In this study, we aimed to evaluate the association between liver clearance values obtained from pre-treatment [⁹⁹ᵐTc]mebrofenin hepatobiliary scintigraphy and conventional liver function scores and biochemical parameters, and to perform an exploratory prognostic assessment of whether baseline clearance is associated with post-treatment outcomes, including overall survival, prior to ⁹⁰Y radioembolization. We also compared the functional assessment of the treatment region (based on mebrofenin uptake) with its anatomical CT volume (derived from [⁹⁹ᵐTc]macroaggregated albumin SPECT/CT) to determine the concordance between functional and volumetric data. Pre-treatment [⁹⁹ᵐTc]mebrofenin and [⁹⁹ᵐTc]MAA scintigraphies were performed in 19 patients scheduled to receive Yttrium-90 (90Y) microsphere therapy. Mebrofenin clearance was calculated, and its association with biochemical parameters and overall survival was examined. The functional definition of the planned treatment territory was estimated based on mebrofenin uptake, and this was compared with the anatomical volume of the same region on MAA SPECT/CT. Mebrofenin liver clearance showed significant (p < 0.05) negative correlations with pre- and post-treatment total and direct bilirubin levels and a positive correlation with post-treatment albumin. Clearance also demonstrated a strong inverse correlation with ALBI score (p < 0.05). Among biochemical changes, only the post-treatment change in direct bilirubin was significantly associated with clearance (p < 0.05). Functional and volumetric definitions of the treatment area showed strong correlation (ρ = 0.837, p < 0.001). In five patients with target ratio greater than 50% of liver volume, functional definition was not concordant with volumetric estimates. The difference in clearance values between patients surviving ≤ 6 months and > 6 months did not reach statistical significance. Among liver function scores, Child-Pugh exhibited the strongest, though non-significant, correlation with survival (ρ = - 0.407, p = 0.084). [⁹⁹ᵐTc]mebrofenin scintigraphy correlated with both pre- and post-treatment biochemical liver function parameters. The functional definition of the treatment region assessed by scintigraphy and volumetric definition derived from SPECT/CT were also well concordant. The difference in clearance values between patients surviving ≤ 6 months and > 6 months did not reach statistical significance. Discrepancies between volumetric and functional definitions were observed in patients with extensive target volume (> 50% of liver volume). These preliminary findings suggest that [⁹⁹ᵐTc]mebrofenin scintigraphy may complement anatomical volumetry in the pretreatment assessment of functional liver reserve, but its potential role in individualized dosimetry requires confirmation in larger prospective studies.
The Pingyin-Changqing section of the Yellow River serves as an important groundwater recharge area in the lower reaches of the Yellow River, and its groundwater quality safety holds significant importance for the regional ecology and the health of its residents. This study systematically collected groundwater samples from this area, detected concentrations of six heavy metals (Mn, Zn, Ni, Pb, As, and Cd), and comprehensively applied mathematical statistics, spatial mapping analysis, source apportionment, and health risk assessment methods to systematically investigate the characteristics, distribution patterns, source mechanisms, and health risks of groundwater heavy metals in the region. The results indicate that (1) the mean concentrations of heavy metals in groundwater of the study area, in descending order, are Mn > Zn > Ni > Pb > As > Cd; compared against the Class III standard limits of the National Standard for Groundwater Quality, Mn shows the highest exceedance rate, followed by Pb, with exceedance rates of 18% and 5%, respectively; (2) heavy metal concentrations exhibit considerable spatial variability, with Mn exceedance points uniformly distributed in upstream and downstream areas on both banks of the Yellow River, while Pb concentrations demonstrate higher values downstream than upstream, with exceedance points mainly concentrated in the junction of Qihe and Dong'e; (3) sources of groundwater heavy metal pollution are identified as follows: Zn, Ni, and Cd primarily originate from different industrial sources, Pb mainly from traffic sources, As primarily from agricultural sources, and Mn predominantly from natural sources; (4) groundwater ingestion was identified as the dominant exposure pathway. Pb was the major contributor to noncarcinogenic risk, whereas As was the primary contributor to carcinogenic risk. Children exhibited higher noncarcinogenic risk levels than adults, reflecting their greater susceptibility to heavy metal exposure. Although both carcinogenic and noncarcinogenic risks remained within acceptable limits overall, relatively elevated risk values were concentrated at the junction of Changqing, Pingyin, Dong'e, and Qihe. Through the technical route of "pollution identification-spatial mapping-source apportionment-risk assessment," this study provides a scientific basis for groundwater safety protection in the Yellow River Basin. It is recommended to strengthen dynamic monitoring of Pb pollution and implement comprehensive prevention and control measures in high-risk areas of this region.
The study aimed to develop and evaluate an itch assessment questionnaire (IAQ) to determine and monitor itch severity and its impact on quality of life (QOL) in a multi-ethnic Asian population. It addresses limitations of existing tools, which assess only narrow aspects of itch and require multiple instruments for a comprehensive evaluation of itch and its impact on patients' QOL. No single, validated multidimensional questionnaire currently reflects the cultural and ethnic diversity of Asian populations. An exploratory, sequential, mixed-methods study was conducted in two phases in a primary care setting in Singapore. Phase one used literature review, preliminary qualitative study findings, expert discussions and qualitative interviews with 13 patients and 10 primary care physicians to develop a draft IAQ. In phase two, 250 participants (with and without itch) completed the draft IAQ, 5-D pruritus scale, and Dermatology Life Quality Index (DLQI) over three points, 4-10 days apart. Data was analysed to assess IAQ's validity and reliability. The final IAQ comprised 10 questions across three parts: itch severity, impact on QOL, and itch management. The IAQ demonstrated a strong correlation with the 5-D pruritus scale (ρ = 0.67, p < 0.001) and DLQI (ρ = 0.77, p < 0.001). The overall intraclass correlation coefficient and Cronbach α were 0.93 (95% CI = 0.91 to 0.95) and 0.94 (95% CI = 0.93 - 0.95), respectively. IAQ demonstrated construct validity and excellent reliability, suggesting its suitability for assessing itch severity and impact on QOL in multi-ethnic Asian populations.
Groundwater is essential for regional water supply, irrigation, and drinking safety. This study assessed groundwater quality around the northern Nansi Lake. Results show slightly alkaline water with HCO3 - and Ca2+ as dominant ions. Hydrochemical types are mainly HCO3·Ca·Mg and SO4·Cl·Ca·Mg, controlled by rock weathering and cation exchange. Positive Matrix Factorization (PMF) analysis reveals industrial activities and evaporite dissolution prevail in dry season, while agricultural nitrate pollution intensifies in wet season. The evaluation of drinking water quality shows that overall water quality is good to excellent (better in the dry season), with 5% of samples unfit for drinking. Irrigation indicators indicate that most samples are suitable for irrigation. Health risk assessment shows children face higher risks from NO3 - and F- than adults. In wet season, children's mean HI is 1.62, with 37% of samples HI > 1, mainly near farmland and urban areas.
Heavy metals (HMs) contamination in agricultural soil environmental systems poses a critical threat to ecosystem security, food safety, and public health. To investigate the pollution characteristics, sources, and ecological-health risks of HMs in agricultural soils in a concentrated gold mining area, topsoil samples were collected from the vicinity of industrial squares, tailings ponds, and potentially affected zones. The concentrations of Hg, Cd, Cr, Ni, As, Pb, Cu, and Zn were determined. The geo-accumulation index (Igeo), enrichment factor (EF), potential ecological risk index (RI), and human health risk assessment (HRA) model were employed to evaluate the contamination level and associated risks. Principal component analysis (PCA) and positive matrix factorization (PMF) were combined to quantitatively apportion the sources of HMs. The results indicated that, except for one sample each exceeding the standard for Cd and Hg near tailings ponds, the concentrations of the remaining HMs fell within the corresponding risk screening values. The Igeo and EF results revealed that Cd exhibited the highest enrichment, with over 30% of samples showing moderate enrichment, whereas other elements remained at minimal enrichment levels. The PMF model identified five sources: natural parent material (51.62%), gold mining and smelting (15.19%), atmospheric deposition (Hg, 14.77%), a mixed source of natural background and mining activities (14.45%), and a localized minor anthropogenic mixed source (3.97%). The potential ecological risk was largely attributed to the accumulation of Cd and Hg. The comprehensive RI indicated that 76.67% of sites were at low risk and 23.33% at moderate risk. The non-carcinogenic risk for both children and adults fell beneath the acceptable threshold (HI < 1), while the carcinogenic risks (especially for Cr and As) posed potential health threats, particularly concerning children. Overall, the agricultural soils are generally clean with localized contamination, and Cd and Hg are identified as the priority control elements.
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Cancer continues to be a leading cause of global mortality, highlighting the ongoing need for novel anticancer compounds that offer high efficacy with improved side effect profiles. In the present study, a series of 3H-1,2-dithiole-3-thione derivatives (DTT-S1-18) were synthesized as promising anticancer agents, and the structures of products were confirmed by spectral techniques. H2S-releasing experiments showed that most of the compounds released higher amounts of H2S slowly over time compared to standard ADT-OH. All compounds were tested for antiproliferative activity on HT-29, PC-3, MCF-7, and HUVEC cell lines. Compounds DTT-S6 (3-nitrophenyl derivative) and DTT-S8 (methionine derivative) have the lowest IC50 values of 41.6 and 38.9 µM on the MCF-7 cell line, respectively. Based on the wound healing and colony formation assays performed in MCF-7 cells, the wound areas were not significantly changed after treatment with compounds DTT-S6 and DTT-S8, whereas compound DTT-S8 at double IC50 dose inhibited colony formation by 81.82%. In addition, molecular docking, MD simulations, MM/GBSA binding free energy calculations, and binary QSAR analyses were performed to explore the potential target interactions and predicted activity profiles of the synthesized compounds toward inflammation-related proteins, including COX-1, COX-2, 5-LOX, and iNOS, thereby supporting the development of mechanistic hypotheses for future validation. Furthermore, structure-activity relationship (SAR) analyses were conducted to correlate the structural characteristics of the synthesized compounds with their H2S releasing potential and biological profiles. Overall, this work integrates experimental anticancer evaluation with computational pathway and structure-based cancer/inflammation analyses to characterize novel DTT-based H2S donors. The findings identify particularly compound DTT-S8, as a promising in vitro anticancer candidate, while the computational results suggest a putative involvement of inflammation-related targets, particularly the COX-2/5-LOX axis, which requires direct biochemical and cellular validation.
Pectus excavatum (PE) can mechanically displace and compress the heart, often altering right ventricular (RV) geometry and function. Comprehensive preoperative echocardiographic characterization in large adult cohorts is limited. This study describes structural and functional cardiac findings in a large cohort of adults with PE evaluated by transthoracic echocardiography (TTE) prior to surgical repair. We retrospectively reviewed adult patients undergoing primary minimally invasive repair of PE (MIRPE) at a single tertiary center between January 2016 and July 2024 who had at least one preoperative TTE. Echocardiographic measurements followed scientific guidelines and included anatomical, functional, and hemodynamic assessment of the cardiac chambers, evaluation of valvular morphology, and visual assessment of cardiac compression. Among 639 adults (median age 28 years), cardiac compression was identified in 64% of cases on preoperative TTE. An additional 21% (increased to 85%) had compression subsequently seen on intraoperative echocardiography. Despite preserved conventional systolic parameters such as tricuspid annular plane systolic excursion, a high prevalence of RV functional abnormalities was observed, including reduced tissue Doppler S' velocity in 61.9%, reduced RV fractional area change in 62.4%, impaired RV free-wall longitudinal strain in 70.6%, and reduced RV stroke volume index in 54.7% of patients. Septal motion abnormalities were present in 24%. Mitral valve morphological abnormalities were frequent, with elongated anterior mitral valve leaflets observed in 76.9% of patients and mitral valve prolapse or bowing in 24%. In this large adult PE cohort, cardiac compression, subclinical RV systolic dysfunction, reduced stroke volume, and mitral valve morphological abnormalities were common, often despite preserved conventional echocardiographic parameters. These findings highlight the importance of a standardized and comprehensive echocardiographic evaluation to detect clinically relevant cardiac involvement in PE.
Presenteeism is commonly assessed using retrospective instruments such as the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ); however, how daily presenteeism assessed using experience sampling relates to these standard measures remains unclear. This study quantified within-person variability in daily presenteeism assessed using experience sampling methods (ESM) among Japanese workers, while also examining its convergence with retrospective WHO-HPQ presenteeism. This observational study enrolled 94 white-collar employees; 93 were included in the final analysis after exclusion of one participant because of missing data. Participants completed daily work performance assessments on 19 weekdays using a mobile-based ESM approach. Aggregated daily presenteeism scores were compared with retrospective WHO-HPQ presenteeism scores assessed over the preceding four weeks. Convergence was evaluated using Spearman's rank correlation coefficient, and agreement was examined using Bland-Altman analysis. Within-person variability was quantified using the coefficient of variation (CV) and intraclass correlation coefficient (ICC). Mean daily absolute presenteeism scores were strongly correlated with retrospective WHO-HPQ presenteeism scores (Spearman's rs = .783, P < .001). Bland-Altman analysis showed minimal systematic differences on average, despite substantial individual-level variability. Daily presenteeism exhibited substantial variability, with a CV of 42.2% (95% confidence interval: 36.7-47.6) and an ICC of .431. Daily presenteeism converged with retrospective WHO-HPQ presenteeism while capturing substantial within-person variability that is not fully reflected in retrospective assessments. These findings support interpreting presenteeism as a dynamically fluctuating state and highlight the importance of selecting measures with appropriate temporal resolution.
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is generally responsive to immunotherapy, but some patients remain refractory despite treatment escalation. Lymphoplasmapheresis (LPE), a modified apheresis technique that removes both plasma components and circulating lymphocytes, may offer a salvage option in selected cases. We report a 61-year-old woman with refractory anti-NMDAR encephalitis who showed limited improvement after corticosteroids, intravenous immunoglobulin, and ofatumumab. After a prolonged interval following ofatumumab induction, she remained severely impaired with persistent disease activity and elevated cerebrospinal fluid and serum anti-NMDAR IgG titers. Three sessions of LPE were performed over 5 days. Clinical improvement was observed after LPE, accompanied by a decline in antibody titers. At 5-month follow-up after LPE, she maintained sustained recovery, with a Clinical Assessment Scale in Autoimmune Encephalitis score of 6 and a modified Rankin Scale score of 2. This case supports a close temporal association between LPE and clinical and immunological improvement, although causality cannot be definitively established from a single case.
Visual age reflects a set of external signs formed under the influence of genetic factors, environmental conditions, lifestyle, and general health status. The relationship between visual age, biological age, and cardiovascular and metabolic disorders is discussed. Particular attention is given to morphological changes of facial skin and soft tissues, as well as to the role of endothelial dysfunction and oxidative stress in accelerating aging processes. Assessment of visual age may serve as an additional indicator for identifying premature aging. Визуальный возраст отражает совокупность внешних признаков старения, формирующихся под влиянием генетических факторов, условий окружающей среды, образа жизни и состояния здоровья человека. Отмечена взаимосвязь визуального возраста с биологическим возрастом и развитием сердечно-сосудистых и метаболических нарушений. Рассмотрены основные морфологические изменения кожи и мягких тканей лица, а также роль эндотелиальной дисфункции и окислительного стресса в ускорении процессов старения. Оценка визуального возраста может использоваться как дополнительный показатель при выявлении признаков преждевременного старения.
The recent discourse by Andaria and Mole regarding the ecological imperatives of medical laboratory practices marks a significant intellectual contribution to the burgeoning field of planetary health. While the authors cogently argue for the integration of sustainability within diagnostic frameworks, there remains an urgent need to transition from qualitative advocacy to a more rigorous, quantitative paradigm of environmental accountability. This critique posits that the current reliance on voluntary "eco-conscious" shifts is insufficient against the backdrop of escalating global diagnostic demands. Specifically, the tension between the stringent requirements of clinical precision-governed by frameworks such as ISO 15189-and the mandates of ecological preservation requires a more nuanced exploration of "regulatory synergy". Of note, while the authors correctly identify the disparate impact on lower- and middle-income countries (LMICs), the discussion must move beyond infrastructural deficits to address the systemic "exportation of ecological debt" through the global medical supply chain. Furthermore, by implementing standardized Lifecycle Assessments (LCAs) and integrating sustainability metrics into the very core of healthcare accreditation, the laboratory sector can evolve from a passive participant in the Sustainable Development Goals (SDGs) to a proactive vanguard of the "One Health" initiative. This letter advocates for a mandatory "Green Diagnostic Charter" that transcends institutional goodwill to ensure that the pursuit of human health no longer occurs at the deleterious expense of our shared biosphere.
The purpose of this review is to summarize and critically analyze data on markers of metabolic and mitochondrial stress in atherosclerosis in older and oldest-old patients, highlighting differences between circulating clinical biomarkers, metabolic-epigenetic indicators, and intracellular regulators of mitochondrial quality control, as well as the limitations of age-specific interpretation. An analytical narrative review of the literature was performed using PubMed, Scopus, and Web of Science for 2010-2025; the last control search was conducted on April 27, 2026. The keywords used were signaling molecules, FGF21, GDF15, endothelial dysfunction, mitochondrial dysfunction, lactate, endothelial aging, and cellular senescence. The analysis included 38 sources with a focus on clinical cohorts, age-stratified data, experimental studies on vascular aging, and publications with translational potential. The selection of markers was based on their representation of different levels of the pathological process: systemic stress response, metabolic-epigenetic remodeling, and intracellular mitochondrial quality control. The most clinically relevant circulating candidates are FGF21 (fibroblast growth factor 21) and GDF15 (growth differentiation factor 15). FGF21 is associated with atherosclerotic lesions and cardiovascular risk, but its increase should be interpreted as a reflection of an activated stress response rather than as an independent diagnostic criterion. GDF15 is associated with age, functional decline, comorbidity, and poor prognosis, but it is not a specific marker of atherosclerosis. Lactate and lactylation represent a promising metabolic-epigenetic mechanism linking glycolytic shift, cellular senescence, and vascular inflammation, but evidence of correspondence between circulating and tissue levels is still required. AMPK, PGC-1α, and PINK1/Parkin have predominantly mechanistic significance and should currently be considered intracellular regulators and therapeutic targets rather than clinically validated biomarkers. In atherosclerosis in older and oldest-old patients, markers of metabolic and mitochondrial stress should be assessed within a hierarchical evidence model and with mandatory consideration of age, comorbidity, and treatment-related confounders. FGF21 and GDF15 are the closest to clinical validation; lactate and lactylation represent a promising direction for translational research; AMPK, PGC-1α, and PINK1/Parkin form the pathogenic basis of mitochondrial quality control but require clinically reproducible assessment methods. Цель обзора — обобщить и критически проанализировать данные о маркерах метаболического и митохондриального стресса при атеросклерозе у лиц пожилого и старческого возраста, выделив клинически доступные циркулирующие биомаркеры, метаболические индикаторы и внутриклеточные регуляторы митохондриального контроля, а также ограничения их возраст-специфической интерпретации. Выполнен аналитический нарративный обзор литературы по данным PubMed, Scopus и Web of Science за 2010–2025 гг., последний контрольный поиск проведён 27 апреля 2026 г. Использованы ключевые слова: сигнальные молекулы, FGF21, GDF15, эндотелиальная дисфункция, митохондриальная дисфункция, лактат, старение эндотелия, клеточная сенесценция. В анализ включено 38 источников с приоритетом клинических когорт, возраст-стратифицированных данных, экспериментальных работ по сосудистому старению и публикаций с трансляционным потенциалом. Выбор маркеров был основан на их принадлежности к разным уровням патологического процесса — системной стресс-реакции, метаболической перестройке и внутриклеточному митохондриальному контролю. Наиболее клинически обоснованным циркулирующим кандидатом является FGF21. Этот фактор связан с атеросклеротическим поражением и сердечно-сосудистым риском, но его повышение следует трактовать как отражение активированной стресс-реакции, а не как самостоятельный диагностический критерий. GDF15 ассоциирован с возрастом, функциональным снижением, коморбидностью и неблагоприятным прогнозом, однако не является специфическим маркером атеросклероза. Лактат и лактилирование представляют собой перспективный метаболико-эпигенетический механизм связи гликолитического сдвига, клеточной сенесценции и сосудистого воспаления, но требуют доказательства соответствия между циркулирующим и тканевым уровнями. AMPK, PGC-1α и PINK1/Parkin имеют преимущественно механистическое значение и в настоящее время должны рассматриваться как внутриклеточные регуляторы и терапевтические мишени, а не как клинически валидированные биомаркеры. При атеросклерозе у лиц пожилого и старческого возраста маркеры метаболического и митохондриального стресса целесообразно оценивать в рамках иерархической модели доказательности и с обязательным учётом возрастных, коморбидных и лекарственных факторов. FGF21 и GDF15 наиболее близки к клинической валидации; лактат и лактилирование представляют перспективное направление трансляционных исследований; AMPK, PGC-1α и PINK1/Parkin формируют патогенетическую основу митохондриального контроля качества, но требуют разработки клинически воспроизводимых способов оценки.
Despite the considerable burden of diarrheal disease in Asia, etiology-specific patterns remain insufficiently characterized. This study aimed to provide a comprehensive assessment of the diarrheal disease burden across Asia from 1990 to 2023, focusing on the implications for travelers' diarrhea. We estimated the burden of diarrheal disease in Asia, including Central, East, South, Southeast Asia, and High-income Asia Pacific, across 34 countries from 1990 to 2023 using the Global Burden of Diseases Study 2023. Disease burden was calculated using age-standardized disability-adjusted life year rates (ASDRs) per 100,000 population, with 95% uncertainty intervals (UIs). Additionally, we assessed the burden attributable to risk factors and calculated pathogen-specific estimates for 13 major etiologies. From 1990 to 2023, ASDRs of diarrheal disease declined across Asia, with the largest decline in South Asia from 9124.29 (95% UI, 7594.46-11,673.82) per 100,000 population to 1216.90 (965.73-1633.55). The decline was accompanied by reductions in cumulative etiologic burden, particularly for rotavirus. Although norovirus was the leading etiology in High-income Asia Pacific, rotavirus remained dominant across all other Asian regions in 2023. Burdens were concentrated among those aged <5 years and ≥95 years. Among children aged <5 years, rotavirus and adenovirus were the leading etiologies, with adenovirus showing a particularly high age-specific DALY rate in South Asia (891.96 [484.65-1392.81] per 100,000 population). Among adults aged ≥ 95years, Clostridium difficile and norovirus had the highest burdens. Sex-specific burdens were generally higher in males, except in South Asia. In 2023, unsafe water sources were the leading risk factor, especially in South Asia, 831.77 (423.32-1206.25) per 100,000 population. For viral, parasitic, and gram-negative etiologies, burdens consistently declined with increasing SDI, whereas Clostridium difficile showed a U-shaped pattern with SDI. The heterogeneity in etiology-specific burden, age- and sex-related vulnerability, and associations with SDI across Asia underscores the need for destination-specific risk assessment and context-sensitive prevention strategies for travelers' diarrhea in Asia.
Hepatocellular carcinoma is one of the most common cancers worldwide and the third leading cause of cancer-related mortality. The therapeutic landscape of hepatocellular carcinoma, especially systemic therapies, is constantly changing and characterized by a multimodal approach. The aim of this study was to investigate whether and how treatment sequencing according to tumor stage and liver function has changed over time and if the introduction of new therapeutic options has led to improved survival rates. Therapy concepts were retrospectively recorded and evaluated in a cohort of 1288 patients with hepatocellular carcinoma with a first diagnosis between January 2013 and December 2022 who were divided into two cohorts with a cut-off for dividing in 2020 owing to the approval of atezolizumab and bevacizumab for the treatment of hepatocellular carcinoma by the European Medicines Agency (Cohort A initial diagnosis 2013-19, Cohort B initial diagnosis 2020-22). All patients were treated at Hannover Medical School, Germany. Baseline characteristics differed significantly between cohorts, with Cohort B presenting at earlier tumor stages and with better preserved liver function. Across all treatment modalities, liver function emerged as the primary determinant of prognosis, independent of tumor stage and performance status. Over time, a treatment shift from transarterial chemoembolization towards systemic therapies was observed. Median overall survival from initial diagnosis did not differ between cohorts. In unadjusted analyses, patients treated with immune checkpoint inhibitor-based regimens demonstrated longer median overall survival compared with those receiving tyrosine kinase inhibitors. However, after multivariable adjustment for baseline imbalances, no independent survival difference between treatment groups remained. This study provides a detailed longitudinal assessment of evolving treatment patterns and outcomes, highlighting a clear shift in therapeutic strategies over time with the increasing adoption of systemic therapies. Despite evolving treatment strategies and increased use of systemic therapies, liver function remained the dominant prognostic factor across treatment settings. Observed survival differences between treatment modalities were strongly influenced by baseline patient characteristics and treatment selection.
China healthcare system has undergone significant reforms in recent years. Promoting the integration of treatment and prevention, strengthening collaboration between medical institutions and preventive services, and consolidating medical and preventive resources have become key priorities in the healthcare sector. Traditional Chinese Medicine (TCM) offers distinct advantages in disease prevention, health maintenance and rehabilitation. Systematically incorporating TCM into the healthcare and prevention system can help extend and enhance the continuum of care, thereby improving overall service effectiveness. However, there remains a lack of a standardized and scientifically rigorous evaluation framework to comprehensively assess the actual impact of TCM within integrated healthcare and prevention practices. To establish a scientifically grounded evaluation framework for the integration of clinical and preventive medicine within Traditional Chinese Medicine (TCM), thereby supporting the enhancement of TCM's capacity and quality in healthcare delivery and disease prevention. From September 2024 to January 2025, an initial pool of indicators was developed based on policy analysis, literature review, and expert interviews. Between February and April 2025, a two-round Delphi expert consultation was carried out to finalise the indicator system. The Analytic Hierarchy Process (AHP) was then used to determine both individual and combined weights for all indicators. A total of 19 experts participated in both rounds of the Delphi consultation. After two rounds of correspondence, the evaluation index system includes 6 first-level indicators, 17 s-level indicators and 57 third-level indicators. The expert authority coefficients for these rounds were 0.90 and 0.91, respectively, indicating a high level of expertise among the participating experts. Additionally, the Kendall's W of each index are, respectively, was 0.23 and 0.82 (p < 0.05). The consistency test was conducted using the AHP for all judgement matrices, with a consistency ratio (CR) for all levels of indicators < 0.10, indicating good consistency in the weight settings. The weights assigned to the first-level indicators were as follows: Resource Integration (0.3512), Technological Integration (0.2704), Service Integration (0.2146), Institutional Integration (0.0681), System Integration (0.0541) and Standardization Integration (0.0416). Together, Resource Integration and Technological Integration accounted for over 60% of the total weight. Among the second-level indicators, notable weights included TCM Information Platform (0.1476), Integrated TCM-Western Medicine Clinical Collaboration (0.1803) and Financial Resources for TCM (0.0943). This study developed a dedicated evaluation index system for Traditional Chinese Medicine (TCM) within the context of medical-preventive integration, filling an important gap in standardized assessment tools. The framework highlights the crucial role of resource allocation and technological collaboration in the integration process. It offers a practical framework for comprehensively assessing the integration of clinical and preventive medicine in Traditional Chinese Medicine and enhancing medical services quality.
Magnetic resonance-guided focused ultrasound (MRgFUS) is an expanding therapy for tremor in Parkinson's disease (PD). This study aimed to characterize trajectories of tremor and cognitive functions following MRgFUS treatment over 24 hours, 1 month, and 6 months, and to explore potential predictors of outcomes. This single-center, prospective, observational cohort study included PD patients undergoing MRgFUS over a 7-year period. Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM) and the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III). Cognitive performance was evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). 107 patients were included. Tremor severity showed a significant time effect (FTM and MDS-UPDRS-III: both p < 0.001), with a marked reduction at 24 hours followed by partial attenuation and stabilization over time, while remaining lower than baseline at 1 and 6 months (both p < 0.001). The 24-hour improvement was greater in patients with longer disease duration, who showed higher baseline severity (p < 0.001) and converged to cohort-level severity at post-treatment timepoints (all p ≥ 0.085). Cognitive status (MMSE and MoCA scores) remained stable throughout follow-up (all p ≥ 0.287). Levodopa equivalent daily dose (LEDD) significantly decreased from baseline to 6 months (F = 19.992, p < 0.001), suggesting a reduced need for dopaminergic treatment following tremor improvement. MRgFUS provided meaningful tremor improvement without negative effects on cognition. The significant LEDD reduction at 6 months supports a beneficial medication-sparing effect associated with tremor improvement.
Computed tomography of the chest is a cornerstone imaging modality in the diagnosis of pulmonary diseases; however, conventional systems based on energy-integrating detectors have inherent physical limitations, including restricted spatial resolution, electronic noise, and reduced image quality at low radiation doses, which may compromise diagnostic accuracy in certain clinical scenarios. Photon-counting detector computed tomography represents a novel technological approach based on the individual detection and energy discrimination of incoming X-ray photons. This enables improved dose efficiency, reduced image noise, higher spatial resolution, and intrinsic spectral imaging from a single acquisition. The aim of this review is to provide an overview of the role of photon-counting detector computed tomography in pulmonary imaging. Based on the available literature, this technology offers particular advantages in the detection and characterization of small pulmonary nodules, subsolid and ground-glass lesions, as well as in the assessment of fine morphological features of interstitial lung diseases. In addition, it improves the visualization of infectious, vascular, and traumatic pulmonary abnormalities. Spectral imaging capabilities, including virtual monoenergetic reconstructions and iodine maps, provide additional functional information on tissue perfusion, lesion characterization, and treatment response. The technique also shows promise in interventional applications by improving the visualization of target lesions and interventional devices. Photon-counting detector computed tomography represents a significant technological advancement in lung imaging. However, its widespread clinical implementation is currently limited by restricted availability, high costs, and challenges related to inter-system comparability. Nevertheless, current evidence suggests that this technology will play an increasingly important role in pulmonary diagnostics in the future. Orv Hetil. 2026; 167(30): 1186-1198. A mellkasi komputertomográfia a pulmonalis betegségek diagnosztikájának alapvető képalkotó módszere. A hagyományos, energiaintegráló detektorral működő rendszerek azonban fizikai korlátokkal rendelkeznek: a térbeli felbontás limitált, az elektronikus zaj jelenléte, valamint a kis dózisú vizsgálatok során romló képminőség egyes klinikai helyzetekben csökkentheti a diagnosztikus pontosságot. A fotonszámláló detektoros komputertomográfia új technológiai megközelítést képvisel, amely az egyes röntgenfotonok egyedi detektálásán és energiaszint szerinti osztályozásán alapul. Ennek köszönhetően javul a dózishatékonyság, csökken a képzaj, nő a térbeli felbontás, és egyetlen adatgyűjtésből spektrális információ is nyerhető. A jelen összefoglaló célja a fotonszámláló detektoros komputertomográfia szerepének áttekintése a pulmonalis képalkotásban. A rendelkezésre álló irodalmi adatok alapján a technológia különösen előnyös a kis méretű pulmonalis nodulusok, a subsolid és tejüveghomályos elváltozások, valamint az interstitialis tüdőbetegségek finom morfológiai jeleinek megjelenítésében. Emellett részletesebb ábrázolást tesz lehetővé infektív, vascularis és traumás eredetű eltérések esetén is. A spektrális képalkotás – beleértve a virtuális monoenergetikus rekonstrukciókat és a jódtérképeket – kiegészítő funkcionális információt nyújthat a perfúziós viszonyokról, a szöveti karakterizálásról és a terápiás válasz megítéléséről. A módszer intervenciós alkalmazások során szintén ígéretes, mivel javíthatja a célzott eltérések és a beavatkozó eszközök környezetének megítélését. Összességében a fotonszámláló detektoros komputertomográfia jelentős technológiai előrelépést képvisel a tüdőképalkotásban. Széles körű elterjedését jelenleg még korlátozza a hozzáférhetőség, a költségek, valamint az eltérő rendszerek közötti összehasonlíthatóság kérdése. A jelenlegi adatok alapján azonban várható, hogy a módszer a jövőben egyre meghatározóbb szerepet tölt be a pulmonalis diagnosztikában. Orv Hetil. 2026; 167(30): 1186–1198.
Interprofessional clinical reasoning is essential for ensuring quality and safety in healthcare, yet evidence remains fragmented, with limited integration of contextual and organizational factors. This scoping review aimed to identify facilitating and hindering factors influencing interprofessional clinical reasoning in healthcare and their implications for patient safety and quality of care. The review followed the JBI methodology and the PRISMA-ScR checklist. Searches were conducted in five databases, with additional studies identified through reference screening. Eligible empirical studies published in English, Portuguese, or Spanish were analyzed thematically using a combined deductive and inductive approach and organized into three domains: organizational culture, non-technical skills, and decision-making. Forty studies were included. Facilitating factors comprised process systematization, supportive organizational culture, structured communication, shared leadership, role clarity, and collaborative decision-making, particularly when supported by simulation-based interprofessional education. Hindering factors included disorganized environments, hierarchical structures, communication failures, cognitive and emotional biases, and limited mutual understanding among team members. Most interventions lacked theoretical frameworks or long-term evaluation. Interprofessional clinical reasoning emerges from the interplay between interpersonal, cognitive, and contextual factors. These findings support the development of targeted educational strategies and assessment tools to strengthen collaborative reasoning and improve patient outcomes while informing future research grounded in theoretical frameworks.