Hip fractures (HFs) are increasingly common in aging populations and often require surgical intervention, leading to significant blood loss from both the injury and the procedure, increasing the need for red blood cell (RBC) transfusions. Despite evidence from randomized controlled trials, indicating the risks associated with RBC transfusions, they remain a standard treatment for patients with HF. This systematic review and meta-analysis aimed to evaluate the impact of RBC transfusions on mortality and 30 d clinical outcomes. We conducted a systematic review of observational and experimental studies on RBC transfusions in adults undergoing HP surgery. Without language restrictions, we searched PubMed, Scopus, Web of Science, and EMBASE up to September 1, 2024. Effect sizes for continuous variables are reported as means with 95% confidence intervals (CIs), whereas dichotomous variables are reported as risk ratios with 95% CIs. A random-effects model was used for the analysis. We included 26 studies involving 59,627 patients with HF, 42% of whom received RBC transfusions. Transfusion rates varied widely by country. Women and older patients with HF received fewer RCB transfusions than men and those under 90 years old. RBC transfusions were associated with increased 30 d mortality, 30 d skin infections, and pneumonia, with a tendency toward higher 1 year mortality. RBC transfusions in patients with HF are associated with increased risks of 30 d mortality, 30 d skin infections, and pneumonia. Careful consideration is essential when administering transfusions to this vulnerable population.
Elucidating alterations in the electrophysiological properties of biological tissues during aging is crucial for understanding the mechanisms of tissue aging and developing early diagnostic strategies.Electrochemical Impedance Spectroscopy (EIS) serves as a robust tool for characterizing tissue electrical properties. However, the systematic and quantitative effects of age and frequency on complex impedance parameters-such as magnitude (Z), resistance (R), and reactance (X)-across multiple tissues remain inadequately explored. In this study, we applied EIS to systematically profile the complex impedance spectra of ten major tissues from 2-and 18-month-old male and female mice, including skin, brain, spleen, heart, lung, liver, kidney, muscle, testis, and adipose tissue, over a frequency range of 20 Hz to 1 MHz. Our results indicate that aging significantly alters key impedance parameters (Z, R, and X) of skin, muscle, adipose, and liver tissue in a frequency-dependent manner, whereas other tissues exhibited minimal age-related changes. Using Nonlinear least-squares regression algorithms, we elucidated the complex, nonlinear relationships among frequency, age, and impedance parameters, establishing highly accurate predictive models, particularly for organs showing pronounced changes. The derived fitting equations effectively captured essential features of the impedance spectra. This study quantitatively reveals the significant influence of age and frequency on impedance parameters in specific tissues, providing new insights into the electrophysiological basis of tissue aging and highlighting the potential of EIS as a rapid biophysical tool for detecting biological aging.
The primary objective was to establish the prevalence of newly acquired pressure ulcers (PUs) in a cohort of patients with COVID-19 admitted to a specialist respiratory intensive care unit (ICU) during the first ICU surge and who were allocated the Nimbus Professional Alternating Pressure Mattress System (Arjo AB, Sweden) for the entirety of their admission. Secondary objectives were to establish the prevalence of newly acquired PUs in the cohort of patients receiving extracorporeal membrane oxygenation (ECMO) who were aligned to a six-hourly repositioning protocol, as well as in the cohort of proned patients. A retrospective skin injury evaluation of the Surface, Skin Inspection, Keep moving, Incontinence/moisture and Nutrition (SSKIN) document bundle of every patient who tested positive for the COVID-19 virus, who was admitted to the ICU between 16 March 2020 and 26 June 2020 and allocated the Nimbus Professional mattress for the entirety of their admission. Of the 32 patients who were identified in this service evaluation, three (9.4%) developed ≥1 PU while allocated to the alternating pressure mattress. Of the 23 patients treated with ECMO who were routinely repositioned every six hours, two (8.7%) experienced a PU, and of the remaining nine patients not receiving ECMO, one (11.1%) experienced a PU. Out of the 11 patients who were proned, one (9.1%) experienced a PU, and in the 21 patients who were not proned, two (9.5%) experienced a PU. No deep category 3 or 4 PUs, deep tissue injuries or unstageable PUs were recorded. All PUs were of a category 1 or 2 superficial depth ulceration. There were no newly acquired PUs to the chest, abdomen or knees when patients were in the proned position. The rate of deep PUs in patients allocated to the alternating pressure mattress was low when combined with a systematic approach to repositioning. The cohort of proned patients largely relied on the mattress function to provide pressure relief while in the prone position. The absence of any new PUs to the chest, abdomen, knees and feet in the proned cohort, indicated that allocating a dynamic mattress with cells that can be manually deflated under high-risk anatomical points, can be an effective method of protecting patients from skin injury. There was no link between an increased risk of PUs and an increased length of stay. A larger cohort requires studying to establish if these outcomes can be replicated consistently.
Lipotoxicity-induced endothelial dysfunction impairs wound healing in obesity and type 2 diabetes, yet the underlying mechanisms remain elusive. While Angiogenin promotes endothelial function, its role under lipotoxic stress has been unknown. Here, we demonstrate for the first time that Angiogenin effectively protects against lipotoxicity-induced delayed skin repair. In a cellular lipotoxicity model induced by oleic and palmitic acids (OPA) using human umbilical vein endothelial cells (HUVECs), the levels of Angiogenin decreased in a time- and dose-dependent manner. Meanwhile, a similar reduction was also observed in the skin tissue of high-fat diet/streptozotocin (STZ)-induced diabetic mice and Apolipoprotein E (APOE)-/- mice. Restoring Angiogenin levels significantly enhanced endothelial proliferation, migration, and angiogenesis, rescuing OPA-induced impairment. Through RNA-seq and subsequent validations, we provide novel mechanistic insight into Angiogenin's protective action: Angiogenin directly binds and stabilizes Caveolin-1 (Cav1) mRNA, leading to increased Cav1 expression. Critically, we show that the Angiogenin-mediated endothelial rescue is strictly dependent on this Cav1 upregulation. Furthermore, topical administration of Angiogenin peptide significantly accelerated wound closure and neovascularization in both APOE-/- and high-fat diet/STZ-induced diabetic mice. Collectively, our study unveils a novel Angiogenin-Cav1 axis in endothelial protection, positioning Angiogenin as a promising therapeutic candidate for lipotoxicity-induced impairment of skin wound healing.
To determine whether procedural efficiency, catheter stability, and safety differ between specially designed double-loop (DPC) and single-loop (SPC) 10.2-Fr multihole pigtail catheters for pleural effusion, and to assess the independent association between catheter type and instability. This single-center retrospective study (Jan 2024-Aug 2025) analyzed 577 procedures (DPC, n = 299; SPC, n = 278). Inclusion required 10.2-Fr multihole catheters under combined ultrasound-fluoroscopic guidance. Minimal effusions or incomplete records were excluded. Sample size included all eligible procedures without an a priori power calculation. Primary outcomes were catheter retraction and dislodgement. Secondary outcomes included procedure/fluoroscopy time, radiation exposure, success rates, and adverse events. Multivariable logistic regression evaluated the association between catheter type and retraction. DPC showed significantly lower retraction (0.7% [95% confidence interval (CI): 0.1%-2.4%] vs. 16.9% [12.7%-21.8%]; p < 0.001) and dislodgement (0.3% [0.0%-1.8%] vs. 2.9% [1.3%-5.6%]; p = 0.02). On multivariable analysis, DPC was independently associated with lower retraction odds (adjusted odds ratio: 0.034; 95% CI: 0.008-0.141; p < 0.001). DPC significantly reduced procedure time (11.9 vs. 16.3 min), fluoroscopy time (20.4 vs. 43.7 sec), and radiation exposure (4.6 vs. 10.0 mGy) (all p < 0.001). Technical and clinical success rates were 100% in both groups. Overall adverse event rates were low and similar (2.0% vs. 1.8%; p>0.05). DPC demonstrated lower retraction and dislodgement rates than SPC. Its intrinsic anchoring mechanism simplifies the procedure and obviates the need for skin fixation, while also reducing overall procedure time and radiation exposure.
Real-world evidence on the treat-to-target strategy in atopic dermatitis (AD) remains limited. To evaluate targeted combined endpoints in AD, we conducted a cross-sectional study that included 100 adults with AD receiving treatment ≥ 6 months. Targeted endpoints included Patient Global Assessment (PGA) ≤ 2, Eczema Area and Severity Index (EASI) ≤ 7, visual analog scale (VAS) of pruritus ≤ 4, Patient Oriented Eczema Measure (POEM) ≤ 7, and Dermatology Life Quality Index (DLQI) ≤ 5. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify factors associated with achieving treatment targets. Latent class analysis (LCA) and principal component analysis (PCA) were performed to identify patient subgroups and data components. Only 30% met all five targeted endpoints. An increased age was associated with a higher probability of achieving all treatment targets (aOR: 1.04; 95% CI: 1.00-1.09). DLQI could favorably predict the achievement of all 5 treatment targets (AUROC: 0.93; 95% CI: 0.88, 0.97). Despite no significant differences across treatment groups, the proportion of patients achieving all targets was the highest in the dupilumab group, followed by the Janus kinase inhibitor (JAKi) group. LCA identified one subgroup of patients achieving favorable skin control but poor life quality. PCA showed that life quality-related factors other than the severity of skin lesions explained the majority of variance. In conclusion, achievement of targeted combined endpoints in AD remains suboptimal, partly due to life quality-related factors.
Androgenetic Alopecia (AGA) is the most prevalent hair disorder. Conventional topical minoxidil is limited by suboptimal follicular penetration, local adverse effects, and poor adherence; nanocarrier-based "nanominoxidil" systems may optimize delivery, but their clinical value remains uncertain. To synthesize experimental and clinical evidence on nanocarrier-based topical minoxidil for AGA. We systematically searched databases (2015-2024) for in vitro, ex-vivo, in vivo, and human studies evaluating nanocarriers < 1000 nm loaded with minoxidil versus conventional minoxidil, placebo, or no treatment. Primary outcomes were follicular and cutaneous penetration or retention; secondary outcomes included hair length, density and/or coverage, biomarker modulation, adverse events, and formulation stability. Risk of bias was assessed with SYRCLE and OHAT. Of 410 records, 20 studies met eligibility criteria, predominantly preclinical, and one evaluated cutaneous tolerability in healthy volunteers. Across platforms (lipid, polymeric, hybrid and deformable systems, nanoemulsions), nanominoxidil consistently increased follicular deposition and cutaneous retention (≈2- to > 7-fold vs conventional solutions) and improved hair growth surrogates and angiogenic or stem-cell markers. Local tolerability was generally acceptable and systemic exposure was negligible when reported. Evidence is preclinical, with a single non-therapeutic human study; heterogeneity across models, comparators, doses, follow-up, and outcomes, and frequent lack of randomization, blinding, and standardized safety reporting, precluded meta-analysis and limited internal validity and generalizability. Nanotechnology-based minoxidil formulations enhance follicular targeting and hair-growth surrogate outcomes in experimental models and appear locally safe, but randomized trials in patients with AGA are required before nanominoxidil can be recommended for routine clinical use.
Ultraviolet B (UVB) radiation is a major cause of skin photoaging by oxidative stress, mitochondrial dysfunction, and barrier disruption. Plant-derived extracellular vesicles (PDEVs) have emerged as promising bioactive nanocarriers, but their roles in mitochondrial regulation and skin barrier homeostasis remain unclear. This study aimed to investigate the protective effects of extracellular vesicles derived from Alpinia zerumbet leaves (AZEVs) against UVB-induced photoaging in HaCaT keratinocytes. The results indicated that AZEVs exhibited typical extracellular vesicle characteristics, with an average size of 150 nm and a negative surface charge. Functionally, AZEVs significantly enhanced cell viability in UVB-exposed HaCaT cells, reduced ROS accumulation, and restored mitochondrial membrane potential and ATP production. Moreover, AZEVs upregulated mitochondrial biogenesis-related signaling pathway proteins (SIRT1, PGC-1α, Nrf2, and p-AMPK/AMPK) and TJ protein expression (ZO-1, occludin, and claudin-3), preserving barrier integrity and promoting wound healing. In addition, AZEVs are enriched in conserved miRNAs (miR166, miR159, and miR156) and a novel miRNA (novel_1), with predicted targets involved in redox regulation and energy metabolism. In summary, AZEVs protect keratinocytes against UVB-induced damage by enhancing mitochondrial function, reducing oxidative stress, and preserving skin barrier integrity. These findings highlight AZEVs as a promising natural nanoplatform for anti-photoaging and skin repair applications.
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Neurofibromatosis type 1 (NF1) is associated with cognitive impairments affecting attention, executive function, memory, visuospatial abilities, and processing speed, which are well described in children and adolescents and may interfere with daily functioning. In contrast, cognitive functioning in adults with NF1 remains less clearly defined, particularly in individuals without previous neurological or psychological conditions affecting cognitive functioning that may confound neuropsychological performance. This cross-sectional study aimed to characterize cognitive performance across multiple domains in adults with NF1 and to examine the relationship between cognitive performance and psychological and clinical variables. Eighty-seven adults with NF1 and no intellectual disability or previously diagnosed cognitive or psychiatric disorders underwent standardized neuropsychological assessment across seven cognitive domains commonly reported as affected in NF1, particularly in pediatric populations: visual memory, verbal memory, executive function, attention, visuospatial ability, working memory, and visuomotor speed. Participants also completed questionnaires assessing sociodemographic and psychological variables. Cognitive performance was standardized using age-adjusted normative Z-scores. Adults with NF1 performed below the normative mean across several cognitive domains relative to age-adjusted Spanish reference data. Executive function showed clinically significant impairment (z = -2.267), whereas attention showed low-average performance (z = -1.171). Although attention was associated with skin severity and visuospatial ability with depressive symptoms (p < 0.05), these associations were not significant after correction for multiple comparisons. These findings suggest a consistent pattern of cognitive underperformance in adults with NF1 without previous neurological or psychological conditions affecting cognitive functioning, supporting the presence of a specific cognitive vulnerability associated with the condition. Although some clinical factors showed associations with specific cognitive domains, these relations were small and did not remain significant after correction for multiple comparisons. These results highlight the importance of routine cognitive assessment and targeted cognitive and psychosocial support strategies, including their integration into genetic counseling, to improve clinical follow-up and patient care.
SERINC3, a member of the serine incorporator protein family, is known for its roles in viral resistance and tumorigenesis, however, its function in osteogenesis remains unexplored. Lentivirus infection, alkaline Phosphatase/Alizarin Red S Staining, and RT-qPCR were used to evaluate the osteogenic differentiation of mesenchymal stem cells mediated by SERINC3. MicroCT, H&E, and Masson staining were performed to investigate the bone formation and bone defect repair via Serinc3 knockout (KO) mice and nude mice. RNA sequencing, Co-IP, Western blotting, and Seahorse energy metabolism analysis were performed to elucidate the regulatory mechanism of SERINC3. Here, we identify SERINC3 as a critical regulator of osteogenic differentiation of bone marrow-derived stem cells (BMSCs) and bone regeneration. SERINC3 expression was significantly upregulated during osteogenic differentiation of BMSCs and stem cells from human exfoliated deciduous teeth (SHED). Functional assays revealed that SERINC3 overexpression enhanced osteogenic differentiation, proliferation, and migration of MSCs, while Serinc3-KO impaired these processes and led to osteopenia in mice. In a calvarial defect model, Serinc3-KO mice exhibited 42% less bone volume (BV/TV) and 35% lower bone mineral density (BMD), whereas SERINC3-overexpressing BMSCs significantly improved bone repair. Mechanistically, RNA sequencing and pathway analysis revealed that SERINC3 interacts with IL32 to activate the AMPK-ULK1-autophagy axis, thereby promoting osteogenesis. Additionally, SERINC3 enhanced mitochondrial energy metabolism by upregulating tricarboxylic acid cycle enzymes (ACO1, DLAT, SDHA) and increasing oxygen consumption rates. Rescue experiments confirmed that AMPK inhibition or autophagy blockade abolished SERINC3-mediated osteogenic effects, whereas mitochondrial electron transport chain activators restored osteogenesis in SERINC3-knockdown cells. In summary, this study identifies SERINC3 as a novel regulator of bone formation that orchestrates osteogenesis through IL32-AMPK-autophagy signaling axis and mitochondrial metabolism. These findings highlight SERINC3 as a potential therapeutic target for enhancing bone regeneration and treating skeletal defects.
This meta-analysis evaluates the efficacy of traditional Chinese medicine, alone or in combination with Western medicine, for the treatment of adult Henoch-Schönlein purpura. We searched clinical randomized controlled trials on the treatment of adult Henoch-Schönlein purpura with traditional Chinese medicine from the Chinese Journal Literature Database (CNKI), Wanfang Database, Embase, PubMed, Cochrane, Scopus, the Journal of Pharmacopuncture, and the National Library of China. After removing duplicate literature and reviewing titles, we selected the final studies based on our inclusion and exclusion criteria. These studies were assessed for bias using the Cochrane risk of bias assessment tool, and statistical analysis was performed using Review Manager 5.3.0 software. The PRISMA guidelines were followed when conducting the meta-analysis. Eighteen studies were included, with a combined sample size of 1632 cases, including 811 in the experimental group and 821 in the control group. The results indicated that traditional Chinese medicine, whether used alone or in combination with Western medicine, was more effective than Western medicine alone in terms of overall effectiveness and improvement in skin purpura, digestive tract, and joint symptoms. We found that the total clinical effective rate of patients in the experimental group was higher than that of the control group (OR = 6.04, 95% CI [4.01, 9.10], p < 0.001). Meta-analysis indicates that the difference between the control and experimental groups in improving skin purpura symptoms is statistically significant (SMD = -1.09, 95% CI [-1.22, -0.96], p < 0.001). We found that a more significant improvement occurred in the experimental group than in the control group (SMD = -0.95, 95% CI [-1.08, -0.82], p < 0.001). People in the experimental group showed a greater decrease in joint symptoms than those in the control group (SMD = -0.95, 95% CI [-1.08, -0.82], p < 0.001). Traditional Chinese medicine, either alone or combined with Western medicine, is more effective than Western medicine alone in treating Henoch-Schönlein purpura. It also shows superior efficacy in improving skin purpura, digestive tract, and joint symptoms.
Atopic dermatitis (AD) is a common inflammatory skin disease associated with substantial disease burden. Traditional Chinese medicine (TCM) has shown beneficial effects in improving AD symptoms and reducing recurrence. Inflammation Formula Number 1 (IFN-1), a TCM prescription consisting of 10 herbal ingredients, has demonstrated favorable efficacy in clinical practice. However, traditional decoction preparation is time-consuming and inconvenient for long-term standardized use. Granule formulations may improve convenience, stability, and quality control, but their dose-response relationship and equivalence to traditional decoction remain unclear. This multicenter, prospective, randomized equivalence trial aims to evaluate the efficacy, safety, and dose-response relationship of IFN-1 granule formulations compared with traditional decoction in patients with mild to moderate AD. A total of 300 patients with mild to moderate AD aged 18 to 60 years will be recruited from 5 hospitals between April 2026 and January 2027. Participants will be randomly assigned in a 2:2:1:1 ratio to the traditional decoction group (n=100, 33.3%), standard-dose granule group (n=100, 33.3%), two-thirds dose granule group (n=50, 16.7%), or one-tenth dose granule group (n=50, 16.7%). All groups will receive 4 weeks of treatment. The primary end point is the proportion of patients achieving at least 50% improvement in the Eczema Area and Severity Index (EASI) at week 4. Secondary outcomes include EASI75, EASI90, Investigator Global Assessment score of 0 or 1, body surface area involvement, Dermatology Life Quality Index, pruritus numerical rating scale, Patient-Oriented Eczema Measure, and TCM syndrome scores. Outcomes will be assessed at baseline and weeks 1, 2, and 4. Statistical analyses will be conducted using SAS (version 9.4). Equivalence will be evaluated using a 2-sided 95% CI approach with a predefined equivalence margin of -15% to +15%. Funding for this study was obtained in 2025. Ethical approval was granted by the Ethics Committee of Shanghai Skin Disease Hospital in December 2025, and the trial was registered with the International Traditional Medicine Clinical Trial Registry (ITMCTR2026000452). Participant recruitment is scheduled to begin in April 2026 and continue through January 2027. No patients were recruited at the time of manuscript submission. Data analysis is expected to commence in March 2027, and the primary study findings are anticipated to be published in 2028. This trial will determine whether IFN-1 granules achieve efficacy comparable to traditional decoction while improving treatment convenience. The findings may provide evidence for dose optimization and standardized clinical application of TCM granule formulations in AD management.
Psoriasis represents a prevalent long-term inflammatory skin condition marked by the dysregulation of immune responses. T cells are integral to the pathogenesis of psoriasis. This study conducted a comprehensive analysis to recognize biomarkers associated with T cell infiltration in psoriasis and to elucidate their underlying molecular mechanisms. Three biomarkers (AKR1B10, C10orf99, and CKS2) demonstrated high sensitivity and specificity in receiver operating characteristic (ROC) curve, and the reliability of the developed nomogram diagnostic model was observed. In addition, gene set enrichment analysis (GSEA) revealed notable enrichment of the biomarkers in the NOD-like receptor signaling pathway and focal adhesion. Immune infiltration analysis indicated elevated levels of activated B cells and CD8 T cells in psoriasis samples, with the biomarkers showing meaningful correlations with the majority of immune cell infiltration statuses. Importantly, preliminary reverse transcription quantitative PCR (RT-qPCR) validation showed increased expression of AKR1B10, C10orf99, and CKS2 in psoriasis tissues, confirmed higher expression of AKR1B10, C10orf99, and CKS2 in psoriasis patients. AKR1B10, C10orf99, and CKS2 may serve as candidate molecules for future mechanistic studies and provide potential diagnostic biomarkers for further investigation of psoriasis-related immune regulation.
Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a heterogeneous clinical course. Distinct phenotypes show differences in age at onset, severity, and allergic profile; however, evidence from Central and Eastern Europe remains limited. An anonymous online questionnaire distributed via social media targeted parents of children <18 years of age with physician-diagnosed AD. The data included demographics, environmental exposures, AD history, proxy Patient-Oriented Eczema Measure (POEM) scores, comorbidities, and self-reported sensitizations. Children were stratified by age (<6 vs. ≥6 years). Latent class analysis (LCA) was used to identify phenotypes in age groups using age of onset, current severity, recent exacerbations, viral skin infections, and sensitization type. A total of 435 children were included in this analysis (mean age, 3.92 years; 59.8% male). AD onset before 6 months occurred in 67.1% of patients. In children <6 years (n = 359), three phenotypes were identified: "early-onset, moderate-severe with co-sensitization" (n = 100, 27.9%), with highest frequency of food allergy; "early-onset, mild with food sensitization" (n = 195, 54.3%), and "later-onset, mild with aeroallergen sensitization" (n = 64, 17.8%). In children ≥6 years (n = 76), two phenotypes emerged: "early-onset with co-sensitization" (n = 53, 69.7%), which displayed higher frequency of atopic comorbidities, and "later-onset with aeroallergen sensitization" (n = 23, 30.3%). The classes showed clear separation based on selected features. Distinct, clinically relevant AD phenotypes were identified in children, which were in line with phenotypes reported in previous longitudinal studies, although based on cross-sectional data. These findings underscore AD heterogeneity and support the utility of pragmatic, region-specific surveys for phenotype identification outside longitudinal cohorts.
Effective, non-invasive treatments for motor and non-motor symptoms in Parkinson's disease (PD) remain limited, and wearable vibrotactile stimulation may help by enhancing sensorimotor integration. This multi-centre, double-blind, pilot randomised controlled trial evaluated the usability, safety and tolerability of the CUE1+ sternum-worn vibrotactile device, with exploratory clinical outcomes compared with a sham device. Fifty adults with idiopathic PD, stable on antiparkinsonian medication, were randomised to active CUE1+ (n = 25) or sham (n = 25) for 12-weeks (8 h/day), with ON-medication assessments at baseline and week-13. Four participants (8%) discontinued; compliance exceeded 95% in both groups, and 2 (4.2%) experienced mild, transient skin irritation. Exploratory between-group differences favoured active stimulation on MDS-UPDRS Part III (-11.1 points; 95%CI -17.3 to -4.9) and the PDQ-39 Summary Index (-7.6 points; 95%CI -12.3 to -3.0). CUE1+ was usable, safe, and well tolerated. The exploratory clinical signals do not establish efficacy and require confirmation in adequately powered trials using an active vibrotactile sham. Trial registration: ClinicalTrials.gov, NCT06174948. Registered 13 February 2024.
BACKGROUND Dermatomyositis is a rare autoimmune condition characterized primarily by proximal muscle weakness and cutaneous rashes, such as Gottron's papules and heliotrope rash, and is classified as a subtype of idiopathic inflammatory myopathies. While the clinical spectrum of dermatomyositis is broad, its initial onset as fulminant rhabdomyolysis (complicated by acute renal failure) is exceedingly rare. Such atypical presentations necessitate proactive clinical vigilance to ensure a prompt and accurate diagnosis. CASE REPORT Our patient was a 53-year-old woman who presented with progressive proximal muscle weakness, dysphagia, dysphonia, elevated creatinine kinase levels, hyperkalemia, and renal impairment. She was initially treated for rhabdomyolysis; however, due to increasing creatinine kinase levels and renal impairment, she required hemodialysis. During hospitalization she developed characteristic skin manifestations, including heliotrope rash and sleeve sign. Further investigation revealed pancreatic adenocarcinoma of the pancreatic head. CONCLUSIONS This report underscores the diagnostic difficulties in differentiating paraneoplastic-associated dermatomyositis from isolated primary rhabdomyolysis. It emphasizes the imperative of screening for occult malignancies in adult patients presenting with profound muscle necrosis and secondary kidney impairment. Identifying unusual clinical patterns of dermatomyositis early, combined with the rapid initiation of immunosuppressant and rigorous cancer surveillance, is essential for improving prognosis. This becomes paramount in scenarios in which the clinical presentation is suggestive of a paraneoplastic origin, notably pancreatic malignancy.
Lung cancer-associated pulmonary embolism (PE) is an acute and fatal clinical syndrome. Kimura disease is defined as a rare, chronic inflammatory disease, primarily characterized by swollen lymph nodes in the head and neck, elevated levels of eosinophils and immunoglobulin (Ig) E. PE can also occur in patients with Kimura disease due to eosinophilia. We herein reported a case of lung cancer-associated PE mimicking Kimura disease. A 36-year-old Han Chinese male was admitted complaining of repeated cough, hemoptysis, and chest pain, and his recurrent PE with pulmonary artery and bronchial artery were confirmed by chest computed tomographic angiogram (CTA) during both of his two admissions. He had enlarged lymph nodes of bilateral axilla and mediastinum and complained of skin itches, further laboratory examination showed elevated levels of eosinophils and Ig E, which mimicked the syndrome of Kimura disease. In order to clarify the diagnosis, his lymph node biopsy was suggested and performed, however, the pathologic profile of the resected lymph node referred not to Kimura disease, but lung adenocarcinoma. Then, upon definite diagnosis, the patient received standardized anticoagulant and targeted antitumor therapy, he got relief and stayed in stable condition at the time of discharge and during the subsequent 1-month follow-up. PE, swollen lymph nodes and eosinophilia may occur in both Kimura disease and solid cancer, the differential diagnosis between the two is crucial for the rational management of patients and warranted adequate attention.
To benchmark zero-shot generative pre-trained transformer (GPT)-based multimodal large language models (MLLMs) for pressure injury (PI) staging from photographs and quantify the effects of prompt strategy, structured outputs, and clinically meaningful label granularity. We performed a retrospective observational benchmark using 1,091 public, de-identified PI photographs labeled Stage I-IV. In the standardized analysis, all 10 model/prompt conditions were evaluated using a standardized, resume-safe application programming interface pipeline with per-image logging. We evaluated exact four-class staging, three-class staging (I/II/III-IV), skin-break screening (I vs. II-IV), and an advanced-intervention threshold (I-II vs. III-IV). Reporting followed Strengthening the Reporting of Observational Studies in Epidemiology and artificial intelligence/machine learning guidance; metrics included accuracy, Wilson 95% confidence intervals, F1 scores, weighted kappa, and threshold sensitivity/specificity. All conditions yielded parsed predictions for all 1,091 images. The best accuracy was 93.77% for skin-break screening (GPT-5.2 structured JavaScript Object Notation [JSON]), 90.28% for the advanced-intervention threshold (GPT-5.1 full prompt, low reasoning), 83.78% for three-class staging (GPT-5.1 full prompt, low reasoning), and 65.08% for exact four-class staging (GPT-5.2 structured JSON). The best advanced-intervention condition achieved sensitivity 96.72%, specificity 83.79%, and negative predictive value 96.19%. Stage IV undercalling remained safety-relevant; GPT-5.2-pro had Stage IV recall 8.79% and false-negative rate 91.21%. This prompt-transparent benchmark shows how outcome granularity, prompting, and structured outputs affect GPT-based PI staging and adds ordinal, threshold-based, and safety metrics. GPT-based MLLMs may support clinician-supervised triage and prioritization, but image-only autonomous exact staging is not clinically ready.[Figure: see text].
The trend of homemade sunscreen recipes has rapidly gained popularity over the last decade, being largely fueled by social media influencers, natural health blogs, and the growing mistrust of large health organizations like the US Food and Drug Administration (FDA). Consumers are increasingly drawn to products labeled "natural," "organic," "vegan," and "cruelty-free," often conflating these terms with safety and effectiveness. However, when applied to sun protection, these assumptions can be dangerously misleading. According to the FDA, there is no verified mathematical formula that can be used to determine an accurate sun protection factor (SPF) rating for the amount of zinc oxide used in many of the recipes found online. The objective of this review is to examine the rising popularity and efficacy of homemade sunscreens compared to commercial sunscreens and highlight the potential public health implications of skin cancer risk related to homemade sunscreen use. Multiple databases were searched to find current and relevant literature analyzing the social media impact relating to homemade sunscreens and the efficacy of homemade sunscreens compared to commercially available products. Digital content that included or discussed homemade sunscreen recipes was included as well to provide examples of information trending online. One study analyzing social media trends found that many strong, unverified claims relating to homemade sunscreen versus commercial sunscreen use are being presented in the media, potentially influencing public knowledge. Additional studies analyzing the components of homemade sunscreen recipes compared to components in commercially available products found that homemade sunscreens offer little to no sun protection, therefore increasing the risk of UV damage for individuals using homemade products. Based on the presented evidence, the adoption of unregulated homemade sunscreens presents a substantial threat to public health. Misinformation spread through social media and influencer culture may unintentionally contribute to an increase in UV-related skin cancers. Greater efforts are needed from health care professionals, regulatory bodies, and online platforms to educate the public and promote the use of scientifically validated sun protection methods.