Health-related Quality of Life (HRQoL) is an excellent measure of life expectancy, particularly for those with a specific condition. Evaluation of QoL facilitates clinical decision-making, enhances communication with the patient, and aids in predicting therapy response. QoL can forecast a person's ability to control their illness and preserve their long-term health and well-being. This study aimed to determine HRQoL and its socio-demographic and clinical determinants among Diabetes Mellitus (DM) patients attending endocrinology clinics at a tertiary care hospital in Sri Lanka.

This study was conducted from March to April 2024. QoL was assessed using the WHOQOL- BREF questionnaire. Socio-demographic factors, clinical characteristics, and treatment options of DM patients were assessed in relation to the QoL. T-test and ANOVA used to determine the differences in the QOL domain. The Pearson correlation coefficient was used to determine the linear relationship between two QOL domains. Multiple Linear Regression was applied to examine the relationship between QOL domains and socio-demographic factors, clinical characteristics, and treatment options.

A total of 170 patients with DM (Female - 62%, age range - 18-87 years, mean age 60.9 (± 11.4) years) participated. The environment domain showed the highest mean of QOL (57.89 ± 15.02), followed by psychological health (57.44 ± 18.72), physical health (53.38 ± 20.67), and social relationship domain (52.12 ± 18.71). Age, education level, comorbidities, and complications were significantly associated with QOL in physical health, while age, education level, smoking, comorbidities, and complications were significantly associated with QOL in psychological health. Additionally, education level was significantly associated with social relationships and residential area, and education level and comorbidities were significantly associated with the environment domain.

Findings emphasize the importance of addressing both medical and socio-environmental aspects in diabetes management to improve overall well-being. Understanding these variations can guide interventions aimed at enhancing the physical, psychological, social, and environmental domains of individuals living with DM.

Not applicable.

Physical activity adherence is critical for effective diabetes management, yet non-adherence remains common in community settings. This study sought to construct and internally evaluate an interpretable machine learning model for identifying poor physical activity adherence among patients with Type 2 diabetes mellitus (T2DM) in a community-based setting.

This single-center cross-sectional study included 207 patients with T2DM receiving community-based care at the Shiqiao Community Health Service Center, China, between January and September 2025. Candidate predictors were selected using Elastic Net regularization followed by multivariable logistic regression. Multiple machine learning algorithms were developed and compared using a randomly allocated training dataset (70%, n = 145) and an internal validation dataset (30%, n = 62). Model discrimination and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA), respectively. Shapley Additive exPlanations (SHAP) was used to interpret individual predictor contributions to model outputs.

Among the 207 participants, 113 (54.6%) demonstrated high physical activity adherence. The final model incorporated five key predictors: Summary of Diabetes Self-Care Activities (SDSCA) score, estimated glomerular filtration rate (eGFR_CKD-EPI_2009), family history of diabetes, International Physical Activity Questionnaire (IPAQ) score, and albumin (ALB). The SVM model achieved the highest discrimination ability among the tested algorithms and was subsequently selected as the final model (AUC = 0.787, 95% CI: 0.671-0.903). SHAP analysis provided transparent visualization of the relative contribution of each predictor to model outputs.

This study provides an explainable machine learning approach for identifying key variables associated with physical activity adherence among individuals with T2DM in community diabetes management. Further validation in independent populations is needed before the model can be considered for risk assessment and personalized behavioral intervention planning in community diabetes care.

Seminal vesicle integrity supports semen composition and sperm function, whereas type 2 diabetes mellitus can induce atrophy and fibrosis in this organ. Using a high-fat diet/streptozotocin-induced model in male mice and primary mouse seminal vesicle epithelial cells exposed to high glucose, we assessed fibrotic remodeling, lipid metabolism, PPARα/PGC-1α signaling, endoplasmic reticulum stress, and apoptosis through histological, biochemical, and lipidomic analyses. Diabetic seminal vesicles showed atrophy and fibrosis together with altered lipid profiles, free fatty acid accumulation, reduced PPARα/PGC-1α expression, and increased IRE1-associated stress and apoptosis. Levocarnitine attenuated these changes in vivo and reduced profibrotic responses in vitro. PPARα overexpression reproduced several protective effects, whereas IRE1 inhibition reduced stress-associated injury without restoring PPARα/PGC-1α signaling. These findings identify metabolic dysregulation and endoplasmic reticulum stress as associated features of diabetic seminal vesicle remodeling and support further evaluation of levocarnitine for diabetes-associated reproductive tract injury.

This pilot study evaluated the operational feasibility, workflow integration, and care coordination of an on-site telemedicine clearance pathway (the Medically Integrated Oral Health Program) for medically complex dental patients presenting with hypertension and/or diabetes mellitus.

A non-randomized, two-arm interventional (quasi-experimental) pilot study was conducted with a pragmatic sample of 20 adult dental patients (11 Telemedicine group, 9 Conventional referral group). Allocation was participant selected. Evaluated feasibility metrics included protocol adherence, missed appointments, and data completeness across a 12-month period. Descriptive clinical and laboratory parameters, including Oral Health Risk Assessment Value Index (OHRAVI) scores, body mass index (BMI), blood pressure (BP), and HbA1c, were tracked longitudinally at approximately three-month intervals.

The in-office telemedicine protocol was successfully executed at baseline. However, substantial patient attrition was observed over time, with retention dropping to 54.5% in the Telemedicine group and 44.4% in the Conventional group by the first follow-up. Descriptive observations indicated stable median OHRAVI scores and relative stability in median BMI within the telemedicine cohort, whereas the conventional cohort exhibited slight increases in weight metrics. Blood pressure data demonstrated high variability across both groups. Follow-up HbA1c data were heavily limited by missing data and sparse reporting, which precluded statistical or causal interpretation. Total appointment non-adherence was comparable between groups.

The on-site telemedicine clearance pathway was operationally feasible at initial presentation. However, severe attrition and incomplete longitudinal data prevented reliable evaluation of comparative clinical effectiveness or sustained care coordination. These findings primarily identify implementation and data-collection challenges that should inform a future adequately powered study.

Human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) is increasing in Sweden with implications for both the incidence and management of HPV+ head and neck cancer of unknown primary (HNCUP). In OPSCC, the combined presence of HPV DNA (HPV DNA+) and p16^INK4a (p16+) overexpression has been shown to provide superior prognostic information compared with either marker alone. In this study, we therefore aimed to assess whether the prognostic impact of HPV DNA and p16 concordance/discordance in HNCUP mirrors that observed in OPSCC, within a high HPV-prevalent and low smoking population.

In this retrospective population-based cohort of 141 patients with HNCUP diagnosed at Karolinska University Hospital between 2000 and 2024, 128 had complete HPV DNA and p16 data and were included in analyses.

Consistent with previous findings in OPSCC, combined assessment of HPV DNA and p16 provided superior prognostic stratification compared with either marker alone. Nevertheless, HPV DNA+ as a single marker showed a prognostic impact almost comparable to that of combined HPV DNA+/p16+ status, while p16+ alone, although associated with some prognostic value, was less informative. HPV DNA-negative disease was associated with poor prognosis irrespective of p16 status.

The data suggest that combined assessment of HPV DNA and p16 is superior in HPV-associated HNCUP. However, in settings where a single test must be chosen, and especially in areas with high prevalence of HPV + OPSCC, HPV DNA is preferable to p16. Such a strategy could simplify diagnostic workflows while still enabling effective risk stratification and supporting tailored patient management.

Apocrine hidrocystoma is an uncommon benign cystic neoplasm of apocrine gland origin that most frequently occurs in the head and neck region, particularly around the eyelids. Because its clinical appearance is often nonspecific, it may be difficult to distinguish from other benign eyelid cystic lesions before excision. We report the case of a 33-year-old man who presented with a painless, skin-colored subcutaneous mass on the medial aspect of the left lower eyelid. The patient reported no seasonal change in lesion size, and no conjunctival abnormality was observed. The lesion was clinically suspected to be a benign cystic tumor and was excised under local anesthesia. Histopathological examination revealed a cyst lined by one to two layers of cuboidal to columnar epithelial cells with papillary infoldings and characteristic apical decapitation secretion. An outer myoepithelial cell layer was also identified. There was no cytological atypia or mitotic activity, and the lesion was diagnosed as an apocrine hidrocystoma. The postoperative course was uneventful, with no evidence of recurrence at the one-month follow-up. This case illustrates the clinicopathological features of apocrine hidrocystoma and emphasizes the role of histopathological examination in the definitive diagnosis of clinically nonspecific eyelid cystic lesions.

Introduction Tumour biology remains the key determinant of prognosis in appendiceal neoplasms. In this study, we analyse the clinicopathological characteristics and outcomes of patients with appendiceal neoplasms treated at our institution, with particular emphasis on overall survival among different tumour types. Material and methods Patients with histologically confirmed appendiceal neoplasms treated between January 2021 and December 2025 were included. Clinical, pathological, treatment, and follow-up data were retrieved from medical records and institutional databases. Variables analysed included age, gender, histological subtype, disease stage, treatment modality, recurrence status, and survival outcomes. The primary endpoint was overall survival (OS) among treated appendiceal neoplasms with different tumor subtypes. A subgroup analysis was also performed to study the difference in treatment outcomes in patients with low-grade appendiceal mucinous neoplasm (LAMN) and their overall survival. Results Among the 55 patients in our study, the following observations were made. The median age of patients at presentation was 54 years [95% confidence interval (CI): 46-61], with a slight female predominance, 30(54.5%). The majority of patients, 37 (67.3%), had LAMN, followed by eight (14.5%) with high-grade appendiceal mucinous neoplasm (HAMN), eight (14.5%) with adenocarcinoma, and two (3.6%) with signet ring adenocarcinoma. Many patients presented with advanced disease, with stage IV accounting for 53.7% of cases (22 out of 41 patients had stage 4 disease). Overall survival differed significantly by histopathology. Patients with LAMN histology had better survival compared with other histologic subtypes (log-rank p = 0.026). In Cox proportional hazards analysis, LAMN was also associated with a lower risk of death [hazard ratio (HR) = 0.24, p = 0.040]. Among patients with LAMN histology, overall survival did not differ significantly between those undergoing appendectomy alone and those undergoing other surgical procedures (log-rank p = 0.48). Both groups demonstrated high survival rates (> 85%) up to three years, with very few deaths observed. Conclusion Our findings demonstrate that survival in treated appendiceal neoplasms is predominantly influenced by tumour biology, particularly histological risk group and metastatic status at presentation. Patients with low-grade mucinous neoplasms experienced relatively favourable outcomes, often surviving without recurrence, whereas high-risk histology variants were associated with poorer survival and increased incidence of peritoneal dissemination.

Plasma cell neoplasms involving the jaws are rare, with mandibular involvement representing an uncommon initial manifestation of systemic multiple myeloma (MM). Their nonspecific clinical and radiographic presentation often mimics more common odontogenic and inflammatory conditions, making early diagnosis challenging. We report the case of an 81-year-old man who presented with pain and swelling over the left posterior mandible of two months' duration. Clinical examination revealed diffuse swelling involving the left mandibular body and angle. Orthopantomography (OPG) demonstrated a well-defined unilocular radiolucent lesion extending from the left mandibular second premolar to the retromolar region with associated cortical expansion. The histopathological examination of an incisional biopsy revealed diffuse sheets of atypical plasma cells. Initial immunohistochemistry (IHC) demonstrated CD56 positivity, and subsequent evaluation showed diffuse membranous CD138 positivity with kappa light-chain restriction and lambda negativity, confirming a monoclonal (M) plasma cell neoplasm. To differentiate a solitary bone plasmacytoma (SBP) from systemic disease, whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) was performed. Imaging demonstrated a hypermetabolic destructive soft tissue mass involving the left hemimandible measuring 4.6 × 3.9 cm (maximum standardized uptake value {SUVmax}: 16.5), along with multiple FDG-avid osteolytic lesions involving the frontal calvarium, left fourth rib, left iliac bone, and cervical, thoracic, and lumbar vertebrae. Bone marrow biopsy revealed marked plasma cell infiltration, and the correlation of the clinical, radiological, histopathological, immunophenotypic, and marrow findings established the diagnosis of multiple myeloma presenting as a mandibular plasmacytoma. The patient subsequently received palliative external beam radiotherapy (20 Gy in five fractions) to the mandibular lesion and was referred for systemic hematologic management. This case underscores the importance of considering plasma cell neoplasms in the differential diagnosis of destructive mandibular lesions and highlights the indispensable role of comprehensive diagnostic evaluation, including immunohistochemistry, whole-body PET-CT, and bone marrow examination, in distinguishing localized plasmacytoma from multiple myeloma. Early recognition and multidisciplinary management are essential to ensure timely diagnosis, accurate staging, and appropriate treatment, ultimately improving patient outcomes.

Thermal ablation is a minimally invasive treatment for localized prostate cancer (PCa). MRI-guided transurethral ultrasound ablation (TULSA) enables precise, temperature-controlled therapy, but its 3 cm ablation radius may limit coverage in large prostates or capsule-adjacent tumors. Neoadjuvant androgen deprivation therapy (nADT) may improve treatment feasibility by reducing prostate and tumor size.

In this prospective, single-arm pilot study (NCT05917860), 15 treatment-naïve patients with organ-confined, intermediate-risk ISUP 2-3 PCa and at least one biopsy-concordant PI-RADS ≥ 3 lesion received 3-month nADT with degarelix before whole-gland TULSA. Multiparametric MRI was performed at baseline and monthly thereafter to assess prostate and lesion volumes, tumor-capsule relationship, and urethra-capsule distance.

All patients completed nADT. Across 27 PI-RADS ≥ 3 lesions, four patients had unifocal disease, and 11 had multifocal disease (2-3 lesions). Twenty lesions were ISUP Grade Group 2 and three were Grade Group 3. PSA declined by 87% (-7.6 ng/mL; 95% CI. -9.7 to -5.7; p < 0.001), and all patients achieved castrate testosterone levels. Prostate volume decreased by 26% (-15 mL; 95% CI. -20 to -12; p < 0.001), index lesion volume by 69% (-0.8 mL; 95% CI. -1.2 to -0.5; p < 0.001), and index-lesion capsule contact length by 40% (-5 mm; 95% CI. -7 to -4; p < 0.001). Capsule bulging resolved in four of seven patients, and urethra-capsule distance decreased to ≤ 30 mm in all six patients with a baseline distance > 30 mm.

Short-term nADT with degarelix was associated with significant changes in prostate and tumor morphology. Future studies should determine whether these changes improve TULSA outcomes.

Menopause is associated with increased cardiovascular risk due to estrogen depletion. This study aimed to compare carotid intima-media thickness (CIMT) and serum endocan levels in women with natural menopause, surgical menopause, and premenopausal status, and to evaluate their potential roles as biomarkers for cardiovascular risk stratification.

This prospective observational study included 88 healthy women aged 45-60 years: 32 with surgical menopause, 30 with natural menopause, and 26 who were premenopausal. Serum endocan concentrations were measured using an enzyme-linked immunosorbent assay, and bilateral CIMT was assessed ultrasonographically. Between-group comparisons were performed using appropriate parametric or non-parametric tests. Multivariable linear regression analyses adjusted for age and body mass index (BMI) were performed. Serum endocan was natural-log transformed before multivariable analysis because of its skewed distribution.

Serum endocan concentrations differed significantly among the three groups (overall p < 0.001), with the highest levels in surgical menopause, followed by natural menopause and premenopause. The association between menopausal group and log-transformed endocan remained significant after adjustment for age and BMI (overall p < 0.001). Overall mean CIMT did not differ significantly among the groups in either unadjusted (p = 0.913) or adjusted analyses (p = 0.703). Age, but not menopausal group or BMI, was independently associated with overall mean CIMT (p = 0.003).

Serum endocan levels were independently associated with menopausal status after adjustment for age and BMI, with the highest concentrations observed in women with surgical menopause. In contrast, CIMT was not independently associated with menopausal status. These findings support further investigation of endocan as a potential marker of menopause-associated endothelial alterations. However, prospective longitudinal studies are strictly required to validate this indirect hypothesis and establish causality.