BACKGROUND Sarcopenia has been indicated to be related to the postoperative outcome of patients with various digestive tract diseases. However, no studies have investigated the association between sarcopenia and esophageal stenosis after endoscopic submucosal dissection (ESD). AIM To explore the correlation between sarcopenia and post-ESD esophageal stenosis, and subsequently develop a risk prediction model. METHODS Retrospective data from 499 patients who underwent esophageal ESD were collected. After stratification via the L3 skeletal muscle indices (L3-SMIs) into sarcopenia and non-sarcopenia groups, post-ESD stenosis rates were compared. Propensity score matching (PSM) was used for sensitivity analysis. The original cohort was randomly split at a ratio of 7:3 into training (n = 350) and validation (n = 149) groups to construct and validate a risk prediction model for post-ESD stenosis. RESULTS Sarcopenia was significantly associated with post-ESD esophageal stenosis (48.23% vs 22.35%, P < 0.001). Furthermore, multivariate analysis confirmed its independence as a predictor of this postoperative complication [odds ratio (OR): 3.86; 95% confidence interval: 1.76-8.45; P < 0.001]. This conclusion was consistent across the subgroup analyses and PSM analyses. The risk prediction model incorporating sarcopenia had area under the curve values of 0.848 (training set) and 0.794 (validation set). Calibration curves and Hosmer-Lemeshow tests indicated good calibration of the model. Moreover, decision curve analysis confirmed a positive net clinical benefit for the model. CONCLUSION Sarcopenia is an independent risk predictor of post-ESD esophageal stenosis. Our model integrating muscle mass assessment aids in early high-risk identification and intervention.

BACKGROUND Fatigue is debilitating and costly for patients with Crohn’s disease (CD) and the healthcare system. Thus, as there are no well-established therapies for fatigue in patients with CD, it is essential to investigate its risk factors and collaborate to prevent or reduce its burden. AIM To evaluate the variables associated with fatigue in outpatients with CD receiving pharmacological treatment. METHODS It is an observational study. Data, including sociodemographic information, inflammatory bowel disease fatigue scores, visual analog scale scores, Depression Anxiety Stress Scale-21 scores, insomnia assessment results, and laboratory test results, were collected. Statistical analyses included Student’s t tests, logistic and linear regressions, and receiver operating characteristic curve analysis, with a P value of < 0.05 indicating statistical significance. RESULTS One hundred patients were included (77% presented with fatigue). In the linear regression analysis, symptoms of depression, anxiety, stress, and insomnia were simultaneously included as predictors of fatigue. Although the model was statistically significant (adjusted R 2 = 0.128; P = 0.002), no single symptom was significantly associated. A composite score (0-4) was developed by summing the scores of the 4 symptoms, which were coded dichotomously (odds ratio = 2.60; 95% confidence interval: 1.61-4.83; P < 0.001). The composite score showed good discriminative capacity (area under the curve = 0.775). Patients with fatigue had higher total leukocyte (P = 0.034) and segmented neutrophil (P = 0.017) counts and lower lymphocyte (P = 0.019) and eosinophil (P = 0.036) counts. Effect sizes ranged from moderate to high (Cohen’s d 0.39-0.61), indicating that fatigue may be associated with a leukocyte pattern consistent with relative neutrophilia and lymphopenia. CONCLUSION Fatigue is associated with psychological symptoms, a sedentary lifestyle, and alterations in leukocyte subpopulations. Assessments incorporating composite symptom scales and hematological parameters may be practical and cost-effective for patients with fatigue.

The aim of this study was to identify factors associated with continuity of medication administration following transitions-of-care from hospitals to residential aged-care facilities (RACFs). This was a prospective, observational study of randomly selected patients discharged to an RACF from hospitals within four public health services in Victoria, Australia. Data were collected from hospital medical records and structured telephone interviews with RACF nurses post-discharge. Multivariable regression analysis using a modified Poisson model with generalised estimating equations was performed to estimate adjusted relative risks (RRs) and confidence intervals (CIs). The dependent variable was missed or significantly delayed medication doses at RACFs 24-h post-discharge. Nurses for 397 patients at 78 RACFs were interviewed. Ninety (22.7%) patients had one or more missed or significantly delayed doses. There was lower risk of missed/delayed doses when the hospital supplied discharge medications (RR 0.53, 95% CI 0.33-0.85), community pharmacy delivered repackaged medications on the day-of-discharge (RR 0.48, 95% CI 0.30-0.76), the hospital provided an interim medication administration chart (RR 0.63, 95% CI 0.46-0.85), and there was more time between discharge and the first post-discharge medication dose-time (RR 0.91, 95% CI 0.86-0.96 for each additional hour). There was higher risk of missed/delayed doses when there were multiple medication changes in hospital (RR 1.05, 95% CI 1.04-1.07 for each additional change) and when the RACF medication chart was prepared/updated by a GP or locum on the day-of-discharge (RR 1.38, 95% CI 1.23-1.56). Missed and significantly delayed doses were less likely when hospitals provided discharge medications and an interim medication administration chart, and when community pharmacies delivered repackaged medications on day-of-discharge.

Objective: To investigate the effects of pre-pregnancy and prenatal exposure to six major air pollutants (CO, NO2, O3, PM10, PM2.5, SO2) on birth weight in newborns and identify critical exposure windows. Methods: This retrospective cohort study analyzed data from 1 561 mother-infant pairs who delivered at Taiyuan Central Hospital between January 2020 and December 2023, combined with contemporaneous air pollution monitoring records. This study used the geographic information system (GIS) technology to evaluate the individual air pollutants exposure level of pregnant women, and calculated the average pollutant concentrations for four stages: preconception (the 12 weeks before conception), first trimester (weeks 1-13), second trimester (weeks 14-27) and third trimester (weeks 28-37). Multiple linear regression models were used to assess the associations between air pollutant exposure and birth weight at different pregnancy stages. The distributed lag nonlinear model (DLNM) was further constructed to characterize the nonlinear exposure-lag-response relationships, identify sensitive windows, and examine sex differences. Results: Preliminary multiple linear regression showed that third-trimester exposures to PM2.5(β^=-43.00, 95%CI:-79.40- -6.68), PM10(β^=-35.00, 95%CI:-66.00- -4.07), NO2(β^=-35.50, 95%CI:-66.90- -4.08) and SO2(β^=-28.80, 95%CI:-52.70- -4.97) were negatively associated with birth weight (all P<0.05), but these associations disappeared after full adjustment for covariates. DLNM analysis revealed exposure-response relationships for CO, O3, PM10, and SO2 on birth weight, with distinct critical exposure windows: CO (weeks 2-13, 14-20), O3 (weeks 4-13, 14-24), PM10 (weeks 22-27, 28-37), and SO2 (weeks 11-13, 14-27 and 28-37). Among these, the largest effect were observed for CO at gestational week 12, O3 at week 13, and for both PM10 and SO2 at week 37. The effect estimates and their 95% confidence intervals were -37.12(-62.78- -11.45), -3.61(-6.45- -0.77), -5.01(-8.98- -1.04) and -8.31(-12.07- -4.56), all P<0.05. Gender differences in pollutant effects were observed: male newborns were more sensitive to SO2 across multiple stages, to CO in mid-pregnancy, and to PM10 in late-pregnancy; female newborns were more susceptible to PM10 in the preconception and early-to-mid-pregnancy periods, to O3 in early-to-mid pregnancy, and to SO2 in late pregnancy. Conclusion: Exposure to air pollutants during pregnancy is associated with reduced birth weight in newborns. Different pollutants have specific exposure windows, and gender differences exist. This finding provides important scientific evidence for preventing adverse pregnancy outcomes and developing intervention strategies to improve neonatal health.

Balloon-expandable valve (BEV) and self-expanding valve (SEV) are used in transcatheter aortic valve replacement (TAVR). Patients with a small aortic annulus (SAA) make up to one-third of the cases and face higher risks of prosthesis-patient mismatch and high valvular gradients. This meta-analysis aimed to compare balloon-expandable and self-expanding valves used in TAVR in patients with a SAA, focusing on hemodynamic and clinical outcomes. We systematically searched Cochrane Central, PubMed, and EMBASE for studies comparing balloon-expandable and self-expanding valves in patients with SAA undergoing TAVR. Random effects models were applied to generate odds ratios (ORs) and mean differences with 95% confidence interval (CI). Fifteen studies (two randomized controlled trials and 13 propensity-matched studies) with 5149 patients (48.4% balloon-expandable valves) were identified. BEVs were associated with a lower indexed effective orifice area (mean difference: -0.18, 95% CI: -0.25 to -0.10; P < 0.00001) and higher transvalvular mean pressure gradient (mean difference: 4.32, 95% CI: 3.39-5.24; P < 0.00001) and peak pressure gradients (mean difference: 4.87, 95% CI: 1.23-8.51; P = 0.009). Permanent pacemaker implantation (OR: 0.57, 95% CI: 0.44-0.73; P < 0.0001) and major bleeding (OR: 0.67, 95% CI: 0.47-0.96; P = 0.03) were lower in balloon-expandable valves. BEVs increased the odds of any prosthesis-patient mismatch (OR: 2.28, 95% CI: 1.61-3.22; P < 0.00001) and severe prosthesis-patient mismatch (OR: 3.16, 95% CI: 2.19-4.58; P < 0.00001). In patients with SAA undergoing TAVR, SEVs offer superior hemodynamic performance, whereas BEVs are associated with fewer conduction disturbances and bleeding events. Both valve platforms yielded similar clinical outcomes, underscoring the need for individualized device selection.

This study aimed to comprehensively evaluate the efficacy of music intervention as a non-pharmacological approach for improving physiological and psychological outcomes in patients with hypertension through a systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Embase, The Cochrane Library, Web of Science Core Collection, Wanfang Data, and CNKI for RCTs investigating the effects of music therapy on blood pressure, heart rate (HR), anxiety, and depression in hypertensive adults. Data were pooled using random-effects models, and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. The robustness of findings was assessed via sensitivity analysis, and publication bias was evaluated using Egger's and Begg's tests. Twenty-one RCTs involving 1436 participants were included. Meta-analysis revealed that music intervention significantly reduced systolic blood pressure (SBP) (WMD = -8.26mmHg, 95% CI: -10.56 to -5.96), diastolic blood pressure (DBP) (WMD = -5.91mmHg, 95% CI: -8.03 to -3.79), HR (WMD = -4.17, 95% CI: -7.22 to -1.12), anxiety levels (measured by Self-Rating Anxiety Scale, SAS) (WMD = -5.22, 95% CI: -7.03 to -3.40), and depression levels (measured by Self-Rating Depression Scale, SDS) (WMD = -7.12, 95% CI: -10.27 to -3.98). Sensitivity analyses confirmed the stability of these findings, and statistical tests showed no significant publication bias for primary outcomes. Music therapy is an effective complementary intervention for reducing blood pressure, HR, anxiety, and depression in hypertensive patients. Personalized music selections and longer intervention sessions may enhance efficacy. Future research should focus on standardizing intervention protocols, clarifying underlying mechanisms, and exploring long-term efficacy.

The optimal conversion treatment for patients with borderline resectable pancreatic cancer or locally advanced pancreatic cancer (BRPC/LAPC) remains unclear. In this study, we present the efficacy and safety results of a phase II trial evaluating tislelizumab combined with hypofractionated radiotherapy plus nab-paclitaxel/gemcitabine (THAG) in patients with BRPC/LAPC (ChiCTR2000032955, NCT05634564). This phase II trial enrolled 56 patients with BRPC/LAPC (BRPC: 17, 30.4%; LAPC: 39, 69.6%). Participants received tislelizumab plus nab-paclitaxel/gemcitabine (AG) in 21-day cycles. Nonprogressing patients received concurrent radiotherapy during the third chemotherapy cycle. After four treatment cycles, a multidisciplinary team assessed eligibility for radical surgery. Dynamic biomolecular profiling was performed. Fifty-six eligible patients were enrolled. The objective response rate was 51.8% [95% confidence interval (CI), 38.0%-65.3%]. Median progression-free survival (mPFS) was 13.2 months (95% CI, 11.6-19.4 months), and median overall survival (mOS) was 21.3 months [95% CI, 18.8-not reached (NR)]. Among 30 patients who met criteria for surgical resectability, 22 patients (22/56, 39.3%) underwent radical resection, comprising nine patients with BRPC (9/17, 52.9%) and 13 patients with LAPC (13/39, 33.3%). The margin-negative resection rate reached 90.9% (95% CI, 70.8%-98.9%), and the mOS of patients who underwent surgery was 34.0 months (95% CI, 20.1-NR). Grade ≥3 adverse events (AE) occurred in 33/56 patients (58.9%). Dynamic biomarker exploration revealed that baseline IL6 level (>5 pg/mL) predicted better PFS. Moreover, circulating tumor DNA (ctDNA) status and clearance demonstrated superior survival. The THAG regimen as preoperative therapy showed encouraging clinical activity with a manageable safety profile. Dynamic biomarker findings reveal potential for guiding precision treatment strategies with THAG.

The optimal threshold to blood transfusion in patients after hip fracture surgery is unclear. This study leveraged regression discontinuity to quantify blood transfusion practices across haemoglobin thresholds of 7.0, 8.0, and 10.0 g/dL. This study used the enhanced claims-based Premier Inc. database and included inpatients, aged 50+, with an ICD-10 code for hip fracture and hip surgery, and at least one haemoglobin following surgery. For each patient-day following surgery, we determined the lowest haemoglobin level and whether blood transfusion was administered. Regression discontinuity (RD) models with local linear regression were used to calculate risk differences, mean differences, and 95% confidence intervals (CIs) for blood transfusion use. There were 320,194 patient-days (among 93,111 patients) included in analyses. Transfusion occurred on 29,425 patient-days (9.2%). The median haemoglobin on patient-days with a transfusion was 7.0 (interquartile range [IQR] 6.7-7.6) g/dL and the median haemoglobin on patient-days without a transfusion was 9.3 (IQR 8.4-10.4) g/dL. There was a statistically significant increase in transfusion use crossing a haemoglobin threshold of 7.0 g/dL (19.0; 95% CI, 13.5-22.5 absolute percentage points) and a small, statistically significant increase in transfusion use crossing an 8.0 g/dL haemoglobin threshold. (3.2; 95% CI, 0.9-6.2 absolute percentage points). There was no discontinuity in transfusion use across a haemoglobin concentration threshold of 10.0 g/dL (-0.2; 95% CI -0.7-0.3 absolute percentage points). After hip fracture surgery, transfusion based on a haemoglobin threshold of 7.0 g/dL was more common than at guideline recommended 8.0 g/dL or at the liberal threshold of 10 g/dL.

Despite improvements in availability, young adults in many low- and middle-income countries still do not use reproductive health (RH) services much. However, there is not much research on this in oil producing and semi urban areas like Bonny Island, Nigeria. This study aims to model and understand how young adults in Bonny Island use RH services and to find the social-demographic, knowledge based and access related factors that affect this use. A community based cross sectional survey was done with 800 participants aged 15 – 29 years. The use of a single RH service was used to define RH service utilization. A pretested questionnaire was used for the purpose of data collection. Descriptive statistics were used to summarize the characteristics of the participants. Chi-square tests were then used to examine the relationships between pairs of variables. In addition, multivariable logistic regression using cluster-robust standard errors was used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). The model’s performance was evaluated using the area under the receiver operating curve (AUC), pseudo –R 2 and calibration metrics. This showed that 59.6% of the participants reported using RH services. Furthermore, awareness of RH services was high, as 73.8% and 45.0% of the participants found the service locations convenient. In the multivariable analysis, none of the predictors reached statistical significance, and the effect estimates were small and uncertain, as indicated by confidence intervals that included one for all variables examined. These included gender [AOR: 1.01, 95% CI: 0.73 – 1.41], age groups, education, awareness of RH services [AOR: 0.87, 95% CI: 0.60 – 1.26], and service convenience [AOR: 0.86, 95% CI: 0.64 – 1.16]. The model showed poor discrimination [AUC: 0.549], had limited explanatory power (pseudo- R 2 ) and demonstrated poor calibration. Traditional socio-demographic, knowledge based and access related factors explained little of the RH service utilization observed among young people in Bonny Island. The model’s weak performance and the wide confidence intervals suggest that unmeasured factors, particularly service quality, confidentiality, stigma, and the nature of provider–youth interactions, are significant influences on utilization.

Docetaxel improves survival in metastatic hormone-sensitive prostate cancer (mHSPC) and high-risk localized disease, but benefits vary substantially among patients. Without predictive biomarkers, clinicians cannot identify patients who will benefit, exposing many to unnecessary toxicity. We developed and validated an artificial intelligence-based pathology image classifier (APIC) to predict docetaxel benefit. We analyzed digitized hematoxylin and eosin-stained biopsy specimens from two phase 3 trials: CHAARTED (286/790 patients with mHSPC) and NRG/RTOG 0521 (350/563 patients with high-risk localized disease). APIC used features capturing tumor-immune spatial interactions and nuclear heterogeneity. We evaluated the predictive value of APIC for docetaxel benefit on overall survival (OS) and castration resistance using Cox proportional hazards with interaction terms. In CHAARTED, APIC-positive patients (56.7%) showed significant OS improvement with docetaxel [HR, 0.52; 95% confidence interval (CI), 0.31-0.85; P = 0.008] and delayed castration resistance (HR, 0.48; 95% CI, 0.33-0.71; P < 0.001), whereas APIC-negative patients (43.3%) showed no benefit (HR, 1.31; 95% CI, 0.71-2.44; P = 0.39). Treatment-APIC interactions were significant (P = 0.022 and P = 0.031). In NRG/RTOG 0521, APIC-positive patients (44.7%) demonstrated survival benefit (HR, 0.49; 95% CI, 0.26-0.92; P = 0.023), whereas APIC-negative patients (55.3%) showed no benefit. Treatment-APIC interaction was significant (P = 0.024). Predictive value remained significant after adjusting for clinical variables. Limitations include retrospective analysis and need for prospective validation. APIC predicts docetaxel benefit in both metastatic and localized prostate cancers, independent of clinical factors. Validation in triplet therapy with androgen receptor pathway inhibitors is needed.

We explored the efficacy of PARP inhibition combined with sapacitabine, an orally bioavailable prodrug of the deoxycytidine analog 2'-C-cyano-2'-deoxy-1-β-D-arabino-pentofuranosylcytosine, in patients with germline BRCA1/2-mutated HER2-negative metastatic breast cancer. In this phase Ib investigator-sponsored study of sapacitabine and olaparib, patients who were PARP inhibitor-naïve were enrolled. The primary objective was determination of the recommended phase 2 dose (RP2D) of sapacitabine with olaparib. Archival samples were subjected to IHC for biomarkers of homologous recombination repair (HRR) deficiency and replication stress. Serial blood samples were collected for ctDNA analysis. Ten patients (3 BRCA1 and 7 BRCA2) were enrolled. The RP2D was not determined due to hematologic toxicities. The objective response rate (ORR) was 50% (95% confidence interval, 18.7%-81.3%), with median progression-free survival (mPFS) of 9.7 months (95% confidence interval, 8.02-not estimable). Three patients had clinical benefit greater than 15 months, including two who remained on trial for more than 40 months. Tumors from responding patients demonstrated HRR deficiency and/or replication stress by IHC. At progression, ctDNA from two patients had evidence of BRCA reversion mutations associated with a microhomology-mediated end-joining signature, and three patients had acquired putative nonreversion mechanisms of resistance. Sapacitabine with olaparib produces high rates of hematologic toxicity. However, the ORR of 50%, mPFS of 9.7 months, and durability of response in some patients suggest possible combinatorial benefit. Further exploration of olaparib with different sapacitabine schedules or substitution of a PARP1-selective inhibitor to potentially decrease hematologic toxicity is warranted.

Female underrepresentation in clinical trials of acute coronary syndromes (ACS) may hinder the assessment of sex-based differences in the outcomes of long-term pharmacological therapy. The presence of these differences and their potential association with female representation in clinical trials remain unclear. A systematic search of Embase, Medline Ovid, and Cochrane Central was conducted through July 1, 2025, in accordance with the reporting standards of the PRISMA guidelines. Eligible randomized controlled trials (RCTs) compared long-term pharmacological therapy for ACS with placebo or standard care, included ≥1-year follow-up, and reported a clinical event as the primary outcome. Sex differences in treatment effects were analysed using a random-effects meta-analysis, while meta-regression was used to assess the association between the proportion of females in each trial and these differences. The main outcome was the sex difference in the relative effect measure (REM; mostly a hazard ratio) for the primary efficacy endpoint. Among 102 RCTs, female representation ranged from 10% to 52%. Forty-eight trials provided sex-stratified data. Pooled analysis showed no evidence of sex-related differences in efficacy: the mean difference in the log of the REM of males minus females was 0.00 (95% confidence interval, -0.05 to 0.05; P = 0.98; heterogeneity I² = 0%). Meta-regression indicated no relationship between female trial participation and sex-specific treatment effects. In RCTs of long-term pharmacological therapy after ACS, treatment efficacy was comparable between sexes, irrespective of sex distribution. These findings support current guidelines recommending equivalent long-term pharmacological strategies for secondary prevention in both sexes.

A retrospective study. To develop a nomogram to predict functional independence (FI) in patients undergoing lumbosacral spine surgery (LSSS). LSSS aims to improve functional outcomes and restore activities of daily living. We hypothesized that demographic, clinical, surgical, and neurological characteristics could be used to predict FI, as defined by the Barthel index (BI) scores. The medical records of patients who underwent LSSS between October 2023 and September 2024 were reviewed. Univariate and multivariate logistic regression analyses were used to construct a predictive nomogram. Model performance was assessed using receiver operating characteristic curve analysis for discrimination and a bootstrap-based plot for calibration. Decision curve analysis and the Youden index were used to determine the optimal threshold probability for identifying patients requiring additional rehabilitation. The study included 111 patients (35 men and 76 women; mean age, 63.66±11.37 years), of whom 68 (61.26%) achieved FI. The nomogram, incorporating preoperative BI score, hospital stay <7 days, and absence of metabolic comorbidities and postoperative anemia, demonstrated excellent discrimination (area under the receiver operating characteristic curve=0.91; 95% confidence interval, 0.84- 0.98) and good calibration with the goodness-of-fit test (p>0.05). The optimal threshold probability cutoff was 0.58, with a sensitivity of 84% and specificity of 88%. This tool demonstrated excellent discriminative ability between patients who required further rehabilitation and those who did not, with a Youden index of 0.71. This nomogram exhibited excellent discrimination and good calibration and could serve as a predictive tool for FI on the day of hospital discharge. Its application may support discharge planning and facilitate patient stratification to optimize postoperative rehabilitation.

Background: Rotaviruses are among the most common causal pathogens of severe dehydrating diarrhoea in children. Little is known about the burden of rotavirus diarrhoea in Gabon. Aim: This study aimed to determine the proportion of rotavirus infection in children under 5 years with diarrhoea in Lambaréné and seen at the hospital and factors associated with rotavirus infection. Setting: The data used in this study were collected between February 2020 and February 2021 in children presenting with acute diarrhoea in the Albert Schweitzer Hospital paediatric ward. Methods: A cross-sectional study was carried out. Stool samples were tested for rotavirus antigens using the rotavirus Standard Diagnostic (SD) BIOLINE Rota and Adeno enzyme immunoassay detection kit. Results: A total of 178 children were included in the study. The proportion of rotavirus infection was 22% (n = 39/178; 95% confidence interval [CI]: 16% – 29%). In the multivariate analysis, the rotavirus was independently associated with dehydration (adjusted odds ratio [aOR] = 2.65; 95% CI: 1.09–6.86), vomiting (aOR = 3.15; 95% CI: 1.29–8.25), lethargy (aOR = 3.12; 95% CI: 1.16–8.71) and hospitalisation (aOR = 4.63; 95% CI: 1.7–13.65). Conclusion: Rotavirus infection was associated with severe diarrhoea and hospitalisation. This study shows the need to integrate and support free rotavirus vaccination into the expanded vaccination programme in Gabon. Contribution: This study provides evidence that could guide public health strategies and inform vaccine policies that could ultimately reduce the burden of rotavirus-associated diarrhoea in children.

Cochlear implant (CI) non-use and minimal-use are important, but sparsely investigated parameters. This study investigates the risk of becoming a CI non-user or a minimal-user in a post-lingual deafness adult population. Retrospective cohort study. Tertiary medical institution. All adult patients (18 years or above) who received CI surgery at a single center from 2010 to 2022 (n=599) were invited to participate in a questionnaire study concerning the CI usage after surgery. The questionnaire information was combined with data from medical records. Non-use was defined as never/rarely usage of the device. Minimal-users were patients who reported <4 hours of daily use, and patients considering ceasing to use their device, and not included in the non-use group. In total, 472 (78.8%) patients replied to the questionnaire regarding CI usage. Hereof, 20 patients (4.2%) were non-users and 26 patients (5.5%) were minimal-users with mean follow-up times of 8.4±3.4 years. Rehabilitation was provided for 97% of the participants by a speech-language pathologist for 6 to 12 months. Abnormal cochlear anatomy was associated with CI non-use (odds ratio=5.7, 95% confidence interval [1.1-30.8], P=0.04). No additional correlations were found between non-users, minimal-users, and CI users. The CI non-user rate was 4.2% and these patients experienced lower QoL compared with CI users. In addition, 5.5% of the patients were minimal-users. In adults with abnormal cochlear anatomy, an increased risk of non-use was identified, reflecting the need for thorough information regarding surgical outcomes in this specific subgroup of patients.

HER2DX is a validated genomic assay used to support treatment decisions in early-stage HER2-positive (HER2+) breast cancer. It provides three scores: relapse risk, likelihood of pathologic complete response (pCR), and ERBB2 mRNA expression. This study aimed to evaluate the association between HER2DX and histopathologic features and assess its relationship with pCR after neoadjuvant therapy. Patients with newly diagnosed stage I to III HER2+ breast cancer were analyzed based on available HER2DX results during routine care in Spain (January 2022-June 2025). Centralized HER2DX testing was performed on formalin-fixed, paraffin-embedded tumor samples. Histopathologic analysis included tumor grade, hormone receptor status, histologic subtype, Ki67 index, HER2 IHC score, stromal tumor-infiltrating lymphocytes (TIL), tertiary lymphoid structures, and spatial immune distribution. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with pCR after neoadjuvant trastuzumab-based therapy. A total of 410 HER2+ tumors were analyzed, and 250 patients received neoadjuvant trastuzumab-based therapy with available surgical outcomes (36% achieved a pCR). HER2DX pCR scores were significantly associated with all eight histopathologic features, whereas relapse risk and ERBB2 scores were associated with five and two, respectively. TIL correlated with the immune/immunoglobulin signature (r = 0.59), and Ki67 with the proliferation signature (r = 0.50). The HER2DX pCR score remained the only independent predictor of pCR in multivariable analysis (OR, 1.77; 95% confidence interval, 1.08-2.97; P = 0.030). HER2DX reflects key biological and pathologic features of HER2+ breast cancer and independently predicts pCR, supporting its utility for individualized treatment decision-making.

ABSTRACT Self-piercing riveting (SPR) is increasingly applied in lightweight structures; however, reliable non-destructive evaluation of its fatigue service state remains challenging due to inaccessible internal damage. In this study, the fatigue behavior of TA1 titanium alloy SPR joints was investigated through dynamic response characterization and strength degradation tests. The evolution of natural frequency under cyclic loading exhibited a distinct three-stage degradation behavior corresponding to damage initiation, stable crack propagation, and rapid failure. Based on this relationship, a frequency-based residual life prediction model was developed using a Weibull framework, achieving prediction errors below 5% over the entire fatigue process. In addition, residual strength tests conducted at representative fatigue stages enabled the establishment of a strength degradation model with errors below 3%. By coupling natural frequency variation with strength attenuation, a dual-parameter prediction model was proposed to simultaneously estimate residual life and residual strength from real-time dynamic response data. Experimental validation confirmed that the predicted results consistently fell within the 95% confidence intervals, demonstrating the robustness and accuracy of the proposed method.

Anti-vascular endothelial growth factor (anti-VEGF) drugs have limitations in the treatment of neovascular age-related macular degeneration (nAMD). This study aims to evaluate the efficacy and safety of radiotherapy combined with anti-VEGF therapy versus anti-VEGF monotherapy in the treatment of nAMD.Methods: This systematic review and meta-analysis (PROSPERO registration number: CRD420251010811) searched PubMed, Embase, Cochrane, Web of Science, LILACS, ISRCTN registry, and ClinicalTrials.gov up to February 25, 2025. Two radiotherapy modalities were analyzed: epimacular brachytherapy (EBM) and stereotactic radiotherapy (SRT). The primary outcome was the proportion of participants who lost more than 15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 12 and 24 months. A total of four studies were included, yielding 7 articles for meta-analysis. For EBM combined with anti-VEGF therapy, compared with anti-VEGF monotherapy, there was a higher risk of losing more than 15 ETDRS letters at 12 months (relative risk [RR] 2.36, 95% confidence interval [CI] 1.49-3.74) and 24 months (RR 2.39, 95% CI 1.68-3.39). The difference in best-corrected visual acuity (BCVA) was 0.10 logarithm of the minimum angle of resolution (logMAR) (95% CI 0.05-0.15) at 12 months and 0.17 logMAR (95% CI 0.13-0.21) at 24 months. For SRT combined with anti-VEGF therapy, there was a greater risk of losing more than 15 ETDRS letters at 24 months (RR 1.75, 95% CI 1.12-2.74) compared with anti-VEGF monotherapy; however, the SRT group required 2.10 fewer ranibizumab injections than the sham-irradiation group (mean difference [MD] -2.10, 95% CI -2.97 to -1.22). Epimacular brachytherapy (EBM) combined with anti-VEGF therapy may worsen patient outcomes and increase the risk of adverse events. In contrast, stereotactic radiotherapy (SRT) combined with anti-VEGF therapy does not improve visual acuity but can reduce the frequency of anti-VEGF injections, potentially alleviating the treatment burden for patients with nAMD.

This systematic review and meta-analyses provide the first synthesis of the literature on trait mindfulness and psychotic-like experiences (PLEs). Theoretical models suggest a protective function of mindfulness and it is important to understand any potential role of mindfulness in the prevention and treatment of PLEs. We examined the following: (1) What is the relationship between trait mindfulness and PLEs in nonclinical populations?; and (2) What is the effect of mindfulness-based interventions (MBIs) on PLEs in nonclinical populations? Five databases were searched, and effect sizes were extracted for each study. Seventeen papers were included in the review. Eleven papers explored the relationship between mindfulness and PLEs, and the meta-regression found a small negative association between PLEs and mindfulness (k=8; pooled correlation r=-0.25; 95% confidence interval [CI]: -0.37, -0.13, p<.001). Eight studies investigated the effect of MBIs on PLEs and the summary effect was not significant in the meta-analysis (k=5; pooled standard mean difference=.09; 95% CI: -0.61, 0.79, p=0.80). Overall, the findings suggest that higher levels of mindfulness are associated with reduced PLEs, with no evidence for the effectiveness of MBIs in reducing PLEs. Findings should be interpreted cautiously given the small number of studies and high heterogeneity in the meta-analyses. Future studies are needed to determine whether MBIs might prevent the transition to psychosis or an at-risk mental state and might usefully measure a broader range of clinically relevant outcomes.

Even in cases of bilateral osteonecrosis of the femoral head (ONFH), only one side often collapses and the contralateral side is often asymptomatic at the time of initial diagnosis. This study aimed to evaluate the presence of asymptomatic ONFH based on the radiographic necrotic area on the symptomatic side. The study included 89 hips of patients with ONFH who were divided into two groups: unilateral ONFH and bilateral ONFH groups, with a minimum follow-up of 3 years. The extent of the necrotic area in the anteroposterior (ANA) and lateral (LNA) radiographic hip joint views on the symptomatic side in the groups was assessed using plain radiography. The most effective cut-off value was extracted from the receiver operating characteristic (ROC) curve of the radiographic necrosis area of symptomatic ONFH in the absence of contralateral ONFH. The unilateral ONFH and bilateral ONFH groups included 36 and 53 patients, respectively. There was a significant difference in ANA and LNA between the unilateral ONFH and bilateral ONFH groups (ANA: 66.5 ± 16.3% vs. 77.2 ± 16.4%, p < 0.01; LNA: 62.2 ± 17.7% vs. 72.9 ± 17.6%, p <0.01). Multivariate analysis revealed that only LNA of the symptomatic side was a predictor of contralateral ONFH (odds ratio 1.052, 95% confidence interval 1.01-1.12, p = 0.028). A cut-off value of 67% of the LNA was extracted from the ROC curve analysis. The 4-year survival rates with the collapse progression as the endpoint were 30.6% in LNA ⩾67% and 80.0% in LNA <67% (p <0.01 and p <0.01, respectively). The LNA of ONFH on the symptomatic side is a useful indicator of the presence and prognosis of contralateral ONFH. The findings of this study provide useful information for planning treatment strategies and predicting the prognosis of patients with ONFH.