Background:Proton pump inhibitors (PPIs) have been shown to reduce the therapeutic efficacy and alter the clinical outcomes of co-administered medications due to cytochrome P450 family 2 subfamily C member 19 (CYP2C19) enzyme inhibition. Compared with conventional PPIs, Ilaprazole may have a minimal or negligible inhibitory effects on CYP2C19, potentially lowering the risk of drug-drug interactions, as per the results of preliminary studies and its pharmacokinetic variability.
Objective:This study aimed to evaluate the CYP2C19 interaction potential of ilaprazole versus conventional PPIs using a computational approach (SuperCYP and SMARTCyp).
Study design: This was a computational in silico study combining database-driven predictions (SuperCYP) with structure-based metabolism modeling (SMARTCyp).
Methods:Computational techniques such as SuperCYP predict cytochrome P450 (CYP450) interactions (inhibition, induction, or substrate affinity) of drugs and SMARTCyp predicts sites of metabolism (SOM) in small molecules by CYP450 enzymes, specifically identifying vulnerable atoms within drug structure.
Results:Based on MORGAN and MACCS fingerprints, ilaprazole was predicted to be inactive for CYP2C19 inhibition, with a low probability value (0.552-0.587) using cytochrome enzyme inhibition activity. SMARTCyp predicts SOM by the cytochrome P450 family 3 subfamily A member 4 (CYP3A4) enzyme, where a lower 3A4 ranking and score (S.9 with 41.5) indicate a higher probability of metabolism, and lower energy values (S.9 with 46.9) suggest increased reactivity. Higher 2DSASA values (C.26 with 64.3) indicated stronger enzyme-substrate interactions.
Conclusion:This study supports the hypothesis that ilaprazole does not inhibit CYP2C19, as evidenced by its low probability and inactivity predictions.

Background:Rural caregivers of older patients with multiple chronic conditions bear a substantial caregiver burden. Self-efficacy and family support may mediate the relationship between caregiver burden and subjective well-being; however, their specific pathways remain unclear.
Objective:To examine the mediating roles of self-efficacy and family support in the association between caregiver burden and subjective well-being among caregivers of older patients with multiple chronic conditions in rural China.
Study design:A cross-sectional survey.
Methods:Between August and September 2022, face-to-face structured questionnaires were administered to caregivers. Data were collected on demographics, clinical information, caregiver burden, subjective well-being, self-efficacy, and family support. Hayes's PROCESS macro was used to conduct parallel mediation analysis.
Results:Caregiver burden was negatively correlated with subjective well-being, self-efficacy, and family support (all P < 0.05). Subjective well-being was positively correlated with self-efficacy (r = 0.300, P < 0.01) and family support (r = 0.388, P < 0.01). Self-efficacy was also positively correlated with family support (r = 0.258, P < 0.01). Mediation analysis indicated that self-efficacy and family support were parallel mediators of the relationship between caregiver burden and subjective well-being, accounting for 26.15 % and 73.85 % of the total indirect effect, respectively.
Conclusions:Self-efficacy and family support significantly mediated the relationship between caregiver burden and subjective well-being. Interventions aimed at reducing caregiver burden, enhancing self-efficacy, and strengthening family support may improve the subjective well-being of caregivers of patients with multiple chronic conditions.

Background:Fatigue is a prevalent and burdensome symptom in patients with breast cancer undergoing chemotherapy, and middle-aged women may be especially vulnerable.
Objective:To explore fatigue levels and the key factors associated with fatigue in middle-aged patients with breast cancer undergoing chemotherapy.
Study design: A cross-sectional study.
Methods:This multicenter, cross-sectional study was conducted between August 2022 and November 2023. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Form 8a to assess fatigue, anxiety, depression, sleep disturbance, and pain interference. Univariate tests, Pearson’s correlation analysis, and hierarchical linear regression were used to identify the influencing factors.
Results:A total of 651 patients from two tertiary hospitals in Shanghai and Guangxi were included. The mean fatigue score was 49.4 ± 7.4, with 21.2 % of the patients experiencing mild or more fatigue. The results of hierarchical linear regression analysis showed that absence of medical insurance coverage (b = 0.073, P = 0.010), the period from 3 months to 1 year in the disease course (b = 0.073, P = 0.047), undergoing the fourth or higher cycle of chemotherapy (b = 0.071, P = 0.040), depression (b = 0.605, P < 0.001), and pain interference (b = 0.231, P < 0.001) were positively associated with fatigue, while the third chemotherapy cycle (b = -0.096, P = 0.002) was negatively associated with fatigue. All these variables in the model explained 54.9 % of the variance in fatigue, with depression and pain interference alone accounting for 46.7 % of the variance.
Conclusions:Middle-aged patients with breast cancer undergoing chemotherapy in China had a relatively low percentage of and usually mild levels of fatigue. Interventions targeting depression and pain may effectively alleviate fatigue in this population.

Background:Cyber-deviance is widespread among adolescents with obesity; however, its core symptoms and network structure remain unknown.
Objective:To identify the core symptoms and intricate internal structure of cyber-deviance in Chinese obese adolescents using network analysis.
Study design: A cross-sectional study.
Methods:This cross-sectional study recruited 19,249 adolescents aged 12-18 years from 25 middle schools in Wuyuan County, Jiangxi Province, China, between June and July 2024. Cyber-deviance was assessed using the Scale for Adolescent Internet Deviance (SAID). Propensity score matching and network analysis were applied to adjust for confounding and to identify influential nodes within the network.
Results:Among obese adolescents (n = 1050), the symptom “Deception makes me happy” emerged as the central node, exhibiting the highest strength and expected influence in the network. Furthermore, “Deception is fun” was identified as a bridge symptom. Gender-specific analyses revealed distinct patterns: male participants exhibited heightened involvement in “internet pornography,” while female participants showed a stronger propensity for “cyber deception.” A significant difference in network structure was identified between genders (Mean [M] = 0.484, P < 0.05). However, there were no significant differences in global network strength (male participants= 15.880, female participants = 15.058; Statistic [S] = 0.770; P > 0.05).
Conclusions:This study highlighted the complex relationships in cyber-deviance among adolescents with obesity, identifying “Deception makes me happy” as a key target for intervention, and “Deception is fun” as a bridge symptom. Gender-specific differences emphasize the need for tailored prevention strategies, offering actionable insights for mitigating cyber-deviance in this vulnerable group.