Incidence of malignant transformation in giant cell tumor of bone following denosumab therapy: a systematic review and meta-analysis.

Examining adverse effects in a large clinical trial of rTMS application as a treatment for Alzheimer's disease.

In this prospective, survey-based study conducted from May 2023 to February 2025 at the Juravinski Cancer Center, patient preferences and perceptions of clinically meaningful outcomes in the adjuvant treatment of resected stage IIB-IV melanoma were evaluated. Sixty-four eligible patients with resected stage IIB-IV melanoma who were considering adjuvant systemic therapy completed an online survey assessing their understanding and prioritization of treatment outcomes, thresholds for meaningful clinical benefit, and willingness to accept toxicity risks. Overall survival (OS) and quality of life (QoL) emerged as the most important endpoints, prioritized by 37 and 31% of respondents respectively, with patients choosing surveillance tending to prioritize QoL while those on active treatment favoured OS. Willingness to accept disease-free/progression-free benefit in the absence of an OS benefit declined as the risk of potential side effects increased, even among patients who ultimately chose active treatment. Patients considered a reduction in recurrence risk from 27 to 10% over 2 years (stage IIB-IIC) and from 50 to 20% over 5 years (stage III-IV) to be clinically meaningful, accepting a median 10-12.5% risk of significant side effects, and desired a minimum cancer-free interval of 4.75 years. These findings suggest that while OS remained a primary concern, many melanoma patients placed high value on QoL and were cautious about initiating adjuvant therapies without demonstrable survival benefit. Reluctance to accept hypothetical treatment with potential toxicity contrasted with those who proceeded with treatment. This highlighted the importance of incorporating patient preferences and risk tolerance into shared decision-making and trial design.

ObjectiveSystemic lupus erythematosus (SLE) is a chronic autoimmune disorder associated with considerable morbidity and mortality, particularly due to frequent hospitalisations. This study aimed to describe the causes, clinical course, and outcomes of hospitalisations among patients with SLE in a multinational cohort.MethodsThis retrospective cohort included adults (aged ≥18 years) with SLE hospitalised at Hamad General Hospital, Qatar, between June 2016 and August 2020. Each admission was considered separately. Data included demographics, clinical features, SLE Disease Activity Index (SLEDAI), serological markers, complications, treatments, and prognoses. Predictors of intensive care unit (ICU) admission were evaluated using univariable and multivariable logistic regression.ResultsThere were 281 admissions among 153 patients. Most patients (87%) were female, with a median age of 34 years (IQR: 26-44). The principal causes of admission were lupus flares, haematologic (38%), renal (28%), and articular (20%), followed by infection (20%). The median hospital stay was 7 days (IQR: 4-12). Re-admission occurred in 51% of the patients, and 17% of the admissions required ICU care. ICU admission was associated with a longer hospital stay (median 16 vs 6 days, p < 0.001) and higher mortality (11% vs 0%, p < 0.001). Factors predicting ICU admission were a higher SLEDAI score (odds ratio (OR) 1.14, 95% confidence interval (CI)1.07-1.21, p < 0.001), sepsis (OR 4.91, 95% CI 2.02-11.89, p < 0.001), and cardiac involvement (OR 7.57, 95% CI 1.74-32.93, p = 0.007).ConclusionsIn this multinational cohort, SLE flares and infections were the leading causes of hospitalisation. Sepsis, comorbid conditions, and high disease activity are associated with adverse outcomes. Optimising disease control, preventing infection, and managing comorbidities are essential to improve hospitalisation outcomes and reduce mortality.

Congenital syphilis (CS) remains a major cause of stillbirth and neonatal morbidity, with an estimated 700,000 cases and 390,000 adverse birth outcomes annually. We evaluated the diagnostic utility of combined treponemal (TT) and nontreponemal (NTT) rapid point-of-care test and Treponema pallidum polymerase chain reaction (PCR) for detecting active maternal syphilis, CS, and treatment response in a high-prevalence, low-resource setting. Secondary analyses were conducted from a prospective case-control study at Queen Elizabeth Central Hospital, Malawi. Women were recruited ≤48 h postpartum. Maternal and infant sera underwent testing with the DPP® Syphilis Screen and Confirm (Dual rapid diagnostic test [RDT]) and T. pallidum PCR (maternal vaginal swabs and infant nasopharyngeal swabs), with predefined clinical-serological reference standards based on qualitative rapid plasma reagin (RPR). Among 504 of 510 women with complete data, Dual RDT identified 110 seropositive cases at delivery, including 86 new maternal syphilis diagnoses. The NTT band showed good performance in mothers versus RPR (sensitivity: 84.8% [95% confidence interval: 77.4%-92.1%]; specificity 92.7% [95% confidence interval: 90.3%-95.1%]) but reduced sensitivity in infants, increasing from 51.9% to 80.0% with RPR titer. Laboratory visual and microreader interpretation showed high concordance (99.5%), while bedside visual accuracy was lower (77.4%). Any Dual RDT positivity identified 19 high-risk infants, of whom 7 of 19 (36.8%) were NTT positive. PCR detected maternal infection in 11 of 504 (2.2%), including 3 serology-negative cases. Dual RDT improves detection over TT alone. The NTT band without quantitation is insufficient for treatment monitoring or infant diagnosis. Combining Dual RDT with PCR may enhance detection of active maternal infection and CS in high-burden settings.

Effects of an imagery-enhanced behavioral activation intervention on depressive symptoms and activation levels: Results from the WIMBA-trial.

Changing pH, organic matter, and redox state govern contaminant mobility during waste stabilization in landfill simulation reactors.

This article reports the management of a female patient who initially presented at onset with severe pneumonia and profound anaemia. The patient was critically ill and deteriorated rapidly, developing acute respiratory failure that necessitated endotracheal intubation. After stabilization of vital signs, a definitive diagnosis was established through a multimodal workup including bronchoalveolar lavage, bone marrow aspiration, and renal biopsy, among other modalities. The findings ultimately confirmed anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with pulmonary and renal involvement; in addition, the potential association between Tropheryma whipplei and pneumonia was discussed. With active etiology-targeted treatment, the patient's symptoms improved rapidly, and the pulmonary inflammation eventually resolved completely.

Safety, immunogenicity, and dose ranging of a bivalent respiratory syncytial virus and human metapneumovirus glycoprotein F-molecular clamp vaccine candidate in older adults: 1-month interim analysis of an ongoing randomised, observer-blind, placebo- and active-controlled, phase 1 trial.

Seroepidemiology, clinical correlates, and GRA6-based genotyping of Toxoplasma gondii among immunocompromised patients in northeastern Iran.

Symptoms of anxiety, including worry and sleep, can be exacerbated by impending medical appointments. These symptoms can impact cancer survivors' ability to prepare for or process information during their appointments. The current study aimed to investigate how worry and sleep change during days or weeks prior to a medical appointment in individuals receiving active treatment for cancer or those in follow-up care. In addition, we examined how coping strategies are associated with fluctuations in worry and sleep around medical appointments. Participants with a history of cancer (N=259, age M=49, 90.7% female, 84.2% non-Hispanic white) completed a baseline assessment, ecological momentary assessments, and weekly surveys for 5 weeks. We conducted a series of multi-level models to examine how appointment day, treatment status, and coping strategies, along with their interactions, predict daily worry and self-reported sleep. On average, participants reported greater worry on days with (vs. without) a medical appointment, regardless of their coping strategies and treatment status. In addition, greater use of emotion suppression was associated with worse self-reported sleep quality the night before an appointment. Reduced self-reported sleep duration was also associated with greater use of suppression, but only among those in active treatment. Medical appointments are associated with worry and self-reported sleep difficulties among cancer survivors, but effects on sleep depend on stage in treatment and/or habitual use of suppression. Cancer survivors may benefit from strategies to manage appointment-related anxiety, with an emphasis on targeted interventions to improve putatively adaptive coping strategies.

College students are vulnerable to depressive symptoms, suicidal ideation, sleep disturbance, and stress-related psychological problems. Aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) have each shown therapeutic potential in affective disorders, but evidence on their combined application in college students at suicide risk remains limited, particularly when neurophysiological outcomes are considered. To evaluate the feasibility, safety, and preliminary effects of aerobic exercise combined with rTMS on suicidal ideation, depressive symptoms, sleep, and prefrontal functional activation in college students at suicide risk. This prospective single-centre non-randomised controlled pilot study will enrol students aged 18-21years who are identified as being at suicide risk by the Xinhai University Crisis Intervention System. At-risk participants will enter one of three groups: active rTMS plus aerobic exercise, sham rTMS plus aerobic exercise, or standardised group psychological intervention/usual support. A separately recruited healthy reference cohort will complete the same assessment schedule without active treatment. Active rTMS will be delivered over the left dorsolateral prefrontal cortex at 10Hz and 120% of the individual motor threshold once daily for 2weeks. Aerobic exercise will be prescribed at a target heart-rate zone of 135-164 beats/min for 30-60min per session every 2days for 2weeks, with heart rate and adherence objectively monitored. The primary outcomes are changes in the Self-rating Idea of Suicide Scale (SIOSS) total score and Self-rating Depression Scale (SDS) standard score from baseline to week 4. Secondary outcomes include SIOSS and SDS dimensions, total sleep time, task-related and resting-state functional near-infrared spectroscopy (fNIRS) measures, adherence, concomitant care, and adverse events. The study was approved by the Ethical Review Committee of Yancheng First People's Hospital (Approval No. 2023-K-230) and the Ethics Committee of INTI International University (Approval No. INTI-IU/FHLS-RC/BTCMI/AUGUST2022/003). Findings will be disseminated through peer-reviewed publications and academic conferences. Chinese Clinical Trial Registry, ChiCTR2400079723.

To generate India-specific health state utility values for head and neck cancers (HNCs) using EuroQol 5-Dimension 5-Level (EQ-5D-5L) and EuroQol Visual Analog Scale (EQ-VAS) instruments, enabling context-relevant cost-utility analyses and health technology assessments. A cross-sectional study was conducted at a tertiary HNC center in India from July 2023 to June 2024. Adults with confirmed HNCs across 53 predefined health states were enrolled. A health state is a specific condition of overall well-being, represented by a utility value indicating how preferable it is compared with perfect health or death. Utility scores were derived from the EQ-5D-5L index using the Indian tariff set and the EQ-VAS. Utility variations across treatment phases, tumor subsites, stage, and comorbidity status were also examined. Of 767 recruited patients, 753 were included for analysis across 48 health states, excluding 5 health states with less sample size. The mean EQ-5D-5L utility was 0.84 (SD 0.20), significantly higher than EQ-VAS (mean 0.73, SD 0.18; P < .001). Utilities varied significantly across treatment phases (P < .001). Clinically, patients in active treatment and palliative recurrence had the poorest perceived health, whereas those in remission showed the highest utility, mirroring expected functional recovery patterns. EQ-5D-5L produced consistently higher utility values than EQ-VAS, reflecting differences between population-weighted and self-perceived health assessments. To our knowledge, this is the first Indian data set of real-world health state utility values in HNC. These values provide essential inputs for economic evaluations and health technology assessments in oncology, supporting more accurate, locally relevant healthcare decision making in resource-limited settings.

Study on microstructure and permeability of modified cut-off wall materials under chemical environmental effects.

Severe acute malnutrition remains a major public health concern, yet a large proportion of affected children do not receive appropriate treatment. Understanding the barriers and associated factors is essential for informing targeted, context-specific interventions. A door-to-door screening campaign among children aged 6-59 months was conducted from May to September 2024 in Kersa (agrarian) and Jeldessa (pastoralist) woredas of Ethiopia. The treatment coverage of severe acute malnutrition was 12.8% (95% CI: 9.0%-17.9%). The most frequently reported barriers to treatment included lack of awareness of the child's nutritional status, time and financial constraints, and absence of family permission. Multivariable analysis revealed that household wealth index (aPR: 2.9; 95% CI: 1.5-5.5), use of water treatment methods (aPR: 4.6; 95% CI: 1.7-11.9), recent community MUAC screening (aPR: 12.0; 95% CI: 5.4-26.8), availability of treatment services at a nearby health post (aPR: 3.2; 95% CI: 1.1-9.9), and possession of a vaccination card (aPR: 3.2; 95% CI: 1.1-9.1) were significantly associated with severe acute malnutrition treatment coverage. The findings highlight that severe acute malnutrition treatment coverage in both pastoralist and agrarian settings of Ethiopia remains critically low. Stronger implementation of active screening and treatment services recommended by Ethiopian national guidelines, together with social protection measures for the poorest households, may improve treatment coverage. Trial Registration: ClinicalTrials.gov (NCT06380504).

We aimed to evaluate the effectiveness of combining low-frequency (1 Hz) rTMS (LF-rTMS) over the unaffected hemisphere or intermittent theta burst stimulation (iTBS) over the affected hemisphere with conventional rehabilitation (CR) on lower extremity motor function, balance, and gait. This single-center, randomized, sham-controlled study included patients with chronic stroke (>6mo) and unilateral hemiplegia (Brunnstrom stages 3 to 5), who were assigned to LF-rTMS+CR (n=21), iTBS+CR (n=21), or sham rTMS+CR (n=21) for 10 sessions using a figure-of-eight coil. All active participants completed treatment, and 18 sham participants were analyzed. The Fugl-Meyer Assessment, Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, Functional Independence Measure, and 36-item Short-Form Health Survey (SF-36) were performed during pretreatment, post-treatment, and 6-week follow-up, alongside assessments of the Hmax/Mmax amplitude at baseline and 6-week follow-up. Both real rTMS groups showed greater improvements in balance and mobility (BBS and TUG) versus sham group. In addition, intragroup evaluation revealed that improvements in mental function and general health (SF-36) were more pronounced in the real rTMS groups. The combination of rTMS, including LF-rTMS or iTBS, with CR may serve as an effective neurorehabilitation strategy to improve balance and mobility in individuals with chronic stroke.

Quantitative scrutiny of biomass-derived battery electrodes: A strategic analysis.

The exponential growth of cancer survivors represents a major healthcare challenge, with more than 23 million people in Europe and 2.2 million in Spain requiring long-term specialized follow-up. Five-year survival has reached 60% in our country, creatinga growing population of long-term survivors who need comprehensive care beyond the stage of active oncological treatment. This consensus document between oncology and primary care professionals establishes a care framework based on shared management for the follow-up of cancer survivors. The proposed model is based on the principles of continuity and ongoing communication, equity in access, and efficiency in resource use, recognizing that the needs of these patients go beyond purely medical aspects to encompass physical, psychological, social, and functional dimensions. This proposal defines a dynamic risk stratification that enables the identification of high-risk patients, who will continue to receive preferential hospital follow-up, and low-risk patients, whose care can be led by primary care with the support of other specialists. Specific roles are established for each level of care, along with bidirectional communication pathways and multidisciplinary coordination tools that include shared medical records, agreed protocols, and rapid referral channels.

The study aims to understand the perceptions and provision of survivorship care among cancer survivors and identify barriers to optimal care. The findings will also provide insights to help Cancer Council NSW to develop policy recommendations to ensure survivors receive comprehensive support throughout their post-treatment journey. A cross-sectional survey was conducted among cancer survivors aged 18 and older who had completed active treatment (n = 209). Data on survivorship care experiences, barriers to access, and unmet needs were collected. Firth logistic and ordinal regression models were used to analyse associations between outcomes (ease of accessing care, information about supportive care, care effectiveness, and unmet needs) and demographic, socioeconomic, and clinical predictors. Most patients (64.2%) received information about supportive care services, and 72.2% felt their needs were met, but only 44.8% found access easy. Educational level was significantly associated with the effectiveness of care after treatment; while lacking a survivorship care plan was associated with lower perceived effectiveness of care after treatment (adjusted OR: 12.80, P < 0.001). Women reported significantly greater difficulty accessing supportive care services (adjusted OR: 0.08, P = 0.004) compared to men. Key barriers included high costs and long appointment wait times, particularly for psychological support, exercise physiology and specialist care. Addressing barriers to survivorship care in NSW requires targeted policy interventions, including financial support, enhanced access across gender groups, and standardised survivorship care plans. The findings assist Cancer Council NSW advocate for policy recommendations to enhance survivorship care services, ensuring equitable access for all cancer survivors.

Community integration is a key outcome for individuals with a history of homelessness after they attain permanent housing. The goals of finding purpose, meaning, and belonging in one's community-despite their importance in predicting mental well-being and housing stability-are frequently elusive for recently housed individuals. This study aimed to evaluate a novel psychosocial intervention that combines two evidence-based practices, motivational interviewing (MI) and cognitive-behavioral therapy (CBT), to improve motivation and functional outcomes related to community integration. Sixty veterans with a recent history of homelessness who were admitted to a U.S. Department of Veterans Affairs supportive housing program in the past year were included in a randomized controlled trial comparing the 12-session MI-CBT treatment with treatment as usual. Participants were assessed at four time points during the study period, which included 24 weeks of active treatment and 12 weeks of follow-up. The primary outcome measures were motivational deficits (negative symptoms), level of behaviors consistent with motivational change, and social and work functioning. Compared with participants in the control group, participants who received MI-CBT showed significantly greater improvement (p<0.05) in motivational deficits over the 12-week acute treatment period. Their gains relative to baseline were maintained at follow-up. MI-CBT yields improvements in motivational deficits. Implications for future studies and for improving generalizability of the motivational negative symptom gains to daily functioning domains are discussed.