Universal Credit (UC) is a major UK welfare reform that consolidates six means-tested benefits into a single monthly payment, aiming to simplify benefits delivery and incentivize labor market participation. However, concerns have emerged regarding its potential adverse consequences on recipients' mental and physical well-being. Existing evidence is limited by methodological weaknesses, short follow-up time, and a narrow focus on psychological distress. Applying the heterogeneous difference-in-differences approach developed by Callaway and Sant'Anna, we used waves 6-14 of the UK Household Longitudinal Survey (UKHLS), focusing on working-age individuals receiving social benefits to evaluate the short- and long-term effects of that welfare reform on psychological distress (GHQ-12), mental functioning (SF-12 MCS), physical functioning (SF-12 PCS), but also employment, perceived financial outlook, benefits income, and total income. Transitioning to UC significantly increased GHQ-12 scores by 1.20 points (95% CI: 0.33 to 2.07) and decreased SF-12 MCS scores by 2.19 points (95% CI: - 3.79 to - 0.59), indicating deteriorating mental health. No significant effect was observed for SF-12 PCS. UC was also associated with a £93.05 reduction in monthly benefit income, a £222 decrease in total income, and an 8%-point decrease in perceived financial optimism. No significant effect on employment status was detected. Our findings suggest that the transition to UC adversely affected mental health and financial well-being, while yielding limited employment benefits. These adverse impacts reflect both implementation challenges, such as payment delays and benefit deductions, and structural design flaws, including rigid conditionality and reduced income security for vulnerable groups. The results underscore the need for welfare reforms that integrate health considerations and provide more flexible, targeted support to mitigate unintended harms.
Sleep-disordered breathing (SDB) is associated with adverse outcomes in cardiopulmonary diseases, but its prognostic relevance in community-acquired pneumonia (CAP) is not well established. This study investigates whether pre-diagnosed SDB increases the risk for severe CAP. In the prospective CAPNETZ cohort, 4686 adult patients with radiologically confirmed CAP were assessed for pre-existing SDB and continuous positive airway pressure (CPAP) therapy. Outcomes included intensive care unit (ICU) admission, mechanical ventilation (MV) and 28-day mortality. Univariable and multivariable logistic regression analyses were performed. SDB was present in 120 patients (2.6%), and 74 (1.6%) had established CPAP therapy. SDB was significantly associated with ICU admission and MV, but not with 28-day mortality in univariate analyses. In multivariable models, SDB (OR 1.46, 95% CI 2.35-3.80), male sex, confusion and older age were independently associated with ICU admission. Similarly, SDB (OR 5.16, 95% CI 2.99-8.89), male sex, confusion, older age, tachypnoea and elevated heart rate were linked to MV. CPAP therapy did not emerge as an independent predictor in multivariable analysis. Mortality within 28 days was independently associated only with confusion, older age and malignancy. Our results highlight SDB as a potential novel risk factor for severe courses of CAP, including the need for ICU and MV. It suggests that SDB should be considered a critical component in the risk stratification and management of CAP and that established CPAP treatment may have a protective effect. Additional study data are needed to further substantiate these findings.
Musculoskeletal (MSK) diseases involve complex immune mechanisms. Conventional flow cytometry is restricted by spectral overlap, limiting multidimensional immune characterization. Mass cytometry by time-of-flight (CyTOF) can measure over 40 proteins per cell using metal-tagged antibodies and time-of-flight detection, providing deep immune phenotyping. The aim of this narrative review was to summarize the applications of CyTOF in the study of human orthopaedic and rheumatic diseases, highlight key immune findings including shared markers, and identify gaps to guide future research and panel standardization. A literature search of peer-reviewed studies published from 1 January 2014 to 31 December 2024 was conducted using PubMed, Scopus, and Web of Science. Search terms included "CyTOF" and "mass cytometry". Studies were included if CyTOF was applied to human MSK disorders with immune or inflammatory components and if the full text was available in English. Data extracted included disease type, sample source, computational pipeline, immune cell types analyzed, and main findings. A total of 22 studies were included. Since some studies reported results for more than one disease, the total number of disease-specific entries was 26: rheumatoid arthritis (n = 13), osteoarthritis (n = 4), psoriatic arthritis (n = 3), juvenile idiopathic arthritis (n = 2), ankylosing spondylitis (n = 1), idiopathic inflammatory myopathies (n = 1), and post-surgical immune monitoring (n = 2). Human models were represented. CyTOF identified disease-specific immune cell subsets, cytokine profiles, and treatment-response signatures. No eligible studies addressed osteoporosis or osteonecrosis likely reflecting that these conditions would yield low immune-cell density and/or technical challenges in acquiring bone tissue. Eight recurrent markers emerged across diseases: program cell death protein 1 (PD-1), inducible T-cell costimulator (ICOS), CXC motif chemokine receptor (CXCR)5, CXCR4, phosphorylated signal transducer and activator of transcription 4 protein (pSTAT3), tumour necrosis factor receptor II (TNFRII), p16 inhibitor of cyclin-dependent kinase 4a (p16INK4a), and cluster of differentiation (CD)180, which reflect shared pathways of inflammation, senescence, and tissue damage. CyTOF enables high-dimensional immune profiling in MSK diseases, offering insights into pathogenesis, treatment response, and patient stratification. Broader application of this technology to underexplored conditions is warranted. A minimal eight-marker backbone may enhance panel harmonization and support future multicentre translational studies in orthopaedic immunology.
Dental caries is one of the most prevalent chronic diseases affecting children worldwide and remains a major public health concern. It is a multifactorial condition influenced by oral hygiene practices, dietary habits, and behavioral factors. The mixed dentition period (6-11 years) is particularly critical as children are more susceptible to developing caries due to changing oral environments and inconsistent oral hygiene practices. The aim of the present study was to assess the prevalence of dental caries and its association with oral hygiene practices among primary school children aged 6-11 years in the district of Panchkula, Haryana, India. A cross-sectional study was conducted among 1040 school-going children selected using multistage random sampling. Dental caries in the permanent dentition was recorded using the decayed-missing-filled teeth (DMFT) index, whereas caries in the primary dentition was assessed using the decayed-extracted-filled teeth (deft) index. Oral hygiene practice was evaluated using a structured questionnaire. Data were analyzed using appropriate statistical tests, including chi-square analysis, with the significance level set at p < 0.05. The overall prevalence of dental caries was 84.4%. No significant association was found between sex and the prevalence of caries (p > 0.05). However, the prevalence of caries increased significantly with age (p < 0.001). Oral hygiene practices showed a statistically significant association with dental caries (p < 0.0001), with a higher prevalence among children with poor brushing habits, infrequent brushing, improper cleaning methods, high consumption of sweets, and irregular dental visits. Mean DMFT and deft scores increased significantly with age (p = 0.001). Additionally, children with poor oral hygiene scores demonstrated significantly higher DMFT and deft values than those with good and fair hygiene (p < 0.001). This study revealed a high prevalence of dental caries among children in the mixed dentition stage, with oral hygiene practices playing a significant role. Early preventive interventions, improved oral health education, and parental involvement are essential for reducing the burden of dental caries in children.
Not every groin swelling is what it appears to be. An uncommon presentation of a common symptom can challenge even routine clinical assumptions. We report a 34-year-old female with a long-standing right groin swelling, clinically indistinguishable from an inguinal hernia. Despite supportive examination and imaging, laparoscopy identified an intact inguinal canal and instead identified a small defect along the lateral border of the rectus abdominis, consistent with a Spigelian hernia. A laparoscopic transabdominal preperitoneal (TAPP) repair with mesh placement was performed successfully, and recovery was uneventful. This case underscores a key surgical lesson: rare hernias can convincingly mimic common ones. In such scenarios, laparoscopy serves as both a decisive diagnostic tool and a definitive means of treatment.
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Background Ankle injuries are among the most common reasons for urgent care visits. Evidence-based guidelines, particularly the Ottawa Ankle Rules (OAR), aim to standardize assessment and reduce unnecessary imaging. Despite strong evidence supporting their diagnostic accuracy, clinicians' adherence remains variable. This variability can lead to suboptimal patient outcomes, such as chronic joint instability and increased healthcare costs. This study assesses physicians' compliance with OAR and related management recommendations and identifies barriers that hinder appropriate guideline use. Objectives The primary objective is to measure the prevalence of adherence to evidence-based guidelines, specifically the OAR, among urgent care physicians. Secondary objectives include evaluating physicians' self-reported familiarity with these guidelines, identifying associated factors affecting compliance, and exploring perceived barriers to implementation. Methods A cross-sectional analytical survey was distributed electronically to physicians working in urgent care and emergency services. A total of 74 participants completed the questionnaire. The survey addressed physicians' use of OAR, rehabilitation advice, perceived barriers, and training background. Results While only 41.9% routinely applied structured rehabilitation protocols, 70.3% of physicians reported using the OAR. Most respondents (83.8%) provided patient education regarding prevention and rehab. However, 68.9% indicated a need for further training. The most commonly cited barriers were time constraints (32.4%), inadequate guideline training (31.1%), insufficient resources (14.9%), and patient non-adherence (19.4%). Additionally, 87.7% had not attended recent workshops, though 85.1% expressed willingness to receive further education. Conclusion The study reveals inconsistencies in adhering to ankle injury guidelines in urgent care. Enhancing clinician training and implementing standardized protocols can reduce diagnostic errors and unnecessary imaging. Ongoing education and quality improvement initiatives are essential for providing better care for ankle injuries.
Contrast-associated acute kidney injury (CA-AKI) is more common in patients with heart failure (HF). Stratified by left ventricular ejection fraction (LVEF), the effect of disease severity is still unknown. There is little and inconsistent data comparing the risk of CA-AKI among the various forms of HF identified by the latest guidelines of the European Society of Cardiology (ESC). A systematic search of PubMed, Embase, Cochrane Library, and Web of Science (January 1, 2011 - December 11, 2025) for studies reporting CA-AKI outcomes stratified by LVEF phenotypes (heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF)) was performed. We planned a meta-analysis, but due to heterogeneity in adjusted models and limited study data available, we present a narrative synthesis of adjusted effect estimates. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E). Two observational cohort studies comprising 3,499 patients with HF met the eligibility criteria. Both studies reported multivariable-adjusted odds ratios. One study found no significant association between reduced ejection fraction (EF) and CA-AKI after adjustment (HFrEF vs. HFpEF adjusted OR 1.01, 95% CI 0.69-1.74; HFmrEF vs. HFpEF adjusted OR 1.31, 95% CI 0.87-1.96). Another study reported adjusted estimates suggesting higher odds with HFrEF compared with other phenotypes (reported adjusted OR 0.85, 95% CI 0.73-0.98 for phenotype-level comparisons). Because of the differences in study design, populations, and covariate adjustment, we did not pool estimates quantitatively; instead, we describe the findings narratively. Current evidence is limited to two observational cohorts and yields inconsistent adjusted estimates. Therefore, pooled effect estimates weren't reported. The findings suggest that EF alone may not fully reflect kidney vulnerability. Due to the limited number of observational studies, these findings should be interpreted with caution, highlighting the need for larger studies in the future.
A 54-year-old man presented with an abrupt onset disabling orthopnoea preventing supine sleep for several months. Cardiopulmonary imaging excluded heart failure, pulmonary embolism, interstitial lung disease, and upper airway obstruction. Pulmonary function testing demonstrated restrictive ventilatory impairment, and arterial blood gas revealed hypercapnia suggestive of hypoventilation. Neurological examination in the supine position showed paradoxical breathing with inspiratory thoracic expansion and inward abdominal movement, raising suspicion of diaphragmatic dysfunction. Sleep study demonstrated moderate obstructive sleep apnoea with an apnoea-hypopnoea index (AHI) of 25 events per hour and disproportionate nocturnal hypoxaemia (mean oxygen saturation 84%, nadir 65%). Profound hypomagnesaemia with associated hypokalaemia was identified and corrected. Computed tomography (CT) imaging showed a subtle elevation of the left hemidiaphragm and documented marked dyspnoea during supine acquisition. Respiratory muscle testing demonstrated severe inspiratory muscle weakness consistent with ventilatory pump limitation. Nocturnal continuous positive airway pressure (CPAP) resulted in rapid symptomatic improvement, allowing recumbent sleep. Despite extensive in-hospital evaluation, the underlying cause of orthopnoea remained undetermined. Structured differential diagnosis of progressive diaphragmatic weakness included cervical myelopathy, phrenic neuropathy, neuromuscular junction disorder, and primary myopathy. Further outpatient evaluation was planned but could not be completed because of the patient's unexpected death from acute myocardial infarction one month after discharge. This case highlights the importance of considering ventilatory pump failure when orthopnoea is severe and cardiopulmonary evaluation is unrevealing.
Tuberculous aortitis (TA) is a rare complication of Mycobacterium tuberculosis (TB) characterized by persistent inflammatory infiltration and weakening of the aortic wall. The disease most commonly results from contiguous spread from adjacent infected tissue and can lead to life-threatening complications, notably pseudoaneurysm formation and aortic rupture. The present case describes a 66-year-old man with sudden-onset back pain and hemoptysis. He was initially found to have a penetrating aortic ulcer (PAU), but subsequent radiographic imaging and recurrent hospitalizations later revealed aortic findings more consistent with TA. This report highlights the rarity of TA co-occurring with a PAU and emphasizes existing treatment plans for this clinical scenario.
Background Chronic Achilles tendon rupture remains a challenging condition, particularly in cases involving large tendon defects that preclude end-to-end repair. Among reconstructive options, techniques using local tissues avoid the donor-site morbidity associated with tendon transfers. This study describes a modified gastrosoleus fascial turndown flap based on the Rush technique, reinforced with the plantaris tendon, and reports preliminary clinical outcomes. Methodology A total of 13 patients presenting with chronic Achilles tendon rupture (≥4 weeks) with a defect ≥6 cm were included. All underwent reconstruction using a tubularized gastrosoleus fascial flap based on the Rush principle, combined with plantaris tendon augmentation in a framing configuration. Outcomes were assessed using the Achilles Tendon Total Rupture Score (ATRS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the ability to perform heel raises. Body mass index (BMI) was analyzed descriptively as an exploratory variable, given the limited sample size precluding formal statistical analysis. Results At a mean follow-up of 16.1 ± 2.7 months, the mean ATRS was 81.0 ± 3.9, and the mean AOFAS score was 83.9 ± 2.3. Patients performed a mean of 14.5 ± 1.3 single-leg heel raises. No reruptures or complications were observed. The mean BMI was 25.2 ± 3.4 kg/m², with a slight decrease in ATRS observed in overweight patients. Conclusions The modified Rush technique with plantaris tendon augmentation appears to be a reproducible biological option for the management of chronic Achilles tendon ruptures with large defects. In this preliminary series, satisfactory functional outcomes were observed, supporting the feasibility of a fully biological reconstruction strategy using local tissues without tendon sacrifice. This approach may represent a potential alternative to tendon transfers for defects ≥6 cm.
Eosinophilic airway inflammation predicts asthma attacks and inhaled corticosteroid (ICS) response in adults; similar mechanisms may apply to preschool wheeze. This study assessed whether blood eosinophil count (BEC) alone or combined with allergic sensitisation and fractional exhaled nitric oxide (F ENO) was associated with future wheeze attacks. 95 preschool children (12-59 months old) with clinician-confirmed wheeze were recruited from primary and secondary care. At baseline, finger-prick BEC, skin-prick testing for allergic sensitisation and offline F ENO were performed. Children were followed for 8-9 months. The primary outcome was the number of acute wheeze attacks diagnosed during unscheduled visits to an emergency department or general practitioner, documented by parental reports, medical records or oral corticosteroid prescriptions. Exploratory analyses examined ICS association with wheeze attack odds across different biomarker subgroups. Children with BEC ≥300 cells·μL-1 had higher wheeze attack odds over 9 months (n=60, odds ratio (OR) 4.27, 95% confidence interval (CI) 1.7-11.38). Odds were greatest in those with BEC ≥300 cells·μL-1 and F ENO ≥10 ppb (n=12, OR 60.74, 95% CI 2.98-1238.9). ICS prescription was associated with reduced 3-month wheeze attack odds among children with elevated BEC (n=21, OR 0.11, 95% CI 0.02-0.49) or allergic sensitisation (n=19, OR 0.11, 95% CI 0.01-0.65), with further reduction when both were combined (n=10, OR 0.06, 95% CI 0.002-0.59). Elevated BEC may identify preschool children at increased wheeze attack odds, particularly when combined with F ENO. ICS treatment was associated with odds reduction in children with elevated BEC or allergic sensitisation. These findings provide a rationale for future randomised controlled trials comparing biomarker-guided and symptom-based treatment strategies.
A 61-year-old male patient presented with reticular epithelial edema (REE) and bullae in the inferonasal quadrant of the right eye (RE) one month after initiation of topical netarsudil 0.02%. The findings were confirmed on anterior segment optical coherence tomography (AS-OCT). Following discontinuation of the medication, the epithelial edema resolved over a period of six weeks. Nine months later, the patient re-presented with redness, increased lacrimation, and blurred vision in the RE, occurring two weeks after re-initiation of topical netarsudil 0.02%. Slit-lamp examination revealed REE with a few bullae and an epithelial defect in the inferonasal paracentral cornea, corresponding to the location of the previous lesion. Corneal sensations were absent over and in the surrounding area of the lesion. AS-OCT confirmed the presence of epithelial edema and bullae. Netarsudil was promptly discontinued. The patient was managed with topical lubricants, and a bandage contact lens was applied. Due to a persistent epithelial defect, he subsequently underwent amniotic membrane transplantation combined with lateral tarsorrhaphy. Four weeks later, the epithelial defect had healed, leaving a residual nebular corneal opacity. He later underwent implantation of an Ahmed glaucoma valve (AGV) for intraocular pressure (IOP) control. Ophthalmologists should be cognizant of the potential corneal adverse effects associated with netarsudil, including REE and bullae formation. In cases of persistent epithelial defects, underlying predisposing factors should be carefully evaluated and managed appropriately.
COPD is a heterogeneous condition characterised by persistent, poorly reversible airflow obstruction. While some patients experience accelerated decline in forced expiratory volume in 1 s (FEV1), others remain stable. We hypothesised that unsupervised analysis of chest computed tomography (CT) scans using machine learning-derived radiomic features may identify endophenotypes associated with distinct clinical and biological characteristics and FEV1 decline trajectories. We analysed 101 radiomic features from 1759 chest CT scans of COPD patients in the ECLIPSE study. Unsupervised consensus clustering identified six mutually exclusive radiomic clusters, and we derived six corresponding average patient score clusters (APSC1-6). Random coefficient models assessed associations between each APSC and baseline clinical characteristics, FEV1 and its 3-year change, adjusting for relevant covariates. Associations with baseline gene expression in sputum and blood were also evaluated. Radiomic scores were associated with multiple baseline clinical features. Higher APSC2 (-5.3 mL·year-1; 95% CI -9.5- -1.0; p=0.01) and APSC6 (-5.5 mL·year-1; 95% CI -9.6- -1.3; p=0.01) predicted greater FEV1 decline, whereas higher APSC3 was associated with slower decline (+5.2 mL·year-1; 95% CI 0.8-9.6; p=0.02). APSC6 was associated with increased sputum expression of genes enriched in respiratory infection pathways, relevant COPD loci such as TRIM38 and IFIT3, and higher blood neutrophil counts. Unsupervised CT radiomic analysis identifies distinct COPD endophenotypes associated with variability in FEV1 decline and biological markers, supporting potential stratified treatment.
Primary CNS lymphoma (PCNSL) is an uncommon extranodal non-Hodgkin lymphoma that often presents with nonspecific neurologic symptoms and may be complicated by metabolic derangements. Hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a clinically significant but underrecognized manifestation of CNS pathology, and presentation as severe symptomatic hyponatremia in pineal-region PCNSL is particularly unusual. We report the case of a 76-year-old man with a biopsy-proven pineal-region mass who presented with severe symptomatic hyponatremia and progressive encephalopathy. Histopathologic evaluation demonstrated a CD5-positive large B-cell lymphoma with a markedly elevated proliferative index and no evidence of double-hit or triple-hit lymphoma on fluorescence in situ hybridization. The biochemical profile demonstrated hypotonic hyponatremia with inappropriately concentrated urine and elevated urine sodium, supporting SIADH in the setting of intracranial malignancy. The patient required intensive care unit monitoring and was treated with fluid restriction, sodium supplementation, oral urea, and carefully monitored hypertonic saline, resulting in gradual correction of serum sodium and clinical stabilization. This case illustrates how severe SIADH may serve as the presenting clinical manifestation of deep midline PCNSL and underscores the importance of integrating neuroimaging, neuropathology, and electrolyte physiology in medically complex neuro-oncologic presentations.
Bipolar-spectrum illness emerging after traumatic brain injury (TBI) can be difficult to treat and may present with mixed or agitated depressive features that appear sensitive to glutamatergic modulation. In post-TBI cases, diagnostic certainty is often limited because irritability, impulsivity, sleep disturbance, affective lability, and cognitive change may overlap with frontal-limbic injury syndromes. This case is, therefore, framed as probable bipolar-spectrum disorder secondary to TBI rather than definitive idiopathic bipolar disorder. The Cheung Glutamatergic Regimen (CGR)--low-dose dextromethorphan with CYP2D6 inhibition plus piracetam--is used here only as a shorthand for an open-source, free-to-use, non-proprietary combination of off-patent components, not as a branded product. This report describes a woman in her mid-thirties with right frontal atrophy after a 2009 subdural hematoma who later developed probable bipolar-spectrum illness. On 21 October 2025, she presented with severe depressive relapse, insomnia, persistent rumination, irritability, and hypnagogic phenomena, with a Patient Health Questionnaire-9 (PHQ-9) score of 22. After partial improvement on valproate, risperidone, and Deanxit, dextromethorphan 30 mg nightly and piracetam 600 mg nightly were added on 5 November 2025. Within weeks, rumination decreased and mental flexibility improved, but transient mild hypomanic or frontal-disinhibition-like symptoms emerged, especially inappropriate laughter with a moria-like quality. She self-reduced dextromethorphan to 22.5 mg, piracetam was increased, and euthymia returned. Over the next six months, PHQ-9 scores improved to 10-12 and Generalized Anxiety Disorder-7 (GAD-7) scores to 8-13, with functional gains including exercise and motorcycle riding lessons. Later medications included aripiprazole, paroxetine-controlled release, pregabalin, and low-dose quetiapine. By April 2026, dextromethorphan and piracetam were used as needed during stress-related or premenstrual dips. No further psychotic symptoms were reported, and later mild dissociative or cognitive complaints became manageable after dose adjustment. This single-patient course suggests a three-phase pattern: induction with a narrow therapeutic window and brief activation/overshoot, stabilization after titration, and later PRN maintenance. Dextromethorphan appeared temporally most linked to both clinical benefit and transient activation, while piracetam may have acted as a modulator. However, causal inference is limited by the uncontrolled design, early PHQ-9 improvement before CGR initiation, later polypharmacy, unmeasured pharmacokinetics, absence of standardized mania/cognitive measures, and incomplete PRN-frequency documentation. The case is also only hypothesis-generating in relation to transcriptomic findings implicating bipolar-specific plasticity-related biology. Low-dose oral glutamatergic augmentation may warrant study as a closely monitored induction and consolidation strategy in post-TBI bipolar-spectrum illness, but prospective controlled trials are needed before broader recommendations can be made.
Bronchiectasis is a complex disease with geographical variability in its presentation and management. Despite the growing contribution of international registries, real-world data on the Italian bronchiectasis population remain limited. The objective of the present study was to describe the demographic, clinical, microbiological, functional and treatment characteristics of Italian patients with bronchiectasis and to compare them with those of patients from other Southern European countries. This was a secondary analysis of adults from 18 Italian centres included in the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) registry, with comparisons made to patients in Spain, Greece, Portugal, Turkey, Israel and Malta (Southern European countries). Demographics, comorbidities, exacerbation history, spirometry, microbiology and treatment patterns were evaluated. Among 1657 Italian patients, the majority were female (70.5%) with a median age of 65 years, with high rates of idiopathic bronchiectasis (55.4%) and preserved lung function. Compared with other Southern European countries (n=2638), Italian patients had lower disease severity (median Bronchiectasis Severity Index: 6 versus 7; p<0.001), less frequent isolation of Pseudomonas aeruginosa, and lower prevalence of daily sputum production and purulence, despite identical quality of life (median Quality of Life Questionnaire-Bronchiectasis Respiratory Symptom Score: 70.4 in both groups). Treatment patterns differed, with lower use of inhaled antibiotics (1.1% versus 13.1%) and macrolides (6.0% versus 14.3%), but more widespread use of airway clearance (48.4% versus 35.9%) among patients from Italy versus other Southern European countries. These findings may reflect earlier referral, diagnostic preferences or structural differences in care delivery in Italy compared with other Southern European countries. This work lays the foundation for tailored national strategies and future longitudinal studies. The largest bronchiectasis cohort ever studied in Italy reveals unique clinical traits and highlights key differences from other Southern European countries, and provides real-world data to shape better care models and guide future research.
Despite adequate primary and secondary prevention of cardiovascular events, significant residual risk remains. Part of this risk has been attributed to lipoprotein(a) (Lp{a}). This is a genetically determined lipoprotein that has been linked to cardiovascular disease. Its variability and pathogenicity are attributed to the unique apolipoprotein(a) (apo{a}) within the molecule. This protein has been related to proatherogenic, proinflammatory, prothrombotic, and procalcific mechanisms that favor cardiovascular disease (CVD). Although it is recognized as a causal factor in disease, there are currently no approved therapeutics targeting this lipoprotein. Current management focuses on aggressive control of traditional cardiovascular risk factors. Novel therapeutics targeting Lp(a), including small interfering ribonucleic acids (siRNAs) and antisense oligonucleotides (ASOs), showed promising results in phase 2 trials. Multiple therapeutics are currently undergoing phase 3 trials, promising to bring a solution to this unsolved issue.
Postoperative stiffness remains a significant complication following total knee arthroplasty (TKA), affecting functional recovery and patient satisfaction. Manipulation under anesthesia (MUA) is commonly employed when conservative measures fail, yet the impact on patient-reported outcomes remains unclear. This systematic review evaluated functional outcomes following MUA, focusing on the Knee Society Score (KSS), Oxford Knee Score (OKS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library was conducted up to February 1, 2026, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Six studies, including retrospective and prospective cohorts and a systematic review, were included. Early MUA (<8-12 weeks) consistently achieved a superior range of motion (ROM) gains (+25° to +34°) compared to delayed interventions. Functional outcomes showed modest short-term improvements with sustained long-term benefits, and complications were rare. While ROM gains were reliably achieved, patient-perceived functional recovery depended on pain control, rehabilitation adherence, and individual factors. Early and standardized MUA is effective for improving mobility and functional recovery after TKA. Future high-quality prospective studies are warranted to refine timing, standardize techniques, and clarify the relationship between mechanical improvements and patient-centered outcomes.
Flat-detector computed tomography (FDCT) is increasingly used for periinterventional cerebral imaging. The recently introduced Sine Spin FDCT (S-FDCT) aims to improve cerebral soft tissue contrast compared with conventional FDCT (C-FDCT). Reliable visualization of healthy brain parenchyma is essential for detecting pathological changes. This study compared gray-white matter differentiation between intraindividually acquired S-FDCT and C-FDCT. A retrospective analysis of a prospectively maintained database included patients with ischemic stroke treated by mechanical thrombectomy who underwent both S-FDCT and C-FDCT within the same interventional session on a latest-generation angiography system. Quantitative image quality was assessed using the contrast-to-noise ratio (CNR). Qualitative image quality was evaluated using a five-point scale at basal ganglia and supratentorial cortex. Analyses focused on healthy brain parenchyma contralateral to infarction. Radiation dose was assessed using entrance-skin dose and dose-area product (DAP). Forty patients (74.2 ± 15.3 years) were analyzed. S-FDCT demonstrated a higher CNR than C-FDCT (mean CNR ± SD: 2.62 ± 1.36 versus 1.03 ± 0.38; p < 0.001). Qualitative ratings were higher for S-FDCT at the basal ganglia (2.45 ± 0.71 versus 1.54 ± 0.53; p < 0.001) and supratentorial cortex (3.01 ± 0.80 versus 1.71 ± 0.60; p < 0.001). Inter-reader agreement was good (κ = 0.798). S-FDCT showed a moderately higher radiation dose than C-FDCT (DAP: 50.6 ± 3.10 versus 46.89 ± 2.86 Gy·cm², p < 0.001). S-FDCT improves cerebral soft tissue visualization compared with C-FDCT in periinterventional imaging. These findings highlight the potential of Sine Spin technology to enhance FDCT image quality and support its role in advanced angiography-suite-based neuroimaging.