Effective cancer health education enhances patients' understanding, emotional regulation, and treatment compliance. However, validated instruments specific to educational outcomes remain limited. These items reflect the proximal effects of education and are not meant to represent generic mental health states.

To develop and validate a multidimensional scale to assess the effects of cancer health education, including a clear distinction of the outcomes as proximal educational results.

Following ethical approval, a cross-sectional study was conducted among 236 adult cancer patients recruited at the Third Affiliated Hospital of Chongqing Medical University, Chongqing, China, from 06 January 2025 to 21 March 2025. Item generation was informed by the Health Belief Model, patient interviews, and expert review. The 13-item scale was administered via self-report questionnaire. Internal consistency was evaluated using Cronbach's alpha, and construct validity was assessed through exploratory factor analysis (EFA).

EFA revealed a three-factor structure-Health Knowledge Comprehension, Emotional-Attitudinal Support, and Health Behavior Implementation-that explained 60.07% of the total variance. This suggests the multidimensional nature of cancer health education outcomes. The scale demonstrated excellent internal consistency (α =0.902), with all subscale alphas exceeding 0.80. Factor loadings ranged from 0.72 to 0.89, indicating strong item-factor relationships.

The Cancer Health Education Scale is a multidimensional instrument with preliminary psychometric support for evaluating educational outcomes in cancer care. Further validation in diverse populations is required. The scale may provide a useful foundation for tailoring patient education programs and supporting future cross-cultural validation studies.

Pseudouridine (Ψ) modification is a prevalent epitranscriptomic mark with critical roles in carcinogenesis; however, the function of its catalytic "writer" enzyme, pseudouridine synthase 1 (PUS1), in renal cell carcinoma (RCC) remains elusive. Our analysis revealed that PUS1 mRNA is upregulated in RCC and is associated with an unfavorable prognosis. Strikingly, this transcriptional upregulation results in a concomitant and exclusive increase in the protein abundance of PUS1 isoform 2. Mechanistically, although PUS1 markedly enhances global mRNA translation, this effect is not directly mediated via Ψ modification of either mRNA or tRNA. Instead, PUS1 regulates pre-mRNA splicing, and its deficiency induces elevated intron retention. This, in turn, culminates in the formation of double-stranded RNA (dsRNA), which subsequently activates the innate antiviral immune response and inhibits global translation. Furthermore, depletion of PUS1 in tumor cells significantly sensitizes RCC to immune checkpoint blockade therapy. Collectively, our findings demonstrate that PUS1 shields tumor cells from endogenous dsRNA accumulation and the consequent detrimental innate immune activation, thereby unveiling a novel and promising therapeutic strategy for RCC.

Evaluate the effect of inspiratory muscle training in adults with post-COVID-19 condition (PCC) and inspiratory muscle weakness.

Randomized controlled trial.

Adults with PCC and inspiratory muscle weakness.

Participants were randomized to inspiratory muscle training twice daily plus individualized exercise twice weekly or exercise alone, with weekly follow-ups over 8 weeks.

inspiratory muscle strength (Maximal Inspiratory Pressure).

expiratory muscle strength (Maximal Expiratory Pressure); functional capacity (Six‑Minute Walk Test; One‑Minute Sit‑to‑Stand); lung function (spirometry); dyspnoea (mMRC); respiratory symptoms (chest tightness, impaired deep breathing, breathing‑related pain); cough frequency (CAAT cough item); fatigue (Fatigue Severity Scale); physical activity (Frändin-Grimby Activity Scale); activity limitations (Patient‑Specific Functional Scale); and health-related quality of life (EQ‑5D‑5L). Intention-to-treat analyses used imputed missing data. Estimated sample size: 90.

Forty-four participants were included (median age 47; 82% women; n = 22/group). Between‑group differences favoured the intervention for inspiratory muscle strength (mean difference: 18%; 95% CI: 5-30; OR for clinically meaningful improvement: 7.08, 95% CI: 1.31-38.32) and cough frequency. No other between-group differences were observed.

Inspiratory muscle training may improve inspiratory muscle strength and reduce cough frequency, but limited sample size and underrepresentation of the most severely affected warrant cautious interpretation.

Cystic fibrosis (CF) is an inherited multi-organ disorder. People with CF (pwCF) experience recurrent and chronic lung infections and a progressive loss of lung function. PwCF with poor and rapidly declining lung function may be considered for lung transplantation (LTx), which may improve their quality of life and survival. Nontuberculous mycobacteria (NTM) can cause pulmonary disease in pwCF, and NTM infection is a poor prognostic factor in LTx. Guidelines recommend NTM infection should not automatically preclude LTx. It is important to evaluate the evidence base for LTx in pwCF and NTM pulmonary disease.

To evaluate clinical outcomes in pwCF and with NTM infection (NTM infection alone or with NTM pulmonary disease) who undergo LTx by comparing: 1. pwCF with current NTM lung infection who undergo LTx versus those with NTM infection who do not undergo LTX; 2. pwCF with current NTM lung infection who undergo LTx versus those without NTM undergoing LTx.

We searched the Cochrane Cystic Fibrosis Trials Register, CENTRAL, MEDLINE, Embase, and PubMed as well as two ongoing trials registries. We checked references. The latest search date was 17 February 2026.

We considered non-randomised studies of pwCF (any age) with or without NTM lung infection or disease being considered for LTx as well as studies of pwCF and NTM who either did or did not undergo LTx.

Our critical outcomes were mortality, disseminated NTM infection post-LTx, time to chronic lung allograft dysfunction (CLAD), and quality of life at any time points reported. We additionally planned to report lung function, hospitalisations for pulmonary exacerbations, and nutritional parameters in the review.

We assessed the risk of bias in three studies using ROBINS-I and in one study using the Joanna Briggs Institute checklist for case series.

We could only report results narratively. We used GRADE to assess the certainty of the evidence.

We included four single-centre retrospective studies (388 adults). Sample sizes ranged from nine to 177 participants. Mycobacteria abscessus was the most common NTM species identified, and all studies reported infection with other pathogens. All studies compared pwCF and NTM infection to pwCF without NTM infection, all undergoing LTx. Each study reported mortality and disseminated NTM infection post-LTx; two studies recorded CLAD. No study reported quality of life, specific lung function measures (although one study commented briefly on lung function in general), hospitalisations for pulmonary exacerbations, or nutritional parameters.

We analysed all NTM infections together for practical reasons and were not able to undertake a planned subgroup analysis by subspecies, but acknowledge that the prognosis and clinical trajectory of pwCF infected with different NTM may not be similar. We downgraded the certainty of the evidence due to non-randomised study design and serious risk of bias across all studies. We assessed all identified evidence as of very low certainty, such that lung transplant may have little to no effect on any of the outcomes listed below, but the evidence is very uncertain. Mortality Two studies (18 participants with NTM) reported similar survival data between NTM-positive LTx recipients and matched controls without NTM. Another study (9 participants) reported that two of five participants NTM-positive at LTx died within a few months post-LTx, whilst one of four NTM-negative participants died three years post-LTx due to chronic rejection. One study (177 participants) found that pwCF who had positive NTM cultures pre-LTx had a longer median survival duration than those who had negative cultures. This study additionally reported on survival of participants with post-LTx NTM infection, finding that the five participants who had post-LTx NTM disease had a longer mean survival duration than the 141 participants without post-LTx NTM disease. Disseminated NTM infection post-LTx In the largest study, of the 18 pwCF with NTM at the time of LTx, seven had at least one positive NTM culture, and four developed NTM disease post-LTx. Conversely, 79 of the 89 pwCF without NTM remained so post-LTx; 10 participants recorded a positive NTM culture, but none developed NTM disease. For the 39 participants without a baseline NTM culture, three participants recorded positive NTM cultures post-LTx, and one developed NTM disease. Of the remaining small studies, one reported that NTM was isolated in four of 13 participants at LTx and in three of these post-LTx. A second study reported that one out of five pwCF had NTM infection post-LTx (all were positive at LTx). The third study reported that five out of nine participants had NTM disease at LTx, and two of these five remained NTM-positive post-LTx. CLAD Two studies assessed CLAD. One study reported that none of the five NTM-positive LTx recipients developed CLAD, stating that the risk of CLAD appeared to be similar between the NTM and the comparator group. The second study stated that three out of nine LTx recipients with NTM disease developed chronic rejection or graft dysfunction.

There are no randomised trials to guide clinicians and patients or their families when making decisions regarding LTx in pwCF with NTM. The available data come from observational studies and registry data, often with few people with NTM reported. It has not been possible to pool the available data in meta-analysis, and we are very uncertain of the effect of NTM on pwCF undergoing LTx on the risk of developing NTM disease post-LTx, survival after LTx, and the development of CLAD. The studies were small and at times contradictory. In the era of highly effective modulator treatments, as some centres do not offer LTx to people with a history of NTM, there is an urgent need for more data to guide decision-making.

This review is part of a suite of reviews on NTM funded jointly by the CF Foundation and the CF Trust.

Protocol registration (2024): www.crd.york.ac.uk/PROSPERO/view/562682.

Periodic surveillance of antifungal susceptibility among Aspergillus isolates is essential to guide effective treatment. This multicenter study analyzed 550 clinical Aspergillus isolates collected in Taiwan from 2021 to 2023, primarily from the respiratory tract (69.6%) and ear (12.9%). Calmodulin-based sequencing identified 24 species across six Aspergillus sections: Flavi (28.7%), Fumigati (28.5%), Nigri (21.6%), Terrei (15.8%), Nidulantes (5.1%), and Circumdati (0.2%). The major sections were represented by Aspergillus fumigatus (99.4%), Aspergillus flavus (91.8%), and Aspergillus terreus (100%), while section Nigri comprised nine species, with Aspergillus welwitschiae (57.1%) predominant. Using Clinical Laboratory Standards Institute (CLSI) M38-A3 protocols, reduced susceptibility to amphotericin B (MIC > 1 µg/mL) was observed in A. flavus (8.3%), A. terreus (22.7%), and section Nidulantes (32.1%). Acquired voriconazole resistance was found in 5.8% (9/156) of A. fumigatus isolates, including eight with cyp51A mutations (3 TR₃₄/L98H, 4 TR₃₄/L98H/S297T/F495I, and 1 TR₄₆/Y121F/T289A). Voriconazole non-wild-type phenotypes were identified in 2.1% (3/158) of A. flavus isolates, including one carrying a novel P214L mutation (orthologous to A. fumigatus P216L). Members of the Aspergillus niger clade exhibited reduced susceptibility to itraconazole and isavuconazole. Anidulafungin, along with novel antifungals including orolofim, manogepix, and rezafungin, demonstrated broad activity across Aspergillus species, including those with intrinsic or acquired azole resistance. Ibrexafungerp also showed efficacy against azole-resistant A. fumigatus and A. flavus. In contrast, opelconazole exhibited limited activity against A. flavus, the A. niger clade, Aspergillus sydowii, and voriconazole-resistant A. fumigatus. These findings underscore the need for species-level identification, susceptibility testing of causative isolates, and continued surveillance to detect emerging resistance and support the use of novel non-azole antifungals for azole-resistant aspergillosis.

Timely and effective antifungal therapy is essential for aspergillosis. This multicenter surveillance study provides comprehensive insights into the species distribution and antifungal susceptibility of 550 clinical Aspergillus isolates in Taiwan, with intrinsic reduced susceptibility to amphotericin B, itraconazole, or isavuconazole noted in certain species. Regarding acquired resistance, a novel cyp51A mutation, P214L, was identified in an azole-resistant Aspergillus flavus, orthologous to Aspergillus fumigatus P216L. Recovery of azole-resistant A. fumigatus harboring TR34/L98H or TR46/Y121F/T289A mutations remains a concern and emphasizes the need for antifungal stewardship in the environment. Novel antifungals, including orolofim, manogepix, rezafungin, and ibrexafungerp, demonstrated broad activity across Aspergillus species, including resistant isolates. Nevertheless, the inhaled agent opelconazole exhibited limited activity against A. flavus regardless of voriconazole susceptibility and against other species showing reduced susceptibility to itraconazole. These findings highlight the importance of species-level identification, susceptibility testing, and continued surveillance and support the use of novel antifungals for aspergillosis.

Selective inhibition of interleukin-23 (IL-23) has emerged as a highly effective therapeutic strategy in inflammatory bowel disease, targeting a central pathway of chronic intestinal inflammation while preserving host defense mechanisms. Across phase II and phase III randomized controlled trials, risankizumab, mirikizumab, and guselkumab consistently demonstrated robust efficacy in both ulcerative colitis and Crohn's disease, achieving clinical remission rates approaching 40-50% in ulcerative colitis and exceeding 50% in Crohn's disease during maintenance, with parallel improvements in endoscopic and histological outcomes. Notably, mirikizumab and guselkumab showed particularly high rates of endoscopic and histological remission in ulcerative colitis, whereas guselkumab achieved some of the highest induction remission rates in Crohn's disease. These benefits were durable over time, with long-term extension studies confirming sustained remission beyond two years in a substantial proportion of patients. Across trials, IL-23 inhibitors displayed a favorable safety profile, with low rates of serious adverse events, infections, and major cardiovascular events, supporting their use in long-term disease management. Real-world evidence further reinforces these findings, demonstrating consistent effectiveness in heavily pretreated and complex patient populations, including those with prior biologic failure, comorbidities, or difficult-to-treat disease phenotypes. In particular, risankizumab has shown strong performance in multi-refractory Crohn's disease cohorts, while emerging data for mirikizumab confirm its effectiveness in real-life ulcerative colitis settings. Beyond clinical outcomes, differences in molecular structure, pharmacokinetics, and Fc-mediated interactions may contribute to subtle distinctions among agents, potentially influencing therapeutic positioning. Ongoing development of oral compounds and combination strategies targeting complementary inflammatory pathways is expected to further expand the role of IL-23 inhibition. Overall, interleukin-23 inhibitors represent a cornerstone of modern inflammatory bowel disease therapy, combining high efficacy, durable responses, and an excellent safety profile, with growing evidence supporting their use across a broad spectrum of patients.

This study aimed to investigate the association between botulinum toxin type A treatment and changes in spasticity and abnormal flexor synergies in patients with chronic stroke.

Twenty-eight patients with chronic stroke (mean age 56.5 years; mean time since onset 6.3 years) who received botulinum toxin type A injections into upper-arm flexor muscles (biceps brachii, brachialis, or brachioradialis) were enrolled.

This was a retrospective, single-centre cohort study. Assessments were performed before and approximately 2 months after injection. Primary outcomes were changes in spasticity measured by the Modified Ashworth Scale and the abnormal flexor synergy index based on kinematic analysis. Secondary outcomes included changes in voluntary shoulder flexion angle and subgroup analyses according to baseline upper extremity motor severity and responder/non-responder status based on changes in the Modified Ashworth Scale scores of the elbow flexors.

Generalized estimating equation analyses showed significant changes in Modified Ashworth Scale elbow flexor scores and the abnormal flexor synergy index after injection. In severity-stratified analyses, significant Time × Severity interactions were observed for Modified Ashworth Scale scores of the elbow and wrist flexors, whereas no significant interaction was found for the abnormal flexor synergy index. In responder/non-responder analyses, a significant Time × Responder-status interaction was observed for the abnormal flexor synergy index. Non-responders showed no significant changes in Modified Ashworth Scale scores or the abnormal flexor synergy index and showed reduced maximum voluntary shoulder flexion angle.

This study suggests that botulinum toxin type A treatment was associated with changes in abnormal flexor synergies, in addition to reducing muscle tone. These findings highlight the value of incorporating kinematic assessments such as the abnormal flexor synergy index into the clinical evaluation of botulinum toxin treatment.

One comprehensive stroke centre (CSC), in North Queensland, Australia, supports almost 700 000 people across 750 000 km². Access to urgent ischaemic stroke treatment is challenging for remote and regional residents, who are more likely to carry stroke risk factors and have a 17% higher stroke incidence than those in major cities.

To review and report on patient demographics, stroke characteristics, interventions, and outcomes of ischaemic stroke in this regional population.

Retrospective review of admissions to a North Queensland CSC (March 2022-September 2023) with acute ischaemic stroke (ICD-10-AM: 163).

Among 305 patients, the median age was 72 years, 57% were male, and 10.5% identified as First Nations. Common stroke risk factors included hypertension (83%), smoking background (58%) and hypercholesterolaemia (57%). Stroke aetiology was unknown in 42%, followed by cardioembolic (31%). Median onset-to-emergency department time was 90 min, and to the CSC was 343 min. Thrombolysis was administered to 6% at the referring facility, and 7% on arrival to the CSC (median door-to-needle time, 73 min). Endovascular clot retrieval occurred in 11.7% of the primary presenters, with an overall successful recanalisation rate of 89%. The 6-month mortality rate was 22%.

High rates of modifiable risk factors require improved community management. Delayed presentation highlights potential gaps in stroke awareness and access to healthcare in this region. Reaching timely reperfusion targets should become a priority, which requires support from multiple stakeholders. The high proportion of unknown aetiologies may reflect incomplete stroke work-up, documentation, or loss to follow-up. Targeted stroke education for regional and remote communities and healthcare providers is recommended.

Cardiovascular disease (CVD) prevention strategies are predominantly informed by studies conducted in men from the general population, which can disadvantage women-particularly Indigenous women-whose CVD needs differ in terms of symptom presentation, healthcare access, receipt of guideline-recommended care and sociocultural roles. This review aims to summarize the effectiveness of CVD prevention interventions in Indigenous women in the USA, Canada, New Zealand and Australia. Umbrella review of systematic reviews and randomized and non-randomized interventions examines the effectiveness of pharmacological and nonpharmacological interventions in reducing CVD risk in target countries in Indigenous adult studies with ≥50% women. Systematic searches were conducted across six electronic databases between January and February 2024 (update: February 2025). Quality assessment applied standard methods and evidence was synthesized qualitatively. The protocol was PROSPERO registered (CRD42024575310). Six systematic reviews and 16 primary studies (7 randomized and 9 non-randomized; 11,473 participants; 50%-100% women) in Indigenous participants were included. Evidence was limited and generally of low certainty. Four randomized studies were exclusively in Indigenous women (Australia and USA). Only one pharmacological study was identified, investigating vitamin D in reducing blood pressure. Non-pharmacological interventions demonstrated potential to improve CVD risk factors, primarily adiposity, blood pressure, lipids, and glucose. Participant involvement was generally limited and continuation was problematic. This first umbrella review on CVD risk reduction in Indigenous women suggests an urgent need for high-quality evidence to inform and make CVD prevention accessible and equitable for them. Future studies should employ consumer-led, innovative, and context-specific strategies to ensure inclusive recruitment and sustain participant engagement.

Traditional diagnostics rely on microscopy, dipstick tests, and the gold‑standard urine culture, which is reliable but time‑consuming. Flow cytometry for urinary analysis offers a fast, objective, and highly automated approach that can improve the selection of samples for culture and accelerate clinical decision‑making. Flow cytometry uses fluorescent and scatter detection to quantify cells, bacteria, and other particles in urine, processing thousands of events per sample and generating parameters that correlate with the presence of infection.

This retrospective study included 200 hospitalized adult patients (>18 years) admitted to the Clinic for Infectious Diseases, University Clinical Center Tuzla in Tuzla, Bosnia and Herzegovina. A urinary tract infection (UTI) was diagnosed based on standardized clinical and laboratory criteria. Urine samples were analyzed using the Sysmex UF‑4000 flow cytometer, and diagnostic thresholds for leukocyte and bacterial counts were determined by receiver operating characteristic (ROC) analysis and Youden's Index.

Among 200 hospitalized patients, females predominated (124 vs. 76). Optimal cut-offs were ≥120/µL for leukocytes (area under the curve (AUC) 0.88, sensitivity 91.2%, specificity 75.3%) and ≥1367/µL for bacteria (AUC 0.95, sensitivity 90.3%, specificity 90.7%). Sex-specific analyses showed higher accuracy in males, with cut-offs of ≥1012/µL for bacteria (AUC 0.97) and ≥122/µL for leukocytes (AUC 0.94), while in females, the best thresholds were ≥1797/µL for bacteria (AUC 0.94) and ≥113/µL for leukocytes (AUC 0.84). The empirically developed UTI risk score (0-2) further improved stratification: Score 0 strongly predicted negative cultures (NPV >97%), while Score 2 was highly associated with positive cultures (PPV >94%).

Automated urine flow cytometry offers a fast and accurate screening tool for UTIs, with bacterial counts outperforming leukocytes in diagnostic reliability. Sex-specific cut-offs and the UTI risk score enhance clinical applicability by improving stratification and reducing unnecessary cultures. While findings support integration of flow cytometry into routine practice, the single-center design, hospitalized cohort, and exclusion of pregnant women and children limit broader generalization, warranting validation in larger, multicenter studies.