bluuebunny/crossref_metadata_2025 huggingface dataset:
The Potential of Oncolytic Virotherapy in the Treatment of Head and Neck Cancer: A Comprehensive Review
Authors: Spirito Francesca , Nocini Riccardo , Mori Giorgio , Albanese Massimo , Georgakopoulou Eleni A. , Sivaramakrishnan Gowri , Khalil Basel , Špiljak Bruno , Surya Varun , Mishra Deepika , Chaurasia Akhilanand
Published: December 2024

Head and neck cancer (HNC) represents a challenging oncological entity with significant morbidity and mortality rates. Despite advances in conventional therapies, including surgery, chemotherapy, and radiation therapy, the overall survival rates for advanced HNC remain suboptimal. In recent years, the emerging field of oncolytic virotherapy has gained attention as a promising therapeutic approach for various malignancies, including HNC. This review provides a comprehensive overview of the current understanding of oncolytic viruses (Ovs) in the context of HNC treatment, including their mechanisms of action, preclinical and clinical studies, challenges, and future directions. Future oncolytic virotherapy focuses on improving delivery and specificity through nanoparticle carriers and genetic modifications to enhance tumor targeting and immune response. Combining different OVs and integrating them with immunotherapies, such as checkpoint inhibitors, could overcome tumor resistance and improve outcomes. Personalized approaches and rigorous clinical trials are key to ensuring the safety and effectiveness of virotherapy in treating HNC.
The Natural History of Cervical Cancer and the Case for MicroRNAs: Is Human Papillomavirus Infection the Whole Story?
Authors: Palomino-Vizcaino Giovanni , Bañuelos-Villegas Evelyn Gabriela , Alvarez-Salas Luis Marat
Published: December 2024

MicroRNAs (miRNAs) are small non-coding RNAs (ncRNAs) that negatively regulate gene expression. MiRNAs regulate fundamental biological processes and have significant roles in several pathologies, including cancer. Cervical cancer is the best-known example of a widespread human malignancy with a demonstrated viral etiology. Infection with high-risk human papillomavirus (hrHPV) has been shown to be a causative factor for cervical carcinogenesis. Despite the occurrence of prophylactic vaccines, highly sensitive HPV diagnostics, and innovative new therapies, cervical cancer remains a main cause of death in developing countries. The relationship between hrHPV infection and cervical cancer depends on the integration of viral DNA to the host genome, disrupting the viral regulator E2 and the continuous production of the viral E6 and E7 proteins, which are necessary to acquire and maintain a transformed phenotype but insufficient for malignant cervical carcinogenesis. Lately, miRNAs, the tumor microenvironment, and immune evasion have been found to be major players in cervical carcinogenesis after hrHPV infection. Many miRNAs have been widely reported as deregulated in cervical cancer. Here, the relevance of miRNA in HPV-mediated transformation is critically reviewed in the context of the natural history of hrHPV infection and cervical cancer.
Insights into Microbiota–Host Crosstalk in the Intestinal Diseases Mediated by Extracellular Vesicles and Their Encapsulated MicroRNAs
Authors: Zeng Yan , Yin Yulong , Zhou Xihong
Published: December 2024

Microorganisms that colonize the intestine communicate with the host in various ways and affect gut function and health. Extracellular vesicles (EVs), especially their encapsulated microRNAs (miRNAs), participate in the complex and precise regulation of microbiota–host interactions in the gut. These roles make miRNAs critically important for the prevention, diagnosis, and treatment of intestinal diseases. Here, we review the current knowledge on how different sources of EVs and miRNAs, including those from diets, gut microbes, and hosts, maintain gut microbial homeostasis and improve the intestinal barrier and immune function. We further highlight the roles of EVs and miRNAs in intestinal diseases, including diarrhea, inflammatory bowel disease, and colorectal cancer, thus providing a perspective for the application of EVs and miRNAs in these diseases.
Genetic Abnormalities of Oocyte Maturation: Mechanisms and Clinical Implications
Authors: Baldini Giorgio Maria , Ferri Daniele , Malvasi Antonio , Laganà Antonio Simone , Vimercati Antonella , Dellino Miriam , Baldini Domenico , Trojano Giuseppe
Published: December 2024

Genetic anomalies in oocyte maturation present significant fertility and embryonic development challenges. This review explores the intricate mechanisms of nuclear and cytoplasmic maturation, emphasizing the genetic and molecular factors contributing to oocyte quality and competence. Chromosomal mutations, errors in segregation, genetic mutations in signaling pathways and meiosis-related genes, and epigenetic alterations are discussed as critical contributors to oocyte maturation defects. The role of mitochondrial defects, maternal mRNA dysregulation, and critical proteins such as NLRP14 and BMP6 are highlighted. Understanding these genetic factors is crucial for improving diagnostic approaches and therapeutic interventions in reproductive medicine, particularly for couples encountering recurrent in vitro fertilization failures. This review will explore how specific genetic mutations impact fertility treatments and reproductive success by examining the intricate oocyte maturation process. We will focus on genetic abnormalities that may disrupt the oocyte maturation pathway, discussing the underlying mechanisms involved and considering their potential clinical implications for enhancing fertility outcomes.
Genomic Profiling in Glioma Patients to Explore Clinically Relevant Markers
Authors: Varachev Viacheslav , Susova Olga , Mitrofanov Alexei , Naskhletashvili David , Krasnov George , Ikonnikova Anna , Bezhanova Svetlana , Semenova Vera , Sevyan Nadezhda , Prozorenko Evgenii , Ammour Yulia , Bekyashev Ali , Nasedkina Tatiana
Published: December 2024

Gliomas are a heterogeneous group of brain tumors, among which the most aggressive subtype is glioblastoma, accounting for 60% of cases in adults. Available systemic treatment options are few and ineffective, so new approaches to therapies for glioblastoma are in high demand. In total, 131 patients with diffuse glioma were studied. Paired tumor–normal samples were sequenced on the Illumina platform; the panel included 812 genes associated with cancer development. Molecular profiles in clinically distinct groups were investigated. In low-grade glioma (LGG) patients (n = 18), the most common mutations were IDH1/2 (78%), ATRX (33%), TP53 (33%), PIK3CA (17%), and co-deletion 1p/19q (22%). In high-grade glioma (HGG) patients (n = 113), more frequently affected genes were CDKN2A/B (33%), TERTp (71%), PTEN (60%), TP53 (27%), and EGFR (40%). The independent predictors of better prognosis were tumor grade and IDH1/2 mutations. In IDH—wildtype glioblastoma patients, a history of other precedent cancer was associated with worse overall survival (OS), while re-operation and bevacizumab therapy increased OS. Also, among genetic alterations, TERTp mutation and PTEN deletion were markers of poor prognosis. Nine patients received molecular targeted therapy, and the results were evaluated. The search for molecular changes associated with tumor growth and progression is important for diagnosis and choice of therapy.
Fibroblast Heterogeneity in Inflammatory Bowel Disease
Authors: Ke Bo-Jun , Dragoni Gabriele , Matteoli Gianluca
Published: December 2024

Intestinal fibroblasts are pivotal players in maintaining tissue homeostasis and orchestrating responses to injury and inflammation within the gastrointestinal (GI) tract. Fibroblasts contribute significantly to the pathogenesis of inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis (UC), by secreting pro-inflammatory cytokines, modulating immune cell activity, and promoting fibrosis. In addition, fibroblasts play crucial roles in tissue repair and regeneration following acute injury or chronic inflammation. The dysregulation of fibroblast functions can lead to fibrotic complications, such as intestinal strictures and obstruction, which are common in advanced stages of IBD. Understanding the complex interplay between fibroblasts and other cell types in the intestine is essential to elucidate the underlying mechanisms of intestinal diseases and identify novel therapeutic targets. Future research aimed at deciphering the heterogeneity of intestinal fibroblasts and their dynamic roles in disease progression holds promise for the development of precision therapies to mitigate fibrosis and inflammation in intestinal disorders.
Monocyte/Macrophage-Specific Loss of ARNTL Suppresses Chronic Kidney Disease-Associated Cardiac Impairment
Authors: Yoshida Yuya , Nishikawa Naoki , Fukuoka Kohei , Tsuruta Akito , Otsuki Kaita , Fukuda Taiki , Terada Yuma , Tanihara Tomohito , Kumamoto Taisei , Tsukamoto Ryotaro , Nishi Takumi , Oyama Kosuke , Hamamura Kengo , Mayanagi Kouta , Koyanagi Satoru , Ohdo Shigehiro , Matsunaga Naoya
Published: December 2024

Defects in Aryl hydrocarbon receptor nuclear translocator-like 1 (ARNTL), a central component of the circadian clock mechanism, may promote or inhibit the induction of inflammation by monocytes/macrophages, with varying effects on different diseases. However, ARNTL’s role in monocytes/macrophages under chronic kidney disease (CKD), which presents with systemic inflammation, is unclear. Here, we report that the expression of Arntl in monocytes promoted CKD-induced cardiac damage. The expression of G-protein-coupled receptor 68 (GPR68), which exacerbates CKD-induced cardiac disease, was regulated by ARNTL. Under CKD conditions, GPR68 expression was elevated via ARNTL, particularly in the presence of PU.1, a transcription factor specific to monocytes and macrophages. In CKD mouse models lacking monocyte-specific ARNTL, GPR68 expression in monocytes was reduced, leading to decreased cardiac damage and fibrosis despite no improvement in renal excretory capacity or renal fibrosis and increased angiotensin II production. The loss of ARNTL did not affect the expression of marker molecules, indicating the origin or differentiation of cardiac macrophages, but affected GPR68 expression only in cardiac macrophages derived from mature monocytes, highlighting the significance of the interplay between GPR68 and ARNTL in monocytes/macrophages and its influence on cardiac pathology. Understanding this complex relationship between circadian clock mechanisms and disease could help uncover novel therapeutic strategies.
Cenobamate, a New Promising Antiseizure Medication: Experimental and Clinical Aspects
Authors: Błaszczyk Barbara , Czuczwar Stanisław J. , Miziak Barbara
Published: December 2024

About 40–50% of patients with drug-resistant epilepsy do not properly respond to pharmacological therapy with antiseizure medications (ASMs). Recently approved by the US Food and Drug Administration and European Medicines Agency as an add-on drug for focal seizures, cenobamate is an ASM sharing two basic mechanisms of action and exhibiting a promising profile of clinical efficacy. The drug preferably inhibits persistent sodium current and activates GABA-mediated events via extrasynaptic, non-benzodiazepine receptors. Thus, its antiseizure potential is dependent on both reducing excitation and enhancing inhibition in the central nervous system. In experimental seizure models, cenobamate exhibited a clear-cut activity in many of them with promising protective indexes, with only bicuculline-induced seizures being unaffected. Randomized clinical trials indicate that combinations of cenobamate, with already prescribed ASMs, resulted in significant percentages of seizure-free patients and patients with a significant reduction in seizure frequency, compared to other ASMs in the form of an add-on therapy. Its greater antiseizure efficacy was accompanied by adverse events comparable to other ASMs. Cenobamate has also been shown to possess neuroprotective activity, which may be of importance in affecting the process of epileptogenesis and, thus, modifying the course of epilepsy.
Electromyographic Activity of Cervical Muscles in Patients with Neck Pain and Changes After Dry Needling: A Narrative Review
Authors: Müller-Thyssen-Uriarte Julián , Lucha-López María Orosia , Hidalgo-García César , Sánchez-Rodríguez Rocío , Vicente-Pina Lucía , Ferrández-Laliena Loreto , Vauchelles-Barré Pierre , Tricás-Moreno José Miguel
Published: December 2024

Neck pain can be associated with specific conditions, such as neurological disorders, vascular or inflammatory diseases, fractures, herniated discs, etc. However, the majority of neck pain cases cannot be attributed to a specific cause. The objective of this review is to describe the muscle dysfunctions associated with neck pain, as measured by electromyography, and to determine the effectiveness of dry needling in improving these muscular dysfunctions. The research was conducted using the following databases: PubMed, Alcorze, and Google Scholar. The next conclusions have been extracted after the revision of the 65 selected manuscripts. The current scientific evidence supports electromyographic pathological findings in individuals with chronic neck pain, especially during general upper limb movement, repetitive work, violin playing, cervical force, and cervical movement tasks. Dry needling applied to an active myofascial trigger point in the upper trapezius can be suggested as an intervention to enhance the performance in the cranio-cervical flexion. Dry needling applied to latent myofascial trigger points in the upper trapezius after typing tasks in healthy subjects resulted in decreased upper trapezius activity and fatigue in the short term. In women with trapezius myalgia, dry needling applied to the upper trapezius led to a lower increase in electromyography activity compared to no intervention.
The Unappreciated Value of a Cheap, ‘Good Enough’ Method of Detecting Thyroid Cancer
Authors: Sciacchitano Salvatore , Rugge Massimo , Bartolazzi Armando
Published: December 2024

The advent of advanced molecular diagnostic techniques has revealed plenty of information about signaling pathways and gene regulation in cancer, as well as new inputs for the classification of cancer subtypes, diagnosis, prognosis, and prediction of response to therapy. However, in most cases we do not have single biomarkers yet and, therefore, the final diagnosis is often rendered by the combination of multiple results by means of complex algorithms, eventually leading to an increase in their costs. The problem of the costs of such tests is particularly relevant in the case of thyroid cancer (TC), because of the observed increase in the number of patients affected by thyroid nodules (TN)s, in what is considered a global pandemic. High-income countries can afford the cost of the advanced molecular tests for such a multitude of TNs, since they are covered by private insurances. People living in upper-middle, lower-middle, and especially in low-income countries, where the costs for these advanced molecular tests are supported by general taxation and out-of-pocket payments, are exposed as a personal financial burden. Immunohistochemistry in cancer management represents an extremely cost-effective method in different clinical scenarios. In the preoperative recognition of TC, the use of such method, based on Galectin-3 and others protein markers, such as HMBE1, proved to be effective in diagnosing TC in TNs indeterminate at conventional cytology (Bethesda classification III or IV), with an extremely low cost. Moreover, Galectin-3 fulfills one of the major criteria of an ideal marker, being involved in the thyroid cell transformation. Despite this evidence, Galectin-3 ThyroTest is not considered and not even mentioned in many reviews, focused on the appropriate identification of TC, as well as in studies where the cost-effectiveness of the different approaches is comparatively evaluated. The aim of this review is to emphasize the value of the Galectin-3 based immunohistochemistry as a cheap and “good enough” method in the preoperative diagnosis of TC especially in, but not limited to, low-middle income countries.
Immediate Effect of Compression Contrast Therapy on Quadriceps Femoris Muscles’ Regeneration in MMA Fighters
Authors: Trybulski Robert , Roczniok Robert , Gałęziok Kamil , Matuszczyk Filip , Bichowska-Pawęska Marta , Wilk Michał , Muracki Jarosław
Published: December 2024

Objectives: This study aimed to evaluate the immediate effect of Game Ready (GR) heat–cold compression contrast therapy (HCCT) on changes in the biomechanical parameters of the quadriceps femoris muscles and tissue perfusion. Methods: Fifteen male MMA fighters were subjected to HCCT on the dominant leg’s thigh and control sham therapy on the other. The experimental intervention used a pressure cuff with the following parameters: time—20 min; pressure—25–75 mmHg; and temp.—3–45°C, changing every 2 min. For the control group, the temp. of sham therapy was 15–36 °C, and pressure was 15–25 mmHg, changing every 2 min. Measurements were taken on the head of the rectus femoris muscle (RF) 5 min before therapy, 5 min after, and 1 h after therapy in the same order in all participants: microcirculatory response (PU), muscle tension (MT), stiffness (S), flexibility (E), tissue temperature (°C), and pressure pain threshold (PPT). Results: The analysis revealed significant differences between the HCCT and sham therapy groups and the measurement time (rest vs. post 5 min and post 1 h) for PU, MT, E, and °C (p < 0.00001) (a significant effect of time was found) in response to GR therapy. No significant differences were found for the PPT. Conclusions: The results of this study prove that GR HCCT evokes changes in the biomechanical parameters of the RF muscles and perfusion in professional MMA fighters.
Coldness or Darkness? Which Places Greater Stress on the Thyroid? Seasonal Changes in Thyroid-Stimulating Hormone and Thyroid Hormones
Authors: Tam Abbas Ali , Fakı Sevgul , Demir Pervin , Ozdemir Didem , Topaloglu Oya , Ersoy Reyhan , Cakir Bekir
Published: December 2024

Background: Although seasonal changes were suggested to be among the many factors that affect thyroid functions, this issue is still controversial. In this study, we aimed to investigate the possible relationship between seasonal changes and thyroid function. Methods: We retrospectively scanned all thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) values checked in our hospital between 2019 and 2023. Using the big data approach, we examined the relationship between TSH and thyroid hormones and monthly and seasonal recorded climatic changes, particularly the duration of daylight and temperature. Results: A total of 195,534 serum samples were analyzed for TSH, 195,491 for FT3, and 195,487 for FT4. There were significant differences in the values of TSH, FT3, and FT4 between months (p = 0.001 for TSH, p < 0.001 for FT3 and FT4). The months with the highest levels of TSH, FT3, and FT4 values were January, December, and June, while the months with the lowest levels were July, May, and March-April, respectively. The differences between the maximum and minimum median values were 14.5% for TSH, 4.9% for FT3, and 5.7% for FT4. From January to August, as the temperature rose, there was a decrease in TSH values. Between September and December, as the temperature decreased, an increase in TSH was observed. Conclusions: This study revealed that TSH, FT3, and FT4 show seasonal variability and change in temperature is an important factor that plays role in this variability. It would be appropriate to take these changes into consideration when interpreting thyroid function tests.
Counselling in Fetal Medicine: Complications of Monochorionic Diamniotic Twin Pregnancies
Authors: Sorrenti Sara , Khalil Asma , D’Antonio Francesco , D’Ambrosio Valentina , Zullo Fabrizio , D’Alberti Elena , Derme Martina , Mappa Ilenia , Di Mascio Daniele , Rizzo Giuseppe , Giancotti Antonella
Published: December 2024

Twin pregnancies are at increased risk of morbidity and mortality compared to singletons. Among all twins, monochorionic pregnancies are at higher risk of specific and non-specific complications compared to dichorionic pregnancies. Therefore, it is of great importance to properly counsel future parents with monochorionic pregnancies regarding the risks of adverse outcomes and the modalities of monitoring and intervention of the potential complications. Conditions related to the monochorionicity include twin-to-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence (TRAP), and twin anemia polycythemia syndrome (TAPS); other complications include selective fetal growth restriction (sFGR) and congenital anomalies. This review aims to summarize the information available in the current literature regarding the complications in monochorionic diamniotic twin pregnancies, including outcomes and guideline recommendations about the clinical surveillance, management, and timing of interventions of these conditions that should be included in counselling in routine clinical practice.
Clinical Application of 3D-Assisted Surgery Techniques in Treatment of Intra-Articular Distal Radius Fractures: A Systematic Review in 718 Patients
Authors: Roelofs Lisanne J. M. , Assink Nick , Kraeima Joep , ten Duis Kaj , Doornberg Job N. , de Vries Jean-Paul P. M. , Meesters Anne M. L. , IJpma Frank F. A.
Published: December 2024

Objectives: Three-dimensional (3D) technology is increasingly applied in the surgical treatment of distal radial fractures and may optimize surgical planning, improve fracture reduction, facilitate implant and screw positioning, and thus prevent surgical complications. The main research questions of this review were as follows: (1) “How do 3D-assisted versus 2D-assisted distal radius fracture surgery compare in terms of intraoperative metrics (i.e., operation time and fluoroscopy frequency)?”, and (2) ”What are the effects of 3D-assisted versus 2D-assisted surgery on postoperative outcomes (patient-reported outcome measures (PROMs), range of motion (ROM), fracture reduction, complication rate, and screw placement accuracy)?” Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. In total, 873 articles were found between 1 January 2010 and 1 April 2024, of which 12 (718 patients) were suitable for inclusion. The quality of the studies, assessed using the McMaster quality assessment, ranged from moderate to excellent, although the surgical techniques and outcome measures varied widely. Articles comparing a 3D group to a 2D group (conventional imaging) and reporting on primary or secondary outcomes were included in the analysis, for which weighted means and ranges were calculated. Results: Three different concepts of 3D-assisted surgery techniques were identified: (1) 3D virtual surgical planning (VSP), (2) 3D-printed handheld models, and (3) 3D intraoperative guides. Differences between 3D-assisted and conventional 2D-assisted surgery were evaluated. Regarding intraoperative metrics, 3D-assisted surgery significantly reduced operation time by 6 min (weighted mean 66.9 versus 73.2 min) and reduced the fluoroscopy frequency by 1.1 images (5.8 versus 4.7 times). Regarding postoperative outcomes, the weighted mean of the DASH score differed between the 3D- and 2D-assisted groups (17.8 versus 23.9 points), and no differences in PRWE or VAS score were found. Furthermore, our results showed no significant differences in the ROM and fracture reduction parameters. In terms of complications, the application of 3D-assisted surgery decreased the complication rate from 10.7% to 3.6%, and the use of screws with appropriate lengths improved from 75% to 86%. Conclusions: Applications of 3D-assisted surgery in distal radial fracture surgery can slightly reduce the operation time and fluoroscopy frequency. Evidence for the improvement of fracture reduction and functional outcomes is still lacking, although it likely reduces the complication rate and improves the use of appropriate screw lengths.
Diagnosis of Child Sexual Abuse
Authors: Csorba Roland , Atas Elfrink Zeynep , Tsikouras Panagiotis
Published: December 2024

Child sexual abuse (CSA) is a widespread and alarming issue, with an estimated global prevalence of 12–13% (affecting 18% of girls and 8% of boys). Despite its prevalence, many physicians working with children have insufficient knowledge of the medical diagnosis of CSA. This lack of expertise, combined with the sensitive and complex nature of these cases, often hampers proper identification and management. Diagnosing CSA is particularly challenging and requires specialized skills. A majority of children assessed for suspected sexual abuse present with normal genital and anal findings, which complicates the diagnostic process. Barriers such as professional isolation, societal taboos, and the sensitive nature of the subject often result in diagnostic failures. Accurate medical history taking, diagnosis, and documentation of findings are essential for ensuring a precise diagnosis, safeguarding children, and supporting legal proceedings. However, achieving these goals remains elusive without standardized guidelines and adequately trained healthcare professionals. Training of professionals in observing and reporting child sexual abuse is badly needed. This review explores the current state of medical diagnosis in suspected cases of CSA. This article is based on a selective review of pertinent literature retrieved from various databases, including PubMed and the overall index of the Quarterly Update.
Reviewing Evidence and Patient Outcomes of Cheilectomy for Hallux Rigidus: A Systematic Review and Meta-Analysis
Authors: Arceri Alberto , Di Paola Gianmarco , Mazzotti Antonio , Zielli Simone Ottavio , Artioli Elena , Langone Laura , Sgubbi Federico , Faldini Cesare
Published: December 2024

Background: Cheilectomy is a joint-sparing surgery for the treatment of moderate stages of Hallux Rigidus (HR). The purpose of this systematic review was to assess the clinical outcomes, range of motion (ROM), complications, and revision rates associated with cheilectomy. Methods: A literature search of the PubMed, Scopus, and Cochrane databases was performed. PRISMA guidelines were used. Risk of bias was assessed through the Newcastle–Ottawa Scale. Meta-analysis of the clinical outcomes scores was performed. Results: The initial search identified 317 articles, with 16 included. Cheilectomy improved ROM by 51.15% (41.23° to 62.32°), with greater gains in traditional (67.72%) vs. minimally invasive (48.74%) techniques. VAS decreased by 72.61%, more in traditional (79.35%) than minimally invasive (64.97%). AOFAS improved by 33.99%, from 61.83 to 82.85. Complications occurred in 11% (11.68% traditional, 9.73% minimally invasive), with residual pain (7.46%) more common in traditional and nerve injury (3.78%) in minimally invasive procedures. Revision rates were 7.4% overall (6.1% traditional, 8.8% minimally invasive). Conclusions: This procedure showed satisfactory results regardless of whether the traditional or minimally invasive technique is used. Current evidence does not allow for a definitive indication, but careful patient selection is advisable, particularly for mild to moderate cases.
A Review of the Literature on Videoscopic and Robotic Inguinal–Iliac–Obturator Lymphadenectomy in Patients with Cutaneous Melanoma
Authors: Matteucci Matteo , Bruzzone Paolo , Pinto Sabrina , Covarelli Piero , Boselli Carlo , Popivanov Georgi I. , Cirocchi Roberto
Published: December 2024

Inguinal–iliac–obturator lymph node dissection is essential in the treatment of patients with cutaneous melanoma exhibiting the clinical or radiological involvement of pelvic lymph nodes. The open procedure is associated with elevated mortality rates. Numerous minimally invasive approaches have been suggested to mitigate the impact of this surgery on the patient’s quality of life. The preliminary findings of robotic-assisted dissection have been documented in the literature. They demonstrate a decrease in potential issues linked to robotic-assisted treatments as compared to open or video laparoscopic methods. No implications have been reported for long-term oncological outcomes. The present study compares the outcomes in 64 patients with robotic procedures, 187 with videoscopic procedures, and 83 with open pelvic lymph node dissection (PLND). However, the quality of evidence is too low to draw any valid conclusions. The available literature shows that a robotic procedure is feasible and has similar complication rates and oncological outcomes to other methods. The reason for the shorter operative time is not clear, but is associated with lower hospital costs. It is probable that, from a surgeon’s point of view, robotic techniques offer several advantages over videoendoscopic techniques, such as three-dimensional imaging, ergonomic control, and tools that mimic human hand movements. Randomized controlled trials are necessary to validate the benefits of robotic inguinal–iliac–obturator lymph node dissection (RIIOL) compared to videoscopic and open procedures, but the recruitment rate is very low because of the restricted indications for lymph node dissection against the background of the continuously evolving system of therapy.
Reply to Maffulli, N.; Spiezia, F. Comment on “Foti et al. Identification of Achille’s Tendon Tears: Diagnostic Accuracy of Dual-Energy CT with Respect to MRI. J. Clin. Med. 2024, 13, 4426”
Authors: Foti Giovanni , Bortoli Luca , Tronu Matteo , Montefusco Sabrina , Serra Gerardo , Filippini Roberto , Iacono Venanzio
Published: December 2024

I need to thank my colleagues for their valuable comments on the recently published paper entitled “Identification of Achille’s Tendon Tears: Diagnostic Accuracy of Dual-Energy CT with Respect to MRI” [...]
Air Pollution and Myocardial Infarction—A New Smoker’s Paradox?
Authors: von Lewinski Friederike , Quehenberger Franz , Sacherer Michael , Taucher Valentin , Strohhofer Christoph , Ablasser Klemens , Verheyen Nicolas , Sourij Caren , Kainz Andreas , Wünsch Gerit , Berghold Andrea , Berghaus Thomas M. , Kanoun Schnur Sadeek Sidney , Zirlik Andreas , von Lewinski Dirk
Published: December 2024

Background/Objectives: Ambient air pollution is a significant public health concern, known to affect cardiovascular health adversely. Research has identified both long-term and short-term cardiovascular risks associated with various air pollutants, including those linked to acute coronary syndromes. However, the observed effects are rather small, with most data sourced from highly polluted regions. Methods: This study utilized a prospective registry database, documenting 12,581 myocardial infarction (MI) events in Styria, Austria from January 2007 to December 2015. Pollutants analyzed included particulate matter (PM2.5, PM10) and gases, such as NO2, CO, SO2, O3 and NOx. We employed generalized linear models to examine the interaction of each of these pollutants on the daily incidence of MI. Additionally, we conducted separate analyses for patients with specific comorbidities: diabetes mellitus (DM), arterial hypertension (HTN), heart failure with reduced ejection fraction (HFrEF), chronic obstructive pulmonary disease (COPD) and current smokers. Results: No significant associations were identified between any of the pollutants and MI incidence, both in the overall cohort and in patient subgroups with DM, HTN, HFrEF or COPD. However, among active smokers, we observed a decreased relative risk of MI associated with elevated levels of NO2, CO, SO2 and NOx on the day of MI (p < 0.01 for all pollutants). Conversely, an increased MI risk was associated with rising ozone levels (p = 0.0027). This counterintuitive finding aligns with previously published data and may suggest a new dimension to the “smoker’s paradox”. Conclusions: In regions with low pollution levels, air pollutants pose only minor or insignificant short-term risks for myocardial infarction. Active smokers exhibit an altered response to ambient air pollution.
Blood Transfusion Utilization in Patients with Severe Coronavirus Disease 2019 in the Republic of Korea: A Nationwide Population-Based Study
Authors: Oh Young Joo , Kim Jeong Yeon , Suh Jin Woong , Jeong Yujin , Choi Yumin , Lim Hyung-Jun , Sohn Jang Wook , Ahn Ki Hoon , Yoon Young Kyung
Published: December 2024

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected both supply and demand for blood transfusion. This study aimed to investigate the prescription patterns of blood products and identify the risk factors for blood transfusion in patients with severe COVID-19. Methods: This nationwide population-based cohort study was performed in the Republic of Korea between January 2021 and December 2021. Adult patients (≥19 years) with severe COVID-19 who received oxygen therapy were examined. Data were obtained from the National Health Insurance Service database. Results: During the study period, 41,203 patients developed severe COVID-19. The overall transfusion rate was 7.11%, with 14,477 units of packed red blood cells, 4501 units of fresh frozen plasma, 20,532 units of platelet concentrates, and 1875 units of cryoprecipitate. Blood transfusion was independently associated with 90-day mortality (hazard ratio: 1.36, 95% confidence interval: 1.21–1.53, p < 0.001). Multivariate logistic regression analysis identified underlying chronic kidney disease; exposure to surgery, thrombolysis, or thrombectomy; renal replacement therapy; mechanical ventilation; and extracorporeal membrane oxygenation as significant risk factors for blood transfusion in patients with severe COVID-19. Conversely, underlying cerebrovascular diseases, a Charlson Comorbidity Index score of ≥6, admission to intensive care units, and anticoagulant use were identified as protective factors. Conclusions: This study provides an overview of blood transfusion patterns in patients with severe COVID-19. Understanding these patterns may help optimize the stockpiling of medical resources.
CT-Guided Transthoracic Core-Needle Biopsy of Pulmonary Nodules: Current Practices, Efficacy, and Safety Considerations
Authors: Constantinescu Amalia , Stoicescu Emil Robert , Iacob Roxana , Chira Cosmin Alexandru , Cocolea Daiana Marina , Nicola Alin Ciprian , Mladin Roxana , Oancea Cristian , Manolescu Diana
Published: December 2024

CT-guided transthoracic core-needle biopsy (CT-TTNB) is a minimally invasive procedure that plays a crucial role in diagnosing pulmonary nodules. With high diagnostic yield and low complication rates, CT-TTNB is favored over traditional surgical biopsies, providing accuracy in detecting both malignant and benign conditions. This literature review aims to present a comprehensive overview of CT-TTNB, focusing on its indications, procedural techniques, diagnostic yield, and safety considerations. Studies published between 2013 and 2024 were systematically reviewed from PubMed, Web of Science, Scopus, and Cochrane Library using the SANRA methodology. The results highlight that CT-TTNB has a diagnostic yield of 85–95% and sensitivity rates for detecting malignancies between 92 and 97%. Several factors, including nodule size, lesion depth, needle passes, and imaging techniques, influence diagnostic success. Complications such as pneumothorax and pulmonary hemorrhage were noted, with incidence rates varying from 12 to 45% for pneumothorax and 4 to 27% for hemorrhage. Preventative strategies and management algorithms are essential for minimizing and addressing these risks. In conclusion, CT-TTNB remains a reliable and effective method for diagnosing pulmonary nodules, particularly in peripheral lung lesions. Advancements such as PET/CT fusion imaging, AI-assisted biopsy planning, and robotic systems further enhance precision and safety. This review emphasizes the importance of careful patient selection and procedural planning to maximize outcomes while minimizing risks, ensuring that CT-TTNB continues to be an indispensable tool in pulmonary diagnostics.
Looking Back, Leaning Forward—A Contemporary Overview of Acute Coronary Syndrome
Authors: Fardman Alexander , Chernomordik Fernando , Beigel Roy
Published: December 2024

Cardiovascular disease (CVD) remains the most common cause of morbidity and mortality worldwide [...]
Revolutionizing Radiology with Natural Language Processing and Chatbot Technologies: A Narrative Umbrella Review on Current Trends and Future Directions
Authors: Lastrucci Andrea , Wandael Yannick , Barra Angelo , Ricci Renzo , Pirrera Antonia , Lepri Graziano , Gulino Rosario Alfio , Miele Vittorio , Giansanti Daniele
Published: December 2024

The application of chatbots and NLP in radiology is an emerging field, currently characterized by a growing body of research. An umbrella review has been proposed utilizing a standardized checklist and quality control procedure for including scientific papers. This review explores the early developments and potential future impact of these technologies in radiology. The current literature, comprising 15 systematic reviews, highlights potentialities, opportunities, areas needing improvements, and recommendations. This umbrella review offers a comprehensive overview of the current landscape of natural language processing (NLP) and natural language models (NLMs), including chatbots, in healthcare. These technologies show potential for improving clinical decision-making, patient engagement, and communication across various medical fields. However, significant challenges remain, particularly the lack of standardized protocols, which raises concerns about the reliability and consistency of these tools in different clinical contexts. Without uniform guidelines, variability in outcomes may hinder the broader adoption of NLP/NLM technologies by healthcare providers. Moreover, the limited research on how these technologies intersect with medical devices (MDs) is a notable gap in the literature. Future research must address these challenges to fully realize the potential of NLP/NLM applications in healthcare. Key future research directions include the development of standardized protocols to ensure the consistent and safe deployment of NLP/NLM tools, particularly in high-stake areas like radiology. Investigating the integration of these technologies with MD workflows will be crucial to enhance clinical decision-making and patient care. Ethical concerns, such as data privacy, informed consent, and algorithmic bias, must also be explored to ensure responsible use in clinical settings. Longitudinal studies are needed to evaluate the long-term impact of these technologies on patient outcomes, while interdisciplinary collaboration between healthcare professionals, data scientists, and ethicists is essential for driving innovation in an ethically sound manner. Addressing these areas will advance the application of NLP/NLM technologies and improve patient care in this emerging field.
Novel Therapies for Inherited Retinal Dystrophies
Authors: Kay Christine Nichols
Published: December 2024

With the approval of the first retinal gene therapy, voretigene neparvovec [...]
The First Patient in Poland Treated for SMA with Nusinersen During Pregnancy
Authors: Stawicka Elżbieta , Skarżyńska Urszula , Lipiec Agata , Mazanowska Natalia , Stankiewicz Joanna , Gos Monika , Wyszczelska-Namięta Milena
Published: December 2024

Background: The accessibility of effective SMA (spinal muscular atrophy) treatment is resulting in a growing number of affected women reaching fertility age and deciding to conceive. Pregnancy in women with SMA is associated with a high risk of rapid progression of symptoms, including increased weakness, growing paresis, or even onset of respiratory failure requiring ventilation support. Muscle weakness frequently leads to disability, which in a high percentage is irreversible. Pre-term labor and delivery by cesarean section are the most commonly described cases in the literature. Methods: This paper aims to describe the first case in Europe, a 21-year-old patient treated with Nusinersen under the drug program during the third trimester of pregnancy. Despite the significant progression of the disease during pregnancy, the patient did not lose gait function. The pregnancy was ended at 33Hbd, and the baby’s condition was unremarkable. In addition to clinical data, this paper also discusses the economic aspects. Conclusions: Thanks to the rapid initiation of treatment, the patient did not lose her ability to walk, and a significant improvement in motor function was observed after the postpartum period. No side effects or negative effects on the fetus were observed.
Lower Urinary Tract Dysfunction Among Patients Undergoing Surgery for Deep Infiltrating Endometriosis: A Prospective Cohort Study
Authors: Villiger Anna-Sophie , Hoehn Diana , Ruggeri Giovanni , Vaineau Cloé , Nirgianakis Konstantinos , Imboden Sara , Kuhn Annette , Mueller Michael David
Published: December 2024

Background/Objectives: Postsurgical lower urinary tract dysfunction (LUTD) is a common problem following deep infiltrating endometriosis (DIE) resection. The condition may be caused either by surgically induced damage to the bladder innervation or by pre-existing endometriosis-associated nerve damage. The aim of this study is to evaluate the efficacy of preoperative and postoperative multichannel urodynamic testing (UD) in identifying pre-existing or surgically induced LUTD among patients with DIE. Methods: Women with suspected DIE and planned surgical resection of DIE at the Department of Obstetrics and Gynecology at the University Hospital of Bern from September 2015 to October 2022 were invited to participate in this prospective cohort study. UD was performed before and 6 weeks after surgery. The primary outcome was the maximum flow rate (uroflow), an indicator of LUTD. Secondary outcomes were further urodynamic observations of cystometry and pressure flow studies, lower urinary tract symptoms (LUTS) as assessed by the International Prostate Symptom Score (IPSS), and pain as assessed by the visual analog scale (VAS). Results: A total of 51 patients requiring surgery for DIE were enrolled in this study. All patients underwent surgical excision of the DIE. The cohort demonstrated a uroflow of 22.1 mL/s prior to surgery, which decreased postoperatively to 21.5 mL/s (p = 0.56, 95%CI −1.5–2.71). The mean bladder contractility index (BCI) exhibited a notable decline from 130.4 preoperatively to 116.6 postoperatively (p = 0.046, 95%CI 0.23–27.27). Significant improvements were observed in the prevalence of dysmenorrhea, abdominal pain, dyspareunia, and dyschezia following surgical intervention (p = <0.001). The IPSS score was within the lower moderate range both pre- and postoperatively (mean 8.37 vs. 8.51, p = 0.893, 95%CI −2.35–2.05). Subgroup analysis identified previous endometriosis surgery as a significant preoperative risk factor for elevated post-void residual (43.6 mL, p = 0.026, 95%CI 13.89–73.37). The postoperative post-void residual increased among participants with DIE on the rectum to 54.39 mL (p = 0.078, 95%CI 24.06–84.71). Participants who underwent hysterectomy exhibited a significantly decreased uroflow (16.4 mL/s, p = 0.014, 95%CI 12–20) and BCI (75.1, p = 0.036, 95%CI 34.9–115.38). Conclusions: Nerve-respecting laparoscopy for DIE may alter bladder function. UD is not advisable before surgery, but the measurement may detect patients with LUTD.
Usefulness of Point-of-Care Testing for Respiratory Viruses in a Pediatric Emergency Department Setting
Authors: Bellini Tommaso , Fueri Elena , Formigoni Clelia , Mariani Marcello , Villa Giovanna , Finetti Martina , Marin Marta , De Chiara Elena , Bratta Anna , Vanorio Barbara , Casabona Federica , Pepino Carlotta , Castagnola Elio , Piccotti Emanuela , Moscatelli Andrea
Published: December 2024

Background: Respiratory tract infections (RTIs) are a leading cause of pediatric emergency department (PED) visits, especially in children under five. These infections are primarily viral, complicating diagnosis and management. This study assesses the impact of point-of-care (POC) rapid diagnostic tests for respiratory viruses on clinical and economic outcomes in a PED setting. Materials and Methods: A retrospective analysis of 1396 POC tests for RSV, adenovirus, and influenza A/B was conducted in the PED of the Giannina Gaslini Institute, Genoa, Italy, from December 2022 to April 2024. Demographics, blood tests, admissions, and readmission rates were evaluated. Statistical analyses were performed using appropriate tests for categorical and continuous variables. Results: Of the tests, 31.5% were positive for at least one virus. Positive patients were younger and had higher hospitalization rates (50.7% vs. 39.9%) but fewer blood tests (38.2% vs. 51.7%). Economic analysis indicated lower costs for virus-positive patients. RSV-positive patients showed a significant association with higher hospitalization rates (67.8%) and readmission within 72 h. Conclusions: POC testing significantly improves patient management in PEDs by enabling rapid diagnoses, reducing unnecessary tests and hospitalizations, and guiding appropriate treatment. This approach supports better resource allocation, crucial during peak seasons, and has implications for reducing antibiotic use and resistance. Further research is warranted to explore long-term impacts on patient outcomes and healthcare efficiency.
Lung Cancer with Brain Metastasis—Treatment Strategies and Molecular Characteristics
Authors: Wang Shuai , Uriel Matan , Cheng Haiying
Published: December 2024

Lung cancer is a leading cause of brain metastases (BMs), with 10–20% of patients with non-small cell lung cancer (NSCLC) presenting with BMs at diagnosis and 25–50% developing them over the course of their disease. Historically, BMs have posed significant therapeutic challenges, partly due to the blood brain barrier (BBB), which restricts drug penetration to the central nervous system. Consequently, BMs were initially managed with local treatments, including surgical resection, stereotactic radiosurgery, and whole brain radiation therapy. In recent years, however, systemic treatments for BMs have advanced significantly, particularly with the development of molecularly-targeted therapies and immunotherapies. The discovery of driver mutations and the development of novel tyrosine kinase inhibitors (TKIs) have yielded encouraging intracranial responses in NSCLC patients with actionable genetic alterations (e.g., EGFR, ALK, ROS1). Genomic profiling has also suggested genetic heterogeneity between BMs and primary sites. Immunotherapies, alone or in combination with other treatments, have demonstrated promising results in NSCLC with BMs, although most clinical trials have included only selected patients with asymptomatic or previously treated BMs. In this review, we discuss the molecular and immune characteristics of NSCLC with BMs, analyze intracranial efficacy findings from clinical trials, and explore treatment strategies for lung cancer patients with BMs.