Effectiveness of respiratory muscle training on pulmonary function recovery in patients with spinal cord injury: a systematic review and meta-analysis
Objective This study conducted a thorough review and meta-analysis to examine how respiratory muscle training (RMT) affects lung function recovery in individuals with spinal cord injury (SCI). Methods We conducted a systematic review of Randomized Controlled Trials (RCTs) examining the effects of RMT on lung function in patients with SCI. The search included databases such as PubMed, Embase, The Cochrane Library, Scopus, and Web of Science up to October 2025. The experimental group received RMT as the main intervention, while the control group received either no treatment, a placebo, or conventional rehabilitation. Outcome measures included Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC), Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure (MEP), Peak Expiratory Flow (PEF), Minute Ventilation Volume (MVV), Total Lung Capacity (TLC), Inspiratory Capacity (IC), and Vital Capacity (VC). Two reviewers independently screened, extracted data, and assessed bias. Meta-analysis was conducted using RevMan 5.3 software, and the quality of included studies was evaluated using the Cochrane bias risk assessment tool and the Physical Therapy Evidence Database scale. The reporting of this study followed the PRISMA guidelines and was registered with PROSPERO (ID: CRD42024627736). Results In this meta-analysis, 25 RCTs were included, comprising a total of 679 patients. The meta-analysis showed that compared with conventional rehabilitation, respiratory muscle training significantly improved FEV1 (p < 0.0001), FVC (p = 0.0001), MIP (p < 0.00001), MEP (p = 0.0004), PEF (p < 0.00001), MVV (p < 0.0001), TLC (p = 0.05), VC (p = 0.04), and their differences were statistically significant. However, IC (p = 0.40) was not statistically significant. Subgroup analyses showed that resistive training and surface electromyography biofeedback training were effective for improving FEV1 and FVC, while threshold training significantly improved MVV. Conclusion This meta-analysis provides strong evidence that RMT is an effective intervention for enhancing respiratory muscle strength and key parameters of pulmonary function in individuals with SCI. Further research with robust methodologies and extensive sample sizes is needed to validate this finding.
Yao et al. (2025) Effectiveness of respiratory muscle training on pulmonary function recovery in patients with spinal cord injury: a systematic review and meta-analysis. PeerJ 13:e20373 https://doi.org/10.7717/peerj.20373
Genomics, population dynamics, immune evasion and resistance determinants foster the competence and global dissemination of Klebsiella pneumoniae
Background According to the World Health Organization (WHO), Klebsiella pneumoniae is a critical public health concern and an established ESKAPE (E. faecium, S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, and Enterobacter spp.) pathogen. Mounting incidence of MDR K. pneumoniae is worrisome across the globe. K. pneumoniae is an established ubiquitous pathogen and associated with various infections in a wide range of hosts. Methods The peer reviewed findings with given problem statements were thoroughly studied through literature review technique. Multiple antibiotic-resistance genes and virulence genes across various Klebsiella species were studied to explore their evolutionary dynamics and genetic diversity. Results Population dynamics revealed that the clonal group (CG) 258 and CG 14 are considered as global disseminated clones. The genome size (5.7 Mbps) of K. pneumoniae is reported to be larger than the other Enterobacteriaceae which allows K. pneumoniae to survive in diverse geographical niches. It has adequate resistome and virulence machinery to evade the host immune system and establish the infection. Due to the emergence of resistant variants K. pneumoniae needs appropriate alternative control measures. Conclusion The current review described the characteristics features of K. pneumoniae which are the key players in making this organism a credential pathogen. Additionally, it would be instructive and underpin the molecular insights that may aid in restraining this pathogen.
Aslam et al. (2025) Genomics, population dynamics, immune evasion and resistance determinants foster the competence and global dissemination of Klebsiella pneumoniae. PeerJ 13:e20296 https://doi.org/10.7717/peerj.20296
Structure and diversity of microbial communities in the rhizosphere soil of Trichosanthes kirilowii from different cultivation patterns
Background To analyze the effects of different cultivation patterns on the structure and diversity of the microbial community in the rhizosphere soil of Trichosanthes kirilowii (T. kirilowii) arms to establish reasonable and effective strategies to mitigate the continuous cropping barriers and promote the high-quality cultivation of T. kirilowii. Methods Three distinct cultivation patterns were investigated: open-field cultivation (TM1), film-mulched cultivation (TM2), and soybean intercropping cultivation (TM3). High-throughput sequencing and bioinformatic analyses were employed to evaluate the rhizosphere microbiome, and redundancy analysis was utilized to investigate the relationship between the microbial communities and soil nutrient indicators. Results TM2 and TM3 increased soil bacterial community diversity, reduced fungal community diversity, elevated the relative abundance of beneficial bacterial genera, and reduced the abundance of detrimental fungal genera in the rhizosphere soil. The relative abundance of Pseudarthrobacter, unclassified_Steroidobacteraceae, and Nocardioides in TM2 and TM3 was markedly higher than in TM1. Conversely, the relative abundance of Fusarium, Rhizoctonia, Ceratobasidium, and Plectosphaerella in TM2 and TM3 was significantly reduced compared to TM1. The contents of available potassium (AK), total nitrogen (TN), total phosphorus (TP), and pH in the rhizosphere soil of TM2 and TM3 were significantly higher than those in TM1. The distribution of soil bacterial genera was significantly influenced by the contents of TN and AK, while the distribution of soil fungal genera was significantly or extremely significantly impacted by the contents of TP, total potassium (TK), soil organic matter (SOM), and pH. The content of AK was extremely significantly positively correlated with the relative abundance of Nocardioides, whereas the content of TK showed an extremely negative correlation with the relative abundance of Ceratobasidium. Similarly, pH demonstrated an extremely negative correlation with the relative abundance of Rhizoctonia and Ceratobasidium. Conclusions Film-mulched cultivation and soybean intercropping cultivation altered the soil nutrients, as well as the structure and diversity of soil microbial communities. Thus, in agricultural production, film-mulched cultivation and soybean intercropping cultivation can serve to regulate soil nutrients and microbial communities, thereby mitigating the barriers of continuous cropping of T. kirilowii.
Zheng et al. (2025) Structure and diversity of microbial communities in the rhizosphere soil of Trichosanthes kirilowii from different cultivation patterns. PeerJ 13:e20459 https://doi.org/10.7717/peerj.20459
Long-term glycemic variability and the risk of heart failure: a meta-analysis
Background Long-term glycemic variability (GV) has emerged as a potential cardiovascular risk factor beyond average glycemic levels. However, its association with the risk of heart failure (HF) remains unclear. This meta-analysis evaluated the relationship between long-term GV and the incidence of HF in adults. Methods We systematically searched PubMed, Embase, and Web of Science from inception to January 31, 2025, for observational studies assessing the association between long-term GV—measured by variability indices of hemoglobin A1c (HbA1c) or fasting plasma glucose—and HF risk. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models by incorporating the influence of heterogeneity. Results Eleven datasets from 10 studies involving 4,229,377 adults were included. Compared with participants with low GV, those with high long-term GV had a significantly increased risk of incident HF (HR = 1.69; 95% CI [1.38–2.06]; p < 0.001; I2 = 92%). The association remained consistent in sensitivity analyses restricted to patients with type 2 diabetes, high-quality studies, and studies adjusting for mean hemoglobin A1c (HbA1c) levels (HR = 1.96, 1.78, and 1.95, respectively; all p < 0.001). Subgroup analyses revealed consistent findings across GV metrics, geographic regions, study designs, mean age, sex distribution, follow-up duration, and study quality (p for subgroup difference > 0.05). No significant publication bias was detected (Egger’s test, p = 0.29). Conclusion High long-term GV is independently associated with an increased risk of HF. These findings underscore the clinical relevance of GV monitoring in cardiovascular risk assessment, including risk stratification for the incidence of HF.
Li et al. (2025) Long-term glycemic variability and the risk of heart failure: a meta-analysis. PeerJ 13:e20401 https://doi.org/10.7717/peerj.20401
Retrospective analysis of cervical screening abnormalities in women with type 3 transformation zone without visible lesions
Objective Women with abnormal cervical screening but without visible lesions, particularly those with a type 3 transformation zone (TZ3), present a clinical challenge due to the non-visible squamocolumnar junction, increasing the risk of missed high-grade lesions. There is currently no consensus on optimal follow-up strategies for this group. This study aims to evaluate a risk-based management approach for these patients. Methods A cross-sectional study analyzed data from 4,648 women with TZ3 who underwent colposcopy and endocervical curettage (ECC) with or without cervical biopsies at Hunan Provincial Maternal and Child Health Care Hospital (2021–2024). Logistic regression with restricted cubic splines analyzed demographic, cytological and HPV data to identify HSIL+ predictors and age-risk thresholds. Results Among the study population, 3.1% (145 cases) of HSIL+ were identified despite negative colposcopy, although additional undetected cases may exist. Women with high-grade cytology (ASC-H/HSIL/AGC) had a consistently high HSIL+ risk (32.5%–37.2%) across all HPV subgroups. In low-grade cytology (NILM/ASCUS/LSIL), HPV 16/18 positivity increased HSIL+ risk (2.4%–5.0%) compared to non-HPV 16/18 cases (1.6%–1.8%), with the highest rate observed in LSIL cases (5.0%). In women with low-grade cytology and non-HPV 16/18 positivity, age and HSIL+ risk showed a nonlinear relationship (RCS P-nonlinear = 0.008). Threshold analysis identified 55 years as a critical cutoff, with a 10% annual increase in HSIL+ risk for women ≥ 55. (OR = 1.10, 95% CI [1.02–1.19]; P = 0.015). Further age-stratified analysis in this subgroup showed a clear upward trend: HSIL+ detection rates were 4.42% in women aged ≥ 65. Conclusion Among women with abnormal cervical screening and no visible lesions at type 3 transformation zone, HSIL+ risk varies by cytology, HPV genotype, and age. Our findings suggest that immediate diagnostic evaluation is warranted for those with high-grade cytology, HPV 16/18 with LSIL, and women aged ≥ 65 years with low-grade cytology and non-16/18 HPV, as their HSIL+ risk exceeds the 4% threshold recommended by current US guidelines. Conversely, women under 65 with low-grade cytology and non-16/18 HPV, or those with NILM/ASCUS and HPV 16/18, may be appropriate candidates for conservative follow-up. These results support a more tailored, risk-based approach to management in this challenging population.
Yang et al. (2025) Retrospective analysis of cervical screening abnormalities in women with type 3 transformation zone without visible lesions. PeerJ 13:e20396 https://doi.org/10.7717/peerj.20396
Effects of creatine supplementation on muscle strength gains—a meta-analysis and systematic review
Creatine (Cr) is a widely utilized nutritional supplement. Empirical evidence indicates that Cr supplementation significantly elevates intramuscular Cr content, thereby providing an energy substrate reservoir for exercise performance and facilitating improvements in muscle strength. Although numerous studies have examined the relationship between Cr and muscle strength, comprehensive investigations into population-specific ergogenic responses, optimal Cr dosage, and concomitant training intensity remain limited. These parameters are critical determinants for maximizing the efficacy of Cr supplementation. Against this backdrop, this study adopts meta-analysis, integrating conventional and Robust Variance Estimation (RVE) models, to comprehensively evaluate the intervention effects of Cr supplementation across three dimensions: population applicability, dosage optimization, and training intensity (PROSPERO registration number: CRD42024547697). It aims to provide evidence-based support for precise clinical application and subsequent research directions. Results Results showed no statistical difference in baseline muscle strength between the Cr intervention group and the control group; after intervention, the Cr group exhibited significant strength gains. Further subgroup analysis revealed: untrained individuals had greater muscle strength improvements than trained ones; the low-to-moderate dose group showed better effects than the high-dose group; high-intensity training had more significant effect sizes than low-intensity training; and no definitive conclusion was reached on muscle strength improvements between middle-aged/elderly and young populations. Conclusion Cr supplementation significantly improves muscle strength in the general population. Specifically: untrained individuals show greater muscle strength improvements; low-dose supplementation combined with high-intensity exercise yields better effects; no definitive conclusion was reached on effect differences between middle-aged/elderly and young populations, requiring larger-sample studies for more precise effect size analysis.
Zhang et al. (2025) Effects of creatine supplementation on muscle strength gains—a meta-analysis and systematic review. PeerJ 13:e20380 https://doi.org/10.7717/peerj.20380
Application analysis of two nucleic acid detection systems in blood detection of hepatitis B virus, hepatitis C virus and human immunodeficiency virus
Objective This study aimed to compare the diagnostic efficacy between the Kehua and Roche nucleic acid testing (NAT) systems for detecting hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in blood donation screening. Methods We analyzed retrospective data from 670,775 transient blood donation samples collected between 2016 and 2024. Key performance indicators (KPIs) included the types of reactive samples, effective split rate, effective reaction rate, single pool invalid number, batch invalid number, and pooling missing samples. Annual trends in cycle threshold (CT) value distributions and overall system performance were also evaluated. Results Among 419 reactive samples (Kehua: 202; Roche: 217), no significant differences were observed in the effective split rates (P > 0.05) or overall specimen reaction rates (P > 0.05) between the two systems. The HCV detection rate was significantly lower for the Kehua system (P < 0.05), while the detection rates for HBV and HIV showed no significant inter-system differences (P > 0.05). The separation efficiency of reactive pools varied significantly across different CT value ranges (P < 0.05). The Kehua system demonstrated stable annual effective split and reaction rates (P > 0.05), whereas the Roche system exhibited significant annual fluctuations in these metrics (P < 0.05). The Kehua system had significantly fewer single pool invalid numbers and pooling omissions than the Roche system (P < 0.05). Conclusion The Kehua and Roche NAT systems demonstrated comparable overall performance in blood screening, with Kehua proving non-inferior to Roche. Kehua’s advantages included fewer invalid tests and fewer pooling errors, which could reduce economic and time costs. The Roche system exhibited higher automation, supporting continuous batch processing. The observed CT value-dependent separation efficiency suggests potential for protocol optimization in detecting low viral load samples.
Wang et al. (2025) Application analysis of two nucleic acid detection systems in blood detection of hepatitis B virus, hepatitis C virus and human immunodeficiency virus. PeerJ 13:e20365 https://doi.org/10.7717/peerj.20365
Validity, reliability and minimal detectable change in the sit-to-stand test for synchronous and asynchronous tele-assessment in post-COVID-19 condition
Background Individuals with symptoms of long-term COVID-19 (coronavirus disease 2019) who presented mild infection without needing invasive ventilatory support require rehabilitation and performance and monitoring evaluations. The 1-minute sit-to-stand test (STS) is used to assess individuals with COVID-19 and might be an alternative for remote use in this population. Objective The current study aimed to validate the synchronous and asynchronous STS tele-assessment in individuals with post-COVID-19 condition to analyze the inter-evaluator reliability of the asynchronous STS, and identify the relationship between the participants’ self-reported asynchronous STS results and those of the evaluator. Methods Thirty-eight men and women with post-COVID syndrome who did not require invasive ventilator support were included in this study. The participants were assessed using STS in-person (STS-IP), synchronous (STS-S), and asynchronous (STS-A) tele-assessments. The participants also self-reported the total executed repetitions (STS-SR). The main outcomes were the number of repetitions performed in the STS-IP, STS-S, STS-A, and STS-SR. To verify STS-A reliability, the total repetitions registered between evaluators were compared. Results STS-IP showed significant correlations and lower total repetitions compared to STS-S and STS-A. STS-A repetitions were significantly lower compared to STS-SR; however, a significant correlation was observed. The STS-S and STS-A showed minimal detectable change values of 6.6 and 10.5, respectively. In terms of reliability, there were no significant differences in total repetitions or errors found between evaluators’ assessments of STS-A. Conclusion The study demonstrated good and moderate evidence of validity for synchronous and asynchronous remote STS assessments, respectively, highlighting the impact of the assessment protocol on STS performance interpretation. Asynchronous STS presented high reliability.
Machado Marques et al. (2025) Validity, reliability and minimal detectable change in the sit-to-stand test for synchronous and asynchronous tele-assessment in post-COVID-19 condition. PeerJ 13:e20211 https://doi.org/10.7717/peerj.20211
Insights into the interactions between Deverra tortuosa and Schizomyia buboniae: phytochemicals, antioxidant capacity, and enzyme inhibitory effects
Schizomyia buboniae (Diptera: Cecidomyiidae) induces berry-like galls on the stems of Deverra tortuosa (Desf.) DC. It is also known as “Shabat El-Gabal” and is one of the most important aromatic medicinal plants in Egypt. Many researchers have reported the relationship between galling insects and plant secondary metabolites, but this relationship is not quantitative. This study investigated the impact of S. buboniae-induced galls on physiological traits, phytochemical profiles, antioxidant capacity, and antinutrient levels in D. tortuosa stems. Our results reported that photosynthetic pigment levels, including chlorophyll a, chlorophyll b, total chlorophyll, and carotenoids significantly decreased in galled stems by 63%, 14%, 44%, and 53%, respectively (p < 0.05). Antioxidant enzyme activities such as polyphenol oxidase (PPO), peroxidase (POX), catalase (CAT) and superoxide dismutase (SOD) significantly increased in galled stems by 173%, 88%, 125% and 25%, respectively, indicating elevated oxidative stress response. The analysis of phytochemical compositions revealed that the galled stems of D. tortuosa contained significantly higher levels of total flavonoids, flavonols, saponins, steroids, tannins, alkaloids, cardiac glycosides, and total phenolic compounds compared to non-galled stems, suggesting enhanced production of secondary metabolites. Additionally, galled stems exhibited higher levels of phytates, oxalates, and cyanogenic glycosides than non-galled stems. Proximate contents, including lipids, carbohydrates and proteins, were also elevated in galled stems. Furthermore, galled stems exhibited significantly (p < 0.05) stronger antioxidant activity than non-galled stems. S. buboniae appears to modify the phenotype of D. tortuosa, inducing tissue differentiation and activating defense-related responses. These results reveal that gall composition alters key physiological and biochemical traits in D. tortuosa, possibly as a defense response or as a result of insect interference. The study provides novel insights into the complex plant-insect interaction and highlights the potential implications for the plant medicinal value and suggests that gall-induced tissues of D. tortuosa may be valuable sources of bioactive compounds for pharmaceutical applications.
Mahmoud et al. (2025) Insights into the interactions between Deverra tortuosa and Schizomyia buboniae: phytochemicals, antioxidant capacity, and enzyme inhibitory effects. PeerJ 13:e20052 https://doi.org/10.7717/peerj.20052
Patterns of pre-sleep music use and sleep quality: exploratory survey findings on state anxiety
Music listening is a widely used self-help approach that may influence psychological and physiological processes associated with sleep. This cross-sectional study explored patterns of pre-sleep music use in relation to psychological distress (state anxiety, mood disturbance, stress) and subjective sleep quality. Adults (N = 269, 52.6% female; Mage = 27.7, SD = 9.0) completed validated self-report measures of sleep quality (the Pittsburgh Sleep Quality Index (PSQI)) and psychological distress. Pre-sleep music use was modestly associated with poorer sleep quality (r = 0.23, p < 0.01). A borderline interaction between state anxiety and music use (β = −0.170, p = 0.050) suggested, but did not confirm, a possible buffering pattern in which the anxiety-sleep association appeared weaker among more frequent music users. No moderation effects were observed for mood or stress. These preliminary findings suggest that pre-sleep music use may reflect a coping-oriented effort among individuals experiencing anxiety. However, given the cross-sectional design, self-report measures, and borderline statistical support, the results should be viewed as descriptive and hypothesis-generating.
Danso et al. (2025) Patterns of pre-sleep music use and sleep quality: exploratory survey findings on state anxiety. PeerJ 13:e20444 https://doi.org/10.7717/peerj.20444