Both domestic and international guidelines recommend using dual tracers and retrieving at least three sentinel lymph nodes (SLNs) for SLN biopsy (SLNB) in patients who are downstaged from clinical N1 lymph node status (cN1) to clinical N0 status after neoadjuvant therapy (NAT). However, because of various limitations, most hospitals in China still perform SLNB using a single blue dye. This discrepancy between guidelines and real-world practice warrants further reflection.

Adult women who had clinical cT1-cT4, cN1, M0 breast cancer scheduled who were for NAT were eligible. After NAT, patients underwent sequential SLNB and axillary lymph node dissection, with SLNs identified using single dye. The primary end point was the false-negative rate (FNR) of single-dye SLNB.

Among 432 patients from 12 centers, single-dye SLNB succeeded in 393 of 432 (90.97%). Pathology revealed node metastases in 201 of 393 patients. The FNR was 8.96% (18 of 201 patients; 95% upper confidence limit, 12.02%). The FNR was lower in women aged 60 years and younger (3.80% vs. 27.91%; p < .0001), and in those with a body mass index (BMI) <25 kg/m² (4.20% vs. 14.47%; p = .0151), with four or more SLNs (5.19% vs. 16.67%; p = .0152), and with estrogen receptor-negative tumors (3.52% vs. 12.93%; p = .0242). BMI ≥25 kg/m² (odds ratio, 5.68; 95% confidence interval, 2.05-18.33; p = .0006), estrogen receptor-positive tumors (odds ratio, 3.49; 95% confidence interval, 1.15-12.72; p = .0264) were independently associated with a false-negative SLNB. Examining a greater number of SLNs was independently associated with a lower FNR (odds ratio, 0.65; 95% confidence interval, 0.45-0.90; p =.0088). In hormone receptor-negative/human epidermal growth factor receptor-positive patients, the FNR was 0%.

Single-dye SLNB after NAT in patients initially diagnosed with cN1 breast cancer yielded a clinically acceptable FNR. When four or more SLNs were identified, an additional benefit was observed in patients who had a BMI <25 kg/m² and negative estrogen receptor status.

To evaluate the efficacy and safety of a standardized, drug-induced sleep endoscopy guided, single-stage multilevel protocol combining expansion sphincter pharyngoplasty (ESP), anterior palatoplasty, and coblation-assisted tongue base resection in positive airway pressure (PAP)-intolerant obstructive sleep apnea (OSA).

Twenty adults with OSA (19 men, 1 woman) underwent single-stage ESP, anterior palatoplasty, and coblation-assisted tongue base resection. Preoperative and 3-month postoperative polysomnography and Epworth Sleepiness Scale (ESS) scores were compared; postoperative adverse events were recorded during follow-up.

Mean age was 43.75 ± 11.85 years. ESS decreased from 11.5 (IQR 9.0) to 4.5 (IQR 6.0) (p < 0.001). Overall AHI decreased from 17.55 events/h (IQR 12.43) to 7.05 events/h (IQR 8.55) (p < 0.001). Minimum oxygen saturation increased from 84% (IQR 7) to 87% (IQR 4) (p = 0.039), and T90 decreased from 2.85% (IQR 15.38) to 0.25% (IQR 1.85) (p = 0.003). After excluding recordings with < 60 min of supine sleep, supine AHI decreased from 28.3 to 7.8 events/h (n = 15; p = 0.002). Surgical success (postoperative AHI < 20 and > 50% reduction) was achieved in 13/20 (65%); 9/20 (45%) achieved postoperative AHI < 5. No major complications occurred.

Single stage multilevel surgery combining ESP, anterior palatoplasty, and coblation-assisted tongue base resection provides significant short-term improvements in symptoms, polysomnographic indices, and nocturnal oxygenation, with a favorable safety profile in PAP-intolerant OSA.

Global Initiative for Asthma (GINA) has recommended inhaled corticosteroid (ICS)-Formoterol as Track-1 treatment for patients. Using ICS and SABA (Short-Acting Beta-Agonist) as a reliever is an alternative Track-2 option. Both modalities are tied to type of inhaler use, dry powder inhalers (DPI) and propellent-containing metered-dose inhalers (pMDI). Compared to propellent-free DPI, pMDI have much higher carbon footprint (CF) detrimental to the environment. Leveraging on dispensed inhaler data from the electronic medical records of patients managed in primary care, the study aimed to quantify their CF using Budesonide-Formoterol (BUD-FOR) DPI alone, compared to those who were treated with BUD-FOR DPI + pMDI as a reliever.

Electronic medical records from 8 public primary care clinics were analysed, covering adult asthma patients (aged ≥21) between 2018 and 2023. Data on inhaler dispensing, asthma control test (ACT) scores and rescue therapy (RT) needs were assessed. CF was computed based on inhaler canisters dispensed. Associations between treatment modality, asthma control, RT and CF were analysed using Generalized Estimating Equations.

A total of 5634 patients using BUD-FOR DPI were included. Over the study period, Track-1 usage increased substantially from 466 to 2317 patients, while Track-2 rose modestly from 628 to 758. In 2023, 78.5% of patients achieved good asthma control compared to 68.7% in Track-2. The total CF per patient was substantially lower in Track-1 compared to Track-2 (3.3 vs 62.4 kgCO₂e). Patients in Track-1 had a significantly lower CF by 60 kgCO₂e (P < .001), had 1.5 times higher odds to achieve good asthma control based on ACT scores (P < .001) and had approximately 30% lower odds of receiving RT (P < .001). The average number of SABA-pMDI canisters dispensed per patient declined from 2.8 to 2.1 over the study period. BUD/FOR inhalers use per patient per year was consistently higher in Track 2 compared to Track 1, with an average difference of 1.2 canisters (5.3 vs 4.1).

Patients managed under Track-1 treatment approach demonstrated significantly better asthma outcomes and lower CF. These findings highlight potential of Track-1 treatment as the preferred strategy, enabling better clinical outcomes and reduced environmental impact.

ImportanceDespite a surge in the volume of evidence assessing the safety and efficacy of biologics for the treatment of chronic rhinosinusitis (CRS), nuances relating to geographic variations in this literature remain insufficiently elucidated.ObjectiveTo assess the diversity and representation of populations within the literature investigating the use of biological agents for CRS.Design/SettingSystematic review.ParticipantsAdults ≥18 years with CRS treated with biologic agents.InterventionsFollowing PRISMA guidelines, 2 complementary analyses of all studies published between 2006 and 2023 (analysis A), and randomized controlled trials (RCT) and real-world (RW) studies published between 2006 and 2025 (analysis B) were performed.Main outcomes measuresPatients' number and country of origin, race/ethnicity, authors' affiliated countries and Human Development Index (HDI). Types of biologics agents and metrics of the publications were collected.ResultsOut of 2768 studies reviewed, 169 were included in the final analyses. Dupilumab was the most studied biologic agent (37.8%), followed by mepolizumab. The United States had the highest absolute representation and Belgium the highest number of authors per capita, which was correlated with patients' nationality. The majority of the journals' and authors' country of origin was the United States. Only 19 (11.2%) studies disclosed patients' race/ethnicity, with Asian and Caucasian subjects most commonly represented. The authors' HDI correlated with journals' H-index and impact factor. Sixty-seven studies (39.6%) had industry funding, with dupilumab representing the highest number (15.9%).ConclusionAlthough the use of biologics has shown promising results in the management of CRS, most of the evidence comes from the United States and Europe. There is a paucity of representation from certain regions, including Africa, Latin America, and Asia, and inadequate overall disclosure of race/ethnicity in existing studies. This warrants further high-quality investigation of biological agents' safety and efficacy among these underrepresented populations.RelevanceAddressing gaps in clinical studies is important for furthering understanding of the pathophysiology and pharmacology of biologic agents for CRS, and bridging treatment disparities.

The COVID-19 pandemic has spurred significant research into artificial intelligence (AI) applications in healthcare. This study analyzes the intellectual structure and knowledge flow in COVID-19 and AI research through descriptive citation and bibliographic coupling analysis.

This study aims to explore the current research landscape on AI in the context of COVID-19, identify the most influential publications, and outline the conceptual framework of this research area.

Using the Web of Science (WoS) and Scopus databases, documents were collected with keywords such as "COVID-19," "SARS-CoV-2," "coronavirus," "artificial intelligence" and "deep learning." After merging results and removing duplicates, the final sample included 8057 documents. The top 1000 most cited papers were selected for descriptive citation analysis, while the entire sample was used for bibliographic coupling analysis. Data analysis and visualization were conducted using R Bibliometrix/Biblioshiny and VOSviewer.

The descriptive analysis revealed that original research papers were predominant (85.21%), with a substantial increase in publications on COVID-19 and AI since the pandemic began. China and the United States led in publication volume, with notable international collaborations. Network analysis identified research clusters such as AI-driven diagnostics and healthcare resource optimization. The bibliographic coupling analysis highlighted influential research themes, mainly focusing on diagnostic imaging and AI algorithms.

AI has played a crucial role in addressing the COVID-19 crisis, especially in diagnostics and healthcare optimization. The bibliometric analysis provides insights into the research landscape, emphasizing AI's multifactorial contributions and suggesting areas for future research.

Menopause significantly impacts cardiovascular risk factors, the leading cause of mortality in women experiencing menopause. The present study examined the effects of combined exercise modalities on nontraditional lipid ratios in menopausal women. A total of 139 women were randomized into two groups-brisk walking with yoga or brisk walking alone-for a 3-month intervention. Anthropometric and biochemical parameters, including lipid indices, were assessed before and after the intervention. Baseline characteristics were comparable between groups. ANCOVA with repeated measures showed that the brisk walking with yoga group achieved greater improvements than brisk walking alone in BMI (-1.0 kg/m2, p = 0.001), waist circumference (-5.3 cm, p = 0.003), and hip circumference (-4.8 cm, p < 0.001). There was a significant group × time interaction for diastolic blood pressure (-8.3 mmHg, p < 0.001) and in total cholesterol (-25.1 mg/dL, p < 0.001), triglycerides (-36.6 mg/dL, p < 0.001), LDL cholesterol (-22.2 mg/dL, p < 0.001), and non-HDL cholesterol (-31.2 mg/dL, p < 0.001). The cardiovascular risk indices CRI-I (-1.06, p < 0.001), CRI-II (-0.77, p < 0.001), and AC (-1.06, p < 0.001) showed significantly greater improvements in the brisk walking with yoga group, while HDL cholesterol increased significantly only in this group (+6.1 mg/dL, p < 0.001). The combined exercise group participants showed better satisfaction compared to brisk walking alone, suggesting that integrating yoga may be more efficacious, acceptable, and feasible, potentially improving midlife health and long-term outcomes. Our results underscore the importance of lipid ratios in predicting cardiovascular disease risk in women experiencing menopause and advocate for yoga's inclusion in exercise routines. Further research incorporating longer intervention periods and larger sample sizes is warranted to comprehensively establish the long-term cardiovascular benefits of combined exercise in women experiencing menopause.

Youth living with congenital heart disease face impaired cardiorespiratory fitness and reduced physical activity, compromising long-term health outcomes. Cardiac rehabilitation is crucial for optimizing functional capacity and preventing secondary complications, yet access barriers limit participation in traditional center-based programs. Nurse-led, mHealth-based models may improve accessibility and effectiveness.

To evaluate the effectiveness of a nurse-led, mHealth-based cardiac rehabilitation program (HeartFIT) versus usual care on cardiorespiratory fitness and physical activity in youth with congenital heart disease.

A prospective, randomized, open-label, parallel-group controlled trial.

Two tertiary hospitals in Chengdu, China.

Youth aged 8 to 18 years, ≥6 months post-correction for congenital heart disease, with impaired exercise capacity.

Participants (N = 68) were randomized (1:1) to HeartFIT or usual care. HeartFIT comprised a 12-week, nurse-led, home-based mHealth cardiac rehabilitation intervention (via WeChat), with the entire program design grounded in the Individual and Family Self-Management Theory and incorporating specific Behavior Change Techniques. The program featured individualized exercise prescriptions based on baseline cardiopulmonary exercise testing and risk stratification, tailored health education, goal-setting with self-monitoring, and remote nursing support. The primary outcome was change in cardiorespiratory fitness (peak oxygen uptake, VO_{2 peak}) measured by cardiopulmonary exercise testing. Secondary outcomes included other cardiopulmonary exercise testing parameters (oxygen pulse, exercise duration, maximal workload, ventilatory efficiency) and physical activity levels assessed by accelerometry and the Physical Activity Questionnaire. Analysis of covariance (ANCOVA), adjusting for baseline values, was used to determine between-group differences.

The HeartFIT group demonstrated statistically significantly greater improvement in VO_{2 peak} versus controls (adjusted mean difference: 3.60 ml·kg^-1·min^-1, 95% CI 1.48 to 5.73; P = 0.001). Significant improvements favoring HeartFIT were also observed in oxygen pulse (0.78 ml·beat^-1), exercise duration (0.76 min), maximal workload (11.70 W), and physical activity levels (P = 0.004 for accelerometry; P = 0.001 for Physical Activity Questionnaire). No serious adverse events occurred.

The nurse-led, mHealth-based cardiac rehabilitation program effectively improved cardiorespiratory fitness and physical activity in youth with congenital heart disease, offering a safe and scalable approach for accessible pediatric cardiac rehabilitation.

Chinese Clinical Trial Registry (ChiCTR2100050259, Registered 24/08/2021, first recruitment 08/11/2021).

An independent dataset was used to retrospectively test the ability of an artificial intelligence (AI) program to detect radiographic signs of right or left heart failure (HF) and combine these findings to make a radiographic assessment of HF in dogs and cats. Experimental groups included 105 confirmed cases of heart disease in failure and a control group of 40 confirmed cases of heart disease not in failure. The program had an 87.04% sensitivity and an 80% specificity for radiographically concluding HF in dogs. Compared to true findings, the program had a 98% sensitivity in detecting an interstitial pattern, 100% sensitivity in detecting cardiomegaly, and 95% sensitivity in detecting a vascular pattern among other findings. In cats, the program had a 96% sensitivity in detecting an interstitial pattern, 96% sensitivity in detecting cardiomegaly, and 94% sensitivity in detecting a vascular pattern, among other findings. Despite this high sensitivity performance, the program only combines these findings to conclude HF with a sensitivity of 9.8% and specificity of 95%. The AI software had a similar success rate compared to radiologists in identifying the individual findings of HF in both species. This software has reached a level of sophistication to identify the different abnormalities as accurately as a large radiology group and also combine these findings and arrive at the radiographic conclusion of HF in dogs. The performance of this program in cats highlights the importance for veterinarians to utilize their medical knowledge to interpret the AI report like any other ancillary diagnostic test.