To evaluate whether non-tobacco nicotine dependence (NTND) in adolescents and young adults is associated with an increased risk of new-onset fractures over a medium and long term follow up.

Design: retrospective cohort query of TriNetX network.

Multi-center study conducted using de-identified electronic health records from the TriNetX network of participating healthcare organizations.

Adolescents and young adults (≤21 years) were included if they had a diagnosis of NTND between June 1, 2005, and June 1, 2020. Exclusions: any prior tobacco use, environmental tobacco exposure, tobacco use disorder, pre-existing bone/joint pathology (e.g., osteoporosis, osteoarthritis, osteogenesis imperfecta, malignant neoplasms of bone/cartilage), or prior fracture. NTND patients were propensity score matched 1:1 with controls without any documented nicotine or tobacco use.

The primary outcome was incident fracture after the most recent eligible clinical encounter documented between June 1, 2005, and June 1, 2020. Fracture risk was assessed over a fixed 5-year period following the index date and across the longest available follow-up in TriNetX. Risk ratios (RR) and 95% confidence intervals (CI) were calculated. Kaplan-Meier survival analysis was used to estimate hazard ratios (HR) for time-to-event comparison.

The matched cohort was comprised of 10,576 patients per group with an average age at index of 19.4 + 1.7 years. The NTND group was comprised of 44.9% males and 54.7% females while the control group was comprised of 44.7% males and 55.0% females. At 5 years, fracture incidence was 1.1% in the NTND group and 0.5% in controls (RR, 2.1; 95% CI, 1.5 - 2.9; p < 0.001). Over the extended follow-up, fracture incidence was observed to be 2.0% in NTND group and 1.0% in the control group (RR, 1.9; 95% CI, 1.5-2.4; p < 0.001). Over the extended follow-up, the elevated fracture risk in NTND group when compared to controls was confirmed time-to-event analysis (HR, 1.9; 95% CI, 1.5-2.4).

Non-tobacco nicotine dependence was associated with a two-fold increased risk of fracture among adolescents and young adults (RR, 2.1; 95% CI, 1.5-2.9 at 5 years; RR, 1.9; 1.5-2.4 over an extended follow up period). It is suggested by these findings that skeletal health consequences should be considered when evaluating the long-term impact of nicotine use in youth.

Level III.

Cuproptosis represents a promising therapeutic strategy for cancer; however, its clinical application remains limited. We observed elevated copper levels and increased expression of DLAT, a key procuproptosis gene, in colorectal cancer (CRC) tissues, suggesting inherent susceptibility to cuproptosis. Furthermore, NAT10 enhances DLAT mRNA stability by mediating its N⁴-acetylcytidine (ac4C) modification, thereby promoting cuproptosis. We also discovered that lactylation of NAT10 at lysine 426 (K426) enhances NAT10 catalytic activity. Conversely, SIRT1 mediates the delactylation of NAT10-K426, leading to the inhibition of cuproptosis. The combination of elesclomol (a cuproptosis inducer) and selisistat (a SIRT1 inhibitor) effectively induced cuproptosis in CRC. Notably, the reduction of soluble DLAT induced by elesclomol treatment was found to enhance NAT10-K426 lactylation. Moreover, DLAT supplementation establishes a positive feedback loop that amplifies cuproptosis. These results underscore the critical role of nonhistone NAT10 lactylation in tumor cuproptosis and highlight the therapeutic potential of targeting this pathway for CRC treatment.

Solitary fibrous tumors are mesenchymal neoplasms that make up 2% of soft tissue tumors. Doege-Potter syndrome (DPS) occurs between 5-10% of patients with solitary fibrous tumor of the pleura (SFTP). Little is mentioned about DPS in the relapse setting, where malignant transformation should always be ruled out (until 12% of cases) according to tumor size, histopathologic aspects (including mitotic index) and immunohistochemical markers. This is the first case of Doege-Potter syndrome in the setting of a fibrous tumor relapse of the pleura without malignant transformation described in Colombia.

This systematic review study method to investigate the effects of yoga therapy in oncological nursing care for children undergoing cancer treatment. Between 2009 and 2024, searches were conducted in Science Direct, Web of Science, PubMed, and Google Scholar databases using the keywords "pediatric oncology, cancer, child, adolescent, yoga, nursing care, stress, fatigue, sleep quality," yielding a total of 502 studies, 45 of which were classified as articles. Twelve of the reviewed articles met the inclusion criteria. In this systematic review, the question "What is the effectiveness of yoga therapy on stress, fatigue, and sleep quality in pediatric oncology care?" was addressed. The reviewed articles found that yoga therapy improved stress, fatigue, physical activity, psychological well-being, sleep quality, and pain levels in pediatric oncology. While reviewing the articles, the identities of the authors, the publishing journals, the research method, the country in which the study was conducted, the number of patients, the age range of the intervention, the type of intervention, and the parameters determined to be effective on yoga were all examined, and it was concluded that yoga can be used as an alternative nursing care for children with cancer.

BackgroundLimited research evidence exists on the experiences of adolescents living with HIV about their access to antiretroviral therapy during the COVID-19 pandemic in Tanzania.ObjectiveTo explore the lived experiences of adolescents living with HIV during the COVID-19 pandemic, including COVID-19-related anxiety, facilitators and barriers to accessing HIV care and treatment, and the coping strategies employed to remain healthy and resilient and if differences existed based on levels of anxiety.MethodsWe adopted a case study design to understand both normative and individual lived experiences of purposefully sampled adolescents receiving HIV care during the COVID-19 pandemic with higher and lower anxiety levels. A total of 32 participants took part in the study, including 24 in focus group discussions and 8 in in-depth interviews. Data were analyzed using thematic analysis.ResultsAdolescents living with HIV faced heightened anxiety and notable barriers to accessing HIV services during the COVID-19 pandemic. Their anxiety was driven by fear of infection, uncertainty about prevention measures, concerns about receiving care outside HIV clinics, and a perceived increased vulnerability. Many reported difficulty attending clinic appointments, largely due to government- and parent-imposed restrictions such as stay-at-home directives, mandatory mask use, and limited public transport capacity, but no difference based on anxiety level.To cope, adolescents relied on treatment adherence knowledge, self-efficacy, and family support. Both low- and high-anxiety groups encountered similar barriers to care and treatment adherence; however, those with higher anxiety reported greater fear of infection, less confidence in coping, and less helpful coping skills. No differences were observed by sex or age.ConclusionThe findings highlight that self-efficacy, risk-reduction knowledge, problem-solving skills, and family support helped reduce anxiety and support treatment adherence among adolescents living with HIV, underscoring the need for targeted support programs during public health crises.

Post-transplant deep vein thrombosis (DVT) is common after lung transplantation and may contribute to pulmonary embolism and other complications. Whether DVT adversely affects contemporary outcomes and how venovenous ECMO (VV-ECMO) bridging influences early DVT patterns remain unclear. We performed a retrospective single-center study of adult lung transplant recipients (2018-2025). DVT and clinical outcomes were ascertained. Primary analyses compared outcomes and overall survival between recipients with and without DVT in the overall cohort. Secondary analyses assessed DVT-free survival and early anatomic distribution among recipients bridged with preoperative VV-ECMO. Comparisons used Fisher's exact/Mann-Whitney U tests; survival used Kaplan-Meier/log-rank tests. Among 502 recipients, 240 developed DVT. Compared with those without DVT, recipients with DVT had higher rates of pulmonary embolism (22.5% vs. 5.0%, p < 0.0001), acute kidney injury (52.9% vs. 41.2%, p = 0.009), PGD grade 3 (18.3% vs. 10.7%, p = 0.016), longer hospitalization (21 vs. 14 days, p < 0.001), and worse overall survival (HR 2.19, 95% CI 1.49-3.23; log-rank p < 0.001). Of 240 DVT cases, 31 (12.9%) were bridged with VV-ECMO. Within 14 days, upper-extremity DVT was more frequent with VV-ECMO (53.3% vs. 23.5%, p = 0.03), whereas lower-extremity and neck distributions were similar. In multivariable models, operative time was independently associated with DVT (OR 1.18 per hour, 95% CI 1.07-1.31, p < 0.001). Post-transplant DVT is frequent and portends worse outcomes. VV-ECMO bridging is associated with an upper-extremity-predominant DVT pattern but is not an independent DVT predictor after adjustment. Vigilant surveillance is warranted in this high-risk population.

Although coronavirus disease 2019 (COVID-19) usually exhibits a mild clinical course in children, concerns remain regarding persistent airway dysfunction after recovery. This study aimed to evaluate pulmonary function tests (PFTs) in children following mild COVID-19 infection and to compare the findings with those of healthy controls.

In this prospective cross-sectional study, children aged 6-18 years with polymerase chain reaction-confirmed COVID-19 infection were identified retrospectively from February 2022 and evaluated prospectively between June and December 2022. Fifty-eight post-COVID-19 patients and 56 age- and sex-matched healthy controls were included, and their demographic and clinical characteristics were recorded. PFTs were assessed using impulse oscillometry (IOS) followed by spirometry.

There were no significant differences in demographic and anthropometric measurements between the post-COVID-19 group and the healthy controls. In terms of IOS measurements, zR5 and R5-20 (reflecting airway resistance) were higher and zX5 and zX20 (reflecting airway reactance) were lower in the post-COVID-19 group (p = .006, p = .002, p < .001, and p = .001, respectively). No significant differences were observed in spirometric parameters, including zFEV1, zFVC, zFEV1/FVC, and zFEF25-75. Notably, three patients exhibited persistent cough and dyspnea after COVID-19, had FEV1 values <90% predicted, positive bronchodilator reversibility, and inhalant allergen sensitization despite having no prior history of asthma or allergic rhinitis.

Children recovering from mild COVID-19 infection may exhibit persistent airway dysfunction detectable by IOS despite normal spirometric findings. IOS appears to be a sensitive tool for identifying subclinical airway involvement in children following COVID-19.

Regression analysis of correlated data, where multiple correlated responses are recorded on the same unit, is ubiquitous in many scientific areas. With the advent of new technologies, in particular high-throughput omics profiling assays, such correlated data increasingly consist of a large number of variables compared with the available sample size. Motivated by recent longitudinal proteomics studies of COVID-19, we propose a novel inference procedure for linear functionals of high-dimensional regression coefficients in generalized estimating equations, which are widely used to analyze correlated data. Our estimator for this more general inferential target, obtained via constructing projected estimating equations, is shown to be asymptotically normally distributed under mild regularity conditions. We also introduce a data-driven cross-validation procedure to select the tuning parameter for estimating the projection direction, which is not addressed in the existing procedures. We illustrate the utility of the proposed procedure in providing confidence intervals for associations of individual proteins and severe COVID risk scores obtained based on high-dimensional proteomics data, and demonstrate its robust finite-sample performance, especially in estimation bias and confidence interval coverage, via extensive simulations.

Infectious disease outbreaks (outbreaks) are increasing across the globe due to climate change, urbanisation and changes in land use, and many of their response measures impact risk factors for violence against women and girls (VAWG). We conducted a systematic review to consolidate existing evidence on the impact of any outbreaks, and their public health responses, on the change in magnitude of VAWG and mechanisms facilitating violence among women and girls in low-income and middle-income countries. Though our search strategy aimed to capture studies from any outbreak since 2014, all quantitative evidence on VAWG impacts, and all but one qualitative study, focused on the COVID-19 pandemic, and only three studies disaggregated outcomes for women versus girls. Overall, our synthesis of the evidence points to increased VAWG during the first year of the COVID-19 pandemic compared with pre-pandemic levels. We identified five broad mechanisms through which violence occurred against women and girls: (1) income loss due to economic shutdown, financial insecurity, and/or job loss, (2) movement restrictions, (3) changes in access to public services, (4) fear of exposure to infectious disease, and (5) a legacy of mistrust in health systems from previous outbreaks. Our study demonstrates the novelty of VAWG monitoring during outbreaks, the need for increased surveillance and the known mechanisms to date through which VAWG may be perpetrated during outbreaks. By implementing both short-term protective measures and long-term structural reforms, outbreak responses may not only break the cycle of VAWG exacerbated by public health emergencies but build resilient systems that protect women, girls and marginalised populations before, during and after crises.

To explore families' experiences participating in a 10-week web-based lifestyle programme for school-aged children with overweight or obesity.

A qualitative study using inductive analysis of semi-structured interview data.

Victoria, Australia.

Families (children aged 7-13 years with overweight or obesity-body mass index ≥85th percentile-and accompanying parent) recruited for a randomised controlled trial that evaluated the effectiveness of the web-based programme and who received the programme (n=102 children/85 families) were invited to participate in a semi-structured interview at 3 months post-programme.

Families received a 10-week family-focused electronic health (e-Health; web-based) lifestyle programme with health coaching sessions-an evidence-based programme adapted from its in-person, group-based counterpart.

A total of 28 families, including 34 children (eight siblings) and mostly mothers, shared their experiences. 10 themes were identified on family members' experiences and aligned with the socioecological model: intrapersonal-knowledge development on healthy living; experiences and stigma related to overweight, obesity or weight; engaging with structural features of the web-based programme, interpersonal-family dynamic; connections with others (non-healthcare professionals) outside of home; relationship with healthcare professionals, environmental/institutional-impact of COVID-19 lockdowns; health-promoting environments; promotion of and access to overweight or obesity management programmes; web-based programme as part of a larger or established system. Each theme highlighted factors that influenced programme uptake and engagement.

Valuable insights were gained on ways to better adapt e-Health (web-based) lifestyle programmes for children with overweight or obesity. Families perceived advantages in a web-based lifestyle programme and highly regarded humanised features and elements comparable to conventional in-person programmes. Further research is needed to explore the perspectives of families from diverse populations, fathers and families who decline participation in the follow-up period. Web-based lifestyle programmes that incorporate contemporary e-Health technologies, including responsive AI, also warrant further investigation to maximise programme benefits.

ACTRN12621001762842.