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Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease with a high incidence of acute exacerbation and an increasing mortality rate. Currently, treatment methods and effects are limited. Therefore, we conducted a meta-analysis of the incidence of acute exacerbation in patients with IPF, hoping to provide reference for the prevention and management of IPF. We systematically searched the PubMed, Embase, Cochrane Library and Web of Science databases. From the creation of the database to the cohort study on April 3, 2023, we collected studies on the incidence of acute exacerbation of IPF patients, and used Stata software (version 16.0) for meta analysis. We used the Newcastle Ottawa Quality Assessment Scale (NOS) to assess the risk of bias for each study. We calculated the incidence of acute exacerbation in IPF patients and analyzed the risk factors for acute exacerbation in IPF patients and prognostic factors for overall survival from the initial IPF diagnosis. A total of ten cohort studies on the incidence of AE-IPF were included, including 11,855 IPF patients. The results showed that the incidence of acute exacerbation within one year was 9%; the incidence of acute exacerbation within 2 years is 13%; the incidence of acute exacerbation within 3 years is 19%; the incidence of acute exacerbation within 4 years is 11%. In addition, one study reported an acute exacerbation rate of 1.9% within 30 days. The incidence of acute exacerbation within ten years reported in one study was 9.8%. Mura et al.'s article included a retrospective cohort study and a prospective cohort study. The prospective cohort study showed that the incidence of acute exacerbation within 3 years was 18.6%, similar to the results of the retrospective cohort study meta-analysis. Our system evaluation and meta-analysis results show that the incidence of AE-IPF is relatively high. Therefore, sufficient attention should be paid to the research results, including the management and prevention of the disease, in order to reduce the risk of AE. Trial registration: PROSPERO, identifier CRD42022341323.

Background Proactive health behaviours are crucial for enhancing adolescent health. However, there is limited evidence on the potential pathways through which social support influences adolescents’ proactive health behaviours. This cross-sectional study aimed to examine the relationships between social support, self-efficacy, peer relationships and proactive health behaviours in Chinese adolescents. Methods From October to December 2023, we recruited 6075 adolescents from Shandong Province, China. They completed self-report questionnaires on social support, self-efficacy, peer relationships and proactive health behaviours. Results Linear regression analysis indicated that social support was positively associated with proactive health behaviours among adolescents ( β  = 0.571, 95% CI = 0.542, 0.600). Further mediation analyses revealed that self-efficacy ( β  = 0.085, 95% CI = 0.069,0.101) and peer relationships ( β  = 0.156, 95% CI = 0.136,0.177) mediated this relationship. Conclusions Increased social support was associated with better proactive health behaviours in Chinese adolescents. Additionally, higher self-efficacy and positive peer relationships enhanced this association. Our findings emphasised the significance of providing supportive environments at home and at school to promote proactive health behaviours in adolescents.

Objective: Current evidence on the association between serum testosterone and cognitive performance has been inconsistent, especially in older adults. To investigate the associations between serum testosterone and cognitive performance in a nationally representative sample of older men and women. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. 1,303 men and 1,349 women aged 60 years or older were included in the study. Serum total testosterone was preformed via isotope dilution liquid chromatography tandem mass spectrometry (ID-LC-MS/MS) method. Free testosterone was calculated by Vermeulen’s formula. Cognitive performance was evaluated by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) test, Animal Fluency test, and Digit Symbol Substitution Test (DSST). Binary logistic regression and restricted cubic spline models were applied to evaluate the association of testosterone and cognitive performance. Results: In men, higher concentrations of total testosterone were associated with better performance on CERAD test (OR = 0.51; 95%CI = 0.27–0.95) and DSST (OR = 0.54; 95%CI = 0.30–0.99) in adjusted group. Similarly, higher concentrations of free testosterone were associated with better performance on CERAD test (OR = 0.32; 95%CI = 0.17–0.61) and DSST (OR = 0.41; 95%CI = 0.17–0.96) in men. These associations were not seen in women. Conclusion: Serum testosterone concentrations were inversely associated with cognitive performance in older men but not women in the United States.

Objective The stratification of microsatellite instability (MSI) status assists clinicians in making treatment decisions for colorectal cancer (CRC) patients. This study aimed to establish a CT-based radiomics signature to predict MSI status in patients with CRC. Methods A total of 837 CRC patients who underwent preoperative enhanced CT and had available MSI status data were recruited from two hospitals. Radiomics features were extracted from segmented tumours, and a series of data balancing and feature selection strategies were used to select MSI-related features. Finally, an MSI-related radiomics signature was constructed using a genetic algorithm–enhanced artificial neural network model. Combined and clinical models were constructed using multivariate logistic regression analyses by integrating the clinical factors with or without the signature. A Kaplan–Meier survival analysis was conducted to explore the prognostic information of the signature in patients with CRC. Results Ten features were selected to construct a signature which showed robust performance in both the internal and external validation cohorts, with areas under the curves (AUC) of 0.788 and 0.775, respectively. The performance of the signature was comparable to that of the combined model (AUCs of 0.777 and 0.767, respectively) and it outperformed the clinical model constituting age and tumour location (AUCs of 0.768 and 0.623, respectively). Survival analysis demonstrated that the signature could stratify patients with stage II CRC according to prognosis (HR: 0.402, p = 0.029). Conclusions This study built a robust radiomics signature for identifying the MSI status of CRC patients, which may assist individualised treatment decisions. Key Points • Our well-designed modelling strategies helped overcome the problem of data imbalance caused by the low incidence of MSI. • Genetic algorithm–enhanced artificial neural network–based CT radiomics signature can effectively distinguish the MSI status of CRC patients. • Kaplan–Meier survival analysis demonstrated that our signature could significantly stratify stage II CRC patients into high- and low-risk groups.

Physical activity plays an important role in cognitive function in older adults, and the threshold effect and saturation effect between physical activity and cognitive function are unclear. The purpose of this study was to explore the threshold effect and saturation effect between physical activity and cognitive function in the elderly. The International Physical Activity Questionnaire (IPAQ) was used to measure moderate-intensity physical activity and vigorous-intensity physical activity and total physical activity in older adults. Cognitive function assessment uses the Beijing version of the Montreal Cognitive Assessment Scale (MoCA). The scale consists of seven parts: visual space, naming, attention, language, abstract ability, delayed recall and orientation, for a total of 30 points. The total score of the study participants < 26 was defined as the optimum cutoff point for a definition of mild cognitive impairment (MCI). The multivariable linear regression model was used to initially explore the relationship between physical activity and total cognitive function scores. The logistic regression model was used to assess the relationship between physical activity and cognitive function dimensions and MCI. The threshold effect and saturation effect between the total physical activity and the total cognitive function scores were investigated by smoothed curve fitting. This cross-sectional survey had a total of 647 participants aged 60 years and older (mean age: 73 years, female: 53.7%). Participants' higher level of physical activity were associated with higher visual space, attention, language, abstract ability, and delayed recall scores ( < 0.05). Physical activity was not statistically associated with naming and orientation. Physical activity was a protective factor for MCI ( < 0.05). Physical activity was positively correlated with total cognitive function scores. There was a saturation effect between total physical activity and total cognitive function scores, and the saturation point was 6546 MET × min/wk. This study showed a saturation effect between physical activity and cognitive function, and determined an optimal level of physical activity to protect cognitive function. This finding will help update physical activity guidelines based on cognitive function in the elderly.

Occupational fatigue, characterized by both physical and mental exhaustion, is a pressing concern in various professions, particularly among nurses. Studies have consistently linked occupational fatigue to decreased productivity, heightened error rates, and compromised decision-making abilities, posing significant risks to both individual nurses and healthcare organizations. Despite its recognized impact, the global prevalence of occupational fatigue among nurses remains incompletely understood, and rigorous evaluations of the multifaceted factors influencing nurses' occupational fatigue are scarce in the existing literature. This study aims to estimate the pooled score of nurses' occupational fatigue, and to systematically review the factors associated with nurses' occupational fatigue. The review searched eight databases, including PubMed, Web of Science, Scopus, CINAHL, PsycINFO, and Chinese databases such as China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), and Wan Fang Database. The temporal scope of our search covers the period from the inception of each database to October 1, 2023. The PRISMA guidelines were followed in the reporting of the meta-analysis and systematic review. The meta-analysis was conducted using Stata 18.0 software, employing a random-effects model to pool the mean score and standard deviation of the Occupational Fatigue Exhaustion Recovery (OFER) scale. The restricted maximum-likelihood estimator was utilized to calculate the heterogeneity variance τ². Subgroup analysis was conducted to explore sources of heterogeneity. The registration PROSPERO number is CRD42023456337. After a rigorous selection process, 28 articles were ultimately deemed suitable for inclusion in this article, which encompassed a total of 13,290 registered nurses. The pooled mean scores for chronic fatigue, acute fatigue, and inter-shift recovery were 53.24 (95% CI: 48.42-58.28), 64.00 (95% CI: 60.62-67.38), and 47.37 (95% CI: 43.24-51.50), respectively. The subgroup analyses of occupational fatigue among nurses yield crucial insights into the way regional, age, temporal, and departmental factors interact to influence fatigue levels. In addition, the factors affecting nurses' occupational fatigue were found to include cultural, organizational and individual variables. A moderately high level of acute and chronic fatigue was observed among nurses, while the level of inter-shift recovery was low to moderate. It is imperative that healthcare systems provide enhanced support for nurses, a multifaceted approach is required, encompassing cultural shifts to reduce the normalization of overwork, organizational reforms to enhance staffing and scheduling, the implementation of fair compensation mechanisms, the development of targeted educational programs and individual-level interventions to promote healthier lifestyle practices.

Scope Male fertility and sperm quality are negatively affected by psychological stress. Chronic restraint stress (CRS) is a common psychological stress that has a negative effect on sperm. Betaine (BET), an active ingredient isolated from Lycium barbarum, has anti-oxidant, anti-inflammatory and other pharmacological activities. This study aims to explore whether betaine has a therapeutic effect on sperm deformity and vitality under CRS and its mechanism. Methods and results Chronic restraint stress was induced in 8-week-old male C57BL/6 J mice by fixation for 6 h a day for 35 days. Mice were intraperitoneally injected with betaine (BET) or normal saline (NS) for 14 days. Thirty-five days later, the animals were sacrificed. The results showed that the detrimental effects of CRS on testes as evident by disrupted histoarchitecture, increased oxidative stress, inflammation and apoptosis that compromised male fertility. BET injections can reverse these symptoms. Conclusions BET can improve spermatogenesis dysfunction caused by CRS, which may provide potential dietary guidance. Graphical abstract

Reduning (RDN) injection is a traditional Chinese medicine (TCM) extract injection commonly used as an adjunct therapy for severe pneumonia (SP) in clinical practice in China; however, further validation is required. This study aims to systematically assess the efficacy and safety of RDN injection in treating SP. The study was conducted using the data from CNKI, WanFang, VIP, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases from their inception to 6 April 2024. We collected randomized controlled trials on the treatment of SP using RDN injection, and used Review Manager (version 5.3) for meta analysis. The primary outcomes was clinical efficacy. We used the Cochrane Risk of Bias Assessment Tool 2 (RoB 2) to assess the risk of bias for each study. A total of 1,897 patients with SP from 22 studies were included. The meta-analysis results showed that the combination of RDN injection and conventional treatment or antibiotic treatment for patients with SP was superior to traditional and antibiotic treatments alone in terms of clinical efficacy [risk ratio = 1.25%; 95% confidence interval (CI) (1.20, 1.30); < 0.00001], fever reduction time [mean difference (MD) = -1.55 days; 95% CI (-1.91, -1.18); < 0.00001], cough disappearance time [MD = -1.97 days; 95% CI (-2.63, -1.31); < 0.00001], lung rales disappearance time [MD = -2.39 days; 95% CI (-3.09, -1.70); < 0.00001], chest X-ray improvement time [MD = -2.73 days; 95% CI (-2.96, -2.49); < 0.00001], and hospitalization time [MD = -3.11 days; 95% CI (-3.80, -2.41); < 0.00001]. Moreover, no significant improvement was observed in the Acute Physiology and Chronic Health Evaluation II (APACHE II) scale compared to the control group [MD = -2.45 points; 95% CI (-6.07, 1.17); = 0.19]. Lastly, not all studies reported any serious adverse events; however, some studies did report adverse reactions. The administration of RDN injection as an adjunct therapy for SP can enhance clinical efficacy, reduce fever duration, accelerate cough resolution, shorten the time for lung rales to resolve, accelerate chest X-ray improvement, and decrease hospitalization duration. Further well-designed and standardized large sample clinical studies are needed for validation. PROSPERO, identifier CRD42024540365.

Background Diabetes mellitus (DM), a chronic metabolic disease, severely impairs male reproductive function. However, the underpinning mechanisms are still incompletely defined, and there are no effective strategies or medicines for these reproductive lesions. Icariin (ICA), the main active component extracted from Herba epimedii , is a flavonoid traditionally used to treat testicular dysfunction. Whether ICA can improve male reproductive dysfunction caused by DM and its underlying mechanisms are still unclear. In this study, by employing metformin as a comparative group, we evaluated the protective effects of ICA on male reproductive damages caused by DM and explored the possible mechanisms. Methods Rats were fed with a high fat diet (HFD) and then intraperitoneally injected with streptozotocin (STZ) to induce diabetes. Diabetic rats were randomly divided into T2DM + saline group, T2DM + metformin group and T2DM + ICA group. Rats without the treatment of HFD and STZ were used as control group. The morphology of testicular tissues was examined by histological staining. The mRNA expression levels were determined by quantitative real-time PCR. Immunostaining detected the protein levels of proliferating cell nuclear antigen (PCNA), hypoxia-inducible factor 1-alpha (HIF-1α) and sirtuin 1 (SIRT1) in testicular tissues. TUNEL assay was performed to determine cell apoptosis in the testicular tissues. The protein expression levels of HIF-1α and SIRT1 in the testicular tissues were determined by western blot assay. Results ICA effectively improved male reproductive dysfunction of diabetic rats. ICA administration significantly decreased fasting blood glucose (FBG) and insulin resistance index (IRI). In addition, ICA increased testis weight, epididymis weight, sperm number, sperm motility and the cross-sectional area of seminiferous tubule. ICA recovered the number of spermatogonia, primary spermatocytes and Sertoli cells. Furthermore, ICA upregulated the expression of PCNA, activated SRIT1-HIF-1α signaling pathway, and inhibited intrinsic mitochondria dependent apoptosis pathway by upregulating the expression of Bcl-2 and downregulating the expression of Bax and caspase 3 . Conclusion These results suggest that ICA could attenuate male reproductive dysfunction of diabetic rats possibly via increasing cell proliferation and decreasing cell apoptosis of testis. ICA potentially represents a novel therapeutic strategy against DM-induced testicular damages.

Objectives The aim of this study is to evaluate the feasibility of clinicopathological characteristics and computed tomography (CT) morphological features in predicting lymph node metastasis (LNM) for patients with T1 colorectal cancer (CRC). Methods A total of 144 patients with T1 CRC who underwent CT scans and surgical resection were retrospectively included in our study. The clinicopathological characteristics and CT morphological features were assessed by two observers. Univariate and multiple logistic regression analyses were used to identify significant LNM predictive variables. Then a model was developed using the independent predictive factors. The predictive model was subjected to bootstrapping validation (1000 bootstrap resamples) to calculate the calibration curve and relative C-index. Results LNM were found in 30/144 patients (20.83%). Four independent risk factors were determined in the multiple logistic regression analysis, including presence of necrosis (adjusted odds ratio [OR] = 10.32, 95% confidence interval [CI] 1.96–54.3, p  = 0.004), irregular outer border (adjusted OR = 5.94, 95% CI 1.39–25.45, p  = 0.035), and heterogeneity enhancement (adjusted OR = 7.35, 95% CI 3.11–17.38, p  = 0.007), as well as tumor location (adjusted OR right-sided colon  = 0.05 [0.01–0.60], p  = 0.018; adjusted OR rectum  = 0.22 [0.06–0.83], p  = 0.026). In the internal validation cohort, the model showed good calibration and good discrimination with a C-index of 0.89. Conclusions There are significant associations between lymphatic metastasis status and tumor location as well as CT morphologic features in T1 CRC, which could help the doctor make decisions for additional surgery after endoscopic resection. Key Points • LNM more frequently occurs in left-sided T1 colon cancer than in right-sided T1 colon and rectal cancer. • CT morphologic features are risk factors for LNM of T1 CRC, which may be related to fundamental biological behaviors. • The combination of tumor location and CT morphologic features can more effectively assist in predicting LNM in patients with T1 CRC, and decrease the rate of unnecessary extra surgeries after endoscopic resection.