Chung Shan Medical University Hospital

were recurrent miscarriage, placental insufficiency, preeclampsia, and fetal death.Significant variation existed in how key obstetric symptoms like recurrent miscarriage, fetal death, stillbirth, and recurrent implantation failure are defined.Although many respondents routinely recommend aPL testing after severe pregnancy complications, the timing and interpretation of antibody results vary widely.Tests for lupus anticoagulant, anticardiolipin, and anti-2-glycoprotein I antibodies were commonly used, although thresholds for clinical relevance varied.Both the updated Sapporo and the 2023 ACR/EULAR classification criteria were frequently used in clinical practice.For treatment, most obstetric cases favored low-dose aspirin combined with prophylactic low-molecular-weight heparin, particularly for patients with double or triple aPL positivity, whereas additional therapies, such as hydroxychloroquine, were used less consistently.Conclusions This international survey underscores considerable variability in the definitions, diagnostic procedures, and management strategies for OAPS within routine practice.Although there is widespread consensus on antithrombotic therapy, disparities in classification criteria and laboratory interpretation underscore the need for more precise, harmonized guidelines and educational initiatives to enhance standardization and patient care in OAPS.

BackgroundEffective patient education is a core component of supportive care delivered by radiotherapy teams. However, conventional text-based materials may not adequately address the needs of patients with limited health literacy or high anxiety. Visual-enhanced educational tools may help patients better understand treatment procedures, manage side effects, and engage in self-care, but evidence from randomized controlled trials in radiotherapy settings remains limited.MethodsWe conducted a single-center, prospective, parallel-group randomized controlled trial including 200 adults (100 breast cancer and 100 head and neck cancer) initiating radiotherapy at a medical center. Participants were randomly assigned 1:1 (stratified by cancer type) to receive either visual-based illustrated pamphlets (enhanced group) or traditional text-based pamphlets (control group) as part of a standardized education session delivered by certified oncology nurses. Anxiety was assessed using the Hamilton Rating Scale for Anxiety (HAMA), and self-care knowledge was measured using a structured questionnaire, both at baseline and at two weeks after radiotherapy initiation. Inter-group differences in changes over time were examined using independent t-tests and analysis of covariance, with effect sizes and 95% confidence intervals reported.ResultsBoth groups demonstrated reductions in anxiety and improvements in self-care knowledge over time; however, the visual-based group showed significantly greater benefits. Participants who received illustrated materials had a larger decrease in total HAMA scores compared with the control group (mean change − 3.39 ± 4.48 vs. −0.17 ± 3.11; p < 0.0001). Enhanced improvements were also observed across multiple anxiety-related domains. In addition, the visual-based group achieved higher post-intervention scores on key self-care knowledge items, particularly in areas such as treatment frequency, skin protection, dietary adjustment, and hydration, with consistently significant inter-group differences.ConclusionsVisual-based educational materials delivered by certified oncology nurses significantly reduced anxiety and enhanced self-care knowledge among patients initiating radiotherapy, compared with traditional text-only materials. Integrating illustrated educational tools into routine radiotherapy education may promote patient-centered care and improve health literacy. Future studies should evaluate long-term behavioral outcomes, broader implementation in diverse oncology settings, and resource/workflow impact.Trial registrationThis randomized controlled trial was retrospectively registered at ClinicalTrials.gov (NCT06678204) on 29 October 2024 and is reported in accordance with the CONSORT 2025 Statement.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12912-026-04442-0.

The palatine tonsils and adenoids are critical inductive sites for the mucosa-associated lymphoid tissue (MALT) system, educating B cells for salivary defense. While their removal is common, the long-term impact on mucosal autoimmunity remains unclear. We hypothesized that disrupting this lymphoid network increases susceptibility to Sjögren's syndrome (SS). Using the TriNetX US Collaborative Network (2006-2023), we conducted a retrospective cohort study matching 302,737 patients who underwent tonsillectomy/adenoidectomy with 302,737 non-surgical controls (propensity score-matched 1:1). Hazard ratios (HR) for incident SS were estimated using Cox proportional hazards models. The surgical cohort exhibited a significantly elevated risk of SS (HR 1.52; 95% CI 1.23-1.87; p<0.001) compared to controls. This risk was most profound in individuals operated on before age 18 (HR 2.27) and in African American patients (HR 2.26). Sensitivity analyses using negative outcome controls (e.g., burns, injuries) confirmed the specificity of the association. Tonsillectomy is independently associated with an increased risk of SS. These findings suggest that early-life removal of nasopharyngeal lymphoid tissue may disrupt the MALT axis, impairing oral tolerance and predisposing to salivary autoimmunity.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder associated with systemic comorbidities. Its potential link with urolithiasis, a common urological disease, remains unclear. We conducted a multicenter, retrospective cohort study using the TriNetX US Collaborative Network. Adults ≥18 years with HS diagnoses and more than two visits between 2005 and 2018 were identified and matched 1:1 with non-HS controls using propensity scores. Patients with prior urolithiasis or malignancy were excluded. The final analytic cohort included 79,567 patients with HS and 79,567 controls. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Sensitivity analyses applied alternative definitions, wash-out periods, and follow-up durations. Comparator groups included psoriasis, rosacea, and androgenic alopecia. Stratified analyses were performed by age and sex. HS was associated with an increased risk of urolithiasis in 15-year follow-up (HR=1.334, 95% CI=1.260-1.413). This association persisted across sensitivity analyses. Comparisons with psoriasis, rosacea, and androgenic alopecia also demonstrated significantly elevated risks (HRs ranging from 1.247 to 1.296). Stratified analyses showed consistent results in both sexes (males: HR=1.340, 95% CI=1.202-1.493; females: HR=1.326, 95% CI=1.214-1.417) and age groups (18-64 years: HR=1.317, 95% CI=1.237-1.402; ≥65 years: HR=1.308, 95% CI=1.160-1.475). Site-specific analyses demonstrated increased risks for renal, ureteric, and lower urinary tract calculi. HS is associated with elevated risk of urolithiasis, consistent across analytic models and subgroups. These findings highlight the existence of overlapping inflammatory pathways and underscore the importance of renal monitoring in HS management.

Few genome-wide association studies have examined genetic variants associated with hepatocellular carcinoma (HCC) risk in individuals seronegative for HBsAg and anti-HCV, and the long-term impact of these variants remains uncertain. This multi-stage study analyzed adults >30 years old who were seronegative for HBsAg and anti-HCV. In the genome-wide association study discovery phase, 765 HCC cases and 9,949 controls were analyzed for 308,693 SNPs, with significant SNPs confirmed in community-based (171 HCC cases, 684 controls) and hospital-based (470 HCC cases, 5,460 controls) validation sets. A cohort of 67,909 participants, followed from 2012 to 2021, was used to evaluate the long-term HCC risk associated with these variants. Ten SNPs in PNPLA3/SAMM50 were significantly associated with HCC risk (p <1.62 × 10-7) and were in high linkage disequilibrium. Three SNPs (rs738409, rs2281135, rs2235776) were replicated and demonstrated strong associations with HCC, independent of steatosis. Over 267,238 person-years of follow-up, 32 new HCC cases occurred, with elevated risks observed in individuals homozygous for the risk genotypes: GG (rs738409), AA (rs2281135), and TT (rs2235776). The adjusted hazard ratios (95% CI) were 3.37 (1.32-8.63), 2.80 (1.06-7.37), and 2.64 (0.91-7.66), respectively. In allelic models, carriers of the risk allele had higher HCC risk, with adjusted hazard ratios (95% CI) of 1.88 (1.14-3.10) for rs738409, 1.68 (1.02-2.78) for rs2281135, and 1.61 (0.98-2.67) for rs2235776. This study identified PNPLA3/SAMM50 variants significantly associated with long-term HCC risk in individuals without viral hepatitis. These findings highlight their potential utility as biomarkers for HCC risk stratification and underscore the need for further research into underlying mechanisms. Variants in the PNPLA3/SAMM50 locus were significantly associated with hepatocellular carcinoma (HCC) risk in individuals seronegative for HBsAg and anti-HCV. The stepwise increase in HCC risk with higher numbers of risk alleles suggests their potential utility as biomarkers to identify high-risk individuals without a history of chronic hepatitis B or C virus infection. These findings provide a foundation for genetic risk stratification and precision prevention strategies in populations where non-viral etiologies of HCC are becoming increasingly important.

<sec><title>BACKGROUND</title>Post-TB bronchiectasis is a recognised but under-investigated category of bronchiectasis. This study evaluated its clinical features and identified risk factors for acute exacerbations (AEs).</sec><sec><title>METHODS</title>This retrospective observational cohort study analysed data from the Taiwan Bronchiectasis Registry. Patients with bronchiectasis were included, and those with post-TB bronchiectasis were identified for subgroup analysis. We collected demographics, symptoms, lung function, microbiological data, and modified Reiff scores to assess risk factors for AEs.</sec><sec><title>RESULTS</title>A total of 1,444 patients were analysed, including 222 (15%) with post-TB bronchiectasis. Among them, 54 (24%) experienced at least one AE during the study period. Post-TB bronchiectasis patients had more frequent AEs, higher FACED and modified Reiff scores, lower body mass index (BMI) and forced expiratory volume in 1 s (FEV1), and more symptoms than non-post-TB cases. Post-TB bronchiectasis patients with AEs had higher FACED and Reiff scores, lower BMI and FEV1, and higher rates of positive sputum cultures for gram-negative bacilli (GNB). Multivariable analysis identified FEV1 ≤ 60% predicted (adjusted odds ratio [aOR]: 2.334, 95% CI: 1.192-4.572) and positive GNB cultures (aOR: 3.075, 95% CI: 1.362-6.942) as independent risk factors for AEs.</sec><sec><title>CONCLUSION</title>Post-TB bronchiectasis is associated with a higher risk of exacerbations. Reduced FEV1 and positive GNB cultures are independent risk factors for AEs.</sec>.