Search Results (4,910)

Background: Community-acquired respiratory viruses (CARVs) cause significant morbidity and mortality in patients with haematological malignancies and those undergoing haematopoietic cell transplantation (HCT). Despite this, clinical management remains variable. This study evaluated clinicians’ awareness, diagnostic practices, and treatment approaches to major respiratory viruses in this high-risk population. Methods: An international electronic survey using non-probability convenience sampling was conducted among haematology, oncology, intensive care and emergency medicine physicians. Four real-life clinical cases were converted into standardised vignettes covering human metapneumovirus (HMPV), respiratory syncytial virus (RSV), human parainfluenza virus (HPIV) and influenza A virus (IAV). The questionnaire assessed reported testing strategies and intended management, including antiviral and immunoprophylactic interventions. Responses were analysed descriptively; no inferential between-group comparisons were performed. Results: Ninety-eight clinicians from 26 countries responded. Diagnostic approaches, including testing indications and panel selection, varied among respondents. For HMPV and HPIV, respondents mainly reported supportive care, immunoglobulin replacement, and infection-control measures in the absence of established pathogen-specific interventions. RSV practice was heterogeneous: systemic ribavirin was considered by 45/96 (46.9%) respondents, including 34/96 (35.4%) when guided by an immunodeficiency score. IAV management was more consistent, with reported availability of vaccination and antiviral therapy and frequent use of post-exposure prophylaxis. Conclusions: Within this international convenience sample, clinicians reported variation in respiratory viral testing and in how results informed intended management. Because sampling was non-probability-based and respondent groups were small and unevenly distributed, the findings should not be interpreted as representative estimates of international practice. IAV testing was most consistently linked to established treatment and prevention, RSV showed greater therapeutic and preventive heterogeneity, and HMPV/HPIV testing primarily informed infection control, monitoring and antimicrobial stewardship. Full article

Background: Borderline ovarian tumors (BOTs) represent a distinct group of rare epithelial ovarian neoplasms with excellent prognosis, but persistent uncertainty in patient understanding and clinical management. This study evaluated disease awareness, perceptions, and treatment patterns among affected women in Germany. Methods: The national multicenter Expression VIII survey was conducted across 34 centers by the North-Eastern German Society of Gynecologic Oncology (NOGGO). Using a standardized 46-item questionnaire, 286 patients with BOTs provided data on symptoms, treatment, fertility, follow-up, and illness perception. Descriptive analyses were performed. Results: Most participants (mean age 51 years) underwent surgery (94%), while systemic therapy was infrequent (chemotherapy 9%, bevacizumab 4%). Fertility-sparing surgery was performed in 14% overall, corresponding to 71% of those desiring future childbearing. Although 81% identified their physician as their main information source and rated information quality highly (mean 8.6/10), 29% believed they had ovarian cancer and 64% were unaware of their tumor stage. Nearly all patients (97%) received regular follow-up, though 18% were uncertain about the procedures performed. Disease severity was rated moderately high (mean 5.4/10), and recurrence risk and mortality were often overestimated. Conclusions: Despite good overall physician communication, substantial misconceptions persist among patients with BOTs, including the mistaken belief that they have been diagnosed with cancer, suggesting a need for clearer, structured education about its favorable prognosis and management of the disease. Improved guideline adherence and treatment centralization in specialized centers may reduce overtreatment and optimize fertility-preserving approaches. Full article

Healthy nutrition is pivotal for the prevention of atherosclerotic cardiovascular disease (ASCVD). In addition to traditional risk factors, other components, like low-grade chronic inflammation, play a pathogenetic role in ASCVD. Research efforts aim to identify low-grade chronic inflammation in patients with established ASCVD and in subjects with low ASCVD risk, and to validate effective nutritional strategies. Here, current nutritional approaches to counteract low-grade chronic inflammation related to ASCVD and possibly mitigated ASCVD risk are discussed, along with related molecular pathways and clinical biomarkers. Low-grade chronic inflammation results from a pro-inflammatory response promoted by large multiprotein complexes (inflammasomes). Within the ASCVD context, the nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome is the most characterized protein complex, whose activation leads to increased release of downstream effectors (interleukin (IL)-1β, IL-18, IL-6). In the current clinical practice, high-sensitivity C-reactive protein (hsCRP) is used as a circulating biomarker for systemic inflammation, although it is not univocally associated with ASCVD. Some nutritional strategies have been shown effective to mitigate low-grade chronic inflammation and to reduce hsCRP, reducing in some cases ASCVD risk. The Mediterranean Diet and related trials showed that their beneficial effects on cardiovascular disorders could also be related to the anti-inflammatory properties of specific active compounds. Contradictory results have also been obtained, due to lack of standardization and to the specific nature of nutritional studies, which often rely on adherence and compliance of participants. Given the relevance of low-grade chronic inflammation for ASCVD risk, future work will need to increase awareness, identify and validate novel biomarkers, and implement novel effective nutrition strategies. Full article

Immune checkpoint blockade (ICB) has transformed cancer therapy, but clinical responses remain heterogeneous across tumor types and patient populations. Cancer-associated fibroblasts (CAFs) are key stromal components of the tumor microenvironment and can contribute to immunotherapy resistance through immune exclusion, extracellular matrix remodeling, chemokine signaling, and interactions with suppressive immune cells. Although CAF-directed strategies are under active investigation, their clinical translation is limited by marked CAF heterogeneity and the lack of scalable biomarkers for patient stratification. Computational pathology based on hematoxylin and eosin (H&E) whole-slide images (WSIs) provides a potential approach for extracting stromal and spatial features from routine histology, although digitized WSIs and the infrastructure required for large-scale AI analysis are not universally available. In this review, we synthesize current evidence on CAF classification, CAF-mediated immunotherapy resistance, H&E-based computational pathology, and emerging histology-based biomarker models. We further propose a conceptual roadmap for developing CAF-aware H&E spatial signatures with potential relevance to future immunotherapy stratification. Current evidence supports the biological rationale and computational feasibility of this approach, whereas its clinical utility remains to be established through rigorous external validation and prospective clinical evaluation. Full article

Cognitive tunnelling poses significant risks in OB/GYN, where rapid clinical deterioration and time-pressured decision-making are common. This critical review synthesized evidence from a comprehensive literature search across multiple databases, yielding 414 unique papers examining cognitive tunnelling mechanisms, patient safety consequences, and mitigation strategies in obstetric and gynecological contexts. Medicolegal analysis reveals that cognitive tunnelling contributes to malpractice exposure and that adoption of structured safety programs addresses root causes and strengthens the clinical record for forensic review. Mitigation strategies were critically evaluated: metacognition and individual cognitive forcing strategies such as DECLARE (Differential, Examine, Consider, List, Assess, Review, Evaluate) and Pivot-and-Cluster show theoretical promise but depend on intact executive capacity that is depleted under the very conditions that precipitate tunnelling; debriefing demonstrates consistent improvements in team situational awareness and latent threat identification but requires organizational just culture and psychological safety; and hierarchical closed-loop communication systems provide the strongest evidence of reducing preventable adverse events by distributing attentional load across teams, though authority gradients risk suppressing junior-staff dissent. Despite growing recognition, significant knowledge gaps remain regarding measurement methodologies, obstetric-specific research, intervention effectiveness, and the integration of emerging artificial intelligence technologies. Addressing cognitive tunneling through quality studies with patient-centered outcomes and validated measures is essential for reducing medical errors and enhancing patient safety in women’s healthcare. Full article

The posterior communicating artery (PComA) aneurysm is a challenging microsurgical problem due to multiple factors. These include the technical complexity of the surgery itself, potential injury to blood vessels during surgery, recovery of cranial nerve function, and overall neurological outcome after the operation. These are all related to the area where the PComA aneurysm is located, but they have fundamentally different biological determinants. Prior methods of describing aneurysms do not adequately describe how the relationships of the internal carotid artery (ICA) and PComA/P1 configuration influence the proximity of the aneurysm to other important structures such as the perforating arteries, the anterior choroidal artery (AChA), cranial nerve III (CN III), and the surgical corridor. We created PComA-CORE, an artificial intelligence-based framework designed to evaluate whether the elements of experienced microsurgeons’ thought processes can be measured individually while still maintaining temporally valid predictions, human interpretability, and explicit estimates of predictive uncertainty. Methods: Using a highly detailed database of clinical, radiographic, anatomical, intraoperative, and longitudinal data from 687 adult patients who underwent microsurgical clipping of PComA aneurysms over the period 1997–2026, we applied PComA-CORE to predict separately: Microsurgical Complexity (C); Oculomotor Recovery (O); Neurovascular Preservation Risk (R); and Expected 90-Day Functional Outcome (E). The models used cases from 1997–2020 (n = 564) for development and cases from 2021–2026 (n = 123) for temporal evaluation. Several architectures, including penalized regression, machine-learning techniques, interpretable machine learning, and ensembles, were compared using nested cross-validation, discrimination metrics, calibration metrics, decision-curve analysis, explainability measures, uncertainty-aware prediction, inter-observer reproducibility, and model-to-score distillation. Results: Four discrete predictive architectures were identified by PComA-CORE. PComA-C was found to be highly dependent upon anatomy because the specific geometric characteristics of individual vascular segments and the presence or incorporation of branches around the aneurysm strongly influenced temporal predictions. PComA-R was found to behave as a distributed susceptibility phenotype based on neurovascular attributes rather than a deterministic injury model and achieved a temporal AUC of 0.703. Among patients with preoperative CN III palsy, PComA-O identified that recovery primarily depended upon the time course of neurological dysfunction and structural deformation of the affected nerve. Temporal validation was not feasible given the small number of recent non-recovery events. Conversely, PComA-E showed that global functional outcome continued to depend predominantly upon clinical neurological severity, with a temporally evaluated penalized model achieving an AUC of 0.878. Uncertainty-aware predictions indicated that some cases would benefit from greater caution in interpretation. High-resolution anatomical phenotypes demonstrated good inter-observer reproducibility. Score distillation demonstrated that simplification preserved predictive information, but did so differently depending on the endpoint. Conclusions: The problem of predicting the consequences of clipping a PComA aneurysm is multidimensional and does not exist as a single “risk” prediction problem. Technical complexity, neurovascular vulnerability, neural recovery, and global disability each exist within distinct predictive spaces and require different levels of anatomical detail and/or computational complexity. PComA-CORE establishes a human-supervised framework to transform expert microsurgical thought processes into explicit, reproducible, uncertainty-aware, and clinically interpretable representations. While prospective multicenter validation will be needed prior to clinical use, it has the potential to establish a basis for explainable AI, precision cerebrovascular neurosurgery, anatomy-informed risk stratification, and clinically interpretable decision-support systems in complex aneurysm surgery. Full article

Background and Clinical Significance: Horner’s syndrome is an uncommon but recognised complication of neuroaxial analgesia in obstetric procedures, with an incidence of 0.4–4%. Case Presentation: This case report describes a 28-year-old primigravida who developed unilateral Horner’s syndrome approximately one hour after lumbar epidural analgesia placement for labour pain relief. Upon examination the patient presented with left-sided ptosis, anisocoria, and unexpected sensory blockade extending to the T3–T4 level, accompanied by localised numbness in the left breast and transient upper limb paraesthesia. The pathophysiology of Horner’s syndrome involves cephalad spread of local anaesthetic toward the superior cervical sympathetic chain, disrupting sympathetic innervation to the ocular and facial areas. Primary and secondary damage to the sympathetic pathways in the central nervous offer a wide differential diagnosis. The management was conservative, including reduction in epidural bolus infusion rates and careful monitoring. The patient experienced complete resolution of all symptoms within five hours and delivered vaginally without complications. Conclusions: This case demonstrates the characteristically benign and self-limited nature of this complication, emphasising the importance of clinical awareness, proper reassurance of patients, and avoidance of unnecessary diagnostic testing. Full article

Hereditary angioedema (HAE) is a rare genetic disorder characterized by recurrent episodes of severe, non-pitting edema, most commonly caused by a deficiency or dysfunction of C1 esterase inhibitor (C1-INH), resulting in excessive bradykinin production. HAE subtypes differ according to C1-INH levels, functional activity, underlying genetic variants, and increasingly recognized molecular mechanisms. Awareness of HAE outside specialized medical fields remains limited, and recurrent angioedema may arise through different pathophysiological mechanisms, which together contribute to frequent misdiagnosis, particularly in patients without a positive family history. Consequently, many patients experience significant diagnostic delays and inappropriate interventions. Rapid advances in endotype-based classification, molecular diagnostics, and targeted therapies have substantially changed the understanding and management of HAE, highlighting the need for an updated clinical overview. This review provides a comprehensive overview of HAE classification, clinical presentation, genetic background, diagnosis, and current management. Particular attention is given to advances in diagnostic biomarkers and genetic testing, newly approved targeted therapies, and oral on-demand treatment. Together, these advances are moving HAE management toward earlier diagnosis, more individualized treatment, and more patient-centered care. Full article

Objective: Heritable thoracic aortic disease (HTAD) is an important cause of thoracic aortic aneurysm and dissection, yet remains underdiagnosed. We aimed to summarize the prevalence of syndromic and non-syndromic HTAD, describe variants of uncertain significance (VUS), and evaluate the impact of family screening in a contemporary cardiothoracic surgical cohort. Methods: Between 2018 and 2026, 163 patients underwent genetic testing for suspected HTAD at our institution. A total of 139 patients with completed genetic testing were included in the analysis. Indications for testing included root aneurysm or acute aortic dissection before the age of 60 years with or without positive family history, aneurysms involving multiple vascular territories, or syndromic features suggestive of a heritable aortopathy. Results: The mean age at testing was 45.8 ± 15.1 years and 33% of patients were female. Aortic dissection represented the initial manifestation of disease in 40% of patients. Positive family history was present in 60% of patients. Pathogenic variants were identified in 24%. Twenty-three patients were diagnosed with syndromic HTAD, most commonly Marfan syndrome, while 10 patients were found to have non-syndromic HTAD. Variants of uncertain significance were detected in 27 patients (19%), predominantly affecting MYLK and MYH11. Following diagnosis, 87 relatives underwent screening, resulting in 18 prophylactic aortic operations. Conclusions: Cardiac surgeons should be aware of the importance of genetic testing in patients with aortic disease. Beyond the individual patient, the broader goal is to identify at-risk family members and prevent acute aortic syndromes. Continued collection of genotype–phenotype data is essential to improve interpretation of variants of uncertain significance and optimize future patient care. Full article

The increasing availability of electronic clinical records has enabled new opportunities for predictive modeling in healthcare. However, clinical data are characterized by heterogeneous patient information, limited sample availability, and highly imbalanced outcome distributions, which may hinder the ability of predictive models to capture complex patterns and generalize across underrepresented groups. This work investigates deep learning-based representation learning strategies for predicting the final post-stroke functional state derived from the modified Rankin Scale (mRS) using clinical tabular data. The proposed methodology learns informative patient representations while addressing class imbalance without altering the original data distribution, avoiding limitations of conventional resampling strategies. Specifically, the proposed framework combines a TabTransformer encoder with Supervised Contrastive Learning and Focal Loss to jointly optimize discriminative representation learning and imbalance-aware classification. By obtaining more separable latent representations and reducing the bias toward majority-class predictions, the approach aims to improve the identification of patients with unfavorable functional outcomes. Experimental results show that the proposed model achieves the highest accuracy (0.92) and macro-averaged F1-score (0.80), with balanced minority-class precision (0.67) and recall (0.64), unlike the other models, which showed a trade-off between these metrics. These results demonstrate improved minority-class identification while maintaining overall predictive performance in clinical outcome prediction. Full article

Background/Objectives: Surveillance of local antibiotic resistance plays a critical role in guiding empirical antibiotic therapies in emergency departments (EDs). This study aimed to collect and analyze a five-year period of prevalence and AMR rates among “ESKAPE” pathogens in a tertiary-care ED setting. Methods: This retrospective observational study included a complete census of microbiological specimens collected from patients presenting to the emergency department between 1 January 2019 and 31 December 2023. Data was retrieved from the MedBakter laboratory information system. Non relevant isolated and duplications were excluded. Only the first isolates per patient per phenotype were included in the final dataset. Results: The final dataset contained 6510 isolates. The most frequent isolates were E. coli (2717, 41.7%), K. pneumoniae (715, 11.0%), and P. mirabilis (696, 10.7%) followed by E. faecalis (662, 10.2%). Prevalence of multi-drug resistance (MDR) was 23.26% among “ESKAPE” pathogens, with highest prevalence in M. morganii (79.6%), P. stuartii (78.5%) and S. marcescens (77.1%). Difficult-to-treat resistance (DTR) was found in 32 isolates, while extensive drug resistance (XDR) was found in 5 isolates. The prevalence of other high-priority MDR bacteria was 12.4% for MRSA and 4.7% for VRE, while among Gram-negative bacteria the prevalence of carbapenem-resistant Enterobacterales was 0.52%. The prevalence of cephalosporin-resistant Enterobacterales varied greatly between 0 and 33%. Conclusions: Despite these important AMR trends, the cumulative antibiogram, according to the World Health Organization (WHO)-issued Access, Watch and Reserve (AWaRe) classification, revealed room for empirical antibiotic choices that spare Watch and Reserve agents. The results will aid the revision of the local antibiotic guidelines. Full article

Background: Reliability-aware integration of heterogeneous data sources remains a fundamental challenge in multimodal deep learning: prevailing fusion strategies assume uniform reliability across sources and instances, limiting their responsiveness to data-dependent trustworthiness. Methods: We introduce REM-Fuse (Reliability-aware Evidential Multimodal Fusion), an evidential deep learning (EDL) framework in which per-source Dirichlet uncertainty adaptively weights each source through dual-channel weighting, asymmetric cross-scale enhancement, and Dempster–Shafer-inspired evidence accumulation. As a case study for cancer prognosis, REM-Fuse integrates multi-scale histopathology (10×, 20×) and RNA-seq on TCGA-BRCA (n = 831) via five-fold cross-validation with subtype- and stage-stratified analyses. Results: REM-Fuse attained a concordance index of 0.715 and a 60-month time-dependent AUC of 0.729, indicating moderate discrimination and significant risk separation (log-rank p < 0.001). Adaptive source weights and per-patient uncertainty varied significantly across molecular subtypes (Kruskal–Wallis p = 0.010 and p = 0.007), indicating patient-specific rather than fixed multimodal integration. Conclusions: REM-Fuse provides a compact reliability-aware fusion strategy for cancer prognosis, although external validation is needed before broader clinical or cross-cohort generalization. Full article

Background/Objectives: Breast cancer is the most common malignancy among women worldwide. Vacuum-assisted breast biopsy (VABB) has emerged as a minimally invasive alternative to surgical excision, but it may cause post-biopsy scarring that could mimic or obscure malignancies on follow-up imaging. This study aimed to evaluate the imaging characteristics, evolution, and clinical implications of post-VABB scar formation. Methods: We conducted a retrospective study of patients who underwent mammographic or magnetic resonance imaging-guided VABB at our institution between January 2010 and December 2020 and whose follow-up report describes a post-biopsy scar. Patients with malignant or high-risk lesions requiring subsequent surgery or prior breast surgery were excluded. Post-biopsy follow-up mammograms and ultrasounds were reviewed by a fellowship-trained breast radiologist for scar formation, visibility across imaging modalities, and evolution over time. Statistical analysis was performed to assess associations between scar detection and patient or lesion characteristics. Results: Thirty-seven patients (39 lesions) with documented post-biopsy scarring on follow-up imaging reports met the study inclusion criteria. The mean age at biopsy was 51.97 ± 12.40 years. Lesions were almost equally distributed between the right and left breasts, with 19 cases involving the right breast (48.7%) and 20 cases involving the left breast (51.3%). Most cases did not need any workup, except for six cases, where two required further biopsy and four required short-term follow-up. No malignancy was detected during the available follow-up or additional evaluation. Twenty-two scars regressed over time. The estimated mean time to scar regression was 69.47 months. Conclusions: Post-biopsy scarring was documented in a small subset of our institution’s VABB cases over the study period and may resemble malignant findings, particularly on tomosynthesis. Awareness of typical scar characteristics, careful documentation of biopsy sites, and correlation with clip markers are essential to avoid unnecessary interventions. Full article

Background/Objectives: Communication training in undergraduate nursing skills courses is often overshadowed by procedural skill acquisition, leaving limited opportunities for students to develop patient-centered communication skills and engage in reflective learning. This study evaluated a reflection-integrated CICARE communication program embedded in a Fundamentals of Nursing skills course and explored students’ learning experiences. Methods: A quasi-experimental study with an embedded qualitative component was conducted among second-year undergraduate nursing students in China. The quantitative component used a non-equivalent control group design, while reflective journals from the Intervention Group provided qualitative data on students’ learning experiences. Two intact classes were assigned to the Intervention Group (n = 65), and two intact classes were assigned to the Control Group (n = 66). The Intervention Group received an 18-week CICARE-based communication program integrated into skills training, including scenario-based role-play, emotional cue recognition, demonstration videos, feedback, and reflective journals. The Control Group received conventional skills training. Outcomes included communication competence, empathy, professional identity, clinical judgment, and course performance. Analysis of covariance was used to compare post-intervention outcomes after adjustment for baseline scores. Reflective journals from the Intervention Group were analyzed thematically. Results: After adjustment for baseline scores, the Intervention Group showed significantly higher communication competence than the Control Group (adjusted mean difference = 2.699, 95% CI: 0.108–5.291, p = 0.041). Empathy was also higher in the Intervention Group (adjusted mean difference = 3.796, 95% CI: 0.538–7.053, p = 0.023). The between-group difference in professional identity was not statistically significant (p = 0.073). The Intervention Group achieved higher total clinical judgment scores than the Control Group (31.52 ± 5.50 vs. 27.20 ± 6.45, p < 0.001), with significant differences in noticing, interpreting, and reflecting. Course performance was also higher in the Intervention Group. In their reflective journals, students described greater patient-centered awareness, attention to patients’ emotional needs, professional reflection, and motivation for self-directed learning. Conclusions: Integrating CICARE-based communication training with reflective learning may strengthen communication competence, empathy, clinical judgment, and course performance in undergraduate nursing skills education. Further studies with longer follow-up are needed to determine whether the observed differences persist over time and whether professional identity and action-oriented clinical responses improve with longer educational exposure. Registration: This study was not registered. Full article

Introduction: Acute type A aortic dissection (ATAAD) is a rare but potentially catastrophic complication following transcatheter aortic valve implantation (TAVI). Most reported cases occur during or shortly after the procedure and are attributed to procedural aortic injury. Very late presentations occurring years after successful TAVI are exceptionally uncommon, and evidence regarding their optimal management remains limited. Case Presentation: An 86-year-old man presented with acute chest pain four years after transfemoral implantation of a self-expanding Evolut R 29-mm transcatheter heart valve. Transthoracic echocardiography revealed pericardial effusion with signs of impending cardiac tamponade. Computed tomography angiography confirmed Stanford type A acute aortic dissection involving the ascending aorta. Emergency surgical repair was performed through replacement of the ascending aorta and hemiarch using a vascular graft. The previously implanted transcatheter valve was preserved because it remained structurally intact and functionally normal. The postoperative course was uneventful, and the patient was discharged on postoperative day 9 with preserved prosthetic valve function (mean gradient 11 mmHg, peak velocity of 2.1 m/s, EOA 1.8 cm², EF 50%, TAPSE 18 mm and no evidence of paravalvular or intraprosthetic regurgitation). Discussion: To better contextualize this rare presentation, a focused review of the literature on delayed and late ATAAD after TAVI was performed. Only a limited number of cases were identified, highlighting the exceptional rarity of this complication. Reported management strategies included conservative treatment, endovascular interventions, and open surgical repair, with considerable heterogeneity in outcomes. Compared with previously published reports, the present case is notable for the exceptionally long interval between TAVI and dissection onset and for the successful valve-preserving surgical repair. These findings suggest that emergency surgery with preservation of a functioning transcatheter valve may be a feasible option in carefully selected patients. Conclusions: Very late ATAAD after TAVI is an exceptionally rare but life-threatening condition. This case demonstrates that valve-preserving surgical repair can be successfully performed even in selected octogenarian patients. As the population of long-term TAVI survivors continues to expand, awareness of late aortic complications, prompt diagnosis, and referral to specialized aortic centers remain essential for achieving favorable outcomes. Full article