Methotrexate (MTX) is the cornerstone therapy for rheumatoid arthritis (RA) and psoriatic arthritis (PsA), yet gastrointestinal adverse events (GIAE), including intolerance and hepatotoxicity, remain major causes of treatment modification and discontinuation. Identifying baseline predictors of these reactions is essential to optimizing treatment safety and persistence.

To identify clinical and laboratory predictors of MTX-related GIAE and to compare risk profiles between RA and PsA.

Retrospective observation study including MTX-treated patients with RA or PsA. Baseline demographics, comorbidities, laboratory results, MTX characteristics, and concomitant medications were extracted from medical records. GIAE comprised either gastrointestinal (GI) intolerance or toxicity. Associations were assessed through univariate tests followed by multivariable logistic regression. Kaplan-Meier curves evaluated treatment survival according to administration route and disease type.

Among 369 patients (62.6% female; mean age 57.5 +/- 12.6 years), 50.9% developed GIAE. GI intolerance occurred in 127 patients, mainly presenting as nausea (68.5%). GI toxicity occurred in 75 patients, with baseline alanine transaminase (ALT) significantly higher in affected patients. Independent predictors of GIAE were diabetes mellitus (aOR 2.22), female sex (aOR 1.82) and PsA (aOR 1.67). Predictors of GI intolerance included higher baseline ALT (aOR 1.02), concomitant leflunomide (aOR 1.91), and female sex (aOR 2.08). Predictors of GI toxicity included diabetes (aOR 2.98), alcohol consumption (aOR 2.79), and baseline ALT (aOR 1.03). Survival analysis showed earlier MTX-related GIAE in patients receiving the subcutaneous formulation across diseases (p<.001).

MTX-related GIAE are frequently and largely driven by metabolic comorbidities, lifestyle exposures, sex and baseline ALT. These routinely available parameters allow early identification of high-risk patients and may guide personalized MTX initiation and monitoring strategies.

Background: This case study reviews the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for weight management in older adults. A 69-year-old male patient discusses weight loss goals with his health care provider and seeks pharmacotherapy options in addition to lifestyle modifications. His medical history includes type 2 diabetes mellitus (T2D), coronary artery disease (CAD), prior coronary artery bypass graft, heart failure with reduced ejection fraction (HFrEF), hypertension, hyperlipidemia, and allergic rhinitis. He initiated weight loss efforts following a myocardial infarction; however, dietary and physical activity changes alone have not resulted in substantial weight reduction. Assessment: This patient is an appropriate candidate for GLP-1 RA therapy given his T2D, obesity, CAD, and a recent elevation in serum creatinine (SCr). The patient will initiate semaglutide, a medication approved for weight management with demonstrated cardiovascular benefit. The dose will be titrated to a maintenance dose of 2 mg once weekly, with ongoing monitoring of tolerability and weight loss.Given his age, there is concern for sarcopenia associated with excessive weight loss. The patient will be advised to maintain a balanced diet with an emphasis on protein intake and to engage in regular physical activity to minimize loss of muscle mass. Outcome: The patient experiences weight reduction within the first few weeks of therapy and tolerates treatment well. He has incorporated additional strength training into his exercise routine and increased his intake of vegetables and protein. The patient has insurance coverage for semaglutide due to his comorbid T2D; therefore, medication cost is not a barrier to treatment. Conclusion: When evaluating the use of GLP-1 RA agents in older adults, these agents demonstrate benefits beyond glycemic control and weight loss, including cardiovascular and renal outcomes. However, GLP-1 RA-associated weight loss may contribute to muscle loss, which is of particular concern in older adults who are at risk for frailty or falls. Patients receiving GLP-1 RA therapy should be encouraged to maintain adequate protein intake and engage in regular physical activity, particularly resistance training, to preserve muscle mass. Additionally, the high cost of GLP-1 RA agents may limit access for patients without insurance.

This study identified risk factors that distinguish non-aneurysmal subarachnoid hemorrhage (naSAH) from aneurysmal subarachnoid hemorrhage (aSAH). It also assessed a clinical-radiographic predictive model for risk stratification, especially when initial computed tomography angiography (CTA) is negative.

A retrospective study of 275 patients with spontaneous SAH was conducted. Multivariate logistic regression identified independent predictors of naSAH. The model's performance was evaluated using the area under the receiver operating characteristic curve (AUROC).

Independent predictors of naSAH included perimesencephalic SAH (PMSAH) (OR: 9.46, P < 0.001), good World Federation of Neurosurgical Societies (WFNS) grades 1-3 (OR: 2.72, P = 0.008), and diabetes mellitus (DM) (OR: 2.78, P = 0.046). Furthermore, a model combining CTA negativity, PMSAH, good WFNS grade, and DM demonstrated an AUROC of 0.9587. Notably, when all three clinical features were present and CTA was negative, the predicted probability of naSAH was 98%.

PMSAH, good WFNS grade, and DM are strongly associated with naSAH. While these factors increase the pre-test probability of non-aneurysmal etiology, digital subtraction angiography (DSA) remains the gold standard for definitive diagnosis. This model serves as a supplementary tool for clinical counseling and prioritizing diagnostic urgency.

Annual anal cancer screening for sexual minority men and transgender women with HIV has been recommended by experts for more than 15 years and is now endorsed by the United States Department of Health and Human Services. The prevalence of anal cancer screening in these populations was estimated in the Chicago, Houston, and Milwaukee metropolitan areas which are in US regions with the highest anal cancer incidence among people with HIV (PWH).

Survey responses collected in 2020-2022 from individuals in the Prevent Anal Cancer studies were analyzed. The prevalence of anal cytology within the prior year and any history of high-resolution anoscopy (HRA) was stratified by HIV status in individuals of screening age (≥ 35 years for people with HIV and ≥ 45 years if HIV-negative). Factors associated with cytology and HRA were assessed using logistic regression. Barriers to anal cancer screening were assessed and stratified by HIV status.

A total of 540 individuals were of screening age and reported HIV status and anal cytology screening within the prior year. Most participants (84.4%, 456/540) were aged 45 years or older, and 52.0% (281/540) reported having HIV. The prevalence of anal cytology in the prior year was 8.3% (45/540) and did not differ by HIV status. Only a history of anal warts was associated with cytology (adjusted odds ratio, aOR 2.57, 95% CI 1.31-5.06). A history of undergoing HRA among PWH differed by metropolitan area: 35.9% (28/78) in Chicago, 18.1% (27/149) in Houston, and 20.8% (11/53) in Milwaukee (p = 0.001). PWH had more than double the odds of reporting a history of HRA (aOR 2.36, 95% CI 1.32-4.22) than HIV-negative people.

Among communities highly vulnerable to anal cancer, screening uptake was low and differed by metropolitan area. Interventions are urgently needed at clinical, provider, and individual levels to increase uptake.

NCT04090060 and NCT03489707.

In October 2023, Bangladesh introduced a free, single-dose human papillomavirus (HPV) vaccine for girls aged 9-14 through its national vaccination program to prevent cervical cancer, the second most common cancer among Bangladeshi females, caused by the HPV. Although vaccine hesitancy was not a significant issue before the COVID-19 pandemic, experiences from that pandemic and global literature suggest that the population's uptake of this vaccine may face barriers due to concerns related to reproductive health, fertility, and cultural and religious beliefs. This is particularly relevant in a country where Islam is the state religion, 91% of the population is Muslim, and religious leaders hold significant influence over public opinion.

Building upon the recently developed Integrative Public Policy Acceptance (IPAC) framework, this qualitative study explores the factors shaping religious leaders' support for the HPV vaccine informing their potential role in promoting it. Semi-structured interviews with leaders from Bangladesh's five main Islamic traditions were thematically analysed using NVivo 14 with inductive and deductive coding.

Islamic religious leaders' varying support for HPV vaccinations in Bangladesh was influenced by their limited awareness of cervical cancer, as well as their religious and social concerns about ingredients, side effects and a fear of promoting promiscuity. Political ideologies also played a significant role, as leaders were less supportive of the program when they perceived the government as ideologically opposed to the beliefs or practices of their specific religious tradition.

The study's contribution to the IPAC framework highlights the importance of political consensus in policy acceptance, explaining how partisanship and ideological differences impact public policy compliance. The findings underscore the need for health systems in Muslim majority countries to engage with religious authorities, build political inclusivity and consensus, and align health policies with religious and cultural values.

Gastroenterological guidelines consider pancreatic serous cystadenomas (SCAs) to have minimal malignant potential and generally do not recommend intervention or surveillance. In contrast, the American College of Radiology recommends surgical consultation for large SCAs (> 4 cm).

To evaluate the association between initial SCA size and lesion growth during follow-up.

The final reports of all patients who underwent magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) at our institution between the years 2011 and 2021 were reviewed for the diagnosis of serous cystadenoma. Patients with typical microcystic serous cystadenomas who had at least two MRCP examinations were included. We collected clinical data from the patients during the follow-up period, including history, symptoms, and laboratory results. The primary and maximal cyst size diameters and additional radiological characteristics were collected.

Our cohort included 35 patients (21 females, 14 males) with a median age of 68 years. The median follow-up period was 32 months. None of our patients developed malignant transformation. Nineteen lesions grew during follow-up. We found no connection between the lesion size at presentation and the enlargement during follow-up. In total, 21 patients had smaller lesions < 4 cm and 14 had larger lesions > 4 cm. There were no significant clinical or radiological differences between the smaller and larger lesions.

We investigated whether the current radiological recommendations for serous cystadenomas should be revised. Surgical consultation may not be needed for typical asymptomatic SCAs, regardless of the size.

Airway management and evaluation of functional and aesthetic results after total maxillectomy and chimeric osteo-musculo-cutaneous scapula tip flap reconstruction without tracheotomy.

A single-center retrospective study of patients with malignant or benign maxillary bone or sinus tumors managed by total maxillectomy and free scapula tip flap reconstruction between January 2015 and July 2023 was performed. Data collected allowed postoperative airway management analysis. The EORTC QLQ-C30 and H&N43 questionnaires, DASH, UW-QOL-V4 and the FOIS scale were used for functional and aesthetic assessments.

Analyze the perioperative data of patients operated on. Secondary objective was to evaluate functional and aesthetic results.

Sixteen patients underwent total maxillectomy with scapula tip free flap reconstruction during the study period. Twelve (75%) patients spent an average of one day in the intensive care unit (ICU), 12 patients (75%) were extubated immediately at the end of surgery, the remaining 4 patients were extubated on day 1. No patient required re-intubation or tracheotomy. The pulmonary complication rate was low (6.2%). The mean time to resumption of feeding was 7.3 (±1.8) days, and the mean hospital stay was 14 (±3.8) days. Functional analysis was performed on 11 patients. More than half the patients had a normal diet. No patients limited their activities because of their appearance.

This series shows that it is possible to perform this surgery without systematic tracheotomy. A good aesthetic result and satisfactory recovery of functional and swallowing abilities is possible.

BACKGROUND Thyroid cancer (TC) and prostate cancer (PC) are common endocrine-related malignancies. Given the growing population of patients diagnosed with both cancers, their prognosis requires clarification. This study aimed to compare mortality between patients with both TC and PC and those with TC or PC alone. MATERIAL AND METHODS In this retrospective cohort study, data were derived from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021), including 2334 men with records of both TC and PC (TC+PC group), 37 979 men with only TC (TC-only group), and 876 838 men with only PC (PC-only group). Cox proportional hazards regression and competing risk models were used to analyze patient mortality, supplemented by a propensity score-matching sensitivity analysis. RESULTS Cox regression modeling showed that survival among patients with TC and a history of PC was better than among patients with TC and no history of PC. Hazard ratios (HRs) for all-cause mortality and TC-specific mortality, compared with the TC-only group, were 0.78 (95% confidence interval [CI], 0.71-0.87) and 0.58 (95% CI, 0.47-0.72), respectively. Similarly, patients with PC and a history of TC showed reduced all-cause mortality (HR=0.83, 95% CI, 0.75-0.91) and PC-specific mortality (HR=0.62, 95% CI, 0.50-0.78). Superior survival in the TC+PC group was confirmed by competing risk models and propensity score-matching analysis. CONCLUSIONS This study demonstrates a mutually favorable survival association between TC and PC, indicating that a history of either cancer warrants consideration in prognostic evaluation.

Colorectal cancer (CRC) is the third most prevalent malignancy globally, with its incidence and mortality rates exhibiting a consistent upward trend. It is commonly diagnosed at an advanced stage, constraining the available therapeutic strategies. Despite extensive research on CRC development and treatment, its specific pathological mechanisms are still not fully understood, and existing therapies face limitations. As one subtype of programmed cell death (PCD), pyroptosis is increasingly connected to complex interactions in cancer. Driven by the gasdermin (GSDM) family, pyroptosis plays context-dependent dual roles in CRC: it can promote tumorigenesis via sustained chronic inflammation and an immunosuppressive tumor microenvironment (TME), or suppress tumors through direct cancer cell killing and antitumor immunity activation. To build on prior work, this review systematically integrates its core molecular mechanisms, context-dependent dual roles, pathway crosstalk (apoptosis, ferroptosis, PANoptosis), and multilevel regulatory networks (gut microbiota, metabolism, epigenetics, non-coding RNAs (ncRNAs)), which have rarely been synthesized cohesively. We explore the clinical implications, with a focus on pyroptosis-based therapeutic strategies (chemotherapy sensitization, natural compounds, nanomedicines, photodynamic therapy (PDT)/sonodynamic therapy (SDT)) and their translational potential, while addressing the critical challenge of balancing their dual effects-an aspect that has not been fully elaborated in previous reviews.

Durvalumab plus gemcitabine-cisplatin (GCD) has become a standard first-line therapy for advanced biliary tract cancer (BTC) following the TOPAZ-1 trial. However, whether the survival benefit observed in trial-eligible patients can be generalized to broader real-world populations remains uncertain. We evaluated the impact of TOPAZ-1 eligibility on the effectiveness of GCD in routine clinical practice.

In this multicenter retrospective cohort study, 610 patients with unresectable or recurrent BTC treated with first-line GCD (n = 268) or gemcitabine-cisplatin (GC) (n = 342) at 19 Japanese institutions were analyzed. Patients were classified according to TOPAZ-1 eligibility criteria. Overall survival (OS) was compared between treatment groups in the entire cohort and stratified by eligibility status. Multivariable Cox models were constructed separately for eligible and ineligible patients.

Among 610 patients, 324 (53.1%) met TOPAZ-1 eligibility criteria. In the overall cohort, GCD was associated with longer OS than GC (median, 13.7 vs 11.3 months; p = 0.009). Among eligible patients, GCD significantly improved OS compared with GC (18.0 vs 13.1 months; p = 0.004), whereas no significant difference was observed among ineligible patients (10.8 vs 10.0 months; p = 0.675). However, the interaction between treatment and TOPAZ-1 eligibility was not statistically significant (p for interaction = 0.162).

In this real-world cohort, the survival benefit of GCD appeared to be primarily observed in patients meeting TOPAZ-1 eligibility criteria. Trial-based eligibility may influence the magnitude of benefit from immunochemotherapy in advanced BTC, underscoring the importance of patient selection in routine practice.