Disease Duration Research Articles (Page 1)

Caregivers provide essential support to patients with mild cognitive impairment (MCI). However, limited research has been conducted to validate instruments that assess their self-perceived competence in caregiving. This study aimed to assess the psychometric properties of the 7-item Sense of Competence Questionnaire (S-SCQ) in informal caregivers of patients with MCI. A non-interventional, cross-sectional study was conducted in collaboration with the Spanish Confederation of Alzheimer's Disease, enrolling informal caregivers of patients with MCI. A non-parametric item response theory procedure (Mokken analysis) was performed to evaluate the S-SCQ's dimensional structure using scalability coefficients. Internal reliability was assessed using Cronbach's α. Concurrent validity was examined through Spearman's correlations between S-SCQ scores and measures of caregiver burden, psychological distress, resilience, and the caregiver-patient relationship. A total of 196 caregivers were studied. Caregivers had a mean age of 63.5 (SD 13.1) years, and most (63%) were female. The care recipients had a mean age of 72.9 (7.0) years, with a mean disease duration of 2.9 (2.2) years. The mean S-SCQ score was 26.1 (6.1). The S-SCQ demonstrated strong unidimensionality (H = 0.52) and good internal reliability (Cronbach's α = 0.86). Higher S-SCQ scores (greater sense of competence) correlated with lower caregiver burden (ρ = - 0.63, p < 0.001), reduced anxiety and depressive symptoms (ρ = - 0.32, p < 0.001), stronger caregiver-patient relationship (ρ = 0.72, p < 0.001), and greater resilience (ρ = 0.34, p < 0.001). The S-SCQ is a reliable tool for assessing self-perceived competence in informal caregivers of patients with MCI. Its integration into clinical and research settings may offer an opportunity to enhance the early detection of caregiver burden and facilitate timely, targeted interventions.

Leprosy is a chronic disease that severely affects the skin and nerves, sometimes leading to disability. The deformities deepen stigma and discrimination, even among patients who have been cured. Consequently, leprosy patients are more likely to suffer from mental illnesses than other diseases. A cross-sectional study was conducted in four Chinese provinces (Fujian, Yunnan, Shandong, and Guizhou), including patients who had completed the full course of multidrug therapy (MDT). We assessed anxiety and depression using the SAS and SDS scales, and functional ability using the ADLs. Influencing factors were analyzed with multiple linear regression, and structural equation modeling (SEM) was used to examine the relationships between anxiety, depression. A total of 382 valid questionnaires were received, with a participation rate of 95.5%. Among the participants, 24.08% reported anxiety, 22.51% reported depression, 45.81% experienced impairments in ADLs, and 65.18% had at least one of these conditions. Notably, 3.66% of patients experienced anxiety, depression, and ADL impairments concurrently. Multiple linear regression results showed that the No. of other chronic diseases (P = 0.004), income (P = 0.016), live with patients (P = 0.005), and other ethnic (P<0.001) have a significant correlation with anxiety (R2 = 0.546). Duration of disease (P = 0.014), No. of other chronic diseases (P = 0.000), live with patients (P = 0.015), and live with family (P = 0.040) were associated with depression (R2 = 0.155). SEM results indicated that the paths SDS-SAS, SDS-No.of other chronic diseases, and ADLs-SAS had the highest direct effects of 0.75(95CI%:0.656 ~ 0.834), 0.56(95%CI:0.103 ~ 1.016) and - 0.33(95%CI:-0.490~-0-165). The association between SAS and the (No.of other chronic diseases) was also indirectly influenced by SDS (0.420), exceeding the direct effect (0.040). Similarly, the indirect effect (-0.240) of SAS between SDS and ADLs was higher than the direct effect (-0.100). This study demonstrates that Chinese leprosy patients exhibit high levels of anxiety and depression, which are associated with impaired daily functioning. Mental health is influenced by multiple factors, including comorbid chronic diseases, living arrangements, disease duration, ADLs, income, and ethnicity. SEM revealed that anxiety mediates the impact of depression on functional limitations, highlighting the complex interplay between psychological factors and physical functioning. These findings underscore the need for comprehensive care strategies and psychosocial interventions to improve mental health and overall well-being in leprosy patients.

Psoriasis is a chronic, complex, inflammatory skin disease that significantly impacts the quality of life of patients. Research has found excessive accumulation of iron in the skin tissue of psoriasis patients. However, no clinical studies have reported the relationship between serum ferritin (SF) and psoriasis. This cross-sectional study aimed to explore the correlation between SF levels and psoriasis. The study was conducted from June 2020 to December 2023 at the affiliated hospital of Jiujiang University, involving 105 psoriasis patients and 52 controls. Mild and severe disease was defined based on the Psoriasis Area Severity Index. Fasting SF levels were analyzed in blood samples. Compared with the control group, SF levels were significantly elevated in psoriasis patients. In severe psoriasis patients, SF levels were even higher. SF was positively correlated with Psoriasis Area Severity Index, C-reactive protein, and disease duration, with statistically significant differences. In the receiver operating characteristic curve analysis, the optimal cutoff value (area under the curve, sensitivity, specificity) for SF was 216.1 (0.74, 63.98%, 75.00%). High SF levels are associated with the severity of psoriasis. Dysregulation of iron metabolism may play a role in the development of psoriasis. SF levels serve as markers for the severity and duration of psoriasis. By measuring ferritin levels early in the disease process, we can adopt preventive strategies to better manage and improve the survival and quality of life of psoriasis patients.

Familial multiple sclerosis (MS), defined by the occurrence of MS in one or more relatives, is thought to represent a genetically influenced subtype of the disease. To compare clinical progression, cerebrospinal fluid (CSF) parameters, and treatment responses between familial and sporadic MS patients. We conducted a retrospective analysis of 1,035 patients diagnosed with MS according to the 2017 McDonald criteria (523 familial, 512 sporadic). Demographic variables, MS subtypes, expanded disability status scale (EDSS) scores, CSF oligoclonal band (OCB) status, IgG index, and treatment regimens were evaluated. Statistical tests included t tests, chi-square, and multivariable regression. Familial MS patients showed a higher incidence of secondary progressive MS (10.9%) compared to sporadic cases (7.0%, p = 0.030). Disease duration was significantly longer in familial MS (14.5 vs. 12.3years, p < 0.01) though time to diagnosis did not differ. OCB positivity rates were comparable, but the IgG index was significantly elevated in familial MS (p < 0.01). Treatment responses did not differ between groups. Familial MS is associated with more rapid disease progression and enhanced humoral immune activation, suggesting a distinct phenotype. These findings support the need for genetic and immunologic investigations to guide personalized treatment strategies.

Hepatic steatosis frequently emerges as one of the earliest clinical features of Wilson's disease (WD), particularly in pediatric populations. This study aimed to investigate the relationship between demographic characteristics, biochemical indicators, and lipid metabolism markers with hepatic steatosis in children diagnosed with WD. Although noninvasive imaging techniques such as acoustic attenuation parameter and liver stiffness measurement were employed to assess hepatic changes, the primary focus was not on imaging validation. A retrospective observational study was conducted among 239 pediatric patients with WD treated at the Center for Encephalopathy, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, from 2021 to 2024. Serological and imaging data were collected to evaluate hepatic steatosis, defined by acoustic attenuation parameter thresholds. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of hepatic steatosis. The cohort had a mean age of 14.0 years (range: 11.0-16.0), with 160 males (66.95%) and 79 females (33.05%). The average disease duration was 5.0 years. In multivariable logistic regression, higher alanine aminotransferase and triglycerides were independently associated with hepatic steatosis, while high-density lipoprotein cholesterol showed an inverse association. Aspartate aminotransferase was not significant after adjustment. In this single-center retrospective cohort, alanine aminotransferase and triglycerides were independently associated with hepatic steatosis in this analysis. These observational findings require external and prospective validation before informing clinical decision-making.

The sigmoid-type achalasia is an advanced stage of achalasia characterized by severe dilatation, tortuous angulation, and rotation of the esophageal body. Our aim is to explore the safety, and efficacy of peroral endoscopic myotomy (POEM) for sigmoid-type achalasia. A total of 78 patients who underwent POEM for sigmoid-type achalasia were retrospectively included. The primary outcome was clinical success, defined as a postoperative Eckardt score ≤ 3 points. Secondary outcomes were perioperative adverse events (AEs), and procedure-related parameters. The mean pre-POEM Eckardt score was 7.3 ± 2.0 and 52 patients (66.7%) had a disease duration of ≥ 10years. S1 type was found in 62 patients and S2 type in 16 patients. The technical success rate was 100%. The mean procedure duration was 80.4 ± 40.5min and the mean hospital stay was 2.9 ± 1.7days. Intraoperative mucosal injury occurred in 18 (23.1%) patients, including 14 (17.9%) type I and 4 (5.1%) type II. All mucosal injury were clipped and did not induce any complications. CT revealed gas-related AEs in 7 cases (9.0%), pleural effusions in 10 cases (12.8%), pneumonitis in 10 cases (12.8%), and focal atelectasis in 6 cases (7.7%). The above AEs only appear on CT scans, are asymptomatic, and do not require intervention. Major AEs were found in 1 patient. This patient developed a postoperative pleural effusion that required drainage. The clinical failure rate at 2-year, 5-year, and 10-year follow-up visits were 1.3%, 12.8%, and 42.5%, respectively. There were no significant differences between type S1 and S2 achalasia in terms of procedure-related parameters, AEs and clinical failure rates. POEM is a safe and effective procedure for sigmoid-type achalasia at the 2-year and 5-year follow-up visits. However, a significant rate of clinical failure was observed at 10years, highlighting that long-term durability remains a concern in managing this advanced disease stage. Clinical outcomes were similar for both S1 and S2 types of achalasia.

Background: The aim of this ongoing observational prospective multicentric study is to investigate whether the duration of Chronic Migraine (CM) for over or less than 10 years can predict Onabotulinumtoxin-A (OBT-A) effectiveness. Since psychiatric symptoms impact migraine treatment effectiveness, we also aimed at evaluating if the psychopathological profile may influence the outcome of the enrolled patients. Methods: Consecutive CM patients, undergoing OBT-A treatment in 6 Italian headache centers, have been enrolled since January 2024. Evaluation times were at baseline and after 3, 6, 9 and 12 months. We collected Monthly Headache Days (MHDs), number of Monthly Acute Medications (MAMs), HIT-6 and MIDAS scores for disability. Pain intensity was evaluated by NRS. The psychopathological profile was evaluated by means of BDI-II, BIS-11, STAI-Y, DERS, TAS-20 questionnaires. Results: We have currently enrolled 185 patients (mean age 46.9 yrs, SD 15.7; 160 females, 85.5%), undergoing OBT-A for the first time; 115 patients (62.7%) had a CM history longer than 10 years. At latest data reconnaissance, 163 participants (88%) have been followed for ≥3 months, 140 (76%) for ≥6 months, 111 (60%) for ≥9 months, 83 (45%) for 12 months. To capitalize on all available follow-up measurements and taking into account drop-outs, a mixed-linear model was applied. MHD, MAMs, MIDAS, HIT-6 and NRS showed a strongly significant decrease (p&lt;.001) across the follow-up. In almost all cases, the trend was neither influenced by disease duration, psychiatric comorbidities, nor by their combination (p&gt;0.05). Only for MIDAS a clear dependence on psychiatric symptoms was found (p=0.002). This interaction is due to the higher scores in the group with psychiatric comorbidities (PSY+) at baseline and at three months, while afterwards the two groups (PSY+ and PSY-) reached approximately the same levels of migraine-related disability. In addition, a slight significance (p=0.064) was found for the triple interaction duration x psychiatric comorbidities x time, mainly due to the high MIDAS score in the group with disease duration &lt;10 years and psychiatric symptoms. Conclusion: In this preliminary report OBT-A effectiveness was not affected by disease history or psychiatric comorbidities, except for the latter influencing MIDAS in the short term.

Background: Migraine has a complex pathophysiology involving genetic predispositions, comorbidities, and psychosocial factors. Emerging evidence highlights the glymphatic system – responsible for brain waste clearance – as a potential contributor to migraine pathogenesis. As poor sleep quality exacerbates glymphatic dysfunction, it might have an impact on migraine chronification. Methods: This cross-sectional study included 106 individuals with migraine (80.2% female; median age: 45.0 years, IQR = 37.0–52.0) between June 2018 and February 2020. Glymphatic function was assessed using the DTI-ALPS index derived from brain magnetic resonance imaging, while sleep quality was evaluated with the Pittsburgh Sleep Quality Index. First, we evaluated the association between DTI-ALPS index and monthly headache days. A second model included the dichotomized Pittsburgh Sleep Quality Index score (“poor” vs. “good” sleepers) and its interaction with the DTI-ALPS index to examine the moderating role of sleep quality in the relationship between glymphatic function and monthly headache days. Results: Higher DTI-ALPS index values were associated with fewer monthly headache days in the overall sample while controlling for age and sex [adjusted IRR = 0.37, 95% CI = 0.16 – 0.86, p = 0.020]. Additionally, there was a significant interaction between DTI-ALPS index and sleep quality [adjusted IRR = 0.13, 95% CI = 0.02 – 0.76, p = 0.024] in predicting monthly headache days. We found an association between lower DTI-ALPS and higher headache days only in participants with poor sleep quality [adjusted IRR = 0.21, 95% CI = 0.08 – 0.59, p = 0.003] whereas no association was found in good sleepers [adjusted IRR = 1.66, 95% CI = 0.38 – 7.16, p = 0.500]. Results remained consistent after adjusting for clinical variables such as disease duration, medication overuse, cutaneous allodynia, aura status, and migraine subtype. Conclusion: Poor sleep quality moderates the association between glymphatic dysfunction and monthly headache days. The results highlight the potential importance of sleep interventions in managing migraine and improving brain glymphatic function.

This study aimed to investigate the profiles of myositis-specific autoantibodies (MSA) and their correlation with distinct clinical features in patients with idiopathic inflammatory myopathy (IIM) in southern China. We retrospectively analyzed the medical records of 208 IIM patients, collecting data on their demographic variables, clinical manifestations, comorbidities, and MSA test results. Of the 208 patients, 185 were positive for MSAs. 69 patients were anti-MDA5 positive, 61 patients were anti-ARS positive followed by anti-SRP (34), anti-TIF1-γ (26), anti-Mi-2β (10), anti-NXP2 (10), anti-HMGCR (9), anti-Mi-2α (6), anti-cN-1A (6), and anti-SAE1 (1). Distinct clinical phenotypes were strongly associated with specific antibodies. Anti-MDA5 positive patients had shorter disease duration, less muscle involvement, but higher rates of rash, alopecia, arthritis, fever, and ILD with poorer prognosis. Anti-ARS positive patients had longer disease duration, mechanic’s hands, arthritis, fever, and ILD, but better prognosis. Both anti-MDA5 and anti-ARS antibodies were independent risk factors for developing ILD. Anti-TIF1-γ and anti-Mi-2 were most detected in IIM patients combined with malignancies, and nasopharyngeal carcinoma was the most common malignant tumor. Furthermore, hyperlipidemia and elevated cardiac biomarkers were frequently observed, particularly in patients positive for anti-SRP. The 3-month survival rate for anti-MDA5 positive patients was 87.8%, with all deaths attributed to rapidly progressive-ILD (RP-ILD). In contrast, other antibody positive patients had a 100% survival rate. This comprehensive analysis of a southern Chinese IIM cohort underscores that MSA profiles can effectively stratify patients into clinically distinct subgroups, which is crucial for predicting specific organ involvement, prognosis, and developing tailored treatment strategies.

Approximately 50-70% of people with multiple sclerosis (MS) experience at least one fall event during their lifetime. These events can have debilitating consequences in the quality of life of the individuals' experiencing them, as they can often result in injury, extending beyond physical harm, which may negatively impact the rehabilitation process as well as their psychological wellbeing. This systematic review and meta-analysis aimed to determine the proportion of one-time and repeated falls among patients with MS within a year and investigate any potential associations with demographic and disease-specific characteristics. Adhering to PRISMA guidelines, a systematic search of the MEDLINE PubMed, Scopus and Google Scholar databases was conducted. Results from 4342 patients were included. The pooled proportion of one fall within a year was estimated at 28.03% (95% CI [20.21, 36.57]), and for repeated falls, 31.74% (95% CI [23.73, 40.31]). Subgroup analyses revealed significant heterogeneity, while meta-regression showed no significant associations between fall prevalence and age, EDSS, or disease duration. 42.5% of patients experienced a one-time fall, while 44.7% reported repeated falls. These findings, demonstrate the significant prevalence of falls among individuals with MS, underlying the need for targeted interventions to mitigate fall risk.

ABSTRACT Background Anti-IL-23 monoclonal antibodies have shown strong efficacy in achieving complete clearance (PASI 100) in psoriasis. Real-world evidence is needed to confirm these outcomes and define predictors of response. Research design and methods We performed a monocentric retrospective study on 243 adults with moderate-to-severe psoriasis treated with guselkumab, risankizumab, or tildrakizumab at the University of Pisa. The primary endpoint was PASI 100 achievement; secondary endpoints were maintenance and predictors of response. Survival analysis and Cox regression were applied. Results PASI 100 was achieved in 67.4% of patients, on average at 27 weeks. Among responders, 81.7% maintained clearance for a mean of 90 weeks. Palmoplantar involvement reduced the likelihood of achieving PASI 100 (HR 0.575), while facial involvement (HR 2.261) and longer disease duration (HR 1.020) favored maintenance. Prior cyclosporine use (HR 0.644) and higher baseline PASI (HR 0.973) were negative predictors. No unexpected safety issues were observed. Conclusions Anti-IL-23 therapies are effective in achieving and sustaining PASI 100 in routine care. Outcomes are influenced by disease localization, duration, prior treatments, and baseline severity. Limitations include retrospective design, single-center setting, and absence of comparators.

Background: Interactions between calcitonin gene-related peptide (CGRP) levels and ovarian sex hormones, mainly estradiol serum levels, have been described, and hormonal assessment may influence the response to CGRP blocking medication. The aim of our study was to verify possible different response outcomes between women of reproductive age and postmenopausal women treated with monoclonal antibodies targeting CGRP or its receptor (anti-CGRP/R mAbs), considering both traditional outcome parameters (monthly migraine days -MMD- and migraine-related disability) and parameters related to migraine comorbidities (fatigue, subjective sleep quality, psychiatric symptoms, and allodynia), since several studies have shown effects of anti-CGRP/R mAbs on anxiety and depression independently of migraine improvement. Methods: This open-label longitudinal study enrolled 41 women, 22 of childbearing age (median age 43,63 yr) and 19 postmenopausal (median age 60 yr). Clinical parameters and migraine comorbidities were assessed using a headache diary and validated questionnaires (Migraine Disability Assessment Scale – MIDAS, Allodynia Symptom Checklist 12 – ASC-12, Fatigue Severity Scale – FSS, Generalized Anxiety Disorder 7 – GAD-7, Patient Health Questionnaire 9 – PHQ-9, Pittsburgh Sleep Quality Index – PSQI) at baseline (T0) and after 3 (T1) and 6 months (T2) of treatment. Differences in scores between T1 and T0 and between T2 and T0 in the two groups were assessed. Results: There were no significant differences between the two groups at baseline, except for the mean disease duration (27.6 vs. 41.7 years). At T1 and T2, both groups showed a statistically significant reduction in traditional migraine outcome parameters, without significant differences between groups. At T1, a greater reduction in PSQI scores was detected in women of childbearing age compared to postmenopausal women; however, this difference was no longer present at T2 due to improvement in the postmenopausal group. At T2, greater improvements in GAD-7 and PHQ-9 scores were observed in women of reproductive age compared to postmenopausal women. Conclusion: Anti-CGRP/R mAbs resulted effective in treating migraine regardless of the patient's reproductive status. However, our findings suggest that mAbs have a stronger impact on comorbidities related to sleep and psychiatric symptoms in reproductive age women. Subjective sleep quality showed an initial greater benefit in reproductive age women, with a delayed improvement in postmenopausal ones, which may be explained by a slower response in patients with lower CGRP levels.

Factors associated with inflammatory bowel disease control among IBD patients in Palestine (2023-2024): A cross-sectional study.

Cerebral microbleeds (CMBs) are highly prevalent in patients with Parkinson's disease (PD), but their impact on clinical symptom severity and genetic association remains unclear. This study investigates the relationship between CMBs and PD severity. We recruited patients with PD from the outpatient clinic and inpatient wards of the First Affiliated Hospital of Chongqing Medical University. All participants had undergone susceptibility-weighted imaging (SWI) and had complete clinical assessments. Participants were categorized into groups based on their CMB count. We subsequently analyzed the risk factors for CMBs and examined the correlations between CMB burden and motor, cognitive, and emotional function, respectively. Furthermore, utilizing a genome-wide association study (GWAS) dataset, we investigated the association between genetic susceptibility to CMBs and PD severity preliminarily by Mendelian randomization (MR). Among 158 patients with PD, 53 (33.5%) were found to have CMBs. Age, disease duration, and hypertension were independently associated with the presence of CMBs (p < 0.05). Multiple linear regression analysis indicated that a higher CMB burden was associated with poorer motor function and the presence of anxiety disorders. To gain deeper insight into the relationship between CMB and severity of PD, MR analysis further suggested that genetic susceptibility to CMBs is potentially causally linked to worse motor function (OR = 1.301, p = 0.047), lower scores on the Montreal Cognitive Assessment (MoCA) (OR = 0.207, p = 0.021) and the Mini-Mental State Examination (MMSE) (OR = 4.915, p = 1.63E-08), as well as an increased risk of dementia in PD (OR = 4.915, p = 1.63E-08). The high prevalence of CMBs was associated with age, disease duration, and hypertension. Furthermore, our MR analysis provides preliminary evidence that a higher CMB burden may exacerbate the severity of Parkinson's disease.

To identify predictive factors for successful oral glucocorticoid (GC) tapering in a longitudinal cohort of Behçet's disease (BD) patients in remission or with low disease activity, and to evaluate post-tapering outcomes over a one-year period. This is an observational longitudinal cohort study, focusing on BD patients who began GC tapering and achieved remission or low disease activity. Patients who achieved sustained remission or low disease activity while maintaining a prednisone dose of ≤ 5 mg/day were classified as "successful tapering," while those who failed to achieve this outcome were classified as "failed tapering". A regression model was used to identify predictors of successful GC tapering to ≤ 5 mg/day. A total of 72 BD patients were enrolled and followed-up for 12months. Multivariate analysis confirmed that short disease duration (odds ratio (OR) = 0.395, 95% CI: 0.197-0.794, p = 0.009), low activity at disease onset (OR = 0.177, 95% CI: 0. 037-0.846, p = 0.03), low severity score for BD at baseline (OR = 0.092, 95% CI:.010-0.876, p = 0.038), and low C-reactive protein value at baseline (OR = 0.186, 95% CI:0.039-0.883, p = 0.034) were the predictors for successful GC tapering. The independent factors linked to success in tapering glucocorticoid in BD were shorter disease duration, low activity at disease onset, low severity score at baseline, and low C-reactive protein value. These findings suggest that they could be used in clinical settings to identify tapering candidates. Key Points •1- Behcet disease is a challenge to treat and usually necessitates a multidisciplinary strategy •2- Glucocorticoids have been used to treat almost all disease lesions •3- Long-term Glucocorticoids use is associated with adverse events •4- The independent factors linked to success in tapering glucocorticoid in Behcet disease were short disease duration, low activity at disease onset, low severity score at baseline, and low C-reactive protein value.

Objective To compare the effects of eculizumab and rituximab on visual function, motor function, and social quality of life in patients with aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (NMOSD). Methods This retrospective study included NMOSD patients treated with eculizumab (EG, n = 114) or rituximab (CG, n = 114) at the Department of Neurology, First Hospital of Hebei Medical University, and the First Hospital of Shanxi Medical University between January 2018 and August 2024. Patients were followed for 6 months to assess changes in visual, motor, and social outcomes. Results Baseline characteristics, including demographics, disease duration, AQP4-IgG status, annual recurrence rate, EDSS score, and comorbidities, were comparable between groups ( P &amp;gt; 0.05). Both groups showed gradual improvement in visual acuity after treatment ( P &amp;lt; 0.05). However, the EG demonstrated significantly better uncorrected visual acuity at 1, 3, and 6 months ( P &amp;lt; 0.001) and higher corrected visual acuity ( P &amp;lt; 0.05). Visual field defects decreased more in the EG (61.40%−33.33%) compared with the CG (64.91%−50.88%, P &amp;lt; 0.05). Abnormal color vision improved in both groups, with greater reduction in the EG, though not statistically significant at 6 months ( P = 0.065). Motor function outcomes showed significant time, group, and interaction effects ( P &amp;lt; 0.001). The EG achieved higher Fugl-Meyer Assessment (FMA) scores and lower Modified Ashworth Scale (MAS) scores at all time points ( P &amp;lt; 0.05). Social function (SFS) improved significantly in both groups, with greater gains in the EG ( P &amp;lt; 0.001). Anxiety (HAMA) and depression (HAMD) scores decreased in both groups, but reductions were more pronounced in the EG ( P &amp;lt; 0.001). Conclusion NMOSD significantly impairs visual, motor, and social functions. Eculizumab demonstrated superior efficacy over rituximab in improving functional outcomes and quality of life, supporting its role as an effective therapeutic option for NMOSD.

To assess the impact of chronic inflammatory burden on the risk of aortic valve outcomes and atrioventricular block (AVB) in spondyloarthritis (SpA). Ambispective cohort study of 461 SpA patients meeting ASAS criteria between September 2022 and April 2024. Chronic inflammation burden was measured by symptom duration, number of DMARDs discontinued due to inefficacy, and total exposure to persistent inflammation. Statistical analysis was performed with multiple time-dependent Cox regression, maintaining a variable-to-event ratio. Disease duration, especially from initial musculoskeletal (MSK) symptoms, affected all outcomes. Every five-year increase in symptom duration raised the risk of aortic regurgitation (HR 1.21, 95% CI 1.06-1.37), valve sclerosis (HR 1.07, 95% CI 1.02-1.12), root dilation (HR 1.31, 95% CI 1.08-1.59), and AVB (HR 1.34, 95% CI 1.05-1.71). Age also increased risks, particularly for aortic regurgitation (HR 1.46 per decade) and valve sclerosis (HR 1.74 per decade). Surprisingly, hypertension showed a consistent protective effect, decreasing the risk for aortic root dilation (HR 0.55, 95% CI 0.36-0.84), valve sclerosis (HR 0.62, 95% CI 0.40-0.96), and aortic regurgitation (HR 0.60, 95% CI 0.37-0.98). Peripheral SpA significantly predicted aortic valve sclerosis (HR 1.95, 95% CI 1.13-3.36), and enthesitis strongly influenced AVB risk (HR 3.04, 95% CI 1.24-7.44). The duration of MSK symptoms more strongly predicted all outcomes than extra-MSK symptoms. Age's impact mirrored general population trends. Surprisingly, hypertension protected against aortic conditions, prompting further research into IL-17 therapies. Peripheral SpA significantly predicted aortic valve sclerosis, and enthesitis strongly predicted AVB.

BackgroundThe internet has emerged as a critical avenue for the public to access health information resources. As online health information is a key resource for older adults, the factors influencing their online health information–seeking behaviors (OHISBs) are crucial.ObjectiveThis study aims to examine the trajectories and influencing factors of OHISB among community-dwelling older adults and to explore their attitudes toward this information in daily contexts.MethodsA longitudinal mixed methods study was conducted involving 346 older adults from three communities in Shandong Province, China. In the quantitative phase, data were collected at three time points: baseline (T1), 6 months postbaseline (T2), and 12 months postbaseline (T3). Latent class growth modeling and logistic regression identified trajectories and predictors of OHISB, while a cross-lagged panel model analyzed longitudinal relationships among digital health literacy (DHL), technology anxiety (TA), and OHISB. Subsequently, we conducted semistructured, in-depth interviews with 16 older adults from different OHISB trajectory subgroups using a descriptive phenomenological approach. Quantitative and qualitative results were integrated via triangulation.ResultsLatent class growth modeling identified three OHISB trajectories: low-level declining group (92/346, 26.6%), medium-level stable group (187/346, 54%), and high-level declining group (67/346, 19.4%). Multivariate logistic regression identified household registration, education, income, chronic disease status, internet frequency and duration, online health information attitude and experience, DHL, and TA as significant predictors of OHISB trajectory. TA mediated the relationship between DHL and OHISB, with an effect size of 0.04 (SE 0.014, 95% CI 0.0123–0.068). Qualitative interviews with 16 participants revealed four themes: personal cognition, emotional experience, external environment, and behavioral choices. The quantitative study elucidated the pathway between DHL, TA, and OHISB, providing a data-driven foundation for the qualitative inquiry. In a complementary manner, the qualitative study revealed themes not captured quantitatively—particularly how personal factors influence behavior through attitudes—and elaborated on sources of social support and the role of the medical environment. Together, both methods convergently demonstrate that older adults’ information behavior is not static but shaped by individual and environmental factors, resulting in distinct behavioral patterns.ConclusionsBoth quantitative and qualitative findings clarified the developmental process of OHISB among older adults in communities and the important effects of DHL, TA, and risk perception on OHISB. Although self-efficacy, health anxiety, self-perceived aging, social support, and health care environment were not addressed in the quantitative study, they emerged as important factors shaping older adults’ OHISB in qualitative interviews. Personalized intervention measures should target various OHISB trajectory characteristics and their influencing factors to enhance the health conditions of community-dwelling older adults.

In an aging society, solving problems associated with the diagnosis and treatment of dementia-related diseases represents a serious challenge. The aim of the study was to evaluate the possibility of applying molecular biology methods to test polymorphisms recognized in the global literature as potentially useful in assessing the risk of developing dementia in a group of patients with hyperlipidemia. A sample of 203 patients: 109 diagnosed with both dementia and hyperlipidemia, 94 with hyperlipidemia, and 101 individuals as an allele frequency control group—were genotyped. Additional data about cognitive decline and neuropsychological assessment were collected. Among all the studied polymorphisms, the frequency of the ABCA1 rs2230806 polymorphism differed between the analyzed groups. The GG genotype (p = 0.0002, RR = 3.22, CI = 1.63 ÷ 6.37) and the G allele (p = 0.0007, RR = 1.53, CI = 1.19 ÷ 1.97) were more frequent in patients diagnosed with dementia, specifically in those with Alzheimer’s disease. Furthermore, the GG genotype was more common in individuals with a shorter disease duration and lower scores on the Montreal Cognitive Assessment (MoCA) scale, and consequently, with greater cognitive function deficits during early stages of the diagnostic process. ABCA1 rs2230806 genotyping is a potential marker for the early identification of dementia risk in patients with hyperlipidemia, which supports the validity of exploring options for incorporating diagnostics based on molecular biology methods.

BackgroundType 2 diabetes mellitus (T2DM) is a prevalent noncommunicable disease that is strongly associated with metabolic dysfunction-associated steatotic liver disease, a leading cause of cirrhosis and hepatocellular carcinoma. The Fibrosis-4 (FIB-4) index, a noninvasive tool for liver fibrosis assessment, is recommended for all patients with T2DM, yet its use in routine clinical practice remains unclear. We aimed to determine the prevalence of intermediate- and high-risk of advanced liver fibrosis using FIB-4 in patients with T2DM and to identify associated factors. We also assessed documentation of FIB-4 scores and referrals to gastroenterologists in primary care.MethodsWe conducted a cross-sectional study among patients with T2DM receiving continuous follow-up care in a primary care setting at a university hospital in southern Thailand during 2024. The FIB-4 index was calculated and categorized into low-, intermediate-, and high-risk groups. Binary logistic regression was used to identify factors associated with intermediate-to-high FIB-4 risk level.ResultsAmong 829 patients, 46.9% were classified as the intermediate-risk and 6.2% as the high-risk groups for having advanced fibrosis. A diabetes duration of ≥ 10 years was significantly associated with intermediate-to-high risk of advanced liver fibrosis [adjusted OR (95% CI) = 2.06 (1.51–2.81)]. Conversely, elevated triglyceride levels, low HDL cholesterol, and obesity were significantly associated with low risk of advanced liver fibrosis [adjusted OR (95% CI) = 0.65 (0.46–0.93), 0.68 (0.51–0.91) and 0.65 (0.49–0.88), respectively]. Imaging in the high-risk group revealed fatty liver in 61.1% and cirrhosis in 22.2%. However, FIB-4 scores were documented in only 1.6% of records, and only 4.1% of intermediate- to high-risk patients were referred to gastroenterology specialists.ConclusionMore than half of the patients with T2DM had a FIB-4 index suggesting increased risk of advanced liver fibrosis, especially those with longer disease duration. Despite this, FIB-4 remains underutilized in primary care, indicating missed opportunities for early detection and intervention.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-025-03039-x.