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Background: The benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) in ovarian cancer with peritoneal metastasis remains debated outside selected indications. We performed a systematic review and meta-analysis to quantify survival, perioperative morbidity, and completeness of cytoreduction using study-level data.

Methods: PubMed/MEDLINE, Embase, and Web of Science were searched. Eligible English-language studies included ovarian cancer patients undergoing CRS plus HIPEC and reported at least one of the following: overall survival (OS), progression-free survival (PFS), Grade III-IV complications, or CC-0 rate. Random-effects meta-analyses were conducted using inverse-variance pooling. For HR outcomes, DerSimonian-Laird τ² with Hartung-Knapp confidence intervals was applied. Proportions were pooled using logit transformation (PLOGIT) with random-effects models.

Results: Twelve studies (n = 567) were included. Only two studies provided extractable HRs for OS and PFS (n = 217). CRS plus HIPEC was associated with improved OS (HR 0.68, 95% CI 0.52-0.90, p = 0.0023; I² = 0%; prediction interval 0.14-3.34) and improved PFS (HR 0.70, 95% CI 0.31-1.57, p = 0.0007; I² = 0%; prediction interval 0.18-2.66). Across 12 studies (n = 563), the pooled Grade III-IV complication rate was 0.18 (95% CI 0.14-0.22; I² = 16.3%; prediction interval 0.12-0.26). In 10 studies (n = 385), the pooled CC-0 rate was 0.87 (95% CI 0.79-0.92; I² = 46.7%; prediction interval 0.66-0.96).

Conclusions: CRS plus HIPEC shows a favorable signal for OS and PFS in the limited HR-eligible evidence and appears feasible, with a pooled severe complication rate of ~18% and high CC-0 rates. Current data support HIPEC primarily as a targeted intensification strategy in carefully selected patients, while broader adoption requires additional randomized, context-specific evidence.

Background: Acute kidney injury (AKI) is a frequent and prognostically relevant complication of COVID-19. However, reliance on static creatinine values or binary AKI definitions may overlook clinically meaningful early renal dynamics. We evaluated whether early renal function trajectories within the first 24-48 h of hospitalization provide incremental prognostic information.

Methods: We conducted a retrospective, single-center cohort study of adults hospitalized with laboratory-confirmed COVID-19 between December 2020 and December 2021. Early renal function patterns were defined using KDIGO-based changes in serum creatinine between admission and 24-48 h, classifying patients as stable, early improvement, or early deterioration. The primary outcome was in-hospital mortality. Multivariable logistic regression adjusted for age, sex, chronic kidney disease, comorbidities, inflammatory burden (C-reactive protein), nutritional status (albumin), pulmonary involvement, and treatment variables.

Results: Among 721 patients, 65.2% had stable renal function, 22.5% had early improvement, and 12.3% had early deterioration. In-hospital mortality differed significantly across dynamic patterns (p = 0.007). Mortality was lowest in the stable group (35.1%) and higher in both early improvement (48.1%) and early deterioration (44.9%). After multivariable adjustment, early improvement remained independently associated with higher in-hospital mortality compared with stable renal function (adjusted OR 1.53, 95% CI 1.03-2.28), while early deterioration showed a directionally similar but non-significant association. Early improvement was also associated with higher AKI burden and increased need for acute de novo hemodialysis.

Conclusions: Early renal function change patterns within the first 24-48 h of hospitalization carry prognostic value beyond static creatinine measures. Apparent early creatinine improvement may reflect recovery from prior injury or systemic instability rather than true renal recovery, identifying a subgroup at heightened risk. Classification based on early renal function assessment may enhance early risk stratification in hospitalized patients with COVID-19.

In the original publication [...].

Background: Endometrial cancer (EC) represents one of the most prevalent gynecological malignancies worldwide, with increasing incidence rates attributed to rising obesity, metabolic syndrome, and demographic aging. Recent evidence suggests that dyslipidemia, including elevated triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and reduced high-density lipoprotein cholesterol (HDL-C), may have a significant role in the pathogenesis of EC through inflammatory, oxidative stress, and hormonal mechanisms.

Objective: This meta-analysis aims to systematically evaluate the association between serum lipid biomarkers and endometrial cancer risk by synthesizing quantitative data from observational studies.

Methods: We conducted a comprehensive search of five electronic databases (PubMed, Web of Science, Scopus, EMBASE, and Cochrane) to identify studies examining lipid biomarkers in patients with EC compared to healthy controls. After screening 639 articles and applying rigorous inclusion/exclusion criteria, six studies were selected for final analysis. The standardized mean differences (SMD) were calculated with 95% confidence intervals using random-effects and fixed-effects models, considering heterogeneity assessed by the I² statistic. Publication bias was evaluated using funnel plots and Egger's regression test.

Results: The meta-analysis revealed significantly elevated TG levels in EC patients compared to controls (SMD +0.87, 95% CI [+0.65, +1.10]), markedly reduced HDL-C levels (SMD -0.92, 95% CI [-1.15, -0.69]), and increased LDL-C levels (SMD +0.74, 95% CI [+0.50, +0.98]). The heterogeneity was moderate to substantial, with an I² ranging from 49% to 62%. Subgroup analyses demonstrated stronger associations in Type I EC and obese patients (BMI > 30 kg/m²).

Conclusions: This meta-analysis establishes a significant association between dyslipidemia and endometrial cancer risk, with elevated triglycerides and LDL-C conferring increased risk while HDL-C appears protective. These findings support the integration of lipid profiling into EC risk assessment protocols and suggest the potential preventive value of lipid-modulating interventions. Further studies are needed to establish causality and evaluate therapeutic applications.

Introduction: Respiratory rehabilitation programs for geriatric patients with chronic obstructive pulmonary disease (COPD) after COVID-19 require a precise assessment of needs and an individualized approach. However, there is a lack of specific recommendations for aerobic training in this patient group.

Objective: The study aimed to compare two types of aerobic training-continuous and interval-and to determine which one is more effective and should be included in the respiratory rehabilitation program for geriatric patients with COPD after COVID-19.

Methods: Of the 480 patients examined, 80 were included in the study. All patients underwent exercise tolerance tests (6-Minute Walk Test-6MWT) and functional performance tests (get-up-and-go test-TUG) before and after a 3-week intensive respiratory rehabilitation program.

Results: Both types of training-interval and continuous-contributed to improved exercise tolerance and functional fitness in patients. However, analysis of the differences between the groups showed that continuous training with increasing exercise intensity resulted in significantly greater improvements in distance covered during the 6MWT, energy expenditure (METs), and TUG test time (p < 0.05).

Conclusions: Continuous training on a cycle ergometer is more effective in the rehabilitation of geriatric patients with COPD after COVID-19 and should be included in therapeutic programs.

Transoral robotic surgery (TORS) offers a targeted surgical option for addressing base of tongue (BOT) and epiglottic obstruction in selected obstructive sleep apnoea (OSA) cases; however, most published evidence evaluates TORS within multilevel approaches, limiting understanding of single-level outcomes. A PRISMA-guided systematic review of PubMed, Embase, and Central Cochrane was conducted from inception to March 2025, aiming to evaluate objective sleep outcomes and patient-reported measures following single-level TORS BOT surgery. Inclusion criteria were adult patients with moderate-to-severe OSA and CPAP failure/intolerance, with evidence of BOT hypertrophy. Of 219 screened records, five studies met the inclusion criteria with 105 patients. Eighty-six (81.9%) were male with a combined mean age of 45.2 years and BMI of 28.2 kg/m². Combined mean AHI improved from 34.2 preoperatively to 14.7 events/hour postoperatively. Reported surgical success ranged from 54.2% to 100%. Where reported, ESS improved postoperatively with a combined mean reduction from 13 to 4.5. Most commonly reported complications were dysgeusia (n = 16, 15.2%), dysphagia/odynophagia (n = 14, 13.3%), and postoperative bleeding (n = 10, 9.5%). Single-level TORS BOT appears to improve objective and subjective outcomes in carefully selected patients, although heterogeneity and inconsistency of reported outcomes limit definitive conclusions and highlight the need for standardised outcome reporting and follow-up.

Background: Bruton's tyrosine kinase inhibitors, particularly ibrutinib, have improved outcomes in patients with chronic lymphocytic leukemia but are associated with an increased risk of atrial fibrillation. The early identification of patients with increased susceptibility to atrial fibrillation remains a major challenge in cardio-oncology. Methods: This prospective pilot study included 45 patients with chronic lymphocytic leukemia treated with ibrutinib. All patients underwent comprehensive transthoracic echocardiography at baseline and after 6 months. Left atrial structure and function were assessed, with particular emphasis on speckle-tracking-derived left atrial strain parameters, including peak atrial longitudinal strain and peak atrial contraction strain. Results: At follow-up, a modest but significant increase in indexed left atrial volume was observed, while left atrial functional parameters remained stable. Patients who developed atrial fibrillation showed significantly lower baseline Peak Atrial Contraction Strain values compared with those who remained in sinus rhythm, whereas no significant differences in Peak Atrial Longitudinal Strain were detected. Conclusions: Ibrutinib-related atrial fibrillation appears to be driven primarily by pre-existing atrial vulnerability rather than early drug-induced atrial dysfunction. The baseline impairment of left atrial contractile function may represent a candidate echocardiographic marker of atrial functional vulnerability and may inform cardiovascular surveillance and monitoring strategies in patients treated with ibrutinib.

Background: Skin and myocardial microvascular dysfunction in prediabetes remains underexplored, and limited studies have investigated the microcirculation in prediabetes in multiple vascular beds. This study aimed to examine microvascular alterations in patients with prediabetes, patients with type 2 diabetes mellitus (DM), and normoglycemic controls without established cardiovascular disease (CVD).

Methods: In this cross-sectional study, the microcirculation was assessed using established and novel noninvasive techniques. The skin microvascular reactivity was evaluated using laser speckle contrast analysis (LASCA). The myocardial perfusion was assessed by the subendocardial viability ratio (SEVR). The retinal microvasculature was evaluated using digital nonmydriatic fundus photography, the renal microvascular damage through the urinary albumin-to-creatinine ratio (ACR), and the peripheral vasculopathy by the augmentation index (AIx).

Results: Sixty-seven participants were included (22 controls, 24 with prediabetes, 21 with DM; aged: 55.9 ± 9.4 years). Patients with prediabetes and DM showed significantly reduced baseline-to-peak skin flux responses in LASCA compared with controls (p = 0.006), and lower SEVR values (p = 0.001). Moreover, no significant differences were identified in the retinal, renal, or peripheral microvascular indices. In multivariate analysis, systolic blood pressure and glucose were independently associated with skin microvascular dysfunction, while the heart rate and arteriovenous ratio were associated with the SEVR.

Conclusions: In this cross-sectional study, impaired skin and myocardial microvascular function were observed in patients with prediabetes in the absence of overt CVD. These findings suggest that LASCA and the SEVR may serve as sensitive markers for the detection of early, subclinical microvascular dysfunction in prediabetes.

Purpose: This study develops a predictive model for radiation pneumonitis (RP) risk in lung cancer patients after volume-modulated arc therapy (VMAT) that leverages high-dimensional dosiomics and dose-volume histogram (DVH) features within IDLSS (incremental-dose interval-based lung subregion) lung subregions. Methods: We retrospectively analyzed data from 136 lung cancer patients treated with VMAT between 2015 and 2022, including 39 patients who developed RP greater than Grade 2. Using the IDLSS method, seven regions of interest (ROIs), including the Planning Target Volume (PTV), normal lung, and five subdivided lung areas, were delineated on pretreatment Computed Tomography (CT) images. DVH, radiomics, and dosiomics features were extracted from these ROIs and organized into nine distinct feature sets. A comprehensive pipeline was applied, integrating IDLSS-defined lung subregions, high-dimensional dosiomics features, LASSO-based feature selection, and SMOTE oversampling to address class imbalance in the training data. Logistic regression, random forest, and feedforward neural networks were constructed and optimized via tenfold cross-validation. Model performance across different feature sets was evaluated via the average AUC, F1 score, and other performance metrics. Results: LASSO regression revealed that BMI and volume within the 5-10 Gy and 10-20 Gy lung subregions were significant predictors of RP. The performance evaluation demonstrated that the dosiomics features consistently outperformed the DVH features across the models. Combining radiomics and dosiomics achieved the highest predictive accuracy (AUC = 0.91, ACC = 0.89, NPV = 0.95, PPV = 0.78, F1 score = 0.82, sensitivity = 0.88, specificity = 0.90). Applying SMOTE during training significantly improved sensitivity without compromising specificity, confirming the value of balancing strategies in enhancing model performance. Incorporating all the features together did not provide additional performance gains. Conclusions: Integrating radiomics and dosiomics features extracted from IDLSS-defined lung subregions significantly enhances the ability to predict RP after VMAT, surpassing traditional DVH metrics. The substantial contribution of dosiomics features highlights the importance of spatial dose heterogeneity in RP risk assessment.

Objectives: Cerebral ischemia/reperfusion (IR) injury is characterized by excessive oxidative stress and activation of apoptotic pathways, which play a central role in neuronal loss and poor neurological outcomes. Modulation of these mechanisms represents a clinically relevant strategy for neuroprotection. This study aimed to investigate the neuroprotective effects of dexmedetomidine (Dex) on oxidative stress, apoptotic signaling, and neuronal integrity in an experimental rat model of cerebral IR injury.

Materials and methods: Female Wistar rats were assigned to control, IR, and IR+Dex groups. Transient cerebral ischemia was induced for 45 min followed by 2 h of reperfusion. Oxidative stress was evaluated using serum antioxidant enzyme activities (superoxide dismutase [SOD], catalase [CAT], glutathione peroxidase [GSH-Px]), total oxidant and antioxidant status (TOS, TAS), and lipid peroxidation levels (malondialdehyde [MDA]). Apoptotic signaling was assessed by histopathological examination, transmission electron microscopy, and immunohistochemical analysis of B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax) and apoptotic peptidase activating factor-1 (APAF-1) expression, quantitatively evaluated using QuPath with statistical comparison between groups. Bioinformatic network analysis and molecular docking were performed to explore predicted interactions between Dex and apoptosis-related proteins.

Results: Cerebral IR induced a marked oxidative imbalance, characterized by reduced antioxidant enzyme activities and increased lipid peroxidation. Dex treatment partially improved antioxidant capacity and reduced oxidative stress parameters. Histopathological and ultrastructural analyses demonstrated severe neuronal degeneration following IR, whereas Dex-treated rats exhibited attenuated neuronal damage and improved ultrastructural preservation. Immunohistochemical analysis showed increased Bax and APAF-1 expression and reduced Bcl-2 expression after IR; these alterations were significantly modulated toward control levels in the IR+Dex group. Bioinformatic analysis identified apoptosis-related pathways, including apoptosis, p53 signaling, and necroptosis, as significantly enriched, while molecular docking suggested stable predicted interactions between Dex and key apoptotic regulators.

Conclusions: In this experimental rat cerebral IR model, Dex exerted partial but significant neuroprotective effects by attenuating oxidative stress, modulating apoptotic marker expression, and preserving neuronal morphology. These findings support the potential role of Dex as a neuroprotective agent in ischemia-related brain injury, warranting further translational investigation.