Search Results (1,783)

The hemodialysis population has progressively aged over the past two decades; in several settings, adults aged ≥75 years represent one of the fastest-growing populations receiving dialysis. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, has emerged as a critical determinant of outcomes and is commonly assessed using validated instruments such as the Fried Frailty Phenotype or the Clinical Frailty Scale (CFS). Reported frailty prevalence in hemodialysis varies widely (approximately 20% to >80%), largely depending on the assessment instrument and the population studied, with consistently higher prevalence in older cohorts. It is consistently associated with older age, female sex, diabetes, lower serum albumin, cardiovascular disease, longer dialysis vintage, and lower physical activity. Compared with non-frail patients, frail hemodialysis patients have a substantially higher risk of death (approximately two-fold in pooled analyses). Seminal trials and large observational programs that shaped hemodialysis targets underrepresented very old, frail, and highly comorbid patients, limiting generalizability. In frail older adults with limited life expectancy and substantial comorbidity burden, standard thrice-weekly schedules, higher ultrafiltration intensity, and a uniform ‘fistula-first’ approach may increase treatment burden without clear proportional gains in patient-centered outcomes. This review examines evidence supporting individualized hemodialysis strategies in frail older adults. As the dialysis population continues to age, proficiency in goal-concordant, personalized prescribing is increasingly important for nephrologists and dialysis teams. Full article

Background: Patients with pancreatic cancer (PC) commonly present with reduced aerobic fitness, sarcopenia, and malnutrition, which may increase perioperative risk and compromise access to chemotherapy treatments. Although exercise-based prehabilitation can improve physical fitness, its implementation is often limited by short diagnostic-to-surgery intervals and treatment-related toxicity. Methods: We conducted a pilot prospective pretest–posttest feasibility study in Torino, Italy. Patients with PC undergoing neoadjuvant chemotherapy prior to surgery were offered a 4-week, partially supervised, home-based bimodal exercise prehabilitation program (single-arm design) combining remotely monitored high-intensity interval training (HIIT) on a cycle ergometer with functional and resistance exercises. The primary outcome was adherence to prescribed exercise frequency, intensity, and duration, objectively assessed via remote monitoring. Secondary outcomes included cardiorespiratory fitness (CPET), muscle function, body composition, fatigue, quality of life, and circulating inflammatory markers. Results: From July 2022 to February 2024, 23 patients were screened; 15 were eligible and 10 enrolled. Four participants discontinued the intervention (two due to asthenia/fatigue, one due to chemotherapy-related adverse events, and one for organizational reasons), leaving six participants who completed the program. Among completers, fatigue and quality of life did not change meaningfully. Aerobic capacity and muscle function outcomes were generally stable, with few pre–post changes exceeding the minimum clinically important difference (MCID) thresholds used. Body composition markers and the assessed circulating cytokines/chemokines remained unchanged except for IL-6 levels, which decreased significantly (p < 0.05). Conclusions: A partially supervised, home-based HIIT-based prehabilitation program is feasible for a subset of PC patients undergoing neoadjuvant therapy, but a substantial attrition rate suggests the need for more flexible symptom-adapted prescriptions and enhanced supportive strategies. Full article

Epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) has historically been regarded as a therapeutically uniform entity, characterized by marked sensitivity to EGFR tyrosine kinase inhibitors (TKIs) and limited responsiveness to immune-checkpoint inhibitors (ICIs). However, accumulating clinical and translational data suggest heterogeneity within EGFR-mutant NSCLCs. In particular, patients whose tumors express high levels of programmed death-ligand 1 (PD-L1) consistently experience inferior outcomes with EGFR-TKI monotherapy, including earlier progression and reduced response durability, even with third-generation EGFR-TKIs. This review synthesizes clinical, molecular, and immunologic evidence supporting the hypothesis that EGFR-mutant NSCLC with high PD-L1 expression may represent a biologically distinct phenotype. Key findings include data from retrospective cohorts, real-world analyses, and translational studies showing high PD-L1 expression to be associated with attenuated oncogene addiction, increased genomic complexity, tumor cell plasticity, and a dysfunctional but non-quiescent immune microenvironment. Notably, in this context, PD-L1 expression does not reliably predict benefit from ICIs but, rather, serves as a marker of aggressive tumor biology and early resistance to EGFR-TKI therapy. Lastly, we discuss the therapeutic implications of these observations, outlining the rationale for biomarker-informed, risk-adapted treatment strategies, including EGFR-TKI-based combinations, while emphasizing the need for careful integration of immunotherapy and prospective validation. Full article

Acute type A aortic dissection is a life-threatening condition requiring emergency surgery and complex postoperative management. Although survival rates have improved, many patients experience long-term functional impairments, reduced quality of life, and an elevated risk of complications. Despite strong evidence supporting cardiac rehabilitation in other cardiovascular populations, structured programs remain underutilized in patients with surgically resolved acute type A aortic dissection. Exercise-based cardiac rehabilitation appears feasible and can be delivered safely in carefully selected patients when appropriately adapted to individual needs and conducted under close supervision. Postoperative patients are often physically deconditioned, prone to hospital-acquired disability, and may misjudge exercise intensity. Therefore, individualized exercise prescription, guided by exercise testing when available, is important to support safe training thresholds. Early and gradual introduction of physical activity may help prevent complications associated with immobility, support blood pressure control, and contribute to improvements in functional capacity. However, training volume should be purposefully lower than in conventional program settings to reduce hemodynamic stress. Education on safe exercise parameters and self-monitoring plays a central role in enabling long-term adherence and promoting patient autonomy. Cardiac rehabilitation programs should incorporate dietary, nutritional, and psychological support. Although evidence specific to this patient population remains limited, available data suggest the feasibility and potential benefits of cardiac rehabilitation when delivered with appropriate precautions. Our review underscores the need for a tailored, multidisciplinary CR approach aimed at enhancing physical recovery, supporting cardiovascular stability, and improving overall quality of life in patients following surgery. Further research is required to define optimal program protocols. Full article

Background/Objectives: Despite demonstrated mortality benefits, annual low-dose computed tomography (LDCT) screening faces challenges in real-world adoption due to low uptake and poor longitudinal adherence. This review evaluates patient- and provider-level factors that influence screening participation and highlights strategies to strengthen equitable engagement throughout the screening pathway. Methods: A structured literature search of PubMed and Web of Science was performed to identify studies published between 2013 and November 2025 (search conducted on 25 November 2025). Eligible publications included qualitative and quantitative studies, study protocols, and reviews examining LDCT screening uptake, adherence, and follow-up practices. Extracted evidence was synthesized, with particular attention being paid to patient- and provider-level determinants. Results: The evidence demonstrates that both patient- and provider-level factors substantially influence screening participation and continuity. At the patient level, limited awareness of screening, misconceptions regarding asymptomatic disease, and psychosocial factors such as fear, fatalism, stigma, and medical mistrust were consistently associated with reduced uptake and adherence. At the provider level, gaps in guideline familiarity, time constraints, and challenges in delivering high-quality shared decision-making limited referrals and follow-up. Conclusions: Improving real-world effectiveness of LDCT lung cancer screening requires reframing screening as a longitudinal program of care. Strategies that support patient navigation, enhance provider capacity for sustained engagement, and integrate tobacco dependence treatment into screening pathways are central to improving adherence and reducing disparities. Full article

Background/Objectives: Gasdermin D (GSDMD) is a critical mediator of pyroptosis—an inflammatory form of programmed cell death increasingly implicated in tumor biology. Our objective was to evaluate the utility of GSDMD as a diagnostic and prognostic biomarker and to investigate its association with tumor burden and hematological parameters. Methods: We analyzed GSDMD expression levels in patients with adult-type diffuse gliomas compared to healthy controls and assessed correlations with tumor size, histological grade, hematological markers, and survival outcomes. Data was complemented by transcriptomic analysis from The Cancer Genome Atlas (TCGA). Diagnostic performance was assessed using ROC curve analysis. Results: GSDMD expression was significantly elevated in adult-type diffuse glioma patients and increased with tumor grade, suggesting an association with disease severity. A positive correlation was observed between GSDMD level and tumor size (R = 0.332; p = 0.01). ROC analysis showed moderate classification ability (AUC = 0.657) with high specificity (96%), supporting its diagnostic potential. Survival analysis showed that higher GSDMD expression was associated with reduced disease-specific survival. GSDMD also correlated positively with the erythrocyte parameter mean corpuscular hemoglobin (MCH, R = 0.34, p = 0.016) and negatively with the systemic inflammatory marker C-reactive protein (CRP, R = −0.32; p = 0.042). TCGA data showed no significant sex-related differences in GSDMD expression. Baseline characteristics such as age, BMI, and coagulation parameters were matched between patients and controls. Conclusions: GSDMD is significantly associated with astrocytoma severity, tumor size, and inflammatory status, with elevated expression indicating a worse prognosis. Its correlation with tumor grade, survival and high specificity in distinguishing patients from healthy individuals, underlines its promise as a clinically relevant, non-sex-specific biomarker for diagnosis and monitoring. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

Background/Objectives: Rapid population aging has increased the need for effective sarcopenia management. Physical therapists are expected to play a key role in screening and intervention. This study aimed to assess sarcopenia awareness, current clinical practice, and barriers among Korean physical therapists to inform future education and policy improvements. Methods: A cross-sectional survey was conducted in Korea from 14 August to 31 December 2025. The questionnaire was developed through a two-step process, including a qualitative survey and cognitive interviews with physical therapists, and consisted of items on demographics, sarcopenia knowledge, screening, treatment, and care environment factors. Results: A total of 236 participants were included in the analysis. Although awareness of sarcopenia was high, implementation in clinical practice remained limited. Most participants were familiar with sarcopenia and considered it important in patient management, yet only 16.9% reported screening for sarcopenia and 23.7% reported providing treatment. Among those who performed screening, half were unsure which guideline was being followed. Resistance exercise was the most commonly used intervention, whereas nutritional support was the most frequently identified additional need. Collaboration with nutrition professionals was rare, and fewer than half reported team-based treatment. The main barriers were lack of knowledge, lack of workplace training, and limited exposure to internal sarcopenia-related education. Conclusions: Despite high awareness, sarcopenia-related practice among Korean physical therapists remained limited. These findings highlight the need for standardized screening and treatment guidelines, structured continuing education programs, workplace-based training opportunities, and reimbursement policies that support routine sarcopenia screening and management. Full article

Background: Neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) are increasingly recognized as biologically heterogeneous disorders. Although biomarker-based frameworks have improved disease stratification, they may not fully capture the molecular diversity underlying disease mechanisms. This study aimed to define biologically meaningful AD and PD subtypes by employing large-scale plasma proteomics to characterize mechanism-driven patient stratification. Methods: We analyzed plasma proteomic data from the Global Neurological Proteomics Consortium (GNPC) dataset and performed disease-specific unsupervised clustering to identify molecular subtypes. We performed differential protein expression and pathway enrichment analyses to characterize subtype-specific and shared biological signatures. Results: Clustering analysis revealed three molecular AD subtypes and two PD subtypes, each exhibiting unique proteomic signatures despite similar demographic and cognitive profiles. AD subtypes differed in the relative involvement of immune activation, mitochondrial dysfunction, synaptic signaling, and calcium-related pathways, whereas PD subtypes showed divergence in neuroinflammatory, oxidative stress, and mitochondrial programs. Conclusions: We demonstrated stratification of AD and PD into molecular subtypes, potentially supporting scalable, mechanism-directed stratification and the development of future targeted, disease-modifying therapies. Full article

Background/Objectives: Renal denervation (RDN) has re-emerged as an adjunctive treatment option for patients with uncontrolled or resistant hypertension, with contemporary sham-controlled trials showing a modest but reproducible reduction in out-of-office blood pressure. However, in routine practice, apparent treatment resistance often reflects pseudoresistance caused by the white-coat effect, poor measurement quality, therapeutic inertia, or nonadherence. This review aimed to summarize the contemporary evidence on renal denervation in uncontrolled or resistant hypertension and to propose a pragmatic, measurement-first framework for patient selection, integration into routine care, and a structured post-procedural response assessment. Methods: This article is a narrative, implementation-focused review. A structured search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was performed from database inception through January 2026. We prioritized the randomized sham-controlled RDN trials, major meta-analyses, guidelines, consensus documents, and studies addressing ABPM, HBPM, medication adherence, and telemonitoring. Results: The contemporary sham-controlled trials support RDN as an adjunctive option with a modest blood pressure-lowering effect, which is best assessed by out-of-office measurements. The placebo-adjusted reductions in ambulatory systolic blood pressure were generally in the 4–6 mmHg range. Appropriate use requires the confirmation of sustained uncontrolled hypertension, the exclusion of pseudoresistance, the optimization of treatment, and an adherence assessment. We identified three phenotypes most likely to benefit and proposed a three-axis framework for a response assessment at 3 and 6 months. Conclusions: RDN should be viewed not as a substitute for antihypertensive therapy but as a program-based adjunct for carefully selected patients. The measurement-first care pathway presented here should be interpreted as a pragmatic clinical model intended to operationalize the available trial and guideline evidence in routine care, rather than as a prospectively validated algorithm or formal consensus recommendation. Full article

The sodium/iodide symporter (NIS/SLC5A5) is a major determinant of radioiodine therapy efficacy in differentiated thyroid cancer (DTC). This narrative review examines the molecular mechanisms underlying NIS dysregulation and radioiodine refractoriness in DTC. Reduced NIS expression or function in radioiodine-refractory DTC is associated with multiple mechanisms, including transcriptional suppression linked to MAPK/ERK and PI3K/AKT pathway activation and disruption of thyroid differentiation programs; epigenetic silencing involving SLC5A5 regulatory regions; impaired protein trafficking and membrane localization; and post-transcriptional regulation by microRNAs such as miR-221-3p, miR-222-3p, miR-146b-3p, and miR-204-5p. Genetic alterations including BRAF V600E and TERT promoter mutations are associated with dedifferentiated tumor phenotypes and poor radioiodine response. Redifferentiation approaches using MAPK pathway inhibitors such as selumetinib and dabrafenib can restore iodine uptake in selected patients, although the overall clinical applicability of these strategies remains under evaluation. A better understanding of these mechanisms may support improved biologic stratification and more selective therapeutic decision-making in radioiodine-refractory DTC. Full article

Background: Pneumoconiosis remains a major occupational lung disease associated with progressive respiratory impairment, reduced functional capacity, and diminished quality of life. Non-pharmacological rehabilitation has been increasingly proposed as a supportive intervention; however, evidence regarding its effectiveness remains heterogeneous. Objective: This study aimed to systematically review and synthesize the available evidence on the effects of non-pharmacological rehabilitation interventions on functional capacity, quality of life, and psychological outcomes in patients with pneumoconiosis. Methods: A systematic literature search was conducted in major electronic databases and grey literature sources in accordance with PRISMA 2020 guidelines. Studies evaluating non-pharmacological rehabilitation interventions in adults with pneumoconiosis were eligible for inclusion. Outcomes of interest included functional capacity, health-related quality of life, and psychological well-being. Due to methodological heterogeneity across studies, a qualitative synthesis was performed. Results: Six studies met the predefined inclusion criteria and were included in the qualitative synthesis. The reviewed evidence suggests that structured rehabilitation interventions were associated with clinically meaningful improvements in functional capacity, particularly in structured rehabilitation programs, most consistently reflected by increases in six-minute walk distance exceeding established minimal clinically important differences in three studies. Improvements in health-related quality of life and selected psychological outcomes were also reported, although outcome measures and intervention protocols varied across studies. Significant improvements in exercise capacity, dyspnea severity, and health-related quality of life were reported. Conclusions: Non-pharmacological rehabilitation may provide clinically meaningful benefits for patients with pneumoconiosis, based on limited and heterogeneous evidence, particularly in terms of functional capacity and quality of life. Nevertheless, the current evidence base is limited by heterogeneity in study design and outcome reporting. Further high-quality, standardized trials are needed to strengthen the evidence and guide the clinical implementation of rehabilitation programs for occupational lung diseases. Full article

Background: Robotic-assisted thoracic surgery is increasingly recognized as an advanced minimally invasive technique for treating non-small cell lung cancer, offering technical advantages such as enhanced precision and visualization. Although numerous studies have been published worldwide, there are no comparable data from Poland. Therefore, evidence on the perioperative safety and oncologic adequacy of robotic-assisted lobectomy during early phase of program implementation within the Polish healthcare system remains limited. Methods: This retrospective, single-institution observational study included 81 consecutive patients who underwent robotic-assisted lobectomy for primary NSCLC between January 2022 and December 2024. All procedures were carried out using the da Vinci Xi system with a standardized four-arm portal approach. Clinical, perioperative, and pathologic parameters were prospectively collected and analyzed descriptively. Postoperative complications were classified according to Clavien-Dindo. Results: The median patient age was 70 years (IQR: 65–74), 52% were male, and 67% had a history of smoking. Adenocarcinoma was the predominant histologic subtype (51%). The median operative time was 176 min (IQR: 149–220). There were no conversions to thoracotomy and no 30-day mortalities. Postoperative complications occurred in 24% of cases, with prolonged air leak being most common (17%). The median hospital stay was 8 days (IQR: 6–10). R0 resection was achieved in 96% of patients, with a median of 14 lymph nodes dissected across 5 nodal stations. Conclusions: Robotic-assisted lobectomy performed during the early implementation phase of a national program demonstrated low morbidity, high rates of complete (R0) resection, and adequate lymph node yields consistent with international benchmarks. These results support the feasibility of robotic lobectomy within the Polish healthcare setting; however, the single-surgeon, single-center design limits generalizability. Further multicenter prospective studies are needed to confirm reproducibility, assess learning curves, and evaluate long-term oncologic outcomes. Full article

Purpose: The purpose of this preliminary study was to investigate the prevalence of Charles Bonnet Syndrome (CBS) among patients attending the National Centre of Service and Research for the Prevention of Blindness and Vision Rehabilitation of the Visually Impaired, Rome, Italy. Furthermore, the research aimed to delineate the psychological profile of these individuals to determine whether significant differences exist compared with visually impaired patients who do not experience hallucinatory phenomena and to identify likely predictors. Methods: A preliminary cross-sectional analysis was conducted on a convenience sample of patients recruited between January 2025 and December 2025. Prevalence was calculated based on structured clinical interviews, while the psychological profile was assessed by comparing the CBS group with a control group (non-CBS) matched for visual acuity. Participants underwent comprehensive ophthalmological and psychological assessments, including best-corrected visual acuity (BCVA), reading acuity (RA), contrast sensitivity (CS), fixation stability, and retinal sensitivity (RS). Psychological status was evaluated using the Symptom Check List-90-Revised (SCL-90-R), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder Questionnaire (GAD-7). Patients experiencing CBS were further interviewed regarding the specific characteristics and patterns of their hallucinations. The association between CBS and both psychological profiles and visual function parameters was evaluated using regression analysis. Results: Out of 385 individuals screened, 120 participants (58% women; mean age 55.4 ± 18.8 years) were included; CBS was detected in 19%. No significant differences were observed between participants with and without CBS in demographic variables or psychological questionnaire scores (p > 0.05). Mean SCL-90-R, PHQ-9, and GAD-7 scores indicated mild psychological distress, depression, and anxiety, with no significant group differences (p > 0.05). Using standard cut-off values, depressive and anxiety symptoms were prevalent in 65% and 88% of participants, respectively, but were not significantly associated with CBS in chi-square or logistic regression analyses (p > 0.05). Logistic regression analysis of SCL-90 scores showed that only anxiety was significantly associated with hallucination occurrence among the visually impaired participants (OR = 0.27; 95% CI = 0.08–0.87; p < 0.05). Among the visual function parameters, poorer RA in the worse eye was significantly associated with CBS (p < 0.05). Conclusions: This study confirms that CBS is a prevalent, yet frequently under-reported, condition within rehabilitation settings. While overall visual function did not differ significantly between patients with and without CBS, reduced reading acuity (RA) in the worse eye emerged as a potential specific risk factor. Characterizing the psychological profile of these patients is essential to differentiate the syndrome from psychiatric disorders and to develop tailored support pathways. Despite its preliminary nature, this research underscores the necessity of systematic screening to enhance clinical management and the emotional well-being of visually impaired individuals. Consequently, integrating psychological support into visual rehabilitation programs is vital to addressing the high prevalence of comorbid anxiety and depression. Full article

Patients with end-stage lung diseases awaiting lung transplant frequently experience severe hypoxemia, dyspnea, and functional limitations that may compromise survival and transplant eligibility. Optimizing noninvasive respiratory support during the waiting period is crucial to preserve oxygenation, maintain physical conditioning, and avoid escalation to invasive mechanical ventilation, which is associated with poorer transplant outcomes. High-flow nasal cannula therapy has emerged as an important noninvasive respiratory support modality capable of providing physiological and clinical benefits such as precise fractions of inspired oxygen, a low level of positive end-expiratory pressure, dead-space washout, and reduced work of breathing. This review summarizes the pathophysiology of hypoxemia in lung transplant candidates, the mechanisms of action of high-flow nasal cannulas, and the current clinical evidence supporting its use in this population during the pre-transplant period. Available evidence suggests that the use of high-flow nasal cannulas improves oxygenation, relieves dyspnea, enhances exercise tolerance, facilitates participation in pulmonary rehabilitation programs, and may reduce the need for endotracheal intubation, thereby improving the likelihood of survival to transplantation. The review also discusses patient selection, the practical implementation of high-flow nasal cannula therapy, and comparisons with other respiratory support modalities. Although the current evidence is largely observational and heterogenous, high flow appears to be a valuable supportive and bridging therapy for selected patients awaiting lung transplant. Future prospective studies are needed to define standardized protocols and evaluate transplant-specific outcomes. Full article