Search Results (6,316)

Background: Rheumatic diseases (RDs) are associated with increased cardiovascular morbidity, including a 40% higher risk of atrial fibrillation (AF). While ablation has become the cornerstone of rhythm control, its safety in patients with rheumatic diseases remains poorly defined. Methods: Adults with a primary admission diagnosis of AF catheter ablation from 2016 to 2022 were identified using the National Inpatient Sample. We excluded patients with other forms of supraventricular tachycardia, pacemaker/defibrillator procedures, and atrioventricular junction ablations. Sociodemographic, clinical characteristics, and outcomes were compared between groups. Multivariate logistic regression adjusted for age, race, sex, and potential comorbid confounders was used to assess for independent associations. Results: A weighted total of 48,855 patients were included, 2.5% of which had RD. These patients were predominantly female, older, and had higher rates of renal dysfunction, hypertension, heart failure, history of stroke, ischemic heart disease, heart failure, and obstructive sleep apnea (all p < 0.001). Patients with RD had higher complication rates (12.9% vs. 8.8%, p < 0.001); specifically, bleeding (p < 0.001), infection (p = 0.008), pericardial (p = 0.003), and respiratory complications (p < 0.001). RDs were not found to be an independent predictor of complications, though there was a trend towards more complications (odds ratio 1.43, 95% confidence interval 0.97–2.11, p = 0.070). Conclusions: Patients with RD undergoing AF ablation were older, female, and had higher rates of comorbidities. This translated to higher unadjusted periprocedural complications in patients with rheumatic diseases. While RDs were not independently associated with adverse outcomes, a trend towards increased complications was observed. Full article

The Paleoproterozoic represents a pivotal but poorly constrained interval in the tidal evolution of the Earth–Moon system. Quantifying Earth–Moon orbital parameters over this interval is fundamental for predicting the long-term dynamical evolution of the Earth–Moon system, yet direct geological evidence remains scarce. In this study, we conducted cyclostratigraphic analyses of the middle and upper members of the Dagushi Formation on the southern margin of the North China Craton, using high-resolution magnetic susceptibility (MS) and phosphorus (P) data as paleoclimate proxies. By employing two independent astrochronologic approaches—the main obliquity estimation method ($k+s_3$) and Bayesian inversion (TimeOptMCMC)—we reconstructed key parameters of the Earth–Moon system, including the precession constant k, Earth–Moon distance, and length of day (LOD). The $k+s_3$ approach yields $k=98.12\pm 1.07$ arcsec/yr, from which the Earth–Moon distance is derived as 329,732 (+888/−877) km, with a LOD of $17.69\pm 0.08$ h. In contrast, the TimeOptMCMC method produces $k=95.20\pm 1.68$ arcsec/yr, implying an Earth–Moon distance of 331,292 (+1446/−1418) km, with a LOD of $17.91\pm 0.13$ h. The MS and P indicators exhibit remarkable symmetry and phase synchronicity between their curves in both depth and time domains, serving as a robust indicator of stable sedimentation and primary depositional signals. These results provide direct geological constraints on Earth–Moon system parameters at ∼1787 Ma, contributing to a refined understanding of its tidal evolution during the Paleoproterozoic. Full article

Background/Objectives: The NETest is a blood-based, machine learning-enhanced multigene transcript assay designed to detect and monitor neuroendocrine tumors (NETs). This study evaluated the accuracy of the recently validated NETest2.0^® (2025) to (1) detect the presence of disease and (2) assess its utility as a clinically meaningful tool for monitoring NET status across diverse patient cohorts, including post-surgical surveillance, observation (“watch-and-wait”), and treatment settings. Methods: This registry study (NCT02270567) evaluated two objectives. For Objective 1, 1290 samples from 886 patients, of which 404 had paired follow-up samples, were analyzed for concordance between NETest2.0^® and imaging-detectable disease. For Objective 2, paired blood samples (n = 404; median interval 7 months [IQR 4–13.8]) from NET patients across specialized centers were assessed. NETest2.0^® scores were correlated with clinically adjudicated disease status using imaging as the comparator. Cohorts included post-surgical residual disease detection (n = 71), post-surgical recurrence monitoring (n = 44), observation (n = 72), and treatment monitoring (n = 217; somatostatin analogs, PRRT, and other therapies). Analyses were performed by cohort and in aggregate. Results: For Objective 1, NETest2.0^® (cut-off ≥ 50) demonstrated an AUC of 0.96, sensitivity of 91.9%, specificity of 94.9%, PPV of 98.4%, NPV of 77.1%, and overall accuracy of 92.5%. Performance was consistent across tumor grades and sites. For Objective 2, 286 patients (70.8%) were stable, and 118 (29.2%) had progression or recurrence. NETest2.0^® score changes correlated significantly with outcomes: scores decreased in stable patients (median −14.6%) and increased in progressive disease (median + 15.4%; p < 0.0001). Any increase (>0%) in score was associated with progression. Diagnostic performance for detecting progression reached a sensitivity of 78.0%, specificity of 98.3%, PPV of 91.1%, NPV of 90.2%, and accuracy of 83.9%. Conclusions: NETest2.0^® accurately detects disease and provides a clinically actionable tool for monitoring NETs. Its high specificity and predictive performance support risk-adapted surveillance, potentially reducing unnecessary imaging while identifying early progression across diverse clinical settings. Full article

Background/Objectives: Congenital heart defects (CHDs) are associated with disruptions in one-carbon metabolism. In a family-based trio design, we investigated whether plasma concentrations of choline, betaine, and folate are associated with CHD severity. Methods: The study included 72 children with CHD, 69 of their mothers and 64 of the fathers. CHD clinical severity was classified according to the European network of population-based registries for the epidemiological surveillance of congenital anomalies (EUROCAT) system and the German PAN study (Prevalence of Congenital Heart Defects in Newborns). Concentrations of choline, betaine, and folates were quantified in plasma and urine samples from a subgroup of the participants. Results: The children [mean (SD) age 3.1 (3.2) years, 59.7% males] presented with varying CHD severities according to EUROCAT (62.5% severe and 37.5% mild) and PAN classifications (45.8% severe, 30.6% moderate and 23.6% mild). The means (SD) of plasma concentrations of choline were 14.0 (10.0) µmol/L in the children, 9.5 (5.1) µmol/L in the mothers and 10.3 (5.4) µmol/L in the fathers. Plasma choline concentrations < 10 µmol/L were observed in 38 mothers (66.7%) and were associated with having a child with severe CHD [adjusted odds ratio (aOR) 3.7; 95% confidence intervals (95%CIs) = 1.1, 12.2] compared to mothers with choline ≥ 10 µmol/L. Lowered plasma choline concentrations were detected in 27 fathers (62.8%) and were also associated with severe CHD (aOR 7.4; 95%CIs = 1.7, 31.5). Child concentrations of choline, betaine and folate and parents’ concentrations of betaine and folate were not associated with disease severity. Conclusions: Lower plasma choline in the parents detectable several years after conception was related to having a child with severe CHD compared to families of children with higher plasma choline. Maternal and paternal choline metabolism may have a role in modulating CHD severity. Etiological studies aiming at the prevention of congenital anomalies should focus on maternal and paternal risk factors in the preconception and early pregnancy. Full article

Background: Short QT syndrome (SQTS) is a rare inherited cardiac channelopathy associated with high risk of atrial and ventricular arrhythmias and sudden cardiac death (SCD). Data on its natural history, genotype–phenotype correlations, and risk stratification remain limited. We aimed to evaluate all families with a confirmed diagnosis of SQTS identified at our National Referral Center through a descriptive case series, thereby contributing additional real-world data on this rare condition. Methods: A retrospective review was conducted of all families evaluated for suspected SQTS between 2011 and 2025 at the Inherited Cardiac Diseases Unit. Diagnosis was based on 2022 ESC guidelines (QTc ≤320 ms or ≤360 ms plus supportive features), clinical evaluation, and genetic testing. Families meeting diagnostic criteria were included for detailed phenotypic and genotypic characterization and longitudinal follow-up. Results: Among all patients assessed, two families met the criteria for SQTS. One family with three phenotype-positive individuals was gene-elusive. This family had a history of SCD and the proband presented atrial fibrillation. The second family carried a pathogenic KCNJ2 variant (p.Asp172Asn). However, only the proband fulfilled ECG criteria for SQTS (phenotype-positive) and there was no family history of SCD. No patients were treated with pharmacological therapy for QT prolongation. All affected individuals showed stable QT intervals (none <320 ms) and there were no malignant arrhythmic events during follow-up. Conclusions: These two families illustrate the wide phenotypic spectrum of SQTS and underscore the difficulty of risk stratification in asymptomatic individuals. The rarity of the disease, variable penetrance, and absence of robust prospective data hinder evidence-based management. Systematic registry participation and longitudinal studies are essential to refine risk prediction and therapeutic strategies. Full article

Introduction: It is accepted that nano- and micro-plastic (NMP) pollutants threaten ecosystems and human health by their bioaccumulation but, interestingly, their toxicity is shape-dependent. However, a clear definition of irregular NMPs, as the dominant shape in environmental and biological samples, is currently lacking when compared to spherical and fibrous NMPs. Objectives: This study quantifies morphometric descriptors in order to develop a standardized definition for irregular NMPs. Methods: Hyperspectral images of 34 spherical, 50 fibrous, and 45 irregular NMPs were collected from the literature. All shape-related features reported previously were analyzed using a machine learning model. Using five-fold cross-validation, a decision tree-based ensemble classifier with fixed parameters and Gini coefficient was established to screen key morphometric descriptors and their optimal interval ranges. The model was independently validated, enabling the accurate distinction of irregular NMPs from spherical and fibrous NMPs. Results: Three morphometric descriptors, including circularity, roundness, and perimeter-to-area ratio, were identified using five-fold cross-validation as optimal indicators for NMP shape classification. Optimal interval ranges for irregular NMPs were as follows: circularity (0.388 ± 0.004–0.768 ± 0.004), roundness (0.248 ± 0.01–0.752 ± 0.06) and perimeter-to-area ratio (>11.608 ± 1.39). This approach generated a 96.0% macro-averaged accuracy across these NMPs, with 100% precision and 89.0% recall. Conclusions: Irregular NMPs may be characterized using three morphometric descriptors, such as circularity, roundness, and perimeter-to-area ratio. The three-descriptor combination has highly accurate discrimination from spherical and fibrous NMPs. Full article

Background: Soil-transmitted helminth (STH) infections are a recognized public health challenge, particularly in rural and island settings. Despite the implementation of national control programs, epidemiological data from geographically isolated communities remain limited. In this study, we aimed to determine the prevalence of STH infections and identify associated risk factors among adults in Koh Yao Islands, southern Thailand. Methods: A community-based cross-sectional survey was conducted in three subdistricts of Koh Yao, Phang Nga Province, from January to September 2024. Demographic data and information on potential risk factors were collected using structured questionnaires. Stool specimens were analyzed using the formalin–ethyl acetate concentration technique and the modified Kato–Katz method. Associations were assessed using univariate and multivariate logistic regression analyses. Results: A total of 241 adults participated in the study, with females accounting for 68.9% and males for 31.1%. The overall prevalence of STH infections was 2.49%, with hookworms and Trichuris trichiura identified as the predominant species. All infected individuals had an educational level lower than a bachelor’s degree. Univariate analysis showed that participants who did not use hygienic toilets at home had a significantly higher likelihood of developing STH than those who did (crude odds ratio = 46.80; 95% confidence interval [CI]: 2.55–859.00; p = 0.010). Multivariable logistic regression analysis confirmed that the absence of hygienic toilet use at home was independently associated with STH infection (adjusted odds ratio = 30.69; 95% CI: 1.17–804.65; p = 0.040). Conclusions: This study documents low overall prevalence of STH infections in the study area, with hookworms and T. trichiura as the predominant organisms. These findings support continued targeted public health measures, including periodic deworming and health education initiatives, to strengthen hygiene practices, particularly in high-risk populations. Future investigations should incorporate environmental assessments and longitudinal monitoring to evaluate the durability of current control strategies. Full article

Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic plate may be considered as a less invasive alternative. This systematic review aimed to evaluate the effectiveness of such reconstructive techniques, in terms of success rate and complication rate, in patients aged over 55. Methods: Studies were included if the sample size consisted of at least 20 patients undergoing mandibular reconstruction with an ALT flap and plate following oral cavity resection for benign or malignant conditions. Studies were excluded if relevant outcomes were not reported and the mean age was <55 years. An electronic search was conducted in PubMed, Scopus, Web of Science and Embase. The last search was made on 26 February 2026. Data extracted included patient demographics, clinical outcomes and postoperative plate-related and overall complications. Risk of bias assessment was undertaken using the Joanna Briggs Institute tool for cohort studies and case series. Proportional meta-analysis was conducted to estimate the overall clinical success and the complication rate. Results: Of the 525 studies initially screened, four studies including a total of 329 patients (292 males, 37 females) with an overall mean age > 55 years were included. Mean hospital stay ranged from 10 to 24 days. The overall clinical success rate of the ALT flap procedure was 97% (95% confidence intervals (CIs): 92%, 99%). Flap-related complications were rare, with flap loss reported in only one patient and partial necrosis or failure affecting up to 6.6% of cases. Conversely, the overall plate-related complications rate was 28% (95% CI: 15%, 41%), with plate exposure rates ranging from 10% to 38.7% in the included studies. Wound complications, including infection and fistula formation, ranged from 20% to 38.7% of patients. Conclusions: In patients over 55, despite the not negligible rate of complications, the use of ALT flaps and reconstruction plate represents a viable alternative to vascularized bone flaps for mandibular reconstruction, particularly when comorbidities or frailty preclude more complex procedures. Further studies with a large sample size are needed to validate these findings and guide clinical decision-making. Full article

Purpose: To evaluate the safety and feasibility of repeated subtenon administration of autologous platelet-rich plasma (PRP) in patients with degenerative retinal diseases and to explore preliminary, hypothesis-generating functional observations in retinitis pigmentosa (RP) and extensive macular atrophy with pseudodrusen-like appearance (EMAP). Methods: This prospective, open-label, uncontrolled pilot study included 13 patients (6 RP, 7 EMAP) who received three subtenon PRP injections (1.5 mL each) at baseline, Month 2, and Month 4, with follow-up through Month 6. The study was designed primarily to assess safety and feasibility and was not powered or intended to evaluate efficacy. The primary outcome was safety, including adverse events and intraocular pressure changes. Exploratory secondary outcomes included best-corrected visual acuity (BCVA, logMAR), visual field mean deviation (MD), and structural optical coherence tomography (OCT) parameters. Electrophysiological outcomes were analyzed descriptively due to incomplete paired data. Analyses were conducted within diagnostic groups, and no between-group comparisons were performed. Results: All 13 patients completed the study. No serious adverse events or permanent ocular morbidity were observed. Two transient and self-limited adverse events occurred (anterior uveitis and intraocular pressure elevation), both resolving without sequelae. In the overall cohort, BCVA remained stable without statistically significant change. In the RP subgroup, a small exploratory change in BCVA was observed (mean ΔlogMAR −0.09; nominal p = 0.048), corresponding to approximately 4–5 ETDRS letters; however, this finding was associated with wide confidence intervals and limited statistical power and should be interpreted cautiously. In the EMAP subgroup, functional stability was observed without evidence of consistent improvement. Visual field mean deviation and OCT findings were consistent with absence of short-term deterioration across available paired data. Electrophysiological outcomes showed no consistent directional change. Conclusions: Repeated subtenon PRP administration appeared feasible and well tolerated in this small, uncontrolled pilot cohort. Any observed functional changes are preliminary and hypothesis-generating only and do not establish efficacy. Larger, adequately powered controlled studies with standardized endpoints are required to determine the potential role of PRP in degenerative retinal diseases. Full article

Background: Supplementation with long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may mitigate exercise-induced muscle damage (EIMD) and enhance post-exercise recovery. However, the systematic reviews/meta-analyses evaluating these effects across populations and exercise models are limited and do not provide dosing recommendations. Objective: This systematic review and meta-analysis aimed to evaluate the effects of LC n-3 PUFA supplementation on key post-exercise recovery outcomes, including muscle soreness, muscle function, and muscle damage biomarkers in healthy adults. Methods: Following the PRISMA guidelines, a comprehensive search of PubMed, Scopus, and clinical trial registry databases was conducted (to January 2025). All studies that met the inclusion criteria underwent appropriate methodological quality assessments using established tools. The data were extracted for inputting into random-effects models, with effect sizes reported as Hedges’ g and 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Results: Among the 2539 records, 43 studies met the inclusion criteria for the systematic review, and nine met the inclusion criteria for the meta-analysis. The effect of LC n-3 PUFA supplementation on recovery outcomes was equivocal, with significant methodological limitations noted across the literature. However, the meta-analysis of nine placebo-controlled, eccentric exercise trials demonstrated that LC n-3 PUFA supplementation significantly reduced delayed onset muscle soreness (DOMS) (Hedges’ g = −0.75; 95% CI: −1.14 to −0.36), creatine kinase (CK) (Hedges’ g = −0.40; 95% CI: −0.70 to −0.10), and muscle swelling (Hedges’ g = −0.45; 95% CI: −0.83 to −0.07), and significantly improved muscle strength (Hedges’ g = 0.45; 95% CI: 0.07 to 0.83) and range of motion (ROM) (Hedges’ g = 0.93; 95% CI: 0.33 to 1.53) at peak impairment compared with placebo. Conclusions: LC n-3 PUFA supplementation may support recovery from EIMD. However, due to the methodological limitations across the literature base it was not possible to assess effective dosing strategies. Future studies should address dose–response and duration requirements and incorporate objective assessments of omega-3 status (e.g., the Omega-3 Index [O3I] or comparable biomarkers) alongside standardized compliance measures. These approaches are necessary to determine effective dosing strategies and to test the relationship between omega-3 status and recovery outcomes. Full article

Chrononutrition, which emphasizes the timing, frequency, and regularity of eating in alignment with circadian rhythms, has emerged as an important yet understudied determinant of obesity, particularly in children and adolescents. We aimed to compare chrononutrition and physical fitness between elementary and intermediate schoolgirls and to examine their associations with obesity. Methods: This cross-sectional study included 457 schoolgirls aged 10–14 years from elementary and intermediate schools. Chrononutrition behaviors were evaluated. Anthropometric measurements and physical fitness, including handgrip strength, standing long jump, and 20 m shuttle run, were assessed. Fasting blood glucose and lipid profile were determined using capillary blood samples. Results: Compared with intermediate students, elementary school students demonstrated more favorable meal-related behaviors, longer overnight fasting durations, and better dietary intake (p < 0.05), along with higher VO₂ max and higher standing long jump performance. Conversely, intermediate students exhibited greater absolute handgrip strength. A higher number of meals/day (aOR = 0.68, p = 0.039) and a longer interval between the last meal and bedtime (aOR = 0.78, p = 0.013) were inversely associated with obesity. Furthermore, higher HGS/BMI was associated with lower odds of obesity (aOR = 0.01, p < 0.001), while HDL cholesterol was inversely associated with obesity (aOR = 0.91, p < 0.001). Conclusions: Chrononutrition behaviors and physical fitness varied across school stages and were associated with obesity among school-aged girls. Higher meal frequency, a longer interval between the last meal and bedtime, and greater handgrip strength relative to body mass index (HGS/BMI) were associated with lower odds of obesity. Non-obese students also demonstrated higher VO₂ max. These findings suggest that chrononutrition behaviors and physical fitness may contribute to obesity prevention, underscoring the importance of early nutrition and physical activity interventions. Full article

Background: Melatonin has antioxidant and anti-inflammatory properties that may attenuate ischemia-reperfusion injury, but randomized cardiovascular trial data remain inconsistent. Objectives: This study sought to evaluate the association of melatonin supplementation with cardiovascular outcomes across randomized trials. Methods: We performed a systematic review and meta-analysis of randomized trials comparing melatonin with placebo, usual care, or no melatonin in patients with cardiovascular disease. PubMed, Embase, and CENTRAL were searched from inception to 1 January 2026. Random-effects models with Hartung–Knapp–Sidik–Jonkman confidence intervals were used. Prespecified outcomes included left ventricular ejection fraction (LVEF), change in LVEF, troponin, infarct size by cardiac magnetic resonance, heart failure outcomes, inflammatory and oxidative stress biomarkers, and adverse events. Results: A total of 14 randomized controlled trials involving 1027 participants were included. Melatonin significantly improved change in LVEF from baseline to follow-up (mean difference: 3.95 percentage points; 95% CI: 1.70–6.20; p < 0.001), with the most consistent signal in coronary artery bypass grafting studies (mean difference: 4.65 percentage points; 95% CI: 2.56–6.74). Final LVEF was numerically higher with melatonin but not statistically significant. Troponin reduction was not significant. Narrative synthesis suggested lower inflammatory and oxidative stress markers after coronary artery bypass grafting and improvement in heart failure symptoms and quality of life, whereas infarct size findings in ST-segment elevation myocardial infarction were mixed and timing-dependent. Conclusions: Melatonin was associated with improved LVEF change, particularly in coronary artery bypass grafting settings, but benefit was not consistently demonstrated across final LVEF, troponin, or infarct size outcomes. Full article

Background/Objectives: MRI is a non-invasive tool which can be used to assess baseline gonadal anatomy, including changes during puberty. Volumetric characterization offers valuable insights about the reproductive system and gonads, but annotation is cumbersome, and no AI tool is currently available. This study aimed to develop two open-source AI models to segment bilateral gonads at MRI scans in healthy subjects. Materials and Methods: This study uses a longitudinal dataset consisting of 182 MRIs from 22 healthy girls (median age 13) and 266 MRIs from 44 healthy boys (median age 13) from a single institute. MRI acquisition included T2-weighted (T2W) sequence, along with fat-saturated (FS) T2W when indicated. An expert radiologist segmented gonadal anatomy, including ovarian cysts (>3 cm). Three-dimensional nnUnet models were trained for ovary, cyst, and testicle segmentation, respectively. The ovary–cyst segmentation model was applied to an external dataset with 30 adult subjects. Model performance was evaluated on the test set using the Dice similarity coefficient for ovary (DSCOV), cyst (DSCCY), and testicles (DSCTS). Subject-level total volumes for ovaries (TOV), cysts (TCV), and testicles (TTV) were computed. Results: Ovary, cyst, and testicle segmentation models achieved DSCOV of 0.86, DSCCY of 0.69, and DSCTS of 0.90 in the in-house test set, respectively. Average mean difference with 95% confidence intervals for TOV, TCV, and TTV were 0.87 (−5.78, 7.5), −0.41 (−3.3, 2.5), and 0.19 (−1.5, 1.9) cm³, respectively. Conclusions: The developed models show promising and reliable performance in volumetric and morphologic evaluation of gonads during puberty. Full article

Background/Objectives: Psychiatric inpatient care varies substantially in its clinical goals, resource demands, and financial implications. Acute units focus on short-term crisis stabilization, whereas chronic units provide prolonged supervision for patients with persistent functional impairment. Limited evidence exists from Eastern Europe on how these differing service models impact both hospital costs and clinical outcomes such as early rehospitalization. This study aimed to compare the economic and operational performance of Acute versus Chronic Psychiatry and to identify predictors of 30-day readmission following acute psychiatric hospitalization. Methods: This retrospective observational study analyzed routinely collected data from a Romanian public hospital. All adult admissions to Acute and Chronic Psychiatry recorded between 1 January 2024 and 31 December 2024 were included. Standardized financial indicators were derived from administrative data, while clinical variables and readmission outcomes were extracted from electronic medical records. Between-group comparisons of economic and operational indicators were performed using t-tests. Multivariable logistic regression was used to determine independent predictors of 30-day readmission in Acute Psychiatry, reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI). Model performance was evaluated with area under the curve (AUC), Hosmer–Lemeshow tests, and Nagelkerke R². Results: Acute Psychiatry demonstrated significantly higher mean cost per bed-day (798.76 vs. 373.75 lei; p < 0.001), but a lower mean cost per patient due to shorter hospitalization (10.17 vs. 53.32 days). A total of 188 acute patients (13.7%) were readmitted within 30 days. No early readmissions occurred in Chronic Psychiatry, consistent with its long-stay care model. Independent predictors of readmission included psychotic disorder diagnosis (aOR = 1.62, 95% CI: 1.18–2.23), multiple prior admissions (aOR = 1.35, 95% CI: 1.18–1.54), shorter length of stay (LOS) (aOR = 0.88 per 5-day increase, p = 0.006), and absence of a post-discharge plan (aOR = 0.54, 95% CI: 0.39–0.76). Model discrimination was acceptable (AUC = 0.74). Conclusions: Acute and chronic psychiatric services differ markedly in cost structures and care pathways. Early rehospitalization is a clinically relevant outcome within acute psychiatric care and is influenced by both patient-level and continuity-of-care factors. Enhancing discharge coordination, expanding continuity-of-care strategies, and optimizing resource allocation toward community-based support may reduce early rehospitalizations while improving hospital cost-efficiency. Full article

Background and Objectives: Biological therapy is widely used to treat moderate-to-severe psoriasis. This study aimed to assess the real-world effectiveness and drug survival of biologic treatment in patients with moderate-to-severe psoriasis. Materials and Methods: A retrospective study of 210 patients with moderate-to-severe psoriasis who were treated with biological therapy between 2018 and 2023 was conducted. Baseline data included demographics, comorbidities, prior treatments, Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores, laboratory results, current psoriasis treatment, and treatment-related adverse events. Results: Of the 210 patients, 60.0% were male (n = 126). The mean age was 48.3 ± 13.6 years in men (range 16–74) and 48.4 ± 13.6 years in women (range 17–79). The mean PASI at initiation of biologic therapy was 15.0 ± 8.1 and decreased to 3.3 ± 4.7 at 1 year, 2.7 ± 4.0 at 3 years, and 2.8 ± 3.3 at 5 years. Drug discontinuation differed between therapies: etanercept had a higher hazard of discontinuation than ustekinumab (hazard ratio (HR) 2.55, 95% confidence interval (CI) 1.17–5.52; p = 0.0179), infliximab (HR 0.36, 95% CI 0.13–0.97; p = 0.0429) and adalimumab (HR 0.47, 95% CI 0.23–0.98; p = 0.0453). Conclusions: In routine clinical practice, biologic therapy was associated with substantial and sustained improvements in the PASI over up to 5 years of follow-up. Drug survival was initially high for all agents but separated over time, with etanercept showing the poorest long-term persistence and a higher hazard of discontinuation compared with other drugs. Full article