To develop a chitosan/polyvinyl alcohol (CS/PVA) hydrogel co-loaded with polyhexamethylene biguanide (PHMB) and celecoxib (CEL) for synergistic treatment of diabetic foot ulcers (DFUs). Blank CS/PVA, CEL/CS/PVA, PHMB/CS/PVA, and CEL/PHMB/CS/PVA hydrogels were prepared by freeze-thaw cycles. Their microstructure, swelling, degradation, antibacterial activity, hemocompatibility, and fibroblast migration were evaluated in vitro. A full-thickness wound model in streptozotocin-induced type 1 diabetic mice was used to assess wound healing, inflammation, angiogenesis, macrophage polarization, and biosafety. All hydrogels showed comparable swelling. On Day 7, the degradation rates were 71.04%, 55.80%, 47.49%, and 25.42%, respectively, with CEL/PHMB/CS/PVA showing the lowest degradation rate. PHMB-containing hydrogels inhibited E. coli and S. aureus. All materials had hemolysis rates < 5%, and the composite group showed 1.74%. The 24 h migration rates were 30%, 37%, 48%, and 67%, with the composite group being highest (p < 0.001). In diabetic mice, the composite group achieved 68.89% wound healing on Day 7 and 94.44% on Day 14, versus 69.59% on Day 14 in the untreated diabetic group (p < 0.001). It also increased collagen deposition, reduced IL-1β and IL-6, and promoted CD31⁺ angiogenesis, α-SMA⁺ vascular maturation, and CD206⁺ M2 macrophage polarization, with no obvious systemic toxicity. The CEL/PHMB/CS/PVA composite hydrogel promotes the healing of diabetic wounds through the synergistic effects of PHMB's antibacterial action and CEL's anti-inflammatory action. The hydrogel demonstrates good biosafety and potential for clinical translation.

Diabetes mellitus is associated with a wide spectrum of macrovascular and microvascular complications affecting multiple organ systems. Ultrasound offers a noninvasive, accessible imaging modality for the early detection of these complications. This systematic review and meta-analysis evaluated the diagnostic role of ultrasound across diabetes-related complications, including nephropathy, neuropathy, hepatic fibrosis, carotid atherosclerosis, plantar fasciitis, and cardiac vascular alterations. Relevant studies were identified from PubMed, Scopus, and the Cochrane Library, supplemented by gray literature, and appraised using the Newcastle-Ottawa Scale. The meta-analysis was performed using Jamovi software in accordance with PRISMA guidelines. Pooled findings demonstrated that the renal resistive index (RI) measured by Doppler ultrasound was significantly elevated in diabetic nephropathy compared with controls. Plantar fascia thickness, peripheral nerve cross-sectional area, and liver stiffness were all significantly greater in diabetic patients than in non-diabetic controls (p < 0.05 across outcomes). Carotid intima-media thickness and vascular resistance parameters were also measurably increased, reflecting early atherosclerotic changes. These results confirm that ultrasound is a versatile and diagnostically valid tool across multiple diabetes-related complication domains, with particular strength in hepatic, neurological, renal, and musculoskeletal assessment. The consistent findings across organ systems support its integration into routine diabetic surveillance. Standardized acquisition protocols and larger prospective studies are needed to consolidate reference ranges and strengthen clinical applicability.

Spitzoid tumours (ST) represent a diagnostic chal-lenge and the accuracy of dermoscopy in these cases remains unclear. This retrospective study evaluated dermoscopic images collected from 2011 to 2016. Two dermatologists, blinded to clinical/ histopathological data, identified lesions with spitzoid dermoscopic patterns, using histopathology as the gold standard. Of 4,337 dermoscopic images, 240 (5.5%) showed spitzoid dermoscopic patterns (221 patients; median age 40; 57.9 % female). Histopathology revealed 23 % (55/240) ST, 62 % (149/240) non--spitzoid melanocytic lesions and 15 % (36/240) non--melanocytic lesions. Overall, 25.4 % (61/240) were malignant, mainly melanoma/melanoma metastases (50/240). Across excised tumours, 1.5 % (67/4,337) were ST. Sensitivity and specificity were 82.1 % (95% CI 70.8%-90.4%) and 95.7 % (95% CI 95%-96.3%), with an AUC of 0.88 (95% CI 0.84-0.93). Positive predictive value (PPV) was 22.9 % (95% CI 17.8%-28.8%), and nega-tive predictive value (NPV) was 99.7 % (95% CI 99.5%-99.9%). Starburst pattern was more frequent in ST (p=0.007). Linear vessels (OR 5.12; 95% CI 2.08-13.1) and glomerular vessels (OR 3.03; 95% CI 1.37-6.69) correlated with malignancy. Dermoscopy demonstrated high diagnostic accuracy and NPVnegative predictive value. However, low PPVpositive predictive value highlights limited specificity in adults; since one1 in four4 lesions with a spitzoid dermoscopic pattern was malignant, any spitzoid lesion in adults warrants high clinical suspicion.

This annual report represents a collaborative effort by leading cancer surveillance organizations to present reliable, comprehensive US statistics on cancer incidence and mortality.

Cancer incidence data were obtained from population-based cancer registries funded by the Centers for Disease Control and Prevention and/or the National Cancer Institute and compiled by the North American Association of Central Cancer Registries. Cancer death data were obtained from the National Center for Health Statistics' National Vital Statistics System. Age-standardized rates (per 100,000) and average annual changes in rates calculated with joinpoint regression are reported by cancer type, sex, race and ethnicity, and age. Lung cancer risk factors and outcomes during 2000-2025 were assessed.

Overall cancer incidence rates were 504.6 among males and 443.0 among females during 2018-2019/2021-2022. Excluding 2020, cancer incidence rates were stable among males (2013-2022) and increased 0.4% per year among females (2011-2022). Lung cancer incidence decreased 3.5% among males and 1.9% among females per year during 2018-2022. During 2019-2023, overall cancer death rates were 171.5 among males and 126.3 among females, decreasing 1.6% per year among males and 1.1% among females. During this period, lung cancer death rates decreased 4.7% per year among males and 3.0% among females. Since the early 2000s, smoking fell by one half, early diagnosis of lung cancer increased by two thirds, and 5-year relative survival for lung cancer doubled.

Cancer incidence was stable among males but increased slowly among females. Cancer mortality continued to decline, largely because of sustained progress against lung cancer.

Background Imaging-derived extranodal extension (iENE) was added to the N3 criteria for nasopharyngeal carcinoma (NPC) in the ninth version of the tumor-node-metastasis (TNM) staging system. Purpose To evaluate the reliability and prognostic value of a proposed joint task force iENE grading system in NPC. Materials and Methods This retrospective single-center study included patients with NPC treated between January 2007 and March 2025. For patients with cervical lymph node metastases, three radiologists independently graded iENE at pretreatment CT and/or MRI using the proposed four-tier classification system. Inter- and intrarater reliability was assessed using the intraclass correlation coefficient (ICC) and weighted κ. Overall survival (OS), disease-free survival, local-regional recurrence-free survival, and distant metastasis-free survival (DMFS) were evaluated across iENE grades using Kaplan-Meier and multivariable Cox regression analyses adjusted for age, sex, T and M categories, and chemotherapy status. Results A total of 401 patients (median age, 52 years [IQR, 44-60 years]; 296 male patients) were included. According to the consensus-based final iENE grades, 223, 36, 94, and 48 patients were classified as having iENE grade 0, 1, 2, and 3, respectively. Interrater reliability (ICC, 0.87 [95% CI: 0.85, 0.89]) and intrarater reliability (κ = 0.95) for iENE grading were excellent. Compared with patients with iENE grade 0, patients with iENE grade 3 had shorter OS (hazard ratio, 3.30 [95% CI: 1.70, 6.41]; P < .001). In addition, patients with iENE grade 1, 2, and 3 had shorter DMFS than patients with iENE grade 0, with hazard ratios of 2.33 (95% CI: 1.12, 4.87; P = .02), 2.11 (95% CI: 1.24, 3.60; P = .006), and 2.39 (95% CI: 1.28, 4.45; P = .006), respectively. There was no evidence of a difference in prognostic performance between the TNM-8 and TNM-9 systems. Conclusion The joint task force iENE grading system had excellent reliability and good prognostic value in patients with NPC. © RSNA, 2026 Supplemental material is available for this article.

BackgroundBreast cancer is one of the most prevalent cancers among women, making its prevention a crucial public health priority. Health ambassadors serve as essential mediators, helping raise knowledge and promote preventive behaviors within households.ObjectiveThis study examined the impact of Teach-Back Education, grounded in PMT, on breast cancer prevention behaviors.DesignA quasi-experimental study with a pretest-posttest control-group design conducted among women health ambassadors in Khoy City, Iran.MethodsA total of 160 women health ambassadors were selected through simple random sampling and allocated to either the Teach-back education group (four weekly sessions, 45 min/session) or the control group (no intervention). Outcomes were measured using a validated Protection Motivation Theory (PMT)-based questionnaire at baseline and at the three-month follow-up. Data were analyzed using SPSS version 20.ResultsThe results indicated that the implementation of the Teach -Back Education grounded in the PMT led to a significant increase in knowledge, most components of the PMT, and the overall breast cancer prevention behavior score in the intervention group compared to the control group (P<0.05). Subgroup analysis revealed that the educational intervention had a more pronounced impact on older health ambassadors, had lower education levels, or were housewives (P<0.05).ConclusionThis study demonstrated that educational interventions based on the PMT, utilizing Teach-Back Education, effectively enhanced knowledge and motivation and improved breast cancer prevention behaviors among women health ambassadors. Expanding Teach-Back Education programs based on PMT across various communities is recommended to raise knowledge, enhance sensitivity, and promote preventive behaviors against breast cancer.

Large language models (LLMs) exhibit extensive medical knowledge but are prone to hallucinations and show low fact-level explainability, limiting clinical adoption and regulatory compliance. Existing approaches, such as retrieval-augmented generation, partially address these issues by grounding answers in source documents; however, the aforementioned problems persist.

We propose the application of an atomic fact-checking framework designed to enhance the reliability and explainability of LLMs in medical long-form question answering. By decomposing generated answers into discrete atomic facts and verifying each against an authoritative knowledge base of medical guidelines, this approach enables precise identification and correction of incorrect statements, alongside explicit linkage to supporting literature.

The fact-checking algorithm operates within a retrieval-augmented generation framework: LLM-generated answers are decomposed into atomic facts (smallest and self-contained information units), each of which is assessed and corrected if FALSE. To determine an optimal strategy, the validation-question and answer (Q&A) set on prostate cancer treatment was tested under varying instructions. An extensive evaluation, including multireader assessments by human medical experts and the automated open Q&A benchmark AMEGA (Autonomous Medical Evaluation for Guideline Adherence), was conducted for the final pipeline. In addition to another radiooncologic test-Q&A set, anonymized real-world tumor board cases and an independent, established neurology-Q&A set were used. Given their transparency and accessibility advantages, we compared various open-source models in pairs of generalist models and their medical fine-tuned counterparts, with regard to performance and improvements by fact-checking.

The framework significantly reduced hallucinations and inaccuracies. Medical expert assessment and automated benchmarks demonstrated significant improvements in factual accuracy, achieving up to a 50% overall answer improvement and an 80% hallucination detection rate. Notably, the observed gain was strongest in real tumor-board questions-the most challenging dataset. Additionally, the framework achieved high explainability by tracing each atomic fact back to the most relevant chunks from the database, providing a granular, transparent explanation of the generated responses.

To conclude, we present the application of an atomic fact-checking algorithm to medical Q&A. It identifies factual inaccuracies and hallucinations in LLM-generated answers, achieving the greatest gains on clinically realistic, complex questions. Correction via fact-checking improves the overall answer quality while achieving fact-wise explainability, paving the way for more credible clinical use of LLMs.

Traditional Chinese medicine (TCM) has demonstrated potential benefits in cancer treatment, yet its relatively low utilization may limit the realization of these benefits. This study aimed to explore cancer patients' preferences for TCM services and assess how various service characteristics influence their utilization. A discrete choice experiment was conducted among 500 cancer patients aged 18-75 years. Each patient completed nine choice tasks, each involving two hypothetical TCM service alternatives characterized by five attributes: service institution, care provider, type of treatment, risk of side effects, and monthly cost. A mixed logit model was used to estimate patients' preferences, willingness to pay and predicted utilization. In total, 469 patients (93.8%) completed the questionnaire. All five attributes significantly influenced patients' preferences. Service institution had the greatest impact on TCM utilization (importance score, 47.59%), followed by care provider and type of treatment. Changing the service setting from a TCM clinic to a cancer hospital or a general hospital would increase the predicted utilization of TCM services by 87.60% and 69.20%, respectively. Gender, age, annual family income, cancer stage, and family history of cancer were also associated with TCM utilization. Cancer patients generally had positive attitudes toward TCM services. Service institution was the primary driver of TCM utilization, whereas monthly cost was the least important factor. These findings provide policymakers and healthcare professionals with valuable insights into the effective integration of TCM as an adjunct to cancer treatment, with the potential to improve patient care.

Clinician assessment of adverse events in oncology systematically underestimates the severity and frequency of symptoms that patients actually experience, creating risks in both drug development and routine care. Electronic patient-reported outcome (ePRO) systems help to address this gap by enabling frequent remote symptom monitoring, bringing the patient voice into the care pathway between clinic visits. Published studies confirm that automated data-driven alerting in response to ePRO data entries can drive better patient outcomes including reduced emergency department visits, delayed physical function deterioration, and improved symptom control, with early intervention the likely mechanism. Translating this evidence into practice demands deliberate attention to how data are visualized, communicated, and acted upon. This perspectives article examines, primarily in the context of oncology clinical trials, the tools and design principles that translate ePRO data into timely clinical action, including heatmap visualizations that reveal symptom trajectories at a glance, predefined alert thresholds that trigger proactive responses, and patient-facing self-management support delivered at the moment of reporting. The regulatory, ethical and methodological case for embedding active monitoring within oncology trial design is also considered.

Organized colorectal (CRC) screening programmes offer an opportunity to reduce the burden of the disease on populations. CRC screening participation among women is substantially lower than breast or cervical cancer screening. Uptake is also lower in areas of greater deprivation which could exacerbate inequalities in CRC; however, few studies have been conducted with women resident in lower socio-economic areas who were invited for screening but did not participate. The aim of this study was to explore women's decisions not to take part in Ireland's population-based BowelScreen programme.

Semi-structured interviews were conducted with women resident in lower socio-economic areas, who had not participated in BowelScreen. Deductive thematic analysis, guided by the Theoretical Domains Framework (TDF: 14 domain version), using the framework approach was conducted.

Fifteen women from lower socio-economic areas in Ireland who had not participated in BowelScreen were interviewed. Six TDF domains were identified as influencing non-participation; (1) Environmental Context and Resources; stressful life events and lack of healthcare professional recommendations, (2) Memory, Attention and Decision Making; delayed decision making and deciding screening is not personally relevant, (3) Knowledge; poor knowledge negating need for screening, (4) Emotions; disgust, embarrassment and fear, (5) Skills; low self-efficacy and instruction complexity, and (6) Social influence; did not encourage testing or was overridden by emotion and poor knowledge.

Greater consideration should be given to the targeting of interventions towards specific determinants of non-participation within subgroups of the population, in particular non-participant women living within lower socio-economic areas. Tackling environmental stressors, emotional factors, lack of healthcare professional support and the perception that feeling healthy equates with not needing screening could help improve CRC screening uptake among women living in low socioeconomic areas.