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Background/aim: Our study compares repeat cesarian section with and without labor in progress and evaluates adverse maternal outcomes that could discourage pregnant women in planning labor at term or at least after 39 weeks of gestation as recommended due to benefits in neonatal outcome.

Patients and methods: In this retrospective study, we analyzed 191 patients undergoing third C-section and compared two groups of women of undergoing C-section either before or after the onset of labor. The primary outcome measure was the incidence of maternal morbidity. Values of p≤0.05 were regarded as significant.

Results: Comparing the two subgroups, we did not find any significant differences in the occurrence of maternal complications or severe acute morbidity except for incomplete uterine rupture (p=0.04).

Conclusion: Undergoing a third C-section after the start of labor has no relevant or adverse impact on maternal outcome. Therefore, elective repeat C-section can be planned in late weeks of gestation aiming at reducing neonatal morbidity. The higher rate of uterine dehiscence was not associated with other issues of severe acute maternal morbidity.

Background/aim: Melanoma, as a type of skin cancer, has undoubtedly gathered the interest of the global community in recent years, due to its rising incidence. Patients suffering from melanoma experience effects on their mental health, mainly depression and anxiety disorders. The present study aimed to examine the association of melanoma with the psychosomatic burden, personality traits, and demographic factors of the participants.

Patients and methods: The psychometric instruments administered were: the Psychopathology Questionnaire (SCL-90), Beck Depression Scale (BDI), Eysenck Personality Questionnaire (EPQ), and Hostility Questionnaire (HDHQ). The research sample consisted of 80 cancer patients, of whom 57.5% were women and 42.5% men, and whose ages ranged from 15 to 85, with a mean age of 56.95 and a standard deviation of 13.52 years.

Results: The majority of patients presented introverted hostility (77.5%) and 22.5% presented extroverted hostility. Male cancer patients seemed to score on average statistically significantly higher on the self-criticism scale than females (4.44±2.31 vs. 3.17±1.98, p<0.01) The patients in an advanced stage scored statistically significantly higher on the phobic anxiety scale than the patients in the initial stage (5.17±3.60 vs. 2.86±2.04, p<0.01). Also, early-stage patients presented statistically significantly higher scores on the paranoid hostility scale than advanced-stage patients (2.00±1.18 vs. 1.37±0.89, p<0.05).

Conclusion: The majority of patients with melanoma presented introverted hostility, and those in advanced stages scored significantly higher on the phobic anxiety scale compared to the patients in the initial stage.

Background/aim: In spot-scanning proton therapy, intra-fractional anatomical changes by organ movement can lead to deterioration in dose distribution due to beam range variation. To explore a more robust treatment planning method, this study evaluated the dosimetric characteristics and robustness of two proton therapy planning methods for liver cancer.

Patients and methods: Two- or three-field treatment plans were created for 11 patients with hepatocellular carcinoma or metastatic liver cancer using a single-field uniform dose (SFUD) technique. The plans were optimized using either beam-specific planning target volume (BSPTV) or worst-case optimization (WCO). The target coverage for the gross tumor volume (GTV), planning target volume (PTV), and organs at risk (OAR) parameters related to toxicity were calculated from the perturbed dose distributions, considering setup and range uncertainties. Statistical analyses of the BSPTV and WCO plans were performed using the Wilcoxon signed-rank sum test (p<0.05). The calculation times for a single optimization process were also recorded and compared.

Results: The robustness of the WCO plans in the worst-case scenario was significantly higher than that of the BSPTV plan in terms of GTV target coverage, prevention of maximum dose increase to the gastrointestinal tract, and the dose received by normal liver regions. However, there were no significant differences in PTV, and the calculation time required to create the WCO plan was considerably longer.

Conclusion: In SFUD proton therapy for liver cancer, the WCO plans required a longer optimization time but exhibited superior robustness in GTV coverage and sparing of OARs.

Background/aim: Renal cell carcinoma (RCC) is highly heterogeneous, with distinct patient management between clear cell RCC (ccRCC) and non-ccRCC groups. Previous bioinformatics and machine learning techniques identified fatty acid binding protein 7 (FABP7) as a potential ccRCC biomarker. However, FABP7 expression studies between ccRCC and non-ccRCC were incomplete. This study aimed to assess FABP7 as a biomarker for distinguishing between ccRCC and non-ccRCC tissue samples.

Patients and methods: FABP7 expression was evaluated via immunohistochemical staining in 58 RCC cases, including 43 ccRCC and 15 non-ccRCC cases. Staining results were interpreted using H-scores; scores above the cut-off were deemed positive. The correlation between FABP7 expression and clinicopathological RCC features was investigated.

Results: FABP7 positivity was 48.8% in ccRCC and only 13.3% in non-ccRCC cases, with weak positivity in non-ccRCC tissues. FABP7 expression significantly differed between ccRCC and non-ccRCC (p<0.05). This finding was confirmed in a TCGA dataset. However, FABP7 expression was not correlated with other RCC clinicopathological features in our dataset. TCGA results linked FABP7 expression to tumor stage and disease-free survival in patients with ccRCC.

Conclusion: This study preliminarily evaluated FABP7 as a differential diagnostic biomarker in RCC subtyping, showing higher expression in ccRCC than non-ccRCC. FABP7 may serve as a potential diagnostic and prognostic biomarker for ccRCC.

Background/aim: Ovarian cancer remains a major cause of death in women worldwide, mainly due to late diagnosis and the lack of a reliable screening test for early detection of the disease. In this context, attention has been focused on the identification of other prognostic factors that might allow a better identification of cases with worse long-term outcome.

Patients and methods: Data of patients who underwent cytoreductive surgery between 2014-2019 were retrospectively reviewed and 57 patients were considered eligible for this study. These cases were further classified according to preoperative platelet count, with a cut-off value of 335,000/μl as a positive predictive value for long-term survival.

Results: According to this value, there were 27 cases with a preoperative platelet count lower than 335,000/μl and 30 cases with a preoperative platelet count higher than 335,000/μl. Cases in the second group had a significantly higher peritoneal carcinomatosis index (p=0.002), a higher proportion of digestive serosa involvement (p<0.001), and a higher proportion of mesenteric lymph node involvement and hematogenous metastases (p=0.005 and p=0.001, respectively). When analyzing long-term outcomes, all these factors had a significant impact on overall survival.

Conclusion: Preoperative thrombocytosis appears to be positively associated with gastrointestinal serosa involvement, mesenteric lymph node invasion, and the presence of hematogenous metastases, thus significantly influencing the long-term outcome of patients with advanced ovarian cancer.

Background/aim: Radiation oncologists are reluctant to treat cancer in Fanconi Anemia (FA) patients due to their lack of homologous recombination repair of DNA strand breaks in normal tissues. To determine the therapeutic effects of irradiation and combination chemotherapy on cancer in syngeneic, radiosensitive FA mice, we derived transplantable cancers of the same genotype in three FA mouse strains.

Materials and methods: Fancd2-/- mice on a C57BL/6 or Sv/129 background and Fancg-/- mice (C57BL/6 background) that received 3-methylcholanthrene (3-MCA), were monitored for the development of subcutaneous tumors.

Results: Tumors were induced at the site of 3-MCA injection, and tumor cell lines were established and found to be transplantable. Explanted tumors were identified as pleomorphic/rhabdomyosarcomas using immunohistochemical biomarkers.

Conclusion: These transplantable FA mouse tumor cell lines should be valuable for testing effects of new radiation therapy protocols including FLASH high dose rate radiation delivery, immunotherapies, and combined radiation and chemotherapy treatments for radiosensitive FA patients.

Background/aim: Endoscopic submucosal dissection (ESD) effectively treats selected early gastric cancers (EGCs). However, the association of microsatellite instability (MSI), Epstein-Barr virus (EBV), p53, and β-catenin status with clinicopathologic parameters in EGCs treated with ESD have not been well studied.

Patients and methods: We retrospectively collected 312 consecutive EGC cases treated with ESD from January 2021 to December 2023 at Kyungpook National University Chilgok Hospital. MSI polymerase chain reaction, EBV encoded RNA in situ hybridization, and p53 and β-catenin immunostaining were performed for all cases.

Results: Among 312 EGC cases, there were 42 MSI-High (MSI-H) cases (13.5%), 13 EBV-associated gastric cancer (EBVaGC) cases (4.2%), 249 intestinal type cases (79.8%), and eight poorly cohesive carcinoma cases (2.6%). MSI-H was significantly associated with lymphovascular invasion (p=0.02), local recurrence (p=0.03), and synchronous tumors (p<0.001). More than half of EBVaGC cases showed submucosal invasion (61.5%, 8/13) (p=0.016). Consequently, non-curative ESD was more frequently found in EBVaGC than in other subtypes (p<0.001). Mutant p53 patterns and nuclear translocation of β-catenin were almost exclusively found in the intestinal type (p<0.001), without association with clinicopathologic parameters. Margin involvement was frequent in poorly cohesive carcinoma (p=0.003).

Conclusion: We demonstrated that MSI-H and EBVaGC are strongly associated with clinicopathologic parameters and risk factors in EGCs treated with ESD. Molecular testing of gastric cancers should be considered before ESD for better patient management.

Background/aim: Pediatric patients with primary refractory or relapsed B-cell non-Hodgkin lymphoma (B-NHL) have highly unfavorable prognosis. In this study, we retrospectively analyzed outcomes in pediatric B-NHL patients treated in a single center in Poland from 1995 to 2022, with emphasis on therapy results in patients with progression or relapse.

Patients and methods: The primary objectives were a 5-year probability of overall survival (pOS) and a 5-year probability of event-free survival (pEFS). The secondary objectives involved the assessment of prognostic factors.

Results: A total of 76 children were eligible for the analysis. The 5-year pOS was 76.7%, and the 5-year pEFS was 72.9%. At diagnosis, elevated lactate dehydrogenase activity, the presence of B symptoms, bone marrow, skeletal or mediastinal involvement, and stage IV disease were associated with inferior outcomes. Nine children experienced progression and four relapse. The 5-year pOS for patients with progression was 38.1%. Two patients treated with hematopoietic stem cell transplantation (HSCT) as part of salvage therapy survived. However, only one out of seven patients who were treated without HSCT survived. The 5-year pOS was 0.0% in patients with relapsed disease.

Conclusion: The most significant factor related to outcomes in pediatric B-NHL is therapy response, with a high mortality rate in children with refractory disease and relapse. There is no consensus on the salvage therapy approach; however, HSCT appears to be the optimal choice.

Background/aim: Gout, characterized by acute inflammatory symptoms and monosodium urate crystal deposits in joints, is prevalent among males and the elderly. Total knee arthroplasty (TKA) is a common treatment for knee osteoarthritis (OA), but its impact on the risk of developing gout is unclear. This study examined the risk of gout in patients undergoing TKA.

Patients and methods: Utilizing the TriNetX research network, a retrospective cohort study was conducted on OA patients without prior gout. The TKA cohort was compared to a non-TKA control group using propensity score matching to balance covariates. The primary outcome was the incidence of gout over a five-year follow-up period.

Results: The study included 38,834 matched pairs of TKA and non-TKA patients. TKA patients had a 15.6% higher risk of developing gout (HR=1.156; 95%CI=1.042-1.284) compared to controls. Sensitivity analyses confirmed the increased risk across various models and follow-up durations.

Conclusion: TKA is associated with a higher risk of developing gout, particularly in females and older adults. Clinicians should monitor and manage gout risk in TKA patients, emphasizing preventive measures and early intervention. Further research is needed to understand the underlying mechanisms and improve patient care post-TKA.

Background/aim: SARS-CoV-2 infection presents different severity levels that suggest the influence of genetic factors on the clinical outcome of the disease. In cases of severe COVID-19, the presence of elevated coagulation markers, increased platelet activation and aggregation and the risk of thrombotic complications are described. Given the participation of these cells in several serious viral infections and their negative role when associated with a prothrombotic response, it is important to understand the mechanistic role of SARS-CoV-2 in platelet physiology. This study evaluated the hyperexpression of platelet-activating factor receptor (PTAFR) and platelet factor 4 (PF4) in unvaccinated and hospitalized patients with COVID-19.

Patients and methods: The study included 43 COVID-19 patients stratified according to WHO guidelines. Subsequently, the expression of the PTAFR and PF4 genes were evaluated using the real-time quantitative PCR and their possible correlation with the severity of the disease and clinical variables including hospitalization, outcome, sex, age and laboratory parameters (platelet count, INR and D-dimer).

Results: The analysis demonstrated a significant (p<0.05) hyperexpression of these genes COVID-19 patients (n=43) compared to healthy controls. Expression of these genes in patients was not statistically significant (p>0.05) different between patients stratified according to clinical variables.

Conclusion: The expression of PTAFR and PF4 suggests an important molecular pathway in the pathophysiology of the disease and may be valuable platelet biomarkers to indicate increased risk in patients with COVID-19 who require hospital care, contributing to personalized intervention strategies and improving their clinical management.