Objective: To draw attention to the diagnosis of active Takayasu arteritis (TAK) in middle-aged and elderly patients and to analyze the clinical characteristics of this population. Methods: Clinical data of 106 patients newly diagnosed with TAK at Beijing Chao-Yang Hospital, Capital Medical University, between 2017 and 2025 were retrospectively collected; 11 patients aged over 50 years (2 men and 9 women) were enrolled in this study. Onset characteristics, medical history, clinical manifestations, laboratory findings, and imaging features were collected and analyzed. Disease activity was evaluated, treatment regimens and prognosis were recorded, and all patients underwent at least one follow-up. Results: Among patients first diagnosed with TAK at this single center, middle-aged and elderly patients with active TAK accounted for 10.40% (11/106) during the same period, with a median age at diagnosis of 61 years. Among them, 6 patients (6/11) were over 60 years old. The median time from symptom onset to diagnosis was 13 months (interquartile range: 12, 36 months). Although all 11 patients had multiple arterial involvements, none underwent complete evaluation of all arteries covered by the international criteria. Among the 8 patients who underwent CT pulmonary angiography (CTPA) or chest contrast-enhanced CT, all showed pulmonary artery luminal stenosis. All 8 patients who underwent contrast-enhanced magnetic resonance pulmonary angiography (MRPA) exhibited pulmonary artery wall thickening with enhancement and luminal stenosis. Of the 9 patients who underwent PET-CT, 7 showed pulmonary artery hypermetabolism. Among the 4 patients with elevated levels of multiple autoantibodies, 2 were male (2/2) and 2 were female (22.2% of female patients, 2/9). Moreover, both male patients had severe TAK-related complications (one with an abdominal aortic aneurysm and the other with pulmonary hypertension). Conclusion: Active TAK can occur in individuals over 60 years of age and the disease may be more severe in middle-aged and elderly male TAK patients. Middle-aged and elderly patients with active TAK require comprehensive evaluation of arterial involvement with modalities such as ultrasound, so as to enhance the capability of clinical differential diagnosis. For patients presenting primarily with respiratory symptoms, CTPA and MRPA should be performed to clarify pulmonary artery involvement in TAK.

This case report describes a rare instance of drug-induced acute lung injury in a 16-year-old male patient following circumcision performed under sevoflurane-based general anesthesia. Although sevoflurane is a widely used inhalational anesthetic with a favorable safety and tolerability profile, this case demonstrates that it may, in rare instances, precipitate acute lung injury. The clinical features, imaging findings, and laboratory findings of this case were analyzed alongside a systematic review of the relevant literature to clarify the diagnostic basis and differential diagnoses. This case report aims to raise clinicians' awareness of sevoflurane-induced acute lung injury.

STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by mutations in TMEM173 gene encoding STING (stimulator of interferon genes). It typically presents in infancy and is mainly characterized by interstitial lung disease, skin rash, and systemic inflammation. This report presents the case of adult-onset SAVI:A 28-year-old male patient was admitted with recurrent episode of cough, expectoration, chest tightness with shortness of breath and erythematous rashes on the extremities, chest, and back.His CT revealed bilateral diffuse fine reticular opacities and irregular reticular shadows, with focal areas of honeycombing. Further inquiry into the family history revealed that the patient's mother had been diagnosed with interstitial lung disease (ILD).Thus, a genetic etiology should be highly suspected.Later, whole-exome sequencing identified a heterozygous mutation in the STING1 gene: c.842G>A (p.R281Q), establishing the diagnosis of SAVI. The patient was subsequently referred to a tertiary care hospital for specialized management. During one year of follow-up, the patient underwent lung transplantation in August 2025 and had since received long-term immunosuppressive therapy for rejection prophylaxis. Cough and expectoration improved markedly, although exertional dyspnea persisted; the cutaneous rash had resolved completely.

Neuromyelitis optica spectrum disorder (NMOSD) is a recurrent demyelinating disease of the central nervous system (CNS)characterized by inflammatory attacks on the CNS. This article reports a 56-year-old male patient admitted with over a year history of shortness of breath, a 2-week history of decreased vision in the right eye, and a 1-week history of hiccups. Physical examination revealed digital clubbing of both hands and bilateral lower lung Velcro rales. The patient had concurrent anti-aquaporin-4 (AQP4) antibody-positive NMOSD, primary Sjögren's syndrome (pSS), and interstitial lung disease (ILD), which were confirmed by characteristic clinical features, serological antibody testing, high-resolution chest CT, cranial and optic nerve MRI, and labial gland biopsy. Treatment included high-dose glucocorticoid pulse therapy combined with efgartigimod for pathogenic autoantibody clearance, inebilizumab targeted therapy, and mycophenolate mofetil (MMF) for long-term immunosuppression. After discharge, sequential maintenance therapy with oral prednisone and MMF tablets was administered. The patient's visual acuity and neurological symptoms improved. At follow-up >2 months after discharge, dyspnea recurred and worsened. After intensifying anti-infective therapy while maintaining the immunomodulatory regimen, the condition was effectively controlled, with follow-up high-resolution CT showing marked resolution of pulmonary interstitial exudates. This case suggests that anti-AQP4 antibodies may co-mediate pathological processes in both the central nervous system and peripheral organs. For patients with anti-AQP4 antibody-positive NMOSD, further screening for ILD or pSS is warranted. Early neurological assessment and antibody screening are crucial, facilitating early diagnosis and individualized treatment under multidisciplinary collaboration.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with well-recognized female predominance; however, disease expression and severity may differ by gender. Data on gender-based differences in SLE from Bangladesh remain limited. This study aimed to compare sociodemographic characteristics, clinical manifestations, immunological profiles and disease activity indicators between male and female patients with SLE. This cross-sectional study was conducted at the Lupus Clinic, Department of Rheumatology, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from December 2019 to January 2021. A total of 140 patients who fulfilled the classification criteria for SLE were enrolled, including 130 females and 10 males. Demographic data, clinical features, immunological and serological parameters, Safety of Estrogens in Systemic Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) were analyzed and compared by gender. The female-to-male ratio was approximately 13:1. Male patients presented at younger ages (p=0.002) and had earlier disease onset than females (p=0.011). Lupus nephritis was significantly more frequent among male patients (p=0.037). Anti-dsDNA levels were higher in male patients, though not statistically significant; complement (C3) levels were significantly lower in male patients (p=0.014). Male patients had significantly higher disease activity (SELENA-SLEDAI) scores than females (p=0.044), whereas cumulative organ damage was comparable. Despite lower prevalence, male SLE patients exhibited more severe disease manifestations and higher activity. These findings underscore the importance of heightened clinical vigilance and gender-sensitive management strategies in SLE.

Aortic stenosis (AS) may lead to left ventricular (LV) hypertrophy (LVH). After aortic valve replacement (AVR), LVH often does not regress fully. This has been associated with a worse prognosis. This study aimed at comparing LVH regression between male and female patients and to discover cardiac molecular factors associated with it. Myocardial samples were collected from 18 patients (50% female) who underwent surgical AVR. Preoperative and postoperative LV mass indices (LVMi) were compared between male and female patients. Expression of ADGRL4 and AQP7 was quantified by PCR and assessed with relative regression of LVMi. High-depth RNA-sequencing data from LV free-wall tissues of subjects with heart failure were employed for RNA editing analysis. Male patients had significant LVH regression (P < 0.05) after AVR, while female patients did not (P = 0.116). In male patients, a significant relationship was found between the expression of ADGRL4 (P < 0.05, R2 = 0.497) and AQP7 (P < 0.05, R2 = 0.576) and LVMi regression after AVR. This relationship was insignificant for ADGRL4 (P = 0.704, R2 = 0.0220) and AQP7 (P = 0.860, R2 = 0.00477) in female patients. RNA editing analysis revealed significant sex-biased differences in intronic adenosine-to-inosine (A-to-I) editing of AQP7, with five positions, particularly within Alu elements, along with sex-biased predicted RBP binding motifs. Recognizing patients at risk of defective LVH regression using molecular factors could lead to more intensive postoperative follow-up and earlier treatment, consequently improving reverse remodeling and prognosis. The present findings warrant further research in a larger study.NEW & NOTEWORTHY Regression of left ventricular hypertrophy is associated with better long-term outcome. This study demonstrates a significant relationship between ADGRL4 and AQP7 gene expression in perioperatively collected myocardial tissues and the regression of left ventricular mass postoperatively in male patients with aortic stenosis only. This could contribute to the development of a sex-based tool to predict the extent of postoperative hypertrophy regression.

Status epilepticus in male and female patients: Clinical presentation, management, and outcomes.

Sex-based differences in atrial fibrillation (AF) symptom burden and response to rhythm control strategies are recognised. Whether female and male patients differ in escalation to atrioventricular (AV) node ablation after AF catheter ablation remains uncertain. To evaluate sex differences in AV node ablation following AF ablation in a large real-world cohort. Adults undergoing first-time AF ablation between 2015 and 2024 were identified from a global federated research network. Patients with prior AV node ablation or cardiac implantable electronic devices were excluded. Female and male patients were compared before and after 1:1 propensity score matching for demographics, AF type, heart failure phenotype, co-morbidities, medication use and prior cardioversion. The primary outcome was AV node ablation within 5 years. Secondary outcomes included repeat AF ablation, electrical cardioversion and all-cause mortality. Pre-specified falsification endpoints (pneumonia and intestinal obstruction) were assessed to evaluate residual confounding. Before matching (28,004 female; 52,137 male), AV node ablation occurred in 2.5% of female and 1.1% of male patients (risk ratio [RR] 2.31, 95% CI 2.07-2.58). After matching (24,377 female and 24,377 male), baseline characteristics were well balanced, yet AV node ablation remained more frequent in female than male patients (2.3% vs. 1.2%; RR 1.94, 95% CI 1.68-2.23). Female patients were also more likely to undergo repeat AF ablation (14.7% vs. 14.1%; RR 1.04, 95% CI 1.01-1.08), whilst mortality was modestly lower (4.5% vs. 4.9%; RR 0.91, 95% CI 0.84-0.99; p = 0.027). Falsification endpoints did not differ between groups after matching. Female patients were more likely than male patients to undergo AV node ablation following AF ablation despite robust adjustment, suggesting important sex-based differences in downstream AF management.

Tyrosine kinase inhibitors (TKIs) and programmed cell death protein-1 (PD-1) inhibitors are well-established first-line systemic therapies for hepatocellular carcinoma (HCC), with hypothyroidism as a prominent immune-related adverse event. However, the female sex is a known risk factor for thyroid dysfunction associated with TKIs. The present study aimed to determine whether PD-1 inhibitor plus TKIs-induced hypothyroidism predicts treatment efficacy in male patients with HCC. A retrospective cohort study enrolled 77 male patients with confirmed HCC who received PD-1 inhibitor-TKIs combination therapy at Nanjing Second Hospital (Nanjing, China). According to the evaluation of thyroid function, patients were divided into normal thyroid function and hypothyroidism groups, based on serial thyroid function evaluations. The primary endpoint of the present study was progression-free survival (PFS). Baseline serum thyroid-stimulating hormone (TSH) and thyroglobulin antibody (TgAb) levels were significantly higher in the hypothyroidism group compared with the group with normal thyroid function [TSH, 4.2 mIU/l; 95% confidence interval (CI), 2.0-4.6 mIU/l vs. 1.7 mIU/l (95% CI, 1.2-3.1 mIU/l); P<0.001; TgAb, 12.4 IU/ml (95% CI, 2.1-18.2 IU/ml) vs. 1.4 IU/ml (95% CI, 0.8-5.0 IU/ml); P=0.007]. The group with hypothyroidism had a median PFS of 8.0 months, which was longer compared with the group with normal thyroid function (6.1 months; P<0.001). Cox regression analysis demonstrated that PD-1 inhibitors plus TKIs-induced hypothyroidism [hazard ratio (HR)=0.320; 95% CI, 0.160-0.641; P=0.001] and baseline serum α-fetoprotein >200 ng/ml (HR=2.354; 95% CI, 1.277-4.340; P=0.008) were independent prognostic factors of PFS in male patients with HCC. In conclusion, de novo hypothyroidism during PD-1 inhibitors combined with TKIs is associated with prolonged PFS in male patients with HCC.

Sex-specific brain morphometric associations with psychopathology severity in obsessive-compulsive disorder.

The Influence of Gender on the Outcomes of Revascularization for Aortoiliac Occlusive Disease.

The mandibular lingual foramen (MLF) is a clinically significant structure due to its proximity to neurovascular bundles. Variations in its morphology pose risks of hemorrhage and neurosensory injury during anterior mandibular surgery. The aim of this study was to evaluate the morphometric characteristics of the MLF using cone-beam computed tomography (CBCT) and analyze its relationship with age and gender to define safe surgical boundaries. A retrospective analysis was performed on 486 CBCT scans obtained from adult patients. Measurements included the number of lingual foramina, foramen diameter, canal length, distances from the alveolar crest and mandibular base, and total bone height. Gender-based comparisons were performed using Student's t-test, and correlations with age were assessed using Spearman's correlation analysis. Inter- and intra-observer reliability were evaluated using intraclass correlation coefficients (ICC). A single lingual foramen was observed in 62.8% of cases, while 31.9% presented with two foramina, 4.9% with three, and 0.4% with four foramina. Male patients exhibited significantly greater vertical and horizontal bone measurements, including distances from the alveolar crest and mandibular base, total bone height, and canal length (p < 0.05). No significant gender difference was observed in foramen diameter. Age showed no correlation with foramen diameter; however, a weak but significant negative correlation was detected between age and canal length (p = 0.045). Inter- and intra-observer reliability values were excellent (ICC > 0.98). The mandibular lingual foramen exhibits considerable anatomical variability influenced by gender and age. Male patients present with larger bone dimensions, while age-related bone resorption leads to a reduction in canal length without affecting foramen diameter. These findings emphasize the importance of individualized CBCT-based evaluation prior to surgical procedures in the anterior mandible to minimize the risk of complications.

Antipsychotics-induced metabolic syndrome (APs-induced MetS) is a common side-effect of antipsychotics, significantly increasing the risk of cardiovascular diseases and mortality. However, the genetic risk factors underlying APs-induced MetS remain poorly understood. Thus, we conducted a sex-stratified genome-wide association study (GWAS) in 3067 patients from Schizophrenia In Non-Occidental participants (SINO) trial, and significant results were validated in an independent cohort (all samples = 200) and proteomic data. Post-GWAS analyses were used to further explore the genetic mechanisms involved in APs-induced MetS. Multi-omics prediction incorporating both polygenic risk and proteomic markers was conducted. After quality control, 1956 patients (965 males, 991 females) were included. We identified significant genetic variants (rs73762168; P = 1.77 × 10-8) on chromosome 6q21, associated with three highly linked genes, NR2E1, SNX3 and AFG1L/LACE1, which were correlated with APs-induced MetS in male patients. Top SNP genotype was validated in independent cohort, showing associations with increased weight and waist circumference. Enrichment analyses across genetic and proteomic data consistently highlighted the PPAR signaling pathway involved in oxidative stress and fatty acid metabolism as a key contributor to APs-induced MetS development. Proteomic analyses confirmed baseline SNX3 protein levels associated with weight gain (P = 0.03) and increased waist circumference (P = 8.87 × 10-3) following six-week antipsychotic treatment. The multi-omics prediction (R2 = 0.18) yielded better prediction of APs-induced metabolic side effects than using either marker alone(R2 = 0.13 or 0.07). This study provides novel genetic insights into the development of APs-induced MetS, particularly in males. The identified genetic variants and pathways offer potential targets for early risk prediction and personalized treatment strategies.

Antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAA) is a systemic disorder involving small vessels. Neuropathy may be associated with the involvement of other organs such as the kidneys, lungs, and heart. ANCA is detected in only 80%-90% of cases; hence, high degree of clinical suspicion is required. We report a case of 49-year-old male patient who had a known case of type-2 Diabetes mellitus and chronic kidney disease on regular peritoneal dialysis. He developed progressive tingling and burning paresthesia and weakness in all four limbs. Examination revealed quadriparesis, hypotonia, areflexia, and sensory loss in the glove and stocking pattern. The nerve conduction study was suggestive of severe generalized axonal sensorimotor neuropathy. He had rapidly progressive breathlessness. High-resolution computed tomography of the chest revealed bilateral ground-glass opacities with interstitial thickening suggestive of interstitial lung disease. He was treated with biweekly hemodialysis. He suffered a cardiac arrest due to an acute myocardial infarction and was successfully revived. Given multisystem involvement, the possibility of small vessel vasculitis was kept. Antinuclear antibodies and ANCA were negative. Sural nerve biopsy was reported as an inflammatory axonopathy, probably vasculitic. The patient was treated as a case of seronegative ANCA with six cycles of injection cyclophosphamide followed by immunosuppression with injection rituximab. He made a steady neurological recovery over 2 years with improved muscle power to grade 3 in both lower limbs and grade 4 in both upper limbs. ANCA may be negative in 10%-20% of cases. AAA should be strongly suspected in the presence of axonal neuropathy with evidence of multisystem involvement. A nerve biopsy can clinch the diagnosis.

Depth of anaesthesia (DoA) is often guided by standard dosing protocols and evaluated through clinical signs, assuming these signs reliably indicate unconsciousness. However, this assumption is problematic: patients respond differently to anaesthetic drugs, and physiological markers can misrepresent brain state. Nociceptive responses may persist despite apparent unconsciousness. Excessive DoA is associated with cardiovascular instability and post-operative cognitive dysfunction, whereas insufficient DoA increases the risk of intraoperative awareness. Processed electroencephalography (pEEG), such as the Bispectral Index (BIS), was introduced to address these limitations by enabling monitoring of frontal cortical brain activity during general anaesthesia. We aimed to investigate how pEEG, measured as BIS, reflects anaesthetic depth across patient subgroups and anaesthetic techniques. This large-scale prospective observational cohort study analysed electronic health records from patients who underwent general anaesthesia between 1 January 2017, and 31 December 2020. The study evaluated associations between BIS values and patient age, sex and health status measured by American Society of Anaesthesiologists (ASA) scores. Clinical data were extracted from 97,733 patients, of whom 26,650 underwent continuous BIS monitoring. BIS monitoring was more frequent in patients classified as ASA scores of 1 or 2 and those receiving total intravenous anaesthesia. Patients with higher ASA scores, increasing age and female patients showed deeper anaesthesia with significantly lower BIS values. In this large observational cohort, older patients, patients with higher ASA score and females exhibited lower BIS values during general anaesthesia compared with younger, healthier and male patients, even when anaesthetic dosing followed standard protocols. These observed associations may reflect practise patterns, unmeasured confounding or physiological differences, and should not be interpreted as causal. Further studies are warranted to explore more individualised anaesthetic strategies and tailored neuromonitoring approaches to optimise anaesthetic depth, particularly in vulnerable patient subgroups. Using a large database of cases with processed EEG (BIS) and anaesthesiological data, this study found that older patients and those with higher ASA-class had the deepest anaesthetic depth despite standard anaesthetic dosing protocols. These findings support the need for more individualised EEG-monitoring, especially in the elderly and frail, but also how these BIS indicators should guide management. It remains unresolved if deeper anaesthesia with presumed benefits of reducing the surgical stress, can be balanced by improving brain perfusion rather than reducing anaesthetic depth.

Prolonged QT interval is associated with 90-day mortality in sepsis independent of onset timing and heightened in male patients: A cohort study.

Cytomegalovirus (CMV) is a herpes virus that usually affects immunocompromised hosts. However, there has been a recent increase in CMV-associated infections in immunocompetent hosts, with the most common sites including the gastrointestinal tract, lungs, liver, and spleen. We present a case of a 60-year-old male patient who presented with abdominal pain and diarrhea with radiological findings including circumferential mural thickening in the rectum, rectosigmoid, and descending colon with loss of haustrations in the transverse colon suggestive of colitis with toxic megacolon. A subtotal colectomy was performed, which showed gross features of inflammatory bowel disease; however, histopathological findings were suggestive of CMV colitis with typical nuclear and cytoplasmic features. The patient succumbed to death within 2 weeks postsurgery. This case emphasizes the fact that an immunocompetent host present with dreaded complications of CMV colitis, especially older patients, hence elderly age being one of the vulnerable groups.

Sex-based prognostic differences in upper tract urothelial carcinoma: A multicenter cohort study from Taiwan.

Migraine headache is a common primary headache disorder which is multifactorial in origin. On the other hand, iron deficiency anemia causes metabolic abnormalities in the brain which leads to a reduction in neuronal activities. The study was designed to determine the association between iron deficiency anemia and migraine. This was a case-control study which was conducted among patients attending at the outpatient department of Neurology of Mymensingh Medical College Hospital with migraine headache fulfilling the International Headache Society criteria and non-Migraine age and sex matched healthy individuals from November 2019 to April 2021. Total 155 migraine patients (case) and 155 non-migraine healthy individuals (control) were included in this study. After signing the informed written consent, the blood samples were collected for complete blood count and serum ferritin level. The study result showed that iron deficiency anemia was more common in migraine patients than non-migraine healthy individuals (p<0.001). In female patients, serum hemoglobin and ferritin level were significantly low in migraine (p<0.001 and p<0.001 respectably) but in male patients only serum ferritin level was significantly low (p=0.001). There is also an association between severity of migraine attack and iron deficiency anemia (p=0.042). The patients with severe headache had lower serum hemoglobin and ferritin level which were statistically significant (p=0.005 and p<0.01 respectably). The study observed an association between iron-deficiency anemia, serum hemoglobin and ferritin levels with migraine. Therefore, iron deficiency anemia may be investigated in migraine patients and iron supplements might be an effective treatment in patients with migraine.

Systemic lupus erythematosus (SLE) can rarely present as concurrent acute pancreatitis (AP), splenic infarction, and renal failure. This case demonstrates that prompt diagnosis and immunosuppression are crucial for reversing organ damage-even in male patients, expanding the known clinical spectrum of this disease.