In vivo最新文献

Background/aim: Sensitive bioactive coatings, such as polycaprolactone with cholecalciferol, present handling challenges in animal models due to their susceptibility to mechanical damage. This study aimed to develop and validate a refined surgical protocol for inserting such polycaprolactone-cholecalciferol-coated titanium microscrews into the proximal tibia of Sprague-Dawley rats, ensuring primary stability and preserving the integrity of the nanofibrous coating.

Materials and methods: Fourteen male Sprague-Dawley rats (300-350 g) were used: one pilot and 13 animals in the main trial. A 3D anatomical tibia model was created for in-vitro validation of the surgical technique. The refined protocol incorporated enlarged cortical drilling (1.8 mm) before inserting microscrews (1.5×7 mm) to minimize friction on the outer cortical bone. Multimodal anesthesia, postoperative analgesia, and systematic clinical monitoring were implemented. Coating integrity, primary stability, wound healing, and animal welfare were evaluated through clinical observation, micro-computed tomography, and scanning electron microscopy (SEM).

Results: The refined protocol achieved 100% procedural success. All implants reached immediate primary stability with uneventful first-intention healing and no critical adverse events. SEM confirmed preservation of morphology of the nanofibrous coating exclusively in the refined protocol group. Micro-computed tomography demonstrated consistent bone-to-implant contact in both cortical and trabecular compartments. Clinical recovery was rapid and spontaneous, with all animals maintaining optimal welfare indicators throughout follow-up.

Conclusion: The refined protocol safeguards the structural integrity of functionalized surfaces, ensures primary stability, and promotes early osseointegration, while complying with the principles of replacement, reduction, and refinement (3Rs). This model provides a valid experimental platform for investigations into osseointegration dynamics and the controlled local release of therapeutic agents.

Background/aim: Pembrolizumab, an immune checkpoint inhibitor used in cancer therapy, is associated with immune-related adverse effects, yet its impact on female reproductive health remains unclear. This study aimed to evaluate the effects of pembrolizumab on ovarian function and hormonal balance in a mouse model.

Materials and methods: Twenty-four Swiss albino mice were divided into acute and chronic groups, each comprising a pembrolizumab-treated and a saline-control subgroup (n=6 per subgroup). All mice underwent a superovulation protocol, and serum levels of estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH) were measured using enzyme-linked immunosorbent assay kits. Ovarian tissues were evaluated histologically for follicular counts, including primordial, preantral, and secondary follicles.

Results: Estradiol levels were significantly reduced in pembrolizumab-treated mice compared with controls (p=0.007). Significantly higher levels of LH were observed in the chronic control group compared to the chronic pembrolizumab-treated group (p=0.023), while FSH and AMH levels did not differ significantly (p=0.461 and p=0.460, respectively). Primordial follicle counts were significantly higher in control groups than in pembrolizumab-treated groups (p=0.009).

Conclusion: Pembrolizumab administration in mice led to reduced estradiol levels and diminished primordial follicle counts, indicating potential adverse effects on ovarian reserve. These findings highlight the importance of evaluating reproductive risks in female patients receiving immunotherapy.

Background/aim: The usefulness of robot-assisted surgery for elderly colorectal cancer patients remains controversial. The aim of this study was to examine the impact of the surgical approach on short-term prognosis in patients aged ≥80 years.

Patients and methods: A total of 1,115 colorectal cancer patients aged ≥80 years who underwent surgery at 6 hospitals between 2016 and 2024 were included in the study. Patients were divided into three groups according to surgical approach: robotic surgery (R group, n=55), laparoscopic surgery (L group, n=910), and open surgery (O group, n=150). Patient characteristics and surgical outcomes were compared among the three groups.

Results: The O group had higher proportions of patients with a body mass index (BMI) <25 kg/m² (R vs. L vs. O: 72.7% vs. 80.8% vs. 87.3%, p=0.040), a performance status ≥3 (9.1% vs. 18.6% vs. 27.3%, p=0.006), an operation time <240 min (47.3% vs. 59.1% vs. 79.3%, p<0.001), and postoperative complications (9.1% vs. 23.0% vs. 27.3%, p=0.022). Multivariable analysis demonstrated that robotic surgery [odds ratio (OR)=0.243, 95% confidence interval (CI)=0.088-0.668, p=0.006] and BMI <25 kg/m² (OR=0.626, 95% CI=0.419-0.936, p=0.032) were associated with a reduced risk of postoperative complications.

Conclusion: Robotic-assisted colorectal surgery in elderly patients is safe, with relatively few complications.

Background/aim: Operative mortality following surgical intervention for perihilar cholangiocarcinoma (PHCC) is attributable to clinically relevant liver failure (CRLF). Nonetheless, the risk factors for CRLF in patients undergoing preoperative portal vein embolization (PVE) remain undetermined. This study aimed to investigate the risk factors for CRLF following major hepatectomy with PVE in patients with PHCC.

Patients and methods: We retrospectively assessed patients with PHCC. Post PVE, a value for rate of plasma disappearance of indocyanine green×residual liver volume (%) (ICGKF) ≥0.05 warranted curative resection.

Results: In total, 346 patients were reviewed. CRLF developed in 27.5% of the patients. Operative time >660 min, blood loss >1,900 ml, and procedures other than left hepatectomy were independent risk factors for CRLF. Subsequently, 167 patients undergoing PVE were included in the analysis. Pre-PVE ICGKF <0.05, long operative time, and high intraoperative bleeding were independent risk factors for CRLF. The mortality rate for patients with all three risk factors was 25%. The incidence of CRLF after hepatectomy with extended bile duct resection for perihilar cholangiocarcinoma was 27.5%.

Conclusion: Prolonged surgery, and high blood loss are associated with an elevated mortality rate following PHCC surgery, particularly when accompanied by low pre-PVE ICGKF.

Background/aim: Prostate cancer is a multifactorial disease influenced by both genetic and environmental factors. Previous studies have identified a correlation between p21 expression and the clinical severity of prostate cancer. However, the contribution of cyclin-dependent kinase inhibitor 1A (CDKN1A), which encodes p21, to prostate cancer susceptibility remains unclear. This study aimed to evaluate the association between CDKN1A polymorphisms rs1801270 and rs1059234 and the risk of prostate cancer in a Taiwanese population.

Patients and methods: A total of 218 patients with prostate cancer and 436 cancer-free controls were genotyped for CDKN1A rs1801270 and rs1059234 using the PCR-RFLP method. Genotypic distributions were analyzed for associations with prostate cancer risk overall and stratified by age and smoking status.

Results: No significant association was observed between either CDKN1A rs1801270 or rs1059234 genotypes and overall prostate cancer risk (both p>0.05). However, stratified analysis showed that individuals aged <55 years carrying the rs1801270 variant genotypes (AC and AA) had a significantly increased risk of early-onset prostate cancer [odds ratio (OR)=2.16 and 2.51, 95% confidence interval (CI)=1.25-3.71 and 1.37-4.61, p=0.0069 and 0.0041, respectively]. Additionally, among non-smokers, carriers of the rs1059234 variant genotypes (CT and TT) exhibited a significantly reduced prostate cancer risk (OR=0.27 and 0.36, 95%CI=0.11-0.64 and 0.14-0.98, p=0.0042 and 0.0739, respectively), indicating a potential gene-environment interaction.

Conclusion: While CDKN1A rs1801270 and rs1059234 may not serve as general predictive markers for prostate cancer susceptibility, they appear to modulate prostate cancer risk under specific age and smoking contexts. These findings merit further validation in larger and ethnically diverse populations and may contribute to more refined risk stratification and personalized prevention strategies.

Background/aim: Zinc finger CCCH-type containing 12A (ZC3H12A), also known as monocyte chemotactic protein-induced protein 1, has emerged as having a potential role in the landscape of some human cancer types, contributing to anti-tumorigenesis through signaling pathways of inflammation, apoptosis, autophagy and angiogenesis. However, its specific impact on the prognosis of oral squamous cell carcinoma (OSCC) remains to be investigated.

Patients and methods: We conducted in-vitro cell models in a pilot study and performed a retrospective cohort study involving 242 patients with OSCC to unravel the association between ZC3H12A expression level and oral cancer prognosis during 3, 5, and 10-year follow-up.

Results: The findings showed that endogenous ZC3H12A expression was decreased in both the malignant (BQO) and highly metastatic (HSC-3-M3) OSCC cell lines compared to dysplastic oral keratinocytes (DOK) and the parental cell line of HSC-3-M3 (HSC-3). The analysis of clinical cancerous tissue arrays from patients with OSCC showed a significant association between complete loss of ZC3H12A expression and heightened cancer mortality, particularly at 3 and 5 years. Moreover, the complete loss of ZC3H12A expression may be associated with increased risk of lymph node involvement in OSCC.

Conclusion: Our investigation suggests that the complete loss of ZC3H12A expression exacerbated the unfavorable prognosis of OSCC in this Taiwanese population, but further study on elucidating the gradual decline of ZC3H12A expression in OSCC is imperative.

Background/aim: Instagram is a widely used visual communication platform with over one billion global users. Its visual and interactive features suggest potential for use in medical education, particularly for asynchronous learning.

Materials and methods: To evaluate effective strategies for account promotion, content design, and outcome measurement, we launched the Instagram account "ilearnonco2021" during a hematology and medical oncology teaching module. Educational posts were uploaded according to a randomized controlled protocol. Post engagement was assessed using 'likes' as a surrogate marker for student interest. These assumptions were cross-validated through a post-course survey assessing students' content preferences.

Results: Of 126 enrolled students, 49 (38.9%) subscribed to the account, with the majority recruited following a personalized email and references in the online study guide. Single-slide posts received a similar number of likes as multi-slide posts. Combining clinical trial content with supplementary visuals (e.g., comics, mnemonics, images) did not significantly increase engagement compared to single-slide trial posts. Posts in the category "mnemonics" received significantly more likes than clinical trial posts (p=0.01). Compared to a prior cohort, the current group showed a significantly lower rate of engagement, measured in likes per follower and post.

Conclusion: Instagram may serve as a supportive tool for asynchronous learning in medical education. However, its capacity to increase interest in clinical research appears limited. While 'likes' can indicate trends in engagement, they should be cross-validated with independent user surveys to ensure reliability.

Background/aim: Preoperative planning in oncoplastic and reconstructive breast surgery requires synthesizing patient- and tumor-specific variables with aesthetic considerations. Variability in documentation and expertise may hinder reproducibility across centers. Large language models (LLMs) can process structured data into consistent outputs. We assessed whether a prompt-engineered artificial intelligence (AI) assistant (BREAST AI-PLAN) could replicate multidisciplinary team (MDT) decisions and aesthetic scores from routinely collected clinical data.

Patients and methods: This single-center retrospective study included 30 women undergoing breast cancer surgery. Each case was recorded in a standardized form covering demographics, comorbidities, breast anatomy, tumor biology, and staging. This form was used to generate structured prompts for the AI assistant. The AI returned eight outputs: 1) neoadjuvant therapy suitability; 2) planned surgery; 3) surgical approach; 4) reconstruction type; 5) direct-to-implant feasibility; 6) implant type; 7) adjuvant therapy; and 8) an aesthetic score (BCCT.core-aligned). Clinical MDT decisions were the reference standard. Agreement was measured using Cohen's κ, with linear and quadratic weights for aesthetics.

Results: Mean age was 59.2±9.8 years; median body mass index (BMI) 24.2 (20.9-26.8). One patient carried a BRCA2 mutation; 13.3% had prior radiotherapy; 33.3% were smokers. Tumors were mainly Luminal A (43.3%) and Luminal B (26.7%). Agreement was very good for neoadjuvant therapy (κ=0.91; observed 96.7%) and good/moderate for planned surgery (κ=0.58; observed 70.0%), surgical approach (κ=0.43; observed 60.0%), reconstruction (κ=0.36; observed 57.1%), and adjuvant therapy (κ=0.29; observed 64.3%). Aesthetic scoring showed high observed concordance (0.778-0.896) but only slight weighted κ (0.14-0.16).

Conclusion: BREAST AI-PLAN reproduced MDT planning elements and aesthetic assessments with moderate-to-very-good agreement. Transparent, auditable AI assistance may standardize surgical planning and support training. Prospective validation with imaging integration is warranted.

Background/aim: Currently, a combination of an immune checkpoint inhibitor (ICI) and a tyrosine kinase inhibitor (TKI) is the most widely used first-line treatment for metastatic renal cell carcinoma (mRCC). However, patients in the IMDC favourable risk group have been reported to have a relatively good prognosis, even when they undergo TKI monotherapy. The aim of this study was to evaluate whether ICI/TKI combination therapy or TKI monotherapy is more effective in patients with favourable IMDC risk.

Patients and methods: We retrospectively reviewed 11 patients with favourable IMDC risk who underwent ICI/TKI combination therapy and 12 who underwent TKI monotherapy as first-line treatment for mRCC at our institution between April 2008 and September 2024 and compared their characteristics and treatment outcomes. The endpoints were overall survival (OS), progression-free survival (PFS) and treatment response, which was assessed using the overall response rate (ORR) and disease control rate (DCR). The safety of the regimens was evaluated using the incidences of grade ≥3 adverse events (AEs) and treatment discontinuation.

Results: There was a significant difference between the groups regarding the duration of follow-up (24.4 months for the ICI/TKI group vs. 65.9 months for the TKI group, p=0.01), but no other differences were noted in the characteristics of the patients. The PFS and OS of the groups did not significantly differ following initial treatment. The ORR did not significantly differ, but tended to be better in the ICI/TKI group. The incidence of grade ≥3 AEs and the discontinuation of treatment owing to AEs did not significantly differ but tended to be higher in the TKI group.

Conclusion: Based on its superiority with respect to ORR and AE at our Institution, ICI/TKI therapy should be considered whenever possible, even in patients in the IMDC favourable risk group.

Background/aim: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and disabling side-effect of various chemotherapeutic agents. This scoping review aimed to systematically map the existing literature on diagnostic methods used to identify, assess, and monitor CIPN. The review was guided by the research question: "What diagnostic methods have been used in the literature to identify, assess, or monitor chemotherapy-induced peripheral neuropathy in adult cancer patients?"

Materials and methods: We searched PubMed, Web of Science, Scopus, and the Cochrane Library from 2000 to 2024. Studies were included if they evaluated diagnostic methods for CIPN such as clinical assessments, patient-reported outcomes, biomarkers, neurophysiological tests, or digital tools. Data were extracted and narratively synthesized by diagnostic method type. The methodological quality of each included study was assessed using the Joanna Briggs Institute Critical Appraisal Tools.

Results: Twenty-nine studies met the inclusion criteria. The most frequently used tools were patient-reported questionnaires, notably the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Chemotherapy-Induced Peripheral Neuropathy 20 (EORTC QLQ-CIPN20) and the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE). Biomarkers such as neurofilament light chain and microRNAs, neurophysiological tests including nerve conduction studies, diffusion tensor imaging, functional magnetic resonance imaging, as well as digital technologies, such as mobile applications and wearable sensors, were also employed. Studies showed considerable heterogeneity in design, population, timing of assessments, and tool validation.

Conclusion: Despite growing interest in multimodal approaches that integrate subjective and objective tools, a lack of standardization and validation limits the clinical applicability of many diagnostic methods. There is an urgent need to develop and validate reliable, reproducible, and feasible tools for the diagnosis and monitoring of CIPN in routine practice.