The World Health Organization (WHO) recently published the 5th edition of head and neck tumors. This edition describes both existing entities and a group of emerging entities, along with updates regarding taxonomy and detailed characteristics of tumors and tumor-like lesions. Sinonasal tumors and skull base tumors represent a heterogeneous group of tumors with significant histological variability and overlap in imaging methods. An important change in the 5th edition of the WHO classification is the relocation of recurrent soft tissue, hematolymphoid, and neuroectodermal tumors into a separate chapter, meaning they are no longer repeated in other chapters as they were previously. Only those tumors that are unique to the sinonasal area remain classified in this chapter. In this review article, we will primarily provide a brief overview of all 24 diagnostic entities, allowing readers to gain a concise understanding. We will focus in detail on the new entities of SWItch/Sucrose Non-Fermentable complex-deficient sinonasal carcinomas and human papillomavirus-related multiphenotypic sinonasal carcinoma. In another review article in this issue, we detailed IDH-mutated sinonasal malignancies; therefore, we will exclude them from this overview and concentrate on DEK::AFF2 carcinomas, currently classified as sinonasal undifferentiated carcinomas or non-keratinizing squamous cell carcinomas, respectively.
The review article describes the most important news in head and neck pathology, that were published in the period 2021-2025, and that are only marginally mentioned or not mentioned at all in the WHO Classification of Head and Neck Tumors 2024, the 5th edition. The article focuses solely on the pathology of the salivary glands and sinonasal tract and deals only with malignant tumors. Regarding salivary gland pathology; palisading adenocarcinoma, microcribriform adenocarcinoma, mucoacinar carcinoma, mucoepidermoid carcinoma devoid of morphologically distinct squamous cell differentiation, metatypical adenoid cystic carcinoma, adenoid cystic carcinoma with striking tubular hypereosinophilia, and new proposals for a  grading system for acinic cell carcinoma and secretory carcinoma are discussed. Regarding pathology of the sinonasal tract; olfactory carcinoma and IDH2-mutated sinonasal carcinoma are mentioned.
The salivary gland section in the 5th edition of the World Health Organization classification of head and neck tumors features a description and inclusion of several new entities, including sclerosing polycystic adenoma, keratocystoma, intercalated duct adenoma, and striated duct adenoma among the benign neoplasms; and microsecretory adenocarcinoma and sclerosing microcystic adenocarcinoma as the new malignant entities. The new entry also includes mucinous adenocarcinoma subdivided into papillary, colloid, signet ring, and mixed subtypes with recurrent AKT1 E17K mutation across patterns suggesting that mucin-producing salivary adenocarcinomas represent a histologically diverse single entity that may be related to salivary intraductal papillary mucinous neoplasm (IPMN). Cribriform adenocarcinoma of salivary gland origin (CASG) now represents a distinctive subtype of polymorphous adenocarcinoma (PAC). PAC is defined as a clinically, histologically and molecularly heterogeneous disease group. Whether CASG is a different diagnostic category or a subtype of PAC is still controversial. New defining genomic alterations have been characterized in many salivary gland tumors. In particular, they include gene fusions, which have shown to be tightly tumor-type specific, and thus valuable for use in diagnostically challenging cases. The recurrent molecular alterations were included in the definition of mucoepidermoid carcinoma, adenoid cystic carcinoma, secretory carcinoma, polymorphous adenocarcinoma, hyalinizing clear cell carcinoma, mucinous adenocarcinoma, and microsecretory adenocarcinoma. Importantly, the number of entities in the salivary chapter has been reduced by omitting tumors or lesions if they do not occur exclusively or predominantly in salivary glands, including hemangioma, lipoma, nodular fasciitis and hematolymphoid tumors. They are now discussed in detail elsewhere in the book.
Cardiovascular medicine has entered a paradoxical era [...].
Atherosclerosis remains a leading cause of morbidity and mortality worldwide, representing a complex and multifactorial disease at the intersection of aging, metabolism, inflammation, and environmental exposures [...].
Demyelinating diseases damage myelin, the protective sheath surrounding nerve fibres in both the central and peripheral nervous systems which assists in the transmission of nerve signals and in the conservation of energy during the propagation of action potentials [...].
The global burden of obesity continues to rise, and metabolic and bariatric surgery is the most effective intervention for durable weight loss and improvement of obesity-related diseases. The International Federation for the Surgery and Other Therapies for Obesity (IFSO) Global Registry was established in 2013 to provide standardised, multinational surveillance of MBS. No longitudinal synthesis of the successive IFSO Global Registry reports has been undertaken. We performed a retrospective secondary analysis of all nine IFSO Global Registry reports published from 2014 to 2024; all source reports were accessed on October 18, 2025. Following RECORD principles, we prespecified core domains, harmonised definitions across editions, and documented transformations in a reproducible extraction log. Report-level patterns were described for registry participation, procedure volumes and mix, operative approach, patient demographics, perioperative outcomes, and methodological evolution. A FAIR-informed appraisal of report-level transparency was conducted using a pragmatic, registry-oriented rubric. Because the registry underwent a structural transition from individual-level or mixed reporting to aggregated national reporting between the sixth and seventh editions, analyses were structured into two non-equivalent reporting eras: Reports 1-6 and Reports 7-9. Cross-era comparisons were therefore interpreted as descriptive contrasts shaped by reporting architecture, rather than as continuous epidemiological trends. Reported metabolic and bariatric surgery activity ranged from 100,092 operations across 18 countries in the First Report to 598,736 operations across 36 countries in the Ninth Report, with the highest submitted volume in the Fifth Report. These values reflect changing contributor networks and reporting frameworks and should not be interpreted as directly comparable estimates of global procedural incidence. Within submitted primary-procedure data, Sleeve gastrectomy increased from 22.0% in the First Report to 60.4% in the Ninth Report, while Roux-en-Y gastric bypass decreased from 66.0% in the First Report to 29.7% in the Ninth Report; adjustable gastric banding became uncommon, and one-anastomosis gastric bypass accounted for 4-7% where reported. Median age and body mass index were broadly stable, and Female patients represented 71.3-79.5% of patients in reports with comparable sex reporting. Revisional procedures showed higher rates of unplanned reoperation, intensive care unit admission, readmission, and mortality than primary procedures. Report-level Findable, Accessible, Interoperable, and Reusable transparency scores improved modestly, mainly through gains in findability and accessibility, while interoperability and reusability remained limited. Across successive public reports, sleeve gastrectomy became the most frequently reported primary procedure within submitted registry data, with substantial regional heterogeneity and important limitations in cross-edition comparability. Further harmonisation of definitions, improved follow-up completeness, and privacy-preserving access to more granular data would enhance the registry's value for benchmarking, policy, and patient-level research. No specific funding was received for this study.
Fine-needle aspiration biopsy (FNAB) remains the cornerstone of preoperative evaluation of thyroid nodules and represents one of the most enduring and successful applications of cytopathology in clinical medicine. Over the past decade, however, the role of thyroid FNAB has evolved considerably. This transformation reflects advances in ultrasound-based risk stratification systems; refinements in cytologic reporting, culminating in the third edition of the Bethesda System for Reporting Thyroid Cytopathology, ongoing international harmonization initiatives including the forthcoming World Health Organization (WHO) Reporting System for Head and Neck Cytopathology (WHO RSHNC); the integration of molecular diagnostic testing into routine workflows; and major revisions in thyroid tumor classification introduced in the fifth edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. Collectively, these developments have shifted thyroid FNAB from a predominantly morphologic screening modality to a central component of a multidimensional, precision-based diagnostic pathway. In contemporary practice, thyroid FNAB operates within an integrated clinical framework that combines imaging-based risk assessment, cytomorphologic interpretation, molecular testing, and risk-adapted management strategies. This review summarizes the current status of thyroid FNAB with emphasis on FNAB indications, specimen adequacy, cytomorphologic interpretation within the Bethesda framework, management of indeterminate thyroid nodules, and the expanding role of molecular classifiers. Emerging diagnostic and management approaches, including artificial intelligence, radiogenomics, active surveillance and ablation therapies, are also discussed. Attention is given to the practical implications of these advances for surgical pathologists and cytopathologists engaged in multidisciplinary thyroid nodule management.
Twelve years after the 2013 fifth edition, the American College of Radiology has released BI-RADS® v2025, with substantial revisions across mammography, ultrasonography, MRI, and the newly independent contrast-enhanced mammography (CEM) section. This review compares the two editions and reads the main changes against the available evidence on diagnostic performance and reader agreement, rather than only cataloguing them. Examples featuring digital breast tomosynthesis, synthetic mammography, and automated whole-breast ultrasonography now appear throughout the modality sections. "Lobulated" has been added as a shape descriptor across all modalities, while "microlobulated" was dropped from the mammography margin list. Calcification terms shifted from etiology to morphology: "milk of calcium" became "layering," "punctate" was folded into "round," and "dystrophic" moved under "coarse." Ultrasonography gained two new entries, "non-mass lesion" and "echogenic rind," and on MRI, "initial phase" was renamed "early phase." Category 6 was rewritten; therefore, surgical excision is recognized as one of several definitive local treatments, and an "uncoupled" principle now separates assessment from management. The auditing section folds Category 3 follow-up into basic auditing and adds a Method of Detection data field. Most supporting data, however, predate v2025, and reader agreement remains lower for newer descriptors such as non-mass enhancement; whether the revisions measurably improve reproducibility is still unproven. Integrating every high-sensitivity tool also brings more false positives, overdiagnosis, and cost; artificial intelligence and radiomics may help close the reproducibility gap, but resource-stratified, equitable implementation will be essential. With v2025, BI-RADS becomes a multimodality framework rather than a reporting lexicon alone.
To assess the effect of age and aging on thermoregulatory responses during a 15-km road race under real-world conditions. Observational field study combining cross-sectional and longitudinal analyses during the 2008, 2009, and 2024 editions of a 15-km road race. Data were collected in n = 57 participants for cross-sectional comparisons, and in n = 12 participants for longitudinal analyses, to determine the effects of age and aging, respectively. Ambient temperature across editions ranged from 8 to 12 °C. Intestinal core temperature (Tcore) and skin temperature (Tskin) were continuously measured, while metabolic heat production was estimated using running speed. Running speed and estimated metabolic heat production were higher in younger (29 [26-34] years, n = 28) versus older (65 [62-69] years, n = 29) runners (12.3 ± 1.9 versus 11.2 ± 1.6 km/h, p = 0.027; 15.1 ± 2.1 versus 14.0 ± 1.8 W/kg, p = 0.027, respectively), while sweat rates were similar. Start Tcore (37.4 ± 0.4 °C) increased to 38.8 ± 0.6 °C at the finish, with no differences between groups (p = 0.98). Older runners required more time to reach a steady state Tcore (37.0 ± 11.8 versus 27.2 ± 8.4 min, p = 0.003). Tskin at start and finish did not differ between groups. Start Tcore was lower after fifteen years of aging (37.3 ± 0.4 °C versus 37.7 ± 0.3 °C, p < 0.001). Finish Tcore (38.6 ± 0.6 °C versus 38.7 ± 0.7 °C, p = 0.38) and Tcore elevations (1.2 ± 0.3 °C versus 1.0 ± 0.6 °C, p = 0.20) remained unchanged, despite lower estimated metabolic heat production (13.8 ± 2.0 versus 15.7 ± 1.7 W/kg, p < 0.001). Thermoregulatory responses did not differ between younger and older runners, and Tcore elevations were comparable after fifteen years of aging. These findings indicate similar thermoregulatory responses during self-paced running in the cold across age groups and over fifteen years of aging.
Mental health screening in prisons is vital to uphold prisoners' right to mental health services, ensure safety, improve quality of life and reduce recidivism among incarcerated individuals. As frontline staff, correctional officers need a guideline for this screening to refer cases to the appropriate medical services. The currently available screening tool in Indonesia is unsuitable for detecting a number of relevant mental health issues and lacks sensitivity. Therefore, this study aimed to develop a new screening tool for mental disorders among inmates in Indonesia through an evidence-based approach. To develop a standardized screening tool for mental disorders in Indonesian inmates, we conducted a literature review, needs assessment survey, and Delphi-based expert consensus to identify gaps in Indonesia's present tool, to refine and modify the domain items in line with the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Six widely used screening tools were reviewed and the mental disorders screened were examined. Findings from the needs assessment survey and expert panel highlighted several key needs, including clearer operational definitions, more observable item indicators, integration of assessment methods, and the inclusion of structured risk stratification and emergency management flowcharts. We designed an eight-domain (depression, risk of suicide, anxiety, psychosomatic disorder, aggression, bipolar disorder, psychotic disorders, and psychiatric/medical drug consumption history) and 27-item screening tool to screen for mental disorders among inmates in Indonesia. The new 27-item screening tool was developed based on a review of the international research literature, needs assessment survey, and Delphi-based expert consensus. The tool demonstrated preliminary content validity through expert consensus and may serve as a structured screening framework for early identification of priority mental health conditions in Indonesian correctional settings. Further psychometric and field validation studies are required before routine implementation.
Chronic pain is common in older adults and is associated with psychological distress, including suicidality. In patients with dementia, impaired cognitive and communication may further increase vulnerability. This study aimed to investigate associations between chronic pain and suicidality in hospitalized patients with dementia. This population-based, retrospective cross-sectional study analyzed hospitalizations of patients aged ≥60 years with dementia between 2016 and 2020, extracted from the U.S. Nationwide Inpatient Sample (NIS). Chronic pain, suicide attempts, and suicidal ideations were identified using International Classification of Diseases, Tenth edition-CM diagnostic codes. Propensity score matching (1:4) was performed to balance baseline characteristics, including age, sex, race, dementia type, and major comorbidities. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Stratified analyses were conducted by age, dementia type, sex, Charlson comorbidity index (CCI), race, and insurance. After matching, 29,185 hospitalized patients with dementia were analyzed (5,837 with chronic pain; 23,348 without). Chronic pain was significantly associated with higher odds of suicidal ideations (adjusted odds ratio [aOR] = 1.49, 95% CI: 1.30-1.71, p < .001) and suicide attempt (aOR = 2.02, 95% CI: 1.08-3.76, p = .028). Stronger associations were observed among patients aged 60-69 years, those with CCI ≥ 1, without Medicare/Medicaid. Only 16 suicide attempts occurred in the chronic pain group, limiting statistical precision. Chronic pain is associated with increased suicidality in hospitalized older patients with dementia. Longitudinal studies are needed to confirm these findings.
To investigate associations among auditory processing (AP), working memory, and language function in preschool children with developmental language disorder (DLD), and to analyze the mediating role of working memory. A prospective cross-sectional design was adopted. Forty-two children with DLD (DLD group) and 45 typically developing children (normal control group) were enrolled. The Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C), Preschool Auditory Processing Assessment Scale (PAPAS), Wechsler Intelligence Scales (Fourth Edition), and Conners Parent Symptom Questionnaire (PSQ) were used for evaluation. Correlations among scales were analyzed. The relationships among auditory decoding, working memory, and overall language function, as well as the mediating effect of working memory, were examined. Scores on all PAPAS dimensions and the proportion of children at risk for AP abnormalities were significantly higher in the DLD group than in the control group (P0.001). In all children, DREAM-C dimension scores were negatively correlated with PAPAS dimension scores (P0.05). In the DLD group, working memory was negatively correlated with total PAPAS score and scores for auditory decoding, auditory attention, and communication (P0.05). PSQ scores for conduct problems, learning problems, and hyperactivity index were positively correlated with total PAPAS score and scores for auditory decoding, auditory attention, communication, and hyperactivity-impulsivity (P0.05). The impulsivity-hyperactivity score was positively correlated with total PAPAS score and scores for auditory attention and hyperactivity-impulsivity (P0.05). The anxiety score was positively correlated only with the communication score (P0.05). After controlling for confounders, the auditory decoding score (b'=-0.431, P=0.009) and the working memory score (b'=0.437, P0.001) were independently associated with the DREAM-C overall language score. Working memory partially mediated the association between auditory decoding and overall language ability, accounting for 40% of the total effect. Auditory processing in preschool children with DLD is closely associated with language, cognitive, and behavioral problems. Auditory decoding directly affects language function and indirectly influences it through working memory. PAPAS may serve as a convenient screening tool for clinical use. 目的: 探讨学龄前发育性语言障碍（developmental language disorder, DLD）儿童听处理 （auditory processing, AP）、工作记忆与语言功能的关联，分析工作记忆的中介作用。方法: 采用前瞻性横断面设计，选取42例DLD儿童（设为DLD组）及45例正常儿童（设为正常对照组）为研究对象，采用梦想普通话听力理解和表达能力标准化评估（Diagnostic Receptive and Expressive Assessment of Mandarin‑Comprehensive, DREAM‑C）、学龄前儿童听处理评估量表（Preschool Auditory Processing Assessment Scale, PAPAS）、韦氏智力量表第4版及Conners父母用症状问卷（Conners Parent Symptom Questionnaire, PSQ）对所有儿童进行评估，分析量表间相关性，并分析听觉解码、工作记忆与整体语言的关系及工作记忆的中介效应。结果: DLD组PAPAS各维度得分及AP异常风险比例高于正常对照组（P0.001）。所有儿童DREAM‑C各维度得分与PAPAS各维度得分呈负相关（P0.05）。DLD组工作记忆得分与PAPAS总分、听觉解码、听觉注意、沟通交流维度得分呈负相关（P0.05）;PSQ品行问题、学习问题和多动指数得分与PAPAS总分、听觉解码、听觉注意、沟通交流、多动-冲动维度得分呈正相关（P0.05），冲动-多动得分与PAPAS总分、听觉注意、多动冲动维度得分呈正相关（P0.05），焦虑得分仅与沟通交流维度得分呈正相关（P0.05）。控制混杂因素后，听觉解码得分（b'=-0.431，P=0.009）、工作记忆得分（b'=0.437，P0.001）与DREAM‑C整体语言维度得分独立相关。工作记忆在听觉解码与整体语言间起部分中介作用，效应占比40%。结论: 学龄前DLD儿童AP与语言、认知及行为问题密切相关;听觉解码不仅直接影响语言功能，还通过工作记忆发挥间接效应。PAPAS可作为简便筛查工具在临床中推广应用。.
Posterior pituitary and hypothalamic neuronal tumors are uncommon sellar and suprasellar neoplasms that can mimic pituitary neuroendocrine tumors clinically and radiologically. The 5th edition World Health Organization classifications (Endocrine and Neuroendocrine Tumors) reinforce a lineage-based framework that separates anterior pituitary tumors from posterior pituitary and hypothalamic neuronal lineages, which is particularly important in hormone-negative lesions and limited tissue samples. This narrative review provides a practical, pathology-centered approach to classification by integrating key anatomic and radiologic clues with histomorphology and targeted immunohistochemistry. We highlight the value and limitations of thyroid transcription factor 1, outline a stepwise workflow incorporating anterior pituitary transcription factors and neuronal differentiation markers, and discuss when vasopressin immunostaining is informative. We also summarize selected molecular insights and clinical management considerations relevant to surgical planning and follow-up.
Background: Cracked teeth may present with variable and atypical symptoms, sometimes mimicking non-odontogenic orofacial pain conditions, making diagnosis challenging, particularly when cracks appear limited to enamel. Case presentation: A 36-year-old woman presented with intermittent pain in a mandibular molar radiating to the ipsilateral temporal region. Clinical examination identified a crack line on the lingual surface of the mandibular first molar. Pulp sensibility testing (cold test and electric pulp test), occlusal loading tests, and cone-beam computed tomography (CBCT) were performed. CBCT was used primarily to exclude vertical root fracture and periapical pathology, and no radiographic abnormalities were identified. Differential diagnosis was conducted using structured diagnostic frameworks, including the International Classification of Orofacial Pain and the International Classification of Headache Disorders (3rd edition). Diagnostic local anaesthesia eliminated both biting pain and referred pain, supporting an odontogenic source. Collectively, the findings suggested that the enamel crack was the most likely source of odontogenic pain, although a definitive causal relationship could not be established. Because pulp sensibility remained normal, conservative management was selected. Crack sealing with a methyl methacrylate-based adhesive resin resulted in complete symptom resolution that was maintained throughout a 3-year follow-up period without the need for root canal treatment. Conclusions: Although the diagnosis remained probabilistic, the structured diagnostic approach, together with the favourable clinical response after crack sealing, supported the enamel crack as the most likely source of odontogenic pain.
Adult outcomes of childhood-diagnosed specific learning disorder (SLD) remain insufficiently characterized, particularly in non-Western clinical samples. We examined the neuropsychological and attentional profile of Turkish adults with documented childhood SLD. In this exploratory case-control study, 20 adults with childhood-diagnosed SLD and 20 age- and sex-comparable healthy controls completed a multimodal assessment including the Stroop Test-TBAG form, Digit Span, Adult Attention Deficit Hyperactivity Disorder (ADHD) Self-Report Scale, Adult Reading History Questionnaire, and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition-Clinician Version (SCID-5-CV) diagnostic interview. The prespecified primary outcome was Stroop total completion time. Four prespecified secondary outcomes-Stroop interference, Digit Span total, Digit Span forward, and Adult ADHD Self-Report Scale (ASRS) Part A positive-item count-were corrected using Benjamini-Hochberg false discovery rate. Adjusted analyses used HC3 robust standard errors. Adults with SLD showed substantially longer Stroop total completion time than controls, with a large adjusted group effect that remained robust after additional adjustment for education. All four secondary outcomes met the corrected significance threshold, indicating poorer interference control, lower verbal attention and working-memory performance, and higher adult ADHD symptom burden. Reading-history scores were also consistent with persistent self-reported difficulties. Adults with childhood-diagnosed SLD showed a measurable multidomain neuropsychological and attentional profile, supporting executive and attentional screening in adult SLD assessment.
Background Posttraumatic stress disorder (PTSD) is a trauma- and stressor-related disorder characterized by persistent intrusion symptoms, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity after exposure to a qualifying traumatic event. Symptoms must persist for more than one month and cause clinically significant distress or functional impairment under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. Reported PTSD prevalence in older adults varies according to diagnostic criteria and sampling frame; nationally representative studies have reported lifetime prevalence estimates of approximately 4.5% under the DSM-IV criteria and higher probable DSM-5 estimates when functional impairment was not included. Aging-related gene-set annotations may therefore provide one way to investigate biological vulnerability without directly measuring aging phenotypes. This secondary gene-set analysis tested whether supplied Polycomb-derived aging modules were competitively enriched in PTSD transcriptome-wide association study (TWAS) signals and whether their strongest gene-level signals were distinct from the curated GenAge human aging comparator. The post-hoc analyses were exploratory and hypothesis-generating. Methods PTSD S-PrediXcan/TWAS summary files were analyzed using absolute meta-Z-score ranking. Competitive gene set enrichment analysis (GSEA) used 2,000 gene-label permutations, and over-representation analysis (ORA) examined genes with absolute Z-scores greater than 3. Leading-edge overlap, signed directionality, top-gene comparisons, manual functional categorization, and sensitivity analyses after removing GenAge-overlapping genes were performed as secondary analyses. Results At the set level, GenAge showed the highest normalized enrichment score (NES = 1.0971; permutation p = 0.124938), while Module B was the strongest Polycomb-derived module but did not exceed GenAge (NES = 1.0474; p = 0.206397; false discovery rate (FDR) = 0.825588). None of the Polycomb-derived modules reached significance after FDR correction, and their ORA results were non-significant. Exploratory analysis of Module B showed larger top-tail absolute TWAS Z-scores than GenAge among the available top-50 output (median |Z|, 4.7845 versus 3.8822; nominal Mann-Whitney U p = 0.000474). Immune/major histocompatibility complex (MHC)/co-stimulation genes had the most negative descriptive mean Z-score, but no leading-edge or top-gene sign test showed statistically significant directional skew. Module B shared little leading-edge or top-gene overlap with GenAge. Conclusions Primary analyses did not demonstrate robust competitive enrichment of Polycomb-derived aging modules in PTSD TWAS. The Module B findings are secondary and exploratory. They generate a testable hypothesis that selected immune/MHC, adhesion, and membrane-signaling genes may contribute to PTSD vulnerability through a focal neuroimmune-adhesion interface that is partly separable from broad cellular aging programs. This possibility requires independent replication, formal pathway testing, and functional validation before mechanistic or translational conclusions can be drawn.
To identify and map the main guidelines for carrying out home-based enzyme replacement therapy (ERT) administered to children and adolescents diagnosed with mucopolysaccharidosis. A scoping review, conducted according to JBI Manual for Evidence Synthesis (Edition 2024). Twelve data sources were consulted using specific search strategies. Data were extracted using a specific form and analyzed using simple descriptive statistics and a qualitative PAGER approach. The final sample consisted of 13 articles published between 2007 and 2020, mostly conducted in European countries, with a predominance of authors affiliated with the Royal Manchester Children's Hospital. Five patterns were identified for consolidating qualified and safe care in the context of homebased ERT administered to children and adolescents with types I, II, IV-A, and VII mucopolysaccharidoses. The nurse emerges as an essential professional in all stages and activities presented. Despite the progress made regarding guidelines for the decentralization of ERT, challenges to its implementation still persist, among which the need for dissemination of technical and scientific knowledge stands out.
This study examined the psychiatric and medical characteristics of children and adolescents receiving health protection measures and explored their associations with maltreatment types, self-injurious behaviors, and suicide attempts. Medical records of 331 children and adolescents followed under health protection measures at a single tertiary care hospital were retrospectively reviewed. Data were collected using a standardized file review form that included sociodemographic variables, psychiatric diagnoses, child protection characteristics, and risk factors. Psychiatric diagnoses were established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Statistical analyses compared diagnostic distributions across maltreatment subgroups and examined associations with self-injurious behavior and suicide attempts. Of the 331 included cases, 235 children (71.0%) underwent psychiatric evaluation. Diagnostic distributions were analyzed within this subgroup. Among children exposed to neglect (n=161), intellectual disability (29.8%), attention-deficit/hyperactivity disorder (28.6%), and conduct disorder (24.2%) were the most prevalent diagnoses. Major depressive disorder was significantly more common among children exposed to physical abuse (50.0%; p<0.001), whereas major depressive disorder (37.5%; p=0.008) and social anxiety disorder (18.8%; p=0.003) were more frequent in the extrafamilial sexual abuse group. Self-injurious behaviors and suicide attempts were observed across maltreatment groups, with significant associations between self-injury and intrafamilial sexual abuse and between suicide attempts and physical and emotional abuse. Girls exhibited higher rates of both self-injurious behavior and suicide attempts than boys (p<0.01). Neurological (26.0%) and endocrine (8.5%) disorders were the most common non-psychiatric medical conditions. Children referred to a tertiary care facility under health protection measures demonstrated a high burden of psychiatric morbidity. Diagnostic patterns varied according to maltreatment type, highlighting the need for trauma-informed, multidisciplinary care.
In the era of precision medicine, managing non-small cell lung cancer (NSCLC) requires pathological confirmation, accurate nodal staging, and comprehensive biomarker profiling performed rapidly and concurrently. In the 9th edition of the TNM classification, the N2 category is subdivided into single-station (N2a) and multistation (N2b) subcategories, highlighting the clinical importance of precise mediastinal staging. This refinement necessitates systematic nodal evaluation using minimally invasive modalities such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to appropriately stratify patients for surgery, neoadjuvant therapy, and definitive chemoradiotherapy. Concurrently, although N1 has not been formally subclassified because of the lack of standardized clinical diagnostic criteria, the increasing use of sublobar resection for early-stage NSCLC requires more precise hilar and intrapulmonary nodal assessments, which can potentially be facilitated by emerging technologies such as thin convex-probe EBUS. Concurrently, adequate tissue acquisition is essential for timely biomarker testing. Before administering neoadjuvant immune checkpoint inhibitors, actionable driver alterations, such as epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements, must be identified to select appropriate treatment and prevent severe sequential toxicities associated with subsequent targeted therapies. This review highlights the indispensable role of endoscopic nodal staging and multidisciplinary collaboration in adapting to the updated TNM classification and optimizing personalized treatment strategies for patients with NSCLC.