bluuebunny/crossref_metadata_2025 huggingface dataset:
Observation on the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP) with preservation of the urethral mucosa from the bladder neck to the tip of the prostate for the treatment of benign prostatic hyperplasia
Authors: Qiu Lei , Gu Zhibo , Pan Yongsheng , Zhang Yong , Chen Jiangang
Published: November 2024

This study investigates the efficacy and safety of transurethral prostate laser resection (HoLEP) with preservation of the urethral mucosa from the bladder neck to the tip of the prostate for the treatment of benign prostatic hyperplasia (BPH). A retrospective study was conducted on 208 patients with BPH treated at our hospital. In the control group, the urethral mucosa from the bladder neck to the tip of the prostate was not retained during surgery to ensure maximum removal of possible diseased tissue. The urethral mucosa was preserved in the observation group, which was finely separated to avoid injury, in order to protect urinary control function to the greatest extent and reduce postoperative complications. The surgical-related indicators, urinary function, sexual function, quality of life (QOL), and occurrence of postoperative complications were compared between the 2 groups of patients. After the procedure, both groups of patients experienced an increase in maximum flow rate and a decrease in residual urine volume (P < .05). The observation group showed a higher immediate postoperative urinary continence rate of 98.23% compared to 85.26% in the control group (P < .05). After the procedure, both groups of patients exhibited a significant increase in International index of erectile function-5 scores (P < .05). The retrograde ejaculation rates were compared between the 2 groups of patients before the procedure (P > .05). After the procedure, the occurrence rate of retrograde ejaculation decreased in both groups of patients, with the observation group being lower than the control group (P < .05). The International prostate symptom score (IPSS) scores and QOL scores were compared between the 2 groups of patients before and after the procedure (P > .05). After the procedure, both groups of patients showed a decrease in IPSS scores and QOL scores compared to before the procedure (P < .05). The occurrence of complications such as urethral injury, urinary incontinence, urinary retention, and postoperative bleeding was compared between the 2 groups of patients (P > .05). The efficacy and safety of performing HoLEP treatment for BPH patients with preservation of the urethral mucosa from the bladder neck to the tip of the prostate are comparable to those without preservation. However, it can improve immediate urinary continence rate and reduce retrograde ejaculation rate.
Short term efficacy and safety of PD-1 inhibitor and apatinib plus S-1 and oxaliplatin as neoadjuvant chemotherapy for patients with locally advanced gastric cancer
Authors: Tang Yunchuan , Dai Li , Wang Zhiqin , Zhang Meifeng , Xie Haitao , Yang Yunshan , Zhou Yongjin , Yan Zhiqiang , Wang Haibin , Yang Hongxin , Zhang Lei , He Tong , Chen Jiaju , Wang Guanghai , Jin Xiangren , Wang Qian
Published: November 2024

Surgical resection is the cornerstone of treatment for locally advanced gastric cancer (LAGC). Hence, downstaging of the tumor with neoadjuvant therapy is critical for R0 resection and prolongs the overall survival. Data from related studies are lacking, and the literature is scarce. Therefore, a single arm-study was performed on PD-1 inhibitor and apatinib plus S-1 and oxaliplatin as neoadjuvant chemotherapy for patients with LAGC. The findings are expected to serve as a reference for neoadjuvant therapy for LAGC. We assessed 130 LAGC patients using PD-1 inhibitor, apatinib plus S-1, and oxaliplatin as neoadjuvant chemotherapy from January 2021 to October 2022. A total of 104 patients received gastric transcatheter chemoembolization (GTC). The primary endpoint was the rate of clinical complete response, pathological complete response, and safety, while the secondary endpoints were the R0 resection rate and objective response rate of the disease and the disease control rate. A total of 130 patients completed the clinical assessment, of which 6 patients (4.6%) achieved clinical complete response, 87 patients (66.9%) achieved partial response, 30 patients (23.0%) achieved stable disease, and 7 patients (5.5%) experienced progressive disease. The overall response rate was 71.5% (93/130), and the disease control rate was 94.5% (123/130). A remarkable downstaging effect was observed in this study. Downstaging of the T stage and N stage was achieved in 71.5% and 80% of the patients, respectively, which translated into a high R0 resection rate. The findings revealed that 125 patients underwent R0 resection, and the R0 resection rate was 96.1%. According to the observed results, 21.6% of the patients achieved pathological complete response after neoadjuvant chemotherapy. Gastric transcatheter chemoembolization in the first cycle of neoadjuvant therapy was beneficial for tumor regression (P < .001). All adverse events were relieved and disappeared after symptomatic treatment, and no grade 4 adverse events were noted. PD-1 inhibitor and apatinib plus S-1 and oxaliplatin are safe and effective as neoadjuvant treatment of LAGC. Gastric transcatheter chemoembolization is useful for tumor regression during neoadjuvant therapy.
Reoperation after short-segment lumbar spinal fusion surgery in dialysis patients: A retrospective cohort study
Authors: Inoue Tomohisa , Wada Keiji , Sugaya Jun , Okazaki Ken , Doi Toru
Published: November 2024

Patients with dialysis are at high risk of reoperation after lumbar spinal fusion surgery. However, the risk of reoperation after short-segment (≤2 fusion levels) lumbar spinal fusion surgery in this patient group has not been completely investigated. This study aimed to compare the risk of reoperation after short-segment lumbar spinal fusion surgery between patients with dialysis and matched controls without dialysis. We retrospectively evaluated 85 patients who underwent short-segment lumbar spinal fusion surgery at a single institution. Based on the current dialysis treatment, patients were divided into the non-dialysis and dialysis groups. We compared the patients’ characteristics, surgical data, pre- and postoperative radiographic measurements, locomotive functional levels in activities of daily living (ADL), rate of whole reoperation, and cause-specific incidence of reoperation such as adjacent segmental disease (ASD) and implant failure between the non-dialysis and dialysis groups. Then, these variables were compared after adjusting for age, sex, and body mass index (BMI) via a propensity-score-matched analysis. In total, 68 patients in the non-dialysis group and 17 patients in the dialysis group were included in this study. The dialysis group was significantly younger and had a lower postoperative ADL status than the non-dialysis group. Moreover, the dialysis group had a significantly higher rate of whole reoperation (8.8% vs 41.2%, P = .003), reoperation due to ASD (4.4% vs 23.5%, P = .027), and reoperation due to implant failure (0.8% vs 11.8%, P = .038) than in the non-dialysis group. Based on a propensity-score-matched analysis, the dialysis group had a significantly higher rate reoperation rate after short-segment lumbar spinal fusion surgery than the non-dialysis group (0.0% vs 58.3%, P = .005). The current study firstly clarified that patients with dialysis are at significantly high risk of reoperation even after short-segment lumbar spinal fusion surgery.
Clinical risk factors to predict prognosis in wake-up stroke patients: A retrospective study
Authors: Xu Qiwu , Hu Miaomiao , Tan Guoxiang , Zhao Yong , Yin Hao , Ding Ting , Zhou Ying
Published: November 2024

This study aimed to develop and validate a clinical risk model based on clinical factors to predict prognosis in patients with wake-up stroke (WUS) after multimodal magnetic resonance imaging combined with recombinant tissue plasminogen activator intravenous thrombolysis. The study enrolled 263 patients with WUS, who were divided into the training (n = 162) and validation cohorts (n = 101). In the training cohort, patients were stratified based on modified Rankin Scale (mRS) score at 90 days after thrombolysis, with mRS ≤ 2 indicating a good prognosis (n = 117), and mRS > 2 indicating a poor prognosis (n = 45). Multivariate regression analyses were employed to identify independent risk factors and develop clinical risk models. The performance and stability of the clinical risk model were evaluated using receiver operating characteristic analysis and Hosmer–Lemeshow test. The clinical risk nomogram was constructed based on this model, and evaluated using decision curve analyses. Patients with poor prognosis showed a higher proportion of hyperlipidemia and diabetes and showed a higher levels of National Institute of Health Stroke Scale (NIHSS) at admission, NIHSS at 24 hours, triglyceride, and total cholesterol. Diabetes (odds ratio [OR] = 3.823), hyperlipidemia (OR = 7.361), NIHSS at admission (OR = 5.399), NIHSS at 24 hours (OR = 2.869), triglyceride (OR = 13.790), and total cholesterol (OR = 9.719) were independent predictors of poor prognosis in patients with WUS. Hosmer–Lemeshow test showed that the clinical risk model had a good fit in the training (χ
2 = 19.573, P = .726) and validation cohorts (χ

2
 = 19.573, P = .726). The clinical risk model had an area under the curve value of 0.929 (95% confidence interval, 0.886–0.978) in the training cohort and 0.948 (0.906–0.989) in the validation cohort. The decision curve analysis indicated clinical risk nomogram has application value. The clinical risk model can effectively predict WUS prognosis outcomes.
Is intralymphatic immunotherapy effective and safe for allergic rhinitis?: A meta-analysis
Authors: Liu Liangrong , Liang Yacheng , Yan Le , Li Zhiyong
Published: November 2024

Background:

As there is much controversy in using intralymphatic immunotherapy (ILIT) as a therapeutic means for allergic rhinitis (AR), its efficacy and safety for AR were investigated based on a systematic review and meta-analysis.

Methods:

Databases PubMed, Embase, Cochrane library, and Web of Science were employed to retrieve relevant randomized control studies on ILIT for AR. The search deadline was September 15, 2023. Meta-analysis was performed on the data of the included literature using Stata 15.0.

Results:

Eleven randomized control studies were included involving a total of 406 patients. Meta-analysis results revealed that ILIT improved patients’ quality of life [standardized mean difference (SMD) = ‐0.53, 95% confidence interval (CI) = (‐1.00, ‐0.050)], and reduced the adverse events of nasal symptoms [risk ratio (RR) = 0.16, 95% CI = (0.06, 0.45)] as compared to control, whereas no significant difference was discovered in symptom score [SMD = 0.14, 95% CI = (‐0.34, 0.62)], IgE [SMD = 0.93, 95% CI = (‐0.44, 2.30)], medication scores [SMD = 1.37, 95% CI = (‐0.45, 3.18)], comprehensive symptom and medication scores [SMD = 0.93, 95% CI = (‐0.62, 2.47)], nasal symptoms [RR = 0.16, 95% CI = (0.06, 0.45)], and lymphadenectasis [RR = 2.27, 95% CI = (0.37, 6.73)] versus control.

Conclusion:

After the application of the ILIT strategy against AR, the quality of life of patients was improved and the incidence of adverse events associated with nasal symptoms was reduced, but the conclusion needed further verification with more high-quality research.
Efficacy and safety of percutaneous mechanical circulatory support in patients with cardiogenic shock following acute myocardial infarction: A meta-analysis of randomized controlled trials
Authors: Tariq Muhammad Daoud , Jain Hritvik , Khan Abdul Moiz , Shahnoor Syeda , Goyal Priya , Zulfiqar Eeshal , Ahsan Areeba , Jaiswal Vikash , Daoud Mohamed , Sohail Amir Humza
Published: November 2024

Background:

Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI) with high mortality rates. While mechanical circulatory support devices like intra-aortic balloon pump (IABP) and Impella are used to manage CS, their comparative effectiveness remains unclear. This meta-analysis aims to evaluate the safety and efficacy of Impella in the treatment of AMI-associated CS.

Methods:

A comprehensive literature search was performed across PubMed, EMBASE, Google Scholar, SCOPUS, and Web of Science. The primary efficacy endpoint was 6-month all-cause mortality. Secondary efficacy endpoints included 30-day mortality, major bleeding, limb ischemia, sepsis, and left ventricular ejection fraction. Pooled odds ratios (OR) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random-effects model via Revman version 5.4. Statistical significance was determined at P < .05.

Results:

Four RCTs with a total of 442 patients were included in this meta-analysis. The pooled analysis showed that the odds of 6-month all-cause mortality were significantly lower with Impella compared to standard of care (OR: 0.64, 95% CI: 0.43–0.95; P value: .03). However, 30-day mortality reported no statistically significant difference between the 2 groups (OR: 1.03; 95% CI: 0.43–2.48; P = .95). Our analysis found that the use of impella is associated with a statistically significant increase in the odds of major bleeding (OR: 3.61; 95% CI: 1.14–11.40; P = .03), limb ischemia (OR: 4.91; 95% CI: 1.37–17.59; P = .01), and sepsis (OR: 2.75; 95% CI: 1.25–6.08; P = .01). No statistical significance was found in left ventricular ejection fraction at follow-up between the 2 groups (SMD: −0.35; 95% CI: −0.78 to 0.07; P = .11).

Conclusion:

Impella significantly reduces 6-month all-cause mortality in patients with CS following AMI compared to standard of care. However, this survival benefit is offset by a substantial increase in major bleeding, limb ischemia, and sepsis risks associated with Impella. Future large scale trials are needed to validate these findings and refine clinical guidelines for the optimal use of Impella in treating CS.
Evaluation of empirical antibiotic use in diabetic foot infections at a tertiary hospital in Vietnam: A retrospective study
Authors: Tran Nam Quang , Dang Trang Nguyen Doan , Vo Cam Thai Nguyet , Nguyen Thu Thi Anh , Pham Quoc Nguyen Bao , Do Minh Duc
Published: November 2024

Empirical antibiotic prescription guidelines were developed at the University Medical Center Ho Chi Minh City in 2020, which included recommendations for the use of antibiotics to treat diabetic foot infections (DFIs). This study investigated the treatment outcomes when implementing empirical antibiotic guidelines. This retrospective study included 120 inpatients with DFIs at the Department of Endocrinology, University Medical Center Ho Chi Minh City. This study had 2 periods (before and after implementation of hospital antibiotic guidelines): Period 1 from July 2019 to June 2020 and Period 2 from July 2021 to June 2022, with 60 random patients in each period. Treatment outcomes were assessed as follows: improvement (defined as the absence of fever and a white blood cell count within the normal range) at 72 hours and 7 days; duration of hospitalization; and clinical status at hospital discharge. After implementing empirical antibiotic guidelines, a greater proportion of improvement in the first 7 days of hospitalization (75.0% vs 56.7%, P = .03), and a shorter median duration of hospitalization (12.5 days vs 15.0 days, P = .02) were observed in patients with DFIs. All the patients showed improvement at the time of hospital discharge. The study findings revealed the encouraging effects of implementing empirical antibiotic prescription guidelines for DFI treatment.
Metabolic syndrome among patients with type 2 diabetes in Jordan: A cross-sectional study
Authors: Hyassat Dana , Al-Refai Ala’a , Khader Yousef S. , Juweid Malik E. , AlSharaydeh Saja , Layyous Nadera , Aljabiry Husam , AlDurgham Ahmad , Baqain Laith Z. , Abu Summaqa Joud , Al-Shimi Rana , Atieh Fatima Mohammad , Mahasneh Awn , Alaraj Shaker , Al-wakfi Alanoud , Mahafza Omar , EL-Khateeb Mohammad , Ajlouni Kamel
Published: November 2024

Metabolic syndrome is a major public health problem worldwide and an independent predictor of cardiovascular disease in patients with type 2 diabetes (T2DM). This study aimed to determine the prevalence of metabolic syndrome and its individual components among Jordanian patients with T2DM. A cross-sectional design was conducted among T2DM patients at the National Center for Diabetes, Endocrinology and Genetics in Jordan. Data were collected using a structured questionnaire and clinical data extracted from medical records. The National Cholesterol Education Program-Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) diagnostic criteria were used to define metabolic syndrome. Among 1017 participants aged between 22 and 90 years, the overall prevalence of IDF defined metabolic syndrome was 84.2% (72.5% and 96.2% among males and females, respectively). Using ATP III criteria, overall prevalence was 79.1% (77.4% and 80.8% among males and females, respectively). Advancing age, female gender, nonadherence to a diet regimen, sedentary lifestyle or insufficient physical activity, and duration of diabetes ≥10 years were significantly associated with increased odds of metabolic syndrome, regardless of the definition used. Current smoking status and family history of cardiovascular diseases were significantly associated with increased likelihood of ATP III defined metabolic syndrome. The prevalence of metabolic syndrome among Jordanian patients with T2DM is extremely high. The main modifiable risk factors of metabolic syndrome among these patients include nonadherence to a diet regimen, insufficient physical activity, being overweight/obese and smoking. It is recommended that healthcare providers counsel patients on the importance of maintaining physical activity, smoking cessation, and adherence to a diet regimen.
Neutrophil phenotypes in prolonged labor: Implications for therapeutic strategies
Authors: Obeagu Emmanuel Ifeanyi , Obeagu Getrude Uzoma
Published: November 2024

Prolonged labor, defined as labor extending beyond 20 hours for nulliparas and 14 hours for multiparas, poses significant risks to both maternal and neonatal health. The inflammatory response plays a crucial role in the pathophysiology of prolonged labor, with neutrophils being key players in this process. Neutrophils, the most abundant leukocytes, exhibit diverse phenotypes and functions in response to prolonged labor, influencing both the onset and progression of labor through their inflammatory actions. Classical neutrophils (N1) are involved in acute inflammatory responses, aiding in tissue remodeling and labor onset, but their prolonged activation can lead to tissue damage. Regulatory neutrophils (N2), which produce anti-inflammatory cytokines, help resolve inflammation and facilitate labor progression. Low-density granulocytes and aged neutrophils, associated with chronic inflammation and impaired function respectively, contribute to labor complications. The balance among these neutrophil phenotypes is crucial for maintaining a controlled inflammatory response during labor. Therapeutic strategies targeting neutrophil recruitment, NETosis, and cytokine production hold promise for managing prolonged labor. Modulating chemokine pathways, regulating NET formation, and balancing cytokine profiles may reduce inflammation and improve labor outcomes. Further research into the mechanisms of neutrophil regulation and the development of targeted therapies is essential for mitigating the adverse effects of prolonged labor and enhancing maternal and neonatal health.
Changes of coronary blood flow before and after post-dilation following primary percutaneous coronary intervention in patients with STEMI
Authors: Xu Meng-Cheng , Zhao Maolin
Published: November 2024

This retrospective cohort study aimed to examine changes in coronary blood flow before and after post-dilation following primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI). 419 eligible patients who underwent PPCI due to STEMI between January 2019 and September 2023 were enrolled. The corrected thrombolysis in myocardial infarction frame count (CTFC), final quantitative coronary angiography, and the incidence of no-reflow and slow-flow during different procedure moments were assayed. The changes in coronary blood flow before and after post-dilation in the post-dilation group were analyzed. Among the 419 patients enrolled, 259 patients underwent post-dilation. The post-dilation procedure was more frequently performed in patients with calcium plaque present, longer stents, bigger-diameter stents, and overlapping stents. The incidence of final no-reflow and slow-flow in the post-dilation group was not significantly higher than that observed in the non-post-dilation group. In contrast post-dilation patients had significantly increased CTFC values by 3.54 ± 10.54 frames (P < .001) and the rate of no-reflow/slow-flow increased on average by 114% (P < .001) in comparison to patients not undergoing post-dilation. The receiver operating characteristic curve showed that if post-dilation was performed in patients when their after-stent CTFC was smaller than 23.25, no-reflow/slow-flow was less likely to occur (63.5% sensitivity, 88.8% specificity, [AUC]: 0.817, 95% CI: 0.749–0.886, P < .001). Post-dilation exacerbates the coronary blood flow and increases the incidence of no-reflow/slow-flow during PPCI for STEMI patients, except where after-stend CTFC values were <23.25.
Psychological determinants and evidence-based behavior change interventions in adherence to therapy for familial hypercholesterolemia
Authors: Hagger Martin S. , Hamilton Kyra
Published: November 2024

Purpose of review

Patients with familial hypercholesterolemia have an elevated risk of premature atherosclerotic cardiovascular disease. Risks can be minimized through pharmacological and ‘lifestyle’ behavioral (low fat diet, physical activity) therapies, although therapeutic adherence is sub-optimal. Behavioral interventions to promote familial hypercholesterolemia therapy adherence should be informed by theory-based psychological determinants for maximal efficacy. The current review summarizes research on determinants of familial hypercholesterolemia therapy adherence and behavior change interventions, identifies limitations of the extant research, and sets future research agenda.

Recent findings

A recent meta-analysis identified attitudes, subjective norms, self-efficacy, and risk perceptions as key determinants of familial hypercholesterolemia therapy adherence intentions, with intentions identified as a key correlate of concurrent behavior. Studies have specified techniques targeting key theory-based determinants that may be efficacious in interventions. Research is limited by overuse of cross-sectional correlational study designs, use of self-report behavioral measures, few theory-based intervention tests, and limited consideration of nonconscious processes and effects of socio-structural variables.

Researchers should adopt study designs permitting better directional and causal inferences in determinant effects, provide tests of interventions targeting determinants and their mechanisms of action, consider determinants representing nonconscious processes (habits, implicit attitudes), and test determinants as mediators of socio-structural variables on familial hypercholesterolemia therapy adherence.
Local and systemic biodistribution of a small-molecule radiopharmaceutical probe after transcatheter embolization and intra-arterial delivery in a porcine orthotopic renal tumor model
Authors: Rice Samuel L. , Muñoz Fernando Gómez , Benjamin Jamaal L. , Alnablsi Mhd Wisam , Osborne Joseph R. , Beets-Tan Regina
Published: November 2024

Background

Small-molecule biomacromolecules target tumor-specific antigens. They are employed as theranostic agents for imaging and treatment. Intravenous small-molecule radioligands exhibit rapid tumor uptake and excretion. However, systemic administration for peptide receptor radionuclide therapy still lacks the therapeutic index to completely treat solid tumors beyond palliation. We study intra-arterial delivery with tumor embolization of a small molecule as a means to deliver local intertumoral brachytherapy for curative internal ablation.

Results

18F-fluorodeoxyglucose (FDG) was used as a surrogate for a small-molecule theranostic agent in a porcine renal tumor model, this tumor model is not known to specifically express human tumor antigens, but the model demonstrates similar vascularity. Angiography and micron particle embolization of the tumor arterioles were performed in a renal tumor model. Significantly more tumor uptake (2–4×), was observed for intra-arterial administration (IA) compared to intravenous (IV) (%ID/g = 44.41 ± 2.48 vs. 23.19 ± 4.65; P = 0.0342 at 1 min and 40.8 ± 2.43 vs. 10.94 ± 0.42; P = 0.018 at 10 min). At later time points, up to 120 min after injection, washout of the tracer from the tumor was observed, but the percent injected dose per gram remained elevated, with three times higher concentration of FDG with IA administration compared with IV, but the difference was not statistically significant. A trend towards diminished systemic percent injected dose per gram measured in the blood, liver, kidney, spleen, muscle, and urine for study IA compared to IV administration is observed.

Conclusion

Combining IA administration of a small-molecule radioprobe surrogate with embolization of the tumor’s arterioles extending the time for interaction of the drug within the tumor by diminishing flow out of the tumor via the efferent capillaries significantly increases the first-pass uptake of the small-molecule drug within a tumor and decreases the radiation to normal nontumor tissues when compared with IV injection of the same drug. The minimally invasive drug delivery allows tumor-specific theranostic treatment of renal tumors with a brachytherapy-absorbed dose of radiation that is potentially curative.
Updates on therapeutic endoscopic ultrasound
Authors: Wahba George , Lee Jeffrey H.
Published: November 2024

Purpose of review

Multiple endoscopic ultrasound (EUS) guided therapeutic interventions have been developed for the management of benign and malignant pancreaticobiliary and gastrointestinal luminal pathology. Recent high-quality evidence is increasingly validating these interventions and positioning them within evidence-based therapeutic algorithms.

Recent findings

Here we review therapeutic EUS-guided interventions including pancreatic fluid collection drainage, gastroenterostomy, biliary drainage, pancreatic duct drainage and gallbladder drainage. The most up-to-date high-quality evidence supporting these interventions is presented including comparative data with other conventional treatment options. Newer emerging interventions such as tumor ablation are also reviewed. Current controversies and future avenues for research are discussed. The key role of EUS-guided interventions in managing pancreaticobiliary pathology in patients with a surgically altered anatomy is highlighted.

Multiple EUS therapeutic interventions have evolved from experimental or rescue options to now well established first- and second-line interventions over other endoscopic, percutaneous and surgical alternatives with the support of high-quality data. Further research is needed to better optimize patient selection and guide long term postintervention follow-up.
Modern management of distant metastases from head and neck squamous cell carcinoma
Authors: Bradley Patrick , Montenegro Claudia , Piazza Cesare
Published: November 2024

Purpose of review

The rate of distant metastases in patients with head and neck squamous cell carcinoma (HNSCC) ranges between 4 and 26%. Their appearance marks a critical stage in disease progression, significantly reducing survival rates. Treatment options require a multidisciplinary approach and differ based on the number and extension of distant metastases. The aim of this narrative review is to provide a comprehensive and updated overview of the current state of the art in management of such a clinical scenario.

Recent findings

Accurate detection and staging of distant metastases are essential to determine prognosis and guide therapeutic strategies. Oligometastatic condition refers to patients with only a few distant metastases (up to 5). Surgery or stereotactic body radiotherapy are the best curative treatment options for oligometastatic. However, the majority of HNSCC has a polymetastatic disease, not amenable to curative approach. Therefore, systemic therapies, including chemotherapy (CHT) or target molecular therapy and/or best supportive care, are usually reserved to these patients. Rarely, head and neck region, in particular supraclavicular cervical lymph nodes, may be a site of distant metastases from non-head and neck cancer, particularly from the genitourinary and gastrointestinal tracts.

The occurrence of distant metastases in HNSCC represents a pivotal point in the disease progression, lowering survival rates. Pattern of distant metastases has been related to survival outcomes. Patients with distant metastases from an HNSCC always require a multidisciplinary approach and an accurate selection is necessary to individualize the best treatment strategy.
Assessing the Reliability of the Bleeding Assessment Scale in Critically Ill Children (BASIC) Definition: A Prospective Cohort Study
Authors: Nellis Marianne E. , Chegondi Madhuradhar , Willems Ariane , Alqatani Mashael , McMichael Ali , Aran Adi A. , Lerner Reut Kassif , Karam Oliver ,   on behalf of the Bleeding Assessment Scale in critically Ill Children (BASIC)-Kappa Investigators, and in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: November 2024

OBJECTIVES:

To determine the reliability of the Bleeding Assessment Scale in critically Ill Children (BASIC) definition of bleeding severity in a diverse cohort of critically ill children.

DESIGN:

Prospective cohort study.

SETTING:

Eight mixed PICUs in the Netherlands, Israel, and the United States.

SUBJECTS:

Children ages 0–18 years admitted to participating PICUs from January 1, 2020, to December 31, 2022, with bleeding noted by bedside nurse.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The bleeding events were classified as minimal, moderate, or severe, according to the BASIC definition, by two independent physicians at two different time points. Patient demographic data, laboratory values, and clinical outcomes were collected. Three hundred twenty-eight patients were enrolled. The overall inter-rater reliability was substantial (weighted kappa coefficient, 0.736; 95% CI, 0.683–0.789), and the intra-rater reliability was “almost-perfect” (weighted kappa coefficient, 0.816; 95% CI, 0.769–0.863). The platelet count (p = 0.008), prothrombin time (p = 0.004), activated partial thromboplastin time (p = 0.025), and fibrinogen levels (p = 0.035) were associated with the bleeding severity, but the international normalized ratio was not (p = 0.195). Patients were transfused blood components in response to any bleeding in 31% of cases and received hemostatic medications in 9% of cases. More severe bleeding was associated with increased 28-day mortality, longer hospital length of stay, and more days receiving inotropic support.

CONCLUSIONS:

The BASIC definition is a reliable tool for identifying and classifying bleeding in critically ill children. Implementing this definition into clinical and research practice may provide a consistent and reliable evaluation of bleeding.
Minor Head Trauma in Children Younger Than 3 Months and Clinical Predictors of Clinically Important Traumatic Brain Injuries
Authors: Vajna de Pava Marco , Samperi Martina , Bresesti Ilia , Bertù Lorenza , Plebani Anna Maria , Agosti Massimo
Published: November 2024

Objectives

Major studies have defined clinical rules to regulate the use of computed tomography in children after head trauma. Infants younger than 3 months are considered at higher risk of brain injuries than older children and at the same time at higher risk of radiation-induced damage. Hence, it would be desirable to have clinical decision rules more adapted to this subset of patients. The objectives of this study are to compare the rate of brain injuries in children younger than 3 months or 3 to 24 months and to assess predictors of clinically important traumatic brain injuries (ciTBIs) (the ones causing death, neurosurgical intervention, long intubation, or hospitalization for 2 days or more) in the former group.

Methods

Records of children younger than 24 months evaluated in a single emergency department for minor head trauma during a 3 years period were retrospectively reviewed. The rates of brain injuries were compared in children younger or older than 3 months. Variables associated with severe lesions were assessed in younger children.

Results

The study included 744 patients, 86 (11.6%) aged 0 to 90 days and 658 (88.4%) aged 91 to 730 days. Within the young group, we found higher rates of traumatic brain injuries (14.0% vs 4.1%, P = 0.0008) and ciTBI (8.1% vs 1.5%, P = 0.002) compared with the old group. A significant correlation with ciTBI in the young group was observed for heart rate (odds ratio [OR], 12.3; 95% confidence interval [CI], 2.4–62.4), nonfrontal scalp hematoma (OR, 9.2; 95% CI, 1.8–46.1), severe mechanism (OR, 5.6; 95% CI, 1.1–27.6), presence of hematoma (OR, 6.1; 95% CI, 1.2–30.0), hematoma size >3 cm (OR, 23.8; 95% CI, 4.2–135.6), and hematoma location (OR, 9.2; 95% CI, 1.8–46.1).

Conclusions

Children younger than 3 months presenting after minor head trauma constitute a relevant population. Available clinical predictors well correlate with ciTBIs in this age group.
Large Branchial Cleft Cyst of Face and Neck
Authors: Wang Yuxin , Li Wen , Yang Liu , Chen Guo , Li Long
Published: November 2024

Objective:

The authors present a case of a patient with a large branchial cleft cyst on the right side of the neck and face that rapidly increased after eating Angelica-stewed chicken.

Methods:

An older adult patient was admitted to West China Hospital on February 28, 2021, with a large branchial cleft cyst. Resection of the right cervical cystic tumor and partial resection of the parotid gland were performed.

Results:

After complete surgical resection of the cyst, the patient was followed up for 3 years without any recurrence in the surgical area.

Conclusions:

Angelica is a type of traditional Chinese medicine, which has the effect of promoting blood circulation to remove meridian obstruction. However, it is difficult to determine whether this case that occurred after eating Angelica-stewed chicken coincides with the sudden growth of cysts and related pathological changes.
Economic evaluation of Danhong injection for the treatment of chronic stable angina in China: A cost-effectiveness analysis
Authors: Su Pengli , Zhi Kai , Xiao Jing , Xu Huanhuan , Liu Jun , Wang Zhong , Yu Yanan , Dang Haixia
Published: November 2024

Objective

Danhong injection (DHI) is commonly used in China to treat chronic stable angina (CSA), demonstrating significant clinical efficacy and safety. The present study aimed to estimate the cost-effectiveness of DHI combined with standard treatment (ST) compared with ST alone in patients with CSA.

Methods

A Markov model with a 3-month cycle and a 1-year time horizon was used to assess the cost-effectiveness of DHI + ST for CSA. Health outcomes were measured as quality-adjusted life years (QALYs), and societal perspective costs were collected in China. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed to test the robustness of results to parameter uncertainty.

Results

Analysis demonstrated DHI + ST provided 0.8190 QALYs at an average cost of $3644.24, while ST yielded 0.7884 QALYs costing $2739.54 over 1 year. The incremental analysis indicated DHI + ST dominance, with an ICER of $29,588.91 per QALY gained compared with ST. One-way sensitivity analysis confirmed the robustness of base case findings, and probabilistic sensitivity analysis suggested a 61.66% probability of DHI + ST being cost-effective over ST at a $37,663.26 per QALY threshold.

Conclusion

From a societal perspective in China, DHI + ST appears cost-effective for the treatment of CSA compared with ST alone. These findings support recommending DHI as a clinically valuable and cost-effective option in CSA treatment guidelines.
Cost-Effectiveness of Nonoperative Management vs Upfront Laparoscopic Appendectomy for Pediatric Uncomplicated Appendicitis for 1 Year
Authors: Gil Lindsay A , Asti Lindsey , Chen Huey-Fen , Saito Jacqueline M , Pattisapu Prasanth , Deans Katherine J , Minneci Peter C ,   for the Midwest Pediatric Surgery Consortium
Published: November 2024

BACKGROUND:

Nonoperative management (NOM) with antibiotics alone for pediatric uncomplicated appendicitis is accepted to be safe and effective. However, the relative cost-effectiveness of this approach compared with appendectomy remains unknown. We aimed to evaluate the cost-effectiveness of nonoperative vs operative management for pediatric uncomplicated acute appendicitis.

STUDY DESIGN:

A trial-based real-world economic evaluation from the healthcare sector perspective was performed using data collected from a multi-institutional nonrandomized controlled trial investigating NOM vs surgery. The time horizon was 1 year, with costs in 2023 US dollars. Ratio of costs-to-charges-based data for the initial hospitalization, readmissions, and unplanned emergency department visits were extracted from the Pediatric Health Information System. Utility data were derived from patient-reported disability days and health-related quality-of-life scores. Multiple scenarios and 1-way deterministic and probabilistic sensitivity analyses accounted for parameter uncertainty. Willingness-to-pay threshold was set at $100,000 per quality-adjusted life year (QALY) or disability-adjusted life year. Primary outcome measures included total and incremental mean costs, QALY, disability-adjusted life year, and incremental cost-effectiveness ratios.

RESULTS:

Of 1,068 participants, 370 (35%) selected NOM and 698 (65%) selected urgent laparoscopic appendectomy. Operative management cost an average of $9,791 per patient and yielded an average of 0.884 QALYs, whereas NOM cost an average of $8,044 per patient and yielded an average of 0.895 QALYs. NOM was both less costly and more effective in base case and scenario analyses using disability days and alternate methods of calculating uses.

CONCLUSIONS:

NOM is cost-effective compared with laparoscopic appendectomy for pediatric uncomplicated appendicitis for 1 year.
Catatonia as a debut of systemic lupus erythematosus: a case report on a diagnostic challenge
Authors: Andreu Helena , Serra-Sarró Blanca , Bueno Laura , de Juan Òscar , Ochandiano Iñaki , Olivier Luis , Álvarez Helena , Herrero Ailin , Mantellini Cecilia , Vicente Miguel , Sagué-Vilavella Maria , Ilzarbe Lidia , Pintor Luis , Garriga Marina , Llorca-Bofí Vicent , Bioque Miquel
Published: November 2024

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by a wide variety of symptoms, including frequent neurological and psychiatric symptomatology. Psychiatric symptoms encountered in SLE are frequent, between 37 and 95% of SLE patients present them, can appear at any point in the course of the disease and may include almost any type of disorder. We present the case of a 32-year-old woman who presented an SLE debut with catatonic symptoms without previous psychiatric history, representing a diagnostic and therapeutic challenge given that the diagnosis was initially wrongly filtered out and required up to three hospital admissions in a row to reach a proper diagnosis and treatment.
Genome resource of chitin-degrading bacterium Brevibacillus formosus YSY-2.2
Authors: TRAN Dinh Minh , Huynh To Uyen , Nguyen Dinh Sy , Pentekhina Iuliia
Published: November 2024

This work announced the whole genome resource of Brevibacillus formosus YSY-2.2, a chitin-degrading bacterium possessing antifungal activity and producing phytohormones previously isolated from Yok Don National Park, Vietnam. The genome contained 6,191,946 bp with 47.3% GC content, 5,791 CDSs, 116 RNAs, 101 CAZymes, and 13 BGCs. It showed the highest values of both ANI (95.07%) and dDDH (72.6%) to those of B. formosus NF2 (CP018145). The genome sequence will provide useful information for further studies on the functional gene and application of B. formosus YSY-2.2.
Newly found rat CD103-dendritic cells are the highly immunogenic conventional DC2 subpopulation, corresponding to the known DC subsets in mice and humans
Authors: Sawanobori Yasushi , Ogawa Tadayuki , Ueta Hisashi , Kitazawa Yusuke , Tokuda Nobuko
Published: November 2024

Dendritic cells (DCs), the primary antigen-presenting cells, have traditionally been identified by CD103 molecules in rats, whereas mouse and human DCs are identified by CD11c molecules. However, this history does not preclude the existence of CD103-DCs in rats. To explore this possibility, we examined MHCII+cells in rat spleen and thymus, identifying a novel population of CD103-MHCII+CD45R-CD172a+cells. These cells are negative for CD103 and B cell marker CD45R, but positive for the type-2 conventional DC (cDC2) marker CD172a. Transcriptomic analyses revealed that they represent a subpopulation of cDC2. Additionally, gene set enrichment analysis predicted enhanced immunogenic activities for this novel population compared to known rat cDC2s. Mixed leukocyte reaction assays confirmed that the rat CD103-cDC2s induce T cell proliferation more effectively than other DC subsets, suggesting enhanced immunogenic potential. In reaggregated thymic organ culture assays, both the rat CD103-and CD103+cDC2 subsets suppressed the total number of generated thymocytes and skewed the differentiation toward CD8 single-positive cells. Comparisons with previously published single-cell RNA-sequencing datasets showed that the rat CD103-cDC2 subset shares markers and GO terms of known mouse and human cDC2 subpopulations: cDC2a, cDC2b, inf-cDC2, and moDC. In contrast, the classic rat CD103+cDC2 subset expresses only cDC2a markers. These findings provide new insights into DC subpopulations, particularly in species other than mice and humans, where much remains to be uncovered.
ecPath detects ecDNA in tumors from histopathology images
Authors: Choudhury Mudra , Liu Lihe , Yadav Anamika , Chapman Owen , Ahmadi Zahra , Younis Raneen , Sharma Chinmay , Goel Navansh , Sridhar Sunita , Kenkre Rishaan , Dutta Aditi , Wang Shanqing , Shulman Eldad , Dhruba Saugato Rahman , Hoang Danh-Tai , Tharp Kevin , Paul Megan , Malicki Denise , Yip Kevin , Ruppin Eytan , Chavez Lukas , Sinha Sanju
Published: November 2024

Circular extrachromosomal DNA (ecDNA) can drive tumor initiation, progression and resistance in some of the most aggressive cancers and is emerging as a promising anti-cancer target. However, detection currently requires costly whole-genome sequencing (WGS) or labor-intensive cytogenetic or FISH imaging, limiting its application in routine clinical diagnosis. To overcome this, we developedecPath(ecDNA from histopathology), a computational method for predicting ecDNA status from routinely available hematoxylin and eosin (H&E) images. ecPath implements a deep-learning method we call transcriptomics-guided learning, which utilizes both transcriptomics and H&E images during the training phase to enable successful ecDNA prediction from H&E images alone, a task not achievable with models trained on H&E images only. It is trained on more than 6,000 tumor whole-slide images from the TCGA cohort with the best performance in predicting ecDNA status in brain and stomach tumors (average AUC=0.78). ecPath revealed that ecDNA-positive tumors are enriched with pleomorphic, larger and high-density nuclei. Testing in an independent cohort, ecPath predicted ecDNA status of 985 pediatric brain tumor patients with an AUC of 0.72. Finally, we applied ecPath to identify ecDNA-positive tumors in the TCGA cohort for which no WGS data were available. Like WGS-based ecDNA-positive labels, the predicted ecDNA-positive status also identify poor prognoses for low grade glioma patients. These results demonstrate that ecPath enables the detection of ecDNA from routinely available H&E imaging alone and help nominate aggressive tumors with ecDNA to study and target it.
Tissue clocks derived from histological signatures of biological aging enable tissue-specific aging predictions from blood
Authors: Abila Ernesto , Buljan Iva , Zheng Yimin , Veres Tamas , Weng Zhilong , Nackenhorst Maja , Hulla Wolfgang , Tolkach Yuri , Wöhrer Adelheid , Rendeiro André F.
Published: November 2024

Aging, the predominant risk factor for numerous diseases, manifests in various forms across the structure and architecture of tissues of the human body, offering the opportunity to quantify and interpret tissue-specific aging. To address this, we present a comprehensive assessment of tissue changes occurring during human aging, utilizing a vast array of whole slide histopathological images from the Genotype-Tissue Expression Project (GTEx). We analyzed 25,712 images from 40 distinct tissue types across 983 individuals, applying deep learning to quantify the nuanced morphological changes that tissues undergo with age.

We developed ‘tissue clocks’—predictors of biological age based on tissue images—which achieved a mean prediction error of 4.9 years and were associated with telomere attrition, the incidence of subclinical pathologies, and comorbidities. In a systematic assessment of biological age rates across organs, we identified pervasive non-uniform rates of aging across the human lifespan, with some organs exhibiting earlier changes (20–40 years old) and others showing bimodal patterns of age-related changes. We also uncovered several associations between demographic, lifestyle, and medical history factors and tissue-specific acceleration or deceleration of biological age, highlighting potential modifiable risk factors that influenced the aging process at the tissue level. Finally, by combining paired histological images and gene expression data, we developed a strategy to predict tissue-specific age gaps from blood samples. This approach was validated in external cohorts of both healthy individuals and those with chronic diseases, revealing the organs most differentially affected by aging in disease contexts.

This work offers a new perspective on the aging process by positioning tissue structure as an integrator of cellular and molecular changes that reflect the physiological state of organs. These findings underscore the value of histopathological imaging as a tool for understanding human aging and provide a foundation for the exploration of tissue-specific aging processes in age-associated diseases.