Medicine international最新文献

Metastatic cancer remains a significant global health challenge, contributing to the majority of cancer-related mortality due to late detection, therapeutic resistance and the complexity of disseminated disease. Recent advances in artificial intelligence (AI) and augmented reality (AR) are transforming the landscape of metastatic cancer detection and management. AI-driven tools, including radiomics, deep learning models, and predictive analytics, enhance early identification of metastatic lesions, improve diagnostic accuracy, and support personalized treatment strategies by integrating multimodal clinical, imaging and molecular data. At the same time, AR technologies are increasingly applied in image-guided surgery, real-time tumor visualization and patient education, enabling more precise interventions and improved clinical decision-making. The combined use of AI and AR fosters multidisciplinary collaboration, facilitates comprehensive treatment planning, and may ultimately improve patient outcomes. However, despite these advancements, several challenges limit widespread implementation, including algorithmic bias, variability in data quality, concerns regarding patient privacy, and regulatory and ethical constraints. Furthermore, integration into clinical workflows requires robust validation, clinician training, and standardized guidelines. Future efforts are required to focus on developing transparent, generalizable AI models, strengthening data-security frameworks, and enhancing AR usability to ensure equitable, safe, and effective incorporation of these emerging technologies into metastatic cancer care.

Pregnancy is considered a relative contraindication for thrombolysis. Moreover, mechanical thrombectomy should be considered for pregnant patients, as it would be indicated in non-pregnant patients. The present study describes the clinical case of a 29-year-old female full-term pregnant patient who presented to the emergency room with a sudden onset symptomatology characterized by pronunciation disorder and motor impairment in the right arm with numbness at the same level, and with a National Institutes of Health Stroke Scale score of 7 points. The patient presented in the revascularization window, and the series of acute medical interventions were as follows: Clinical examination, native head computed tomography (CT) scan, emergency cesarean section, CT angiography of the cerebral arteries, and, eventually, mechanical thrombectomy. A brain MRI revealed a hyperintense lesion in diffusion sequence with low apparent diffusion coefficient correspondence at the frontal level of the left side, affecting the middle and precentral gyrus. A transesophageal ultrasound revealed a small patent foramen ovale with a risk of paradoxical embolism score of 8 points. Usual thrombophilia laboratory test results were negative; however, a homozygous methylenetetrahydrofolate reductase gene mutation and a heterozygous positive plasminogen activator inhibitor-1 gene mutation were detected. On the whole, the present case report emphasizes the importance of evaluating inherited genetic thrombophilia and PFO in young patients suffering a stroke. Moreover, the need for the psychological and psychiatric evaluation for possible reactive depression, anxiety and burnout in young patients suffering a stroke, and particularly in the peripartum period, is highlighted.

Primary sclerosing cholangitis (PSC) is a recognised risk factor for hilar cholangiocarcinoma (hCCA). In selected patients, neoadjuvant chemoradiotherapy followed by liver transplantation provides the optimal chance of long-term survival. However, for the patient described in the present case report, at the time of the patient s treatment, the UK did not have an approved transplant programme for cholangiocarcinoma, and access to liver transplantation was limited, often necessitating upfront surgical resection despite its complexity and limited curative potential. The present study describes the case of a 52-year-old male patient with PSC who was diagnosed with hCCA and underwent an extended right hepatectomy. After 26 months, progressive liver dysfunction due to PSC-related cirrhosis prompted liver transplantation, which was approved following a lengthy appeals process. Over the following years, the patient developed metastases in the bowel, lungs and abdominal wall, all of which were successfully managed with surgical resections. He remained disease-free for 8 years following his initial diagnosis before developing intrahepatic recurrence. The tumour was HER2-positive, and the compassionate use of zanidatamab was initiated following progression on standard therapies. At the time of the writing of the present case report, the patient remained alive 101 months following this initial diagnosis. On the whole, the present case report highlights the potential impact of tumour biology and multimodal treatment in PSC-associated hCCA. The prolonged survival of the patient despite delayed transplant and metastatic recurrence suggests that PSC-related hCCA may follow a more indolent course compared to de novo cases. Future efforts are required to focus on tumour profiling and stratified therapeutic approaches to better guide treatment in this complex disease.

Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder characterized by recurrent orofacial edema, peripheral facial palsy and a fissured tongue, although the complete triad is rarely observed. The present study reports the case of a 22-year-old male patient who initially presented with facial paralysis, later developing cheek edema, dermatosis and systemic symptoms; the histopathological findings consistent with granulomatous cheilitis. Laboratory analyses revealed a low C1q level and positive antinuclear antibody. Based on clinical and biopsy findings, MRS was diagnosed. The patient responded well to a 6-month regimen of deflazacort, epinastine and methotrexate. On the whole, the present case report illustrates an incomplete, yet clinically significant form of MRS. Diagnosis is primarily clinical, supported by histology and exclusion of similar conditions. Treatment focuses on symptom control with corticosteroids; immunomodulators or biologics may be used in refractory cases. Early recognition is essential, even in the absence of the full triad.

The coronavirus disease 2019 (COVID-19) pandemic triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a profound impact on global public health. The complexity of its pathogenic mechanisms and host interactions urgently requires high-fidelity animal models to support research. Humanized mouse models break the species barrier through gene editing and immune reconstitution technologies, providing a key tool to simulate human infection characteristics and pathological processes. A number of studies have reported the application of humanized mouse models in the fields of COVID-19 research, such as SARS-CoV-2 pathogenesis, anti-SARS-CoV-2 drug discovery and vaccine development, etc. The present review aimed to systematically document the latest advances in the application of humanized mouse models based on different construction strategies, such as receptor humanization, immune system humanization and composite humanization. These models have not only elucidated the pathogenicity differences and immune escape mechanisms of SARS-CoV-2 variants, but have also validated the efficacy of broad-spectrum anti-SARS-CoV-2 strategies, including angiotensin-converting enzyme 2-targeted therapies, antibody cocktail regimens and mucosal vaccines. Additionally, humanized mouse models have played a pivotal role in investigating the mechanisms underlying long COVID. By revealing the multi-system pathogenic mechanisms of pulmonary fibrosis, neurodegeneration and intestinal microbiota dysregulation, these models provide a theoretical foundation for the development of targeted intervention strategies.

Blood gas analysis represents a cornerstone diagnostic method in clinical practice, providing rapid assessment of respiratory and metabolic status through evaluation of pH, partial pressure of oxygen, partial pressure of carbon dioxide and bicarbonate. The present comprehensive review discusses recent advances in blood gas analysis, including emerging artificial intelligence (AI) applications, controversial practices in venous vs. arterial sampling and closed-loop management systems in critical care. The present review critically synthesizes evidence from recent systematic reviews and meta-analyses, addressing key controversies, such as the clinical utility of venous blood gas analysis with venous-to-arterial conversion technology (sensitivity, 97.6%; specificity, 36.9% for respiratory failure diagnosis) and automated interpretation systems. The present review encompasses physiological foundations, evidence-based clinical applications, structured interpretation methodologies and quality improvement strategies. Emphasis is placed on technological innovations including AI-assisted interpretation, non-invasive monitoring technologies and integration with closed-loop therapeutic systems. Through the analysis of >50 recent publications and current guidelines, the present review aimed to provide evidence-based recommendations for modern clinical practice, highlighting when venous sampling provides adequate diagnostic information, while reducing patient discomfort. Future perspectives include predictive algorithms for early clinical deterioration recognition and personalized diagnostic approaches. The present review aimed to provide unique clinical value by bridging traditional blood gas analysis with cutting-edge technological applications, providing practitioners with contemporary, evidence-based guidance for optimal patient care.

Non-invasive fluid biopsies are emerging as a promising, low-risk complementary method to traditional diagnostic approaches in reproductive biology, allowing for repeated sampling throughout different stages of assisted reproductive technology. These approaches hold significant potential, not only for clinical diagnosis, but also for personalized medicine. The present review summarizes recent findings on key biomolecular components found in accessible body fluids, such as follicular fluid, embryo culture medium, uterine secretions and saliva, namely cell-free nucleic acids, extracellular vesicles and microRNAs. These biomarkers indicate critical cellular events, such as apoptosis, oxidative stress, mitochondrial dysfunction and intercellular signaling pathways. Special emphasis is placed on the molecular profile of granulosa and cumulus cells, which are essential for oocyte maturation and have strong predictive value for fertilization potential and subsequent pregnancy outcomes. Their molecular signatures provide critical information about the developmental competence of the oocyte and early embryo. However, limitations such as maternal contamination, mosaicism and variable compliance, along with a lack of guideline-level approval, currently restrict their routine clinical use. These non-invasive samples are valuable complements to current invasive methods, providing information about chromosomal competence and embryo viability without compromising embryo integrity. Overall, the current evidence highlights the potential of fluid-based biomarker discovery to improve the outcomes of in vitro fertilization (IVF) and support the development of personalized, sustainable fertility treatments. The present review aimed to summarize and critically evaluate developments in non-invasive liquid biopsy techniques in IVF, highlight their clinical applications for improving IVF outcomes, and examine the molecular profile of granulosa and cumulus cells as determinants of oocyte and embryo quality. The fundamental hypothesis is that non-invasive liquid biopsies can serve as effective, low-risk alternatives to traditional invasive diagnostic approaches, minimizing harm to patients and embryos, while improving embryo selection, preimplantation genetic testing and overall IVF success.

Malakoplakia is a rare granulomatous inflammatory disease that primarily affects the genitourinary tract and is often associated with coliform infections. In rare cases, it can mimic tumors; however, to date, to the best of our knowledge, no case of malakoplakia due to Morganella morganii mimicking as a tumor has been reported. The present study describes the case of a patient with bladder malakoplakia caused by Morganella morganii, mimicking a bladder tumor. A 78-year-old male patient presented with complaints of dysuria, urinary frequency, urgency and incontinence. Upon a urinalysis, a marked number of pus cells were observed, and an abdominal ultrasound revealed bladder wall thickening. Flexible cystoscopy revealed a tight urethra and multiple sessile masses in the bladder. A urine culture revealed infection with Morganella morganii, and the patient was treated with antibiotics. Following transurethral resection of the masses, histopathological analysis revealed von Hansemann cells and Michaelis-Gutmann bodies, confirming the diagnosis of malakoplakia. Immunohistochemistry was negative for AE1/AE3 and S100, but positive for CD68. In addition, 10 cases in the literature were reviewed; all patients in these cases were elderly or adults, apart from one case. Of note, 6 cases had Escherichia coli infection, and 1 case also had Pseudomonas aeruginosa infection. A total of 6 cases underwent mass resection, while 4 cases were managed conservatively; one of these experienced recurrence. On the whole, the present study demonstrates that bladder malakoplakia can also arise from infection with Morganella morganii and mimic a tumor; thus, it should be considered in the differential diagnosis of bladder inflammation or masses.

Mantle cell lymphoma (MCL) usually affects the lymph nodes; however, extranodal involvement is also common, particularly in Waldeyer's ring and the gastrointestinal tract, spleen and bone marrow. Other organs that may be affected include the skin, endocrine glands, lungs and central nervous system, with these sites most commonly affected by relapsing disease. However, in rare, extranodal MCL has arisen in the ocular adnexa, soft tissue and heart. The present study reports the case of a 75-year-old male patient, who experienced repeated relapses of MCL, involving ocular adnexa, soft-tissue and cardiac lesions, which are rare. The aim of the present case report was to demonstrate that clinicians should be aware of the various extranodal sites at which MCL can arise, and monitor patients carefully during and after treatment.

Psammoma bodies (PBs) are round, layered calcified structures usually associated with papillary thyroid cancer and may be observed in 40-50% of cases, but may rarely occur in benign thyroid disease. The present study describes a rare case of PBs being found in a benign thyroid gland. In addition, a brief review of the literature is presented. A 28-year-old female patient presented with a 3-month history of weight loss, poor appetite and generalized weakness. Her thyroid was firm and mildly enlarged. Thyroid function was within normal limits (thyroid-stimulating hormone, 0.85 µIU/ml; free T4, 20.1 pmol/l; thyroglobulin, 6.15 ng/ml). An ultrasound demonstrated bilateral TI-RADS-3 nodules measuring 25x21x19 mm (right) and 17x15x13 mm (left). A total thyroidectomy revealed thyroid follicular nodular disease with focal lymphocytic thyroiditis and PBs, but no malignancy. In the literature, 4 cases of PBs or psammomatous calcifications linked to benign conditions were identified, 2 males and 2 females. Half of the cases involved the thyroid-region lesions and half were pediatric (2/4). All cases underwent surgical excision, and fine-needle aspiration was diagnostic in only 1 case (25%). A computed tomography scan was used in 2 cases (50%). A histological analysis confirmed PBs or psammomatous calcifications in every case, and all patients had favorable outcomes with no recurrence upon follow-up. When PBs are detected without tumor cells, submitting the entire thyroid tissue for histology is recommended to rule out microscopic carcinoma. PBs can arise in benign thyroid follicular nodular disease, mimicking malignancy on imaging and cytology, accurate diagnosis requires comprehensive histopathological evaluation.