Explore the vast range of titles available.

Nonalcoholic steatohepatitis (NASH) is considered as a progressive form of nonalcoholic fatty liver disease (NAFLD). To distinguish NASH from nonalcoholic fatty liver (NAFL), we evaluated the diagnostic value of circulating miRNAs. Small RNA sequencing was performed on 12 NAFL patients and 12 NASH patients, and the miRNA expression was compared. After selecting miRNAs for the diagnosis of NASH, we analyzed the diagnostic accuracy of each miRNA and the combination of miRNAs. External validation was performed using quantitative reverse transcription PCR. Among the 2,588 miRNAs, 26 miRNAs significantly increased in the NASH group than in the NAFL group. Among the 26 elevated miRNAs in the NASH group, 8 miRNAs were selected, and in silico analysis was performed. Only four miRNAs (miR-21-5p, miR-151a-3p, miR-192-5p, and miR-4449) showed significant area under the receiver operating characteristic curve (AUC) values for NASH diagnosis. The combination of the four miRNAs showed satisfactory diagnostic accuracy for NASH (AUC 0.875; 95% CI 0.676–0.973). External validation revealed similar diagnostic accuracy for NASH (AUC 0.874; 95% CI 0.724–0.960). NASH represents significantly distinct miRNA expression profile compared with NAFL. The combination of serum circulating miRNAs can be used as a novel biomarker for the NASH diagnosis in NAFLD.

Background Health-promoting interventions are important for preventing frailty and sarcopenia in older adults. However, there is limited evidence that nutritional interventions yield additional effects when combined with resistance training. This systematic review and meta-analysis aimed to compare the effectiveness of nutritional interventions with resistance training and that of resistance training alone. Methods Randomized controlled trials published in peer-reviewed journals prior to July 2020 were retrieved from databases and other sources. The articles were screened according to the inclusion and exclusion criteria. The methodological quality of the included studies was assessed using Cochrane’s risk of bias tool 2. A meta-analysis was performed using the RevMan 5.4 program and STATA 16 program. Results A total of 22 studies were included in the meta-analysis. The results of the meta-analysis showed no significant differences between groups in muscle mass, muscle strength, or physical functional performance. In the subgroup analysis regarding the types of nutritional interventions, creatine showed significant effects on lean body mass ( n  = 4, MD 2.61, 95% CI 0.51 to 4.72). Regarding the other subgroup analyses, there were no significant differences in appendicular skeletal muscle mass ( p  = .43), hand grip strength ( p  = .73), knee extension strength ( p  = .09), chair stand test results ( p  = .31), or timed up-and-go test results ( p  = .31). In the meta-regression, moderators such as the mean age of subjects and duration of interventions were not associated with outcome variables. Conclusions This meta-analysis showed that nutritional interventions with resistance training have no additional effect on body composition, muscle strength, or physical function. Only creatine showed synergistic effects with resistance training on muscle mass. Trial registration CRD42021224843 .

Detecting neuroplastic changes during locomotor neurorehabilitation is crucial for independent primal motor behaviours. However, long-term locomotor training-related neuroplasticity remains unexplored. We compared the effects of end-effector robot-assisted gait training (E-RAGT) and bodyweight-supported treadmill training (BWST) on cortical activation in individuals with hemiparetic stroke. Twenty-three men and five women aged 53.2 ± 11.2 years were recruited and randomly assigned to participate in E-RAGT (n = 14) or BWST (n = 14) for 30 min/day, 5 days/week, for 4 weeks. Cortical activity, lower limb motor function, and gait speed were evaluated before and after training. Activation of the primary sensorimotor cortex, supplementary motor area, and premotor cortex in the affected hemisphere significantly increased only in the E-RAGT group, although there were no significant between-group differences. Clinical outcomes, including the Fugl-Meyer assessment (FMA), timed up and go test, and 10-m walk test scores, improved after training in both groups, with significantly better FMA scores in the E-RAGT group than in the BWST group. These findings suggest that E-RAGT effectively improves neuroplastic outcomes in hemiparetic stroke, although its superiority over conventional training remains unclear. This may have clinical implications and provides insight for clinicians interested in locomotor neurorehabilitation after hemiparetic stroke. Trial Registration: ClinicalTrials.gov Identifier NCT04054739 (12/08/2019).

Subscription to multiple subscription video-on-demand (SVOD) services, known as multi-homing, is increasingly prevalent. This research explores the relationship between multi-homing and traditional media consumption and identifies the key factors that predict multi-homing tendencies among SVOD users. We analyzed data from 2019 to 2021 across the U.S., Canada, China, Japan, Germany, and France to investigate the impact of SVOD usage on legacy media viewing time, and then explored the predictors of multi-homing behaviors. Our findings indicate that multi-homing users are more inclined to consume content on legacy media platforms, such as terrestrial or cable television, compared with single-homing users. Critical differentiators between multi-homing and single-homing users include demographic profiles, lifestyle preferences, content expectations, and usage habits, particularly in terms of account sharing and primary devices for content consumption. These results are crucial for both SVOD and traditional media providers, as they offer strategic guidance for companies to effectively operate in various international markets. Such a comprehensive analysis of multi-homing behavior also offers a new perspective on the dynamics of global media consumption. Plain language summary This study delves into the growing trend of “multi-homing” in media consumption, where individuals subscribe to multiple online streaming platforms alongside their traditional TV viewing. We sought to uncover who these multi-homers are and how their behavior impacts their engagement with conventional television. Over 3 years, we surveyed participants across six countries: the USA, Canada, China, Japan, Germany, and France. Our analysis reveals that multi-homing is not just about having more choices; it’s about a shift in how people engage with media. Those who subscribe to several streaming services also tend to watch more traditional TV, suggesting that rather than replacing old with new, digital and traditional media consumption can coexist and complement each other. Demographically, younger individuals, those with higher education levels, and people with greater household incomes are more inclined to be multi-homers. This group values diversity in their content and expects a high-quality viewing experience. Lifestyle choices, content expectations, and viewing habits also play significant roles in their propensity to subscribe to multiple services. Our findings offer valuable insights for streaming service providers and traditional TV broadcasters, highlighting the importance of understanding viewer preferences and consumption patterns in the evolving media landscape. For academia, this research contributes to the broader discourse on digital media’s impact on traditional media consumption, offering a nuanced understanding of viewer behavior in the age of streaming services.

Background Women with disabilities are susceptible to compounded discrimination based on gender and disability, which can constrain healthcare access and worsen health outcomes. Quantitative evidence on determinants of unmet healthcare needs in Women with disabilities remains limited. This study aimed to identify predictors of unmet healthcare needs among women with disabilities and to provide evidence to inform improvements in healthcare accessibility. Methods We conducted a cross-sectional analysis of 2873 Women with disabilities from the nationally representative 2023 Survey of People with Disabilities in Korea. Guided by Andersen’s Behavioral Model of Health Services Use, we examined predisposing, enabling, and need factors associated with unmet healthcare needs using descriptive statistics, chi-square tests, and multivariable logistic regression. Results Among women with disabilities, the prevalence of unmet healthcare needs was 19.7%. The most common reasons were difficulty traveling to healthcare facilities (41.2%) and financial constraints (25.8%). In multivariable analysis, the odds of experiencing unmet healthcare needs were higher among those with lower household income, physical disabilities, severe disability, dependence in instrumental activities of daily living (IADL), poor self-rated health, experience of depression, difficulty using transportation, and inability to go out alone. Conclusions Women with disabilities experience high rates of unmet healthcare needs. Limitations in daily living due to physical disability, low socioeconomic status (SES), and mental health vulnerability emerged as major factors underlying unmet healthcare needs among women with disabilities. Integrated policies addressing financial barriers, healthcare accessibility, and women’s health are needed to meet the unique needs of women with disabilities.

Randomness is perceived in two different extremes, in macroscopic homogeneity and local heterogeneity, but apparently far away from order. Here we show that a periodic order spontaneously arises from a binary random copolymer when self-assembly occurs in an ensemble containing > 10 15 possible chain sequences. A Bernoullian distribution of hydrophilic and hydrophobic side chains grafted onto a linear backbone was constructed by random copolymerization. When the polymer chains associate in water, a sequence matching problem occurs because of the drastic heterogeneity in sequence: this is believed to generate local curvature mismatches which deviate from the ensemble-averaged interfacial curvature. Periodic folding of the self-assembled bilayer stabilizes the curvature instability as recurring hinges. Reminiscent of chain-folded lamellae found in polymer crystallization, this new liquid crystalline mesophase, characterized as bilayer-folded lamellae, manifests itself as an anisotropically alignable birefringent hydrogel with structural hierarchy across multiple length scales. Randomness is perceived in two different extremes, in macroscopic homogeneity and local heterogeneity, but apparently far away from order. Here, the authors show that a periodic order can spontaneously arise from an ensemble of binary random copolymer sequences to induce recurrent folding of a self-assembled bilayer structure in water.

Tumor budding (TB), a histopathological manifestation of epithelial–mesenchymal transition, is an important step in cancer invasion and metastasis development. TB has been considered a strong prognostic indicator in colorectal cancer. The International Tumor Budding Consensus Conference (ITBCC) scoring system is the standardized method used for patient outcome prediction in several human tumors. We investigated the clinicopathological implications and applicability of TB measured using the ITBCC scoring system in gallbladder cancer (GBC). The TB grades assigned to the 78 GBC patients were as follows: Bd1 (low TB), 41 (52.6%) patients; Bd2 (intermediate TB), 22 (28.2%) patients; and Bd3 (high TB), 15 (19.2%) patients. A higher TB grade correlated with a poorer histological differentiation (P < 0.000), higher pT category (P < 0.000), the involvement of surgical resection margin (P = 0.005), presence of nodal metastasis (P < 0.000), lymphatic and venous invasion (P < 0.000), and perineural invasion (P = 0.004). Univariate Cox regression analysis revealed that a poor histological grade, high pT category, lymphatic invasion, perineural invasion, and intermediate to high TB grades were associated with worse 5-year overall survival and disease-free survival. TB was not significantly associated with death or recurrence risk in multivariate Cox analysis. The interobserver agreement of TB grading was substantial. This study is the first to apply the ITBCC scoring system and suggest the prognostic value of TB in GBC.

Introduction People with physical disabilities inevitably experience barriers to social participation, including physical limitations, health issues, stigma, discrimination, policies, and socio‐environmental factors. Although this is a critical public health issue, no multidimensional, comprehensive, evidence‐based intervention has previously addressed the specific factors affecting social participation in people with physical disabilities. This study explores the various factors influencing social participation, which contribute to health inequalities for people with physical disabilities. In particular, the physical and mental health, socio‐environmental factors, and quality of life (QoL) among people with physical disabilities are examined. Methods The study used health data from surveys and clinical examinations conducted in 2021 and 2022 for 301 participants with physical disabilities in Korea. An observational, cross‐sectional analysis was performed using 47 independent variables to analyze the risk factors affecting social participation. Results Crude analysis revealed 29 variables in demographic characteristics, disability characteristics, health behaviors, health status, mental health, socio‐environmental factors, and QoL that correlated significantly with social participation. The adjusted analysis revealed that difficulties in social participation were influenced in the following order: poor subjective health, lower QoL, inability to freely use public buildings in the community, lack of necessary income sources, difficulty in using transportation, selective eating habits, increased depression, and experiences of discrimination. The explanatory power of the regression model is 46.4%. Conclusion To strengthen social participation, it is necessary to develop community programs that integrate rehabilitation treatment for managing physical disabilities and secondary health conditions with psychological and emotional support. In addition, social discrimination and health inequalities should be addressed through raising awareness and education about disabilities and participation. Crude analysis revealed 29 variables in demographic characteristics, disability characteristics, health behaviors, health status, mental health, socio‐environmental factors, and QoL that correlated significantly with social participation. The adjusted analysis revealed that difficulties in social participation were influenced in the following order: poor subjective health, lower QoL, inability to freely use public buildings in the community, lack of necessary income sources, difficulty in using transportation, selective eating habits, increased depression, and experiences of discrimination. The explanatory power of the regression model is 46.4%.

To date, there have been no studies comparing the molecular subtypes of Index gastric cancers (IGCs) and metachronous gastric cancers (MGCs). We evaluated a cohort of 42 patients with 43 IGCs and 45 MGCs. Molecular subtyping was performed by immunohistochemistry of mismatch repair (MMR) proteins, E-cadherin, p53, and Epstein–Barr virus– (EBV–) in situ hybridization (ISH). Gastric adenocarcinomas were classified into 5 subtypes: EBV-associated, MMR deficient (MMRD), E-cadherin aberrant, p53-aberrant [p53(+)], and p53 non-aberrant [p53(neg)]. All IGCs had been successfully treated by either surgery (19%) or endoscopic resection (81%). The mean interval between IGCs and MGCs was 85 months. Among the IGCs, EBV-associated, MMRD, E-cadherin–aberrant, p53(+), and p53(neg) molecular subtypes represented 2 (5%), 4 (9%), 2 (5%), 21 (49%), and 14 (32%) of the cases, respectively. Two cases had concomitant p53(+) and aberrant E-cadherin molecular subtypes. Among metachronous cancers, EBV-associated, MMRD, E-cadherin–aberrant, p53(+), and p53(neg) molecular subtypes represented 3 (7%), 11 (24%), 0 (0%), 22 (49%), and 9 (20%) cases. Concomitant p53(+) was observed in 1 EBV-associated and 2 MMRD MGCs. Although, there was no significant difference in the frequency of most molecular subtypes in IGCs and MGCs, the number of MMRD gastric cancers more than doubled in the MGC group. Half of the MGCs had a divergent molecular subtype compared to that of the IGCs. Notably, the interval between the development of IGCs and MGCs was significantly longer in patients with divergent molecular subtypes (P = 0.010). All 4 patients with MMRD IGC developed MMRD MGCs. Although the concept of mucosal field cancerization may explain the matching molecular subtypes in early-developing MGCs, the presence of divergent subtypes in late-occurring MGCs suggests a shift in the carcinogenic mechanism affecting the residual mucosa possibly related to Helicobacter pylori eradication.

Background Brain-computer interface (BCI) technology can enhance neural plasticity and motor recovery in persons with stroke. However, the effects of BCI training with motor imagery (MI)-contingent feedback versus MI-independent feedback remain unclear. This study aimed to investigate whether the contingent connection between MI-induced brain activity and feedback influences functional and neural plasticity outcomes. We hypothesized that BCI training, with MI-contingent feedback, would result in greater improvements in upper limb function and neural plasticity compared to BCI training, with MI-independent feedback. Methods This randomized controlled trial included persons with chronic stroke who underwent BCI training involving functional electrical stimulation feedback on the affected wrist extensor. Primary outcomes included the Medical Research Council (MRC) scale score for muscle strength in the wrist extensor (MRC-WE) and active range of motion in wrist extension (AROM-WE). Resting-state electroencephalogram recordings were used to assess neural plasticity. Results Compared to the MI-independent feedback BCI group, the MI-contingent feedback BCI group showed significantly greater improvements in MRC-WE scores (mean difference = 0.52, 95% CI = 0.03–1.00, p  = 0.036) and demonstrated increased AROM-WE at 4 weeks post-intervention ( p  = 0.019). Enhanced functional connectivity in the affected hemisphere was observed in the MI-contingent feedback BCI group, correlating with MRC-WE and Fugl-Meyer assessment-distal scores. Improvements were also observed in the unaffected hemisphere’s functional connectivity. Conclusions BCI training with MI-contingent feedback is more effective than MI-independent feedback in improving AROM-WE, MRC, and neural plasticity in individuals with chronic stroke. BCI technology could be a valuable addition to conventional rehabilitation for stroke survivors, enhancing recovery outcomes. Trial registration CRIS (KCT0009013).