Osteoporosis is a prevalent skeletal disorder characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and a heightened risk of fractures, particularly among the elderly. This condition poses a significant global public health challenge, as osteoporotic fractures contribute substantially to morbidity, mortality, and escalating healthcare costs. Conventional treatments, such as calcium and vitamin D supplementation, often face limitations including side effects, suboptimal efficacy, and poor long-term compliance. Consequently, there is a growing impetus to explore innovative therapeutic strategies that can more effectively enhance bone regeneration and repair. Hydroxyapatite-based bone-targeting nanosystems have emerged as a promising frontier in regenerative medicine and drug delivery for bone-related disorders, including osteoporosis. Hydroxyapatite, a naturally occurring mineral and a principal component of bone tissue, offers several advantages for nanosystem development: exceptional biocompatibility, chemical similarity to native bone mineral, and the capacity for controlled drug delivery to specific bone sites. These nanosystems can be engineered to optimize size, morphology, and surface functionality, enabling improved integration with bone tissue and targeted delivery of therapeutic agents. Recent advances have demonstrated that hydroxyapatite-based nanosystems can facilitate personalized care, enhance drug efficacy, and reduce systemic side effects by concentrating therapeutic agents at sites of bone degeneration. Functionalization strategies, like polymer coatings, ion doping, and ligand conjugation-have expanded their potential for bone regeneration, targeted therapy, and combination treatments. This review examines the current trends, mechanisms, and future directions of hydroxyapatite-based nanosystems for osteoporosis, highlighting their potential to transform clinical management and improve patient outcomes.

There is a nationwide need to include social justice topics in medical education to reduce health disparities of culturally diverse patients. Cultural competence and humility act as a link between historically marginalized racial and ethnic groups and social justice to foster health equity among patients. We implemented a Social Justice in Medicine curriculum in the Internal Medicine residency program to prepare cultural competencies for social justice among residents. We sought to investigate the impact of curriculum implementation on residents' cultural competency.

Generative artificial intelligence (GenAI) tools, including large language models (LLMs) such as ChatGPT, have potential as educational adjuncts to enhance student learning. This study evaluated the perceived utility of and performance outcomes associated with formative, AI-generated, USMLE-style practice questions among preclinical medical students. Multiple-choice questions (MCQs) aligned with 15 microbiology and endocrinology lectures were generated with ChatGPT 4.0 and distributed via Google Forms to 386 students (198 MS1, 188 MS2) at a U.S. medical school. Each question set consisted of 6 questions on average, and these groupings were considered individual "question sets" in our analysis. Question completion was optional for students and a total of 490 question sets were completed. Students provided feedback on 94.9% of sets, with 82.8% rating the questions as "Helpful," 16.1% as "Somewhat Helpful," and 1.1% as "Not Helpful." MS2 students answered a significantly higher number of questions correctly relative to MS1 students (84.4% vs. 78.6%, p < .001), and performance varied by lecture topic. However, average scores did not differ significantly based on whether students provided feedback or how they rated the questions (p = .587). These findings suggest that AI-generated MCQ questions are well-received by students as a formative learning tool and may serve as scalable, curriculum-aligned tools to support self-directed learning in medical education. .

This study aimed to examine the effect of the DRD4 gene on the tendency toward violence among athletes and sedentary individuals. The research included a total of 328 participants: 214 athletes aged 16-32 with an average of 10.04 years of sports experience, and 114 sedentary controls. Data were collected using a personal information form and the Violence Tendency Scale developed by Göka, Bayat, and Türkçapar. DRD4 genotypes and alleles were identified through DNA isolation and genotyping methods. Analysis conducted with SPSS 24 revealed significant differences in certain DRD4 VNTR genotypes (2/4 and 4/4) and alleles (2R and 4R) between athletes and the control group (p<0.05), while other variants showed no significant differences (p>0.05). No association was found between repeat length (short vs. long) and demographic or background variables (p>0.05). However, a significant relationship was observed between athletes' aggressive reactions toward referees and opponents and the penalties they received for violent behavior during their careers (p<0.05). These findings suggest that the DRD4 gene may influence violence-related behaviors in athletes and may contribute to biologically grounded strategies for violence prevention in sports.

Depression is a severe mental disorder often associated with inflammation and metabolic disorders. The C-reactive protein-to-lymphocyte ratio (CLR) may better assess inflammation than CRP alone, but its relation to depression is unclear. The weight-adjusted waist index (WWI), a central obesity measure, may foster depression via inflammatory responses. This study explores the CLR-depression link and evaluates WWI's potential mediating role.This study used data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018. A logistic regression model was used to examine the associations between CLR, WWI, and depression, with subgroup analyses assessing effect modifications by sex, age, and other factors. Restricted cubic splines evaluated the linearity of the relationship between CLR and depression, while mediation analysis explored WWI's role in this association.A total of 6024 participants were included. Both CLR (fully adjusted model: OR: 1.095, 95% CI: 1.011, 1.188, P<0.05) and WWI (fully adjusted model: OR: 1.162, 95% CI: 1.004, 1.345, P<0.05) showed positive correlations with depression risk. A linear relationship between CLR and depression was found (Poverall<0.05, Pnonlinear>0.05). Subgroup analyses showed stronger associations in males, married/cohabiting individuals, those without heart failure, people aged >60, high school-educated individuals, and middle-income groups. Mediation analysis indicated WWI partially mediated (about 23%) the CLR-depression association.The inflammatory marker CLR is significantly associated with the risk of depression, and WWI partially mediates such an association.This study provides some new insights into the pathogenesis of depression and suggests the potential importance of inflammation and metabolic factors.

Chronic kidney disease (CKD) is a leading cause of morbidity and mortality worldwide, with early detection being vital for effective treatment and management. Traditional diagnostic methods often struggle with the difficulty of CKD datasets, leading to delays in diagnosis and intervention. Despite advancements in machine learning, there remains a need for more effective and accurate models that can manage the intricacies of CKD data. This paper proposes an advanced AI-based system for early detection and diagnosis of CKD by developing an AI-based system that can efficiently handle complicated healthcare data. The workflow begins with data collection, where the CKD dataset, including patient health features, is gathered. The data is then preprocessed, involving missing data imputation using Expectation Maximization and outlier removal with One-Class SVM. Feature extraction is performed using Principal Component Analysis to reduce dimensionality while retaining significant features. The extracted features are passed through the TabNet model for feature selection and the long short-term memory (LSTM) for capturing temporal dependencies. Finally, the system makes abnormality detections, providing predictions based on the extracted features and temporal patterns. The model achieves a performance of 98.58% accuracy, 98.89% precision, 98.24% recall, and 98.56% F1-score, outperforming existing models such as XGBoost, SVM, and KNN. This work presents an effective combination of TabNet for feature selection and LSTM for sequential pattern recognition, resulting in a robust system for early CKD detection with minimal false positives and false negatives.

Prostate cancer (PCa) is one of the most prevalent malignancies affecting men and a significant contributor to the rising global cancer-related mortality rate. Nevertheless, intricate processes underlying invasion and metastasis remain largely unclear. Objective of our research was to explore the function and underlying mechanisms of HCAR2 in the invasion and metastasis of PCa.

People experiencing homelessness (PEH) face significant barriers to primary care, compounded by stigma from healthcare professionals. Health professions education offers a critical window to shape attitudes, yet research suggests these attitudes can worsen during training. A cross-sectional survey at a multi-professional graduate institution assessed attitudes toward PEH among students and educators across seven health professions colleges. Attitudes varied significantly by profession, with osteopathic medicine and graduate nursing reporting more favorable views than pharmacy, veterinary medicine, dental medicine, physician assistant studies, and physical therapy. More positive attitudes were associated with greater physical comfort, more frequent prior experiences with PEH, and higher interest in learning about homelessness. Respondents who expressed interest in receiving more information also scored significantly higher on attitude measures. Findings suggest that targeted, profession-specific educational interventions that emphasize meaningful exposure to PEH may improve comfort and reduce bias. Integrating experiential learning alongside didactic content could foster more holistic, equitable care across disciplines.

The pan-immune-inflammation value (PIV) is a bioindicator that provides a broader evaluation of systemic immune and inflammatory responses. However, limited research exists regarding its ability to predict chronic kidney disease (CKD) and all-cause mortality, which this study intends to investigate. This analysis drew on data from 1999-2018 National Health and Nutrition Examination Survey (NHANES). Logistic regression analyzed the association of PIV with CKD prevalence, while Cox proportional hazards regression and Kaplan-Meier curves assessed its link to all-cause mortality in CKD patients. To explore nonlinear relationships, we applied restrictive cubic splines (RCS) and two-piece regression models. Subgroup and interaction analyses assessed how covariates influence these associations. This study included 40,735 participants, all aged 20 or above (mean age 49.73 years, with 49% male). Among 6,988 CKD patients, 2,560 (36.6%) experienced all-cause mortality. Increased PIV levels showed a strong independent association with higher CKD prevalence (OR = 1.69, 95% CI: 1.46-1.95) and all-cause mortality (HR = 1.47, 95% CI: 1.20-1.81). RCS analysis confirmed a nonlinear, progressively stronger association between PIV and CKD prevalence. A U-shaped link was found between PIV and all-cause mortality in CKD patients, with the inflection point at Log10-PIV 2.317. Mortality decreased before the inflection point and increased thereafter. Subgroup and interaction analyses showed their association was unaffected by covariates (all p > 0.05). Elevated PIV levels are linked to a higher incidence of CKD, while elevated or depressed PIV values are each linked to increased all-cause mortality risk among CKD patients.

This study conducted a meta-analysis to evaluate the efficacy and safety of neuromodulators in treating refractory or unexplained chronic cough (R/UCC), given the limited treatment options and concerns about medication safety. Nine randomized controlled trials were included, focusing on the impact of neuromodulators on chronic cough symptoms. Results showed significant improvements in quality of life, with a mean difference (MD) in the Leicester Cough Questionnaire (LCQ) score of 3.21 and a reduction in 24-hour cough frequency with an MD of -7.91. Gabapentin demonstrated the most substantial enhancements. Longer treatment durations, specifically 12 weeks, were found to be more effective. Sensitivity analysis and publication bias assessment confirmed the reliability of these findings, indicating the clinical efficacy of neuromodulators in managing R/UCC. Future research should investigate patient population differences and treatment strategies to expand the broader application of neuromodulators in the management of chronic cough.

This study aims to unravel the impact of anesthesia precision intervention on perioperative serum myocardial injury markers and major adverse cardiac events in high-risk cardiovascular patients undergoing non-cardiac surgery. One hundred and sixty high-risk cardiovascular disease patients were randomly allocated into two groups. The control group received conventional empirical management, while the observation group underwent precise anesthesia interventions. We compared the general data, the levels of myocardial injury markers, including cardiac troponin (cTn), creatine kinase isoenzyme (CK-MB), and myoglobin (Mb). Furthermore, the levels of cardiac function markers, such as brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as the levels of inflammatory factors and the incidence of adverse cardiac events were compared between the two groups. Postoperatively, the observation group exhibited significantly lower levels of cTn, CK-MB, Mb, BNP, NT-proBNP, C-reactive protein. Additionally, the total incidence of adverse cardiac events in the observation group was noticeably lower than that in the control group. The application of precise anesthetic intervention in the perioperative period of non-cardiac surgery for high-risk cardiovascular patients can further mitigate cardiac injury and reduce the incidence of adverse cardiac events, making it worthy of clinical application.

Antiretroviral therapy (ART) is treatment for people infected with human immunodeficiency virus (HIV). We aimed to investigate the short-term effects of ART on T lymphocyte counts and the expression of activation markers, CD38 and HLA-DR, on CD4+ and CD8+ T cells. Thirty HIV patients (PWH group, People with HIV), 30 patients who received 3 months of ART (PWH on ART group), and 20 HIV-negative controls were included in the study. Whole blood samples were collected in EDTA-containing tubes. The percentages of CD38- and HLADR-expressing T cells were estimated by flow cytometric assay. Absolute counts were calculated by the double platform method. Viral load was analyzed by the PCR method. PWH showed a significant decrease in CD4+ T cells, with numerical recovery after three months of ART (p=0.001), while CD8+ T cells increased (p=0.011) and remained unchanged post-ART (p=0.943), despite a percentage decrease (p=0.031). After adjusting for CD4+ T cell counts, there was no significant difference in the percentage of CD4+CD38+ T cells among the groups. In contrast, CD8+CD38+ and CD8+HLA-DR+ T cells significantly increased in the PWH group (p<0.001) and decreased after ART (p<0.001, p=0.003), even after adjusting for CD8+ T cell counts and other potential confounders. The percentage of CD4+CD38+ T cells was negatively (r=-0.578, p=0.030), and CD8+CD38+ T cells were positively correlated with viral load (r=0.530, p=0.013). However, we observed no correlation between HLADR-expressing CD4+ and CD8+ T cells and viral load. These findings suggest that CD8+CD38+ T cells could serve as a useful marker for both immune activation and assessing the effectiveness of ART in HIV patients.

Triglyceride-deposit cardiomyovasculopathy (TGCV) is characterized by diffuse narrowing of the coronary arteries because of triglyceride-deposit atherosclerosis. However, the plaque characteristics and prognosis of TGCV in patients with diffuse coronary artery disease remain unclear. This study aimed to describe the morphology of coronary arteries in TGCV using integrated backscatter intravascular ultrasound (IB-IVUS) and assess the effects on clinical outcomes. This single-center, retrospective observational study compared the IB-IVUS findings and clinical outcomes of patients with native coronary lesions of TGCV with those of patients with non-TGCV, all of whom had diffuse coronary artery disease. TGCV was diagnosed as (1) a low washout rate of iodine-123-β-methyl iodophenyl-pentadecanoic acid (BMIPP; <10%) on BMIPP single-photon emission computed tomography and (2) diffuse narrowing of the coronary arteries on coronary angiography. Thirty-one patients with diffuse coronary artery disease who underwent percutaneous coronary intervention were enrolled. Among these patients 10 (32%) were diagnosed with TGCV. IB-IVUS revealed that TGCV lesions had a significantly smaller ratio of the lipid area than non-TGCV lesions (20% ± 0.8% vs 23% ± 0.5%,  = 0.02). Conversely, the ratio of the calcification area tended to be larger. The Kaplan-Meier analysis revealed a significant increase in the rates of major adverse cardiovascular events in the TGCV group ( = 0.01). Patients with diffuse coronary artery disease present TGCV characterized by a smaller ratio of the lipid area. TGCV might be associated with worse clinical outcomes. The study findings may contribute to its early diagnosis and management.

The role of esophagogastroduodenoscopy (EGD) in evaluating patients with a positive fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT) and normal colonoscopy findings remains uncertain, with current recommendations based on limited and low-quality evidence. This retrospective cohort study (2012-2022) included consecutive patients with positive FOBT or fecal FIT and normal colonoscopy, alongside asymptomatic controls referred for routine EGD prior to bariatric surgery. Demographic, clinical, and endoscopic data were collected and analyzed. Predictors of upper gastrointestinal malignancy and clinically significant findings (CSFs) were examined. Among 858 patients with positive FOBT/FIT and 2010 controls, significant differences in age and sex distribution were observed ( < 0.001). Hiatus hernia and reflux esophagitis were more common in controls ( < 0.01). CSFs were more frequent in the FOBT-positive group (11.3% vs 8.3%,  < 0.01). On multivariate analysis, male sex, older age, and endoscopist experience (>3 years) were independent predictors of CSFs, while positive FOBT was not independently associated with their presence. The diagnostic yield of EGD in patients with positive FOBT/FIT but normal colonoscopy is modest and comparable to that of asymptomatic controls. These findings suggest that universal EGD may not be routinely warranted in this setting, supporting instead a selective, risk-based approach. Prospective studies are warranted to confirm these findings and assess the cost-effectiveness of universal versus selective EGD in this population.

Peripheral artery disease (PAD) is associated with a high risk of cardiovascular events. While glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated cardiovascular benefit in patients with diabetes, their role in patients with PAD without diabetes is not well understood. This study aimed to assess the impact of GLP-1RA therapy on cardiovascular outcomes in non-diabetic PAD patients.

Serum total bile acid (BA) concentration, while linked to cardiovascular disease, lacks established associations with atrial fibrillation (AF). This cross-sectional study investigated the relationship between fasting serum total BA and AF prevalence/classification (paroxysmal vs persistent) in 522 patients aged ≥75 years. Participants were categorized by AF diagnosis and stratified by BA tertiles. Results revealed significantly lower serum total BA concentrations in AF patients compared to sinus rhythm controls. Notably, within the AF group, persistent cases exhibited lower BA levels than paroxysmal cases (3.00 (1.67-5.00) vs 3.80 (2.30-6.40) μmol/L,  = 0.005). Analysis demonstrated a nonlinear L-shaped relationship between BA and AF prevalence (inflection point: 4.08 μmol/L), with lower BA levels independently associated with higher AF risk (adjusted odds ratio = 1.84, 95% CI: (1.03-3.29),  = 0.040). These findings establish an L-shaped correlation, indicating reduced fasting serum total BA as an independent predictor for increased AF risk in the elderly.

Inherited retinal disorders (IRDs) are genetically heterogeneous vision disorders, including conditions such as retinitis pigmentosa (RP), Leber congenital amaurosis (LCA), and congenital achromatopsia. This study aimed to identify the underlying genetic causes of IRDs in six consanguineous Iranian families. We performed whole-exome sequencing (WES) on probands from six families with IRDs. Putative pathogenic variants were validated and analyzed for segregation in family members using Sanger sequencing. We identified six homozygous, likely causative variants in five distinct IRD- associated genes. A novel frameshift variant, c.408delG (p.Val136fs), in led to a definitive diagnosis of achromatopsia in one family, revising the initial clinical impression. A novel missense variant, c.G1216A (p.Glu406Lys), was identified in in a patient with RP. Previously reported pathogenic variants were found in (c.1199G>A; p.Arg400Gln) and (c.392G>A; p.Trp131Ter) in two families with RP. In two other families with LCA, we identified known pathogenic variants in (c.1088C>G; p.Pro363Arg and c.858+1delG). All variants segregated with the disease in an autosomal recessive pattern. Our findings expand the mutational spectrum of IRDs and highlight the crucial role of WES in providing precise molecular diagnoses, which can refine clinical classifications and inform genetic counseling. The identification of two novel variants underscores the importance of studying underrepresented populations, such as that of Iran, to fully characterize the genetic architecture of these disorders.

Hemophagocytic lymphohistiocytosis (HLH) secondary to visceral leishmaniasis (VL-HLH) is a severe and often fatal condition marked by systemic inflammation and immune dysfunction. In this retrospective cohort study at Shanxi Children's Hospital, 31 pediatric patients diagnosed with VL-HLH were analyzed to assess clinical characteristics, treatment outcomes, and the potential impact of stibogluconate (SSG) + adjunctive corticosteroids. Patients exhibited multisystem involvement, including persistent fever, hepatosplenomegaly, anemia, and thrombocytopenia. Laboratory findings reflected elevated inflammation markers and immune dysregulation, with effective treatment achieved through anti-leishmanial therapy utilizing SSG. The study compared outcomes between monotherapy and SSG + corticosteroids groups, revealing no significant difference in overall recovery time but higher triglyceride levels in the SSG + corticosteroids cohort. While SSG + corticosteroids did not reduce recovery time, it potentially impacted lipid metabolism. The results underscore the need for larger-scale studies to further delineate the applicability and benefits of SSG + corticosteroids in managing VL-HLH, highlighting the significance of understanding immune activation and treatment strategies in this rare and high-risk condition.

Traditional serological methods often struggle with the accurate identification of rare or complex blood groups. This study addresses the challenges in diagnosing clinically difficult blood groups by employing genotyping and sequencing techniques to enhance blood supply accuracy. Two patients with challenging blood groups underwent serological testing and molecular diagnostics using fluorescent PCR typing and Sanger sequencing. Patient 1 showed a discrepancy in serological typing, indicating a B subgroup confirmed by a B/O\*1 genotype and a 721C>T mutation in the ABO gene Exon 7, establishing the Bw. 03/O.01.01 genotype. Patient 2, with negative Rh antigen detection and typed as CcDEe, was diagnosed with a Rh-null phenotype due to a homozygous frameshift mutation (c.732delC) in the RHAG (Rh-Associated Glycoprotein) gene Exon 5. Integrating serological screening with genotyping and sequencing technologies is recommended for accurately identifying challenging blood groups. This three-step diagnostic process facilitates precise blood group determination, ensuring accurate blood supply management.

The role of early endoscopy in patients with non-variceal upper gastrointestinal bleeding (UGIB) is controversial; additionally, the timing of endoscopy in patients with variceal hemorrhage has been poorly studied. We aimed to determine the effect of time to endoscopy on clinical outcomes in non-variceal and variceal UGIB.