Cancer in women represents a significant disease burden, posing challenges for prevention, treatment, and caregiving. This study aimed to analyze the epidemiological trends of the women's cancer burden and the main influencing factors in the group of twenty (G20) from 1990 to 2023.

Incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for breast, cervical, uterine, and ovarian cancers, as well as fertility rates for G20 and its 98 locations, were sourced from the Global Burden of Disease Study 2023. Age-standardized rates (ASRs), quality of care index (QCI), and 5-year relative survival of integrated women's cancers were calculated. Average annual percent changes (AAPCs) were used to determine the temporal trends by age and region. Decomposition analysis identified drivers of changes in case numbers, linear regression assessed the associations with DALY rate changes, and dominance analysis identified dominant predictors.

In 2023, the incidence, prevalence, mortality, and DALYs from women's cancers in G20 were 3.29 [95% uncertainty interval (UI) 2.60-4.14], 26.71 (95% UI 21.99-32.40), 1.16 (95% UI 0.91-1.45), and 36.58 million (95% UI 28.40-46.32), respectively, with ASRs of 87.63/100,000 (95% UI 65.12-115.85), 706.16/100,000 (95% UI 555.75-890.02), 30.03/100,000 (95% UI 22.10-39.58), and 994.79/100,000 (95% UI 728.43-1328.81). The QCI was 75.13 [95% confidence interval (CI) 73.67-76.59], and the 5-year relative survival was 65.74% (95% CI 65.53-65.95). From 1990 to 2023, there was a significant increase in incidence, prevalence, mortality, and DALYs in G20, primarily driven by population growth. Age-standardized incidence rate, QCI, and 5-year relative survival increased, while age-standardized mortality and DALY rates decreased. Changes in prevalence rates of breast cancer and cervical cancer for women aged 15-49 years were positively associated with changes in DALY rates of women's cancers, whereas changes in the total fertility rate were negatively associated. Dominance analysis confirmed these three factors consistently as dominant predictors between 1990 and 2023. Reducing the prevalence of breast and cervical cancers and increasing fertility among women aged 15-49 years could lower the overall DALY burden attributable to women's cancer.

The incidence, prevalence, mortality, and DALYs of women's cancers in G20 have increased substantially from 1990 to 2023. Tailored prevention strategies should consider age and cancer type, emphasizing reproductive health for women of reproductive age.

We evaluated how much cardiorespiratory fitness (CRF)-related genetics contribute to the risk of common noncommunicable diseases (NCDs) and mortality, and whether individuals with different levels of CRF and genetic predispositions differ in health characteristics. We used a validated SBayesR-based genome-wide polygenic score, leveraging information from 905 707 single-nucleotide polymorphisms, to measure CRF genetics (PGS CRF). Associations with register-based incident NCDs and mortality were analyzed using Cox proportional hazards models in the FinnGen cohort (N = 262 137; 53.5-years at baseline, 52.0% women) and replicated in the HUNT3 cohort (N = 26 115; 59.0-years, 52.4% women). In HUNT3, we also compared the health characteristics of individuals having age- and sex-specific high or low CRF (V̇O_2peak), and high or low PGS CRF (N = 1316). PGS CRF was negatively associated with any CVD (hazard ratio [HR] 0.99, 95% confidence interval 0.98-1.00), ischemic heart diseases (HR 0.98, 0.97-0.99), hypertensive diseases (HR 0.99, 0.97-1.00), stroke (HR 0.98, 0.97-1.00), lung cancer (HR 0.95, 0.92-0.97), chronic lower respiratory disease (HR 0.98, 0.97-0.99), chronic obstructive pulmonary disease (HR 0.97, 0.95-0.99), type 2 diabetes (T2D) (HR 0.96, 0.95-0.97), and all-cause mortality (HR 0.98, 0.97-0.99), per each standard deviation increase in PGS. Replication analyses supported the association with T2D. No differences in health characteristics were observed by genetic predisposition to CRF, while those with high V̇O_2peak had a healthier profile in comparison to those with low V̇O_2peak. The genome-wide PGS explains only a fraction of the CRF phenotype, yet some small associations were observed, particularly for T2D incidence.

Ischemic stroke is a fatal cerebrovascular disease, and reperfusion, the primary approach for restoring blood supply, can lead to significant oxidative stress and subsequent damage to the cerebrovascular system. Developing strong antioxidant agents could be a solution, but it remains a Herculean challenge. Herein, inspired by the three-dimensional coordination structures and active center of natural Mn-superoxide dismutase, coupled with the synergistic monoatom/cluster sites found in antioxidases, we propose the de novo design of Mn-organic complex-supported Ru clusters (MnCP-Ru) to function as an artificial metalloenzyme for cascade elimination of reactive oxygen species (ROS), aimed at protecting against cerebral ischemic-reperfusion injury. Our studies show that Mn-organic ligands increase the electron density of Ru clusters, thereby improving their binding to oxygen species and resulting in effective, cascade-like antioxidase activities. Accordingly, the MnCP-Ru can reduce the number of apoptotic neurons by attenuating ROS-induced cell damage and exert powerful anti-inflammatory effects by inhibiting lipid peroxidation, microglial and astrocyte activation in brain tissues, thus leading to powerful protection and repair of cerebral ischemia-reperfusion injury. We believe the MnCP-Ru biocatalyst, with its synergistic sites and cascade ROS elimination, offers effective antioxidative performance, paving the way for developing materials to treat ischemic-reperfusion injury and other oxidative stress-related diseases.

Malignant ovarian germ cell tumors (MOGCTs) are aggressive cancers affecting mainly young women, in whom fertility preservation is important. Diagnosis is often delayed because early symptoms are non-specific, leading to advanced disease or emergency surgery that may limit optimal staging and fertility-sparing treatment. As no effective screening exists and early detection improves survival, increased symptom awareness is essential. This study describes the demographic and clinical characteristics of MOGCTs to support earlier diagnosis.

The present study is a descriptive-analytical cohort study conducted at Vali-ASR Hospital in Tehran, Iran, from 2001 to 2018. Patients with malignant ovarian tumors were evaluated with respect to demographic characteristics, obstetric and medical history, pathological findings, and clinical signs and symptoms before and at the time of diagnosis. The duration of symptoms was also recorded. Data was analyzed using SPSS version 24, employing descriptive statistical methods.

The mean age of MOGCT cases (128 ones) was 23.88 ± 7.85 years. We found abdominal distension (45%) followed by acute pain (40.95%), chronic pain (23.95%), menstrual irregularity (14.7%), sense of abdominal firmness and mass (7.72%), nausea (5.4%), fever (5.4%), lack of apatite (4.63%), virilization (3.1%), and depletion of weight (3.1%). Abdominal distension and pain, acute or chronic, and menstrual disorders were the most common symptoms in all patients, but their incidence declined along with aging. The percentage of abdominal distention, ascites, and menstrual disorders in parous women was less than that of nullipara.

MOGCTs present a significant diagnostic challenge due to their nonspecific and often misinterpreted symptoms, which vary notably by histologic subtype. Our findings emphasize that a high index of suspicion, coupled with an understanding of this symptom variability, is crucial for the timely diagnosis and improved management of these aggressive tumors, particularly in young women.

Exposure to harmful environments during pregnancy and maternal nutritional status are key factors that affect offspring development; however, the underlying mechanisms of maternal-fetal interaction remain to be elucidated. In recent years, research on gut microbiota and epigenetics has provided new perspectives for understanding these mechanisms. This review systematically summarizes the potential mechanisms by which the maternal gut microbiota influences prenatal development from an epigenetic perspective. Furthermore, it discusses the role of personalized nutritional interventions in the prevention of non-communicable diseases during embryonic and fetal development, aiming to provide new insights and intervention targets for promoting healthy pregnancies and enabling early disease prevention.

Trans-radial access (TRA) offers advantages in elective settings, but its safety and feasibility in emergencies remain understudied. This study compares TRA and trans-femoral access (TFA) in emergency embolizations at a Level 1 trauma center.

Ethical approval was obtained for this retrospective analysis. A total of 421 emergency embolizations performed on 389 patients were included. TRA (n = 95, including 44 distal radial) and TFA (n = 326) were compared for technical success rate, procedural success rate, and access-site complications. Multivariate analysis was used to identify independent predictors of complications.

TRA patients were younger (median 58 vs. 66 years; p = 0.044) with less hypertension (33.7% vs. 46.6%; p = 0.025). Technical success rate was 99.0% for TRA and 99.7% for TFA (p = 1.000). Procedural success was 100% for TRA and 99.7% for TFA (p = 1.000). Overall complications occurred in 5.5% (3.2% TRA vs. 6.1% TFA; p = 0.234), most were minor bleeding-related complications (2.1% TRA vs. 5.2% TFA; p = 0.164). Major complications (1.0% total) included pseudoaneurysm formation (n = 3; 1 in TRA, 2 in TFA) and retroperitoneal hemorrhage (n = 1 in TFA), with no group differences (p = 0.908). Adjusting for age, hypertension, diabetes mellitus, antithrombotic use and sheath size, multivariate analysis found that access site (TRA vs. TFA) was not found to be an independent predictor of all complications (OR 0.524; 95% CI: 0.147 - 1.859; p = 0.317).

TRA, including distal radial "snuffbox" access, is a safe alternative to TFA for emergency embolization, demonstrating high technical and procedural success rates.

Level 4, Cohort study.

Emergency department (ED) patients with hyperglycemia, acidosis, and/or ketosis may have diabetic ketoacidosis (DKA) or any of several well-described conditions. Though the diagnosis of DKA is based on specific laboratory criteria, DKA often presents with mixed clinical pictures, making a strictly laboratory diagnosis problematic. When laboratories fail to meet criteria, patients may nevertheless be diagnosed with DKA. The extent of this is not reported.

We conducted a retrospective observational study at an urban academic ED (01/01/2019-02/28/2023) of adult patients with point of care (POC) glucose > 300 mg/dL and POC ketone > 1.1 mmol/L and/or an ED diagnosis of DKA. We present the proportion whose initial laboratories met DKA criteria based on one of two laboratory definitions, the proportion whose initial laboratories did not meet criteria but who were nevertheless diagnosed with DKA, and the frequencies of non-DKA diagnoses potentially explaining these laboratory abnormalities. Analyses were descriptive.

Of 1676 patients included, 883 (53%, 95% CI: 50, 55) met lab criteria for DKA. Of 740 screening positive by POC testing whose initial labs did not meet DKA criteria, 229 (31%, 95% CI: 28, 34) were diagnosed with DKA. Primary ED diagnoses of the remaining 511 included: hyperglycemia (196, 38%), starvation ketosis (58, 11%), hyperosmotic hyperglycemic state (11, 2%), and other ketosis (9, 2%), while 67 (13%) had a primary diagnosis of infection, 1 (< 1%) metabolic acidosis and 169 (33%) an unrelated diagnosis.

In this single center study of patients screening positive for DKA or given an ED diagnosis of DKA, 53% met laboratory criteria for DKA, and of those not meeting criteria, 31% were nevertheless diagnosed with DKA. This suggests that emergency physicians use criteria beyond laboratory values to diagnose DKA and supports the idea that DKA is ultimately a clinical rather than a purely laboratory-diagnosed condition.

Diabetic foot ulcers (DFUs) are representative examples of refractory chronic cutaneous wounds. Autologous platelet-rich gel (APG), a blood-derived therapeutic modality, has demonstrated efficacy in promoting the healing of DFUs. However, several limitations have been identified in both clinical practice and basic research, including restricted availability, short shelf life and suboptimal physical characteristics. In recent years, significant efforts have been directed towards prolonging the preservation period of APG and diversifying its sources. The integration of platelet-rich plasma with biomaterials and cell-based therapies not only mitigates the physical constraints associated with APG but also enhances therapeutic outcomes through synergistic effects in DFU healing. Moreover, emerging research on platelet-derived extracellular vesicles demonstrates promising potential for standardizing and advancing the engineered application of APG, although this field remains in its early stages. This review summarizes key findings from the literature published over the past 3-5 years and outlines prospective directions for future research in this field.

BackgroundDietetic care plays a crucial role in the management of Gestational Diabetes Mellitus (GDM). Little is known about its utilization in the United Arab Emirates (UAE).ObjectiveThis study assessed the prevalence, correlates, and patient experiences of the use of dietetic services among pregnant women with GDM.DesignA cross-sectional study was conducted in six hospitals (public and private) in the Emirates of Dubai, Sharjah, and Ajman, between May and November 2024.MethodsA total of 223 pregnant women, aged 18-45 years, in their third trimester with a confirmed GDM diagnosis, were recruited. Data were collected using a multicomponent questionnaire and medical record reviews. The main outcome in this study was visiting a dietitian following GDM diagnosis (yes/no). Descriptive, bivariate, and multiple logistic regression analyses identified factors associated with dietitian visits.ResultsOf the 223 participants, 93 visited a dietitian (41.7%); of whom 92 (99%) were referred by a physician. Examining the sociodemographic, lifestyle and health related factors showed that daily breakfast consumption (aOR=3.3, p=0.009), initiating exercise post-diagnosis (aOR=3.9, p=0.012), sleeping ≥8 hours/night (aOR=3.2, p=0.004), previous history of GDM (aOR=2.7, p=0.039), and family history of GDM (aOR=3.2, p=0.009) were associated with higher odds of visiting the dietitian. Non-Emirati nationality (aOR=0.3, p=0.004), GDM medication use (aOR=0.3, p=0.007), and perceiving health as good/excellent (aOR=0.3, p=0.030) were inversely associated with visiting the dietitian. Among participants who visited the dietitian, the majority were either very satisfied (16.1%) or satisfied (63.4%), with only 3% reporting dissatisfaction with their visit to the dietitian.ConclusionA considerable proportion of women with GDM did not visit the dietitian, with physician referral being the most influential factor of dietitian visits. Dietitian consultations are associated with healthier behaviors and high satisfaction, emphasizing their critical role in GDM care. Promoting access to dietetic care, including strengthening referral systems, is needed to improve pregnancy outcomes and reduce future disease burden in mothers and children.

Type 2 diabetes mellitus remains a major public health challenge in Australia. This cross-sectional pilot feasibility study evaluated the feasibility of pharmacy-led diabetes screening in rural New South Wales and examined diabetes knowledge, AUSDRISK, and follow-up behavior after referral.

This was a 5-month (January-May 2023) cross-sectional pilot feasibility study conducted across community pharmacies within Western New South Wales LHD. Pharmacies were enrolled, into the study following expression of interest. Point-of-care HbA1c and/or random blood glucose (RBG) testing was conducted for eligible participants. All individuals with abnormal results were referred to general practitioners (GP) and followed up by a clinician. Descriptive analysis was performed using R (version 4.3.1). All tests were two-sided with α = 0.05.

Of the 17 enrolled pharmacies, 9 completed the study with a total of 116 adults recruited from the participating pharmacies. Ninety-five participants completed the Diabetes Knowledge Questionnaire and AUSDRISK assessment. Seventy-six percent (76.6% [95% CI: 67.1%, 84.0%]) were classified as high risk using AUSDRISK. Fifty-seven percent (57.7% [95% CI: 47.7%, 67.2%]) had elevated HbA1c and/or RBG levels. Following GP referral, only 15% attended follow-up testing. Among attendees, 44% were diagnosed with diabetes.

Pharmacy-based diabetes screening is operationally feasible in rural Australia and identifies substantial undiagnosed diabetes. However, effective linkage to primary care remains a significant challenge.