The relationship between atrial fibrillation (AF) and myocardial infarction (MI) remain unclear. We aimed to examine the sex-specific risk of MI, ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) in participants with AF, overall and by time since AF diagnosis. We followed 25 132 participants (53% women) from the Tromsø Study (1994-95) without AF and MI at baseline through 2021. Cox proportional- and Fine-Gray sub-distribution-hazard regression assessed AF as a risk factor for MI, STEMI and NSTEMI overall and by time since AF diagnosis (0 to <0.5, 0.5 to <1, 1 to <5, 5 to <10 and ≥10 years). During follow-up, 115 women and 124 men experienced incident AF and subsequent MI. AF was associated with increased hazard of MI in women (sub-distribution hazard ratio [sHR] 1.39, 95% confidence interval [CI] 1.12-1.72), but not in men. In women, the hazard of MI increased 1-10 + years since AF, peaking at ≥10 years (sHR 1.75, 95% CI 1.07-2.84). In men, hazard was increased within the first six months (sHR 2.27, 95% CI 1.45-3.54) but not thereafter. STEMI hazard was increased only in men within six months. NSTEMI hazard was elevated in women 1-10 + years since AF and in men within the first year. AF is a risk factor for MI in both sexes, but risk patterns differ. Women are at increased hazard of NSTEMI 1-10 + years since AF, while men are at increased hazard of STEMI within six months and NSTEMI within the first year.
To evaluate risk factors for the recurrence of teat fistulas following surgery and to assess the long-term outcomes of surgery for teat fistulas in lactating dairy cows. A retrospective case series was conducted on 92 lactating dairy cows that underwent surgical repair for congenital or acquired teat fistulas from 1994 to 2019 at the Veterinary Teaching Hospital of Urmia University, Iran. Acquired fistulas were further subdivided etiologically into 2 distinct categories: (1) primary chronic fistulas, defined as full-thickness teat lacerations that were not recognized promptly and healed by second intention, and (2) surgery-related fistulas, defined as fistulas arising as a postoperative complication of primary laceration closure. Defects were closed using a 2- or 3-layer technique with polyglactin 910 or chromic gut sutures. A binary logistic regression model was used to analyze the association between fistula recurrence and the predictor variables in cows with acquired fistulas. Surgical repair was uniformly successful for congenital fistulas, whereas the overall recurrence rate following surgery for acquired fistulas was 40.5%. The presence of postsurgical mastitis was the most significant risk factor, increasing the odds of recurrence more than 16-fold. Holstein cows with surgery-related fistulas had 4.7 times the odds of recurrence compared with Holsteins with primary chronic fistulas. The prognosis is favorable for congenital teat fistulas, while it is guarded for acquired fistulas. Postoperative mastitis is a profound risk factor for failure. Successful surgical outcomes depend more on infection control than the specific choice of closure technique or suture material.
Background: Persistent Postural-Perceptual Dizziness (PPPD) is a chronic vestibular disorder that has been receiving more research attention lately. Nonetheless, there is a lack of systematic bibliometric overviews tracing the conceptual evolution, knowledge structure, and emerging research frontiers within this field. The utilization of bibliometric and visualization analyses can enhance the understanding of trends and central themes in PPPD research, offering valuable insights for future studies. Methods: Data were retrieved from the Web of Science Core Collection, yielding a final dataset of 370 bibliographic records ("DATA"). We employed CiteSpace, HistCite, the Alluvial Generator, and R software to conduct multi-dimensional statistical and visualization analyses on publication trends, collaborative networks (countries/institutions/authors), disciplinary distribution, citation bursts, and the evolution of keyword clusters. Results: Starting from 2005, there has been a notable increase in publication volume, reaching its peak in 2024. The United States and Germany are at the forefront of national collaboration, with the University of Munich and the Mayo Clinic being key research institutions. The research focus has transitioned from a primary emphasis on Psychiatry to a broader scope encompassing Neurosciences, Otorhinolaryngology, and General Medicine. Keyword analysis reveals a shift towards standardized terminology, transitioning from "phobic postural vertigo" to "diagnostic criteria" and "consensus documents". Current research trends are centered around comorbidity mechanisms like "vestibular migraine", therapeutic approaches such as "vestibular rehabilitation", and quality of life assessments using the "dizziness handicap inventory". The 2017 consensus document by the Bárány Society is highlighted as a pivotal publication with significant citation impact. Conclusions: The intellectual structure of the field, as revealed by this bibliometric analysis, has transitioned from a phenomenological description to a conceptual unification. The bibliometric analysis indicates that the field is currently in a conceptually stabilized stage characterized by a research focus on refining diagnostic precision and comorbidity exploration, while scholarly attention remains biologically exploratory regarding objective biomarkers and pathophysiological mechanisms.
Intravenous immunoglobulin (IVIg) is the standard of care for the treatment of Kawasaki disease (KD) and should be administered within 10 days of the onset of fever. Management guidelines for children with KD who defervesce spontaneously are not clear. In this study, we analysed patients with KD diagnosed between 1994 and 2024 at our centre who had defervesced spontaneously, had normal acute-phase reactants, and underwent echocardiographic examination, and in whom IVIg had not been administered. We reviewed the records of patients with KD from January 1994 - December 2024. The diagnosis of KD was based on standard guidelines. Patients with KD were said to be in spontaneous defervescence when they remained afebrile for ≥ 48 h, had normal acute-phase reactants [C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR)] and no coronary artery abnormalities (CAAs) on echocardiography at presentation, and when IVIg was not administered. Patients with spontaneous defervescence were subdivided into (i) early defervescence (Ed-KD), if the interval between onset of symptoms and defervescence was < 10 days, and (ii) late defervescence (Ld-KD), if the duration between onset of symptoms and defervescence was ≥ 10 days, respectively. Details of the clinical profile, laboratory investigations, and echocardiography findings were obtained from the records. Of the 1499 patients with KD enrolled during the study period, 115 patients (7.7%; 86 boys) defervesced spontaneously. The median age at disease onset was 6 years (mean, 5.6 years; range, 0.8-15 years). The median duration of fever, defined as the total duration of the febrile episode before spontaneous defervescence, was 5 days (range, 1-21 days). The median interval between illness onset (defined as fever onset) and diagnosis of KD was 15 days (range, 4-40 days), indicating that diagnosis was often made after fever had already subsided. The most common clinical feature was periungual desquamation, followed by rash, oral-mucosal changes, cervical lymphadenopathy, and conjunctival injection. Incomplete presentation was noted in 73.9% (n = 85/115) of patients. No patient has developed CAAs or other cardiac sequelae over a median follow-up of 9 months (range 2 months-156 months). The cumulative follow-up for the cohort was 235 patient-years. The 'low-risk' subgroup of patients with KD who defervesce spontaneously, and have normal acute phase reactants with no CAAs at presentation, have good clinical and coronary outcomes.
Copyright: © 2026 Kahlon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Multiple myeloma (MM), the second most common hematologic malignancy in the United States, has undergone transformative therapeutic innovation over the past five decades. Using SEER data from 1975 to 2023, we conducted a retrospective cross-sectional analysis to evaluate MM-specific mortality trends in relation to major treatment milestones. Age-adjusted mortality rates and Annual Percent Change (APC) were estimated using Joinpoint regression. Mortality increased from 1975 to 1994 (APC: 1.43%; P < .01), declined modestly from 1994 to 2002 (–0.70%; P = .02), dropped steeply from 2002 to 2009 (–1.85%; P < .01), plateaued between 2009 and 2014 (0.52%; P = .10), resumed decline from 2014 to 2021 (–1.73%; P < .01), and sharply decreased from 2021 to 2023 (–5.64%; P < .01). These inflection points align with the introduction of stem cell transplantation, proteasome inhibitors, immunomodulatory drugs, and next-generation immunotherapies including CAR T-cell therapy and bispecific antibodies. While these advances have improved survival, they also introduced chronic treatment burdens and rising costs. Our findings highlight the real-world impact of targeted therapies on population-level outcomes and underscore the urgent need for care models that ensure accessibility, affordability, and long-term sustainability in the era of precision oncology.
Sarculator is a widely validated prognostic tool that estimates overall survival and crude cumulative incidence (CCI) of distant metastasis in patients with resected soft tissue sarcomas in the extremities. Sarculator relied on external cohorts only for performance testing and could not incorporate new information or adapt to temporal changes. We aimed to develop BayeSarc, a prognostic model based on Bayesian sequential learning (BSL), which enables continuous updating by incorporating new clinical cohorts and provides more accurate estimates. In this retrospective, multicentre cohort study, eligible patients were adults (aged ≥18 years) with primary, localised, surgically treated soft tissue sarcomas in the extremities (excluding desmoid tumours, undifferentiated small round cell sarcoma of soft tissue, alveolar or embryonal rhabdomyosarcoma, dermatofibrosarcoma protuberans, and well differentiated liposarcoma). Data were retrieved from institutional databases at each participating hospital. BayeSarc used the same clinicopathological variables as Sarculator (age, size, grade, and histology) and was developed with a historical cohort of consecutive patients treated surgically at the Istituto Nazionale dei Tumori (Milan, Italy) and sequentially updated with five independent cohorts from Canada, France, the UK, USA, and Italy. Bayesian Cox (overall survival) and Fine-Gray (CCI distant metastasis) models were reformulated within a BSL framework combining Bayesian updating with prior-information adaptive borrowing. The primary objective was to compare the discrimination and calibration of BayeSarc versus Sarculator for predicting overall survival and CCI-distant metastasis. We evaluated the performance of BayeSarc at each update using prequential estimates, reflecting model transport to a new cohort without local recalibration, and post-update estimates, reflecting performance after sequential updating. We included a total of 4916 patients (2204 [44·8%] female, 2694 [54·8%] male, and 18 [0·4%] with sex not recorded) drawn from six cohorts: Istituto Nazionale dei Tumori, Milan, Italy (Jan 1, 1994-Dec 31, 2013; median follow-up 86 months [IQR 81-90]); Mount Sinai Hospital, Toronto, Canada (Jan 1, 1994-Dec 31, 2013; 85 months [81-90]); Institut Gustave Roussy, Villejuif, France (Jan 1, 1996-May 15, 2012; 75 months [68-82]); Royal Marsden Hospital, London, UK (Jan 1, 2006-Dec 31, 2013; 54 months [48-59]); Brigham and Women's Hospital, Boston, USA (Jan 1, 2014-Dec 31, 2021; 72 months [66-84]); and Istituto Nazionale dei Tumori, Milan, Italy (Jan 1, 2014-Dec 31, 2021; 61 months [57-64]). 12 patients from the UK were missing follow-up data and were excluded from survival analyses. At the final step of the BSL update, BayeSarc achieved higher discrimination than Sarculator for both overall survival (prequential mean C index: 0·784 [95% credible interval 0·759-0·794]; after update: 0·801 [0·790-0·809]; Sarculator: 0·773) and distant metastasis (prequential mean C index: 0·723 [0·704-0·738]; after update: 0·738 [0·730-0·743]; Sarculator: 0·718). Calibration improved consistently across updates, and uncertainty around estimates and predictions decreased. BayeSarc is a continuously updatable, accurate, and precise prognostic tool for soft tissue sarcomas in the extremities. It reduces uncertainty, adapts to temporal changes, and refines variable weights. Its incorporation into the Sarculator app enables immediate clinical use, with potential to improve patient counselling, guide treatment decisions, and refine trial design. More broadly, the BSL framework provides an innovative and generalisable approach to prognostication in rare cancers, moving beyond the traditional two-step development-validation paradigm, enabling more efficient use of patient data. Associazione Italiana per la Ricerca sul Cancro, Cancer Research UK, Fundacion Científica, and Asociacion Espanola Contra el Cancer.
Malignant neoplasms of the salivary glands are a heterogeneous group of cancers that include more than 24 malignant histological types in the salivary glands, with different genetic, morphological, and immunohistochemical features and clinical behavior. A retrospective population-based analysis of salivary gland cancers diagnosed between 1994 and 2018 was performed, using data from the Girona and Tarragona cancer registries. Crude incidence rates, European and world-age-standardized incidence rates and incidence trends, measured as the annual percentage change, were estimated. Observed and net survival at 5 and 10 years and 10-y/5-y conditional survival were calculated. The analysis was focused on histological type. A total of 301 cases were recorded in the provinces of Girona and Tarragona during 1994-2018, of which 51.5% were in men and 76.1% in the parotid salivary gland. The most common histology type was the squamous cell carcinoma (17.9%) followed by the mucoepidermoid carcinoma (16.9%). Incidence was 9.2 cases per 1,000,000 person-years for all salivary gland tumors. A decrease in incidence for all cases and in most of the histology types specifically, was observed. For the cohort, the 10-year observed and net survival rates were 37.3 and 55.5%, respectively. Acinar cell carcinoma was the histology with better prognosis at 10 years. A decrease in the overall incidence of cases has been observed, which may be due to better diagnostic or registration accuracy along with changes in exposure to etiological factors such as smoking. Net survival at 10 years was 55.5% for the entire cohort.
We conducted a proof-of-concept study to evaluate the diagnostic performance of the serum creatinine/cystatin C ratio (CrCyR) in distinguishing pseudo-acute kidney injury (AKI) from true AKI. This study included patients with confirmed AKI (excluding rhabdomyolysis) at the First Affiliated Hospital of Nanjing Medical University (May 2023-August 2024) and pseudo-AKI cases identified through a literature review (1994-2025). CrCyR values (unit: l/dl) measured before (CrCyRpre) and during AKI onset (CrCyRpost) were collected. Diagnostic performance of CrCyRpost was assessed using the area under the receiver-operating-characteristic curve (AUC). Of the 239 patients, 197 had true AKI and 42 had pseudo-AKI (mechanisms: reduced creatinine excretion [n = 18], assay interference [n = 14], urine leakage [n = 7], and increased creatinine production [n = 3]). Median CrCyRpost was significantly higher in the pseudo-AKI group than in the true AKI group (1.89 [Inter Quartile Range {IQR}: 1.32-3.28] vs. 0.78 [0.64-0.94] l/dl; P < 0.001). CrCyRpost showed a preliminary AUC of 0.97 (95% confidence interval [CI]: 0.95-1.00); an exploratory threshold of > 1.11 l/dl yielded 95% sensitivity and 91% specificity for diagnosing pseudo-AKI. After adjustment for age and sex, the covariate-adjusted AUC remained high at 0.98 (0.96-1.00). Diagnostic utility was consistently high across pseudo-AKI subtypes (AUCs: 1.00 for assay interference, urine leakage, and increased creatinine production; 0.94 for reduced creatinine excretion). A cross-center robustness assessment using patients with true AKI from the Salzburg Intensive Care database suggested consistent diagnostic utility (AUC: 0.94 [0.90-0.98]) in Europeans. CrCyRpost preliminarily demonstrates promising diagnostic accuracy for distinguishing pseudo-AKI from true AKI. Further validation in prospective studies is warranted.
As Tsikandilakis et al. (2025) illustrate, an intense back and forth scientific debate on the existence and scope of unconscious processing has existed for at least 2000 years and within the field of psychology for well over 100 years. The focus of my commentary highlights important contributions from signal detection theory, which my work was based upon, beginning over 30 years ago (Haase, 1994). Much more research has been done in the last 30 years as interest in the topic has grown and achieved a higher degree of respect within psychology and related disciplines. The controversy is obviously not resolved, but ideas are offered for making progress, some of which are emphasized in Tsikandilakis et al. (2025). Other approaches may have merit as well, based on experimental and observational data that acknowledge and emphasize the importance of subjective principles such as weak or fragmentary conscious experiences of masked prime stimuli that continue to "haunt" interpretations of unconscious perception.
Pancreaticoduodenectomy is one of the most technically demanding procedures in digestive surgery. Historically, laparoscopy in pancreatic surgery was limited to staging and palliative interventions. Since the first laparoscopic pancreaticoduodenectomy was completed in 1994, significant advances have improved perioperative safety, operative time, and lowered postoperative morbidity. Nevertheless, the complexity of pancreatic surgery paired with the technical challenges of pancreatic minimally invasive approach have restricted laparoscopic pancreatoduodenectomy to high-volume centers until recent times. The aim of this technical note presentation is to describe novel laparoscopic techniques of performing the three anastomoses - pancreaticojejunostomy and pancreaticogastrectomy, hepaticojejunostomy, and gastrojejunostomy- in an intracorporeal fashion, highlighting methods of facilitating the reconstructive process. This technical note s purpose is to also present new training models for surgeons, meant to reduce post-operative complications, such as pancreatic fistula or biliary leakage, to shorten operating times, and, ultimately, to increase the availability of laparoscopic pancreaticoduodenectomy as a safe and efficient treatment option.
Cirrodrilus osumi sp. nov. (Clitellata: Branchiobdellida: Branchiobdellidae) is described based on the specimens on the freshwater crab Geothelphusa exigua Suzuki and Tsuda, 1994 (Decapoda: Potamidae) collected from headwater areas in Osumi Peninsula, Kagoshima, southern Japan. Although the new branchiobdellidan resembles the continental East Asian Cirrodrilus kawamurai (Yamaguchi, 1934) in having four membranous large dorsal lobes on the peristomium, it differs by having shorter dorsal lobes and four pairs of small teeth in the jaws. Additionally, Ci. kawamurai is partially redescribed based on Yamaguchi's original slide collection. The Bayesian inference tree using partial mitochondrial cytochrome c oxidase subunit I sequences supported that the new species is genetically more closely related to a congener from the Korean Peninsula than to the endemic congeners from northern Japan. The finding of the new species in this study represents the record of the 12th species of the genus Cirrodrilus Pierantoni, 1905 from Japan, as well as the first record of a branchiobdellidan associated with freshwater crabs in East Asia.
Eligibility criteria for lung cancer (LC) screening aim to identify long-term smokers who have exceeded a minimum-risk threshold of having LC, while still having sufficiently long remaining life expectancy. For individuals who have once met eligibility criteria (i.e., reached sufficiently high LC risk), a question is whether longer-term smoking cessation and corresponding improvement in other-cause mortality risk could justify a higher maximum screening age for former smokers than for continuing smokers. We performed time-varying Cox models in the EPIC-Heidelberg cohort (N = 24,715), using 3-yearly questionnaire data collected between 1994 and 2014 to estimate hazard ratios (HRs) and incidence rates for death by LC or other causes, in relation to age-specific smoking status and eligibility by German LC screening criteria (LCSC). Depending on age, models showed up to 3-fold higher risk of other-cause mortality for recent and LCSC-eligible smokers, relative to never smokers. Among former smokers, those who quit before age 30 or 40 showed no significant difference in other-cause mortality compared with never-smokers, in men and women, respectively. However, at higher quitting ages HRs increased up to about 1.9 for men who stopped at age ≥60, or 1.5 in women who stopped at age 50-<60. Also, depending on age, former smokers who had once met the LCSC, but then quit for >10 years (thereby losing formal screening eligibility), showed HRs of about 1.5–3.0 for other-cause mortality in men and 1.3–1.9 in women. In both sexes, the absolute incidence rate for other-cause mortality amongst past-eligible smokers age 75-<80 was similar to that for current-eligible smokers of the younger, 70-<75-year age group. For LC, both current and former smoking were associated with persistently increased HRs, even after long-term cessation. For smokers who once met LCSC, but then quit for >10 years the risk of other-causes mortality remains elevated, but less so than for continuing smokers, which may argue for a moderate extension of the maximum age limit for LC screening. Larger studies will be needed to obtain more precise risk estimates.
Legacy lead (Pb) contamination from a century-long Pb-Zn mining operation (1906-1994) continues to pose severe environmental health threats in Kabwe, Zambia, one of the world's most polluted sites. While elevated blood lead levels (BLLs) in children are well-documented, maternal exposure remains understudied despite its critical implications for fetal development. We conducted a cross-sectional biomonitoring study among 510 pregnant women across four townships in Kabwe (Makululu, Kasanda, Katondo, and Mahatma Gandhi), stratified by proximity to the former mine (1.5-4.5 km). Sociodemographic and clinical data were collected utilizing a structured questionnaire. Venous blood samples were analyzed for Pb using graphite furnace atomic absorption spectrophotometry (GFAAS), with rigorous quality control (recovery: 92.3-95.1%; MDL: 0.012 µg/dL). Maternal BLLs varied significantly by township (p < 0.001): median BLLs were highest in Makululu (6.5 µg/dL; 84.4% elevated), followed by Kasanda (3.4 µg/dL; 48.1%), and lowest in Katondo (1.8 µg/dL; 10.0%) and Mahatma Gandhi (1.6 µg/dL; 8.8%). Overall, 43.7% of women exceeded the reference level of 3.5 µg/dL, disproportionately affecting those in the informal settlements near the mine waste. Elevated BLLs were significantly associated with longer years of stay in the area (p = 0.007), unemployment (p < 0.001), smoking (p = 0.021), lower BMI (p = 0.023), and higher gravidity (p < 0.001), reflecting intersecting environmental, biological and socioeconomic vulnerabilities. Maternal Pb exposure in Kabwe remains alarmingly high, especially in mining-proximal, low-resource communities, underscoring a critical environmental injustice. Given potential for Pb to cross the placenta and documented links to negative birth outcomes, urgent interventions, including regular maternal screening and policy reform, are needed to potentially protect the health of the unborn baby and break cycles of intergenerational toxicity.
Introduction Obesity is a significant global public health concern, and there has been an increase in the prevalence of obesity globally over the past three decades. A region that has been particularly affected by the increasing trends of obesity over time is the Indian subcontinent region. The study was conducted (1) to assess the trends in the prevalence of obesity in adults, children, and adolescents in India and compare it with the median global prevalence over the past three decades and (2) to correlate the changes in economic, globalization, urbanization, and physical activity parameters and the prevalence of obesity in Indian adults, children, and adolescents over the same period. Methods This is a retrospective, longitudinal, ecological data-based (national- and global-level measures) study of the prevalence of obesity in India over the period from 1990 to 2022. The main outcome was obesity in adults, 10-19-year-olds, and 5-9-year-old children in India. We also compared this to the median global prevalence over the same period. We correlated the prevalence of obesity with gross domestic product (GDP) per capita-purchasing power parity (PPP), globalization score, economic globalization score, social globalization score, the proportion of urbanization, and insufficient physical activity. We used linear regression models to estimate the change in prevalence and Pearson's correlation coefficients for correlation. Results The prevalence of age-adjusted obesity in the adult population was 0.79% in 1990, and it had increased to 7.27% in 2022. The prevalence of obesity in the 10-19-year-olds was 0.082% in 1990, and it had increased to 2.72% in that age group, and it had changed from 0.20% in 1990 to 4.96% in the 5-9-year-olds. The percentage increase in the prevalence of obesity was highest in 10-19-year-old boys and lowest in adult women from 1990 to 2022. The change in the prevalence for the Indian adult male population was 0.145 (95% confidence interval {CI}: 0.132, 0.157; p<0.001), and it was 0.254 (95% CI: 0.236, 0.271; p<0.001) for women. The change in prevalence for both groups (male and female population) was 0.083 (95% CI: 0.075, 0.091; p<0.001) for 10-19-year-olds, and it was 0.153 (95% CI: 0.141, 0.165; p<0.001) for the 5-9-year-olds. The change in the ratio of global prevalence to Indian prevalence was steepest in 1990-1994 for adults and in the 1995-1999 period for the 10-19-year-old and 5-9-year-old age groups. There was a strong and significant correlation between economic, globalization, urbanization, and physical activity parameters. Conclusions With the changes in socio-economic and urbanization patterns in India, obesity has become an important public health concern. Additionally, as the prevalence of obesity increases, associated conditions such as non-communicable diseases, including their complications, may also show an increase and may be an additional burden on the healthcare system. Thus, there is a need to implement targeted national programs to address issues related to obesity in adults. Children and adolescents have shown a sharp increase in the prevalence of obesity in the past three decades in India. Thus, there should be a greater emphasis on the prevention and management of obesity in these groups in the public health programs in India.
PurposeTo identify and synthesize the scientific evidence available in the literature on the NANDA-I nursing diagnosis Impaired Skin Integrity (00046), with a focus on the analysis of its concept validity, content validity, and clinical validity.MethodsAn integrative review with a critical synthesis approach was conducted to investigate the nursing diagnosis Impaired Skin Integrity (00046). The literature search was performed in databases using controlled and free-text terms related to impaired skin integrity and nursing diagnoses. Studies addressing concept analysis, content validation, or clinical validation of the diagnosis were included, with no time restrictions. Data extraction encompassed methodological characteristics, type of validation, diagnostic indicators, and contributions to taxonomic refinement.FindingsFive studies published between 1994 and 2025 met the inclusion criteria, four conducted in Brazil and one originating from the United States. The evidence demonstrated a predominance of content validation studies and clinical validation investigations. No studies addressing concept validation were identified. Across all studies, defining characteristics related to epidermal or cutaneous disruption, impaired skin continuity, and exposure to moisture or mechanical forces were consistently supported. However, variability was observed in the relevance of diagnostic indicators across different populations and care settings. Limited empirical evidence was found regarding related factors, indicating gaps in the etiological structure of the diagnosis.ConclusionThe nursing diagnosis Impaired Skin Integrity shows advanced conceptual development but remains at an intermediate level of empirical maturity. Although defining characteristics are relatively well established, the limited number of clinical validation studies and the insufficient exploration of related factors restrict diagnostic accuracy and taxonomic robustness.
Few commonly available factors are known which independently of treatment are associated with post- diagnosis paternity in Testicular Cancer Survivors (TCSs). In TCSs and age-matched controls we assessed the associations between first-time post TC paternity and respectively the level of pre-diagnosis paternity and diagnostic age. Using data from the Medical Birth Registry of Norway paternity was assessed during 30 post-diagnosis years in 1062 tumour-free TCSs, (treatment:1980-1994) and 10620 age-matched controls. Analyses comprised post-orchiectomy treatment type (loco-regional versus systemic), diagnostic age (<30 versus ≥30 years), number of pre-diagnosis children (0, 1 versus ≥2) and calender year of TC diagnosis (≤1987 versus ≥1988). Kaplan-Meier estimates, log-rank tests, Cox regression analyses; significance level: p < 0.05 RESULTS: 30 years after the TC diagnosis 45% of the TCSs had fathered ≥ 1 post-TC child (controls: 55%; p < 0.001), Post-TC paternity increased during treatment de-escalation, Compared to pre-TC paternity of one child, pre-diagnosis childlessness (HR: 0.58;[55-0.62]) or fatherhood of ≥ 2 pre-TC children (HR: 0.34;[0.32-0.37]), as well as diagnostic age of ≥ 30 years (HR: 0.40; [0.38-0.43]) reduced post-TC fatherhood. 23% of the TCSs remained finally childless. (Controls: 17%; p < 0.001). Immortal time bias represents a limitation of this study. TCSs can be informed about the generally favourable probability of post-TC fatherhood at least once.The probability of post-TC paternity is, however,slightly lower in TCSs than in controls, even after de-escalated treatment. During post-TC paternity counselling age at diagnosis and the number of pre-diagnosis children should be considered together with treatment type and intensity.
Hospice is designed to support comfort-focused care at the end of life, yet enrollment often depends on whether supportive caregiving infrastructures are in place. Prior studies rely on single indicators such as living arrangements, offering limited insight into the structural care environments that shape hospice feasibility. This study conceptualizes end-of-life care environments as graded structural positions: care formalization (how care is organized across household and institutional settings) and care scarcity (the availability of hands-on support) and examines their associations with hospice use among older decedents, including gender differences shaped by gendered life-course trajectories. Using nationally representative data from the HRS Harmonized End-of-Life Interview (1994-2021; N = 12,477), we estimated multivariable logistic regression models of hospice use in the last year of life. Occupying more formalized structural care positions was associated with greater odds of hospice use (OR = 1.39), whereas greater care scarcity was associated with lower odds (OR = 0.69). Gender moderated both associations: the facilitating effect of formalization was weaker for women (OR = 0.87), while the constraining effect of scarcity was attenuated for women (OR = 1.20), indicating steeper structural gradients among men. Hospice use is embedded within structurally patterned caregiving ecologies rather than driven solely by clinical trajectories or preferences. Erosion of support may constrain hospice access, whereas more formalized care settings may enhance referral and coordination. Strengthening caregiving infrastructures and targeting older adults experiencing care scarcity may promote more equitable end-of-life care.
Pediatric gliomas pose significant treatment challenges due to their location in eloquent areas and the vulnerability of the developing brain to toxicity. Gamma knife radiosurgery (GKRS) has emerged as a minimally invasive alternative aimed at maximizing local control while sparing healthy tissue. This systematic review and meta-analysis evaluated the efficacy and safety profile of GKRS in the management of pediatric gliomas. A comprehensive search was conducted across PubMed, Embase, and Web of Science databases for studies published between January 1994 and September 2024, adhering to PRISMA guidelines. Eligible studies included at least four patients and reported on tumor regression, control rates, or safety outcomes. Data were pooled using a random-effects model with single proportion analysis. Eleven studies encompassing 203 patients were included in the quantitative synthesis. The pooled analysis demonstrated a complete tumor regression rate of 17% (95% CI 10-28%) and a partial regression rate of 47% (95% CI 34-60%). Favorable neurological outcomes were achieved in nearly all evaluated patients - 100% (95% CI 95-100%). Regarding safety, procedure-related mortality was 0%. The overall mortality rate was 9% (95% CI 4-18%), with significantly lower mortality observed in pilocytic astrocytomas (2%) compared to other tumor types (15%). Major and minor complications occurred in 3% and 6% of patients, respectively, while adverse radiation effects were noted in 11%. GKRS is a safe and effective treatment modality for pediatric gliomas, offering high rates of tumor regression and excellent neurological preservation. The procedure is associated with minimal morbidity and zero procedure-related mortality, supporting its utility as a reliable therapeutic option for selected pediatric patients.
Older individuals (≥65 years) are at greatest risk of severe influenza requiring hospitalization. Since 2009, influenza-associated hospitalization rates during A(H1N1)pdm09-predominant influenza seasons have been lower than during A(H3N2) -predominant seasons. \. Using laboratory-confirmed influenza hospitalization rates from U.S. population-based surveillance, we investigated the relative A(H1N1)pdm09 to A(H3N2) hospitalization rate ratios by patient year of age and birth cohort from 2010 through 2025. Results suggest partial protection against A(H1N1)pdm09 hospitalizations relative to A(H3N2) hospitalizations among patients born before 1945 (pre-1945 birth cohorts), and among individuals born during 1994 through 2009. Impact of partial protection against A(H1N1)pdm09-associated hospitalizations has diminished over time among older adults, contributing to elevated influenza hospitalization rates during the 2024-2025 influenza season. Our findings suggest that influenza A hospitalization rates may increase during future influenza seasons when both influenza A(H3N2) and A(H1N1) viruses circulate or following the emergence of novel A(H1N1)pdm09-like viruses.
Comparative evidence regarding the efficacy and safety of medical versus surgical management for missed miscarriage has not been consistently evaluated. The meta-analysis was in line with the PRISMA 2020 and MOOSE guidelines. The Web of Science, PubMed, Embase, and ScienceDirect databases were searched for eligible studies. The outcomes were the success rate, bleeding duration, infection rate and complication rate. The pooled results were synthesized via random-effect model. Influential publication was determined by performing sensitivity analysis. In addition, the potential sources of heterogeneity were examined by using subgroup analyses. Publication bias was assessed using the funnel plot, Begg's and Egger's tests. The seven included studies (four RCTs and three cohort studies) were conducted between 1994 and 2025, with a total of 1,637 patients with missed miscarriage. We found that surgical management demonstrates superior clinical efficacy and safety compared to medical management, with higher success rate [risk difference (RD) = 0.26, 95% confidence interval (95% CI): 0.14 to 0.39, P < 0.001], shorter bleeding duration [weighted mean difference (WMD) = -2.72, 95% CI: -4.53 to -0.92, P < 0.001] and fewer complications (RD = -0.29, 95% CI: -0.43 to -0.15, P < 0.001). No significant difference in infection rate (RD = -0.02, 95% CI = -0.07 to 0.03, P = 0.404). Subgroup analysis showed that patients' mean gestational week was the potential source of heterogeneity. No influential publications and significant publication bias were detected across studies. Surgical management demonstrates superior clinical efficacy and safety compared to medical management, especially in pregnancies with earlier gestational age. A truly patient-centered approach must balance individual preferences, gestational age, follow-up access, and awareness of clinical risks.