Search Results (6,313)

Treatment of non-small cell lung cancer (NSCLC) has been transformed by immunotherapy and targeted therapies. We aimed to characterize clinical features, treatment patterns, and healthcare resource use in patients with early and locally advanced NSCLC before incorporation of these therapies. This retrospective observational study included adults diagnosed with stage I–III NSCLC at four Spanish hospitals between 2014 and 2018, with follow-up until 2021, using artificial intelligence to extract data from electronic health records. A total of 951 patients were included (34.7% stage I, 16.7% stage II, 48.6% stage III), with a median age of 66 years and 31.9% female. Surgery was performed in 78.5% of stage I, 74.8% of stage II, and 35.5% of stage III patients. Among surgical patients, 62.5% received adjuvant chemo- and/or radiotherapy, 20.8% neoadjuvant therapy, and 15.7% both; among non-surgical patients, chemoradiotherapy was the most common treatment (50.4%). Beyond hospitalization, outpatient visits were the most frequently used healthcare resource. These findings provide a historical benchmark of NSCLC care before introduction of immunotherapy and targeted therapies in these settings, highlighting treatment variability and the need for earlier diagnosis, structured treatment pathways, and multidisciplinary management. Full article

Background: Psychological distress, particularly anxiety and depression, is highly prevalent among cancer patients, and is associated with impaired quality of life, reduced treatment adherence, and increased mortality risk. Standardized screening instruments, such as the Hospital Anxiety and Depression Scale (HADS), are effective, but face implementation barriers in busy oncology outpatient settings. This cross-sectional study investigated whether BERT-based Natural Language Processing (NLP) analysis of brief patient-generated free texts would correlate with HADS scores in a consecutive cohort of cancer outpatients. Material and Methods: A total of 165 consecutive adult cancer outpatients were enrolled at a tertiary oncology center in Turkey. All participants completed the HADS questionnaire and were asked to write freely about their current emotional state in Turkish. Patient-generated texts were analyzed using a pre-trained Turkish BERT model to derive a continuous BERT Sentiment Score (BSS) and a categorical BERT Sentiment Cluster (BSC) via unsupervised hierarchical clustering. Univariate and multivariate linear regression analyses were performed to examine associations between clinical, demographic, and NLP-derived variables and the logarithmically transformed HADS score. Results: The mean total HADS score was 10.46 (range, 0–33), consistent with a moderate level of psychological distress. In multivariate analysis, two variables were independently associated with HADS scores: female sex (β = 0.20, t = 2.14, p = 0.034), associated with higher HADS scores, and BERT Sentiment Score (BSS) (β = −0.18, t = −2.43, p = 0.016), with higher values corresponding to lower HADS scores. Hierarchical clustering identified two distinct thematic groups: ‘Coping and Fighting Spirit’ (74%), and ‘Hope and Negative Feelings’ (26%); however, cluster membership (BSC) was not independently associated with HADS scores (β = −0.02, p = 0.789). Clinical variables, including cancer stage, diagnosis type, treatment status, and time since diagnosis, also were not independently associated with HADS scores. Conclusions: BERT-based sentiment analysis of brief patient-generated free texts yielded a continuous measure that independently correlated with HADS scores in cancer outpatients, alongside female sex. These findings provide proof-of-concept evidence that NLP-derived sentiment scoring may offer a practical, scalable, and complementary approach to standardized psychological screening in routine oncology care. Full article

Objectives: To assess the prevalence of high-risk human papillomavirus (hrHPV) infection and selected genitourinary pathogens and to examine their co-detection patterns in sexually active adolescent females. Methods: In this single-center cross-sectional study, 167 consecutive outpatients aged 13–17 years with self-reported sexual initiation underwent multi-pathogen polymerase chain reaction (PCR) testing for hrHPV, Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Ureaplasma parvum (UP), and Mycoplasma genitalium (MG). Prevalence estimates are reported with 95% confidence intervals (CIs). Associations with hrHPV positivity were explored using univariable and parsimonious multivariable logistic regression; sensitivity analyses examined alternative age parameterization and exclusion of sparse variables. Results: The prevalence of hrHPV was 28.1% (47/167; 95% CI: 21.5–35.6). The prevalence of CT, UU, UP, and MG was 3.0%, 28.1%, 25.1%, and 0.6%, respectively. Any bacterial pathogen was detected in 61/167 participants (36.5%), while hrHPV–bacterial co-detection was observed in 24/167 (14.4%). In univariable analysis, UU was associated with hrHPV positivity (OR 2.55, 95% CI: 1.24–5.24; p = 0.013); this signal remained in the primary multivariable model (adjusted OR 2.46, 95% CI: 1.07–5.93; p = 0.035). A graded increase in hrHPV positivity was observed with increasing bacterial burden (p for trend = 0.018). Conclusions: Sexually active adolescent girls attending gynecologic outpatient care showed a substantial burden of hrHPV and bacterial genitourinary pathogen detection. This Central and Eastern European adolescent outpatient cohort contributes integrated multi-pathogen PCR-based epidemiologic data from a clinically relevant and underreported population. An exploratory association between UU and hrHPV positivity was observed; this signal is best interpreted as reflecting shared sexual exposure or the cervicovaginal microbial milieu rather than as evidence of an independent causal role for UU. The absence of vaccination status, behavioral, and longitudinal data represents a principal limitation. Prospective studies incorporating these variables are needed to clarify the epidemiology of hrHPV and co-detected pathogens in adolescents. Full article

Background: Otitis media with effusion (OME) is a common pediatric middle-ear disorder with multifactorial pathogenesis. Allergic rhinitis and allergic sensitization have been proposed as contributing factors, but previous evidence remains heterogeneous. This systematic review and meta-analysis aimed to clarify the association between allergic rhinitis, allergic sensitization, and pediatric OME, while separately considering Eustachian tube dysfunction (ETD) and middle-ear dysfunction. Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, and the Cochrane Library. Observational studies evaluating allergic rhinitis, rhinitis, atopy, IgE sensitization, or allergy-related symptoms in relation to OME, ETD, abnormal tympanometry, or middle-ear dysfunction were considered eligible. Random-effects meta-analyses were performed separately for allergic rhinitis/rhinitis–OME and atopy/IgE sensitization–OME. ETD and middle-ear dysfunction outcomes were synthesized narratively because of methodological heterogeneity. Results: After removal of duplicates, 956 records were screened, 46 reports were assessed for eligibility, and 21 studies were included in the qualitative or narrative synthesis. Nine studies contributed to at least one pooled quantitative synthesis, while one additional birth-cohort study contributed adjusted estimates to the narrative sensitivity interpretation. Allergic rhinitis/rhinitis was significantly associated with OME in the primary meta-analysis (OR = 3.73, 95% CI 1.79–7.74, p < 0.001; I² = 69.7%). The association remained significant in an expanded sensitivity analysis including one additional community-based study (OR = 3.46, 95% CI 1.92–6.23, p < 0.001; I² = 63.7%). Atopy/IgE sensitization was also associated with OME (OR = 5.45, 95% CI 1.33–22.35, p = 0.018; I² = 86.0%), although this analysis included only two studies. Most pooled estimates were derived from crude data and should therefore be interpreted as associations rather than causal effects. Conclusions: Allergic rhinitis/rhinitis and allergic sensitization are associated with increased odds of pediatric OME. However, the available evidence is mainly observational and heterogeneous. Allergic disease should be considered a potential contributing factor in selected pediatric OME phenotypes, rather than a universal or isolated cause. A phenotype-based approach involving both otolaryngology and allergy/immunology may be clinically useful. Full article

Background/Objectives: The acute complications of COVID-19 have been well characterized and are frequently associated with increased mortality. Although substantial knowledge regarding long COVID has accumulated since the beginning of the pandemic, important uncertainties remain regarding the long-term clinical, functional, radiological, and metabolic consequences of SARS-CoV-2 infection. Identification of post-COVID-19 complications is therefore essential for appropriate recognition and management. This study aimed to evaluate the long-term complications of COVID-19 at 3 and 9 months after infection. Methods: This prospective study was conducted at Inonu University Turgut Ozal Medical Center. Patients who presented with active post-COVID-19 complaints or for routine follow-up were enrolled. Participants were evaluated at the pulmonology outpatient clinic at 3 and 9 months. At each visit, persistent or new-onset symptoms were assessed, and pulmonary function tests (PFT), the six-minute walk test (6MWT), echocardiography (ECHO), and thoracic computed tomography (CT) were performed as clinically indicated. Patients were stratified into three groups according to the severity of acute illness: outpatient, ward-hospitalized, and ICU-hospitalized. Results: A total of 205 patients (120 male, 85 female) were included. Male patients had significantly higher rates of ward and ICU hospitalization than female patients (p = 0.006). At 9 months, 85.3% of patients had at least one persistent symptom; dyspnea (69.6%), cough (35.6%), and chest pain (32.5%) were the most common. FVC showed a statistically significant increase between months 3 and 9 (p = 0.014), and the 6MWT distance improved significantly (423.56 m vs. 464.10 m; p = 0.008). Ground-glass opacity, present in 90.2% of patients at admission, persisted in 44.3% at 9 months (p < 0.001). Reticular opacities, pleuroparenchymal bands, and mosaic perfusion patterns increased over time. ICU patients had significantly lower ejection fraction values compared with ward and outpatient groups at 9 months (p = 0.046). During follow-up, 13 patients developed pulmonary embolism and 7 developed new-onset diabetes mellitus. Conclusions: Despite the well-characterized acute phase, the long-term sequelae of COVID-19 remain a significant clinical challenge. Identification of late complications is critical for reducing morbidity and understanding the long-term societal and healthcare burden of the pandemic. Multidisciplinary long-term follow-up is warranted, particularly for patients who experienced severe acute illness. Full article

Background/Objectives: Serum 25-hydroxyvitamin D [25(OH)D] is a clinically used biomarker of vitamin D nutritional status, although it is also influenced by sunlight exposure, supplementation, season, and other host factors. Short-term functional status after extracorporeal shock wave therapy (ESWT) for lateral epicondylitis varies. We evaluated whether serum 25(OH)D level and status were associated with 12-week functional outcomes among ESWT-treated patients. Methods: This single-center retrospective cohort included 62 adults with lateral epicondylitis who received outpatient ESWT and had baseline and 12-week assessments. Baseline variables included grip strength ratio, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, serum 25(OH)D measured using the Architect 25-OH D vitamin kit, common extensor tendon (CET) thickness, age, sex, and body mass index. Multivariable linear regression was used in an analysis-of-covariance framework. Serum 25(OH)D was assessed continuously and as <20 versus ≥20 ng/mL in exploratory threshold analysis. Results: Serum 25(OH)D was 21.0 ± 8.4 ng/mL; 30 patients (48.4%) had <20 ng/mL, 22 (35.5%) had 20–29.9 ng/mL, and 10 (16.1%) had ≥30 ng/mL. QuickDASH decreased from 42.0 ± 17.4 to 27.0 ± 13.7, and grip strength ratio increased from 0.58 ± 0.14 to 0.76 ± 0.14. Higher serum 25(OH)D was associated with lower 12-week QuickDASH after adjustment (β per 10 ng/mL = −4.04, 95% CI −7.17 to −0.91; p = 0.012). Additionally, 25(OH)D <20 ng/mL was associated with higher 12-week QuickDASH (β = 6.43, 95% CI 1.17 to 11.69; p = 0.017). Serum 25(OH)D was not clearly associated with 12-week grip strength ratio. Conclusions: Lower serum 25(OH)D, interpreted as a vitamin D nutritional-status marker rather than as a nutrition-specific causal exposure, was associated with worse 12-week patient-reported function, but not grip strength ratio. The <20 ng/mL threshold analysis was exploratory and was not powered for subgroup inference. These findings should be interpreted as observational and hypothesis-generating. Full article

Background: Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal (GI) disorders. Omeprazole is one of the most commonly prescribed PPIs in Thailand. However, it is frequently overprescribed in hospital settings, increasing the risk of adverse effects. Moreover, such overuse imposes unnecessary healthcare costs. Objectives: To determine the prevalence of potentially inappropriate omeprazole prescribing and its associated factors, and to assess the financial impact of its overuse. Methods: This retrospective cross-sectional study was conducted in a general hospital in Thailand. Outpatients who received omeprazole between 1 January 2025 and 30 June 2025 were included. Descriptive statistics were used to summarize the data. The Chi-square test and Fisher’s exact test were used to compare categorical variables, as appropriate. Factors associated with inappropriate omeprazole prescribing were evaluated using logistic regression analysis. Results: A total of 229 patients receiving 347 omeprazole prescriptions were included. The mean age was 61.35 ± 17.17 years, and 59.4% were female. Inappropriate omeprazole prescribing was identified in 58.2% of prescriptions, primarily due to lack of appropriate indications (75.2%), followed by inappropriate duration. Antiplatelet use (OR 0.21, 95% CI 0.11–0.38, p < 0.001) and dual antiplatelet therapy (OR 0.05, 95% CI 0.01–0.37, p = 0.004) were significantly associated with a lower likelihood of inappropriate prescribing. Conclusion: Inappropriate omeprazole prescribing was common and largely driven by the absence of a clear indication, which was the main contributor to excess costs. Targeted interventions focusing on appropriate initiation, GI risk assessment, and regular reassessment may improve prescribing quality and reduce unnecessary healthcare expenditure. Full article

Background/Objectives: Sarcopenia may compound mobility limitations and fall vulnerability among older adults with coexisting knee osteoarthritis (KOA) and chronic spinal pain. This secondary analysis of a previously reported or substantially overlapping cohort estimated the proportion meeting Asian Working Group for Sarcopenia (AWGS) 2019 criteria and explored additional adjusted associations in a selected Vietnamese outpatient sample. Methods: A hospital-based secondary cross-sectional analysis included 88 outpatients aged ≥60 years (mean age, 70.5 ± 6.7 years; 69 women, 78.4%) with coexisting KOA and chronic spinal pain who were recruited by convenience sampling at Thai Binh General Hospital from May to October 2024. Source-record verification confirmed that all of the analytic participants had both diagnoses. Their muscle mass, grip strength, and gait speed were assessed using the InBody 770, an InGrip handgrip dynamometer, and a 15-foot walk test, respectively. The prespecified primary classification used AWGS 2019. The AWGS 2025 framework was considered during revision, but numerical reclassification was not feasible because the retained participant-level analytic dataset contained the derived AWGS 2019 outcome and covariates used in the reported regression and CHAID analyses, but not the original continuous age, appendicular skeletal muscle mass index, handgrip values, or a complete raw component record sufficient to independently reconstruct the AWGS 2019 status or apply AWGS 2025 thresholds. Multivariable logistic regression and CHAID were treated as exploratory. Results: Under AWGS 2019, 36/88 participants (40.9%) had sarcopenia, including 15 (17.0%) with severe sarcopenia. All 88 participants had both KOA and chronic spinal pain; therefore, diagnostic-category subgroup comparisons were not applicable. In the exploratory adjusted analysis, an age >70 years (adjusted odds ratio [AOR]: 9.00, 95% confidence interval [CI]: 2.40–33.60), a history of falls (AOR: 6.33, 95% CI: 2.77–14.45), low educational attainment (AOR: 2.86, 95% CI: 1.46–5.61), and a higher Pittsburgh Sleep Quality Index score (AOR: 1.16, 95% CI: 1.02–1.32) remained associated with sarcopenia. Wide CIs and approximately 4.5 events per regression coefficient indicated substantial imprecision. Conclusions: This secondary report provides setting-specific descriptive evidence rather than independent replication, a validated prediction tool, or a fully auditable reconstruction of the original AWGS component measurements. Because AWGS 2025 reclassification could not be reconstructed from the retained dataset and raw component records, the AWGS 2019 estimate should not be treated as directly interchangeable with the estimates generated under the updated framework. The observed associations and within-sample subgroup patterns require confirmation in larger, prospectively auditable studies. Full article

Background/Objectives: Oral prednisolone (PSL) and budesonide multi-matrix (BUD-MMX) are used to induce remission in ulcerative colitis (UC); however, their therapeutic positioning remains unclear. Comparative data from real-world practices are limited. This study assessed the efficacy and safety of PSL and BUD-MMX in patients with active UC. Methods: Consecutive outpatients with UC initiated on oral PSL or BUD-MMX at two tertiary referral centers were included. The primary outcome was clinical remission at week 8, defined as a partial Mayo score (PMS) ≤ 1 with a rectal bleeding subscore of 0. Secondary outcomes included clinical response and safety. Pre-specified subgroup analyses were performed according to baseline disease activity. Results: Sixty PSL-treated and 40 BUD-MMX-treated patients were evaluated at week 8. Clinical remission was achieved in 65.0% and 55.0% of the PSL and BUD-MMX groups, respectively, whereas a clinical response was observed in 75.0% and 62.5%, respectively. No patient with a baseline PMS of 2–3 was initiated on PSL. Among patients with a baseline PMS of 4–5, the remission and response rates at week 8 were similar between the groups. In contrast, remission in patients with a baseline PMS ≥ 6 was numerically lower in the BUD-MMX group. Treatment escalation rates were comparable in the overall cohort, whereas adverse events were more frequent in the PSL group (23.3% vs. 2.4%). Conclusions: Treatment selection between PSL and BUD-MMX appeared to reflect baseline disease activity, with a partial overlap in the moderate clinical range. BUD-MMX may be a reasonable initial option for selected patients. Full article

Background/Objectives: Antidepressant treatment response is highly variable, and CYP2D6 metabolizer phenotype has been proposed as a contributor to this variability. It was examined whether CYP2D6 metabolizer phenotype is associated with real-world antidepressant treatment outcomes in a large population-based cohort. Methods: Using genetic and longitudinal primary care prescription data from the UK Biobank, we evaluated associations between CYP2D6 metabolizer phenotype and prescription-based proxies of treatment outcomes, including discontinuation, switching, and side effects. Analyses were stratified by antidepressant and adjusted for demographic covariates. Results: Among 26,957 individuals of European ancestry prescribed CYP2D6-metabolized antidepressants, reduced metabolic capacity was significantly associated with early discontinuation of paroxetine (N = 5718), venlafaxine (N = 2327), and mirtazapine (N = 3340). For paroxetine, poor metabolizers had higher odds of discontinuation compared with normal metabolizers and, among discontinuers, were more likely to stop immediately rather than later. Similar early discontinuation signals were observed for venlafaxine, with intermediate metabolizers showing increased risk. Mirtazapine also demonstrated increased odds of early discontinuation among poor metabolizers. No significant association was observed for fluoxetine. Associations with switching were limited, and no significant associations were detected for side effects. Conclusions: CYP2D6 variation appears to primarily influence early antidepressant discontinuation within the first 30 days of treatment, particularly for paroxetine, venlafaxine, and mirtazapine, rather than treatment switching or side effects. These findings provide observational support relevant to drug-specific gene interactions and suggest a role for CYP2D6-guided prescribing in clinical practice, notably in the first 30 days of antidepressant treatment. Full article

Background/Objectives: Atrial fibrillation (AF) imposes a substantial long-term clinical and healthcare system burden, recurrent hospitalizations, impaired quality of life, and increasing long-term healthcare costs. Although patient-reported outcome measures (PROMs) are increasingly used in AF research and clinical practice, their broader role in healthcare delivery, implementation, and system-level decision-making remains insufficiently defined. Existing assessment strategies frequently prioritize symptom burden while underrepresenting cognitive, emotional, social, and functional dimensions of AF-related impairment. This narrative implementation review examines the current role of PROMs in AF management from a healthcare system and implementation perspective. Methods: Literature addressing AF-specific and generic PROM instruments, implementation strategies, health system integration, value-based care, and digital health approaches was reviewed and synthesized across PubMed, Scopus, and Google Scholar. Particular emphasis was placed on implementation barriers, workflow integration, evidence strength, and challenges encountered across diverse healthcare settings. Results: Current PROM frameworks incompletely capture several important dimensions of AF burden, including cognitive dysfunction, sleep disturbance, emotional distress, social participation, sexual health, and productivity loss. Beyond conventional symptom assessment, PROMs may support longitudinal patient monitoring, treatment evaluation, shared decision-making, and patient-centred care. Emerging evidence also suggests potential roles in outpatient prioritization, healthcare quality assessment, and value-based healthcare initiatives, although prospective AF-specific implementation studies remain limited. Mapping PROM applications to the 2024 ESC AF-CARE pathway demonstrates the strongest alignment with the Evaluation and Reducing symptoms domains while supporting patient engagement, comorbidity management, and individualized care planning. Implementation remains constrained by clinician workload, questionnaire fatigue, limited interoperability, heterogeneous digital infrastructure, and variability in organizational resources, with these challenges potentially being more pronounced in smaller or resource-limited healthcare systems. Conclusions: PROM integration in AF care may provide opportunities to strengthen patient-centered management and improve healthcare system responsiveness beyond conventional rhythm- and symptom-focused approaches. Successful implementation may require careful adaptation to local healthcare infrastructure, workflow feasibility, and long-term sustainability. Future developments involving digital platforms, wearable technologies, and artificial intelligence-assisted interpretation may further expand the clinical and operational relevance of PROM-guided AF care. Full article

Background/Objectives: Dysphagia may adversely affect nutritional status in patients with Multiple Sclerosis (MS). This study aimed to investigate the associations between dysphagia severity and (i) nutritional status, assessed by the Malnutrition Universal Screening Tool (MUST) and Global Leadership Initiative on Malnutrition (GLIM) criteria, and (ii) secondary sarcopenia indicators according to the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) framework. Materials and Methods: This cross-sectional study enrolled 32 consecutive adult outpatients with confirmed MS and self-reported dysphagia (DYMUS ≥ 1). Dysphagia severity was evaluated using the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire, the Eating Assessment Tool-10 (EAT-10), and the Yale Swallow Protocol. Nutritional assessment included MUST screening and GLIM-based malnutrition diagnosis. Muscle function was evaluated via handgrip strength, calf circumference, and 4-metre gait speed. Results: GLIM-defined malnutrition was identified in 12 (37.5%) patients. Dysphagia severity was significantly associated with MUST score (ρ = 0.596, p < 0.001) and the presence of GLIM-defined malnutrition (median DYMUS 6.5 vs. 4.0; p = 0.012). In exploratory logistic regression, higher DYMUS scores were associated with GLIM-defined malnutrition. Conversely, no significant associations were found between dysphagia severity and handgrip strength, calf circumference, or sarcopenia classification (p > 0.30 for all). The categorical severe-sarcopenia rate was not considered reliably interpretable because of a pronounced gait speed floor effect. Conclusions: In ambulatory MS patients with dysphagia, dysphagia severity was associated with nutritional risk indicators and GLIM-defined malnutrition, but not with the primary muscle strength and mass indicators evaluated. Because MUST and GLIM reflect composite nutritional risk rather than confirmed protein–energy deficiency, these findings should be regarded as exploratory and hypothesis-generating. The present data did not permit a reliable estimate of sarcopenia prevalence because of a pronounced gait speed floor effect and the absence of body composition measurement. As a preliminary practical consideration, these findings may support combined dysphagia and nutritional screening in multidisciplinary MS outpatient care, pending confirmation in larger prospective cohorts. Full article

Background/Objectives: To evaluate whether frontal and maxillary sinus hypoplasia/aplasia are associated with differences in CT-based craniofacial morphometric measurements in adults. Methods: This retrospective case–control study included adults who presented to the otolaryngology outpatient clinic and underwent paranasal sinus CT at a single institution between 3 April 2023, and 30 May 2024. Of 3000 CT scans reviewed, 117 adults with frontal and/or maxillary sinus hypoplasia/aplasia and 53 healthy controls met the eligibility criteria. The sinus variation groups included unilateral frontal sinus variation (UFSV, n = 46), unilateral maxillary sinus variation (UMSV, n = 13), and bilateral frontal sinus variation (BFSV, n = 55); and bilateral maxillary sinus variation (BMSV, n = 3), which was described descriptively but excluded from the main statistical comparisons because of the very small subgroup size. Craniofacial morphometric distances were measured using standardized anthropometric landmarks, and group comparisons were performed using analysis of covariance adjusted for age and sex. Results: Significant adjusted between-group differences were found for left orbital breadth (p = 0.0001), left orbital height (p = 0.0250), right orbital breadth (p < 0.0001), biorbital breadth (p < 0.0001), upper facial breadth (p = 0.0204), and bizygomatic breadth (p = 0.0026). In general, the UFSV and BFSV groups showed lower adjusted values for orbital and upper facial measurements, whereas the healthy control and UMSV groups showed relatively higher adjusted means. No significant between-group differences were observed for the remaining measurements. Conclusions: Frontal sinus hypoplasia/aplasia, particularly unilateral and bilateral frontal sinus variation, was associated with selected differences in craniofacial morphology, especially in the orbital and upper facial regions, rather than demonstrating a direct effect. These findings may help to characterize craniofacial morphometric patterns in adults with sinus variation and could be considered in radiologic evaluation and preoperative assessment, but require confirmation in larger studies. Full article

Background/Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder. Rotterdam-defined phenotypes may need adjunctive, non-invasive signals for research-level phenotypic stratification. Saliva deserves attention because it is easy to collect repeatedly, acceptable in outpatient settings, and may reflect oral-systemic inflammatory and endocrine-metabolic interactions. This study evaluated whether salivary qPCR signals for Lactobacillus, Prevotella, and Bifidobacterium differ across Rotterdam-defined PCOS phenotypes and controls, with emphasis on the exploratory relevance of Prevotella. Methods: This cross-sectional proof-of-concept study included 110 women: 87 with PCOS and 23 controls. PCOS phenotypes were classified according to the Rotterdam criteria. Salivary microbial targets were assessed using SYBR Green-based genus-specific qPCR. Available instrument-export spreadsheets were reviewed for standard-curve quality control. Because the available assay outputs did not support robust absolute quantification, inferential analyses used Cq-based microbial signals only. Lower Cq values indicate stronger target DNA signal. No universal bacterial 16S rRNA reference, exogenous spike-in, salivary flow correction, or fully validated copy-number conversion was available. Group differences were evaluated using non-parametric tests with Bonferroni-corrected post-hoc comparisons. ROC, regression, and correlation analyses were retained as hypothesis-generating analyses only. Results: Prevotella Cq values differed significantly across groups (p < 0.001), with lower median Cq values in phenotypes A, B, and C than in phenotype D and controls. Lactobacillus Cq values did not differ significantly (p = 0.249). Bifidobacterium showed an overall group difference (p < 0.001), but its pattern and assay performance were less consistent. Among women with PCOS, Prevotella Cq values were associated with Ferriman-Gallwey score and polycystic ovarian morphology. Conclusions: Salivary Prevotella showed the clearest exploratory genus-level qPCR signal across Rotterdam-defined PCOS phenotypes. The findings support further technical and clinical validation of saliva-based microbial profiling as a possible adjunct to conventional PCOS phenotyping. They do not validate Prevotella as a standalone diagnostic biomarker, do not define clinical cutoffs, and do not quantify absolute bacterial load. Full article

Objective: Disorders of gut–brain interaction (DGBIs) are characterized by functional impairments without identifiable organic causes, with their prevalence increasing with age. Emerging evidence suggests that selective serotonin reuptake inhibitors (SSRIs), such as escitalopram oxalate, may influence DGBIs through the brain–gut axis, though the precise mechanisms driving their therapeutic effects remain unclear. This study investigated the impact of escitalopram oxalate on elderly patients with DGBIs in an outpatient department to elucidate these mechanisms. Methods: This study was an observational cohort study. We recruited elderly patients diagnosed with DGBIs. Patients receiving standard treatment alone were assigned to the control group, while patients receiving standard treatment plus 10 mg of escitalopram oxalate daily were assigned to the exposure group. Emotional and gastrointestinal symptoms were assessed at baseline and after 12 weeks of treatment using validated symptom scales. Additionally, stool samples were collected at both time points and analyzed via 16S amplicon sequencing to evaluate the changes in gut microbiota. Results: A total of 83 elderly patients with DGBIs were included in the study, comprising 40 patients in the control group and 43 in the exposure group. After 12 weeks, the exposure group showed significantly greater reductions in their scores on the Gastrointestinal Symptom Rating Scale (GSRS), Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) compared with the control group (e.g., GSRS: 17.00 ± 0.85 vs. 22.58 ± 3.18, p < 0.001; p < 0.01 for all other scale comparisons), with higher effective and recovery rates. Notably, the exposure group showed significant alterations in the abundance of four genus-level taxa (Blautia, Butyricicoccus, Prevotellaceae UCG-003, and Streptococcus) and two species-level taxa (Eubacterium-hallii-group and Parabacteroides-merdae). Conclusions: The escitalopram oxalate treatment was associated with significant improvements in both emotional and gastrointestinal symptoms in elderly patients with DGBIs. These improvements may be linked to alterations in specific gut microbiota taxa, offering a preliminary hypothesis for further investigating the underlying mechanisms of the gut–brain axis. Full article