Search Results (1,305)

Background/Objectives: Central bone mineral density (cBMD) is widely utilized for assessing bone quality, but its reliability as a predictor of knee bone strength for cementless total knee arthroplasty (TKA) remains unclear. This study aimed to determine whether cBMD reliably estimates bone strength suitable for cementless fixation. Methods: 188 patients scheduled for TKA underwent preoperative cBMD assessment of the lumbar spine and femoral neck. During surgery, femoral bone specimens were collected for indentation tests. We compared distal femoral bone strength among osteoporosis classification groups (normal, osteopenia, osteoporosis) and examined the distribution of cementless suitable versus cemented mandatory cases with chi-square tests. ROC analysis evaluated cBMD’s diagnostic performance in predicting cementless TKA suitability, with AUC, sensitivity, and specificity calculated for both measurement sites. Results: No significant differences in distal femoral bone strength existed between osteopenia and osteoporosis groups (p = 0.845 for lumbar spine, p = 0.857 for femoral neck). Among patients with normal cBMD, 35.4% (lumbar spine) and 30.7% (femoral neck) were unsuitable for cementless TKA, whereas 30.8% and 45.0% of osteoporotic patients, respectively, had adequate bone strength for cementless fixation. The AUC values for predicting cementless suitability were 0.656 (lumbar spine) and 0.669 (femoral neck), with sensitivity and specificity below 0.75 for both measurements. Conclusions: Central BMD does not reliably represent distal femoral bone strength and demonstrates inadequate predictive capability for identifying appropriate candidates for cementless TKA in this predominantly Asian female cohort. Future multi-center, multi-ethnic studies are needed to enhance generalizability. Full article

Ultra-processed foods (UPFs) are increasingly consumed worldwide, particularly during childhood, raising growing concerns for health. Although UPFs have been associated with obesity and cardiometabolic disorders, emerging evidence suggests a potential role also in respiratory and allergic diseases. This review critically examines the epidemiological evidence and biological mechanisms linking UPF consumption to respiratory and allergic outcomes in children. To this end, a structured literature search was conducted in the PubMed database, including articles published between 2006 and 2025, selected based on their relevance to the association between UPF consumption and asthma, wheezing, or food allergies in the pediatric population. Four cohort studies on asthma and wheezing, conducted mainly in Brazil and Spain, and two cross-sectional studies—including one global multicenter study—were identified. In addition, four pediatric studies on food allergies from Europe and South America were found, consisting of two cohort studies and two cross-sectional studies. The proposed mechanisms include disruption of the gut barrier, microbiota dysbiosis, chronic inflammation through the AGE–RAGE axis, skewing of immune responses toward a Th2 profile, and indirect effects through obesity and micronutrient deficiencies. Similar pathways may promote allergic sensitization and the development of food allergies. Although current evidence supports the potential role of UPFs in pediatric respiratory and allergic diseases, further longitudinal and interventional studies are needed. Meanwhile, promoting fresh and minimally processed dietary patterns may help protect children’s respiratory and immune health. Full article

Background: Kidney transplant recipients (KTRs) experience improved survival and quality of life compared to dialysis treatment, but chronic immunosuppression may increase the risk of de novo post-transplant cancer. Colorectal cancer (CRC) is increasingly recognized in this population. This systematic review aims to synthetize contemporary evidence on CRC epidemiology, outcomes, and risk determinants among KTRs. Methods: A comprehensive search for observational and registry-based studies reporting CRC in adult KTRs was conducted on PubMed, Scopus, Web of Science, and ProQuest. The studies found were subsequently subjected to screening, data extraction, and the risk-of-bias appraisal process. Due to heterogeneity, findings were synthesized narratively. Results: Twenty-six studies encompassing 863,005 KTRs met inclusion criteria: 22 retrospective cohorts, 1 prospective cohort, 2 cross-sectional, and 1 case-control. Absolute CRC occurrence varies by geography, population, and follow-up. Reported risks ranged from no excess to modestly elevated standardized incidence ratios (SIRs): ~0.76–3.60 overall, with a right-sided colon predominance. Overall, higher mortality and worse prognosis were reported in kidney transplant recipients with colorectal cancer compared to the general population, as a result of later-stage diagnosis and more aggressive histologies. Consistent risk factors included older age, time since transplantation, diabetes and metabolic comorbidities, prior dialysis duration/graft failure, and smoking; the female sex showed higher relative CRC risk in some cohorts. The remarkable role of immunosuppression profiles was consistently highlighted: cyclosporine—azathioprine maintenance and alemtuzumab induction were associated with higher CRC risk in large registries, whereas tacrolimus—mycophenolate regimens showed lower risk signals and mTOR inhibitors suggested possible protective effects. Conclusions: Contemporary evidence suggests a modest, heterogenous increase in CRC risk among KTRs, a proximal (right-sided) predominance, and a tendency toward advanced-stage presentation with reduced survival. These findings justify the need to consider risk-tailored, lifelong surveillance strategies anchored in a full colonoscopy, with earlier initiation in younger or otherwise high-risk recipients, alongside careful optimization and periodic re-evaluation of immunosuppression. Prospective multicenter studies and cost-effectiveness analyses should refine screening thresholds and therapeutic strategies. PROSPERO ID: CRD420251071658. Full article

Background/Objectives: Fabry disease (FD) is a rare X-linked disease caused by the deficient activity of the enzyme α-galactosidase A. Cardiac involvement is particularly critical, often determining the disease prognosis. Epidemiological data on FD in Portugal are limited and inconsistent, highlighting the need for targeted screening. The F-CHECK study aimed to determine the prevalence of FD through the systematic screening of a Portuguese cohort of patients with unexplained cardiomyopathies. Methods: This multicenter observational study (NCT05409846) assessed the prevalence and clinical characteristics of FD in a Portuguese cohort (n = 409) of patients from 10 central hospitals who presented with unexplained cardiomyopathies, including idiopathic hypertrophic cardiomyopathy (HCM), left ventricular hypertrophy, dilated-phase HCM, and dilated cardiomyopathy with late gadolinium enhancement in the inferolateral segment. Screening was performed using dried blood spot assays to measure α-galactosidase A activity and/or by GLA gene sequencing in whole-blood samples. Results: FD was diagnosed in 14 patients, corresponding to a prevalence of 3.4%. FD diagnosis was significantly associated with systemic manifestations such as acroparesthesias (p = 0.027) and angiokeratomas (p = 0.003), as well as an increased risk of prior arrhythmic events (p = 0.021) and cerebrovascular disease (p = 0.016). Most FD patients (57%) presented a non-founder mutation in the GLA gene; however, they were pathogenically relevant. Conclusions: The observed 3.4% prevalence highlights the importance of systematic FD screening among Portuguese patients with unexplained cardiomyopathy, extending beyond classic hypertrophic presentations to dilated forms. Specific clinical signs, electrocardiogram findings, and cardiac imaging features can serve as valuable indicators to guide targeted genetic testing for FD. Full article

Background and Objectives: While transurethral resection of the prostate remains the gold standard for surgical treatment of benign prostatic hyperplasia, anatomical endoscopic enucleation of the prostate provides a safe, durable, and size-independent alternative. Our study introduces a specific technical innovation, i.e., en bloc bipolar prostate enucleation performed exclusively via sheath-tip mechanical dissection without the use of a dedicated enucleation loop, combined with the mushroom technique and early apical release. Materials and Methods: Between January 2018 and May 2023, 252 patients with prostate volumes > 30 mL and significant lower urinary tract symptoms underwent en bloc bipolar prostate enucleation via the mushroom technique with early apical release. Data were retrospectively evaluated to assess perioperative results, postoperative outcomes, and complications. Results: The median age of the cohort was 70 (65–76) years, with a median prostate volume of 60 (40–88.5) mL. The median operative time was 40 (30–70) min, and the median weight of enucleated tissue was 34 (16.5–60) g. Significant improvements were observed in the International Prostate Symptom score, Quality of Life score, maximum flow rate, average flow rate, and postvoid residual urine at 12 months (p < 0.001). The rate of transient stress urinary incontinence decreased from 19.44% at 1 month to 2.38% at 12 months. Conclusions: En bloc bipolar prostate enucleation using the mushroom technique is a safe and effective treatment for benign prostatic hyperplasia, yielding significant improvements in urinary symptoms and flow rates, with a manageable complication profile. Further multicenter studies are needed to confirm these findings. Full article

Background: Ovarian cancer remains a major contributor to cancer-related morbidity and mortality worldwide. Primary cytoreductive surgery is the cornerstone of treatment, and accurate preoperative assessment of tumor resectability is critical to guiding optimal therapeutic strategies in patients with advanced tubo-ovarian cancer. Methods: A narrative review about the role of ultrasound for assessing tumor spread and prediction of tumor resectability was performed. Results: The ISAAC study represents the largest prospective multicenter trial to date comparing the diagnostic performance of ultrasound (US), computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in predicting non-resectability, using surgical and histopathological findings as the reference standard. Key strengths of the study include the use of standardized imaging and intraoperative reporting protocols across ESGO-accredited high-volume oncologic centers. All three imaging modalities were performed within four weeks prior to surgery by independent, blinded expert operators. US demonstrated diagnostic accuracy comparable to that of CT and WB-DWI/MRI. The study also defined modality-specific thresholds for the Peritoneal Cancer Index (PCI) and Predictive Index Value (PIV), offering quantitative tools to support surgical decision-making. A noteworthy secondary finding was patient preference: in a cohort of 144 participants who underwent all three imaging modalities, nearly half preferred US, while WB-DWI/MRI was the least favored due to discomfort and examination duration. Conclusions: The ISAAC study represents a significant advancement in imaging-based prediction of surgical non-resectability in tubo-ovarian cancer. Its findings suggest that, in expert hands, ultrasound can match or even surpass cross-sectional imaging for preoperative staging, supporting its integration into routine clinical practice, particularly in resource-constrained settings. Full article

Background and Objectives: Acute kidney injury (AKI) is a common complication in patients with trauma and is associated with increased morbidity and mortality rates. Early identification of patients at risk of AKI may enable timely intervention and improved outcomes. Biomarkers such as urinary mitochondrial DNA copy number (mtDNAcn) may play a role in predicting AKI. However, its role as a predictor of AKI has rarely been studied in patients with trauma. Therefore, the aim of this study was to evaluate the utility of mtDNA for early detection of AKI in this patient population. Materials and Methods: This single-center prospective observational study included patients with trauma admitted to a regional trauma center between July 2022 and July 2023. Serum and urine samples were collected at baseline and at 24, 48, and 72 h to measure mtDNAcn using real-time polymerase chain reaction test. Clinical variables, including hemoglobin (Hb) levels, were also recorded. Results: Among 65 enrolled patients, 25 (38.5%) developed AKI. Patients with AKI showed significantly lower Hb levels and higher urinary mtDNAcn at admission. Multivariate logistic regression analysis identified low Hb and elevated urinary mtDNAcn as independent predictors of AKI. The optimal cutoff value was 10.95 g/dL for Hb and 738.0 copies/μL for urinary mtDNAcn. However, no significant temporal differences in serum mtDNAcn were observed between the AKI and no-AKI groups. Conclusions: Both Hb and urinary mtDNAcn may serve as independent biomarkers for early identification of AKI in patients with trauma. Future studies are warranted to determine optimal targets and validate these findings in larger multicenter cohorts. Full article

Background: The VARIPULSE platform is an advanced Pulsed Field Ablation (PFA) system fully integrated with electro-anatomical mapping system, employing a variable loop circular catheter (VLCC) for atrial fibrillation (AF) ablation. The objective of the study is to assess for the first time the feasibility, safety, and procedural impact of AI (artificial intelligence)-assisted ICE (intracardiac echocardiography) mapping with the CARTOSOUND FAM Module compared with conventional electroanatomical mapping during PFA. Methods: In this retrospective, multicenter study, 157 consecutive patients undergoing PFA for paroxysmal or persistent AF were included. Patients were divided into two groups: ICE-guided cohort (n = 64) and non-ICE-guided cohort (n = 93). Propensity score matching (PSM) was used to adjust for baseline differences. Results: AI-assisted ICE mapping was feasible in all cases. Compared with conventional mapping, it significantly reduced LA (left atrium) mapping time (median 5 vs. 8 min; p < 0.001), LA dwell time (33.5 vs. 38.5 min; p = 0.001), and fluoroscopy time (7.5 vs. 14 min; p < 0.001). The total number of PFA applications was similar across groups (p = 0.136). No major adverse events occurred in either cohort during the procedure or within the first month of follow-up. Conclusions: AI-assisted ICE mapping using the CARTOSOUND FAM Module enables accurate anatomical reconstruction and significantly optimizes procedural efficiency in PFA. This approach supports further development toward radiation-sparing and potentially fluoroscopy-free PFA workflows. For the first time, it addresses a gap in the current evidence regarding the use of ICE in PFA, building on evidence already established for radiofrequency ablation procedures. Full article

Background: Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) are significant challenges in reproductive medicine. For both, embryonic aneuploidy is the leading etiological factor. Preimplantation genetic testing for aneuploidy (PGT-A) via trophectoderm biopsy is the current standard for embryo selection. However, it is limited by its invasiveness, potential for embryo damage, and diagnostic errors due to mosaicism. Rationale/Objectives: This review critically evaluates the emerging role of noninvasive PGT (niPGT). NiPGT analyzes cell-free DNA from spent blastocyst culture media, thus, it is a potential alternative for managing RPL and RIF. Hence, the primary objective is to determine whether current evidence supports niPGT as a reliable replacement for conventional biopsy-based PGT-A in these high-risk populations. Outcomes: The analysis reveals that niPGT offers significant theoretical advantages. These include complete non-invasiveness, enhanced embryo preservation, and high patient acceptability. However, its clinical application is hampered by substantial limitations. Key amongst them is the inconsistent and often suboptimal diagnostic accuracy (sensitivity 70–85%, specificity 88–92%) compared to biopsy. Other significant factors include the high rates of amplification failure (10–50%), vulnerability to maternal DNA contamination, as well as low DNA yield. Crucially, there is a definitive lack of robust, prospective randomized controlled trial (RCT) data demonstrating improved live birth rates or reduced miscarriage rates specifically in RPL and RIF cohorts. As such, niPGT is not yet ready to be a standalone clinical adoption in RPL and RIF cases. However, it may serve as a valuable adjunct for rescue scenarios following biopsy failure or for ethical reasons. Wider Implications: The integration of niPGT with artificial intelligence, time-lapse imaging, and multi-omics profiling underlies a promising future. However, its transition from a predominantly research tool to a clinical standard necessitates various critical undertakings. These include rigorous multicenter RCTs, standardizing international protocol, and tailoring validation for the RPL and RIF subgroups. This review highlights the need for cautious optimism, positing that evidence-based integration, rather than premature adoption, is essential to realizing niPGT’s full potential without compromising patient care in these complex fertility scenarios. Full article

Background: To report a deep learning-based algorithm for automated segmentation of geographic atrophy (GA) among patients with age-related macular degeneration (AMD). Methods: Validation of a deep learning algorithm was performed using optical coherence tomography (OCT) images from patients in routine clinical care diagnosed with GA, with and without concurrent nAMD. For model construction, a 3D U-Net architecture was used with the output modified to generate a 2D mask. Accuracy of the model was assessed relative to the manual labeling of GA with the Dice similarity coefficient (DSC) and correlation r² scores. Results: The OCT data set included 367 scans from the Spectralis (Heidelberg, Germany) from 55 eyes in 33 subjects; 267 (73%) scans had concurrent nAMD. In parallel, 348 scans were collected using the Cirrus (Zeiss), from 348 eyes in 326 subjects; 101 (29%) scans had concurrent nAMD. For Spectralis data, the mean DSC score was 0.83 and r² was 0.91. For Cirrus data, the mean DSC score was 0.82 and r² was 0.88. Conclusions: The reported deep learning algorithm demonstrated strong agreement with manual grading of GA secondary to AMD on the OCT data set from routine clinical practice. The model performed well across two OCT devices as well as amongst patients with GA with concurrent nAMD, suggesting applicability in the clinical space. Full article

Background: This narrative review examines the role of artificial intelligence (AI) in bowel sound analysis for the diagnosis and management of inflammatory bowel disease (IBD). Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, presents a significant clinical burden due to its unpredictable course, variable symptomatology, and reliance on invasive procedures for diagnosis and disease monitoring. Despite advances in imaging and biomarkers, tools such as colonoscopy and fecal calprotectin remain costly, uncomfortable, and impractical for frequent or real-time assessment. Meanwhile, bowel sounds—an overlooked physiologic signal—reflect underlying gastrointestinal motility and inflammation but have historically lacked objective quantification. With recent advances in artificial intelligence (AI) and acoustic signal processing, there is growing interest in leveraging bowel sound analysis as a novel, non-invasive biomarker for detecting IBD, monitoring disease activity, and predicting disease flares. This approach holds the promise of continuous, low-cost, and patient-friendly monitoring, which could transform IBD management. Objectives: This narrative review assesses the clinical utility, methodological rigor, and potential future integration of artificial intelligence (AI)-driven bowel sound analysis in inflammatory bowel disease (IBD), with a focus on its potential as a non-invasive biomarker for disease activity, flare prediction, and differential diagnosis. Methods: This manuscript reviews the potential of AI-powered bowel sound analysis as a non-invasive tool for diagnosing, monitoring, and managing inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. Traditional diagnostic methods, such as colonoscopy and biomarkers, are often invasive, costly, and impractical for real-time monitoring. The manuscript explores bowel sounds, which reflect gastrointestinal motility and inflammation, as an alternative biomarker by utilizing AI techniques like convolutional neural networks (CNNs), transformers, and gradient boosting. We analyze data on acoustic signal acquisition (e.g., smart T-shirts, smartphones), signal processing methodologies (e.g., MFCCs, spectrograms, empirical mode decomposition), and validation metrics (e.g., accuracy, F1 scores, AUC). Studies were assessed for clinical relevance, methodological rigor, and translational potential. Results: Across studies enrolling 16–100 participants, AI models achieved diagnostic accuracies of 88–96%, with AUCs ≥ 0.83 and F1 scores ranging from 0.71 to 0.85 for differentiating IBD from healthy controls and IBS. Transformer-based approaches (e.g., HuBERT, Wav2Vec 2.0) consistently outperformed CNNs and tabular models, yielding F1 scores of 80–85%, while gradient boosting on wearable multi-microphone recordings demonstrated robustness to background noise. Distinct acoustic signatures were identified, including prolonged sound-to-sound intervals in Crohn’s disease (mean 1232 ms vs. 511 ms in IBS) and high-pitched tinkling in stricturing phenotypes. Despite promising performance, current models remain below established biomarkers such as fecal calprotectin (~90% sensitivity for active disease), and generalizability is limited by small, heterogeneous cohorts and the absence of prospective validation. Conclusions: AI-powered bowel sound analysis represents a promising, non-invasive tool for IBD monitoring. However, widespread clinical integration requires standardized data acquisition protocols, large multi-center datasets with clinical correlates, explainable AI frameworks, and ethical data governance. Future directions include wearable-enabled remote monitoring platforms and multi-modal decision support systems integrating bowel sounds with biomarker and symptom data. This manuscript emphasizes the need for large-scale, multi-center studies, the development of explainable AI frameworks, and the integration of these tools within clinical workflows. Future directions include remote monitoring using wearables and multi-modal systems that combine bowel sounds with biomarkers and patient symptoms, aiming to transform IBD care into a more personalized and proactive model. Full article

Background and Aims: Severe acute respiratory distress syndrome (ARDS) in patients with long COVID remains associated with extremely high mortality and significant long-term sequelae. Non-invasive ventilatory strategies such as continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) are widely used before endotracheal intubation (ETI). Still, their comparative effectiveness in this population is not well established. Understanding survival outcomes and sequelae can help refine treatment strategies for this high-risk group. This study aimed to evaluate outcomes, sequelae, and treatment strategies in long COVID patients with severe ARDS, focusing on non-invasive ventilatory support before ETI. Materials and Methods: A retrospective cohort analysis was performed using a study comparing severe ARDS patients with and without COVID-19. The inclusion criterion was a Horovitz quotient (PaO₂/FiO₂) < 50 mmHg. Results: The study included a total of 59 patients diagnosed with long COVID-19 ARDS, with a mortality rate of 85%. A significant proportion of the patient population was male, accounting for 75%. The highest survival rate was observed among patients who initially received CPAP support, with a survival rate of 23.08%, in contrast to those treated solely with HFNC or those who alternated between HFNC and CPAP. Among patients who required endotracheal intubation and subsequent mechanical ventilation, survival rates were 40% for those who had previously received CPAP, 10% for those treated with alternating HFNC and CPAP, and 0% for those managed exclusively with HFNC before ETI. Survivors often exhibited sequelae, such as impaired pulmonary function, persistent dyspnea, and diminished physical performance. Conclusions: Patients with long COVID who develop severe ARDS (PaO₂/FiO₂ < 50 mmHg) face exceptionally high ICU mortality, with outcomes determined mainly by age, comorbidities, and profound hypoxemia. Although CPAP showed a trend toward improved survival, the data do not establish superiority and should be regarded as hypothesis-generating. Rather, they highlight the complexity of managing this underrepresented subgroup and underscore the need for larger, multicenter studies with broader inclusion criteria to confirm or refute these preliminary observations. Full article

Background/Objective: The recurrence of hallux valgus (HV) after primary surgical correction remains a clinical challenge, often requiring combined approaches to address both bony realignment and soft tissue imbalance. While locking plates have shown some biomechanical advantages in HV correction, evidence regarding their application in revision procedures is limited. This study presents a retrospective single-surgeon experience with a small cohort, aiming to describe radiographic and functional outcomes and to share practical insights rather than provide definitive conclusions. Methods: In this retrospective case series, patients undergoing revision surgery for failed HV correction over the past ten years at a single tertiary institution were analyzed. Radiographic parameters—hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position—were assessed. Functional outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale for pain. Surgical strategies were tailored according to recurrence mechanisms, and some cases involved Wilson osteotomy with intramedullary plate fixation. The Mann–Whitney U test and the Wilcoxon signed-rank test were applied to assess efficacy. Results: A total of 11 feet treated by one surgeon were included. Both soft tissue procedures and combined osteotomy with intramedullary plate fixation led to statistically significant but preliminary improvements in HVA, IMA, DMAA, and sesamoid alignment. Functional scores improved, and the complication rate was within the range reported in the previous literature. Conclusions: This retrospective single-surgeon study with a limited sample size suggests that Wilson osteotomy combined with intramedullary plate fixation may represent a joint-preserving and biomechanically supportive option for recurrent HV, particularly in cases with large DMAAs and severe sesamoid displacement. However, the findings should be interpreted cautiously given the small cohort, retrospective design, and absence of multi-angle radiographic visualization. The results highlight a potential approach in specific clinical settings rather than a definitive solution. Larger, prospective, multi-center studies are required to confirm long-term utility. Full article

Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a major cause of mortality in intensive care units. Methods: We analyzed plasma levels of sTREM-1, CRP, PCT, sCD14-ST, HMGB1, IL-6, IL-10, vitamin D (VD), and sHLA-G in patients with SIRS/sepsis, and assessed their relationships with APACHE II, SOFA scores, and survival. Results: Septic patients showed significantly elevated sTREM-1, CRP, PCT, sCD14-ST, and higher neutrophil-to-lymphocyte ratio, while VD levels were markedly reduced. Logistic regression identified CRP and PCT as the strongest univariate predictors of sepsis, but after adjustment for age, sex, BMI, and comorbidities, CRP lost significance, whereas VD and sCD14-ST remained independent predictors. Prognostically, higher IL-10 levels significantly correlated with 7- and 28-day mortality and with SOFA scores, while higher VD concentrations predicted better survival. Conclusion: CRP, PCT, and sCD14-ST are reliable diagnostic biomarkers of sepsis, with sTREM-1 providing additional value for disease monitoring. After adjustment for clinical covariates, VD emerged as an independent protective factor, whereas elevated IL-10 significantly predicted 7- and 28-day mortality. These findings underscore the utility of combining inflammatory and immunoregulatory biomarkers to improve sepsis diagnostics and prognostication, warranting validation in larger multicenter cohorts. Full article

Background: Upper-extremity morbidity after breast cancer surgery—including pain, lymphedema, and restricted shoulder range of motion—often develops gradually, emerging months after treatment and limiting daily activities. We aimed to characterize morbidity trajectories, physical therapy utilization, and predictors of physical therapy use. Methods: A retrospective multicenter cohort included 1602 women treated with breast surgery 0–36 months earlier. Patient-reported outcomes included Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain, range of motion limitation, axillary web syndrome, and lymphedema. Clinical variables included surgery type and nodal procedure. Outcomes were summarized across four postoperative windows (0–6, 7–12, 13–24, 25–36 months). Logistic and multinomial regression identified predictors of physical therapy uptake and timing (early, ≤3 months vs. late, >3 months; No physical therapy). Results: Anxiety declined across postoperative windows (p < 0.001), and axillary web syndrome decreased from early to later periods (p < 0.001). In contrast, range of motion restriction and decreased function remained common without significant differences between windows (p = 0.145 and p = 0.273). Pain was generally low-to-moderate by median [interquartile range], with a modest rise at 7–12 months (p < 0.001). In adjusted multinomial models (reference: Early physical therapy ≤ 3 months), higher pain was associated with No physical therapy and Late physical therapy (both p < 0.05); lymphedema with No PT and Late physical therapy (both p < 0.05); and axillary web syndrome with Late physical therapy (p = 0.001). Other symptoms (range of motion, function level, anxiety and physical activity) were not independently associated with physical therapy timing. Conclusions: Long-term postoperative morbidity is common. Early assessment and structured follow-up can mitigate its impact and should be embedded as core elements of survivorship health-promotion policy. Full article