Diagnostics最新文献

Background/Objectives: Cryotherapy is used for local tissue destruction through rapid freeze-thaw cycles. It induces cancer cell necrosis followed by inflammation in the treated tumor microenvironment, and it stimulates systemic adaptive immunity. Combining cryotherapy with immunotherapy may provide a sustained immune response by preventing T cell exhaustion. Methods: Fifty-five patients with metastatic non-small cell lung cancer who had received no prior treatment were randomized into two groups in a 1:1 ratio: the bronchoscopic cryotherapy group or the control group. Patients received up to four cycles of pembrolizumab as monotherapy or in combination with platinum-based chemotherapy. Immune-related adverse events (irAEs), complications, tumor size changes, overall response rate (ORR), and disease control rate (DCR) were evaluated. Results: Lung tumors, treated with cryotherapy, demonstrated continuous reduction from the baseline (22.4 cm² vs. 14.4 cm² vs. 10.2 cm², p < 0.001). Similar changes were observed in pulmonary tumors in the control group (19.0 cm² vs. 10.0 cm², p < 0.001). The median change in pulmonary tumors between two groups was not significant (-42.9% vs. -27.7%, p = 0.175). No significant differences were observed in the ORR (28.6% vs. 23.1%, p = 0.461) or target lesion decrease (-24.0% vs. -23.4%, p = 0.296) between the groups. However, the DCR was significantly higher in the cryotherapy group (95.2% vs. 73.1%, p = 0.049). No cases of serious bleeding during cryotherapy or pneumothorax were observed. Six patients (25.0%) in the cryotherapy group and eight (26.7%) in the control group experienced irAEs. Conclusions: Our study demonstrated that combined bronchoscopic cryotherapy and immunotherapy with or without chemotherapy may reduce the rate of progressive disease in metastatic non-small cell lung cancer patients while maintaining a satisfactory safety profile.

Background: we evaluated regression models based on quantitative ultrasound (QUS) parameters and compared them with a vendor-provided method for calculating the ultrasound fat fraction (USFF) in metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: We measured the attenuation coefficient (AC) and the backscatter-distribution coefficient (BSC-D) and determined the USFF during a liver ultrasound and calculated the magnetic resonance imaging proton-density fat fraction (MRI-PDFF) and steatosis grade (S0-S4) in a combined retrospective-prospective cohort. We trained multiple models using single or various QUS parameters as independent variables to forecast MRI-PDFF. Linear and nonlinear models were trained during five-time repeated three-fold cross-validation in a retrospectively collected dataset of 60 MASLD cases. We calculated the models' Pearson correlation (r) and the intraclass correlation coefficient (ICC) in a prospectively collected test set of 57 MASLD cases. Results: The linear multivariable model (r = 0.602, ICC = 0.529) and USFF (r = 0.576, ICC = 0.54) were more reliable in S0- and S1-grade steatosis than the nonlinear multivariable model (r = 0.492, ICC = 0.461). In S2 and S3 grades, the nonlinear multivariable (r = 0.377, ICC = 0.32) and AC-only (r = 0.375, ICC = 0.313) models' approximated correlation and agreement surpassed that of the multivariable linear model (r = 0.394, ICC = 0.265). We searched a QUS parameter grid to find the optimal thresholds (AC ≥ 0.84 dB/cm/MHz, BSC-D ≥ 105), above which switching from a linear (r = 0.752, ICC = 0.715) to a nonlinear multivariable (r = 0.719, ICC = 0.641) model could improve the overall fit (r = 0.775, ICC = 0.718). Conclusions: The USFF and linear multivariable models are robust in diagnosing low-grade steatosis. Switching to a nonlinear model could enhance the fit to MRI-PDFF in advanced steatosis.

As medical imaging continues to expand, concerns about the potential risks of ionizing radiation to the developing fetus have led to a preference for non-radiation-based alternatives such as ultrasonography and fetal MRI. This review examines the current evidence on the safety of MRI during pregnancy, with a focus on 3 T MRI and contrast agents, aiming to provide a comprehensive synthesis that informs clinical decision-making, ensures fetal safety and supports the safe use of all available modalities that could impact management. We conducted a comprehensive review of studies from 2000 to 2024 on MRI safety during pregnancy, focusing on 3 T MRI and gadolinium use. The review included peer-reviewed articles and large database studies, summarizing key findings and identifying areas for further research. Fetal MRI, used alongside ultrasound, enhances diagnostic accuracy for fetal anomalies, particularly in the brain, thorax, gastrointestinal and genitourinary systems, with no conclusive evidence of adverse effects on fetal development. While theoretical risks such as tissue heating and acoustic damage exist, studies show no significant harm at 1.5 T or 3 T, though caution is still advised in the first trimester. Regarding gadolinium-based contrast agents, the evidence is conflicting: while some studies suggest risks such as stillbirth and rheumatological conditions, animal studies show minimal fetal retention and no significant toxicity, and later clinical research has not substantiated these risks. The existing literature on fetal MRI is encouraging, suggesting minimal risks; however, further investigation through larger, prospective and long-term follow-up studies is essential to comprehensively determine its safety and late effects.

Background/Objectives: As an endocrine organ, adipose tissue produces adipokines that influence coronary artery disease (CAD). The objective of this study was to assess the potential value of CTRP5 and chemerin in differentiating coronary computed tomography angiography (CCTA)-confirmed coronary artery disease (CAD) versus non-CAD. Secondarily, within the CCTA-confirmed CAD group, the aim was to investigate the relationship between the severity and extent of CAD, as determined by coronary artery calcium score (CACS), and the levels of CTRP5 and chemerin. Methods: Consecutive individuals with chest pain underwent CCTA to evaluate coronary artery anatomy and were divided into two groups. The CCTA-confirmed CAD group included patients with any atherosclerotic plaque (soft, mixed, or calcified) regardless of calcification, while the non-CAD group consisted of individuals without plaques on CCTA, with zero CACS, and without ischemia on stress ECG. Secondarily, in the CCTA-confirmed CAD group, the severity and extent of CAD were evaluated using CACS. Blood samples were collected and stored at -80 °C for analysis of CTRP5 and chemerin levels via ELISA. Results: Serum CTRP5 and chemerin levels were significantly higher in the CAD group compared to the non-CAD group (221.83 ± 103.81 vs. 149.35 ± 50.99 ng/mL, p = 0.003 and 105.02 ± 35.62 vs. 86.07 ± 19.47 ng/mL, p = 0.005, respectively). Receiver operating characteristic (ROC) analysis showed that a CTRP5 cutoff of 172.30 ng/mL had 70% sensitivity and 73% specificity for identifying CAD, while a chemerin cutoff of 90.46 ng/mL had 61% sensitivity and 62% specificity. A strong positive correlation was observed between CTRP5 and chemerin, but neither adipokine showed a correlation with the Agatston score, a measure of CAD severity and extent, nor with coronary artery stenosis as determined by CCTA. Conclusions: CTRP5 and chemerin were significantly elevated in the CCTA-confirmed CAD group compared to the non-CAD group, with CTRP5 showing greater sensitivity and specificity. However, neither adipokine was linked to CAD severity and extent, differing from findings based on invasive coronary angiography (ICA). CTRP5 may serve as a promising "all-or-none biomarker" for CAD presence.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a benign lesion that may arise from the oral mucosa consisting in an ulcerative lesion usually localized in the tongue or cheek. Palate localization is very rare. Background/Objectives: The aim of this study is to describe a case of TUGSE occurring in the hard palate of an 83 y.o. female patient, manifesting as a non-painful growing palatal lesion approximately of 3.5 × 2 cm with firm consistency and a central area of erosion and erythema, the difficulties in clinical diagnosis, and the criteria for the differential diagnosis. Also, considering the rare occurrence of TUGSE in the palate, we performed a review of the literature too. Methods: A comprehensive review of the literature was conducted following the 2020 PRISMA guidelines and a total of seven records were identified as matching the inclusion criteria of this study. Results Conclusions: Although TUGSE is a benign lesion, the clinical presentation as a proliferative and ulcerative lesion may be challenging for clinicians mainly when arising in rare sites of occurrence (e.g., the hard palate).

Background/Objectives: The study aimed to validate the diagnostic system proposed by the Standardized Tool for the Assessment of Bruxism (STAB) by correlating the results obtained based on questionnaire and non-instrumental and instrumental tools. Methods: The study had three stages (questionnaire, clinical examination, and electromyographic study). The subjects completed a questionnaire and clinical exam. Positive signs of bruxism included oral mucosal signs and the presence of dental wear according to the BEWE index. In stage three, sEMG was performed after allocating subjects into four groups according to the questionnaire and clinical exam results: sleep bruxism (SB), awake bruxism (AB), sleep and awake bruxism (SB AB), and no bruxism (no B). After the third stage, a new selection was made, and the subjects were divided into four groups, according to sEMG results. Diagnostic accuracy was computed for possible bruxism SB and grinding and clenching sound diagnosis, possible bruxism AB and AB acknowledgment, possible bruxism SB AB, and tooth wear index. Results: For SB, the sensitivity and specificity of the tools were the highest. The non-instrumental questionnaire and clinical assessment identified 67% of SB cases and 89% without SB. For AB, the specificity was higher (84%), while the sensitivity was lower (55%), as almost half of the subjects were not aware of the presence of AB. The tests showed a low sensitivity (15%) but a high specificity (83%) for tooth wear. The absence of tooth wear was frequently associated with the absence of bruxism, while the presence of tooth wear did not necessarily imply the existence of bruxism. Conclusions: Non-instrumental evaluation of bruxism through questionnaires and clinical exams is valuable, especially for SB. Instrumental evaluation through electromyography remains a gold standard for bruxism diagnosis.

Background: Anal HPV infection can cause squamous intraepithelial lesions (SILs), which are precursors of anal squamous cell carcinoma (SCC). The early detection of HPV infections and improvement of effective screening programmes are, therefore, essential to prevent progression from pre-cancerous lesions to SCC, especially in people living with HIV (PLWH), who represent a population at higher risk of HPV infection and associated lesions. Among prevention strategies, HPV vaccination is relevant too, but its efficacy in persons already infected by HPV is still debated. Methods: This is a retrospective single-center study on a cohort of PLWH who performed longitudinal screening for anal dysplasia and HPV infection. The screening included cytological and molecular analyses. Results: A total of 110 PLWH performed at least one anal HPV screening, with an overall prevalence of HPV infection of 86.4% [23.6% low risk (LR)-HPV and 62.7% high risk (HR)-HPV genotypes]. Abnormal cytology was demonstrated in 39.1% of subjects, of whom ASCUS 6.4%, LSIL 30.9% and HSIL 1.8%. In total, 80 patients (72.7%) had an available longitudinal screening. No patient developed SCC during follow-up. However, a high incidence of new cytological abnormalities and new HPV infections was observed. On the other side, clearance of some HPV genotypes was also frequent, confirming that HPV infection is a dynamic process. A CD4 cell count > 500/mmc was an independent predictor of HPV clearance. HPV vaccination was performed on 30.9% of patients. A trend toward an increased clearance of HPV genotypes included in 9-valent vaccine was observed in vaccinated patients (40.6% versus 30.8% in unvaccinated, p = 0.079). Conclusions: A high prevalence of HPV infection and SILs was observed in our cohort of PLWH. A high incidence of new HPV infections and HPV-associated lesions was also observed in the longitudinal cohort, highlighting the need of strengthening immunization programs and continuous screening for anal HPV infection. Whether HPV vaccination may be efficacious in patients already infected by HPV remains to be determined.

Aim: This study aims to evaluate the management of oro-antral communications (OAC) and fistulas (OAF), focusing on treatment strategies based on defect size, epithelialization, and the presence of sinus infections, while exploring both traditional and emerging techniques. Materials and Methods: The systematic review was conducted following the PRISMA guidelines and registered on PROSPERO (CDR ID 623251). Using targeted keywords, articles in English published within the last 10 years were analyzed from databases such as PubMed, WoS and Scopus, selecting only clinical studies on human patients. After thorough screening, 20 publications were included in the qualitative analysis, among 734 initially identified. Results: Small OACs (<5 mm) were managed conservatively with hemostatic materials, while larger defects (>5 mm) required surgical closure, with the Bichat flap proving highly effective for large defects. Innovative treatments using autologous bone grafts and PRF showed promise in supporting tissue regeneration. In cases with sinusitis, the combination of FESS and intra-oral closure techniques resulted in high success rates for infection resolution and defect closure. Conclusions: Treatment outcomes for OAC and OAF are highly dependent on the size of the defect and the presence of sinusitis. Multidisciplinary collaboration, along with timely surgical intervention and adherence to medical therapies, is essential for successful management. Emerging techniques and minimally invasive procedures continue to improve patient outcomes, offering hope for more effective and sustainable solutions in complex cases.

Background: CABG is a commonly performed procedure to improve survival and quality of life in patients with coronary artery disease. Despite advances in surgical techniques and perioperative care, postoperative pneumonia remains a serious complication contributing to increased morbidity, mortality and healthcare costs. This study aims to evaluate the incidence of postoperative pneumonia (POP) and identify its risk factors in patients undergoing isolated CABG. Methods: This retrospective study analyzed 430 patients who underwent CABG between 2019 and 2024. Patient demographics, clinical characteristics, surgical details and laboratory data were collected. Statistical analysis included univariate and multivariate logistic regression to identify significant predictors of pneumonia. Results: The incidence of POP after CABG was 10% (43/430). In patients with POP, diabetes mellitus (p = 0.03) and chronic kidney disease (p = 0.048) prevalence was higher, cardiopulmonary bypass (CPB) (p = 0.01) and cross-clamp time (p = 0.003) was longer, LDH levels (p = 0.017) were higher, hemoglobin (p = 0.012) and albumin (p = 0.015) levels were lower, and lymphocyte % (p = 0.04) was lower; prevalence of COPD and length of stay (LOS) in hospital tended to be higher (both p < 0.06). Multivariate binary logistic regression identified COPD (OR 4.383, 95% CI: 1.106-17.363, p = 0.035), CPB time (OR 1.013, 95% CI: 1.001-1.025, p = 0.030) and LOS (OR 1.052, 95% CI: 1.004-1.103, p = 0.035) as independent predictors of POP. Conclusions: Postoperative pneumonia is a common complication after CABG and is strongly associated with preoperative COPD, CPB time and length of stay in hospital. These findings underline the importance of preoperative risk assessment and optimization. Early identification of high-risk patients may allow targeted strategies such as enhanced respiratory support and prophylactic antibiotics to reduce the incidence of pneumonia and improve clinical outcomes.

Background: This review evaluates needle navigation technologies in minimally invasive cardiovascular surgery (MICS), identifying their strengths and limitations and the requirements for an ideal needle navigation system that features optimal guidance and easy adoption in clinical practice. Methods: A systematic search of PubMed, Web of Science, and IEEE databases up until June 2024 identified original studies on needle navigation in MICS. Eligible studies were those published within the past decade and that performed MICS requiring needle navigation technologies in adult patients. Animal studies, case reports, clinical trials, or laboratory experiments were excluded to focus on actively deployed techniques in clinical practice. Extracted data included the study year, modalities used, procedures performed, and the reported strengths and limitations, from which the requirements for an optimal needle navigation system were derived. Results: Of 36 eligible articles, 21 used ultrasound (US) for real-time imaging despite depth and needle visibility challenges. Computer tomography (CT)-guided fluoroscopy, cited in 19 articles, enhanced deep structure visualization but involved radiation risks. Magnetic resonance imaging (MRI), though excellent for soft-tissue contrast, was not used due to metallic tool incompatibility. Multimodal techniques, like US-fluoroscopy fusion, improved accuracy but added cost and workflow complexity. No single technology meets all the criteria for an ideal needle navigation system, which should combine real-time imaging, 3D spatial awareness, and tissue integrity feedback while being cost-effective and easily integrated into existing workflows. Conclusions: This review derived the criteria and obstacles an ideal needle navigation system must address before its clinical adoption, along with novel technological approaches that show potential to overcome those challenges. For instance, fusion technologies overlay information from multiple visual approaches within a single interface to overcome individual limitations. Additionally, emerging diagnostic methods like vibroacoustic sensing or optical fiber needles offer information from complementary sensory channels, augmenting visual approaches with insights into tissue integrity and structure, thereby paving the way for enhanced needle navigation systems in MICS.