A clinical observation of the development of complications in the form of recurrent sclerosis (stricture) of the bladder neck in a patient following pancreas transplantation for type 1 diabetes mellitus with the imposition of duodenocystoanastomosis is presented.Severe enzymuria led to the development of bladder neck sclerosis with clinical symptoms of bladder outlet obstruction, accompanied by chronic urinary tract infection and inflammatory changes in the lower urinary tract. Previous transurethral resection of the stenotic bladder neck did not provide a lasting positive effect and resulted in recurrent bladder outlet obstruction 5 years later. The authors believe the recurrence of bladder neck stricture is due to impaired tissue regeneration in the resection area, coupled with recurrent infection and ongoing enzymuria. A relevant solution to this problem is a modified pancreas transplantation technique with enzyme diversion to the small intestine.

To synthesise and quantify the association between parental monitoring and therapeutic adherence in adolescents and young adults (10-24 years) with Type 1 Diabetes Mellitus (T1DM).

We conducted a systematic review with meta-analysis following PRISMA guidelines (PROSPERO: CRD420251231615). Searches were conducted in PubMed, CINAHL, SCOPUS, and PsycINFO up to June 2026. Observational studies examining the association between parental monitoring (active supervision of diabetes self-management) and multidimensional therapeutic adherence in individuals aged 10-24 years with T1DM were included. Random-effects models were used to pool correlation coefficients. Heterogeneity (I²), publication bias (Egger's test and trim-and-fill method), and sensitivity analyses were assessed. Methodological quality and certainty of evidence were evaluated using predefined criteria and GRADE principles.

Eight studies (8 independent samples; N = 1209) met inclusion criteria. All the studies were cross-sectional and conducted in the United States. The pooled analysis showed a significant positive association between parental monitoring and therapeutic adherence (r = 0.286; 95% CI: 0.232-0.337), with no statistical heterogeneity. Findings were consistent across informants (parent- or adolescent-reported) and remained robust in sensitivity analyses. Risk of publication bias was low and did not materially affect the estimates. Overall certainty of evidence was moderate.

Parental monitoring is consistently and positively associated with therapeutic adherence in adolescents and young adults with T1DM. Although effect sizes were small to moderate and studies were cross-sectional, the findings support the clinical relevance of collaborative and non-intrusive parental supervision. Family-centred interventions promoting adaptive monitoring may help mitigate the decline in adherence during adolescence.

Olfactory dysfunction is increasingly recognized as a complication of diabetes that negatively impacts eating behavior and quality of life. This study investigates olfactory function in adolescents with Type 1 diabetes and evaluates the impact of disease duration and long-term glycemic control (mean HbA1c) on olfactory performance.

Olfactory function was assessed using the validated "Sniffin' Sticks" test, which evaluates odor threshold, discrimination, and identification to generate a composite TDI score for diagnosing hyposmia (TDI < 30.75).

Hyposmia was identified in 30% of adolescents with Type 1 diabetes, whereas none exhibited anosmia. Overall olfactory performance (TDI scores) did not differ significantly by diabetes duration, age, sex, BMI, lipid profiles, or insulin therapy method. However, a strong negative correlation was observed between long-term mean HbA1c and total TDI scores (r = -0.65, p < 0.001). Logistic regression confirmed that elevated mean HbA1c (> 7.0%) was a significant independent predictor of olfactory impairment, increasing the risk of hyposmia 3.7-fold (OR = 3.726, p = 0.018).

Poor long-term glycemic control significantly impairs olfactory function in adolescents with Type 1 diabetes. This is demonstrated by the marked reduction in olfactory scores among adolescents with high mean HbA1c. Consequently, future research may validate olfactory testing as an effective, early biomarker for diabetic complications.

Type 2 diabetes mellitus (T2DM) is a multifactorial metabolic disorder characterized by insulin resistance, progressive β-cell dysfunction, and chronic hyperglycemia, leading to microvascular and macrovascular complications. Among current therapeutic strategies, inhibition of intestinal carbohydrate-hydrolyzing enzymes, namely α-amylase and α-glucosidase, represents an established approach for controlling postprandial glucose excursions. However, clinically used inhibitors such as acarbose, miglitol, and voglibose are associated with gastrointestinal intolerance, limited selectivity, and variable efficacy, highlighting the need for improved therapeutic agents. In this context, 1,3,4-oxadiazole-based scaffolds have emerged as promising pharmacophores in antidiabetic drug design. The 1,3,4-oxadiazole ring acts as a bioisostere of amide and ester functionalities, conferring favorable physicochemical properties including enhanced metabolic stability, lipophilicity, and hydrogen-bonding capability. Structure-activity relationship (SAR) studies reported between 2015 and 2025 demonstrate that substituent effects-particularly phenolic hydroxyl groups, halogenation patterns, and extended aromatic systems-play a critical role in optimizing enzyme inhibition through hydrogen bonding, hydrophobic interactions, and π-π stacking within catalytic sites. While several oxadiazole-based hybrids incorporating privileged scaffolds such as benzimidazole, coumarin, and thiazolidinedione have been explored, evidence supporting modulation of additional targets including protein tyrosine phosphatase 1B (PTP1B), aldose reductase (ALR2), and inflammatory pathways such as the NLRP3 inflammasome remains limited and primarily derived from in vitro or computational studies. Computational approaches, including molecular docking, 3D-QSAR, and molecular dynamics simulations, have supported the rational optimization of oxadiazole derivatives, although their predictive limitations should be acknowledged. Despite encouraging preclinical findings, clinical translation remains constrained by insufficient pharmacokinetic, toxicological, and long-term efficacy data. Future research should prioritize systematic ADMET evaluation, standardized biological validation, and mechanistic expansion beyond carbohydrase inhibition to enable the development of clinically viable oxadiazole-based antidiabetic agents.

Evidence remains limited on whether telmisartan with partial peroxisome proliferator-activated receptor-gamma (PPAR-γ) activity lowers new-onset diabetes mellitus (NODM) risk compared with non-PPAR-γ-active angiotensin II receptor blocker (ARB). We therefore evaluated the NODM risk of telmisartan compared with losartan, valsartan, and candesartan using real-world clinical data. We conducted a multicenter, retrospective, treatment-control cohort study using clinical data from 17 institutions between 2005 and 2023, covering 19 283 922 patients converted to a common data model. Adults newly prescribed telmisartan or other ARBs (losartan, valsartan, or candesartan) and taking the medication for ≥6 months were included, while patients with pre-existing diabetes were excluded. Propensity score matching (PSM) was performed, and hazard ratios (HR) were estimated using a Cox proportional hazards model. The primary outcome was incident NODM, defined by a diagnosis of diabetes (ICD-10), initiation of glucose-lowering medications, or HbA1c ≥ 6.5%. A total of 6 868 patients of new-users of telmisartan and 22 500 patients of other ARBs were included. In the overall population, telmisartan was associated with lower NODM risk (HR 0.87, 95% CI 0.80-0.94). After 1:2 PSM, there was no significant difference in the risk of NODM between telmisartan and other ARBs (10.61% [39.50/1 000 person-years] vs. 11.02% [40.42/1 000 person-years]; HR 0.97, 95% CI 0.88-1.08). Secondary analyses were also not significantly different. Overall, this study did not detect sufficient evidence that telmisartan reduces NODM risk compared with losartan, valsartan, or candesartan.

The aim of this review was to critically evaluate the applicability of predictive models for planning nephron-sparing surgery in patients with localized renal parenchymal tumors. A narrative review of publications from 2020-2025 indexed in PubMed/MEDLINE, as well as earlier key studies, was performed. Nephrometry scores, regression models, machine learning, radiomics, and deep learning based on computed tomography data were analyzed. Nephrometry scores remain valuable as standardized tools for describing anatomical complexity but have limited ability to predict individual complications and composite outcomes. Multimodal models combining clinical and imaging features appear promising. A limited set of preoperative variables is often sufficient to predict postoperative renal function. Surgeon experience and the learning curve remain important factors but are frequently not incorporated into predictive models. Clinical implementation requires external validation, assessment of model calibration and clinical utility, while maintaining the leading role of the physician in clinical decision-making.

Background Identifying tumor histologic subtypes in complex regions is challenging for generalist radiologists. Whether reasoning large language models can bridge this expertise gap by interpreting radiologic descriptions remains underexplored. Purpose To evaluate whether Generative Pretrained Transformer (GPT)-5-Thinking can perform similarly to subspecialists and help bridge the generalist expertise gap in interpretation of MRI scans of orbital and head-and-neck tumors. Materials and Methods This dual-center retrospective study was performed at a generalist practice center and a subspecialist practice center and included convenience series of patients with pathologically confirmed orbital or head-and-neck tumors who had pretreatment MRI reports. GPT-5-Thinking processed narrative MRI reports to output benign-malignant classification and top-3 differential diagnoses. Phase 1 compared model accuracy with routine clinical report diagnoses in generalist and subspecialist practice settings. In Phase 2, seven generalists interpreted selected tumor reports twice, without and with GPT-5-Thinking assistance. McNemar tests and mixed-effects logistic regression models were used for analysis. Results This study included 1000 patients (mean age ± SD, 51 years ± 17.0; 520 men). In phase 1, the top-1 accuracy of GPT-5-Thinking was similar to that of subspecialists in patients with orbital tumors (76.7% [230 of 300] vs 78.3% [235 of 300]; P = .64) and head-and-neck tumors (67.5% [135 of 200] vs 68.0% [136 of 200]; P = .92). GPT-5-Thinking had higher top-1 accuracy than did routine generalists for patients with orbital tumors (74.0% [222 of 300] vs 68.7% [206 of 300]; P = .03) and head-and-neck tumors (64.0% [128 of 200] vs 27.0% [54 of 200]; P < .001). In phase 2, GPT-5-Thinking assistance was associated with an increase in generalist top-1 diagnostic accuracy from 61.4% (430 of 700) to 70.3% (492 of 700) (P < .001) in patients with orbital tumors and from 47.0% (329 of 700) to 61.0% (427 of 700) (P < .001) in patients with head-and-neck tumors. Conclusion Using MRI reports of patients with orbital or head-and-neck tumors, Generative Pretrained Transformer (GPT)-5-Thinking showed diagnostic accuracy similar to that of subspecialists; GPT-5-Thinking assistance was also associated with higher generalist diagnostic accuracy. © RSNA, 2026 Supplemental material is available for this article.

To evaluate whether a risk-stratified colorectal cancer (CRC) screening approach based on a single faecal immunochemical test (FIT) performed better than one using two consecutive tests.

Approximately 420,000 negative FIT results (positivity cut-off: 20 µg faecal haemoglobin, f-Hb/g) were collected between 2000 and 2015 within the Florence screening program.

The 3-year CRC risk was 15.9‰ in individuals with 15-20 µg/g on a single test, and 9.36‰ for those with a cumulative f-Hb concentration of 20-40 µg/g across two tests.

The two-tests approach showed lower discriminatory capacity in identifying the highest-risk subgroup compared to a single test. Screenees with 15-20 µg/g accounted for <1%, but faced a significantly increased 3-year CRC risk.

While increasing screening intensity would require more colonoscopies, extending the screening interval for individuals <60 years with undetectable f-Hb, could allow for the reallocation of colonoscopy resources.

Teclistamab, a B-cell maturation antigen (BCMA) × CD3 bispecific antibody, is effective in relapsed/refractory multiple myeloma, but its real-world post-marketing safety profile remains incompletely characterized.

To evaluate adverse event (AE) signals, temporal patterns, and clinical priorities associated with teclistamab using the FDA Adverse Event Reporting System (FAERS).

We retrospectively analyzed FAERS reports from 2022 to 2025 using four disproportionality methods: reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker. Time-to-onset, Weibull, Kaplan-Meier, and semi-quantitative clinical prioritization analyses were also performed.

Among 2,631 reports, 85.2% involved serious outcomes and 21.7% fatal outcomes. The most frequently reported system organ class was infections and infestations. Seventy significant preferred-term signals were identified, including 52 previously documented and 18 novel signals. Cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, infection, pneumonia, pyrexia, and neutropenia were most frequently reported. Sepsis was the sole high-priority signal, with fatal outcomes in 58.57% of sepsis-related reports. Immune-related and neurological events occurred earlier, whereas infectious complications tended to occur later. Safety profiles were generally consistent across sex and age groups, although septic shock was less frequently reported in females.

The safety profile broadly aligned with clinical trial data, but novel signals and sepsis-related fatality highlighted clinically important risks.

These findings support targeted risk mitigation and continued monitoring, particularly for severe infections and immune-related toxicities.

Minimally invasive approaches to pancreatoduodenectomy (PD) are increasingly being adopted worldwide. However, direct comparisons between laparoscopic PD (LPD) and robot-assisted PD (RPD) remain limited and inconclusive. This study aimed to compare perioperative outcomes between LPD and RPD within a national multicentre cohort.

This retrospective multicentre study included patients who underwent LPD or RPD at participating Italian centres within the Italian Group of Minimally Invasive Pancreas Surgery registry between October 2019 and December 2024. Propensity score matching was performed in a 1 : 1 ratio based on age, body mass index, American Society of Anaesthesiologists score, tumour type (pancreatic ductal adenocarcinoma versus other histologies), receipt of neoadjuvant chemotherapy, and requirement for vascular and/or organ resection. Primary outcomes were estimated blood loss and operative time. Secondary outcomes included conversion rate, postoperative morbidity, pancreas-related complications, reoperation, length of hospital stay, histopathological features, and deaths.

Among 774 minimally invasive PDs, 163 (21.1%) were LPD and 611 (78.9%) were RPD. After propensity score matching , 161 LPDs were compared with 161 RPDs. RPD was associated with a longer operative time (median 506 (interquartile range (i.q.r.) 427.5-600) versus 500 (411.5-551) minutes; P = 0.030) but lower estimated blood loss (median 200 (i.q.r. 100-337.5) ml versus 250 (150-500) ml; P < 0.001). On multivariable analysis, surgical approach was not an independent predictor of operative time, whereas RPD was independently associated with lower estimated blood loss (β -0.372, 95% confidence interval -0.641 to -0.102; P = 0.007). Conversion to open surgery was significantly more frequent after LPD (24 of 161; 14.9%) than RPD (11 of 161; 6.8%) (P = 0.023). Postoperative outcomes-including major morbidity, pancreas-specific complications, reoperation, length of hospital stay, and in-hospital or 90-day deaths-were comparable between groups. Histopathological findings were also similar.

RPD was associated with lower estimated blood loss and a reduced conversion rate compared with LPD. However, these differences were modest in absolute terms and did not translate into clinically meaningful differences in postoperative outcomes, which remained comparable between the two approaches.