Data videos are an increasingly popular storytelling medium, effectively communicating data-driven insights to diverse audiences. However, designing compelling data videos requires not only domain knowledge of the data but also expertise in cinematic design, posing substantial challenges for non-experts in design. To study how AI can support non-experts in addressing such challenges during early-stage design, we introduce ideate-through-cocreate, a design concept in which users' ideation is scaffolded through co-creation with generative AI. We instantiate this concept by proposing Data Video Designer (DVD), a proof-of-concept system that supports the ideation of data video opening scenes. DVD facilitates non-experts' ideation processes by generating exemplary video scripts and visuals from high-level topic and data summaries, referencing relevant design guidelines, and integrating accurate visualizations derived from their own data into the generated scenes. Through this workflow, DVD turns abstract cinematic guidelines and AI-generated materials into actionable ideation support. A workshop and a comparative study demonstrated the usefulness of the structured co-creation support provided by DVD within the scope of opening-scene design and revealed the creative potential in balancing the data authenticity and stylized expression. These findings provide initial evidence for the potential of structured human-AI co-creation to support data video ideation.
Small cell lung cancer (SCLC) remains one of the most lethal malignancies, with a five-year survival of <10% despite advances in treatment. Seizure-related gene 6 (SEZ6), a type I transmembrane protein preferentially expressed in neuroendocrine tumors, has recently emerged as a promising therapeutic target, supported by clinical activity of SEZ6-targeted antibody-drug conjugates in relapsed SCLC. Here, we developed and evaluated a humanized anti-SEZ6 monoclonal antibody for SEZ6-targeted positron emission tomography (PET) imaging and α-particle radioimmunotherapy. Immunohistochemistry of patient tissues confirmed strong, stage-independent SEZ6 expression. Cell-based studies demonstrated high SEZ6 receptor densities, supporting high-affinity antibody binding and rapid receptor-mediated internalization. [89Zr]Zr-DFO-SEZ6-Ab administered at low antibody mass exhibited rapid hepatosplenic clearance with minimal tumor uptake despite high intratumoral levels. This pattern was consistent with active ectodomain shedding and local accumulation of soluble antigen within the tumor microenvironment, creating an extracellular antigen sink and limiting effective target engagement. Increasing the antibody mass overcame this barrier, dramatically increasing tumor uptake in xenografts. Treatment with [225Ac]Ac-Macropa-SEZ6-Ab induced complete tumor regression, while co-administration of the ATR inhibitor berzosertib enhanced efficacy at lower radioactivity doses without added toxicity. Together, these findings identify tumor-localized SEZ6 shedding as a biological barrier to SEZ6-targeted therapy, define dosing strategies to overcome it, and demonstrate potent antitumor activity of SEZ6-directed α-particle radioimmunotherapy in SCLC.
Generative artificial intelligence (AI) tools are increasingly used by medical students and may influence clinical reasoning. These systems can assist with information retrieval, differential diagnosis generation, and clinical decision support. Studies demonstrate widespread student interest in AI despite limited formal training. However, concerns remain regarding overreliance, inaccurate outputs, and effects on diagnostic reasoning. This study evaluated how second-year medical students use AI during clinical reasoning and their primary concerns. We conducted a survey of second-year medical students at the USD Sanford School of Medicine. Students reported frequency of AI use for clinical reasoning tasks, including clarifying medical knowledge, generating differential diagnoses, prioritizing diagnoses, suggesting diagnostic tests, and recommending management strategies. Students also identified commonly used AI platforms and completed an open-ended question regarding concerns. Data were analyzed descriptively, with thematic review of qualitative responses. A total of 28 students completed the survey. AI use was widespread, with nearly all respondents reporting use. ChatGPT was the most commonly used platform (~90%), followed by OpenEvidence. Students most frequently used AI to suggest diagnostic tests, propose management strategies, and clarify medical knowledge, indicating early integration into clinical reasoning workflows. Common concerns included overreliance on AI, loss of independent diagnostic reasoning, and incorrect AI-generated information. AI is already integrated into clinical reasoning among medical students. Educational efforts should emphasize critical evaluation and calibrated use of AI to support, rather than replace, independent diagnostic reasoning.
Obesity affects over 40% of adults in the U.S., and bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is among the most effective treatments for sustained weight loss and comorbidity reduction. However, emerging evidence has linked bariatric surgery to an increased risk of alcohol use disorder (AUD), particularly in the years following surgery. To review the evidence surrounding the incidence, timing, mechanisms, and risk factors associated with AUD following bariatric surgery, with an emphasis on RYGB. A comprehensive review of the literature examining postoperative rates of AUD among bariatric surgery patients was conducted, highlighting trends, mechanisms, and subpopulations at risk. RYGB is associated with a significantly increased risk of developing AUD, with incidence rising notably 2-8 years postoperatively. Risk factors include younger age, male gender, preoperative substance use, poor mental health, low social support, and undergoing RYGB rather than other surgical procedures. The delayed increase in AUD appears to result from both physiological changes such as faster alcohol absorption and higher peak blood alcohol levels and psychological factors like addiction transfer. Additionally, bariatric surgery increases risks for alcohol-related liver disease and psychiatric hospitalization related to alcohol misuse. AUD is a significant long-term risk following RYGB, warranting routine preoperative screening, patient education, and long-term postoperative monitoring. Use of validated screening tools and provision of behavioral health support are critical to mitigate this risk and ensure optimal long-term outcomes for bariatric surgery patients.
The continuity of essential medications is a fundamental component of clinical governance within custodial healthcare. National standards, including the Royal Pharmaceutical Society (RPS) Professional Guidance on the Safe and Secure Handling of Medicines1 and the College of Policing's 2024 Authorised Professional Practice (APP) for Custody,2 emphasise the importance of maintaining prescribed treatments to prevent avoidable clinical deterioration. Yet hormone replacement therapy (HRT) frequently remains excluded from rapid medicines continuity pathways, resulting in abrupt interruption for women entering police and prison custody despite risks highlighted in the UK National Preventive Mechanism (NPM) Menopause in Detention Toolkit.3 This article examines the immediate physiological and psychological consequences of abrupt iatrogenic oestrogen withdrawal, framing endocrine withdrawal as an acute patient safety issue rather than a lifestyle concern. It integrates emerging evidence, including the UK National Preventive Mechanism (NPM) Menopause in Detention Toolkit,3 the Independent Custody Visiting Association (ICVA) Menopause Impact Report,4 and the growing recognition that women and clinicians require clearer evidence to support decisions regarding the continuation or discontinuation of hormone replacement therapy(Hamoda and Panay, 2024).5 It also incorporates peer-reviewed neuroendocrine research demonstrating the destabilising effects of abrupt oestradiol withdrawal 6-8. The paper argues for a paradigm shift in custodial healthcare, recognising hormone replacement therapy as an essential endocrine treatment requiring timely continuity of care. It proposes practical approaches to medicines verification and rapid bridging protocols to reduce avoidable endocrine withdrawal, support accurate clinical assessment and improve patient safety.
Intensive care bed block has been a persistent problem worldwide. Current Australian evidence is mostly from single or small-scale multisite studies, and there is a lack of evidence on a bigger scale. To explore multidisciplinary ICU staff's perspectives on the facilitators and barriers to timely ICU patient discharge in Australia. A national cross-sectional online survey was distributed via professional organisations to ICU staff across Australia. The survey comprised 45 quantitative and eight qualitative items informed by systematic reviews and studies at end of the sentence. A total of 114 ICU staff completed the survey. Three-quarters (n = 77, 75%) reported the discharge process as 'extremely' or 'somewhat difficult', with the majority (n = 91, 80%) reporting ward bed unavailability as the primary cause of discharge delay. Respondents expressed that emergency departments and operating theatres were prioritised over ICUs during hospital bed allocation. Ward bed allocation was mostly communicated verbally (n = 44, 39%) or by phone (n = 71, 62%), with only 39% (n = 44) using digital methods. Facilitators included post-ICU ward follow-up assessment and management, ICU discharge liaison nurse coordination of patient transfer and assessment of ward staffing, skill-mix and bed readiness. Additional factors included early identification of dischargeable patients, the use of guidelines, and adherence to policies and checklists. Barriers included lack of ward-level clinical support, incompatibility of documentation platforms, staff shortages and discharge task inefficiencies. Few respondents reported existing strategies to address discharge delays in their hospitals. Respondents highlighted the need for improved digital systems, permanent discharge liaison or co-ordination roles, and post-ICU clinical support services with dedicated funding and appropriate or 24/7 coverage to support timely ICU discharge. Findings highlight the need for organisational-level and workflow-focused strategies to reduce ICU exit block to support timely and safe patient discharge across Australian ICUs.
Commercial tobacco use is a significant public health concern in American Indian communities. Updated, community-specific data are essential to inform culturally grounded tobacco control and policy initiatives. This study describes commercial tobacco use patterns, cessation behaviors, and policy perceptions among adult members of the Cheyenne River Sioux Tribe (CRST) in 2022. A survey was conducted among 400 adult CRST members in 2022. Participants reported tobacco behaviors, quit attempts, cessation methods, sacred tobacco practices, perceptions of Tribal smoke-free policy, and the impact of COVID-19 on tobacco use. Commercial tobacco use was highly prevalent (58.5%). Cigarette and poly-tobacco use were more common among participants reporting lower income (p>0.001) and lower educational attainment (p=0.014). Most tobacco users reported at least one quit attempt (62.5%). Family/community resources were frequently cited as sources of quit support, pharmacologic aids and healthcare providers were less commonly utilized. Sacred tobacco use was common (60%) and did not differ significantly by commercial tobacco use status. Commercial tobacco use among CRST adults is prevalent and socially patterned, despite high levels of quit intent. Findings highlight the need for culturally grounded, multi-product cessation strategies and strengthened integration between policy initiatives and accessible community-based support services.
Depression during pregnancy is an important public health concern, with national recommendations calling for universal screening throughout prenatal care. However, recent analysis within the Sanford Health system (2011-2021) found that depression during pregnancy was diagnosed in 11.20% of all pregnancies but in only 4.55% of Black pregnancies, suggesting underdiagnosis in this population. This study aims to identify barriers to effective prenatal depression screening for Black women and assess potential solutions to improve provider practices and patient outcomes. This qualitative study will involve up to 25 semi-structured informational interviews with prenatal care providers within the Sanford Health system. Providers will be recruited via email using a voluntary participation approach. Interviews will last 15-20 minutes and be conducted in person or via phone in a private setting. Recruitment will continue until thematic saturation, anticipated within 12-25 interviews. We anticipate identifying several recurring themes representing provider-perceived barriers to screening for depressive symptoms during Black pregnancy. Based on preliminary literature and project rationale, expected themes may include time constraints in clinical workflow, limited training in culturally sensitive screening, differences in patient-provider communication, provider uncertainty regarding follow-up procedures, and perceived stigma surrounding mental health. Additional themes may reflect systemic, cultural, or institutional gaps that influence screening practices across clinics. Identifying provider-perceived barriers will inform targeted recommendations for improving depression screening during Black pregnancy within the Great Plains region. Insights from this study may guide development of provider training initiatives, workflow modifications, and system-level supports that promote equitable mental health screening. Ultimately, this work aims to support earlier identification and treatment of depression, reduce disparities in prenatal care, and strengthen culturally responsive practices within regional health systems.
Critical-sized and load-bearing bone defects remain major clinical challenges. The intrinsic regenerative capacity of bone is frequently insufficient to achieve complete functional repair. Recent advances in smart nanocomposite scaffolds have shifted bone tissue engineering from passive structural support toward biologically instructive platforms capable of dynamically regulating cellular behavior and tissue repair. These advances represent a major conceptual and mechanobiological transformation in scaffold design; however, they should not be interpreted as indicating widespread clinical readiness. Despite encouraging preclinical outcomes, most smart scaffold systems remain in the preclinical or early translational stage because critical challenges related to mechanical reliability, scalable manufacturing, long-term biosafety, and regulatory approval remain unresolved. This review examines the mechanobiological mechanisms by which smart nanocomposite scaffolds regulate bone regeneration, with particular emphasis on interactions between scaffolds and stem cells, immune modulation, angiogenic coupling, and translational feasibility. Key regenerative pathways involving osteoconduction, mechanotransduction, ion-mediated signaling, electrical conductivity, and stimuli-responsive activation are analyzed in relation to scaffold composition, nanotopography, and microenvironmental regulation. Comparative translational analysis is provided for bone marrow-derived mesenchymal stem cells, adipose-derived stem cells, induced pluripotent stem cell-derived progenitors, and emerging exosome-based acellular regenerative strategies. In addition, major translational barriers, including manufacturing scalability, mechanical limitations in load-bearing environments, regulatory complexity, long-term biosafety, and reproducibility of cell-based therapies, are critically analyzed. Overall, this review provides a mechanobiological and translational framework for development of clinically applicable smart biomaterials for next-generation bone regenerative engineering. This review presents an evidence-stratified translational framework linking mechanistic pathways to supporting study types and corresponding translational barriers.
Simultaneous separation of structurally similar flavonoid glycosides remains challenging in functional food analysis. This study investigated the migration behavior of eight flavonoid glycosides by capillary zone electrophoresis with UV detection (CZE-UV). Phenolic deprotonation governed effective charge and electrophoretic mobility. However, strong pH dependence reduced robustness, prompting the exploration of less charge-dependent strategies. Deep eutectic solvents (DESs) provided limited improvement, whereas methyl-β-cyclodextrin (Me-β-CD) enabled stereoselective host-guest recognition and separated all eight analytes within 12 min under optimized conditions (5.0 mM Me-β-CD). The method showed good linearity and an LOD of approximately 0.3 μg/mL, supporting its use in quality control of purified moringa leaf extracts and related functional food materials. It quantified isoquercitrin and hyperoside as major flavonoid glycosides and detected two trace peaks tentatively assigned to spiraeoside and isovitexin with LC-MS/MS support.
Transthoracic echocardiography is a widely used, noninvasive tool for cardiac imaging, but the quality of image acquisition remains highly operator-dependent. Existing artificial intelligence-based systems often require large amounts of labeled data and provide only global quality scores, limiting their utility in real-time clinical applications. We propose a multi-task guidance framework that jointly performs supervised view classification and cardiac structure segmentation, and reuses their outputs to enable label-efficient, structure-specific image quality scoring through entropy-based metrics without additional quality annotations. A lightweight maneuver predictor then uses these features to suggest one of seven corrective probe maneuvers in real-time. To train and validate the system, we constructed a 43-case maneuver-tagged dataset capturing intentional transitions from standard to nonstandard views. The proposed quality metric successfully distinguished standard from nonstandard views across multiple cardiac structures (AUC: 0.901-0.987). The maneuver predictor achieved a top-1 accuracy of 85.1% (mAP: 0.904) and inference time of 17 ms per frame, supporting its feasibility for real-time use. This system can assist novice or trainee users in consistently acquiring acceptable echocardiographic views with minimal additional annotation, which can improve clinical efficiency and reliability.
Inspired by reports that HDAC blockade can trigger compensatory activation of the LIFR-JAK1-STAT3 axis in solid tumors, we designed and synthesized a series of niclosamide-based STAT3/HDAC dual-target inhibitor candidates by incorporating a SAHA-derived hydroxamate zinc-binding group into the pleiotropic, STAT3-modulating niclosamide scaffold. Biological evaluation identified NS06 as the best-balanced analogue, with IC50 values of 1.49 and 1.41 μM against MDA-MB-231 and HCT116 cells, respectively. Mechanistic studies showed that NS06 bound STAT3 in vitro (SPR, KD = 5.82 μM), suppressed STAT3 phosphorylation, and inhibited HDAC1, HDAC3, and HDAC6 with IC50 values of 129.1, 451.2, and 230.4 nM, respectively, while showing limited inhibition of HDAC4 and HDAC11 in the primary screen. NS06 also increased histone H3 acetylation, induced apoptosis, and inhibited migration and colony formation. In addition, NS06 retained antiproliferative activity in a 3D tumor spheroid model and showed improved Caco-2 permeability together with moderate liver microsomal stability (t1/2 ≈ 48.6 min in rat liver microsomes). Docking and 100-ns molecular dynamics simulations further supported chemically plausible binding modes in the HDAC1 catalytic pocket and the STAT3 SH2 domain. Overall, these findings support niclosamide as a tractable scaffold for mechanism-driven STAT3/HDAC dual-target inhibitor design and identify NS06 as a promising lead for further optimization against solid tumors.
Boredom‑related metacognitions have recently been proposed as cognitive predictors of maladaptive online behaviors. The present longitudinal study examined whether positive and negative metacognitive beliefs about boredom are prospectively associated with problematic social media use (PSMU) through increased boredom proneness. A community sample of Persian‑speaking adults (N = 1,796; mean age = 38.24 years, 56.5% female) was followed across four waves over nine months. Using random‑intercept cross‑lagged panel models, within‑person dynamics were separated from between‑person stability and a coherent temporal sequence of associations was identified. Higher positive metacognitive beliefs about boredom predicted subsequent within‑person increases in boredom proneness, which in turn predicted elevations in negative metacognitive beliefs. These negative beliefs subsequently predicted increases in PSMU. Bootstrapped indirect effects confirmed significant serial mediation across two‑ and three‑wave intervals. Nested model comparisons indicated that retaining the full serial mediation pathway significantly improved model fit, supporting the importance of all proposed associations in the longitudinal process. Sensitivity analyses confirmed the findings' robustness, remaining stable with gender control and multiple imputation. Future prevention and intervention programs that address boredom‑related metacognitions as upstream cognitive vulnerabilities may be relevant targets for prevention and intervention efforts aimed at reducing maladaptive online use patterns.
This study investigated developmental changes and the underlying molecular mechanisms in testicular tissue of Yangzhou geese during the transition from the peak production (PP) to egg production shutdown (PF) periods. We hypothesized that this transition is accompanied by a reciprocal shift in resource allocation-declining spermatogenic activity offset by enhanced immune function-reflecting an adaptive life-history trade-off in this seasonally breeding species. Five Yangzhou geese were randomly selected each during the PP (day 73) and PF (day 135) periods, based on the endogenous seasonal reproductive rhythm of this breed under standard 12L:12D production lighting. Blood samples were collected for serum biochemical and hormonal analysis, and left testicular tissues were collected for RNA sequencing (RNA-seq) and quantitative RT-PCR (qRT-PCR) validation. The results show: the Johnsen spermatogenic score and the number of mature spermatozoa were significantly higher in the PP group (P < 0.05). Serum follicle-stimulating hormone (FSH) concentration was significantly higher in the PP group than in the PF group (P < 0.05). RNA-seq identified 3605 DEGs (FDR <0.05, |log2FC| > 1); enrichment analysis (BH adj. P < 0.05) revealed significant upregulation of immune-related pathways (phagosome, hematopoietic cell lineage, complement and coagulation cascades) and downregulation of spermatogenesis-related terms (cilium movement, axonemal dynein complex assembly) in the PF group. Serum concentrations of interferon-gamma (IFN-γ) and immunoglobulin G (IgG) were also significantly elevated in the PF group (P < 0.01), and immune indices were negatively correlated with reproductive indices. These findings support an adaptive immune-reproductive trade-off during seasonal testicular regression in Yangzhou geese, advancing our understanding of resource allocation strategies in seasonally breeding poultry.
Agglomerate fog at tunnel entrances creates a coupled hazard of sudden visibility loss and luminance transition, yet its effect on driver perception-behavior coordination is underexamined. This study investigates how visibility and multi-level guidance facilities influence such coordination. Driving simulation experiments with 21 drivers were conducted under two visibilities (50 m and 200 m) and four guidance configurations (basic, information-enhanced, speed-control, integrated). Dynamic time warping (DTW) clustering, behavior sequence analysis, and a coupling coordination degree model were applied. (1) At 50 m visibility, drivers adopted a conservative strategy: speed reduced by approximately 60 km/h, fixation duration increased, and saccade scope narrowed. (2) Facility effectiveness was visibility-dependent; the integrated scheme (red fog lamps, dense layout, VMS, markings) performed best under agglomerate fog, as speed reduction markings alone attracted excessive gaze and suppressed saccades. (3) Enhanced facilities improved perception-behavior synergy; coupling coordination degree increased from basic to integrated scheme. At 200 m, advanced schemes approached saturation (diminishing returns). (4) Under basic facilities, coordination at 50 m (0.343) slightly exceeded that at 200 m (0.297), suggesting a tendency toward passive but tightly synchronized coordination under extreme conditions. The integrated guidance scheme robustly supports driver coordination in dense fog. The coupling coordination degree effectively quantifies system synergy. These findings guide optimal design of tunnel entrance guidance facilities under agglomerate fog.
The rapid spread of metallo-β-lactamase (MBL)-mediated resistance, particularly by NDM- and VIM-type enzymes, poses a major threat to the clinical efficacy of β-lactam antibiotics. Building on our previous work, we report the design, synthesis, and evaluation of 4-substituted 3,5-diarylpyrrole-2-carboxylic acids as MBL inhibitors. Structure-activity relationship studies revealed that both the nature and position of substituents in the A and B rings, as well as functionalization at the C4 position, critically influence inhibitory activity. Notably, C4 halogenation, especially bromination, significantly enhanced inhibition of VIM-2 while maintaining activity against NDM-1. Molecular modelling supported these findings, indicating distinct binding modes and coordination patterns within the enzyme active sites. The most active compounds displayed nanomolar potency and effectively restored the activity of β-lactam antibiotics, including meropenem, against NDM- and VIM-producing resistant strains. Importantly, the compounds exhibited no detectable cytotoxicity and lacked intrinsic antibacterial activity. These results identify C4-functionalized pyrrole-2-carboxylic acids as promising dual-target MBL inhibitors for combination antibacterial therapy.
The term sepsis is commonly used in surgical and critical care settings, yet its linguistic and emotional impact on patients' families is underexplored. Misinterpretation can influence perception, critical decision, and heighten fear. This work examines how the diagnosis of sepsis functions as both a physiologic and communicative event, and to propose the SEPSIS Dialogue; a novel, structured framework for family-centered communication in acute surgical care. Narrative reflection and synthesis integrating surgical physiology, health literacy, and communication ethics. This framework was developed by mapping common communicative friction points in the ICU and perioperative setting against established principles of serious illness conversations. Families frequently interpret sepsis as a fixed, catastrophic outcome, whereas clinicians view it as a dynamic spectrum. In surgical contexts, this "comprehension gap" is often widest at critical decision points, such as the need for re-operation. The SEPSIS Dialogue (State mechanism, Explain source, Present the spectrum, Speak to uncertainty, Invite questions, Support emotions, Demonstrate understanding) provides a structured pathway to bridge the gap in ways that respect comprehension, emotional experience, and clinical context. Structured, plain-language communication can transform sepsis conversations from fear-driven moments into opportunities for partnership, clarity, and informed, values-based care.
Interpretability remains a central challenge in the deployment of deep neural networks, particularly in safety-critical and decision-sensitive fields. This work proposes a unified framework for post-hoc global interpretability by transforming general neural network architectures-including the Residual Network and Transformer-into equivalent decision diagrams over real-valued inputs and multi-class outputs. These decision diagrams provide a transparent, structured view of the neural network's overall behavior, where each path encodes a tractable and interpretable decision rule. We identify a counterintuitive yet effective modification in the node merging process during diagram construction, which leads to faster entropy reduction and smaller equivalent intervals, thereby significantly reducing the diagram size while maintaining equivalence with the original network. The resulting representations not only support the exploration of logical properties, such as decision boundary tracing, equivalence checking, robustness analysis, and model counting, but also serve as globally interpretable surrogates for the original neural networks. Experiments validate the effectiveness and scalability of the proposed methods, highlighting their potential for reliable neural network analysis and verification.
Porphyrin metal-organic frameworks (PMOFs) offer structurally ordered and compositionally tunable platforms for sensitized photovoltaics. Titanium- and indium-based PMOFs, together with a tin-doped indium analog, were investigated as photosensitizers in solid-state dye-sensitized solar cells (ssDSSCs). Electrochemical and optical measurements confirmed favorable energy-level alignment with the TiO2 conduction band and the hole-transporting material, supporting charge injection and transport. Distinct crystallite morphologies between Ti- and In-based PMOFs govern interfacial geometry and recombination pathways within the mesoporous TiO2 scaffold. In contrast, the enhanced performance of In-PMOF(Sn) relative to In-PMOF is attributed primarily to dopant-induced modifications in redox behavior and interfacial charge-transfer kinetics rather than substantial shifts in frontier orbital energies. Although overall efficiencies remain modest, these findings establish clear structure-kinetics-performance relationships and demonstrate that node chemistry and dopant incorporation provide complementary strategies for tuning interfacial charge-transfer dynamics in PMOF-sensitized ssDSSCs.
Purpose We aimed to describe the treatment landscape for biliary tract cancer (BTC), including patient characteristics, initial treatment patterns, and survival outcomes, and examine factors associated with receiving no active anticancer treatment (NT). Methods We conducted a retrospective cohort study of patients diagnosed with BTC between April 2014 and March 2020 identified through cancer registries and linked with the Kyoto City Integrated Database. Patient characteristics, factors associated with NT, and median overall survival (mOS) were analyzed using multivariate logistic regression and Kaplan-Meier methods. Results Among 1367 eligible patients, 30.1% underwent curative surgery, whereas 44.3% received NT. NT was significantly associated with distant metastasis (adjusted odds ratio [AOR] 4.24; 95% CI 2.92-6.15), certified long-term care (AOR 2.34; 1.76-3.10), and age ≥75 years (AOR 2.23; 1.70-2.93). The mOS was 54.6 months in the curative surgery group, 7.7-18.0 months in the noncurative surgical and nonsurgical treatment groups, and 5.2 months in the NT group. Conclusions Over 40% of patients with BTC in Kyoto City received no active treatment and had shorter survival. Older age and certification for long-term care were significantly associated with the selection of no active treatment. These findings describe treatment patterns among older adults with BTC and may help inform future strategies to improve treatment access, supportive care, and early detection.