Search Results (1,128)

This review examines the clinical and practical implications of embedding molecular profiles directly into the 2023 FIGO staging system for endometrial carcinoma, in the context of the 2025 ESGO/ESTRO/ESP guidelines. The primary purpose is to navigate a central conflict in modern oncology: how to deliver increasingly personalized care while maintaining a globally accessible, equitable, and standardized cancer classification system. The 2023 FIGO update represents a paradigm shift from the traditional dualistic model (Type I versus Type II) by allowing molecular findings to redefine stage itself. While this integration offers clear benefits, it introduces significant challenges. First, the system depends on advanced molecular testing, creating a “rich-poor” divide where patients in resource-limited settings are systematically overtreated because testing is unavailable. Second, stage becomes unstable, changing with sequential histologic and molecular re-review, which causes confusion for patients and clinicians. Third, the system lumps prognostically distinct histotypes (Serous, Clear Cell, Carcinosarcoma, and Grade 3 Endometrioid) into a single aggressive stage, obscuring meaningful differences in survival. Fourth, it relies on subjective parameters such as “substantial” lymphovascular space invasion, for which no standardized definition exists, leading to high inter-observer variability. After analyzing these controversies, the review proposes a pragmatic solution: decouple anatomical staging from molecular risk stratification. Staging should remain a purely anatomical, universally applicable descriptor of tumor extent, while molecular and histologic data are used separately within a dynamic risk assessment model, as suggested by the European guidelines. This dual-track approach preserves global comparability, reduces inequity, and maintains diagnostic stability, while still enabling personalized treatment where advanced diagnostics are available. Full article

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article

Background: Predicting recurrence after liver transplantation (LT) for hepatocellular carcinoma (HCC) remains important for post-transplant risk stratification and surveillance planning. The Milan criteria discriminate only moderately and some machine-learning re-analyses report overly optimistic results because of information leakage. Aim: The current study aimed to re-evaluate a previously published transplant cohort under a leakage-free survival-analysis framework and to benchmark post-transplant, explant-informed survival learners against the Milan criteria as a fixed pre-transplant reference. We hypothesised moderate rather than near-perfect discrimination, similar performance across learners of differing complexity, and better discrimination than the Milan criteria. Methods: This secondary analysis included 356 patients with HCC who underwent LT. The primary endpoint was recurrence-free survival, analysed from the observed event indicator and follow-up time rather than from a derived risk label. Seven survival learners were benchmarked with repeated nested cross-validation, using three repeats of a five-fold outer loop with a three-fold inner tuning loop. All data-dependent preprocessing, including robust multivariable outlier handling and imputation, was fitted within training folds only. Performance was assessed by the concordance indices of Harrell and Uno, the time-dependent area under the curve, the integrated Brier score, calibration, decision-curve analysis and descriptive competing-risk assessment. Results: Recurrence developed in 183 of the 356 patients over a median follow-up of 52 months. Discrimination was moderate rather than near-perfect and similar across learners; the random survival forest ranked highest and the Elastic-Net Cox model performed comparably. All learners showed higher descriptive concordance than the Milan criteria, and dependency-corrected comparisons supported higher concordance for the full-feature Cox model than for the Milan criteria, whereas the random survival forest and Cox did not differ materially. Out-of-fold calibration of the Elastic-Net Cox model at 36 months was acceptable, decision-curve analysis indicated positive net benefit across clinically relevant thresholds, and tumour size and alpha-fetoprotein were the leading contributors to prediction. Findings were stable in ablation and threshold-sensitivity analyses. Conclusions: Leakage-free survival modelling gave moderate but internally validated prediction of post-transplant recurrence and higher concordance than the Milan criteria in this cohort, supporting the stated hypotheses. Careful study design may matter more than architectural complexity in this setting, and leakage-free survival analysis is a practical standard for prognostic modelling in transplant oncology. Full article

Glucagon-like peptide (GLP)-1 receptor agonists (GLP-1RAs) (including medications that contain GLP-1 and other RAs), hereafter referred to as GLP-1 medicines, have significantly advanced the management of metabolic disease and weight management. Obesity is highly prevalent among cancer survivors at the time of diagnosis, and cancer treatments are associated with subsequent changes in weight, either gain or loss. Research has shown that obesity can adversely affect cancer treatment outcomes and survivorship, leading researchers to investigate the potential integration of GLP-1 medicines into oncology care. There is growing interest in understanding the effects of GLP-1 medicines on weight loss and cancer-related outcomes among individuals with obesity who are taking anticancer therapies, as well as individuals treated for cancer in the past who are long-term survivors. This review examines the literature to characterize what is known about GLP-1 medicine use among cancer survivors. The current literature, though limited and largely retrospective, suggests that GLP-1 medicines may contribute to weight loss among cancer survivors, with outcomes varying by cancer stage and type of anticancer therapy. It is important for healthcare providers to consider the potential negative impact of these GLP-1 medications on their patients, especially those with cancer cachexia or sarcopenic obesity, as well as those undergoing anticancer treatments that often lead to weight loss. While there is preclinical evidence suggesting that there are weight-loss independent effects that may be beneficial to individuals with cancer, use of GLP-1 medicines in patients of normal weight for reasons other than treatment of type 2 diabetes should be initiated with caution. On the positive side, these agents may help mitigate therapy-related toxicities, such as cardiotoxicity, with the potential to enhance survivorship outcomes. Unfortunately, there is a notable lack of well-designed randomized controlled trials evaluating the effects of GLP-1 medicines on weight loss, clinical endpoints, and cancer-related outcomes. Advancing the field requires a focus on elucidating the interactions between GLP-1 medicines and anticancer therapies, particularly their impact on treatment efficacy, nutritional status, and overall patient outcomes, both during treatment and in the long term. Full article

Background: Legionella pneumophila is a leading cause of community- and hospital-acquired pneumonia (HAP/CAP), although the clinical and radiological features associated with infection remain incompletely defined. This study aimed to identify clinical, comorbidity-related, and chest computed tomography (CT) features associated with L. pneumophila pneumonia in hospitalized adults with community-acquired pneumonia (CAP). Methods: A retrospective case–control study was conducted at a tertiary-care university hospital in Italy between January 2019 and August 2025. Eighty patients positive for L. pneumophila were compared with 79 controls negative for L. pneumophila. Demographic, clinical, microbiological, and radiological data were collected, and factors independently associated with infection were evaluated using multivariable logistic regression analysis. Results: Patients with L. pneumophila infection exhibited a greater comorbidity burden, particularly heart failure, and were more frequently smokers. Bilateral lung involvement and hilar/mediastinal lymphadenopathy were significantly more common among Legionella-positive patients, whereas overall pulmonary complications and bilateral pleural effusion were more frequently observed in controls. Multivariable analysis identified comorbidity burden as an independent positive predictor of L. pneumophila infection, while intensive care unit admission, oxygen therapy, and pulmonary complication score were independently associated with a lower likelihood of infection. Conclusions: The integration of comorbidity assessment with readily available chest CT findings may help raise clinical suspicion of L. pneumophila pneumonia and support consideration of appropriate diagnostic testing. Full article

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease associated with significant physical, psychological, and social distress. Given its terminal nature and high symptom burden, early integration of palliative care is essential. The inpatient Palliative Care Consult Team (PCCT) provides specialist palliative care to hospitalized patients with ALS. Hospitalizations are common throughout the ALS disease trajectory, particularly as patients experience progressive functional decline, respiratory compromise, and increasing care needs, making inpatient encounters important opportunities for specialist palliative care involvement. To extend palliative care beyond the inpatient setting and facilitate earlier involvement, an ALS ambulatory clinic was established in 2018. Despite the importance of palliative care, limited data describes its involvement among hospitalized ALS patients. This retrospective review examines the relationship between the PCCT and ALS patients admitted to a tertiary care facility between 2006–2019. Data collected included patient demographics, referral indications, clinical course, and disposition. Most patients referred to the PCCT had poor functional status and a guarded prognosis at initial consultation. Symptom management and support for complex decision-making were leading reasons for referral. Approximately half of patients died in the hospital within three months of referral. Most deaths occurred within one week, underscoring the importance of timely palliative care. Full article

Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of lung injury. Lung ultrasound (LUS) is progressively reshaping the clinical approach to BPD by enabling radiation-free, bedside, and repeatable assessment of peripheral lung abnormalities throughout the neonatal course. This narrative review examines the current role of LUS in BPD, integrating its pathophysiological basis with the available evidence and distinguishing explicitly between its diagnostic, prognostic, monitoring, and treatment-guiding applications, which are supported by markedly different levels of evidence. We discuss how LUS findings reflect the major components of BPD pathophysiology, compare LUS with conventional imaging modalities, and summarize the scanning protocols, semiquantitative scoring systems, examination schedules, and patient populations that have been evaluated to date. We also review the emerging contribution of artificial intelligence to automated image analysis, standardized image acquisition, and personalized risk prediction. Most of the available evidence is prognostic rather than diagnostic: early LUS scores predict BPD subsequently defined at 36 weeks’ postmenstrual age, whereas LUS has not been validated as a diagnostic test for established BPD, and reported cutoffs remain study- and protocol-specific rather than universally applicable. Randomized evidence is confined to LUS-guided surfactant administration, where the demonstrated benefits concern the timing of treatment and the need for invasive ventilation; no trial has yet shown that LUS-guided management reduces the incidence of BPD. Current evidence supports LUS as a complementary imaging modality that extends beyond the assessment of acute neonatal respiratory disease and enables longitudinal bedside monitoring of peripheral lung aeration. Although further multicenter prospective studies are required to harmonize protocols and validate LUS-guided management strategies, the integration of standardized LUS assessment with emerging artificial intelligence technologies has the potential to establish LUS as a key component of precision respiratory care for infants at risk of BPD. Full article

Background/Objectives: Family dietary imbalance is an important source of the double burden of malnutrition, and dietary arrangements in multigenerational households are often deeply embedded in intergenerational caregiving relationships. However, the cognitive formation mechanism through which dietary caregiving behaviors driven by care and responsibility may instead lead to dietary imbalance still lacks systematic explanation. Therefore, this study aimed to examine the cognitive formation mechanism of dietary imbalance behaviors in Chinese multigenerational households. Methods: This study takes primary dietary caregivers in Chinese three-generation households as the research subjects. It integrates the false consensus effect, cognitive dissonance theory, and the information–motivation–behavioral skills (IMB) model. Based on 467 valid samples, the study conducts empirical analysis using partial least squares structural equation modeling (PLS-SEM) and importance-performance map analysis (IPMA). Results: The results show that caregivers’ subjective judgments about family members’ dietary needs based on their own experience trigger cognitive dissonance and further promote their re-examination of dietary risk information, caregiving responsibilities, and family normative expectations. Among these factors, caregiving responsibilities and subjective norms are key factors in improving dietary regulation self-efficacy, whereas the effect of risk information perception on self-efficacy is not significant. The IPMA results further show that self-efficacy is the most important factor driving the formation of behavioral intention to regulate healthy family diets. Conclusions: This study reveals the psychological mechanism through which dietary imbalance behavior in multigenerational households moves from subjective need judgment to the formation of future regulation intention. It extends the application of the IMB model in family caregiving contexts and provides a theoretical basis and practical implications for the formulation of family health promotion and dietary intervention strategies. Full article

Background: Upper airway tract infections (UATIs) are among the most common infectious diseases worldwide, accounting for an estimated 12.8 billion episodes annually and more than 8 million disability-adjusted life years (DALYs). Despite their generally self-limiting nature, their cumulative clinical, socioeconomic, and public health burden remains substantial, particularly in children, older adults, and low- and middle-income countries (LMICs). Methods: We performed a structured narrative review of the peer-reviewed literature and reports from major international health organizations to summarize the current evidence on the epidemiology, etiology, clinical impact, socioeconomic burden, prevention strategies, and future challenges associated with UATIs. Particular attention was given to the influence of antimicrobial resistance, vaccination policies, and lessons learned from the COVID-19 pandemic. Results: UATIs remain one of the leading causes of healthcare utilization worldwide. Children experience the highest incidence, averaging 6–8 episodes annually, whereas vulnerable populations are at increased risk of complications and hospitalization. Marked geographical disparities persist, with LMICs experiencing a disproportionate burden due to limited healthcare access, lower vaccination coverage, and higher complication rates. Inappropriate antibiotic prescribing continues to accelerate antimicrobial resistance, while the COVID-19 pandemic profoundly altered the epidemiology of respiratory infections and demonstrated the effectiveness of non-pharmaceutical interventions. Advances in vaccination, antimicrobial stewardship, rapid diagnostics, and novel therapeutic strategies offer promising opportunities to reduce disease burden. Conclusions: Reducing the global burden of UATIs requires integrated public health strategies combining equitable vaccine access, effective antimicrobial stewardship, strengthened healthcare systems, and sustained surveillance. Lessons learned from the COVID-19 pandemic provide a unique opportunity to improve preparedness for future respiratory outbreaks while addressing persistent regional inequalities in prevention and care. Full article

Older adults represent a growing proportion of patients presenting with acute coronary syndromes (ACS), yet they remain a highly heterogeneous population in terms of biological reserve, comorbidity burden, functional status, cognitive performance, and recovery potential. Chronological age alone is an insufficient basis for invasive decision-making, as it may lead to both therapeutic nihilism and disproportionate treatment escalation. Frailty has emerged as a clinically meaningful construct that captures vulnerability to acute stressors and may refine prognostic assessment beyond traditional cardiovascular risk scores. In ACS, frailty is associated with mortality, bleeding, procedural complications, delirium, functional decline, readmission, and loss of independence. However, frailty should not be interpreted as an automatic contraindication to invasive management. Rather, it should inform proportional care by integrating ischemic risk, procedural burden, reversibility potential, patient preferences, and expected quality of recovery. This narrative review examines the role of frailty assessment in older adults with ACS, focusing on its implications for invasive decision-making. We discuss frailty tools, clinical outcomes, therapeutic bias, healthcare inequities, and patient-centered endpoints. Finally, we propose a vulnerability-based framework for cardiovascular care, in which frailty guides individualized therapeutic intensity rather than justifying age-based exclusion from evidence-based treatment. Full article

Background: Falls are the most common hospital-acquired adverse event, leading to extended hospitalization, loss of independence, disability, and premature death. Routine fall risk assessments are time-consuming, even with limited factors. An AI-derived fall prediction model can provide more comprehensive and comparably accurate risk predictions quickly and as often as needed. Objective: To develop and validate a fall prediction model for fall risk in adult inpatients. Methods: Patient records from 2016 were extracted from the adult inpatient database, including information from the Electronic Inpatient Medication Records, SAP, and Hospital Incident Reporting System. The sample consisted of 1506 cases (1:5 faller to non-faller). The fall prediction model was trained using the following four variables: demographics, diagnosis, medications, and surgery. Data sources included the hospital’s data repository, integrating admission/discharge, pharmacy, laboratory, and incident reports. Results: The support vector machine model performed best among all tested models, achieving an AUC of 0.803, recall of 0.816, and precision of 0.440. In the validation cohort (978 patients: 163 fallers and 815 non-fallers), the fall prediction model demonstrated moderate-to-good discrimination (AUC 0.79), with accuracy of 0.67, sensitivity of 0.46, and specificity of 0.86. Compared with the nursing four-item fall risk assessment, which showed lower discrimination (AUC 0.65, accuracy 0.65, sensitivity 0.58, specificity 0.72), the fall prediction model had better specificity and overall discrimination, though the nursing tool was more sensitive in identifying fallers. Conclusions: The fall prediction model using demographics, diagnoses, medication, and surgery data predicts falls risk effectively. It enables timely, accurate risk assessments and supports preventive interventions, saving nurses’ time for direct patient care. Full article

Background: Lung cancer remains the leading cause of cancer-related mortality in the United States, characterized by poor overall survival rates (OS), particularly for advanced-stage disease. While smoking is a primary risk factor, other contributors include environmental exposures, genetics, comorbidities, and socioeconomic factors. Methods: We included 232 patients with lung cancer (96% NSCLC). Patients were categorized into DNA damage response (DDR)-mutant (DDR^mt, n = 67, 29%) and DDR-wild-type (DDR^wt, n = 165, 71%) groups. We evaluated the correlations between individual and socioeconomic factors between DDR^mt and DDR^wt lung cancer patients. Results:Nineteen DDR genes were identified, with ARID1A(31.3%), CHEK2 (19.4%), ATM (14.9%), BRCA2 (14.9%), ATRX (11.9%), MUTYH (11.9%), ATR (8.9%), and MSH6 (5.9%) being the most common. The DDR^mt group had a significantly higher median tumor mutational burden (TMB) (12 vs. 9; p = 0.006) and a higher prevalence of adenocarcinoma (85.1% vs. 64.8%, p = 0.003). Logistic regression identified adenocarcinoma histology (OR = 10.03, p = 0.002) and lower area deprivation index (OR = 0.98, p = 0.04) as predictors of DDR mutation status. Having advanced stage at diagnosis was associated with, age (p = 0.03), lack of lung cancer screening (p < 0.001), and adenocarcinoma histology (p < 0.001). While median OS was 61 months for the DDR^mt group vs. 44 months for the DDR^wt group (p = 0.654), patients with ATR mutations had significantly shorter survival (13 vs. 67 months; p = 0.0008). Population-level factors, including food insecurity (HR = 2.33, p = 0.002), lack of insurance (HR = 2.39, p = 0.008), and proximity to potential chemical accidents (HR = 1.73, p = 0.037), were significant predictors of OS. Conclusions: These findings suggest that DDR^mt lung cancers represent a biologically distinct subgroup characterized by higher tumor mutational burden and enrichment for adenocarcinoma histology; however, DDR mutation status alone was not associated with overall survival. Instead, outcomes appeared to vary by individual DDR gene, with ATR alterations identifying a subgroup with particularly poor survival. In parallel, food insecurity, lack of insurance, and proximity to potential environmental hazards were associated with outcomes, highlighting the need to integrate genomic biomarkers with social and environmental determinants of health. These data suggest the need for future prospective studies incorporating treatment-response data, longitudinal social determinants of health (SDOH) assessment, and environmental exposure measures to define how DDR alterations can guide precision oncology strategies while addressing modifiable barriers to equitable cancer care. Full article

Refugees and asylum seekers in Germany face significant barriers to accessing routine dental care, leading to untreated conditions that escalate into costly emergency hospital admissions and increased public healthcare expenditures. This study evaluates the economic impact of an NGO-led dental care facility designed to address this critical gap in care for uninsured populations. Using a retrospective cost-effectiveness analysis, we compare three scenarios: (1) the NGO intervention, (2) the “status quo” reliance on emergency care, and (3) a dental clinic arm-based model. We test the hypothesis that NGO-led interventions reduce public healthcare costs by curbing preventable emergency admissions, thereby addressing systemic policy and market failures. Results demonstrate that the NGO facility is a cost-effective solution, generating a return of €0.60 for every euro invested, while the alternative scenarios yielded no financial returns. By providing equitable, preventive dental care, the NGO model reduced emergency admissions by addressing delayed treatment-seeking behaviors and structural access barriers. These findings confirm that NGO-led interventions can mitigate market failures by serving as a Pareto-improving solution, optimizing resource allocation and reducing long-term fiscal burdens. The study underscores the potential of NGOs to complement public health systems in achieving equitable and sustainable healthcare delivery. Policymakers should consider scaling such models to alleviate disparities in underserved populations while curbing avoidable costs linked to emergency care. This research contributes critical evidence for integrating NGO-led initiatives into healthcare strategies, particularly in contexts marked by fragmented access and systemic inefficiencies. Full article

Background/Objectives: Sciatica and hip osteoarthritis (OA) are common causes of lower extremity pain and functional impairment. Because both conditions may produce overlapping symptoms, distinguishing them can be challenging. Misdiagnosis may lead to inappropriate treatment, delayed intervention and unnecessary procedures. In addition, the frequent coexistence of hip and lumbar degenerative pathology, commonly referred to as hip–spine syndrome, further complicates diagnostic evaluation. This review aims to examine current diagnostic strategies used to differentiate lumbar radiculopathy from hip OA and to introduce the Athena Sign, which is presented as a preliminary, hypothesis-generating clinical observation requiring prospective validation. Methods: A narrative review of the literature was performed focusing on the pathophysiology, clinical presentation, differential diagnosis, physical examination and imaging evaluation of sciatica and hip OA. Particular emphasis was placed on clinical examination techniques and diagnostic injections used to identify the primary pain generator. Results: Both conditions share overlapping symptom patterns and inflammatory mechanisms, which may obscure the source of pain. Careful assessment of gait, hip range of motion, neurological findings and provocative maneuvers remains essential for accurate diagnosis. Imaging findings should be interpreted in conjunction with clinical examination due to the high prevalence of asymptomatic degenerative changes. The Athena Sign, observed with internal and external rotation of the hips in a prone position with the knee flexed, is associated with anterior intra-articular hip pathology and may provide an additional diagnostic indicator in patients with ambiguous hip–spine presentations. Conclusions: A systematic diagnostic approach integrating clinical examination, imaging and targeted diagnostic injections is essential for distinguishing between lumbar radiculopathy and hip OA. Recognition of dynamic clinical findings such as the Athena Sign may further improve diagnostic accuracy and guide appropriate management in patients presenting with overlapping hip and lumbar symptoms. Full article

Introduction: Melanoma is a chronic disease that significantly affects patients’ daily functioning and emotional well-being. Beyond its somatic burden, it often leads to substantial changes in quality of life (QoL). This study aimed to assess illness acceptance among melanoma patients and examine its associations with selected clinical characteristics (disease stage, pruritus and time since diagnosis), psychological distress (depression and anxiety) and QoL. Materials and Methods: A cross-sectional study was conducted between June 2025 and February 2026 at two tertiary oncology centers in Poland. Initially, 191 consecutive melanoma patients were recruited, of whom 162 (58.6% men; mean age 59.8 ± 13.7 years) were included in the final analysis (response rate: 84.8%). Participants completed validated questionnaires assessing illness acceptance (Acceptance of Illness Scale (AIS)), depression (PHQ-9, HADS-D), anxiety (GAD-7, HADS-A), and QoL (DLQI). Statistical analyses were performed, with p < 0.05 considered statistically significant. Results: The mean AIS score was 13.28 ± 7.50 points, indicating a remarkably low level of illness acceptance. In the multivariable linear regression analysis, greater depressive symptoms (HADS-D: β = −1.16, 95% CI −1.79 to −0.54; p < 0.001) and more advanced melanoma stage (β = −1.52, 95% CI −2.92 to −0.12; p = 0.034) were independently associated with lower illness acceptance. In addition, illness acceptance showed significant correlations with depressive symptoms, anxiety symptoms, and dermatology-related QoL, whereas no significant associations were observed with most evaluated demographic and clinical variables. Conclusions: Patients with melanoma demonstrated remarkably low illness acceptance. Depressive symptoms and more advanced melanoma stage were independently associated with lower illness acceptance. These findings support the integration of psychological assessment into comprehensive melanoma care. Full article