To explore the association between the glycated albumin to hemoglobin A1c (GA/HbA1c) ratio and all-cause and cardiovascular mortality among adults with type 2 diabetes.

We used data from the PREMIRE cohort, which was established among patients with type 2 diabetes using electronic health records. The baseline GA/HbA1c ratio was calculated from the first available measurements of GA and HbA1c during the patient's initial visit to the hospital for type 2 diabetes.

The study included 20,012 participants, and 3,293 deaths occurred, including 1,313 cardiovascular deaths over a median follow-up of 3.39 years. The GA/HbA1c ratio serves as a robust predictor of mortality, offering superior discriminative ability compared with GA or HbA1c alone. RCS analysis revealed a U-shaped association between the ratio and mortality. The ratio > 3.00 was associated with increased all-cause [HR 1.60 (95% CI, 1.49-1.73)] and cardiovascular mortality [HR 1.61 (95% CI, 1.43-1.81)], while the ratio < 2.00 was also associated with higher all-cause [HR 1.89 (95% CI, 1.64-2.18)] and cardiovascular mortality [HR 1.61 (95% CI, 1.26-2.06)]. The association is further validated in the National Health and Nutrition Examination Survey 1999-2004.

The GA/HbA1c ratio was significantly and independently associated with both all-cause and cardiovascular mortality, following a U-shaped pattern.

Peripheral neuropathy is a chronic common complication of diabetes mellitus. Continuous hyperglycemia induces metabolic disturbances and elicits oxidative stress. However, the impact of hyperglycemia on the maturation of Schwann cells is not fully understood. Therefore, we examined whether hyperglycemia affects the maturation process of IMS32 Schwann cells treated with forskolin, a Schwann cell maturation enhancer, using promoter assays and immunoblotting of Schwann cell markers such as MBP, CNPase, and GFAP. IMS32 cells exposed to high-glucose conditions showed decreased expression of these markers. Exogenous pyruvate plays a crucial role in maintaining glucose metabolism and reducing oxidative stress under hyperglycemic conditions. These decreases were prevented by pyruvate supplementation. Pyruvate treatment also prevented IMS32 cells from producing reactive oxygen species and from impairing mitochondrial membrane potential. These results indicate that hyperglycemia impairs Schwann cell maturation accompanied by mitochondrial dysfunction and oxidative stress, contributing to the development and progression of diabetic peripheral neuropathy.

To describe age- and latency-specific patterns of excess incidence of malignant brain and other nervous system tumors after cancer diagnosed before age 40 years.

We studied first primary malignancies other than brain and other nervous system cancers in SEER 8 (1975-2023). Standardized incidence ratios (SIRs) compared observed with population-expected events across diagnosis age groups and latency intervals. A supplementary competing risk analysis estimated cumulative incidence.

Among 276,844 individuals contributing 3,970,462 person-years, 345 tumors occurred versus 236.97 expected (SIR, 1.46; 95% confidence interval [CI], 1.31-1.62; excess absolute risk [EAR], 2.72 per 100,000 person-years). SIRs were 5.20 at ages 0-14, 1.84 at 15-19, 1.17 at 20-29, and 1.23 at 30-39 years. Age patterns varied by latency (interaction p = .0012). At 10 or more years, the childhood SIR was 4.64 (95% CI, 3.22-6.49). The 20-year cumulative incidence after the 2-month landmark was 0.257% (95% CI, 0.193-0.341%) after childhood cancer.

In this population-based descriptive analysis, childhood cancer survivors had the greatest relative excess incidence, which remained evident beyond 10 years. Absolute excess and cumulative incidence were small. Joint assessment of diagnosis age and latency characterized patterns obscured by the overall estimate.

Actinic keratosis (AK), a common ultraviolet light-induced keratinocyte neoplasm arising within chronically photodamaged skin, is associated with field cancerization and potential progression to cutaneous squamous cell carcinoma (cSCC). Photodynamic therapy (PDT) is an established field-directed treatment option for AK, but Canadian-specific practical guidance on its use remains limited. This study aimed to develop Canadian expert consensus recommendations on the overall role, positioning, technique, safety, follow-up, and use of PDT as well as PDT use in special sites and populations.

A targeted literature review was conducted using PubMed/MEDLINE for English-language publications from 2005 onward, with the final search run on October 10, 2025. Evidence was used to inform candidate statements across predefined PDT-related domains. Ten Canadian dermatologists with extensive experience with management of AK and use of PDT participated in a structured modified Delphi process, rating statements anonymously over two rounds using a 5-point Likert scale. Consensus was defined a priori as at least 75% agreement or strong agreement.

All 10 panelists participated in both Delphi rounds. A total of 25 consensus statements were finalized across six domains: disease framing and need for AK treatment; lesion- versus field-directed treatment strategies for AK management; role and positioning of PDT in AK management; PDT technique and modalities for AK management; PDT for AK management in special sites and populations; and PDT safety, follow-up, and combination strategies. All finalized statements achieved consensus. The panel positioned PDT as an effective field-directed strategy, particularly for non-hypertrophic facial and scalp AKs, with treatment selection guided by disease extent and the need for field cancerization with PDT; efficacy, tolerability, cosmetic outcome, and access to PDT; and patient preference for PDT.

This Canadian expert consensus supports PDT as a practical field-directed strategy for appropriately selected patients with AK, while emphasizing individualized care, shared decision-making, realistic expectations for chronic disease management, and ongoing follow-up. Further research is needed to clarify re-treatment intervals, outcomes for special sites and populations, and optimal combination strategies.

Febrile neutropenia (FN) is an important complication of first-line immunochemotherapy for diffuse large B-cell lymphoma (DLBCL). Thresholds for primary granulocyte colony-stimulating factor (G-CSF) prophylaxis are risk-based, but the FN burden in routine practice is uncertain, and whether trial-derived estimates describe it is unknown.

Systematic review and meta-analysis of proportions. MEDLINE, CENTRAL, ClinicalTrials.gov, Europe PMC, Epistemonikos, Lens.org, Google Scholar, and citation tracking were searched from inception to 8 September 2026. Eligible studies reported FN incidence in adults with DLBCL receiving first-line R-CHOP or R-CHOP-like therapy. Analyses were stratified by design, because observational cohorts and trials measure FN under materially different conditions. Risk of bias and certainty were assessed using ROBINS-I/RoB 2 and GRADE.

Fifteen studies (5440 patients; 885 FN events) were included. Across ten observational cohorts (4020 patients), pooled FN incidence was 19.0% (95% CI 17.1-21.1; I² = 34.0%), prediction interval 15.3-23.3%, and was stable across all sensitivity and leave-one-out analyses. Five clinical trials (1,420 patients) reported 11.7% (95% CI 5.7-22.7) but were markedly heterogeneous (I² = 79.4%; estimates 2.4-20.0%); the difference between designs was not significant (p = 0.051) and depended substantially on one trial.

In routine practice, approximately one in five adults with DLBCL receiving first-line R-CHOP-based therapy develops FN-an incidence at, rather than below, the conventional 20% threshold for primary G-CSF prophylaxis. Trial-derived estimates should not be assumed to represent this burden.

This study aimed to classify upper tract urothelial carcinoma (UTUC) using GATA3, KRT5, and P16 immunohistochemistry and to evaluate associations of these molecular subtypes with clinicopathological features and outcomes.

Tissue samples from 102 UTUC patients who underwent radical nephroureterectomy were analyzed. Tumors were classified into genomically unstable (GU), urothelial-like (URO), and basal subtypes based on GATA3, KRT5, and P16 expression. Associations with pathological features, recurrence, and survival were analyzed. Kaplan-Meier and Cox regression analyses were used.

The GU, URO, and basal subtypes accounted for 33%, 45%, and 22% of cases, respectively. Subtype was significantly associated with infiltrative pattern (p = 0.009), perineural invasion (p = 0.016), histological variant (p < 0.001), T stage (p = 0.004), N stage (p = 0.017), and vital status (p = 0.005). The basal subtype showed the poorest prognosis, with 3-year overall survival of 41% vs. 85% for the URO subtype (p < 0.001). Multivariable analysis identified diffuse infiltrative pattern (HR 6.84, P = 0.004), lymphovascular invasion (HR 2.12, p = 0.046), and T4 stage (HR 9.80, p = 0.023) as independent risk factors for overall survival, and diffuse infiltrative pattern (HR 6.37, p = 0.006) and T4 stage (HR 12.6, p = 0.012) for recurrence-free survival.

IHC-based subtyping using GATA3, KRT5, and P16 is significantly associated with aggressive clinicopathological features in UTUC, with the basal subtype showing poor prognosis in univariate analysis. However, it was not an independent prognostic factor in multivariable analysis. While this exploratory strategy may aid in risk stratification, its clinical utility requires further validation in larger, prospective cohorts.

Breast cancer is common and often diagnosed at an advanced stage in Mali. The aim of this study was to describe the stage at diagnosis and to identify associated factors.

As part of the SENOVIE project, a prospective multicenter cohort study was conducted from October 2023 to October 2024 in five healthcare facilities in Bamako. The clinical stage at diagnosis was assessed according to the UICC classification. A univariate analysis was performed, followed by a multivariable multinomial logistic regression.

A total of 265 patients were included in this study. Early-stage diagnosis (stages I&amp;#8211;II) was observed in 13.6% of patients, late-stage diagnosis (stage III) in 63.4%, and metastatic disease (stage IV) in 23.0%. In univariate analysis, late-stage diagnosis was associated with living outside Bamako (p&amp;#160;=&amp;#160;0.019), lack of formal education (p&amp;#160;=&amp;#160;0.005), low socioeconomic status, absence of health insurance (p&amp;#160;=&amp;#160;0.012), and not owning a television (p&amp;#160;=&amp;#160;0.042). In multivariable analysis, only body mass index remained significantly associated with stage at diagnosis. Overweight patients were more likely to be diagnosed at an early stage (aOR&amp;#160;=&amp;#160;2.99; 95% CI: 1.19&amp;#8211;7.48), while obese patients were less likely to be diagnosed at a metastatic stage (aOR&amp;#160;=&amp;#160;0.26; 95% CI: 0.12&amp;#8211;0.60).

These findings confirm the high proportion of advanced-stage diagnoses in Mali and suggest that socioeconomic factors and care pathways influence diagnostic delay.

In Mali, breast cancer is predominantly diagnosed at a late stage. Body mass index is associated with stage at diagnosis. Strengthening screening and improving access to care are essential to promote earlier diagnosis.

Liquid biopsy coupled with optical spectroscopy holds immense potential for disease screening. Specifically, laser-induced breakdown spectroscopy (LIBS) and fourier transform infrared spectroscopy (FTIR) provide rapid, complementary insight into elemental and molecular profiles. During biofluid drying, the "coffee-ring effect" (CRE) produces an uneven solute deposit, causing large fluctuations in LIBS signals. FTIR molecular features are generally less affected by this heterogeneity. We therefore designed a superhydrophobic SiO₂NPs@Si-microgroove and combined it with a multimodal CNN for renal cell carcinoma (RCC) detection. The substrate confined the urine droplet during drying, improved deposit uniformity, and enhanced LIBS measurement repeatability, reducing the relative standard deviation (RSD) of representative emission signals to approximately 10%. By combining the more reproducible LIBS measurements with complementary FTIR data, the CNN model achieved an Accuracy (ACC) of 99.22% for RCC detection. This work offers a novel approach for the standardized, intelligent, and precise analysis of future biofluids.

Multimodal detection significantly enhanced detection accuracy in complex biological matrices. In this work, a high-efficiency multimodal biosensor is proposed based on multifunctional SnO₂/SnS₂/CdSe QDs heterojunction and CuO nanoenzyme-regulating synergistic strategy, which achieves ultra-sensitive and specific detection of breast cancer-related BRCA1 gene. A high-performance photoelectrochemical (PEC) SnO₂/SnS₂/CdSe QDs heterojunction was constructed for the first time, which effectively enhances the light absorption capability and photogenerated charge separation efficiency. The heterojunction yields a PEC signal approximately 3.75-fold higher than that of pure SnO₂/SnS₂ and 11.3-fold higher than that of CdSe QDs, realizing stable PEC and electrochemiluminescence (ECL) dual signals. Notably, CuO nanoenzyme with intrinsic oxidase-like activity are introduced onto the sensing interface through target-induced amplification strategies, serving as multifunctional signal regulatory units. The CuO nanoenzyme can not only catalyze the oxidation of ascorbic acid but also trigger the ECL resonance energy transfer effect. This dual functionality enables the simultaneous "shutdown" of PEC and ECL signals and "activation" of fluorescence signals, constructing a self-verifiable triple-modal sensing platform for BRCA1 detection. The developed biosensor has been successfully applied to the quantitative detection of BRCA1 in human serum samples. This report offered a promising and versatile platform for early clinical diagnosis of breast cancer and detection of other important disease biomarkers.

Lung cancer surgery has evolved substantially, but safety alone does not define quality. Using the Avedis Donabedian model, quality encompasses structure, process, and outcomes. Structural factors include surgeon specialization, institutional volume, and multidisciplinary care. Process indicators involve guideline-concordant staging, systematic lymphadenectomy, and complete resection; inadequate nodal assessment or uncertain resection negatively affects survival. Outcomes extend beyond mortality to oncologic results and patient-centered measures. Composite metrics such as textbook outcome and failure-to-rescue support benchmarking, while society-driven databases enable risk-adjusted comparisons. Current frameworks emphasize perioperative and technical metrics, but underrepresent patient-reported outcomes, long-term survival, and multimodality care.