Metabolic syndrome (MetS) is a cluster of key clinical risk factors for cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), making it essential to address its components through targeted lifestyle interventions, such as exercise. This study aimed to investigate the impact of a combined training (CT) programme on adult women diagnosed with MetS. We hypothesized that participating in the programme would improve glucose and lipid metabolism, cardiovascular health, functional fitness abilities (FFA), body composition and anthropometrics in women with MetS. 105 inactive women were randomly assigned to either a CT (n=84) or control group (n=21). The CT group performed supervised combined aerobic and resistance training 3 days/week for 6 months. Blood glucose, haemoglobin A1c (HbA1c), insulin levels, homeostatic model assessment for insulin resistance (HOMA-IR), lipid profile, mean arterial pressure (MAP), resting (r-HR) and maximal heart rate (max-HR), body composition, anthropometrics and FFA were assessed before and after 3 and 6 months of training. After 3 months, the CT group showed significant improvements compared to controls in blood glucose (-36.4%), HbA1c (-22.8%), HOMA-IR (-12.5%), MAP (-16.9%), max-HR (-5.3%), r-HR (-20.4%), skeletal muscle to fat ratio (MFR) (+37.5%), and FFA (+200%). At 6 months, benefits were sustained or enhanced, particularly in glycaemic regulation, cardiovascular parameters, MFR, and FFA levels (p < 0.05). MFR was positively and linearly associated with changes in FFA, cardiovascular function, and glycometabolic markers. A 24-week CT programme significantly improved key MetS parameters in women, suggesting that it may be an effective non-pharmacological strategy to reduce CVD and T2DM risk.

Listeria innocua is widely distributed in the natural environment and food products. Human infections caused by L. innocua are extremely rare, with only approximately 5 cases reported globally over the past three decades (1990-2025).

We report a case of a 74-year-old female with a history of poorly controlled type 2 diabetes mellitus (HbA1c 9.88%) and hypertension, who was admitted with headache, low-grade fever, and progressive altered mental status over 5 days. Cerebrospinal fluid analysis revealed pleocytosis. Both blood cultures (two sets) and the cerebrospinal fluid culture were positive for L. innocua, identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Despite an epidemiological investigation, the source of infection could not be determined. Initial treatment with ceftriaxone for 3 days failed with no clinical improvement. The patient was successfully treated with ampicillin for 49 days after culture results and antibiotic susceptibility testing became available. Cerebrospinal fluid parameters were normalized, and the patient was discharged after a 49-day treatment.

This is a rare case of bacteraemia with meningitis caused by L. innocua in an elderly diabetic patient. The case emphasizes the importance of awareness of the pathogenic potential of L. innocua in immunocompromised patients, and the need to add ampicillin to empiric antibiotic regimens for meningitis in high-risk groups (age >65, diabetes mellitus, cancer, or immunosuppression).

Listeria innocua, although considered non-pathogenic in healthy individuals, can cause severe bacteraemia and meningitis in elderly patients with poorly controlled diabetes mellitus.Third-generation cephalosporins are not effective against all Listeria species; empiric treatment in patients >65 years with diabetes mellitus and meningitis must include ampicillin.Recent molecular studies have identified some atypical L. innocua strains carrying virulence genes, challenging the traditional view of the harmlessness of this species.

The Asia-Pacific Heart Rhythm Society Atrial Fibrillation (APHRS-AF) Registry is a prospective study in Asian metropolitan cities, which provides important information on the baseline characteristics, therapeutic patterns, and 1-year clinical outcomes in patients with atrial fibrillation (AF). This report describes data from Japanese patients recruited in this registry.

A total of 4666 patients with AF were enrolled. Of these, 794 patients were recruited from 28 large cardiovascular centers in Japan between 2015 and 2017. We analyzed 1-year follow-up outcome of these patients. Mean age at recruitment was 65.7 years and 69.0% were males. Major comorbidities were hypertension (37.5%), lipid disorder (29.0%), heart failure (15.9%), and diabetes mellitus (15.0%). Mean CHADS2 score, CHA2DS2-VASc score, and HAS-BLED score were 1.0, 2.0, and 1.1, respectively. At baseline, use of oral anticoagulants was 81%, including 7% prescribed a vitamin K antagonist (VKA) and 74% a direct oral anticoagulant (DOAC). Majority of the patients (N = 459, 57.8%) were planned to undergo catheter ablation. One-year follow-up was conducted in 743 patients. One-year all-cause mortality was 0.1% (n = 1) and the incidence of stroke/thromboembolic events was also 0.1% (n = 1). Major bleeding events were observed in 5 patients (0.7%), including 3 intracranial hemorrhages.

In this 1-year analysis, a high prevalence of oral anticoagulant use was recorded. A low mortality rate and a low incidence of stroke/thromboembolic events were observed in Japanese patients of the APHRS-AF Registry.

Objective:This article reports a case of a 29-year-old male with type 2 diabetes mellitus complicated by fungal sepsis, resulting in bilateral profound sudden sensorineural hearing loss （SSNHL）. A literature review was conducted to summarize the clinical features, pathogenesis, and management strategies of this condition. The patient initially presented with bilateral hearing loss, accompanied by tinnitus and aural fullness in the right ear. Audiological examination revealed bilateral profound sensorineural hearing loss, with tympanometry indicating bilateral Eustachian tube dysfunction and auditory brainstem response （ABR） testing showing severe bilateral hearing impairment. Laboratory findings included elevated white blood cell count, inflammatory markers, and fungal D-glucan levels, with blood and urine cultures positive for Candida albicans. The Widal test suggested Salmonella paratyphi C infection. The patient was diagnosed with bilateral sudden sensorineural hearing loss, type 2 diabetes mellitus, sepsis （candidemia complicated by Salmonella paratyphi A and a urinary tract infection）, and acute renal failure. Treatment involved anti-infectives, renal support, blood purification, glycemic control, and corticosteroids. While the patient's overall condition improved, his hearing did not recover. This case highlights the critical role of assessing the overall systemic condition in the management of SSNHL. Sepsis, especially fungal sepsis, may serve as a significant trigger or complication of SSNHL.

Organophosphates have been used for decades as pesticides, insecticides and herbicides, both in agricultural and industrial settings. However, their toxic effects on multiple body systems limit their safety. The clinical presentation of organophosphate toxicity varies depending on the route and duration of exposure. Although most research is focused on their cholinergic toxicity, emerging evidence points to their crucial contribution to metabolic dysfunction, including Type 2 diabetes and neuroinflammation. Beyond acetylcholinesterase inhibition, recent research highlights the potential role of organophosphates in disrupting endocannabinoid signalling, particularly by affecting endogenous ligands that modulate G protein-coupled receptors. This dysregulation may contribute to organophosphate-induced metabolic disturbances and inflammation. This review aims to explore how chronic subtoxic exposure to organophosphates contributes to metabolic syndrome and neuroinflammation through disruption of insulin and endocannabinoid signalling. It highlights the role of the endocannabinoid system in mediating these effects and evaluates its potential as a therapeutic target in organophosphate-induced toxicity.

Cancer is the leading cause of death for Latino and Latina individuals in the US. Lack of insurance is one of the leading contributing factors to low prevalence of colorectal cancer screening. In 2021, the state Medicaid coverage programs in California and Oregon were amended to expand income-based eligibility for Medicaid to adults aged 50 years or older regardless of immigration status.

To evaluate whether expanding Medicaid eligibility regardless of immigration status to adults aged 50 years or older with low income was associated with improvements in the prevalence of up-to-date colorectal cancer screening among Latino and Latina patients who received care at community health centers.

This retrospective case-control study used electronic health record data from clinics from January 2018 to December 2023 in states that expanded Medicaid eligibility regardless of immigration status by 2021 (California and Oregon) and from those that did not amend their eligibility (Indiana, Minnesota, Ohio, and Washington). The dataset included Latino and Latina patients aged 50 to 63 years who were uninsured at baseline and had visits both before (2018-2019) and after (2021-2023) the Medicaid eligibility amendment (excluding 2020 because of the COVID-19 pandemic and its association with primary care delivery).

State adoption of the 2021 Medicaid income-based eligibility amendment regardless of immigration status to adults aged 50 years or older.

The prevalence of up-to-date colorectal cancer screening was assessed using a doubly robust covariate-adjusted difference-in-differences model to estimate the average treatment effect on the treated (ATT).

There were 6503 Latino and Latina patients (mean [SD] age, 54.04 [3.32] years; 3623 females [55.7%]) from 218 clinics included in the study, of whom 5957 (91.6%) preferred the Spanish language. The prevalence (in percentage points) of colorectal cancer screening increased among uninsured English-preferring Latino and Latina patients (ATT = 19.53 [95% CI, 9.04-30.02]), English-preferring Latino men (ATT = 16.72 [95% CI, 1.27-32.16]) when considering all 3 years of the posteligibility period, and Spanish-preferring Latina women (ATT = 8.58 [95% CI, 1.48-15.67]) in the third posteligibility year in eligibility amendment states more than their counterparts in nonamendment states.

In this case-control study of Latino and Latina patients, expansion of Medicaid eligibility was associated with significantly higher prevalence of colorectal cancer screening rates among Spanish-preferring Latina women and English-preferring Latino and Latina patients. The findings suggest that state-funded coverage expansions may help increase colorectal cancer-screening prevalences in this population.

The goal of this study was to systematically analyze tumor subgroup, location, and volume in relationship to extent of resection (EOR) through a retrospective approach and examine the role for second-look surgery with a single-institution case series.

Retrospective data review of pathologically confirmed medulloblastoma patients under the age of 21 who underwent surgery at the Mayo Clinic Rochester.

There were 45 patients who met the inclusion criteria. All subgroups were represented, and those without subgroup data were classified as unknown with histopathologic confirmed grade IV medulloblastoma. The most common location of tumors was the fourth ventricle, though this varied by subgroup. The foramen of Lushka was the most invaded structure. Tumor size and volume were classified with respect to EOR and subgroup and there was no statistically signifcant difference noted. There were 5 non-WNT non-SHH subgroup patients who underwent second look surgery. EOR and the location of residual tumor varied, but GTR was achieved in all cases.

When indicated, second look surgery is safe and offers an opportunity to achieve GTR. The EOR and role of second look surgery remain controversial, and larger multicenter studies will be needed.

To analyze the difference in general clinical data, clinical manifestations, hysteroscopic manifestations, prognosis and fertility between patients with complex endometrial hyperplasia (CH) and simple endometrial hyperplasia (SH).

Collected the medical records of 616 premenopausal endometrial hyperplasia (EH) patients from January 2012 to October 2023, of which 419 SH patients and 197 CH patients were included in the study. All the patients were followed up at least 12 months, and asked about the follow-up treatment plan, review, pregnancy and reproductive outcome of the patients with reproductive needs.

Obesity (P = 0.044), having diabetes or insulin resistance (P = 0.032) and polycystic ovary syndrome (PCOS) (P < 0.001) are risk factors for the occurrence of CH, while gravidity ≥ 1 (P = 0.045) is a protective factor for the occurrence of CH. Compared with the SH group, the reversal rate in the CH group was significantly lower (69.7% vs 83.6%, P < 0.001), while the rate of persistence, progression, recurrence and canceration were higher (P < 0.001). Compared with no treatment, oral progesterone (P < 0.001) and levonorgestrel-releasing intrauterine system (LNG-IUS) treatment (P < 0.001) could improve the prognosis of patients with EH. The live birth rate of the CH group was obviously lower than that of the SH group ( 42.3% VS 61.1%, P = 0.038). CH (OR = 2.68, 95%CI 1.12-6.39, P = 0.043) is an independent risk factor affecting the live birth rate of patients with EH.

Obesity, diabetes, insulin resistance, PCOS and nulligravidity are risk factors for patients with EH, while gravidity ≥ 1 served as a protective factor, particularly against CH. The type of hyperplasia is associated with a low live birth rate. The prognosis of EH patients is usually poor, with a low reversal rate and a long reversal time. However, LNG-IUS can improve their prognosis.

In the last days of life, saying good-bye between terminally ill patients and their family members-sharing meaningful final conversations-is considered a core element of a good death. However, the role of healthcare professionals in facilitating this process remains insufficiently examined. This study aimed to assess bereaved family members' perceptions of (1) the achievement of saying good-bye and (2) the appropriateness of support timing.

This nationwide cross-sectional survey included bereaved family members of cancer patients who died in inpatient hospices or palliative care units in Japan. Families evaluated two outcomes and ten professional practices. Exploratory factor analysis identified practice domains, and multivariate logistic regression examined their associations with the outcomes.

Of 954 questionnaires distributed, 683 were returned (71.5%), and 384 were analyzed. Among respondents, 17.5% disagreed that they had been able to say good-bye, and 12.4% felt support was provided too late. Four professional practice domains were identified. "Clarifying the patient's estimated prognosis" was significantly associated with all outcomes. Furthermore, "Encourage families to say good-bye not to miss the moment to talk" was associated with family-perceived achievement of saying good-bye with marginal statistical significance (p = 0.054).

Clear and timely prognostic communication may help patients convey meaningful last words to their families.

Patient navigation programs have demonstrated intervention efficacy associated with barrier reduction and health outcome improvements in the context of cancer care. Greater characterization of barriers and barrier resolution likelihoods may support program optimization.

A 3-month longitudinal, non-comparative community-focused (i.e., lay navigator) patient navigation program was implemented at an NCI-designed cancer center between 2018 and 2021. Barriers to cancer care were reported by patients (n = 207) at pre-intervention and re-assessed at post-intervention. Descriptive analyses examined patient-level associations among pre-intervention barriers and post-intervention rates of barrier resolution. Logistic regressions were conducted at the barrier level and patient level to estimate the likelihood of barrier resolution associated with Health Access, Financial, and Psychosocial barrier domains.

Participants reported an average of 3.54 distinct barriers to cancer care. Barriers associated with Health Access and Financial domains were most frequently endorsed. Post-navigation, barriers were found to differ in their resolution rates. At the barrier domain level, resolution rates differed significantly (X²(2) = 7.826, p = 0.02), with Financial barriers significantly less likely (OR = 0.61; 95% CI = 0.41, 0.89) to be resolved. For participants who reported barriers exclusively within the Financial domain, the odds of any of their barriers being "resolved" were approximately 77% lower compared to participants who reported barriers in other domains.

In this community-focused patient navigation program, barriers in the Financial domain proved to be the most difficult to resolve. The amenability of specific barriers to resolution via patient navigation can guide program tailoring and optimization.