Verrucous porokeratosis (VP) is a rare variant that typically presents as solitary hyperkeratotic plaques on acral sites, and atypical morphology or unusual location is exceptionally uncommon. We report a rare case of VP on the right lower leg with a striking rupioid (oyster-shell-like) morphology in a patient with long-standing diabetes mellitus and a history of rectal cancer resection and the patient received oral isotretinoin combined with topical corticosteroids and microcirculation-targeting agents, which was well tolerated and led to clinical improvement, which expanding the clinicopathological spectrum of porokeratosis.

Preoperative carbohydrate loading has been known to overcome discomfort and complications associated with cesarean section, but there is a scarcity of evidence on its safety and benefits in patients with gestational diabetes mellitus (GDM). In this study, pregnant women with normoglycemia and GDM were recruited and grouped according to their nutritional choice prior to cesarean delivery. Blood samples and clinical data were collected, and maternal comfort scores based on self-reports and neonatal data recorded. Metabolomic profiling was performed to explore underlying metabolic responses. Results showed perioperative carbohydrate loading significantly reduced thirst, hunger, and anxiety compared with fasting controls in both the normal and GDM groups. The two groups showed no significant differences at any time point in terms of glycemic measures, inflammatory markers, or maternal and neonatal outcomes. Metabolomic analysis revealed distinct but partially overlapping alterations in metabolic pathways at 1 h before surgery between the two groups.

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection, with the lower limbs being a common site. Diabetes mellitus (DM) is a significant risk factor that influences the progression, outcome, and management of NF. Despite its clinical relevance, comparative data on diabetic versus non-diabetic NF outcomes remain limited. This study aimed to compare mortality, amputation rates, and other key outcomes between diabetic and non-diabetic patients with NF.

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Eligible studies assessed outcomes in diabetic and non-diabetic NF patients. Primary outcome measures included amputation rates, mortality, admission length, debridement frequency, and microbial growth. Secondary outcomes included the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and unplanned reoperations. Pooled analyses were performed using OpenMeta[Analyst] software, reporting odds ratios (OR) and mean differences (MD) with 95% confidence intervals.

Nine studies comprising 1,890 patients met the inclusion criteria. Diabetic patients had significantly higher rates of amputation (OR 3.77, 95% CI 3.04 to 4.68; p < 0.001) and polymicrobial infections (OR 2.53, 95% CI 1.50 to 4.26; p < 0.001). Mortality was higher among diabetic patients after sensitivity analysis (OR 1.60, 95% CI 1.09 to 2.33; p = 0.02). Length of admission did not differ significantly between groups, whereas the pooled number of debridements was marginally higher in diabetic patients (MD 0.28, 95% CI 0.05 to 0.52; p = 0.02), based on only two studies. Diabetic patients had significantly higher LRINEC scores (MD 2.02, 95% CI 1.33 to 2.72; p < 0.001).

Diabetic patients with NF experience worse clinical outcomes, including increased amputation, mortality, and polymicrobial infection. These findings highlight DM as a key prognostic factor and underscore necessity for aggressive intervention and risk stratification. Further high-quality prospective studies are needed.

This study aimed to evaluate the real-world safety profile of combination therapy with a sodium-glucose cotransporter-2 inhibitor (SGLT-2i) and metformin relative to monotherapy, utilizing the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database.

We extracted adverse event (AE) reports from the FAERS database from the first quarter (Q1) of 2013 to the fourth quarter (Q4) of 2025 in which the combined regimen (ertugliflozin, dapagliflozin, empagliflozin, or canagliflozin plus metformin) was designated as the primary suspect. Disproportionality analyses were performed using the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS) algorithms. Additionally, we examined the time-to-onset distribution and the clinical outcomes of the documented AEs.

A total of 23,407 combination-therapy reports were included. At the System Organ Class (SOC) level, ROR-based signal detection identified pronounced disproportionalities in metabolism and nutrition disorders (ROR = 9.00), renal and urinary disorders (ROR = 3.91), reproductive system and breast disorders (ROR = 2.59), and infections and infestations (ROR = 2.49). At the Preferred Term (PT) level, the five most frequently reported events cross-validated by all four algorithms were diabetic ketoacidosis (n = 3,522), weight decreased (n = 1,294), blood glucose increased (n = 1,226), acute kidney injury (n = 1,153), and euglycaemic diabetic ketoacidosis (euDKA, n = 1,114). Notably, euDKA demonstrated the highest signal intensity (ROR = 335.43), with the point estimate for the combination group being numerically higher than that observed for SGLT-2i monotherapy (ROR = 185.24). Regarding documented outcomes, hospitalisation or prolonged hospitalisation constituted the most prevalent serious outcome (33.7%), followed by life-threatening events (7.6%) and death (2.7%). In the sub-cohort with definitive time-to-onset data, 39.56% of AEs occurred within the first 30 days following treatment initiation.

This pharmacovigilance analysis of the FAERS database detected significant disproportionality signals for SGLT-2i/metformin combination therapy, particularly within metabolic/nutritional, renal/urinary, and infectious disease categories. The euDKA signal appeared prominent in descriptive comparisons. The predominance of hospitalisation-related events, coupled with the substantial concentration of AEs within the initial 30-day window, highlights the early treatment phase as a potentially critical monitoring period. These exploratory findings warrant rigorous validation through prospective cohort studies.

Prophylactic cranial irradiation (PCI) is the standard preventive strategy for limited-stage small-cell lung cancer (LS-SCLC). However, the evidence supporting this strategy is largely based on the pre-MRI era. With the advancement of modern MRI and treatment techniques, the survival benefit of PCI remains unclear, particularly given the potential for neurocognitive toxicity to impair quality of life. This study aims to re-evaluate the value of PCI in contemporary LS-SCLC patients and investigate whether active MRI surveillance is non-inferior to PCI regarding overall survival (OS).

This is a prospective, randomized, multicenter, phase III trial, enrolling patients with LS-SCLC who achieve complete response (CR) or partial response (PR) after platinum-based chemoradiotherapy. Participants will be randomly assigned (1:1) to receive either PCI or active MRI surveillance. The primary endpoint is OS. Secondary endpoints include 1- and 3-year OS rates, progression-free survival (PFS), brain metastasis rate, and neurocognitive function. Exploratory analyses will integrate clinical characteristics with the longitudinal kinetics of tumor biomarkers in collected peripheral blood to identify patient subgroups who are more likely to benefit from PCI.

This study will re-evaluate the role of PCI in the MRI era for LS-SCLC. If active MRI surveillance proves non-inferior, it may provide evidence supporting a less intensive management approach that could potentially reduce treatment-related neurotoxicity and preserve quality of life. Furthermore, our trial aims to identify patient subgroups that derive a clinical benefit from PCI, and leverage serial biomarker dynamics to guide personalized clinical management for LS-SCLC patients.

This trial is registered at ClinicalTrials.gov (NCT04829708).

To synthesize qualitative evidence on how financial toxicity is experienced, sustained, and managed at the family level in pediatric cancer.

A qualitative systematic review using meta-aggregation.

PubMed, Web of Science, Embase, PsycINFO, CINAHL, and three major Chinese databases (CNKI, WanFang, VIP) were searched up to May 2025.

Two reviewers independently conducted study screening, data extraction, and quality appraisal following Joanna Briggs Institute (JBI) guidelines. Discrepancies were resolved through discussion and team consensus. Meta-aggregation was applied to synthesize findings.

Fourteen studies of moderate-to-high methodological quality, involving 524 participants (primarily parents of children with cancer) from seven countries, were included. Thirty-eight initial findings were aggregated into 10 categories and further synthesized into three final findings: (1) Financial toxicity arose from the accumulation of direct medical costs, indirect expenses, income loss due to employment disruption, and inadequate insurance or social support; (2) These financial pressures compromised family economic security and were associated with debt, reduced living standards, long-term financial vulnerability, and psychosocial impacts; (3) Families attempted to manage financial toxicity through external financial assistance and reorganization of life around the child's treatment, although such strategies often provided only partial relief.

Financial toxicity in pediatric oncology is a sustained and family-level burden that undermines household stability beyond clinical treatment phases. The limited effectiveness of existing coping strategies highlights structural gaps in supportive care. Early identification of financial risk, family-centered counseling, and coordinated system-level support may mitigate long-term consequences and promote more equitable survivorship outcomes.

No patient or public contribution.

This review was prospectively registered with PROSPERO, the International Prospective Register of Systematic Reviews (CRD42024519179). Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD42024519179 .

Patients with colorectal carcinoma (CRC) frequently experience adverse effects during chemotherapy, including gastrointestinal reactions, weight loss, and myelosuppression, which may compromise treatment continuity and functional status. Gut microbiota dysbiosis has been associated with CRC progression, chemotherapy-related adverse effects, and treatment response. This study aims to evaluate the clinical efficacy and safety of Jianpi Jiedu optimized formula (JPJDYHF) as an adjunct to chemotherapy in patients with stage Ⅲ-Ⅳ CRC and to investigate its effects on gut microbiota composition.

A total of 121 patients with primary stage III-IV CRC were prospectively enrolled and allocated, according to patient preference, to a combination group (JPJDYHF plus chemotherapy) or a control group (chemotherapy alone). The control group received first-line chemotherapy regimens recommended by the Chinese Society of Clinical Oncology (CSCO) guidelines, whereas the combination group additionally received JPJDYHF Formula No.1 and Formula No.2 orally in a stage-specific manner. After exclusion of dropouts, 113 patients who completed 6 chemotherapy cycles were included in propensity score matching (PSM) based on 9 baseline variables, including age, sex, TNM stage, and chemotherapy regimen. Using 1꞉1 nearest-neighbor matching with a caliper of 0.25, 60 patients were selected for statistical analysis, with 30 patients in each group. The ability to proceed with chemotherapy from the first to the second cycle was recorded. At the end of each chemotherapy cycle, the objective response rate (ORR), disease control rate (DCR), Karnofsky Performance Status (KPS) score, traditional Chinese medicine (TCM) syndrome score, and chemotherapy-related adverse effects, including gastrointestinal reactions, weight loss, and myelosuppression, were assessed. Serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and liver and renal function indices were measured before and after chemotherapy. After completion of six chemotherapy cycles, fecal samples were collected and total DNA was extracted. High-throughput sequencing targeting the V3-V4 region of the 16S ribosomal RNA (16S rRNA) gene was performed. Alpha and beta diversity were evaluated, and differentially abundant taxa were identified using linear discriminant analysis effect size (LEfSe). Functional profiles were predicted using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2 (PICRUSt2) and the Clusters of Orthologous Groups (COG) database.

After PSM, baseline characteristics were well balanced between the two groups. In terms of clinical efficacy, the combination group showed better chemotherapy continuation than the control group and had higher ORR (46.67% vs 16.67%) and DCR (90.00% vs 73.33%) (both P<0.05). The overall response rate for TCM syndromes was 73.3% in the combination group, significantly higher than 30.0% in the control group (P<0.05). At cycles 3 and 6, KPS scores were higher in the combination group than in the control group (both P<0.05). Regarding safety and adverse effects, by the end of cycle 6, the combination group showed less severe gastrointestinal reactions, less weight loss, and less myelosuppression than the control group (all P<0.05), whereas changes in liver and renal function indices did not differ significantly between the groups (all P>0.05). For serum biomarkers, CEA levels were lower and the reduction rate was greater in the combination group at the end of cycles 5 and 6 (all P<0.05), whereas no significant between-group differences were observed in CA19-9 levels or reduction rates (all P>0.05). Gut microbiota analysis showed no significant difference in alpha diversity between the 2 groups (P>0.05), whereas beta diversity showed significant separation (P<0.05). LEfSe analysis indicated decreased relative abundances of Bacteroidota, Fusobacteriota, and Campylobacterota in the combination group. At the genus level, the relative abundances of Bacteroides, Parabacteroides, and cancer-associated genus Fusobacterium were reduced, whereas the relative abundances of the short-chain fatty acid-producing genera Blautia and Ruminococcaceae-UCG-014 were increased (all P<0.05). COG-based functional prediction showed downregulation of pathways related to lipid transport and metabolism and cell wall/membrane/envelope biogenesis, together with activation of signal transduction functions, in the gut microbiota of the combination group.

In patients with stage III-IV CRC, adjunctive JPJDYHF may improve chemotherapy tolerance and short-term objective response, reduce myelosuppression and gastrointestinal adverse effects, promote reductions in serum CEA levels, and improve overall functional status. These effects may be related to remodeling of the gut microbial ecosystem, including reduced abundance of drug resistance-associated taxa such as Fusobacterium and enrichment of short-chain fatty acid-producing bacteria, thereby modulating lipid metabolism and signal transduction pathways. Future studies integrating multi-omics approaches with large multicenter cohorts are warranted to further clarify the specific molecular targets through which gut microbiota-derived metabolites regulate host immunity and enhance chemotherapy efficacy.

Objective: To systematically evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) versus surgical resection for early gastric cancer (EGC) in patients aged 75 years and above. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, and CNKI from the inception of the database to April 2026, to include relevant literature on ESD and surgery for aged 75 years and above patients with EGC. The experimental group consisted of patients aged≥75 years treated with ESD (ESD group), while the control group included those treated with surgery (surgery group). According to inclusion and exclusion criteria, two researchers independently performed literature screening, data extraction using the Newcastle-Ottawa Scale, and conducted meta-analysis using RevMan 5.4 and Stata 18.0 software to assess heterogeneity using I². Outcome measures included the 5-year survival rate, recurrence rate, recurrence-related mortality rate, and tumor incidence rates across different mucosal layers in both groups of patients. Funnel plots and leave-one-out analysis were adopted for publication bias analysis and sensitivity analysis. Results: A total of 6 studies involving 2 045 patients were included, with 988 in the ESD group and 1 057 in the control group. The 5-year survival rate (82.9% vs 77.4%, OR=1.29, 95%CI: 1.01-1.65, P=0.040, I²=0) and gastric cancer recurrence rate (8.5% vs 4.3%, OR=2.39, 95%CI: 1.37-4.14, P=0.002, I²=24%) were higher in the ESD group than those in the surgical group, whereas the recurrence-related mortality rate was lower in the ESD group (1.9% vs 4.9%, OR=0.47, 95%CI: 0.25-0.86, P=0.020, I²=34%). Subgroup analysis by tumor incidence rates across different mucosal layers showed that the proportion of mucosal tumors was higher in the ESD group than that in the surgical group (78.8% vs 38.3%, OR=3.40, 95%CI: 1.15-10.07, P=0.030, I²=95%), whereas the proportion of submucosal tumors was lower in the ESD group than in the surgical group (20.7% vs 61.4%, OR=0.29, 95%CI: 0.10-0.87, P=0.030, I²=95%). Funnel plot analysis showed that the studies were generally symmetrically distributed on both sides of the pooled effect size (log OR), forming an inverted funnel shape; sensitivity analysis demonstrated that the point estimates of individual studies fluctuated slightly around the original pooled effect size (log OR=1.05). Conclusion: For EGC patients aged 75 years and above, ESD demonstrates superior clinical efficacy and safety compared to surgical treatment.

The sensitive, point-of-care detection of acute myeloid leukemia (AML)-derived exosomes is essential for non-invasive diagnosis and therapy monitoring, but remains technically challenging. Here we report a colorimetric biosensor based on a dual -aptamer-initiated catalytic cascade, where simultaneous recognition of exosomal markers CD63 and PTK7 by engineered aptamers triggers an in situ rolling circle amplification (RCA) reaction. The resulting RCA product templates the assembly of a metal-organic framework (MOF) nanozyme, which acts as an efficient peroxidase mimic to generate a colorimetric readout. This integrated "recognition -amplification-transduction" nanoarchitecture achieves a detection limit of 0.1 ng/mL for PTK7-positive exosomes and successfully discriminates patient serum samples from healthy controls as well as AML-bearing mouse models from healthy mice, with consistent results obtained via UV-vis spectroscopy, visual colorimetry, and smartphone-based grayscale analysis. By synergizing nucleic acid nanotechnology with nanozyme catalysis, this work provides a rapid, equipment-free visual platform for exosome-based liquid biopsy in AML management.

Artificial intelligence (AI) is increasingly integrated into oncology care, with oncology nurses playing a key role in patient education, communication, and trust in these technologies. Although artificial intelligence is increasingly integrated into healthcare, existing AI perception and technology acceptance scales have largely been developed for general healthcare settings and do not adequately capture the unique clinical, ethical, and workflow-related aspects of oncology practice. This study aimed to develop and psychometrically validate a scale measuring oncology patients' perceptions of artificial intelligence. The study focused on instrument development rather than testing a theoretical model of technology acceptance.

A methodological, cross-sectional scale development study. The scale was developed according to established nursing research guidelines. An initial item pool was generated using the Technology Acceptance Model, literature review and expert opinions from oncology nursing and interdisciplinary healthcare professionals. Content validity was assessed using the Davis technique and Lawshe method. Data were collected from 382 adult cancer patients receiving nursing care. Construct validity was examined using exploratory and confirmatory factor analyses. Reliability was evaluated using Cronbach's α, split-half reliability and composite reliability. Structural equation modeling with bootstrapping tested the theoretical model.

The final scale included 33 items across three factors: knowledge, awareness, and trust; perceived benefit; and acceptance and use tendencies. Exploratory factor analysis explained 82.37% of the total variance. Confirmatory factor analysis demonstrated good model fit (CFI = 0.99, RMSEA = 0.079, SRMR = 0.038). Internal consistency was excellent for the total scale (α = 0.97) and subscales (α = 0.97-0.98). Perceived benefit partially mediated the relationship between knowledge and acceptance, explaining 52% of the variance.

The scale is a valid and reliable instrument for assessing cancer patients' perceptions and acceptance of AI in oncology nursing practice. This scale provides oncology nurses and nurse researchers with a standardized tool to support nursing-led patient education, shared decision-making and the integration of AI into patient-centred oncology nursing care.