: childbirth was most preserved among survivors of thyroid and skin cancers, whereas those with cervical, uterine, breast, leukemia, and central nervous system cancers had markedly reduced childbirth. Older age at diagnosis and receipt of chemotherapy were strongly associated with lower likelihood of childbirth.

Conclusions

In this large, nationwide study, female cancer survivors in Taiwan experienced substantially reduced childbirth rates, with pronounced variation by cancer type, age at diagnosis, and treatment. These findings provide robust population-level evidence from an Asian context and highlight the need for early fertility counseling and improved access to oncofertility care.

Levofloxacin-associated tendon disorders: Sex-, age-, and route-specific disproportionality analysis using FAERS and JADER

2026-09-11T14:00:00Z

by Toshihisa Nakashima, Yoshihiro Noguchi, Rikuto Masuda, Tomoaki Yoshimura

This study evaluated the association between individual fluoroquinolones and tendon disorders in Japan using two spontaneous reporting systems: the Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER). Five agents—ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin—were analyzed for “Muscle, tendon and ligament injuries” and “Tendon disorders.” All fluoroquinolones showed positive signals in the FAERS, whereas only levofloxacin demonstrated consistent and robust associations in the Japanese subset of the FAERS and the JADER. In the JADER, levofloxacin exhibited strong signals for muscle, tendon, and ligament injuries (reporting odds ratio [ROR] 30.6, information component [IC] 4.5) and tendon disorders (ROR 134.2, IC 5.8). Stratified analysis revealed markedly stronger signals in males, particularly those aged ≥70 years (relative ROR 12.21 and 25.67; IC delta 3.18 and 2.85, respectively). Oral levofloxacin was associated with higher reporting odds than intravenous administration. Time-to-onset analysis indicated that most tendon-related adverse events occurred within 14 days after drug initiation. Levofloxacin exhibited the most consistent and robust association with tendon disorders, especially in males aged ≥70 years in Japan. Therefore, clinicians in Japan should exercise caution when prescribing levofloxacin to older male patients.

Correction: “The system is obviously bonkers”: The APC Trap and the bind of scholarly publishing across four research intensive institutions in the U.S.

2026-09-11T14:00:00Z

by Melissa H. Cantrell, Rachel Caldwell, Jennifer A. Mezick, Matthew Estill, Lauren B. Collister

Physical contact in physical education for women: A cross-sectional questionnaire-based study of discomfort related to initiator gender, relationship with the initiator, and body region

2026-09-11T14:00:00Z

by Megumi Gonno, Noriyuki Kida

Physical contact is frequently used in sports instruction, but perceptions of discomfort may vary according to social and contextual factors. In this study, discomfort toward physical contact was examined using two parallel designs: one focusing on teachers as initiators in relation to initiator gender and body region, and the other focusing on initiators without a specified function in relation to initiator gender, relationship (close friend or acquaintance), and body region. A cross-sectional questionnaire study was conducted among 175 female university students in Japan. Participants evaluated 66 hypothetical scenarios comprising 22 teacher-initiated conditions (2 initiator genders × 11 body regions) and 44 conditions involving close friends or acquaintances (2 initiator genders × 2 relationship levels × 11 body regions). Discomfort was assessed as a binary outcome (yes/no). Data were analyzed using separate binary logistic regression models for the two designs: initiator gender × body region for teacher-initiated contact, and initiator gender × relationship × body region for contact initiated by close friends or acquaintances. For teacher-initiated contact, significant main effects of initiator gender and body region were observed, whereas the initiator gender × body region interaction was not significant. For contact initiated by close friends or acquaintances, significant main effects of initiator gender, relationship, and body region were observed, together with a significant initiator gender × relationship interaction; interactions involving body region were not significant. Across both designs, discomfort was greater for male initiators and varied across body regions. Among close friends and acquaintances, discomfort was greater for male initiators in both relationship conditions, but the estimated gender contrast was larger for close friends than for acquaintances. These findings suggest that physical contact in sports-related contexts should be considered in relation to initiator gender and body region, as well as relational closeness when the initiator’s function is not specified.

Functional acuity score as a surrogate of reading performance in low vision: A Japanese disability evaluation cohort study

2026-09-11T14:00:00Z

by Mieko Tsuruoka, Kenji Inoue

This retrospective cross-sectional study examined whether the Functional Acuity Score (FAS), an administrative impairment measure calculated from routine visual acuity data, was associated with reading performance in individuals undergoing formal visual disability evaluation. Thirty-one participants applying for visual disability certification at a tertiary eye hospital in Japan underwent Goldmann perimetry and MNREAD-J testing within 12 months. FAS, the Functional Field Score (FFS), and the Functional Vision Score (FVS) were calculated according to the AMA Guides. Their associations with reading outcomes, including critical print size (CPS) and the reading accessibility index (ACC), were assessed using correlation and multivariable regression analyses. FAS was strongly correlated with better-eye visual acuity (rho = 0.963) and showed the strongest associations with reading performance among the impairment measures. It was associated with CPS (rho = −0.82) and ACC (rho = 0.69) and remained associated with both outcomes in adjusted regression models, with R² values of up to 0.76 after FAS was included. Field-based measures showed weak or inconsistent associations with reading parameters. The cohort consisted mainly of patients with glaucoma and other non-macular conditions (27/31, 87.1%). In this predominantly non-macular disability-evaluation cohort, FAS may provide an estimate of resolution-dependent reading performance when direct assessment is not available. However, only 4 of 31 participants had macular disease, and whether these findings apply to patients with macular pathology remains unclear.

Correction: Identification of an optimal exogenous gene insertion site (P–M) and establishment of a reverse genetics system for aMPV/A

2026-09-11T14:00:00Z

by Yu Guo, Ting Xue, Bingqing Lu, Jiqing Zheng, Yirong Wang, Xueqiao Xie, Huiting Wang, Furui Cao, Yijun Zhang, Jianhua Wang

Body mass index modifies the association between occupational noise exposure duration and ultrasound‑detected hepatic steatosis: A cross-sectional study among male factory workers

2026-09-11T14:00:00Z

by Dandan Liu, Huixia Ji, Ye Chen, Tongzhou Zhou

Background

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is a multisystem metabolic disorder. The impact of occupational noise exposure on metabolic processes through non-auditory pathways is also closely associated with hepatic steatosis in addition to obesity. Most studies examine noise exposure or Body Mass Index (BMI) alone on ultrasound-detected hepatic steatosis(UDHS), while few examine BMI’s interaction with occupational noise duration. The underlying mechanisms of these combined effects remain unclear. The correlation between occupational noise exposure duration and UDHS in automotive manufacturing workers is examined, as well as the interactive role of BMI

Objective

This study investigates the correlation between occupational noise exposure duration and UDHS in automotive manufacturing workers, as well as the interactive moderating effect of BMI on this association.

Methods

A retrospective study involved 769 male workers exposed to occupational noise. Ultrasound was used to diagnose hepatic steatosis. Modified Poisson regression with robust variance estimation was used to analyze variable associations. A slope analysis and Johnson-Neyman test were used to validate BMI and variable interactions. A sensitivity analysis was performed to ensure robustness.

Results

Overall, 53.2% of workers had UDHS. Noise exposure duration showed a significant independent association with UDHS,with a negative interaction effect on BMI (P = 0.006) after adjusting for confounding factors. In normal-weight workers, each additional year of noise exposure was associated with an 8.2% higher UDHS likelihood (P < 0.001), but not statistically significant in overweight/obese individuals; BMI = 27.7 kg/m² represented the critical threshold where the magnitude of this association approached zero. Alcohol consumption and overweight/obesity were independent risk factors.

Conclusion

Noise exposure is associated with UDHS risk among male workers, yet BMI modifies this association, whereby the magnitude of this association weakens as BMI increases. These findings are specific to male factory workers and cannot be generalized to female populations. Accordingly, tailored occupational health protection strategies can be developed for noise-exposed populations.

The dynamics of loneliness: A longitudinal exploration of transitions in Japan across the COVID-19 period, 2020–2024

2026-09-11T14:00:00Z

by Jargalmaa Amarsanaa, Trinh Xuan Thi Nguyen, Mostafa Saidur Rahim Khan, Yoshihiko Kadoya

Background

Concerns about increased loneliness during the COVID-19 pandemic have been widely reported. However, long-term trajectories of loneliness remain insufficiently described.

Objective

To examine annual trends and five-year transition patterns of loneliness in Japan from 2020 to 2024 using data from a nationwide online panel.

Methods

We analyzed data from 1,673 adults who participated in all five annual survey waves from 2020 to 2024 and had complete information on the variables used in the analysis. Loneliness was measured using the three-item UCLA Loneliness Scale. Descriptive statistics were used to estimate annual prevalence and five-year transition patterns. Sensitivity analyses were conducted using a stricter loneliness threshold.

Results

The prevalence of loneliness peaked in 2021, declined in 2022, and remained relatively stable from 2022 to 2024. Most respondents demonstrated stable trajectories over five years, either consistently reporting loneliness or consistently not reporting loneliness. A smaller proportion exhibited transient loneliness during the pandemic period. Under the stricter loneliness threshold, the 2021 peak and the predominance of stable over transitional sequences were preserved, although the ranking of specific sequences changed.

Conclusions

Among respondents retained in this five-wave online panel, loneliness prevalence peaked in 2021, declined in 2022, and remained relatively stable from 2022 to 2024. Stable trajectories were more common than transitional trajectories. These findings provide descriptive evidence on long-term loneliness patterns but should not be interpreted as nationally representative prevalence estimates.

In vitro antimicrobial potential and phytochemical analysis of root extracts of Rumex abyssinicus from southern Ethiopia

2026-09-11T14:00:00Z

by Gemechu Ameya, Aseer Manilal, Mujib Abdulkadir, Tegenu Gelana, Kuzhunellil Raghavanpillai Sabu

The escalating challenge of antimicrobial resistance require a continuous search for novel compounds with therapeutic potential. The approach of linking traditional practices and knowledge with evidence-based preclinical studies can help minimize the resource-intensive process of drug screening. Rumex abyssinicus is an important plant species used in Ethiopian traditional medicine, and this study aims to conduct a phytochemical analysis of root extracts of R. abyssinicus and determine its antimicrobial activity. R. abyssinicus roots were extracted in six solvents of different polarities. Agar well-diffusion assays of the extracts were performed against type culture bacterial strains, clinically bacterial isolates, and fungi, while the tube dilution method was used to determine the minimum inhibitory concentration of the extracts. The ground root powder was refluxed with acetonitrile (1:10 w/v) and analyzed using reverse-phase high-performance liquid chromatography combined with mass-spectrometry. A one-way analysis of variance followed by post hoc multiple comparisons was performed, and differences were considered statistically significant at p < 0.05. The root extract of R. abyssinicus showed antimicrobial activity against type culture bacteria and clinical isolates, and fungi. Extraction with different solvents yielded extracts with varying antimicrobial activities. The extracts showed a varied range of antimicrobial activities against the test organisms, with inhibition zones of 11–25 mm for bacteria and 9–24 mm for fungi. The MIC range fell between 12.5 and 100 mg/mL. The phytochemical analysis revealed the presence of major compounds such as emodin (30%), chrysophanol (18%), physcion (16%), helminthosporin (12%), citreorosein (11%) and emodic acid (8%) which are envisaged to have functional roles in chemical defense against the tested organisms. The susceptibilities of the tested bacteria and fungi varied depending on the type of solvent used for extraction and extract concentration. Enhanced antimicrobial activities were observed against the entire panel of bacteria compared to those against the test fungi. The results support the traditional use of R. abyssinicus for treating infectious diseases.

Construction of an experimental set up to perform full body micro cannulations of sub-millimetric vessels in an anatomical research setting

2026-09-11T14:00:00Z

by Michael E. J. Stouthandel, Danial Forouhar, Charlotte Debbaut, Jurgen Deviche, Liesl De Graeve, Bernard Depypere, Maarten Meire, Dominique Adriaens, Tom Van Hoof

Introduction

A better 3D visualisation of the lymphatic system could provide more accurate cancer treatment approaches, but this requires contrast agent injections. Since lymphatic vessels are very small, cannulations to administer contrast agent are very difficult to perform manually. As such, a dedicated set up for lymphatic vessel micro cannulations is required.

Materials and methods

A micromanipulator rig for full body micro cannulations was constructed. The rig consists of an aluminium frame that can be positioned over a dissection table. It combines the micromanipulator with a sliding gantry plate and a double jointed positioning system to provide as many possible angles of approach as possible. Fluid pressure control devices and a surgical microscope can also be included in the set up.

Results

Micro cannulations on a full body could successfully be performed using the micromanipulator rig. After only a short learning curve to explore the movement possibilities/range of the device, the micromanipulator rig quickly outperformed manual micro cannulations.

Conclusions

Given the short learning curve and the success rate of the micro cannulations with the micromanipulator rig, we would strongly recommend other microvascular researchers to use the micromanipulator rig for future experiments involving micro cannulations.

HIV and Hepatitis B co-infection in Tanzania: Analysis of the 2022–2023 Tanzania HIV Impact Survey

2026-09-11T14:00:00Z

by Felistar Mwakasungura, Alfateresia Mwasangama, Davis Amani, Elias Bukundi, Bruno Sunguya

Co-occurrence of HIV and Hepatitis B Virus (HBV) in sub-Saharan Africa, although less prevalent, is often more serious and exhibits rapid clinical deterioration even with appropriate treatment, jeopardizing efforts to reach regional and global targets. Evidence varies in the region and not reported in some countries. We used data from the nationally representative survey to characterize the burden and determinants of HIV and HBV co-occurrence in Tanzania. This secondary data analysis of the Tanzania HIV Impact Survey (THIS) involved 33,263 individuals aged 15 years and above, randomly selected from 14,966,262 households from 31 regions of Tanzania. The main outcome variable was HIV and HBV coinfections. Analyses were conducted using descriptive analysis, to estimate prevalence of co-occurrences, while Chi-square test used to characterize the burden. Through bivariable and multivariable binomial logistic regression models, we could estimate the associations between different independent variables with HIV-HBV co-occurrence. The burdens of HIV and HBV in the general population were 4.4% and 3.5% respectively. The prevalence of dual HIV and HBV infections was 0.3%. Among people diagnosed with HIV, 6.2% had HBV co-occurrence. After adjusting for confounder and other variables, age was significantly associated with coinfection (aOR = 1.02; 95% CI: 1.01–1.03; p < 0.001). Participants who were not in union had significantly higher risk of coinfection compared with those in union (aOR = 1.56; 95% CI: 1.01–2.41; p = 0.047). Having one lifetime sexual partner remained strongly protective factor against HIV-HBV coinfection (aOR = 0.19; 95% CI: 0.09–0.42; p < 0.001). Although the burden of HIV/HBV coinfection remains as low as 0.3% in the general population in Tanzania, the risk remains high among older adults and those with multiple sexual partnerships. Integrating HBV screening in all opportunities presented in the successful HIV program may help addressing the dual burden. For effectiveness, more efforts should target people with high-risk sexual behaviors and those with advanced age.

Cross-sensor domain adaptation multi-point monitoring network for mechanical fault diagnosis

2026-09-11T14:00:00Z

by Zhijie Zhou, Jiao Lu, Yu Ren, Songbin Li

In recent years, mechanical fault diagnosis systems based on multi-point sensor data fusion have achieved remarkable advancements. However, they still face several critical challenges: substantial data distribution discrepancies across monitoring points, scarcity of labeled fault samples at newly deployed points, and prohibitive costs of training independent models for each sensor. We propose UCTL, an end-to-end unsupervised cross-sensor transfer learning network that enables the transfer and reuse of fault features from labeled source monitoring points to unlabeled target monitoring points with disparate data distributions, thereby achieving cross-sensor domain adaptation in multi-point monitoring systems. UCTL mainly consists of two major components. First, a one-dimensional (1D) Swin Transformer backbone is developed by modifying the original Swin Transformer. It directly accepts 1D vibration inputs without time-frequency map conversion and efficiently extracts multi-scale and temporally correlated features via shifted-window self-attention. Second, we propose a joint distribution alignment method that extends both Maximum Mean Square Discrepancy (MMSD) and Variance Discrepancy Representation (VDR) to their joint forms (Joint MMSD and Joint VDR). A weighted formulation independently controls the alignment strength of the mean-squared and variance-based distribution discrepancies, improving adaptability across diverse cross-sensor scenarios while mitigating class-mismatch risk. Experiments on six cross-sensor transfer tasks across the CWRU bearing dataset and XJTU Spurgear dataset demonstrate that the proposed method achieves an average diagnostic accuracy exceeding 99%. In addition, initialized with pre-trained parameters from a certain monitoring point, UCTL can significantly reduce the number of training epochs and improve the deployment efficiency of the model. Ablation studies further confirm the superiority of the 1D Swin Transformer backbone and the synergistic effect of the hybrid loss, validating the effectiveness of the proposed approach as a robust cross-sensor domain adaptation approach.

Concept-aware contrastive representation learning for cross-translation semantic consistency modeling of the Analects

2026-09-11T14:00:00Z

by Tang He, Peng Dai, Rong Wang, Yanyang Zhao, Chen Zhao

As a representative Chinese classical text, the Analects has been translated into English in many versions over a long historical period, and different translators show substantial variation in concept rendering and language style. To address the lack of a quantifiable and reproducible framework for comparing semantic consistency across multiple English translations of the Analects, this paper proposes a concept-aware semantic consistency modeling framework for cross-translation comparison. The proposed method first constructs a unified parallel corpus input based on sentence groups aligned by chapter and sentence IDs. It then introduces concept-term normalization and proper-name normalization to reduce surface lexical variation across translations. In addition, it combines a shared sentence encoder, supervised contrastive learning, and concept-aware constraints to learn sentence representations with cross-translation consistency. Based on the learned representations, the framework is evaluated through two primary tasks, namely cross-translation retrieval and low-consistency detection. Experimental results show that, within the five-translation dataset examined in this study, the proposed method achieves the strongest overall performance across the evaluated settings. The Full model achieves R@1 = 0.936 and F1 = 0.807. The supplementary association analysis further shows that higher model scores tend to be associated with translation pairs labeled as high consistency. These findings support the framework as a computational aid for cross-translation comparison and for identifying translation pairs that may warrant closer expert examination, rather than as a general-purpose method for automatic translation-quality assessment.

ISD-YOLO: A lightweight and efficient feature extraction network for invoice seal detection

2026-09-11T14:00:00Z

by Xiaosi Song, Xiaohong Zhao, Caihua Ma, Wenpei Xu, Peng Shen

Invoice seal detection plays an important role in intelligent invoice processing by improving review efficiency and reducing potential financial risks. However, existing methods still face challenges in multi-scale feature representation, complex background interference, and balancing detection accuracy with computational efficiency. In this study, a lightweight detection model, ISD-YOLO, is proposed for invoice seal detection. Specifically, the C3k2-ConvFormer-CGLU module (C3k2_CFC) is designed to enhance multi-scale feature representation by combining local feature enhancement and gated feature selection. A C2BRA module based on bi-level routing attention is introduced to improve the extraction of discriminative seal features by dynamically selecting important regions. In addition, a deformable attention module (DAttention) is incorporated to enhance the focus on key regions and reduce background interference. Furthermore, a lightweight detection head (EfficientHead) is developed to reduce computational complexity while maintaining detection performance, providing potential for resource-constrained applications. Experiments were conducted on a dataset consisting of public seal images and real invoice images. Compared with the baseline model, ISD-YOLO improves mAP50 and mAP50:95 by 2.1% and 2.3%, respectively. Compared with existing detection methods, ISD-YOLO achieves an F1-score of 95.3% and an mAP50 of 97.2%, while requiring only 2.3 M parameters and 5.0 GFLOPs. The results demonstrate that ISD-YOLO achieves a favorable balance between detection accuracy and computational efficiency under the evaluated invoice seal detection conditions. Its lightweight design indicates potential for resource-constrained applications, while further validation under broader scenarios and on actual edge devices is still required.

Identification of functional genes and immune cell infiltration analysis in liposarcoma

2026-09-11T14:00:00Z

by Chunxiao Liu, Yanhua Wang, Qiuxia Liu, Sha Zhang

Liposarcoma (LPS) is a common soft tissue sarcoma; however, its molecular pathogenesis and immune cell infiltration remain poorly understood. This study investigated potential driver genes and pathways in LPS and characterized immune cell infiltration patterns to identify potential markers for targeted therapy. Differentially expressed genes (DEGs) in LPS were analyzed by GO and KEGG pathway enrichment analysis. A protein-protein interaction network was constructed using the STRING database and visualized with Cytoscape. mRNA expression of genes with high |logFC| values was verified by RT-qPCR. Immune cell subsets were quantified using CIBERSORT. GO and KEGG analysis revealed significant functional clusters and pathways, and most verified genes were consistent with the bioinformatics analysis. Survival analysis showed that high expression of TYMS, KIF20A, BUB1B, LMNB1, RRM2, ZWINT, and RACGAP1 was significantly associated with poor overall survival and poor disease-free survival (DFS). High levels of TMSB15A, TPX2, PKM2, and PTTG1 were significantly associated with poor DFS alone. CIBERSORT analysis identified a significantly higher fraction of resting mast cells (MCs) in LPS tissues compared to normal fatty tissues (P < 0.05). TOP2A, IL-6, PCNA, CDK1, JUN, MYC, CCNB1, EGFR, ACACB, and BIRC5 were identified as potential diagnostic biomarkers of LPS, providing strong evidence for hub gene studies. Immune cell infiltration analysis further suggested that resting MCs may play a potential role in LPS development, although further experimental validation is warranted. Collectively, these findings clarify the molecular basis of LPS and provide a foundation for future research into its treatment.

Integrative network analysis identifies candidate genes shared between ferroptosis and cuproptosis pathways in rheumatoid arthritis pathogenesis

2026-09-11T14:00:00Z

by Abbas Ahmad, Shehzad Khalil, Douglas Law, Patricio R. De los Ríos-Escalante, Mostafa A. Abdel-Maksoud, Saeedah Almutairi, Aljawharah Fahad Alabbad, Waheed Ahmad, Ayaz Ahmad

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease characterized by synovial inflammation, progressive joint destruction, and systemic immune dysregulation. Recent findings suggest that disturbed metal homeostasis and regulated cell death pathways, including ferroptosis (iron-dependent lipid peroxidation) and cuproptosis (copper-dependent mitochondrial proteotoxic stress), contribute to RA pathogenesis. In this study, we used an integrative bioinformatic approach combining weighted gene co-expression network analysis (WGCNA), differential expression analysis, functional enrichment, protein-protein interaction (PPI) network construction, and immune cell infiltration deconvolution to identify key metal-dependent cell death regulators in RA. Using bulk RNA-seq data from peripheral CD14⁺ monocytes (GSE294225) from 15 healthy controls and 9 patients with active RA (DAS28 > 2.7), we identified 1,410 significantly differentially expressed genes (DEGs) (adjusted P < 0.05, log2 fold change > 1). WGCNA revealed an RA-associated module enriched in oxidative stress, mitochondrial dysfunction, and cell death pathways. Overlap analysis of ferroptosis- and cuproptosis-related gene sets distinguished three upregulated hub genes, including FTH1 (ferritin heavy chain 1), SOD2 (superoxide dismutase 2), and CDKN2A (cyclin-dependent kinase inhibitor 2A) as key candidate regulators. These genes showed high module membership, significant differential expression in RA monocytes, and notable associations with immune infiltration patterns, including increased pro-inflammatory monocytes/macrophages and reduced regulatory T cells. Functional enrichment also highlighted oxidative stress response, iron and copper homeostasis, mitochondrial respiration, and cellular senescence. The single-cell analysis further showed that these hub genes are predominantly expressed in the RA synovial macrophages and fibroblasts, two major mediators of joint pathology. Together, these findings indicate that there may be an association between ferroptosis-related pathways and cuproptosis-related pathways in RA and suggest that FTH1, SOD2, and CDKN2A are candidate biomarkers and candidate therapeutic targets.

Association of demographic characteristics with evolution of interest in anesthesiology during medical school

2026-09-11T14:00:00Z

by Max Y. Lu, Alexandra M. Hajduk, Jeph Herrin, Mytien Nguyen, Dowin Boatright, Sarwat I. Chaudhry

Background

Physician workforce diversity improves access to care, outcomes, and workforce productivity. Yet, women and sexual minorities remain underrepresented in anesthesiology, while representation for low-income trainees remains poorly characterized. How interest in anesthesiology evolves among these groups during medical school remains unclear.

Methods

This retrospective cohort study of U.S. MD-granting medical school matriculants from 2014–2017 used Association of American Medical Colleges data on self-reported sociodemographic characteristics and anesthesiology interest. Students were grouped by interest evolution from matriculation to graduation: never interested (no-no), cultivated (no-yes), lost (yes-no), sustained (yes-yes). Chi-square tests characterized sociodemographic differences across interest paths. Firth logistic regression models assessed odds of cultivated vs never interested and sustained vs lost paths across sociodemographic groups.

Results

Among 39,910 students in the cohort, 295 (0.7%) sustained, 2,007 (5.0%) cultivated, 494 (1.2%) lost interest, and 37,114 (93.0%) were never interested in anesthesiology. Women were less likely than men to have initial interest (1.5% vs 2.5%, p < .001), whereas initial interest among low-income (2.1% vs 1.9%, p = .087) and sexual minority (1.8% vs 2.0%, p = .505) students did not significantly differ from majority counterparts. Sustained interest did not differ significantly between women and men (OR: 0.85, 95% CI: 0.63–1.14), according to low-income (OR: 0.89, 95% CI: 0.65–1.22), or sexual minority status (OR: 0.77, 95% CI: 0.41–1.45). Women (OR: 0.50, 95% CI: 0.45–0.55) and sexual minority students (OR: 0.79, 95% CI: 0.65–0.96) were less likely to cultivate interest than men and heterosexual students, respectively. Low-income students had greater (OR: 1.27, 95% CI: 1.16–1.40) odds of cultivating interest compared to non-low-income peers.

Conclusions

Women’s underrepresentation in anesthesiology is associated with lower initial and cultivated interest. Sexual minority students also demonstrated lower cultivated interest. These disparities identify time points in training where interest diverges by demographic group and may help prioritize where future research — including studies of targeted interventions — is most needed.

Impact of menopausal status on human papillomavirus detection and cervical neoplasia in middle-aged Senegalese women

2026-09-11T14:00:00Z

by Emily R. Spencer, Rachel L. Winer, Selly Ba, Marie Pierre Sy, John Lin, Qinghua Feng, Geoffrey S. Gottlieb, Papa Salif Sow, Nancy B. Kiviat, Stephen E. Hawes

Hormonal and immunologic changes related to menopause may play a role in human papillomavirus (HPV) and cervical neoplasia detection, yet this relationship has not been examined in West African populations, where cervical cancer remains a leading cause of cancer-related death. The purpose of this study was to assess whether menopausal status is associated with HPV and cervical neoplasia detection in Senegalese women aged 40–60. We conducted a secondary analysis of three prospective cervical cancer studies in Dakar, Senegal (1998–2011). Participants with known menopausal status and a satisfactory HPV test (N = 3,118) and/or Pap smear (N = 2,907) were included, excluding those with cervical cancer or pregnancy; participants without known HIV status were additionally excluded from the cervical neoplasia analysis. Multivariable logistic regression and generalized estimating equations were used to estimate adjusted odds ratios and 95% confidence intervals, adjusting for age, gravidity, and HIV status. Compared with premenopausal women, postmenopausal women had significantly higher odds of HPV detection (OR = 1.48; 95% CI: 1.18, 1.85), including both high-risk (OR = 1.55; 95% CI: 1.25, 1.93) and low-risk types (OR = 1.64; 95% CI: 1.30, 2.08). Odds of cervical neoplasia were elevated, but non-significant, among postmenopausal women (OR = 1.36; 95% CI: 0.97, 1.90), with increased odds for both high-grade (OR = 1.43; 95% CI: 0.90, 2.28) and low-grade lesions (OR = 1.30; 95% CI: 0.84, 2.02). However, in a sensitivity analysis restricted to participants with known HIV status, these cervical neoplasia odds were attenuated, suggesting caution in interpreting the magnitude of these findings. These findings suggest menopause may contribute to HPV persistence or reactivation, and development of cervical neoplasia. Our results highlight the importance of continued surveillance for HPV and cervical neoplasia among older women, particularly in low-resource settings with disproportionately high cervical cancer burden.

Familial risks of hospital treated osteoporosis and fractures in first-, second- and third-degree relatives - A Swedish nationwide real-world family study

2026-09-11T14:00:00Z

by Christian Anker-Hansen, MirNabi Pirouzifard, Jan Sundquist, Kristina Sundquist, Bengt Zöller

Objective

Osteoporosis (OP) is a common degenerative disorder. This is the first real-world nationwide study aimed to determine the familial risks of hospital treated OP and fractures in first-, second- and third-degree relatives.

Design

The Swedish Multigeneration register was linked to the National Patient Register to investigate the familial risks of OP between 1997 and 2018. Offspring born to Swedish parents were included. The adjusted familial hazard ratios (afHRs) with 95% confidence interval (CI) were determined for hospital treated OP and fractures at common osteoporotic fracture sites among twins, full-siblings, half-siblings, and cousins. There was no information about zygosity of the twins. Adjustments were made for birth year, sex, educational level, and comorbidities.

Results

6,548,562 individuals (48.77% women) were included with a mean age of 41 years (range 0−87 years) at the end of follow-up. 57,869 (0.88%) individuals were affected with hospital treated OP, and 403,660 (6.16%) individuals with fractures. The afHRs were increased for both OP and fractures in twins, full-siblings, half-siblings, and cousins. The afHR for OP were for twins 2.92 (95%CI 2.32–3.67), full-siblings 2.22 (95%CI 2.14–2.31), half-siblings 1.74 (95%CI 1.55–1.94), cousins 1.81 (95%CI 1.55–2.11). Age-stratified analysis showed age-dependent familial associations with highest afHR in young individuals (<20 years): among full-siblings afHR was 125.70 (95%CI 59.44–265.84) for OP and 2.34 (95%CI 2.28–2.39) for fractures.

Conclusions

Heredity is associated with risk of hospital treated OP and fractures in the Swedish population. The familial risk of hospital treated OP or fractures is related to the genetic closeness of the affected relative(s).

Therapeutic plasma exchange across multiple organ systems in an Egyptian tertiary center: A seven-year real-world cohort study

2026-09-11T14:00:00Z

by Mohamed Ahmed El Maghawry, Reham Abd Elkhalek, Fatima Altaher Taha, Amira A. A. Othman, Aliaa Mohamed Abd El Khalik Ahmed, Dina A. Abdelhady, Fatma M. Attia Elsayed

Background

Real-world evidence on therapeutic plasma exchange (TPE) from low- and middle-income countries remains limited. Egyptian data across multiple organ systems are scarce. This study aimed to evaluate the indications, safety, efficacy, and predictors of outcomes in patients undergoing TPE at a tertiary center in Egypt over 7 years.

Methods and Findings

This retrospective cohort study included 221 consecutive patients who underwent TPE (2016–2022) at Zagazig University Hospitals, Egypt. Patients were stratified into renal, neurologic, hematologic, and metabolic groups. Primary outcomes were clinical response and all-cause mortality. Multivariate logistic regression, Cox proportional hazards models, and Kaplan–Meier survival analysis were performed. Among 221 patients (57.9% male; mean age 36.0 years), the most frequent indications were Guillain–Barré syndrome, thrombotic thrombocytopenic purpura, and myasthenia gravis crisis. ASFA category I indications constituted 77.8% of procedures, with response rates decreasing significantly across categories (p = 0.03). Overall response rate was 77.9% (complete remission in 93.0% of responders), with mortality 14.5%. Response rates exceeded 85% in autoimmune hemolytic anemia, hyperviscosity syndrome, and TTP. Neurologic indications achieved 81.6% response; renal indications showed lower response (73.2%) and highest mortality (21.3%). Adverse events occurred in 37.2% of patients, all mild-to-moderate with no session terminations. Independent mortality predictors included mechanical ventilation, creatinine >2.5 mg/dL, renal indication, hemoglobin <8 g/dL, while ASFA category I was protective (all aORs 2.67–5.22). In exploratory analyses, PLASMIC score ≥6 and time to TPE ≤ 2 days were associated with complete remission in TTP, while Hughes score ≥4 and time to TPE > 7 days were associated with poor functional outcome in GBS. These findings require external validation before clinical application. Diffuse alveolar hemorrhage (n = 9) demonstrated 100% mortality despite intervention, whereas SLE patients (n = 23) had 52.2% mortality, with 47.8% achieving complete remission or clinical improvement. A three-tier risk model stratified patients into high, intermediate, and low mortality risk groups. Independent predictors of clinical response included neurologic, hematologic, and metabolic indications compared to renal, ASFA category I, and ≥5 TPE sessions, while hemoglobin <8 g/dL and creatinine >2.5 mg/dL predicted poorer response.

Conclusions

This single-center Egyptian TPE cohort demonstrates high efficacy and safety when aligned with ASFA guidelines. Neurologic and hematologic indications achieve optimal outcomes; renal indications and critical illness markers predict poorer prognosis. The PLASMIC score, treatment urgency in TTP and GBS, and the proposed three-tier model represent exploratory findings that, if prospectively validated, could become actionable prognostic tools. These findings suggest that evidence-based TPE expansion in resource-limited settings may be feasible, though multicenter validation is required.

Mathematical model for worm path simulation in 3D

2026-09-11T14:00:00Z

by Neil Vaughan

This research presents the evaluation of a computer simulation for modelling shapes of paths traversed by various artificial species of worm on a 3D orthogonal grid. These resulting 3D worm trace patterns have not been modelled or analysed before. Simulation software was custom developed in multiple programming languages and platforms, supporting 3D graphics and virtual reality visualisations on various headsets and operating systems. A genetic encoding enables exploration of the full range of 3D worm phenotypes, this research modelled every possible unique worm in simulations up to 53.5 million time-steps. The results show that in this new 3D grid, there are 3239 potentially unique worms. Of the 3239 unique worms, 1882 (58%) terminated at the origin. Also 1352 (41%) of worms entered repeating loops, some complex loops were identified with lengths of up to 296639. Currently 5 worms (0.1%) continue to run chaotically beyond 53.5 million population in simulation runs, and their final outcome still has not been identified yet and remains unknown. Simple rules result in surprisingly complex and intricate movements. Images and unique outlier observations are presented demonstrating complex 3D patterns that emerge.

Dual-domain self-supervised feature alignment via spectral–spatial representation learning for deepfake anomaly detection

2026-09-11T14:00:00Z

by Yi He

Deepfake anomaly detection has become increasingly critical in visual security applications. However, many existing methods rely heavily on large-scale supervised forgery annotations and often struggle to capture subtle manipulation traces distributed across both spatial and frequency domains. To address these limitations, we propose a Self-Supervised Dual-Domain Alignment (SDDA) framework that jointly learns spatial and spectral representations without requiring labeled forged samples. Specifically, SDDA employs two parameter-sharing encoders to extract complementary features from RGB images and their frequency-domain counterparts, while a cross-domain alignment module enforces consistency between spatial textures and spectral signatures. To provide explicit and reproducible self-supervised supervision, four complementary descriptors are further derived from FAN feature maps: Local Structural Deviation (LSD) for local gradient inconsistency, Global Pattern Discrepancy (GPD) for holistic channel-correlation differences, Local Residual Difference (LRD) for residual-level inconsistency, and Total Consistency Deviation (TCD) for multi-layer feature deviation. These descriptors are predicted from the fused spatial–frequency embedding, encouraging the model to learn manipulation-sensitive representations in the absence of fake samples. In addition, a dual-domain contrastive objective enhances the discrimination of subtle forgery-related anomalies while improving robustness against real-world degradations such as compression and illumination variations. Experimental results demonstrate that SDDA consistently outperforms state-of-the-art baselines, particularly under challenging unseen-manipulation scenarios. Overall, the proposed framework provides an interpretable and label-efficient solution for dual-domain deepfake anomaly detection.

An exploratory fNIRS study on directional asymmetry in segmental discrimination: Lateral–rhotic (/la–ra/) and labial–dorsal (/ba–ga/) contrasts tested in 5- and 9-month-old Japanese infants

2026-09-11T14:00:00Z

by Yoritaka Akimoto, Miki Takahasi, Naoto Yamane, Natsumi Shibata, Rachel Ka-Ying Tsui, Reiko Mazuka

Directional asymmetry refers to the order-dependent difference in segmental discrimination; however, its underlying cortical mechanisms remain unclear. This exploratory study used near-infrared spectroscopy to measure hemodynamic responses in 5- and 9-month-old Japanese infants (N = 30 [14 girls, 16 boys] and N = 40 [16 girls, 24 boys], respectively) to the lateral–rhotic /la–ra/ and labial–dorsal /ba–ga/ contrasts and to examine whether directional asymmetry was observed. Post hoc analysis revealed significant directional asymmetry for the /la–ra/ contrast in 5-month-old infants, characterized by decreased oxyhemoglobin levels in the right middle-anterior temporal channels, specifically for the /ra/-to-/la/ change. This localized response in the middle portion of the superior temporal gyrus, a region associated with tracking acoustic properties, suggests that infants at this age may rely on acoustic-level processing rather than on fully established phonological categories. This relative deactivation, observed in 5-month-olds but not in 9-month-olds and in the direction that appeared more difficult to discriminate, suggests a potential association between discrimination difficulty and the hemodynamic response. Specifically, the acoustic complexity of the /ra/ standard stimuli could have imposed a higher computational load, potentially leading to incomplete encoding during the baseline periods. This incomplete processing may have elevated hemodynamic activity, thereby resulting in a relative decrease in response to the subsequent change to /la/ stimuli. This phenomenon aligns with the perceptual space learning account, in which hemodynamic activity potentially reflects the computational load involved in the continuous calibration of an infant’s developing perceptual space. Future studies should directly assess this hypothesis.

Surrogate modeling based on computational fluid dynamics for predicting the capsizing moment in a coupled shiplift system

2026-09-11T14:00:00Z

by Tong Tang, Jianbao Yang, Zikang Hu, Junzhe You, Yang Zhang, Duanwei Shi

Accurate prediction of the capsizing moment in shiplift systems remains a significant challenge, primarily due to the strong coupled interactions among the chamber, water body, and ship. Conventional three-dimensional (3D) numerical simulations are associated with high computational costs, while commonly used two-dimensional (2D) simplified models neglect ship effects, potentially leading to underestimation of the actual capsizing moment. In this study, a computational fluid dynamics (CFD)-informed surrogate model is developed for one-step-ahead prediction of capsizing moment in a coupled chamber-water-ship shiplift system. First, 3D models covering 19 scales are established, and the corresponding capsizing moments are obtained via CFD simulations. The CFD methodology is further validated against published smoothed particle hydrodynamics (SPH) results, with a maximum deviation of 4.1%, demonstrating the capability of the numerical framework to capture the relevant hydrodynamic responses. Furthermore, under El-Centro excitation, the peak capsizing moments predicted by the 3D model are substantially higher than those obtained using the conventional 2D simplified model for both the 3000 t light-load and 1350 t full-load conditions, indicating that 2D simplification may underestimate the capsizing moment in the examined cases and that three-dimensional effects should be considered when evaluating extreme responses. Based on the numerically generated CFD dataset, a hybrid surrogate framework is constructed, integrating convolutional neural networks, bidirectional long short-term memory networks, and random forests. To enhance the predictive robustness of the framework, multi-window isolation forest preprocessing, CNN-based feature enhancement, and parameter tuning based on the Mapping Mountain Gazelle Optimizer are employed. Comparisons with seven benchmark models demonstrate that the proposed model achieves the better overall predictive performance, with a mean absolute error of 0.0761 ± 0.0024, a root mean squared error of 0.1408 ± 0.0128, and a coefficient of determination of 0.9466 ± 0.0065 on the test set. Additional engineering cases indicate good generalization under ship-presence operating conditions, with peak prediction deviations below 4.8%. These results suggest that, when current and recent response states are available from monitoring or state-estimation systems, the proposed framework may support short-horizon capsizing-moment estimation.

Vitamin D alleviates indoxyl sulfate-induced inflammatory and cholesterol dysregulation in macrophages: Implications for vascular health in patients receiving hemodialysis

2026-09-11T14:00:00Z

by Kyoung Hye Kong, Kyungwon Yang, Jung-Hwa Ryu

Indoxyl sulfate (IS) is a protein-bound uremic toxin that accumulates in patients with chronic kidney disease (CKD) and promotes oxidative stress, endothelial dysfunction, vascular smooth muscle cell proliferation, and fibrosis, thereby contributing to vascular stenosis in patients receiving hemodialysis. CKD is also commonly associated with vitamin D deficiency, which is linked to vascular calcification, immune dysregulation, and inflammation. This study aims to investigate the preventive effects of 1,25(OH)₂D₃ (active vitamin D) against IS-induced macrophage inflammatory activation and cholesterol dysregulation. Macrophages were pretreated with 30 nM 1,25(OH)₂D₃ for 12 and 24 h, followed by exposure to IS at concentrations of 125 and 250 µg/mL for 24 h. Morphological changes were observed under a microscope. To assess macrophage phenotype-associated changes, qPCR was performed to analyze the expression of M1-like/pro-inflammatory markers (TNF-α and IL-1β) and M2-like/anti-inflammatory phenotype-associated markers (CD163 TGF-β and IL-10). Cholesterol metabolism was assessed using a cholesterol efflux assay, qPCR analysis of ABCA1 and ABCG1 and Oil Red O staining for intracellular lipid accumulation. Protein expression of inflammatory mediators, TGF-β1, and cholesterol efflux transporters was further evaluated by western blotting. 1,25(OH)₂D₃ pretreatment modulated IS-associated inflammatory responses, as reflected by changes in selected M1-like/pro-inflammatory mediators, including iNOS, IL-6 and IL-1β. Conversely, 1,25(OH)₂D₃ increased selected M2-like/anti-inflammatory phenotype-associated markers, including CD163 and IL-10. Furthermore, 1,25(OH)₂D₃ pretreatment preserved cholesterol efflux capacity and modulated ABCA1 and ABCG1 expression in a time- and transporter-dependent manner, accompanied by reduced intracellular lipid accumulation as shown by Oil red O staining. These findings suggest that 1,25(OH)₂D₃ may protect macrophages against IS-induced inflammatory activation and cholesterol dysregulation, highlighting its potential as a preventive or modulatory approach for macrophage-mediated vascular dysfunction in CKD.

Impact of visual mouth image presentation on speech perception in noise in normal hearing subjects and cochlear implant users

2026-09-11T14:00:00Z

by Anna Maria Schneider, Timo Stöver, Tobias Weissgerber

This study investigated the impact of visual speech cues on speech perception in noise and subjective listening effort in cochlear implant (CI) users compared with normal-hearing (NH) individuals. Furthermore, the study compared visual information presented either by a computer-generated avatar or by video recordings of a real speaker. Thirteen NH participants and twelve bilateral CI users completed the Oldenburg Sentence Test (OLSA) in six conditions: auditory‑only, visual‑only, and audiovisual presentations using either video recordings (female speaker) or a computer‑animated avatar (male speaker). Speech reception thresholds (SRTs) in noise and subjective listening effort (LE) were measured. Visual‑only lipreading performance and self‑assessed lipreading skills were also recorded. Video‑based audiovisual presentation significantly improved speech perception compared with audio‑only presentation (NH: 1.6 dB; CI: 3.5 dB). CI users demonstrated substantially higher lipreading scores than NH participants (51% vs. 28%), and lipreading performance strongly correlated with self‑reported ability. Despite SRT improvements, audiovisual presentation yielded only marginal reductions in listening effort for CI users and none for NH participants. In contrast, the computer‑animated avatar provided no measurable audiovisual benefit for speech perception or listening effort in either group. Real‑speaker video recordings considerably enhance audiovisual speech perception in both NH individuals and CI users, particularly benefiting CI listeners. However, reductions in listening effort were minimal, underscoring the dissociation between speech perception and perceived listening effort. Incorporating audiovisual measures may improve ecological validity in clinical assessment of CI outcomes.

GenBank mining reveals novel insights into Rhizobium phylogeny: Identical 16S rRNA sequences are mainly uncoupled from species designation, host plant, and geographic origin: How this search suggested the definition of a direct ‘microbial h-index’

2026-09-11T14:00:00Z

by Rosella Muresu, Monica Rodriguez, Andrea Squartini

16S rDNA is the historical gold standard for bacterial identification, particularly in metabarcoding approaches reliant on sequence similarity thresholds. We analyzed 6,660 Rhizobium 16S rRNA gene sequences from GenBank to examine the relationship between sequence identity and three metadata: species name, host plant, and geographic origin. Using an iterative BLAST-based pipeline, we detected 116,069 pairwise matches and assessed concordance among sequences (average length 1,328 bp) sharing 100% identity. For those in which the organism name, host plant and country of isolation were present in the record, surprisingly, 66.59% of identical sequence pairs showed full discordance across all three metadata, while only 1.40% shared the same name, host, and country. The most widespread sequence, detected 371 times, was associated with over 56 different host plants across 25 countries and bore multiple species name designations. These results highlight a striking mismatch between the 16S barcode and the taxonomic, ecological, and phenotypic variability it is assumed to reflect, likely arising from the slow evolution of rRNA genes contrasted with the mobility of ecologically relevant genes via horizontal transfer on plasmids, transposons, and phages. Our findings further challenge the limitations of relying on 16S rRNA alone for fine-scale taxonomic and metadata-based inference in capturing the true functional and ecological diversity of bacteria, endorsing the critical importance of polyphasic taxonomic approaches that integrate genomic, phenotypic, and ecological data. An interesting byproduct of the analysis was to realize the possibility of treating these data as if they were ‘citations.’ The more one finds the same query sequence, the more that sequence can be considered biologically ‘cited’, i.e., re-proposed elsewhere in the world. Thus, one can also analyze the h-index of such a ranking. In our Rhizobium dataset, we calculated an h-index = 201, meaning the sequence ranked 201^st had 202 identical homologues in GenBank. Although the research effort on given species is directly connected with it, this number provides a quantitative indicator of a taxon’s sequence recurrence and distribution within public databases, independent of nomenclatural inconsistencies, offering a novel framework for assessing bacterial representation across global datasets.

Sustained hypoxia induces divergent response patterns in cardiac metabolic-immune adaptation and circadian rhythm regulation

2026-09-11T14:00:00Z

by Shuting Cheng, Xin Zhuo, Yuhan Deng, Fan Hu, Hanmin Liu, Lihong Wan, Zhou Jiang

Objective

Chronic hypoxia is a critical pathological factor in cardiovascular disease, yet the molecular mechanisms underlying cardiac adaptation to sustained hypoxic stress remain incompletely understood.

Methods

With 3 GEO datasets, we performed comparative transcriptomic analysis across three hypoxia paradigms (sustained, prenatal, and adult subacute hypoxia) using DESeq2, Pearson correlation analysis, and KEGG pathway enrichment. Permutation testing (n = 10,000) validated robustness. Disease enrichment analysis and cardiovascular drug target analysis were conducted using KEGG pathway-disease mappings and four drug-gene interaction databases.

Results

Sustained hypoxia induced 181 DEGs, prenatal hypoxia produced only 2, and adult subacute hypoxia yielded 67, with no overlap among groups. Eight circadian DEGs were identified in the sustained hypoxia group and 7 distinct circadian DEGs in the prenatal adult programmed heart group, with no overlap between the two sets. The circadian interactome showed dramatic remodeling: gene pairs decreased by 67.5% (160–52), with three adaptive patterns (enhanced synchronicity, interaction reversal, weakened synchronicity). ASS1 emerged as the predominant co-expression hub under hypoxia (88.5% vs 11.25% in normoxia), while Bmal1-Npas2 maintained stable correlation (r = 0.838 vs 0.829). Pathway analysis revealed divergent enrichment profiles: 55 KEGG pathways enriched in metabolic-immune system, only 3 pathways for circadian genes, with no overlap. Disease and drug target analyses further corroborated these divergent profiles.

Conclusion

This study identifies ASS1 as a transcript-level co-expression hub within the circadian interaction network under hypoxia, demonstrates the divergent enrichment profiles of metabolic-immune versus circadian systems at the pathway, disease, and drug target levels, and offers potential therapeutic targets for chronic hypoxia-associated cardiovascular diseases.

A pilot study to implement artificial intelligence-enabled, point-of-care obstetric ultrasound for gestational age estimation in Zambia: An evaluation protocol

2026-09-11T14:00:00Z

by Erika Gazzetta, Tulani Francis L. Matenga, Stephanie Martin, Nelly Mandona, Rassil Barada, Modesta Chileshe, Elizabeth Stringer, Manze Chinyama, Beene Chembo, Harmony Chi, Angel Mwiche, Selia Ng’anjo, Jeffrey S.A. Stringer, Benjamin H. Chi, Margaret Kasaro

Background

Ultrasound is essential for accurate pregnancy dating, but its implementation in low- and middle-income countries is hindered by cost, infrastructure, and training barriers. The implementation of point-of-care ultrasound (POCUS) with artificial intelligence (AI) technology to accurately estimate gestational age can potentially address these barriers. We describe a protocol to evaluate the acceptability, feasibility, and fidelity of integrating AI-enabled POCUS for gestational age dating into routine antenatal care (ANC) in Zambia’s Lusaka Province.

Methods

PIKABU (Piloting Integration, Knowledge and Acceptability of Baby Ultrasounds) is a multi-year pilot program to introduce and maintain AI-enabled POCUS in six ANC facilities across three districts. To evaluate these activities, we designed a prospective, mixed methods evaluation to assess acceptability, feasibility, and fidelity. Informed by the Consolidated Framework for Implementation Research, the evaluation comprises six separate components: focus-group discussions, in-depth interviews, patient register reviews, time motion studies, implementation strategy assessments, and patient exit surveys. Participants include patients, community members, and healthcare providers. By collecting baseline and follow-up data every four months, we are able to measure these outcomes in longitudinal fashion.

Discussion

Integrating portable, AI-enabled POCUS into routine ANC can improve gestational age dating and improve maternal health services in resource limited settings. Through its assessment of the acceptability, feasibility, and fidelity, this study provides novel insights about service implementation. Our findings are expected to inform policy and programs considering AI-enabled POCUS and support broader adoption across a range of healthcare settings.

Culturally grounded health communication to support self-care among pregnant women with diabetes: Development and content validation of an educational cordel in Brazil

2026-09-11T14:00:00Z

by Francisca Édla Santos Leite Gurgel, Raimunda Magalhães da Silva, Jonas Loiola Gonçalves, Cidianna Emanuelly Melo do Nascimento, Rita Neuma Dantas Cavalcante de Abreu, Maria Helena de Carvalho Valente Presado, Suely Kazue Nagahashi Marie

Background

Diabetes in pregnancy requires sustained self-care and clear guidance across hospital, home, and primary care settings. Conventional educational materials may be less accessible to women facing social vulnerability or limited health literacy. Culturally grounded communication may improve the understandability and relevance of discharge guidance.

Methods

We conducted a methodological study in two public tertiary maternity hospitals in Fortaleza, Brazil, to develop and content-validate an educational cordel, a traditional Brazilian form of rhymed popular literature. The material was developed through a structured evidence search, collaboration with health researchers and cordelistas, and pilot testing. It was evaluated by 22 hospitalized pregnant women with gestational diabetes mellitus or pre-existing type 2 diabetes and by 40 expert judges. Item-level Content Validity Indices (I-CVIs), scale-level CVI by averaging item values (S-CVI/Ave), Cronbach’s alpha, and Kendall’s coefficient of concordance were calculated.

Results

All target-population items achieved an I-CVI of 1.00, and the S-CVI/Ave was 1.00. The evaluation responses showed modest internal consistency (raw alpha = 0.67; standardized alpha = 0.66). Among expert judges, I-CVIs ranged from 0.95 to 1.00 and the S-CVI/Ave was 0.99. Internal consistency of expert responses was high (raw alpha = 0.96; standardized alpha = 0.97), whereas Kendall’s W was 0.039, indicating weak concordance in the relative ranking of items despite high absolute favorable agreement.

Conclusion

The educational cordel showed strong preliminary evidence of content validity, cultural relevance, and acceptability for hospitalized pregnant women with diabetes. The findings support further testing in larger and more diverse samples, using standardized measures of understandability and actionability and designs that evaluate effects on knowledge, self-care, continuity of care, and clinical outcomes.