Cervical cancer (CC) remains a significant public health challenge in low- and middle-income countries (LMICs), including Brazil. While global incidence has declined, age-specific variations may mask emerging trends among younger women. This study aimed to evaluate trends and age-specific changes in CC incidence in Brazil between 2000 and 2018.

Incidence data and age at diagnosis were obtained from Brazilian Population-Based Cancer Registries (PBCRs) for the period 2000-2018. Temporal trends were evaluated using Joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs).

Between 2000 and 2018, 66,358 CC cases were identified across 33 PBCRs. The median age at diagnosis was 51 years (IQR, 40-63), declining from 52 years in 2000 to 48 years in 2018. The overall adjusted incidence showed a significant decline between 2000 and 2013 (APC: -4.5% [95% CI, -5.3 to -3.7]; P < .001) followed by a nonsignificant increase from 2013 to 2018 (APC: 3.1 [95% CI, -1.6 to 8.1]; P = .20). Age-stratified analyses revealed rising trends among women age 25-44 years, suggesting a transition to younger age at diagnosis.

The observed decrease in median age and rising incidence among women younger than 45 years indicate a potential epidemiologic shift in CC in Brazil. These findings highlight the need to strengthen national screening programs, expand human papillomavirus (HPV) vaccination coverage, and incorporate molecular HPV testing into prevention strategies.

This study aims to evaluate the safety, feasibility, effectiveness, and cost-saving potential of a shortened, vial-sharing outpatient blinatumomab regimen for treating relapsed or refractory (R/R) ALL in children.

We conducted a retrospective study of pediatric patients with R/R B-cell ALL (B-ALL) treated with a shortened outpatient blinatumomab regimen (<21 days), aiming to achieve a negative measurable residual disease (MRD) remission before hematopoietic stem-cell transplantation (HSCT).

Twelve patients were included: three (25%) with primary refractory disease and nine (75%) with relapse. The median follow-up time was 33 months (range, 10-76 months). Blinatumomab was administered for a median of 19 days (range, 11-21), with 75% (9 of 12) of patients completing treatment entirely on an outpatient basis. Five patients (62%) achieved CR with undetectable MRD, and all four patients who initiated treatment because of persistent MRD achieved MRD clearance (100%). Ten patients (83%) proceeded to haploidentical HSCT. The estimated 3-year overall survival (OS) was 54%, and the relapse-free survival (RFS) was 44%. These optimization measures resulted in a 43% reduction in drug-related expenditures.

Reduced-duration outpatient blinatumomab shows promise as a context-adapted strategy for heavily pretreated pediatric patients with ALL. Given the small retrospective cohort, these findings should be interpreted with caution.

Latin America (LATAM), home to over 650 million people, remains under-represented in global oncology trials despite a growing cancer burden. This study aimed to evaluate the evolution of LATAM participation in phase III oncology trials over the past decade, with a focus on site distribution, cancer types studied, therapeutic classes investigated, and demographic reporting.

We conducted a cross-sectional analysis of global phase III oncology trials registered on ClinicalTrials.gov between January 1, 2013, and December 31, 2022. Trials were included if they studied anticancer therapies and listed at least one LATAM site. We extracted data on trial geography, cancer type, treatment modality, control group, and Hispanic ethnicity reporting. Trends in proportional regional site representation and therapy class were assessed using the Mann-Kendall trend test.

A total of 172 phase III trials with LATAM sites were identified, representing 2,609 of 29,718 global sites (8.8%). Brazil (45.8%), Argentina (18.6%), and Mexico (13.0%) accounted for over 75% of LATAM trial sites. LATAM's proportional site representation increased modestly from 7.1% in 2013 to 9.3% in 2021 (Bonferroni-adjusted P = .040), but no individual country showed a statistically significant increase. The most frequently studied cancers were lung (26.7%), breast (22.1%), and genitourinary (16.3%). Targeted therapies (42.4%) and immunotherapies (33.1%) dominated, whereas hormone therapy declined over time. Hispanic ethnicity was reported in only 61.6% of trials, with no improvement over time.

Although LATAM's participation in global oncology trials has increased, it remains geographically concentrated and demographically under-reported. Structural and policy efforts are needed to improve trial equity and align research with regional cancer burdens.

Virtual health care, originally as telephone-based telehealth, has been used for more than 45 years; however, the literature shows limited understanding of the competencies required for safe virtual care practice in nursing and other health-related fields. This has led to a widening education-practice gap.

The aim of this study is to identify (1) clinical guidelines for nurses and other health professionals undertaking routine virtual health (telehealth) assessment, triage, and follow-up care; and (2) curricula for preparing health professionals for virtual care. Subsequently, data will be collected within a major cancer treatment service to codetermine core competencies and curricula for nurses engaged in telehealth clinics.

This was a phased multimethod study including reviews of existing literature, followed by qualitative (in-depth interviews, n=20) and quantitative (online survey, n=200) data collection and co-design workshops (n=5) to achieve project aims. Implementation will involve a pilot and an evaluation before full rollout of the developed guidelines and syllabus.

Literature reviews completed in the initial phase of this project confirm a paucity of existing guidelines for virtual health assessment and an urgent need to develop telehealth or virtual care competency frameworks and curricula for health professionals in training or practice. We propose an approach to develop and test these materials in practice. A total of US $52.6 was provided by a philanthropic alumni for support over the full duration of the project. Recruitment and collection from human participants will commence on February 1, 2026, following procurement of ethics clearance. Phase 2 data collection and analysis will occur from February to December 2026. Results will be presented to the ethics committee and clearance gained to implement and evaluate the program in 2027.

Working with health providers, consumers, and academics toward standards of practice and curricula is clearly needed to ensure that the current and future nursing workforce is prepared for the continuing rise in virtual care. Completion of this project will fill an existing gap in the provision of guidelines and education for nurses providing virtual care.

BackgroundMalignant neoplasms of bone and articular cartilage represent a rare group of highly invasive tumours with a poor prognosis, whose molecular mechanisms remain incompletely understood. Systematic identification of potential pathogenic proteins holds significance for early diagnosis and targeted therapy.MethodsA genetic tool was constructed using nine large-scale cis-protein quantitative trait loci (pQTL) datasets. Dual-sample Mendelian randomisation analysis was performed with plasma proteins as exposure and malignant neoplasms of bone and articular cartilage risk as the outcome. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed on proteins showing suggestive causal associations (p < 0.05). Sensitivity analyses, Steiger's directionality tests and co-localisation studies were conducted on Bonferroni-corrected significant proteins. Finally, candidate small-molecule drugs were predicted using the Enrichr database and molecular docking analysis.ResultsPreliminary Mendelian randomisation analysis identified 171 suggestive causal proteins, with 80 positively and 91 negatively correlated with the risk of malignant neoplasms of bone and articular cartilage. Enrichment analysis revealed that these proteins primarily participated in immune regulation, extracellular matrix degradation and proteolysis-related pathways. Following Bonferroni correction, seven proteins-GNLY, PCSK7, ADAMTS5, PDCD1LG2, SCG3, CXCL16 and CNTN1-retained significant causal associations. Further co-localisation analysis revealed that ADAMTS5, GNLY and PCSK7 shared genetic variants associated with the risk of malignant neoplasms of bone and articular cartilage. Molecular docking analysis indicated that compounds such as aspirin and vitamin E exhibited low binding energies with GNLY, PCSK7 and ADAMTS5, suggesting potential therapeutic intervention opportunities.ConclusionThis study identified three proteins (GNLY, PCSK7 and ADAMTS5) associated with a high risk of malignant neoplasms of bone and articular cartilage through Mendelian randomisation and co-localisation analyses, providing novel molecular evidence for early diagnosis, risk assessment and potential targeted therapies for malignant neoplasms of bone and articular cartilage.

To measure serum insulin-regulated aminopeptidase levels in women diagnosed with polycystic ovary syndrome and to investigate their potential contribution of these levels to the development of insulin resistance, which plays a central role in the pathophysiology of polycystic ovary syndrome.

The study group, recruited between May and December 2021, consisted of 40 patients diagnosed with polycystic ovary syndrome and 40 age-matched healthy controls. Serum insulin-regulated aminopeptidase levels were compared between the groups using the ELISA method.

Serum insulin-regulated aminopeptidase levels were significantly lower in the polycystic ovary syndrome group compared with the control group (p < 0.001). Subparameter assessments revealed that insulin-regulated aminopeptidase levels were even lower in insulin-resistant polycystic ovary syndrome patients (p = 0.001). Moreover, insulin-regulated aminopeptidase levels demonstrated a statistically significant negative correlation with fasting blood glucose, insulin, glycated hemoglobin, and HOMA-IR values.

Serum insulin-regulated aminopeptidase levels were found to be lower in women with polycystic ovary syndrome than those in healthy controls. Furthermore, these levels appear to reflect insulin resistance, a key factor in the pathogenesis of polycystic ovary syndrome. Overall, these findings suggest that insulin-regulated aminopeptidase may serve as a potential biomarker for the identifification of insulin resistance in women with polycystic ovary syndrome.

Aging is a major risk factor for breast cancer, yet how it shapes tumor development, molecular phenotype, and immune evasion remains incompletely understood. Deciphering how aging influences cancer evolution is critical for improving risk assessment, prevention, and treatment. Here, using a N-nitroso-N-methylurea (NMU)-induced rat mammary tumor model that recapitulates key features of human breast cancer, we integrated bulk and single-cell transcriptomics, whole-exome sequencing, and histopathological analysis to dissect age-associated differences in mammary tumorigenesis. We found that the age at NMU exposure critically influences tumor incidence, mutational burden, molecular subtype, and the tumor immune microenvironment. Tumors arising in aged rats originated from aging luminal progenitor-like cells, exhibited increased genomic instability, reduced immune cell infiltration, and impaired antigen presentation linked to loss of heterozygosity at chromosome (Chr) 20p. The age-associated epithelial and immune changes we identified were conserved in human breast cancers, where the loss of the homologous Chr 6p region correlated with reduced lymphocyte infiltration and shorter relapse-free survival. These findings reveal that aging profoundly affects tumor-initiating cell populations and promotes immune evasion through chromosomal instability-driven defects in antigen presentation. Our work provides a molecular basis for understanding disease onset and progression that may impact efficacy of immunotherapy in older breast cancer patients.

Due to the difficulty of obtaining population-based individual-level data, ecological studies are often used to explore factors related to geographic variations in health outcomes. This study proposes a novel framework to identify area-level predictors of spatial variations in lung cancer outcomes and generate a lung cancer vulnerability index (LcVI) based on these predictors.

Data on 11,313 persons diagnosed with invasive lung cancer in Queensland, Australia (2016-2019) were sourced from the population-based Queensland Cancer Register. Bayesian spatial models estimated smoothed standardised incidence ratios (SIRs) for 519 geographic areas. Area-level variables (n = 911) were extracted from multiple data collections. Random forest models were fitted to identify important predictors for lung cancer incidence rates. A novel non-parametric dimensionality reduction approach incorporating the final random forest model results was developed to generate the LcVI which ranged from 0-10.

Eight variables were identified as predictors for lung cancer incidence with the top two being the prevalence of diabetes and adequate fruit intake. Areas having incidence rates below the Queensland average had significantly lower LcVI than those with average incidence rates (mean difference = 2.80, 95% CI: 2.34-3.25, p < 0.001) while areas with above average incidence rates had significantly higher LcVI than those with average incidence (mean difference = 2.70, 95% CI: 2.20-3.19, p < 0.001). The LcVI was strongly associated with the continuous SIR, explaining 57% of the variation (R² = 0.57, p < 0.001).

This novel approach identified a small number of important predictors for lung cancer incidence from a high-dimensional dataset. The lung cancer vulnerability index partially explained the geographic variations, potentially offering insights into underlying drivers. As an ecological analysis, this associations reflect relationships at the population level. Future research incorporating individual-level data is needed to confirm whether the area-level associations observed here hold true for individuals.

Non-submucosal injection endoscopic submucosal excavation (NSI-ESE) and mucosal snare resection-assisted endoscopic submucosal excavation (MSR-ESE) are novel techniques for the treatment of gastric submucosal tumors (SMTs). This study aims to evaluate the feasibility, safety, and efficacy differences between these two methods in the management of gastric SMTs.

A retrospective analysis was conducted on 95 eligible patients who underwent endoscopic treatment for gastric SMTs between 01/01/2022 and 31/12/2024, including 41 patients treated with MSR-ESE and 54 with NSI-ESE. Differences in operative time, safety, and cost-effectiveness between the two groups were compared, and multivariate linear regression analysis was performed to investigate the independent impact of the surgical approach on operative time.

There were no significant differences between the two groups in baseline characteristics, en bloc resection rate, or incidence of adverse events such as intraoperative perforation and delayed bleeding. However, the MSR-ESE group had significantly longer tumor exposure time (6.37 ± 2.98 min vs. 4.61 ± 2.94 min, p = 0.001), tumor excavation time (29.59 ± 9.09 min vs. 24.09 ± 9.87 min, p = 0.007), and total procedure time (35.95 ± 10.23 min vs. 30.63 ± 11.61 min, p = 0.022) compared with the NSI-ESE group. Multivariate regression analysis confirmed that MSR-ESE was an independent factor associated with prolonged tumor exposure time (β = 1.60, p = 0.005) and total procedure time (β = 5.43, p = 0.012). In addition, the surgery-related cost was significantly higher in the MSR-ESE group than in the NSI-ESE group (US$874.94 ± 106.40 vs. US$731.90 ± 108.98, p < 0.038).

In the treatment of gastric SMTs, MSR-ESE did not demonstrate any advantages in efficiency or safety compared with NSI-ESE; instead, it resulted in a significantly longer procedure time, more discomfort and increased economic burden. Therefore, the routine use of snare-assisted mucosal resection during ESE is not recommended in clinical practice.

The post-coronavirus disease 2019 (COVID-19) pulmonary sequelae have garnered public concern. We conducted a multicenter cross-sectional study in outpatient and health exam populations from 23 clinical centers (including university-affiliated/provincial general hospitals, municipal general hospitals, county hospitals, and specialized hospitals) in China (2019-2023), to assess temporal trends and potential influencing factors in the detection of CT-diagnosed pulmonary nodules, pleural effusion, pneumonia, and suspected lung tumors, cancer and viral pneumonia, clarifying pandemic impacts on lung health. Dynamic comparisons across key phases including initial outbreak, vaccine rollout, population-wide vaccination, and major adjustment of pandemic control policies, were performed. This study analyzed 1,616,750 clinical samples (1,102,605 outpatient, 514,145 health examination; 885,945 males, 730,805 females). Pulmonary nodule detection rose progressively, with surges in 2020-2021 and 2023, plateauing in 2021-2022. Outpatients and males showed steeper increases. University-affiliated/provincial hospitals had sharpest increases vs. municipal and county tiers. Specialized hospitals matched general hospital rates. AI boosted detection rates. CT-suspected lung tumors/cancer remained low and stable, unrelated to nodule trends. These results underscore 2019-2023 pulmonary nodule detection surges linked to SARS-CoV-2 infections and AI adoption. COVID-19 vaccination did not accelerate detection but may have slowed it short-term. Long-term studies on infection, vaccine impacts and pandemic-detected nodules' outcomes are urgently needed.