Search Results (9,541)

Introduction: Patients with inflammatory arthritis are at increased risk of infection due to immune dysregulation and immunosuppressive therapy. National and international guidelines recommend vaccination against pneumococcal disease, influenza, COVID-19, and herpes zoster; however, uptake remains inconsistent. This study evaluated op-world uptake of multiple recommended vaccines within a large UK cohort. Methods: We conducted a cross-sectional study of adults with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis across three hospital sites serving ~800,000 people. Eligible patients had a healthcare encounter within 12 months prior to 1 January 2026. Vaccination status (pneumococcal, influenza, COVID-19, shingles) was obtained from linked primary care records. Demographic and clinical variables were collected. Uptake was reported as percentages with 95% confidence intervals. Associations with pneumococcal vaccination were assessed using Poisson regression with robust standard errors. Results: Among 2158 patients (median age 58 years; 72% female), rheumatoid arthritis was most common (61%). Most were receiving biologic or targeted synthetic DMARDs. Vaccine availability was not limited. Uptake was suboptimal: pneumococcal 30%, influenza 29%, COVID-19 53%, and shingles 12%. Pneumococcal uptake was higher in those aged ≥65 years. Increasing age (aRR 1.92, 95% CI 1.52–2.42) and at-risk comorbidities (aRR 1.42, 95% CI 1.20–1.69) were associated with higher uptake, while biologic or targeted therapy was associated with lower uptake (aRR 0.55, 95% CI 0.48–0.63). Discussion: Vaccination uptake remains suboptimal in this high-risk population. Lower uptake in patients on advanced therapies highlights a gap in care. Targeted education and better integration of vaccination pathways within rheumatology services are needed. Full article

Background/Objectives: Patient satisfaction and supportive care are key quality indicators in certified Head and Neck Cancer Centers (HNCC). We assessed patient-reported experiences across diagnostic staging and surgical treatment pathways, focusing on discharge management and supportive service integration. Materials and Methods: In this prospective cross-sectional study, 84 inpatients were surveyed at the time of hospital discharge after diagnostic tumor staging (n = 45) or surgical treatment (n = 39) at a German tertiary HNCC. Phase-specific standardized questionnaires with five-point Likert scales were analyzed using Pearson’s chi-square and Fisher’s exact tests. Associations of sex and treatment intensity with satisfaction and supportive care utilization were explored descriptively and in an exploratory manner. Results: Overall ratings were high across both cohorts for admission processes, inpatient organization and medical and nursing care, with no statistically significant between-group differences (p > 0.05). Information regarding diagnostic and perioperative procedures was rated very positively in both groups. Discharge-related items were generally favorable. However, patients who underwent surgery reported greater uncertainty and lower reported utilization of formal discharge management. This difference did not reach statistical significance (p = 0.0559) and should therefore be interpreted as a non-significant trend toward less positive evaluation compared with diagnostic patients. Supportive services were rated predominantly good to very good by users (>95% positive ratings). Utilization differed by treatment intensity: Speech therapy was more frequent in operative patients (p < 0.001) and social work counseling was offered and utilized more often in patients undergoing extensive surgery (p = 0.042 and p = 0.027, respectively). Overall dissatisfaction was strongly associated with perceived deficiencies in information on diagnostic procedures and tumor-related counseling (both p < 0.001), whereas waiting time for surgery was not associated with negative overall ratings. Conclusions: Patient satisfaction was consistently high across diagnostic and surgical pathways. Adequate, transparent and repeated information, particularly on diagnostics and tumor counseling, was strongly associated with higher overall satisfaction, whereas objective timing metrics were not associated with negative ratings. Discharge management may represent a sensitive transition point, particularly after extensive surgery and may therefore be a relevant target for further optimization and proactive integration of supportive care services. Sex-specific findings were limited and should be interpreted cautiously due to small subgroup sizes. Full article

Background/Objectives: In Palliative Care (PC), the communication is an essential aspect of care becoming particularly significant at the end-of-life. In neurodegenerative diseases, communication involves additional complexity due to prolonged disease trajectories, early cognitive decline, and frequent loss of decision-making capacity. The aim of this study was to explore PC healthcare professionals’ experiences with communication process and relational dynamics involving families of patients with advanced and terminal neurogenerative disease. Methods: The study design was qualitative, using semi-structured interviews and reflexive thematic analysis. Participants were healthcare professionals directly involved in communication with the family. Results: Twenty PC professionals were interviewed, generating 792 coded excerpts. Four themes emerged: (1) Navigating PC in neurodegenerative diseases, highlighting shift from oncology-centred palliative models toward neuropalliative care, with distinctive relational challenges; (2) Navigating conversations between professionals and families, describing multidisciplinary communication, core clinical and emotional topics, and goal-oriented decision-making in contexts of impaired patient capacity; (3) Facing challenges in health care professional–family communication, including conspiracy of silence, absence of Advance Treatment Directives (ATD) or Shared Care Planning (SCP), and limited collaboration with neurologists; and (4) Envisioning methods for improvement, emphasizing the need for disease-specific competencies, advanced relational skills, interprofessional coordination, and support for professionals’ emotional wellbeing. Conclusions: Communication in neurodegenerative palliative care is an ongoing relational and interpretative process requiring professionals to mediate uncertainty, surrogate decision-making, and caregiver burden. Strengthening disease-specific communication skills, early integrated PC, and structured interprofessional collaboration may enhance shared decision-making, caregiver support, and care continuity. Full article

Background/Objectives: Diet is a primary and modifiable determinant of gut microbiota composition, diversity, and metabolic activity, thereby shaping microbial-derived metabolites, immune and inflammatory signalling, neuroendocrine regulation, and neural communication with the central nervous system. Western dietary patterns, characterised by high intake of ultra-processed foods, saturated fats, and low dietary fibre, are consistently associated with gut dysbiosis, impaired intestinal barrier function, chronic low-grade inflammation, and increased risk of depression, anxiety, cognitive impairment, and neurodegenerative disorders. Methods: This narrative review synthesises evidence from human observational studies, randomised controlled trials, animal models, and mechanistic investigations examining interactions among diet, gut microbiota, and mental health or neurobiological outcomes. Literature searches were conducted in PubMed, Scopus, and Web of Science for articles published up to December 2025. Results: The study highlights the therapeutic potential and limitations of dietary interventions, prebiotics, probiotics, and psychobiotics, and critically evaluates them. Also facilitates an improved understanding of diet–microbiome–brain interactions, which may help the development of personalised, nutrition-based strategies integrated into mental health prevention and clinical care. Conclusions: These findings support diet-based, microbiome-informed strategies as scalable adjuncts in mental health prevention and care. Full article

Wilson’s disease (WD) is an autosomal recessive disorder of copper metabolism caused by ATP7B mutations, characterized by hepatic copper accumulation and multisystem involvement. Several rare inherited and acquired conditions can closely mimic WD, posing diagnostic challenges and the risk of inappropriate therapy. By examining neuroimaging patterns and distinguishing between diagnostic criteria, this narrative review provides a comprehensive synthesis of WD-mimicking disorders, emphasizing their molecular mechanisms, clinical phenotypes, and biochemical features. WD-mimicking disorders encompass ATP7A-related neurodegenerations (Menkes disease, occipital horn syndrome, X-linked distal hereditary motor neuropathy), MEDNIK syndrome, Huppke–Brendel syndrome, aceruloplasminemia, congenital disorders of glycosylation, primary familial intrahepatic cholestasis type 3, and acquired copper deficiency syndromes. Mechanisms include systemic copper deficiency, impaired intracellular trafficking, defective ceruloplasmin biosynthesis, secondary hepatic copper accumulation, and abnormal glycosylation. Clinical features range from neurodevelopmental delay, movement disorders, and hepatic dysfunction to dermatologic, hematologic, and connective-tissue abnormalities. Biochemical profiles may overlap with WD, particularly low serum ceruloplasmin and total copper, altered urinary copper excretion, and elevated hepatic copper in some disorders. Neuroimaging and genetic testing provide critical discriminative value. Management is largely supportive, with disease-specific therapies available in selected conditions, such as subcutaneous copper in Menkes disease or monosaccharide supplementation in certain congenital disorders of glycosylation subtypes. Accurate differentiation between WD and WD-mimicking disorders requires careful integration of clinical, biochemical, imaging, and molecular data. Recognition of distinctive features and understanding underlying pathophysiology are essential to avoid misdiagnosis and inappropriate anti-copper therapy, optimize management, and improve patient outcomes. Full article

Introduction: Stroke remains a leading cause of mortality and long-term disability worldwide. Accurate prognosis prediction is essential for timely intervention and personalized treatment planning. However, previous studies have often overlooked the role of patients’ medical history, age-specific risk factors, and time-dependent mortality patterns. This study aimed to develop and evaluate machine learning models for predicting mortality in stroke patients by incorporating vital signs, blood test results, demographic characteristics, and medical history, while also exploring subgroup-specific factors. Methods: We retrospectively analyzed data from 1780 stroke patients admitted to Hallym University Sacred Heart Hospital between 2018 and 2023. Input features included both original and binarized forms of vital signs and blood test values, along with age and medical history. Random Forest models were developed to predict mortality at 1, 2, and 3 years post-admission, as well as overall mortality. Model performance was assessed using AUC and 95% confidence intervals, and variable importance was evaluated using Mean Decrease Gini and SHAP values. Results: The highest predictive performance was observed in a model for patients under 60 using binarized input features, achieving an AUC of 0.995 (CI: 0.98–1). Across all models, pulse rate consistently emerged as the most important predictor. Additional key features included platelet count and diastolic blood pressure. SHAP analysis revealed that pulse rate was associated with higher mortality risk. Subgroup analyses based on age and medical history improved interpretability and predictive power. Conclusions: This study demonstrates that integrating clinical indicators with demographic and medical history variables can significantly enhance the accuracy and interpretability of mortality prediction models in stroke patients. The results underscore the importance of stratified modeling and continuous monitoring of vital signs, particularly pulse rate, to support precision stroke care. Full article

The growing prevalence of chronic diseases, population aging, and the shift toward preventive and personalized care under Healthcare 5.0 have increased the need for continuous health monitoring beyond clinical settings. While wearable devices enable remote monitoring, their long-term use is often limited by user compliance, comfort issues, battery dependence, and disruption of daily routines. To address these limitations, unobtrusive home-based health monitoring systems have emerged, integrating sensing technologies into domestic environments and everyday objects. This review provides a system-level analysis of unobtrusive health monitoring technologies for smart homes. It examines seven major sensing approaches, including camera-, laser-, radar-, infrared-, mechanical-, bioelectrical-, and optical-based sensors, and their integration into four home environments: living areas, bathrooms, bedrooms, and home offices. For each sensing modality, the operating principles, monitored physiological parameters, representative applications, and key advantages and limitations are discussed. Overall, existing solutions reveal trade-offs among measurement accuracy, robustness in real home conditions, energy autonomy, privacy preservation, and user acceptance. Heart rate and respiratory rate are the most commonly monitored parameters, while multimodal and clinically validated systems remain limited. Although unobtrusive sensing technologies show strong potential for proactive and personalized healthcare, challenges related to accuracy, interoperability, privacy, and cost continue to hinder large-scale adoption. Full article

Background/Objectives: Bronchogenic cysts are rare congenital cystic lesions caused by congenital bronchopulmonary dysplasia; incidental discovery during preoperative investigations or unrelated procedures raises operative management questions. We report successful concurrent resection during laparoscopic Nissen fundoplication. Methods/Case presentation: During elective laparoscopic Nissen fundoplication, a cystic lesion adjacent to the distal oesophagus, previously identified on preoperative imaging, was encountered. Laparoscopic enucleation was performed without compromising the integrity of the gastrointestinal tract or the cyst wall, and the 360° fundoplication was then completed. The specimen was sent for histopathology. Results: Resection was completed without conversion. Histology showed a glandular epithelial lining without features of malignancy, consistent with a bronchogenic cyst. The patient recovered uneventfully with resolution of reflux symptoms. Conclusions: Distal oesophageal bronchogenic cysts accessible via the hiatus can be safely enucleated during laparoscopic Nissen fundoplication in experienced hands, allowing definitive treatment in a single operation. Careful dissection, assessment of gastrointestinal patency and integrity, and histopathological confirmation are essential. Full article

Background/Objectives: Placenta accreta spectrum (PAS) disorders are a major cause of life-threatening obstetric hemorrhage and frequently necessitate cesarean hysterectomy. Abdominal aorta balloon occlusion (AABO) has been increasingly adopted as a strategy to reduce intraoperative blood loss during cesarean section. This study aims to evaluate the effectiveness and safety of AABO during cesarean delivery in women with PAS disorders. Materials and Methods: A systematic review and meta-analysis of studies published in English from 2015 to April 2025 was conducted using the following databases: Embase, Scopus, PubMed, Google Scholar, and Web of Science. Articles that met inclusion criteria focused on human participants, original studies, female participants, and studied the efficacy of AABO on blood loss during cesarean delivery for PAS. Articles that were reviews, case reports, other occlusion procedures, and animal studies were excluded. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Results: Twenty-four studies comprising 1958 cesarean deliveries with AABO and 1791 without AABO met the inclusion criteria. Data on blood loss, transfusion, hysterectomy, maternal complications, and neonatal outcomes were extracted, synthesized, and analyzed. The majority of studies (91.6%) applied the balloon at the infrarenal level. Cesarean delivery with AABO resulted in substantially lower mean blood loss (1231 ± 688 mL vs. 2253 ± 857 mL, p < 0.001) and reduced requirements for blood transfusion compared with cesarean delivery alone. Hysterectomy rates were threefold lower with AABO (7.8% vs. 25.8%, p < 0.001), and the incidence of hemorrhagic shock and re-laparotomy were markedly reduced. Complications associated with AABO, including lower limb arterial thrombosis and fever, were uncommon and generally manageable. Conclusions: AABO during cesarean delivery for PAS disorders is associated with reduced intraoperative blood loss, lower transfusion requirements, and decreased hysterectomy rates, suggesting improved maternal hemodynamic stability. Although the procedure is generally safe, vigilance for vascular and thromboembolic complications is essential, and preventive strategies should be incorporated into perioperative care. These findings support the integration of AABO into multidisciplinary management protocols for women with PAS disorders. Future randomized prospective studies should be performed to improve patient selection criteria, standardize the protocols, and further evaluate the long-term maternal and neonatal safety/outcomes of the procedure. Full article

Background/Objectives: Neoadjuvant chemotherapy is widely used in the treatment of breast cancer and improves oncological outcomes; however, its impact on patients’ psychosocial well-being remains insufficiently explored. This study aimed to assess changes in life satisfaction and self-esteem in women with breast cancer undergoing neoadjuvant chemotherapy. Methods: A prospective observational study was conducted among 211 women diagnosed with breast cancer and treated with neoadjuvant chemotherapy. Life satisfaction was assessed using the Satisfaction with Life Scale, and self-esteem was measured with the Rosenberg Self-Esteem Scale. Assessments were performed one week before initiation of chemotherapy and three weeks after its completion. Statistical analyses included descriptive statistics, the Wilcoxon signed-rank test, and Spearman correlation analysis. Results: A significant decrease in life satisfaction was observed after chemotherapy (mean 21.6 vs. 18.7; p < 0.001), indicating a shift from slight satisfaction to slight dissatisfaction. Self-esteem also significantly decreased (29.4 vs. 27.8; p < 0.001), although it remained within the average range. A decline in life satisfaction was reported in 60.7% of patients and a decrease in self-esteem in 50.2%. A significant positive correlation between life satisfaction and self-esteem was observed both before and after treatment. Financial status significantly differentiated both outcomes after chemotherapy. Conclusions: Neoadjuvant chemotherapy is associated with a significant decline in life satisfaction and self-esteem in women with breast cancer, highlighting its psychosocial impact. These findings support the need for routine assessment of psychological well-being and the integration of psycho-oncological support into comprehensive cancer care. Because the post-treatment assessment was performed shortly after chemotherapy completion, the findings primarily reflect short-term changes during treatment phase. Full article

Background: Chronic pain in children with cancer is a major challenge in pediatric palliative care. It results from the interaction of disease-related and treatment-related factors, psychological distress, and the child’s family and social environment. When poorly controlled, it can impair quality of life, emotional development, social functioning, and family well-being. This narrative review examines the challenges and management strategies for chronic pain in children with cancer from a pediatric palliative care perspective, with attention to pain mechanisms, assessment difficulties, and psycho-emotional influences. Methods: This narrative review was based on a structured literature search conducted in PubMed/MEDLINE, Scopus, and Web of Science for English-language articles published between January 2000 and October 2025. Of 135 records identified, 15 studies judged most relevant to the thematic scope of the review were included in the final synthesis. A PRISMA-based flowchart was used to illustrate study identification and selection without implying a formal systematic review. Results: Chronic pain in children with cancer emerged as a multidimensional problem requiring an integrated approach to assessment and management, and some studies suggest that 20–26% of childhood cancer survivors experience persistent pain. Pharmacological strategies, including opioids and adjuvant medications, remain central, while psychological, supportive, and non-pharmacological interventions may complement multimodal care. Conclusions: Chronic pain in children with cancer should be managed through an integrated, individualized, and child-centered approach that addresses the physical, emotional, social, and relational dimensions of suffering and may improve quality of life for both children and their families. Full article

Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide, with prognosis critically dependent on the stage at diagnosis. Traditional tissue biopsy presents well-known limitations, including tumor heterogeneity and invasiveness. Liquid biopsy, encompassing the analysis of circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, and other cell-free biomarkers, has emerged as a transformative approach for non-invasive tumor profiling. This comprehensive narrative review outlines the recent evidence published on the current state and future perspectives of liquid biopsy in CRC, with a focused emphasis on the role of artificial intelligence (AI), machine learning (ML), and deep learning (DL) in data analysis and clinical translation. Methods: A narrative review of the literature was conducted by searching PubMed/MEDLINE, EMBASE, and ClinicalTrials.gov for articles published between January 2020 and January 2026, using a predefined Boolean search string combining terms related to liquid biopsy biomarkers, colorectal cancer, and artificial intelligence methodologies. Filters were applied to include only English-language human studies. Additional relevant sources were consulted to ensure comprehensive coverage of the available literature. Liquid biopsy platforms, particularly ctDNA sequencing and methylation profiling, demonstrate increasing clinical utility across the CRC care continuum from population screening to post-surgical minimal residual disease (MRD) detection and real-time therapy monitoring. AI-driven analytical frameworks, including Random Forest, Convolutional Neural Networks, LSTM models, and more recently Large Language Models (LLMs), substantially augment the sensitivity and specificity of liquid biopsy interpretation, enabling multimodal data integration. The convergence of liquid biopsy technology and AI-driven analytics represents a paradigm shift toward precision oncology in CRC. Remaining challenges include analytical standardization, model explainability, regulatory harmonization, and equitable access. Future integration of federated learning frameworks and LLM-based clinical decision support tools will be essential for responsible clinical translation. Full article

Background: Augmented reality (AR)-based systems offer novel opportunities for digital support in physiotherapy and rehabilitation. This is especially relevant in the context of an aging population and the growing shortage of healthcare professionals. Methods: This study employed a user-centered design with iterative prototype refinement and investigated the perceived usability and user acceptance of a prototype AR-based sports therapy system (“STAR”), developed within an ongoing interdisciplinary research project, from the perspectives of patients and healthcare professionals across one iteration cycle. After an initial needs analysis (T0), participants interacted in an observer role with the system at two time points (T1, T2) using an AR headset (Microsoft HoloLens 2). They did not perform exercises but only interacted with the application by navigating through the system and viewing the exercise demonstrations. Between T1 and T2, a tutorial was integrated, exercise animations and voiceovers were revised, and voiceover controls and navigation were optimized. Usability was measured using the System Usability Scale (SUS), and user acceptance via the Technology Usage Inventory (TUI). Results: A total of 15 participants (10 patients and 5 therapists) completed both testing sessions. The average SUS score across both patients and therapists improved from 54.5 (SD = 18.8) to 71.2 (SD = 13.1), reflecting a statistically significant increase in perceived usability (p < 0.001). The usability rating improved from “ok” to “good” according to the SUS interpretation scale. The TUI subscales skepticism, immersion, accessibility and usability improved significantly, while interest, usefulness and intention-to-use only showed trend-level changes. Conclusions: The findings suggest that a user-centered development process can enhance the perceived usability and user acceptance of AR- based virtual care tools during the prototype stage by providing early-stage empirical evidence linking specific user-centered design interventions to changes in Technology Acceptance Model-related acceptance constructs. Full article

Intestinal tuberculosis (ITB) is a complex form of extrapulmonary tuberculosis characterized by nonspecific gastrointestinal symptoms and substantial overlap with conditions such as Crohn’s disease and gastrointestinal malignancies. These similarities frequently lead to diagnostic uncertainty, delayed diagnosis, and inappropriate management. This systematic review summarizes current evidence on the clinical presentation, diagnostic approaches, and therapeutic strategies for ITB, with particular emphasis on emerging diagnostic technologies and their role in reducing surgical interventions. A systematic literature search was conducted using PubMed, Scopus, and Google Scholar following PRISMA guidelines to identify relevant studies published from 2000 to 2025. The review focused on clinical manifestations, imaging findings, endoscopic features, histopathological characteristics, molecular diagnostics, pharmacological therapy, and minimally invasive therapeutic interventions. Accurate diagnosis requires an integrated approach combining clinical assessment with imaging, endoscopic evaluation, and histopathological confirmation. Molecular techniques such as GeneXpert MTB/RIF and GeneXpert MTB/RIF Ultra and multiplex polymerase chain reaction assays improve diagnostic accuracy and shorten detection time. Emerging technologies including artificial intelligence-assisted radiologic interpretation and CRISPR-based stool sequencing platforms show promise for earlier detection. Standard anti-tubercular therapy remains the cornerstone of treatment, while minimally invasive endoscopic and surgical procedures are effective for managing complications such as strictures, obstruction, and perforation. Early and precise diagnosis of intestinal tuberculosis is essential to prevent complications and optimize patient outcomes. Integrating conventional diagnostic approaches with emerging molecular and artificial intelligence-based technologies may enhance diagnostic precision and support individualized treatment strategies. Further ITB-specific clinical studies are needed to validate novel diagnostic tools and refine therapeutic approaches for improved patient care. Full article

Background: Low anterior resection syndrome (LARS) is a frequent survivorship problem after sphincter-preserving rectal cancer surgery. Pelvic radiotherapy (RT), often combined with chemotherapy, is frequently implicated in LARS development, but its apparent effect may be confounded by low tumor location and diversion. We evaluated whether RT (±chemotherapy) separates the risk of postoperative LARS severity—especially major LARS—beyond classical anatomic and pathway determinants. Methods: We conducted a single-centre observational cohort study of operated rectal cancer patients managed between 2013 and 2024, who completed the Romanian-validated LARS score by standardized telephone interview after restoration of bowel continuity (up to 18 months postoperatively). Outcomes were postoperative LARS score, LARS category, and major LARS. Comparisons were performed by RT status and by oncologic treatment pattern. Multivariable logistic regression assessed associations with major LARS, adjusting a priori for tumor location and diverting ileostomy; furthermore, extended sensitivity models incorporated technical/pathway variables. Discrimination was explored using 5-fold cross-validated ROC/AUC. Item-level LARS responses were analyzed to characterize symptom phenotype. Results: Overall, 182 patients were included (RT: 106; no RT: 76); 43.4% had LARS (minor 14.8%, major 28.6%). RT-treated patients had higher postoperative LARS scores (median 21 vs. 12; p = 0.002) and a higher prevalence of major LARS (35.8% vs. 18.4%; p = 0.012). Across treatment patterns, LARS severity was highest in RT + chemotherapy. Item-level analyses indicated that RT-associated differences were driven mainly by urgency and clustering domains. In adjusted models, RT was not independently associated with major LARS, whereas low tumor location and diverting ileostomy were strong predictors. Discrimination for major LARS was modest: AUC 0.561 for RT alone, 0.643 for location + ileostomy, and 0.654 for location + ileostomy + RT (5-fold cross-validation). Conclusions: RT is associated with worse unadjusted postoperative bowel dysfunction after rectal cancer surgery and is linked to urgency/clustering-dominant symptom patterns. However, in this cohort, the risk of major LARS was predominantly explained by tumor location and diversion rather than RT alone, supporting integrated risk stratification and early symptom-directed survivorship care. Full article