Abstract: Background and Objectives: Procalcitonin (PCT) kinetics have emerged as a promising prognostic marker in sepsis; however, their interpretation is complicated by dynamic changes in renal function during acute illness. Most previous studies relied on a single baseline estimated glomerular filtration rate (eGFR), which may lead to misclassification in patients with evolving acute kidney injury. This study aimed to evaluate the prognostic value of procalcitonin kinetics (ΔPCT) for 30-day mortality in critically ill patients with sepsis or septic shock by incorporating serial kinetic eGFR measurements and renal function–adapted ΔPCT cut-off values based on the mean kinetic eGFR during the first 72 hours of intensive care unit (ICU) admission. Materials and Methods: This retrospective cohort study included 106 adult patients admitted to a general ICU with sepsis or septic shock. Procalcitonin levels were measured serially, and ΔPCT was calculated as the logarithmic ratio of follow-up to baseline values. Renal function was assessed using kinetic eGFR calculated at serial time points from ICU admission, and the mean kinetic eGFR over the first 72 hours was used for renal function stratification. Multivariable logistic regression models incorporating ΔPCT and severity scores (APACHE II and SOFA) were constructed, and discriminative performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Thirty-day mortality was 43.4%. ΔPCT was a strong independent predictor of mortality across all models. When stratified according to mean kinetic eGFR, optimal ΔPCT cut-off values expressed as absolute proportional PCT decline differed markedly by renal function: an 81.2% decrease in PCT best discriminated mortality in the overall cohort, whereas renal function–specific thresholds were 63.7% for patients with mean kinetic eGFR <30 mL/min, 87.6% for those with kinetic eGFR 30–59 mL/min, and 92.6% for patients with kinetic eGFR ≥60 mL/min. The combination of APACHE II and ΔPCT demonstrated the highest discriminative performance (AUC 0.946). Conclusions: Procalcitonin kinetics provide robust prognostic information in sepsis when interpreted alongside dynamic renal function. Using serial kinetic eGFR measurements and the 72-hour mean renal function enables renal function–adapted ΔPCT cut-off determination and may improve mortality risk stratification in critically ill septic patients.

Abstract: Long COVID is the consequence of having had COVID. Long COVID has many other names including Long-haul COVID, Post-COVID conditions (PCC), Post-COVID-19 syndrome, Post-acute sequelae of SARS-CoV-2 condition (PASC) and Chronic COVID. Long COVID is the name most frequently used. COVID is not alone in having severe post infection consequences. Influenza, Ebola, Marburg, Dengue, and Lyme Disease are other infections with severe post infection consequences. Long COVID has emerged over the past few years and is ill-defined. Long COVID’s underlying science and treatments are rapidly evolving. There is no diagnostic test for it. The most-often reported lower bound on its prevalence is about 7%. Seven percent doesn’t sound like much, but under the assumption that 75% of the people in the world have had COVID, that means 420 million people in the world have Long COVID which is about 5 times the number of people killed or injured in the 20th and 21st century wars. There are several root causes for Long COVID with inflammation and mitochondrial dysfunction being the two leading villains. Long COVID prevalence goes down with recent variants, COVID vaccination, early antiviral use, being fit, being young, and surprisingly being male. The most important action to reduce the chance of Long COVID is COVID vaccination. The impact of COVID vaccination on Long COVID prevalence is quite uncertain. Papers report 10% to 100% reduction in Long COVID rates from pre-disease vaccination. The average reported reduction is 50%. The impact of vaccination on people with no comorbidities is uncertain with wide ranges being reported. There are no guaranteed treatments for Long COVID; however, some treatments offer either broad or organ-specific relief for many. This paper reviews 179 different Long COVID treatments described in 249 papers. These papers came from the author’s personal data base called The Mouse That Roared of 24,000+ papers that have been accumulated over the last five and a half years. The Mouse That Roared papers cover all aspects COVID including the SARS-CoV-2 virus, the COVID disease, therapeutics, vaccines, behavior, testing, herd immunity, Long COVID, Long COVID Treatment, Politics and National COVID responses, etc. Unlike COVID, there are no excellent treatments, which I call silver bullets, for Long COVID Fortunately, there are some treatments that help some a bit. I will call those “bronze bb’s.” Even with them, healing is very slow. The recovery time with Long COVID is longer than the body’s normal times because COVID’s damage is widespread and because COVID damages our body’s healing process.

Abstract: Intermediate Syndrome (IMS) is a delayed neuromuscular complication of organophosphate poisoning, typically occurring 24–96 hours post-exposure and often leading to respiratory failure. The author reports a 39-year-old male who ingested 40% chlorpyrifos and developed IMS on day 4 post-ingestion, presenting with proximal muscle weakness, neck flexor involvement, and respiratory compromise. Laboratory tests revealed markedly decreased serum cholinesterase, and electromyography confirmed postsynaptic receptor desensitization with early proximal involvement. Pralidoxime was initially administered but discontinued after 48 hours due to early receptor desensitization. The patient received supportive care, including mechanical ventilation for eight days, physiotherapy, and structured follow-up. He regained independent walking by day 10 and was discharged on day 11. By integrating clinical, laboratory, electrophysiological, and follow-up data, this case highlights IMS progression and recovery, emphasizing the critical role of supportive care in resource-limited settings and providing valuable insights into its management.

Abstract: Introduction: Patients with major burn injuries are highly susceptible to hypothermia due to extensive skin loss, aggressive fluid resuscitation, repeated surgical procedures, and exposure during wound care. Hypothermia is associated with coagulation disorders, increased blood loss, impaired immune response, prolonged hospitalization, and increased mortality. When conventional warming strategies fail, intravascular temperature management systems may be employed, although they carry risks inherent to central venous catheters. Case Report: We report the case of a 26-year-old male with 66% total body surface area flame burns and inhalational injury, admitted to the Burns Intensive Care Unit with persistent hypothermia despite standard warming measures. An intravascular temperature management catheter was inserted via the femoral vein and successfully restored normothermia. Due to clinical instability, the catheter remained in situ beyond the recommended duration. During attempted catheter removal, significant resistance was encountered, raising concern for mechanical malfunction. Imaging confirmed catheter entrapment without fracture. Multidisciplinary management involving vascular surgery and interventional radiology enabled successful removal using endovascular snare techniques. A detached balloon fragment was identified and secured with venous stenting. Conclusions: This report describes the first documented case of complicated removal of an intravascular warming catheter due to balloon detachment in burn patients. Physicians using these devices should be aware of this possible complication and be prepared for its management.

Abstract: Polysubstance use, particularly the combination of opioids with stimulants such as cocaine and methamphetamine, is increasingly prevalent and contributes to severe morbidity and mortality. It results in complex clinical consequences, with an expanded spectrum of complications and reduced efficacy of standard emergency interventions. Co-occurring psychiatric disorders and under-recognized systemic injuries beyond primary target organs further complicate patient assessment and management. We report a clinical case of a 37-year-old male with chronic Hepatitis C Virus in-fection and documented polysubstance abuse, including fentanyl, cocaine, metham-phetamine, and cannabis, resulting in fatal complications. The patient developed mas-sive rhabdomyolysis, acute kidney injury with anuria, generalized edema, and left-sided deep vein thrombosis. The clinical course demonstrated rapid progression of multisystem dysfunction, severe electrolyte disturbances, and high-risk metabolic de-rangements. Management included intensive intravenous hydration, diuretic therapy, urinary alkalinization, electrolyte correction, anticoagulation, hemodialysis, and com-prehensive supportive care. This case illustrates the complex pathophysiology of polysubstance toxicity, in which additive and potentially synergistic interactions exacerbate organ damage. Acute rhabdomyolysis emerged as a central mechanism, driven by both sympathomi-metic-induced hypermetabolism and opioid-related immobilization, ultimately precip-itating fatal renal and systemic complications. Despite intensive medical interventions, including hemodialysis, and active family support, the patient’s refusal to continue treatment proved a critical determinant of the fatal outcome. The case underscores the urgent need for effective strategies to manage patients with substance use disorders in acutely life-threatening conditions. It raises the importance of early psychiatric in-volvement, assessment of decision-making capacity, and, where legally justified, tem-porary measures to prevent self-harm resulting from treatment refusal.

Abstract:

Background/objectives: Structural joint damage remains a major determinant of long-term disability in psoriatic arthritis (PsA). However, its relationship with current disease activity and patient-reported impact in routine clinical practice is not fully understood. We aimed to assess the prevalence and burden of structural joint damage in PsA and to examine its associations with disease activity, patient-reported impact, and clinical characteristics using complementary analytical approaches. Methods: This cross-sectional real-world study included 165 patients with PsA. Structural damage was assessed on conventional radiographs and defined as the presence of at least one joint with erosion, deformity/ankylosis, or joint space narrowing. Damage was analyzed as a binary outcome and as an ordinal burden (0, 1–2, ≥3 affected joints). Disease activity was evaluated using DAPSA, and patient-reported impact using PsAID and the ASAS Health Index (ASAS HI). Multivariable logistics and ordinal regression models were applied. Sensitivity analyses included alternative damage definitions, exclusion of joint space narrowing, restriction to longer disease duration, and adjustment for treatment exposure. Results: Structural damage was present in 26.7% of patients. Disease duration was consistently associated with the presence (OR 1.10 per year; 95% CI 1.05–1.15) and increasing burden of structural damage across all analyses. Distal interphalangeal involvement at presentation was strongly associated with higher damage burden (OR 4.29; 95% CI 1.88–9.78). No significant association was observed between structural damage and current disease activity as assessed by DAPSA, while PsAID showed only a non-significant trend. In contrast, ASAS HI scores were significantly higher in patients with structural damage and increased progressively with greater damage burden (ρ=0.172; p=0.027). Findings remained robust across sensitivity analyses, including restriction to erosive damage and exclusion of joint space narrowing. Conclusions: In PsA, structural joint damage is primarily driven by cumulative disease exposure rather than current inflammatory activity. Disease duration and distal interphalangeal involvement identify patients at higher structural risk, while health impact measured by ASAS HI reflects accumulated damage more closely than conventional activity indices.

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus are dangerous respiratory pathogens with high pandemic potential. Since 2021, these two viruses have been co-circulating, which implies additional risks of co-infection with both pathogens. According to clinical data, influenza and SARS-CoV-2 cause sim-ilar symptoms, and co-infection can increase disease severity and significantly enhance the risks of pneumonia and acute respiratory distress syndrome progressing with a poor outcome. Therefore, management of such patients requires special consideration. Prophylactic vaccination is widely recognized as the most effective way to prevent COVID-19 and influenza and to reduce the severity of these diseases. A range of influ-enza and COVID-19 vaccines built on different technological platforms is currently available on the market, with proven effectiveness, immunogenicity, and safety. Im-portantly, multiple countries have approved recommendations for simultaneous vac-cination against both viral pathogens. This approach is more convenient for patients and is associated with better response to treatment, while also improving vaccine cov-erage and compliance and offering significant resource savings for healthcare systems. This review analyzes recent data on the simultaneous circulation of influenza and SARS-CoV-2 viruses worldwide. We review epidemiological data and the pathogenetic mechanisms of co-infection with these two viruses. Next, we focus on current ap-proaches to simultaneous and combined vaccination against influenza and COVID-19. We outline the types of vaccines and summarize the available findings on the effec-tiveness and safety of co-vaccination.

Abstract: Movement disorders frequently arise as secondary manifestations of systemic, metabolic, toxic, infectious, vascular, autoimmune, and iatrogenic conditions, yet they remain underrecognized in clinical practice. This narrative review aims to provide a comprehensive and clinically oriented overview of secondary movement disorders, emphasizing common and uncommon etiologies, underlying pathophysiological mechanisms, diagnostic challenges, and management considerations. A broad literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on movement disorders associated with medications, stroke, infections, metabolic abnormalities, demyelinating and autoimmune diseases, neurodegenerative conditions, and systemic illnesses. Secondary movement disorders encompass a wide spectrum of hyperkinetic and hypokinetic phenomenologies, including tremor, dystonia, chorea, myoclonus, parkinsonism, ataxia, and mixed syndromes, often reflecting disruption of basal ganglia–thalamo–cortical and cerebellothalamic networks. Drugs—particularly antipsychotics, antiseizure medications, antidepressants, and antiemetics—represent the most frequent cause, while vascular lesions, infections, and metabolic disturbances constitute important and potentially reversible contributors. Neuroimaging and ancillary testing play a pivotal role in identifying secondary etiologies and distinguishing them from primary neurodegenerative or functional disorders. Recognition of secondary movement disorders is essential, as prompt identification and treatment of the underlying cause may lead to symptom resolution or significant improvement. This review highlights the importance of systematic evaluation, interdisciplinary collaboration, and individualized management strategies, reinforcing the concept that movement disorders often reflect multisystem disease rather than isolated motor pathology.

Abstract:

The predominant forms of inflammatory bowel disease (IBD) are Crohn's disease and ulcerative colitis, which occur in approximately 0.5-1% of the World population. Alterations in the microbial flora (dysbiosis) are considered the primary precipitating factor in IBD. Because antibiotics are major disruptors of the microbiome, it was hypothesized that different antibiotic classes might induce distinct alterations in gut flora, reflected in positive or negative associations with IBD incidence at the population level. Average yearly consumption was calculated from ECDC reports (2004-2023) for the major antibiotic classes, which cover 99.87% of total antibiotic consumption across 30 European countries. Data were compared with age-stratified IBD incidence (15–39 years) estimated for 2021. Ordinal logistic regression modeled the association between antibiotic class proportions and IBD-incidence categories, entering each antibiotic class separately as a continuous predictor. Pearson correlation analyses were conducted to assess linear associations, and Kruskal-Wallis tests were applied to compare incidence categories. Statistical significance was set at p < 0.05. Tetracyclines (J01A), narrow-spectrum penicillin (J01CE, J01CF), and sulfonamides (J01E) showed a significant positive association with IBD incidence, indicating that higher consumption was associated with higher national incidence. In contrast, cephalosporins, macrolides, aminoglycosides, and quinolones showed significant negative associations, suggesting links to lower national incidence levels. Different antibiotic consumption patterns across 30 European countries may be associated with the IBD incidence.

Abstract: While chronic alcohol consumption is an established risk factor for lipid metabolic dysregulation, the underlying genetic mediators remain largely elusive. This study investigated the synergistic impact of CCDC63 (Coiled-Coil Domain Containing 63) polymorphisms and alcohol intake on dyslipidemia risk within a Korean cohort. Leveraging data from the KARE study (n=6,655; 4,327 dyslipidemia cases vs. 2,328 controls), we analyzed SNPs across the CCDC63 locus via Affymetrix SNP Array 5.0. Logistic regression, adjusted for age and sex, was performed to evaluate genotype-phenotype association, and gene-environment interactions by alcohol exposure duration. Three intronic variants (rs10849915, rs11065756, and rs2238149) were significantly associated with dyslipidemia (OR ≥1.15, P <0.005). Notably, stratified analysis revealed a clear gene–environment interaction. In current drinkers, the G-allele of rs10849915 was significantly associated with a higher risk of dyslipidemia (OR = 1.23, P <0.05) , significantly lower γ-GTP levels (β =-8.08), and reduced HDL (β =-1.42). However, no such genetic associations were observed in the non-drinking group (P > 0.05 for all traits). Our findings demonstrate that CCDC63 variants specifically modulate lipid metabolism and hepatic enzyme levels in an alcohol-dependent manner. The paradoxical association—lower γ-GTP yet higher dyslipidemia risk in drinkers—suggests that CCDC63 plays a critical role in the complex interplay between alcohol exposure and systemic lipid homeostasis.

Abstract: Background/objectives: Diagnostic methods for minimally invasive disease are needed worldwide; Raman spectroscopy is a promising technology. In this study aiming to improve diagnostic technology using Raman spectroscopy, we evaluated a Raman spectroscopic substrate made of a quartz glass fiber sheet to obtain high sensitivity Raman spectra with a high signal-to-noise ratio. Methods: We investigated methods to amplify the intensity of Raman scattered light from humoral biological samples such as serum and urine. We evaluated two methodologies: 1) the needle method (NM) [for capturing Raman spectra by irradiating a droplet of liquid sample at the tip of a fine stainless-steel needle with a laser]; and 2) the quartz sheet method (QSM) [a quartz glass fiber sheet is saturated with a liquid sample, and the sheet surface is irradiated with a laser to obtain Raman spectra]. The Raman spectra of sodium benzoate, sodium sulfate, human serum, and human urine were recorded. Results: The samples crystallized and became concentrated in the quartz glass fiber sheet, allowing Raman spectra with highly intense scattered light to be recorded even from low-concentration samples. The QSM produced scattered light intensity ~7.3 and ~7.8 times higher for serum and urine, respectively, than the NM, which obtains spectra while the sample is still in liquid form. Conclusions: Our QSM enables quick and convenient acquisition of Raman spectra from samples using a very low-cost quartz glass fiber sheet and a standard Raman microscope. The QSM may be useful for obtaining Raman spectra from liquid biological samples with low analyte concentrations.

Abstract:

Aortic aneurysms (AAs), both abdominal and thoracic, remain one of the most fatal cardiovascular emergencies, with a growing prevalence and incidence, especially for sporadic forms in our populations, which are primarily comprised of elderly individuals. A high mortality risk also appears to be linked to managerial delays, despite advances in imaging techniques that facilitate the difficult diagnosis, and in surgical procedures. This is the result of the clinical decision-making approach, which is unfortunately still based, as per guidelines, on the maximum aortic diameter. This parameter, as suggested, fails to capture the biological and biomechanical complexity underlying these pathological conditions, which are influenced, among other things, by entirely individual factors (genetics, gender, lifestyle, etc.). With the emergence of network medicine and omics sciences, diverse and complex sets of clinical, imaging, and biomarker data are now available. These could be precisely processed by artificial intelligence (AI), enabling accurate prediction of AA risk and facilitating its complex management. Therefore, AI could represent an excellent tool for AAs, showing the potential not only to refine AA risk prediction but also to radically transform the way we understand, monitor, and manage AA patients, despite some limitations. These aspects are the subject of this review, as are their therapeutic applications.

Abstract: Obstructive sleep apnea (OSA) is a highly prevalent yet frequently underdiagnosed condition that is associated with significant cardiopulmonary, metabolic, and neurocognitive outcomes. Risk factors for OSA overlap with illnesses commonly observed in intensive care unit (ICU) patients, resulting in a disproportionately elevated burden in healthcare. This study evaluates the prevalence, diagnostic challenges, and management limitations of OSA in the ICU to identify strategies to improve awareness and outcomes in critically ill populations. An analysis of published literature was conducted using PubMed, EMBASE, and Scopus. Key search terms included “obstructive sleep apnea,” “ICU,” and “critical illness.” Results showed that OSA is present in up to 60–70% of ICU patients, yet only ~5% are formally diagnosed during hospitalization. Underdiagnosis is linked to prolonged mechanical ventilation, extubation failure as high as 30%, 2-fold higher perioperative complication rates, cardiovascular instability, 1.8-fold greater 30-day ICU readmission, and 2.2-fold mortality. Standard screening tools have limited applicability in ICU patients. Emerging alternatives, such as overnight oximetry, polygraphy, and machine learning models lack validation. Our analyses reveal that current diagnostic and treatment strategies are poorly adapted to critically ill patients. Integration of OSA as a part of ICU management, diagnosis, and intervention may reduce readmissions and mortality.

Abstract: Background: Vulvar diseases remain underreported and possibly under-recognised in Nigeria due to limited awareness, primarily, poor health-seeking behaviour, and absence of structured screening programmes. Vulvar self-examination (VSE) has been proposed as a low-cost method for early detection of vulvar pathology. Objective: To assess the knowledge, attitudes and practices surrounding vulvar self-examination and determine vulvar disease prevalence in a community-based Nigerian cohort. Methods: This cross-sectional observational study was conducted in September 2025 across three centres (two urban and one rural). Women attending a community cervical screening programme were recruited through convenience sampling. Participants completed a survey assessing knowledge, attitudes and practices related to VSE. Clinicians performed vulvar examinations, and detailed findings were recorded. Descriptive and inferential statistics were used. Results: A total of 183 women participated, with only 2.2% of women demonstrating some knowledge of structured VSE. Over 95% admitted they had benefited from the VSE education. The prevalence of vulvar disease was 15.8%, with all conditions being benign. Increasing age, urban residence and longer duration of menopause were significantly associated with higher odds of vulvar disease, though not statistically significant. Conclusion: Knowledge and practice of vulvar structured self-examination are poor among Nigerian women and represent a significant unmet need. Structured education on VSE may facilitate earlier detection of vulvar disease and improve outcomes.

Abstract: Tyrosine kinase inhibitors (TKIs) added to chemotherapy have improved outcomes ofadult patients with Philadelphia-positive B-cell acute lymphoblastic leukemia (Ph+ B-ALL). These improvements initially led to a larger proportion of patients realizing allogeneic stem cell transplantation (alloSCT), long considered essential for cure, but there has been a re-evaluation of alloSCT. At Princess Margaret Hospital (PM), adult patients with Ph+ B-ALL have been treated with a pediatric-inspired chemotherapy protocol with mostly imatinib. In the last two decades, we have witnessed many iterative changes in our approach. Here we examine the outcomes of all Ph+ B-ALL patients treated at our institution from 2001 to 2019. During this time, there were two major protocol changes – omission of asparaginase in 2009, and discontinuation of routine referral for first complete remission (CR1) alloSCT from the early 2010s. Median follow-up was 41.13 months (range, 0.46-228.79). 141 patients (91.56%) achieved CR1. Patient outcomes improved iteratively, with best results seen in the final (2016-2019) cohort: no asparaginase, no routine alloSCT referral in CR1; 4-year OS and RFS were 87.0% and 69.3%, respectively. The long-term OS in this patient group retained statistical significance in the multivariable analysis (p=0.0176) when BCR::ABL1 molecular residual disease (MRD) were considered.

Abstract: Background/Objectives: A comprehensive geriatric assessment (CGA) was demon-strated to reduce treatment-related toxicities CTCAE III-V° in older adults with cancer undergoing systemic cancer treatments. However, practical implementation of this important procedure is insufficient. To evaluate the feasibility of implementing CGA into routine care and multidisciplinary tumor boards (MDTs) in Germany, we per-formed this bicentric feasibility trial. Methods: Patients ≥65 years with positive geriatric screening (G8< 15 points) and all patients ≥70 years received CGA as part of their routine care. Results were presented during MDT discussions to derive treatment recommendations. After CGA, patients were asked for trial participation which included data analysis and a telephone fol-low-up after 3 months. Physicians participating in the MDT were asked about the added value of CGA presentation. Primary endpoint was the estimation of patient’s willing-ness to participate with an accuracy of ± 7.5% to inform design for a later effectiveness trial. Results: 75 patients received CGA. Of those, 72 (96%) agreed to participate (95% confi-dence interval, [0.8875; 0.9917]). With an accuracy of estimating the willingness to par-ticipate of < |7.5%|, the primary endpoint was reached. The median age was 76.6 years (range: 69-92 years). A member of the geriatric team attended 2/3 of the MDT meetings. Physicians rated the integration of CGA results predominantly as useful. Conclusions: Integration of CGA into routine care of older cancer patients is feasible but will likely require adequate geriatric staffing per center. A larger implementation study, evaluating efficacy and cost effectiveness in the German healthcare system, is necessary.

Abstract: Background: Neuropathic pain is increasingly recognized as a significant con-tributor to chronic pain and reduced quality of life in patients with rheumatoid arthritis (RA). However, its clinical correlates and relationship with disease ac-tivity and patient-reported outcomes in RA remain incompletely understood. Objective: To evaluate the prevalence of likely neuropathic pain features in RA patients and to investigate their associations with disease activity, pain intensity, fatigue, sleep quality, and health-related quality of life. Methods: In this cross-sectional study, 160 RA patients were enrolled. Neuro-pathic pain features were assessed using the PainDETECT questionnaire. Dis-ease activity was evaluated with the Disease Activity Score in 28 joints (DAS28). Pain intensity, fatigue, sleep quality, and health-related quality of life were as-sessed using the visual analog scale (VAS), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36), respectively. Group comparisons, correlation analyses, and multivariate linear regression models were performed to identify factors associated with neuropathic pain. Results: Likely neuropathic pain was identified in 22.5% of patients. Patients with neuropathic pain had significantly higher pain intensity, greater fatigue, poorer sleep quality, and lower SF-36 scores across all domains compared with patients without neuropathic pain (all p < 0.001). Although DAS28 scores were higher in patients with neuropathic pain, PainDETECT scores correlated more strongly with VAS pain in-tensity (ρ = 0.679, p < 0.001) than with DAS28 (ρ = 0.536, p < 0.001). PainDETECT scores were negative-ly correlated with FACIT-F (ρ = −0.512, p < 0.001) and multiple SF-36 domains, indicating substantial quality-of-life impairment. In multivariate regression analysis, only pain intensity independently predicted neuropathic pain features. Conclusions: Neuropathic pain is common in RA and is more closely associated with pain intensity and patient-reported outcomes than with inflammatory activ-ity alone. Routine assessment of neuropathic pain features may facilitate more personalized and effective pain management strategies in RA, highlighting the clinical relevance of targeting neuropathic mechanisms alongside inflammation.

Abstract:

Background/Objectives: Considering the excretion pathways and gadolinium concentrations of gadolinium-based contrast agents (GBCAs), our institution has developed a tailored administration protocol for patients with renal impairment to facilitate more rapid elimination and minimal retention of gadolinium. This study aims to evaluate the 8-year clinical outcomes and safety of this institutional protocol. Methods: This single-center retrospective study included patients with renal impairment who underwent GBCA-enhanced MRI between January 2015 and December 2022. The protocol recommended specific GBCAs and adjusted doses based on chronic kidney disease (CKD) stage and serum bilirubin levels: gadoxetate disodium was used for normal serum bilirubin level due to its dual excretion pathway, while macrocyclic agents were used for those with elevated serum bilirubin levels. During the follow-up period, occurrence of nephrogenic systemic fibrosis (NSF) and evidence of gadolinium deposition in brain tissues were evaluated. Results: A total of 288 patients (age, 64.6 ± 11.7 years; male, 64.9%) underwent 716 GBCA-enhanced MRI examinations in accordance with the institutional protocol. The cohort included 62 patients with CKD stage 4 and 131 patients with CKD stage 5 or undergoing hemodialysis. In patients with CKD stage 4 and 5 and those undergoing hemodialysis, 597 examinations were performed using gadoxetate disodium, and 119 used macrocyclic agents. No cases of NSF or gadolinium deposition in brain tissues were identified over mean follow-up intervals of 27.5 and 27.8 months, respectively. Conclusions: The tailored GBCA administration protocol, considering the excretion pathways and gadolinium concentrations, appears to be safe with respect to NSF and gadolinium deposition in brain tissues for patients with renal impairment.

Abstract: Background/Objectives: Whole‑body cryotherapy (WBC), a brief exposure to extreme cold (−90 °C), has been proposed to modulate immune, metabolic, and stress‑related pathways. This exploratory one‑armed pilot study investigated the effects of an 18‑session WBC protocol on immune markers, body composition, and perceived stress in healthy adults. Methods: Nineteen participants (mean age 52.9 ± 9.8 years) completed 18 WBC sessions over 9 weeks (3–6 minutes each), followed by a 9‑week follow‑up. Assessments were performed at baseline (M1), post‑intervention (M2), and follow‑up (M3). Primary outcomes included immune parameters (lymphocytes, granulocytes, cytokines, soluble ACE2), body composition (waist circumference, water compartments, lean mass), and perceived stress (Trier Inventory for Chronic Stress, TICS). Results: Waist circumference decreased from 83.8 ± 5.7 cm (M1) to 80.2 ± 4.2 cm (M2) (p = 0.001; M1 vs M2; p = 0.004). Total body water (p = 0.008), lean body mass (p = 0.008), intracellular water (p = 0.005), and extracellular water (p = 0.021) also showed time-dependent effects. Immune modulation included increased lymphocytes (25.6 ± 7.1% to 29.3 ± 8.3%, p = 0.012) and decreased granulocytes (63.5 ± 6.8% to 58.7 ± 7.9%, p = 0.011) at M2. Anti‑inflammatory IL‑10 (virus‑stimulated) rose markedly (33.5 ± 29.3 to 63.5 ± 50.5 pg/mL, p < 0.001), while IFN‑γ (virus‑stimulated) increased over time (p = 0.031). Soluble ACE2 decreased at follow‑up (0.5 ± 0.7 to 0.3 ± 0.4 ng/mL, p = 0.029). Perceived stress improved in several TICS domains, including Work Overload (p = 0.009) and Pressure to Succeed (p = 0.018). Conclusions: This pilot study demonstrates that repeated WBC at −90 °C induces measurable changes in immune regulation, body composition, and perceived stress. These findings support the feasibility and potential physiological relevance of WBC and providing effect‑size estimates for future randomized controlled trials.

Abstract:

Follicular lymphoma (FL) is the second most common form of non-Hodgkin’s lymphoma (NHL) and accounts for about 5% of all hematological malignancies. Despite therapeutic advances, FL follicular lymphoma remains an incurable disease, with frequent relapses and increasingly shorter disease control intervals. Bispecific antibodies (bsAbs) are molecules that target two different epitopes or antigens. The mechanism of action is determined by the molecular targets and structure of the bsAbs. Several bsAbs have already changed the therapeutic landscape of hematological malignancies and some solid tumors. In particular, in this article we review the general principles on follicular lymphoma and established and innovative therapies including bsAbs, in particular the bsAb mosunetuzumab, a new bispecific antibody that acts on CD3 epitopes of T lymphocytes and CD20 epitopes of B lymphocytes with the aim of inducing T lymphocyte-mediated elimination of malignant B lymphocytes, its safety and efficacy with the analysis of no. 3 patients who completed treatment with the drug mosunetuzumab in the A.O. Pia Fondazione di Culto e Religione ‘Card. G. Panico’, Tricase (Lecce).