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Background: The aim of the present study was to evaluate the impact of intratumoral metabolic heterogeneity and quantitative 18F‐FDG PET/CT imaging parameters in predicting patient outcomes in thymic epithelial tumors (TETs). Methods: This retrospective study included 100 patients diagnosed with TETs who underwent pretreatment 18F‐FDG PET/CT. The maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on PET/CT were measured. Heterogeneity index‐1 (HI‐1; standard deviation [SD] divided by SUVmean) and heterogeneity index‐2 (HI‐2; linear regression slopes of the MTV according with different SUV thresholds), were evaluated as heterogeneity indices. Associations between these parameters and patient survival outcomes were analyzed. Results: The univariate analysis showed that Masaoka stage, TNM stage, WHO classification, SUVmax, SUVmean, TLG, and HI‐1 were significant prognostic factors for progression‐free survival (PFS), while MTV, HI‐2, age, gender, presence of myasthenia gravis, and maximum tumor diameter were not. Subsequently, multivariate analyses showed that HI‐1 (p < 0.001) and TNM stage (p = 0.002) were independent prognostic factors for PFS. For the overall survival analysis, TNM stage, WHO classification, SUVmax, and HI‐1 were significant prognostic factors in the univariate analysis, while TNM stage remained an independent prognostic factor in multivariate analyses (p = 0.024). The Kaplan Meier survival analyses showed worse prognoses for patients with TNM stages III and IV and HI‐1 ≥ 0.16 compared to those with stages I and II and HI‐1 < 0.16 (log‐rank p < 0.001). Conclusion: HI‐1 and TNM stage were independent prognostic factors for progression‐free survival in TETs. HI‐1 generated from baseline 18F‐FDG PET/CT might be promising to identify patients with poor prognosis. [ABSTRACT FROM AUTHOR]

Introduction: This article mainly studies the risk factors for postoperative acute myocardial infarction (AMI) in elderly hip fracture patients combined with coronary heart disease (CHD), constructs a prediction model, and evaluates the prognosis of all the patients. Methods: This article retrospectively collected elderly patients with hip fracture and CHD who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January 2019 to December 2021. Demographic data, laboratory indicators, and imaging examination results were collected from the medical case system. The risk factors of postoperative AMI were determined by univariate and multivariate logistic regression, and a nomogram prediction model was established. The ROC curve, calibration curve and DCA decision curve were plotted by R language software. The patients in the training set were followed up for 2 years to evaluate their survival situation. Results: 1094 eligible patients were divided into a training set (n = 824 from January 1, 2019 to September 31, 2021) and a validation set (n = 270 from October 1, 2021 to December 31, 2022). In the training set, women accounted for 58.6%; The average age of the patients was 79.45 years old; The main type of fracture was intertrochanteric fracture. There were 64.7% patients taken B receptor blockers; A total of 166 (20.1%) patients underwent percutaneous coronary intervention (PCI); Hypertension accounted for 55.5%; 520 (63.1%) patients had a preoperative waiting time greater than 3 days; The average hemoglobin value upon admission was 101.36 g/L; The average intraoperative bleeding volume was 212.42 ml; The average surgical time was 2.5 ± 0.3 h; Reginal anesthesia accounted for 29.7%; 63 (68.5%) AMI patients had no obvious clinical symptoms; 68 (73.9%) AMI patients did not show ST-segment elevation in ECG; The risk factors of postoperative AMI were age, hemoglobin at admission, diabetes, chronic kidney disease, intraoperative bleeding, and reginal anesthesia. The AUC of the nomogram prediction model was 0.729. The AUC in the validation set was 0.783. Survival analysis showed a significant statistical difference in 2-year mortality between patients with AMI and without AMI, among all the patients with AMI, patients with ECG ST-segment elevation has higher mortality than patients without ECG ST-segment elevation. Conclusion: Our research results found that the incidence of postoperative AMI in elderly patients with hip fractures and CHD was 11.1%. Age, diabetes, hemoglobin at admission, regional anesthesia, chronic kidney disease, and intraoperative bleeding are risk factors. The AUC of the nomogram in training set is 0.729. The 2-year mortality rate of the patients with AMI is higher than that of patients without AMI. [ABSTRACT FROM AUTHOR]

Simple Summary: We developed an attention-based whole slide image (WSI)-level classification deep learning model employing surgically and endoscopically resected specimens to predict LNM in T1 CRC. Our AI model with H&E-stained WSIs and without annotations showed good performance power with the validation of an independent cohort in a single center. The area under the curve of our model was 0.781–0.824, higher than that of previous artificial intelligence (AI) studies with only WSIs. Our AI model, which showed the highest sensitivity (92.9%), reduced unnecessary additional surgery by 14.2% more than using the current JSCCR guidelines (68.3% vs. 82.5%). This revealed the feasibility of using an AI model with only H&E-stained WSIs to predict LNM in T1 CRC. According to the current guidelines, additional surgery is performed for endoscopically resected specimens of early colorectal cancer (CRC) with a high risk of lymph node metastasis (LNM). However, the rate of LNM is 2.1–25.0% in cases treated endoscopically followed by surgery, indicating a high rate of unnecessary surgeries. Therefore, this study aimed to develop an artificial intelligence (AI) model using H&E-stained whole slide images (WSIs) without handcrafted features employing surgically and endoscopically resected specimens to predict LNM in T1 CRC. To validate with an independent cohort, we developed a model with four versions comprising various combinations of training and test sets using H&E-stained WSIs from endoscopically (400 patients) and surgically resected specimens (881 patients): Version 1, Train and Test: surgical specimens; Version 2, Train and Test: endoscopic and surgically resected specimens; Version 3, Train: endoscopic and surgical specimens and Test: surgical specimens; Version 4, Train: endoscopic and surgical specimens and Test: endoscopic specimens. The area under the curve (AUC) of the receiver operating characteristic curve was used to determine the accuracy of the AI model for predicting LNM with a 5-fold cross-validation in the training set. Our AI model with H&E-stained WSIs and without annotations showed good performance power with the validation of an independent cohort in a single center. The AUC of our model was 0.758–0.830 in the training set and 0.781–0.824 in the test set, higher than that of previous AI studies with only WSI. Moreover, the AI model with Version 4, which showed the highest sensitivity (92.9%), reduced unnecessary additional surgery by 14.2% more than using the current guidelines (68.3% vs. 82.5%). This revealed the feasibility of using an AI model with only H&E-stained WSIs to predict LNM in T1 CRC. [ABSTRACT FROM AUTHOR]

Background: New nurses are prone to workplace deviant behavior in the constrained hospital environment, which will not only directly affect the safety of patients, but also reduce the work efficiency of nurses and bring negative results to the hospital. The purpose of this study was to investigate the relationship between perceived organizational justice, emotional labor, psychological capital, and workplace deviant behavior of new nurses. Methods: A cross-sectional study was used in this study. A survey was conducted in 5 hospitals in Henan Province, Chain from February to April 2023. The sample size was 546. The questionnaire included general information, perceived organizational justice scale, emotional labor scale, psychological capital scale, and workplace deviant behavior scale. SPSS 26.0 and PROCESS Macro were used for data analysis. PROCESS Model 4 and Model 14 were used to verify the model. Results: This study displays that perceived organizational justice was negatively correlated with emotional labor and workplace deviant behavior, and emotional labor was positively correlated with workplace deviant behavior. Meanwhile, emotional labor plays a partial mediating role between perceived organizational justice and workplace deviant behavior, accounting for 32.7% of the total effect. Moreover, the path of emotional labor on workplace deviant behavior is moderated by psychological capital. Conclusion: This study further understood the workplace deviant behavior of new nurses, and provided a new perspective for solving this problem. Nurse managers can reduce workplace deviant behavior by enhancing the perceived organizational justice and psychological capital of new nurses and improving emotional labor. [ABSTRACT FROM AUTHOR]

Over the past several decades, significant criticism of the categorical classification system for personality disorders has highlighted the need to transition to a dimensional classification system. This study reviewed key issues involved in the potential conversion of the diagnostic system of personality disorders from a categorical to a dimensional model. The result suggests that Kernberg's concept of personality organization can be used to indicate the overall severity of personality pathology. [ABSTRACT FROM AUTHOR]

HPV vaccine hesitancy in Asia is unique compared to western countries. Concerning whether social media promotion about HPV vaccine will be related with parental support for Chinese adolescent girls, we investigated the correlation among social media promotion, risk perception of HPV vaccine and parental support. Through the theoretical lens of Health Action Process Approach model (HAPA), we found that social media promotion could reduce the risk perception of HPV vaccine and promoted parental supportive decision, and risk perception played a mediation role between social media information exposure to vaccine and parental support. Consideration of future consequences has been found to play a moderating role between social media promotion and risk perception, and parents' sexual attitudes moderated the effect of social media promotion on parental support. Implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

This study analyzed the content, visual features, and audience engagement data of Instagram posts from two mental health organizations over one year (N = 725). For content features, mental health literacy and communicative strategies were examined. Posts that promoted knowledge of mental disorders and treatments, used information and community strategy were more likely to receive higher audience engagement. Visual features of demographic segments, visual composition, and visual framing topics were analyzed. Images that covered an unspecific population, used illustrated images, and focused on anti-stigma topical frames obtained more engagement. Theoretical contributions and practical applications regarding visual message design and management on social media to promote mental health are also offered. [ABSTRACT FROM AUTHOR]

A plethora of scientific evidence has pinpointed that teaching English as a foreign or second language (EFL) is difficult, challenging, and emotionally burdensome. Nevertheless, most English language teachers remain committed to the teaching profession and actively engage in the instructional environment. This has inspired several scholars worldwide to explore what personal, emotional, and psychological factors motivate English language teachers to engage enthusiastically in their workplace. While a large body of studies have to date examined the personal, emotional, and psychological predictors of English language teachers' work engagement, to our knowledge, no inquiry has investigated the role of academic buoyancy and self-efficacy in predicting EFL teachers' work engagement. Furthermore, the potential impact of demographic variables on the interplay between EFL teachers' academic buoyancy, self-efficacy, and work engagement has been disregarded. To bridge this gap, we examined the interplay of these three constructs among Chinese EFL teachers. To do so, we administered three pre-designed questionnaires to 242 EFL teachers working in Chinese schools and universities. The collected data were then analyzed using structural equation modeling (SEM). The outcomes of SEM divulged positive and strong relationships between Chinese EFL teachers' academic buoyancy, self-efficacy, and work engagement. The SEM results also indicated that academic buoyancy and self-efficacy could strongly and favorably predict Chinese EFL teachers' work engagement. Additionally, the study outcomes disclosed that demographic variables, including gender, educational degree, and teaching experience, directly impacted the interplay between Chinese EFL teachers' academic buoyancy, self-efficacy, and work engagement. These results may have significant implications for English teachers, teacher trainers, and educational principals. [ABSTRACT FROM AUTHOR]

Background: Students who are blind are integrated into public schools in many countries, yet are often excluded from full participation in science since most learning materials are visual. To create a compensatory route, an existing model‐based inquiry‐learning environment was adapted by means of sonification (addition of non‐speech sounds that represent dynamic information). The learning environment uses agent‐based models and a complex systems approach to teach the Kinetic Molecular Theory (KMT) and Gas Laws. The models are accompanied by a workbook consisting of text (printed or auditory) and images (printed or tactile). Objectives: The current research examined whether such perceptual compensation creates a comparable learning environment for learners who are blind compared with learners who are sighted using the original learning environment. The aim of the study is to expand knowledge about how the auditory channel may compensate the visual channel among individuals who are blind. Methods: Conceptual learning in science and reasoning about complex systems were assessed using pre‐ and post‐questionnaires. To explore learners' learning progression throughout the unit, four progression analysis 'windows' were selected. These were groups of adjacent or nearly adjacent items in the workbook that permitted a glimpse of learners' progression. Results: The sonified environment not only supported the learning of learners who are blind compared with the learning of learners who are sighted using visual material, but even furthered their learning with respect to diffusion, one of the more challenging concepts in KMT. It seems the types of sonified representations used in this study increased listeners' sensitivity to the micro‐level interactions in a way less accessible in visual representations. Takeaways: Sonified environments can be provide learners who are blind with equitable participation by compensating and complementing the visual channel. Sonification can have implications for students who are blind as well as students who are sighted. Lay Description: What is already known: Sonification is the use of non‐speech sounds to represent dynamic information. Sonification can potentialy be used to allow equitable participation for students who are blind. What this paper adds: To test this, the study compared the outcomes of learners who are blind who used a sonified learning environment (L2C) to that of learners who are sighted who used a visual environment. Implications for practice: Learners who are blind showed equal or better learning outcomes using the sonified models compared with the learners who are sighted using the visual models. There are major implications for integrating students who are blind in public school classrooms. [ABSTRACT FROM AUTHOR]

Background: The clinical staging of non‐small cell lung cancer (NSCLC) is well known to be related to their prognosis. However, there is usually a discrepancy between clinical staging and pathological staging. There are few analyses of clinical staging accuracy in patients with NSCLC. We compared the concordance rate between clinical and pathological staging of NSCLC and evaluated factors affecting the accuracy in real‐world data. Methods: Altogether, 811 patients with primary NSCLC who had undergone curative lung resection surgery in Severance Hospital from January 2019 to December 2020 were retrospectively reviewed. We used the eighth edition of the American Joint Committee on Cancer TNM staging. Results: Among 811 patients, endobronchial ultrasound (EBUS) and positron emission tomography (PET‐CT) were performed in 31.6% and 96.7%, respectively. The concordance rates between clinical and pathological TNM staging, T factor, and N factor, were 68.7%, 77.7%, and 85.8%, respectively. With multivariable logistic regression analysis, current smokers (OR 0.49; 95% CI: 0.32–0.76, p = 0.001) and a higher clinical stage (p < 0.001) contributed to the clinical staging inaccuracy. Additionally, the presence of a bronchoscopy specialist was significantly associated with clinical staging accuracy (OR 1.53; 95% CI: 1.10–2.13, p = 0.011). Conclusion: Clinical staging accuracy in NSCLC improved compared to before the widespread use of PET‐CT and EBUS in clinical staging work‐up. Smoking history and absence of expert bronchoscopy specialists showed a meaningful correlation with the inaccuracy of clinical staging. Thus, training more bronchoscopy experts would improve the staging accuracy of NSCLC, which could positively affect the prognosis of NSCLC. [ABSTRACT FROM AUTHOR]

Background: There is substantial evidence to support the use of several methods for preventing deep-vein thrombosis (DVT) following intracerebral hemorrhage (ICH). However, the extent to which these measures are implemented in clinical practice and the factors influencing patients' receipt of preventive measures remain unclear. Therefore, we aimed to evaluate the rate of the early implementation of DVT prophylaxis and the factors associated with its success in patients with ICH. Methods: This study enrolled 49,950 patients with spontaneous ICH from the Chinese Stroke Center Alliance (CSCA) between August 2015 and July 2019. Early DVT prophylaxis implementation was defined as an intervention occurring within 48 h after admission. Univariate and multivariate logistic regression analyses were conducted to identify the rate and factors associated with the implementation of early prophylaxis for DVT in patients with ICH. Results: Among the 49,950 ICH patients, the rate of early DVT prophylaxis implementation was 49.9%, the rate of early mobilization implementation was 29.49%, and that of pharmacological prophylaxis was 2.02%. Factors associated with an increased likelihood of early DVT prophylaxis being administered in the multivariable model included receiving early rehabilitation therapy (odds ratio [OR], 2.531); admission to stroke unit (OR 2.231); admission to intensive care unit (OR 1.975); being located in central (OR 1.879) or eastern regions (OR 1.529); having a history of chronic obstructive pulmonary disease (OR 1.292), ischemic stroke (OR 1.245), coronary heart disease or myocardial infarction (OR 1.2); taking antihypertensive drugs (OR 1.136); and having a higher Glasgow Coma Scale (GCS) score (OR 1.045). Conversely, being male (OR 0.936), being hospitalized in tertiary hospitals (OR 0.778), and having a previous intracranial hemorrhage (OR 0.733) were associated with a lower likelihood of early DVT prophylaxis being administered in patients with ICH. Conclusions: The implementation rate of early DVT prophylaxis among Chinese patients with ICH was subpar, with pharmacological prophylaxis showing the lowest prevalence. Various controllable factors exerted an impact on the implementation of early DVT prophylaxis in this population. [ABSTRACT FROM AUTHOR]

Objective: Emerging evidence suggests that meeting the 24‐h movement guidelines is associated with optimal mental health. However, there remains some uncertainty regarding this association in children. Therefore, this study aimed to examine the association between meeting the 24‐h movement guidelines and psychosocial health in children. Methods: A cross‐sectional study design was employed to investigate 2005 children aged 9–12 years from four districts of Shanghai, China. The 24‐h movement behaviours were assessed using selected items from the Health Behaviour in School‐aged Children (HBSC) survey questionnaire. Children's self‐rated psychosocial health was evaluated using the Strengths or Difficulties Questionnaire (SDQ). Generalised Linear Models with the ordinal logistic module were employed to analyse the association between meeting the 24‐h movement guidelines and psychosocial health. Results: The overall prevalence of meeting all three 24‐h movement recommendations was 10.2%. Among children, 7.9% of them exhibited abnormal total difficulties, with a notable difference between sex (boys: 11.2%, girls: 7.0%, p = 0.001). Meeting all three 24‐h movement behaviour recommendations was associated with reduced total difficulties, emotional symptoms, conduct problems, hyperactivity and peer problems. Furthermore, a dose–response association was observed, indicating that meeting a greater number of 24‐h movement behaviour recommendations was associated with enhanced psychosocial health, particularly in boys. Conclusion: The findings of this study highlight the positive association between meeting the 24‐h movement guidelines and psychosocial health in children. Notably, meeting more of these recommendations was associated with a lower likelihood of experiencing psychosocial problems, with greater benefits observed in boys compared with girls. [ABSTRACT FROM AUTHOR]

Simple Summary: Accurate assessment of the presence and progression of bone metastases will guide individual treatment plans. Sophisticated cross-sectional imaging techniques, such as magnetic resonance diffusion-weighted imaging (DWI), have gained favor due to their superior soft tissue contrast and resolution without the need for ionizing radiation. Many DWIS are available on clinical scanners, which show promise for objective assessment of bone metastases. Background: The purpose of this study is to compare turbo spin echo diffusion-weighted images in radial trajectory (BLADE DWI) with multi-shot echoplanar imaging (RESOLVE DWI) for imaging the metastatic lesion in the pelvic bone to find a correlation between ADC values and standardized uptake values (SUVs) of FDG uptake in PET/CT. The study also seeks to compare the values of metastatic lesions with those of benign bone lesions, specifically red marrow hyperplasia. Methods: The retrospective IRB-approved study included patients with bone metastasis and red marrow hyperplasia in the pelvic bone who underwent 3.0 T MRI with BLADE/RESOLVE DWI sequences and F-18 FDG PET/CT within one month. BVC (best value comparator) was used in determining the nature of bone lesions. Apparent diffusion coefficient (ADC) and standardized uptake value (SUV) were measured by a radiologist and a nuclear medicine physician. MRI image quality was graded with a Likert scale regarding the visualization of the sacroiliac joint, sacral neural foramen, hamstring tendon at ischial tuberosity, and tumor border. Signal-to-noise ratio (SNR) and imaging time were compared between the two DWIs. Mean, peak, and maximum SUVs between metastatic and benign red marrow lesions were compared. SUVs and ADC values were compared. AUROC analyses and cut-off values were obtained for each parameter. Mann–Whitney U, Spearman's rho, and Kolmogorov–Smirnov tests were applied using SPSS. Results: The final study group included 58 bone lesions (19 patients (male: female = 6:13, age 52.5 ± 9.6, forty-four (75.9%) bone metastasis, fourteen (24.1%) benign red marrow hyperplasia). ADCs from BLADE and RESOLVE were significantly higher in bone metastasis than red marrow hyperplasia. BLADE showed higher ADC values, higher anatomical scores, and higher SNR than RESOLVE DWI (p < 0.05). Imaging times were longer for BLADE than RESOLVE (6 min 3 s vs. 3 min 47 s, p < 0.05). There was a poor correlation between ADC values and SUVs (correlation coefficient from 0.04 to 0.31). The AUROC values of BLADE and RESOLVE MRI ranged from 0.892~0.995. Those of PET ranged from 0.877~0.895. The cut-off ADC values between the bone metastasis and red marrow hyperplasia were 355.0, 686.5, 531.0 for BLADE min, max, and average, respectively, and 112.5, 737.0, 273.0 for RESOLVE min, max, and average, respectively. The cut-off SUV values were 1.84, 5.01, and 3.81 for mean, peak, and max values, respectively (p < 0.05). Conclusions: Compared with RESOLVE DWI, BLADE DWI showed improved image quality of pelvic bone MRI in the aspect of anatomical depiction and SNR, higher ADC values, albeit longer imaging time. BLADE and RESOLVE could differentiate bone metastasis and red marrow hyperplasia with quantifiable cut-off values. Further study is necessary to evaluate the discrepancy between the quantifiers between PET and MRI. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to compare the attitudes and preferences on cancer diagnosis disclosure (CDD) among suspicious lung cancer patients (SLCPs), lung cancer patients (LCPs), and their family members and to explore their associations with resilience. Methods. A cross-sectional study was conducted at Yunnan Cancer Hospital in China, from March to August 2022. A total of 1016 participants including 254 SLCP-family pairs and 254 LCP-family pairs completed self-administered questionnaires to assess their attitudes toward CDD and resilience. Continuous variables were expressed by means and standard deviations, while categorical variables were presented by numbers and percentages. The comparisons between groups were tested by using a t-test or chi-squared test. Associations between resilience and CDD attitudes in the four groups were estimated by multivariate logistic regression models. Results. Compared with LCPs, more SLCPs believed that patients should be informed of their cancer diagnoses (63.8% vs 43.7%, p < 0.001), and the distribution of the first one to know the diagnosis was disequilibrium (p < 0.05). The significant difference was identified in participants' attitudes toward patients being told the facts by resilience levels among the different groups. Subsequent multivariate logistic regression analyses showed that resilience was associated with participants' preference for patients being informed of their cancer diagnoses in the SLCPs group (adjusted OR: 1.87, 95% CI: 1.08–3.25), LCPs group (adjusted OR: 2.21, 95% CI: 1.32–3.74), and family of LCPs group (adjusted OR: 1.79, 95% CI: 1.04–3.12). We further performed a sensitivity analysis using quantiles of resilience. Conclusion. SLCPs and LCPs exhibited different attitudes towards CDD. Resilience plays a positive role in CDD. Our study suggests that healthcare practitioners should consider patients' diagnosis state when disclosing a cancer diagnosis and tailor their disclosure methods based on the patients' and families' preferences and resilience. Our findings provide important implications to guide future research and intervention programs to improve cancer diagnosis disclosure for SLCPs, LCPs, and their families. [ABSTRACT FROM AUTHOR]

Purpose: To assess the relationship between anticoagulant use and rehabilitation outcomes in post-acute hip fracture patients. Methods: A retrospective study (1/2017 to 5/2019) of 299 hip fractured patients. Outcome measures: Functional Independence Measure (FIM) and the motor FIM's effectiveness. Results: Patients treated with anticoagulation drugs exhibited a significant longer latency time from fracture to surgery (U?-4.37, p<0.001) and from surgery to rehabilitation (U=-2.27, p=0.023), and a significantly higher rate of cardiovascular diseases (χ²=0.15, p= 0.023) compared with untreated patients. No significant differences between the two patient groups were found regarding the rate of blood transfusions, perioperative complications (infections, reoperation), or functional outcome measures. Conclusions: Oral anticoagulants are not associated with rehabilitation outcomes of hip fracture patients. [ABSTRACT FROM AUTHOR]

The study investigated the influence of the humanistic orientation on the perspectives of service providers working with individuals with intellectual and developmental disabilities (IDD) and the self‐evaluation of service users. The humanistic orientation, which emerged in the 1990s, emphasizes the rights of people with IDD to lead a meaningful life based on their personal needs and desires. However, challenges persist as some service providers prioritize the acquisition of normative life skills over fostering autonomy. The study was based on quantitative methodology and included 61 service providers and 95 of their service users. The study's findings indicate that the humanistic orientation was endorsed by nearly one half of the service providers compared with one third who endorsed a medical orientation. Those endorsing a humanistic orientation also reported that their service users had higher levels of efficacy than those with a medical perception of IDD. Positive correlations were found regarding the assessments made by service providers and their service users on self‐efficacy. Findings suggest that a humanistic orientation encourages optimism among service providers and a positive dyadic interaction between providers and users. It is suggested that the humanistic orientation be applied as a guiding principle underlying the daily support provided to adults with IDD. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder (MDD) poses a significant social and economic burden worldwide. Identifying exposures, risk factors, and biological mechanisms that are causally connected to MDD can help build a scientific basis for disease prevention and development of novel therapeutic approaches. Methods: In this systematic review, we assessed the evidence for causal relationships between putative causal risk factors and MDD from Mendelian randomization (MR) studies, following PRISMA. We assessed methodological quality based on key elements of the MR design: use of a full instrumental variable analysis and validation of the three key MR assumptions. Results: We included methodological details and results from 52 articles. A causal link between lifestyle, metabolic, inflammatory biomarkers, particular pathological states and MDD is supported by MR investigations, although results for each category varied substantially. Conclusions: While this review shows how MR can offer useful information for examining prospective treatment targets and better understanding the pathophysiology of MDD, some methodological flaws in the existing literature limit reliability of results and probably underlie their heterogeneity. We highlight perspectives and recommendations for future works on MR in psychiatry. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the clinical efficacy and safety of percutaneous endoscopic interlaminar discectomy (PEID) for treating highly downward-migrated disc herniation. Methods: We conducted a retrospective study on 39 patients with highly downward-migrated disc herniation who underwent PEID treatment between January 2015 and October 2020. The clinical outcomes, including the preoperative and postoperative visual analogue scale (VAS) for the back and leg, Oswestry Disability Index (ODI), and MacNab criteria for surgical success, were evaluated and compared to thirty-seven patients treated with posterior lumbar interbody fusion (PLIF). Results: The mean operation time of PEID was 93.00(77.00,110.00) min, while that of PLIF was 169.00(157.00,183.00) min. Continued improvement in both PEID and PLIF was observed in the VAS and ODI scores immediately after the surgery to the last follow‐up. The VAS and ODI scores of PEID one week after surgery were significantly different from those of PLIF. One patient with recurrent lumbar disc herniation in the same segment improved after undergoing repeat PEID, two patients had dura tears, and conservative treatment helped relieve the symptoms. The overall percentage of patients with good to excellent results of PELD according to the modified MacNab criteria was 97.43%, while that of PLIF was 94.60%. Conclusions: PEID has reliable efficacy and safety for treating highly downward-migrated disc herniation. And the long-term efficacy of PEID is comparable to PLIF. No severe complications occurred after surgery, and most patients' symptoms were relieved. [ABSTRACT FROM AUTHOR]

Background: Blended learning is increasingly being adopted, and yet a gap remains in the related literature pertaining to its skill performance, learning engagement and inner experience in undergraduate surgical nursing skills course. Objectives: To investigate the changes in skills performance and learning engagement in the application of blended learning, and what it actually brings to nursing students. Design: The study uses a historical control, two-armed, mixed and quasi-experimental design. Methods: The blended learning version of the course was offered to the 2019 class of 334 nursing undergraduates. Quantitative and qualitative data were collected after the course to obtain a comprehensive understanding of the course effects compared with the 304 nursing undergraduates of grade 2017 who adapted traditional learning. Quantitative data were analyzed by descriptive and inferential statistics using IBM SPSS 26.0, and qualitative data were encoded using Nvivo11.0. Results: There were significant differences in skill performance and learning engagement between the class of 2017 and 2019 (p < 0.001). Combined with further analysis of the interview data, 3 first-level nodes and 8 secondary nodes were determined. Students' opinions, comments and suggestions on the application of blended learning are refreshing. Conclusion: Moving forward with blended learning: opportunities and challenges go hand in hand. Researchers need to continually modify their research designs to respond to variable educational environments. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between type 2 diabetes mellitus (T2DM) patients' attitude, subjective norms (SN), perceived behavioral control (PBC), behavioral intention (BI) and behavior associated with integrated treatment and preventive (ITP) services. Methods: A convenient sampling method was employed at a community health center in Nanjing, China between January and July 2022. The collected data were processed using Epidata 3.1, SPSS 26.0, and AMOS 24.0. Descriptive statistics and a structural equation model based on the theory of planned behavior (TPB) were used to explore the correlation between the study variables. Results: 430 participants were eventually included, with a response rate of 98.6%. The mean age was 72.50 ± 5.69 years. The TPB model proved to be suitable and explained 41% of the variance in the BI. Attitude (β = 0.289, P < 0.001), SN (β = 0.314, P < 0.001) and PBC (β = 0.261, P < 0.001) were the main predictors of BI, and the SN was the strongest. BI (β = 0.452, P < 0.001) and PBC (β = 0.452, P < 0.001) had similar direct effects on patients' behavior. Conclusion: The TPB model explained the behavioral variations associated with ITP services and provided a framework for developing targeted interventions and improving community-based ITP services for T2DM. To encourage patients to engage in desirable behaviors, interventions should focus on modifying patients' SN towards behavior associated with ITP services by promoting peer pressure and increasing the family's emphasis on health. [ABSTRACT FROM AUTHOR]

Background: Chronic primary pain (CPP) is an intractable pain of unknown cause with significant emotional distress and/or dysfunction that is a leading factor of disability globally. The lack of a suitable animal model that mimic CPP in humans has frustrated efforts to curb disease progression. 2R, 6R-hydroxynorketamine (2R, 6R-HNK) is the major antidepressant metabolite of ketamine and also exerts antinociceptive action. However, the analgesic mechanism and whether it is effective for CPP are still unknown. Methods: Based on nociplastic pain is evoked by long-term potentiation (LTP)-inducible high- or low-frequency electrical stimulation (HFS/LFS), we wanted to develop a novel CPP mouse model with mood and cognitive comorbidities by noninvasive low-frequency percutaneous electrical nerve stimulation (LF-PENS). Single/repeated 2R, 6R-HNK or other drug was intraperitoneally (i.p.) or intrathecally (i.t.) injected into naïve or CPP mice to investigate their analgesic effect in CPP model. A variety of behavioral tests were used to detect the changes in pain, mood and memory. Immunofluorescent staining, western blot, reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR) and calcium imaging of in cultured dorsal root ganglia (DRG) neurons by Fluo-8-AM were used to elucidate the role and mechanisms of 2R, 6R-HNK in vivo or in vitro. Results: Intrathecal 2R, 6R-HNK, rather than intraperitoneal 2R, 6R-HNK or intrathecal S-Ketamine, successfully mitigated HFS-induced pain. Importantly, intrathecal 2R, 6R-HNK displayed effective relief of bilateral pain hypersensitivity and depressive and cognitive comorbidities in a dose-dependent manner in LF-PENS-induced CPP model. Mechanically, 2R, 6R-HNK markedly attenuated neuronal hyperexcitability and the upregulation of calcitonin gene-related peptide (CGRP), transient receptor potential ankyrin 1 (TRPA1) or vanilloid-1 (TRPV1), and vesicular glutamate transporter-2 (VGLUT2) in peripheral nociceptive pathway. In addition, 2R, 6R-HNK suppressed calcium responses and CGRP overexpression in cultured DRG neurons elicited by the agonists of TRPA1 or/and TRPV1. Strikingly, the inhibitory effects of 2R, 6R-HNK on these pain-related molecules and mechanical allodynia were substantially occluded by TRPA1 antagonist menthol. Conclusions: In the newly designed CPP model, our findings highlighted the potential utility of intrathecal 2R, 6R-HNK for preventing and therapeutic modality of CPP. TRPA1-mediated uprgulation of CGRP and neuronal hyperexcitability in nociceptive pathways may undertake both unique characteristics and solving process of CPP. Highlights: 1) We first establish the CPP mouse model by LF-PENS to mimic nociplastic pain. 2) Intrathecal 2R, 6R-HNK effectively alleviates LF-PENS-induced CPP in mouse models by inhibiting TRPA1 in DRG neurons. [ABSTRACT FROM AUTHOR]

Aims: To systematically identify the risk factors for cognitive impairment in maintenance haemodialysis patients and to assess its prevalence in included studies. Design: Systematic review and meta‐analysis about observational studies. Data Sources: Systematic search of seven databases, including PubMed, Web of Science, Scope, Wanfang Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Weipu Chinese Science and Technology Journal Database, from inception until October 2021. Review Methods: Observational studies reporting the risk factors for cognitive impairment in maintenance haemodialysis patients in English and Chinese language were included. Meta‐analysis was performed to identify risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients with STATA 15.0 software. Results: Overall, 37 eligible studies encompassing 129,849 cases were included. The risk factors with statistical significance after meta‐analysis were older age, female sex, fewer years of education, hypertension, diabetes, cerebrovascular accident, multiple comorbid conditions, systolic blood pressure variability, arterial stiffness and low haemoglobin and albumin level. The overall prevalence of cognitive impairment in maintenance haemodialysis patients was 49.1%. Conclusion: The current analysis indicated a high prevalence of cognitive impairment in maintenance haemodialysis patients. Eleven risk factors for cognitive impairment in maintenance haemodialysis patients were identified, among which more attention should be paid to modifiable factors such as cardiovascular disease risk factors and specific kidney and dialysis‐related factors. Impact: This paper provides an updated estimate of the pooled prevalence of cognitive impairment in maintenance haemodialysis patients. Identification of risk factors associated with cognitive impairment may assist in developing targeted prevention strategies for maintenance haemodialysis patients at high risk. No Patient or Public Contribution: This study was a systematic review completed by the authors in accordance with relevant guidelines and processes and did not include the participation of patients, service users, caregivers or the general public. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate treatment effects of naming therapy targeting nouns and verbs in Mandarin-English bilingual adults with aphasia (BWA). Method: Twelve Mandarin-English bilingual adults with chronic aphasia completed a 40-hr semantic-based naming treatment for either nouns or verbs. Eight of these participants completed both noun and verb treatment, and the other four completed either noun or verb treatment. Participants were trained in either Mandarin or English for both treatment cycles. Weekly naming probes were measured to capture the direct treatment gain and within- and cross-language generalizations. Performance on the standardized language assessments was analyzed to examine further generalizations beyond the word level and to standardized naming tasks. Results: Responses in the weekly naming probes showed significant treatment gains in both noun and verb treatment, but the effect was greater in verb treatment. Generalization to semantically related items was captured in noun treatment only. Cross-language generalization was identified in both noun and verb treatment with a larger effect in verb treatment. Additionally, widespread generalizations beyond the word level and to standardized naming tasks were found following both noun and verb treatment, but the effect was larger following noun treatment in discourse and verb naming tasks. Conclusions: Findings from this study suggested robust treatment effects of semantic-based naming treatment targeting nouns and verbs in Mandarin-English BWA. However, patterns of treatment gains and generalizations differed between these word categories. This study provides strong evidence of bilingual aphasia rehabilitation in Mandarin-English BWA. [ABSTRACT FROM AUTHOR]

The researchers' aim to quantitatively study the impacts of education, health expenditure, Internet, mobile phone, and open-access articles in medical science on women's health in China. We found that there are very strong significant negative correlations between the data of women's mortality rates and female school enrollment (p≪0.01), whereas there are strong significant negative correlations for open-access papers in eight disciplines of medical science, individuals using the Internet, and mobile cellular subscriptions (p≪0.01). The first principal component explains 96.8%, 96.6%, and 99.6% of the variation in the mortality rate of female infants (p = 0.002 < 0.01), females under-5 (p = 0.003 < 0.01), and female adults (p = 0.002 < 0.01), respectively. There is a similar relationship between open-access medical papers and women's health. The above results could be helpful to interdisciplinary audiences (patients, practitioners, and policymakers) to develop strategies for the effective implementation of knowledge on women's health (how to disseminate knowledge more effectively in the whole society). [ABSTRACT FROM AUTHOR]

Introduction: Little research has explored galactagogue food consumption in China. This study aims to investigate consumption patterns and how they relate to perceived insufficient milk supply and exclusive breastfeeding. Methods: Data were collected from postpartum women in China at six time points: baseline demographic questionnaire before hospital discharge (T0), galactagogue food questionnaire at 1 month postpartum (T1), Hill and Humenick Lactation Scale at 6 weeks postpartum (T2), and breastfeeding practices at 1, 2, 3 and 4 months postpartum (T1, T3, T4, T5). Results: Of 218 participants who completed the galactagogue food questionnaire, 64.68% were consumers. No association was found between galactagogue food consumption and perceived insufficient milk supply. Consumers were less likely to breastfeed exclusively. Discussion: Future research should emphasize a deeper understanding of consumer behaviors and family support in providing professional guidance on postpartum nutrition that considers not only social and cultural experiences but also broader medical aspects. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio‐ecological model. Background: PA has been linked to poor long‐term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. Design: Cohort study. Methods: We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group‐based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow‐up. A STROBE checklist was used to guide the reporting of this study. Results: Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow‐up. Conclusions: This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. Relevance to Clinical Practice: It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. No Patient or Public Contribution: A national cohort study was used and no patients or the public were involved in the design and implementation of this study. [ABSTRACT FROM AUTHOR]

Background: Individuals with autism spectrum disorder (ASD) are challenged not only by the defining features of social-communication deficits and restricted repetitive behaviors, but also by a myriad of psychopathology varying in severity. Different cognitive deficits underpin these psychopathologies, which could be subjected to intervention to alter the course of the disorder. Understanding domain-specific mediating effects of cognition is essential for developing targeted intervention strategies. However, the high degree of inter-correlation among different cognitive functions hinders elucidation of individual effects. Methods: In the Philadelphia Neurodevelopmental Cohort, 218 individuals with ASD were matched with 872 non-ASD controls on sex, age, race, and socioeconomic status. Participants of this cohort were deeply and broadly phenotyped on neurocognitive abilities and dimensional psychopathology. Using structural equation modeling, inter-correlation among cognitive domains were adjusted before mediation analysis on outcomes of multi-domain psychopathology and functional level. Results: While social cognition, complex cognition, and memory each had a unique pattern of mediating effect on psychopathology domains in ASD, none had significant effects on the functional level. In contrast, executive function was the only cognitive domain that exerted a generalized negative impact on every psychopathology domain (p factor, anxious-misery, psychosis, fear, and externalizing), as well as functional level. Conclusions: Executive function has a unique association with the severity of comorbid psychopathology in ASD, and could be a target of interventions. As executive dysfunction occurs variably in ASD, our result also supports the clinical utility of assessing executive function for prognostic purposes. [ABSTRACT FROM AUTHOR]

This study analyzed tweets posted over 1 year from three mental-health organizations in the United States, along with audience engagement data of comments, retweets, and likes. The results revealed that tweets focused on mental illnesses or mental health received more engagement than those that emphasized event promotion or relationship building. In addition, there were more gain-framed than loss-framed messages, although the latter triggered more public engagement. Thematic framing was used more frequently than episodic framing and related to higher levels of engagement. Call-to-action (CTA), other audience engaging methods and multimedia strategies were used in various frequencies in these tweets; and the use of CTA, other engaging methods, photos/pictures, and external links, but not videos, were positively related to public engagement. Theoretical contributions and practical implications regarding using social media for mental health promotion were offered. [ABSTRACT FROM AUTHOR]

Aim: To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery. Methods: A systematic review and meta‐analysis was conducted. PubMed, Cochrane Library, CINAHL, Web of Science, EMBASE, and ClinicalTrials.gov databases were systematically searched from inception to April 30th, 2022. Cross‐sectional, cohort, case–control, and secondary analysis of randomized controlled studies that reported the incidence of PPH and the related risk factors in vaginal delivery were eligible through screening of 2343 articles. The incidence, associated standard error, adjusted odds ratios, relative risks and associated 95% confidence intervals were combined in the meta‐analysis. Results: Thirty‐six articles were included in the descriptive review. The incidence of PPH (blood loss ≥500 mL and blood loss ≥1000 mL) was 17% and 6%, respectively. Forty‐one identified risk factors were divided into five categories under two criteria: history and demographics; maternal comorbidity; pregnancy‐related factors; labor‐related factors; delivery‐related factors. Conclusions: With the increasing incidence of PPH globally, obstetric health care providers need to improve their awareness of these multi‐factorial risks to optimize obstetric care and reduce maternal morbidity. This systematic review and meta‐analysis have raised important questions about the nature of vaginal delivery, such as the duration of prolonged labor, details on the use of oxytocin, and the presence of genital tract trauma. There should be highlighted by obstetric personnel on these factors during a patients' labor process. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal hypokinesis can occur transiently after benign gynecologic surgery. Opioids cause the side effect of postoperative gastrointestinal hypokinesis, but an opioid-sparing anaesthetic protocol based on esketamine reduces intraoperative opioid consumption. Therefore, this study hypothesised that an opioid-sparing anaesthetic protocol based on esketamine would shorten the gastrointestinal function recovery time after benign gynaecological laparoscopic surgery. Methods: This was a prospective randomized controlled double-blind study conducted in a single centre. All patients scheduled for elective benign laparoscopic gynaecological surgery at Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, from November 2021 to April 2022 were consecutively enrolled and randomly divided into the opioid-sparing anaesthesia group (Group OS) and the conventional anaesthesia group (Group C). Postoperative first exhaust time, feeding time and postoperative nausea and/or vomiting (PONV) were analyzed in both groups. Results: A total of 71 patients were enrolled in this study, including 35 in Group OS and 36 in Group C. The general condition, operative time, type of surgery, intraoperative bleeding, intraoperative fluid volume and intraoperative urine volume were not statistically different between the two groups. Compared with Group C, significantly shorter first postoperative flatus time (11 [8, 14] h vs. 14 [11, 18], p = 0.003) and anaesthesia resuscitation time (7 [6, 9] h vs. 9 [7, 11] h, p = 0.013)were observed in the OS group. The incidence of PONV in Group OS was significantly lower compared with Group C (11.4% vs. 41.7%, p = 0.007). Conclusion: The esketamine-based opioid-sparing anaesthetic protocol can shorten the postoperative first flatus time after benign laparoscopic surgery in gynaecology, and reduce the incidence of PONV. In addition, the application of esketamine may reduce the postoperative opioid dose requirement of patients. Trial registration: : This study was registered with the China Clinical Trials Registry (registration number: ChiCTR2100052528, 30/10/2021). [ABSTRACT FROM AUTHOR]

Background: First-pass perfusion imaging in magnetic resonance imaging (MRI) is an established method to measure myocardial blood flow (MBF). An obstacle for accurate quantification of MBF is the saturation of blood pool signal intensity used for arterial input function (AIF). The objective of this project was to validate a new simplified method for AIF estimation obtained from single-bolus and single sequence perfusion measurements. The reference MBF was measured simultaneously on 13N-ammonia positron emission tomography (PET). Methods: Sixteen patients with clinically confirmed myocardial ischemia were imaged in a clinical whole-body PET-MRI system. PET perfusion imaging was performed in a 10-min acquisition after the injection of 10 mCi of 13N-ammonia. The MRI perfusion acquisition started simultaneously with the start of the PET acquisition after the injection of a 0.075 mmol/kg gadolinium contrast agent. Cardiac stress imaging was initiated after the administration of regadenoson 20 s prior to PET-MRI scanning. The saturation part of the MRI AIF data was modeled as a gamma variate curve, which was then estimated for a true AIF by minimizing a cost function according to various boundary conditions. A standard AHA 16-segment model was used for comparative analysis of absolute MBF from PET and MRI. Results: Overall, there were 256 segments in 16 patients, mean resting perfusion for PET was 1.06 ± 0.34 ml/min/g and 1.04 ± 0.30 ml/min/g for MRI (P = 0.05), whereas mean stress perfusion for PET was 2.00 ± 0.74 ml/min/g and 2.12 ± 0.76 ml/min/g for MRI (P < 0.01). Linear regression analysis in MBF revealed strong correlation (r = 0.91, slope = 0.96, P < 0.001) between PET and MRI. Myocardial perfusion reserve, calculated from the ratio of stress MBF over resting MBF, also showed a strong correlation between MRI and PET measurements (r = 0.82, slope = 0.81, P < 0.001). Conclusion: The results demonstrated the feasibility of the simplified AIF estimation method for the accurate quantification of MBF by MRI with single sequence and single contrast injection. The MRI MBF correlated strongly with PET MBF obtained simultaneously. This post-processing technique will allow easy transformation of clinical perfusion imaging data into quantitative information. [ABSTRACT FROM AUTHOR]

Background: We have previously demonstrated that ginsenoside compound K can attenuate the formation of atherosclerotic lesions. Therefore, ginsenoside compound K has potential for atherosclerosis therapy. How to improve the druggability and enhance the antiatherosclerotic activity of ginsenoside compound K are the core problems in the prevention and treatment of atherosclerosis. CKN is a ginsenoside compound K derivative that was previously reported to have excellent antiatherosclerotic activity in vitro, and we have applied for international patents for it. Methods: Male C57BL/6 ApoE−/− mice were fed a high-fat and high-choline diet to induce atherosclerosis and were subjected to in vivo studies. In vitro, the CCK-8 method was applied to evaluate cytotoxicity in macrophages. Foam cells were utilized, and cellular lipid determination was performed for in vitro studies. The area of atherosclerotic plaque and fatty infiltration of the liver were measured by image analysis. Serum lipid and liver function were determined by a seralyzer. Immunofluorescence and western blot analysis were conducted to explore the alterations in the expression levels of lipid efflux-related proteins. Molecular docking, reporter gene experiments and cellular thermal shift assays were used to verify the interaction between CKN and LXRα. Results: After confirming the therapeutic effects of CKN, molecular docking, reporter gene experiments and cellular thermal shift assays were used to predict and investigate the antiatherosclerotic mechanisms of CKN. CKN exhibited the greatest potency, with a 60.9% and 48.1% reduction in en face atherosclerotic lesions on the thoracic aorta and brachiocephalic trunk, reduced plasma lipid levels and decreased foam cell levels in the vascular plaque content in HHD-fed ApoE−/− mice. Moreover, CKN in the present study may exert its antiatherosclerotic effects through activated ABCA1 by promoting LXRα nuclear translocation and reducing the adverse effects of LXRα activation. Conclusions: Our results revealed that CKN prevented the formation of atherosclerosis in ApoE−/− mice by activating the LXRα pathway. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the response prediction and prognostic values of different peripheral blood cell biomarkers for advanced lung adenocarcinoma (LUAD) patients receiving first‐line therapy. Methods: Patients diagnosed with advanced LUAD as well as healthy controls and patients with benign pulmonary diseases were collected in this retrospective study. Propensity score matching (PSM) was performed in a 1:1 ratio. Survival state was estimated by the Kaplan–Meier method and the Cox proportional hazard model was used to assess the prognostic factors. Results: Compared with the control groups, the level of peripheral blood leucocyte, neutrophil, monocyte, platelet, and neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio, and systemic inflammation response index (SIRI) were higher in LUAD patients (all p < 0.001). Some inflammatory markers decreased at the time of optimal response and then increased again as the disease progressed. Multivariate analysis revealed that SIRI and lactate dehydrogenase (LDH) were independent prognostic factors no matter before or after PSM analysis. Area under the curve (AUC) of SIRI and LDH were 0.625 (p < 0.001) and 0.596 (p = 0.008), respectively. When SIRI and LDH were combined, the AUC reached 0.649 (p < 0.001). Conclusions: Pretreatment SIRI was an independent prognostic factor of progression free survival (PFS) in advanced LUAD patients. Dynamic monitoring of inflammatory index changes could help to predict therapeutic efficacy. The combination of SIRI and LDH is expected to be a promising clinically accessible biomarker in the future. [ABSTRACT FROM AUTHOR]

The purpose of this study: (1) propose an evaluation indicator of the fattening efficiency of commercial pigs (Yorkshire × Landrace × Duroc)—fattening efficiency index (FEI). (2) Analyze the correlation to find the main productive factors affecting the FEI. (3) Compare and analyze the yearly/monthly/different piglets' sources of productive performance in 2020 and 2021. The data included 2592 commercial pig batches in 2020 and 3266 in 2021, with a total of 6,134,234 commercial pigs. Descriptive statistics and difference analysis were carried out on 16 productive factors of a whole year and single/multiple sources for two consecutive years. The same period difference between the monthly data and the annual average were also analyzed. The top six productive factors correlated with FEI were average daily gain (ADG) (0.8080), feed conversion rate (FCR) (− 0.7203), survival rate (SR) (0.6968), number of deaths (− 0.4103), feeding days (− 0.3748) and body weight (BW) of marketing pigs (0.3369). The overall productive performance in 2021 was lower than that in 2020, which was reflected in more piglet sources and a lower BW of piglets, more deaths, a lower SR, longer feeding days, a lower ADG, a higher FCR and a lower FEI. The productive performance of a single source was better than that of multiple ones. The contrastive results of monthly data in 2020 and 2021 showed significant differences in most factors except for the number of marketing pigs, the number of piglets and feed consumption. The monthly trend of 15 factors for two consecutive years revealed similar trends only in the month of piglets purchasing, number of piglets sources, number of deaths and ADG. Compared with the annual average, the ADG significantly increased in May. The FEI of multiple sources was markedly lower than that of a single source. FEI may be suitable for evaluating the fattening efficiency of commercial pigs. The annual and monthly productive performance and fattening efficiency in 2021 were significantly lower than those in 2020. Single source was represented better productive performance and fattening efficiency than multiple ones. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated native Cantonese-speaking preschool children’s diadochokinetic performance, including rate, accuracy, and regularity. The second aim of this study was to examine whether language-specific patterns exist by comparing diadochokinetic rates with the average DKK rate for native English speakers. Method: Sixty-four typically developing preschool children who were native Cantonese speakers participated. The diadochokinetic task administered to the children involved repetitions of monosyllabic, disyllabic, and trisyllabic words and nonsense words. The maximum performance of the children was compared by diadochokinetic rate (number of syllables per second), accuracy (percentage of matched production), and regularity (pairwise variability indexes, known as PVIs). Results: Monosyllabic units were produced faster, more accurately, and more regularly than multisyllabic units. Word repetition showed higher accuracy and generally lower regularity than nonsense words but similar rates. Older children were faster and more regular (higher raw PVI of initial consonants) than younger children, but younger children performed as accurately as them. When compared with data from English speakers, the diadochokinetic rates of Cantonese children were generally lower. Conclusions: Developmental progression was evident in terms of rate and regularity. The distinctive accuracy and regularity patterns between word and nonsense word repetition suggest a clinical value for both stimulus types. Language typology plays a role in diadochokinetic rate, supporting the use of languagespecific reference data in practice. The typical diadochokinetic profile obtained in this study could serve as a clinical reference for speech motor assessments. [ABSTRACT FROM AUTHOR]

Background. Obstructive airway disease is a major health problem and has a great impact on global socioeconomic burden. Despite therapeutic advances in recent decades, there is still a need for effective and safe therapeutic agents for patients with asthma or chronic obstructive pulmonary disease (COPD). Methods. This prospective observational study explored the effects of herbal medicines in patients with asthma and COPD. All participants visited the hospital at least every 4 weeks for 12 weeks to receive their herbal medicines based on their pattern identification and to evaluate safety and efficacy endpoints. We followed the diagnostic criteria used by Korean medicine doctors to prescribe herbal medicines, explored variations in prescribed herbal medicines, and explored a number of clinical features in patients with asthma or COPD. Results. A total of 24 patients were enrolled: 14 were diagnosed with asthma and 10 with COPD and 19 completed the study. After 12 weeks of herbal medicine treatment, herbal medicines significantly improved the modified Clinical Asthma Measurement Scale in Oriental Medicine-V in asthma patients and the modified Medical Research Council Dyspnoea Scale and St. George's Respiratory Questionnaire in COPD patients. For all patients, modified Medical Research Council Dyspnoea Scale score and interleukin-13 were found to be significantly different after treatment. Additionally, the majority of patients were satisfied with our herbal medicine treatments, and no severe adverse events were reported during the study. Conclusions. Our study provides preliminary clinical data on the safety and efficacy of herbal medicines in patients with asthma and COPD. [ABSTRACT FROM AUTHOR]

Background: In an increasingly multicultural society, cultural competence and transcultural self-efficacy of public health nurses is important for providing culturally congruent care for client from diverse cultural background. To improv this, it is needed tailored and effective educational program based on the cultural competence educational needs. This study investigated the moderating effect of cultural competence educational needs on the relationship between transcultural self-efficacy and cultural competence. Methods: This cross-sectional study recruited 217 public health nurses in Korea using convenience sampling from August 2018 to January 2019. A direct questionnaire was used to collect data. Study variables were analyzed using descriptive statistics, correlation, and the Hayes PROCESS macro (Model 1) moderation model. Results: The mean scores for transcultural self-efficacy, cultural competence educational needs, and cultural competence were 62.33 ± 11.08, 58.19 ± 15.08, and 97.96 ± 17.09, respectively. Transcultural self-efficacy and cultural competence educational needs were positively associated with cultural competence. In the tested model, cultural competence educational needs had a conditional moderating effect on the relationship between transcultural self-efficacy and cultural competence. The positive association between transcultural self-efficacy and cultural competence was significant at low, medium, and high levels of cultural competence educational needs and stronger for those with high needs. Conclusions: Cultural competence educational needs may be an important determinant of cultural competence among public health nurses. To effectively increase cultural competence, transcultural self-efficacy should be increased by education programs tailored by cultural competence educational needs. [ABSTRACT FROM AUTHOR]

Two new withaphysalin-type withanolides (18-O-ethylwithaphysalin R and 5-O-ethylphysaminimin C, 1 and 2), along with twelve known withanolides (3–14), were purified and identified from Physalis peruviana L. The chemical structures of these new isolates were elucidated through analyzing spectroscopic and HRESIMS data. All the obtained metabolites were appraised for their potential antiproliferative activity against the human breast cancer cell line MCF-7. Compound 7 was discovered to exhibit potent activity with an IC50 value of 3.51 µM and compounds 2, 6 and 14 showed weak cytotoxic effect. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for people with incomplete spinal cord injury. Methods: PubMed, Embase, Web of Science, PEDro, CENTRAL and CINAHL were searched from inception until September 4, 2022. Randomized controlled trials that evaluated the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury were selected. Mean differences (MD) with 95% confidence interval (CI) were calculated. The methodological quality was evaluated by the Cochrane Risk of Bias 2.0 tool. Subgroup analyses were conducted according to the time since injury. Results: In total 19 studies involving 770 patients were eligible for analysis. Individuals with acute incomplete spinal cord injury in robotic-assisted gait training groups showed significantly greater improvements in 6-minute walking test (MD 53.32; 95% CI 33.49 to 73.15; P < 0.001), lower extremity motor scale (MD 5.22; 95% CI 3.63 to 6.80; P < 0.001) and walking index for spinal cord injury II (MD 3.18; 95% CI 1.34 to 5.02; P < 0.001). Robotic-assisted gait training improved peak oxygen consumption to a greater degree for chronic incomplete spinal cord injury patients (MD 4.90; 95% CI 0.96 to 8.84; P = 0.01). Conclusion: Robot-assisted gait training may be a feasible and effective intervention in terms of cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury. [ABSTRACT FROM AUTHOR]

This study aimed to develop and evaluate a population pharmacokinetic (PPK) combined machine learning approach to predict tacrolimus trough concentrations for Chinese adult liver transplant recipients in the early posttransplant period. Tacrolimus trough concentrations were retrospectively collected from routine monitoring records of liver transplant recipients and divided into the training data set (1287 concentrations in 145 recipients) and the test data set (296 concentrations in 36 recipients). A PPK model was first established using NONMEM. Then a machine learning model of Xgboost was adapted to fit the estimated individual pharmacokinetic parameters obtained from the PPK model with Bayesian forecasting. The performance of the final PPK model and Xgboost model was compared in the test data set. In the final PPK model, tacrolimus daily dose, postoperative days, hematocrit, aspartate aminotransferase, and concomitant voriconazole, were identified to significantly influence the clearance. The postoperative days along with hematocrit significantly influence the volume of distribution. In the Xgboost model, the first 5 predictors for predicting the clearance were concomitant with voriconazole, sex, single nucleotide polymorphisms of CYP3A4*1G and CYP3A5*3 in recipients, and tacrolimus daily dose, for the volume of distribution were postoperative days, age, weight, total bilirubin and graft : recipient weight ratio. In the test data set, the Xgboost model showed the minimum median prediction error of tacrolimus concentrations, less than the PPK model with or without Bayesian forecasting. In conclusion, a PPK combined machine learning approach could improve the prediction of tacrolimus concentrations for Chinese adult liver transplant recipients in the early posttransplant period. [ABSTRACT FROM AUTHOR]

Purpose. The study aims to determine the correlation between management care perception and the professional quality of life of intensive care unit (ICU) nurses in China and examine the influencing factors. Design and Methods. A cross-sectional descriptive study was conducted with 486 ICU nurses (response rate: 97.2%) from five tertiary hospitals in China from 1 January to 31 July, 2022, by convenience sampling. Data were collected through the general information questionnaire, the management care assessment scale, and the professional quality of life scale. Findings. The score of management care perception of ICU nurses was (132.24 ± 28.04), and the scores of compassion satisfactory, compassion fatigue, and burnout of professional quality of life were (37.54 ± 7.73), (20.80 ± 6.49), and (17.79 ± 5.14), respectively. Multiple linear regression analysis showed that age and the total score of managed care were positively correlated with the score of compassion satisfaction dimension (β = 1.62, 0.19) and that the total score of perceived management care was negatively correlated with the score of compassion fatigue and job burnout (β = −0.04, −0.07). ICU nurses' perceived level of managerial care was at a moderate level. The younger the nurse and the less managerial care they perceived, the lower their job satisfaction and the greater the burnout. Practice Implications. ICU nurses' perceptions of management care and professional quality of life are at a medium level, and a significant correlation exists between them. Therefore, measures to improve the professional quality of life should be taken. Nursing administrators are obliged to actively create a good atmosphere of management care, reduce the job burnout of ICU nurses, improve their professional quality of life, optimise the quality of nursing service, and stabilise the nursing team. [ABSTRACT FROM AUTHOR]

The birth prevalence of symptomatic congenital cytomegalovirus (cCMV) disease among live birth in Korea from a multicenter study was 0.06% during 2001–2015 with increasing frequency. The administrative prevalence of cCMV infection by big-data analysis from the national health insurance system was 0.01% and the average healthcare cost was US$2010 per person. [ABSTRACT FROM AUTHOR]

Poverty, lack of education and gender inequality make unemployed and out-of-school young women extremely vulnerable to HIV infection. Promotive social protection programmes aim to increase livelihood and capabilities and could empower this priority population to act on HIV prevention choices. In Botswana, they rarely benefit from such programmes. A modified Policy Delphi engaged a panel of 22 unemployed and out-of-school young women and eight frontline service providers to consider alternative policy and practice options, and tailor available programmes to their own needs and social situation. The panel assessed the desirability and feasibility of improvement proposals and, in a second round, ranked them for relative importance. Nearly all 40 improvement proposals were considered very desirable and definitely, or possibly, feasible, and panellists prioritised a wide range of proposals. Frontline service providers stressed foundational skills, like life skills and second chance education. Young women preferred options with more immediate benefits. Overall, panellists perceived positive role models for programme delivery, access to land and water, job skills training, and stipends as most important to empower HIV-vulnerable young women. Results suggest ample policy space to make existing social protection programmes in Botswana more inclusive of unemployed and out-of-school young women, hence more HIV-sensitive. [ABSTRACT FROM AUTHOR]

Background: The tourniquet technique is often used in total knee arthroplasty (TKA). However, its effect on postoperative delirium (POD) in elderly patients undergoing TKA is unknown. Methods: This prospective randomized controlled trial assessed the eligibility of 245 elderly patients. A total of 197 patients who met the inclusion criteria were randomly divided into a tourniquet group (n = 98) and a non-tourniquet group (n = 99). The primary outcome was the incidence of POD within 72 h after surgery. The secondary outcome was the quality of rehabilitation, including inflammatory reaction, postoperative pain, hypoproteinemia and anemia. Results: Of 245 patients, 184 patients completed this clinical trial, with 92 cases in each group. There were 14 patients (15.22%) with POD in the tourniquet group and 5 patients (5.43%) in the non-tourniquet group (95% CI 1.076 to 9.067, P = 0.029). The changes in white blood cell count (WBC), the proportion of neutrophils (NEUT%), c-reactive protein (CRP), interleukin-6 (IL-6) and middle patellar circumference in the tourniquet group were higher than those in the non-tourniquet group (P < 0.05). The visual analog scale (VAS) at rest and activity in the tourniquet group were higher than those in the non-tourniquet group (F = 170.102, P < 0.001 F = 75.391, P < 0.001). There were 41 (44.57%) patients with hypoproteinemia in the tourniquet group and 26 (28.26%) in the non-tourniquet group (95% CI 1.106 to 3.765, P = 0.022). Conclusion: The application of the tourniquet technique in elderly patients with TKA procedures increased the incidence of POD. This may be attributed to the increased inflammatory reaction, severe postoperative pain and hypoproteinemia caused by the tourniquet technique. Trial registration: Clinical trial registration number: ChiCTR2100045711. Full date of the first registration: 23/04/2021. [ABSTRACT FROM AUTHOR]

Background: To explore the efficacy and safety of remimazolam for procedural sedation during ultrasound-guided nerve block administration in patients undergoing abdominal tumor surgery, in order to improve and optimize remimazolam use in procedural sedation and clinical anesthesia. Methods: The enrolled patients were randomly divided into three groups: 50 patients in the remimazolam group (R group), 50 patients in the dexmedetomidine group (D group), and 50 patients in the midazolam group (M group). Before administering an ultrasound-guided nerve block, all patients received sufentanil AND remimazolam or midazolam or dexmedetomidine. Remimazolam 5 mg was administered intravenously in group R, dexmedetomidine 0.6 µg/kg was administered intravenously in group D, and midazolam 0.025 mg/kg was administered intravenously in group M. Sedation was evaluated by the Modified Observer's Assessment of Alertness and Sedation scale.When the Modified Observer's Alertness/Sedation (MOAA/S) score was ≤ 2, block operation was started. If the target sedation level was not reached, rescue sedatives of remimazolam 2.5 mg may be intravenously given in group R, dexmedetomidine 0.4 µg/kg be intravenously given in group D, 0.01 mg/kg midazolam may be intravenously given in Group M. Hemodynamic indicators (systolic and diastolic blood pressure, heart rate), pulse oxygen saturation, depth of anesthesia (Narcotrend), MOAA/S,and the incidences of hypoxemia, injection pain, bradycardia and requirement for rescue sedatives were monitored and recorded. Results: Compared with the control groups (midazolam and dexmedetomidine groups), the Narcotrend index and MOAA/S decreased more in the remimazolam group (P < 0.01). Compared with the control groups, the incidence of hypoxemia and injection pain was slightly higher in the remimazolam group, but the difference was not statistically significant (P > 0.05). Compared with the dexmedetomidine group, the incidence of bradycardia was significantly lower in the remimazolam group. Conclusion: Remimazolam can be used safely for procedural sedation during ultrasound-guided nerve block administration in patients undergoing abdominal tumor surgery. The sedation effect is better than that with either midazolam or dexmedetomidine, and sedation can be achieved quickly without obvious hemodynamic fluctuations. Remimazolam is associated with better heart rate stability, and slightly higher incidences of hypoxemia and injection pain than are midazolam and dexmedetomidine (no statistically significant difference). The higher incidence of hypoxemia with remimazolam may be related to enhanced sufentanil opioid analgesia, and the mechanism of injection pain with remimazolam must be studied further and clarified. Trial registration: This study was approved by the Ethics Committee of Anhui Provincial Cancer Hospital (Ethical Review 2021, No. 23) and registered at https://www.chictr.org.cn (ChiCTR2000035388). The pre-registration time of this experiment is 09/08/2020, due to ethical committee of the hospital met irregularly,the ethical approval time is 21/06/2021. The recruitment of patients began after the ethical approval (21/06/2021) and registration update (06/07/2021).The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines. [ABSTRACT FROM AUTHOR]

Background: A physical performance evaluation can inform fall risk in older people, however, the predictiveness of a one‐time assessment is limited. The trajectory of physical performance over time has not been well characterized and might improve fall prediction. We aimed to characterize trajectories in physical performance and determine if fall prediction improves using trajectories of performance. Methods: This was a cohort design using data from the National Health and Aging Trends Study. Physical performance was measured by the short physical performance battery (SPPB) with scores ranging from 0 (worst) to 12 (best). The trajectory of SPPB was categorized using latent class modeling and slope‐based multilevel linear regression. We used Cox proportional hazards models with an outcome of time to ≥2 falls from annual self‐report to assess predictiveness after adding SPPB trajectories to models of baseline SPPB and established non‐physical‐performance‐based variables. Results: The sample was 5969 community‐dwelling Medicare beneficiaries aged ≥65 years. The median number of annual SPPB evaluations was 4 (IQR, 3–7). Mean baseline SPPB was 9.2 (SD, 3.0). The latent class model defined SPPB trajectories over a range of two to nineteen categories. The mean slope from the slope‐based model was −0.01 SPPB points/year (SD, 0.14). Discrimination of the baseline SPPB model to predict time to ≥2 falls was fair (Harrell's C, 0.65) and increased after adding the non‐performance‐based predictors (Harrell's C, 0.70). Discrimination slightly improved with the SPPB trajectory category variable that had the best fit (Harrell's C, 0.71) but did not improve with the SPPB linear slope. Calibration with and without the trajectory categories was similar. Conclusions: We found that the trajectory of physical performance did not meaningfully improve upon fall prediction from a baseline physical performance assessment and established non‐performance‐based information. These results do not support longitudinal SPPB assessments for fall prediction. [ABSTRACT FROM AUTHOR]

Background: As a cardiometabolic disease, hypertension has shown an obvious upward trend, becoming a global epidemic chronic disease. Lifestyle intervention is a fundamental method for lowering blood pressure. This systematic review and meta-analysis aimed to evaluate the effects of time-restricted eating (TRE) on blood pressure. Methods: Studies were retrieved from the PubMed, Embase, Cochrane Library, and Web of Science databases to evaluate the effects of TRE on blood pressure. The time frame of search was from the start of database construction until July 14, 2022.There were no language restrictions. Meta-analysis and meta-regression were performed using Stata version 16. The weighted mean difference with 95% CI was used to assess the effect of TRE on blood pressure, heart rate, weight, blood glucose, total cholesterol, HDL-C, LDL-C, and triglycerides. The main ending of this article were blood pressure and heart rate, while the secondary ending were weight, blood glucose, total cholesterol, HDL-C, LDL-C, and triglycerides. Results: Ten randomized controlled trials involving 694 patients were identified. TRE significantly reduced systolic blood pressure (SBP) (mean difference = −4.15; 95% CI: −6.73, −2.30; P < 0.0001), but had no significant effect on diastolic blood pressure (DBP) (mean difference = −2.06; 95% CI: −4.16, 0.02; P = 0.053) and no beneficial effect on heart rate (mean difference = 0.36; 95% CI: −2.83, 3.54; P = 0.0825). TRE promoted weight loss (mean difference = −1.63; 95% CI: −2.61, −0.64; P = 0.001) and decreased blood glucose levels (mean difference = −2.80; 95% CI: −4.64, −0.96; P = 0.003), but had no significant effect on total cholesterol (mean difference = 0.03, 95% CI: −10.01, 10.08; P = 0.995), HDL-C (mean difference = 0.85, 95% CI: −1.80, 3.49; P = 0.531), LDL-C (mean difference = −0.86, 95% CI: −6.47, 4.76; P = 0.764), or triglycerides (mean difference = −3.524, 95% CI: −9.49, 2.45; P = 0.248). In a separate meta-regression analysis, the degree of SBP change was related to weight loss (P = 0.044) but not to glucose improvement (P = 0.867). Conclusions: The present meta-analysis suggests that TRE significantly reduced SBP, while no effect of reducing DBP was seen. The observed lower blood pressure may be attributed to significant weight loss. The effects of TRE on heart rate and blood lipid levels were not apparent. [ABSTRACT FROM AUTHOR]

Objective: Nurses' palliative care practice ability is the key to evaluating the quality of palliative care. This study aimed to identify the current situation of palliative care practices, competence and difficulties among nurses and determine whether difficulties play a mediating role between practices and competence. Methods: A cross‐sectional study was conducted. The online survey comprised demographics, the Palliative Care Self‐Reported Practices Scale, the Palliative Care Nursing Self‐competence Scale and the Palliative Care Difficulties Scale. Data were analysed by using descriptive statistics, univariate analysis, linear regression and mediation analysis. Results: A total of 284 questionnaires were included for statistical analysis. The mean scores for practices, competence and difficulties were 67.81 (SD = 13.60), 124.28 (41.21) and 44.32 (12.68), respectively. There was a correlation between practices, competence and difficulties (p < 0.01). Competence and difficulties were independent predictors of practices (R2adj = 0.384, p < 0.001). Furthermore, difficulties mediated the relationship between practices and competence (b = 0.052, 95% confidence interval: 0.008–0.155). Conclusions: Continuous efforts should be made to enhance nurses' practices, competence and problem‐solving abilities in palliative care. This study suggested further targeted education programmes, especially in special symptom management, interagency and multidisciplinary communication. [ABSTRACT FROM AUTHOR]

Introduction. Febuxostat is a novel inhibitor of xanthine oxidase that suppresses cell adhesion molecules-mediated (CAMs) inflammation by activating KLF6. In this study, we explored the therapeutic function and potential mechanisms of febuxostat against allergic rhinitis (AR). Methods. We investigated the role of febuxostat through in vitro cell and in vivo animal experiments. Human nasal epithelial cells (hNECs) were cultured with histamine as an in vitro model. To establish the AR animal model, rats were exposed to ovalbumin. Rats were randomly grouped into control, model, 7.5 mg/kg febuxostat, and 15 mg/kg febuxostat groups. Results. In the in vitro study, we found significantly increased release of lactate dehydrogenase, elevated production of inflammatory factors and chemokines, and upregulated CAMs in histamine-treated hNECs. However, these results were significantly reversed for the 10 and 20 μM febuxostat treatments. The enhanced adhesion between hNECs and monocytes induced by histamine was dramatically repressed by febuxostat. In the vivo experiments, we observed that febuxostat ameliorated the increased sneezing times, the number of nose scratching episodes, and elevated HE pathological scores as well as alleviated the inflammation in nasal mucous tissues of AR mice. We found that KLF6, which was downregulated in histamine-treated hNECs, was significantly upregulated by febuxostat. The inhibitory effects of febuxostat on the expression levels of CAMs and adhesion between histamine-treated hNECs and monocytes were significantly abolished by the knockdown of KLF6. Conclusion. Febuxostat alleviates AR by inhibiting inflammation and monocyte adhesion in human nasal epithelial cells through the regulation of KLF6. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency poses a global public health burden; however, there are limited studies on the relationship between vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) concentration in Koreans with a special focus on seasonal variables. We hypothesized that the relationship between serum 25(OH)D and vitamin D intake levels in Korean adults would change with the seasons, and that the distribution of food sources for vitamin D would vary according to sex and age. We established a new version of the food vitamin D database, analyzed the Korean National Health and Nutrition Examination Survey 2013 to 2014 data (n = 3257), and calculated the vitamin D intake of Koreans using a complex sample model. We found that the daily vitamin D intakes of men and women were 4.09 ± 0.26 µg and 2.87 ± 0.17 µg and their 25(OH)D levels were 16.98 ± 0.24 ng/mL and 15.62 ± 0.21 ng/mL, respectively. A significant positive correlation was observed between vitamin D intake and serum 25(OH)D levels in all participants. Serum 25(OH)D levels in the spring and winter (low ultraviolet irradiation seasons) were significantly higher in the 3rd tertile of vitamin D intake than in the first tertile. Fish and shellfish were the main sources of vitamin D for Koreans, the consumption of which was the least in the 19- to 29-year-old group; additionally, their serum 25(OH)D level was the lowest. In conclusion, insufficient vitamin D intake during low ultraviolet irradiation seasons is associated with lower levels of serum 25(OH)D. Serum 25-hydroxyvitamin D levels in the spring and winter (low ultraviolet irradiation seasons) were significantly higher in the third tertile of vitamin D intake than in the first tertile. However, the summer and fall (high ultraviolet irradiation seasons) were not significant. In this case, the median value of vitamin D intake was 0.97 to 2.59 µg/d. [Display omitted] [ABSTRACT FROM AUTHOR]