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12 pages, 605 KB  
Systematic Review
Vertebral Fracture as a Predictor of Subsequent Extremity Fractures: A Systematic Review
by Yousif Qais Al-Khafaji, Árpád Viola, Siran Aslan, Murtadha Qais Al-Khafaji, Mohamad Abdul Al, Mustafa Qais Al-Khafaji, Faris Ayasra, Shahad Qais Al-Khafaji, András Gati, Viktor Foglar and Mohammad Walid Al-Smadi
J. Clin. Med. 2026, 15(7), 2596; https://doi.org/10.3390/jcm15072596 (registering DOI) - 28 Mar 2026
Abstract
Background: Vertebral fractures are the most common osteoporotic fractures and are frequently underdiagnosed. Although prior fragility fractures increase the risk of subsequent fractures, the magnitude and distribution of extremity fracture risk following vertebral fractures remain incompletely defined. Objective: The objective of this study [...] Read more.
Background: Vertebral fractures are the most common osteoporotic fractures and are frequently underdiagnosed. Although prior fragility fractures increase the risk of subsequent fractures, the magnitude and distribution of extremity fracture risk following vertebral fractures remain incompletely defined. Objective: The objective of this study is to evaluate the risk of subsequent extremity fractures following vertebral fractures in adults aged ≥ 50 years and to characterize fracture patterns and timing. Methods: A systematic review was conducted using three databases (PubMed, OVID, and Scopus) covering studies published between January 2005 and December 2025. Studies reporting subsequent extremity fractures after an index vertebral fracture in adults aged ≥ 50 years were included. Data extraction included patient demographics, fracture characteristics, treatment variables, and incidence of subsequent fractures. Results: Eight studies were included in the qualitative (narrative) synthesis, comprising a total of 488,770 patients with an index vertebral fracture. The reported incidence of subsequent extremity fractures ranged from 1.4% to 12.4%, with a crude aggregated incidence of 6.90% (33,605 patients). Hip fractures accounted for 73.3% of extremity fractures, followed by forearm/wrist (11.8%), humerus (10.3%), and ankle fractures (3.26%). Most subsequent extremity fractures occurred within 1–3 years after the index vertebral fracture. Additionally, 23,542 patients (4.82%) experienced subsequent vertebral fractures. Rates of dual-energy X-ray absorptiometry utilization and pharmacologic treatment ranged from 5% to 34.5%. Conclusions: Vertebral fractures in adults aged ≥ 50 years are strong predictors of subsequent extremity fractures, particularly hip fractures, with risk concentrated in the early post-fracture period. These findings support the concept of a systemic fracture cascade and emphasize the need for early detection and structured secondary prevention strategies. Full article
(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Technical Nuances and Outcomes)
12 pages, 1625 KB  
Article
Assessment of Anatomical Variations in the Sacroiliac Joint Using Magnetic Resonance Imaging: A Retrospective Study of 840 Patients
by Selen Beyazıt, Gezmiş Kimyon and Sinem Karazincir
Diagnostics 2026, 16(7), 1020; https://doi.org/10.3390/diagnostics16071020 (registering DOI) - 28 Mar 2026
Abstract
Background/Objectives: This study aimed to examine the prevalence of anatomical variations in the sacroiliac joints (SIJs) as observed through Magnetic Resonance Imaging (MRI), to characterize their manifestations, and to identify MRI features that may resemble inflammatory alterations. Methods: A retrospective review was conducted [...] Read more.
Background/Objectives: This study aimed to examine the prevalence of anatomical variations in the sacroiliac joints (SIJs) as observed through Magnetic Resonance Imaging (MRI), to characterize their manifestations, and to identify MRI features that may resemble inflammatory alterations. Methods: A retrospective review was conducted on consecutive MRI scans of the SIJ performed from January 2009 to January 2022. Eight anatomical variations, along with associated edematous and structural changes, were assessed. Results: The study encompassed 840 patients, with anatomical variations identified in 39.7% of the cohort, occurring more frequently among female participants. The most prevalent variations were accessory SIJ (36.2%) and the iliosacral complex (32.2%). Notably, isolated synostosis and persistent ossification center variations were absent. The increased frequency of variations in women, as well as their correlation with advancing age, was statistically significant (p = 0.034). Accessory SIJ and dysmorphic alterations were linked to bone marrow edema and structural modifications. In the iliosacral complex and semicircular defect variations, prominent vascular structures were observed extending along the bone surfaces. The number and depth of edema slices in sacroiliitis exceeded those observed in the variation (p < 0.001). Conclusions: Anatomical variations of the SIJ are prevalent among women and tend to increase with advancing age. Given that these variations, particularly accessory SIJ and dysmorphic alterations, may present with edematous and structural signal intensity changes that resemble sacroiliitis, it is crucial to recognize these variations. It is recommended to assess axial and coronal images concurrently and to exercise caution in the interpretation of SIJ MR images. Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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12 pages, 1035 KB  
Article
Long-Term Effects of Rheumatoid Arthritis Treatments on Bone Mineral Density: 8-Year-Follow-Up Data from Real-World Practice
by Louis-Edmond Barbaro, Lindsay Bustamente, Léa Evenor, Angelina Villain, Abdellahi Vall, Roxane Fabre, Laurent Bailly, Véronique Breuil, Christian Pradier and Christian Roux
J. Clin. Med. 2026, 15(7), 2594; https://doi.org/10.3390/jcm15072594 (registering DOI) - 28 Mar 2026
Abstract
Objectives: The long-term effects of rheumatoid arthritis (RA) therapies on bone mineral density (BMD) remain incompletely characterized. We aimed to evaluate BMD trajectories over an 8-year follow-up in patients with RA treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs [...] Read more.
Objectives: The long-term effects of rheumatoid arthritis (RA) therapies on bone mineral density (BMD) remain incompletely characterized. We aimed to evaluate BMD trajectories over an 8-year follow-up in patients with RA treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs) in real-world practice. Methods: Patients were selected from an observational RA cohort established at Nice University Hospital between 2001 and 2016. Participants were classified into two groups according to treatment regimen (csDMARD only or any bDMARD exposure). BMD was assessed by dual-energy X-ray absorptiometry at baseline and after 1, 2, 3, 5, and 8 years at the lumbar spine, femoral neck, and total hip. Longitudinal changes in BMD were analyzed using multivariable linear mixed-effects models adjusted for age, sex, body mass index (BMI), disease duration, seropositivity, glucocorticoid use, anti-osteoporosis treatment, and clinical response. Results: A total of 312 patients were included, of whom 181 received bDMARDs and 131 were treated exclusively with csDMARDs. BMD showed limited change during the first two years in both groups. Beyond two years, modest declines were observed at hip sites at subsequent time points, whereas lumbar spine BMD did not demonstrate significant longitudinal change in pointwise analyses. In mixed-effects models, the treatment group–time interaction was significant for lumbar spine (p = 0.004) and total hip (p = 0.04), but not for the femoral neck (p = 0.34), indicating differential BMD trajectories over time between treatment groups. In the csDMARD group, lumbar spine and total hip BMD decreased by a mean of 0.0006 and 0.0005 g/cm2 per month, respectively, whereas no significant slopes were observed in the bDMARD group. Older age was associated with lower BMD, while male sex and higher BMI were associated with higher BMD across sites. Conclusions: In this long-term real-world cohort, BMD remained relatively stable during the first two years of follow-up. Longitudinal analyses suggested a less pronounced decline in lumbar spine and total hip BMD trajectories among bDMARD-treated patients compared with those receiving csDMARD alone, underscoring the need for ongoing bone health monitoring in RA. Full article
(This article belongs to the Section Immunology & Rheumatology)
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12 pages, 1902 KB  
Article
Beyond Histology: Tensiomyography as an Integrated Measure of Muscle Function in Osteoporotic and Osteoarthritic Patients
by Chiara Greggi, Caterina Scaminaci, Manuela Montanaro, Pierpaolo Talarico, Antonio Matticari, Marco Albanese, Jure Jemec, Sergej Rozman, Alessandro Mauriello, Riccardo Iundusi, Elena Gasbarra and Umberto Tarantino
J. Clin. Med. 2026, 15(7), 2583; https://doi.org/10.3390/jcm15072583 - 27 Mar 2026
Abstract
Background/Objectives: Osteoporosis and osteoarthritis are age-related musculoskeletal disorders with a high socio-health burden, affecting both healthcare systems and individuals’ quality of life. Both conditions are generally accompanied by a concomitant decline in muscle mass and strength, referred to as sarcopenia. In this context, [...] Read more.
Background/Objectives: Osteoporosis and osteoarthritis are age-related musculoskeletal disorders with a high socio-health burden, affecting both healthcare systems and individuals’ quality of life. Both conditions are generally accompanied by a concomitant decline in muscle mass and strength, referred to as sarcopenia. In this context, tensiomyography emerges as a novel, non-invasive potential diagnostic strategy for assessing muscle quality, as this parameter influences the progression of both conditions. Methods: Histomorphometric and immunohistochemical analyses were performed on vastus lateralis muscle tissue obtained from patients undergoing surgery for femoral fracture affected by osteoporosis or osteopenia, patients operated for hip osteoarthritis, and patients undergoing hip arthroplasty for osteoarthritis, concomitantly affected by osteoporosis or osteopenia. In addition, muscle function was assessed in these patients using tensiomyographic analysis. Results: In osteoarthritic, osteoporotic, and osteopenic patients, a reduction in muscle quality and function was observed compared with the other two experimental groups, indicating an unfavorable effect of the coexistence of the two conditions on the muscular component. Furthermore, contraction time (Tc) measured by tensiomyography was negatively correlated with lumbar spine bone mineral density values and positively correlated with the percentage of type II muscle fibers. Conclusions: This study highlights how tensiomyography may represent a valuable non-invasive diagnostic strategy for assessing muscle status in osteoporotic and osteoarthritic patients, as it is able to detect muscle alterations that parallel the worsening of bone status and that cannot be inferred from simple biopsy analysis. Thus, tensiomyography could be considered a practical adjunct tool in the clinical assessment of musculoskeletal frailty. Full article
(This article belongs to the Section Orthopedics)
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13 pages, 1253 KB  
Article
Age-Stratified Imaging Selection in Langerhans Cell Histiocytosis: Towards a Clinical Decision Framework
by Brandon Gettleman, Sumin Jeong, Kole Joachim, Michael Fice, Adrian Lin, Casey Abernethy, Ezekiel Dingle, Amanda Perrotta, Alexandra E. Richards, Nicholas M. Bernthal and Alexander B. Christ
J. Clin. Med. 2026, 15(7), 2568; https://doi.org/10.3390/jcm15072568 - 27 Mar 2026
Abstract
Background/Introduction: Standardized staging imaging for Langerhans Cell Histiocytosis (LCH) is lacking. This study aims to identify patient and disease factors that influence imaging selection and propose a clinical decision algorithm that supports more deliberate, radiation- and cost-conscious use of imaging. Methods: [...] Read more.
Background/Introduction: Standardized staging imaging for Langerhans Cell Histiocytosis (LCH) is lacking. This study aims to identify patient and disease factors that influence imaging selection and propose a clinical decision algorithm that supports more deliberate, radiation- and cost-conscious use of imaging. Methods: A retrospective review of patients with biopsy-proven LCH, evaluated at a single institution, was conducted from 2001 to 2025. Age, sex, and presenting location at diagnosis were compared across imaging groups (Positron emission tomography/computed tomography [PET/CT], bone scintigraphy, and skeletal survey). Disease extent (unifocal, multifocal, multisystem) was summarized according to the imaging modality each patient received. Results: The cohort included 78 patients: 30 PET/CT, 11 bone scans, and 37 skeletal surveys. Median age differed significantly by modality: PET/CT 34 years (interquartile range [IQR] 8–56) vs. bone scan 13 years (3–37) vs. skeletal survey 7 years (2–14) (p < 0.001). Imaging selection varied significantly by anatomic location (p = 0.016): bone lesions were assessed with skeletal survey (52.8%), PET/CT (28.3%), and bone scan (18.9%). All pulmonary cases received PET/CT imaging. Six of the 78 patients had multisystem disease, and all six had been staged with PET/CT (Fisher’s exact p = 0.006, PET/CT vs. skeletal survey; Bonferroni-adjusted p = 0.018). Conclusions: In addition to age, the initial presentation site influences the choice of imaging modality. Given the higher radiation burden and cost of PET/CT, further research is needed to determine whether this observed practice pattern translates to improved clinical outcomes. Full article
(This article belongs to the Section Oncology)
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21 pages, 4699 KB  
Article
Leveraging Deep Learning to Construct a Programmed Cell Death-Driven Prognostic Signature in Acute Myeloid Leukemia
by Chunlong Zhang, Haisen Ni, Ziyi Zhao and Ning Zhao
Curr. Issues Mol. Biol. 2026, 48(4), 354; https://doi.org/10.3390/cimb48040354 - 27 Mar 2026
Abstract
Acute myeloid leukemia (AML) is an aggressive hematologic malignancy characterized by profound molecular heterogeneity and high relapse rates, posing significant clinical challenges. Programmed cell death (PCD), encompassing diverse regulated modalities such as apoptosis, necroptosis, and ferroptosis, plays a key role in leukemogenesis and [...] Read more.
Acute myeloid leukemia (AML) is an aggressive hematologic malignancy characterized by profound molecular heterogeneity and high relapse rates, posing significant clinical challenges. Programmed cell death (PCD), encompassing diverse regulated modalities such as apoptosis, necroptosis, and ferroptosis, plays a key role in leukemogenesis and therapeutic response; however, a comprehensive prognostic framework integrating multi-modal PCD pathways in AML remains elusive. In this study, we performed a systematic transcriptomic analysis of 1624 genes associated with 13 distinct PCD forms. A novel computational pipeline combining a variational autoencoder (VAE) for dimensionality reduction and a multilayer perceptron (MLP) for classification was employed to identify robust PCD-related biomarkers, interpreted via SHapley Additive exPlanations (SHAP) analysis. This approach identified 48 candidate genes with discriminative potential between AML and normal bone marrow. Unsupervised consensus clustering based on these genes delineated two molecular subtypes exhibiting divergent clinical outcomes and immune microenvironment profiles. The subtype demonstrated an immunosuppressive phenotype, characterized by enriched regulatory T cells, M2 macrophages, and elevated expression of inhibitory immune checkpoints, correlating with inferior survival. We developed an 8-gene prognostic signature (SORL1, PIK3R5, RIPK3, ELANE, GPX1, VNN1, CD74, and IL3RA) that effectively categorized patients into high- and low-risk groups with notable survival differences, validated across independent cohorts. A prognostic nomogram combining the risk score, age, and cytogenetic risk enhanced the prediction accuracy for overall survival. Our study presents an integrative model that connects multi-modal PCD pathways to AML prognosis, offering a new molecular subtyping system and a clinically applicable risk assessment tool for improved prognostication and personalized treatment strategies. Full article
(This article belongs to the Special Issue Linking Genomic Changes with Cancer in the NGS Era, 3rd Edition)
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12 pages, 600 KB  
Article
Bone Turnover Markers as Biomarkers of Cough Dysfunction and Respiratory Risk in Subacute Ischemic Stroke
by Ki-Hyeok Ku, Seung Don Yoo, Dong Hwan Kim, Seung Ah Lee, Sung Joon Chung, Jinkyeong Park, Sae Rom Kim and Eo Jin Park
Diagnostics 2026, 16(7), 1008; https://doi.org/10.3390/diagnostics16071008 - 27 Mar 2026
Viewed by 75
Abstract
Background/Objectives: Peak cough flow (PCF) is an objective measure of cough effectiveness after stroke, but biomarkers reflecting physiological vulnerability related to reduced PCF are not well established. We investigated whether bone turnover markers (BTMs)—C-terminal telopeptide of type I collagen (CTX) and procollagen [...] Read more.
Background/Objectives: Peak cough flow (PCF) is an objective measure of cough effectiveness after stroke, but biomarkers reflecting physiological vulnerability related to reduced PCF are not well established. We investigated whether bone turnover markers (BTMs)—C-terminal telopeptide of type I collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)—were associated with PCF in subacute ischemic stroke. Methods: In this retrospective study, 112 patients admitted within 21 days of stroke onset had fasting morning CTX and P1NP measured by electrochemiluminescence immunoassay, and PCF measured within 72 h of admission. Associations were assessed using Spearman correlation and multivariable linear regression with BTMs standardized (per 1 standard deviation increase), adjusting for age, sex, body mass index, onset-to-admission days, National Institutes of Health Stroke Scale score, Korean version of the Modified Barthel Index, estimated glomerular filtration rate, smoking status, and brainstem lesion. Results: CTX showed an inverse correlation with PCF (rho = −0.469; p < 0.001) and remained independently associated with lower PCF after multivariable adjustment (β = −42.32 L/min; 95% confidence interval, −56.12 to −28.52; p < 0.001), whereas P1NP showed weaker associations. In secondary outcome analyses, higher CTX was associated with low PCF (PCF < 160 L/min), aspiration pneumonia, and longer length of stay. Conclusions: Higher CTX levels were independently associated with lower peak cough flow and selected respiratory-related outcomes in this retrospective cohort. These findings are hypothesis-generating, do not imply prognostic validation, and warrant confirmation in prospective multicenter studies assessing incremental predictive value. Full article
(This article belongs to the Special Issue Clinical Diagnostics and Management of Stroke)
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8 pages, 739 KB  
Case Report
Severe Short Stature and rhGH Resistance in a Child Born SGA: The Role of a Novel IGF1R Mutation, Case Report and Narrative Review
by Giovanni Luppino, Eleonora Ini’, Letteria Anna Morabito, Tiziana Abbate, Cecilia Lugarà, Tommaso Aversa, Malgorzata Wasniewska and Domenico Corica
Children 2026, 13(4), 458; https://doi.org/10.3390/children13040458 - 27 Mar 2026
Viewed by 62
Abstract
Background: Genetic causes of growth failure should be suspected in patients born small for gestational age (SGA) who fail to show postnatal catch-up growth, present with severe short stature (SS), and exhibit a poor or absent response to growth hormone (rhGH) therapy. [...] Read more.
Background: Genetic causes of growth failure should be suspected in patients born small for gestational age (SGA) who fail to show postnatal catch-up growth, present with severe short stature (SS), and exhibit a poor or absent response to growth hormone (rhGH) therapy. Mutations in the insulin-like growth factor 1 receptor (IGF1R) gene are associated with impaired growth, intrauterine growth restriction (IUGR), low birth weight and/or length, and postnatal SS. Case Description: A 9-year-old boy, born SGA for birth length, was evaluated for severe SS. Common causes of SS were excluded. At 9 years and 7 months of age, his height was 112.6 cm (−3.99 SDS), weight 18 kg (−3.79 SDS), and BMI 14.2 kg/m2 (−1.8 SDS); pubertal development was Tanner stage 1. The target height was 158 cm (−2.62 SDS). Bone age was delayed by approximately one year compared with chronological age. Serum IGF-1 levels were within the upper-normal range for age. GH therapy (0.035 mg/kg/day) was initiated due to the lack of catch-up growth in an SGA subject. After three years of treatment, the height gain was only 0.5 SDS. IGF-1 levels showed a transient treatment-related increase, followed by persistent normalization during ongoing therapy. Next-generation sequencing (NGS) analysis identified novel heterozygous paternal nonsense variant in the IGF1R gene: c.3498C>G (p.Tyr1166Ter). At 12 years of age, impaired fasting glucose and reduced glucose tolerance were detected; consequently, it was decided to discontinue rhGH therapy, also in light of the IGF1R mutation and the lack of height recovery. Conclusions: This case underlines the critical role of genetic testing in the evaluation of patients born SGA. The coexistence of SGA status and an IGF1R gene mutation may provide a clear explanation for both the poor response to rhGH therapy and the increased risk of alterations in glucose metabolism. An extensive narrative review of the literature on growth outcomes and glucose metabolism abnormalities during GH treatment in SGA patients carrying IGF1R variants was also performed. Full article
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14 pages, 1004 KB  
Article
Optimization of Region-of-Interest Configuration for Fractal Analysis of Peri-Implant Bone on Panoramic Radiographs
by Devrim Deniz Üner, Bozan Serhat İzol, Remzi Boynukara and Nezif Çelik
Fractal Fract. 2026, 10(4), 215; https://doi.org/10.3390/fractalfract10040215 - 26 Mar 2026
Viewed by 169
Abstract
Objective: The aim of this study was to determine the optimal region-of-interest (ROI) pixel size for fractal dimension analysis on panoramic radiographs that best reflects implant stability assessed by resonance frequency analysis (ISQ) and to investigate whether implant stability can be directly [...] Read more.
Objective: The aim of this study was to determine the optimal region-of-interest (ROI) pixel size for fractal dimension analysis on panoramic radiographs that best reflects implant stability assessed by resonance frequency analysis (ISQ) and to investigate whether implant stability can be directly estimated from radiographic images. Materials and Methods: This retrospective cross-sectional study included 65 patients for whom panoramic radiographs and resonance frequency analysis measurements were available. All panoramic images were converted to TIFF format and standardized to a resolution of 2627 × 1646 pixels. All radiographic images were obtained using the same panoramic imaging device and standardized acquisition protocol. Exposure parameters were adjusted within the manufacturer’s recommended range to ensure optimal image quality while maintaining methodological consistency across patients. During ROI selection, care was taken to avoid cortical bone margins, overlapping anatomical structures, and radiographic artifacts in order to ensure that the analyzed regions represented trabecular bone adjacent to the implant surface. Fractal dimension analysis was performed in the cervical peri-implant bone region, starting from the first bone–implant contact and extending apically, using three different ROI configurations. The ROI size was defined as 30 pixels apically and 10 pixels horizontally for FMD1, 30 × 20 pixels for FMD2, and 30 × 30 pixels for FMD3. Implant stability was assessed using ISQ values. Data distribution was evaluated using the Shapiro–Wilk test. Associations between ISQ and fractal dimension measurements were analyzed using Pearson and Spearman correlation analyses. Multiple linear regression models adjusted for age and sex were constructed to assess independent associations. Results: The mean age of the participants was 50.0 ± 9.9 years, and the mean ISQ value was 78.6 ± 5.9. The mean fractal dimension values were 1.466 ± 0.055 for FMD1, 1.595 ± 0.031 for FMD2, and 1.655 ± 0.046 for FMD3. No significant association was found between ISQ and FMD1 or FMD3. A weak positive correlation was observed between ISQ and FMD2; however, this association did not remain statistically significant after correction for multiple comparisons. In multiple linear regression analysis, ISQ was identified as an independent predictor of FMD2, but not of FMD1 or FMD3. Age and sex had no significant effect on fractal dimension measurements. Conclusions: Fractal dimension measurements derived from panoramic radiographs showed a weak association with implant stability that was dependent on the selected ROI pixel size. Among the evaluated configurations, the 30 × 20-pixel ROI at the cervical peri-implant region demonstrated the strongest association with ISQ values, suggesting that this ROI configuration showed the most consistent association with ISQ values among the tested ROI sizes. Full article
(This article belongs to the Special Issue Fractal Analysis in Biology and Medicine)
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16 pages, 1719 KB  
Article
Calcium Intake and Food Sources Among Children, Adolescents and Women in Madagascar: Results from a Nationally Representative Survey
by Lantonirina Ravaoarisoa, Valeria Galetti, Ravakamaharitra Rakotovao, James Peter Wirth, Carla El-Mallah, Fabian Rohner, Mathieu Joyeux, Niry Randrenarizo, Zeinab Annan, Malaza Armel Alex Razanatsila, John Syllie Noela Randriarivony, Zo Nantenaina Raveloson and Rita Wegmüller
Nutrients 2026, 18(7), 1041; https://doi.org/10.3390/nu18071041 - 25 Mar 2026
Viewed by 216
Abstract
Background: Many countries in sub-Saharan Africa are at risk of inadequate calcium intake, yet no data exist for vulnerable population groups in Madagascar. We aimed to assess daily calcium intake, the major contributing food sources, and the prevalence of inadequate intake in [...] Read more.
Background: Many countries in sub-Saharan Africa are at risk of inadequate calcium intake, yet no data exist for vulnerable population groups in Madagascar. We aimed to assess daily calcium intake, the major contributing food sources, and the prevalence of inadequate intake in young children, adolescents, and women of reproductive age. Methods: The 2024 National Micronutrient Survey used a two-stage probabilistic design across all 23 regions. The daily calcium intake was estimated using a food frequency questionnaire that focused on calcium-rich foods that are commonly consumed in Madagascar and the calcium concentration measured in drinking water. Results: Calcium intake was low across all population groups, averaging 200–300 mg/d in adolescents and women and below 180 mg/d in young children. The prevalence of inadequate intake exceeded 96% in every population group. While calcium intake increased with increasing household wealth in children, the opposite pattern was observed for adolescents and women, whose intake decreased with increasing wealth. The main contributors to calcium intake were cassava leaves, cassava roots, small fresh and dried fish eaten with bones, drinking water across all population groups, and breastmilk in young children. Conclusions: The calcium intake is low throughout Madagascar and across all demographic groups. Strategies to improve intake are urgently needed and should include promoting continued breastfeeding and the consumption of calcium-rich, locally available, affordable foods such as small fish eaten with bones and leafy green vegetables, alongside a consideration of wheat flour fortified with calcium. Full article
(This article belongs to the Section Nutrition and Public Health)
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17 pages, 5698 KB  
Article
Transtemporal Endoscopic Subcutaneous Face-and-Neck Lift with SMAS Plication
by Alexey E. Avdeev, Valentin I. Sharobaro, Anastasiya S. Borisenko and Anna S. Bairamova
Cosmetics 2026, 13(2), 81; https://doi.org/10.3390/cosmetics13020081 - 24 Mar 2026
Viewed by 139
Abstract
Introduction: Facial aging is characterized by progressive soft-tissue descent, affecting all anatomical layers—from bone structures to the skin envelope. Early manifestations include downward displacement of the midface soft tissues, deepening of the nasolacrimal and nasolabial folds, and the appearance of soft-tissue “puckering” in [...] Read more.
Introduction: Facial aging is characterized by progressive soft-tissue descent, affecting all anatomical layers—from bone structures to the skin envelope. Early manifestations include downward displacement of the midface soft tissues, deepening of the nasolacrimal and nasolabial folds, and the appearance of soft-tissue “puckering” in the lower third of the face. At this stage, patients typically seek aesthetic correction to restore youthful facial contours with minimal or no visible signs of surgical intervention. Methods: This study is an observational analysis of a prospectively maintained surgical database including 201 female patients who underwent TESL between 2006 and 2024. Patient demographic data, surgical technique specifics, and postoperative outcomes were collected. A total of 612 procedures were performed. The cohort was stratified into two age groups: 30–35 years (n = 72) and 36–45 years (n = 129). Results: No cases of facial nerve injury or neurological complications were observed. Complications included 13 cases of localized cicatricial alopecia (6.47%) and four postoperative hematomas (1.99%). Eleven patients (5.47%) required minor secondary revision to address preauricular skin pleating. The technique demonstrated consistent and favorable outcomes in restoring soft-tissue volume and positioning, eliminating early lower-face “puckering,” and improving the cervicomental and mandibular contours. Conclusions: For patients under 45 years of age presenting with early signs of facial soft-tissue ptosis, endoscopic subcutaneous midface elevation with vertical SMAS plication is a safe, effective, and minimally invasive approach to rejuvenating the mid and lower face. Full article
(This article belongs to the Section Cosmetic Technology)
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15 pages, 966 KB  
Article
Omitting Elective Pelvic Nodes Irradiation in High Risk Prostate Cancer: Report on 43 Consecutive Elderly Patients
by Emanuele Chioccola, Mara Caroprese, Christina Amanda Goodyear, Angela Barillaro, Gianluca Valerio, Caterina Oliviero, Mauro Buono, Stefania Clemente, Antonio Farella, Manuel Conson and Roberto Pacelli
J. Pers. Med. 2026, 16(4), 177; https://doi.org/10.3390/jpm16040177 - 24 Mar 2026
Viewed by 40
Abstract
Background: Radiotherapy (RT) combined with androgen deprivation therapy (ADT) is a standard treatment for non-metastatic high-risk (HR) prostate cancer (PC). However, the benefit of elective nodal irradiation (ENI) in clinically node-negative (cN0) patients, although suggested, remains controversial, particularly in the elderly. We [...] Read more.
Background: Radiotherapy (RT) combined with androgen deprivation therapy (ADT) is a standard treatment for non-metastatic high-risk (HR) prostate cancer (PC). However, the benefit of elective nodal irradiation (ENI) in clinically node-negative (cN0) patients, although suggested, remains controversial, particularly in the elderly. We report the outcomes of elderly HR PC patients treated with prostate-only RT (PORT) and ADT in a “real-word” setting. Methods: Between 2016 and 2022, 43 consecutive elderly patients (median age 76 years) with HR- or very HR-PC according to NCCN criteria version 1.2026 (cN0, cT3-cT4 and/or ISUP Grade Group 4–5 and/or PSA serum levels at diagnosis ≥ 20 ng/mL) were treated at our institution. All patients were staged with abdominal MRI or CT and bone scan; nineteen patients (44.2%) also underwent 68Ga-PSMA-11 or 18F-fluorocholine PET/CT. All patients received PORT (predominantly moderate hypofractionation, 67.5–70 Gy in 25–28 fractions) and ADT (median duration 24 months). To ensure consistency, all oncological endpoints—Biochemical Failure-Free Survival (BFFS; Phoenix criteria), Disease-Free Survival (DFS), Metastasis-Free Survival (MFS), Prostate Cancer-Specific Survival (PCSS), and Overall Survival (OS)—were calculated from a unified time-zero (initiation of first oncological treatment). DFS was defined as a composite endpoint including biochemical failure, radiological recurrence, or initiation of salvage therapy. Results: at a median follow-up of 60 months, no patient reached the Phoenix threshold, resulting in a 100% 5- and 7-year BFFS. However, 4 patients (9.3%) experienced radiological recurrence detected via PET/CT before reaching the nadir + 2 threshold, yielding an estimated 5-year and 7-year DFS of 94.7% and 71.8%, respectively. The 5- and 7-year MFS was of 97.6% and 88.7%, respectively. Seven deaths occurred, all non-PC related, resulting in a 5-year OS of 86.7% and a Prostate Cancer-Specific Survival of 100%. Gastrointestinal toxicity was notably low (no acute or late G3-G4 events). Conclusions: Our findings suggest that PORT, when combined with long-term ADT and modern staging, provides excellent disease control and a favorable safety profile in elderly HR PC patients. Given the high rate of competing mortality in this population, treatment de-escalation via PORT appears to be a clinically reasonable strategy. These results are hypothesis-generating and warrant validation in prospective randomized trials. Full article
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16 pages, 764 KB  
Article
Integrating Tumor Biology and Host Factors in mCRPC: The Prognostic Value of ‘Time to Castration Resistance’, Systemic Inflammation, and Comorbidity Burden in Patients Treated with Enzalutamide
by Seda Sali, Arife Ulaş, Sibel Oyucu Orhan, Sevgi Topçu, Muharrem Koçar, Mürsel Sali, Birol Ocak, Adem Deligönül, Türkkan Evrensel and Erdem Çubukçu
Diagnostics 2026, 16(6), 950; https://doi.org/10.3390/diagnostics16060950 - 23 Mar 2026
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Abstract
Background: Outcomes with enzalutamide in metastatic castration-resistant prostate cancer (mCRPC) are influenced by tumor burden, disease kinetics, and host factors. We evaluated the relative prognostic impact of metastatic pattern, laboratory markers, and prostate-specific antigen (PSA) dynamics in a real-world cohort. Methods: We retrospectively [...] Read more.
Background: Outcomes with enzalutamide in metastatic castration-resistant prostate cancer (mCRPC) are influenced by tumor burden, disease kinetics, and host factors. We evaluated the relative prognostic impact of metastatic pattern, laboratory markers, and prostate-specific antigen (PSA) dynamics in a real-world cohort. Methods: We retrospectively analyzed 72 patients with mCRPC treated with enzalutamide. Progression-Free Survival (PFS) and Overall Survival (OS) were estimated using the Kaplan–Meier method. Multivariate Cox proportional hazards models were utilized to identify independent predictors of survival, incorporating clinical variables (visceral metastases, bone tumor burden), kinetic parameters (Time to Castration Resistance [TTCR], Time to PSA Nadir [TTN]), and host factors (Charlson Comorbidity Index [CCI], Eastern Cooperative Oncology Group Performance Status (ECOG PS), Systemic Immune-Inflammation Index [SII], HALP score). Results: Visceral metastasis was a dominant predictor of poor outcomes, increasing the risk of death by 4.0-fold (HR: 4.05; 95% CI: 1.84–8.89; p < 0.001). A high skeletal tumor burden (≥5 bone lesions) was identified as a critical threshold, associated with a 5.5-fold increase in mortality risk (HR: 5.53; p < 0.001). Delays in initiating enzalutamide significantly compromised survival, with each 1-month delay increasing the risk of death by 7.3% (HR: 1.07; p = 0.003). While early PSA decline (≥50% at 3 months) did not independently predict OS, a prolonged TTN (>12 months) was associated with superior survival. Notably, host-related factors, including age, CCI, and ECOG PS, were not found to be significantly associated with survival outcomes in this specific dataset. Conclusions: Our preliminary findings suggest that survival in real-world mCRPC patients treated with enzalutamide may be influenced predominantly by intrinsic tumor biology—specifically anatomical extent and resistance kinetics—rather than host frailty or comorbidity burden. However, given the retrospective and single-center nature of this study, these findings should be considered hypothesis-generating and require validation in larger, multi-center cohorts. Host-related variables (including age and CCI) were evaluated but were not retained as independent predictors in the final multivariable model. Early initiation of therapy and monitoring of kinetic markers like TTN and TTCR offer superior prognostic stratification compared to static baseline characteristics. Full article
(This article belongs to the Special Issue Prostate Cancer: Innovations in Diagnosis and Risk Stratification)
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14 pages, 937 KB  
Article
Identification of High-Risk Individuals for Osteoporosis and Fragility Fractures in Cushing’s Syndrome: A Promising Predictive Approach
by Enes Ucgul, Burak Menekse, Ogulcan Boz, Huseyin Demirci, Bekir Ucan, Erman Cakal, Takako Araki and Muhammed Kizilgul
J. Clin. Med. 2026, 15(6), 2442; https://doi.org/10.3390/jcm15062442 - 23 Mar 2026
Viewed by 152
Abstract
Background: Cushing’s syndrome (CS) causes excessive cortisol exposure, leading to significant skeletal complications. However, there is no validated, CS-specific model to predict osteoporosis and fracture risk. This study aimed to identify independent predictors and develop a practical clinical scoring system. Methods: [...] Read more.
Background: Cushing’s syndrome (CS) causes excessive cortisol exposure, leading to significant skeletal complications. However, there is no validated, CS-specific model to predict osteoporosis and fracture risk. This study aimed to identify independent predictors and develop a practical clinical scoring system. Methods: A retrospective study was conducted on 139 patients with CS diagnosed between 2014 and 2025. Demographic, clinical, and biochemical data were analyzed. Osteoporosis was defined using dual-energy X-Ray absorptiometry criteria. Logistic regression analyses identified independent predictors, and the Cushing-Related Osteoporosis Risk Estimation (CORE) Score was constructed from normalized beta coefficients of significant variables. Results: Osteoporosis was present in 35.9% and fragility fractures in 13.4% of patients. Independent predictors included age ≥ 51 years, symptom duration ≥ 13.5 months, diabetes mellitus, late-night salivary cortisol ≥ 0.42 μg/dL, and midnight serum cortisol ≥ 10.25 μg/dL (all p < 0.05). The CORE Score (0–6 points) showed strong diagnostic performance for osteoporosis (AUC 0.827; sensitivity 88%, specificity 72%) and fractures (AUC 0.866; sensitivity 84%, specificity 78%). Each one-point increase in the CORE Score elevates the risk of osteoporotic fracture by 3.13 times (p < 0.001). Conclusions: The CORE Score represents a promising disease-specific tool for early identification of CS patients at increased risk of osteoporosis and fragility fractures, enabling more personalized management and follow-up strategies, such as prioritizing bone-protective interventions and closer skeletal monitoring. Early identification of high-risk individuals may also facilitate timely therapeutic interventions, potentially reducing future fracture risk. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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23 pages, 5759 KB  
Article
Performance Assessment of Acrylate Metal Complex (AMC) and Conventional Consolidants for Fragile Bone Artefacts
by Di Chen, Liangshuai Zhang, Yuanzhe Mao, Wanling Song and Jiachang Chen
Coatings 2026, 16(3), 387; https://doi.org/10.3390/coatings16030387 - 21 Mar 2026
Viewed by 199
Abstract
Archaeological bone artifacts frequently exhibit diminished mechanical integrity as a result of organic matrix degradation. Under adverse environmental conditions, such artifacts are particularly susceptible to surface cracking and disintegration into powder. It is urgently necessary to develop protective materials that possess high permeability, [...] Read more.
Archaeological bone artifacts frequently exhibit diminished mechanical integrity as a result of organic matrix degradation. Under adverse environmental conditions, such artifacts are particularly susceptible to surface cracking and disintegration into powder. It is urgently necessary to develop protective materials that possess high permeability, strong reinforcing power and good compatibility. This study evaluated the protective performance of a novel Acrylate Metal Complex (AMC) and two conventional commercial consolidants (acrylic resin Paraloid B72 and ethyl silicate-based material Remmers 300) on fragile bone artifacts. Using simulated samples resembling bone artefacts, a systematic evaluation was conducted to assess the penetration, mechanical reinforcement efficacy, microstructural modifications, chromatic impact, and aging resistance of three consolidants. The results indicate that AMC demonstrates optimal permeation capability and can significantly enhance the surface hardness of bone specimens, achieving an increase of 7.7%. The colorimetric changes observed in all three reinforced materials following treatment remained within acceptable limits (ΔE* < 1.5). Accelerated aging tests—including 300 h of UV irradiation and 30 cycles of alternating dry-wet conditions—demonstrated that bone-mimetic composites reinforced with AMC exhibited significantly superior aging resistance relative to those treated with B72 and Remmers 300. In the actual application verification of the archaeological bone relics, the surface hardness of the reinforced AMC increased by 10%, the wave velocity increased by 14.8%, and there was no glare or crust on the surface. Comprehensive comparison shows that AMC outperforms traditional commercial materials in key performance indicators, demonstrating great potential as a next-generation bone relic conservation material. Full article
(This article belongs to the Section Environmental Aspects in Colloid and Interface Science)
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