BackgroundExistential distress, marked by hopelessness, loss of meaning, and spiritual suffering, is prevalent among patients with advanced illness, and is associated with psychological burden and a wish to hasten death (WTHD).PurposeThis systematic review aimed to synthesize current evidence on meaning in life (MIL) in adult palliative care (PC) populations, focusing on its associations with quality of life (QOL), mental health, existential and spiritual well-being (SWB), and WTHD.MethodsMEDLINE, Web of Science, Scopus, and the Cochrane Library were searched for eligible studies (English, 2016-2024) involving adult cancer patients receiving PC. MIL was examined as a central intervention component or outcome. Risk of bias was assessed: findings were synthesized narratively. The review was registered in PROSPERO.ResultsEight studies (n = 1733 participants) were included: four cross-sectional, two randomized controlled trials, one longitudinal observational study, and one qualitative study. Several studies had small samples and substantial attrition. Risk of bias was high (n = 7), and moderate in one cross-sectional study. MIL was inversely associated with depression, anxiety, demoralization, and WTHD; and positively associated with QOL and SWB. MIL may also mediate psychological outcomes (eg, purpose, coherence, and personal values). However, heterogeneity in MIL conceptualization and measurement, combined with low methodological quality, limited comparability and certainty of findings.ConclusionMIL may be relevant to psychosocial/existential outcomes in PC. Conclusions are constrained by a small and methodologically weak evidence base. Further high-quality, longitudinal research is needed before MIL-centered interventions can be recommended for routine clinical practice.

Up to 70% of patients near the end of their lives experience dyspnea, a common and upsetting symptom of advanced disease. Fan therapy is a straightforward nonpharmacologic intervention that may provide symptom relief, although trial results have been mixed. To address this uncertainty, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), including both parallel-group and crossover designs, evaluating face-directed fan therapy in adults with advanced disease, such as advanced cancer, COPD, interstitial lung disease, or heart failure.

We searched PubMed, Embase, and Cochrane CENTRAL from inception to August 2025 for RCTs evaluating face-directed fan therapy in adults with advanced disease. Eligible comparators included sham interventions, usual care, or no intervention. Primary outcome was change in dyspnea severity scores; secondary outcomes included breathing frequency and oxygen saturation. Random-effects meta-analysis was used to calculate standardized mean differences (SMDs) with 95% CIs.

Twelve RCTs with 463 subjects were included. Fan therapy significantly reduced immediate dyspnea compared with control (SMD = -1.33, 95% CI -2.12 to -0.53, P = .001), although heterogeneity was high (I² = 91%). No statistically significant benefit was observed for cumulative short-term dyspnea (SMD = -0.10, 95% CI -0.41 to 0.21, P = .53), breathing frequency (SMD = -0.73, 95% CI -1.81 to 0.36, P = .19), or oxygen saturation (SMD = 0.44, 95% CI -0.21 to 1.08, P = .19).

In subjects with advanced disease, fan therapy is a safe, affordable, and well-tolerated intervention that quickly relieves dyspnea, especially in supportive and palliative care settings. Larger, multi-center RCTs with standardized outcomes are necessary to elucidate sustained effects, as its long-term benefits are still unclear.

Myelofibrosis (MF) is a chronic myeloproliferative neoplasm. Although Ruxolitinib, a JAK1/2 inhibitor, remains the cornerstone of MF treatment, it does not reverse disease progression, and resistance frequently emerges. These limitations have prompted investigation into combination therapies targeting pathways beyond the JAK-STAT axis. This meta-analysis aims to evaluate the efficacy and safety of Ruxolitinib-based combination therapies in patients with MF.

We conducted a systematic search of databases for studies published through August 1, 2025. Thirteen distinct Ruxolitinib-based combination regimens were included. Primary efficacy endpoints were ≥35% spleen volume reduction at 24 weeks (SVR35) and ≥50% reduction in total symptom score (TSS50). Safety endpoints focused on the incidence of grade 3/4 thrombocytopenia and anemia. Subgroup analyses were performed based on prior JAK inhibitor exposure and therapeutic mechanism of action.

A total of 19 studies comprising 1,088 patients were included in the meta-analysis. Among JAK inhibitor-naïve patients, the combination of Ruxolitinib with Selinexor demonstrated the highest efficacy (SVR35: 92%; TSS50: 78%), followed by Ruxolitinib plus BMS-986158 (SVR35: 90%). For patients with prior JAK inhibitor exposure, Ruxolitinib plus Siremadlin (SVR35: 45%) showed notable activity.

For JAK inhibitor-naïve patients, Ruxolitinib-based combination regimens demonstrated satisfactory clinical responses and the potential for meaningful disease control. For patients with prior JAK inhibitor exposure, the addition of combination therapy drugs may further enhance the efficacy. Personalized treatment selection remains essential, as therapeutic efficacy is significantly influenced by prior JAK inhibitor exposure.

Colorectal cancer (CRC) is a globally prevalent malignancy with rising incidence and mortality rates over the past decades. N6-methyladenosine (m6A) is the most abundant internal RNA modification in eukaryotes, and plays a pivotal role in post-transcriptional regulation. m6A is dynamically modulated by three core components, namely methyltransferases (writers), demethylases (erasers), and binding proteins (readers), which together govern the transcription, processing, translation, decay, and stability of mRNA. There has been accumulating evidence for the association of dysregulated m6A modification with CRC pathogenesis, metastasis, and therapeutic resistance. This review summarizes the biogenesis of m6A modification and its regulatory mechanisms, and discusses the dysregulation of m6A-related factors in CRC and the functional impacts. Most importantly, the review highlights the key roles of m6A modification in mediating CRC resistance to chemotherapy, targeted therapy, and immunotherapy. These insights may facilitate the development of novel therapeutic strategies for CRC.

Accurate evaluation of coronary artery disease is critical for guiding treatment decisions, particularly in complex coronary lesions. Fractional flow reserve (FFR) remains the gold standard for assessing lesion-specific ischemia but is invasive and requires pharmacological hyperemia. Noninvasive alternatives, such as quantitative flow ratio (QFR) from coronary angiography and ultrasonic flow ratio (UFR) from intravascular ultrasound (IVUS), offer promising diagnostic approaches.

This study aimed to compare the diagnostic performance of UFR and QFR against FFR in assessing complex coronary lesions.

This retrospective multicenter study included 217 patients (220 vessels) who underwent IVUS and FFR. UFR was derived from IVUS imaging, and QFR was calculated using coronary angiography data. Correlation, agreement, and diagnostic metrics (sensitivity, specificity) were analyzed, with receiver operating characteristic curves assessing accuracy.

UFR demonstrated stronger correlation with FFR (r = 0.79; 95% CI: 0.74-0.84; P < 0.001) compared with QFR (r = 0.68; 95% CI: 0.60-0.74; P < 0.001). UFR also showed better diagnostic performance, with an area under the receiver operating characteristic curve of 0.91 (95% CI: 0.86-0.94) compared with QFR's 0.86 (95% CI: 0.81-0.90). In complex lesions (diffuse, bifurcation, calcified), UFR consistently outperformed QFR, particularly in bifurcation and lesions heavily calcified, where QFR accuracy dropped significantly (72.5% vs 86.8%, P = 0.001).

In this retrospective hypothesis-generating study, UFR showed numerically higher diagnostic accuracy than QFR in complex coronary lesions. These findings suggest UFR may have potential as a complementary tool for functional assessment, but definitive conclusions about superiority require validation in larger prospective studies. (Comparison of UFR With QFR in Stable Coronary Artery Disease; NCT06322355).

Second-generation aldosterone-synthase inhibitors (ASIs) may offer a novel treatment for hypertension.

The objective of the study was to assess the efficacy and safety of ASIs in this clinical setting.

We searched major databases for randomized controlled trials assessing ASIs (baxdrostat, lorundrostat, and vicadrostat) in patients with hypertension. For efficacy outcomes, mean differences (MD) with 95% credible intervals (CrIs) were estimated using a Bayesian random-effects model. For adverse events, OR with 95% CrI were estimated using a Bayesian binomial-normal hierarchical model. The protocol was registered in Prospective Register of Systematic Reviews (CRD420251132306).

Eight randomized controlled trials were included (n = 3,371; 2,430 [72%] randomized to ASI). ASI reduced systolic blood pressure (SBP) (MD: -6.7 mm Hg; CrI: -8.78, -4.59; τ² 3.24), diastolic blood pressure (MD: -2.09 mm Hg; CrI: -3.68, 0.44; τ² 1.44), and hypertensive urgency (OR: 0.36; CrI: 0.13, 0.90; τ² 0.07) compared with placebo. There was no difference in all-cause mortality (OR: 0.45; CrI: 0.06, 3.20; τ² 0.10) or adrenal insufficiency (OR: 0.5; CrI: 0.1, 3.0; τ² 0.3) between groups. However, ASIs increased the odds of hyperkalemia (OR: 7.1; CrI: 3.56, 15.2; τ² 0.23), hyponatremia (OR: 2.6; CrI: 1.25, 5.98; τ² 0.1), and hypotension (OR: 3.28; CrI: 1.43, 8.16; τ² 0.1). In subgroup analysis, the probability of achieving a clinically meaningful reduction in SBP (MD <5 mm Hg) was 87.5% with baxdrostat and 94.3% with lorundrostat.

Second-generation ASIs had a high likelihood of a clinically significant reduction in SBP compared with placebo. However, hyperkalemia, hyponatremia, and hypotension were more frequent with ASIs.

Periodontitis, a chronic inflammatory disease, is linked to systemic conditions such as cardiovascular and kidney disease. Serum α-Klotho, an anti-aging protein with anti-inflammatory properties, has been associated with systemic diseases, but its role in periodontitis is unclear. This study evaluated the relationship between serum α-Klotho levels and periodontitis severity while accounting for confounders.

In this cross-sectional study, data from 961 participants in the National Health and Nutrition Examination Survey (NHANES) database were analyzed. Periodontitis was classified into stages (I-IV) and grades (A-C) using the ACES (Application of the 2018 periodontal status Classification to Epidemiological Survey data) guidelines. Serum α-Klotho levels were measured via enzyme-linked immunosorbent assay (ELISA). Ordinal logistic regression assessed associations between α-Klotho levels and periodontitis, adjusting for confounders such as age, smoking, comorbidities, and oral hygiene. The number of lost teeth was analyzed as a secondary outcome.

In both adjusted and unadjusted regression models, no significant association was found between α-Klotho levels and periodontitis. Particularly, adjusted models revealed no significant association between α-Klotho levels and periodontitis stage (OR = 1.0001, p = 0.547, 95% CI: 0.9997-1.0006) or grade (OR = 0.9996, p = 0.144, 95% CI: 0.9991-1.0001). Age, smoking, and comorbidities significantly predicted severity. Despite a weak negative correlation between α-Klotho and tooth loss (r = -0.07, p = 0.023), this association was no longer significant after adjustment.

No significant association was found between serum α-Klotho levels and periodontitis severity. Age, smoking, and comorbidities were key predictors, highlighting the multifactorial nature of periodontitis. Further longitudinal and mechanistic studies are needed to clarify whether α-Klotho has a value as a biomarker of periodontal inflammation or disease progression.

Abnormal sleep duration and poor sleep quality have been associated with increased risks of cardiovascular disease (CVD) incidence and mortality. However, little is known about how these sleep problems affect total life expectancy (LE) and LE free of CVD and its subtypes.

We included 483,384 adults from the China Kadoorie Biobank (CKB) who were free of heart disease, stroke, cancer, major depressive disorder, and generalized anxiety disorder at baseline. Sleep duration was categorized as < 6 h/d, 6-9 h/d, and >9 h/d. Three sleep disturbance symptoms were considered: self-reported difficulties initiating and maintaining sleep, early morning awakening, and daytime dysfunction. Participants with at least one of the three symptoms were considered to have a sleep disturbance. We estimated sex-specific LE with and without CVD at age 40 by using multistate Markov models, with separate models specified for total CVD, ischemic heart disease (IHD), ischemic stroke (IS), and hemorrhagic stroke (HS) as the disease state.

During a median follow-up of 12.1 years, we documented 135,429 incident CVD events, including 46,479 IHD events, 47,562 IS events, and 10,844 HS events. Overall, there were 48,372 deaths. Compared to other sleep problems, longer sleep duration (>9 h/d) had the greatest impact on total LE and LE free of CVD and its subtypes, with the impact on total LE greater than that of disease-free LE. In men, the reduction in total LE and LE without CVD (95% confidence intervals) at age 40 associated with longer sleep duration was 2.11 (-2.50, -1.71) and 1.29 (-1.68, -0.98) years, respectively. The corresponding values for women were 1.37 (-1.81, -0.98) and 0.43 (-0.75, -0.07) years. In contrast, sleep disturbance had a stronger impact on disease-free LE than on total LE, thereby reducing the proportion of life spent in a healthy state. Compared with participants without sleep disturbance, the total LE at age 40 was 0.46 (-0.77, -0.15) and 0.22 (-0.47, 0.06) years lower in men and women with sleep disturbance, respectively, and the LE without CVD was 0.99 (-1.23, -0.73) and 1.05 (-1.27, -0.85) years lower.

In this Chinese population, abnormal sleep duration, especially long sleep, and sleep disturbance were linked with lower total LE and LE free of CVD. This study confirmed the importance of good sleep habits in health management for both those without and with CVD.

Psychiatric disorders are often accompanied by complex comorbidities. Even non-psychiatric medical professionals are increasingly encountering patients with mental disorders during routine clinical practice. This study assessed post-training mental health knowledge and additional training needs across grassroots medical workers who had recently undergone systematic training, aiming to provide empirical evidence for building the capacity of mental health professionals.

This study surveyed 503 medical staff from various levels and types of medical institutions in Tongxiang city, China, who had undergone systematic mental health training. Data regarding baseline characteristics and mental health-related knowledge were obtained 1-2 days after training completion using two questionnaire types: the "Questionnaire on Medical Staff's Awareness of Mental Health Issues" and the "Questionnaire on Training Needs of Medical Staff". The Kruskal-Wallis (K-W) test was used to compare the demand for psychiatric services and total psychiatric knowledge scores among primary care medical staff with different job positions, specialties, professional titles, and years of service.

The mean mental health knowledge score among 503 grassroots medical workers was 53.22 ± 17.44 out of the total 70 points. Regarding mental health service training content, over 80% of the respondents reported knowledge and skills items as "urgently needed" or "needed", with some items exceeding 90%. Short-term training workshops were the preferred delivery approach, with centralized on-site lectures or distance education as the favored formats. High demand was reported for theoretical knowledge sessions, simulated case-based discussions, simulation exercises, and internship practice; the preferred training duration was half a working day per session. The leading motivations for participating in training were job requirements, personal professional development needs, and skill enhancement, whereas the main barriers to participating in training were workload or scheduling conflicts. Multiple factors were found to affect training effectiveness, including training time, format, and content. Significant differences were observed in the proportion of mental health service needs regarding primary job positions, specialties, professional titles, and years of service (p < 0.05). Total mental health knowledge scores also varied by primary job position, years of service, and prior participation in mental health work (p < 0.05).

Grassroots medical workers demonstrated a foundational level of mental health knowledge following recent systematic training, with significant inter-individual variation. Demand for mental health service training was generally high, with job requirements and personal capacity enhancement as the primary drivers, while time constraints and insufficient course practicality of the modules were the main barriers. It is recommended to develop and implement corresponding strategies to address these challenges and enhance grassroots medical workers' mastery of mental health knowledge.

The production of science is characterized by socio-political and technological forces that influence what knowledge is produced. In this context, empty reviews have received little attention, with debate ranging over the pros and cons of their publication. However, their dissemination may improve the ability to recognize and prioritize research gaps. The main aim of the study was to map empty reviews published in nursing science.

A scoping review in accordance with Arksey and O'Malley, Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The review protocol was registered in the Open Science Framework database in April 2025. Four databases and grey literature were searched; there were eligible scoping or systematic reviews defined as "empty" in the field of nursing. A modified framework of Patterns, Advances, Gaps, Evidence for practice, and Research recommendations was used to summarize the extracted data.

Fifteen empty reviews were identified. In terms of Patterns, the empty reviews were mainly published in high-income countries over the last 10 years and related to clinical practise and outcomes, education and training, organizational and human resources, and approaches to maternity care, mental health, and nursing education. In general, reporting guidelines were used, while funding was not documented. In terms of Recommendations, more primary studies, the development of tools and the strategic use of empty reviews to inform the funding and research agenda were suggested.

Empty reviews in nursing may indicate neglected or emerging areas that can help orient research agendas to ensure equity-oriented priorities and reduce the marginalization of under-investigated topics. Recognizing empty reviews as legitimate scholarly outputs supports transparent mapping of knowledge gaps, helping funders, institutions, and research programs direct resources to under-investigated areas. Dedicated registries that publicly report empty reviews, establish minimum reporting standards, and require explicit keywords in titles and abstracts would improve transparency and accessibility, and stimulate targeted primary research that can turn "empty" areas into active inquiry. From this perspective, empty reviews may attract research investment rather than be seen as methodological failures.