Photodynamic therapy and cryotherapy are treatment options for actinic keratosis; however, their efficacy and safety remain debated.

To perform a high-quality systematic review and meta-analysis exploring the efficacy and safety of photodynamic therapy and cryotherapy in actinic keratosis.

A systematic search was performed applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Web of Science, Cochrane, Science Direct, Ovid, EBSCO, Wiley, and Google Scholar for randomized controlled trials.

A total of seven studies with 1233 patients were identified. PDT and cryotherapy showed similar success in clearing lesions (RR, 1.02; 95% CI, 0.92-1.13; p = 0.74). While both treatments performed comparably on the head and face (RR, 1.10; 95% CI, 0.94-1.28; p = 0.24), data from one trial suggested cryotherapy might be more effective for lesions on the arms and legs (RR, 0.88; 95% CI, 0.82-0.94; p < 0.05). However, more research is needed to confirm this finding. Cosmetic outcomes were significantly better for PDT (74.62% vs. 49.11%: RR, 1.52; 95% CI, 1.4-1.65; p < 0.00001) than cryotherapy. Similarly, PDT was superior to cryotherapy in patient satisfaction though the overall difference was not statistically significant (RR, 1.43; 95% CI, 0.91-2.25; p = 0.12). PDT was associated with a significantly higher risk of burning sensations and pain (RR, 1.95; 95% CI, 1.27-3.02; p = 0.002), whereas cryotherapy more frequently led to vesicles and blisters.

Lesion clearance may depend on location. It is comparable for head and face lesions, while data from one trial suggests cryotherapy may be better for extremity lesions. PDT is associated with a higher occurrence of pain/burning, while cryotherapy leads to more vesicles/blisters. Future research should focus on standardized protocols, including blinded post-treatment assessments to improve reliability and minimize bias.

Upper extremity (UE) impairment is a leading cause of decreased function in breast cancer (BC) survivors. Failure to recognize and properly manage these impairments can lead to significant and sustained functional limitations. Few supports exist to help survivors monitor UE impairments related to BC over time. The purpose of this project was to evaluate usability of the StrongArms-Cancer mHealth system from the patient and the health-provider perspective. This project had 2 parts to evaluate the usability of the StrongArms-Cancer system. Part 1: Participant usability testing; Part 2: Expert heuristics evaluation. In part 1, participants were adults with a previous diagnosis of BC. They were asked to use the think-aloud method while completing 6 tasks in the system to assess usability. Users completed the mHealth App Usability Questionnaire (MAUQ) and System Usability Scale (SUS) at the end of the session. Session transcripts were coded using deductive content analysis to identify specific types of usability issues. Quantitative data from the MAUQ and SUS were summarized using descriptive statistics. Participants in part 2 were health providers living in Canada. They were asked to review and evaluate the mHealth system based on established heuristic principles. Data from the heuristic evaluations were summarized descriptively into main usability issues identified. Think-aloud transcripts highlighted 10 categories of usability issues. Most users (n = 12; 75%) rated the system as "excellent" or better; the mean SUS score was 86.9 (SD 12.06), demonstrating a "superior" score. MAUQ total scores averaged 104.7 (SD: 14.91). The 2 heuristic criteria that resulted in the greatest number of violations (n = 5) were "help and documentation" and "consistency and standards." The findings from think-aloud sessions and heuristic evaluations revealed high user satisfaction and demonstrated effective usability. The StrongArms-Cancer mHealth system shows promise in aiding the proactive surveillance and monitoring of individuals with BC.

Maintenance avelumab therapy after first-line induction chemotherapy is a viable option in the evolving treatment paradigm for metastatic urothelial carcinoma (mUC); however, the clinical determinants of its efficacy remain unknown. Here, we explored the prognostic factors of maintenance avelumab therapy for mUC using a multicenter real-world database.

The review of the multicenter database identified 59 patients with mUC who did not progress during first-line chemotherapy and subsequently received maintenance avelumab therapy. Progression-free survival (PFS) and overall survival (OS) after the initiation of avelumab were analyzed, and prognostic factors were explored.

The median age was 70 years, and the primary lesion was the bladder in 28 (47.5%) patients. In the first-line chemotherapy, gemcitabine plus cisplatin was administered in 40 (67.8%) patients. The number of chemotherapy cycles was 2-3/4/5/6 in 7 (11.9%)/22 (37.3%)/6 (10.2%)/24 (40.7%) patients. With a median follow-up period of 13.2 months, 38 (64.4%) patients progressed and 20 (33.9%) died. The median PFS and OS were 6.1 months and not reached, respectively. Multivariable analysis demonstrated that hypoalbuminemia was the only independent predictor of poor PFS (hazard ratio, 2.70; p = 0.013). Patients with hypoalbuminemia showed significantly shorter median PFS (3.3 vs. 12.0 months; p = 0.004) and OS (9.3 months vs. not reached; p < 0.001) compared to those with normal albumin.

Hypoalbuminemia was an independent prognostic factor in patients with mUC who were treated with maintenance avelumab therapy. Efforts to preserve nutritional status and avoid hypoalbuminemia may help optimize its efficacy.

Sir Charles Gairdner Hospital (SCGH) commenced an observation strategy in patients with a complete clinical response, Watch and Wait (W&W), for rectal adenocarcinoma in 2017 using a rigorous surveillance protocol. Our earlier results (2017-2019) have been published. We report updated results and present a revised treatment pathway and surveillance protocol.

A retrospective review of a prospectively maintained database and medical records was performed. All patients from 2017 to 2023 referred for long-course chemoradiotherapy (LCCRT) as part of rectal adenocarcinoma treatment with curative intent were included.

A total of 142 patients were referred for induction LCCRT for rectal cancer. Consolidation chemotherapy usually followed. Six patients did not complete treatment; 31 had a complete or near-complete clinical response and were enrolled in W&W. Six patients declined surgery and were offered W&W. Of the 31 patients in W&W, 5 patients had suspected local regrowth and underwent surgical resection. Two of five had pCR on histopathology. Regrowth cases were identified within 9 months by flexible sigmoidoscopy and sometimes on imaging (PET or MRI). A total of 95 patients did not have cCR and had surgical resection; of these, 20 had pCR.

A total of 24% of patients referred for LCCRT at SCGH achieved cCR, and this was sustained in 84%. Sixteen percent of W&W patients had suspected local regrowth. Our surveillance protocol detected regrowth early, and surgical salvage was always possible. Twenty percent of patients undergoing surgery having pCR despite not having cCR highlights the difficulty of avoiding TME in all patients who have a pCR but suggests optimisations of our practice are possible. We propose a reduction in the length and intensity of our current protocol.

The COVID-19 pandemic disrupted face-to-face alcohol and other drug (AOD) treatment services and prompted greater use of telehealth. This study measured the impact of COVID-19 on outpatient treatment episodes before, during, and after stay-at-home orders were introduced.

This observational study used routinely collected data from community-based non-government AOD services in New South Wales (NSW), Australia across 4 years (209 7-day intervals from January 1, 2019-January 2, 2023). Interrupted time-series analyses with seasonal autoregressive integrated moving average (ARIMA) modeling estimated weekly changes in outpatient treatment episodes associated with stay-at-home (lockdown) orders, including (1) commencements, (2) planned cessations, and (3) unplanned cessations. Episode counts were also examined by gender (male, female), age group (< 25 years, 25-59 years, ≥ 60 years), principal drug of concern (alcohol, amphetamines, cannabinoids, opioids, and other), and location (metropolitan and non-metropolitan).

There were no significant level or trend changes in the overall number of episode commencements (ARIMA (2,0,0)(1,0,0), lockdown one: β_level = -814.85, p = 0.098; β_slope = 11.14, p = 0.127; lockdown two: β_level = 317.3, p = 0.427; β_slope = -3.47, p = 0.237), planned cessations (ARIMA (1,0,0)(0,0,1), lockdown one: β_level = -142.1, p = 0.66; β_slope = 1.16, p = 0.808; lockdown two: β_level = -199.07, p = 0.432; β_slope = 0.18, p = 0.932), or unplanned cessations (ARIMA (1,0,0), lockdown one: β_level = -92.4, p = 0.717; β_slope = 1.4, p = 0.711; lockdown two: β_level = -121.19, p = 0.563; β_slope = 0.53, p = 0.732) in outpatient non-government AOD services at either lockdown. For subgroups, during lockdown one, commencements per week increased for metropolitan participants (ARIMA (1,0,0) β_level = -725.12, p = 0.024; β_slope = 10.07, p = 0.035) and those with amphetamines (ARIMA(3,0,0)(1,0,0) β_level = -338.44, p = 0.036; β_slope = 4.68, p = 0.05) as their principal drug of concern.

The introduction of COVID-19 lockdown measures did not appear to adversely impact the number of NSW non-government AOD outpatient treatment episodes delivered nor the likelihood of unplanned dropout. Our findings illustrate the likely role of telehealth in sustaining (and for some groups, perhaps temporarily increasing) AOD service provision during the COVID-19 pandemic. This highlights the sector's resilience in sustaining care under challenging circumstances.

Older adults faced heightened vulnerability during the COVID-19 pandemic, leading to increased mortality. This study investigated the impact of COVID-19 vaccination on COVID-19-related mortality among the main ethnic groups in long-term care during the Delta-Omicron wave in New Zealand.

We used national health datasets (interRAI Long Term Care Facility, COVID-19 immunisation, COVID-19 test results, mortality) from August 2021 to August 2022. Multi-state modelling assessed transition hazards from infection to COVID death and other causes of death among Māori, Pacific, Asian and European residents. Transition hazard ratios compared the risk of transitioning from infection to COVID versus non-COVID death.

A total of 34,147 long-term care residents (female: 64.0%, mean age: 84.8 years SD = 8.5) were included. For Māori aged < 85, Asians < 63 and Europeans < 93 who had 3+ doses of vaccine, the risk of COVID death was statistically lower than non-COVID death. Unvaccinated residents showed higher hazards for transitioning to COVID death. For Pacific peoples, transition hazard ratios were not statistically significant, likely due to small sample size. However, successive vaccine doses suggested reduced COVID mortality.

COVID-19 vaccination reduced the risk of COVID deaths across ethnicities in New Zealand's long-term care. However, the level of protection offered by the vaccine varied by ethnicity and age.

This text discusses the impact of the COVID-19 pandemic on the sociability of men who have sex with men (MSM) in northeastern Brazil, between 2020 and 2021. We analyze ethnographic data focused on the narratives of leisure professionals and workers in government and non-governmental organizations. In March 2020, social distancing measures were announced, including the closure of leisure establishments, which had a financial impact on owners and workers. Many returned to work illegally before it was allowed. MSM, affected by family homophobia and loneliness, resumed social activities, disobeying health regulations. Intersectionality between sex-gender, sexuality, race and class, together with federal denial of the virus's lethality, and weak economic mitigation policies, produced an environment conducive to death. Based on the experiences of the gay community in the Recife Metropolitan Region and other contexts, we propose an agenda for reflection and action for future health crises that affect sexually dissident populations.

Although laxatives are commonly used for constipation in critically ill patients with acute myocardial infarction (AMI), the optimal initial choice is unclear. We are aimed at comparing the clinical outcomes of initiating therapy with stimulant, stool softener, and osmotic laxatives.

This retrospective study analyzed ICU patients with AMI from the MIMIC-IV database, comparing three initial laxative strategies using propensity score matching (PSM). The primary outcome was 28-day mortality. Secondary outcomes included ICU, in-hospital, and 365-day mortality; cardiogenic shock; malignant arrhythmia; delirium; and bowel sound recovery. Findings were validated with inverse probability of treatment weighting (IPTW) and subgroup analyses.

In the 1:1:1 PSM cohort of 1887 patients, stool softeners were associated with significantly lower mortality versus stimulants: in-hospital (adjusted OR = 0.39, 95% CI 0.22-0.69, p = 0.001), 28-day (aHR = 0.55, 95% CI 0.40-0.76, p < 0.001), and 365-day (aHR = 0.57, 95% CI 0.45-0.72, p < 0.001). Osmotic laxatives correlated with lower in-hospital (aOR = 0.52, 95% CI 0.30-0.89, p = 0.017) and 28-day (aHR = 0.72, 95% CI 0.55-0.95, p = 0.019) mortality, but not 365-day compared with stimulant laxatives. Both agents were linked to lower delirium risk and better bowel sound recovery. IPTW sensitivity analyses showed consistent results.

Among ICU-admitted AMI patients, the initial use of stool softeners or osmotic laxatives was associated with a lower risk of short-term mortality compared with stimulant laxatives. These findings indicate that a more robust and gentle laxative management strategy may have potential clinical value for this high-risk population.

Ischemia-reperfusion injury severely impacts the heart and brain, and although ferroptosis is a key therapeutic target, the role of interleukin-6 in regulating ferroptosis during cardiac and cerebral I/R remains unclear. In vitro oxygen-glucose deprivation (OGD)-treated PC12 and H9C2 cells and in vivo myocardial I/R mice and MCAO rats were used to model ischemic injury. IL6 expression was silenced using siRNA or lentivirus, whereas IL-6 overexpression was achieved using an IL6 overexpression plasmid. Cells or animals were subsequently treated with glutamate (Glu), haptoglobin (HP), ferrostatin-1 (Fer-1), or colivelin, a JAK2/STAT3 pathway agonist. IL6 knockdown significantly suppressed OGD-induced ferroptosis by upregulating GPX4 and SLC7A11, thereby improving cell survival and reducing ROS and Fe²⁺ accumulation. IL6 silencing attenuated OGD-induced apoptosis, effects that were significantly abolished by Glu or HP. In myocardial I/R and MCAO models, IL6 knockdown preserved cardiac function, reduced cerebral infarction, alleviated oxidative stress, and mitigated ferroptosis, whereas Glu or HP co-treatment reversed these benefits. Mechanistically, IL6 silencing inhibited JAK2/STAT3 activation, while colivelin treatment reinstated pathway phosphorylation and ferroptosis. IL6 downregulation alleviates cardiac and cerebral I/R injuries by suppressing ferroptosis through regulation of the JAK2/STAT3 pathway.

Hyperlipidemia, a common metabolic disorder marked by elevated serum lipids like total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C), raises risks for cardiovascular diseases, atherosclerosis, nonalcoholic fatty liver disease, and diabetes. Conventional treatments like statins have limitations, including liver damage and resistance, driving interest in natural compounds with multi-target, low-toxicity effects. This study assessed Astragalus polysaccharide (APS), a traditional Chinese medicine component with antioxidant and metabolic-regulatory properties, for its therapeutic effects on hyperlipidemic rats and its mechanism via the miR-128-3p/NRF2/antioxidant pathway. SD rats were grouped into normal, model, simvastatin, and APS. Except normal, all received high-fat diet for 8 weeks to induce hyperlipidemia. Then, APS (700 mg/kg) or simvastatin (6.7 mg/kg) was administered via gavage for 8 weeks; controls received saline. Serum indices were monitored periodically; pancreatic and hepatic tissues were analyzed histologically and molecularly. In vitro, lipid accumulation was induced in BRL and HepG2 cells with oleic/palmitic acids (2:1). Optimal APS dose/time was determined by CCK-8; lipid and oxidative markers were measured. A high-fat diet caused hyperlipidemia, elevating lipids, body weight, and energy intake. APS reduced glucose/lipid levels, and transaminase activity and improved pancreatic/hepatic pathology, including β-cell function. APS lowered MDA and miR-128-3p while boosting T-SOD and hepatic NRF2. In cells, APS reversed lipid buildup and oxidative stress. APS mitigates hyperlipidemia via the miR-128-3p/NRF2/antioxidant pathway, providing a multi-target strategy for lipid metabolism, oxidative stress, and organ protection. This supports natural interventions for hyperlipidemia, especially with glucose/organ issues, meriting clinical exploration.