Cancer is one of the leading causes of death worldwide. Oncology nurses play an essential role in the care of oncology patients. Providing care for cancer patients and managing complex treatment processes can be challenging for oncology nurses. The psychological effects of caring for cancer patients and facing their illness and death are often overlooked. The relationships between aging anxiety, job stress, and psychological resilience remain unclear. The aim of this study was to determine the relationship between aging anxiety, job stress, and psychological resilience in oncology nurses.

This cross-sectional, correlational and descriptive study was conducted with 220 nurses working in an oncology hospital from December 2023 to February 2024. The Personal Information Form, Relational Aging Anxiety Scale (RASS), Nurse Stress Scale (NSS), and Resilience Scale for Nurses (RSN) were used to collect the data. Descriptive analyses, correlation analysis, and Structural Equation Modeling (SEM) were performed.

Correlation analyses revealed a statistically significant low positive correlation between the relational aging anxiety subscale and NSS scores (r = 0.240, p < 0.05), and a low negative correlation with RSN scores (r = - 0.182, p < 0.05). SEM indicated that RAAS scores were a significant negative predictor of RSN scores (β = -0.214, p < 0.05) and a significant positive predictor of NSS scores (β = 0.608, p < 0.05). No significant direct effect between RSN and NSS scores (β = -0.007, p > 0.05).

These findings suggest that higher aging anxiety among nurses is associated with greater stress and lower psychological resilience, highlighting the need for comprehensive training programs to reduce aging anxiety and job stress, and to enhance psychological resilience among oncology nurses. Interventions focusing on stress management, emotional regulation, and self-care are recommended. Experimental studies to evaluate the effectiveness of these interventions are encouraged.

Breast-related symptoms are common in primary care and frequently prompt imaging or referral. While a palpable breast lump is strongly associated with breast cancer, isolated mastalgia is generally considered low risk. Most evidence comes from secondary care, limiting applicability to general practice.

To estimate the likelihood of breast cancer associated with breast-related symptoms in primary care and to evaluate current GP management of women with isolated mastalgia.

Retrospective cohort study using electronic health records from a Dutch primary care research network.

We included women aged ≥ 30 years presenting with breast-related symptoms or diagnosed with breast cancer between 2014 and 2021. Multivariable logistic regression assessed associations between symptoms and breast cancer. Mastalgia was classified as either isolated (without any other breast-related symptoms) or in combination with other symptoms. In women with isolated mastalgia, GP-initiated imaging and referrals were recorded and evaluated.

We included 2073 episodes from 1752 women (median age: 45.0 years, range 30-100 years); 189 episodes (9.1%) resulted in breast cancer. Presentation with a breast lump (OR 10.57, 95%-CI 4.89-22.84), skin or nipple retraction (OR 5.54, 95%-CI 2.28-13.48), and increasing age (OR 1.07 per year, 95%-CI 1.05-1.08) were independently associated with breast cancer. Mastalgia was associated with lower odds (OR 0.56, 95%-CI 0.34-0.92). Mastalgia was reported in 26 episodes that ultimately resulted in a breast cancer episode, but no cases occurred among women with isolated mastalgia (0 of 588 episodes). Despite this, 39.6% of women with isolated mastalgia underwent breast imaging, nearly half within three months.

In primary care, breast cancer is strongly associated with a palpable lump, skin or nipple retraction, and increasing age. Isolated mastalgia was not associated with breast cancer. However, mastalgia occurring in combination with other breast-related symptoms may indicate a higher risk. Imaging and referral may often be safely deferred in women presenting with short-duration isolated mastalgia.

Poorly differentiated gastric carcinomas (PDGC) comprise 30% of gastric cancers and are associated with poor prognosis, correlating with tumor size and microvascular invasion. PDGC may be subcategorized as Epstein-Barr virus (EBV)-positive or EBV-negative. Based on prior work with EBV-positive nasopharyngeal carcinomas, we interrogated 33 PDGC samples for EBV DNA/RNA/protein, CD8, PDL1, PD1, Inducible T cell Co-Stimulator Ligand (ICOSL), ICOS, MHC-I, Suppressor of cytokine signaling 1 (SOCS1), and miR-155. The 13 EBV-positive tumors each showed intense PD1, PDL1, and CD8+ T cell responses that were largely absent in EBV-negative tumors. EBV EBER-1/2 RNA strongly colocalized with miR-155 in cancer cells with a concomitant loss of ICOSL expression as well as downregulation of cytokine signaling suppressor, SOCS1. In contrast, the 20 EBV-negative PDGCs showed weak to no miR-155 expression, with strong ICOSL and SOCS1 expression. On the other hand, the MHC-I expression was lost in both PDGC types. These data suggest that, despite the similar histological patterns of the cancer cells, EBV-driven induction of miR-155 suppresses SOCS1 expression, resulting in intense cytotoxic T cell infiltration, but also loss of the other miR-155 target, ICOSL, making tumor cells invisible to the surrounding intense T cell infiltration. Conversely, EBV-negative tumors retain ICOSL/SOCS1 expression, but exhibit minimal T cell infiltration, partly due to high SOCS1 expression, preventing immune-mediated clearance. Overall, our data indicate that SOCS1 expression, regulated by EBV-induced miR-155, along with ICOSL status determines whether tumors attract T cells and whether those T cells can effectively eradicate cancer cells.

Accurate hospital bed occupancy forecasting is essential for effective resource planning and patient flow management. While complex machine learning models have gained popularity in healthcare forecasting, their operational utility often falls short due to high maintenance costs and limited interpretability. This study evaluates the performance and practicality of Prophet, a parsimonious time-series model, for mid-term hospital bed occupancy forecasting.

We applied the Prophet model to daily bed occupancy data from the Medical Center - University of Freiburg (2010-2023), incorporating public holidays and a COVID-19 pandemic indicator as exogenous regressors. Prophet decomposes time series into trend, seasonality, and holiday effects, offering interpretable components. Forecast accuracy was assessed via rolling cross-validation over 2022-2023 for horizons of 30, 60, 90, and 180 days. A production-ready forecasting pipeline and dashboard were also implemented using cloud-native tools.

Prophet achieved low MAPE values across all horizons (3.21%-3.53%) with coverage above 80%, demonstrating reliable accuracy comparable to or better than more complex models that often require higher computational resources and operational costs, such as deep neural networks. Component analysis revealed patterns aligned with hospital operations; weekly and yearly cycles, and holiday effects, highlighting the model's interpretability.

This study shows that mid-term hospital bed occupancy can be accurately forecasted using a simple, interpretable model like Prophet. In contrast to more complex architectures, Prophet offers robust performance with minimal tuning, faster deployment, and clearer insights that are critical in operational settings. These findings reinforce the argument that, for structured forecasting tasks like bed occupancy, simple models can rival complex ones, not only in accuracy, but also in reproducibility, scalability, and operational value.

The COVID-19 pandemic and accompanying social distancing measures might have caused adverse health consequences. We aimed to describe changes in participants' self-rated health and mental health (depression, anxiety, and stress), and investigate factors associated with them.

We collected data from the German National Cohort (NAKO). We first described changes in participants' self-rated health and mental health from the baseline examination (1 to 6 years earlier) to the early phase of the COVID-19 pandemic. We then applied the multinomial logistic regression model (self-rated health) and the quantile regression model (mental health) to investigate the potential factors associated with the health status and changes.

After a median of 3.1 [2.1, 4.1] years from baseline to the early pandemic phase (N = 91,809), 39.3% of participants with good health and 69.7% with less good health status at baseline reported better health. However, the percentage of participants with high depression, anxiety, and stress scores (≥ 10) increased from 6.2%, 4.1%, and 4.3% to 8.6%, 5.6%, and 10.1%, respectively. In the multivariable models, we found that being younger, being male, highly educated, being employed, having higher life satisfaction at baseline, being more physically active, drinking heavily, and experiencing improved anxiety symptoms were associated with improved self-rated health. In contrast, smoking and having mental health disorders were all associated with worse self-rated health. Our results showed that being younger, being female, smoking, drinking heavily, and drinking more since baseline were associated with higher depression scores. Having had a coronavirus test was associated with worse self-rated health and more severe anxiety and stress.

During the early COVID-19 pandemic, many participants experienced improvements in self-rated health but suffered deterioration in mental health and physical activity engagement. Female participants, those who were physically inactive, and those with pre-existing mental disorders were more likely to report poorer health.

Osteoporosis and asthma are prevalent chronic conditions that significantly impact public health. Inflammatory cell merging, leading to reduced bone density, increases the risk of fractures, while asthma is a chronic respiratory disease characterized by airway inflammation and bronchoconstriction. More and more emerging research suggests a potential connection through shared pathways and biological mechanisms. In this study, we aim to investigate the causal effect of anti-osteoporosis drug treatment on chronic disease asthma through the Mendelian randomization (MR) analysis method.

In our study, we employed a two-stage study design, utilizing observational data from the National Health and Nutrition Examination Survey (NHANES) and summary statistics data from genome-wide association studies (GWAS) with a large sample of European adults. Section-cross research was performed using NHANES datasets and analysis of the risk of asthma with bone mineral density (BMD) through a risk proportion regression model. After that, a two-sample MR analysis was performed to investigate the causal effect of anti-osteoporosis drug therapy on asthma. Finally, sensitivity analysis was conducted to evaluate the stability of the results.

Our study revealed a non-linear association between femur BMD and asthma risk, with a critical inflection point at a BMD value of 1.114 g/cm². MR analysis indicated that denosumab did not exert a causal effect on asthma risk (OR = 1.008, 95% CI: 0.994-1.022, P = 0.285) but was associated with improved lung function (β = 0.085, 95% CI: 0.006-0.164, P = 0.035). Conversely, calcitriol exhibited a protective effect against both asthma (OR = 0.931, 95% CI: 0.894-0.969, P < 0.001) and lung function decline (β = 0.294, 95% CI: 0.062-0.525, P = 0.013). These findings suggest a pleiotropic role for these anti-osteoporosis drugs in respiratory health.

This study provides novel insights into the complex relationships between osteoporosis treatments, bone health, and asthma risk. The use of MR analysis enhances the reliability of our findings and highlights the potential benefits of osteoporosis treatments in reducing asthma risk and improving lung function. These results call for further research and may have implications for developing integrated treatment approaches for individuals managing osteoporosis and asthma.

This bidirectional cohort study included 452 patients with pneumonia (modeling cohort) from the Department of Respiratory and Critical Care Medicine at Jinan People's Hospital retrospectively enrolled between January 2021 and December 2023, and 300 patients with newly diagnosed pneumonia (validation cohort) prospectively recruited from January to December 2024. The least absolute shrinkage and selection operator regression (10-fold cross-validation, λ=0.023) was initially applied for dimensionality reduction. Subsequently, Firth-penalized logistic regression was used to construct the predictive model, followed by the development of a P-Sep scoring system. The system was validated using the bootstrap method (500 resamples) and an independent prospective cohort. Multivariate analysis identified four independent predictors of interest: invasive mechanical ventilation (OR=5.12, 95%CI 3.05-8.61); positive blood culture (OR=4.23, 95%CI 2.38-7.51); lactate ≥ 2 mmol/L (OR=3.15, 95%CI 1.92-5.18); and serum amyloid A ≥100 mg/L (OR=2.58, 95%CI 1.52-4.39). The investigators established that the P-Sep score (0-12 points) was an independent predictor denoting low risk (0-5 points), intermediate risk (6-8 points), and high risk (≥9 points). In the modeling cohort, the area under the curve was 0.87 (95%CI 0.83-0.91; sensitivity: 85.2%; specificity: 89.3%). In the validation cohort, the area under the curve was 0.86 (95%CI 0.82-0.89; sensitivity: 84.8%; specificity: 89.1%). In addition, based on data from both cohorts, the predictive performance of the P-Sep score was compared with that of the Quick Sequential Organ Failure Assessment and CURB-65. The results demonstrated that the P-Sep score exhibited favorable predictive efficacy in the warning of secondary sepsis in patients with pneumonia.

Objective: To investigate the clinicopathological features, diagnosis, and prognosis of Erdheim-Chester disease. Methods: The clinical and imaging data of 16 patients with Erdheim-Chester disease diagnosed in the Department of Pathology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China from August 2002 to July 2025 were retrospectively analyzed. A comprehensive evaluation was conducted on histopathology, immunophenotype, molecular characteristics, clinical treatment and follow-up outcomes, supplemented by a review of relevant literature. Results: There were 16 patients with Erdheim-Chester disease, including 7 males and 9 females. The age at onset ranged from 38 to 70 years, with an average age of 48.0 (43.5, 54.5) years. Two of the 16 cases were complicated by Langerhans cell histiocytosis. Isolated skeletal involvement was observed in 5 cases (most commonly affecting the long bones of the lower extremities), while skeletal involvement with extra-skeletal systemic manifestations (including pulmonary, pituitary, urinary system, pericardial, and aortic involvements) was identified in 11 cases. The characteristic imaging presentation consisted of bilateral symmetric, multifocal diffuse osteosclerosis predominantly involving the diaphyses and metaphyses of long bones. Bone scintigraphy revealed symmetrically increased radiotracer uptake. Magnetic resonance imaging showed hypointense signals on T1-weighted images and heterogeneously hyperintense signals on T2-weighted images, with significant enhancement observed after contrast administration. Histopathological examination revealed osteosclerosis accompanied by infiltration of abundant lipid-laden foamy histiocytes or small mononuclear histiocytes within the intertrabecular spaces. These cells exhibited uniformly eosinophilic, pale pink-stained cytoplasm and round to oval nuclei with inconspicuous nucleoli. The lesion was also characterized by variable numbers of Touton giant cells and varying degree of fibrosis. Immunohistochemical analyses demonstrated the expression of CD68, CD163, and PGM1, but no expression of S-100 or Langerin. BRAF V600E gene mutation was detected in five cases. Clinical management regimens encompassed curettage of intraosseous lesions, potentially combined with adjuvant therapies such as hormonal agents, chemotherapy, interferon-alpha, or BRAF V600E inhibitors. At the end of follow-up (ranging from 2 to 18 years), seven patients died of the disease, six survived with it, and three remained disease-free. Conclusions: Erdheim-Chester disease is a rare condition characterized predominantly by multifocal and symmetrical involvement of long bones, with the majority of patients presenting with systemic manifestations. Pathological examination combined with imaging studies aids in distinguishing it from inflammatory disorders and other histiocytic proliferative lesions. The overall prognosis is poor, especially in cases involving multiple bones and systemic involvement.

Sinonasal symptoms occur in up to 80% of patients with granulomatosis with polyangiitis (GPA), affecting quality of life. This study aimed to evaluate the association between self-perceived sinonasal symptoms (SNOT-22 questionnaire), and clinical variables, and to describe discrepancies between self-reported symptoms, ENT findings, and radiographic abnormalities.

A cross-sectional study was conducted at a tertiary center in Mexico City (November 2024-July 2025). Patients with GPA and a paranasal sinus CT scan within two years were included. Data collection comprised demographic, clinical, laboratory, and treatment variables. Assessments included disease activity (BVAS/GPA), cumulative damage (VDI), patient and physician global assessments (PhGA and PtGA), and PROMs (SNOT-22, AAV-PRO). All patients underwent ENT examination with nasal endoscopy.

Fifty patients were included, 64% women, median age 49.5 years, and disease duration 88.5 months. Most were in remission (median BVAS/GPA 0). The median VDI was 3, PtGA 10.7mm, and PhGA 1.8mm. The median SNOT-22 score was 30.5. Common ENT findings were rhinorrhea (64%), hypertrophic turbinates or hyperemic mucosa (36%), nasal crusts (34%), and septal perforation (20%). CT abnormalities included chronic sinusitis (46%) and sinus destruction (32%). Self-reported symptoms showed moderate-to-strong correlations with AAV-PRO domains and global assessments, but no associations with disease activity, damage, or treatment. Discrepancies were observed between SNOT-22 items and ENT or CT findings.

Self-reported sinonasal symptoms correlated with PROMs, whereas associations with disease activity or damage were not evident in this cohort. Discrepancies highlight the need for GPA-specific studies integrating PROMs, standardized ENT assessments, and imaging.

This study aimed to co-design a tailored model of care for older people with long COVID.

Using a human-centred design approach, semistructured interviews were conducted with patients and health professionals from a long COVID service to explore their experiences. Insights were further developed during a co-design workshop involving patients, health professionals and community members who identified as older people and who had experience with chronic illness. Key themes were identified and used to map an ideal patient journey and inform the final model of care.

Long COVID outpatient service in a tertiary hospital in Adelaide, South Australia.

Four patients and four health professionals participated in the interviews. The workshop included four patients, five health professionals and seven community members.

The co-design process identified challenges experienced by people with long COVID, including lack of validation, delayed multidisciplinary care, mental health deterioration and difficulties navigating the healthcare system. These challenges were described as having particular relevance for older adults. In response, a model of care was developed focused on comprehensive assessment, coordinated multidisciplinary care, education for self-management, mental health support and opportunities for research participation.

A comprehensive and adaptable model of care is needed to address the complex and multifaceted nature of long COVID. This human-centred design approach ensured the model was grounded in lived experience, clinically informed and aligned with patient priorities. While not unique to older adults, the findings highlight areas that may require particular attention in this population, including care coordination, validation and support for comorbidities and social vulnerabilities. While developed in a single tertiary service, these principles may inform the design of services for similar populations in other healthcare settings.