Cardiovascular disease mortality among women diagnosed with de novo metastatic breast cancer.

Impact of ABO compatibility on outcomes after allogeneic hematopoietic cell transplantation (HCT): increased risk of acute GVHD with ABO bidirectional mismatch, independent of traditional and emerging GVHD prophylaxis strategies.

Bioavailability-informed sediment assessment in the transboundary Begej Canal: A comparative evaluation of active and passive methods.

Letermovir (LMV), a novel antiviral agent targeting the cytomegalovirus (CMV) terminase complex, has significantly changed the management of adult allogenic hematopoietic stem cell transplant (allo-HSCT) recipients. In this retrospective, single-center study, we assessed our real-life experience in using an implemented diagnostic protocol to identify patients needing pre-emptive therapy (PET) or at high risk of developing CMV-related disease. The study included allo-HSCT recipients who received LMV prophylaxis (LMV group), compared with a historical control group of CMV seropositive patients undergoing allo-HSCT. These patients were managed using a pre-emptive strategy. Both study groups were followed from the day of transplant for up to 200 days. Among the 110 patients receiving LMV prophylaxis, CMV DNAemia was detected in 43 cases (39.1%). However, infectious virions associated with active CMV infection were identified only in four patients (4/43, 9.3%), who required the interruption of LMV and the initiation of PET (CS-CMVi cases). We evaluated the incidence of CS-CMVi at 100 and 200 days post-transplant, comparing patients undergoing LMV prophylaxis with a historical group managed by PET. At 100 days post-transplant, the cumulative incidence of CS-CMVi was significantly lower in the LMV group compared to the control group (3.6% versus 39.1%; p<0.001). The same result was observed at 200 days post-transplant. These findings confirm that LMV has significantly decreased the incidence of CS-CMVi in CMV seropositive patients and underline the clinical utility of an implemented diagnostic protocol including DNase or RNAemia tests to discriminate between active and abortive CMV infection.

The Kidney Donor Profile Index (KDPI) guides organ allocation but blends donor and recipient influences, potentially misclassifying organ quality and contributing to inequity. We developed the Equitable Donor Assessment Model (EDAM), a donor-focused index that isolates intrinsic graft-failure risk independent of recipient survival. Using the United Network for Organ Sharing (UNOS) data (2010-2020; N = 122,646), we modeled death-censored graft failure with death as a competing event using Fine-Gray regression. Donor coefficients were adjusted for recipient and transplant covariates-including human leukocyte antigen (HLA) mismatch and ischemia time-to derive donor-specific subhazard ratios (SHRs) for the EDAM score. Performance was evaluated using Harrell's C-index and internal-external cross-validation across 5 geography-aligned US super-regions. Higher donor age, diabetes, hypertension, stroke as cause of death, proteinuria, cytomegalovirus (CMV) seropositivity, and elevated creatinine independently increased graft-failure risk. EDAM demonstrated robust discrimination (C-index = 0.69) and excellent calibration across US regions (pooled slope = 1.02; intercept = -0.002). Stratification into 5 data-driven categories showed a graded rise in cumulative incidence of graft failure (Gray's P < 0.05). Nearly half of kidneys classified as moderate-to-high KDPI (≥ 0.20) were reclassified as low-risk by EDAM (< 0.80) and achieved identical 10-year graft survival to conventional KDPI < 0.20 organs. EDAM provides an equitable, donor-centric framework for assessing kidney quality. Although these categorical thresholds were derived in a data-driven manner within the US system and require external validation in international cohorts, EDAM's ability to safely expand the low-risk pool without compromising outcomes suggests it could significantly refine allocation policy and enhance fairness in kidney transplantation.

The incidence and risk factors for brain metastases among patients with stage I-III breast cancer remain poorly defined. We conducted a population-based cohort study using Ontario health administrative databases to identify patients diagnosed with stage I-III breast cancer between 2009 and 2021. Treatment of brain metastases with surgery or radiation was extracted from the same databases. Patients were stratified by breast cancer subtype: human epidermal growth factor receptor 2 positive/hormone receptor positive (HER2+/HR+), HER2+/hormone receptor negative (HER2+/HR-), HR+/HER2-, and triple-negative breast cancer (TNBC). Primary outcomes were the cumulative incidence of treated brain metastases and time to brain metastasis (TTBM) as defined by the time from primary breast cancer diagnosis to brain metastases treatment. Among 92,973 patients, 7.9% had HER2+/HR+, 3.5% HER2+/HR-, 54.1% HR+/HER2-, 7.3% TNBC, and 27.2% unknown subtype. Median (IQR) follow-up was 84.2 (50.8-125.2) months. The 12-year cumulative incidence of treated brain metastases was 2.8% in the overall cohort. Among patients with stage III disease, 12-year incidence was 11.8% (HER2+/HR+), 14.3% (HER2+/HR-), 5.9% (HR+/HER2-), and 13.4% (TNBC); corresponding 5-year incidences were 7.5%, 11.2%, and 13.1% for stage III HER2+/HR+, HER2+/HR-, and TNBC, respectively. Among patients with stage III HER2+/HR- and TNBC, median TTBM was 23.3 and 18.0 months, respectively. Up to 13% of patients with stage III HER2+ or TNBC received treatment for brain metastases within 5 years of diagnosis with early-stage breast cancer. These findings support prospective studies of risk-stratified screening for asymptomatic brain metastases in patients with early-stage breast cancer.

Studies on the efficacy and safety of haploidentical hematopoietic stem cell transplantation (haplo-SCT) with anti-thymocyte globulin (ATG) in patients aged ≥60 years remain limited. We performed a study presenting data from 54 patients aged ≥60 years with hematologic malignancies who underwent haplo-SCT with ATG. The median follow-up was 15 months. The median overall survival (OS) at 1-, 2-, and 3-year was 68.4%, 51.2%, and 47.6%, respectively. The cumulative incidence of non-relapse mortality (NRM) at 1 and 3 years post haplo-SCT was 22.9% and 34.8%, respectively. The cumulative incidence of 1- and 3-years relapse rate was 11.3% and 25.6%. The 100-day cumulative incidence of Grade II-IV acute graft-versus-host disease (aGvHD) was 23.1%, while the 3-year cumulative incidence of extensive chronic graft-versus-host disease (cGvHD) was 10.4%. The absence of complete remission at the time of haplo-SCT was identified as a risk factor for OS, relapse, and NRM. Our study suggests that haplo-SCT with ATG is a safe and effective treatment option for patients aged ≥60 years. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.

This study evaluated the association between percutaneous transthoracic needle biopsy (PTNB) and recurrence in early-stage non-small-cell lung cancer (NSCLC). A retrospective study was conducted to analyze patients with cT1b-2aN0M0 NSCLC who underwent lobectomy between 2009 and 2021. The exclusion criteria ruled out multiple primary lung cancers and bronchoscopic biopsy. Patients were classified into a PTNB group and a non-biopsy group according to whether they underwent preoperative PTNB. Propensity score-matching was applied, and cumulative incidence of recurrence (CIR) was compared. Fine and Gray competing-risk regression was used to evaluate the association between PTNB and recurrence. Subgroup analyses were conducted according to pathologic stage and the presence of high-risk pathologic features. Of 2208 eligible patients, 674 (30.5 %) underwent PTNB, and 1534 (69.5 %) did not. After propensity score-matching, each group included 416 patients with balanced baseline characteristics. In the matched cohort, the 5-year CIR was significantly higher in the PTNB group (21.1 %; 95 % confidence interval [CI], 18.0-26.1 %) than in the non-biopsy group (13.7 %; 95 % CI, 10.2-17.3 %; P < 0.001). In multivariate competing-risk regression analysis, PTNB was independently associated with increased recurrence risk in models incorporating clinical variables alone (subdistribution hazard ratio [SHR], 1.892; 95 % CI, 1.407-2.545; P < 0.001) as well as in models incorporating both clinical and pathologic variables (SHR, 1.851; 95 % CI, 1.375-2.493; P < 0.001). Subgroup analyses demonstrated that the association between PTNB and recurrence persisted regardless of pathologic tumor-node-metastasis (pTNM) stage and the presence of high-risk pathologic features. Preoperative PTNB was associated with an increased risk of recurrence for patients with early-stage NSCLC.

Outcomes of tisagenlecleucel versus allogeneic hematopoietic stem cell transplantation in relapsed or refractory large B-cell lymphoma.

Development of clinical manifestations in individuals positive for antiphospholipid antibodies according to the 2023 ACR/EULAR serological domains.

Cumulative incidence of schizophrenia-spectrum disorders in children and adolescents with neurodevelopmental disorders: A retrospective cohort study.

Breast cancer is the most diagnosed cancer among Australian women. Recently, incidence rates have risen but mortality rates have decreased. The extent to which these changes are the result of cumulative risk factor effects (age-effects), events affecting all women at specific points in time (period effects), or changes in generational risk factors (cohort effects) is unclear. This study investigates whether observed trends in breast cancer incidence and mortality are associated with age, period, or cohort effects. Annual Australian breast cancer incidence (1982-2020) and mortality data (1907-2022) were obtained from the Australian Institute of Health and Welfare. Age-Period-Cohort (APC) modelling with a drift in cohort function was used to estimate adjusted age, period and cohort effects. Age effects showed higher incidence and mortality rates with increasing age, peaking at 75-84 years. Cohort effects showed progressively increasing risk among women born after the 1940s, with higher incidence among younger cohorts. Incidence peaks corresponded with introduction of population-based mammography screening, and also changes in population level risk factors. Period effects (adjusting for cohort effects) were modest, demonstrating reductions in incidence over time, while mortality peaked in the 1990s before declining after 2000. Increasing age-related breast cancer incidence and mortality reinforce the importance of early prevention. Incidence has shifted due to cohort and period effects with younger generations showing the highest increases in incidence, suggesting generational shifts in breast cancer risk, likely attributable to mammography screening and increased prevalence of modifiable risk factors.

Intergenerational transmission of adverse childhood experiences: Differential maternal and paternal associations with offspring mental health in Chinese school-aged children by multi-method.

Evaluation of exposure characteristics and radiological risks for cyclotron-based 18F radiopharmaceutical production workers in China.

Hypertensive disorders during the postpartum period are a major contributor to maternal morbidity and mortality. The most recent statistics suggest that 16% of pregnancies are complicated by hypertension, and that number is increasing. The majority of complications occur in the postpartum period, and new publications have revolutionized the way we manage postpartum hypertension. Recent studies have shown that tight blood pressure (BP) control in the postpartum period may decrease adverse maternal outcomes. Several studies have demonstrated that nifedipine lowers BP more effectively than labetalol, resulting in fewer readmissions. The use of diuretics is a topic of controversy, with mixed evidence regarding their effectiveness. A remote patient monitoring system may improve postpartum BP follow-up in low-resource settings. Patients with hypertension during pregnancy have an increased lifetime risk of cardiovascular diseases, and establishing care for long-term follow-up is an essential part of postpartum care. Contrary to historical teaching, not all hypertensive disorders are cured by delivery. Hypertension requires close follow-up during the fourth trimester, and these patients may benefit from tighter BP control. Further research should be done to establish guideline-based treatment and monitoring throughout the lifetime.

Real-world management of familial hypercholesterolemia in paediatric patients: a 3-year follow-up from the LIPIGEN registry.

Infertility is emerging as a significant but under-recognized public health challenge in many developing countries, with profound demographic, psychosocial, and economic consequences. Cameroon provides a compelling case study for examining the multifactorial drivers of rising infertility across sub-Saharan Africa. This paper synthesizes epidemiological evidence to analyze infectious, health-system, environmental, and socioeconomic determinants shaping infertility patterns. Persistent reproductive tract infections including untreated sexually transmitted infections, post-abortal sepsis, and puerperal infections remain leading contributors to tubal factor infertility. Weak health-system capacity, limited access to skilled obstetric and gynecological care, inadequate laboratory diagnostics, and fragmented referral pathways exacerbate delayed diagnosis and treatment. Environmental exposures, including pesticide use, heavy metals, and endocrine-disrupting chemicals associated with rapid urbanization and informal industrial activity, further compound reproductive risks for both men and women. Socioeconomic pressures poverty, gender inequities, stigma, and limited insurance coverage for fertility services intensify barriers to timely intervention and amplify psychosocial distress. The Cameroon case illustrates how infectious burden interacts with structural and environmental vulnerabilities, producing a cumulative risk framework rather than isolated causes. Addressing infertility in similar contexts requires integrated strategies encompassing infection prevention, strengthened reproductive health systems, environmental regulation, male reproductive health inclusion, and financial protection mechanisms. Recognizing infertility as a cross-sectoral development issue is essential for advancing reproductive justice and sustainable population health outcomes in resource-constrained settings.

Placental anti-angiogenic and inflammatory markers and postpartum cardiovascular risk following preeclampsia.

Smoking has been reported to be inversely associated with Parkinson disease (PD). However, the higher premature mortality among smokers may act as a competing risk, potentially confounding the inverse association. Because smoking behavior is dynamic, the long-term impact of changes among current smokers remains unclear. We investigated the association between longitudinal changes in smoking status and the risks of PD and all-cause mortality using a competing risk framework and an age-based time scale with left truncation. This large-scale retrospective cohort study included current smokers aged 40 years or older who participated in all 3 examination periods of the Korean National Health Screening. Based on longitudinal changes from the initial smoking status to 2 subsequent time points, participants were categorized into 4 groups: persistent smokers, recent quitters, sustained quitters, and relapsed smokers. Cumulative incidence functions for PD were estimated, with all-cause mortality as a competing event, and subdistribution hazard ratios (sHRs) with 95% CIs were obtained using Fine-Gray models. Data were obtained from 410,489 eligible participants (mean age 51.7 ± 9.0 years; 93.5% male). During a median 9.1-year follow-up, persistent smokers exhibited the lowest risk of PD. Both recent quitters and sustained quitters had higher PD risk than persistent smokers (sHR 1.60 [1.41-1.82] and 1.61 [1.42-1.81]), whereas relapsed smokers did not differ from persistent smokers (sHR 1.05 [0.87-1.28]). For all-cause mortality, recent and sustained quitters had 3% and 17% lower risks, respectively, compared with persistent smokers, whereas relapsed smokers showed no significant difference. The observed pattern of PD risk was suggested to be primarily associated with current smoking status rather than cumulative smoking exposure, as relapsed smokers and recent quitters, who had the same number of smoking time points, showed distinctly different risks. Furthermore, 1 time point (∼2 years) of short-term abstinence did not attenuate the protective association. Mortality was lowest in sustained quitters while recent quitters showed a marginal trend toward lower risk, supporting the benefit of early cessation. Interpretation should be cautious because smoking status was assessed at 3 time points, subsequent changes were unknown, and most participants were male.

The use of induction immunosuppression agents has improved kidney transplant outcomes, but selecting the optimal agent remains a point of debate. To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction, focusing on graft function, acute rejection, infection, malignancy, post-transplant glomerulonephritis, and survival, using a propensity score matched cohort design. Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated. Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts. Baseline characteristics, immunosuppression regimens, and outcomes were analyzed. Linear, binary logistics and Cox proportional hazard regression models. A total of 436 recipients were included, with a median follow-up of 5.2 years. The matched cohort (n = 262) had a mean age of 51.1 ± 13.5 years; 39% were female and 92% were white. There was no significant difference in the cumulative incidence of acute rejection [odds ratio (OR) = 2.10; 95%CI: 0.9-4.9; P = 0.110]. Compared with basiliximab, alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months (-6.6 mL/minute/1.73 m2; 95%CI: -10.5 to -2.7; P < 0.001) and higher risks of cytomegalovirus viremia (OR = 3.2; 95%CI: 1.6-6.5; P < 0.001), BK viremia (OR = 2.4; 95%CI: 1.1-5.5; P = 0.02), post-transplant malignancy (OR = 6.2; 95%CI: 1.6-29.9; P = 0.013), and death-censored graft loss (hazard ratio = 3.6; 95%CI: 1.2-11.4; P = 0.03). No significant differences were observed in post-transplant glomerulonephritis or recipient mortality. In this propensity score-matched analysis, alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection, post-transplant malignancy, and graft loss compared with basiliximab. These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.