The global community faces a significant disability burden from road traffic injuries (RTIs). This study investigated factors associated with disability three months after hospital discharge among patients with RTIs at the University Teaching Hospital, Lusaka, Zambia. We analysed secondary data from a prospective observational study, conducted between October 2021 and April 2022, of adults aged ≥ 18 with moderate-to-severe RTIs. Patients were contacted at three months after hospital discharge to assess their disability using WHODAS-II. We used multiple linear regression analysis to determine the risk factors of disability level using Stata 17. The study involved 147 patients, with 85.7% presenting with some level of disability ranging from mild to extreme disability (mean disability score = 9.8 ± 9.1), and 81.2% of participants who were working prior to the injury returned to work. Age, unemployed, spinal injuries, multiple injuries, moderate Glasgow Coma Scale score and length of hospital stay were significantly associated with higher disability score following RTIs. Most patients still experience disability three months after hospital discharge and this is influenced by sociodemographic and injury factors, emphasising the need to improve road safety infrastructure, enforce road traffic laws and invest in rehabilitation.
Exclusive breastfeeding for 6 months and continued breastfeeding for 24 months remain low due to various challenges. The aim of this study was to examine the impact of mothers' infant feeding attitudes and parenting styles, as modifiable factors, on breastfeeding duration. This cross-sectional descriptive study was conducted at Akdeniz University Faculty of Medicine Hospital between April 1, 2023, and April 1, 2024. The sample comprised 224 mothers of children aged 2-3 years who attended the child health follow-up clinic. Data were obtained through face-to-face interviews using the Introductory Information Form, Child Nutrition Questionnaire, Iowa Infant Feeding Attitudes Scale, and Parenting Styles Scale. Group differences were examined with t-tests and analysis of variance, correlations with Pearson's coefficient, and categorical data with chi-square tests. A binary logistic regression evaluated the effects of parenting style and feeding attitudes on breastfeeding beyond 2 years. While 98.7% of participants breastfed at least once, only 38.8% exclusively breastfed for the first 6 months, and 40.6% continued breastfeeding for 24 months or longer. It was found that a one-unit increase in the Iowa Infant Feeding Attitudes Scale score increased the probability of breastfeeding beyond 24 months by 5.4%, while each unit increase in the authoritarian attitude decreased it by 9.7%. Formula feeding duration was also positively correlated with authoritarian and overprotective parenting styles. Parenting styles and mothers' infant feeding attitudes are two important factors affecting the rates of exclusive breastfeeding for the first 6 months and continuing breastfeeding beyond 24 months.
Combining CDK 4/6 inhibitors with endocrine therapy (ET) extends progression-free survival (PFS) and overall survival (OS) in hormone receptor (HR) positive, human epidermal growth factor receptor-2 (HER2) negative metastatic breast cancer. We aimed to explore the relationship between metabolic tumor volume (MTV), total lesion glycolysis (TLG), and PFS/OS in these patients. MTV and TLG were measured from baseline 18 F-fluorodeoxyglucose (18-FDG) positron emission tomography/computed tomography (PET/CT) of 87 HR-positive/HER2-negative metastatic breast cancer patients and their effects on survival were analyzed using Kaplan-Meier methods. The median OS was 42.0 months for patients with MTV < 121.7 cm³ and 24.6 months with ≥ 121.7 cm3 (p = 0.001). The median OS was 40.3 months for patients with TLG < 732.4 g and 24.6 months with ≥ 732.4 g (p = 0.006). The median OS for patients with an ECOG score of 0 was 53.6 months, while for those with an ECOG score of 1-2, it was 26.4 months (p = 0.005). Age ≥ 60 years (HR = 5.11, p = 0.002) and ECOG score > 0 (HR = 3.38, p = 0.011) are independent predictors of PFS. Baseline 18 F-FDG PET/CT may provide prognostic insights in HR+/HER2- metastatic breast cancer. High MTV and TLG are associated with poorer OS in univariate analyses but not in multivariable analyses. ECOG score > 0 and age ≥ 60 years are independent predictors of PFS.
AimCalcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP) play a crucial role in migraine pathophysiology. In recent years, anti-CGRP(R) monoclonal antibodies (mAbs) have emerged as the first targeted and highly effective therapy for migraine. This study aimed to assess any changes in plasma CGRP levels following prophylactic treatment with anti-CGRP(R) mAbs and to compare CGRP dynamics between anti-receptor (erenumab) and anti-ligand (galcanezumab, fremanezumab) therapies. Secondary objectives were: (i) to evaluate changes in VIP and PACAP plasma levels following treatment with anti-CGRP(R) mAbs and (ii) to investigate whether baseline or post-treatment plasma levels of CGRP, VIP and PACAP were associated with clinical response to anti-CGRP(R) monoclonal antibody therapy.MethodsBetween February 2022 and February 2023, we enrolled 56 migraine patients who initiated prophylaxis with either erenumab (26 patients), galcanezumab (16 patients) or fremanezumab (14 patients). Responders were defined as those achieving a ≥50% reduction in monthly migraine days after six months. Blood samples were collected at baseline and at each follow-up visit (baseline, T0; three months, T1; six months, T2; 12 months, T3). Plasma levels of CGRP, VIP and PACAP were measured using a validated radioimmunoassay and commercially available enzyme-linked immunosorbent assay kits.ResultsOverall, 80.3% (45 out of 56) of patients responded to anti-CGRP(R) mAbs. No correlation was found between baseline CGRP, VIP and PACAP plasma levels and clinical response to anti-CGRP(R) mAbs therapy. Regarding CGRP trend, significant differences were found between patients treated with the anti-receptor monoclonal antibody (erenumab) and those receiving anti-ligand therapies. In patients treated with erenumab, CGRP levels did not show a significant change over the treatment period (T1-T3), whereas, in the galcanezumab group, CGRP levels significantly decreased as early as T1 (p < 0.01). CGRP longitudinal assessment of the fremanezumab group were excluded due to assay interference with the drug. VIP and PACAP plasma levels remained stable over time for all treatments, with no significant differences between responders and non-responders.ConclusionsGalcanezumab reduced CGRP plasmatic levels already after three months, whereas erenumab did not affect significantly CGRP plasmatic levels. VIP and PACAP levels were not influenced by the therapy.
Lumbar disc herniation (LDH) is rare in juveniles and may present atypically, potentially delaying referral for neurosurgical evaluation. We aimed to assess diagnostic and treatment delays and to evaluate short-term surgical outcomes in pediatric patients undergoing microdiscectomy for LDH at our department over a 10-year period. We retrospectively reviewed consecutive patients under 18 years of age who underwent microdiscectomy for LDH at our institution between 2015 and 2025. Clinical presentation, timing of imaging and surgery, and postoperative outcomes were analyzed. Twenty-one patients were included (mean age 14.6 ± 2.1 years, 57% females). Median body mass index (BMI) was 21.2 (range 18.7-36.9). All patients presented with low back pain, and 92.5% had radicular symptoms. The median time from symptom onset to MRI was 6 months (range 0-12 months), and to surgery 12 months (range 0-36 months). Most patients (90.5%) were operated at one level; L4/L5 and L5/S1 were the most commonly affected levels. At 3 months after surgery, 95.2% of patients reported improvement of back pain, while all patients experienced relief of radicular symptoms. In our cohort of pediatric patients with LDH, short-term outcomes following microdiscectomy were generally favorable despite substantial delays in diagnosis and referral for surgical treatment. These findings may suggest that, unlike in adults, prolonged symptom duration does not necessarily compromise recovery in children, although this should be interpreted with caution given the limited sample size and follow-up period. Nevertheless, increased awareness of pediatric LDH could facilitate earlier neurosurgical evaluation, streamline care pathways, and potentially further optimize patient management.
Patients with epidermal growth factor receptor (EGFR) gene variant nonsquamous non-small cell lung cancer (NSCLC) who have disease progression after prior EGFR tyrosine kinase inhibitor (TKI) therapy have limited treatment options, creating a need for more effective subsequent therapies. To provide final overall results of a trial assessing whether adding ivonescimab (a bispecific antibody targeting programmed cell death protein 1 and vascular endothelial growth factor) to chemotherapy improves overall survival in this population. Randomized, double-blind, placebo-controlled phase 3 trial conducted at 55 sites in China. From January 25 to November 2, 2022, a total of 322 adult patients with locally advanced or metastatic EGFR-variant nonsquamous NSCLC who had received prior EGFR-TKI therapy were enrolled. The data cutoff date was April 12, 2025. Patients were randomized 1:1 to receive ivonescimab (20 mg/kg; n = 161) or placebo (n = 161) plus chemotherapy with pemetrexed and carboplatin once every 3 weeks for 4 cycles, followed by maintenance therapy. This final results report focuses on overall survival, the key secondary end point, tested in a hierarchical manner (the primary end point was progression-free survival assessed by an independent radiology review committee). The 322 enrolled patients had a median age of 59.4 years, and 51.6% were female. During a median follow-up of 32.5 months, ivonescimab plus chemotherapy improved overall survival compared with chemotherapy alone (median survival, 16.8 months vs 14.1 months; stratified hazard ratio, 0.74; 95% CI, 0.58-0.95; P = .02). The absolute difference in median overall survival was 2.7 months. Estimated 30-month survival rates were 29.1% (95% CI, 22.1%-36.4%) with ivonescimab and 18.4% (95% CI, 12.8%-24.8%) with placebo. Grade 3 or higher treatment-emergent adverse events occurred in 67.1% and 54.7% of patients receiving ivonescimab and placebo, respectively. Ivonescimab plus chemotherapy provided a statistically significant and clinically meaningful improvement in overall survival with an acceptable safety profile in patients with EGFR-variant NSCLC after EGFR-TKI therapy. ClinicalTrials.gov Identifier: NCT05184712.
Study DesignRetrospective cohort study.ObjectivesTo examine the impact of non-tobacco nicotine (NTN) dependence on pseudarthrosis and postoperative complications following posterior cervical fusion (PCF).MethodsThe TriNetX national database was queried for adult patients (18-80 years) who underwent a primary posterior cervical fusion (2012-2025). Patients were stratified into 3 cohorts: non-tobacco nicotine-dependent (NTND) patients, tobacco-dependent (TD) patients, and non-dependent controls. Patients underwent propensity-score matching, and pairwise comparisons (NTND vs control, TD vs control, NTND vs TD) were performed. The primary outcome was pseudarthrosis development, and secondary outcomes included medical/surgical complications.ResultsA total of 7102 patients were included. At 3 years, NTND patients had higher rates of pseudarthrosis (2.51% vs 1.84%, P = 0.019) compared to matched controls. Compared to controls at 3 months and 3 years, NTND was associated with significantly higher risks of all other postoperative complications (P < 0.05) except DVT. Compared to controls, TD patients had higher rates of all postoperative complications at 3 months and 3 years, except pseudarthrosis (P < 0.05). Compared to TD patients, NTND patients had higher rates of cervical fracture and pneumonia at 3 months (P < 0.05), and higher rates of cervical fracture at 3 years (P < 0.05). At 3 months, the NTND cohort demonstrated lower rates of opioid abuse/dependence, readmission, and emergency service use (P < 0.05).ConclusionsNon-tobacco nicotine dependence is associated with risk of perioperative and long-term complications following posterior cervical fusion compared to control patients, yet is not significantly different from TD patients. Providers may consider this data during preoperative counseling and surgical optimization.Level of EvidenceIII.
To investigate the effects of recreational therapy on psychological and social outcomes in stroke survivors and identify key intervention features. Eleven databases were systematically searched up to 15 April 2026. Two reviewers independently performed study selection, risk of bias assessment using Cochrane RoB 2.0, and evidence grading via GRADE. Meta-analyses were conducted with RevMan 5.4. Nineteen studies were included. Recreational therapy significantly improved depressive symptoms (SMD = -0.46, 95% CI: -0.65 to -0.28; p < 0.01, I2 = 44%, low certainty), social participation (SMD = 0.53, 95% CI: 0.07-0.99; p = 0.02, I2 = 87%, moderate certainty), but had no significant effect on anxiety (SMD = -0.32, 95% CI: -0.92 to 0.29; p = 0.31, I2 = 79%, moderate certainty) or quality of life (SMD = 0.77, 95% CI: -0.05 to 1.59, p = 0.07, I2 = 94%, very low certainty). Art-based recreational therapy may alleviate depressive symptoms. Available studies failed to show a meaningful sustained effect beyond 3 months. Recreational therapy may improve depressive symptoms and social participation in stroke survivors, particularly with interventions ≤3 months. Given the very low to moderate evidence quality, well-designed studies are needed to confirm long-term effectiveness. This review suggests that recreational therapy has beneficial effects on depressive symptom and social participation in stroke survivors, but has no significant effect on anxiety or quality of life.Subgroup analysis suggests that art-based recreational therapy could be effective in alleviating depressive symptoms.Subgroup analysis suggests that short-term (≤3 months) interventions may yield more pronounced effects on both depressive symptoms and social participation.
Therapeutic options beyond platinum, gemcitabine and immunotherapy in r/m NPC remain limited. Median overall survival for R/M disease is 20 months. This study evaluated the efficacy and safety of FTD/TPI in platinum-resistant R/M NPC. In this single-arm, phase II study, patients received oral FTD/TPI at 35 mg/m² twice daily on days 1-5 and 8-12 of each 28-day cycle. The primary endpoint was disease control rate (DCR) at 12 weeks. Secondary endpoints included progression-free survival (PFS), overall response rate (ORR) and safety. Thirty-five patients were enrolled. Median age was 56 years with a median of 2 prior lines of systemic therapy (range, 1-7). 45% had prior fluoropyrimidine. DCR at 12 weeks was 57.1% (95% CI: 39.4%-73.7%) and the ORR was 22.9% (95% CI: 10.4-40.1). DCR was comparable with and without fluoropyrimidine exposure (55.6% vs 58.8%). Median PFS was 6.5 months, and median OS was 13.1 months. Treatment-emergent adverse events were predominantly hematologic, including ≥ Grade 3 neutropenia (43%), anemia (26%), and thrombocytopenia (9%), with grade ≥3 events largely hematologic. Dose modifications were required in 60%, most commonly due to neutropenia, manageable with dose reduction. One patient discontinued treatment due to symptomatic anemia. G3-4 neutropenia was significantly associated with improved ORR (p<0.001). Exploratory plasma proteomic analyses suggested potential differences in baseline and on-treatment protein expression between responders and non-responders, warranting further validation in larger cohorts. FTD/TPI demonstrated a manageable safety profile and encouraging antitumor activity. It is a convenient oral alternative to intravenous chemotherapy.
There is no established treatment for patients with recurrent/metastatic (R/M) olfactory neuroblastoma (ONB), a rare sinonasal tumor. We conducted the first immunotherapy clinical trial (NCT05012098) in patients with R/M ONB, to evaluate the activity of the bifunctional TGF-β "trap"/anti-PD-L1 fusion protein bintrafusp alfa (BA). Patients received BA (1200 mg, intravenously) every 2 weeks. Primary endpoint was overall response rate (ORR); secondary objectives included safety, progression-free survival (PFS), and overall survival (OS). Between June 2022 and June 2023, 11 patients received treatment (Cohort 1, no prior immunotherapy, n=9; Cohort 2, prior immunotherapy received, n=2); enrollment was stopped due to BA development discontinuation. No objective responses were observed. In Cohort 1, 4 patients (of 8 evaluable, 50%) had stable disease (SD), three confirmed and long lasting; median PFS was 3.7 months, median OS was not reached; and one of SD patients had a complete metabolic response on 68Ga-DOTATATE imaging. In Cohort 2, 1 patient had SD; median PFS was 3 months, and median OS was 6.8 months. Grade 3/4 treatment-related adverse events occurred in 3 patients (immune-mediated diabetes, esophageal hemorrhage, anemia, epistaxis). Although the primary endpoint was not met, BA showed a manageable safety profile and a subset of patients derived clinical benefit with prolonged stable disease, including one patient with a complete metabolic response. This first clinical trial of systemic therapy in R/M ONB serves as proof of clinical trials feasibility in this setting and supports further investigation of combinatorial immunotherapy strategies in this patient population. Trial registration ClinicalTrials.gov Identifier: NCT05012098, https://clinicaltrials.gov/ct2/show/NCT05012098. Registered 18 August 2021.
Friedreich ataxia (FA), a fatal, autosomal recessive disorder caused by pathogenic variants in the frataxin (FXN) gene, is characterized by progressive neurologic and cardiac disease, with cardiac disease being the major cause of death. Preclinical studies have demonstrated that systemic administration of AAVrh.10hFXN, an rh.10 serotype cardiotropic adenoassociated virus (AAV) vector expressing the normal human FXN coding sequence, reverses the cardiomyopathy in FXN-deficient mice. To assess the safety and preliminary efficacy of administration of AAVrh.10hFXN to adults with FA cardiomyopathy. This nonrandomized clinical trial evaluates the pooled data of 2 independent, open-label, dose-escalation trials that used the same gene therapy vector and similar clinical protocols among patients with FA cardiomyopathy at academic medical centers. Data were collected from February 22, 2022, to October 4, 2025, for trial 1 and from February 14, 2023, to September 10, 2025, for trial 2 and analyzed together from November 5, 2025, to March 12, 2026. AAVrh.10hFXN, administered intravenously in 3 dose cohorts (1.8 × 1011, 5.6 × 1011, and 1.2 × 1012 vector genomes per kilogram of body weight). In addition to safety as the primary outcome, multiple parameters of exploratory end points were assessed, including cardiac biopsy levels of FXN protein, cardiac magnetic resonance imaging-derived left ventricular mass index (LVMI), and serum high-sensitivity (hs) troponin I. Seventeen patients with FA cardiomyopathy (mean [SD] age, 25 [6] years; 11 [65%] female) were followed up for a mean (SD) of 20 (8) months. There were 4 serious adverse events, 3 possibly related to prednisone immunosuppression and 1 possibly vector-related myocarditis 12 months after therapy, all of which resolved. Other adverse events were transient, nonserious, or not treatment related. In all 8 patients with cardiac biopsy 3 months after therapy, there were higher levels of cardiac FXN (dose cohort 1, 20%; cohort 2, 81%; cohort 3, 123%). After therapy, LVMI was lower by at least 10% in 9 patients and stabilized in 8 patients. Excluding the patient with myocarditis, posttherapy values of serum hs troponin I were lower by at least 10% in 15 patients and higher by at least 10% in 2 patients. Findings of this nonrandomized clinical trial suggest that intravenous administration of AAVrh.10hFXN was well tolerated and may be a potential treatment for FA cardiomyopathy, as evidenced by preliminary improvement in exploratory efficacy end points. ClinicalTrials.gov Identifiers: NCT05302271 and NCT05445323.
Although routine episiotomy is discouraged, mediolateral episiotomy remains necessary in selected clinical situations. Variability in incision technique may influence pelvic floor-related morbidity. We hypothesized that a standardized blade-based episiotomy technique would be associated with lower rates of persistent perineal pain and improved sexual function compared with conventional scissors. In this randomized controlled trial, 60 nulliparous women undergoing vaginal delivery with a clinical indication for mediolateral episiotomy were randomized to episiotomy performed using a standardized blade-based device (BasIQ-4) or conventional Braun-Stadler scissors. Perineal pain was assessed using a visual analog scale at 2 and 48 h postpartum. The primary outcome was persistent perineal pain at 6 months postpartum, evaluated using a structured clinical interview. Sexual function at 6 months was assessed using the Female Sexual Function Index (FSFI). Sixty nulliparous women were randomized and included in the intention-to-treat analysis (BasIQ-4, n = 30; scissors, n = 30). Baseline demographic and obstetric characteristics were largely similar between groups. Pain scores at 2 h postpartum were lower in the BasIQ-4 group, with no differences at 48 h. Persistent perineal pain at 6 months was significantly less frequent in the BasIQ-4 group (6.7% vs. 50.0%, p < 0.001). Total FSFI scores were significantly higher in the BasIQ-4group, primarily driven by differences in pain-related domains. When mediolateral episiotomy is clinically indicated, incision standardization using a blade-based technique is associated with reduced long-term perineal pain and improved pain-related aspects of postpartum sexual function.
Serial thoracentesis is an established management strategy for hepatic hydrothorax (HH) patients who are intolerant to diuretics or not candidates for transjugular intrahepatic portosystemic shunt (TIPS) placement, but it carries a risk of complications. The role of indwelling pleural catheters (IPCs) in HH management remains controversial. This study aims to evaluate the safety and efficacy of IPCs compared with serial thoracentesis in patients with HH. We conducted a retrospective, propensity-matched cohort study using US population-based data, aged 18 to 89 years with HH secondary to cirrhosis of any etiology. Exclusion criteria included malignancy, congestive heart failure, nephrotic syndrome, chronic kidney disease, TIPS placement, or pleural effusions due to causes other than hepatic hydrothorax. Patients were stratified into 2 cohorts: (1) HH managed with IPCs placement and (2) HH managed with serial thoracentesis. After 1:1 propensity score matching, multivariate regression analysis was performed to evaluate primary and secondary outcomes over 18 months following the index intervention. All-cause mortality at 18 months was comparable between the IPCs and serial thoracentesis cohorts (odds ratio [OR]: 0.662, 95% CI: 0.434-1.108). However, patients in the serial thoracentesis group demonstrated higher odds of emergency room visits (OR: 2.273, 95% CI: 1.423-3.631), urgent care visits (OR: 1.581, 95% CI: 1.464-2.531), hepatic encephalopathy (OR: 2.351, 95% CI: 1.354-4.084), pneumonia (OR: 1.889, 95% CI: 1.075-3.320), liver transplantation (OR: 2.744, 95% CI: 1.276-5.897), and hypokalemia (OR: 2.028, 95% CI: 1.136-3.619) compared with the IPCs cohort. IPCs placement was associated with a lower risk of emergency room and urgent care visits, hepatic encephalopathy, pneumonia, hypokalemia, and reduced need for liver transplantation compared with serial thoracentesis in patients with HH.
Acromial stress fractures can occur after reverse total shoulder arthroplasty (rTSA). We performed this study to assess the incidence, risk factors, characteristics, and outcome of acromial stress fractures and reactions after rTSA. We determined the incidence of acromial stress fractures and reactions in a cohort of patients who underwent rTSA, and assessed risk factors using a case-control design. Each patient who developed an acromial stress fracture or reaction after rTSA (case) was matched by date of rTSA with 2 patients who did not develop acromial stress fractures/reactions after rTSA (control subjects); univariate and multivariable analyses were performed to identify risk factors. Characteristics of acromial stress fractures/reactions are described. Outcomes were compared between cases and control subjects. The incidence of acromial stress fracture/reaction after rTSA was 11% (24/220 rTSAs). Acromial stress fractures/reactions occurred at a median time of 5.5 months after rTSA (range: 20 days-118 months) and most were fractures (18/24, 75%). Using a multivariable analysis, we found 2 factors to be independently associated with the occurrence of an acromial stress fracture/reaction after rTSA: corticosteroids use (adjusted OR: 9.6, 95% confidence interval: 1.1-86.1, P = .04) and previous shoulder surgery (adjusted OR: 7.2, 95% confidence interval: 1.4-36.6, P = .02). In this cohort, in which the management was exclusively conservative, the occurrence of post-rTSA acromial stress fracture/reaction was associated with a significantly worse functional outcome at last follow-up visit, as compared with control subjects. This was illustrated by significantly lower American Shoulder and Elbow Surgeons Shoulder score, higher Shoulder Pain and Disability Index and Disabilities of the Arm, Shoulder and Hand scores, and worse forward elevation and internal rotation as compared with control patients who did not develop acromial stress fracture/reaction after rTSA. In our Australian cohort, acromial stress fractures/reactions were relatively common after rTSA, and independently associated with corticosteroids use and previous shoulder surgery. The occurrence of acromial stress fracture/reaction was associated with a significantly worse functional outcome, as compared with patients who do not develop this complication after rTSA.
BackgroundDespite substantial global progress in HIV prevention and treatment, mother-to-child transmission (MTCT) of HIV remains a major public health challenge in sub-Saharan Africa, which accounts for approximately 65% of the world's 39.9 million people living with HIV. Vertical transmission rates vary substantially across regions and over time. We conducted a systematic review and meta-analysis to estimate the overall, temporal, regional, and country level prevalence of HIV MTCT in sub-Saharan Africa.MethodsThis research was conducted between June 2024 and May 2025, in accordance with PRISMA guidelines and a protocol registered in PROSPERO (CRD42025637989). We systematically searched six databases (MEDLINE, Embase, PubMed, ScienceDirect, Web of Science, and the Cochrane Library) for articles published in English or French. We included cross-sectional, cohort, and case-control studies involving HIV-positive pregnant women aged ≥18 years that reported MTCT prevalence. Two reviewers independently screened, extracted data, and assessed study quality (Joanna Briggs Institute and Newcastle-Ottawa Scale). Pooled prevalence and 95% CI were calculated using a random-effects model in STATA 17. Heterogeneity (I2), subgroup analyses (by period, region, country), sensitivity analysis, and funnel plots for publication bias were performed.ResultsFrom 5,848 records, 48 studies (86,376 mothers; 2,875,104 infants) across 15 countries were included. The pooled MTCT prevalence was 7.0% (95% CI 5.2-9.4%; I2 = 99.1%). Temporal trends showed a decline from 26.0% (1993-2000) to 8.0% (2001-2010) and 5.0% (2011-2023). Regionally, West Africa had the highest prevalence (12.1%; 95% CI 6.5-21.6%), Southern Africa had the lowest (4.7%; 95% CI 2.6-8.1%). Approximately 9% of HIV-exposed infants were infected by 24-48 months, 6% were infected by 24 months after enrolment, and 7% tested positive at their first HIV test conducted between 1 and 12 weeks of age.ConclusionAlthough MTCT rates have declined, the current 7.0% remains above the WHO target (<5%) with noted significant regional and national disparities. However, this rate should be interpreted cautiously due to the extremely high heterogeneity (I2 = 99.1%) knowing it's a directional synthesis of available evidence rather than a precise population-level figure.
The Coalition (Globus Medical) hybrid PEEK-titanium cage has been widely utilized in our practice for Anterior Cervical Discectomy and Fusion (ACDF) over a 5-year period. A preliminary review of all the cases that we performed in these five years show to us an unexpectedly high rate of postoperative cage subsidence with the Coalition (Globus Medical) stand-alone cage. This prompted a formal investigation, the purpose of this study was, therefore, to systematically determine the true rate of subsidence for the Coalition cage in our cohort and to identify the independent risk factors that could explain this finding. We conducted a retrospective analysis of 70 consecutive patients who underwent ACDF with the Coalition cage between 2018 and 2023. Data on demographic, clinical, and surgical variables were collected. The primary outcome was cage subsidence (≥ 3 mm) assessed on lateral radiographs at a mean follow-up of 28.8 months (range 12-48). Independent predictors were identified through a multivariable logistic regression model constructed using the purposeful selection of covariates strategy, a multi-step iterative process that accounts for both statistical significance and confounding effects. The overall patient-based subsidence rate was 38.6% (27 of 70 patients) at a mean radiographic follow-up of 28.8 months. Interrater reliability for subsidence assessment was substantial (Kappa = 0.759). In the multivariable analysis, preoperative diagnosis of radiculopathy was identified as the only independent predictor of subsidence, with an Adjusted Odds Ratio of 3.51 (95% CI: 1.13-10.91, p = 0.029). Contrary to initial assumptions, multi-level surgery (p = 0.441), smoking status (p = 0.615), and implant dimensions were not significant predictors in this cohort. The Coalition cage demonstrated a high rate of subsidence in this series. A preoperative diagnosis of radiculopathy was the primary independent risk factor for this outcome, rather than multi-level fusion or specific implant characteristics. These findings suggest that the biomechanical requirements of disc height restoration in patients with radiculopathy may predispose them to higher subsidence rates when utilizing this specific standalone integrated fixation device.
To compare 24-month persistence and compliance of denosumab with alendronate in postmenopausal women with osteoporosis across 5 Asia-Pacific territories. This prospective cohort study included women aged ≥ 50 years from Australia, Taiwan, South Korea, Hong Kong, and Singapore. Participants received either a bi-annual denosumab injection or weekly oral alendronate as osteoporosis treatment, based on physician judgment. Multivariable logistic regression assessed whether therapy (denosumab or alendronate) was significantly associated with treatment persistence and compliance over 24 months of follow-up. The models were adjusted for age, fracture history, baseline bone mineral density (BMD), prior osteoporosis therapy, and prior oral glucocorticoid treatment. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Among 687 enrolled patients, 549 completed their 24-month visit (295 in denosumab and 254 in alendronate group). Patients in the denosumab group were older and a higher proportion previously received osteoporosis treatment. Overall treatment persistence and compliance were 74.9% and 56.6%, respectively. Patients prescribed with denosumab exhibited higher persistence (86.1% vs. 61.8%; P < 0.001) and compliance (62.4% vs. 50.0%; P = 0.004), compared with those on alendronate. Regression results also demonstrated that patients receiving denosumab were more likely to be persistent (aOR = 3.91; 95% CI 2.52-6.08), and compliant (aOR = 1.61; 95% CI 1.12-2.31). BMD T-scores improved in both the treatment groups after 24 months with no significant association between treatment type and change in T-score. No significant difference was also observed in the occurrence of adverse events between the two treatment cohorts. Patients on alendronate reported gastrointestinal issues more frequently, whereas those on denosumab had a higher incidence of bone and joint injuries. Postmenopausal women with osteoporosis were more likely to be persistent and compliant with a bi-annual denosumab injection, compared with weekly oral alendronate.
Primary splenic angiosarcoma (PSA) is a rare vascular malignancy with a poor prognosis and limited therapeutic options. A 62-year-old man with metastatic PSA underwent splenectomy followed by first-line paclitaxel, achieving stable disease for 7 months. Disease progression manifested as hepatic and bone marrow metastases with tumor-induced hepatic failure and refractory thrombocytopenia. Sequential treatment with liposomal doxorubicin, eribulin, toripalimab, and lenvatinib failed to control the disease failed to control the disease. Genomic profiling identified a PIK3CA p.P471L missense mutation. A combination regimen of inavolisib (a selective PI3Kα inhibitor) and lenvatinib was initiated. Bilirubin levels normalized, and platelet counts recovered within 2 weeks; follow-up MRI confirmed radiological stabilization. At 16 months postdiagnosis, the patient remains alive on this regimen, though long-term durability of response has yet to be determined. To our knowledge, this is the first reported use of inavolisib in angiosarcoma. The rapid biochemical and radiological response observed in this PIK3CA-mutated PSA supports early genomic profiling to identify actionable alterations and warrants prospective evaluation of combined phosphoinositide 3-kinase and vascular endothelial growth factor pathway inhibition in refractory angiosarcoma.
To compare the incidence of bond failures and white spot lesions (WSLs) between brackets bonded with either light-cured resin-modified glass ionomer cement (GC Fuji Ortho LC) or light-cured composite resin (3M Transbond Plus Color Change Adhesive) after 18 months of treatment. 90 patients were allocated to the trial, and 84, with a mean age of 16.7 ± 2.6 years, were analyzed. The cross-mouth method was employed in each patient, in which two diagonal quadrants (e.g., upper right and lower left, or vice versa) were randomly assigned to the FujiOrtho group, and the opposite diagonal quadrants to the Transbond group. All patients were monitored for an average of 18 months for bond failure and WSL incidence. Multilevel mixed Poisson regression with robust standard errors was used to compare the groups. Overall, failure rates were 12.9% in the FujiOrtho group and 2.1% in the Transbond group, with an adjusted relative risk (aRR) of 6.21 (95% CI: 3.89-9.94), adjusted for age, sex, maxilla/mandible, tooth position, and treating orthodontist. Overall, WSL incidence was 8.3% in the FujiOrtho group and 8.8% in the Transbond group, with an aRR of 0.95 (95% CI: 0.80-1.13). Transbond Plus demonstrated a significantly lower bond failure rate compared to GC FujiOrtho LC, with a 3.6 times reduced risk of bracket failure. There were neither statistically nor clinically significant differences in the incidence of WSLs between the two groups.
Hypopigmented mycosis fungoides (HMF) is uncommon in adults, and data on clinicopathologic features and long-term outcomes remain sparse. To investigate the clinicopathologic features and outcomes of adults with HMF in a large multicenter cohort. This retrospective multicenter cohort study conducted from January 2011 to October 2023 at 6 US tertiary referral centers and included adults (18 years or older at diagnosis) with biopsy-confirmed HMF and hypopigmentation documented at diagnosis, with a median (range) follow-up of 39 (1-347) months. Data were analyzed from February to December 2025. Clinical variant, immunophenotype predominance, and polymerase chain reaction-based T-cell receptor (TCR) gene rearrangement in peripheral blood and/or skin. Best overall response, defined as complete response, partial response, stable disease, or progressive disease, and progression to a higher stage. The cohort included 224 adults with HMF (median [range] age, 44 [18-74] years), of whom 164 (73%) were women (60 men [27%]), 5 (2%) were Asian individuals, 1 (0.4%) was a Hispanic/Latino individual, 1 (0.4%) was a Middle Eastern individual, 19 (8%) were White individuals, and 186 (83%) were Black individuals; 219 (98%) presented with early-stage disease. Most had hypopigmented lesions only (159 [71%]), whereas 65 (29%) exhibited mixed-variant mycosis fungoides; outcomes were similar between groups. Among 141 patients with available immunophenotyping, 88 (63%) had CD8-positive predominance. Among 207 treated patients, most (179 [90%]) received skin-directed therapy alone. Among 198 evaluable patients, the best overall response was complete response for 52 (26%), partial response for 101 (51%), stable disease for 34 (17%), and progressive disease for 11 (6%). Over a median (range) follow-up of 39 (1-347) months, 14 of 224 patients (6%) experienced progression to a higher stage, including 5 of 219 patients (2%) with early-stage disease at baseline who experienced progression to advanced-stage disease. Peripheral blood TCR monoclonality was detected in 23 of 85 tested patients (27%) and was associated with poorer treatment response but not with disease progression. The finding of this cohort study suggest that adult HMF demonstrated a generally indolent course, with favorable response to skin-directed therapy, irrespective of immunophenotype or mixed-variant presentation. Peripheral blood TCR monoclonality was associated with lower treatment response but not disease progression.