Non-gastric subtype of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs) are associated with high-grade dysplasia/invasive adenocarcinoma (HGD/IC) and disease progression. We evaluated preoperative prediction of gastric vs. non-gastric BD-IPMN subtypes and assessed a needle-based confocal laser endomicroscopy-guided artificial intelligence algorithm (nCLE-AI) for detecting HGD/IC in pathologist-reclassified BD-IPMNs.

Participants with resected BD-IPMNs were enrolled from prospective studies (2015-2024). Phase 1: lesions were reclassified by subtype and dysplasia grade through blinded pathologist review, with discordant cases receiving MUC immunostaining and consensus review. Phase 2: using this reclassified pathology data, preoperative clinical and morphological features were analyzed to predict BD-IPMN subtypes. Phase 3: nCLE-AI performance in detecting HGD/IC within reclassified gastric and non-gastric BD-IPMNs was evaluated using preoperative endomicroscopy videos.

Among 63 resected BD-IPMNs (mean diameter=35.0±10.1 mm), 38% were classified as HGD/IC. Phase 1: The interobserver agreement among pathologists for subtype classification was moderate (k=0.52; 95%CI: 0.27-0.77). Phase 2: Multivariable analysis or preoperative variables revealed Kyoto high-risk stigmata (aOR=11.568, p=0.007), unifocal lesions (aOR=8.354, p=0.041), and lower BMI (aOR=1.37, p=0.04) predicted non-gastric subtype. Phase 3: The nCLE-AI algorithm using presurgical endomicroscopy imaging showed comparable sensitivity for detecting HGD/IC in non-gastric and gastric IPMN subtypes (83% vs. 82%, p=0.92), but significantly higher specificity (100% vs. 44%, p=0.06) and accuracy (87% vs. 53%, p<0.02) in the non-gastric subtype.

Moderate interobserver variability in BD-IPMN subtype classification among pathologists highlights the need for immunohistochemistry and consensus review in challenging cases. Preoperative clinical variables can predict non-gastric subtype which is associated with less favorable prognosis. nCLE-AI shows improved performance in detecting HGD/IC in non-gastric BD-IPMNs, where accurate risk stratification is particularly important due to higher risk of progression.

This analysis of the Slovak health system reviews developments in governance, organization, financing and delivery of care, health reforms and health system performance. Slovakia, a central European country with a population of 5.4 million, continues to face significant health and health care system challenges. Slovakia's health system is founded on universal coverage with compulsory health insurance, a broad benefits package and a competitive insurance model. Although life expectancy improved between 2000 and 2019, the COVID-19 pandemic reversed gains, and in 2023 Slovak life expectancy remained three years below the European Union (EU) average. Circulatory diseases and cancer are the leading causes of death, and noncommunicable diseases such as diabetes and mental illness are rising. Nearly one third of all mortality is linked to behavioural risk factors, including poor diet, high smoking rates, low physical activity and obesity. Slovakia's health care system features competition among three insurers - one state-owned (Všeobecná zdravotná poisťovňa, VšZP) and two private. Since major reforms in 2004, the system has decentralized responsibilities and adopted selective contracting to enhance efficiency. However, structural weaknesses remain, particularly in financial sustainability, accessibility and equity. Health spending from public sources was 8.3% of gross domestic product (GDP) in 2024, yet out-of-pocket (OOP) payments account for nearly 19% of expenditures, disproportionately burdening low-income households. Workforce shortages, especially in nursing and primary care, are worsened by emigration and an ageing staff. Urban-rural disparities persist, with modern infrastructure and specialized services concentrated in cities. Digital health advancements, such as the National Health Information System (NHIS), aim to modernize care and facilitate telemedicine, though implementation is uneven. Ongoing reforms target cost containment, infrastructure optimization and integration of long-term care (LTC). Key priorities include addressing regional disparities, improving workforce retention, reducing waiting times and enhancing eHealth adoption. Despite universal coverage, Slovakia must address persistent gaps in health outcomes, resource distribution and system resilience to meet the needs of its population.

Emerging evidence suggests that Spirulina may reduce inflammation by modulating key cytokines, including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Accordingly, this study conducted a systematic review and meta-analysis to evaluate the effects of Spirulina supplementation on serum levels of inflammatory mediators in adults aged 18 years and older.

Relevant randomized clinical trials (RCTs) were identified through searches of several databases, including the Cochrane Library, ClinicalTrials.gov, ISI Web of Science, Scopus, and PubMed up to August 2025. The pooled effects were calculated using the DerSimonian and Laird random-effects model. Statistical heterogeneity was assessed using I-squared statistics and Cochran's Q test.

Eight studies met the inclusion criteria. The administered dosages of Spirulina varied from 1 g/day to 8 g/day, with intervention durations spanning 3 to 16 weeks. The pooled analysis demonstrated that Spirulina supplementation significantly reduced serum CRP concentrations compared with placebo group (weighted mean difference (WMD): -0.09 mg/L; 95% confidence interval (CI): -0.16 to -0.02). In contrast, Spirulina supplementation caused non-significant reduction in TNF-α concentration (WMD: -0.43 pg/mL; 95% CI: -1.44 to 0.59) and IL-6 (WMD: -0.44 pg/mL; 95% CI: -0.98 to 0.1). However, heterogeneity concerning all inflammatory mediators was significant.

The findings of this study indicated that Spirulina supplementation significantly reduced serum CRP levels, whereas its effects on IL-6 and TNF-α were not statistically significant. Owing to the significant heterogeneity, further high-quality RCTs are needed to confirm these beneficial effects. PROSPERO Registration: The study was registered in PROSPERO (CRD42024606496).

The burden of non-communicable diseases (NCDs), including hypertension, diabetes, and mental health conditions, is escalating in Ghana. Robust primary health care policies and effective health systems can prevent illness and complications and improve quality of life for ambulatory care-sensitive conditions like hypertension, diabetes and mental health. Understanding the capacity of Ghana's PHC system to manage NCDs is critical for designing effective policies. However, published evidence on this is limited. In this study we evaluated Ghana's primary health care system capacity to manage these NCDs effectively.

A multi-method approach combined a desk review of national policy documents with a cross-sectional survey of 207 PHC facilities in the Greater Accra and Eastern Regions. The desk reviews analyzed policy goals, resource allocation, and training provisions for NCD care. The survey, conducted between October 2023 and February 2024, used the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to evaluate service availability and readiness for hypertension, diabetes, and mental health services across domains such as staff, guidelines, equipment, diagnostics, and medications. Multivariable logistic regression using Stata 18 assessed readiness determinants, adjusting for facility type, managing authority, location (urban/rural), and region, with standard errors clustered at the district level. Ethical approval was obtained from the Ghana Health Service and the London School of Hygiene and Tropical Medicine.

A total of 13 national policy documents were reviewed, highlighting strong frameworks for resource allocation, workforce training, and NCD care integration into PHC, but revealing gaps in rural resource distribution and lower-tier workforce training. Service availability was highest for hypertension (39%), followed by mental health (38%) and diabetes (35%). District hospitals exhibited the most comprehensive availability (100% for hypertension and diabetes, 79% for mental health), while Community-based Health Planning and Services (CHPS) compounds had the lowest (4.2%). Readiness followed similar trends, with district hospitals scoring 77%-82%, and CHPS compounds 30%-36%. Medication availability was critically low, ranging from 1.6% for diabetes to 3.9% for mental health. Logistic regression identified private and urban facilities as having higher readiness than public and rural counterparts.

Significant disparities exist in the readiness of PHC facilities in the Greater Accra and Eastern Regions of Ghana to manage NCDs. Targeted interventions to strengthen CHPS compounds, address rural gaps, and improve medication availability are essential for achieving equitable NCD care delivery.

Myeloid-derived suppressor cells (MDSCs) play a pivotal role in establishing an immunosuppressive tumor microenvironment (TME), yet the mechanisms underlying their functional activation remain incompletely defined. Here, we identify the Fgl2-FcγRIIB signaling axis as a critical mediator of MDSC-driven immune evasion across solid tumors. Analysis of clinical specimens revealed that Fgl2 expression is significantly elevated in tumor tissues and inversely correlates with CD8⁺ T cell infiltration, while positively associating with the accumulation of FcγRIIB⁺ MDSCs and poor patient prognosis. We demonstrate that tumor-derived exosomes (TEX) function as efficient carriers that deliver membrane-bound Fgl2 (mFgl2) to MDSCs. These exosomes are internalized by MDSCs through FcγRIIB-mediated endocytosis, leading to an enhanced immunosuppressive function characterized by upregulated arginase-1 (Arg-1) and inducible nitric oxide synthase (iNOS) expression and an increased capacity to suppress CD8⁺ T cell proliferation. Genetic ablation of FcγRIIB or antibody-mediated neutralization of Fgl2 abolished this exosome-mediated immunosuppressive programming, restoring T cell activity and impairing tumor growth in vivo. Importantly, a therapeutic strategy combining an exosome secretion inhibitor, in combination with PD-L1 blockade and MDSCs depletion, synergistically achieved potent antitumor effects. Our findings unveil a novel exosome-dependent mechanism through which tumors systemically educate MDSCs, establishing the Fgl2-FcγRIIB axis as a promising broad-spectrum target for cancer immunotherapy.

Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic inflammatory breast disease of uncertain etiology. It often mimics infectious mastitis and inflammatory breast cancer in both clinical and radiologic presentations, leading to diagnostic and therapeutic challenges. This review aims to provide a comprehensive summary of the current literature regarding the etiology, pathogenesis, clinical manifestations, diagnostic strategies, and treatment options for IGM. A narrative review was conducted using an extensive search of the PubMed database, focusing on articles that discuss various aspects of IGM, including its potential autoimmune, hormonal, and infectious origins, as well as current diagnostic and management approaches. IGM most commonly affects women of reproductive age, often within a few years postpartum. Histologically, it is characterized by non-caseating granulomatous inflammation centered on breast lobules. Although corticosteroids are widely used as the first-line therapy, treatment regimens vary significantly across centers, and relapse is not uncommon. Immunosuppressive agents, such as methotrexate, have shown promising results in steroid-resistant cases. Surgical interventions are generally reserved for refractory cases because of the risk of recurrence and unfavourable cosmetic outcomes. The role of infectious agents, particularly Corynebacterium kroppenstedtii, remains controversial, and distinguishing between idiopathic and infectious GM is crucial for management. IGM is a multifactorial and clinically heterogeneous condition requiring individualized, multidisciplinary management. There remains a need for further prospective studies and consensus guidelines to optimize diagnosis and treatment, especially in recurrent or refractory cases.

The comorbidity of dementia and type 2 diabetes mellitus exacerbates the burden on family caregivers (FCGs). Mobile health (mHealth) technology offers a promising alternative to overcome the spatiotemporal limitations of traditional interventions, but evidence for its efficacy in supporting dementia-type 2 diabetes mellitus caregivers remains scarce.

This study aimed to evaluate the effectiveness of an mHealth supportive care program for FCGs of individuals with dementia and diabetes, focusing on caregiver burden, social support, and dementia care knowledge.

A 2-arm, parallel-group randomized controlled trial was conducted. Between September 2022 and January 2023, FCGs were recruited from 5 urban and 10 rural communities under a community health center in Xiamen, China. Eligible caregivers were legally related to the patient, providing care for more than 8 hours per day for at least 1 month, conscious adults with basic literacy, owning and able to use a smartphone, and willing to provide informed consent. Their care recipients met diagnostic criteria for both dementia and type 2 diabetes, aged more than 60 years. Participants were randomly allocated (1:1) to intervention (n=30) or wait-list control (n=30). The intervention group received a 12-week mHealth supportive care program via the "Xiamen i-Health" platform, comprising 6 core modules (updated biweekly) and on-demand teleconsultation, in addition to conventional offline health education. The control group received conventional monthly 1-hour home-visit health education only. The primary outcome was caregiver burden measured by the Caregiver Burden Inventory (CBI). Secondary outcomes included social support (Social Support Rating Scale; SSRS) and dementia care knowledge (Dementia Care Knowledge Scale; DCKS). Assessments were performed at baseline (T0) and 3-month postintervention (T1). Only data collectors and statistical analysts were blinded.

Of 108 potential participants, 60 were randomly assigned. Per-protocol analysis included 55 participants (intervention group n=28 and control n=27). Postintervention, the intervention group showed a significantly greater reduction in CBI scores compared to the control group (between-group difference, Z=-3.534, P<.001, r=0.477). The intervention group also demonstrated significantly greater improvements in SSRS (Z=2.494, P=.01) and DCKS scores (Z=-4.233, P<.001, r=0.570). Subgroup analyses revealed that the reduction in caregiver burden was more pronounced among male, younger (60 y), physical labor, and lower-income caregivers. No intervention-related adverse events were reported.

This theoretically grounded mHealth supportive care program effectively reduced burden and improved outcomes for FCGs managing dementia-diabetes comorbidity. The integrated online-offline delivery model shows particular promise for male, younger, manual labor, and lower-income caregivers, suggesting mHealth's potential to address health equity. These findings provide a feasible model for scalable caregiver support in resource-limited primary care settings. Future research should involve multicenter trials with longer follow-up and cost-effectiveness analyses.

Diabetes mellitus (DM) is highly prevalent among patients with chronic liver disease (CLD) and is associated with disease progression and complications. However, the impact of DM on physical function, particularly balance, in patients with CLD remains unclear. The aim of this study was to investigate the association between DM and physical function in patients with CLD, with a specific focus on impaired single-leg stance test (SLST). This retrospective study analyzed the medical records of patients with CLD at Hiroshima University Hospital between 2014 and 2017. Logistic regression analysis was performed to identify factors associated with impaired SLST. Receiver operating characteristic curve analysis was conducted to determine cutoff values for predictive factors. The analysis included 152 patients with CLD, of whom 78% had comorbid DM. Patients with DM had a significantly higher prevalence of impaired SLST than those without DM (20% vs. 0%, p = 0.002, Cramer's V 0.23). In 118 patients with CLD who had comorbid DM, age (odds ratio [OR] 1.089, 95% confidence interval [CI] 1.020-1.177, p = 0.009), body mass index (OR 1.176, 95% CI 1.045-1.343, p = 0.006), and extracellular water-to-total body water ratio (ECW/TBW) (OR 1.065, 95% CI 1.003-1.138, p = 0.039) were significant independent factors associated with impaired SLST (Nagelkerke pseudo-R² 0.31, p < 0.001). The ECW/TBW had the highest predictive accuracy, with a cutoff value of 0.393 (area under the curve = 0.733, sensitivity = 73.9%, specificity = 68.8%). DM was associated with impaired SLST in patients with CLD, suggesting a decline in balance. Age, body mass index, and ECW/TBW are significant predictors of impaired SLST. An ECW/TBW ratio of 0.393 indicates "subclinical" edema in patients with CLD and DM and should be considered in the assessment of fall risk.

This systematic review investigates how sociodemographic factors influence diabetic retinopathy (DR) screening adherence among individuals with diabetes. The review examines individuals with diabetes as the target population, focusing on the impact of various sociodemographic exposures on DR screening uptake.

A comprehensive systematic search was conducted across Ovid MEDLINE, Embase, and the Cochrane Library from inception to November 2024. The primary outcome was the overall rate of DR screening among individuals, while secondary outcomes included the odds ratios or proportions of individuals screened for DR, stratified by sociodemographic factors.

Thirty-three studies were included, spanning more than 100,000 participants. Older age, higher education, higher income, and private insurance were consistently associated with higher screening adherence. Employed individuals, particularly those in manual labor or with rigid schedules, had lower participation. Women generally showed higher adherence, although findings varied. Ethnic disparities were observed, with Black and Hispanic populations demonstrating lower screening rates. Geographic distance and travel burden were frequently reported barriers.

This review demonstrates that sociodemographic factors significantly affect DR screening adherence. Strengths include the broad geographic scope and diversity of populations studied. Limitations involve study heterogeneity and occasional reliance on self-reported data.