Mathematical modelling of tumor-immune interactions in breast cancer.

BACKGROUND The clinical outcomes of endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB) have not yet been well studied. AIM To evaluate the efficacy and safety of ERBL, IS, and ESB for treating grade I-III internal hemorrhoids. METHODS This retrospective cohort study was performed on 201 patients, who were grouped according to their endoscopic treatment (ERBL, IS, and ESB groups). Postoperative follow-ups were initially carried out at 1, 3, and 6 months, and then every 6 months, with the longest follow-up extending to 24 months. The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events. Additionally, subgroup analysis was conducted based on the internal hemorrhoid grade (I or II-III). RESULTS The patient distribution across the ERBL, IS, and ESB groups was 70, 66, and 65, respectively. Both the ERBL and ESB groups demonstrated lower overall recurrence rates compared with the IS group (post-hoc analysis, P ’ = 0.024 and P ’ = 0.015, respectively). Subgroup analysis revealed that sclerotherapy resulted in a higher total recurrence rate than that achieved by sclerobanding (45.95% vs 19.57%, P ’ = 0.03), specifically for grade II-III internal hemorrhoids. No significant difference was found in grade I hemorrhoids. The ERBL group exhibited a higher incidence of postoperative pain, a worse median visual analog scale score, and a longer median duration of pain compared with those reported by the other groups (P < 0.001). This trend was consistent for grade II-III hemorrhoids. No significant differences were found among the three groups regarding clinical efficacy or recurrence rates within 6 months post-surgery, even when examined by subgroup. CONCLUSION The three treatments evaluated (ERBL, IS, and ESB) provide durable clinical outcomes for grade I hemorrhoids, with no significant differences in postoperative adverse events. For grade II-III hemorrhoids, ESB possesses the dual advantages of lower recurrence rates and reduced postoperative pain compared with IS and ERBL.

BACKGROUND Low drug concentrations have been linked to antidrug antibody (ADA) formation. High clearance is a major reason for low drug levels leading to treatment failure in patients with inflammatory bowel disease (IBD) receiving infliximab (IFX). AIM To explore the predictive value of initial IFX clearance on outcomes and assess the impact of Bayesian model (iDose)-guided IFX dosing on clearance and outcomes during induction and early maintenance treatment. METHODS Data from a Phase 3 study of 220 CT-P13/originator IFX-treated patients with Crohn’s disease were used to develop probability models for outcomes including mucosal healing (MHEAL), biomarker response [C-reactive protein (CRP)], ADA development, and time to first ADA formation, based on initial clearance. Subsequently, patients with characteristics suggesting rapid initial clearance were enrolled in a ≤ 120-day (October 2018 to December 2019) compassionate use program of iDose-guided IFX treatment as a proof of concept to determine if the probabilities from initial clearance could be improved with individualized therapy. Serial serum IFX concentrations, clearance, outcome probabilities, and treatment outcomes were analyzed. RESULTS In the CT-P13 study, population pharmacokinetic was consistent with previously published models. Initial clearance was a significant predictor of several outcomes including MHEAL, CRP normalization, and ADA formation. In the proof-of-concept study, 10 patients received iDose-guided IFX treatment. Initial clearance ranged from 0.017 L/day to 1.11 L/day, prompting up to three IFX infusions within the first 2 weeks. Two patients were discontinued due to ADA. Generally, clearance slowed over time and inflammatory biomarker levels improved. There were no adverse effects. CONCLUSION Initial IFX clearance correlates with efficacy metrics and ADA formation. These probability curves may be useful to identify patients at risk of treatment failure or ADA who may benefit from individualized therapy. iDose-guided treatment successfully achieved targeted serum IFX concentrations, reducing risk of ADA formation. Proactive therapeutic drug monitoring and targeted dosing based on early IFX clearance may improve treatment outcomes for patients with IBD.

This study investigated the clinical features, misdiagnosis patterns, and treatment outcomes of vulvar lichen sclerosus (VLS) in girls through a single-center, observational, retrospective cohort analysis of 105 pediatric patients diagnosed at Beijing Children's Hospital between January 2021 and September 2024. The results showed a mean age of onset of (5.47±2.13) years (median: 5 years) and a misdiagnosis rate of 29.52% (31/105), with vitiligo being the most frequent initial misdiagnosis (20.95%, 22/105). Lesions predominantly presented in a "figure-of-8" pattern involving both the vulva and perianal regions (45.71%, 48/105), with symmetrical hypopigmented or depigmented patches observed in most cases (96.19%, 101/105). Subjective symptoms were reported by 49.52% (52/105) of patients, most commonly pruritus (32.40%, 34/105). Dermoscopy revealed whitish to yellowish structureless areas in all examined cases (100%, 30/30) and purpuric globules in 70% (21/30). Histopathological examination consistently demonstrated the characteristic"sandwich-like"pattern of hyperkeratosis, homogenization of dermal collagen, and band-like lymphocytic infiltration. Regarding treatment, the median time to lesion remission was 4 months for topical calcineurin inhibitor monotherapy and 3 months for combination therapy with a topical corticosteroid, while the median time to symptom relief was 2 months and 3 months, respectively. In conclusion, this study indicates that pediatric VLS in this cohort presented at a relatively early age with a high misdiagnosis rate, typically manifesting as symmetrical hypopigmented patches in a vulvo-perianal distribution. Dermoscopy and histopathology are valuable adjuncts for early diagnosis, and standardized treatment effectively alleviates symptoms.

The nominal group technique has been shown to be an effective method for reaching consensus among a group of healthcare experts when selecting clinical indicators for application in primary care research, especially where there are competing prioritisation criteria being considered. In the context of manifest barriers to traditional face-to-face meetings, and with the advent of evolving and improved digital tools, alternative approaches are being more commonly utilised to overcome these challenges. In this study, we sought to prioritise a set of existing, validated clinical indicators proposed for inclusion in ACTMed (ACTivating primary care for MEDicine safety), a clinical trial aiming to reduce medicine-related harm in primary care. A modified nominal group technique, using a fully online approach, was employed to facilitate consensus among a group of pharmacists and general practitioners. Quantitative data were obtained using an online survey platform both prior to the structured virtual forum and again following group discussion. Qualitative material was gathered from written feedback included in the pre-forum questionnaire and through verbal contributions made during the online forum. The highest priority indicators determined by the two-staged survey process were for myocardial ischaemia, cerebrovascular ischaemia related to atrial fibrillation, heart failure, asthma/chronic obstructive pulmonary disease and falls with fracture. Qualitative reasoning behind the participants' evaluation of the clinical indicators included value for money, impact of the intervention, consequences of clinical outcomes and ability to implement the intervention in practice. In this study, the interactive component of the nominal group technique process had little impact on the final prioritisation of the clinical indicators. Potential explanations for this might include previously established strong participant views and preferences or relative group homogeneity based on similar learning, research or clinical experience.

ABSTRACT Objective To evaluate the predictive value of parameters derived from nerve conduction studies (NCS) for respiratory failure in patients with Guillain-Barré syndrome (GBS). Methods We conducted a retrospective analysis of 213 patients with GBS admitted between January 2020 and August 2023. Patients were categorized into respiratory failure (n = 92) and non-respiratory failure groups (n = 121). Demographic, clinical, and neuro-electrophysiological parameters were compared. Multivariate logistic regression analysis was performed to identify independent predictors of respiratory failure. The model’s predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. Results Among 213 GBS patients (92 with respiratory failure, 121 without), multivariate logistic regression analysis identified two independent electrophysiological predictors of respiratory failure: slower peroneal motor conduction velocity (MCV, OR = 0.230, 95% CI: 0.063–0.838, p = .026) and slower tibial MCV (OR = 0.640, 95% CI: 0.539–0.760, p = .032). The predictive model demonstrated excellent discriminative ability with an AUC of 0.947 (95% CI: 0.921–0.973), sensitivity of 81.8%, and specificity of 95.7%. Patients with respiratory failure also had significantly higher Hughes functional scores (p < 0.001). Conclusion Motor conduction velocities of the peroneal and tibial nerves provide reliable and objective predictors for respiratory failure in GBS patients. Incorporating these markers into early risk assessment may facilitate prompt intervention and improve clinical outcomes.

Wound care in the UK has long been challenging, clinically complex and economically burdensome. Wounds affect millions of patients annually, costing the NHS billions of pounds. Despite the scale of this problem, wound care services have historically been subject to fragmentation, variable clinical practice, delayed interventions, a lack of coordinated policy focus and poor data collection. Between 2015 and 2025, this situation has persisted in the face of increasing pressure on NHS resources, rising patient demand and growing evidence of suboptimal outcomes, particularly for chronic wounds such as diabetic foot ulcers, pressure ulcers and venous leg ulcers. This article critically analyses the literature relating to clinical and financial outcomes of wound care in the UK from 2015 to 2025 published by Professor Julian Guest. Critically analysing Guest's publications on wound care is important for several reasons, especially in relation to clinical and policy-making contexts in the latest NHS plans; it is essential to understand what strategies have worked, what gaps remain and how future services should be designed. There is a pressing need to synthesise the decade of research and policy developments in wound care. This article serves to critically appraise the progress and effectiveness of recent efforts.

Analysis of ischemic intestinal tissue composition based on visible and near-infrared reflectance hyperspectral imaging and multivariate curve resolution.

In this study, we aimed to compare the clinical outcomes of unilateral biportal endoscopic (UBE) lumbar discectomy and open lumbar microdiscectomy (MD) for recurrent disc herniation. Ninety patients who underwent discectomy, including 44 and 46 who underwent UBE and MD, respectively, were enrolled. All surgeries were performed between March 2020 and April 2023. Only patients with single-level recurrence were included; patients with multilevel recurrence or unstable disease, as well as those who had undergone surgery less than 6 months prior, were excluded. Visual analog scale (VAS) scores, recurrence rates, and complications were compared between the groups. The average follow-up periods were 19.09 and 20.45 months in the UBE revision and MD revision discectomy groups, respectively. The mean bleeding loss and hospital stay were shorter in the UBE group than in the MD group. Postoperative short-term back pain was lower in the UBE group (VAS score, 3.32) than in the MD group (VAS score, 7.89) (p<0.001). Radiating pain showed similar patterns in both groups at all time points. Recurrence was more frequent in the MD group; however, this difference did not reach statistical significance, likely owing to the small sample size (p=0.677). Similarly, incidental durotomy occurred less frequently in the UBE group (6.8% vs. 8.7%), but this difference was not statistically significant. Both UBE and MD could achieve good long-term outcomes; however, UBE revision was superior in terms of short-term back pain, bleeding loss, and length of hospital stay after surgery.

This study aimed to investigate the clinicopathological characteristics, response to chemotherapy, and clinical outcomes according to estrogen receptor (ER) expression levels in breast cancer (BC) patients treated with neoadjuvant chemotherapy (NAC). ER expression levels were categorized as ER-negative (expression in <1% of tumor cells), ER-low positive (1-10%), ER-intermediate positive (11-50%), and ER- high positive (>50%). Of the 1,365 cases, 647 (47.4%) were classified as ER-negative, 49 (3.6%) as ER- low positive, 48 (3.5%) as ER-intermediate positive, and 621 (45.5%) as ER-high positive BCs in pre-NAC biopsies. ER-intermediate positive tumors as well as ER-low positive tumors showed no differences in clinicopathological characteristics compared to ER-negative tumors with the exception of progesterone receptor positivity. While ER-low positive and ER-negative tumors showed similar chemo-responsiveness, ER-intermediate positive tumors were less responsive to NAC compared to ER-negative tumors. In patients with residual disease, pre- and post-NAC ER expression levels were found to be independent prognostic factors, but with no significant differences among ER-negative, ER-low positive, and ER-intermediate positive tumors. Our study indicates that ER-low positive BCs are similar to ER-negative BCs and that ER-intermediate positive BCs exhibit characteristics heterogeneous between ER-negative and ER-high positive BCs in terms of clinicopathological characteristics, chemo-responsiveness, and clinical outcomes.

Human papillomavirus (HPV) integration (HPVint) is associated with carcinogenesis and tumor progression in HPV-associated cancers, including head and neck squamous cell carcinomas (HNSCC). Although its impact on human DNA has been well characterized, its relationship with clinical outcomes remains unconfirmed. We analyzed HPVint events from 261 HPV-associated HNSCC bulk and single-cell RNA sequencing (scRNA-seq) samples from five cohorts, including 62 from a new University of Michigan cohort, and DNA HPVint events from 102 HPV(+) HNSCC participants in two of the cohorts. We investigated the consequences of HPVint both with respect to human and HPV gene expression and clinical outcomes (recurrence and overall survival). By leveraging this large meta-cohort of HNSCC, we first reveal an oncogenic gene network based on the recurrent HPVint locations in the human genome and gene expression alterations, highlighting key recurrent and overexpressed genes, including NR4A2, CD274, and CCER1, and genes from the CAMK and KLF families. We then stratify HPVint-positive participants by risk using HPV RNA features, specifically spliced HPV-human fusion transcripts (E1* integration) and HPV gene expression ratios, showing that subsets of participants have worse clinical outcomes based on these two candidate biomarkers. By focusing on RNA instead of DNA, we expand our understanding of the carcinogenic mechanisms of HPVint, in part addressing the conflicting findings of whether HPVint is associated with aggressive phenotypes and worse clinical consequences, and provide potential biomarkers to advance precision oncology in HPV-associated HNSCC. Newly identified genes with recurrent integration events may serve as candidates for targeted therapy.

This study investigates the clinical course and long-term outcomes of adults with subvalvular aortic stenosis (SAS). Adults with SAS, prospectively registered in the Dutch Congenital Cor Vitia (CONCOR) registry between 2001-2019, were included. All-cause mortality, SAS (re-) operation, and cardiovascular events, including arrhythmias, heart failure, (re-)operation for aortic regurgitation (AR), were assessed. Longitudinal changes in echocardiographic peak velocity, interventricular septal thickness (IVST), and left ventricular posterior wall thickness (LVPW) were analysed using linear mixed-effects models. Differences in the history of SAS repair (operated/unoperated patients), isolated/non-isolated SAS, and sex were explored. Overall, 312 patients were included [age: 26.0 (interquartile range, IQR: 20.0-35.3) years, 68.3% history of SAS repair] with a median follow-up of 16 (IQR: 10-20) years (4423 patient-years). Unadjusted survival at 15 years was lower in the operated group compared to the unoperated group (P = .009) and no significant differences were observed between sexes (P = .083) or isolated/non-isolated SAS (P = .810). The cumulative incidence of (re-)operation for AR at 15 years was 7.6% (95% CI 4.7%-11.0%). The hazard of SAS repair during follow-up was higher in the unoperated group compared to the operated group [HR 0.2 (95% CI 0.1-0.5), P < .001], after correction for covariates. Peak velocity progression was 0.1 m/s (P = .357) during the first period and 0.3 m/s (P = .032) during the second (after ±10 years). No patient showed fast progression (≥0.3 m/s/year) in peak velocity. At baseline no evidence of left ventricular hypertrophy was observed, following IVST/LVPW criteria. Survival of adult SAS patients with a history of SAS repair was substantially lower compared to the unoperated group, reflecting a potentially more severe SAS phenotype. Nevertheless, long-term clinical event rates were considerable. SAS remained stable, suggesting less echocardiographic follow-up may suffice, particularly in mild phenotypes without AR. Additionally, follow-up should focus on the clinical sequelae of SAS.

Balloon-expandable valve (BEV) and self-expanding valve (SEV) are used in transcatheter aortic valve replacement (TAVR). Patients with a small aortic annulus (SAA) make up to one-third of the cases and face higher risks of prosthesis-patient mismatch and high valvular gradients. This meta-analysis aimed to compare balloon-expandable and self-expanding valves used in TAVR in patients with a SAA, focusing on hemodynamic and clinical outcomes. We systematically searched Cochrane Central, PubMed, and EMBASE for studies comparing balloon-expandable and self-expanding valves in patients with SAA undergoing TAVR. Random effects models were applied to generate odds ratios (ORs) and mean differences with 95% confidence interval (CI). Fifteen studies (two randomized controlled trials and 13 propensity-matched studies) with 5149 patients (48.4% balloon-expandable valves) were identified. BEVs were associated with a lower indexed effective orifice area (mean difference: -0.18, 95% CI: -0.25 to -0.10; P < 0.00001) and higher transvalvular mean pressure gradient (mean difference: 4.32, 95% CI: 3.39-5.24; P < 0.00001) and peak pressure gradients (mean difference: 4.87, 95% CI: 1.23-8.51; P = 0.009). Permanent pacemaker implantation (OR: 0.57, 95% CI: 0.44-0.73; P < 0.0001) and major bleeding (OR: 0.67, 95% CI: 0.47-0.96; P = 0.03) were lower in balloon-expandable valves. BEVs increased the odds of any prosthesis-patient mismatch (OR: 2.28, 95% CI: 1.61-3.22; P < 0.00001) and severe prosthesis-patient mismatch (OR: 3.16, 95% CI: 2.19-4.58; P < 0.00001). In patients with SAA undergoing TAVR, SEVs offer superior hemodynamic performance, whereas BEVs are associated with fewer conduction disturbances and bleeding events. Both valve platforms yielded similar clinical outcomes, underscoring the need for individualized device selection.

Background: Botulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraine (CM), yet the accompanying neurochemical changes remain incompletely characterized. Objective: To evaluate the effects of BoNT-A on plasma substance P (SP), γ-aminobutyric acid (GABA), glutamate, glutamine, and 5-hydroxytryptamine (5-HT), and on urinary 5-HT, and to explore relationships with clinical outcomes. Methods: In this prospective study, plasma neurotransmitters were analyzed in CM patients (n = 31) at baseline and one month after BoNT-A (155 U; PREEMPT protocol) and in healthy controls (n = 30). Plasma SP was measured using enzyme-linked immunosorbent assay (ELISA); plasma GABA, glutamate, and glutamine were quantified via liquid chromatography–tandem mass spectrometry (LC–MS/MS) with isotopically labeled internal standards; plasma and urinary 5-HT were determined by high-performance liquid chromatography (HPLC). Clinical outcomes included monthly headache frequency, Visual Analog Scale (VAS), and Migraine Disability Assessment (MIDAS). Statistical analyses applied appropriate parametric or non-parametric tests with p &lt; 0.05 considered significant. Results: One month post-BoNT-A, headache frequency, MIDAS, and VAS were significantly reduced (all p &lt; 0.001). SP levels were significantly higher after BoNT-A than at baseline and versus controls. Plasma 5-HT increased post-BoNT-A, while urinary 5-HT decreased. Plasma GABA was elevated in patients versus controls without statistical significance. Glutamine was significantly higher before treatment, whereas the Glu/Gln ratio increased after BoNT-A. Correlations revealed that higher GABA was associated with lower VAS and attack frequency post-treatment. Conclusions: BoNT-A provided short-term clinical improvement with distinct neurochemical changes, including increased plasma SP and 5-HT, decreased urinary 5-HT, reduced glutamine, and a higher Glu/Gln ratio. These biomarkers, particularly Glu/Gln, may serve as indicators of cortical excitability and therapeutic response in CM.

CO intoxication is a leading cause of poisoning-related death worldwide. Little is known about the connection between the source of poisoning and the clinical outcome. Our primary goal in this study was to establish this connection. We conducted a retrospective cohort study using data retrieved from medical records of all cases presented to the Pediatric Emergency Department at University Medical Center (UMC), between 2016 and 2024, of children aged 0 to 18 years who were admitted with suspected CO intoxication and carboxyhemoglobin (COHb) levels exceeding 5%. "The exposure mechanisms were categorized into 3 groups: smoke inhalation by fire, intentional heating, or gas used for water heating." Ninety-five children had COHb levels above 5%. The mean age of patients varied across exposure groups (P <0.001). Individuals exposed to gas were older (13.65±3.2y), compared with smoke inhalation (6.9±5.85y) or heating-related incidents (10.26±4.64y). Poor outcomes (defined as death, intensive care admission, or hyperbaric chamber treatment) were most frequent in the gas group (90%, P = 0.002), followed by fire exposures (65%) and heating-related cases (49%). We found a strong correlation between causality (gas for water heating) and outcomes. We also showed some correlation between clinical and laboratory features that could result in severe outcomes. These findings could help guide preventive measures and further studies in the future.

Ultrasound (US)-guided microwave ablation (MWA) has emerged as a promising minimally invasive therapy for both benign and malignant breast tumors. This review comprehensively examines the current clinical status, technical principles, and therapeutic outcomes of US-guided MWA in breast tumor management. We discuss the biophysical mechanisms of MWA, its advantages over other ablation techniques-such as rapid temperature elevation, the ability to create more extensive coagulation areas, and diminished impact from heat sink phenomena-and the critical role of real-time US guidance in enhancing procedural precision and safety. Clinical evidence supports the efficacy of US-guided MWA in achieving high rates of complete ablation and significant volume reduction for benign tumors, such as fibroadenomas, with minimal complications and excellent cosmetic results. For early-stage breast cancers, initial studies indicate that US-guided MWA provides local tumor control comparable with surgical resection in the short- to mid-term, while also offering the benefits of shorter operation times, reduced hospitalization, and stimulation of systemic antitumor immune responses. However, challenges remain, including technical limitations in treating tumors near critical structures, the lack of long-term oncological data, and operator dependence. Future directions involve technological refinements, integration with artificial intelligence and advanced imaging, combination with immunotherapy, and standardization of protocols. US-guided MWA represents an important advancement toward personalized, organ-preserving breast tumor therapy, with ongoing innovations poised to expand its clinical applicability.

Multiple Sclerosis (MS) severity is influenced by several factors. Understanding the impact of age at disease onset may help to better characterize clinical and disease features across age groups. This study aimed to characterize the clinical features and disability outcomes of late-onset MS (LOMS) and very late-onset MS (vLOMS), compared to adult-onset MS (AOMS). We conducted an observational study using data from the MSBase registry and categorized patients based on age at MS onset: AOMS (18-39years), transition onset (40-49years), LOMS (50-59years), and vLOMS (≥ 60years). Disease progression was assessed using the 24week confirmed disability progression, EDSS4 and 6 milestones, conversion to secondary progressive MS(SPMS), and the first progression independent of relapse activity (PIRA) event. Cox proportional hazard regression models were used to determine unadjusted hazard ratios(HR), and propensity score inverse probability of treatment weighting(PS-IPTW) balanced covariate distributions. Among 81,236 patients, 5.2% had LOMS and 1% had vLOMS. Primary progressive MS was more frequent in LOMS and vLOMS (21.7 and 24%, respectively). Patients with LOMS and vLOMS had a significantly increased risk of 24week confirmed disability progression (HR:LOMS = 1.39, vLOMS = 1.80), EDSS 4 (HR:LOMS = 2.14, vLOMS = 2.95), EDSS 6 (HR:LOMS = 2.33, vLOMS = 6.33), SPMS (HR:LOMS = 1.62, vLOMS = 2.38), and first PIRA event (HR:LOMS = 2.12, vLOMS = 2.93). LOMS and vLOMS exhibited a more progressive disease onset and higher disability milestones compared with AOMS.

Overuse of carbapenems and other broad-spectrum antibiotics increases both costs and the risk of antimicrobial resistance (AMR). This study assessed whether optimizing antimicrobial susceptibility testing (AST) reports could improve clinical and economic outcomes for hospitalized patients with bloodstream infections (BSIs). From June 2022 to May 2023, a series of microbiology laboratory interventions were implemented at the Affiliated Hospital of North Sichuan Medical College, including the use of BacT/Alert Virtuo system (bioMérieux, France) for rapid loading, VITEK MS (bioMérieux, France) for rapid microbiology identification (ID), 24-hour laboratory service, and dual AST cards (N335 + XN04) replacing the single card (GN13). Previous simultaneously reported ID and AST results were successfully replaced by a separate reporting process. Data from BSI patients before (June 2021-May 2022) and after (June 2023-May 2024) interventions were retrospectively analyzed for ID and AST reporting time, antibiotic use, length of stay (LOS), and costs. A total of 256 BSI patients were analyzed (125 pre-intervention; 131 post-intervention). The post-intervention group had significantly shorter times to ID (median 41.26 vs. 74.35 h) and AST reports (56.02 vs. 74.35 h), with earlier opportunities for targeted antibiotic adjustments. Antibiotic modifications occurred ~ 36 h sooner within the first 72 h. Among all agents, carbapenems underwent the most MIC-based changes (20 additions and 10 discontinuations), reflecting improved carbapenem stewardship driven by expanded AST coverage. Post-intervention patients also showed shorter LOS, reduced antibiotic and testing costs, and a potential improvement in survival, especially in ICU cases. Optimized microbiology workflows, including dual AST cards and faster AST report, significantly accelerated reporting and facilitated timely, precise antimicrobial therapy, particularly carbapenem stewardship, while reducing clinical and economic burdens.

Long-term outcomes in patients with lung metastases from sarcomas remain unreported. We retrospectively evaluated the clinical utility of lung radiofrequency ablation (RFA) in 52 patients with musculoskeletal sarcoma-derived lung metastases. The study cohort included 29 men and 23 women with a mean age of 55years at the time of the initial lung RFA, with a mean follow-up duration of 49.2months. Complete treatment was defined as achieving a tumor-free status following the initial lung RFA. Cases failing to achieve this were classified as incomplete treatment. At the final follow-up, 14 patients remained alive, while 38 had died from this disease. Multivariate analysis confirmed that complete ablation and longer disease-free interval were significant prognostic factors. The median survival time for the 27 patients with complete treatment was 96.7months, compared with 13.1months for the 25 patients with incomplete treatment. The 3- and 5-year survival rates after the initial RFA in the 27 patients with complete treatment were 55.3% and 51.4%, respectively, whereas the corresponding rates for the incomplete treatment group were 16% and 10.7%. Of the 27 patients who achieved complete treatment, 4 had no new lung metastases, whereas 23 developed new lung metastases and/or local relapse. Local tumor progression occurred in 30 of 266 lung tumors (11%); larger tumors showed a higher incidence of progression. No procedure-related mortality was reported. Lung RFA can be a valuable option for treating lung metastases in patients with musculoskeletal sarcoma.

Gastric adenocarcinoma with peritoneal metastasis (PM) has a poor prognosis, yet clinical outcomes vary significantly. This study aimed to identify independent prognostic determinants of PM-specific survival (PM-OS), focusing on tumor biology and disease burden surrogate. We retrospectively analyzed 166 patients with gastric adenocarcinoma and PM treated at a single center between 2015 and 2024. Prognostic factors were evaluated using multivariable Cox proportional hazards models. To mitigate immortal time bias and confounding by indication, receipt of systemic therapy was excluded from the primary multivariable model. The median PM-OS was 8.2 months (95% CI, 6.63-9.79). Patients diagnosed via surgical exploration (radiologically occult) achieved a significantly longer median PM-OS compared to those diagnosed radiologically (13.6 vs. 7.4 months; p = 0.003). In multivariable analysis, HER2 positivity (HR0.312, 95% CI 0.164-0.593; p < 0.001) and surgical diagnosis (HR 0.555, 95% CI 0.338-0.913; p = 0.020), interpreted as a surrogate for radiologically occult/low tumor burden, were identified as independent predictors of improved survival. Additionally, an optimized CA 19 - 9 cutoff (> 175.4 U/mL), unlike the standard threshold, significantly stratified survival. Traditional factors, including signet-ring cell histology and age, did not retain independent significance.In sensitivity analysis including systemic therapy, treatment was strongly associated with survival and the prognostic significance of HER2 and diagnostic context remained. Survival in gastric PM is fundamentally driven by HER2 status and the extent of PM. Surgical detection identifies a subgroup with limited, occult disease who achieve superior outcomes compared to those with radiologically overt metastases. Furthermore, the magnitude of biomarker elevation, rather than mere positivity, serves as a critical stratifier. These findings support a paradigm shift towards burden-based risk stratification to guide treatment intensity and clinical trial eligibility.