Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver condition, closely associated with obesity and type 2 diabetes mellitus.

Despite its prevalence, there are no approved pharmacotherapies, making the search for effective treatments crucial.

This study investigates the impact of vertical sleeve gastrectomy (VSG) on NAFLD, focusing on changes in bile acid metabolism as a potential therapeutic mechanism. We employed an ApoE-/- mouse model to simulate human NAFLD conditions. Mice were divided into two groups: one underwent VSG and the other served as a control. We monitored body weight, food intake, liver function, lipid profiles, and histological changes in hepatic tissues. Bile acid profiles were analyzed using Ultra Performance Liquid Chromatography coupled with Tandem Mass Spectrometry (UPLC-MS/MS).

Post-VSG, mice exhibited significant weight loss and reduced food intake. Biochemical analyses showed substantial improvements in liver function tests (ALT and AST), lipid profiles (cholesterol and triglycerides), and glucose regulation. Histological examination revealed marked reductions in hepatic steatosis and inflammation. Notably, VSG led to significant alterations in bile acid profiles, particularly increased primary bile acids and decreased secondary bile acids, correlating with improved liver histology and metabolic parameters.

Our findings suggest that VSG, beyond its role in weight reduction, significantly improves NAFLD. The surgery alters bile acid metabolism, which may contribute to its therapeutic effects. These results highlight the potential of VSG as a metabolic surgery for NAFLD and open avenues for exploring bile acid-related therapies.

The InTempo adaptive imaging system is an important component of the Accuray CyberKnife System, designed to enhance the system's ability to track and correct tumor motion during treatment. However, a limitation of this feature is the reduction of available nodes for treatment planning. The impact of a reduced number of nodes on the quality of InTempo-based treatment plans has not previously been evaluated. This retrospective study aims to compare the dosimetry of CyberKnife plans with and without The InTempo path set for both prostate and lung stereotactic body radiotherapy (SBRT).

This study included twelve consecutive prostate SBRT patients and twenty selected lung SBRT patients. The selection criteria for the 20 lung patients were motivated by being able to construct a data set representative of common treatment tracking methods and dose prescriptions. To evaluate the impact of InTempo imaging, treatment plans were re-optimized using the same optimization parameters and machine settings, except for the path set with the maximum number of nodes. To ensure a fair comparison, the study plans were prescribed using identical planning target volume coverage as the clinical treatment plans. Statistical analyses were performed using mean and standard deviation, dose metric plots, and a two-sided Wilcoxon signed rank test with multiple testing correction to compare dose metrics between different path sets.

No statistically significant differences were observed among the Prostate, Prostate_Short, and their corresponding InTempo path sets in at least 8 of the 14 evaluated plan metrics, including prostate clinical tumor volume (CTV) V40Gy(%), conformity index, and homogeneity index. For example, the mean prostate CTV V40Gy (%) for the Prostate, Prostate_Short, and their corresponding InTempo path sets was 90.8 ± 4.7, 89.4 ± 4.7, 90.2 ± 3.9, 91.0 ± 7.0, respectively. However, compared with the Prostate path set, the Prostate_InTempo path set exhibited a statistically significant reduction in delivery time (p = 0.0010), number of beams, and bladder V18Gy (%), along with a statistically significant increase in the number of imaging beams (p = 0.0010). Additionally, Prostate_Short demonstrated statistically significant reductions in delivery time and number of beams compared with the Prostate path set, while the number of imaging beams remained statistically equivalent. In contrast, the Reduced_Prostate and Reduced_Prostate_InTempo sets consistently resulted in inferior dosimetric outcomes, with several plans deemed unoptimizable due to insufficient node availability. For lung SBRT, statistically significant differences were observed in delivery time and the number of imaging beams between plans with and without InTempo. However, no statistical differences were found in dose distribution metrics between these two lung groups.

InTempo-compatible path sets do not significantly compromise plan quality for prostate or lung SBRT, provided adequate node availability. Specifically, the Prostate_InTempo and Prostate_Short path sets demonstrated a reduction in delivery time and an increase in adaptive imaging frequency compared with the Prostate path set. However, the Reduced_Prostate and Reduced_Prostate_InTempo result in inferior plan quality and reduced deliverability and should be used with caution. These findings support the selective use of InTempo imaging in SBRT planning without sacrificing dosimetric integrity.

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by the accumulation of protein fibrils with an abnormal 3D configuration in the myocardium. The introduction of targeted therapies for the two most common forms, light-chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), has made prompt recognition and accurate typing of the amyloid protein indispensable. Although in some ATTR cases a diagnosis can be reached with noninvasive imaging methods, diagnostic confirmation by peripheral or endomyocardial biopsy remains fundamental for many patients with ATTR and for all those with AL or rarer CA variants. The available typing complementary techniques are immunohistochemistry, immunofluorescence, immune electron microscopy, and mass spectrometry, each with specific strengths and limitations. This review describes the current indications for tissue analysis and compares the options for amyloid typing, with the aim of providing guidance relevant to clinical practice.

Whole brain radiation therapy (WBRT) has been shown to provide palliation but with negative neurocognitive effects associated with radiation-induced damage to the hippocampus. Sparing of the hippocampus has been shown to reduce the risk of neurocognitive deficit. The goal of this study is to develop a VMAT planning strategy for WBRT with hippocampal avoidance (HA) that will minimize hippocampal dose while achieving homogeneous coverage of whole brain PTV.

A retrospective study was performed on 10 patients previously treated for intracranial lesions. CT and MRI fused images were used to delineate the whole brain and hippocampus. Strictly following RTOG 0933 atlas guidelines, the hippocampus was manually delineated by a single radiation oncologist. A 4-arc noncoplanar VMAT approach was studied and compared with a 2-arc coplanar method for a prescription of 30 Gy in 10 fractions. We first generated an intermediate plan that optimized only the portion of the whole-brain PTV located farther from the hippocampus. Optimization was then continued by adding the remaining portions of the whole-brain PTV to the optimization structure. In the 4-arc VMAT optimization, a similar intermediate plan was utilized but in addition to this, the hippocampus was blocked for both entry and exit. Dosimetric parameters from both techniques were compared by paired t-test.

When compared to RTOG 0933 dosimetric criteria, both the 2-arc coplanar plans and 4-arc noncoplanar met them with a great margin. However, the 4-arc noncoplanar VMAT approach achieved dramatically better dose sparing for hippocampus as measured by D_0.03cc (10.55 Gy vs 12.66 Gy, p < 0.001), and D_mean (8.43 Gy vs 9.74 Gy, p < 0.001) when compared to the 2-arc coplanar plans. Dose homogeneity of whole brain PTV was also improved substantially in the 4-arc noncoplanar approach as measured by D_2% (32.49 Gy vs 32.90 Gy, p < 0.001), D_98% (28.55 Gy vs 27.97 Gy, p < 0.001), and the homogeneity index (HI) (0.126 vs 0.155, p < 0.001).

Using an intermediate plan in VMAT optimization, both the 2-arc coplanar plans and 4-arc noncoplanar plans meet RTOG 0933 criteria with a great margin, while the 4-arc noncoplanar VMAT planning method for HA-WBRT further improves the hippocampus sparing, as well as whole brain PTV coverage and dose homogeneity.

To overcome limitations of conventional VMAT for cervical cancer, specifically restricted OAR sparing due to static collimators and delivery constraints inherent to dynamic modulation, we systematically evaluate RapidArc Dynamic (RAD) technology. This first comprehensive assessment focuses on RAD's multi-axis coordination for optimized pelvic radiotherapy planning.

Twenty cervical cancer patients treated with TrueBeam whose energy was 6MV X-ray were retrospectively analyzed. The prescription was 45 Gy/25Fractions. Seven RAD-based planning strategies with varying collimator rotation modes (Optimize [OPT] vs. Optimize Between Static Angles [OBSA] vs. Static [STAT]) and aperture sizes (15 vs. 30 cm) and different static angle ports were developed using identical optimization objectives. Re-optimized clinical plan using Eclipse v18.1. All RAD and clinical plans were normalized so that the target received a certain dose with 95% target coverage for final dosimetric comparison. Dosimetric comparisons employed ANOVA (with LSD post hoc) for parametric data or Kruskal-Wallis's test (with Mann-Whitney U post hoc) for non-parametric data, with significance set at p < 0.05.

RAD plans showed slightly inferior conformity and homogeneity compared to clinical plans, they achieved superior dose fall-off gradients. RAD's advantage was particularly evident in sparing organs at risk (OARs). Specifically, for the bladder, significant reductions were noted in D m e a n ${{D}_{mean}}$ (8.29%-13.05%), V 20 Gy ${{V}_{20{\mathrm{\ Gy}}}}$ (4.04%-26.71%), and V 30 Gy ${{V}_{30{\mathrm{\ Gy}}}}$ (26.98%-32.46%) compared to the clinical plans. Similarly, for the rectum, reductions in D m e a n ${{D}_{mean}}$ (9.21%-15.58%), V 20 Gy ${{V}_{20{\mathrm{\ Gy}}}}$ (5.03%-14.77%), V 30 Gy ${{V}_{30{\mathrm{\ Gy}}}}$ (18.24%-28.11%), and V 40 Gy ${{V}_{40{\mathrm{\ Gy}}}}$ (23.73%-31.22%) were observed. Other OARs also benefited from improved dosimetric parameters. While both the 2ARC+OBSA+15 and 2ARC+STAT+15 plans outperformed other RAD configurations, the 2ARC+OBSA+15 plan generally provided superior results. Notably, although RAD plans overall showed significantly higher small intestine D_2cc, the 2ARC+OBSA+15 configuration achieved comparable doses to clinical plans. In terms of monitor units (MU) and plan complexity, RAD plans were more complex but maintained a high verification pass rate of over 97%.

The preliminary exploration of RAD plans reveals superior capability in sparing the doses of OARs. Moreover, in the RAD plans, the optimization of collimator angles and aperture at 15 cm yields better dosimetric outcomes. Therefore, further exploration of different mechanical axis combinations is of great significance in future studies.

To systematically evaluate and synthesize qualitative evidence on the lived experiences of self-management engagement among adult patients with hematologic malignancies to inform the development of targeted interventions.

A systematic literature search was conducted across eight databases (including PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, WanFang, and CBM) from inception to July 2025, with an updated search performed in January 2026. Sixteen qualitative studies involving adults (≥ 18 years) with hematologic malignancies were included. The methodological quality of the included studies was appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist (2020). Data were synthesized using the thematic synthesis method.

This meta-synthesis integrated findings from 16 studies involving adults with diverse hematologic malignancies across 11 countries, covering trajectories from active treatment to long-term survivorship. Using NVivo 15.0 for inductive thematic analysis, the synthesis established four overarching analytical themes reflecting the unique demands of this population: (1) The Hidden Work: Vigilance and Risk Management, which details the hyper-vigilance required for infection prevention, bleeding risks, and continuous physiological monitoring; 2) Psychological Labor and Emotional Adaptation, encompassing the cognitive burden of dyadic coping, protective buffering, and managing the pervasive fear of relapse; 3) Engagement Capacity: Drivers and Resources, which bridges intrinsic drivers with the essential knowledge and skills required for self-management; and 4) The Context of Care Continuum, highlighting the systemic barriers and information gaps encountered during critical disease transitions.

This meta-synthesis indicates that self-management engagement in hematologic malignancies extends beyond task adherence to involve continuous "risk work" and significant emotional labor within the family unit. Findings suggest that nursing interventions should prioritize targeted strategies, such as sepsis-prevention education and dyadic coping support, over generic approaches. Addressing these specific, high-stakes demands is critical for optimizing patient safety and quality of life throughout complex treatment transitions.

Survivors of childhood, adolescent, and young adult cancers (CAYA) experience unique survivorship needs that are often unaddressed. We characterized young adult CAYA survivors' perspectives on the acceptability and utility of a novel model for routinely identifying and addressing their needs in survivorship care.

Our onco-primary care program implemented routine needs-based care using age-appropriate needs and distress screening at survivorship visits. Survivors completed a screener and ranked their top three concerns for discussion, and clinicians discussed and addressed survivors' prioritized concerns. Research personnel recruited English-speaking survivors ages 18-39 with a history of cancer during their clinic visit. Twelve survivors completed semi-structured interviews about their needs-based care experience. We conducted iterative thematic content analysis to identify themes.

The sample was 41.7% male and included some diversity of race and ethnicity (e.g., 16.7% Asian American, 25.0% Hispanic). We defined five themes: (1) Being asked relevant, age-appropriate questions made survivors feel "seen" and enhanced connection to the care team. (2) The model helped survivors identify their concerns and overcome barriers to talking about them with the clinician. (3) Prioritizing concerns was challenging but facilitated focus in the visit. (4) Completing the assessment at the visit and at every visit was acceptable. (5) Survivors were satisfied with communication and how their needs were addressed.

Young adult CAYA survivors had positive perceptions of routine age-appropriate needs assessment followed by clinician discussion in survivorship. This model was relevant, useful, and acceptable, and enhanced their perceptions of providers and satisfaction with care.

Accurate classification of cancer-related biomedical abstracts is critical for advancing cancer informatics and supporting decision-making in healthcare research. Yet progress in this domain is often constrained by limited availability of labeled corpora and the high computational demands of transformer-based approaches. To address these challenges, we propose a Residual Graph Attention Network (R-GAT) that integrates multi-head attention with residual connections to capture semantic and relational dependencies in biomedical texts. Evaluated on a curated dataset of 1,875 PubMed abstracts spanning thyroid, colon, lung, and generic cancer topics, R-GAT achieves stable and competitive performance (macro-F1: 0.96 ± 0.01), comparable to transformer-based models such as BioBERT and BioClinicalBERT and strong classical baselines like Logistic Regression, while requiring significantly fewer computational resources. Ablation studies confirm the importance of attention and residual connections in ensuring robustness under limited-data conditions. To support reproducibility and facilitate future research, we also release the curated dataset. Together, these contributions demonstrate the value of lightweight graph-based architectures as reliable and resource-efficient alternatives to computationally intensive transformers in biomedical NLP.

Healthcare transition readiness is crucial for adolescent and young adult childhood cancer survivors (AYA CCS) to ensure continuity of care as they move from pediatric to adult healthcare services. A systematic review of the evidence linking social determinants of health (SDoH) and healthcare transition readiness is needed to provide valuable insights into the impact of disparities on transition.

A mixed-methods systematic review (MMSR) was conducted on studies published through November 2025. Quantitative data were extracted to assess measurable outcomes related to healthcare transition readiness and SDoH, while qualitative studies exploring the perceptions and experiences of AYA CCS, their families, and healthcare providers on transition readiness were analyzed using thematic synthesis. The final synthesis followed a convergent integrated approach, guided by the Healthy People 2030 SDoH framework.

Seventeen studies (five quantitative and twelve qualitative) were included. Healthcare access and quality emerged as the most influential SDoH, with consistent evidence showing that relationships with knowledgeable healthcare providers, and access to health insurance and healthcare services were associated with healthcare transition readiness. Social and community context - including parental and peer support - also contributed to readiness. Evidence for economic stability was mixed, while education access and quality and neighborhood factors were the least examined and remain inconclusive. Integrated analysis indicated that structural (e.g., insurance, provider access) and relational SDoH (e.g., communication quality, family and peer support) influence healthcare transition readiness among AYA CCS. CONCLUSIONS AND IMPLICATIONS: This MMSR provides a comprehensive understanding of how SDoH impact healthcare transition readiness among AYA CCS. The findings underscore the need for future research to address gaps in the current literature and to improve transition outcomes and reduce disparities during the transition process in this population.

Integrated digital diagnostics can support complex surgeries in many anatomic sites, and brain tumour surgery represents one of the most complex cases. Neurosurgeons face several challenges during brain tumour surgeries, such as differentiating critical tissue from brain tumour margins. To overcome these challenges, the STRATUM project will develop a 3D decision support tool for brain surgery guidance and diagnostics based on multimodal data processing, including hyperspectral imaging, integrated as a point-of-care computing tool in neurosurgical workflows. This paper reports the protocol for the development and technical validation of the STRATUM tool.

This international multicentre, prospective, open, observational cohort study, STRATUM-OS (study: 28 months, pre-recruitment: 2 months, recruitment: 20 months, follow-up: 6 months), with no control group, will collect data from 320 patients undergoing standard neurosurgical procedures to: (1) develop and technically validate the STRATUM tool and (2) collect the outcome measures for comparing the standard procedure versus the standard procedure plus the use of the STRATUM tool during surgery in a subsequent historically controlled non-randomised clinical trial.

The protocol was approved by the participant ethics committees. Results will be disseminated in scientific conferences and peer-reviewed journals.

NCT07036783.