Across African countries and contexts, there is robust evidence of how forests and trees can support people's diets. In particular, indigenous food trees are an important source of micronutrient-rich fruits, leaves, nuts, and seeds. Yet in large-scale landscape restoration projects, these species are often overlooked in favor of exotic, fast-growing tree species-limiting the potential of restoration initiatives to co-address biodiversity loss and malnutrition. With local practitioners in Malawi, we explore challenges to and opportunities for better integration of indigenous food trees in landscape restoration projects. We argue that scientists, policymakers, and restoration practitioners should focus on three primary domains for greater knowledge management and capacity building: (i) tree propagation, (ii) improving seedling survival rates, and (iii) value chain development for tree-based foods. Targeted support for incorporating indigenous food trees in these areas can help promote synergies between human and ecological health in natural resource management agendas.
Carers are individuals who provide unpaid care to family members and friends with disabilities, medical conditions, mental illness, or who are frail and aged. The contribution of carers to the Australian health, aged care, disability, and social care systems is significant. However, they face high levels of emotional, social, physical, and financial burdens. The Australian Government has recently introduced policy reforms to improve recognition of carers. However, there is limited evidence on research priorities to facilitate the translation of policies into practice. To involve Australian stakeholders to a) identify evidence gaps and research needs; and b) set research priorities for carers within the context of ageing, palliative care and end of life. Stakeholder consultation study for research priority setting. Australian stakeholders with expertise in areas related to carers, aged care, and palliative care were engaged through an online survey, a research roundtable and a focus group to discuss research priorities for carers. The survey qualitative responses, notes from the roundtable, and focus group transcript have been summarised and analysed thematically, using NVivo 14 qualitative software. Two main considerations as found from the study are 'what to research' and 'how to research' to improve recognition and support of carers in Australia. Research priorities identified include recognition and early identification of carers, timely and equitable access to support services, helping carers navigate services, support during the transition of care, post caring, including grief and bereavement support, evaluation of existing services, and carer self-care and wellbeing. Participants commented on the importance of research that engages carers meaningfully, respectfully, and in a timely and flexible manner to ensure maximum impact. This study guides the design of carer-centred research to facilitate the translation of carer policies into practice. It also assists in evaluating the effectiveness, cost-effectiveness and sustainability of existing and new support services. Unpaid carers are individuals who help a family member or friend with a disability, medical condition, including terminal or chronic illness, mental illness, or are frail and aged. In Australia, carers play a critical role in providing care, and they make significant contributions to health, care and social care services. There are many programs to support carers, but carers still have problems accessing the right support services at the right time. They also lack the support they need to maintain their own health and wellbeing. To improve carer policy, it is important to look at research that helps put policy into practice in real-life situations. This study, aimed to give participants, including carers, a voice to help identify and shape future research that could make a difference in the lives of carers. The main areas of research priorities identified in the study are recognition and early identification of carers, timely and equal access to support services, helping carers to navigate support services, carer support during the transition of care, post caring, including grief and bereavement support, evaluation of existing support services, and carer self-care and wellbeing. Carers are diverse, and it is important that support services are culturally sensitive and support the cultural and individual needs of carers. It is also important that carers are involved in research design, implementation and evaluation. The study will inform future research and strengthen research that impacts carers.
IntroductionLymphomas are a heterogeneous group of haematological malignancies commonly treated with chemotherapy. Hodgkin lymphoma predominantly affects younger adults, while Non-Hodgkin lymphoma is more prevalent among older adults. Although survival outcomes have improved, treatment-related cardiovascular, musculoskeletal, and functional adverse effects contributing to fatigue, reduced cardiorespiratory fitness (CRF), diminished quality of life (QoL), and increased frailty risk, remain, particularly among older adults. Reduced CRF, measured by peak oxygen uptake (VO2peak), is an independent predictor of all-cause and cancer-specific mortality, and chemotherapy tolerance, making its preservation a clinically meaningful target. Evidence supporting exercise during active chemotherapy remains limited. This study aims to evaluate the effect of a 20-week combined exercise (EX) intervention on CRF in people with lymphoma receiving chemotherapy, compared with a treatment-as-usual (TAU) group.MethodsEDONOLA is a randomised (1:1), multicentre, parallel-group, open-label controlled clinical trial involving adults aged >18 years (n=180, EX, n=90; TAU, n=90). The exercise intervention comprises supervised sessions (two days/week) of low-to high-intensity resistance and aerobic interval training, plus two days/week of unsupervised exercise. The TAU group will receive standard clinical care and physical activity advice. Assessments will be conducted at baseline, 10 weeks, and 20 weeks. The primary outcome will be CRF, measured as VO2peak. Secondary outcomes will include muscular strength, frailty, body composition, physical activity, sedentary behaviour, QoL, fatigue, sleep, and biochemical profile, including immune biomarkers. Older participants (≥70 years) will additionally undergo a comprehensive geriatric assessment, and EX participants will be invited to a voluntary semi-structured qualitative interview.DiscussionThis multidisciplinary project integrates structured exercise into standard oncology care, aligned with Sustainable Development Goal 3. The intervention aims to mitigate treatment-related side effects, preserve CRF and muscular strength, improve QoL, and reduce frailty risk in people with lymphoma undergoing chemotherapy, while potentially decreasing long-term healthcare burden. People with lymphoma often receive chemotherapy, which can cause tiredness, loss of strength and fitness, and make everyday activities more difficult. These effects can be especially challenging for older adults. Exercise may help reduce these problems, but there is still limited research on how helpful it is for people receiving treatment for lymphoma. The EDONOLA study will test whether a 20-week exercise programme can help people with lymphoma stay stronger and fitter during chemotherapy. The study will include 180 adults with Hodgkin and non-Hodgkin lymphoma. Half of the participants will take part in supervised exercise sessions that combine strength and aerobic activities, along with additional exercise at home. The other half will receive their usual medical care and general advice about physical activity. Researchers will measure changes in physical fitness, strength, tiredness, sleep, daily activity, and quality of life during the study. Older participants will also receive additional health assessments. The goal is to find out whether exercise can help people cope better with treatment, maintain independence, and improve wellbeing during and after chemotherapy.
Datopotamab deruxtecan (Dato-DXd) is a TROP2-directed antibody-drug conjugate (ADC) that has received accelerated approval in the US for adults with locally advanced or metastatic EGFR-mutated non-small cell lung cancer (NSCLC) after progression on EGFR-directed therapy and platinum chemotherapy. In pooled analyses from TROPION-Lung01 and TROPION-Lung05, Dato-DXd achieved an objective response rate of ~45% and a median duration of response of 6.5 months, which compares favorably with historical outcomes with docetaxel. Dato-DXd is being evaluated in combination with osimertinib in the first-line and post-osimertinib settings, following encouraging activity in the phase II ORCHARD platform trial evaluating therapeutic strategies for EGFR-TKI-resistant disease. Importantly, Dato-DXd demonstrates a favorable safety profile and has lower rates of grade ≥3 adverse events and less hematologic toxicity than docetaxel. Adverse events of special interest include mucositis, interstitial lung disease, and ocular surface events. While these toxicities are generally manageable, they require prophylaxis, monitoring, and early intervention. Current research aims to elucidate the mechanisms underlying these toxicities and to identify modifiable risk factors to further improve tolerability. The biological mechanisms contributing to the differential efficacy of Dato-DXd are also under investigation and may further inform its clinical role.Expert opinion: Determining how best to integrate Dato-DXd within existing treatment sequences has the potential to meaningfully address persistent unmet needs in EGFR-mutated NSCLC. Some people with lung cancer have a change in a gene called EGFR (a part of the cell that helps control growth). At first, these cancers often respond well to targeted therapy, which is treatment designed to attack cancer cells more directly. Over time, the cancer usually stops responding. When this happens, doctors often use chemotherapy, but it may not work well and can cause difficult side effects. Datopotamab deruxtecan (Dato-DXd) is a newer treatment. It is designed to carry a cancer drug straight to cancer cells, which may help protect healthy cells. In studies, Dato-DXd helped shrink tumors in patients whose cancer had already stopped responding to other treatments. It also helped patients live longer without their cancer getting worse compared with standard chemotherapy. Many side effects were easier to manage, and fewer patients had serious drops in blood counts. Some side effects still need attention. These include mouth sores, lung inflammation, and eye irritation. Doctors typically manage these side effects effectively with close follow-up. Researchers are now studying if this treatment can be used earlier or with other drugs. It may offer a new option for patients who have few choices left.
Orthopedic regenerative medicine (ORM) addresses musculoskeletal disorders in which effective repair requires coordinated structural reconstruction, biological repair, mechanical adaptation, and functional recovery. These processes generate heterogeneous information across biomaterials, construct design, imaging, intraoperative execution, rehabilitation monitoring, and clinical follow-up. Artificial intelligence (AI) is increasingly relevant for organizing multimodal data and supporting decision-making across regenerative care. This review summarizes current applications of AI in ORM, focusing on regenerative design and fabrication, intraoperative guidance, postoperative monitoring, repair evaluation, and clinical translational pathways. In regenerative design, AI can assist the optimization of material composition, scaffold architecture, biofabrication parameters, and construct performance by linking design variables with biological and biomechanical outcomes. During intervention and recovery, AI-supported systems may improve defect-specific spatial matching, support longitudinal functional assessment, and help identify delayed or unfavorable repair trajectories through integrated analysis of imaging, wearable, and clinical data. The review also discusses translational challenges, including data heterogeneity, limited external validation, algorithmic bias, interpretability, regulatory requirements, and governance constraints. AI may help connect design, intervention, monitoring, and feedback within a continuous analytical workflow, but future progress will require robust datasets, prospective validation, clinically interpretable models, and implementation strategies aligned with regenerative practice.
Congenital pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is exceptionally rare, and prenatal diagnosis remains challenging. We report a rare case of a congenital P-MAIVF diagnosed prenatally. The fetus was closely monitored throughout pregnancy and after birth. Surgical resection was performed at 12 months because of progressive enlargement and concern for fistula formation. The combination of imaging techniques helped in detecting the complication and guiding management. Postoperative outcome was excellent. The diagnosis of such a rare congenital anomaly is challenging, and improving its recognition is essential. Multimodality imaging may help in diagnosis, clinical decision-making, and longitudinal follow-up.
Timely diagnosis and treatment are critical for improving cancer survival; however, significant delays persist across the cancer care continuum, particularly in resource-constrained settings like India. This study aimed to analyze the extent and patterns of delays among patients with breast, cervical, and head and neck cancers in northwestern India. This exploratory cross-sectional study included all histopathologically confirmed cases of the three cancer types who initiated radiotherapy at the Radiotherapy Department of Government Medical College, Amritsar, during December 1, 2023, to November 30, 2024. Data on sociodemographic profiles, clinical details, and treatment timelines were collected through interviews and medical records. Delays were categorized as appraisal, help-seeking, diagnostic, pre-treatment, system, and total delays. Analysis was conducted at the descriptive, bivariate, and multivariable levels. Median delays and interquartile ranges were calculated for each cancer type. Differences in delay intervals between cancer groups were assessed using the Kruskal-Wallis H test, and differences between two-category variables were assessed using the Mann-Whitney U test. Associations between categorical variables and the presence of prolonged total delay (≥120 days) were examined using the chi-square test or Fisher's exact test, as appropriate. Correlation between total delay and number of medical contacts was evaluated using Spearman's rank correlation coefficient. Finally, multivariable binary logistic regression was performed to identify independent predictors of prolonged total delay, and adjusted odds ratios with 95% confidence intervals were reported. A p-value of <0.05 was considered statistically significant. Among the 119 patients included in the study (45 breast, 28 cervical, and 46 head and neck cancers), breast cancer patients experienced the longest total delay (median: 282 days), followed by cervical (median: 199 days) and head and neck cancers (median: 190 days). System delay was the primary contributor across all three cancer types, driven largely by diagnostic delays. Appraisal delay was longest for breast cancer (median 155.5 days), help-seeking delay was longest for head and neck cancer (median 65 days), and pre-treatment delay was also longest for breast cancer (median 51.5 days). Variations in delays were observed across sociodemographic factors, but none reached statistical significance. This study highlights the need for a targeted, cancer-specific approach to address delays, with a focus on strengthening diagnostic services and improving system efficiency within the healthcare infrastructure. Implementing multi-pronged strategies for early detection, timely care, and prevention is crucial in reducing the cancer burden in this high-risk region.
We aimed to identify causes of surgeon fear in the operating room (OR) and to understand how surgeons manage that fear. Emotions like fear can impact attention, memory, risk-tolerance, judgement, and decision-making. Yet, few studies have sought to elucidate what causes surgeon fear in the OR. Further, management strategies for surgeon fear also remain poorly described. This was a nested, descriptive analysis from a larger, qualitative study in which we interviewed 18 attending surgeons from 14 surgical subspecialties affiliated with a large, academic institution. Snowball and purposive sampling were used to achieve diversity in our sample. Data coding was inductive and descriptive and conducted until thematic saturation was reached. There were 3 over-arching causes of fear: operating alone in chaos, operating in uncertainty, and operating alone in judgement. All surgeons used mitigating strategies to interrupt the escalation of fear, which if uninterrupted, could be calamitous. These strategies can be mapped to the causes of fear, but can also be called "emotion regulation." Calling for help was the most commonly listed strategy for managing fear. Fear was distinctly aversive, but commonly reappraised as "useful" provided it was well managed. Most surgeons in this study experienced fear in the OR, though the causes were myriad. Some fear was recognized as useful, though too much fear was considered deleterious. All surgeons endorsed receiving help from trusted colleagues as the ultimate rescue strategy for both the presence of and the management of fear in the OR.
Thailand has long implemented public insurance schemes for cross-border migrants, though psychiatric care is not explicitly included in the schemes' benefit package. As evidence related to the association between public insurance and migrants' out-of-pocket (OOP) expenditure for psychiatric services remains limited, this study aims to assess if and to what extent the insurance is associated with OOP spending among migrants utilizing psychiatric-related care in Thailand. A cross-sectional analysis of routine service data was applied. We analyzed nationwide service utilization data of cross-border migrants receiving psychiatric care in public hospitals between 2018 and 2022. A two-part model (TPM) with machine learning was employed. The first part used a decision tree classifier to estimate the probability of incurring OOP spending, and the second part applied a non-negative least squares ensemble to predict the magnitude of OOP spending. A total of 4,559 migrant patients accounted for 13,744 visits (inpatient and outpatient care combined), of which 84.1% were uninsured. The mean OOP spending per visit was 449 Baht, ranging from zero to 109,075 Baht. Public insurance was associated with about 50% reduction in the likelihood of incurring any OOP payment. After integrating both parts of the model, the estimated mean OOP spending per visit was 471.3 Baht (95% confidence interval [CI] = 433.8-511.3) among the uninsured, compared with 7.4 Baht (95% CI = 6.7-8.1) among the insured-about 98% OOP spending avoidance. Public insurance for cross-border migrants in Thailand was associated with reduced OOP spending for psychiatric services at the point of care. Inclusion of psychiatric services in migrant health insurance benefit packages may be considered as an option to help reduce inconsistent interpretations of coverage. Further research examining the financial burden of psychiatric illnesses among migrant households would be valuable. Ongoing monitoring of migrant-related policy changes may help inform future policy decisions.
A 67-year-old male, presented with urosepsis, severe anemia, advancing azotemia requiring blood transfusion. Patient grouped as O RhD positive. Antibody screening was pan-positive (4+). Similar strong pan-positivity seen on antibody identification with extended cell panel. DAT was 4+ positive for IgG and negative for complement C3. Repeated identification with eluate also showed pan-positive (4+) reaction. Serum haptoglobin markedly reduced. Bone marrow aspirate suggested pure red cell aplasia with suspicion of parvovirus-related changes. Bone marrow biopsy suggested T-cell lymphoproliferative disorder. Immunophenotyping elucidated a suspicious clone of CD7-negative T-cells with CD4 restriction. Histopathological examination revealed angioimmunoblastic T-cell lymphoma (AITL) with bystander Epstein-Barr virus-driven large B-cells. Owing to rarity and nonspecific symptoms, diagnosis of AITL is often challenging. Antibody screen acted as a whistleblower for an undiagnosed aggressive lymphoma. Thus, it will be prudent to look beyond the obvious in complex cases, and a detailed workup will help put together all parts of the jigsaw puzzle.
Artisanal and small-scale gold mining has rapidly reshaped southeastern Senegal's Kédougou region from a sparsely populated savanna-forest landscape into a highly connected frontier marked by land-use change, intense population mobility, and fragile basic services. Over the past decade, this corridor has recorded clustered outbreaks and warning signals involving mosquito-borne, tick-borne, and water-associated infections, including sylvatic dengue, yellow fever, chikungunya, Crimean-Congo haemorrhagic fever, and hepatitis E. These events suggest that mining settlements can function both as amplification sites, where ecological disruption, mobility, and weak services increase transmission risk, and as detection nodes, where clustered febrile illness may reveal emerging threats early. Using Kédougou as a case example, this Conceptual Analysis synthesizes outbreak experience, operational lessons, and published evidence to propose an evidence-informed One Health operational framework for mining corridors. The framework brings together fever triage and specimen referral, targeted vaccination for mobile populations, frontier-adapted mosquito and tick surveillance and control, minimum water and sanitation standards, community engagement, and joint One Health investigations supported by selective genomic sequencing when operationally useful. Rather than reporting an implemented intervention, this paper offers a structured prevention model for prospective adaptation, implementation, and evaluation in mining-affected frontier settings. The framework is intended to help districts strengthen routine services, support prevention of spillover and amplification, and improve cross-border preparedness in ecologically and socially dynamic mining corridors.
Obesity is highly prevalent among patients with cancer and is associated with increased risks of treatment-related complications, poorer oncological outcomes, and long-term morbidity. Despite this, current oncology nutrition guidelines primarily address malnutrition and provide limited direction for clinical management of patients with obesity. Intentional weight loss interventions during cancer treatment are uncommon, partly due to concerns about safety and feasibility. The CANOBESE study aims to address this evidence gap by evaluating the feasibility of implementing a structured, multimodal weight management programme for patients with obesity undergoing curative oncological treatment. This single-arm feasibility trial will recruit 50 adult patients with a BMI ≥ 30 kg/m2 and newly diagnosed stage II-IV solid tumours receiving chemotherapy, radiotherapy, immunotherapy, targeted therapy alone, or in combination with curative intent. The intervention includes a personalized hypocaloric and high-protein diet, a supervised home-based aerobic and resistance exercise programme, and integrated behavioural support delivered throughout the programme, with psycho-oncological input when more intensive individualized support is needed. Follow-up will continue for the duration of active treatment (3-9 months). The study will evaluate feasibility by examining key aspects such as recruitment and retention rates, intervention adherence and fidelity, participant acceptability, and the completeness of data collection throughout the intervention period. Secondary outcomes include exploratory changes in weight, body composition, physical performance, dietary intake, quality of life, and inflammatory biomarkers. The broad eligibility criteria were selected to evaluate feasibility in a pragmatic real-world oncology setting, while predefined exclusions were used to reduce baseline nutritional risk and improve safety. The CANOBESE study represents one of the first efforts to assess whether a comprehensive lifestyle intervention can be effectively delivered to patients with obesity during curative cancer treatment. This protocol incorporates patient and public involvement, a multidisciplinary team approach, and real-world implementation considerations. Findings will inform the scalability of the intervention, characterize implementation challenges across a pragmatic oncology population, and guide the design of a future randomized controlled trial. The study is not intended to provide subgroup-specific clinical recommendations, but to generate feasibility data that may help refine tailored approaches to intentional weight management in oncology settings. ClinicalTrials.gov identifier: NCT07058207. Registered on 9 July 2025. https://clinicaltrials.gov/study/NCT07058207.
Trousseau syndrome-related cerebral infarction (TSCI) is a severe complication of lung cancer, but tools for early risk stratification remain limited. In this retrospective case-control study, we enrolled 94 patients with newly diagnosed lung cancer and TSCI and 94 matched lung cancer controls without stroke at the First Affiliated Hospital of Zhengzhou University between 2021 and 2025. Using cases in which TSCI occurred at diagnosis or within 6 months thereafter, we developed and internally validated a five-variable model based on serum magnesium, international normalized ratio, prothrombin time, albumin-to-globulin ratio, and a history of hypertension. Concurrent-onset (Fulminant) and delayed-onset TSCI subgroups were compared across coagulation, inflammatory, tumor-burden, and nutritional domains. Temporal biomarker patterns were examined using locally estimated scatterplot smoothing (LOESS). The model showed good discrimination (AUC = 0.861) and sample-specific calibration within the selected case-control sample. Fulminant TSCI showed pronounced abnormalities across coagulation/fibrinolysis, inflammatory, tumor-burden, and nutritional domains. Temporal analyses suggested heterogeneity in biomarker patterns: early-onset TSCI was associated with higher Ki67, neuron-specific enolase, and lactate dehydrogenase, whereas late-onset TSCI was more closely associated with higher triglyceride levels. These findings identify a set of routinely available clinical variables associated with early high-risk TSCI in patients with lung cancer. The proposed nomogram demonstrated favorable discriminative performance and may provide a useful framework for early risk stratification and clinical surveillance. Further validation in independent prospective cohorts would help to confirm its generalizability and support future clinical application.
Dear Editor, Morphea (localized scleroderma) is a cutaneous inflammatory fibrosing disorder characterized by heterogeneous clinical presentation and variable disease activity. Although diagnosis is predominantly clinical, accurate assessment of activity can be challenging, particularly in plaque-type disease where inflammatory and sclerotic components coexist. Non-invasive imaging may support the identification of active disease areas and help guide correct clinical management. [...].
Myocardial infarction (MI) initiates a rapid and highly coordinated immune response that is essential for the clearance of necrotic tissue and activation of reparative processes. However, prolonged or dysregulated post-MI inflammation can exacerbate myocardial injury, promote adverse cardiac remodeling, and ultimately contribute to heart failure. Although current therapeutic strategies improve survival and symptom management, they remain limited in their ability to restore lost cardiomyocytes or effectively modulate the post-infarction immune microenvironment. In this context, stem cell-derived extracellular vesicles (EVs) have emerged as promising cell-free therapeutic candidates due to their immunomodulatory, regenerative, and paracrine properties. These nanoscale vesicles carry a diverse cargo of bioactive molecules, including microRNAs, proteins, lipids, and other signaling mediators that regulate intercellular communication and tissue repair. EVs derived from mesenchymal stem cells, cardiac progenitor cells, and induced pluripotent stem cells have demonstrated the ability to modulate key immune pathways by attenuating neutrophil-mediated inflammatory injury, promoting macrophage polarization towards a reparative M2 phenotype, and regulating T-cell responses by suppressing pro-inflammatory activity while enhancing regulatory T-cell function. Collectively, these effects help restore immune homeostasis and reduce adverse cardiac remodeling following MI. Moreover, advances in EVs engineering, cargo modification, and targeted delivery systems may enhance their therapeutic efficacy and translational potential. However, several critical challenges, including large-scale production, cargo heterogeneity, and the lack of standardized protocols for isolation and characterization, still need to be addressed before successful clinical translation. This review summarizes the current understanding of stem cell-derived EVs biology, comparative advantages over conventional and cell-based therapies, and their immunomodulatory mechanisms in post-MI repair. Moreover, it highlights recent innovations and the major challenges that must be addressed for successful clinical translation.
To examine how patients undergoing high-risk abdominal cancer surgery perceive the decision to proceed with surgery, particularly regarding whether surgery is experienced as a choice or a perceived necessity. Patients considering high-risk abdominal cancer surgery face decisions about whether or not to proceed with surgery, yet prior work suggests that patients may not fully perceive surgery as a choice. How patients make sense of surgical decisions remains poorly understood. A qualitative study was conducted using semi-structured interviews with adults scheduled for or recently undergoing curative-intent abdominal cancer surgery at 2 academic centers from 2023 to 2024. Thirty-four participants completed 45- to 60-minute in-depth interviews exploring expectations, decision-making experiences, and perceptions of surgical choice. Transcripts were deidentified, coded by a multidisciplinary team, and analyzed using qualitative content analysis informed by grounded theory techniques, with iterative content mapping to identify cross-cutting themes. Participants described a continuum of perceived choice. Some recalled surgeons explicitly offering options and felt they were making an intentional choice, although others viewed surgery as technically optional but effectively unavoidable given a perceived lack of meaningful alternatives, their desire for a cure, or strong recommendations from clinicians or family. A subset reported no perceived decision at all, describing surgery as a predetermined step or an event that simply happened. Across categories, patients frequently equated surgery with survival, which shaped whether alternatives felt viable. Surgeon communication and patient perception did not consistently align, as explicit options did not always translate into a perceived sense of agency. Patients considering high-risk cancer surgery often perceive limited or no choice, even when surgeons describe options. Recognizing how patients interpret choice may help refine shared decision-making approaches and guide the development of communication tools for complex surgical decisions.
To investigate whether preoperative cardiology consultation reduces the incidence of major adverse cardiac events (MACE) in patients undergoing non-cardiac surgeries. This cohort study was conducted among 7019 elderly patients (above 65 years) with abnormal ECGs undergoing non-cardiac surgeries. The main outcome was MACE occurrence within 30 days post-surgery. The patients were divided into model development and validation cohorts in a 7:3 ratio, and each cohort was categorized into two subgroups with high-risk and low-risk abnormal ECG. MACE prediction models were constructed for the subgroups, and their predictive power was evaluated using ROC curves; the value of preoperative cardiology consultation for reducing MACE was assessed using decision curve analysis. Among the 4914 patients in the model development cohort, 61 of the 3010 patients with low-risk abnormal ECGs experienced MACE (2.0%), as compared with 59 out of 1904 patients (3.1%) in the high-risk group. The predictive model for MACE for the low-risk group contained 6 risk factors (AUC=0.772), and that for the high-risk group contained 5 risk factors (AUC=0.769). In patients with low-risk abnormal ECG, undergoing cardiovascular specialist consultation did not show significant benefits (the survival rate for predicting MACE was 0.02). However, in patients with high-risk abnormal ECG and those with low-risk abnormal ECG but having specific risk factors, undergoing cardiovascular specialist consultation showed significant benefits with survival rates for predicting MACE of 0.3 and 0.229, respectively. For patients with high-risk abnormal ECG and those with low-risk abnormal ECG and specific risk factors, preoperative cardiology consultation may help to reduce the occurrence of MACE following non-cardiac surgeries, but for patients with simple low-risk abnormal ECG cases without risk factors, preoperative cardiology consultation can be omitted, which does not affect the incidence of MACE but can improve medical efficiency. 目的: 探讨术前心内科会诊是否可以降低非心脏手术患者主要不良心脏事件（MACE）的发生率。方法: 研究共纳入7019例65岁及以上非心脏手术患者，患者均存在心电图（ECG）异常。主要结局指标为术后30 d内MACE的发生率。按7∶3比例将人群分为开发队列和验证队列，并根据ECG异常风险分为高危组和低危组。各亚组建立了MACE预测模型，采用受试者工作特征曲线（ROC曲线）分析其预测效能，并通过决策曲线分析（DCA）评估术前心内科会诊的价值。结果: 开发队列共有4914例患者，3010例为低风险的异常心电图，其中61例发生MACE（2.0%），1904例为高风险的异常心电图，其中59例发生MACE（3.1%）。在MACE的预测模型中，低风险组包含6个危险因素（AUC=0.772），而高风险组包含5个危险因素（AUC=0.769）。对于低风险的异常心电图患者，接受心内科会诊并未显示出显著的益处（预测发生主要不良心脏事件的风险阈值为0.02）。高风险异常心电图组和合并某些危险因素的低风险异常心电图组中，接受心内科会诊显示出显著的获益（预测发生主要不良心脏事件的风险阈值分别为0.3和0.229）。结论: 高危异常ECG和有特定危险因素的低危异常ECG患者行心内科会诊可降低术后MACE发生率;而单纯低危异常ECG患者术前心内科会诊并未见明显获益，且未改善MACE的发生率。.
Quality of life (QoL) is an individual's perception of life quality based on cultural values, goals, and standards in physical, psychological, social, and environmental aspects. The objective of this study was to investigate the associations between demographic characteristics, health information factors, and the QoL of durian farmworkers. Additionally, proposed implementation strategies were developed based on factors associated with the QoL. This cross-sectional study was designed to assess the QoL of 160 durian farmworkers in Nakhon Si Thammarat province, Thailand. Participants were selected through purposive sampling, and a face-to-face interview was conducted using a structural questionnaire that collected general demographic characteristics and health information. The validated, Thai-translated World Health Organization Quality-of-Life Scale (WHOQOL-BREF) tool was used to collect data on the QoL. The multiple linear regression analysis was used to examine the factors associated with the QoL. The finding factors were used to propose implementation strategies aligned with the RE-AIM principles (Reach, Effectiveness, Adoption, Implementation, and Maintenance). The majority (83.1%) of durian farmworkers reported a good QoL, with an overall mean score of 106.9 (range: 80-130). Domain-specific scores of physical health 27.1 (range: 20-34), mental health 25.3 (range: 16-30), social relationships 12.8 (range: 8-15), and environment 31.8 (range: 16-40) were within the good level. The results showed that stress, age, marital status, and annual income were significantly associated with the QoL (p < .05). Based on four key factors, proposed implementation strategies were developed, including expected outcome, activities, lead person, timelines, resources, and the evaluation method for RE-AIM alignment. The study highlights age, marital status, annual income, and stress as key factors influencing the QoL of durian farmworkers. The proposed implementation strategies, may help inform health promotion and community-based initiatives aimed at improving the well-being of durian farmworkers and potentially similar fruit cultivation systems.
Traumatic birth experiences are increasingly recognized as a significant issue in maternity care. While many studies focus on the perspectives of birthing persons, little is known about how healthcare providers perceive the causes of traumatic births and possible strategies to prevent them. This study explores obstetric care providers' perceptions of factors contributing to traumatic birth experiences and their suggestions for improving trauma sensitive obstetric care. A convergent parallel mixed methods design was used. An online survey among obstetric care providers in Germany was conducted between October 2024 and February 2025 (n=102). Quantitative data were analyzed descriptively and using logistic regression models. In addition, four expert interviews were conducted and analyzed using qualitative content analysis. Findings from both strands were integrated during interpretation. Most respondents defined traumatic birth experiences primarily through loss of control (85.3%) and negative emotions (75.5%). Lack of communication and information was identified as the most important contributing factor (97.1%), followed by lack of emotional support (89.2%). Emotional support was rated as the most important preventive measure (mean=4.86; SD=0.51). The main barriers to trauma sensitive care were lack of time (mean=4.52; SD=0.81) and staff shortages (mean=4.35; SD=0.83). Interview findings highlighted structural challenges, the importance of reflective practice among caregivers, and the need for systematic training in trauma sensitive communication. The findings highlight the need to strengthen trauma sensitive approaches in obstetric care through improved communication, emotional support, and shared decision making. In addition to structural improvements such as adequate staffing, regular training and reflective practice among providers may help reduce traumatic birth experiences.
Brain glucose metabolism declines and myelin deteriorates as Alzheimer's disease (AD) develops. Adequate energy supply to white matter (WM) is critical to maintain myelin integrity and axonal function. An exogenous source of ketones bypasses the glucose‑specific brain energy deficit and improves cognitive outcomes in mild cognitive impairment (MCI). The BREAK-AD (BRain Energy Activation with Ketones in AD) trial tested a ketone salt and nicotinamide adenine dinucleotide (NAD+) precursor mixture to compensate for reduced brain glucose uptake in MCI. Participants were randomized to a placebo (n = 15) or active supplement (β-hydroxybutyrate salts + nicotinamide riboside (NR); n = 15). Brain ketone and glucose metabolism (quantified by positron emission tomography [PET]), and cognitive performance were assessed before and at the end of the 6-month intervention. For WM analysis, seven tracts of interest were extracted using diffusion magnetic resonance imaging (MRI), and myelin density measures were derived from magnetization transfer (MT) imaging. Total gray matter ketone uptake increased by 2.4-fold (p < 0.001) in the active group, with no change in gray matter glucose uptake in either group. In WM, ketone uptake increased in the active group by 3.1-3.6-fold across all seven tracts of interest (p < 0.001). In the placebo group, myelin density declined by up to 10% in specific regions of the fornix (p = 0.027), with no change in the active group. Improved processing speed was significantly associated with post-intervention change in myelin density (r = -0.39 to -0.59; p = 0.002-0.046) and ketone uptake (r = -0.40 to -0.52; p = 0.010-0.046) in WM tracts. Ketone uptake in specific WM tracts (fornix, uncinate and arcuate fasciculi), as well as in the composite of all tracts of interest was strongly associated with myelin density. This study shows for the first time that improved myelin density may help explain the positive association between increased WM ketone uptake and improved processing speed in MCI after a ketone salt and NAD+ precursor supplementation.