peripherally inserted central catheters (PICCs) and totally implantable ports (Ports) are used for chemotherapy administration. This study aimed to compare their morbidity, mortality, and complication rates.

a prospective, randomised, comparative single-centre study with 6 months of follow-up included adult patients with non-hematological malignancies eligible for chemotherapy (palliative, curative, or adjuvant intent). Primary endpoints were the frequency of adverse events (minor/major), impact on quality of life (EORTC QLQ-C30), and medico-economic cost.

out of 206 randomised patients, 192 were analysed (Port: 102; PICC: 90). The overall complication rate was 12.5% (n=24). Major complications were significantly more frequent with PICCs (17.8%; 16/90) than with Ports (4.9%; 5/102), with a relative risk of 3.6 (95% CI 1.3-9.9; p=0.041). For chemotherapy lasting less than 6 months, the mean total cost was significantly higher for Ports (160,123.41 DA) than for PICCs (43,259.69 DA) (p<0.001). No significant difference was observed in overall quality of life, with a modest trend favoring Ports for global health and pain at three months.

Ports, although costlier, are associated with a significantly lower risk of major complications. They may be preferred as a safe and effective access for long-term chemotherapy. The optimal choice should integrate treatment duration, patient risk profile, and economic constraints.

This study aims to systematically evaluate the impact of exercise interventions on reproductive endocrine profiles in adult patients with polycystic ovary syndrome (PCOS) using a three-level meta-analytical approach.

We performed a systematic search of PubMed, Web of Science, The Cochrane Library, and Embase for randomized controlled trials (RCTs) investigating the effects of exercise on reproductive endocrine profiles in PCOS patients, spanning from database inception through April 7, 2026. A three-level meta-analysis was conducted in R using a random-effects model fitted via restricted maximum likelihood (REML). Effect sizes were quantified as Hedges' g with 95% confidence intervals (CIs). Global heterogeneity was assessed using the Cochran's Q test, and the robustness of results was verified through leave-one-out sensitivity analyses. Model fit was compared using likelihood ratio tests (LRT). Publication bias was scrutinized via Egger's test, with the trim-and-fill method employed as a corrective measure where necessary. Methodological quality was appraised using the PEDro scale, and the certainty of evidence was graded via the GRADE profiler.

Nineteen studies involving 1,018 participants were synthesized. Exercise interventions significantly lowered testosterone levels (g = -0.34; 95% CI [-0.61 to -0.07]; P = 0.0146). Subgroup analysis revealed that the "aerobic exercise" group was statistically significant (k = 14, g = -0.5120, 95% CI [-0.8230 to -0.2010], P = 0.0027). The mean body mass index (BMI) "25 to 29.9" group was also statistically significant (k = 17, g = -0.4859, 95% CI [-0.7775 to -0.1943], P = 0.0025), as was the mean age group of "26 to 30 years old" (k = 13, g = -0.4878, 95% CI [-0.8465 to -0.1290], P = 0.0105).

In conclusion, exercise interventions exert a favorable impact on serum testosterone (T) levels in adult patients with polycystic ovary syndrome (PCOS).

PROSPERO (registration no. CRD420251108464; https://www.crd.york.ac.uk/prospero/).

Definitive radiotherapy is a standard larynx-preserving treatment for early-stage glottic squamous cell carcinoma. This study evaluated recurrence patterns and freedom from recurrence after definitive radiotherapy in Panama; explored baseline clinical, pathological, and treatment-related factors associated with recurrence; and analyzed initial post-treatment response as an early marker of subsequent recurrence risk.

We conducted a retrospective cohort study of adults diagnosed between 2013 and 2022 with T1-T2 N0 M0 glottic squamous cell carcinoma and treated with definitive radiotherapy at the National Oncology Institute of Panama. Time to recurrence, event-free survival, overall survival, and laryngeal preservation with oncologic control were evaluated. Freedom from recurrence was estimated using the Kaplan-Meier method, with deaths without prior recurrence censored. Survival outcomes were compared using log-rank tests and Cox proportional hazards models.

Ninety-four patients were included: 79.8% had T1a, 13.8% had T1b, and 6.4% had T2 disease; 94.7% received three-dimensional conformal radiotherapy. An initial complete response was achieved in 86/93 patients (92.5%). With a median observed follow-up of 65.9 months (38.6-96.6), 17/94 patients (18.1%) developed recurrence: local recurrence occurred in 13.8% and regional recurrence in 4.3%, with no distant metastases. Freedom from recurrence at two and five years was 87.0% and 80.2%, respectively; five-year event-free survival was 70.4%, and five-year overall survival was 81.7%. Laryngeal preservation with oncologic control was achieved in 77/94 patients (81.9%). Partial response was associated with lower five-year freedom from recurrence compared with complete response (28.6% vs. 84.2%; p < 0.001). Five-year freedom from recurrence was 85.4% with hypofractionation and 78.5% with conventional fractionation (p = 0.483).

In this retrospective cohort with a median observed follow-up of 65.9 months, definitive radiotherapy achieved a high initial complete response rate, predominantly local recurrence patterns, and a five-year freedom from recurrence of 80.2%, with deaths without prior recurrence censored. Partial response identified a high-risk subgroup as an early post-treatment response marker. Hypofractionation showed a non-significant numerical trend toward higher five-year freedom from recurrence, but the study did not demonstrate superiority, equivalence, or non-inferiority between fractionation schedules.

Traditional cancer therapy has limitations due to a lack of specificity and efficiency in tumor-targeting, toxicity issues, and biological barriers, which affect the clinical efficacy of traditional agents as well as synthetically designed carriers. Exosomes have gained popularity as excellent biological carriers owing to their inherent biocompatibility, capability to overcome biological barriers, and ability to transport cargoes between cells naturally. This review discusses how engineering of exosomes, hybrid exosomes, and exosome mimics could be employed to deliver therapies, enhance tumor penetration, and enable multimodal treatment of cancers, including chemotherapy, gene therapy, immunotherapy, and theranostics. The biomimetic and hybrid platforms may overcome key limitations of native exosomes, particularly low production yield, heterogeneity, limited drug-loading efficiency, and scalability constraints, while preserving desirable biological functionality. Moreover, the review also emphasizes that the standardization in manufacturing, reproducibility in cargo, safety evaluation, and regulatory approval are the major obstacles to clinical application. Unlike many earlier reviews that were mainly centered on native exosomes, the current review discusses the engineering aspects of exosome-like nanoplatforms from a translational viewpoint.

Tenosynovial giant cell tumor (TGCT) is a rare mesenchymal neoplasm arising from the synovium, tendon sheath, or bursa. Although the localized and diffuse forms of TGCT are typically considered benign, malignant TGCT characterized by marked histologic atypia and increased mitotic activity may exhibit aggressive clinical behavior. Pulmonary metastasis from malignant TGCT is rare and, in previously reported cases, pulmonary involvement has predominantly been described as parenchymal nodules or pleural lesions. In this article, we describe a rare case of endobronchial pulmonary metastasis occurring approximately 72 months after the initial diagnosis of malignant TGCT originating from the tendon sheath of the knee.

Inflammatory myofibroblastoma tumor (IMT) is a rare mesenchymal neoplasm that develops in the lungs, retroperitoneum, or abdominopelvic region, and is most common in children and adolescents; although IMT usually has a good prognosis, some cases still show local invasion, recurrence, and even distant metastasis. Effective standard treatment for locally advanced or metastatic IMT is limited, but therapy with anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) improves the prognosis in some patients with ALK protein expression or ALK gene fusions. This case reports a 39-year-old woman with recurrent fever, cough, sputum, chest tightness, and shortness of breath for more than 2 weeks. Contrast-enhanced computed tomography (CT) revealed a mass in the upper lobe of the right lung with ill-defined borders involving the mediastinum, pleura, and right hilum. Multiple pleural nodules and right-sided pleural effusion were also observed. IMT was diagnosed by lung biopsy, and ALK positive was confirmed by immunohistochemistry. The patient's lung CT was reviewed after 3 weeks of treatment with brigatinib, and the right lung lesion and multiple metastases in the right pleura, hilar region, and mediastinum were significantly smaller than before. Additionally, the right pleural effusion was reduced, and the clinical symptoms were significantly improved compared to prior evaluations. Unlike most IMT cases, this patient's tumor showed highly malignant biology, with pleural metastasis at the initial diagnosis, as well as rapid progression and a favorable response to ALK TKI. Brigatinib represents a potential therapeutic option for the treatment of IMT.

During infectious and noninfectious inflammatory diseases, disruption of the immune-hemostatic balance increases both thrombotic and hemorrhagic risk. We propose that this bidirectional dysregulation reflects the integrated contribution of megakaryocyte reprogramming during thrombopoiesis and direct remodeling of circulating platelets by inflammatory mediators, two interconnected regulatory levels that together shape the prothrombotic and hemorrhagic platelet phenotypes observed across inflammatory conditions.

Current evidence supports a two-level framework through which inflammation remodels platelet responses. Upstream, recent studies demonstrate that inflammation remodels thrombopoiesis, megakaryocyte transcriptional programs, and immunometabolism, generating platelets with altered immunothrombotic, thromboinflammatory, and prothrombotic properties. Converging evidence from aging, sepsis, myeloproliferative neoplasms, and rheumatoid arthritis identifies autophagy as a central target of inflammatory signaling linking megakaryocyte and platelet reprogramming to mitochondrial dysfunction and impaired clot contraction. Downstream, inflammatory mediators directly remodel platelet receptor signaling and promote receptor transfer, generating context-dependent platelet functional states that contribute to both thrombotic and hemorrhagic complications.

The platelet phenotype observed across inflammatory diseases reflects the integrated contribution of megakaryocyte reprogramming during thrombopoiesis and direct remodeling of circulating platelets by inflammatory mediators. These two levels of regulation likely operate simultaneously and may amplify each other, yet how they interact to determine platelet functional outcomes in specific inflammatory contexts remains to be determined. Defining these interactions will inform the development of mechanism-based therapeutic strategies that target inflammation-driven platelet dysfunction to reduce thrombotic and hemorrhagic complications across inflammatory diseases.

Workplace violence against nurses and midwives intensified during the COVID-19 pandemic, exposing and amplifying longstanding structural marginalization in health systems across Latin America. This study analyzes how different forms of violence were experienced and described by nursing professionals during this period. A secondary qualitative analysis was conducted using text-based responses from an international online survey developed by the Global Consortium, which included 3860 nurses and midwives from 18 Latin American and Caribbean countries. Data were examined through Descending Hierarchical Classification using IRaMuTeQ, followed by reflective thematic analysis for interpretive integration. The analysis identified five lexical classes, reorganized into three interconnected themes: direct violence related to care delivery and system collapse; stigma, fear, and disruption of social belonging; and ethical-political suffering associated with structural blame, moral suffering, and moral injury. Despite contextual differences across countries, narratives revealed recurring patterns of emotional overload, professional delegitimization, and exposure to multiple forms of violence. These findings position violence against nursing professionals during the pandemic as a structural and multifaceted phenomenon rooted in historical inequities and institutional fragility, underscoring the need for sustained policies that strengthen workforce protection, ethical accountability, and institutional support in both routine healthcare settings and future public health emergencies.

several studies have shown the evolution of SARS-CoV-2 between 2020 and 2023 in Guinea. This study provides updated information on the circulation dynamics of SARS-CoV-2 from 2024 to 2025 and the variants circulating in Guinea.

as part of the integrated influenza/COVID-19 sentinel surveillance program, 2423 nasopharyngeal samples were analysed using RT-PCR, and those positive for SARS-CoV-2 were sequenced using the Illumina COVIDSeq Assay protocol.

all age groups, ranging from <2 years to > 64 years, were affected by COVID-19, with an average SARS-CoV-2 positivity rate of 2.3%. The virus showed sporadic activity throughout the 2024-2025 period, with a higher level of activity during epidemiological week 42 (October) of 2024. Genomic analysis showed that only the Omicron variant circulated, along with its subvariants JN.1 and LF.7, in 2024. Subvariant LF.7 and recombinant XFJ also circulated in 2025.

SARS-CoV-2 subvariants continue to circulate sporadically in Guinea, with the XFJ recombinant having been detected in humans. Therefore, it is imperative to strengthen sentinel, genomic, and environmental surveillance for the early detection of any new COVID-19 outbreak and the potential emergence of new variants.

Digital health technologies offer a promising approach to strengthening self-management capacity among patients with chronic obstructive pulmonary disease (COPD), yet clinical application is hampered by poor adherence, low sustained engagement, and limited self-management ability. Although previous studies have identified general self-management challenges in COPD, few have systematically investigated patients' preferences for digital tools or translated these insights into actionable design principles. This hinders the user-centred development and effective deployment of digital interventions for this population.

This study aimed to explore the self‑management challenges and preferences for mobile health (mHealth) among COPD patients, with the ultimate goal of translating these findings into design principles for a persuasive self‑management application.

We conducted in-depth personal interviews with 15 patients with COPD and five healthcare professionals to explore the challenges of self-management and preferences for mHealth. Data were analyzed using thematic analysis. Subsequently, a structured expert consultation was held to translate the findings into key principles for a persuasive self-management application.

Five themes regarding barriers to effective self-management were identified: (1) negative emotional experience, (2) poor health literacy, (3) insufficient family support, (4) inadequate professional health care, and (5) economic burden. Patients expressed four key preferences for digital health technologies: (1) simplicity, (2) personalized decision support, (3) self-report, (4) early warning of deterioration. Furthermore, the panel discussion distilled these findings into eight essential key principles: motivation, simplicity, credibility, guidance, personalization, self-report, warning, and continuity.

This study provides new insights into user-centered mHealth tools for COPD self-management. We derived core design principles from patients' demands to inform targeted digital interventions. These principles require validation in female, higher-literacy and multi-center samples before wide application. Future work will complete the remaining CeHRes Roadmap stages of design, operationalization and evaluation to refine this framework.