Background/Objectives: Anorexia nervosa (AN) remains difficult to treat, and evidence for biological adjunctive interventions is limited. This study assessed the effectiveness of transcranial direct current stimulation (tDCS) as an adjunctive intervention in hospitalized patients with AN. Methods: In this double-blind, randomized, sham-controlled trial, 40 female inpatients with AN were allocated 1:1 to active tDCS or sham stimulation. Participants received 30 sessions over 3 weeks (2 mA, 25 min, twice daily on weekdays; anode F3, cathode F4), alongside standard inpatient treatment. Assessments were performed at baseline, post-intervention, and 2-week follow-up. Outcomes included eating disorder (ED) symptoms (EAT-26), depressive symptoms (BDI), perceived stress (PSS-10), self-esteem (SES), body mass index (BMI), and selected biological markers. Results: EAT-26 scores improved significantly from baseline to post-intervention in both groups; at the 2-week follow-up, scores remained significantly lower than baseline only in the active tDCS group. BMI and leptin increased significantly in both groups, while NT-3 decreased only in the active group. In multivariate analyses, higher leptin levels and greater perceived stress, adjusted for longer illness duration, were associated with greater improvement in ED symptoms; perceived stress predicted symptom improvement only in the active group. Conclusions: Active tDCS did not produce significantly greater short-term symptom reduction than sham in hospitalized patients with AN. However, findings observed at the 2-week follow-up and associations involving stress-related and metabolic measures require confirmation in studies with longer follow-up periods.
Background/Objectives: The Endothelial Activation and Stress Index (EASIX) combines lactate dehydrogenase, creatinine, and platelet count in a three-variable laboratory index. We evaluated its association with early mortality after acute myocardial infarction (AMI) and its incremental prognostic information beyond the Global Registry of Acute Coronary Events (GRACE) score. Methods: This retrospective study included a primary hospital cohort of 4167 patients with AMI and an independent MIMIC-IV cohort of 3183 patients with AMI requiring intensive care. EASIX was calculated from the first component measurements within 24 h after admission and log2-transformed. Cox models assessed 30-day mortality and changes in the association over time. Incremental performance beyond GRACE and sex was examined in the primary cohort. Results: Thirty-day mortality was 3.3% in the primary cohort and 22.9% in MIMIC-IV. Each doubling of EASIX was associated with higher 30-day mortality after adjustment for GRACE and sex in the primary cohort (hazard ratio [HR], 1.25; 95% CI, 1.13–1.38) and after clinical adjustment in MIMIC-IV (average HR, 1.40; 95% CI, 1.36–1.45). The association was strongest near admission and remained consistent across 6, 12, and 24 h exposure windows. Adding EASIX to GRACE modestly improved discrimination, whereas calibration and decision-curve net benefit changed little. Conclusions: Early EASIX was independently associated with short-term mortality across two clinically distinct AMI cohorts and provided complementary prognostic information beyond GRACE. Its three laboratory components offer a low-burden summary of early systemic physiological stress.
Background: Heart transplantation has evolved into a life-saving intervention for thousands of patients with end-stage disease worldwide. Advances in surgical techniques and immunotherapy have increased life expectancy in this specific patient group, resulting in the emergence of degenerative diseases such as osteoarthritis. Concurrently, due to the frequent administration of corticosteroids to transplant recipients, the rates of joint osteonecrosis remain high. This review aims to evaluate the final functional outcomes as well as the complications of patients with a history of heart transplantation who underwent total hip, knee, or shoulder arthroplasty. Methods: A systematic review of the literature was conducted according to PRISMA guidelines. The primary objective of the study was the improvement of various functional scores at the final clinical follow-up, as well as the recording of postoperative complication rates. Results: A total of 19 retrospective studies were included in the review, including small case series. Among the studies specifically evaluating functional outcomes, patients demonstrated statistically significant improvement in final clinical scores and quality of life. However, regarding complication rates, 12 out of the 19 articles identified a higher ratio compared to the general population, involving either systemic (e.g., renal failure), musculoskeletal (periprosthetic fracture, infection), or cardiac-related adverse events concerning the graft. Conclusions: According to the data analyzed in this systematic analysis, total arthroplasty of major joints demonstrates consistent potential to significantly improve the daily life and functional status of transplant patients. However, evidence regarding overall safety remains heterogeneous.
Background/Objectives: Oxygen-enriched oils represent an emerging class of advanced dressings based on the controlled release of reactive oxygen species, with the potential to modulate the wound microenvironment and support reparative processes. Despite their increasing clinical use, the available evidence remains fragmented, and no comprehensive synthesis is currently available on their fields of application and associated outcomes. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and the PRISMA-ScR reporting guidelines. PubMed, CINAHL, Scopus, and Web of Science were searched without time restrictions. Studies conducted in patients and evaluating oxygen-enriched oil-based dressings for the management of skin wounds were included. Two independent reviewers selected the studies, extracted and narratively synthesized the data, and performed the quality appraisal. Results: The search identified 142 records; after the selection process, nine studies including a total of 501 patients were included. The studies comprised different designs, ranging from randomized controlled trials to case reports. Applications included pediatric postoperative wounds (distal hypospadias and pilonidal disease), postsurgical wounds related to hidradenitis suppurativa, angular cheilitis, and oncological wounds. The most frequently investigated outcomes included reductions in healing time, pain, local complications, and infectious burden, as well as improvements in scar quality and patient satisfaction. Conclusions: Oxygen-enriched oils represent a promising wound-care strategy in different clinical settings. Although preliminary findings are favorable, independent controlled studies with larger samples and standardized outcomes are needed to define their comparative effectiveness and role in clinical practice more precisely.
Arterial stiffness is increasingly recognized as an important marker of vascular aging and an independent predictor of cardiovascular disease. Among the available methods for assessing arterial stiffness, brachial-ankle pulse wave velocity (baPWV) has gained widespread clinical acceptance because it is simple, noninvasive, highly reproducible, and suitable for routine practice and large-scale population screening. Accumulating evidence has demonstrated that baPWV is associated with hypertension-mediated target organ damage, coronary artery disease, cardiovascular events, and mortality. Beyond its prognostic value, baPWV has been investigated as a potential marker of vascular responses to pharmacological and lifestyle interventions. Emerging evidence also suggests that serial assessment and visit-to-visit variability of baPWV may provide additional prognostic information, although their clinical applicability requires further validation. Another advantage of baPWV is its simultaneous measurement of the ankle-brachial index, enabling comprehensive assessment of both arterial stiffness and peripheral artery disease without additional examination time. This review summarizes the physiological basis, measurement principles, strengths and limitations, and current clinical applications of baPWV, with particular emphasis on cardiovascular risk stratification, target organ damage, therapeutic monitoring, serial assessment, and combined ankle-brachial index evaluation. Finally, future perspectives for integrating baPWV into precision cardiovascular medicine are discussed.
Background: The optimal sequencing of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement after decompressive craniectomy (DC) remains uncertain, particularly in pediatric patients. This study aimed to describe our pediatric experience and provide an exploratory comparison of simultaneous and staged procedures. Methods: We retrospectively reviewed the medical records of 12 pediatric patients who developed hydrocephalus after DC at a single tertiary center between 2015 and 2023. Six patients underwent simultaneous CP and VPS placement, while six underwent staged VPS placement followed by CP. Demographic and clinical characteristics, surgical timing, postoperative complications, and neurological outcomes were compared. Given the small sample size, analyses were exploratory and primarily descriptive. Results: Postoperative complications occurred in two patients in each group (33.3%), including one wound infection and one shunt dysfunction requiring revision. No intracranial hemorrhage or deep shunt infection occurred in either group. The complication rate did not differ between the groups (p = 1.000). The median final Glasgow Outcome Scale score was 2.5 (range, 2–3) in the simultaneous group and 3.0 (range, 1–5) in the staged group (p = 0.457). Neurological outcomes likely reflected the severity of the underlying brain injury; however, the small sample size precluded adjustment for prognostic factors. Conclusion: In this small retrospective pediatric cohort, simultaneous CP and VPS placement was technically feasible, but postoperative complications occurred in one-third of patients. No significant differences were observed between the simultaneous and staged groups; however, these findings should not be interpreted as evidence of equivalence because of the limited sample size and non-randomized design. Surgical strategy should be individualized, and larger multicenter pediatric studies are needed.
Background: Blunt liver traumatic injuries are associated with high mortality and remain a significant challenge for modern healthcare systems. The aim of this study was to identify early clinical predictors of mortality in patients undergoing surgery for blunt liver injury. Material and Methods: A single-centre, retrospective observational study was conducted involving 27 adult patients who underwent surgery between 2013 and 2025 due to blunt liver injury (traffic accidents, falls from height). Clinical parameters such as GCS and shock index (SI) were correlated with the degree of injury according to the AAST OIS and WSES classifications and with the length of hospitalisation (LOS) using Spearman’s rank correlation coefficient. The study was approved by the Bioethics Committee (resolution number: RNN/86/25/KE). Results: Traffic accident victims predominated in the analysed group (81.5%). Deep consciousness disorders (GCS; ρ = −0.65) were shown to be the strongest negative predictor of survival—all deaths occurred in patients with a baseline GCS = 3. A strong positive correlation was also observed between the risk of death and the anatomical level of injury according to the AAST OIS (ρ = 0.70) and shock assessed using the SI (ρ = 0.50). Half of the patients who underwent surgery received packing (tamponade), while 51.8% underwent splenectomy. Conclusions: The GCS is the strongest independent clinical predictor of death in this group. Simple neurological and haemodynamic assessment is more useful in practice for quickly identifying critically ill patients than complex anatomical classifications such as AAST or WSES.
Background: Intraoperative hypotension is an established risk factor for postoperative acute kidney injury (AKI), but whether arterial waveform morphology adds prognostic information beyond the hypotension burden is unknown. Methods: In this study, 2587 adult surgical cases from the Vital Signs Database (VitalDB) with continuous invasive arterial waveforms and creatinine-based (KDIGO) AKI ascertainment were analyzed retrospectively. Maximal systolic upstroke (dP/dtmax), a late-diastolic pressure-decay descriptor (τ), and a waveform-derived dynamic arterial elastance (Eadyn), modeled as latent-class trajectories and as case-level features, were added to a base logistic model of log-transformed hypotension burden (time-weighted MAP < 65 mmHg), age, sex, and baseline eGFR. Results: AKI occurred in 143 cases (5.5%); the base model had an AUC of 0.725 (95% CI 0.680–0.770). A five-class dP/dtmax solution yielded distinct phenotypes whose membership was nominally associated with AKI (likelihood-ratio p = 0.02) but did not improve discrimination (change in AUC (ΔAUC), 0.008, 95% CI −0.005 to 0.021; optimism-corrected 0.002), and the association was attenuated after clinical adjustment (p = 0.13); τ showed no stable trajectory structure. No feature improved discrimination: the optimism-corrected ΔAUC was ≤0.007, upper confidence limits did not exceed 0.03 on any adequately fitting reference model, and the signal disappeared after adjustment for procedure type and comorbidity. The likelihood-ratio test had 80% power for a ΔAUC of 0.009. Conclusions: Arterial waveform morphology did not improve prediction of postoperative AKI beyond the hypotension burden; overall, these data exclude an incremental gain larger than approximately 0.02–0.03 AUC units.
Background: Minimally invasive cardiac valve surgery (MIVS) provides distinct clinical advantages, yet annular suturing remains a technically demanding step. Automated annular suturing devices (RAM®) have been developed to standardize suture placement during valve replacement. This study evaluates the initial clinical feasibility, technical safety, and operational integration of automated suturing during its institutional adoption phase. Methods: We retrospectively evaluated 43 consecutive patients undergoing MIVS supported by the RAM® system (2021–2025), stratified into mitral valve replacements (RAM-MVR, n = 26) and aortic valve replacements (RAM-AVR, n = 17). Technical parameters, procedural safety metrics, and perioperative outcomes were descriptively analyzed and contextualized against our broader institutional MIVS platform using percutaneous femoral cannulation (n = 182). Results: Automated annular suturing achieved a 100% technical feasibility rate (43/43, 95% CI: 91.8–100.0%) with zero mechanical device failures or intraoperative suture-line disruptions (0%, 95% CI: 0.0–8.2%). In the RAM-MVR cohort, median cross-clamp and cardiopulmonary bypass (CPB) times were 73.0 min (IQR 64.0–91.0) and 114.5 min (IQR 94.8–129.5), respectively. In RAM-AVR, median cross-clamp time was 75.0 min (IQR 71.0–83.0). Thirty-day mortality was 4.7% (2/43, 95% CI: 0.6–15.8%), secondary to non-device-related medical complications in high-risk baseline patients. Postoperative echocardiography demonstrated no paravalvular regurgitation (0%, 95% CI: 0.0–8.2%). Conclusions: Initial institutional experience demonstrates that automated annular suturing is technically feasible and safe in minimally invasive mitral and aortic valve replacement. The system enables consistent procedural execution across valve positions. These observational data support automated suturing as a feasible alternative to manual suturing in MIVS workflows.
Background/Objectives: Systemic inflammatory indices derived from the complete blood count differ in whether they incorporate platelet count. Whether platelet-containing indices outperform platelet-free indices and whether platelet count adds independent prognostic information remain insufficiently tested. Methods: We retrospectively analyzed 2244 consecutive patients undergoing percutaneous coronary intervention (PCI) at a single center. The neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), systemic immune–inflammation index (SII) and pan-immune–inflammation value (PIV) were derived from the baseline blood count. The outcome was 1-year (400-day) major adverse cardiovascular events (MACEs). Because SII and PIV equal NLR and SIRI multiplied by platelet count, the platelet contribution was tested with nested likelihood ratio tests. Calibration, decision-curve, 30-day landmark, time-varying coefficient and subgroup analyses were also performed. Results: MACEs occurred in 170 patients (7.6%). After adjustment, NLR, SII and PIV remained associated with MACEs. SII showed the highest C-index and lowest AIC, but no index significantly improved discrimination over the clinical model (ΔC-index +0.009, p = 0.060 for SII), no head-to-head difference was detected, and the added net benefit was negligible (0.38 per 100 patients). Adding platelet count did not improve model fit over the whole follow-up (p = 0.104 and 0.146) but did beyond the 30-day landmark (p = 0.025 and 0.033); the platelet-by-period interaction was not significant (p = 0.197). Exploratory analyses suggested larger associations in ST-segment elevation MI based on few events. Only the adjusted SII association survived within-family Holm correction; no result met the global 5% false-discovery-rate threshold. Conclusions: The four indices showed similar, modest discrimination without evidence of superiority or meaningful incremental utility; the post-30-day platelet signal was not confirmed by interaction testing and remains hypothesis-generating.
Background/Objectives: To compare computed tomography (CT)-derived body composition parameters across hormonal subtypes of adrenal adenomas and investigate their associations with hormonal activity. Methods: This retrospective study included 171 patients with unilateral adrenal adenomas categorized as Cushing syndrome (CS), mild autonomous cortisol secretion (MACS), non-functioning adenoma (NFA), or primary aldosteronism (PA). Adipose tissue and skeletal muscle parameters were quantified on CT images at the third lumbar vertebral (L3) level. Comparisons were adjusted for age, sex, and body mass index, and associations between hormonal and body composition parameters were assessed. Results: After adjustment, significant differences in non-psoas skeletal muscle index (SMI) were observed among the groups. Non-psoas SMI was lower in the CS group than in all other groups and in the MACS group than in the NFA and PA groups. Muscle attenuation was significantly reduced only in the CS group. In multivariable analyses adjusted for age, sex, and BMI, higher post-dexamethasone cortisol levels were independently associated with lower skeletal muscle parameters, with the strongest association observed for non-psoas SMI (β = −0.396, p < 0.001). Adipose tissue parameters did not differ significantly among hormonal subtypes. In exploratory analyses, aldosterone levels and the aldosterone-to-renin ratio were positively associated with the visceral-to-subcutaneous fat area ratio. Conclusions: Cortisol excess in adrenal adenomas was associated primarily with alterations in skeletal muscle mass and quality, particularly within the non-psoas compartment. Adipose tissue parameters demonstrated more heterogeneous associations with hormonal activity. These findings support further investigation of CT-derived body composition parameters across hormonal subtypes of adrenal adenomas.
Artificial intelligence (AI) and machine learning (ML) are transforming the landscape of rheumatological and systemic inflammatory disease management, offering unprecedented capacity to integrate complex, multidimensional data for diagnostic support, disease monitoring, and therapeutic decision-making. This comprehensive narrative review, based on a non-systematic literature search of PubMed/MEDLINE and Google Scholar combined with the authors’ clinical expertise, provides a clinically oriented synthesis of current and emerging AI applications across the full spectrum of immune-mediated inflammatory diseases—including rheumatoid arthritis, systemic lupus erythematosus, vasculitis, inflammatory bowel disease, psoriatic arthritis, systemic sclerosis, inflammatory myopathies, and sarcoidosis—with particular attention to applications that have demonstrated or are approaching clinical utility. We discuss deep learning-based image analysis, natural language processing of electronic health records, multi-omic biomarker discovery, and the application of Fourier transform-based signal processing to biological time series as a novel approach to continuous disease monitoring. Fourier transform methods—already foundational in MRI reconstruction, cardiac electrophysiology, and clinical neurophysiology—are here systematically extended to rheumatological and inflammatory disease signals, including accelerometry, electromyography, heart rate variability, and longitudinal biomarker time series. The phenomenon of large language model hallucination—particularly critical in rare inflammatory diseases—is addressed alongside retrieval-augmented generation as a mitigation strategy. We further argue that AI-driven methods do not merely improve the interpretation of clinical data, but fundamentally expand what is observable—with profound epistemological implications for clinical knowledge transmitted through generations of medical tradition. Ethical considerations and future directions toward precision inflammatory disease medicine are outlined.
Objectives: Lumbar vertebral wedge angles reflect vertebral body geometry and may influence lordosis. Whether the total wedge index (TWI) and segmental wedge angles differ between asymptomatic individuals and chronic low back pain (CLBP) patients, and predict lordosis independently of pelvic morphology, remains unclear. Methods: Standing lateral full-spine radiographs from 72 volunteers (49 male; mean age 28.3 ± 7.7 years) and 72 CLBP patients (28 male; mean age 52.0 ± 17.9 years; NRS 4.5 ± 2.2; pain > 3 months) were digitized using a validated quadrilateral vertebral body model. L1–L5 wedge angles and TWI (L1 + L2 + L3 + L4 + L5; negative = net posterior taper) were calculated. Pearson correlations, hierarchical OLS regression, and centile distributions were assessed, following STROBE guidelines. Results: In CLBP, L1 wedge was lower (3.33 ± 4.32° vs. 4.87 ± 3.55°; p = 0.020; d = −0.39) and L5 wedge differed significantly (−6.50 ± 6.32° vs. −8.65 ± 6.30°; p = 0.043; d = +0.34). TWI correlated most strongly with lordosis in volunteers (r = +0.531) and CLBP (r = +0.478; both p < 0.001), and with sacral tilt in both groups. TWI added ΔR2 = 0.183 over pelvic morphology (PTPIA) in volunteers and ΔR2 = 0.210 in CLBP, where PTPIA alone explained <2% of lordosis variance. L1 wedge was greater in males (5.27 ± 3.64° vs. 2.76 ± 4.03°; p < 0.001; d = 0.67). T4-HA translation did not correlate with wedge variables. In CLBP, L1 and L5 lost lordosis correlations, while L2–L4 remained significant. TWI was the primary structural predictor of lumbar lordosis. Conclusions: In CLBP, the pelvic–lordosis relationship is disrupted, yet TWI remains predictive (ΔR2 = +0.210), indicating that vertebral body geometry remains linked to lordosis when pelvic morphology does not. Normative TWI centiles may support radiographic outcome measurement.
Objectives: To characterize the frequency and temporal patterns of anterior segment findings after radiotherapy for sinonasal and nasopharyngeal cancer, with particular focus on anterior segment neovascularization and its association with superselective intra-arterial cisplatin infusion with concurrent radiotherapy (RADPLAT). Methods: We retrospectively reviewed 113 patients treated with intensity-modulated radiotherapy between 2019 and 2022. Anterior segment findings were evaluated using the whole cohort as the denominator and among patients referred for ocular symptoms. Cumulative incidence was estimated with death as a competing risk using the Aalen–Johansen estimator and compared using Gray’s test. Results: Median follow-up was 1666 days. Forty-seven patients (41.6%) were referred to ophthalmology. Anterior segment findings occurred in 16/60 patients (26.7%) with nasal cavity cancer and 13/31 (41.9%) with maxillary sinus cancer (p = 0.16); 5-year cumulative incidences were 27.7% and 46.1%, respectively (p = 0.018). Anterior segment neovascularization occurred in 7/113 patients (6.2%), including 6/21 (28.6%) treated with RADPLAT and 1/92 (1.1%) without RADPLAT (p < 0.001); 5-year cumulative incidences were 31.4% and 1.4%, respectively (p < 0.001). Among patients with maxillary sinus cancer, neovascularization occurred in 5/19 RADPLAT-treated patients and 0/12 non-RADPLAT patients (p = 0.13); however, median follow-up was substantially shorter in the non-RADPLAT group (385 vs. 1784 days). Neovascularization developed late (median, 975 days), and four affected patients had final best-corrected visual acuity below 0.05. Conclusions: Anterior segment findings showed distinct temporal patterns after radiotherapy. Late, vision-threatening neovascularization was strongly associated with RADPLAT, although causality cannot be established because treatment selection was confounded by tumor site, disease extent, orbital invasion, and radiotherapy characteristics. These findings identify anterior segment neovascularization as an important safety signal warranting prospective evaluation. Standardized baseline ophthalmological assessment, long-term surveillance, and patient-level ocular dosimetry are needed to clarify mechanisms and define appropriate follow-up strategies.
Intracranial hypertension is a major modifiable pathway of secondary brain injury after acute neurological insults. Osmotherapy is an early cornerstone of tiered intracranial pressure management. Hypertonic saline and mannitol reliably reduce intracranial pressure through osmotic reduction in brain water, with additional haemodynamic and rheological effects. However, neither agent has shown consistent improvement in survival or long-term neurological recovery. Current practice is therefore guided by physiological rather than patient-centred outcomes. This review summarises the physiological basis, clinical evidence, and practical limitations of conventional osmotherapy, and explores investigational chloride-free osmotherapies including sodium lactate, sodium bicarbonate, sodium ascorbate, and sodium acetate. Chloride-free therapies aim to preserve sodium-driven osmotic efficacy while reducing chloride exposure or targeting metabolic and oxidative pathways implicated in secondary brain injury. At present, evidence is limited to small physiological trials, retrospective cohort studies, and mechanistic human studies. Future progress requires large collaborative trials that combine pragmatic treatment comparisons with multimodal neuromonitoring, biochemical safety endpoints and patient-centred outcomes.
Background: Albumin-based biomarkers have emerged as practical tools for prognostic assessment in coronary artery disease (CAD), but their comparative prognostic patterns and potential clinical utility have not been systematically evaluated. Methods: We performed a systematic review and meta-analysis of albumin-based biomarkers, including the C-reactive protein-to-albumin ratio (CAR/hsCAR), neutrophil percentage-to-albumin ratio (NPAR), lactate-to-albumin ratio (LAR), and C-reactive protein–albumin–lymphocyte (CALLY) index, in patients with CAD. Pooled associations with mortality and MACE were assessed, together with discriminative performance and clinical utility. Results: Thirty-four studies involving 47,763 patients were included. Higher CALLY values were associated with lower all-cause mortality (HR 0.46, 95% CI 0.24–0.87) and a directionally protective but non-significant association with MACE (HR 0.44, 95% CI 0.18–1.08). Elevated CAR/hsCAR was associated with increased mortality (OR 1.61, 95% CI 1.09–2.38) and MACE (HR 1.37, 95% CI 1.21–1.56) in acute coronary syndrome (ACS)-related cohorts. NPAR showed the most consistent association with mortality (HR 1.88, 95% CI 1.71–2.08; I2 = 4.8%), whereas its association with MACE was less stable (HR 1.86, 95% CI 0.56–6.13). LAR showed the largest pooled effect estimate for mortality (HR 2.50, 95% CI 1.78–3.51). In discriminative analyses, CAR showed the most balanced performance for long-term MACE, NPAR showed the strongest rule-in profile for long-term MACE, and CAR and CALLY showed the best discrimination for mortality. Conclusions: Albumin-based biomarkers are linked to adverse CAD outcomes, especially in ACS, with distinct prognostic patterns by biomarker and endpoint. They provide complementary risk stratification information, and further prospective studies are needed to confirm their incremental clinical utility.
Objectives: Major depressive disorder (MDD) frequently co-occurs with substance use disorders, resulting in greater clinical severity and poorer outcomes. Sedative–hypnotic/anxiolytic agents (SHA) are commonly used to manage anxiety and insomnia, also in MDD. However, their long-term intake might lead to misuse and physical and cognitive complications. Trazodone, an antidepressant with sedative and anxiolytic properties, has been proposed as an option in SHA detoxification, but data on patients with comorbid MDD and SHA use disorders (MDD+SHA-UD) are limited. This study retrospectively evaluated the effects of a three-month treatment with extended-release trazodone in this population. Methods: Seventy-four outpatients with MDD+SHA-UD treated with extended-release trazodone were evaluated at baseline and after one and three months. Depressive symptoms were assessed using the Hamilton Depression Rating Scale. Secondary outcomes included anxiety (Hamilton Anxiety Rating Scale), sleep disturbances (Pittsburgh Sleep Quality Index), physical symptoms (Hamilton Depression–Anxiety subscales, 36-Item Short-Form Health Survey), cognitive functioning (Perceived Deficits Questionnaire–Depression, 5-item), and quality of life (World Health Organization-Five Well-Being Index). Results: Trazodone was associated with a significant reduction in depressive symptoms (p < 0.001), with 47.3% of the initial sample achieving remission at endpoint. Improvements were also observed in measures of anxiety, physical symptoms, subjective sleep quality, perceived cognitive functioning, and quality of life (all p < 0.001). Side effects were mild (25.7% at one month) and declined over time. Conclusions: In this uncontrolled preliminary study, extended-release trazodone was associated with significant improvements across multiple symptom domains in MDD+SHA-UD, warranting controlled investigation.
Background/Objectives: Adolescent idiopathic scoliosis (AIS) is associated not only with structural spinal deformities but also with alterations in postural control and sensorimotor integration. Objective assessment of balance and plantar-load distribution may provide additional insight into functional impairments, particularly in patients with mild and moderate curves. The aim of this study was to compare static plantar-load distribution and stabilometry parameters in children and adolescents with idiopathic scoliosis under different sensory and postural conditions. Methods: This pilot study included 19 children and adolescents (18 female, 1 male) diagnosed with mild and moderate AIS. Load distribution and stabilometric parameters were assessed using a capacitive platform under three testing conditions: eyes open, eyes closed, and head extension. Parameters evaluated included load distribution across plantar regions and center-of-pressure-related stability measures. Comparisons were performed between conditions to evaluate the influence of visual and vestibular modulation on postural control. Results: Total plantar load did not differ between the right and left foot, and global relative plantar-load distribution remained stable across the three testing conditions. A consistent side-to-side asymmetry was present at the fifth metatarsal head, where load on the left side was significantly lower than on the right in every condition and remained significant after Holm correction for multiple comparisons (p = 0.001–0.002; |r| = 0.94–0.99). Higher left-sided load was also observed at the first metatarsal head and heel; the heel asymmetry remained significant after correction only in the eyes-open condition (Holm p = 0.044), whereas the remaining differences did not survive correction and are reported as exploratory. The left side corresponded to the side of lumbar convexity. Postural stability differed markedly between conditions: center-of-pressure path length, 90% confidence-ellipse area and maximum center-of-pressure speed were greater under the eyes-closed and head-extension conditions than with eyes open, indicating reduced postural stability when visual input was removed or head position was altered. The two challenge conditions did not differ significantly from each other. Conclusions: In this uncontrolled pilot study, children and adolescents with mild-to-moderate idiopathic scoliosis showed a consistent reduction in load under the left fifth metatarsal head, whereas, apart from a higher left heel load that was significant only with eyes open, other regional asymmetries were exploratory. Stabilometric parameters deteriorated under both visual deprivation and head extension, with no statistically significant difference between the two challenge conditions. Because postural changes became apparent mainly when visual or head-position conditions were altered, assessment under such conditions may reveal condition-related changes in postural control within this AIS cohort. However, because no healthy control group was included, these findings should not be interpreted as evidence of AIS-specific sensory-integration deficits. These preliminary findings require confirmation in larger controlled studies including healthy age-matched participants.
Background: Sarcopenic obesity (SO) is a clinically relevant but often under-recognized condition in older adults. This study examined whether obesity severity and body fat distribution are associated with physical capacity, functional autonomy and health-related quality of life in a sex-specific manner. Methods: In this observational case–control study with cross-sectional assessments, 45 older obese adults (OB; 27 men and 18 women) and 40 non-obese (NOB) comparison participants (18 men and 22 women), aged 65–85 years, underwent anthropometric assessment, bioelectrical impedance analysis, geometric body shape indexing, physical performance testing, autonomy assessment, physical activity evaluation and health-related quality-of-life assessment. SO was classified using a study-specific operational application of the ESPEN/EASO framework based on excess adiposity, impaired muscle function, and BIA-derived skeletal muscle mass adjusted for body mass. Results: Using this operational framework, all participants in the OB group were classified as presenting an SO phenotype. OB men showed substantially greater visceral adipose tissue mass than OB women (+106.5%, ES: 1.27, large, p < 0.001) and a higher A body shape index-associated relative risk (+27.9%, ES: 0.82, large, p < 0.001). Conversely, OB women showed more severe mobility impairment than OB men, with lower performance in the 8-Foot Up-and-Go (−22.9%, ES: 0.66, medium, p < 0.001) and 6-Min Walk test (−23.4%, ES: 0.64, medium, p < 0.001) and slightly lower basic autonomy. Health-related quality of life was significantly reduced only in OB men (−10.8%, ES: 1.07, large, p < 0.001) than NOB. Conclusions: In this clinical sample, an operational SO phenotype was identified among older OB adults and exhibited divergent sex-specific profiles. Men showed a predominantly geometric visceral risk phenotype and poorer perceived health status, whereas women showed more pronounced impairment in mobility and basic functional autonomy. These findings support sex-differentiated, multidisciplinary rehabilitation strategies in older adults with obesity.
Background/Objectives: Lung-RADS was introduced to standardize the management of nodules detected during lung cancer screening. However, significant interobserver variability has been reported, and its consistency across different hospital settings remains insufficiently investigated. This study aimed to compare Lung-RADS categorization and diagnostic performance between tertiary and non-tertiary hospitals, and to evaluate interobserver variability and associated differences in recommended management. Methods: This single-tertiary-center, referral-based retrospective study included patients referred to a tertiary hospital after lung cancer screening at 29 non-tertiary hospitals between September 2019 and December 2023. CT images were reinterpreted at a tertiary hospital using Lung-RADS. A blinded review was performed by an independent thoracic radiologist, and interobserver variability was assessed using Cohen’s kappa. Discordance rate and major discordance (≥9-month follow-up difference) were determined. Sensitivity, specificity, and diagnostic accuracy were calculated and compared. Results: Sixty patients (median age, 63 years [interquartile range, 58–68]; 59 men and one woman) with 43 confirmed final diagnoses (18 of lung cancer and 25 of benign lesions) were included. Interobserver variability was fair between tertiary and non-tertiary hospitals (κ = 0.30), and between non-tertiary hospitals and thoracic radiologist (κ = 0.28), but almost perfect between tertiary hospital and thoracic radiologist (κ = 0.82). Lung-RADS discordance occurred in 50.0% of the cases (30/60), with 70.0% (21/30) classified as major discordance. Among the 43 patients with confirmed final diagnoses, specificity was significantly higher in tertiary hospital reports (68.0%, 95% CI 46.5–85.1) compared to non-tertiary hospital reports (20.0%, 95% CI 6.8–40.7; p = 0.001), while sensitivity was comparable (100.0%, 95% CI 81.5–100 vs. 88.9%, 95% CI 65.3–98.6; p = 0.480). Conclusions: Frequent discordances in Lung-RADS categorization were observed between tertiary and non-tertiary hospitals. Higher specificity was observed for tertiary hospital interpretations within this referral cohort. These discrepancies may affect patient management, highlighting the need for strategies to improve consistency.
