Search Results (703)

Background and Objectives: Metastatic renal cell carcinoma (mRCC) remains a lethal disease despite advances with immune checkpoint inhibitors such as nivolumab. However, a substantial proportion of patients exhibit primary resistance or early progression, highlighting the need for reliable and easily accessible prognostic biomarkers. The C-reactive protein–albumin–lymphocyte (CALLY) index is a novel immunonutritional biomarker integrating systemic inflammation, nutritional status, and immune competence. Materials and Methods: In this retrospective single-center study, 91 patients with mRCC treated with nivolumab were analyzed. Patients were stratified into low and high CALLY index groups based on a receiver operating characteristic-derived cut-off (0.322). Survival outcomes were assessed using Kaplan–Meier analysis and Cox regression models. Results: Patients with a low CALLY index demonstrated significantly shorter progression-free survival (4.5 vs. 13.5 months, p < 0.001) and overall survival (9.1 vs. 25.5 months, p = 0.003). Multivariate analysis confirmed the CALLY index as an independent prognostic factor for both progression-free survival (HR: 2.63, p = 0.002) and overall survival (HR: 1.88, p = 0.035). Conclusions: The CALLY index is a simple, cost-effective, and reproducible biomarker that independently predicts survival in nivolumab-treated mRCC. It may serve as a practical tool for risk stratification and personalized treatment planning in the immunotherapy era. Full article

Spirituality and religiosity (S/R) are significant dimensions in mental health care and provide an important foundation for spiritual care, particularly in sociocultural contexts where religious beliefs are deeply embedded in personal and collective life. This study investigates the role of S/R in the treatment of psychiatric patients hospitalized in a private mental health clinic in southern Brazil. Using validated instruments—the Centrality of Religiosity Scale (CRS-10BR), the Brief-RCOPE-14, and the Inventory of Attachment to God (IAD-Br)—the study assessed religious centrality, coping strategies, and attachment styles to God among 100 participants. Based on CRS parameters, the sample was classified as predominantly “religious.” The findings revealed that most patients identified with some form of religion or belief in God, reported moderate to high levels of positive religious coping, and predominantly exhibited secure attachment patterns. Statistically significant correlations were observed between higher religiosity, greater use of positive coping strategies, and lower avoidance in the relationship with God. Despite these findings, spiritual and religious aspects were rarely addressed in clinical interactions. The findings are discussed through the lens of clinical bioethics, emphasizing the ethical relevance of spirituality and religiosity in psychiatric care and highlighting the relevance of developing practical approaches to spiritual care within a whole-person, patient-centered model. Full article

Objectives: Although obesity is known to cause low-grade chronic inflammation, the extent to which body mass index (BMI) reflects this remains questionable. To investigate this, we classified a national obesity cohort by BMI and evaluated its association with complete blood count (CBC)-derived systemic inflammatory indices. Methods: This retrospective, multi-center study included 6499 adults from the OBREDI-TR cohort with available laboratory data. Patients were categorized by BMI into Class I (30.0–34.9 kg/m², n = 2751), Class II (35.0–39.9 kg/m², n = 1804), and Class III (≥40.0 kg/m², n = 1944) obesity. We compared demographic, clinical, and laboratory parameters, especially in terms of CBC-derived inflammation parameters: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). Results: The Class III group was younger (42.73 ± 13.21 vs. 45.14 ± 14.12 in Class I) and predominantly female (p < 0.001 for both). None of the evaluated inflammatory indices showed significant differences across the groups (NLR, p = 0.435; PLR, p = 0.141; LMR, p = 0.520; SII, p = 0.326; SIRI, p = 0.459). Interestingly, hypertension was less common in the Class III obesity group (49.0% vs. 53.5% in Class I, p = 0.009). Conclusions: The failure of increasing inflammatory indices to parallel BMI, creating a “ceiling effect,” reflects the inadequacy of BMI in determining inflammatory burden. Evaluating the inflammatory burden of obesity through visceral adiposity and metabolic phenotyping (metabolically healthy (MHO) vs. metabolically unhealthy obesity (MUO) rather than BMI will provide a more accurate basis for objective clinical evaluation and personalized treatment. Full article

Background: Anaplastic large cell lymphoma (ALCL) accounts for up to 15% of all pediatric and adolescent non-Hodgkin lymphomas and is characterized by significant clinical, morphological, and immunohistochemical heterogeneity. Expression of T-cell markers on tumor cells is considered as one of the factors in an unfavorable prognosis in ALCL. However, no treatment protocols based on ALCL immunological heterogeneity have been used, yet. Objective: To compare the effectiveness of immunophenotype-oriented chemotherapy in children with ALCL treated according to the ALCL NII DOiG 2003 protocol versus the standard NHL-BFM 95 protocol. Methods: A retrospective–prospective analysis of 100 newly diagnosed ALCL patients, who were treated between 2000 and 2023, was performed across five pediatric oncology and hematology centers in Russia. Patients were divided into two groups: those treated with the NHL-BFM 95 protocol (n = 52) and those treated with the ALCL NII DOiG 2003 protocol (n = 48). Comparative analysis used Kaplan–Meier survival curves constructed for each group, and statistical analysis was performed with IBM SPSS Statistics 21.0. Results: The 10-year overall survival was significantly higher in the ALCL NII DOiG 2003 group (95.3 ± 3.3%) compared to that of the NHL-BFM 95 group (82.0 ± 5.4%, p = 0.037). Event-free survival was also improved (95.3 ± 3.3% vs. 68.6 ± 6.5%, p = 0.001), as well as the relapse-free survival (97.3 ± 2.7% vs. 74.4 ± 6.4%, p = 0.003). Conclusions: The immunophenotype-oriented approach of the ALCL NII DOiG 2003 protocol provides significantly improved long-term outcomes compared to the common NHL-BFM 95. These findings support the benefit of personalized immunologically targeted therapy in pediatric ALCL treatment. Full article

Many people suffer from cervical disc herniation, which significantly affects the lives of individuals, causing chronic pain and functional limitations. This paper presents the development and evaluation of an AI-powered inflatable neck collar designed to provide personalized and adaptive support for individuals experiencing neck pain, particularly those with disc herniations. The system seamlessly integrates motion sensors, a robust AI model trained on a dataset of MRI scans, and a custom-designed inflatable collar. The AI model accurately detects disc herniations and segments vertebral structures, enabling real-time, targeted inflation adjustments based on the user’s unique anatomy, posture, and movements. A user-centered design approach ensures a seamless and intuitive user experience, allowing for personalized profile management, control over inflation levels, and data logging for tracking progress. Extensive simulations using 3D models and real-time data flow systems validated the effectiveness of the AI-guided system. Results demonstrated accurate detection and segmentation of disc herniations, robust real-time response, and adaptability to user needs. The proposed system, reviewed and validated by a neurosurgeon, demonstrates significant potential as a novel and effective solution for personalized treatment of neck pain, particularly in cases of disc herniation. Further development and research will focus on expanding the dataset to improve fairness and accuracy for diverse demographics and increasing the robustness and generalizability of the system. Full article

Background: Lupus nephritis (LN), a major complication of systemic lupus erythematosus, remains a key determinant of morbidity and mortality despite therapeutic progress. Objective: An expert report aims to present multidisciplinary insights from leading Italian centers on current LN management and future perspectives. Methods: Seven specialists—including nephrologists and rheumatologists with expertise in lupus nephritis—addressed key aspects of LN management, including treatment goals, available therapeutic options, treatment selection across disease stages, and emerging strategies. Results: The authors highlight evolving treatment paradigms—shifting from traditional induction–maintenance strategies to early combination regimens integrating biologics such as belimumab and calcineurin inhibitors like voclosporin—aligned with updated EULAR and KDIGO guidelines. Regional experiences underscore individualized therapy tailored by histology, disease activity, and patient profile. Multidisciplinary collaboration between nephrologists and rheumatologists, equitable access to innovative therapies, and integration of registries and digital records are identified as priorities. Conclusions: Emerging agents, including obinutuzumab, anifrolumab, and CAR-T cell therapies, represent promising advances toward steroid-sparing and potentially curative strategies. Continued research, biomarker development, and application of artificial intelligence are pivotal to optimizing outcomes and achieving personalized LN management. Full article

Background/Objectives: Retinal vein occlusion (RVO) commonly causes vision loss from macular edema (ME). OCT biomarkers (IRF, SRF, HRF, and ELM/EZ disruption) inform prognosis and treatment but are rarely quantified routinely due to time burden and interobserver variability. We aimed to validate a deep-learning algorithm for automated detection and quantification of key OCT biomarkers in RVO-ME versus expert assessment. Methods: In this retrospective single-center study, 93 eyes with RVO-ME imaged with spectral-domain OCT were analyzed. The AI quantified IRF/SRF volumes, ELM/EZ interruption, and HRF counts. Two masked expert clinicians provided reference evaluations. Performance and agreement were assessed using ROC AUC, Cohen’s kappa, intraclass correlation coefficient (ICC), Pearson correlation, and Bland–Altman analysis. Image-quality metrics (foveal centration and retinal layer segmentation) were recorded. Results: The AI showed high diagnostic performance (AUC: SRF 0.969; ELM 0.871; EZ 0.958) and substantial-to-almost-perfect agreement (kappa: SRF 0.807; ELM 0.788; EZ 0.914). HRF quantification correlated strongly with experts (r = 0.89, p < 0.001), with very good agreement (ICC = 0.87) and minimal bias. Image-quality accuracy exceeded 98% for foveal centration and layer segmentation. Conclusions: This AI software enables reliable, rapid automated assessment of major OCT biomarkers in RVO-ME, supporting streamlined personalized management; prospective studies should confirm longitudinal monitoring and treatment-guidance value. Full article

Background/Objectives: Cancer-related pain remains one of the most prevalent and distressing symptoms across the disease trajectory, significantly impairing function and quality of life. Although opioids are central to managing moderate to severe pain, their limitations, including adverse effects, dependence risk, and societal concerns, highlight the need for more individualized and comprehensive strategies. This review aims to synthesize current approaches to cancer pain management within a palliative care framework, emphasizing multimodal, mechanism-based, and patient-centered care. Methods: A narrative review was conducted using literature searches of PubMed, Scopus, and Google Scholar. Articles published between 2010 and 2026, with emphasis on recent literature (2020–2026), were included. Search terms included combinations of “cancer pain,” “palliative care,” “multimodal analgesia,” “opioids,” “adjuvant analgesics,” and “neuropathic pain.” Peer-reviewed studies, clinical guidelines, systematic reviews, and meta-analyses relevant to cancer pain mechanisms and management were considered. Results: Cancer pain is heterogeneous, arising from tumor progression and treatment-related injury, and includes neuropathic, visceral, and somatic components. Effective management requires mechanism-based assessment and multimodal strategies. Adjuvant analgesics, such as antidepressants, anticonvulsants, corticosteroids, and topical agents, enhance pain control and reduce opioid reliance. Non-pharmacological interventions and early integration of palliative care further improve symptom management and quality of life. Emerging therapies, including cannabinoid-based treatments and gene-targeted approaches, show promise but require further clinical validation. Conclusions: A multidisciplinary, patient-centered approach that integrates pharmacologic and non-pharmacologic strategies is essential for optimizing cancer pain management. Advancing toward personalized and multimodal care models may improve outcomes, reduce opioid-related risks, and enhance quality of life for patients with cancer. Full article

Purpose: The purpose of this study was to examine the effects of a medically centered, interdisciplinary treatment model on adaptive behavior in children with Autism Spectrum Disorder (ASD). The Cortica model involves a comprehensive program including behavioral and developmental therapies, overseen by a neurodevelopmental physician. Here, we investigated how adaptive behaviors change over time during care at Cortica. Methods: We analyzed changes in the Vineland Adaptive Behavior Scales over the course of Cortica care compared to a community sample comprising longitudinal data from the National Database for Autism Research (NDAR). Results: Using propensity score weights to match cohorts based on baseline functioning, multilevel growth curve models showed significant Cohort × Time interactions for the Adaptive Behavior Composite (ABC) score and all subscale scores, indicating increased growth in adaptive behavior skills for children in the Cortica cohort relative to NDAR. Conclusions: Results of this study highlight the importance of using adaptive behaviors as a primary outcome in clinical research studies and suggest that a personalized, multidisciplinary approach to intervention can result in improved adaptive behavior skills over time. Full article

Adolescents and young people (AYP) experience a disproportionate burden of both mental health conditions and HIV, particularly in low- and middle-income countries (LMICs)-nations classified by the World Bank as having lower or middle economies. Mental health problems such as depression, anxiety, and substance use increase HIV (Human Immunodeficiency Virus that attacks the human immune system and leads to various illnesses when untreated) risk, and negatively affect treatment adherence and outcomes. However, mental health remains insufficiently integrated into HIV research and programming. Evidence on how mental health services are operationally integrated into HIV prevention and treatment for this population is limited and fragmented. This scoping review mapped existing evidence on the integration of mental health services into HIV treatment programs for AYP in LMICs, guided by PRISMA-ScR (a guideline used for reporting scoping reviews in research) and the Person–Concept–Context framework, a framework used to define specific research question in research. In this case, the population was adolescents and young people (10–24 years) receiving HIV prevention or treatment services, the concept referring to the integration of mental health interventions such as screening, assessment and counseling within HIV services, and the context focused on low- and middle-income countries (LMICs). PubMed, MEDLINE, Scopus and PsycINFO databases were searched for studies published between 2014 and 2024. Eligible studies reported mental health screening, assessment, treatment, or referral within HIV services for AYP in LMICs. Two reviewers independently screened studies, assessed full texts, and extracted data. Of 634 records identified, ten (10) studies met the inclusion criteria. All were conducted in Sub-Saharan Africa and primarily used qualitative or pilot designs. Four integration approaches were identified: routine mental health screening within HIV services, task-shifting to trained lay providers, peer-led and community-based psychosocial support, and culturally adapted, youth-centered psychological interventions. Common barriers included stigma, low mental health literacy, limited training and supervision, staffing constraints, and weak referral systems. Existing evidence is limited, remains exploratory, preliminary, and largely focused on feasibility and implementation experiences, suggesting that integrating mental health services within adolescent HIV care in LMICs may be feasible and acceptable when approaches are contextually adapted and participatory. Full article

Background: Femoral pseudoaneurysms are clinically heterogeneous, with substantial variability in anatomical features and patient-related bleeding risk. Standard treatment algorithms may be inadequate, particularly in patients receiving anticoagulation or presenting with altered coagulation profiles. A personalized, risk-adapted interventional strategy may optimize outcomes while preserving procedural safety. This study compares ultrasound-guided compression with endovascular and percutaneous therapies and evaluates the safety of minimally invasive approaches across different risk profiles to support individualized management. Methods: This single-center retrospective cohort study included 65 consecutive patients treated for femoral pseudoaneurysms between January 2019 and May 2025. Treatment modalities comprised ultrasound-guided compression, endovascular embolization (coils, covered stents, NBCA–Lipiodol), percutaneous glue injection, and hybrid approaches. Primary endpoints were technical and clinical success. Safety was assessed using pre- and post-procedural INR, platelet count, and hemoglobin levels. High-risk status was defined as ongoing anticoagulation or antiplatelet therapy, INR > 1.5, or platelet count <50 × 10⁹/L. Results: Endovascular and percutaneous approaches achieved significantly higher technical (100% vs. 68.5%, p = 0.006) and clinical success rates (100% vs. 77.8%, p = 0.009) compared with ultrasound-guided compression. In minimally invasive cohorts, INR and platelet counts remained stable after treatment, while hemoglobin showed an expected post-procedural decrease (p < 0.001). High-risk patients demonstrated technical success rates comparable to standard-risk patients, with no significant differences in laboratory trends. Favorable outcomes were observed across different embolic materials. Conclusions: Endovascular and percutaneous therapies provide superior effectiveness compared with ultrasound-guided compression while maintaining a reassuring safety profile, even in patients at increased bleeding risk. These findings support a personalized, patient-tailored interventional approach based on individual anatomical and clinical characteristics. Full article

Erectile dysfunction (ED) is a common multifactorial condition with significant physical, psychological and relational consequences. While historically associated with aging, its rising prevalence among younger men underscores the need for updated diagnostic and therapeutic frameworks. This narrative review synthesizes contemporary evidence on the pathophysiology, diagnostic workup and management of ED, with emphasis on guideline-directed care and emerging treatment modalities. A comprehensive literature search was conducted, with evidence synthesized from key clinical guidelines, landmark trials and recent peer-reviewed studies. Lifestyle optimization remains the foundational step, followed by first-line pharmacotherapy with phosphodiesterase type 5 inhibitors (PDE5is), which demonstrate high efficacy and safety across diverse patient populations. For patients with inadequate PDE5is response, second-line options include alprostadil (intracavernosal, with approximately 70% success rates or intraurethral), vacuum erection devices and penile prosthesis surgery, with patient and partner satisfaction exceeding 95% for the latter when performed in experienced centers. Psychosexual therapy is an integral adjunct, particularly in psychogenic or mixed etiologies. Regenerative approaches such as low-intensity extracorporeal shockwave therapy (Li-SWT) and platelet-rich plasma (PRP) injections are under investigation; current evidence supports their use only in experimental settings due to limited long-term data. A multidisciplinary, individualized strategy—incorporating pharmacologic, surgical and psychosocial interventions—remains the cornerstone of modern ED management. This review critically distinguishes well-established evidence from ongoing clinical debates and translates findings into practical guidance for daily practice. Ongoing technological advances may further refine diagnostic accuracy and treatment personalization, but high-quality studies are needed to establish the role of regenerative and digital tools. Full article

Tobacco use remains disproportionately high among adults living with mental illnesses (MIs), contributing to excess morbidity and mortality, particularly in high-burden states such as Kentucky. Behavioral healthcare providers are well-positioned to address this disparity but often lack formal training in evidence-based tobacco treatment. Tobacco Treatment Specialist (TTS) training provides healthcare providers with skills to deliver evidence-based tobacco treatment; however, traditional TTS training models often rely on synchronous, in-person or live virtual formats, which may limit accessibility for some healthcare workforces. Asynchronous, web-based delivery models may reduce these barriers. This study evaluates a targeted, asynchronous TTS training program designed for providers working in Community Mental Health Centers (CMHCs) across Kentucky between 2020 and 2024. Using a one-group post-test-only design to assess engagement and completion and a one-group pre-test–post-test design among completers, we examined program outcomes and changes in knowledge and attitudes. Eligible participants were nominated by the administrative team at each CMHC. Of 100 registered participants, 70.0% enrolled and 55.0% completed the program. Among completers (n = 55), knowledge scores increased significantly from pre- to post-test (t[51] = 7.6, p < 0.001). Participants also reported significant improvements in perceived skills (t[51] = 7.9, p < 0.001) and knowledge of resources to deliver tobacco treatment (t[51] = 7.8, p < 0.001), while perceived time to deliver services did not change significantly. These findings suggest that asynchronous TTS training is a feasible approach to improving tobacco treatment knowledge and confidence among behavioral health providers, though additional strategies may be needed to enhance completion and assess practice-level impact. Full article

Objectives: Small-cell lung cancer (SCLC) is an aggressive malignancy often diagnosed at the extensive stage (ES-SCLC). While chemoimmunotherapy (CIT) has emerged as a first-line option, SCLC’s “cold” immune profile limits broad efficacy. This study evaluates the real-world clinical efficacy of CIT versus chemotherapy (CT) alone and analyzes the association between gene mutation characteristics and clinical indicators. Methods: We retrospectively analyzed 170 patients with ES-SCLC treated at a single center between January 2020 and January 2024. Patients were categorized by first-line treatment (CIT vs. CT). Subgroup analyses were conducted to evaluate treatment response. Genomic profiling was integrated for a subset of patients to identify associations between mutation signatures and clinicopathological factors. Results: Of the 115 patients (67.6%) who received CIT and 55 (32.4%) who received CT, the CIT group achieved a significantly higher objective response rate (76.5% vs. 56.4%). Median progression-free survival was numerically but not significantly longer in the CIT group (6.0 vs. 5.8 months). Adrenal metastasis was identified as an independent adverse prognostic factor. Genomic analysis revealed site-specific correlations: MYC mutations with pleural metastasis, NTRK3 with brain metastasis, ALK with adrenal metastasis, and NTRK1 with intrapulmonary metastasis. Additionally, smokers showed higher mutation frequencies in SMAD4 and PIK3CA. Conclusions: CIT significantly improves initial response rates in ES-SCLC compared to CT alone. Baseline adrenal metastasis serves as a poor prognostic indicator. Distinct genomic mutation signatures are associated with clinical characteristics, suggesting potential pathways for personalized treatment strategies. Full article

Breast cancer stem-like cells (bCSCs) fundamentally represent a highly dynamic “immune-adaptive functional state” rather than a fixed cellular lineage, serving as the core engine driving tumor recurrence, metastasis, and therapeutic resistance. Despite rapid advances, the heterogeneity of bCSC states and their intricate interactions with the immune microenvironment lack systematic integration. This review centers on the dynamic evolution and niche adaptation of bCSCs. First, we systematically dissect the multilayered regulatory network maintaining stemness, encompassing core transcription factors, epigenetic–metabolic coupling, and the synergistic mechanisms of critical signaling pathways such as Wnt and Notch. Second, we propose a trinary “stemness–immune–spatial” feedback model, elucidating how bCSCs achieve active immune evasion by downregulating antigen presentation, secreting immunosuppressive factors, and embedding within perivascular “immune-cold niches.” Finally, leveraging a multi-omics integration perspective, we reconstruct precision intervention strategies, exploring the synergistic potential of targeting stemness pathways in conjunction with immunotherapies like PD-1/PD-L1 blockade and STING agonists. Furthermore, we highlight the pivotal role of integrating organoids, PDX models, and AI-assisted decision systems in overcoming heterogeneity and enabling personalized treatment. By establishing a closed-loop framework spanning mechanistic insight to spatially precise intervention, this review aims to provide novel theoretical foundations and translational pathways to surmount the bottleneck of therapeutic resistance in breast cancer. Full article