Regulatory approval of B-cell maturation antigen (BCMA)-CD3 bispecific antibodies (BsAbs) has revolutionized the treatment of patients with heavily pretreated relapsed or refractory multiple myeloma. Label-recommended premedications and step-up dose (SUD) regimens are used to mitigate the incidence and severity of serious adverse events such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. Hospitalization of patients during the SUD regimen is also recommended by the manufacturers to facilitate the rapid therapeutic management of adverse events that may arise. Administering these therapies in an inpatient hospital setting increases the costs of delivering care, creates patient inconvenience, and most importantly, reduces overall access to this class of medication. Thus, the practice of administering BCMA-directed BsAb SUD regimens in an outpatient (OP) setting is being slowly adopted at some community practice sites; however, the development of robust OP administration models for these therapies requires more data on the feasibility and safety of doing so. Herein, we describe the OP BsAb program developed at our independent community oncology practice, New England Cancer Specialists (NECS). The program was designed with the intent to reduce health care resource utilization, improve patient experience, and expand treatment access for patients living in remote or underserved areas while preserving a coordinated care model. We outline the operational infrastructure and workflow implemented at NECS to administer BCMA-directed BsAb therapy in an OP setting to patients drawn from a vast rural geography. Finally, based on our clinical experiences, we discuss the potential to expand OP administration programs to BsAb therapies for other malignancies.

Maintaining a relative dose intensity (RDI) ≥ 85% during chemotherapy is established as a critical threshold for optimal outcomes in early breast cancer. This study investigates whether the prognostic impact of reduced RDI differs based on the presence of chemotherapy-induced neutropenia requiring treatment modifications (rCIN). We analyzed 730 patients with early breast cancer receiving anthracycline/cyclophosphamide and taxane-based chemotherapy at the University Hospital Tübingen between 2014 and 2021. rCIN was defined as any dose reduction > 15%, delay ≥ 5 days, or discontinuation attributed to neutropenia per Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Patients were stratified into four groups based on RDI (≥ 85% vs. < 85%) and rCIN status. Differences in overall survival (OS) and disease-free survival (DFS) were assessed by Kaplan-Meier analysis, and predictors of DFS were evaluated by Cox regression. rCIN occurred in 21.8% of patients, with 59.7% of rCIN patients receiving RDI < 85% versus 16.1% of non-rCIN patients (p < 0.001). Despite lower RDI, rCIN patients maintained similar pathological complete response rates after neoadjuvant therapy. In Kaplan-Meier analysis, patients with RDI < 85% without rCIN had significantly worse DFS and OS than the reference group with RDI ≥ 85% without rCIN (DFS p = 0.003; OS p = 0.002), while patients with RDI < 85% with rCIN showed comparable survival to high-RDI groups (all pairwise p > 0.170). Direct comparison between the two reduced-RDI groups was not statistically significant for either DFS or OS (DFS p = 0.055; OS p = 0.159). Cox regression confirmed RDI < 85% as a negative prognostic factor (HR 2.53; 95% CI 1.38-4.65; p = 0.003). The rCIN × RDI < 85% interaction term was not statistically significant (HR 0.44; 95% CI 0.12-1.60; p = 0.212). In this retrospective cohort, reduced RDI was associated with poorer outcomes, particularly in patients without rCIN. By contrast, patients with RDI < 85% and rCIN showed no significant differences in Kaplan-Meier survival, and similar pathological complete response rates were observed despite lower RDI in the neoadjuvant subgroup. These findings are hypothesis-generating and require confirmation in larger prospective studies.

Multiple trials have found no difference in secondary stroke prevention between anticoagulation and antiplatelet therapy after cryptogenic stroke. Due to limitations of current stroke mechanism classification, one possible explanation is the failure to exclude patients with hypertension-related cerebrovascular disease. To determine whether hypertension with high-risk features is associated with treatment effect modification of anticoagulation vs antiplatelet therapy. This exploratory analysis of the Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) randomized clinical trial was conducted between April and August 2025. The original trial was conducted from February 2018 to February 2023 at 185 sites in North America. From 1015 randomized patients with a recent cryptogenic stroke and atrial cardiopathy, 945 with available hypertension data were included in this analysis after exclusions for missing blood pressure and echocardiography data. Apixaban, 5 mg or 2.5 mg, twice daily vs aspirin, 81 mg, once daily. The primary outcome was recurrent ischemic stroke or systemic embolism. Hypertension with high-risk features was defined as systolic blood pressure ≥160 mm Hg at enrollment, left ventricular hypertrophy on echocardiography, or both. Cox proportional hazards models evaluated treatment interaction with hypertension with high-risk features and estimated hazard ratios within hypertension with high-risk features subgroups. Among 945 patients (mean [SD] age, 68.0 [10.8] years; 513 [54.3%] female), 351 (37.1%) met criteria for hypertension with high-risk features. Over a median (IQR) follow-up of 1.6 (0.7-3.0) years within the analytic cohort, 67 patients experienced a recurrent ischemic stroke or systemic embolism. A significant interaction between hypertension with high-risk features and antithrombotic treatment was observed. In 594 patients without hypertension with high-risk features, apixaban was associated with lower risk compared to aspirin (hazard ratio [HR], 0.43; 95% CI, 0.22-0.85; annualized rate difference: -3.4%), whereas no significant association was observed in patients with hypertension with high-risk features (HR, 1.68; 95% CI, 0.78-3.62; annualized rate difference: 2.4%). The findings in this study indicate that hypertension with high-risk features may be associated with modifications in the effect of antithrombotic treatment in patients with cryptogenic stroke. An unappreciated inclusion of strokes due to hypertensive arteriopathy may account for the lack of benefit with anticoagulation in prior trials of embolic stroke of undetermined source. ClinicalTrials.gov Identifier: NCT03192215.

This paper presents a review of contemporary deep learning methods for processing remote photoplethysmography data. Architectures of convolutional neural networks, transformers, recurrent, and generative models are examined for video signal preprocessing and for extracting physiologically significant parameters under conditions involving artifacts caused by motion, illumination changes, or low video quality. An analysis of the prospects for implementing deep learning algorithms in real-world medical scenarios is conducted based on the proposed criteria, considering existing integration challenges, the demand for such solutions, and issues related to result validation. The study includes a review of existing deep learning approaches that utilize video signals to estimate imaging photoplethysmography. The methods are evaluated using newly proposed criteria, including the multidimensionality of the photoplethysmography output signal, the availability of open-source code, and the reporting of computational time costs, which is essential for their practical real-time application in medical institutions. It is shown that deep learning methods significantly outperform traditional approaches in physiological parameter estimation, cardiovascular disease diagnosis, and video signal preprocessing. However, most existing deep learning-based solutions are limited to one-dimensional output signals due to the complexity of obtaining multidimensional annotations required for supervised learning. Additional analysis revealed a lack of information regarding temporal and computational costs, which restricts the practical real-time implementation of these methods. The proposed systematization clarifies key terms related to photoplethysmography signal processing: contact photoplethysmography, imaging photoplethysmography, remote photoplethysmography, and photoplethysmographic imaging. Approaches to dataset collection are also described, considering the concepts of multidimensionality, multichannel, and multimodal signals. The results may be applied in the development of remote health monitoring systems, including medical and consumer devices. The review will be of interest to specialists in biomedical engineering, medical informatics, and developers of physiological signal analysis solutions.

Postoperative risk stratification using calcitonin doubling rate in medullary thyroid carcinoma with biochemical persistent disease.

Nearly 1million older adults are hospitalized annually for emergency general surgery (EGS) conditions in the United States. Recent literature has demonstrated the impact of discordant care in EGS, defined as a mismatch between treatment choice and patients' clinical risk profile. In the present work, we characterize the association between preoperative decision variation and outcomes in elderly EGS patients.MethodsAll geriatric (≥65years) hospitalizations with EGS conditions (appendicitis, diverticulitis, cholecystitis, hernia, bowel obstruction, perforated peptic ulcer, intestinal ischemia, perforated bowel) were tabulated from the 2022 National Inpatient Sample (NIS). A propensity score (PS) was developed to estimate the likelihood of undergoing operative management. Low and high probability for surgery was defined using a cut-off of PS = 0.5. Model-concordant cases were defined as those whose treatment matched their predicted likelihood, while model-discordant cases did not. Multivariable regression models were developed to determine the association of care variation on outcomes.ResultsOf an estimated 900 730 patients with EGS conditions, 154 300 (17.1%) were classified as model-discordant. Following risk adjustment, model-discordance was associated with greater odds of mortality (AOR: 1.33, 95% CI: 1.25-1.42), as well as gastrointestinal (AOR: 2.07, 95% CI: 1.95-2.19), infectious (AOR: 1.41, 95% CI: 1.36-1.46), and respiratory (AOR: 1.26, 95% CI: 1.20-1.32) complications. Furthermore, model-discordance was associated with increased hospitalization costs (β: +$9 760, 95% CI: +$9 255-10 265) and length of stay duration (β: +2.72days, 95% CI: +2.59-2.84).ConclusionPatients classified as model-discordant exhibited elevated rates of in-hospital mortality and postoperative complications. Given this variation, our study warrants investigation into guideline adherence and outcomes in this vulnerable population.

Preoperative anemia is a common, yet inadequately managed condition in patients undergoing total knee arthroplasty (TKA) and is associated with an increased need for perioperative blood transfusions. However, variability in physicians' transfusion practices remains understudied. This study investigated the influence of preoperative anaemia on transfusion rates and clinical outcomes and examined inter-physician variability in transfusion procedures. This study included 265 patients who underwent TKA. Preoperative anaemia was defined as haemoglobin <13 g dL-1. Demographic characteristics, perioperative variables, laboratory parameters, transfusion data, and postoperative outcomes were recorded. Transfusion rates, complications, and lengths of hospital stay were compared between anemic and non-anemic groups. Inter-physician variability in transfusion decisions was also analysed. Preoperative anaemia was present in 43% of individuals. Transfusion rates were significantly higher in patients with anaemia (69.3% vs. 54.3%, P=0.013). When postoperative outcomes were analysed according to anaemia and transfusion status, anaemia was not independently associated with postoperative complications (P=0.072). Perioperative blood transfusion was associated with significantly higher complication rates (31.7% vs. 15.4%, P=0.003) and a prolonged hospital stay (P < 0.001). Receiver operating characteristic analysis showed modest discrimination for predicting transfusion (area under the receiver operating characteristic curve =0.61; cut-off =13.15 g dL-1). Significant inter-physician variability was observed, independent of anaemia status (P < 0.05). Preoperative anemia is common among TKA patients and has been associated with higher transfusion rates. Transfusion was associated with adverse clinical outcomes, including prolonged hospitalisation and higher complication rates. The substantial physician-related variability observed in transfusion practices underscores the need for standardised, evidence-based perioperative transfusion protocols.

Background Acute kidney injury (AKI) is a common complication among critically ill patients with traumatic brain injury (TBI) and is associated with adverse clinical outcomes. Glycemic variability (GV), reflecting short-term fluctuations in blood glucose, may contribute to organ dysfunction; however, its relationship with AKI in ICU patients with TBI remains incompletely characterized. Methods We conducted a retrospective cohort study using the MIMIC-IV database, including 2,151 adult ICU patients with TBI, and performed replication in an independent cohort of 265 patients to evaluate reproducibility and incremental prognostic value. GV was quantified as the coefficient of variation (CV) of glucose measurements obtained during ICU stay until the occurrence of AKI or ICU discharge. Multivariable logistic regression models were used to examine the association between GV and AKI, with stepwise adjustment for potential confounders. Predictive performance was assessed using receiver operating characteristic (ROC) analysis, while dose–response relationships were explored with restricted cubic spline models. The incremental prognostic utility of adding GV to SOFA- and APACHE II-based models was evaluated using calibration plots, decision curve analysis, Integrated Discrimination Improvement (IDI), and Net Reclassification Improvement (NRI). Results AKI occurred in 59.1% (1,271/2,151) of patients in the MIMIC-IV cohort. Higher GV was independently associated with AKI across all adjusted models (fully adjusted model: OR 1.16, 95% CI 1.02–1.34). ROC analysis yielded an area under the curve of 0.73 (95% CI 0.71–0.75) with 66% sensitivity and 69.7% specificity. Restricted cubic spline analyses suggested an approximately linear increase in AKI risk with rising GV. The association was consistent across prespecified subgroups, robust to adjustment for glucose monitoring intensity, and replicated in the independent cohort. Incorporating GV into SOFA- and APACHE II-based models led to modest but statistically significant improvements in risk stratification. Conclusion In ICU patients with TBI, greater glycemic variability is independently associated with subsequent AKI and provides incremental prognostic information beyond established severity scores. These findings highlight the potential utility of GV as a complementary marker for risk stratification. Prospective studies using standardized GV definitions and harmonized glucose monitoring strategies are warranted to confirm these results and clarify their clinical implications.

People living with mental illness experience significantly poorer oral health compared with the general population, yet oral hygiene behaviours are often overlooked in mental health care. This mixed-methods study explored behavioural drivers of daily toothbrushing among mental health consumers and their care coordinators, using the Capability, Opportunity, Motivation - Behaviour framework. Participants from two community mental health centres engaged in an oral health program that included education, oral health assessments, plaque disclosure and brushing diaries to support routine-building. Follow ups at 4 and 8weeks reinforced habit formation. Semi-structured interviews were conducted with consumers and care coordinators. Quantitative data, including the Treatment Self-Regulation Questionnaire, Perceived Competence Scale, plaque score and oral health knowledge, were drawn from a preceding feasibility study to support triangulation of findings. Data were analysed using a hybrid inductive-deductive approach guided by the Capability, Opportunity, Motivation - Behaviour framework. Consumers described psychological barriers, such as forgetfulness, low mood and cognitive overload, that disrupted oral hygiene routines. Visual and hands-on tools, such as animated videos and plaque disclosure, enhanced motivation. Linking toothbrushing with existing routines, such as taking medication, emerged as a practical enabler through habit stacking. Care coordinators highlighted the importance of social support, structured prompts and environmental cues. Quantitative findings aligned with qualitative insights, underscoring the importance of autonomous motivation and perceived competence in supporting behavioural change. Integrating oral health promotion into routine mental health care through person-centred, behavioural strategies appears to support oral health practices and may reduce health disparities in this vulnerable population.

Charting individualized pathways: IGF-1 and vitamin D in guiding personalized medicine for residual risk after AMI.

To evaluate operator workload and usability of a dual-arm teleoperated robotic platform designed for solo-physician outpatient otorhinolaryngology (ENT) procedures. A dual-arm system integrating a flexible endoscope manipulator (EndoBot) and an instrument manipulator (ToolBot) was developed and controlled via dual joysticks and a multi-view interface. Five otolaryngologists performed simulated nasal and oral procedures on an anatomical phantom and completed standardized workload (NASA-Task Load Index [TLX]) and usability questionnaires. All scheduled trials were completed successfully. Workload was higher for nasal than for oral tasks (NASA-TLX total score, sum of six 0-10 subscales; nasal: 44.0 vs oral: 22.2), which may reflect the narrower nasal workspace and more frequent view management. Key limitations included conservatively-restricted motion speed, limited depth perception in multi-view teleoperation, and timing metrics defined from entry pose to task completion (excluding full setup/docking steps). These preliminary phantom-based findings characterize early-operator workload and interface constraints of a dual-arm teleoperated system for outpatient ENT procedures. The results provide hypothesis-generating signals to guide system refinement. Future patient-based, head-to-head studies are required to assess full workflow performance and clinical applicability.

PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition is a potent cholesterol-lowering strategy. This study examined the effects of PCSK9 monoclonal antibodies (mAbs) and high-intensity statins beyond low-density lipoprotein cholesterol reduction, which are not fully defined, particularly in patients with acute myocardial infarction (MI). Proteomic and lipidomic analyses were conducted on plasma from 265 patients with acute MI from the PACMAN-AMI (Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction) randomized, placebo-controlled PCSK9 mAb trial and 34 patients without MI with hyperlipidemia from the Vienna Lipid Clinic registry, also receiving PCSK9 mAbs. Discovery proteomics revealed changes in apolipoproteins and increased PCOLCE (procollagen C-endopeptidase enhancer 1) levels in both the PCSK9 mAb and placebo groups after MI. UK Biobank data confirmed PCOLCE and PCSK9 upregulation as associated with statin use. Hepatoma cell experiments demonstrated a dose-dependent PCOLCE induction on statin treatment. Compared with placebo (statins only), PCSK9 mAb therapy resulted in greater reductions in APOB (apolipoprotein B), APOE (apolipoprotein E), APOC2 (apolipoprotein C2), and APOC3 (apolipoprotein C3), as shown by targeted proteomics. Mediation analysis indicated that these changes were largely explained by low-density lipoprotein cholesterol lowering. Lipidomics identified more pronounced reductions in cholesteryl esters, ceramides, sphingomyelins, phosphatidylcholines, triglycerides, and diglycerides in PCSK9 mAb-treated patients with MI. Results were largely consistent in patients without MI. However, levels of LPA (apolipoprotein[a]), the characteristic protein component of lipoprotein(a), remained unchanged in PCSK9 mAb-treated patients with MI, since a rise of LPA was observed in the placebo group post-MI. Most apolipoprotein changes after PCSK9 mAb therapy following MI were mediated by low-density lipoprotein cholesterol lowering. Statin use is associated with increased circulating PCOLCE, with hepatoma cell experiments supporting a predominant hepatic origin. Combining PCSK9 mAbs with high-intensity statins mitigates post-MI increases in lipoprotein(a). URL: https://www.clinicaltrials.gov; Unique identifier: NCT03067844.

To determine the composite cut-off value and diagnostic accuracy of C-reactive protein (CRP) for diabetic foot osteomyelitis (DFO). A retrospective study of patients was combined with a meta-analysis. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity and area under the curve (AUC) were calculated via forest plots and summary receiver operating characteristic curves. A composite cut-off model was developed using R 4.4.3 (R Foundation for Statistical Computing, Austria). The experimental cohort comprised 265 patients (204 with DFO and 61 without). The meta-analysis comprised 12 studies, including a total of 1828 patients. The retrospective cohort demonstrated that CRP achieved an AUC of 0.63 (95% confidence interval (CI): 0.55, 0.71) for diagnosing DFO, with an optimal cut-off value of 9.57mg/l (sensitivity 74%, specificity 53%). Meta-analysis revealed pooled sensitivity of 74% (63-83%) and specificity of 73% (65-79%) (AUC=0.79; 95%CI: 0.75, 0.82). The composite model suggested a CRP cut-off of 15.20mg/l (sensitivity 80%, specificity 53%). In this study, CRP demonstrated moderate diagnostic utility for DFO and could function as a screening adjunct.

Consumer and community involvement (CCI) in health research is recognised as an essential component of ethical, effective and relevant research practice. While the recommended principles that enable high-quality CCI are well established, consistent implementation remains a challenge. To inform consumer involvement strategies and practices, this study explored the experiences of researchers and consumers involved in CCI in research at a large metropolitan health service precinct in Brisbane, Australia. Semi-structured interviews were used to explore participants' experiences of CCI. Researchers and consumers who had undertaken CCI activities were purposively sampled from two hospitals and six research institutes. Thematic analysis using the framework method was employed to interpret the data. Coding was conducted both inductively and deductively, utilising a data-driven approach guided by the study's objectives. A total of 27 participants contributed (researchers, n = 17; consumers, n = 10). Five themes captured supportive and challenging elements of CCI and participants' visions for meaningful CCI in research. Themes included 'Laying the Groundwork', which reflects the foundational elements needed for meaningful partnering, and 'Navigating the Human Factor', which captures the interpersonal dynamics that shape CCI. 'Bridging Methods' described methodological approaches to CCI. Participants' challenging experiences with organisational structures and culture were represented by 'Opportunities: Organisational Barriers', while 'Paving the Way Forward' pointed to practical strategies for embedding CCI meaningfully and sustainably into research processes. This study shows that while CCI in health research is highly valued, it faces challenges like organisational barriers, administrative load and limited support. Meaningful CCI depends on early relationship building, role clarity, flexible processes and culturally safe, trauma-informed practices. To turn policy into action, research-active health services must streamline systems and create structures for long-term, inclusive involvement. Researcher training should cover CCI principles, as well as interpersonal and facilitation skills crucial for building successful and meaningful involvement partnerships. This study benefited from the involvement of a health consumer partner (J.M.) throughout all stages of the research. Our consumer partner contributed to (1) drafting the initial grant proposal; (2) developing the research protocol, methods and processes; (3) research governance meetings; (4) the design and refinement of interview guides to ensure relevance and clarity of questions; (5) providing feedback in the form of sense checking developing themes to refine interpretation of findings; and (6) critically reviewing and providing feedback on manuscript drafts.

Tongue reconstruction is a complex surgical procedure that may require intricate microvascular surgery that increases morbidity rate and length of hospital stay. The use of new materials to enable easier procedures is currently a vast focus of research. We report the feasibility of use of a novel Polylactide Membrane (PLM) to reconstruct post-oncologic lateral tongue defects. Patients included in the trial presented to the outpatient ENT clinic complaining of lesions/tumours of the lateral tongue requiring resection and reconstruction. After resection, the PLM was fixed onto the defect bed and sutured in place using resorbable sutures. The patients were hospitalized for an average of 5 days with assessment of healing (photographs were taken), pain scores and need for analgesia and assessment of tongue function by video recording of movement and reading of a standard German text. A total of 7 patients were included in this report with no complications noted postoperatively. All cases were fully oralised by day 2 postoperatively and by day 5 speech was classified comprehensible. Patients reported low pain levels postoperatively and no bleeding episodes were noted. in cases where non- sano resection was identified (3 of our cases); a 2nd surgery was performed and clear margins were confirmes before the PLM was placed in the same manner. The use of PLM may be a promising alternative to tongue and mucosal reconstruction. The resorption of the membrane starts on day 2 postoperatively allowing for the granulation of the underlying defect bed while the PolyLactide residue continues to enhance healing and reduce pain.

ABSTRACT Quercetin (Qu), a dietary flavonoid with potent antioxidant and bioactive properties, requires accurate quantitation in food matrices to ensure health benefits and consumer safety. Conventional determination methods often suffer from high cost, complex operation, or susceptibility to electrode fouling. Herein, we report a high‐performance electrochemical sensor for Qu detection, employing nitrogen‐doped graphene quantum dots (NGQDs)‐electrochemically reduced graphene oxide (ErGO) nanocomposite integrated with vertically‐ordered mesoporous silica films (VMSF). This work distinguishes itself by uniquely combining the signal‐amplifying NGQDs‐ErGO nanocomposite with the antifouling VMSF nanochannels in a single in situ fabrication step, achieving both high sensitivity and exceptional robustness for direct detection in complex samples. The NGQDs‐graphene oxide (GO) nanocomposite was dropped onto gold electrodes (AuE), followed by in situ reduction of GO to ErGO during rapid VMSF growth via electrochemically assisted self‐assembly method. The synergistic combination of NGQDs and ErGO provides enhanced conductivity, abundant active sites, and improved analyte enrichment, while VMSF nanochannels confer strong anti‐fouling capabilities, molecular selectivity and preconcentration ability for Qu through hydrogen bonding effect. The developed VMSF/NGQDs‐ErGO/AuE sensor demonstrated excellent analytical performance, featuring a low detection limit of 61 nM, a high sensitivity of 1.37 µA/µM, and two wide linear ranges of 0.1–10 µM and 10–100 µM. It also showed outstanding reproducibility and stability for direct Qu detection in complex onion samples, with minimal interference from coexisting species. This strategy offers a versatile platform for antioxidant monitoring, quality control, and safety assurance in the food industry.

Aims: The purpose of this systematic review is to systematically review and synthesize qualitative studies involving the perceptions of patients and health care professionals about pulmonary telerehabilitation to understand patients’ attitudes and determine the obstacles in the use of telemedicine. Design: Systematic review of qualitative studies. Data sources: Qualitative studies were extracted from MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, PubMed, CBM, CNKI, and WanFang Database from the inception of each database until November 2025. Qualitative research and mixed-method research, including perspectives on remote pulmonary rehabilitation in chronic respiratory patients, were included. Review methods: The systematic search method SPIDER (sample, phenomenon of interest, design, evaluation, research type) was used. Thematic synthesis of qualitative data was used. Results: 870 studies were screened, and finally 12 studies. 12 articles included were published between 2015 and 2025. 265 patients with chronic respiratory disease and Health-care Professionals were included. 3 themes and 12 sub themes were extracted from the views of patients and health professionals on remote pulmonary rehabilitation. Conclusion: In general, patients with chronic respiratory diseases have a positive attitude toward telepulmonary rehabilitation. Patients have a lot of perceived benefits in telepulmonary rehabilitation. Many factors affect patients’ participation in telepulmonary rehabilitation. It is necessary to address the obstacles that affect patients’ participation in telepulmonary rehabilitation, so as to promote the development and improvement of tele pulmonary rehabilitation.

The 2025 Asian Working Group for Sarcopenia (AWGS) updated diagnostic criteria redefine sarcopenia based on low muscle strength and low skeletal muscle mass, incorporating body mass index (BMI)-adjusted appendicular skeletal muscle mass (ASM) alongside height-adjusted ASM. The clinical relevance of these definitions in heart failure (HF) patients remains unclear. This retrospective study included 594 patients aged ≥65 years hospitalized for HF (2016-2024). Sarcopenia was defined according to AWGS 2025 criteria as H-sarcopenia (height-adjusted ASM) or B-sarcopenia (BMI-adjusted ASM). The primary outcome was all-cause mortality. Physical function was assessed using gait speed. We analyzed associations using Cox proportional hazards and linear regression models. The prevalence of H-sarcopenia and B-sarcopenia was similar (24.2% vs. 25.1%, respectively), but BMI-dependent patterns differed, with the prevalence of H-sarcopenia decreasing and B-sarcopenia increasing as BMI increased. H-sarcopenia was independently associated with higher mortality (adjusted hazard ratio 1.48; 95% confidence interval 1.04-2.12), although its prognostic impact was attenuated at higher BMI. B-sarcopenia was not associated with mortality. Both sarcopenia definitions were associated with slower gait speed (P<0.001), but B-sarcopenia showed superior model performance (P<0.001 for the difference in root mean square error). In patients hospitalized with HF, H-sarcopenia and B-sarcopenia had distinct prognostic and functional implications: H-sarcopenia was related to mortality, particularly for lower BMI, whereas B-sarcopenia better reflected physical function, supporting outcome-specific sarcopenia definitions.

In unresectable advanced gastric cancer (AGC), overall survival (OS) is influenced more strongly by post-progression survival (PPS) than by progression-free survival (PFS). Although several determinants of PPS are known, the clinical significance of nutritional and immune status at the time of first disease progression remains unclear. We investigated the prognostic impact of the Prognostic Nutritional Index (PNI) at first progression on PPS after first-line chemotherapy for AGC. This retrospective single-center cohort study included 265 patients with unresectable recurrent or AGC who received first-line chemotherapy (January 2011-December 2016). PPS was defined as the interval from the date of first documented cancer progression to death. The PNI was calculated as 10 × serum albumin (g/dl) + 0.005 × peripheral lymphocyte count (/μl). Patients were grouped by PNI <45 (n=184) or ≥45 (n=81), and PPS and OS compared. Independent PPS predictors were assessed using Cox proportional hazards models. The PNI <45 group had worse Eastern Cooperative Oncology Group performance status (ECOG-PS), lower body mass index, fewer first-line chemotherapy cycles, a lower second-line therapy transition rate, and significantly shorter PPS (median 3.4 vs. 9.9 months; log-rank p<0.001). On multivariate analysis, ECOG-PS ≥1, type-4 macroscopic appearance, shorter PFS of first-line chemotherapy, no second-line therapy, and PNI <45 (hazard ratio=2.080, 95% confidence interval=1.568-2.759; p<0.001) independently predicted poor PPS. PPS correlated strongly with OS (Spearman's ρ=0.84; p<0.001). PNI at first disease progression robustly and independently predicts PPS in unresectable AGC, highlighting the critical clinical relevance of host nutritional and immune status after disease progression.

IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide and a leading cause of end-stage renal disease. Renal histopathology represents a key intermediate phenotype linking clinical features and long-term renal outcomes. This study aimed to develop and validate a nomogram to estimate the likelihood of higher renal histopathological burden in patients with IgAN based on routinely available clinical variables. This was a retrospective study including patients with primary IgAN confirmed by renal biopsy. Clinical and histopathological data at the time of biopsy were collected. Least absolute shrinkage and selection operator (LASSO) regression followed by multivariable logistic regression was used to identify factors associated with higher histopathological burden. A nomogram was constructed, and its performance was evaluated using calibration plots, receiver operating characteristic (ROC) curves with area under the curve (AUC), and Harrell’s concordance index (C-index). A total of 594 patients were included in the analysis. Age, mean arterial pressure, hemoglobin, estimated glomerular filtration rate, and proteinuria were identified as factors independently associated with higher histopathological burden and were incorporated into the final nomogram. The nomogram demonstrated acceptable discrimination, with C-indices of 0.702 (95% CI 0.643–0.761) in the development cohort and 0.732 (95% CI 0.647–0.817) in the validation cohort, along with good calibration. A nomogram based on routinely available clinical variables was developed to estimate the likelihood of higher renal histopathological burden in patients with IgAN. This estimation model may provide complementary information for pathological assessment in clinical settings where renal biopsy data are limited.