This study aimed to identify factors associated with hospitalization among older adults with mild traumatic injuries who presented to a regional emergency medical center or regional trauma center. This retrospective secondary data analysis used medical records from trauma patients aged ≥ 65 years who were triaged as Korean Triage and Acuity Scale levels 4 or 5 and visited a regional emergency medical center or regional trauma center in Korea between January 1 and December 31, 2022. Of 38,371 visits during the study period, 442 older adults with mild traumatic injuries were included. Data on general characteristics, disease-related characteristics, medical treatments, and nursing interventions were analyzed using descriptive statistics, t-tests, χ² tests, and multivariate logistic regression analysis. The 442 participants comprised 228 men (51.6%) and 214 women (48.4%); 225 participants (50.9%) were aged 65-74 years. In the multivariate analysis, longer emergency department stays were associated with a higher likelihood of hospitalization (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.00-1.01). Patients with fractures were more likely to be hospitalized (OR = 11.25; 95% CI, 1.12-111.78), whereas those who received counseling and education were less likely to be hospitalized (OR = 0.01; 95% CI, 0.00-0.04). These findings highlight the important role of emergency nursing care in the hospital admission process and support the need to incorporate nursing-related factors into future emergency department research and intervention strategies.
Major oncological breast surgery can be associated with significant postoperative pain. The aim of this systematic review was to update existing recommendations for postoperative pain management after major oncological breast surgery. A systematic review was undertaken following PROcedure SPECific postoperative pain managemenT (PROSPECT) methodology. Randomised controlled trials and systematic reviews that investigated peri-operative analgesic, anaesthetic and surgical interventions were included. The evidence for these interventions was reviewed using a modified Delphi process for their invasiveness, efficacy, adverse effects and complications. In total, 176 randomised controlled trials and eight systematic reviews were included. Analgesia with paracetamol, nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors, and dexamethasone continues to be advocated. Given the occurrence of problematic adverse effects, gabapentin is no longer recommended. Single-shot erector spinae plane block; interpectoral plane and pectoserratus plane block; superficial serratus anterior plane block; deep serratus anterior plane block; thoracic paravertebral block; and local infiltration analgesia are recommended. We no longer recommend a continuous thoracic paravertebral block, as single-shot regional analgesic modalities are sufficient to cover the worst part of the acute pain trajectory. Physiotherapy in the pre-operative and postoperative period is recommended. No perineural adjuncts; specific surgical techniques; or complementary medicine therapies are recommended. The updated PROSPECT recommendations for pain management following major oncological breast surgery include pre- or intra- and postoperative administration of paracetamol; nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 selective inhibitors; dexamethasone; single-shot regional analgesic techniques; and physiotherapy. The value of regional analgesic techniques is underlined, but the listed single-shot regional analgesic techniques are considered equivalent to each other. Researchers looked at all the best available studies about pain relief after major breast cancer surgery. They reviewed 176 clinical trials and eight review papers to find out which treatments worked best. They compared different pain medicines, nerve blocks, physiotherapy and other treatments to update the latest recommendations for doctors. Major breast surgery can be painful, and good pain control helps people recover more comfortably and get back to normal activities sooner. New research has become available since the last guidelines were published, so the researchers wanted to make sure patients receive the safest and most effective pain treatments. The researchers found that regular pain medicines such as paracetamol and anti‐inflammatory drugs, together with a medicine called dexamethasone, should continue to be used after surgery. They also found that several types of single‐injection nerve blocks work well to reduce pain and are equally effective. Gabapentin is no longer recommended because its side effects outweigh its benefits. Physiotherapy before and after surgery is also recommended to help recovery. Overall, the updated guidance supports using a combination of pain medicines, a single nerve block and physiotherapy to help patients recover safely and comfortably after breast cancer surgery.
Tuberculosis (TB) remains a major public health challenge in the WHO Western Pacific Region, which accounts for over one quarter of the global TB burden. This study provides an updated regional assessment of TB epidemiology and programmatic performance to inform priority actions. We conducted a retrospective descriptive analysis of estimated TB burden and country-reported surveillance and programme data from the WHO global TB database, examining trends in TB epidemiology and programme performance in the Western Pacific Region between 2010 and 2024 with emphasis on progress since 2015 in line with the End TB Strategy. Analyses were undertaken at regional and country levels across 37 countries and areas, covering TB burden, case notifications, diagnostics, drug-resistant TB, TB-HIV care, treatment outcomes, TB preventive treatment (TPT), and costs faced by TB-affected households. In 2024, an estimated 2.9 million people developed TB in the Region, with 227,000 TB-related deaths. Since 2015, TB incidence has stagnated (1.6% increase) and mortality has declined only modestly (1.3%). Following COVID‑19‑related disruptions, TB case notifications rebounded to near pre-pandemic levels by 2022, reaching 2.2 million in 2024; however, treatment coverage remained suboptimal at 75%. TB cases were concentrated in a small number of countries, led by Indonesia, the Philippines, and China. TB epidemiology was heterogeneous: children accounted for > 20% of notifications in several Pacific countries, older adults ≥ 65 years for > 50% in low-incidence economies, and foreign-born individuals for a large share of cases in migrant-receiving countries. Diagnostic performance improved substantially, with use of WHO‑recommended rapid diagnostics increasing from 4.2% in 2015 to 70% in 2024, and bacteriological confirmation from 43 to 59%. Detection of multidrug- or rifampicin-resistant TB doubled over the past decade. TB-HIV co‑infection accounted for 2.2% of notified TB, with HIV status ascertained in 70%, and ART coverage remaining at 50-69%. Treatment success for new and relapse TB declined slightly to 86-87% in 2022-2023. TPT enrolment increased more than 14-fold since 2015, yet coverage of eligible contacts remained low at 7.4%. Despite notable programmatic achievements in TB diagnosis, treatment and prevention, overall progress toward ending TB in the Western Pacific Region remains slow and uneven. Accelerating progress will require country-tailored strategies that respond to diverse epidemiological contexts and risk-group needs, alongside urgent action to close persistent case-detection and notification gaps, strengthen equitable TB care for vulnerable populations, and expand access to short‑course TPT.
Placental MRI has shown T2* decreases during contractions and increases during maternal hyperoxia. However, how contraction-induced placental oxygenation and deformation relate to uterine deformation and differ from hyperoxia-induced responses remains unknown. To quantify placental T2* and deformation changes during spontaneous non-labor uterine contractions and maternal hyperoxia, testing the hypothesis that contractions produce mechanically mediated placental responses distinct from hyperoxia. Retrospective. Forty-nine MRI datasets from 46 pregnant participants with singleton pregnancies (24-39 weeks gestation). 3 T; dynamic multi-echo gradient-echo echo-planar imaging. Non-labor uterine contractions were defined as events lasting ≥ 0.5 min with peak uterine volume reduction > 2.5%. Placental T2* and deformation of the uterus, myometrium, placenta, fetus and amniotic fluid were quantified during normoxia (normal air, 21% O2, 5 min) with and without contractions, and maternal hyperoxia (100% FiO2, 4 min). Regional analyses were performed within and outside imaging-defined placental cotyledons. Linear regression, linear mixed-effects models, Pearson correlation and paired t-tests (p < 0.05). Complete contractions during normoxia were identified in 22 datasets, reducing placental T2* by 4.64 ± 0.75 ms. Maternal hyperoxia increased placental T2* by 11.36 ± 0.62 ms relative to normoxia. Significant gestational age-by-duration interactions were observed for contraction-associated placental deformation (β = 2.47 ± 1.04% points/min/week) and T2* reduction (β = 1.50 ± 0.44 ms/min/week). At baseline, cotyledons exhibited higher T2* than surrounding placental tissue (β = -11.56 ± 0.95 ms). Contractions significantly reduced the inside-outside cotyledon T2* difference (β = 3.14 ± 1.34 ms), whereas hyperoxia preserved regional heterogeneity (p = 0.48). Spontaneous non-labor uterine contractions induced coordinated decreases in placental volume and oxygenation that intensified with gestational age and contraction duration. In contrast, maternal hyperoxia produced larger, more uniform increases in oxygenation. 3. Stage 3. The uteroplacental system adapts to changing conditions during pregnancy to support the developing fetus. In this study, we used magnetic resonance imaging (MRI) to examine how the placenta responds to two physiological challenges: naturally occurring non‐labor uterine contractions and maternal hyperoxia. We found that contractions temporarily reduced placental oxygenation and compressed the placenta, with larger effects later in pregnancy and during longer contractions. These changes were smaller than those observed during maternal oxygen administration and varied across different placental regions. These findings may improve understanding of normal placental function during pregnancy and help guide future MRI‐based assessment of placental health.
Synthetic cathinones are a chemically diverse class of novel stimulants that continue to emerge in the U.S. and globally. Trends in overall and specific synthetic cathinone availability in the U.S. (as indicated by seizures) remain poorly characterized. We analyzed annual counts of reports submitted from 2010-2024 to the U.S. Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS). We grouped reports into chemical subclasses of beta-keto methylenedioxyamphetamines ("-ylones"), pyrrolidinophenones ("pyrros"), and beta-keto amphetamines ("-drones"). Temporal trends in total reports and subclasses were modeled using negative binomial regression spline models. To further contextualize subclass trends, we descriptively examined the contribution of individual synthetic cathinones over time. Between 2010 and 2024, 178,892 synthetic cathinone reports were submitted to NFLIS, of which 73.3% were classified as -ylones, 19.9% as pyrros, 5.2% as -drones, and 1.6% as other. 68.7% of total reports were from the South, with 33.5% from Florida. Nationally, total reports increased sharply in 2010-2013, declined mid-period, rose again from 2019-2020, and then stabilized. Additional regional and temporal heterogeneity was noted across subclasses. We identified patterns of rapid emergence and replacement of individual compounds within subclasses, particularly within the -ylone subclass. Overall, we found substantial temporal, regional, and subclass-specific variation in synthetic cathinone reports to NFLIS from 2010-2024, largely driven by reports from the South and from successive cycles of replacement of -ylones. These findings emphasize the need to strengthen forensic and epidemiological surveillance of the evolving synthetic cathinone landscape in the U.S.
This study investigated factors influencing job satisfaction among emergency department (ED) nurses, focusing on job stress, sleep, physical activity, professional identity, and peer support, based on Roy's adaptation model. This descriptive cross-sectional study included 64 nurses working at a regional emergency medical center. Job stress and job satisfaction were measured using Kim and Gu's nursing job stress questionnaire and Lee's job satisfaction questionnaire, respectively. Sleep and physical activity were objectively measured using a wrist-worn actigraph for seven consecutive days. Professional identity and peer support were assessed using self-report questionnaires. The mean job satisfaction score was 117.70. Job satisfaction showed significant positive correlations with total sleep time (p = .024), daily step count (p = .032), professional identity (p < .001), and peer support (p < .001). Hierarchical regression analyses showed that the final model explained 65.0% of the variance in job satisfaction (p < .001). Total sleep time (p = .028), professional identity (p < .001), and peer support (p < .001) were significant predictors. However, job stress and physical activity were not significant predictors in the final model. Professional identity was the strongest predictor of job satisfaction among ED nurses. Job satisfaction among ED nurses appeared to be more closely associated with total sleep time than with sleep quality. These findings suggest that improving job satisfaction requires not only managing physiological factors, such as adequate sleep duration, but also strengthening professional identity and fostering supportive peer relationships.
Analysis of the implementation and use of telemedicine technologies in the field of maxillofacial surgery at the Federal Center of the National Medical Research Center "Central Research Institute of Maxillofacial Surgery" of the Ministry of Health of the Russian Federation in 2022-2024. The data of 3229 telemedicine consultations (TMC) in 88 constituent entities of the Russian Federation for the period 2022-2024 were ranked. The share of cases requiring patient routing to the federal center and additional examination was determined. The analysis of the availability and staffing of maxillofacial surgeons was carried out. The increase/decrease of indicators was calculated using the standard formula for relative change as a percentage. The relationship between indicators (population size, staffing, availability, number of CFLs and number of TMCs) was estimated using the Pearson correlation coefficient (r). The total number of TMCs increased from 833 in 2022 to 1296 in 2024, an increase of 55.6%. The leader in absolute number of TMCs is the Volga Federal District. At the same time, a decrease in the number of consultations was noted in the North-Western District. The share of TMCs that required patient routing to the federal center was 26.6% in 2024. There was a steady increase in the share of cases that required additional examination: from 65% in 2022, 73.7% in 2023, and 69.5% in 2024. A moderate negative correlation was found between the number of doctors and the number of TMK (r≈-0.61…-0.64), and a weak positive correlation was found between the number of doctors and the volume of consultations (r≈0.37-0.38). Despite fluctuations in the number of doctors in 2023 and subsequent growth in 2024, the overall staffing increased by 5.8% over the three-year period. The data obtained indicate that telemedicine technologies in maxillofacial surgery are an effective tool for increasing the availability of specialized and high-tech medical care, especially in regions with a severe shortage of personnel and a large territorial distance. TMC contributes to early diagnosis, clarification of treatment tactics, optimization of patient routing to federal centers, and strengthening the professional competencies of regional specialists. Повышение доступности медицинской помощи за счет внедрения телемедицинских технологий по профилю «челюстно-лицевая хирургия» в федеральном центре ФГБУ НМИЦ «ЦНИИСиЧЛХ» Минздрава России в 2022—2024 гг. Проведено ранжирование данных 3229 телемедицинских консультациях (ТМК) по 88 субъектам Российской Федерации за период 2022—2024 гг. Определена доля случаев, требующих маршрутизации пациентов в федеральный центр и дополнительного обследования. Проведен анализ обеспеченности и укомплектованности врачами-челюстно-лицевыми хирургами (ЧЛХ). Прирост/убыль показателей рассчитывали по стандартной формуле относительного изменения в процентах. Взаимосвязь между показателями (численность населения, укомплектованность, обеспеченность, число врачей ЧЛХ и число ТМК) оценивали с использованием коэффициента корреляции Пирсона (r). Общее число ТМК увеличилось с 833 в 2022 г. до 1296 в 2024 г., прирост составил 55,6%. Лидером по абсолютному числу ТМК является Приволжский федеральный округ. В то же время в Северо-Западном округе отмечено уменьшение числа консультаций. Доля ТМК, потребовавших маршрутизации пациентов в федеральный центр, в 2024 г. составила 26,6%. Выявлен устойчивый рост доли случаев, требующих дополнительного обследования: с 65% в 2022 г., 73,7% в 2023 г. и 69,5% в 2024 г. Установлена умеренная отрицательная корреляция между укомплектованностью врачами ЧЛХ и числом ТМК (r≈−0,6…−0,64) и слабая положительная корреляция между числом врачей и объемом консультаций (r≈0,37—0,38). На фоне колебаний численности врачей в 2023 г. и последующего роста в 2024 г. общая кадровая обеспеченность за 3 года увеличилась на 5,8%. Полученные данные свидетельствуют, что телемедицинские технологии в челюстно-лицевой хирургии служат эффективным инструментом повышения доступности специализированной и высокотехнологичной медицинской помощи, особенно в регионах с выраженным дефицитом кадров и большой территориальной удаленностью. ТМК способствуют ранней диагностике, уточнению тактики лечения, оптимизации маршрутизации пациентов в федеральные центры и укреплению профессиональных компетенций специалистов регионального уровня.
Objective.Radiation pneumonitis (RP) is an important toxicity following breast radiotherapy. Although modern treatment techniques limit lung exposure, some patients still develop symptomatic RP, and predicting who is at risk remains difficult. This study aimed to develop and validate machine learning (ML) models based on ipsilateral-lung dosimetric parameters to predict clinically significant RP after breast radiotherapy.Approach.We retrospectively studied 184 women with breast cancer treated with three-dimensional conformal radiotherapy using either conventional or hypofractionated fractionation schemes, with or without regional nodal irradiation, including internal mammary node irradiation when indicated. Clinically significant RP was defined as Common Terminology Criteria for Adverse Events (CTCAE v5.0) grade ⩾2 within six months of treatment. Ipsilateral-lung dose-volume metrics (V5Gy-V45Gy), maximum lung dose (Dmax), mean lung dose (MLD), and effective dose (Deff) were extracted from treatment plans. Four ML models (LightGBM, random forest, support vector machine, and logistic regression) were trained and evaluated using cross-validation. Model performance and feature reduction were analyzed.Results.Fifty-two patients (28%) developed clinically significant RP. All four models showed good and consistent predictive performance, with cross-validated AUC values >0.8. Across all models, high-dose lung parameters were the most reliable predictors. Models with reduced features (using V45Gy,Dmax,Deff, and MLD) showed competitive performance metrics compared to the respective full models.Significance.ML models built from simple, routinely available lung dosimetric data can effectively predict clinically significant RP after breast radiotherapy. Our findings suggest that small regions of the lung receiving higher doses play a greater role in RP risk than low-dose exposure alone. With further validation, this approach could support more personalized treatment planning and earlier identification of patients who may benefit from closer monitoring or preventive strategies.
The primary care system (PCS) is an essential national health infrastructure defined by the delivery of comprehensive, integrated, and accessible services that serve as the patient's first and sustained point of contact with the healthcare system. A comparative review was performed through searches of PubMed, KoreaMed, and J-STAGE databases using terms including "primary care," "general practitioner," "family physician," "gatekeeping," "Korea," and "Japan." Gray literature from the Japan Medical Association, Korea Medical Association, and OECD (Organisation for Economic Co-operation and Development) was also reviewed. Clinical case examples from one author's practice were included to illustrate real-world general practitioner (GP) challenges. Both Japan and South Korea feature universal health insurance but differ substantially in physician training pathways, gatekeeping enforcement, and community care integration. Japan is transitioning toward a kakaritsuke-i (registered home doctor) model with a nascent GP specialty board, whereas South Korea relies primarily on specialist-led private clinics for primary care delivery. International evidence suggests that structured, continuous family physician (FP) training is associated with improved chronic disease management, preventive care utilization, and patient satisfaction. Strengthening South Korea's PCS requires a clearly defined mandatory FP residency framework, reinforced gatekeeping mechanisms, and greater investment in community-based integrated care. Japan's ongoing reforms offer a useful regional comparator, while international FP models provide a proven evidence base for structural improvement.
Mathematics is a complex skill requiring the coordination of distributed gray matter brain regions connected by white matter tracts. Diffusion tensor imaging (DTI) studies have revealed a network of white matter tracts that support math processing, but the specific microstructural features driving this relationship remain unclear. Other magnetic resonance imaging (MRI) methods-neurite orientation dispersion and density imaging (NODDI), inhomogeneous magnetization transfer (ihMT), multicomponent driven-equilibrium single-pulse observation of T1 and T2 (mcDESPOT), and g-ratio imaging-can probe microstructural features like axon packing, fiber orientation, and myelin more specifically than DTI. We applied these methods alongside DTI to evaluate links between white matter microstructure and math in a longitudinal cohort of 33 6-16 year olds (66 datasets total). Partial correlations between metrics of white matter microstructure and math skill, controlling for age and gender, were carried out in the left superior longitudinal and inferior longitudinal fasciculi, corticospinal tract, and the splenium. Cross-sectionally, fiber coherence of the corticospinal tract and superior longitudinal fasciculus correlated to mathematics performance. Longitudinally, change in markers of axonal packing and myelin were linked to changes in both math skill and fluency in a regionally-specific manner, with links to myelin-sensitive metrics most prevalent. Notably, decreases in myelin were linked to improvements in mathematics over time, suggesting ongoing refinement of the math network. Findings presented here did not survive multiple comparisons corrections, but provide insight for future work elaborating upon these associations in larger samples.
Green sea turtles (Chelonia mydas) are globally distributed and use tropical and subtropical beaches for nesting. Green turtles exhibit temperature-dependent sex determination (TSD), a mechanism by which incubation temperature during a critical developmental window determines offspring sex. As global temperatures rise, many nesting populations could be producing increasingly female-biased sex ratios, raising concerns about long-term population viability. Our ability to assess demographic risks has been hindered by the absence of validated models that accurately convert field-recorded nest temperatures into sex ratios. In this study, we combine high-resolution temperature data from 62 monitored nests with known hatchling sex ratios (n = 594 individuals) to develop and validate a predictive model for sex ratio in green turtles. We developed several methodological innovations to study the impact of temperature-dependent sex determination (TSD) under natural conditions. First, we developed a novel approach to quantify spatial temperature heterogeneity (H, range between the 2.5th and 97.5th percentiles of the pairwise differences of nest temperatures recorded at the same time) on a nesting beach. The median heterogeneity of the beach is 1.58°C (95% credible interval: 1.52-1.64°C). Second, using a Bayesian mixed-model framework and experimental data from 1480 embryos incubated at constant temperatures under different moisture conditions, we detected genetic and/or maternal differences among clutches in the thermal sensitivity of sex ratio estimates, but no effect of Regional Management Units (RMU). Third, we fitted nine models to estimate field sex ratios; the best-performing model combined a thermal reaction norm of sexualization with a sensitivity function across the thermosensitive period (TSP), showing that both the timing and magnitude of temperature exposure influence sex determination. Our results indicate that males can be produced even under apparent female-producing conditions, due to temperature heterogeneity, temporal autocorrelation of nest temperatures that increased sex ratio variance and non-linear sensitivity to male-producing temperatures. This study establishes a new standard for predicting sex ratios in reptiles with TSD, offering critical insights for population assessments and adaptive conservation planning under changing climatic conditions.
Pharmacogenomics has the potential to improve medication responses for the public; however, its adoption in clinical practice has been slow. Consumer representation and engagement are crucial for pharmacogenomics implementation, since it is their data that is central to testing. This study investigated the Australian public's awareness, knowledge, and perceptions of pharmacogenomics via a mixed-methods approach. Firstly, a cross-sectional survey with a nationally representative sample of 772 members of the Australian general public assessed the frequency of pharmacogenomics awareness, knowledge, perceived benefit and concern. Subsequent semi-structured interviews with 21 members of the Australian public provided deeper insights into perceptions through thematic analysis. Over three-quarters (76.3%) of participants were unaware of pharmacogenomics, while 6.2% categorized themselves as aware and knowledgeable about the topic. Interviews found five major themes: (1) Knowledge and Understanding, (2) Trust, (3) Personalized and Holistic Care, (4) Clinical Utility, and (5) Accessibility. Overall, participants highlighted several key steps for pharmacogenomics integration into clinical practice and to increase awareness. These include the importance of simplifying the terminology, providing education and transparency to overcome apprehension, addressing cost concerns, communicating the value clearly and increasing community engagement.
Clinically relevant weight loss (≥ 5%) is a key treatment goal in dietetic care for patients with overweight or obesity. While clinical trials often demonstrate successful weight loss, less is known about success rates in routine dietetic practice, timing of weight loss and maintenance. This study examined when patients achieve and maintain ≥ 5% weight loss during 12 months of dietetic treatment in Dutch primary care, and how this relates to treatment intensity and patient characteristics. In this retrospective cohort study, routinely collected data from dietetic electronic health records (EHRs) was used. Follow-up duration was 12 months. Weight change was analysed at 3, 6, 9 and 12 months. The study included 4503 adults (≥ 18 years) with overweight or obesity (BMI ≥ 25 kg/m2) receiving dietetic treatment between 2016 and 2020 in over 70 primary care dietetic practices in the Netherlands. The primary outcome was achieving and maintaining ≥ 5% weight loss from baseline at 3, 6, 9 and 12 months. Multivariable logistic regression assessed associations of ≥ 5% weight loss with visit frequency, visit time, sex, age, BMI and comorbidity. Overall, 33% of patients achieved ≥ 5% weight loss. Of these, 60% did so within 3 months. Each additional visit in the first 3 months was associated with threefold higher odds of success (OR = 3.0). In months 3-6, each additional visit was associated with 61% higher odds of success. Early dietetic treatment intensity is strongly associated with weight loss success. Structuring care around the early treatment phase warrants prospective evaluation in routine dietetic practice.
Hemangiosarcomas are heterogeneous malignancies possibly originating in any part of the body, rare in humans. The web of causation of human hemangiosarcomas remains poorly understood, to date, except for subsets of cases which have been recognized in a well-defined causal correlation to vinyl chloride or to ionizing radiation. In 2005, the International Agency for Research on Cancer ranked formaldehyde as a human carcinogen, causally related to both nasopharyngeal cancers and acute non-lymphocytic leukemias; at the time, the evidence in favor of a causal relationship of formaldehyde to sinonasal cancers was stated as "limited". In 2024, an umbrella review reported a significantly increased risk for sinonasal cancers among formaldehyde-exposed workers. A sinonasal hemangiosarcoma affecting an Italian male born in 1957, diagnosed in 2022, was reported to the Italian National Registry of Sino-Nasal Cancers (ReNaTuNS); the patient's occupational history revealed a remote exposure to formaldehyde, used as a disinfectant, when breeding farm animals, from 1967 to 1976. No previous reporting has been found about a possible association between formaldehyde and sinonasal non-epithelial cancers. Formaldehyde is, in our opinion, a suitable candidate to be considered for playing a causal role in the causation of the neoplasm; formal studies are required to test the hypothesis.
Early language development forms the foundation for cognitive, social, and academic skills. This study aimed to compare the language, speech, and communication skills of twins and singleton children aged 24-36 months and to explore associations with sociodemographic, biological, and environmental factors in the Turkish population METHOD: The study was conducted with 100 children, comprising 30 twin pairs (60 children, 30 male, 30 female) and 40 singletons (23 male, 17 female), with a mean age of 33.4 ± 5.26 months. Receptive and expressive language skills were evaluated using the Test of Early Language Development-Third Edition, Turkish Version (TEDIL), parent-reported language skills were assessed with the Adapting the Language Development Survey to Turkish (DILTAR), communication skills were evaluated with the Children's Communication Checklist-2 (CCC-2), and speech development was assessed with the Ankara Articulation Test (AAT). Sociodemographic (maternal age, education), biological (birth weight, gestational age), and environmental (television viewing time) factors were analyzed through correlational analyses. Twins exhibited significantly lower birth weights and earlier gestational age at birth compared to singletons. Twins demonstrated lower performance in TEDIL receptive language scores and AAT scores compared to singletons (p < 0.05). In the CCC-2 subscales of speech, syntax, semantics, use of context, and social relationships, twins scored significantly lower than singletons. A negative correlation was found between TEDIL receptive language scores and television viewing time across all children (r = -0.603). In twins, statistically significant correlations were observed between language-related scores and maternal age, maternal gestational age, birth weight, and maternal education (p < 0.05). This study provided culturally grounded evidence from Turkish children and demonstrated that 24-36-month-old twins are at increased risk for delays in language, speech, and communication skills compared to singleton peers. The findings suggest that the twinness effect in early toddlerhood reflects the combined influence of biological maturity at birth (e.g., lower birth weight and earlier gestational age), sociodemographic characteristics (e.g., maternal education and age), and environmental factors (e.g., television viewing time). Rather than being attributable to a single determinant, early language and communication outcomes in twins appear to emerge from dynamic interactions between biological and environmental conditions. These results underscore the importance of early, multidimensional screening and comprehensive assessment of twins' communication development to facilitate the timely identification of potential delays. Early intervention approaches that combine speech-language therapy with enriched environmental support strategies may help mitigate developmental risk and promote optimal communication outcomes.
The expanding use of targeted therapies in inflammatory bowel disease has made treatment sequencing increasingly relevant, yet evidence on anti-TNF effectiveness after prior biologics with different mechanisms of action (MOA) remains limited. Our objective is to evaluate the durability of anti-TNF treatment in this scenario. Multicentre study based on data from the ENEIDA registry. Patients who received second-line anti-TNF therapy after a first biologic with a different MOA for active luminal disease were identified. Using propensity score matching, each case was matched with three controls from two cohorts: patients treated with second-line anti-TNF after another anti-TNF and patients receiving first-line anti-TNF therapy. Treatment durability and short- and long-term clinical effectiveness were assessed. Sixty-six Crohn's disease patients and 117 UC patients receiving anti-TNF after other MOA were included. In CD, second-line anti-TNF therapy after a different MOA (62% ustekinumab) was associated with a higher risk of treatment discontinuation compared with first-line anti-TNF therapy (HR 1.55; 95% CI, 1.05-2.30), without significant differences in short- or long-term clinical effectiveness. In UC, anti-TNF therapy after a different MOA (90% vedolizumab) was associated with lower treatment durability compared with first-line anti-TNF therapy (HR 1.69; 95% CI, 1.31-2.19) and with anti-TNF after another anti-TNF agent (HR 1.91; 95% CI, 1.48-2.48), its remission rates significantly lower at both short- and long-term follow-up (p < 0.001). Anti-TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first-line therapy or after another anti-TNF agent, especially in UC.
Exercise has well-established benefits across the cancer continuum for people living with and beyond cancer, yet the exercise oncology field faces a research-to-practice gap. Understanding the factors that influence implementation in any given context is essential to ensure implementation strategies have the greatest likelihood of success. The study mapped onsite exercise oncology services, staff-reported implementation barriers and facilitators, organisational readiness, and experiences reported by people living with or beyond cancer, across a large public healthcare organisation. Staff and people living with and beyond cancer across cancer care centres within the public healthcare organisation completed an online survey. Data were analysed using descriptive statistics and manifest content analysis. Across 10 regions, 115 participants completed the survey (59 staff and 56 people living with and beyond cancer). Although both groups valued and viewed exercise as important, organisation-wide and region-specific constraints were evident, particularly the absence of onsite exercise professionals and absent or unclear referral pathways. Among people living with and beyond cancer, 54% received an exercise discussion and 13% received a referral. Across the organisation, strong support for exercise did not translate into action, as mainly outer and inner setting barriers restricted routine discussions, referrals and service delivery. Although regions within the same organisation shared several contextual factors, region-specific conditions that hindered or facilitated implementation were present. Findings reinforce that the development of implementation strategies and plans depends on a clear understanding of the context in which they will occur. These findings are informing an implementation plan in a pilot region.
Auricular anomalies, including microtia and preauricular tags (PATs), are frequently overlooked findings on prenatal ultrasound, yet they may represent the earliest and sometimes the only clue to a wide spectrum of craniofacial and multisystem disorders. Distinguishing isolated anomalies from syndromic conditions remains a major diagnostic challenge in fetal medicine. In this illustrated, state of the art case-based review, we propose a practical, imaging-driven diagnostic framework for the prenatal evaluation of auricular anomalies. Drawing on a decade of clinical experience and a curated series of representative cases, we integrate high-resolution ultrasound features with a structured anatomical approach and current advances in molecular genetics. Syndromes associated with microtia and PATs are organized into 3 clinically relevant groups: branchial arch disorders, overlapping syndromic entities, and conditions in which auricular findings are non-specific. Our approach is based on systematic assessment of 3 key craniofacial regions: the auricle and pretragal area, the mandible, and the zygomatic-mandibular complex, combined with evaluation of craniofacial symmetry and targeted screening of extra craniofacial structures. This strategy enables pattern recognition that refines differential diagnosis and guides the appropriate use of genetic testing. Although molecular analyses contribute to etiologic characterization, their diagnostic yield remains limited in certain conditions, particularly craniofacial microsomia, reinforcing the pivotal role of detailed morphological assessment. This integrated imaging-genomic approach provides a clinically applicable framework for improving diagnostic orientation, prenatal counseling, and perinatal management, and highlights the central role of ultrasound in navigating the complexity of auricular anomalies.
To investigate whether immunosuppressant (IS) use contributes to the inverse association between rheumatoid arthritis (RA) and Alzheimer's disease (AD). We analyzed NHANES 2011-2014 data, including 217 RA patients aged ≥ 60 years on prescription medications. Cognitive function was assessed using the Digit Symbol Substitution Test (DSST), CERAD, Animal Fluency Test (AFT), and a global cognition z-score (Z-score). Associations between IS use and cognition were evaluated using multivariable linear regression. Additionally, two-sample Mendelian randomization (TSMR) and multivariable MR (MVMR) analyses were performed with GWAS datasets for RA, AD, and IS to examine potential causal effects. We observed that patients with RA using IS performed better in z.DDST (β: 0.335, p = 0.036) and Z-score (β: 0.214, p = 0.032) after adjusting for covariates, with sex-specific differences in cognitive domains. TSMR indicated that genetically predicted RA was associated with lower AD risk (OR: 0.936, p = 4.531E-04), and this effect was largely mediated by IS use. MVMR further validated the independent neuroprotective effect of IS on AD (OR = 0.884, p = 0.003) after adjusting for glucocorticoid and NSAID use, while these other medications showed no significant association with AD risk. These results suggest that the reduced risk of AD observed in RA patients may be partly related to IS use, highlighting a potential role of IS in improving cognitive function and modulating AD risk.
Combined effects of multiple risk factors on incident late-onset Parkinson's disease (PD; LOPD) remain poorly characterized. The objective of this study was to quantify the impact of joint risk exposures and estimate the contribution of potentially modifiable factors to incident LOPD risk. In this prospective cohort study, 311,261 UK Biobank participants aged ≥50 years and free of PD at baseline were followed for up to 15 years. During follow-up, 2769 individuals developed incident LOPD. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) for 65 candidate risk factors. Combinations of two (pairs) or three (triplets) risk factors were evaluated for additive interaction. Population-attributable fractions (PAFs) were estimated for potentially modifiable risk factors. Eighteen risk factors (mean HR, 1.43) were independently associated with incident LOPD and subsequently evaluated as joint exposures. Thirteen pairs (mean HR, 2.00) and 14 triplets (mean HR, 4.21) demonstrated significant positive additive interaction and larger effect sizes than individual factors alone. A limited set of modifiable factors-loneliness, low handgrip strength, epilepsy, hearing loss, and diabetes-within the highest-risk pairs (HR range, 2.55-2.93) and triplets (HR range, 5.28-12.24) emerged as major contributors to elevated LOPD risk. Removing modifiable exposures from additive pairs and triplets was associated with reduction in mean HRs of 30% and 49%, respectively (P = 0.001). At the population level, removal of modifiable risk factors accounted for an estimated 34.4% reduction in LOPD incidence. Integrating traditional single-factor approaches with high-risk additive joint exposure profiles may improve risk stratification and inform targeted prevention strategies for incident PD. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.