RNA 5-methylcytosine (m⁵C), a prevalent epitranscriptomic modification that critically regulates gene expression and cellular homeostasis. While its roles in solid tumors have been increasingly recognized, the functional landscape of m⁵C in acute myeloid leukemia (AML) remains unexplored. Here, we identified NSUN2, the principal RNA m⁵C methyltransferase, as a key regulator of AML progression. NSUN2 was aberrantly upregulated in AML patient samples and correlated with poor prognosis. Functional studies demonstrated that NSUN2 promoted leukemic cell proliferation, enhanced tumor growth in xenograft models, and conferred resistance to ferroptosis-a regulated cell death process driven by lipid peroxidation. Mechanistically, NSUN2 catalyzed m⁵C deposition on the 3'UTR of FSP1 (ferroptosis suppressor protein 1) mRNA, facilitating its recognition and stabilization by the m⁵C reader protein YBX1. This NSUN2-YBX1-FSP1 axis protected AML cells from ferroptotic stress by suppressing lipid peroxidation and oxidative damage. Depletion of NSUN2 or FSP1 induced mitochondrial remodeling, which primed cells for ferroptosis. Reconstitution of wild-type NSUN2 or FSP1 rescued ferroptosis resistance, whereas catalytically inactive NSUN2 (C271A/C321A) or non-functional FSP1 mutants (G2A/E156A) failed to reverse this phenotype. Pharmacological inhibition of NSUN2 with MY-1B or targeting FSP1 with iFSP1 exhibited potent anti-leukemic effects, synergizing robustly with ferroptosis inducers, standard chemotherapy, and the BCL-2 inhibitor venetoclax. Our study unveils NSUN2 and FSP1 as prognostic biomarkers and therapeutic targets in AML. We highlight a novel epitranscriptomic mechanism linking RNA methylation to ferroptosis evasion, providing a dual-strategy approach to overcome AML treatment resistance.

Gratitude journaling is a simple and effective way to improve emotional well-being. However, its impact on people with breast cancer in South Korea has not been clearly understood. This study explored how writing a gratitude journal can help patients with breast cancer feel more grateful, resilient, and satisfied with life. Sixty patients from a university hospital in Jeollanam-do were randomly assigned to either a gratitude journaling group or a control group. The journaling group received guidance and wrote at least ten journal entries over three weeks, with weekly phone check-ins. The control group received no intervention. Before and after the program, the participants completed surveys. The results showed that those who kept gratitude journals had higher levels of gratitude, resilience, and quality of life than those who did not. These findings suggest that gratitude journaling can be a valuable and easy-to-use nursing strategy to support the emotional health of breast cancer patients.

Mobile health (mHealth) technology has the ability to integrate personalized health management into patients' daily routines. In prior investigations of mHealth apps for asthma, patient satisfaction and acceptability have been high. However, rigorous randomized controlled trials (RCTs) examining their effectiveness are sparse; the majority of mHealth asthma apps lack personalization and real-time feedback and fail to include at-risk pediatric populations, and many previous studies are not randomized.

This full-scale RCT will examine the effectiveness of the Pulmonary Education and Asthma Knowledge Mobile Asthma Action Plan (PEAKmAAP), an interactive mHealth asthma action plan (mAAP) smartphone app, among adolescents compared to enhanced usual care (eUC). The study has 3 aims: (1) examine the effectiveness of PEAKmAAP in reducing asthma morbidity, as measured by the Asthma Control Test (ACT) score, health care use, medication use, and lung function; (2) examine the effectiveness of PEAKmAAP in asthma self-efficacy and medication adherence; and (3) examine the impact of sharing PEAKmAAP-generated data with the primary care provider (PCP) for a subset of enrolled subjects. We hypothesize that the PEAKmAAP groups will experience reduced asthma morbidity compared to the eUC group. Furthermore, we hypothesize that PCP data sharing is expected to enhance PCP prescribing patterns and that more adolescents in the Pulmonary Education and Asthma Knowledge Mobile Asthma Action Plan with data sharing (PEAKmAAP-DS) group will have sustained controlled at follow-up visits compared to PEAKmAAP alone or eUC.

Using a 3-arm RCT lasting 12 months, we will assess the effectiveness of PEAKmAAP in reducing morbidity among 432 adolescents (age 12-20 years). The study population includes adolescents with uncontrolled symptoms who receive primary care at the Arkansas Children's Hospital (ACH) or asthma care at ACH specialty clinics. At baseline, participants are randomly assigned to 1 of 3 groups: (1) PEAKmAAP group, (2) PEAKmAAP-DS group, and (3) eUC group using a smartphone app with daily non-asthma-related notifications. Study procedures will include baseline, 3-month, and 12-month in-person visits and telephone visits at 6 and 9 months. In-person visits will measure the ACT score, lung function, and self-efficacy; telephone visits will measure the ACT score. Participants will complete monthly online surveys to assess health care use and medication use.

Recruitment and data collection began in March 2019, and data collection concluded in May 2024. Full data analysis began in December 2024.

This RCT aims to examine the effectiveness of a mAAP with real-time feedback and PCP data sharing. The study addresses existing gaps in knowledge regarding implementation of a mAAP for high-risk adolescents and has the potential to serve as a model for other populations at high risk for asthma.

ClinicalTrials.gov NCT03842033; https://clinicaltrials.gov/study/NCT03842033.

DERR1-10.2196/69903.

Interhospital transfer (IHT) for pulmonary embolism (PE) is increasingly performed to improve access to advanced reperfusion therapies, but it is unclear if IHT times influence overall outcomes. We studied the association between transfer times and outcomes of patients with acute PE requiring IHT.

139 patients with acute PE undergoing IHT to the Mount Sinai Health System between September 2021 and June 2023 were retrospectively studied. Primary outcomes were 30-day mortality and 30-day major bleeding. 'Door to IHT' time was defined as the time from diagnosis of acute PE to the time patient physically arrived in the receiving hospital. Patients were divided into groups based on quartiles of 'door to IHT' time; those within the first and fourth quartiles of 'door to IHT' time were compared using propensity score-weighted analyses. The propensity score was calculated from six variables: age, sex, BMI [Body Mass Index], PESI [PE Severity Index] score, ESC [European Society of Cardiology] risk class and presence of a central PE. Multivariable regression models were fitted within the propensity score-matched sample to assess the association of 'door to IHT' time with primary outcomes.

Median age of included patients was 61 years and 76 (54.7%) were women. Median PESI score was 88 points. Median 'door to IHT' time was 10.8 (IQR: 7.3-19.4) hours. Rates of 30-day mortality and 30-day major bleeding were 7.2% and 2.2%. Within propensity score-weighted analyses, no significant associations were found between 'door to IHT' time and any of the primary outcomes (30-day mortality or 30-day major bleeding).

In this retrospective study of patients with acute PE undergoing IHT, differences in 'door to IHT' time were not significantly associated with 30-day mortality or 30-day major bleeding. This suggests that delays in IHT do not adversely influence outcomes of patients with acute PE undergoing IHT.

Although some studies have explored changes in PT-IgG levels following vaccination or Bordetella pertussis infection, the relationship between PT-IgG levels and clinical characteristics in patients with acute-phase pertussis remains unclear. We retrospectively analyzed clinical data from 333 infants aged 3-12 months hospitalized with acute pertussis at the Children's Hospital of Chongqing Medical University between April 1, 2018, and July 31, 2019. Patients were stratified into vaccinated and unvaccinated groups based on their immunization records. We evaluated differences in clinical manifestations, complications, laboratory findings, and dynamics of PT-IgG antibody. The median age of disease onset was 137.5 days for unvaccinated patients and 163 days for vaccinated patients. PT-IgG levels were significantly higher in the vaccinated group (19.25 [1.58, 59.18] IU/mL) compared to the unvaccinated group (2.43 [0.05, 24.01] IU/mL; P < 0.001). Unvaccinated patients exhibited higher incidences of peak white blood cell (WBC) counts in the range of 20-30 × 10⁹/L, 30-50 × 10⁹/L, and > 50 × 10⁹/L (P = 0.031). Vaccinated patients demonstrated a rapid elevation of PT-IgG, peaking at week 5 post-infection (52.08 IU/mL), while unvaccinated patients showed delayed antibody production, with levels rising significantly only by week 6 (26.99 IU/mL). Although clinical symptoms and complications did not differ significantly between the groups, unvaccinated patients had higher rates of severe indicators.

Vaccination against pertussis accelerates PT-IgG production in infants aged 3-12 months. Unvaccinated patients experience delayed antibody responses, lower PT-IgG levels, and increased risks of severe complications. These findings emphasize the critical role of vaccination in mitigating pertussis-related morbidity.

Two-thirds of outpatients were non-adherent to anti-infectives in acute infectious diseases.

• Pertussis vaccination influences PT-IgG levels following Bordetella pertussis infection and affects disease severity.

• To our knowledge, this study represents the first large-scale analysis of the impact of pertussis vaccination on antibody kinetic changes during the initial 6 weeks post-Bordetella pertussis infection. • Unvaccinated patients exhibited delayed antibody production and lower peak antibody titers, resulting in a higher probability of severe clinical manifestations. Particular clinical attention should be given to pertussis-unvaccinated patients.

The COVID-19 pandemic and recent viral outbreaks have highlighted the need for viral diagnostics that balance accuracy with accessibility. While traditional laboratory methods remain essential, point-of-care solutions are critical for decentralized testing at the population level. However, a gap persists between academic proof-of-concept studies and clinically viable tools, with novel technologies remaining inaccessible to clinics due to cost, complexity, training, and logistical constraints. Recent advances in surface functionalization, assay simplification, multiplexing, and performance in complex media have improved the feasibility of both optical and non-optical sensing techniques. These innovations, coupled with scalable manufacturing methods such as 3D printing and streamlined hardware production, pave the way for practical deployment in real-world settings. Additionally, software-assisted data interpretation, through simplified readouts, smartphone integration, and machine learning, enables the broader use of diagnostics once limited to experts. This review explores improvements in viral diagnostic approaches, including colorimetric, optical, and electrochemical assays, showcasing their potential for democratization efforts targeting the clinic. We also examine trends such as open-source hardware, modular assay design, and standardized reporting, which collectively reduce barriers to clinical adoption and the public dissemination of information. By analyzing these interdisciplinary advances, we demonstrate how emerging technologies can mature into accessible, low-cost diagnostic tools for widespread testing.

To analyze primary care nurses' experiences of integrating and using digital health in their daily practice.

The integration of digital health in primary care, accelerated by the COVID-19 pandemic, has transformed nursing practices with a view to provide better support and services to patients.

The World Health Organization defines "digital health" as the use of electronic technologies to improve health. Its 2020-2025 strategy seeks to integrate these technologies into health systems to facilitate communication between professionals, patients, and authorities. Tools such as telehealth, electronic records, artificial intelligence, and big data are transforming the role of nurses, who must become familiar with them for their performance.

Qualitative studies on digital health in primary care nursing were reviewed following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines and using the Joanna Briggs Institute for Qualitative Research (JBI-QARI) criteria.

Eleven articles were analyzed using thematic coding according to Thomas and Harden's approach, identifying three main themes: adaptation to digital health, nurses' perspective on digital health, and nurse-patient digital interaction.

The integration of digital health has required nurses to adapt quickly. They have expressed both benefits and challenges, highlighting the importance of adequate training, personalization in the use of digital tools, information security, and optimization of technological infrastructure.

It is essential to assess the current competencies of nurses in digital health in order to meet their needs. Health systems should incorporate new technologies into clinical practice guidelines and health programs to improve and update the continuity and quality of care in primary care. Health policies should support the continuing education of nurses and the effective integration of technology.

In 2021, 23.9% of Korean workers were self-employed, with the majority working in small enterprises. As the unemployment rate increased after the COVID-19 outbreak, the number of small enterprises increased annually. Although interest in the health of small enterprises is increasing, insufficient research has been conducted. This study compared the well-being levels of self-employed and salaried workers in small enterprises and identified the factors affecting them.

Data were obtained from the 6th Korean Working Conditions Survey (KWCS). Adults aged ≥40 years with Korean nationality working in small enterprises (less than 50 employees) in the service/sales private sector were included. Of the 50538 respondents, 2511 (942 male, 1569 female) were included. The general characteristics of the participants were identified. The well-being levels were analyzed using subjective health items and the WHO-5 well-being index, included in the 6th KWCS. Statistical analysis was performed using logistic regression analysis.

People without chronic illnesses and salaried workers reported higher levels of well-being. Additionally, people who were younger, more educated, and had higher monthly incomes reported higher levels of well-being. Salaried workers showed higher levels of well-being compared to self-employed workers when stratified by the number of employees, working hours per week, and chronic illness.

Self-employed workers had significantly lower levels of well-being compared to salaried workers in small enterprises. Therefore, future health policies should include measures to improve the well-being or mental health of self-employed workers. Given past trends, involuntary self-employment tends to rise during recessions, making policy interventions crucial during such periods.

BACKGROUNDAligned with World Health Organization (WHO) goals, Ukraine aims to eliminate viral hepatitis. While some data on viral hepatitis B and C prevalence exist among key populations, nationwide prevalence in the general population has never been assessed.AIMTo assess the prevalence of viral hepatitis B, C, and D seromarkers in Ukraine in 2021 to plan and monitor elimination measures.METHODSBlood samples available from a cross-sectional household-based SARS-CoV-2 serosurvey conducted in 2021 were tested for hepatitis C virus (HCV) antibodies, total antibodies against hepatitis B virus (HBV) core antigen (HBc), hepatitis B surface antigen (HBsAg) and hepatitis D virus (HDV) antibodies. We calculated crude and weighted proportions for anti-HCV, anti-HBc and HBsAg positivity. To account for differences in sex, age group and urbanisation level, we applied post-stratification weights using inverse probability weighting based on the distribution of the Ukrainian population. We calculated proportions positive for anti-HDV among HBsAg-positive cases and weighted regional estimates for HBV and HCV seromarkers.RESULTSWeighted prevalence of anti-HCV was 3.3% (95% CI: 2.8-4.0), anti-HBc 11.6% (95% CI: 10.8-12.5) and HBsAg 0.9% (95% CI: 0.7-1.2). Among HBsAg-positive individuals, 7.5% (95% СI: 3.0-17.9) were anti-HDV positive. We found higher prevalence of HBV and HCV seromarkers among men and in southern Ukraine.CONCLUSIONHBsAg prevalence and considerably high anti-HBc and anti-HCV prevalence indicate substantial lifetime exposure. This reinforces the necessity of sustained prevention such as HBV vaccination of newborns and groups at increased risk, regular hepatitis B and C screening, early treatment, and raising awareness to reduce ongoing transmission.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, with limited early detection strategies. While previous studies have examined the relationship between per- and polyfluoroalkyl substances (PFAS) and COPD, limited research has applied interpretable machine learning (ML) techniques to this association.

We investigated the association between PFAS exposure and COPD risk in 4,450 National Health and Nutrition Examination Survey (NHANES) participants from 2013 to 2018. After excluding missing covariates and extreme PFAS values and applying K-nearest neighbors (KNN) imputation, nine ML models, including CatBoost, were built and evaluated using metrics like accuracy, area under the curve (AUC), sensitivity, and specificity. The best-performing model was further analyzed using partial dependence plots (PDP) and SHapley additive exPlanations (SHAP) analysis. To enhance clinical applicability, the final model was deployed as a publicly accessible web-based risk calculator.

CatBoost emerged as the best model, achieving an accuracy of 84%, AUC of 0.89, sensitivity of 81%, and specificity of 84%. PDP revealed that higher perfluorooctane sulfonic acid (PFOS) and perfluoroundecanoic acid (PFUA) levels were associated with reduced COPD risk, whereas perfluorooctanoic acid (PFOA) and 2-(N-Methyl-perfluorooctane sulfonamido) acetic acid (MPAH) showed positive associations with COPD. perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDE), and perfluorohexane sulfonic acid (PFHxS) demonstrated mixed or non-linear effects. SHAP analysis provided insights into individual predictions and overall variable contributions, clarifying the complex PFAS-COPD relationship. The deployed web-based calculator enables interactive prediction and risk interpretation, supporting potential public health applications.

CatBoost identified PFOS and PFUA as protective factors against COPD, while PFOA and MPAH increased risk of COPD. These findings emphasize the need for stricter PFAS regulation and highlight the potential of machine learning in guiding prevention strategies.