Bellotti ES et al. · Jul 1, 2026
Background Accurate range verification is crucial in hadrontherapy to fully exploit the ballistic advantages of charged particles and prevent damage to healthy tissues. Among the proposed approaches, prompt gamma imaging (PGI) has emerged as an effective technique for real-time monitoring, but its performance is limited by the intense neutron background generated during irradiation, especially with carbon-ions. Purpose This work presents a Monte Carlo study performed with the FLUKA code to investigate prompt gamma and neutron emission in proton and carbon-ion therapy. A prototype detection system based on a knife-edge collimator coupled to a pixelated LYSO scintillator was simulated to evaluate its capability for range verification. The aim is to quantify how neutron fields and neutron induced signals bias or degrade range related quantities, and how these effects differ between proton and carbon-ion beams. Methods The analysis includes the characterization of prompt gamma energy spectra and spatial profiles, the assessment of neutron fields within a treatment room, and the decomposition of the detector signal into primary gammas, secondary gammas, and neutrons. Results Results show that prompt gamma profiles correlate well with the Bragg peak position, particularly within the 3-7 MeV energy window, while carbon ions exhibit higher prompt gamma yields but also significantly stronger neutron backgrounds compared to protons. Detector simulations highlight the impact of neutron capture on lutetium, producing distinct peaks that must be accounted for in the detector signal analysis. The fall-off retrieval precision (FRP) analysis indicates that the distal fall-off of prompt gamma profiles can be used to estimate the Bragg peak position, while secondary radiation components introduce additional fluctuations that affect the achievable precision, particularly for carbon-ion beams. Conclusions The study provides a detailed characterization of prompt gamma and neutron contributions in proton and carbon-ion therapy and highlights the main physical factors affecting PGI-based range monitoring, particularly in the presence of neutron-induced backgrounds. These results provide useful insights for the design and optimization of prompt gamma detection systems in clinical applications.
Medicine
Bartsch DK et al. · Jul 1, 2026
Introduction VIPoma is an extremely rare functioning pancreatic neuroendocrine tumor. Therefore, data regarding treatment and outcome are very limited. Aim (s): This multicenter study aimed to analyze clinical characteristics, real-world management, and outcomes of patients with VIPoma. Methods Patients with VIPoma treated in a 20-year period at 14 referral centers for neuroendocrine tumors (NET) were collected in the ENETS Database. Clinical characteristics, therapeutic interventions, and outcomes were analyzed retrospectively. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Results Of 70 patients, 59 (54% male) with a median age of 55 years were included. Forty-six (78%) patients were diagnosed due to the classical watery diarrhea-hypokalemia-achlorhydria (WDHA) syndrome, and 40 (68%) presented with distant metastases at diagnosis. Fifty-two (88%) had serum VIP levels >2 times the upper normal limit and the median Ki-67 index was 5% (range 1%-40%). Surgery of the primary VIPoma was performed in 32 (54%), with curative intent in 22 (37%). In patients with stage I-III disease (n = 19), long-term cure was achieved in only 26% (5/19), with a median DFS of 81 (95%-CI: 1-215) months and 10-year OS of 78% (95%-CI: 61%-100%). In stage IV patients (n = 53, 40 at diagnosis, 13 disease progression), the sequence and type of 354 treatment lines varied, while SSA (n = 77, 22%), loco-regional liver-directed therapy (n = 72, 20%), and chemotherapy (n = 69, 19%) were most often applied. Median OS for patients with stage IV at diagnosis was 142 (95%-CI: 87-not available (NA)) months with 10-year survival of 50% (95%-CI: 35%-73%). Conclusion Patients with VIPoma treated at NET centers have relatively favorable survival, even with distant metastases at diagnosis, although long-term cure rates remain low.
Medicine
Nguyen HV. · Jul 1, 2026
Issue addressed Underage alcohol use has been linked to risks of physical, mental, and social harms to young people. Despite the known risks, research shows that parents may choose to supply alcohol to their children on occasions for various reasons. This has prompted several health promotional campaigns aimed at parents to discourage the practice of parental supply of alcohol, but there has been little evidence of how the messages are received by the target audiences, i.e., parents of adolescents. Methods Grounded in the existing literature on alcohol-related harms, social dimensions and communication of risks, the current paper conducted a qualitative analysis of interviews with parents of adolescents to understand their interpretation of risks in a series of Australian health promotion campaigns that addressed underage drinking. Result The study demonstrated how target audiences brought in their own lived experiences and social worldviews to interpret and internalise messaging about risks in ways that are nuanced and situational. Conclusions The findings demonstrated how parents' lived experiences and worldviews influenced their interpretation and alignment with the health promotion messages about parental supply of alcohol. While the ways the parents negotiated with the health promotion messages may not be scientifically-grounded, it was not always due to unawareness of risks but based upon strategies and assessment of risks in situational contexts. SO WHAT?: Understanding of how lived experiences inform interpretation of health promotion campaigns has implications for more effective alcohol-related risk communication aimed at behaviour change to reduce alcohol-related harms among young people.
Medicine
Olar-Pop L et al. · Jul 1, 2026
Antinutrients like phytic acid and oxalates reduce mineral bioavailability by forming insoluble complexes with iron, zinc, and calcium. Probiotic supplementation may counteract these effects through enzymatic activity (e.g., phytase, oxalate decarboxylase) and microbiota modulation. This PRISMA-based meta-analysis evaluated 27 in vivo studies (chickens, mice, rats) published between 2005 and 2025. Controlled trials assessing probiotic effects on mineral absorption under antinutrient-rich diets were analyzed using random effects models, expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Probiotic supplementation may enhance selected markers of mineral bioavailability across animal models (broiler, mouse, and rats), although the certainty of evidence was low and between-study heterogeneity was substantial. In broiler chickens, probiotics increased hepatic iron (SMD = 2.05; CI: 0.91-3.20) and liver ferritin levels (SMD = 2.85; CI: 0.90-4.80). In rat models of hyperoxaluria, probiotics reduced renal calcium oxalate deposition (SMD = 0.77; p = 0.0001), though the impact on urinary oxalate levels was not significant (SMD = 0.20). In mouse models, the interventions demonstrated improved gut microbiota diversity without significant alterations in total body weight (SMD = 0.02). Based on low-certainty evidence from heterogeneous animal studies, probiotic supplementation may improve selected mineral-bioavailability outcomes and may reduce calcium oxalate deposition under antinutrient-rich conditions. These findings should be interpreted cautiously. Further well-designed, species-specific studies using standardized interventions and outcome measures are needed before firm conclusions can be drawn.
Medicine
Schatz M et al. · Jul 1, 2026
Introduction Phosphate plays a critical role in numerous metabolic processes, and sex-specific differences have been identified in its concentrations in the general population. However, such differences have not been investigated in the context of CKD, in which additional factors may exert a more pronounced impact on these levels. Methods This retrospective study was conducted in an outpatient nephrology clinic and included data from 632 patients with CKD stages 1-5. Results Serum phosphate was negatively associated with age (r = -0.08; p = 0.04) and estimated glomerular filtration rate (eGFR) (r = -0.23; p Conclusion Even in the presence of CKD, women have higher serum phosphate (P) levels than men. This sex difference should be considered in the management of CKD-mineral and bone disorder (CKD-MBD).
Medicine
Pistone I et al. · Jul 1, 2026
Introduction Alcohol use disorder is a major public health issue, impacting health, well-being, relationships and work performance. In Sweden, employers are legally required to provide access to and cover the cost of alcohol treatment for individuals with alcohol use disorder. Employer-supported alcohol treatment is therefore rather common in Sweden; however, research on employees' experiences with this type of treatment remains unexplored. This qualitative study investigates how a group of Swedish employees who had received employer-supported alcohol treatment experienced workplace management before, during and after treatment. Method Interviews with 15 participants were analysed using thematic analysis, revealing three key themes. Results The first theme highlights that many participants viewed their employer as a lifeline, experiencing relief when they received support to seek help for their alcohol problems. The second theme captures employees' reliance on their employer's ability to handle the situation, emphasising the crucial role managers play in the process, with varying levels of competence and support. Third, participants often felt alone upon returning to work, facing a discrepancy between their expectations of support and the actual workplace support provided post-treatment. Discussion and conclusions The findings show how employer-supported treatment may facilitate access to care and workplace reintegration under relatively favourable circumstances, particularly when supported by managerial competence, clear routines and continued follow-up.
Medicine
Nti H et al. · Jul 1, 2026
This study investigated the role of early-life nutrition supplementation in regulating the development of hypothalamic-pituitary-adrenal (HPA) axis activity, as evidenced by hair cortisol concentration (HCC), in the iLiNS-DYAD randomized controlled trial in Ghana. Pregnant women were randomized to one of three conditions: (1) iron and folic acid (IFA) during pregnancy and placebo 0-6 mo postpartum; (2) multiple micronutrients (MMN) during pregnancy and 0-6 mo postpartum; or (3) small-quantity lipid-based nutrient supplements (SQ-LNS) during pregnancy and 0-6 mo postpartum and for their children from 6 to 18 mo. At 9-11 y of age, usable hair samples were obtained from 680 children from which cortisol was assayed. ANCOVA models assessed differences between groups and potential effect modifiers, including maternal education, household asset index, pre-pregnancy BMI, child sex, child BMI, and pubertal stage. HCC did not differ between SQ-LNS and control groups in adjusted and unadjusted models (p > 0.10), but maternal education was a significant effect modifier (P-interaction = 0.043). Children exposed to SQ-LNS had lower HCC than control children among those whose mothers had 0-5 years schooling (Median (interquartile range): 6.3 (4.8, 9.9) vs. 7.8 (5.3, 9.9); p = 0.031) but not among those whose mothers had > 5 years of schooling (p = 0.949). No other interactions were significant. Although these findings should be viewed with caution, they suggest that early-life SQ-LNS may buffer physiological stress in children of less educated mothers, highlighting its potential to compensate for socioeconomic disadvantage with regard to HPA axis regulation. Trial Registration: Clinical Trial Registry number and website: clinicaltrials.gov as NCT00970866 https://clinicaltrials.gov/ct2/show/record/NCT00970866.
Medicine
Toki R et al. · Jul 1, 2026
Background & aims Aminotransferases are widely used for metabolic dysfunction-associated steatotic liver disease (MASLD) evaluation, especially in type 2 diabetes mellitus (T2DM). Whether within-person seasonal variation affects classification near commonly used thresholds or relates to long-term metabolic outcomes remains unclear. Methods This registry-based cohort analysed monthly aspartate aminotransferase (AST) and alanine aminotransferase (ALT) measurements from 6039 adults with T2DM in the Japan Diabetes Clinical Data Management registry (2014-2020). Classification discordance across the 30 IU/L threshold was compared between winter-mean and summer-mean values. Individual seasonal amplitude was derived from seasonal-trend decomposition of multiply imputed monthly time series. Final glycated haemoglobin (HbA1c) and non-achievement of HbA1c Results Both AST and ALT showed significant seasonal variation, with the highest values in late autumn to early winter and the lowest in summer (p Conclusions AST and ALT exhibited reproducible seasonal variation peaking in late autumn to early winter, with approximately one in nine patients near the MASLD screening threshold reclassified depending on season. Greater seasonal amplitude, especially AST, was independently associated with poorer glycemic control, supporting season-aware interpretation in routine clinical practice.
Medicine
Durrwachter R et al. · Jul 1, 2026
In people, magnetic resonance imaging (MRI) with high-resolution, high T2-weighted (T2w) contrast-balanced steady-state free precession (b-SSFP) pulse sequences and 3D fast spoiled gradient-echo (FSPGR) pulse sequences can improve visualization of cranial nerves (CNs) and associated osseous foramina. This prospective, observational study aimed to determine whether the addition of b-SSFP and FSPGR sequences improves confidence in the identification of canine CNs compared to the standard imaging protocol at 1.5 T. The head of 10 canine cadavers was imaged, including transverse T1-weighted (T1w) and T2w fast spin echo (FSE); sagittal T2w FSE; 3D Fast Imaging Employing Steady-State Acquisition with Cycling (FIESTA-C); and 3D Liver Acquisition with Volume Acceleration (LAVA). Board-certified radiologists rated their confidence in identifying CNs II-XII using a four-point scale. Observers evaluated standard sequences alone, then with the addition of transverse FIESTA-C, and finally with the inclusion of FIESTA-C and transverse LAVA. Scores between protocols were compared with the Wilcoxon matched-pairs signed-rank test. Interobserver agreement was measured with weighted kappa. Median score increased when adding FIESTA-C for all observers for nerves VII, VIII, IX, and X, and for two observers for nerves III and XI. Matched-pairs comparison revealed significant differences for nerves VII and VIII for all observers, and for nerves III, IX, X, XI, and XII for two observers. Further addition of LAVA generally did not improve confidence. Interobserver agreement was overall moderate to substantial, but slight to fair for some nerves and pulse sequences. Addition of a 3D b-SSFP sequence may improve identification of some CNs, especially VII and VIII, which are somewhat commonly affected by middle ear pathology in dogs.
Medicine
Marinko S et al. · Jul 1, 2026
Introduction Many patients do not benefit from cardiac resynchronization therapy (CRT) with current guideline parameters. The objective of this study was to examine the relationship between left ventricular activation time (LVAT) from the standard 12-lead surface electrocardiogram (ECG) and clinical outcome from CRT. Methods A retrospective study was performed on patients receiving CRT implants at a large-volume tertiary care center. Digital ECGs were collected pre- and post-implant. LVAT was defined as the time from QRS onset to maximum deflection in lead V6. The primary combined endpoint was heart failure hospitalization or all-cause mortality. Results The study group comprised 415 patients (median age [Q1-Q3] of 72.8 years [65.1-78.7], 77.3% male, median baseline LVEF 27.5% [22-30], and 43.1% with ischemic heart failure etiology) who were followed for up to 7.6 years (median 2.8). LVAT was measured pre-implant (median 78 ms [66-98]) and post-implant (median 88 ms [74-106]). In Kaplan-Meier analysis, a longer pre-implant LVAT was associated with a reduced risk of reaching the primary endpoint in patients with LBBB (log-rank p = 0.046). Post-implant LVAT was not associated with clinical outcome. Conclusion Our results show that a longer baseline LVAT is associated with a lower risk of heart failure hospitalization and all-cause mortality. This relationship was of borderline significance in multivariable analysis. Prospective trials would be useful to further explore the potential role of pre-implant LVAT in patient selection for CRT.
Medicine