Aims/Background Peripheral neuropathy (PN) is a common and debilitating complication in patients with multiple myeloma (MM), which results from both disease-related mechanisms and treatment-induced neurotoxicity. Despite its clinical significance, comprehensive investigations assessing PN risk in MM, along with examining demographic, clinical, nutritional, and inflammatory factors, remain limited. Therefore, this study aimed to investigate independent risk predictors associated with PN in MM patients using univariate and multivariate logistic regression analysis, thereby enhancing clinical risk management and improving treatment outcomes. Methods This retrospective observational study included 161 MM patients who were treated at Ganzhou People's Hospital between February 2020 and February 2024. Study participants were divided into the PN (n = 45) and non-PN (n = 116) groups. PN diagnosis was conducted based on new neurological signs and symptoms post-treatment, confirmed through abnormal sensory, motor, autonomic, or nerve conduction assessments. Baseline characteristics, including demographic information, clinical features, and laboratory parameters, were compared between the two groups using Mann-Whitney U and Chi-square tests. Univariate logistic regression analysis evaluated potential parameters associated with PN. Furthermore, a multivariate logistic model was used to assess independent risk predictors. Finally, model performance was evaluated via receiver operating characteristic (ROC) curve analysis. Results This study analyzed 161 patients, of whom 45 (27.95%) developed PN. Patients in the PN group were significantly older, and had higher body mass index (BMI), increased immunoglobulin G (IgG) and interleukin-6 (IL-6) levels, and increased diabetes prevalence than the non-PN group. However, they exhibited lower hemoglobin (Hb) and serum 25-hydroxyvitamin D [25(OH)D] levels (p < 0.05). Multivariate logistic regression analysis identified older age (odds ratio [OR] = 1.49, 95% confidence interval [CI]: 1.07-2.08), higher BMI (OR = 2.05, 95% CI: 1.01-4.17), reduced 25(OH)D levels (OR = 0.54, 95% CI: 0.29-0.97), elevated IgG (OR = 1.64, 95% CI: 1.12-2.41), and increased IL-6 (OR = 2.07, 95% CI: 1.10-3.88) as independent PN predictor. The model showed excellent discrimination capability (area under the curve [AUC] = 0.998, 95% CI: 0.996-1.000, p < 0.001). Conclusion This study identified older age, higher BMI, vitamin D deficiency, elevated IgG, and increased IL-6 levels as independent risk predictors for PN. Assessing these parameters in the early stages facilitates the identification of high-risk patients, allowing for targeted preventive strategies and personalized nursing interventions in MM patients which can reduce PN incidence and enhance overall clinical outcomes.

Aims/Background Breast signet ring cell carcinoma (SRCC) represents an uncommon tumour that has not been extensively studied. This investigation sought to assess the clinical characteristics and prognosis of breast SRCC and compare them with those of invasive ductal carcinoma (IDC). Methods We obtained clinicopathological data from the Surveillance, Epidemiology, and End Results (SEER) database, including 222 patients with breast SRCC and 492,559 patients with IDC. Clinical features, treatments, and survival outcomes were compared between the two groups. Propensity score matching (PSM) methodology was used to balance baseline characteristics when evaluating overall survival (OS) and cancer-specific survival (CSS). Sensitivity analyses employing E-values quantified the potential impact of unmeasured confounding, and multiple imputation by chained equations (MICE) was used to address missing data for molecular subtype and histological grade. Additionally, predictive models in the form of nomograms were developed to estimate OS and CSS for patients with breast SRCC. Results Compared with IDC, breast SRCC was significantly associated with older age and more advanced tumour, node, metastasis (TNM) stage (p < 0.05 for all). Kaplan-Meier analyses revealed that breast SRCC patients exhibited markedly poorer survival outcomes (OS and CSS, p < 0.05) compared to IDC patients before PSM. For breast SRCC, the median OS was 67.0 months and the median CSS was 90.0 months. The OS rates at 3, 5, and 8 years stood at 60.9%, 51.5%, and 39.6%, respectively, while the corresponding CSS rates were 67.7%, 59.7%, and 48.6%. Following PSM analysis, survival outcomes between breast SRCC and IDC patients became comparable (p > 0.05). Multivariable assessment identified age, histological grade, T stage, and surgical intervention as independent OS predictors (p < 0.05 for all) in breast SRCC, while histological grade, T stage, and surgical approach were independent CSS factors (p < 0.05 for all). The nomograms were subsequently validated using the concordance index (C-index), receiver operating characteristic (ROC), calibration curves, and decision curve analysis (DCA), demonstrating robust prognostic capability. Sensitivity analysis revealed E-values of 1.35 (OS) and 1.49 (CSS), which exceeded typical confounder effects. Multiple imputation demonstrated consistent results (OS: hazard ratio [HR] = 1.20, 95% confidence interval [CI] 0.94-1.54; CSS: HR = 1.30, 95% CI 0.86-1.97), supporting the robustness of the findings. Conclusion Breast SRCC is associated with poorer outcomes primarily due to more advanced stage at presentation rather than histological type alone. Nomograms were developed to estimate OS and CSS for patients with breast SRCC.

As the demographics of global and European countries change, the healthcare systems need to review existing pathways and service models. An ageing population is being offered more complex and invasive surgical procedures. Furthermore, there is an additional risk with this changing population profile, especially due to increasing frailty, sarcopenia, the incidence of cancer is high, and complex co-morbidities. An emerging challenge for the surgical population is the higher prevalence of obesity. These patients, with complex co-morbidities and needs, form the so-defined "high-risk" surgical patients-who account for 12.5% of surgical procedures but 80% of deaths. Prehabilitation is emerging as an important intervention to address the risk to functional capacity and quality of life. Trials have shown reductions of complications, length of stay and readmissions postoperatively. The best impact is arguably when prehabilitation is multimodal (exercise, nutrition, psychological, and lifestyle) and personalised. This article aims to explore the barriers to the availability of prehabilitation in the UK. The authors found the three most significant barriers were cost-effectiveness, workforce shortage and lack of national policy at the time of publication.

Aims/Background In rheumatoid arthritis (RA) patients, malnutrition and sarcopenia are commonly associated with poor prognosis. The prognostic nutritional index (PNI), which includes serum albumin levels and lymphocyte counts, reflects the nutritional and inflammatory status of the patient. Therefore, this study aims to assess the relationship between PNI and sarcopenia in RA and examine its role as a diagnostic tool. Methods This retrospective study analysed data from 178 RA patients hospitalised at Affiliated Jinhua Hospital, Zhejiang University School of Medicine, between June 2023 and June 2025. Sarcopenia was diagnosed following the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Demographic, clinical, and laboratory data were collected, and PNI was calculated. Univariate and multivariate logistic regression analyses were performed to examine the association between PNI and sarcopenia, and receiver operating characteristic (ROC) curves were used to evaluate its diagnostic performance. Results Out of the total 178, 56 (31.5%) patients were diagnosed with sarcopenia. Multivariate regression analysis indicated lower PNI as an independent risk factor for sarcopenia (odds ratio [OR] = 0.88, 95% confidence interval [CI]: 0.80-0.97, p = 0.007), indicating that each 1-point increase in PNI was associated with a 12% decrease in risk. Older age (OR = 1.07), longer RA disease duration (OR = 1.50), and higher C-reactive protein (CRP) (OR = 1.06) were also independent risk factors. A prediction model combining age, PNI, disease duration, and CRP showed excellent discriminatory ability for sarcopenia, with an area under the curve (AUC) of 0.92 (95% CI: 0.87-0.97, p < 0.001), a sensitivity of 95.1%, and a specificity of 80.4%. Conclusion PNI is a simple, cost-effective measure that integrates nutritional (albumin) and inflammatory (lymphocyte) markers, facilitating early identification of RA patients at higher risk for sarcopenia and providing a basis for timely intervention.

Lower extremity amputation is the most feared complication in people living with diabetes and produces a significant physical, psychosocial and economic burden. The annual cost of diabetes-related ulceration and amputation is £837-£962 million, i.e., 0.8-0.9% of the National Health Service budget for England. Major amputation rates have reduced globally, largely in association with the introduction of diabetes foot multidisciplinary team services. However, more recently, amputation rates have stagnated in the UK and started to increase again in the USA, driven by increased amputation rates in younger patients and those from areas of greater social deprivation. We discuss interventions shown to reduce lower limb amputation in diabetes including multidisciplinary team services, root cause analysis, prompt referral for expert assessment and whole systems approaches designed to improve diabetic foot care throughout the patient experience. Some recent novel clinical interventions also demonstrate potential for greater limb preservation. We also discuss recent novel plastic and vascular surgery interventions and advanced dressing solutions, which show promise in improving limb salvage rates in the context of diabetic foot ulceration.

Aims/Background Esketamine exhibits strong sedative and analgesic effects. Similarly, erector spinae plane block (ESPB) blocks somatic and visceral nerves and is commonly used for pain relief in thoracic surgery. Therefore, this study aims to investigate the impacts of combining esketamine with ESPB on opioid consumption, inflammatory stress, and cognitive function after thoracoscopic surgery. Methods This retrospective study collected clinical data from 114 patients who underwent thoracoscopic surgery at Jinhua Municipal Central Hospital, between January 2022 and January 2024. Based on anesthesia approaches, patients were divided into the ESPB (n = 62) and esketamine + ESPB groups (n = 52). Several variables, such as perioperative indicators, postoperative recovery, inflammatory stress, and cognitive function were compared between the two groups. Results In both groups, the Numeric Rating Scale (NRS) score increased at 6 h postoperatively compared to at 1h, and gradually decreased at 12 h, 24 h, and 48 h (p < 0.05). Compared to the ESPB group, the NRS score was significantly decreased in the esketamine + ESPB group at 6 h, 12 h, 24 h, and 48 h after surgery (p < 0.001). The oxycodone consumption was significantly lower in the esketamine + ESPB group at 24 h and 48 h post-surgery than in the ESPB group (p < 0.001). Furthermore, the incidence of adverse reactions was 30.6% (19/62) in the ESPB group and 34.6% (18/52) in the esketamine + ESPB group, with the difference being statistically insignificant (p = 0.652). Compared to the ESPB group, the white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-6, and tumor necrosis factor (TNF)-α levels were significantly decreased in the Esketamine + ESPB group at day 3 after surgery (p < 0.001). Compared to the ESPB group, the Montreal Cognitive Assessment Scale (MoCA) score was substantially elevated in the esketamine + ESPB group at days 1 and 3 after surgery (p < 0.001, p = 0.001). Conclusion The combination of esketamine and ESPB effectively alleviated postoperative pain and reduced opioid consumption after thoracoscopic surgery. Furthermore, the combined approach significantly improved postoperative inflammatory stress and cognitive impairment compared to the use of ESPB alone without increasing adverse reactions.

Aims/Background The efficacy of antiplatelet therapy exhibits interindividual variability, highlighting the need to identify underlying factors contributing to this heterogeneity in clinical settings. Increasing clinical attention has been directed toward genetic polymorphisms, aiming to optimise antiplatelet therapy based on patient genotype to enhance treatment efficacy and improve prognosis. This study aimed to analyse the relationship between cytochrome P450 2C19 (CYP2C19) and glycoprotein 1b alpha subunit gene (GP1BA) polymorphism and the efficacy of antiplatelet therapy and prognosis in patients with acute cerebral infarction (ACI). Methods A total of 200 ACI patients treated at First Affiliated Hospital of Bengbu Medical University between January 2021 and May 2024 were enrolled. The distributions of CYP2C19 and GP1BA gene polymorphisms were determined. Differences in platelet inhibition rates among patients with various CYP2C19 and GP1BA genotypes were compared. Clinical characteristics and genotype distributions were analysed between patients with varying prognoses. A nomogram model was constructed to predict prognosis. Results Among the CYP2C19 genotypes, 84 patients were classified as fast metabolizers, 82 as intermediate metabolizers, and 34 as slow metabolizers. For GP1BA, 94 patients had the CC genotype, 78 had CT, and 28 had TT. The platelet inhibition rate in slow metabolizers was (50.12 ± 13.32) %, markedly lower than in fast and intermediate metabolizers (p < 0.05). Among GP1BA genotypes, the platelet inhibition rate in CC type patients was (55.30 ± 9.92) %, significantly lower than in CT and TT types (p < 0.05). Patients with poor prognosis had a mean age of (65.59 ± 9.92) years and a baseline National Institutes of Health Stroke Scale (NIHSS) score of (14.50 ± 2.02), both significantly higher than those in the good prognosis group (p < 0.05). The proportion of patients with diabetes in the poor prognosis group was 43.75%, significantly higher than in the good prognosis group (p < 0.05). Significant differences in CYP2C19 and GP1BA genotype distributions were observed between patients with poor and good prognoses (p < 0.05). Logistic regression analysis identified age, NIHSS score at admission, diabetes, and both CYP2C19 and GP1BA genotypes as independent factors influencing poor prognosis (p < 0.05). The nomogram model constructed for prognosis prediction showed good performance, with the area under the curve (AUC) of 0.815 (95% confidence interval [CI]: 0.737-0.894, p < 0.05). The model demonstrated a sensitivity of 87.5% and a specificity of 65.90%. Conclusion CYP2C19 and GP1BA polymorphisms are related to the efficacy of antiplatelet therapy and are influencing factors for prognosis in ACI patients. The constructed nomogram model demonstrates good predictive value for clinical outcomes.

Aims/Background Burnout among nursing students has become a critical issue, negatively impacting their academic performance, psychological well-being, and professional development. This systematic review aims to synthesise literature on nursing student burnout and explore its effects on self-concept, engagement, and psychological health, along with strategies to mitigate burnout. Methods This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included studies published between January 2015 and January 2024. Data were extracted from peer-reviewed studies identified in databases including MEDLINE, CINAHL, PsycINFO, and SCOPUS, focusing on burnout among undergraduate and graduate nursing students. Results A total of 28 articles were included in the review. Three major themes emerged: (1) burnout's negative effect on student self-concept and self-efficacy, (2) the protective role of academic and clinical engagement in preventing burnout, and (3) interventions such as resilience training and mindfulness-based programs that help reduce burnout. Promoting self-concept, fostering engagement, and building resilience were identified as key strategies to alleviate student burnout. Conclusion Burnout in nursing students is linked to poorer academic performance and psychological distress. Early interventions, such as resilience training and mindfulness, should be integrated into nursing programs to help mitigate burnout. Nurse educators and clinical supervisors can play a pivotal role by creating supportive and engaging learning environments that reduce burnout and promote students' well-being.

Epilepsy is a serious neurological condition that can affect individuals of all ages. Treatment is far from perfect, and roughly 30% of patients can experience seizures that are resistant to antiseizure medications. Interestingly, the cannabis plant, specifically the phytocannabinoids, cannabidiol and delta-9-tetrahydrocannabinol, has been shown to possess anticonvulsant properties and are effective in the treatment of seizures. The clinical evidence base for cannabis for epileptic conditions has been growing in the last few decades with studies aiming to establish the clinical efficacy and safety profile of the plant. Despite the advancements that are being made, clinicians and medical regulatory bodies are still reluctant for epilepsy patients to use cannabis. Thus, it is essential that individuals are educated about the therapeutic properties of cannabis and the clinical evidence base to help patients gain access to cannabis medicines.

The use of [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) in breast cancer response assessment and monitoring is well established. However, there are limitations not only to the use of [18F]FDG PET/CT in breast cancer, but also deficiencies in the conventional imaging assessment of treatment response. Breast cancer is biologically heterogeneous, and heterogeneity of tumours limits the accuracy of [18F]FDG PET/CT assessment in some subtypes of breast cancer. Increased understanding of tumour biology and the tumour microenvironment have led to the development of new, specific radio-tracers. These targeted tracers may offer a solution in terms of more accurate response assessment, and prognostication.