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This retrospective analysis aimed to evaluate the diagnostic performance of 18F-flotufolastat PET/MRI for the detection of clinically significant prostate cancer (csPCa). The primary objective of the study was to assess the proportion of patients for whom a prostate biopsy could be safely circumvented by combining the Prostate Imaging Reporting and Data System (PI-RADS) from multiparametric MRI and quantitative data from PET. Methods: This study included 79 patients with suspicion of csPCa based on elevated prostate-specific antigen (>4 ng/mL) who underwent 18F-flotufolastat PET/MRI before biopsy or surgical resection of the prostate. Analytic methods included receiver operating characteristic analysis, logistic regression, and threshold-based evaluation of PI-RADS and of SUVmax Imaging findings were compared against histopathology. Results: csPCa (International Society of Urological Pathology grade group ≥ 2) was confirmed in 42 patients, whereas histopathology excluded csPCa in 37 patients. The combination of PI-RADS and SUVmax resulted in an area under the curve (AUC) of 87.1%, outperforming PI-RADS alone (AUC of 75.2%) and SUVmax alone (AUC of 80.7); however, differences were not statistically significant. A PI-RADS score of at least 3 and 18F-flotufolastat PET showed comparable sensitivity (0.90 vs. 0.91) and specificity (0.42 vs. 0.32) in the detection of csPCa, when applying a low SUVmax threshold (>4.5). Using a high SUVmax threshold (>10.0) increased the specificity of 18F-flotufolastat PET to 100%. Furthermore, combined PET/MRI increased the number of patients for whom csPCa can be reliably diagnosed to 28%, as well as increasing to 29% the number of patients for whom csPCa can be ruled out with a very high degree of certainty. Conclusion: This retrospective analysis suggests that prostate-specific membrane antigen PET/MRI can stratify patients with suspected prostate cancer into 3 groups: one with a very high likelihood of csPCa who may undergo definitive therapy without biopsy, one with a very low risk for csPCa who may not require biopsy, and an indeterminate group who still need biopsy. Overall, in our cohort, prostate biopsy would have been avoided in 57% of patients. Therefore, there is an urgent need for prospective studies on prostate-specific membrane antigen PET/MRI to reduce the number of unnecessary biopsies in men with suspected prostate cancer.
68 Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) is a more accurate way to distinguish neuroendocrine tumors compared with conventional diagnostic methods and a standard impressive way to evaluate disease entities. This is based on 68 Ga-DOTATATE affinity to somatostatin receptors that are overexpressed in the majority of neuroendocrine tumors. In this case presentation, it is aimed to demonstrate the role of 68 Ga-DOTATATE PET/CT scan beyond the detection of neuroendocrine tumors. A 59-year-old Iranian male patient with clear cell renal cell carcinoma who underwent nephrectomy 4 years ago has been referred for evaluation of a diagnosed painful abdominal mass by CT. 68 Ga-DOTATATE PET/CT scan showed a large, lobulated border 68 Ga-DOTATATE avid retroperitoneal tumoral mass in the region of pancreatic head and uncinate process, with fat plane obliteration with duodenum and inferior vena cava. Conspicuous physiological uptake has been reported in the pancreatic head in 16 to 70% of 68 Ga-DOTATATE. Pathological results and immunohistochemistry evaluations confirmed the renal cell carcinoma based on metastases; so, the suspicious diagnosis of neuroendocrine tumor was ruled out. Malignancies, a part of neuroendocrine tumors, may express somatostatin receptors and 68 Ga-DOTATATE or other octreotide derivatives based radiopharmaceuticals uptake appears.
In emergency care, clinicians currently have scarce evidence-based guidance on whether to order diagnostic tests for suspected pulmonary embolism in children. We aimed to test whether the Pulmonary Embolism Rule-Out Criteria in Children (PERC-Peds) can safely rule out pulmonary embolism in children. This multicentre, prospective, observational, diagnostic accuracy study was done in 21 paediatric emergency departments across the USA. We enrolled children aged 4-17 years who presented with symptoms prompting the emergency physician to order, or strongly consider ordering, a diagnostic test for pulmonary embolism. Participants formed a consecutive series. At the point of care, clinicians completed a case report form to record the components of the PERC-Peds rule. Diagnostic testing, including D-dimer testing, was done at clinician discretion. Trained research personnel collected patient-reported demographic data, symptoms, medications, and past medical histories prospectively and cross-checked patient-reported past medical histories and medications against data in the electronic health record. Follow-up was done 45 days after enrolment with a standardised, automated SMS message to caregivers. The criterion standard for pulmonary embolism was the outcome of any venous thromboembolism (VTE; including image-proven pulmonary embolism or proximal deep vein thrombosis [DVT; above knee or elbow, but not including isolated saphenous, brachial, or calf vein clots]) within 45 days, as adjudicated by an independent committee of three board-certified paediatric emergency physicians. Adjudicators viewed all imaging reports, information from the 45-day follow-up, and outside medical records. The primary endpoint was safe exclusion by use of PERC-Peds in all participants who were adjudicated, defined as the upper limit of the 95% CI for the false-negative rate not crossing 1·5%. Between July 29, 2020, and Sept 29, 2024, 4039 children were enrolled, with 4011 participants adjudicated for pulmonary embolism or proximal DVT. Date of last follow-up was Sept 18, 2025. The median age of the adjudicated population was 15 years (IQR 13-16); 2567 (64·0%) were female and 1444 (36·0%) were male. 3988 participants had complete data, and 253 (6·3%, 95% CI 5·6-7·2) were diagnosed with pulmonary embolism or proximal DVT within 45 days. The sensitivity of the PERC-Peds rule was 99·6% (95% CI 97·8-100·0), specificity was 19·6% (18·4-20·9), and false-negative rate was 0·1% (0·0-0·8). D-dimer test was ordered in 3161 (78·8%) of 4011 participants. Sequential use of PERC-Peds followed by D-dimer test ruled out pulmonary embolism or proximal DVT in 2167 (54·3%) with a false-negative rate of 0·9% (0·6-1·4). In this multicentre, prospective, observational, diagnostic accuracy study of children with suspected pulmonary embolism in the emergency department, we found a 6·3% prevalence of pulmonary embolism or proximal DVT; in this population, the PERC-Peds negative rule can safely rule out pulmonary embolism. Use of PERC-Peds might reduce low-value diagnostic testing for pulmonary embolism in children and adolescents. US National Institutes of Health.
Spontaneous hemorrhage from meningiomas causing intracranial hematomas is rare (1%-2% of cases), and concurrent acute subdural hematoma (ASDH) is even rarer, which is easily misdiagnosed and may lead to inadequate preoperative planning. Combined endovascular-craniotomy hybrid surgery enables precise diagnosis and treatment, serving as an effective approach for complex intracranial lesions. A 34-year-old married female was admitted with a 4-day history of sudden headache. Cranial CT showed left temporal lobe hemorrhage and left frontoparietotemporal-occipital ASDH; CTA indicated a left temporal mass, subdural hematoma, sigmoid sinus compression, cerebral edema, and tortuous superficial vessels. Emergency hybrid surgery was conducted. Digital subtraction angiography (DSA) first ruled out intracranial vascular malformations and confirmed that the left temporal lesion was supplied by the temporal branch of the left middle meningeal artery (ball-holding sign). Given the tumor's location at the cerebral convexity with a relatively superficial distribution, combined with the potential risk of ischemic complications and aggravated cerebral edema secondary to preoperative endovascular embolization, preoperative embolization of tumor-feeding arteries was therefore omitted. Direct craniotomy was subsequently adopted as the definitive surgical approach. A left subtemporal craniotomy was subsequently performed, achieving gross total resection of the tumor (2 × 3 × 4 cm) and complete evacuation of the hematoma. Postoperative pathology confirmed angiomatous meningioma (WHO Grade Ⅰ) with hemorrhage. The patient recovered well without complications or neurological deficits, and no recurrence was noted at 1-year follow-up. Combined endovascular-craniotomy hybrid surgery achieves integrated diagnosis and treatment through simultaneous endovascular evaluation and craniotomy, improving the efficiency and accuracy in the management of meningioma-related stroke complicated with ASDH. Preoperative endovascular embolization may be added for large, hypervascular tumors to reduce bleeding, but clinicians should remain vigilant for ischemic risks. Rational application of this hybrid surgery effectively improves patient prognosis.
The three Caribbean medicinal plants Momordica charantia (cerasee/bitter melon), Annona muricata (soursop/graviola), and Petiveria alliacea (Guinea hen weed/anamu) have been traditionally used to treat inflammatory, metabolic, and neurological disorders. Although research in plant phytochemistry has increased, the evidence base in preclinical settings regarding neuroprotective and immunomodulating effects remains underexplored. This systematic review aimed to synthesize published preclinical evidence on the neuroprotective, immunomodulatory, and anti-inflammatory mechanisms of M. charantia, A. muricata, and P. alliacea and to assess their translational and public health relevance within Caribbean and resource-limited contexts. An exhaustive literature search was performed in PubMed, Scopus, Web of Science, and Cochrane Library through specific Boolean search strategies. Relevant articles were selected based on predefined inclusion criteria by one independent reviewer. Articles that met the inclusion criteria were defined as those consisting of original experimental studies (in vitro, in vivo, or both) involving mechanistic immunomodulatory, anti-inflammatory, and neuroprotective mechanisms. Systematic reviews and articles not containing any mechanistic information were ruled out. The methodological quality of the included papers was evaluated using the MMAT (McGill University, Montreal, Canada) and the JBI critical appraisal tool (JBI, Adelaide, Australia). Since the included studies were diverse, results were described descriptively. Out of a total of 1,182 sources, 13 articles were found to fulfill the criteria: nine on M. charantia, two on A. muricata, and two on P. alliacea. All three medicinal plants demonstrated similar anti-inflammatory effects: downregulation of pro-inflammatory cytokines, inhibition of ROS production, and regulation of key signaling cascades, including PI3K/AKT/NF-κB, MAPK, Nrf2/HO-1, and SIRT1/β-catenin. Neuroprotection included inhibition of neuronal apoptosis, promotion of neural stem cell differentiation, and increased permeability of the blood-brain barrier. Additionally, microbiome alteration and miRNA modulation were recognized as promising mechanisms. Dose-dependent cytotoxic effects were reported for certain compounds, while significant methodology heterogeneity hampered comparability between studies. The reviewed literature supports significant neuroprotective and immunomodulatory effects of these Caribbean medicinal herbs in preclinical settings. Nevertheless, translational research is needed to develop recommendations for the clinical use of these herbs, including pharmacological research and clinical trials.
Microbial communities in natural environments are consistently challenged by toxic compounds, such as polycyclic aromatic hydrocarbons (PAHs). The capacity for rapid phenotypic diversification is key to survival in these dynamic and often hostile niches. Here, we report a mechanism by which Escherichia coli (E. coli) generates immediate phenotypic heterogeneity in response to a model PAH, perylene. Utilising single-cell techniques, we revealed unexpected efflux phenotypic switches occurring in a single division event by examining the asymmetric distribution of perylene, a TolC-related efflux system substrate. Contrary to gradual changes in many generations, the phenotypic switch we observed is abrupt, resulting in daughter cells with distinct efflux phenotypes and asymmetric viability. We ruled out uneven efflux pump distribution and suggested the switch is linked to asymmetric proton motive force. Furthermore, we found a correlation between the age of the inherited pole during division and the propensity for phenotypic switching. New pole cells are identified as more prone to this switch. Our findings reveal a rapid division-based strategy for generating phenotypic diversity that could enhance the adaptive potential and resilience of bacterial populations facing fluctuating environmental toxins.
Context-dependent decision-making enables flexible behavior by allowing identical sensory inputs to guide different actions depending on memory, rules, or goals. Recent advances in large-scale neural recordings have shifted the focus from single-neuron tuning to population-level representations, revealing principles by which neural populations support such flexibility. Here, we review evidence of how context-dependent decisions are implemented by population coding mechanisms, including nonlinear mixed selectivity, task-dependent population geometry, shared representational subspaces, and structured across-neuron correlations. Nonlinear mixed selectivity expands representational dimensionality, allowing downstream readout of arbitrary combinations of task variables. Learning reshapes population geometry, and it may balance flexibility and generalization by promoting the reuse of shared representations when task components overlap. Structured correlations between neurons that share a projection target enhance transmission of context-dependent information to downstream circuits. These population-level coding mechanisms provide a conceptual framework for understanding how neural circuits integrate sensory and contextual information to guide behavior.
Multiple primary cancers (MPCs) are increasingly recognized among lung cancer survivors; however, incidence patterns and prognostic impact of lung-involving MPCs (MPC-LC) remain incompletely characterized, particularly given substantial competing mortality. This study aimed to quantify MPC-LC burden and patterns, identify predictors of incident MPC following lung cancer diagnosis, and evaluate factors associated with overall survival. Patients diagnosed with lung cancer between 2013 and 2022 at Korea Cancer Center Hospital were retrospectively analyzed. MPCs were ascertained using Surveillance, Epidemiology, and End Results multiple-primary rules and classified by synchronicity and sequence. Incident metachronous MPCs (mMPC) following lung cancer diagnosis were evaluated using landmark Fine-Gray models, with death as a competing event. OS was assessed using multivariate time-varying Cox models with landmark and lag-time sensitivity analyses. MPC-LC was detected in 317 of 3195 patients (9.9%; 99 synchronous, 218 metachronous). The 3- and 5-year cumulative incidence of mMPC was 7.3% and 9.6%, respectively, whereas competing mortality was 56.2% and 77.0%. Although unadjusted Kaplan-Meier estimates suggested longer crude survival in patients with MPC-LC, time-aware analyses demonstrated an association between MPC-LC and increased mortality, persisting across inverse probability of treatment weighting and sensitivity analyses. Advanced or unknown stage and neuroendocrine carcinoma histology were adverse prognostic factors. MPC-LC occurs amid substantial competing mortality, and its prognostic impact is best understood using bias- and time-aware analytical approaches. These findings support stage- and histology-informed surveillance and coordinated multidisciplinary care in thoracic oncology.
We created fictional case scenarios that might be managed either in primary or secondary care to compare the approaches of a general practitioner, a neurology trainee and a consultant neurologist. Overall, we found them to be similar, with a preference for an approach of 'ruling out worst-case scenarios' but with differences relating to their context and personal risk appetite. A possible diagnosis of functional neurological disorder raised the greatest differences. We discuss these approaches and consider the importance of cognitive strategies, bias and risk appetite in clinical decision-making.
Microplastic contamination in bottled drinking water is an emerging environmental and public health concern, particularly when bottles are exposed to varying storage and thermal conditions. This study introduces FMIND (fuzzy microplastic inference for detection risk), an IoT-enabled fuzzy inference framework for rapid and low-cost microplastic contamination risk assessment. Bottled water stored in PET and stainless-steel containers under sunlight, shade, and freezer conditions was evaluated using IoT sensors measuring temperature, turbidity, and total dissolved solids (TDS) before and after 30 days of storage. Statistical analysis revealed strong correlations between sensor variations and contamination-related physicochemical indicators, including turbidity (r = 0.861), TDS (r = 0.793), and temperature (r = 0.565) (p < 0.001). The FMIND fuzzy model applied 12 Sugeno rules to generate a contamination risk score (0-100), while the HFIRM-GT enhanced configuration improved classification consistency within the experimental dataset, achieving an F1 score of 0.91. Laboratory validation using FTIR spectroscopy, SEM imaging, and EDAX elemental analysis on selected high-risk samples supported the presence of polymer-associated microplastic fragments in sunlight-exposed PET bottles. The proposed framework does not directly quantify microplastics through IoT sensors; instead, it estimates contamination risk using indirect physicochemical indicators supported by laboratory validation. FMIND integrates IoT sensing, fuzzy reasoning, and chemical validation into a unified and interpretable framework for periodic bottled water contamination risk assessment. The reported predictive performance reflects evaluation within a limited experimental dataset and should be interpreted as preliminary proof-of-concept validation rather than generalized field-scale performance. The system provides a scalable and cost-effective approach that supports Sustainable Development Goal 3 (Good Health and Well-Being), Sustainable Development Goal 6 (Clean Water and Sanitation), and Sustainable Development Goal 12 (Responsible Consumption and Production).
Cancer progression is regulated by the dynamic matrix code of the tumor microenvironment, which influences cellular behavior and disease development. Importantly, matrix remodeling in three-dimensional cancer models more accurately reflects in vivo conditions compared to conventional two-dimensional systems. Matrix engineering through bioscaffolds supports physiologically relevant tumor modeling, while matrix-based platforms offer valuable tools for preclinical research and therapeutic development.
The gating and function of γ-aminobutyric acid type A receptors (GABAARs) depend on their hetero-pentameric subunit composition, yet the rules guiding subunit selection remain unclear. We show that a conserved N-linked glycan in α subunits, uniquely positioned within the extracellular pore, acts as a structural constraint that limits the functional viability of α-containing assemblies. A total of 32 µs of molecular dynamics simulations of native and hypothetical non-canonical assemblies show that adding a third pore-facing glycan or placing two glycans on adjacent subunits disrupts key interactions at the β+/α- interface containing the GABA-binding site. These perturbations propagate allosterically, alter extracellular-transmembrane domain coupling, and promote deep gate closure. Systems with three pore-facing glycans consistently adopt deep-closed conformations, whereas native assemblies with two glycans preserve interfacial integrity and pore hydration. These results identify the pore-facing glycan as a structural constraint on functionally viable GABAAR architecture and gating.
Multimorbidity is common among older adults and is associated with substantial treatment burden, functional decline, and complex care needs. Although self-management has received increasing attention, less is known about how older adults organize everyday management activities within the temporal and spatial structures of daily life. This study aimed to explore how older adults with multimorbidity organized their everyday management activities from a time-geography perspective. A qualitative descriptive study was conducted with 26 community-dwelling older adults with two or more chronic conditions. Participants were purposively recruited through the outpatient pharmacy of a tertiary hospital. Semi-structured interviews were conducted face to face and focused on daily routines, management activities, bodily changes, healthcare use, and adjustment strategies. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis informed by time-geography. Data from 26 interviews reached saturation. Thematic analysis generated four themes and eight subthemes: (1) management embedded in everyday routines (management within household life, routine as a stabilizing strategy); (2) capability constraints and fragile routines (symptom fluctuation and disrupted plans, limited mobility, energy, and digital capacity); (3) coordination burden under coupling and authority constraints (constant alignment with people and facilities, restricted choice under rules and roles); and (4) active reorganization under multiple constraints (simplifying and planning ahead, unequal capacity to absorb disruption). Everyday management among older adults with multimorbidity is not a separate or clearly bounded medical activity but a dynamic time-space process embedded in daily life. A time-geography perspective helps reveal how personal, relational, and institutional constraints shape management practices and highlights the need for more realistic, person-centered support for older adults living with multimorbidity.
Although existing approaches, such as Arden Syntax and Asbru, support computable medical knowledge representation, formalizing clinical practice guidelines (CGs) and their individual recommendations so that the logic is clear, consistent and usable, remains challenging. We propose a pre-structuring formalism based on Event-Condition-Action (ECA) - a well-established paradigm in computer science for modeling reactive systems, demonstrate its applicability to real-world examples and map it to Arden Syntax and Asbru. Our results show that this formalism provides a semantically coherent foundation that aligns with the structure of other formal guideline representations.
Randomized multidomain trials have established that cognitive decline requires coordinated action across modifiable contributors, but routine care lacks delivery infrastructure. We evaluated real-world cognitive trajectories in older adults receiving uMETHOD Health clinical decision support system (CDSS)-guided care plans and assessed whether this multidomain approach could be operationalized in routine care. This retrospective, nonrandomized implementation-and-outcomes study analyzed the complete eligible paired cohort: individuals with CDSS-guided care plans and two valid sameinstrument cognitive assessments ≥6 months apart. No additional selection was made by outcome, adherence, or trajectory. The CDSS integrates EHR-derived diagnoses, medications, biomarkers, vital signs, genomics, and lifestyle factors through expert clinical rules with constrained AI support to generate individualized clinician-, patient-, and caregiver-facing plans. Favorable cognitive trajectories were observed in 294 of 345 matched assessment pairs (85.2%) over a mean follow-up of 14.1 months. Assessments used seven validated instruments; mean age was 74.6 years, and baseline medication use was 11.7 medications/patient. Favorable trajectories included 83.5% stable, improved, or minor decline without diagnostic progression and 1.7% slower-than-expected decline on benchmarked instruments (MoCA, MMSE, or SAGE). The CDSS served as an implementation layer, translating multidomain evidence into prioritized, patient-specific next-best actions within ordinary clinical workflows. This positions multidomain cognitive management as a scalable, routine-care activity rather than a researchonly protocol. Multidomain cognitive management was made executable in routine practice, with favorable trajectories observed in 85.2% of paired assessments. The practical implication is immediate: evidence-based cognitive management can be operationalized now at the point of care.
The transition toward Software-Defined Vehicles has rendered internal networks, particularly the Controller Area Network, vulnerable to sophisticated cyberattacks. Although recent research has prioritized Deep Learning Intrusion Detection Systems for their statistical accuracy, these black-box models often fail to meet the strict latency and explainability constraints of automotive safety standards. This article proposes a Multi-Standard (CAN/CAN-FD) logic extraction framework validated herein on legacy CAN and CAN Flexible Data-rate, that reconciles high-precision detection with the deterministic requirements of embedded systems. By employing an elastic parsing mechanism and a constrained Classification and Regression Tree algorithm, the methodology distills complex attack signatures into compact, interpretable boolean rules. Unlike computationally intensive neural networks, this white-box approach ensures deterministic, bounded, worst-case execution time by design. Experimental validation using diverse datasets, including legacy and high-bandwidth CAN Flexible Data-rate traffic, demonstrates that the extracted boolean logic achieves a deterministic algorithmic inference latency as low as 0.15 microseconds. When benchmarked in an identical hardware environment, this represents a 14× empirical speedup over optimized internal ML baselines (XGBoost), and theoretically eliminates the heavy matrix multiplication overhead typical of state-of-the-art deep learning approaches, while maintaining average detection accuracy above 99.97 percent for the CAN Flexible Data-rate. Furthermore, the generated logic satisfies the interpretability mandates of functional safety standards.
Non-tuberculous mycobacteria (NTM) infections are globally prevalent, yet species distribution and antibiotic susceptibility vary considerably across regions. In India, limited epidemiological data have led to treatment practices based largely on western guidelines. This retrospective observational study aims to generate data on the distribution of NTM species and species-specific antibiotic susceptibility patterns at our centre, and to compare these findings with both local and international data to improve treatment outcomes. A 9-year retrospective observational study was conducted at our institute in Mumbai, India, from June 2014 to June 2023. A total of 891 NTM isolates were analyzed-728 (81.7%) rapidly growing mycobacteria (RGM) and 163 (18.3%) slow-growing mycobacteria (SGM). Speciation was performed for 68.2% of RGM isolates, and antimicrobial susceptibility testing was done using standardized protocols. Among RGM, M. abscessus, M. fortuitum, and M. chelonae were predominant. High susceptibility rates were observed to amikacin (100%) and linezolid (M. abscessus 100%, M. fortuitum 100%, M. chelonae 95%). Clarithromycin susceptibility was 90% for M. abscessus, 78% for M. fortuitum, and 90% for M. chelonae. M. fortuitum showed significantly higher susceptibility to quinolones (90% vs <20% for other species). Susceptibility to clarithromycin, linezolid, imipenem, and tobramycin differed notably from western data. RGM susceptibility patterns vary significantly between and within countries, underscoring the need for regional antimicrobial surveillance and India-specific treatment guidelines. Speciation was done for 68.2% of RGM isolates, and inducible macrolide resistance testing was included only after 2017. Clinical correlation was unavailable for a few isolates; hence, colonization could not be ruled out for some respiratory samples. SGM susceptibility data was not available.
This study aimed to explore the prescription patterns of TCM in the treatment of cerebral small vessel disease(CSVD) based on latent structure model combined with association rules and provide a reference for clinical diagnosis and treatment based on syndrome differentiation. Multiple databases including PubMed, EMbase, Cochrane Library, CNKI, Wanfang, VIP, SinoMed, ITMCTR, and ChiCTR were searched from their inception to November 17, 2025. Literature related to TCM prescriptions for CSVD was selected, and a database of TCM prescriptions was established using Microsoft Excel 2019. Lantern 5.0 and Rstudio were used to conduct latent structure analysis and association rule analysis on high-frequency TCMs with a frequency >4.00% to explore the prescription patterns of TCM in the treatment of CSVD. A total of 126 TCM prescriptions involving 164 TCMs and 1 313 total frequencies were included. High-frequency TCMs included Chuanxiong Rhizoma, Pheretima, Astragali Radix, Acori Tatarinowii Rhizoma, and Salviae Miltiorrhizae Radix et Rhizoma, with the main efficacy shown by tonic TCMs and blood-activating and stasis-resolving TCMs. Latent structure analysis identified 12 latent variables, 24 latent classes, 6 comprehensive clustering models, and 17 core prescriptions. Based on the prescriptions, the common syndromes of CSVD were speculated to be Qi deficiency with blood stasis, liver-kidney Yin deficiency, intermingled phlegm and stasis, and wind-phlegm obstructing the collaterals. Association rule analysis identified 39 strong association rules, with Astragali Radix→Chuanxiong Rhizoma having the highest support and Paeoniae Radix Rubra + Persicae Semen→Chuanxiong Rhizoma having the highest confidence. CSVD is a syndrome characterized by deficiency in nature and excess in superficiality, with Qi deficiency and essence depletion as the fundamental aspects, and turbid phlegm and blood stasis as the manifestations. The treatment principles should focus on tonifying Qi, activating blood, and nourishing the liver and kidney, as well as resolving phlegm, dispelling stasis, subsiding wind, unblocking the collaterals, pacifying liver, and subduing Yang.
In view of the shifting standard of care for non-small cell lung cancer (NSCLC), we aimed to capture the evolution of the epidemiological and systemic treatment (ST) landscape in Greece. This non-interventional, single-country, multicenter, retrospective study, collected high-level aggregate data for adult patients who were newly diagnosed with histologically/cytologically confirmed Stage I-IV NSCLC between 01-Jan-2016 and 31-Dec-2020 (index period) at leading oncology clinics across the country. Overall, 10,644 patients were newly diagnosed with NSCLC during the entire 5-year index period at the 18 participating sites (63.8% of the patients inside Attica; 51.0% at public academic institutions). An increasing trend in NSCLC diagnoses was observed throughout the index period, with the largest rise seen from n = 1765 in 2016 to n = 2013 in 2017 which was driven by an abrupt increase in Stage IV diagnoses, and the lowest from n = 2332 in 2019 to n = 2373 in 2020. Over the index period, 5.9%, 10.3%, 23.4% and 60.4% of all cases were Stage I, II, III, and IV, respectively. Of the Stage I and II patients, 41.3% and 73.3% were treated with ST, respectively, which mostly comprised of chemotherapy, with negligible variations through the years. Most of the Stage III and IV patients received ST (85.9% and 88.4%, respectively) with respective overall chemotherapy rates of 82.6% and 63.8% which remained relatively constant over the examined years, and immunotherapy utilisation rates of 29.6% and 31.3% which exhibited gradual and substantial increases (reaching 43.5% and 55.0% in 2020). Among Stage IV patients, 6.6% and 4.8% were treated with targeted and investigational therapies, respectively, accounting for the majority of NSCLC patients treated with such therapies (88.4% and 86.6%). Institutional variations were noticed in temporal trends of NSCLC diagnoses, stage distribution, and ST rates. The number of new NSCLC cases continues to rise with more than half still presenting with metastatic disease. Albeit certain medical practice variations, the observed remarkable increases in immunotherapy use are aligned with immune checkpoint inhibitor approvals and their incorporation into European and national clinical practice guidelines.
Understanding the factors that support sustained smoking cessation is essential for evaluating the effectiveness of tobacco control measures and improving quit outcomes at the population level. This study investigates successful quitting smoking (SQS), defined as abstinence for at least six months, using two waves of the Global Adult Tobacco Survey (GATS), and explores the factors associated with and contributing to changes in SQS over time. We conducted a secondary analysis of GATS India Wave 1 (2009-2010) and Wave 2 (2016-2017). Adults who smoked either currently or in the past 12 months were included, and SQS was assessed among those who reported quitting and remaining abstinent for six months or more. Chi-squares and z-tests were used to examine the difference in characteristics of included participants between two waves and the change in prevalence of SQS among them. Multivariate logistic regression was used to examine associations between SQS and explanatory or tobacco control-related factors within each wave. Multivariate decomposition analysis was conducted to quantify the contribution of each factor to the change in SQS between waves. While the prevalence of smoking decreased significantly from 17.18% in Wave 1 to 13.18% in Wave 2, the prevalence of SQS remained unchanged at 0.70%. Higher education and the presence of indoor smoking restrictions at home were consistently associated with greater odds of SQS. Receiving cessation support other than physician advice was associated with higher SQS in Wave 2. However, no significant change in SQS was observed among individuals who received advice from healthcare professionals. The decomposition analysis revealed no statistically significant contribution of individual factors to the overall change in SQS, although smoke-free home rules showed a high positive contribution within the sample. The findings suggest that while India has made strong policy gains in reducing smoking, these have not translated into improvements in sustained quitting. Strengthening evidence-based cessation support, particularly beyond routine provider advice, and leveraging digital platforms and household-level interventions could be key to improving SQS rates. Continued monitoring and targeted policies are essential to ensure quit attempts result in lasting success.