Clinical pharmacist-led antimicrobial stewardship (AMS) programs have proven effective in tertiary care, yet rigorous pharmacoeconomic evidence from primary care remains limited. This study evaluates the cost-effectiveness of clinical pharmacist consultation in a Chinese county hospital setting. This retrospective cohort study analyzed 200 hospitalized patients (March to December 2024). The intervention group (n = 100) received pharmacist-led AMS including pre-prescription review and therapeutic monitoring. The control group (n = 100) received standard care without pharmacist consultation. Primary outcomes were antimicrobial therapy costs and duration. Pharmacist-led AMS reduced antimicrobial costs by 52% (mean difference: ¥290.43, 95% CI: -428.29 to -152.56; p < 0.001) and therapy duration by 23% (7.0 vs. 9.1 days; p < 0.001). Cost savings were most pronounced in patients without obvious infection focus (97% reduction). Clinical efficacy was comparable between groups despite higher baseline severity in the intervention group. Clinical pharmacist-led AMS achieves substantial cost containment and prescribing optimization in county-level hospitals without compromising clinical safety. These findings support expanding clinical pharmacy services as a cost-effective strategy for antimicrobial resistance containment in resource-limited settings.
Thoracic electrical impedance tomography (EIT) has emerged as a powerful, non-invasive, and radiation-free tool for real-time bedside monitoring of regional lung ventilation and perfusion. Its unique ability to visualize spatial and temporal heterogeneity has established clinical value across intensive care, perioperative management, and chronic respiratory disease settings. Despite decades of recognized potential, the global translation of EIT from laboratory research to routine clinical practice has faced significant challenges, including high device costs, lack of standardization and guidelines, workflow integration challenges, and insufficient evidence linking its use to clinical outcomes. China's experience over the past decade presents a compelling and instructive case of rapid adoption that contrasts sharply with the slower global pace. Unlike prior descriptive reviews that catalogued milestones achieved, this article provided an analytical framework that examined how and why this accelerated translation occurred in China. It first evaluated the specific clinical value driving adoption across diverse scenarios. It then identified the distinctive ecosystem that enabled this rapid translation. Several factors worked synergistically: rapid clinical validation was achieved through China's vast hospital network. Domestic industry innovation drove down device costs and improved portability. Chinese researchers provided proactive leadership in building national and international standards. Most importantly, strategic government support-including reimbursement policies-removed economic barriers to adoption. Transferable lessons from this model were discussed for overcoming implementation barriers and accelerating the adoption of innovative medical technologies globally.
Previous studies have demonstrated that Herbal Xingqin Ganke Granules (XQGK) exhibit significant antitussive effects across various dosage groups and ameliorate airway hyperreactivity in mice models. However, the clinical efficacy in humans warrants further investigation through additional clinical trials. The present study aims to evaluate the efficacy and safety of XQGK in the treatment of postinfectious cough (PIC) with the syndrome of latent wind-heat in the lung. This multicenter, randomized, double-blind, dose-ranging, placebo-controlled trial intends to recruit 240 patients with PIC. Subjects will be randomly assigned in a 1:1:1 ratio to either the low-dose XQGK group, the high-dose XQGK group, or the control group, with 80 patients in each group. The treatment duration will be 14 days, followed by a 3-day post-treatment follow-up. The primary efficacy outcomes include: (I) cough response rate; (II) initial cough resolution rate. The secondary efficacy outcomes include: (I) time to cough relief; (II) time to initial cough resolution; (III) sustained cough resolution duration; (IV) Leicester Cough Questionnaire (LCQ) scores; (V) Traditional Chinese Medicine (TCM) symptom score variation; (VI) TCM symptom efficacy evaluation; (VII) individual TCM symptom score variation; and (VIII) Patient Global Impression of Change (PGIC) scores. Safety endpoints will encompass the incidence of adverse events and serious adverse events, vital signs, physical examinations, laboratory biochemical indices, and 12-lead electrocardiogram findings. This study will provide comprehensive, large-scale, multicenter clinical data on the efficacy and safety of XQGK in the treatment of PIC with the syndrome of latent wind-heat in the lung. It will contribute significant clinical evidence for the use of TCM in the management of PIC. Chinese Clinical Trial Registry, ChiCTR-IPR-2400085269. Registered on 04 June 2024. https://www.chictr.org.cn/showproj.html?proj=215559.
Biological aggressiveness varies substantially even within clinical stage IA invasive lung adenocarcinoma. The International Association for the Study of Lung Cancer (IASLC) grading system identifies grade 3 tumors as a high-risk subset associated with adverse outcomes and aggressive pathological features. Preoperative identification of grade 3 tumors may therefore be useful for surgical planning and nodal assessment. Both maximum standardized uptake value (SUVmax) on fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and three-dimensional consolidation-to-tumor ratio (3D-CTR) on CT are candidate preoperative markers, but direct comparison of their discriminative ability in the same cohort has been limited. We therefore compared the diagnostic performance of SUVmax and 3D-CTR for predicting IASLC grade 3 in clinical stage IA invasive lung adenocarcinoma. We retrospectively analyzed 224 patients with clinical stage IA invasive lung adenocarcinoma who underwent curative resection at Osaka Medical and Pharmaceutical University Hospital between January 2019 and October 2025. The primary endpoint was IASLC grade 3 determined on resected specimens. SUVmax and 3D-CTR were evaluated preoperatively. Receiver operating characteristic (ROC) analysis was used to calculate the area under the curve (AUC), and AUCs were compared using DeLong's test. Secondary analyses included correlation analysis, logistic regression analysis, and exploratory ROC analyses for occult lymph node metastasis (OLNM), spread through air spaces (STAS), lymphatic vessel invasion (LVI), and pleural invasion (PL). Of the 224 patients, 59 (26.3%) had IASLC grade 3 tumors. Compared with grade 1-2 tumors, grade 3 tumors were more frequently associated with smoking history, a pure-solid appearance, and significantly higher CTR, 3D-CTR, and SUVmax. In ROC analysis, SUVmax had a significantly higher AUC than 3D-CTR for predicting grade 3 (0.792 vs. 0.694, DeLong P=0.02). SUVmax and 3D-CTR showed a moderate positive correlation (Spearman's ρ=0.486, P<0.001). In multivariable logistic regression analysis, SUVmax remained independently associated with grade 3 [odds ratio (OR) 1.25, 95% confidence interval (CI): 1.13-1.38, P<0.001], whereas 3D-CTR showed only borderline significance (OR 1.01, 95% CI: 1.00-1.02, P=0.050). In exploratory ROC analyses, SUVmax also outperformed 3D-CTR for predicting OLNM, whereas no significant differences were observed for STAS, LVI, or PL. In clinical stage IA invasive lung adenocarcinoma, SUVmax showed stronger discriminative ability than 3D-CTR for preoperative prediction of IASLC grade 3 in this cohort. These findings should be interpreted cautiously and require validation in independent cohorts before clinical application.
Bronchodilator responsiveness (BDR) is a common indicator in chronic obstructive pulmonary disease (COPD), but its clinical relevance remains controversial. Traditional spirometry may fail to detect small airway reversibility, which can be captured by maximum mid-expiratory flow (MMEF). The clinical significance of combined-BDR (integrating spirometric indices and MMEF) in guiding phenotype-based and individualized COPD management under current Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations remains unclear. This study aimed to investigate the clinical significance of combined-BDR in patients with COPD. In this single-center prospective study, a total of 137 patients with stable COPD were enrolled [post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) <0.70, age ≥40 years, smoking ≥10 pack-years]. Combined-BDR was defined as ≥12% and ≥200 mL increase in FEV1 or FVC and/or ≥30% increase in MMEF post-bronchodilator. Symptoms [COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnea scale, and St. George's Respiratory Questionnaire for COPD (SGRQ-C)], lung function, and moderate-to-severe exacerbations were assessed at baseline and 12 months. Multivariable regression and linear mixed-effects models were used to evaluate the associations between combined-BDR and clinical outcomes. Of 137 patients, 49 (35.8%) exhibited Combined-BDR, while 88 (64.2%) did not. Baseline demographic characteristics, including age, sex, body mass index (BMI), smoking status, and fractional exhaled nitric oxide (FeNO) levels, were comparable between the two groups. Patients with combined-BDR had significantly higher mMRC scores (P<0.01), CAT total scores (11.73±6.29 vs. 9.26±5.71, P=0.02), and lower baseline FEV1 (1.32±0.45 vs. 1.78±0.72 L, P<0.001). Over 12 months, patients with combined-BDR demonstrated greater improvements in pre-bronchodilator FEV1 [adjusted mean difference 0.12 L, 95% confidence interval (CI): 0.02-0.21, P=0.02] and FVC (adjusted mean difference 0.22 L, 95% CI: 0.04-0.39, P=0.02). Combined-BDR identifies a distinct COPD phenotype characterized by a higher baseline symptom burden but greater functional improvement following inhaled therapy, highlighting its potential value for phenotype-guided and individualized disease management.
The clinical outcome of secondary spontaneous pneumothorax (SSP) was mostly evaluated in chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD) patients whereas data were limited in non-COPD/ILD-related pneumothorax. This study aimed to describe the clinical outcome of pneumothorax secondary to different pulmonary conditions. A retrospective observational study was conducted on SSP patients in a Hong Kong hospital. Clinical outcome of pneumothorax secondary to different underlying lung diseases including persistent air leak (PAL), 2-year post-discharge pneumothorax recurrence and all-cause mortality were evaluated. Logistic regression and cox regression analysis were applied for covariates adjustment. Of the 223 SSP patients enrolled, 32 (14.3%) had acute chest infection and 191 (85.7%) had chronic lung diseases. The acute chest infection group had higher risk of PAL >14 days (40.6% vs. 17.8%; P=0.003), longer hospitalization (24 vs. 13 days; P=0.001) and higher all-cause mortality rate (25.0% vs. 12.0%; P=0.049) than chronic disease group. Among those with chronic lung diseases, COPD/ILD-related pneumothorax led to higher PAL risk (>2 days: OR: 2.14, 95% CI: 1.01-4.54, P=0.046; >14 days: OR: 4.02, 95% CI: 1.49-10.88, P=0.006) and prolonged hospitalization (14 vs. 12 days; P=0.02) but similar post-discharge all-cause mortality and recurrence rate at two years compared to non-COPD/ILD-related pneumothorax. Higher proportion of COPD/ILD group was considered unfit for surgical pleurodesis. One-year recurrence rate was lower in asthma (8.3%) and bronchiectasis (0%) patients than other disease groups (15.8-33.3%). Our study demonstrated heterogeneous clinical phenotypes among different lung diseases with poorer outcome in acute chest infection and COPD/ILD population. Differentiation between infective and non-infective, COPD/ILD-related and non-COPD/ILD-related SSP may enable more personalized management.
Increasing evidence suggests that microbiota plays important roles in the pathogenesis and progression of interstitial lung diseases (ILDs). However, the global research landscape and emerging trends in this field remain insufficiently characterized. This study aimed to systematically characterize the research landscape, evolving hotspots, and future trends in the field of host microbiota and ILDs using bibliometric and visualization approaches, and to further explore the progress of related clinical studies. Publications up to November 8, 2025 were retrieved from the Web of Science Core Collection. Concurrently, clinical trials within the same timeframe were extracted from PubMed to assess advancements in the field. Bibliometric and visual analyses were conducted using VOSviewer, CiteSpace, SCImago Graphica, and Microsoft Excel. A total of 295 publications were included, showing a marked increase in research output since 2012. China and the United States were the leading contributors, with the United States demonstrating higher academic impact and stronger international collaboration. Core institutions and authors were mainly concentrated in North America and Europe. Keyword analysis revealed a clear evolution of research focus, shifting from early exposure-related studies and hypersensitivity pneumonitis to lung microbiome dysbiosis, the gut-lung axis, and metagenomic approaches. Recent hotspots emphasize microbiome-based clinical applications, with increasing attention to host-microbiome interactions and immune regulatory mechanisms. Research on microbiota and ILDs has expanded rapidly and shows increasing interdisciplinary integration. Future studies should enhance international collaboration, clarify underlying mechanisms, and promote clinical translation of microbiome-based biomarkers and personalized therapeutic strategies.
Delirium is common and serious among older adults in emergency departments (EDs) yet screening often falls short of national expectations. This study evaluated current delirium screening practices in a metropolitan ED and identified barriers and enablers to implementing screening in line with the Australian Delirium Clinical Care Standard. A mixed-methods quality assurance study was conducted in The Prince Charles Hospital ED. A retrospective audit of 238 medical records for patients aged ≥ 65 years examined the frequency of delirium screening and associated clinical or operational factors. Semi-structured interviews with nine staff members explored perceptions, experiences and decision-making processes related to screening. Deductive framework analysis guided integration of quantitative and qualitative data. Of eligible patients, 4.2% were screened, with most assessments completed by specialist teams during weekday hours. Screened patients had longer ED stays, although this finding should be interpreted as exploratory. Nurses recognised major delirium risk factors but described screening as reactive rather than routine. Reported barriers included time pressures, environmental limitations, lack of digital integration and uncertainty about role responsibilities. Awareness of the Australian Delirium Clinical Care Standard was limited, contributing to inconsistent practice. Despite baseline knowledge of delirium risk, ED screening remains inconsistent and specialist-dependent. Strengthening adherence to national standards requires embedding screening into routine nursing workflows through clearer role delineation and the integration of prompts to support systematic assessment for all older patients.
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Brain metastases from small cell lung cancer (SCLC) are characterized by high malignancy and poor prognosis. Emerging evidence demonstrates that combining brain radiotherapy (BRT) and immunotherapy may improve outcomes; however, the optimal strategy for combining these therapies remains undefined. This study was conducted to evaluate the efficacy and safety of concurrent BRT combined with tislelizumab and chemotherapy in patients with SCLC and brain metastases. Patients with treatment-naive or previously treated SCLC and brain metastases who were admitted to Zhejiang Cancer Hospital (Hangzhou, China) between September 2023 and November 2025 were enrolled. All patients received one cycle of chemotherapy combined with tislelizumab, followed by initiation of BRT within one week. Chemotherapy plus immunotherapy was subsequently continued, followed by maintenance immunotherapy until disease progression. The primary endpoint was intracranial objective response rate (iORR). Secondary endpoints included overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and treatment-related adverse events (TRAEs). Twenty-five patients were included. Among them, the iORR was 76.0%, and intracranial DCR was 100.0%. The systemic ORR and DCR were 56.0% and 80.0%, respectively. The median OS was 11.1 months [95% confidence interval (CI): 7.4-14.8], the median PFS was 5.6 months (95% CI: 3.1-8.1), and the median intracranial PFS was 7.6 months (95% CI: 5.7-9.5). TRAEs of any grade were identified in all patients, while grade ≥3 adverse events were found in 36.0% of patients. Hematological toxicity was most common (88.0%). Concurrent BRT combined with tislelizumab and chemotherapy demonstrated promising intracranial and systemic efficacy with manageable toxicity in SCLC patients with brain metastases and warrants further validation in larger prospective studies.
Lung cancer associated with cystic airspaces (LCCA) is an uncommon subtype of lung cancer in which cystic lesions are present within or adjacent to the tumor. Despite advances in computed tomography (CT) screening, early diagnosis remains challenging, and radiologic tumor size is often underestimated. This study aimed to evaluate surgical cases of LCCA with radiologic tumor diameter ≤2 cm and to clarify their clinicopathological characteristics and prognostic impact. Among 606 patients who underwent surgical resection for primary lung cancer between 2017 and 2020, 299 had radiologic tumor diameters ≤2 cm. These patients were classified into an LCCA group (n=26) and a non-LCCA group (n=273). Clinicopathological characteristics, radiologic-pathologic tumor size discrepancies, and survival outcomes were compared. Prognostic factors were analyzed using the Cox proportional hazards model, and disease-free survival (DFS) and overall survival (OS) were evaluated using Kaplan-Meier analysis. Preoperative carcinoembryonic antigen (CEA) levels were significantly higher in the LCCA group compared with the non-LCCA group (6.13 vs. 4.71 ng/mL). Univariate analysis identified sex, smoking history, CEA level, and LCCA as prognostic factors, while multivariate analysis demonstrated LCCA as the only independent predictor of poor prognosis. Both DFS and OS were significantly worse in the LCCA group. The mean radiologic tumor diameter in LCCA was 1.5 cm, whereas the mean pathological diameter was 2.53 cm, indicating an approximate 1 cm underestimation on preoperative imaging. In small lung cancers, LCCA is associated with poorer prognosis and substantial radiologic-pathologic size discrepancy. These findings highlight the need for careful surgical decision making, as radiologic measurements may underestimate true tumor extent in LCCA.
Covering the bronchial stump with a free pericardial fat pad (FPFP) is widely performed to prevent bronchopleural fistula (BPF) following thoracoscopic lobectomy. This procedure is a simple technique that can be readily performed even in minimally invasive procedures, and may be considered as one of several options for bronchial stump reinforcement. In patients at risk of bronchial stump fistula, the bronchial stump is aggressively covered with an FPFP at our institution. Among the 620 patients of thoracoscopic lobectomy performed, BPF occurred in three of the 483 patients (0.6%) in which the bronchial stumps were not covered, all patients required open window thoracostomies immediately. On the other hand, among 137 patients who underwent bronchial stump coverage using an FPFP, postoperative bronchial stump dehiscence occurred in three. In two patients, air was detected within the covering fat tissue; however, both remained asymptomatic, and this problem resolved spontaneously over time, resulting in complete healing. In contrast, the remaining patient was initially asymptomatic, despite the presence of air within the covering fat tissue, but ultimately progressed to empyema with fistula formation, thereby necessitating an open window thoracotomy. This report suggests that coverage with FPFP may not only prevent BPF, but also has the potential to delay or prevent progression to empyema with fistula when bronchial stump dehiscence occurs.
Pulmonary thromboembolism (PTE) is a common and potentially fatal cardiopulmonary vascular disease. Early and accurate diagnosis is crucial for improving patient prognosis. Computed tomography pulmonary angiography (CTPA) is widely used as a first-line imaging modality, while the clinical value of pulmonary ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) in specific patient populations is increasingly recognized. However, systematic evidence comparing the diagnostic performance and corresponding patient clinical phenotypes across different imaging techniques remains limited. This study aimed to compare the application differences between V/Q SPECT and CTPA in diagnosing PTE, along with their associated clinical characteristics, physiological functional status, and risk stratification features, thereby providing evidence-based support for optimizing imaging diagnostic pathways. A retrospective case-control study was conducted, enrolling hospitalized patients diagnosed with PTE between January 1, 2017, and April 30, 2022, at a tertiary hospital in Shandong Province. Initially, 1,124 cases were retrieved via electronic medical record (EMR) and imaging databases. After screening, 726 patients were finally included: 312 in the V/Q SPECT group and 414 in the CTPA group. Demographic characteristics, clinical manifestations, laboratory indicators [D-dimer, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2), etc.], lower limb venous ultrasound, and echocardiographic parameters were systematically collected. Propensity score weighting was employed to balance baseline differences. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed. After weighting, baseline characteristics were well-balanced between the two groups. Patients in the V/Q SPECT group more frequently presented with central or lobar emboli, accompanied by more significant hypoxemia and right ventricular dysfunction (RVD). Their levels of D-dimer, NT-proBNP, and myocardial injury markers were higher than those in the CTPA group. The CTPA group in our cohort predominantly consisted of patients with relatively milder clinical symptoms and biomarker profiles. Multivariable analysis revealed that elevated NT-proBNP, RVD, and lower limb deep vein thrombosis (DVT) were significantly associated with the use of V/Q SPECT. The multi-parameter combined model demonstrated good discriminative ability, with an area under the curve (AUC) of 0.832 [95% confidence interval (CI): 0.801-0.862]. V/Q SPECT and CTPA are associated with distinct clinical phenotypes in real-world practice, largely reflecting systematic selection patterns driven by patient-specific contraindications and baseline risk profiles. In our cohort, V/Q SPECT was more commonly utilized in patients with higher clinical risk and biomarker levels, reflecting a clinical selection pattern where this modality was assigned to a more physiologically compromised population, while CTPA was applied to a relatively lower-risk cohort. The selection of imaging modality should integrate comprehensive assessment of clinical probability, biomarkers, and cardiopulmonary function to achieve individualized diagnostic decision-making.
Frontotemporal dementia (FTD) is an umbrella term that encompasses a group of clinically heterogeneous neurodegenerative disorders. It is biologically referred to as Frontotemporal lobar degeneration (FTLD) and is characterized by progressive degeneration of frontal and/or temporal lobes. FTD poses substantial diagnostic and therapeutic challenges due to its heterogeneous clinical presentations, limited biomarker specificity, and overlap with other neurodegenerative and psychiatric diseases. This review synthesizes updated knowledge on the clinical phenotypes of FTD, their prognostic elements, and the underlying genetic and molecular mechanisms. Advances in diagnostic strategies are discussed, including structural and functional neuroimaging, fluid biomarkers, and genetic testing, together with emerging digital and AI-assisted tools that may enhance diagnostic precision. Evidence-based management approaches are examined, alongside the role of multidisciplinary care and caregiver support. Promising therapeutic strategies, including gene-targeted interventions, antisense oligonucleotides, progranulin restoration strategies, immunotherapies, and neuromodulation techniques, are discussed considering recent clinical and preclinical developments. Despite the absence of approved disease-modifying therapies, rapid progress in biomarker development, patient stratification, and personalized approaches offers encouraging prospects for more effective interventions across the FTD spectrum. PubMed/MEDLINE was searched for peer-reviewed articles on FTD diagnosis and management; reference lists of key articles were screened to identify additional sources.
Lung squamous cell carcinoma (LUSC) is associated with poor prognosis and low 5-year survival rates, and effective targeted therapies remain unavailable in clinical practice. To investigate the expression levels and clinical significance of YTH N6-methyladenosine RNA-binding protein 1 (YTHDF1) and YTH N6-methyladenosine RNA-binding protein 2 (YTHDF2) in LUSC tissues, and to preliminarily demonstrate that YTHDF1 promotes the expression of programmed death-ligand 1 (PD-L1) through N6-methyladenosine (m6A) RNA modification. (I) The Cancer Genome Atlas (TCGA) database was utilized to explore the relationships between the expressions of YTHDF1 and YTHDF2 in LUSC, pathological characteristics, and patient prognosis. (II) Gene set enrichment analysis (GSEA) was used to explore the biological functions and signaling pathways involved in YTHDF1 and YTHDF2. The correlation between YTHDF1 and YTHDF2 expression and 22 immune cells was analyzed using CIBERSORT. (III) Immunohistochemistry is used to detect the expression levels of YTHDF1 and YTHDF2 in 60 LUSC and adjacent tissue samples and their relationship with clinical characteristics, and to evaluate their correlation with PD-L1 expression. (IV) Quantitative real-time polymerase chain reaction (qRT-PCR), flow cytometry analysis and other methods are used to detect the expression level of PD-L1 in LUSC cells after overexpression of YTHDF1. (V) Western blot, lactate dehydrogenase (LDH) release assay, T cell-mediated tumor cell-killing assay and other in vitro experiments verify whether YTHDF1 could enhance PD-L1 expression in an m6A-dependent manner in LUSC cells. Registration number for a clinical trial: ChiCTR2600118358. YTHDF1 and YTHDF2 are elevated in LUSC compared to the adjacent tissues, and their messenger RNA (mRNA) levels correlate with advanced pathological tumor (T), node (N), and metastasis (M) categories and clinical stage. Multivariate Cox regression analysis showed that high YTHDF1 expression and T stage independently predicted a shortened disease-specific survival. GSEA indicated that the gene signatures driven by YTHDF1 and YTHDF2 were enriched for E2F targets and G2M checkpoint pathways. CIBERSORT revealed significant associations with multiple immune-infiltrating cells. Immunohistochemistry confirmed the overexpression of YTHDF1 and YTHDF2 in LUSC specimens, demonstrating a positive correlation between YTHDF2 and PD-L1 expression. YTHDF1 expression is significantly associated with PD-L1 expression. Functional assays showed that YTHDF1 increased PD-L1 levels in an m6A-dependent manner and reduced T-cell cytotoxicity. Bioinformatics analysis showed that YTHDF1 mRNA expression was significantly higher in LUSC tissues than in adjacent non-cancerous tissues (P<0.05), and YTHDF2 mRNA expression was higher in LUSC tissues than in adjacent non-cancerous tissues in paired analysis (P<0.05), but no significant difference was found in the unpaired analysis (P>0.05). YTHDF1 and YTHDF2 may serve as potential prognostic biomarkers and therapeutic targets, and YTHDF1-mediated m6A modification may open new avenues for LUSC immunotherapy.
The World Health Organization recommends surveillance, including audits with case reviews of severe maternal morbidities such as eclampsia, to improve obstetric outcomes. We aimed to audit eclampsia and to identify learning opportunities in eclampsia care in Norway. Our study population included all women discharged with a diagnosis of eclampsia (ICD-10: O15) and with a documented generalized seizure in medical records at two university hospitals in Norway from 2013 to 2022. An eclampsia working group developed a digital eclampsia case report form for gathering clinical information from medical records. Based on a structured summary of information from the digital case report form, the group reviewed the care for women with eclampsia. Each case was discussed and reviewed according to the clinical guidelines by the group. Learning opportunities to improve care were identified and classified according to whether they contributed to the outcome. Among 93 139 deliveries, 22 women with an initial eclampsia diagnosis were identified (2.4 per 10 000). Subsequent clinical information identified an alternative probable etiology of seizures in five women. None of the 22 women received magnesium sulfate prior to the seizure, and cerebral imaging was performed in 11 of 22 women. In 18 women, learning opportunities were identified, and for eight women, a different management could potentially have prevented eclampsia. The eclampsia working group identified learning opportunities related to underuse of magnesium sulfate prophylaxis when indicated, inadequate management of hypertension both before and after eclamptic seizure, underuse of cerebral imaging as a diagnostic tool, and lack of follow-up consultation with an obstetrician in women diagnosed with eclampsia. Learning opportunities were found in 18 of 22 women, and improvements in care could potentially have changed the outcome for eight of the women. This audit highlights the importance of differential diagnostic consideration for seizures in pregnant and postpartum women, the use of prophylactic magnesium sulfate when indicated, and the diagnosis and management of hypertension in pregnancy. Eclampsia audits should be incorporated into national routine surveillance and learning systems to improve obstetric care.
Occult lymph-node metastasis (ONM) occurs in 10-20% of primary lung cancers and can influence surgical and treatment strategies. Improving preoperative prediction of ONM may optimize lymph-node dissection and multidisciplinary planning. We aimed to develop machine learning (ML) models to predict ONM using clinical data and to assess whether adding fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) data, including individual lymph-node maximum standardized uptake value (SUVmax), could enhance predictive performance. We retrospectively analyzed 77 patients who underwent curative lobectomy for primary lung adenocarcinoma at our institution between 2016 and 2018. Four ML models-Random Forest (RF), Support Vector Machine (SVM), Gradient Boosting Machine (GBM), and eXtreme Gradient Boosting (XGB)-were developed using clinical data, PET/CT data, and their combination. Feature selection was performed using the Minimum Redundancy Maximum Relevance (mRMR) algorithm to reduce feature redundancy. The dataset was divided into training and testing sets in an 8:2 ratio with no overlapping. Hyperparameters were tuned using five-fold cross-validation. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and average precision (AP), with confidence intervals estimated via bootstrap resampling. Feature importance was assessed using SHapley Additive exPlanations (SHAP). Using clinical data alone, AUCs were 0.88 (RF), 0.69 (SVM), 0.73 (GBM), and 0.82 (XGB). Incorporation of PET/CT features improved predictive performance, yielding AUCs of 0.91 (SVM), 0.87 (GBM), and 0.91 (XGB). SHAP analysis demonstrated that while primary tumor PET features were important, the SUVmax of individual lymph nodes emerged as additional key predictors, highlighting the critical contribution of nodal PET data to ONM prediction. Incorporating PET/CT data, including individual lymph node SUVmax, improved ONM prediction in ML models. These findings highlight the critical contribution of nodal PET data and support the integration of imaging data into ML tools to guide personalized surgical and treatment decisions in lung adenocarcinoma.
Fear of movement is a significant psychological factor in musculoskeletal disorders, negatively impacting clinical outcome. Currently there are many assessment tools measuring the fear of movement. This systematic review aims to analyze and compare the psychometric properties of the main scales used to measure fear of movement in populations with musculoskeletal disorders. A systematic literature review was conducted following the PRISMA criteria, analyzing studies published in the following databases: MEDLINE (via PubMed), CINAHL (via EBSCO), Web of Science and Scopus. Study quality was assessed using the COSMIN checklist. For the meta-analysis, studies reporting the internal consistency were analyzed. 99 studies were included in the selection, which identified a total of 29 assessment tools. Most of these instruments have demonstrated good reliability and validity, althoughthere is significant heterogeneity in methodological quality and a notable lack of reporting on measurement error and responsiveness across the included studies. Numerous assessment tools for fear of movement are available in the literature, with some scales distinguished by high levels of reliability and validity across different clinical and linguistic contexts. These findings provide useful guidance for selecting appropriate tools for clinical practice and research, helping to improve the assessment and management of fear of movement in patients with musculoskeletal pain. http://www.crd.york.ac.uk/prospero identifier is CRD420251009756.
Interpretation of urine culture results requires key clinical information such as symptom status, catheterization, and multidrug-resistant organism (MDRO) risk. However, this information is frequently absent from routine request forms, contributing to overtreatment of asymptomatic bacteriuria (ASB) and suboptimal antimicrobial prescribing. This study evaluated the impact of implementing a structured urine-culture request form as part of a diagnostic and therapeutic stewardship program. This prospective, non-randomized interventional study was conducted at an 1800-bed tertiary-care hospital in India (March 2023-March 2024). Patients undergoing urine culture testing in Urology/Nephrology departments used a structured request form capturing symptoms, risk factors, and clinical context (test arm), while General Medicine continued routine forms (control arm). Primary outcomes included ASB treatment, MDRO detection, recurrence, and guideline-concordant prescribing. Patients were followed for one year. A total of 484 patients were included (198 test arm, 286 control arm). Antibiotic treatment for ASB was significantly lower in the test arm compared with the control arm (3.6% vs 67.0%; p < 0.001), without adverse outcomes. Guideline-compliant prescribing was higher in the test arm (73.7% vs 26.2%; p < 0.001). MDRO prevalence was higher in the test arm (32.2% vs 11.3%), reflecting greater clinical complexity rather than the intervention itself. Recurrent urinary tract infection (UTI) within one year was significantly lower in the test arm (14.1% vs 29.0%; p < 0.001). Introducing a structured urine-culture request form improved diagnostic clarity and antibiotic prescribing, particularly by reducing unnecessary treatment of ASB and increasing guideline compliance, without compromising patient outcomes. This low-cost intervention represents a practical and scalable diagnostic stewardship strategy for improving UTI management.
Patients with chronic pulmonary aspergillosis (CPA) frequently face severe clinical challenges due to hemoptysis. Although bronchial artery embolization (BAE) is effective in controlling acute hemoptysis, the long-term recurrence rate remains high (up to 50%). Current research has mostly focused on culprit vessels originating from the systemic circulation, whereas the role of the pulmonary artery system (e.g., pulmonary artery pseudoaneurysm) in hemoptysis recurrence remains unclear. This study aimed to analyze the clinical characteristics of patients with CPA complicated by hemoptysis who underwent BAE, and to identify independent risk factors for hemoptysis recurrence. In this single-center retrospective observational study, 58 CPA patients who underwent BAE for hemoptysis between January 2021 and January 2024 were enrolled. Based on hemoptysis recurrence within one-year post-procedure, patients were divided into a recurrence group (n=23) and a non-recurrence group (n=29). Baseline characteristics, imaging findings, and details of interventional procedures were collected. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for hemoptysis recurrence, and Kaplan-Meier survival curves were plotted. Among the 58 patients, the median age was 63 years and 62.1% were male. The one-year recurrence rate was 39.7%. Univariate analysis revealed that male sex, parenchymal destruction, the presence of three or more underlying pulmonary diseases, pulmonary artery involvement, and an increased number of embolized non-bronchial systemic arteries were associated with recurrence (P<0.05). Multivariate Cox regression analysis indicated that pulmonary artery involvement was an independent risk factor for hemoptysis recurrence after BAE [hazard ratio (HR) =3.43, 95% confidence interval (CI): 1.31-9.02, P=0.01]. The proportion of patients with pulmonary artery involvement was significantly higher in the recurrence group than in the non-recurrence group (60.9% vs. 27.6%, P=0.02). Hemoptysis-free survival was significantly shorter in patients with pulmonary artery involvement (P=0.008). Pulmonary artery involvement is an important independent risk factor for hemoptysis recurrence after BAE in patients with CPA. This finding suggests that the pathological mechanism of hemoptysis in CPA involves "a dual systemic-pulmonary circulation mechanism". In clinical practice, when performing interventional therapy for CPA patients with hemoptysis, in addition to the thorough embolization of culprit systemic arteries, routine assessment and active management of pulmonary artery lesions should be considered, as this may help reduce the long-term risk of recurrence.