Definitive treatment of lung cancer with radiotherapy is challenging, as respiratory motion and anatomical changes can increase the risk of severe off-target effects during radiotherapy. Online adaptive radiotherapy (ART) is an evolving approach that enables timely modification of a treatment plan during the interfraction of radiotherapy, in response to physiologic or anatomic variations, aiming to improve the dose distribution for precise targeting and delivery in lung cancer patients. The effectiveness of online ART depends on the seamless integration of multiple components: sufficient quality of linear accelerator-integrated imaging guidance, deformable image registration, automatic recontouring, and efficient quality assurance and workflow. This review summarizes the present status of online ART for lung cancer, including key technologies, as well as the challenges and areas of active research in this field.
Humans ; Lung Neoplasms/radiotherapy* ; Radiotherapy Planning, Computer-Assisted/methods*

Oral squamous cell carcinoma (OSCC) progresses from preneoplastic precursors via genetic and epigenetic alterations. Previous studies have focused on the treatment of terminally developed OSCC. However, the role of epigenetic regulators as therapeutic targets during the transition from preneoplastic precursors to OSCC has not been well studied. Our study identified lysine-specific demethylase 1 (LSD1) as a crucial promoter of OSCC, demonstrating that its knockout or pharmacological inhibition in mice reversed OSCC preneoplasia. LSD1 inhibition by SP2509 disrupted cell cycle, reduced immunosuppression, and enhanced CD4+ and CD8+ T-cell infiltration. In a feline model of spontaneous OSCC, a clinical LSD1 inhibitor (Seclidemstat or SP2577) was found to be safe and effectively inhibit the STAT3 network. Mechanistic studies revealed that LSD1 drives OSCC progression through STAT3 signaling, which is regulated by phosphorylation of the cell cycle mediator CDK7 and immunosuppressive CTLA4. Notably, LSD1 inhibition reduced the phosphorylation of CDK7 at Tyr170 and eIF4B at Ser422, offering insights into a novel mechanism by which LSD1 regulates the preneoplastic-to-OSCC transition. This study provides a deeper understanding of OSCC progression and highlights LSD1 as a potential therapeutic target for controlling OSCC progression from preneoplastic lesions.
STAT3 Transcription Factor/metabolism* ; Animals ; Histone Demethylases/genetics* ; Phosphorylation ; Mouth Neoplasms/immunology* ; Mice ; Carcinoma, Squamous Cell/immunology* ; Disease Progression ; Cyclin-Dependent Kinase-Activating Kinase ; Precancerous Conditions/metabolism* ; Humans ; Cyclin-Dependent Kinases/metabolism* ; Disease Models, Animal

Obesity and sleep apnea contribute to significant challenges in ambulatory surgical centers which include airway management and perioperative recovery. This narrative review was written following a literature review of articles available on ScienceDirect, PubMed, and Google Scholar from 2009 to 2024. This article highlights that obesity-related anatomical changes, such as increased neck circumference (NC) and reduced cervical extension, may complicate airway management. Successful ambulatory surgery for these high-risk patients depends on detailed attention throughout the perioperative period. Advanced airway techniques, along with continuous pulse oximetry and capnography, are vital for safe care. The use of continuous positive airway pressure or bilevel positive airway pressure in the perioperative phase is particularly beneficial in preventing respiratory complications. A systematic, multidisciplinary approach emphasizing preoperative screening, risk stratification, and standardized protocols is crucial for optimizing results.

AIM

To determine the reliability of the Philippine nurse licensure examination (PNLE) results from 2010 to 2019.

The PNLE first-time pass rate (FTPR) is a major criterion used to evaluate nursing program quality. There is wide variability in PNLE results ranging from 0% to 100% across nursing schools. There are no published studies to investigate the reliability of the PNLE.

Aretrospective correlational research design was used to determine the reliability of PNLE. Secondary data analysis of 517 nursing schools' PNLE FTPR results was conducted. Descriptive statistics described trends in PNLE results over 10 years. Spearman correlation was used to determine PNLE reliability.

The PNLE FTPR increased from 2010 to 2019. More than half of Philippine nursing schools have low PNLE performance. Combined annual PNLE results, that is, adding May/June and November/December results, provided a more accurate measure of reliability.

The PNLE is a reliable measurement tool to evaluate nursing program outcomes. Regulatory bodies should use caution in using PNLE results as a criterion in assessing nursing program quality.

Prior research suggests metformin has anti-cancer effects, yet data are limited. We examined the association between diabetes treatment (metformin versus sulfonylurea) and risk of incident diabetes-related and non- diabetes-related cancers in US veterans.This retrospective cohort study included US veterans, without cancer, aged ≥ 55 years, who were new users of metformin or sulfo-nylureas for diabetes between 2001 to 2012. Cox proportional hazards models, with propensity score-matched inverse probability of treatment weighting (IPTW) were constructed. A total of 88,713 veterans (mean age 68.6 ± 7.8 years; 97.7% male; 84.1% White, 12.6% Black, 3.3% other race) were followed for 4.2 ± 3.0 years. Among metformin users (n = 60,476), there were 858 incident diabetes-related cancers (crude incidence rate [IR; per 1,000 person-years] = 3.4) and 3,533 non-diabetes-related cancers (IR = 14.1). Among sulfonylurea users (n = 28,237), there were 675 incident diabetes-related cancers (IR = 5.5) and 2,316 non-diabetes-related cancers (IR = 18.9). After IPTW adjustment, metformin use was associated with a lower risk of incident diabetes-related cancer (hazard ratio [HR] = 0.66, 95% CI 0.58-0.75) compared to sulfonylurea use. There was no association between treatment group (metformin versus sulfonylurea) and non-diabetes-related cancer (HR = 0.96, 95% CI 0.89-1.02). Of diabetes-related cancers, metformin users had lower incidence of liver (HR = 0.39, 95% CI 0.28-0.53), colorectal (HR = 0.75, 95% CI 0.62-0.92), and esophageal cancers (HR = 0.54, 95% CI 0.36-0.81). Among US veterans, metformin users had lower incidence of diabetes-related cancer, particularly liver, colorectal, and esophageal cancers, as compared to sulfonylurea users. Use of metformin was not associated with non-diabetes-related cancer. Further studies are needed to understand how metformin use impacts cancer incidence in different patient populations.

Purpose: This study evaluates the use of ChatGPT-4o in creating tailored continuing professional development (CPD) plans for radiography students, addressing the challenge of aligning CPD with Medical Radiation Practice Board of Australia (MRPBA) requirements. We hypothesized that ChatGPT-4o could support students in CPD planning while meeting regulatory standards. Methods: A descriptive, experimental design was used to generate 3 unique CPD plans using ChatGPT-4o, each tailored to hypothetical graduate radiographers in varied clinical settings. Each plan followed MRPBA guidelines, focusing on computed tomography specialization by the second year. Three MRPBA-registered academics assessed the plans using criteria of appropriateness, timeliness, relevance, reflection, and completeness from October 2024 to November 2024. Ratings underwent analysis using the Friedman test and intraclass correlation coefficient (ICC) to measure consistency among evaluators. Results: ChatGPT-4o generated CPD plans generally adhered to regulatory standards across scenarios. The Friedman test indicated no significant differences among raters (P=0.420, 0.761, and 0.807 for each scenario), suggesting consistent scores within scenarios. However, ICC values were low (–0.96, 0.41, and 0.058 for scenarios 1, 2, and 3), revealing variability among raters, particularly in timeliness and completeness criteria, suggesting limitations in the ChatGPT-4o’s ability to address individualized and context-specific needs. Conclusion ChatGPT-4o demonstrates the potential to ease the cognitive demands of CPD planning, offering structured support in CPD development. However, human oversight remains essential to ensure plans are contextually relevant and deeply reflective. Future research should focus on enhancing artificial intelligence’s personalization for CPD evaluation, highlighting ChatGPT-4o’s potential and limitations as a tool in professional education.

Background and Objectives: Atrial fibrillation (AF), the most common atrial arrhythmia (AA), is an increasing healthcare burden in Korea. The objective of this sub-analysis of the Cryo Global Registry was to evaluate long-term efficacy, symptom burden, quality of life (QoL), and healthcare utilization outcomes and factors associated with AA recurrence in Korean patients treated with cryoballoon ablation (CBA). Methods: Patients were treated and followed up according to local standard-of-care in 3 Korean hospitals. Kaplan-Meier estimates were used in analyzing (1) efficacy defined as freedom from ≥30 second recurrence of AA at 24 months, (2) healthcare utilization, and (3) predictors of 24-month AA recurrence. Patient-reported QoL (using European Quality of Life-5 Dimensions-3 Levels) and predefined AF-related symptoms were assessed at baseline and 24-month follow-up. Results: Efficacy was 71.9% in paroxysmal AF (PAF) and 49.3% in persistent AF (PsAF) patients (p<0.01). A larger left atrial diameter (LAD), an increased time from AF diagnosis to CBA, and PsAF were independent predictors of AA recurrence. The percentage of patients with no AF symptoms significantly increased from baseline (24.5%) to 24-month (89.5%)follow-up (p<0.01). Improvement in QoL from baseline to 24 months was not statistically different between AF cohorts. PAF patients experienced greater freedom from repeat ablations (93.9% vs. 81.4%) and cardiovascular hospitalizations (91.3% vs. 72.5%, p<0.001 for both). Conclusions In alignment with global outcomes, CBA is an effective treatment for AF in the Korean population, with patients possessing a large LAD and not receiving ablation soon after diagnosis being the most at risk for AA recurrence.