Treatment guidelines recommending omission of axillary surgery in breast cancer are largely based on the SOUND and INSEMA trials. However, the extent to which their study populations represent real-world patients remains unclear. We aimed to evaluate the real-world applicability and external validity of these trial populations. All consecutive patients treated for early breast cancer at a single university hospital between 2010 and 2018 were included. Patients with clinically node-negative disease were identified, and eligibility according to the SOUND and INSEMA inclusion criteria was determined. Clinicopathologic characteristics were compared between trial-eligible real-world patients and published trial populations. A total of 2787 consecutive patients with clinically negative axilla were included; 71% (1982/2787) fulfilled the INSEMA and 52% (1461/2787) the SOUND trial eligibility criteria. Patients eligible in the SOUND trial were largely representative of real-world patients in terms of clinicopathologic characteristics. In contrast, the INSEMA trial appeared more selected, with a higher proportion of biologically favorable tumors. Both trials predominantly included patients with small (< 2 cm) luminal breast cancers. Patients with larger tumors and more aggressive subtypes were underrepresented. The SOUND and INSEMA eligibility criteria are broadly applicable to real-world patients with small luminal breast cancers. However, differences between trial populations and real-world patients highlight the need for careful consideration when applying SLNB omission beyond these lower-risk subgroups.
Major depressive disorder (MDD) affects millions of Americans each year and is often diagnosed and treated in primary care. Evidence shows that self-management techniques, shared decision-making (SDM), and goal setting are effective strategies for managing MDD, but the required collaboration between patients and primary care clinicians can be difficult. Primary Care Path is a program for supporting depression management in primary care that includes a patient-facing mobile app and an accompanying care team-facing web interface. Leveraging programs that provide clinician-facing software with companion patient-facing mobile technology may help patients and physicians align depression treatment and management goals, support effective SDM, alleviate barriers, and improve both clinical care and patient outcomes. To pilot-test the use of Primary Care Path for MDD management in primary care and evaluate the impact of its use on depression treatment, symptoms, goal setting and attainment, and SDM. Four primary care clinical practices in the United States were assigned to program use (2 practices; intervention) versus usual care (2 practices; control). Intervention practices used the Primary Care Path program in their clinics and engaged patient participants in app use for 18 weeks. Clinical care teams engaged with the patient-informed program portal primarily during patient encounters (in-person, virtual or calls). Patient participants were smartphone users aged 18 years and older who were being treated for MDD. Patient participants received online surveys (medication changes, Patient Health Questionnaire-9 [PHQ-9], goal setting and attainment questions, and Shared Decision-Making Questionnaire-9 [SDM-Q-9]) at baseline, 6, 12, and 18 weeks. A total of 76 patient participants (34 intervention; 42 control) were enrolled; the majority were female (27/34, 79%; 32/42, 76%), White (31/34, 91%; 40/42, 95%), non-Hispanic/Latino/a (29/34, 85%; 40/40, 100%), and employed (26/34, 77%; 34/42, 81%). Control patient participants' conversations with their medical providers increased over the study period, while intervention patient conversations with their medical providers decreased over time. At week 18, intervention participants felt more successful than control in achieving their personalized treatment goals. More intervention patient participants initiated antidepressant medication by weeks 12 (P=.03) and 18 (P=.04) and switched medications by weeks 6 (P=.009) and 12 (P=.04) versus control. All patient participants demonstrated significant improvement in PHQ-9 scores throughout the study period (P<.001), with no difference in change by group. Clinicians and patients indicated using the program to support SDM, but no significant differences were observed in SDM-Q-9 between intervention and control. Preliminarily, the use of this digital health program related to earlier medication optimization, earlier conversations between patients and medical providers, and patient attainment of goals that matter most to them, indicating that coordinated use of the program by both patients and clinical team members may enhance MDD management in primary care clinical settings.
To investigate the clinical and genetic characteristics of a patient with hereditary Spastic paraplegia type 84 (SPG84) due to compound heterozygous variants of the PI4KA gene. A patient diagnosed at the Affiliated Hospital of Xuzhou Medical University in 2021 was selected as study subject. Clinical and imaging data were retrospectively analyzed. Peripheral blood samples were collected from the patient and his parents for whole exome sequencing (WES). Candidate variants were validated by Sanger sequencing and bioinformatics analysis. Pathogenicity of the variants was assessed based on the guidelines from American College of Medical Genetics and Genomics (ACMG). Quantitative real-time PCR (qPCR) was used to determine the level of PI4KA mRNA in peripheral blood samples, and lipidomics technology was employed to analyze the levels of plasma phosphatidylinositol (PI) and its metabolite phosphatidylinositol 4-phosphate (PI4P). Relevant literature was retrieved from the China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, Chinese Medical Journal Full-Text Database, and PubMed Database. Previous reports of SPG84-associated PI4KA gene variants were summarized. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: XYFY2024-KL644-01). The patient, a 13-year-old boy, had presented with unsteady gait, spastic paraplegia of lower limbs, increased muscle tone, and cognitive impairment. Diffusion tensor imaging (DTI) revealed absence of right frontoparietal fiber tract and partial interruption of right parietal fiber tract. WES revealed that he has harbored compound heterozygous variants of the PI4KA gene, including a paternally derived c.4076T>G (p.Leu1359Arg) and a maternally derived c.6082C>T (p.Arg2028Trp). Based on the guidelines from ACMG, both were classified as variants of uncertain significance (PM2_Supporting+PP2 PP3). The variants were absent from databases including ClinVar, ExAC, and gnomAD. Conservation analysis indicated high evolutionary conservation of the affected residues, and multiple in silico tools all predicted deleterious effects. Protein structure modeling suggested the variants may disrupt dimer formation and catalytic activity. Functional studies demonstrated significantly reduced PI4KA mRNA expression (P < 0.05) and a decreased plasma PI4P/PI ratio in the patient (P < 0.05). Literature review identified 4 relevant publications involving a total of 6 SPG84 patients with PI4KA variants. The c.4076T>G and c.6082C>T compound heterozygous variants of the PI4KA gene probably underlay the genetic etiology of SPG84 in this patient. Above finding has expanded the mutational spectrum of the PI4KA gene. Functional analyses has provided preliminary evidence for its pathogenicity, though further validation is still required.
Renal denervation is an innovative method of treating hypertension, used in clinical practice for about a decade. The pathophysiological basis of this method derives from the role of efferent and afferent fibers of the sympathetic nervous system, entering and leaving the kidneys, in the development of hypertension, especially treatment-resistant hypertension. Initial clinical trials suggested the high efficacy of denervation in the treatment of patients with resistant hypertension. However, the results of the Symplicity HTN-3 trial, which introduced a sham procedure as control procedure, undermined these hopes. This trial was criticized in terms of its methodology Recent research, using latest generation catheters and more stringent protocols, confirms a significant reduction in blood pressure in patients after surgery. Renal denervation should be considered in patients with hypertension (after excluding all hormonal causes and ischemic etiology), which is resistant to pharmacological treatment. Pseudo resistance, e.g., caused by the so-called white-coat hypertension, should be ruled out. Every patient should have their blood pressure monitored 24 hours a day. Lack of cooperation between the patient and the physician, and non-systematic taking of antihypertensive medications and non-compliance with other therapeutic recommendations should also be excluded. However, the condition for the success of renal denervation is the precise determination of patient eligibility and the performance of the procedure in specialized centers with appropriate experience.
A patent foramen ovale (PFO) is present in 20%-30% of the adult population. It is usually found in patients incidentally, but clinical presentations could include stroke, seizures, and migraines. The aim of this study is to review the experience of PFO closure at our institution. In this IRB approved clinical research study, we completed a retrospective chart review of 289 patients between the ages of 18-100 y old who came to our institute between January 2012 and December 2022. Our cohort had 173 female patients and 116 male patients. The patients' average age was 50.34 y. Our patient population identified as White (93.1%), Black (5.2%), and either Hispanic, Asian, or of mixed race (less than 2%). The most common presenting symptoms for these patients included cerebrovascular accident, transient ischemic attack, migraine, venous thromboembolism, and dyspnea. The mean duration for follow-up was 3.2 y with a range of 1 wk-12 y. There were 10 immediate post-operative complications which included tachycardia (4), femoral vein bleed, rash due to an unknown reason, excessive fatigue, bradycardia, ascites, and severe headache. There were 18 deaths during the patient follow-up period due to co-morbidities or unrelated causes. Eighty-three patients reported to be asymptomatic at follow-up. When dividing patients between a younger and older group, both groups had similar rates of patients with no complications as well as post-operative complications of arrhythmias, cerebrovascular accidents, migraines, and syncope at follow-up. The procedure-related deaths of PFO closure were low, but a significant number of patients died due to their co-morbidities and disease processes.
Robot-assisted laparoscopic surgical procedures are commonly perceived to result in fast recovery; however, the postoperative course can be challenging for many patients. We have previously found severe pain and a significant decrease in the patient-reported outcome measure Quality-of-Recovery 15 (QoR-15) in a cohort of patients undergoing robot-assisted upper urinary tract surgery. In similar settings, intrathecal analgesia is sometimes used to improve recovery; however, its benefits have not been established. Therefore, this study aims to examine the effects of intrathecal analgesia in this setting compared with an active comparator intravenous lidocaine. In this randomised, assessor-blinded multicentre trial, 220 patients scheduled for robot-assisted upper urinary tract surgery under general anaesthesia are recruited after obtaining informed consent. They are randomised to receive either intrathecal analgesia or an intraoperative infusion with lidocaine. The primary study outcome is the decrease in QoR-15 from baseline to postoperative day 1. Other outcomes of interest include postoperative pain, length of stay and postoperative complications. Differences in intraoperative haemodynamics and postoperative inflammatory parameters will also be analysed. This study has been approved by the Swedish Medical Products Agency (5.1.1-2023-69740 and 5.1.2-2025-030145). The results of this study will be presented at national and international meetings and submitted for publication in peer-reviewed international medical journals. NCT06349668.
In 2024, a comprehensive framework for the screening, diagnosis, and management of metabolic dysfunction-associated steatotic liver disease (MASLD) was incorporated in the EASL-EASD-EASO clinical practice guidelines. However, physicians often face barriers applying these recommendations in routine clinical care, especially in the Southeastern Europe, Middle East, and Africa (SEEMEA) region. As a multidisciplinary group of physicians involved in MASLD and metabolic dysfunction-associated steatohepatitis (MASH) management, our objective is to provide a practice-oriented roadmap including practical and educational considerations beyond the hepatology field that could improve patient care and support implementation of clinical guidance within the SEEMEA region. This work is informed by a narrative review and expert input obtained through structured discussions, to examine the status quo and identify key gaps in the MASLD/MASH management, unravelling the patient journey from screening and diagnosis to treatment and follow-up. Furthermore, we advise on priorities on screening triggers and, considering the limited availability of vibration-controlled transient elastography (VCTE), discuss alternative approaches to achieve accurate and timely diagnosis. Finally, following the approval of resmetirom and semaglutide 2.4 mg for MASH treatment, we review the evolving pharmacotherapy landscape and propose a "blueprint" for a specialised MASLD clinic, suggesting mandatory and optional facilities for optimised care.
BACKGROUND IgA-associated vasculitis (IgAV), although relatively uncommon in adults, is frequently associated with increased vasculitis severity. Sudden abdominal pain and bloody diarrhea are among the usual manifestations of IgAV in children. In older patients, clinical manifestations of the disease may be typical, but advanced age and comorbidities can make the final diagnosis unexpected. CASE REPORT A 67-year-old man with multiple underlying medical conditions, including diabetes mellitus and arterial hypertension, was admitted with acute abdominal pain. Baseline evaluation revealed venous ischemic necrosis of the ileum and concurrent acute kidney injury. Given the patient's age and diabetic status, an atherogenic etiology was initially considered. Further diagnostic investigation, including renal biopsy, identified features consistent with IgAV. The patient's clinical course was complicated by simultaneous gastrointestinal and renal involvement, highlighting the systemic nature of the vasculitis. CONCLUSIONS Although IgAV is predominantly a pediatric condition, its presentation in older adults is rare and often atypical, commonly mimicking other vascular or ischemic disorders; this pattern may delay diagnosis and appropriate treatment. The present case emphasizes the need to maintain awareness of IgAV in older patients who present with acute abdominal symptoms, particularly when renal dysfunction is present. Advanced age and diabetic status are associated with increased severity and worse renal outcomes, underscoring the need for thorough evaluation and close monitoring. This report contributes to the limited literature on IgAV in older patients; it illustrates the diagnostic and therapeutic challenges in this population.
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. It is characterized by inflammation, areas of demyelination and axonal loss called plaques, recruitment of lymphocytes and monocytes, and bursts of focal blood-brain barrier leakage. Treatment strategies for MS focus on delaying disease progression and increasing patients' quality of life. However, most therapies have inconsistent efficacies and are associated with various side effects. Recently, long non-coding RNAs have been found to play a major role in the pathogenesis and development of several diseases. Several long non-coding RNAs have been correlated with MS. We focus on the role of AFAP1-AS1 in regulating the function of M2 macrophages, one of the immune cells believed to attenuate MS. Assessing this long non-coding RNA will improve our understanding of the molecular mechanics of immune cells in MS. We observe the impact of AFAP1-AS1 silencing in M2 macrophages on essential effector and regulatory proteins like MMP9, CCL5 and CXCL10 in MS patients receiving different treatments (Fingolimod, Interferon beta-1a, Interferon beta-1b, Teriflunomide or Dimethyl fumarate). Our results reported an upstream regulatory effect of AFAP1-AS1 on MMP9, CCL5, and CXCL10 in differently treated patients. By measuring the levels of proteins upon silencing of AFAP1-AS1, it was confirmed that this lncRNA has varying effects on the expression of these proteins depending on the treatment the patient is undergoing. These data shed light on the potential role of manipulating the anti-inflammatory activity of M2 cells making it a possible therapeutic target for certain MS patients.
To evaluate the patient-reported outcome measures (PROMs) of hip arthroscopy (HA) in patients with concomitant low back pain and lumbar spine pathology (LSP) compared with those without back concerns at a minimum of 5 year follow-up and determine the prevalence of low back pain (LBP) and LSP in Asian patients with femoroacetabular impingement syndrome (FAIS). Patients with FAIS, who underwent primary HA for FAIS with labral repair by a single surgeon between July 2017 and October 2019 with minimum 5-year follow-up, were identified. Patients were placed into 3 groups based on presence of preoperative LBP and LSP. These groups included: group LBP (with LBP), group Both (with LBP and LSP), and group None (neither diagnosis). The presence of concomitant LSP was identified using preoperative imaging with a pathologic lumbar spine diagnosis. All patients included in the study were asked to complete the Harris Hip Score (HHS) and Visual Analog Scale (VAS). All patients enrolled in the study were asked to fill out this survey preoperatively, at 3 months postoperatively, and latest follow-up. Satisfaction ratings were collected. Patient-reported outcomes (PROs) were compared between groups, postoperative with preoperative, along with revision arthroscopy, and conversion to total hip arthroplasty (THA). The groups were similar in age (46.2 ± 14.4 years, 46.0 ± 15.5 vs 43.9 ± 13.8, P = .16), sex (55.4% female, 58.2% vs 55.4%,P = .91), and body mass index (23.4 ± 2.2 kg/m2, 23.6 ± 2.5 vs 23.1 ± 2.2, P = .93). Comparing HHS and VAS between groups, no significant differences were observed preoperatively and at 5-year follow-up (P ≥ 0.057). Postoperative PROs significantly improved compared with preoperative PROs in all groups at 5-year follow-up (P < .0001). The LBP, Both, and None groups showed comparable rates of any patient acceptable symptomatic state (PASS) (89.1%, 88.1% vs 90.1%, P = .86) at 5-year follow-up. No significant differences in the rates of revision or THA conversion were identified between groups (P = .45). The prevalence of LBP and LSP was 28.9% and 11.5% in the cohort, respectively. The patients with LBP and/or LSP undergoing HA achieved comparable PROs, achievement of PASS, and reoperation-free survivorship to patients with isolated FAIS at minimum 5-year follow-up. The prevalence of LBP and LSP was 28.9% and 11.5% in Asian patients with FAIS, respectively. Level III, retrospective therapeutic comparative case series.
Comprehensive genomic profiling (CGP) tests have been covered by insurance in Japan since 2019, and their use in cancer genomic medicine (CGM) has expanded since then. Although extensive data are available from core hospitals, real-world data from community-based cooperative hospitals are limited. Using data from 514 consecutive patients with advanced cancer who underwent CGP testing at our institution between June 2019 and March 2025, we investigated the proportion of cases receiving therapeutic recommendations, the rate of drug administration based on CGP test results, and the prevalence and management of presumed germline pathogenic variants (PGPVs). The most common cancer sites were the pancreas (18.7%), breast (16.9%), bowel (14.6%), lung (12.8%), and prostate (12.5%). An expert panel made up of molecular oncologists recommended 360 targeted therapies for 311 patients (60.5% of the total cohort). Ultimately, 80 patients (15.6%) received matched therapy, among whom 56 received medication under health insurance coverage, 22 through clinical trials, and 2 via the patient-requested medical treatment system. PGPVs were identified in 68 patients (13.2%). After discussion by the expert panel, confirmatory germline testing was offered to patients with PGPVs, and subsequent germline testing confirmed pathogenic variants in 18 patients (3.5% of the total cohort). The proportion of patients who received targeted therapy at our cooperative hospital was comparable to proportions reported from core hospitals. However, disease progression was a significant barrier to accessing targeted therapies and genetic counseling. To maximize the benefits of CGM, the timing of CGP testing must be optimized and collaboration across departments and institutions must be strengthened.
Individuals experience lower levels of well-being when admitted to hospital. Maximising well-being may lead to improved outcomes for patients and the health service. We aimed to (1) implement co-designed strategies to improve patient well-being on subacute wards, (2) evaluate the well-being levels of the patient cohort before and after implementation and (3) identify barriers and enablers to implementation of strategies. We conducted a quality improvement study with pre-post evaluation across six subacute wards in a tertiary hospital. Data from interviews with patients and meetings between ward staff and management enabled the co-design of strategies to enhance patient well-being. Strategies were prioritised and implemented using plan, do, study, act cycles. Well-being levels were assessed in the cohort using a scale before (n=153) and after (n=145) implementation. A total of 17 strategies to optimise patient well-being were generated; each ward prioritised implementing key strategies relevant to their setting. While intentions to implement the strategies were high, implementation fidelity of strategies varied due to several barriers identified by staff. Well-being levels reported by patients after implementation were not significantly different from those reported by patients before. Despite extensive consultation and co-design of strategies with patients and staff, well-being levels were not improved at the conclusion of the improvement project. Confounders (such as high hospital demand at the follow-up evaluation time) may have impacted results. Suboptimal implementation fidelity may have also reduced the impact of the initiative.
Loss of nipple-areolar complex (NAC) sensation following nipple-sparing mastectomy (NSM) remains a significant psychosocial, psychosexual, and quality-of-life concern for patients. Sensory neurotization using nerve allografts has emerged as a promising technique for NAC sensation restoration with prior studies demonstrating favorable outcomes, including more than 80% of patients achieving good-to-excellent sensory recovery (Peled et al.); however, reproducible identification and safe dissection of the main NAC sensory nerve during oncologic surgery can be challenging. This video demonstrates a standardized, oncologically safe approach to identifying and dissecting the lateral intercostal sensory breast nerve for NAC reinnervation during NSM. The video presents a step-by-step operative technique performed during NSM in a patient undergoing immediate implant-based reconstruction with planned sensory restoration. Key steps include standard NSM dissection except the lateral dissection, herniation of the breast parenchyma laterally, identification of the lateral intercostal sensory nerve at the fourth intercostal space approximately 2-cm lateral to the lateral border of the pectoralis minor, and nerve dissection and transection with adequate length for coaptation. This is performed prior to permanent implant placement to facilitate exposure and allow inversion of the nipple-areolar complex. A nerve allograft is subsequently coapted to the NAC by the plastic reconstructive surgeon. The lateral fourth intercostal sensory nerve was identified and safely dissected without compromising oncologic principles. The technique allowed sufficient nerve length for tension-free allograft coaptation. Immediate direct-to-implant reconstruction was successfully completed, and the patient demonstrated satisfactory early postoperative outcomes, including objective NAC sensation restoration. This video provides a reproducible and oncologically safe method for identifying and dissecting the lateral NAC sensory intercostal nerve during NSM. Standardization of this technique may facilitate broader adoption of NAC sensory restoration as part of breast reconstruction.
Ophthalmic examination is central to the diagnosis and monitoring of eye disease. However, there is a paucity of qualitative studies about the patient's experience. The Patient Experience of Eye Examination eValuation Study (PEEEVS) was designed to evaluate patient experiences of key examination-related components of routine ophthalmic care. PEEEVS employs a cross-sectional, mixed methods design combining quantitative visual analogue scales (VAS) with qualitative semi-structured interviews. Data from 203 patients (M:F - 101:102) were analysed with respect to their experiences of topical anaesthesia, optical coherence tomography (OCT) imaging, tonometry, slit lamp examination, and mydriasis. Quantitative analysis indicated predominantly favourable responses, with median VAS scores ranging between 88 and 89 for all tests. In contrast, qualitative findings identified specific areas of concern, including challenges with maintaining proper positioning during slit lamp examination and OCT, particularly for individuals with pre-existing neck/back pain, larger body habitus, or advanced pregnancy. While participant experience of most monitoring tests was good, specific examination aspects can impact patient comfort and potentially affect long-term adherence to ocular monitoring. The study highlights the need for targeted considerations, such as ergonomic improvements and enhanced patient communication strategies to alleviate discomfort and support sustained engagement in ophthalmic care.
Understanding patients as persons is foundational to person-centred care, yet this is particularly challenging in intensive care units (ICUs), where patients are often unable to communicate. The Patient Dignity Question (PDQ)-"What do we need to know about you as a person in order to give you the best care possible?"-offers a brief means of eliciting personhood. This study qualitatively examined PDQ responses provided by family members of critically ill ICU patients to understand what families want clinicians to know about their loved ones. Family members of critically ill adults admitted to four ICUs across three hospitals in Winnipeg, Canada, were recruited between July 2021 and August 2022. Following informed consent, participants completed brief PDQ-guided interviews conducted by trained researchers. Response summaries were verified with participants and analyzed using an interpretive description approach. Multiple coders iteratively identified themes describing patient personhood from the family perspective. PDQ responses from 33 family members revealed a central theme of Shared Narratives of Personal Identity, encompassing four interrelated themes: Patients at Their Core, Key Elements of the Person's Story, Illness Experience, and Messages from Family to Staff. Families highlighted personal qualities, relationships, values, roles, spirituality, life experiences, and the impact of illness. PDQs also conveyed practical care recommendations, gratitude, and hopes for comfort, dignity, and compassion. Family members provide rich insights into ICU patients' personhood. The PDQ is a feasible, low-resource tool for integrating personhood into ICU care and may support dignity-conserving, person-centred, and family-centred practice in high-acuity settings.
Physician awareness of a patient's social and functional barriers to effective and safe care after discharge from the emergency department (ED) is crucial. Yet, limited data exist evaluating the ability of resident physicians to identify these barriers. We performed a prospective cohort study of patients age ≥ 18 at a single urban ED with an emergency medicine (EM) residency program from 10/2024 to 5/2025. A research team member assessed barriers with each patient, including transportation access, difficulty affording medications, need for assistance with activities of daily living (ADL), and lack of a primary care provider. We measured health literacy and cognitive function with the Rapid Estimate of Adult Literacy in Medicine-Revised and Mini-Cog, respectively. Patient report or measurement of barriers (criterion standard) was matched to written survey data completed by the EM resident caring for the patient. We calculated sensitivity of resident identification of barriers and measured agreement using Cohen's kappa. The sample included 234 patients with complete barrier data cared for by 40 EM residents. Patients consistently reported barriers at higher rates than physicians. Physicians had poor sensitivity for accurate identification of patient barriers. For example, 20.4% of patients reported they had no primary care physician (PCP) and 9.8% of residents reported their patient had no PCP [sensitivity 26.1% (95% CI 14.3-41.1), κ = 0.25]. Limited health literacy was identified in 59.0% of patients and reported by 37.6% of residents [sensitivity 44.7% (95% CI 35.7-53.9), 57.7% agreement]. Abnormal cognition was present in 53.6% of adults age ≥ 65 and reported by 16.7% of residents [sensitivity 27.3% (95% CI 13.3-45.5), 58.6% agreement]. Patients report barriers to effective care transitions after ED discharge at higher rates than resident physicians identify these barriers. Poor agreement between patient-reported and physician-identified challenges suggests a need for enhanced training, systematic screening, and interdisciplinary collaboration.
This study aimed to explore how women experienced benign gynecological care during the initial phase of the COVID-19 pandemic in the Netherlands, when healthcare capacity was constrained and elective services were often postponed or restructured. By focusing on the patient perspective, we sought to identify which adaptations were acceptable, which were perceived as inadequate, and what patients considered "good enough" care during a period of absolute scarcity. We conducted online focus group discussions (FGDs) with patients from five hospitals, covering three care pathways: heavy menstrual bleeding, uterine fibroids, and prolapse. Data were analyzed using reflexive thematic analysis to identify patterns in patient experiences. Analysis identified five themes: insecurity, loneliness, efficiency and focus, mutual understanding, and communication. Negative experiences included uncertainty about treatment timing, feelings of abandonment, and isolation due to restrictions on accompaniment. Positive experiences involved shorter waiting times, more focused consultations, and practical benefits of digital appointments. Neutral experiences reflected empathy for healthcare pressures, despite personal inconvenience. Communication emerged as the decisive factor shaping perceptions of care. Consistent, honest, and empathetic communication fostered trust and acceptance, while vague or fragmented information heightened distress. Patients demonstrated considerable understanding of systemic constraints. Yet, delays, reduced relational continuity and lack of clarity had significant emotional impact. In times of scarcity, appropriate care is defined not only by clinical feasibility but by the quality of engagement, information, and emotional support. Embedding open, responsive communication as a core component of care may help maintain patient trust and acceptance during times of limited capacity. These insights extend beyond pandemic conditions, offering guidance for managing care under structural staff shortages and rising demand in healthcare systems.
Cutaneous metastases from breast cancer (CMBC), including those involving the scalp, are typically observed in advanced stages of the disease and are relatively uncommon, particularly in hormone receptor-positive subtypes. We present the case of a 68-year-old woman with breast cancer metastatic to the skin, characterized by multiple firm, hyperpigmented, painless nodules distributed over the body, including the scalp. The patient has been treated with a CDK4/6 inhibitor (ribociclib) in combination with endocrine therapy (ET) (letrozole) since April 2024. During follow-up, all subcutaneous nodular lesions showed significant regression. By April 2026, skin color had returned to normal in most previously affected areas, and the majority of nodules had resolved. The scalp lesion completely disappeared, with full hair regrowth at the affected site. Treatment of CMBC with CDK4/6 inhibitor-based therapy has been scarcely reported, with most cases describing ET alone. This case highlights the potential role of CDK4/6 inhibitors and documents a notable response in the scalp, skin, and subcutaneous tissue, which has not been widely described.
Glioblastoma is the most common and aggressive primary brain tumor. Surgical resection is the mainstay of treatment, and the extent of tumor resection significantly impacts the patient's survival period. Fluorescence imaging can intuitively outline the tumor boundaries with high resolution, offering broad application prospects in tumor surgery navigation. Although 5-ALA and fluorescent probes targeting CD36, EGFR, etc. have been reported for intraoperative fluorescence-guided glioma surgery, the substantial interpatient heterogeneity of glioblastoma limits their ability to effectively image tumors in a subset of patients. In this study, we developed a novel fluorescent probe, QM-SO3H, that targets the wild-type IDH1 enzyme to enable intraoperative navigation for glioblastoma (GBM). This probe was designed using a sulfonated quinoline-malononitrile framework with aggregation-induced emission (AIE) characteristics, achieving fluorescence "turn-on" through a restricted intramolecular rotation mechanism upon binding to the IDH1 enzyme. It exhibited an excellent, highly selective fluorescence response to the IDH1 enzyme and can specifically label and track the dynamic changes of the IDH1 enzyme at the cellular level. In an orthotopic U87Luc GBM xenograft model, QM-SO3H could effectively penetrate the impaired blood-brain barrier in tumors (BBTB) and specifically light up tumors with excellent biocompatibility. Notably, the probe can clearly delineate tumor boundaries, guide complete surgical resection, and even detect microtumors with a diameter of less than 1 mm. Our study established a novel glioblastoma imaging strategy by targeting the IDH1 enzyme, offering a promising alternative approach for fluorescence-guided tumor resection in GBM patients exhibiting high IDH1 expression. Additionally, the probe QM-SO3H can also serve as a valuable visualization tool for investigating IDH1-associated pathophysiology.
Many depressed patients opt for complementary integrative medicine (CIM). We aim to evaluate whether there is an association between the severity of depressive symptoms and CIM. A cross-sectional study using the Brazilian National Survey (PNS, 2019), a population-based study. A sample of 4,792 participants (15-107 years old) reporting a current treatment of depression was categorized into 3 groups: 1 (N=4,307, Yes Psychotherapy/Medication-No CIM), 2 (N=148, Yes CIM-No Psychotherapy/Medication) and 3 (N=337, Yes Psychotherapy/Medication-Yes CIM). Participants answered a sociodemographic questionnaire and the Patient Health Questionnaire-9. We used three categories of depression: no depression (score ≤9), mild (score 10-14) and moderate/severe (≥15). Multinomial logistic regression estimated crude/adjusted odds ratios and 95% confidence intervals. Among participants who reported using at least one type of CIM, 3.2% and 7.0% used CIM exclusively or associated with conventional treatments, respectively. The higher the intensity of depressive symptoms, the lower the chance of using CIM exclusively. In Brazil only a minority of depressed people use CIM exclusively.