The influence of diet and sleep and their combined effect on daily glucose control in individuals with gestational diabetes mellitus (GDM) remains unclear. This study investigated real-time associations between eating and sleep patterns with overnight and morning glucose using ecological momentary assessment.

Thirty-four untreated patients with GDM wore a continuous glucose monitoring at 28 ± 2 weeks of gestation for 6 days; data from the first day were excluded. Five-day average and daily measures of overnight mean glucose, variability (SD), glycemic area under the curve (AUC), and glucose upon waking were calculated. Predictors included daily food diaries, sleep questionnaires, and sensor day. Multivariate stepwise regressions identified key predictors, and ANOVAs assessed temporal differences in glucose outcomes.

Participants were 34 ± 6 years old with a pre-pregnancy BMI of 28 ± 6 kg/m². Greater day-to-day variability in snack intake was associated with increased 5-day average overnight mean glucose and AUC (p ≤ 0.03). Later dinner was associated with greater overnight glucose variability (p ≤ 0.01). Sleep parameters were not associated with glucose outcomes. Glucose measures differed significantly across days (p ≤ 0.03).

Daily variations in overnight and morning glucose should be considered. Irregular snacking and delayed meal timing could disrupt circadian glucose regulation; promoting consistent and earlier evening meals could support improved nocturnal glycemic control in patients with GDM.

Studies on surveillance of Intraductal Papillary Mucinous Neoplasms (IPMNs) are mainly retrospective with inherited bias.

To identify factors associated with the development of relevant changes in low risk IPMN under surveillance.

This study analysed IPMN patients enrolled between 2015-2017 in the prospective observational multicentric registry PANcreatic CYsts (PANCY), focusing on brunch duct (BD). Extension of surveillance until December 31st, 2021 was proposed to the recruited patients. Relevant changes were defined as: worrisome features/high risk stigmata/pancreatic cancer, pancreatectomy, death due to IPMN/pancreatic cancer.

At diagnosis, from 647 IPMNs, 547 (60%) were BD, 87 (9%) mixed type, and 13 (1%) main duct. 57 (8.8%) underwent immediate surgery and 590 (91.2%) active surveillance. Of them 34 (5.7%) underwent surgery with 2/3 malignancy. Malignancy rates for BD- and mixed-IPMNs under surveillance were 2.7% and 12.5%. Smoking (OR 2.2) and cyst size >15 mm at diagnosis (OR 7.1) were independent risk factors for relevant changes at multivariate analysis. The combination of cyst size ≤15 mm & age >65 was a protective factor at univariate analysis (OR 0.1), mainly in no smokers (OR 0.2, p < 0.01).

BD-IPMN progression risk is low for lesions <15 mm in non-smokers, >65 years patients. Surgery and follow-up criteria are still imperfect, leading to inappropriate utilization of resources.

Laryngeal cancer remains a significant public health concern, with pronounced sex- and age-related disparities in mortality. In Spain, recent national analyses are scarce. This study provides a comprehensive assessment of laryngeal cancer mortality trends from 1999 to 2023 and disentangles the contributions of age, period, and cohort effects.

We conducted a population-based time-series analysis of laryngeal cancer mortality in Spain over a 25-year period (1999-2023). Age-standardised mortality rates (ASMRs) were calculated, and Joinpoint Regression identified temporal trends. Age-Period-Cohort (A-P-C) modelling (for ages 35-84) decomposes changes into effects attributable to age, period (reflecting clinical management), and birth cohort (reflecting generational risk factor exposure).

A total of 36,598 deaths were recorded, 94% among men. Male ASMRs fell sharply from 12.10 to 4.76 per 100,000, with an annual percentage change (APC) of -4.0%. Female ASMRs remained largely stable. APC modelling for men showed a strong negative net drift (-6.27%), driven by a pronounced negative cohort effect, with rate ratios declining from the 1919 to 1984 birth cohort. In women, APC analysis revealed an age-dependent reversal: mortality declined in younger women but increased significantly in those aged 55 and over (e.g., APC +4.13% at ages 60-64).

Male laryngeal cancer mortality in Spain has declined markedly, primarily due to decreasing smoking-related cohort risks. The rising mortality in older women reflects the delayed impact of past smoking uptake. Continued, gender-sensitive tobacco control strategies are essential.

Those living beyond a cancer diagnosis experience unmet supportive care needs due to fragmented post-treatment pathways and limited integration of digital health tools. The Linking You to Support and Advice (LYSA) trial assessed the feasibility of a complex-intervention which incorporated a nurse- and dietitian-led multidisciplinary clinic and a digital platform for capturing and responding to electronic Patient-Reported Outcome (ePRO) data for women with early-stage breast and gynecologic cancer less than 12 months post-primary curative therapy.

The LYSA trial was an unblinded, randomized, controlled, feasibility trial co-designed with public and patient involvement, conducted across two cancer centers in Ireland. Participants were randomized to the experimental arm, receiving bi-monthly ePRO assessments and trigger-initiated responses to ePROs for 12 months; or the active comparator arm, receiving usual care. Primary feasibility outcomes included participant enrolment, ePRO survey completion, and healthcare professional engagement triggered by ePRO assessments. Secondary outcomes focused on symptom scores, health-related quality of life (HRQOL), and patient satisfaction. A process evaluation explored factors affecting implementation.

The trial met its three predefined feasibility outcomes: 200 participants were enrolled (84% breast, 16% gynecologic), >85% of baseline and endpoint surveys were completed, and >70% of participants in the experimental arm engaged in nurse and dietetic consultations following ePRO symptom triggers. The experimental arm demonstrated significant improvements in fatigue (p = 0.018), anxiety (p = 0.012), depression (p < 0.001) and HRQOL (p = 0.031) scores. The process evaluation indicated high levels of satisfaction with the intervention, with positive feedback on the multidisciplinary approach and responsive symptom management.

LYSA demonstrates the feasibility and acceptability of an ePRO-led survivorship approach, with potential HRQOL and symptom benefits, warranting a powered efficacy trial.

Hemangioblastomas (HB) are rare CNS neoplasms. Their main differential diagnosis includes meningioma, glioma, and metastatic clear cell renal carcinoma. However, the diagnostic immunoprofile of HBs is only imprecisely defined. We analyzed a multicentric cohort of HBs using tissue microarrays and whole sections to determine immunoreactivities of a range of selected meningothelial, glial and other markers used in diagnostic pathology. The clinical and pathological features were correlated. The cohort included 112 tumors from 104 patients (46.1% males, 53.9% females) with a mean age 50.1 years. The tumors occurred in cerebellum (72%), spine (18.9%) and medulla oblongata (5.4%). No HB expressed SSTR2A, MUC4 or STAT6. Expression of glial markers S100, GFAP, Olig2, and SOX10 was observed in 93.3%, 80.6%, 5.1%, and 8.1% of cases, respectively. Inhibin-α was positive in 84.5% and carbonic anhydrase IX (CAIX) in 100% of the cases. Negative PAX8 immunostaining was observed using specific C-terminus antibody whereas N-terminus anti-PAX8 staining yielded 63.2% positivity. T-brachyury, SATB2, and GPNMB were observed in 3.8%, 2.1%, and 20.8%, respectively. No expression of SOX17, CDX2, Sall4, GATA3, or INSM1 was observed. Thus, HBs show a consistent PAX8-negative/CAIX-positive immunoprofile while they lack meningothelial markers and occasionally may express SOX10 and Olig2.

Duodenal neuroendocrine tumors (DNETs) are rare neoplasms with malignant potential, and the optimal strategy between endoscopic resection (ER) and surgical resection (SR) remains debated. This study evaluated the clinical outcomes of ER and SR in patients with DNETs at a single tertiary center.

We retrospectively reviewed patients diagnosed with DNETs at Seoul St. Mary's Hospital between 2009 and 2025. The clinical features, treatment modalities, pathology, complications, and long-term outcomes were analyzed. Median follow up was 4.76 years (0.03-13.70) Results: Sixty-five patients were included (mean age, 62.9 years; 31 men). Fifty patients underwent ER (26 EMR, 9 EMR-L, 11 EMR-P, 1 ESD, 2 ampullectomy, and 1 removal with hot biopsy), while 15 underwent SR (10 wedge resections and 5 pancreatoduodenectomy/Whipple). The en bloc resection rate for ER was 93.9% (46/49), with a histopathologically curative resection rate of 69.4%. Fourteen ER patients had positive margins; one underwent additional surgery with a confirmed residual tumor, but the others showed no recurrence during a median follow-up of 6.8 years. Perforation occurred in three ER cases (6%), all of whom were successfully treated. Among the wedge resections, R1 resection occurred in 3/10 cases. One patient developed lymph node recurrence 12 years after wedge resection, whereas the others remained disease-free. Overall, recurrence was rare in both groups.

ER and local surgical resection are effective, minimally invasive treatments for small DNETs, with high resection rates and acceptable safety. However, positive margins and lymphovascular invasion are risk factors for remnant tumors or late recurrence, underscoring the importance of long-term surveillance in high-risk patients.

To determine the international availability of practice guidelines, training in and method used for the reprocessing of endocavity (EC) ultrasound transducers post-EC scan.

A series of six questions were developed via Survey Monkey relating to the use of EC transducers. Questions included country of practice and type of EC ultrasounds performed, use of transducer covers for EC ultrasound examinations, availability of infection prevention guidelines, availability of training in the reprocessing of ultrasound EC transducers, and type of transducer reprocessing used. The anonymous survey was launched in May 2024 and was open for 6 mo via the WFUMB website.

There were 1436 respondents from 105 countries, with 37% of respondents having access to guidelines for infection prevention and control (IPC) and 46% receiving training in reprocessing EC transducers post-use. High-level disinfection was the preferred reprocessing method for 40% of respondents.

This survey was an important adjunct to the previous WFUMB IPC survey conducted in 2016, which revealed significant differences in IPC practices throughout the world. The results of this new survey reflect that, internationally, many ultrasound users still do not have access to infection prevention guidelines, nor training in the use of their chosen transducer cleaning/disinfection methods. Inadequate reprocessing of EC ultrasound transducers increases the possibility of transmission of bacteria and viruses, such as human papillomavirus and HIV, and puts patient safety at risk.

Sudden and unexpected death (SUD) is the abrupt death of a seemingly healthy individual, which requires medico-legal investigation under the South African Inquest Act (1959) and the National Health Act (2003). Studies conducted in South Africa from 2001 to 2016 report a SUD prevalence between 4% and 14%; however, research is limited. This study aimed to review SUD in adults at Tygerberg Forensic Pathology Services Mortuary (TFPSM) to determine the prevalence, leading causes, and demographic and temporal patterns.

This was a retrospective descriptive study employing non-probability convenience sampling. The study included all cases of SUD in adults admitted for medico-legal death investigation to the TFPSM in Cape Town between 2021 and 2022. This study determined the prevalence of SUD in adults, identified the leading causes of death, and profiled the demographics and temporal characteristics.

Cases of SUD in adults comprised 9.3% of all deaths admitted to TFPSM, with cardiovascular disease (34%) being the leading cause, followed by respiratory-related causes (26.6%) and HIV/TB (8.5%). Males accounted for 70.9% of cases, and deaths were most common in the 51-60 age group. Khayelitsha and Bellville were identified as locations with the highest number of deaths. Alcohol and toxicology results showed an association with cardiovascular disease.

The study highlights the high number of cardiovascular disease deaths, along with respiratory and infectious diseases. Improving healthcare access, implementing screening programs, and establishing medical histories are key to reducing SUD cases in the future.

Cardiovascular diseases (CVD) remain the leading global cause of mortality. Approximately 50% of the CVD burden is attributable to five modifiable risk factors, including dyslipidemia. Effective management of low-density lipoprotein cholesterol (LDL-C) through accurate cardiovascular (CV) risk stratification is fundamental to prevention. However, in daily practice, significant variability exists in how clinicians assess CV risk and determine appropriate LDL-C targets, potentially leading to suboptimal patient care.

This cross-sectional survey aimed to evaluate the consistency and alignment with current guidelines of CV risk assessment and LDL-C target selection among clinicians working at Avicenne University Hospital, Assistance publique-Hôpitaux de Paris (Bobigny, France), when presented with diverse and challenging clinical scenarios, that formal risk calculation tools cannot assess.

Between September and November 2025, a questionnaire-based cross-sectional survey was conducted at Avicenne University Hospital. Thirty doctors and residents from five departments (internal medicine, vascular-thoracic surgery, cardiology, geriatrics, endocrinology) participated. They were presented with six clinical vignettes designed to probe CV risk assessment in complex contexts such as heart failure, atherosclerotic cardiovascular disease (ASCVD), recurrent events, and chronic kidney disease. Responses were categorized into CV risk groups (low to extreme) based on the proposed LDL-C target, in accordance with the 2025 ESC/EAS dyslipidemia guidelines. Responses without a specific target were classified as "No category."

Analysis revealed significant heterogeneity in responses. The "no category" response was the most frequent overall (29.4% of all answers), indicating substantial clinician uncertainty. Key discrepancies from guidelines included: high uncertainty (43.3% "no category") in assigning risk after heart failure; underestimation of risk in confirmed ASCVD (most answers were moderate or high risk, not very high); reluctance to use the Extreme-risk category (<40mg/dL) for recurrent events; and insufficient recognition of moderate CKD as a High-risk factor. Vascular surgeons most frequently gave "no category" answers (54.8% of their responses) however, there was no statistically significant difference in the proportion of "no category" responses across departments (P=0.093).

This survey identified a notable gap between guideline recommendations and clinical practice in CV risk assessment at the hospital level. Clinicians demonstrated a tendency to underestimate risk in key areas like ASCVD and CKD, and exhibited significant uncertainty in complex scenarios such as heart failure and recurrent events. These findings underscore the need for targeted educational initiatives and strategies to promote more consistent, guideline-concordant CV risk stratification to optimize preventive therapy.

α-linolenic acid is a naturally occurring ω-3 polyunsaturated fatty acid that is essential for human health but cannot be synthesized by the body and must be obtained through the diet. Studies have demonstrated that α-linolenic acid offers a variety of health benefits, particularly showing potential in the prevention and adjunctive treatment of metabolic syndrome. In terms of lipid-lowering effects, α-linolenic acid suppresses the expression of genes involved in cholesterol and triglyceride synthesis, while promoting the expression of genes related to fatty acid oxidation. In cardiovascular protection, α-linolenic acid prevents or ameliorates atherosclerosis by improving endothelial function, inhibiting thrombosis, and reducing oxidative stress and inflammation. Although some clinical studies show that α-linolenic acid can lower lipids, regulate blood glucose, and provide cardiovascular protection, other studies suggest its effects may not be entirely consistent. Therefore, while α-linolenic acid has potential value in regulating lipid metabolism, inflammatory responses, and cellular signaling pathways, especially in metabolic diseases and cardiovascular protection, its clinical effects still exhibit certain heterogeneity.