Accurate prediction of therapeutic pressure for Continuous Positive Airway Pressure (CPAP) therapy is essential for effective treatment of Obstructive Sleep Apnea (OSA). Existing methods often rely on complex sleep-related parameters and small sample sizes, limiting their generalizability. This study aims to develop a more accessible, data-driven model using readily available demographic and physiological variables to predict CPAP pressure, improving both accuracy and scalability.

We employed a machine learning approach, integrating decision trees, gradient boosting algorithms (LightGBM, XGBoost, CatBoost), and neural networks to predict therapeutic pressure. Forward selection based on the Akaike Information Criterion (AIC) was used to identify the most relevant variables. The model was trained on a dataset of 2,092 patients, with model performance assessed using mean absolute error (MAE).

The most influential variables identified were BMI, neck circumference, and waist-to-hip ratio. Among the algorithms, LightGBM achieved the highest predictive accuracy, with the lowest MAE. Ensemble methods, such as voting, did not improve performance beyond LightGBM alone. Subsample analyses revealed that prediction accuracy varied across BMI ranges and ventilator brands.

The study demonstrates that BMI and other physical parameters play a pivotal role in determining CPAP pressure, offering a simplified yet effective prediction model. This approach has significant potential for clinical applications, particularly in resource-limited settings, where access to complex sleep studies may be restricted. Future research could enhance the model by incorporating real-time physiological data and expanding data collection to diverse populations.

A growing body of evidence suggests that exposure to environmental noise is linked to the development of cardiovascular disease (CVD). Here, we used two-sample Mendelian randomization (MR) to investigate whether noise-related DNA methylation (DNAm) alterations are causally associated with CVDs and their risk factors.

Publicly available genome-wide association study data on cardiovascular outcomes and epigenome-wide association study data on noise-related alterations in DNAm were used. Thirteen cytosine-phosphate-guanine sites previously associated with noise exposure were selected as exposures, and genetic instruments (methylation quantitative trait loci) were obtained from the Genetics of DNA Methylation Consortium. Summary-level data for six CVDs (heart failure, coronary heart disease, peripheral atherosclerosis, atrial fibrillation/flutter, arrhythmia, and ischemic stroke) and six CVD risk factors (body mass index, sleep, hypertension, hyperlipidemia, type 2 diabetes, and total cholesterol) were extracted. Primary causal estimates were derived using an inverse variance-weighted method. The robustness of these findings was evaluated using supplementary sensitivity analyses, including MR-Egger, weighted median, weighted mode, and Wald ratio.

Among 13 noise-related DNAm sites, 11 (84.6%) were significantly associated with at least one CVD outcome, with most (10/11) showing risk-enhancing effects. Specifically, cg13402217 (located in the SNX27 gene) and cg16218477 (located in the C7orf50 gene) were repeatedly linked to elevated risks of CVD outcomes, such as heart failure (odds ratio [OR], 0.897; 95% confidence interval [CI], 0.884-0.911, P  = 3.243E-46) and coronary heart disease (OR, 0.999; 95% CI, 0.998-0.999, P  = 2.213E-10). Conversely, cg19270309 (located in the ENPP7 gene) was associated with protective CVD outcomes; for example, it was associated with a lower risk of coronary heart disease (OR, 0.996; 95% CI, 0.993-1.000, P  = 2.984E-02). The sensitivity analysis results were consistent with the above results.

Our findings provide novel causal evidence that environmental noise influences CVDs and the related risk factors through DNAm alterations.

Physical activity is one of the modifiable risk factors for non-communicable diseases. According to the World Health Organization PA country report for India, 25% of adult males and 44% of adult females are physically inactive.

This review seeks to explain the implementation of community-based interventions on physical inactivity associated with non-communicable diseases. A search was carried out on PubMed, Scopus and Embase to source the relevant articles.

The review focused on assessing the implementation of community-based interventions for physical inactivity between January 2015-February 2024. The review included primary studies that are published on the implementation of community-based interventions on physical inactivity to control non-communicable diseases.

The scoping review includes 31 articles that met the inclusion criteria out of the 823 records identified. 75% of the studies included were conducted in USA, Europe and 25% were from LMICs. The major facilitators were internal motivation, peer support, health education, and availability of trained personnel to support implementation of interventions. The major barriers were socio-economic constraints, maintenance of facilities, distance from the facility, and poor understanding of positive lifestyle change. The review underscores the potential of effective implementation plans to promote physical activity and mitigate these barriers through evidence-based strategies which need to be integrated early in the intervention design phase.

By advancing evidence-based practices and tailoring interventions to local contexts, stakeholders can effectively promote active lifestyles and contribute to population-wide health improvements. Some implications for practice include the incorporation of behavioural theories in the design phase to improve adoption and impact, increasing collaboration particularly with the education sector and the use of digital tools within interventions.

Breast cancer poses a major threat to women's health in China, with its incidence rate continuously rising, leading to an increasing disease burden and an urgent need for novel and effective treatment strategies. In recent years, poly ADP-ribose polymerase (PARP) inhibitors, as a new class of anti-tumor drugs targeting the DNA damage repair pathway, have demonstrated significant efficacy in the treatment of breast cancer with BRCA1/2 mutations. These agents induce a "synthetic lethality" effect by specifically inhibiting DNA repair in tumor cells, offering a new option for precision therapy. Currently, PARP inhibitors such as olaparib and fluzoparib have been approved for clinical use. Based on the latest evidence-based medical data, the Professional Committee on Clinical Research of Oncology Drugs, China Anti-Cancer Association, Expert Committee for Monitoring the Clinical Application of Antitumor Drugs and Breast Cancer Expert Committee of National Cancer Quality Control Center, Cancer Chemotherapy Quality Control Expert Committee of Beijing Cancer Treatment Quality Control and Improvement Center have jointly organized and invited domestic oncology experts with rich diagnosis and treatment experience as well as relevant interdisciplinary experts to compile the "Expert consensus on the clinical application of PARP inhibitors in breast cancer (2025 edition)". This consensus aims to provide guidance on the standardized application and safety management of PARP inhibitors in breast cancer treatment, with the goal of supporting clinical practice.

The mammalian pineal gland maintains normal circadian rhythms and homeostasis by secreting melatonin. However, the lack of a single-cell-resolved regulatory map limits our understanding of how these neuroendocrine functions are orchestrated. Here, we constructed a multiomics atlas of the pineal gland from Macaca fascicularis by integrating snRNA-seq, snATAC-seq, and spatial transcriptomics. We identified pinealocytes as the predominant cell type, alongside six glial and vascular lineages. Chromatin accessibility analysis delineated cell-type-specific regions enriched for melatonin synthesis and phototransduction genes. Notably, we resolved a dual-layer regulatory architecture: While melatonin synthesis programs are robustly organized, circadian clock regulators exhibit a distinct, sparse spatial pattern. Coexpression networks further identified core modules and regulatory hubs-including CRX/OTX2, LHX4, and RORA-that integrate these circadian and light-responsive signals. Cell-cell communication analysis identified signaling axes, such as PTN-ALK/SDC2, RA-RORB, and NRG1-ERBB4, that potentially coordinate this spatial functional organization. Integrating genetic traits showed that sleep and neuropsychiatric risk variants preferentially map to these pineal regulatory modules. Specifically, sleep-associated loci converged on MEIS1-linked elements, while bipolar disorder-associated loci highlighted candidate genes of RDH12 and SDK2. Overall, this study reveals the cellular diversity and spatial regulatory logic of the primate pineal gland, providing a physiological foundation for investigating circadian and neuroendocrine regulation in healthy and disease models.

Ureteral stenosis remains a significant urological complication after kidney transplantation. This study aimed to identify independent risk factors for the development of post-transplant ureteral stenosis and to evaluate their temporal impact using survival analysis in a contemporary cohort.

A retrospective single-center cohort study was conducted, including 342 deceased donor kidney transplant recipients between 2014 and 2024. The primary endpoint was the time to radiologically confirmed ureteral stenosis within the first post-transplant year. Univariate analysis and Kaplan-Meier survival curves were used to identify associated factors. A multivariable Cox proportional hazards model was constructed to determine independent predictors, adjusting for clinically relevant variables.

The incidence of ureteral stenosis was 11.1% (n = 38). Multivariable Cox regression identified urinary fistula as the strongest associated factor (Hazard Ratio [HR]: 8.28; 95% CI: 3.87-17.72; p < 0.001), drastically reducing median stenosis-free survival to 188.9 days. Diabetes mellitus showed a borderline association with stenosis (HR: 2.41; 95% CI: 1.02-5.72; p = 0.046). Conversely, the prophylactic use of a double-J stent was an independent protective factor, reducing the risk of stenosis by 72% (HR: 0.28; 95% CI: 0.11-0.73; p = 0.009). Postoperative urinary tract infection showed a non-significant trend (HR: 1.89; p = 0.079).

Urinary fistula was the strongest predictor of ureteral stenosis, underscoring the importance of its prevention. Routine prophylactic double-J stenting appeared to be an effective protective strategy. Diabetes mellitus showed a borderline association with stenosis and may identify a subgroup requiring closer postoperative urological surveillance; this finding should be interpreted cautiously and confirmed in larger studies.

Type 2 diabetes mellitus (T2DM) is a growing public health concern in Brazil, especially in underserved regions where social and geographic barriers may affect disease management and quality of life. Functional capacity and health-related quality of life (HRQoL) are critical dimensions often overlooked in primary care approaches. To assess the functional capacity and HRQoL of individuals with T2DM receiving care in primary health units in Tocantinópolis, Northern Brazil, and to explore associations with sociodemographic and clinical variables. This is a cross-sectional, descriptive, and analytical study involving 99 adults diagnosed with T2DM. Functional capacity was assessed through validated protocols measuring upper and lower limb muscle strength, hamstring flexibility, mobility and cardiorrespiratry fitness. Physical activity was analyzed using the International Physical Activity Questionnaire (IPAQ) and HRQoL was assessed through Diabetes Quality of Life (DQOL). Sociodemographic and clinical data were also collected. Statistical analysis included descriptive statistics and linear regression models. Most participants were women (71%), with a mean age of 58.7 years. The physical and psychological domains of DQOL presented the lowest scores, while the social domain had the highest. Functional capacity was low for most participants. There were significant associations between low physical activity levels and poorer HRQoL scores in the physical and psychological domains. Individuals with T2DM in this sample presented reduced functional capacity and compromised HRQoL, particularly in domains related to physical and psychological well-being. These findings highlight the urgent need for integrated health strategies in primary care that address physical activity and emotional support for people living with diabetes in remote and low-resource settings.

Diabetes mellitus accounts for a significant share of morbidity and mortality in ages 30-70 years worldwide. In sub-Saharan Africa, diabetes care is often suboptimal for reasons ranging from health system weaknesses to patient illiteracy and non-compliance with recommendations. This study explores the potential costs and health benefits of optimising care for uncomplicated type 2 diabetes in Lagos State, Nigeria.

Longitudinal data on medical care patterns and resource use (consultations, medications, diagnostics and lifestyle counselling) over a 1-year period were collected retrospectively from 84 health facilities in Lagos. Medical resource prices were obtained from a subsample of 26 facilities. Patient care gaps were assessed by comparing actual journeys to official diabetes management guidelines. Mixed-effect regression analyses were employed to explore the impact of care elements on blood glucose control and model the potential complications averted if all patients received recommended care, with extrapolation to the entire Lagos population.

Data from 642 patients with uncomplicated type 2 diabetes were analysed. A one-unit increase in consultation score (a measure of the adequacy of consultation visits) and having health insurance coverage were linked to 47-unit and 29-unit lower blood glucose levels, respectively. Optimising diabetes care requires US$3716 per patient annually, totalling US$2.1 billion statewide, with medications comprising 97% of costs. Enhanced care could reduce stroke and myocardial infarction by 2% (12 675 cases) and 4% (22 282 cases) over 7 years, respectively, at a cost of US$61 492 per complication averted.

The investment required to optimise diabetes care in Lagos is currently unfeasible in the existing approaches. There is a need to explore innovative financing and delivery options, including digital value-based care interventions and cost-saving care approaches such as pooled medication procurement, while also investing in local medicines production capacity and expansion of the health insurance coverage.

Steatotic liver disease is common and has increased prevalence among those with type II diabetes mellitus or hazardous alcohol use. Identifying individuals with advanced liver disease early through screening may afford timely opportunities to reduce disease progression. This study assesses the application of non-invasive tests in at-risk populations to identify clinically important disease.

The enhanced liver fibrosis (ELF) test and liver stiffness measurement (LSM) were used as non-invasive means to assess risk of fibrosis in two at-risk populations in Leeds, UK. Patients in a community diabetes clinic and patients with hazardous alcohol use attending alcohol treatment services between March 2019 and March 2020 were offered ELF testing alongside routine review. Those with ELF ≥9.5 were offered LSM.

In total, 972 patients were assessed, of whom 325 underwent both ELF and LSM. Patients referred from the diabetes clinic were typically older and had higher body mass index values, while alanine aminotransferase and serum bilirubin values were higher in those referred from alcohol services. Forty-five per cent of patients referred from the diabetes service had an ELF score below 9.5, and only 7.9% undergoing LSM had readings ≥15 kPa. Seventy-two per cent of patients referred from the alcohol service had ELF scores below 9.5, with 31% subsequently having LSM values ≥15 kPa.

Steatotic liver disease is relatively common in those with risk factors and particularly those drinking excess alcohol. Strategies for identifying at-risk individuals may help to increase early diagnosis, though care must be taken when selecting appropriate tests.

To explore the lived experiences of children with type 1 diabetes (T1D) and their caregivers in Armenia, a post-Soviet country, and to identify system-level barriers to care from the community perspective.

Qualitative study using a phenomenological design with inductive thematic analysis.

Muratsan Hospital Complex, the primary national referral centre for paediatric endocrinology, Yerevan, Armenia.

12 children aged 13-17 years with T1D and their caregivers, recruited through purposive sampling across 7 of Armenia's 10 administrative regions.

Five themes emerged from the data: (1) barriers to care, (2) quality of care, (3) perceived control of T1D, (4) knowledge of T1D and (5) government and non-governmental organisation (NGO) support. Participants described unreliable government-supplied glucose strips, geographical barriers rooted in the centralisation of specialist care in the capital, abrupt withdrawal of state support at age 18, reliance on the KATIL NGO to fill gaps in both clinical and psychosocial support and pervasive stigma encountered across family, school and clinical settings.

Children with T1D in Armenia navigate a post-Soviet health system where provisions exist but remain fragmented, limited by centralised care, geographical barriers and variable support. This unique context shapes the relationship and expectations patients have of the healthcare system. Community perspectives are indispensable in these settings, surfacing system-level gaps that conventional data cannot capture. These findings have relevance for other health systems navigating similar structural transitions.