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The global COVID-19 vaccination campaign has raised concerns about potential side effects, including cardiac involvement or axillary lymphadenopathy. This study investigated the relationship between COVID-19 vaccination and thallium-201 myocardial perfusion imaging (Tl-201 MPI) findings, aiming to elucidate the impact of the vaccine impact on cardiac health. This retrospective analysis enrolled patients referred for MPI examination post-COVID-19 vaccination between June 2021 and January 2022. Eligible participants included symptomatic individuals without prior coronary artery disease (CAD) or with stable CAD, experiencing symptoms within one-month post-vaccination. MPI was conducted post dipyridamole-stress testing, and positive stress test results were further evaluated by cardiac catheterization. The association between vaccination and MPI results, including axillary lymphadenopathy presence, was assessed. Sixty-four patients were included, with a mean age of 54.7 years, and a predominance of males (64.3%). A notable incidence of positive MPI findings and axillary lymphadenopathy was observed, particularly in patients vaccinated with mRNA vaccines. Among the 15 patients with positive MPI, visible axillary lymphadenopathy was observed in 4 cases (26.7%), compared with 6 of 49 patients (12.2%) with negative MPI. Although this difference was not statistically significant, it suggests a possible trend toward a higher prevalence in the MPI-positive subgroup. Most patients with positive MPI findings had received the Moderna vaccine. Our findings indicate a potential link between mRNA COVID-19 vaccination and cardiac issues detected via MPI, as well as an increase in axillary lymphadenopathy. Although further prospective studies are warranted to establish causality, our findings underscore the importance of post-vaccination monitoring, particularly in symptomatic patients, and the need of continued efforts to comprehensively assess vaccine safety to help reduce mortality rates.

Background Tzu Chi University in Taiwan offers a unique mentoring program. This program differs from others as it comprises triple mentorship, namely, faculty mentors, Tzu Cheng/Yi De (TC/YD; senior volunteers), and school counselors. This study aimed to survey the role functions of the mentors from the perspective of medical students. Methods The Role Functions of the Mentoring Program Scale (RFMPS) was developed on the basis of literature reviews and focus groups and it underwent exploratory factor analysis for internal consistency and reliability. RFMPS comprises four role functions, namely, mental, educational, career, and humanistic/moral guidance counseling. The survey was distributed to 171 medical students via an online network with two-month intervals and was analyzed using multivariate analysis of variance. Results The overall response rate was 64% (116/171). The mean scores of the four role functions in descending order belonged to faculty mentors, TC/YD, and school counselors. For humanistic/moral guidance, students had an equal preference for the faculty mentors and TC/YD over school counselors. As for educational, career, and mental guidance counseling, students preferred faculty mentors over TC/YD and school counselors. Faculty mentors provided students with the required guidance counseling for all the four role functions, especially educational guidance; TC/YD in particular offered prominent humanistic/moral guidance and career counseling; school counselors were less preferred but guided students in need. Conclusions Medical students value different role functions provided by faculty mentors, TC/YD, and school counselors. A diversified focus could be provided by the faculty mentors, particularly in educational, career, mental, and humanistic/moral counseling; TC/YD specialized in humanistic/moral guidance; and the school counselors carried out their role function only when needed. Humanistic/moral guidance is equally preferred to other types of guidance, which can be equally valuable in future mentoring programs.

We report a case of a 73-year-old man with minimally invasive lung adenocarcinoma, post-resection, evaluated with [sup.18]F-FDG PET/CT for suspected disease progression. Imaging showed increased FDG uptake in the right lower lung mass and systemic lymphadenopathy (mediastinal, supraclavicular, axillary, paraaortic, and iliac regions). The appearance of a stable lymph node and a clinical history of IgG4 lymphadenopathy suggested an inflammatory process, although malignancy in the lung mass and mediastinal nodes could not be excluded. Lobectomy confirmed the presence of lung adenocarcinoma, while radical lymph node dissection identified IgG4-related lymphadenopathy without metastasis. This case underscores the need for considering differential diagnosis of PET-positive lymphadenopathy, especially in patients with comorbid conditions that mimic or coexist with malignancy.

We report a case of a 73-year-old man with minimally invasive lung adenocarcinoma, post-resection, evaluated with 18F-FDG PET/CT for suspected disease progression. Imaging showed increased FDG uptake in the right lower lung mass and systemic lymphadenopathy (mediastinal, supraclavicular, axillary, paraaortic, and iliac regions). The appearance of a stable lymph node and a clinical history of IgG4 lymphadenopathy suggested an inflammatory process, although malignancy in the lung mass and mediastinal nodes could not be excluded. Lobectomy confirmed the presence of lung adenocarcinoma, while radical lymph node dissection identified IgG4-related lymphadenopathy without metastasis. This case underscores the need for considering differential diagnosis of PET-positive lymphadenopathy, especially in patients with comorbid conditions that mimic or coexist with malignancy.

We report a case of a 73-year-old man with minimally invasive lung adenocarcinoma, post-resection, evaluated with F-FDG PET/CT for suspected disease progression. Imaging showed increased FDG uptake in the right lower lung mass and systemic lymphadenopathy (mediastinal, supraclavicular, axillary, paraaortic, and iliac regions). The appearance of a stable lymph node and a clinical history of IgG4 lymphadenopathy suggested an inflammatory process, although malignancy in the lung mass and mediastinal nodes could not be excluded. Lobectomy confirmed the presence of lung adenocarcinoma, while radical lymph node dissection identified IgG4-related lymphadenopathy without metastasis. This case underscores the need for considering differential diagnosis of PET-positive lymphadenopathy, especially in patients with comorbid conditions that mimic or coexist with malignancy.

Background: Tzu Chi University (TCU) in Taiwan offers a mentoring program that differs from others since it comprises triple mentors: faculty mentors, Tzu Cheng/Yi De (TC/YDs who are senior volunteers), and school counselors. This study aimed to analyze medical student’s perceptions of the triple mentors’ role functions using a self-developed assessment tool. Methods: The Role Functions of the Mentoring Program Scale (RFMPS) was developed through literature reviews, focus groups, and underwent exploratory factor analysis for internal consistency and reliability. The RFMPS consists of 16 items measuring the triple mentors’ role functions on a five-point Likert scale. Items covered four role functions: mental counseling, educational guidance, career counseling, and humanistic/moral guidance. Student’s perceptions were collected through an online survey and analyzed using a multivariate analysis of variance (MANOVA). Results: The overall response rate was 64% (116/171). Faculty mentors provided students with preferable guidance counseling in all four role functions; TC/YDs particularly offered prominent humanistic/moral guidance and career counseling; school counselors were less preferred and guided students in need. Besides, students were evenly guided regarding their gender and year. The RFMPS was a reliable tool for evaluating the mentoring program as a whole. Conclusions: Faculty mentors, TC/YDs, and school counselors comprehensively performed their role functions in the mentoring program. Humanistic/moral guidance is current and comparable to educational, career, and mental guidance counseling; the mentoring program can extend its scope by including humanistic, moral, or spiritual connotations.

Premature atrial complexes (PACs) have been suggested to increase the risk of adverse events. The distribution of PAC burden and its dose–response effects on all-cause mortality and cardiovascular death had not been elucidated clearly. We analyzed 15,893 patients in a medical referral center from July 1st, 2011, to December 31st, 2018. Multivariate regression driven by ln PAC (beats per 24 h plus 1) or quartiles of PAC burden were examined. Older group had higher PAC burden than younger group ( p for trend < 0.001), and both genders shared similar PACs distribution. In Cox model, ln PAC remained an independent risk factor for all-cause mortality (hazard ratio (HR) = 1.09 per ln PAC increase, 95% CI = 1.06‒1.12, p  < 0.001). PACs were a significant risk factor in cause-specific model (HR = 1.13, 95% CI = 1.05‒1.22, p  = 0.001) or sub-distribution model (HR = 1.12, 95% CI = 1.04‒1.21, p  = 0.004). In ordinal PAC model, 4th quartile group had significantly higher risk of all-cause mortality than those in 1st quartile group (HR = 1.47, 95% CI = 1.13‒1.94, p  = 0.005), but no difference in cardiovascular death were found in competing risk analysis. In subgroup analysis, the risk of high PAC burden was consistently higher than in low-burden group across pre-specified subgroups. In conclusion, PAC burden has a dose response effect on all-cause mortality and cardiovascular death.

Background Real-world evidence comparing long-term safety between PD-1 and PD-L1 inhibitors is limited, and the impact of competing mortality is unclear. Methods This retrospective cohort study utilized the TriNetX platform (2014–2024). Adults with advanced solid tumors initiating a PD-1 or PD-L1 inhibitor within 3 months of diagnosis were included. A 1:1 propensity score match created balanced cohorts. The primary outcome was the 1-year incidence of immune-related adverse events (irAEs). Standard Cox models and Fine-Gray competing risk models (accounting for death) were used to estimate hazard ratios (HRs) and subdistribution hazard ratios (sHRs), respectively. Results After matching, 22,672 patients (11,336 per group) were analyzed. In standard Cox analysis, PD-L1 inhibitors were associated with a lower risk of skin rash (HR 0.66, 95% CI 0.56–0.78), colitis (HR 0.79, 0.71–0.87), and nephritis (HR 0.71, 0.54–0.94) compared to PD-1 inhibitors. The competing risk analysis revealed that all-cause mortality was the overwhelmingly dominant outcome. Consequently, PD-L1 inhibitor use was associated with uniformly lower sHRs for every irAE analyzed (range: 0.85–0.88), with the sHR for mortality itself at 0.88 (0.84–0.92). This pattern, indicating the safety signal was heavily confounded by survival, was consistent across sex and age subgroups but more pronounced in males and older patients. Conclusion PD-L1 inhibitors are associated with a lower risk of specific irAEs. However, mortality is the dominant competing risk in advanced cancer, fundamentally shaping safety assessments. Real-world studies must account for competing mortality to avoid distorted conclusions.

Endometriosis is a chronic, estrogen-dependent condition associated with substantial physical and psychological burden. Although psychiatric comorbidities are frequently reported, large-scale real-world data remain limited. We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, including women aged 21–60 diagnosed with endometriosis between 2001 and 2020. Patients were matched 1:1 with controls without endometriosis using propensity score matching (PSM) based on age, race, nicotine dependence, alcohol abuse, obesity, infertility, delivery history, insomnia, and menopause. Psychiatric outcomes included depressive episodes, recurrent major depressive disorder, anxiety disorders, and substance use disorders. Subgroup analyses assessed differences by race, age, and postoperative hormonal therapy use. After PSM, each group included 7563 patients. Endometriosis was significantly associated with increased risks of several psychiatric disorders, including depressive episodes (HR = 1.35, 95 % CI: 1.24–1.47), recurrent major depressive disorder (HR = 1.30, 95 % CI: 1.10–1.53), anxiety disorders (HR = 1.39, 95 % CI: 1.29–1.49), phobic anxiety disorder (HR = 1.47, 95 % CI: 1.01–2.13), and substance use disorders (HR = 1.43, 95 % CI: 1.30–1.56). The composite outcome of all assessed psychiatric disorders—including depressive episodes, recurrent major depressive disorder, anxiety disorders, phobic anxiety disorder, mental and behavioral disorders due to psychoactive substance use, and suicidal ideation—was also significantly elevated in the endometriosis group (HR = 1.38, 95 % CI: 1.30–1.46). These associations were most pronounced among White patients, while Black patients showed elevated risks for recurrent depression and anxiety disorders only. No significant associations were observed among Asian patients. Additionally, postoperative hormonal therapy did not significantly reduce the risk of psychiatric disorders compared to surgery alone. Women with endometriosis face elevated risks of psychiatric disorders, with notable racial disparities. Hormonal therapy may not mitigate these mental health risks. Our findings underscore the importance of integrated gynecologic and psychological care in the management of endometriosis. •Endometriosis increases risk of depression, anxiety, and substance use.•Psychiatric risks vary by race, with White patients most affected.•Hormonal therapy after surgery shows no protection against mental disorders.

Due to a unique cortical venous drainage pattern without sinus drainage, ethmoidal dural arteriovenous fistula (DAVF) are uncommon cerebral vascular lesions that carry a high risk of brain bleeding and neurologic deficit. Surgical intervention has been found to have a lower complication rate and a more satisfactory obliteration rate than endovascular treatment among the various DAVF treatment options. The supraorbital keyhole subfrontal approach is one of the least invasive and appropriate surgical techniques for addressing the anterior fossa vascular lesion in eDAVFs. We describe two men, ages 60 and 71, who underwent this surgical intervention to treat asymptomatic Cognard type IV eDAVFs. Complete obliteration with a detached fistulous point and skeletonization was accomplished with the aid of intraoperative neuronavigation. Thus, we suggest that a suitable surgical method for the treatment of eDAVFs would be to use a supraorbital keyhole subfrontal approach.