Search Results (5,666)

Background/Objectives: To investigate the prevalence of the Motoric Cognitive Risk (MCR) Syndrome among older adults in long-term care facilities and its associated risk factors. Methods: From January to December 2024, older adults were recruited from five long-term care facilities in Southwest China via convenience sampling. All participants underwent a series of standardized assessments, including a self-designed demographic questionnaire, the 15-item Geriatric Depression Scale (GDS-15), the Timed Up and Go (TUG) test, the Fried frailty phenotype scale, sarcopenia assessment based on the SARC-F sarcopenia screening scale, the Basic Activities of Daily Living (BADL) scale, the Lawton Instrumental Activities of Daily Living (IADL, Lawton) scale, and the Mini-Mental State Examination (MMSE). The 4 m walk test was performed to measure participants’ gait speed. This cross-sectional study aimed to explore the prevalence of MCR syndrome and its associated influencing factors among institutionalized older adults. Results: The overall MCR prevalence was 8.6%. Univariate tests detected intergroup differences in BMI, depressive symptoms, hearing loss, multimorbidity, mobility impairment, frailty and several chronic diseases (all p < 0.05). Multivariate logistic regression analysis further demonstrated that, after adjustment for confounders, higher depressive symptom scores (OR = 1.169, 95% CI: 1.079–1.265, p < 0.001), mild mobility impairment (OR = 4.725, 95% CI: 1.340–16.663, p = 0.016), moderate mobility impairment (OR = 3.921, 95% CI: 1.146–13.420, p = 0.029), and more than three chronic comorbidities were independent risk factors for MCR among institutional older adults residing in long-term care facilities (OR = 2.789, 95% CI: 1.465–5.309, p = 0.002). Conclusions: Depressive symptoms, mild-to-moderate mobility impairment and multimorbidity were independent correlates of MCR among institutional older adults. Distinct risk-factor patterns existed for SG and SCCs, highlighting the separable nature of motor and subjective-cognitive dimensions. Integrated screening for emotional, physical and chronic disease risk and personalized activity interventions are warranted for long-term care residents. Full article

Background and Objectives: brain arteriovenous malformations (AVMs) are a leading cause of spontaneous intracranial hemorrhage in children and carry a disproportionately high lifetime hemorrhagic risk. Materials and Methods: We retrospectively analyzed clinical, morphological, and surgical factors associated with functional outcome in 30 consecutive pediatric patients (≤18 years) who underwent microsurgical AVM resection at a single tertiary neurosurgical center between January 2015 and December 2025. Results: Functional status was assessed with the modified Rankin Scale (mRS) at hospital discharge and at 6–9 months of follow-up; the Wilcoxon signed-rank test, Mann–Whitney U test, Fisher’s exact test, Spearman correlation, and univariable logistic regression were used for analysis. Complete resection on early postoperative CT angiography was documented in all 30 patients (100%). The proportion with a favorable outcome (mRS 0–2) improved significantly from 50.0% at discharge to 76.7% at follow-up (p < 0.0001); 80.8% of survivors improved by at least one mRS point, and none deteriorated. In univariable analysis, the variable most strongly associated with poor outcome was intraventricular hemorrhage (IVH; odds ratio [OR] 28.5, 95% CI 2.65–306.6; p = 0.002); the wide confidence interval reflects the small number of events and precludes a precise estimate of effect size. Lower admission Glasgow Coma Scale (GCS) score (p = 0.0006), higher Supplemented Spetzler–Martin (S–M) grade (p = 0.019), and postoperative complications (p = 0.016) were likewise associated with poor outcome. Because these associations are univariable and unadjusted for confounding, they should be regarded as exploratory and hypothesis-generating rather than as independent predictors. All four deaths occurred in malformations in eloquent locations (p = 0.037). Microsurgical resection achieved complete resection on early postoperative CT angiography in all patients; however, functional recovery appeared to be associated primarily with the severity of the initial hemorrhagic insult—particularly IVH—and with lesion complexity rather than with the achievement of angiographic resection alone. Conclusions: Given the small, surgically selected cohort and the limited follow-up, these findings require confirmation in larger multicenter studies. Full article

Myopia is a growing public health problem expected to affect half the global population by 2050, making appropriate management of the condition necessary. Therefore, the purpose of this study was to investigate the knowledge and practices of South African optometrists regarding childhood myopia management. A quantitative, cross-sectional, descriptive design with a survey method was employed. An online questionnaire was distributed to practicing optometrists and included questions related to demographic information, knowledge of myopia and associated ocular pathologies, diagnostic work-up and management of childhood myopia. Data were summarised using descriptive statistics, and further analysed with univariate binary and ordinal logistic regression analysis where the independent variables were years of experience, certification and interest. A total of 124 completed questionnaires were received. The majority of participants used non-cycloplegic refraction and less than 20% performed dilated fundus examinations. Single vision distance spectacles were most commonly prescribed despite awareness of the efficacy of interventions to slow myopia progression. However, factors such as cost and the need for clinical guidelines limit the practice of evidence-based management. Participants were aware of some of the ocular pathologies associated with high myopia, indicating that this knowledge needs to be reinforced. Results from this study may be used to aid optometry policy development, regulatory council decisions and guide the content of professional development programmes to enhance knowledge. Full article

Background/Objective: Sex estimation from cranial remains is essential in forensic biological profile reconstruction, yet systematic comparisons of statistical classifiers under formally verified assumption conditions remain limited in Thai populations. This study aimed to develop and validate sex estimation models from craniofacial measurements in a Northeastern Thai skeletal sample using DFA, BLR, and SVM, and to examine whether distributional assumption violations influence classifier performance and generalizability under holdout validation. Methods: Eight linear craniometric parameters connecting five osteometric landmarks were measured in 300 adult skeletal specimens (150 males, 150 females) from the Unit of Human Bone Warehouse for Research, Khon Kaen University. Specimens were allocated into a training dataset (n = 200) and a holdout dataset (n = 100). Five multivariate model configurations were developed under direct-entry and stepwise parameter-entry strategies. Formal assumption diagnostics included Shapiro–Wilk normality testing, Levene’s test, Box’s M test, and variance inflation factor analysis. Results: All parameters demonstrated excellent interobserver reliability and significant sex-based differences (p < 0.01), with males recording larger mean values throughout. Apparent multivariate accuracy ranged from 78.0% to 85.5%. Holdout validation revealed consistent performance decline across all five configurations, with accuracy reductions of 3.0 to 9.5 percentage points and AUC reductions of 0.042 to 0.079. The stepwise DFA model showed the smallest overall accuracy decline, although this apparent stability reflected an uneven sex-specific trade-off, with a specificity decline offset by a sensitivity gain, while SVM and DFA direct-entry models showed the largest decline. Conclusions: Craniofacial measurements provide moderate discriminatory capacity for sex estimation in Northeastern Thai skeletal remains. Although univariate assumption violations were observed, DFA’s performance remained comparable to BLR and SVM under the present large, balanced sample; multivariate analysis or distributional assumption-free methods offer practical alternatives where violations are present. Apparent performance alone is insufficient to establish forensic reliability, and holdout validation should be regarded as a necessary component of sex estimation model development. Full article

Phosphorylated ACC (pACC), a downstream effector of the LKB1/AMPK pathway, may support tumor bioenergetics and exert a tumor-promoting role in glioblastoma (GBM). In the randomized REGOMA trial, pACC expression was associated with improved overall survival (OS) in GBM patients treated with regorafenib, but its validity in large cohorts is unclear. This study aimed to characterize pACC and phosphorylated AMPK (pAMPK) expression in a real-world GBM cohort and to assess their prognostic and predictive value in patients receiving second-line regorafenib or fotemustine/lomustine. In this retrospective, multicenter translational study, pACC and pAMPK were assessed by immunohistochemistry on FFPE tumor sections from 174 IDH-wild-type GBM patients treated with regorafenib (n = 84) or fotemustine/lomustine (n = 90). Staining was performed with a validated anti-pACC monoclonal antibody and quantified by digital pathology. Survival analyses included univariable and multivariable Cox proportional hazards models, with interaction testing. pACC and pAMPK were expressed in 85.6% and 95.4% of samples, respectively, with heterogeneous spatial patterns. Neither marker was significantly associated with OS in the univariable analyses, and neither retained independent prognostic value in multivariable analysis. Regorafenib was associated with significantly longer OS than alkylating agents (10.4 vs. 6.3 months; p = 0.0021). However, the treatment-by-pACC interaction test was not statistically significant (adjusted p = 0.610), providing no formal evidence of a differential treatment effect by pACC status. Although pACC-positive expression was enriched among patients experiencing longer overall survival under regorafenib, formal treatment-by-biomarker interaction was non-significant. These exploratory findings indicate that pACC is not an established predictive biomarker and warrant prospectively powered evaluation. Full article

Objective: The glioma prognostic literature contains a large number of transcriptomic risk signatures, yet whether these signatures add measurable information beyond a clinical model containing grade and molecular markers is rarely tested. We pursued three objectives jointly: to evaluate a leakage-controlled signature in terms of both discrimination and calibration; to test it against a clinical reference model and against a null distribution of random signatures; and to quantify the reporting practice of the field. Methods: The CGGA mRNAseq_693 cohort (n = 404, 209 deaths) served as development, the CGGA mRNAseq_325 cohort (n = 222, 138 deaths) as independent internal validation, and the TCGA lower-grade glioma and glioblastoma cohorts (n = 664, 247 deaths) as external validation. A univariate Cox score test was applied to 17,544 genes with false discovery rate control by the Benjamini–Hochberg procedure, and an elastic-net penalised Cox model was fitted on the top 200 candidate genes. Every model-building operation-imputation, scaling, candidate pool, and penalty selection was confined to the development cohort, and the final model was locked. Three arms were compared: clinical only, transcriptomic only, and combined. Calibration was quantified by the integrated calibration index derived from a smoothed calibration curve. In addition, the abstract-level reporting content of 515 glioma signature records indexed in Web of Science was analysed. Results: The signature made no measurable contribution beyond the clinical reference model. In the independent internal validation cohort the clinical model reached a concordance index of 0.800 (95% CI 0.767–0.831) and the signature 0.801 (0.769–0.832); the paired bootstrap difference was indistinguishable from zero (Δ = +0.001; 95% CI −0.032 to +0.035), and restricting the clinical model to variables known at diagnosis did not change this (Δ = +0.008; −0.024 to +0.043). Against a null distribution of 1000 random 20-gene sets drawn from the same candidate pool, the signature exceeded the null internally (p = 0.015) but was indistinguishable from it in external validation (p = 0.154); 99.2% of random sets reached a concordance index above 0.75 and 82.2% above 0.80 in the external cohort (^{Figure 3}). Discrimination fell markedly within the IDH-wildtype (0.629) and WHO grade IV (0.606) strata, and the risk score correlated at 0.722 with a proliferation metagene despite containing no canonical proliferation gene. The concordance indices themselves—0.801 internally and 0.824 externally for the 17-gene subset available in TCGA, with an integrated calibration index of 0.045 at 36 months—are therefore best read as an illustration of the problem rather than as evidence of clinical utility: they sit squarely inside the range that random gene sets reach in the same data, and they fall in the range routinely presented as successful in the published literature. In the literature survey, 8.7% of the 515 records mentioned calibration, 4.5% decision curve analysis, and only 1.0% any comparison against a clinical reference model; none reported all three. Conclusions: A signature developed under a leakage-controlled protocol and well calibrated was nevertheless indistinguishable from the appropriate references on two of the three criteria we propose. Most of its discrimination rests on the IDH and grade axis that a broad range of prognostic gene sets can capture. Concordance indices reported in the glioma signature literature cannot be interpreted without a clinical reference model and a random-signature null distribution. Full article

Compaction parameters of soil material, maximum dry density (MDD) and optimum moisture content (OMC), are critical control indicators for highway embankment construction. In this study, a dataset containing 199 compaction test results for fine-grained soils was collected. Using MDD and OMC as prediction targets, Random Forest (RF), Gradient Boosting (GB), Extreme Gradient Boosting (XGBoost), and Support Vector Regression (SVR) were developed and optimized using the Wild Horse Optimization (WHO) algorithm. Five universal evaluation metrics, combined with radar charts, were used to comprehensively compare the predictive performance of each model. Based on univariate sensitivity analysis and SHapley Additive exPlanations (SHAP) global feature interpretation, two-way partial dependence plots (PDPs) were applied to reveal the pairwise nonlinear relationships between soil physical indices and compaction indicators. The results demonstrate that WHO-tuned XGBoost achieves optimal comprehensive predictive performance for both MDD (test set R² = 0.8226) and OMC (test set R² = 0.7486), outperforming SVR, GB, and RF in terms of fitting accuracy and generalization under small-sample conditions. Plastic limit (PL) exerts a significant influence on compaction performance. By further comparing WHO, Particle Swarm Optimization (PSO), Gray Wolf Optimizer (GWO), Random Search, Bayesian Optimization and Grid Search on the optimal model, the applicability and feasibility of WHO-XGBoost in predicting compacted-soil compaction parameters were validated. The proposed data-driven compaction evaluation framework (WHO-XGBoost-SA-SHAP-PDPs) acts as an auxiliary tool to lower the workload and cost of laboratory Proctor tests, offering theoretical support and technical guidance for rapid refined embankment compaction control in green transportation infrastructure. Full article

Background/Objectives: Patients aged ≥ 65 years undergoing colorectal cancer surgery are at increased risk of postoperative complications and mortality due to advanced age, comorbidity burden, frailty, and reduced physiological reserve. The aim of this study was to evaluate perioperative predictors associated with early in-hospital mortality in patients aged ≥ 65 years undergoing colorectal cancer surgery. Methods: This single-center retrospective cohort study included 438 patients aged ≥ 65 years who underwent colorectal cancer surgery at a tertiary referral center between January 2017 and December 2018. Demographic characteristics, comorbidities, American Society of Anesthesiologists (ASA) classification, surgical urgency, perioperative laboratory parameters, and transfusion requirements were analyzed. The primary endpoint was early in-hospital mortality. Survival analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression analysis. Results: The overall in-hospital mortality rate was 9.4% (41/438). Emergency surgery was associated with significantly reduced in-hospital survival compared with elective procedures (log-rank p < 0.001). Non-survivors more frequently presented with emergency surgical indications, higher ASA scores, greater comorbidity burden, anemia, nutritional impairment, elevated inflammatory markers, renal dysfunction, and increased transfusion requirements. In univariate Cox regression analysis, emergency surgery, ASA score ≥ 3, elevated creatinine, leukocyte count, and C-reactive protein levels, lower hemoglobin, albumin and total protein levels, and red blood cell transfusion were significantly associated with mortality. In multivariate analysis, elevated creatinine (HR 1.004, p = 0.030), leukocyte count (HR 1.064, p = 0.004), C-reactive protein (HR 1.009, p < 0.001), and lower hemoglobin concentration (HR 0.938, p < 0.001) remained independent predictors of in-hospital mortality. Conclusions: Early in-hospital mortality after colorectal cancer surgery in patients aged ≥ 65 years is associated with systemic inflammation, anemia, and renal dysfunction. Routinely available clinical and laboratory parameters may assist in identifying high-risk patients and improving perioperative risk assessment and postoperative management. Full article

Background and Objectives: Tumor regression grade (TRG) in gastric cancer patients treated with neoadjuvant/perioperative chemotherapy is increasingly recognized as an important indicator of treatment efficacy and long-term prognosis. However, in geriatric patients, data on neoadjuvant therapy and on the relationship between pathological response and survival remain limited. In this study, we investigated the prognostic significance of pathological response, assessed according to Becker’s TRG in geriatric patients with locally advanced gastric adenocarcinoma who received neoadjuvant/perioperative chemotherapy and underwent gastrectomy. Materials and Methods: We retrospectively analyzed 82 patients aged ≥65 years with histologically confirmed gastric adenocarcinoma who received neoadjuvant/perioperative chemotherapy followed by curative gastrectomy at a single center between 2017 and 2024. Pathological response was evaluated using the Becker tumor regression grading (TRG) system and classified as good (TRG 1–2) or poor (TRG 3). Clinicopathological features, treatment characteristics, disease-free survival (DFS), and overall survival (OS) were compared between groups. Survival was estimated using the Kaplan–Meier method and compared with the log-rank test. Univariable and multivariable Cox proportional hazards models were used to assess the prognostic impact of TRG and other clinicopathological factors on DFS and OS. Results: The study included 82 geriatric patients, of whom 50 (61.0%) showed a good pathological response (TRG 1–2), while 32 (39.0%) showed a poor pathological response (TRG 3). Poor response was more frequently seen in clinical stage III disease and was accompanied by a higher rate of lymphovascular invasion. Median DFS was 42.4 months in the good response group versus 13.0 months in the poor response group (p < 0.001), and median OS was 47.7 and 15.5 months, respectively (p < 0.001). In multivariable analysis, ECOG performance status (HR 2.697; 95% CI 1.381–5.269; p = 0.004), lymphovascular invasion (HR 4.960; 95% CI 1.545–15.919; p = 0.007), and poor pathological response (HR 2.066; 95% CI 1.055–4.045; p = 0.034) remained independent predictors of DFS. For OS, ECOG performance status (HR 2.719; 95% CI 1.398–5.290; p = 0.003), lymphovascular invasion (HR 4.448; 95% CI 1.400–14.132; p = 0.011), and poor pathological response (HR 2.311; 95% CI 1.161–4.601; p = 0.017) remained independent predictors of OS. Conclusions: Our study suggests that pathological response assessed by the TRG system is a valuable prognostic marker in geriatric gastric adenocarcinoma. Good pathological response was associated with longer DFS and OS, while poor pathological response remained an independent predictor of both shorter DFS and OS. Full article

Asthma is a heterogeneous disease that often begins in childhood and frequently occurs alongside allergic conditions. In asthma research, it is important to focus on proteins that are the primary regulators of cellular physiology. The differences in the proteome between children with asthma and those with an atopic background remain poorly understood. The present study included 130 serum samples from four groups of pediatric patients under the age of five: (1) with asthma and IgE-dependent allergies; (2) with non-atopic asthma; (3) non-asthmatics with IgE-dependent allergy; and (4) a control group without asthma and IgE-dependent allergies. The serum samples were used for protein–peptide profiling and proteomic identification using nanoLC-MALDI-TOF/TOF MS/MS. The obtained data were analyzed using univariate statistics and the STRING tool v12.0 to identify protein–protein potential interactions. A total of seven proteins were identified as discriminative between the study groups: A2M, AACT, IgG3, C3, ITIH2, IgG3 and IGK. All of them were upregulated in patients with IgE-dependent allergy compared to other study groups. STRING analysis identified functional associations among four proteins (AACT, A2M, C3, and ITIH2) with discriminatory potential for distinguishing between non-atopic asthma and non-asthmatic patients with IgE-dependent allergy. The results suggest that the identified putative protein markers overlap in cellular pathways, including those associated with the pathophysiology of asthma and allergic disorders. These findings provide further insight into the overall proteomic profile of pediatric patients with asthma and IgE-dependent allergy, highlighting its heterogeneity across the analyzed groups. Full article

Background: Severe COVID-19 reflects a multi-layered host response with systemic inflammation, thrombo-inflammation, tissue damage, oxidative stress and altered antiviral interferon biology. We performed an integrated exploratory analysis of first-wave hospitalized patients to identify biomarker patterns associated with adverse clinical evolution during established admission. Methods: We analyzed 60 hospitalized COVID-19 patients and 18 healthy controls for soluble IFNAR2 (sIFNAR2) comparison. Biomarker samples were obtained during hospitalization, approximately seven days after symptom onset. Outcomes were final clinical status, severe respiratory involvement, post-sampling clinical worsening and death. Analyses included non-parametric testing, false-discovery-rate adjustment, effect-size estimation, exploratory ROC curves, parsimonious regression, penalized internal validation, composite scores and molecular-structure analyses. Results: Final status was favorable outcome in 31 patients, severe non-fatal disease in 22 and death in 7. sIFNAR2 was higher in patients than in healthy controls and highest among non-survivors, but did not distinguish favorably from severe non-fatal disease. The most consistent severity-associated signals were IL-6, D-dimer, total thiols, IL-10, LDH, ferritin, leukocytes and IL-1RA. D-dimer, IL-6 and ferritin yielded the largest exploratory univariable AUCs for severe respiratory involvement, whereas ferritin, IL-10, IL-1RA and sIFNAR2 predominated in event-limited mortality analyses, which were based on only seven deaths. Composite multi-axis scores and PLS-DA were tools requiring external validation. Conclusions: Biomarker patterns during admission were associated with adverse evolution. Conventional markers remained the most practical signals, while cytokines, redox markers and sIFNAR2 provided complementary biological information. sIFNAR2 should be interpreted as an exploratory complementary marker of the interferon receptor axis, mainly linked to mortality, not as a stand-alone clinical test or functional measure of IFNAR signaling. Full article

Background/Objectives: Data regarding the association between diffusing lung capacity for carbon monoxide (DLCO) and nail-fold Videocapillaroscopy (NVC) patterns are sparse in Very Early Diagnosis of Systemic Sclerosis (SSc; VEDOSS). The aim of this study was to detect differences in VEDOSS patients exhibiting reduced versus normal values of DLCO/single-breath (SB)% predicted (with a cut-off of 80%). Methods: A cross-sectional study was conducted in 65 VEDOSS patients, enrolled due to their fulfillment of the 2021 criteria, while not meeting the 2013 ACR/EULAR Criteria. Pulmonary function tests and NVC evaluations were conducted from January to March 2026. Univariate tests were used for intergroup analysis. Logistic and linear regression models were employed to identify predictors of DLCO/SB < 80% and DLCO/SB% values, respectively. p-values < 0.05 were considered statistically significant. Results: Forty-two (64.6%) patients reported preserved DLCO/SB% and twenty-three (35.4%) exhibited reduced DLCO/SB%. Patients with only ANA positivity were more prevalent in the DLCO-preserved group (p = 0.026), while SSc-specific autoantibodies were more frequently present in the DLCO < 80% group (p = 0.028), as well as gastrointestinal symptoms (p = 0.039). The late pattern was identified exclusively in the DLCO < 80% group (p = 0.013), while patients with advanced NVC abnormalities (namely, the active/late pattern) reported lower values of DLCO/SB%. A logistic regression model confirmed a trend toward significance in predicting reduced DLCO for the active/late pattern, while the latter was negatively associated with the unitary increase in DLCO/SB% values (standardized β= −0.38, p = 0.008) in linear regression analysis. Conclusions: Reduced DLCO/SB (<80%) is associated with an active/late pattern on NVC in VEDOSS. Full article

Objective: Patients with prostate-specific antigen (PSA) levels in the 4–10 ng/mL gray zone present a diagnostic challenge, as PSA alone cannot reliably distinguish clinically significant prostate cancer (csPCa) from benign conditions or indolent disease, potentially leading to unnecessary biopsies or missed clinically significant disease. This study aimed to develop a risk prediction model for csPCa in this population using clinical indicators and magnetic resonance imaging (MRI) quantitative data, and to evaluate its potential value for risk stratification and as a supplementary tool for biopsy decision-making. Methods: We retrospectively included 210 patients with PSA levels in the 4–10 ng/mL range and confirmed pathological diagnoses, who were admitted to our hospital between January 2018 and June 2025. csPCa was defined as a Gleason score ≥ 7. Patients were stratified by pathological diagnosis (csPCa vs. non-csPCa) and randomly divided into training and internal validation sets in a 7:3 ratio. The following variables were collected for analysis: age, PSA, apparent diffusion coefficient (ADC), and relative T2 value. Univariate and multivariate logistic regression were used to identify independent predictors of csPCa. We constructed a prediction model and nomogram. The discriminating ability, calibration, and stability of the model were assessed using receiver operating characteristic (ROC) curves, calibration curves, and Bootstrap internal validation. Decision curve analysis (DCA) was performed to evaluate the model’s net benefit across clinically relevant threshold probabilities. Risk stratification was performed based on predicted probabilities. Results: Of the 210 patients, 50 had csPCa and 160 had non-csPCa lesions. Univariate regression showed associations between age, ADC value, and relative T2 value. Multivariate logistic regression identified age and relative T2 value as independent predictors in the final model. Internal validation using 1000 Bootstrap resampling with optimism correction yielded a corrected AUC of 0.698 (95% CI: 0.669–0.716), with a mean optimism of only 0.016, indicating minimal overfitting. The area under the curve (AUC) of the model was 0.720 in the training set and 0.711 in the validation set. The calibration curve for the training set demonstrated good agreement between predicted and observed probabilities. DCA showed net benefits across certain threshold probabilities. Risk stratification based on predicted probability showed csPCa detection rates of 14.7%, 28.3%, and 47.4% in low-, intermediate- and high-risk groups, respectively. Conclusions: The logistic binary classification model based on age and relative T2 value may assist in risk assessment for csPCa in PSA gray zone patients. However, its moderate discrimination suggests it should be used as a supplementary tool rather than a standalone diagnostic test. Risk stratification based on predicted probability may help identify different csPCa risk populations, but given the exploratory nature of this single-center retrospective study, multi-center, large-sample, and prospective studies are required for external validation and optimization before clinical implementation. Full article

Background: Pulmonary arterial hypertension (PAH) is characterized by progressive vascular remodeling and right ventricular (RV) dysfunction. ¹⁸F-FDG PET/MRI may reveal metabolic alterations in the pulmonary parenchyma and vasculature. We investigated pulmonary FDG uptake in PAH versus healthy controls and its associations with hemodynamics, RV function, and clinical outcomes. Methods: Twenty-eight stable PAH patients and 12 age-matched healthy controls underwent ¹⁸F-FDG PET/MRI. Standardized uptake values (SUVs) were measured in lung parenchyma and proximal pulmonary arteries. Hemodynamic parameters were obtained via right heart catheterization; RV–PA coupling was assessed as stroke volume/end-systolic volume (SV/ESV). Twenty PAH patients underwent follow-up imaging after targeted therapy. Clinical endpoints (CEPs: death, hospitalization, disease progression) were analyzed by Kaplan–Meier and Cox regression. Results: PAH patients showed markedly elevated lung parenchymal SUV (0.405 [0.338–0.533] vs. 0.225 [0.207–0.273], p < 0.001) and proximal PA SUV (3.46 [1.95–6.89] vs. 1.48 [1.15–1.65], p < 0.001). The two metrics were uncorrelated (r = +0.105, p = 0.595). SUV PA Proximal correlated with mPAP (r = +0.551) and PVR (r = +0.517), while SUV Lung showed no hemodynamic correlations. After 24 months of therapy, RV–PA coupling improved significantly (p = 0.037); lung SUV showed a non-significant trend toward reduction (Δ = −0.10, p = 0.128). Sixteen CEPs occurred; impaired RV–PA coupling (HR = 0.04, p = 0.002), elevated mPAP (HR = 1.08, p < 0.001), and reduced RVEF (HR = 0.91, p < 0.001) were strong univariable predictors. Neither SUV metric retained independent prognostic value in multivariable analysis. Conclusions: Pulmonary parenchymal and proximal PA FDG uptake are markedly elevated in PAH. However, neither metric independently predicts hemodynamic severity or clinical outcomes, limiting their current role as reliable prognostic surrogates. Full article

Background/Objectives: Cancer patients undergoing treatment experience a wide range of physical and psychological symptoms that significantly impact their quality of life. This study aimed to evaluate the occurrence and intensity of symptoms in cancer patients using the Edmonton Symptom Assessment System Revised (ESAS-R) during two distinct phases of treatment. Methods: A prospective cohort study with consecutive recruitment of eligible patients within a convenience sample was conducted in a tertiary public cancer hospital in Athens, Greece. The initial sample included 189 adult cancer patients assessed after the third chemotherapy cycle. Of these, 105 patients completed a second assessment after the final chemotherapy cycle and constituted the longitudinal follow-up sample. Symptom intensity was measured using the 10-item ESAS-R self-report tool. Results: The study population was predominantly female (77.2%), married (71.4%), and diagnosed with breast cancer (59.3%). Statistically significant changes between the two measurements (p < 0.05) were observed in pain, fatigue, and well-being. Total symptom burden scores remained relatively stable, slightly decreasing from 25.09 to 24.19. Age showed a consistent negative correlation with pain (p < 0.001) in the second measurement and nausea across both measurements (p = 0.004 and p = 0.017), indicating that younger patients reported higher symptom intensity. Logistic regression indicated that employment/housework was primarily linked to the total symptom score in Measurement A (p = 0.010), with patients less likely to have high symptom severity (Exp(B) = 0.101). Baseline symptom burden category at Measurement A was identified as a significant predictor of symptom intensity at Measurement B (p = 0.028), with patients presenting mild symptom burden at baseline being less likely to report moderate-to-high symptom burden at the final assessment. Conclusions: While pain, fatigue, and perceived well-being deteriorated from the early to the final chemotherapy cycle, the total symptom burden remained relatively stable. Younger patients appeared to experience higher symptom burden, while lower educational level was associated with higher symptom burden in the univariate analysis at the final assessment, highlighting the need for age-sensitive and educationally tailored nursing interventions to enhance symptom management in oncology settings. Full article