Background: Optical coherence tomography angiography (OCTA) provides quantitative metrics of the retinal microvasculature, most prominently vessel density (VD), that are increasingly used as biomarkers in ocular, systemic, and cerebrovascular disease. Because OCTA relies on the detection of flow-related motion contrast, image quality has emerged as a pervasive determinant of these metrics, yet its effect has been reported in fragmentary and non-comparable ways across the literature. Methods: We identified OCTA studies indexed in PubMed that examined the relationship between image quality and quantitative OCTA parameters, and we summarised their methods and findings across the macular, foveal avascular zone, and peripapillary regions and across vascular layers. We integrated directly comparable per-unit scan-quality effects using random-effects meta-analysis and separately synthesized direct cross-sectional Pearson correlations between manufacturer-reported image quality and macular vessel-density outcomes from independent healthy cohorts. Results: Higher image quality was associated with higher measured vessel density in every contributing dataset. On the Optovue scan-quality (SQ, 0–10) scale, superficial macular VD increased by 3.46% (95% CI 1.85–5.07) per SQ unit in controlled signal-attenuation experiments and by covariate-adjusted observational estimates ranging from 0.90% to 2.16% per SQ unit; a combined order-of-magnitude estimate across both estimator types was 1.64% (95% CI 1.15–2.12). Peripapillary estimates were heterogeneous and derived from only two independent cohorts; they were therefore summarised descriptively rather than pooled. Across three independent externally authored healthy cohorts reporting direct cross-sectional Pearson correlations, higher image quality was strongly associated with higher macular vessel-density outcomes (random-effects pooled r = 0.64, 95% CI 0.50–0.75; I2 = 49%). Conclusions: Image quality is an important, directional confounder of VD-based OCTA metrics whose magnitude can rival the biological or physiological signal of interest. Platform-appropriate standardisation, transparent reporting, and consideration of image quality in acquisition and analysis are therefore important for the valid interpretation of vessel-density measurements, particularly in functional and longitudinal studies.
BACKGROUND:Prognostic stratification remains challenging in patients with stage IIIC non-small cell lung cancer (NSCLC) treated with definitive chemoradiotherapy (CCRT), and the relative performance of host-related prognostic indices in this setting is unclear. The CARWL (C-reactive Protein, Albumin, and Recent Weight Loss) score and the Naples prognostic score (NPS) have each been proposed as prognostic tools, but direct comparisons are lacking. This study compared their prognostic performance. METHODS:We retrospectively analyzed 795 patients with stage IIIC NSCLC treated with CCRT between 2010 and 2020. Patients were stratified into three prognostic groups according to CARWL and NPS. Overall survival (OS) was the primary endpoint; progression-free survival (PFS) and locoregional PFS (LRPFS) were secondary endpoints. Survival was assessed using Kaplan-Meier analysis and Cox regression. RESULTS:Both CARWL and NPS significantly stratified OS, PFS, and LRPFS (all p < 0.001). CARWL demonstrated modestly higher discriminatory performance across endpoints. The OS difference between unfavorable and favorable groups was larger with CARWL than with NPS (19.3 vs. 12.3 months). CARWL also provided greater separation for PFS (5.3 vs. 3.2 months) and LRPFS (4.9 vs. 3.4 months). In multivariable analyses, both indices retained independent prognostic significance; however, CARWL consistently exhibited stronger hazard gradients and maintained prognostic value when modeled alongside NPS. CONCLUSIONS:Both CARWL and NPS offered meaningful prognostic stratification in stage IIIC NSCLC treated with CCRT, but CARWL demonstrated a modest but more consistent prognostic discrimination than NPS. Pending external validation, CARWL represents a practical and biologically grounded tool for risk stratification in this population.
Background: Pregnancies tend to progress without any serious complications. Nonetheless, for a subset of women, obstetric complications may develop, ranging in severity. The most critical of these life-threatening events is referred to as Maternal Near Miss (MNM). To identify the epidemiological and obstetric characteristics, as well as clinical outcomes of MNM cases reported over the year 2021 in the Brazilian state of Paraná. This quantitative, population-based study analyzed 888 notifications that occurred in 2021, obtained from the MNM Notification System. Descriptive statistics and a one-sample Chi-square goodness-of-fit test were applied to the data. Among the women reported, 92.6% were pregnant, the mean age was 29 years, 67.1% identified as white, and 45.2% had preexisting health conditions. Regarding obstetric characteristics, 41.6% were classified as high-risk pregnancies, but nearly one-third (32.3%) of MNM cases occurred in women initially classified as usual risk. The clinical worsening event occurred most frequently during the third trimester (71.9%), and emergency cesarean section was indicated in 60.1% of cases with complete information for this variable. Cesarean delivery predominated over vaginal delivery, with an emergency-to-elective cesarean ratio of approximately 4.7:1. Most women (75%) were discharged after recovery. MNM events are not restricted to women initially classified as high-risk, underscoring the need to strengthen early detection strategies and ensure appropriate management at all levels of care. Improved training of healthcare professionals responsible for reporting and the standardization of MNM monitoring systems in Brazil are also essential.
Cardiovascular diseases (CVDs) remain the leading global cause of morbidity and mortality, imposing an increasing clinical and socioeconomic burden. Despite significant therapeutic advances, optimal control of risk factors and long-term outcomes remain challenging, particularly in patients with complex comorbidities. This narrative review provides a comprehensive and up-to-date synthesis of pharmacological options across major cardiovascular domains, with a specific focus on hypertension, heart failure, arrhythmias, and hypertrophic cardiomyopathy, conditions in which hemodynamic, neurohormonal, and electrophysiological pathways play central roles. We summarize mechanisms of action, clinical evidence, safety profiles, and guideline-based indications of established therapies, highlighting their relevance to vascular tone regulation, neurohormonal modulation, endothelial signaling, and myocardial function, the mechanistic axes that intersect with pathways implicated in pulmonary vascular disease (PVD). In addition, we discuss emerging therapeutic targets and innovative agents such as renin-angiotensin-aldosterone system silencers, endothelin pathway modulators, SGLT2 inhibitors, soluble guanylate cyclase stimulators, myosin inhibitors, and other mechanism-based approaches. Current challenges and unmet clinical needs are examined in the context of translational relevance for PVD and the broader goal of advancing individualized pharmacotherapy. Continued therapeutic innovation targeting shared vascular, metabolic, and neurohormonal pathways holds promise for improving outcomes across both systemic and pulmonary vascular diseases.
BACKGROUND:Acute drug poisoning is one of the leading causes of admission to pediatric emergency departments and represents a significant public health concern because of its potential severity and associated morbidity and mortality. This study aimed to describe the clinical, epidemiological, and severity characteristics of pediatric patients with acute drug poisoning treated at a tertiary care hospital in western Mexico. METHODS:A retrospective, observational, descriptive study was conducted in the pediatric emergency department of Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca" from January 2016 to December 2024. RESULTS:The mean age of the patients was 77.1 months, with a predominance of females (61.9%). Most poisoning events (97.1%) occurred in the home. Accidental poisoning was the most frequent mechanism (54.5%), followed by suicide attempts (24.4%) and drug overdoses (17.6%). Regarding medical care, 50% of patients arrived at the emergency department within the first four hours after exposure, and 55.1% had a hospital stay of less than 12 h. The most involved drug groups were anxiolytics, mainly benzodiazepines (21.6%), followed by polypharmacy (17.6%) and antiemetic use (13.6%). The most frequent toxidrome was hypnotic-sedative syndrome (42.6% of cases). Multivariate analysis showed that exposure to anticonvulsants was significantly associated with a longer hospital stay (odds ratio [OR] = 7.31, p = 0.003). Most cases were classified as mild according to the Poisoning Severity Score, and no deaths were reported. CONCLUSIONS:Although pediatric drug poisoning generally has a favorable prognosis, it remains a significant public health issue. These findings highlight the need for targeted preventive strategies, including caregiver education, safe medication storage at home, and increased awareness and training programs for both families and healthcare professionals.
Background: Renal vasculitis encompasses a heterogeneous spectrum of disorders where vascular inflammation leads to organ dysfunction. Given that renal involvement is the primary determinant of long-term morbidity, timely diagnosis and intervention are paramount. This review aims to synthesize recent pathogenic insights and evaluate how these mechanistic breakthroughs are reshaping current diagnostic and therapeutic paradigms. Methods: A narrative review of the literature was performed to analyze the pathophysiology, diagnosis, and management of pediatric renal vasculitis. The analysis synthesizes current clinical guidelines and recent trial data, highlighting the transition toward biomarker-driven precision medicine for refined disease assessment and management. Results: Diagnosis remains multimodal, necessitating the integration of clinical, laboratory, and histopathological data. In ANCA-associated vasculitis (AAV), recent evidence has challenged the traditional “pauci-immune” concept. Management of pediatric IgA vasculitis utilizes a risk-stratified approach, whereas cryoglobulinemic vasculitis requires targeted trigger elimination. Across all pediatric syndromes, there is a shift toward minimizing corticosteroid exposure and utilizing individualized frameworks. Conclusions: Despite substantial progress in targeted biological therapies and reduced corticosteroid burden, the long-term morbidity of pediatric renal vasculitis remains substantial. Outcomes are dictated by a synergy of disease-specific and patient-specific factors. Addressing persistent unmet needs in the field requires further refinement of individualized management protocols and the continued validation of dynamic biomarkers, alongside the implementation of pediatric-specific guidelines and age-appropriate outcome measures.
Small intestinal bacterial overgrowth (SIBO) refers to an abnormal increase in the number of bacteria in the small intestine and is observed in various diseases. SIBO can also develop after long-term use of proton pump inhibitors (drug-induced SIBO), bariatric surgery, gastrectomy, and other surgeries (postoperative SIBO). The aim of this narrative review is to summarize all of the published information on the treatment of SIBO in as much detail as possible and present it separately for each specific disease and intervention associated with SIBO. The most extensively studied drug for the treatment of SIBO is rifaximin. It eliminates SIBO in 63% of cases; however, most studies lack a control group. Small RCTs assessing the effects of this antibiotic on SIBO have reported conflicting results, and a meta-analysis showed no effect. A large RCT is required to verify the results of uncontrolled studies. Neomycin and norfloxacin showed efficacy in the treatment of SIBO in single RCTs, with elimination rates of 20 and 100%, respectively. Ciprofloxacin, rifamycin, metronidazole, and other antibiotics, as well as ursodeoxycholic acid, showed positive effects for the treatment of SIBO, but only in uncontrolled studies or in comparison with rifaximin or other drugs. The reported elimination rates were 54%, 67%, 79%, and 75%, respectively. Eradication therapy for Helicobacter pylori infection eliminated SIBO at a rate of approximately 70%. Probiotics have been tested for treatment of SIBO in various diseases. VSL#3 and Saccharomyces boulardii CNCM I-745 were effective in RCTs, with elimination rates of 58% and 80%, respectively. In conclusion, when selecting SIBO treatment regimens, those that have demonstrated the greatest efficacy for a specific concomitant disease should be preferred, despite the generally low level of evidence supporting these approaches in most cases.
Background: Liver transplantation (LT) remains the definitive treatment for end-stage liver disease; however, post-LT outcomes may differ depending on underlying disease etiology. Our study aimed to compare post-LT outcomes between alcoholic and non-alcoholic steatohepatitis (NASH)-related liver transplant recipients in the United States. Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Adult liver transplant recipients (≥18 years) were categorized into two mutually exclusive cohorts: alcoholic liver disease and NASH-related liver disease. Propensity score matching (1:1) was performed to balance baseline characteristics. Clinical outcomes were assessed. Comparative analyses included risk ratios, risk differences, odds ratios, Kaplan–Meier survival analysis, and hazard ratios with log-rank testing. Results: Compared with NASH recipients, alcoholic LT recipients had a significantly higher risk of rejection (14.5% vs. 12.1%; RR 1.195, 95% CI 1.076–1.327; p = 0.001) and hepatic encephalopathy (14.3% vs. 8.3%; RR 1.720, 95% CI 1.526–1.938; p < 0.001). Acute kidney injury was also more frequent in the alcoholic cohort (47.3% vs. 43.6%; RR 1.084, 95% CI 1.036–1.133; p < 0.001). In contrast, sepsis (15.6% vs. 18.0%; RR 0.869, 95% CI 0.794–0.952; p = 0.003) and CKD (46.1% vs. 51.1%; RR 0.901, 95% CI 0.863–0.939; p < 0.001) occurred less frequently in alcoholic LT patients. No significant differences were observed for liver transplant failure or ascites. Kaplan–Meier analyses demonstrated significantly lower rejection-free survival (HR 1.241, p < 0.001), higher hepatic encephalopathy (HR 1.808, p < 0.001), increased AKI risk (HR 1.150, p < 0.001) and higher all-cause mortality in the alcoholic cohort (HR 1.106, p = 0.031). Conclusions: In this large real-world matched cohort study, alcoholic LT recipients demonstrated higher risks of complications and all-cause mortality compared with NASH LT recipients.
Background: Carotid atherosclerosis and plaque instability are major drivers of ischemic stroke. The NLRP3 inflammasome and interleukin-1 (IL-1) pathway are recognized as key upstream regulators of atherogenesis. This systematic review aims to synthesize the available evidence regarding the impact of NLRP3 and IL-1-mediated inflammation on plaque vulnerability and clinical outcomes in patients undergoing carotid endarterectomy (CEA). Materials and Methods: A systematic search was performed relying on MEDLINE, Scopus, and Web of Science for studies assessing NLRP3 inflammasome and IL-1-mediated biomarkers in adult patients undergoing CEA. Data extraction and risk-of-bias evaluation were independently performed using the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool. Due to substantial methodological heterogeneity, a narrative synthesis was conducted. Results: Sixteen studies involving 1677 participants were included. Evidence demonstrates that NLRP3 inflammasome components (NLRP3, ASC, Caspase-1) and IL-1 family cytokines (IL-1β, IL-18) are consistently elevated in unstable plaques and in symptomatic patients compared to asymptomatic counterparts. These markers were associated with histological features of instability, such as intraplaque haemorrhage, large lipid cores and extensive macrophage infiltration. While some data suggest a link between these biomarkers and Major Adverse Cardiovascular Events (MACE), most studies were limited by a lack of adjusted multivariable modelling and an overall unclear risk of bias. Conclusions: NLRP3/IL-1/-mediated inflammation is a promising biomarker axis for carotid plaque vulnerability and symptomatic disease. However, small, heterogeneous cohorts and limited adjusted analyses highlight the need for larger, well-designed studies to refine risk stratification and guide targeted anti-inflammatory strategies in carotid atherosclerosis.
Background—Generalized pustular psoriasis (GPP) is a rare and severe inflammatory skin disorder—and evidence regarding relative impact of treatments thereof is currently scant. Objective—We aimed to systematically review and narratively synthesize comparative interventional therapies for GPP and secondarily explore their relative effectiveness through exploratory network meta-analyses (NMAs). Methods—Comprehensive searches were performed in PubMed and EMBASE to identify comparative interventional studies that investigated the impact of biologics in GPP. Bayesian NMAs were conducted only for exploratory analyses. Results—Eleven studies met our inclusion criteria and data from 4 of the 11 were used for NMAs. Methodological heterogeneity was evident; the various biologics demonstrated effectiveness in treating GPP. Inhibitors of interleukin (IL)-36 (e.g., spesolimab) resulted in rapid pustular clearance within one week and sustained reductions in flare occurrence. Inhibitors targeting IL-17, IL-23, TNF, and IL-12/23 also demonstrated high response rates, durable disease control, and improvements in quality of life among diverse patient populations. Results from our exploratory NMAs revealed patterns of relative effectiveness with IL-17 and IL-36 inhibitors that are consistent with the existing literature. However, methodological limitations across the four studies deterred us from making conclusive inferences. Conclusions—Biologic therapies provide significant clinical benefit in patients with GPP. Our narrative syntheses highlight the need for future quantitative syntheses.
Patient embarrassment represents a significant yet often underrecognized barrier to effective gynecological care. This review integrates multidisciplinary evidence from Embase, PubMed, PsycINFO, and the Cochrane Library (2000–2025) to examine the relationship between embarrassment, shame, and modesty and their impact on care-seeking behaviors, clinical outcomes, and healthcare utilization. Available data indicate that embarrassment is consistently associated with reduced participation in preventive screening, with up to one-third of non-attenders citing modesty-related concerns. In symptomatic patients, these emotional barriers contribute to clinically meaningful diagnostic delays, particularly in conditions such as cervical cancer, vulvar cancer, and endometriosis. Embarrassment also affects in-consultation behavior, with a substantial proportion of patients reporting withheld concerns or incomplete disclosure of medically relevant information. The consequences extend beyond delayed diagnosis to include reduced treatment adherence, increased disease severity at presentation, and higher healthcare costs due to more complex and resource-intensive interventions. Contributing factors include cultural stigma, prior negative clinical experiences, fear of judgment, and aspects of the clinical environment that may heighten patient vulnerability.
Introduction: Glycemic control in patients with type 2 diabetes mellitus undergoing intermittent hemodialysis represents a clinical challenge. The pathophysiological alterations inherent to chronic kidney disease (CKD) and the dialysis procedure limit the usefulness of traditional metrics. In this context, continuous glucose monitoring (CGM) enables dynamic assessment of glycemic profiles and can reveal patterns of dysglycemia that go undetected in routine clinical practice. Methods: An observational, cross-sectional, and analytical pilot study involved 10 patients from the hemodialysis (HD) unit. CGM was carried out for 14 days. A paired analysis was performed to compare glycemic parameters on days with and without HD. Statistical evaluation was performed using the Shapiro-Wilk test and Student's t-test; a p-value < 0.05 indicated statistical significance. Results: Time in range (TIR) showed considerable interindividual variability (24-100%), with hyperglycemia being the predominant factor. During HD sessions, glucose levels showed a marked intradialytic decline followed by incomplete post-dialysis recovery, a pattern that differed from non-dialysis days (paired t-test, p < 0.001; n = 10 paired observations). These findings should be interpreted as exploratory. Hypoglycemic episodes were infrequent, whereas persistent hyperglycemia prevailed. Conclusions: CGM reveals metabolic dysregulation frequently overlooked by traditional indicators such as glycated hemoglobin (HbA1c). These exploratory findings suggest that CGM may provide clinically relevant information in this population, although larger studies are needed before therapeutic recommendations can be established.
Background/Objectives: Clozapine is the sole antipsychotic approved for treatment-resistant schizophrenia, but it is a double-edged therapeutic option due to various lethal adverse reactions. This study aimed to assess the risk of long-term clozapine medication-induced cardiotoxicity, which has not yet been fully elucidated. Methods: This study is a multicenter retrospective cohort study of patients with schizophrenia in Japan and China who received clozapine monotherapy. Cases for which serum NT-proBNP concentration and LVEF derived from echocardiography were available in 2025 were included. In addition, blood examinations, including those administered by the Japanese Clozaril Patient Monitoring Service, were statistically analyzed as independent variables. Results: Among a total of 315 cases, including 99 Japanese (clozapine exposure duration: 57.5 ± 4.0 months) and 216 Chinese (208.1 ± 11.0 months) cases, were enrolled. In both Japan and China, age-standardized prevalence of heart failure among patients with prescribed clozapine were higher compared to general population, with odds ratios of 3.2 (95%CI: 1.4–6.4) and 6.9 (95%CI: 3.6–12.0), respectively. The risk factors for stage-B heart failure associated with clozapine were prolonged exposure duration, higher plasma levels of clozapine, and increasing monocytes. Unexpectedly, over 70% of cases with stage-B heart failure associated with clozapine identified in this study did not have metabolic complications. Other than those with cardiomyopathy, myocardial infarction, ileus, or chronic renal failure, no cases with ejection fraction < 50% were observed, suggesting that stage-B heart failure associated with clozapine is speculated to be likely suggestive of HFpEF. Conclusions: Traditionally, psychiatry has focused on myocarditis and cardiomyopathy developing several weeks and months after initiation of clozapine medication; however, this study revealed asymptomatic heart failure as a third cardiac adverse reaction of clozapine that develops years later. Therefore, regular monitoring of NT-proBNP contributes to improving long-term prognosis of treatment-resistant schizophrenia with prescribed clozapine.
Familial Mediterranean Fever (FMF) is among the most frequent autoinflammatory diseases in populations originating from the area of Middle Eastern and Mediterranean countries. It is caused by mutations in the MEFV gene, which causes dysregulated pyrin expression and thus an immunologic anomaly. FMF is diagnosed by recurrent episodes of fever and serosal inflammation, predominantly peritonitis and pleuritis, as well as other systemic symptoms. Recent research is dedicated to searching for factors beyond genetic code contributing to how FMF evolves, the severity of its symptoms and response to conventional therapy—colchicine. These factors include epigenetic modifications of the MEFV gene and other environmental factors, such as cold exposure, stress, composition of gut flora and diet. Among these factors, vitamin D, best known for its classical role in musculoskeletal health, has emerged as a powerful immune modulator. It has been documented that vitamin D has been implicated in the regulation of pro-inflammatory cytokines and may modulate immune responses. Notably, in regions with some of the highest reported prevalences of MEFV mutations—likely reflecting Mediterranean populations more broadly—vitamin D concentrations are frequently low. This overlap raises the hypothesis that vitamin D deficiency may be associated with FMF pathogenesis, although current data are largely correlational and do not establish causality. In this review, we summarize current evidence on FMF pathogenesis, potential triggers, and vitamin D metabolism, and explore how vitamin D may modulate immune responses and intersect with key autoinflammatory pathways, considering whether adequate vitamin D supplementation could help reduce disease burden in some patients with FMF.
Background: Patients undergoing open-heart surgery (OHS) are at risk of postoperative morbidity and mortality. Physical performance has been increasingly recognized as an important factor influencing postoperative outcomes. Therefore, the study aimed to investigate the associations and predictive value of physical performance on postoperative complications and duration of hospital stay. Methods: A prospective cohort study was conducted in 116 patients who were admitted to OHS. Preoperative assessment of physical performance, i.e., Short Physical Performance Battery (SPPB), Five Times Sit to Stand Test (5STS), gait speed (5 m walk test: 5MWT), Timed Up and Go (TUG), and handgrip strength. Duration of hospital stay and incidence of post-operative complications were recorded. Differences between participants with and without postoperative complications were analyzed using independent samples t-tests for continuous variables and chi-square tests for categorical variables. The associations between physical performance and postoperative outcomes were assessed using Spearman’s rank correlation coefficient. Hierarchical regression analysis was conducted to determine the predictive contribution of physical performance. Results: A total of 116 participants were submitted for OHS in two medical school hospitals; however, 108 individuals completed the pre-operative physical performance. The most common procedures were coronary artery bypass grafting and valve surgery. Fifty-one participants (47.22%) experienced postoperative complications, including five deaths, corresponding to 4.63% mortality. For the length of hospital stay analysis, five participants who died postoperatively were excluded, resulting in a final sample of 103 participants. Physical performance was significantly associated with the length of hospital stay (p < 0.05). Hierarchical regression analysis showed that the final prediction model explained 13.4% of the variance in length of hospital stay, with SPPB independently contributing an additional 6.0% to the model, followed by 5STS, 5MWT, handgrip strength, and TUG, which accounted for an additional 5.1%, 4.6%, 4.4%, and 3.7%, respectively. Conclusions: Preoperative physical performance was associated with length of hospital stay. While each measure explained a relatively small proportion of the variance in hospital stay, these assessments offer a simple, non-invasive, and clinically feasible approach to evaluating functional reserve before surgery. These findings highlight the importance of incorporating functional assessment into perioperative care to support risk stratification and guide rehabilitation strategies.
Background/Objectives: Psoriasis is a chronic inflammatory disorder characterized by epidermal hyperproliferation and immune dysregulation. This study evaluated the topical efficacy of Echinacea leaf extract and allantoin compared to a corticosteroid (mometasone furoate) in an imiquimod (IMQ)-induced psoriasis-like model in Sprague-Dawley rats. Methods: Psoriasiform lesions were induced by daily application of 5% IMQ for six days, followed by six weeks of treatment with one of the following formulations: Echinacea cream or gel, allantoin cream or gel, and mometasone. Disease severity was assessed using a modified Psoriasis Area and Severity Index (PASI) and histological analysis. Results: All groups developed psoriasis-like lesions; however, Echinacea cream produced the most pronounced and sustained reduction in PASI scores, with near-complete macroscopic recovery. Echinacea gel and allantoin cream showed moderate effects, while allantoin gel and mometasone exhibited limited efficacy. Histological findings supported these results, with Echinacea cream restoring near-normal epidermal architecture. Conclusions: In conclusion, topical Echinacea leaf extract formulations, particularly the cream formulation, demonstrated superior efficacy in reducing psoriasis-like skin inflammation and restoring epidermal structure compared to allantoin based treatments and mometasone. These findings suggest that Echinacea-derived bioactive compounds may represent promising candidates for the development of alternative or adjunctive therapies for inflammatory skin diseases.
Background/Objectives: Intestinal malignant melanoma is a rare entity, most commonly presenting as metastatic disease from a cutaneous primary source. The distinction between primary and secondary intestinal melanoma remains challenging, yet it has important diagnostic, therapeutic, and prognostic implications. This study aims to highlight the diagnostic difficulties and therapeutic considerations associated with intestinal melanoma. Methods: A narrative literature review was conducted using the PubMed database, only including articles published between January 2015 and December 2025. Case reports, case series, and reviews that described primary-like (i.e., presumed primary) or metastatic small bowel melanoma were considered eligible. Extracted data consisted of clinical presentation, diagnostic workup, histopathological and immunohistochemical features, treatment strategies, and outcomes. Results: Twenty articles met the inclusion criteria, comprising ten reporting primary intestinal melanoma and ten reporting metastatic intestinal melanoma. Primary-like intestinal melanoma was frequently solitary, amelanotic, and occurred in patients without a prior history of melanoma, whereas metastatic disease was usually multifocal and associated with a known cutaneous primary source. Clinical manifestations were nonspecific, most frequently including anemia, gastrointestinal bleeding, abdominal pain, or intestinal obstruction. Immunohistochemistry confirmed melanocytic origin in each case, but could not reliably differentiate primary from metastatic disease. Surgical resection remained the cornerstone of treatment, with systemic therapy reserved primarily for metastatic cases. Conclusions: Diagnosis of primary intestinal melanoma relies on excluding other primary sites through comprehensive clinical and imaging evaluations. Early detection using advanced endoscopic techniques and multidisciplinary management are vital for optimizing outcomes. While metastatic intestinal melanoma carries a poor prognosis, complete surgical resection of primary lesions has been associated with improved outcomes in selected patients.
Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disease of the paranasal sinuses. Imaging, particularly high-resolution computed tomography (HRCT), cone-beam computed tomography (CBCT) in selected scenarios, and magnetic resonance imaging (MRI), supports diagnosis, treatment planning, and follow-up by combining anatomic mapping, disease extent, remodeling, and complication assessment. This systematic review synthesizes evidence on endotype-aware imaging in CRS and proposes a structured reporting model grounded in quantitative, management-oriented criteria. Methods: Following PRISMA 2020, the review protocol was registered in PROSPERO 2026 (CRD420261356154); we searched MEDLINE, Scopus, Embase, and Cochrane (January 2000–September 2025). Ninety-six studies were included in qualitative synthesis; 38 studies reported quantitative outcomes summarized descriptively. We evaluated HRCT/CBCT/MRI protocols, radiologic indices (Lund–Mackay, GOSS), diagnostic performance in relevant clinical domains, imaging–endotype correlations, and radiomics/artificial intelligence (AI) applications. Key Results: HRCT served as the reference modality for anatomic assessment and preoperative planning in most cohorts; CBCT was selectively used for bony evaluation with lower radiation exposure than conventional CT, albeit without reliable soft-tissue characterization. MRI was mainly applied for soft-tissue characterization, unilateral disease, and suspected complications. Radiomics/AI studies reported areas under the receiver operating characteristic curve (AUC) ranging from 0.79 to 0.93 for distinguishing type 2-high from non-type 2-high CRS, with external validation reported in a minority of studies. Conclusions: Endotype-aware imaging can support more precise, quantitative CRS management when interpreted together with clinical, endoscopic, and biomarker data. Structured reporting and radiomics may contribute to standardization, but require prospective validation and transparent reporting to enable clinical translation within multidisciplinary care pathways aligned with international guidance.
Background/Objectives: Choosing the most appropriate intraocular lens (IOL) for presbyopia management may be challenging given the expanding selection of available designs. This review provides an updated overview of current monofocal plus, extended depth of focus (EDoF), and trifocal IOLs, summarizing their optical properties and laboratory and clinical findings, including visual acuity outcomes and side effects. Methods: A literature search was conducted using PubMed to identify studies on monofocal plus, EDoF, and trifocal IOLs, with emphasis on optical characteristics, visual acuity outcomes, and reported photic phenomena. Results: Monofocal plus IOLs demonstrate an improvement in depth of field compared to monofocal lenses, as evidenced by significant broadening of the defocus curve. Both refractive and diffractive EDoF IOLs show improved intermediate visual acuity, with diffractive models offering greater depth of field but a higher risk of dysphotopsia. Trifocal IOLs offer the best visual acuity at all three foci: near, intermediate, and distance. Patients’ needs may be customized using sulcus- or capsulotomy-fixated IOLs, mix-and-match strategies, and binocular IOL systems. Conclusions: Based on this literature review, clinical and optical bench studies to date support optimized IOL selection based on individual patient needs for presbyopia management. However, consideration of understudied or newly released IOL models is limited as future research is needed. Additionally, further prospective, randomized, controlled, and masked studies with large sample sizes on all IOL models may further support patient decision-making by contributing to a more comprehensive literature.
BACKGROUND:Thoracic aortic aneurysm (TAA) remains a high-risk vascular condition despite major advances in imaging surveillance, operative repair, and endovascular therapy. Medical management still relies largely on blood pressure control and global cardiovascular risk reduction. Renin-angiotensin-aldosterone system (RAAS) inhibitors are frequently used in TAA, but contemporary data evaluating survival and cardiovascular outcomes in broad TAA populations are limited. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) have established cardiometabolic benefits, yet their role in TAA has not been well defined. METHODS:We performed a retrospective multicenter cohort study of adults with imaging-confirmed TAA diagnosed between 1 January 2018 and 1 January 2026 using a Mayo Clinic electronic data platform encompassing more than 15 million patient records. Primary exposures were documented use of RAAS inhibitors, GLP-1 RAs, and SGLT2 inhibitors, evaluated individually and in prespecified combination-therapy analyses. Propensity score matching was used to balance demographics, comorbidities, aortic procedural history, and concomitant cardiovascular medications. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE) through 60 months. RESULTS:The study included 162,126 patients with TAA. After matching, RAAS inhibitor use was associated with higher 60-month overall survival (88.3% vs. 85.5%; hazard ratio [HR], 0.79; 95% CI, 0.76-0.83; p < 0.001) and MACE-free survival (86.1% vs. 84.2%; HR, 0.87; 95% CI, 0.83-0.91; p < 0.001). GLP-1 RA therapy was associated with higher overall survival (97.5% vs. 92.5%; HR, 0.32; 95% CI, 0.27-0.38; p < 0.001) and MACE-free survival (93.2% vs. 89.3%; HR, 0.62; 95% CI, 0.56-0.70; p < 0.001). SGLT2 inhibitor therapy was similarly associated with higher overall survival (89.8% vs. 81.5%; HR, 0.51; 95% CI, 0.47-0.54; p < 0.001) and MACE-free survival (86.3% vs. 79.1%; HR, 0.62; 95% CI, 0.58-0.66; p < 0.001). Combination therapy with RAAS inhibitors plus either GLP-1 RAs or SGLT2 inhibitors was associated with incremental improvements in overall survival and MACE-free survival compared with GLP-1 RA or SGLT2 inhibitor monotherapy. CONCLUSIONS:In this large propensity-matched TAA cohort, RAAS inhibitors, GLP-1 RAs, and SGLT2 inhibitors were each associated with improved survival and fewer major cardiovascular events, with additional benefit observed for RAAS-based combination therapy. These findings support further prospective investigation of integrated cardiometabolic and vascular-targeted therapy in TAA, while underscoring that observational associations should not be interpreted as proof of aneurysm-specific disease modification.
