Search Results (6,944)

Background/Objectives: Postoperative opioid requirements vary substantially after gastrointestinal surgery. Oxycodone-based patient-controlled intravenous analgesia (PCIA) is used for postoperative pain control, but perioperative factors associated with early postoperative oxycodone requirement remain insufficiently defined. This study investigated factors associated with 48 h oxycodone consumption after gastrointestinal surgery. Methods: This single-center retrospective cohort study included 493 adults who underwent elective gastrointestinal surgery and received oxycodone-based PCIA between January and December 2025. The primary outcome was cumulative oxycodone consumption within 48 h after surgery. Multivariable linear regression was used for the primary continuous-outcome analysis. An exploratory analgesia-adjusted model additionally included regional block, incisional local infiltration, and routine postoperative non-opioid analgesic use. High consumption, defined as a 48 h dose >38 mg, was evaluated using exploratory logistic regression models. Results: The median 48 h oxycodone consumption was 34 mg (interquartile range, 27–38 mg), and 105 patients (21.3%) had high consumption. In the prespecified clinical continuous-outcome model, gastric surgery, rectal surgery, open surgery, converted-to-open surgery, radical resection, and longer operation time were associated with higher 48 h oxycodone consumption, whereas older age was associated with lower consumption. After adjustment for available analgesia-related variables, the main associations remained broadly stable, although the association for converted-to-open surgery was attenuated. Regional block and incisional local infiltration were associated with lower 48 h oxycodone consumption in the analgesia-adjusted model. In the exploratory logistic models, younger age, rectal surgery, open or converted-to-open surgery, radical resection, and longer operation time were associated with high consumption. Body mass index (BMI) was not independently associated with oxycodone requirement. Conclusions: Age and procedure-related characteristics were associated with 48 h oxycodone requirement after gastrointestinal surgery. These routinely available perioperative factors may help identify patients who warrant earlier postoperative pain reassessment, closer acute pain service follow-up, and individualized multimodal analgesic planning. Prospective multicenter validation is required before formal risk-stratified analgesic protocols can be recommended. Full article

Background: Relative muscular function has emerged as a clinically relevant marker of muscle quality and health in obesity. However, limited evidence is available regarding age-related associations between relative handgrip strength and body composition outcomes in women with obesity. Methods: This cross-sectional study included 419 female outpatients with obesity (age range 18–80 years). Participants were stratified into age groups according to sample distribution. Body composition was assessed using Body Mass Index (BMI), waist circumference (WC), fat mass percentage (FM%), fat-free mass (FFM%), and waist-to-height ratio (WHtR). Relative handgrip strength (relative HST) was assessed together with balance performance (M-BESS), lower-body functional performance (5STS), and movement quality (FMS CS). Kruskal–Wallis analyses were performed for all functional measures. Age-stratified linear regressions and pooled models including relative HST × age-group interaction terms were used to examine associations with body composition outcomes; whole-sample models were additionally adjusted for age and physical activity level (IPAQ-SF). Results: Significant differences across groups were observed for BMI (p = 0.0006), FM% (p = 0.0308), relative HST (p = 0.0002), M-BESS score (p < 0.0001), and 5STS performance (p < 0.0001). Relative HST was significantly associated with lower FM% and higher FFM% across all age groups. In addition, significant associations with lower WC were observed in middle-aged and older women. However, pooled interaction analyses provided no evidence that the associations between relative HST and FM%, FFM%, WC, or WHtR differed significantly across age groups (p of all interactions > 0.29). Conclusions: Relative HST was associated with body composition outcomes across different age groups of women with obesity, but the strength of these associations did not differ significantly by age group. These findings suggest that relative HST may provide clinically relevant information beyond traditional anthropometric measures. However, prospective studies are needed to determine its potential clinical utility in individualized, person-centered obesity management. Full article

Background/Objectives: Inflammatory and metabolic abnormalities are common in patients hospitalized with heart failure (HF), particularly during episodes of decompensation. Their associations with short-term in-hospital outcomes remain incompletely understood. Methods: We retrospectively reviewed 499 patients with documented chronic HF who were admitted for acute medical conditions between January and May 2024. The cohort was not limited to patients admitted for HF exacerbation; patients were classified as having compensated or decompensated HF at admission. Body mass index (BMI) was available for 498 patients, whereas HF status at admission was available for all 499 patients. Clinical, metabolic, and laboratory parameters were analyzed, with particular attention to C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune–inflammation index (SII), and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Patients were stratified according to BMI category (<25 kg/m² or ≥25 kg/m²) and HF status at admission. Associations with all-cause in-hospital mortality were evaluated using multivariable logistic regression analysis. Results: Patients with decompensated HF at admission had higher CRP, NLR, PLR, SII, and NT-proBNP levels, as well as lower hemoglobin and eGFR values. All-cause in-hospital mortality was numerically higher in patients with BMI < 25 kg/m² than in those with BMI ≥ 25 kg/m² (8.4% vs. 4.2%), but the difference was not statistically significant (Pearson’s χ² test, p = 0.063). In adjusted analyses, CRP and SII were associated with all-cause in-hospital mortality, whereas NT-proBNP was not. Patients with higher BMI more often had glycemic and lipid abnormalities, whereas those with lower BMI had a more pronounced inflammatory profile. The apparent area under the curve (AUC) values were 0.793 for the CRP-based model and 0.814 for the SII-based model; after bootstrap correction, the optimism-corrected AUC values were 0.729 and 0.754, respectively. Conclusions: Higher CRP and SII levels were associated with all-cause in-hospital mortality after adjustment for selected clinical variables. Full article

Background and Objectives: Chronotype and sleep quality are related but non-identical dimensions of sleep health. We examined whether later chronotype is associated with subclinical visceral adiposity and atherogenic dyslipidaemia independently of perceived sleep quality, and whether this association differs by sex, in adults without previously diagnosed chronic disease. Materials and Methods: This single-centre cross-sectional study included 282 adults without previously diagnosed chronic disease or regular medication use. Chronotype was assessed with the Morningness–Eveningness Questionnaire (MEQ) and sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Composite cardiometabolic indices were calculated from routine anthropometric and biochemical data. Primary dependent variables were log-transformed Visceral Adiposity Index (log[VAI]) and Atherogenic Index of Plasma (AIP). Multivariable linear models used heteroscedasticity-consistent type 3 (HC3) robust standard errors and adjusted for age, sex, education, physical activity, and PSQI; body mass index (BMI) was additionally included in the AIP model. Sex × MEQ interactions, false-discovery-rate (FDR) correction, and glycaemic sensitivity analyses were performed. Results: Median age was 28.0 years; 50.4% were women, 25.9% were evening type, and 51.8% had poor sleep quality. Higher MEQ score (greater morningness) was independently associated with lower log(VAI) (B = −0.0096; 95% confidence interval (CI), −0.0159 to −0.0033; β = −0.190; p = 0.003) and AIP (B = −0.0035; 95% CI, −0.0063 to −0.0008; β = −0.160; p = 0.011), whereas PSQI was not independently associated with either outcome. Sex × MEQ interactions were nominally significant and estimates were stronger in women, but interaction terms did not survive FDR correction. Associations persisted after excluding diabetes-range glycaemia but attenuated in strictly normoglycaemic participants. Conclusions: Later chronotype was associated with a less favourable subclinical adiposity–atherogenic profile independently of perceived sleep quality. Findings are cross-sectional, and the sex-specific pattern is hypothesis-generating. Prospective studies with objective circadian, sleep, dietary-timing, behavioural, and hormonal measures are required. Full article

Background: Skeletal muscle index (SMI, kg/m²) derived from bioelectrical impedance analysis (BIA) is widely used to assess muscle mass. However, SMI is influenced by extracellular fluid, potentially leading to inaccurate estimation in patients with fluid imbalance. Intracellular water normalized by height squared (ICW/height², L/m²) may reflect intracellular body cell volume and provide complementary information to BIA-derived SMI, particularly in patients with altered hydration or low nutritional reserve. Based on these considerations, we hypothesised that ICW/height² would demonstrate stronger correlations with BMI than SMI, that the SMI–ICW/height² correlation would differ significantly by sex, and that hydration status (ECW/TBW) would modulate this relationship. Objective: To compare ICW/height² with SMI and evaluate their relationships with nutritional status and hydration in hospitalized patients. Specifically, we tested the hypotheses that (1) ICW/height² correlates more strongly with BMI than SMI; (2) the SMI–ICW/height² correlation differs significantly between sexes; and (3) ECW/TBW and sex interact to modulate the SMI–ICW/height² relationship. Methods: This single-centre, retrospective, exploratory cross-sectional study included 477 hospitalized patients (232 men and 245 women) who underwent body composition assessment using BIA. SMI and ICW/height² were examined in relation to body mass index (BMI) and hydration status assessed by extracellular water to total body water ratio (ECW/TBW). Correlation analyses were performed overall and stratified by sex, BMI categories (<18.5, 18.5–24.9, ≥25 kg/m²), and ECW/TBW groups (<0.36, 0.36–0.40, >0.40). Results: ICW/height² showed a stronger correlation with BMI than SMI in both men (R² = 0.492 vs. 0.338) and women (R² = 0.354 vs. 0.121). A strong correlation between SMI and ICW/height² was observed in men (R² = 0.634), whereas the correlation was weaker in women (R² = 0.316). In BMI-stratified analyses, the correlation between SMI and ICW/height² increased with higher BMI in men (R² = 0.192, 0.467, 0.791), while in women it was markedly attenuated in the low BMI group (R² = 0.134). Stratification by ECW/TBW showed that in men, the correlation remained strong under normal hydration conditions but was attenuated in the high ECW/TBW group. In contrast, in women, the correlation was weak even within the normal ECW/TBW range (R² = 0.336) and particularly poor in the low ECW/TBW group (R² = 0.060). Among women with normal ECW/TBW, those with low BMI demonstrated clear discordance between SMI and ICW/height². Exploratory four-quadrant classification using sex-specific SMI and ICW/height² thresholds further demonstrated that patients with discordant SMI and ICW/height² values had distinct BMI profiles, and BMI differed significantly among the four groups in both men and women (Kruskal–Wallis test, p < 0.001). Conclusions: These exploratory findings suggest that ICW/height² and BIA-derived SMI may show systematic discordance under specific clinical conditions, particularly in underweight or fluid-imbalanced hospitalised patients. Prospective validation against reference-standard body-composition measures is required before any clinical application. Full article

Background/Objectives: Universal screening for gestational diabetes mellitus (GDM) is performed at 24–28 gestational weeks, but recommendations for earlier risk stratification differ across guidelines. Overweight pregnant women (body mass index [BMI] 25.0–29.9 kg/m²) without established major GDM risk factors constitute a clinical gray zone for which current guidelines provide no explicit directive. We evaluated the first-trimester diagnostic performance of two composite anthropometric indices—the Body Roundness Index (BRI) and A Body Shape Index (ABSI)—for subsequent IADPSG-defined GDM within this specific clinical niche. Methods: This prospective single-center cohort study enrolled 198 consecutive overweight pregnant women without major GDM risk factors at 11 + 0 to 13 + 6 gestational weeks; 186 participants completed the 75 g OGTT at 24–28 weeks and were analyzed. Anthropometric measurements were obtained by trained nurses blinded to outcome. Glucose was assayed by hexokinase enzymatic reference method (intra-assay CV ≤ 1.5%). Discrimination, calibration, reclassification (NRI, IDI), decision curve analysis, and three independent internal validation procedures were performed. Results: GDM prevalence was 18.28% (34/186). BRI achieved an AUC of 0.905 (95% CI 0.835–0.974) and ABSI an AUC of 0.889 (95% CI 0.815–0.963), both significantly greater than BMI (AUC 0.705; DeLong p < 0.001). The optimal BRI cutoff of 4.45—interpreted as a cohort-specific analytic anchor rather than a transferable clinical threshold—yielded 85.3% sensitivity and 90.8% specificity. Adding BRI to BMI improved discrimination by 45.6% (IDI). Bootstrap optimism remained below 0.01 across all models. Conclusions: Following internal validation through bootstrap optimism correction and cross-validation, first-trimester BRI and ABSI provided strong supplementary risk stratification for GDM in overweight pregnant women without major risk factors. External validation in independent populations is required before clinical implementation. Full article

Objective: Fertility-preserving therapies are a potential option for selected patients with early-stage endometrial cancer and atypical endometrial hyperplasia/endometrial intraepithelial neoplasia. This systematic review aims to evaluate the impact of fertility-preserving strategies according to molecular subtype. Methods: A comprehensive search was conducted in PubMed, Cochrane Library, EMBASE, and Web of Science for English-language studies published until June 2024, investigating fertility-sparing treatments using endocrine therapy in early-stage endometrial cancer, considering molecular classification. The PRISMA checklist was followed, and the protocol was registered in PROSPERO (CRD42025649342). Data on body mass index (BMI), age, and molecular classification (POLE-mutant, non-specific molecular profile [NSMP], p53-abnormal, and mismatch repair deficient [dMMR]) were extracted. The study assessed objective response rates (ORR), pregnancy outcomes, and survival outcomes. Statistical analyses were performed using R software. Results: The search identified 941 articles, and 10 studies with 457 patients were selected for final analysis. Pregnancy outcomes were reported in three studies, whilst all reported ORR data. Baseline median age (dMMR 35 years, POLE-mutant 38.2 years, p53-abnormal 33.9 years, and NSMP 31.6 years) and BMI (dMMR 24.3, POLE-mutant 27.9, p53-abnormal 26.2, and NSMP 29.8) differed by molecular subtype. Aggregated full-term delivery rates from the three studies reporting pregnancy outcomes were 36.4% (4/11) for POLE-mutant, 22.1% (27/122) for NSMP, 14.3% (1/7) for p53-abnormal, and 4.0% (1/25) for dMMR tumours, but statistical comparison was not feasible due to small sample size. Overall response rate was highest in NSMP (87.4%) and POLE-mutant tumours (84.6%), while dMMR (59.3%) and p53-abnormal (58.8%) had significantly lower ORR (compared to NSMP, p < 0.001 and p = 0.03, respectively). Conclusions: These findings support the potential role of molecular classification in refining patient selection for fertility-sparing treatment in early-stage endometrial cancer. Pregnancy-related outcomes should be interpreted with caution given the limited available evidence. Full article

Previous studies have shown that physical activity (PA) can improve insulin sensitivity and reduce insulin resistance (IR), a key determinant of metabolic dysfunction. While the beneficial effects of PA are well-documented in adults, evidence regarding the relationship between PA intensity and insulin resistance in adolescents, particularly in North African populations, remains scarce. This study aimed to compare the effects of a 12-week school-based high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) intervention, versus usual physical education, on insulin resistance as assessed by the homeostasis model assessment of insulin resistance (HOMA-IR) in overweight and obese non-diabetic Moroccan adolescents. The study included 90 non-diabetic overweight and obese Moroccan adolescents aged 12 to 17 years. Participants were randomly assigned to three groups (HIIT, MICT, and control) within a 12-week school-based intervention. Insulin resistance was assessed using the HOMA-IR index. Linear regression models were used to examine the associations between exercise modality and HOMA-IR, adjusting for age, sex, baseline body mass index (BMI), and baseline HOMA-IR. Compared with the control group, both HIIT and MICT were associated with significant reductions in HOMA-IR. In the fully adjusted models, HIIT showed a greater decrease of −0.90 (95% CI: −1.07 to −0.72) (all p < 0.001) and MICT showed a decrease of −0.77 (95% CI: −0.94 to −0.61). Stratified analyses by BMI categories showed consistent improvements in insulin resistance for both overweight and obese adolescents. These findings suggest that school-based structured exercise interventions, particularly HIIT and MICT, independent of dietary modification, may contribute to improvements in insulin sensitivity and help reduce early metabolic risk in overweight and obese non-diabetic Moroccan adolescents. However, these results should be interpreted with caution given that dietary intake and other lifestyle factors were not strictly controlled. Full article

Pregnancy is associated with physiological adaptations in calcium metabolism and skeletal homeostasis that may result in temporary reductions in bone mineral density (BMD). However, routine skeletal assessment during pregnancy remains limited because dual-energy X-ray absorptiometry (DXA) involves ionizing radiation. This study aimed to compare bilateral femoral neck BMD and Z-scores in pregnant and non-pregnant women using Radiofrequency Echographic Multi-Spectrometry (REMS), a radiation-free ultrasound-based technology, and to assess correlation between bilateral measurements. In this cross-sectional study, 100 women were enrolled, including 40 pregnant women and 60 non-pregnant women with comparable age and body mass index (BMI). Bilateral femoral neck BMD and age-adjusted Z-scores were evaluated using REMS. Pregnant women had a mean age of 33 ± 5 years, pre-pregnancy BMI of 25.8 ± 6.5 kg/m², and gestational age of 21 ± 5 weeks, with no significant differences in age or pre-pregnancy BMI compared with controls. Pregnant women demonstrated significantly lower left femoral neck BMD than controls (0.805 vs. 0.862 g/cm²; p = 0.0018) and lower left femoral neck Z-scores (−0.08 vs. 1.18 SD; p = 0.003). A strong positive correlation between left and right femoral neck BMD was observed (R = 0.78). Similarly, right femoral neck BMD was significantly lower in pregnant women compared with controls (0.835 g/cm² vs. 0.892 g/cm²; p = 0.0026). The right femoral neck Z-score was 0.15 ± 1.15 SD in pregnant women and 1.45 ± 1.10 SD in controls (p = 0.002). REMS demonstrated the ability to detect differences in femoral neck bone parameters between pregnant and non-pregnant women while providing bilateral measurement consistency. These findings support the feasibility of REMS as a safe, radiation-free approach for assessing maternal skeletal status during pregnancy. However, the cross-sectional design and lack of longitudinal follow-up limit conclusions regarding the progression and reversibility of pregnancy-associated bone changes. Future prospective studies with larger cohorts and postpartum monitoring are needed to further define the clinical role of REMS in maternal bone health assessment. Full article

Background: Knee osteoarthritis (KOA) in people with overweight or obesity is clinically heterogeneous, reflecting mechanical loading, synovial and systemic inflammation, metabolic dysfunction, structural severity, and pain-related factors. We evaluated multidomain outcomes after semaglutide initiation and characterized clinically relevant response patterns. Methods: This retrospective, self-controlled cohort included 93 adults treated in routine rheumatology care; 88 completed a six-month follow-up. There was no untreated concurrent comparator; within-patient changes and exposure–outcome associations were therefore interpreted as non-causal. Changes in pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, anthropometry, inflammatory markers, glycated hemoglobin (HbA1c), lipids, dose exposure, and safety were evaluated. Joint multivariable models included percentage weight loss and maximum achieved dose. Exploratory K-means phenotyping integrated dose, weight loss, body mass index (BMI) decrease, visual analog scale (VAS) and WOMAC improvement, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and HbA1c reductions, with candidate solutions and resampling stability examined. Results: At six months, mean weight decreased by 10.88 kg, VAS pain score by 2.47 points, WOMAC total by 22.50 points, CRP by 2.67 mg/L, ESR by 7.62 mm/h, and HbA1c by 0.51 percentage points (all p < 0.001). Weight loss remained independently associated with WOMAC improvement, while achieved dose retained positive adjusted associations with pain, function, inflammatory, and metabolic changes. Exploratory clustering identified five clinically interpretable patterns along a broader response-intensity gradient, including high-burden multidomain response, high-dose concordant response, dose-modified intermediate response, inflammation-preserved response despite moderate weight loss, and dose-limited graded response. These observational coefficients and clusters cannot distinguish treatment-related effects from residual confounding or co-interventions. Conclusions: Substantial within-patient improvements were observed, but the uncontrolled design precludes causal attribution. The exploratory patterns may be compatible with contributions from baseline disease burden, dose exposure, mechanical unloading, and residual inflammatory variation; they do not establish weight-independent pharmacologic effects or validated patient subtypes. Prospective controlled, multicenter validation is required. Full article

Background/Objectives: Taste perception has emerged as a key determinant of eating behavior and metabolic regulation, but its relationship with body mass index (BMI) remains incompletely understood. We investigated the relationships among global, sweet, and lipid taste sensitivity; sweet- and lipid-taste-related polymorphisms; caloric intake; and BMI. Methods: Taste sensitivity was assessed using taste strips (overall and sweet) and detection thresholds for fatty acids (oleic, linoleic, and palmitic acids). Genotyping of polymorphism genes was conducted. Pearson correlation analyses examined bivariate associations between taste variables and BMI. Multiple regression models were performed to identify independent predictors of BMI and to evaluate the mediating role of caloric intake. Results: A strong inverse correlation was found between total and sweet taste sensitivity and BMI, particularly in super-tasters (STs) and participants with the sensitive genotype of sweet-taste-related polymorphisms. Similarly, greater sensitivity to fatty acids was associated with lower BMI, specifically in non-tasters (NTs) and participants with the insensitive genotype of CD36 polymorphisms. In multiple regression models, overall and lipid sensitivity were the most significant predictors of BMI, which were inversely associated with it. TAS1R2 and TAS1R3 also showed independent effects. Importantly, caloric intake was not retained in the final model. Conclusions: Taste sensitivity is inversely associated with BMI independently of caloric intake. These findings suggest that the gustatory system could influence body weight through mechanisms beyond energy consumption, probably involving food choice and extra-oral receptor-mediated metabolic regulation. Taste perception and related genetic factors may represent important targets for personalized nutrition and obesity prevention strategies. Full article

Background: The prevalence of pediatric obesity in Spain is among the highest in Europe. Although national surveillance reports a 4.5% decrease in excess weight, these primarily cross-sectional data may underrepresent the metabolic complexity observed in clinical settings. We aim to characterize the evolution of abnormal adiposity and to evaluate the transition probabilities between body mass index (BMI) categories in a multi-regional Spanish cohort. Methods: We analyzed Real-World Data (RWD) from 37,465 children and adolescents (ages 0–18) treated at HM Hospitales “Observatorio de la Obesidad Infantil,” between 2021 and 2026. Longitudinal BMI z-score trajectories were evaluated using continuous-time Markov chain models to determine transition probabilities between weight categories and identify developmental windows of adiposity plasticity. Results: At baseline, 21.6% of the cohort presented overweight/obesity, with a higher frequency of overweight in females than males (13.0% and 11.2%, respectively; p < 0.01) and obesity similar between sexes (~10%). Markov modeling identified a “critical window” in children aged 2–5, who demonstrated a 75% probability of reverting to a normal weight. Conversely, children aged 6–11 entered an “adiposity trap,” characterized by a 60.0% obesity persistence rate and a 23.2% risk of progressing from overweight to obesity. A sharp initial drop in z-scores was observed immediately following the baseline clinical assessment across all groups. Conclusions: Our study reveals a significant window of opportunity for abnormal adiposity improvement between the ages of two and five, which contrasts with the adiposity inertia (diminished category fluidity) observed after age five. Full article

Background: Postoperative hemoglobin (Hb) reduction reflects the physiologic extent of perioperative blood loss after total knee arthroplasty (TKA). Whereas previous studies have relied on transfusion as a binary endpoint, transfusion decisions are highly variable across institutions, obscuring the underlying hematologic trajectory. This study aimed to develop and interpret machine learning (ML) models to characterize and quantify the determinants of postoperative Hb reduction in a standardized cohort of non-transfused TKA patients. Methods: A retrospective cohort of 866 patients who underwent primary TKA under a standardized operative protocol—with identical cemented posterior-stabilized implants and uniform cementing technique—was analyzed (1 January 2014–31 March 2024). During the study period, a consistent 1 g intra-articular tranexamic acid (TXA) regimen administered through the drain was introduced and applied to a subset of patients, allowing TXA use to be modeled as a binary predictor. Four ML algorithms (Linear Regression, Random Forest, XGBoost, and Stacking Regressor) were trained using preoperative, demographic, and perioperative variables. Fivefold cross-validation assessed model performance, and SHapley Additive exPlanations (SHAP) values were used to identify influential predictors and enhance interpretability. Results: Across all ML models, preoperative Hb emerged as the strongest determinant of postoperative Hb reduction, followed by TXA use, body mass index (BMI), and platelet count. Ensemble models captured non-linear and interacting effects more effectively than linear regression. Test-set performance was modest (best R² = 0.330), consistent with the influence of unmeasured physiologic factors such as hidden blood loss, fluid dynamics, and inflammatory responses. Accordingly, the primary value of the framework lies in the exploratory and transparent assessment of determinant importance rather than in individual-level prediction. Conclusions: This study provides an interpretable, exploratory ML framework for identifying factors associated with percentage Hb reduction after TKA. Preoperative Hb was the dominant determinant, while TXA use and higher BMI were recurrently associated with smaller predicted percentage reductions. Given the modest test-set performance and the absence of external validation and clinical utility assessment, the models should not be interpreted as tools for individual-level prediction or clinical decision making. Full article

Background: Cetuximab-based therapies continue to play an important role in the management of recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) despite the increasing use of immunotherapy. However, data regarding treatment outcomes and prognostic factors remain limited. This study aimed to evaluate treatment outcomes and prognostic factors associated with survival in patients with R/M HNSCC treated with cetuximab-based regimens. Methods: This retrospective single-center cohort study included patients with recurrent/metastatic HNSCC who received cetuximab-based systemic therapy at the Department of Medical Oncology, Manisa Celal Bayar University Faculty of Medicine, between May 2012 and September 2025. Demographic, clinical, laboratory, and PET/CT data were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Prognostic factors associated with survival were evaluated using univariable and multivariable Cox proportional hazards regression analyses. Results: A total of 57 patients were included in the study. The median age was 65 years, and 91.2% of patients were male. Most patients had ECOG performance status 0–1 (94.7%) and stage IV disease (71.9%). The larynx was the most common primary tumor site (50.9%), while distant lymph node metastasis (63.2%) and lung metastasis (61.4%) were the predominant metastatic sites. Median PFS and OS were 4.6 months and 13.8 months, respectively. Kaplan–Meier analysis demonstrated that patients with a body mass index (BMI) > 25 had longer OS, whereas chronic kidney disease (CKD), primary tumor localization, and best response to first-line treatment were significantly associated with survival. In multivariable Cox regression analysis, chronic kidney disease (CKD) (HR: 5.15, p = 0.004), oral cavity primary tumor localization (HR: 2.55, p = 0.013), progressive disease as the best response to first-line treatment (HR: 4.44, p < 0.001) and the absence of grade 1–2 cetuximab-related dermatologic toxicity (HR: 3.20, p = 0.027) remained independent adverse prognostic factors. BMI was not independently associated with survival in multivariable analysis. Conclusions: Cetuximab-based therapy demonstrated clinically meaningful activity in patients with R/M HNSCC. Comorbidities, primary tumor localization, the absence of grade 1–2 cetuximab-related dermatologic toxicity and treatment response appear to substantially influence survival outcomes. Larger prospective studies are warranted to validate these findings. Full article

Chronic coronary syndrome (CCS) is characterized by persistent low-grade inflammation and impaired resolution of inflammatory responses within the vascular wall. Specialized pro-resolving mediators (SPMs), including resolvins and maresins, play an essential role in terminating inflammation and restoring tissue homeostasis. This prospective observational study included 83 patients hospitalized due to stable angina or angina-equivalent symptoms. Serum concentrations of leukotriene B4 (LTB4), maresin-1 (MaR1), resolvin E1 (RvE1), resolvin D1 (RvD1), and prostaglandin E2 (PGE2) were determined using enzyme-linked immunosorbent assays. Associations between mediator concentrations and clinical characteristics—including sex, age, and body mass index (BMI)—were analyzed using nonparametric statistical tests with false-discovery-rate correction. Women, patients ≥65 years of age, and individuals with BMI ≥ 30 kg/m² demonstrated significantly higher concentrations of LTB4, MaR1, and RvD1. In contrast, higher RvE1 concentrations were observed in men, younger patients, and those with a BMI < 30 kg/m². PGE2 levels did not differ significantly between the analyzed subgroups. Multivariable analysis identified age, LTB4, and RvD1 as independent predictors associated with coronary artery disease in the studied cohort. Circulating lipid mediator profiles differ according to sex, age, and obesity status in patients with chronic coronary syndrome. These findings demonstrate differential circulating lipid mediator profiles associated with age, sex, and obesity in patients with chronic coronary syndrome. Whether these profiles reflect adaptive inflammatory resolution or impaired resolution requires further investigation. Full article