Local recurrence after definitive radiotherapy for prostate cancer (PCa) remains a challenging clinical problem. Salvage irreversible electroporation (sIRE) is a non-thermal focal ablation approach with limited published evidence in the radiorecurrent setting. We report safety and early oncologic outcomes of sIRE for these patients.

We performed a retrospective review of consecutive patients undergoing sIRE at a single institution (December 2023 to June 2025). Inclusion required biopsy-confirmed intraprostatic recurrence and PSMA PET demonstrating no metastatic disease. Outcomes included perioperative morbidity, early PSA response, and post-treatment prostate MRI findings.

Eighteen patients underwent sIRE. Mean age was 73.78 ± 7.0 years. Seventeen patients were discharged on the day of surgery. Postoperative urinary morbidity included urinary tract infection in 3 patients (16.7%), urinary retention requiring limited TURP in 2 (11.1%), and new bothersome storage lower urinary tract symptoms requiring treatment in 2 (11.1%). Mean PSA decreased from 5.37 ± 2.09 ng/mL pre-IRE to 1.61 ± 1.57 ng/mL at approximately 3 months, and 2.17 ± 1.92 ng/mL at approximately 6 months. Twelve patients underwent post-IRE prostate MRI; results included post-treatment change, or ablation defect, or susceptibility artifact in most patients. One patient underwent repeat PSMA PET for a rising PSA and was found to have a PSMA-avid lung lesion consistent with metastatic disease.

Salvage IRE for radiorecurrent prostate cancer has generally manageable short-term urinary morbidity and encouraging early PSA responses, with limited utility of post-treatment MRI. A longer follow-up is needed to define durability and optimal selection.

Alongside the physical burden of cancer and its treatments, women with gynecologic cancer face substantial psychological and social challenges that strongly shape quality of life. Adaptive coping and timely psychosocial support may facilitate adjustment, adherence, and rehabilitation. To summarize coping strategies used by women with gynecologic cancer and their association with quality of life, and to describe the role of the multidisciplinary care team in delivering psychosocial support. We conducted a systematic search of PubMed, ScienceDirect, Google Scholar, BioMed Central, AKJournals, and ResearchGate for studies published between 2018 and 2025 without language restrictions. The search yielded 1419 records; after screening and full-text assessment, 36 studies were included. We extracted data on coping patterns, psychological outcomes, quality of life, and the contribution of psychosocial care and communication. Adaptive coping - particularly problem solving and seeking social support - was associated with better emotional well-being, lower distress, and higher quality of life. Avoidant coping was linked to higher anxiety, depressive symptoms, and poorer quality of life. Structured psychosocial interventions and consistent, empathic clinician-patient communication reduced tension, strengthened trust, and improved adherence. Integrating psychosocial support into oncologic care for women with genital tumors can enhance adaptive coping and improve quality of life. A patient-centered, interdisciplinary approach should include decision-making support, early assessment of coping and psychological burden, timely referral to appropriate professionals, and continuous development of communication and patient management competencies among providers. Orv Hetil. 2026; 167(18): 691-701.

Evidence on sociodemographic disparities in COVID-19 booster vaccine uptake remains limited. We examined disparities in COVID-19 vaccine uptake among the Arab, ultraorthodox Jewish, and general Jewish populations in Israel (January 2021-August 2022), focusing on vaccine dose, community characteristics, and policy analysis.

Publicly available COVID-19 data from 135 cities (≥ 10,000 residents) were analyzed. Cumulative vaccine uptake by dose was assessed by age and population group across 3 periods (period-1: to June 2021, period-2: to December 2021, period-3: to August 2022). Policy analysis was conducted using Walt and Gilson's Policy Triangle framework, drawing on the literature, government reports, official websites, and media coverage.

Data from 76 predominantly non-ultraorthodox Jewish cities, 10 ultraorthodox Jewish cities, and 49 Arab cities were included. Compared to the general Jewish population, dose 1 uptake was lower in ultraorthodox (incidence rate ratio (IRR) = 0.51, 95% CI 0.26-0.99) and Arab cities: IRR = 0.76, 0.53-1.09), with similar gaps for dose 2. Disparities widened with boosters: for dose 3, uptake was significantly lower in ultraorthodox cities (period-2 IRR = 0.38 [0.20-0.74], period-3: IRR = 0.39 [0.20-0.75]); and Arab cities (period-2 IRR = 0.55 [0.38-0.79], period-3 IRR = 0.56 [0.39-0.81]). For dose 4, gaps were largest in adults aged ≥ 60 years (ultraorthodox: IRR = 0.24 [0.12-0.47]; Arab: IRR = 0.15 [0.10-0.22]). Higher socioeconomic status was consistently associated with uptake, particularly for boosters. The peripherality index was associated with lower dose 4 uptake, suggesting geographic disparities and access barriers. Policy analysis highlighted Israel's rapid mass vaccination rollout and evidence-based booster adoption, but also declining booster uptake and widening sociodemographic inequities. The primary campaign relied on centralized mass vaccination efforts and intensive public messaging, achieving high coverage, while the booster phase was mainly integrated into existing infrastructure, with more targeted outreach and reduced media emphasis, shifting from infection prevention to severe-disease prevention policy.

Persistent disparities in COVID-19 vaccine uptake widened during the booster phase in Israel. While rapid, centralized rollout achieved high initial coverage, sustaining equitable uptake proved challenging. These findings highlight the need for ongoing, equity-focused strategies, including targeted outreach and culturally tailored interventions throughout all phases of public health emergencies, particularly in the long-term phase, to strengthen existing healthcare infrastructure.

Influenza vaccine hesitancy remains a major barrier to achieving adequate vaccination coverage, particularly in densely populated urban areas with aging populations. Seven Chinese megacities are especially vulnerable to influenza transmission, yet evidence on drivers of vaccine hesitancy in these contexts remains limited. This study aimed to assess the prevalence and determinants of influenza vaccine hesitancy (IVH) among urban populations to inform strategies for improving vaccine uptake in China.

We conducted a multi-city cross-sectional survey from March to June 2025 across seven Chinese megacities (Beijing, Shanghai, Guangzhou, Shenzhen, Tianjin, Chongqing, and Chengdu). Participants were selected using a stratified sampling strategy within communities; eligible participants were residents (aged ≥ 18 years) who had lived in the selected communities for at least six months. Data on demographic, socioeconomic, attitudinal factors, and behavioural factors were collected. Multivariable logistic regression was used to identify factors associated with IVH and pre-season influenza vaccine uptake.

A total of 8689 participants were included. Overall, 45% of participants were classified as vaccine hesitant, while the self-reported influenza vaccination coverage for the 2024 season was 30%. Substantial variation in hesitancy was observed across megacities. Older adults (≥ 65 years) were less likely to report IVH than younger adults (18-44 years) [adjusted odds ratio (aOR) = 0.72, 95% confidence interval (CI): 0.55-0.93] and more likely to be vaccinated (aOR = 1.63, 95% CI: 1.35-1.96). Psychosocial factors were the strongest predictors of hesitancy, particularly low perceived vaccine benefit (aOR = 11.18, 95% CI: 8.45-14.64) and low trust in health authorities (aOR = 17.13, 95% CI: 13.51-21.71). Vaccination uptake was primarily associated with behavioural factors, especially prior COVID-19 vaccination (aOR = 0.32, 95% CI: 0.25-0.39).

Influenza vaccination in Chinese megacities is driven by a mix of demographic, psychosocial, and behavioural factors. Targeted strategies addressing both hesitancy and uptake are needed to improve coverage and reduce influenza transmission.

Nurse and patient outcomes in South Africa were poor before COVID-19 and are believed to have worsened during and after the pandemic. Limited evidence exists on modifiable organisational factors contributing to these outcomes hindering targeted interventions.

This paper aims to develop a better understanding of potentially modifiable organisational factors of hospitals that, if addressed, would likely contribute to improving nurse wellbeing and retention, and quality and safety of patient care.

Data were collected from 143 private and public hospitals (n = 4298 nurses) across South Africa using a cross-sectional survey. Independent variables included working time with COVID-19 patients, incidence of death and dying, resources, staffing, and the practice environment; dependent variables focused on nurse outcomes (job satisfaction, intent to leave, burnout, mental and physical health) and patient outcomes (quality of care and patient safety).

Nurse and patient outcomes were worse in public compared to private hospitals. Favourable practice environments had the strongest association with nurse and patient outcomes, followed by staffing and resources. Within the practice environment, nurse management, leadership and support of nurses showed the greatest association with job satisfaction (OR = 4.71^∗∗; 95% CI = 3.97-5.58), lower intent to leave (OR = 2.81^∗∗; 95% CI = 2.33-3.38) and more favourable mental health (OR = 2.58^∗∗; 95% CI = 2.19-3.04). Greater nurse participation in hospital affairs was associated with more favourable nurse assessments of quality of care (OR = 3.74^∗∗; 95% CI = 3.22-4.33 to OR = 6.51^∗∗; 95% CI = 3.81-4.95) and patient safety (OR = 4.35^∗∗; 95% CI = 3.81-4.95).

Interventions to improve nurse wellbeing and retention as well as quality and safety of care should focus on improving hospital practice environments, specifically nurse manager expertise, nurse leadership, nurse participation in hospital affairs, and adequate staffing and resources.

ObjectiveDespite of the tentative role of asbestos in chronic obstructive pulmonary disease (COPD), their lung function variation in relation to air pollution remains unexplored. This cross-sectional study aimed to explore the effects of air pollution on severe airway obstruction (SAO) in asbestos-related COPD.MethodsCOPD subjects were retrospectively recruited, and their asbestos exposure and SAO were verified using the existence of pleural plaque in chest X-ray and the predicted value of forced expiratory volume in 1 second in percentage less than 50%, respectively, followed by examining the association between PM_2.5, PM₁₀, SO₂, NO₂, O₃, and CO and SAO stratified by asbestos exposure using regression model.ResultsSAO percentage was 67.2% (41/61) and 65.2% (15/23) in COPD subjects without and with asbestos exposure, respectively. An increased 3-day average concentration of CO and O₃ correlated with SAO (odds ratio, 95% confidence interval: 0.06, 0.01-0.41 and 0.09, 0.01-0.64, respectively). Moreover, an increased 5-day average CO concentration also correlated with SAO (0.13, 0.02-0.71) prior to hospital admission of COPD subjects irrespective of asbestos exposure, and SAO failed to be associated with asbestos exposure.ConclusionsCertain gaseous pollution at low concentration might generally exhibit a negative association with SAO in COPD subjects, indicating the negligibly negative impact of air pollution on lung function deterioration in asbestos-related COPD.

BACKGROUND Above-average exercise capacity and a high threshold for symptoms such as dyspnea or chest pain in athletes can create false reassurance regarding the absence of clinically significant coronary artery disease (CAD). The aim of this report is to present the diagnostic reasoning and therapeutic management of an amateur endurance athlete who developed exertional dyspnea during a marathon run. CASE REPORT A 50-year-old man who was an amateur long-distance runner with a history of hypertension, hyperlipidemia reported recurrent exertional dyspnea with the onset approximately at the 20th kilometer of a marathon run, forcing a short rest but not preventing completion. Cardiopulmonary exercise testing (CPET) showed normal exercise capacity (peak oxygen uptake of 34 ml/min/kg, 104% of the predicted value). No dyspnea or chest pain occurred during maximal exertion, although ECG showed 1- to 2-mm ST-segment depression and T-wave changes in leads II, III, aVF, V5, and V6. Coronary computed tomography angiography (CCTA) showed a circumferential non-calcified plaque in the left anterior descending (LAD) artery, suggesting spontaneous coronary artery dissection. Coronary angiography confirmed severe left anterior descending artery (LAD) disease with 80% stenosis in segment 6 and a critical lesion in segment 7. Two drug-eluting stents were implanted into the LAD during a single procedure. CONCLUSIONS Firstly, supranormal exercise capacity and mildness of symptoms in endurance athletes can mask advanced CAD. Secondly, electrically positive CPET findings (1-2 mm ST-segment depression) warrant further anatomical assessment even in patients with low risk factor-weighted clinical likelihood. Finally, CCTA should be considered early in athletes with new-onset exertional symptoms, as it can reveal significant stenosis.

Highly Pathogenic Avian Influenza Virus (HPAIV) poses a serious threat to the poultry industry and public health due to its global spread to avian and non-avian hosts. To combat the spread of HPAIVs in poultry and reduce the risk of zoonotic transmission, the World Health Organization underscores the importance of strategic surveillance and advancements in vaccination strategies. For the prevention of avian influenza outbreaks in poultry and their transmission to humans and cattle, vaccination would be a critical tool. We critically review the limitations of current vaccine platforms and highlight innovative vaccine strategies against HPAIV that are essential for addressing future pandemic threats. The aim is to clarify the progress and challenges in AIV vaccine development and offer insights into recent technological advancements shaping future vaccination strategies.

Barth syndrome (BTHS; OMIM 302060) is an ultra-rare, life-limiting genetic disorder characterized by cardiomyopathy, skeletal muscle myopathy, neutropenia, gastrointestinal issues, and fatigue. Formal analyses of survival and clinical progression remain limited. Barth Syndrome Foundation has maintained an intake database (n = 502), representing > 80% of the known global population, as well as a patient-inputted registry for a subset of individuals (n = 162) with up to 11 years of longitudinal outcome data. We estimate the survival curve, identify factors associated with mortality, characterize clinical manifestations over time, and evaluate causes of death. Death disproportionately affected young children, with a 59% transplant-free survival rate for those age < 5. The risk of death plateaued between ages 5-25 before rising again. Heart transplantation (HR = 0.316, 95% CI: 0.162-0.619, p < 0.001) and living in a developed country (HR = 0.109, 95% CI: 0.018-0.659, p < 0.05) were associated with reduced risk of death. Clinical manifestations increased with age, with musculoskeletal/fatigue (66%) being most frequent. Top causes of death were cardiac-related complications, with cardiomyopathy/heart failure (51.3%), mostly in young children < 5, and arrhythmia/cardiac arrest (15%). This is the most comprehensive longitudinal assessment of BTHS survival, mortality risk, and clinical manifestation progression. Early childhood is a period of high mortality risk, driven in large part by heart failure. Although risk of death and hospitalizations plateaued between ages 5-25, the clinical burden of BTHS increases throughout the lifespan. Our results may guide clinical care, identify time windows for optimal intervention, and help clinicians better recognize BTHS clinical features.

An ultrasound artifact is a feature in an ultrasound image that does not accurately represent the true anatomy or pathology. Cardiac ultrasound artifacts are common and inevitable findings as they originate from the physical properties of ultrasound. Additionally, artifacts may occur due to interference from external equipment and devices producing ultrasound waves. This document provides a uniform and structured approach to managing ultrasound artifacts, including the appearance of the artifact on the image, the mechanism behind the artifact generation, the clinical impact of the artifact on the diagnosis and management of the patient, examples of real cases, and how the artifact can be avoided or mitigated. In addition to true artifacts, we also discuss a series of artifact-like phenomena. Everyone involved in performing or interpreting cardiac ultrasound should be familiar with artifacts and their potential for misdiagnosis, which in some instances may lead to serious clinical consequences. Despite continued improvements in ultrasound imaging technologies, artifacts remain common in all echocardiographic modes, including two-dimensional, spectral, and color Doppler, as well as three-dimensional echocardiography.