Sarcopenia is increasingly recognized as a critical complication of type 2 diabetes mellitus (T2DM), representing the convergence of global population ageing and escalating metabolic disease prevalence. Reliable assessment of appendicular skeletal muscle mass (ASM) is essential for timely detection and effective intervention. This study evaluated the validity of a widely adopted anthropometric equation for estimating ASM in healthy adults and T2DM patients, using dual-energy X-ray absorptiometry (DXA) as the reference method.

We retrospectively analyzed 402 adults who underwent DXA at Linyi People's Hospital from January 2016 to December 2022, including 175 patients with T2DM and 227 healthy controls. DXA-derived ASM and skeletal muscle index (SMI) were obtained from whole-body scans. Predicted ASM (ASM2) was calculated using the Wen equation, and predicted SMI (SMI2) was derived accordingly. Low muscle mass was defined by Asian Working Group for Sarcopenia 2019 criteria. Correlation, Bland-Altman analysis, Lin's concordance correlation coefficient, calibration, receiver operating characteristic (ROC) analysis, multivariable regression, and age-stratified analyses were performed. Shannon entropy was used exploratorily to describe subgroup distributional heterogeneity.

ASM2 correlated strongly with DXA-measured ASM in both healthy controls (r = 0.882) and T2DM patients (r = 0.871; both P < 0.001), with no significant difference between groups. However, Bland-Altman analysis showed systematic overestimation of ASM by the Wen equation, with only moderate agreement overall and wider limits of agreement in T2DM, especially in women. Concordance was better in men than women. For low muscle mass detection, SMI2 performed well in healthy men (area under the curve (AUC) = 0.851) and men with T2DM (AUC = 0.858), acceptably in healthy women (AUC = 0.793), but poorly in women with T2DM (AUC = 0.596), who also had the highest misclassification rate (40.0%). Higher body mass index independently predicted greater estimation error; age did not.

The Wen equation may be useful for preliminary population-level screening, but its individual diagnostic utility is limited by systematic overestimation and moderate agreement with DXA. Caution is especially needed in women with T2DM, for whom confirmatory DXA should be considered when feasible.

Catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT) are established endovascular strategies for the treatment of deep vein thrombosis (DVT). However, comparative outcomes data specific to upper extremity deep vein thrombosis (UEDVT) remain limited. Given that PMT is associated with improved outcomes in lower extremity DVT, we hypothesize that PMT is associated with improved mortality and morbidity compared to CDT in treating UEDVT. This study evaluates outcomes associated with CDT versus PMT for UEDVT and Paget-Schroetter Syndrome (PSS).

A retrospective cohort study was conducted using the TriNetX US Collaborative Network. Patients diagnosed with UEDVT who underwent CDT (n=1,399) or PMT (n=1,406) between 2005 and 2025 were identified. Patients who received both modalities were excluded. Propensity score matching was performed, yielding 1,198 patients in each cohort (n=2,396) balanced across demographics, comorbidities (including malignancy, type 2 diabetes mellitus, hypertension, coagulation disorders, and end-stage renal disease), and medication use. A subgroup analysis was performed for patients with PSS who underwent CDT or PMT, with similar propensity score matching (n=280). Thirty-day and one-year outcomes were compared using odds ratios (ORs).

After matching, pulmonary embolism (PE) rates did not differ significantly between groups at 30 days or one year. Compared with PMT, CDT was associated with significantly higher odds ratio of 30-day mortality (OR, 1.82), myocardial infarction (OR, 2.43), ischemic stroke (OR, 9.11), transfusion (OR, 1.95), 30-day readmission (OR, 2.34), and intracranial hemorrhage (OR, 6.59). These differences persisted at one year, with CDT demonstrating significantly higher OR of mortality (OR, 1.56), myocardial infarction (OR, 2.01), ischemic stroke (OR, 6.69), and intracranial hemorrhage (OR, 3.93). Repeat intervention occurred more frequently in the PMT cohort at one year (12.2% versus 7.68%; OR 1.67). Among patients with PSS, one-year mortality was low in both groups. There were no significant differences in PE or subsequent first rib resection between CDT and PMT treated patients. However, repeat intervention occurred more frequently in the PMT cohort (21.4% vs 10.7%; OR 2.27).

In this national propensity-matched analysis, CDT for UEDVT was associated with higher 30-day and one-year morbidity and mortality compared with PMT, whereas PMT was associated with a greater need for repeat intervention. In patients with PSS, CDT and PMT demonstrated similar clinical outcomes, although PMT was associated with higher reintervention rates. These findings suggest differential risk profiles between the two treatment strategies and may inform procedural selection in the management of UEDVT.

Obesity represents a pandemic, independent and modifiable cardiovascular risk factor, distinct from other well-known risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus. The impact of this condition on cardiovascular outcomes is remarkably potentiated when obesity is associated with hypertension. These include the development and progression of left ventricular hypertrophy, endothelial dysfunction, sympathetic activation to the heart and peripheral vessels, impaired arterial distensibility, pro-atherogenic vascular alterations and kidney dysfunction and failure. On the clinical ground these alterations favor the development and progression of cardiovascular complications, such as coronary artery disease, chronic heart failure, life-threatening cardiac arrhythmias cerebrovascular disease and sleep apnea syndrome. In conclusion, the present paper will provide a comprehensive in-depth pathophysiological background, clinical consequences and therapeutic implications of the obesity-related hypertensive phenotype.

Type 2 diabetes (T2D) disrupts male reproductive function by impairing Leydig and Sertoli cell activity, leading to hormonal imbalances and defective spermatogenesis. This systematic review explores the molecular mechanisms underlying T2D-induced dysfunction in these testicular cells, emphasizing alterations in steroidogenesis, cell signaling, and metabolic regulation.

A systematic review of peer-reviewed studies was conducted using databases such as PubMed. to identify relevant studies published between January 1, 2010, and December 30, 2024. Studies investigating the effects of type 2 diabetes mellitus on Leydig and Sertoli cells. Key molecular markers, androgen receptors, insulin-like growth factor-binding proteins (Igfbp5), and cell junction proteins (Cx43, TJP1, GJA1), were analyzed. Additionally, pathways such as PI3K/Akt, MEK5-ERK5-MEF2C, and inflammatory markers (PERK, IKKβ) were reviewed to understand their roles in diabetic testicular dysfunction. The risk of bias was assessed using the SYRCLE tool.

T2D reduces Leydig cell function by downregulating insulin receptors (IR-β, IR-α) and disrupting steroidogenic pathways, leading to lower testosterone levels. Increased miR-504 and miR-935 expression suppresses the MEK5-ERK5-MEF2C survival pathway, promoting apoptosis in Leydig cells. Sertoli cell dysfunction is characterized by decreased VEGF expression, impaired BTB integrity, and metabolic shifts favoring glycogen accumulation instead of lactate production. Insulin resistance further exacerbates these effects, leading to defective spermatogenesis.

Diabetes-induced dysfunction in Leydig and Sertoli cells is a key contributor to male infertility. Targeting VEGF restoration, insulin signaling pathways, and miRNA regulation may offer potential therapeutic strategies. Further studies are needed to develop interventions that preserve testicular function in diabetic individuals.

The aim of this study was to evaluate the visibility of colorectal liver metastases (CRLM) using photon-counting detector computed tomography (PCD-CT) and to determine the optimal virtual monoenergetic image (VMI) and iodine map reconstructions for improved contrast detection between metastases and surrounding liver parenchyma.

A total of 117 patients with 227 CRLM (up to three measurements per patient) who underwent abdominal PCD-CT for staging between 09/2022 and 08/2024 were retrospectively included. VMI were reconstructed at energy levels between 40 and 90 keV (in 10 keV increments), and scanner-generated iodine maps were additionally analysed. To quantify contrast between CRLM and liver parenchyma, the parenchyma-to-lesion ratio (PLR) was calculated for each VMI and iodine map. The contrast-to-noise ratio (CNR) was determined based on attenuation values of the metastases and the bilateral musculus erector spinae, as well as its standard deviation. For the iodine map, lesion and parenchyma iodine concentrations were used analogously. Subjective assessment of metastases visibility on the three best VMIs in PLR and CNR (40-60 keV) and iodine maps were independently performed by three radiologists.

Lesion and liver attenuation decreased steadily with higher keV levels. Iodine maps showed markedly higher iodine concentration in liver parenchyma than in metastases. The PLR was highest on the iodine map (3.29 ± 2.01), followed by 40 keV (2.19 ± 0.73). Regarding CNR, the 40 keV VMI showed the highest value (1.49 ± 1.70), followed by the iodine map (1.09 ± 0.99). CNR values decreased further at higher energies and significantly reduced at 70-90 keV. Paired superiority testing confirmed 40 keV as the best-performing VMI, showing significantly higher CNR than the iodine map, whereas PLR remained superior on the iodine map. Subjective ratings indicated that the 50 keV VMI provided the best visibility of CRLM. The iodine map consistently received lower subjective ratings across all criteria.

Both iodine maps and low-keV VMIs, particularly at 40 keV, demonstrated high PLR and CNR values, contributing to improved depiction of CRLM in PCD-CT. The complementary use of these reconstructions may enhance lesion detection and overall diagnostic confidence.

The tuberous sclerosis complex is an autosomal dominant genetic disorder caused by mutations in the TSC 1 or 2 genes. Cardiac rhabdomyomas are the most frequent initial manifestation and leading cause of mortality in children under 10 years of age. Data on Brazilian patients with rhabdomyomas are scarce.

This study aims to describe the diagnostic aspects and clinical features observed during the follow-up at a high-complexity cardiology centre.

This was a retrospective, descriptive, single-centre study, based on medical records. Patients of all age groups and sexes were included, with a confirmed diagnosis of tuberous sclerosis and at least two serial transthoracic echocardiograms performed at the service from January 1997 to January 2024. Patients with uncertain diagnoses and incomplete records were excluded.

Among the 69 patients evaluated, 42 (60.86%) had cardiac tumours, with 41 rhabdomyomas and one pericardial lipoma, with a mean follow-up time of 6 years. The median age of the cohort at first evaluation was 3.5 years [1.0; 15.8]. Multiple tumours were observed in 75.6% of cases. Most patients with rhabdomyomas were asymptomatic at both evaluations (73.8% and 85.71%, respectively); however, episodes of arrhythmia were recorded in 21.43% of the sample during follow-up. Only one patient presented with ventricular dysfunction, and one patient required surgical treatment, resulting in death. Incomplete involution of the mass occurred in 76.2% of cases, complete regression in 16.7%, and maintenance, increase, or need for surgical treatment in 7.2%.

Our data indicate a considerable prevalence of arrhythmias and the persistence of identifiable masses throughout follow-up in a Brazilian cohort of patients with tuberous sclerosis complex, emphasizing the clinical relevance of persistent lesions as potential arrhythmogenic substrates requiring long‑term surveillance.

As improvements in anti-cancer treatments have extended survival, patients with advanced cancer and their family caregivers face existential tension between engaging in life and coping with uncertainty about illness trajectory and the course of treatment. For a subgroup, this tension is associated with overwhelming fear and existential distress. Such adjustment difficulties may increase the risk of mental disorders, poor quality of life, and suicidality, and impair prognostic awareness and patient-clinician communication. Despite growing interest in open conversations about end-of-life issues, systematic evidence on effective psychotherapies to best support psychological adaptation in patients with high levels of existential distress is still scarce. We aim to evaluate the effectiveness of a short-term psychodynamic therapy (ORPHYS) to mitigate existential distress compared to usual psycho-oncological treatment (TAU).

We conduct a two-arm parallel randomized controlled trial with an active control group. ORPHYS is a manualized individual face-to-face psychotherapy focusing on emotional and relational conflicts specific to cancer patients' illness situation. Treatment lasts between 5 and 11 months with 15 to 31 weekly sessions (50 min). TAU includes at least one individual session provided by physicians or psychologists with experience in psycho-oncological care. Patients will be assessed pre-intervention and 3, 6, 9, and 12 months after baseline. Target sample size is 160 randomized participants. We recruit patients with stage III/IV solid tumors or advanced hematological cancer and clinically significant existential distress from psycho-oncology clinics and referring oncologists at Hamburg, Düsseldorf, and Würzburg Comprehensive Cancer Centers, Germany. The primary outcome is demoralization (Demoralization Scale-II). Secondary outcomes include diagnoses of affective, anxiety and stress-related disorders, death anxiety, dignity-related distress, and quality of life. Outcome assessments are conducted via self-report questionnaires and diagnostic interviews. Linear mixed models examine outcome differences between trial arms. A confirmatory test of the group contrast at 6-month follow-up after baseline is conducted.

Due to an aging population and prolonged survival, there is a growing demand to help patients deal with existential challenges undergoing palliative cancer care. The study will contribute to knowledge about how clinicians can best help patients with advanced cancer who substantially struggle with uncertainty at the end of life.

German Clinical Trials Registry, DRKS00038173. Registered October 20th, 2025, https://drks.de/search/en/trial/DRKS00038173 .

gov, NCT07312760. Registered December 30, 2025, https://clinicaltrials.gov/study/NCT07312760 .

Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults impairing the quality of life. Among several surgical options, flap reconstruction offers faster healing and lower recurrence. This randomized comparative study evaluated the keystone perforator island flap (KSF) versus the Limberg flap (LF) in PSD repair, focusing primarily on patient satisfaction depending on the flap type, alongside perioperative outcomes following PS excision as secondary outcomes.

A total of 50 patients with simple PSD were randomized equally to undergo KSF or LF reconstruction after sinus excision. Operative data, complications, and recovery metrics were recorded. Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale. Statistical analysis employed the t-test, chi-squared test, and multivariate linear regression to identify independent predictors of satisfaction (p < 0.05 significant).

The KSF group showed shorter operative time (54.9 ± 3.7 versus 73.4 ± 7.9 min, p < 0.001), faster wound healing (13.5 ± 3.1 versus 17.1 ± 3.5 days, p < 0.001), and earlier return to activity (6.8 ± 0.8 versus 8.5 ± 0.8 days, p < 0.001). Complications were lower (24% versus 56%, p = 0.02). Satisfaction was significantly higher with KSF (96% versus 72%, p = 0.046). Regression analysis identified wound-healing time (p = 0.008) and return to activity (p < 0.001) as the independent predictors of satisfaction.

The KSF provides faster recovery, better comfort, and higher patient satisfaction than the LF. Functional recovery parameters, rather than flap type alone, are the strongest determinants of postoperative satisfaction.

To systematically evaluate and update the evidence about photobiomodulation therapy (PBMT) as a therapy for the prevention and/or treatment of oral mucositis (OM) induced by antineoplastic therapies.

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was conducted across PubMed, Web of Science, Scopus, and Embase as the primary databases. Additional searches were performed in the Virtual Health Library (VHL) and LILACS through the BIREME platform, as well as in Redalyc and the Wiley Online Library, covering the period from 2020 to 2026. Only randomized clinical trials published within the last six years investigating PBMT as a preventive or therapeutic intervention for oral mucositis (OM) in cancer patients receiving chemotherapy and/or radiotherapy were included.

Seven studies comprising 329 patients were included. PBMT proved to be highly effective in the management of OM (RR 0.50, 95% CI 0.35-0.73). Moderate heterogeneity was observed across studies (I² = 40%). PBMT protocols varied, with laser wavelengths ranging from 635 to 980 nm, most commonly 660 nm for intraoral (IO) application. Application sites included IO and/or extraoral (EO) approaches, with IO application times ranging from 3 to 20 s. OM was consistently assessed using World Health Organization (WHO) criteria across all studies. The included trials demonstrated a low risk of bias and publication bias.

Evidence from recent randomized clinical trials confirms that PBMT is highly effective for the management of oral mucositis, reducing its incidence and severity, improving quality of life and treatment adherence, and potentially lowering healthcare costs during cancer therapy.

Aquaporins (AQPs) are membrane channel proteins implicated in tumor biology, but their clinicopathological and prognostic relevance in diffuse large B-cell lymphoma (DLBCL) remains insufficiently characterized. This study evaluated the immunohistochemical expression of AQP1, AQP2, AQP8, and AQP9 and their associations with clinicopathological features and survival outcomes in DLBCL. In this retrospective cohort study, formalin-fixed, paraffin-embedded tissue samples from 164 DLBCL cases diagnosed at Mansoura University Oncology Center between 2011 and 2022 were analyzed using tissue microarray-based immunohistochemistry. Associations between marker expression and clinicopathological variables were assessed using appropriate comparative tests. Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan-Meier methods and Cox proportional hazards regression. A sensitivity Cox analysis was additionally performed to assess whether the association of AQP9 with overall survival persisted after adjustment for rituximab exposure. Positivity for AQP1, AQP2, AQP8, and AQP9 was detected in 9.8% (16/164), 1.8% (3/164), 0.6% (1/164), and 11.6% (19/164) of cases, respectively. AQP1 positivity was associated with higher International Prognostic Index (IPI) risk category (P = 0.007) and lower hemoglobin levels (P = 0.012), but not with significant differences in survival. AQP9 expression was significantly associated with inferior OS, with a median OS of 20.7 months in AQP9-positive cases versus 78.6 months in AQP9-negative cases (log-rank P = 0.002). In multivariable analysis, AQP9 remained an independent adverse predictor of mortality (HR 2.44, 95% CI 1.35-4.40; P = 0.003). This association remained significant in a sensitivity model additionally adjusting for rituximab exposure (HR 2.26, 95% CI 1.25-4.09; P = 0.007). None of the evaluated markers significantly predicted DFS. AQP9 expression identifies a subgroup of DLBCL patients with significantly poorer overall survival and may provide prognostic information beyond conventional clinical risk stratification. In contrast, AQP1 was associated with adverse baseline features but had no significant impact on survival, while AQP2 and AQP8 were rarely expressed. Larger multi-center studies are warranted to validate the prognostic role of AQP9 in DLBCL.