Background: Despite advances in treatment strategies, osteosarcoma patients undergoing limb-salvage surgery (LSS) still face a considerable risk of recurrence and unsatisfactory long-term survival. Therefore, reliable pretreatment baseline prognostic assessment tools are needed to improve postoperative risk stratification and guide individualized treatment. Methods: This single-center retrospective prediction model development study analyzed 118 patients with pathologically confirmed osteosarcoma treated at Shengjing Hospital, China Medical University, between January 2019 and January 2025. After applying predefined inclusion and exclusion criteria, 81 patients were included in the final analysis. All predictors were defined as before-treatment baseline measurements at the diagnosis stage: alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were serum biochemical markers, whereas fibrinogen (FIB) and D-dimer were plasma coagulation-related markers. Ki-67 index, age, sex, tumor size, and lung metastasis status were also assessed at this before-treatment baseline. A diagnosis-stage baseline prognostic model for overall survival (OS) among patients undergoing LSS was subsequently constructed. Internal validation of model performance was performed using bootstrap resampling only, with no external validation performed. Results: Kaplan–Meier analysis demonstrated 1-, 3-, and 5-year survival rates of 87.3%, 74.3%, and 64.1%, respectively. Survival curve analysis revealed that patients with elevated levels of all four laboratory biomarkers were associated with shorter OS. Multivariate Cox regression analysis revealed that baseline ALP remained independently associated with OS, while FIB showed borderline significance (p = 0.050). The final OS prognostic model incorporated ALP, LDH, FIB, and D-dimer. The apparent Harrell’s concordance index (C-index) of the model was 0.838 for the full dataset, with an optimism-corrected C-index of 0.780 after Bootstrap internal validation. The area under the receiver operating characteristic curve (AUC) of the model for predicting 1-, 3-, and 5-year OS in the full dataset was 0.831, 0.864, and 0.871, respectively; the optimism-corrected AUC values after Bootstrap validation were 0.771, 0.810, and 0.814. Conclusions: In this single-center retrospective cohort, higher baseline levels of ALP, LDH, FIB, and D-dimer were associated with adverse clinicopathological characteristics and poorer survival outcomes in patients with osteosarcoma. The LASSO-Cox-based prognostic model showed promising discrimination and calibration after internal Bootstrap validation. However, given the limited sample size and absence of external validation, these findings should be considered preliminary, and prospective multicenter external validation is required before the model can be considered for routine clinical implementation.
Background: Gastrointestinal (GI) diseases contribute substantially to healthcare utilization and chronic disease burden through recurrent symptoms, ongoing specialist care, and diagnostic evaluation. However, disparities related to race, ethnicity, and immigration status may arise at multiple points along the GI care continuum, and their association with access, diagnosis, treatment, and outcomes remains incompletely characterized. This scoping review synthesizes evidence on these differences in GI healthcare delivery. Methods: MEDLINE and Embase were searched from 1 January 2000 to 17 June 2025, with supplementary grey literature searches of relevant GI, liver, surgical, and endoscopic society websites. Findings were synthesized thematically due to heterogeneity in study design, populations, outcomes, and reporting. Results: Seventy-four studies were included across various GI diseases, including inflammatory bowel disease, hepatobiliary disease, esophageal disorders, and liver transplantation. Differences in care were reported across multiple care stages, including specialist access; diagnostic and treatment delays; use of medical, procedural, and surgical therapies; emergency care reliance; and transplant access and outcomes. Findings were, however, heterogeneous, with some studies reporting no differences or higher utilization among minority groups. Conclusions: Racial, ethnic, and immigration-related differences are reported across GI care pathways. Future research should identify modifiable factors that may lead to practice-changing interventions that will improve timely, equitable, longitudinal care.
Background: Malocclusion is a highly prevalent condition, affecting approximately 56% of the global population. Beyond its functional and physical characteristics, malocclusion has been associated with psychosocial outcomes, particularly body image concerns and perceived quality of life. The present study aimed to investigate the associations among Angle class, body image concerns, and oral health-related quality of life. Methods: A total of 136 adolescents aged 10 to 19 years (M = 15.49; SD = 2.64; 47.8% males and 52.2% females) were recruited from the “Gaetano Martino” University Hospital of the University of Messina. Following the clinical diagnosis and classification of malocclusion according to Angle’s classification (Class I, Class II, and Class III), participants underwent a psychodiagnostic assessment comprising a sociodemographic questionnaire, the Italian version of the Body Image Concern Inventory (I-BICI), and the Oral Health Impact Profile (OHIP-14). Results: Greater body image concerns were significantly associated with poorer oral health-related quality of life. Female participants reported significantly higher levels of body image concerns than males, whereas no significant sex differences emerged in OHIP-14 scores. Generalized linear models further showed that Angle class was significantly associated with body image concerns and oral health-related quality of life after controlling for age and sex. Conclusions: The findings indicate that Angle class is associated with body image concerns and oral health-related quality of life in adolescents with malocclusion. These results highlight the relevance of considering body image concerns and patient-reported oral health-related quality of life alongside conventional orthodontic assessment, supporting a more comprehensive, patient-centered approach to orthodontic care.
Background/Objectives: Traumatic brain injury (TBI) is a global burden and a leading cause of death and disability worldwide. Delayed healthcare presentation is significantly associated with poor outcomes. This systematic review and meta-analysis aim to estimate the prevalence of delayed healthcare presentation in patients with traumatic brain injury, identify associated determinants, and synthesize evidence to inform strategies for early intervention and improved healthcare accessibility worldwide. Methods: A comprehensive electronic search was performed in PubMed and Google Scholar, including all studies published up to 1 July 2025. Eligible studies encompassed patients of any age diagnosed with mild, moderate, or severe TBI, with both the definitions of delayed presentation and TBI severity determined according to the criteria specified by each individual study. Risk of bias in the studies was assessed using the MINORS criteria for non-randomized studies and the Appraisal Tool for Cross-Sectional Studies (AXIS). All analyses were performed using OpenMeta [Analyst] software. Results: A total of 13 studies were included in the meta-analysis. The pooled analysis of 10 studies of participants presenting to healthcare after 24 h was 23.3% (95% CI 19.1–27.4%, I2 = 99.22%, p < 0.001). Across 8 studies that included participants aged 2 years or older, the pooled proportion presenting after 24 h was 18.7% (95% CI 13.8–23.6%, p < 0.001). Five studies enrolling infants younger than 2 years yielded a pooled delayed-presentation proportion of 19.8% (95% CI 14.6–25.0%, p < 0.001). However, the random-effects pooled proportion of participants who presented to healthcare within 24 h of head trauma was 78.0% (95% CI 73.7–82.2%, p < 0.001). Substantial heterogeneity was noted across all studies. Conclusions: This meta-analysis estimates the prevalence and evaluates the determinants of delayed healthcare presentation in patients with predominantly mild TBI, as moderate-to-severe injuries were substantially underrepresented in the included studies. Our results report several factors that contributed to the delayed presentation of TBI, including geographic, socioeconomic, and clinical factors. Additionally, it demonstrates the clinical characteristics of TBI involving timing, presenting symptoms, and injury mechanism.
Background/Objectives: Evidence regarding changes in oral and oropharyngeal squamous cell carcinoma (SCC) care across the COVID-19 pandemic remains limited, particularly in Eastern Europe. This study evaluated temporal changes in surgical admission volume, operative complexity, and comorbidity burden before, during, and after the pandemic at a Romanian tertiary maxillofacial center. Methods: This retrospective mixed-methods study included 248 admissions for oral and oropharyngeal SCC between 2018 and 2024. A structured administrative database was deterministically linked to narrative discharge summaries. Admissions were grouped into pre-pandemic (n = 117), pandemic (n = 93), and post-pandemic (n = 38) periods. Statistical analyses included between-period comparisons, segmented interrupted time-series analysis, and multivariable logistic regression. Qualitative thematic analysis was used to contextualize surgical and perioperative complexity. Results: Mean monthly admissions decreased from 4.9 before the pandemic to 2.6 during the pandemic and 1.6 in the post-pandemic period. Interrupted time-series analysis identified a significant declining baseline monthly trend (IRR 0.973, 95% CI 0.950–0.996; p = 0.024), without a significant immediate level change or post-onset slope change. Neck dissection increased from 23.9% before the pandemic to 39.8% during the pandemic (p = 0.045) and was independently associated with the pandemic/post-pandemic period (adjusted OR 1.87, 95% CI 1.06–3.29; p = 0.030). Qualitative findings identified recurrent codes related to surgical complexity, reconstruction, extensive nodal surgery, comorbidity burden, and perioperative management. Conclusions: Oral and oropharyngeal SCC surgical admissions showed a significant declining baseline trend between 2018 and 2024, while patients treated during and after the pandemic had higher adjusted odds of undergoing neck dissection. The findings support sustained oncological surveillance, timely referral, and multidisciplinary perioperative planning. Further multicenter studies incorporating standardized tumor–node–metastasis (TNM) staging and human papillomavirus (HPV) documentation are required to confirm these observations.
Background/Objectives: Cabazitaxel is an established treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC), but outcomes beyond the conventional 10-cycle threshold remain incompletely characterized. This threshold largely reflects clinical trial design. We therefore evaluated outcomes associated with cabazitaxel treatment beyond 10 cycles using a predefined 8-month landmark analysis intended to reduce early immortal time bias. Methods: This retrospective single-center study included 98 patients with mCRPC treated with cabazitaxel between 2010 and 2020. The final cohort comprised 74 patients who were alive at the predefined 8-month landmark. The primary endpoint was overall survival (OS) from the landmark, and secondary endpoints included conditional radiologic progression-free survival (rPFS), conditional prostate-specific antigen progression-free survival (PSA-PFS), treatment response, and safety. Results: Among the 74 patients included in the landmark cohort, 45 (60.8%) ultimately received ≤10 cycles and 29 (39.2%) received >10 cycles. The median landmark OS was numerically longer in the >10-cycle group (17.6 vs. 10.4 months; p = 0.123). Conditional rPFS and PSA-PFS did not differ significantly between groups (>10 vs. ≤10 cycles: 4.4 vs. 2.3 months; p = 0.255 and 4.2 vs. 2.2 months; p = 0.137, respectively). In a broader baseline-adjusted sensitivity model, the treatment duration association was not statistically significant (HR for ≤10 vs. >10 cycles, 1.58; 95% CI, 0.91–2.74; p = 0.105). The crude cumulative proportions of grade ≥3 neutropenia and febrile neutropenia were higher in the >10-cycle group. Conclusions: Cabazitaxel treatment beyond 10 cycles appeared feasible in selected patients. However, future-derived exposure classification and responder enrichment limit causal interpretation. The survival association was not consistently maintained across sensitivity analyses, supporting a hypothesis-generating interpretation rather than evidence of a survival benefit from continuation beyond 10 cycles.
Background/Objectives: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technically demanding, low-frequency intervention that requires both operator proficiency and coordinated trauma-system performance. We systematically reviewed direct clinical evidence on REBOA learning curves and indirect experience-related temporal trends. Methods: PubMed/MEDLINE, Embase, and the Cochrane Library were searched through 24 April 2026. The prespecified primary outcomes were procedural efficiency and safety; mortality and survival were secondary outcomes. The review protocol was prospectively registered in PROSPERO (CRD420261357432). Because of substantial clinical and methodological heterogeneity, quantitative pooling was not performed, and the evidence was synthesized narratively. Studies were classified as direct case-based learning-curve analyses using sequential case numbers or cumulative procedural volume, or as indirect temporal-trend analyses using calendar year or successive study periods as proxies for institutional or system-level experience. Results: Seven observational studies were included. Three studies provided direct case-based learning-curve evidence using sequential case numbers, whereas four registry-based studies evaluated calendar-time trends as indirect proxies for institutional or system-level experience. The three direct studies identified study-specific inflection points at different case numbers, including approximately 5 and 10 cases for individual- and institutional-level technical challenges and 5, 17, and 34 cases for risk-adjusted mortality across three of five centers; improvement was not consistently observed across all centers. In contrast, the four temporal-trend studies generally reported improved outcomes over time but did not identify case-volume thresholds and could not isolate the effect of accumulated experience from concurrent changes in trauma care. Conclusions: Direct clinical evidence on the REBOA learning curve remains limited to a small number of case-based studies. Calendar-time trends may reflect broader institutional or system-level maturation but cannot independently establish a learning-curve effect. By providing an integrated clinical perspective on how REBOA proficiency may develop in real-world practice, this review highlights the need for prospective studies using standardized procedural outcomes and risk-adjusted learning-curve methods.
Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe adverse event associated with antiresorptive therapy, particularly bisphosphonates, and represents a significant challenge in oral and maxillofacial practice. This study aimed to characterize the epidemiological profile, clinical presentation, and anatomical distribution of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and to investigate potential associations between demographic variables and major underlying systemic diseases. Methods: A retrospective single-center observational study was performed using medical records collected between January 2020 and December 2025 at the Emergency County Clinical Hospital of Craiova. After data validation and removal of duplicate records, 121 patients diagnosed with osteonecrosis of the jaw were identified. Among them, 94 patients fulfilled the inclusion criteria for BRONJ and were included in both the statistical and clinical analyses. Demographic characteristics, systemic diseases, bisphosphonate therapy, lesion localization, clinical manifestations, and statistical associations were evaluated using appropriate non-parametric and categorical statistical methods. Results: The final analytical sample comprised 94 patients with BRONJ associated with bisphosphonate therapy. Of these, 75 (79.8%) had received bisphosphonates for malignant disease and 19 (20.2%) for osteoporosis. The mandible was affected in 77% of patients, predominantly in the posterior premolar–molar region, whereas maxillary lesions mainly involved the posterior maxilla and maxillary tuberosity. Exposed necrotic bone was identified in all patients, while purulent discharge and oral fistulas were recorded in 37% and 35% of cases, respectively. Associations involving sex, age, residence, diabetes, hypertension, and other comorbidities were re-evaluated using the final 94-patient cohort. Conclusions: Among the BRONJ cases identified at this referral center, most patients had received bisphosphonate therapy for malignant disease, and lesions showed a marked predilection for the mandible, particularly its posterior region. These findings describe the clinical profile of the cases managed at our institution but do not permit estimation of BRONJ incidence or comparative risk between treatment regimens. The results support careful dental assessment before bisphosphonate therapy and multidisciplinary follow-up of patients receiving antiresorptive treatment.
Systolic anterior motion (SAM) of the mitral valve remains a clinically relevant complication after mitral valve repair and may result in dynamic left ventricular outflow tract (LVOT) obstruction, SAM-associated mitral regurgitation, and hemodynamic instability. Despite advances in surgical techniques and perioperative imaging, SAM remains an important cause of difficult separation from cardiopulmonary bypass and postoperative circulatory compromise. The development of SAM is multifactorial and results from the interaction between mitral valve anatomy, ventricular geometry, surgical repair characteristics, and perioperative hemodynamic conditions. Contemporary evidence has identified several echocardiographic predictors, including excessive posterior leaflet height, elongated anterior leaflets, reduced coaptation–septal distance, a narrow mitro–aortic angle, basal septal hypertrophy, and small hyperdynamic left ventricles. Recognition of these risk factors facilitates perioperative risk assessment and pre-repair surgical planning. Transesophageal echocardiography plays a pivotal role throughout the perioperative period, enabling risk assessment before repair, early diagnosis after cardiopulmonary bypass, and guidance of therapeutic interventions. Initial treatment is based on preload optimization, afterload augmentation, withdrawal of inotropic stimulation, and heart rate control, whereas refractory cases may require surgical revision. This narrative review summarizes the current understanding of SAM after mitral valve repair, focusing on pathophysiological mechanisms, echocardiographic predictors, surgical prevention and perioperative management, with particular emphasis on the practical role of cardiac anesthesiologists and mitral valve surgeons.
Background: PADS combines two neural networks predicting ICU mortality and discharge within 48 h, placing critically ill patients into one of four clinically meaningful states. Developed on MIMIC-IV alone, it left open whether it generalizes to other ICUs, whether its models transfer across hospitals, and whether its predictions can be explained at the bedside. Methods: We evaluated PADS on four ICU databases from different hospitals and countries (MIMIC-IV, AmsterdamUMCdb, eICU-CRD, and HiRID), using the same routinely collected variables. Mortality is scored on the final 48-h window (terminal-window, not early-warning, discrimination). For each external database, we compared the MIMIC model used as-is, retrained from scratch, and retrained from the MIMIC weights, and added an explainability layer. Results: For mortality, reusing and retraining the MIMIC model gave the highest discrimination on every database (AUROC 0.955–0.986; terminal-window (near-outcome) discrimination) and stabilized training; used as-is, it ranged from chance (Amsterdam) to good (eICU, HiRID). For discharge, training fresh on local data matched or beat reusing MIMIC on every external database, consistent with discharge timing depending on local organization rather than physiology. The explainability layer produced clinically coherent, cross-checked explanations. Conclusions: Transportability was task-dependent: mortality transferred between hospitals, discharge did not. PADS demonstrated promising external transportability across heterogeneous ICU databases, particularly after local adaptation. Reusing and adapting the MIMIC-IV mortality model across hospitals improves accuracy. This approach also stabilizes training, providing a basis for potential federated deployment, whereas discharge is better trained locally. The mortality results reported here are terminal-window discrimination and do not support use of the framework as an early-warning model. A transparent explainability layer provides an interpretable representation of model predictions, addressing a key barrier to clinical adoption.
Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) are leading causes of visual impairment and require long-term intravitreal anti-vascular endothelial growth factor (VEGF) therapy. However, treatment burden and suboptimal real-world outcomes remain major challenges. Faricimab is a bispecific monoclonal antibody that simultaneously inhibits VEGF-A and angiopoietin-2 (Ang-2), a key mediator of vascular destabilization, leakage and inflammation, offering a novel dual-pathway approach aimed at improving efficacy and durability. This narrative review summarizes evidence from pivotal clinical trials and recent real-world studies evaluating the efficacy, durability, and safety of faricimab in patients with nAMD and DME. Real-world evidence from international cohorts and emerging data from Spanish routine clinical practice largely corroborate previous findings, showing anatomical improvements, stable or improved visual outcomes, and reduced treatment burden in treatment-naïve and previously treated eyes. Overall, the evidence reviewed indicates that faricimab is an effective and well-tolerated therapeutic option that may help address unmet needs in the long-term management of nAMD and DME. Importantly, data from real-world clinical practice are consistent with findings from pivotal trials, supporting the translation of faricimab’s outcomes into routine care.
Background/Objectives: Mastoid obliteration is being increasingly used to reduce cavity-related morbidity after mastoidectomy. Alongside autologous grafts, synthetic biomaterials and tissue-engineering approaches have emerged as potential alternatives. This systematic review synthesized the clinical and preclinical evidence on biomaterials for mastoid obliteration, focusing on efficacy, safety, biological integration, and translational potential. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant search of PubMed, Scopus, and Web of Science identified studies published between January 2010 and May 2026. Eligible studies evaluated biomaterials for mastoid obliteration in clinical settings or experimental models. Data on study design, biomaterial type, intervention, outcomes, complications, and biological endpoints were extracted. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I), Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2), and the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk-of-bias tool. Results: Twenty-eight studies were included (19 clinical, 9 preclinical). Clinical evidence supported mastoid obliteration as an effective strategy for improving cavity stability, reducing chronic otorrhea, promoting epithelialization, and aiding cholesteatoma control. Outcomes appeared to depend more on successful cavity elimination than on the superiority of a specific biomaterial. Autologous materials showed reliable and reproducible results, while S53P4 bioactive glass demonstrated comparable effectiveness with additional antibacterial properties. Hydroxyapatite-based materials and allografts showed more variable outcomes. Biologically enhanced approaches, including concentrated growth factors and composite constructs, yielded promising but limited clinical evidence. Preclinical studies indicated that conventional biomaterials are primarily osteoconductive, whereas composite scaffolds, bone morphogenetic protein-2 (BMP-2) delivery systems, and stem cell-based strategies may enhance osteogenesis and tissue integration. However, clinical translation remains limited. Conclusions: Mastoid obliteration is an effective reconstructive strategy whose success depends mainly on stable cavity reduction and adequate epithelial coverage. Autologous materials and S53P4 bioactive glass currently have the strongest clinical support, whereas advanced tissue-engineering approaches require further validation through prospective comparative studies, standardized outcomes, long-term follow-up, and translational research.
Background: Patients presenting with concurrent lung and brain lesions pose a unique diagnostic and therapeutic challenge. The role of neurosurgical resection in the management of de novo non-small-cell lung cancer brain metastases (NSCLC-BM) remains poorly defined. Methods: Consecutive patients undergoing resection for NSCLC-BM between February 2018 and October 2025 were retrospectively analyzed. De novo NSCLC-BM was defined as radiographic detection of pulmonary and intracranial lesions concurrently or within 1 month during the initial diagnostic work-up. Clinical characteristics and outcomes were compared between de novo and metachronous brain metastases (BM). Multivariable Cox regression identified factors associated with overall survival (OS). Factors associated with long-term postoperative survival in the de novo subgroup were further explored using Firth logistic regression. Results: Among 248 surgically treated patients, 113 (45.6%) presented with de novo BM. Compared with metachronous BM, de novo patients more frequently presented with symptomatic and multifocal intracranial disease. Among 73 de novo patients with evaluable survival, median postoperative OS was 57.0 months (95% CI, 22.9–not reached). Postoperative OS and intracranial progression-free survival (iPFS) did not differ significantly between the two groups, and de novo presentation was not independently associated with postoperative survival. Driver-positive status and lower intracranial tumor burden were associated with durable postoperative survival in the de novo subgroup. Conclusions: Neurosurgical resection represents a reasonable option for appropriately selected patients with de novo NSCLC-BM. These findings provide real-world evidence to inform multidisciplinary, individualized decision-making in patients presenting with concurrent lung and brain lesions.
Background/Objectives: Estimating mortality risk in older adults presenting to the emergency department (ED) is challenging because risk is shaped by comorbidity burden, frailty, and systemic inflammation. We examined the individual and combined prognostic contributions of the Age-adjusted Charlson Comorbidity Index (CCI), the Clinical Frailty Scale (CFS), and the Systemic Immune-Inflammation Index (SII) to 30-day mortality. Methods: This prospective observational cohort included 326 adults aged ≥65 years evaluated in a tertiary ED from September 2025 through April 2026. CCI, CFS, and SII were assessed at admission, with SII analyzed after logarithmic transformation [ln(SII)]. Associations with 30-day mortality were examined using logistic regression. Discriminative performance was evaluated by receiver operating characteristic analysis, and the integrated model underwent bootstrap internal validation and calibration assessment. Results: Thirty-day mortality occurred in 60 patients (18.4%). CCI, CFS, and ln(SII) were each independently associated with mortality in the integrated multivariable model (all p < 0.05). Individual AUCs were 0.741 for CCI, 0.703 for CFS, and 0.662 for ln(SII), with CCI showing the highest value. The integrated model achieved the highest observed discrimination (AUC 0.793; optimism-corrected AUC 0.783) and showed acceptable internal calibration (Brier score 0.127; bootstrap-corrected calibration intercept 0.003; calibration slope 0.957). Conclusions: Comorbidity burden, frailty, and systemic inflammation each provided independent prognostic information for 30-day mortality in older ED patients. Although CCI was the strongest individual predictor, the integrated model achieved the highest observed discrimination. However, its incremental benefit over some two-predictor models was modest and not statistically significant.
Objective: To compare sleep quality, psychological resilience, and attachment dimensions between women with unexplained infertility and those with male factor infertility undergoing in vitro fertilization (IVF). Materials and Methods: In this single-center, cross-sectional study, 201 women undergoing IVF (101 with unexplained and 100 with male factor infertility) completed the Pittsburgh Sleep Quality Index (PSQI), the Brief Resilience Scale (BRS), and the Experiences in Close Relationships–Relationship Structures (ECR-RS) questionnaire. Poor sleep quality was defined as a global PSQI score greater than 5. The primary outcome was the global PSQI score. Between-group comparisons were supplemented by multivariable analyses adjusted for age, economic status, chronic disease, infertility duration, and number of previous IVF attempts. Results: No statistically significant differences were observed in most baseline characteristics, although low economic status was more frequent in the male factor group (34.0% vs. 15.8%; p = 0.008). The median global PSQI score did not differ significantly between the unexplained and male factor groups (6.0 vs. 5.0; p = 0.143). Poor sleep quality was observed in 51.5% and 42.0% of women, respectively (p = 0.178), with an overall prevalence of 46.8% (95% CI, 40.0–53.7%). Psychological resilience (3.33 vs. 3.17; p = 0.474), attachment avoidance (9.0 vs. 9.5; p = 0.336), and attachment anxiety (3.0 vs. 3.0; p = 0.648) did not differ significantly between the groups. After adjustment, unexplained infertility was not significantly associated with global PSQI score (β = 0.76, 95% CI −0.17 to 1.69; p = 0.110) or poor sleep quality (adjusted prevalence ratio = 1.24, 95% CI 0.92–1.67; p = 0.162). Conclusions: Women with unexplained and male factor infertility undergoing IVF showed similar patterns of sleep quality, psychological resilience, and attachment dimensions, with no statistically significant between-group differences detected. Poor sleep quality affected nearly half of the study population. These findings should not be interpreted as evidence of equivalence between infertility etiologies but highlight the potential relevance of sleep assessment in women undergoing IVF.
Background/Objectives: Lower serum C-peptide, reflecting reduced beta-cell reserve, has been linked to diabetic complications, but whether these associations are independent of diabetes duration and glycaemic control is unclear. The objective of this study was to determine which microvascular and macrovascular complications of type 2 diabetes mellitus (T2DM) remain associated with fasting C-peptide after adjustment for these factors. Methods: In this single-centre, cross-sectional study with consecutive prospective enrolment, non-pregnant adults with an established diagnosis of T2DM attending routine outpatient follow-up were eligible; those with pancreatic malignancy or exocrine pancreatic insufficiency, monogenic or autoimmune diabetes, or acute hyperglycaemic crises were excluded. A total of 590 patients were stratified by fasting C-peptide into insufficient (<1.0 ng/mL; n = 35), borderline (1.0–1.8 ng/mL; n = 212) and normal/high (≥1.8 ng/mL; n = 343) groups. Logistic regression adjusted for age, sex, diabetes duration, HbA1c and body mass index assessed each complication. Receiver operating characteristic analysis using DeLong’s test assessed incremental discrimination. Results: In the unadjusted analyses, every complication was more frequent at lower C-peptide. After adjustment, C-peptide was not associated with the presence of albuminuria (insufficient versus normal/high, odds ratio 1.60, 95% CI 0.16–15.86) but was strongly associated with its severity: for severely increased or nephrotic-range albuminuria, the adjusted odds ratios were 13.47 (5.33–34.07) and 6.90 (3.83–12.44) in the insufficient and borderline groups (both p < 0.001). Adding C-peptide to a model of diabetes duration, HbA1c and fasting glucose was associated with a statistically significant, but modest, improvement in discrimination for severe albuminuria (area under the curve of 0.748 to 0.783; ΔAUC = 0.035, p = 0.027). Associations with macrovascular complications were present in the unadjusted analyses but were substantially attenuated after adjustment and no longer statistically significant, except for peripheral arterial disease and foot ulcer, which remained associated with insufficient C-peptide in models based on small numbers of events and should be regarded as exploratory. Conclusions: Low C-peptide was independently associated with the severity of albuminuria rather than its presence and was associated with a modest incremental improvement in discrimination. These exploratory findings suggest that C-peptide, an inexpensive and widely available measurement, may provide information associated with advanced diabetic kidney disease; prospective, externally validated studies are needed before clinical application.
Background/Objectives: Lower limb congenital deficiencies represent challenging disorders that require a complex strategy for limb reconstruction and lengthening procedures guided by the anatomical type and severity of the deformity. This review aims to summarize current treatment approaches in limb reconstruction and lengthening for patients with common congenital lower limb deficiencies, including fibular hemimelia, congenital femoral deficiency, and tibial hemimelia. Methods: A literature search was conducted using major databases, complemented by the senior author’s clinical experience and case series, to identify relevant studies and current procedures for the management of common congenital lower limb deficiencies, including limb reconstruction and lengthening techniques. Results: The various clinical presentation and classification systems of congenital lower limb deficiencies are presented, as well as up to date surgical techniques including limb reconstruction and lengthening. These approaches demonstrated effectiveness in congenital limb deficiencies management by facilitating joint stabilization and subsequent limb lengthening, leading to improved functional outcomes. However, significant challenges persist, including prolonged treatment duration and patient discomfort. Modern surgical approaches have significantly improved the outcomes of treatment for congenital limb deficiencies. However, the complexity of these clinical entities requires individualized treatment strategies. Conclusions: Successful management of congenital lower limb deficiencies relies on individualized, patient-specific treatment planning, incorporating preparatory surgical interventions and sequential limb lengthening procedures to maximize functional outcomes.
Background and Objectives: Terminal ileitis is a frequent radiologic finding in patients presenting to the emergency department with acute right lower quadrant pain, yet whether it represents an early manifestation of Crohn’s disease remains challenging to predict. This study aimed to identify early clinical, laboratory, and imaging predictors of Crohn’s disease in patients with newly identified radiologic terminal ileitis to improve early risk stratification. Materials and Methods: A retrospective cohort study evaluated adult patients presenting to the emergency department between 2010–2021 with radiologically confirmed terminal ileitis and no prior history of inflammatory bowel disease. Clinical data, laboratory markers, and imaging findings captured at presentation were analyzed. Patients were followed for 12 months for a subsequent Crohn’s disease diagnosis. Results: Out of 68 included patients, 23 (33.8%) were diagnosed with Crohn’s disease within one year. Multivariable logistic regression identified lower haemoglobin levels (OR 2.17 per 1 g/dL decrease, 95% CI 1.02–4.76, p = 0.044), elevated platelet counts (OR 1.03 per 103/µL, 95% CI 1.01–1.05, p = 0.002), and a composite radiologic finding of stenosis or proximal bowel distension (OR 28.5, 95% CI 2.35–345.6, p = 0.008) as independent predictors of a subsequent Crohn’s disease diagnosis. Standalone platelet count (AUC = 0.897) and the platelet-to-hemoglobin ratio (AUC = 0.896) demonstrated excellent diagnostic discrimination. Conclusions: In this small retrospective cohort, approximately one-third of patients presenting with new-onset radiologic terminal ileitis were subsequently diagnosed with Crohn’s disease within 12 months. Low hemoglobin, elevated platelet count, and radiologic evidence of stenosis or proximal bowel distension were independently associated with this diagnosis. These associations are hypothesis-generating and require external prospective validation before informing clinical decision-making.
Objectives: Robot-assisted stereoelectroencephalography (SEEG) is increasingly used for invasive presurgical evaluation in drug-resistant epilepsy. Feasibility and accuracy data for robotic alignment systems remain limited. We analyzed our initial institutional experience and compared the results with the contemporary literature. Methods: We retrospectively analyzed nine consecutive patients who underwent SEEG depth electrode implantation using the Brainlab Cirq robotic alignment system and intraoperative MRI for registration. Demographic and operative variables were extracted from institutional records. Implantation accuracy was measured on fused postoperative imaging as Euclidean entry point error (EPE) and target point error (TPE). A PubMed-focused literature screen was performed to identify studies reporting robotic SEEG implantation accuracy and/or efficiency metrics for comparison. Results: Nine patients underwent implantation of 69 SEEG electrodes. Mean age was 21.7 ± 11.4 years. A mean of 7.7 ± 2.1 electrodes was implanted per patient. Mean operative time was 120.2 ± 31.9 min, corresponding to 16.0 ± 3.4 min per electrode. Mean EPE was 1.36 ± 0.60 mm and mean TPE was 1.79 ± 0.69 mm. Moreover, the maximum projected skull-entry angle was not independently associated with either EPE or TPE. In comparison with published robotic SEEG series and meta-analyses, our accuracy results fall within the established high-precision range and compare favorably with the most recent robotic-arm-specific data. Conclusions: In this initial consecutive series, our robotic arm alignment system enabled accurate SEEG implantation with sub-2-mm mean target error. These findings support robotic arm systems as effective robotic alignment platforms for invasive epilepsy monitoring, while larger multicenter studies remain necessary to define comparative accuracy, learning curve effects, and complication profiles.
Background: Although ABO blood groups have been implicated in several vascular and neurological disorders, evidence regarding their association with epilepsy remains limited and inconclusive. We performed the largest and most comprehensive case–control evaluation to date to determine whether ABO/RhD blood groups are associated with epilepsy. Methods: We conducted a retrospective hospital-based case–control study including 806 adults with epilepsy and 14,032 controls from the same institutional population between January 2015 and January 2026. Epilepsy diagnoses were confirmed independently by two neurologists according to International League Against Epilepsy criteria. Associations between epilepsy and ABO/RhD blood groups were evaluated using a comprehensive analytical framework incorporating multivariable-adjusted logistic regression, binary blood group comparisons, age- and sex-matched sensitivity analyses, and epilepsy subtype-specific analyses. Results: No significant association was identified between epilepsy and ABO/RhD blood groups across any analytical approach. Overall ABO blood group (p = 0.777) and RhD status (p = 0.611) distributions were comparable between patients with epilepsy and controls. Binary analyses showed no significant associations for non-O versus O (OR 1.05, 95% CI 0.90–1.22; p = 0.535), non-A versus A (OR 0.93, 95% CI 0.80–1.06; p = 0.297), non-B versus B (OR 1.03, 95% CI 0.85–1.25; p = 0.748), non-AB versus AB (OR 1.05, 95% CI 0.81–1.34; p = 0.723), or RhD-negative versus RhD-positive status (OR 1.06, 95% CI 0.85–1.31; p = 0.611). These findings remained unchanged after multivariable-adjusted logistic regression, 1:4 age- and sex-matched sensitivity analyses (806 patients with epilepsy and 3224 matched controls; ABO p = 0.774, RhD p = 0.740), and comparisons between focal and generalized epilepsy subtypes (ABO p = 0.531; RhD p = 0.995). Conclusions: In this large hospital-based case–control study, no significant association was identified between epilepsy and ABO/RhD blood groups. However, the hospital-based control population and the availability of blood group data should be considered when interpreting these findings.
