Clinical cardiovascular disease (CVD) is often present in frail individuals. However, it remains unclear whether subclinical CVD, e.g., abdominal aortic calcification (AAC), is associated with frailty. This study investigated the cross-sectional relationship between AAC scored using a validated machine learning model (ML-AAC24) and physical frailty. 49,081 participants from the UK Biobank Imaging Study without atherosclerotic CVD (ASCVD) diagnosis were included. ML-AAC24 extent was categorised as low, moderate and high, based on established severity categories. Physical frailty was based on a modified Fried's frailty phenotype comprising weak hand grip strength, slow walking speed, weight loss, exhaustion, and physical inactivity. Individuals with three or more deficits were considered frail, while one or two deficits was considered pre-frail. Multivariable-adjusted multinominal logistic regression models were used to test the associations between ML-AAC24 extent and frailty status. One in five individuals had moderate or high ML-AAC24. Compared to individuals with low ML-AAC24, those with moderate and high ML-AAC24 had greater odds of being pre-frail (ORs 1.06 95%CI 1.00-1.12 moderate; 1.14 95%CI 1.04-1.26 high) or frail (ORs 1.27 95%CI 1.12-1.44 moderate; 1.58 95%CI 1.31-1.91 high), adjusted for multiple covariates. When stratified by sex, similar results for frailty were recorded. In a population, those with moderate and high ML-AAC24 were more likely to present as pre-frail and frail. AAC identified from lateral spine images obtained during routine bone density testing, could serve as a useful marker for the early detection of frailty, highlighting the importance of multimodality care.
Background Spinal degenerative lesions are prevalent on MRI scans and radiographs in the general population and axial spondyloarthritis (axSpA) cohorts. However, their interrelationships remain poorly understood. Purpose To investigate longitudinal relationships between spinal degenerative lesions in axSpA over 10 years. Materials and Methods This secondary analysis of a prospective cohort (Devenir des Spondylarthropathies Indifférenciées Récentes [DESIR]) included whole-spine MRI scans and cervical and lumbar radiographs from individuals with axSpA assessed for 10 MRI and six radiographic degenerative lesions by three readers at baseline, 5 years, and 10 years. Patients with two or more time points were included. Multilevel logistic regression analyses using a generalized estimating equations approach (logit link, binomial family) were developed to assess whether the presence of a lesion at one time point was associated with subsequent lesions at the same and adjacent vertebral units. Time-lagged and autoregressive models evaluated inter- and intralesion temporal relationships, accounting for within-patient, within-reader, and within-vertebral unit dependence, and were adjusted for age, sex, HLA-B27 status, body mass index, smoking, job type, and biologic agents during follow-up. Results Imaging was available for 329 patients (mean age, 35 years ± 9 [SD]; 175 women). At MRI, longitudinal associations were found between disk degeneration and subsequent herniation (odds ratio [OR], 3.97 [95% CI: 3.41, 4.62]; P < .001), high-intensity zone (OR, 1.77 [95% CI: 1.49, 2.11]; P < .001), and Modic type 1 lesions (OR, 4.53 [95% CI: 3.53, 5.80]; P < .001) within the same vertebral unit. Modic type 1 lesions were associated with subsequent Modic type 2 lesions within the same unit (OR, 49.36 [95% CI: 34.66, 70.28]; P < .001). Herniations persisted over time (OR, 184.00 [95% CI: 154.00, 221.00]; P < .001). On radiographs, disk height loss was associated with osteophyte formation (OR, 4.33 [95% CI: 3.63, 5.17]; P < .001). MRI lesions were associated with the appearance of corresponding degenerative lesions on subsequent radiographs at the same level (OR, 2.49 [95% CI: 2.18, 2.83]; P < .001). Conclusion Long-term imaging analyses in axial spondyloarthritis demonstrated temporal relationships between spinal degenerative lesions on MRI scans and radiographs, highlighting the progressive nature of spinal degeneration. © RSNA, 2026 Supplemental material is available for this article.
To describe a multidisciplinary protocol for the resection and reconstruction of complex lateral skull base pathology, based on over two decades of experience in a high-volume tertiary referral center in the United Kingdom. Retrospective descriptive analysis of institutional practice. A high-volume tertiary skull base unit in the United Kingdom. This study presents a summary of clinical experience in managing lateral skull base pathologies-both benign and malignant-over a 20-year period. It outlines a multidisciplinary approach involving ENT, neurosurgery, plastic surgery, anesthesia, radiology, oncology, and specialist nursing teams. The institutional protocol for resection and reconstruction is described, including surgical planning, intraoperative decision-making, perioperative care, and long-term rehabilitation strategies. The integrated multidisciplinary protocol enabled safe and effective management of a broad range of lateral skull base lesions. The team achieved high rates of complete resection and functional reconstruction, with acceptable levels of morbidity. Complex anatomy, tumor extent, and reconstructive requirements were successfully navigated through coordinated team-based planning. The approach has been refined through iterative experience and now serves as a reference pathway for similarly structured centers. Effective management of lateral skull base pathology requires a highly coordinated multidisciplinary strategy. The described protocol, developed and implemented over two decades, offers a structured and reproducible approach that may serve as a valuable reference for other high-volume centers involved in skull base surgery.
In the desert areas with indigenous communities, they have a rich array of traditional knowledge regarding the usage of medicinal plants and this has become a major form of their primary health care practices. This broad ethnobotanical strategy in the desert ecosystems and the exploration revealed indigenous knowledge, sustainable resource use, and community well-being can be enhanced through the adoption of the traditions of healing. The data collection of the medicinal plants were conducted from Thal desert using semi-structured interviews, guided field interviews, direct observation, focus group discussions, and surveys, between spring and monsoon 2022.The analysis was done in terms of qualitative as well as quantitative indices; Use value (UV), Relative Frequency of citation (RFC) and Cultural Value Index (CVI). An extensive survey documented about 111 plant species of 26 families, of which Amaranthaceae, Asteraceae, Fabaceae and Euphorbiaceae, were mostly represented, which were typical practices found in Thal desert. Among others, it is worth noting that Tribulus terrestris, Tecomella undulata, and Tamarix aphylla were the most commonly used plants. The most used part of plants was leaves and herbal preparation of traditional remedies mainly the raw, powder and paste application form. In the quantitative analysis, Ziziphus nummularia was found to have the highest RFC value (0.52), while Iphione grantioides had the least RFC value (0.05),The survey uses quantitative ethnobotanical measures, such as the UV, RFC and CVI importance indices to measure and record the indigenous knowledge in a systematic manner in the context of primary health care. Folk tradition in the primary health care practices with an ethnomedical approach to the Thal desert is not only an improved way of improving the well-being of the community, but also an indication of a need to use resources in a sustainable manner.
Acinetobacter soli is an environmentally adaptable species increasingly recognized as an emerging pathogen in hospital settings, particularly in intensive care units (ICUs). In this study, we report the first A. soli isolate from an ICU patient that co-harbors three carbapenemase-encoding genes (blaNDM-1, blaIMP-14, and blaOXA-58) on a single plasmid. Whole-genome sequencing revealed that multidrug resistance in this strain is mediated by a 294,790 bp plasmid, pSLAB-A, carrying 16 antimicrobial resistance genes, including all three carbapenemases. Comparative plasmid analysis showed a highly conserved backbone but identified a unique ~40 kb multidrug-resistance region containing blaNDM-1, blaIMP-14, and eight additional resistance genes. Genetic context analysis indicated that insertion sequences (ISAba125 and ISAba3) and class 1 integrons contribute to the mobilization and accumulation of carbapenemase-encoding genes. Plasmid stability assays demonstrated that pSLAB-A remained stably maintained for more than 90 generations without antibiotic selection. A global survey of the NCBI database identified 15 A. soli strains carrying carbapenemase-encoding genes, most of which were isolated from China, with clinical specimens representing the predominant source. Seven carbapenemase-encoding genes were detected, with blaNDM-1 being the most prevalent. Among eight isolates with complete genomes, all carried carbapenemase-encoding genes on plasmids. Phylogenetic analysis revealed regional dissemination of a clonal lineage across hospitals in Zhejiang Province and sustained nosocomial transmission within a hospital in Taiwan. These findings suggest that the spread of carbapenem resistance in A. soli is largely driven by multidrug-resistance plasmids, facilitating clonal expansion in hospital environments and posing a growing challenge for antimicrobial therapy and infection control in ICUs.IMPORTANCECarbapenem-resistant A. soli is an emerging clinical concern, capable of causing severe invasive infections, including bacteremia, in intensive care unit settings, and its emergence poses substantial challenges to antimicrobial therapy. In this study, we demonstrate that carbapenem resistance in A. soli is predominantly mediated by the acquisition of multidrug-resistance plasmids carrying carbapenemase-encoding genes. Owing to its strong environmental persistence, A. soli can readily undergo nosocomial clonal dissemination once carbapenem resistance is acquired. Moreover, the spread of multidrug plasmids co-harboring multiple carbapenemase-encoding genes may accelerate the evolutionary trajectory of resistance in A. soli, further exacerbating the threat to clinical management. Given its demonstrated capacity to cause hospital-associated infections and to rapidly acquire multidrug resistance, A. soli warrants heightened vigilance from both clinical and public health perspectives.
Hepatic encephalopathy (HE) is a frequent and life-threatening neurological complication of acute liver failure (ALF) encountered in the intensive care unit and remains a major determinant of short-term mortality and long-term neurological outcomes. Increasing evidence indicates that HE in ALF is primarily driven by hyperammonemia, with synergistic contributions from systemic inflammation, cerebral hemodynamic dysregulation, metabolic failure, and osmotic imbalance. These interacting mechanisms promote astrocytic swelling, disruption of the blood-brain barrier, cerebral edema, and intracranial hypertension. In patients with ALF, early recognition of cerebral involvement and systematic exclusion of alternative causes of altered mental status are essential. Given the dynamic and heterogeneous neurological manifestations of HE, reliance on isolated clinical, biochemical, or radiological parameters is insufficient. Multimodal neuromonitoring-integrating neurological examination, ammonia kinetics, cerebral hemodynamic assessment, and neuroimaging-allows more accurate assessment of cerebral injury and supports timely, targeted intervention. This review summarizes current evidence on the pathophysiology of HE in ALF with a focus on mechanisms relevant to intensive care practice. We highlight evidence-based strategies for cerebral protection, including early and sustained control of hyperammonemia with continuous renal replacement therapy, optimization of cerebral perfusion and osmotic balance, selective use of plasma exchange, and structured neurocritical care. An integrated management framework is proposed to guide prognostication and inform timely decisions regarding advanced liver support and liver transplantation in the ICU setting.
Use of herbal and dietary supplements (HDS) is widespread among patients with chronic liver disease (CLD). Despite the potential for adverse effects (AEs) and drug interactions (ADRs), these products are often perceived as "natural," safe, and not requiring medical prescription. This study aimed to assess HDS, oligo and trace element consumption among patients with CLD, to examine sociodemographic correlates, to determine the extent to which use is overseen by general practitioners or specialists versus self-medication, and to document reasons for use and perceived benefits. Over a 6-month period, patients with CLD attending the outpatient clinic of the Internal Medicine and Hepatology Unit of the University Hospital of Palermo, along with their caregivers, were surveyed regarding their use of supplements. A self-administered questionnaire collected information on demographics, lifestyle habits, supplement use, motivations, perceived benefits, and prescription awareness. A total of 323 participants were enrolled: 220 (68.1%) were CLD patients and 103 (31.9%) were caregivers. Overall, 110 (34%) subjects, 39 patients and 71 caregivers, reported using at least one supplement. Consumption was slightly more frequent among caregivers than patients (37.9% vs 32.3% p = ns). Among users, HDS were the predominant products (87/110; 79.1%), followed by oligo and trace elements (36/110; 33.0%); 21/110 (19.1%) reported combined use. The most common reasons for supplement use were anxiety and sleep disorders (each 15/110; 13.6%), osteoporosis/osteoarthrosis (15/110; 13,6%), dyslipidemia (12/110; 10.9%), and dyspepsia (11/110; 10.0%). Compared with caregivers, patients more frequently used supplements for anemia (7.3%), anxiety (13.6%), and steatotic liver disease (7.3%). Perceived benefit was reported by 70.9% of users, whereas AEs and ADRs were uncommon (3.6%). Supplement consumption for liver steatosis was more common among males than females (14.3% vs 2.9%; p = 0.034). Osteoporosis-related supplement use showed a significant positive correlation with age (p = 0.019). Consumption of HDS, oligo and trace elements is common among CLD patients, and it increases with age. Their use appears driven by perceived health knowledge and a desire for well-being. Further studies are needed to enhance health education and prevent inappropriate or excessive use of these products.
Occupational noise in healthcare settings is a persistent workplace hazard that may adversely affect nurses and other healthcare workers. This clinical update reviews recent evidence on hospital noise sources, associated health risks, and practical strategies for prevention and management, with emphasis on implications for occupational health nursing practice. A narrative review of recent literature was conducted to examine occupational noise exposure in healthcare environments. Common hospital noise sources include alarms, conversations, patient activity, and equipment. Occupational noise exposure has been linked to hearing-related effects, stress, fatigue, reduced job satisfaction, impaired concentration, and alarm fatigue. Noise-reduction approaches include monitoring, alarm management, acoustic modifications, administrative controls, and staff education, although evidence for many interventions remains limited. Occupational noise exposure remains an important concern in healthcare settings and may affect worker well-being and aspects of care delivery. Occupational health nurses are well positioned to support monitoring, education, and interdisciplinary prevention efforts. More intervention research is needed to identify feasible, effective, unit-specific strategies.
Urinary incontinence (UI) is a frequent yet often underrecognized morbidity among postpartum women. Understanding its prevalence, trajectory, and risk factors is essential for informing preventive and management strategies. This study aimed to investigate the prevalence and progression of UI across four postpartum periods-first week (M1), first month (M2), first year (M3), and third year (M4)-and to identify predictors associated with UI persistence at three years postpartum. A prospective longitudinal cohort study was conducted including 139 women who completed the validated Portuguese version of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Data were collected at M1, M4, and at least one intermediate time point (M2 or M3). Descriptive statistics and logistic regression analyses were performed to assess prevalence patterns, symptom severity, and predictors of long-term UI. UI prevalence was highest at M1 (51.1%), declined at M2 (23.0%), increased again at M3 (41.2%), and stabilized at M4 (38.1%). Stress urinary incontinence was the predominant subtype across all time points. Symptom severity tended to progress from mild-moderate (M1-M2) to moderate-severe (M3-M4) among women with persistent symptoms. Higher body mass index (BMI) and gestational duration ≥ 39 weeks were independently associated with long-term UI, increasing the odds by approximately 13% per BMI unit and 3.7-fold, respectively. Persistent urinary incontinence remains relatively common up to three years postpartum, particularly among women with higher body mass index and longer gestational duration. Early postpartum screening may help identify women at increased risk of persistent symptoms, although the impact of specific therapeutic interventions was not assessed in this study. Promoting pelvic floor health awareness together with weight-management counselling within routine postpartum care may inform preventive strategies for postpartum continence care, although further interventional studies are required to confirm effectiveness.
Data describing the incidence and clinical outcomes of respiratory syncytial virus (RSV) infection among patients with inflammatory bowel disease (IBD) are limited. We conducted a nationwide retrospective cohort study using the Veterans Health Administration (VHA) database. Adults with IBD were identified using a previously validated algorithm and matched 1:2 to non-IBD controls using propensity score matching. Laboratory-confirmed RSV infections that occurred between January 1, 2021, and December 31, 2024, were identified using standardized laboratory codes and confirmed by manual chart adjudication. Primary outcomes included RSV incidence and hospitalizations. Secondary outcomes included intensive care unit (ICU) admission and patient outcomes stratified by IBD medication class. After propensity score matching, 52 740 IBD patients and 104 997 non-IBD controls were included. Infection with RSV occurred in 219 patients with IBD and 426 non-IBD patients. Incidence rates of RSV were similar between cohorts across all years in our study period. Hospitalization related to RSV occurred in 18.26% of IBD-RSV patients compared with 13.15% of non-IBD patients (P = .08). ICU admission was rare in both groups (<1%). Among patients with IBD, RSV-related hospitalization did not differ significantly by medication class, when comparing biologic therapy (8.93%) with 5-aminosalicylic acid monotherapy (17.58%) (P = .15). In this nationwide cohort, patients with IBD, with predominantly lower exposure to advanced therapies, did not have higher rates of RSV infection or worse clinical outcomes compared with matched non-IBD controls. RSV outcomes were similar across IBD medication classes. These findings support current vaccination recommendations and provide reassurance regarding RSV risk among patients with IBD. In this nationwide cohort of patients with inflammatory bowel disease (IBD), respiratory syncytial virus (RSV) incidence and clinical outcomes were similar when compared to those of matched non-IBD controls. RSV outcomes were also similar across various IBD medication classes.
Umbilical venous catheterization is a common procedure performed in intensive care units. Point-of-care ultrasonography enables efficient vascular access and reliable assessment of catheter tip position. This prospective study aimed to determine whether the angle formed between the terminal segment of the umbilical vein (UV) and the initial segment of the ductus venosus (DV) can predict successful umbilical venous catheter (UVC) placement in the inferior vena cava, and to evaluate the effectiveness of ultrasound-guided navigation. Between 2021 and 2023, 78 neonates in a single-center study underwent umbilical venous catheterization. Ultrasonography, performed by an experienced ultrasonographer, was used to assess UVC tip position, DV caliber, and the UV-DV angle. After identifying catheter tip malposition, infants were classified into two groups: low and correct catheter positions. Ultrasound-guided maneuvers were applied to achieve optimal tip placement. The umbilical vein-ductus venosus (UV-DV) angle differed significantly between low and correctly positioned UVCs, median 136.9° (IQR 128.8-151.5°) vs. 157.4° (IQR 151.4-164.6°), p < 0.001. In multivariable analysis, both the UV-DV angle (p = 0.0032) and ductus venosus caliber (p = 0.0047) were independent predictors of correct catheter positioning. The catheter was correctly positioned on the first attempt in 73% of cases, increasing to 85% after adjustment maneuvers. These findings highlight the usefulness of ultrasound navigation for effective UVC placement and the UV-DV angle appears to be a promising ultrasound marker for predicting optimal catheter positioning. The study was approved by the Bioethics Committee of the Medical University of Warsaw No. KB/110/2020 and retrospectively registered at ClinicalTrials.gov (NCT07434102) on 25.02.2026. • Umbilical venous catheterization is associated with complications related to incorrect catheter positioning. • Thoracoabdominal radiography has traditionally been used to assess UVC tip position; however, point-of-care ultrasound provides the most accurate evaluation. • The umbililcal vein-ductus venosus angle may serve as a novel ultrasound marker of difficult UVC advancement and may support bedside procedural planning. • Point-of-care ultrasound emerged as an essential tool for guiding maneuvers to achieve correct catheter positioning.
Breast abscesses are common benign surgical conditions, particularly among lactating women but they are increasingly recognized in non-lactational settings. Despite their clinical and psychosocial impact, management remains heterogeneous and lacks widely accepted guidelines. A structured narrative review (2012-2024) was conducted using PubMed, Scopus and Web of Science. Evidence from randomized trials, observational studies and systematic reviews was combined with the clinical experience of a high-volume tertiary Breast Unit to develop a multidisciplinary, ultrasound-based management algorithm. Across seven studies (including randomized trials, comparative studies, and a meta-analysis), US-NA demonstrated high resolution rates (85-92%) with shorter healing times and improved patient-reported outcomes compared with I&D. Surgical drainage remains the preferred treatment for collections > 5 cm, multiloculated or recurrent abscesses, particularly in non-lactational cases. Breast surgeons play a pivotal role in diagnosis, intervention selection and coordination of multidisciplinary care. The proposed algorithm provides a reproducible, evidence-based tool to standardize management. Multicenter, surgeon-led studies are needed to support international guideline development.
Brain-on-a-chip is a microphysiologic platform that comprises cultured brain cells to understand brain disease pathogenesis and treatment. The blood-brain barrier (BBB) of the neurovascular unit serves as a highly selective molecular transport interface for brain homeostasis. BBB dysfunction promotes neuroinflammation, exacerbates disease progression, and contributes to neurodegenerative diseases. However, the mechanisms of BBB disruption underlying brain disorders remain poorly understood; thus, developing neurotherapeutics that can effectively cross the BBB remains a major challenge. Recent advances in microfluidic brain-on-a-chip platforms now enable the creation of BBB-on-a-chip systems that replicate key structural and functional aspects of the human BBB under dynamic flow conditions. Integration of microelectrode arrays into these microfluidic systems enhances their utility by enabling high-throughput drug screening and targeted delivery, allowing real-time monitoring of neuronal activity and network behavior. Although current brain organoid, brain-on-a-chip, and BBB-on-a-chip platforms remain in developmental stages, significant progress has been made using induced pluripotent stem cell-derived neurons, astrocytes, endothelial cells, pericytes, and microglia from healthy individuals and patients with neurodegenerative diseases. This review highlights recent advances in brain- and BBB-on-a-chip technologies and their potential applications in studying disease pathogenesis and preclinical drug screening for neurodegenerative disorders.
Pediatric-acquired demyelinating syndromes, including multiple sclerosis (MS), aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) constitute distinct entities arising during critical periods of neurodevelopment. Early and effective treatment is therefore crucial to prevent long-term disability. Converging evidence supports a central role of B-cells in central nervous system autoimmunity, extending beyond antibody production to include antigen presentation, cytokine production, and T-cell modulation. B-cell-depleting anti-CD20 therapies are increasingly used in this setting, but the strength and consistency of evidence differ substantially across diseases and individual drugs. Available data indicate that anti-CD20 treatment provides significant suppression of relapses and MRI activity in pediatric MS. Rituximab, although used off-label, has shown a significant reduction in annualized relapse rates and inflammatory MRI activity across observational cohorts. Ocrelizumab has the most advanced pediatric evidence among approved anti-CD20 agents, including dose-selection data from OPERETTA I and comparative Phase 3 data from OPERETTA II, where it reduced MRI activity compared with fingolimod and showed sustained B-cell depletion. In contrast, evidence for ofatumumab in pediatric MS remains limited to very small case series, although dedicated pediatric trials are ongoing. No pediatric data are currently available for ocrelizumab or ofatumumab in AQP4+NMOSD or MOGAD. In pediatric AQP4+NMOSD, rituximab remains the best-supported anti-CD20 option, with observational studies showing relapse reduction and a close relationship between CD19-positive B-cell repopulation and breakthrough disease activity. In relapsing MOGAD, responses to rituximab are heterogeneous: some cohorts report reduced relapse frequency during sustained B-cell depletion, whereas others describe continued relapses despite treatment, suggesting that pathogenic mechanisms beyond CD20-positive B-cells, including long-lived plasma cells or non-B-cell immune pathways, may contribute to disease activity. Across pediatric cohorts, anti-CD20 therapies are generally well tolerated. Infusion-related reactions are common but usually mild, infections are typically non-severe, and hypogammaglobulinemia, leukopenia, delayed neutropenia, vaccine-response attenuation, and early B-cell repopulation require individualized monitoring. Upcoming trials of ofatumumab, ublituximab, and rituximab-based strategies in MOGAD will be critical to refine pediatric dosing, define biomarkers of treatment durability, and establish age-specific safety surveillance for the developing immune system. This review summarizes knowledge on B-cell maturation in early life and anti-CD20 treatment outcomes in pediatric patients with these conditions. Safety and tolerability considerations, optimal timing of therapy, and remaining gaps in evidence are also explored, highlighting the need for age-specific biomarkers and prospective studies to better define individualized treatment strategies and to clarify long-term consequences of B-cell-depleting therapies in children.
This cross-sectional study examined whether cumulative adverse social determinants of health (SDOH) were associated with accelerometer-derived rest-activity rhythms and multidimensional sleep metrics, and whether depression and overactive bladder statistically accounted for part of the SDOH-relative amplitude association in exploratory pathway analyses. We analyzed 6,130 U.S. adults aged 20-80 y (mean age 49.5 y; 51.7% female) from NHANES 2011-2014. From wrist-worn 7-d accelerometer recordings, nonparametric rest-activity indices (interdaily stability, intradaily variability, and relative amplitude) and sleep parameters (duration, efficiency, timing irregularity, social jetlag, and catch-up sleep) were derived. A composite SDOH score (0-8) was constructed across economic, educational, healthcare, housing, and social domains. In fully adjusted survey-weighted linear regression, each 1-unit higher SDOH score was associated with lower relative amplitude (beta = -0.007; 95% CI, -0.008 to -0.005), greater rhythm fragmentation, shorter sleep duration, lower sleep efficiency, and more irregular sleep timing. Graded associations were observed across SDOH quartiles. At the component level, unpartnered status, unemployment, and food insecurity showed the most consistent inverse associations with rhythm robustness. Exploratory pathway analyses were consistent with small indirect associations through depression severity and overactive bladder. Overall, greater cumulative adverse SDOH burden was associated with less robust, more fragmented rest-activity rhythms and poorer multidimensional sleep health.
Pharmacists' role in primary care has rapidly evolved in recent years, driven by pressures on primary care and supported by increased government funding, further enabling full scope of practice while reducing patient costs. To optimize healthcare delivery, the patient outcomes of pharmacist-led primary care in community settings must be evaluated. This scoping review aimed to identify and explore the breadth of patient health outcomes used to assess the quality, effectiveness, and safety of pharmacist-led primary care. A comprehensive search was conducted in four databases and Google for articles published from 1997 to July 2023, updated in February 2025. Database records were screened independently by two reviewers at two stages in Covidence. Google search results were screened by one reviewer, with selections verified by a second reviewer. Studies were included if they involved pharmacist-led primary care and reported patient health outcomes related to quality, effectiveness, and/or safety. Extracted data on study design, disease state, clinical services, and patient outcomes were categorized by two reviewers. Data are reported descriptively (frequencies, percentages) and are displayed using heat maps. Results were reported using PRISMA-ScR guidelines. A total of 299 studies (297 peer-reviewed, 2 grey literature) were included from 10,498 database records and 300 grey literature search results. Experimental study designs were the most common (61%) and increased in prevalence over the study period. Patient populations primarily comprised those with chronic diseases, primarily endocrine (27%) and cardiovascular (26%), with the volume of studies focused on these groups also increasing over time. Studies often evaluated multiple types of clinical service, with more focusing on education or counselling (29%) and chronic disease management (23%). A wide variety of outcomes were measured, with more than 70% being positive. The number of studies reporting outcomes increased markedly after 2002, particularly those examining clinical measures (29%), resource use (19%), and laboratory measures (14%). This scoping review identified patient health outcomes used to evaluate pharmacist-led primary care. Although studies on pharmacist-led clinical services have increased, the most assessed services may not reflect current practice. These findings should inform health system metrics grounded in outcomes that matter to patients to ensure safe, effective pharmacist-led care.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Psoriasis is an immune-mediated chronic skin disease associated with multiple extracutaneous comorbidities, causing a severe quality of life impairment, whose treatment with risankizumab, a humanized anti-IL-23 monoclonal antibody, is very effective, with good safety profile and long-term outcomes. However, prescription in a real-world setting is conditioned by local health care system constraints, as the proven ineffectiveness or appearance of adverse events to first-line drugs. Such delay and selection of multi-failure patients might affect efficacy and outcomes. A prospective multicenter study, approved by the Ethical Independent Committee of AOU Cagliari, acronym ESSOS-BIO-PSO, Prot N° 2023/2532, was conducted to evaluate risankizumab's effectiveness and safety in Sardinian psoriasis centers over 6, 12, and 24 months. 73 patients with moderate-to-severe psoriasis treated with risankizumab over at least 6 months were recruited, predominantly male (70%) with a median age of 50 years and a median disease duration of 22 years. Most patients had extensive, difficult-to-treat areas involved, psoriasis arthritis and other comorbidities. Prior treatments included traditional systemic therapies and biologics (60%). At week 52, 74% achieved PASI-90, increasing to 76.7% at week 104, with all initial PASI-90 responders maintaining the response. Faster and sustained responses were observed in biologic-naïve patients and those with shorter disease duration. The difference between groups was statistically significant at week 16 (Mann-Whitney P=0.042), identifying naïve patients as "super-responders." No severe adverse events occurred; risankizumab was well tolerated and adherence was 100%. This real-world study investigates effectiveness and safety of Risankizumab in a population with a distinctive historical and genetic background, as well as environmental factors which may influence disease patterns and response to treatments. This first Sardinian study confirms durable results with excellent adherence in moderate-to-severe psoriasis patients, regardless of prior treatments and comorbidities burden, although in biologic-naïve patients the response is quicker.
Valproic acid (VPA), a widely prescribed mood stabilizer and antiepileptic drug, is frequently associated with metabolic side effects, particularly weight gain. Despite its clinical relevance, the range and diversity of mechanisms underlying VPA-associated weight gain remain incompletely mapped. To map the breadth of evidence on mechanisms of VPA-associated weight gain, characterize the types of studies and populations investigated, and identify knowledge gaps to inform future research. This PRISMA-ScR-guided scoping review searched PubMed, Cochrane Library, Scopus, and Google Scholar for studies on VPA-weight gain mechanisms in adults. One reviewer charted data using a piloted form; two independently assessed quality (Newcastle-Ottawa Scale). Sources were grouped by mechanistic pathway with descriptive summaries and vote-counting. Fifteen studies (n = 1,339 participants) were included, representing diverse designs: cross-sectional (n = 4), prospective observational (n = 3), genetic association (n = 2), and others. Evidence mapped to three primary mechanistic domains: hormonal dysregulation (like elevated insulin, leptin, insulin resistance, and other findings); genetic predispositions, including CYP2C19 polymorphisms, CRTC1 methylation, and other genetic variants; and lipid metabolism alterations (increased TC, LDL-C, TG, FFAs; decreased Apo A1; mixed HDL-C findings). Hormonal and lipid pathways are well-documented, while genetic mechanisms require validation in larger, standardized cohorts. This scoping review identifies a heterogeneous evidence base with well-established hormonal and lipid mechanisms and emerging genetic pathways. Key gaps include underrepresentation of bipolar disorder populations, limited longitudinal genetic studies, and lack of integrated frameworks combining hormonal, genetic, and metabolic data. Findings inform future research priorities and highlight the need for personalized monitoring strategies.