Search Results (40,330)

Background/Objectives: Toric intraocular lens (IOL) implantation is the standard approach for correcting corneal astigmatism during cataract surgery and refractive lens exchange (RLE). Evidence on outcomes in eyes with high corneal astigmatism (≥2.00 diopters, D), particularly in heterogeneous real-world settings, remains limited. This study evaluated visual, refractive, and astigmatic vector outcomes of toric IOL implantation in a consecutive high-astigmatism cohort and investigated predictors of residual astigmatic error. Methods: This single-center, single-surgeon retrospective analysis of prospectively collected data included 161 eyes (118 patients) with preoperative corneal astigmatism ≥ 2.00 D undergoing cataract surgery or RLE with toric IOL implantation (June 2023–December 2025). Primary outcomes at one month included visual acuity, manifest refraction, and Alpins vector analysis at the corneal plane. Secondary analyses comprised refractive stability assessment (n = 75 eyes, median seven months), comparison of astigmatic outcomes between emmetropia-targeted and intentional myopia-targeted eyes, and multivariate regression of predictors of residual astigmatic error. Results: Mean postoperative UDVA and CDVA were 0.19 ± 0.24 and 0.09 ± 0.15 logMAR, respectively. Spherical equivalent prediction error was −0.19 ± 0.42 D (69.6% within ±0.50 D of target). Mean residual cylinder was 0.52 ± 0.49 D; 62% and 88.8% of eyes achieved ≤0.50 D and ≤1.00 D, respectively. Vector analysis demonstrated a mean difference vector of 0.53 ± 0.44 D, a correction index of 1.04 ± 0.20, and near-zero centroid deviation (0.03 D @ 43°), indicating the absence of systematic directional prediction error. Refractive outcomes were stable at medium-term follow-up. Astigmatic correction accuracy was equivalent between emmetropia-targeted and intentional myopia-targeted eyes (p > 0.05 for all primary metrics). Multivariate regression identified IOL cylinder power (β = 0.051, p = 0.031) and oblique astigmatism orientation (β = 0.299 vs. WTR, p = 0.032) as independent predictors of greater residual astigmatic error. No sight-threatening complications occurred. Conclusions: Toric IOL implantation provides safe, predictable, and stable correction of high corneal astigmatism in a real-world mixed cohort. Astigmatic accuracy is maintained regardless of intended spherical refractive strategy, supporting the use of toric IOLs in highly myopic patients targeted for residual myopia. Oblique astigmatism orientation is an independent predictor of reduced correction accuracy, consistent with known limitations of current toric calculators for this meridian. Full article

Background and Objectives: Pregnancy causes various physiological and hormonal changes that disrupt sleep architecture and modify respiratory patterns, increasing the risk of sleep-related breathing disorders (SBDs) such as obstructive sleep apnea (OSA) and potentially exacerbating pre-existing conditions. These disorders have been linked to adverse maternal and fetal outcomes. However, current screening tools remain inadequate, and data, including from Portugal, remain limited. This study aimed to assess the prevalence of SBD symptoms suggestive of sleep-disordered breathing during pregnancy, characterize the population, and explore associations with demographic and anthropometric parameters. Materials and Methods: A prospective observational study was conducted from July to December 2024 at Hospital da Luz Lisboa, involving pregnant women ≥ 18 years attending routine consultations. Participants completed a structured questionnaire that assessed demographic and anthropometric data, comorbidities, ten SBD symptoms, and the Epworth Sleepiness Scale (ESS). Results: The cohort included 289 participants, with a mean age of 34.4 years and pre-pregnancy body mass index (BMI) of 23.6 kg/m². On average, women reported 3.1 SBD symptoms, with fatigue (65.4%), memory/concentration impairment (52.2%), and non-restorative sleep (50.5%) being the most common. Excessive daytime sleepiness (ESS >10) was present in 22.8% of the population. Snoring was significantly associated with older age and higher BMI (p = 0.0009 and p < 0.0001, respectively). Both the number of symptoms and ESS scores tended to increase with gestational age, particularly in the third trimester. Women with diabetes had higher odds of reporting snoring, nocturnal dyspnea, and witnessed apneas, with odds ratios of 4.65, 8.77, and 11.38, respectively. Conclusions: SBD symptoms and daytime sleepiness are highly prevalent in pregnancy and typically increase with advancing gestation. These findings emphasize the need for improved clinical strategies to enable early identification and management of SBD in pregnant women, thereby reducing maternal-fetal complications. Full article

Background: Migraine is a highly prevalent neurological disorder associated with substantial disability and socioeconomic burden. Although pharmacological therapies remain the mainstay of treatment, their effectiveness may be limited by incomplete response and adverse effects. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a non-invasive neuromodulatory technique that may modulate cortical excitability and pain-processing networks involved in migraine pathophysiology. This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of rTMS compared with sham stimulation in individuals with migraine. Methods: A systematic search was conducted in PubMed (MEDLINE), PsycNet, and Ovid (including MEDLINE and Embase) from database inception to December 2025 in accordance with PRISMA 2020 guidelines. Studies investigating rTMS in adults with migraine and including a sham comparator were eligible for inclusion. Data regarding study design, participant characteristics, rTMS parameters, outcomes, and adverse events were extracted using a predefined template. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Results: Seven studies comprising a total of 301 participants were included. Most trials evaluated high-frequency rTMS targeting the dorsolateral prefrontal cortex. Across studies, rTMS was generally associated with reductions in migraine frequency and severity compared with sham stimulation, although results varied depending on stimulation parameters and study design. Treatment was consistently well tolerated, with only mild and transient adverse effects reported. However, considerable heterogeneity was observed in diagnostic criteria, stimulation protocols, outcome measures, and follow-up duration. Conclusions: Preliminary evidence suggests that rTMS may represent a promising and well-tolerated neuromodulatory approach for migraine management. Nevertheless, methodological variability, limited sample sizes, and concerns regarding risk of bias restrict definitive conclusions. Larger randomized controlled trials with standardized protocols and longer follow-up periods are needed to clarify the clinical role of rTMS in migraine treatment. Full article

Artificial lighting is a central and resource-intensive component of controlled environment agriculture, directly regulating plant physiological processes while influencing energy efficiency and production outcomes. Chlorophyll fluorescence analysis, particularly pulse-amplitude-modulated fluorometry, provides a rapid and non-destructive method for assessing plants’ photosynthetic efficiency. However, the extent to which chlorophyll fluorescence reflects plant responses to different light spectra across species remains insufficiently understood. In this study, species-specific photoresponses of leafy vegetables (Amaranthus tricolor, Barbarea verna, Chrysanthemum coronarium, Perilla frutescens) to different light spectra were investigated by integrating chlorophyll fluorescence with growth, antioxidant, and pigment traits. Plants were cultivated under monochromatic red, blue, and combined red–blue light, with additional far-red supplementation. Correlation analysis was performed among growth, antioxidant parameters, pigment contents, and chlorophyll fluorescence parameters. The obtained results show that chlorophyll fluorescence parameters respond selectively, but species-specifically, to applied lighting-spectrum conditions. Relationships between fluorescence indices and physiological traits varied between species, and no single parameter consistently reflected plant performance across all crops. Therefore, to employ chlorophyll fluorescence as a useful proxy for assessing plant responses to lighting spectrum, a species-specific and context-dependent approach is required. Full article

Background/Objectives: Malignant PEComa is a rare sarcoma subtype and usually represents PEComa-NOS (not otherwise specified), one of the several entities of the PEComa family. Surgery is the primary treatment for localized disease; chemotherapy is used mainly for metastatic or unresectable cases. Radiotherapy (RT) may be considered in selected cases; however, its role remains unclear due to the rarity of the disease and limited radiotherapy-specific studies. Methods: This is a descriptive literature review of a limited number of reports on RT use in PEComa. Descriptive statistics were used to summarize reported case characteristics and outcomes. Results: We identified 28 publications reporting 33 cases. In neoadjuvant settings, there was a significant local response to RT in one case. In other neoadjuvant cases, although quantitative response assessments were not reported, most showed no recurrence during follow-up, with the longest follow-up at 34 months, suggesting that a possible benefit in local disease control may exist. In the adjuvant setting, some reports described prolonged disease-free survival following RT, though the lack of direct comparisons between surgery with versus without RT and heterogeneous follow-up periods limit definitive conclusions. In selected metastatic cases, palliative RT achieved notable local responses, potentially contributing to durable local control. Conclusions: In conclusion, although the only available data on RT in PEComas come from case studies with overall heterogeneous management approaches, RT has shown some potential as a therapeutic option across neoadjuvant, adjuvant, and palliative settings, warranting further dedicated clinical studies. Full article

Background: Although minimally invasive glaucoma surgery (MIGS), including trabecular micro-bypass stent implantation, is safe, its surgical outcomes remain variable, with limited reliable success predictors. We evaluated whether preoperative trabecular meshwork (TM) thickness is associated with surgical outcomes after iStent inject^® W implantation. Methods: Patients with open-angle glaucoma (n = 28) who underwent iStent inject^® W implantation were included. Preoperative AS-SS-OCT was used to measure TM thickness and conventional angle parameters, including angle opening distance, angle recess area, trabecular–iris space area, and trabecular–iris angle. Surgical success was IOP ≤ 15 mmHg with ≥25% reduction or final IOP ≤ 12 mmHg under specified conditions. Logistic regression analyses were performed to identify factors associated with surgical outcomes. Results: At 12 months, 22 eyes (78.6%) achieved surgical success. Mean TM thickness was significantly greater in the unsuccessful than in the successful group (250.62 ± 32.05 μm vs. 180.75 ± 30.61 μm, p = 0.001), with similar findings for nasal and temporal TM thickness. Conventional angle parameters were not associated with surgical outcomes. In univariable analysis, both mean and nasal TM thickness were significantly associated with an increased risk of failure (per 10 μm increase; mean TM: OR = 2.77, 95% CI = 1.12–6.86, p = 0.027; nasal TM: OR = 1.64, 95% CI = 1.04–2.58, p = 0.034). Conclusions: Increased preoperative mean and nasal TM thickness was significantly associated with surgical failure following iStent inject^® W implantation. TM’s microstructural properties are more relevant than angular configuration in determining MIGS outcomes. Preoperative assessment of TM thickness using AS-SS-OCT may serve as a useful imaging biomarker for optimizing patient selection. Full article

Background and Objectives: Acute cholecystitis is a common indication for emergency surgery. While acute calculous cholecystitis (ACC) is most common, acute acalculous cholecystitis (AAC) occurs without gallstones and is often associated with severe systemic illness. We compared early postoperative outcomes after cholecystectomy for AAC versus ACC, with emphasis on complication severity and overall morbidity burden. Materials and Methods: We performed a single-center retrospective cohort study of consecutive adults undergoing urgent or emergent cholecystectomy for acute cholecystitis between December 2020 and April 2025. Patients with chronic cholecystitis, duplicate records, missing group assignment, or incomplete 30-day follow-up were excluded. The primary 30-day endpoints were postoperative complications, their severity (assessed with Clavien–Dindo scale), and cumulative morbidity assessed using the Comprehensive Complication Index. Secondary outcomes included operative approach, postoperative length of stay, 30-day readmission, and mortality. Results: A total of 221 patients were analyzed (181 ACC, 40 AAC). Patients with AAC were older and more frequently male. Any complication within 30 days occurred substantially more often in AAC patients than in ACC patients. Morbidity severity also differed markedly, with higher-grade complications occurring more frequently in the AAC group. AAC patients exhibited a substantially greater overall morbidity burden, indicating not only more frequent complications but also a heavier cumulative impact. Thirty-day mortality was considerably higher in AAC. Open surgery was more commonly required in AAC, whereas postoperative length of stay and 30-day readmission rates were similar between groups. Conclusions: In this cohort, AAC was associated with substantially worse early outcomes after cholecystectomy than ACC, characterized by a pronounced increase in clinically significant complications (Clavien–Dindo ≥ IIIa), greater cumulative morbidity (CCI), and markedly higher 30-day mortality. These findings support treating AAC as a high-risk phenotype warranting intensified perioperative optimization and vigilant postoperative monitoring. Full article

Background/Objectives: Despite substantial progress in the management of psoriasis, evidence on as-needed dosing strategies for biologic therapies remains scarce. In this context, the present study aimed to assess the effectiveness of a previously defined as-needed bimekizumab (BKZ) dosing regimen in a larger cohort of patients with psoriasis, as well as to identify clinical factors associated with treatment response. Methods: In this retrospective study, medical records of 64 patients with moderate-to-severe psoriasis treated with BKZ between May 2023 and November 2025 at a specialized psoriasis unit in Madrid, Spain, were reviewed. Patients followed an off-label, as-needed dosing regimen, consisting of two initial 320 mg doses at Weeks 0 and 4, with subsequent administrations only upon loss of a PASI 90 response. The primary outcome was the proportion of patients achieving and maintaining optimal disease control (PASI 90) over time. The duration of treatment effect was defined as the interval between the second dose and loss of PASI90 in the absence of further treatment. Safety outcomes were also evaluated. Results: A total of 59 out of 64 patients achieved a PASI 90 response after the initial two BKZ doses, and all maintained disease control with the as-needed dosing strategy over time. On average, patients received approximately one-third of the doses expected under the standard dosing regimen. The mean duration of treatment effect following the second dose was approximately 24 weeks. Systemic and bio-naïve patients presented the longest treatment effect duration under the as-needed dosing regimen. Oral candidiasis was reported in two patients and resolved without complications. Conclusions: This study reinforces previous evidence supporting the effectiveness of an as-needed BKZ dosing strategy, particularly in patients naïve to systemic and biologic therapies for psoriasis. Nevertheless, larger prospective studies are required to confirm these findings. Full article

Background: Sepsis has heterogeneous etiologies. Although bacteria are the most common causative agents, viral and yeast forms of sepsis also occur. Procalcitonin (PCT) is widely used to monitor severe bacterial infections and may support the differential diagnosis of infection etiology. Methods: We evaluated the diagnostic value of PCT in viral sepsis using PCT levels at ICU admission and PCT kinetics during ICU treatment. Results: During the COVID-19 pandemic, 191 adult ICU patients with sepsis and a positive SARS-CoV-2 PCR test at hospital admission were included and classified into two groups according to the presence or absence of bacterial or yeast co-infection. PCT showed a distinct diagnostic pattern influenced by the presence of co-infection. PCT remained low in isolated viral sepsis, whereas elevated concentrations were associated with superimposed bacterial or yeast co-infection and worse clinical outcomes. Overall mortality was significantly lower in patients with isolated viral sepsis compared to those with co-infection (50 vs. 69%, p = 0.009). Conclusions: In viral sepsis, persistently low PCT concentrations argue against bacterial co-infection, whereas elevated or rising values should prompt increased diagnostic evaluation. Although PCT provides clinically relevant diagnostic information, it must be interpreted cautiously and in conjunction with clinical assessment and microbiological data. PCT should serve as an adjunctive, not a standalone, marker of infection etiology in sepsis. Full article

Objectives: To evaluate the influence of two surface finishing procedures—mechanical polishing and glaze firing—on the color stability and wear behavior of lithium aluminium disilicate (LAD) hybrid abutment crowns over a three-year clinical observation period. Methods: Twenty-four patients requiring 34 implant-supported single crowns were included in this prospective clinical study. LAD abutment crowns were fabricated using n!ce ceramic and a CAD/CAM workflow and finished either by mechanical polishing (P, n = 17) or glaze firing (G, n = 17). After insertion as well as after one and three years (P: n = 9, G: n = 9) of clinical use color measurements were performed using spectrophotometry, and color differences (ΔE00) were calculated. Wear was assessed by digital surface comparison of baseline and the two follow-up scans using three-dimensional analysis software. Reference teeth (R) were defined and evaluated comparable to the P and F groups. Biological and technical complications were recorded throughout the observation period. Results: Color deviations increased over time in all groups (P, G, R). After three years, G showed lower mean color differences (ΔE00 ≈ 2.77) compared with F (ΔE00 ≈ 5.40), although the difference was not statistically significant. No significant differences in vertical height loss were observed between P and G. One adhesive fracture occurred both in the P and G group, five crowns (P: n = 3, G: n = 2) developed periimplantitis. Conclusions: Both polishing and glazing resulted in comparable clinical outcomes regarding color stability, wear behavior, and complication rates. Clinical Significance: Both finishing protocols might be a reliable option for LAD hybrid abutment crowns. Full article

Background/Objectives: Despite high recanalization rates associated with mechanical thrombectomy (MT), disability and death remain possible for many patients. Baseline stroke severity and reperfusion status predict outcomes; however, the influence of modifiable perioperative factors during general anesthesia (GA) remains unclear. We investigated actionable perioperative determinants of functional outcomes and 90-day mortality following MT under GA. Methods: We retrospectively analyzed 166 patients with acute ischemic stroke who underwent emergency MT with GA over 10 years (2014–2024). Poor functional outcomes were defined as a 90-day modified Rankin Scale score of 3–6, with all-cause 90-day mortality as the secondary endpoint. Independent predictors were identified using multivariable logistic regression, and discrimination was assessed using receiver operating characteristic analysis. Results: At 90 days, 56.6% of patients had poor functional outcomes, and mortality was 24.1%. Independent predictors of poor outcomes included preoperative hyperglycemia ≥140 mg/dL, vasopressor requirement, incomplete reperfusion, prolonged ventilator duration, and severe post-procedural neurological deficit. Optimal anesthetic induction dosing was strongly protective. Shorter groin puncture-to-recanalization time predicted better functional recovery. Mortality was associated with hyperglycemia, National Institutes of Health Stroke Scale ≥16, poor reperfusion, and prolonged ventilation. The models demonstrated excellent discrimination (area under the curve, 0.879 for poor outcomes; 0.923 for mortality). Perioperative physiological factors remained associated with outcomes independent of procedural success. Conclusions: Beyond technical success, perioperative physiological stability strongly influenced outcomes following MT under GA. Optimization of metabolic control, hemodynamic stability, procedural efficiency, and early ventilator liberation represents a clinically actionable strategy for improving neurological recovery and survival. Full article

Higher education institutions (HEIs) play a central role in fostering sustainability competencies to address environmental challenges. Within Education for Sustainable Development (ESD) and Sustainable Development Goal (SDG) 4 frameworks, universities must cultivate not only knowledge but also attitudes and behaviours promoting environmental responsibility. This study examines environmental attitudes as sustainability learning outcomes among undergraduate students, analysing differences by gender, age, and discipline in six Andalusian universities. Sustainable Education is defined as an approach integrating environmental, social, and economic sustainability dimensions into teaching to develop active competencies for sustainable development. A cross-sectional survey (n = 1471) used the validated CASEM questionnaire (see previous validation studies) to assess environmental knowledge, environmental education knowledge, and pro-environmental behaviour. The results show significant differences: women outperformed men across all dimensions, students aged over 25 exhibited stronger profiles, and Education Sciences students outperformed Engineering students. A persistent knowledge–behaviour gap emerged, especially in technical fields. These findings reveal curricular inequalities in sustainability integration. Mandatory, discipline-specific ESD—particularly in engineering—may help bridge these gaps and enhance uniform learning outcomes. By employing a multidimensional instrument and stratified sample, this study offers robust evidence of structural disparities, informing policy for equitable Higher Education for Sustainability. Full article

Ischemic stroke remains a leading cause of death and disability worldwide. While thrombolysis and endovascular thrombectomy are current mainstays of treatment, their clinical efficacy is often undermined by ischemia–reperfusion injury (I/R). This injury induces secondary brain damage, primarily via disruption of the blood–brain barrier (BBB). No approved therapies directly target BBB protection. This review reinterprets the pathophysiological mechanism of BBB disruption after stroke through a dynamic spatiotemporal framework. The pathological cascade reaction is clearly divided into two core stages: the ischemic phase is mainly driven by energy failure and calcium overload; the reperfusion phase is further divided into four consecutive and progressive sub-stages, namely, oxidative stress burst, amplification of inflammatory response, matrix metalloproteinase 9 (MMP-9)-mediated barrier degradation and programmed cell death. This review critically assesses current therapies and identifies major clinical translation gaps, including a temporal mismatch between preclinical and clinical windows, unacceptable toxicity, lack of durable efficacy and biphasic effects. Matching specific interventions to the different pathophysiological stages of blood–brain barrier disruption is essential for optimizing clinical outcomes. Full article

This study aims to examine the impact of the COVID-19 pandemic on the hospitality sector in Greece during the COVID-19 period. To this end, questionnaires were distributed in 320 enterprises operating throughout Greece exclusively in the hospitality industry. Structural equation modeling (SEM) was employed for analyzing data. The results reveal a structured transmission pathway: Business Survival Anxiety and Psychological Distress intensify Financial Strain; financial pressure constrains Strategic Capability; and diminished strategic flexibility shapes firms’ evaluation of the crisis’s overall impact. Financial Strain emerges as the central mediating mechanism, bridging managerial perceptions and organisational outcomes. These findings confirm that crisis impact is embedded in firm-level dynamics, where psychological pressures, resource constraints, and strategic contraction interact systematically. Ultimately, the study shows that the severity of the pandemic was not assessed solely in terms of immediate revenue loss, but in relation to the erosion of strategic capacity—innovation, investment potential, and long-term competitiveness. Resilience in tourism therefore depends on the alignment between psychological stability, financial robustness, and strategic adaptability. Full article

Capsular contracture (CC) remains the most common long-term complication of implant-based breast reconstruction (IBBR), significantly impacting cosmetic outcomes, patient satisfaction, and reoperation rates. Despite substantial advances in surgical technique, implant technology, and perioperative management, the incidence of clinically significant contracture persists at approximately 3–5% at five years in non-irradiated patients and escalates dramatically—to 20–50%—in those receiving postmastectomy radiation therapy (PMRT). The etiology is multifactorial, involving subclinical biofilm formation, a dysregulated host immune and foreign-body response, and radiation-induced fibrosis. This narrative review synthesizes contemporary evidence on the pathophysiology, clinical assessment, and modifiable risk factors for CC in IBBR, with particular emphasis on implant surface characteristics (smooth, textured, and polyurethane[PU]-coated), placement plane (prepectoral versus subpectoral), the role of acellular dermal matrices (ADMs), reconstruction timing (direct-to-implant versus two-stage), and the complex interplay with radiotherapy—including radiation timing, fractionation, and emerging delivery techniques. We also address ongoing controversies, including the lack of standardized objective diagnostic criteria, the comparative effectiveness of ADM versus PU-coated implants, and the optimal sequencing of radiation relative to reconstruction. By integrating the latest evidence from very recent major meta-analyses and national registries, this review provides an updated synthesis. We further propose an evidence-based clinical decision framework for CC risk mitigation. This review aims to inform individualized surgical decision-making and identify priority areas for future investigation. Full article