Search Results (21,408)

Background: Angling-related injuries include acute trauma and chronic overuse conditions, but detailed clinical descriptions of different injury mechanisms remain limited. This retrospective case series presents four clinically distinct injuries associated with recreational and sport angling. Methods: Four purposively selected patients were recruited between 6 November 2025 and 30 April 2026 through questionnaires, angling forums, events, and regional angling associations. All provided written informed consent and sufficient medical documentation. Clinical data were obtained from participant-provided medical documentation, imaging reports, and interviews, with follow-up varying according to the clinical course. Results: Cases included high-velocity open-globe ocular trauma, a penetrating palmar injury caused by a baiting needle, a penetrating finger injury caused by a large barbed double hook, and rotator-cuff tendinopathy with lateral epicondylitis in the context of high angling exposure. Management included surgery, antimicrobial treatment, rehabilitation, and load modification. Outcomes ranged from substantial visual recovery to persistent scar-related hand limitation and improvement in overuse symptoms. Conclusions: These cases illustrate projectile, penetrating, and repetitive-load injury mechanisms associated with angling and support clinical awareness, careful assessment of equipment-related trauma, and activity modification and rehabilitation in overuse conditions. Preventive measures discussed should be regarded as clinical considerations and hypotheses for further study rather than interventions of established effectiveness. Full article

Background: Family and community are key support sources for children and adolescents with chronic illnesses. This study aimed to map the characteristics of family- and community-centered interventions for pediatric chronic somatic disease. Methods: This scoping review followed the Arksey and O’Malley guidance. Through a systematic search in Medline (PubMed), EMBASE, PsycINFO, Cochrane, and CINAHL, free web sources, the gray literature, and citations, we identified publications of randomized controlled trials evaluating family- and community-centered interventions for children aged 0–17 years with asthma, type 1 diabetes, or juvenile idiopathic arthritis. Two or more reviewers independently conducted screening, verification of machine-assisted data extraction, risk-of-bias assessment, and narrative synthesis. Results: Of 7285 items identified, we included 76 publications on 71 interventions comprising 16,342 participants (median n = 157; IQR 81–303; range 12–1316) with a median age of 9 (range 0–19) years. Interventions incorporating educational, psychosocial, and care-coordination elements targeted asthma (68%), type 1 diabetes (29%), and juvenile idiopathic arthritis (3%) that had lasted ≤6 months (63%) and were delivered in person (83%) by healthcare professionals (62%). Primary outcomes included symptom burden (44%), coping with the disease (24%), disease control (20%), activity participation, child psychosocial functioning, medication or healthcare use (18% each), or child quality of life (17%). Usual care (59%) and other treatment (31%) were frequent comparators. Conclusions: Most interventions were short-term, healthcare professional-led multicomponent programs compared with usual care. Primary outcomes targeted symptom management and disease control. Mixed diagnoses, peer support, family activities, and non-professional delivery were uncommon. This study identified gaps in diagnosis coverage and the need for additional high-quality studies. Full article

The war in Ukraine, beginning in February 2022, disrupted continuous medical care for Ukrainian childhood and adolescent cancer patients (UCC), many of whom were relocated to pediatric cancer centers worldwide, including Switzerland. In this Brief Report, we describe their health-related quality of life (HRQoL) after arrival. In a multicenter, cross-sectional survey across five Swiss pediatric oncology centers, we included patients ≤18 years at diagnosis who arrived after 24 February 2022 and were undergoing active treatment. HRQoL was assessed by the PedsQL™ 4.0 Generic Core Scales (self- and parent-reports). Fourteen of 23 eligible families (61%) participated. HRQoL declined with age, particularly in physical functioning, while psychosocial functioning remained relatively stable but lower among adolescents; parent scores closely matched self-reports. Scores were referenced against a published cohort of healthy Ukrainian children and previously reported pediatric cancer populations. Given the small sample and lack of a matched control group, the findings cannot separate the effects of displacement, cancer, and treatment and are hypothesis-generating. They suggest a potential role for age-tailored supportive care in displaced children with cancer and call for larger, controlled studies. Full article

Background: Obesity is a complex, chronic disease with metabolic complications. Many patients respond suboptimally to conventional interventions like the hypocaloric Mediterranean diet (MD), highlighting the need to investigate alternative supervised nutritional strategies in patients with an insufficient response to conventional dietary treatment. Objectives: This study aimed to evaluate the KETOCOMP (Food-Based KETOgenic Nutritional Protocol for Patients with COMPlicated Obesity), a medically and dietitian-supervised, food-based sequential ketogenic nutritional protocol consisting of a ketogenic phase followed by controlled carbohydrate reintroduction, for improving anthropometric and body composition in patients with complicated obesity who were non-responsive to conventional dietary treatment. Methods: In this longitudinal, observational study, adult patients with obesity/overweight and metabolic comorbidities, previously non-responsive to a hypocaloric MD, were identified. Patients followed a 4-week food-based ketogenic diet (approx. 1200 kcal/day, <20 g carbohydrate, CHO) followed by a 4-week low-carbohydrate reintroduction phase (approx. 1300 kcal/day, up to 100 g CHO). Anthropometric and body composition parameters were assessed at baseline (T0), after the MD (T1), after the ketogenic phase (T2), and after the low-carbohydrate phase (T3). Intra-subject comparisons were performed. Results: Across the entire observed nutritional pathway (T0–T3), body weight (BW), body mass index (BMI), and fat mass (FM) decreased by 7.7%, 9.45%, and 23.1%, respectively. Using T1 as the relevant baseline for the second-line KETOCOMP sequence, mean BW and FM decreased by 7.79 kg and 6.29 kg, respectively, from T1 to T3; during the ketogenic phase alone (T1–T2), BW decreased by 6.10 kg and FM by 4.80 kg. Body Cell Mass (BCM) and Phase Angle (PhA) showed no statistically significant changes during the ketogenic and carbohydrate-reintroduction phases, whereas Fat-Free Mass (FFM) decreased significantly. Significant reductions in waist and hip circumferences (WC, HC) were also observed. No serious adverse events were documented among included participants; however, discontinuation rates could not be assessed because completion through T2 formed part of cohort selection. Conclusions: The KETOCOMP protocol may represent a clinically applicable second-line nutritional strategy for patients with obesity and metabolic complications who respond suboptimally to conventional dietary treatment. The observed reductions in body weight and fat mass, together with the absence of significant changes in BCM and PhA, suggest a favorable short-term change in body composition. However, larger prospective controlled studies incorporating standardized clinical and biochemical safety monitoring and direct assessment of skeletal muscle are required to confirm these findings and evaluate longer-term outcomes. Full article

Background and Clinical Significance: Epstein–Barr virus (EBV) is a common infection that rarely causes acute pancreatitis. EBV-associated acute pancreatitis is an uncommon but potentially serious complication that may result from direct viral invasion of pancreatic tissue or immune-mediated inflammation. Because its presentation can overlap with other causes of acute pancreatitis, EBV may be overlooked when common aetiologies are not identified. Recognising EBV as a potential cause is important for accurate diagnosis and appropriate management, particularly in patients presenting with pancreatitis alongside features of acute EBV infection; Case Presentation: We report a case of 58-year-old female with EBV-induced acute pancreatitis. She had a flu like illness two weeks prior to hospital admission, tested positive for EBV IgM antibodies and received supportive treatment by her general practitioner. However, her condition deteriorated, leading to hospital admission. She developed epigastric pain and investigations showed elevated serum lipase, impaired liver function tests and acute kidney injury. CT abdomen showed hepatosplenomegaly, lymphadenopathy and peripancreatic oedema consistent with acute pancreatitis. She was initially treated with antibiotics, however; her condition worsened and she developed severe hypotension requiring intensive care admission. Aggressive fluid resuscitation, inotropic support and continuous veno-venous haemofiltration (CVVH) were required. She gradually improved and subsequently was stepped down to the medical ward for supportive care and rehabilitation. She made full recovery and was discharged home after a 6-week length of stay; Conclusions: EBV-associated acute pancreatitis is an uncommon but potentially severe complication of EBV infection. EBV should be considered in patients with acute pancreatitis when common aetiologies have been excluded, particularly when pancreatitis occurs alongside features of acute viral infection. Early recognition and appropriate supportive management may be important in preventing or limiting severe complications. Full article

Background: Premenstrual disorders (PMDs), including premenstrual syndrome and premenstrual dysphoric disorder, are common conditions that may substantially affect adolescents’ physical and psychological well-being. However, their presentation and management during adolescence are complicated by reproductive-axis maturation, overlap with other medical conditions, and limited adolescent-specific evidence. This review aimed to provide an interdisciplinary perspective on PMDs in adolescents, integrating biological, psychological, developmental, clinical, and sociocultural aspects. Methods: A structured narrative review was conducted. Publications addressing the neuroendocrine and developmental mechanisms, clinical manifestations, psychosocial consequences, diagnosis, and treatment of PMDs were considered, with adolescent-specific evidence prioritized where available. Results: Current evidence suggests that PMDs are associated with altered sensitivity to physiological ovarian steroid fluctuations and their neuroactive effects rather than abnormal circulating hormone concentrations alone. In adolescents, PMDs may present with diverse somatic, affective, cognitive, and behavioral symptoms and are associated with impaired quality of life, school functioning, interpersonal relationships, and psychological well-being. Diagnostic assessment remains challenging because symptoms may overlap with normal pubertal changes and psychiatric disorders. Prospective monitoring of symptom cyclicity and functional impairment is therefore essential. Pharmacological treatments, particularly selective serotonin reuptake inhibitors and selected combined oral contraceptives, represent important therapeutic options, while psychological, lifestyle, physical activity, and physiotherapeutic interventions may provide additional benefits. However, most treatment evidence is derived from adult populations. Conclusions: PMDs in adolescents should be conceptualized as multidimensional conditions requiring an interdisciplinary approach integrating gynecological, psychiatric, psychological, endocrinological, primary care, and lifestyle perspectives. Greater recognition and developmentally appropriate assessment may facilitate earlier diagnosis and individualized management. Further prospective, adolescent-specific research is needed to clarify the biological and psychosocial determinants of PMDs and establish evidence-based strategies for their multidisciplinary management. Full article

Background/Objectives: Our objective was to compare clinical outcomes of the Hydrus^® Microstent implantation combined with cataract surgery in eyes with pseudoexfoliation glaucoma (PXG) and primary open angle glaucoma (POAG). Methods: This retrospective, single-center comparative cohort study included eyes with POAG or PXG undergoing combined cataract surgery and Hydrus^® Microstent implantation between June 2021 and December 2025 at the University Eye Hospital of the Ludwig Maximilian University in Munich, Germany. Clinical outcomes were evaluated until 8–14 months after surgery. Results: A total of 74 eyes were included, comprising 49 POAG eyes and 25 PXG eyes. After cataract surgery plus Hydrus^® Microstent, IOP decreased significantly in both groups from baseline to the final 8–14-month follow-up (POAG: 17.6 ± 3.9 to 13.8 ± 2.3 mmHg, p < 0.0001; PXG: 19.2 ± 4.3 to 14.6 ± 2.7 mmHg, p < 0.0001). The magnitude of IOP reduction did not differ between groups (p = 0.410). Meanwhile, the number of IOP-lowering medications decreased significantly in both groups with no between-group difference (POAG: −1.20 medications; PXG group −1.09 medications, p = 0.724). Surgical success rates were comparable. Conclusions: Hydrus^® Microstent implantation combined with cataract surgery showed comparable surgical outcomes in POAG and PXG eyes. Regardless of the more aggressive disease characteristics of PXG, no significant differences were observed between PXG and POAG eyes regarding IOP reduction, medication burden, BCVA, surgical success, complications or safety outcomes. These findings suggest that combined cataract surgery and Hydrus^® Microstent implantation may be a useful treatment option in selected patients with PXG. Full article

Background and Objectives: Psychogenic erectile dysfunction (ED) is a distinct clinical condition characterized by predominant psychological or relational factors. Despite its prevalence, diagnostic criteria remain heterogeneous and are often based on exclusion of organic causes. Current guidelines recommend cognitive behavioral therapy (CBT), eventually combined with medical therapy such as phosphodiesterase type 5 inhibitors (PDE5i), as first-line treatment. However, evidence regarding alternative conservative and surgical therapies remains limited. This narrative review aims to evaluate the available evidence on these treatments in psychogenic ED. Materials and Methods: A comprehensive literature search was conducted in PubMed, Scopus, and MEDLINE using MeSH terms and free-text keywords related to psychogenic ED and therapeutic interventions. Eligible studies included those involving human subjects, published in English, and reporting outcomes specifically for psychogenic or non-organic ED. Reviews, case reports, and non-full-text articles were excluded. Study selection and data extraction were performed independently by two authors. Due to heterogeneity, a narrative synthesis was conducted. Results: Evidence on alternative therapies is limited and heterogeneous, with many studies predating the 2000s. Vacuum erection devices (VEDs) may improve outcomes, particularly when combined with psychotherapy. Constriction rings showed promising preliminary results. Acupuncture demonstrated inconsistent efficacy, although recent randomized trials suggest potential benefits. Intracavernosal injections (ICI) showed favorable outcomes, particularly in patients refractory to first-line therapies, with some reports of restored spontaneous erections. Penile prosthesis (PP) implantation remains underexplored in contemporary literature on psychogenic ED; however, recent evidence reports good satisfaction rates. Conclusions: Beyond CBT and PDE5i, evidence for alternative treatments in psychogenic ED is scarce and methodologically limited. Selected patients may benefit from adjunctive therapies, including VED, ICI, and acupuncture, while PP can be considered a definitive treatment option. Further well-designed studies are needed to clarify their role within a structured, evidence-based management approach. Full article

Background: Despite the rapid proliferation of mobile health applications in oncology, real-world uptake, determinants of use, and patient needs among breast cancer patients remain insufficiently described, particularly in the German healthcare context. This study aimed to assess health app use in breast cancer patients and to identify sociodemographic, lifestyle, and psychosocial correlates. Methods: We conducted a non-interventional, cross-sectional, anonymous paper-based survey among adult breast cancer patients receiving outpatient, day-care, or inpatient treatment, or follow-up at a tertiary university hospital (July 2022–January 2023). Descriptive statistics and group comparisons with false discovery rate correction and multivariable logistic regression were used to examine associations between app use and sociodemographic, lifestyle, and psychosocial variables. Results: A total of 202 patients were included (mean age 56.4 ± 13.8 years). Health app users were significantly younger than non-users (51.7 ± 11.0 vs. 64.7 ± 13.8 years, p < 0.001, Cohen’s d = 1.08). Age was the only variable that was independently associated with the use of health apps in the multivariable analysis (adjusted OR 0.43 per 10 years, 95% CI 0.29–0.64). Health app use showed no significant associations with indicators of physical fitness or lifestyle, perceived social support, or emotional burden. Health and fitness apps were the most frequently used app category (77.4%). Physicians were the most frequently consulted source of medical information (77.6%), and only one participant reported having received a digital health application on prescription. Conclusions: In this breast cancer cohort, health app use was common and age-associated. Given patients’ reliance on physicians and the near-absent DiGA prescription rate, age-sensitive implementation strategies and structured clinician guidance are needed to support equitable digital engagement in breast cancer care. Full article

The role of hospital pharmacists is broadening from primarily operational responsibilities towards greater involvement in clinical and research activities. Poland’s growing position in the clinical-trials sector and recent legislative changes create new opportunities for pharmacists to manage investigational medicinal products (IMPs) and contribute to multidisciplinary research teams. This narrative review and commentary, based on 27 sources, examines pharmacists’ roles and contributions in clinical trials. The reviewed literature describes pharmacists as contributors to medication safety, pharmacovigilance, drug-interaction assessment, IMP management, and maintenance of blinding. Their involvement may also support protocol adherence, patient education and participant care; however, the available evidence does not yet permit firm conclusions regarding its impact on medication-error rates, treatment adherence, recruitment, dropout rates, or clinical outcomes. In oncology and advanced therapy medicinal product (ATMP) trials, pharmacists may provide specialised expertise in complex medication-management and logistical processes. Nevertheless, a gap appears to persist in Poland between pharmacists’ professional readiness and their practical involvement in clinical research. Key barriers include minimum staffing requirements, insufficient protected research time and organisational constraints. Hospital pharmacists therefore represent a valuable but underused resource in clinical research. Appropriate training, institutional support, dedicated research time, and regulatory development could facilitate their broader participation in clinical-trial conduct and enable future evaluation of their effects on trial quality and participant safety. Full article

The accurate placement of lines, drains, and airways (LDAs) is essential for the safe management of critically ill patients, as malpositioned medical devices can result in severe complications ranging from ineffective treatment to life-threatening injury. Chest radiography (CXR) is the primary imaging modality for confirming the placement of many LDAs; however, the growing volume and complexity of bedside CXRs have created increasing demand for rapid, reliable interpretation. Recent advances in artificial intelligence (AI) have enabled automated detection, localization, and position assessment of LDA devices, supporting opportunities to improve clinical workflow and patient safety. This review summarizes recent developments in AI algorithms for automated LDA assessment on CXRs, emphasizing their clinical applications, technical approaches, performance, and limitations. The review begins with clinical characteristics, radiographic appearance, and placement criteria of common LDA categories, followed by a survey of AI methods for presence detection, device localization, and position classification. Although some models have achieved performance approaching that of radiologists, most do not perform at the level needed for clinical deployment. Future research should prioritize multicenter validation, standardized annotation protocols, pediatric-specific datasets, and anatomically informed models capable of simultaneously evaluating multiple LDA devices. Advances in these areas will facilitate the integration of AI-assisted LDA assessment into clinical decision support and ultimately improve patient care. Full article

Colles fracture is a common type of wrist fracture, typically resulting from falling onto an outstretched hand. Postoperative patients often require long-term self-rehabilitation to restore wrist function. However, traditional rehabilitation relies on medical personnel and lacks real-time feedback and progress tracking, which may lead to poor rehabilitation or even deterioration of the condition. This article proposes an intelligent wearable system based on edge computing to enhance the efficiency of self-rehabilitation, improve system portability, and ensure comprehensive recording of rehabilitation data. The system performs real-time data processing and feedback to assist patients and healthcare providers in monitoring rehabilitation progress and optimizing recovery outcomes. The proposed system integrates an STM32 microcontroller, NanoEdge AI, and a 9-axis inertial sensor to detect and evaluate the accuracy of hand rehabilitation movements, ensuring the precision of self-rehabilitation. All rehabilitation movements are schemed under the guidance of professional physicians to ensure correctness and minimize the risk of secondary injuries caused by improper rehabilitation. Data such as motion records, training duration, and count are transmitted via Bluetooth to the Local database for further analysis. A custom web interface allows healthcare providers to monitor and analyze collected data. This approach improves diagnostic accuracy, supports personalized rehabilitation recommendations, and improves treatment outcomes and patient recovery success rates. Full article

Background: Chronic coronary syndrome (CCS) remains a major cause of morbidity and mortality worldwide, and real-world data on outpatient management are limited. Methods: In total, 697 patients with previously diagnosed CCS who visited outpatient cardiology clinics at 25 centers in Turkey between June 2023 and December 2023 were prospectively enrolled and followed up for 12 weeks. Demographic and clinical characteristics, diagnostic and therapeutic strategies, a modified questionnaire derived from the Seattle Angina Questionnaire (modified SAQ-based questionnaire), and clinical outcomes were recorded. Results: The most common diagnostic modalities were exercise stress testing (31.6%) and coronary angiography (38.2%). Medical therapy (58.5%) was preferred over interventional treatment (41.5%). Among patients who were not receiving the respective medication at baseline, beta-blockers (61.8%), statins (46.5%), and ranolazine (40.4%) were the most commonly newly initiated medications. Patients in the intervention group were younger, were more frequently current smokers, had greater nitrate use, and had lower ejection fraction than those in the medical treatment group. Patient-reported responses to the modified SAQ-based questionnaire shifted toward less functional limitation, lower angina burden, and better perceived quality of life over the 12-week follow-up. Conclusions: Medical therapy was the predominant management strategy for CCS in Turkey. The observed diagnostic and therapeutic patterns reflect real-world management of patients with established CCS, with substantial use of invasive coronary angiography and high baseline utilization of guideline-directed medical therapies. Full article

Purpose: We aimed to compare the real-world effectiveness of four myopia-control spectacle lens interventions for childhood myopia control using a doubly robust causal inference framework. Design: This was a retrospective cohort study with multi-treatment augmented inverse probability weighting. Participants: A total of 2764 myopic children (right eyes) aged 3–18 years were included, screened from 13,071 electronic medical records at Ineye Hospital, Chengdu University of Traditional Chinese Medicine, between January 2023 and January 2026. Methods: Participants were allocated to four myopia-control spectacle lens groups and one single-vision spectacle lens group: Higher-Order Aberration Defocus (n = 912), Defocus Incorporated Multiple Segments (n = 800), Highly Aspherical Lenslets (n = 476), Diversified Segmental Defocus Optimization (n = 238), and single-vision lenses (n = 338). A doubly robust estimator combining multinomial propensity-score weighting with outcome regression was applied to adjust for confounding. Outcome Measures: The primary outcomes were one-year changes in axial length and spherical equivalent. The secondary outcomes were the rates of rapid progression. Treatment-effect heterogeneity was explored across prespecified baseline age, refractive error, and axial length subgroups. Results: After adjustment, all four myopia-control designs significantly outperformed single-vision correction (p < 0.05). The design based on Higher-Order Aberration Defocus demonstrated the greatest efficacy, with an axial length change of 0.107 mm and a spherical equivalent change of −0.146 D. Within this group, 25.5% of children exhibited rapid axial elongation (≥0.36 mm/year) and 8.3% exhibited rapid myopic progression (≥−0.50 D/year). The treatment effect was statistically significant in children with low myopia or an axial length no greater than 26 mm (p < 0.05), but not in those with high myopia or pathological axial elongation. Conclusions: All four myopia-control spectacle lens designs demonstrated significant advantages over single-vision correction in real-world clinical practice. Particular emphasis should be placed on the role of myopia-control spectacles during the early stages of myopia. As myopia progresses to high myopia or pathological axial elongation, the efficacy of myopia-control spectacle lenses as a standalone intervention diminishes, and combined approaches incorporating multiple myopia management strategies may be warranted. Full article

Three-dimensional medical image segmentation is critical for clinical diagnosis and treatment planning. Medical images typically exhibit heterogeneous characteristics of low inter-slice resolution and high in-plane resolution, leading 3D CNNs to lose fine edge details via cross-slice feature averaging and traditional 2D slice-based methods to produce discontinuous results due to neglected inter-slice spatial relationships. Multi-view learning shows potential in addressing these issues but lacks sample-adaptive dynamic consistency awareness, as conventional fixed-weight fusion cannot adaptively calibrate view discrepancies for heterogeneous medical data. To tackle this, we propose a dynamic consistency-aware multi-view framework enhanced with SAM3 for 3D medical image segmentation. The framework embeds pairwise cross-view similarity-driven dynamic gating into the multi-view pipeline: decomposing 3D images into three orthogonal views, extracting fine-grained features with a frozen SAM3 encoder, and using a dynamic consistency-aware fusion module that computes pairwise view similarity to dynamically calibrate resolution-induced discrepancies, capture inter-slice and cross-view spatial dependencies, and reconstruct unified 3D features, which are then mapped to segmentation masks via a decoder. Experiments on Automated Cardiac Diagnosis Challenge (ACDC) and infrapatellar fat pad (IPFP) datasets demonstrate that our method achieves superior segmentation accuracy over state-of-the-art approaches, with promising technical performance that supports further multicenter prospective clinical validation. Full article