Medical sciences (Basel, Switzerland)最新文献

Spinal vascular malformations (SVMs) are rare and heterogeneous lesions that may lead to progressive neurological decline or hemorrhage, posing significant challenges for management due to their complex angioarchitecture and proximity to critical neural structures. This review examines the role of angiographic imaging modalities used intraoperatively and postoperatively in guiding treatment, confirming therapeutic success, and informing follow-up strategies. We summarize evidence on two-dimensional digital subtraction angiography (2D DSA), indocyanine green videoangiography (ICG-VAG), and emerging adjunctive techniques. 2D DSA remains the reference standard, offering superior temporal and spatial resolution for real-time visualization of vascular anatomy, catheter navigation, and embolic delivery, though its invasive nature, radiation exposure, and two-dimensional projection limit long-term applicability. ICG-VAG provides a complementary, non-ionizing method for intraoperative fluorescence imaging, aiding in shunt localization and venous preservation, although its restricted field of view and limited capacity for quantitative analysis reduce its standalone value. Advances in quantitative angiographic metrics, patient-specific hemodynamic modeling, and artificial intelligence-driven image analysis are anticipated to enhance diagnostic accuracy and reproducibility. The development of standardized multimodal protocols will be crucial for optimizing patient-centered treatment of these complex and rare lesions.

Background: Liver resection remains the primary curative treatment for many malignant liver diseases. Advances in patient selection, perioperative care, and surgical technique have markedly reduced procedure-related (surgical) complications in experienced centres. However, despite these improvements, medical (non-surgical) complications continue to represent a substantial source of postoperative morbidity, particularly after major liver resections. Herein, we aim to assess the incidence, nature, and predictors of medical versus surgical complications after liver resection and to develop an individual risk calculator for estimating medical morbidity after liver resection.

Methods: This is an observational single-centre study including patients who underwent liver resection for cancer between 2013 and 2025. Postoperative complications were classified into medical and surgical categories based on clinical and diagnostic criteria. Demographic, clinical, and intraoperative data were analyzed to identify risk factors associated with each type of complication, and a multivariate logistic regression model was used to select significant variables, which were imputed in a prediction nomogram made available as an interactive web-based calculator.

Results: Of the 231 patients included, 36 patients (15.6%) developed postoperative complications. From multivariate analysis, independent predictors of medical complications included cirrhosis (OR 2.8, 95% CI 1.2-6.8, p < 0.05), operative time > 180 min (OR 2.0, 95% CI 1.1-7.4, p < 0.05), intraoperative blood loss > 500 mL (OR 2, 95% CI: 0.9-4.8, p < 0.05), and ASA score ≥ 3 (OR 3.7, 95% CI 1.1-12.5, p < 0.05). Major hepatic resection was the only independent predictor of surgical complications (OR 7.42, 95% CI: 1.14-48.52, p = 0.036). The logistic regression model demonstrated fair discriminative ability with an AUC of 0.682 (95% CI: 0.544-0.729). The risk-prediction nomogram showed a 24.7% risk of postoperative medical morbidity in patients with all four risk factors vs. a 5.4% risk in patients without any risk factor.

Conclusion: Postoperative medical complications are significantly more frequent in patients undergoing oncological liver resection with an ASA score ≥ 3, history of cirrhosis, prolonged operative time, and increased intraoperative blood loss. Our logistic regression model and web-friendly nomogram may be used for external validation in larger cohorts and could support preoperative counselling and perioperative risk stratification.

Objective: The omentum is a highly vascularized and immunologically active tissue with significant regenerative potential. Despite its versatility, its use has traditionally been limited to intra-abdominal applications due to access challenges. Conventional open harvest requires laparotomy, and laparoscopic techniques are hindered by limited visualization and poor ergonomics. We describe the use of robotic-assisted omental flap harvest for thoracic reconstruction, offering a minimally invasive alternative.

Methods: A retrospective review was conducted of patients who underwent robotic omental flap harvest for intrathoracic reconstruction at a single-center institution between January 2023 and January 2024. Data collected included demographics, indications, surgical technique, operative details, and postoperative outcomes, with a focus on flap viability and complications. Additionally, a systematic review was conducted to evaluate current evidence and experiences with this type of technique.

Results: Three patients underwent robotic omental flap harvest for indications including chest wall reconstruction and pleural space obliteration in infected thoracic cavities. The average robotic flap harvest time was 79 ± 13 min, with an estimated ± blood loss of 20 cc. The mean postoperative hospital stay was 10 days, influenced by the primary procedure and patient comorbidities. At an average follow-up of 8 months, all flaps remained viable, with no flap-related complications or losses. The systematic review demonstrated limited data in the current literature regarding this type of surgical approach.

Conclusions: Robotic-assisted omental flap harvest is a safe, feasible, and effective technique for complex thoracic reconstructions. It provides a minimally invasive alternative to traditional harvest methods, with reduced morbidity and excellent clinical outcomes. This technique expands the reconstructive options for intrathoracic defects and infections.

Background/objectives: Type 2 diabetes and obesity present escalating global health and economic challenges, highlighting the need for therapies that can effectively manage glycemic levels and reduce excess adiposity. Semaglutide, a glucagon-like peptide-1 receptor (GLP-1R) agonist available in subcutaneous or oral formulation, has quickly evolved from a theoretical concept to a crucial component of modern metabolic care. This review explores the comprehensive development journey of semaglutide, drawing on evidence from medicinal chemistry, animal studies, initial human trials, the pivotal SUSTAIN and STEP programs, and real-world post-marketing surveillance.

Methods: We conducted a detailed analysis of preclinical data sets, Phase I-III clinical trials, regulatory documents, and pharmaco-epidemiological studies published between 2008 and 2025.

Results: Through strategic molecular modifications, such as specific amino-acid substitutions and the addition of a C18 fatty-diacid side chain to enhance albumin binding, the half-life of the peptide was extended to approximately 160 h, allowing for weekly dosing. Studies in rodents and non-human primates showed that semaglutide effectively lowered blood glucose levels, reduced body weight, and preserved β-cells while maintaining a favorable safety profile. Phase I trials confirmed consistent pharmacokinetics and tolerability, while Phase II trials identified 0.5 mg and 1.0 mg once weekly as the most effective doses. The extensive SUSTAIN program validated significant reductions in HbA1c levels and weight loss compared to other treatments, as well as a 26% decrease in the relative risk of major adverse cardiovascular events (SUSTAIN-6). Subsequent STEP trials expanded the use of semaglutide to chronic weight management, revealing that nearly two-thirds of patients experienced a body weight reduction of at least 15%. Regulatory approvals from the FDA, EMA, and other regulatory agencies were obtained between 2017 and 2021, with ongoing research focusing on metabolic dysfunction-associated steatohepatitis, cardiovascular events, and chronic kidney disease.

Conclusions: The trajectory of semaglutide exemplifies how intentional peptide design, iterative translational research, and outcome-driven clinical trial design can lead to groundbreaking therapies for complex metabolic disorders.

Annexin A1 (ANXA1), a calcium-dependent phospholipid-binding protein, is considered a key modulator of cancer biology. Numerous pieces of evidence support its multifaceted involvement in tumor progression, metastatic dissemination, immune escape, and resistance to therapy in various malignancies, such as melanoma, along with liver, lung, and digestive tract tumors, including stomach and colorectal cancer (CRC). Although colon and rectal cancer (RC) exhibit overlapping characteristics, they are classified as separate clinical entities due to differences in tumor biology and therapy approaches. Moreover, locally advanced rectal cancer (LARC) raises clinical challenges due to variable treatment responses and its therapy resistance, preventing successful treatment and patients' recovery. Considering ANXA1's involvement in chemoresistance, further investigation is currently focused on ANXA1-targeted therapies. This review aims to update the knowledge on ANXA1, as a CRC predictive and prognostic biomarker, with involvement in therapy resistance, highlighting its significance in LARC patients. Through emerging evidence, our research provides valuable insights into the potential of ANXA1's clinical utility and its prospective value as a target in chemoresistance approaches.

Background/objectives: Free gracilis (GM) and latissimus dorsi muscle (LDM) flaps are reliable options for complex defect coverage, but long-term sensory outcomes remain underexplored. Sensory impairment, especially the loss of protective cutaneous sensation, increases the risk of injury, thermal damage, and ulceration in reconstructed areas. This study aimed to systematically assess multidimensional sensory recovery after free muscle flap (FMF) reconstruction.

Methods: In a prospective single-center study, 94 patients (49 GM, 45 LDM) underwent standardized sensory testing following FMF transfer. Five modalities were evaluated: pressure detection (Semmes-Weinstein monofilaments), vibration perception, two-point discrimination (2PD), sharp-dull differentiation, and temperature differentiation. Measurements were compared to contralateral healthy skin (CHS). Subgroup analyses were performed by anatomical region (head, trunk, extremities).

Results: All sensory modalities were significantly impaired in FMF compared to CHS (p < 0.0001). Mean pressure thresholds were markedly higher in FMF (248.8 g) versus CHS (46.8 g). Vibration perception scores were reduced (FMF 3.97 vs. CHS 5.31), and 2PD was significantly poorer (11.6 cm vs. 4.7 cm). Sharp-dull and thermal discrimination were largely absent in FMF (positivity rates < 20%), with 58.5% of patients demonstrating only deep pressure sensation (≥300 g). No significant differences were found between GM and LDM in most modalities, except for worse 2PD in GM. Subgroup analyses confirmed uniform deficits across all anatomical regions.

Conclusions: FMFs without neurotization result in profound, persistent sensory deficits, particularly the loss of protective sensation. Clinically, fascio-cutaneous flaps with nerve coaptation should be considered in functionally critical regions. Future strategies should focus on neurotization techniques to enhance sensory recovery.

Purpose: The COVID-19 pandemic has led to the publication of numerous primary studies and meta-analyses; however, conclusive evidence on whether HIV infection influences COVID-19 outcomes among people living with HIV (PLHIV) is still lacking. This research uses a novel technique, the exit meta-analysis, to conclusively update the evidence of HIV's impact on COVID-19-related mortality, hospitalization, and need for Intensive Care Unit (ICU) admission in severe disease. Methods: A search of PubMed, EMBASE, Cochrane Reviews (CDSR), SCOPUS, CINAHL reviews and Google Scholar databases was conducted up to the 18 January 2024 for meta-analyses and observational studies that reported adjusted associations for the effect of HIV on COVID-19 related mortality, hospitalization, and ICU admission. Evidence from existing meta-analyses was summarized narratively, and an updated meta-analysis was carried out using a bias-adjusted inverse variance heterogeneity model. Subgroup analysis was carried out for age groups and geographical regions. Results: Of 3153 records identified, 20 meta-analyses and 56 primary studies, with a total of 27,936,428 participants, including 655,882 PLHIV, were included. A review of the meta-analyses showed conflicting results for all outcomes. In the updated synthesis, HIV was associated with higher odds of mortality (aOR 1.43, 95% CI: 1.01-1.86, I² = 90.7%) and ICU admission (aOR 1.49, 95% CI: 0.67-2.30, I² = 88.8%), but not hospitalization (aOR 1.11, 95% CI: 0.78-1.48, I² = 97.5%). The results for both ICU admission and hospitalization include the null value, leading to lower certainty. The exit meta-analysis suggested conclusive results for mortality (DAts score = -0.012) and hospitalization (DAts score = -0.014), but not for ICU admission. Conclusions: This exit meta-analysis provides conclusive evidence that HIV increases mortality in people with COVID-19; however, more studies may be required to address ICU admission and hospitalization.

Background: Rare diseases represent a significant research challenge due to the limited availability of data, small patient cohorts, and heterogeneous phenotypes. Data augmentation and synthetic data generation are increasingly adopted to mitigate these limitations.

Methods: This scoping review maps the application of data augmentation and synthetic data generation methods as strategies to address these limitations. A total of 118 studies published between 2018 and 2025 were identified through PubMed, Scopus, and Electronics Engineers (IEEE) Xplore.

Results: Imaging data headed the field, followed by clinical and omics datasets. Classical augmentation, mainly geometric and photometric transformations, emerged as the most frequent approach, while deep generative models have rapidly expanded since 2021. Rule- and model-based methods were less common but demonstrated high interpretability in small datasets.

Conclusions: Overall, these techniques enabled dataset expansion and improved model robustness. However, both approaches require rigorous validation to confirm biological plausibility. Together, these methods can transform data scarcity from a barrier into a driver of methodological innovation, enabling more inclusive rare disease research.

Background: Osteonecrosis of the femoral head is a progressive disorder leading to femoral head collapse and early disability, often affecting young adults. Core decompression (CD) is the most established hip-preserving treatment for early-stage disease, yet the comparative benefits of biological and structural augmentation remain uncertain.

Methods: This systematic review and meta-analysis, registered in PROSPERO (CRD420251108396), evaluated 14 studies encompassing 1210 patients treated with CD alone or CD combined with biological (e.g., platelet-rich plasma, mesenchymal stem cells, bone marrow aspirate concentrate) or structural (e.g., bone grafting, fibular support) augmentation.

Results: Pooled random-effects models demonstrated that biological augmentation yielded significant improvements in Harris Hip Score and pain reduction (VAS) up to 24 months, with early peaks and subsequent stabilization, whereas structural augmentation showed no functional advantage at any time point. Radiological progression and conversion to total hip arthroplasty were not significantly reduced, though long-term trends favored biologically augmented CD.

Conclusions: Overall, biological augmentation provides durable functional and symptomatic benefits in early-stage osteonecrosis, supporting its use as a first-line adjunct to CD, while structural augmentation appears less consistent and warrants further evaluation through large, standardized trials.