Incidental prostate cancer is frequently identified in men undergoing radical cystoprostatectomy for urothelial carcinoma of the bladder. While usually clinically insignificant, its long natural history raises questions about long-term impact as systemic therapies prolong bladder cancer survival. The aim of this study is to describe the natural history, recurrence patterns, and survival outcomes of prostate cancer detected incidentally following radical cystoprostatectomy in a prospective cohort, and to provide a follow-up protocol for these patients. A retrospective cohort study with prospective follow-up of consecutive men undergoing radical cystoprostatectomy with urinary diversion for urothelial carcinoma at a tertiary referral center (1999-2020) was conducted. Follow-up included serial prostate-specific antigen (PSA) testing, imaging, and cause-specific survival. Associations with recurrence and survival were assessed using Cox regression. Incidental prostate cancer was diagnosed in 384 of 940 men (41%). Prostate cancer recurrence was reported in 23 men (6%) at a median of 25mo, most often in bone and lymph nodes. Seven patients died of prostate cancer at a median of 72mo after surgery. Risk factors for recurrence included higher International Society of Urological Pathology grade (hazard ratio [HR] 2.9, 95% confidence interval [CI] 2.2-3.9; p<0.001), locally advanced stage (HR 6.8, 95% CI 4.1-11.2; p<0.001), preoperative PSA (HR 2.3, 95% CI 1.4-3.8; p=0.002), and nodal metastasis (HR 29.3, 95% CI 10.8-79.3; p<0.001), although HR effect estimates were exploratory and based on a limited number of events. Overall survival was determined by bladder cancer stage, comorbidity, and age; prostate cancer features were prognostic only beyond 3yr. Incidental prostate cancer after radical cystoprostatectomy is usually organ confined and of low grade, with a low short-term risk. In long-term survivors with adverse pathological features, incidental prostate cancer represents a clinically non-negligible contributor to cause-specific mortality, despite a low absolute risk at the population level. Selective risk-adapted PSA surveillance should be considered in patients with higher-risk pathology and favorable bladder cancer outcomes following a protocol. We studied men with prostate cancer diagnosed incidentally during bladder cancer surgery. While most cases of prostate cancer were at a low risk and rarely caused early problems, some patients with higher-risk prostate cancer developed metastases or died from the disease later. Careful follow-up for prostate cancer may benefit selected long-term bladder cancer survivors.

Long-term impact of the COVID-19 pandemic on childhood vaccination coverage in Quebec, Canada: A cohort study from the Canadian immunization research network.

Insight into the long-term impact of fire in dry pine forests on biological soil crust and underlying soil

Recycling the growing stock of organic waste products (OWP) from cities, factories, and farms is a key challenge for sustainable agriculture. However, it must be done with awareness of performances but also potential long-term environmental and health risks. In this context, the SOERE PRO observatory was established ("Systèmes d'Observation et d'Expérimentation pour la Recherche en Environnement - Produits Résiduaires Organiques'', a label granted by the French National Research Alliance for the Environment (AllEnvi) to recognize high-quality research infrastructures, which translates to "Long-term Observation and Experimentation Systems for Environmental Research - Organic Waste Products''), including the trial in Sangalkam, in the Dakar region of Senegal, where these data are collected. Since 2016, four fertilizer types - one mineral (synthetic) and three organic - have been applied annually to three successive vegetable crops (tomato, lettuce, carrot). The dataset currently covers the period 2016 - 2025, with data collection ongoing and new data to be added in the future. Manual weeding and hoeing is carried out regularly for each crop, no pesticides are used for crop protection on the trial. A comprehensive, multi-variable dataset is consistently documented, including soil physico-chemical parameters measured annually at three depths, organic waste product characterization, crop yield and quality parameters, and detailed management activities, making it particularly suitable for process-based modelling and long-term impact assessment. The originality of this dataset lies in its long duration, the diversity of organic and mineral fertilization strategies, the inclusion of multiple vegetable crops per year, and its location under Sub-Sahelian conditions, a context for which long-term agronomic datasets remain scarce. All soil, OWP and vegetables samples are stored in a sample bank in Dakar, and available for additional analyses. The objective of this dataset is to provide long-term, integrated information on crop productivity, crop quality, and soil responses to repeated organic and mineral fertilization in a Sub-Sahelian market-gardening system. The dataset is publicly available through a Dataverse repository for free (re)use in meta-analyses, process-based modelling, and environmental studies, notably to improve understanding of nutrient cycling, contaminant dynamics, soil biodiversity, and long-term soil functioning in Sub-Sahelian agroecosystems, and to support sustainable land management and food security in Southern countries under future climate change.

A reduced model for the long-term effects of physical activity on type 2 diabetes.

The impact of childhood conditions and lifestyles on depression trajectories in older adults: a latent growth model approach.

While adult oral health has been consistently linked to cardiovascular disease, the long-term impact of childhood oral health remains underexplored. Thus, we investigated the association between dental caries and gingivitis in childhood and the incidence of atherosclerotic cardiovascular disease (ASCVD) in adulthood. This nationwide Danish cohort study included 568,778 individuals born between 1963 and 1972, with oral health data from the National Child Odontology Registry (1972-1987) and ASCVD outcomes from the National Patient Register (1995-2018). Dental caries and gingivitis were categorized by severity and trajectory across childhood. Cox regression models stratified by sex, education level, and type 2 diabetes status were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for incident ischemic heart disease, myocardial infarction, and ischemic stroke. Severe childhood dental caries was associated with increased ASCVD incidence in both males (HR 1.32; 95% CI: 1.18-1.50) and females (HR 1.45; 95% CI: 1.25-1.68). High gingivitis scores also predicted elevated ASCVD risk (males: HR 1.21; 95% CI: 1.10-1.32; females: HR 1.31; 95% CI: 1.14-1.50). Disease trajectories with moderate to severe level oral disease and oral health deterioration were significantly associated with higher ASCVD incidence. Within the limitations of this study, poor childhood oral health, particularly persistent or worsening dental caries and gingivitis, is associated with an increased risk of ASCVD in adulthood. These findings highlight the potential of early oral health interventions in reducing long-term cardiovascular risk.

Long-term behavioral and physiological consequences of developmental group size history in mice.

Postoperative delirium (POD) is a common and serious complication in intensive care unit (ICU) patients after cardiac surgery. Its long-term impact remains uncertain. The aim was to determine the association between postoperative delirium and 8-year all-cause mortality in adult cardiac ICU patients. This retrospective cohort study analysed patients admitted to a university hospital ICU following cardiac surgery. Data from pre-, peri-, and postoperative phases were collected. The primary outcome was mortality up to 8years after ICU discharge. Secondary outcomes included POD incidence, ICU readmission, mortality at day 7 and 30 post-discharge, and ICU and hospital length of stay (LoS). Regression analyses were conducted to examine associations. The study included 551 patients, predominantly male (71%, n=397), with a median age of 72 (IQR 64-77) years. POD was diagnosed in 18.7% (n=103). Overall, the 8-year mortality rate was 16.7% (n=92). Compared to non-POD patients, those with POD had significantly higher 6-8years mortality (n=9 (8.7%) vs. n=16 (3.6%), p=0.033). Patients with POD had a longer LoS in ICU (median 4 vs. 2days, p<0.001) and hospital (15 vs. 12days, p<0.001), as well as higher ICU readmission rates within 30days (12.3% vs. 6.6%, p=0.037). POD patients also showed higher mortality at 30days (3.8% vs. 0.9%, p=0.028). However, after adjusting for confounders, POD was no longer significantly associated with long-term 6-8years mortality (p=0.205). POD affects nearly one in five patients after cardiac surgery and is associated with adverse short-term outcomes, including longer stays and higher readmission and early mortality rates. Its independent effect on long-term mortality may be limited. Further studies are needed to explore its influence on quality of life and cognitive function.

Long-term impact of arthritis on sensory function: Evidence from the Chinese elderly population.

Impact of Hepatitis C screening and treatment among incarcerated populations in Alberta, Canada on population-level Hepatitis C elimination efforts.

This study evaluates the long-term impact of a gender-transformative intervention that provided bicycles to adolescent girls in rural Zambia to enhance school attendance and empowerment. Implemented in 2017 across 100 schools, the intervention aimed to reduce travel barriers and improve educational access. Using an experimental design with a final sample of 1615 adolescent girls (676 treatment, 939 control) in 92 school clusters, we estimate the causal impact of bicycle ownership on sexual, reproductive, maternal and child health indicators five years post-intervention. Our findings indicate a statistically significant 11.5 percentage point increase in adolescent motherhood among the treatment group compared to the control group. However, the intervention did not significantly affect antenatal care visits, iron and folic acid use, institutional deliveries, birth weight, or exclusive breastfeeding (n=382). For sexual reproductive health outcomes, girls in the treatment group were 11 percentage points more likely to report sexual debut and eight percentage points more likely to report wanting the pregnancy. Causal mediation analysis suggests increased empowerment partially mediated the observed rise in adolescent motherhood. Complier analysis indicates a higher likelihood of adolescent childbearing for girls who use the bicycle for school as intended by the programme. These findings highlight the complexities of gender-transformative interventions in low-resource settings. While aiming to empower adolescent girls, increased mobility and decision-making power may intersect with unintended reproductive health consequences. This underscores the need for integrated program designs that complement empowerment initiatives with comprehensive sexual health education and services to mitigate adverse outcomes.

The increasing exposure to manufactured environmental pollutants, especially plastics, is linked to adverse neurological effects. While prenatal exposure to plastics has been associated with neurodevelopmental disorders, particularly autism, the role of this exposure in schizophrenia remains under-investigated. This narrative mini-review examines the potential impact of endocrine-disrupting plastics, e.g. bisphenols and phthalates, on schizophrenia onset risk. These chemicals are ubiquitous and pervasive neurotoxicants, implicated in neuroinflammation-a key feature of schizophrenia. Additionally, microplastics have been detected in human brains, raising concerns about their potential long-term impact on neurological health. Despite the growing evidence of plastic-induced neurodevelopmental harm, this issue has been neglected for schizophrenia, with scarce human or valid animal model literature available. Limited studies indicate that plastic chemicals cause behavioural deficits, hormonal dysregulation and altered brain function relevant to schizophrenia. Cumulative exposure to multiple plastic chemicals over the life course necessitates carefully designed approaches. Future studies should investigate the mechanisms by which plastics contribute to schizophrenia risk. Epidemiological research with multi-omic approaches is needed to strengthen regulatory action and inform exposure prevention strategies particularly in high-risk populations. Given the increasing burden of environmental pollutants, urgent attention is required to address their role in neurodevelopmental disorders, particularly schizophrenia.

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.

BACKGROUND Traditional gastrointestinal endoscopy (GIE) apprenticeship training raises concerns regarding patient safety, prompting growing adoption of simulation-based training approaches. Virtual reality (VR) simulators provide a risk-free, learner-centered environment in which trainees can develop and refine endoscopic skills prior to clinical practice. Although VR-based training has been increasingly implemented worldwide, its efficacy relative to conventional training methods has yet to be conclusively established. AIM To evaluate the effectiveness and outcomes of VR-based training in GIE through a systematic review of interventional studies. METHODS This systematic review followed PRISMA 2020 guidelines. PubMed, ScienceDirect, and Google Scholar were searched through June 2025 using Boolean combinations of terms related to VR, simulation, and GIE. Eligible studies were interventional trials evaluating VR-based training that reported changes in endoscopist competency. Procedures included esophagogastroduodenoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. RESULTS VR-based training consistently improved trainee competency, procedural independence, and patient safety compared with baseline performance, with outcomes comparable to conventional training. In esophagogastroduodenoscopy, VR simulation significantly increased independent procedure completion rates (odds ratio: 65.7; 95% confidence interval: 20.1-214.4) and achieved similar procedure times to traditional training (10.5 minutes vs 12.4 minutes). In endoscopic retrograde cholangiopancreatography, VR effectively differentiated skill levels, with experts outperforming novices in key metrics such as papilla visualization and cannulation time (P &lt; 0.05). Endoscopic ultrasound competency improved when VR was combined with clinical training (64.53 ± 4.91 vs 60.09 ± 5.49; P = 0.028). Colonoscopy studies reported higher pass rates and improved objective skill scores in VR-trained groups (100% vs 88.9% pass rate in proficiency-based VR training). CONCLUSION These findings support integrating VR simulation as an adjunct to conventional endoscopy training and underscore the need for standardized training frameworks and further research to optimize implementation and assess long-term clinical impact.

Imidacloprid exposure at population-relevant doses induces hepatic lipid dysregulation: Exploring the role of cGAS-STING pathway-mediated hepatocyte senescence.

ABSTRACT This phenomenological study explores the lived experiences of Indian women professionals engaged in workplace flexibility arrangements and examines how such arrangements influence career continuity. Despite the rapid adoption of hybrid and remote work models across India, limited qualitative evidence exists regarding their long-term impact on women’s professional growth. Using in-depth semi-structured interviews with 25 women professionals across IT, banking, education, and healthcare sectors, this study identifies five key themes: flexibility as empowerment, flexibility as hidden career penalty, managerial trust and support, intensified dual burden, and negotiated career aspirations. The findings reveal that flexibility enhances workforce participation and retention; however, structural biases, performance visibility norms, and socio-cultural expectations continue to shape advancement opportunities. The study contributes context-specific insights to gender and HRM literature in India and provides managerial recommendations for designing equitable and career-sustaining flexible work systems. Keywords: Workplace Flexibility, Women Professionals, Career Continuity, Phenomenology, Gendered Organizations, India.

To report 1.5-year real-world outcomes on the incidence of sterile intraocular inflammation (IOI) following intravitreal aflibercept 8mg injections, with emphasis on differences between vial and pre-filled syringe (PFS) use. This retrospective multicenter study reviewed the electronic medical records of all patients who received aflibercept 8mg injections at Vista Augenklinik sites between March 1, 2024, and November 30, 2025. The primary outcome was the incidence of IOI per injection. Secondary analyses included stratification by treatment indication and by vial versus PFS administration. A total of 2631 injections were administered to 453 eyes of 398 patients. IOI was documented in 41 eyes (37 patients), corresponding to an incidence of 1.56% per injection (95% confidence interval [CI], 1.21-2.41), 9.05% per eye (95% CI, 7.13-13.0), and 9.30% per patient (95% CI, 7.0-13.32). Mean time to presentation was 7.3days (range 2-31) after a mean of 4.7 injections. All cases presented with anterior chamber and/or vitreous inflammation without posterior involvement. No retinal vasculitis or infiltrates were observed. Inflammation resolved with topical corticosteroids and/or nonsteroidal anti-inflammatory drugs (NSAIDs), with no significant change in best-corrected visual acuity (VA) compared to pre-event VA (20/32 versus 20/35 Snellen equivalent, p = 0.62). The incidence differed significantly between formulations: 2.26% per injection with the vial versus 0.21% per injection with the PFS (p = 0.010). In a real-world setting, aflibercept 8mg was associated with a higher incidence of IOI than reported in pivotal trials, particularly when administered from vials. Conversion to the PFS markedly reduced the incidence, suggesting a formulation- or preparation-related effect. All cases were mild, anterior, and reversible under topical therapy without long-term visual impact.

The considerable long-term psychological impact of childhood cancer on the patient and their parents.

IntroductionAcute kidney injury (AKI) is commonly observed after Type A aortic dissection (TAAD) repair and is associated with increased morbidity and mortality. The long-term impact of postoperative AKI, including the influence of severity and operative factors, remains incompletely defined.MethodsWe conducted a systematic review and meta-analysis of studies reporting long-term survival after surgical TAAD repair stratified by postoperative AKI status, published through February 2025. Kaplan-Meier curves were digitized to reconstruct individual patient data.ResultsNine studies with 6,608 patients were analyzed. Postoperative AKI occurred in 35.6% (95% CI 26.4-45.9%) and was associated with three-fold higher long-term mortality (HR 3.00, 95% CI 2.59-3.49, p < 0.001). Survival for AKI versus non-AKI patients was 75% (95% CI 73-77) versus 93% (95% CI 92-94) at 1year and 52% (95% CI 47-58) versus 68% (95% CI 59-77) at 10years, with a 2-years reduction in expected survival (95% CI -2.35 to -1.64, p < 0.001). Mortality was time-dependent, with early 3-months risk markedly elevated (HR 4.72, 95% CI 3.82-5.83) and sustained beyond 3months (HR 1.74, 95% CI 1.41-2.15). Risk increased with AKI severity: stage 1 HR 1.79 (95% CI 1.30-2.48), stage 2 HR 2.88 (95% CI 2.02-4.10), stage 3 HR 5.06 (95% CI 3.75-6.81). Multiple sensitivity analyses confirm robustness.ConclusionPostoperative AKI affects one-third of TAAD patients and triples long-term mortality, especially early after surgery. These findings highlight the need for renal-protective strategies, careful operative planning, and structured follow-up to improve outcomes.