title: PeerJ description: Articles published in PeerJ link: https://peerj.com/articles/index.rss3?journal=peerj&page=86 creator: info@peerj.com PeerJ errorsTo: info@peerj.com PeerJ language: en title: Preventive behaviors of COVID-19 during the COVID-19 pandemic among community-dwelling older adults in Thailand link: https://peerj.com/articles/19412 last-modified: 2025-05-13 description: BackgroundThe COVID-19 pandemic was a major public health crisis, especially among older people. This study aimed to examine factors affecting preventive behaviors among community-dwelling older adults across all regions of Thailand during the COVID-19 pandemic using the health belief model (HBM).MethodsThis cross-sectional study included 910 participants from Thailand in July and August 2021. A multistage stratified random sampling technique was used to select participants. Data were collected through a structured interview process. Data analysis was conducted using multiple linear regression.ResultsThe participants’ mean age was 66.5 ± 4.64 years, with the majority being female (61.8%) and residing in the central region (26.5%). The results indicated that all participants (100.0%) agreed that COVID-19 can be prevented by personal protective equipment, such as masks and disposable gloves. Furthermore, the participants’ adherence to COVID-19 preventive measures was evaluated, revealing that the majority (55.8%) always practiced hand hygiene by washing hands with alcohol gel or soap and cleaning them with water before eating. Regression analysis indicated that COVID-19 preventive behaviors were significantly associated with knowledge (b = 0.091), perceived susceptibility (b = 0.066), perceived benefits (b = 0.111), perceived barriers (b = −0.040), and cues to action (b = 0.110) with p < 0.01.ConclusionsIncreased knowledge, perceived susceptibility, perceived benefits, cues to action, and decreased perceived barriers scores were associated with higher practice scores among community-dwelling older adults during the COVID-19 pandemic in Thailand. To improve practices, health information campaigns should focus on highlighting the advantages of preventive behaviors, offering tips and advice to overcome barriers, providing cues to action through various reminders on social media, and increasing awareness about disease prevention and control in future pandemics or new disease outbreaks. creator: Kanchana Piboon creator: Jarinthip Chomchaipon creator: Dhammawat Ouppawongsapat creator: Wanlop Jaidee creator: Patchana Hengboriboonpong Jaidee creator: Paiboon Pongsaengpan creator: Wiriya Mahikul uri: https://doi.org/10.7717/peerj.19412 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Piboon et al. title: Has_circRNA_0122683 (circ-PRKCI) relieves ferroptosis of HPAEpiCs in sepsis-induced acute lung injury by sponging miR-382-5p link: https://peerj.com/articles/19404 last-modified: 2025-05-13 description: Circular ribonucleic acid (RNA) protein kinase C iota (circ-PRKCI, hsa_circRNA_0122683) has been previously reported to be involved in the development of sepsis. However, the knowledge regarding the potential role and mechanism of circ-PRKCI in sepsis-induced acute lung injury (ALI) is unclear. An in vitro cellular model of sepsis-ALI was simulated by the treatment of lipopolysaccharide (LPS) in human pulmonary alveolar epithelial cells (HPAEpiCs). The expression of circ-PRKCI in plasma samples from sepsis patients with or without ALI as well as sepsis-ALI cell model was determined by quantitative real-time PCR (qRT-PCR). The diagnostic utility of circ-PRKCI was analyzed using receiver operating characteristic (ROC) curves. The levels of iron content (Fe2+), glutathione (GSH), malondialdehyde (MDA), and reactive oxygen species (ROS) were detected using corresponding commercial kits. The assessment of cell viability and production of pro-infammatory cytokines (IL-6, IL-1β and TNF-α) was measured using Cell Counting Kit-8 (CCK-8) and enzyme-linked immunosorbent assay (ELISA). The targeting relationship between circ-PRKCI and miR-382-5p was predicted by bioinformatics analysis, and subsequently confirmed by luciferase reporter and RNA immunoprecipitation (RIP) assays. Results shows that decreased circ-PRKCI expression but increased miR-382-5p expression was observed in sepsis patients with ALI and sepsis-induced ALI cell model. The area under the curve values of ROC curves for circ-PRKCI in differentiating septic ALI patients from healthy individuals and septic non-ALI patients were 0.996 and 0.999, respectively. Functional in vitro assays revealed that enforced expression of circ-PRKCI alleviated LPS-induced ferroptosis and inflammatory response of HPAEpiCs, which were reversed by Erastin or FIN56 administration. Mechanistically, circ-PRKCI was identified as a sponge of miR-382-5p and negatively regulated miR-382-5p expression. Further rescue experiments showed that miR-382-5p overexpression could compromise the anti-ferroptosis and anti-inflammatory response effects of circ-PRKCI on LPS-induced injury of HPAEpiCs. Our study demonstrated that circ-PRKCI may be a promising biomarker for septic ALI diagnosis. circ-PRKCI inhibits ferroptosis and inflammatory response in sepsis-induced ALI by sponging miR-382-5p, indicating that the circ-PRKCI/miR-382-5p axis might be a novel therapeutic target for the treatment of sepsis-induced ALI. creator: Limei Yan creator: Xiajun Lu creator: Ning Wang creator: Peng Jia uri: https://doi.org/10.7717/peerj.19404 license: https://creativecommons.org/licenses/by-nc/4.0 rights: © 2025 Yan et al. title: Antarctic macroalgal-associated amphipod assemblages exhibit long-term resistance to ocean acidification link: https://peerj.com/articles/19368 last-modified: 2025-05-13 description: The pH of the world’s oceans has decreased since the Industrial Revolution due to the oceanic uptake of increased atmospheric CO2 in a process called ocean acidification. Low pH has been linked to negative impacts on the calcification, growth, and survival of calcifying invertebrates. Along the Western Antarctic Peninsula, dominant brown macroalgae often shelter large numbers of diverse invertebrate mesograzers, many of which are calcified. Mesograzer assemblages in this region are often composed of large numbers of amphipods which have key roles in Antarctic macroalgal communities. Understanding the impacts of acidification on amphipods is vital for understanding how these communities will be impacted by climate change. To assess how long-term acidification may influence the survival of different members in these assemblages, mesograzers, particularly amphipods, associated with the brown alga Desmarestia menziesii were collected from the immediate vicinity of Palmer Station, Antarctica (S64°46′, W64°03′) in January 2020 and maintained under three different pH treatments simulating ambient conditions (approximately pH 8.1), near-future conditions for 2100 (pH 7.7), and distant future conditions (pH 7.3) for 52 days then enumerated. Total assemblage number and the relative proportion of each species in the assemblage were found to be similar across the pH treatments. These results suggest that amphipod assemblages associated with D. menziesii may be resistant to long-term exposure to decreased pH. creator: Hannah E. Oswalt creator: Julie B. Schram creator: Margaret O. Amsler creator: Charles D. Amsler creator: James B. McClintock uri: https://doi.org/10.7717/peerj.19368 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Oswalt et al. title: Effects of perioperative massive transfusion on postoperative outcomes of children undergoing brain tumor removal: a retrospective cohort study link: https://peerj.com/articles/19350 last-modified: 2025-05-13 description: ObjectiveTo examine the influence of massive perioperative transfusion on both short-term and long-term outcomes in children undergoing brain tumor resection.MethodsThis retrospective cohort study analyzed pediatric patients who underwent brain tumor surgeries at the Women and Children’s Medical Center, Guangzhou Medical University, between October 2014 and March 2022. Massive transfusion was characterized as the transfusion of red blood cells equivalent to or exceeding the estimated preoperative blood volume within 48 h after surgery. To evaluate the relationship between massive transfusion and patient outcomes, logistic regression models were utilized. Survival curves were constructed to compare the long-term outcomes of patients who received massive transfusion with those who did not. The primary outcomes assessed were 30-day all-cause mortality (short-term outcomes) and 1-year survival rates (short-term outcomes).ResultsAmong the 306 patients included in the analysis, 78 were categorized as part of the massive transfusion group, while 228 were in the non-massive transfusion group. Multivariable regression analysis indicated that perioperative massive transfusion was significantly linked to an increased risk of 30-day mortality (odds ratio (OR): 0.137, 95% confidence interval (CI) [0.036–0.528], p = 0.004). Additionally, patients in the massive transfusion group exhibited higher incidences of postoperative intracranial hypertension (OR: 4.788, 95% CI [1.547–14.824], p = 0.007), extended mechanical ventilation duration (OR: 0.247, 95% CI [58.739–147.895], p < 0.001), and prolonged intensive care unit (ICU) stays (ß = 0.184, 95% CI [3.874–15.077], p = 0.001).ConclusionsMassive transfusion has a pronounced impact on short-term outcomes, particularly increasing perioperative mortality and complication risks in children undergoing brain tumor surgery. Careful consideration of the risks and benefits of transfusion is crucial in managing these cases. creator: Yingyi Xu creator: Na Zhang creator: Xinxu Ou creator: Yuyin Ye creator: Jianhua Liu creator: Siyi Zhang creator: Xinke Xu creator: Yu Gao creator: Wenchu Chen creator: Xingrong Song uri: https://doi.org/10.7717/peerj.19350 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2025 Xu et al. title: Mechanical loading regulates osteogenic differentiation and bone formation by modulating non-coding RNAs link: https://peerj.com/articles/19310 last-modified: 2025-05-13 description: Bone tissue is highly responsive to mechanical stimuli, with mechanical loading serving as a crucial regulator of bone formation and resorption. The cellular transduction of mechanical loading involves intricate mechanisms, prominently featuring non-coding RNAs (ncRNAs). Various ncRNAs, including long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), collaboratively regulate pathways involved in bone formation under mechanical loading. This article elucidates the mechanisms by which mechanical loading influences bone formation through ncRNAs, summarizing key ncRNAs and their regulatory pathways. Aimed at researchers and clinicians in molecular biology, orthopedics, and regenerative medicine, this study provides a theoretical foundation for the future application of mechanical loading to regulate osteogenic differentiation and offers insights into treating diseases associated with abnormal bone formation. creator: Huili Deng creator: Dongfeng Wan uri: https://doi.org/10.7717/peerj.19310 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2025 Deng and Wan title: Efficacy of high-frequency sonic irrigation on removing debris from root canal isthmus: an in vitro study based on simulated root canals link: https://peerj.com/articles/19445 last-modified: 2025-05-12 description: BackgroundInfection control is important in root canal treatment. Effective cleaning and shaping are challenging due to complex anatomy, particularly in the isthmus—narrow connections between canals that can harbor bacteria. Conventional needle irrigation (CNI) is inadequate in this region, prompting the use of passive ultrasonic irrigation (PUI) and high-frequency acoustic instruments like EDDY. This study evaluates the cleaning effects of four irrigation protocols using 3D-printed isthmus models.MethodsSixty digital root canal models with isthmuses in the coronal, middle, and apical thirds were designed using Ansys 19.0 and 3D printer (20 specimens per isthmus location). Specimens were prepared to 30#, 0.04 without irrigation. Debris accumulation in the isthmus was photographed and analyzed using Image J to calculate the initial debris area (S1). Specimens were then irrigated using CNI, low-frequency sonic irrigation (EndoActivator, EA; Dentsply, Charlotte, NC, USA), PUI, or high-frequency sonic irrigation (EDDY), followed by re-imaging to calculate remaining debris area (S2). Debris reduction percentage was determined using the formula: (S1–S2)/S1 × 100%.ResultsDebris reduction varied with isthmus position. In the coronal third, EDDY achieved the highest debris reduction (86.18 ± 2.25%), followed by PUI, EA, and CNI, with significant differences among groups (P < 0.05). The same trend was observed in the middle third, with EDDY showing the highest efficacy (73.96 ± 6.75%). In the apical third, debris reduction was lower overall, with no significant difference between EDDY and PUI, but both outperformed EA and CNI.DiscussionOur results showed that EDDY demonstrated superior debris removal in the coronal and middle thirds, but all irrigation protocols showed limited efficacy in the apical third. creator: Chun-Hui Liu creator: Qiang Li creator: Xiao-Ying Zou creator: Lin Yue uri: https://doi.org/10.7717/peerj.19445 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2025 Liu et al. title: A cross-sectional study evaluating insulin injection techniques and the impact of instructions from various healthcare professionals on insulin users in the southern region of Saudi Arabia link: https://peerj.com/articles/19394 last-modified: 2025-05-12 description: BackgroundIt is evident that proper use of the insulin injection technique (IIT) is important for optimizing the efficacy of the therapy. Despite the readily available manufacturers’ instructions, healthcare professionals (HCPs) play a major role in educating patients. This study aims to investigate the knowledge, practices, and challenges faced by insulin users regarding IIT, as well as the impact of healthcare professionals’ education on it.MethodsWe conducted a questionnaire-based cross-sectional study using a validated online questionnaire to gather demographic and clinical data, as well as the participants’ knowledge, practices, and challenges related to insulin therapy.ResultsThe mean age of the participants was 38.25 ± 15.58 (mean ± SD) years, with a nearly equal distribution of genders. Thirty-six percent of the participants educated by the diabetes educators demonstrated an appropriate IIT, such as storage, priming the insulin pen (54%), skin folding (63%), injection hold time, and “use-by” date. Furthermore, the absence of diabetes education specialist training increases the likelihood of errors, potentially leading to a loss of glycemic control. Patients reported carrying insulin when traveling as one of the major challenges (27.9%), followed by timely injections (23.7%), priming (21.6%), and adjusting the insulin dose (16.8%). Forgetfulness (47.7%), traveling or altering the regular routine (15.5%), missing a meal (15.5%), and being overly busy (13.5%) were among the reasons for missing the insulin dose; all of which are easily manageable with proper education.ConclusionConsistent education and re-education are necessary for the insulin users to resolve the issues associated with suboptimal IIT. The inclusion of all stakeholders in insulin therapy, particularly the diabetes education specialists, is essential. Therefore, the Ministry of Health in Saudi Arabia should take the initiative to ensure that appropriately trained diabetes education specialists, pharmacists, nurses and other HCPs assess and follow up on patients. creator: Sirajudeen Shaik Alavudeen creator: Md Sayeed Akhtar creator: Sultan Mohammed Alshahrani creator: Vigneshwaran Easwaran creator: Asif Ansari Shaik Mohammad creator: Noohu Abdulla Khan creator: Abubakr Taha Hussein creator: Salem Salman Almujri creator: Abdulrahman Saeed Alshaiban creator: Khalid Orayj uri: https://doi.org/10.7717/peerj.19394 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Shaik Alavudeen et al. title: The effect of patellar taping combined with isometric strength training on pain, muscle strength, and functional performance in patients with patellofemoral pain syndrome: a randomized comparative study link: https://peerj.com/articles/19381 last-modified: 2025-05-12 description: BackgroundPatellar taping and quadriceps strengthening exercises are commonly used in physiotherapy to manage patellofemoral pain syndrome (PFPS). However, previous research has reported inconsistent findings regarding quadriceps strength gains at specific knee angles during strength training in individuals with PFPS.ObjectivesThis study investigated the efficacy of patellar taping and quadriceps isometric strength training (quadriceps-IST) at 60° knee flexion on quadriceps strength, pain, and functional performance in female patients with PFPS.MethodsA two-arm, parallel-group, randomized comparative design was employed. Sixty adult females with PFPS were randomly assigned to either the experimental group (n = 30), which received patellar taping combined with quadriceps strength training at 60°, or the control group (n = 30), which received placebo taping with the same training. Both interventions lasted six weeks. Pain intensity, quadriceps muscle strength, and functional performance were assessed using the numeric pain rating scale (NPRS), maximum voluntary isometric contraction (MVIC) at 60° knee flexion, single leg triple hop (SLTH) test, and anterior knee pain scale (AKPS). For within and between groups comparison, a Wilcoxon signed-rank test and a Mann–Whitney U tests was employed, with confidence interval (α) set at 95%.ResultsWithin-group analysis showed significant improvements in NPRS and MVIC at 60° knee flexion, SLTH, and AKPS scores post-intervention (p < 0.05). Between-group comparisons revealed that the experimental group had significantly greater improvements in all outcomes at six weeks post-intervention. Additionally, the pre-to-post changes (i.e., mean difference scores) were larger in the experimental group compared to the control group, which confirmed the superiority of the experimental group over the control group.ConclusionsThe study demonstrates that patellar taping combined with quadriceps -IST at a 60° knee flexion improves pain, muscle strength, and functional performance compared to placebo taping combined with quadriceps-IST. These findings suggest that incorporating this combined approach may enhance rehabilitation outcomes for patients with PFPS, providing a valuable addition to clinical practice.Trial registrationThis study was registered prospectively in the ClinicalTrials.gov PRS under a trial identifier NCT05168332 and last updated date 15/03/2024. creator: Shahnaz Hasan uri: https://doi.org/10.7717/peerj.19381 license: https://creativecommons.org/licenses/by/4.0/ rights: ©2025 Hasan title: Risk assessment of heavy metal toxicity induced by platinum accumulation in tumor patients link: https://peerj.com/articles/19375 last-modified: 2025-05-12 description: BackgroundMany studies have focused on adverse reactions caused by platinum drugs but neglected subsequent toxicities and the mechanisms during patient recovery after chemotherapy with different platinum drugs, which need attention because of the heavy metal platinum.ObjectivesWe aimed to explore the correlations between platinum accumulation, hematological indices, and clinical toxicity in patients after a metabolism period following platinum drug chemotherapy, to better understand real-world clinical toxicity caused by platinum accumulation.MethodsWe enrolled patients receiving platinum chemotherapy, specifically cisplatin, oxaliplatin, or carboplatin. On the 25th day post-chemotherapy, we measured serum platinum concentrations and hematological indices, documented clinical toxicities, and subsequently performed correlation analyses.ResultsThe serum platinum concentrations in oxaliplatin-, cisplatin-, and carboplatin-treated patients were 208.60, 349.15 and 211.30 µg/L (χ2 = 51.755, p < 0.001), respectively. Mediation effect analysis showed that decreased erythrocyte, hemoglobin and glutamic-pyruvic transaminase individually mediated 21.39, 12.0 and 10.94%, respectively, of the platinum positive effect on fatigue. Decreased erythrocyte counts mediated 5.89%, while increased creatinine mediated 5.2% of the platinum positive effect on adverse reactions. The cutoff values of hematological indices, the risk of adverse reactions and fatigue were also obtained in this research which will be applied in clinical practice.Discussion and ConclusionsPlatinum accumulation, by disrupting the red blood cell system and liver and kidney function, influences fatigue severity and common adverse reactions in patients during the post-chemotherapy recovery period. creator: Yuling Zhang creator: Pi Guo creator: Xiaoting Huang creator: Yi-Wei Xu creator: Zhiwei Zheng creator: Ling Fang uri: https://doi.org/10.7717/peerj.19375 license: https://creativecommons.org/licenses/by-nc/4.0 rights: ©2025 Zhang et al. title: Perceived fear and exercise difficulty in patients with migraine and their association with psychosocial factors: a cross-sectional study link: https://peerj.com/articles/19342 last-modified: 2025-05-12 description: PurposeAlthough pharmacological treatments for migraine have advanced, non-pharmacological approaches, such as exercise, offer additional benefits. However, many patients avoid physical activity due to fear of symptom exacerbation. This study aims to identify the most threatening and difficult exercises for patients with migraine and examine the relationship between exercise perceptions and factors such as physical activity levels, kinesiophobia, catastrophizing, and self-efficacy.MethodsThis cross-sectional study explored the perceived fear and difficulty of nine exercises shown via video demonstrations, and their association with psychological variables in patients with migraine. Participants aged 18–65 with physician-diagnosed migraines completed self-report measures of physical activity, kinesiophobia, catastrophizing, fear-avoidance beliefs, headache impact, neck disability, and self-efficacy.ResultsA total of 110 patients with migraine participated (88% women), with a mean age of 36 years. Chronic migraine was reported by 53% of participants. Significant differences in perceived fear and difficulty were observed across the nine exercises (p < 0.001), with jumping and spine extension rated as the most fear-inducing and difficult exercises, respectively. Beta regression models showed that the physical activity level, measured by the short form of the International Physical Activity Questionnaire (IPAQ-SF), was negatively associated with fear of jumping and difficulty of spine extension, whereas fear-avoidance beliefs were positively associated with both. A correlation analysis revealed a moderately significant negative association between the IPAQ-SF score and perceived fear of running.ConclusionJumping, running, and spine extension were perceived as the most aversive exercises. Perceived fear and difficulty levels were associated with physical activity levels and fear avoidance beliefs, emphasizing the need to assess these factors before implementing therapeutic exercise interventions. creator: Álvaro Reina-Varona creator: Beatriz Madroñero-Miguel creator: Alba Paris-Alemany creator: Roy La Touche uri: https://doi.org/10.7717/peerj.19342 license: https://creativecommons.org/licenses/by/4.0/ rights: © 2025 Reina-Varona et al.