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Severe pulmonary vasoconstriction induced by protamine is a rare complication. We report a case of a 77-year-old male patient with a history of mitral valve plasty (MVP). He underwent redo MVP via right thoracotomy under the totally endoscopic procedure (MICS redo-MVP). Immediately after weaning cardiopulmonary bypass (CPB), protamine was administrated. 10 min later peak systolic pulmonary arterial pressure (sys PAP) rose to 62 mmHg, and 30 min later to 80 mmHg. Due to the negative impact of protamine administration, nitric oxide inhalation (iNO) therapy was started with a concentration of 20 ppm. 10 min after iNO therapy started, sys PAP decreased to 63 mmHg. After entering the intensive care unit (ICU), sys PAP decreased to 35 mmHg. Here, we present an effective iNO therapy case for pulmonary hypertension due to protamine and the patient had a good postoperative recovery. This study was approved by the Institutional Review Board at Kitaharima Medical Center (IRB-0602) with the waiver of informed consent.

Abstract Triple-negative breast cancer (TNBC) is characterised by the lack or low expression of estrogen, progesterone, and human epidermal growth factor receptor 2 receptors. TNBC has a high recurrence rate, swiftly metastasizes, and has a high mortality rate. Subsequently, the increase in cases of TNBC has signaled the need for treatment strategies with improved drug delivery systems. New diagnostic approaches, chemical entities, formulations particular those in the nanometric range have emerged after extensive scientific research as alternative strategies for TNBC treatment. As compared to contemporary cancer therapy, nanoparticles offer peculiar tunable features namely small size, shape, electrical charge, magnetic and fluorescent properties. Specifically in targeted drug delivery, nanoparticles have been demonstrated to be highly efficient in encapsulating, functionalization, and conjugation. Presently, nanoparticles have ignited and transformed the approach in photodynamic therapy, bioimaging, use of theranostics and precision medicine delivery in breast cancer. Correspondingly, recent years have witnessed a drastic rise in literature pertaining to treatment of TNBC using nanomaterials. Subsequently, this manuscript aims to present a state-of-the-art of nanomaterials advance on TNBC treatment; the ubiquitous utility use of nanomaterials such as liposomes, dendrimers, solid lipid nanomaterials, gold nanomaterials and quantum dots as anticancer agents and drug delivery systems in TNBC.

Fibrosis resulting from pathological repair secondary to recurrent or persistent tissue damage often leads to organ failure and mortality. Biliary fibrosis is a crucial but easily neglected pathological feature in hepatobiliary disorders, which may promote the development and progression of benign and malignant biliary diseases through pathological healing mechanisms secondary to biliary tract injuries. Elucidating the etiology and pathogenesis of biliary fibrosis is beneficial to the prevention and treatment of biliary diseases. In this review, we emphasized the importance of biliary fibrosis in cholangiopathies and summarized the clinical manifestations, epidemiology, and aberrant cellular composition involving the biliary ductules, cholangiocytes, immune system, fibroblasts, and the microbiome. We also focused on pivotal signaling pathways and offered insights into ongoing clinical trials and proposing a strategic approach for managing biliary fibrosis-related cholangiopathies. This review will offer a comprehensive perspective on biliary fibrosis and provide an important reference for future mechanism research and innovative therapy to prevent or reverse fibrosis.

Taku Yamada,1 Taketomo Kikuchi,1 Sachiko Nagasu,2,3 Kayoko Hashimoto,4 Eri Furukawa,4 Hirokazu Matsumoto,1 Kazuki Tsutsumi,1 Toshimitsu Tanaka,2,5 Miho Kugishima,3 Takumi Kawaguchi,5 Fumihiko Fujita,3 Kyouko Higuchi,1 Keisuke Miwa2 1Department of Pharmacy, Kurume University Hospital, Kurume, Fukuoka, Japan; 2Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan; 3Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan; 4Department of Nursing, Kurume University Hospital, Kurume, Fukuoka, Japan; 5Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, JapanCorrespondence: Keisuke Miwa, Multidisciplinary Treatment Cancer Center, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan, Tel +81-942-31-7566, Fax +81-942-34-0709, Email miwa_keisuke@kurume-u.ac.jpPurpose: Elastomeric infusion pumps are widely used in colorectal cancer chemotherapy. However, no studies to date have investigated patient preferences regarding different infusion pump types.Patients and Methods: Twenty patients with unresectable colorectal cancer undergoing chemotherapy were initially treated with a portable hard-shelled continuous infusion pump, followed by a soft-shelled continuous infusion pump. The respondents used a numerical rating scale (0– 10) to rate their comfort when using each pump, their ease of carrying it, the pump size and shape, its weight, their ease of reading its memory, and their overall satisfaction with it. They were then asked to determine which pump they would ultimately prefer.Results: In terms of comfort, significantly higher user satisfaction was reported for the soft-shelled pump during the daytime and when going out (P < 0.001, P < 0.001, respectively). For pump portability, size, shape, and weight, the soft-shelled type also outperformed the hard-shelled one (P < 0.001, P=0.0011, P < 0.001, respectively). However, the hard-shelled pump scored significantly better in terms of ease of viewing memory (P < 0.001). Overall satisfaction was significantly higher for the soft-shelled pump than the hard-shelled type (P=0.0095). Finally, 13 patients (65%) indicated that they would prefer a soft-shelled pump for their next treatment, while only one patient (5%) preferred a hard-shelled alternative. A preference for soft-shelled pump was observed, particularly in female patients and those with a body mass index of < 22 kg/m2.Conclusion: The selection of portable elastomeric infusion pumps should consider the preferences of patients with colorectal cancer, as these devices have the potential to enhance their quality of life.Keywords: colorectal cancer, chemotherapy, infusion pump, elastomeric infusion pump, portable infusion pump, patient preference

Keita Okoshi,1 Shotaro Ito,1 Megumi Matsuoka,1 Yoshinori Kinugasa,1 Eri Shimizu,2 Kosei Tanaka,2 Joji Okada,3 Takahiro Nishizaka,1 Azumi Nagasawa,1 Tsuyoshi Seki,1 Makoto Iijima,1 Masatoshi Abe,4 Osamu Nemoto4 1Human Health Care Products Research, Kao Corporation, Tokyo, Japan; 2Analytical Science Research, Kao Corporation, Tochigi, Japan; 3Skin Care Products Research, Kao Corporation, Tokyo, Japan; 4Sapporo Skin Clinic, Sapporo, JapanCorrespondence: Azumi Nagasawa, Human Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan, Tel +81-3-5630-7690, Fax +81-3-5630-9342, Email nagasawa.azumi@kao.comPurpose: Atopic dermatitis is characterized by chronic inflammation and dryness accompanied by severe itching. The combined use of moisturizers and topical anti-inflammatory drugs is essential for alleviating atopic dermatitis. We have developed a topical anti-inflammatory drug with a steroid and a moisturizer with heparinoid, both in lamellar structure-based formulations containing synthetic pseudo-ceramides. Here, assessed the efficacy of this combination in the treatment of atopic dermatitis.Methods: We included 22 patients with mild to moderate atopic dermatitis and subjected them to a seven-week treatment with the test formulations, followed by a four-week post-treatment period.Results: Clinical findings and the quality of life of participants remarkably improved after one week of treatment. Furthermore, skin hydration and transepidermal water loss considerably improved at weeks one and three, respectively. The Cer [NP]/[NS] ratio, an indicator of epidermal turnover, substantially increased during the treatment period and remained elevated even thereafter. The improvement in stratum corneum function was distinctive in participants with lower barrier function.Conclusion: These findings indicated that the combined use of the anti-inflammatory drug and moisturizer, both in lamellar structure-based formulations, is effective in treating atopic dermatitis in patients with fragile barrier function.Keywords: base formulations, lamellar structure, steroid, heparinoid, barrier function, TEWL

Soichiro Hotta,1 Kaoru Ashida,2 Makoto Tanaka1 1Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan; 2Department of Nursing, College of Nursing, Kanto Gakuin University, Kanazawa-ku, Yokohama, JapanCorrespondence: Soichiro Hotta, Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan, Tel +81 3 3813 6111 Ex 7768, Email hotta.s.130@outlook.comBackground: Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores.Methods: We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics.Results: By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach’s alpha and McDonald’s omega coefficients were 0.81– 0.84 and 0.81– 0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician’s charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores.Conclusion: We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians’ characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.Keywords: clinical deterioration, interprofessional collaboration, scale development, nighttime

Taisuke Ezaki,1 Hiroshi Hongo,1 Kimiharu Takamatsu,1 Nobuyuki Tanaka,2 Mototsugu Oya2 1Department of Urology, Nerima General Hospital, Tokyo, Japan; 2Department of Urology, Keio University School of Medicine, Tokyo, JapanCorrespondence: Taisuke Ezaki, Department of Urology, Nerima General Hospital, 1-24-1 Asahigaoka, Nerima-Ku, Tokyo, 176-8530, Japan, Tel +81-3-5988-2200, Fax +81-3-5988-2250, Email tezaki@nerima-hosp.or.jpPurpose: Contact laser vaporization of the prostate (CVP) for benign prostatic hyperplasia is a widely accepted and safe procedure for elderly patients because of its lower bleeding risks. However, CVP lacks a postoperative pathological examination for prostate cancer. Concomitant prostate biopsy and CVP may complement this disadvantage; however, the risk of bleeding associated with this procedure remains unclear. This study aimed to evaluate the safety of a concomitant prostate biopsy and CVP.Patients and Methods: This retrospective study included 106 men who had undergone CVP in Nerima General Hospital. Prostate biopsies and CVP were performed simultaneously on 16 patients. We defined the “hemorrhage group” by a > 5% decrease in hemoglobin the day after surgery. Preoperative and operative indices were evaluated based on the association with the hemorrhage group.Results: Participants in the concomitant biopsy group were older (p = 0.001), had larger prostates (p = 0.014), a lower rate of prostate biopsy history (p = 0.046), longer postoperative urinary catheter duration (p = 0.024), and a higher rate of decline in hemoglobin levels the day after surgery (p = 0.023). Patients in the hemorrhage group (n = 20, 18.9%) showed a significantly higher rate of concomitant biopsy and CVP (p = 0.006). Multivariate analysis showed that concomitant prostate biopsy (p = 0.009, odds ratio = 4.61) was the sole statistically significant predictive factor for hemorrhage.Conclusion: Concomitant prostate biopsy and CVP of the prostate may increase the risk of bleeding.Keywords: benign prostatic hyperplasia, contact laser vaporization of the prostate, diode laser, prostate biopsy, vaporization

Yoichi Tanaka,1,2 Ren Fujii,2,3 Hayato Shigetoh,2,4 Gosuke Sato,2 Shu Morioka2 1Department of Occupational Therapy, School of Rehabilitation, Hyogo Medical University, Hyogo, Japan; 2Neuro Rehabilitation Research Center, Kio University, Nara, Japan; 3Musashigaoka Clinical Research Center, Musashigaoka Hospital, Kumamoto, Japan; 4Department of Physical Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, JapanCorrespondence: Yoichi Tanaka, Department of Occupational Therapy, School of Rehabilitation, Hyogo Medical University, 1-3-6 Minatojima Chuo-ku, Kobe, Hyogo, Japan, Tel +81 78-304-3180, Email yi-tanaka@hyo-med.ac.jpPurpose: This study aimed to juxtapose the circadian rhythm of pain with the conventional 7-day assessment and ascertain the feasibility of condensing the evaluation of the circadian rhythm of pain into a 3-day timeframe.Patients and Methods: Seventy-three patients with pain persisting for a minimum of 3 months and a numerical rating scale (NRS) score of ≥ 2 were recruited from three medical centers. The circadian patterns of pain were appraised over a 7-day period by quantifying the intensity of pain at six temporal junctures each day using a 10-cm visual analog scale (VAS). Cluster analysis was performed using six standardized variables derived from the VAS score of each participant at six designated time points to identify cohorts with analogous circadian rhythms of pain. The clusters were discerned for the 7- and 3-day assessments (Tuesday–Thursday, Friday–Sunday, and Sunday–Tuesday), according to the research objectives. Cohen’s kappa coefficient was calculated to gauge the intra-observer variability to assess the consistency between the outcomes of the cluster analysis for the 7-day assessment and each of the 3-day assessments.Results: The highest Cohen’s kappa coefficient was observed for the 3-day evaluation spanning from Friday to Sunday, indicating a substantial concordance with the results of the 7-day assessment.Conclusion: Our results suggest that it may be prudent to consider implementing a condensed 3-day evaluation of the circadian rhythm of pain that is tailored to individual characteristics. This approach will allow a better understanding of the diurnal rhythms of chronic pain in patients and implement more targeted and specific pain management strategies. Furthermore, it will contribute to increased patient satisfaction through early intervention.Keywords: pain, chronic pain, physical activity, circadian rhythm

Yukihito Kato,1,&ast; Takashi Kojima,1,2 Akeno Tamaoki,3 Yoshiki Tanaka,1,&ast; Naoki Yamamoto,4,5,&ast; Kazuo Ichikawa1 1Chukyo Eye Clinic, Nagoya, Aichi, Japan; 2Nagoya Eye Clinic, Nagoya, Aichi, Japan; 3Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan; 4Center for Society-Academia Collaboration, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan; 5International Center for Cell and Gene Therapy, Research Promotion Headquarters, Fujita Health University, Toyoake, Aichi, Japan&ast;These authors contributed equally to this workCorrespondence: Kazuo Ichikawa, Chukyo Eye Clinic, 12-22, Sanbonmatsu-cho, Atsuta-ku, Nagoya-city, Aichi, Japan, Tel +81 52 884 7976, Fax +81 52 884 7977, Email ichikawa@chukyogroup.jpPurpose: This study aimed to evaluate the efficacy of a majority decision algorithm that integrates intraoperative aberrometry (IA) and two intraocular lens (IOL) frequency formulas. The primary objective was to compare the accuracy of three formulas (IA; Sanders, Retzlaff, and Kraff/Theoretical (SRK/T); and Barrett Universal II (BUII)), in achieving emmetropia in eyes implanted with TFNT lenses (Alcon).Patients and Methods: A total of 145 eyes of 145 patients were included in the evaluation. Preoperative data were obtained from IOLMaster 700, while intraoperative data were collected from ORA SYSTEMTM. Visual acuity ≥ 0.8 at the 3-month post-surgery mark was confirmed. We assessed refractive prediction error (RPE), which is the difference between predicted refraction (PR) and postoperative subjective refraction. This evaluation aimed to identify the optimal IOL power with the implemented algorithm.Results: Among the 145 eyes evaluated, 55.9%, 78.7%, and 97.2% achieved postoperative subjective refraction within ± 0.13 Diopters (D), ± 0.25 D, and ± 0.50 D, respectively. The percentages of eyes within ± 0.25 D of PR varied by formula type, with values of 57%, 57%, and 54% for IA, BUII, and SRK/T, respectively. For eyes with short to medium axial length (AL< 26.00 mm), the percentages within ± 0.25 D of RPE were 52%, 58%, and 58% for IA, SRK/T, and BUII, respectively. In contrast, for eyes with long axial length (≥ 26.00 mm) the percentages were 68%, 52%, and 45% for IA, BUII, and SRK/T, respectively.Conclusion: The proposed majority decision algorithm incorporating IA and two IOL frequency formulas was effective in reducing postoperative refractive error. IA was particularly beneficial for eyes with long axial length. These findings suggest the algorithm has potential to optimize IOL power selection to improve quality of life of patients and clinical practice outcomes.Keywords: multifocal intraocular lens, cataract, intraocular lens power calculation, axial length, optimum visual acuity

In this paper we study the following nonlinear fractional Hartree (or Choquard-Pekar) equation (−Δ)su+μu=(Iα*F(u))F′(u) inRN, ${\left(-{\Delta}\right)}^{s}u+\mu u=\left({I}_{\alpha }{\ast}F\left(u\right)\right){F}^{\prime }\left(u\right)\quad \text{in} {\mathbb{R}}^{N},$ (*) where μ > 0, s ∈ (0, 1), N ≥ 2, α ∈ (0, N), Iα∼1|x|N−α ${I}_{\alpha }\sim \frac{1}{\vert x{\vert }^{N-\alpha }}$ is the Riesz potential, and F is a general subcritical nonlinearity. The goal is to prove existence of multiple (radially symmetric) solutions u∈Hs(RN) $u\in {H}^{s}\left({\mathbb{R}}^{N}\right)$ , by assuming F odd or even: we consider both the case μ > 0 fixed and the case ∫RNu2=m>0 ${\int }_{{\mathbb{R}}^{N}}{u}^{2}=m{ >}0$ prescribed. Here we also simplify some arguments developed for s = 1 (S. Cingolani, M. Gallo, and K. Tanaka, “Multiple solutions for the nonlinear Choquard equation with even or odd nonlinearities,” Calc. Var. Partial Differ. Equ., vol. 61, no. 68, p. 34, 2022). A key point in the proof is given by the research of suitable multidimensional odd paths, which was done in the local case by Berestycki and Lions (H. Berestycki and P.-L. Lions, “Nonlinear scalar field equations II: existence of infinitely many solutions,” Arch. Ration. Mech. Anal., vol. 82, no. 4, pp. 347–375, 1983); for (*) the nonlocalities play indeed a special role. In particular, some properties of these paths are needed in the asymptotic study (as μ varies) of the mountain pass values of the unconstrained problem, then exploited to describe the geometry of the constrained problem and detect infinitely many normalized solutions for any m > 0. The found solutions satisfy in addition a Pohozaev identity: in this paper we further investigate the validity of this identity for solutions of doubly nonlocal equations under a C 1-regularity.

Satoshi Tanaka,1 Hiroyuki Karibe,1 Yuichi Kato,1 Ayuko Okamoto,1 Michihiko Koeda,2 Tomoko Hama3 1Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan; 2Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan; 3Department of Medical Technology, Faculty of Health Sciences, Ehime Prefectural University of Health Sciences, Ehime, JapanCorrespondence: Hiroyuki Karibe, Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi Chiyoda-ku, Tokyo, 102-8159, Japan, Tel +81 3 3261 6524, Fax +81 3 5216 3720, Email h-karibe@tky.ndu.ac.jpPurpose: Fearful dental patients often cite various dental instruments or procedures as triggers for their dental fear. Thus, visual dental stimuli provoke anxiety. This preliminary study aimed to assess the level of aversion to visual stimuli in dental patients and compare it with that in dentists.Patients and Methods: A total of 43 dental patients (25 women, 18 men; average age, 29.9 ± 13.3 years; patient group) and 13 dentists (4 women, 9 men; average age, 28.2 ± 2.0 years; dentist group) were included. All participants had previously undergone dental treatment. The dental fear level was assessed using the self-reported Dental Fear Survey (DFS). Thirty-two images associated with dental treatment were prepared and classified into three categories: dental instruments, dental procedures, and the dental environment. All participants rated their level of disgust toward each image on a visual analog scale with scores ranging from 0 to 100.Results: In the patient group, the disgust ratings for tooth extraction, dental drilling, and local anesthesia were > 60, which were significantly different from those in the dentist group (Mann–Whitney U-test, p< 0.001, p=0.001, and p=0.001, respectively). The ranking order of the disgust ratings for the 32 images showed significant correlation between the patient and dentist groups (Spearman correlation coefficient, r=0.80, p< 0.001). In the patient group, the disgust ratings for dental impressions and the interdental brush, dental light, and dental chair were significantly correlated with DFS scores (r=0.61, p< 0.001; r=0.47, p=0.001; r=0.41, p=0.006; and r=0.40, p=0.008, respectively).Conclusion: This study revealed that patients have more negative feelings toward invasive procedures than dentists. However, a significant correlation was identified between the ranking of aversion-provoking dental stimuli by patients and dentists. Furthermore, the level of aversion to several dental-related items that do not cause pain was correlated with the dental fear level.Keywords: dental anxiety, pain perception, visual stimuli, dental impression, visual analog scale

Reeko Osada,1 Chiyako Oshikata,1– 3 Yuichi Kurihara,4 Kosuke Terada,1 Yuka Kodama,1 Yuga Yamashita,1 Ryo Nakadegawa,1 Hinako Masumitsu,1 Yuto Motobayashi,1 Hirokazu Takayasu,1 Nami Masumoto,1,3 Saki Manabe,1 Yingyao Zhu,4 Ryo Tanaka,4 Takeshi Kaneko,3 Aya Sasaki,5 Naomi Tsurikisawa1– 3 1Department of Respirology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan; 2Department of Allergy and Respirology, Hiratsuka City Hospital, Hiratsuka, Japan; 3Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; 4Department of Dermatology, Hiratsuka City Hospital, Hiratsuka, Japan; 5Department of Clinical Laboratory, Tokyo Dental College Ichikawa General Hospital, Ichikawa, JapanCorrespondence: Naomi Tsurikisawa, Department of Respirology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama, 245-8575, Japan, Tel +81-45-851-2621, Fax +81-45-851-3902, Email User831328@aol.comAbstract: Monosodium glutamate (MSG), a salt form of a non-essential amino acid, is widely used as a food additive, particularly in Asian cuisines, due to its unique flavor-enhancing qualities. Type I allergic reactions to MSG have not previously been reported. Our patient, a 21-year-old woman, was 14 years old when she first noticed swelling of her tongue (but no oral itching, diarrhea, or abdominal pain) after eating various snack foods. Current skin prick testing elicited a weak positive reaction to MSG. We then performed an oral challenge test during which our patient ingested potato snacks. Subsequent histology showed telangiectasia of the buccal mucosa, interstitial edema in the subepithelial submucosa, and mast cell infiltration. Oral mucosal challenge tests using sodium glutamate confirmed oral swelling in this patient. This report is the first to confirm a case of type 1 allergy to MSG by combining pathology findings with the results of challenge testing.Keywords: food additive, mast cell, monosodium glutamate, food allergy

BackgroundDespite the well-documented benefits of regular physical activity (PA), many university students are physically inactive. Personal, socio-economic, and environmental factors predict PA engagement behaviours in university students. There is a need to understand context-specific perceived barriers and benefits to exercise engagement and physical activity levels amongst university students from low-income settings. This study primarily evaluated the barriers and facilitators to PA engagement in Zimbabwean undergraduate students. We also assessed the correlates of perceived barriers and benefits to PA engagement, risk of common mental disorders (CMDs) and health-related quality of life (HRQoL).MethodsWe used a cross-sectional study to recruit 465 university undergraduate students. The Exercise Benefits and Barriers Scale, International Physical Activity Questionnaire (IPAQ), Shona Symptoms Questionnaire (SSQ-8) and EuroQol 5 Dimension (EQ5D-5l) were used to measure barriers and facilitators, physical activity level, risk of depression and anxiety and HRQoL, respectively. Data were analysed through descriptive statistics and logistic regression.Results and conclusionMost participants were male (58.5%) with a mean age of 21.7 (SD 1.6) years. Majority of the participants were first year students (37.2%), consumed alcohol (66.5%), did not smoke (88.2%) and had a normal BMI (64.7%). The prevalence of low PA levels was 17.4%, with 33.5% of students at risk of CMDs. The most perceived benefits were in the physical performance (e.g., exercise improves my level of physical fitness) and life enhancement (e.g., exercise improves my self-concept) domains, while the most perceived barriers were lack of exercise infrastructure (e.g., exercise facilities do not have convenient schedules) and physical exertion (e.g., exercise tires me). Food insecurity (AOR 2.51: 95% CI 1.62–3.88) and the risk of CMDs (AOR 0.49: 95% CI 0.32–0.76) were associated with increased odds of experiencing barriers to exercise. Not using substances (AOR = 2.14: 95% CI 1.11–4.14) and a higher self-rated HRQoL (AOR 24.34: 95% CI 1.77–335.13) were associated with increased odds of a high perception of exercise benefits. Improving access to community and on-campus exercise facilities and campus-wide health promotional interventions is necessary to enhance PA amongst university students.

Abstract Past forest use often has a long‐term negative impact on the recovery of the original plant composition of semi‐natural grasslands, which is known as a legacy effect. This study investigates the impact of seed dispersal limitations on the restoration of grassland plant diversity on ski slopes with past forest use, highlighting the negative legacy effect on biodiversity recovery. Focusing on ski areas, our research contrasts the vegetation on ski slopes originally created on semi‐natural grasslands such as pasture (pasture slopes) and constructed by clearing secondary forests or conifer plantations (forest slopes). We examined species richness and diversity, considering seed dispersal modes, grassland management history, and seed source proximity. We reveal that the proximity to species‐rich grassland sources is pivotal for the restoration of native grassland vegetation. Particularly, wind‐dispersed species show significant recovery on slopes with sustained management for more than 70 years and those with neighboring species‐rich grasslands, suggesting that both the duration of management and the proximity to seed sources are critical for overcoming the legacy effects of past forest use. Meanwhile, gravity‐dispersed species failed to recover their richness and diversity regardless of both the duration of management and the proximity to seed source grasslands, which their diversity recovered where seed sources neighbored. Our findings emphasize the importance of considering seed dispersal limitation and management history in the restoration and conservation of grasslands and their biodiversity, particularly in landscapes experiencing past human intervention.