Search Results (2,303)

Background: Sleep disturbances are a clinically relevant and transdiagnostic dimension of eating disorders (EDs), particularly during adolescence and young adulthood. Although early improvements in insomnia severity during residential treatment have been described, the longitudinal trajectory of sleep disturbances, habitual sleep timing, and eating disorder psychopathology across a six-month residential stay has not been systematically characterised. Methods: This prospective real-world observational study enrolled 30 female adolescents and young adults (aged 14–22 years) in a small exploratory cohort, predominantly with anorexia nervosa (AN; 83.3%) and a minority with bulimia nervosa (BN; 16.7%), all with clinically significant insomnia at admission (Insomnia Severity Index [ISI] > 14). All sleep outcomes were based on subjective self-report; no objective sleep assessment (actigraphy or polysomnography) was available. Participants were consecutively recruited from the Regional Residential Centre for Eating Disorders “Mariconda”, ASL Salerno, Italy. Of 38 consecutive admissions assessed for eligibility, 8 were excluded (ISI ≤ 14 at admission: n = 5; incomplete baseline data: n = 3), yielding a final enrolled sample of n = 30. All 30 participants completed the six-month residential programme; no drop-outs occurred. ISI was assessed monthly (T0–T6); PSQI and EDE-Q were assessed at T0, T3, and T6; diary-derived sleep timing (sleep midpoint) was assessed monthly (T0–T6), while diary-derived sleep continuity parameters (SOL, WASO, TST, SE%) were available at T0, T1, T3, and T6. Linear mixed-effects models (LMM) and bootstrap-resampled paired analyses were used. Results: ISI declined progressively from 21.1 ± 2.5 at baseline to 7.4 ± 2.7 at month 6 (Δ = −13.7; 95% CI [−14.4, −13.1]; p < 0.001). By month 6, 56.7% of participants had achieved remission (ISI < 8) and 100% had met response criteria (ΔISI ≤ −8). Sleep midpoint advanced progressively by 86 min over six months (from ~04:41 to ~03:16 after midnight), with no significant association with BMI or pharmacological treatment in linear mixed-effects models. EDE-Q global scores decreased from 4.57 ± 0.49 to 2.06 ± 0.58. Changes in ISI were not correlated with changes in EDE-Q at month 3 (r = 0.042, p = 0.826) but were significantly correlated at month 6 (r = 0.480, p = 0.007). All pharmacological regimens remained stable throughout the six-month observation period. The association between improvement in insomnia severity and eating-disorder psychopathology was not evident at month 3 but emerged at month 6, suggesting that these domains may change at different rates during residential treatment. Given the exploratory nature of the analyses, p-values are reported without adjustment for multiple comparisons and should be considered hypothesis-generating. Conclusions: Across six months of residential treatment, progressive improvements were observed in insomnia severity, subjective sleep continuity, habitual sleep timing, BMI, and eating-disorder psychopathology. In the absence of a control group, spontaneous remission, regression to the mean, and non-specific components of care, including the routinely administered Passiflora incarnata L. adjunct, cannot be individually distinguished as contributors to the observed changes, and these findings should be interpreted within the constraints of an uncontrolled observational design relying on subjective sleep measures. Controlled studies are needed to determine whether these changes are directly attributable to treatment or primarily reflect concurrent weight restoration and clinical improvement. Full article

(1) Background: Women in the peripartum period are at increased vulnerability to the development or worsening of mental disorders. However, data from specialized psychiatric settings in Southeast Europe on this topic remain limited. In this study, we assessed the distribution of perinatal mental health disorders, diagnostic changes, hospitalizations, obstetric complications, and breastfeeding among women treated at the Perinatal and Reproductive Psychiatry Unit in Belgrade, Serbia. (2) Methods: A retrospective review of medical records from 287 patients (2015–2024), including sociodemographics, ICD-10 diagnoses, hospitalizations, obstetric complications, and breastfeeding data, was performed. (3) Results: The mean age of the women in this cohort was 33.1 ± 5.6 years. Mood disorders (F30–F39) were most common (39.6% before, 42.2% during, and 32.1% after pregnancy), followed by neurotic and stress-related disorders (F40–F48). Postpartum F50–F59 diagnoses (especially mental and behavioral disorders associated with the puerperium, not elsewhere classified—F53) rose significantly (p < 0.001). Overall, 38.7% of patients had at least one psychiatric hospitalization; hospitalization was recorded before pregnancy in 30.0%, during pregnancy in 5.9%, and postpartum in 6.6%, with overlap between periods. Leading obstetric complications were emergency cesarean (1.0%) and fetal loss (1.4%). Only 41.3% of the women whose data were available breastfed (mean 4.7 months). (4) Conclusions: Mood disorders predominate in specialized psychiatric perinatal care. The results of this study indicate the frequency of perinatal mental disorders and the need for both outpatient and inpatient treatment. It is, therefore, essential to continue developing mental health care systems for women in Serbia and to provide ongoing education for health professionals in order to ensure timely diagnosis and treatment of pregnant and postpartum women. Full article

Background/Objectives: Biphasic reactions are an important consideration during post-treatment observation of children with anaphylaxis; however, real-world pediatric data on observation practices and the timing of these reactions remain limited. This study aimed to describe the clinical characteristics, management practices, observation duration, and occurrence of biphasic reactions among children presenting with anaphylaxis to a tertiary pediatric emergency department (PED). Methods: This single-center retrospective observational study included children aged 0–18 years who presented with anaphylaxis to a tertiary PED between January 2014 and December 2024. Potential cases identified through ICD-10 codes and PED intramuscular adrenaline administration records were reviewed to confirm the diagnosis according to established criteria. Demographic and clinical characteristics, suspected triggers, treatments, observation duration, and biphasic reactions were evaluated. Results: Seventy anaphylaxis episodes in 68 patients were analyzed. The median age was 93.5 months (IQR, 50–156). Food (32.9%) and insect stings (28.6%) were the most common suspected triggers, followed by drug/vaccine-related triggers (18.6%) and allergen immunotherapy (11.4%). Adrenaline was administered in 94.3% of episodes, and intravenous fluid therapy in 50.0%. Central nervous system involvement and age-adjusted hypotension were more frequent among episodes receiving intravenous fluid therapy (p = 0.004 and p < 0.001, respectively). The median PED observation duration was 5.5 h (IQR, 2–8). Biphasic reactions occurred in three episodes (4.3%), all within three hours after initial symptom resolution. Conclusions: In this tertiary PED cohort, adrenaline administration was frequent, and biphasic reactions were uncommon and occurred during the early observation period. Given the small number of biphasic reactions, these findings should be interpreted as descriptive and are insufficient to determine the optimal observation duration. Full article

Evidence regarding endoscopic retrograde cholangiopancreatography (ERCP) in adults in their 90s and 100s remains limited, and chronological age may not adequately reflect procedural vulnerability. We compared ERCP strategy and short-term outcomes across advanced age strata and included a contemporary younger reference cohort. This retrospective cohort included 48 patients aged ≥80 years undergoing ERCP for choledocholithiasis or stone-related acute cholangitis between 2023 and 2025: 80–89 years (n = 20), 90–99 years (n = 21), and ≥100 years (n = 7). A reference group of 15 consecutive patients aged <80 years treated during the same period under the same eligibility criteria was added. Only the first eligible ERCP per patient during the study period was analyzed as the index procedure; subsequent ERCPs were outcomes rather than additional observations. Clinical Frailty Scale (CFS), stone burden, treatment strategy, drainage, adverse events, intensive care use, and 30-day mortality were analyzed using nonparametric and Fisher–Freeman–Halton methods. Frailty–outcome analyses were restricted to the ≥80-year primary cohort and were exploratory and unadjusted. Median CFS was 4.0, 4.5, 6.0, and 8.0 in the <80, 80–89, 90–99, and ≥100-year groups, respectively (p < 0.001). Complete index stone clearance was 93.3%, 90.0%, 76.2%, and 71.4% (p = 0.358), while stenting was used in 6.7%, 10.0%, 33.3%, and 42.9% (p = 0.055). Successful biliary drainage remained 100%, 95.0%, 95.2%, and 100% (p = 1.000). Repeat ERCP occurred in 0%, 0%, 14.3%, and 28.6% (p = 0.027), and median length of stay increased from 3 to 4, 5, and 6 days (p < 0.001). Within the ≥80-year cohort, higher CFS remained associated with failed index clearance, stenting, post-procedure ICU requirement, and 30-day mortality in exploratory analyses. ERCP achieved high biliary drainage rates across age strata, including centenarians. The small younger reference cohort provided clinical context, while the ≥80-year analyses continued to show increasing frailty and more frequent staged management in the oldest groups. The retrospective design, small reference cohort, sparse events, and strong age–frailty correlation preclude causal or independent prognostic claims. Full article

Background/Objectives: Many adolescent athletes fast during Ramadan, similar to adults. However, research on Ramadan fasting during adolescence, a critical period for growth and development, is insufficient. This study aimed to examine changes in nutritional status and sport-specific performance during Ramadan in adolescent volleyball players and to explore whether these changes differed by Ramadan fasting adherence. Methods: This prospective cohort study included 35 male adolescent volleyball players (age: 16.43 ± 1.29 years, height: 1.75 ± 0.07 m, training experience: 6.20 ± 2.13 years) who fasted during Ramadan. Energy and macronutrient intake, anthropometric measurements, and sport-specific performance tests were conducted before, during, and at the end of Ramadan, and biochemical parameters were measured before and at the end of Ramadan. Results: Fat intake decreased during and at the end of Ramadan (1.60 ± 0.16 and 1.52 ± 0.15 g/kg BW, respectively; p = 0.021). Energy and macronutrient intakes were generally consistent with recommended levels, whereas fluid intake remained relatively low (1.60 ± 0.11 L, 1.35 ± 0.09 L, 1.44 ± 0.10 L, respectively). Anthropometric measurements remained unchanged. Left-hand grip strength (p = 0.006), 20 m sprint performance (p < 0.001), and agility performance (p = 0.002) decreased over the study period. Significant group effects were observed for 5 m, 10 m, and 20 m sprint, SJ, and standing long jump performances according to fasting adherence. Chloride, urea, and the BUN/creatinine ratio increased at the end of Ramadan, whereas albumin and potassium remained unchanged. Conclusions: In adolescent male volleyball players, Ramadan fasting may be associated with changes in dietary intake, certain sport-specific performance measures, and biochemical parameters potentially related to hydration status. Full article

Background: Nutritional deficiencies are associated with poor prognosis in a wide range of illnesses. However, the prognostic impact of poor nutritional status with respect to long-term all-cause mortality in the general non-diseased population is not well described. Objectives: This study sought to report the prevalence, clinical associations, and prognostic consequences of poor nutritional status in a contemporary urban population in Germany. Methods: A cohort of 8398 participants from the LIFE-Adult Study was enrolled. Four objective nutritional scores, the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status Score (CONUT), the Nutritional Risk Index (NRI), and the Triglyceride Cholesterol Body Weight Index (TCBI), were calculated at baseline, and participants’ nutritional status was classified according to score tertiles. The relationship between nutritional status and common risk factors as well as major diseases was assessed. In addition, the association between poor nutritional status at baseline and the risk of all-cause mortality during a seven-year follow-up period was examined. Results: According to the WHO definition of obesity, the LIFE-Adult Study cohort was, on average, overweight, with almost two-thirds of participants (67%) having a BMI ≥ 25 and only 1% being underweight. However, poor nutritional status was not associated with a specific BMI category. Higher age, female sex, cancer, and chronic kidney disease were more common, whereas active smoking and hypercholesterolemia were less prevalent among participants in the lowest PNI tertile (p < 0.01). In the overall population, the cumulative incidence of all-cause mortality was significantly higher among participants in the lowest PNI, NRI, and TCBI tertiles and the highest CONUT category (log-rank test, p < 0.01 for PNI, CONUT, and NRI, and p < 0.04 for TCBI, respectively). After adjustment for confounding factors, the lowest PNI and NRI tertiles and the highest and medium CONUT categories remained independently and significantly associated with an increased risk of all-cause mortality (all p < 0.01) in multivariable Cox regression analyses. TCBI was not associated with all-cause mortality in any regression model. Conclusions: Poor nutritional status is associated with increased mortality in the general population. Clinical trials are needed to prospectively evaluate the efficacy of nutritional interventions on health outcomes. Full article

Purpose: To characterize baseline spinal multimorbidity, we investigated sex-associated differences in disability, and the temporal distribution of patients aged 80 years or older presenting to a tertiary spine center over three decades. Methods: We performed a retrospective single-center study (1994–2024). Of 3199 screened unique patient medical records evaluated for low back pain, 193 unique patients were age-eligible; 71 were excluded for prespecified record-quality criteria, leaving 122 patients in the analytical cohort. Baseline Visual Analog Scale (VAS) scores were available for all 122 patients and Oswestry Disability Index (ODI) scores for 99. Diagnoses required clinical-imaging concordance. A Lumbar Pathology Count (LPC) summarized seven coexisting degenerative diagnosis categories. Temporal distributions across study periods (D1: 1994–2004, D2: 2005–2014, D3: 2015–2024) were examined descriptively. Multivariable robust linear regression evaluated the association between sex and ODI. Results: Mean age was 84.2 years, and median VAS was 8/10. Among 99 patients with ODI data, mean ODI was 47.6%. Women with complete sex and ODI data had higher disability than men (51.5% vs. 39.8%; p = 0.002; Cohen d = 0.66). In the adjusted model (n = 98), female sex remained associated with a 12.3-point higher ODI (95% CI 4.5–20.2; p = 0.002). Most patients (76.2%) had more than one lumbar diagnosis (mean LPC, 1.99), but LPC was not significantly correlated with VAS or ODI. From D2 to D3, facet arthrosis increased from 31.3% to 65.3% and central disc herniation decreased from 37.5% to 9.9%; both remained significant after Benjamini–Hochberg correction (q = 0.039). The analytical cohort comprised five patients in D1, 16 in D2, and 101 in D3. Conclusions: In this selected referral-center cohort, advanced-age patients presented with severe baseline pain, disability, and frequent coexisting lumbar degeneration. Female sex was independently associated with higher baseline disability. Temporal patient distributions reflect complete-record inclusion criteria rather than population epidemiology. These findings emphasize the necessity of explicit functional phenotyping in late-life spine care. Full article

Background/Objectives: Real-world evidence on influenza vaccine effectiveness (VE) against severe outcomes among older adults in China remains limited. We evaluated influenza vaccination against medically attended influenza, influenza hospitalization, and influenza-related intensive care unit (ICU) admission among adults aged ≥60 years in Yichang, China. Methods: We conducted a multi-season population-based retrospective cohort study using linked immunization and healthcare records. Season-specific propensity scores and overlap weighting were used to improve comparability between vaccinated and unvaccinated participants. Weighted Cox regression with individual-level clustered robust variance was used to estimate VE; proportional-hazards assumptions were formally assessed, with extended Cox models fitted when treatment-specific non-proportionality was detected. Results: The cohort comprised 1,106,886 person-seasons, including 31,540 vaccinated and 1,075,346 unvaccinated person-seasons. Vaccination was associated with lower hazards of medically attended influenza (VE, 55.7%; 95% CI, 43.4–65.3%), influenza hospitalization (54.4%; 39.4–65.7%), and influenza-related ICU admission (52.7%; 14.2–73.9%). Protective associations were observed in both winter seasons and persisted when the vaccination window was restricted to 14–180 days before the index date, with VE estimates of 78.4% for medically attended influenza and 83.1% for influenza hospitalization; findings were also robust across other sensitivity analyses. VE point estimates were numerically higher during higher antigenic-concordance periods, although the interaction was not statistically significant. Conclusions: Influenza vaccination within the prespecified pre-index exposure window was associated with lower risks of medically attended influenza and severe influenza-related outcomes among older adults in Yichang. Residual confounding and outcome misclassification cannot be excluded, and the estimates primarily apply to the overlap population rather than all older adults in Yichang. Full article

Background: Thyroid cancer (TC) is the most common endocrine malignancy, with a steadily increasing incidence observed worldwide. However, temporal trends and demographic patterns may vary across populations. Objectives: To assess hospital-based incidence rates, demographic characteristics, and selected epidemiological patterns of TC in Poland between January 2012 and December 2024. Material and Methods: This population-based, retrospective study utilized hospitalization records of TC patients in Poland obtained from the Nationwide General Hospital Morbidity Study. Only first-time hospitalizations in the study period with reported primary or secondary diagnoses of TC were included in the study. Results: The study cohort included 60,604 patients, and the mean annual hospital-based incidence rate was 12.2 per 100,000 inhabitants (95% CI: 11.0–13.4). The hospital-based incidence rate decreased from 15.2 in 2012 to 9.8 per 100,000 in 2020, followed by a marked increase, peaking to 16.6 per 100,000 in 2024. Women constituted 82.2% of cases, indicating a strong sex-related disparity. The mean age at diagnosis was 51.1 years (SD: 15.9). The mean age at diagnosis was 51.1 years (SD: 15.9), and a greater proportion of hospitalized thyroid cancer patients were urban than rural residents (67.4% vs. 32.6%). Marked regional variation was observed, with the highest rates recorded in selected northern and central voivodeships. Conclusions: TC hospitalization hospital-based incidence rates in Poland showed significant temporal variability, with the lowest rate in 2020, which may reflect disruptions in healthcare access during the COVID-19 pandemic and a possible diagnostic catch-up effect in subsequent years. Regional disparities may suggest the potential influence of environmental, socioeconomic, or healthcare-related factors. Full article

Background: Enterococcal infections are major healthcare-associated infections associated with increasing antimicrobial resistance and substantial mortality. However, long-term epidemiological data integrating antimicrobial resistance trends with clinical outcomes remain limited in Saudi Arabia. This study evaluated antimicrobial resistance trends, clinical characteristics, and mortality among patients with enterococcal positive cultures over an 11-year period. Methods: We conducted a single-center retrospective cohort study of 2272 hospitalized adults with culture-positive Enterococcus spp. between March 2015 and November 2025. Demographic, clinical, microbiological, and outcome data were extracted from electronic medical records. Temporal resistance trends and independent predictors of in-hospital mortality were evaluated using logistic regression. Results: Enterococcus faecalis accounted for 74.1% of isolates. Vancomycin-resistant enterococci (VRE) prevalence showed no significant temporal trend during the study period, with an overall prevalence of 11.3%, whereas high-level gentamicin resistance declined significantly (OR per year 0.933, 95% CI 0.903–0.964; p < 0.001). Multidrug resistance showed no significant temporal change. Compared with E. faecalis, E. faecium exhibited substantially higher resistance to vancomycin, ampicillin, and ciprofloxacin, while susceptibility to linezolid, daptomycin, and tigecycline remained above 95%. Overall, in-hospital mortality was 15.6% and was independently associated with age ≥60 years, intensive care unit admission, bloodstream infection, coinfection, and E. faecium positive culture. Conclusions: This study provides one of the largest long-term evaluations of enterococcal positive culture in Saudi Arabia, demonstrating stable VRE prevalence, declining high-level aminoglycoside resistance, and persistent species-specific differences in antimicrobial resistance and mortality. These findings support local antimicrobial resistance surveillance and antimicrobial stewardship efforts by providing updated epidemiological data on enterococcal positive cultures. Full article

Background: Osteoarthritis (OA) is a chronic disease requiring long-term management, and its burden is expected to grow with population aging, including in South Korea’s rapidly aging population. Although total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common interventions for OA, their long-term association with healthcare utilization and expenditures across benefit classifications remains unclear. This study examined differences in medical utilization and expenditures, disaggregated by benefit classification, between patients who underwent TKA/THA and matched non-surgical controls, before and after surgery. Methods: This retrospective cohort study used 1:3 direct matching on sex, calendar date, and OA duration to compare patients who underwent TKA/THA (2012–2019) with matched non-surgical controls at a tertiary hospital in Seoul, South Korea. Outcomes were inpatient and outpatient medical utilization and expenditures over 30-day intervals, disaggregated by benefit classification (covered, uncovered, and out-of-pocket payments (OOPs)). Generalized estimating equation models with an autoregressive correlation structure estimated associations before and after surgery. Poisson regression was used for inpatient and outpatient visits, and Negative Binomial regression was used for LOS given evidence of overdispersion and excess zeros. Medical expenditures were log-transformed and analyzed using normal distribution models. Results: A total of 351 surgical patients and 984 matched controls were included. Before surgery, the surgical cohort had lower inpatient utilization and expenditures than matched controls. Inpatient visits were 27% fewer (95% CI: 0.62–0.87). Covered, uncovered, and OOP expenditures were 25% (95% CI: 0.65–0.86), 24% (95% CI: 0.67–0.87), and 25% (95% CI: 0.65–0.86) lower, respectively. Outpatient OOPs were 46% higher (95% CI: 1.30–1.64). After surgery, this pattern reversed for inpatient services. Visits (exp(β) = 2.09, 95% CI: 1.64–2.67), average length of stay (exp(β) = 2.51, 95% CI: 1.78–3.54), covered expenditures (exp(β) = 3.12, 95% CI: 2.51–3.89), uncovered expenditures (exp(β) = 2.93, 95% CI: 2.41–3.58), and OOPs (exp(β) = 2.99, 95% CI: 2.42–3.71) were all higher than matched controls. Outpatient visits (exp(β) = 0.74, 95% CI: 0.65–0.84), covered expenditures (exp(β) = 0.52, 95% CI: 0.38–0.70), uncovered expenditures (exp(β) = 0.37, 95% CI: 0.24–0.58), and OOPs (exp(β) = 0.57, 95% CI: 0.48–0.68) were all lower. These results were consistent after Bonferroni correction for multiple comparisons (α = 0.0028). Conclusions: The association between arthroplasty and healthcare utilization differed markedly by period. Inpatient burden concentrated around surgery, while outpatient utilization at this institution declined thereafter. This may be partly explained by post-surgical care being dispersed toward non-tertiary institutions. These findings are hypothesis-generating and should be examined further using multi-institutional data. If substantiated, resource planning may need to prioritize the perioperative period while strengthening community-level coverage during recovery. Full article

Purpose: The aim of this study was to evaluate the long-term results of transarterial chemoembolization (TACE) and microwave ablation (MWA) as locoregional interventional treatments for lung cancer liver metastases (LCLM) in different protocols and settings. Material and Methods: A total of 56 patients (31 males and 25 females; mean age 59.1 ± 9.8 years) with LCLM were included in our retrospective study, conducted at our department between 2009 and 2024. These patients had undergone different therapies and were divided into two groups depending on the treatment protocol. Twenty-six patients (13 women and 13 men; mean age: 56.8 ± 11.7 years) with 49 tumors were solely treated by TACE, who underwent 77 sessions. A total of thirty patients (18 males and 12 females; mean age 61.2 ± 7.3 years) with 48 tumors were in the ablation-based group (TACE + MWA or MWA-only), who underwent 94 TACE and 53 MWA treatment sessions. Results: The ablation-based group exhibited significantly longer overall survival than the TACE-only group, achieving a median Overall Survival (mOS) of 1.6 years (95% CI: 1.1–2.1) versus 0.5 years (95% CI: 0.2–0.9) for the TACE-only group (Log-Rank χ² = 12.17, p < 0.001). The survival rates at 1-, 3-, and 5-years were 70%, 23% and 8% for the ablation group, respectively, compared to 20%, 10%, and 0% for the TACE monotherapy group, in which no patient survived beyond 4.5 years. In a multivariable Cox model adjusted for histological subtype, number of lesions, and maximum lesion diameter, TACE monotherapy remained independently associated with mortality (hazard ratio [HR]: 2.711, 95% CI: 1.363–5.391, p = 0.004). With respect to neoadjuvant chemosensitivity, a per-lesion analysis revealed no statistically significant difference in tumor downsizing between Gemcitabine-based (12.6%) and Irinotecan-based (19.7%) regimens (p = 0.452). No major procedure-related complications or treatment-related deaths were identified in the available records across 224 treatment sessions. Conclusions: The ablation-based cohort exhibited significantly longer overall survival than the TACE monotherapy group, and the treatment group remained independently associated with survival after adjustment. Because treatment allocation followed hepatic tumor burden rather than randomization, this association is subject to confounding by indication and is interpreted accordingly. TACE was effective as a neoadjuvant downsizing modality with either chemotherapeutic combination, although the two were applied in different periods and were therefore not compared under equivalent conditions. These findings support the further evaluation of ablation-containing treatment strategies in appropriately selected patients and require confirmation in larger prospective studies. Full article

The choriocapillaris is the terminal capillary bed that sustains the retinal pigment epithelium (RPE) and the outer retina, and its integrity is inseparable from that of the RPE–Bruch’s membrane complex it supplies. Histopathological work established decades ago that choriocapillaris density declines with age and falls further in disease, but for most of that period, the layer could not be assessed reliably in living eyes. Optical coherence tomography angiography (OCTA), particularly with swept-source instrumentation, signal compensation and validated thresholding, has changed this: choriocapillaris flow deficits can now be quantified reproducibly and followed over time. A flow deficit is, however, a signal-level measurement that does not by itself establish anatomical capillary loss, and this distinction is maintained throughout. This review examines what that capability has revealed. We first summarize choriocapillaris anatomy, its functional coupling to the RPE through polarized vascular endothelial growth factor secretion, and the mechanisms implicated in its failure, including complement-mediated endothelial injury, Bruch’s membrane thickening, oxidative stress and venous overload. We then address the methodology in detail—slab definition, shadow compensation, binarization, averaging and the artefacts that inflate or mask flow deficits—because the comparability of published values depends almost entirely on these choices. The clinical sections review choriocapillaris involvement in age-related macular degeneration, where baseline flow impairment has been associated with subsequent drusen formation and with the rate of geographic atrophy enlargement, an association that is temporal rather than proven causal and that rests on a small number of cohorts; in the pachychoroid spectrum, where the layer is thought to be compressed rather than primarily diseased; and in diabetic retinopathy, myopia, inherited retinal dystrophies, inflammatory chorioretinopathies and systemic vascular disease. We conclude by considering structure–function relationships with outer retinal integrity and visual sensitivity, the relevance of choriocapillaris metrics as trial endpoints and stratification variables in the complement inhibitor era, and the standardization, validation and automation required before these biomarkers can be used in individual patients. Full article

Background and Objectives: Unstable angina has traditionally been considered the least severe acute coronary syndrome presentation, but ten-year prognostic data remain limited. We compared the clinical characteristics and ten-year prognosis of unstable angina versus non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction. Materials and Methods: This retrospective study included consecutive patients older than eighteen years admitted with suspected acute coronary syndrome to a Spanish tertiary hospital between January 2009 and December 2015. Ten-year survival and clinical outcomes were evaluated retrospectively through long-term tracking of electronic medical records and official regional death registries. Results: Of 3029 patients (10.6% with unstable angina, 45.0% with non-ST-segment elevation myocardial infarction, and 44.4% with ST-segment elevation myocardial infarction), those with unstable angina had a median age of 66.0 years (vs. 67.0 and 62.0 years in the other cohorts, respectively; p < 0.001) and a significantly higher prevalence of prior myocardial infarction (31.5% vs. 21.9% and 11.4%, respectively; p < 0.001). However, unstable angina presented lower-risk acute profiles (Killip class >I: 2.5% versus 17.5% and 20.7%; p < 0.001; median GRACE score: 89.9 versus 107.6 and 113.3; p < 0.001) and 0% in-hospital mortality (versus 3.3% and 5.4%; p < 0.001). At ten years, cumulative mortality reached 23.4% in unstable angina, converging with ST-segment elevation myocardial infarction (29.1%; p > 0.05) but remaining lower than non-ST-segment elevation myocardial infarction (35.3%; p < 0.05). In multivariable Cox analysis, unstable angina was not independently associated with ten-year mortality (overall p = 0.066; vs. STEMI p = 0.743; vs. NSTEMI p = 0.133). Conclusions: Despite favorable acute stabilization and the absence of in-hospital mortality, the survival advantage of unstable angina over ST-segment elevation myocardial infarction appears to attenuate over a ten-year period. This trend toward mortality convergence is likely associated with the baseline comorbidity burden, highlighting the clinical need for intensive secondary prevention. Full article

The first 1000 days of life, spanning from conception to approximately two years of age, represent a period of exceptional biological plasticity during which nutritional, metabolic, inflammatory, psychosocial, microbial, and environmental exposures may shape developmental trajectories across the life course. For this narrative review, PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to June 2026, focusing primarily on human cohorts, systematic reviews, meta-analyses, guidelines, and consensus documents, with selected experimental studies included for mechanistic evidence. Within the framework of the Developmental Origins of Health and Disease (DOHaD), we examine the epigenetic, oxidative, inflammatory, mitochondrial, and telomere-related mechanisms proposed to link early-life exposures with lifelong health and biological aging. Because most human evidence in this field is observational, whereas much of the mechanistic evidence derives from experimental models, these relationships are presented as associations and biologically plausible hypotheses rather than as demonstrated causal pathways. We then consider how these processes may become clinically apparent during childhood through four illustrative “sentinel phenotypes”—allergic and atopic disease, respiratory vulnerability, renal–cardiovascular risk, and altered metabolic growth—proposed here as a conceptual framework rather than as an established classification. We also review preventive opportunities during pregnancy, infancy, and early childhood. Overall, the first 1000 days should be viewed as a critical window for developmental health, while the specific contribution of this review is to integrate early-life biological mechanisms with clinically observable pediatric sentinel phenotypes within the broader framework of biological and healthy aging. Full article