Background Impaired clinical insight in schizophrenia is associated with poor treatment adherence and outcomes. Previous research on the influence of symptoms, cognition, and antipsychotic exposure has been inconclusive and restricted to multi-episode samples. We examined time-specific associations between overall psychopathology, cognitive functioning, antipsychotic D₂ receptor mechanisms, antipsychotic exposure and dosage, and insight, whether these associations changed over time, and whether dosage moderated them. Methods In 144 individuals with schizophrenia, including antipsychotic-naïve and previously treated participants, multiple regressions were conducted at five cross-sectional time points and examined changes in associations over one year. Insight was assessed using PANSS item G12. Symptom severity was represented by the sum of the remaining PANSS items (mPANSS). Antipsychotic exposure was quantified as cumulative Defined Daily Doses and classified as dopamine antagonists (DA) or partial agonists (DPA). Cognitive functioning was expressed as a mean t-score. Results Greater symptom severity was consistently associated with poorer insight across time points and was the only variable showing a linear increase in strength over time. Higher DPA doses were associated with poorer insight at baseline and 12 months, but improved insight at 12 weeks. Higher cognitive functioning was associated with better insight at baseline and interacted with lower doses at 6 weeks and 12 months. No consistent associations were observed in antipsychotic-naïve participants. Conclusion Clinical insight was most consistently associated with symptom severity, with an increasingly robust association over time, highlighting the need to assess insight across the symptom spectrum, including when symptoms are mild and independently of antipsychotic dosage.
The aim of this study was to evaluate differences in safety and efficacy outcomes of PCNL between elderly and non-elderly patients, with special focus on commonly applied age cut-off values. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of PCNL in elderly versus non-elderly patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to February 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to different age thresholds used to define elderly populations (60, 65, and 70 years). Seventeen studies encompassing 45,603 patients, including 10,745 elderly individuals, were included. When pooled across all age definitions, rates of overall complications (OR 1.20, 95
Abstract Background Digital solutions for knee arthroplasty rehabilitation hold promise for improving outcomes, however, rigorous evaluation is essential. Guided by the Medical Research Council framework for complex interventions, we aimed to assess feasibility and user and clinician experience of a novel digital system – Grasp – which enables patients to report pain intensity by squeezing a handheld device and register other health status parameters through a mobile application (app) during knee arthroplasty rehabilitation. Methods For 6 postoperative weeks, participants used the Grasp device to report pain at rest and during exercise, while the app was employed to report sleep, appetite, activity, medication, and general condition. Pain and recovery trajectories were visualised in the app and informed physiotherapy evaluations. Feasibility was examined across recruitment, retention, adherence, and acceptability using logs, questionnaires, and participant and physiotherapist interviews in a convergent mixed-methods design. Quantitative data were analysed descriptively; qualitative data underwent reflexive thematic analysis. Findings were integrated through joint displays and narrative synthesis to explain adherence patterns, user experience, and inform refinements. Results Recruitment was 62%, with 34 of 55 eligible participants included (mean age 61.8 years; 68% female), and retention was 88%. Median daily pain reports declined from 9.0 (interquartile range (IQR) 3.8–14.8) at rest and 3.0 (IQR 1.0–6.0) during exercise in week 1 to 1.4 (IQR 0.6–4.9) and 0.5 (IQR 0.0–1.0) in week 5, respectively. Mean adherence declined across study weeks: rest ≥ 1 report/day from 88.9% to 60.4%, rest ≥ 5/day from 64.2% to 27.9%; exercise ≥ 1/day from 60.5% to 40.0%, exercise ≥ 3/day from 43.4% to 28.7%. App adherence was high in weeks 1–2 (85–87%), when daily reporting was scheduled. Early adherence and perceived usefulness were driven by feedback and self-monitoring, fostering motivation and awareness of pain and recovery trajectories. Declining adherence reflected recovery progress, intervention burden, and unclear exercise definitions. Physiotherapists valued data for overview and conversation but questioned workflow fit and clinical utility. Conclusions The Grasp system demonstrated moderate feasibility and potential to support pain and recovery monitoring and engagement after knee arthroplasty. However, declining adherence and usability challenges limited sustained use. Refinements are needed before progressing to effect studies. ClinicalTrials.gov identifier NCT06825988 – retrospectively registered on Feb 4th, 2025
Allergen-specific immunotherapy (AIT) is a treatment for upper airway allergy that is resistant to optimal symptomatic management. Traditionally, it is administered via repeated subcutaneous injections (subcutaneous immunotherapy, SCIT) or daily sublingual tablets/drops (sublingual immunotherapy, SLIT) for 3–5 years. Direct allergen exposure has also been attempted through intralymphatic immunotherapy (ILIT) via injections into inguinal lymph nodes. To evaluate the clinical and immunological effects of intratonsillar allergen immunotherapy for timothy grass pollen allergy. This uncontrolled, prospective, cross-sectional, pilot study included 12 patients with allergic rhinoconjunctivitis to timothy grass pollen, refractory to symptomatic treatment. Each patient received a dose of 1 mL 10,000 SQ-U standardized, aluminum hydroxide-adsorbed depot grass pollen extract (Alutard, ALK-Abelló, Denmark) for SCIT at four-week intervals. Follow-up was conducted 18 months after the final injection. During the first two injections, 7 out of 12 patients developed systemic adverse reactions within minutes, including generalized itching, edema with rashes, tiredness, and mild dyspnea, all resolving spontaneously within two hours without epinephrine administration. Patients reported significant symptom improvement, including reduced nasal congestion, rhinorrhea, sneezing, mouth breathing, and ocular itching. Immunologically, the antibody responses to timothy pollen (IgE and IgG4) showed similarities to patterns previously described for SLIT, SCIT and ILIT. Intratonsillar depot grass pollen extract injections improved symptoms of timothy-induced allergic rhinoconjunctivitis. It also induced immunological alterations characteristic for allergen-specific immunotherapy. To our knowledge, this is the first study to report the intratonsillar administration of AIT for grass pollen allergy.
Semi-quantitative uptake measurements are part of the PROMISE framework for PET/CT interpretation of tracers targeting the prostate-specific membrane antigen (PSMA), where tumor uptake is compared to uptake in reference tissues. [18F]PSMA-1007 has primarily hepatobiliary excretion and it is suggested to use spleen as reference tissue instead of liver. The aim of this study is to investigate the normal range and interpatient variability of [18F]PSMA-1007 uptake in reference tissue for prostate cancer patients, with particular focus on the splenic uptake. A total of 102 [18F]PSMA-1007 PET/CT scans of prostate cancer patients with biochemical recurrence (BCR) from three hospitals were included in the analysis. SUVmax and SUVmean measurements were performed in the blood pool, liver, spleen, and parotid glands. Results are reported as median with percentiles [5th, 95th]. For 15/102 (15
