To examine the association between branched-chain α-keto acids (BCKAs) and pancreatic steatosis in patients with type 2 diabetes (T2DM).

This cross-sectional study was conducted from January 2023 to March 2025. Upper abdominal computerized tomography was performed, pancreatic volume (PV), PV index (PVI), CT attenuation of pancreas (CTA_P), and CTA_p/s were then calculated. Levels of serum BCKAs and BCAAs were determined by ELISA kits. Partial correlation and linear regression analysis were performed to investigate the relationship between BCKA and pancreatic parameters. Mediating models were employed to explore the role of BMI in the relationship between BCKA and pancreatic parameters.

There were significant differences in median PV, PVI, CTAp, and CTAp/s according to BCKA tertiles (all p < 0.05). BCKAs were positively associated with PV and PVI but negatively correlated with CTAp and CTAp/s after adjustment for age and gender (all P < 0.05). Linear regression analysis showed that BCKA was associated with PV, CTAp, and CTAp/s after adjustment for confounders in all models (Model 1, Model 2, Model 3) (all P < 0.05). There existed no significant association of BCAA with pancreatic parameters after adjustment for confounders. Mediation analysis suggested that BMI played approximately 20% indirect effect in the relationship between BCKAs and PV or CTAp/s.

Serum BCKAs rather than BCAAs were associated with PV and CTAp in T2DM patients, indicating an association between BCAA malmetabolism and pancreatic steatosis. Additionally, obesity may serve as a mediator between BCKAs and pancreatic steatosis, which should be validated by prospective cohort.

Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by the destruction of pancreatic β cells, leading to lifelong insulin dependence and an increased risk of severe complications. Three-dimensional stem cells (3D SCs) culture systems have emerged as a superior alternative by more accurately mimicking the in vivo microenvironment and enhancing stemness maintenance, regenerative efficiency, and paracrine secretion. However, studies exploring the application of 3D SCs in T1D remain limited. Here, we developed a novel serum- and cytokine-free orbital-shaking system. It enables efficient and large-scale reprogramming of somatic cells into 3D embryonic-like stem cell spheroids (Sph-Es) characterized by robust pluripotency and improved safety. To enhance therapeutic utility, Sph-Es were irradiated and transduced with INS-expressing adenoviral vectors to generate Sph-R-Ins, allowing transient insulin production without permanent genomic modification. In STZ-induced T1D mice, Sph-R-Ins improved glycemic control and glucose tolerance and increased mouse insulin and C-peptide responses, indicating improved endogenous islet function. Donor-cell tracking analyses showed no pancreatic engraftment, supporting an indirect mode of action. Additional transcriptomic, immunological, and ex vivo studies indicated that the therapeutic benefit was accompanied by ECM-related signaling changes, reduced inflammatory infiltration, enhanced M2 macrophage polarization and Treg-associated immune regulation, improved metabolic signaling, and spheroid-derived paracrine support of islet function. Together, these findings establish a mechanically guided 3D stem cell-gene therapy platform with both endocrine and immunometabolic benefits in T1D.

Childhood cancer survivors (CCS) are at risk for health-related and social challenges that can extend far into adulthood. However, CCS' trajectories are heterogeneous. As a potential influencing factor, the present work investigated adult romantic attachment in conjunction with their relationship perceptions and experiences and help-seeking behavior. CCS (N = 633, aged 24-49 years) were recruited in cooperation with the nationwide German Childhood Cancer Registry (GCCR). Participants underwent a comprehensive medical examination at the study centre. Validated self-report questionnaires (including the ECR-RD8, PHQ-9, F-SozU K6, UCLA 3-item loneliness scale) and further items regarding help-seeking behavior were applied. Adult romantic attachment orientations were substantially related to CCS' relationships in adulthood: Both more attachment anxiety and avoidance were linked to higher loneliness (r = 0.471, p < .001; r = 0.320, p < .001) and lower perceived social support (r = -0.349, p < .001; r = -0.300, p < .001). While 20.2% of CCS reported a need for psychosocial support, only 7.3% reported currently using a professional support offer. Lastly, attachment orientations also played a role in whether CCS voiced such a need when experiencing distress: Attachment anxiety moderated the relationship between suicidal ideation and the expression of a need for support, diminishing help-seeking. The findings emphasize the importance of integrating attachment-informed approaches in the long-term care of CCS. Tailored interventions addressing the interpersonal and emotional needs shaped by attachment styles could enhance resilience and mitigate barriers to seeking psychosocial support.

Objective: To investigate the correlation between advanced lung cancer inflammation index (ALI) and renal pathological activity index (AI) in lupus nephritis (LN) patients, and to evaluate its predictive value for moderate-to-severe renal pathological activity. Methods: This cross-sectional study retrospectively included 279 LN patients who underwent renal biopsy at the First Affiliated Hospital of Xi'an Jiaotong University from January 1, 2017, to December 31, 2024. The median age of the patients was 34.0 (27.0, 45.0) years, and 234 (83.9%) were female. Based on the AI, patients were divided into a low-activity group (n=177) and a moderate-to-severe activity group (n=102). Logistic regression analysis was performed to identify the influencing factors for moderate-to-severe AI. Correlation analysis was used to explore the relationship between ALI and clinical indicators. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of ALI for moderate-to-severe AI. Results: The ALI level in the moderate-to-severe activity group was significantly lower than that in the low-activity group (15.4 vs. 18.8, P<0.001). Multivariate logistic regression analysis showed that the 2000 Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) score (OR=5.54, P<0.001) and serum creatinine (OR=1.01, P=0.007) were risk factors for moderate-to-severe AI; whereas hemoglobin (OR=0.98, P=0.001) and ALI (OR=0.97, P=0.048) were protective factors. Correlation analysis revealed that ALI was negatively correlated with AI (r=-0.31, P<0.001), and positively correlated with body mass index, hemoglobin, albumin, complement C4, and IgG. ALI was negatively correlated with SLEDAI-2K, white blood cell count, neutrophil-to-lymphocyte ratio (NLR), serum creatinine, blood urea nitrogen, and C-reactive protein. ROC curve analysis demonstrated that the area under the curve (AUC) of ALI for predicting moderate-to-severe AI was 0.658 (95%CI 0.592-0.724, P<0.001). The optimal cutoff value was 13.14, with a sensitivity of 72.8% and a specificity of 55.9%. The proportion of patients with moderate-to-severe LN in the ALI <13.14 group was significantly higher than that in the ALI ≥13.14 group (50.9% vs. 27.7%, P<0.001). Conclusions: ALI is closely correlated with renal pathological AI in LN and serves as a protective factor against moderate-to-severe AI. ALI holds certain predictive value and may serve as a non-invasive auxiliary tool for evaluating renal pathological activity in LN.

Lung cancer associated with cystic airspaces (LCCA) is a rare and distinct subtype of lung cancer. Patients are often without specific clinical symptoms in the early stage, and the radiological features can be easily confused with pulmonary bullae, benign pulmonary cysts, and other cystic lung lesions, resulting in a high rate of missed diagnosis and misdiagnosis. We report the case of a middle-aged woman with LCCA pathologically confirmed following surgical resection. A chest computed tomography (CT) scan performed during a routine health examination initially revealed an air-containing lesion adjacent to the oblique fissure in the right lower lobe, measuring approximately 1.1 cm×0.8 cm. Serial CT examinations over a 12-year period demonstrated gradual evolution of the lesion, with the development of a lobulated contour, interlobar pleural indentation, and vascular convergence, raising suspicion for malignancy. The patient subsequently underwent surgical resection. Based on histopathological and immunohistochemical findings, the lesion was finally diagnosed as invasive lung adenocarcinoma (lepidic predominant, 60%; acinar, 30%; papillary, 10%). No evidence of tumor recurrence or metastasis was observed during postoperative outpatient follow-up.

The treatment of locally advanced rectal cancer has been transformed over the last century with nearly 40% of patients achieving complete eradication of their tumor with total neoadjuvant therapy alone. Nonoperative management with a watch-and-wait approach has now allowed a subset of patients the chance to avoid surgery altogether with 50% of watch-and-wait patients achieving long-term organ preservation. However, the other half of patients develop either local regrowth, which requires expeditious surgical intervention, or distant recurrence. Watch-and-wait is a reasonable option for select patients in a protocolized environment that can successfully deliver the recommended surveillance protocol, which ensures its safety.

Timely access to curative-intent colorectal cancer (CRC) surgery is a central component of surgical quality. Yet contemporary evidence challenges historical assumptions that shorter wait times always confer better outcomes. Drawing on population-based studies which offer the most robust and generalizable data this article synthesizes what is known about the relationship between surgical delay and oncologic outcomes in CRC. We outline key conceptual considerations in defining wait-time intervals, discuss lessons from the coronavirus disease 2019 pandemic, and identify gaps for future research. Ultimately, wait times should be applied as flexible, evidence-informed quality indicators that support patient-centered, biologically sound, and operationally feasible cancer care.

The dramatic rise in thyroid cancer incidence in recent decades is driven primarily by the detection of small, biologically indolent papillary microcarcinomas rather than a true increase in clinically significant disease. Robust long-term data now show that active surveillance is a safe and effective initial strategy for appropriately selected low-risk patients, with very low rates of progression and oncologic outcomes comparable to immediate surgery. Reflecting this evidence, contemporary guidelines endorse active surveillance as an alternative to upfront resection, emphasizing shared decision-making, structured ultrasound monitoring, and clearly defined triggers for intervention, shifting modern thyroid cancer care toward individualized care minimizing overtreatment.

The potential of image-based deep learning (DL) in the diagnosis of oral squamous cell carcinoma has been investigated recently. This review aims to evaluate its effectiveness to provide an evidence base for future development.

Cochrane Library, Embase, PubMed, and Web of Science were systematically searched up to June 3, 2025. The QUADAS-2 tool was utilized for the risk of bias assessment. Subgroup analyses were conducted by the classification type (binary classification and multiclass classification) and image type (histopathological images, oral photographs, and Raman spectral images).

Fifty-two studies were included. For binary classification, DL demonstrated strong performance. Four studies developed DL based on Raman spectral images, yielding a pooled sensitivity of 0.99 (95% CI 0.98-0.99) and a specificity of 0.98 (95% CI 0.96-0.99), with an area under the summary receiver operating characteristic value (AUC) of 0.99 (95% CI 0.20-1.00). Eight studies developed DL based on oral photographs, yielding a pooled sensitivity of 0.97 (95% CI 0.91-0.99) and a specificity of 0.93 (95% CI 0.85-0.97), with an AUC of 0.99 (95% CI 0.85-1.00). DL was developed based on histopathological images in 31 studies, which had a pooled sensitivity of 0.98 (95% CI 0.97-0.98) and a specificity of 0.97 (95% CI 0.96-0.98), with an AUC of 0.99 (95% CI 0.50-1.00).

Image-based DL has demonstrated promising diagnostic performance and advantages across multiple imaging modalities including histopathological images, oral photographs, and Raman spectral images, suggesting that it is a promising direction for the development of intelligent diagnostic tools for oral squamous cell carcinoma diagnosis. DL may become an effective adjunct to diagnosis.

The incidence of oral squamous cell carcinoma (OSCC) has been rising in recent years, substantially affecting patients' quality of life and psychological well-being. Identifying effective prognostic indicators is critical for guiding clinical decision-making. Currently, the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in OSCC remains controversial. This meta-analysis aimed to systematically examine the relationship between preoperative NLR and postoperative survival outcomes among individuals with OSCC.

Studies on the association between preoperative NLR and postoperative overall survival (OS), disease-free survival (DFS), and other survival outcomes in OSCC patients were systematically searched from the Cochrane Library, Web of Science, Embase, and PubMed from inception to March 1, 2025. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias. Stata 15 was utilized to perform statistical analyses.

In total, 30 studies were included, all of which had a Newcastle-Ottawa Scale score of 7 or higher. Among them, 21 studies reported OS, 10 reported disease-specific survival (DSS), 3 reported progression-free survival, and 11 reported DFS. The meta-analysis results suggested that a higher preoperative NLR was significantly associated with poorer postoperative OS (hazard ratio [HR] = 1.79, 95% confidence interval [CI]: 1.48-2.16; P < .001), DFS (HR = 1.70, 95% CI: 1.48-1.94; P < .001), and DSS (HR = 2.10, 95% CI: 1.72-2.57; P < .001) in individuals with OSCC. No significant association was found between NLR and progression-free survival (HR = 1.24; 95% CI: 0.78-1.99; P = .367). Sensitivity analyses revealed that the pooled effect sizes for OS, DSS, and DFS did not significantly change. The publication bias assessment results showed that significant publication bias was found for OS, DFS, and DSS (P < .05). After the trim and filling method, the direction of the pooled effect size did not reverse, and the 95% CI of the effect estimates remained statistically stable, indicating that the study results were relatively robust.

Elevated preoperative NLR may be an effective predictor of poor survival prognosis among individuals with OSCC and may be applied as a low-cost prognostic biomarker to assist in prognostic prediction. However, due to the limited number of included studies, high-quality research is warranted in the future to validate these findings.