Background: As the global prevalence of dementia rises, an increasing number of patients with cognitive impairment require Total Joint Arthroplasty (TJA). However, the specific impact of dementia on postoperative outcomes remains underreported. This systematic review evaluates the complications, mortality, and healthcare utilization associated with dementia in patients undergoing Total Hip (THA) and Total Knee Arthroplasty (TKA). Methods: A systematic search of PubMed, Scopus, Web of Science, Embase, and the Cochrane Library was conducted following PRISMA guidelines. Eligible studies included comparative cohorts of patients with and without a diagnosis of dementia undergoing primary TJA. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS). Data were synthesized regarding mortality, readmissions, implant-related complications, and discharge disposition. Results: Seven retrospective cohort studies comprising 13,816 patients with dementia and 869,061 controls were included. The mean NOS score was 8.4/9, indicating high methodological quality. Patients with dementia exhibited significantly worse outcomes across both procedures, including higher rates of postoperative delirium (OR: 4.25–6.40), mortality (HR: 1.43–3.05), and discharge to skilled nursing facilities (OR: 1.87). Stratification by procedure revealed distinct risk profiles: while both cohorts faced high readmission rates, THA patients demonstrated specific vulnerability to mechanical complications, including increased risks of dislocation, periprosthetic fracture (OR: 2.07), and revision surgery. These mechanical failures were frequently driven by falls and poor compliance with postoperative precautions rather than infection alone. Conclusion: Dementia is a robust independent predictor of adverse outcomes after TJA. While both THA and TKA carry elevated systemic risks, THA poses unique mechanical challenges that may warrant the use of high-stability implants (e.g., dual-mobility cups) to mitigate dislocation risks. Perioperative strategies should prioritize caregiver-led surveillance and strict fall prevention protocols to improve safety in this vulnerable population.

A 45-year-old female presented with a 15-day history of headache and blurred vision. MRI of the brain revealed multiple irregular, T2-hyperintense lesions with significant surrounding edema, central necrosis, peripheral rim enhancement, and corpus callosum involvement resulting in a "butterfly" appearance. These imaging features led to an initial radiological impression of multifocal glioblastoma multiforme. Subsequent histopathological examination of a brain biopsy provided a definitive diagnosis of CNS non-Hodgkin's lymphoma (CNS-NHL). The biopsy showed dense perivascular cuffing by atypical large lymphocytes with notable mitoses and adjacent edema. This report illustrates an imaging presentation of CNS lymphoma that differed from common patterns, particularly the prominent T2 hyperintensity within the enhancing rim and central necrosis, posing a diagnostic challenge resolved using histopathological analysis. The findings emphasize the importance of tissue diagnosis in cases with complex neuroimaging presentations suggestive of high-grade glioma.

Background/Objectives: Right heart catheterization (RHC) is the diagnostic gold standard for pulmonary hypertension (PH), defined as mean pulmonary arterial pressure (mPAP) greater than 20 mmHg at rest. It is invasive and carries procedural risk. Machine learning (ML) and deep learning (DL) applied to non-invasive modalities may provide a non-invasive adjunct for screening, triage, and earlier identification. Methods: Methodological quality was assessed using QUADAS-2. Primary non-comparative pooling was restricted to RHC-confirmed studies using Reitsma hierarchical bivariate random-effects models. Comparative studies were analyzed using a paired hierarchical bivariate model, with between-method differences assessed using paired Wald tests. Sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were estimated; predictive values were evaluated as secondary outcomes. GRADE certainty was assessed separately for non-comparative ML/DL, comparative ML/DL, and traditional methods. Results: Nine studies involving multiple pulmonary hypertension subtypes met the inclusion criteria: five non-comparative (single-arm) studies including approximately 26,530 participants and four comparative (double-arm) studies including 330 paired participants per arm. In the primary synthesis restricted to RHC-confirmed single-arm studies, ML/DL models achieved a pooled sensitivity of 0.720 (95% CI: 0.647–0.783) and specificity of 0.883 (95% CI: 0.796–0.936), with a diagnostic odds ratio of 19.4 (95% CI: 13.6–27.7). Estimates were similar when all five single-arm studies were included (sensitivity 0.716, 95% CI: 0.654–0.771; specificity 0.891, 95% CI: 0.820–0.937). In comparative studies analyzed with a paired hierarchical bivariate model, ML/DL outperformed traditional methods for both sensitivity (0.838, 95% CI: 0.668–0.930 versus 0.707, 95% CI: 0.421–0.889; paired Wald p = 0.019) and specificity (0.849, 95% CI: 0.512–0.968 versus 0.640, 95% CI: 0.376–0.840; paired Wald p = 0.0076). At a 25% pre-test probability, ML/DL was projected to yield 34 additional true positives (95% CI: −30 to 109) and 142 fewer false positives (95% CI: −381 to 129) per 1000 patients tested, although all absolute difference intervals crossed zero. Certainty of evidence was very low across all outcomes. GRADE certainty ranged from low to very low depending on outcome and stratum. Conclusions: ML/DL-based methods showed promising non-invasive diagnostic accuracy for PH, with significantly higher pooled sensitivity and specificity than traditional methods in paired comparisons. However, evidence certainty ranged from low to very low, and projected absolute benefits remained imprecise. These findings are hypothesis-generating; ML/DL tools may serve as adjuncts in the diagnostic pathway but cannot replace RHC at this stage.

Background: Skull base plasmacytomas are rare plasma cell neoplasms arising from the clivus, sphenoid bone, and petrous apex, presenting with cranial neuropathies and bearing a high risk of progression to multiple myeloma. Optimal management remains poorly defined due to their rarity. Objective: The objectives of this study are to comprehensively characterize the clinical presentation, management strategies, and outcomes of skull base plasmacytomas and identify evolving trends in the literature. Methods: A systematic search of PubMed, EMBASE, Web of Science, and Cochrane databases was conducted, yielding 92 studies (18 case series and 74 case reports) encompassing 118 patients. Data on the demographics, symptoms, imaging, histopathology, treatment, and outcomes were extracted and analyzed. Results: The median patient age was 56 years; visual disturbances (66.1%) and headache (54.2%) were the most common presenting symptoms. The middle and posterior cranial fossae were most frequently involved, and cranial nerve VI was most affected (65.7%). Surgical resection was performed in 63.6% of cases with a gross total resection in 36%. At a median follow-up of 12 months (calculated across the entire cohort of 118 patients, including the 29 who presented with a prior diagnosis of multiple myeloma), 81.4% were alive, with symptom resolution at 38.1% or improvement at 26.2%. Recurrence occurred in 19.4% of patients, and multiple myeloma developed in 25.8% of patients without a prior diagnosis. Multiple myeloma status was the only independent predictor of survival on multivariate analysis (OR = 10.14, 95% CI: 1.63–63.04, p = 0.013). Conclusions: Skull base plasmacytomas show consistent clinical patterns but variable management strategies. Surgery is increasingly utilized; yet, its survival benefit remains unclear. Prospective multicenter studies with standardized outcome reporting and molecular profiling are needed to optimize individualized care.

This article pertains to the study by Liu et al . Myocarditis caused by immune checkpoint inhibitors in patients with esophageal cancer is a concerning issue. This was found to be linked by increased levels of creatine kinase (CK) and CK isoenzymes, as well as older age and male gender. All these risk factors behind this phenomenon, which could be incorporated into a unified prediction model, have been briefly discussed. Several recommendations have been made to validate this prediction model for use in different clinical scenarios.