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Background: Laparoscopic living donor nephrectomy (LLDN) has become the gold standard for renal transplantation. However, performing LLDN concurrently with other surgical procedures remains scarcely reported. This study evaluates the safety and feasibility of simultaneous LLDN with additional laparoscopic surgeries., Methods: A prospective analysis was conducted on 294 cases from November 2018 to May 2023 at our transplant center. Among these, 15 donors underwent concomitant laparoscopic procedures alongside LLDN. Pre-operative evaluations included comprehensive medical histories, laboratory tests, and dual-CT angiography. The surgical outcomes, including operative time and intra- and post-operative complications, were meticulously recorded., Results: The median age of donors was 57 years, with a median BMI of 27 kg/m 2 . The majority (66%) were female. Simultaneous procedures included laparoscopic cholecystectomy (10 cases), hernia repair (3 cases), a hepatic cyst unroofing (1 case), and an ovarian cyst excision (1 case). The mean operative time for LLDN was 140 min, with a total mean operative time of 164.33 min for combined surgeries. No intra-operative complications were observed. The mean hospital stay was 3 days, with early mobilization and no significant post-operative complications reported., Conclusion: Simultaneous LLDN and additional laparoscopic procedures are safe and feasible when performed by an experienced surgical team. This approach can improve donor outcomes by avoiding the need for multiple surgeries and additional anesthesia, thereby enhancing recovery and quality of life., Competing Interests: Declarations. Disclosures: The authors have no conflict of interest or financial ties to disclose. Dr. Apostolos Angelis has nothing to disclosure. Dr. Dionysios Prevezanos has nothing to disclosure. Dr. Christos Doudakmanis has nothing to disclosure. Dr. Michalis Belivanis has nothing to disclosure. Dr. Spyridon Vernadakis has nothing to disclosure. Ethical approval: The research was conducted in accordance with the principles embodied in the Declaration of Helsinki and in accordance with local statutory requirements. All participants gave written informed consent to participate in the study., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Acquisition of multiple carbapenemase genes by Klebsiella pneumoniae (Kp) is an emerging public health threat. Here, we aim to elucidate the population structure of Kp blood isolates carrying two different carbapenemase genes and identify the mechanism facilitating their dissemination. The study was conducted in a tertiary healthcare center between 2014 and 2022. Twenty-four patients with bacteremia caused by Kp carrying two different carbapenemase genes were identified. All 24 blood isolates were analyzed by short-read genome sequences supplemented by long reads in a selected number of isolates. All isolates carried bla KPC (23 bla KPC-2 , 1 bla KPC-3 ) and bla on IncC, or a fusion of the IncFIB(pNDM-Mar) and IncHI1B(pNDM-MAR) plasmids. Comparison of plasmid content of eight isolates carrying a single carbapenemase gene from a previous study with eight isolates carrying two carbapenemase genes from the present study, matched by clonal lineages, revealed that the second carbapenemase gene was acquired by addition of another plasmid. Identical plasmids were found within the same lineage and across lineages. These findings suggest that dissemination of carbapenemase genes in our hospital setting was driven by multiple plasmids across a variety of highly efficient clones.VIM-1 genes, along with a variety of antimicrobial resistance determinants. The isolates were clustered in six clonal lineages (ST39, ST147, ST323, ST258, ST3035, and ST340). Long-read genome sequences demonstrated that each carbapenemase gene was located in a separate group of plasmids: the bla KPC-2 on a fusion of IncFIB(pQil) and IncFII(K) plasmids, the bla KPC-3 on IncX3, the bla VIM-1 on IncC, or a fusion of the IncFIB(pNDM-Mar) and IncHI1B(pNDM-MAR) plasmids. Comparison of plasmid content of eight isolates carrying a single carbapenemase gene from a previous study with eight isolates carrying two carbapenemase genes from the present study, matched by clonal lineages, revealed that the second carbapenemase gene was acquired by addition of another plasmid. Identical plasmids were found within the same lineage and across lineages. These findings suggest that dissemination of carbapenemase genes in our hospital setting was driven by multiple plasmids across a variety of highly efficient clones., Competing Interests: G.L.D. has received fee for speaking and consultancy fee from Pfizer and MSD; S.R. has received travel and speaking fee from Illumina. The other authors have nothing to declare.

Malignant mesothelioma (MM) is a rare but aggressive cancer linked to asbestos exposure and characterized by advanced‑stage disease at presentation. Despite advances in treatment, prognosis remains abysmal, highlighting the imperative for the development of novel biomarkers and treatment approaches. Telomere biology plays a pivotal role in the tumorigenic process and has emerged as a key area in oncology research. Short telomeres have been associated with genomic instability, and substantially shorter telomere length (TL) has been identified in MM, showcasing the potential of TL in risk assessment, early detection, and disease progression monitoring. MM predominantly maintains TL through telomerase activity (TA), which in research has been identified in >90% of MM cases, underscoring the potential of TA as a biomarker in MM. Telomerase reverse transcriptase (TERT) polymorphisms may serve as valuable biomarkers, with research identifying associations between single nucleotide polymorphisms (SNPs) and the risk and prognosis of MM. Additionally, TERT promoter mutations have been associated with poor prognosis and advanced‑stage disease, with the non‑canonical functions of TERT hypothesized to contribute to the development of MM. TERT promoter mutations occur in ~12% of MM cases; C228T, C250T and A161C are the most common, while the distribution and frequency differ depending on histological subtype. Research reveals the promise of the various approaches therapeutically targeting telomerase, with favorable results in pre‑clinical models and inconclusive findings in clinical trials. The present review examines the role of telomere biology in MM and its implications in diagnosis, prognosis, and therapy.

Background: The Mediterranean diet (MD) is considered the best dietary approach for patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Recently, time-restricted feeding (TRF) has gained attention for its lifestyle compatibility and health benefits., Aims: This study aimed to compare the effects of a hypocaloric MD with a 10-h TRF protocol to an unrestricted MD in MASLD patients with overweight/obesity and evaluate differences between early and late TRF., Methods: This 12-week randomised controlled trial in MASLD patients with overweight/obesity consisted of three groups, all following a hypocaloric Mediterranean-type diet. The control group had no eating time restrictions. The early TRF (eTRF) and late TRF (lTRF) groups had a 10-h eating window, from 8 AM to 6 PM and from 12 PM to 10 PM, respectively. Various health parameters were measured. Compliance was tracked via food diaries, and an 8-week follow-up occurred post-intervention., Results: Fifty-nine MASLD individuals (27 males; 52.9 years; body mass index 32.1 kg/m 2 ) completed the trial (control, n = 19; eTRF, n = 20; lTRF, n = 20). All groups showed significant 12-week reductions in body weight, anthropometry and blood pressure. Glycated haemoglobin A 1c and insulin resistance, as measured by the Matsuda index, homeostatic model assessment for insulin resistance and fasting glucose-to-insulin ratio, improved in the eTRF group at 12 weeks., Conclusions: This study corroborates the efficacy of MD in ameliorating cardiometabolic risk factors such as body weight and blood pressure in MASLD patients. The combination with an eTRF protocol may improve glycaemic control (NCT05866744)., Trial Registration: The study is registered at clinicaltrials.gov (NCT05866744)., (© 2025 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)

Purposeof Review: Ultra-processed foods (UPFs) are becoming more and more important in daily diets around the world; in some cases, they can account for as much as 60% of daily energy intake. Epidemiological evidence suggests that this shift toward high levels of food processing may be partially responsible for the global obesity epidemic and the rise in the prevalence of chronic diseases., Recent Findings: Few prospective studies have examined the relationship between UPF consumption and cancer outcomes. According to currently available information, UPFs may increase the risk of cancer due to their obesogenic properties and exposure to substances that can cause cancer, such as certain food additives and pollution from product processing. The complex relationship between obesity and cancer involves factors such as immune dysregulation, altered adipokine and sex hormone levels, abnormal fatty acid metabolism, extracellular matrix remodeling, and chronic inflammation. Addressing cancer risk associated with UPF consumption could involve a multifaceted approach, including consumer behavior modification programs and robust public health regulations aimed at enhancing food environments. Improved knowledge of the potential dual negative impacts of UPFs on the environment and cancer risk is one of the priority areas we identify for future research and policy implications. Various approaches could be used to prevent cancers associated with UPF consumption, such as consumer behavior change programs and stricter public health regulations needed to improve the food environment. This review examines for the first time the potential role of UPFs in cancer risk associated with obesity, exploring underlying biological mechanisms and identifying key areas for future research and policy action, including the dual environmental and health impact of UPFs., Competing Interests: Declarations. Conflict of Interest: The authors declare no competing interests. Animal and Human Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors., (© 2025. The Author(s).)

Background/objectives: Nutrition epidemiology research scarcely focuses on the relationship between dietary patterns that are beneficial for both planet and human health. This study aimed to examine the association between adherence to a sustainable, planetary-healthy dietary pattern, i.e., the EAT-Lancet Reference Diet (EAT-LD), and 20-year cardiovascular disease (CVD) incidence, in a Mediterranean population., Subjects/methods: Τhe ATTICA study is a prospective cohort study with a baseline phase in 2002 and 3 consecutive follow-ups (in 2006, 2012, 2022). The EAT-Lancet Index (EAT-LI) and the MedDietScore scales were calculated based on previously published guidelines to assess the adherence to the respective dietary pattern. The current sample consisted of 1,988 Greek adults initially free-of-CVD at baseline. The development of a cardiovascular event was assessed throughout the 20-year period (WHO-ICD-10 classification)., Results: The 20-year incidence of CVD was 3600 cases/10,000 individuals (95%Confidence Interval-CI: 3506 to 3695/10,000). Median (interquartile range) values for EAT-LI and MedDietScore were 17 (6.2) out of possible 42 points and 27 (2.9) out of possible 55 points, respectively. Both diet scales were inversely associated with 20-year CVD incidence [Hazard Ratio-HR (95% CI) per 1 point (of possible 42 points) of EAT-LI: 0.83 (0.77-0.90) and per 1 point (of possible 55 points) of MedDietScore: 0.90 (0.84-0.93)]., Conclusion: Our findings highlight that diets that are good for planetary health, are also healthy for humans. Promoting diets that are culturally acceptable, economically viable, easily accessible, planet-friendly, and sustainable should be a key strategy for enhancing both public and planetary health., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval: The ATTICA study was carried out in accordance with the Declaration of Helsinki (1989) of the World Medical Association and was approved by the Institutional Ethics committee of Athens Medical School (#017/1.5.2001), and the Bioethics Committee of Harokopio University (#38/29.03.2022). All participants provided written consent to participate in the study., (© 2025. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Dysfunctional vascular access is a major cause of morbidity and mortality in patients undergoing hemodialysis, affecting both arteriovenous fistulas and grafts. The most optimal strategy to restore long-term patency has not been established. This meta-analysis compares drug-coated balloon (DCB) versus uncoated balloon (UCB) angioplasty for dysfunctional vascular access., Methods: We performed a systematic literature search across multiple databases from inception to June 2024. Randomized-controlled trials (RCTs) comparing DCB and UCB in dialysis patients with dysfunctional vascular access were included. Risk ratios were pooled using a random-effects model., Results: Twenty-seven RCTs (2645 patients) were included. Target lesion patency (TLP) at 6 months was significantly superior in the DCB group (RR 1.22, 95% CI 1.07-1.39, p = 0.003). The two regimens were comparable for TLP at 3 months (RR 1.14, p = 0.24) and 12 months (RR 1.14, p = 0.10). The two regimens were comparable in terms of circuit patency rate, target-lesion revascularization, and all-cause mortality., Conclusion: DCB has significantly superior TLP and a comparable risk of mortality to UCB. Further research is warranted to identify factors affecting outcomes following DCB angioplasty for dysfunctional dialysis access., Competing Interests: Declarations. Conflict of interest: The authors report no relationships that could be construed as a conflict of interest., (© 2025. The Author(s), under exclusive licence to Japanese Society of Nephrology.)

Ultra-processed foods (UPFs) are foods that have undergone extensive industrial processing with the addition of various substances in order to make them more tasty, eye-catching, and easy to consume. UPFs are usually rich in sugars, salt, and saturated fat, whereas they lack essential nutrients. The aim of this review is to elaborate upon the current evidence associating overconsumption of UPFs with the development of type 2 diabetes mellitus (T2DM). We will discuss data interconnecting UPFs and T2DM risk and will further describe specific ingredients that have been suggested to increase this risk. In addition, we will thoroughly explain how additives, such as emulsifiers or sweeteners, or other compounds formed during manufacturing, such as acrylamide and acrolein, and during packaging, such as bisphenol-A, are proposed to be implicated in the pathogenesis of insulin resistance and T2DM.

Purpose of Review: Obesity is strongly associated with cardiometabolic disorders and certain malignancies, emphasizing the key role of adipose tissue in human health. While incretin mimetics have shown effectiveness in glycemic control and weight loss, a holistic strategy for combating obesity and associated comorbidities remains elusive. This review explores peroxisome proliferator-activated receptor gamma (PPAR-γ) agonism as a potential therapeutic approach, highlighting its benefits, addressing its limitations, and outlining future directions for developing more effective treatment strategies., Recent Findings: Both natural and synthetic PPAR-γ agonists hold significant therapeutic potential as insulin sensitizers, while also demonstrating anti-inflammatory properties and playing a critical role in regulating lipid metabolism. However, the clinical use of natural agonists is limited by poor bioavailability, while synthetic agents like thiazolidinediones are associated with adverse effects, including fluid retention, weight gain, and bone loss. Current research is focused on developing modified, tissue-specific PPAR-γ agonists, as well as dual PPAR-α/PPAR-γ agonists, with improved safety profiles to mitigate these side effects. Nanotechnology-based drug delivery systems also hold promise for enhancing bioavailability and therapeutic efficacy. Furthermore, the transformative potential of machine learning and artificial intelligence offers opportunities to accelerate advancements in this field. PPAR-γ agonists exhibit significant potential in addressing metabolic syndrome, cardiovascular disease, and cancer. However, their clinical use is restricted by safety concerns and suboptimal pharmacokinetics. Innovations in modified PPAR-γ agonists, nanotechnology-based delivery systems, and computational tools hold promise for creating safer and more effective therapeutic options for obesity and its associated disorders., Competing Interests: Declarations. Conflict of Interest: The authors declare no competing interests. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To evaluate the paths between lifelong physical activity levels and the development of cardiometabolic disease., Methods: The ATTICA is a population-based cohort study with a 20-year follow-up conducted in the Attica region, Greece and included, 3042 adult males and females (45 [11] y). Participants physical activity levels' tracking together with data regarding cardiovascular disease, obesity, hypertension, hypercholesterolemia, and diabetes incidence, were available in 1988 participants (45 [12] y old, 987 males and 1001 females), at 20-year follow-up. Physical activity levels were evaluated using the validated International Physical Activity Questionnaire, in all examinations (2001-2002, 2006, 2012, and 2022). Four physical activity trajectories were defined, that is, consistently active/inactive and changed from active/inactive. Path analysis was applied using structure equation models., Results: 54% of participants were classified as always inactive, 5% classified as became inactive from physically active, 38% as became active and, only 3% sustained physical activity levels. Participants who reported being consistently physically active throughout the 20-year period were 6% (OR, 0.94, 95% CI, 0.89-0.99) less likely to develop cardiovascular disease as compared with those who remained consistently physically inactive, had 21% lower risk of developing hypercholesterolemia (OR, 0.79, 95% CI, 0.59-1.04), 33% lower risk of obesity (OR, 0.67, 95% CI, 0.44-1.02), and 30% lower risk of diabetes (OR, 0.70, 95% CI, 0.48-1.03)., Conclusions: Lifelong physical activity was strongly associated with reduced fatal or nonfatal cardiovascular disease events, as well as reduced risk of developing other cardiometabolic disorders, hypercholesterolemia, obesity, and diabetes.

Background: Despite the established link between obesity and cardiovascular disease (CVD), the optimal anthropometric index for risk prediction remains uncertain., Aims: This prospective cohort study aimed to compare various anthropometric indices for their association with 20-year atherosclerotic cardiovascular disease (ASCVD) risk in a healthy adult population and to assess their incremental predictive value., Methods: In 2002, n = 3,042 adults free of CVD, residing in Athens metropolitan area, in Greece, were recruited. A 20-year follow-up was conducted in 2022, comprising n = 2,169 participants, of which n = 1,845 had complete data on both CVD occurrence and anthropometric measures., Results: Almost all the studied anthropometric measures were significantly associated with 20-year ASCVD incidence. However, after full adjustment, none of these measures retained a significant association. The inclusion of any individual obesity index within the SCORE2 model enhanced the model's discriminatory power, while the continuous NRI exhibited positive values, suggesting improved risk reclassification. The indices linked to adipose tissue dysfunction exhibited greater efficacy in distinguishing and reclassifying CVD risk beyond SCORE2. Stratified analysis according to obesity and metabolic health status revealed that the optimal obesity index varies according to individual obesity and metabolic health profiles., Conclusion: Obesity indices are strongly associated with long-term risk of ASCVD, underscoring the major role of excessive body fat in the pathogenesis of this condition. The inclusion of an obesity index in a CVD risk model significantly enhances its predictive accuracy and reclassification of risk, emphasizing the importance of these indices in refining CVD risk assessment among the general population., Competing Interests: Declaration of competing interest The authors declare they have no conflict of interest., (Copyright © 2025 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Transfusion-dependent thalassemia (TDT) is a type of protein aggregation disease. Its clinical heterogeneity imposes challenges in effective management. Red blood cell (RBC) variables may be clinically relevant as mechanistic parts or tellers of TDT pathophysiology. This is a cross-sectional study of RBC and plasma physiology in adult TDT subjects versus healthy control. TDT plasma was characterized by increased protein carbonylation, antioxidants, and larger than normal extracellular vesicles. RBCs were osmotically resistant but prone to oxidative hemolysis. They overexposed phosphatidylserine and exhibited pathologically low proteasome proteolytic activity (PPA), that correlated with metabolic markers of the disease. RBC ultrastructure was distorted, with splenectomy-related membrane pits of 300-800 nm. Plasma metabolomics revealed differences in heme metabolism, redox potential, short-chain fatty acids, and NO bioavailability, but also in catecholamine pathways. According to coefficient of variation assessment, hemolysis, iron homeostasis, PPA and phosphatidylserine exposure were highly variable among patients, as opposed to RBC fragility, and plasma antioxidants, amino acids, and catecholamines. Sex-based differences were detected in hemolysis, redox and energy variables, while splenectomy-related differences referred to thrombotic risk, RBC morphology, and plasma metabolites with neuroendocrine activity. Hepcidin varied according to oxidative hemolysis and metabolic markers of bacterial activity. Subjects with higher (>10 g/dL) pretransfusion Hb levels presented mildly distorted profiles and lower membrane-associated PPA, while classification by severity of mutations revealed different levels of hemostasis, inflammation, plasma epinephrine, hexosamines, and methyltransferase activity markers. The currently reported heterogeneity of cellular and biochemical features probably contributes to the wide phenotypic diversity of TDT at clinical level., (Copyright © 2025 American Society of Hematology.)

Alzheimer's disease (AD), the most prevalent form of dementia, is a progressive neurodegenerative disorder characterized by a gradual decline in several domains of higher cortical function. Both preclinical and clinical research has suggested that the supplementation omega-3 fatty acids (FAs) may have potential benefits for individuals with AD. The present study aimed to identify all randomized controlled trials (RCTs) examining the association between omega-3 FA supplementation and cognitive function in patients with AD, using the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) Subscale test as the primary outcome measure. A comprehensive search of the PubMed and Cochrane Library databases was conducted for all published RCTs up to December, 2023 that assessed cognition following omega-3 FA supplementation compared to placebo. A total of five studies met the eligibility criteria and were included in the qualitative synthesis, with four of these studies being incorporated into the meta-analysis. From these studies, data were collected from a total of 702 patients with AD, with 376 participants receiving omega-3 FA supplementation and 326 participants receiving a placebo. The primary outcome measure was the ADAS-Cog score. The meta-analysis revealed that omega-3 FA supplementation had a non-significant impact on the ADAS-Cog score compared to placebo, with a mean difference of 1.37 [95% confidence interval (CI) 0.00-2.73]. The heterogeneity among the included studies was moderate (I 2 =35%, P=0.17). The test for overall effect (z=1.96, P=0.05) indicated no statistical significance. Therefore, it was concluded that omega-3 FA supplementation does not significantly affect the cognitive function of adults with AD., Competing Interests: DAS is the Editor-in-Chief for the journal, but had no personal involvement in the reviewing process, or any influence in terms of adjudicating on the final decision, for this article. The other authors declare that they have no competing interests., (Copyright: © 2025 Kalamara et al.)

Background: Osteoporosis is characterized by reduced bone mineral density (BMD) and disrupted microarchitecture estimated by trabecular bone score (TBS), resulting in increased bone fracture risk. "Osteostrong®" is a bone-strengthening system implementing 4 devices and incorporating brief (10-minute), weekly, low-impact, and high-intensity osteogenic loading exercises. We evaluated the efficacy of the Osteostrong® intervention in postmenopausal osteoporotic women., Methods and Subjects: 147 postmenopausal osteoporotic women were separated into two groups: Group A comprised 74 women receiving Osteostrong® intervention (mean age 58.8 years, 56.6-61 years 95% CI), and was subdivided into G1 receiving no antiresorptive medication, and G2 on such medication. Group B comprised 73 women that received no Osteostrong® intervention (mean age 61.8 years, 59.4-64.1 95% CI) and was subdivided into G3 on no antiresorptive therapy, and G4 on such treatment. All participants underwent a physical examination and had an assessment for secondary osteoporosis. Dual-energy X-ray absorptiometry (DXA) examinations (Horizon W [S/N 300472M]) were performed at the time of trial inclusion and 12 months later., Results: Statistically significant increases were observed in the following parameters: i) BMD of the lumbar spine (L1-L4) in G1(p=0.0039), G2(p<0.001), and G4(p=0.0059): ii) TBS in G2(p=0.0078): iii) BMD of the right femoral neck in G1(p=0.0382) and G4(p=0.032): iv) BMD of the left femoral neck G2(p=0.0089) and in G4(p=0.0498) and total femur in G2(p=0.0162)., Conclusions: Osteostrong® improved BMD of the lumbar spine in women with osteoporosis both off and on antiresorptive treatment. Furthermore, Osteostrong® enhanced the effect of antiresorptive therapy on BMD and TBS of the spine, hip and femoral neck., (© The Author(s) 2025. Published by Oxford University Press on behalf of the Endocrine Society.)

Cholangiocarcinoma is a rare primary liver cancer with poor prognosis, due to the advanced stage at the time of diagnosis and limited therapeutic options, with poor response. Chemotherapy remains the standard first-line treatment, but the advent of immunotherapy has recently induced promising results. Given the fact that diagnosis frequency is increasing nowadays and the survival rate remains very low, it is crucial to recognize patients who are suitable for immunotherapy and will have the best response. Different types of biomarkers, such as interleukins, exosomes, mi-RNA, ctDNA, and gene mutations, have been studied for their feasibility, not only for the early diagnosis of biliary tract cancer but also for the determination of responsiveness in treatment. Less frequently, these studies focus on finding and observing biomarkers in patients who receive immunotherapy. This review aims to summarize current knowledge of existing/promising biomarkers in patients with unresectable or metastatic cholangiocarcinoma, treated with immunotherapy as monotherapy, or combined with chemotherapy.

Systemic mastocytosis (SM) encompasses a wide spectrum of myeloproliferative disorders defined by the aggregation of abnormal mast cells in various tissues, including the bone marrow, gastrointestinal tract, liver and lymph nodes. The release of tryptase, interleukins and cytokines by the accumulated mast cells causes a multi-system response that can range from mild flushing and pruritus to severe anaphylactic reactions, gastrointestinal disturbances, and cardiovascular symptoms, including hypotension and syncope. Furthermore, severe osteoporosis manifesting as bone-lytic lesions or pathologic fractures due to mast cell mediator-triggered bone resorption, is a rather common manifestation of SM, occurring in more than two-thirds of patients. The vast majority of SM cases harbor the D816V KIT mutation, which is an independent prognostic factor, and serves as a therapeutic target. This is a rare case of a young male who presented with new-onset back pain due to osteoporotic fractures and was diagnosed with SM without the D816V KIT mutation. Our case aims to emphasize one of the most underrecognised causes of osteoporosis in adults, and to shed light on a frequently misdiagnosed yet potentially severe hematologic disorder., Competing Interests: CONFLICTS OF INTEREST Authors have no conflicts of interest to declare.

Background: To evaluate the influenza-like illness (ILI) and acute respiratory infection (ARI) case definitions in the diagnosis of COVID-19 and influenza in healthcare personnel (HCP)., Methods: We followed a cohort of 5752 HCP from November 2022 to May 2023. Symptomatic HCP were tested for SARS-CoV-2 and influenza by real-time PCR and/or rapid antigen detection test. ILI was defined as the sudden onset of ≥1 systemic symptom and ≥1 respiratory symptom. ARI was defined as the sudden onset of ≥1 respiratory symptom. Patients with respiratory symptoms were grouped either as ILI or as ARI based on the presence of fever, malaise, headache and/or myalgia., Results: Overall, 466 ILI cases and 383 ARI cases occurred. HCP with ILI had an adjusted odds ratio (aOR) of 22.05 [95% confidence interval (CI): 6.23-78.04] to be diagnosed with influenza. HCP with ARI had an aOR of 2.70 (95% CI: 1.88-3.88) to be diagnosed with COVID-19. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ILI for influenza were 96.6%, 49.9%, 18.2%, and 99.2%, respectively. The sensitivity, specificity, PPV, and NPV of ARI for COVID-19 were 51.7%, 73.6%, 84.9%, and 34.8%, respectively. ILI and ARI had an overall correct classification rate of 89.6% and 74.1%, respectively., Conclusion: Our findings support the use of both ILI and ARI case definitions in the diagnosis of influenza and COVID-19 in HCP., Competing Interests: Declaration of competing interest Dr Maltezou received an honorarium from Novavax to participate in a symposium. The authors have no conflict of interest to declare., (Copyright © 2024 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)

Objective: As a result of conflicting, inadequate or controversial data in the literature, several issues concerning the management of patients with abdominal aortic aneurysms (AAAs) remain unanswered. The aim of this international, expert-based Delphi consensus document was to provide some guidance for clinicians on these controversial topics., Methods: A three-round Delphi consensus document was produced with 44 experts on 6 prespecified topics regarding the management of AAAs. All answers were provided anonymously. The response rate for each round was 100%., Results: Most participants (42 of 44 [95.4%]) agreed that a minimum case volume per year is essential (or probably essential) for a center to offer open or endovascular AAA repair (EVAR). Furthermore, 33 of 44 (75.0%) believed that AAA screening programs are (probably) still clinically effective and cost effective. Additionally, most panelists (36 of 44 [81.9%]) voted that surveillance after EVAR should be (or should probably be) lifelong. Finally, 35 of 44 participants (79.7%) thought that women smokers should (or should probably/possibly) be considered for screening at 65 years of age, similar to men. No consensus was achieved regarding lowering the threshold for AAA repair and the need for deep venous thrombosis prophylaxis in patients undergoing EVAR., Conclusions: This expert-based Delphi consensus document provides guidance for clinicians regarding specific unresolved issues. Consensus could not be achieved on some topics, highlighting the need for further research in those areas., Competing Interests: Disclosures A.K. has received speaker fees from Cook Inc., & W.L. Gore & Associates, and is a consultant for Bentley Innomed. M.A.F. has received clinical trial support and is a Consultant for Cook, W. L. Gore & Associates, Getinge, and ViTAA. He has received research support from Cook and has stock options in Centerline Biomedical. M.E. is a paid consultant for W. L. Gore & Associates and Silk Road Medical. M.G. is a consultant for Cook Medical, W. L. Gore & Associates and Medtronic and a proctor for Cook Medical., (Copyright © 2024 Society for Vascular Surgery. All rights reserved.)

Multidrug (MDR) and extensive drug (XDR) resistance in Gram-negative bacteria (GNB) emerges worldwide. Although bone and joint infections are mostly caused by Gram-positive bacteria, mainly Staphylococci, MDR GNB substantially increase also as a complication of hospitalization and previous antibiotic administration. This narrative review analyzes the epidemiological trend, current experimental data, and clinical experience with available therapeutic options for the difficult to treat (DTR) GNB implicated in bone and joint infections with or without orthopedic implants. The radical debridement and removal of the implant is adequate therapy for most cases, along with prompt and prolonged combined antimicrobial treatment by older and novel antibiotics. Current research and clinical data suggest that fluoroquinolones well penetrate bone tissue and are associated with improved outcomes in DTR GNB; if not available, carbapenems can be used in cases of MDR GNB. For XDR GNB, colistin, fosfomycin, tigecycline, and novel β-lactam/β-lactamase inhibitors can be initiated as combination schemas in intravenous administration, along with local elution from impregnated spacers. However, current data are scarce and large multicenter studies are mandatory in the field.

Background: Acute kidney injury (AKI) represents a commonly seen condition in the natural course of cirrhosis associated with unfavourable outcomes., Aims: To evaluate and compare the pooled mortality rates of patients with cirrhosis, with versus without AKI, across different clinical settings and diagnostic criteria., Methods: A systematic search of several databases was performed up to Oct 2023. Meta-analysis was performed using a generalised linear mixed model with a random effects model for all calculations., Results: A total of 59 studies comparing patients with cirrhosis, with and without AKI, were included in the meta-analysis, encompassing 1,153,193 individuals with AKI and 4,630,814 without AKI. AKI development predisposed to significantly higher short (in-hospital and 30-days)-, intermediate (90-days)- and long (1-year)-term mortality rates in both inpatients and outpatients. Remarkably, patients with AKI admitted to intensive care unit (ICU) or diagnosed with acute-on-chronic liver failure (ACLF) experienced the higher short-term mortality rates, reaching 76% [95% confidence interval (CI): 73%-79%] and 54% (95%CI: 33%-73%), respectively. AKI staging correlated with mortality risk, with higher stages indicating higher mortality rates, while the timing of AKI development, whether community-acquired or hospital-acquired, plays a crucial role in patient prognosis, with distinct mortality patterns observed in each group. The selection of diagnostic criteria for AKI may also impact its association with the short-term mortality risk., Conclusions: AKI substantially affects the prognosis of patients with cirrhosis, especially those in ICU and/or with ACLF. Prognosis is also greatly influenced by the AKI stage, timing of onset and diagnostic criteria., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)

Background: Studies over the last years have revealed the possible impact of endovascular repair of abdominal or thoracic aortic aneurysms on the arterial stiffness and secondary on the cardiac function and the central hemodynamics., Methods: A literature search was conducted to collect data on current methods of arterial stiffness assessment and the induced changes in arterial stiffness after endovascular or open surgical repair of abdominal or thoracic aortic aneurysms., Results: Seventeen studies were analyzed. In most of these studies, arterial stiffness, either assessed by pulse wave velocity or augmentation index, was found to be increased after aortic aneurysm repair. Factors that increase arterial stiffness seem to be endovascular repair of the aneurysm and the proximity of the stent graft to the heart. The clinical implications of increased arterial stiffness are left ventricular hypertrophy, coronary arteries malperfusion and potential end-organ damage., Conclusions: Both endovascular and open aortic aneurysm repair can alter arterial stiffness, with endovascular repair having a greater effect. Future research is essential, particularly in exploring the impact of aortic aneurysm repair methods on vital organs and cardiac function. Extended follow-up studies are proposed to gain a better understanding of the long-term cardiovascular consequences of both endovascular and open surgical repair outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Patients with type 1 diabetes (DM1), even in the setting of adequate glycaemic control, have an excess risk for developing cardiovascular disease. Residual insulin secretion (RIS), measured by detectable C-peptide levels in patients with DM1, might protect against diabetes-related complications. This study aimed to examine the relationship between residual insulin secretion and prognostic markers of cardiovascular complications in patients with DM1., Methods: A total of 137 patients with DM1 were included in this analysis. They were of young age (<45 years), with an established diagnosis of over two years before the study entry and without a history of cardiovascular complications. All patients underwent complete clinical and laboratory evaluation. A c-peptide measurement of ≥0.05 ng/ml was used to identify the presence of RIS. Pulse wave velocity (PWV), cardiac autonomic function assessed both at rest, by total power of heart rate variability and dynamically, by the expiration to inspiration (e/i) index, albumin to creatinine ratio (ACR), and high sensitivity CRP (hs-CRP) were used as predictive biomarkers of cardiovascular complications., Results: Female participants represented 63.5% of the population [mean age: 29.7 (±8.1) years, mean HbA1c: 7.6% (±1.4), median diabetes duration:15 (10-21) years, median age at diabetes diagnosis: 13 (8-17) years]]. The median value of fasting c-peptide was 0.04 (0.03-0.05) ng/ml, and RIS was detected in 32 patients (23.4%). Patients with RIS had a shorter diabetes duration, an older age at diagnosis and a lower BMI, while no significant association was found between residual c-peptide and age or HbA1c. RIS was significantly associated with lower PWV values [8.1 m/s² (7-8.7) vs 9.2 m/s² (7.8-10.1), p <0,001], higher total power values [1124 Hz (600-3277) vs 577 Hz (207-2091), p <0,001], and higher E/I measurements [1.4 (1.2-1.5) vs. 1.3 (1.2-1.4), p=0.01]. No significant association was noted between RIS and either ACR or hs-CRP. In multivariable linear regression analysis, the association between RIS and lower PWV values remained significant (p= 0.007) regardless of age, sex, diabetes duration or age of diagnosis, blood pressure and BMI. Similarly, residual insulin secretion retained a significant independent association with total power (p= 0.032) and E/I (p=0.045)., Conclusion: In young patients with DM1, free of macrovascular complications, residual insulin secretion is independently associated with more favorable prognostic markers of subclinical atherosclerosis and cardiac autonomic function., Competing Interests: Declaration of competing interest Barmpagianni Aikaterini has received financial support (scholarship) from Hellenic Diabetes Association, in 2019, for the purposes of this research., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: In light of the new nomenclature of steatotic liver disease (SLD), we aimed to enhance the existing knowledge on the epidemiology and clinical outcomes of metabolic and alcohol related/associated liver disease (MetALD)., Methods: A systematic review and meta-analysis were performed in Medline/PubMed, Embase, Scopus and Cochrane databases to evaluate the prevalence and outcomes of MetALD within the SLD population and to compare the characteristics between MetALD patients and those with metabolic dysfunction associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD). Nineteen studies from nine countries that evaluated 4,543,341 adult participants with SLD were included., Results: The pooled overall prevalence of MetALD among the SLD population was 10 % (95%CI:7-13 %) without significant difference between Asian and non-Asian populations. However, MetALD was more frequent in men than women (86 % vs 14 %, p < 0.01), while Asian MetALD patients, were more frequent men (92 % vs 66 %, p < 0.01) compared to non-Asians. Additionally, in terms of metabolic characteristics there were no significant differences between MetALD, MASLD and ALD patients. Regarding outcomes, patients with MetALD, compared to non-SLD, were at increased risk of all-cause [HR 1.44 (95%CI:1.24-1.66)], cardiovascular disease (CVD) [HR 1.17 (95%CI:1.12-1.21)] and cancer-related mortality [HR 2.07 (95%CI:1.32-3.25)]. Finally, patients with MetALD, had increased incidence of CVD and liver decompensating events, compared to non-SLD participants [HR 1.49 (95%CI:1.03-2.15); HR 10.55 (95%CI:3.46-32.16) respectively]., Conclusions: Based on the existing literature, patients with MetALD consist a significant part of the SLD population, with high all-cause, CVD and cancer-related mortality and increased risk for CVD and hepatic decompensation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Pre-eclampsia (PE) is a complex, advancing condition marked either by the recent emergence of hypertension and proteinuria or by the recent onset of hypertension accompanied by notable end-organ impairment, which may occur with or without proteinuria. PE usually appears in the postpartum phase or after the 20th week of gestation, though it might appear sooner in cases of molar pregnancy. Pathophysiology: This disorder is a serious multisystem condition during pregnancy that can lead to serious, life-threatening complications for both the mother and the fetus if it is not diagnosed and managed promptly. These changes result from widespread and intense vasoconstriction caused by renin, angiotensin II (Ang II), aldosterone, and catecholamines. The renin-angiotensin-aldosterone system (RAAS) and its sequence of signaling reactions demonstrate its crucial role in regulating blood pressure and electrolyte balance that diverges in PE from that observed in healthy pregnancies. However, it is widely recognized that the above description is incomplete for pre-eclampsia and further relationships should be analyzed. The purpose of this article is to review and synthesize alterations in renal function and the RAAS during normal pregnancy and pre-eclampsia. We aim to provide clinical gynecologists with a comprehensive understanding of how pregnancy-specific adaptations can impact renal function and the RAAS, as well as the deviations observed in pre-eclampsia. Conclusion: This information is essential to enhance clinical awareness, improve the accuracy of diagnosis, and support evidence-based decision-making in the management of pregnant patients, especially those complicated by pre-eclampsia.

The estimated annual incidence of out-of-hospital cardiac arrest (OHCA) is approximately 120 cases per 100000 inhabitants in western countries. Although the rates of bystander cardiopulmonary resuscitation (CPR) and use of automated external defibrillator are increasing, the likelihood of survival to hospital discharge is no more than 8%. To date, various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients. The aim of this review is to discuss strategies that facilitate resuscitation, increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the pre-hospital setting., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background and Aims: Diet, physical activity, sleep and smoking have been individually associated with glycemic control (GC) in adults with type 1 diabetes mellitus (T1D). However, the combined effect of these factors has not been investigated. The aim of the present study was to examine the single and combined effects of lifestyle parameters on GC of people with T1D (PwT1D)., Methods and Results: Dietary, physical activity and sleep habits were evaluated using validated questionnaires. Diet quality was assessed with two scores (MedDietScore and PURE Diet Score) and two healthy lifestyle indices (HLI) were constructed (MLI based on MedDietScore and PLI based on PURE score). The score of both HLI ranged from 0 to 12 with higher scores indicating greater adherence to the healthy lifestyle pattern. One hundred ninety-two adults [61 % female, median age 42 (34, 51) years] with T1D were included in the analysis. Good GC (defined as HbA1c<7 %) was observed in 31 % of study participants. Examining lifestyle components separately, only smoking was marginally inversely associated with good GC [odds ratio (OR): 0.48, (95 % confidence interval, CI:0.23-1.00; p = 0.050)]. Individuals with better GC had significantly higher HLI scores (both p < 0.05). After adjusting for age, sex, body mass index, wearing an insulin pump and using continuous glucose monitoring, one-unit increase in the PLI was associated with 16 % higher likelihood of good GC (OR:1.16, 95 % CI:1.01-1.35, p = 0.04) and a similar trend was recorded for MLI (p = 0.05)., Conclusion: Our results suggest that adherence to a healthy lifestyle, more so than single lifestyle parameters, is associated with better GC in PwT1D., (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.)

Renal transplantation is the preferred treatment for end-stage renal disease (ESRD); however, patients with significant vascular abnormalities may require innovative approaches to vascular anastomosis. This report describes a 72-year-old male with ESRD of unknown etiology who was assessed for a deceased donor kidney transplant. Severe atherosclerosis of the iliac arteries was identified on preoperative imaging, leading to the selection of the inferior epigastric artery (IEA) as the vascular conduit. Anastomosis was performed using interrupted 6-0 prolene sutures, resulting in successful graft reperfusion without intraoperative complications. Postoperatively, the patient experienced delayed graft function (DGF), remaining anuric for 10 days and requiring multiple hemodialysis sessions as well as antithymocyte globulin (ATG) therapy. Urine output resumed on the 10th postoperative day, and the patient was discharged two weeks after surgery. Despite initial challenges, including DGF requiring temporary dialysis, the patient achieved full recovery with stable graft function confirmed at follow-up. One-month follow-up with CT angiography confirmed satisfactory graft perfusion. This case underscores the feasibility of utilizing the IEA as an alternative vascular access in complex kidney transplantation, highlighting the critical importance of preoperative imaging, surgical adaptability, and the ongoing challenges of limited graft availability and long waiting times for transplant candidates., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Prevezanos et al.)

The choice of treatment of two modalities, open surgical or endovascular, in posterior cerebral artery (PCA) intracranial aneurysms must be taken based on their special characteristics. The objective of this study is to assess the potential superiority in outcomes, operative mortality, and clinical improvement after microsurgical and endovascular management repair in PCA intracranial aneurysms. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we created this study, performing a systematic investigation on the PubMed database, with the last search carried out on June 12, 2016. The eligibility limitations were that only full text was used in the English language, and double-checking was applied. Extracted data was organized on a standard table form, including first author, publication year, general number of patients and patients at follow-up, mortality rate (with 30 days from the selecting treatment), improvement (showing postoperatively at the clinical progress (muscle strength, thinking ability, and disorientation, due to ischemic infarctions following parent vessel occlusion) for the patients of both modalities. There were eight articles that matched our study criteria. The total study population included 8,863 patients with an aneurysm, 184 (2.07%) of which had an aneurysm at the different segments of the PCA. The pooled results revealed no statistically significant difference between the two groups, in terms of mortality, but with substantial statistical results concerning clinical improvement. We concluded that the aneurysmal site and size do not influence the treatment outcome. However, clinical improvement was a statistically significant factor, demonstrating the superiority of open surgical management over endovascular treatment (EVT) for PCA aneurysms. The selection of the appropriate procedure for every case must be done based on its special characteristics., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Fotakopoulos et al.)

Background: Cognitive function decline is a problem in aging people living with HIV (PLWHIV). COVID-19 infection is associated with neuropsychiatric manifestations that may persist. The aim of our study was to evaluate cognitive function in PLWHIV before and after COVID-19 infection., Methods: This was a prospective observational study conducted at "Laiko" General Hospital from July 2019 to July 2024. The Montreal Cognitive Assessment (MOCA) scale was used to evaluate cognitive functions., Results: 116 virally suppressed PLWHIV participated (mean age: 47.6 years, 91.4% male); 60 underwent repeated evaluation after the pandemic at a median interval of 3.1 years. The median MOCA score was 24 (22-26), with 35.3% scoring within normal limits. A negative correlation was observed between MOCA scores and age (ρ = -0.283, p = 0.002), but not with a CD4 count at diagnosis (ρ = 0.169, p = 0.071) or initial HIV RNA load (ρ = 0.02, p = 0.984). In the subgroup with repeated testing, MOCA was correlated with the CD4 count (ρ = 0.238, p = 0.069 in the first and ρ = 0.319, p = 0.014 second test). An improvement in performance was observed (median score increase from 24 to 25, p = 0.02)., Conclusions: MOCA can detect early changes in cognitive function in PLWHIV. Further studies are required to determine the role of COVID-19 over time.

Introduction: Lung cancer remains a major health challenge, and accurate diagnosis is crucial for effective treatment. Rapid on-site evaluation (ROSE) has emerged as a valuable tool in lung cancer diagnosis. This study aimed to assess the performance of ROSE in the intraoperative diagnosis of lung cancer and its correlation with the histological findings of frozen sections., Methods: A retrospective review was conducted on 414 cases of intraoperative ROSE performed during lung surgeries between 2017 and 2022. Cytological findings were classified according to the World Health Organization Reporting System for Lung Cytopathology and compared with the subsequent histological diagnoses., Results: ROSE demonstrated a high diagnostic accuracy of 92.2%. The risk of malignancy varied across diagnostic categories, highlighting the value of ROSE in risk stratification. Only 12% of cases with a ROSE diagnosis of malignancy or suspicion of malignancy were discordant with the final histological diagnosis and only as to the specific tumor type., Conclusions: ROSE is a reliable technique for lung cancer diagnosis, not only during EBUS- or CT-guided FNA but also in the setting of lung surgery, offering high accuracy and risk stratification. It contributes to improved patient management by optimizing procedures, reducing complications, and enhancing specimen quality for further analyses. ROSE is a valuable asset in the modern era of personalized medicine, facilitating tailored treatment approaches., (© 2025 S. Karger AG, Basel.)

Objective : The aim of this study was to assess whether aerobic exercise, as opposed to resistance training or a combination of both, is associated with long-term cardiovascular outcomes. Methods : The ATTICA study is a population-based cohort study with a 20-year follow-up (2002-2022); it was conducted in the Attica region, Greece, and included 3042 adult participants (45 ± 11 years, 1518 females). Physical activity engagement in aerobic, resistance, or combined exercise, and 20-year tracking, together with information regarding atherosclerotic cardiovascular disease (ASCVD) incidence were available for 1988 participants (45 ± 12 years old, 987 males, 1001 females). Physical activity levels were evaluated using the validated International Physical Activity Questionnaire, in all follow-up examinations (2001-2002, 2006, 2012, and 2022). Cox proportional hazard models were applied; the results are presented as hazard ratio (HR) and 95% confidence intervals (CIs). Results : Participants engaged in the combined (aerobic and resistance) physical activity group had 0.41-times [95%CI (0.20, 0.82)] lower ASCVD risk compared to inactive participants; participants in the healthy engaging aerobic physical activity (HEPA) group had 0.54-times [95%CI (0.36, 0.80)] lower ASCVD risk; no significant associations were observed regarding the minimally active aerobic group [HR, 0.81, 95%CI (0.57, 1.17)], or the resistance training only group [HR, 1.17, 95%CI (0.25, 1.52)]. Conclusions : These findings carry a strong public health message, underscoring the importance of incorporating aerobic or combined aerobic-resistance training into physical activity guidelines to enhance cardiovascular health and reduce the long-term risk of CVD.

Neuraxial anesthetic techniques have become part of the multimodal analgesia approach for gynecologic surgeries. Specifically, intrathecal morphine is one of the opioids most commonly used for prolonged pain management postoperatively. However, doses above a certain threshold pose a greater risk of adverse effects, especially respiratory complications. This case highlights the challenges faced during the management of an accidental administration of a tenfold dose of morphine in the subarachnoid space for a patient subjected to major gynecologic surgery. Surprisingly, yet to our advantage, the patient exhibited no evidence of the anticipated adverse effects and no further intervention was required. A key indicator that was crucial in identifying the mistake was a diminution in the minimal alveolar concentration (MAC) of the anesthetic agent used., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Antonaki et al.)

Anorexia nervosa (AN) is a severe psychiatric disorder, characterized by restricted eating, fear to gain weight, and a distorted body image. Mu-opioid receptor (MOR) functions as a part of complex opioid system and supports both homeostatic and hedonic control of eating behavior. Thirteen patients with AN and thirteen healthy controls (HC) were included in this study. We measured (1) MOR availability with [ 11 C]carfentanil positron emission tomography (PET), (2) brain glucose uptake (BGU) with 2-deoxy-2[ 18 F]fluoro-D-glucose ([ 18 F]FDG) PET during hyperinsulinemic-euglycemic clamp and (3) blood-oxygen-level-dependent signal with functional magnetic resonance imaging. All subjects underwent a screening visit consisting of physical examination, anthropometric measurements, fasting blood samples, an oral glucose tolerance test, psychiatric assessment, and an inquiry regarding medical history. Body fat mass (%) was measured and M value was calculated. MOR availability from caudate and putamen was higher in patients with AN and those from nucleus accumbens (NAcc) and thalamus showed the higher trend in patients with AN. There was no area where MOR availability was lower in patients with AN. BGU was not different between AN and HC. MOR availability and BGU were negatively correlated in caudate, NAcc and thalamus and showed the trend of negative association in putamen. In conclusion, AN is associated with higher MOR availability in the brain regions implicated in reward processing, while BGU remains unaltered. Therefore, the endogenous opioid system might be one of the key components underlying AN. This better understanding of AN could support the development of new treatments for AN., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Nature Limited.)

Introduction: Tobacco consumption poses severe health risks, particularly for pregnant women, where it exacerbates maternal and fetal morbidity and mortality. This issue is especially critical among minority groups such as the Roma, who face unique socio-economic and cultural challenges that contribute to higher smoking rates. This study investigates the smoking behaviors of pregnant Roma women and the general population, highlighting the role of midwives in smoking cessation., Methods: The study involved 142 pregnant women, split equally between Roma women from specific regions in Greece and their counterparts from the general population in 2023. We conducted data collection through multiple site visits, utilizing a comprehensive questionnaire that covered aspects like tobacco use, exposure to passive smoking, and the role of midwives. We performed statistical analysis using SPSS, focusing on differences between the two groups using chisquared tests and linear regression analyses., Results: We noted significant differences between the groups in age, education level, income, and living conditions (p<0.05). The Roma participants displayed a higher prevalence of smoking during pregnancy (76% vs 54.9%, p=0.018). A higher proportion of the Roma group exhibited moderate to high nicotine dependence compared to the non-Roma group, with 27.8% having moderate and 24.1% having high nicotine dependence (p=0.029). The study also found that Roma women are less likely to have structured healthcare support (17.2% had monitoring from a specific doctor compared to 78.9% of non-Roma, p=0.020) and more likely to engage midwives in discussions about smoking cessation (56.5% vs 48.7%, p=0.024)., Conclusions: The findings emphasize the need for culturally informed healthcare interventions that enhance the training of midwives in smoking cessation techniques. Such approaches are vital for improving health outcomes for pregnant women within marginalized communities like the Roma, where socio-economic and cultural barriers significantly influence health behaviors., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2025 Christopoulou C.P. et al.)

Background and Aim: This study aims to investigate the role of the built environment in terms of urban-rural disparities in cardiovascular disease (CVD) epidemiology, focusing on middle- and long-term CVD risk assessment. Moreover, this study seeks to explore sex-specific differences in urban and rural settings., Methods: The ATTICA Study is a prospective study conducted from 2002 onwards. At baseline, a random sample of 3,042 CVD-free adults (49.8% men) were randomly drawn from the population of the Attica region, in Greece, with 78% dwelling in urban and 22% in rural municipalities. Follow-up examinations were performed in 2006, 2012, and 2022. Of the total participants, 1,988 had complete data for CVD assessment in the 20-year follow-up., Results: The 10-year and 20-year CVD incidence was 11.8%, 28.0% in rural municipalities and 16.8%, 38.7% in urban municipalities, respectively ( p s < 0.05). Unadjusted data analyses revealed significant differences in clinical, laboratory, and lifestyle-related CVD risk factors between urban and rural residents ( p s < 0.05). Additionally, sex-based discrepancies in clinical, anthropometric, circulating, and lifestyle risk factors were observed in stratified analyses of urban and rural settings. Multivariate analyses, including generalized structural equation modeling (GSEM), revealed that the impact of the urban built environment on the long-term (20-year) CVD risk is mediated by lifestyle-related risk factors., Conclusion: Urban inhabitants exhibit a higher long-term CVD incidence compared to their rural counterparts, which was partially explained by their lifestyle behaviors. Targeted strategic city planning efforts promoting healthier lifestyle-related behaviors at the micro-environment level could potentially mitigate built-environment impacts on CVD health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2025 Sigala, Chrysohoou, Barkas, Liberopoulos, Sfikakis, Faka, Tsioufis, Pitsavos and Panagiotakos.)