title: PeerJ description: Articles published in PeerJ link: https://peerj.com/articles/index.rss3?journal=peerj&page=25 creator: info@peerj.com PeerJ errorsTo: info@peerj.com PeerJ language: en title: Modified STOP-Bang questionnaire for detecting obstructive sleep apnea in individuals with a body mass index below 35 kg/m2 link: https://peerj.com/articles/20310 last-modified: 2025-11-11 description: BackgroundObstructive sleep apnea (OSA) is a common clinical condition. Due to its high prevalence, the waiting list for polysomnography is often long. A screening tool is needed to identify individuals at high risk for OSA who should undergo polysomnography. The STOP-Bang questionnaire is a widely used screening tool; however, it may require modification for individuals with a body mass index (BMI) below 35 kg/m2. This study aimed to evaluate whether the STOP-Bang questionnaire should be modified for patients with a BMI under 35 kg/m2.MethodsThis retrospective analytical study included adult patients suspected of having OSA who underwent polysomnography. Exclusion criteria included pregnancy and a BMI over 35 kg/m2 or meeting criteria for bariatric surgery. Patients were categorized into OSA and non-OSA groups. Logistic regression analysis was used to assess the predictive value of STOP-Bang factors for OSA.ResultsA total of 188 patients were included, of whom 158 (84.04%) were diagnosed with OSA. Among the eight STOP-Bang criteria, only age was independently associated with OSA after adjustment for other variables (adjusted odds ratio: 1.04; 95% CI [1.02–1.08]). Optimal cut-off points for predicting OSA were identified as age ≥ 40 years (sensitivity: 84.18%), BMI ≥ 23 kg/m2 (sensitivity: 82.91%), and neck circumference ≥ 35 cm (sensitivity: 86.08%). A modified STOP-Bang score incorporating these cut-offs showed improved sensitivity at a score of 3: 93.0% for apnea-hypopnea index (AHI) ≥ 5 events/hr, 95.9% for AHI ≥ 15 events/hr, and 97.6% for AHI ≥ 30 events/hr. In comparison, the original STOP-Bang score of 3 had sensitivities of 50.0%, 53.6%, and 56.1% for AHI ≥ 5 events/hr, AHI ≥ 15 events/hr, and AHI > 30 events/hr, respectively.ConclusionsThe STOP-Bang questionnaire may require modification for individuals with a BMI below 35 kg/m2 who are suspected of having OSA. Revised cut-off values for age, neck circumference, and BMI—40 years, 35 cm, and 23 kg/m2, respectively—may enhance its diagnostic performance. creator: Napassorn Sinsopa creator: Viriya Tripakornkusol creator: Sittichai Khamsai creator: Kittisak Sawanyawisuth uri: https://doi.org/10.7717/peerj.20310 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Sinsopa et al. title: Effects of combined application of compound fertilizer and biochar on absorption and utilization of phosphorus by wheat link: https://peerj.com/articles/20308 last-modified: 2025-11-11 description: Unreasonable fertilization practices are still applied in agricultural production, resulting in reduced crop yields and wasting resources. Therefore, it is essential to optimize fertilization regimes to improve the nutrient absorption capacity of crops. However, the effects of combining nitrogen, phosphorus, and potassium (NPK) compound fertilizer with biochar on the uptake and utilization of phosphorus (P) by wheat and soil fertility remain poorly understood. Thus, we tested three biochar levels (0 quintal (q) ha−1 (B1), 75 q ha−1 (B2), and 150 q ha−1(B3)) and four compound fertilizer levels (0 q ha−1 (F1), 2.25 q ha –1(F2), 4.50 q ha−1 (F3), and 6.75 q ha−1 (F4)), and compared the effects of different experimental combinations across two years. The results showed that combined application could increase the wheat yield, soil P content, accumulated plant P, and P utilization efficiency. Among the different treatments, the wheat yields in both years were highest under B2F3, and the total soil P contents in the booting and flowering stages were also the highest. The soil available P contents in the jointing stage, booting stage, and flowering stage were highest under B3F3. The available P soil contents at maturity in both years were highest under B3F4. In addition, compared with B1F4, the accumulated plant P amounts in the booting and flowering stages were 17.6–77.3% and 17.0–87.3% higher, respectively, under B2F2, B2F3, B3F2, and B3F4 (P < 0.05). The accumulated plant P amounts in the maturity stage during the two years were highest under B2F3 (0.83 q ha−1) and B3F3 (0.42 q ha−1), respectively. Moreover, the partial factor productivity and agronomic use efficiency were significantly higher under B2F2, B2F3, B3F2, and B3F3 than B1F4. In summary, under the experimental conditions in this study, applying compound fertilizer at 4.50 q ha−1 combined with biochar at 75 q ha−1 is recommended as the optimal fertilization scheme. creator: Yun Li creator: Jiatong Wang creator: Jiahui Lu creator: Yanfei Feng creator: Jingjing Li creator: Zhenqing Guo creator: Xiaohu Lin creator: Yucui Han uri: https://doi.org/10.7717/peerj.20308 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Li et al. title: Impact of historical land use change on the brown bear habitat connectivity in the Polish Carpathians link: https://peerj.com/articles/20295 last-modified: 2025-11-11 description: BackgroundEurope has undergone dynamic land use changes in recent decades that have affected the extent, quality, and connectivity of large carnivore habitats. However, the current distribution of large carnivores also depends on historical land use processes. In this article, we analyse the impact of historical land use changes on the potential connectivity of brown bear habitats in the region linking the western and eastern parts of the Carpathians, one of Europe’s biodiversity hotspots.MethodsThe analyses were conducted based on elevation, slope, and distance-based, land use-related variables representing four time periods: 1860s, 1930s, 1970s, and 2013, using cost surface and least-cost path analyses. We used two different approaches to create cost surfaces: weighted, where the weights differentiated between variables according to their relative importance, reflecting their role in either bear space selection or avoidance, and unweighted, where all the variables were treated as equally important.ResultsThe results of both approaches showed a gradual improvement in habitat connectivity for brown bears over time, driven by the increase in forest cover observed over the whole analysed period. However, the dynamics of these changes were much higher after the forced post-war resettlement in the 1940s. These tragic events resulted in the removal of settlements over large areas, substantially reducing human pressure and allowing brown bears to spread into new territories, expanding their habitats and creating new connectivity opportunities. We found that up to 40% of the current corridor was stable since mid-19th century. Our analysis shows that the current population decline in many rural areas of Europe may have positive implications for the habitats and population connectivity of large carnivores, but careful planning is needed to avoid negative interactions with local communities. creator: Anna Szwagierczak creator: El.zbieta Ziółkowska creator: Joanna Wąs creator: Michał Jakiel creator: Dominik Kaim uri: https://doi.org/10.7717/peerj.20295 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Szwagierczak et al. title: Integrated bioinformatics screening and experimental validation: construction of a LUAD prediction model based on Treg-related genes link: https://peerj.com/articles/20287 last-modified: 2025-11-11 description: BackgroundThe prognosis of lung adenocarcinoma (LUAD) is poor, and clinical treatment mainly comprises a combination of traditional therapy and immunotherapy. However, the role and mechanism of tumor-infiltrating regulatory T cells (Tregs) in immunotherapy remain controversial. Therefore, we aimed to determine the role of Tregs in LUAD and to construct a relevant prognostic model for future clinical treatment.MethodsA LUAD dataset was downloaded from the Gene Expression Omnibus (GEO) database, screened, integrated, and divided into test and validation datasets. CIBERSORT and weighted correlation network analysis (WGCNA) algorithms were combined to screen for Treg cell-related modules. Minimum absolute contraction and selection operator (LASSO) and univariate and multivariate Cox regression analyses were used to screen genes in the key modules and construct Treg-related prognostic models. Then, the expression differences of genes in the prognostic model were analyzed, and the results were verified by Western blotting.ResultAmong all cluster modules, the correlation between the brown module and Treg s (R2 = 0.43, P = 1e − 30) was the highest. After LASSO and univariate and multivariate Cox regression screening, six genes (ADARB2, B3GALT, FER, LTB4R2, N6AMT1, and SCN9A) were selected to construct the prognosis model, and the prognosis of low-risk patients was found to be better than that of high-risk patients. Finally, the SCN9A gene with the highest correlation with the model was selected and verified using Western blot analysis. The results showed that the expression of Treg surface markers in LUAD cells was increased, and the expression of SCN9A was decreased compared with that in normal lung epithelial cells.ConclusionWe identified the role of Treg-related genes in LUAD, constructed and verified a related prognostic model, and explored a potential therapeutic target, SCN9A, to provide a new perspective for the clinical treatment of LUAD. creator: Tian Zhao creator: Yan Yao creator: Yan Sun creator: Qingliang Lv creator: Changgang Sun creator: Yining Cheng creator: Chundi Gao creator: Jing Zhuang uri: https://doi.org/10.7717/peerj.20287 license: https://creativecommons.org/licenses/by-nc/4.0 rights: ©2025 Zhao et al. title: IPI score as a new prognostic index in extensive stage small cell lung cancer link: https://peerj.com/articles/20343 last-modified: 2025-11-10 description: BackgroundPersonalized prognostic assessment in extensive-stage small cell lung cancer (ES-SCLC) necessitates a comprehensive understanding of systemic inflammatory markers and their impact on survival outcomes. This study aimed to evaluate the prognostic significance of a novel Inflammatory Prognostic Index (IPI) score, derived from four inflammation-related biochemical markers—albumin, C-reactive protein (CRP), neutrophils, and lymphocytes—in patients with ES-SCLC.Methods Patients diagnosed with ES-SCLC were eligible if adequate clinical, pathological, and follow-up data were available. The IPI score was derived using the formula: C-reactive protein × neutrophil-to-lymphocyte ratio (NLR)/serum albumin. The threshold value for the IPI score was identified using receiver operating characteristic (ROC) curve analysis within the cohort and was applied in an exploratory manner. Based on the predefined cut-off, patients were stratified into low- and high-IPI groups. The log-rank test was used to compare survival times, while Kaplan–Meier curves and Cox regression analyses assessed variables associated with long-term survival. Overall survival (OS) served as the primary endpoint, and progression-free survival (PFS) was evaluated as a secondary endpoint.ResultsPatients with a high IPI score had a mean OS of 9 months (95% CI [4.8–13.2]), while those with a low IPI score had a mean OS of 23 months (95% CI [11.4–34.6]), a statistically significant difference (p = 0.005). The prognostic significance of IPI was confirmed in both univariate (p = 0.003) and multivariate (p = 0.012) analyses.ConclusionThe IPI score in ES-SCLC patients was associated with prognosis, with a high IPI score indicating poorer OS. These findings should be considered hypothesis-generating and warrant validation in larger prospective cohorts. creator: Ahmet Burak Ağaoğlu creator: Ferhat Ekinci creator: Mustafa Şahbazlar creator: Atike Pınar Erdoğan uri: https://doi.org/10.7717/peerj.20343 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Ağaoğlu et al. title: The association of maternal pre-pregnancy body mass index with macrosomia: a birth cohort study from China link: https://peerj.com/articles/20332 last-modified: 2025-11-10 description: ObjectiveTo investigate the association between pre-pregnancy body mass index (BMI) and the risk of macrosomia through a preconception-early pregnancy-birth cohort in China.MethodsAmong the 12,254 women initially recruited between July 2018 and December 2021, a total of 11,438 (drop out rate: 6.66%) mother–infant pairs were included in the final analysis after excluding participants with missing data on key variables or lost to follow-up. We collected basic demographic characteristics and lifestyle behavior information of the subjects through questionnaires and practical measurements, and conducted further follow-up for pregnancy outcomes. The study assessed the association between pre-pregnancy BMI-defined categories (underweight, normal weight, overweight, and obesity) and macrosomia using multivariable logistic regression models, adjusting for sociodemographic characteristics, lifestyle behaviors, and maternal clinical factors during pregnancy. A linear trend test was also conducted. Moreover, we utilized restricted cubic spline models with three knots (placed at the 10th, 50th, and 90th percentiles of BMI) and polynomial regression to investigate the non-linear relationship of pre-pregnancy BMI with macrosomia.ResultsA total of 11,438 subjects were included in this study, among whom 645 infants were diagnosed with macrosomia, resulting in a prevalence of 5.64%. The results indicated that, compared with the normal weight group, overweight women had a significantly higher risk of macrosomia (odds ratio (OR) = 1.66, 95% CI [1.35–2.01]), as did obese women (OR = 1.66, 95% CI [1.13–2.45]), while underweight women had a significantly lower risk (OR = 0.55, 95% CI [0.41–0.73]). A similar association pattern between pre-pregnancy BMI and grade 1 macrosomia was observed, consistent with that for overall macrosomia. The use of restricted cubic splines revealed that the prevalence of macrosomia/grade 1 macrosomia increased with rising pre-pregnancy BMI. Furthermore, when we stratified the data by covariates, the nonlinear relationship between pre-pregnancy BMI and macrosomia/grade 1 macrosomia persisted. The results of the polynomial regression showed a gradual increase in fetal birth weight with increasing pre-pregnancy BMI levels.ConclusionsPre-pregnancy overweight and obesity were associated with higher risks of macrosomia. Therefore, these findings suggest that promoting healthy weight management before conception may be an effective public health strategy to reduce the risk of macrosomia and improve perinatal outcomes. creator: Mingxin Yan creator: Yunbo Zhang creator: Doudou Zhao creator: Yan Zhao creator: Danmeng Liu creator: Li Shan creator: Yang Mi creator: Leilei Pei creator: Pengfei Qu uri: https://doi.org/10.7717/peerj.20332 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2025 Yan et al. title: Research progress of tsRNAs in kidney diseases link: https://peerj.com/articles/20315 last-modified: 2025-11-10 description: Transfer RNA-derived small RNAs (tsRNAs) are a class of regulatory non-coding RNAs generated through enzymatic cleavage of precursor or mature tRNAs. In recent years, tsRNAs have garnered growing interest in nephrology due to their diverse biological functions and potential clinical significance. This review summarizes current research on the roles of tsRNAs in kidney diseases, including their involvement in gene expression regulation, signal transduction, apoptosis, and inflammation-related pathways. We further highlight their emerging mechanistic contributions in conditions such as acute kidney injury, chronic kidney disease, and glomerulonephritis. Finally, we discuss the prospects of tsRNAs as novel biomarkers for early diagnosis, prognosis assessment, and therapeutic targeting in renal disorders, aiming to offer new insights into kidney disease pathogenesis and management. creator: Jialing Wang creator: Yanzhe Wang creator: Fengqin Li creator: Xinmiao Xie creator: Xinyue Chen creator: Tong Wu creator: Xiaoxia Wang uri: https://doi.org/10.7717/peerj.20315 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Wang et al. title: A preliminary assessment of population genetic structure of the common vampire bat (Desmodus rotundus) in Colombia link: https://peerj.com/articles/20306 last-modified: 2025-11-10 description: Rabies virus (RABV) is a neglected tropical pathogen in Latin America predominantly transmitted to mammals by the common vampire bat (Desmodus rotundus). Transmission of RABV among D. rotundus individuals and colonies is a function of individual dispersal between colonies, patterns of which can be inferred from population genetic structure. Nevertheless, a baseline assessment of population genetic structure among D. rotundus individuals has been lacking for some areas of South America, including Colombia, where RABV has impacted some areas more heavily than others. To assess individual dispersal and hence population structure of D. rotundus across heterogenous landscapes in Colombia, we conducted a cross-elevational assessment of population genetic variation using nuclear microsatellite DNA markers. We quantified genetic variance and geographic distribution of genetically clustered D. rotundus individuals across the landscape of Colombia with reference to a comparator group of individuals from Mexico. We found population-level differentiation and genetic structure within our collection of samples, and we inferred patterns of dispersal and genetically effective migration between D. rotundus populations. Analysis of molecular variance (AMOVA) showed considerable variation among inferred populations in Colombia (14.9% of genetic covariance, df = 2, Sum of Squares = 164.9, Sigma = 1.28, ϕ = 0.15, p = 0.01), with an associated G′ST of 0.34. Direct migrant identification suggested 15 likely first-generation migrants among sites. We found that there were no statistically significant differences between the landscapes occupied by the inferred populations, though our limited sampling size suggests a trend toward differences in relation to elevation (t = 1.91, df = 71.72, p = 0.06). These results indicate that D. rotundus is mobile within the region, potentially contributing to RABV transmission among colonies. Our results support previous hypotheses ecological resistance-mediated patterns of dispersal for D. rotundus, and inform future research on the role of genetic connectivity in RABV transmission among bat colonies. creator: Paige Van de Vuurst creator: Analorena Cifuentes-Rincon creator: Andrea S. Bertke creator: Diego Soler-Tovar creator: Nicolás Reyes-Amaya creator: Fabiola Rodriguez Arévalo creator: Julieth Stella Cárdenas Hincapié creator: Jhon Rivera-Monroy creator: Luis E. Escobar creator: Eric Hallerman uri: https://doi.org/10.7717/peerj.20306 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Van de Vuurst et al. title: Development and validation of a functional assessment tool for Chinese inpatient rehabilitation: insights from a Delphi study based on the International Classification of Functioning, Disability, and Health (ICF) link: https://peerj.com/articles/20280 last-modified: 2025-11-10 description: ObjectivesTo develop and validate a functional assessment tool for inpatient rehabilitation in China using the International Classification of Functioning, Disability, and Health (ICF) Rehabilitation Set (ICF-RS) framework and the Delphi method.MethodsA three-round Delphi process engaged 15 experts to refine ICF-RS items via a 5-point importance questionnaire. Validation involved 2,574 inpatients assessed with a numerical rating scale. Reliability (Cronbach’s alpha) and structural validity (factor analysis) were evaluated.ResultsThrough three rounds of Delphi meetings, 10, 2, and 1 ICF items with mean importance scores below the threshold were respectively removed, resulting in 17 ICF items achieving expert consensus for inclusion in the final assessment tool, named ICF-RS-17. Expert authority coefficient was 0.81. Cronbach’s alpha exceeded 0.9. Factor analysis identified two factors explaining 68.86% (admission) and 73.25% (discharge) of variance, confirming structural validity.ConclusionsThe study developed a 17-item functional assessment tool, ICF-RS-17, demonstrating strong reliability and validity for inpatient rehabilitation. These findings help promote the application of the ICF in clinical settings, enhance rehabilitation clinical management, and potentially support the further development of rehabilitation insurance policies. creator: Jiahui Li creator: Guangxu Xu creator: Juan Jin creator: Na Li creator: Jianan Li creator: Shouguo Liu uri: https://doi.org/10.7717/peerj.20280 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Li et al. title: Patient satisfaction after outpatient hysteroscopy: a retrospective descriptive study link: https://peerj.com/articles/20272 last-modified: 2025-11-10 description: BackgroundThe aim of the study is to analyse the overall satisfaction level of patients undergoing diagnostic and/or therapeutic hysteroscopy in an ambulatory setting and examine factors related to satisfaction.MethodsA retrospective descriptive study was conducted to analyse outpatient hysteroscopies performed between January 2020 and June 2022 at the University Hospital of Igualada. Patient demographic and clinical data as well as hysteroscopic features were collected. A telephonic questionnaire on patient satisfaction was conducted retrospectively.ResultsA total of 435 hysteroscopies were analysed. Hysteroscopy was successful in 95.6% of them with a clinical remission in 69.8% of patients. The mean pain score was 3.33 (Visual Analogue Scale). An average overall satisfaction score of 9 was obtained. Pain was the main reason in patients with low satisfaction ratings. A positive correlation was found between the patient satisfaction score and the level of information received before the procedure. An inverse relationship was detected between the patient satisfaction score and the pain experienced during the hysteroscopy.ConclusionsOutpatient diagnostic and/or therapeutic hysteroscopy is a technique accepted by the majority of patients and with a high level of satisfaction. Variables such as pain or the previous information received are important and directly related to the final satisfaction level of the procedure. creator: Claudia Sanchez Carbonell creator: Jennifer Rovira Pampalona creator: Carla Oliveres Amor creator: Alexandra Caballol Arteaga creator: Maria Degollada creator: Pere Brescó Torras uri: https://doi.org/10.7717/peerj.20272 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Sanchez Carbonell et al.