Search Results (2,245)

Background/Objectives: Compression therapy serves as first-line conservative management for low-flow vascular malformations and Klippel–Trénaunay syndrome (KTS). However, ready-made garments are frequently ill-fitting for patients with limb overgrowth, asymmetry, deformity, or heterogeneous body habitus. Custom-made compression elastic garments offer an individualized solution, yet systematic data across diverse clinical entities remain scarce. This study evaluated objective and subjective outcomes of custom-made compression garments across vascular anomalies and edematous disorders in a multi-institutional real-world setting. Methods: A retrospective observational case series was conducted between May 2023 and September 2025 at four institutions: a tertiary medical center, a pediatric specialty hospital, a corporate hospital, and a corporate clinic. Patients who received custom-made compression elastic garments for vascular anomalies, edema, varicose veins, post-traumatic or post-burn venous stasis, or postoperative conditions were included. Objective outcome (limb circumference change) and subjective outcome (patient satisfaction) were analyzed. Results: A total of 191 patients who received custom-made garments were described (117 females, 61.3%; 74 males, 38.7%; mean age 36.3 years; median 22 years; range 1–96 years). The age distribution was bimodal, with 91 patients (47.6%) aged 0–19 years and 50 patients (26.2%) aged ≥70 years. The tertiary center and pediatric hospital treated vascular anomaly patients exclusively (n = 102), while the corporate hospital and clinic primarily served adult and elderly edematous disorder patients (n = 88; one additional vascular anomaly case was managed at the corporate hospital). Quantitative paired outcome analysis was feasible in the subgroups with complete paired data: 20 vascular anomaly patients (objective outcome) and 20 edematous disorder patients (subjective outcome). In the vascular anomaly subgroup (n = 20), the affected limb showed a significantly greater circumference reduction at the ankle’s narrowest point (median −2 mm, IQR −4.2 to 0.0) compared with the unaffected contralateral limb (median +0.5 mm, IQR −0.2 to +1.0; Wilcoxon signed-rank test T = 4; p < 0.001; effect size r = 0.83). In the edematous disorder subgroup (n = 20), patient satisfaction scores improved significantly from a median of 3 (IQR 2.0–4.0) to 4 (IQR 3.0–6.0) after garment use (Wilcoxon signed-rank test T = 0; p < 0.001; effect size r = 0.83). Representative cases illustrated pediatric vascular anomaly (Case A, vascular malformation; Case C, KTS) and adult edematous disorder (Case B, chronic lower limb edema) presentations and outcomes. Conclusions: Custom-made compression elastic garments were feasible and well tolerated across a broad real-world spectrum of vascular anomalies and edematous disorders. In the analyzed subgroups, a measurable reduction in affected-limb circumference was observed in pediatric vascular anomaly patients, and patient satisfaction improved in adult and elderly edematous disorder patients. Because each subgroup was evaluated with only one outcome domain and no head-to-head comparison of measures was performed, these findings should be regarded as hypothesis-generating. We propose that outcome measures may need to be tailored to disease background and age, a hypothesis that warrants testing in prospective studies capturing both objective and subjective endpoints across all patient groups. Full article

Background: Current treatments for myasthenia gravis (MG), while improving outcomes, are often associated with adverse effects, and a proportion of patients remain refractory to standard therapies. Eculizumab, a humanized monoclonal antibody targeting complement protein C5, is approved for refractory anti-acetylcholine receptor antibody-positive generalized MG (AChR-Ab+ gMG). Aim of the present study is to explore the rapidity of onset of eculizumab efficacy in a single-center cohort of MG patients. Methods: This retrospective, observational, single-center study evaluated the real-world effectiveness and rapidity of response to eculizumab in patients with AChR-Ab+ gMG. Patients received eculizumab according to the approved regimen and were assessed at baseline (T0), 5 weeks (T1), and 3 months (T2) using the Myasthenia Gravis Activities of Daily Living (MG-ADL) score, Quantitative Myasthenia Gravis (QMG) score, and Myasthenia Gravis Foundation of America (MGFA) classification. Results: Eight patients were eligible for the study with a mean age of 73.1 years. A rapid clinical improvement was observed after treatment initiation. Mean MG-ADL scores decreased from 8.38 at T0 to 2.13 at T1 (p < 0.001; Cohen’s d = 2.075), while QMG scores declined from 13.75 to 5.63 (p = 0.001; Cohen’s d = 1.824). Improvements were maintained at T2. Mean percentage reductions from T0 to T1 were 73.5% for MG-ADL and 60.6% for QMG. Eculizumab was well tolerated. Conclusions: These real-world findings confirm a rapid and clinically meaningful response to eculizumab in elderly patients with refractory gMG. These findings highlight its potential role in achieving early symptom control and reducing disease burden in this clinically vulnerable population. Full article

Background: Acinetobacter baumannii is an important opportunistic pathogen responsible for healthcare-associated infections, particularly among critically ill, intensive care unit (ICU), and post-surgical patients. The emergence of carbapenem-resistant A. baumannii (CRAB) has become a major therapeutic challenge worldwide because of its multidrug-resistant nature and limited treatment options. Despite the increasing prevalence of CRAB in Pakistan, information regarding the molecular characterization of carbapenem resistance genes among isolates recovered from surgical site infections (SSIs) remains limited. Methods: A cross-sectional study was conducted from November 2023 to February 2024 at Khalifa Gul Nawaz Hospital, Bannu, Khyber Pakhtunkhwa, Pakistan. A total of (n = 118) surgical wound specimens were collected from patients with clinically diagnosed SSIs. A. baumannii isolates were identified using standard biochemical tests and confirmed by 16S rRNA gene sequencing. In vitro antimicrobial susceptibility was determined by Kirby–Bauer disk diffusion according to CLSI 2024 guidelines. In addition, the concentration-dependent inhibition-zone response of imipenem and meropenem against carbapenem-resistant isolates was evaluated using an agar well diffusion assay. Molecular detection of blaNDM-1 and blaOXA-23 was performed by polymerase chain reaction (PCR), and representative amplicons were subjected to Sanger sequencing for further analysis. Results: In the current study, the total number of (n = 118) wound specimens from healthcare-associated patients were processed, in which A. baumannii-positive isolates (n = 23, 19.5%) were documented. Its prevalence was higher in males (69.6%) compared to females, and was strongly associated (78.2%) with elderly patients (aged 51–68 years). In vitro susceptibility testing revealed that 91.3% of isolates harbored multidrug-resistant (MDR) attributes. Antimicrobial susceptibility profiling revealed high levels of multidrug resistance, with 82.6% of isolates resistant to imipenem and meropenem, as well as 100% resistance to aztreonam and gentamicin. Colistin showed the highest activity, with 87.0% of isolates remaining susceptible. In the agar well diffusion assay, measurable inhibition of the carbapenem-resistant isolates by imipenem and meropenem occurred only at higher concentrations. Molecular screening of resistance genes identified blaOXA-23 in 60.9% and blaNDM-1 in 30.4% of isolates. Co-expression of both genes was detected in some (n = 4) isolates. Among the selected MDR isolates included in the gene resistance analysis, imipenem and meropenem resistance were recorded in 9/14 blaOXA-23-positive isolates and 5/7 blaNDM-1-positive isolates. Conclusions: This study substantiates an escalated incidence of carbapenem-resistant, MDR A. baumannii in post-surgical infections. blaOXA-23 were documented as the predominant carbapenemase gene, with co-expression of blaNDM-1 in a substantial proportion of isolates. These findings provide an important phenotypic and molecular characterization of selected carbapenemase genes in healthcare-associated infections, highlighting the exigency for strengthened antimicrobial stewardship and infection control strategies in the hospitals of the region. Full article

Objective: Varicella zoster virus (VZV), a member of the Herpesviridae family, is known as the causative agent of chickenpox (varicella). Following primary infection, VZV can remain latent for life and may reactivate over time to cause herpes zoster (shingles). Advanced age, immunodeficiency, and certain chronic illnesses are major risk factors for the development of herpes zoster. To prevent herpes zoster, a live zoster vaccine was licensed in 2006, followed by a recombinant zoster vaccine with higher efficacy in 2018. In Türkiye, the recombinant zoster vaccine was licensed in 2024. Raising awareness among healthcare workers is important both for their own health and the safety of vulnerable patients. This study aimed to evaluate healthcare workers’ knowledge and awareness of herpes zoster infection and zoster vaccines across the country, as well as to determine the prevalence of prior herpes zoster infection among them. Methods: After obtaining ethical approval, a nationwide multicenter survey was conducted. A questionnaire was distributed to healthcare workers via an online link. Participation was entirely voluntary. The survey collected demographic information (age, sex, profession, years of experience) and included questions on knowledge of herpes zoster, history of zoster infection, symptoms and severity (if applicable), awareness of the zoster vaccine, and vaccination attitudes. Results: A total of 5180 healthcare workers participated, of whom 3505 were female. The participants ranged in age from 18 to 79 years (mean age: 34.24 ± 11.52). Regarding professions: 47.9% were physicians, 21.3% were nurses or midwives, 0.8% were dentists or dental technicians, and 30% were from other healthcare professions. Among participants, 54.4% had ≤10 years of professional experience, 20% had comorbidities, and 10.5% were using immunosuppressive medications. It was found that 9.6% had previously had herpes zoster, 8.8% had no knowledge of the disease, 39.6% were aware of the vaccine, and 20.1% were unwilling to pay for vaccination. Multivariate binary logistic regression analysis revealed that being a physician significantly increased the likelihood of having correct knowledge by 1.961 times compared to other professions (p < 0.001, CI: 1.608–2.392). Similarly, those who had heard of herpes zoster were 3.191 times more likely to answer correctly than those who had not (p = 0.011, CI: 1.650–6.172). Male gender was significantly associated with a lower likelihood of having accurate knowledge compared to females (p = 0.001, OR = 0.720, CI: 0.594–0.874). Conclusions: This study revealed that healthcare workers’ knowledge and awareness regarding herpes zoster and its vaccines are generally insufficient. The recent licensing of the vaccine in Türkiye may explain this, but it is critical for healthcare professionals to be more informed about risk groups and vaccination indications in order to enhance the effectiveness of preventive healthcare services. Given the potential for serious complications of herpes zoster in elderly and immunocompromised individuals, the importance of vaccination should be emphasized more strongly to healthcare workers. Furthermore, the finding that 20.1% of those aware of the vaccine were deterred by its cost highlights the need to improve vaccine accessibility. Economic barriers preventing healthcare workers from being vaccinated emphasize the importance of making the vaccine widely available through public support to protect both healthcare workers and patient safety. Full article

Percutaneous kidney biopsy (PKB) is an essential tool in the nephrologist’s armamentarium that plays a major role in establishing the diagnosis, monitoring response to interventions and providing prognostication. Over the last few decades, the technique of PKB has evolved from a blind procedure with a high complication rate to an image-guided procedure with substantially reduced but still clinically relevant complication rates, with major bleeding reported in approximately 1–6% of biopsies in contemporary series. With appropriate pre-procedure planning, patient selection, and experienced operators, PKB generally has a low rate of major complications and a high diagnostic yield, while clinicians must remain vigilant for bleeding and other adverse events. In this narrative review, we summarize current indications, contraindications, technical considerations, and complication mitigation strategies for PKB, integrating contemporary guideline recommendations and key observational studies to support bedside decision-making. Further, we review details pertaining to peri-procedure protocols. Special populations that require PKB such as morbid obesity, pregnancy, elderly, single kidney and anatomic abnormalities are discussed as well. Alternative approaches to performing PKB, when PKB is infeasible or challenging, are briefly covered in this review. Full article

Background/Objective: With the rapid ageing of the global population, promoting mental health and well-being among older adults has become a key priority for healthcare systems. Social support is widely recognized as an important social determinant of health; however, the underlying psychological mechanisms through which it influences well-being in community-dwelling older adults remain insufficiently understood. This study aimed to examine the association between social support and subjective well-being among community-dwelling older adults in urban China and to determine whether psychological resilience mediates this relationship after adjusting for key sociodemographic factors. Methods: A cross-sectional study was conducted between May and July 2023 among 1227 older adults aged ≥ 65 years in three urban communities in Dongguan, China. Stratified cluster sampling was applied. Social support was assessed using the Lubben Social Network Scale (LSNS-6), psychological resilience using the Connor–Davidson Resilience Scale (CD-RISC-10), and well-being using the Elderly Well-Being Scale (EWBS). Pearson correlation and mediation analyses (PROCESS Model 4 with bootstrap resampling) were performed to examine the relationships among variables, adjusting for key sociodemographic factors. Results: A significant positive correlation emerged between social support and well-being (r = 0.410, p < 0.01), with psychological resilience exhibiting an even stronger correlation with well-being (r = 0.573, p < 0.01). Mediation analyses showed that psychological resilience partially mediated the social support–well-being relationship (indirect effect = 0.324, 95% CI: 0.262–0.391), explaining 38.5% of the total effect. Higher educational attainment and stable economic security (e.g., pension coverage) were significantly associated with better well-being outcomes. Conclusions: These findings suggest that social support is associated with better well-being both directly and indirectly through psychological resilience. From a healthcare perspective, community-based interventions that strengthen social networks and improve psychological resilience may represent effective strategies for promoting healthy ageing. Integrating psychosocial support and resilience-building programs into primary care and community health services could contribute to improving mental health and quality of life in ageing populations. Full article

Background and Objectives: The method of femoral canal opening during intramedullary fixation may influence the biological response to surgery. The aim of this study was to compare the early biological responses associated with mechanical canal opening and manual canal opening during Proximal Femoral Nail Antirotation (PFNA) fixation in patients with pertrochanteric femoral fractures, with a particular focus on inflammation, coagulation, organ dysfunction, and bone metabolism. Materials and Methods: This single-centre prospective randomised study consisted of 60 participants (50 women) with a mean age of 80.33 ± 11.13 years, who were randomly assigned to either manual femoral canal opening (n = 30) or mechanical canal opening (n = 30). Outcomes were assessed preoperatively and postoperatively during a 72 h follow-up period. This study was registered at ClinicalTrials.gov (ClinicalTrials.gov ID NCT07648719; registration date: 15 June 2026; study start: 1 March 2025). Results: Across all participants, surgery was associated with a significant decrease in haemoglobin levels, calcium, and estimated glomerular filtration rate, while fibrinogen, urea, creatinine, CRP (C-reactive protein), and NT-proBNP (N-terminal pro-B-type natriuretic peptide) significantly increased postoperatively. Patients in the mechanical canal opening group demonstrated significantly higher postoperative levels of leukocytes (p = 0.002), CRP (p = 0.001), NT-proBNP (p = 0.002), fibrinogen (p = 0.026), activated partial thromboplastin time (p = 0.035), urea (p = 0.001), and creatinine (p = 0.018), as well as greater reductions in haemoglobin (p < 0.001), compared with the manual canal opening group. Bone turnover markers also differed between groups: postoperative bone-specific alkaline phosphatase levels were significantly higher in the mechanical canal opening group (p = 0.001), whereas the increase in total procollagen type 1 N-terminal propeptide was more pronounced in the manual canal opening group (p = 0.045). Conclusions: The method of femoral canal opening during PFNA fixation significantly influences early postoperative systemic inflammation, coagulability, organ stress, and bone turnover dynamics. Manual opening of the femoral canal was associated with lower early systemic and bone stress biomarker responses compared with mechanical canal opening. Whether these differences translate into improved clinical outcomes, particularly in elderly patients with limited physiological reserve, remains to be determined. Full article

Background/Objectives: This meta-analysis primarily aimed to evaluate the effects of the Otago Exercise Program (OEP) on physical function performance related to the risk of falls in the elderly. Methods: A literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science for studies on OEP interventions related to falls in older adults. Eligible studies were randomized controlled trials that reported at least one physical function outcome related to fall risk, including the Timed Up and Go test (TUG), Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), 30-Second Sit-to-Stand Test (30s-SST), Falls Efficacy Scale-International (FES-I), or 6-Minute Walk Test (6MWT). Subsequently, a risk of bias assessment, as well as data extraction and synthesis, was performed. Results: Data were synthesized from a total of 13 studies, involving 1278 participants from OEP (n = 660) and control (n = 618) trials. The results suggested that OEP was associated with improvements in TUG (WMD = −1.47; 95%CI: −2.44, −0.51), BBS score (WMD = 4.43; 95%CI: 2.50, 6.36), SPPB scores (WMD = 0.76; 95%CI: 0.43, 1.09), 30s-SST (WMD = 2.68; 95%CI: 0.86, 4.49), FES-I score (WMD = −1.74; 95%CI: −3.15, −0.33). However, no significant effect was observed for the 6MWT. Subgroup analysis suggested that group-based OEP appeared to provide greater improvements in TUG, BBS scores, and 30s-SST, whereas home-based OEP did not show significant effects. In addition, interventions lasting ≥4 months were associated with greater improvements for TUG, BBS scores, and the 30s-SST. Older adults aged ≥75 showed significant improvements in TUG and 30s-SST. However, substantial heterogeneity was observed across several outcomes, and evidence for SPPB, FES-I, and 6MWT was based on a limited number of studies. Conclusions: OEP may improve physical function performance related to fall risk in older adults, such as the TUG, BBS, SPPB, 30s-SST, and FES-I, while no significant effect was observed for the 6MWT. Importantly, the findings support improvements in physical function performance rather than a direct reduction in actual fall incidence. These findings should be interpreted cautiously due to substantial heterogeneity and the limited number of trials for some outcomes. A group-based OEP lasting at least 4 months may provide greater benefits for improving physical function related to fall risk, particularly among adults aged ≥75 years. Full article

This study, based on the WELL Health Building Standard as the theoretical framework, combined with case analyses of 38 geriatric care hospital wards in South Korea and multi-group questionnaires (60 responses each from the medical service, design field, and elderly population groups), systematically explored the design elements and their importance cognition of healing environments in hospital rooms. Through cross-comparison analysis, quantitative (SPSS 25.0 multiple regressions, correlation analysis) and qualitative (ATLAS.ti 9 coding) data fusion methods, the study proposed four core design principles centered on “Beauty and Design,” “Nature Connectedness,” “Privacy,” and “Community and Information” and selected 36 key assessment indicators. The data analysis indicated that the perceived importance of the elderly population (AX) had the greatest impact on the compliance rate of rooms (AR) (β = 0.506, p = 0.002) and the medical staff group (AT) paid more attention to functional design (β = 0.506, p = 0.005), while the designer group (AV) emphasized aesthetic innovation and natural light planning (β = 0.367, p = 0.28). The study further proposed a hierarchical optimization strategy, emphasizing the balanced design of functional requirements, aesthetic innovation, and patient experience through cross-group collaborative design mechanisms. The research results provide theoretical and practical guidance for the healing environmental optimization of hospital rooms in elderly care hospitals. Full article

Background: Endovascular repair with covered stent is an established minimally invasive treatment for popliteal artery lesions, particularly in elderly or high-risk patients. Infectious complications are exceptionally rare but may result in arterial destruction, limb loss, and death. Salmonella species demonstrate a well-recognized affinity for diseased arterial walls and prosthetic vascular material. Case Presentation: An 82-year-old man with stage G4 chronic kidney disease and previous nephrectomy for renal cell carcinoma, complicated by Salmonella Enteritidis septic shock 20 years earlier, presented with acute left lower limb ischemia caused by a post-traumatic popliteal artery pseudoaneurysm. Urgent endovascular repair was performed using a 6 × 100 mm covered stent (Viabahn) with adjunctive angioplasty of the anterior tibial artery. Two weeks later, he was readmitted with fever, severe popliteal pain, local erythema, and elevated inflammatory markers. Imaging demonstrated early stent occlusion with a large peri-graft abscess and contained arterial rupture. Emergency open conversion included radical debridement, complete graft explantation, and popliteal-to-posterior tibial bypass using an autologous great saphenous vein. Cultures grew Salmonella Enteritidis. Retrospective history revealed a previously undocumented episode of Salmonella Enteritidis bacteremia approximately 20 years earlier. At 2-year follow-up, the patient remained free of recurrent infection with a patent vein graft and preserved ambulatory function. Conclusions: Early Salmonella Enteritidis infection of a popliteal covered stent is an exceptionally rare but life-threatening complication. This case suggests that remote Salmonella bacteremia may represent a potential, hypothesis-generating risk factor for prosthetic graft infection. Prompt graft explantation followed by radical debridement and autologous venous reconstruction remain essential for durable limb salvage. Full article

With the advancement of healthy city development, optimizing the spatial allocation of urban parks has become a key issue in territorial spatial planning. However, existing studies mainly focus on accessibility and spatial equity, with limited attention to multidimensional suitability assessment and coordinated optimization based on public health needs. Taking Jinjiang City, Fujian Province, China, as a case study, this study used ArcGIS 10.8-based spatial analysis and multi-source geospatial data to classify urban park scenarios into eight categories based on public health needs: child-friendly, elderly wellness, rehabilitation and therapeutic, camping and leisure, cultural and creative, science education, scenic check-in, and outdoor sports. A four-dimensional framework integrating ecological, population vitality, accessibility, and health service function suitability was established to evaluate the suitability between park scenarios and public health needs. The results show that park scenarios exhibit significant spatial clustering with marked north–south and urban–rural disparities. Overall suitability is low, although high-density areas show better population–park matching, while health service facilities remain unevenly distributed. Based on multidimensional coordinated analysis, the 330 scenarios across 81 parks were classified into coordinated advantage, improvement, and potential zones, supporting differentiated spatial optimization and zonal governance. The proposed framework provides theoretical and practical support for health-oriented urban park planning and territorial spatial optimization. Full article

Background: Tooth root caries and periodontal tissue loss remain major challenges in elderly and periodontally compromised patients, while current restorative materials lack combined antibacterial and regenerative properties. Objective: The objective of this study was to develop a novel metformin-containing antibacterial composite for root cavity restorations to prevent recurrent caries and potentially promote periodontal tissue regeneration. Methods: Experimental composites contained 5% dimethylaminohexadecyl methacrylate (DMAHDM), varying metformin concentrations (2.5–15%), and glass fillers. Mechanical and antibacterial properties as well as cytocompatibility toward human periodontal ligament stem cells (hPDLSCs) were investigated. Results: The experimental composites achieved flexural strengths of 67.9 to 50.1 MPa (n = 6), significantly higher than (41.3 ± 3.4 MPa) of commercial control Vitremer (p < 0.05), while maintaining clinically acceptable elastic moduli of 3.7–3.1 GPa. Experimental composites achieved an 8-log reduction in Streptococcus mutans (S. mutans) biofilms and significantly reduced lactic acid production and metabolic activity compared to biofilms on commercial controls. The composite containing 15% metformin demonstrated acceptable cytocompatibility toward hPDLSCs under clinically relevant diluted conditions, matching commercial controls (p > 0.1). Conclusions: These findings suggest that this novel composite possesses potent antibacterial activity, acceptable cytocompatibility, and adequate mechanical properties, making it promising for multifunctional root caries restorations. Full article

The 15-minute life circle has become a critical planning paradigm for developing age-friendly cities; however, its implementation in small and medium-sized cities (SMSCs) is often constrained by topographical heterogeneity and the oversimplified use of facility density as a proxy for service efficiency. This study challenges the conventional assumption that a higher facility density automatically leads to better service outcomes and proposes a dynamic “space–demand–policy” analytical framework to identify the mechanisms underlying spatial mismatch. Using Zhifu District, Yantai, a rapidly aging urban area with complex topography, as a case study, we integrated kernel density estimation (KDE), slope-adjusted network analysis, a modified Gaussian-based two-step floating catchment area (2SFCA) method, and standard deviational ellipse (SDE) analysis. Our results reveal three key findings. First, a “high-density, low-efficiency” paradox is prevalent: older urban cores contain clusters of facilities but have supply–demand ratios below 0.5 because of limited service diversity and slope-induced reductions in accessibility, with the effective service radius decreasing to 750 m. Second, newly developed areas achieve service coverage rates below 50% when terrain constraints are considered, highlighting the limitations of static planning radii. Third, a 90% overlap between the directional distributions of residential areas and elderly care facilities, as indicated by their SDE major axes, supports the spatial feasibility of community-embedded aging-in-place models; however, physical proximity alone does not guarantee effective service delivery. By adapting generic spatial algorithms to create a terrain-sensitive planning tool, this study provides a transferable framework for evidence-based and targeted elderly care planning in SMSCs facing similar demographic and geographic constraints. The proposed framework contributes to the global sustainability agenda and advances SDG 11 (Sustainable Cities and Communities) and SDG 3 (Good Health and Well-being) by promoting more equitable resource allocation and supporting the development of age-friendly, walkable, and sustainable communities in topographically complex urban areas. Full article

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality in the elderly worldwide. Over the past two decades, there has been a wealth of evidence of a close relationship between autonomic nervous system activity and cardiovascular mortality, including sudden cardiac death. Heart rate variability (HRV), derived from photoplethysmographic (PPG) signals, is increasingly recognized as a promising non-invasive digital marker for evaluating autonomic nervous system function and stratifying CVD risk. The application of machine learning algorithms to PPG-derived HRV analysis offers a promising approach for improving CVD risk stratification and facilitating the development of personalized medicine strategies. Background/Objectives: To evaluate the potential of heart rate variability indicators in predicting the risk of developing CVD in individuals aged 65 years and older. Methods: The study involved individuals aged 65 years and older, divided into two groups: those with a risk of developing CVD (n = 54) and those without risk (n = 46). The first stage included a questionnaire as well as anthropometric and hemodynamic measurements. At the second stage, a PPG was performed using the Eldar computer photoplethysmograph and Eldar-Vario software, followed by an analysis of time-domain and spectral HRV parameters. Statistical data analysis was conducted using the SPSS Statistics 22.0 software package, focusing on the evaluation of associations between HRV indicators and the presence of CVD. Interpretable machine learning models were developed using logistic regression and a random forest algorithm within a nested cross-validation framework. In addition to the discriminatory characteristics, Brier score, LogLoss, calibration analysis, error matrices, permutation importance, and SHAP interpretation were analyzed in the study. Results: In patients with cardiovascular diseases, a statistically significant decrease in heart rate variability was revealed: SDNN by 2 times (26 [Q1–Q3: 15, 35] ms), pNN50 by 3.5 times (4 [3, 5]%), TINN by 5 times (31 [20, 51] ms), and HRV by 2.5 times (6 [4, 8.7]). In addition, a decrease was seen in the spectral components of VLF by one-fold (2450 [Q1–Q3: 2450, 4500] ms²), LF by four-fold (750 [750, 1500] ms²) and HF by five-fold (450 [450, 750] ms²) (p < 0.05). At the same time, there was a significant increase in the VLF/HF and LF/HF ratios, which indicates a predominance of sympathetic activity. According to the results of the correlation analysis, statistically significant associations of HRV indicators with age, physical activity level, body mass index and systolic blood pressure were revealed. The results of machine learning also revealed the association of HRV with arterial hypertension, physical activity and BMI. The best final results were demonstrated by a random forest model with a combined set of clinical and HRV signs of HF and RMSSD (ROC-AUC was 0.9988). The signs of heart rate variability obtained by photoplethysmography demonstrated additional prognostic value in relation to clinical signs. PPG-derived HRV features demonstrated additional discriminatory value for cardiovascular risk stratification. Conclusions: The obtained data demonstrate a close association between the risk of developing cardiovascular disease and autonomic nervous system dysfunction. The decrease in heart rate variability is most pronounced in elderly individuals with existing cardiovascular disease and can be considered a potential tool for developing diagnostic, prognostic, and risk stratification strategies. The use of machine learning demonstrated that heart rate variability features obtained using photoplethysmography improve diagnostic prognostication and classification of cardiovascular diseases compared to models based solely on clinical data. Full article

Background/Objectives: Azacitidine (AZA) is the standard of care for patients with higher-risk Myelodysplastic Syndromes (MDS). There is limited real-life data, however, characterizing its efficacy and safety profile in elderly patients. Methods: We conducted a single-center retrospective cohort chart review to compare front-line AZA therapy in patients ≥75 years (elderly) vs. <75 years (younger) with higher-risk MDS treated at our cancer center. The primary endpoint was overall survival and main secondary endpoints included response, as per the 2006 International Working Group consensus criteria, leukemia-free survival, transfusion independence, and safety outcomes. Results: In total, 55 patients were elderly (median age: 79.9 years), including 27 patients >80 years, and 41 were younger (median age: 69.4 years). Baseline demographic variables were similar between both groups. The majority of elderly patients (98%) received the full dose of AZA (75 mg/m²), compared with 90% of younger patients. The median number of AZA cycles was 8 (range: 2–69) in elderly and 7.75 (range: 1–96) in younger patients. Treatment delays occurred in 36.4% of elderly and 29.3% of younger patients, most commonly due to infection complications in both groups (p = 0.076). Disease control rates (complete remission + partial remission + stable disease) were 92.9% in the younger subgroup and 96.4% in the elderly subgroup (p = 0.154). Relapse occurred in 48.8% of younger patients and 40.0% of elderly patients. Median overall survival (OS) was 17.3 months for the younger subgroup, 15.7 months for the elderly subgroup (p = 0.771), and 11.9 months among patients >80 years (p = 0.381). Mortality rates and causes of death were similar between both subgroups. Most common causes of death included disease progression, sepsis, febrile neutropenia, and pneumonia. Conclusions: AZA monotherapy resulted in a high response rate and was well-tolerated in elderly patients with higher-risk MDS. These findings remain consistent in the real-world setting despite potential confounding factors that may contribute to inferior outcomes. Full article