Non-muscle-invasive bladder cancer (NMIBC) accounts for approximately 75% of newly diagnosed bladder cancers and is particularly prevalent in men. Guidelines stratify patients into risk categories based on disease characteristics as patients often recur or progress to muscle-invasive disease. Most guidelines recommend transurethral resection of bladder tumor (TURBT) followed by up to 3 years of Bacillus Calmette-Guerin (BCG) therapy for high-risk (HR) patients. For very HR patients or those who recur after BCG, radical cystectomy (RC) is recommended. This study aimed to describe the profile of individuals with HR-NMIBC, alongside treatment patterns and outcomes across Europe, North America, and Japan. Data were extracted from the Adelphi Disease Specific Program for 1,864 patients initially diagnosed with HR-NMIBC and 273 with very HR-NMIBC. First-line treatment was mainly intravesical BCG, however, less than half of patients received the guideline recommended maintenance BCG and none received RC. Second-line treatment options were similar to first-line, with RC usage still rare. While TURBT+BCG was shown to be the current standard of care, the underutilization of full guideline recommended treatment alongside the relatively high number of recurrences highlights the need for novel therapeutic approaches, either in combination with BCG therapy, or as alternative first-line treatments. High-risk non-muscle-invasive bladder cancer (NMIBC) is a type of cancer that has not spread into the bladder wall’s muscle layer but is likely to spread or return after treatment. This study looked at characteristics of people with high-risk NMIBC in Europe, North America, and Japan. It also evaluated what treatments patients received. Researchers conducted a survey with doctors and patients with high-risk NMIBC to collect this information. Patient characteristics were similar across regions: 75% male with an average age of 71 years; two out of 10 patients were in full- or part-time employment, another eight out of 10 were current or ex-smokers. Disease characteristics, including symptoms and tumor stage of included patients were representative of the general high-risk NMIBC population. Typical care was similar across regions. Most patients underwent transurethral resection of bladder tumor (TURBT) followed by insertion of Bacillus Calmette-Guérin (BCG) into the bladder. TURBT is a procedure that removes cancer cells from the bladder’s inner layers to leave the rest of the bladder intact, BCG is a live vaccine that stimulates the immune system to attack cancer cells. Fewer than half of patients continued BCG treatment for the recommended one-year maintenance period. Few patients underwent radical cystectomy, a procedure that consists in removing the bladder and nearby tissue affected by cancer. Many patients’ cancer returned within 1 year despite receiving recommended treatments. There is therefore a need for new treatments that reduce the risk of cancer returning or growing and that improve quality of life for these patients.
Introduction Baseline investigations are recommended before initiating psychotropic medications to identify pre-existing medical conditions and reduce treatment-related adverse effects. This audit assessed compliance with recommended baseline investigations among first-contact patients receiving psychotropic treatment at a tertiary hospital in South-West Nigeria. Materials and methods A retrospective clinical audit was conducted using electronic medical records (EMRs) of first-contact patients managed between January 2024 and December 2025. Audit standards were derived from the National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists (RCPsych) recommendations. Compliance was categorized as high (≥75%), moderate (50%-74%), or low (<50%). Data were analyzed using descriptive statistics, chi-square tests, independent-samples t-tests, and one-way analysis of variance (ANOVA). Results Of 345 first-contact patients reviewed, 262 (75.9%) received at least one psychotropic medication and were included in the audit. Substance use disorders (61, 23.28%) and depressive episodes (60, 22.90%) were the most common diagnoses. Compliance with weight/body mass index (BMI) assessment, vital signs, and movement disorder screening was 100%. Compliance with laboratory and cardiac investigations was substantially lower: electrolytes/urea/creatinine (E/U/Cr) (25.2%), full blood count (FBC) (22.5%), fasting glucose/glycated hemoglobin (HbA1c) (19.6%), electrocardiography (11.4%), liver function tests (LFTs) (8.8%), and fasting lipid profile (FLP) (7.1%). No patient completed baseline prolactin testing. Overall, 180 patients (68.7%) had low compliance. Inpatients demonstrated significantly higher compliance than outpatients (55.5% versus 34.8%; p < 0.001). Conclusions Compliance with recommended baseline investigations was suboptimal, particularly for laboratory and electrocardiogram (ECG) monitoring. Local monitoring protocols, improved access to investigations, and regular re-audit may improve adherence to recommended standards.
Recent evidence suggests that psychosocial factors such as life satisfaction, emotional support, and social isolation may influence adherence to cancer screening behaviors. Limited evidence exists in the case of lung cancer screening (LCS). Hence, we are investigating how life satisfaction, emotional support, and social isolation were associated with the recommended annual LCS use among the screening-eligible population. We utilized population-based data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), comprising 12,380 LCS-eligible adults aged 50-79 years. Most of our sample self-reported as White (78.55%), aged 50-64 years (60.52%), urban residents (89.08%), and with health insurance (93.85%). About 12.51% reported feeling of rare/never emotional support, and 9.5% reported dissatisfaction or very dissatisfied with life. Almost 12.16% reported that they felt always or usually socially isolated. Among participants, 17.56% met the recommended LCS in the past year. Sample reporting dissatisfaction/very dissatisfaction with life has 47% lower relative likelihood of utilizing LCS within the past year than those with life satisfaction (RRR=0.53, 95% CI 0.34-0.84, p = 0.007). Those experiencing social isolation always/usually are less likely to LCS within the past year compared to those who have never experienced social isolation (RRR=0.69, 95% CI 0.49-0.98, p = 0.036). Rare/never emotional support is associated with lower adherence to the LCS within the past year than those who always felt emotionally supported (RRR=0.61, 95% CI 0.38-0.99, p = 0.045). Overall, our findings emphasize a significant association between psychosocial factors and LCS utilization, indicating the need for personalized, psychosocially informed interventions to facilitate LCS utilization.
Objective: To compare the predictive efficacy of the midnight 1 mg dexamethasone suppression test combined with the adrenocorticotropic hormone(ACTH) stimulation test versus three prediction models for idiopathic hyperaldosteronism (IHA). Methods: Clinical data of patients diagnosed with aldosterone-producing adenoma (APA) and IHA at the First Medical Center of Chinese PLA General Hospital from January 2020 to August 2025 were retrospectively analyzed. Patients were definitively diagnosed by adrenal vein sampling (AVS), adrenal surgical pathology, and postoperative follow-up, and were divided into APA group and IHA group. The midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test, the Xiao model, the Kobayashi 2018 model, and the Umakoshi model were respectively used to predict IHA. The McNemar test was used to compare the sensitivity and specificity of the midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test with those of the three prediction models for IHA. Results: A total of 175 patients were enrolled, aged 54.0 (45.0, 59.5) years, including 85 males and 90 females. Among them, 82 were in the APA group and 93 in the IHA group. Using the criterion of 90 min plasma aldosterone concentration (PAC)<39.05 ng/dl after the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test to predict IHA, the sensitivity and specificity were 90.3% and 93.9%, respectively. Using the recommended predictive probability≥0.9 of the Xiao model as the criterion to predict IHA, the sensitivity and specificity for diagnosing IHA were 47.3% and 95.1%, respectively. Using the recommended score≥ 8 points of the Kobayashi 2018 model as the criterion to predict IHA, the sensitivity and specificity for diagnosing IHA were 16.1% and 98.8%, respectively. The Umakoshi model showed a sensitivity of 17.2% and a specificity of 97.6% for diagnosing IHA. The sensitivity of the midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test in diagnosing IHA was significantly higher than that of the Xiao model, the Kobayashi 2018 model, and the Umakoshi model (all P<0.001), while there were no statistically significant differences in specificity between the combined test and the three models (all P>0.05). Conclusions: The midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test shows higher sensitivity for predicting IHA than the Xiao model, Kobayashi 2018 model, and Umakoshi model, and its specificity is comparable to these three prediction models. 目的： 比较午夜1 mg地塞米松抑制试验联合促肾上腺皮质激素（ACTH）兴奋试验与3种预测模型预测特发性醛固酮增多症（IHA）的预测效能。 方法： 回顾性分析2020年1月至2025年8月解放军总医院第一医学中心确诊为醛固酮瘤（APA）和IHA患者的临床资料。通过肾上腺静脉取血（AVS）、肾上腺手术病理以及术后随访评估后明确诊断，分为APA组和IHA组。分别应用午夜1 mg地塞米松抑制试验联合ACTH兴奋试验、Xiao模型、Kobayashi 2018模型以及Umakoshi模型预测IHA，采用McNemar检验比较午夜1 mg地塞米松抑制试验联合ACTH兴奋试验与3个预测模型预测IHA的灵敏度和特异度。 结果： 共纳入175例患者，年龄54.0（45.0，59.5）岁，男85例，女90例，其中APA组82例、IHA组93例。以午夜1 mg地塞米松抑制试验联合ACTH兴奋试验90 min 血浆醛固酮浓度（PAC）<39.05 ng/dl为预测IHA标准，诊断IHA的灵敏度和特异度分别为90.3%和93.9%；以Xiao模型推荐预测概率≥0.9为预测IHA标准，诊断IHA的灵敏度和特异度分别为47.3%和95.1%；以Kobayashi 2018模型推荐评分≥8分为预测IHA标准，诊断IHA的灵敏度和特异度分别为16.1%和98.8%；Umakoshi模型诊断IHA的灵敏度和特异度分别为17.2%和97.6%。午夜1 mg地塞米松抑制试验联合ACTH兴奋试验诊断IHA的灵敏度均高于Xiao模型、Kobayashi 2018模型以及Umakoshi模型（均P<0.001），其特异度与Xiao模型、Kobayashi 2018模型以及Umakoshi模型差异均无统计学意义（均P>0.05）。 结论： 1 mg地塞米松抑制联合ACTH兴奋试验用于预测IHA的灵敏度高于Xiao模型、Kobayashi 2018模型以及Umakoshi模型，特异度与这3种预测模型接近。.
Anaphylaxis can be life-threatening-due to its rapid-progressing and often unpredictable nature. Especially in such medical emergencies, robust clinical trials regarding adjunctive therapies can be scarce and recommendations across literature may vary. Hence, the aim of this study is to investigate the evolution of recommendations for the pharmacological management of anaphylaxis in established pharmacology textbooks over time. The following German textbook series were included: Aktories, Lüllmann, and Karow. The US standard work Goodman & Gilman was reviewed for an international comparison. This study focuses on epinephrine, H1R-antagonists, H2R-antagonists, and GCR-agonists-analyzing their potential use in anaphylaxis via predefined criteria and contextualizing it using the current AWMF anaphylaxis guideline. Epinephrine is continuously recommended as first-line treatment in anaphylaxis across textbooks and decades-with a shift towards i.m. use. Differences prevail regarding the anaphylaxis grade at which epinephrine is indicated vs. when H1R-antagonists are considered sufficient. Overall, H1R-antagonists are noted as adjuncts in at least more severe anaphylaxis. H2R-antagonists appear to lack clinical relevance and are inconsistently discussed as adjunctive add-ons. While GCR-agonists are consistently recommended as adjuncts in anaphylaxis, the included US literature deviates from the German consensus of a high-dose approach. Moreover, there are differences regarding fluid resuscitation-some textbooks merely predate the guideline's recommendation to refrain from colloids, whereas others remain at odds with it even in their latest editions. While there is general agreement on epinephrine's central role in anaphylaxis management, recommendations in literature regarding the specific roles of certain adjunctive measures vary-likely reflecting the limited evidence.
Roux-en-Y gastric bypass (RYGB) is an important bariatric and metabolic surgical procedure, and the design of intestinal limb lengths is a key factor affecting weight loss outcomes, metabolic improvements, and postoperative nutritional status. Currently, there are no established international standards for the optimal lengths of the biliopancreatic limb, alimentary limb, and common channel. This article reviews the evolutionary history of RYGB and its common classification, with a focus on analyzing the impact of the lengths of the alimentary limb, biliopancreatic limb, common channel, and total alimentary limb on postoperative weight loss outcomes and complications. The length of the alimentary limb can be designed based on the patient's BMI stratification: for patients with BMI ≥ 50 kg/m², 130-150 cm is recommended; for those with BMI <50 kg/m², ≤ 100 cm is recommended. The length of the biliopancreatic limb ranges from 50-150 cm, and the sum of the lengths of the biliopancreatic limb and alimentary limb should be controlled at approximately 200 cm, as excessive length may increase the risk of adverse events. A common channel length exceeding 400 cm can reduce the risk of complications. The total length of the alimentary limb should be greater than 400 cm to balance weight loss and nutritional safety. However, the optimization of intestinal limb lengths still needs to consider the patient's baseline characteristics and the type of surgical procedure. This article aims to provide guidance for clinical decision-making regarding intestinal limb lengths in RYGB based on guidelines, emphasizing the importance of formulating individualized plans in conjunction with patient characteristics, with particular attention to ethnic-specific factors relevant to the Chinese population to optimize surgical outcomes. Roux-en-Y胃旁路术（RYGB）作为减重代谢手术的重要术式，其肠支长度设计是影响减重效果、代谢改善及术后营养状态的关键因素。目前国际上尚未确立胆胰支、食物支与共同通路的最佳长度标准。本文综述RYGB术式的演变历程与常见术式分类，重点分析食物支、胆胰支、共同通路及总食物支长度对术后减重效果和并发症的影响。食物支长度可按患者体质指数（BMI）分层设计，BMI≥50 kg/m²推荐130~150 cm，BMI<50 kg/m²推荐≤100 cm；胆胰支长度范围为50~150 cm，与食物支长度之和建议控制在200 cm左右，过长会增加不良风险；共同通路长度超过400 cm可降低并发症风险；总食物支长度应>400 cm以平衡减重与营养安全。但肠支长度的优化仍需考虑患者基线特征及术式类型，制定个体化方案。本文旨在综述RYGB肠支长度的临床证据，以为临床决策提供参考。.
Robotic-assisted total hip arthroplasty (RTHA) promises enhanced implant positioning precision versus conventional THA (CTHA), potentially lowering complications, though evidence from systematic reviews remains inconsistent. The present umbrella review investigates the efficacy of RTHA over CTHA. This umbrella review followed Cochrane guidelines. PubMed, Scopus, and Cochrane Library were accessed. Eleven reviews were included after PRISMA screening. Data on complications, revisions, operative time, leg-length discrepancy (LLD), Forgotten Joint Scores, and alignment (safe zones, cup inclination/anteversion, delta-HCOR/VCOR) were extracted independently. AMSTAR-2 was used to assess methodological quality. The mean difference (MD) and odds ratio (OR) were used, with 95% confidence intervals (CIs). RTHA improved Lewinnek safe-zone placement (OR 7.37, 95% CI 5.51-9.86) and Callanan zone (OR 7.20, 95% CI 5.42-9.55), reduced complications (OR 0.60, 95% CI 0.41-0.87), LLD (MD -1.60 cm, 95% CI -2.30 to -0.90), and Forgotten Joint Scores (MD -6.82, 95% CI -9.81 to -3.83), but increased operative time (MD 15.66 min, 95% CI 10.91-20.41). No differences emerged in revisions (OR 1.08), cup inclination/anteversion, or delta-VCOR. Robust fail-safe N supported findings; funnel asymmetry varied. RTHA enhances precision and reduces short-term complications compared with CTHA, despite longer operative times. Selective use is recommended for high-risk misalignment cases; long-term, cost-effectiveness RCTs are needed.
Introduction of the statutory process of independent medical scrutiny in England and Wales, provides an excellent opportunity to identify shortfalls, concerns and helps us to learn from deaths. The system adopted by Wales (in contrast to England) guarantees fully independent scrutiny as recommended by the confidential enquiries into deaths. Evidence shows that a significant proportion of deaths has been referred to the care providers for a clinical review and to improve patient care. However, the system has created so many steps in the death certification process it leads to delays in issuing death certificates causing distress and anguish to the bereaved families. A multipronged approach to streamline the death certification process should include: education and training of doctors, a prompt, proportionate and pragmatic scrutiny by MEs, a review of the criteria for referral to coroners, implementation of digital MCCD and an overhaul of the list of causes of death.
BACKGROUND Congenital absence of the right coronary artery (RCA) is a rare anomaly often identified incidentally. We report a case of transient left ventricular systolic dysfunction followed by recovery of ejection fraction and new-onset mitral chordal rupture, which became the primary driver of pronounced N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation. The coexistence of 2 distinct pathologies complicated causal attribution; we discuss proposed mechanisms while recognizing their limitations. CASE REPORT A 58-year-old woman presented with exertional chest pain. At initial admission, she exhibited sinus tachycardia, elevated NT-proBNP (910 pg/mL), and reduced left ventricular ejection fraction (LVEF; 43% [M-mode]) with hypokinesis of the anterior wall and anteroseptum. Symptoms improved with anti-ischemic therapy. Three weeks later, LVEF recovered to 56% (biplane Simpson method), but NT-proBNP increased to 2440 pg/mL. Echocardiography revealed rupture of a small chord of the anterior mitral leaflet with mild-to-moderate regurgitation and elevated filling pressures (E/e'=13.8). Coronary angiography demonstrated congenital absence of the RCA ostium, with an enlarged left circumflex artery supplying the RCA territory and no evidence of atherosclerotic stenosis. Retrospective quantitative mitral regurgitation indices from archived images were examined. Management was conservative; symptoms resolved and NT-proBNP levels decreased during follow-up. CONCLUSIONS In patients with rare coronary anomalies, newly acquired common valvular disease may dominate the clinical presentation. Transient systolic dysfunction and subsequent chordal rupture occurred in our patient; a direct causal relationship remains speculative. Multimodality imaging is essential to accurately attribute hemodynamic changes and guide therapy. Long-term surveillance of coronary anatomy and valve function is recommended.
1. This study determined the requirement of digestible valine (dVal) and the optimal digestible valine-to-digestible lysine (dVal:dLys) ratio for Japanese quails during the starter phase (1-21 d).2. A total of 1000 one day old unsexed Japanese quail chicks (Coturnix japonica) were randomly assigned to five experimental diets: dVal (7.5, 8.5, 9.5, 10.5 or 11.5 g/kg diet), as five pen replicates each holding 40 birds.3. The optimal dietary dVal level for weight gain (WG), feed intake (FI), and feed conversion ratio (FCR) during d 1-21 were estimated using linear broken-line (LBL), quadratic broken-line (QBL), quadratic and logistic regression models to determine the optimal responses. Model evaluation was based on the coefficient of determination (R2), Akaike information criterion (AIC) and Bayesian information criterion (BIC).4. Chicks receiving a diet containing 0.95% dVal exhibited significantly higher WG (p = 0.0003) and improved FCR (p = 0.0330) compared to other treatments. The FI was unaffected by dVal levels over the 1-21 d period.5. Dose-response analysis using regression models revealed that the quadratic model provided the most accurate estimation of dVal requirements. The optimal dVal requirement for maximising WG and minimising FCR was determined to be 0.95% of the diet. Higher dVal levels (>9.5 g dVal/kg) were associated with increased FCR (p < 0.05). The estimated ideal dVal:dLys ratio to optimise performance in starter phase for Japanese quail was 0.79.6. The data showed that precise Val supplementation at recommended levels in low-protein diets can enhance growth in Japanese quail.
This work systematically investigates the adsorption behaviors and gas-sensing performances of Pd and Pt single-atom modified Mo2TiC2O2 toward SF6 decomposition gases (H2S, SO2, SOF2, and SO2F2) using first-principles calculations. Key parameters including adsorption energy, charge transfer, density of states, band structure, molecular orbitals, work function, and recovery time are calculated. Pd and Pt favor the hollow and bridge sites, respectively. Both substrates exhibit the strongest adsorption toward H2S (-1.440 to - 1.644 eV), but the excessively long recovery times at room temperature preclude reversible detection. SO2 and SOF2 show moderate adsorption energies (-0.964 to -1.157 eV) with considerable charge transfer, and their recovery times reach the second-to-millisecond scale at 398-498 K. SO2F2 exhibits the weakest adsorption and response. Electronic structure analyses reveal that Pd/Pt modification opens a small band gap (0.019-0.055 eV) in the metallic pristine substrate; H2S and SO2 further reduce the gap (Pt-H2S reaching 0 eV), whereas SO2F2 widens it. Work function and orbital distributions confirm the electron donor/acceptor behavior and hybridization differences among gases. Considering all factors, SO2 and SOF2 are the most suitable target gases with a recommended operating temperature of 398-498 K. This study provides a theoretical basis for single-atom modified MXene-based gas sensors.
Recommended performance validity test (PVT) cutoffs may vary across examinee characteristics. This study evaluated Word Choice (WC) and Test of Memory Malingering Trial 1 (TOMM T1) cutoffs in a diverse clinical sample (41% Hispanic/Latino, 26% English/Spanish bilingual, education: 5-20 years). Logistic regressions examined predictors of performance using established cutoffs. Older age predicted reduced odds of WC valid performance. Higher education predicted increased odds of WC and TOMM T1 valid performance. Ethnicity and language were not statistically significant predictors. WC false positive rates were low (4.8%-6.5%) and did not differ by ethnicity or language. TOMM T1 false positives were higher in Hispanic/Latino and bilingual participants (13.5%-14.3%) compared to Non-Hispanic/Latino and monolingual participants (9%-10%); differences were nonsignificant. WC and TOMM T1 cutoffs appear appropriate for Hispanic/Latino and bilingual examinees, though caution is warranted given elevated TOMM T1 false positives and risk of misclassification in examinees with less education.
Recently, the "weekend warrior" pattern, characterized by meeting recommended physical activity (PA) guidelines within one or two weekly sessions, has received increasing attention. However, its association with mental health outcomes remains unclear. This study aimed to examine the relationship between PA patterns and depressive symptoms. This study analyzed data from 26,424 adults from the Korea National Health and Nutrition Examination Survey conducted in 2014, 2016, 2018, 2020, and 2022. PA was assessed by a self-reported questionnaire and classified according to World Health Organization guidelines for moderate-to-vigorous PA. Participants were categorized as inactive (<150 min/ wk), weekend warriors (≥150 min/wk over 1-2 days), or regularly active (≥150 min/wk over ≥3 days). Depressive symptoms were defined as a Patient Health Questionnaire-9 score ≥5. Associations were examined using multivariable logistic regression, stratified by sex and age. Prevalence of depressive symptoms among participants was 19.3%. The weekend warrior PA pattern was not significantly associated with depressive symptoms. Contrarily, the regularly active PA pattern was inversely associated with depressive symptoms (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.66-0.79); this association remained significant after multivariable adjustment (OR, 0.81; 95% CI, 0.74-0.89). In stratified analyses by sex and age group, the regularly active group consistently showed an inverse association with depressive symptoms, whereas no significant association was observed for the weekend warrior PA pattern. Regularity of physical activity may be more important for mental health than total activity volume alone.
Immersive natural environments in virtual reality can capture involuntary attention, thereby contributing to improved health-promoting practices according to the Attention Restoration Theory. Landscapes and waterscapes provide restorative environments that foster a sense of connection with nature and create a peaceful and relaxing atmosphere. This study investigated the health effects of VR exercise in two specific implementations: professionally produced waterscapes and self-recorded landscapes. The study design was a randomized controlled trial conducted between September 2022 and June 2023. Forty eligible participants were randomly assigned to a waterscape group, and 32 participants were allocated to a landscape group. All participants received identical exercise program sessions of 30 min each conducted weekly for 12 weeks. The virtual reality headsets displayed two different series of non-repetitive 360° videos of professionally produced waterscapes or self-recorded landscapes. Data were collected at the pre- and post-test periods through a body composition analyzer and self-administered questionnaires. The comprehensive and mental quality of life, skeletomuscular index, and fat-free mass of participants in the waterscape group improved, while their body mass index decreased. Participants in the waterscapes group revealed a greater experience in perceived restorativeness and less virtual reality sickness than those in the landscapes group. Professionally produced VR waterscapes yielded superior mental and physical health outcomes compared to self-recorded landscapes. Virtual reality exercise in immersive natural environments is recommended as a restorative experience for health promotion.
Elicit information from stakeholders to plan implementation of the Extension for Community Healthcare Outcomes (Project ECHO) model in Lebanon to improve cancer diagnosis and treatment in underserved and rural areas. A qualitative descriptive study guided by the Greenhalgh diffusion of innovation framework. Semi-structured interviews explored five diffusion components: relative advantage, compatibility, low complexity, potential risks, and needed support. Lebanon. Twenty-six purposively sampled leaders representing governmental, non-governmental, academic, clinical, and public health sectors. The interviews were coded and thematically analyzed to characterize the perceived facilitators, barriers, and implementation considerations related to Project ECHO adoption. Following a standardized introduction to the ECHO model, participants generally perceived the model as acceptable and potentially beneficial for building primary care providers' (PCPs) knowledge and increasing patient access to quality care in underserved communities. Collectively, these leaders recommended careful pilot planning of infrastructure readiness, identification of clinical champions, and the use of performance indicators to monitor and evaluate implementation progress. They identified long-term sustainability, consistent financial support, workforce engagement, and medico-legal considerations as potential barriers to successful ECHO adoption. They viewed the current unstable environment in Lebanon as both a challenge and an opportunity for system transformation through strengthened collaboration, capacity building, and multi-level commitment to improve community health outcomes. Findings suggest the need for a structured, evidence-based approach to guide the implementation of Project ECHO in Lebanon. Potential early benefits may include strengthening PCP knowledge, confidence, and capacity in underserved communities. The findings provide an evidence-informed foundation for organizations and governmental agencies to support national-level adoption of the ECHO model. Future efforts should prioritize developing a practical action plan that includes provider training, infrastructure development, and sustainable funding to improve cancer care in rural areas.
Idiopathic normal pressure hydrocephalus (iNPH) is a common and treatable syndrome related to cerebrospinal fluid circulation disorders in the elderly, with clinical problems including missed diagnosis, misdiagnosis and significant variations in therapeutic efficacy. Therefore, multidisciplinary experts in the Chinese Association for Geriatric Health Care's Hydrocephalus Specialty Branch, the Chinese Medical Association's Neurosurgery Branch, the Chinese Neurosurgery Critical Care Management Collaborative Group, and the Beijing Medical Association's Neurosurgery Branch were organized to formulate the Expert consensus for the diagnosis and treatment of idiopathic normal pressure hydrocephalus (2026 edition). Based on the Chinese expert consensus on the diagnosis and treatment of idiopathic normal pressure hydrocephalu (2016 edition), this consensus systematically reviews relevant literature from January 2016 to June 2025. Combining the findings of comprehensive qualitative analysis and clinical practice, it develops clinical practice recommendations covering epidemiology, pathophysiological mechanisms, diagnosis, assessment, treatment and follow-up. This consensus clarifies the core clinical features, characteristic imaging features, and key auxiliary diagnostic indicators. Comprehensive diagnosis of iNPH requires integration with the results of the cerebrospinal fluid tap test, and differential diagnosis should be made from various neurodegenerative diseases and secondary hydrocephalus. The cerebrospinal fluid tap test is recommended as the core preoperative evaluation tool, with standardized multi-dimensional assessment methods for cognition, urinary function and gaitto match the test. Surgical shunting is confirmed as the current effective treatment, with detailed recommendations on the selection of surgical approaches, shunt system selection and the management of comorbidities, 39 recommendations were finally established. This consensus provides a standardized reference for the clinical diagnosis, assessment and treatment of iNPH. It also highlights future research directions, including early diagnostic biomarkers, minimally invasive surgical techniques and intelligent shunt systems. 特发性正常压力脑积水（iNPH）是老年人群中常见、可干预的脑脊液循环障碍相关综合征之一，临床诊治中存在漏诊、误诊及治疗效果差异大等问题。基于此，中国老年保健协会脑积水专病分会、中华医学会神经外科学分会、中国神经外科重症管理协作组以及北京医学会神经外科学分会组织多学科专家制订《特发性正常压力脑积水诊治专家共识（2026版）》。该共识在《中国特发性正常压力脑积水诊治专家共识（2016）》基础上，系统检索2016年1月至2025年6月相关文献，结合定性综合分析结果及临床实践，从流行病学、病理生理机制、诊断、评估、治疗及随访等方面制订临床实践建议，明确iNPH的核心临床特征、特征性影像学表现，以及辅助诊断关键指标，同时需结合脑脊液释放试验结果综合诊断，并与多种神经退行性疾病、继发性脑积水等鉴别；推荐脑脊液释放试验为术前核心评估手段，同时规范与之相关的认知、排尿、步态等多维度评估方法；外科分流手术为目前有效治疗方式，在手术方式选择、分流系统选择、合并症处理方面提供了详尽的建议，最终形成39条推荐意见。该共识为iNPH的临床规范化诊断、评估及治疗提供了标准化参考，同时指出疾病早期诊断标志物、微创手术技术、智能分流系统等方面为未来研究方向。.
The Pingyin-Changqing section of the Yellow River serves as an important groundwater recharge area in the lower reaches of the Yellow River, and its groundwater quality safety holds significant importance for the regional ecology and the health of its residents. This study systematically collected groundwater samples from this area, detected concentrations of six heavy metals (Mn, Zn, Ni, Pb, As, and Cd), and comprehensively applied mathematical statistics, spatial mapping analysis, source apportionment, and health risk assessment methods to systematically investigate the characteristics, distribution patterns, source mechanisms, and health risks of groundwater heavy metals in the region. The results indicate that (1) the mean concentrations of heavy metals in groundwater of the study area, in descending order, are Mn > Zn > Ni > Pb > As > Cd; compared against the Class III standard limits of the National Standard for Groundwater Quality, Mn shows the highest exceedance rate, followed by Pb, with exceedance rates of 18% and 5%, respectively; (2) heavy metal concentrations exhibit considerable spatial variability, with Mn exceedance points uniformly distributed in upstream and downstream areas on both banks of the Yellow River, while Pb concentrations demonstrate higher values downstream than upstream, with exceedance points mainly concentrated in the junction of Qihe and Dong'e; (3) sources of groundwater heavy metal pollution are identified as follows: Zn, Ni, and Cd primarily originate from different industrial sources, Pb mainly from traffic sources, As primarily from agricultural sources, and Mn predominantly from natural sources; (4) groundwater ingestion was identified as the dominant exposure pathway. Pb was the major contributor to noncarcinogenic risk, whereas As was the primary contributor to carcinogenic risk. Children exhibited higher noncarcinogenic risk levels than adults, reflecting their greater susceptibility to heavy metal exposure. Although both carcinogenic and noncarcinogenic risks remained within acceptable limits overall, relatively elevated risk values were concentrated at the junction of Changqing, Pingyin, Dong'e, and Qihe. Through the technical route of "pollution identification-spatial mapping-source apportionment-risk assessment," this study provides a scientific basis for groundwater safety protection in the Yellow River Basin. It is recommended to strengthen dynamic monitoring of Pb pollution and implement comprehensive prevention and control measures in high-risk areas of this region.
Esophageal varices (EVs) are a common and life-threatening complication of liver cirrhosis. Endoscopic screening is recommended but remains invasive and resource-intensive. This study aimed to evaluate the diagnostic performance of the albumin-bilirubin (ALBI) and ALBI-platelet (ALBI-PLT) scores for predicting the presence of esophageal varices in cirrhotic patients. This cross-sectional study included 152 patients with liver cirrhosis who underwent screening endoscopy at Cho Ray Hospital between November 2022 and May 2023. ALBI and ALBI-PLT scores were calculated from routine laboratory parameters. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance. Among 152 cirrhotic patients (mean age 56 years, 65.8% male), the prevalence of EVs was 56%. The ALBI score showed moderate predictive performance for EVs (AUC 0.78; 95% CI 0.70-0.84) and varices needing treatment (AUC 0.79). The ALBI-PLT score demonstrated similar performance (AUC 0.76 and 0.77, respectively). Using a cutoff of ALBI > -2.76, 20.4% of patients could potentially avoid screening endoscopy, with 9.7% of varices needing treatment missed. ALBI and ALBI-PLT scores may serve as simple non-invasive triage tools to identify low-risk cirrhotic patients who may safely defer screening endoscopy, particularly in resource-limited settings.
This narrative review examines endovascular treatments for acute pulmonary embolism (PE), focusing on percutaneous mechanical thrombectomy (MT). PubMed (Medline) and Google Scholar were searched from January 1990 up to November 2024 (updated Feb 2026). Studies were included if they discussed PE and the use of thrombectomy devices. Full-text randomised controlled trial studies, observational studies, case series, and case reports were included. Opinion articles, letters to the editor, animal studies, and non-English studies were excluded. A total of 116 articles were reviewed. Current guidelines recommend systemic thrombolysis as first-line reperfusion for high-risk PE, whereas intermediate-high-risk PE is managed with anticoagulation and monitoring, with reperfusion reserved for deterioration. MT is currently an alternative, mainly when thrombolysis is contraindicated or has failed. However, the last two decades have seen a surge in thrombectomy devices including the FlowTriever, Indigo, and AngioVac. Numerous studies, most notably the PEERLESS trial, have reported rapid haemodynamic improvement with MT, including reduced pulmonary artery pressure, low major bleeding rates, and fewer intensive care admissions [1]. MT has shown early promise in the management of PE. Much of the current evidence derives from single-arm trials, registries, and industry-sponsored observational studies, with randomised comparative data still limited. Nonetheless, randomised evidence suggests MT may reduce clinical deterioration, intensive care use, and hospital length of stay compared with catheter-directed thrombolysis, though without a demonstrated difference in mortality, intracranial haemorrhage, or major bleeding. Further trial evidence is required before MT is recommended as first-line in PE.
Acute watery diarrhea (AWD) remains a major global public health problem, and cholera continues to cause substantial morbidity and mortality in settings with inadequate water, sanitation, and hygiene (WASH). Chattogram, a coastal district of Bangladesh, is particularly vulnerable due to seasonal hydroclimatic changes, salinity intrusion, and high population density. On May 6, 2023, an increase in AWD cases was reported, prompting an outbreak investigation. We aimed to describe the epidemiology, identify the causative pathogens and source, assess environmental contributors, examine seasonal trends, and recommend preventive measures. We conducted a descriptive investigation from May 7 to May 15 2023, in two tertiary hospitals, two Upazila Health Complexes, and affected communities. Five-year historical data were reviewed to assess seasonal patterns, and facility-based surveillance data from April 2023 were analyzed. Active community case finding, standardized interviews, environmental assessments, stool culture and sensitivity testing, and water-quality testing for coliforms, Vibrio cholerae, and salinity were performed. Between April 1 and May 15 2023, 7956 AWD hospital admissions were reported, with sustained transmission during the pre-monsoon period. Among 166 interviewed patients, adults aged 18-40 years were most affected (65/166, 39%); all had AWD, and 85% (141/166) reported vomiting. Six (6) of 23 stool cultures yielded V. cholerae. Coliform was detected in two (2) of three (3) tube wells and all pond samples, while non-O1/non-O139 V. cholerae was identified in multiple water sources. Salinity ranged from 210 to 2320 mg/L, with several sources exceeding recommended limits. Urban cases mainly relied on intermittent piped water, whereas rural households depended on tube wells and contaminated surface water with low treatment practices. The outbreak was associated with unsafe and saline water, intermittent supply, and inadequate household water treatment. Strengthening climate-resilient water systems, routine water-quality monitoring, sanitation, and pre-monsoon preparedness is essential to prevent recurrent cholera-associated AWD outbreaks in coastal Bangladesh.