The tracheostomy procedure in adults is an invasive intervention usually performed for complicated respiratory problems that cannot be managed conservatively. The proximity of the trachea and esophagus, along with shared pathways, can increase the likelihood of swallowing challenges in individuals with a tracheostomy. A post-tracheostomy care bundle provided by a multidisciplinary service significantly improves decannulation rates and oral diet tolerance. Eleven experts within the Union of European Phoniatricians (UEP) Swallowing Committee were selected based on their experience and practice in the field. Each working group conducted a bibliographic search on the assigned topics using Medline (PubMed), covering articles from the last 10 years or earlier if deemed of interest. Based on bibliographic research, each working group formulated a text supporting the position statements. The reference texts were revised through a series of periodic meetings, held at least quarterly, over a year (from June 2023 to June 2024), until a unanimous agreement was reached for all. A review group reviewed the material produced, providing final suggestions that were incorporated by the panel until the final document was reached, which was then proposed to a group of reviewers from the UEP Board. Dysphagia is a common complication in patients with tracheostomy tubes, with significant implications for patient safety and quality of life. They are susceptible to aspiration, and if it does occur, it is likely to be silent and difficult to detect during a clinical evaluation. It is necessary to prioritize the assessment and management of dysphagia alongside respiratory and ventilator considerations. Addressing swallowing difficulties early in the weaning process can help minimize complications and improve patient outcomes.
Cardiometabolic factors may influence migraine biology through metabolic, inflammatory, and vascular mechanisms, but studies examining insulin resistance and dyslipidaemia in migraine have yielded inconsistent results, partly due to heterogeneity in study design, fasting status, and timing of blood sampling relative to migraine attacks. We evaluated insulin-resistance indices and lipid profiles, including derived lipid ratios, in episodic migraine compared with healthy controls under standardised interictal fasting conditions. In this cross-sectional case-control study, 45 adults with episodic migraine and 45 healthy controls aged 18–50 years underwent 12-hour fasting blood sampling during the interictal period. Co-primary endpoints were homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C ratio), and atherogenic index of plasma (AIP). Multivariable linear regression models were adjusted for age, sex, body mass index, and smoking. After adjustment for age, sex, BMI, and smoking, episodic migraine remained associated with a higher TC/HDL-C ratio (B = 0.956, p < 0.001), higher AIP (B = 0.122, p = 0.008), higher total cholesterol, LDL-C, non-HDL-C, and fasting glucose, and lower HDL-C, whereas no adjusted association was found for HOMA-IR or fasting insulin. In unadjusted analyses, triglycerides were also higher in the migraine group. Monthly migraine days and attack intensity were not associated with the co-primary metabolic indices. Exploratory subgroup analyses showed nominal lipid-related differences by aura status, which did not remain significant after false discovery rate correction. Under standardised interictal fasting conditions, episodic migraine was associated with a more atherogenic lipid profile, including higher TC/HDL-C ratio and AIP. In contrast, fasting surrogate markers of insulin resistance were not associated with episodic migraine after adjustment for selected covariates, although small effects cannot be excluded. Larger longitudinal studies with more detailed metabolic assessment are needed to confirm these findings.
Background and Objectives: Vascular dementia (VaD) and mixed dementia (MD) represent prevalent causes of cognitive decline in the elderly, as they share similar pathological pathways and clinical features. Distinguishing between these two conditions remains a challenge, due to their frequent clinical and neuroimaging overlap. Nevertheless, it is important from a prognostic perspective. Materials and Methods: The study comprised 114 participants, including patients with VaD (n = 33), MD (n = 26), Alzheimer's disease (AD; n = 26), and 29 cognitively healthy controls (C). We evaluated routinely used cerebrospinal fluid (CSF) biomarkers (total tau, p-tau181, Aβ1-42) and their ratios to assess inter-group differences, diagnostic accuracy, and correlations with cognitive score. Results: Patients with MD demonstrated significantly higher levels of t-tau and p-tau181, and lower levels of Aβ1-42, compared to VaD (p < 0.004 for all analyses). With the exception of p-tau181/t-tau, all calculated ratios enabled differentiation between these groups. ROC analysis confirmed the high diagnostic accuracy of CSF Aβ1-42 and t-tau (AUC 0.82 and 0.79 respectively) for detecting AD pathology in dementia patients. Furthermore, the t-tau/Aβ1-42, p-tau181/Aβ1-42 ratios were the most effective in differentiating AD-related from vascular pathologies (AUC 0.78 and 0.80 respectively), and in differentiating MD from VaD (AUC 0.79 and 0.77 respectively). A significant correlation was observed between CSF biomarkers (especially tau markers) and cognitive impairment severity. Conclusions: CSF biomarkers effectively differentiate mixed from vascular dementia by identifying underlying AD pathology independent of the clinical phenotype. This supports the use of CSF biomarkers in clinical practice to reveal the neurodegenerative component in patients with cerebrovascular disease, which is of fundamental importance for emerging disease-modifying treatment strategies in mixed neuropathologies.
Total hip arthroplasty (THA) is increasingly performed in younger men, many of whom regard sexual function as an important component of postoperative quality of life. Regular sexual activity contributes to overall well-being. Hip osteoarthritis (OA) impairs sexual activity in up to 70
Aims:Surgical management of intermediate and malignant tumours in the pelvis is complex. Complications are frequent and either related to the surgery itself or to post-surgical failure of the reconstruction technique. This systematic review and meta-analysis aims at analyzing all reported complications following PI to PIII pelvic resections for intermediate and malignant tumours. Methods:Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis. Results:Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001). Conclusion:Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs.
