Search Results (9,355)

Cancer during adolescence and young adulthood (AYA; 18–39 years) can disrupt age-related milestones and impair social functioning. Many AYA patients report unmet social support needs and relationship changes, leading to isolation. This mixed-methods study explores social challenges among AYA patients actively seeking support through a communication tool, the ‘AYA Match app’, supporting communication with loved ones. Upon downloading the app, participants completed questionnaires on social support (MOS-SSS) and social functioning (EORTC CAT) and open-ended questions about social challenges. Eligibility included a first cancer diagnosis at AYA age and fluency in Dutch. The findings show that cancer negatively affected AYA patients’ social functioning. Physical limitations and difficulty relating to peers caused isolation and feelings of loneliness. Some preferred solitude or withheld emotions to protect loved ones. Challenges included forming new relationships, feeling left behind as peers reach milestones, and struggling with a changed life perspective. Participants with children reported less social support. This study highlights the complex social challenges AYA cancer patients face. While support from loved ones is crucial, it may not always be effective. Personalized interventions like peer support, improved family communication, and tailored digital tools are needed to improve social well-being and quality of life in AYAs with cancer. Full article

Background. Oncological diseases are among the leading causes of death in people living with HIV (PLWH). With the introduction of antiretroviral therapy and the consequent reduction in AIDS-defining cancers (ADC), there has been a growing incidence of non-AIDS-defining cancers (NADC). Methods. A retrospective observational study (cross sectional prevalence analysis) was conducted to investigate the prevalence and spectrum of oncological diseases in patients attending the HIV/AIDS Division at the Ferrara Hospital. The sample included 534 patients evaluated between January 2023 and November 2024 (534/682 met eligibility). Demographic, clinical, and serological data were extracted from medical records. The CDC’s 2014 definition has been adopted for the ADC/NADC classification. Statistical analysis was performed using SPSS version 29 and G*Power 3.1 software. Results. The data analysis revealed 62.8% NADC vs. 37.2% ADC (44 NADCs vs. 26 ADCs). Male individuals and those aged 50 and older were more represented. Patients with ADC more often fell into C2–C3 groups, indicative of severe immunodeficiency, while NADCs were more prevalent in clinical groups A1–B3. Statistical analysis showed that viral load was more frequently under 50 copies/mL in the NADC group, while it tended to be higher in the ADC group. Conclusions. These results align with current scientific evidence regarding the global prevalence of ADCs and NADCs. The findings highlight the need to implement targeted oncological screening strategies for HIV-positive patients to promote early diagnosis and improve prognosis. Full article

Background/Objectives: Cytokines play a fundamental role in the tumor microenvironment, influencing breast cancer progression, metastasis, and therapeutic resistance. The objective of this systematic review and meta-analysis was to evaluate the prognostic impact and therapeutic relevance of key cytokines in breast cancer, based on human studies published between 2015 and 2025. Methods: We systematically searched PubMed, Web of Science, and Scopus for eligible studies reporting on cytokine expression and clinical outcomes in breast cancer. Inclusion criteria were based on the PRISMA framework, focusing on human cohorts and excluding in vitro or animal models. Data were extracted on cytokine types, measurement methods, patient population, and outcomes. Meta-analyses were performed using random-effects models for cytokines with sufficient data, notably IL-6 and TNF-α. Results: Twenty-three studies were included. Elevated IL-6 was consistently associated with poor overall survival (pooled HR = 2.25, 95% CI 1.83–2.76), while high TNF-α levels showed a trend toward worse outcomes but without statistical significance. IL-1β, IL-8, and IL-10 were also linked to increased metastasis and reduced response to therapy. Immunosuppressive cytokines such as IL-10 and TGF-β facilitated tumor immune evasion, while IL-17 promoted inflammation and angiogenesis. Cytokines such as IL-12 and IFN-γ were associated with improved immune responses and a favorable prognosis. Conclusions: Cytokines are central mediators of breast cancer progression and immune regulation. Elevated levels of pro-inflammatory and immunosuppressive cytokines correlate with poor outcomes and may serve as prognostic biomarkers and therapeutic targets. Their integration into personalized treatment strategies holds significant clinical potential but requires further prospective validation and biomarker standardization. Full article

Background: The depressed population needs to be treated and they do not have access to evidenced-based psychological practices (EBPPs). The consequences lead to significant daily impairments and huge economical costs. A large amount of research has focused on the demand for a more extensive use of EBPPs. However, despite these practices being essential to the mental health system, EBPPs are poorly applied in clinical settings. This situation has led to the development of Implementation Research (IR), a scientific field that aims to address the challenge of translation and identify the factors involved in the implementation process. Several implementation studies have been carried out in the field of health. However, the evidence from implementation studies of psychological treatments addressing depression has not yet been summarized. The aim of this study is to conduct a systematic review to assess implementation studies that use EBPPs to address depression. Methods: A systematic review was conducted following the PRISMA guidelines, including implementation studies that applied EBPPs to address depressive disorders. The following databases were used: PubMed, Embase, APA PsycInfo, Cochrane Central, Scopus, and Web of Science. Two independent reviewers revised the studies to determine whether the eligibility criteria were met. Results: A total of 8797 studies were identified through database searches. After removing duplicates, a total of 3757 studies were screened based on titles and abstracts. Finally, 127 full-text articles were reviewed, yielding 31 studies that satisfied the inclusion criteria. Conclusions: This review offers valuable insights into the current state of IR in the implementation of EBPPs for treating depressive disorders. It underlines the necessity for a standardized nomenclature for study designs within the realm of IR and emphasizes the potential of hybrid efficacy–implementation studies to help close the gap between research and clinical practice. Despite the challenges encountered, this review points to a positive outlook for the use of IR in clinical psychology. A gradual adoption of IR is likely to strengthen its role in psychology and support the development of more effective strategies for implementing evidence-based interventions in clinical settings. Full article

Background/Objectives: This systematic review aimed to evaluate the effectiveness and predictability of lower incisor intrusion with clear aligners in permanent dentition, addressing one of the most challenging aspects of vertical tooth movement control in the mandibular anterior region. Methods: A comprehensive literature search was conducted across five databases (PubMed, Scopus, Embase, and Cochrane) according to PRISMA guidelines. Eight clinical studies fulfilled the eligibility criteria. Risk of bias was assessed using ROBINS-I, and certainty of evidence was graded with GRADE. Key outcomes included the amount of achieved versus planned intrusion, predictability, treatment protocols, use of auxiliaries, and patient-related factors such as age and compliance. Results: Reported mean intrusion values ranged from 0.4 to 1.5 mm, with predictability between 35% and 65%. The effectiveness of intrusion was influenced by the magnitude of planned movement, auxiliaries (e.g., attachments, elastics), refinement strategies, and patient-specific factors. Substantial heterogeneity was present in measurement methods (CBCT, cephalometry, digital models) and clinical protocols (aligner change intervals, refinement frequency), preventing meta-analysis. Seven of the eight studies were rated as having a serious risk of bias, and the overall certainty of evidence was moderate to low. Long-term outcomes and patient-centered measures were not adequately assessed. Conclusions: Within the limitations of the available evidence, lower incisor intrusion with clear aligners may be considered a feasible orthodontic option when supported by biomechanically informed clinical management. However, conclusions should be interpreted with caution due to heterogeneity, high risk of bias, and lack of long-term data. Further standardized studies with longer follow-up are required to strengthen reliability and clinical applicability. Full article

Purpose: We aimed to systematically review the current literature on the bond strength between custom tray materials and impression materials, including the various parameters affecting the strength. Methods: Four electronic databases were used: Ovid, Web of Science, PubMed, and Scopus. Relevant studies were chosen based on their eligibility, determined through inclusion and exclusion criteria. This review followed the PRISMA strategy. A risk of bias assessment was produced to evaluate the validity of each study. Results: There were 173 initial relevant studies identified, and after the screening process, this was reduced to seven. Two additional studies were also included from hand searching, resulting in total nine studies to be included in the review. Four of the nine evaluated studies concerned additively manufactured (AM) materials, including acrylonitrile butadiene styrene (ABS), polyethylene terephthalate glycol polyester (PETG), high-impact polystyrene (HIPS), and polylactic acid (PLA). Five studies evaluated an auto-polymerizing resin and one a thermoplastic material. All studies used polyvinyl siloxane impression materials and an adhesive selection following manufacturers’ recommendations. Three studies used scanning electron microscopy (SEM) to analyze their specimens. All studies reported a low risk of bias. Conclusions: Surface roughening was shown to reduce the strength of the bonding interface, whereas combining chemical and mechanical retention was shown to increase the bond strength. Inconsistent results exist in determining if AMed (3D-printed) tray materials are comparable or perform better than the conventional tray materials, highlighting the need for further study. Clinical Significance: The bond strength of the custom tray to the dental impression material is critical as it affects the model produced and therefore the final prosthesis. It is therefore invaluable to use materials with high bond strength for the construction of custom trays. Full article

Background and Objectives: Urinary tract infections (UTIs) are a major cause of emergency department (ED) visits and hospital admissions among older adults. Although most seniors present hemodynamically stable, a sizeable fraction deteriorate during hospitalization, and no ED-specific tool exists to identify those at greatest risk. We sought to determine risk factors for in-hospital mortality in this population and to develop a predictive model. Materials and Methods: We analyzed the MIMIC-IV-ED database (2011–2019) and enrolled culture-confirmed UTI patients aged ≥ 65 years who were hemodynamically stable—defined as a systolic blood pressure ≥ 100 mm Hg without vasopressor support. Demographics, comorbidities, triage vital signs, and initial laboratory tests were extracted. Least Absolute Shrinkage and Selection Operator (LASSO) regression with 10-fold cross-validation was performed for variable selection. Discrimination was quantified with the C-statistic, calibration with the Hosmer–Lemeshow test, and clinical utility with decision curve analysis. Internal validation was assessed via 1000-sample bootstrap resampling. Results: Among 1571 eligible encounters (median age 79 years, 33% male), in-hospital mortality was 4.5%. LASSO selected eight variables; six remained significant in multivariable analysis: age, systolic blood pressure, oxygen saturation, white blood cell count, red cell distribution width, and blood urea nitrogen. The predictive nomogram demonstrated a C-statistic of 0.73 (95% CI 0.66–0.79) and outperformed traditional early warning scores. Conclusions: A six-variable nomogram may stratify mortality risk in hemodynamically stable older adults with UTI. Because the model was developed in a single U.S. tertiary-care ED, it remains hypothesis-generating until validated in external, multicenter cohorts to confirm generalizability. Full article

The relationship between exercise and immune function has been widely studied, yet findings remain inconsistent regarding how different exercise modalities and intensities influence acute and chronic immunological responses. Previous reviews have often focused on single exercise types or limited outcomes, leaving a gap for an integrated synthesis. This narrative review aims to address this gap by summarizing and comparing immunological effects across aerobic exercise, resistance training, high-intensity interval training (HIIT), blood flow restriction (BFR), isometric exercise, mind–body interventions, and hypoxic training. A structured narrative approach was adopted. Literature published between January 2000 and December 2024 was searched in PubMed, Scopus, and Web of Science. Experimental and observational studies on humans and animal models were included, with study selection and data extraction performed by two reviewers. Findings were synthesized thematically by exercise modality to capture both acute and chronic immune responses. Twenty-four eligible studies were identified. Aerobic and mind–body exercises consistently demonstrated anti-inflammatory and immunoprotective effects, including increased IL-10 production, improved T cell profiles, and reduced inflammatory markers. Isometric training showed favorable modulation of cytokines and T cell balance, while resistance training evidence was limited but suggested cortisol-lowering benefits. HIIT, BFR, and hypoxic exercise produced mixed results, often combining transient pro-inflammatory responses with immunological benefits. Acute and chronic immunological responses to exercise are highly modality- and intensity-dependent. Aerobic and mind–body interventions provide the most consistent benefits, whereas HIIT, BFR, and hypoxic training show variable effects. Further high-quality trials are needed to clarify mechanisms and guide exercise-based immune recommendations. Full article

Background: Neuroendocrine neoplasms (NENs) are a diverse group of malignancies in which somatostatin receptor expression can be crucial in guiding therapy. We aimed to evaluate the effectiveness of [^99mTc]Tc-EDDA/HYNIC-TOC SPECT/CT in differentiating neuroendocrine tumor histology, selecting candidates for radioligand therapy, and identifying correlations between somatostatin receptor expression and non-imaging parameters in metastatic NENs. Methods: This retrospective study included 65 patients (29 women, 36 men, mean age 61) with metastatic neuroendocrine neoplasms confirmed by histology, follow-up, or imaging, comprising 14 poorly differentiated carcinomas and 51 well-differentiated tumors. Somatostatin receptor SPECT/CT results were assessed visually and semiquantitatively, with mathematical models incorporating histological, oncological, immunohistochemical, and laboratory parameters, followed by biostatistical analysis. Results: Of 392 lesions evaluated, the majority were metastases in the liver, lymph nodes, and bones. Mathematical models estimated somatostatin receptor expression accurately (70–83%) based on clinical parameters alone. Key factors included tumor origin, oncological treatments, and the immunohistochemical marker CK7. Associations were found between age, grade, disease extent, and markers (CEA, CA19-9, AFP). Conclusions: Our findings suggest that [^99mTc]Tc-EDDA/HYNIC-TOC SPECT/CT effectively evaluates somatostatin receptor expression in NENs. Certain immunohistochemical and laboratory parameters, beyond recognized factors, show potential prognostic value, supporting individualized treatment strategies. Full article

Background: Breast cancer is the most frequently diagnosed cancer in women, and advances in genetic screening have led to a growing number of patients being identified as BRCA mutation carriers. For these women, the safety of pregnancy following cancer treatment remains insufficiently studied, and possible biological mechanisms—including defective DNA repair pathways and accelerated depletion of the ovarian reserve—may influence fertility potential and pregnancy outcomes. This exploratory research set out to examine whether BRCA status impacts reproductive outcomes in breast cancer survivors, while also considering underlying biological explanations for any observed differences. Methods: We performed a retrospective, single-institution cohort study involving young women with non-metastatic breast cancer who had undergone BRCA testing over a 17-year period. Clinical, oncologic, and reproductive data were collected and patients were followed longitudinally. Results: Of the 117 women who met eligibility criteria, 15 conceived at least once after cancer therapy; 11 carried no BRCA mutation, and 4 were BRCA-positive (2 with BRCA1 and 2 with BRCA2 variants). While the overall cohorts were broadly comparable, significant differences emerged in terms of tumor grade, hormone receptor status, HER2 expression, and treatment modalities. BRCA mutation status did not appear to influence reproductive outcomes, and all pregnancies in both groups progressed to full-term delivery without major obstetric complications or congenital anomalies. Conclusions: Within the limitations of a small, retrospective, single-center dataset without adjustment for confounding variables, these preliminary findings suggest that pregnancy after breast cancer may be safe for BRCA mutation carriers, with no apparent adverse effect on maternal prognosis or birth outcomes. Confirmation from larger, prospective, multicenter studies is essential to validate these results, clarify possible biological mechanisms, and inform evidence-based fertility counseling and survivorship planning for this patient population. Full article

Background: Shift work, especially during nighttime hours, disrupts the circadian system and is linked to higher rates of metabolic, gastrointestinal, cardiovascular, and neurocognitive disorders. Emerging evidence suggests that gut microbiota may mediate these associations. This systematic review assessed whether shift work alters gut microbiota composition and explored potential health consequences. Methods: A systematic search was conducted in PubMed, Scopus, and ScienceDirect from inception to March 2025. Studies reporting gut microbiota alterations in adult shift workers were included. Two reviewers independently screened articles and extracted data. Risk of bias was assessed using the NIH Quality Assessment Tool and the ROBINS-E framework. Five studies met the eligibility criteria and were included in the final synthesis. Results: The selected studies comprised four observational investigations with small sample sizes and one Mendelian randomization study leveraging large-scale genetic datasets. Observational studies reported reduced α-diversity and increased relative abundance of pro-inflammatory genera—including Escherichia/Shigella, Blautia, and Dialister—in night shift workers. These microbiota alterations were associated with gastrointestinal complaints and indicators of cardiometabolic dysfunction. The Mendelian randomization study provided preliminary evidence supporting a causal relationship between circadian misalignment, gut dysbiosis, and increased cardiovascular risk. Conclusions: Shift work is associated with significant alterations in gut microbiota composition that may contribute to adverse health outcomes. However, current evidence is limited and heterogeneous, preventing firm causal conclusions. Further high-quality longitudinal and interventional research is needed to clarify underlying mechanisms and inform preventive strategies. Full article

Identifying strategies to enhance patient engagement and to control healthcare costs promotes a responsive and efficient healthcare system. The aim of this study is to predict healthcare cost savings associated with delivering telehealth advance care planning (ACP) to patients living with dementia. Two Geriatrics Workforce Enhancement Programs delivered training to primary care providers on using telehealth to provide ACP. Using electronic health records data from 6344 dual-eligible Medicare/Medicaid patients receiving telehealth primary care from trained providers in an urban safety net system, persons living with dementia (n = 401) were identified by extracting ICD-10 codes. The primary outcome was the estimated hospitalization-associated cost, with a key independent variable of ACP billing status. Multiple linear regressions and machine learning techniques estimated the impact of telehealth ACP on hospitalization-associated costs with a differential analysis by race. Compared to non-Hispanic Whites, hospitalization costs among Hispanic elders were higher by USD 14,232.40. Costs for non-English speakers or those having increased comorbidities were higher by USD 27,346.60 and USD 26,072.70, respectively. Overall, receiving ACP was associated with lower costs of USD 23,928.84. Dementia patients seen by primary care providers in a system receiving training to offer ACP via telehealth realized significant cost savings, with marked differences among those of non-White racial backgrounds. Full article

Background: Football has a high injury risk due to speed and contact, and injury patterns may vary by playing position. Positional roles affect physical and physiological demands and may influence injury characteristics. Although this has been examined in professionals, data from amateur players are scarce. This study examined the incidence, type, and severity of injuries among amateur footballers in Greece with respect to playing position. Methods: A retrospective epidemiological study analyzed musculoskeletal injuries in 222 amateur male football players during the 2022–2023 season. Data were collected via a CHERRIES-compliant online survey (SurveyMonkey^®) from May to July 2023. Eligible participants were active male athletes aged ≥18 years competing in amateur Greek leagues. Injuries were defined according to the FIFA–UEFA consensus and expressed as incidence rates per 1000 h of exposure. Statistical analyses used SPSS v25 with significance at p < 0.05. Results: Among players (mean age: 25.3 ± 5.7 years), injury prevalence ranged from 65.1% (DFs) to 79.3% (GKs) with no significant association between playing position and injury risk (p = 0.379). Injury incidence ranged from 4.5 to 5.7 per 1000 h, highest among MFs. Incidence rates ranged between 1.33 and 2.74 injuries/1000 h in matches versus 1.33 to 2.09/1000 h in training, with DFs, FWs, and MFs more prone to match injuries, whereas GKs had slightly higher training rates; however, the number of injuries did not significantly differ between games and training across positions (χ² = 5.21, p = 0.517). Muscle strains and lower-limb injuries predominated. Injury severity differed significantly by position (p = 0.001), but injury type and mechanism did not. Conclusions: GKs and MFs showed the highest prevalence and incidence, but position was not linked to overall risk. Severity differences highlight the need for position-specific prevention strategies. Full article

Background: Pelvic organ prolapse (POP) significantly impairs patients’ quality of life, especially in urinary, bowel, and sexual domains. While laparoscopic sacrocolpopexy (LS) is the current gold standard for apical prolapse repair, it is associated with certain complications. Laparoscopic pectopexy (LP), a newer technique utilizing the iliopectineal ligament for apical suspension, may offer improved outcomes with fewer adverse effects. This scoping review aimed to evaluate patient-reported outcomes (PROs) and quality of life (QoL) following LP and compare its effectiveness to other established surgical approaches. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Searches of PubMed, Scopus, and Web of Science databases were performed through June 2025. Eligible studies included randomized controlled trials, prospective and retrospective cohorts, and case series that reported PROs following LP. Data on validated QoL tools (e.g., P-QOL, PFDI-20, PFIQ-7, FSFI, PISQ-12), surgical technique, and follow-up duration were extracted. Due to heterogeneity in the study design and outcomes, findings were synthesized qualitatively. Results: Thirteen studies including a total of 742 patients met the inclusion criteria. Across all included studies, LP was associated with significant improvements in QoL metrics, including urinary and sexual function, and overall patient satisfaction. Tools such as PFDI-20, FSFI, PISQ-12, and PGI-I consistently showed postoperative improvement (p < 0.05). Comparative studies demonstrated that the outcomes for LP were similar or superior to those of sacrocolpopexy, sacrospinous fixation, or sacrohysteropexy, particularly regarding sexual function. Conclusions: LP is an effective surgical alternative for apical POP repair, offering significant improvements in patient-reported quality of life and functional outcomes. Its favorable safety profile and comparable efficacy to traditional methods make it a compelling option, particularly for patients with contraindications to sacral dissection. Findings are limited by small and heterogeneous studies, short follow-up, and potential publication and language biases. Further prospective studies with long-term follow-up periods are necessary to confirm these findings and refine patient selection criteria. Full article

The specialty background of intensive physicians managing severely injured patients varies internationally, with trauma ICUs often led by either trauma surgeons or anesthesiologists, both of whom receive additional intensive care training. Whether physician specialty affects outcomes remains uncertain. We conducted a retrospective single-center cohort study of patients aged ≥ 16 years with an Injury Severity Score (ISS) ≥ 16 admitted to a level I trauma center between January 2005 and December 2022. Patients were treated either in a trauma surgery ICU (T-ICU) or an anesthesiology ICU (A-ICU). Briefly, 1:1 matching was conducted based on demographic and injury-related variables, with the primary outcome being in-hospital mortality and secondary outcomes including transfusion requirements, duration of mechanical ventilation, ICU and hospital length of stay, and Glasgow Outcome Scale (GOS) at discharge. Among the 1015 eligible patients (T-ICU: n = 920; A-ICU: n = 95), 52 patients (26 per group) were successfully matched with comparable baseline characteristics. No significant differences were observed in mortality, GOS, transfusion requirements, ventilation duration, or ICU/hospital length of stay. These findings suggest that, when both are led by certified intensive care specialists, trauma surgery- and anesthesiology-based ICUs achieve comparable outcomes, supporting multidisciplinary models while highlighting the need for larger multicenter studies. Full article