Journal of Clinical Medicine最新文献

{"title":"Health Behaviour and Body Esteem Profiles in Women Who Achieved a Normal BMI After Non-Pharmacological Weight Loss: Differences in Life Satisfaction.","authors":"Klaudia Boniecka, Hanna Liberska","doi":"10.3390/jcm15197690","DOIUrl":"10.3390/jcm15197690","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Women who reach a normal BMI after non-pharmacological weight loss may differ in health behaviours and body esteem. We identified profiles based on four health behaviour and three body esteem dimensions and compared their life satisfaction. <b>Methods:</b> This exploratory analysis included 122 women aged 20-37 who reported reaching a BMI of 18.5-24.9 kg/m² and completed the second assessment of a two-stage study. They were married or cohabiting and had at least one child. Approximately 1000 women participated in the first assessment but were not actively followed. Standardised post-weight-loss indicators were analysed using Ward clustering and k-means++; solutions (k = 2-6) and stability were assessed using silhouette coefficients, classification agreement, and bootstrapping. <b>Results:</b> Two descriptive profiles emerged: relatively more favourable (<i>n</i> = 69) and relatively less favourable (n = 53). Overall life satisfaction was higher in the former (245.75 ± 46.63 vs. 197.77 ± 43.16; Hedges' g = 1.06, 95% CI 0.68-1.44), as were scores across ten life domains. Profile membership was associated with the self-selected weight-loss method (χ²(3) = 53.80; <i>p</i> < 0.001; Cramer's V = 0.66), without implying a causal advantage or effectiveness of any method. <b>Conclusions:</b> Among these 122 women, a similar final BMI co-occurred with distinct health behaviour and body esteem patterns associated with life satisfaction. Because participants who did not return were not actively followed, the frequency of these profiles among all initially assessed women or all women attempting weight loss cannot be estimated. The exploratory profiles require independent replication.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Symptom Control: Remission as a Depth-Stratified Treatment Goal in Severe Asthma.","authors":"Martina Votto, Fabio Manzo, Mauro Maniscalco, Giorgio Castellana, Giuseppe Cascone, Agostino Buonauro, Antimo Papa, Roberto Formisano, Christian Basile, Guido Grassi, Pasquale Ambrosino","doi":"10.3390/jcm15197686","DOIUrl":"10.3390/jcm15197686","url":null,"abstract":"<p><p>The management of severe asthma has shifted from symptom control to the ambition of remission, a goal borrowed from rheumatology. Biologics targeting immunoglobulin E, interleukin-5 and its receptor, the interleukin-4 receptor alpha subunit, and thymic stromal lymphopoietin have made sustained quiescence realistic for many patients, yet estimates that roughly one-third achieve remission shift by tens of percentage points depending on the definition used. This narrative review advances two linked arguments. First, that the heterogeneity of definitions, not any shortage of effective agents, is the central obstacle to using remission as a treatment target. Second, that remission is best read as a multidimensional construct in which clinical, functional and biological quiescence are distinct axes, reached independently and often discordantly, with complete remission denoting their convergence rather than the last step of a sequence. Where each biologic acts within the type 2 cascade determines which biomarkers move under treatment and, only hypothetically, how deep remission can reach. Structural remodeling and the fact that current agents suppress rather than reset inflammation cap that depth, so remission remains a pharmacologically maintained state on treatment. Concomitant chronic rhinosinusitis with nasal polyps is treated as a modifier of asthma remission rather than a separate endpoint. The framework is conceptual and unvalidated. The priority is a harmonized, depth-resolved definition, explicit about treatment burden and patient-centered outcomes, against which any therapy can be judged.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residual Sleep-Related Respiratory Events During Early Versus Long-Term NIV Follow-Up: Burden and Relationship with Gas Exchange.","authors":"Pierre Tankéré, Marjolaine Georges, Ameline Vagner, Jade Chorvoz, Geoffroy Mery, Cedric Bongard, Philippe Bonniaud, Claudio Rabec","doi":"10.3390/jcm15197695","DOIUrl":"10.3390/jcm15197695","url":null,"abstract":"<p><p><b>Background:</b> A recent study published by our group demonstrated that patient-ventilator asynchrony (PVA) is independently associated with impaired gas exchange during long-term non-invasive ventilation (NIV). We aimed to determine whether the burden and phenotype of residual PVA vary according to disease category, NIV initiation context and follow-up timing, and whether the relationship between PVA and gas exchange differs according to follow-up timing. <b>Methods:</b> We performed a secondary analysis of 123 NIV-treated patients included in the primary study. PVA burden, upper-airway obstructive events and leaks were compared across disease categories and follow-up settings. Multivariable models for gas exchange outcomes were extended by introducing interaction terms between PVA burden and follow-up category. Patients underwent either long-term follow-up performed >3 months after NIV initiation (<i>n</i> = 74), early acute follow-up, i.e., after stabilization following NIV initiation in acute respiratory failure (<i>n</i> = 30), or early planned follow-up, i.e., within 3 months after NIV initiation in stable chronic respiratory failure (CRF) (<i>n</i> = 19). <b>Results:</b> Overall, leaks, upper airway obstructions (UAOs) and PVA burden did not significantly differ across disease categories, and neither leaks nor UAO differed across follow-up categories. In contrast, patients undergoing early follow-up after acute NIV initiation exhibited a significantly greater burden of residual PVA than those initiated in stable CRF, predominantly because of ineffective efforts. Within the subgroup of patients undergoing early follow-up, total PVA burden was more than doubled after acute NIV initiation (4.5% versus 1.5% of recording time; 6.2 versus 2.5 events·h^-1). The association between PVA burden and post-NIV PaCO₂ did not differ according to follow-up timing. Conversely, in an exploratory analysis limited to 40 patients, the relationship between PVA burden and nocturnal TcPCO₂ was significantly attenuated during early compared with long-term follow-up (interaction β = -1.04, 95% CI -1.68 to -0.40; <i>p</i> = 0.003). However, this interaction was attenuated after adjustment for daytime PaCO₂ (β = -0.55, 95% CI -1.12 to 0.03; <i>p</i> = 0.076). Stratified analyses demonstrated significant associations between PVA burden and both post-NIV PaCO₂ (β = 0.38, <i>p</i> = 0.034) and nocturnal TcPCO₂ (β = 0.80, <i>p</i> < 0.001) during routine long-term follow-up. <b>Conclusions:</b> Patients evaluated after acute NIV initiation exhibited the highest burden of residual PVA, predominantly ineffective efforts. However, PVA was independently associated with nocturnal hypercapnia primarily during established long-term NIV. These findings should be considered hypothesis-generating and require confirmation in larger prospectively monitored cohorts.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthorexic Eating Tendencies and Body Shape Concern in Women with Lipedema: A Controlled Cross-Sectional Study.","authors":"Muhsin Doran, Dilara Ekici Zincirci, Ece Güreli Şahan","doi":"10.3390/jcm15197678","DOIUrl":"10.3390/jcm15197678","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Lipedema is an adipose tissue disorder associated with body-related burden. This study compared orthorexic eating tendencies between women with and without lipedema and examined associations with body-shape concern and psychological symptoms. <b>Methods</b>: This controlled cross-sectional study included 44 women with lipedema and 44 women without lipedema. Participants completed the Düsseldorf Orthorexia Scale (DOS), Body Shape Questionnaire (BSQ), and Hospital Anxiety and Depression Scale (HADS). Associated variables were examined using multiple linear regression. <b>Results</b>: Women with lipedema had higher DOS scores than women without lipedema (25.07 ± 6.55 vs. 20.48 ± 5.05; Cohen's d = 0.79; <i>p</i> < 0.001). BSQ, HADS-Anxiety, and HADS-Depression scores were also higher in the lipedema group (all <i>p</i> ≤ 0.001). DOS and BSQ scores were positively correlated in both groups. In the multivariable model, which included group status, age, BMI, BSQ, HADS-A, and HADS-D scores, BSQ score was independently associated with DOS score (B = 0.067; 95% CI 0.025-0.108; <i>p</i> = 0.002), whereas group status and the other covariates were not. The model's adjusted R² was 0.234. <b>Conclusions</b>: Women with lipedema exhibited greater orthorexic eating tendencies, body-shape concern, and psychological symptoms than controls. Body-shape concern was independently associated with orthorexic eating tendencies. The group difference in DOS scores is largely explained by the higher BSQ scores accompanying lipedema; this should not be interpreted as indicating that lipedema is unrelated to orthorexic tendencies. These findings support consideration of body image when addressing eating behavior in lipedema care.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in Osteoporosis Treatment Gaps Across Fracture-Related and Elective Orthopedic Surgeries: A Single-Center Retrospective Cohort Study in Taiwan.","authors":"Yuan-Sheng Hsu, Ya-Lian Deng, Sheng-Chieh Tseng, Cheng-Hung Lee, Kun-Hui Chen, Shih-Yi Lin","doi":"10.3390/jcm15197683","DOIUrl":"10.3390/jcm15197683","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background/Objectives&lt;/b&gt;: Fracture liaison services (FLSs) typically use fragility fractures as triggers to identify patients for osteoporosis care. Patients undergoing elective orthopedic surgery who already have osteoporosis documented on a preoperative densitometry report fall outside this trigger. This study compared recorded initiation of osteoporosis treatment after elective operations with that after operations performed for a fracture. A secondary, exploratory objective was to describe how preoperative T-score relates to subsequent fractures in patients without recorded treatment. &lt;b&gt;Methods&lt;/b&gt;: A retrospective cohort study (2015-2025) was performed at a tertiary center in Taiwan. The source population was the institutional densitometry cohort (all patients with at least one DXA examination at the hospital), within which five index operations were identified: vertebroplasty/kyphoplasty, hip fracture internal fixation, hip arthroplasty (hemi- or total), lumbar spinal fusion, and total knee arthroplasty. Operations in patients already receiving osteoporosis therapy were excluded. The primary outcome was recorded initiation of anti-osteoporosis therapy, defined as the first dispensing at the study hospital within 365 days of surgery. Odds ratios were estimated by logistic regression with patient-clustered standard errors. &lt;b&gt;Results&lt;/b&gt;: Among 6171 operations in 5739 patients, recorded one-year initiation was 28.4% overall: 46.9% after vertebroplasty, 43.1% after hip fracture fixation, 33.0% after hip arthroplasty, 17.4% after lumbar fusion, and 7.2% after total knee arthroplasty. Adjusted odds ratios versus fusion ranged from 3.16 (95% CI: 2.69-3.72) for vertebroplasty to 0.28 (0.21-0.37) for knee arthroplasty. Within hip arthroplasty, initiation was 43.9% after hemiarthroplasty, which is performed for femoral neck fracture, and 6.7% after total hip arthroplasty. Across all operations, an accompanying fracture diagnosis was associated with initiation (adjusted OR: 6.19, 5.26-7.29). The contrast persisted among the 871 operations with osteoporosis documented before surgery (48.2% after vertebroplasty, 7.5% after knee arthroplasty). In the exploratory analysis of 1971 operations without recorded treatment (99 fractures), each one-unit lower T-score was associated with a higher hazard of major osteoporotic fracture (adjusted HR: 1.25, 1.04-1.49). The estimate for the T ≤ -2.5 dichotomy was less precise (HR: 1.33, 0.83-2.12). &lt;b&gt;Conclusions&lt;/b&gt;: In this selected single-center densitometry cohort, preliminary findings indicate that recorded initiation of osteoporosis treatment after orthopedic surgery followed whether the operation was performed for a fracture rather than the patient's documented bone density, including among patients whose osteoporosis was already documented. A national reimbursement rule that requires a fracture in addition to low bone density probably contributes. Treatment outside the study hospital was not captur","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Outcomes of Patients Undergoing Pericardiocentesis for Pericardial Effusion: A Single-Center Experience with Exploratory Inflammatory Biomarker Analysis.","authors":"Zeynep Yapan Emren, Gamze Erkılınç","doi":"10.3390/jcm15197679","DOIUrl":"10.3390/jcm15197679","url":null,"abstract":"<p><p><b>Objective</b>: We aim to characterize patients undergoing pericardiocentesis for clinically significant pericardial effusion and explore differences in inflammation-based biomarkers according to malignancy status and one-year outcome. <b>Methods</b>: We retrospectively evaluated 113 consecutive patients who underwent pericardiocentesis between January 2021 and January 2026. Clinical, laboratory, pericardial fluid, cytopathological, recurrence, and mortality data were analyzed. NLR, PLR, SII, SIRI, and PIV were assessed as secondary exploratory biomarkers. <b>Results</b>: Malignancy-associated pericardial effusion was present in 36 patients (31.9%), while 77 (68.1%) had non-malignant effusion. The malignancy-associated group had more frequent dyspnea (77.8% vs. 55.8%; <i>p</i> = 0.025), effusion >15 mm (80.6% vs. 58.4%; <i>p</i> = 0.021), hemorrhagic fluid (75.0% vs. 54.5%; <i>p</i> = 0.038), and recurrence (38.9% vs. 20.8%; <i>p</i> = 0.042). Malignant cells were identified in pericardial fluid cytology in 15/36 patients (41.7%). One-year mortality was 22.2% versus 13.0% (<i>p</i> = 0.211). NLR, PLR, SII, SIRI, and PIV did not differ significantly according to malignancy status or one-year mortality; NLR, PLR, and SIRI were higher in the exploratory lung cancer subgroup. <b>Conclusions</b>: Malignancy-associated pericardial effusion showed distinct clinical and fluid characteristics. No statistically significant associations were detected between the evaluated inflammation-based biomarkers and malignancy status or one-year mortality; however, the exploratory design and limited number of outcome events warrant cautious interpretation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Pharmacological Treatments for Chronic Inducible Urticaria: A Narrative Synthesis.","authors":"Eleni Chatzidimitriou, Elisavet Tsiogka, Aikaterini Tsiogka, Ioannis-Alexios Koumprentziotis, Michael Makris, Dimitrios Rigopoulos, Alexandros I Stratigos, Stamatios Gregoriou","doi":"10.3390/jcm15197685","DOIUrl":"10.3390/jcm15197685","url":null,"abstract":"<p><p><b>Background</b>: Several treatments for chronic inducible urticaria (CIndU) have been studied, but reviews covering all subtypes are limited. <b>Objectives</b>: Our goal is to synthesize the effectiveness and safety of available therapies across all CIndU subtypes. <b>Methods</b>: We performed a review of PubMed and Scopus databases to identify studies reporting treatment data on cold urticaria, symptomatic dermographism, solar urticaria, delayed-pressure urticaria, exercise-induced urticaria, cholinergic urticaria and mixed subtypes. No studies were identified that specifically focused on heat, aquagenic, or contact urticaria; however, these subtypes are encompassed within certain studies examining mixed subtypes. <b>Results</b>: Our search yielded 36 studies. Second-generation H1-antihistamines as first-line treatment provided significant symptom control in most CIndU subtypes, with updosing to four times the standard dose showing greater effectiveness than standard doses. Omalizumab was highly effective as second-line treatment for antihistamine-refractory patients, although relapse after discontinuation was common. In delayed-pressure urticaria dapsone and high-dose intravenous immunoglobulin yielded good responses. Narrowband UVB benefited symptomatic dermographism and solar urticaria but with high relapse rates. Emerging mast cell-depleting therapies (barzolvolimab, lirentelimab) showed promising effectiveness, while the interleukin-1 inhibitor rilonacept failed to demonstrate clinical benefit. Across the 36 studies, adverse events were generally low for most treatments, with higher incidence reported with barzolvolimab. <b>Conclusions</b>: Updosed antihistamines are more effective than standard doses in controlling CIndU symptoms without a significant increase in adverse events. Omalizumab at 150-300 mg every 4 weeks is effective for antihistamine-refractory CIndU, though it is off-label. Relapse after treatment cessation is frequent, highlighting the need for personalized long-term strategies. Novel endotype-specific treatments require dedicated CIndU trials, as current evidence is largely extrapolated from chronic spontaneous urticaria.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Flapless Static Computer-Aided Implant Surgery in Post-Oncological Patients: A Retrospective Study.","authors":"Edoardo Brauner, Andrea Albini, Giulia Amelina, Federico Laudoni, Eleonora Sforza, Nicola Pranno, Francesca De Angelis, Stefano Di Carlo","doi":"10.3390/jcm15197691","DOIUrl":"10.3390/jcm15197691","url":null,"abstract":"<p><p><b>Objectives:</b> The present retrospective study evaluates the clinical outcomes of a standardized implant-supported rehabilitative workflow based on flapless static computer-assisted implant surgery (S-CAIS) in post-oncological patients, compared with a non-oncological cohort treated using the same approach. <b>Methods:</b> In total, 26 patients were included in this study. They were divided into oncological patients (11) and non-oncological patients (15). The protocol used for digital implantoprosthetic surgical planning was the same in both groups, and it involved different decision-making algorithms depending on whether the patient was partially or completely edentulous. Only flapless surgery was performed in this study. In the case of intercalated edentulism without loss of vertical dimension, implant-prosthetic rehabilitation proceeded directly; by contrast, in the case of severe occlusal and vertical dimension alterations, temporary rehabilitation was performed to stabilize occlusion. For totally edentulous patients, the absence of stable landmarks complicated the alignment of the CT dental scan/CT cone beam, so the Evobite device was used. Implant survival was evaluated over a follow-up ranging from 1 to 3 years. The primary outcome was implant survival, defined as the proportion of functioning implants among the total number of implants placed in each group. <b>Results:</b> The implant survival rate was 96.2% in oncological patients and 98.8% in non-oncological patients. <b>Conclusions:</b> High implant survival rates were observed in post-oncological patients treated with flapless S-CAIS, although these findings should be interpreted within the limitations of the retrospective study design and selected patient population.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the Burden of Vision Impairment in Saudi Arabia, 1990-2023: A Global Burden of Disease Study Analysis.","authors":"Ahmed Alduais, Abdullah Alduais","doi":"10.3390/jcm15197682","DOIUrl":"10.3390/jcm15197682","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Vision impairment (VI) in Saudi Arabia is common, largely preventable or treatable, and increasingly linked to chronic disease rather than solely to the causes that have historically dominated blindness. Recent Saudi-specific evidence places adult VI prevalence at approximately 17% and blindness at under 2%, with diabetic retinopathy affecting roughly one in three Saudi adults with diabetes; however, no study has yet examined how this burden has trended nationally over time using the full 1990-2023 window made available by the Global Burden of Disease (GBD) 2023 round. This study quantified trends in the burden of VI in Saudi Arabia by severity, cause, sex, and age, and characterised the contribution of population ageing to the observed pattern. &lt;b&gt;Methods:&lt;/b&gt; This repeated cross-sectional trend analysis used GBD 2023 national-level modelled estimates for Saudi Arabia (1990-2023). The estimated annual percentage change (EAPC) was calculated via log-linear regression on age-standardised prevalence and years-lived-with-disability (YLD) rates. A Durbin-Watson check confirmed autocorrelation in every annual series, and because GBD point estimates carry their own reported uncertainty, EAPC confidence intervals were derived two further ways alongside the naive ordinary-least-squares (OLS) interval: a Newey-West heteroskedasticity- and autocorrelation-consistent (HAC) interval, and a Monte Carlo interval that resampled each annual estimate within its GBD-reported 95% uncertainty interval. A trend is reported here as confirmed only where all three methods agreed on direction, and as suggestive where they did not. Segmented-regression sensitivity checks, cause decomposition, and comparison of age-standardised against crude rates were used to characterise breakpoints and the contribution of ageing. &lt;b&gt;Results:&lt;/b&gt; Age-standardised blindness and severe VI declined substantially and robustly (blindness prevalence EAPC = -2.60%/year, confirmed decreasing in females and males separately, both &lt;i&gt;p&lt;/i&gt; &lt; 0.05 on a formal sex-difference test), while moderate VI rose robustly overall and among males specifically (EAPC = +0.61%/year); the female-specific rise in moderate VI, and the decline in presbyopia, were directionally consistent but not robust to the choice of uncertainty method. Diabetes-attributable rates increased faster than any other tracked cause and did so robustly under every uncertainty specification (crude prevalence EAPC ≈ +4.47%/year), and males carried a disproportionate, formally sex-different share of diabetes-attributable blindness relative to females; these tracked causes covered only 44-51% of the total VI envelope, so cause-specific conclusions are restricted to the causes examined. The largest proportional increases in case counts were concentrated in working-age adults (30-59 years) rather than older adults, and the gap between crude and age-standardised trends is consistent with an important contribution from S","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Heterogeneity and Survival Disparities in Leiomyosarcoma: An Exploratory Single-Center Retrospective Observational Study.","authors":"Rakesh Pinninti, Kiruthika Subramaniyan, Rajagopalan Iyer, Tasneem Rushdi, Harveen Kaur Gulati, Naga Prasanthi Akkineni, Srinath Gupta, Krishna Mohan Mallavarapu, Yashaswini Nallacheruvu, Sujit Chyau Patnaik, Santa Ayyagari, Suseela Kodandapani, Veeraiah Koppula, Deleep Gudipudi, Subramanyeshwar Rao Thammineedi, Senthil Rajappa","doi":"10.3390/jcm15197693","DOIUrl":"10.3390/jcm15197693","url":null,"abstract":"<p><p><b>Background:</b> Leiomyosarcoma (LMS) is a rare aggressive sarcoma with substantial heterogeneity in anatomical presentation, stage, treatment, and survival. We evaluated clinical characteristics, treatment patterns, and survival, with particular emphasis on whether anatomical site independently predicted overall survival (OS). <b>Methods:</b> We retrospectively reviewed 240 adults with histologically confirmed LMS diagnosed between January 2015 and May 2026. OS was calculated from diagnosis to death or last contact, with administrative censoring on 1 July 2026. Kaplan-Meier and Cox proportional-hazards methods were used to evaluate age, sex, anatomical site, histologic grade, and disease stage. Multivariable models adjusted for age, sex, grade, and stage assessed the independent association of anatomical site with OS. <b>Results:</b> Median age was 56 years, and 152 patients (63.3%) were female. Disease was localized in 120 (50.0%), de novo metastatic in 53 (22.1%), recurrent metastatic in 35 (14.6%), and recurrent localized in 12 (5.0%). Median OS was 37.0 months. Localized disease was associated with substantially longer OS than metastatic disease (61.0 vs. 13.0 months; <i>p</i> < 0.001). Grade 3 disease was associated with shorter OS than grade 1/2 disease (25.6 vs. 61.1 months; <i>p</i> < 0.001). In multivariable analyses, metastatic disease remained strongly associated with inferior OS (HR, 5.59-5.94; <i>p</i> < 0.001), as did age ≥ 50 years (HR, 1.86-1.92; <i>p</i> = 0.006-0.004) and grade 3 histology (HR, 1.74-1.92; <i>p</i> = 0.018-0.007). Anatomical site was not independently associated with OS (extremity/trunk vs. non-extremity: HR, 1.60; <i>p</i> = 0.063; non-uterine vs. uterine: HR, 1.23; <i>p</i> = 0.41). <b>Conclusions:</b> Disease stage was the strongest prognostic factor, while older age and grade 3 histology were independently associated with poorer OS. Although extremity/trunk LMS showed better univariable survival, anatomical site was not independently associated with OS after adjustment.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}