Radu Adrian Nitu

Background: Pancreatic neuroendocrine tumors (pNETs) represent a heterogeneous group of neoplasms characterized by variable biological behavior and clinical outcomes. Multiple therapeutic strategies have been investigated, including surgery, targeted therapies, peptide receptor radionuclide therapy, and systemic treatments. The present study aimed to summarize survival-related outcomes reported across studies investigating the management of pNETs. Methods: A systematic review of the literature was conducted including studies reporting clinical outcomes in patients with pancreatic neuroendocrine tumors. A total of 27 studies were included in the qualitative analysis. Survival-related outcomes, such as progression-free survival (PFS), recurrence-free survival (RFS), and recurrence rates, were extracted. Studies reporting quantitative survival values were included in the meta-analytical component. A random-effects model was applied, and a forest plot was generated to summarize the reported outcomes. Results: Reported survival outcomes varied substantially across studies. Median PFS values ranged from approximately 5.6 to 86.5 months, while several surgical series reported 5-year overall survival rates exceeding 90%. Recurrence rates following surgical resection ranged from approximately 12% to 26% in some cohorts. The pooled estimate derived from the meta-analytical model was 32.22 (95% CI: 15.65–48.80). Conclusions: The analysis summarizes survival-related outcomes reported in studies investigating pancreatic neuroendocrine tumors and provides a quantitative overview of the reported progression-related endpoints across the analyzed literature.

Advanced chronic kidney disease (CKD) presents a complex hemostatic paradox, characterized by a simultaneous increase in bleeding and thromboembolic risks. This study aimed to evaluate and compare the safety and efficacy of apixaban versus acenocoumarol in a real-world cohort of patients across advanced CKD stages (pre-dialysis and hemodialysis). We conducted a retrospective observational study including 84 adults with CKD stages 4 and 5 (40.5% in stage 4; 59.5% in stage 5, of whom 86.0% were on chronic hemodialysis) receiving oral anticoagulation for at least 3 months. Patients were stratified by CKD stage and anticoagulant type (apixaban vs. acenocoumarol). Clinical outcomes included major and clinically relevant bleeding, anticoagulant overdose, and thromboembolic events. Bleeding events were more frequent in CKD stage 5 than in stage 4 (66.0% vs. 44.1%, p = 0.06), highlighting a pronounced hemorrhagic burden that increases with disease progression. Apixaban was associated with significantly fewer total bleeding events (44.4% vs. 66.7%, p = 0.04) and a lower rate of anticoagulant overdoses (5.6% vs. 18.8%, p = 0.04) compared with acenocoumarol. Thromboembolic event rates did not differ significantly between the two anticoagulant groups (13.9% vs. 16.7%, p = 0.72). Conventional risk scores (CHA₂DS₂-VASc and HAS-BLED) showed limited discriminatory capacity for actual clinical events in this advanced CKD population. In patients with advanced CKD, oral anticoagulation is associated with a high hemorrhagic burden that intensifies as renal function declines. Apixaban demonstrated a more favorable safety profile than acenocoumarol without a loss of thromboembolic protection. These findings suggest that stage-specific biological factors, rather than conventional risk models alone, should guide anticoagulation strategies in this population.

Background: Intimate partner violence (IPV) represents a major global public health concern with profound psychological and social consequences for women. This review synthesizes contemporary evidence (2020–2025) on IPV prevalence, mental health outcomes, and healthcare implications among female populations worldwide. Methods: 18 peer-reviewed studies, encompassing approximately 62,000 women across various countries, were analyzed for study design, sample characteristics, IPV prevalence, and associated outcomes. Results: IPV prevalence varied widely across studies, ranging from 15% in population-based antenatal samples to over 85% among incarcerated or trauma-exposed groups. Across studies reporting mental health outcomes, depression prevalence ranged from 20% to over 50%, while PTSD prevalence ranged from approximately 30% to 70%, depending on measurement tools and population characteristics. No pooled estimates were calculated. IPV survivors showed higher emergency department use (2.6-fold), inpatient admissions (2.2-fold), and healthcare costs (2.2-fold) compared with non-exposed women. Emerging interventions, such as digital safety programs, behavioral antenatal packages, and validated screening tools, demonstrated encouraging effectiveness. Conclusions: IPV remains widespread and linked to psychological distress and elevated healthcare burden. Integration of routine screening, trauma-informed mental health services, and multisectoral prevention frameworks is essential to mitigate its enduring impact on women’s health and well-being.

This systematic review examines chronic kidney disease-associated pruritus (CKD-aP) as a complex clinical manifestation in patients undergoing hemodialysis. Traditionally considered a secondary symptom of end-stage renal disease, emerging evidence now positions CKD-aP as a multidimensional disorder with substantial pathogenic influence on patient outcomes. Using the PRISMA 2020 methodology, we critically evaluated 54 peer-reviewed studies published between 2020 and 2025. Our synthesis highlights a convergence of five mechanistic frameworks underpinning CKD-aP: elevated levels of uremic toxins originating from gut microbial dysbiosis, immune activation driven by IL-31 and other pro-inflammatory cytokines, heightened peripheral and central neural sensitization, dysregulation of endogenous opioid receptor pathways favoring μ-receptor activation, and xerosis-related epidermal barrier dysfunction. These mechanisms contribute to a systemic cycle of microinflammation, pruritogenic signaling, and neural hyperexcitability. We also identified and compared validated assessment tools—including the NRS, VAS, Skindex-10, and the UP-Dial scale—that facilitate standardized quantification of disease burden. While available treatments such as gabapentinoids and phototherapy offer partial relief, targeted therapies—including κ-opioid receptor agonists—represent a major advancement, although long-term effectiveness and accessibility remain under investigation. Growing scientific consensus establishes CKD-aP as a priority therapeutic target in hemodialysis care, underscoring the need for integrated, mechanism-based management strategies to improve quality of life and clinical outcomes. This work represents a narrative systematic review, integrating evidence from mechanistic, translational, and clinical studies to critically examine the biological pathways underlying CKD-associated pruritus.

Rationale: Accurate identification of victims in postcrash scenarios presents significant forensic challenges, particularly when the remains are extensively burned, fragmented, or carbonized. This study focused on multiple victims of 2 aircraft crashes, highlighting the intricate methods and obstacles encountered during their identification. Patient concerns: Severe thermal damage, widespread tissue degradation, and advanced carbonization have hindered traditional identification techniques, requiring a multidisciplinary forensic approach that combines DNA analysis, dental profiling, tattoo recognition, and artifact examination. Diagnoses: In addition to establishing the causes of death, which also required histopathological examinations, the difficulty involved in assigning the identity of each corpse made the forensic pathologists resort to all the information and details they could observe during the autopsy. Interventions: Personal objects such as jewelry, tattoos, and prosthetic devices helped to reconstruct the identity of each corpse, in some cases being assigned identification by exclusion. Outcomes: Severe cranial fractures, rib and thoracic injuries, and extensive organ damage, such as pulmonary contusions, alveolar hemorrhages, and hepatic lacerations, were consistently observed in all cases. Forensic dental identification, which, in the present case, helped identify one of the victims through dental analysis. Lessons: This study highlights the critical role of the identification of victims in circumstances in which the body is largely destroyed and underlines the importance and necessity of forensic identification through dental identification methods, which potentially represent one of the most effective methods that retain their accuracy regardless of the degree of destruction of the corpse.