Engineered stone, a composite material containing high levels of crystalline silica, has led to a surge in silicosis among workers who perform cutting, grinding, and other finishing tasks. To improve our understanding of respirable crystalline silica (RCS) and respirable dust exposures and exposure determinants for these tasks, this study extracted data from previously published studies and (i) calculated the emission rate of respirable dust and RCS (mass per time) from experimental simulation studies, (ii) assessed whether control technology or task are determinants of emission rate, and (iii) applied a 2-zone mathematical model to estimate RCS exposures using the calculated emission rates and evaluated the model predictions against task-duration exposure measurements. Emission rates were calculated from 4 published experimental simulation studies, and regression analysis showed that emission rates of RCS were positively associated with slab crystalline silica content and negatively associated with the use of control technologies. Near-field RCS concentrations predicted by model tended to underestimate exposures, but the distribution overlapped with field-based exposure measurements. The model performance is reasonable, though further simulation studies or field-based studies with detailed exposure determinant data can be used to improve emission rate estimates and model performance. The emission rates calculated in this study can be used to reconstruct past exposures for epidemiologic and risk analyses, and assist with attribution of silicosis and lung cancer to work-related causes. A multifaceted approach is necessary to ensure that employers are providing workplaces that eliminate hazardous exposures to RCS and other components of engineered stone.

We analyzed 2015-2024 national surveillance data on Kudoa septempunctata parasite-associated foodborne disease in South Korea. Monthly cases decreased 95% during the COVID-19 pandemic, with no significant recovery through 2024; affected municipalities dropped from 89 to 27. Our findings are consistent with restaurant-based raw fish consumption as the principal transmission pathway.

Persons with occupational exposure to swine might be at disproportionate risk for zoonotic swine influenza A virus. To evaluate human antibody responses, we tested serum or plasma from swine veterinarian, farm employee, and general population cohorts by hemagglutination inhibition assays against representative swine and human seasonal influenza vaccine strains. We analyzed hemagglutination inhibition data by antigenic cartography to assess strain relationships and reproduction number modeling to evaluate pandemic potential using age-stratified immunity profiles. Occupationally exposed groups had lower human seasonal vaccine uptake (45.5% vs. 70%) and lower odds of seropositivity to several H1 and H3 strains from swine than did general population cohorts. One swine strain exhibited significant antigenic drift (3.62 antigenic units) from its nearest vaccine strain. Multiple strains required lower reproduction number thresholds for pandemic spread (1.09-1.35) than recorded pandemic strains (1.46-1.80), demonstrating that population immunity gaps heighten zoonotic risk to circulating swine H1 and H3 strains.

Varicose veins (VVs) are one of the most common consequences of chronic venous disease. The present multicentric three-arm study aimed to compare the clinical outcomes of endovenous laser ablation (EVLA) versus ligation plus stripping or sclerotherapy for primary lower limb VVs.

The study included 300 patients with VVs. They received EVLA (GI, n = 100), ligation plus stripping (GII, n = 100) or ligation plus sclerotherapy (GIII, n = 100). Groups were matched using propensity score. The primary outcome measures were 1-year total occlusion and recurrence rates.

At 1 year follow up, no significant differences were found between the total occlusion rates for GI (75.0%), GII (76.0%) and GIII (83.0%). It was demonstrated that GII had significantly higher recurrence rate (24.0%) as compared to GI (6.0%) and GIII (5.0%). It was also found that GII group had significantly higher frequency of ecchymosis, hematoma and surgical site infection as compared to the other two groups. In contrast, GI had significantly higher frequency of skin ulceration/burn as compared to the other two groups. Also, it was found that GIII had significantly lower frequency of deep vein thrombosis than GI and GII.

Ligation plus sclerotherapy achieved slightly better total occlusion rate in comparison to EVLA and ligation plus stripping while avoiding important side effects related to them mainly traumatic and thermal injury effects and recurrence.

To generate the evidence base, using national cohort data, to design a clinical trial evaluating whether cesarean section (CS) or vaginal birth (VB) offers better outcomes for very preterm infants.

Severe intraventricular hemorrhage (IVH) remains a major cause of death and brain injury amongst very preterm infants. Observational studies have suggested CS may reduce the risk, but it is not known which infants might benefit and whether a randomized trial, to generate robust evidence to guide clinical decisions, would be feasible.

We examined births in England and Wales between 22 + 0 and 31 + 6 weeks' gestation (2012-2022; n = 74,423) and identified the infants that could take part in a trial. Three emulated target trials (ETTs) were constructed examining intended mode of birth (iVB vs iCS), across different populations, with confounding controlled by inverse probability weighting.

One in four(25.2%) very preterm infants could be considered for participation in a future trial. Infants born by CS had lower rates of severe IVH or death than those born by VB (4,319 (9.6%) vs 5,542 (18.7%)) (p < 0.001), although in the adjusted analyses using intended mode of birth the difference did not persist (e.g. ETT#1: 13.3% vs 13.0%, p = 0.609); except for non‑cephalic (breech) infants. Infants in a non-cephalic presentation in the iCS group had a significantly lower chance of death or sIVH in all three emulated trials (ETT#1, OR 0.73 (0.64-0.83); ETT#2, OR 0.65 (0.56-0.76); ETT#3, OR 0.81 (0.70-0.94).

Only a minority of very preterm births are realistically randomisable in a future trial, particularly babies in breech presentation who may benefit from a CS. An international multi-centre trial is needed to examine this question.

Objective: To evaluate the efficacy and clinical outcomes of transcatheter closure of intracristal ventricular septal defect (VSD) using an eccentric occluder. Methods: In this case series study, 39 children with intracristal VSD who underwent attempted transcatheter closure using an eccentric occluder at the Second Affiliated Hospital of Wenzhou Medical University from January 2011 to December 2021 were included. All children were regularly followed up at 1, 3, 6, 12, 24 and 36 months after the procedure. Echocardiography, electrocardiography and treadmill exercise testing were used for postoperative follow-up evaluation. The main outcomes included occlude morphology and position, residual shunt, valvular regurgitation, cardiac function, arrhythmia and postoperative exercise capacity. Comparisons among different follow-up time points were performed using the paired t-test or repeated-measures analysis of variance, Friedman test or Wilcoxon signed-rank test. Results: Device implantation was successful in 38 of 39 children (97%). One child underwent surgical repair because the aortic valve prolapse protruded into the VSD shunt orifice, making transcatheter closure unsuitable. No severe complications occurred after the procedure. Follow-up showed that residual shunt was observed in 7 children (18%) after the procedure and disappeared within 24 months of follow-up. Valvular regurgitation occurred in 9 children (24%) and did not worsen during follow-up; in 7children, valvular regurgitation disappeared within 36 months. Arrhythmia occurred in 6 children (16%), including incomplete right bundle branch block in 2 children and premature ventricular contractions in 4 children. Five children resolved within 12 months, and the remaining 1 child resolved by 36 months of follow-up. Compared with baseline, the Z scores of left ventricular end-diastolic diameters and left atrial diameters showed a progressive decrease during the first 1 to 6 months after transcatheter closure (both P<0.05), and remained stable after 24 months. Right ventricular diameter and left ventricular ejection fraction showed no significant changes before and after the procedure (all P>0.05). A total of 20 children underwent treadmill exercise testing 1 year after the procedure, and 19 children (95%) had negative results. Conclusion: Transcatheter closure of intracristal VSD using an eccentric occluder is effective and feasible, with favorable safety and efficacy during short-and mid-term follow-up.

Objective: To investigate the risk factors of vascular function damage in children with primary hypertension and establish a risk prediction model. Methods: In this retrospective case-control study, a total of 117 children aged 6-17 years with primary hypertension, hospitalized at Capital Center for Children's Health, Capital Medical University, between February 2024 and October 2025 were included. Flow mediated dilation (FMD) and carotid-femoral pulse wave velocity (cfPWV) were used as indicators of vascular function impairment. The children were divided into a vascular function damage group and a normal vascular function group according to the presence or absence of vascular function damage. Independent samples t-test or Mann-Whitney U test was used for intergroup comparison of measurement data, χ² test or Fisher's exact test was used for enumeration data. Differences in clinical, laboratory and vascular function-related indicators were compared between the two groups. Multivariate Logistic regression was employed to identify independent risk factors, based on which a nomogram was constructed. The predictive performance was verified by the receiver operating characteristic (ROC) curve. Results: Among 117 hypertensive children, there were 92 (78.6%) males and 25 (21.4%) females, with the age of (13.0±2.1) years at admission. There was 58 (49.6%) with vascular function damage. The body fat percentage, 24 h mean systolic blood pressure, daytime systolic blood pressure, nocturnal systolic blood pressure, low-density lipoprotein, total cholesterol, triglycerides, homocysteine, folic acid, fasting insulin, uric acid and cfPWV levels in the vascular function damage group (58 cases) were significantly higher than those in the normal group (59 cases), while the FMD level in the vascular function damage group was significantly lower than that in the normal group (all P<0.05). Multivariate Logistic regression identified that: nocturnal systolic blood pressure (SBP) (OR=1.06, 95%CI 1.01-1.10, P=0.019), serum low-density lipoprotein (LDL) (OR=5.51,95%CI 2.41-12.58,P<0.001), and homocysteine (OR=1.11,95%CI 1.03-1.19,P=0.005) were independent risk factors for vascular function damage. A nomogram prediction model was constructed accordingly, and the Logistic regression equation was: Logit(P)=-10.73+0.05×nocturnal systolic blood pressure+1.71×low-density lipoprotein+0.10×homocysteine. The ROC curve for the nomogram showed an area under curve of 0.82 (95%CI 0.74-0.89, P<0.001), with a sensitivity of 0.76 and a specificity of 0.71. Conclusion: Nocturnal systolic blood pressure, low-density lipoprotein and homocysteine are independent risk factors for vascular function damage in children with primary hypertension.

Objective: To explore age-adapted left ventricular ejection fraction (LVEF) diagnostic thresholds for heart failure with preserved ejection fraction (HFpEF) in children. Methods: In this multicenter retrospective cohort study, children with chronic heart failure were selected from 3 546 hospitalized pediatric heart failure patients across 30 medical centers in 20 provinces, autonomous regions and municipalities in China from January 2013 to December 2022. Children were divided into 3 groups based on LVEF:<50%, 50%-<55%, and ≥55%. Age-stratified analyses were performed using cutoffs at 9, 10, 11, 12, and 13 years of age. Intergroup comparisons were conducted using the chi-square test or Fisher's exact test, Wilcoxon rank-sum test or Kruskal-Wallis test. Multivariable linear regression was used to analyze the independent association between LVEF categories and cardiac structural parameters. Results: A total of 1 018 pediatric patients were included in the analysis. Among them, 527 (51.8%) were male and 491 (48.2%) were female, with an age of 1.2 (0.4, 7.1) years. There were 447 children in LVEF <50% group, 62 children in 50%-<55% group, and 509 children in ≥55% group. Statistical differences in baseline clinical characteristics were observed among the 3 groups, including age, heart rate, respiratory symptoms, systemic congestion symptoms, congenital heart disease, cardiomyopathy cardiovascular events, growth retardation (all P<0.05). Age-stratified analysis showed that when using 9, 10 and 11 years of age as cutoffs, left ventricular end-systolic diameter (LVESD) differed between the LVEF <50% and 50%-<55% groups in children aged at or above the respective cutoff (all P<0.05). When using 12 and 13 years of age as the cutoff, left atrial diameter differed between the LVEF 50%-<55% and ≥55% groups in children below 12 and 13 years of age (both P<0.05). After adjustment for covariates using multivariable linear regression, when using 10 and 11 years of age as the cut-offs, LVEF were correlated with LVESD in both children aged ≥10 years and those aged ≥11 years (β=11.62 and 10.94,95%CI 2.38-20.85 and 1.32-20.56, P=0.018 and 0.029). And when using 12 years of age as the cut-offs, LVEF was correlated with left atrial diameter in children aged <12 years of age (β=-1.82,95%CI -3.29--0.35,P=0.015). Conclusion: Age-related heterogeneity may exist in the LVEF thresholds for pediatric HFpEF, an LVEF threshold of 55% is recommended for children younger than 12 years, whereas 50% consistent with adult criteria, may be considered for those aged 12 years or older.

Orbital venolymphatic malformations (OVLM) are rare congenital vascular anomalies that may cause progressive proptosis, visual loss, facial disfigurement and marked psychosocial burden. Management is challenging especially when the disease is multifocal, diffuse and with limited response to conventional therapies. We describe a school-aged child with a right eye refractory extensive orbital venolymphatic malformation leading to marked visual impairment and disfigurement despite multiple prior sclerotherapy sessions. After multidisciplinary evaluation, oral sirolimus was initiated with written informed consent from the parents in a refractory setting. After 9 months of treatment, visual acuity improved from counting fingers at 3 metres to 6/12, proptosis reduced substantially, conjunctival chemosis resolved completely, ocular motility became full with minimal residual hypotropia and the palatal lesion resolved, with mild residual lip hypertrophy. At 19 months of follow-up after initiation of therapy, visual acuity had further improved to 6/9-2, MRI demonstrated near-complete radiological regression of the lesion, no clinically significant adverse effects or recurrence. The child resumed normal activities. This case highlights the potential role of systemic mechanistic target of rapamycin (mTOR) inhibition in complex, refractory orbital venolymphatic malformations and highlights careful patient selection and long-term follow-up.

The risk of rehospitalization in patients with heart failure (HF) has initiated various efforts to prevent and simultaneously improve quality of life. Self-monitoring at home is one option, and technology is increasingly being used for this purpose.

This pilot study aimed to evaluate the feasibility and preliminary effects of a digital home monitoring intervention on patient-reported outcomes and 30-day readmissions among patients with HF in Indonesia.

A mixed methods pilot study was conducted, combining qualitative system development and quantitative evaluation. Patients were assigned to an intervention group (digital monitoring) or control group (standard care). Readmission rates were compared using chi-square tests and odds ratios. Changes in Kansas City Cardiomyopathy Questionnaire scores were analyzed using linear mixed-effects models.

A total of 60 patients were included (n=30, 50% in the intervention group; n=30, 50% in the control group). Readmission occurred in 20% (6/30) of patients in the intervention group and 43.3% (13/30) of patients in the control group (odds ratio 0.33, 95% CI 0.10-1.09; P=.10). Linear mixed-effects analysis showed greater improvement in Kansas City Cardiomyopathy Questionnaire overall summary score in the intervention group (P=.02). Improvements were observed in the physical limitation, symptom frequency, symptom burden, quality of life, and social limitation domains. During follow-up, 3.3% (1/30) of the patients in the intervention group died of non-HF-related causes, and 10% (3/30) of the patients in the control group died due to HF.

This pilot study suggests that digital home monitoring is feasible and associated with improvements in patient-reported outcomes, with a potential signal toward reduced readmission. Larger studies are needed to confirm effectiveness.