Journal of Medicine and Life最新文献

Zebrafish patient-derived xenografts (zPDX) are a powerful emerging platform for personalized oncology, offering a rapid in vivo system for high-throughput chemoprofiling. Recent studies have demonstrated a strong predictive correlation between drug response in zPDX and patient clinical outcomes. However, current protocols show significant variability in drug concentrations, which can hinder comparison across studies. We aimed to establish toxicity profiles for commonly used clinical chemotherapeutic agents in wild-type Tübingen (TU) and Casper (CSP) zebrafish (ZF) strains. Embryos aged 48-72 hours post-fertilization (hpf) were exposed to a clinically relevant chemotherapeutic panel, including standard combination regimens, for 72 hours. Toxicity was assessed using two parameters: mortality rate and any adverse effects (AAE), defined as embryos exhibiting either mortality or morphological abnormalities. Screening of single agents was similar between the two strains, but the combination regimes revealed toxicity disparities, with AAE proving to be the more sensitive endpoint. Highly toxic agents, such as paclitaxel, caused rapid, dose-dependent lethality, whereas antimetabolites like 5-fluorouracil (5-FU) showed high safety margins. Multi-agent protocols demonstrated synergistic toxicity, with more complex regimens correlating with increased adverse effects, particularly in the CSP strain. This study establishes a toxicological framework for standardizing chemotherapy dosing in ZF larvae and recommends AAE as the primary metric for defining non-toxic concentrations. Our results also underscore the necessity of testing the exact clinical drug formulation, due to potential excipient effects, and of screening multi-agent protocols for synergistic toxicity. We hope these findings will contribute to the further standardization of zPDX models for clinical applications.

Diffuse gliomas are biologically heterogeneous primary brain tumors with variable clinical behavior, and age is a well-recognized prognostic factor; however, integrated real-world data from Eastern European populations remain limited. The aim of this study was to describe how clinical, imaging, molecular, treatment, and survival data co-vary across age groups in a Romanian tertiary neuro-oncology cohort, rather than to identify new biological associations. We conducted a single-center retrospective cohort study of 283 consecutive adult patients with histologically confirmed diffuse gliomas diagnosed between 2021 and 2024, classified according to the WHO 2021 framework. Patients were stratified into three predefined age groups (<40, 40-60, and >60 years), and clinical, histopathological, molecular, preoperative imaging, and treatment variables were compared using Pearson chi-square or Fisher exact tests; recurrence-free survival (RFS) was estimated using the Kaplan-Meier method with log-rank tests. Molecular testing availability varied across the cohort, reflecting progressive adoption of integrated molecular diagnostics. Older patients more frequently harbored IDH-wildtype glioblastoma, more aggressive imaging features, lower Karnofsky Performance Status, and received less intensive multimodal therapy. Unadjusted RFS decreased with advancing age (log-rank P < 0.001); without multivariable adjustment, this reflects the combined effects of age-correlated covariates rather than an independent age effect. This study contributes region-specific real-world evidence from an underrepresented Eastern European setting, where integrated molecular diagnostics were being progressively implemented during the study period.

Healthcare-associated infections represent a major public health problem, significantly impacting patient safety and the quality of medical care. Beyond their clinical and epidemiological implications, the prevention of these infections raises important ethical issues. Healthcare professionals have both a professional and moral responsibility to adopt all necessary measures to reduce the risk of healthcare-associated infections. The present article aimed to analyze the ethical dimension of preventing healthcare-associated infections, highlighting the role of fundamental bioethical principles, such as beneficence, non-maleficence, and professional responsibility, in guiding clinical practice. In addition, the responsibilities of healthcare personnel and the ethical dilemmas that may arise in preventing and reporting these infections are discussed. The integration of bioethical principles into medical practice improves the quality of healthcare and strengthens the relationship of trust between patients and healthcare professionals.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for hematological malignancies, but it is associated with substantial gut microbial dysbiosis linked to graft-versus-host disease, infections, and transplant-related mortality. The conditioning regimen represents the first major iatrogenic insult delivered within the transplant pathway, but its specific contribution to microbiota injury, independent of subsequent aplasia, antibiotic exposure, and mucositis, remains incompletely characterized. We conducted a prospective, single-center, observational longitudinal study at Fundeni Clinical Institute between August 2024 and February 2025, analyzing paired stool samples collected before conditioning (T0) and on the day of stem cell infusion (T1) from 47 adult allo-HSCT recipients. Microbial diversity was assessed using 16S rRNA gene sequencing (V4-V5 region), with the Shannon diversity index as the primary outcome. Statistical analyses were performed using SPSS, including Wilcoxon signed-rank tests for paired comparisons, Mann-Whitney U tests for between-group differences, and Kruskal-Wallis H tests. Shannon diversity decreased substantially between T0 and T1 (median 4.91 vs. 3.51; Wilcoxon P < 0.001; effect size r = 0.62), with 37 of 47 patients (78.7%) showing decline. This conditioning-induced injury was reproducible across three stratification dimensions: agent type (chemotherapy vs. TBI-containing; P = 0.67), intensity (RIC vs. MAC; P = 0.92), and number of cytotoxic agents (2 vs. 3; P = 0.54), with statistically significant within-subgroup decline observed in the four most represented regimens. Beta diversity analysis revealed a significant shift in community composition (PERMANOVA P < 0.001) without differential dispersion. Conditioning produces a substantial, biologically coherent microbiota injury before aplasia-associated factors come into play, but further studies on large cohorts are needed.

The COVID-19 pandemic significantly altered the epidemiology of respiratory viral infections in children. This study aimed to compare the clinical and epidemiological characteristics of influenza and COVID-19 infections in hospitalized pediatric patients in Romania during the pandemic. We conducted a retrospective observational study at the Alessandrescu-Rusescu National Institute for Mother and Child Health in Bucharest between January 1, 2020, and November 2025. Pediatric patients (0-18 years) hospitalized with COVID-19 infection or influenza A/B type were included. Demographic data, clinical presentation, comorbidities, complications, and outcomes were analyzed. A total of 234 patients with COVID-19 and 235 patients with influenza type A/B were included. The median age in the COVID-19 group was 13.9 months with a median length of hospitalization of 4 days, while in the influenza group, the median age was 32.6 months, with a median length of stay of 5 days. Influenza virus was associated with higher risks of intensive care unit admission, longer hospitalization (P < 0.001), pneumonia (22.0% vs 6.0%, P < 0.001), and acute respiratory failure (18.3% vs 10.7%, P = 0.025). In contrast to adult populations, influenza infection was associated with a more severe clinical course than COVID-19 in hospitalized pediatric patients, despite the younger age of COVID-19 patients. These findings emphasize the importance of preventive strategies against influenza in children.

Postoperative morbidity remains an important challenge following curative-intent surgical treatment for non-small cell lung cancer (NSCLC), despite advances in minimally invasive thoracic surgery and perioperative management. Identification of factors associated with clinically relevant postoperative complications may improve perioperative risk stratification and patient selection. The aim of the present study was to evaluate predictors of clinically relevant postoperative morbidity following pulmonary resection for NSCLC in a single tertiary oncologic center. A retrospective observational cohort study was conducted that included 163 consecutive patients who underwent curative-intent anatomical pulmonary resection for NSCLC. Clinically relevant postoperative morbidity was defined as Clavien-Dindo grade ≥ II. Demographic, clinical, functional, and perioperative variables were analyzed, including age, Charlson Comorbidity Index (CCI), pulmonary function (FEV1), surgical approach, pathological stage, and type of resection. Comparative analysis between patients with and without clinically relevant morbidity was performed. Univariate and multivariate logistic regression analyses were subsequently performed to identify factors associated with postoperative morbidity. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis. Clinically relevant postoperative morbidity occurred in 21.5% of patients. Patients who developed postoperative complications tended to be older and presented lower preoperative FEV1 values compared with patients without clinically relevant morbidity. Increased CCI demonstrated an association with increased postoperative morbidity risk (adjusted OR = 2.04, 95% CI, 0.54-7.70), while lower FEV1 values were associated with increased postoperative risk (adjusted OR = 0.98, 95% CI, 0.95-1.01). Increasing age also demonstrated a modest association with postoperative complications (adjusted OR = 1.02, 95% CI, 0.97-1.07). The final multivariate model demonstrated fair discriminatory performance, with an area under the ROC curve (AUC) of 0.645. Clinically relevant postoperative morbidity following NSCLC surgery appears to be influenced by multiple patient-related and procedure-related factors, particularly comorbidity burden, pulmonary reserve, and age. Although the predictive performance of the present exploratory model was modest, careful preoperative evaluation and individualized perioperative risk stratification remain essential in thoracic oncologic surgery.

Spinal infections comprise a heterogeneous group of disorders involving the spinal column and adjacent neural elements, including spondylitis, discitis, spondylodiscitis, meningitis, myelitis, spinal epidural abscess, and infectious polyradiculopathy. The use of spinal instrumentation in infected fields remains a debated topic, although recent evidence suggests it may be safe when combined with adequate debridement and antibiotic therapy. Our objective was to evaluate the impact of segmental instrumentation on clinical, laboratory, and microbiological outcomes in patients undergoing surgery for spinal infections. We conducted a retrospective study of 98 adult patients who underwent surgical treatment for spinal infections between 2016 and 2024. Patients were divided into instrumented and non-instrumented groups based on intraoperative decision-making. Clinical outcomes, inflammatory markers, reoperation rates, and hospital stay were analyzed. The results showed that instrumentation was performed in 86 patients, while 12 patients underwent surgery without fixation. Instrumented patients showed comparable infection resolution and clinical recovery despite more severe preoperative presentations. Mean hospital stay was 18.79 days in the instrumented group and 17.91 days in the non-instrumented group. Inflammatory markers improved consistently in the instrumented group. Microbiological confirmation was achieved in approximately half of the cases. In conclusion, segmental instrumentation appears safe in the surgical management of spinal infections when combined with thorough debridement and targeted antibiotic therapy. Clinical outcomes are primarily influenced by infection control rather than the avoidance of implants.

Urinary tract infections (UTIs) and the widespread use of antibiotics are a growing concern in both the urological field and public health. UTIs affect both male and female patients similarly, with a higher incidence among individuals with excessive rates of stone formation. This study aimed to evaluate the main microorganisms and antimicrobial agents involved in urinary tract infections in men undergoing surgical procedures for urolithiasis over a 2-year period. We conducted a retrospective, single-center, observational study over 24 months, from January 2024 to December 2025. Criteria for inclusion consisted of male patients of at least 18 years old, at least one positive urine culture (>105 CFU/ml), a single bacterial agent, imaging-confirmed urolithiasis, and a history of surgical management of renal stone disease (FURS, URS, and/or PCNL). Cases that were conservatively managed or presented no evidence of urolithiasis, as well as female patients, were excluded from this study. A total of 543 patients underwent assessment. Differences were observed between the incidence of Gram-positive (155, 28.55%) and Gram-negative (388, 71.45%) microbial agents. The highest incidence was highlighted for Escherichia coli (32.33% of cases), followed by Enterococcus spp. (20.81%) and Klebsiella spp. (20.81%). Among the resistance rates for the main antibiotics evaluated, the highest values were observed for Levofloxacin (44.53% for Gram-negative and 55.47% for Gram-positive). This study underscores the importance of appropriate and optimized antimicrobial management, especially in patients undergoing surgery for renal stone disease, reinforcing current data.

Vitamin K is essential for coagulation and has increasingly been recognized for its potential role in inflammatory processes. In patients with chronic viral hepatitis, alterations in coagulation parameters and persistent systemic inflammation are frequently observed. This study aimed to evaluate the association between vitamin K administration and changes in liver enzymes, inflammatory markers, and coagulation parameters in patients with chronic viral hepatitis. This retrospective observational study included 94 patients with chronic viral hepatitis hospitalized between January 2020 and December 2024. Laboratory parameters reflecting liver function, inflammatory status, and coagulation profile were assessed at admission and discharge following vitamin K administration. Changes in biological parameters were analyzed using non-parametric tests for paired data. Reductions in liver enzymes, inflammatory markers, and coagulation parameters were observed between admission and discharge. Aspartate aminotransferase and alanine aminotransferase levels decreased, accompanied by lower values of C-reactive protein and erythrocyte sedimentation rate. Coagulation parameters, including prothrombin time and international normalized ratio, also decreased. No significant differences were identified between patients with and without hepatitis B infection. Vitamin K administration in patients with chronic viral hepatitis was associated with changes in liver enzymes, inflammatory markers, and coagulation parameters. These findings suggest a potential role for vitamin K in the interplay between inflammation and hemostasis in chronic liver disease, while its clinical utility should be considered on an individual basis.