Bicuspid aortic valve (BAV) is a common congenital anomaly leading to early aortic stenosis. Although transcatheter aortic valve replacement (TAVR) offers a less invasive treatment for BAV stenosis, sex-specific outcome data are scarce. This study evaluates clinical outcomes after TAVR by sex in BAV patients. A systematic literature search was performed across PubMed, ClinicalTrials.gov, and Cochrane CENTRAL to identify relevant English-language randomized controlled trials and observational studies. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models based on heterogeneity. Statistical significance was set at p < .05, and heterogeneity was assessed using the I² statistic. Analyses were performed with Review Manager Version 5.3. Four observational studies comprising 7585 patients met inclusion criteria. Males had a higher incidence of acute kidney injury (AKI) (RR = 1.33; 95% CI: 1.13–1.57; p = .0008) and acute myocardial infarction (MI) (RR = 2.18; 95% CI: 1.54–3.07; p = .00001), but a lower risk of in-hospital mortality (RR = 0.71; 95% CI: 0.51–0.99; p = .04), stroke (RR = 0.70; 95% CI: 0.50–0.95; p = .02), and bleeding (RR = 0.79; 95% CI: 0.63–0.98; p = .03) compared to females. No statistically significant differences were observed in one-year mortality (RR = 1.08; 95% CI: 0.58–2.03; p = .81), 30-day mortality (RR = 1.18; 95% CI: 0.51–2.75; p = .69), or arrhythmia (RR = 0.83; 95% CI: 0.52–1.33; p = .45). Males had increased risks of AKI and MI, while females experienced higher in-hospital mortality, stroke, and bleeding. These findings, derived from a limited number of retrospective observational studies, are hypothesis-generating and highlight the need for sex-specific risk stratification and further prospective research to confirm these patterns and guide clinical practice.

Hemodialysis patients with comorbid urolithiasis represent a high-risk subgroup within chronic kidney disease, facing unique challenges from altered physiology, including electrolyte imbalances, secondary hyperparathyroidism, and increased stone formation risks. Traditional risk scores, such as the Charlson Comorbidity Index or Recurrence of Kidney Stone (ROKS) nomogram, rely on linear assumptions and fail to capture nonlinear interactions, dialysis-specific parameters like Kt/V or parathyroid hormone levels, and outcomes like stone recurrence, sepsis, or mortality, leading to suboptimal predictive accuracy. This narrative review explores the potential of machine learning (ML) models, including ensemble methods like Random Forest and XGBoost, and deep learning architectures, which excel in handling high-dimensional, multimodal data from electronic health records, imaging, and longitudinal trends. Comparative evidence from nephrology and urology domains suggests ML outperforms traditional approaches by 5%–15% in AUC for discrimination, though direct comparisons in hemodialysis-urolithiasis cohorts are lacking; future studies are needed. However, barriers such as interpretability issues, data biases, and lack of prospective validation persist, necessitating explainable AI tools like SHapley Additive exPlanations (SHAP) and adherence to diversity principles. Future directions emphasize multicenter registries, hybrid models, and decision curve analysis to enhance clinical utility, ultimately shifting toward personalized risk stratification for improved outcomes in this vulnerable population.

Coronary artery disease (CAD) is characterized by significant genetic diversity with interindividual genetic variation. Genomewide association studies have discovered many CAD-associated single-nucleotide polymorphisms (SNPs) and provided for the development of polygenic risk scores (PRS) to measure total genetic susceptibility. This review reviews the present evidence of SNPs in connection with CAD risk, discusses biological mechanisms whereby genetic variation affects vascular and metabolic phenotypes, and provides some methodological advances and limitations in PRS construction and testing. Although PRS extends risk stratification beyond clinical factors, its clinical utility is limited by population-level effects, limited biological interpretability, and variable predictive performance. Furthermore, we also discuss new approaches incorporating genetically informed risk assessment into clinical and imaging-based schemes to aid precision prevention. By explicitly bridging genetic association, biological interpretabilities, and clinical support, we aim to encourage responsible translation of genetic risk stratifying into CAD prevention.

Intermediate coronary stenoses (40–70% diameter narrowing) pose a diagnostic challenge, as angiography alone often leads to inappropriate revascularization. Whether fractional flow reserve (FFR) or intravascular ultrasound (IVUS) guidance yields superior outcomes remains unclear. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis searched PubMed, Embase, ScienceDirect, and ClinicalTrials.gov from inception to November 2025. Eligible studies were RCTs or observational comparisons of FFR- or angiography-derived FFR versus IVUS-guided percutaneous coronary intervention (PCI) in intermediate or angiographically significant lesions with ≥12-month follow-up. Pooled risk ratios (RR) and mean differences were calculated using random-effects models. Evidence certainty was graded using GRADE. Six studies (2 RCTs, 4 observational; n = 5050) were included. No significant difference was found in major adverse cardiac events (MACE: RR 1.17, 95% confidence interval [CI] 0.99–1.39; p = .06) or all-cause mortality (RR 1.05, 95% CI 0.79–1.38; p = .74). Myocardial infarction rates were similar (RR 1.48, 95% CI 0.88–2.51; p = .14). Ischemia-driven target vessel revascularization was significantly higher with FFR guidance (RR 1.43, 95% CI 1.07–1.91; p = .02). Mean stent length was numerically shorter with FFR (mean difference −2.07 mm, 95% CI −4.87 to 0.73; p = .15). Evidence certainty was moderate for MACE and target vessel revascularization, low for hard endpoints, and very low for stent length. In intermediate and angiographically significant coronary stenoses, FFR- and IVUS-guided PCI showed comparable hard clinical outcomes, but IVUS was associated with reduced target vessel revascularization. These findings support individualized modality selection based on clinical context and operator expertise, with a potential role for hybrid approaches combining physiological assessment for deferral decisions and imaging for procedural optimization.

This study aimed to clarify the relationship between all prescription medication with chronic diarrhea (CD) and chronic constipation (CC) in adults. Population data was extracted from the 2007–2008 and 2009–2010 National Health and Nutritional Examination Surveys (NHANES). CD and CC were defined according to the Bristol Stool Form Scale (BSFS), and frequent laxative users were also defined as having CC. Prescription medication was obtained from a questionnaire. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs); restricted cubic spline (RCS) dose response curve was used to estimate the relationship between prescription medication use and CD. 1:1 propensity score matching (PSM) was performed to test the validity of the results. No significant associations between prescription medication use and CC were found. RCS showed a nonlinear positive association between prescription medication use and CD. Multivariate logistic regression analysis showed that the adjusted ORs (95% CI) compared with reference in model 1, 2, and 3 were 1.575 (1.297–1.912), p < 0.001, 1.384 (1.126–1.700), p = 0.002, and 1.350 (1.098–1.661), p = 0.004. The same results were found in the subgroup analyses by sex. In addition, similar conclusions were reached after analysis of PSM in the normal bowel habits and CD. This study indicated that prescription medication use may induce the occurrence of CD. This finding is of particular clinical significance for vulnerable populations, who require complex polypharmacy regimens.

To explore the application effect of the problem-oriented model combined with the situational simulation teaching method in the training of intravenous infusion skills for pediatric rotation nurses. Ninety-six rotation nurses (8 per month) from the hospital's infusion room were selected from September 2022 to August 2023 and randomly divided into the experimental group and the control group (48 cases each). The control group received conventional teaching and training, while the experimental group was supplemented with training based on the problem-oriented model combined with the situational simulation teaching method. The assessment results showed that the experimental group had significantly higher scores in theoretical assessment, scenario simulation practical assessment, and a higher assessment pass rate than the control group (p < 0.05). In sub-assessments, the experimental group performed better in communication, operation process, aseptic concept, assessment, and material preparation, with statistically significant differences (p < 0.05), while there was no significant difference in personal instrumentation and evaluation scores between the two groups (p > 0.05). The problem-oriented model combined with the situational simulation teaching method can effectively improve the training effect of intravenous infusion skills for pediatric rotation nurses, help nurses master the characteristics of professional operations, and enhance their learning motivation.

This study was conducted to compare the difference between the use of a puncture angle guide device assisted needle insertion and manual needle entry for the treatment of single metastatic lymph nodes above the thoracic entrance by ¹²⁵I seeds implantation, and explore the feasibility and safety of ¹²⁵I seeds implantation assisted by the puncture angle guide device. Twenty patients who underwent ¹²⁵I seeds implantation for the treatment of single metastatic lymph nodes above the thoracic entrance at Jiangsu Cancer Hospital from April 2023 to December 2024 were enrolled in this study, and they were randomly divided into two groups. In the Auxiliary group, the puncture angle guide device was used for ¹²⁵I seeds implantation, while in the Manual group, the needles were deployed only by hand for ¹²⁵I seeds implantation. The puncture time, the number of puncture needle adjustments, the number of CT scans, the number of implanted seeds, the dosimetry indicators, and the occurrence of complications were compared between the two groups, and the differences were statistically analyzed. Both groups successfully completed the ¹²⁵I seeds implantation. The needle deployment time, the number of puncture needle adjustments, and the number of CT scans in the Auxiliary group were less than those in the Manual group, and the difference was statistically significant (p <.05). There was no statistical difference in the dosimetry parameters, the difference in dosimetry parameters, and the incidence of complications (Bleeding, pneumothorax) between the two groups before or after the operation (p >.05). The puncture angle guide device assisted ¹²⁵I seeds implantation is safe and feasible. Compared with the manual deployment of needles, the puncture time, the number of puncture needle adjustments, and the number of intraoperative CT scans are significantly reduced, which can be used in clinical applications.

Hormone deprivation therapy (HDT)-induced hot flashes are burdensome neuro-autonomic adverse effects in cancer patients. While acupuncture is increasingly utilized for these vasomotor symptoms, the optimal treatment exposure required for clinically meaningful benefit remains unclear. We conducted a regression-based dose–response meta-analysis and narrative review to evaluate the association between acupuncture session number and HDT-induced hot flash improvement. Including randomized controlled trials (RCTs) and case series, we analyzed hot flash frequency (HFF) and hot flash score (HFS) using random-effects meta-regression and restricted cubic spline models. Fourteen studies were included. Among ten studies reporting HFF, a linear association existed between acupuncture sessions and daily HFF reduction. Estimates indicated that symptom reduction exceeding the minimal clinically important difference emerged after approximately 10 sessions (−5.29 episodes/day [95% CI, −7.68 to −2.90]). Sensitivity analyses restricted to RCTs (−4.07 episodes/day [95% CI, −5.67 to −2.47]) and excluding auricular acupuncture (−4.13 episodes/day [95% CI, −5.83 to −2.44]) yielded consistent trends. Four studies reporting HFS revealed a nonlinear pattern: early improvement plateaued after approximately 9 sessions. This study provides quantitative evidence of a session-dependent dose–response relationship for acupuncture in managing HDT-induced hot flashes. While not establishing a definitive optimal dose, approximately 10 sessions represent a robust benchmark for clinically meaningful improvement, guiding clinical practice and future dose-optimization trials in supportive oncology.

Smoking, ozone, and fine particulate matter (PM2.5) provoke simultaneous chemical reactions that damage and irritate the lungs, leading to chronic obstructive pulmonary disease (COPD). The fundamental biological mechanisms are ambiguous, hindering the advancement of treatment alternatives. We performed a comprehensive systems-biology study of 2847 genes associated with these three primary environmental exposures to investigate these pathways. We used differential gene expression analysis of exposure-specific transcriptomic datasets and advanced computational methods, including pathway overrepresentation analysis, protein interaction network construction, and computational drug repurposing. A fundamental set of 647 genes was recognized as dysregulated across all three exposure categories. Research on network centrality identified cytochrome P450 1B1 (CYP1B1) as a hub gene (betweenness centrality = 0.94), underscoring its regulatory function. CYP1B1 plays a crucial function in integrating xenobiotic signals via the AhR, linking metabolic activities to subsequent inflammatory and oxidative stress pathways. We identified three dominant pathways: TNF-α/NF-κB signaling (false discovery rate [FDR] = 1.2 × 10⁻¹⁵ to 4.3 × 10⁻¹⁸), oxidative stress response (FDR = 2.1 × 10⁻¹⁸ to 8.9 × 10⁻¹⁶), and xenobiotic metabolism (FDR = 1.8 × 10⁻²⁵ to 3.4 × 10⁻³⁰). Our network analysis reveals a highly interconnected regulatory module in which CYP1B1 directly modulates NF-κB activity, indicating that xenobiotic metabolism activates the inflammatory response. A thorough regulatory network model identified 187 genes critical for this conserved response. Computational drug repurposing found 15 candidate activators of the NRF2 pathway and inhibitors of cytokine signaling that target these interrelated pathways. A network-proximity-based approach discovered medicines with markedly improved targeting within core network modules. Key options for inflammatory respiratory illnesses are NRF2 pathway activators, such as sulforaphane, and cytokine signaling inhibitors, such as tocilizumab. This article clarifies the molecular structure behind environmentally induced COPD pathogenesis, with an emphasis on CYP1B1. Irrespective of initial exposure, the essential pathways and revised therapeutic choices establish a basis for accurate, preventive, and mechanism-oriented therapies designed to mitigate environmentally generated respiratory illnesses.