In patients with resectable non-small cell lung cancer (NSCLC), the use of immune checkpoint inhibitors in both the neoadjuvant and perioperative settings has been associated with significant survival benefits. However, the comparative efficacy of neoadjuvant versus perioperative therapy remains unclear, particularly among patients who achieve pathological complete response (pCR). This study investigated the role of postoperative adjuvant therapy in patients with NSCLC achieving pCR after neoadjuvant therapy.

In this retrospective multicenter study, patients with clinical stage II-IIIB NSCLC who achieved pCR following neoadjuvant therapy between 2019 and 2024 were identified. To balance baseline covariates between the two groups, inverse probability of treatment weighting was employed for patients who did and did not receive adjuvant therapy. Disease-free survival (DFS) and overall survival (OS) were subsequently compared between the two groups, with subgroup analyses conducted according to pathological type and clinical stage.

A total of 186 patients were included, with 135 receiving adjuvant therapy and 51 undergoing observation alone. After a median follow-up of 33 months and adjustment via inverse probability of treatment weighting, no significant differences in DFS or OS were observed between the adjuvant therapy group and the observation cohort. Specifically, the comparison of DFS yielded a log-rank P value of 0.818 [hazard ratio (HR) =1.17; 95% confidence interval (CI): 0.31-4.37], and the comparison of OS yielded a log-rank P value of 0.705 (HR =1.37; 95% CI: 0.26-7.14). Treatment-related adverse events occurred in 18 patients receiving adjuvant therapy, leading to discontinuation in 10 cases.

In this multicenter real-world cohort, postoperative adjuvant therapy was not associated with improved DFS or OS among patients achieving pCR after neoadjuvant therapy. Given the limited number of events and wide CIs, these findings should be interpreted as exploratory and further validated in prospective studies.

Chest computed tomography (CT) examinations became more frequent during and after the coronavirus disease 2019 (COVID-19) pandemic, increasing incidental pulmonary nodule detection and concern about surveillance burden and lung cancer risk. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause persistent focal pulmonary abnormalities that may resemble nodules on CT. Population-level evidence on changes in pulmonary nodule detection or progression after vaccination and widespread infection remains limited. We aimed to determine whether COVID-19 vaccination phases and the late-2022 SARS-CoV-2 infection wave were associated with abrupt changes in pulmonary nodule detection or CT-based progression.

We conducted a retrospective cohort study using records from The First Affiliated Hospital of Guangzhou Medical University and the Guangzhou Cadre Health Management Center in Guangzhou, China. We analyzed 772,506 chest CT scans acquired from January 2013 to December 2023, including 627,164 inpatient scans, 46,411 hospital health-examination scans, and 98,931 cadre health-examination scans. Monthly pulmonary nodule detection and progression rates were calculated using 6-30 mm as the main nodule-size criterion and 0-30 mm as a secondary criterion. Regression discontinuity-in-time (RDiT) analyses examined four prespecified calendar time points: the first, second, and third COVID-19 vaccination phases in December 2020, June 2021, and September 2021, respectively, and the concentrated SARS-CoV-2 infection wave beginning in December 2022 after China's late-2022 policy restructuring.

The cohorts included 328,223 inpatients, 29,279 hospital health examinees, and 46,587 cadre health examinees. Median ages were 55 [interquartile range (IQR), 43-65], 46 (IQR, 36-54), and 50 (IQR, 43-57) years, respectively. Male proportions were 53.57%, 47.69%, and 66.81%. From 2013 to 2023, detection rates for 6-30 mm nodules increased from 25.85% to 31.19% in the inpatient cohort, from 12.11% to 21.64% in the hospital health-examination cohort, and from 18.38% to 29.49% in the cadre health-examination cohort. Nodules smaller than 6 mm accounted for an increasing share of detections over time. RDiT analyses showed no reproducible abrupt increase in 6-30 mm nodule detection around the three vaccination phases or the late-2022 SARS-CoV-2 infection wave. Detection P values ranged from 0.06 to 0.85, and progression P values, where estimable, ranged from 0.058 to 0.94. Secondary analyses using the 0-30 mm criterion and sex-specific inpatient analyses showed consistent patterns.

In these Guangzhou cohorts, the gradual increase in pulmonary nodule detection from 2013 to 2023 primarily reflected greater ascertainment of nodules smaller than 6 mm. COVID-19 vaccination phases and the late-2022 SARS-CoV-2 infection wave were not accompanied by consistent abrupt increases in 6-30 mm nodule detection or progression.

People with HIV (PWH) are at higher risk of cardiovascular disease (CVD) despite spontaneous or antiretroviral therapy-induced long-lasting suppressed viremia. Traditional and HIV-specific factors have been identified, but CVD incidence and mortality remain high. A microbiome is a community of germs living close to their human host, and bacterial dysbiosis is associated with atherosclerosis and chronic non-communicable disease development.

We conducted a pilot study designed to analyze the effect of tailored diet intervention on body mass index (BMI), metabolic features and microbiota composition in PWH with suppressed HIV viremia (HIV RNA <50 copies/mL) under combination antiretroviral treatment. Biomarkers and parameters were measured at baseline and 6 months (M6) after.

Ten male participants were enrolled. The median age was 60.5 years (54-69) and the 10-year CV risk was 11.7% (7.2-21.2). CD4+ T lymphocyte count was 568 cells/mm³ (398-625). Approximately 75% of participants declared to be adherent to the given dietary recommendations. Participants showed reduced amounts of food intake (p = 0.022) and, specifically, of saturated fat (p = 0.007) and cholesterol (p = 0.011). At M6, most metabolic and inflammatory parameters remained stable. TMAO concentrations were higher at M6 than at baseline (157 vs. 129 ng/mL, p = 0.050). Microbiota alpha and beta diversity did not change over time: yet we observed a significant reduction of Firmicutes (p = 0.047) and an increase in Proteobacteria (p = 0.028) relative abundance at M6.

In this pilot study assessing a tailored dietary intervention in high CV-risk PWH, we observed stable metabolic and inflammatory parameters and an unexpected increase in TMAO levels at 6 months. Microbiome composition was marginally affected, and active interventions are probably needed to elicit significant changes over time.

Radiotherapy remains a cornerstone of cancer treatment, while its efficacy is often limited by tumor radioresistance and the risk of normal tissue toxicity. Conventional preclinical models, including two-dimensional (2D) cell cultures and murine xenografts, exhibit significant limitations in recapitulating human tumor pathophysiology, thereby impeding the clinical translation of novel radiotherapeutic strategies. Patient-derived organoids (PDOs) have emerged as transformative three-dimensional (3D) ex vivo models that recapitulate key aspects of original tumor heterogeneity and are increasingly applied in oncology research.

This article provides a comprehensive review of the literature on the application of PDOs in radiation oncology, with a focused analysis of their pathway toward clinical translation.

PDOs demonstrate significant utility in predicting radiosensitivity, elucidating radioresistance mechanisms, optimizing combination therapies, modeling radiation injury, and screening targeted drugs. The integration of organoid technology with microfluidic organ-on-a-chip (OoC) platforms also offers unprecedented capability to dynamically simulate the tumor microenvironment and conduct high-throughput dose-response studies. A translational roadmap is presented for leveraging these biomimetic systems to advance personalized radiotherapy, ultimately aiming to accelerate the clinical translational application of organoids.

Despite challenges in standardization and immune component recapitulation, PDOs represent a powerful platform for advancing personalized radiotherapy.

Diabetes mellitus is a major global health challenge that is controlled through insulin therapy; however, its use is limited by several barriers. This study assessed physicians' perceptions of insulin use, associated barriers and suggested improvements in a tertiary care hospital in Lahore, Pakistan.

A cross-sectional survey was conducted at a tertiary care public sector hospital of Lahore, Pakistan, from September 2024 to February 2025. A total of 808 physicians participated. Data were collected through a questionnaire and analysed using descriptive and inferential statistics. Chi-square, Kruskal-Wallis, Bonferroni post hoc tests and binary logistic regression were applied using IBM SPSS Version 27.

Among 808 physicians, 369 were males, and 439 were females. Most had 5-10 years of clinical experience, with medicine as the largest speciality. Common barriers to insulin therapy included patient resistance, hypoglycaemia, regimen complexity, cultural beliefs and limited resources. Male physicians were more likely to report barriers in both unadjusted and adjusted analyses (OR = 1.414, p = 0.015; AOR = 1.392, p = 0.024). MRCP-qualified physicians also had higher odds of reporting barriers (OR = 1.642, p = 0.034; AOR = 1.657, p = 0.042). Physicians with 5-10 years' experience were less likely to report barriers than those with < 5 years (OR = 0.557, p < 0.001; AOR = 0.588, p < 0.001). Physicians recommended that diabetes educators and regular follow-up can improve adherence.

Major barriers to insulin therapy included patient resistance, inadequate education, cultural beliefs, financial constraints and fear of hypoglycaemia. Physicians emphasized the need for better patient education, regular follow-up and improved communication to enhance insulin adherence.

Type 2 diabetes affects everyday life, requiring patients to learn to live with the illness. Although group-based education can improve clinical outcomes and support self-care, it remains underutilised in Sweden. Only about a fifth of healthcare centres offer group-based education, and many patients opt out of participation. Understanding the various reasons patients opt out is crucial for designing group-based education that meets individual needs and promotes long-term disease management. This study aims to describe variations in the conceptions of patients with type 2 diabetes who opted out of group-based education.

A phenomenographic approach was applied based on 18 individual interviews with patients in primary care who opted out of group-based education for type 2 diabetes.

Three conceptions emerged regarding group-based education for type 2 diabetes, reflecting patients' varied views and understanding. Some patients saw no need for group-based education and preferred individual learning. Others recognised the benefits and barriers of group-based education, such as inflexible schedules. Others appreciated the reflective and supportive environment, shared experiences, and greater self-insight.

Patients who declined group-based education held varied conceptions, from preferring individual counselling to recognising benefits. Understanding these variations supports more personalised education and better long-term self-management. These insights may inform clinical and assistive practices by promoting more flexible and person-centered approaches to diabetes education within primary care.

Aim: To identify factors associated with ocular structural changes inherent to PEX among Ukrainian patients.

Materials and Мethods: The study was based on a clinical examination of 56 patients (112 eyes) aged 14 to 88 years. The main group included 39 patients (78 eyes) with ocular structural changes confirming the diagnosis of PEX: 14 patients (28 eyes) and 25 patients (50 eyes) with uni- and bilateral lateral involvement, respectively. The control group consisted of 17 patients (34 eyes) without any signs of PEX. The follow-up period was 5 years.

Results: The findings of the study support the concept of PEX as a systemic fibrillopathy, accompanied by a significant association with chronic coronary syndrome (64%), joint pathology (72%), diabetes mellitus (40%), and central nervous system (56%) disorders compared with the control group. Environmental factors, particularly urbanization (52%) and increased radiation background (64%), are likely additional contributors to disease development. The study demonstrated that bilateral PEX is accompanied by changes in eye structures: pronounced trabecular pigmentation (48%), a critical decrease in corneal endothelial cell density (80%), progression of age-related macular degeneration (40-44%), and the development of posterior subcapsular cataract (96%). In contrast, patients with unilateral PEX demonstrated a significantly higher long-term risk of nuclear cataract progression.

Conclusions: Managing patients with PEX necessitates a comprehensive multidisciplinary approach in view of the associated comorbidities and contributing factors. The clinical course of unilateral PEX is strongly linked to exposure to exogenous triggers (urbanization, increased background radiation, and tobacco smoking). The absolute majority of eyes with bilateral PEX showed biomechanical weakness of the sclera and cornea.

Familial hypercholesterolaemia (FH) is a genetic disorder characterised by elevated levels of circulating low-density lipoprotein cholesterol. Serious presentations are challenging to treat. We report a case of complex cardiovascular outcomes in a 28-year-old man with diabetes mellitus and untreated FH. The diagnostic workup was compatible with a homozygous phenotype. The patient presented with a non-ST-elevation myocardial infarction, which revealed severe premature three-vessel coronary artery disease with significant proximal blockages, including severe ostial left main stenosis, as well as severe valvular and supravalvular aortic stenosis. Aortic computed tomography angiography (CTA) confirmed the presence of a porcelain aorta and guided the surgical repair. Despite the porcelain aorta, the patient underwent conventional cardiac and aortic surgery with an uneventful post-operative course. This case highlights a rare case of successful cardiac and aortic surgery in the context of a porcelain aorta, performed safely by experienced surgeons using current perfusion and operative techniques guided by CTA imaging. Ongoing efforts are required to improve early detection and prompt management of FH.

Clinical inertia, defined as the failure to initiate or intensify therapy when clinically indicated, represents a major and under-addressed barrier to achieving cardiovascular risk (CVR) factor control in primary care. Despite the availability of evidence-based guidelines and effective pharmacological treatments, many patients with uncontrolled hypertension, diabetes, or dyslipidaemia do not receive appropriate treatment intensification. We aimed to evaluate the prevalence of clinical inertia, identify associated patient-level factors, and assess its impact on CVR factor outcomes in high-risk primary care patients.

This was a pre-specified secondary analysis of the Objetivo Punto de Mira (OPM) study, a multicentre, prospective, quasi-experimental interventional study conducted in primary care settings across nine Spanish regions (2024-2025). We included 711 participants with at least one uncontrolled CVR factor at baseline (hypertension, diabetes, or dyslipidaemia). Clinical inertia was operationalised, among therapeutically adherent patients, as the absence of documented pharmacological treatment initiation, dose escalation, or appropriate combination therapy when a risk factor remained uncontrolled. We estimated prevalence with 95% confidence intervals (CIs). Multivariable logistic regression identified factors associated with clinical inertia. Linear mixed-effects models assessed changes in CVR factors from baseline to 90-day follow-up, comparing patients with and without clinical inertia. Risk analysis quantified the association between clinical inertia and persistent uncontrolled status.

Among patients with uncontrolled conditions at baseline, clinical inertia was observed in 49.3% (n/N = 208/422) for hypertension, 31.1% (n/N = 73/235) for diabetes, and 38.2% (n/N = 217/568) for dyslipidaemia. Overall, 54.3% of participants (n/N = 386/711) exhibited clinical inertia in at least one condition. We found no statistically significant associations between clinical inertia and age, sex, CVR category, or excess weight. Clinical inertia significantly increased the risk of remaining uncontrolled across any condition (relative risk = 1.13; 95% CI = 1.03, 1.24; absolute risk difference = 9.3%; 95% CI = 2.4, 16.2; number needed to harm ≈ 11, P = 0.007), though not for individual conditions separately. At 90-day follow-up, patients with clinical inertia showed significantly smaller reductions in total cholesterol (between-group difference in change = 19.3 mg/dL; 95% CI = 12.4, 26.3, P < 0.001) and low-density lipoprotein cholesterol (15.5 mg/dL; 95% CI = 8.9, 22.0, P < 0.001) compared with patients who received treatment intensification. We also observed a small but statistically significant difference in body mass index reduction (0.25 kg/m²; 95% CI = 0.02, 0.49, P = 0.036). Both groups showed significant within-group reductions in systolic and diastolic blood pressure (P < 0.001); however, the magnitude of change did not differ significantly between patients with and without clinical inertia (between-group interaction P > 0.05 for systolic blood pressure and diastolic blood pressure). We found no significant between-group differences for glycaemic parameters, high-density lipoprotein cholesterol, or triglycerides.

Clinical inertia affects more than half of high-risk primary care patients with uncontrolled CVR factors. Patient demographic and clinical characteristics examined (age, sex, CVR category, excess weight) did not predict clinical inertia in this sample, consistent with, but not proof of, provider- and system-level influences described in prior literature.

Diabetes, a chronic condition prevalent among older adults, imposes a substantial disease burden. Effective care requires sustained self-management, and digital health technologies increasingly support this process. For older adults, engagement in digital health depends not only on individual skills but also on health-related social needs (HRSNs), which reflect unmet social and environmental conditions that hinder effective health maintenance. This study aimed to examine associations between diabetes status and HRSNs and to investigate their associations with eHealth literacy in community-dwelling older adults with chronic diseases. A cross-sectional survey was conducted with community-dwelling adults aged ≥60 years in South Korea. HRSNs were assessed using the Accountable Health Communities Screening Tool, and eHealth literacy was measured using the eHealth Literacy Scale. Multivariable logistic regression was used to examine differences in domain-specific HRSNs by diabetes status and generalized linear models were applied to assess the associations of diabetes status and HRSNs with eHealth literacy. The overall HRSN burden did not differ according to diabetes status; however, older adults with diabetes were less likely to report unmet mental health needs. Diabetes status, but not HRSNs, was associated with lower eHealth literacy. These findings suggest that digital self-management support for older adults with diabetes should consider eHealth literacy levels and diabetes-related characteristics, while HRSN screening may provide complementary information on unmet social needs relevant to digital health access and engagement.