Search Results (1,202)

Background: Chronic obstructive pulmonary disease (COPD) disproportionately affects older adults. While targeted biologic therapies have shown efficacy in type 2 eosinophilic endotypes, elderly patients remain underrepresented in pivotal clinical trials. This narrative review examines the pathophysiological rationale, efficacy data, and unique geriatric challenges of biologic therapies in older adults. Methods: A literature search was conducted in PubMed and Scopus for phase II and III randomized controlled trials (RCTs) and observational studies evaluating biologic agents (anti-IL-5, anti-IL-4/IL-13, and anti-alarmins) in COPD, focusing on populations aged ≥ 65 years, comorbidities, and frailty. Discussion: Phase III data for dupilumab and mepolizumab indicate significant reductions in annualized exacerbations in patients with blood eosinophils ≥ 300 cells/μL. However, the mean age in the landmark trials (65 years) is a decade lower than the real-world average. Age-related immune remodeling—specifically immunosenescence and inflammaging—coexists with disease-specific pathways, potentially altering therapeutic responses. Furthermore, clinical trials systematically exclude older individuals with severe multimorbidity, physical frailty, cognitive impairment, and malnutrition. Conclusions: Biologics provide a precise, mechanism-based approach, yet evidence in the oldest-old remains limited. Future management should utilize the treatable traits framework, shifting selection criteria from chronological age to biological age metrics, including frailty status and functional reserve. Full article

Background: Severe obesity is a chronic condition that adversely affects physical health and quality of life, including sexual function. However, its impact on multidimensional psychosexual outcomes remains unexplored. This study aimed to assess changes in erectile function, genital self-image, and psychological distress in men who underwent bariatric surgery. Methods: This prospective cohort study involved 50 male participants undergoing primary bariatric surgery who were evaluated within 30 days prior to the surgical procedure and at a minimum of 12 months postoperatively. Standardised questionnaires were used, including the International Index of Erectile Function-5 (IIEF-5), Male Genital Self-Image Scale (MGSIS-7), and Hospital Anxiety and Depression Scale–Modified (HADS-M). Secondary outcomes encompassed parameters of weight loss, sexual activity, and selected aspects of sexual behaviour, such as the utilisation of various sexual positions, their associated pleasure, and frequency. Results: Significant postoperative improvements were observed in BMI reduction from 42.8 kg/m² to 31.7 kg/m² (p < 0.001), erectile function (IIEF-5 improved from 16.3 to 19.6; p < 0.001), genital self-image (MGSIS-7 improved from 19.1 to 21.9; p < 0.001), and psychological distress (HADS-M reduction from 13.3 to 8.7; p < 0.001). Glycated haemoglobin decreased significantly (5.89% to 5.31%; p < 0.001), obstructive sleep apnoea severity improved (p < 0.001), and remission or clinically meaningful improvement of at least one major metabolic comorbidity was documented in 24 of 37 participants (64.9%). Sexual activity increased from 37/50 (74.0%) to 43/50 (86.0%), although this change was not statistically significant (p = 0.114). After FDR correction, frequency increased for 3 of the assessed positions, whereas pleasure increased only for one of them. Weight loss magnitude was not significantly correlated with changes in the IIEF-5 or MGSIS-7 scores. A greater reduction in the HADS-M score correlated with a greater improvement in the IIEF-5 score (ρ = −0.307, p = 0.030). Conclusions: Bariatric surgery was associated with improvements in erectile function, genital self-image, and psychological distress, alongside marked glycaemic and sleep-related recovery. Because the psychosexual changes were not statistically associated with the magnitude of weight loss and of metabolic and respiratory improvement, and because the design was uncontrolled, these exploratory findings indicate association rather than causation and support the incorporation of psychosexual and mental health assessment into postoperative bariatric care. Full article

Background/Objectives: Takotsubo cardiomyopathy (TTC), also known as “broken heart syndrome”, is an acute and reversible cardiac condition often triggered by emotional or physical stress. Increasing evidence suggests a strong comorbidity between TTC and psychiatric disorders, particularly anxiety and depression. However, the nature, prevalence, and implications of these associations remain incompletely understood. This scoping review aimed to systematically map the available evidence on the association between Takotsubo cardiomyopathy and anxiety and depressive disorders, characterize the prevalence and nature of these psychiatric comorbidities, evaluate the methods used for their assessment, and identify knowledge gaps to guide future research and clinical practice. Methods: A systematic search of MEDLINE (via PubMed), Embase, Web of Science, and Google Scholar was conducted for peer-reviewed human studies published up to December 2025 in English or French. Eligible studies reported on psychiatric comorbidities in TTC populations, including pre-existing disorders, psychiatric triggers, or psychological sequelae. A standardized extraction grid and the Joanna Briggs Institute appraisal tools were used for data collection and quality assessment. Results: Eighteen studies were included. Depression and anxiety were prevalent among TTC patients, frequently preceding or accompanying cardiac events. Emotional stressors such as bereavement or panic attacks were commonly cited as triggers. Despite this, only a minority of studies used validated psychometric tools, and longitudinal psychiatric follow-up was rare. Most studies were limited by small sample sizes, retrospective designs, and heterogeneity in diagnostic approaches. Conclusions: The findings reveal a consistent association between TTC and affective disorders, underscoring the role of the brain–heart axis. Integrating psychiatric screening and follow-up into TTC management may enhance outcomes. Future interdisciplinary research is needed to clarify causal pathways and inform prevention and treatment strategies. Full article

Akkermansia muciniphila is regarded as a beneficial mucin-degrading commensal, yet in Japanese populations the genus Akkermansia occurs at low abundance and is frequently undetectable. We examined its dietary correlates and its relationship with physical function in 786 community-dwelling older Japanese adults (age ≥ 65 years). Dietary patterns were derived from 31 food groups by principal component analysis (PCA) with varimax rotation, and Akkermansia was quantified by 16S rRNA gene sequencing and expressed as centered log-ratio (CLR)-transformed z-scores. Akkermansia was undetectable in 356 participants (45.3%) and of low abundance among carriers (median ≈ 0.35%). A noodle-based dietary pattern (principal component [PC] 4) was inversely associated with Akkermansia after adjustment for age, sex, body mass index, and lifestyle/comorbidity covariates (β = −0.125; p = 0.0007), with a dose–response across quartiles (p for trend = 0.004). In a two-part model, this association was confined to detection (adjusted odds ratio per 1 standard deviation = 0.80; 95% confidence interval, 0.69–0.93) and was absent among carriers (p = 0.25), indicating that diet was related to whether Akkermansia was present rather than to its abundance. Akkermansia was unrelated to grip strength, muscle mass, and frailty; weak carrier-restricted associations did not survive false discovery rate correction (p = 0.056) and are considered exploratory. These findings provide limited evidence for a role of Akkermansia in physical function in this low-abundance population. Full article

Background/Objectives: Long COVID (LC) has affected 7.2% of the population of the United States (US). Mental and physical health have been increasing in prevalence over the last few years. This study aimed to investigate the association between various characteristics and mental and physical health status among US adults with LC. Methods: The study was cross-sectional in design and used data from the 2023 Medical Expenditure Panel Survey (MEPS). We assessed predisposing, enabling, and need variables in US adults with MEPS-defined LC using multivariable logistic regression analysis. The data was weighted to produce nationally representative estimates. Results: It was determined that individuals with a low income level, a high degree of pain, and poor physical health were each associated with higher odds of poor mental health in US adults with LC. An age of 50–70+ was associated with lower odds of poor physical health in US adults with LC. Educational achievement up to and including high school, having a functional limitation, exercise participation, any pain, multiple comorbid conditions, and poor mental health were each associated with higher odds of poor physical health in US adults with LC. Conclusions: Several variables were associated with poor mental and physical health status among US adults with LC. Further research should be conducted to explore these variables in more detail and investigate possible interventions for healthcare providers. Full article

There remains a widespread lack of knowledge regarding hidradenitis suppurativa (HS) among physicians in the United States, impeding timely diagnosis and implementation of comprehensive treatment interventions. Despite the presence of supporting communities for affected adolescents and their caretakers, the overall awareness of HS remains low, and a greater consensus on the treatment of HS is needed. Current research highlights the lack of standardized pediatric guidelines for treatment of HS largely due to the varied nature of the disease and limited efficacy of current therapies. Our study aims to explore the relationship between the chronic skin condition HS and social–emotional concerns, mental health, and physical health issues in US children and adolescents. Using the Arksey and O’Malley framework and PRISMA-ScR reporting, we searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase for U.S. studies (2015–2025) on pediatric HS (<18 years) and social–emotional, mental health, or quality-of-life outcomes. Recommendations were synthesized, and study quality was appraised with CASP checklist methods and rigor. Ten studies (2020–2025) met inclusion criteria. Pediatric HS was associated with depression, anxiety, social withdrawal, shame, low self-esteem, and reduced quality of life. Physical comorbidities increased psychosocial burden. Socioeconomic and racial disparities worsened outcomes and access to care. Studies emphasized early diagnosis, routine screening, multidisciplinary management, and disparity-focused interventions. Findings may inform clinical practice and guide research initiatives aimed at improving outcomes for children and adolescents with HS. Full article

Background: Intraoperative blood pressure variability (BPV) is associated with adverse perioperative outcomes, although the prognostic meaning of variability itself, once blood pressure level is accounted for, remains uncertain. Preoperative metabolic indicators have not been examined in relation to intraoperative BPV. The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, is associated with arterial stiffness in community populations. We examined whether the preoperative TyG index is associated with intraoperative BPV in surgical patients, and whether an estimated pulse wave velocity (ePWV) surrogate statistically accounts for part of this association. Methods: This single-center retrospective cohort study included 7081 adults who underwent elective major abdominal surgery under general anesthesia for at least 120 min at Beijing Tsinghua Changgung Hospital between January 2016 and December 2022. The primary outcome was the coefficient of variation of intraoperative mean arterial pressure (CV-MAP). ePWV was calculated from age and preoperative mean arterial pressure (MAP) and is therefore a surrogate rather than a direct measure of arterial stiffness. Multivariable linear regression assessed the TyG-CV-MAP association; models excluding and including age are reported as co-primary analyses. Exploratory mediation analysis using the Baron-Kenny framework with 5000 bootstrap iterations estimated the proportion of the association statistically accounted for by ePWV. Subgroup analyses tested age as an effect modifier, and a sensitivity model additionally adjusted for antihypertensive and antidiabetic medication use. Results: After adjustment for sex, body mass index, comorbidities, surgical duration, American Society of Anesthesiologists physical status, and surgery type, each unit increase in the TyG index was associated with a 0.0128-unit increase in CV-MAP (95% confidence interval [CI], 0.0097 to 0.0158; p < 0.001); with age additionally included, the estimate was 0.0086 (95% CI, 0.0056 to 0.0117; p < 0.001). In absolute terms, each unit increase in TyG corresponded to a 1.074 mmHg higher standard deviation of intraoperative MAP (MAP-SD; 95% CI, 0.842 to 1.305), against a cohort mean MAP-SD of 12.0 mmHg. ePWV statistically accounted for approximately one quarter to one third of the total effect (indirect effect, 0.0038; bootstrap 95% CI, 0.0030 to 0.0046). The association was present in patients younger than 65 years (β = 0.0132, p < 0.001), with no evidence of an association in those aged 65 years or older (β = 0.0008, 95% CI, −0.0054 to 0.0071; p = 0.79; interaction β = −0.0124, 95% CI, −0.0187 to −0.0061; p < 0.001). Sensitivity analyses supported the robustness of these findings, including a model adjusted for antihypertensive and antidiabetic medication use (β = 0.0128, 95% CI, 0.0098 to 0.0159; p < 0.001). Conclusions: The preoperative TyG index was independently associated with greater intraoperative BPV in major abdominal surgery, with the association present in patients younger than 65 years but not in older patients. An ePWV-based surrogate statistically accounted for approximately one quarter to one third of this association; because ePWV is derived from age and blood pressure rather than measured directly, this proportion may reflect the structure of the surrogate rather than a causal arterial-stiffness pathway. The clinical significance remains uncertain given the modest incremental predictive contribution and the absence of clinically anchored endpoints; prospective validation with directly measured pulse wave velocity is required. Full article

Background: The demographic and clinical heterogeneity of dementia is well recognised; however, the consistency of core symptom profiles across age and gender in clinical populations remains underexplored. This study aimed to determine the burden and distribution of dementia-related symptoms in selected rural health facilities in South Africa. Methods: A retrospective cross-sectional study was conducted among 260 patients with a diagnosed dementia condition. Data on demographics and key symptoms (memory loss, short-term memory loss, behavioural changes, delusions and communication difficulties), as well as chronic disease comorbidities, were extracted from electronic health records. Associations were assessed using Chi-square tests. Results: The cohort was predominantly female (59.6%) and older (64.3% aged ≥71 years). Symptom prevalence was high: short-term memory loss and behavioural changes (96.9% each), general memory loss (91.2%), chronic disease comorbidity (75.8%), communication difficulties (67.3%), and delusions (57.7%). No statistically significant associations were found between any of the dementia symptoms and age or gender (p > 0.05), indicating a uniformly high symptom burden across demographic subgroups. Conclusions: Dementia-related symptoms and comorbidities were consistently high and severe in this clinical population, irrespective of age or gender. These findings underscore the need for integrated, person-centred care models addressing both cognitive and physical health in resource-limited settings. Full article

Physical performance can be understood as a continuum throughout the life course, ranging from peak athletic ability in early life to the preservation of mobility and functional independence in old age. This narrative review explores whether the biological and genetic pathways involved in athletic performance might also modulate the risk of geriatric motor dysfunctions (GMDs), a conceptual umbrella proposed here for sarcopenia, dynapenia, lower-limb weakness and the motor component of physical frailty. The available evidence suggests a convergence between performance and motor decline in mechanisms such as mitochondrial function and mitophagy, anabolic–catabolic balance, oxidative stress and low-grade chronic inflammation, neuromuscular integrity, satellite cell function, mechanotransduction, myokine-mediated signalling, and the gut–muscle axis. Although classic candidate genes such as ACTN3, ACE and PPARGC1A have been useful for formulating mechanistic hypotheses, genome-wide association studies support a highly polygenic architecture for strength, lean mass, muscle weakness and frailty. These effects are strongly modulated by the exposome, particularly by physical activity, nutrition and comorbidities. Overall, the relationship appears consistent with predominantly beneficial pleiotropy, although context-dependent effects cannot be ruled out. Genetics may influence functional reserve and decline trajectories, but exercise, particularly strength and power training, along with adequate nutrition and the management of comorbidities, remain the primary strategies for preventing or delaying sarcopenia, frailty and lower-limb weakness. Full article

Background/Objectives: Early detection of breast cancer (BC) substantially improves outcomes, with a 5-year survival rate of 99% for early-stage disease. Risk-based screening, which tailors recommendations according to individual clinical, personal, and lifestyle factors, is a promising strategy to enhance early detection. However, previous studies have reported inconsistent evidence of association with BC risk for several modifiable lifestyle factors including premenopausal adiposity, sedentary behaviour, oral contraceptive use. To address these uncertainties, we investigated the association between clinical, personal, and modifiable lifestyle factors and BC risk in the Prevention, Imaging, Network, Knowledge (P.I.N.K.) project. P.I.N.K. generated real-world evidence by integrating clinical data with information collected through a structured questionnaire evaluating the associations between BC and clinical, personal, and lifestyle factors in 27,123 Italian women aged ≥ 40 years, who underwent integrated breast imaging diagnostics. Methods: Characteristics of women with and without BC were compared. Adjusted logistic regression, Least Absolute Shrinkage and Selection Operator (LASSO), and Random Forest models were applied to identify relevant predictors. Variables selected by at least two methods were included in a multivariate logistic regression model, with BC diagnosis as the outcome. Results: Accordingly with previous studies a consistent association was found for high breast density, late menopause, overweight, abdominal adiposity, cardiovascular-cerebrovascular and oncological comorbidities and smoking. Greater consumption of plant-based foods, lower intake of red and processed meat, and regular physical activity were associated with lower odds of BC as well. Conversely, an unexpected inverse association was assessed for menstrual irregularities, hyperlipidaemia, and oral contraceptive use. Conclusions: The integration of multiple sources of information both clinical and self-reported data collected directly from women adds to the growing evidence on the role of modifiable lifestyle factors in BC risk in supporting more targeted prevention strategies. Future prospective studies should further investigate the long-term effects of lifetime physical activity trajectories, different oral contraceptive formulations, and detailed reproductive history, including menstrual cycle characteristics and menopausal timing, to refine individualized BC risk prediction. Full article

Background/Objectives: Surgical treatment of colorectal cancer (CRC) is associated with a substantial risk of postoperative complications and delayed recovery of functional capacity, particularly in older patients and those with multiple comorbidities. Preoperative prehabilitation has emerged as a strategy aimed at optimizing patients’ physical, nutritional, and psychological status prior to surgery; however, its clinical effectiveness and feasibility of implementation remain subjects of ongoing debate. The aim of this narrative review was to provide a clinically oriented synthesis of current evidence regarding multimodal prehabilitation in patients undergoing CRC surgery, with particular emphasis on perioperative outcomes, functional recovery, nutritional optimization, and implementation-related considerations. Methods: A targeted narrative review of the peer-reviewed literature indexed in PubMed (2015–2025) was conducted to identify contemporary review-type publications, including narrative reviews, systematic reviews, scoping reviews, and meta-analyses, addressing prehabilitation in CRC surgery. The findings were synthesized narratively and interpreted with emphasis on clinical applicability and translational relevance. Results: Twenty contemporary review publications were included in the analysis. Across the included publications, the most frequently reported favorable effects were observed for multimodal prehabilitation, incorporating physical exercise, nutritional support, and a psychological component. These interventions were associated with improvements in functional capacity and, in some meta-analyses, with a reduction in postoperative complication rates and shorter length of hospital stay, particularly in high-risk patients. Prehabilitation was assessed as safe and well tolerated. Conclusions: The current body of evidence indicates that multimodal prehabilitation may constitute a beneficial adjunct, particularly in improving functional capacity, while its impact on hard postoperative outcomes remains closely dependent on intervention quality, appropriate patient selection, and seamless integration with established perioperative care pathways. Future meta-analyses should address underexplored components of prehabilitation, including preparation for stoma formation and targeted educational and psychological support related to sexual health. Full article

Background: Pharmacological treatments are frequently prescribed for adolescents with anorexia nervosa (AN), mainly to address psychiatry comorbidities and associated clinical features, although evidence supporting medication-specific effects remains limited. This retrospective study examined 12-month clinical trajectories associated with different pharmacological treatment patterns in a cohort of female adolescents with AN admitted to a tertiary university hospital. Methods: Clinical records of 102 female patients aged 12–18 years with AN were retrospectively reviewed. Participants were first classified according to whether they received any pharmacological treatment and were subsequently divided into six groups: no medication, antidepressants, antipsychotics, mood stabilizers, combination therapy, and medication switching. Body mass index (BMI), Clinical Global Impression—Severity (CGI-S), Children’s Global Assessment Scale (C-GAS), and item 40 of the Structured Interview for Anorexic and Bulimic Syndromes—Expert Form (SIAB-EX) were evaluated at admission (T0, before treatment initiation), at 6-month follow-up (T1), and at 12-month follow-up (T2). Results: BMI improved significantly over time across all treatment groups. Compared with participants who received any form of pharmacological treatment, the non-medicated group exhibited a significantly greater increase in mean CGI-S scores and significantly greater reductions in mean C-GAS and SIAB-EX scores. Baseline comparison among the six treatment groups showed significant differences in CGI-S, C-GAS, and SIAB-EX item 40 scores, indicating that the groups were not fully comparable in terms of initial clinical severity, global functioning, and physical hyperactivity. Patients in the medication-switching group generally showed smaller improvements, whereas findings in the mood-stabilizer group should be interpreted cautiously because of the very small sample size. Conclusions: In this real inpatients cohort, adolescents with AN showed clinical improvement over 12 months across different pharmacological treatment patterns. However, baseline differences between groups and the non-randomized retrospective design preclude causal conclusions regarding medication-specific effectiveness. These findings should be interpreted as descriptive clinical trajectories associated with treatment patterns selected in routine care. Further prospective studies with standardized treatment data and adequately powered subgroups are needed. Full article

Over the last few decades, survival among patients with lung cancer (LC) has progressively improved due to major advances in treatment strategies, particularly the introduction of immunotherapy and targeted therapies, as well as the increased detection of early-stage disease resulting from the widespread use of chest computed tomography (CT). Although the reduction in mortality, frequently achieved through effective control of the primary disease, represents a major therapeutic success, it also raises new clinical challenges, including the long-term management of cancer remission or disease stability and the competing risk of adverse outcomes related to comorbidities and treatment-related toxicities. Among these, cardiovascular (CV) complications have emerged as particularly relevant because of their frequency and prognostic impact. Within the framework of a holistic long-term management approach, increasing attention should be directed toward non-pharmacological interventions targeting lifestyle factors, particularly nutrition and physical exercise, whose role remains underestimated. These interventions may modulate chronic inflammation and immune responses, which are key drivers influencing both the effectiveness of novel anticancer therapies and the progression of cardiovascular complications. Patients with LC frequently present malnutrition and unfavorable lifestyle patterns associated with substantial physical and psychological stress, factors that may negatively affect treatment outcomes and overall prognosis. This narrative review examines the emerging role of targeted nutritional strategies and structured physical exercise as integral components of supportive care in LC, with a specific focus on their impact on cardiac metabolism, CV risk, and response to anticancer therapies, including immunotherapy. Full article

Background: Urinary incontinence (UI) is a common condition that affects women’s physical, psychological, and social well-being. Evidence from Central Asia remains limited. This study assessed factors associated with UI, its subtypes, and quality-of-life impairment among women in Kazakhstan. Methods: A multicenter age-matched case–control study was conducted from February to May 2025 in healthcare facilities across Kazakhstan. The study included 2061 women. Sociodemographic, obstetric, lifestyle, comorbidity, and symptom data were collected using a structured questionnaire. Quality of life was assessed using Kazakh and Russian versions of the Incontinence Quality of Life Questionnaire (I-QOL). Multivariable logistic regression with backward elimination identified factors independently associated with UI. Results: UI was identified in 687 women (33.3%). Stress urinary incontinence (SUI) was the most common subtype (n = 356; 51.8%), followed by urgency urinary incontinence (UUI) (n = 191; 27.8%) and mixed urinary incontinence (MUI) (n = 140; 20.4%). UI was independently associated with vaginal delivery (OR = 1.48), multiple birth (OR = 2.26), macrosomia (OR = 1.83), and BMI ≥ 25 kg/m² (OR = 2.08). UUI showed the greatest burden, including the lowest total I-QOL score [36.4 (23.9–88.6)]. Conclusions: UI in Kazakhstan was mainly associated with obstetric and metabolic factors, supporting targeted prevention through weight management, antenatal care, and early pelvic floor assessment. Full article

Background/Objectives: Possible sarcopenia has been proposed as an early clinical category for identifying individuals at risk of adverse muscle-related outcomes before full diagnostic evaluation. This study examined whether comorbidity burden is associated with possible sarcopenia more strongly than routinely available clinical and laboratory variables. Methods: We conducted a retrospective propensity score-matched case–control study using the Korean National Health Insurance Service database (2002–2019). Possible sarcopenia was not defined according to guideline-based muscle strength, muscle mass, or physical performance criteria. Instead, we used KCD code M62.5 as a claims-based proxy for clinically suspected muscle wasting or atrophy suggestive of possible sarcopenia. After exclusion of individuals with missing data, 1793 cases were matched 1:1 with 1793 controls according to age, sex, residential area, and insurance type. Anthropometric measures, biochemical parameters, lifestyle factors, and Charlson Comorbidity Index (CCI) scores were compared. Logistic regression and receiver operating characteristic analyses were performed to evaluate associations and discriminatory performance. Results: In the matched population, most anthropometric, biochemical, and lifestyle variables were not significantly different between groups. Fasting blood glucose and gamma-glutamyl transferase were higher in the claims-based possible sarcopenia group, but these associations were not retained in the multivariable model. The CCI score was independently associated with possible sarcopenia (odds ratio: 1.25, 95% confidence interval: 1.20–1.30; p < 0.001). In receiver operating characteristic analysis, the CCI showed the highest discriminatory ability among individual predictors (area under the curve, 0.603). The multivariable model yielded an area under the curve of 0.610. Conclusions: In administrative health data, claims-recorded muscle wasting or atrophy suggestive of possible sarcopenia was more consistently associated with multimorbidity burden than with individual routine clinical or laboratory markers. These findings support cautious, comorbidity-aware interpretation of muscle wasting/atrophy codes, but do not establish diagnostic validity for possible sarcopenia. Full article