Total Joint Arthroplasty in Solid Organ Transplant Patients.

To investigate the patterns of human papillomavirus (HPV) genotype distribution and identify high-risk factors for HPV infection, focusing on their etiological significance and potential public health implications. This study enrolled 496 women from the Gynecology Outpatient Department of Wuhan Central Hospital between September 2021 and September 2024. Data were collected through medical records and questionnaire surveys to analyze the distribution characteristics of HPV infection. High-risk factors were evaluated using multivariate binary logistic regression analysis. HPV infection exhibited the highest infection rate among women ≤25 years (63.5%) and ≥49 years (55.0%), with the most common types of high-risk HPV being HPV52, 16, and 58. Protective factors included frequent condom use (odds ratio [OR]=0.580) and HPV vaccination (OR=0.564). High-risk factors included diabetes (OR=6.620), anxiety (OR=2.126), and low work intensity (OR=1.670). This study demonstrated diabetes, anxiety, and low work intensity as significant risk factors for HPV infection, providing valuable etiological insights. Psychological assessments and diabetes management should be integrated into public health strategies for HPV prevention. Furthermore, multidisciplinary collaboration among gynecologists, psychologists, and endocrinologists, is also recommended to prevention and care efforts.

Scoping review on the economic aspects of machine learning applications in healthcare.

Emerging technologies and strategies in epilepsy surgery: toward personalised medicine.

Introduction: Sustainable architecture is a design and construction approach that seeks to reduce human impact on the environment and promote a more sustainable future. It is based on the use of environmentally friendly materials, energy efficiency, and adaptability to the changing needs of users and the environment. The One Health approach views sustainable architecture as a fundamental pillar in the ambition to achieve a comprehensive and holistic approach to minimize the environmental impact of buildings and improve the quality of life of their occupants.Objective: To analyze sustainable architecture from a One Health approach.Methods: 67 articles were identified, of which 25 were included, more than 75% from the last 3 years. These articles were sourced from academic search engines such as PubMed, MedLine, Ovid, ResearchGate, and Google Scholar.Development: Green building strategies, the use of non-toxic materials, and the integration of green spaces not only reduce environmental impact but also promote the physical and mental health of residents while preserving surrounding ecosystems. However, their implementation requires multidisciplinary collaboration, coherent public policies, and greater social awareness to scale effective solutions.Conclusions: The review highlights how sustainable architecture, aligned with OneHealth, can mitigate global crises such as climate change, biodiversity loss, and emerging diseases.

Exosomal cargoes as potential biomarkers for latent tuberculosis infection: a promising frontier in diagnosis?

Epilepsy beyond seizures: embracing a holistic perspective. Proceedings of the 2nd meeting (Episicily) of the epilepsy study group of the Italian Society of neurology.

Gaps and Challenges in the Transition of Care in Neuromuscular Disorders With a Focus on Duchenne Muscular Dystrophy.

Tele-health has revolutionized healthcare delivery by bridging geographical barriers and expanding access to timely medical services. In sports nursing, where rapid response, continuous monitoring, and specialized interventions are vital, telehealth provides an innovative solution to the challenges athletes face in receiving care. Athletes often require multidisciplinary support for injury management, rehabilitation, nutrition, and mental health, but access to specialized services is not always feasible, particularly in remote or underserved regions. This article examines the applications of telehealth in sports nursing, emphasizing its role in enhancing care accessibility, efficiency, and outcomes for athletes. Key areas explored include injury assessment and management, rehabilitation support, nutritional counseling, mental health services, and chronic condition monitoring. The paper also evaluates the benefits and limitations of telehealth, including technological challenges, data privacy concerns, and the importance of nurse training. Telehealth represents a paradigm shift in sports nursing, offering innovative solutions to expand access to care for athletes. Its applications range from injury management and rehabilitation to nutrition, mental health, and chronic disease monitoring. By eliminating geographical barriers, promoting timely care, and facilitating multidisciplinary collaboration, telehealth enhances both health outcomes and performance in athletes. Despite challenges such as technological barriers, privacy concerns, and limitations in physical assessment, the benefits of telehealth outweigh the drawbacks. Nurses, as frontline healthcare providers, play a central role in delivering telehealth services, educating athletes, and ensuring ethical practice. The integration of telehealth into sports nursing has the potential to redefine athlete care, ensuring that healthcare keeps pace with the dynamic and demanding nature of sports. The integration of telehealth into sports nursing practice holds significant promise for improving athlete well-being, reducing healthcare disparities, and fostering holistic, patient-centered care.

Traditional residency training often struggles to equip general practitioners with the integrated, multidisciplinary skills needed for complex chronic disease management. The multidisciplinary team (MDT) teaching model offers a potential solution, but its effectiveness requires systematic evaluation. This study aimed to evaluate the effectiveness of an MDT-based teaching approach, structured by the CIPP (Context, Input, Process, Product) model, in general clinical training. In a quasi-intervention study, 40 General Practice residents from the 2021–2023 cohorts at Nanjing Medical University Clinical Yancheng Hospital participated. The intervention group (n = 20; 2022–2023 cohorts) received teaching based on the CIPP-MDT approach. The control group (n = 20; 2021 cohort) underwent traditional teaching. educational outcomes were assessed through theoretical exam scores and a post-course satisfaction survey. The intervention group’s theoretical exam scores (82.20 ± 3.35) were significantly higher than those of the control group (74.50 ± 3.10) (P < 0.05). Furthermore, teaching satisfaction in the intervention group reached 100%, a notable improvement compared with the control group’s 65% (P < 0.05). Residents in the intervention group also reported enhanced engagement, increased interest in learning, and greater motivation for independent study. The application of the CIPP-based MDT teaching model in general clinical training at Nanjing Medical University Clinical Yancheng Hospital proved highly effective. It significantly improved teaching quality and resident satisfaction, fostering self-directed learning and enhancing multidisciplinary collaboration. This model also strengthened the development of clinical practice skills, demonstrating substantial potential for broader application, particularly in General Practice residency training.

This case report describes the complex management of a 62-year-old immunocompromised male presenting with acute appendicitis and concurrent West Nile virus (WNV) meningoencephalitis. Initially treated conservatively with antibiotics for appendicitis, the patient's condition deteriorated due to neuroinvasive WNV, complicating clinical assessment and decision-making. Imaging confirmed acute appendicitis without progression, and antibiotic therapy was continued successfully despite impaired consciousness. This case highlights the challenges of managing intra-abdominal infections in patients with concurrent central nervous system involvement, emphasizing the need for multidisciplinary collaboration and the potential viability of non-surgical appendicitis treatment in select high-risk cases.

Whole eye transplantation (WET) has long been looked to as a potential solution for the aesthetic and functional deficits caused by severe ocular pathology and trauma. Here, we describe the first successful combined face and whole eye transplantation (FT/WET), highlighting the logistical, ethical, and technical considerations that enabled this milestone. A 46-year-old male with severe facial and ocular deficits underwent multidisciplinary evaluation and was deemed a candidate for FT/WET. Subsequently, a surgical algorithm was developed through rigorous preoperative planning and team based surgical simulations. This process focused on techniques that would allow for efficient graft procurement and inset, while simultaneously limiting trauma to the globe and its adnexa. Longitudinal monitoring demonstrated maintained graft viability throughout the postoperative period. Fluorescein angiography and ICG angiography confirmed robust retinal and choroidal perfusion. Diffusion-weighted MRI revealed structural preservation of the optic tracts, despite inner retinal atrophy. The patient has also experienced significant improvement in facial aesthetics and functionality with no episodes of graft rejection to date. This case demonstrates the feasibility of addressing deficits once deemed irreparable through advanced surgical techniques, preoperative planning, and multidisciplinary collaboration. Although functional vision recovery has not been observed, this innovation expands the reconstructive options available for patients with severe facial and ocular deficits, paving the way for future advancements in vascularized composite allotransplantation.

Axillary management in early-stage, HER2-negative, hormone receptor-positive breast cancer has undergone major changes in recent years. While axillary lymph node dissection (ALND) was once considered essential for staging and regional control, increasing evidence supports the safety of surgical de-escalation in selected patients. At the same time, systemic therapies such as CDK4/6 and PARP inhibitors rely on nodal burden to define eligibility, raising new challenges in balancing oncologic benefit with treatment-related morbidity. This narrative review summarizes current strategies in axillary management for patients undergoing upfront surgery for HR-positive, HER2-negative early breast cancer. It explores the role of sentinel lymph node biopsy (SLNB), the indications for ALND, the integration of adjuvant systemic therapy, and the emerging role of radiotherapy and predictive tools in guiding individualized treatment decisions. Key randomized trials including Z0011, AMAROS, SENOMAC, SOUND, and INSEMA have demonstrated that omission of ALND is safe in patients with limited nodal involvement, especially when combined with whole-breast or regional nodal radiotherapy. However, trials such as MonarchE and OlympiA have introduced systemic therapies whose indications are closely tied to nodal status, prompting reconsideration of the extent of axillary staging. Advances in imaging and risk stratification tools offer new avenues for safely limiting surgical intervention while preserving access to systemic options. In conclusion, modern axillary management in HR-positive, HER2-negative breast cancer involves navigating the intersection between de-escalated surgery and risk-adapted systemic therapy. Future strategies should prioritize individualized care, incorporating tumor biology, imaging findings, and patient preferences, with multidisciplinary collaboration playing a central role in optimizing outcomes.

Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide. The recent introduction of immune checkpoint inhibitors (ICIs) has transformed the therapeutic landscape of advanced HCC. Combination regimens such as atezolizumab plus bevacizumab, durvalumab plus tremelimumab, and nivolumab plus ipilimumab have demonstrated significant survival improvements over conventional tyrosine kinase inhibitors (TKIs) and have become the new standard of care. However, ICIs can trigger immune-related adverse events (irAEs) through immune system overactivation, affecting multiple organs including the skin, gastrointestinal tract, liver, endocrine system, lungs, and heart. Patients with HCC frequently have underlying liver diseases such as chronic hepatitis or cirrhosis, placing them at higher risk of hepatic irAEs compared with other cancer types, which can markedly influence prognosis. The pathophysiology of irAEs is driven by a series of interconnected immune mechanisms, including excessive T-cell activation, disruption of immune tolerance, cytokine dysregulation, complement-mediated injury, and innate immune activation. Clinical decisions regarding the continuation, interruption, or discontinuation of ICIs, as well as the administration of corticosteroids or immunosuppressants, should be guided by the severity of toxicity. Organ-specific management strategies and multidisciplinary collaboration are essential, particularly in severe presentations. This review summarizes the incidence, mechanisms, and management strategies of ICI-related irAEs in advanced HCC, providing practical insights for clinical decision-making.

Anticoagulants are life-saving drugs used to prevent and treat thrombosis, and a wide use of these drugs is increasing overtime. However, anticoagulants are one of the most common causes of drug-related adverse events in- and out-of-hospital. The need for empowering clinicians and patients, enhancing compliance and favoring multidisciplinary collaboration, has been widely outlined. Programs of Anticoagulation Stewardship (ACS) have been implemented worldwide. It has been widely demonstrated that ACS is associated with reduction of hospital-acquired blood clots, drug-drug interactions, bleeding events, hospital readmissions, length of hospital stay and other healthcare costs. Although ACS is widely discussed, no ACS model has been extensively and officially realized in the Italian healthcare system. Since its constitution, the Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (i.e. FCSA) supported healthcare professionals providing educational programs, aimed to improve anticoagulation quality and to decrease associated risks and costs. In 2021, FCSA developed an app for mobile phones named FCSApp, which was distributed to affiliated physicians. Aim of this study is to describe this experience. FCSApp was actively used for three years by 100 of 232 registered users, with approximately 3200 messages. The channels of main interest were the so-called 'Clinical Cases' with 1671 messages [52.3%]), and 'Laboratory' (with 586 messages [18.3%]). This experience should be considered in the organization of more comprehensive ACS programs for each national or regional healthcare system.

Follicular lymphoma (FL), traditionally considered an indolent yet incurable malignancy, is experiencing a substantial evolution in its therapeutic landscape with the emergence of chemo-free treatment strategies. These novel approaches challenge conventional chemotherapy-based paradigms and offer promising alternatives for both newly diagnosed and relapsed/refractory (RR) FL patients. Among these innovations, bispecific antibodies (BsAbs) have demonstrated compelling efficacy while providing practical advantages, including outpatient administration and generally manageable safety profiles. Chimeric antigen receptor (CAR) T-cell therapies have further expanded the therapeutic armamentarium, achieving unprecedented response rates in heavily pretreated and high-risk populations, although their implementation remains limited by logistical complexity and high associated costs. Additional targeted agents-such as Enhancer of zeste homolog 2 (EZH2) inhibitors, lenalidomide, and Bruton tyrosine kinase (BTK) inhibitors-also contribute meaningfully to chemo-free treatment options, particularly within combination regimens that may enhance clinical benefit. Despite these advances, several challenges persist. Early disease progression (POD24) remains one of the most powerful prognostic determinants in FL. The FLIPI-C model, incorporating machine-learning-derived risk stratification, has shown promise in identifying high-risk patients who may benefit most from innovative approaches. Introducing chemo-free therapies earlier in the treatment algorithm may improve outcomes for these patients while mitigating the long-term toxicities associated with conventional chemotherapy. Ongoing validation through prospective clinical trials and real-world evidence will be essential to define the optimal integration of these therapies. Overall, this evolving paradigm highlights the urgent need for continued innovation, multidisciplinary collaboration, and equitable access to ensure that the full potential of chemo-free strategies can be realized for patients with this complex disease.

Perioperative anaphylaxis (POA) is one of the most critical acute complications in anesthesia practice, characterized by rapid onset, diagnostic complexity, and potentially fatal outcomes. Despite global improvements in anesthesia safety, the unpredictable nature of anaphylaxis continues to challenge clinicians. The Japanese Epidemiologic Study for Perioperative Anaphylaxis (JESPA) established the first nationwide, prospective surveillance system for POA, providing valuable insights into the epidemiology and mechanisms of POA in Japan. Large-scale studies from multiple countries, including the United Kingdom's National Audit Project 6 (NAP6) and France's Groupe d'Étude des Réactions Anaphylactiques Périopératoires (GERAP), have reported similar incidence rates, at approximately 1 in 5000 to 10,000 general anesthesia cases, indicating that POA is a rare but consistently serious global event. In Japan, JESPA confirmed a comparable frequency, identifying neuromuscular blocking agents (NMBAs), antibiotics, and sugammadex as major culprits causing anaphylaxis. Notably, the frequency of sugammadex-induced anaphylaxis is higher in Japan, likely reflecting its extensive clinical use. POA involves both immunologic and non-immunologic pathways, culminating in mast cell activation and mediator release. Its presentation, primarily hypotension and bronchospasm, is often masked under anesthesia, complicating its recognition. Diagnosis requires integrating clinical findings, measuring tryptase using the European Academy of Allergy and Clinical Immunology (EAACI) consensus formula (1.2 × baseline + 2 ng/mL), and identifying causative drugs via skin testing, basophil activation tests (BATs), or drug provocation tests (DPTs). Future priorities include expanding access to tryptase testing, strengthening multidisciplinary collaboration, and promoting anesthesiologist-led allergy investigations to enhance diagnostic precision and patient safety in perioperative care.

Palliative Care in the 21st Century: Multidisciplinary Collaboration, Digital Health, and Equitable Access

Background: Recurrent pregnancy loss (RPL) is a complex and emotionally burdensome condition affecting approximately 2% of pregnant women. It is defined as two or more consecutive pregnancy losses in the U.S. and three or more in the U.K., with up to 50% of cases remaining unexplained despite comprehensive evaluation. Aim: To provide an evidence-based framework for etiologic evaluation, risk stratification, and patient-centered management of RPL. Methods: This review synthesizes current literature on RPL, including epidemiology, pathophysiology, diagnostic strategies, and management approaches. It emphasizes high-yield investigations such as endocrine screening, parental karyotyping, uterine imaging, antiphospholipid antibody testing, and genetic analysis of products of conception. Results: RPL is multifactorial, involving genetic, anatomic, endocrine, immunologic, and lifestyle factors. Established interventions include endocrine optimization, surgical correction of uterine anomalies, and anticoagulation for antiphospholipid syndrome. Emerging therapies such as immunomodulators show limited evidence. Despite structured evaluation, many cases remain unexplained; however, prognosis is generally favorable with supportive care and multidisciplinary management. Conclusion: Effective RPL care requires individualized, evidence-based evaluation, avoidance of low-value testing, and integration of psychosocial support. Multidisciplinary collaboration and patient education are essential to improve outcomes and reduce emotional distress.

Mental health (MH) conditions place a significant disease burden on the UK. Pharmacists are healthcare professionals and may contribute to addressing this burden; however, the evidence regarding their specific role in MH care in the UK is sparse. The objective of this review was to assess the evidence regarding pharmacists' roles in managing common MH conditions within UK primary and secondary care settings. A scoping review was conducted following the Arksey and O'Malley framework and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, Scopus, PsycINFO, Web of Science, and the Web of Science (Core collection) databases for English-language studies published between 2004 and 2024 were accessed. Eligible studies were UK-based and reported pharmacists' involvement in MH care. Data were charted and synthesized into descriptive themes. Fourteen studies highlighted pharmacists' multifaceted roles in MH care across primary and secondary care settings. Key domains included prescribing and deprescribing, medicines management, patient education, team collaboration, and specialized services such as assessments, referrals, and social prescribing. Pharmacist involvement improved medication optimization, patient understanding, and interdisciplinary communication, though gaps in MH training and role standardization were noted. Pharmacists play diverse roles in supporting MH services through medicines optimization, prescribing support, and multidisciplinary collaboration, and have positive impacts on adherence and medicines management, but limited evidence on effectiveness. Strengthening pharmacist integration, workforce training, and evaluation of scalable interventions is essential to enhance their contribution to MH care in the UK.