Medicina, Volume 61, Issue 6 (June 2025) – 69 articles

Background and Objectives: Medical residency programs play a crucial role in emergency departments (EDs). However, clinical processes may differ between EDs staffed with medical residents and those staffed only by attending physicians. This study aims to compare clinical process times and clinical outcomes between these two types of EDs. Materials and Methods: A retrospective observational study was conducted, analyzing patients aged ≥ 18 years who visited an ED with a medical residency program and an ED staffed only by attending physicians. Time variables, including the time to first physician encounter, first order, CT order, consultation request, consulted specialist arrival, disposition decision, ED length of stay (LOS), and ED dispositions were compared between the two ED settings. Results: A total of 24,942 patients in an ED with a medical residency program and 19,867 patients in an ED staffed only by attending physicians were included in the final analysis. The ED with a medical residency program exhibited significantly longer times in all time variables including time to first physician encounter (7.0 [4.0–12.0] vs. 3.0 [1.0–5.0] min), first order (15.0 [9.0–23.0] vs. 9.0 [5.0–13.0] min), consultation request (95.0 [42.0–146.0] vs. 72.0 [27.0–124.0] min), consulted specialist arrival (156.0 [90.0–238.0] vs. 117.0 [63.0–176.0] min), and disposition decision (134.0 [70.0–208.0] vs. 92.0 [32.0–139.0] min). However, the proportion of discharges, admissions, and deaths were similar between the two EDs. Conclusions: The ED with a medical residency program may contribute to delays in clinical processing times; however, it appears to have no significant impact on clinical outcomes. Full article

Background and Objectives: Endovascular treatment (EVT) has been shown to enhance long-term recovery and lower mortality rates in patients with intracranial large vessel occlusion-associated acute ischemic strokes (AISs).We aimed to evaluate the predictive value of the pre-stroke CHA₂DS₂-VA, R₂CHA₂DS₂-VA, CHA₂DS₂-VASc, and R₂CHA₂DS₂-VASc scores in determining 90-day functional outcomes based on the modified Rankin Scale (mRS). Methods: In a single center between 2018 and 2023, 665 AIS patients who underwent EVT and achieved successful reperfusion were screened retrospectively. After inclusion and exclusion criteria, 583 patients were included. Based on 90-day mRS scores, patients were classified into two groups: good (mRS ≤ 2, n = 257) and poor functional outcomes (mRS 3–6, n = 326). The pre-stroke scores were calculated. Results: When ROC curve analysis was performed, R₂CHA₂DS₂-VA demonstrated the highest AUC value (p = 0.0443) among these scores. The optimal cutoff score was determined to be 4, yielding a sensitivity of 75.77% and specificity of 93.39%. In multivariable analysis, a higher R₂CHA₂DS₂-VA score was significantly associated with worse outcomes (OR = 1.637, 95%, CI: 2.436–5.510, p < 0.001). A longer onset-to-recanalization time (OR = 1.009, 95%, CI: 1.005–1.014, p < 0.001) and presence of hyperlipidemia (OR = 2.960, 95%, CI: 1.254–6.988, p = 0.01) were correlated with poor prognosis. Higher baseline NIHSS scores were associated with unfavorable outcomes (OR = 1.201, 95%, CI: 1.014–1.422, p = 0.034), and this association remained significant for NIHSS scores measured 24 h post-EVT (OR = 1.467, 95%, CI: 1.230–1.748, p < 0.001). Conclusions: The R₂CHA₂DS₂-VA score demonstrates superior predictive ability for 90-day functional outcomes in AIS patients treated with EVT, surpassing CHA₂DS₂-VASc and similar scoring systems. Full article

Background and Objectives: Infrapatellar fat pad impingement syndrome (IFPIS) is a relatively underdiagnosed cause of anterior knee pain. While conservative management is the initial approach, some patients require surgical intervention. This study aimed to evaluate the long-term clinical and radiologic outcomes following arthroscopic resection of the infrapatellar fat pad in patients with IFPIS. Materials and Methods: Eighteen patients (10 females, 8 males; median age 22) diagnosed with IFPIS and unresponsive to conservative therapy underwent arthroscopic partial or subtotal resection between 2007 and 2013. Diagnosis was based on physical examination (Hoffa’s test), MRI findings, and response to lidocaine injection. Clinical outcomes (VAS, IKDC-2000, Kujala, Lysholm, Tegner activity scores) and radiologic assessments (ISR, CDI, PFJ osteoarthritis grade) were evaluated preoperatively, at 2 years, and at a final follow-up (mean 148.7 months). Results: All clinical scores significantly improved postoperatively. VAS decreased from 7.25 ± 0.79 to 2.43 ± 1.50 at 2 years, and to 3.66 ± 1.50 at the final follow-up (p < 0.001). Similar long-term improvements were observed in the Kujala, IKDC-2000, Lysholm, and Tegner scores (all p < 0.001). Radiographic parameters including ISR and CDI remained stable, and there was no statistically significant progression in patellofemoral osteoarthritis. However, 5 of 18 patients (27.8%) reported persistent symptoms at long-term follow-up. Conclusions: Arthroscopic resection of the infrapatellar fat pad in patients with IFPIS showed favorable and sustained clinical outcomes over a 10-year follow-up, without significant radiological changes. These results suggest that arthroscopic resection is a viable treatment option when accurate diagnosis is established. Full article

Background: SARS-CoV-2 infection can lead to persistent or newly emerging symptoms lasting for months, a condition known as long COVID (LC). The pathophysiology of LC remains poorly understood, with cytokine dysregulation proposed as a key mechanism, although findings across the studies have been inconsistent. Patients and methods: We conducted a longitudinal study using the Olink^® Target 96 Inflammation Panel to assess cytokines in COVID-19 (COV) patients at three months and six months post-infection. These profiles were compared with those of individuals recovering from other upper respiratory tract infections (non-COV). Additionally, we analyzed differences between individuals with LC and those who recovered from COVID-19. Predictive models for LC at three months and sixth months post-infection were developed using inflammatory markers and relevant clinical cofactors, including gender, age, BMI, hemogram, Β2-microglobulin, D-dimers, LDH, AST, ALT, Ferritin, vitamin D, CRP, and the severity of acute COVID-19 infection as classified by WHO criteria. Results: We observed a general decline in inflammatory biomarkers in post-COVID-19 patients over time, with only a few cytokines elevated (CCL4 at month 3 and CST5 at month 6) compared to non-COV controls. In LC patients, an early phase of low-grade inflammation transitioned into significant reduction in proinflammatory biomarkers compared to recovered individuals. Rather than indicating immune normalization, this pattern suggests a possible suppression or exhaustion of the immune response in the months following acute infection. Importantly, our predictive modeling demonstrated that this specific cytokine signature, in combination with acute disease severity and clinical cofactors, described well the presence of LC. Conclusions: Our findings suggest that inflammation-related biomarker dysregulation following acute SARS-CoV-2 infection evolves dynamically over a six-month period. By the sixth month, compared to the third month, the presence of LC is more accurately predicted by a combination of persistent biomarker alteration and the severity of the initial infection, as defined by WHO criteria. This represents a novel insight, as previous studies have primarily associated LC with elevated proinflammatory markers, whereas our results suggest that immune suppression or exhaustion may play a more prominent role in the later stages. Full article

Background and Objectives: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. The etiology of PCOS is complex and is associated with low-grade chronic inflammation. The current study aimed to investigate inflammation markers in PCOS patients with and without metformin treatment. Materials and Methods: This cross-sectional study included 30 age-matched PCOS patients not receiving metformin treatment, 50 PCOS patients receiving metformin treatment, and 30 healthy controls. The groups were compared according to inflammatory (hs-CRP, NLR, and PLR) and metabolic parameters (lipids, fasting blood-sugar insulin, HOMA-IR). Results: Insulin (p < 0.001) and HOMA-IR (p < 0.001) score median values of PCOS patients were found to be significantly higher than the control group. CRP levels of PCOS patients receiving metformin treatment were found to be higher than both control and PCOS patients not receiving metformin treatment (p < 0.001). There was a significant difference between the groups in terms of PLR mean value (p = 0.031). The mean PLR value of PCOS patients, both those receiving metformin treatment and those not receiving treatment, was found to be significantly higher than the control group. In PCOS patients not receiving metformin treatment, there was a negative significant correlation between NLR and HDL level (r: −0.384; p: 0.036), NLR and insulin (r: 0.422; p: 0.020), and HOMA-IR score (r: 0.439; p: 0.015). There was a positive significant correlation between them. Conclusions: In the current study, PLR was significantly increased in all PCOS patients compared to controls. CRP levels in PCOS patients receiving metformin treatment were significantly higher than both control and untreated PCOS patients. PLR is positively associated with insulin and HOMA-IR scores in PCOS patients. Full article

Background and Objectives: The anterior cruciate ligament (ACL) is crucial for knee stability, preventing anterior displacement of the tibia and rotation relative to the femur. Despite ACL reconstruction (ACLR), residual instability is common, affecting knee function. Anterolateral ligament reconstruction (ALLR) alongside ACLR improves outcomes, as the ALL plays a significant role in rotational stability. This study aims to assess the clinical and functional outcomes of the ACLR+ALLR combination using biomechanical testing in patients with at least ten months of follow-up. Materials and Methods: This cross-sectional comparative cohort study involves patients with ACLR. Inclusion criteria were adult patients who underwent ACLR within the last 3 years, with the same surgical technique performed by a single operator. Patients underwent anamnestic and clinical evaluation and completed Lysholm and KOOS questionnaires. Biomechanical tests included a Unilateral Drop Jump, a Countermovement Jump with knee rotation, and a five-repetition Sit-To-Stand. Force platforms, a camera, and surface electromyography were used to assess biomechanical stability and joint function. Results: This study included 18 subjects, 5 with ACLR and ALLR, and 13 with ACLR alone. The groups showed no significant differences in the KOOS and Lysholm scales and clinical outcomes. Muscle trophism reduction compared to the contralateral limb was noted in both groups. Biomechanical evaluations showed no difference in Quadriceps muscle activity during the landing phase of the Drop Jump. However, the ACL-ALL group exhibited fewer spikes and fewer knee joint angular excursions during ground impact stabilization. In the 5-STS task, a significant difference was observed in the vertical force peak. Differences in muscle activity during foot rotation and force components during the jumping phase were noted in the Countermovement Jump. Conclusions: ACLR combined with ALLR shows similar perceived joint function but improved biomechanical joint stability. Further studies with larger samples and longer follow-ups are needed for validation. Full article

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive diagnostic and therapeutic procedure utilized in various thoracic conditions. VATS has grown in popularity with ever-expanding knowledge of enhanced recovery after surgery (ERAS) protocols and its benefits regarding patient care and outcomes. Pain control following VATS is of utmost importance to minimize the complication risk. Options for pain control following VATS have traditionally included systemic IV analgesia but have evolved to include loco-regional analgesia as well. The serratus anterior plane block (SAPB) is one form of loco-regional analgesia utilized in VATS that has been shown to provide effective pain control of the anterolateral chest wall. Patients who received SAPB compared to control methods of anesthesia demonstrated significant decreases in postoperative pain and postoperative opioid consumption. SAPB is effective and offers a promising safety profile as the block is typically more superficial than other types of loco-regional analgesia. This review outlines the recent literature surrounding the use of SAPB for pain control in VATS. Full article

Multisensory integration is fundamental for coherent perception and interaction with the environment. While cortical mechanisms of multisensory convergence are well studied, emerging evidence implicates specialized retinal ganglion cells—particularly melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs)—in crossmodal processing. This review explores how hierarchical brain networks (e.g., superior colliculus, parietal cortex) and ipRGCs jointly shape perception and behavior, focusing on their convergence in multisensory plasticity. We highlight ipRGCs as gatekeepers of environmental light cues. Their anatomical projections to multisensory areas like the superior colliculus are well established, although direct evidence for their role in human audiovisual integration remains limited. Through melanopsin signaling and subcortical projections, they may modulate downstream multisensory processing, potentially enhancing the salience of crossmodal inputs. A key theme is the spatiotemporal synergy between melanopsin and melatonin: melanopsin encodes light, while melatonin fine-tunes ipRGC activity and synaptic plasticity, potentially creating time-sensitive rehabilitation windows. However, direct evidence linking ipRGCs to audiovisual rehabilitation remains limited, with their role primarily inferred from anatomical and functional studies. Future implementations should prioritize quantitative optical metrics (e.g., melanopic irradiance, spectral composition) to standardize light-based interventions and enhance reproducibility. Nonetheless, we propose a translational framework combining multisensory stimuli (e.g., audiovisual cues) with circadian-timed melatonin to enhance recovery in visual disorders like hemianopia and spatial neglect. By bridging retinal biology with systems neuroscience, this review redefines the retina’s role in multisensory processing and offers novel, mechanistically grounded strategies for neurorehabilitation. Full article

Background and Objectives: Breast cancer remains one of the most prevalent malignancies affecting women and one of the most emotionally distressing diagnoses. Emerging evidence suggests that chronic psychological stress may influence cancer progression via neuroendocrine and immune mechanisms. This rapid narrative review explores three key arguments for integrating psycho-oncologists into the multidisciplinary care of breast cancer patients: (1) early detection and reduction of psychological distress, (2) improvement of treatment adherence, and (3) enhancement of quality of life through personalized psychological interventions. Materials and Methods: The review was conducted through comprehensive searches in PubMed, Scopus, and Web of Science for peer-reviewed articles published between 2010 and 2025. Inclusion criteria comprised randomized controlled trials, systematic reviews, meta-analyses, and theoretical papers. Of 246 identified articles, 50 met the inclusion criteria. Results: Selected studies show that psycho-oncological interventions—including cognitive–behavioral therapy, mindfulness-based techniques, narrative therapy, and guided imagery—significantly reduce anxiety, depression, and fear of recurrence. These approaches improve adherence to endocrine therapy and chemotherapy, enhance emotional resilience, and promote overall well-being. Also, recent research concepts emphasize the role of psycho-oncologists in encouraging post-traumatic growth and helping patients redefine cancer as an opportunity for transformation. Conclusions: Integrating psycho-oncologists into standard breast cancer care improves psychological and clinical outcomes. By addressing emotional distress, strengthening coping mechanisms, and supporting existential resilience, psycho-oncologists contribute to a holistic, patient-centered model of oncology care. Wider implementation of psycho-oncological services is warranted as a core component of comprehensive cancer management. Full article

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide, emphasizing the urgent need for reliable biomarkers for early diagnosis and prognosis. MicroRNA-141 (miR-141) is a small non-coding RNA molecule that plays a regulatory role in cell proliferation and differentiation and has been linked to various types of cancer. Objective: This study aims to evaluate the clinical and prognostic relevance of circulating levels of miR-141 in untreated patients with CRC. Method: A total of 40 patients with CRC and 20 healthy subjects matched for age and sex were selected for this study. Blood samples from these individuals were analyzed using real-time PCR to determine the levels of miR-141. Results: Despite the absence of any substantial correlations between levels of miR-141 and conventional prognostic factors, including disease stage, lymph node involvement, vascular/perineural invasion, or metastasis, a statistically significant correlation was identified between miR-141 levels and the extent of local tumor invasion (T stage) (p = 0.034). These findings suggest that microRNA-141 may be involved in local tumor infiltration and warrant further validation in larger, multicenter studies. Conclusions: Although miR-141 alone may not serve as a definitive biomarker for CRC diagnosis or prognosis, its potential role—particularly in combination with other markers—could contribute to refined risk stratification strategies in CRC management. Full article

Background and Objectives: Stroke is a common and fatal condition impacting millions worldwide. Understanding the risk factors, symptoms, and consequences at an earlier stage, specifically in highly at-risk populations such as smokers, is crucial for mitigating the stroke burden. Materials and Methods: A cross-sectional study was conducted in Saudi Arabia on more than 1000 smokers. The survey was randomly shared across the kingdom. Multiple logistic regression models were applied to assess the association and find the variables associated with poor stroke awareness. Results: The study included 1029 smokers, with 88% (904) being male. The majority (61%; 630) are between the ages of 18 and 30 years, with a university degree (84%, 862). Cigarettes (33.9%; 349), shisha (25.9%; 267), and e-cigarettes (40.1%; 413) were the most common smoking types. About 30% of smokers have never heard of stroke, and 44% were unaware that stopping smoking can prevent stroke. Smokers (55%) perceive smoking as the top risk factor, followed by heart disease (41%), and high blood pressure (40.8%), while 26% of the smokers did not identify any risk factors. Around 58% of the smokers did not identify any stroke symptoms. Only 20% of smokers were capable of identifying 50% of both stroke risk factors and symptoms. Around 8% reported all stroke-related consequences, whereas 44% were unable to identify any. Current smokers were more likely than ex-smokers to identify ≥1 stroke risk factor (OR = 1.95, p = 0.001), with no significant associations found for other variables. Males, university degrees, and current smokers were the only significant predictors for the identification of ≥1 stroke symptom. University education, current smokers, employment, and smoking types were significant predictors in identifying ≥1 stroke consequence. Compared to E-cigarette users, cigarette smokers exhibited twice the awareness of stroke consequences (OR = 2.01, p = 0.001), whereas shisha smokers demonstrated lower awareness (OR = 0.63, p = 0.01). Conclusions: Smokers’ awareness of stroke in Saudi Arabia is suboptimal. Targeted educational and smoking cessation initiatives are essential to address this gap and mitigate the impact of smoking-related strokes in Saudi Arabia. Full article

Background and Objectives: Our study aimed to retrospectively examine the routine radiographs on the first postoperative day of osteosynthesis applications performed in the supine position with the help of a traction table, in the lateral decubitus position, and in the supine position in patients with intertrochanteric fractures of the femur who had a proximal femoral nail applied. It also aimed to compare them in terms of radiology. This study investigated the effects of three different patient positions on fracture reduction, a topic rarely encountered in the literature. Materials and Methods: Patients who underwent proximal femoral nailing in three different positions—the supine, traction table, and lateral decubitus positions—due to femoral intertrochanteric fractures in two different centers were analyzed. A total of 157 patients with complete early radiographs were included in this study to evaluate the quality of postoperative reduction and fixation. Results: There was a significant difference between the traction table-assisted supine position group (mean: 25.31 mm) and both the lateral decubitus position (mean: 31.91 mm) and supine position (mean: 31.79 mm) groups in terms of the TAD (p = 0.000). Regarding the collodiaphyseal angle, the traction table-assisted supine position (mean: 130.720°) and lateral decubitus position (mean: 130.290°) groups showed significantly higher values than the supine position group (mean: 124.190°) (p = 0.000). The average lengths of the lag and compression screws were lower in the lateral decubitus position group compared with the other groups (p = 0.000). Patients in the supine position group had smaller nail diameters and lengths (p = 0.000). When examining the Cleveland–Bosworth lag screw placements, the most frequent position was center–center, including 22 patients (31%) in the traction table-assisted supine position group, 15 patients (30.6%) in the lateral decubitus position group, and 9 patients (24.3%) in the supine position group, though the difference was not statistically significant (p = 0.203). Among the reduction criteria we investigated, the TAD on the traction table was statistically significantly closer to the targeted measurement, with an average of 25.31 mm, compared with the other two positions (p = 0.000). The collodiaphyseal angle was significantly within the target range in the traction table-assisted supine group, averaging 130.720°, compared with the supine position (p = 0.000). In the traction table group, according to the modified Baumgaertner classification, 59.2% achieved a good reduction; according to the Ikuta classification, subtype N accounted for 69.4%; and according to the Cleveland–Bosworth classification, a center–center placement was present in 31% of patients. Conclusions: All three types of operation can be preferred according to the habits of the surgeon operating and the variables during the operation (the fracture type, history of orthopedic surgery, and the material components of the application phase). Accompanied by these data, we recommend the traction table operation as a priority and the lateral decubitus position operation as a second preference in compliance with the technical requirements. Full article

Background and Objectives: This meta-analysis aimed to determine whether pre-implantation uterine artery (UtA) Doppler measurements are associated with clinical pregnancy in women undergoing assisted reproductive technologies (ART). Materials and Methods: A systematic search of MEDLINE, Scopus, and the Cochrane Library from inception until 25 March 2025 was conducted to identify relevant studies. Additional records were retrieved through grey literature searching and manual reference checks. Eligible publications were observational studies or clinical trials that evaluated UtA Doppler indices prior to embryo transfer in adult women undergoing ART. Studies were required to report on clinical pregnancy rates, while those enrolling participants under 18 years of age, lacking Doppler data, or providing no pregnancy endpoints were excluded. Three reviewers independently assessed study quality using the Newcastle–Ottawa Scale and the Quality in Prognosis Studies tool. Meta-analyses were performed using a random-effects model to calculate mean differences (MDs) with 95% confidence intervals (CIs). Heterogeneity was examined via Cochran’s Q and the I² statistic. Sensitivity analyses excluded studies at high risk of bias. Results: In total, 12 studies met the inclusion criteria, including a population of 3317 women. Women who achieved clinical pregnancy had a lower mean UtA pulsatility index (PI) (MD, −0.26; 95% CI, −0.46 to −0.06) and a higher peak systolic velocity (PSV) (MD, 8.59; 95% CI, 2.31 to 14.87) than those who did not conceive. Subgroup analyses showed that UtA PI measured during the menstrual cycle was lower in clinical pregnancy cases (MD, −0.38; 95% CI, −0.66 to −0.10). Measurements on the day of hCG administration or the day before showed a non-significant difference in UtA PI (MD, −0.43; 95% CI, −1.03 to 0.17), while assessments on the day of embryo transfer showed no significant difference between groups (MD, −0.02; 95% CI, −0.28 to 0.24). Conclusions: This meta-analysis suggests that lower UtA PI and higher PSV prior to embryo transfer are associated with higher clinical pregnancy rates in ART, particularly when measurements are taken during the menstrual cycle. Although these findings highlight a potential role for uterine hemodynamics in successful clinical pregnancy, UtA Doppler alone may not be a reliable predictor. Future studies should focus on earlier-cycle Doppler measurements and their integration into multifactorial models to improve prognostic accuracy. Full article

Background and Objectives: Neuropsychiatric disorders, including schizophrenia, bipolar disorder, and major depression, constitute a leading global public health challenge due to their high prevalence, chronicity, and profound cognitive and functional impact. This systematic review explores the role of electroencephalography (EEG)-based cognitive biomarkers in improving the understanding, diagnosis, monitoring, and treatment of these conditions. It evaluates how EEG-derived markers can reflect neuro-cognitive dysfunction and inform personalized and scalable mental health interventions. Materials and Methods: A systematic review was conducted following PRISMA guidelines. The databases searched included PubMed, Scopus, PsycINFO, and Web of Science for peer-reviewed empirical studies published between 2014 and 2025. Inclusion criteria focused on EEG-based investigations in clinical populations with neuropsychiatric diagnoses, emphasizing studies that assessed associations with cognitive function, symptom severity, treatment response, or functional outcomes. Of the 447 initially identified records, 132 studies were included in the final synthesis. Results: This review identifies several EEG markers—such as mismatch negativity (MMN), P300, frontal alpha asymmetry, and theta/beta ratios—as reliable indicators of cognitive impairments across psychiatric populations. These biomarkers are associated with deficits in attention, memory, and executive functioning, and show predictive utility for treatment outcomes and disease progression. Methodological trends indicate an increasing use of machine learning and multimodal neuroimaging integration to enhance diagnostic specificity. While many studies exhibit moderate risk of bias, the overall findings support EEG biomarkers’ reproducibility and translational relevance. Conclusions: EEG-based cognitive biomarkers offer a valuable, non-invasive means of capturing the neurobiological underpinnings of psychiatric disorders. Their diagnostic and prognostic potential, as well as high temporal resolution and portability, supports their use in clinical and public health contexts. The field, however, requires further standardization, cross-validation, and investment in scalable applications. Advancing EEG biomarker research holds promise for precision psychiatry and proactive mental health strategies at the population level. Full article

Background and Objectives: The aging population and the COVID-19 pandemic have led to a rise in severe conditions, including musculoskeletal (MSK) disorders. Although MSK conditions are often managed in primary care, they may sometimes mask serious illnesses requiring urgent diagnosis. The red flag (RF) concept is essential for identifying signs and symptoms of potentially severe disease. However, RF criteria vary across clinical guidelines and lack consistency. With the growing role of direct access to physiotherapy—bypassing physician referral—physiotherapists must develop strong differential diagnostic skills to identify serious pathologies that mimic MSK disorders. This review aims to systematically map how RFs are defined in MSK clinical practice guidelines (CPGs), supporting the move toward a standardized definition for clinical and research use. Materials and Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane databases. Included studies were CPGs and systematic reviews (SRs) of CPGs addressing MSK disorders and incorporating the RF concept. Data extraction followed a rigorous process, and RF definitions were synthesized and compared in table format. Results: Out of thirteen-thousand three-hundred and ninety-three articles identified, fourteen met inclusion criteria (seven CPGs and seven SRs of CPGs), spanning both physiotherapy and medical fields. All definitions described RFs as signs or symptoms indicating possible serious pathology requiring further investigation or referral. Some definitions referred broadly to “patterns of signs or symptoms”, while others offered more precise criteria. Conclusions: This review highlights the lack of a standardized RF definition in MSK care, leading to inconsistencies in clinical decision-making and diagnosis. To improve patient safety and guide clinicians—especially in direct-access contexts—a unified, internationally recognized definition of RFs is needed in future guidelines. Full article

Background and Objectives: When pacemakers were first introduced, their indications and implantation techniques were quite limited. Over 400,000 permanent pacemakers are implanted annually worldwide, mostly under local anesthesia (LA), which is preferred for its hemodynamic stability. However, inadequate LA often leads to excessive use of local anesthetics or analgesics. This study evaluates the efficacy of combining interscalene brachial plexus block (ISB) and superficial cervical plexus block (SCPB) as regional anesthesia (RA) techniques during permanent pacemaker implantation compared to LA. Materials and Methods: A total of 42 patients were divided into RA and LA groups. The RA group underwent ISB and SCPB under ultrasound guidance, while the LA group received traditional local anesthetic methods. Results: The RA group exhibited superior pain control, reduced analgesic requirements, and higher satisfaction rates compared to the LA group. Ultrasound guidance enhanced block success rates and minimized complications. Conclusions: ISB and SCPB offer a superior alternative to LA for pacemaker implantation, especially in patients with anxiety or insufficient LA response. Full article

The importance of sleep has been reported for decades. Epilepsy is a heterogeneous disorder comprising multiple elements that might influence sleep and wakefulness. Notably, animal studies show disruptions of the circadian molecular system in different models of epilepsy, along with altered rest–activity and other circadian rhythms. So far, studies of molecular circadian systems in people with epilepsy are lacking, prompting further research. Seizures—the primary and most debilitating symptom of epilepsy—and interictal activity disrupt regular sleep and sleep–wake rhythms. Alterations in one’s sleep structure are seen in both drug-naïve and drug-resistant patients with epilepsy. In particular, low sleep efficiency, a reduction in total sleep time, and changes in sleep stages were found in both homogenous and mixed samples of epilepsy patients. Both ictal and interictal activity were also shown to be associated with changes in peripheral circadian phase biomarkers such as melatonin and cortisol. Moreover, epilepsy comorbidities, antiseizure medications, and a variety of syndromes can be a cause of sleep problems or even sleep disorders. Sleep disorders vary depending on various comorbidities and syndromes, and encompass all major groups of sleep disorders defined in the International Classification of Sleep Disorders. Controversial findings on the effects of various antiseizure medications were found in the literature. However, medications such as benzodiazepines, gabapentinoids, and barbiturates are particularly associated with excessive daytime sleepiness. Overall, a sleep evaluation must be included in the management of every patient with epilepsy. Full article

Background and Objectives: Shift work and night work are common among emergency physicians. It is necessary to provide continuous care to patients, especially with acute diseases, including throughout the night. Literature studies show that shift and night workers have an altered light exposure, timing of sleep and intake of food. The consequence of this desynchronization with the biological clock can lead these workers to be more exposed to developing some acute and chronic health conditions. In particular, the alteration of the sleep–wake cycle, fatigue, the shortened sleep duration and the misalignment of the body’s hormone production is a codified risk factor of gut dysbiosis that can lead to acute and chronic diseases, also gastrointestinal ones. The aim of this narrative review is to collect and summarize evidence about the association between the disruption of the circadian rhythm, sleep and food timing alterations, gut dysbiosis and the risk of gastrointestinal diseases among shift and night workers. Materials and Methods: we searched for evidence about the association of shift and night work, dysbiosis, gut microbiota and gastrointestinal diseases among shift workers in healthcare settings. Results: shift work and night work are associated with a higher risk of diseases, an inflammatory state and the alteration of the gut microbiota composition; but definitive data are still inconsistent. Conclusions: Until now, obtaining conclusive results in regard to the relationship between shift work, the gut microbiota and the increased risk of gastrointestinal disorders has been particularly complex and not yet feasible. More confirmatory studies are needed to better characterize risk factors and realize preventive measures. Full article

Background and Objectives: The comparative efficacy and safety of nivolumab plus ipilimumab (Nivo-Ipi) combination therapy between patients with either postoperative recurrent non-small cell lung cancer (NSCLC) or inoperable stage III/IV NSCLC have yet to be conclusively determined. Materials and Methods: This retrospective study reviewed the medical records of consecutive patients diagnosed with either postoperative recurrent NSCLC or inoperable stage III/IV NSCLC. Both groups, referred to as the postoperative and inoperable cohorts respectively, underwent Nivo-Ipi therapy at four Japanese medical institutions between December 2020 and November 2022. The study’s primary aim was to evaluate and compare the efficacy and safety outcomes across these two groups. Results: A total of 161 patients received Nivo-Ipi therapy (postoperative group, n = 30; inoperable group, n = 131). The objective response rate was comparable between the postoperative and inoperable groups (36.7% vs. 32.1%, p = 0.67). Median progression-free survival did not differ significantly between groups (8.9 months vs. 6.5 months, p = 0.14). However, median overall survival was significantly longer in the postoperative group (not reached vs. 13.0 months, p = 0.012). The incidence of grade ≥ 3 adverse events in the postoperative group included lung injury (13.3%), liver dysfunction (10.0%), adrenal insufficiency (6.7%), and colitis (6.7%). No significant difference was observed in the frequency of grade ≥ 3 treatment-related adverse events between the groups, and no treatment-related deaths occurred in the postoperative group. Conclusions: Patients with postoperative recurrent NSCLC treated with Nivo-Ipi demonstrated significantly longer overall survival compared to those with inoperable NSCLC. Given its favorable efficacy and acceptable toxicity profile, postoperative recurrent disease may warrant consideration as a stratification factor in clinical trials for advanced NSCLC. Nivo-Ipi therapy could serve as a preferred first-line treatment option for patients with postoperative recurrent NSCLC. Full article

Background and Objectives: Chronic kidney disease-associated pruritus (CKD-aP) is a burdensome symptom associated with impaired patient-reported outcomes. There is a paucity of research in this area with unclear aetiology, under-reporting of this symptom, and limited treatment options and management strategies in clinical settings. The objective of this study was to investigate the prevalence of CKD-aP, patient and dialysis-related factors associated with the occurrence of CKD-aP, and the correlation between CKD-aP severity and quality of life, sleep, anxiety, and depression. Materials and Methods: This cross-sectional study was conducted in 88 adult (≥18 years) patients undergoing haemodialysis at the outpatient dialysis centre at a major Australian tertiary care university teaching hospital. Demographic- and dialysis-related factors were obtained from electronic medical records and/or patients, while patient outcomes were determined from the self-reported questionnaires; 5-D itch scale, EQ-5D-5L, Patient Health Questionnaire-9, and Beck Anxiety Inventory. We compared demographic, patient-, and dialysis-related factors associated with CKD-aP. Results: Out of 88 patients, 67 (76%) agreed to participate in the study. In total, 27 patients (40%) reported having CKD-aP. Most participants experienced moderate CKD-aP severity (n = 12), followed by severe or very severe (n = 9) and mild (n = 6) symptoms. Whilst there was no significant difference in the demographic characteristics, number of medications, dialysis vintage, and Kt/V, a higher number of pruritic participants experienced obstructive sleep apnoea. There was a statistically significant correlation between CKD-aP severity and depression scores (p = 0.009). However, there were no significant correlation between CKD-aP and HRQOL (p = 0.506). The correlations between CKD-aP severity and outcomes such as sleep and anxiety were also not statistically significant, although they were marginally close (p = 0.069 and p = 0.095, respectively). Conclusions: This study reports a substantial prevalence of CKD-aP reported among patients undergoing HD and the association of severe CKD-aP with depression. Despite the limitation of a small sample size from a single dialysis centre, our findings suggest that the severity of CKD-aP may have implications for patient-reported outcomes. This warrants further investigation in larger-scale studies to better understand the association and optimise outcomes. Full article

Aims: This study aimed to evaluate whether the pan-immune inflammation value (PIV) has prognostic value for major adverse cardiac events (MACEs), including stroke, rehospitalization, and in-hospital and one-year all-cause mortality, in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods: A total of 152 patients undergoing TAVI were retrospectively analyzed and stratified into two groups based on a PIV cutoff value of 488. Baseline clinical, laboratory, echocardiographic, and procedural characteristics were compared. Clinical outcomes, including mortality, cerebrovascular events, and bleeding complications, were assessed. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent mortality predictors and evaluate the predictive performance of PIV. Results: Among the 152 patients (mean age 77 ± 7 years; 59.9% female), 52 (34.2%) had a PIV ≥ 488. These patients had significantly higher rates of diabetes mellitus (62% vs. 38%, p = 0.006), chronic kidney disease (31% vs. 12%, p = 0.005), and chronic obstructive lung disease (31% vs. 15%, p = 0.022), along with higher STS scores (16.3 vs. 11.7, p = 0.003). Inflammatory markers were elevated, and lymphocyte and hemoglobin levels were reduced in the high PIV group (p < 0.001). Patients with PIV ≥ 488 experienced significantly higher one-year mortality (58% vs. 4%, p < 0.001), in-hospital mortality (21% vs. 2%, p < 0.001), rehospitalization (29% vs. 4%, p < 0.001), ischemic cerebrovascular events (12% vs. 4%, p < 0.001), and major bleeding (10% vs. 2%, p = 0.034). Multivariable analysis identified age (OR: 1.108; 95% CI: 1.010–1.217; p = 0.031) and PIV (OR: 1.006; 95% CI: 1.003–1.008; p < 0.001) as independent mortality predictors. The PIV showed a strong predictive performance (AUC: 0.90, p < 0.001), with 88% sensitivity and 81% specificity. Kaplan–Meier analysis showed significantly lower survival in the high PIV group (p < 0.001). Conclusions: A high preprocedural PIV is an independent predictor of MACEs, in-hospital, and one-year mortality in AS patients undergoing TAVI. Full article

Background and Objectives: Chronic kidney disease (CKD) is an increasingly significant global public health issue, with cardiovascular disease being the leading cause of mortality. Endothelial dysfunction plays a critical role, but diagnostic tools have certain limitations. Endocan, a soluble proteoglycan, emerged as a promising endothelial dysfunction marker and potential major adverse cardiovascular event (MACE) predictor in haemodialysis (HD) patients. Materials and Methods: In this single-centre, observational, prospective study, non-diabetic HD patients without prior MACEs were monitored. A total of 75 participants met the inclusion criteria. We measured serum endocan, standard biochemical and anthropometric parameters, and parameters of peripheral and central haemodynamics before and after HD in all participants. Results: Patients with higher endocan were older, had elevated CRP and reduced albumin concentrations, and often had a tunnelled central venous catheter (TCVC) for vascular access. Higher serum endocan levels were independently associated with an increased risk of MACEs (aHR = 4.09, 95%-CI: 1.72–9.74), MACE-related mortality (aHR = 2.64, 95%-CI: 1.23–5.66), and all-cause mortality (aHR = 1.86, 95%-CI: 1.07–3.23), both before and after adjusting for predefined confounders, with the highest endocan tercile exhibiting the shortest event-free survival. Conclusions: Endocan is a valuable marker of inflammation and endothelial dysfunction in non-diabetic HD patients. Its elevated concentration indicates an increased cardiovascular risk and more frequent MACEs. Future multicentre studies with repeated endocan assessments should validate its prognostic and diagnostic utility, particularly in long-term patient follow-up. Full article

Background and Objectives: Healthcare-associated infections (HAIs) are on the rise worldwide because the range of etiologic agents involved is very diverse and their antimicrobial resistance poses a threat to population health in the third millennium. Materials and Methods: We conducted a retrospective, longitudinal, descriptive clinical–epidemiological study in a hospital with a neurosurgical profile in northeastern Romania (“Prof. Dr. N. Oblu” Clinical Emergency Hospital in Iasi), during 2020–2024. The study is centered on the involvement of Acinetobacter spp. in the occurrence and evolution of HAIs. Results: The highest incidence of Acinetobacter spp. HAIs was recorded in the intensive care unit (ICU)—82.78% compared to neurosurgical wards (15.38%), with predominance in males (69.23%) and rural residence patients (55.67%). Most HAIs were represented by ventilator-associated pneumonia (42.13%) and lower respiratory tract infections (23.08%). Strains with high virulence and pathogenicity (CR-MDR, ESBL-MDR) were found, with the highest proportion of CR-MDR strains (88.27%). Conclusions: Our study provides useful data for surveillance of the antimicrobial resistance of pathogens involved in HAIs at the hospital level and for guiding antibiotic therapy in hospital-acquired infections. Full article

Background and Objectives: This study aimed to investigate the prognostic value of the hemoglobin–albumin–lymphocyte–platelet (HALP) score—a marker reflecting both inflammatory and nutritional status—in patients with metastatic non-small cell lung cancer (NSCLC) undergoing immunotherapy. We also sought to determine whether dynamic changes in the HALP score during treatment could predict therapeutic success and help distinguish between pseudoprogression and hyperprogression. Materials and Methods: A retrospective analysis was conducted on 160 patients diagnosed with metastatic NSCLC and treated with immunotherapy at the Ankara Atatürk Sanatorium Training and Research Hospital. Chemotherapy regimens, metastatic sites, baseline and third-month hemograms and biochemistry parameters, and survival data were recorded. Survival outcomes were analyzed using the Kaplan–Meier method with the log-rank test and the Cox proportional hazards regression model using IBM SPSS Statistics. Results: The median overall survival (OS) for the entire cohort was 15 months (95% CI: 11.88–18.12). HALP1 score (p = 0.048), HALP2 score (p = 0.026), and hyperprogression (p < 0.001) were statistically significant predictors of OS. Regarding progression-free survival (PFS), the HALP2 score (p = 0.031), line of immunotherapy (p = 0.046), and hyperprogression (p < 0.001) were found to be significant. When comparing patients with increasing versus decreasing HALP scores, those with increasing HALP scores demonstrated significantly better outcomes for both OS (p = 0.034) and PFS (p = 0.007). Conclusions: In patients with metastatic NSCLC undergoing immunotherapy, the HALP score and its dynamic alterations during treatment appear to be non-invasive, easily calculable biomarkers that may predict both OS and PFS. Full article

Background and Objectives: Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant may offer a viable alternative to conventional rotator cuff repair. Most notably, it offers potential advantages, particularly in reducing postoperative pain and promoting faster recovery. Accordingly, this study aims to evaluate the clinical outcomes of treating bursal-sided partial-thickness rotator cuff tears using bioinductive collagen implants alone, without concurrent rotator cuff repair. Materials and Methods: We followed 32 patients who had bursal-sided partial-thickness rotator cuff tears (Ellman grade I or II) and received conservative care for more than six months but continued to experience symptoms. These patients received surgery using bioinductive collagen implants without rotator cuff repair, and we followed up on their postoperative prognosis for at least one year after surgery. For a more accurate contrast, we performed clinical evaluation preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Western Ontario Rotator Cuff (WORC) score were used as assessment tools in this study. As for radiological outcomes, magnetic resonance imaging (MRI) and ultrasonography were helpful. This supported our assessment of graft integration and failure. Results: These 32 patients included 13 with Ellman grade I tear and 19 with grade II tear. In both cases, they underwent surgery only using bioinductive collagen implants, and any anchor-based cuff repair was completely excluded. As for VAS (3.8 ± 2.9), certain statistically significant improvements were found starting at 2 weeks postoperatively. On the other hand, the scores of ASES (58.6 ± 20.3), SANE (60.1 ± 23.2), and WORC (59.8 ± 22.4) began to indicate a significant improvement starting at 6 weeks postoperatively (p < 0.001), showing continuous progress. At each final step, we confirmed that there were no cases of graft failure by radiological evaluation and found successful healing indicators, such as much less pain in all patients. Conclusions: The findings of this study provide the clinical evidence that a surgery using bioinductive collagen implant for bursal-sided partial-thickness rotator cuff tears is a highly effective treatment option in patients unresponsive to conservative therapy. Particularly, its practical clinical effectiveness includes facilitating rapid recovery without a significant risk of complications. Full article

Background and Objectives: The myocardial performance index (MPI) is a diagnostic tool that assesses both the systolic and diastolic function of ventricles. The MPI provides a comprehensive view of the overall efficiency of the heart’s pumping ability, making it a valuable tool for detecting early signs of heart dysfunction, even in the absence of overt symptoms. In this regard, we aimed to explore the relationship between the triglyceride–glucose (TyG) index and subclinical heart failure (HF), as well as its correlation with the MPI, in asymptomatic patients visiting a routine cardiology outpatient clinic. The study specifically excluded individuals with known diabetes, hypertension, and HF, focusing instead on those who had undergone 12 h fasting blood glucose (FBG) and triglyceride (TG) tests. Materials and Methods: The study included 125 patients with FBG, TG, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) data after the exclusion criteria were applied. Results: When asymptomatic patients were categorized as MPI normal or MPI (+) subjects, significant differences were found between the groups in terms of body mass index (BMI), metabolic syndrome (MetS) components, and serum TG values. Pearson correlation analysis revealed a significant and positive correlation between the MPI and TyG index (r = 0.358, p < 0.001). Regression analysis was used to determine the effective parameters in subclinical left ventricular dysfunction (SCLVD). In univariate regression analysis, obesity, the presence of MetS, serum TG, and the TyG index were identified as risk factors. In multivariate regression analysis, the TyG index was found to be the independent risk factor. Conclusions: The positive association found between the MPI and TyG index suggests a link with metabolic disorders and myocardial performance. Obesity, the presence of MetS, serum TG, and the TyG index were identified as risk factors for SCLVD in asymptomatic patients. Notably, the TyG index was identified as an independent risk factor for SCLVD, highlighting its potential role in the early identification and risk stratification of individuals at risk for cardiac dysfunction. These findings suggest that monitoring the TyG index could provide valuable insights into subclinical heart dysfunction, particularly in patients with metabolic abnormalities. Full article

Background and Objectives: Angular modifications in the physiological curvatures of the spine have been associated with spinal dysfunction and altered biomechanics, which may contribute to musculoskeletal complaints. The main objective of this experimental study was to investigate the association between lumbar lordosis and thoracic kyphosis angles and muscle activations during three different lower back exercises. Materials and Methods: Participants were divided into a hyperlordotic lumbar angle group—with increased thoracic kyphosis (n = 11)—and a normal lordotic lumbar thoracic angle group (n = 11). Thoracolumbar muscular activities during three different exercises were measured by surface electromyography. Results: Muscular activity was less in almost all exercises (except iliocostalis lumborum-pars lumborum) in the hyperlordotic lumbar angle/increased thoracic kyphosis group (p < 0.05). The unstable superman exercise was the exercise that produced the most muscular activity in both groups (p < 0.05). Conclusions: The study analyzed the association between lumbar lordosis, increased thoracic kyphosis, and muscle activations during specific lower back exercises. These findings highlight the relationship between spinal alignment and muscular responses during functional tasks, which may inform future biomechanical research or rehabilitation strategies. Full article

Background and objectives: Brachial plexus block is one of the most effective anesthesia and analgesia methods for upper extremity surgeries across different age groups. However, the number of studies on this block in children is insufficient. The aim of this study was to retrospectively analyze and discuss the efficacy and safety of ultrasound (US)- and Ultrasound with nerve stimulator (US + NS)-guided infraclavicular brachial plexus block (ICB) in pediatric patients. Materials and Method: In this study, we retrospectively analyzed the data of 240 pediatric patients admitted to our clinic between October 2020 and April 2023, 120 of whom underwent US-guided ICB and 120 who underwent US + NS-guided ICB. Results: Demographic data of both groups who underwent US and US + NS-guided ICB were similar. The mean procedure time was 6.1 ± 0.8 min for the US group and 8.31 ± 0.82 min for the US + NS group (p < 0.001). The mean operative time was 62.4 ± 11.3 min in the US group and 62.4 ± 9.5 min in the US + NS group (p = 0.73). Intraoperative and postoperative opioid and additional analgesia use and pain scores at 1, 3, 6, 9, 12, 15, and 24 h were recorded in both groups. The mean duration of the motor block (MBD) was 6.20 ± 0.95 h in the US group and 6.29 ± 0.88 h in the US + NS group (p = 0.46). The mean duration of sensory block (SBD) was 9.38 ± 2.13 h in the US group and 9.53 ± 2.05 h in the US + NS group (p = 0.38). Conclusions: In pediatric patients, US and US + NS-guided ICB applications are effective and safe in ease of application, prolonged analgesia, and low complication rates. In skilled hands, US-guided ICB can be as effective as US + NS-guided ICB. Further prospective studies with more significant patient populations are needed to validate these findings. Full article

Background and Objectives: Postoperative atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG), and is particularly associated with poor outcomes. Heart rate variability (HRV), a non-invasive marker of autonomic function, has been proposed as a tool to predict AF risk, but its utility in off-pump CABG remains unclear. This study aimed to evaluate the predictive value of preoperative HRV parameters, including nonlinear metrics, for postoperative AF in patients undergoing off-pump CABG. Materials and Methods: We prospectively enrolled 67 patients undergoing elective off-pump CABG. HRV was assessed using 15 min high-resolution ECGs. Linear and nonlinear HRV parameters were analyzed. Postoperative AF was monitored through continuous ECG (days 0–4), daily 12-lead ECGs (days 5–7), and a 24 h Holter ECG on day 7. Statistical comparisons between AF and non-AF groups were performed, and the predictive accuracy was evaluated using ROC analysis. Results: Postoperative AF occurred in 40.3% (n = 27) of patients. Standard HRV measures (total power, frequency components, LF/HF ratio) did not differ significantly between groups. However, preoperative DFA Alpha 1 was significantly lower in patients who developed AF (p = 0.010) and showed the highest predictive value (AUC = 0.725, specificity = 80%). Alpha 1 also remained significantly reduced postoperatively in the AF group. Other nonlinear parameters, such as low and average fractal dimension, were also lower postoperatively in the AF group. Conclusions: Traditional HRV parameters showed limited predictive value for postoperative AF following off-pump CABG. The nonlinear DFA Alpha 1 index demonstrated a moderate predictive performance and may serve as a useful marker of autonomic dysregulation. Incorporating nonlinear HRV measures into preoperative assessment may improve AF risk stratification. Full article

Background and Objectives: Chromobox 1 (CBX1), a key epigenetic regulator involved in chromatin remodeling, has been implicated in various cancers; however, its role in liver hepatocellular carcinoma (LIHC) remains underexplored. This study aimed to investigate the expression patterns, epigenetic regulation, and non-coding RNA (ncRNA) networks involving CBX1 in LIHC, assess their potential as diagnostic and prognostic biomarkers, and explore their relevance as a putative therapeutic target. Materials and Methods: A multi-omics bioinformatics approach was employed using datasets from GEPIA2, OncoDB, UALCAN, Human Protein Atlas, KM Plotter, MethSurv, miRNet, and ENCORI. These databases were used to analyze mRNA and protein expression, DNA methylation, prognosis, and interaction networks involving CBX1 and ncRNAs. Results: CBX1 was significantly upregulated in both the mRNA and protein expression in LIHC. Upregulated CBX1 expression was associated with poor prognosis. DNA methylation analysis revealed that both hypermethylated and hypomethylated probes were significantly associated with CBX1 expression and poor prognosis. hsa-miR-212-3p and hsa-miR-132-3p were significantly upregulated in LIHC and were positively correlated with CBX1 expression and poor prognosis. The ncRNA network was identified, including long ncRNAs, circular RNAs, and pseudogenes, many of which were linked to tumor progression and poor prognosis, and competing endogenous RNAs were associated with tumor progression and poor prognosis in LIHC. Conclusions: CBX1 was significantly overexpressed in LIHC and was regulated by both DNA methylation and ncRNA interactions. Its expression is closely associated with a poor prognosis. The CBX1–micro-RNA–long ncRNA/circular RNA axis is a promising avenue for the development of novel diagnostic and therapeutic strategies. This study provides system-level insights into the regulatory landscape of CBX1 in LIHC and supports its potential role in precision medicine. Full article