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20 pages, 651 KiB  
Review
Communication Disorders and Mental Health Outcomes in Children and Adolescents: A Scoping Review
by Lifan Xue, Yifang Gong, Shane Pill and Weifeng Han
Healthcare 2025, 13(15), 1807; https://doi.org/10.3390/healthcare13151807 - 25 Jul 2025
Abstract
Background/Objectives: Communication disorders in childhood, including expressive, receptive, pragmatic, and fluency impairments, have been consistently linked to mental health challenges such as anxiety, depression, and behavioural difficulties. However, existing research remains fragmented across diagnostic categories and developmental stages. This scoping review aimed [...] Read more.
Background/Objectives: Communication disorders in childhood, including expressive, receptive, pragmatic, and fluency impairments, have been consistently linked to mental health challenges such as anxiety, depression, and behavioural difficulties. However, existing research remains fragmented across diagnostic categories and developmental stages. This scoping review aimed to synthesise empirical evidence on the relationship between communication disorders and mental health outcomes in children and adolescents and to identify key patterns and implications for practice and policy. Methods: Following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and Arksey and O’Malley’s framework, this review included empirical studies published in English between 2000 and 2024. Five databases were searched, and ten studies met the inclusion criteria. Data were charted and thematically analysed to explore associations across communication profiles and emotional–behavioural outcomes. Results: Four interconnected themes were identified: (1) emotional and behavioural manifestations of communication disorders; (2) social burden linked to pragmatic and expressive difficulties; (3) family and environmental stressors exacerbating child-level challenges; and (4) a lack of integrated care models addressing both communication and mental health needs. The findings highlight that communication disorders frequently co-occur with emotional difficulties, often embedded within broader social and systemic contexts. Conclusions: This review underscores the need for developmentally informed, culturally responsive, and interdisciplinary service models that address both communication and mental health in children. Early identification, family-centred care, and policy reforms are critical to reducing inequities and improving outcomes for this underserved population. Full article
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15 pages, 1357 KiB  
Article
Real-World Sex Differences in Response to Treatment with Glucagon-like Peptide-1 Receptor Agonists: Analysis of Single-Center Outpatient Case Series
by Georgeta Victoria Inceu, Anca-Elena Crăciun, Dana Mihaela Ciobanu, Antonia Berchisan, Adriana Fodor, Cornelia Bala, Gabriela Roman and Adriana Rusu
Medicina 2025, 61(8), 1343; https://doi.org/10.3390/medicina61081343 - 25 Jul 2025
Abstract
Background and Objectives: Type 2 diabetes (T2D) is a global health burden with increasing prevalence, necessitating effective management strategies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as beneficial therapies, promoting both glycemic control and weight loss, yet real-world data on sex [...] Read more.
Background and Objectives: Type 2 diabetes (T2D) is a global health burden with increasing prevalence, necessitating effective management strategies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as beneficial therapies, promoting both glycemic control and weight loss, yet real-world data on sex differences in response are limited. This study aimed to investigate sex-based differences in glycemic and weight outcomes, as well as adverse effects, in T2D patients treated with GLP-1 RAs at a single diabetes center. Materials and Methods: In this retrospective analysis, 114 patients (58.8% men) with T2D who were initiated on GLP-1 RA therapy between 2015 and 2023 were evaluated. Data on HbA1c, BMI, and adverse events were collected at baseline and 3, 6, and 12 months post-treatment initiation. Results: Our findings indicated a statistically significant HbA1c reduction (from 8.6% at GLP-1 RA initiation to 6.9% at 12 months in men (p < 0.001) and from 8.4% at initiation to 7.0% at 12 months after GLP-1 RA initiation (p < 0.001) in women). By 12 months, a significantly greater proportion of women compared to men achieved ≥ 5% (51.1% vs. 28.4%, p = 0.019) and ≥10% weight loss (29.8% vs. 9.0%, p = 0.006), with both differences reaching statistical significance. A statistically significant difference in weight loss in mean weight change and percent weight change in men vs. women was observed from month 6 of therapy. Conclusions: These findings underscore the effectiveness of GLP-1 RAs in improving glycemic control and weight loss in a real-world setting and suggest that women may experience greater weight reduction. Understanding these differences could inform personalized treatment strategies for optimized outcomes in T2D management. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)
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19 pages, 744 KiB  
Article
The Epidemiology of Mobility Difficulty in Saudi Arabia: National Estimates, Severity Levels, and Sociodemographic Differentials
by Ahmed Alduais, Hind Alfadda and Hessah Saad Alarifi
Healthcare 2025, 13(15), 1804; https://doi.org/10.3390/healthcare13151804 - 25 Jul 2025
Abstract
Background: Mobility limitation is a pivotal but under-documented dimension of disability in Saudi Arabia. Leveraging the 2017 National Disability Survey, this cross-sectional study provides a population-wide profile of mobility-related physical difficulty. Objectives: Five research aims were pursued: (1) estimate national prevalence and severity [...] Read more.
Background: Mobility limitation is a pivotal but under-documented dimension of disability in Saudi Arabia. Leveraging the 2017 National Disability Survey, this cross-sectional study provides a population-wide profile of mobility-related physical difficulty. Objectives: Five research aims were pursued: (1) estimate national prevalence and severity by sex; (2) map regional differentials; (3) examine educational and marital correlates; (4) characterize cause, duration, and familial context among those with multiple limitations; and (5) describe patterns of assistive-aid and social-service use. Methods: Publicly available aggregate data covering 20,408,362 Saudi citizens were cleaned and analyzed across 14 mobility indicators and three baseline files. Prevalence ratios and χ2 tests assessed associations. Results: Overall, 1,445,723 Saudis (7.1%) reported at least one functional difficulty; 833,136 (4.1%) had mobility difficulty, of whom 305,867 (36.7%) had mobility-only impairment. Severity was chiefly mild (35% of cases), with moderate (16%) and severe (7%) forms forming a descending pyramid. Prevalence varied more than threefold across the thirteen regions, peaking in Aseer (9.4%) and bottoming in Najran (2.9%). Mobility difficulty clustered among adults with no schooling (36.1%) and widowed status (18.5%), with sharper female disadvantage in both domains (p < 0.001). Among those with additional limitations, chronic disease dominated etiology (56.3%), and 90.1% had lived with disability for ≥25 years; women were overrepresented in the longest-duration band. Aid utilization was led by crutches (47.7%), personal assistance (25.3%), and wheelchairs (22.6%), while 83.8% accessed Ministry rehabilitation services, yet fewer than 4% used home or daycare support. Conclusions: These findings highlight sizeable, regionally concentrated, and gender-patterned mobility burdens, underscoring the need for education-sensitive prevention, chronic-care management, investment in advanced assistive technology, and distributed community services to achieve Vision 2030 inclusion goals. Full article
(This article belongs to the Section Health Informatics and Big Data)
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12 pages, 632 KiB  
Article
Tailoring Inflammatory Biomarker Assessment in Axial Spondyloarthritis: A Comparative Study of Erythrocyte Sedimentation Rate and C-Reactive Protein Across Disease Profiles
by Rubén Queiro, Sara Alonso, Stefanie Burger, Estefanía Pardo, Ignacio Braña, Marta Loredo and Mercedes Alperi
J. Pers. Med. 2025, 15(8), 329; https://doi.org/10.3390/jpm15080329 - 25 Jul 2025
Abstract
Background: Personalized medicine in axial spondyloarthritis (axSpA) requires accurate tools to assess inflammation and tailor disease monitoring. The role of traditional biomarkers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) remains controversial due to limited sensitivity and variability across disease [...] Read more.
Background: Personalized medicine in axial spondyloarthritis (axSpA) requires accurate tools to assess inflammation and tailor disease monitoring. The role of traditional biomarkers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) remains controversial due to limited sensitivity and variability across disease profiles. Objective: To compare the performance of ESR and CRP in different clinical scenarios of axSpA, including disease activity, functional impact, severity, disease duration, and exposure to biologic therapy. Methods: We conducted a cross-sectional analysis of 330 patients with axSpA. Correlations among ESR, CRP, and composite disease indices were evaluated. The discriminatory capacity of each biomarker for relevant clinical thresholds was analyzed using ROC curves and optimal cut-offs identified by the Youden index. Results: ESR showed broader correlations with disease impact and activity scores than CRP. While both markers had low sensitivity overall, they were highly specific for identifying patients with very high disease activity in select scenarios. ESR ≥ 8.5 mm/h and CRP ≥ 1.88 mg/dL were strongly discriminatory in patients not exposed to biologics. CRP ≥ 0.56 mg/dL showed good performance in early disease. Conclusions: Both ESR and CRP provide complementary insights into disease activity in axSpA. ESR may offer a broader reflection of disease burden beyond inflammation. These results support a more personalized biomarker strategy in real-world axSpA management, adapted to patient profile and treatment context. Full article
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14 pages, 640 KiB  
Article
Transforming Patient Experience: Real-World Impact of Mepolizumab on Symptom Burden in Chronic Rhinosinusitis with Nasal Polyps—A Multicenter Perspective
by Alfonso García-Piñero, Tomás Pérez-Carbonell, María-José Gómez-Gómez, Encarna Domenech-Campos, Fernando Martinez-Expósito, Noelia Muñoz-Fernández, Jordi Calvo-Gómez, Carmen García-Navalón, Lucas Fito-Martorell, Felip Ferrer-Baixauli, Ainhoa García-Lliberós, Nezly Mosquera-Lloreda, Chakib Taleb, Carlos Zac-Romero, Cecilia López-Valdivia, Juan Pardo-Albiach and Miguel Armengot-Carceller
J. Clin. Med. 2025, 14(15), 5248; https://doi.org/10.3390/jcm14155248 - 24 Jul 2025
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic upper airway disease that may involve different inflammatory endotypes, although in Western populations it is most commonly associated with type 2 inflammation. CRSwNP has a significant impact on the patient’s quality of [...] Read more.
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic upper airway disease that may involve different inflammatory endotypes, although in Western populations it is most commonly associated with type 2 inflammation. CRSwNP has a significant impact on the patient’s quality of life. The recommended appropriate medical therapy is effective in controlling CRSwNP symptoms in many patients; however, a subset continues to exhibit persistent type 2 inflammation, evidenced by recurrent nasal polyps, elevated eosinophil counts, or the need for systemic corticosteroids or surgery. Monoclonal antibodies have recently become a novel and personalized treatment that can help refractory patients restore disease control. Objective: The present study aims to evaluate the effectiveness of mepolizumab in real-world settings in a diverse patient population, focusing on assessing the impact of this therapy on patient-reported outcomes after six months of treatment. Methods: This is a multicenter, observational study of CRSwNP patients treated with mepolizumab carried out in five hospitals located in Spain. Adult patients with a diagnosis of uncontrolled CRSwNP were included in the study. The change in the nasal polyp score (NPS) was the main clinical endpoint. Changes in the Sinonasal Outcome Test (SNOT-22), nasal congestion and smell impairment visual analogue scale scores, and blood and nasal polyp tissue eosinophil counts were among other endpoints included. Results: In total, 47 patients were included, and 91% were asthmatic. The nasal polyp score (0–8) was reduced significantly in the cohort (mean change: −2.56, p < 0.0001). The mean SNOT-22 score improved 25.29 points. Nasal congestion (−3.57, p < 0.0001) and smell impairment (−4.0, p < 0.0001) visual analog scale scores (0–10) showed a significant improvement. Blood and tissue eosinophil median counts showed significant reductions versus baseline of 86% and 26%, respectively. Among those patients with asthma, the asthma control test score achieved a median value of 24 points. Conclusions: This study provides real-world evidence supporting the effectiveness of mepolizumab in managing CRSwNP in patients with features suggestive of type 2 inflammation. The observed improvements in patient-reported outcomes, nasal polyp burden, and asthma control suggest that mepolizumab may be a valuable therapeutic option for this patient population. Full article
(This article belongs to the Section Otolaryngology)
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23 pages, 454 KiB  
Article
Gastric Cancer Surgery Before and During the COVID-19 Pandemic in Turkey: A Multicenter Comparison of Prognostic Factors, Mortality, and Survival
by Yasin Dalda, Sami Akbulut, Zeki Ogut, Serkan Yilmaz, Emrah Sahin, Ozlem Dalda, Adem Tuncer and Zeynep Kucukakcali
Medicina 2025, 61(8), 1336; https://doi.org/10.3390/medicina61081336 - 24 Jul 2025
Abstract
Background/Objectives: The COVID-19 pandemic disrupted global cancer care. This study compared gastric cancer surgical outcomes before and during the pandemic in Turkey. We also aimed to analyze the impact of the pandemic and factors on survival and mortality in gastric cancer patients. Materials [...] Read more.
Background/Objectives: The COVID-19 pandemic disrupted global cancer care. This study compared gastric cancer surgical outcomes before and during the pandemic in Turkey. We also aimed to analyze the impact of the pandemic and factors on survival and mortality in gastric cancer patients. Materials and Methods: This retrospective, multicenter cohort study included 324 patients from three tertiary centers in Turkey who underwent gastric cancer surgery between January 2018 and December 2022. Patients were stratified into Pre-COVID-19 (n = 150) and COVID-19 Era (n = 174) groups. Comprehensive demographic, surgical, pathological, and survival data were analyzed. To identify factors independently associated with postoperative mortality, a multivariable logistic regression model was applied. For evaluating predictors of long-term survival, multivariable Cox proportional hazards regression analysis was conducted. Results: The median time from diagnosis to surgery was comparable between groups, while the time from surgery to pathology report was significantly prolonged during the pandemic (p = 0.012). Laparoscopic surgery (p = 0.040) and near-total gastrectomy (p = 0.025) were more frequently performed in the Pre-COVID-19 group. Although survival rates between groups were similar (p = 0.964), follow-up duration was significantly shorter in the COVID-19 Era (p < 0.001). Comparison between survivor and non-survivor groups showed that several variables were significantly associated with mortality, including larger tumor size (p < 0.001), greater number of metastatic lymph nodes (p < 0.001), elevated preoperative CEA (p = 0.001), CA 19-9 (p < 0.001), poor tumor differentiation (p = 0.002), signet ring cell histology (p = 0.003), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001). Multivariable logistic regression identified total gastrectomy (OR: 2.14), T4 tumor stage (OR: 2.93), N3 nodal status (OR: 2.87), and lymphovascular invasion (OR: 2.87) as independent predictors of postoperative mortality. Cox regression analysis revealed that combined tumor location (HR: 1.73), total gastrectomy (HR: 1.56), lymphovascular invasion (HR: 2.63), T4 tumor stage (HR: 1.93), N3 nodal status (HR: 1.71), and distant metastasis (HR: 1.74) were independently associated with decreased overall survival. Conclusions: Although gastric cancer surgery continued during the COVID-19 pandemic, some delays in pathology reporting were observed; however, these did not significantly affect the timing of adjuvant therapy or patient outcomes. Importantly, pandemic timing was not identified as an independent risk factor for mortality in multivariable logistic regression analysis, nor for survival in multivariable Cox regression analysis. Instead, tumor burden and aggressiveness—specifically advanced stage, lymphovascular invasion, and total gastrectomy—remained the primary independent determinants of poor prognosis. While pandemic-related workflow delays occurred, institutional adaptability preserved oncologic outcomes. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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23 pages, 1417 KiB  
Article
Symptom Burden, Treatment Goals, and Information Needs of Younger Women with Pelvic Organ Prolapse: A Content Analysis of ePAQ-Pelvic Floor Free-Text Responses
by Georgina Forshall, Thomas J. Curtis, Ruth Athey, Rhys Turner-Moore, Stephen C. Radley and Georgina L. Jones
J. Clin. Med. 2025, 14(15), 5231; https://doi.org/10.3390/jcm14155231 - 24 Jul 2025
Abstract
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of [...] Read more.
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of illness, this study aims to assess the symptom burden, treatment goals, and information needs of younger women complaining of prolapse by analyzing questionnaire responses from an existing electronic Personal Assessment Questionnaire—Pelvic Floor (ePAQ-PF) dataset. Methods: Mixed-methods content analysis was conducted using free-text data from an anonymized multi-site ePAQ-PF dataset of 5717 responses collected across eight UK NHS trusts (2018–2022). A quantitative, deductive approach was first used to identify younger women (≤50 years old) with self-reported prolapse. ePAQ-PF scores for younger women with prolapse were compared with those aged >50 years, using Mann–Whitney tests. Free-text response data were analyzed inductively to qualitatively explore younger women’s symptom burden, treatment goals, and information needs. Results: Of the 1473 women with prolapse identified, 399 were aged ≤50 years. ePAQ-PF scores of the younger cohort demonstrated significantly greater symptom severity and bother than those aged >50, particularly in bowel, prolapse, vaginal, body image, and sexual health domains (p < adjusted threshold). Qualitative analysis undertaken to understand women’s concerns and priorities produced five health-related themes (physical health; functionality; psychosocial and emotional wellbeing; reproductive and sexual health; and healthcare journeys) and a sixth intersecting theme representing information needs. Conclusions: The findings highlight the substantial symptom burden of younger women with prolapse, as well as treatment goals and information needs specific to this population. The development of age-specific resources is identified as a requirement to support this group. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Challenges and Future Perspectives)
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35 pages, 4256 KiB  
Article
Automated Segmentation and Morphometric Analysis of Thioflavin-S-Stained Amyloid Deposits in Alzheimer’s Disease Brains and Age-Matched Controls Using Weakly Supervised Deep Learning
by Gábor Barczánfalvi, Tibor Nyári, József Tolnai, László Tiszlavicz, Balázs Gulyás and Karoly Gulya
Int. J. Mol. Sci. 2025, 26(15), 7134; https://doi.org/10.3390/ijms26157134 - 24 Jul 2025
Abstract
Alzheimer’s disease (AD) involves the accumulation of amyloid-β (Aβ) plaques, whose quantification plays a central role in understanding disease progression. Automated segmentation of Aβ deposits in histopathological micrographs enables large-scale analyses but is hindered by the high cost of detailed pixel-level annotations. Weakly [...] Read more.
Alzheimer’s disease (AD) involves the accumulation of amyloid-β (Aβ) plaques, whose quantification plays a central role in understanding disease progression. Automated segmentation of Aβ deposits in histopathological micrographs enables large-scale analyses but is hindered by the high cost of detailed pixel-level annotations. Weakly supervised learning offers a promising alternative by leveraging coarse or indirect labels to reduce the annotation burden. We evaluated a weakly supervised approach to segment and analyze thioflavin-S-positive parenchymal amyloid pathology in AD and age-matched brains. Our pipeline integrates three key components, each designed to operate under weak supervision. First, robust preprocessing (including retrospective multi-image illumination correction and gradient-based background estimation) was applied to enhance image fidelity and support training, as models rely more on image features. Second, class activation maps (CAMs), generated by a compact deep classifier SqueezeNet, were used to identify, and coarsely localize amyloid-rich parenchymal regions from patch-wise image labels, serving as spatial priors for subsequent refinement without requiring dense pixel-level annotations. Third, a patch-based convolutional neural network, U-Net, was trained on synthetic data generated from micrographs based on CAM-derived pseudo-labels via an extensive object-level augmentation strategy, enabling refined whole-image semantic segmentation and generalization across diverse spatial configurations. To ensure robustness and unbiased evaluation, we assessed the segmentation performance of the entire framework using patient-wise group k-fold cross-validation, explicitly modeling generalization across unseen individuals, critical in clinical scenarios. Despite relying on weak labels, the integrated pipeline achieved strong segmentation performance with an average Dice similarity coefficient (≈0.763) and Jaccard index (≈0.639), widely accepted metrics for assessing segmentation quality in medical image analysis. The resulting segmentations were also visually coherent, demonstrating that weakly supervised segmentation is a viable alternative in histopathology, where acquiring dense annotations is prohibitively labor-intensive and time-consuming. Subsequent morphometric analyses on automatically segmented Aβ deposits revealed size-, structural complexity-, and global geometry-related differences across brain regions and cognitive status. These findings confirm that deposit architecture exhibits region-specific patterns and reflects underlying neurodegenerative processes, thereby highlighting the biological relevance and practical applicability of the proposed image-processing pipeline for morphometric analysis. Full article
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18 pages, 692 KiB  
Review
Literature Review and Policy Recommendations for Single-Dose HPV Vaccination Schedule in China: Opportunities and Challenges
by Kexin Cao and Yiu-Wing Kam
Vaccines 2025, 13(8), 786; https://doi.org/10.3390/vaccines13080786 - 24 Jul 2025
Abstract
Cervical cancer remains a significant global public health challenge, with human papillomavirus (HPV) as its primary cause. In response, the World Health Organization (WHO) launched a global strategy to eliminate cervical cancer by 2030 and, in its 2022 position paper, recommended a single-dose [...] Read more.
Cervical cancer remains a significant global public health challenge, with human papillomavirus (HPV) as its primary cause. In response, the World Health Organization (WHO) launched a global strategy to eliminate cervical cancer by 2030 and, in its 2022 position paper, recommended a single-dose vaccination schedule. The objective of this review is to critically examine the current HPV vaccination landscape in China, including vaccination policies, immunization schedules, supply–demand dynamics, and the feasibility of transitioning to a single-dose regimen. By synthesizing recent developments in HPV virology, epidemiology, vaccine types, and immunization strategies, we identify both opportunities and barriers unique to the Chinese context. Results indicate that China primarily adheres to a three-dose vaccination schedule, with an optional two-dose schedule for girls aged 9–14, leaving a notable gap compared to the most recent WHO recommendation. The high prevalence of HPV types 52 and 58 contributes to a distinct regional infection pattern, underscoring the specific need for nine-valent vaccines tailored to China’s epidemiological profile. Despite the growing demand, vaccine supply remains inadequate, with an estimated annual shortfall of more than 15 million doses. This issue is further complicated by strong public preference for the nine-valent vaccine and the relatively high cost of vaccination. Emerging evidence supports the comparable efficacy and durable protection of a single-dose schedule, which could substantially reduce financial and logistical burdens while expanding coverage. This review advocates for the adoption of a simplified single-dose regimen, supported by catch-up strategies for older cohorts and the integration of HPV vaccination into China’s National Immunization Program (NIP). Sustained investment in domestic vaccine development and centralized procurement of imported vaccines may also possibly alleviate supply shortage. These coordinated efforts are critical for strengthening HPV-related disease prevention and accelerating China’s progress toward the WHO’s cervical cancer elimination targets. Full article
(This article belongs to the Special Issue Vaccination Strategies for Global Public Health)
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21 pages, 1563 KiB  
Systematic Review
Anhedonia and Negative Symptoms in First-Episode Psychosis: A Systematic Review and Meta-Analysis of Prevalence, Mechanisms, and Clinical Implications
by Valerio Ricci, Alessandro Sarni, Marialuigia Barresi, Lorenzo Remondino and Giuseppe Maina
Healthcare 2025, 13(15), 1796; https://doi.org/10.3390/healthcare13151796 - 24 Jul 2025
Abstract
Background: Anhedonia, defined as the diminished capacity to experience pleasure, represents a core negative symptom in first-episode psychosis (FEP) with profound implications for functional outcomes and long-term prognosis. Despite its clinical significance, comprehensive understanding of anhedonia prevalence, underlying mechanisms, and optimal intervention [...] Read more.
Background: Anhedonia, defined as the diminished capacity to experience pleasure, represents a core negative symptom in first-episode psychosis (FEP) with profound implications for functional outcomes and long-term prognosis. Despite its clinical significance, comprehensive understanding of anhedonia prevalence, underlying mechanisms, and optimal intervention strategies in early psychosis remains limited. Objectives: To systematically examine the prevalence and characteristics of anhedonia in FEP patients, explore neurobiological mechanisms, identify clinical correlates and predictive factors, and evaluate intervention efficacy. Methods: Following PRISMA 2020 guidelines, we conducted comprehensive searches across PubMed, Embase, PsycINFO, and Web of Science databases from January 1990 to June 2025. Studies examining anhedonia and negative symptoms in FEP patients (≤24 months from onset) using validated assessment instruments were included. Quality assessment was performed using appropriate tools for study design. Results: Twenty-one studies comprising 3847 FEP patients met inclusion criteria. Anhedonia prevalence ranged from 30% at 10-year follow-up to 53% during acute phases, demonstrating persistent motivational deficits across illness trajectory. Factor analytic studies consistently supported five-factor negative symptom models with anhedonia as a discrete dimension. Neuroimaging investigations revealed consistent alterations in reward processing circuits, including ventral striatum hypofunction and altered network connectivity patterns. Social anhedonia demonstrated stronger associations with functional outcomes compared to other domains. Epigenetic mechanisms involving oxytocin receptor methylation showed gender-specific associations with anhedonia severity. Conventional antipsychotic treatments showed limited efficacy for anhedonia improvement, while targeted psychosocial interventions demonstrated preliminary promise. Conclusions: Anhedonia showed high prevalence (30–53%) across FEP populations with substantial clinical burden (13-fold increased odds vs. general population). Meta-analysis revealed large effect sizes for anhedonia severity in FEP vs. controls (d = 0.83) and strong negative correlations with functional outcomes (r =·−0.82). Neuroimaging demonstrated consistent ventral striatum dysfunction and altered network connectivity. Social anhedonia emerged as the strongest predictor of functional outcomes, with independent suicide risk associations. Conventional antipsychotics showed limited efficacy, while behavioral activation approaches demonstrated preliminary promise. These findings support anhedonia as a distinct treatment target requiring specialized assessment and intervention protocols in early psychosis care. Full article
(This article belongs to the Section Medication Management)
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18 pages, 999 KiB  
Article
Anxious Traits Intensify the Impact of Depressive Symptoms on Stigma in People Living with HIV
by Alexia Koukopoulos, Antonio Maria D’Onofrio, Alessio Simonetti, Delfina Janiri, Flavio Cherubini, Paolo Vassallini, Letizia Santinelli, Gabriella D’Ettorre, Gabriele Sani and Giovanni Camardese
Brain Sci. 2025, 15(8), 786; https://doi.org/10.3390/brainsci15080786 - 24 Jul 2025
Abstract
Background/Objectives: Despite medical advances, stigma remains a major challenge for people living with HIV (PLWH). This study examined clinical, sociodemographic, and psychological predictors of HIV-related stigma, and explored whether affective temperament moderates the impact of depression on stigma. Methods: This cross-sectional [...] Read more.
Background/Objectives: Despite medical advances, stigma remains a major challenge for people living with HIV (PLWH). This study examined clinical, sociodemographic, and psychological predictors of HIV-related stigma, and explored whether affective temperament moderates the impact of depression on stigma. Methods: This cross-sectional observational study included 97 PLWH attending a tertiary infectious disease unit in Rome, Italy. Participants completed a battery of validated psychometric instruments assessing depressive symptoms, anxiety, manic symptoms, mixed affective states, general psychopathology, impulsivity, and affective temperament. HIV-related stigma was evaluated using the Berger HIV Stigma Scale, which measures personalized stigma, disclosure concerns, negative self-image, and concerns with public attitudes. Descriptive statistics were used to characterize the sample. Univariate linear regressions were conducted to explore associations between clinical, psychometric, and sociodemographic variables and each stigma subdimension, as well as the total stigma score. Variables significant at p < 0.05 were included in five multivariate linear regression models. Moderation analyses were subsequently performed to assess whether affective temperaments moderated the relationship between significant psychopathological predictors and stigma. Bonferroni correction was applied where appropriate. Results: Higher depressive symptom scores are significantly associated with greater internalized stigma (B = 0.902, p = 0.006) and total stigma (B = 2.603, p = 0.008). Furthermore, moderation analyses showed that anxious temperament significantly intensified the relationship between depressive symptoms and both negative self-image (interaction term B = 0.125, p = 0.001) and total stigma (B = 0.336, p = 0.002). Conclusions: Depressive symptoms and anxious temperament are associated with HIV-related stigma. Integrating psychological screening and targeted interventions for mood and temperament vulnerabilities may help reduce stigma burden in PLWH and improve psychosocial outcomes. Full article
(This article belongs to the Section Neuropsychiatry)
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11 pages, 1381 KiB  
Article
Avelumab Maintenance Therapy for Advanced Urothelial Carcinoma with Low Tumor Burden
by Nobuki Furubayashi, Jiro Tsujita, Azusa Takayama, Shin Nakashima, Motonobu Nakamura and Takahito Negishi
Cancers 2025, 17(15), 2447; https://doi.org/10.3390/cancers17152447 - 23 Jul 2025
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Abstract
Background/Objectives: Commonly characterized by limited metastatic sites, low tumor burden has been associated with favorable patient outcomes in various malignancies. However, its prognostic relevance in avelumab maintenance therapy for advanced urothelial carcinoma (UC) remains incompletely defined. Methods: We retrospectively analyzed 26 patients with [...] Read more.
Background/Objectives: Commonly characterized by limited metastatic sites, low tumor burden has been associated with favorable patient outcomes in various malignancies. However, its prognostic relevance in avelumab maintenance therapy for advanced urothelial carcinoma (UC) remains incompletely defined. Methods: We retrospectively analyzed 26 patients with advanced UC who received avelumab maintenance therapy following disease control with first-line platinum-based chemotherapy between March 2021 and May 2025. Patients were categorized by their metastatic pattern at a chemotherapy initiation: lymph node-only (as a surrogate for low tumor burden), non-visceral (excluding visceral organ involvement, but including bone), or visceral disease. Survival outcomes were assessed using the Kaplan–Meier method. Results: Among the cohort, 46.2% had lymph node-only metastasis and 57.7% had non-visceral disease. The median progression-free survival (PFS) and overall survival (OS) from the start of avelumab were 5.6 months and 21.7 months, respectively. OS from the initiation of platinum-based chemotherapy was 28.7 months. Patients with lymph node-only metastasis demonstrated significantly longer OS from chemotherapy initiation compared with those with other metastatic patterns (41.1 vs. 22.9 months, p = 0.044). However, the PFS and OS from avelumab initiation did not significantly differ. No survival benefit was observed for patients with non-visceral disease compared with those with visceral metastases. Conclusions: Lymph node-only metastasis, representing low tumor burden, was associated with significantly improved long-term survival in advanced UC patients undergoing avelumab maintenance following chemotherapy. These findings support the clinical utility of baseline tumor burden and metastatic pattern in risk stratification and shared decision-making for maintenance therapy in advanced UC. Full article
(This article belongs to the Special Issue Immunotherapy in Urothelial Carcinoma)
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14 pages, 954 KiB  
Article
Left Ventricular Ejection Fraction Predicts Outcomes in Different Subgroups of Patients Undergoing Coronary Angiography
by Henning Johann Steffen, Tobias Schupp, Mohammad Abumayyaleh, Lasse Kuhn, Philipp Steinke, Jonas Dudda, Kathrin Weidner, Jonas Rusnak, Mahboubeh Jannesari, Fabian Siegel, Daniel Duerschmied, Michael Behnes and Ibrahim Akin
J. Clin. Med. 2025, 14(15), 5219; https://doi.org/10.3390/jcm14155219 - 23 Jul 2025
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Abstract
Objectives: To evaluate the long-term prognostic value of left ventricular ejection fraction (LVEF) in consecutive patients undergoing invasive coronary angiography (CA). Background: LVEF is a key prognostic marker in cardiovascular disease, but its value across different clinical indications for CA remains insufficiently characterized. [...] Read more.
Objectives: To evaluate the long-term prognostic value of left ventricular ejection fraction (LVEF) in consecutive patients undergoing invasive coronary angiography (CA). Background: LVEF is a key prognostic marker in cardiovascular disease, but its value across different clinical indications for CA remains insufficiently characterized. Methods: Consecutive patients undergoing CA between January 2016 and August 2022 were retrospectively included at one institution. Patients were stratified into four LVEF groups: ≥ 55%, 45–54%, 35–44%, and <35%. The primary endpoint was rehospitalization for heart failure (HF) at 36 months. Secondary endpoints were acute myocardial infarction (AMI) and coronary revascularization. Kaplan–Meier and multivariable Cox regression analyses were conducted within the entire study cohort and pre-defined subgroups. Results: A total of 6888 patients were included (median age: 71 years; 65.2% males). LVEF < 35% was associated with a higher comorbidity burden and more extensive coronary artery disease (e.g., three-vessel CAD: 38.6% vs. 20.7%, p < 0.001). Event rates for HF rehospitalization and AMI increased progressively with declining LVEF, while revascularization rates varied across categories. Statistically significant differences across LVEF groups were observed for all three endpoints in unadjusted analyses (log-rank p < 0.001). In multivariable models, LVEF < 35% independently predicted HF rehospitalization (HR = 3.731, p < 0.001) and AMI (HR = 4.184, p < 0.001), but not revascularization (HR = 0.867, p = 0.378). The prognostic association was demonstrated across all subgroups stratified by age, sex, subtype of acute coronary syndrome, and CAD severity. Conclusions: Reduced LVEF is an independent predictor of HF rehospitalization and AMI in patients undergoing coronary angiography, irrespective of its indication, whereas no independent association was observed with coronary revascularization. Full article
(This article belongs to the Section Cardiology)
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25 pages, 4283 KiB  
Review
Review on Upper-Limb Exoskeletons
by André Pires, Filipe Neves dos Santos and Vítor Tinoco
Machines 2025, 13(8), 642; https://doi.org/10.3390/machines13080642 - 23 Jul 2025
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Abstract
Even for the strongest human being, maintaining an elevated arm position for an extended duration represents a significant challenge, as fatigue inevitably accumulates over time. The physical strain is further intensified when the individual is engaged in repetitive tasks, particularly those involving the [...] Read more.
Even for the strongest human being, maintaining an elevated arm position for an extended duration represents a significant challenge, as fatigue inevitably accumulates over time. The physical strain is further intensified when the individual is engaged in repetitive tasks, particularly those involving the use of tools or heavy equipment. Such activities increase the probability of developing muscle fatigue or injuries due to overuse or improper posture. Over time, this can result in the development of chronic conditions, which may impair the individual’s ability to perform tasks effectively and potentially lead to long-term physical impairment. Exoskeletons play a transformative role by reducing the perceived load on the muscles and providing mechanical support, mitigating the risk of injuries and alleviating the physical burden associated with strenuous activities. In addition to injury prevention, these devices also promise to facilitate the rehabilitation of individuals who have sustained musculoskeletal injuries. This document examines the various types of exoskeletons, investigating their design, functionality, and applications. The objective of this study is to present a comprehensive understanding of the current state of these devices, highlighting advancements in the field and evaluating their real-world impact. Furthermore, it analyzes the crucial insights obtained by other researchers, and by summarizing these findings, this work aims to contribute to the ongoing efforts to enhance exoskeleton performance and expand their accessibility across different sectors, including agriculture, healthcare, industrial work, and beyond. Full article
(This article belongs to the Special Issue Design and Control of Assistive Robots)
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10 pages, 608 KiB  
Article
Performance of the InfraScanner for the Detection of Intracranial Bleeding in a Population of Traumatic Brain Injury Patients in Colombia
by Santiago Cardona-Collazos, Sandra Olaya-Perea, Laura Fernández, Dylan Griswold, Alvaro Villota, Sarita Aristizabal, Elizabeth Ginalis, Diana Sanchez, Angelos Kolias, Peter Hutchinson and Andres M. Rubiano
Emerg. Care Med. 2025, 2(3), 35; https://doi.org/10.3390/ecm2030035 - 23 Jul 2025
Viewed by 48
Abstract
Background/Objectives: Traumatic brain injury (TBI) is a global public health concern, affecting over 60 million people annually. It is associated with high rates of mortality and disability, particularly among young and economically active individuals, and remains the leading cause of death in [...] Read more.
Background/Objectives: Traumatic brain injury (TBI) is a global public health concern, affecting over 60 million people annually. It is associated with high rates of mortality and disability, particularly among young and economically active individuals, and remains the leading cause of death in people under 40 years of age. Although computed tomography (CT) is the standard method for excluding intracranial bleeding (ICB), it is frequently unavailable in resource-limited settings where the burden of TBI is greatest. The InfraScanner 2000 is a near-infrared spectroscopy (NIRS) device designed to detect ICB and may serve as a triage tool in environments without access to CT imaging. This study aimed to evaluate the diagnostic performance of the InfraScanner 2000 for detecting ICB in the emergency department (ED) of a trauma center in a cohort of Colombian patients with TBI. Methods: This prospective study was conducted in Cali, Colombia, between December 2019 and February 2021. Adult patients presenting to the ED with blunt TBI were enrolled. InfraScanner assessments were performed according to a standardized protocol, and all participants underwent head CT within 6 h of injury. Results: A total of 140 patients were included. Of these, 66% were male and 34% were female. Most patients (63.57%) were between 18 and 39 years old, with a median age of 39 years (IQR: 18–86). The InfraScanner demonstrated a sensitivity of 60.0% (95% CI: 32.5–84.8), specificity of 78.4% (95% CI: 71.2–85.6), positive predictive value (PPV) of 25.0%, and negative predictive value (NPV) of 94.2% for detecting ICB. Conclusions: The InfraScanner 2000 showed good specificity and high NPV in identifying ICB among Colombian patients with TBI. These findings suggest it could serve as a useful triage tool to support decision-making in emergency settings with limited access to CT imaging. Full article
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