Automated insulin delivery (AID) systems improve glycemic control in people with type 1 diabetes (PwT1D), but evidence on effectiveness and safety in routine clinical practice over 2 years remains limited.

The Observatoire de la Boucle Fermée en France is a nationwide prospective observational study evaluating AID use in children and adults with type 1 diabetes in real-world conditions. The primary end point was time in range (TIR, 70-180 mg/dL). The primary analysis assessed the noninferiority of TIR at 24 months (M24) compared with 12 months (M12). Secondary analyses evaluated the superiority of glycemic outcomes at M24 versus baseline (M0), including HbA1c, continuous glucose monitoring metrics, and safety outcomes. A sensitivity analysis using a linear mixed-effects model examined the change in TIR between M0 and M24 according to baseline HbA1c (<8% vs. ≥8%), adjusted for age, sex, and diabetes duration.

Among 2741 PwT1D who initiated AID therapy, 2225 (81.1%) had available data at M24. Median TIR at M24 was noninferior to M12 (70.0% [62.0-77.0] at both time points). Compared with baseline, TIR increased by 12.0% at M24 (P < 0.0001), and HbA1c decreased from 7.6% to 7.1% (P < 0.0001). AID discontinuation at M24 occurred in 2.1% of participants. The proportions of participants experiencing at least one episode of severe hypoglycemia over the preceding 12 months were lower at M24 than at baseline. A significant interaction between time of AID use and baseline HbA1c category was observed (P < 0.001). At M24, TIR remained higher in participants with baseline HbA1c <8% compared with those with baseline HbA1c ≥8% (P < 0.0001).

In a large nationwide real-world cohort, AID use was associated with noninferior TIR between 12 and 24 months, significant improvements in glycemic outcomes compared with baseline, low rates of treatment discontinuation, and favorable safety outcomes.

To evaluate the predictive value of the Vasoactive Inotropic Score (VIS) for 28-day mortality in intensive care unit (ICU) patients with atrial fibrillation (AF)-related hemodynamic deterioration, to determine its optimal cutoff value, and to analyze its independent association with 28-day mortality risk.

A retrospective cohort study was conducted. Patients with AF-related hemodynamic deterioration treated in the Department of Critical Care Medicine of Sichuan Provincial People's Hospital from September 2020 to May 2025 were enrolled. General clinical data, laboratory indices at ICU admission, arterial blood gas analysis and vital signs at AF onset, and the peak VIS within 48 hours of AF onset were collected through the electronic medical record system. According to the 28-day outcome, the patients were divided into a survivor group and a non-survivor group. Clinical data were compared between the two groups. Receiver operator characteristic curve (ROC curve) analysis was performed to evaluate the predictive value of VIS for 28-day mortality and to determine its optimal cutoff value. After stratifying patients by VIS using the optimal cut off value, variables with statistically significant differences in univariate analysis were entered into a multivariable logistic regression model to identify independent predictors of 28-day mortality. An ROC curve was further plotted to evaluate the predictive performance of the combined predictive model.

A total of 123 ICU patients who met the definition of AF-related hemodynamic deterioration were identified through retrospective review of continuous electrocardiographic monitoring records and expert adjudication. Among them, 68 died and 55 survived within 28 days. Univariate analysis showed that, compared with the survivor group, patients in the non-survivor group were older, had higher proportions of diabetes mellitus, sepsis, and severe pneumonia, were more likely to receive continuous renal replacement therapy (CRRT), and had a lower proportion of postoperative cardiac surgery patients. The levels of the VIS, Acute Physiology and Chronic Health Evaluation II(APACHE II), Sequential Organ Failure Assessment (SOFA), CHA₂DS₂-VASc score, HAS-BLED score, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and lactic acid (Lac) at AF onset were higher in the non-survivor group than in the survivor group. In contrast, the proportion of patients receiving anticoagulation therapy, bicarbonate (HCO₃^-) levels at AF onset, and mean arterial pressure (MAP) at AF onset were lower, while the total length of hospital stay was shorter (all P<0.05). ROC curve analysis showed that VIS had good predictive performance for 28-day mortality, with an area under the curve (AUC) of 0.801 [95% confidence interval (95%CI) was 0.722-0.880, P<0.001]. When the optimal cutoff value of VIS was 129.705, the sensitivity was 61.8%, the specificity was 92.7%, and the Youden index was 0.545. Multivariable logistic regression analysis showed that VIS≥129.705 was an independent risk factor for 28-day mortality [odds ratio (OR)=70.532, 95%CI was 10.043-495.320, P<0.001], whereas anticoagulation therapy was an independent protective factor (OR=0.073, 95%CI was 0.006-0.870, P=0.038). Variables including age, history of diabetes mellitus, cardiac surgery, and CRRT were not significantly associated with 28-day mortality (all P>0.05). The combined prediction of anticoagulation and VIS≥129.705 achieved an AUC of 0.938 (95%CI was 0.898-0.977, P<0.001), with a sensitivity of 92.6% and a specificity of 81.8%, indicating good predictive performance.

VIS can effectively predict 28-day mortality in ICU patients with AF-related hemodynamic deterioration. The optimal cutoff value was 129.705, and VIS≥129.705 was an independent risk factor for 28-day mortality in this population. The combined predictive model based on VIS exhibited favorable predictive performance and may serve as a bedside reference tool for early identification of high-risk patients, facilitating clinical risk stratification and individualized therapeutic optimization.

Veterinary epidemiology studies of the Miniature Schnauzer have revealed high prevalence of several breed-associated diseases. However, owner-reported disease data has not been evaluated, particularly with respect to pancreatic diseases, for which this breed is considered predisposed. This study aimed to examine Miniature Schnauzer health from the owner perspective, and explore relationships between reported pancreatitis and other conditions.

An online survey open to UK-based owners of Miniature Schnauzers in 2023, including directed disease-specific questions and opportunity for free-text reporting. Analyses were performed using R, including multivariable logistic regression modelling.

Responses from 4,786 owners were received, of which 2,910 contained sufficient data for analysis. The most prevalent diseases reported were categorised as "dermatological", "mass-associated" and "allergic". Pancreatitis was reported in 7.6% of dogs. A reported diagnosis of pancreatitis was also associated with increased odds of a diabetes mellitus diagnosis. Hyperlipidaemia was reported in 1% of all Miniature Schnauzers, increasing to 3.3% of dogs over the age of 9 years.

This study identifies a high owner-reported prevalence of pancreatitis in UK Miniature Schnauzers, differing from previous veterinary epidemiological studies. The findings highlight the value of incorporating owner-reported data into breed health research and underscores the importance of effective communication between clinician and owner.

Management of adult WHO CNS grade 2 IDH-mutant diffuse gliomas has entered a more precise postoperative era. Vorasidenib has changed the discussion because it can slow progression and delay the next intervention in selected patients, but the key therapeutic question is not whether mutant IDH inhibition is active; it is where it should be placed relative to observation, reoperation, radiotherapy, and alkylating chemotherapy. We believe treatment should begin with maximal safe resection, integrated molecular diagnosis, and a careful assessment of residual non-enhancing disease, growth kinetics, symptoms, seizure burden, neurocognitive priorities, fertility goals, and patient preference. Observation remains appropriate after gross-total or near-total resection, in patients with absent or minimal residual disease, stable serial MRI, controlled seizures, and no immediate need for durable cytoreduction. Vorasidenib is best framed as an active-delay strategy for patients with measurable, non-enhancing, clinically stable residual or recurrent grade 2 IDH-mutant astrocytoma or oligodendroglioma, particularly when radiotherapy and chemotherapy can reasonably be deferred and preservation of cognition, work capacity, quality of life, or fertility options is a major priority. It should not be presented as a universal substitute for definitive local or adjuvant therapy. Radiotherapy followed by PCV, or selected temozolomide-based approaches when PCV is not feasible, remains appropriate for rapid growth, symptomatic mass effect, new or nodular enhancement, neurological decline, uncontrolled seizures, high-risk molecular pathology such as CDKN2A/B homozygous deletion, or suspected grade transformation. During surveillance or vorasidenib, treatment failure should be judged by trajectory rather than a single scan. Sustained T2/FLAIR volumetric growth, new enhancement, worsening seizures, steroid requirement, functional decline, or need for next intervention should prompt multidisciplinary re-review, repeat tissue sampling when useful, and timely transition to radiochemotherapy, salvage surgery, or clinical-trial enrollment.

Cancer-related pain remains a complex and persistent clinical challenge due to its multidimensional nature and the limitations of pharmacological treatments alone. In our view, telemedicine and virtual reality (VR) technologies represent complementary and increasingly relevant approaches that address different yet interconnected dimensions of pain management in oncology care. Telemedicine should be considered a key component of contemporary cancer care, particularly for continuous symptom monitoring, early detection of pain exacerbation, and timely clinical intervention. Its ability to enhance communication between patients and healthcare providers and to support continuity of care makes it especially valuable in the long-term management of cancer-related symptoms. In contrast, VR interventions offer a targeted, non-pharmacological strategy for modulating pain perception through attentional distraction, emotional regulation, and immersive engagement. Based on current evidence, VR appears particularly useful in the management of procedure-related pain and in patients experiencing persistent pain that is insufficiently controlled with standard approaches. We propose that the integration of telemedicine and VR should be considered within a coordinated, patient-centered care model, where telemedicine facilitates ongoing assessment and identification of patient needs, and VR is applied as an adjunctive intervention tailored to individual symptom profiles. Such an approach has the potential to enhance both symptom control and psychological well-being while supporting treatment adherence. However, despite their promise, the implementation of these technologies requires careful consideration of clinical context, patient characteristics, and system-level factors, including digital literacy and technological infrastructure. Future research should prioritize the development of standardized protocols and the evaluation of long-term outcomes to support the sustainable integration of these digital health strategies into routine oncology practice.

To identify factors associated with adherence to breast cancer (BC) screening among women with a pathogenic or likely pathogenic (P/LP) variant in a moderate-risk gene, ATM, BARD1, CHEK2, RAD51C, and RAD51D or with empiric lifetime risk ≥ 20%.

We reviewed medical records of women without breast cancer who underwent genetic counseling and testing and were advised to undergo annual breast MRI and mammography. Adherence to screening for up to three years was compared between women with a P/LP variant in a moderate-risk gene and women with an elevated empiric risk of 20-40% by the Tyrer-Cuzick model.

The study population included 44 women with P/LP variants (P/LP group) and 117 with lifetime BC estimates of 20-40% (Empiric group). Within one year, the P/LP group had significantly higher rates of screening than the Empiric group with 58% vs. 37% obtaining breast MRI and 88% vs. 55% obtaining mammograms. Time-to-event analysis demonstrated the P/LP group initiated screening significantly sooner than the Empiric group. After adjusting for having family history of BC or personal history of non-BC, the P/LP group was 3.18 and 7.04 times more likely to obtain breast MRI and mammograms, respectively. Adherence declined in both groups in the second and third year of follow-up.

Women with P/LP variants were more adherent to BC screening than those with empiric risk, underscoring the role that genetic test results may play in screening behavior. Future efforts should focus on understanding the barriers to screening and improving long-term adherence.

To determine the two-year burden, timing, and predictors of thyroid hormone therapy initiation after hemithyroidectomy in previously euthyroid adults.

Retrospective population-based cohort study using de-identified electronic health record data from Clalit Health Services (2003-2020), extracted through the MDClone research platform. Adults undergoing hemithyroidectomy with preoperative TSH < 5.0 mIU/L, no preoperative thyroid hormone therapy, and at least two years of follow-up were included. The primary endpoint was first levothyroxine dispensing or overt biochemical hypothyroidism within 24 months.

Among 8,467 eligible patients, 3,362 (39.7%) reached the endpoint within 24 months: 2,179 (25.7%) by 4 months and 3,100 (36.6%) by 12 months. Extended follow-up identified 558 additional initiations (cumulative 46.3%). Treatment initiation was markedly higher among patients with thyroid cancer (72.7%) than those without (33.4%). The strongest multivariable predictors were preoperative TSH (OR 1.55 per 1 mIU/L; 95% CI, 1.47-1.64) and thyroid cancer (OR 4.99; 95% CI, 4.29-5.81).

Thyroid hormone therapy initiation is common after hemithyroidectomy, affecting nearly 40% of previously euthyroid adults within two years. Preoperative TSH and thyroid cancer identify high-burden subgroups and should inform preoperative counseling when hemithyroidectomy is chosen to preserve endogenous thyroid function.

This study aimed to acquire a comprehensive understanding of the experiences and needs of healthcare professionals (HCPs) in a university medical center at the medical oncology department regarding the provision of uniform information on nutrition and nutritional supplements to adult patients with cancer.

This explanatory sequential mixed-methods study employed an online questionnaire that was sent to HCPs and included questions on indications for providing nutrition advice, knowledge about nutrition and nutritional supplements, and needs regarding providing uniform advice about these topics. This was followed by semi-structured interviews with HCPs to gain deeper insights into their experiences and needs.

Thirty-two HCPs completed the questionnaire, and nine HCPs participated in semi-structured interviews. The results identified five themes: knowledge of nutrition and nutritional supplements, interdisciplinary care, patient-centered care, information sources, and (scientific) basis of nutrition information and research.

This study shows that HCPs express a need for enhanced knowledge and greater consistency in nutritional care during cancer care. Although HCPs reported confidence in their general nutrition knowledge, they were less familiar with nutritional supplements. Education, awareness of guidelines, access to evidence-based information, a clearer division of roles between HCPs, and interprofessional collaboration are key to improving confidence, quality, and delivering personalized nutritional support in cancer care.

We reviewed patients with resectable advanced OSCC who underwent curative surgery with or without NAC.

This study reviewed 159 patients (NAC, 58; no-NAC, 101 patients). NAC with docetaxel and nedaplatin was administered before curative surgery for cases suspected of OSCC with high clinical and histological malignancy. The impact of NAC on overall survival (OS), local, and latent metastasis was analyzed by uni- and multivariate analysis. A decision tree analysis was performed to explore cases where NAC is expected to be effective.

N-classification and histologic differentiation significantly affected OS; NAC showed a near-significant impact, especially in invasive OSCC without nodal metastasis. On multivariate analysis, NAC and T-classification were significantly associated with local control, with NAC potentially effective for T4 or other invasive tumors; however, this association with local control did not translate into a significant difference in overall survival between the NAC and no-NAC groups. NAC did not prevent latent metastasis but had no negative effect on planned treatment.

In this retrospective single-center cohort, NAC administered before curative surgery was associated with improved local control in selected patients with advanced OSCC, particularly those with T4 tumors or high-grade histological invasion (Yamamoto-Kohama grade 4). However, this association did not translate into a significant overall survival benefit. The findings should be interpreted as hypothesis-generating given the observational design and substantial baseline imbalances between groups, and prospective validation is required before clinical recommendations can be made.

While growing evidence supports the benefits of early palliative care (PC) referral for patients with cancer, the optimal timing of referral remains unclear. This study aimed to examine the association between the timing of PC consultation and end-of-life (EOL) outcomes in patients with cancer.

This retrospective cohort study included patients with cancer who were referred for PC consultation at a tertiary hospital in the Republic of Korea between January 2018 and December 2022 and had died by June 2023. Clinical data were linked to the National Health Insurance Service database. Referral timing was categorized as late (≤ 30 days), intermediate (31-90 days), or early (> 90 days) before death. Primary outcomes included completion of advance statements, hospice use, aggressive care during the last month of life, and total medical costs near the EOL.

Among 6,151 patients, 43.3% received late referrals, and 23.8% received early referrals. Earlier referrals were more common among older patients and those with longer disease duration, Medicaid coverage, or lung and non-gastrointestinal solid tumors. Compared with late referrals, early referrals were associated with a higher likelihood of completing advance statements (adjusted odds ratio [aOR] 1.98; 95% confidence interval [CI] 1.73-2.27), greater hospice use (aOR 1.30; 95% CI 1.12-1.51), lower rates of aggressive care, and reduced medical costs near EOL.

Early PC consultation offers an important opportunity to enhance advance care planning, promote hospice use, and reduce unnecessary healthcare utilization at EOL, supporting earlier integration of PC into routine oncology practice.