Childhood absence epilepsy (CAE) is one of the most common epilepsy syndromes in childhood and has traditionally been regarded as a condition with a favorable neurological prognosis. However, increasing evidence suggests that CAE is associated with functional disturbances in neuronal networks that extend beyond seizure generation and may involve sleep and wakefulness regulation. Methods: This narrative mini-review summarizes and critically discusses current clinical and neurophysiological evidence regarding alterations in sleep architecture and sleep electroencephalographic (EEG) microstructures in children with CAE, based on a focused analysis of selected clinical and observational studies. Results: The available data suggest that children with CAE, particularly before treatment initiation, may exhibit sleep macrostructure abnormalities, including reduced total sleep time, prolonged rapid eye movement sleep latency, increased arousal frequency, and decreased sleep efficiency. In addition, changes in sleep microstructure have been reported, most notably reduced sleep spindle density during stage-N2 sleep, especially in patients with concomitant cognitive impairment. These findings may reflect alterations in thalamocortical network function, although current evidence remains limited and heterogeneous. Conclusions: Sleep disturbances appear to represent an important component of the clinical phenotype of childhood absence epilepsy. Assessing the sleep architecture and sleep EEG microstructure, particularly sleep spindles, may provide insights into network dysfunction and cognitive vulnerability; however, further studies are needed to clarify their clinical utility.

Background: Delirium is a common neuropsychiatric syndrome among hospitalized patients and has been associated with increased short- and long-term mortality. However, data on long-term outcomes and prognostic significance remain limited, particularly in Middle Eastern populations. Methods: This prospective observational cohort study was conducted at a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients admitted to medical, surgical, and intensive care units (ICUs) underwent standardized clinical neuropsychiatric assessment for delirium. Five-year follow-up data were obtained from electronic health records and phone follow-up with patients/caregivers. Clinical outcomes and survival were compared between patients with and without baseline delirium. Kaplan–Meier survival analysis assessed five-year survival, and Cox regression explored the association between delirium and time-to-death adjusting for medical/psychiatric morbidity. Results: Among 278 patients, 71 (25.5%) were diagnosed with delirium during initial hospitalization. At five years, 51 patients (18.3%) had died. Patients with delirium had higher mortality (35.2% vs. 12.6%, p < 0.001), reduced five-year survival, and greater cumulative ward and ICU stays. In Cox regression including 50 deaths with complete data, delirium at initial assessment was associated with a higher hazard of death during follow-up (HR 1.93, 95% CI 1.06–3.55). Older age per year (HR 1.02, 95% CI 1.00–1.04), kidney disease (HR 2.12, 95% CI 1.20–3.75), and psychiatric disorders (HR 2.16, 95% CI 1.17–3.97) were independently associated with a higher hazard of death. Conclusions: Delirium was associated with increased five-year mortality and adverse long-term clinical outcomes. These findings support the prognostic significance of delirium in hospitalized patients.

Background/Objectives: A disadvantage of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with prior glaucoma filtration surgery is the difficulty in maintaining air tamponade during the procedure. Herein, we report the use of bleb compressive sutures in managing air tamponade in the anterior chamber during DSAEK in eyes with blebs following trabeculectomy. Methods: This retrospective case series included 34 eyes of 33 patients that developed bullous keratopathy following trabeculectomy. Bleb compression suturing was performed using a 10-0 nylon suture in eyes with an intraocular pressure (IOP) < 10 mmHg or a fragile ischemic bleb. Postoperative IOP, air ingress into the bleb, rebubbling, bleb leakage, and bleb damage were evaluated. Results: Of the 34 eyes, 13 underwent bleb compression suturing before DSAEK (suture group), whereas 21 eyes did not (non-suture group). The mean preoperative IOP was 7.5 ± 2.5 mmHg and 11.2 ± 4.2 mmHg in the suture and the non-suture groups, respectively. The IOP was measured 2 h postoperatively in 14 eyes, increasing by 18 ± 9.3 and 11.7 ± 3.1 mmHg in the suture and non-suture groups, respectively, compared to the preoperative IOP, with no significant differences. At 2 h postoperatively, two eyes in the suture group and one eye in the non-suture group exhibited an IOP spike (≥30 mmHg). One eye in the non-suture group required rebubbling owing to air ingress into the bleb. The mean IOP was 7.1 ± 3.2 and 9.4 ± 4.6 mmHg in the suture and non-suture groups, respectively, 1–2 weeks postoperatively. Preoperative and postoperative IOPs did not significantly differ in either group, and no suture-related complications were observed. Conclusions: For eyes with blebs, bleb compression suturing in DSAEK provides effective air tamponade during graft adhesion.

Objectives: Perioperative blood transfusion for acute type A aortic dissection (ATAAD) lacks clinical guidelines. This study aims to investigate the application of a thromboelastography (TEG)-based risk-stratified transfusion protocol in these patients. Methods: We conducted a two-stage study. Firstly, a retrospective analysis of ATAAD patients undergoing surgery in 2023 was performed to identify predictors of postoperative/perioperative excessive bleeding and develop a predictive model. Subsequently, a single-center prospective validation study was conducted in 2024, comparing a TEG-based risk-stratified transfusion protocol against conventional empirical transfusion. Results: In the retrospective phase (n = 57), 18 patients (31.6%) developed perioperative excessive bleeding. Preoperative activated clotting time (ACT) and TEG parameters (K-time) were independent predictors. A predictive model incorporating these variables achieved an AUC of 0.788. In the prospective phase (n = 47), 21 patients received the TEG-based risk-stratified transfusion protocol. Compared to the conventional group, the TEG risk-stratified group exhibited significantly lower postoperative drainage volume (p = 0.046), a reduced incidence of perioperative excessive bleeding (4.8% vs. 34.6%, p = 0.033), and lower transfusion costs (p = 0.029), without an increase in total transfusion volume. Conclusions: Preoperative ACT and TEG parameters effectively predict perioperative excessive bleeding in ATAAD patients. Implementing a TEG-based risk-stratified transfusion protocol optimizes blood product utilization, improves clinical outcomes, and reduces costs, offering a promising evidence-based approach for perioperative management.

Introduction: This study explored how illness severity scores correspond to hypoxic-ischemic brain injury (HIBI) after cardiac arrest. Methods: This study included cardiac arrest survivors with sufficient data to calculate the Pittsburgh Cardiac Arrest Category (PCAC) and revised post-cardiac arrest syndrome for therapeutic hypothermia (rCAST) scores who underwent brain magnetic resonance imaging and cerebrospinal fluid neuron–specific enolase (CSF-NSE) measurement within 6 h after return of spontaneous circulation. The primary outcome was the association of PCAC and rCAST with quantitative brain injury markers assessed using whole brain mean apparent diffusion coefficient (mean ADC), low ADC volume fractions (PV600, 650, and 700), and CSF-NSE. Results: In total, 81 patients were included. PCAC was not significantly associated with CSF-NSE, mean ADC, or PVs. The rCAST score was significantly associated with higher CSF-NSE, lower mean ADC, and higher PV700. The neurologic sub-score of PCAC was independently associated with all evaluated brain injury markers, whereas the systemic sub-score was not. Of the individual rCAST components, anoxic time was independently associated with CSF-NSE, whereas no other single component was associated with these markers. Conclusions: rCAST was significantly associated with degree of HIBI, whereas PCAC was not. The neurologic sub-score of PCAC showed independent associations with HIBI.

Background: Three-dimensional (3D)-printed vertebral body replacement (VBR) and artificial vertebral body (AVB) implants are increasingly used for anterior column reconstruction after spinal tumor resection. However, the available evidence on complications remains limited, heterogeneous, and methodologically inconsistent. This systematic review aimed to synthesize reported complications, revision patterns, and mechanical outcomes of 3D-printed VBR/AVB implants in spinal oncology and to critically appraise the quality of the available clinical literature. Methods: This systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from 1 January 1980 to 26 February 2026. Eligible studies included clinical series and cohort studies reporting extractable complication and/or revision data in patients who underwent spinal tumor resection followed by reconstruction with a 3D-printed VBR/AVB implant. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Due to substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed. Results: Eleven studies comprising 217 analyzable 3D-printed reconstructions were included. Most were retrospective single-center series and showed marked heterogeneity in tumor histology, spinal level, implant strategy, follow-up duration, and complication definitions. Because adverse-event reporting was inconsistent across studies, no pooled overall complication rate was calculated. Reported perioperative non-mechanical complications included neurological deterioration, cerebrospinal fluid- or dural-related events, wound infection, pleural effusion, pneumonia, and vascular injury. Mechanical implant failure appeared relatively uncommon, although radiographic subsidence was variably defined and inconsistently reported. Implant mismatch and hardware-related problems were infrequent but clinically relevant, particularly with prefabricated or off-the-shelf devices. Revision procedures were most commonly associated with wound complications, clinically significant subsidence, hardware failure, or tumor recurrence. Overall study quality was limited by retrospective designs, small sample sizes, and non-standardized outcome reporting. Conclusions: Current evidence suggests that 3D-printed VBR/AVB implants are a feasible option with encouraging mechanical performance for spinal reconstruction after tumor resection. Most reported adverse events appear to reflect the complexity of oncologic spine surgery rather than device-specific failure alone. However, the available evidence remains low level and heterogeneous. Larger multicenter comparative studies with standardized outcome definitions and longer follow-up are needed to better define the clinical value and durability of 3D-printed vertebral reconstruction in spinal oncology.

Objectives: CD93, an angiogenesis-related transmembrane glycoprotein, is transcriptomically downregulated in uterine corpus endometrial carcinoma, yet circulating protein levels have not been clinically evaluated. This study aimed to evaluate serum CD93 as a diagnostic biomarker for EC and to examine its association with clinicopathological parameters. Methods: In this single-center case–control study, serum CD93 concentrations were measured by enzyme-linked immunosorbent assay in 46 patients with histologically confirmed primary EC and 35 controls with histologically verified benign gynecological pathology. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results: Serum CD93 was significantly lower in EC patients than controls (median 4.55 [IQR 3.51–6.97] vs. 10.24 [7.18–12.14] ng/mL; p < 0.001). In multivariable analysis adjusted for age and body mass index, lower CD93 remained independently associated with EC (OR = 0.521; 95% CI 0.061–0.720; p < 0.001). ROC analysis yielded an area under the curve of 0.845 (95% CI 0.759–0.921), with 82.6% sensitivity and 74.3% specificity at a cut-off of 7.338 ng/mL. CD93 levels showed no significant association with histological subtype, grade, lymphovascular space invasion, nodal metastasis, or recurrence. Conclusions: Serum CD93 is significantly reduced in EC and demonstrates independent diagnostic performance, supporting its prospective validation as a non-invasive biomarker in larger multicenter cohorts.

Introduction: Idiopathic pulmonary fibrosis (IPF) is associated with high morbidity and mortality and a substantial burden of comorbidities, which may influence prognosis and survival. This study aimed to evaluate the burden of comorbidity in patients with IPF receiving antifibrotic therapy using the Charlson, TORVAN, and GAP indices and to analyse their relationships and prognostic impact on survival. Methods: Retrospective observational study including patients with IPF diagnosed according to ATS/ERS/JRS/ALAT criteria. Patients receiving antifibrotic therapy between June 2010 and September 2025 were included. Baseline comorbidities were recorded, and the Charlson, TORVAN, and GAP indices were calculated. Associations between indices were assessed using chi-square tests and kappa statistics. Survival was analysed using Kaplan–Meier curves and compared with the log-rank test. Cox proportional hazards regression and model comparison metrics (Harrell’s C-index and Akaike Information Criterion) were also performed to assess the independent prognostic value of each index. Results: Seventy-two patients were included (76.7% male; mean age 73.8 ± 7.4 years). Pirfenidone was prescribed in 63.9% and nintedanib in 36.1%. The most frequent comorbidities were gastro-oesophageal reflux disease (62.5%), arterial hypertension (57.5%), pulmonary hypertension (32.9%), diabetes mellitus (24.7%), and non-metastatic solid tumours (17.6%), including lung cancer. Survival differed significantly according to GAP stage (p = 0.020) and Charlson categories (p = 0.006). The TORVAN stage was associated with the GAP stage (p < 0.001; kappa = 0.246), whereas the Charlson index showed no association with GAP or TORVAN. Conclusions: In this cohort of patients with IPF receiving antifibrotic therapy, both the GAP and Charlson indices were associated with survival. These findings suggest that combining disease-specific and comorbidity indices may provide a more comprehensive prognostic assessment, although further validation in larger cohorts is required.

Background/Objectives: Systemic lupus erythematosus (SLE) is a heterogeneous disease with substantial variability in clinical manifestations and outcomes, influenced by ethnic and geographical diversity. Remission is the optimal treatment target, while low lupus disease activity state is an accepted alternative goal. Although sustained remission has been associated with reduced organ damage, the impact of early attainment of treatment targets on subsequent damage accrual in SLE remains incompletely defined. To explore a potential window of opportunity, this study aimed to identify factors associated with achieving remission or low lupus disease activity state within the first year of SLE diagnosis and to examine their associations with organ damage. Methods: This retrospective study was conducted across 22 rheumatology centres in Malaysia and included patients with systemic lupus erythematosus (SLE) who had complete follow-up from diagnosis until attainment of treatment targets. Treatment targets were defined as achieving either early remission or a low disease activity state (LDAS). Given the retrospective nature of the study and the unavailability of complete Physician’s Global Assessment data, the definitions of early remission and LDAS were modified by excluding this component. Accordingly, treatment targets were defined as attainment of a clinical SLE Disease Activity Index (cSLEDAI) score of 0 with oral prednisolone doses of ≤5 mg/day and ≤7.5 mg/day, respectively, within 12 months of SLE onset. Multivariable Cox proportional hazards regression and logistic regression analyses were performed to determine factors associated with early remission and organ damage, respectively. Results: A total of 1599 patients were included, the majority of whom were female (92.5%). The cohort was predominantly Malay (68.7%), followed by Chinese (17.4%), Indigenous groups (10.8%) and Indian (3.0%). Early attainment of treatment targets was achieved in 45.7% of patients, while 54.3% experienced delayed attainment. In the multivariable cox regression model, the Malay and Chinese ethnic group demonstrated a significantly lower likelihood of achieving early remission compared to the Indigenous ethnic group. Patients with longer SLE duration, low C4 levels, presence of haematological and renal manifestations at the initial presentation, were identified as additional adverse factors associated with lower likelihood of early remission. Overall, 16.9% of patients accrued organ damage. Independent factors associated with organ damage included Indian ethnicity [OR 5.75, 95% CI 1.39–23.81, p = 0.02], delayed remission [OR 2.97, 95% CI 1.51–5.83) and absence of baseline hydroxychloroquine therapy [OR 4.13, 95% CI 1.21–14.07; p = 0.020]. Conclusions: Ethnic disparities were observed in the early attainment of the treatment targets, as well as in organ damage accrual within the Malaysian multi-ethnic SLE cohort. The significant association between the delay in achieving the treatment targets and organ damage underscores the importance of adopting an early treat-to-target approach in SLE management.

Background: The impact that various methods of calcaneal fracture treatment have on functional outcomes is not thoroughly understood. The purpose of this study was to analyze the impact of calcaneal fractures on the level of physical activity and foot and ankle mobility following various fixation methods. Methods: In our two-center retrospective analysis, we compared treatment outcomes of intra-articular calcaneal fractures in 50 patients treated with the Ilizarov method and 49 patients who underwent internal plate fixation. The following parameters were analyzed: range of motion of the foot and ankle joint; the UCLA Activity Scale, the Saltin–Grimby scale, and the Visual Analog Scale (VAS) of Activity. No multivariable adjustment was performed. Accordingly, between-group comparisons are unadjusted, except where stratified analyses are indicated. Results: Postoperatively, a significant improvement was noted in terms of UCLA Activity parameters and the Saltin–Grimby score in the Ilizarov group. A comparison of post-treatment physical activity levels in the two groups revealed significantly better scores in the Grimby scale and VAS activity in the Ilizarov group than in the internal fixation group. The ranges of motion in the Ilizarov group showed significantly worse mobility in the operated limb than in the intact limb. The ranges of dorsiflexion, foot inversion, and foot eversion in the ORIF group were comparable for the treated and intact limb. A comparison of ranges of motion in the study groups showed significantly lower ranges of motion in the Ilizarov group than in the ORIF group. Conclusions: Calcaneal fracture treatment with the Ilizarov method may be associated with better physical activity levels than internal plate fixation. Foot and ankle mobility following calcaneal fracture treatment is better in patients treated with internal plate fixation. The results should be taken with caution due to the lack of randomization, two-center design and the retrospective nature of the study.