Search Results (4,166)

Background/Objectives: Psychological distress, including symptoms of anxiety and depression, is common among individuals with inflammatory bowel disease (IBD) and may adversely affect well-being and disease management. However, routine assessment of mental health is not consistently integrated into clinical care. This study assessed the prevalence of anxiety and depression among patients newly diagnosed with IBD at diagnosis and after three months of treatment and explored associations between psychological symptoms, disease activity, and clinical characteristics. Methods: This prospective cohort study included 304 adults newly diagnosed with IBD and treated at Stavanger University Hospital between 2012 and 2019. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and after three months. Disease activity was evaluated using the Harvey–Bradshaw Index and Partial Mayo Score. Clinical variables included C-reactive protein, faecal calprotectin, folate, cobalamin, and body mass index. Multivariable regression analyses were conducted to identify factors associated with psychological symptoms. Results: The prevalence of anxiety decreased from 29.8% at diagnosis to 21.6% after three months, while the prevalence of combined anxiety and depression declined from 22.2% to 16.3%. The prevalence of depression alone remained stable over time. Higher disease activity, particularly as measured by the Harvey–Bradshaw Index, showed the strongest association with anxiety and depressive symptoms. However, after adjustment for potential confounders, no significant improvement in psychological symptoms was observed, suggesting that the association between time and HADS scores may be explained by changes in one or more measured covariates. Conclusions: Psychological symptoms remained common during the first months following an IBD diagnosis and were closely associated with disease activity. Medical treatment alone was insufficient to achieve meaningful improvements in mental health outcomes. These findings highlight the importance of systematic psychological assessment, early identification of emotional distress, and integrated multidisciplinary care, including nursing-led screening and supportive interventions, for individuals newly diagnosed with IBD. Full article

Achieving integrated water resources management at all levels, as called for by Sustainable Development Goal (SDG) target 6.5, requires assessment tools that operate at the local administrative scale. However, watershed sustainability assessments are mostly conducted at the whole-basin or provincial scale, which masks the spatial disparities that matter for local water management. This study develops a sub-district-scale Watershed Sustainability Index (WSI) for the Nong Han Basin, Thailand, by integrating the HELP framework (Hydrology, Environment, Life, and Policy) with the Pressure–State–Response structure, a calibrated QSWAT hydrological model, and spatial analysis in a geographic information system, covering 25 sub-districts. The results show that the basin has a moderate-to-high level of sustainability, with a mean WSI of 0.620: 18 sub-districts are classified as high and 7 as moderate, and none fall into the low category. The Life and Hydrology dimensions are the strongest, whereas the Policy dimension is the limiting factor in most sub-districts. This limitation arises from a low Response component (0.19) rather than from a lack of institutional capacity, as confirmed by the finding that sub-districts with low and high policy scores differ only in the Policy dimension. The apparently uniform aggregate index, combined with the high disparity among dimensional scores, confirms the value of diagnosis at the sub-district scale. The proposed framework translates the assessment results into spatial prioritization, an agency-linked decision matrix, and an intervention typology, thereby supporting evidence-based water management by local administrative organizations. Full article

Background: Age, race, body mass index (BMI), breast density, parity, smoking and alcohol use are associated with increased risk for breast cancer. These factors, as well as tumor characteristics, treatment regimens and comorbidities, are analyzed for associations with five-year event free survival (EFS) in a sample of women with Stage I-III breast cancer who received chemotherapy with curative intent. Methods: EFS was defined in terms of breast cancer recurrence, second primary, metastasis, and overall survival. Analyses were stratified by age (under age 65 vs. over age 65). EFS was estimated using the Kaplan–Meier method and compared using a Cox proportional hazard model. Results: In a sample of 821 women, mean age at diagnosis was 54 years, with 75% White and 22% Black. Younger women had higher proportions of Stage II and III tumors (p = 0.005), larger tumor size (p = 0.0004), and higher breast density (p = 0.003). Five-year EFS was 91% among younger vs. 82% among older women (p = 0.0005). In women aged < 65, there were 48 EFS events, and triple negative patients had significantly worse EFS compared to other subtypes (p = 0.003). Smokers also had worse EFS (p = 0.04). In women aged ≥ 65, there were 26 events, and both tumor size (p = 0.02) and mastectomy (p = 0.03) were significant for EFS. Conclusions: In our sample, triple negative subtype, smoking history, tumor size, and surgery type were significantly associated with shorter EFS. Race, BMI, alcohol use, parity, breast density, radiation treatment, and specific chemotherapy regimen were not significant for EFS in either age group. Full article

Introduction: Infective endocarditis (IE) remains a serious life-threatening condition associated with substantial morbidity and mortality. Within the Republic of Ireland, there is limited national data regarding the clinical and economic impact of IE. This study aimed to describe IE in Ireland. Methods: We conducted a retrospective cohort study using national Hospital Inpatient Enquiry (HIPE) data accessed through the National Quality Assurance and Improvement System (NQAIS). All admissions with a principal diagnosis of acute or subacute infective endocarditis (ICD10: I33.0, I33.8) from 1 January 2018–30 July 2025 were included. Duplicate episodes, incomplete records, nonemergency admissions, and cases without documented transoesophageal echocardiography (TOE) were excluded. Demographic, clinical, procedural, and outcome variables were explored. Costs were assigned using Healthcare Pricing Office guidance for length of stay (LOS). Results: A total of 441 patients met inclusion criteria. The mean age was 64.1 years (SD 17.0), and 75.5% were male. Surgical intervention occurred in 18.4% of cases. Surgically managed patients were younger than medically managed patients (mean age 58.8 years vs. 65.7 years, p < 0.001) and experienced a longer LOS (mean of 51 days vs. 36 days, p < 0.001). The overall in-hospital mortality rate was 9.5% (n = 42). On multivariable analysis, higher comorbidity burden (measured by Charlson comorbidity index (CCI)) was independently associated with in-hospital mortality (OR 1.09, 95% CI 1.06–1.13, p < 0.001). The total expenditure was €20.6 million. Discussion: IE in Ireland affects predominantly older, comorbid patients and is associated with significant healthcare resource utilization. In-hospital mortality rates appear favourable compared with published international series. Full article

Respiratory and systemic deterioration after intraventricular hemorrhage (IVH) can be difficult to interpret when airway, infectious, neurogenic, and treatment-related factors develop in parallel. A 31-year-old obese man (body mass index 37.56 kg/m²) arrived late at night with right caudate hemorrhage, massive IVH, and acute hydrocephalus. Initial consciousness disturbance was mild and oxygenation was preserved, so close observation was selected. Approximately 6–7 h after arrival, worsening headache, restlessness, and progression of hydrocephalus prompted bilateral external ventricular drainage (EVD). The right EVD output remained poor despite lowering the drainage level. From Day 2 to Day 3, positional snoring, desaturation, tachypnea, fever, and inflammatory marker elevation developed; oxygenation improved with lateral positioning and head elevation, suggesting obesity-related upper-airway compromise with probable sleep-disordered breathing (SDB). On Day 4, recurrent hypoxemia required intubation, and computed tomography (CT) showed entrapment of the right lateral ventricle, prompting endoscopic clot evacuation. Chest CT after the second procedure showed bilateral lower-lobe consolidation consistent with hospital-acquired pneumonia (HAP), and cefazolin was changed to meropenem. Serial glucose measurements showed no persistent hypoglycemia, and early coagulation profiles were not markedly abnormal. However, cultures, arterial blood gas analysis, lactate measurement, echocardiography, abdominal CT, and autopsy were not obtained. Despite treatment, hyperpyrexia, persistent tachypnea, and vasopressor-dependent hypotension progressed, and he died on Day 7. The terminal course was most consistent with infection-associated circulatory collapse and ventilatory failure, while central hyperthermia and other unexcluded causes may have contributed. This case illustrates diagnostic uncertainty rather than a single confirmed terminal diagnosis and emphasizes early systemic evaluation when respiratory, thermal, and circulatory findings evolve after IVH. Full article

Sudden tailings dam breaches trigger large-scale heavy metal compound pollution in coupled surface water–groundwater systems, requiring systematic full-cycle ecological damage quantification tools applicable to diverse contamination types. This study constructs an integrated full-cycle ecological damage assessment framework for sudden water pollution accidents, integrating three core modules: multi-model pollutant migration prediction, multi-scale aquatic biological damage diagnosis, and three-dimensional ecological-economic loss accounting. The framework adopts a modular design that can potentially accommodate heavy metals (Cd, Cr, As, Pb) and organic pollutants such as polycyclic aromatic hydrocarbons (PAHs), with standardized molecular, individual, and population-level biological endpoints and corresponding pollutant dose–response templates reserved as reference calculation modules. However, applicability beyond this case has not been validated and requires case-specific calibration. To verify the operability and accuracy of the proposed integrated system, a typical tailings dam leakage incident dominated by hexavalent chromium (Cr(VI)) and arsenic (As) pollution was selected as the practical validation case; all field monitoring, pollutant simulation, and final economic loss quantification in this case exclusively rely on on-site measured Cr(VI) and As data, while Cd and PAH-related biological response curves and remediation cost formulas retained in the manuscript only serve as illustrative universal template components of the framework rather than case-measured results. For the Cr(VI)/As pollution case, the advection–diffusion model simulation revealed that the Cr(VI) contamination plume horizontally spread 250 m within 48 h and extended to 560 m after seven days, and anaerobic groundwater environments drove the transformation of toxic mobile trivalent arsenic (As(III)) from primary pentavalent arsenic. The calibrated SWAT model achieved Nash–Sutcliffe efficiency (NSE) coefficients of 0.75 for dissolved Cr(VI) and 0.68 for particulate As. The graph theory-based rapid prediction model cut computation duration down to minutes; when validated against independent field monitoring data, it yielded an average relative error of 14.2%, and its consistency with the SWAT model reached 10.5% relative deviation, satisfying the accuracy requirement for emergency early warning. Field biological monitoring demonstrated substantial ecological impairment: metallothionein (MT) expression in fish tissues was markedly elevated (the reported 6.2-fold induction value derives from standard Cd exposure template tests within the framework, with analogous MT upregulation also observed for field Cr(VI)/As co-stress), and benthic community Shannon diversity declined by over 50% in polluted river reaches. The standardized Ecological Damage Index (EDI) of the case was calculated as 480.2, indicating severe aquatic ecosystem damage, with total comprehensive ecological and economic losses reaching 17.25 million CNY. This study innovatively couples high-precision physical transport models with fast emergency prediction algorithms and establishes a complete multi-tier biological indicator chain linking molecular biomarkers to community integrity metrics; the three-dimensional loss accounting system integrating ecosystem service impairment, restoration expenditure, and post-pollution recovery loss realizes closed-loop full-cycle damage evaluation. The proposed framework, demonstrated for Cr(VI) and As pollution, has a modular design that may potentially be extended to other pollutants such as Cd and PAHs by adjusting model parameters, providing a quantitative reference for emergency disposal, pollution remediation, and ecological compensation of water contamination accidents, although further validation across different pollutants and hydrological settings is required. Full article

Objectives: Women with a history of breast cancer are at increased risk of developing subsequent breast cancer, including ipsilateral recurrence and contralateral new primary breast cancer. This study evaluated the discriminatory performance of a mammogram-based artificial intelligence (AI) risk model for predicting subsequent breast cancer within one year after a negative screening mammogram. Methods: This enriched retrospective case–control study included women with a prior history of breast cancer who underwent screening digital breast tomosynthesis between January 2018 and December 2023 at three affiliated academic breast imaging centers. Digital breast tomosynthesis examinations classified as BI-RADS 1 or 2 were retrospectively analyzed using the ProFound AI^® Risk model version 1.0 to estimate 1-year breast cancer risk. Patients were classified according to whether they developed subsequent breast cancer within one year of the index screening examination. Model discrimination was evaluated using receiver operating characteristic analysis. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated at an exploratory cutoff selected by maximizing the Youden index. Results: The study included 96 women (mean age, 65.3 ± 8.7 years), of whom 32 developed subsequent breast cancer within one year, and 64 did not. The mean AI risk score was significantly higher in the subsequent breast cancer group than in the control group (1.18 ± 0.59 vs. 0.49 ± 0.41; p < 0.001). The AI model demonstrated an AUC of 0.824 (95% CI: 0.728–0.921). At an exploratory cutoff of 0.39, sensitivity was 81.3%, specificity was 76.6%, PPV was 63.4%, and NPV was 89.1%. In separate exploratory analyses, the AUC was 0.790 (95% CI: 0.641–0.939) for ipsilateral recurrence and 0.860 (95% CI: 0.752–0.974) for contralateral new primary breast cancer. AI risk scores were not significantly correlated with tumor size or age at subsequent breast cancer diagnosis. Conclusions: In this enriched retrospective case–control study, higher mammogram-based AI risk scores were associated with subsequent breast cancer within one year after a negative screening examination. The model demonstrated discriminatory performance for both ipsilateral recurrence and contralateral new primary breast cancer; however, these analyses were exploratory. Because the cohort was enriched for subsequent breast cancer events, the reported predictive values are specific to the study sample and should not be extrapolated to routine surveillance populations. Larger prospective cohorts are needed to validate discrimination, calibration, and clinical utility. Full article

Background and Objectives: Ovarian cancer remains the most lethal gynecologic malignancy, largely due to late diagnosis and the limitations of currently available diagnostic tools. Systemic inflammatory markers derived from routine blood tests have emerged as potential low-cost biomarkers, reflecting the interaction between tumor biology and the host immune response. This study aimed to evaluate the association and diagnostic value of preoperative inflammatory markers in distinguishing malignant from non-malignant ovarian tumors. Materials and Methods: This retrospective, single-center observational study included 780 adult female patients diagnosed with ovarian tumors and treated surgically between January 2020 and December 2025. Preoperative hematological parameters were obtained from complete blood count analyses performed before any therapeutic intervention. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. Comparisons were performed among benign, borderline, and malignant tumors. To avoid collinearity between mathematically interrelated inflammatory indices, three separate multivariable logistic regression models were constructed, each including age, CA-125, and one inflammatory index. Diagnostic performance of the individual inflammatory indices was assessed using receiver operating characteristic (ROC) curve analysis. Results: Patients with malignant tumors were significantly older and exhibited higher NLR and PLR values and lower LMR values than patients with non-malignant tumors (all p < 0.001). In separate multivariable models adjusted for age and CA-125, higher NLR (OR = 1.79, 95% CI: 1.41–2.27, p < 0.001) and PLR (OR = 1.43, 95% CI: 1.17–1.75, p = 0.001) remained significantly associated with malignant ovarian tumors, whereas higher LMR was inversely associated with malignancy (OR = 0.66, 95% CI: 0.52–0.85, p = 0.001). ROC analysis demonstrated moderate discriminative ability for NLR and PLR (AUC = 0.72 for both), whereas LMR showed lower discriminative performance (AUC = 0.64). Conclusions: Preoperative systemic inflammatory indices are significantly associated with ovarian tumor malignancy. NLR and PLR were positively associated with malignant disease, whereas LMR showed an inverse association, and these relationships remained significant after adjustment for age and CA-125. However, their individual discriminative performance was modest, suggesting that these readily available inflammatory indices should be considered complementary rather than standalone biomarkers for preoperative risk assessment. Full article

El Niño–Southern Oscillation (ENSO) modulates tropical South American rainfall, but its Colombian expression is filtered by terrain, rainfall regime, moisture pathways, and atmospheric state. We quantify ENSO-related sensitivity of standardized precipitation anomalies in the Colombian Andes and Orinoquia using Climate Hazards Group InfraRed Precipitation with Station data (CHIRPS v2.0; 1981–February 2026), station records from Colombia’s Institute of Hydrology, Meteorology, and Environmental Studies (IDEAM), ERA5 atmospheric fields, and 1981–2010 climatologies. CHIRPS reproduced station-derived standardized anomalies ($r=0.94$ in the Andes; $r=0.91$ in Orinoquia), supporting regional anomaly analysis while retaining cautious comparison framing. Lagged associations with the Oceanic Niño Index (ONI) were evaluated for lags 0–6 months using effective sample size, block-bootstrap confidence intervals, and maximum-lag tests. ENSO sensitivity was stronger and more coherent in the Andes: annual lag-1 ONI–precipitation correlation was $-0.374$, with marked December–February and June–August responses. El Niño minus La Niña composites of column water vapor, 850-hPa moisture-flux convergence, 500-hPa vertical velocity, and Convective Available Potential Energy (CAPE) revealed seasonally heterogeneous moisture and convergence responses, but coherent positive $\omega$ anomalies over the Andes in DJF and JJA, consistent with reduced ascent. CAPE was significantly higher in MAM–SON, whereas the positive DJF difference was not statistically significant, showing that thermodynamic instability alone did not determine rainfall. Orinoquia did not exhibit a comparably consistent four-variable atmospheric signature. An elevation-stratified analysis showed a modest lowland-to-upland strengthening that plateaued above approximately 1000 m. A strictly antecedent ONI-lag model retained modest fixed-split skill in the Andes ($R^2=0.138$) but negligible skill in Orinoquia ($R^2=0.003$). The results support regional diagnosis, not causal or operational claims. Full article

Background/Objectives: Post-COVID syndrome (PCS) remains a clinically heterogeneous condition. In patients with chronic diseases, real-world evidence is needed to describe its frequency and to identify clinical factors associated with its current presence. This study assessed the prevalence of PCS and factors associated with current PCS status among patients with chronic diseases. Methods: This observational cross-sectional study included a consecutively enrolled source clinical sample of 850 adults receiving inpatient or outpatient care in Almaty and the Almaty Region between June and December 2025. The primary analytic cohort comprised participants with documented prior COVID-19 (n = 250). PCS was assessed at study enrollment according to the national clinical protocol as current symptoms persisting for more than 12 weeks and not explained by an alternative diagnosis. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). COVID-19 vaccination was excluded from the primary model and evaluated only in a sensitivity analysis because vaccination timing relative to infection was unavailable. The exploratory association-based probability model was evaluated using the AUC with 95% CI, Brier score, calibration assessment, bootstrap internal validation with 1000 resamples, assessment of age nonlinearity, and decision curve analysis. Results: PCS was identified in 147 of 250 participants with prior COVID-19 (58.8%). In the revised primary multivariable model, age (OR = 1.24 per 10-year increase; 95% CI: 1.01–1.54; p = 0.040) and endocrine diseases (OR = 3.36; 95% CI: 1.69–6.98; p < 0.001) remained associated with current PCS status. The association with endocrine diseases persisted after adjustment for body mass index. The apparent AUC was 0.687 (95% CI: 0.620–0.753), and the Brier score was 0.218. Bootstrap internal validation yielded an optimism-corrected AUC of 0.655, a calibration intercept of 0.061, and a calibration slope of 0.816. Conclusions: PCS was frequent among patients with chronic diseases who had prior COVID-19. Older age and endocrine pathology were the most consistent factors associated with current PCS status. All model-performance estimates were obtained within the development sample; the model should not be used for individual prediction or follow-up planning without prospective external validation. Full article

Background: GLP-1 receptor agonists (GLP-1 RAs) are increasingly used for obesity and metabolic disease, but their use in people with chronic pancreatitis is not a chronic pancreatitis-directed indication and direct evidence is limited. We described recorded outcomes among non-diabetic adults carrying a chronic pancreatitis diagnosis who did or did not have recorded GLP-1 RA exposure. Methods: We performed a retrospective propensity score-matched cohort study using the TriNetX Collaborative Network. Chronic pancreatitis was identified from a recorded diagnosis; supporting imaging, histological, functional, or specialist-confirmation criteria were unavailable. The exposed cohort included patients receiving dulaglutide, semaglutide, or tirzepatide (n = 1441 before matching), and the comparator cohort included patients without recorded GLP-1 RA exposure (n = 142,047 before matching). One-to-one propensity score matching generated 1422 patients in each cohort. Outcomes were assessed from 1 to 1095 days after the index date using risk comparisons and time-to-event analyses. Results: Mean follow-up after matching was 458.8 days in the exposed cohort and 664.4 days in the comparator cohort. Recurrent acute pancreatitis was recorded in 19/799 (2.4%) versus 76/704 (10.8%) patients (HR 0.247, 95% CI 0.149–0.409), pancreatic cancer in 10/1373 (0.7%) versus 40/1345 (3.0%) (HR 0.255, 95% CI 0.128–0.511), and all-cause mortality in 21/1419 (1.5%) versus 157/1416 (11.1%) (HR 0.167, 95% CI 0.105–0.263). A similar direction was observed across several coded outcomes. Vitamin D deficiency showed a higher hazard (HR 1.556, 95% CI 1.129–2.145), although its risk comparison was not significant. Conclusions: These estimates describe outcomes in a selected treatment-exposed phenotype of chronic pancreatitis. The findings are hypothesis-generating and should not guide prescribing decisions. Further prospective studies are required to confirm this hypothesis. Full article

Background/Objectives: Pulmonary function tests (PFTs), especially spirometry, are important for chronic respiratory disease diagnosis and management, but Baidu-based online search interest in PFT-related information remains insufficiently characterized. This study examined long-term Baidu search activity for a selected PFT-related keyword in China from 2011 to 2024, with attention to pandemic-period changes, provincial variation, spatial inequality, and associated socioeconomic factors. Methods: We analyzed Baidu Index data from 1 January 2011 to 31 December 2024. The selected PFT-related keyword, “pulmonary function instrument,” was compared with “blood pressure monitor” and “blood glucose meter.” Daily Baidu Index values were aggregated into monthly and annual series. Temporal trends, relative search-intensity ratios, interrupted time-series analysis, inequality indices, fixed-effects regression, subgroup heterogeneity, and convergence dynamics were assessed. Results: PFT-related Baidu search activity remained lower than that for blood pressure and glucose monitoring, with relative search-intensity ratios below 0.35. Descriptively, PFT-related searches increased during 2020–2022; however, the re-specified seasonality-adjusted ITSA using unsmoothed monthly observations did not provide strong statistical evidence for an immediate level change at pandemic onset or a sustained slope change. Provincial differences persisted, with higher values generally observed in several eastern coastal provinces. Inequality indices were lower on average during 2020–2022 but fluctuated over time, and beta-convergence analyses provided limited statistical evidence of systematic catch-up among initially low-index provinces. Urbanization, per capita GDP, and population aging were positively associated with PFT-related Baidu Index values, while subgroup findings were interpreted as exploratory ecological associations. Conclusions: PFT-related Baidu search activity in China remained lower than search activity for blood pressure and glucose monitoring and showed persistent provincial variation. These findings suggest lower visibility of PFT-related information within the Baidu-based online environment. Full article

Background/Objectives: Primary thyroid lymphoma accounts for approximately 0.2–2% of thyroid malignancies. Plasmablastic lymphoma (PBL), an aggressive large B-cell neoplasm with plasma-cell differentiation and frequent loss of conventional B-cell markers, is a rare thyroid presentation. We report a thyroid PBL presenting as an acute surgical airway emergency in an immunocompetent patient and highlight the diagnostic and management pitfalls that distinguish this from anaplastic thyroid carcinoma. Case Presentation: A 75-year-old man without any significant past medical history presented with rapidly progressive right-sided neck swelling, dysphagia, inspiratory stridor, and respiratory failure. Imaging demonstrated a large, thyroid-centered mass with tracheal involvement, initially raising concern for anaplastic thyroid carcinoma. Histopathology revealed a diffuse infiltrate of large, atypical cells with immunoblastic and plasmablastic morphology. The neoplastic cells were CD20- and CD138-negative but strongly MUM1-positive, with lambda light-chain restriction, bright CD38 by flow cytometry, a Ki-67 proliferation index exceeding 95%, aberrant cytoplasmic CD3 expression, and a MYC::IGH rearrangement, supporting a diagnosis of PBL. Staging identified extranodal perinephric disease and mesenteric lymphadenopathy, consistent with disseminated extranodal Ann Arbor stage IV disease. The patient underwent systemic treatment and initially had an excellent response; however, one month after the last treatment cycle they presented to the hospital with a mass consistent with recurrence. Discussion: Rapid growth, fixation, and tracheal invasion strongly suggest anaplastic thyroid carcinoma in routine clinical practice. However, plasmablastic lymphomas can present similarly and require fundamentally different treatment. In this case, loss of conventional B-cell markers, CD138 negativity, and aberrant cytoplasmic CD3 expression created substantial diagnostic challenges. Light-chain restriction, plasma-cell-associated markers, flow cytometry, and MYC cytogenetics were vitally important. Conclusions: Thyroid-presenting PBL is exceptionally rare and may closely mimic anaplastic thyroid carcinoma, including presentation with life-threatening airway compromise and tracheal involvement. This case highlights several diagnostic pitfalls: CD138 negativity despite plasma-cell differentiation, and aberrant cytoplasmic CD3 expression. Prompt airway stabilization, adequate tissue acquisition, broad immunophenotyping, light-chain assessment, flow cytometry, EBV/HHV8/ALK testing, and MYC cytogenetics are essential for accurate diagnosis and lymphoma-directed treatment. Full article

Background: Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary fungal disease, predominantly caused by Aspergillus fumigatus, which develops in patients with pre-existing structural lung abnormalities. Chronic cavitary pulmonary aspergillosis (CCPA), the most common form of CPA, is characterized by one or more pulmonary cavities, with or without intracavitary fungal balls (aspergillomas), and requires prolonged oral triazole therapy. Long-term treatment may be limited by adverse events, drug–drug interactions, and the need for therapeutic drug monitoring with conventional azoles. Case Presentation: A 69-year-old former smoker with a history of breast cancer and right upper lobectomy for pulmonary adenocarcinoma presented with fever, productive cough, hyporexia, sarcopenia, and an unintentional 6 kg weight loss over three months. Two years earlier, she had undergone atypical pulmonary resection for an Aspergillus fumigatus aspergilloma and had been treated with amphotericin B followed by voriconazole for six months. HRCT revealed a recurrent intracavitary fungal lesion within a residual post-surgical cavity with extensive inflammatory consolidation. Bronchoalveolar lavage demonstrated a positive galactomannan index (4.74) and septate fungal hyphae on cytology, supporting the diagnosis of recurrent CCPA. Treatment with oral isavuconazole resulted in clinical recovery, weight gain, and complete radiological resolution after six months, without treatment-related adverse events or QTc abnormalities. Conclusions: This case highlights the successful outpatient management of CCPA developing within a persistent post-lobectomy cavity despite previous surgical resection and antifungal therapy. The favourable clinical response, excellent tolerability, and absence of treatment-related toxicity support the growing evidence that isavuconazole may represent a valuable therapeutic option for selected patients with recurrent CCPA. Full article

Objective: Diagnosis-to-treatment interval (DTI) has been investigated in several lymphoma subtypes, but its significance in T-lymphoblastic lymphoma (T-LBL) remains unclear. We evaluated whether DTI reflects clinical urgency, disease burden and early outcomes in newly diagnosed T-LBL. Methods: We retrospectively analyzed 220 patients with newly diagnosed, mass-dominant, and histologically diagnosed T-LBL treated at four centers between 2003 and 2025. DTI was operationally defined as the interval from diagnostic biopsy to first systemic anti-lymphoma therapy and was primarily analyzed as a continuous variable per 7-day increase. Descriptive DTI groups were <15, 15–29 and ≥30 days. Results: Median DTI was 20 days (interquartile range [IQR], 14–32). Shorter DTI was associated with advanced stage, elevated lactate dehydrogenase (LDH), multiple extranodal involvement, central nervous system (CNS) involvement, B symptoms, lower hemoglobin and higher International Prognostic Index (IPI) score. CNS involvement remained independently associated with DTI < 15 days. In adjusted analyses, each 7-day increase in DTI was associated with lower odds of early treatment failure within 2 years (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.58–0.88), lower hazards of progression-free survival (PFS) events (hazard ratio [HR] 0.84, 95% CI 0.74–0.94) and lower mortality (HR 0.84, 95% CI 0.73–0.98), but not complete response. Conclusions: Shorter DTI appears to reflect clinical urgency and disease burden rather than a causal effect of early treatment. Full article