Glomus tumours are uncommon, typically benign neoplasms of specialised dermal thermoregulatory structures known as glomus bodies. Wide local excision is the gold standard management for such tumours with good recurrence-free outcomes. Rarely, they may exhibit malignant and metastatic behaviour. The efficacy of systemic treatments to manage widespread or metastatic disease has been trialled with varying degrees of success but remains poorly understood.This case report describes a cutaneous glomus tumour in a female patient. Despite prompt wide local excision of the primary lesion and subsequent nodal recurrence, the patient developed metastatic disease that failed to respond to taxane chemotherapy but was stabilised for several months with selective internal radiation therapy and doxorubicin. She passed away shortly after developing widespread abdominal and bony metastases.This case highlights the potentially aggressive recurrence of glomus tumours, the importance of close follow-up and the challenges of treating lesser understood cancers.

Across the United States (U.S.), many communities experience disproportionate exposure to environmental health hazards due to their proximity to coal-fired power plants and associated coal ash disposal sites. These facilities release toxic heavy metals such as arsenic, mercury, and lead into the surrounding environment, posing serious public health risks. Although prior research has documented adverse health effects of coal-fired power plants, few studies have specifically examined the relationship between cancer incidence and proximity to coal ash impoundments, as well as exposure to elevated concentrations of toxic constituents in coal ash. Using complementary contingency table analyses, bivariate spatial association techniques, and spatial regression methods, this study finds consistent evidence that counties containing or adjacent to coal ash impoundments exhibit significantly higher cancer incidence rates compared to more distant counties, even after adjusting for potential confounders. Incidence rates for both total cancer and lung cancer were significantly associated with smoking, drinking, and physical inactivity, corroborating prior research on these behavioral risk factors. The lung cancer model further revealed significant positive associations between cancer incidence and PM₂.₅, arsenic concentrations, and airborne cancer risk scores, highlighting specific environmental risk factors for the disease. These findings strengthen the evidence linking coal ash exposure to adverse health outcomes and underscore the urgent need for robust enforcement and compliance measures to protect communities from coal ash contamination.

Bladder cancer (BCa) and kidney cancer are increasingly significant public health concerns in China. However, comprehensive analyses of their long-term disease burden trends and future projections remain limited. This study analyzed trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for BCa and kidney cancer in China from 1990 to 2021 using Global Burden of Disease (GBD) data, and projected their future burden over the next two decades.

GBD 2021 data were used to evaluate age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years rate (ASDR). Trends were assessed using Joinpoint (v5.2.0) and R (v4.5.1) to calculate average annual percentage changes (AAPCs). Future burdens (2022-2041) were forecasted with an autoregressive integrated moving average (ARIMA) model.

From 1990 to 2021, China experienced significant increases in BCa and kidney cancer incidence, prevalence, mortality, and DALYs. For BCa, ASIR and ASPR increased, while ASMR and ASDR decreased relative to 1990. Kidney cancer showed rising ASIR, ASPR, and ASMR, with ASDR slightly declining. AAPC analysis revealed BCa trends of ASIR (+0.12%), ASPR (+1.59%), ASMR (-1.60%), and ASDR (-1.74%); kidney cancer showed ASIR (+2.39%), ASPR (+3.47%), ASMR (+0.41%), and ASDR (-0.01%). Projections suggest BCa ASIR will keep rising in both sexes by 2041, while ASPR will decline, particularly in males. Kidney cancer ASIR is expected to rise in males but stabilize in females, with ASPR remaining steady.

Between 1990 and 2021, China faced growing burdens of BCa and kidney cancer, with notable sex-specific patterns. Projections highlight the need for targeted, age- and sex-specific prevention and control strategies.

Prior research has highlighted immune cells' critical role in multiple myeloma (MM) pathogenesis, yet the causal relationships between them have remained obscure.

We utilized data from genome-wide association studies (GWAS) of European cohorts to conduct a Mendelian Randomization (MR) analysis, aiming to establish causal links between immune cell phenotypes and MM. We selected single nucleotide polymorphisms (SNPs) associated with immune cell traits at a suggestive significance threshold (P < 1 × 10^-5) to ensure sufficient instrumental variables, with F-statistics (>10) calculated to assess instrument strength. Multiple MR methods were applied to 731 immune phenotypes and MM.

Eight immunophenotypes showed nominal associations with MM risk (P < 0.05). However, no associations survived the strict Bonferroni correction for multiple testing. Suggestive causal effects of MM on immunophenotypic traits are predominantly negative, implying that MM may impair the functionality of immune cells.

This study uses GWAS data to elucidate the genetic impact of immune cells on the initiation and progression of MM. It presents genetic evidence suggesting that immune cells could alter MM risk based on a thorough genetic analysis. Bidirectional two-sample MR identified eight distinct immunophenotypes (encompassing four immune signatures: MFI, RC, AC, MP) with causal effects on MM.

Our study provides preliminary evidence for potential causal links between specific immune traits and MM risk. Independent replication in larger cohorts and functional validation are warranted given the nominal significance of these associations, which may inform future immunotherapeutic investigations. These findings contribute to a better understanding of the complex immune - MM interplay and may guide future investigations into immunotherapeutic approaches.

Alveolar epithelial cell (AEC) senescence is a crucial driver of pulmonary fibrosis (PF). Epoxyeicosatrienoic acids (EETs) are synthesized from arachidonic acid through the cytochrome P450 cyclooxygenase (CYP) pathway. We have reported that EETs inhibit AEC senescence, alleviating bleomycin (BLM)-induced PF in mice. However, EETs have a short half-life in vivo and are rapidly degraded to low-active end-product diols by soluble epoxide hydrolase (sEH). We observed a significant increase in sEH expression in senescent AECs, but the underlying mechanism remains unclear. In this study, we found that inhibition of sEH significantly attenuated senescence in AECs and lung senescence in premature aging mice. Mechanistically, bioinformatics results showed that the spleen focus forming virus proviral integration oncogene (Spi1) might be a key transcription factor upstream of sEH in AECs. ChIP assay showed that Spi1 could bind to the sEH promoter. Knockout of Spi1 in AECs mediated by lentivirus significantly reduced BLM-induced sEH expression and AEC senescence, while overexpression of Spi1 had the opposite effect. Furthermore, specific silencing of Spi1 in AECs significantly inhibited BLM-induced PF in mice. Taken together, these findings provide new ideas for the treatment of PF by targeting Spi1 to improve AEC senescence. KEY MESSAGES: Spi1 is a key transcription factor upstream of sEH in AECs. Inhibition of Spi1 significantly attenuated AEC senescence. Inhibition of Spi1 alleviated pulmonary fibrosis in aging mice.

The initial step in diagnosing tuberculosis involves the microscopic examination of sputum samples using acid-fast staining to identify bacilli. However, this conventional method is labor-intensive, requires specialized expertise, is susceptible to errors, and has limited sensitivity. Research literature indicates that deep learning models demonstrate significant potential for detecting acid-fast bacilli (AFB) in sputum smear preparations. This study investigates the effectiveness of deep learning methods in identifying AFB within sputum smear samples. Our objective was to assess the performance of these models in tuberculosis diagnosis based on microscopic examination and to identify improvements they could bring in terms especially of sensitivity and availability within this field. We employed several transfer learning models: DenseNet201, ResNet101V2, Xception, InceptionResNetV2, and InceptionV3. In order to determine the effectiveness of these models, basic performance metrics such as accuracy, recall, precision, and F1 score were used. Among the transfer learning models we recommended, the InceptionV3 and Xception models exhibited the highest performance, achieving 99.00% high performance across all evaluation metrics. Our findings underscore that deep learning models can be effectively utilized for rapid and accurate detection of Mycobacterium tuberculosis in acid-fast stained sputum preparations.

During epidemics, individuals may adjust their social behavior in response to the threat. This may affect the course of the epidemic, and, in turn, again modify people's behavior. Game theoretically, the system may end up in a Nash equilibrium, where no member of the population can benefit by unilaterally changing their behavior. Compartmentalized epidemic models can incorporate such endogenous decision making, where individuals try to optimize a utility function via their behavior. Typically, such models can only be solved numerically. Here, we extend a recently discovered analytic solution for time-dependent social distancing and the corresponding epidemic dynamics: now, the probability of an infection taking place can depend on both the susceptible and infectious individual behaviors. We show that the more effectively the susceptible individual can reduce the probability of infection, the more self-organized social distancing is expected to occur. The previously identified heuristic that the strength of rational social distancing is proportional to both the perceived infection cost and prevalence is found to also hold in the generalized model.

In response to the 2020 COVID-19 pandemic, a nongovernmental organization in Nepal piloted a maternal and newborn health helpline program in partnership with the Government of Nepal and the Nepal Society of Obstetricians and Gynaecologists. The program connected service providers in remote areas with real-time clinical support during obstetric and neonatal emergencies via telephone consultations with clinical experts. 551 primary health care facilities across 14 districts of Nepal were included in the program and connected to a roster of 33 clinical expert volunteers from district or tertiary care hospitals. To assess the results of the program, we collected both quantitative and qualitative data, including monthly health facility record reviews from July 2020 to June 2021 and semi-structured interviews with clinical experts and service providers conducted in June 2021. Of the 551 health facilities included in the program, 160 facilities (29%) reported using the helpline during the study period, with 429 teleconsultation cases recorded. We found that 21% of these cases that otherwise would have been referred to a hospital were effectively managed by telephone on-site at rural health facilities, revealing the promising potential for impact using a low-tech solution. Of the health facilities that participated in the program, the helpline was predominantly used in remote facilities where access to higher-level referral centers for emergencies was limited. Feedback from both experts and service providers revealed that the program helped to improve clinical decision-making during emergencies, build confidence and skills of service providers, and improve referral efficiency. Implementation challenges included service providers' underreporting of helpline utilization, a lack of essential drugs at primary health care facilities, unreliable phone signals, and a lack of financial incentives for clinical experts. The results and implementation experiences shared in this article provide a template for the design and implementation of similar support programs for service providers managing clinical emergencies in rural contexts.

Wheeze is a common paediatric winter presentation, requiring bronchodilator therapy. Use of jet nebulisers (JN) is currently standard practice, but vibrating mesh nebulisers (VMN) have demonstrated quicker, quieter and more effective drug delivery, with reduced emergency department (ED) length of stay (LOS) in adults. A retrospective review of JN versus VMN use was conducted in a paediatric population (n=38 and n=19, respectively). An apparent reduction in ED LOS, nebuliser requirement and respiratory rate was seen with VMN use, indicating the potential for this device to improve the effectiveness of bronchodilator administration and warranting further investigation in paediatric patients.

We highlight the complex management considerations in a patient with cerebral amyloid angiopathy who developed venous thromboembolism, explicitly navigating the balance between risks of thromboembolism and bleeding with anticoagulation therapy. This case highlights a man in his 70s who presented to the emergency department with an acute right frontal intracerebral haemorrhage secondary to cerebral amyloid angiopathy with an acute segmental pulmonary embolism managed with an inferior vena cava (IVC) filter. During hospitalisation, the patient developed a large expansile thrombus extending inferior from the IVC filter to the right popliteal vein. This necessitated the initiation of anticoagulation therapy, beginning with unfractionated heparin, transitioning to enoxaparin and ultimately to apixaban. He was treated with 3 months of anticoagulation with no haemorrhagic complications. The patient's successful outcome underscored the potential for safe and effective anticoagulation management in this complex clinical scenario.