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There is a bidirectional relationship between emotional distress and pain. However, this relationship is understudied in people with HIV in low-resource settings. This study sought to describe the temporal relationship between emotional distress and pain in people with HIV. Longitudinal observational study. Participants with virally suppressed HIV, reporting either no pain or persistent pain at baseline, provided weekly remote ratings of distress, worst pain, and average pain using 0-10 visual analogue scales. Within-individual fluctuations in distress and pain were visualised over time. Group-level correlations were determined using Spearman's correlation tests. Cumulative link mixed models assessed whether distress and pain each predicted the other in the following week. 72 participants provided responses over 49 weeks. The participants had a median (IQR) age of 43 (37-51) years, 63% (n=45) were unemployed and most were females (n=51;71%). Distress and pain fluctuated concurrently within individuals: distress was positively correlated with worst pain (&#x3c1;=0.66, 95% CI= 0.60-0.72, p<0.001) and average pain (&#x3c1;=0.70, 95% CI=0.64-0.75, p<0.001) intensity within the same week. Worst pain (OR=1.42, 95% CI=1.17-1.71, p<0.001) and average pain (OR=1.43, 95% CI=1.20-1.71, p<0.001) intensity both predicted distress in the next week. Distress predicted worst pain intensity (OR=1.25, 95% CI=1.07-1.46, p=0.023) but not average pain intensity (OR=1.19, 95% CI=1.01-1.40, p=0.152) in the next week. The temporal relationship between distress and worst pain intensity was bidirectional, whereas distress did not temporally predict average pain intensity. Both pain and emotional distress should receive attention from HIV research and clinical care in low-resource settings.

Reliable probability estimates and robust performance across heterogeneous acquisition settings are important for artificial intelligence-assisted screening mammography. In federated learning, acquisition-driven non-identically distributed data can impair both discrimination and calibration across clients. This study aimed to develop a federated multi-view mammography framework that improves worst-client robustness and probability calibration while avoiding calibration procedures that require sharing instance-level prediction-label pairs. We proposed EquiFL-X, a federated framework combining client-local masked autoencoder pretraining, worst-client-oriented aggregation, and post-hoc temperature scaling from label-aggregated histogram statistics. Evaluation followed a public-data-based protocol with explicitly documented experimental settings using the Newfoundland and Labrador Breast Screening (NLBS) Dataset (NL-Breast-Screen), in which two native-resolution acquisition domains were treated as federated clients. Examination-level predictions were obtained through permutation-invariant pooling across available views. External testing was performed on the RSNA Screening Mammography dataset using the frozen model without fine-tuning, threshold re-selection, or recalibration. Uncertainty was quantified using 95% bootstrap confidence intervals and paired bootstrap comparisons. Compared with standard federated averaging on pooled held-out examinations from NLBS, EquiFL-X improved the area under the receiver operating characteristic curve from 0.880 to 0.915 and improved worst-client area under the receiver operating characteristic curve from 0.860 to 0.910, while reducing expected calibration error from 7.0% to 2.5%. At the predefined operating points, sensitivity reached 0.60 at 95% specificity and specificity reached 0.80 at 90% sensitivity. External testing on the RSNA Screening Mammography dataset was restricted to threshold-free metrics. EquiFL-X improved pooled discrimination, worst-client robustness, and probability calibration under acquisition-driven heterogeneity while limiting calibration-time information exchange to aggregated statistics. The framework may support more reliable federated decision support for screening mammography, although broader multi-institutional validation remains necessary.

Moderate hypofractionation (HF) is standard of care for adjuvant whole-breast irradiation after breast-conserving surgery (BCS). While boost irradiation has traditionally been administered sequentially (seq) after whole-breast irradiation, a growing amount of data suggests that delivery of a simultaneous integrated boost (SIB) may be equally effective and tolerable. HYPOSIB is a randomized controlled non-inferiority trial enrolling patients with breast cancer after BCS. Patients were randomized 1:1 to HYPOSIB (40 Gy in 16 fractions to the breast with SIB of 48 Gy to the tumor bed) or to the standard arm (investigator's choice: conventionally fractionated radiotherapy (CF) with SIB (CFSIB) or CFseq or HFseq). The focus of this manuscript is the secondary endpoint of selected prespecified acute adverse events (radiation dermatitis, pain, feeling of pressure in the breast - further termed breast discomfort) according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 up to 3 months after treatment. From 06/2015 to 01/2019, 2310 patients were enrolled. The analysis set included 2264 consenting patients that received radiotherapy. HYPOSIB resulted in fewer cases with worst grade of radiation dermatitis (grade 2: 25.3% vs. 38.6%; grade 3: 2.3% vs. 3.1). Radiation dermatitis occurred earlier during HYPOSIB but resolved more rapidly. There were more worst grade hot flashes during the HYPOSIB (grade 2: 29.7% vs. 26.0%; grade 3: 8.6% vs. 6.8%). Only 3.3% of hot flashes were judged as radiotherapy-related. Pain and breast discomfort were more frequent during the standard treatment and at later time points after HYPOSIB, mirroring the temporal trends for radiation dermatitis. HYPOSIB in 16 fractions led to a clinically relevant reduction in worst grade radiation dermatitis. There were temporal differences between treatments in the occurrence of radiation dermatitis, pain, and breast discomfort with adverse events occurring and resolving earlier with HYPOSIB.

This study aimed to compare the robustness of beam-specific planning target volume (bs-PTV)-based single-field uniform dose (SFUD) and robustly optimized intensity-modulated proton therapy (IMPT) plans against setup, range, and anatomical uncertainties in ultra-hypofractionated (UHF) proton therapy for localized prostate cancer. SFUD and IMPT plans were generated and compared using imaging datasets from ten consecutive patients who underwent proton therapy for prostate cancer at our institution. SFUD plans using a bs-PTV and IMPT plans using robust optimization were generated with 36.25&#x202f;Gy equivalent (GyE) to the clinical target volume (CTV) in 5 fractions. To evaluate robustness against setup and range uncertainties, 20 error scenarios were applied, including combined &#xb1;3&#x202f;mm isocenter shifts and &#xb1;3.5% Hounsfield Unit (HU) variations. Additionally, the SFUD and IMPT plans were recalculated using virtual CT (vCT) derived from weekly cone-beam CT (wCBCT) to estimate accumulated doses under anatomical changes. The worst-case and accumulated doses to the CTV, rectum, and bladder were compared. Both SFUD and IMPT plans demonstrated stable target coverage under setup, range, and anatomical uncertainties. Variations in CTV D99 remained within commonly accepted robustness criteria for all patients. Although a statistically significant difference in worst-case CTV D99 was observed between SFUD and IMPT plans, the magnitude of this difference was small. Dose variations under uncertainties were smaller for selected organs at risk (OAR) dose metrics in IMPT. Across the nominal, worst-case, and accumulated dose evaluations, IMPT plans achieved lower low- and intermediate-dose metrics for the rectum and bladder. Both bs-PTV-based SFUD and robustly optimized IMPT plans maintained adequate target coverage under uncertainties in UHF proton therapy for prostate cancer. The lower OAR doses and slightly improved OAR robustness observed with IMPT likely reflect the combined effects of differences in planning techniques and uncertainty management strategies, suggesting a modest dosimetric benefit.

Pain remains undertreated in 40% of cancer patients with an impact on their quality of life. This study assessed the effectiveness of a Pain Education Programme (PEP) in improving cancer pain management. PEP was evaluated through a stepped-wedge pragmatic trial led in 6 independent clusters to compare usual pain care (before staff training) with the educational approach (after training). PEP was delivered in three 2-hour workshops dealing with understanding of pain, managing its treatment, and coping in daily life. The main endpoint was pain interference with daily life. Patients' adherence to PEP, worst pain intensity, anxiety, analgesic adherence, and educational effect of the PEP were evaluated. Among 145 assessable patients, no significant differences were observed in scores of pain interference with daily life between the 2 groups, who experienced substantial improvement. Similarly, worst pain intensity was reduced in both groups, with no added value after the PEP. In the PEP group, intervention significantly improved anxiety (p&#x202f;=&#x202f;0.009), communication with health professionals (p&#x202f;=&#x202f;0.028), and patients' knowledge of treatment (98.3% of them vs 88.1%). We found high levels of adherence to the PEP (80%), satisfaction and patients' feelings of having acquired skills in managing their pain after the PEP (>50% of patients rated scores >8.9 on a 0-10 scale). No additional benefit of the PEP vs usual care regarding pain interference with daily life was demonstrated. Beyond the fact that patients greatly appreciated the PEP, acquiring skills to better manage their pain and improving communication with health professionals were in line with the goal of therapeutic education. The PEP we applied took into account the French regulatory context concerning the implementation of therapeutic education. This process, although its benefits remain difficult to demonstrate, could enable patients to develop skills to better manage their pain. ClinicalTrials.gov Identifier: NCT03297723, registered on 28, September 2017. (https://clinicaltrials.gov/study/NCT03297723).

Examine the association between the peak and impulse of patellofemoral joint force during running and the severity and duration of pain in adolescents with patellofemoral pain. Exploratory cross-sectional. Fifty-one physically active adolescents with patellofemoral pain (12-19 years). Kinematic, kinetic, and electromyography data were collected, and PFJ force (N) and impulse (N*s) during stance were estimated using an EMG-informed neuromusculoskeletal model. Pain was assessed as: (i) worst pain in the previous week (11-point numerical rating scale [NRS]), (ii) pain immediately after running (NRS), (iii) KOOS-Child pain (0-100), and (iv) pain duration (months). Associations were examined using linear regression adjusted for age, sex, and body mass. Each 100-N increase in peak patellofemoral joint force was associated with trivial changes of -0.01 (95% CI -0.03 to 0.01) in worst pain in the previous week, -0.02 (-0.05-0.01) in pain immediately following running, 0.01 (-0.19-0.21) in KOOS-Child pain, and -0.20 (-0.64-0.24) in duration of pain. Findings were similar for patellofemoral joint force impulse. These exploratory findings suggest the peak and impulse of patellofemoral joint force during running may not be important cross-sectional associates of pain severity or duration in adolescents with patellofemoral pain.

Children's exposure to radio-frequency electromagnetic fields (RF-EMF) above 6 GHz lacks characterization. No study spans sub-GHz cellular bands to millimeter wave while including child phantoms. This study quantifies the specific absorption rate (SAR) and absorbed power density (APD) in two adult and two child anatomical phantoms across 15 frequencies from 450 MHz to 26 GHz. We performed 550 finite-difference time-domain (FDTD) simulations covering environmental (plane-wave) and auto-induced (beamforming) exposure. SAR and APD were computed following IEC/IEEE 62704-1 and IEC/IEEE 63195-4, respectively. The simulations included, for the first time, whole-body dosimetry at 26 GHz in child and adult phantoms, and child APD across 7-15 GHz. Results were normalized to the ICNIRP 2020 reference levels for general public exposure. Children show 1.5-1.9 times higher whole-body SAR than adults at all sub-6 GHz frequencies. A 6-year-old reaches 93% of the 80 mW/kg whole-body SAR limit at 2140 MHz, averaged over 12 plane-wave configurations, and 145% in the worst one. Whole-body SAR, not local SAR, determines compliance margins below 6 GHz. Brain SAR decreases by 96% from 450 MHz to 5.8 GHz as absorption shifts to the skin. Eye SAR drops 77-fold from 7 to 26 GHz as penetration depth falls below eyelid thickness. Under simplified MRT beamforming, psSAR10g at 3500 MHz exceeds the 2 W/kg head/torso limit for all four phantoms (131-158%). APD at 7 GHz exceeds 20 W/m^2 for a 6-year-old by 2.5%. Worst-case whole-body SAR agrees with the literature within 2%. The results identify frequency-phantom combinations where compliance margins narrow: 3500 MHz and 7 GHz under beamforming, and children near 2 GHz under environmental exposure. The organ-specific SAR data for brain, eyes, skin, and genitals support epidemiological exposure assessment and dose modeling across current and prospective wireless bands.

Minimal disease activity (MDA) has recently been introduced as comprehensive treatment target in atopic dermatitis (AD), integrating both clinician- and patient-reported outcomes. Evidence on the real-world feasibility and impact of achieving MDA on quality of life (QoL) remains limited. This analysis evaluated the association between MDA achievement and QoL outcomes in patients with moderate-to-severe AD receiving upadacitinib (UPA) in real-world clinical practice. This interim analysis used data from the ongoing, prospective, multicenter, non-interventional UP-TAINED study (NCT05139836) in Germany. Analyses included all patients without treatment interruptions during the first 12&#xa0;months (n&#x2009;=&#x2009;259). Disease control was classified as optimal, moderate, or none. Optimal control (MDA) was defined as Eczema Area and Severity Index (EASI)&#x2009;&#x2264;&#x2009;3 and Worst Pruritus Numeric Rating Scale (WP-NRS)&#x2009;&#x2264;&#x2009;0/1; moderate control as EASI&#x2009;&#x2264;&#x2009;3 with WP-NRS 2-3 or EASI >&#x2009;3-7 with WP-NRS&#x2009;&#x2264;&#x2009;3; and no control as EASI&#x2009;>&#x2009;7 or WP-NRS&#x2009;>&#x2009;3. QoL outcomes were assessed using validated patient-reported measures. MDA was achieved by 38.2% of patients at month&#xa0;1 and by 42.1% at month&#xa0;12. Those achieving MDA reported substantially greater improvements across all QoL measures compared with patients with moderate or no disease control. QoL outcomes were comparable between patients starting UPA at 15&#xa0;mg or 30&#xa0;mg. The most frequent adverse events were AD, acne, and corona virus disease 2019 (COVID-19) infection; the safety profile was consistent and no new safety signals were identified. Achieving MDA was associated with markedly improved QoL in real-world AD management, supporting MDA as a feasible and clinically meaningful treatment goal in routine practice. ClinicalTrials.gov Identifier, NCT05139836.

Bowel urgency (BU) is a disruptive ulcerative colitis (UC) symptom. Etrasimod, a sphingosine 1-phosphate (S1P)1,4,5 receptor modulator, improved BU in the ELEVATE UC clinical program. We assessed associations between BU and efficacy endpoints, health-related quality of life (HRQoL), and biomarkers (Weeks 12 and 52) in patients receiving etrasimod in ELEVATE UC 52. A patient-reported numerical rating scale (NRS; 0-10; none to worst BU) assessed BU at baseline, Week 12, and Week 52. Binary BU outcomes were BU remission (NRS &#x2264;1), clinically meaningful improvement in BU (NRS &#x2265;3-point decrease), and complete BU remission (NRS&#x2009;=&#x2009;0). At Week 12, etrasimod-treated patients with BU remission were 4.0 times more likely to be in clinical remission (odds ratio [95% confidence interval (CI)]: 4.0 [2.3-7.1]; P&#x2009;<&#x2009;.0001) and 3.6 times more likely to show endoscopic improvement (3.6 [2.1-6.2]; P&#x2009;<&#x2009;.0001) versus patients without BU remission. Patients with BU remission also had significantly greater improvement in Inflammatory Bowel Disease Questionnaire: Total score (least squares mean difference [95% CI] 21.8 [13.5-30.1], P&#x2009;<&#x2009;.0001) and significantly lower fecal calprotectin and high-sensitivity C-reactive protein (mean [standard deviation] 744.5 [1,758.0] vs 2,314.2 [5,182.2] and 3.2 [5.8] vs 10.5 [24.9], respectively, both P&#x2009;<&#x2009;.0001). A similar association was seen for clinically meaningful improvement in BU and complete BU remission at Week 12 and all BU outcomes at Week 52. In etrasimod-treated patients, bowel urgency outcomes are positively associated with efficacy endpoints, HRQoL scores, and inflammatory biomarkers, and may be surrogate markers of disease activity and HRQoL improvement. NCT03945188.

Bilateral hippocampal compromise in temporal lobe epilepsy (TLE) substantially increases the risk of significant adverse memory outcomes following unilateral anterior temporal lobectomy and may contraindicate surgery. The Spatial Learning Task (SLT) of Lhermitte and Signoret (1972) is a simple object-location arbitrary associative learning task proposed as a marker of bitemporal dysfunction. Here, we test whether the SLT might serve as a useful marker in TLE by examining, in individuals with TLE and hippocampal sclerosis (HS), whether performance on the SLT depends on the laterality of the HS (left, right, bilateral). We hypothesize that performance will be worst in the setting of bilateral HS. Retrospective analysis of 63 surgically na&#xef;ve TLE-HS patients (16 bilateral HS, 28 left HS, 19 right HS) who underwent neuropsychological evaluation at a tertiary epilepsy center. Bilateral HS cases showed significantly poorer SLT learning and learning efficiency compared to right HS cases (p&#x2009;&#x2264;&#x2009;.005, BF10&#x2009;&#x2265;&#x2009;25). Left HS cases performed comparably to bilateral HS cases on early trials but typically achieved ceiling performance with repetition, reflecting inefficiency rather than capacity loss. An SLT learning score <13 yielded high specificity (96% [95% CI: 0.85-0.99]) but modest sensitivity (44% [95% CI 0.20-0.70]) for identifying bilateral HS cases. In the setting of TLE-HS, poor performance on the SLT increases the probability of bilateral hippocampal pathology, supporting its utility as a rule-in indicator. Although intact scores do not reliably exclude bilateral pathology, a low score on this task should prompt further investigations as to possible bitemporal compromise, and suggest risk of adverse memory outcomes following surgery. Prospective, post-operative studies will be required to quantify this risk. The results of the study show that the ability to learn arbitrary object-location pairings is compromised in the setting of temporal lobe epilepsy with bilateral hippocampal sclerosis (HS). In contrast, patients with unilateral HS generally retained sufficient capacity to learn the task, though those with left HS were slower to acquire the pairings across repeated trials. A low score on this task was a strong indicator of bilateral hippocampal pathology, whereas an intact score did not reliably exclude it. Our results suggest that performance on this simple learning task provides a useful marker of bilateral hippocampal compromise in epilepsy and may be particularly valuable in patients for whom standard memory tests are less suitable. We provide a cutoff score to facilitate clinical interpretation.

Glyphosate (GLY) and its main degradation product, aminomethylphosphonic acid (AMPA), are frequently detected in aquatic environments due to their extensive use and incomplete removal by conventional wastewater treatment processes. Magnetic nanosorbents have emerged as promising nanomaterials (NMs) for water remediation, although their environmental safety remains insufficiently understood under controlled co-exposure and worst-case scenarios. In this study, trimethyl chitosan-functionalized magnetic (Fe&#x2083;O&#x2084;@SiO&#x2082;/SiTMC) NMs were evaluated for the removal of GLY and AMPA from ultrapure water and wastewater, and their ecotoxicological effects were assessed using Danio rerio embryos under three exposure scenarios: NMs alone, NMs after GLY or AMPA adsorption, and simultaneous exposure with phenmedipham (PHE). In ultrapure water, Fe&#x2083;O&#x2084;@SiO&#x2082;/SiTMC NMs showed high removal efficiency for GLY and lower, yet still substantial, removal of AMPA, whereas adsorption performance decreased markedly in wastewater, highlighting the influence of matrix complexity on nanosorbent efficiency. The NMs alone did not induce relevant toxicity up to 250 mg/L, and only minor effects were observed after their use in GLY and AMPA adsorption assays. In contrast, co-exposure with PHE increased embryo toxicity and behavioral effects, suggesting that the NMs may alter the bioavailability of co-occurring contaminants. These findings demonstrate that Fe&#x2083;O&#x2084;@SiO&#x2082;/SiTMC NMs are promising for herbicide-contaminated water treatment but also indicate that their hazard profile may change in multi-contaminant systems, underscoring the need for ecotoxicological assessment under simulated co-exposure scenarios.

Penile carcinoma is a rare but psychosexually devastating malignancy associated with the worst prognosis among male-specific genitourinary malignancies (prostate, testicular, and penile cancer). In addition to loss of the organ itself, patients frequently suffer from chronic lymphedema following inguinal lymph node dissection. Despite advances in oncology, the prognosis of penile cancer has not substantially improved over the past half century, and the disease has long remained underrepresented in basic research, clinical trials, and patient advocacy initiatives. During the 2020s, however, the situation has begun to change, with an increasing number of large studies and the emergence of the first meta-analyses focused on penile carcinoma. Current morphological and molecular studies aim to identify features of aggressive disease that may guide treatment escalation or de-escalation and thereby improve patients' quality of life. This review summarizes recent advances in the field, with particular emphasis on prognostic parameters accessible by routine histopathological examination. In many settings, simple pathological biomarkers may provide greater clinical utility than expensive molecular analyses. Special attention is devoted to the interplay between morphology, HPV status, immune microenvironment, and molecular alterations. The review discusses histological grading, morphological subtypes, HPV status and its correlation with morphology and mutational profiles, the prognostic significance of tumor-infiltrating lymphocytes and PD-L1 expression, and particularly tumor budding, which is strongly associated with aberrant p53 status and adverse prognosis. Future perspectives include refinement of penile carcinoma classification into: 1) HPV-associated, 2) HPV-independent, p53 wild-type, and 3) HPV independent, p53-altered tumors. Additional parameters with potential to improve prognostic stratification include tumor budding and the subjectively assessed peritumoral lymphocytic rim (brisk versus non-brisk), both of which appear suitable for routine reporting alongside conventional staging and grading. To sum up: Morphology really matters even in the molecular era.

Optimum contribution selection (OCS) balances genetic gain and inbreeding by optimizing parental contributions to the next generation, but current implementations rely on point estimates of breeding values that discard the uncertainty inherent in genetic evaluations. We introduce CVaR-OCS, a novel formulation that incorporates the full posterior distribution of estimated breeding values (EBVs) directly into the OCS objective via Conditional Value at Risk (CVaR) (a coherent risk measure from financial portfolio theory) allowing a single optimization to simultaneously maximize expected genetic gain and protect against worst-case outcomes driven by EBV uncertainty. We evaluate CVaR-OCS on a simulated multi-generation genomic selection dataset with known true breeding values (QTL-MAS 2010; n = 3,226), enabling direct comparison to an oracle solution, and on Norway spruce (Picea abies n = 5,525) and Loblolly pine (Pinus taeda n = 926) forest tree breeding progeny trials, with consistent tail-gain protection observed across all three datasets. On the simulated dataset, point-estimate MAP-OCS recovered only 78% of the genetic gain achieved by an oracle solution with access to true breeding values, illustrating the cost of ignoring predictive uncertainty; CVaR-OCS attained comparable expected gain while improving tail-gain security (CVaR95 +0.69%) and recovering an additional oracle-optimal individual. In Norway spruce, the recommended CVaR-OCS operating point improved tail-gain security by 6.60% and broadened the selection base from 145 to 159 individuals at a genetic gain cost of only 0.70%. Complementary MCMC-based robustness scores revealed that 25 MAP-OCS selections in Norway spruce were unstable across the posterior distribution; post-hoc exclusion of these individuals failed to improve tail-gain security, motivating the principled CVaR-OCS approach. CVaR-OCS provides breeders with a principled, computationally efficient tool for uncertainty-aware selection decisions, and multi-generation simulation studies are needed to fully characterize its long-term effects on genetic gain trajectories and inbreeding accumulation.

Aim: This nationwide cohort study primarily aimed to descriptively characterize real-world treatment patterns, including treatment initiation, adherence, treatment duration and discontinuation of the first treatment drug, among patients who experienced a recurrent osteoporotic fracture. Materials & methods: This population-based, retrospective cohort study used data from the Health Insurance Review and Assessment Database of South Korea. It included male and female patients aged 55&#xa0;years and older who experienced a recurrent osteoporotic fracture within 2 years of their index fracture in 2013. Results: The study period was from 1 January 2012 to 31 December 2021, with an outcome assessment period from 1 January 2013 to 31 December 2017. A total of 34,558 patients with recurrent osteoporotic fractures were observed, and just over half (n&#xa0;=&#xa0;18,462, 53.4%) received osteoporosis medication, with a significant difference in medication rates between males (23.7%) and females (58.8%) (p < 0.001). The estimated median duration of osteoporosis medication was 146&#xa0;days (interquartile range: 61-365&#xa0;days). The discontinuation rate of medication within 2 years of follow-up after their recurrent fracture was 80.5%, with the highest discontinuation rate (90.4%) observed among patients taking daily oral bisphosphonate medication. Conclusion: Although patients with recurrent fractures require intensive management, our results showed a significant unmet need in the initiation and persistence of osteoporosis medication. Therefore, it is crucial to establish a strategic treatment approach to address the treatment gap in managing osteoporosis among very high-risk patients. Dataset name: Health Insurance Review and Assessment Database of South Korea. What is this article about? This article examines whether people with osteoporosis who have more than one bone fracture are receiving the treatment they need. We focused on how many patients started osteoporosis medications, how long they stayed on the medication, and how often they stopped treatment too early. Since people who have more than one fracture are at very high risk for future breaks, it is important to understand if they are being treated properly. What were the results? We used health insurance data from South Korea to study over 34,000 people aged 55 and older who had a second fracture within 2 years of their first one. Only about half of these patients received osteoporosis medication after the second fracture. Many stopped taking their medicine within a few months. Two years later, more than 80% had stopped their first osteoporosis medication. The worst rates of stopping medication were seen with daily oral pills. Why is this important? Osteoporosis is a treatable condition, and people who have already had fractures are at the highest risk for more. This study shows that many patients are not getting or continuing the treatment they need. Better support and follow-up are needed to prevent future fractures in these high-risk individuals.

Epidural steroid injections (ESIs) are commonly used for lumbosacral radicular pain, but clinical outcomes remain variable. This study aimed to identify predictive factors and determine short-term patient-reported outcomes in an understudied Southeast Asian population. A retrospective study involving 198 patients with chronic lumbosacral radicular pain undergoing lumbar ESI was conducted. Treatment success was defined as a &#x2265;30% reduction in the Brief Pain Inventory worst pain score at 4-week follow-up. At follow-up, 167 patients had complete data and were categorized as responders (n = 83) or nonresponders (n = 84). Multivariable binary logistic regression was performed using observed complete-case data to identify factors associated with treatment success. The observed 4-week response rate was 49.7%. In multivariable analysis, previous spine surgery was associated with lower odds of treatment success (adjusted odds ratio [aOR] 0.30, 95% confidence interval [CI] 0.11-0.80, P = 0.016), whereas unilateral transforaminal ESI (TFESI) was associated with higher odds of response compared with bilateral TFESI (aOR 3.16, 95% CI 1.23-8.13, P = 0.017). Baseline current pain intensity showed a negative direction of association but did not reach statistical significance (aOR 0.86, 95% CI 0.73-1.02, P = 0.086). Specific MRI findings were not significantly associated with clinical outcomes. Clinical history and treatment context were more informative than MRI findings for estimating short-term lumbar ESI response. Prior spine surgery was associated with poorer response, whereas unilateral TFESI was associated with higher odds of short-term treatment success.

Glioma is the most common primary malignant brain tumor in adults, among which glioblastoma (GBM) shows the highest degree of malignancy and the worst prognosis. Although standard therapeutic approaches, including surgical resection, radiotherapy, and chemotherapy, are routinely applied, the prognosis of glioma, especially GBM, remains poor. Metabolic rewiring is widely recognized as a major characteristic of malignant tumors and is especially evident in glioma. Recent studies have shown that fatty acid metabolic rewiring is a widespread feature of glioma and plays an important role in its pathogenesis and therapeutic resistance. Therefore, targeting metabolic reprogramming, particularly aberrant fatty acid metabolism, may have potential therapeutic implications in glioma. This review systematically synthesizes the molecular mechanisms underlying abnormal fatty acid metabolism in glioma pathogenesis and treatment responses. It also elucidates the regulatory networks governing key fatty acid metabolic pathways and integrates emerging strategies targeting these pathways to enhance the therapeutic sensitivity of glioma cells. Ultimately, this review aims to provide a conceptual framework and future research directions for overcoming the current limitations of glioma treatment through metabolic therapy.

The purpose of this contribution is to estimate the path-loss of capacitive human body communication (cHBC) systems under varying channel conditions. Accurate modeling of cHBC channel characteristics is critical for system design, and yet, channel characteristics are a complex function of environment, electrode geometries, and posture that are difficult to model. Although full-field electromagnetic simulations can accurately capture such complexity, they are slow to run, making it challenging to assess channel statistics quickly. This paper presents a hybrid model that combines the strengths of full-field electromagnetic simulations, measurements, and circuit model analysis to enable rapid, yet accurate, assessments of cHBC channel characteristics across all the aforementioned variations, with a focus on posture variations as the most common source of channel variation. The proposed model is investigated using a combination of analytical and simulation-based approaches. Experiments with miniaturized battery-operated devices are also conducted to validate the model's results. Simulation results show agreement with measurements across channel variations, with the worst-case mean error magnitude $< $ 2.40&#xa0;dB. Channel variations in cHBC can be significant and pose a major challenge in predicting channel behavior. Therefore, a model that can accurately estimate the channel loss both across frequencies and channel variations is imperative. cHBC is an attractive candidate for building a more secure and energy-efficient body area network. This modeling approach supports a more reliable link budget calculation under varying cHBC channel characteristics, which helps inform efficient designs of cHBC circuits under more realistic use cases.

To evaluate the impact of personalized dwell-time (DT) reductions on symptom prevalence and systemic toxicities in patients undergoing Bacillus Calmette-Gu&#xe9;rin (BCG) instillation for non-muscle invasive bladder cancer (NMIBC). Within a multinational randomized controlled trial (North-REG Dwell Time Study [NCT04701151]), 225 patients provided daily electronic patient-reported outcomes data during BCG induction and maintenance cycles. Participants were randomized 1:1, stratified by clinical site, sex, and concomitant carcinoma in situ, to either a standard care arm (control) or an intervention arm. Toxicity was analysed using a 'worst-day' principle to capture peak symptom burden. All patients initially received a standard 120-min DT. In the intervention group, algorithm-guided DT reductions (to 60 or 30&#x2009;min) were triggered by real-time symptom severity, whereas the control group maintained a 120-min DT. At baseline, 69% vs. 71% (control vs. intervention) of participants reported pre-existing symptoms, primarily lower urinary tract symptoms such as pollakiuria and urgency. During induction, the intervention group experienced significantly lower rates of urgency at week 3 (34% vs. 47%, P&#x2009;=&#x2009;0.04) and week 6 (32% vs. 49%, P&#x2009;=&#x2009;0.01). Significant reductions were also observed during maintenance at week 9 for systemic symptoms (30% vs. 61%, P&#x2009;<&#x2009;0.001) and fatigue (22% vs. 47%, P&#x2009;=&#x2009;0.001). Total adherence to the 15-instillation protocol was 38% in the intervention group and 40% in the control group. Daily electronic patient-reported outcomes monitoring revealed that patients with NMIBC have a high baseline symptom burden prior to BCG therapy. Symptom-guided DT reductions may reduce local urgency and systemic toxicity and improve treatment tolerability. However, treatment completion does not seem to be affected.