Search Results (1,205)

Background/Objectives: The integration of artificial intelligence (AI) into obstetric care poses significant potential to enhance clinical decision-making and optimize maternal and neonatal outcomes. Traditional prediction methods in maternal-foetal medicine often rely on subjective clinical judgment and limited statistical models, which may not fully capture complex patient data. By integrating computational innovation with mechanistic biology and rigorous clinical validation, AI can finally fulfil the promise of precision obstetrics by transforming pregnancy complications into a preventable, personalised continuum of care. This study aims to map the current landscape of AI applications across the continuous spectrum of maternal–foetal health, identify the types of models used, and compare clinical targets and performance, potential pitfalls, and strategies to translate innovation into clinical impact. Methods: A literature search of peer-reviewed studies that employ AI for prediction, diagnosis, or decision support in Obstetrics was conducted. AI algorithms were categorised by application area: foetal monitoring, prediction of preterm birth, prediction of pregnancy complications, and/or labour and delivery. Results: AI-driven models consistently demonstrate superior performance to traditional approaches. Nevertheless, their widespread clinical adoption is hindered by limited dataset diversity, “black-box” algorithms, and inconsistent reporting standards. Conclusions: AI holds transformative potential to improve maternal and neonatal outcomes through earlier diagnosis, personalised risk assessment, and automated monitoring. To fulfil this promise, the field must prioritize the creation of large, diverse, open-access datasets, mandate transparent, explainable model architectures, and establish robust ethical and regulatory frameworks. By addressing these challenges, AI can become an integral, equitable, and trustworthy component of Obstetric care worldwide. Full article

Cardiorenal syndrome (CRS) reflects the intricate and bidirectional interplay between cardiac and renal dysfunction, commonly resulting in diagnostic uncertainty, therapeutic dilemmas and poor outcomes. While traditional biomarkers like serum creatinine (Cr) and natriuretic peptides remain widely used, their limitations in specificity, timing and contextual interpretation often hinder optimal management. This narrative review synthesizes the current evidence on established and emerging biomarkers in CRS, with emphasis on their clinical relevance, integration into real-world practice, and potential to inform precision therapy. Markers of glomerular filtration rate beyond creatinine—such as cystatin C—offer more accurate assessment in frail or sarcopenic patients, while tubular injury markers such as NGAL, KIM-1, and urinary L-FABP (uL-FABP) provide early signals of structural renal damage. The FDA-approved NephroCheck^® test—based on TIMP-2 and IGFBP7— enables risk stratification for imminent AKI up to 24 h before functional decline. Congestion-related markers such as CA125 and bio-adrenomedullin outperform natriuretic peptides in certain CRS phenotypes, particularly in right-sided heart failure or renally impaired patients. Fibrosis and inflammation markers (galectin-3, sST2, GDF-15) add prognostic insights, especially when combined with NT-proBNP or troponin. Rather than presenting biomarkers in isolation, this review proposes a framework that links them to specific clinical contexts—such as suspected decongestion-related renal worsening or persistent congestion despite therapy—to support actionable interpretation. A tailored, scenario-based, multi-marker strategy may enhance diagnostic precision and treatment safety in CRS. Future research should prioritize prospective biomarker-guided trials and standardized pathways for clinical integration. Full article

Pleural Mesothelioma (PM) remains a challenging malignancy associated with asbestos exposure and characterized by poor prognosis. This review aims to consolidate recent findings on the efficacy of perioperative therapies encompassing chemotherapy, surgery, and emerging immunotherapy strategies. Current management strategies debate the role of surgery in early-stage patients, particularly due to the limited success of solitary treatment modalities and significant rates of postoperative complications. Retrospective studies indicate that multimodal treatment, incorporating surgical resection with perioperative chemotherapy, can enhance overall survival (OS), especially in favorable prognostic subsets. However, significant randomized trials, notably the MARS and MARS 2 trials, revealed that the addition of aggressive surgical strategies like extrapleural pneumonectomy (EPP) did not confer survival benefits and was accompanied by heightened morbidity. In light of persistent challenges, integrating perioperative chemotherapy—primarily with platinum-based regimens—has shown improved disease control outcomes. Neoadjuvant chemotherapy permits real-time assessment of tumor responsiveness, providing valuable clinical insights for surgical candidacy. The role of immunotherapy, particularly immune checkpoint inhibitors (ICIs), is also under active exploration, with preliminary results suggesting promising activity and manageable safety profiles. In conclusion, while current protocols primarily recommend surgery for a select group of patients, ongoing investigations into neoadjuvant approaches, adjuvant therapies, and novel immunotherapeutic strategies are crucial for developing effective, personalized treatment paradigms for PM. Future efforts should prioritize clinical trials that integrate these therapies within a structured multidisciplinary approach to optimize patient outcomes. Full article

Introduction: Evidence on orthodontic interventions for temporomandibular disorders (TMD) is fragmented and inconclusive, creating a gap in guidance for clinical decision-making. This study addresses that gap by evaluating current knowledge on these interventions. Methods: A PRISMA-ScR scoping review was conducted with a systematic search of PubMed, Scopus, and Web of Science (2018–2023). Eligible studies were peer-reviewed, English-language, human studies examining TMD treatment and/or etiology. Three independent reviewers screened records and extracted data and a fourth reviewer performed random audits. Results: Of 899 records, 10 studies met inclusion criteria (non-surgical, n = 7: 4 case reports, 2 prospective, 1 longitudinal; combined orthodontic–surgical, n = 3: 1 case report, 2 longitudinal; participant ages 15–71 years). Diagnostics included imaging, clinical examination, occlusal analysis, and questionnaires, although few used RDC/TMD or DC/TMD criteria. Non-surgical orthodontic modalities (fixed appliances, camouflage, TADs, stabilization splints) showed mixed results, with several studies reporting short-term symptom improvement, while others found no effect on TMD onset or progression. Combined orthodontic–surgical approaches (e.g., bilateral sagittal split osteotomy, Le Fort I) also showed variable outcomes. Conclusions: Low-to-moderate quality evidence suggests that orthodontic-surgical interventions may alleviate TMD symptoms in select patients; however, heterogeneity and limited use of standardized diagnostics constrain the certainty of these findings. Future research should prioritize DC/TMD-based diagnostics, core outcomes, comparative designs, and ≥12–24 months of follow-up to identify prognostic factors and responsive subgroups. Full article

Background: Gorlin syndrome (GS) is a rare autosomal dominant disorder, associated with pathogenic PTCH1 or SUFU variants, predisposing to tumors such as basal cell carcinoma, medulloblastoma (MB), odontogenic keratocyst, and, rarely, cardiac fibroma (CF). MB occurs in ~5% of GS cases, typically in early childhood, while CF appears in 1–3%. Their coexistence in childhood is extremely rare. This report describes a pediatric GS case with synchronous MB and CF, focusing on the management priorities between oncologic and cardiac interventions. Methods: A 15-year follow-up is reported for a girl diagnosed at 22 months with desmoplastic/nodular MB and left ventricular CF. GS diagnosis was based on clinical features, imaging, and confirmation of a pathogenic PTCH1 variant (c.3306+1G>T). A literature narrative review on CF in GS was also conducted. Results: MB gross total resection was followed by chemotherapy, during which ventricular tachycardia episodes occurred, managed with cardioversion and antiarrhythmics. Given the favorable prognosis of early-treated MB in GS, oncologic therapy was prioritized. Cardiac status was monitored with ECG, Holter, echocardiography, and cardiac MRI. An adapted AIEOP protocol minimized cardiotoxicity. CF was managed conservatively, with no further arrhythmias and preserved ventricular function throughout 15 years. MB has not recurred. Conclusions: In GS patients with concurrent MB and CF, prioritizing MB treatment and adopting a conservative, closely monitored approach to CF can yield excellent long-term outcomes. In children with MB, especially syndromic forms, routine echocardiography is recommended to detect CF. This case underscores the value of multidisciplinary care in managing complex GS presentations. Full article

Background: Perioperative Cardiac Arrest (POCA) is a rare but catastrophic event with persistently low survival rates. Existing prediction models often fail to capture the perioperative context or predict short-term outcomes. This study aimed to develop and internally validate the POTEC (Platelet count, Oxygen saturation, Time of cardiopulmonary resuscitation (CPR), Elective surgery, and initial end-tidal carbon dioxide (ETCO₂) Score, a simple clinical tool for predicting 24-h survival following perioperative CPR. Methods: We conducted a retrospective cohort study of adult patients (≥18 years) who experienced POCA during or within two hours after non-cardiac surgery under anesthesia at a tertiary university hospital between 2010 and 2023. Multivariable logistic regression was used to identify independent predictors of 24-h survival. The final model’s coefficients were used to construct the POTEC Score, which was internally validated using bootstrapping (1000 replications). Results: Of 321 eligible patients, 65 (20.25%) survived at 24-h. Five variables were independently associated with 24-h survival and included in the POTEC score: preoperative platelet count 100 × 10⁹/L, preoperative oxygen saturation of ≥90% on room air upon arrival in the operating room, CPR duration ≤30 min, elective surgery, and initial end-tidal CO₂ between 35 and 45 mmHg. The score demonstrated good discrimination (AuROC = 0.788, 95% CI: 0.73–0.85) and calibration (Hosmer–Lemeshow p = 0.535). A score of 4 points or higher was associated with significantly higher odds of 24-h survival (adjusted OR = 2.78, 95% CI: 2.05–3.79). Model optimism was minimal (0.009) after bootstrapping. Conclusions: The POTEC Score is a clinically practical tool for early risk stratification in patients undergoing perioperative CPR. Its integration into perioperative workflows may aid in timely decision-making and resource prioritization during critical postoperative care. Full article

Background/Objectives: Video laryngoscopy is one of the primary methods used by otolaryngologists for detecting and classifying laryngeal lesions. However, the diagnostic process of these images largely relies on clinicians’ visual inspection, which can lead to overlooked small structural changes, delayed diagnosis, and interpretation errors. Methods: AI-based approaches are becoming increasingly critical for accelerating early-stage diagnosis and improving reliability. This study proposes a hybrid Convolutional Neural Network (CNN) architecture that eliminates repetitive and clinically insignificant frames from videos, utilizing only meaningful key frames. Video data from healthy individuals, patients with vocal fold nodules, and those with vocal fold polyps were summarized using three different threshold values with the Structural Similarity Index Measure (SSIM). Results: The resulting key frames were then classified using a hybrid CNN. Experimental findings demonstrate that selecting an appropriate threshold can significantly reduce the model’s memory usage and processing load while maintaining accuracy. In particular, a threshold value of 0.90 provided richer information content thanks to the selection of a wider variety of frames, resulting in the highest success rate. Fine-tuning the last 20 layers of the MobileNetV2 and Xception backbones, combined with the fusion of extracted features, yielded an overall classification accuracy of 98%. Conclusions: The proposed approach provides a mechanism that eliminates unnecessary data and prioritizes only critical information in video-based diagnostic processes, thus helping physicians accelerate diagnostic decisions and reduce memory requirements. Full article

Implementing follow-up policies under healthcare warranties for chronic disease patients plays a crucial role in reducing the risk of adverse outcomes (AOs) and controlling long-term medical costs. However, the additional cost associated with these services often discourages hospitals from providing them. Background/Objectives: To incentivize participation from both hospitals and patients in follow-up programs, this paper introduces a patient copayment mechanism. We propose a theoretical mathematical modeling framework to investigate the optimal pricing of follow-up policies from both patients’ and hospitals’ perspectives to achieve win–win outcomes. Methods: Using the Cox frailty model, we stratify patients by risk level and model hazard rate functions for three follow-up policies featuring periodic checkups, incorporating the virtual age method. Building on this framework, we employ the Non-Homogeneous Poisson Process to analyze the total expected costs incurred by hospitals and patients across different policies and risk strata. This analysis derives the minimum price acceptable to hospitals for providing follow-up services and the maximum additional cost patients are willing to bear for them. The feasibility and applicability of the proposed model are demonstrated through a case study of pediatric type 1 diabetes mellitus (T1DM). Results: Win–win price intervals for T1DM patients are more achievable for higher-risk individuals. These intervals narrow or widen with the age reduction factor, checkup cost, and AO treatment cost. Hospitals should prioritize higher-risk patients, improve checkup effectiveness, and balance costs of checkups and treatments when optimizing pricing decisions. Conclusions: These insights provide valuable guidance for hospitals in strategically designing follow-up policies tailored to diverse risk cohorts and determining optimal price intervals. Full article

Homocysteine has long been studied as a potential cardiovascular risk factor due to its biochemical role in endothelial dysfunction, oxidative stress, inflammation, and thrombogenesis. Despite strong epidemiological and mechanistic support, the translation of homocysteine-lowering interventions into clinical benefit remains controversial. This non-systematic review aims to clarify the current understanding of homocysteine in the cardiovascular setting by distinguishing between well-established facts, clinically relevant interventions, and persistent misconceptions. We first revisit the historical emergence of homocysteine as a cardiovascular biomarker and explore its pathophysiological mechanisms, including endothelial damage, atherosclerosis progression, and prothrombotic effects—supported by in vitro and animal model studies. Subsequently, we evaluate evidence-based interventions such as B-vitamin supplementation (folate, B6, B12), lifestyle modifications, and the clinical relevance of homocysteine monitoring in specific populations (e.g., MTHFR mutations, chronic kidney disease). We then discuss common pitfalls, including the overinterpretation of genetic variants, the inappropriate use of supplementation, and the overreliance on surrogate biomarkers in clinical trials. Although elevated homocysteine remains a reproducible biomarker of cardiovascular risk, current evidence does not support routine intervention in unselected populations. A precision medicine approach—targeting high-risk subgroups and integrating homocysteine into broader cardiometabolic management—may help unlock its therapeutic relevance. Future pharmacological strategies should prioritize mechanistic insight, patient stratification, and clinically meaningful endpoints. Full article

Background: Refractory overactive bladder (OAB) poses a significant clinical burden, often severely impacting quality of life (QoL). While intradetrusor onabotulinumtoxinA (BoNT-A) and sacral neuromodulation (SNM) are established therapeutic options, a direct comparison of their efficacy and safety profiles is essential to guide clinical decision-making. This study compares BoNT-A against placebo and SNM for the management of refractory OAB in women. Methods: Following PRISMA guidelines, PubMed, Scopus, CENTRAL, and Google Scholar were searched until February 2025 for randomized controlled trials (RCTs) and cohort studies on treatment alternatives for refractory OAB. Treatment outcomes at 3- (BoNT-A vs. placebo) and 6-month (BoNT-A vs. SNM) follow-up were analyzed. Odds ratios (ORs) and mean differences (MDs) were calculated for dichotomous and continuous variables, respectively, with heterogeneity assessed via I² test. Study quality was evaluated using CASP tools. Results: Pooled data from 12 studies (2645 patients) indicated that BoNT-A significantly reduced urgency urinary incontinence (UUI) episodes compared to placebo (p = 0.02) and SNM (p = 0.0008). Additionally, a ≥75% reduction in UUI episodes was more likely with BoNT-A compared to both placebo (p < 0.00001) and SNM (p < 0.00001). Complete resolution of UUI was more likely with BoNT-A compared to placebo (p < 0.00001); however, when compared to SNM, the latter demonstrated a higher rate of complete UUI resolution (p < 0.00001). Patient-reported QoL did not show significant differences between BoNT-A and SNM (p = 0.2). Urinary tract infection (UTI) risk was higher with BoNT-A than both comparators. Conclusions: While BoNT-A offers robust symptom control, its safety profile necessitates careful patient selection. SNM remains a viable alternative for those prioritizing fewer adverse events. The study highlights the need for standardized outcome reporting, long-term cost-effectiveness analyses, and personalized treatment approaches. Full article

Small Cell Lung Cancer (SCLC) is an aggressive neuroendocrine malignancy representing approximately 15% of all lung cancers. Characterized by rapid progression, early metastasis, and high circulating tumor cell burden, SCLC has a poor prognosis. Although initial responses to chemotherapy, radiotherapy, and immunotherapy are common, relapse due to acquired resistance is nearly inevitable. Molecular studies have identified four transcription factor–driven subtypes—ASCL1, NEUROD1, POU2F3, and YAP1—each with distinct biological traits and therapeutic vulnerabilities. However, clinical classification remains largely homogeneous, limiting precision treatment strategies. Immunotherapy has modestly improved survival, as demonstrated in trials like IMpower133, CASPIAN, and ADRIATIC. Yet only a small subset of patients—approximately 12%—achieve long-term survival beyond five years. Understanding the biological and immunological profiles of these exceptional responders is critical. Future research should prioritize comprehensive biomarker integration, including PD-L1, TMB, DLL3, CD3, and emerging targets. Novel agents such as tarlatamab (DLL3-targeting) and ifinatamab deruxtecan (B7-H3–targeting) have shown encouraging efficacy in early-phase trials, though predictive markers remain elusive. A multi-dimensional approach combining tissue, blood, and immune profiling is essential to advance precision oncology in SCLC and improve patient selection for emerging therapies. Full article

Background: Themanagement of occupational respiratory diseases (ORDs) requires a multidisciplinary approach, yet collaboration between pulmonologists and occupational physicians is often fragmented, potentially compromising patient outcomes. This study aimed to systematically compare the management strategies for ORDs between these two specialties in Italy to identify gaps and opportunities for integration. Methods: A cross-sectional survey was conducted using a structured 12-item questionnaire distributed to board-certified pulmonologists and occupational physicians across Italy. The questionnaire assessed diagnostic pathways, therapeutic strategies, preventive measures, and patterns of interdisciplinary collaboration. A total of 102 specialists (51 pulmonologists and 51 occupational physicians) completed the survey. Comparative analyses were performed using Pearson’s ${\chi }^2$ tests. Results: Significant divergences in practice were identified. Pulmonologists primarily focused on clinical diagnosis, utilizing pulmonary function tests (34.3%) and imaging (11.8%), and favored pharmacotherapy (27.5%) as the first-line treatment, in alignment with clinical guidelines. Conversely, occupational physicians prioritized detailed occupational and exposure histories (15.7%) and preventive interventions aimed at exposure reduction (15.7%). While both groups acknowledged the importance of collaboration, a substantial number reported that it occurred only occasionally (17.6% of pulmonologists and 12.7% of occupational physicians), indicating a significant gap in integrated care. Shared barriers included poor patient adherence and limited access to advanced diagnostic tools. Conclusions: While sharing a common foundation in diagnostic and preventive principles, pulmonologists and occupational physicians in Italy operate with distinct, complementary approaches that remain insufficiently integrated. The observed fragmentation in diagnostic and therapeutic pathways underscores an urgent need for shared national guidelines, structured interdisciplinary training, and formalized communication protocols. Bridging this disciplinary divide is essential to delivering holistic care, optimizing worker health, and preserving work ability. Full article

Few studies provide insights on how to incorporate community members’ perspectives of genomic research during the early phases of study development. Engaging with community members early and consistently throughout the research lifecycle could help identify and mitigate barriers to genomic research participation, particularly among groups with rare and understudied cancers. Methods: The Washington University Participant Engagement and Cancer Genome Sequencing (WU-PE-CGS) study formed a Participant Engagement Advisory Board (PEAB) consisting of patients, patient advocates, and patient advocacy organizations who represented the three understudied cancer populations: cholangiocarcinoma, early-onset colorectal cancer in Black Americans, and multiple myeloma in Black Americans. PEAB members were involved in PE-CGS from the time of the grant submission and provided input on key study procedures by participating in monthly project meetings and serving on the leadership team. PEAB recommendations are described in this process paper. Results: The PEAB provided key feedback on recruitment, consent, and survey development. Recruitment optimization focused on making the script more concise, tailoring to participant’s locale, and providing clearer participation expectations. Consent improvements prioritized key information, addressed data protection, and clarified the process of returning genetic results. Survey enhancements included refining scientific terminology and ensuring inclusivity across the cancer continuum. Conclusions: The PEAB provided valuable feedback that improved the development and implementation of WU-PE-CGS research processes. Incorporating the PEAB’s suggestions helped ensure that patients with rare and understudied cancers were successfully enrolled into the WU-PE-CGS. The PEAB will continue to contribute throughout all study phases. Full article

Background: Individuals with serious mental illness (SMI) die significantly earlier and experience disproportionately higher rates of physical health issues compared with non-SMI groups. Despite advances in care, this mortality gap persists. One factor that contributes to this discrepancy is inadequate access to healthcare, as individuals with SMI are less likely to receive appropriate medical care. Methods: To better understand this, we completed a narrative review synthesizing existing literature on common barriers to care faced by the SMI community. We reviewed 34 articles and identified three primary barriers to receiving healthcare. Results: These included structural and logistical barriers (geographic location, access to technology and internet, disjointed medical and mental healthcare); intrapersonal- and patient-level barriers (symptoms and psychological impact of SMI, lack of awareness or prioritization of medical issues, medical mistrust, and limited health literacy); and provider- and system-level barriers (lack of knowledge or support for integrated care, lack of knowledge of SMI, stigma, and diagnostic overshadowing). Conclusions: We argue that addressing these issues requires a reorientation toward person-centered approaches that prioritize continuity, integration, and dignity in care for individuals with SMI, and we offer specific recommendations in service of these aims. Full article

Recurrence of the original glomerular disease (GN) poses a significant threat to kidney transplant function and longevity. The probability and severity of this recurrence vary, with C3 glomerulopathy and certain forms of FSGS exhibiting particularly high rates. Kidney transplant GN recurrence risk hinges on the characteristics of the initial GN, recipient/donor genetics, recipient age, donor type, end-stage kidney disease (ESRD) progression rate, and proteinuria levels. Standard immunosuppression has limited efficacy in preventing primary disease recurrence; however, agent selection and induction therapy can influence the risk for specific GNs. Diagnosing recurrent GN involves a comprehensive approach, including clinical evaluation, laboratory tests (such as proteinuria, hematuria, and specific biomarkers like anti-PLA2R for membranous nephropathy or complement for C3G), and, critically, an allograft biopsy analyzed with light, immunofluorescence, and electron microscopy. Treatment strategies are evolving towards targeted therapies, such as rituximab for antibody-mediated GN and complement inhibitors for C3G, moving away from broad immunosuppression. This narrative literature review provides practical monitoring algorithms for post-transplant settings, synthesizing information on the incidence, predictors, diagnostic strategies, and therapeutic options for various glomerular disease subtypes. The methodology involved searching MEDLINE, Embase, and Cochrane databases from 1996 to 2025, prioritizing systematic reviews, cohort studies, registries, and interventional reports. Eligibility criteria included adult transplant recipients and English-language reports on recurrent glomerular disease outcomes, excluding most single-patient case reports. Limitations include potential selection bias, omission of relevant studies, and the absence of a formal risk-of-bias assessment or meta-analysis. The evidence base is heterogeneous, with inconsistent outcome reporting and scarce randomized controlled trials. Future efforts should focus on developing predictive biomarkers, standardizing diagnostic and response criteria, conducting multicenter prospective cohorts and pragmatic trials, and creating shared registries with harmonized data. Full article