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We aimed to build a fuzzy logic preanaesthetic risk score tailored to cataract surgery. By fusing systemic comorbidities with key patient attributes in an adaptive rule base, our goal was to generate patient-specific risk estimates that move beyond the coarse granularity of traditional categorical tools. A prospective observational cohort study was conducted at Kanuni Sultan Suleyman Hospital, University of Health Sciences, Istanbul, Turkey. Two hundred fifty-one adults who were scheduled for cataract surgery under either local or general anesthesia were included in the study. Demographic information and comorbidities were gathered prior to surgery. A fuzzy inference system incorporating 5 major (pulmonary, cardiac, renal, liver disease, and diabetes) and 3 minor (age, BMI, and smoking) criteria was developed. Risk levels were generated using 270 expert-defined fuzzy rules. Postoperative transient intraocular pressure (IOP) elevations and other complications were monitored. Among the 251 patients, 70 (27.9%) developed postoperative transient IOP elevations. Fuzzy risk scores correlated strongly with the number of major comorbidities (r = 0.954), confirming internal consistency. However, the model did not significantly differentiate between patients with and without postoperative transient intraocular pressure (IOP) elevations (AUC = 0.439; P > .05). There were no other complications found, but transient IOP elevations was significantly linked to advanced age and long-term smoking. The fuzzy logic model reliably quantified systemic risk burden but lacked predictive power for ophthalmic-specific outcomes driven by ocular factors such as transient IOP elevations. Incorporating domain-specific variables like intraocular pressure and detailed ophthalmologic assessments may improve future performance. The model remains valuable for general preanesthetic risk stratification in surgical populations.

Background: Nasopharyngeal carcinoma (NPC) has a poor prognosis, largely due to immune escape. The programmed cell death protein 1 (PD-1) receptor and its ligand, PD-L1, play critical roles in this immune evasion. Consequently, blocking the PD-1/PD-L1 pathway with immune checkpoint inhibitors has become an established therapeutic strategy.

Methods: We performed a systematic literature search of PubMed, Embase, and the Cochrane Library for studies published up to November 14, 2024, investigating PD-1/PD-L1 inhibitors in recurrent or metastatic NPC. The analyzed outcomes included progression-free survival (PFS), overall survival (OS), 1-year PFS rate, 1-year OS rate, objective response rate, disease control rate, and adverse events (AEs).

Results: Nine studies (comprising 10 datasets with 883 NPC patients) were included, consisting of 2 randomized controlled trials (RCTs) and 7 single-arm studies. The pooled analysis demonstrated a median PFS of 4.21 months (95% confidence interval [CI]: 2.47-5.95; P = .000; I2 = 78.5%) and a median OS of 16.27 months (95% CI: 14.60-17.94; P = .000; I2 = 0%). The pooled 1-year PFS rate was 43% (95% CI: 14%-73%; P = .004; I2 = 99.1%), and the 1-year OS rate was 80% (95% CI: 70%-91%; P = .000; I2 = 82.0%). The objective response rate was 45% (95% CI: 25%-64%; P = .000; I2 = 96.8%), and the disease control rate was 65% (95% CI: 48%-82%; P = .000; I2 = 96.4%). The incidence of any-grade AEs was 90% (95% CI: 74%-99%; P = .000; I2 = 94.1%), while grade ≥3 AEs occurred in 34% of patients (95% CI: 12%-61%; P < .001; I2 = 95.2%). No significant publication bias was identified.

Conclusion: This meta-analysis summarizes the efficacy and safety profile of PD-1/PD-L1 inhibitors in recurrent or metastatic NPC. The findings highlight the need for additional randomized controlled trials to further validate the role of these therapies and provide an updated reference for clinical practice.

Parkinson disease (PD) is a rapidly growing neurodegenerative disorder that presents a significant public health challenge in aging societies, particularly in China. Although genetic, clinical, and environmental risk factors have been well-established, the predictive value of multidimensional factors (encompassing socioeconomic determinants, prodromal functional impairments, and lifestyle) remains underexplored in Chinese populations. We used data from the China Health and Retirement Longitudinal Study (n = 13,649; PD cases = 269) to develop and validate a machine learning prediction model for PD. Candidate predictors covered cognition, socioeconomic status, comorbidities, and lifestyle. Feature selection was performed using an ensemble approach (boruta, least absolute shrinkage and selection operator, and minimum redundancy maximum relevance), followed by extreme gradient boosting (XGBoost) model development with Bayesian hyperparameter optimization. Data were randomly split into a training set (70%) and a validation set (30%) for internal validation. Model performance was evaluated using area under the receiver operating characteristic curve, decision curve analysis, sensitivity, specificity, positive predictive value, negative predictive value, and F1-score. Model interpretability was evaluated using SHapley Additive exPlanations. Key predictors included cognitive impairment (memory and executive deficits), physical inactivity (low metabolic-equivalent scores), socioeconomic indicators (retirement status and financial support), educational attainment, and comorbidities (e.g., liver disease and wrist pain). In the validation set, the optimized XGBoost model achieved an area under the curve of 0.967 (95% confidence interval 0.962-0.972), sensitivity 82.0%, specificity 94.7%, positive predictive value 81.5%, negative predictive value 94.9%, and F1-score 81.7. SHapley Additive exPlanations analyses supported the consistency and relative importance of these predictors. An explainable XGBoost model integrating multidimensional national data showed excellent internal validation performance for identifying individuals with PD in China Health and Retirement Longitudinal Study. This tool may help support PD risk stratification in Chinese populations; external validation and prospective evaluation are warranted before clinical implementation.

Rationale: Blunt traumatic aortic injury (BTAI) is a high-mortality condition often managed by endovascular aortic repair (EVAR) due to its minimally invasive nature and favorable outcomes.

Patient concerns: Six patients with BTAI were admitted to our institution from 2014 to 2023. They presented with symptoms such as chest pain or were diagnosed with aortic injury on chest computerized tomography after motor vehicle collisions.

Diagnosis: All patients underwent computed tomography arteriography to confirm the diagnosis and assess the aortic injury.

Interventions: All patients received EVAR. Among these cases, 5 were classified as grade II and 1 was classified as grade IV. The patient with grade IV injury and intraoperative shock died of respiratory failure postoperatively. The remaining 5 patients had favorable outcomes.

Outcomes: The mean follow-up was 3 years. No recurrent chest pain, spinal cord ischemia, or other aorta-related complications were observed. One patient experienced a pulmonary embolism and another had a cerebral infarction, both managed conservatively.

Lessons: EVAR is effective for BTAI, especially in reducing early mortality and complications. Careful evaluation of comorbidities and associated injuries is crucial, particularly in older patients.

The increasing integration of smartphones into daily life has given rise to partner phubbing - being ignored in favor of a partner phone use - which may impact mental health and family dynamics. Although phubbing has been explored in various relational contexts, empirical evidence on its association with depression and family functioning in primary care populations remains limited. This cross-sectional study was conducted among 222 married individuals aged 18 and above who visited a university-affiliated Family Health Center in Turkey between July and September 2024. Participants completed validated measures including the Phubbing Exposure Scale, Patient Health Questionnaire-2 and -9 (PHQ-2 and PHQ-9), and the Family Adaptability, Partnership, Growth, Affection, Resolve Scale. Statistical analyses included Mann-Whitney U, Kruskal-Wallis, chi-square, and correlation tests, with significance set at P < .05. Phubbing exposure was significantly higher among participants with positive PHQ-2 screenings for depressive symptoms (P < .01) and those with a history of psychiatric medication use (P < .01). Although PHQ-9 scores were not significantly associated with phubbing, early depressive symptoms measured by PHQ-2 were. Women reported higher phubbing exposure than men, and younger participants had higher perceived phubbing levels. Interestingly, individuals with low family functioning reported lower Phubbing Exposure Scale scores compared to those with moderate or high family functioning (P < .01), suggesting possible perceptual or relational dynamics in digitally neglected households. Partner phubbing appears to be linked with early depressive symptoms and various psychosocial characteristics, including gender, age, and psychiatric history. These findings highlight the relevance of digital neglect in clinical assessments and underscore the importance of integrating phubbing awareness into mental health and family care practices. Future research should explore longitudinal effects and develop interventions targeting smartphone-related disruptions in couple dynamics.

Rationale: Orbital metastases are rare, partly because the orbit lacks lymphatic drainage. Metastatic disease initially presenting with isolated ocular symptoms is exceptionally uncommon. We report a case in which ocular manifestations were the first indication of metastatic renal cell carcinoma (RCC).

Patient concerns: An elderly man with no significant prior medical history presented with ocular distension and pain. He reported no systemic symptoms, such as low back pain or hematuria.

Diagnoses: Computed tomography and magnetic resonance imaging revealed a well-circumscribed, round orbital mass with moderate enhancement on contrast-enhanced imaging. Preoperative differential diagnoses included hemangioma and schwannoma. Histopathological examination after surgery confirmed orbital metastasis from RCC. Subsequent abdominal computed tomography identified the primary tumor in the left kidney.

Interventions: Because of the lesion's proximity to the paranasal sinuses, the mass was completely excised through an endoscopic transnasal approach. The right sinus was entered, the lamina papyracea was exposed, and the tumor was removed completely.

Outcomes: The patient was referred to a comprehensive medical center for further systemic management. At the 1-month follow-up, his ocular symptoms had improved significantly.

Lessons: This case highlights the importance of considering metastatic disease in the differential diagnosis of orbital masses, even in the absence of systemic symptoms. The rarity of orbital metastasis from RCC suggests possible organ-specific metastatic pathways and underscores the need for further investigation into tumor heterogeneity and the molecular mechanisms of site-specific metastasis. Awareness of the diagnostic and management strategies for orbital metastases is clinically important.

Background: To provide a comprehensive bibliometric and visualized analysis of global macrodactyly research from 2005 to 2025, identify publication trends, leading contributors, research hotspots, and emerging directions in this rare congenital disorder.

Methods: Publications from January 1,2005 to November 31,2025 were retrieved from the Web of Science Core Collection. English-language articles and reviews were included using the search terms "macrodactyly," "megalodactyly," "digital gigantism," and "giant digit." After removing duplicates, retracted items, and non-relevant records, eligible studies were analyzed. Microsoft Excel, VOSviewer, and CiteSpace were used to evaluate publication trends, geographic distribution, collaboration networks, and keyword co-occurrence patterns.

Results: A total of 162 publications met the inclusion criteria. Annual output increased steadily, with peaks in 2014 and 2020, and a strong upward cumulative trend (R2 = 0.9933). Research was mainly concentrated in the USA, China, and Europe, with limited intercontinental collaboration. Author and institutional analyses revealed several distinct collaboration clusters. Keyword co-occurrence and temporal mapping demonstrated a shift from early clinical and surgical topics toward molecular and genetic research, particularly involving PIK3CA-related mechanisms.

Conclusion: Macrodactyly research has expanded over the past 2 decades, evolving from clinical descriptions to mechanistic studies driven by advances in molecular genetics. The identification of PIK3CA mutations has reshaped the field and introduced opportunities for targeted therapy. Despite increasing output, international collaboration remains limited. Future work should focus on multicenter studies, precision medicine approaches, and the development of evidence-based treatment strategies.

Cold climates have been reported to increase mortality in heart failure patients. Colder regions in Japan often overlap with rural areas where cardiologist availability is limited. However, the relationship between residing in colder regions and mortality from acute heart failure (AHF), while considering the availability of cardiologists, remains unknown. We investigated whether the cold climates were associated with in-hospital mortality after adjusting for patient factors and cardiologist availability. This cross-sectional observational study identified 38,668 AHF patients of 546 acute care hospitals from all Japanese 47 prefectures. Hospital latitude was used as a surrogate for ambient temperature, categorized into colder (>37°N), moderate (34°N-37°N), and warmer (<34°N) climate regions. Hospitals were divided into 4 groups based on the number of cardiologists per facility: none, 1 to 4, 5 to 9, and 10+ cardiologists. Three-level logistic regression analyses were performed to evaluate the associations between latitude and mortality, with 3 models examined (Model 1: null model, Model 2: patient-level factors added, and Model 3: a hospital-level factor added to Model 2) using bootstrapping methods. Model 3 showed higher odds ratio in colder regions (adjusted odds ratio 1.20, 95% confidence intervals 1.06-1.33) and lower odds ratio in warmer regions (adjusted odds ratio 0.88, 95% confidence intervals 0.79-0.98). Colder climates were found to be a risk factor of in-hospital mortality of AHF patients, even after adjusting for patient severity and cardiologist supply. Local climates should be considered when predicting patient outcomes and evaluating hospital performance.

Acute pancreatitis causes malnutrition due to severe systemic inflammatory response and organ failure and is associated with increased susceptibility to severe infections and complications such as peripancreatic fluid collection (PFC). PFC is treated using endoscopic ultrasound-guided transluminal drainage (EUS-TD). Lumen-apposing metal stents (LAMSs) have high drainage efficiency and are useful; however, their impact on improving nutritional status and long-term prognosis is unclear. We aimed to evaluate the clinical outcomes and nutritional status after LAMS versus plastic stent (PS) in patients with PFC. This multicenter retrospective study included 59 patients who underwent EUS-TD (18 LAMS and 41 PS) for PFC between December 2018 and March 2023. Nutritional indices (prognostic nutritional index [PNI] and modified controlling nutritional status [M-CONUT]) were evaluated using blood tests 2, 4, and 8 weeks postoperatively, and compared using analysis of covariance, with pretreatment values as covariates. Endoscopic procedure time (21.0 vs 48.0 min; P <.001) and time to diet initiation (3.0 vs 5.0 days; P = .04) were significantly shorter in the LAMS group. There were no differences in the clinical success rate (88.9 vs 85.4%; P >.99), number of procedures (2.0 vs 2.0; P = .68), time to discharge after the procedure (28.5 vs 36.0 days; P = .19), adverse events (16.7 vs 14.6%; P >.99), or recurrence rate (16.7 vs 17.1%; P >.99). Post-procedure PNI (2 weeks: 4.5 vs -0.1; P = .09, 4 weeks: 7.2 vs 0.7; P = .03, 8 weeks: 11.0 vs 5.1; P = .05) and M-CONUT (2 weeks: -1.7 vs 0.5; P = .03, 4 weeks: -2.2 vs 0.4; P = .03, 8 weeks: -3.5 vs -1.1; P = .03) showed better improvement in the LAMS group. LAMS group show earlier improvement of nutrition status than PS group in this study.

Chronic respiratory diseases (CRDs) are prevalent among Chinese adults aged 45 and older, and the increasing prevalence of multimorbidity in this population presents significant public health challenges. Understanding the comorbidity patterns and their determinants is crucial for targeted interventions. To identify and characterize multimorbidity patterns among Chinese adults aged ≥45 years, delineate the centrality of CRDs within these patterns, and identify biopsychosocial-behavioral determinants for tailored interventions. Data from China Health and Retirement Longitudinal Study (2011-2020) were analyzed using hierarchical clustering and Apriori association rules; multivariable logistic regression was employed to evaluate biopsychosocial-behavioral correlates. From 2011 to 2020, multimorbidity increased from 12.39% to 24.92%. CRDs served as network hubs, asthma and other CRDs frequently co-occurred with hypertension and diabetes. Factors associated with a higher risk of multimorbidity included lower educational attainment, smoking, poor sleep quality, poor mental health, impaired activities of daily living/instrumental activities of daily living and healthcare utilization. CRDs represent critical nodes within growing multimorbidity networks. To address multimorbidity effectively, integrated and personalized strategies, including smoking cessation, sleep enhancement, functional assessment, and optimized healthcare utilization, are essential.