Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100654
Erniao Liu , Qianting Wang , Yaoxian Bai , Xi Zhang , Jingfang Wang
Objective
This study aimed to evaluate the effect of Omega-3 Fatty Acids (ω-3 PUFAs) on endometriosis.
Design
The authors conducted a comprehensive search of the PubMed, Embase, Cochrane Library and Web of Science databases, focusing exclusively on Randomised Controlled Trials (RCTs) to study the impact of ω-3 PUFAs on endometriosis. The included studies were assessed for methodological quality using the Cochrane bias risk assessment tool and analyzed using data analysis software.
Results
The search yielded five RCTs conducted between the database's inception and July 2023, with a total sample size of 424 patients with endometriosis. The meta-analysis results showed no statistically significant effects of ω-3 Polyunsaturated Fatty Acids (PUFAs) on pain (Mean Difference [MD = -0.387], 95 % Confidence Interval [95 % CI -1.742–0.967], I2 = 93.3 %, z = 0.56, p = 0.575), sexual activity (MD = 0.143, 95 % CI -0.210–0.497, I2 = 0 %, z = 0.79, p = 0.427), pain intervention (MD = -0.216, 95 % CI -0.717–0.285, I2 = 0.0 %, z = 0.84, p = 0.399), catastrophic thinking (MD = 0.158, 95 % CI -0.315–0.632, I2 = 0.0 %, z = 0.66, p = 0.512) and the 12-item short form health survey (MD = 0.001, 95 % CI -0.053–0.503, I2 = 0.0 %, z = 0.00, p = 1.000), which were all statistically insignificant. However, ω-3 PUFAs appeared to reduce the inflammatory response in patients with endometriosis (MD = -5.20, 95 % CI -6.21–-4.20, I2 = 0 %, z = 10.13, p < 0.001).
Conclusion
Based on the available evidence, ω-3 PUFAs may reduce the inflammatory response in patients with endometriosis, specifically by decreasing levels of pro-inflammatory cytokines, such as TNF-alpha, IL-6 and IL-1, indicating potential anti-inflammatory properties that warrant further investigation.
Trial registration
PROSPERO: CRD42023441699.
目的探讨ω-3脂肪酸（ω-3 PUFAs）对子宫内膜异位症的治疗作用。作者对PubMed、Embase、Cochrane Library和Web of Science数据库进行了全面的检索，专门关注随机对照试验（RCTs），以研究ω-3 PUFAs对子宫内膜异位症的影响。使用Cochrane偏倚风险评估工具对纳入的研究进行方法学质量评估，并使用数据分析软件进行分析。在数据库建立至2023年7月期间进行了5项随机对照试验，总样本量为424例子宫内膜异位症患者。荟萃分析结果无显著影响的ω3多不饱和脂肪酸(欧米伽)疼痛(平均差MD = -0.387, 95%置信区间(95% CI -1.742 - -0.967), I2 = 93.3%, z = 0.56, p = 0.575),性活动(MD = 0.143, 95% CI -0.210 - -0.497, I2 = 0%, z = 0.79, p = 0.427),疼痛干预(MD = -0.216, 95% CI -0.717 - -0.285, I2 = 0.0%, z = 0.84, p = 0.399),灾难性的思维(MD = 0.158, 95% CI -0.315 - -0.632, I2 = 0.0%, z = 0.66,p = 0.512)和12项简短健康调查（MD = 0.001, 95% CI -0.053-0.503, I2 = 0.0%, z = 0.00, p = 1.000），差异均无统计学意义。然而，ω-3 PUFAs似乎可以降低子宫内膜异位症患者的炎症反应(MD = -5.20, 95% CI -6.21 -4.20, I2 = 0%, z = 10.13, p <；0.001)。结论根据现有证据，ω-3 PUFAs可降低子宫内膜异位症患者的炎症反应，特别是通过降低促炎细胞因子（如tnf - α、IL-6和IL-1）的水平，表明其潜在的抗炎特性值得进一步研究。试验注册号prospero: CRD42023441699。
{"title":"Effect of omega-3 polyunsaturated fatty acid on endometriosis","authors":"Erniao Liu , Qianting Wang , Yaoxian Bai , Xi Zhang , Jingfang Wang","doi":"10.1016/j.clinsp.2025.100654","DOIUrl":"10.1016/j.clinsp.2025.100654","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the effect of Omega-3 Fatty Acids (ω-3 PUFAs) on endometriosis.</div></div><div><h3>Design</h3><div>The authors conducted a comprehensive search of the PubMed, Embase, Cochrane Library and Web of Science databases, focusing exclusively on Randomised Controlled Trials (RCTs) to study the impact of ω-3 PUFAs on endometriosis. The included studies were assessed for methodological quality using the Cochrane bias risk assessment tool and analyzed using data analysis software.</div></div><div><h3>Results</h3><div>The search yielded five RCTs conducted between the database's inception and July 2023, with a total sample size of 424 patients with endometriosis. The meta-analysis results showed no statistically significant effects of ω-3 Polyunsaturated Fatty Acids (PUFAs) on pain (Mean Difference [MD = -0.387], 95 % Confidence Interval [95 % CI -1.742–0.967], <em>I</em><sup>2</sup> = 93.3 %, <em>z</em> = 0.56, <em>p</em> = 0.575), sexual activity (MD = 0.143, 95 % CI -0.210–0.497, <em>I</em><sup>2</sup> = 0 %, <em>z</em> = 0.79, <em>p</em> = 0.427), pain intervention (MD = -0.216, 95 % CI -0.717–0.285, <em>I</em><sup>2</sup> = 0.0 %, <em>z</em> = 0.84, <em>p</em> = 0.399), catastrophic thinking (MD = 0.158, 95 % CI -0.315–0.632, <em>I</em><sup>2</sup> = 0.0 %, <em>z</em> = 0.66, <em>p</em> = 0.512) and the 12-item short form health survey (MD = 0.001, 95 % CI -0.053–0.503, <em>I</em><sup>2</sup> = 0.0 %, <em>z</em> = 0.00, <em>p</em> = 1.000), which were all statistically insignificant. However, ω-3 PUFAs appeared to reduce the inflammatory response in patients with endometriosis (MD = -5.20, 95 % CI -6.21–-4.20, <em>I</em><sup>2</sup> = 0 %, <em>z</em> = 10.13, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Based on the available evidence, ω-3 PUFAs may reduce the inflammatory response in patients with endometriosis, specifically by decreasing levels of pro-inflammatory cytokines, such as TNF-alpha, IL-6 and IL-1, indicating potential anti-inflammatory properties that warrant further investigation.</div></div><div><h3>Trial registration</h3><div>PROSPERO: CRD42023441699.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100654"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Post-acute COVID-19 Syndrome (PACS) occurs in some COVID-19 patients long after acute infection and significantly affects patients’ health. However, the mechanism by which PACS develops is unknown. Myosin light chain 9 (Myl9), produced by activated platelets, plays a role in immune dysregulation and microthrombi formation during acute COVID-19. However, in the PACS phase, the association between Myl9 and residual symptoms remains unclear, and further investigation is needed.
Methods
In this prospective cohort study, serum Myl9 concentrations were measured in 195 COVID-19 patients during hospitalization and at 3- and 6-month follow-up visits. Gaussian mixture modeling was used to identify groups on the basis of Myl9 levels. Relationships between Myl9 levels and residual symptoms were evaluated. Clinical characteristics influencing Myl9 levels were analyzed via logistic regression.
Results
A total of 304 serum samples from 195 patients were collected. Two distinct groups were identified in the Myl9 distribution with a cutoff of 386 ng/mL by Gaussian mixture modeling in this cohort. The high-Myl9 group presented significant residual respiratory symptoms at 6 months post-infection (p < 0.05). Elevated Myl9 levels at 6 months were correlated with increased neutrophil counts (p < 0.01) and respiratory comorbidities at diagnosis (p < 0.05) according to univariate regression analysis. Multivariate regression analysis confirmed the relationship between the neutrophil count and high Myl9 levels.
Conclusion
Prolonged high Myl9 levels are associated with respiratory symptoms, suggesting the potential involvement of prolonged inflammation or endothelial damage in PACS.
{"title":"Prolonged high Myl9 levels are associated with the pathogenesis and respiratory symptom of post-acute COVID-19 syndrome: A 6-month follow-up study","authors":"Jun Sugihara , Chiaki Iwamura , Tomoya Tateishi , Tadashi Hosoya , Sho Shimada , Kiyoshi Hirahara , Shinsuke Yasuda , Yasunari Miyazaki","doi":"10.1016/j.clinsp.2025.100584","DOIUrl":"10.1016/j.clinsp.2025.100584","url":null,"abstract":"<div><h3>Background</h3><div>Post-acute COVID-19 Syndrome (PACS) occurs in some COVID-19 patients long after acute infection and significantly affects patients’ health. However, the mechanism by which PACS develops is unknown. Myosin light chain 9 (Myl9), produced by activated platelets, plays a role in immune dysregulation and microthrombi formation during acute COVID-19. However, in the PACS phase, the association between Myl9 and residual symptoms remains unclear, and further investigation is needed.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, serum Myl9 concentrations were measured in 195 COVID-19 patients during hospitalization and at 3- and 6-month follow-up visits. Gaussian mixture modeling was used to identify groups on the basis of Myl9 levels. Relationships between Myl9 levels and residual symptoms were evaluated. Clinical characteristics influencing Myl9 levels were analyzed via logistic regression.</div></div><div><h3>Results</h3><div>A total of 304 serum samples from 195 patients were collected. Two distinct groups were identified in the Myl9 distribution with a cutoff of 386 ng/mL by Gaussian mixture modeling in this cohort. The high-Myl9 group presented significant residual respiratory symptoms at 6 months post-infection (<em>p</em> < 0.05). Elevated Myl9 levels at 6 months were correlated with increased neutrophil counts (<em>p</em> < 0.01) and respiratory comorbidities at diagnosis (<em>p</em> < 0.05) according to univariate regression analysis. Multivariate regression analysis confirmed the relationship between the neutrophil count and high Myl9 levels.</div></div><div><h3>Conclusion</h3><div>Prolonged high Myl9 levels are associated with respiratory symptoms, suggesting the potential involvement of prolonged inflammation or endothelial damage in PACS.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100584"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to determine the cost-effectiveness of selective laser trabeculoplasty (SLT) as a replacement for hypotensive eye drops in the Brazilian Unified Health System (SUS).
Methods
The authors conducted a cost-effectiveness economic assessment using data from a previously published prospective, non-randomized, single-arm interventional study. The costs were estimated from the perspective of the SUS, using data from the SIGTAP. The authors proposed a value of R$ 588.00 for bilateral SLT, based on the observed cost reduction with medications in the SLT group. Effectiveness was assessed as a reduction in intraocular pressure (IOP).
Results
The average annual cost of medications per patient was R$ 669.53 in the reference group (continuous use of eye drops) and R$ 80.62 in the intervention group (SLT). The average IOP reduction was 9.3 mmHg in the reference group and 9.8 mmHg in the intervention group. SLT proved to be a dominant strategy compared to the continuous use of eye drops, presenting a greater reduction in IOP and a lower total annual cost. The incremental cost-effectiveness ratio (ICER) was negative (-R$ 1.82), indicating that SLT is more effective and less costly.
Conclusions
SLT is a cost-effective alternative to hypotensive eye drops in the treatment of glaucoma in the SUS. The adoption of SLT can optimize resource allocation and improve clinical outcomes for patients with glaucoma. Implementing SLT at the proposed procedural cost optimizes spending by substantially reducing long-term medication costs and offering a sustainable alternative within the healthcare system.
{"title":"Cost-effectiveness of selective laser trabeculoplasty as a replacement for hypotensive eye drops in the Brazilian public health system","authors":"Leopoldo Ernesto Oiticica Barbosa , Wilma Lelis Barboza , Ricardo Agusto Paletta Guedes , Alfredo Chaoubah , Marcelo Hatanaka","doi":"10.1016/j.clinsp.2025.100650","DOIUrl":"10.1016/j.clinsp.2025.100650","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to determine the cost-effectiveness of selective laser trabeculoplasty (SLT) as a replacement for hypotensive eye drops in the Brazilian Unified Health System (SUS).</div></div><div><h3>Methods</h3><div>The authors conducted a cost-effectiveness economic assessment using data from a previously published prospective, non-randomized, single-arm interventional study. The costs were estimated from the perspective of the SUS, using data from the SIGTAP. The authors proposed a value of R$ 588.00 for bilateral SLT, based on the observed cost reduction with medications in the SLT group. Effectiveness was assessed as a reduction in intraocular pressure (IOP).</div></div><div><h3>Results</h3><div>The average annual cost of medications per patient was R$ 669.53 in the reference group (continuous use of eye drops) and R$ 80.62 in the intervention group (SLT). The average IOP reduction was 9.3 mmHg in the reference group and 9.8 mmHg in the intervention group. SLT proved to be a dominant strategy compared to the continuous use of eye drops, presenting a greater reduction in IOP and a lower total annual cost. The incremental cost-effectiveness ratio (ICER) was negative (-R$ 1.82), indicating that SLT is more effective and less costly.</div></div><div><h3>Conclusions</h3><div>SLT is a cost-effective alternative to hypotensive eye drops in the treatment of glaucoma in the SUS. The adoption of SLT can optimize resource allocation and improve clinical outcomes for patients with glaucoma. Implementing SLT at the proposed procedural cost optimizes spending by substantially reducing long-term medication costs and offering a sustainable alternative within the healthcare system.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100650"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100659
Tongqing Yao , Yinhua Xi , Fei Chen , Hao Lin , Jun Qian , Xuebo Liu
Objectives
Heart failure, especially in the elderly, is a growing global issue. This research explores the safety of human albumin infusion in treating heart failure patients with hypoalbuminemia, despite limited clinical data on its use with diuretic therapy.
Methods
Data were collected from the Medical Information Mart for Intensive Care III (MIMIC-III) database, which included a cohort of 6094 patients diagnosed with heart failure. Propensity score matching, logistic regression, Kaplan-Meier curves, and Locally Weighted Scatterplot Smoothing (LOWESS) curves were used to examine how albumin administration correlates with different clinical results. The evaluated results comprised in-hospital mortality, cumulative fluid output over 24 hours, Length of Stay in the Intensive Care Unit (ICU LOS), and overall hospitalization duration (hospital LOS).
Results
Infusing albumin was found to be markedly linked with higher in-hospital mortality among heart failure patients whose serum albumin levels were ≤ 2.9 g/dL (p < 0.001). However, no statistically significant correlation was found between the patients with levels > 2.9 g/dL (p = 0.62). Following propensity score matching in the ≤ 2.9 g/dL serum albumin group, albumin infusion was linked to prolonged hospital and ICU stays (p = 0.002, p < 0.001), but showed no significant association with total 24 hour fluid output and 90-day survival (p = 0.173, p = 0.656).
Conclusion
The use of albumin has been linked to increased risk-adjusted mortality during hospitalization, as well as prolonged stays in both hospital and ICU settings for patients with heart failure and low levels of serum albumin. Physicians should exercise caution when considering the administration of albumin in these cases.
心衰，尤其是老年人心衰，是一个日益严重的全球性问题。本研究探讨了人白蛋白输注治疗心力衰竭伴低白蛋白血症患者的安全性，尽管其与利尿剂治疗的临床数据有限。方法从重症监护医学信息市场III （MIMIC-III）数据库中收集数据，其中包括6094例诊断为心力衰竭的患者。使用倾向评分匹配、逻辑回归、Kaplan-Meier曲线和局部加权散点图平滑（LOWESS）曲线来检查白蛋白给药与不同临床结果的相关性。评估结果包括住院死亡率、24小时内的累计液体输出、在重症监护病房（ICU LOS）的住院时间和总住院时间（医院LOS）。结果在血清白蛋白水平≤2.9 g/dL的心力衰竭患者中，输注白蛋白与较高的住院死亡率显著相关(p <；0.001)。然而，患者的水平>；2.9 g/dL （p = 0.62）根据倾向评分匹配≤2.9 g/dL血清白蛋白组，白蛋白输注与延长住院时间和ICU住院时间相关(p = 0.002, p <；0.001)，但与总24小时排液量和90天生存率无显著相关性（p = 0.173, p = 0.656）。结论：白蛋白的使用与住院期间风险调整死亡率的增加，以及心力衰竭和血清白蛋白水平低的患者在医院和ICU环境中的住院时间延长有关。在这些病例中，医生在考虑给药白蛋白时应谨慎。
{"title":"Safety of human serum albumin infusion in heart failure patients with hypoproteinemia: a propensity score-matched analysis","authors":"Tongqing Yao , Yinhua Xi , Fei Chen , Hao Lin , Jun Qian , Xuebo Liu","doi":"10.1016/j.clinsp.2025.100659","DOIUrl":"10.1016/j.clinsp.2025.100659","url":null,"abstract":"<div><h3>Objectives</h3><div>Heart failure, especially in the elderly, is a growing global issue. This research explores the safety of human albumin infusion in treating heart failure patients with hypoalbuminemia, despite limited clinical data on its use with diuretic therapy.</div></div><div><h3>Methods</h3><div>Data were collected from the Medical Information Mart for Intensive Care III (MIMIC-III) database, which included a cohort of 6094 patients diagnosed with heart failure. Propensity score matching, logistic regression, Kaplan-Meier curves, and Locally Weighted Scatterplot Smoothing (LOWESS) curves were used to examine how albumin administration correlates with different clinical results. The evaluated results comprised in-hospital mortality, cumulative fluid output over 24 hours, Length of Stay in the Intensive Care Unit (ICU LOS), and overall hospitalization duration (hospital LOS).</div></div><div><h3>Results</h3><div>Infusing albumin was found to be markedly linked with higher in-hospital mortality among heart failure patients whose serum albumin levels were ≤ 2.9 g/dL (<em>p</em> < 0.001). However, no statistically significant correlation was found between the patients with levels > 2.9 g/dL (<em>p</em> = 0.62). Following propensity score matching in the ≤ 2.9 g/dL serum albumin group, albumin infusion was linked to prolonged hospital and ICU stays (<em>p</em> = 0.002, <em>p</em> < 0.001), but showed no significant association with total 24 hour fluid output and 90-day survival (<em>p</em> = 0.173, <em>p</em> = 0.656).</div></div><div><h3>Conclusion</h3><div>The use of albumin has been linked to increased risk-adjusted mortality during hospitalization, as well as prolonged stays in both hospital and ICU settings for patients with heart failure and low levels of serum albumin. Physicians should exercise caution when considering the administration of albumin in these cases.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100659"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100625
Fengbo Jin , Wei Qian , Yingying Chen , Wanlu Tian , Ling Ge , Mingzhen Yang , Leiming Xia
Within the intricate tapestry of the global SARS-CoV-2 pandemic, this study delves into the intricate interplay of clinical data to elucidate prognostic factors associated with complications in patients concomitantly afflicted with hematological disorders and SARS-CoV-2. An exhaustive analysis of 71 individuals, spanning the period from November 2022 to March 2023, aims to unveil distinctive clinical characteristics and explicate the nuanced determinants steering the trajectory of the disease. The updated findings reveal a multi-faceted correlation, underscoring the complex interplay of clinical parameters. Among individuals with hematological disorders, anomalously elevated ferritin levels are closely associated with the development of SARS-CoV-2 pneumonia, while interferon-γ is intricately linked to the severity of SARS-CoV-2. Conversely, elevated ferritin levels, increased D-dimer and fibrin degradation products, along with significantly elevated iron levels, manifest a significant association with patient mortality. Intriguingly, those in patients in complete hematologic remission confront an augmented risk of developing SARS-CoV-2 pneumonia, while those abstaining from anti-tumor treatments exhibit mitigated case severity. This study unveils the intricate interplay of clinical factors impacting the prognosis of SARS-CoV-2 complications in individuals with hematological disorders. The cognizance of aberrant interferon-γ activation and nuanced associations with ferritin, iron levels, and coagulation markers contributes to a more holistic comprehension of the prognostic landscape.
{"title":"Decoding prognostic factors in SARS-CoV-2 complications among patients with hematological disorders","authors":"Fengbo Jin , Wei Qian , Yingying Chen , Wanlu Tian , Ling Ge , Mingzhen Yang , Leiming Xia","doi":"10.1016/j.clinsp.2025.100625","DOIUrl":"10.1016/j.clinsp.2025.100625","url":null,"abstract":"<div><div>Within the intricate tapestry of the global SARS-CoV-2 pandemic, this study delves into the intricate interplay of clinical data to elucidate prognostic factors associated with complications in patients concomitantly afflicted with hematological disorders and SARS-CoV-2. An exhaustive analysis of 71 individuals, spanning the period from November 2022 to March 2023, aims to unveil distinctive clinical characteristics and explicate the nuanced determinants steering the trajectory of the disease. The updated findings reveal a multi-faceted correlation, underscoring the complex interplay of clinical parameters. Among individuals with hematological disorders, anomalously elevated ferritin levels are closely associated with the development of SARS-CoV-2 pneumonia, while interferon-γ is intricately linked to the severity of SARS-CoV-2. Conversely, elevated ferritin levels, increased <span>D</span>-dimer and fibrin degradation products, along with significantly elevated iron levels, manifest a significant association with patient mortality. Intriguingly, those in patients in complete hematologic remission confront an augmented risk of developing SARS-CoV-2 pneumonia, while those abstaining from anti-tumor treatments exhibit mitigated case severity. This study unveils the intricate interplay of clinical factors impacting the prognosis of SARS-CoV-2 complications in individuals with hematological disorders. The cognizance of aberrant interferon-γ activation and nuanced associations with ferritin, iron levels, and coagulation markers contributes to a more holistic comprehension of the prognostic landscape.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100625"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100583
Marcio Barcellos , Antonio Braga , Matheus Machado Rech , Solange Artimos de Oliveira , Jose Mauro Madi , Sue Yazaki Sun , Jorge de Rezende-Filho , Kevin M. Elias , Neil S. Horowitz , Ross S. Berkowitz
Objective
To assess the performance of pembrolizumab for the treatment of Gestational Trophoblastic Neoplasia (GTN).
Methods
The Medical Subject Headings related to immunotherapy/pembrolizumab and GTN were used alone or in combination to retrieve relevant articles. The authors searched in EMBASE, MEDLINE/PubMed, Elsevier's Scopus, and Web of Science until November/2024. The authors included any randomized controlled trials, cohort studies, case series, and case reports focusing on pembrolizumab treatment in GTN. Meta-analysis of proportions was carried out employing a random-effects model. The meta-analysis employed the inverse variance method, with the arcsine link function for the analysis of proportional data. All analyses were performed using Stata 18. For all analyses, a p-value < 0.05 indicated statistical significance. This study was registered on PROSPERO (CRD42023493329).
Results
A total of 550 studies were identified after a literature search among which 15 original studies were included in the systematic review and in the meta-analysis. Pembrolizumab induced complete sustained remission in 71.59% (95% CI 53.27‒84.78%; I2 = 0.00%, H2 = 1.00, p = 0.90) of cases. The subgroups meta-analysis showed pembrolizumab had similar performance, regardless of age (< 40 vs. ≥ 40-years-old, p = 0.38), GTN histopathology (Placental Site Trophoblastic Tumor [PSTT], Epithelioid Trophoblastic Tumor [ETT]/noninvasive mole/others versus invasive mole/choriocarcinoma, p = 0.48), time from diagnosis to the beginning of immunotherapy (< 4 vs. ≥ 4-years, p = 0.84), pembrolizumab combined with chemotherapy (yes vs. no, p = 0.66).
Conclusions
Pembrolizumab seems an effective treatment for patients with high-risk GTN with chemoresistant or relapsed disease, including cases of PSTT/ETT, notwithstanding patient age, time to initiate immunotherapy and whether or not it was associated with chemotherapy.
目的评价派姆单抗治疗妊娠滋养细胞瘤（GTN）的疗效。方法采用免疫治疗/派姆单抗和GTN相关的医学主题词单独或联合检索相关文献。作者在EMBASE、MEDLINE/PubMed、爱思唯尔的Scopus和Web of Science中检索到2024年11月。作者纳入了所有随机对照试验、队列研究、病例系列和关注派姆单抗治疗GTN的病例报告。采用随机效应模型对比例进行meta分析。meta分析采用反方差法，用反正弦关联函数对比例数据进行分析。所有分析均使用Stata 18进行。对于所有的分析，p值<；0.05为有统计学意义。本研究已在PROSPERO注册（CRD42023493329）。结果文献检索共纳入550项研究，其中15项原创研究被纳入系统评价和meta分析。派姆单抗诱导的完全持续缓解率为71.59% (95% CI 53.27-84.78%；I2 = 0.00%, H2 = 1.00, p = 0.90)。亚组荟萃分析显示，无论年龄如何，派姆单抗具有相似的疗效(<；40岁vs.≥40岁，p = 0.38)， GTN组织病理学（胎盘部位滋养细胞瘤[PSTT]，上皮样滋养细胞瘤[ETT]/非侵袭性痣/其他与侵袭性痣/绒毛膜癌，p = 0.48），从诊断到开始免疫治疗的时间(<；4年vs≥4年，p = 0.84)，派姆单抗联合化疗（是vs否，p = 0.66）。结论spembrolizumab对于高风险GTN伴化疗耐药或复发的患者（包括PSTT/ETT病例）似乎是一种有效的治疗方法，无论患者年龄、开始免疫治疗的时间以及是否与化疗相关。
{"title":"Pembrolizumab in gestational trophoblastic neoplasia: Systematic review and meta-analysis with sub-group analysis of potential prognostic factors","authors":"Marcio Barcellos , Antonio Braga , Matheus Machado Rech , Solange Artimos de Oliveira , Jose Mauro Madi , Sue Yazaki Sun , Jorge de Rezende-Filho , Kevin M. Elias , Neil S. Horowitz , Ross S. Berkowitz","doi":"10.1016/j.clinsp.2025.100583","DOIUrl":"10.1016/j.clinsp.2025.100583","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the performance of pembrolizumab for the treatment of Gestational Trophoblastic Neoplasia (GTN).</div></div><div><h3>Methods</h3><div>The Medical Subject Headings related to immunotherapy/pembrolizumab and GTN were used alone or in combination to retrieve relevant articles. The authors searched in EMBASE, MEDLINE/PubMed, Elsevier's Scopus, and Web of Science until November/2024. The authors included any randomized controlled trials, cohort studies, case series, and case reports focusing on pembrolizumab treatment in GTN. Meta-analysis of proportions was carried out employing a random-effects model. The meta-analysis employed the inverse variance method, with the arcsine link function for the analysis of proportional data. All analyses were performed using Stata 18. For all analyses, a p-value < 0.05 indicated statistical significance. This study was registered on PROSPERO (CRD42023493329).</div></div><div><h3>Results</h3><div>A total of 550 studies were identified after a literature search among which 15 original studies were included in the systematic review and in the meta-analysis. Pembrolizumab induced complete sustained remission in 71.59% (95% CI 53.27‒84.78%; I<sup>2</sup> = 0.00%, H<sup>2</sup> = 1.00, p = 0.90) of cases. The subgroups meta-analysis showed pembrolizumab had similar performance, regardless of age (< 40 vs. ≥ 40-years-old, p = 0.38), GTN histopathology (Placental Site Trophoblastic Tumor [PSTT], Epithelioid Trophoblastic Tumor [ETT]/noninvasive mole/others versus invasive mole/choriocarcinoma, p = 0.48), time from diagnosis to the beginning of immunotherapy (< 4 vs. ≥ 4-years, p = 0.84), pembrolizumab combined with chemotherapy (yes vs. no, p = 0.66).</div></div><div><h3>Conclusions</h3><div>Pembrolizumab seems an effective treatment for patients with high-risk GTN with chemoresistant or relapsed disease, including cases of PSTT/ETT, notwithstanding patient age, time to initiate immunotherapy and whether or not it was associated with chemotherapy.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100583"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100597
Josef Finsterer , Fulvio A. Scorza , Carla A. Scorza , Ana C. Fiorini
{"title":"Hearing loss and small and large fibre neuropathy associated with the heterozygous variants c.20A>T in HBB and del-3.7 in HBA","authors":"Josef Finsterer , Fulvio A. Scorza , Carla A. Scorza , Ana C. Fiorini","doi":"10.1016/j.clinsp.2025.100597","DOIUrl":"10.1016/j.clinsp.2025.100597","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100597"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2024.100541
Lin Li , Lan He , Minchao Xiong , Xiaoyan Wang
Objective
To investigate the value of Contrast-Enhanced Ultrasound (CEUS) combined with Procalcitonin (PCT) in differentiating Tuberculous Lymph Nodes (TLN) from Metastatic Lymph Nodes (MLN).
Methods
This prospective cohort study included 207 consecutive patients diagnosed with CTL. Before confirming through pathology or laboratory tests, every patient received standard ultrasound, CEUS, and MRI examinations, with the imaging results analyzed afterward. Serum indicators were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Predictive modeling was performed by multifactorial logistic regression. Evaluate the diagnostic and calibration performance of the predictive model by drawing Receiver Operating Characteristic (ROC) curves and calibration curves, and using Area Under the Curve (AUC) and Hosmer-Lemeshow (H-L) tests.
Results
The presence of lymph node lesions was confirmed by routine ultrasound and MRI in 207 patients, of which 102 (49.27 %) had a pathological or laboratory diagnosis of metastatic lymph nodes (MLN), and 50.8 % were tuberculous lymph nodes (TLN). According to imaging findings of CEUS, TLN was more commonly associated with enhanced concentric performance in the arterial phase (67.65 % vs. 40.95 %) and heterogeneous enhancement pattern in lymph nodes (70.59 % vs. 52.38 %). Peak Intensity (PI) of lesions was higher in patients with MLN. Increased age-enhanced concentric performance in the arterial phase, increased PI, and serum PCT greater than 5.39 ng/mL were independent risk factors for MLN. The prediction model of serum PCT combined with CEUS had a higher diagnostic value for MLN. The H-L test indicated a satisfactory model fit (all p > 0.05), and the calibration curve closely approximates the ideal diagonal.
Conclusion
CEUS combined with serum PCT has better clinical application value in the differential diagnosis of TLN and MLN.
目的：探讨超声造影（CEUS）联合降钙素原（PCT）在鉴别结核性淋巴结（TLN）与转移性淋巴结（MLN）中的价值。方法：这项前瞻性队列研究包括207例连续诊断为CTL的患者。所有患者在病理或实验室确诊前均行常规超声和超声造影检查。采用酶联免疫吸附试验（ELISA）测定血清各项指标。采用多因素logistic回归进行预测建模。通过绘制受试者工作特征（ROC）曲线和校准曲线，并使用曲线下面积（AUC）和Hosmer-Lemeshow （H-L）检验来评估预测模型的诊断和校准性能。结果：207例患者中有102例（49.27%）经病理或实验室诊断为MLN，其中50.8%为TLN。超声造影显示，TLN常与动脉期同心增强（67.65% vs. 40.95%）和淋巴结非均匀增强模式（70.59% vs. 52.38%）相关。MLN患者病变的峰值强度（PI）较高。动脉期年龄增强的同心表现、PI升高和血清PCT大于5.39 ng/mL是MLN的独立危险因素。血清PCT联合超声造影预测模型对MLN有较高的诊断价值。H-L检验表明模型拟合满意（p < 0.05），校正曲线与理想对角线非常接近。结论：超声造影联合血清PCT对TLN和MLN的鉴别诊断有较好的临床应用价值。
{"title":"Diagnostic value of contrast-enhanced ultrasound combined with serum procalcitonin in tuberculous lymph nodes and metastatic lymph nodes","authors":"Lin Li , Lan He , Minchao Xiong , Xiaoyan Wang","doi":"10.1016/j.clinsp.2024.100541","DOIUrl":"10.1016/j.clinsp.2024.100541","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the value of Contrast-Enhanced Ultrasound (CEUS) combined with Procalcitonin (PCT) in differentiating Tuberculous Lymph Nodes (TLN) from Metastatic Lymph Nodes (MLN).</div></div><div><h3>Methods</h3><div>This prospective cohort study included 207 consecutive patients diagnosed with CTL. Before confirming through pathology or laboratory tests, every patient received standard ultrasound, CEUS, and MRI examinations, with the imaging results analyzed afterward. Serum indicators were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Predictive modeling was performed by multifactorial logistic regression. Evaluate the diagnostic and calibration performance of the predictive model by drawing Receiver Operating Characteristic (ROC) curves and calibration curves, and using Area Under the Curve (AUC) and Hosmer-Lemeshow (H-L) tests.</div></div><div><h3>Results</h3><div>The presence of lymph node lesions was confirmed by routine ultrasound and MRI in 207 patients, of which 102 (49.27 %) had a pathological or laboratory diagnosis of metastatic lymph nodes (MLN), and 50.8 % were tuberculous lymph nodes (TLN). According to imaging findings of CEUS, TLN was more commonly associated with enhanced concentric performance in the arterial phase (67.65 % vs. 40.95 %) and heterogeneous enhancement pattern in lymph nodes (70.59 % vs. 52.38 %). Peak Intensity (PI) of lesions was higher in patients with MLN. Increased age-enhanced concentric performance in the arterial phase, increased PI, and serum PCT greater than 5.39 ng/mL were independent risk factors for MLN. The prediction model of serum PCT combined with CEUS had a higher diagnostic value for MLN. The H-L test indicated a satisfactory model fit (all p > 0.05), and the calibration curve closely approximates the ideal diagonal.</div></div><div><h3>Conclusion</h3><div>CEUS combined with serum PCT has better clinical application value in the differential diagnosis of TLN and MLN.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100541"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100628
Joe Chih-Hao Chiu, Yu-Cheng Chen, Poyu Chen, Yi Lu, Cheng-Pang Yang, You-Hung Cheng, Alvin Chao-Yu Chen
Background
A 2 mm-thick dermal allograft and autologous Long Head of the Biceps Tendon (LHBT) Superior Capsule Reconstruction (SCR) could provide improved clinical and radiographic outcomes for posterosuperior Massive Irreparable Rotator Cuff Tears (MIRCTs).
Methods
A retrospective study was conducted between April 2019 and October 2021. The LHBT was rerouted 5 mm posteriorly to the bicipital groove, and a 2 mm-thcick dermal allograft was used to cover the rerouted LHBT. Clinical assessment included Constant-Murley Shoulder score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS) pain scores, and active ROM measurements. The radiological assessment included Acromiohumeral Distance (AHD), Superior Capsular Distance (SCD), muscle Fatty Infiltration (FI), and follow-up SCR integrity using ultrasound two years after surgery.
Results
25 patients (7 male, 18 female) were included with a mean age of 64.2 ± 6.9 years. Active ROM, AHD, and SCD did not change significantly after the surgery. Patients' VAS (8.3 ± 0.7 to 1.3 ± 0.6, p < 0.001), SSV (22.4 ± 8.6 to 77.6 ± 12.7, p < 0.001), CMS (36.2 ± 6.8 to 79.9 ± 8.4, p < 0.001), and ASES (37.2 ± 10.0 to 80.5 ± 5.7, p < 0.001) improved significantly at final follow-up. The ultrasound examination of all patients demonstrated a healed dermal allograft on the supraspinatus footprint. One patient (4 %) had a postoperative trauma causing irreparable subscapularis tear, leading to reverse total shoulder arthroplasty during revision surgery.
Conclusions
The combined SCR technique using a 2 mm dermal allograft and autologous LHBT for posterosuperior MIRCTs significantly improved the patient-reported outcomes.
{"title":"Arthroscopic superior capsule reconstruction with dermal allograft and autologous long head of the biceps tendon for irreparable posterosuperior rotator cuff tears, a two-year clinical and radiological results","authors":"Joe Chih-Hao Chiu, Yu-Cheng Chen, Poyu Chen, Yi Lu, Cheng-Pang Yang, You-Hung Cheng, Alvin Chao-Yu Chen","doi":"10.1016/j.clinsp.2025.100628","DOIUrl":"10.1016/j.clinsp.2025.100628","url":null,"abstract":"<div><h3>Background</h3><div>A 2 mm-thick dermal allograft and autologous Long Head of the Biceps Tendon (LHBT) Superior Capsule Reconstruction (SCR) could provide improved clinical and radiographic outcomes for posterosuperior Massive Irreparable Rotator Cuff Tears (MIRCTs).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted between April 2019 and October 2021. The LHBT was rerouted 5 mm posteriorly to the bicipital groove, and a 2 mm-thcick dermal allograft was used to cover the rerouted LHBT. Clinical assessment included Constant-Murley Shoulder score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS) pain scores, and active ROM measurements. The radiological assessment included Acromiohumeral Distance (AHD), Superior Capsular Distance (SCD), muscle Fatty Infiltration (FI), and follow-up SCR integrity using ultrasound two years after surgery.</div></div><div><h3>Results</h3><div>25 patients (7 male, 18 female) were included with a mean age of 64.2 ± 6.9 years. Active ROM, AHD, and SCD did not change significantly after the surgery. Patients' VAS (8.3 ± 0.7 to 1.3 ± 0.6, <em>p</em> < 0.001), SSV (22.4 ± 8.6 to 77.6 ± 12.7, <em>p</em> < 0.001), CMS (36.2 ± 6.8 to 79.9 ± 8.4, <em>p</em> < 0.001), and ASES (37.2 ± 10.0 to 80.5 ± 5.7, <em>p</em> < 0.001) improved significantly at final follow-up. The ultrasound examination of all patients demonstrated a healed dermal allograft on the supraspinatus footprint. One patient (4 %) had a postoperative trauma causing irreparable subscapularis tear, leading to reverse total shoulder arthroplasty during revision surgery.</div></div><div><h3>Conclusions</h3><div>The combined SCR technique using a 2 mm dermal allograft and autologous LHBT for posterosuperior MIRCTs significantly improved the patient-reported outcomes.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100628"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100613
Igor Valdeir Gomes de Sousa, Alexandre Moraes Bestetti, Diego Paul Cadena-Aguirre, Angelo So Taa Kum, Paulo Ferreira Mega, Pedro Henrique Veras Ayres da Silva, Nelson Tomio Miyajima, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Background and aim
Minimally invasive techniques offer alternatives to conventional surgery in the treatment of early-stage colorectal cancer, reducing morbidity. Transanal Endoscopic Microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS) are widely used, while Endoscopic Submucosal Dissection (ESD) is gaining attention for its ability to achieve complete resection with low recurrence rates. This study compares the efficacy and safety of ESD with Transanal Endoscopic Surgery (TES).
Methods
The authors performed a systematic review and meta-analysis of comparative studies involving patients with endoscopically resectable rectal lesions. Electronic searches were conducted in MEDLINE, EMBASE, Cochrane, and LILACS. Outcomes included recurrence rate, complete resection, en bloc resection, hospital stay, procedure time, and complication rate.
Results
The analysis included ten observational studies and one Randomized Controlled Trial (RCT) involving 1,094 patients. No significant differences were found in terms of recurrence rate, en bloc resection, R0 resection, and complications between techniques. The RCT showed a shorter procedure time in the TES (RD = 16.6; 95 % CI 8.88 to 24.32; p < 0.0001), whereas observational studies found no significant difference. In addition, observational studies found a shorter hospital stay duration in the ESD (MD = -1.22; 95 % CI -2.11 to -0.33; I2 = 82 %; p < 0.007), while the RCT found no difference.
Conclusion
ESD and TES are safe and effective for the treatment of early-stage rectal tumors. Rates of local recurrence, block resection, R0 resection, complications, and procedure time were similar. However, the RCT showed a shorter procedure time with TES, while observational studies showed a shorter hospital stay with ESD.
背景和目的微创技术为早期结直肠癌的治疗提供了传统手术的替代方案，降低了发病率。经肛门内镜显微手术（TEM）和经肛门微创手术（TAMIS）被广泛应用，而内镜下粘膜夹层（ESD）因其完全切除和低复发率而受到关注。本研究比较了ESD与经肛门内镜手术（TES）的疗效和安全性。方法：作者对涉及内镜下可切除直肠病变患者的比较研究进行了系统回顾和荟萃分析。在MEDLINE、EMBASE、Cochrane和LILACS中进行电子检索。结果包括复发率、完全切除、整体切除、住院时间、手术时间和并发症发生率。结果纳入10项观察性研究和1项随机对照试验（RCT），共纳入1094例患者。两种方法在复发率、整体切除、R0切除和并发症方面均无显著差异。RCT显示TES手术时间较短(RD = 16.6；95% CI 8.88 ~ 24.32；p & lt;0.0001)，而观察性研究没有发现显著差异。此外，观察性研究发现，ESD患者的住院时间较短(MD = -1.22；95% CI -2.11 ~ -0.33；I2 = 82%；p & lt;0.007)，而RCT没有发现差异。结论esd和TES治疗早期直肠肿瘤安全有效。局部复发率、阻断切除术、R0切除术、并发症和手术时间相似。然而，RCT显示TES的手术时间较短，而观察性研究显示ESD的住院时间较短。
{"title":"Comparison of endoscopic submucosal dissection and transanal endoscopic surgery for the treatment of rectal neoplasia: A systematic review and meta-analysis","authors":"Igor Valdeir Gomes de Sousa, Alexandre Moraes Bestetti, Diego Paul Cadena-Aguirre, Angelo So Taa Kum, Paulo Ferreira Mega, Pedro Henrique Veras Ayres da Silva, Nelson Tomio Miyajima, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura","doi":"10.1016/j.clinsp.2025.100613","DOIUrl":"10.1016/j.clinsp.2025.100613","url":null,"abstract":"<div><h3>Background and aim</h3><div>Minimally invasive techniques offer alternatives to conventional surgery in the treatment of early-stage colorectal cancer, reducing morbidity. Transanal Endoscopic Microsurgery (TEM) and Transanal Minimally Invasive Surgery (TAMIS) are widely used, while Endoscopic Submucosal Dissection (ESD) is gaining attention for its ability to achieve complete resection with low recurrence rates. This study compares the efficacy and safety of ESD with Transanal Endoscopic Surgery (TES).</div></div><div><h3>Methods</h3><div>The authors performed a systematic review and meta-analysis of comparative studies involving patients with endoscopically resectable rectal lesions. Electronic searches were conducted in MEDLINE, EMBASE, Cochrane, and LILACS. Outcomes included recurrence rate, complete resection, en bloc resection, hospital stay, procedure time, and complication rate.</div></div><div><h3>Results</h3><div>The analysis included ten observational studies and one Randomized Controlled Trial (RCT) involving 1,094 patients. No significant differences were found in terms of recurrence rate, en bloc resection, R0 resection, and complications between techniques. The RCT showed a shorter procedure time in the TES (RD = 16.6; 95 % CI 8.88 to 24.32; p < 0.0001), whereas observational studies found no significant difference. In addition, observational studies found a shorter hospital stay duration in the ESD (MD = -1.22; 95 % CI -2.11 to -0.33; I<sup>2</sup> = 82 %; p < 0.007), while the RCT found no difference.</div></div><div><h3>Conclusion</h3><div>ESD and TES are safe and effective for the treatment of early-stage rectal tumors. Rates of local recurrence, block resection, R0 resection, complications, and procedure time were similar. However, the RCT showed a shorter procedure time with TES, while observational studies showed a shorter hospital stay with ESD.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100613"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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