Intravesical bacillus Calmette-Guérin (BCG) therapy remains the standard adjuvant treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), yet real-world maintenance delivery is frequently incomplete. Contemporary benchmarks that link BCG exposure patterns to clinically meaningful outcomes are needed. We evaluated real-world BCG treatment delivery and oncological outcomes in a tertiary cancer center cohort.

We retrospectively analyzed 120 consecutive patients with NMIBC who initiated intravesical BCG between June 2019 and May 2025. The institution-defined minimum BCG exposure was induction (≥5/6 instillations) plus initial maintenance (≥2/3 instillations) or re-induction (≥2/6 instillations). High-risk recurrence-free survival (HR-RFS) was defined as time from BCG initiation to high-risk NMIBC recurrence or pathological upstaging. Progression-free survival (PFS), metastasis-free survival (MFS), and overall survival (OS) were estimated using the Kaplan-Meier method.

Median age was 73 years; pT1 disease occurred in 45.8%, concomitant carcinoma in situ in 29.2%, and high-grade tumors in 98.3%. Induction (≥5/6) was delivered in 94.2% of patients, and an initial maintenance cycle (≥2 instillations in cycle 1) in 68.3%; 73.3% achieved the minimum BCG exposure. Only 2.5% completed maintenance through cycle 7. At a median follow-up of 33.5 months, median HR-RFS, PFS, MFS, and OS were not reached. One-, three-, and five-year HR-RFS rates were 91.4%, 76.7%, and 73.0%; corresponding PFS rates were 98.3%, 92.5%, and 92.5%; MFS rates were 99.2%, 93.3%, and 93.3%; and OS rates were 98.3%, 97.3%, and 86.2%.

These data provide contemporary real-world benchmarks for outcomes achieved with conventional intravesical BCG in high-risk NMIBC when long-term maintenance completion is uncommon.

DICER1 syndrome is a complex autosomal dominant tumor predisposition disorder characterized by a distinct chronological progression of benign and malignant lesions. By mapping the transition from early-childhood pulmonary and renal manifestations to the adolescent emergence of endocrine and reproductive neoplasms, this review provides a longitudinal framework for clinical vigilance. Central to this analysis is the molecular "two-hit" mechanism, specifically investigating how somatic hotspot mutations in the RNase IIIb domain disrupt the miR-140/FGF9 signaling axis and the let-7 feedback loop. The review identifies the neomorphic "Argonaute strand switch" as a primary driver of pathogenesis, resulting in a diagnostic 3p-strand bias that fuels sarcomatous transformation. Beyond the molecular substrate, we define the critical radiographic and clinical markers of malignancy, such as rapid volumetric growth, cystic solidification, and the detection of somatic hotspots via high-sensitivity droplet digital PCR. By integrating the 2024 international surveillance standards with emerging technologies, including Vision Transformer-based radiographic analysis and circulating tumor DNA monitoring, this review offers a proactive, evidence-based roadmap for identifying the predictors of malignancy and better management of the disease. Ultimately, this synthesis aims to equip clinicians and other healthcare profesionals with the predictive tools necessary to achieve definitive cures while minimizing the cumulative clinical and psychological burden on this genetically vulnerable population.

Nurses are one of the professional groups most exposed to psychosocial risks. Excessive responsibilities, time pressure, the need to make quick decisions, shift work, lack of adequate rest, contact with death and human suffering - all these factors can significantly affect the mental state and result in the development of health problems among nursing staff.

The study was conducted among 193 nurses working at the University Clinical Hospital No. 2 of the Pomeranian Medical University in Szczecin. Participation in the study was anonymous and voluntary. The study used a proprietary questionnaire and the following standardized tools: PSS-10, FAS, AIS and MBI.

The aim of the study was to identify psychosocial health risks among nursing staff working in a shift system.

More than half of the respondents (52.85%) showed moderate fatigue according to FAS. It was found that 66.32% of respondents suffered from insomnia according to AIS, 66.84% of respondents experienced high levels of stress according to PSS-10. It was shown that 45.60% of respondents had high levels of emotional exhaustion, 43.01% had high levels of depersonalization, and as many as 73.06% had high levels of lack of accomplishment according to MBI. Fatigue (FAS) and insomnia (AIS) showed significant positive correlations with emotional exhaustion and depersonalization, as well as negative correlations with a sense of professional achievement.

Overall, the findings indicate that shift work constitutes a significant psychological health risk for nurses, with stress, fatigue, sleep disturbances, and burnout forming a closely interrelated cluster of adverse outcomes. The observed associations suggest that chronic occupational strain may reinforce emotional exhaustion, depersonalization, and reduced professional efficacy. Moreover, work organization and length of service appear to play an important role in shaping nurses' vulnerability to these risks. These results highlight the need for targeted organizational and preventive strategies aimed at reducing psychosocial burden and supporting mental well-being among shift-working nursing staff.

Due to its long-term effectiveness in weight control and cost-efficiency, bariatric metabolic surgery (BMS) has emerged as a promising treatment option for patients with severe obesity. However, its impact on certain mental health disorders remains unclear.

This study aimed to utilize a deep learning (DL) model, DeepBiomarker2, which integrates social determinants of health (SDoH) and electronic health records (EHR), to identify clinical features associated with new-onset anxiety disorder following BMS.

We conducted a case-control study using longitudinal EHR data from the University of Pittsburgh Medical Center (Jan 2004-Oct 2019) on patients who underwent bariatric surgery. DeepBiomarker2, a DL model integrating diagnoses, medications, lab tests, and neighborhood socioeconomic status, predicted new-onset anxiety. Perturbation-based contribution analysis identified key predictive features.

A total of 14,856 eligible patients who underwent BMS without a prior history of anxiety disorder were identified. DL models outperformed traditional logistic regression in predicting post-BMS anxiety, yielding area under the curve (AUC) values exceeding 0.89. Key features associated with post-BMS anxiety included abnormal urine and blood lab results, opioid and psychiatric medication use, frequent emergency department (ED) visits, and pre-existing mental health conditions. Potential protective indicators included omega-3 fatty acids, vitamin B12, calcium citrate, and pravastatin. Inclusion of nSES data led to marginal improvements in model performance.

Our DL models successfully identified clinical features potentially associated with new-onset anxiety following BMS, offering valuable insights to support early intervention and personalized mental health strategies for postoperative care.

Young adults report heightened cannabis use yet show gaps in cannabis-related risk knowledge. Risk knowledge gaps in young adults with diverse cannabis use experience and across countries with varying cannabis policies, as well as associations with knowledge levels were explored.

The International Cannabis Policy Study (ICPS) is a cross-sectional, web-based survey that uses non-probability sampling and post-stratification weighting. Data from the 2023 ICPS national surveys conducted in Canada, Germany and the UK were used. A total of n = 2,945 18- to 25-year-olds were included in the analyses (Canada: n = 2,047; Germany: n = 446; UK: n = 452). Risk knowledge gaps were assessed through 7 health-related risk items. Inaccurate responses were turned into an index variable to measure participants’ level of risk knowledge. Negative binomial regression models were used to examine associations between sociodemographic and use-related variables and knowledge level.

Risk knowledge levels were highest among German participants, and lowest among UK participants. Some risks were better known than others across all countries. Risk knowledge was lowest among regular cannabis consumers, for whom being from the UK was associated with decreased knowledge levels (IRR = 1.227) and being at moderate risk of harm from use was associated with increased knowledge levels (IRR = 0.701). Among occasional consumers, age (IRR = 1.041), being male (IRR = 1.222) and being at moderate (IRR = 1.236) and high (IRR = 1.818) risk of harm from use were associated with decreased risk knowledge, whereas peer use (IRR = 0.718) was associated with increased risk knowledge.

This study showed that there are differences in the perception of cannabis risks among young adults, which are associated with individual consumption patterns as well as country-specific and sociodemographic factors. Findings extend the current understanding of differences and similarities in risk knowledge gaps among young adults across different countries, allowing for a more tailored risk education towards the needs of this target group.

Research has produced a substantial and expanding body of evidence-based practices (EBPs), encompassing interventions, programmes, clinical guidelines, protocols, care pathways and models of care supported by the best available evidence. Despite this, healthcare delivery is still frequently characterised as insufficiently evidence-based, reflecting a persistent gap between what is known to be effective and what is routinely implemented in practice. Traditional explanations only partially account for this gap, often overlooking culture as a critical yet under-theorized influence. Culture is a learned phenomenon rooted in social contexts, encompassing shared norms, values, beliefs and assumptions that define a group, whether a team, profession or organization. This paper argues that the uptake and sustainability of EBPs are profoundly shaped by cultural dynamics operating across three key layers: organizational, professional and disciplinary.

Organizational culture shapes openness to change, learning and psychological safety, influencing whether EBPs are seen as improvements or burdens. Professional cultures, rooted in education and identity, affect how physicians, nurses and other professionals apply guidelines and protocols. Disciplinary cultures, tied to clinical environments (e.g. emergency, intensive, mental health, palliative care), also shape how EBPs are received. Enhancing cultural responsiveness requires aligning EBPs with the shared norms, values, beliefs and assumptions of the intended users. Strategies include fostering clinician engagement in the development of EBPs, cultural competence, local adaptation and leveraging cultural champions.

Implementation of EBPs is shaped by culture, not solely by the strength of evidence or implementation strategies. Organizational, professional and disciplinary cultures interact to influence how EBPs are interpreted, accepted, adapted or resisted in practice, helping to explain persistent variation in uptake. Misalignment between EBPs and prevailing norms, values, beliefs and assumptions undermines implementation even when evidence is strong.

Resistant starch (RS) has been widely investigated as a dietary component with potential metabolic benefits, including improved insulin sensitivity, lipid profile, and inflammatory markers. However, clinical findings remain inconsistent, particularly regarding RS type and dosage. This integrative review aimed to synthesize evidence on the effects of RS consumption in dietary interventions on metabolic and cardiovascular parameters in adults and older adults.

RS intake, particularly RS2 and RS3, was associated with significant reductions in postprandial glucose, insulin, and HOMA-IR, as well as improvements in total cholesterol, LDL-C, and triglycerides. Additional findings indicated modest decreases in blood pressure and central adiposity, linked to increased short-chain fatty acid production and higher GLP-1 and PYY levels. Despite promising results, methodological heterogeneity and short intervention durations limit the strength of conclusions. RS shows potential as a functional nutrient for cardiometabolic modulation, particularly for glycemic and lipid control. However, longer, standardized clinical trials are required to confirm efficacy and clarify its physiological mechanisms.

Cardiovascular-kidney-metabolic (CKM) syndrome represents a new framework to address the non-communicable disease burden in ageing populations. However, evidence on the association between physical activity and the integrated CKM syndrome is scarce, particularly among older Asian adults. We aimed to investigate this association in a large sample of older Chinese adults.

This cross-sectional study utilised data from the China Ageing and Health Survey, including 41 829 community-dwelling adults aged ≥65 years. Physical activity was assessed using the validated Physical Activity Scale for the Elderly (PASE). Cardiovascular-kidney-metabolic syndrome was defined based on the 2023 American Heart Association criteria (Stages 1-4 vs. Stage 0). Multivariable logistic regression models were used to examine the association between PASE quartiles and CKM syndrome prevalence.

The prevalence of CKM syndrome was 80.3%. After full adjustment, a significant inverse dose-response relationship was observed between physical activity and CKM syndrome (P for trend <0.001). Participants in the highest physical activity quartile had 21% lower odds of CKM syndrome compared to the lowest quartile (adjusted odds ratio (aOR) = 0.79; 95% CI = 0.74-0.85). This inverse association was consistent across sexes but was strongly age-dependent: it was most pronounced among individuals aged ≥80 years (P for trend <0.001) and non-significant in the 65-69 age group (P for trend >0.05).

Higher physical activity is independently associated with a lower prevalence of CKM syndrome in older Chinese adults. This inverse association was strikingly age-dependent and most pronounced in the oldest-old (aged ≥80 years). For aging populations globally, promoting accessible, age-appropriate physical activity may represent a high-priority, low-cost public health strategy to reduce CKM burden, particularly in this most vulnerable demographic.