International braz j urol : official journal of the Brazilian Society of UrologyNaiwen Chen, Lichen Chen, Jinming Cai, Mingyue Tan, Dongliang Xu
INTRODUCTION: Radical cystectomy (RC) is the standard therapy for muscle-invasive bladder cancer (MIBC) and refractory high-risk non-muscle-invasive bladder cancer (1-3). Single-port robot-assisted radical cystectomy (RARC) offers notable minimally invasive advantages (4-6), whereas conventional transperitoneal approaches are associated with intestinal and gastrointestinal complications (7). This study evaluated an optimized extraperitoneal single-port RARC with orthotopic neobladder reconstruction for improved surgical safety and clinical outcomes. MATERIALS AND METHODS: A 57-year-old male presented with three months of intermittent painless gross hematuria. Pelvic CT revealed a bladder mass. Preoperative biopsy confirmed high-grade urothelial carcinoma with muscularis propria invasion, and the patient received gemcitabine-cisplatin neoadjuvant chemotherapy before radical surgery. Preoperative MRI identified a 3.2×2.9×2.6 cm bladder lesion without extravesical invasion or lymphadenopathy. During the procedure, the patient was placed in a supine position with buttocks elevated. A 5-cm infraumbilical single incision was made for da Vinci Xi-assisted extraperitoneal RARC, and a single-port multichannel device was deployed through the incision. Robotic instruments including a 30° endoscope, monopolar scissors, bipolar forceps, and a robotic stapler were arranged in a chopstick configuration. Via the extraperitoneal approach, we mobilized the bilateral ureters, bilateral vas deferens, and umbilical artery, dissected the bladder lateral ligaments with vascular ligation, and established a sufficient extraperitoneal working space. Bladder and prostate dissection was performed along the perivesical avascular plane, with careful protection and precise hemostasis of the dorsal venous complex. Standard pelvic lymphadenectomy was concurrently conducted during radical resection of the bladder and prostate (8). A segment of ileum was then harvested to construct an orthotopic neobladder (9), followed by anastomosis with the bilateral ureters and urethral stump. RESULTS: Operative time was 400 minutes with 200 mL blood loss and no transfusion. No perioperative complications occurred, and the patient was discharged on postoperative day 6. Pathological diagnosis was pT2aN0M0 with negative surgical margins and negative lymph nodes. The 12-month follow-up showed no tumor recurrence, normal renal function, complete daytime continence, and mild nocturnal incontinence requiring one nightly pad. CONCLUSIONS: Extraperitoneal single-port RARC with orthotopic neobladder reconstruction is a feasible minimally invasive procedure for MIBC. The optimized infraumbilical single-incision technique preserves peritoneal integrity and avoids intestinal mobilization, effectively reducing abdominal complications. It achieves reliable oncological results and improves patients' postoperative continence and quality of life.
International braz j urol : official journal of the Brazilian Society of UrologyMarcos Tobias-Machado, Ricardo C Brianson, John Eder Gamarra Bravo, Alcedir Raiser, Eliney Faria
INTRODUCTION: Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting. CASE PRESENTATION: A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10). CONCLUSION: In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyD V Vankov, O V Obukhova, I A Deev, M A Ivanova
The diseases of circulatory system represent one of the main problems of the population health due to corresponding high morbidity and mortality and load on health care. The purpose of the study is to evaluate direct and indirect costs of medical care under acute coronary syndrome depending on level of medical organization. The study used content-analysis, statistical and analytical methods scientific publications on the research topic, copying of data from the medical documentation of the Vologda Regional Clinical Hospital for the period 2012-2021. The significant number of publications confirm that diseases of circulatory system develop due to multitude of risk factors. Also economic and medical effectiveness of timely applied medical care of diseases of the circulatory system is proved. It is demonstrated that medical care and cardiac rehabilitation under acute coronary syndrome are the most resource-wasteful types of medical care, while prevention of development of disease allows to save human, material and financial resources. In the medium perspective, economic damage under the worst scenario of development of disease when disability is set in makes up to about 400.000 rubles and in case of death of patient, more than five million rubles. Under acute coronary syndrome, medical, social and economic efficiency of emergency medical care is higher in medical organizations of the 3rd level. However, it is more economically advantageous to implement preventive measures.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyV G Zilov, L V Kosmodemyansky
The article considers placement of methods of traditional and complementary medicine in the public health system of the Russian Federation, focusing on prevention and management of chronic non-communicable diseases. The analysis of the evidence base on key methods of traditional and complementary medicine (acupuncture, phytotherapy, homeopathy, manual therapy, osteopathy) was carried out, including differentiated estimate of level of evidence for forms of homeopathy based on the latest systematic review of meta-analyses. The legal framework of its application in Russia are explored. The corresponding collisions and barriers are identified. The following proposals concerning integrative health care model are formulated: differentiated register of methods, clinical guidelines, pilot integration into compulsory health insurance system and enhancement of research.
This study examines mass testing in three Chinese cities since 2020 as a 'stress test' for local governance. It analyses the governance performance of Shenzhen, Nanjing and Wuxi in terms of efficiency, equity and community resilience. Using Melbourne's pandemic lockdown as a reference case, it discusses the underlying mechanisms linking different governance approaches to health equity outcomes. The study adopts a nested governance framework to examine how governance capacities and policy logics operate across different local contexts. The results indicate that Chinese cities can efficiently complete mass testing within a few days, but face pressures related to health equity and community resilience. Melbourne's lockdown governance emphasised participation and institutional transparency, but advanced policies at a relatively slower pace. This study recommends building a dynamic governance mechanism that better balances efficiency and equity.
The Libyan journal of medicineYuhang Yang, Ping Wang, Minshan Feng, Xunlu Yin, Aifeng Liu, Chengliang Zhong, Shengqiang Zhang, Futai Gong, Jian Liu, Zhiquan Wang, Bifeng Fu
BACKGROUND: Axial neck pain is a common manifestation of cervical degenerative disc disease (CDD). Rotation-traction manipulation (RTM) is widely used in China, but its comparative effectiveness and safety versus cervical traction remain uncertain. METHODS: In this prospective multicenter randomized controlled trial, 154 adults with CDD-related axial neck pain were randomized 1:1 to receive RTM (7 sessions over 2 weeks) or cervical traction (daily for 2 weeks). Outcomes were assessed at baseline, during treatment, and at 1 and 3 months after treatment. The primary outcome was pain intensity measured by the visual analogue scale (VAS); secondary outcomes were neck tenderness score (NTS) and cervical range of motion (ROM). Intention-to-treat analyses with multiple imputation were performed. RESULTS: All 154 randomized participants were included in the analyses, and 151 completed follow-up. Both groups showed significant improvement over time in VAS and ROM (both P < 0.001). Confirmatory mixed-effects analyses did not demonstrate significant between-group differences in VAS or ROM after adjustment for multiple comparisons. Exploratory analyses suggested that RTM provided faster improvement during the treatment phase and a small cumulative advantage in pain reduction, whereas cumulative ROM improvement did not differ significantly between groups. RTM was also associated with a faster reduction in neck tenderness severity. Adverse events were mild and infrequent, and no treatment-related radiographic deterioration was observed. CONCLUSIONS: Both RTM and cervical traction were associated with clinical improvement in patients with CDD-related axial neck pain. Confirmatory analyses did not demonstrate robust superiority of RTM for pain or cervical ROM, whereas exploratory analyses suggested faster early improvement and a small cumulative pain benefit with RTM. NTS findings should be interpreted cautiously because the tenderness score has not been formally validated. No serious adverse events were observed. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400082667. Registered retrospectively on 4 April 2024.
Medical education onlineMarisol Angulo-Ramos, César Merino-Soto, Dayana Guillinta-Herrera, Giorgio Aquije-Cardenas, Guillermo M Chans
BACKGROUND: Among Hispanic undergraduate students, the association between research-related coursework and research interest remains largely underexplored. This exploratory study examined differences in research interest among undergraduate nursing students according to their exposure to research-related coursework, drawing on Social Cognitive Career Theory. METHODS: A cross-sectional study was conducted with 106 nursing students from a Peruvian university. Participants completed the Interest in Research Questionnaire (IRQ), which demonstrated excellent internal consistency (α = 0.98). Research interest was compared across four academic-semester groupings reflecting proximal and distal exposure to research-related coursework using rank-based nonparametric methods. RESULTS: Significant differences in research interest were observed across groups (Anderson-Darling test = 9.41, p = 0.001), indicating a curvilinear pattern. Students currently or recently exposed to research-related coursework (levels 2 and 4) reported significantly higher research interest than those with more distal exposure (level 3; p < 0.05; medium effect sizes). First-semester students showed research interest levels comparable to those of the proximally exposed groups. CONCLUSION: Research interest may decline in the absence of sustained engagement in research activities, underscoring the importance of early and continuous integration of research experiences throughout undergraduate nursing curricula. The findings also provide initial evidence supporting the use of the IRQ in Spanish-speaking undergraduate contexts.
International journal of qualitative studies on health and well-beingLi-Ting Chen, Hsin-Tien Hsu, Meei-Fang Lou, Chia-Yi Wu, Cheng-Han Lin, Yueh-Hsiu Lin
BACKGROUND: Most applications for depression lack comprehensive theoretical integration and qualitative assessments of university students' needs remain insufficient. OBJECTIVE: This study aimed to explore the needs and experiences of university students with depressive symptoms and develop a theory-driven app design framework tailored to the target population. METHODS: A post-positivist qualitative framework was used to recognize the value of subjective experience. Semi-structured interviews were conducted with 32 students with moderate to moderately severe depression. Reflexive thematic analysis was used to identify themes in the data. RESULTS: Three themes emerged: app design, help-seeking processes, and core features of cognitive behavioral therapy. Students emphasized the importance of discreet, user-friendly design, such as positive naming, privacy protection, and flexible reminder functions. Although some expressed concerns regarding the empathy and reliability of artificial intelligence, others valued its anonymity and capacity to provide immediate support. Regarding theoretical integration, participants considered monitoring emotions and physical sensations essential but also highlighted the need for diverse and personalized methods. The conceptualization of self-monitoring data was considered useful for facilitating clinical consultations. CONCLUSION: Students considered theory-based health education as effective for improving mental health knowledge and promoting help-seeking awareness. The findings support clinical decision-making in developing more effective digital tools.
Hematology (Amsterdam, Netherlands)Abdullah M Alrajhi, Bashayer Alshehri, Walaa A Alshahrani, Arwa AlHaj Issa, Amal H Alotaibi, Areej Abumustafa, Ghadah Alyousif, Nora Alkhudair, Mai Alalawi, Na…
OBJECTIVE: Hodgkin lymphoma (HL) constitutes 3.4% of all cancers in Saudi Arabia, with advanced-stage relapse rates reaching 40%. While the anti-CD30 agent brentuximab vedotin (BV) has established efficacy, local data are limited. This study aims to assess the real-world effectiveness and safety of Brentuximab vedotin (BV)-containing regimens compared to non-BV regimens in relapsed or refractory classical Hodgkin lymphoma (cHL) in Saudi Arabia. METHODS: A retrospective, multicenter cohort study was conducted including 93 adult patients with relapsed or refractory cHL in Saudi Arabia between 2016 and 2021. Patients were categorized into a BV-containing group (n = 61) and a control group (n = 32). The outcomes were overall response rate (ORR), complete response (CR), event-free survival (EFS), and post-chemotherapy complications. RESULTS: = The BV group showed a higher ORR compared to the non-BV group (82.5% vs. 76.9%), although this difference was not statistically significant (adjusted odds ratio [aOR] = 9.09; 95% CI = 0.67-122.57; P = 0.10). CR rates were comparable between the two groups, at 59.6% in the BV group vs. 61.5% in the control group (aOR = 1.86; 95% CI = 0.24-14.46; P = 0.55). EFS was significantly longer in the BV group compared with the control group in the crude analysis (22.5 vs. 11.2 months; P = 0.03); however, this finding did not reach statistical significance in the regression analysis (beta coefficient = 7.04; 95% CI = -2.96 to 17.03; P = 0.18). Post-chemotherapy complications were comparable and not statistically significant across both groups. CONCLUSION: The research indicates that BV may offer a potential clinical advantage for patients with relapsed or refractory cHL. To validate these findings and optimize treatment strategies for this population, larger long-term studies with expanded patient cohorts are required.
Medical education onlineYvette Martin McGrew, Darrell R Schroeder, Steven H Rose, Bhargavi Gali
BACKGROUND: Anesthesia-specific milestone evaluations are intended to objectively assess performance in ACGME core competencies for anesthesiology residents. Recent reports in several medical specialties have documented differences in resident evaluations based on gender. OBJECTIVE: We studied the impact of faculty and resident gender on milestone evaluations during Anesthesiology residency. DESIGN: This was a retrospective analysis of 20,570 anesthesiology resident milestone evaluations from a single institution over a 7-year period during the ACGME milestones 1.0 time frame. Standardized scores were analyzed using a linear mixed model. RESULTS: 170 anesthesiology residents were evaluated by 194 faculty. For CA1 evaluations, mean standardized milestone scores for the core competencies of professionalism (p = 0.002) and interpersonal/communication (p < 0.001) and for overall assessment (p = 0.009) were dependent on faculty gender. For CA2 evaluations, regardless of the evaluator gender, the mean standardized milestone scores for many individual core competencies were significantly higher for female residents compared to male residents. For CA3 evaluations, mean standardized milestone scores did not differ significantly between male residents and female residents for any core competency, however overall assessment scores were dependent on faculty gender with male faculty scoring male residents more highly and female faculty scoring female residents more highly (p < 0.001). CONCLUSIONS: We observed an association between faculty gender and milestone evaluation scores of residents that was most evident for CA1 residents. We also observed the overall assessment scores for male and female residents were significantly influenced by the gender of the faculty evaluator. Further work is required to better understand and mitigate gender bias to promote equity in resident assessment.
International journal of qualitative studies on health and well-beingFayez Abdulrazeq, Chris Gastmans, Nikola Biller-Andorno, Julian März
PURPOSE: Healthcare providers play a critical role in delivering care to undocumented migrants, who face systemic barriers to healthcare access. While research has documented undocumented migrants' legal and policy barriers, less is known about the ethical challenges and moral stressors experienced by providers. This systematic review synthesizes qualitative studies on providers' experiences when delivering care to undocumented migrants. METHODS: The review followed PRISMA guidelines. PubMed, Embase, CINAHL, and the Cochrane Library were searched for relevant qualitative studies. Studies were screened by title, abstract, and full text using predefined inclusion and exclusion criteria. Quality assessment was conducted using the CASP checklist. Data were synthesized using the Qualitative Analysis Guide of Leuven (QUAGOL), integrating Graneheim and Lundman's approach to qualitative content analysis. RESULTS: The systematic search identified 37 qualitative studies. Analysis revealed 58 themes and subthemes, organized under five key concepts: experiences, perceptions, attitudes, practices and coping mechanisms, and ethical challenges. Providers reported moral distress, emotional exhaustion, and professional dilemmas arising from legal constraints, resource limitations, and conflicting obligations. Ethical tensions centered on beneficence vs. non-maleficence, professional duty vs. legal compliance, and the moral dilemma of deservingness. Across these findings, the synthesis identifies ethical burden-shifting as a central analytical contribution: restrictive systems transfer the moral and practical consequences of exclusionary arrangements onto providers and undocumented migrants at the point of care. CONCLUSION: This review shows that providers' ethical challenges are not only individual clinical dilemmas but structurally generated moral stressors. Addressing these challenges requires structural interventions, including policy reforms that reconcile professional ethics with legal constraints and institutional support to mitigate moral distress.
International journal of qualitative studies on health and well-beingKumiko Hashiratani, Hiroko Azechi
BACKGROUND: Emergency nurses caring for patients who have attempted suicide face ethical dilemmas and negative emotions that hinder empathetic care. Existing studies have mainly reported emotional burden and mixed attitudes, with limited research examining nurses' internal interest processes. Therefore, this study aimed to clarify the structure and processes underlying nurses' interest in caring for these patients in hospital-based emergency care settings, using a grounded theory approach. METHOD: Data were collected through semi-structured interviews with 25 nurses experienced in emergency care in Japan who had provided care to patients who had attempted suicide. Interviews were conducted from August 2022 to December 2023 and analyzed using constant comparative analysis. RESULTS: Six major categories emerged: "Attention towards care," "Being influenced by one's inner self," "Welling up emotions," "Focusing on attention," "Deciding the direction of care," and "Taking a meta-perspective on oneself within the situation." Nurses' beliefs and values were profoundly challenged by the gravity of suicide attempts, eliciting complex emotional responses combining a sense of moral responsibility, discomfort, and conflicting feelings. CONCLUSIONS: Emergency nurses maintained an interest in patient care despite emotional conflict and a destabilized sense of self. Self-awareness and situational awareness, particularly taking a meta-perspective, supported professional caring and decision-making.
Global public healthHang Duong, Nor Kamila Kamaruzaman, Katie Attwell
Conceptually, current definitions of vaccine mandates involve two key elements: the requirement to be vaccinated and sanctions for non-compliance. However, during COVID-19, governments frequently introduced vaccine mandates in contexts where people were already denied access to work, travel, and social activities due to lockdowns and restrictions. This important context disrupts the standard operation of vaccine mandates. Accordingly, this paper explores COVID-19 vaccine mandates in New South Wales (Australia), France, Israel, Malaysia, Singapore, and Vietnam, where mandates primarily served as incentives to restore basic rights to travel, work, and access public spaces, that were restricted during the pandemic. Through document analysis and key informant interviews, the paper examines how governments employed this "removal and restoration" model and explores how mandate policy instruments create incentive structures. In discussing the implications of mandates in relation to lockdowns and restrictions, and the perception of mandates as "coercive offers", the paper proposes a revised conception and a 7S vaccine mandate framework by adding synergy and sustainment to the existing 5S model. It concludes by outlining the significance of this revised conception and framework for vaccine mandate policy research, design, and communication.
OncoimmunologyLorenzo Falchi, Martin Hutchings, David Tybor, Junhua Yu, Abualbishr Alshreef, Anthony Wang, Kavita Sail, Zhijie Ding, Alex Mutebi, Poliana Patah, Nisha Kishor…
Patients with relapsed/refractory follicular lymphoma (R/R FL) often experience multiple disease recurrences with progressively shorter duration of remission. Chemoimmunotherapy (CIT) is commonly used for R/R FL in second-line and later settings but is not curative; novel, improved treatments are needed. Epcoritamab, a CD3 × CD20 bispecific antibody, is approved as monotherapy for R/R FL after ≥ 2 lines of therapy (LOTs) and combined with lenalidomide and rituximab (R2) for R/R FL. Epcoritamab + R2 pivotal data demonstrated superiority over R2, but no comparison of epcoritamab + R2 versus CIT exists. Therefore, we conducted an adjusted comparative analysis of epcoritamab + R2 from arm 2 of the phase 1b/2 EPCORE NHL-2 trial (NCT04663347; n = 111; US, 23.4%) versus R2/CIT using COTA individual patient-level electronic health records (n = 380; US, 100%) of patients with R/R FL after ≥ 1 previous LOT. Epcoritamab + R2 improved response rates over R2/CIT (overall response, 96.9% versus 80.5%, P < .001; complete response, 90.2% versus 55.1%, P < .001). Epcoritamab + R2 improved duration of response (HR, 0.29 [95% CI, 0.18-0.47]; P < .001), duration of complete response (HR, 0.31 [95% CI, 0.17-0.55]; P < .001), progression-free survival (HR, 0.43 [95% CI, 0.28-0.68]; P < .001), and overall survival (HR, 0.33 [95% CI, 0.16-0.70]; P = .003) over R2/CIT. These findings support epcoritamab + R2 as a promising chemotherapy-free treatment option for R/R FL.
HIV research & clinical practiceHamzah M Alghzawi, Syed Zohad Shah, Zain Ul Abideen, Muhammad Farhan Ashraf
BACKGROUND: The combination of doravirine and islatravir (DOR/ISL) is a novel two-drug regimen for HIV-1. Early development faced challenges due to dose-dependent immunological signals. We aimed to synthesize the evidence on the efficacy and safety of DOR/ISL across all treatment-experience categories, specifically evaluating the impact of islatravir dosage (0.25 mg vs 0.75 mg) on clinical and immunological outcomes. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following PRISMA guidelines. We searched PubMed, Embase, Cochrane Library, and Google Scholar from inception through April 2026. Primary outcomes were virological suppression (<50 copies/mL) and mean change in CD4+ T-cell count at week 48. Data were pooled using random-effects models. Islatravir dose was evaluated as a pre-specified moderator. Quality was assessed using Cochrane RoB 2.0 and certainty of evidence was graded using the GRADE approach. RESULTS: Seven RCTs (n = 3,600 participants) were included. At Week 48, DOR/ISL showed non-inferior suppression rates (RR 1.01 [95% CI 0.99-1.02]; p = 0.516; moderate-certainty evidence) and a statistically significant reduction in virological failure risk (RR 0.55 [0.33-0.92]; p = 0.022) compared to active control. Overall CD4+ gain was lower with DOR/ISL (MD -34.55 cells/μL; low-certainty evidence); however, a profound moderator effect of dose was observed (p < 0.0001). The 0.75 mg dose was associated with significant CD4+ and lymphocyte declines, whereas the approved 0.25 mg dose was immunologically neutral. DOR/ISL was weight-neutral compared to bictegravir/emtricitabine/tenofovir alafenamide (MD -0.25 kg [-0.66 to 0.16]; low-certainty evidence). CONCLUSION: DOR/ISL 100/0.25 mg once daily achieved virological suppression comparable to standard-of-care ART regimens and was associated with lower rates of virological failure compared with active comparators. The immunological safety concerns observed in early trials were successfully resolved by dose optimization. These findings support the use of DOR/ISL (IDVYNSO) as a potential treatment option for both treatment-naïve and virologically suppressed adults while emphasizing long-term safety surveillance.
Global public healthKallin C Hermann, Alejandro Andrés Peralta Chiriboga, Kevin T Fuji, Anne L O'Keefe, María Sol Jurado Vaca, Abubakar Tauseef, Karina Kletscher, Jason Beste
Human papillomavirus (HPV) is estimated to cause 99.7% of all cervical cancers and is the main cause of anal cancer. Despite global progress, Ecuador has one of the highest cervical cancer mortality rates in Latin America, with fluctuating vaccine uptake since its introduction for girls in 2014 and expansion to boys in 2024. Semi-structured interviews were conducted with parents of vaccine-eligible children and healthcare providers (HCPs) in Quito. The interviews explored HPV knowledge, perceptions, and access to vaccination. The transcripts were analysed thematically. Forty-one participants (32 parents, 9 HCPs) were interviewed. Eight themes emerged: (1) parents desire more information about HPV, (2) neither parents nor HCPs associate HPV with cancer in men, (3) mothers have more knowledge than fathers, (4) fear of side effects contributes to vaccine hesitancy, (5) fear of sexual promiscuity does not influence vaccination, (6) HPV vaccine administration is conducted at schools, but parents and providers desire better support from these schools, (7) parents perceive a lack of information as their greatest barrier, while HCPs perceive carelessness among parents, and (8) age guidelines for vaccination can be confusing. HPV vaccine uptake is shaped by individual and system-level barriers. Aligning provider-parent perspectives and strengthening school- and community-based education may improve vaccination.
Gut microbesNina M Frerichs, Rimke R de Kroon, Yannick van Schajik, Sofia El Manouni El Hassani, Aranka J van Wesemael, Willem P de Boode, Veerle Cossey, Christian V Hulze…
Intestinal bacterial translocation to the bloodstream is a route of infection for late-onset sepsis (LOS) in preterm infants, highlighting the potential of fecal microbiota profiling for early risk stratification. We aimed to identify and validate LOS-specific gut microbiota signatures. Fifty-eight preterm infants (gestational age < 30 weeks) with blood culture-proven LOS (excluding coagulase-negative staphylococci) were matched to controls (1:1) across three cohorts (Discovery (DC) n = 18; Validation 1 and 2; VC1 n = 12, VC2 n = 28). Fecal samples collected up to 10 days before LOS onset underwent 16S rRNA gene sequencing. Microbial composition, diversity, and discriminatory taxa were compared across LOS subgroups. Random Forest (RF) models were trained in DC and validated in VC1/VC2. Microbiota variation was largely explained by LOS pathogen (R2 = 17%, P < 0.001). Infants with non-staphylococcal and E. coli-LOS showed a temporal increase in relative abundance of Escherichia/Shigella. The RF model distinguishing E. coli-LOS from controls displayed the highest discriminatory performance (AUC = 0.99/0.78/0.61 for DC/VC1/VC2) compared to non-staphylococcal LOS (AUC = 0.96/0.46/0.41). Our findings demonstrate profound microbiota shifts preceding E. coli-LOS, with higher discriminatory ability compared to non-staphylococcal-LOS. While pathogen-specific microbiota-based risk stratification may offer added clinical value, reduced validation performance highlights the limited generalizability and underscores the need for future research before clinical translation.
The aging male : the official journal of the International Society for the Study of the Aging MaleAmar Mann, Richard C Strange, Carola S König, Geoffrey Hackett, Ahmad Haider, Karim Sultan Haider, Peter Desnerck, Michael Zitzmann, Farid Saad, Mruga M Dhebar…
BACKGROUND: Using the Gompertz-Makeham model, we describe associations between age and the probability of mortality in men with adult-onset testosterone deficiency (TD), stratified by testosterone undecanoate (TU) treatment and type 2 diabetes (T2DM). METHODS: We analyzed a registry of 737 men (353 and 384 men on/not on TU, respectively) with adult-onset TD with nearly 9 years of follow-up. We compared associations between age and mortality using nonparametric and logistic regression models (estimating individual mortality probability) in men stratified by TU treatment and T2DM. RESULTS: Mortality was lower (p < 0.001) in men on TU compared to men opting against TU. In the men on TU, age was associated with mortality (odds ratio (OR): 1.26, 95% confidence interval (CI): 1.13-1.40) in the nonlinear pattern expected in the Gompertz‒Makeham model. However, age was not associated with mortality in men not on TU (OR: 1.03, 95% CI: 0.98-1.08). T2DM status did not affect these associations. CONCLUSION: The association between age and mortality differed between men on TU and those opting against treatment. In untreated men, features of metabolic syndrome worsened, which perhaps minimized the relationship between age and mortality. In men on TU, these metabolic risk factors improved, perhaps restoring the association between age and mortality.
OncoimmunologyChang Gon Kim, Junkyu Kim, In-Ho Kim, Eun Hee Jung, Hyeon-Su Im, Byung Woog Kang, Ji Hyun Park, Joo-Hwan Park, Jungmin Jo, Eo Jin Kim, Seung Hoon Beom, Sun You…
Non-clear cell renal cell carcinoma (nccRCC) represents a biologically heterogeneous group of tumors for which optimal systemic treatment strategies remain poorly defined despite recent therapeutic advances. To address this gap, we evaluated the clinical activity and safety of cabozantinib plus nivolumab in patients with advanced nccRCC. In this nationwide, multicenter retrospective cohort study conducted in the Republic of Korea, 62 patients received the combination across multiple lines of therapy, with most treated in the first-line setting. Papillary RCC was the most common histologic subtype (50.0%), followed by FH-deficient (22.6%), TFE3-rearranged (9.7%), chromophobe (6.5%), collecting duct (6.5%), and unclassified tumors (4.8%). With a median follow-up of 22.2 months (95% confidence interval [CI], 15.4-29.1), the objective response rate (ORR) was 45.2% (95% CI, 32.4-57.9) and the disease control rate (DCR) was 93.6% (95% CI, 87.3-99.8). Responses were seen across histologic subtypes (ORR = 48.4% in papillary, 50.0% in FH-deficient, 50.0% in TFE3-rearranged, 25.0% in chromophobe, 25.0% in collecting duct, and 33.3% in unclassified tumors; P = 0.876). Median progression-free and overall survival were 9.7 months (95% CI, 7.7-11.6) and 22.0 months (95% CI, 15.2-28.7), respectively. Grade 3-4 treatment-emergent adverse events occurred in 46.8% of patients, and treatment discontinuation due to toxicity was reported in 6.5%. These findings demonstrate that cabozantinib plus nivolumab provides clinically meaningful and durable antitumor activity with manageable toxicity across diverse histologic subtypes in advanced nccRCC, supporting further prospective evaluation of cabozantinib plus nivolumab in advanced nccRCC.
OncoimmunologyCaroline Truntzer, Marion Thibaudin, Paula Anna Bousquet, Morgane Peroz, Valentin Derangère, Alis Ilie, David Rageot, Kjersti Flatmark, Anne Hansen Ree, Sebast…
BACKGROUND: Colorectal cancer with microsatellite stable (MSS) status is intrinsically resistant to immune checkpoint inhibitor monotherapy targeting PD-1 or PD-L1. However, emerging evidence suggests that chemotherapies may overcome this resistance when combined with immunotherapy. METHODS: We conducted a pooled analysis of individual patient data from two phase II trials evaluating oxaliplatin-based chemotherapy combined with checkpoint inhibitors as first-line treatment for MSS metastatic colorectal cancer. The MEDITREME trial is a single-arm study assessing durvalumab and tremelimumab with oxaliplatin-based chemotherapy, while the METIMMOX trial is a randomized study comparing standard oxaliplatin-based chemotherapy with an alternating regimen of oxaliplatin-based chemotherapy and nivolumab. We compared overall survival (OS), progression-free survival (PFS), and response rates between patients treated with chemotherapy alone versus chemoimmunotherapy, and evaluated the association between these outcomes and transcriptomic and immunoscore data. RESULTS: A total of 130 patients were included: 38 who received chemotherapy alone and 92 chemoimmunotherapy. The median OS was significantly improved in the chemoimmunotherapy group compared with chemotherapy alone (not reached vs. 15.3 months; HR = 0.58; 95% CI, 0.36-0.96; p = 0.03). The complete response rates were higher with chemoimmunotherapy (14% vs. 5%). No significant differences were observed in PFS. High baseline CD8+ T-cell infiltration was associated with improved outcomes in patients receiving chemoimmunotherapy but not in those treated with chemotherapy alone. CONCLUSIONS: This pooled analysis provides compelling evidence supporting the clinical benefit of first-line chemoimmunotherapy in a subset of patients with MSS mCRC. Baseline CD8+ T-cell infiltration may serve as a predictive biomarker for identifying patients most likely to benefit from this treatment approach.