Search Results (2,736)

Acute respiratory failure (ARF) often leads to ICU admission, ventilatory support, illness, and death. The usual classification into hypoxemic and hypercapnic types does not capture its full complexity. Precision medicine uses the concept of “treatable traits” to guide care based on traits that are clinically relevant, identifiable, measurable, and possibly changeable. Arterial carbon dioxide pressure (PaCO₂) reflects factors like alveolar ventilation, dead space, respiratory mechanics, and how patients respond to ventilatory support. This makes it clinically relevant in selected situations. We carried out a scoping review using PRISMA-ScR and JBI guidelines to summarize evidence on hypocapnia and hypercapnia as prognostic, stratification, or clinically relevant variables during respiratory support. We searched PubMed/MEDLINE, ScienceDirect, and Web of Science (1994–2025), and checked references by hand. Thirty-four studies met our criteria and were grouped into four areas: pre-intubation or early acute presentation, non-invasive support (NIV/HFNC), invasive mechanical ventilation (IMV), and weaning or post-extubation. In summary, hypocapnia was linked to worse outcomes or failure of support in hypoxemic or cardiogenic cases. Hypercapnia helped identify patients who benefited from NIV, such as those with chronic obstructive pulmonary disease or obesity hypoventilation. For IMV, the effects depended on the presence and severity of acidosis and on its duration. Overall, PaCO₂ showed context-dependent clinical relevance, acting mainly as a prognostic or stratification marker and, in narrower settings, as a variable that may inform monitoring or support decisions. This review provides a pragmatic framework for interpreting PaCO₂ across respiratory support contexts and highlights the need for safe and clinically meaningful targets. Full article

Background: The relationship between allergic status, SARS-CoV-2 infection, Long COVID, and post-restriction respiratory outcomes in children remains incompletely understood. This study aimed to explore the associations between allergic status and Long COVID, as well as between SARS-CoV-2 vaccination and post-restriction changes in allergic rhinitis (AR), asthma, and upper respiratory infections, in a pediatric tertiary-care cohort. Methods: We conducted a single-center, questionnaire-based observational study involving children aged 0–16 years, who were followed at the Pediatric Allergy Clinic of Umberto I Hospital in Rome. Parents completed an email-based questionnaire addressing SARS-CoV-2 infection, vaccination, persistent post-infectious symptoms, allergic diseases, and respiratory infections following restrictions. Analyses of Long COVID were limited to children with confirmed SARS-CoV-2 infection. Results: A total of 214 questionnaires were analyzed. Allergic status was not significantly associated with SARS-CoV-2 infection in the overall cohort. Among infected children, allergic status was independently associated with higher odds of Long COVID (adjusted OR 3.12, 95% CI 1.20–8.09; p = 0.019). Severe acute infection was also strongly associated with Long COVID (adjusted OR 6.84, 95% CI 2.72–17.21; p < 0.001). Complete vaccination was associated with lower odds of SARS-CoV-2 infection in the overall sample (adjusted OR 0.20, 95% CI 0.09–0.46; p < 0.001) but was not independently associated with Long COVID among infected children. After the removal of COVID-19 restrictions, 90.1% of allergic children reported worsening AR and 52.0% reported worsening asthma, with no significant association with SARS-CoV-2 infection or Long COVID. Group A Streptocossus (GAS) pharyngitis was reported in 50.0% and viral pharyngitis in 10.7% of the cohort, with no significant differences between allergic and non-allergic children. Conclusions: In this single-center, questionnaire-based pediatric cohort, allergic status was correlated with increased likelihood of Long COVID among children with confirmed SARS-CoV-2 infection; however, it was not associated with a higher risk of infection itself. Complete vaccination was linked to a reduced risk of infection, whereas no independent correlation with Long COVID was identified. Post-restriction exacerbation of allergic respiratory symptoms was prevalent, while the incidence of bacterial and viral pharyngitis did not vary significantly according to allergic status. Full article

Background/Objectives: Acute pancreatitis is increasingly recognized as a risk factor for disturbances in glucose metabolism and the development of diabetes mellitus (DM). However, the long-term endocrine consequences of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remain poorly characterized. This study aimed to evaluate the association between post-ERCP pancreatitis and the risk of new-onset diabetes mellitus (NODM). Methods: This retrospective cohort study included patients who underwent ERCP between 2019 and 2024 at a tertiary referral center. New-onset diabetes mellitus was defined using laboratory data and International Classification of Diseases (ICD) diagnostic codes within one year after ERCP. Multivariable logistic regression adjusting for age, sex, hypertension, and coronary artery disease was performed. Results: A total of 2695 patients were included. Post-ERCP pancreatitis occurred in 165 patients (6.1%). New-onset diabetes developed in 9/165 patients (5.5%) in the PEP group and in 27/2530 patients (1.1%) in the non-PEP group. An increased incidence of new-onset diabetes was observed among patients who developed post-ERCP pancreatitis (crude OR 5.35, 95% CI 2.47–11.57; p < 0.001). In multivariable analysis adjusting for age, sex, hypertension, and coronary artery disease, post-ERCP pancreatitis remained significantly associated with new-onset diabetes in the fully adjusted model (adjusted OR 5.33, 95% CI 2.42–11.77; p < 0.001). The absolute risk increase was 4.39%, corresponding to a number needed to harm of 23. Conclusions: An increased incidence of new-onset diabetes was observed among patients who developed post-ERCP pancreatitis. This association remained significant after adjustment for baseline cardiovascular comorbidities. Although the absolute risk increase was modest, these findings may be clinically relevant. Because this was a retrospective study with a limited number of diabetes cases, the findings should be considered hypothesis-generating and require confirmation in prospective studies. Full article

Background: Serum concentrations of 25-hydroxyvitamin D [25(OH)D] are associated with the risk of several chronic and acute diseases. However, updated data on vitamin D status in Mediterranean countries, including Italy, remain limited, hindering effective public health strategies. Objective: To assess serum 25(OH)D levels and their seasonal variation in healthy blood donors aged 18–65 years living in Northern Italy and not taking vitamin D supplements. Given the latitude and the high levels of environmental pollution, cutaneous vitamin D synthesis may be impaired in this population. Recent Italian guidelines on supplementation emphasize the need for updated data on the prevalence of hypovitaminosis D and seasonal variation in endogenous vitamin D synthesis. Methods: In this exploratory retrospective cross-sectional study, 534 blood donors (268 men and 266 women) attending the Transfusion Medicine Unit of the Verona University Hospital were enrolled between April 2016 and May 2018. Serum 25(OH)D concentrations were analyzed by season. Clinical, lifestyle, pharmacological and dietary characteristics were also collected. Results: Among healthy, normal-weight individuals, the prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/L) was low and limited to one-two months per year. Overweight and obesity significantly reduced the likelihood of achieving adequate 25(OH)D levels through cutaneous synthesis for several months. Mean 25(OH)D concentrations were higher than those previously reported in the same area, while seasonal variation remained preserved. Conclusions: In a relatively small non-supplemented population of blood donors living in a high polluted urban area of Northern Italy, seasonal vitamin D synthesis seems to be preserved. These updated data show higher 25(OH)D levels compared to past findings. Although these data certainly warrant further validation through a national survey involving other regions of Italy and in not selected population, they appear to be in line with the SIOMMMS recommendations against indiscriminate serum 25(OH)D testing and against routine supplementation for healthy normal-weight individuals under 70 years. Full article

Background: Segmental arterial mediolysis (SAM) is a non-inflammatory vasculopathy that primarily affects the abdominal visceral arteries leading to hemorrhage, ischemia, or pseudoaneurysms. Its presentation can be mimicked by other vasculopathies including vasculitis involving the medium-sized blood vessels making it difficult to diagnose. Case Presentation: A 55-year-old woman presented with a two-hour history of sudden-onset, severe epigastric pain radiating to the chest. She was noted to be hypotensive with low hemoglobin 8.8 g/dL suspicious for a hemorrhagic cause. Her case was complicated by elevated international normalized ratio 3.7 in the setting of warfarin therapy for the mechanical mitral valve. The remainder of her complete blood count, complete metabolic panel, inflammatory markers, autoantibody serologies, and infectious testing were negative. Abdominal computed tomography angiogram revealed hemoperitoneum, bilateral renal infarctions, a large mesenteric hematoma, aneurysmal disease of the common hepatic and inferior mesenteric arteries, thrombosis and proximal dissection of the superior mesenteric artery, acute thrombosis of the left external iliac vein, and multiple sites of arterial extravasation from the pancreaticoduodenal artery and its branches. Mesenteric artery angiogram showed multivessel visceral artery aneurysms and stenoses characteristic of SAM for which she underwent transcatheter arterial embolization of the bleeding vascular bed. We provide a narrative literature review with a focus on common presentations and differentiating characteristics of vasculopathies that can involve medium-sized blood vessels. It is important to accurately diagnose SAM and its potential mimics as management strategies differ. Conclusions: SAM presents with medium vessel vasculopathy without vasculitis. Differentiation from mimics can be difficult but aided by familiarity of their characteristic findings and differentiating clinical characteristics. Full article

Peripheral artery disease (PAD) is found in 10.9% of patients with ischaemic stroke (IS). This cross-sectional study was performed to investigate the prevalence of PAD and its risk factors among acute IS patients in Singapore. Patients admitted for IS were recruited. Data was collected on sex, age, body mass index (BMI), history of hypertension, diabetes mellitus (DM), hypercholesterolaemia, cigarette smoking, prior stroke (PS) and ischaemic heart disease (IHD). IS was classified as a lacunar infarct (LI) or non-lacunar infarct (NLI) based on neuroimaging. Carotid intima–medial thickening (IMT) and carotid plaques (CP) were determined by ultrasonography. The ankle–brachial Index (ABI) was calculated in both lower limbs; PAD was diagnosed if the ABI was ≤0.9 in any limb. The estimated sample size was 150 subjects. In total, 150 subjects were recruited; the mean age was 62.7 ± 10.2 years, 44.7% were female, and the mean BMI was 24.1 ± 4.1. A total of 63.3% reported hypertension, 42.7% DM, 30.0% hypercholesterolaemia, 38.0% smoking, 18.7% PS, and 6.0% IHD. A total of 30.7% had IMT, 77.3% had CP, and 8.0% had carotid stenosis ≥50%. LI occurred in 64.7%. PAD was diagnosed in 22.0% (95% CI 16.1–29.3). On univariate analysis, based on vascular risk factors alone, PAD was associated with age (p = 0.03), hypercholesterolaemia (p = 0.03), and IHD (p = 0.004). On logistic regression, PAD was only associated with IHD (aOR 6.42, 95% CI 1.25–32.84; p = 0.03). When IMT and CP were added to the model, the association with IHD remained (aOR 5.45, 95% CI 1.03–28.71; p = 0.045). When the results of neuroimaging were added, the association was only with NLI (aOR 2.78, 95% CI 1.09–7.14; p = 0.03). This study found a high prevalence of PAD among Asian patients with IS. It was associated with a non-lacunar infarction. Full article

Background: The extent of coronary artery disease (CAD) is a major determinant of prognosis in patients with myocardial infarction (MI). While structured exercise is known to be cardioprotective, the association between habitual daily physical activity and angiographic CAD extension remains insufficiently characterized. Methods: In this prospective observational study, 269 patients were hospitalized with acute MI underwent coronary angiography. Habitual daily physical activity during the four weeks preceding admission was assessed using 10-point self-reported daily preadmission effort questions to help the patients to report a final effort score. CAD extension was classified as single-, double- or triple-vessel disease. Differences in daily effort across CAD categories were evaluated using the Kruskal–Wallis test. Independent predictors of CAD extension were identified using ordinal logistic regression adjusted for age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia and body mass index. Results: Daily preadmission effort decreased progressively with increasing CAD severity (mean scores: 7.44 in single-vessel, 4.93 in double-vessel and 3.69 in triple-vessel disease; p < 0.0001). In multivariable ordinal logistic regression analysis, older age, hypertension, diabetes mellitus and hyperlipidemia were independently associated with greater CAD extension. Higher daily preadmission effort was strongly and independently associated with lower CAD severity; each one-point increase in effort score was associated with a 46% reduction in the odds of more extensive CAD (odds ratio 0.54, 95% confidence interval 0.45–0.64; p < 0.0001). Conclusions: Greater habitual daily physical activity prior to myocardial infarction is independently associated with less extensive coronary artery disease. Assessment of daily preadmission effort may provide clinically useful information regarding coronary disease burden and highlights the potential importance of everyday physical activity in cardiovascular prevention. These findings should be interpreted with caution given the use of a non-validated, self-reported measure of physical activity and the observational study design. Full article

Colchicine has emerged as a prominent anti-inflammatory candidate in cardiovascular medicine, supported by a hierarchy of evidence spanning chronic and acute coronary syndromes, post-myocardial infarction care, revascularization, atrial fibrillation, pericardial disease, heart failure, peripheral arterial disease, and mechanistic translational models. Across this literature, the most mature study architecture and the strongest clinical support are derived from completed randomized trials in chronic coronary disease and secondary prevention, where colchicine has been shown to prevent major cardiovascular events (MACEs) when added to standard of care. The clearest clinical benefits are the reduction in non-fatal ischemic events in atherosclerotic disease, prevention of recurrent pericarditis and postoperative atrial fibrillation, and attenuation of inflammatory and plaque-related markers. By contrast, mixed or lower-tier evidence renders its application less consistent in acute coronary syndromes, ST-elevation MI (STEMI), percutaneous coronary intervention (PCI)-related hard outcomes, and heart failure, while a definitive mortality benefit has not been demonstrated. Overall, colchicine is best understood as a targeted clinical adjunct whose value depends heavily on precise indication, timing, dose, gastrointestinal tolerability, and the maturity of the supporting evidence. Full article

Background: Dysplasia or absence of anterior communicating artery (ACoA) is a common variation in the circle of Willis (COW) anomaly, and it may elevate the risks of cerebrovascular diseases. We aimed at investigating the association of ACoA dysplasia/absence with plaque imaging features of middle cerebral artery (MCA) atherosclerosis. Methods: We analyzed the prospective data from a vessel wall imaging cohort of adult patients suffering from acute ischemic stroke or transient ischemic attack due to intracranial atherosclerosis (2014 to 2020). Patients demonstrating MCA atherosclerotic plaques were included. The ACoA dysplasia/absence and other incomplete COW configurations were identified on magnetic resonance angiography. The MCA plaques were evaluated through high-resolution vessel wall imaging. Results: Of the 107 patients with MCA atherosclerosis, 29.9% showed ACoA dysplasia/absence. The patients with ACoA dysplasia/absence were more likely to have concomitant dysplasia/absence of anterior cerebral artery (71.9% vs. 18.7%, p < 0.001). For the 158 MCA plaques identified, those with ACoA dysplasia/absence exhibited a significantly higher prevalence of symptomatic status (58.7% vs. 31.3%, p = 0.001) and non-positive remodeling (58.7% vs. 26.8%, p < 0.001) than those without this variant. Regression analyses further demonstrated the robust association of ACoA dysplasia/absence with symptomatic status (odds ratio, 5.158; 95% confidence interval, 1.744–15.254; p = 0.003) and non-positive remodeling (odds ratio, 6.92; 95% confidence interval, 2.396–19.982; p < 0.001) of MCA atherosclerosis. Conclusions: As a common variation among patients with MCA atherosclerosis, ACoA dysplasia/absence may elevate the possibility to develop symptomatic MCA atherosclerosis, which showed non-positive remodeling. Stroke risk stratification based on the ACoA morphology needs further validation. Full article

Background/Objectives: Maintenance hemodialysis patients are particularly vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate clinical outcomes and identify admission laboratory biomarkers associated with in-hospital mortality in hospitalized hemodialysis patients with coronavirus disease 2019 (COVID-19). Methods: We conducted a retrospective observational study including 130 adult hemodialysis patients with confirmed SARS-CoV-2 infection. Clinical characteristics and admission laboratory parameters were analyzed in relation to in-hospital outcomes using comparative, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses. Results: The overall in-hospital mortality rate was 34.6%. The median age of the cohort was 66 years, with 64.6% male patients. Non-survivors showed significantly higher levels of inflammatory and tissue-injury markers, including C-reactive protein (CRP) (p < 0.001) and lactate dehydrogenase (LDH) (p < 0.001), together with lower serum albumin (p < 0.001), platelet count (p < 0.001), and lymphocyte levels (p = 0.03). In multivariable analysis, cardiovascular disease, respiratory disease, dyspnea, and ambulatory origin were independently associated with mortality. ROC analysis identified platelet count as the best individual predictor (area under the curve [AUC] = 0.767). An exploratory composite risk score demonstrated excellent discriminative performance (AUC = 0.902). Conclusions: Admission inflammatory and hematological biomarkers are strongly associated with adverse outcomes in hospitalized hemodialysis patients with COVID-19. The integration of clinical and laboratory parameters into a composite risk score may improve early risk stratification and support clinical decision-making in this high-risk population. Full article

Relapse remains the leading cause of treatment failure after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute myeloid leukemia (AML). Early identification of patients at increased post-transplant relapse risk is essential to enable intensified surveillance and pre-emptive therapeutic strategies. Wilms’ tumor 1 (WT1) is overexpressed in most AML cases and represents a broadly applicable molecular marker; however, its utility as a peripheral blood (PB) measurable residual disease (MRD) marker after allo-HSCT remains incompletely defined. In this prospective multicenter cohort study, 43 adults with AML in complete remission underwent allo-HSCT between 2021 and 2023. WT1 expression in PB was quantified using standardized real-time quantitative PCR before transplantation (WT1_pre) and at day +30 (WT1_30). Receiver operating characteristic analysis identified an optimal threshold for relapse prediction. A WT1 cutoff of ≥3 copies/10⁴ ABL discriminated relapse risk. WT1_30 demonstrated strong prognostic performance (AUC 0.79; p = 0.005), whereas WT1_pre showed more modest predictive value (AUC 0.69; p = 0.037). Patients with WT1_30 ≥ 3 had inferior 12-month progression-free survival compared with those with WT1_30 < 3 (52.9% vs. 90.9%, p = 0.0059) and a higher 12-month cumulative incidence of relapse (31% vs. 9%, p = 0.054). WT1_pre ≥ 3 was also associated with inferior progression-free and overall survival (both p = 0.0008). Relapsed patients had significantly higher WT1_30 levels than non-relapsed patients (median 5.0 vs. 2.0 copies/10⁴ ABL; p = 0.018). Peripheral blood WT1 expression, particularly at day +30, is associated with an increased relapse risk after allo-HSCT in AML and may support early post-transplant risk stratification. The identified cutoff should be considered exploratory and requires validation in larger independent cohorts. Full article

Background: Gallbladder carcinoma (GBC) represents one of the most aggressive malignancies of the hepatobiliary system, evolving along a continuum from chronic inflammation to preneoplastic lesions and invasive cancer. This progression is frequently associated with gallstones and chronic cholecystitis and shares common pathogenic mechanisms with systemic inflammatory and metabolic disorders. Despite its relatively low incidence, GBC is characterized by poor prognosis, largely due to late-stage diagnosis and limited understanding of its molecular underpinnings. Methods: We conducted an observational study including 60 adult patients with radiologically suspected gallbladder cancer (GBC). Patients with disseminated disease, ongoing oncologic treatment, or synchronous malignancies were excluded. Fasting venous blood samples were collected to evaluate tumor markers and biochemical parameters, including carcinoembryonic antigen (CEA) and carbohydrate antigen CA 19-9. Surgical specimens were analyzed histopathologically and staged according to the European Society for Medical Oncology TNM classification system. Statistical analysis was performed using SPSS software (version 26.0), with appropriate parametric or non-parametric tests applied based on data distribution, and a p-value < 0.05 considered statistically significant. Results: Based on histological findings, patients were stratified into benign gallbladder disease (GBD) and GBC groups. CA 19-9 demonstrated higher mean serum levels with lower variability compared to CEA, suggesting superior sensitivity and diagnostic stability for gallbladder adenocarcinoma. In contrast, CEA levels exhibited greater fluctuation, limiting its reliability as a standalone biomarker. Importantly, the combined use of CA 19-9 and CEA improved diagnostic accuracy, supporting a multimarker approach for better clinical stratification. Our findings highlight the diagnostic value of CA 19-9 as a robust biomarker in GBC and support the integration of combined biomarker panels. Beyond tumor markers, the study identified a strong interplay between systemic inflammation and metabolic comorbidities, with obesity and hypertension significantly associated with chronic gallbladder pathology, and diabetes mellitus contributing to increased risk of acute inflammatory episodes. Elevated inflammatory markers, leukocytosis, and cholestatic enzyme alterations further supported the presence of a systemic inflammatory milieu. Multivariate analysis revealed that C-reactive protein (CRP), as a marker of systemic inflammation, was significantly influenced by a combination of clinical and biochemical variables, including age, hemoglobin, hypertension, amylase, CA 19-9, and CEA, explaining over 50% of its variability and up to 85% in advanced fibrotic changes. Additionally, platelet counts were significantly reduced in adenocarcinoma and correlated specifically with CA 19-9 levels, suggesting a potential link between tumor burden, inflammation, and platelet dynamics. Conclusions: Therefore, the observed associations between chronic inflammation, metabolic dysregulation, and tumor marker expression suggest a potential link between gallbladder carcinogenesis and systemic cardiometabolic pathways, opening new perspectives for early detection and targeted therapeutic strategies. Full article

Background/Objectives: Coronary artery disease is a chronic inflammatory disorder characterized by progressive atherosclerosis and heterogeneous clinical presentations ranging from acute coronary events to stable ischemic conditions. Galectin-3 is a β-galactoside-binding lectin involved in inflammatory responses, fibrosis, and tissue remodeling, and has been investigated as a potential biomarker in cardiovascular diseases. However, its diagnostic significance across different clinical stages of coronary artery disease remains unclear. Methods: This prospective study included 180 participants who underwent coronary angiography and were classified into three groups: control (n = 60), acute coronary syndrome (n = 60), and chronic coronary syndrome (n = 60). Serum Galectin-3 concentrations were measured using an enzyme-linked immunosorbent assay. Group comparisons were performed using non-parametric statistical tests. Correlation analysis, receiver operating characteristic curve analysis, and multivariable logistic regression were conducted to evaluate diagnostic performance and independent associations. Results: Galectin-3 concentrations were significantly higher in both acute coronary syndrome and chronic coronary syndrome groups compared with the control group (p < 0.001), whereas no significant difference was observed between the two disease groups. Receiver operating characteristic analysis demonstrated limited diagnostic performance for identifying acute coronary syndrome (area under the curve 0.617, sensitivity 96.7%, specificity 43.3%, p = 0.027) and poor diagnostic performance for chronic coronary syndrome (area under the curve 0.541, sensitivity 91.7%, specificity 30.0%, p = 0.436). In multivariable analysis, Galectin-3 was not identified as an independent predictor of either clinical condition. Age and smoking were independently associated with acute coronary syndrome, while age and male sex were independently associated with chronic coronary syndrome. Conclusions: Galectin-3 levels are elevated in patients with coronary artery disease and appear to reflect the inflammatory burden associated with atherosclerosis. However, its diagnostic discrimination between different clinical stages of coronary artery disease remains limited. Larger prospective studies are required to clarify its clinical value. Full article

Background/Objectives: Intraoperative assessment guides the immediate postoperative management of acute appendicitis, whereas histopathological confirmation becomes available only after key clinical decisions have been made. This study evaluated the agreement between intraoperative and histopathological grading of acute appendicitis and compared their associations with postoperative outcomes, particularly length of hospital stay (LOS) and duration of antibiotic therapy. Methods: This retrospective single-center study included pediatric and adult patients who underwent appendectomy for suspected acute appendicitis at the University Hospital of Split between 1 January 2020 and 31 December 2025. After exclusion criteria were applied, 2279 patients were included. Agreement between intraoperative and histopathological classifications was assessed using Cohen’s kappa and weighted kappa. Associations with postoperative outcomes were examined using Kendall’s tau correlation, bootstrap comparison between age groups, Kruskal–Wallis testing with Bonferroni-adjusted post hoc analyses, adjusted negative binomial regression for length of hospital stay, zero-inflated negative binomial regression for total antibiotic duration, and Firth penalized logistic regression for binary outcomes. Results: Overall concordance between intraoperative and histopathological grading was 74.0%. Agreement was moderate by unweighted Cohen’s kappa (0.539) and substantial by weighted kappa (0.643), with intraoperative grading more often overestimating than underestimating histopathological severity. Intraoperative severity showed stronger correlations than histopathological severity with LOS (τ = 0.347 vs. 0.207) and total duration of antibiotic therapy (τ = 0.331 vs. 0.224). Both outcomes showed a non-linear pattern, with patients with a negative appendix having a longer hospital stay and greater antibiotic exposure than those with phlegmonous appendicitis, while advanced disease was associated with the greatest treatment burden. Thirty-day readmission was uncommon and not associated with severity. Conclusions: Agreement between intraoperative and histopathological grading was moderate to substantial. Intraoperative grading showed stronger associations with immediate postoperative outcomes than histopathological grading, reflecting its role as the primary driver of clinical decision-making in the immediate postoperative period. These findings do not diminish the diagnostic value of histopathological examination, which remains essential for confirmation and detection of unexpected pathology. Full article

This study investigated the role of microglia-derived insulin-like growth factor 1 (IGF-1) in modulating host defense and disease progression in a viral model of neuroinflammation and demyelination. Intracranial infection of susceptible mice with the glial-tropic JHM strain of mouse hepatitis virus (JHMV) induces acute encephalomyelitis, followed by an immune-mediated demyelinating disease that mimics many clinical and histologic features of multiple sclerosis (MS). Utilizing an inducible fractalkine receptor (Cx3cr1) promoter-driven Cre-loxP recombinant system, we performed timed ablation of Igf1 in microglia to assess its impact on the central nervous system (CNS) response to JHMV. While the loss of microglial IGF-1 did not impair the control of viral replication, it significantly exacerbated spinal cord demyelination. CyTOF and imaging mass cytometry analysis of spinal cords indicated increased myelin damage was associated with increased accumulation of CD8⁺Ly6C⁺ effector T cells and reduced expression of TREM2 that impaired transition into a disease-associated microglia (DAM) phenotype capable of sensing and potentially mitigating myelin damage. Collectively, these findings argue that microglial IGF-1 is a non-redundant coordinator of the CNS immune responses that occur in response to CNS viral infection. Full article