title: PeerJ description: Articles published in PeerJ link: https://peerj.com/articles/index.rss3?journal=peerj&page=17 creator: info@peerj.com PeerJ errorsTo: info@peerj.com PeerJ language: en title: Long-term glycemic variability and the risk of heart failure: a meta-analysis link: https://peerj.com/articles/20401 last-modified: 2025-11-27 description: BackgroundLong-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.MethodsWe 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.ResultsEleven 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).ConclusionHigh 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. creator: Yong-Chao Li creator: Ke-Er Mo creator: Li-Shuai Zhang creator: Qiang Zhao creator: Ju Deng creator: Li Li uri: https://doi.org/10.7717/peerj.20401 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Li et al. title: Retrospective analysis of cervical screening abnormalities in women with type 3 transformation zone without visible lesions link: https://peerj.com/articles/20396 last-modified: 2025-11-27 description: ObjectiveWomen 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.MethodsA 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.ResultsAmong 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.ConclusionAmong 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. creator: Jing Yang creator: Qiao Liu creator: Yi Tang creator: Kui Huang creator: Tianmin Chen creator: Jing Zhao uri: https://doi.org/10.7717/peerj.20396 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Yang et al. title: Effects of creatine supplementation on muscle strength gains—a meta-analysis and systematic review link: https://peerj.com/articles/20380 last-modified: 2025-11-27 description: 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.ResultsResults 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.ConclusionCr 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. creator: Haoda Zhang creator: Tian Lan creator: Xueru Yan creator: Haoran Gu creator: Yanhong Li creator: Enpeng He uri: https://doi.org/10.7717/peerj.20380 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Zhang et al. title: Application analysis of two nucleic acid detection systems in blood detection of hepatitis B virus, hepatitis C virus and human immunodeficiency virus link: https://peerj.com/articles/20365 last-modified: 2025-11-27 description: ObjectiveThis 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.MethodsWe 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.ResultsAmong 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).ConclusionThe 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. creator: Tao Wang creator: Jianwei Zhang uri: https://doi.org/10.7717/peerj.20365 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Wang and Zhang title: Validity, reliability and minimal detectable change in the sit-to-stand test for synchronous and asynchronous tele-assessment in post-COVID-19 condition link: https://peerj.com/articles/20211 last-modified: 2025-11-27 description: BackgroundIndividuals 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.ObjectiveThe 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.MethodsThirty-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.ResultsSTS-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.ConclusionThe 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. creator: Juliane Machado Marques creator: Matheus Brasiliano da Paz creator: Rodrigo Rodrigues Gomes Costa creator: Frederico Ribeiro Neto uri: https://doi.org/10.7717/peerj.20211 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Machado Marques et al. title: Insights into the interactions between Deverra tortuosa and Schizomyia buboniae: phytochemicals, antioxidant capacity, and enzyme inhibitory effects link: https://peerj.com/articles/20052 last-modified: 2025-11-27 description: 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. creator: Nashaat N. Mahmoud creator: Abdulaziz R. Alqahtani creator: Noura J. Alotaibi creator: Muhammad I. Haggag creator: Abdelatti I. Nowwar creator: Sanad H. Ragab uri: https://doi.org/10.7717/peerj.20052 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Mahmoud et al. title: Patterns of pre-sleep music use and sleep quality: exploratory survey findings on state anxiety link: https://peerj.com/articles/20444 last-modified: 2025-11-26 description: 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. creator: Andrew Danso creator: Mareike Ehlert creator: Friederike Koehler creator: Rory Kirk creator: Nandhini Natarajan creator: Shannon Eilyce Wright creator: Renee Timmers creator: Suvi Saarikallio uri: https://doi.org/10.7717/peerj.20444 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2025 Danso et al. title: Biological maturation, anthropometric, and physical fitness variables of youth breaking athletes with different competition levels link: https://peerj.com/articles/20383 last-modified: 2025-11-26 description: PurposeThis study aimed to analyze differences in anthropometric characteristics and physical fitness performance based on chronological age, maturation status, and competition level among youth breaking athletes.MethodsMorphological characteristics and selected physical fitness performances were assessed in 23 male youth breaking athletes (mean age: 14.47 ± 1.99 years). Biological maturity was estimated from anthropometric measures and expressed as age at peak height velocity (APHV) and maturity offset. All athletes were classified into two age groups (U14 and U18), three maturity groups (pre-peak height velocity (PHV), circum-PHV, and post-PHV) and two competition level groups (elite and sub-elite). Independent samples t-tests and analysis of variance (ANOVAs) were employed to examine group differences, and Pearson correlation analysis was conducted to investigate intragroup relationships between morphological and physical fitness variables.ResultsThere was no difference in body fat percentage (P > 0.05) between U14 and U18 in terms of anthropometric measurement indicators. In contrast, significant differences (P < 0.05) were observed in most physical fitness indicators (T-test, standing long jump, 30-m sprint, p ull up and 400-m run), with the U18 athletes showing superior performance. No significant differences were observed between elite and sub-elite youth breaking athletes, except in the one-minute sit-up test (P = 0.028). Significant differences among different maturity groups were found in age (P < 0.01), maturity offset (P < 0.001), height (P < 0.001), body mass (P < 0.001), body mass index (BMI) (P < 0.001), sitting height (P < 0.001), leg length (P = 0.016), T-test (P = 0.029), standing long jump (P = 0.019), 30-m sprint (P = 0.006), 30s bodyweight squat (P = 0.030), and 400-m (P = 0.021). While chronological age and maturity status correlated with multiple physical performance indicators, body fat percentage (P > 0.05) showed no such association.ConclusionsChronological age and maturity status play a crucial role in the physical performance of breaking athletes. However, the current physical fitness tests may not effectively distinguish the competitive levels of breaking athletes. Future studies are recommended to further develop and refine sport-specific test batteries. creator: Yifan Zhao creator: Xiaobin Wei creator: Kewei Zhao uri: https://doi.org/10.7717/peerj.20383 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Zhao et al. title: Efflux systems driving resistance and virulence across biological domains link: https://peerj.com/articles/20360 last-modified: 2025-11-26 description: BackgroundEfflux pumps (EPs) are key contributors to multidrug resistance (MDR) in bacteria, fungi, and cancer cells. These membrane proteins actively extrude a variety of therapeutic agents, reducing their intracellular concentration and thus compromising the efficacy of treatment. Beyond resistance, EPs are also involved in virulence, biofilm formation, immune evasion, and environmental persistence.AimThis review aimed to provide a comprehensive and critical synthesis of the role of efflux pumps in antimicrobial and antitumoral resistance, as well as their contribution to virulence and persistence across biological domains.MethodologyA narrative review was conducted following a structured search strategy in PubMed, Scopus, and Web of Science using combinations of terms related to efflux systems, efflux pumps, resistance mechanisms, virulence factors, detection methods, and inhibitors. The review integrates data from in vitro, in silico, and clinical studies, including both classical detection strategies and emerging technologies such as clustered regularly interspaced short palindromic repeats (CRISPR)-based modulation, biosensors, and microfluidics.ResultsEfflux pumps from different families (e.g., resistance-nodulation-division (RND), ATP-binding cassette (ABC), major facilitator superfamily (MFS)) are implicated in the active extrusion of antimicrobial agents, facilitating MDR and treatment failure in pathogens such as E. coli, P. aeruginosa, M. tuberculosis, Candida albicans, and cancer cells. EPs also regulate biofilm formation, virulence factor secretion, and metabolic adaptation. Classical methods for detecting efflux (e.g., minimum inhibitory concentration (MIC) shifts with inhibitors, fluorometric assays) have technical limitations, while novel technologies offer improved precision. Several natural and synthetic efflux pump inhibitors (EPIs) have demonstrated efficacy in preclinical studies, yet few have progressed to clinical use due to toxicity and pharmacokinetic barriers. CRISPR interference systems and combinatory therapies represent promising advances in overcoming EP-mediated resistance.ConclusionEfflux systems are central players in both drug resistance and pathogenicity. Although the development of effective EIs remains challenging, advances in molecular detection, gene editing, and drug design hold potential for translational breakthroughs. A deeper understanding of efflux dynamics across organisms is essential to develop adjuvant therapies and reduce the clinical impact of MDR. creator: Pedro Eduardo Almeida da Silva creator: Andrea Von Groll creator: Ivy Ramis creator: Ana Julia Reis creator: Daniela Ramos creator: Miguel Viveiros uri: https://doi.org/10.7717/peerj.20360 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Almeida da Silva et al. title: Pelvis-Trunk coordination strategies differ a cross preparatory court movement distances during the tennis forehand link: https://peerj.com/articles/20321 last-modified: 2025-11-26 description: ObjectivesTo examine the effects of on-court movement distances on pelvis-trunk coordination during forehand strokes.MethodsEighteen male college tennis athletes participated in this study. They performed forehand stroke task at three different preparatory court movement distances (minimum, medium and maximum movement distances). A one-way repeated-measures ANOVA with Statistical Parametric Mapping was used to determine differences in pelvis-trunk coordination in the transverse plane across the three movement distances, and Pearson’s correlation analysis was used to determine the relationships between each of the four pelvis-trunk coordination features on the dominant and non-dominant side and racket speed.ResultsSignificant differences were observed for different movement distances in the non-dominant pelvis-trunk continuous relative phase (CRP) during 23–41% of the acceleration phase (p = 0.016, F2,34 = 5.901) and in the dominant pelvis-trunk CRP during 76–100% of the acceleration phase (p = 0.016, F2,34 = 5.946). For the minimum distance, significant correlations with racket speed were found in the mean CRP (r =  − 0.889, p = 0.001) and peak CRP (r =  − 0.488, p = 0.04) for the non-dominant side, and the mean CRP (r =  − 0.478, p = 0.045) for the dominant side. Regarding medium distances, significant correlations with racket speed were observed for the non-dominant side in the mean CRP (r =  − 0.493, p = 0.037), peak CRP (r =  − 0.628, p = 0.005), and maximum positive CRP slope (r = 0.477, p = 0.046). For the dominant side, significant correlations with racket speed were noted for peak CRP (r = 0.551, p = 0.018) and maximum positive CRP slope (r = 0.514, p = 0.029). At the maximum distance, significant correlations with racket speed were identified for the dominant side in the maximum positive CRP slope (r = 0.580, p = 0.012) and maximum negative CRP slope (r = 0.566, p = 0.014); however, there was no significant difference in racket speed at impact when approaching from different distances.ConclusionThese findings underscore the role of pelvis-trunk coordination in enhancing racket speed, particularly under varying task constraints. Coaches and players should focus on developing adaptable coordination strategies for optimizing performance across different movement distances. creator: Xiangwei Meng creator: Youngsuk Kim creator: Shuai Wang creator: Sukwon Kim creator: Ming Li uri: https://doi.org/10.7717/peerj.20321 license: https://creativecommons.org/licenses/by-nc/4.0 rights: ©2025 Meng et al.