Search Results (244,210)

Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), patient and clinician aesthetic ratings, patient–clinician agreement, and oral-health-related quality of life (OHRQoL). Methods: Consecutive recall patients with at least one anterior direct composite restoration placed ≥6 months earlier were screened; 128 were enrolled, and 126 completed all assessments (AYA n = 64; AE n = 62). Participants completed the OHIP-14 and aesthetic visual analogue scale (VAS) before receiving any USPHS, clinician VAS, or spectrophotometric feedback. A separate clinician, masked to patient scores and spectrophotometric outputs but not to patient age, recorded clinician VAS and modified USPHS criteria. Results: AE restorations showed higher ΔE*ab than AYA restorations (4.8 ± 1.6 vs. 3.2 ± 1.1; p < 0.001), whereas AYA reported lower patient VAS (72.4 ± 12.3 vs. 81.6 ± 10.8; p < 0.001) and higher OHIP-14 psychosocial burden (7.2 ± 2.8 vs. 4.0 ± 2.3; p < 0.001). Clinician VAS was higher in AYA (85.2 ± 7.3 vs. 79.4 ± 8.9; p < 0.001). Patient VAS correlated modestly with ΔE*ab (ρ = −0.38 in AYA; ρ = −0.31 in AE) and more strongly with psychosocial OHIP-14 scores (ρ = −0.54 and −0.47, respectively). Patient-clinician agreement was poor in AYA (ICC = 0.26) and moderate in AE (ICC = 0.58), with larger negative patient-minus-clinician discrepancies in AYA. Exploratory mediation statistically decomposed the age-related patient-satisfaction difference more through patient–clinician discrepancy than through ΔE*ab; causality cannot be inferred. Conclusions: Younger patients may experience dissatisfaction and psychosocial burden despite better instrumental color match. Assessment of anterior composites should combine objective shade measurement with patient-centered expectation clarification, and longitudinal studies should test temporal mechanisms and communication interventions. Full article

Background: Chung–Jansen syndrome (CHUJANS) is a rare autosomal dominant genetic condition caused by pathogenic variants in the PHIP gene, which encodes a protein involved in neurodevelopmental processes and IGF-1 signalling. The phenotype is characterised by variable degrees of intellectual disability, early-onset obesity or overweight, distinctive facial dysmorphisms, and behavioural disturbances. We here present a case of Chung–Jansen syndrome with a detailed endocrine work-up, highlighting the metabolic component of this syndrome. Case Presentation: We describe the case of a 21-year-old woman referred to our centre for evaluation of oligomenorrhea in the context of severe obesity (BMI 50.4 kg/m²), short stature (151 cm, <3rd percentile), and moderate-to-severe intellectual disability (full-scale IQ 38). Physical examination revealed dysmorphic features, including a round face, upslanting palpebral fissures, prominent zygomatic bones, anteverted nares, a prominent chin, and bilateral brachydactyly type E1. Laboratory investigations documented subclinical primary hypothyroidism of autoimmune origin, impaired glucose tolerance with associated hyperinsulinism, and polyendocrine metabolic ovarian syndrome (PMOS, previously known as PCOS). Exome analysis by next-generation sequencing (NGS) identified a heterozygous c.328C>T [p.(Arg110Cys)] variant in the PHIP gene, already reported in literature and classified as likely pathogenic (ACMG class 4). Segregation analysis in the mother (father was not available for the test) did not reveal the variant, suggesting a de novo origin in the patient. Concurrently, the same analysis revealed a variant of uncertain significance in the ANKRD17 gene, while array-CGH detected a maternally inherited microdeletion of uncertain significance on chromosome X (Xp11.23). Conclusions: This case confirms the association between the PHIP p.(Arg110Cys) variant and the phenotype of Chung–Jansen syndrome, providing a detailed characterisation of the endocrine and psychiatric comorbidities. Indeed, our report expands the knowledge on the endocrine phenotype providing further suggestion for personalised patient management. It underscores the importance of NGS in the diagnostic workup of syndromic obesity with intellectual disability, especially in the presence of negative family history and prior inconclusive genetic testing. This case suggests the inclusion of comprehensive endocrine evaluations in future studies on patients with Chung–Jansen syndrome, in order to support endocrine work-up and facilitate early identification and appropriate management of potentially treatable alterations. Full article

Background: Biliary drainage is a key component of palliative management in patients with malignant biliary obstruction. In cases where endoscopic approaches are unsuccessful or cannot be performed, percutaneous transhepatic biliary drainage (PTBD) represents an established alternative for achieving biliary decompression. The C-reactive protein–albumin–lymphocyte (CALLY) index combines inflammatory, nutritional, and immune-related parameters into a single marker, while the modified Glasgow Prognostic Score (mGPS), based on C-reactive protein and albumin concentrations, reflects the systemic inflammatory status of the patient. This study aimed to evaluate the prognostic value of the preprocedural CALLY index and mGPS in predicting 30-day mortality among patients with advanced malignant biliary obstruction undergoing palliative PTBD. Methods: This single-center retrospective study was conducted in a total of 179 patients who underwent palliative PTBD for malignant biliary obstruction at Ankara Etlik City Hospital between December 2022 and June 2025. Results: The 30-day mortality rate was 25.1%. The cut-off value for CALLY was determined as 67 based on receiver operating characteristic (ROC) curve analysis, and mGPS was categorized as 0–1 versus 2. In univariable Cox regression analyses, pancreaticobiliary tumor type, mGPS = 2, and CALLY < 67 were associated with early mortality. In multivariable Cox analysis, CALLY ≥ 67 was independently associated with a reduced risk of 30-day mortality, whereas pancreaticobiliary tumor type was independently associated with an increased risk. In the CALLY–mGPS risk stratification, 30-day mortality rates were 8.0%, 13.5%, and 44.1% in the low-, intermediate-, and high-risk groups, respectively. Conclusions: In this retrospective cohort, preprocedural inflammation- and nutrition-based markers were found to be associated with early mortality in patients with malignant biliary obstruction undergoing PTBD. Accordingly, risk stratification using readily available parameters such as CALLY and mGPS appears feasible in the preprocedural setting. The CALLY–mGPS-based approach may provide a practical framework for clinical risk assessment; however, prospective multicenter validation, including tumor-specific subgroup analyses, is warranted. Full article

Background/Objectives: In case of EDTA-induced pseudothrombocytopenia (PTCP), MgSO₄-anticoagulated tubes are recommended for platelet counting, requiring the collection of an additional tube. The aim of this study was to analyze whether complete blood count (CBC) and differential performed on MgSO₄-anticoagulated tubes were comparable to the results obtained on K₃-EDTA samples, and to characterize the stability of the CBC over a 24 h period. Methods: In 355 patients (70 with a confirmed PTCP and 285 without PTCP), we compared CBC results obtained on K₃-EDTA- and MgSO₄-anticoagulated tubes, using DxH800 analyzers. In 33 cases, a differential was available for both anticoagulants, and for 10 patients, samples were re-analyzed 6, 12, and 24 h after the first determination. Results: In the presence or absence of clumps, white blood cell (WBC) count, hematocrit, and mean corpuscular volume (MCV) were slightly lower in MgSO₄ than in K₃-EDTA tubes, whereas mean corpuscular hemoglobin concentration (MCHC) was slightly higher. Mean platelet volume (MPV) was significantly lower on MgSO₄- than on K₃-EDTA-anticoagulated tubes. Values were highly correlated between both anticoagulants, and mean relative biases (MRBs) were below Ricos’s recommendations, except for MCHC and MPV. For differential, neutrophils were significantly lower on MgSO₄- in comparison to K₃-EDTA-anticoagulated tubes (MRB = −2.9%, below Ricos’s optimal bias). The morphology of white blood cells (WBCs) was similar on both anticoagulants. During storage at room temperature, MCV and red cell distribution width increased slightly, but the increase was more pronounced in K₃-EDTA than in MgSO₄ tubes. Conclusions: CBC and differentials obtained with the DxH 800 analyzer on MgSO₄-anticoagulated samples are similar to those obtained with K₃-EDTA, except for MPV. Full article

To investigate the predictive factors for resistance to VEN combined with HMAs in the treatment of AML, construct a drug resistance prediction model, and visualize the model. A retrospective analysis was conducted on 74 AML patients. Multivariate logistic regression was used to identify independent predictors of primary resistance, based on which a nomogram model and a risk scoring system for drug resistance were constructed. The results showed that KIT (p = 0.012), TP53 (p = 0.010), and FAB-M5 (p = 0.059) were significantly associated with primary resistance to VEN. A nomogram prediction model incorporating FAB-M5, KIT, and TP53 was established. Based on the nomogram model, a drug resistance prediction scoring tool comprising three variables was developed, categorizing patients into high-risk (6–10 points), intermediate-risk (3–5 points), and low-risk (0–2 points) groups. Significant differences in NR rates were observed among the three risk groups (p < 0.001). KIT, TP53, and FAB-M5 are independent factors influencing VEN resistance. The constructed nomogram prediction model and scoring system may provide valuable references for predicting primary resistance to VEN. Full article

Introduction: As global cancer incidence and survival rates continue to rise, understanding the experiences and needs of individuals in the survivorship phase is critical to inform policies that promote equitable care and adequate support for cancer survivors. Objective: The objective of this study was to examine the lived social and workplace experiences of cancer survivors in Newfoundland and Labrador (Canada) using a qualitative research design. Methods: The study was open to cancer survivors of majority age who resided in Newfoundland and Labrador after their diagnosis. Between June 2023 and August 2024, twenty-five individuals participated in the study. Data were collected virtually through focus groups, individual interviews, or written responses. Demographic and socioeconomic characteristics of participants were collected via a survey. Thematic analysis was performed on all qualitative data. Two patient partner investigators informed the research throughout the entire project. Results: Data were rich and diverse, revealing a range of positive and negative experiences in social and workplace settings. Major themes included stigma in social and workplace environments, financial toxicity, workplace accommodations, social support and information needs. Young participants had unique challenges. Participants offered recommendations aimed at enhancing available supports and improving the quality of life of cancer survivors. Overall, findings highlight shared experiences across different regions and cultures while also painting the local context. Discussion: The results of this study reveal diverse experiences among cancer survivors within social and workplace settings. The findings and resulting recommendations can inform meaningful improvement to policies and programs, thus promoting equity and enhancing the lived experiences of cancer survivors. Full article

A trend toward comorbid conditions is seen in around 50% of gynecological patients, with a significant contribution made by endometriosis as a common and incurable gynecological condition. Over the last decades, the global burdens of different forms of endometriosis have shown a progressive increase, while their diagnosis and management present persistent and significant challenges. Currently, endometriosis is divided into two primary types: genital (adenomyosis and external genital endometriosis, including ovarian endometriosis) and extragenital endometriosis. Regardless of the location of endometriosis, lesions or ectopic endometrium follow a consistent pathological process characterized by active proliferation, local inflammation, neoangiogenesis, and extracellular matrix remodeling. These pathogenetic patterns are associated not only with process progression, but also with the impact on the eutopic endometrium. External genital or extragenital endometriosis and adenomyosis (an internal genital endometriosis) are currently considered as a major cause of infertility and implantation failures due to the negative impact on the eutopic endometrium. However, it has been proven that the pathogenetic pathways for the development of eutopic endometrium dysfunction in these endometriosis phenotypes (despite the common pathophysiology of the ectopic endometrium) differ significantly. This narrative review is focused on highlighting the relevance and pathogenetic patterns of the two most frequently diagnosed forms of endometriosis—adenomyosis and ovarian endometrioid cysts—as key areas of research interest relating to their relevance, specific pathophysiology and impacts on the eutopic endometrium. Full article

Background: Robot-assisted radical prostatectomy (RARP) is the predominant surgical approach for localized prostate cancer in high-volume centers worldwide. However, comprehensive real-world data describing complete institutional transition from open to robotic surgery remain limited. This study evaluated perioperative and early oncological outcomes of a contemporary RARP cohort and characterized the transition from open radical prostatectomy (ORP) to RARP in a European center. Methods: We analyzed 520 consecutive patients who underwent RARP between January 2023 and December 2025. Perioperative, pathological, and biochemical outcomes were assessed. Biochemical recurrence was defined as prostate-specific antigen ≥0.2 ng/mL. Institutional data from 2011 to 2025 were reviewed to evaluate procedural trends and the transition from ORP to RARP. Surgeon-specific and institutional learning curves were analyzed using operative time and linear regression models. Results: Following the introduction of robotic surgery in 2018, annual RARP volume increased from 37 procedures to 205 in 2025. Since 2023, RARP accounted for more than 99% of all radical prostatectomies. Median operative time decreased from 185 min in 2023 to 165 min in 2025, with consistent downward trends observed across all surgeons. Linear regression confirmed progressive improvement in operative efficiency, with learning rates ranging from −0.22 to −0.92 min per case. Estimated blood loss was minimal, no patients required transfusion, and major complications occurred in four patients (0.8%). Hospital stay decreased from 2 days to predominantly 1 day. During follow-up, 36 patients developed biochemical recurrence or PSA persistence. Biochemical recurrence-free survival differed significantly according to pathological stage (log-rank p < 0.001), with 24-month estimates of 93.7%, 91.5%, and 82.1% for pT2, pT3a, and pT3b disease, respectively. Conclusions: RARP provides favorable perioperative safety, minimal morbidity, and favorable early oncological outcomes in a high-volume setting. The complete institutional transition from ORP to RARP, together with demonstrated surgeon-specific and institutional learning effects, supports the feasibility and safety of implementing RARP as the institutional standard within a structured robotic program. Full article

Transepithelial photorefractive keratectomy (Trans-PRK) offers superior re-epithelialization and visual recovery. This study evaluates the impact of preoperative refractive status on clinical outcomes and identifies prognostic factors across varying myopic severities. This retrospective observational study included 125 eyes [64 patients; age > 20 years; best-corrected visual acuity (BCVA) ≥ 20/25] that underwent Trans-PRK between March and December 2022. Patients were stratified into low myopia (LM: > −5.0 D), moderate-to-high myopia (MHM: −5.0 D to −8.0 D), and extremely high myopia (EHM: ≤ −8.0 D) groups. Analysis focused on preoperative refraction, intraoperative parameters, postoperative uncorrected visual acuity (UCVA), and corneal conditions of superficial punctate keratitis (SPKs) and haze. The mean age was 30.20 ± 6.34 years, with a mean initial manifest sphere (MS) of −6.42 ± 2.27 diopter (D) overall and −3.73 ± 0.15 D, −6.28 ± 0.13 D, and −9.17 ± 0.15 D in the LM, MHM, and EHM groups, respectively. At a mean follow-up of 6.69 ± 3.73 months, the overall mean final manifest spherical equivalent (MSE) was −0.12 ± 0.73 D, and the mean final UCVA was 0.01 [Snellen equivalent (SE), 205/200] ± 0.08 logMAR. Predictability was 94.4%, 88.88%, and 94.3% for the final MS ≤ −1.0 D, final MSE ≤ −1.0 D, and UCVA 0.8, respectively. In the LM and MHM groups, cycloplegic and subjective refractions showed the highest concordance with emmetropia, whereas initial manifest refractions were most accurate for the EHM group. Corneal SPK incidence declined from 32.2% (1 month) to 1.6% (6 months), primarily localized to EHM eyes. Corneal haze peaked at 28.2% at three months before receding to 9.4% by 6 months. Refractive and visual stability were achieved by the third month for the LM and MHM groups, whereas the EHM group (mean MSE: −9.59 ± 0.15 D) required six months to reach both refractive and visual plateaus. Despite transiently higher rates of corneal SPKs and haze in EHM eyes, final visual outcomes remained excellent, achieving a mean UCVA of 18/20. Full article

Background and objective: Hypoxemia and respiratory failure (RF) in chronic obstructive pulmonary disease (COPD) are associated with exacerbations, comorbidities and increased mortality. However, the prevalence of hypoxemia and RF in stable COPD is unknown. We aimed at investigating the prevalence and determining predictive factors for chronic gas exchange abnormalities in COPD patients. Methods: A retrospective cohort study that enrolled clinically stable COPD patients referring to a pulmonary outpatient clinic. Anthropometrics, clinical characteristics, blood gas analysis and lung function were analyzed. Patients were grouped according to hypoxemia (PaO₂ <80 and ≥60 mmHg), type 1 (PaO₂ < 60 mmHg) or type II (PaO₂ < 60 and PaCO₂ > 45 mmHg) RF. A sensitivity analysis adopting an age-adjusted definition of hypoxemia was performed. Predictive factors for hypoxemia or RF were assessed with multifactorial analysis. Results: We analyzed data from 515 patients. Fixed-ratio hypoxemia, RF type 1 and type 2 were observed in 352 (68.3%), 27 (5.2%) and 43 (8.3%) patients, respectively. Risk of hypoxemia was associated with preserved alveolar volume, residual volume/total lung capacity, and lung diffusion capacity. Heart failure, ischemic heart disease, atrial fibrillation, and metabolic syndrome were predictive factors for RF. Patients with age-adjusted hypoxemia (n = 321 patients, 62.3%) showed no difference in terms of anthropometrics, lung function, and clinical characteristics as compared with fixed-threshold hypoxemia. Conclusions: Hypoxemia is frequent in stable COPD. Lung function parameters and comorbidities can support the identification of patients at risk of RF. Blood gas analysis should be always performed in patients with COPD to allow for personalized therapy and management. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly associated with the development of cardiovascular disease (CVD); however, the mechanisms responsible are currently unknown. We have developed a model of MASLD due to the loss of hepatocyte peroxisome proliferator-activated receptor α (PPARα^HEPKO). We found that plasma beta-hydroxybutyrate (BHOB) levels were significantly reduced in PPARα^HEPKO mice and aimed to investigate the therapeutic potential of restoring BHOB levels in the development of CVD in these mice. Thirty-week-old PPARα^HEPKO and control PPARα^FL/FL mice were randomized to receive 1,3 butanediol (1,3-BDO), a precursor of BHOB, in drinking water for 6 weeks. 1,3-BDO treatment resulted in a significant increase in plasma BHOB levels, a significant decrease in mean arterial blood pressure, improvement in systolic and diastolic function, a decrease in vascular stiffness, and improved exercise performance in PPARα^HEPKO mice. 1,3-BDO treatment did not alleviate hepatic steatosis in PPARα^HEPKO mice; however, it improved plasma cholesterol levels and decreased cardiac lipid accumulation, fibrosis, and apoptosis. 1,3-BDO treatment also resulted in a significant increase in cardiac AMP-activated protein kinase (AMPK) levels. Increasing plasma BHOB levels reverses CVD in our mouse model of MASLD. A similar approach could be an effective strategy for preventing the development of CVD in patients with human MASLD. Full article

Background: Iron deficiency is common in very-low-birth-weight (VLBW) infants because of limited iron stores, rapid postnatal growth and repeated phlebotomy. Early detection is essential to prevent anaemia and neurodevelopmental impairment. This study investigated the prevalence of, and factors associated with, iron deficiency at hospital discharge using serum ferritin and the reticulocyte haemoglobin equivalent (RET-He). Methods: In this prospective cohort study, iron status was evaluated in 68 VLBW infants admitted between April 2022 and March 2024 at 36 weeks post-menstrual age (PMA) or at discharge. Iron deficiency was defined as serum ferritin below 75 ng/mL or RET-He below 28 pg. Univariable and multivariable logistic regression analyses were performed to explore clinical factors associated with iron deficiency. Iron status and anaemia were reassessed at 6–12 months of age. Results: At 36 weeks PMA or discharge, 39.7% of the infants were iron deficient, whereas only 1.5% were anaemic. Higher gestational age (aOR 1.81, 95% CI 1.07–3.06) and lower haemoglobin at birth (aOR 0.63, 95% CI 0.42–0.96) were independently associated with iron deficiency. Bronchopulmonary dysplasia showed a possible association (aOR 14.02, 95% CI 1.23–160.34), though this estimate should be interpreted cautiously. At 6–12 months, 18.8% of the patients had anaemia and 50% had iron deficiency, with no significant associated factors identified, likely reflecting the limited sample availability. Conclusions: Iron deficiency is common in VLBW infants and often precedes anaemia. Assessment of iron status beyond haemoglobin before discharge may be clinically justified to guide early supplementation, though further prospective multicentre studies are needed to confirm whether routine dual-biomarker screening is warranted. Full article

Background/Objectives: Although the Spinal Instability Neoplastic Score (SINS) is widely used to estimate spinal metastases fracture risk and guide decisions on stabilisation procedures, prior studies have demonstrated mixed results. Patients with the same score exhibit clinically heterogeneous outcomes, with some SINS criteria correlating less well with the estimated fracture risk than others. There are also barriers to implementation such as the time burden required for manual calculation and interobserver variability associated with qualitative morphological criteria. SINS also lacks sensitivity for detecting latent structural compromise in treatment-naive patients and those susceptible to the iatrogenic effects of stereotactic body radiation therapy. This review aims to evaluate emerging imaging, biomechanical, and microstructural markers with the potential to improve fracture risk stratification and prognostication for spinal oncology patients. Methods: We synthesise evidence across three innovative frontiers: (1) biomechanical modelling, including CT-derived finite element analysis and failure-load pattern models; (2) radiomics, utilizing radiomics features from radiological imaging to develop a predictive model; and (3) microstructural MRI biomarkers, exploring the translatability of the Vertebral Bone Quality score, fat fraction, and paraspinal muscle atrophy from osteoporosis to the metastatic spine. Results: Emerging biomechanical, radiomic and microstructural imaging markers show potential in addressing some limitations of traditional SINS criteria for fracture risk stratification across the spinal oncology treatment continuum, from initial diagnosis to post-radiation surveillance, thereby facilitating more precise risk assessment. However, current evidence remains largely retrospective and heterogeneous, and further validation is required before clinical adoption. Conclusions: We propose a framework that shifts the paradigm from conventional morphological scoring toward a multiparametric assessment of spinal stability. Full article

Background/Objectives: Sex differences in ST-elevation myocardial infarction (STEMI) outcomes persist despite advances in primary percutaneous coronary intervention (PCI), but whether female sex independently influences early mortality remains unclear. study aimed to assess sex-based differences in clinical characteristics, management, in-hospital outcomes and to determine whether female sex independently predicts in-hospital mortality. Methods: This retrospective observational study included 512 consecutive patients with STEMI presenting within 6 h of symptom onset and treated with primary PCI. Clinical, laboratory, echocardiographic and angiographic data were analyzed. The primary endpoint was in-hospital mortality. Multivariable logistic regression identified independent predictors of mortality. Results: Women comprised 32.0% of the cohort and were older than men (median 69 vs. 59 years, p < 0.001), with a higher prevalence of diabetes and hypertension, but lower rates of smoking (all p < 0.001). Women had lower hemoglobin levels and a higher prevalence of moderate-to-severe mitral regurgitation (17.1% vs. 8.0%, p = 0.004). Procedural characteristics, including door-to-balloon time and complete revascularization, were similar between sexes. Crude in-hospital mortality was higher in women (13.4% vs. 7.5%, p = 0.047); however, female sex was not independently associated with mortality after adjustment (adjusted OR 1.07, 95% CI 0.48–2.41; p = 0.864). Lower LVEF and reduced GFR were the strongest independent predictors of death. Conclusions: Higher mortality in women is primarily driven by a more adverse clinical profile rather than sex itself, emphasizing the importance of early risk stratification and management. Full article

Background/Objectives: Insomnia is one of the most prevalent and persistent symptoms among patients with breast cancer, yet it remains under-recognized and undertreated in routine clinical practice. Beyond its impact on sleep quality, insomnia is increasingly understood as a multidimensional condition involving neurobiological, psychological, and behavioral mechanisms, closely intertwined with cancer-related stress and psychiatric comorbidities. This narrative review aims to provide a comprehensive and integrative overview of insomnia in breast cancer, focusing on its epidemiology, pathophysiological underpinnings, neuropsychiatric correlates, and clinical implications, while highlighting gaps in current research and management. Methods: A narrative review of the literature was conducted, including studies published in major medical databases (PubMed, Scopus, and Web of Science) up to 2025. Relevant articles addressing insomnia, sleep disturbances, psychiatric symptoms, and neurobiological mechanisms in breast cancer populations were selected and synthesized. Results: Insomnia affects a substantial proportion of breast cancer patients across the disease trajectory, from diagnosis to survivorship. Its etiology is multifactorial, involving dysregulation of the hypothalamic–pituitary–adrenal axis, inflammatory processes, and circadian rhythm, as well as treatment-related factors such as chemotherapy, endocrine therapy, and menopausal symptoms. Insomnia frequently co-occurs with depression, anxiety, fatigue, and pain, forming symptom clusters that significantly impair quality of life and may influence clinical outcomes. Emerging evidence supports a bidirectional relationship between insomnia and psychiatric vulnerability, suggesting a shared neurobiological substrate within the brain–body stress axis. Conclusions: Insomnia in breast cancer should be conceptualized as a neuropsychiatric condition embedded within a broader stress-related symptom network rather than as an isolated sleep disturbance. Improved screening, interdisciplinary management, and the integration of evidence-based interventions such as cognitive behavioral therapy for insomnia are essential. Research should focus on personalized and mechanistically informed approaches to better address this highly prevalent yet insufficiently managed condition. Full article