Frontiers in Medicine

Background: In 2026, the US Food and Drug Administration (FDA) identified uveitis as a potential signal of serious risk for the B-cell maturation antigen (BCMA) x CD3 bispecific antibodies teclistamab and elranatamab. Uveitis in this setting may reflect opportunistic infection or immune-mediated inflammation, which require opposite management. Methods: We analyzed FDA Adverse Event Reporting System (FAERS) reports from July 2020 to June 2026 (8,690,601 reports after deduplication) using a case-non-case design, calculating reporting odds ratios (RORs) and the information component for primary-suspect reports. Comparators were belantamab mafodotin, talquetamab and CD3 bispecific antibodies used outside myeloma. Every primary-suspect uveitis report (n = 76) was classified as infectious, probable immune-mediated (hereafter immune-mediated) or indeterminate by a physician blinded to a rule-based algorithm. Results: Uveitis was reported in 18 of 2,995 teclistamab and 29 of 1,691 elranatamab reports (ROR 4.10 [95% CI 2.58-6.52] and 11.85 [8.21-17.12]). Of these 47 cases, 20 were infectious (18 cytomegalovirus chorioretinitis; median onset 92 days), and infection-specified uveitis was disproportionately reported for both agents and for CD3 bispecific antibodies used outside myeloma. Thirteen were immune-mediated, arose early (median onset 4 days) and were co-reported with cytokine release syndrome in six; immune-mediated uveitis showed a signal only for elranatamab (8 cases; ROR 3.59, 1.79-7.18), not for teclistamab or any comparator. Six of the eight elranatamab cases originated from Japan. Agreement between physician and algorithm was 98.7%. Conclusions: The FDA uveitis signal appears to comprise a late infectious uveitis shared by most T-cell-redirecting bispecific antibodies examined and an early immune-mediated uveitis that showed a signal only with elranatamab. These hypothesis-generating findings support prompt ophthalmological assessment of new visual symptoms and exclusion of cytomegalovirus retinitis before corticosteroids are started.

Healthcare workers are occupationally exposed to blood and body fluids and require effective protection against hepatitis B virus infection. Evidence on hepatitis B surface antibody (anti-HBs) seroprotection among healthcare workers in Namibia remains limited. We estimated the prevalence of anti-HBs seroprotection and examined associated factors among healthcare workers tested at Eastgate Clinic in Windhoek, Namibia. We conducted a cross-sectional analysis of routinely collected anti-HBs test records from 1 January to 31 December 2025. The first chronological test per individual was included. Anti-HBs concentrations [≥]10 mIU/mL were classified as seroprotective. Results outside the assay reporting range were treated as censored but remained classifiable for the binary outcome. Prevalence estimates were reported with Wilson 95% confidence intervals (CIs). Modified Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (aPRs). The register contained 304 test records representing 299 unique individuals. After excluding three individuals with missing anti-HBs results, 296 were analysed; 163 (55.1%) were female. Overall, 148 individuals were seroprotected, corresponding to a prevalence of 50.0% (95% CI 44.3-55.7%). Seroprotection was lowest among participants aged 18-29 years (35.3%) and highest among those aged 50-59 years (71.1%). Each 10-year increase in age was associated with a higher prevalence of seroprotection after adjustment for sex (aPR 1.14, 95% CI 1.06-1.24; p=0.001), whereas sex was not independently associated with seroprotection (aPR 0.97, 95% CI 0.78-1.22; p=0.797). The age association remained consistent across sensitivity analyses. Half of the healthcare workers tested had anti-HBs concentrations below the operational seroprotection threshold. These findings support systematic vaccination verification, appropriately timed post-vaccination testing, and documented follow-up of non-protective results. The absence of vaccination history, occupational characteristics, testing indications, and additional hepatitis B serological markers limited causal and clinical interpretation.

Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region of both women and men. Sexual dysfunction remains among the most debilitating and overlooked consequences of the disease, as available patient-reported outcome measures are either restricted to one sex or capture sexual health only partially. The aim of the present work is to validate the Qualisex questionnaire (in its the Italian version) in patients with LS and to evaluate its psychometric properties, factor structure, convergent, discriminant validity, and sex symmetry. Methods: A cross-sectional study was conducted on 211 patients (167 women, 44 men; mean age 52.9 years) with a confirmed diagnosis of LS. Participants completed the Italian Qualisex, Skindex-29, DASS-21, and sexual-health-specific scales, the Female Sexual Function Index (FSFI) for women, and the International Index of Erectile Function (IIEF) for men. Construct validity was assessed via Principal Component Analysis (PCA), and reliability via Cronbach's alpha. Convergent and discriminant validities were evaluated against standard psychometric batteries. Results: Item 2 was removed due to low communality (0.167). PCA on the remaining 9 items revealed a two-factor structure accounting for 72.5% of total variance: Component 1 (Sexual Functioning and Satisfaction, 59.89%) and Component 2 (Partner Devaluation, 12.66%). Internal consistency was high (alpha= 0.911 overall; alpha= 0.841 in women; alpha= 0.899 in men). Qualisex scores correlated strongly with Skindex-29 Social Functioning (r = 0.582) and Emotions (r = 0.531) subscales, as well as FSFI (r = -0.391) and IIEF (alpha= -0.566). Discriminant validity was supported by low-to-moderate correlations with DASS-21 domains (r < 0.38). While FSFI and IIEF showed significant negative correlations with age (p = 0.002), Qualisex remained age-independent across sexes (p > 0.05). Conclusion. The 9-item Italian Qualisex is a reliable, sex-symmetrical, and age-independent patient-reported outcome measure for assessing sexual health impairment in LS, successfully isolating disease-specific distress from physiological aging and general distress.

Background: Depth of anesthesia is routinely monitored using electroencephalographic (EEG) indices such as the Bispectral Index (BIS), which reduce cortical activity to a single numerical real-time series. However, these scalar descriptors fail to capture inter-individual variability, drug-specific EEG signatures, and transitions between brain states. Methods: We analyzed transient EEG patterns during general anesthesia induced by propofol and sevoflurane in 89 patients. Iso-electric suppressions (IES), $\alpha$-suppressions, and spectral power in the $\alpha$ and $\delta$ bands were quantified across controlled concentration plateaus. We compared conventional BIS monitoring with a novel State-Chart representation mapping EEG activity into discrete depth states. Results: Increasing hypnotic concentration produced a consistent shift from $\alpha$-dominant to $\delta$-dominant activity and a reduction in maximal $\alpha$ frequency. IES occurred predominantly at high propofol concentrations and remained infrequent under sevoflurane. Compared with BIS, the State-Chart showed a marked reduction in temporal variability (0.5 $\pm$ 0.6 vs 4.0 $\pm$ 2.9; $p<10^{-90}$). Importantly, our State-Chart separates stable from transition regimes and discriminates identical concentration levels. Statistics computed over prior dosing (ascending vs descending), reveals refined clustering not captured by BIS. Conclusions: Anesthesia depth drugs concentrations vs EEG effects is more accurately described by structured EEG state transitions than by a single numerical index. The State-Chart provides a stable, physiologically interpretable representation of brain activity and reveals transition states preceding deep cortical suppression, supporting individualized and predictive monitoring of anesthesia.

Sepsis is a global health problem. Patients in the Intensive Care Unit (ICU) are at risk of having sepsis because of their vulnerability and use of invasive medical devices. Emerging antimicrobial-resistance complicates treatment. Understanding bacterial profiles and antibiotic sensitivity patterns in the ICU plays an important role in managing sepsis, optimizing antimicrobial use, and improving patient outcomes. The aim of this study was to show bacterial profiles and antibiotic sensitivity patterns among patients who were admitted to the ICU at Mbeya Zonal Referral Hospital for 12 months. This was a prospective cross-sectional study among 187 sepsis-suspected patients. Data analysis was performed using SPSS Version 27. Categorical data were summarized by frequency and percentage. Fishers exact test, chi-square test, and modified Poisson regression were used to show the association between patients clinical variables and culture positivity at a 95% CI. Statistical significance was set at a p-value < 0.05. Out of 187 samples, 41.7% were culture positive. Gram-negative bacteria were commonly isolated (65.4%, with Klebsiella pneumoniae and Escherichia coli being commonly isolated. Commonly isolated Gram-positive bacteria were Coagulase-negative Staphylococcus species (19%). 100% of gram-positive bacteria and 96% of gram-negative bacteria were Multi-Drug Resistant (MDR), respectively. In multivariable analysis, patients who were intubated and mechanically ventilated (aPR = 2.208, 95% CI: 1.133-4.305, p = 0.020) and post-laparotomy patients (aPR = 3.241,95% CI: 1.320-7.958, p = 0.010) independently had a higher proportion of Gram-negative bacteria. The study reveals a high level of resistance to commonly used antimicrobials in our setting, necessitating strengthening of the antimicrobial stewardship program and routine surveillance of antimicrobial resistance patterns.

Objective: To test the hypothesis that selected SIRS and SOFA criteria measured at ICU admission have divergent associations with (1) the development of new culture-confirmed infections and (2) early empiric broad-spectrum antibiotic receipt in critically ill patients with cirrhosis. Design: Retrospective, observational study using electronic health record (EHR) data. Setting: Both community and academic ICUs within a five-hospital health system between July 2017 and December 2025. Subjects: Adult patients >18 years of age diagnosed with cirrhosis admitted to the ICU within 96 hours of hospital admission. Patients transferred from outside facilities and those with positive cultures collected >24 hours before ICU admission were excluded. Interventions: None. Measurements: Multivariable logistic regression tested the association of the most aberrant values in nine SIRS/SOFA vital sign and laboratory parameters measured during the 24 hours prior to ICU admission with (1) the development a newly positive culture collected during the 24 hours before through the 96 hours after ICU admission and (2) receipt of broad-spectrum antibiotics during the 24 hours before through the 24 hours after ICU admission. Main Results: The presence of hyperthermia, hypothermia, hypoxia, or hypotension at ICU admission was associated with both culture positivity and antibiotic receipt. The presence of leukocytosis was associated with antibiotic receipt but not culture positivity. Among patients in the 21.6% of encounters with newly positive cultures, normothermia and normal WBC were common (respectively present in 97.2% and 77.5% of encounters) and associated with antibiotic omission at ICU admission despite the subsequent development culture positivity. Conclusions: Traditional physiologic markers of infection are often absent in critically ill patients with cirrhosis who develop new culture-confirmed infections at ICU admission, possibly contributing to delayed antibiotics. There may be opportunities to improve antibiotic delivery and stewardship at ICU admission in this high-risk population.

Sepsis mimics resemble sepsis clinically but may require different treatments. We evaluated whether inflammatory protein profiles could distinguish these conditions in a retrospective case-control study using 4 prospective Japanese cohorts. The study included 34 adults with sepsis and 46 with sepsis mimics. We measured 92 proteins using Olink, assessed between-group differences with false discovery rate (FDR) adjustment, and evaluated 3 prediction models using repeated nested cross-validation. No protein met the FDR threshold; the lowest FDR-adjusted P value was 0.345. The primary elastic-net model had an area under the receiver operating characteristic curve of 0.442 (95% confidence interval, 0.315-0.574), based on cross-validation predictions averaged for each participant. Random forest and gradient boosting also showed no clear evidence of discrimination above chance. Confidence intervals included chance performance in both the all-serum and quality-control-Pass sensitivity analyses. In this cohort, a single measurement of an inflammation-focused protein panel showed limited discrimination between sepsis and sepsis mimics. Integration with clinical information and longitudinal measurements warrants further investigation.

Abstract Background: In patients with sepsis and pre-existing hypertension, admission findings may not adequately describe the subsequent course of circulatory support and organ dysfunction. We developed and externally validated a model to reassess in-hospital mortality risk after the first 72 hours of intensive care. Methods: This retrospective study used MIMIC-IV for development and eICU-CRD for external validation. Patients had received vasoactive agents and remained in the ICU for at least 72 hours. Static variables were combined with features from six consecutive 12-hour windows. Imputation, feature selection, model fitting, and calibration were performed within training folds during five-fold cross-validation. The final XGBoost model was applied externally without refitting. Evaluation included discrimination, calibration, decision curves, and risk stratification, with an exploratory comparison of static-only and static-plus-dynamic feature sets. Results: The development and external cohorts included 1019 and 1747 patients, with 338 (33.2%) and 516 (29.5%) deaths, respectively. Internal area under the receiver operating characteristic curve (AUC) was 0.752 (95% CI 0.720-0.784). External AUC was 0.713 (95% CI 0.687-0.739), average precision was 0.536, the Brier score was 0.185, and the calibration slope was 0.744. Mortality increased across external risk tertiles from 13.7% to 47.3%. In an exploratory feature-set comparison, the static-plus-dynamic feature set showed a 0.071 higher internal AUC than the static feature set (95% CI 0.042-0.109). Conclusions: Information accumulated during the first 72 hours supported subsequent mortality risk stratification in this selected population. The model retained moderate discrimination externally, supporting further evaluation as an adjunct to clinical reassessment. Local calibration and the clinical consequences of acting on model predictions require evaluation before routine use.

BACKGROUND: Zinc inhibits energy production, growth, and proliferation in normal prostate cells while suppressing the malignant potential and angiogenesis that are essential to prostate cancer aggressiveness. The study aimed to determine the correlation of serum zinc with Gleason score as a marker for prostate cancer aggressiveness METHODOLOGY: We conducted a hospital-based cross-sectional analytical study carried out on forty-two (42) eligible participants with newly diagnosed histologically confirmed prostate adenocarcinoma over one year. Spearman's rank correlation was used to assess the relationship between serum zinc and prostate cancer aggressiveness as measured by the Gleason score. The impact of serum zinc level on the aggressiveness of severe prostate cancer was assessed using a binary regression model, adjusting for age as a confounder in the logistic regression model. A statistically significant P value was set at 0.05. RESULTS: The mean age of participants was 67.12 years, with a range of 45- 90 years. High-grade disease (Gleason 8) was the most common, representing 57.1% of patients. The median serum zinc concentration was 71.5 microgram/dL (IQ: 47.6 to 88.5 microgram/dL). Serum zinc and Gleason score showed a statistically significant inverse correlation (Spearman r = -0.514, p < 0.001). Reduced zinc levels were significantly associated with higher Gleason scores (MannWhitney; 140.0, p = 0.002). Low serum zinc independently predicted high-grade disease after adjusting for age. CONCLUSION: This study found a statistically significant inverse correlation between serum zinc concentrations and Gleason score in men with prostate cancer. This finding indicates that reduced serum zinc levels are associated with higher Gleason scores

Introduction: In vivo, temporal, and personalized data on immunological-antibiotic interactions may provide richer, earlier information that improves infection treatment. To test this hypothesis, we applied a proof-of-concept approach to evaluate a non-reductionist methodology. Methods: A non-reductionist, data-driven, pattern recognition-based combinatorial method that captures relationships was evaluated with blood leukocyte data collected from 401 individuals from Greece [n=331] and the US [n=70] who experienced sepsis, pneumonia, endocarditis, tuberculosis, syphilis, skin and soft tissue, intra-abdominal, or urinary tract infections associated with meningitis. Results: While ambiguity was observed when variables were measured in isolation by a reductionist alternative, ambiguity was prevented and hidden information was uncovered when complex dynamics were assessed by the non-reductionist method. The combinatorial approach grouped together observations that displayed similar immune profiles, distinguished those with different mortality risks, identified antibiotics that modulated specific leukocytes, differentiated two types of non-responsiveness (associated or not associated with antibiotics), and facilitated earlier and personalized evaluation of therapies. For instance, in tuberculosis, blood monocytes were modulated by isoniazid-related antimicrobials. Discussion: Across numerous syndromes, the non-reductionist method extracted more information from the same data than the reductionist alternative. If corroborated, non-reductionist methodologies may promote research and support personalized medicine.

Background: Indwelling urinary catheters can cause pain, urethral irritation and trauma and provide surfaces for microbial colonisation and biofilm formation. The LubriShield(R) Foley catheter incorporates a covalently bonded, superhydrophilic antifouling hydrogel designed to reduce surface friction and limit biofilm accumulation without releasing an antimicrobial agent. This study evaluated its safety and clinical performance compared with an uncoated silicone Foley catheter, including usability and patient comfort, and explored catheter-associated microbial colonisation and biofilm formation. Methods: This prospective, randomised, single-blind, single-centre controlled clinical investigation enrolled 33 adults requiring indwelling urinary catheterisation for 72 hours to 14 days. Participants received either the LubriShield(R) Foley catheter (n = 16) or an uncoated Sterimed all-silicone Foley catheter (n = 17). The primary endpoint was safety based on adverse-event reporting; the prespecified safety criterion was the absence of a serious adverse device effect in the LubriShield(R) group. Secondary endpoints included investigator-rated ease and functionality of catheter insertion and removal and participant-reported pain and irritation/discomfort assessed using 0-10 numerical rating scales. Urine microbiology, catheter colonisation and catheter-level biofilm measurements were exploratory endpoints. Analyses were performed in the as-treated population. Numerical rating scale outcomes were compared using two-sided Mann-Whitney U tests; exploratory biofilm analyses used permutation tests with bootstrap confidence intervals. Results: No serious adverse events or serious adverse device effects occurred. Nine non-serious adverse events were reported and resolved completely. At least one adverse event occurred in 4/16 (25.0%) participants in the LubriShield(R) group and 4/17 (23.5%) participants in the control group. The prespecified safety criterion, defined as the absence of a SADE in the LubriShield(R) group, was met. LubriShield(R) was rated more favourably for ease of insertion (p = 0.0096), functionality during insertion (p = 0.0051), ease of removal (p = 0.0037) and functionality during removal (p = 0.0085). Participants reported significantly less pain and irritation/discomfort during insertion, while the catheter was indwelling and during removal (all p < 0.05). Outcomes 7 {+/-} 1 days after catheter removal were similar between groups. Absolute biofilm biomass and bacterial and fungal loads did not differ significantly. In a post hoc exploratory normalised analysis, the biofilm-to-bacterial-load ratio was lower with LubriShield(R) (median 0.052 vs 0.080; permutation p = 0.043), although the bootstrap 95% confidence interval for the between-group difference included zero. Conclusions: The LubriShield(R) Foley catheter demonstrated a favourable short-term safety profile and was associated with improved investigator-rated usability and participant-reported comfort compared with an uncoated silicone Foley catheter. A post hoc exploratory analysis was compatible with reduced biofilm accumulation relative to bacterial load, but this finding is hypothesis-generating only and requires confirmation in larger, adequately powered studies with prespecified biofilm endpoints.

Background: Robot-assisted radical prostatectomy is the standard minimally invasive treatment for localized prostate cancer. Conventional multiport robotic surgery is widely applied yet associated with more abdominal trauma and postoperative discomfort. Single-port robotic surgery can further minimize surgical injury. The domestic KangDuo robotic system has been gradually used in urological oncology, but high-level prospective evidence comparing single-port and multiport extraperitoneal radical prostatectomy remains scarce. This trial aims to compare the efficacy and safety of these two surgical approaches. Methods: This is a single-center, prospective, 1:1 randomized, non-inferiority trial. Eligible patients diagnosed with cT1c-cT2cN0M0 localized prostate cancer will be randomized to receive either single-port (experimental group) or multiport (control group) extraperitoneal robotic radical prostatectomy using the KangDuo system. All participants will receive standardized enhanced recovery after surgery (ERAS) protocols. The primary endpoint is postoperative positive surgical margin rate. Perioperative parameters, postoperative recovery, medium-term functional recovery and oncological outcomes will be assessed comprehensively. Expected results: We hypothesize that the single-port approach is non-inferior to the multiport approach in terms of oncological radical effect. The single-port technique is expected to provide better minimally invasive benefits, with comparable perioperative safety, urinary/sexual function recovery and mid-term oncological outcomes between groups. Conclusions: This randomized trial will provide high-quality clinical evidence for the application of domestic single-port robotic surgery. The findings will facilitate individualized surgical selection for patients with localized prostate cancer. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2600125669 (http://www.chictr.org.cn/showproj.aspx?proj=2600125669).

Objectives To assess the effectiveness of our proposed urinary segmentation method based upon image processing, and to contrast its performance against various approaches. Subjects and Methods Non-contrast-enhanced computed tomography (NCCT) scans of instances with stone disease were collected. An experienced urologist and a senior radiology resident generated ground truths by manually drawing the regions of interest (ROIs) of stone samples. The proposed method took loosely defined ROIs as input and included three steps: (1) finding mean_HU_rim, the mean Hounsfield unit (HU) of the stone rim, on each NCCT slice by an edge detection operator; (2) considering pixels with HU higher than the minimum value of all the mean_HU_rim; and (3) removing noise. The entire data was divided into a developing set of 406 samples to evaluate the performance of the proposed method as well as to fine-tune a nnUNetv2 model and a comparison test set of 125 samples to compare the performance and inference time of various segmentation methods. In addition, the reproducibility of our method was tested on the 30 samples randomly selected from the entire data. Results A total of 531 stone samples from 287 instances were included. Our method showed a high level of agreement with the ground truth in the developing set, with the median (interquartile range) Dice coefficient of 0.86 (0.81 - 0.89). The reproducibility of our method was remarkably high with the median (interquartile range) Dice coefficient of 1.0 (0.991 - 1.0). On the comparison test set, our semi-automatic segmentation outperformed the fixed thresholding and deep-learning-based methods. Lastly, the inference time of the proposed method was less than a second. Conclusion The proposed semi-automatic approach provided a consistently reliable, simple, and robust method to segment urinary stones.

PURPOSE: Women with metastatic breast cancer (MBC) are at risk of developing financial toxicity due to prolonged treatment. Resilience has been identified as a key protective factor associated with better quality of life among cancer populations. However, it is unknown if resilience is associated with financial toxicity. We sought to examine the relationship between resilience and financial toxicity among women with MBC and explore whether socioeconomic factors moderate this association. PATIENTS AND METHODS: Our sample included 209 women with MBC who completed self-reported questionnaires of the Resilience Scale Specific to Cancer (RS-SC) and the Comprehensive Score for Financial Toxicity (COST). Participants (n=2) with missing data were excluded from analysis. We conducted multiple linear regression to examine the association of resilience with financial toxicity. Interaction terms were used to test moderating effects of age (18-39, 40-64 and > =65 years), race, education, health insurance, household income and employment status. RESULTS: Of the sample, 56.5% were aged 40-64 years, 76.6% were White, and 79.9% had a college or master degree or above. Women reported moderately high resilience with mean RS-SC score of 34.49 (SD = 6.67), and moderate financial toxicity (mean COST score =21.01 [SD = 10.51]). Adjusting for covariates, higher resilience was linked to better financial well-being (b = 0.37, SE= 0.11, 95% CI [0.14, 0.59], P < 0.01). Age, education and health insurance moderated this relationship, with resilience more strongly associated with better financial well-being among those aged 40-64 years, with college/master degree or above and private insurance. Race, household income, and employment status did not moderate the association between resilience and financial toxicity. CONCLUSION: Women with MBC who reported higher resilience are more likely to experience better financial well-being, but the strength of this association varied by socioeconomic factors. Further research is needed to confirm these findings. Our results have important implications for incorporating resilience into financial toxicity interventions and tailoring such interventions based on individual socioeconomic characteristics.

Background: Emergency conversion from labor epidural analgesia to Category I cesarean section leaves little time for epidural top-up to produce a surgical block. We examined whether low-dose intravenous esketamine could provide short-term bridging analgesia and sedation while maintaining maternal hemodynamics, oxygenation, and early neonatal safety. Methods: In this randomized study, parturients requiring Category I cesarean section after labor epidural analgesia received either esketamine 0.15 mg/kg or normal saline 1 min before skin incision, together with epidural alkalinized lidocaine. The primary outcome was the longitudinal change in maternal systolic blood pressure during the 20-min observation window. Secondary outcomes included heart rate, SpO2, intraoperative pain, surgeon satisfaction with muscle relaxation, Ramsay sedation score, and neonatal Apgar scores. We analyzed repeated continuous outcomes with linear mixed-effects models and repeated binary outcomes with generalized estimating equations. The single post-administration Ramsay outcome was analyzed using logistic regression. Apgar scores were summarized descriptively using medians, interquartile ranges, and counts.Results: We analyzed 55 parturients, 31 in the esketamine group and 24 in the normal saline group. Esketamine did not meaningfully alter the systolic blood pressure trajectory. Heart rate and SpO2 showed broadly similar patterns between groups, with no signal of esketamine-related respiratory deterioration. The esketamine group had lower odds of intraoperative pain at 5, 15, and 20 min and a higher probability of target Ramsay sedation. Surgeon satisfaction with muscle relaxation showed no clear between-group difference. Apgar scores remained high in both groups. Conclusion: Low-dose intravenous esketamine 0.15 mg/kg may be a practical bridging adjunct during emergency conversion from labor epidural analgesia to Category I cesarean section. It improved early pain control and target sedation without a clear adverse signal in systolic blood pressure, heart rate, oxygenation, or early Apgar scores. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2600121948; retrospectively registered.

Objectives: To describe associations between peripheral arterial disease (PAD) and bladder health (BH) and lower urinary tract symptoms (LUTS) among a subset of women in the Coronary Artery Risk Development In Young Adults (CARDIA) study. Methods: Women from CARDIA at Birmingham, AL and Minneapolis, MN were eligible if they completed a questionnaire about bladder symptoms in 2022-23, an ancillary study post-year 35 called CARDIA-PLUS, including the global BH scale (possible range, 0-100) and the LURN-SI 10 (0-38) and the AUASI (0-35). A subset (n=216) completed an in-person examination, including the ankle brachial index (ABI) procedure (n=194). ABI scores were clinically categorized as normal (1.00-1.40), borderline abnormal (0.91-0.99), and abnormal (</=;0.90; evidence of PAD). Continuous BH and LUTS variables were regressed on ABI category, adjusting for sociodemographics, obstetric/gynecologic variables, co-morbidities, and physical activity. Key Results: Among women who completed BH/LUTS questionnaires and the ABI (n=192), the mean age was 63+/-4 years and racial composition was 47% Black and 53% White. ABI results were normal (74%), borderline abnormal (20%), and abnormal (6%). After adjusting for covariates, women with abnormal ABI scores had higher LURN-SI scores (4.1 points, 95% CI 0.7, 7.5) and did not have higher AUASI scores (1.4 points, 95% CI -3.1, 5.7) or lower BH scores (-9.6 points, 95% CI -24.0, 4.9) compared to women with normal ABI scores. Borderline abnormal ABI was not associated with BH or LUTS. Discussion/Conclusion: In this cohort, PAD was associated with greater LUTS severity. PAD and LUTS may share common etiologies and risk factors that need additional research.

Purpose: Post-marketing reports have associated faricimab, the first intravitreal bispecific antibody, with intraocular inflammation (IOI). Its inflammatory phenotype, temporal pattern and systemic safety relative to established anti-VEGF agents remain unclear. We compared faricimab, aflibercept and ranibizumab across three independent pharmacovigilance databases. Methods: We analysed FAERS reports from Q1 2022 to Q2 2026, with external validation in JADER (PMDA, Japan) and EudraVigilance. Reports were de-duplicated, restricted to primary-suspect reports, and a pre-specified list of 36 non-adverse-event preferred terms (PTs) was excluded. We computed reporting odds ratios (ROR), proportional reporting ratios and Bayesian information components, with Benjamini-Hochberg false discovery rate control. Head-to-head RORs were adjusted for demographic confounders by logistic regression. Time to onset (TTO) was modelled with Weibull distributions. Sensitivity analyses addressed masking and differential market duration. Signals were graded with a pre-specified bidirectional cross-database evidence framework (Confirmed, Consistent, Unconfirmed, Discordant). Results: Faricimab was reported more often for anterior-chamber and vitreal inflammation. Adjusted RORs (comparator versus faricimab, values <1 indicating faricimab excess) were 0.27 (95% CI 0.18-0.40) for iridocyclitis and 0.45 (0.35-0.58) for uveitis versus aflibercept, and 0.13 (0.06-0.24) and 0.12 (0.06-0.20) versus ranibizumab. All four PTs were Confirmed in JADER against both comparators; for iridocyclitis, RORs were 0.048 versus aflibercept and 0.109 versus ranibizumab. Faricimab IOI arose late (median TTO 100 days, IQR 31-182, versus 7 days for both comparators; P = 2.6E-14) and its Weibull onset distribution was markedly flatter (shape 0.81 versus {approx}0.42). In contrast, aflibercept predominated for endophthalmitis-spectrum events and intraocular pressure elevation, and ranibizumab for vitreous haemorrhage, the latter confirmed in JADER. Faricimab showed lower reporting across cardiac, nervous system, vascular and renal system organ classes, confirmed in EudraVigilance. An unadjusted FAERS death signal (ROR 3.16, aflibercept versus faricimab) attenuated after adjustment (aROR {approx}1.8) and was absent in outcome-based JADER analyses. Conclusions: Faricimab exhibits a reproducible, delayed-onset, anterior-predominant IOI phenotype alongside a comparatively favourable systemic safety profile. Clinicians should be aware that faricimab-associated IOI may arise weeks to months after injection. Prospective studies with exposure denominators are needed to quantify absolute risk.

Importance: Clinicians often look for a dental source in Staphylococcus aureus bacteremia (SAB), but how often dental disease is found, compared with other bacteremias, is unclear. Objective: To compare documented dental disease in adults with SAB, Escherichia coli bacteremia, and a general population cohort. Design, Setting, and Participants: Retrospective cohort study in the Protege database of 48 975 adults with bacteremia from January 1, 2015, through December 31, 2023, assigned by earliest in-window organism, and 81 945 general population adults. Exposures: SAB, with E coli bacteremia as the primary comparator and the general population as the secondary comparator. Main Outcomes and Measures: Documented dental disease from 7 days before through 30 days after index, defined by a qualifying dental procedure or disease-specific note text and adjusted for age, sex, race, and documentation intensity. Results: Dental disease occurred in 528 of 16 435 patients with SAB (3.21%) and 179 of 24 942 patients with E coli bacteremia (0.72%). The adjusted odds ratio was 3.86 (95% CI, 3.23 to 4.63). By the pathology-only definition, disease occurred in 517 patients with SAB (3.15%) and 399 general population patients (0.49%). The adjusted odds ratio was 3.71 (95% CI, 3.08 to 4.46). Within SAB, rates were highest with prior infective endocarditis (9.8%), opioid use disorder (6.2%), injection drug use (5.3%), and prosthetic valve (5.0%). Prevalence ranged from 0.49% in the general population to 7.98% in other streptococcal bacteremia. Of 437 patients with SAB and an assignable first finding date, 333 (76.2%) had the finding after the index date. Conclusions and Relevance: Dental disease was documented more often in SAB than in E coli bacteremia after adjustment. Most findings were first recorded after bacteremia was recognized, during SAB evaluation. These data do not show that dental disease caused the bacteremia.

INTRODUCTION Large language models (LLMs) have demonstrated substantial performance on medical licensing and board examinations, but their application to anesthesiology remains less well studied. Prior evaluations have not compared current-generation models from different developers or assessed performance on figure-dependent questions that earlier models lacked the capability to interpret. This study evaluates the performance of two current-generation LLMs on a comprehensive anesthesiology in-training examination (ITE) review question bank, including figure-dependent items. METHODS A total of 1,001 single-best-answer questions from an anesthesiology ITE review text, spanning 11 content chapters, were administered to Claude Opus 5 and GPT-5.6. No questions were excluded. Each item was presented once in a fresh, stateless context with no tool access, retrieval, answer key, or explanation provided in the prompt. Performance was analyzed by question format, and all 27 figure-dependent items were administered with their published figures supplied. Accuracy between models was compared using McNemar's test. RESULTS Claude Opus 5 answered 947/1,001 items correctly (94.6%; 95% CI, 93.0-95.8), and GPT-5.6 answered 946/1,001 correctly (94.5%; 95% CI, 92.9-95.8); the difference was not significant (McNemar p=1.00). Accuracy was similar across most question formats. On standard questions, accuracy was 94.3% and 94.6% for Claude Opus 5 and GPT-5.6, respectively; on the 18 figure-based questions with figures supplied, accuracy was 94.4% and 83.3%, respectively; and both models achieved 100% accuracy on image-option items. Withholding figures from the same 18 figure-based questions reduced pooled accuracy from 88.9% to 52.8% (exact McNemar p=0.03 and p=0.04 for Claude Opus 5 and GPT-5.6, respectively). The models agreed on 957/1,001 items (95.6%). Of the 33 items both models answered incorrectly, they selected the same incorrect option on 32 (97%). DISCUSSION Current-generation LLMs achieved approximately 95% accuracy, substantially improving on our prior results with earlier-generation models and placing both models within the highest band of the ITE normative framework, corresponding approximately to the 99th percentile across training levels. By comparison, our prior work with previous models placed ChatGPT-3.5 at the 52nd, 3rd, and 1st percentiles and ChatGPT-4.0 at the 99th, 95th, and 84th percentiles across increasing levels of training. Multimodal capability now permits successful interpretation of many figure-dependent questions, although performance declines markedly when required visual information is unavailable, and highly concordant errors remain. These findings support an increasingly promising role for LLMs as accessible, on-demand educational adjuncts for anesthesiology trainees, provided complete source material is supplied and outputs are critically reviewed.

Abstract Background: Cyprus has transitioned into a high-alert zone for mosquito-borne viruses. This necessitates a proactive assessment of its future physicians. Following the 2022 re-establishment of Aedes aegypti in Larnaca and Aedes albopictus in Limassol, Cyprus, the island is now biologically primed for local outbreaks of dengue, Zika, and chikungunya, alongside Culex-borne West Nile virus. The study assessed medical students' knowledge and risk perception. Methods: A cross-sectional online survey administered the validated MosquitoWise Health Belief Model instrument to undergraduate-entry and graduate-entry students at a university in Cyprus in mid-2026. Results: Of 1023 students, 119 responded (11.6%), with pre-clinical students overrepresented (p<0.001). Mean knowledge was 5.43/9, stronger on mosquito biology (72.5%) than virus knowledge (54.2%). Median severity was 6.00/7 against susceptibility 4.25/7. Knowledge differed by study stage (p<0.001), correlated with severity (rs = 0.399) but not susceptibility. Conclusions: The study establishes a critical baseline for pre-clinical medical students in Cyprus. Overall, participants performed better on mosquito biology when compared to mosquito-borne viruses and how they spread. Our findings highlight the value of integrating theoretical microbiology with clinical practice in medical education to enhance physicians' preparedness for the changing landscape of newly emerging infections in Cyprus and across Europe as a whole. Key Words: Arboviruses, Cross-Sectional Studies, Cyprus, Health Belief Model, Medical Students, Risk Perception.