Search Results (998)

Background: Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal. Methods: This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed. Results: The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted p = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; p = 0.010). Conclusions: Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions. Full article

Background: Global antibiotic consumption continues to rise across pediatric and adult populations, while the genotoxic consequences of host eukaryotic exposure remain less systematically characterized than the parallel problem of antimicrobial resistance. Several lines of evidence, from molecular cytogenetics, redox biology, and systems toxicology, now permit a more mechanistically resolved synthesis of antibiotic-induced genome stress than was previously possible, although a substantial fraction of this evidence is preclinical and warrants cautious clinical extrapolation. Scope: This narrative review evaluates the molecular mechanisms, cytogenetic biomarkers, and translational implications of antibiotic-induced genotoxicity, with a primary focus on six clinically prominent classes (fluoroquinolones, nitroimidazoles, aminoglycosides, macrolides, β-lactams, and tetracyclines) and a brief extension to glycopeptides and glycylcyclines. We organize the evidence around three convergent mechanistic axes rather than around individual drugs. Key findings: Accumulating evidence supports three intersecting off-target axes: (i) eukaryotic topoisomerase II interference, principally documented for fluoroquinolones; (ii) mitochondrial dysfunction, reflecting the evolutionary kinship between the mitoribosome and bacterial ribosomes; and (iii) inflammation-coupled redox stress, often amplified by microbiome perturbation. These pathways converge on a common spectrum of DNA lesions—including double-strand breaks, oxidatively modified bases, replication-fork stalling, and chromosomal mis-segregation) detected by complementary assays (CBMN-Cyt, comet, γH2AX, and oxidative and mitochondrial biomarkers). Pediatric, pregnant, geriatric, and oncology populations may represent biologically distinct susceptibility strata, although direct human evidence for several of these inferences remains limited. Limitations: Causal inference is constrained by infection as a confounder, frequent use of supratherapeutic in vitro concentrations, reliance on immortalized cell lines that may not recapitulate primary-cell repair capacity, inter-laboratory variability across cytogenetic assays, and a marked scarcity of pediatric and pregnancy biomonitoring data. Most existing positive signals derive from preclinical models; clinically validated long-term outcomes, particularly carcinogenic endpoints, remain inconsistently demonstrated for most antibiotic classes outside metronidazole. Conclusions: Antibiotic-induced genotoxicity appears to be a measurable and mechanistically tractable dimension of drug safety, though its clinical magnitude in real-world exposure scenarios requires further investigation. Integrating multi-omics, microphysiological systems, single-cell genotoxicology, and AI-assisted prediction may improve risk resolution, particularly in vulnerable populations. We argue that antimicrobial stewardship discussions should consider host genome integrity alongside resistance, while remaining mindful that the mechanistic case currently outpaces clinical-endpoint validation. Full article

Background/Objectives: Elderly patients with acute upper gastrointestinal bleeding (UGIB) are a high-risk group with significant morbidity and mortality. Various risk scoring systems have been devised to predict clinical outcome in UGIB, but their effectiveness in geriatric patients is unclear. The purpose of the present study was to evaluate the predictive performance of established UGIB risk scores in older adults and to compare the predictive performance of the C-reactive protein–albumin–lymphocyte (CALLY) index with conventional UGIB risk scores. Methods: This study was a retrospective single-center analysis of a cohort of patients aged ≥65 years presenting with acute non-variceal upper gastrointestinal bleeding (UGIB) who had esophagogastroduodenoscopy from January to December 2025. Scores for Glasgow-Blatchford Score (GBS), Rockall, AIMS65, ABC, MAP(ASH), CANUKA, T-score, and CALLY index were calculated. The primary management endpoint was the requirement for endoscopic hemostatic treatment. Secondary outcomes were blood transfusion necessity, rebleeding, intensive care unit (ICU) admission, length of hospital stay, and 30-day death. The predictive performance of each scoring system was assessed by receiver operating characteristic (ROC) curve analysis. Results: We enrolled 113 patients (mean age 77.7 ± 8.3 years; 59.3% male), of whom 42 (37.2%) required endoscopic hemostatic treatment. No single risk score consistently outperformed the others across all clinical outcomes. GBS showed the highest observed AUC for predicting the need for transfusion (AUC = 0.892), whereas Rockall showed the highest observed AUC for rebleeding (AUC = 0.739) and ICU admission (AUC = 0.668). In the exploratory mortality analysis based on seven deaths, the directionally corrected AUC was 0.846 for CALLY, 0.756 for MAP(ASH), and 0.742 for CANUKA; no pairwise AUC comparisons were performed for this outcome. The CALLY index showed modest discrimination for endoscopic hemostatic therapy (AUC = 0.664). In the exploratory rebleeding analysis, CALLY yielded an AUC of 0.724; however, this estimate was based on only eight events. Lower CALLY levels were associated with increased 30-day mortality, whereas the CALLY index was not significantly associated with transfusion requirements or length of hospital stay. After correction for multiple comparisons, CALLY showed significantly lower discriminatory performance for transfusion requirement than GBS, T-score, CANUKA, and MAP(ASH), whereas no significant differences were observed for endoscopic intervention or ICU admission. Conclusions: No single risk score was able to predict all clinically important outcomes in older adults with acute UGIB. Conventional scoring systems remained useful for several established clinical outcomes, whereas the CALLY index showed modest discrimination for endoscopic hemostatic therapy. Its findings for rebleeding and 30-day mortality were exploratory because of the limited number of events and require external validation. More prospective multicenter studies are needed to confirm the clinical value of the CALLY index in older individuals with UGIB. Full article

Pyonephrosis is a rare, life-threatening suppurative disease of the kidney characterised by the accumulation of purulent exudate within the renal pelvis and the destruction of renal parenchyma. It is typically associated with azotaemia and urinary tract obstruction. Extreme leucocytosis (>100 × 10³/µL), known as a leukemoid reaction, has been rarely reported in feline pyonephrosis. A 13-year-old neutered domestic shorthair female cat was brought to a veterinary clinic with symptoms of lethargy and apathy, as well as a significantly enlarged abdominal cavity. Physical examination revealed dehydration and a large, non-painful mass occupying the left abdominal cavity. Haematology revealed severe leucocytosis of 123.22 × 10³/µL and anaemia with haematocrit (HCT) 18.6% and serum biochemistry showed elevated SDMA 17 µg/dL, AST 97 U/L, with hypokalaemia, hypochloraemia and hypoproteinaemia. Creatinine (1.5 mg/dL) and blood urea nitrogen (BUN) (23 mg/dL) remained within reference values. Abdominal X-ray and ultrasound revealed a large mass of anechoic structure encompassing the entire left side of the abdominal cavity, consistent with pyonephrosis. Microbiological studies of purulent material obtained by ultrasound-guided fine-needle aspiration and culturing revealed the presence of Escherichia coli. The day after admission, the patient underwent surgical laparotomy with unilateral nephrectomy. Histopathology confirmed severe inflammatory infiltration of the mucosa, connective tissue proliferation and fibrosis, with partial glomerular hyalinisation and without cellular atypia. Six days after surgical intervention, the leukocyte count decreased to 44.81 × 10³/µL. The patient was alive and clinically healthy 3 months after surgery. This case illustrates that massive unilateral pyonephrosis can occur in geriatric cats without azotaemia due to the compensatory function of the contralateral kidney. Marked leucocytosis of 123.22 × 10³/µL probably represents a leukemoid reaction secondary to severe suppurative inflammation. Moreover, pyonephrosis should be considered in the differential diagnosis of large abdominal masses in cats, even in the presence of a normal creatinine level. Full article

Objectives: The objectives of this study were to assess the association between oral health-related quality of life (OHRQoL) and depressive symptoms among older adults in Canton Zurich, Switzerland, and to explore domain-specific variations. Methods: This pilot cross-sectional study included aging adults aged ≥65 years recruited from a university-based geriatric dental clinic in Zurich between 1 January and 31 March 2025. Participants completed paper-based questionnaires to assess their systemic and oral health, their quality of life (OHIP-14), and depressive symptoms (PHQ-8). Associations were assessed using Spearman’s rank correlation (ρ) with 95% confidence intervals estimated via bootstrap resampling. Domain-level analyses were conducted to explore the structure of the association, and a multivariable linear regression was used to assess whether the association persisted after adjustment. Results: A total of 108 participants were included (mean age of 76.2 ± 7.2 years; 53.4% male). Overall levels of OHRQoL and depressive symptoms were low. Higher OHIP-14 scores were moderately associated with higher PHQ-8 scores (ρ = 0.50; p-value < 0.01; 95% CI: 0.34–0.65). This association was consistent across PHQ-8 severity categories and remained significant after adjustment (β = 0.14; 95% CI: 0.06–0.22; p < 0.001). Domain-level analyses indicated stronger association in psychosocial and pain-related domains than for functional limitation. Conclusions: The study demonstrates that poorer OHRQoL was moderately associated with higher depressive symptoms, independently of the covariates examined, particularly in psychosocial domains. These findings suggest that OHRQoL reflects broader experiential and psychological dimensions of health beyond oral function alone, highlighting its relevance for oral health assessment in older adults. As the findings are based on a convenience sample of clinic attendees, larger population-based longitudinal studies are needed to clarify these relationships further. Full article

Skin is the outermost layer which covers all organs of the body. Skin can be divided into three layers, including epidermis, dermis and hypodermis. Similarly to many organs of the body, skin also experiences biological process that could not resist aging. There are the following two types of human skin aging: endogenous and exogenous. Endogenous aging involves a series of physiological changes that gradually occur over time and are influenced by genes and hormones. In contrast, extrinsic aging (or exogenous aging), also known as photoaging, involves significant structural and functional changes due to external factors, mainly due to lack of sun protection, smoking, air pollution, lifestyle, etc. Skin aging not only affects the appearance but also makes the skin more sensitive to geriatric skin diseases. In order to treat geriatric skin disease effectively and appropriately, it is crucial to study skin aging from a clinical and histological perspective. Full article

Background: Acute confusional state, or delirium, is a common neuropsychiatric disorder in older adults, particularly in emergency departments. It is associated with high morbidity and mortality, as well as difficult detection. Its early identification is crucial to prevent complications and improve prognosis. This study aims to identify and analyze available strategies for the early diagnosis of delirium in geriatric patients in emergency departments. Methods: A literature review and meta-analysis were conducted between 2020 and 2026 using the PubMed, Scopus, Web of Science, CINAHL, and Cochrane databases (PRISMA 2020). To estimate the prevalence of patients with delirium in emergency departments, a meta-analysis was performed using Stats Direct statistical software (Version 4). Methodological quality was evaluated according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Results: Eleven studies were included, demonstrating that delirium in emergency departments is highly prevalent among older adults, particularly those with dementia, polypharmacy, or functional impairment. The 4AT scale was the most frequently used screening tool, notable for its strong sensitivity. Hypoactive delirium emerged as the most common subtype and carried the poorest prognosis. Furthermore, its presence was associated with longer hospital stays, increased complications, and higher mortality rates, while a lack of training among healthcare staff continues to limit early detection. The meta-analysis detected no publication bias and revealed a 20.6% prevalence of delirium among patients in emergency departments. Conclusions: One in five patients attending the emergency department presents with delirium. Delirium in geriatric emergency care demands a structured clinical response grounded in prevention, early detection, and professional training. Integrating validated diagnostic tools and reinforcing the role of nursing professionals are key to improving patient outcomes and safety. Full article

Background: Sarcopenia, the age-related loss of muscle mass and strength, affects over 20% of older adults in Taiwan and contributes to frailty and functional decline. Nutritional supplementation offers a promising strategy for those unable to engage in structured exercise, yet multi-ingredient MCT–leucine–creatine-based interventions remain understudied in clinically defined sarcopenic populations. Methods: We conducted an 8-week randomized, double-blind, placebo-controlled trial at National Taiwan University Hospital (ClinicalTrials.gov NCT06376266). Seventy-three older adults (mean age 77.3 ± 7.7 years) meeting AWGS 2019 sarcopenia criteria were randomized to TLN-01 (a multi-ingredient supplement containing whey protein, branched-chain amino acids, medium-chain triglycerides, creatine, resveratrol, and vitamin D₃, n = 34) or isocaloric placebo (n = 39). Primary outcomes were changes in appendicular skeletal muscle mass (ASM) assessed by DXA and handgrip strength. Targeted plasma amino acid metabolomics (LC-MS) was performed as an exploratory endpoint. Results: ASM increased significantly in the TLN-01 group (+0.42 kg, +3.2%; p < 0.001) but remained unchanged in controls (p = 0.785), with a significant between-group difference (ANCOVA p < 0.01); this absolute change was below the commonly cited minimal clinically important difference. Handgrip strength did not differ significantly between groups (p = 0.32); within-group analysis showed a significant decline in the placebo group (−7.0%; p < 0.001) that was not observed in the intervention group (p = 0.537). Metabolomic analysis revealed reductions in plasma taurine and 1-methylhistidine and an increase in kynurenine; given the absence of clear separation on PCA/PLS-DA, these findings are considered exploratory and hypothesis-generating rather than confirmatory evidence of altered amino acid utilization or proteolysis. No clinically significant adverse metabolic or renal events occurred. Conclusions: Eight weeks of this multi-ingredient MCT–leucine–creatine-based supplement induced a modest increase in muscle mass and attenuated the decline in handgrip strength observed in the placebo group among sarcopenic older adults without a structured exercise program, supporting further investigation as a safe and practical nutritional adjunct in geriatric care. Full article

Background: Chronic obstructive pulmonary disease (COPD) disproportionately affects older adults. While targeted biologic therapies have shown efficacy in type 2 eosinophilic endotypes, elderly patients remain underrepresented in pivotal clinical trials. This narrative review examines the pathophysiological rationale, efficacy data, and unique geriatric challenges of biologic therapies in older adults. Methods: A literature search was conducted in PubMed and Scopus for phase II and III randomized controlled trials (RCTs) and observational studies evaluating biologic agents (anti-IL-5, anti-IL-4/IL-13, and anti-alarmins) in COPD, focusing on populations aged ≥ 65 years, comorbidities, and frailty. Discussion: Phase III data for dupilumab and mepolizumab indicate significant reductions in annualized exacerbations in patients with blood eosinophils ≥ 300 cells/μL. However, the mean age in the landmark trials (65 years) is a decade lower than the real-world average. Age-related immune remodeling—specifically immunosenescence and inflammaging—coexists with disease-specific pathways, potentially altering therapeutic responses. Furthermore, clinical trials systematically exclude older individuals with severe multimorbidity, physical frailty, cognitive impairment, and malnutrition. Conclusions: Biologics provide a precise, mechanism-based approach, yet evidence in the oldest-old remains limited. Future management should utilize the treatable traits framework, shifting selection criteria from chronological age to biological age metrics, including frailty status and functional reserve. Full article

Background/Objectives: Identifying geriatric hip fracture patients who will require postoperative intensive care unit (ICU) admission remains a clinical challenge. The American Society of Anesthesiologists Physical Status (ASA-PS) classification and the Clinical Frailty Scale (CFS) are both used in preoperative risk stratification, yet their comparative utility for this purpose has not been well characterized. Methods: This single-center, retrospectively designed study included 243 patients aged 65 years or older who underwent hip fracture surgery between January 2023 and December 2025. The primary outcome was determined as postoperative ICU admission, while the secondary outcomes were in-hospital mortality and postoperative complications. Discriminative performance was assessed by ROC analysis with DeLong pairwise comparison. Multivariable logistic regression analysis was performed to identify independent predictors of ICU admission. Results: Postoperative ICU admission occurred in 72.8% of patients. On multivariable analysis, neither ASA-PS nor CFS independently predicted ICU admission. Age (OR 1.052, 95% CI 1.009–1.096; p = 0.017), coronary artery disease (OR 3.992, 95% CI 1.581–10.083; p = 0.003), and spinal anesthesia (OR 0.363, 95% CI 0.161–0.823; p = 0.015) were found to be independent determinants. The addition of either scoring system to this clinical model did not improve discriminative performance (AUC 0.712 vs. 0.709 for both). For in-hospital mortality, CFS demonstrated a markedly superior discriminative ability compared to ASA-PS (AUC 0.801 vs. 0.623; DeLong p = 0.047). Conclusions: In this study, ASA-PS and CFS demonstrated comparable performance in predicting ICU admission; however, neither scale retained independent predictive value after adjustment for age, coronary artery disease, and type of anesthesia. Moreover, incorporating either score into the existing clinical risk model did not meaningfully improve discriminative performance (AUC: 0.709 vs. 0.712). Conversely, CFS exhibited superior discriminative ability compared to ASA-PS for in-hospital mortality. Given the low number of mortality events (n = 13), this finding should be interpreted cautiously as exploratory and warrants confirmation in larger, prospective, multicenter studies. Full article

Frailty syndrome and Alzheimer’s disease are prevalent conditions in the elderly that are associated with aging, decreased quality of life, and a significant healthcare burden. Evidence for a relationship between physical frailty and neurodegenerative decline is accumulating. This study analyzed two independent datasets, a frailty dataset based on gait and mobility parameters and an AD dataset with clinical, functional and lifestyle variables, in order to evaluate and compare their classification performance using machine learning. Features were optimized using dimensionality reduction techniques to keep predictors of clinical significance and hyperparameter optimized Random Forest models were built to develop the best model. Evaluation was performed with Accuracy, F1-score, Matthews Correlation Coefficient and Area Under the Curve. The results showed that the models constructed on the whole AD dataset achieved maximum predictive power with an accuracy of 0.946, which was slightly increased to an accuracy of 0.948 after the selection of significant features. Diagnostic models based on frailty were able to demonstrate an ACC predictive capacity of 0.6418, and in terms of feature selection, improvements appeared in all indicators. Regarding the features derived from Alzheimer’s disease associated with geriatric frailty, they managed to surpass the ACC frailty features of 0.741 alone, suggesting some intercalation mechanisms between neurodegeneration and physical vulnerability. These findings show that machine learning algorithms accompanied by feature selection improve clinical discrimination and prediction of frailty and neurodegenerative disorders, which offers a promising aspect for geriatric assessment. The frailty models analyzed demonstrated an ACC predictive capacity of 0.6418, even though feature selection improved all indicators. Alzheimer’s disease-derived features associated with frailty outperformed features in the frailty dataset with an ACC of 0.741, suggesting the mechanism of overlap between neurodegeneration and physical vulnerability. These results support the theory of a motor-cognitive aging continuum, indicating that algorithmic machine learning techniques coupled with feature selection mainly provide computational validation for the biological intersection of neurodegeneration and physical frailty, rather than forming an independent predictive clinical model. Using these algorithms the study highlights shared pathophysiological mechanisms, providing a significant insight into systemic geriatric deterioration. Full article

Background/Objectives: Medication safety is a critical concern in older adults due to age-related vulnerability, multimorbidity, and polypharmacy. Pro Re Nata (PRN, “as needed”) prescribing is common in geriatric care but may be interpreted inconsistently across healthcare professionals, potentially increasing the risk of medication errors. This study aimed to evaluate PRN prescribing patterns in hospitalized older adults and assess interprofessional perceptions of the clarity and appropriateness of PRN prescribing for conditions. Methods: We conducted a prospective, single-day observational study in a French geriatric university hospital, including all patients aged ≥65 years with at least one medication prescription. PRN prescriptions were extracted from electronic medical records and independently assessed by a pharmacist, nurse, and physician for clarity and appropriateness. Descriptive statistics summarized PRN use, chi-square tests assessed interprofessional differences, and multivariate logistic regression identified predictors of appropriate PRN wording. Results: Among 316 patients, 1035 PRN prescriptions were analyzed, representing 24.5% of all medication entries. Only 51.3% (n = 531) were deemed appropriate by all evaluators. Significant differences in interpretation were observed across professional groups (p < 0.001 for most pairwise comparisons). PRN prescriptions were most frequent in long-term care units and primarily involved gastrointestinal agents, analgesics, and psychotropic medications. Multivariate analysis showed that hospitalization in long-term care (OR = 4.17; 95% CI 2.48–7.03) or rehabilitation units (OR = 2.07; 95% CI 1.22–3.53) with a higher number of prescriptions administered under a therapeutic protocol PRN (OR = 2.27; 95% CI 1.39–3.63) were independently associated with appropriate wording, while a higher total number of PRN prescriptions reduced appropriateness (OR = 0.87; 95% CI 0.82–0.94). Conclusions: PRN prescribing is frequent in hospitalized older adults and often involves high-risk or potentially inappropriate medications. Substantial interprofessional variability in the interpretation of PRN medication wording requires appropriate, standardized, and clinical PRN guidelines to improve medication safety and reduce potential adverse events in geriatric practice. Full article

UK cancer waiting-time standards inadequately address the complex needs of older patients, and no standardised, implementable comprehensive geriatric assessment (CGA) case-finding framework exists for this population. Using a nominal group technique involving clinicians and advocates, a consensus was reached to develop the Cancer Risk Assessment and Needs Evaluation (CRANE) CGA case-finding framework. CRANE was designed to be completed in 10–15 min for patients aged 70 and over, incorporating ten key domains, including comorbidity, cognitive function, and social situation, considered essential for routine NHS use. CRANE represents a consensus-derived, pragmatic case-finding framework for identifying unmet geriatric needs in older adults with cancer in NHS pathways. It should be regarded as a consensus framework rather than a validated screening instrument. Prospective implementation and validation studies are required before routine clinical adoption. Full article

Background/Objectives: Urinary incontinence (UI) and impaired balance are common geriatric syndromes that negatively affect health and quality of life in older women. However, the combined effects of power-based multicomponent training (PMT), pelvic floor muscle (PFM) activation instructions, and psychoeducational (PSY) support remain unclear. This study aims to evaluate the effects of a PMT, alone or progressively combined with PFM activation instructions and PSY support, on PFM function, UI symptoms, balance, fear of falling, and physical function in community-dwelling older women. Methods: This study describes the protocol for an 18-week, four-arm additive, parallel-group, assessor- and analyst-blinded randomized controlled trial with a 6-month follow-up. A total of 120 women aged 60–80 years with UI will be randomly assigned to four groups: (1) PMT only (EX), (2) PMT plus verbal PFM activation instructions (EXVERB), (3) PMT combined with PFM activation instructions and psychoeducational sessions (EXVERBPSY), or (4) a control group receiving educational sessions on geriatric syndrome prevention. Sessions will be conducted twice weekly for 18 weeks. The single primary endpoint is maximal PFM strength assessed by the manometric perineometry. Pre-specified secondary outcomes include additional PFM function measures, upper- and lower-limb (LL) strength and power, balance performance, fear of falling, quality of life, psychological well-being, and anthropometric variables. Assessments will be conducted at baseline, post-intervention, and 6-month follow-up. The trial is registered at ClinicalTrials.gov (NCT06839040). Expected results: This trial is expected to provide evidence on the effectiveness of a multidisciplinary intervention combining exercise, PFM activation strategies, and PSY support for reducing UI severity and improving balance performance and fear of falling in older women. Conclusions: This protocol describes a four-arm additive randomized controlled trial evaluating a multidisciplinary intervention targeting two highly prevalent and interrelated geriatric syndromes. The study may contribute to the development of more comprehensive exercise-based and PSY interventions for older women and may inform healthcare strategies aimed at promoting healthy ageing and improving the management of UI and fear of falling. Full article

Objectives: To assess whether muscle morphology and metabolism can inform personalised care in ventral hernias and to define which parts of a proposed postoperative remodelling model are supported by direct evidence. Methods: We conducted a structured narrative review of PubMed/MEDLINE, Scopus and Web of Science from 1 January 2010 through 30 April 2026. Two authors selected 38 publications. Evidence was classified as direct when generated in ventral or incisional hernia cohorts and indirect when drawn from inguinal hernia, transplantation, geriatric, oncological, animal or general muscle studies. No quantitative synthesis was undertaken. Results: Direct studies document lateral muscle displacement, impaired abdominal wall function, inconsistent associations between low muscle mass and clinical outcomes, and CT-derived increases in muscle cross-sectional areas after transversus abdominis release (TAR). The evidence for anterior abdominal wall myosteatosis, biomarker-guided care and the three proposed remodelling trajectories remains largely indirect. In a 37-patient TAR series, the median rectus abdominis cross-sectional area increased by 16.1% (IQR 11.4–27.0%); muscle function and metabolic recovery were not measured. Conclusions: Routine CT can yield muscle area, attenuation and intermuscular adipose tissue measures without further imaging. No anterior abdominal wall-specific thresholds or biomarker cut-offs have been validated, so these measures should not determine current treatment in isolation. Prospective studies should test whether combined imaging, functional and clinical phenotyping improves the selection of prehabilitation and follow-up. Full article