Pulmonary infarction (PI) is a recognised complication of acute pulmonary embolism (PE). While computed tomography pulmonary angiography (CTPA) provides high-resolution morphological imaging, it does not permit direct functional assessment of regional lung perfusion. Spectral CT pulmonary angiography (SCTPA) enables quantitative perfusion analysis using iodine maps. However, the relationship between peripheral perfusion impairment, subsegmental emboli (SSE), and PI remains incompletely understood. This study investigated their association using SCTPA.

This retrospective single-centre study included 62 patients: 31 with SCTPA-confirmed acute PE and at least one PI, and 31 controls without PE or PI. Peripheral iodine concentration (pIC) was quantified in standardised subpleural regions of interest in each lung segment. Embolic burden was assessed using the Mastora score. SSE were identified on SCTPA and analysed on a segmental basis.

A total of 440 embolic occlusions were identified. In this selected cohort, PI occurred exclusively in segments affected by SSE and was not observed in segments without SSE. In mixed-effects modelling, SSE were independently associated with reduced pIC (β = -0.706, p < 0.001), while segmental emboli were also independently associated with lower pIC (β = -0.137, p < 0.001); lobar and central emboli showed no significant independent associations. The Mastora score showed a moderate correlation with the number of manifest PI (ρ = 0.566, p = 0.011).

In this cohort, SSE were closely associated with PI and reduced peripheral iodine concentration. Quantitative pIC reflects regional hypoperfusion and provides functional information on lung perfusion in acute PE.

Question: Can spectral CT-derived peripheral iodine concentration characterise regional perfusion impairment associated with subsegmental emboli and pulmonary infarction in acute pulmonary embolism?

In this selected cohort, pulmonary infarction occurred only in segments with subsegmental emboli, which showed reduced peripheral iodine concentration (pIC) on spectral CT iodine maps.

Spectral CT-derived peripheral iodine concentration may provide functional information on regional hypoperfusion in acute pulmonary embolism and improve understanding of infarction-related perfusion impairment.

To estimate the prevalence of common retinal diseases in Türkiye during 2017-2023 and to characterize age and gender-specific differences.

This retrospective, single-center, hospital-based study included 475,865 adults presenting to an ophthalmology outpatient clinic. The study period was divided into pre-pandemic (January 2017-March 2020), acute pandemic (March-June 2020), and post-pandemic (June 2020-July 2023) phases. Patient age, gender, diagnoses, and major complications were recorded. The primary outcomes were defined as changes in the prevalence of common retinal diseases and their complications before and after the pandemic.

Among 475,865 adults, 10,131 (2.13%) were diagnosed with a retinal disease. Age-related macular degeneration was the most prevalent disease, with prevalence increasing from 0.99% in the pre-pandemic period to 1.23% in the post-pandemic period (P < .001). Diabetic retinopathy was the second most common and remained stable across the pandemic periods (0.95% and 0.97%; P = .395). Diabetic macular edema (DME) exhibited a notable increase, particularly among patients aged ≥ 50 years (from 16.68 to 26.72%; P < .001). Retinal vein occlusion (RVO) ranked third, with prevalence rising from 0.17% before the pandemic to 0.25% after (P < .001). The proportion of patients with DME secondary to RVO requiring injection increased from 38.2% in the pre-pandemic period to 43.8% in the post-pandemic period.

This large-scale longitudinal study demonstrated significant changes in the epidemiology of several retinal diseases across the pre- and post-pandemic periods in Türkiye. However, the mechanisms underlying these changes remain uncertain and need to be clarified through future multicenter population-based studies.

In amyotrophic lateral sclerosis (ALS), the effort-dependent respiratory metrics used to determine the timing of non-invasive ventilation (NIV) lose reliability as bulbar and/or cognitive impairment progresses. We tested whether the effort-independent phrenic nerve compound muscle action potential (CMAP) amplitude predicts the timing of NIV independently of forced vital capacity (FVC) and the revised ALS Functional Rating Scale (ALSFRS-R).

Pre-registered analysis of a single-centre ALS cohort (n = 1,486) contributing 2968 serial phrenic nerve conduction studies. Amplitude was expressed as percentage of an age- and sex-predicted value (per 10% decrease), and time to NIV initiation was the primary outcome (death competing). We used cause-specific Cox models, time-dependent and bootstrap-validated discrimination, and a Bayesian joint longitudinal-survival model.

Lower amplitude predicted earlier NIV (adjusted hazard ratio [HR] 1.22 per 10% decrease, 95% CI 1.16-1.27; likelihood-ratio χ² = 77.6, p ≈ 10⁻1⁸). The association was concentrated in the first year (HR 1.31, 1.24-1.38) and attenuated thereafter. The optimism-corrected discrimination increment over the clinical model was +0.055 (0.034-0.073); below-normal amplitude approximately doubled 12-month NIV risk (62% vs 29%). In the joint model the current amplitude (HR 1.57, 1.46-1.69) and its rate of decline (HR 1.30, 1.20-1.44) were independently prognostic.

Phrenic nerve conduction studies, an effort-independent neurophysiological marker carried robust, near-term, incremental prognostic information for NIV beyond FVC and ALSFRS-R, establishing diaphragmatic motor amplitude as a candidate biomarker for objective respiratory prognostication in ALS. External validation and recalibration are required before clinical use.

Lung collapse and ventilation heterogeneity are common in mechanically ventilated critically ill patients. Electrical impedance tomography (EIT) enables real-time bedside monitoring of regional ventilation and may facilitate individualized respiratory management. This study evaluated the effect of EIT-guided respiratory muscle training (RMT) combined with postural adjustment on lung recruitment in patients with respiratory failure. In this single-center, prospective, randomized controlled trial, 150 patients were randomly assigned to three groups: the EIT collaborative group (EIT-guided RMT+postural adjustment), the EIT posture group (EIT-guided positioning only), and the conventional collaborative group (RMT+postural adjustment without EIT). The primary endpoint was the change in end-expiratory lung impedance (EELI). Secondary outcomes included oxygenation, respiratory mechanics, ventilation homogeneity, and clinical outcomes. Data were analyzed using ANOVA and linear mixed-effects models. The interventions were applied for up to 5 consecutive days after randomization or until ICU discharge, whichever occurred first. After 5 days, EELI increased by 18.4±7.6 % in the EIT collaborative group, which was significantly greater than the increases observed in the EIT posture group (9.1±6.2 %) and the conventional collaborative group (3.7±5.8 %) (P<0.001). CL % decreased markedly without a significant increase in OD %, while CoV and GI index indicated improved ventilation uniformity. The EIT collaborative group also showed favorable trends toward improved oxygenation and respiratory mechanics, along with shorter ventilation duration and higher extubation success rates. A significant interaction between EIT supervision intensity and intervention level was confirmed (F=6.45, P=0.011). No serious adverse events occurred. These findings suggest that EIT-guided RMT combined with postural adjustment may enhance lung recruitment and ventilation homogeneity, with potential benefits for respiratory mechanics and selected short-term clinical outcomes. Real-time EIT feedback may provide a safe, individualized strategy for respiratory rehabilitation in critically ill patients.

To develop and validate the Italian version of the Quebec Sleep Questionnaire (I-QSQ) for assessing quality of life (QoL) in patients with obstructive sleep apnoea (OSA).

The questionnaire was translated, culturally adapted, and back-translated. Internal consistency and test-retest reliability were evaluated in patients with moderate OSA. Normative values were obtained in healthy subjects. Construct and criterion validity were assessed by comparing scores of patients and controls, and by correlating I-QSQ with the Epworth Sleepiness Scale. Responsiveness was examined in patients undergoing sleep surgery.

One hundred-six patients and 173 control subjects completed the I-QSQ without assistance. Internal consistency was acceptable to excellent across domains (Cronbach's α = 0.71-0.9), and test-retest reliability was high (ICC = 0.88-0.96). Patients scored significantly lower than controls in all domains (p < 0.001). A negative correlation was observed between I-QSQ and Epworth Sleepiness Scale scores (r = -0.54). Post-surgical patients showed significant improvement in I-QSQ total score.

I-QSQ is a reliable, valid, and responsive tool for evaluating QoL in Italian-speaking patients with sleep apnoea and can be effectively used in clinical practice and research.

To compare outcomes of functional endoscopic sinus surgery (FESS) and nasalisation (radical ethmoidectomy) in chronic rhinosinusitis with nasal polyposis (CRSwNP), and to identify subgroups benefiting most from nasalisation.

We retrospectively analysed 480 surgeries (374 FESS, 106 nasalisation) from 2012 to 2022. Nasalisation patients had more severe baseline disease than FESS patients (mean Nasal Obstruction Symptom Evaluation [NOSE] score: 76.88 ± 6.18 vs 73.55 ± 7.25; mean Visual Analogue Scale [VAS] olfaction score: 6.53 ± 1.1 vs 8.8 ± 1.15; mean Lildholdt score: 2.09 ± 0.76 vs 1.57 ± 0.83; all p < 0.001). Subjective (NOSE, VAS) and objective (Lildholdt) scores were recorded preoperatively and at one, 3, 6, 12, and 24 months postoperatively.

Despite worse baseline status, nasalisation showed greater improvements in subjective and objective measures, and was particularly effective in diffuse extensive polyposis. Paired t-tests confirmed significant postoperative enhancements (all p < 0.001; Cohen's d > 0.8). At 24 months, nasalisation showed superior outcomes: NOSE (24.5 ± 5.5 vs 41 ± 6), VAS olfaction (1.95 ± 1.05 vs 3.95 ± 1.15) (both p < 0.001); Lildholdt scores were similar (0.5 ± 0.6 vs 0.53 ± 0.65; p = 0.68).

The preliminary results of this retrospective study showed that nasalisation in more severe cases of CRSwNP yielded better long-term clinical outcomes. These results motivate for further investigation through a prospective study that will include comprehensive olfactory testing, quality of life measures, and a more complete methodology with refined variables to address the limitations of the current data set.

This study aimed to characterise laryngeal dystonia (LD) phenotypes using combined classification criteria and to evaluate treatment outcomes with botulinum neurotoxin type A (BoNT-A).

The study retrospectively reviewed patient medical records from our clinic over 5 years to identify cases of LD. We classified LD subtypes (adductor, abductor, mixed) and dystonic vocal tremor (DVT) based on updated criteria.

We analysed 75 cases, predominantly adductor LD (60%) and DVT (28%). In all, 84% of patients were females, diagnosed around 68 years of age. The DVT group had late-onset dysphonia that worsened over time and was associated with essential tremor in almost half of cases. Subjects with mixed LD had the greatest increase in Voice Handicap Index (VHI) over time and the longest duration of disease in all cases associated with DVT. Abductor LD cases had the most severe dysphonia (VHI: 73.3). Two-thirds of cases received BoNT-A therapy; most had adductor LD and had received treatment for longer times and had the lowest rate of treatment refusal.

Correct LD classification aids in diagnosis, prognosis and treatment; it should be dynamic and evolve with the patient's history. However, there is a lack of data in the literature on certain aspects of LD, emphasising the need for further research to improve clinical practice.

Long-term oxygen therapy (LTOT) for patients with severe chronic hypoxemia is a well-established treatment, but data on long-term outcomes are limited. This study aims to describe the characteristics and survival of patients using LTOT in Belgium. Data from patients receiving LTOT were extracted from the Belgian Social Security databank with 4 years of follow-up and compared with a more detailed tertiary care cohort from the University Hospital of Leuven. Kaplan-Meier curves for overall and transplant-free survival were constructed. We performed log-rank univariate analyses for diagnosis and starting treatment modality and applied a Cox proportional hazards model adjusting for age and underlying diagnosis. In Belgium, 4973 patients started LTOT in 2017. Overall 4-year survival was 22% and determined by age, baseline oxygen modality and diagnosis. LTOT was primarily prescribed for patients with COPD (75%) who had higher 4-year survival (24%) compared to patients with restrictive pulmonary disease (17%) (HR 1.23, p < 0.005). In the University hospital cohort (n = 533), 4-year transplant-free survival was 26% with significantly lower survival rates of patients with ILD (13%) (HR 1.98, p < 0.005) and other obstructive lung diseases (24%) (HR 1.56, p < 0.01) as compared to COPD (33%). Survival for patients receiving LTOT remains poor. Best prognosis is seen in patients with COPD, while patients with restrictive pulmonary disease and ILD in particular have the poorest outcome. Palliative care and end-of-life discussions should be an integral part of prescribing LTOT.

Despite the existence of studies evaluating the effect of personal hygiene habits on Demodex mites, which are permanent ectoparasites of humans, there is a paucity of research examining the effect of mask use on the prevalence of Demodex mites during the period of the SARS-CoV-2 pandemic. The present study set out to investigate the impact of mask use during the pandemic and personal hygiene habits on the prevalence of Demodex spp.

Standardized skin surface biopsy were obtained from Marmara University Faculty of Medicine students' foreheads and cheeks during the pandemic. Two areas were sampled: foreheads and cheeks. A quantity of immersion oil (ranging from one to two drops) was deposited on the sampled slide area. The slide was covered with a coverslip, then a microscope was invetigated (x4, x10 and x40). Infestation was indicated by the presence of five or more Demodex per cm². Volunteers were asked to complete a questionnaire about their personal hygiene habits. SPSS v.16.0 (IBM Corp., Armonk, NY, USA) software was used to analyse the results.

A total of 104 volunteers, comprising 43 women and 61 men, participated in the study. Demodex spp. was detected in 49.0% (n=51) of the participants, 51.2% (n=22) of women and 47.5% (n=29) of men. Demodex spp. were identified in 46.2% (n=48) of the samples obtained from the cheek and 13.5% (n=14) of the samples obtained from the forehead. It was determined that all participants with mites were using masks. The detection frequency exhibited an upward trend in proportion to the duration of mask change. Demodex spp. was identified in 52.8% of subjects with a documented history of acne, and a significant correlation was observed between the frequency of facial cleansing and the presence of Demodex spp. (p=0.036).

The research indicates that the increase in Demodex spp. in the cheeks of individuals using medical masks during the pandemic is attributable.

Evidence demonstrates that individual and contextual factors are critical predictors of poor health outcomes at key life stages, including youth and young adulthood. Little is still known how the unprecedented COVID-19 pandemic affected health outcomes like substance use and how this varied across key demographics and community characteristics. This analysis aims to examine how individual and community contexts interact to predict the risk of substance use outcomes among young people (ages 24 and younger) with additional consideration of the COVID-19 pandemic. We employ generalized logistic mixed models to examine the main and interactive effects of individual and community context in predicting substance use-related emergency department (ED) visits. We assess effect modification of this association by key individual variables (age, race, sex, income-using insurance as proxy), community variables (community economic deprivation-derived from principal component analysis), and the COVID-19 pandemic. Results show low-income youth are associated with higher risks of substance use compared to their higher income peers (OR_Uninsured:1.82, CI:1.81-1.83). Community context moderated risk, particularly for children in low-income communities (OR_Alcohol:3.39, CI:1.94-5.93). Findings further demonstrate a higher risk of substance use ED visits during the pandemic among low-income youth (OR_{PublicInsurance}:1.09, CI:1.07-1.10) and youth in low-income communities (OR:1.03, CI:1.01-1.05), those 18 and younger (OR_Adolescents:1.25, CI:1.23-1.27), and Black (OR:1.32, CI:1.30-1.33), Indigenous (OR:1.17, CI:1.12-1.22), and Hispanic youth (OR:1.13, CI:1.11-1.15). Results emphasize the ongoing need for substance use resources targeted to young people in low-income and median-income communities, particularly younger youth and youth of color, who are associated with marked increases in substance use in recent years.