PLoS ONE最新文献

{"title":"Predicting lymph node metastasis in non-small cell lung cancer using clinical and PET/CT-derived morphological features: An interpretable machine-learning study.","authors":"Yunchao Xu, Jiajun Hao, Yujiao Dou, Biao Zeng","doi":"10.1371/journal.pone.0361043","DOIUrl":"10.1371/journal.pone.0361043","url":null,"abstract":"<p><strong>Background: </strong>Accurate prediction of lymph node metastasis (LNM) in non-small cell lung cancer (NSCLC) is crucial for staging and treatment planning. This study aimed to establish a standardized machine learning workflow based on routinely available clinical, serological, and PET/CT-derived parameters to enhance preoperative LNM risk stratification.</p><p><strong>Methods: </strong>This retrospective study included 255 patients with histologically confirmed NSCLC, all of whom underwent systematic lymph-node dissection. Patients were randomly divided, with stratification by pathological lymph-node status, into a training cohort (n = 178) and an internal held-out test test cohort (n = 77). Candidate predictors were screened using univariable and multivariable logistic regression in the training cohort. Six machine-learning algorithms were trained and optimized using repeated nested five-fold cross-validation. After model development was completed, all six models were applied without modification to the test cohort. Test-set AUCs were compared using paired DeLong tests with Holm correction. The primary model was further evaluated for calibration, clinical utility, and feature contribution using SHAP. A conventional multivariable logistic regression model using the same four predictors was added as a simple reference model, and its discrimination and calibration were compared with those of XGBoost.</p><p><strong>Results: </strong>Central tumor location, elevated carcinoembryonic antigen, elevated squamous cell carcinoma antigen, and solid nodule status were retained as predictors; none of the quantitative PET metabolic parameters remained independently associated with LNM. XGBoost achieved the highest cross-validated AUC among the six candidate machine-learning algorithms in the training cohort (0.735; 95% CI, 0.653-0.813) and was therefore designated the primary model. In the internal held-out test cohort, XGBoost achieved an AUC of 0.747 (95% CI, 0.631-0.846). The conventional logistic regression reference model achieved a test AUC of 0.733 (95% CI, 0.612-0.841), with no significant difference from XGBoost (DeLong P = 0.301). Its Brier score was 0.152, compared with 0.198 for XGBoost.</p><p><strong>Conclusion: </strong>XGBoost model showed moderate discrimination and a high negative predictive value for pathological LNM in NSCLC. However, its limited positive predictive value and the absence of significant differences among the candidate algorithms support cautious interpretation. External multicenter evaluation is required before clinical implementation.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0361043"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of angiogenic biomarkers in determining preeclampsia-related perinatal deaths: A cross-sectional study in a high burden setting of southern Mozambique.","authors":"Maureen N Chileshe, Natalia Rakislova, Carla Carrilho, Fabiola Fernandes, Tacilta Nhampossa, Alba Morató, Lorena Marimon, Núria Peñuelas, Anete Mendes, Elvira Luis, Jahit Sacarlal, Isaac Casas, Jessica Navero-Castillejos, Antía Figueroa-Romero, Manuel Morales-Ruiz, Juan Carlos Hurtado, Miguel J Martinez, Jaume Ordi, Clara Menendez, Raquel González","doi":"10.1371/journal.pone.0339830","DOIUrl":"10.1371/journal.pone.0339830","url":null,"abstract":"<p><p>Estimating the contribution of preeclampsia (PE) to perinatal mortality in low-resource settings remains difficult due to limited diagnostic capacity. Lack of specific histopathologic changes in stillbirth, foetuses and/or placenta often hampers assignment of PE as cause of death. While PE angiogenic biomarkers (sFlt-1, PlGF) predict adverse pregnancy outcomes, their post-mortem diagnostic utility is unclear. We evaluated the potential role of these biomarkers in identifying PE-related perinatal deaths. This cross-sectional study was conducted among pregnant women who delivered a stillborn infant or experienced an early neonatal death at Maputo Central Hospital in Mozambique. Concentrations of sFlt-1, PlGF and their ratio (sFlt-1/PlGF) were assessed in maternal blood and post-mortem foetal/neonatal and placental blood. Causes of death were determined via minimally invasive tissue sampling (MITS) and diagnostic accuracy was assessed using ROC curves for standardized and optimal biomarker cut-offs. A total of 100 women with perinatal deaths (98 stillbirths and 2 early neonatal deaths) were included in the study between March 2021 and April 2022. Maternal sFlt-1/PlGF ratios showed the highest diagnostic accuracy for PE-related deaths (area under curve [AUC]=82%), followed by placental (AUC = 75%) and foetal blood (AUC = 61%). PlGF levels were significantly reduced in PE-associated deaths. sFlt-1/PlGF cutoffs of ≥85 and ≥110 in maternal and placental blood were reliable cut-offs for identifying PE-related foetal/neonatal deaths. Optimal ratio cut-offs were ≥50 (maternal blood), ≥ 230 (placental blood), and ≥140 (foetal blood), with maternal and placental sFlt-1/PlGF ratios showing significant associations with PE-related death (OR=10.58 and 5.98 respectively). Sensitivity and specificity in maternal and placental blood were 84% and 73%, and 67% and 78%, respectively, with a positive predictive value (PPV) of 84% in both. In conclusion, maternal and placental angiogenic biomarkers enable reliable identification of preeclampsia-related perinatal deaths and could significantly enhance cause-of-death determination in low-resource, high-burden settings. These findings underscore the potential value of biomarker measurement for both risk stratification and mortality surveillance.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0339830"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom clusters and help-seeking behaviours during neutropenia after autologous haematopoietic stem cell transplantation: A qualitative study to inform oncology nursing support.","authors":"Lili Jiang, Junxue Hua, Fang Teng, Ting Xu, Hongyun Cao, Jingfen Zhou","doi":"10.1371/journal.pone.0361023","DOIUrl":"10.1371/journal.pone.0361023","url":null,"abstract":"<p><strong>Purpose: </strong>To explore how adult autologous haematopoietic stem cell transplantation recipients experience and appraise symptom constellations during neutropenia, and how these appraisals shape help-seeking and interactions with clinicians.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted in an inpatient haematopoietic stem cell transplantation unit in Wuxi, China. Adults aged 18 years or older who had undergone autologous transplantation and were neutropenic were purposively sampled to maximise variation. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Twenty-two participants were interviewed between post-transplant day + 5 and +18. Participants described symptoms as interlocking constellations rather than isolated events. They differentiated expected treatment-related toxicities from possible deterioration by attending to symptom trajectories, including worsening intensity, new symptom combinations, or symptoms that felt different from the previous day. Fever-related patterns usually prompted immediate escalation. Help-seeking ranged from prompt reporting to watchful waiting, self-management followed by reporting, or withholding. These responses were shaped by uncertainty, perceived legitimacy of concerns, and reluctance to bother staff during protective isolation.</p><p><strong>Conclusions: </strong>Symptom constellations and symptom trajectories shaped urgency appraisal and help-seeking during inpatient neutropenia after autologous haematopoietic stem cell transplantation. Cluster-informed assessment and escalation coaching may support timelier reporting and safer supportive care in protective isolation.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0361023"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of structured sexual health training incorporating standardised patients on health professions students' sexual health communication competence: A single-blind randomised controlled trial in Tanzania.","authors":"Gift G Lukumay, Deodatus Kakoko, B R Simon Rosser, Michael W Ross","doi":"10.1371/journal.pone.0360630","DOIUrl":"10.1371/journal.pone.0360630","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the effect of a structured sexual health training programme incorporating standardised patients (SPs) on health professions students' sexual health communication competence, as assessed by SPs, in a Tanzanian setting.</p><p><strong>Design: </strong>Single-blind randomised controlled trial with parallel-group allocation.</p><p><strong>Setting: </strong>Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.</p><p><strong>Participants: </strong>A total of 312 undergraduate medical and nursing students were enrolled at the university.</p><p><strong>Intervention: </strong>Structured sexual health training incorporating didactic teaching, small-group discussions, role-play, and SP-based practice sessions.</p><p><strong>Outcome measures: </strong>Sexual health communication competence was assessed using SP-rated checklists at baseline and at six-month follow-up.</p><p><strong>Results: </strong>Of 310 health profession students, 73.5% were in their final year. The mean age was 24.29 years (SD = 2.51). 22.6% were female, and 60.0% reported prior sexual health training. Baseline competence scores were similar across groups. At the six-month follow-up, competence improved in both groups, with greater gains in the treatment group. Mixed ANOVA showed a significant time effect (p < .001) and a time-by-group interaction (p = .002). Exploratory item-level analyses indicated higher scores in the treatment group across most sexual health communication competencies, particularly in rapport, empathy, and information-gathering, with no significant difference observed for clear and understandable language.</p><p><strong>Conclusion: </strong>Structured SP-based sexual health training incorporating SPs significantly improved sexual health communication competence during simulated consultations, particularly in patient-engagement domains. These findings support incorporating culturally adapted sexual health training into healthcare education and using SP assessments to evaluate communication competence in sensitive clinical contexts.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT06428058. Registered 30 November 2023.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360630"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why can't they \"Go back\"? - A multi-group comparative analysis of pre-service teachers' hometown return intention in local universities based on latent profile analysis.","authors":"Chen Qing, Yu Zhang, Zhichao Wang, Haiying Yu","doi":"10.1371/journal.pone.0360231","DOIUrl":"10.1371/journal.pone.0360231","url":null,"abstract":"<p><p>The high-quality development of rural education urgently requires strengthening the supply of outstanding rural teachers. Based on Social Cognitive Career Theory (SCCT), a survey of 6,546 teacher education students from local universities in Heilongjiang Province revealed that the willingness to teach in rural areas among three identified profiles-the Weak Foundation Profile, the Development-Oriented Profile, and the Excellence-Prepared Profile-is significantly influenced by academic year and family capital. This influence manifests differentiated patterns via the \"environment-person-behaviour\" transmission pathway: family support acts as a common motivating factor for rural teaching willingness across all three groups; for foundation-weak students, professional competence primarily exerts a mediating effect through the family support pathway; for development-oriented students, professional competence shows no significant mediating effect in this pathway; and for excellence-oriented students, the willingness to return to their hometowns for rural teaching is jointly driven by the dynamic interplay between environmental factors and individual professional competence. Therefore, a differentiated approach is imperative: policy orientation should strengthen the enabling role of family support, optimise the pathways for localised training and incentives for rural teachers, and establish a growth system for rural education leaders. These measures will further refine the long-term mechanisms for attracting and retaining talent in rural teaching positions.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360231"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Marking-based load balancing Weighted Clustering Framework for Mobile ADHOC Network.","authors":"Prashant Dixit, Sonia Setia, Ramesh Chandra Sahoo, Manish Sharma, Sameena Pathan","doi":"10.1371/journal.pone.0360099","DOIUrl":"10.1371/journal.pone.0360099","url":null,"abstract":"<p><p>In a mobile ad-hoc network, it has been observed that the existing weighted clustering algorithm induces high computational overhead on the mobile nodes in the cluster-head election process and distributes the load among the cluster-heads unfairly. Also, the cluster maintenance cost is very high due to the expiration or movement of the cluster-head. The purpose of this work is to mitigate the weaknesses of the existing weight-based clustering algorithm. The proposed \"Marking-based Load Balancing Weighted Clustering Framework for Mobile ADHOC Network (MLWCM)\" marks the weak nodes before the beginning of the election process and spares them from massive weight calculation, thus saving the scarce resources of the network. The concept of inmate affiliation reduces the maintenance cost considerably. To ensure fair load distribution among the cluster-heads, a handling factor has been computed, which is the number of nodes that a cluster-head can handle based on its available battery power. Also, to minimize the maintenance cost, a new event called inmate affiliation has been introduced. The simulation outcome reveals that the proposed framework outperforms the existing weighted clustering algorithm. MLWCM produces healthier and more stable cluster-heads. The number of members is fairly assigned to cluster-heads. Inmate affiliation allows a displaced node to get attached to an available nearby cluster silently, without inducing clustering in the complete network, which results in lower maintenance costs. Obtained results: By the simulation, it has been revealed that the MLWCM yields healthy cluster-heads in terms of battery power at a low computational cost, hence prolonging the life of the network and enabling efficient routing in the mobile ad-hoc network. For the proposed framework, MLWCM, the average battery life of the cluster-head is 73.8%, whereas for the existing WCA, the average battery life is 41.8%; hence, MLWCM enhances the stability of the network.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360099"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy awareness among community-dwelling older adults: The roles of cognitive status and digital access.","authors":"Eun Kyung Jung, Hee Young Kim","doi":"10.1371/journal.pone.0357745","DOIUrl":"10.1371/journal.pone.0357745","url":null,"abstract":"<p><p>Policy awareness is a key prerequisite for the effective use of government programs among older adults. In increasingly digitalized information environments, access to policy information may depend not only on digital resources but also on cognitive capacity. However, limited evidence exists regarding whether the relationships between informational resources and policy awareness differ according to cognitive function. This study conducted a secondary analysis using data from the 2023 National Survey of Older Koreans, a nationally representative survey based on stratified multistage cluster sampling. The analytic sample included 9,951 community-dwelling adults aged 65 years or older. Policy awareness was measured using 11 items assessing awareness of government programs for older adults (range 0-22). Cognitive status was categorized using K-MMSE-2 scores into normal cognition, mild cognitive impairment, and moderate-to-severe cognitive impairment. Complex samples general linear models were applied to examine factors associated with policy awareness and to test interaction effects between cognitive status and key predictors. The weighted mean policy awareness score was 8.34 (SE = 0.13). Policy awareness differed significantly across cognitive groups, with the lowest scores observed among those with moderate-to-severe cognitive impairment and the highest among those with normal cognition. The overall model was statistically significant (Wald F = 14.59, p < 0.001) and the model explained 12.9% of the variance in policy awareness (R2 = 0.129). Significant interaction effects were observed between cognitive status and digital access (p < 0.001) and between cognitive status and depression (p = 0.003). The association between digital access and policy awareness appeared stronger among older adults with mild cognitive impairment compared with those with normal cognition. These findings suggest that cognitive status moderates the relationship between digital access and policy awareness. Improving digital access may be associated with higher levels of policy awareness among cognitively vulnerable older adults.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0357745"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognition and function analysis of MKK6 in immune reaction against Vibrio Parahaemolyticus in Crassostrea hongkongensis.","authors":"Jiexiong Zhu, Guohui Shao, Jiayu Chen, Jinji Lin, Qiwen Liang, Feifei Yu, Zhiwen Wang, Baixu Lin, Yongyao Huang, Huiyan Li, Junhui Xu","doi":"10.1371/journal.pone.0360613","DOIUrl":"10.1371/journal.pone.0360613","url":null,"abstract":"<p><p>MKK6 is a key protein kinase that regulates inflammatory response under pathogen infection by activating MAPK signal pathway. However, the function of MKK6 remained unclear within oysters. Our research recognized a novel KK6 gene from C. hongkongensis, which is named ChMKK6. The cDNA of ChMKK6 gene was 2,760 bp in length, containing an ORF of 1,032 bp encoding 344 amino acids, with a conserved S-TKc region and a DVD region. As illustrated by amino acid alignment and phylogenetic tree, ChMKK6 shared the maximal (99.0%) identity showing MKK6 of Crassostrea gigas. As indicated by tissue expression analysis, ChMKK6 possessed the maximal expression within hepatopancreas, and was markedly increased in all tissues following Vibrio Parahaemolyticus (V. Parahaemolyticus) challenge. As stated by the qRT-PCR analysis, ChMKK6 silencing significantly suppressed IL17 transcription, suggesting its involvement in innate immunity by regulating IL17-mediated inflammatory response. Moreover, ChMKK6 silencing led to the suppression of key immune-related enzyme activities (ACP, AKP, CAT, LZM, and SOD), while raising the MDA content in gill. In addition, the antimicrobial viability of hemolymph supernatant was markedly reduced by ChMKK6 silencing. These results collectively demonstrate that ChMKK6 is a key player in immunity defense of C. hongkongensis from V. Parahaemolyticus.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360613"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary microvascular dysfunction in patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis.","authors":"Maethas Panyawongkhanti, Peerawat Chintrakulchai, Chonthicha Tanking, Wongsakorn Luangphiphat","doi":"10.1371/journal.pone.0360374","DOIUrl":"10.1371/journal.pone.0360374","url":null,"abstract":"<p><strong>Background: </strong>Coronary microvascular dysfunction (CMD) is a complication of severe aortic stenosis. Its prevalence after transcatheter aortic valve implantation (TAVI) and prognostic significance are understudied, as are the post-TAVI trajectories of microvascular indices.</p><p><strong>Aims: </strong>The aims of this study were to determine the pooled prevalence of CMD, the influence of the diagnostic modality, the post-TAVI coronary flow reserve (CFR) and microvascular resistance changes, and the prognostic impact of baseline CMD on major adverse cardiovascular events (MACE) in patients with severe aortic stenosis undergoing TAVI.</p><p><strong>Methods: </strong>Five databases were searched from January 2010 to December 2025 for studies involving adults with severe aortic stenosis undergoing TAVI in which CMD was assessed by wire-based thermodilution, angiography-derived indices, Doppler measurements, or stress cardiac magnetic resonance. The risk of bias and certainty of evidence were assessed using the Newcastle-Ottawa Scale and GRADE, respectively. Random-effects meta-analyses (DerSimonian-Laird) pooled CMD prevalence (stratified by modality), CFR change (mean difference; before-after design), and prognostic hazard ratios (HRs). Change in microvascular resistance was synthesized narratively. The protocol was prospectively registered (PROSPERO: CRD42025143775) and reported per the PRISMA 2020 guidance.</p><p><strong>Results: </strong>Eleven primary studies were analyzed, 10 of which (n = 1,212) contributed to the prevalence analyses. An additional study (n = 126) was included in the sensitivity analyses only. CMD prevalence was 46.8% (95% confidence interval [CI] [34.0, 59.9]; I2 = 72%) and 38.4% (95% CI [35.3, 41.7]; I2 = 0%) when assessed using wire-based thermodilution (k = 6, n = 324) and angiographic (k = 4, n = 888) indices, respectively. CFR increased post-TAVI by a pooled mean difference of +0.49 (95% CI [+0.27, + 0.71]; I2 = 72%; k = 5, n = 103 paired observations). Reductions in microvascular resistance were confined to pressure-to-velocity and reserve ratio indices, and absolute minimal microvascular resistance was unchanged (k = 4, n = 85). The HR for MACE was 3.22 (95% CI [0.98, 10.60]; I2 = 78%; k = 2, n = 585). Substantial heterogeneity reflected non-equivalent CMD definitions.</p><p><strong>Conclusion: </strong>The prevalence of CMD pre-TAVI is influenced by the diagnostic method. CFR tends to improve after TAVI, likely due to reduced resting demand rather than structural repair. The CMD-MACE association should be viewed as hypothesis-generating due to limited studies, varied CMD definitions, and incompatible HR calculations. Prospective multicenter studies with standardized CMD definitions are required.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360374"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ancient Greek votive epigraphy: Ancient religion between individual choice and cultural trends.","authors":"Moshe Blidstein","doi":"10.1371/journal.pone.0361143","DOIUrl":"10.1371/journal.pone.0361143","url":null,"abstract":"<p><p>Ancient votive inscriptions, numbering in the tens of thousands across the Mediterranean, offer direct evidence for religious practice but have rarely been studied comprehensively across time and space due to their sheer volume. This paper presents a \"distant reading\" analysis of approximately 11,000 Greek dedicatory inscriptions (sixth century BCE - seventh century CE) drawn primarily from the GIST/I.PHI digital corpus. By tagging inscriptions for key features (votive/dedicatory terminology, deities, motives, gender) and analyzing their distribution chronologically and geographically while controlling for the \"epigraphic habit,\" this study identifies large-scale trends. The results reveal a significant relative increase in the use of explicit votive terminology (forms of euche/euchomai) over time, particularly during the Roman Imperial period and Late Antiquity. This practice exhibits strong regional variation, being markedly more prevalent in Asia Minor and the East than in mainland Greece before the fourth century CE. Furthermore, the use of votive formulae correlates strongly with specific deities (e.g., Men, Meter, Hypsistos, Hosios kai Dikaios) and negatively with others (e.g., emperors, Athena). Votive terminology also appears negatively correlated with the explicit mention of other motives (like dreams or commands) and with the use of standard consecration terms. While demonstrating the potential of computational methods for identifying broad patterns of continuity and change in religious expression, the study also highlights methodological challenges (dating uncertainty, data tagging) and underscores the persistent difficulty in definitively separating shifts in epigraphic conventions from changes in underlying religious mentalities.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0361143"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}