PeerJ
type: channel
link: https://peerj.com/articles/
description: Articles published in PeerJ
publisher: PeerJ Inc.
publication name: PeerJ
issn: 2167-8359
items: Application of an interpretable machine learning model based on optimal feature selection for predicting triple-vessel coronary disease: a multicenter retrospective study
items: Sex ratios in flux: seasonal dynamics and methodological insights in Rumex species
items: Development and content validity of the evaluation of multidimensional functioning and risks in aging scale
items: Chronic cervical instability in mice and rats: a reproducible model to simulate human intervertebral disc degeneration
items: Neutrophil-to-lymphocyte ratio: a potential supportive marker for elderly community-acquired bloodstream infections—a retrospective study
items: Validation of an aspiration risk prediction model for Parkinson’s disease based on nomogram: a single-center study
items: Effects and potential mechanisms of iron metabolism on vascular calcification
items: Variations in length of stay among surviving preterm infants admitted to neonatal intensive care units in Shenzhen, China
items: In situ mechanical behavior of mineralized collagen fibrils in murine cortical bone is altered by aging and disuse
items: Exploring probiotic awareness, perceptions, and practices in the Saudi population: a cross-sectional study

Application of an interpretable machine learning model based on optimal feature selection for predicting triple-vessel coronary disease: a multicenter retrospective study
type: item
type: AcademicArticle
description: Objective This study aimed to evaluate the predictive value of the remnant cholesterol-inflammatory index (RCII) in assessing the risk of triple-vessel disease (TVD), and to construct a comparative framework of predictive models using six machine learning algorithms based on RCII and other clinical features for identifying high-risk individuals. Methods In this retrospective multicenter study, we enrolled 2,911 patients who underwent coronary angiography between January 1, 2024, and December 31, 2024, at two tertiary hospitals. Clinical and laboratory data were collected. Feature selection was performed using both Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression. Six machine learning (ML) algorithms were trained for risk prediction, with multilayer perceptron (MLP) selected as the optimal model for the final feature set. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), and F1 score. SHapley Additive exPlanations (SHAP) analysis was applied to interpret feature contributions and interactions. Results A total of 16 features were selected by LASSO regression, while multivariate logistic regression identified six independent predictors. Four overlapping features—gender, age, aspartate aminotransferase (AST), and RCII—were used for ML model development. Among the six models, the MLP demonstrated the best overall performance on the test set. SHAP analysis revealed that RCII, age, AST, and gender were the top contributors to model prediction, with RCII showing notable interaction effects with other variables, highlighting its both independent and synergistic role in TVD risk stratification. Conclusion RCII, as a composite biomarker integrating lipid metabolism and chronic inflammation, demonstrates strong predictive utility in identifying individuals at high risk for triple-vessel coronary disease.
format: application/pdf
format: text/html
creator: Ling Hou
creator: Ke He
creator: Jinbo Zhao
creator: Ke Su
creator: Changjiang Zhang
subject: Cardiology
subject: Computational Science
subject: Data Mining and Machine Learning
description: doi:10.7717/peerj.20423
publisher: PeerJ Inc.
rights: © 2025 Hou et al.
abstract: Objective This study aimed to evaluate the predictive value of the remnant cholesterol-inflammatory index (RCII) in assessing the risk of triple-vessel disease (TVD), and to construct a comparative framework of predictive models using six machine learning algorithms based on RCII and other clinical features for identifying high-risk individuals. Methods In this retrospective multicenter study, we enrolled 2,911 patients who underwent coronary angiography between January 1, 2024, and December 31, 2024, at two tertiary hospitals. Clinical and laboratory data were collected. Feature selection was performed using both Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression. Six machine learning (ML) algorithms were trained for risk prediction, with multilayer perceptron (MLP) selected as the optimal model for the final feature set. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), and F1 score. SHapley Additive exPlanations (SHAP) analysis was applied to interpret feature contributions and interactions. Results A total of 16 features were selected by LASSO regression, while multivariate logistic regression identified six independent predictors. Four overlapping features—gender, age, aspartate aminotransferase (AST), and RCII—were used for ML model development. Among the six models, the MLP demonstrated the best overall performance on the test set. SHAP analysis revealed that RCII, age, AST, and gender were the top contributors to model prediction, with RCII showing notable interaction effects with other variables, highlighting its both independent and synergistic role in TVD risk stratification. Conclusion RCII, as a composite biomarker integrating lipid metabolism and chronic inflammation, demonstrates strong predictive utility in identifying individuals at high risk for triple-vessel coronary disease.
bibliographic citation: Hou et al. (2025) Application of an interpretable machine learning model based on optimal feature selection for predicting triple-vessel coronary disease: a multicenter retrospective study. PeerJ 13:e20423 https://doi.org/10.7717/peerj.20423
date submitted: 2025-07-22
date accepted: 2025-10-29
issued: 2025-12-09
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Hou
  given name: Ling
author list: Agent
  family name: He
  given name: Ke
author list: Agent
  family name: Zhao
  given name: Jinbo
author list: Agent
  family name: Su
  given name: Ke
author list: Agent
  family name: Zhang
  given name: Changjiang
doi: 10.7717/peerj.20423
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-09
copyright: ©2025 Hou et al.
attribution name: Hou et al.

Sex ratios in flux: seasonal dynamics and methodological insights in Rumex species
type: item
type: AcademicArticle
description: Dioecy–separate male and female individuals–occurs in less than 10% of angiosperms. Studying dioecy and plant sex chromosomes is key to understanding sex determination, genetic diversity, and ecological interactions, with implications for crop breeding, conservation, and pollination management. Many dioecious plant species deviate from the 1:1 sex ratio expected under Fisher’s principle, displaying male- or female-biased populations. The genus Rumex (Polygonaceae) is a valuable model for investigating sex-ratio variation and sex chromosome evolution. The dioecious species Rumex acetosa and R. thyrsiflorus possess heteromorphic sex chromosomes and typically exhibit female-biased sex ratios in natural populations. However, the environmental and developmental drivers of these biases remain largely unresolved. Previous studies on Rumex have often relied on single or infrequent population surveys, potentially overlooking the seasonal dynamics of sex ratios, especially given phenological differences between sexes. Female plants remain morphologically recognizable for longer periods due to seed set, which can bias sex-ratio estimates when sampling is limited to specific reproductive stages or time points. To address these limitations, we systematically investigated the temporal dynamics of observable sex ratios in R. acetosa and R. thyrsiflorus throughout an entire growing season using regular monitoring. Our results demonstrate that observable sex ratios in these populations are dynamic, with significant seasonal fluctuations driven by differences in developmental timing and the duration of morphological recognizability between sexes. As a result, the period during which field-observed sex ratios accurately reflect the true population structure is both limited and highly dependent on the timing of observations. Notably, the earlier flowering of male plants in R. acetosa can lead to male-biased sex ratios in early-season surveys, while the prolonged recognizability of frui…
format: application/pdf
format: text/html
creator: Barbara Pawełek
creator: Dagmara Kwolek
creator: Grzegorz Góralski
subject: Conservation Biology
subject: Developmental Biology
subject: Ecology
subject: Evolutionary Studies
subject: Plant Science
description: doi:10.7717/peerj.20391
publisher: PeerJ Inc.
rights: © 2025 Pawełek et al.
abstract: Dioecy–separate male and female individuals–occurs in less than 10% of angiosperms. Studying dioecy and plant sex chromosomes is key to understanding sex determination, genetic diversity, and ecological interactions, with implications for crop breeding, conservation, and pollination management. Many dioecious plant species deviate from the 1:1 sex ratio expected under Fisher’s principle, displaying male- or female-biased populations. The genus Rumex (Polygonaceae) is a valuable model for investigating sex-ratio variation and sex chromosome evolution. The dioecious species Rumex acetosa and R. thyrsiflorus possess heteromorphic sex chromosomes and typically exhibit female-biased sex ratios in natural populations. However, the environmental and developmental drivers of these biases remain largely unresolved. Previous studies on Rumex have often relied on single or infrequent population surveys, potentially overlooking the seasonal dynamics of sex ratios, especially given phenological differences between sexes. Female plants remain morphologically recognizable for longer periods due to seed set, which can bias sex-ratio estimates when sampling is limited to specific reproductive stages or time points. To address these limitations, we systematically investigated the temporal dynamics of observable sex ratios in R. acetosa and R. thyrsiflorus throughout an entire growing season using regular monitoring. Our results demonstrate that observable sex ratios in these populations are dynamic, with significant seasonal fluctuations driven by differences in developmental timing and the duration of morphological recognizability between sexes. As a result, the period during which field-observed sex ratios accurately reflect the true population structure is both limited and highly dependent on the timing of observations. Notably, the earlier flowering of male plants in R. acetosa can lead to male-biased sex ratios in early-season surveys, while the prolonged recognizability of frui…
bibliographic citation: Pawełek et al. (2025) Sex ratios in flux: seasonal dynamics and methodological insights in Rumex species. PeerJ 13:e20391 https://doi.org/10.7717/peerj.20391
date submitted: 2025-07-09
date accepted: 2025-10-24
issued: 2025-12-09
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Pawełek
  given name: Barbara
author list: Agent
  family name: Kwolek
  given name: Dagmara
author list: Agent
  family name: Góralski
  given name: Grzegorz
doi: 10.7717/peerj.20391
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-09
copyright: ©2025 Pawełek et al.
attribution name: Pawełek et al.

Development and content validity of the evaluation of multidimensional functioning and risks in aging scale
type: item
type: AcademicArticle
description: Introduction Rising life expectancy has led to an increased prevalence of age-related conditions such as pain, dementia, and falls. To address these challenges, healthcare systems require efficient tools to identify which health domains are preserved or impaired in older adults. Existing frailty instruments present both conceptual and operational limitations. Therefore, there is a need to shift toward domain-specific evaluations of functioning and potential risks, aligned with established protocols such as the Comprehensive Geriatric Assessment and framed within the International Classification of Functioning, Disability and Health (ICF). This study aimed to develop the Evaluation of Multidimensional Functioning and Risks in Aging (EMFRA) scale, encompassing four assessment domains: physical function, cognitive function, emotional status, and social situation. Methods The EMFRA scale was developed by identifying potential items through a comprehensive literature review and expert input. The first preliminary version was validated by a panel of 15 experts, who assessed the scale’s clarity, coherence, and relevance using a 5-point Likert scale. Cognitive interviews were then conducted with 10 clinicians and 10 older adults to evaluate the comprehensibility and practical applicability of the second preliminary version. Results Following the literature review, 24 items were grouped into four domains (six items per domain), each supported by evidence linking them to health-related adverse outcomes. Expert evaluation showed substantial agreement on comprehension, coherence, and relevance (Aiken’s V >0.7) for all but two items—language and fear—which were excluded. Cognitive interviews led to the exclusion of one additional item (sedentarism) and further refinement of the remaining items. These changes were incorporated into the final version of EMFRA, enhancing its usability and comprehensiveness. Conclusion EMFRA provides a multidimensional framework for assessing functi…
format: application/pdf
format: text/html
creator: José Fierro-Marrero
creator: Álvaro Reina-Varona
creator: Joaquín Pardo-Montero
creator: Alba Paris-Alemany
creator: Roy La Touche
subject: Geriatrics
subject: Public Health
description: doi:10.7717/peerj.20108
publisher: PeerJ Inc.
rights: © 2025 Fierro-Marrero et al.
abstract: Introduction Rising life expectancy has led to an increased prevalence of age-related conditions such as pain, dementia, and falls. To address these challenges, healthcare systems require efficient tools to identify which health domains are preserved or impaired in older adults. Existing frailty instruments present both conceptual and operational limitations. Therefore, there is a need to shift toward domain-specific evaluations of functioning and potential risks, aligned with established protocols such as the Comprehensive Geriatric Assessment and framed within the International Classification of Functioning, Disability and Health (ICF). This study aimed to develop the Evaluation of Multidimensional Functioning and Risks in Aging (EMFRA) scale, encompassing four assessment domains: physical function, cognitive function, emotional status, and social situation. Methods The EMFRA scale was developed by identifying potential items through a comprehensive literature review and expert input. The first preliminary version was validated by a panel of 15 experts, who assessed the scale’s clarity, coherence, and relevance using a 5-point Likert scale. Cognitive interviews were then conducted with 10 clinicians and 10 older adults to evaluate the comprehensibility and practical applicability of the second preliminary version. Results Following the literature review, 24 items were grouped into four domains (six items per domain), each supported by evidence linking them to health-related adverse outcomes. Expert evaluation showed substantial agreement on comprehension, coherence, and relevance (Aiken’s V >0.7) for all but two items—language and fear—which were excluded. Cognitive interviews led to the exclusion of one additional item (sedentarism) and further refinement of the remaining items. These changes were incorporated into the final version of EMFRA, enhancing its usability and comprehensiveness. Conclusion EMFRA provides a multidimensional framework for assessing functi…
bibliographic citation: Fierro-Marrero et al. (2025) Development and content validity of the evaluation of multidimensional functioning and risks in aging scale. PeerJ 13:e20108 https://doi.org/10.7717/peerj.20108
date submitted: 2025-02-18
date accepted: 2025-08-28
issued: 2025-12-09
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Fierro-Marrero
  given name: José
author list: Agent
  family name: Reina-Varona
  given name: Álvaro
author list: Agent
  family name: Pardo-Montero
  given name: Joaquín
author list: Agent
  family name: Paris-Alemany
  given name: Alba
author list: Agent
  family name: La Touche
  given name: Roy
doi: 10.7717/peerj.20108
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-09
copyright: ©2025 Fierro-Marrero et al.
attribution name: Fierro-Marrero et al.

Chronic cervical instability in mice and rats: a reproducible model to simulate human intervertebral disc degeneration
type: item
type: AcademicArticle
description: Background Chronic low-back pain, a leading cause of global disability, is closely linked to intervertebral disc degeneration (IVDD). Traditional animal models have faced challenges in replicating the gradual, chronic nature of human IVDD. Objective To address these limitations, we aimed to develop a novel mouse model of cervical spine instability that more accurately mimics the progressive degeneration observed in humans. Animals This study used 48 male Sprague–Dawley rats (3 months old, weighing 230 ± 20 g) and 48 male C57BL/6 mice (12 weeks old, weighing 20 ± 2 g). Methods A bilateral cervical laminectomy combined with spinous process resection was performed while preserving the facet joints and posterior cervical muscles to induce chronic intervertebral instability. Longitudinal assessments were conducted using in vivo magnetic resonance imaging (MRI), histological staining (H&E and Safranin O-fast green), immunofluorescence and western blot analyses at 4, 8, and 12 weeks post-operation. Results MRI findings demonstrated progressive degeneration at the C4/5, C5/6, and C6/7 levels, with the most pronounced changes observed at 4 and 8 weeks post-surgery and partial recovery at 12 weeks. H&E and Safranin O staining confirmed significant cellular loss, structural disorganization, and proteoglycan depletion in the affected discs. Immunofluorescence staining revealed a progressive decrease in collagen type II and aggrecan expression over time. Conversely, collagen type I expression increased, indicating a shift toward fibrosis. Western blot analysis confirmed elevated levels of oxidative stress markers (albumin and AOPPs), matrix metalloproteinases (MMP3 and MMP13), senescence markers (p53, p21, p16), and inflammatory cytokines (IL-1β, TNF-α) at 4 and 8 weeks, with a partial decline by 12 weeks. Conclusions This innovative cervical instability model not only minimizes the risk of nerve injury and reduces animal stress compared to previous models but also offers a repr…
format: application/pdf
format: text/html
creator: Kewu Tu
creator: Junhao Tan
creator: Guanhai Zeng
creator: Fuzhou Xu
creator: Dongteng Liao
creator: Weiqi Lu
creator: Kun Zhao
creator: Zhaomou Chen
creator: Beidi Zhou
creator: Xiangheng Dai
subject: Biochemistry
subject: Anatomy and Physiology
subject: Orthopedics
description: doi:10.7717/peerj.20465
publisher: PeerJ Inc.
rights: © 2025 Tu et al.
abstract: Background Chronic low-back pain, a leading cause of global disability, is closely linked to intervertebral disc degeneration (IVDD). Traditional animal models have faced challenges in replicating the gradual, chronic nature of human IVDD. Objective To address these limitations, we aimed to develop a novel mouse model of cervical spine instability that more accurately mimics the progressive degeneration observed in humans. Animals This study used 48 male Sprague–Dawley rats (3 months old, weighing 230 ± 20 g) and 48 male C57BL/6 mice (12 weeks old, weighing 20 ± 2 g). Methods A bilateral cervical laminectomy combined with spinous process resection was performed while preserving the facet joints and posterior cervical muscles to induce chronic intervertebral instability. Longitudinal assessments were conducted using in vivo magnetic resonance imaging (MRI), histological staining (H&E and Safranin O-fast green), immunofluorescence and western blot analyses at 4, 8, and 12 weeks post-operation. Results MRI findings demonstrated progressive degeneration at the C4/5, C5/6, and C6/7 levels, with the most pronounced changes observed at 4 and 8 weeks post-surgery and partial recovery at 12 weeks. H&E and Safranin O staining confirmed significant cellular loss, structural disorganization, and proteoglycan depletion in the affected discs. Immunofluorescence staining revealed a progressive decrease in collagen type II and aggrecan expression over time. Conversely, collagen type I expression increased, indicating a shift toward fibrosis. Western blot analysis confirmed elevated levels of oxidative stress markers (albumin and AOPPs), matrix metalloproteinases (MMP3 and MMP13), senescence markers (p53, p21, p16), and inflammatory cytokines (IL-1β, TNF-α) at 4 and 8 weeks, with a partial decline by 12 weeks. Conclusions This innovative cervical instability model not only minimizes the risk of nerve injury and reduces animal stress compared to previous models but also offers a repr…
bibliographic citation: Tu et al. (2025) Chronic cervical instability in mice and rats: a reproducible model to simulate human intervertebral disc degeneration. PeerJ 13:e20465 https://doi.org/10.7717/peerj.20465
date submitted: 2025-04-22
date accepted: 2025-11-03
issued: 2025-12-08
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Tu
  given name: Kewu
author list: Agent
  family name: Tan
  given name: Junhao
author list: Agent
  family name: Zeng
  given name: Guanhai
author list: Agent
  family name: Xu
  given name: Fuzhou
author list: Agent
  family name: Liao
  given name: Dongteng
author list: Agent
  family name: Lu
  given name: Weiqi
author list: Agent
  family name: Zhao
  given name: Kun
author list: Agent
  family name: Chen
  given name: Zhaomou
author list: Agent
  family name: Zhou
  given name: Beidi
author list: Agent
  family name: Dai
  given name: Xiangheng
doi: 10.7717/peerj.20465
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-08
copyright: ©2025 Tu et al.
attribution name: Tu et al.

Neutrophil-to-lymphocyte ratio: a potential supportive marker for elderly community-acquired bloodstream infections—a retrospective study
type: item
type: AcademicArticle
description: Background Exploring the value of the neutrophil/lymphocyte ratio (NLR) as a potential supportive marker in community-acquired bloodstream infection in elderly patients. Methods By reviewing the data of inpatients in Xuanwu Hospital of Capital Medical University from January 2012 to December 2021, a total of 58 elderly patients with community-acquired bloodstream infection and 174 inpatients without infection during the same period, matched for age, sex, and concomitant diseases, were included. Clinical data were collected and analyzed statistically. Results There were no significant differences in age, sex, and concomitant diseases between the infected and non-infected groups. Multivariate regression analysis showed that only increased NLR among leukocyte indexes was a risk factor for bloodstream infections. The sensitivity, specificity, and area under the curve (AUC) of increased NLR to support the diagnosis of community-acquired bloodstream infections in the elderly were 0.72, 0.99, and 0.95; the optimal cut-off value is 8.0. Conclusion The increase in NLR was superior to the rise of traditional white blood cell and neutrophil counts. Thus, NLR can be used as an indication for the early diagnosis of community-acquired bloodstream infection in the elderly. The optimal cutoff value of NLR for supporting the diagnosis of community-acquired bloodstream infections in elderly patients was determined to be 8.0. When NLR exceeds this threshold (> 8.0), it serves as a clinical alert for community physicians, indicating a significantly elevated probability of elderly patients developing community-acquired bloodstream infections.
format: application/pdf
format: text/html
creator: Peijuan Li
creator: Jiulin Zhang
creator: Kun Chen
creator: Qianqian Pei
creator: Mengxi Ding
creator: Chunmei Wang
subject: Emergency and Critical Care
subject: Geriatrics
subject: Infectious Diseases
description: doi:10.7717/peerj.20449
publisher: PeerJ Inc.
rights: © 2025 Li et al.
abstract: Background Exploring the value of the neutrophil/lymphocyte ratio (NLR) as a potential supportive marker in community-acquired bloodstream infection in elderly patients. Methods By reviewing the data of inpatients in Xuanwu Hospital of Capital Medical University from January 2012 to December 2021, a total of 58 elderly patients with community-acquired bloodstream infection and 174 inpatients without infection during the same period, matched for age, sex, and concomitant diseases, were included. Clinical data were collected and analyzed statistically. Results There were no significant differences in age, sex, and concomitant diseases between the infected and non-infected groups. Multivariate regression analysis showed that only increased NLR among leukocyte indexes was a risk factor for bloodstream infections. The sensitivity, specificity, and area under the curve (AUC) of increased NLR to support the diagnosis of community-acquired bloodstream infections in the elderly were 0.72, 0.99, and 0.95; the optimal cut-off value is 8.0. Conclusion The increase in NLR was superior to the rise of traditional white blood cell and neutrophil counts. Thus, NLR can be used as an indication for the early diagnosis of community-acquired bloodstream infection in the elderly. The optimal cutoff value of NLR for supporting the diagnosis of community-acquired bloodstream infections in elderly patients was determined to be 8.0. When NLR exceeds this threshold (> 8.0), it serves as a clinical alert for community physicians, indicating a significantly elevated probability of elderly patients developing community-acquired bloodstream infections.
bibliographic citation: Li et al. (2025) Neutrophil-to-lymphocyte ratio: a potential supportive marker for elderly community-acquired bloodstream infections—a retrospective study. PeerJ 13:e20449 https://doi.org/10.7717/peerj.20449
date submitted: 2025-06-05
date accepted: 2025-10-31
issued: 2025-12-08
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Li
  given name: Peijuan
author list: Agent
  family name: Zhang
  given name: Jiulin
author list: Agent
  family name: Chen
  given name: Kun
author list: Agent
  family name: Pei
  given name: Qianqian
author list: Agent
  family name: Ding
  given name: Mengxi
author list: Agent
  family name: Wang
  given name: Chunmei
doi: 10.7717/peerj.20449
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-08
copyright: ©2025 Li et al.
attribution name: Li et al.

Validation of an aspiration risk prediction model for Parkinson’s disease based on nomogram: a single-center study
type: item
type: AcademicArticle
description: Objective This study aims to develop and validate a predictive model for aspiration risk in patients with Parkinson’s disease (PD). Methods A total of 160 inpatients with PD were enrolled (December 2022 to December 2023) from the Neurology Department of the Affiliated Drum Tower Hospital. Of 33 candidate variables, univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression were used to identify key predictors and construct a clinical nomogram. Model discrimination and calibration were assessed using receiver operating characteristic (ROC) curves and calibration plots. Results Univariate analysis and LASSO regression reduced the 33 variables to four core predictors: history of choking cough (odds ratio (OR) = 11.427; 95% confidence interval (CI) [2.187–59.709]), abnormal water-swallowing test results (OR = 4.262, 95% CI [1.496–12.140]), reduced facial expression (OR = 2.929, 95% CI [1.055–8.134]), and Barthel Index (OR = 0.972, 95% CI [0.950–0.995]). The area under the curve (AUC) values of the model were 0.882 (optimism-adjusted) and 0.950 for the training and testing sets, respectively. Calibration and decision curve analyses further validated the high performance and clinical utility of this model. Conclusion This nomogram effectively stratified aspiration risk in patients with PD, facilitating earlier detection and intervention. Future studies including more clinical variables and larger multicenter cohorts are required to enhance the predictive accuracy and generalizability of the model.
format: application/pdf
format: text/html
creator: Yan Yan Xu
creator: Yun Wei
creator: Ling Sha
subject: Neurology
subject: Nursing
subject: Respiratory Medicine
description: doi:10.7717/peerj.20443
publisher: PeerJ Inc.
rights: © 2025 Xu et al.
abstract: Objective This study aims to develop and validate a predictive model for aspiration risk in patients with Parkinson’s disease (PD). Methods A total of 160 inpatients with PD were enrolled (December 2022 to December 2023) from the Neurology Department of the Affiliated Drum Tower Hospital. Of 33 candidate variables, univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression were used to identify key predictors and construct a clinical nomogram. Model discrimination and calibration were assessed using receiver operating characteristic (ROC) curves and calibration plots. Results Univariate analysis and LASSO regression reduced the 33 variables to four core predictors: history of choking cough (odds ratio (OR) = 11.427; 95% confidence interval (CI) [2.187–59.709]), abnormal water-swallowing test results (OR = 4.262, 95% CI [1.496–12.140]), reduced facial expression (OR = 2.929, 95% CI [1.055–8.134]), and Barthel Index (OR = 0.972, 95% CI [0.950–0.995]). The area under the curve (AUC) values of the model were 0.882 (optimism-adjusted) and 0.950 for the training and testing sets, respectively. Calibration and decision curve analyses further validated the high performance and clinical utility of this model. Conclusion This nomogram effectively stratified aspiration risk in patients with PD, facilitating earlier detection and intervention. Future studies including more clinical variables and larger multicenter cohorts are required to enhance the predictive accuracy and generalizability of the model.
bibliographic citation: Xu et al. (2025) Validation of an aspiration risk prediction model for Parkinson’s disease based on nomogram: a single-center study. PeerJ 13:e20443 https://doi.org/10.7717/peerj.20443
date submitted: 2025-02-25
date accepted: 2025-10-31
issued: 2025-12-08
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Xu
  given name: Yan Yan
author list: Agent
  family name: Wei
  given name: Yun
author list: Agent
  family name: Sha
  given name: Ling
doi: 10.7717/peerj.20443
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-08
copyright: ©2025 Xu et al.
attribution name: Xu et al.

Effects and potential mechanisms of iron metabolism on vascular calcification
type: item
type: AcademicArticle
description: Vascular calcification (VC) is a prevalent pathological manifestation of cardiovascular and cerebrovascular diseases, and is an active, multifactor-regulated pathological process. Iron is an essential metal that maintains cellular and body functions, and its metabolic homeostasis plays a complex and crucial dual role in the development of VC. This study, based on a comprehensive analysis of numerous studies, revealed that the effect of iron on VC has a significant dose-dependent relationship: physiological concentrations or moderate amounts of iron exert protective effects by enhancing antioxidant defenses, thereby inhibiting the osteogenic phenotype transformation and apoptosis of vascular smooth muscle cells; conversely, iron overload strongly drives VC by inducing oxidative stress, ferroptosis, and pro-inflammatory responses. These findings highlight the importance of maintaining iron homeostasis. Intervention strategies targeting iron metabolism (such as iron-based phosphate binders to correct iron deficiency and iron chelators to alleviate iron overload) have potential clinical value for the prevention and treatment of VC. In summary, this review provides a novel perspective on the diagnosis and treatment of VC, and future studies need to further explore its mechanisms and conduct rigorous clinical validation to manage iron metabolism as a novel approach for personalized prevention and treatment of VC.
format: application/pdf
format: text/html
creator: Hongyu Wang
creator: Yanqiu Song
creator: Qin Qin
subject: Molecular Biology
subject: Cardiology
subject: Internal Medicine
description: doi:10.7717/peerj.20392
publisher: PeerJ Inc.
rights: © 2025 Wang et al.
abstract: Vascular calcification (VC) is a prevalent pathological manifestation of cardiovascular and cerebrovascular diseases, and is an active, multifactor-regulated pathological process. Iron is an essential metal that maintains cellular and body functions, and its metabolic homeostasis plays a complex and crucial dual role in the development of VC. This study, based on a comprehensive analysis of numerous studies, revealed that the effect of iron on VC has a significant dose-dependent relationship: physiological concentrations or moderate amounts of iron exert protective effects by enhancing antioxidant defenses, thereby inhibiting the osteogenic phenotype transformation and apoptosis of vascular smooth muscle cells; conversely, iron overload strongly drives VC by inducing oxidative stress, ferroptosis, and pro-inflammatory responses. These findings highlight the importance of maintaining iron homeostasis. Intervention strategies targeting iron metabolism (such as iron-based phosphate binders to correct iron deficiency and iron chelators to alleviate iron overload) have potential clinical value for the prevention and treatment of VC. In summary, this review provides a novel perspective on the diagnosis and treatment of VC, and future studies need to further explore its mechanisms and conduct rigorous clinical validation to manage iron metabolism as a novel approach for personalized prevention and treatment of VC.
bibliographic citation: Wang et al. (2025) Effects and potential mechanisms of iron metabolism on vascular calcification. PeerJ 13:e20392 https://doi.org/10.7717/peerj.20392
date submitted: 2025-07-18
date accepted: 2025-10-24
issued: 2025-12-08
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Wang
  given name: Hongyu
author list: Agent
  family name: Song
  given name: Yanqiu
author list: Agent
  family name: Qin
  given name: Qin
doi: 10.7717/peerj.20392
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-08
copyright: ©2025 Wang et al.
attribution name: Wang et al.

Variations in length of stay among surviving preterm infants admitted to neonatal intensive care units in Shenzhen, China
type: item
type: AcademicArticle
description: Background The global preterm birth rate is currently around 10%, making it a major contributor to both neonatal mortality and long-term health complications. Length of stay (LOS) in hospital is a key metric when assessing the quality of medical care for preterm infants. Therefore, a comprehensive analysis of LOS in preterm infants, along with the identification of associated risk factors, is essential in order to improve clinical outcomes and optimize healthcare strategies. Objective This study examined the LOS and total hospitalization costs of preterm infants admitted to neonatal intensive care units (NICUs) in three hospitals in China . The study also investigated the factors affecting the LOS and total hospitalization costs of surviving preterm infants admitted to NICUs. Methods This is a retrospective analysis of preterm infants born between January 2020 and December 2023 who were admitted to one of three participating tertiary care centers within one week after birth. Baseline characteristics, LOS, and hospitalization costs were described and summarized. Generalized linear models were utilized to estimate adjusted associations between LOS and various factors. Results This study included 2,887 preterm infants. The median total LOS was 10 days (interquartile range (IQR): 7–20), and the median total hospitalization cost was RMB ¥16,287.3 (IQR: ¥10,541.9–32,342.3). Both LOS and hospitalization costs decreased significantly with increasing gestational age (GA) and birth weight (BW). Infants at 34 to 36+6weeks’ gestation had a 68% shorter LOS compared to those at <28 weeks (relative risk (RR) 0.32, 95% confidence interval (CI) [0.27–0.38]). Similarly, infants with BW ≥ 2,500 g had a 54% shorter LOS than those <1,000 g (RR 0.46, 95% CI [0.39–0.54]). Conclusion Low GA, low BW, maternal hypertension, low Apgar score , small for GA (SGA), bronchopulmonary dysplasia (BPD), sepsis, and extrauterine growth retardation were associated with prolonged hospitalization.
format: application/pdf
format: text/html
creator: Dandan Rao
creator: Zhangbin Yu
creator: Rongtian Liu
creator: Rui Wang
creator: Xin Guo
creator: Huiying Tu
creator: Ping Jiang
creator: Jing Zhang
creator: Jinxing Feng
creator: Linying Yang
creator: Yuqin Yan
creator: Jiebo Liu
subject: Pediatrics
subject: Healthcare Services
description: doi:10.7717/peerj.20344
publisher: PeerJ Inc.
rights: © 2025 Rao et al.
abstract: Background The global preterm birth rate is currently around 10%, making it a major contributor to both neonatal mortality and long-term health complications. Length of stay (LOS) in hospital is a key metric when assessing the quality of medical care for preterm infants. Therefore, a comprehensive analysis of LOS in preterm infants, along with the identification of associated risk factors, is essential in order to improve clinical outcomes and optimize healthcare strategies. Objective This study examined the LOS and total hospitalization costs of preterm infants admitted to neonatal intensive care units (NICUs) in three hospitals in China . The study also investigated the factors affecting the LOS and total hospitalization costs of surviving preterm infants admitted to NICUs. Methods This is a retrospective analysis of preterm infants born between January 2020 and December 2023 who were admitted to one of three participating tertiary care centers within one week after birth. Baseline characteristics, LOS, and hospitalization costs were described and summarized. Generalized linear models were utilized to estimate adjusted associations between LOS and various factors. Results This study included 2,887 preterm infants. The median total LOS was 10 days (interquartile range (IQR): 7–20), and the median total hospitalization cost was RMB ¥16,287.3 (IQR: ¥10,541.9–32,342.3). Both LOS and hospitalization costs decreased significantly with increasing gestational age (GA) and birth weight (BW). Infants at 34 to 36+6weeks’ gestation had a 68% shorter LOS compared to those at <28 weeks (relative risk (RR) 0.32, 95% confidence interval (CI) [0.27–0.38]). Similarly, infants with BW ≥ 2,500 g had a 54% shorter LOS than those <1,000 g (RR 0.46, 95% CI [0.39–0.54]). Conclusion Low GA, low BW, maternal hypertension, low Apgar score , small for GA (SGA), bronchopulmonary dysplasia (BPD), sepsis, and extrauterine growth retardation were associated with prolonged hospitalization.
bibliographic citation: Rao et al. (2025) Variations in length of stay among surviving preterm infants admitted to neonatal intensive care units in Shenzhen, China. PeerJ 13:e20344 https://doi.org/10.7717/peerj.20344
date submitted: 2025-03-13
date accepted: 2025-10-15
issued: 2025-12-08
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Rao
  given name: Dandan
author list: Agent
  family name: Yu
  given name: Zhangbin
author list: Agent
  family name: Liu
  given name: Rongtian
author list: Agent
  family name: Wang
  given name: Rui
author list: Agent
  family name: Guo
  given name: Xin
author list: Agent
  family name: Tu
  given name: Huiying
author list: Agent
  family name: Jiang
  given name: Ping
author list: Agent
  family name: Zhang
  given name: Jing
author list: Agent
  family name: Feng
  given name: Jinxing
author list: Agent
  family name: Yang
  given name: Linying
author list: Agent
  family name: Yan
  given name: Yuqin
author list: Agent
  family name: Liu
  given name: Jiebo
doi: 10.7717/peerj.20344
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-08
copyright: ©2025 Rao et al.
attribution name: Rao et al.

In situ mechanical behavior of mineralized collagen fibrils in murine cortical bone is altered by aging and disuse
type: item
type: AcademicArticle
description: Mineralized collagen fibrils (MCFs) are the fundamental building blocks of bone, determining its mechanical properties. Aging and disuse are known to impair bone mechanics, but their specific effects on the nanoscale, in situ mechanical behavior of MCFs remain poorly understood. The present study utilized a murine model involving adult and aged mice, with a subset from each age group subjected to disuse through hindlimb unloading (n = 6). To investigate the in situ nanomechanical response of bone, murine tibiae were tensile-loaded within a custom-made axial loading device while being simultaneously scanned with atomic force microscopy (AFM). The bone surface was partially demineralized to expose the collagen fibrils. High-resolution AFM imaging in tapping-mode was then employed to quantitatively assess the morphological changes and nanomechanical properties of MCFs throughout the bone’s elastic deformation process. In the adult murine tibia, the initial response to load was characterized by fibril reorientation and an increase in the in situ elastic modulus of MCFs, indicating stretching. It was followed by a sliding phase between adjacent fibrils. In contrast, the aged bone exhibited fibril sliding at the onset of loading, accompanied by a gradual decrease in the elastic modulus of MCFs. The nanomechanical alterations induced by disuse were more pronounced in aged mice compared to adults. The present findings demonstrate that aging and disuse significantly alter the nanoscale deformation mechanisms of bone, shifting the response from fibril stretching to predominant sliding. It provides novel evidence for a unique, age-dependent deformation mechanism at the fibrillar level, enhancing the current understanding of how aging and disuse impair bone quality and mechanics.
format: application/pdf
format: text/html
creator: Fan Li
creator: Fa Liu
creator: Chenxi Ren
creator: Shuyang Zhang
creator: Zhe Wang
creator: Pengfei Yang
subject: Biophysics
subject: Molecular Biology
subject: Anatomy and Physiology
subject: Geriatrics
subject: Biomechanics
description: doi:10.7717/peerj.20313
publisher: PeerJ Inc.
rights: © 2025 Li et al.
abstract: Mineralized collagen fibrils (MCFs) are the fundamental building blocks of bone, determining its mechanical properties. Aging and disuse are known to impair bone mechanics, but their specific effects on the nanoscale, in situ mechanical behavior of MCFs remain poorly understood. The present study utilized a murine model involving adult and aged mice, with a subset from each age group subjected to disuse through hindlimb unloading (n = 6). To investigate the in situ nanomechanical response of bone, murine tibiae were tensile-loaded within a custom-made axial loading device while being simultaneously scanned with atomic force microscopy (AFM). The bone surface was partially demineralized to expose the collagen fibrils. High-resolution AFM imaging in tapping-mode was then employed to quantitatively assess the morphological changes and nanomechanical properties of MCFs throughout the bone’s elastic deformation process. In the adult murine tibia, the initial response to load was characterized by fibril reorientation and an increase in the in situ elastic modulus of MCFs, indicating stretching. It was followed by a sliding phase between adjacent fibrils. In contrast, the aged bone exhibited fibril sliding at the onset of loading, accompanied by a gradual decrease in the elastic modulus of MCFs. The nanomechanical alterations induced by disuse were more pronounced in aged mice compared to adults. The present findings demonstrate that aging and disuse significantly alter the nanoscale deformation mechanisms of bone, shifting the response from fibril stretching to predominant sliding. It provides novel evidence for a unique, age-dependent deformation mechanism at the fibrillar level, enhancing the current understanding of how aging and disuse impair bone quality and mechanics.
bibliographic citation: Li et al. (2025) In situ mechanical behavior of mineralized collagen fibrils in murine cortical bone is altered by aging and disuse. PeerJ 13:e20313 https://doi.org/10.7717/peerj.20313
date submitted: 2025-06-27
date accepted: 2025-10-08
issued: 2025-12-08
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Li
  given name: Fan
author list: Agent
  family name: Liu
  given name: Fa
author list: Agent
  family name: Ren
  given name: Chenxi
author list: Agent
  family name: Zhang
  given name: Shuyang
author list: Agent
  family name: Wang
  given name: Zhe
author list: Agent
  family name: Yang
  given name: Pengfei
doi: 10.7717/peerj.20313
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-08
copyright: © 2025 Li et al.
attribution name: Li et al.

Exploring probiotic awareness, perceptions, and practices in the Saudi population: a cross-sectional study
type: item
type: AcademicArticle
description: Background Probiotics are composed of trillions of microorganisms, mainly located in the gastrointestinal tract (GIT), which play vital roles in digestion, immunity, and overall well-being. They help maintain gut health and prevent various gastrointestinal disorders. Despite the widespread use of probiotics in developed countries, such as North America and Western Europe, little is known about their use in Saudi Arabia. This study aimed to assess the knowledge, attitudes, and factors influencing probiotic awareness among the Saudi public to support healthier dietary choices. Materials A cross-sectional study using a structured questionnaire titled “Public Knowledge and Perception of Probiotics” was conducted among Saudi residents aged 18 years and older from July to October 2024. With a type I error rate of 5% (α = 0.05) and 80% power, the required sample size was 269; ultimately, 286 individuals participated in the study. Data were analyzed using the Statistical Package for the Social Sciences version 27 (IBM). Results The majority of the 286 participants were female (79%) and over 30 years old (54.9%). Awareness of probiotics was moderate (mean score: 5.2; 65%), with yogurt being the most recognized source (95%). Participants generally had positive perceptions (mean score: 3.74 ± 0.60), although barriers such as limited knowledge (56.2%) and high cost (3.28 ± 1.09) were reported. Probiotic use was noted in 54.5% of the respondents, with 71.2% preferring natural sources. Usage was significantly associated with demographic factors, including age ( $\chi^2$χ2 = 15.251, P < 0.001), education level ( $\chi^2$χ2 = 18.787, P < 0.001), marital status ( $\chi^2$χ2 = 9.825, P = 0.002), and monthly income ( $\chi^2$χ2 = 8.548, P = 0.014). Conclusion While awareness and positive perceptions of probiotics are growing among the Saudi population, challenges such as knowledge gaps, affordability, and limited advertising persist. To promote probiotic use and improve public health …
format: application/pdf
format: text/html
creator: Basmah F. Alharbi
subject: Epidemiology
subject: Public Health
description: doi:10.7717/peerj.20490
publisher: PeerJ Inc.
rights: © 2025 Alharbi
abstract: Background Probiotics are composed of trillions of microorganisms, mainly located in the gastrointestinal tract (GIT), which play vital roles in digestion, immunity, and overall well-being. They help maintain gut health and prevent various gastrointestinal disorders. Despite the widespread use of probiotics in developed countries, such as North America and Western Europe, little is known about their use in Saudi Arabia. This study aimed to assess the knowledge, attitudes, and factors influencing probiotic awareness among the Saudi public to support healthier dietary choices. Materials A cross-sectional study using a structured questionnaire titled “Public Knowledge and Perception of Probiotics” was conducted among Saudi residents aged 18 years and older from July to October 2024. With a type I error rate of 5% (α = 0.05) and 80% power, the required sample size was 269; ultimately, 286 individuals participated in the study. Data were analyzed using the Statistical Package for the Social Sciences version 27 (IBM). Results The majority of the 286 participants were female (79%) and over 30 years old (54.9%). Awareness of probiotics was moderate (mean score: 5.2; 65%), with yogurt being the most recognized source (95%). Participants generally had positive perceptions (mean score: 3.74 ± 0.60), although barriers such as limited knowledge (56.2%) and high cost (3.28 ± 1.09) were reported. Probiotic use was noted in 54.5% of the respondents, with 71.2% preferring natural sources. Usage was significantly associated with demographic factors, including age ( $\chi^2$χ2 = 15.251, P < 0.001), education level ( $\chi^2$χ2 = 18.787, P < 0.001), marital status ( $\chi^2$χ2 = 9.825, P = 0.002), and monthly income ( $\chi^2$χ2 = 8.548, P = 0.014). Conclusion While awareness and positive perceptions of probiotics are growing among the Saudi population, challenges such as knowledge gaps, affordability, and limited advertising persist. To promote probiotic use and improve public health …
bibliographic citation: Alharbi (2025) Exploring probiotic awareness, perceptions, and practices in the Saudi population: a cross-sectional study. PeerJ 13:e20490 https://doi.org/10.7717/peerj.20490
date submitted: 2025-02-05
date accepted: 2025-11-07
issued: 2025-12-05
is part of: PeerJ
license: https://creativecommons.org/licenses/by/4.0/
author list: Agent
  family name: Alharbi
  given name: Basmah F.
doi: 10.7717/peerj.20490
volume: 13
issn: 2167-8359
publication name: PeerJ
publication date: 2025-12-05
copyright: © 2025 Alharbi
attribution name: Alharbi

PeerJ
type: Periodical
uri: PeerJ
issn: 2167-8359