To evaluate the association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and nephrolithiasis in adults with type 2 diabetes.

We searched PubMed, Embase, and CENTRAL through April 26, 2026, for comparative studies of SGLT2i in adults with type 2 diabetes. We pooled comparison-level effect estimates using restricted maximum likelihood random-effects models and reported summary odds ratios (ORs). We assessed heterogeneity with I² and 95% prediction intervals, performed subgroup analyses and meta-regression, and assessed risk of bias.

We included 10 studies, contributing 14 comparisons. SGLT2i were associated with lower odds of nephrolithiasis across all comparators (OR 0.72, 95% CI 0.65-0.80; p < 0.001; I² = 97.5%; 95% prediction interval 0.48-1.08). The association was strongest versus non-user controls (OR 0.55, 95% CI 0.52-0.58), followed by placebo (OR 0.65, 95% CI 0.49-0.85), DPP-4 inhibitors (OR 0.74, 95% CI 0.63-0.86), and glucagon-like peptide-1 receptor agonists (OR 0.79, 95% CI 0.70-0.90) (p for subgroup difference < 0.0001). Associations were consistent across study designs; outcome ascertainment methods did not significantly modify the association. Comparator class accounted for 29.5% of between-comparison variability, although the moderator test was not statistically significant (p = 0.10); follow-up duration was not significantly associated with effect size.

SGLT2i were associated with lower odds of nephrolithiasis in adults with type 2 diabetes. Substantial heterogeneity and the largely observational evidence base limit causal interpretation. Future studies should use adjudicated stone outcomes and urinary biochemical data.

A quantifiable preoperative airway evaluation protocol facilitates early recognition of difficult airways and the standardized implementation of perioperative airway care.

To evaluate the application of preoperative three-dimensional computed tomography airway reconstruction images to predicting difficult airway in high-altitude patients with deep odontogenic infection (DOI).

This retrospective cohort study enrolled subjects hospitalized for DOI in the Department of Oral and Maxillofacial Surgery, Xizang Autonomous Region People's Hospital. Patients were excluded if they received intubation/tracheotomy before computed tomography, had diseases altering airway anatomy, or prior maxillofacial radiotherapy/surgery.

The primary predictor variables were upper airway morphological parameters, including airway volume, midsagittal area, minimal cross-sectional area, minimum lateral diameter, minimum anteroposterior diameter, pharyngeal soft tissue thickness, and airway midline deviation distance.

The main outcome variable was airway difficulty. Subjects were grouped into difficult airway and nondifficult airway groups, defined as patients requiring preoperative tracheotomy or postoperative mechanical ventilation after surgery versus those receiving neither intervention, respectively.

The covariates included age, sex, hypertension, diabetes mellitus, alcohol consumption, and smoking status.

Morphological parameters between the difficult and nondifficult airway groups were compared by independent t-test, while qualitative data were analyzed using chi-square test. Multivariate binary logistic regression was performed to identify independent predictors of difficult airway. P < .05 indicated statistical significance.

The sample included 56 subjects with a mean age of 36.7 ± 16.2 years and 26/56 (46.4%) were male. The logistic regression analysis showed that the lateral diameter of the oropharynx at the minimal cross-section (Oro-LAT) (P = .03), the minimal cross-sectional airway area of the hypopharynx (Hypo-Msa) (P = .002), and the airway midline deviation distance at the anteroinferior point of the 2nd cervical vertebrae (C2-Md) (P = .003) were statistically significantly related to difficult airway. Operative time, hospital stay, and total hospitalization costs were statistically significantly greater in the difficult airway group versus the nondifficult airway group (P < .01).

For high-altitude patients with DOI, reduced Oro-LAT, and Hypo-Msa, increased C2-Md are important morphological indicators of difficult airways. Patients with these airway changes tend to require tracheotomy or mechanical ventilation, accompanied by longer operation time, prolonged hospital stay, and higher medical costs.

This systematic review and meta-analysis assesses whether exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) during pregnancy or the periconceptional period is associated with adverse maternal and perinatal outcomes.

Medline, Embase, and the Cochrane Library were searched for observational studies comparing pregnancies exposed and unexposed to GLP-1 RAs within 6 months before a positive pregnancy test. Outcomes included miscarriage, intrauterine death, congenital anomalies, preterm birth (PTB), hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), small for gestational age (SGA), large for gestational age (LGA), and excess gestational weight gain. Random-effects meta-analyses and subgroup analyses by indication were performed.

Ten studies included 2,118,215 women, of whom 8,325 were exposed and 2,109,890 were unexposed. Pooled estimates did not show a clearly detectable increase in miscarriage or intrauterine death, congenital anomalies, preterm birth, HDP, gestational diabetes, abnormal fetal growth, or excess gestational weight gain. A lower pooled estimate for preeclampsia was observed (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.78-0.98; p = 0.02), but this was based on two datasets and should be interpreted cautiously. Subgroup analyses showed no clearly detectable differences by indication. The exposure-window sensitivity analysis, covering 90 days before conception through the end of the first trimester, used the same four studies as the primary congenital-malformation analysis and therefore was not independent.

Available observational evidence did not identify a clearly detectable increase in adverse maternal or perinatal outcomes following periconceptional exposure to GLP-1 RAs. However, these findings do not establish safety because of heterogeneity, residual confounding, and limited datasets.

None.

This systematic review and meta-analysis compared reproductive, perinatal and neonatal outcomes between letrozole-based endometrial preparation, with or without adjuvant gonadotrophins, and programmed-cycle endometrial preparation for frozen embryo transfer (FET) in women with polyendocrine metabolic ovarian syndrome (PMOS), including only randomized controlled trials (RCTs). MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from inception through September 10, 2025. Four RCTs met inclusion criteria (n = 891). Random-effects models were used to pool risk ratios, risk of bias was assessed with RoB-2 and certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations. No significant difference in live birth rate was observed between the two protocols (RR 0.92, 95% CI 0.79 to 1.07). Similarly, no significant differences were observed in clinical pregnancy, miscarriage, hypertensive disorders of pregnancy or cycle cancellation rates. A lower risk of gestational diabetes mellitus (GDM) was observed with programmed-cycle FET in a meta-analysis of two RCTs (RR 0.33, 95% CI 0.14 to 0.82, P = 0.02); however, this hypothesis-generating finding should be interpreted cautiously because of the unexpectedly high GDM rates and requires confirmation in larger studies. Other perinatal and neonatal outcomes did not differ significantly, although evidence was underpowered. In contrast to observational studies, current RCT evidence does not demonstrate superiority of letrozole-based over programmed-cycle endometrial preparation for reproductive outcomes in women with PMOS.

This study examined levels of financial toxicity in older adult cancer patients and assessed the relationship between financial toxicity and levels of life satisfaction and quality of life.

The study sample consisted of 116 cancer patients aged 65 and over who applied to a university hospital in Kahramanmaraş, Türkiye, for treatment. The Comprehensive Score for Financial Toxicity Scale, Life Satisfaction Scale, and Quality of Life Scale were used in the study. Descriptive statistics, correlation analysis, and hierarchical regression analysis were used in the analysis of the data.

Patients were found to have moderate levels of financial toxicity, and this level was correlated with life satisfaction and quality of life. Higher levels of financial toxicity were observed in female and married patients. Similarly, patients with access to caregivers, higher levels of education, and higher income levels were found to have higher quality of life and life satisfaction.

Assessments of life satisfaction and quality of life levels in older adult cancer patients have revealed that financial toxicity and socio-demographic characteristics are significant determinants. However, considering that older adults generally have a fixed income and may find it difficult to generate further financial gain, it is believed that supportive policies should be developed to prevent an increase in financial toxicity levels.

Breastfeeding is associated with a reduced risk of breast cancer yet awareness of this maternal health benefit remains limited. Public health messaging in the United Kingdom has traditionally emphasised infant benefits of breastfeeding with less attention to long-term maternal outcomes. This study aimed to explore breastmilk donor awareness of breastfeeding as a protective factor against breast cancer and their perspectives on communicating this information.

Qualitative study using semistructured interviews analysed through reflexive thematic analysis, adopting a constructivist epistemological position.

Participants recruited from across the United Kingdom through the Hearts Milk Bank took part online using Microsoft Teams. Interviews were conducted between June and July 2025.

Twelve milk bank donors recruited as part of the Breastmilk Epigenetics Cohort Study (BECS). Participants discussed breastfeeding experiences, awareness of breast cancer risk factors, perceptions of personal risk and views on breastfeeding-related health messaging.

Five themes were generated. 'Know more, breastfeed for longer?', describes uneven awareness of breastfeeding as a protective factor against breast cancer. 'Breast cancer is seen as fate, not risk, and breastfeeding is not a part of the picture', describes risk perceptions related to breast cancer. 'A communication system that centres the baby, not the mother-infant dyad', highlights the lack of maternal-focused education postnatally. 'Information reaches women by chance, not design', explores the routes by which participants find breastfeeding and breast cancer information and finally, 'What women want: clear, shame-free, integrated communication', represents participants' clear preferences for non-judgemental, evidence-based information delivered by trusted sources.

Breastfeeding-related breast cancer risk reduction appears poorly integrated into routine health communication for women of reproductive age in the United Kingdom. The fact that breastmilk donors, a niche group of women who are highly motivated and capable of donating excess supplies of breastmilk, had a variable awareness of the maternal benefits of breastfeeding, is not only significant in its own right, but carries broader implications; if awareness gaps exist at this level of commitment, they are almost certainly more pronounced across the general breastfeeding population. As such, while these data are not intended to be representative of breastfeeding women in the UK, these findings offer a compelling case for reform of how breastfeeding benefits are communicated. Future research with broader and more diverse populations is needed to examine whether these patterns extend beyond highly motivated breastfeeding women, and to develop and evaluate targeted communication strategies.

Eliminating cervical cancer requires high screening participation levels. Pregnancy is an opportunity to reach under-screened women, but clinician-collected speculum examination is a barrier to uptake. Patient self-collected cervical screening tests (SC-CST) using a vaginal swab for detection of human papillomavirus (HPV) may offer a solution. The objective of this study was to evaluate the outcomes and implementation of a comprehensive programme embedding SC-CST into antenatal care.This is a prospective quality improvement study in a tertiary hospital servicing a population with one of the lowest cervical screening rates nationally. Pregnant women attending public maternity care and eligible for screening under national guidelines were included. Screening histories were obtained from the national registry to identify screen-overdue or never-screened women for SC-CST offer. Staff education and patient information encouraged participation. Test packs facilitated specimen collection. Referral pathways were created for abnormal results. Main outcome measures include reach, effectiveness, implementation and maintenance of quality improvement.From 19 February 2024 to 31 July 2025, 48.0% (2492/5190) of eligible pregnant women required a CST, 69.7% were offered SC-CST and 93.7% accepted. Cervical screening rates increased 22-fold from 3.0% prior to the programme to 65.3%. Parous women were offered SC-CST at lower rates than nulliparous women (66.5% vs 74.1%; p=0.024). Women residing in the lowest socioeconomic quintile had lower acceptance rates (91.9% vs 94.8%; p=0.024). Being overseas-born and need for interpreter were not barriers to SC-CST offer or acceptance rates. Results were high risk HPV-negative in 88.1%, HPV 16/18 positive in 1.9%, HPV non-16/18 positive in 9.1% and invalid in 0.9%. Colposcopy was performed for 41 women, with 7 cases of biopsy-confirmed high-grade squamous intraepithelial lesion requiring treatment.Introduction of SC-CST into antenatal care is an effective strategy to improve cervical screening rates and was highly acceptable to pregnant women. Programme sustainability requires additional resources, staff engagement, and timely follow-up.

IntroductionHospitalized patients with advanced cancer frequently experience high symptom burden, prognostic uncertainty, and complex decision-making needs. Although specialty palliative care improves patient-centered outcomes, access remains limited in many inpatient settings. Oncology hospitalists may be uniquely positioned to deliver elements of primary palliative care during acute hospitalizations. Communication is a core clinical skill in hospital medicine, yet many oncology hospitalists feel underprepared for breaking bad news, discussing prognosis and leading goals-of-care conversations. As providers of primary palliative care, oncology hospitalists help patients and families understand serious illness, explore personal values, and make decisions that align with what matters most to them. However, despite engaging in these conversations routinely, communication training and educational resources specifically tailored to the oncology hospitalist role remain limited.MethodsDrawing on published literature and established communication frameworks, this narrative review examines the role of oncology hospitalists in delivering primary palliative care communication. Evidence-based frameworks, including SPIKES, NURSE, and Ask-Tell-Ask, are illustrated through representative inpatient oncology case vignettes.ResultsOncology hospitalists are often the clinicians most consistently present during hospitalization and are therefore well positioned to initiate and revisit goals-of-care discussions, clarify prognosis, and align treatment decisions with patient values. Integrating structured communication approaches into inpatient oncology practice may enhance patient understanding, promote goal-concordant care, and reduce fragmentation. Successful implementation requires formal training, institutional support, and clear role delineation alongside specialty palliative services.ConclusionEmbedding primary palliative care competencies within the oncology hospitalist model represents a scalable strategy to strengthen inpatient cancer care delivery. As oncology hospitalist programs continue to expand, integrating structured complementary, well-established, frameworks into routine inpatient practice may improve patient-centered care and promote goal-concordant treatment decisions.

IntroductionImmune checkpoint inhibitor (ICI)-associated myasthenia and myositis are rare, potentially life-threatening neuromuscular immune-related adverse events, but their serological spectrum remains incompletely characterized. This study aimed to elucidate their autoantibody profiles and explore associations with severe clinical features.MethodsThis retrospective, multicenter, serum-repository-based observational cohort study included 50 patients with ICI-associated myasthenia and myositis referred from institutions throughout Japan. Clinical data and serum samples were analyzed using conventional autoantibody assays, cytometric cell-based assays, RNA immunoprecipitation, and immunohistochemistry. Antibody-outcome associations were evaluated exploratorily using Firth logistic regression.ResultsAmong 50 patients, the median age was 71.5 years, and 35 (70%) were male. Two patients had preexisting thymoma-associated myasthenia. Underlying malignancies were diverse and included thoracic, gastrointestinal, urological, and other cancers. All but one patient received programmed cell death protein-1 inhibitors. The median interval from the first ICI administration to symptom onset was 31.5 days, although 7 patients showed delayed onset beyond 62 days. Severe toxicity, defined as Common Terminology Criteria for Adverse Events (CTCAE) grade 4 or 5, occurred in 15 patients, respiratory insufficiency in 12, and myocarditis in 9. Anti-acetylcholine receptor (AChR) antibodies were detected in 9 patients (18%) and showed exploratory associations with severe toxicity and respiratory insufficiency, although anti-muscle-specific kinase antibodies were not detected. Among striational antibodies, anti-titin and anti-Kv1.4 antibodies were detected in 21 and 22 patients, respectively. Anti-Kv1.4 antibodies showed an exploratory association with myocarditis. All 7 weak myositis-specific immunodot reactivities involved RNA-associated targets and lacked corresponding RNA immunoprecipitates. Reactivity on commercial paraneoplastic neurological syndrome (PNS) immunodot assays, accompanied by supportive neuronal tissue reactivity, was observed in 5 patients without classical PNS manifestations.ConclusionIn this retrospective referral cohort, anti-AChR and anti-Kv1.4 reactivities showed exploratory associations with selected severe clinical features. These findings require prospective external validation.

El melanoma cutáneo representa la principal causa de mortalidad por cáncer de piel. La combinación de fotografía corporal total (FCT) y dermatoscopía digital (DD) ha demostrado ser una estrategia eficaz en la detección precoz, particularmente en pacientes con riesgo aumentado. Se realizó un estudio observacional retrospectivo con el objetivo de evaluar el desempeño de la FCT y DD en la detección de melanoma y nevos con displasia severa, y estimar la proporción de resecciones innecesarias de lesiones benignas. Como objetivos secundarios se describieron los hallazgos dermatoscópicos asociados a lesiones malignas y las características histológicas de los melanomas diagnosticados. El 20% de las lesiones resecadas correspondieron a nevos con displasia severa (n=70) o melanomas (n=24), con un VPP del 23,5% (IC95% 19,4-27,6%). La razón maligno:benigno fue de 1:3,24. El 58% de los melanomas fueron in situ, y los invasores presentaron un espesor promedio de 0,56 mm, sin ulceración. Los principales hallazgos dermatoscópicos asociados a melanoma fueron el cambio de estructura (75%) y la presencia de líneas reticulares gruesas/pigmentación atípica (83%). La FCT y DD en pacientes con riesgo elevado demostró ser útil para la detección temprana de melanomas, en su mayoría in situ o de bajo espesor. El estudio resalta la importancia del cambio estructural dermatoscópico y el crecimiento asimétrico como señales de alerta. Aunque los resultados son alentadores, se identifica la necesidad de optimizar la selección de lesiones para reducir las resecciones innecesarias de lesiones benignas.