It is critical that women undertaking medically assisted reproductive (MAR) treatment and their clinicians know whether the treatments are associated with an increased risk of hormone-related cancers.

To determine the risk of hormone-related cancers following MAR treatment.

This cohort study used an emulated target trial design including Australian health registries and administrative datasets. Participants included women enrolled in Medicare, Australia's universal health insurance scheme, aged 18 to 55 years between January 1, 1991, and December 31, 2018. Data were analyzed from April 2024 to July 2025.

Exposures were defined from Medicare records: assisted reproduction therapy, intrauterine insemination or ovarian stimulation, and ovulation induction with clomiphene citrate.

Hormone-related invasive cancers (identified in the Australian Cancer Database) included breast, ovarian, uterine, thyroid, colorectal cancers and melanoma; in situ cancers included breast cancer and melanoma. Three cancers with no hormonal links-pancreatic, lung, and hematological-were included as negative controls. Flexible parametric survival models ascertained hazard ratios (HRs) and cumulative marginal survival differences in incident cancers per 100 000 population. E-values assessed the risk of bias due to unmeasured confounding.

A total of 1 748 927 women were identified, including 396 661 with history of MAR exposure. Although elevated risk of most hormone-related cancers was observed after MAR treatment (HRs, 1.09-1.64), E-value analysis suggested confounding due to underlying infertility conditions (ie, endometriosis, polycystic ovarian syndrome) could account for this observed elevation for uterine, ovarian, and thyroid cancers. For any specific invasive cancer, fewer than 20 extra cancers per 100 000 women each year were estimated for treated vs comparator groups. Emulated trials on the 6 hormone-related cancers and pancreatic and hematological cancers showed increased cancer risk in the first years after treatment, suggesting detection bias. Increased risk of hematological cancers was observed after MAR treatment (HRs, 1.18-1.27), indicating uncontrolled confounding by race and ethnicity may account for observed excess risk seen for several cancers. Some treatments were associated with decreased lung cancer risk (HRs, 0.72-0.82).

In this cohort study of MAR and cancer using a target trial emulation design, although associations between MAR and some hormone-related cancers were observed, the estimated difference in the number of expected cancers was small and may be explained by unmeasured confounding and detection bias.

Lung cancer is typically a cancer of the elderly, with a median age at diagnosis of 71, and more than one third of the people diagnosed with lung cancer are over 75 years old. Immune checkpoint inhibitors (ICIs) have revolutionised the treatment of cancers, including lung cancer. ICIs targeting the programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) axis, administered in the neoadjuvant setting, the adjuvant setting, or both, are currently the standard of care for resectable non-small-cell lung cancer (NSCLC) worldwide. These ICIs are commonly used in combination with platinum-based chemotherapy and have shown superior efficacy in patients eligible for curative surgery. The concept of immunosenescence, which refers to age-related changes in the immune system - particularly a decline in the efficiency of T-cell mediated responses - raises concerns about the benefits of ICIs in the elderly population.

To assess the benefits and harms of ICI with or without chemotherapy compared to no treatment or placebo with or without chemotherapy given before surgery, after, or both in older adults diagnosed with NSCLC at the early resectable stage.

We searched for all eligible randomised controlled trials (RCTs) in electronic databases (CENTRAL, MEDLINE, and Embase), trial registries (clinicaltrials.gov and the World Health Organization ICTRP), references of eligible studies, meeting abstracts of the main world conferences, and the Food and Drug Administration (FDA) and European Medicines Agency (EMA) websites. The search was up to 3 July 2025.

We included parallel designed RCTs comparing ICI with or without chemotherapy versus no treatment or placebo with or without chemotherapy administered before surgery, after, or both for early-stage resectable NSCLC. We excluded studies comparing differential sequencing of ICIs or combinations of ICIs with alternate interventions (e.g. radiotherapy).

Our critical outcomes were overall survival and grade ≥ 3 treatment-related adverse events. Our important outcomes were disease-free survival, event-free survival, pathological complete response rate, major pathological response rate, and health-related quality of life.

Two review authors independently used version 2 of the Cochrane risk of bias tool for randomised trials (RoB 2) to assess bias in the included studies.

We synthesised results for each outcome and pooled data where possible (using a random-effects model with DerSimonian and Laird methods for all outcomes; and the Mantel-Haenszel method for dichotomous outcomes). Where this was not possible due to the nature or the amount of data, we narratively summarised the results. Three authors independently assessed the certainty of the evidence, using the five GRADE considerations for each outcome.

We included a total of 11 studies with 6788 participants, of whom 3152 were ≥ 65 years old (46.4% of all participants). We were also interested in those aged ≥ 75 years old but could not obtain the exact number of such participants in nine studies. The inclusion criteria were similar across studies: adults presenting with a resectable NSCLC (stages II to IIIB according to the eighth edition of the Tumor, Node, Metastasis (TNM) classification), with an Eastern Cooperative Oncology Group performance status score of 0 or 1. One study excluded people ≥ 70 years old. Six studies excluded NSCLC with known alterations in epidermal growth factor receptor and anaplastic lymphoma kinase genes.

The following results relate to people ≥ 65 years old only. The term perioperative is used to label studies evaluating the administration of treatment before (neoadjuvant) and after (adjuvant) surgery. Overall survival at any time point (in all studies) Aggregated data from three studies (590 participants) showed that perioperative ICI probably results in little to no difference in overall survival compared to placebo or no treatment, with a hazard ratio (HR) of 0.88 (95% confidence interval (CI) 0.61 to 1.26) and moderate-certainty evidence (downgraded for risk of bias). Treatment-related adverse events ≥ grade 3 at any time point One study (39 participants) provided data indicating that perioperative ICI combined with neoadjuvant chemotherapy may result in little to no difference in treatment-related adverse events ≥ grade 3 compared to neoadjuvant chemotherapy alone, with a risk ratio (RR) of 2.75 (95% CI 0.38 to 19.83) and low-certainty evidence (downgraded for indirectness and imprecision). Disease-free survival at any time point Aggregated data from three studies (1403 participants) showed that adjuvant ICI probably slightly increases disease-free survival compared to placebo or no treatment (HR 0.85, 95% CI 0.73 to 0.99) with moderate-certainty evidence (downgraded for risk of bias). Event-free survival at any time point Aggregated data from seven studies (1531 participants) showed that neoadjuvant or perioperative ICI likely increases event-free survival compared to placebo or no treatment (HR 0.61, 95% CI 0.52 to 0.71) with moderate-certainty evidence (downgraded for risk of bias). Pathological complete response Aggregated data from six studies (1068 participants) showed that neoadjuvant or perioperative ICI may result in a large increase in pathological complete response rates compared to placebo or no treatment (RR 5.07, 95% CI 3.40 to 7.54) with low-certainty evidence (downgraded for risk of bias and imprecision). Major pathological response Aggregated data from six studies (1068 participants) showed that neoadjuvant or perioperative ICI probably results in a large increase in major pathological response rates compared to placebo or no treatment (RR 2.94, 95% CI 2.32 to 3.72) with moderate-certainty evidence (downgraded for risk of bias).

In people aged ≥ 65 years old, the addition of ICIs probably results in little to no improvement in overall survival. Based on one study, treatment-related adverse events showed a similar profile, with low-certainty evidence. However, ICIs probably increase disease-free survival, event-free survival, and major pathological response rates by a clinically meaningful margin. ICI may also increase complete pathological response rates. No study reported health-related quality of life assessments in older adults. Data were also insufficient to evaluate outcomes precisely in participants aged 65 to 75 years, those ≥ 75 years, or in PD-L1 stratified subgroups. We classified 12 studies as ongoing, as no results are yet available for elderly participants.

This Cochrane review had no dedicated funding.

Protocol available via DOI: 10.1002/14651858.CD014907.

IntroductionSurveillance of at-risk populations for pancreatic ductal adenocarcinoma (PDAC) is a potential strategy to reduce its incidence and improve its prognosis. However, there is considerable debate about who should participate and relatively little information about how people perceive different testing options.MethodsUsing the Health Belief Model as a framework, this qualitative, observational study including eleven focus groups and seven interviews, summarizes the knowledge, motivations, barriers and preferences for PDAC surveillance in underserved populations with low cancer screening rates and for high-risk individuals (HRI).ResultsHRIs have a high motivation to participate in PDAC screening and perceive few barriers to engage. Participants from underserved populations had little knowledge of PDAC and surveillance, but they were interested in surveillance for PDAC based on their perception of the benefits of cancer screenings. The main barriers for participation in PDAC surveillance programs were cost, distrust of the larger medical system, discomfort associated with the testing, lack of a provider's recommendation, and fear of a positive result. These barriers varied based on a person's race/ethnicity and geographic location (urban vs. rural). Preferences expressed by underserved populations suggest that tests for early PDAC detection will need to be accurate, no or low cost, minimally invasive, and convenient to access. There was a correlation between a person's self-perceived susceptibility for PDAC and their willingness to tolerate more invasive and less convenient methods. In addition, participants were motivated to participate in early detection programs with clear guidelines accompanied by their doctor's recommendations.ConclusionThere appears to be an association between actual and perceived risk of PDAC and patient willingness to participate in an early detection program. For populations lower along the risk spectrum, there is limited knowledge about pancreatic cancer or its risk factors, and potentially significant barriers to participate in an early detection program if deemed eligible.

Despite the rising cancer burden in Soweto, South Africa and the recognized role of Traditional Health Practitioners (THPs) in the pluralistic health system, their role in cancer care remains underexplored. This study provides novel insights into THPs' understanding of cancer and their potential contribution to community awareness and early detection within complex sociocultural and health system contexts.

To explore THPs perceptions of cancer and the factors influencing their role in community cancer awareness and early detection in Soweto.

An exploratory qualitative design was adopted. Purposive and snowball sampling were used to recruit 13 THPs in Soweto. Each participated in two in-depth interviews. Data were transcribed, coded, and thematically analyzed using Dedoose.

Seven of the 13 THPs had encountered clients with cancer-related symptoms. The THPs described navigating cancer care with mixed certainty, drawing on experiential, spiritual, and limited biomedical knowledge. They often referred clients to biomedical facilities when symptoms appeared serious or unclear. Participants saw themselves as accessible community figures, offering psychosocial support and helping patients navigate the health system. While motivated to contribute to cancer awareness and early detection, they reported challenges related to limited recognition and legitimacy within the formal health sector.

Traditional Health Practitioners play an informal but important intermediary role in community cancer care in Soweto. Their contributions are shaped by knowledge gaps, social dynamics, and systemic barriers. Strengthening their role in early detection requires interventions that improve training, build trust in biomedical services, and support integration within the health system.

Whether prior coronavirus disease 2019 (COVID-19) independently influences treatment response in children with Kawasaki disease (KD) is unclear, as prior reports may have been confounded by overlap with multisystem inflammatory syndrome in children (MIS-C). We investigated this in a nationwide cohort, accounting for these factors.

We conducted a retrospective cohort study using the Korean National Health Insurance Service database. Children diagnosed with KD on or after January 1, 2020 who received IVIG within 7 days were included. Prior COVID-19 was defined as documented infection within 3 months before KD diagnosis. The primary outcome was second-line treatment within 7 days after initial IVIG (composite of second IVIG or additional steroid). 1:1 propensity score matching was performed using age, sex, MIS-C status, and steroid use with initial IVIG.

Among 6572 eligible children, 512 had prior COVID-19; 431 patients were matched per group. Second-line treatment occurred in 32/431 (7.4%) versus 23/431 (5.3%) (p = 0.265). Prior COVID-19 was not independently associated with second-line treatment (adjusted HR 1.42; 95% CI 0.83-2.43). In subgroup analysis, elevated risk was confined to children with concurrent MIS-C (HR 3.01; 95% CI 1.34-6.74); prior COVID-19 without MIS-C showed no increase (HR 1.18; 95% CI 0.66-2.11). Sensitivity analyses excluding MIS-C and restricted to 2022 onward were consistent.

Prior COVID-19 alone was not independently associated with second-line treatment once MIS-C overlap and concurrent steroid use were accounted for. The elevated treatment escalation rate appeared driven primarily by MIS-C, highlighting the importance of distinguishing MIS-C from classic KD.

This study aimed to evaluate the impact of different restriction measures on parental presence and activities in a neonatal intensive care unit (NICU).

A prospective cohort study was conducted in a level IV NICU in Japan between February 2021 and October 2023. The study included preterm infants born at < 35 weeks of gestation. Study groups included three different restriction measures: R1, only parents could visit the NICU between 9 a.m. and 3 p.m.; R2, grandparents and parents were allowed; and R3, visiting hours were extended to between 7 a.m. and 9 p.m. Primary outcomes were duration of parental presence (minutes per visit) and visiting frequency (days per week). Linear mixed models were used to adjust for potential confounders and to account for each family.

We analyzed 4589 visits made by 89 families of 110 preterm infants. There were 69, 33, and 24 infants in the R1, R2, and R3 groups, respectively. In a linear mixed model, duration of at least one of the parents' presence in the NICU (mean difference [95% confidence interval]) was significantly longer in the R2 group than that in the R1 group (54.9 [36.9-68.5] min), and also in the R3 group than that in the R2 group (28.4 [9.3-45.8] min). Additionally, the frequency of parental visits to the NICU per week did not change between R1 and R2, but it increased significantly between R2 and R3 (0.5 [0.1-0.9]).

Alleviating restrictive measures in NICUs may increase parental presence and visit frequency.

The acquisition of dental skills during the final year of the Dentistry degree is primarily based on clinical training, which was severely disrupted during the coronavirus disease 2019 (COVID-19) pandemic.

The aim of the study was to determine the degree of acquisition of specific skills in the Integrated Dental Clinic course based on students' perceptions.

A total of 84 dental students were included in the study. Online forms were administered to evaluate students' perception of competency acquisition in professionalism, communication, basic knowledge, information management, critical thinking, collection of clinical information, diagnosis, treatment, health establishment, health maintenance, and health promotion. The questionnaires were sent before and after the declaration of the COVID-19 state of alarm in Spain. Statistical analysis was performed using R statistical software, v. 4.1.1.

The highest percentage of students reporting high levels of perceived competency acquisition corresponded to health promotion (72.37%), professionalism (52.86%) and ability to collect clinical information (52.34%). Statistically significant improvements in perceived skill acquisition between the beginning and the end of the course were observed for professionalism, collection of clinical information, diagnosis, treatment, health establishment, health maintenance, and health promotion.

Despite the disruptions caused by the pandemic, fifth-year dental students perceived that they had successfully acquired specific skills by the end of the academic course, particularly professional skills, ability to collect clinical information, ability to diagnose and treat, ability to establish and maintain health, as well as health promotion skills.

Asthma exacerbations are a frequent cause of paediatric intensive care admissions, and early identification of patients at risk of respiratory failure is essential. Because direct ionized magnesium measurement is not routinely available, we evaluated whether estimated ionized magnesium derived from routinely available biochemical data was associated with subsequent invasive mechanical ventilation. We conducted a retrospective observational study of children admitted to a paediatric intensive care unit in Japan between 2016 and 2024 with asthma. Primary exposure was considered as the admission-phase estimated ionized magnesium value, defined as the earliest available value before initiation of invasive ventilation, and applied consistently to ventilated and non-ventilated children. The primary outcome was the need for mechanical ventilation. Receiver operating characteristic analysis and multivariable logistic regression were used to evaluate the predictive performance of estimated ionized magnesium while adjusting for arterial pH and arterial carbon dioxide tension. Among 115 eligible children, 51 (44.3%) required invasive mechanical ventilation. Estimated ionized magnesium was lower in ventilated than in non-ventilated children (median 0.467 vs 0.632 mmol/L; p < 0.001). The area under the receiver operating characteristic curve was 0.90, with a 95% confidence interval of 0.83 to 0.96. Each 0.1-mmol/L decrease in estimated ionized magnesium remained associated with higher odds of mechanical ventilation after adjustment for pH and arterial carbon dioxide tension (adjusted odds ratio: 9.46; 95% confidence interval: 3.94 to 22.71; p < 0.001). Admission-phase estimated ionized magnesium was strongly associated with invasive mechanical ventilation in children with asthma exacerbations and may provide a practical early risk marker.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted a complex, bidirectional relationship between SARSCoV-2 infection and autoimmune diseases. This review examines how SARS-CoV-2 infection influences the incidence, progression, and outcomes of five major autoimmune conditions: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and Guillain-Barré syndrome. Patients with autoimmune diseases are at increased risk of severe COVID-19 due to intrinsic immune dysregulation and the use of immunosuppressive therapies, both of which impair antiviral host defenses. Conversely, COVID-19 has been implicated in the initiation and exacerbation of autoimmune responses through mechanisms such as molecular mimicry and bystander activation. Concerns have also arisen regarding the safety and efficacy of COVID-19 vaccines in immunocompromised populations. Although vaccines are generally tolerated in these individuals, certain immunosuppressive therapies may attenuate humoral and cellular immune responses. Strategies such as adjusting immunosuppressive regimens and optimizing the timing of vaccination have been proposed to improve vaccine efficacy. Disease-specific considerations are essential to balance infection risk with adequate control of autoimmune activity. Overall, this review underscores the importance of individualized treatment strategies, close clinical monitoring, and interdisciplinary care in managing patients with autoimmune diseases during the COVID-19 pandemic. A deeper understanding of these interactions will be critical for improving patient outcomes and preparing for future pandemics involving immune-mediated diseases.

The mortality rate of severe/critical coronavirus disease (COVID-19) is high in the elderly, and early prediction of its prognosis can facilitate timely treatment and reduce mortality. This study aims to identify early predictors of severe COVID-19 in elderly and construct a validated risk prediction model.

This retrospective study included 722 elderly COVID-19 patients (those aged ≥60) who attended Nanfang Hospital of Southern Medical University between July 2022 and November 2023. They were categorized as mild/moderate or severe/critical according to the extent of their condition during hospitalization. Predictive models were constructed using logistic regression analysis and visualized using nomograms. Receiver operating characteristic (ROC) curves were used to assess the model's accuracy and predictive value. An external validation cohort containing 1,249 elderly COVID-19 patients who were admitted to Huashan Hospital of Fudan University between March and May 2022 was also collected.

In multivariable logistic regression analysis, respiratory rate, comorbid diabetes, C-reactive protein (CRP), lymphocyte percentage, and D-dimer were independently associated with severe and critical COVID-19. Based on these findings, the final severity prediction model was constructed using three laboratory markers: CRP, lymphocyte percentage, and D-dimer. This model achieved an area under the curve (AUC) of 0.753 (0.713-0.794). For mortality prediction, CRP and D-dimer emerged as the significant independent predictors; the model showed an AUC of 0.722 (0.653-0.791) in the internal validation cohort and 0.877 (0.833-0.921) in the external validation cohort.

The predictive model incorporating features selected via logistic regression accurately predicts prognosis of severe COVID-19 in elderly, facilitating the implementation of early clinical interventions.