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Sickle cell disease (SCD) remains a challenging hematologic disorder, characterized by chronic hemolysis, vaso-occlusive events, and multi-organ complications. Hypertension, a prevalent comorbidity in SCD, poses significant clinical implications, exacerbating the complexities of disease management and impacting patient outcomes. Understanding the intricate interplay between SCD and hypertension is pivotal. Mechanistic insights uncover a landscape characterized by chronic hemolysis, endothelial dysfunction, altered nitric oxide bioavailability, and increased oxidative stress, contributing to elevated blood pressure and heightened cardiovascular risks in individuals with SCD. The diagnostic challenges inherent in identifying and monitoring hypertension in SCD patients necessitate novel approaches. Current treatment paradigms encompass a spectrum of lifestyle modifications, pharmacological interventions, and multidisciplinary care models. However, the limitations and complexities inherent in managing hypertension in SCD call for innovative strategies. Tailored approaches, personalized treatments, and emerging therapeutic avenues geared explicitly toward SCD patients mark a shift toward more effective management. Advancements in technology, including wearable devices and remote monitoring systems, present opportunities to revolutionize blood pressure monitoring, enhancing patient engagement and compliance while providing more accurate and frequent measurements. Moreover, the review underscores the importance of integrated care models and multidisciplinary collaborations. Collaborative frameworks involving hematologists, cardiologists, nephrologists, and primary care physicians are integral in optimizing hypertension management and addressing the specific needs of individuals with SCD.

Background: Cognitive impairment (CI) is a common complication in chronic kidney disease (CKD) patients, affecting 10% to 50% of individuals depending on disease stage. Despite its clinical significance, the molecular mechanisms remain unclear, and effective interventions are lacking. This bibliometric analysis aimed to comprehensively map the research landscape of CI secondary to CKD from 1995 to 2024, identifying trends, key contributors, and evolving foci.

Methods: A total of 1783 English original articles and reviews were retrieved from the Web of Science Core Collection. Bibliometric analysis was performed using R-bibliometrix (v4.4.2), CiteSpace (v6.3.1), and Excel 2024. Metrics included annual publications, country/affiliation contributions, journal impact (H-index, Bradford Law), citation analysis (local/global citations), author influence (H-index), keyword co-occurrence, burst detection, and thematic evolution.

Results: Publications surged after 2016, with the United States leading output (nearly 500 articles) and collaborations. The University of California System was the top affiliation (n = 243). Core journals were Nephrology Dialysis Transplantation, American Journal of Kidney Diseases, and Clinical Journal of the American Society of Nephrology. Yaffe K was the most influential author (H-index = 19). Key articles by Kurella M and Murray AM were highly cited. Keyword analysis revealed shifting themes: early research focused on prevalence and clinical associations, while current hotspots emphasized molecular mechanisms (α-Klotho, NLRP3 inflammasome) and comorbidities (fatty liver disease).

Conclusions: Research on CKD-associated CI has expanded significantly, with a paradigm shift toward mechanistic exploration. The USA dominates scholarly output, and interdisciplinary collaboration is critical. Emerging themes highlight the roles of inflammation, metabolic dysregulation, and organ crosstalk. These insights inform future research directions, clinical screening strategies, and therapeutic targeting for CI in CKD.

International Organization for Standardization (ISO) standards in healthcare aim to improve the quality, safety, and efficiency of medical devices, clinical processes, and health management systems of various countries across the world. This study reviews the perception of healthcare professionals about ISO standards at Saudi Arabia concerning patient safety, medical device management, and their overall influence on clinical and nonclinical practices. The previous study was based on the global healthcare systems of the US and Europe-like developed countries. The online cross-sectional survey of 300 respondents was selected from all regions and professions. Most of the respondents were from urban regions: Riyadh represented 30.4%, Jeddah 25.2%, and the Eastern Province represented 18.6%. The biomedical engineers constituted 43.3%, physicians comprised 29.2%, and most of the participants were males, 87%. Response to the question about ISO standards was that 79.8% agreed that ISO standards play a critical role in improving patient safety; biomedical engineers demonstrated 85.2%, while physicians were at 82.6%. Medical device calibration garnered 81.0% agree that ISO standards on calibration of medical devices are important. Differences across the 4 major regions demonstrated a strong level of agreement among respondents in Riyadh and Makkah but weaker levels among those in Asir and the Northern Borders, as follows: Riyadh 81.5%, Makkah 78.9%, Asir 58.9%, and Northern Borders 53.2%. ISO adoption barriers were reported for mostly nonclinical areas; training shortage, 56.8%, and resource unavailability were the main factors that acted as the main barriers. Besides, full agreement with relevance among ISO standards came to 85.9% among professionals with more than 15 years of experience. The inference to be drawn from such findings is that the same throw a critical light on the reception and application of ISO standards in Saudi healthcare and pinpoints those areas that require further amelioration and awareness across regions and professional groups.

A retrospective analysis was conducted on the positive rate of HER2 in gastric cancer in the Chinese high-incidence area of Wuwei from 2015 to 2024. The pathological characteristics of HER2-positive gastric cancer were explored to provide a basis for precise diagnosis and treatment in high-incidence areas of gastric cancer. A retrospective study design was adopted to collect and analysis the HER2 expression status of gastric cancer surgical specimens from 2015 to 2024. A total of 416 gastric cancer surgical specimens were collected for HER2 detection, and the positive rate of HER2 was 9.13% (38/416), including 33 males (9.68%) and 5 females (6.67%), with no statistical significance (P >.05). There were 24 (8.63%) HER2 positive patients over 60 years old, 11 (10.67%) HER2 positive patients between 50 and 59 years old, and 3 (8.6%) HER2 positive patients under 50 years old, with no statistical significance (P >.05). In cTNM stages, HER2 was positive in 7 patients (5.65%) in stage Ⅰ, 16 patients (10.32%) in stage Ⅱ, 14 patients (10.61%) in stage Ⅲ, and 1 patient (20%) in stage Ⅳ, with no statistical difference between groups (P >.05). The positive rate of tubular adenocarcinoma HER2 in WHO classification was 10.5%. Other tissue types were 0%, there were differences (P <.05); The positive rate of HER2 in well-differentiated adenocarcinoma was 10.84%, in moderately differentiated adenocarcinoma 16.44%, and in poorly differentiated adenocarcinoma 8.25%, with a difference between moderately and poorly differentiated adenocarcinoma (P <.05). The positive rate of HER2 in T3 infiltration depth was 15.97% higher than that in T1/T2/T4 (P <.05). The positive rate of HER2 in cardiac/fundus was 16.26% higher than that in other sites (P <.05). The proportion of patients with intestinal stype gastric cancer was the largest in Lauren classification (59.13%), but the HER2 positive rate of mixed type was significantly higher than that of other Lauren classification (P <.001). Patients with lymph node metastasis (13%) were significantly higher than those without lymph node metastasis (4.66%), and the difference was statistically significant (P <.01). The research data indicate that correlation between the expression of HER2 in areas with a high incidence of gastric cancer and the pathological characteristics.

With the rapid development of big data technology, smart campuses from medical universities of China have accumulated a large amount of student behavior data. How to extract hidden and valuable information from a large amount of data has become a problem faced by medical universities of China. This study constructed a framework for the portrait model of medical university students of China, which includes 5 dimensions: identity and organizational data, learning data, economic data, and health and interest data. These data are sourced from the smart campus information system of medical universities of China. Then, K-means clustering method is used to calculate these data, extract the characteristic attributes of students, and construct accurate student data portraits. This study uses big data profiling technology to accurately describe the digital characteristics of students, providing reference for the educational environment of medical universities.

This study aims to investigate the effect of misoprostol combined with oxytocin versus oxytocin alone on improving the cervical Bishop score during term labor induction and its impact on delivery outcomes. A retrospective analysis was conducted on 200 pregnant women who underwent term labor induction and met the inclusion criteria at Ningcheng Central Hospital, Chifeng, between Decemeber 2024 and May 2025. According to different clinical medication regimens, they were divided into a control group (oxytocin alone, n = 100) and a study group (misoprostol combined with oxytocin, n = 100). Baseline data, improvements in cervical Bishop score, labor-related indicators, and delivery outcomes were collected for both groups, and subgroup analyses were performed. There were no statistically significant differences in baseline data between the 2 groups (P > .05). After 12 hours of intervention, the improvement in Bishop score was significantly greater in the study group compared with the control group (Δ Bishop score 3.5 ± 1.2 vs 2.4 ± 1.0, P < .001), with a higher overall effective rate (87.0% vs 71.0%, P = .012). The study group also showed significantly shorter times from medication to onset of labor (8.4 ± 2.9 vs 11.8 ± 3.5 hours) and for the first stage of labor (7.2 ± 2.8 vs 9.6 ± 3.2 hours) (both P < .001). The vaginal delivery rate in the study group was 86.0%, higher than 72.0% in the control group (P = .015). Subgroup analysis indicated that the combined regimen had advantages in both primiparas and multiparas, as well as in women at 37 to 39 weeks or ≥40 weeks of gestation, with more pronounced benefits in primiparas and those at 37 to 39 weeks. Misoprostol combined with oxytocin during term labor induction can significantly improve cervical ripening, shorten the time from medication to labor onset and the first stage of labor, and increase the vaginal delivery rate, showing high clinical application value.

This study aims to evaluate the effectiveness of continuity of care combined with family empowerment in managing childhood asthma and provide a reference for optimizing long-term pediatric asthma management. A total of 120 children with asthma treated in our hospital from January 2022 to December 2024 were enrolled and divided into an observation group and a control group (60 cases each). The control group received routine drug therapy and basic health education. The observation group additionally received continuity of care combined with family empowerment, including establishing health records, regular telephone and home follow-ups, individualized guidance on medication and lifestyle, asthma health education, and parent empowerment training. The 2 groups were compared in terms of medication adherence, asthma control, acute attacks, emergency visits, readmission rate, quality of life (pediatric asthma quality of life questionnaire), parental empowerment (family empowerment scale), and nursing satisfaction. Baseline characteristics did not differ significantly between groups (P > .05). After intervention, the observation group showed significantly better medication adherence than the control group (regular medication 88.3% vs 68.3%, correct inhaler use 83.3% vs 63.3%, no missed or reduced doses 86.7% vs 65.0%; all P < .05). The complete asthma control rate was higher (56.7% vs 33.3%; P = .015), while the 6-month frequency of acute attacks (1.2 ± 0.9 vs 2.0 ± 1.1), emergency visits (13.3% vs 30.0%), and readmissions (8.3% vs 25.0%) were lower (all P < .05). The pediatric asthma quality of life questionnaire scores improved more in the observation group across all dimensions (t = 6.32-7.44; P < .001), and family empowerment scale scores for family management, communication, and self-efficacy were also significantly higher (t = 6.02-9.42; P < .001). Nursing satisfaction was greater in the observation group (93.3% vs 75.0%; P = .015). Continuity of care combined with family empowerment significantly enhances medication adherence and asthma control, reduces exacerbations and readmissions, improves children's quality of life, and strengthens parents' management ability and self-efficacy. This integrated model is valuable for the long-term management of childhood asthma.

Medical education's rigorous demands are known to cause significant stress among students. The study investigated how students evaluate stressors and apply coping strategies to handle perceived stress and examined how these processes relate to sociodemographic and lifestyle characteristics. The study was guided by the Transactional Model of Stress and Coping (TMSC), and employed an online cross-sectional survey targeting medical students at a Jordanian university (Yarmouk University). The questionnaire covered mental health, including perceived stress, stressors, and coping mechanisms, and also included measures of sociodemographic and lifestyle factors. Based on the TMSC, stressors were considered external demands evaluated through primary appraisal, whereas secondary appraisal involved assessing available resources and options for coping, which then informed the strategies students employed. Bivariate tests evaluated associations between the measured factors and stress. Exploratory factor analysis identified the underlying factor structure of 31 stressors and 28 coping strategies. Multivariable Partial Proportional Odds Models analyzed factors associated with stress levels. About 2/3 of 618 respondents reported elevated stress. Major stressors identified through primary appraisal included frequent exams, extensive learning content, and insufficient study time. During secondary appraisal, students assessed their available coping resources. Those who effectively recognized and utilized adaptive coping strategies, such as seeking emotional or instrumental support, experienced significantly lower stress (odds ratio = 0.58). Examination-related stressors were the only stressors significantly associated with a higher likelihood of increased stress (odds ratio = 2.01). Multivariable analysis demonstrated that females were significantly less likely than males to experience high stress levels (odds ratio = 0.42). Higher stress levels also correlated with greater insomnia scores (odds ratio = 1.13). Stress was prevalent among medical students at Yarmouk University, mainly driven by academic demands appraised as threatening. Secondary appraisal showed that students who identified and used coping resources, such as social or emotional support and faith-based practices, were more successful in managing stress. These findings highlight the need for structured interventions grounded in the TMSC framework to foster adaptive coping. Support programs that propose evidence-based techniques to cope with stress could positively enhance medical students' educational experiences.

Background: Hemiplegic shoulder pain (HSP) is a common complication after stroke, significantly impairing rehabilitation. While suprascapular nerve block (SSNB) has shown promise in pain management, its long-term efficacy, especially with repeated applications, remains unclear.

Objective: This study aimed to evaluate the effectiveness of ultrasound-guided repeated SSNB in reducing pain, improving range of motion (ROM), and enhancing motor function in patients with HSP.

Methods: This double-blind, randomized controlled trial included 42 patients with HSP, allocated to either the SSNB group or the control group in a 1:1 ratio. The SSNB group received ultrasound-guided injections of levobupivacaine and triamcinolone at baseline, 3 weeks, and 6 weeks, while the control group received sham injections. All participants followed a standardized physiotherapy program. Pain was assessed using the visual analog scale, ROM with a goniometer, spasticity with the Ashworth scale, and motor recovery with the Brunnstrom scale. Assessments were conducted at baseline, 1, 4, and 7 weeks.

Results: Thirty-nine patients completed the study. The SSNB group showed significant reductions in visual analog scale scores at 1, 4, and 7 weeks compared to the control group (P < .05). ROM for abduction and flexion significantly improved in the SSNB group at 7 weeks (P < .05). However, there were no significant differences between groups in Ashworth or Brunnstrom scores at any time point.

Conclusion: Repeated SSNB effectively reduces pain and improves ROM in patients with HSP when combined with physiotherapy. However, it does not significantly impact spasticity or motor function. Further research with longer follow-ups and active comparators is needed to determine its long-term benefits.

The pathophysiological mechanisms implicated in obstructive sleep apnea (OSA) associated with asthma/allergies remain unclear. Apnea-hypopnea index (AHI) alone is insufficient to accurately guide adequate treatment without identifying the specific patient profile. The same recommendations apply for children suffering from sleep-disordered breathing/asthma either OSA. Asthma is considered favoring OSA; however, it is unclear if allergies preexist predisposing patients to OSA. OSA correlates to obesity; however, links between obesity, allergy, and OSA remain unexplored. Obesity is considered a risk factor for OSA. Nevertheless, children with OSA increase their body mass index (BMI) despite adequate sleep apnea treatment and adapted weight interventions. We aimed to study the respiratory polygraphy (PG)/polysomnography (PSG) profile of children with OSA-asthma association and the influence of allergies and asthma treatment (AT)/eviction diet (ED) on the AHI/respiratory effort/BMI to diagnose, treat, and prevent pediatric OSA-asthma and obesity-associated early and accurately. We effectuated a combined STROBE-compliant study with a cross-sectional/case control/diagnostic part and a cohort. We used Statistical Package for the Social Sciences and path analysis (analysis of a moment structure). We evaluated the effects of AT, allergies, and allergen eviction on PG/PSG parameters such as the AHI, the respiratory effort, the BMI, the respiratory distress index, the sleep fragmentation, oxygen desaturation index, and sleep fragmentation ventilatory origin. We identified that AT, ED, and the coexistence of non-IgE-mediated and respiratory allergies influenced the AHI, respiratory effort during sleep, and the BMI. Increased respiratory effort during sleep innately correlates with sleep-disordered breathing/OSA related to allergies, especially the coexistence of respiratory and non-IgE mediated allergies, and is on the origin of the sleep fragmentation of children suffering OSA-asthma/associated, even if AHI remains in low levels; decreases (as AHI) with AT or ED, and if untreated, contributes to AHI increase, thus favoring the persistence of OSA and its comorbidities (hyperactivity, decrease in school performance, behavior/concentration problems) asthma and obesity. Consideration of AT, allergies, and ED upon interpretation of PG/PSG parameters could ameliorate the diagnosis and treatment of OSA-asthma-associated and possibly avoid, upon their origin, asthma, and obesity.