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461 papers

Appraisal of sexual functioning before and after cancer: insights from adolescent and young adult (AYA) cancer survivors and matched healthy controls.

Acquati C et al. · Jun 25, 2026

Purpose Adolescence and young adulthood (AYA) are developmental phases in which individuals establish their identity. A cancer diagnosis during this stage disrupts sexual health, but research remains limited, particularly outside of reproductive-organ cancers. This study examined perceived changes in sexual functioning from pre- to post-diagnosis among survivors and compared their current sexual functioning and satisfaction with matched controls. Methods Dutch-speaking AYA cancer survivors (N = 174; age = 32.7 years; 85.6% female) recruited via convenience sampling and N = 348 matched controls completed self-reported measures of sexual functioning [MOS-SF] and satisfaction [GMSEX]. Paired sample t-tests assessed perceived changes in sexual functioning. Repeated measures ANOVAs tested the effects of sociodemographic and cancer-related factors on these variations. Independent sample t-tests compared current sexual functioning and satisfaction between survivors and controls. Results Survivors reported significant declines in multiple domains of sexual functioning, including interest, arousal, orgasm function, pleasure, and lubrication (women). Greater dysfunction was observed among females, individuals diagnosed in their 30s, those in early survivorship, and those who remained with the same partner. Survivors who had engaged in partnered sexual activity reported less dysfunction than those who had not. Compared with controls, survivors reported significantly greater dysfunction and lower sexual satisfaction, while retrospectively rating their pre-diagnosis sexual functioning as more positive. Conclusions AYA cancer survivors reported declines in sexual functioning over time, worse outcomes than controls, and more favorable recollections of their pre-diagnosis sexual health, a pattern consistent with response shift. Findings emphasize the need for comprehensive survivorship care that includes routine, proactive sexual health discussions, and tailored interventions responsive to survivors' evolving needs.

Medicine

Corticosteroids in immunocompromised ICU patients with pneumonia: risks, evidence, and clinical practice.

Morales-Olivera JA et al. · Jun 25, 2026

Adjunctive corticosteroids are increasingly used in Severe Community-Acquired Pneumonia (sCAP) requiring admission to the intensive care unit (ICU), based on evidence derived largely from immunocompetent populations. Immunocompromised hosts, however, represent a distinct and growing subgroup among critically ill patients with sCAP, characterised by baseline immune defects, broader pathogen spectra, and a heightened susceptibility to treatment-related harm. Whether corticosteroid strategies validated in the general population can be safely and effectively extrapolated to immunocompromised ICU patients with sCAP remains uncertain, despite their growing use in contemporary ICU practice. Immunocompromised patients admitted to the ICU with sCAP experience compounded alterations in host defence, driven by pre-existing immune dysfunction and superimposed critical illness-associated immune dysregulation. In this setting, corticosteroids may attenuate inflammation-mediated lung injury, but may also deepen immune suppression, distort clinical evolution, and increase susceptibility to opportunistic superinfections and pathogen reactivation. Randomised trials and meta-analyses supporting corticosteroid use in sCAP have systematically excluded immunocompromised patients, treating immunosuppression as an exclusion criterion rather than a stratification variable, and commonly rely on short-term endpoints that fail to capture delayed infectious complications relevant to this population. Available observational data and pathogen-specific evidence suggest substantial heterogeneity of treatment effect (HTE) across immunocompromised subgroups, influenced by immune substrate, pathogen context, and cumulative immunosuppressive burden. Among the pathogen-specific contexts in which corticosteroids have the strongest evidence, Pneumocystis jirovecii pneumonia (PJP) stands out as the principal indication: adjunctive corticosteroids have demonstrated clear mortality benefit in AIDS-associated severe PJP, though this benefit does not extend uniformly to HIV-negative immunocompromised patients with PJP. Consequently, standard corticosteroid treatment in all CAP subgroups is unlikely to be appropriate. In immunocompromised ICU patients with sCAP, corticosteroid therapy should neither be routinely applied nor categorically avoided. Instead, decisions should be individualised, guided by a clearly defined therapeutic target, careful assessment of immune status, and consideration of the risk for opportunistic infections. When used, corticosteroids should be administered at the lowest effective dose and for the shortest feasible duration. Dedicated studies incorporating immune stratification, pathogen-informed approaches, and outcomes relevant to delayed infections are urgently needed. Until such evidence is available, careful risk-balance assessments to decide steroids in these patients.

Medicine

Mycobacterium tuberculosis partitions the Krebs cycle under iron starvation.

Serafini A et al. · Jun 25, 2026

In this study, we investigated how iron limitation alters central metabolism in Mycobacterium tuberculosis using metabolomics and stable isotope tracing. Our findings reveal a well-orchestrated metabolic programme to enable Krebs cycle activity despite the inefficient action of its iron-dependent enzymes. Under such conditions, carbon flux through the oxidative branch of the Krebs cycle is stalled, resulting in the accumulation of metabolites that are partially secreted. As a result, carbon flux from glycolysis is partially diverted to the reductive branch of the Krebs cycle to support the production of oxaloacetate and malate through the activity of phosphoenolpyruvate carboxykinase and pyruvate carboxylase. Both branches terminate with the synthesis of malate, which is secreted. This unprecedented split of the Krebs cycle and malate secretion in a bacterial pathogen facilitates the continuous flow of carbon through the core of carbon metabolism, overcoming the metabolic stalling triggered by iron starvation.

Materials Science

SynaptoTagMe, a toolkit for in vivo mapping and modulating neurotransmission at single-cell resolution.

Cuentas-Condori A et al. · Jun 25, 2026

Understanding the organization and regulation of neurotransmission at the level of individual neurons and synapses requires tools that can track and manipulate transmitter-specific vesicles in vivo. Here, we present SynaptoTagMe, a suite of genetic tools in Caenorhabditis elegans to fluorescently label and conditionally ablate the vesicular transporters for glutamate, GABA, acetylcholine, and monoamines. Using a structure-guided approach informed by protein topology and evolutionary conservation, we engineered endogenously tagged versions for each transporter that maintain their physiological function while allowing for cell-specific, bright, and stable visualization. We also developed conditional knockout strains that enable targeted disruption of neurotransmitter synthesis or packaging in single neurons. We applied this toolkit to map co-expression of vesicular transporters across the C. elegans nervous system, revealing that over 10% of neurons exhibit co-transmission. Using the ADF sensory neuron as a case study, we demonstrate that serotonin and acetylcholine are trafficked in partially distinct vesicle pools. Our approach provides a powerful platform for mapping, monitoring, and manipulating neurotransmitter identity and use in vivo. The molecular strategies described here are likely applicable across species, offering a generalizable approach to dissect synaptic communication in vivo.

Biochemistry, Genetics and Molecular Biology

The Challenge of Determining the Etiology of Encephalopathy in an Elderly Patient.

Ionescu VA et al. · Jun 25, 2026

Encephalopathy is a heterogeneous clinical syndrome with numerous neurological and systemic etiologies. We report the case of a 67-year-old man, a chronic ethanol consumer, admitted with a one-week history of confusional syndrome. Initial laboratory tests revealed severe hypercalcemia, acute kidney injury, mild anemia, and hyperproteinemia. Serum ammonia levels were within normal limits, reducing the likelihood of hepatic encephalopathy despite the patient's chronic ethanol use. Cerebral imaging excluded acute cerebrovascular events, while abdominal ultrasound demonstrated splenomegaly and normal-sized kidneys. Serum protein electrophoresis and immunofixation identified a monoclonal IgG-kappa component, strongly suggestive of multiple myeloma. The patient's neurocognitive symptoms improved rapidly following systemic corticosteroid therapy and fluid-electrolyte rebalancing, confirming hypercalcemia as the primary mechanism of encephalopathy. Hypercalcemic encephalopathy as an initial manifestation of multiple myeloma is exceedingly rare. This case highlights the diagnostic complexity in elderly patients with multiple potential contributors to altered mental status, including chronic ethanol exposure and renal dysfunction. The presence of normal renal dimensions, unexplained hypercalcemia, and a monoclonal component should prompt evaluation for plasma cell malignancy. Early recognition of hypercalcemia-induced encephalopathy and prompt investigation for underlying hematologic malignancy are essential to prevent irreversible organ damage and to ensure timely initiation of specific therapy.

Medicine

A Case Series Demonstrating the Spectrum of Invasive Methicillin-Sensitive Staphylococcus aureus (MSSA) Disease.

Mbombo E et al. · Jun 25, 2026

Introduction Staphylococcus aureus , although a common colonizer of skin and mucous membranes in humans, is associated with severe infections in both healthy and debilitated individuals. The mortality induced by invasive MSSA disease is high, especially in patients diagnosed late. In children, skin and joint manifestations are most common. Septic shock is a major contributing factor to early mortality. To date, reported cases of invasive MSSA disease in children are infrequent, especially in Sub-Saharan Africa. Case report We present 4 cases of previously healthy children who presented with various clinical manifestations, but skin lesions and fever were common in all of them. They had multisystem involvement and eventually required aggressive multifactorial therapy. Antibiotic treatment was tailored to the results of antimicrobial sensitivity tests following blood culture. Though the hospital stay was quite long, intensive care and appropriate antibiotics contributed to a good prognosis. Conclusion In children with invasive MSSA disease, early diagnosis and prompt management are key factors to improved prognosis. Skin lesions with tender joints in a febrile infant should raise suspicion for a staphylococcal infection. Intensive care and infection source control are the cornerstones of the management.

Medicine

Incidental Breast Findings on Chest CT: Rates of Report and Follow-Up.

Hui J et al. · Jun 25, 2026

Objective This study aims to determine the incidence and types of breast findings detected on chest CTs at our institution and assess rates of subsequent follow-up imaging and breast cancer screening. Methods A retrospective review of all chest CTs performed at our institution over a 2-year period (1/1/2022-1/1/2024) was conducted, demonstrating 1540 patients above the age of 40 with incidental breast findings identified using a text search of the reports, and follow-up recommendations were documented. Clinical outcomes were analyzed for cases with recommended dedicated breast imaging. Results Incidental breast findings were detected in 14.3% of chest CTs in women above or at the age of 40. Further breast imaging was recommended in 54 cases, with 21 cases having associated dedicated breast imaging performed. Of these, corresponding dedicated workup revealed predominantly benign findings, with 82% representing benign or likely benign etiologies and only 4 cases representing malignancy. The likelihood of performing follow-up imaging was influenced by the language used in the report, with a 40% completion rate for studies using definitive wording as compared to 0% for optional wording. Conclusion There is a considerable rate of incidental breast findings visualized on chest CTs, which are predominantly benign. However, as there is a potential for visualization of malignant lesions, standardized reporting and follow-up protocols are essential to ensure proper evaluation and management. Further research is needed for evaluating and standardizing the potential use of chest CTs for assessing incidental breast lesions.

Medicine

Synergistic Regulation of Postharvest Physiology and Biochemical Quality of Peach (Prunus persica L.) Through Salicylic Acid and Plant-Based Edible Treatments.

Shajari S et al. · Jun 25, 2026

Postharvest deterioration represents a major challenge in maintaining the market quality of peach fruit, and the application of environmentally benign treatments such as edible coatings has gained increasing attention as an effective strategy to extend storage life. Accordingly, the present study evaluated the effects of several natural coating materials on the postharvest quality of peach ( Prunus persica L.). The experimental treatments consisted of salicylic acid at three concentrations (0, 1, and 2 mM), Aloe vera gel at 0%, 20%, and 30%, and clove extract at 0, 150, and 300 ppm. Overall, the application of edible coatings significantly enhanced fruit storability and quality attributes compared with untreated control fruit. Among the treatments, fruit treated with 2 mM salicylic acid and 300 ppm clove extract exhibited the highest fruit weight (89.66 g). Whereas the fruits without salicylic acid application showed the greatest fruit weight loss (15.55%) and the highest vitamin C (32.02 mg 100 g -1 FW) was obtained at 2 mM salicylic acid treatment. In terms of clove extract treatments, fruit coated with 300 ppm clove extract maintained the greatest fruit texture firmness (3.69 kg cm -2 ), total phenolic content (219.88 mg GAE 100 g -1 FW), vitamin C (mg 100 g -1 FW), and total antioxidant capacity (446.94 μmol TE g -1 FW), whereas no application treatment recorded the highest fruit weight loss (14.72%) and total acidity (4.16 g malic acid 100 g -1 FW). In conclusion, the findings demonstrate that natural edible coatings, particularly when applied in combination, are effective in reducing oxidative stress, suppressing enzymatic browning, and improving postharvest quality, thereby representing a promising and sustainable approach for extending the shelf life of peach fruit. These findings suggest that activation of antioxidant system likely stimulated by salicylic acid and supplemented by aloe vera or clove extract was a central mechanism underlying quality preservation.

Materials Science

Accuracy of administrative data in ascertaining health conditions: a systematic review.

Campbell AC et al. · Jun 25, 2026

Objectives To conduct a systematic review of studies assessing the accuracy of International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) codes in administrative data for ascertaining health conditions when compared to a reference standard. Materials and methods We searched MEDLINE, Embase, and PsycINFO, and reported study characteristics and accuracy measures, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We synthesized information about primary and validation sources of administrative data used in this literature and visually described accuracy measures by ICD chapter. Results Our review included 280 studies; only two were conducted in low or middle-income countries. The majority of studies used hospital records as the primary administrative data source (52.1%; n = 146) and medical chart reviews as the data source for validation (53.6%; n = 150). The IQRs of accuracy measures across studies and ICD chapters were 44.0-91.4, 90.0-99.6, 59.4-91.1, and 90.0-99.5 for sensitivity, specificity, PPV, and NPV, respectively. Discussion The assessed literature is heavily skewed towards data from high-income countries. The variance we observed in accuracy measures, particularly for sensitivity and PPV, indicates that we need more evidence on and ongoing monitoring of the accuracy of ICD/DSM codes in administrative data, which are now widely used in population-based epidemiologic studies and therefore highly relevant for public health policymaking. Conclusion Health conditions ascertained using ICD/DSM have moderate to high accuracy in identifying true positives and high to very high accuracy in identifying true negatives.

Health Professions

Patient Perceptions and Acceptance of Blockchain-Based Health Data Sharing in Oncology: Cross-Sectional Survey.

Moraes MV et al. · Jun 25, 2026

Background Fragmentation of electronic health records in oncology hinders coordinated care, delays diagnoses, and limits therapeutic personalization. Blockchains promise to promote secure, interoperable, and patient-centered data governance; however, patient perceptions of blockchains remain underexplored, particularly in middle-income countries such as Brazil. Objective We assessed opinions, attitudes, and willingness among patients with cancer to digitally share clinical information and the feasibility of applying blockchains to restructuring secure health data sharing in the Brazilian public health context. We had three research questions: (1) What is the level of digital health tool acceptance among patients with cancer in Brazil? (2) Which sociodemographic factors are associated with willingness to share health data? (3) Are blockchains feasible and acceptable for restructuring secure oncology data sharing? Methods An exploratory, descriptive, cross-sectional self-report survey was conducted at Hospital Santa Izabel, a national oncology reference center in Salvador, Bahia, Brazil, between September and November 2023. A convenience sample of 110 outpatients with cancer was recruited systematically; data were collected via a self-administered questionnaire. The 20-item instrument, developed de novo and validated via expert panel and pilot testing, covered 5 content domains yielding 3 composite scoring domains: self-management, adherence, and governance. We used Cronbach α to assess internal consistency, independent 2-tailed t tests, 1-way ANOVA, and Pearson correlations to compare domain scores across sociodemographic groups, and a chi-square goodness-of-fit test to examine trust proportions across recipient types. Results We received sufficiently complete responses from 94.5% (104/110) of patients. The sample was predominantly female (63/98, 64.3%), self-identified as pardo (mixed-race; 64/98, 65.3%), and lower income (55/96, 57.3% earned less than twice the minimum wage). Acceptance of technology was high: 86.4% (95/110) would use health apps and 89.1% (98/110) expressed interest in prevention-focused applications. Trust in data sharing varied significantly across recipient types (χ23=210.4; P Conclusions Patients with cancer in Brazil demonstrated high acceptance of digital health tools and openness to data sharing when privacy, security, and governance are guaranteed. This supports the feasibility of blockchain-based health data management systems, provided they incorporate patient-centered principles, digital inclusion strategies, and robust governance aligned with Brazilian regulations (the General Data Protection Law) and the Unified Health System (Sistema Único de Saúde) infrastructure. Importantly, patient support reflected acceptance of blockchain's functional principles, data security, anonymization, and auditability rather than familiarity with the technology itself, a distinction with direct implications for future implementation studies.

Computer Science