Search Results (6,065)

Prenatal ozone (O₃) exposure may trigger systemic inflammation and oxidative stress. These effects could contribute to adverse pregnancy outcomes. We conducted a prospective cohort study involving 235 pregnant women in Ningxia, China. Maternal O₃ exposure during pregnancy and prior to conception was assessed using high-resolution spatiotemporal models. Multivariable logistic and linear regression analyses were employed to evaluate the associations between O₃ exposure and adverse pregnancy outcomes. Mediation and interaction models were further applied to examine the potential modifying roles of gestational diabetes mellitus (GDM) and inflammatory biomarkers. In multivariable analyses adjusted for maternal and environmental covariates, higher prenatal O₃ exposure was significantly associated with an increased risk of preterm birth (PTB) (OR = 1.24, 95% CI: 1.05~1.45, p = 0.010) and low birth weight (LBW) (OR = 1.29, 95% CI: 1.09~1.54, p = 0.004). Similarly, elevated maternal SAA and CRP levels were positively associated with these adverse pregnancy outcomes (p < 0.05). Notably, higher TNF-α levels were inversely associated with the risks of PTB (OR = 0.15, 95% CI: 0.03~0.85, p = 0.032) and LBW (OR = 0.05, 95% CI: 0.01~0.39, p = 0.005). IL-17A levels were inversely associated with neonatal length-for-age Z scores (β = −0.28, 95% CI: −0.55~−0.01, p = 0.043). Our findings suggest that prenatal O₃ exposure is associated with increased risks of PTB and LBW. Alterations in systemic inflammatory markers and metabolic dysfunction during pregnancy were related to adverse pregnancy outcomes and fetal growth deficits, but they did not mediate these associations, with O₃ remaining an independent predictor after adjustment. Full article

Unintended pregnancies among adolescent and young women in low- and middle-income countries pose major public health challenges, underscoring the need for improved access to modern contraceptives. This study examined prevalence, preferences, and correlates of modern contraceptive use among young women living in urban slums of Kampala, Uganda, to inform targeted interventions. We analyzed baseline data from The Onward Project On Wellbeing and Adversity (TOPOWA), an NIH-funded, multi-component prospective cohort study on mental health among women aged 18–24 years. In 2023, 300 participants were recruited from three sites (Banda, Bwaise, Makindye). Interviewer-administered surveys assessed contraceptive choices, lifestyle, and demographic factors. Modified Poisson regression was used to examine correlates of contraceptive use. Among participants, 66.0% had ever used contraception, 40.0% were current users, and 38.0% reported modern contraceptive use. Multivariable analyses showed that having a consistent partner (PR = 3.28; 95% CI: 1.90–5.67), engaging in sex work (PR = 2.10; 95% CI: 1.46–3.02), older age (PR = 1.08; 95% CI: 1.01–1.16), and having children (PR = 1.72; 95% CI: 1.12–2.66) were associated with higher modern contraceptive use. Findings highlight important gaps in sustained contraceptive use and the need for tailored interventions addressing economic, social, and educational barriers to improve reproductive health in this low-resource setting. Full article

Background: Peritoneal metastasis (PM) from colorectal cancer (CRC) carries a poor prognosis. The Peritoneal Cancer Index (PCI) is among the principal prognostic stratification tools, yet the prognostic value of the anatomical distribution of disease beyond total PCI is underexplored. This pilot study evaluated whether quadrant-specific involvement adds prognostic information in patients undergoing cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), with a focused analysis of oligometastatic disease (PCI ≤ 6). Methods: A single-institution cohort of 48 CRC-PM patients treated with CRS + HIPEC was analyzed. Primary endpoints were OS, DFS, and PRFS, with a focused evaluation of the oligometastatic subset (PCI ≤ 6). Comparative statistics used Student’s two-sample t test for continuous variables and chi-square or two-sided Fisher’s exact tests for categorical variables. Survival was estimated by Kaplan–Meier with log-rank tests, and prognostic factors were evaluated using Cox regression. Results: Median follow-up was 177 months (IQR 87–224). Outcomes favored PCI ≤ 6: 5-year OS and DFS were 54% and 37.5% versus 6.6% and 0% for PCI > 6, and median OS 64 vs. 29 months (log-rank p = 0.007), median DFS 30 vs. 7 months (p = 0.0002), and median PRFS 26 vs. 8 months (p = 0.0002). In the PCI ≤ 6 subset (n = 27), quadrant 3 (left upper quadrant) was associated with higher recurrence risk and shorter DFS, remaining independently prognostic for DFS (p = 0.005) and PRFS (p = 0.005). For PRFS, quadrants 7 and 8 also showed associations on univariable analysis; Q7 remained independent (p = 0.047), whereas Q8 was borderline (p = 0.077). A histology-related signal at Q8 (p = 0.011) was exploratory due to very small mucinous and signet-ring strata. Sidedness and synchronicity yielded no significant differences in quadrant involvement within PCI ≤ 6. No quadrant effects were observed in PCI > 6. Conclusions: PCI remains the dominant prognostic determinant after CRS + HIPEC, yet in oligometastatic disease, the anatomical distribution adds complementary prognostic information, particularly involvement of Q3 and Q7. These findings are hypothesis-generating and warrant validation in larger, preferably multicenter cohorts with standardized quadrant mapping. If confirmed, quadrant-directed operative planning, including consideration of prophylactic resection in selected high-risk regions, could be prospectively evaluated. Full article

Background: Conventional CT- or US-guided radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) often limits repeat contrast-enhanced imaging and provides suboptimal intraprocedural conspicuity, which can hinder precise targeting and margin assessment. Purpose: To describe a single-center angiography-assisted cone–beam CT (angio-CBCT) RFA workflow and report early outcomes versus an institutional conventional CT-guided cohort. Materials and Methods: In this IRB-approved single-center retrospective study, consecutive patients underwent angio-CBCT-guided RFA for HCC (n = 14). Selective intra-arterial injections (≈20–40 mL iodinated contrast per CBCT) through a 5-Fr catheter permitted multiple intraprocedural CBCT acquisitions for targeting, verification, and endpoint assessment under general anesthesia. Primary outcomes were technical success, early local recurrence, and complications (CTCAE v6.0). For a secondary imaging analysis, within-patient change in lesion conspicuity (ΔHU = HU_tumor − HU_liver) from preprocedural contrast-enhanced CT to intraprocedural imaging was compared in available cases (angio-CBCT n = 12; conventional CT n = 13). Descriptive statistics were used. Results: Angio-CBCT RFA achieved technical success in 14/14 (100%) procedures; early local recurrence was 0/14 (0.0%); and one complication occurred (1/14, 7.1%; Grade 3). Intraprocedural refinements included immediate re-ablation in 3/14 (21.4%) and electrode repositioning in 2/14 (14.3%), with on-table detection of an additional lesion in 1/14 (7.1%). In the institutional conventional cohort, technical success was 19/20 (95.0%), early local recurrence 2/20 (10.0%), and complications 0/20 (0%). Lesion conspicuity improved with angio-CBCT (median ΔHU 290.1 HU, n = 12) but not with conventional CT (−10.5 HU, n = 13). Conclusions: Angio-CBCT-guided RFA for HCC is feasible and safe and enables repeatable, low-volume contrast-enhanced intraprocedural imaging that supports precise targeting, verification, and timely refinements. Early outcomes and markedly improved lesion conspicuity suggest potential advantages over conventional CT-guided workflows and warrant prospective validation in larger cohorts. Full article

Background/Objectives: Efficient sperm separation is critical for Assisted Reproductive Technology (ART). This study evaluates how assisted liquefaction (AL), a faster sperm preparation technique, affects motile sperm recovery and ART outcomes. Methods: A prospective pair analysis to address the efficiency of AL and retrospective cohort analysis of IUI and IVF/ICSI cycles were performed. Results: The average time to perform AL was 3 min, in comparison to the 15 to 30 min for traditional liquefaction (TL) until initiating sperm preparation. The total motility (p = 0.252) and progressive motility (p = 0.227) of the sperm samples were about 4% higher in the AL group although there was no significant difference. No significant differences were observed between AL and TL in fertilization (80.0% vs. 81.9%, p = 0.297), blastocyst rates (48.2% vs. 48.1%, p = 0.595), positive pregnancy (70.5% vs. 75.0%, p = 0.667), clinical pregnancy (65.9% vs. 68.4%, p = 0.841), or live birth (52.3% vs. 51.3%, p = 0.831) outcomes in IVF. The Positive pregnancy (p = 0.669) and clinical pregnancy (p = 0.841) of IUI were not significantly different between both groups. Conclusions: AL offers similar results to TL while reducing preparation time without interrupting ART outcomes. AL may have benefit to asthenozoospermia cases for ART due to reduced exposure time of sperm to semen that may prevent sperm quality impact. Full article

Background/Objectives: This study evaluated the association between nutrient intake adequacy during early pregnancy and gestational diabetes mellitus (GDM) risk through a prospective cohort study of Korean pregnant women. Methods: A total of 2227 singleton pregnant women were included in this study. Dietary assessment was conducted once during early pregnancy enrollment using the 24 h dietary recall method. The collected dietary data were analyzed using the CAN-Pro Korean food composition database to calculate nutrient-specific intake levels. Nutrient Adequacy Ratio (NAR) for each nutrient and Mean Adequacy Ratio (MAR), which integrates individual NARs, were calculated based on intake levels. GDM diagnosis was determined using oral glucose tolerance test (OGTT) results conducted between 24 and 28 weeks of gestation. Relative risk (RR) for each individual nutrient was calculated, and logistic regression analysis was performed to estimate odds ratios (OR) for GDM risk according to MAR quartiles. Results: Among 2227 participants, 157 women developed GDM. Compared to the highest MAR quartile, women in the lowest quartile showed significantly increased GDM risk (OR = 1.82, 95% CI: 1.10–2.99), with the second lowest quartile demonstrating similarly elevated risk (OR = 1.75, 95% CI: 1.06–2.88). Among individual nutrients, inadequate vitamin D intake was associated with the highest GDM risk (RR = 3.84), followed by insufficient intakes of vitamin K (RR = 1.89), vitamin B₆ (RR = 1.62), niacin (RR = 1.54), and calcium (RR = 1.39). Body mass index-stratified analysis revealed that the association between low nutritional adequacy and GDM risk was particularly pronounced in women with BMI ≥ 25.0 kg/m², showing up to a four-fold increased risk in the lowest adequacy groups. Conclusions: These findings suggest that low overall dietary adequacy and nutritional imbalance during early pregnancy are associated with increased GDM risk. The results underscore the importance of ensuring adequate and balanced nutrition during early pregnancy for GDM prevention. Full article

Background and Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of liver disease in the United States and frequently coexists with other liver diseases. Despite growing interest, the presence of MASLD in patients with primary sclerosing cholangitis (PSC) remains underexplored. This study aimed to assess the prevalence and characteristics of the MASLD-PSC overlap syndrome, with a specific focus on patient-reported outcomes such as pruritus and fatigue. Methods: A cross-sectional analysis was performed within a prospective cohort of patients with PSC enrolled in the Autoimmune Liver Diseases Registry at a United States tertiary medical center (2018–2024). MASLD overlap was established based on evidence of hepatic steatosis on liver imaging or biopsy, combined with at least one cardiometabolic risk factor. Fatigue and pruritus were assessed using the Chronic Liver Disease Questionnaire (CLDQ) and the 5D Itch Scale. Ordinal logistic regression models were used to explore the potential impact of MASLD overlap on fatigue and pruritus severity. Results: Among 103 PSC patients, 33% had MASLD overlap. These patients were older (55 vs. 46 years, p = 0.006), had a higher BMI (30 vs. 25 kg/m², p < 0.001), and were more likely to have small bile duct involvement (43% vs. 12%, p = 0.002). A history of liver transplantation (LT) was noted in 18% of PSC-only patients, compared to 3% of those with PSC/MASLD (p = 0.055). MASLD overlap was significantly associated with higher pruritus intensity (OR 3.09, 95% CI 1.02–9.28, p = 0.044), but was paradoxically linked to lower fatigue levels (OR 0.37, 95% CI 0.16–0.85, p = 0.020). Conclusions: Patients with PSC/MASLD exhibit distinct clinical features. MASLD overlap was found to significantly impact patient-reported outcomes, with lower fatigue intensity but increased pruritus severity, suggesting a role for metabolic or inflammatory pathways, warranting further investigation. Full article

Background/Objectives: Stress during pregnancy critically impacts maternal and fetal health. While prior research has linked sociodemographic and biological factors to stress levels, the role of specific biomarkers, such as vitamin D (VD), remains unexplored. This study examined the relationships among sociodemographic factors, VD status (as measured by serum 25-hydroxyvitamin D [25(OH)D] concentration), and perceived stress in pregnant women. We hypothesized that 25(OH)D concentration would be associated with perceived stress levels during pregnancy. Methods: A post hoc analysis of the Kellogg Pregnancy VD study was conducted on a cohort of 232 pregnant women with Perceived Stress Scale (PSS-10) scores at months 2, 5, and 7 with corresponding 25(OH)D concentrations. PSS-10 scores were classified into two groups: patients with scores of 0–13 were considered to have low stress, while those with scores of 14–40 were considered to have moderate-to-high stress. Logistic regression models identified factors associated with moderate-to-high stress. Results: At month 2, univariate analyses showed that being married (p = 0.002), having a college education (p = 0.0013), and lower BMI (p = 0.018) were associated with lower perceived stress, whereas Black race was associated with higher perceived stress (p = 0.027). By month 7, higher serum 25(OH)D concentration was the only significant predictor of perceived stress in univariate analysis (p = 0.002). In multivariate models at month 7, 25(OH)D approached significance (p = 0.053). Conclusions: Early in pregnancy, race, marital status, college education, and BMI were significantly associated with PSS-10 score. By month 7, 25(OH)D concentration over time emerged as a factor that was significantly associated in univariate analysis and showed a trend toward significance in multivariate models. VD status, as measured by 25(OH)D concentration, may act as a biomarker of stress during pregnancy. Results warrant further study in prospective intervention trials. Full article

Background/Objectives: Socio-cognitive disorders constitute the early-stage disabling dimension of non-motor symptoms of Parkinson’s disease (PD) and affect social functioning and interpersonal adjustment. However, current assessment tools do not adequately reveal the nature of these disorders. The Edinburgh Social Cognition Test (ESCoT) has recently been validated as a multifaceted, sensitive instrument for detecting this dysfunction in various neurological disorders. This study aimed to systematically examine socio-cognitive changes in early-stage PD using the ESCoT and their relationship with executive functions. Methods: This prospective case–control study included 27 early-stage idiopathic PD patients without cognitive impairment and 46 healthy controls. Social cognitive abilities were assessed using the ESCoT, and executive functions via the Frontal Assessment Battery (FAB). Group differences and inter-variable linear associations were evaluated using parametric inferential statistics. The independent predictive contribution of FAB to ESCoT performance was modeled through multiple linear regression. Results: Groups did not differ in age, sex, or education (p > 0.05). PD patients had significantly lower ESCoT total scores (45.67 ± 0.85 vs. 55.52 ± 0.63) and reduced performance across all subscales: Cognitive Theory of Mind (ToM), affective ToM, interpersonal, and intrapersonal norms (p < 0.001). In the PD cohort, FAB correlated strongly with ESCoT (r > 0.40, p < 0.05) and significantly predicted ESCoT total (R² = 0.247, p = 0.008), affective ToM (β = 0.221, p = 0.034), and interpersonal norms (β = 0.447, p = 0.019). Conclusions: This study demonstrates, for the first time, that ESCoT can sensitively capture multidimensional social cognitive deficits in PD, even in preserved global cognitive function. The observed link with executive dysfunction underlines the need for a more integrative approach to cognitive symptoms in PD. Full article

Objective: Existing studies on short-chain fatty acids (SCFAs) and colorectal cancer (CRC) yield contradictory conclusions and are limited to single ethnic groups or sample types. This study aimed to (1) quantify associations between total SCFAs/subtypes (acetate, propionate, butyrate) and CRC/advanced colorectal adenoma (A-CRA) risks; (2) identify modifiers (ethnicity, sample type, intervention); and (3) clarify SCFA–gut microbiota interaction mechanisms via integrative Bayesian meta-analysis and multi-ancestry data integration. Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science (inception to September 2025) using keywords: “Short-chain fatty acids”, “SCFAs”, “Colorectal cancer”, “CRC”, “Gut microbiota”, “Dietary fiber”, and “High-amylose maize starch butyrate”. Eligible studies included 14 peer-reviewed original studies (7 observational, cohort/case–control/cross-sectional; 7 RCTs) covering Europeans, Asians, and African Americans. Inclusion criteria: Quantitative SCFA data (total/≥3 subtypes), clear ethnic grouping, reported CRC/A-CRA risks or intervention outcomes. Exclusion criteria: Reviews, animal/in vitro studies, incomplete data, low-quality studies (Newcastle–Ottawa Scale [NOS] <6 for observational; high Cochrane risk for RCTs), or limited populations (single gender/rare genetics). A Bayesian hierarchical random-effects model quantified effect sizes (Odds Ratio [OR]/Mean Difference [MD], 95% credible intervals [CrI]), with heterogeneity analyzed via multi-ancestry stratification, intervention efficacy, and microbiota interaction analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] 2020; International Prospective Register of Systematic Reviews [PROSPERO]: CRD420251157250). Results: Total SCFAs were negatively associated with CRC (OR = 0.78, 95% CrI: 0.65–0.92) and A-CRA (OR = 0.72, 95% CrI: 0.59–0.87), with butyrate showing the strongest protective effect (CRC: OR = 0.63, 95% CrI: 0.51–0.77). Ethnic heterogeneity was significant: Europeans had the strongest protection (OR = 0.71), Asians had weaker protection (OR = 0.86), and African Americans had the lowest fecal SCFA levels and the highest CRC risk. Fecal SCFAs showed a stronger CRC association than serum/plasma SCFAs (OR = 0.73 vs. 0.85). High-Amylose Maize Starch Butyrate (HAMSB) outperformed traditional fiber in increasing fecal butyrate (MD = 4.2 mmol/L vs. 2.8 mmol/L), and high butyrate-producing bacteria (Clostridium, Roseburia) enhanced SCFA protection (OR = 0.52 in high-abundance groups). Conclusions: SCFAs (especially butyrate) protect against CRC and precancerous lesions, with effects modulated by ethnicity, sample type, and gut microbiota. High-Amylose Maize Starch Butyrate is a priority intervention for high-risk populations (e.g., familial adenomatous polyposis, FAP), and differentiated strategies are needed: 25–30 g/d dietary fiber for Europeans, 20–25 g/d for Asians, and probiotics (Clostridium) for African Americans. Future Perspectives: Expand data on underrepresented groups (African Americans, Latinos), unify SCFA detection methods, and conduct long-term RCTs to validate intervention efficacy and “genetics-microbiota-metabolism” crosstalk—critical for CRC precision prevention. Full article

Background: Transjugular intrahepatic portosystemic shunt (TIPS) has emerged as a feasible therapeutic option for cirrhotic patients with portal vein thrombosis (PVT). This study aimed to assess the long-term outcomes and factors associated with TIPS dysfunction in cirrhotic patients with PVT over an 18-year period in our institution. Methods: A retrospective study was conducted at Hospital Universitario Reina Sofía (Córdoba, Spain), including adult and pediatric cirrhotic patients with PVT who underwent TIPS between January 2006 and December 2024. Patient characteristics, procedural techniques, and clinical outcomes were evaluated. The primary outcomes were TIPS insertion success rate, primary patency, and dysfunction (stenosis or occlusion). Bivariate comparisons, logistic regression and receiver-operating characteristic (ROC) analyses were performed to identify potential predictors of TIPS dysfunction. Survival analyses using the Kaplan–Meier method and log-rank test, complemented by Cox regression, were also conducted. Results: A total of 36 patients (mean age, 44.8 ± 20.1 years old; 22.2% women; 19.4% children) were included, with a mean follow-up of 66.3 ± 45.9 months and nine deaths (one attributable to the procedure). The primary success rate of TIPS placement was 100%, and mean primary patency was 40.3 ± 40.2 months. TIPS dysfunction occurred in 30.3% of patients. Logistic regression identified age as the only significant predictor of TIPS dysfunction (OR = 0.949; 95%CI, 0.907–0.985, p = 0.011). ROC analysis demonstrated an AUC of 0.737 (95%CI, 0.547–0.927), with an optimal age cut-off of 21 (equivalent to 18 years; sensitivity = 91.3%, specificity = 50%). When age was dichotomized into adult versus pediatric groups, the OR was 0.095 (95%CI, 0.011–0.560), consistent with survival analyses (log-rank p = 0.007; HR = 4.85; 95%CI 1.36–16.88, p = 0.015). Conclusions: TIPS is an effective treatment for cirrhotic patients with PVT, achieving high technical success and long-term patency. However, it is not exempt from complications, including death, and potential dysfunction remains a concern, particularly in pediatric patients. Further prospective studies with larger cohorts are warranted to refine patient selection and optimize outcomes. Full article

Sessile serrated lesions (SSLs) are well-known precursors of colorectal cancer in the general population, but their role in inflammatory bowel disease (IBD) is less clear. This narrative review summarizes what is known about the prevalence, molecular features, endoscopic detection, malignant potential, and management of SSLs in patients with IBD, highlighting where evidence supports action nowadays and where prospective studies are urgently needed. IBD-associated colorectal cancer has long been considered a consequence of the inflammation–dysplasia–carcinoma sequence, distinct from the conventional adenoma–carcinoma pathway. Increasing evidence, however, suggests that the serrated pathway, typically characterized by SSLs and traditional serrated adenomas (TSAs), may also contribute to IBD-related oncogenesis. This review synthesizes histopathological, molecular, endoscopic, and clinical data on SSLs in patients with IBD, with contextual reference to TSAs, sessile serrated lesions with dysplasia, and serrated epithelial change only when relevant to their interpretation or risk stratification. SSLs are now more frequently identified in IBD surveillance, especially in ulcerative colitis and the proximal colon, although prevalence estimates remain heterogeneous due to evolving definitions and significant interobserver variability. Molecular studies indicate that IBD-associated serrated lesions often harbor BRAF mutations but display a lower CpG island methylator phenotype than their sporadic counterparts, suggesting an inflammation-modified biology. While most hyperplastic polyps and non-dysplastic SSLs appear to pose limited neoplastic risk, dysplastic serrated lesions carry a markedly higher likelihood of synchronous or metachronous advanced neoplasia. Advances in high-definition endoscopy and chromoendoscopy improve the detection of these subtle, mucus-capped, flat lesions, while endoscopic resection is nowadays feasible in expert hands. Future priorities should include prospective multicenter cohorts integrating molecular profiling to refine surveillance strategies. Full article

Objective: This study aimed to examine the associations between malnutrition and circulating blood markers in older adults. Methods: We conducted a prospective cohort study on octogenarians residing in the mountain community of the Sirente geographic area in Central Italy. Data collection was conducted from December 2023 to September 2024. Malnutrition was defined based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. A panel of blood markers was examined, and principal component analysis (PCA) was used to identify clusters of related molecules. Both unadjusted and adjusted binary logistic regression models were applied to investigate the associations between malnutrition and these molecular clusters. Results: Data from 196 older adults (mean age: 86.2 years) were analyzed. Malnutrition was positively associated with PC 2 (i.e., urea, c-terminal agrin fragment, and potassium) (odds ratio [OR] = 1.647, p-value: 0.039) and negatively associated with PC 3 (i.e., hemoglobin, hematocrit, and red blood cell count) (OR = 0.567, p-value: 0.022) and PC 4 (i.e., calcium, albumin, total protein levels, and HDL cholesterol) (OR = 0.607, p-value: 0.035). Conclusions: Findings of the present study suggest that different clusters of blood markers are associated with malnutrition in older adults. Specifically, malnutrition is associated with clusters related to kidney function, anemia, neuromuscular function, and nutrient availability. These associations likely reflect the underlying biological mechanisms contributing to the development of malnutrition in this population. Full article

Background: Lower-limb fractures often require prolonged use of assistive devices, which may increase mechanical stress on the upper extremities. However, the association between lower-limb fractures and subsequent carpal tunnel syndrome (CTS) remains unclear. Methods: This nationwide population-based cohort study used Taiwan’s National Health Insurance Research Database (2011–2019) to identify 10,140 patients with lower-limb fractures and 10,140 propensity score-matched controls. Cox regression analysis estimated CTS risk after adjusting for demographics and comorbidities. Results: Patients with lower-limb fractures demonstrated increased CTS risk compared to controls (adjusted hazard ratio [HR] = 1.12, 95% confidence interval [CI]: 1.003–1.26; p = 0.044), with stronger associations in males (HR = 1.28, 95% CI: 1.05–1.55) and younger adults aged 20–65 years (HR = 1.19, 95% CI: 1.03–1.38). Conclusions: Lower-limb fractures are associated with modestly increased CTS risk, particularly in males and younger patients. Though biologically plausible, this observational study cannot establish causality. Heightened clinical awareness may be warranted, though prospective validation is needed. Full article

Introduction: The COVID-19 pandemic posed additional challenges for this vulnerable population, such as Sjögren’s disease (SjD), underscoring the need for effective and safe vaccination strategies. Objective: To evaluate the immunogenicity and safety of COVID-19 vaccines in patients with SjD. Methods: This prospective, observational, longitudinal study included SjD patients from the SAFER cohort. Immunogenicity was assessed via anti-spike IgG (IgG-S) titers using chemiluminescence reported as geometric mean titers (GMT) and fold increase in GMT (FI-GMT). Disease activity was evaluated using the ESSDAI score. Adverse events and COVID-19 infections were also monitored. Assessments were conducted at four time points: pre-first dose (T1), pre-second dose (T2), pre-booster (T3), and four weeks post-booster (T4). Primary vaccination involved ChAdOx1 nCoV-19 or inactivated vaccine (CoronaVac), and boosters were either homologous (ChAdOx1 nCoV-19) or heterologous (BNT162b2). Results: Among 51 participants (mean age 46 years; 90% female), 41% had comorbidities and 27% (n = 14/51) were highly immunosuppressed. Among those 73% (n = 37/51) under low immunosuppression, n = 8/51 (13%) were not using any medication. At baseline, 11% (n = 4/35) showed moderate/high disease activity, which decreased to 6.5% (n = 2/31) at T4. Primary vaccination was ChAdOx1 in 94% (n = 48/51) and CoronaVac in 6% (n = 3/51); 73% (n = 37/51) received heterologous and 27% (n = 14/51) homologous boosters. COVID-19 infection post-booster occurred in 20% (n = 10/51). Seroconversion rates reached nearly 100% across all medication subgroups except for biologic users, who showed delayed but stable seroconversion by T4. IgG-S titers increased progressively through T4. Primary immunization induced an ascending GMT in both vaccine types. At T4, the GMT was significantly higher in the BNT162b2 group (2148.03 [1452.05–3155.84]; p < 0.001; 95% CI) than in the ChAdOx1 group (324.29 [107.92–974.48]; p < 0.001; 95% CI); the fold-increase in immune response was six times greater with BNT162b2 (5.98 [2.97–12.03]; p = 0.001; 95% CI). Seroconversion was 100% in the heterologous group versus 83% in the homologous group (p > 0.01). Those with prior infection showed significantly higher titers, particularly at T2 and T3 (p < 0.001 for T1–T3). Adverse events were mild and not statistically significant. Multivariate regression confirmed BNT162b2 as an independent factor for higher antibody titers. Conclusion: COVID-19 vaccination in patients with SjD was safe and induced high anti-spike antibody titers and seropositivity. Heterologous boosting, particularly with BNT162b2, demonstrated superior immunogenicity. No association was found between vaccination and SjD disease flares or worsening activity. Full article