title: PeerJ description: Articles published in PeerJ link: https://peerj.com/articles/index.rss3?journal=peerj creator: info@peerj.com PeerJ errorsTo: info@peerj.com PeerJ language: en title: Association between WeChat-based remote care guidance and diabetic foot ulcer healing: a retrospective cohort study link: https://peerj.com/articles/20624 last-modified: 2026-01-09 description: ObjectiveThe aim of this study was to evaluate the effectiveness of WeChat-based remote care guidance as a supplement to standard care for patients with diabetic foot ulcers. Our specific objectives were to compare healing rates, self-management behaviors, and patient satisfaction between the two groups, with a focus on identifying patient subgroups that might benefit most from this approach.MethodsA retrospective cohort study was conducted at Fujian Maternity and Child Health Hospital between June 2021 and December 2022, with follow-up until December 2024. Among 131 eligible patients with diabetic foot ulcers (Wagner grades 1–4), 59 received WeChat -based guidance (intervention) while 72 received standard care (control). Primary outcomes included wound healing rate and time-to-healing. Quality of life (WHOQOL-BREF) and treatment satisfaction (DTSQs) were assessed at baseline, 3, 6, 12, and 24 months. Analyses were adjusted for demographic characteristics, clinical parameters, and disease severity indicators.ResultsThe intervention group showed significantly higher healing rates (88.1% vs 63.9%, P = 0.001) and faster healing time (HR = 2.27, 95% CI [1.35–3.82], P = 0.002). The effect was particularly pronounced in Wagner grade 2–3 ulcers (HR = 14.3–34.2, P < 0.001) and patients receiving interventional procedures (HR = 3.4, 95% CI [1.8–6.3], P <0.001). At 24 months, the intervention group demonstrated greater improvements in quality of life (mean difference = 7.87, P < 0.001) and treatment satisfaction (mean difference = 6.70, P < 0.001).ConclusionWeChat-based remote care guidance was associated with better diabetic foot ulcer healing outcomes, particularly for moderate-severity ulcers and patients undergoing interventional procedures. Our findings also suggest associations between this approach and improvements in quality of life and treatment satisfaction. creator: De Qin Chen creator: Chao Yun Jiang creator: Tian Hong Cai creator: Rong Zhang creator: Teng Hui Zhan uri: https://doi.org/10.7717/peerj.20624 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2026 Chen et al. title: Improving exercise motivation and physical fitness in college students through a long-term mindfulness-enhanced Tai Chi Chuan program: a randomized controlled trial link: https://peerj.com/articles/20602 last-modified: 2026-01-09 description: BackgroundWhile Tai Chi Chuan (TCC) is widely recognized for its physical and mental health benefits, its mindful components are often overlooked in traditional training. Mindfulness-enhanced Tai Chi Chuan (MTCC) has been proposed to address this limitation, yet little research has explored its long-term impact on exercise motivation and physical fitness. This study extends previous findings by investigating the sustained effects of a 24-week MTCC intervention in improving physical and mental health outcomes among college students, with a focus on long-term sustainability and motivation maintenance that distinguishes it from our prior short-term research.MethodsA randomized controlled trial was conducted with 80 college students assigned to either an MTCC group or a traditional TCC group. Seventy-one participants completed the allocated intervention, while nine participants dropped out for personal reasons. No serious adverse events (SAEs) were reported. The MTCC program was delivered in two stages over 24 weekly sessions. The first stage introduced participants to mindfulness-enhanced Taiyi Mirrored-heart Chuan, emphasizing foundational postures and mindfulness principles. The second stage involved traditional TCC training to consolidate the skills and motivation gained during the first stage. Outcome measures, including exercise motivation, physical fitness, mindfulness and subjective well-being, were assessed pre- and post-intervention.ResultsRepeated measures analysis of variance (ANOVA) indicated that participants in the MTCC group demonstrated significantly greater improvements in all measured outcomes compared to the traditional TCC group. Specifically, the 24-week intervention showed larger effect sizes in physical fitness (η2p = 0.224) compared to our prior study (η2p = 0.033–0.210), highlighting the value of long-term intervention.ConclusionThese findings highlight the long-term benefits of integrating mindfulness into TCC practice, particularly in fostering intrinsic motivation for physical activity and enhancing overall well-being. The study underscores the potential of MTCC as a sustainable intervention for promoting holistic health in college students and its applicability in educational and wellness settings.Clinical review registrationhttps://www.chictr.org.cn/, identifier ChiCTR2200058449. creator: Ping Qu creator: Xiaoqing Zhu creator: Ting Zhu creator: Hui Zhou creator: Minghua Huang creator: Feng Pan creator: Xiaoyan Wang creator: Jingsi Wen creator: Yang Liu creator: Yu Zhang creator: Fangbin Li creator: Yuyin Wang uri: https://doi.org/10.7717/peerj.20602 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2026 Qu et al. title: Beneath the canopy, beneath the ground: how surface microhabitats shape cave communities link: https://peerj.com/articles/20593 last-modified: 2026-01-09 description: Ecosystem dynamics are shaped by spatial and temporal fluctuations in resource availability and species composition across the landscape. Caves exemplify this interconnectedness, as they rely on allochthonous inputs and surface climatic conditions, fostering communities composed of viable populations from both surface and subterranean habitats. Consequently, effective management and conservation of subterranean environments require the protection of adjacent surface ecosystems, a particularly urgent need in the Amazonian ferruginous hills, where mineral exploitation poses a significant threat. In this context, we investigated how vegetation cover and environmental variables influence the distribution of surface and subterranean fauna, and which factors should guide conservation strategies. We sampled six caves and ten epigean transects around each, encompassing both ombrophilous forest and canga (savanna over ferruginous crusts). Environmental structure variables were recorded for all transects. Significant differences were detected between forest and canga in terms of vegetation structure, microclimate, species richness, and community composition. Species most similar to those found in caves were associated with forest leaf litter, particularly in transects closest to cave entrances. Leaf litter depth emerged as a key factor facilitating faunal overlap between surface and subterranean habitats, likely by providing microhabitats with stable temperature and humidity. In contrast, faunal similarity in canga occurred only under specific conditions, namely, milder temperatures, deeper litter layers, and increased canopy cover. Our findings demonstrate that cave-dwelling species in Amazonian ferruginous systems also inhabit adjacent forest environments, which should be prioritized for conservation. creator: Marcus P. A. Oliveira creator: Rodrigo L. Ferreira uri: https://doi.org/10.7717/peerj.20593 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2026 Oliveira and Ferreira title: Integrating cerebrovascular morphology and radiomics features for predicting stroke prognosis: a retrospective study link: https://peerj.com/articles/20588 last-modified: 2026-01-09 description: Accurately predicting 90-day Modified Rankin Scale (mRS) scores for acute ischemic stroke (AIS) patients is crucial for guiding treatment strategies. However, many existing mRS prediction methods rely on clinicians to manually evaluate relevant features, and the accuracy of feature quantification and model reproducibility still need to be further improved. This study proposes a machine learning framework that combines multimodal imaging features in order to predict 90-day mRS outcomes. A retrospective analysis was conducted on 86 AIS cases. Morphological features of the intracranial arterial and venous system were extracted from computed tomography angiography (CTA) images. Additionally, radiomics features were obtained from the ischemic lesion on diffusion-weighted imaging (DWI). Recognizing the significance of the peri-infarct penumbra in stroke prognosis, radiomics features were also extracted from the annular region surrounding the ischemic lesion. Redundant features were eliminated using a sparse representation method, and a sparse representation-based classifier was developed to predict mRS outcomes. Model performance was validated using cross-validation and independent test. A total of 1,066 features, including 40 vascular morphological features and 1,026 radiomics features, were extracted. Both feature types demonstrated statistical significance (P < 0.05). Ultimately, 26 features were selected to construct the classification model. The proposed model achieved robust performance on the independent test set, with a classification accuracy of 0.828, an area under the curve (AUC) of 0.942, sensitivity of 0.789, specificity of 0.900, positive predictive value of 0.937, and negative predictive value of 0.692. By integrating vascular morphological features with radiomics features from the ischemic lesion and peri-ischemic lesion regions in DWI, the proposed machine learning model provides accurate predictions of 90-day clinical outcomes for AIS, offering valuable insights for personalized stroke management. creator: Suying Pu creator: Shunjun Li creator: Jing Shao creator: Jixian Lin creator: Huanyin Li creator: Jinjiang Shen creator: Hui Zheng uri: https://doi.org/10.7717/peerj.20588 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2026 Pu et al. title: Perceived social support as a mediator between left-behind experience and subjective well-being in Chinese college students link: https://peerj.com/articles/20567 last-modified: 2026-01-09 description: BackgroundLeft-behind experience (LBE), where children are separated from one or both parents due to parental migration for work, has been shown to negatively affect college students’ psychological well-being. This study explores the relationship between LBE and subjective well-being (SWB) among college students and investigates whether perceived social support (PSS) mediates this relationship.MethodsA cross-sectional survey was conducted with 1,228 undergraduate students across four Chinese universities. Participants completed the Perceived Social Support Scale (PSSS) and the Subjective Well-Being Scale (SWB). Statistical analyses, including independent t-tests, Pearson correlations, and mediation analysis (using SPSS PROCESS), were performed to test the hypotheses.ResultsStudents with LBE reported lower levels of both PSS and SWB compared to their non-LBE peers. PSS was found to fully mediate the relationship between LBE and SWB. Specifically, LBE negatively affected PSS, which in turn positively influenced SWB. The direct effect of LBE on SWB was non-significant, highlighting the importance of PSS in this relationship.ConclusionsThe study emphasizes that LBE itself does not directly dictate developmental outcomes. Instead, it influences college students through the reduction of perceived social support. These findings suggest that enhancing social support systems in universities and communities can significantly improve the well-being of college students with LBE, and this approach has potential implications beyond the Chinese context. creator: Biwei Zhou creator: Lei Zhang uri: https://doi.org/10.7717/peerj.20567 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2026 Zhou and Zhang title: Comparison of the safety and efficacy of remimazolam for sedation during bronchoscopy: a meta-analysis of randomized controlled trials link: https://peerj.com/articles/20552 last-modified: 2026-01-09 description: ObjectiveTo evaluate the comparative efficacy and safety of remimazolam vs. established sedatives (dexmedetomidine, propofol, midazolam) for sedation during bronchoscopy.MethodsA systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted according to PRISMA guidelines and Cochrane Handbook recommendations (PROSPERO CRD420251071986). Databases (EMBASE, PubMed, Scopus, Cochrane Central, Web of Science) were searched from inception to May 14, 2025. Included studies were RCTs comparing intravenous remimazolam to comparator sedatives in adults (≥18 years) undergoing bronchoscopy. Primary outcome was procedural success rate (completion without rescue sedation). Secondary outcomes included onset time, wake-up time, procedure duration, patient satisfaction, and adverse events (hypotension, hypoxemia, tachycardia, bradycardia, hypertension). Risk of bias was assessed using RoB 2. Data were pooled using random-effects models, reporting mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI).Results13 RCTs (n = 2,002 patients) were included. Remimazolam demonstrated: Procedural success: Significantly higher success rates vs. dexmedetomidine (OR 2.87, 95% CI [1.13–7.29], P = 0.03; I2 = 62%) and vs. midazolam (OR 3.65, 95% CI [1.40–9.49], P = 0.008; absolute rates 77.1% vs. 3.6%). Comparable success rates to propofol (OR 0.55, 95% CI [0.11–2.61], P = 0.45; rates ~98% each). Onset/Recovery: Faster onset vs. dexmedetomidine (MD −2.01 min, 95% CI [−2.08 to −1.93], P < 0.001; I2 = 0%). Shorter wake-up time vs. dexmedetomidine (MD −1.84 min, 95% CI [−3.31 to −0.37], P = 0.01) and vs. midazolam (MD −4.72 min, 95% CI [−8.05 to −1.39], P = 0.005). Comparisons with propofol were inconclusive due to heterogeneity. Safety: Significantly lower risk of hypotension vs. propofol (OR 0.35, 95% CI [0.23–0.55], P < 0.00001) and hypoxemia vs. dexmedetomidine (OR 0.41, 95% CI [0.18–0.96], P = 0.04). Significantly higher risk of tachycardia vs. dexmedetomidine (OR 3.01, 95% CI [1.37–6.60], P = 0.006). No significant safety differences vs. midazolam. Patient satisfaction was equivalent to propofol.ConclusionRemimazolam is a highly effective and safe sedative for bronchoscopy. It offers superior procedural success and faster recovery compared to dexmedetomidine and midazolam, while matching the high success rate of propofol. Its key safety advantage is significantly reduced hypotension risk compared to propofol, making it particularly suitable for vulnerable patients. Remimazolam represents a valuable addition to sedation options for this procedure. creator: Yupei Yuan creator: Chunlei Chang creator: Jing Zhang creator: Liang Liang uri: https://doi.org/10.7717/peerj.20552 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2026 Yuan et al. title: Comparative analysis of transvaginal and transabdominal sliding sign for predicting intra-abdominal adhesions prior to repeat cesarean section: a single center study link: https://peerj.com/articles/20551 last-modified: 2026-01-09 description: BackgroundCaesarean section plays a crucial role in ensuring the health of both mother and newborn, especially when complications arise or are anticipated. However, the increasing global prevalence of caesarean section brings along significant postoperative challenges, notably pelvic adhesions, which can impact subsequent pregnancies and surgeries. Non-invasive preoperative assessment methods, such as ultrasonography, offer promise in enhancing surgical planning and patient outcomes.ObjectiveThis study aims to evaluate the accuracy of transabdominal and transvaginal sliding sign in detecting intraabdominal adhesions in third-trimester pregnant women with a history of caesarean section.MethodThis diagnostic study recruited 35 third-trimester pregnant women with a history of cesarean section undergoing scheduled repeat cesarean at a tertiary referral hospital. All participants underwent both via transvaginal (TV) and transabdominal (TA) ultrasound before surgery. The presence of a positive or negative sliding sign was recorded for each modality. Intra-abdominal adhesions were confirmed intraoperatively and used as the gold standard. Diagnostic accuracy was calculated for each modality. Comparative analysis was conducted across patient characteristics and outcomes.ResultAll 35 patients underwent both TA and TV ultrasound evaluations (within-subject design). The majority of participants were aged between 31 and 40 years (68.6%), were multigravida (65.7%), and had undergone two caesarean sections (51.4%). The sliding sign was negative in 18 (51.4%) and 17 (48.6%) patients using TA and TV approaches, respectively. Both modalities showed high sensitivity (93.75%) and specificity (84.21%) in detecting adhesions. There was no statistically significant difference between TA and TV sliding signs in relation to age or obstetric status. Comparative analysis of both modalities showed equivalent diagnostic performance.ConclusionBoth transabdominal and transvaginal sliding sign evaluations demonstrate high accuracy in detecting intra-abdominal adhesions in women undergoing repeat cesarean section. The within-subject comparison suggests either modality may be reliably used depending on clinical and logistic factors. creator: Peby Maulina Lestari creator: Imas Kartika Dewi E creator: Abarham Martadiansyah creator: Theodorus Theodorus creator: Nuswil Bernolian creator: Putri Mirani creator: Muhammad Al Farisi Sutrisno creator: Bella Stevanny uri: https://doi.org/10.7717/peerj.20551 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2026 Lestari et al. title: New insights into lactylation in respiratory diseases: progress and perspectives link: https://peerj.com/articles/20548 last-modified: 2026-01-09 description: Lactate is conventionally regarded as a metabolic byproduct and generated through diverse pathophysiological pathways. However, a growing body of evidence supports its regulatory roles in energy metabolism and signal transduction, boosting extensive research into lactate-mediated lactylation as a newly discovered post-translational modification (PTM). Lactylation can occur on both histone and non-histone proteins, thereby modulating gene transcription and protein function. By influencing various biological processes, lactylation has been shown to intricately participate in the onset and progression of respiratory diseases that are closely related to metabolic abnormalities and remodeling, including asthma, lung cancer, pulmonary fibrosis, silicosis, pulmonary hypertension (PH), and acute lung injury (ALI). In this review, we summarize the current progress in this field, underscoring the multifaceted regulatory and functional mechanisms underlying lactylation, the pivotal role of lactylation in different respiratory diseases, as well with its potential as a therapeutic target. This comprehensive understanding offers novel insights into the pathogenesis of respiratory diseases and opens new avenues for therapeutic approach. creator: Longmin Chen creator: Yuan Zou creator: Qianqian Xu creator: Jing Zhang uri: https://doi.org/10.7717/peerj.20548 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2026 Chen et al. title: A narrow therapeutic window of platelet P2Y12 reactivity in high-risk Chinese percutaneous coronary intervention patients link: https://peerj.com/articles/20536 last-modified: 2026-01-09 description: BackgroundMuch evidence has been provided that a therapeutic window of P2Y12receptor inhibition exists, which is highly significantly associated with ischemic and bleeding events. The therapeutic window for high-risk stratification after percutaneous coronary intervention (PCI) is lacking. We aimed to investigate the therapeutic window of P2Y12receptor inhibition in high-risk Chinese PCI patients.MethodsIn this observational study, we analyzed 860 high-risk patients who were undergoing PCI. The primary endpoint was the correlation between vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) values with bleeding and ischemic components in high-risk patients. The secondary endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, urgent revascularization, and stroke at 12 months after the index procedure.ResultsAmong high-risk patients, VASP-PRI could significantly discriminate between PCI patients with and without ischemic events (area under the curve (AUC): 0.77; 95% CI [0.72–0.82]; P < 0.001). A VASP-PRI ≥ 0.45 was the optimal cutoff point to predict ischemic events (sensitivity: 86.6%; specificity: 63.6%). Similarly, VASP-PRI could also significantly discriminate between PCI patients with and without bleeding events ((AUC): 0.77; 95% CI [0.73–0.81]; P < 0.001). A VASP-PRI ≤ 0.24 was the optimal cutoff point to predict bleeding events (sensitivity: 72.1%; specificity: 70.3%). Multivariate analysis showed that VASP-PRI was an independent predictor of the risk of major adverse cardiovascular events (odds ratio: 10.67, 95% CI [3.78–30.08]).ConclusionOur results suggest that high-risk Chinese PCI patients have a narrow therapeutic window. Within this window, high-risk patients are at lower risk for both ischemic and bleeding events. Platelet reactivity may have significant implications for personalized antiplatelet therapy in high-risk patients. creator: Liying Gong creator: Yaxin Liu creator: Jingle Li creator: Shiming Tan creator: Chengxian Guo creator: Zhengmei Wang creator: Huiling Song creator: Yun Kuang creator: Yu Cao creator: Guoping Yang uri: https://doi.org/10.7717/peerj.20536 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2026 Gong et al. title: Mountains of diversity: a systematic revision of the Andean rodent genus Oreoryzomys (Cricetidae: Sigmodontinae) link: https://peerj.com/articles/20515 last-modified: 2026-01-09 description: The until recently monotypic cricetid genus Oreoryzomys inhabits piedmont and cloud forests, primarily in eastern Ecuador and northwestern Peru. Erected following the taxonomic revision of a polytypic Oryzomys complex two decades ago, Oreoryzomys has remained poorly understood, with most references limited to the original descriptions of its type species (O. balneator) and a subspecies (O. b. hesperus). Here, we present an integrative taxonomic revision of the genus, based on new field collections and comprehensive museum-based analyses. Phylogenetic reconstructions from mitochondrial and nuclear gene sequences, combined with morphometric and qualitative morphological data, support the recognition of three species: (1) a redescribed O. balneator from central-eastern Ecuador; (2) O. hesperus, elevated to full species rank based on topotypic material; and (3) a new species from populations of the Quijos River Valley, northeastern Ecuador. This revision triples the known species diversity of Oreoryzomys and highlights the genus as a notable radiation of small-bodied oryzomyines adapted to Andean environments. Our findings emphasize the need for systematic revisions of other poorly known Andean rodents to better reveal the hidden diversity of cricetids and the role of the Andes in shaping Neotropical biodiversity. creator: Jorge Brito creator: Rocío Vargas creator: Nicolás Tinoco creator: Rubí García creator: Julio C. Carrión-Olmedo creator: Claudia Koch creator: Ricarda Wistuba creator: Carlos Nivelo-Villavicencio creator: Ulyses F.J. Pardiñas uri: https://doi.org/10.7717/peerj.20515 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2026 Brito et al.