Medical Science Monitor最新文献

BACKGROUND Lymphovascular invasion (LVI) and perineural invasion (PNI) are established markers of aggressive disease in primary gastric cancer, but their specific prognostic role in patients who develop recurrence after curative surgery is less clear. This study aimed to evaluate clinicopathological and treatment-related factors associated with overall survival (OS) and disease-free survival (DFS) in a cohort of gastric cancer patients who experienced recurrence. MATERIAL AND METHODS This retrospective study included 70 patients who underwent curative gastrectomy and subsequently developed confirmed recurrence. OS (from diagnosis) and DFS (from surgery to recurrence) were analyzed using Kaplan-Meier curves and Cox regression. Multivariate models were constructed with a limited number of variables to avoid overfitting. RESULTS The median OS was 38.9 months, and the median DFS was 22.4 months. In multivariate analysis, LVI positivity (HR=3.39; 95% CI: 1.59-7.19; P=0.001) and advanced clinical stage were independent predictors of worse OS, while adjuvant chemoradiotherapy (HR=0.44; P=0.017) and receiving first-line systemic therapy after recurrence (HR=0.22; P<0.001) were protective. For DFS, PNI positivity predicted shorter DFS (HR=1.91; P=0.033). HER2 positivity was associated with longer DFS (HR=0.78; P=0.015); notably, 42.9% of HER2-positive patients received trastuzumab upon recurrence. CONCLUSIONS In gastric cancer patients who develop recurrence, baseline biological markers (LVI, PNI, HER2) retain significant prognostic value for OS and DFS from the time of diagnosis and surgery, respectively. Integrating these markers with treatment parameters may improve risk stratification. This study did not evaluate pure post-recurrence survival (PRS); OS was calculated from diagnosis and therefore reflects pre- and post-recurrence periods combined.

Numerous abnormalities of the endometriosis eutopic endometrium contribute to the initiation and development of ectopic lesions. It is also believed that among the complex causes of the disease, systemic immunological disorders play a significant role. Therefore, this literature review aims to summarize the current knowledge on immunological alterations in the endometriosis eutopic endometrium and the impact of these changes on the progression of this disease. The reviewed studies mostly indicated a pro-inflammatory immunological profile within this tissue. This was evidenced by a predominance of M1 macrophages, which have a pro-inflammatory character and elevated levels of pro-inflammatory cytokines such as interleukin-1 (IL-1) or IL-6. Additionally, an increased number of cytotoxic T lymphocytes and a positive correlation between B lymphocyte levels and the presence of endometriosis have been observed. Some changes in T cells and natural killer (NK) cells receptors, which possibly determine endometriosis development, have been described. Several studies have also revealed that patients with endometriosis exhibit reduced presence of dendritic cells in the eutopic endometrium of affected individuals, which may impair uterine cavity clearance during menstruation and contribute to ectopic lesion formation. In summary, current data indicate a pivotal role of the endometrial immune environment in disease progression, but further research is needed to drive development of immunological treatment in endometriosis management.

BACKGROUND Acromioclavicular (AC) joint dislocation is a common shoulder injury, with a range of suture button techniques available for treatment. This study aimed to evaluate the clinical outcomes of a novel suture button technique - the FengChao button technique. MATERIAL AND METHODS Between December 2019 and December 2021, 25 patients with AC joint dislocation were treated using the arthroscopic triple FengChao button technique. Clinical outcomes measured included UCLA and CMS scores, operative time, and the incidence of complications. Radiological assessment focused on the coracoclavicular (CC) distance. RESULTS The follow-up period ranged from 6 to 19 months, with an average of 13.3 months. One patient required an open revision due to postoperative trauma. The mean operative time was 52.34±13.76 minutes. The UCLA score improved significantly from a preoperative average of 19.32±2.45 to 31.67±2.38 at the final follow-up (P<0.05). Similarly, the CMS score increased from 75.23±2.34 preoperatively to 92.73±2.96 at the final follow-up (P<0.05). The CC distance narrowed from a preoperative measurement of 21.34±1.32 mm to 9.23±1.13 mm 2 to 4 days postoperatively (P<0.05), and further to 11.93±1.03 mm at the final follow-up (P<0.05). CONCLUSIONS The arthroscopic triple FengChao button technique for AC joint dislocation offers satisfactory short-term functional outcomes.

Kidney transplantation is a well-established treatment for patients with end-stage renal disease; however, graft availability is limited. To expand the donor pool, organs from expanded criteria donors and donors after circulatory determination of death (DCDD) are increasingly used. Normothermic in-situ regional perfusion (NRP) delivered using an extracorporeal membrane oxygenation device (ECMO) may be used, mitigating warm ischemia time and improving outcomes of DCDD grafts. NRP using ECMO (nECMO) during DCDD kidney transplantation achieves delayed graft function rates of 5.3% to 43.0%, primary non-function of 0.0% to 6.0%, and a 1-year mortality of 0.0% to 1.3%, closely mirroring DNDD outcomes. The survival rates of nECMO are comparable to DNDD or DCDD with the rapid recovery technique. Kidney discard rates are similar between nECMO and DNDD. Using nECMO in controlled and uncontrolled DCDD leads to better graft function and higher survival rates compared with standard DCDD transplantation. Outcomes are generally comparable to DNDD transplants. Early ECMO cannulation, even before death is declared, may minimize warm ischemia time and enhance graft function, although ethical concerns and strict protocols may hinder its routine use. This article aims to review available literature on ECMO implementation in DCDD kidney transplantation.

BACKGROUND Spondylolisthesis, characterized by anterior displacement of a vertebra, often leads to pain and impaired sleep quality, negatively affecting overall quality of life. While postoperative outcomes in degenerative spinal conditions such as disc herniation and spinal stenosis have been widely studied, evidence focusing on sleep quality in homogeneous cohorts of patients with low-grade lumbar spondylolisthesis remains scarce. This study evaluated changes in sleep quality, pain, quality of life, and functional capacity before and after surgery in this patient population. MATERIAL AND METHODS This prospective observational study included 55 patients who underwent posterior decompression and instrumented fusion surgery for low-grade lumbar spondylolisthesis. The Visual Analog Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), EuroQol-5 Dimensions-3 Levels (EQ-5D-3L), and Oswestry Disability Index (ODI) were administered preoperatively and on the 90th postoperative day. RESULTS All evaluated parameters showed significant postoperative improvements. VAS, PSQI, and ODI scores decreased markedly, indicating effective pain relief, better sleep quality, and improved functional capacity (all P<0.001). EQ-5D-3L scores increased significantly (P<0.001), reflecting enhanced overall quality of life. Subgroup analyses demonstrated consistent benefits across spondylolisthesis types and grades, with male patients exhibiting greater improvements in quality-of-life measures. CONCLUSIONS Surgery for low-grade lumbar spondylolisthesis yields substantial benefits, extending beyond pain control to improvements in sleep quality, functional capacity, and overall quality of life. These findings underscore the role of surgical treatment as a reliable option for patients unresponsive to conservative management and highlight its positive impact on both physical recovery and psychosocial well-being.

BACKGROUND Although atrial fibrillation (AF) is a well-established risk factor for thromboembolic events, patients with a low CHA₂DS₂-VASc score are generally considered at low risk. However, permanent AF may independently worsen outcomes via non-embolic mechanisms such as myocardial remodeling and progression of heart failure (HF). MATERIAL AND METHODS This retrospective observational sub-study used data from the CRAFT study (NCT02987062), a multicenter registry of AF patients hospitalized between 2011 and 2016. We included 418 patients with CHA₂DS₂-VASc ≤2 for women and with ≤1 for men, of whom 63 had permanent AF as defined by ESC guidelines. The primary endpoint was all-cause mortality; secondary endpoints included ischemic events and bleeding during a mean follow-up of 4 years. RESULTS Patients with permanent AF had significantly higher all-cause mortality (39.7% vs 8.7%; P<0.0001) and a comparable rate of ischemic events (12.7% vs 8.5%; P=0.12) despite similarly low thromboembolic risk profiles. They were older (64 vs 60 years; P<0.0001), more frequently had heart failure (48.4% vs 15.5%; P<0.0001) and, lower left ventricular ejection fraction (LVEF) (43.5% vs 55%; P=0.0005), and more often had cardiac devices. CONCLUSIONS Our findings suggest that permanent AF is associated with worse long-term outcomes, even in patients with low thromboembolic risk score. These results show the importance of early rhythm control in preventing AF progression and irreversible structural remodeling.

BACKGROUND With the global rise in geriatric populations, femoral fractures in elderly individuals have become a major health burden. This study aimed to evaluate the prognostic value of 3 readily available laboratory-based indices - HALP (hemoglobin, albumin, lymphocyte, platelet), Prognostic Nutritional Index (PNI), and Systemic Immune-Inflammation Index (SII) - in predicting 1-year mortality among elderly patients with femoral fractures. MATERIAL AND METHODS This retrospective cohort study included 309 patients aged ≥65 years who presented to the emergency department of a tertiary university hospital between 2018 and 2023 with low-energy femoral fractures and who underwent surgery. Demographic, clinical, and laboratory data were collected. HALP, PNI, and SII were calculated preoperatively. In-hospital, 30-day, and 1-year mortality were recorded. ROC analysis was used to assess the predictive accuracy of each index. RESULTS One-year mortality was 32.4%, while in-hospital and 30-day mortality were 5.5% and 11%, respectively. Lower albumin and PNI scores were significantly associated with higher mortality at all time points (P<0.001). PNI demonstrated moderate predictive accuracy (AUC=0.659), while HALP had limited but statistically significant predictive value (AUC=0.577, P=0.030). SII did not show statistically significant prognostic value (AUC=0.549, P=0.166). Multivariate analysis showed PNI and HALP are independent predictors of long-term mortality. CONCLUSIONS PNI and HALP are practical, cost-effective tools with prognostic utility in elderly patients with femoral fractures. Early identification of high-risk individuals using these biomarkers may facilitate targeted interventions and improved outcomes. Future multicenter prospective studies are warranted for external validation.

BACKGROUND Traumatic atrophied eyeballs are often associated with intraocular structural disorders and corneoscleral thickening. Conventional methods, such as ultrasound and biological measurements, cannot accurately and objectively determine eyeball atrophy and severity. In this study, contralateral computed tomography (CT) examination was performed on 48 atrophied eyes and their 48 healthy counterparts to measure the axial length and eyeball volume. The effects on measurement results were observed after adjusting the widths and positions of the windows. MATERIAL AND METHODS This study was designed as a before-and-after control study for the treatment of eye atrophy, in which atrophied and healthy eyes underwent 3 CT examinations. The axial lengths and volumes of the 48 healthy eyes demonstrated almost no differences. These measurements were obtained using conventional (conventional group, n=48) and adjusted (adjusted group, n=48) window widths and positions. The stability of each group was statistically analyzed using the discrete coefficient of variation. A stable method was applied to measure the axial length and volume of the atrophied eyeballs to assess atrophy and severity. RESULTS The adjusted window width and position depicted the CT image contours more accurately. Compared with the conventional group, the adjusted group exhibited significantly more stable results (P<0.05). The measurement method applied to the axis and volume of atrophied eyeballs effectively determined the severity of eyeball atrophy. CONCLUSIONS CT examination can determine ocular atrophy and its severity. Adjusting the window width and position can enhance the stability of the measurement.

Lung cancer in never-smokers and in non-smokers accounts for between 15% and 25% of all lung cancers. Assumptions that lung cancer is almost always associated with cigarette smoking may delay diagnosis, treatment, and outcomes in non-smokers. The incidence of lung cancer in non-smokers is rising, especially in younger populations, presenting as adenocarcinoma with specific genetic mutations, and is associated with factors including air pollution and inhalation of second-hand tobacco smoke. In 2021, the United States Preventive Services Task Force (USPSTF) updated its 2013 lung cancer screening guidelines for low-dose computed tomography (LDCT) screening. However, the USPSTF still does not currently recommend lung cancer screening for non-smoking individuals. Therefore, age-based screening could improve cost-effectiveness and detection of lung cancer without missing diagnoses in women and never-smokers. Currently, only Taiwan has a national lung cancer screening program for early detection using LDCT in high-risk individuals. This editorial aims to highlight that non-smokers have risk factors for lung cancer that may challenge current criteria for inclusion in screening programs.

BACKGROUND Accurate detection of endometrial polyps (EPs), a recognized cause of infertility, is essential prior to in vitro fertilization (IVF). This study compared the diagnostic performance of transvaginal sonography (TVS), hysterosalpingography (HSG), and saline infusion sonography (SIS) for EP detection. MATERIAL AND METHODS This retrospective study included 256 infertile women treated at Acıbadem Maslak Hospital IVF Unit between January 2022 and January 2024. All patients underwent TVS and HSG; SIS was performed in cases with suspected EP. Positive SIS findings were confirmed by diagnostic hysteroscopy, and excised specimens underwent pathological evaluation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Statistical comparisons were made using Cochran's Q test, McNemar's test, and receiver operating characteristic (ROC) curve analysis with DeLong's method. RESULTS The sensitivity and specificity were 60.6% and 52.6% for TVS, 66.8% and 32.0% for HSG, and 94.3% and 28.1% for SIS, respectively. SIS showed significantly higher sensitivity than TVS (P<0.01) and HSG (P<0.01). PPV/NPV were 81.2%/28.3% for TVS, 76.7%/22.0% for HSG, and 81.6%/59.3% for SIS. ROC analysis revealed area-under-the-curve values of 0.566 for TVS, 0.492 for HSG, and 0.612 for SIS, with SIS performing significantly better than HSG (P=0.018). Pathology confirmed that all polyps were functional, and no malignancy was detected. CONCLUSIONS SIS demonstrated the highest sensitivity and diagnostic accuracy, supporting its use as the most reliable non-invasive method for EP detection in infertile women prior to IVF.