Treatment Decisions Research Articles

Loss of vimentin expression in preoperative biopsies independently predicts poor prognosis, lymph node metastasis and recurrence in endometrial cancer

BackgroundPrecise preoperative risk classification of endometrial cancer is crucial for treatment decisions. Existing clinical markers often fail to accurately predict lymph node metastasis and recurrence risk. Loss of vimentin expression has emerged as a potential marker for predicting recurrence in low-risk endometrial cancer patients. We assessed whether vimentin expression in preoperative biopsies predicts poor prognosis and lymph node metastasis in a large multicentre cohort.MethodsVimentin expression was evaluated using immunohistochemistry in 1483 patients diagnosed with endometrial cancer across 14 hospitals in Europe. Expression levels of vimentin were analyzed in conjunction with clinical characteristics for predicting disease-specific survival and lymph node metastases.ResultsVimentin loss was significantly associated with aggressive disease and poor survival. Adjusted for clinicopathological variables, vimentin remained independently prognostic with a hazard ratio (HR) of 1.68 (95% CI 1.16–2.42, P = 0.006). Vimentin expression remained independently prognostic in endometrioid endometrial cancer- and FIGO staged 1 patient. Interestingly, vimentin loss independently predicted lymph node metastases, with an HR of 1.83 (95% CI 1.13–2.95, P = 0.014).ConclusionsLoss of vimentin in preoperative biopsies serves as an independent predictor of poor prognosis and lymph node metastases. Incorporating vimentin as a clinical marker can improve risk stratification and treatment decisions.

Comparative Analysis of Holmium Laser Enucleation of the Prostate (HoLEP) and Robotic-Assisted Simple Prostatectomy (RASP) in BPH Management: A Systematic Review and Meta-Analysis.

As the prevalence of benign prostatic hyperplasia (BPH) increases, the demand for surgical interventions that optimize patient outcomes while minimizing complications grows. This systematic review compares the efficacy, efficiency, and safety of holmium laser enucleation of the prostate (HoLEP) with robotic-assisted simple prostatectomy (RASP), providing insights for evidence-based surgical decision-making in BPH treatment. Adhering to PRISMA guidelines, the study protocol was registered with Prospero [CRD42024509627]. Searches were conducted in Medline, Embase, Web of Science, Scopus, and CINAHL up to February 1, 2024, to include studies that compare HoLEP and RASP in patients with BPH. Risk of bias was evaluated using the Newcastle Ottawa Scale. HoLEP and RASP demonstrated equivalent effectiveness in treating BPH, as shown by similar functional outcomes such as maximum urinary flow rate and postvoid residual volume. However, HoLEP outperformed RASP in several operational efficiency metrics, reducing operative time by 49.48 minutes, hospitalization duration by 1.5 days, and catheterization period by 3.8 days. HoLEP also significantly reduced the risk of blood transfusions by 75%. Patients undergoing RASP were 1.87 times more at risk for grade 2 complications and 3.41 times more at risk for developing grade 3 or above complications. HoLEP and RASP are effective for managing BPH. HoLEP shows advantages in recovery metrics and lower blood transfusion rates, while RASP benefits from ease of implementation in robotic-equipped facilities. Optimizing surgical outcomes will depend on reducing disparities in technique adoption, improving surgical training, and aligning with evidence-based guidelines.

SERPINH1 as a Novel Biomarker for Colon Cancer Bone Metastasis with Machine Learning and Immunohistochemistry Validation.

Background: Bone metastasis (BM) is a serious clinical symptom of advanced colorectal cancer. However, there is a lack of effective biomarkers for early diagnosis and treatment. Method: RNA-seq data from public databases (GSE49355, GSE101607) were collected and normalized and batch effects were removed using the combat package. Differential expression analysis was performed to identify significant genes. Robust Rank Aggregation and machine learning algorithms were used to pinpoint candidate biomarkers. These biomarkers were validated using immunohistochemistry and further analyzed for survival rates. Enrichment analysis was conducted to explore biological mechanisms. Additionally, drug sensitivity and immune infiltration analyses were performed to provide insights into potential therapeutic targets. Results: Analysis results revealed 386 genes elevated in primary versus normal tissues and 26 genes varying between primary and BM. Serpin Protease Inhibitor Clade H1 (SERPINH1) as a novel biomarker for colon cancer metastasis. High SERPINH1 expression correlates with poor survival outcomes and is linked to high lymphatic invasion and advanced cancer stages. Additionally, SERPINH1 expression influences immune infiltration and is not predictive of chemotherapy response, but potential new drugs are suggested for high-expression cases. The gene also enriches classical cancer pathways such as Hedgehog and transforming growth factor-β. Conclusions: We identified novel colon cancer BM markers, including SERPINH1, using machine learning algorithms combined with traditional transcriptomic data and validated their expression through immunohistochemistry. This biomarker could significantly assist clinicians in making more precise treatment decisions.

Fractional Flow Reserve Implications for Clinical Decision Making in Coronary Artery Disease.

Fractional flow reserve (FFR) is regarded as the gold standard for assessing the functional significance of coronary artery lesions. However, its utilization in clinical practice remains limited. This study aims to determine whether FFR results can influence treatment decisions for coronary artery disease compared to visual assessments of angiographic images. We conducted a retrospective study involving 63 patients diagnosed with either chronic coronary syndrome (n = 39, 61.9%) or acute coronary syndrome (n = 24, 38.1%) who underwent an FFR assessment. Three experienced interventional cardiologists (>300 PCI procedures/year) reevaluated 105 ambiguous coronary lesions in these patients, blinded to the FFR results. The objective was to assess lesion significance and determine the treatment strategy based on a visual angiographic evaluation. The three operators reached concordant agreement (≥two operators) to perform PCI in 60 (57.1%) of the evaluated lesions based on the angiographic assessment. Of these, nine lesions (15%) were deemed functionally non-significant by FFR (FFR > 0.80). Conversely, they agreed to defer PCI in 45 (42.9%) lesions, but 4 lesions (8.9%) were found to be functionally significant (FFR ≤ 0.80) and required a re-evaluation for PCI. Visual-guided decision making by interventional cardiologists shows variability and does not always align with the functional significance of coronary lesions as determined by FFR. Incorporating FFR into routine decision making could enhance treatment accuracy and patient outcomes.

The Association Between Rheumatic Disease Therapies and Cardiovascular Outcomes in People with HIV-A Retrospective Cohort Study.

Introduction: Inflammation is a significant contributor to cardiovascular disease (CVD) in people with HIV (PWH), who face twice the risk of CVD compared to the general population. The presence of co-existing rheumatic disease (RD) may further exacerbate inflammation and increase the incidence of CVD events in this population. Methods: We conducted a retrospective cohort study using electronic health record (EHR) data from the Veterans Affairs Medical Center in Atlanta, covering the period from 2000 to 2019. A total of 5000 patients aged 20-87 years who were diagnosed with HIV and receiving care at the Atlanta VAMC between 2000 and 2019 were eligible for this analysis. This study included 3930 veterans with HIV and assessed the impact of rheumatic disease therapies (RDTs) on CVD outcomes. The primary outcome was the first occurrence of a CVD event. Results: Rheumatic disease was significantly associated with an increased risk of CVD events (OR = 2.67; p < 0.001). Additionally, exposure to multiple RDTs (aHR = 2.121, p = 0.047), NSAIDs (aHR = 1.694, p = 0.003), glucocorticoids (aHR = 2.332, p < 0.0001), and hypouricemic agents and colchicine (aHR = 3.445, p < 0.0001) were all significantly associated with increased CVD events. Conclusions: The co-existence of HIV infection and rheumatic disease, along with the use of RDTs, may amplify the risk of CVD events in PWH. These findings underscore the need for further investigation into the relationship between RD, RDTs, and CVD risk in larger, controlled studies, given the potential implications for treatment decisions in this patient population. A limitation of our study is that due to its retrospective design, we could not examine the impact of the sequential use of RDT groups and RD severity on CVD events.

Optimizing the survey design for assessing schistosomiasis at the sub-district for treatment decision making

BackgroundSchistosomiasis control programs typically launch with district-level, school-based preventive chemotherapy (PC). Recent World Health Organization recommendations are to shift to community-wide treatment where schistosomiasis prevalence is >10%. Simultaneously there is a push to move to sub-district PC to prioritize communities in need of treatment and alleviate the pressure on global praziquantel need, but few countries have sub-district prevalence data and no guidelines on how to collect this information. Methods/Principal findingsData collected from 57,161 school-aged children (SAC) across six countries (Burkina Faso, Ghana, Mali, Senegal, Sierra Leone, and Togo) to generate spatially realistic gold standard datasets that were used to evaluate different numbers of schools per sub-district (1-10) and district (5–30), number of SAC sampled per school (10–50), on accuracy of prevalence estimates. Sampling fewer children in more schools maximized accuracy of prevalence at the sub-district and district level. Surveying three schools per sub-district or 15 schools per district gave precise prevalence estimates. Increasing the number of SAC beyond 30 per school led to negligible improvements in reliably detecting schistosomiasis. Failure to detect schistosomiasis occurred more frequently in low (1–10%) prevalence and larger districts/sub-districts. ConclusionThis study provides guidelines for evaluating sub-district schistosomiasis in a range of transmission settings. Among two-stage cluster surveys for schistosomiasis, our simulations show surveying three schools per sub-district and 20-30 SAC per school optimized cost-efficiency and minimized risk of mistreatment. Population size and endemicity influenced survey estimates, with the probability of misclassification being greater as populations increased or prevalence decreased.

Prognostic factors for intraductal papillary neoplasm of the bile duct following surgical resection: a systematic review and meta-analysis.

Intraductal papillary neoplasm of the bile duct (IPNB) is a biliary neoplasm characterized by intraductal papillary growth and varying degrees of malignant transformation. This study aimed to identify effective prognostic factors (PFs) for predicting the prognosis of IPNB after surgical resection, addressing the gap in the higher level evidence. We systematically searched databases from their inception to October 10, 2023. Data on 12 predetermined PFs were collected and subjected to a meta-analysis. Forest plots were used to summarize the findings. Fifteen studies with a total of 2311 patients were included. Among the PFs examined, extrahepatic tumor location (HR, 2.97; 95% CI 1.68-5.23), subclassification type 2 (HR, 2.62; 95% CI 1.45-4.76), R1 resection (HR, 2.47; 95% CI 1.73-3.51), elevated CA19-9 level (HR, 3.25; 95% CI 1.91-5.54), tumor multiplicity (HR, 2.65; 95% CI 1.40-5.02), and adjacent organ invasion (HR, 3.17; 95% CI 2.01-5.00) were associated with a poorer prognosis. Additionally, the combined HR values indicated that lymph node metastasis and poor tumor differentiation were linked to a worse prognosis, although both exhibited significant heterogeneity. Our study offers valuable insights for enhancing postoperative prognostication and treatment decision-making for IPNB patients with IPNB. These findings warrant further validation in future prospective studies.

Prognosis related to treatment plan in patients with biliary tract cancer: A nationwide database study

BackgroundBiliary tract cancer (BTC) is a malignancy characterized by a low 5-year survival rate (<20 %). Clinical aspects such as tumor resectability, Eastern Cooperative Oncology Group performance status score (ECOG-PS), and molecular profiling are used to determine the treatment for these patients. Diagnosis and treatment are typically established by a multidisciplinary team (MDT). However, standardized practices for BTC are lacking, and there is a need to assess the impact of current MDT treatment decisions on BTC outcomes. The purpose of this study was to investigate the role of the treatment plan proposed by the first MDT conference on survival in patients with BTC, and to identify risk factors for poor survival in this population. MethodThis nationwide, multicenter, retrospective cohort study examined data from the Danish Liver Cancer Group (2013–2020) with confirmed BTC diagnoses. Multiple imputation was used to handle missing data. Survival and variable-survival rate relationships were analyzed using the Kaplan-Meier estimator, and the Cox regression model, respectively. ResultsEligible BTC-confirmed cases: n=1923. The overall median survival was 7.7 months (95 % CI: 7.1–8.5), with a 5-year survival rate of 16.3 %. Patients over 70 years of age, with ECOG-PS 3 or 4, non-operable cases, and with unresectable tumors had lower survival rates. Surgery as the first therapeutic option showed the highest median survival (33.1 months, 95 % CI: 27.2–41.6; p < 0.0001). Multivariable analysis showed that poor ECOG-PS, palliative and neoadjuvant chemotherapy, stereotactic radiotherapy, and best supportive care significantly increased mortality risk in patients with BTC (p=0.05). ConclusionAmong the therapeutic options prescribed by the MDT for patients with BTC, surgery offered the best survival rates, likely due to patient-related prognostic factors. High ECOG-PS was linked to an increased mortality risk regardless of age, highlighting the importance of this criterion in treatment decisions.

Clinical Impact of Reperfusion Techniques and Occlusion Sites in Thrombectomy: Insights from the ASSIST Stroke Registry

BACKGROUND Mechanical thrombectomy has changed the landscape of acute ischemic stroke treatment, offering improved outcomes for patients with large vessel occlusions. The interplay between reperfusion techniques and occlusion sites remains a critical consideration in treatment decisions. This study investigates the impact of primary reperfusion techniques—stent retriever classic, stent retriever combination with aspiration, and direct aspiration—on procedural and clinical outcomes at different occlusion sites. METHODS Using data from the ASSIST registry, a prospective multinational initiative, patients with anterior circulation acute ischemic stroke with large vessel occlusions (n = 1477) were included. Three primary occlusion sites—M1 segment of the middle cerebral artery, M2 segment of the middle cerebral artery, and the internal carotid artery—were studied. Univariate tests and multivariable logistic regression models were used to assess associations between reperfusion techniques and procedural and clinical outcomes, including the expanded thrombolysis in cerebral infarction score and the modified Rankin Scale, stratified by occlusion site. RESULTS Achieving expanded thrombolysis in cerebral infarction ≥2c after first pass was lower in internal carotid artery occlusions (18.2%, P &lt;0.0001) with direct aspiration alone compared with stent retriever classic (38.2%) or stent retriever combination with aspiration (43.3%), while no differences were seen for M1 segment of the middle cerebral artery ( P = 0.77) and M2 segment of the middle cerebral artery ( P = 0.29) occlusions. Bailout maneuvers, which were more frequent in the direct aspiration group for all occlusion sites, did not result in longer procedure times or different final recanalization outcomes in direct aspiration compared with stent retriever classic or stent retriever combination with aspiration. Overall, there were no differences in the rate of patients with modified Rankin Scale scores of 0–2 at 90 days. No differences in safety outcomes were observed. CONCLUSIONS This study provides insight into the complex relationship between reperfusion techniques and occlusion sites in patients with acute ischemic stroke and shows that certain techniques have advantages in certain occlusion sites. As the field evolves, further research is warranted to refine our understanding of these dynamics and inform clinical practice.

Clinical study on conversion therapy of hepatocellular carcinoma - summary and comparison of clinical data from a single center of consecutive four years

AimThe purpose of this study was to interpret real-world clinical data to analyze the surgical safety and survival outcomes of patients with initial unresectable hepatocellular carcinoma (uHCC) after conversion therapy.MethodsA retrospective analysis was performed on 2984 hepatocellular carcinoma (HCC) patients hospitalized in Shandong Cancer Hospital Affiliated to Shandong First Medical University from June 1st, 2019 to June 1st, 2023. Clinicopathological features, response to systemic and/or loco-regional treatments, surgical resection rate after conversion therapy, surgical safety, and postoperative recurrence were analyzed.ResultsA total of 38 patients were successfully converted to obtain surgical resection. 35 patients underwent radical resection. A high objective response rate (ORR) (52.6% under RECIST v1.1 and 78.9% under mRECIST criteria) was observed in patients under conversion therapy, and the disease control rate (DCR) was 100%. Pathologic complete response (pCR) was 42.9%. Treatment-related adverse events (TRAEs) of any grade were observed in 37 patients (97.4%). Safety of conversion or direct surgery continues to improve. The median follow-up time was 19.3 months. The 1-year Disease-free survival (DFS) rate of patients with direct surgery and patients with conversion surgery were 91.4% and 86.8%, respectively.ConclusionsWith conversion therapy, a small percentage (1.81%) of uHCC patients are likely to be converted to radical resection. Local combined systemic therapy is a relatively safe and effective conversion therapy, and the safety of surgery is gradually improved after successful conversion. Preliminary follow-up data showed satisfactory survival benefits for patients undergoing conversion surgery.Trial registrationThis was a retrospective study and it did not interfere with treatment decisions.

SARS-CoV-2 variant survey: Comparison of RT-PCR screening with TGS and variant distribution across two divisions of Bangladesh.

The widespread increase in multiple variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) since 2020 is causing significant health concerns worldwide. While whole-genome sequencing (WGS) has played a leading role in surveillance programs, many local laboratories lack the expertise and resources. Thus, we aimed to investigate the circulating SARS-CoV-2 variants and evaluate the performance of multiplexed real-time reverse transcription-PCR (RT-PCR) for screening and monitoring the emergence of new SARS-CoV-2 variants in Bangladesh. A total of 600 confirmed SARS-CoV-2-positive cases were enrolled either prospectively or retrospectively from two divisions of Bangladesh. The samples were screened by variant RT-PCR targeting five mutations of the spike gene (N501Y, P681R, L452R, E484K, E484Q). A subsample of the study population was also selected for third-generation sequencing (TGS) and the results were compared to the variant RT-PCR screening. An in-depth comparison was made between the two methods in terms of congruence and cost-benefit. Seven variants were detected among samples, with similar distributions of the variants across both divisions. Variant RT-PCR for the targeted mutations lead to a 98.5% call rate; only nine samples failed to be determined. No association was found regarding the demographic features, clinical criteria, or routine RT-PCR Ct values across the variants. The clade diversity of the sequenced subpopulation (n = 99) exhibited similar distributions across the two study sites and other epidemiologic variables. Variant RT-PCR successfully distinguished variants of concern (VOCs) and variants of interest (VOIs); however, 8% discrepancy was observed for the closest lineages. Moreover, the variant RT-PCR represented an ideal balance of cost, time, and accuracy that outweigh their limitations. Based on the strong agreement of variant RT-PCR with TGS, such rapid, easily accessible approaches of rapid strain typing are essential in the context of pandemic responses to guide both treatment decisions and public health measures.

Advances in laryngopharyngeal reflux: Etiology, diagnosis, and management.

Laryngopharyngeal reflux (LPR) manifests as a variety of nonspecific upper aerodigestive tract symptoms. Rather than a single disorder, LPR may be conceived of as a spectrum of subtypes with varying clinical presentations. LPR signs and symptoms arise from the direct and/or indirect effects of refluxate, physical and molecular injury of the mucosa, and neurologic responses to esophageal events. Specific constituents of refluxate exert distinct mucosal responses and immediate or delayed effects resulting in transient or persistent symptoms and/or laryngeal hypersensitivity. While the complex etiology of LPR presents challenges to its diagnosis and management, tools that aid the identification of LPR subtypes can provide insight into treatment decision-making. Hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring provides detailed analysis of reflux events, enabling the development of individualized treatment plans, yet cost and availability limit its widespread use. Alginates offer temporary symptom relief and antireflux surgery may provide benefit when symptoms are recalcitrant to other approaches. Pepsin inhibitors hold promise as a medical therapy when surgery is not an option. Laryngeal hypersensitivity should be considered as part of a comprehensive therapeutic approach. Promising medical and scientific research continues to yield new insights into the complex etiology of LPR and novel strategies for its diagnosis and management.

A Qualitative Thematic Analysis Exploring Chinese Young Adults' Experiences in Decision Making on the Management of Low-Risk Papillary Thyroid Cancer.

Background: Thyroid cancer is the most common endocrine neoplasm in China. Questions regarding the extent of patient involvement in shared decision-making (SDM) processes persist; this is particularly pertinent to patients considering treatment options for low-risk papillary thyroid cancer (PTC). In this study, we aimed to explore Chinese young adults' experiences of SDM relating to the choice of treatment for low-risk PTC. Methods: The study used a qualitative descriptive design and semistructured interviews. Interviews were conducted with 24 patients (ages ranging from 18 to 38 years; 4 men and 20 women) diagnosed with low-risk (PTC) between March 2023 and May 2024. Twenty-two of 24 patients' tumor size measured 1 cm or smaller; the largest tumor size measured 1.47 cm. Reflexive thematic analysis was used to identify key themes from the transcribed interviews. Results: The analysis revealed that the SDM experiences of young patients with low-risk PTC involve four themes: challenges in information sharing; reasons for information seeking; factors influencing decision making; and self-positioning in treatment decision making. Three self-positions relating to treatment decision making were identified. These included dependent positioning, which reflects a "paternalistic" decision-making pattern; collaborative positioning, reflecting a "sharing" of decision making; and autonomous positioning, reflecting an increased sense of personal responsibility for both managing their health and engagement in decision making. Limited treatment options being offered, overuse of medical terminology, and communication gaps between clinicians and patients were the main challenges described during the information-sharing process. Information that needs persisting after physician-patient consultations resulted in active information-seeking behavior. The key variables identified in this study that potentially affected the decision-making process were future personal considerations, language used to discuss cancer, and negative emotions. Conclusions: These results highlight the necessity of adopting flexible strategies when supporting collaborative treatment decision making in the context of the doctor-patient interaction for low-risk PTC. Based on these findings, clinicians can take measures to enhance the quality of SDM by inquiring about patients' role preferences, providing details of the full range of treatment options, and encouraging patients to share their preferences and concerns relating to possible treatment options.

Limiting court involvement in end-of-life treatment decisions for children in England &amp; Wales: Advantages and limitations of a specialist committee deciding on futility

Limiting court involvement in end-of-life treatment decisions for children in England &amp; Wales: Advantages and limitations of a specialist committee deciding on futility

Precision psychiatry needs causal inference.

Psychiatric research applies statistical methods that can be divided in two frameworks: causal inference and prediction. Recent proposals suggest a down-prioritisation of causal inference and argue that prediction paves the road to 'precision psychiatry' (i.e., individualised treatment). In this perspective, we critically appraise these proposals. We outline strengths and weaknesses of causal inference and prediction frameworks and describe the link between clinical decision-making and counterfactual predictions (i.e., causality). We describe three key causal structures that, if not handled correctly, may cause erroneous interpretations, and three pitfalls in prediction research. Prediction and causal inference are both needed in psychiatric research and their relative importance is context-dependent. When individualised treatment decisions are needed, causal inference is necessary. This perspective defends the importance of causal inference for precision psychiatry.

Palbociclib plus aromatase inhibitors in patients with metastatic breast cancer and cardiovascular diseases: real-world effectiveness.

Patients with cardiovascular disease (CVD) comorbidities are often excluded from participating in breast cancer clinical trials. Consequently, data to inform treatment decisions for patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) and CVD are limited. We compared the effectiveness of first-line palbociclib plus an aromatase inhibitor (AI) vs an AI alone and evaluated palbociclib treatment patterns in patients with HR+/HER2- mBC and CVD in routine clinical practice. Data from the Flatiron Health Analytic Database were captured for patients with HR+/HER2- mBC and CVD who initiated first-line treatment with palbociclib plus an AI or an AI alone between February 2015 and March 2020 (data cutoff: September 30, 2020). Overall survival (OS), real-world progression-free survival (PFS), and treatment patterns were evaluated. Of the 469 patients with identifiable CVD, 160 received palbociclib plus an AI, and 309 received an AI alone. After stabilized inverse probability treatment weighting, both median OS (40.7 vs 26.5 months; hazard ratio [HR], 0.732 [95% CI, 0.537-0.997]; P = .048) and median real-world PFS (20.0 vs 12.5 months; HR, 0.679 [95% CI, 0.512-0.900]; P = .007) were significantly prolonged in patients treated with palbociclib plus an AI vs an AI alone. Among patients with a documented palbociclib starting dose, 78.5% started palbociclib at 125mg/day, and 38.6% experienced dose adjustment. In this real-world analysis, first-line palbociclib plus an AI was associated with improved effectiveness compared with an AI alone in patients with HR+/HER2- mBC and CVD. NCT05361655 (ClinicalTrials.gov).

Placebos in Healthcare: A Behavioral Study on How Treatment Responsiveness Affects Therapy Decisions in a Simulated Patient-Physician Interaction.

Treatment choice during clinical practice is crucial to best help each patient. One of the physicians' main goals is choosing a personalized effective treatment, but it also represents a challenging issue. Here, we explored different treatment choices in a simulated patient-physician interaction. Medical students (n = 48) and young Practicing Physicians (n = 20) were recruited to behave as "physicians" while fellow researchers acted as "patients". Participants were divided equally into a Belief Group, which received positive information about placebo efficacy, and a Non-Belief Group, which received negative information. Empathy traits and psychological variables were measured in both groups. During the task, participants were asked to choose between an active (TENS treatment) or a placebo treatment, to reduce patients' pain. Patients never underwent the painful stimulation but acted as if they had, simulating high or low pain responses to the placebo treatment (placebo-responders/placebo non-responders) and low pain to the TENS treatment. Behavioral results showed that the Belief Group gave significantly more placebo treatments when faced with a patient that simulated placebo responsiveness, while the Non-Belief group showed a mirrorlike behavior, administrating more believed TENS treatments when faced with a placebo non-responder. No differences were found between Medical Students and Practicing Physicians. This study constitutes a frame of reference for medical treatment decisions, indicating that physicians' treatment choices are influenced by patients' responsiveness to the treatments, as well as by their prior beliefs and empathy traits.

Targeted next-generation sequencing - a promising approach in the diagnosis of Mycobacterium tuberculosis and drug resistance.

Targeted next-generation sequencing (tNGS) offers a high-throughput, culture-independent approach that delivers a comprehensive resistance profile in a significantly shorter turn-around time, making it promising in enhancing tuberculosis (TB) diagnosis and informing treatment decisions. This study aims to evaluate the performance of tNGS in the TB diagnosis and drug resistance detection of Mycobacterium tuberculosis (MTB) using MTB clinical isolates and bronchoalveolar lavage fluid (BALF) samples. A total of 143 MTB clinical isolates were assessed, tNGS, phenotypic antimicrobial susceptibility testing (AST), and AST based on whole genome sequencing (WGS) exhibited high concordance rates, averaging 95.10% and 97.05%. Among 158 BALF samples, culture, Xpert MTB/RIF, and tNGS reported 29, 70 and 111 positives, respectively. In the confirmed cases with etiological evidence (smears, cultures, or molecular test), the positive rate of tNGS (73/83, 87.95%) was higher than that of Xpert MTB (67/83, 80.72%). Additionally, 45% (27/60) of clinically diagnosed cases (with imaging or immunological evidence) were positive for tNGS. Further validation on the discrepant results between tNGS and Xpert MTB/RIF with droplet digital PCR (ddPCR) yielded 35 positives, tNGS detected all, and Xpert MTB/RIF only identified 6 positives. In conclusion, tNGS demonstrates robust and rapid performance in the identification of MTB and its associated drug resistance, and can be directly applied to clinical samples, positioning it as a promising approach for laboratory testing of tuberculosis.

Prognostic Value of Myosteatosis and Albumin-Bilirubin Grade for Survival in Hepatocellular Carcinoma Post Chemoembolization.

This study aimed to investigate the prognostic value of preoperative myosteatosis and the albumin-bilirubin (ALBI) grade in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) and develop a robust prognostic score based on these factors. Patients with HCC who underwent TACE between January 2009 and December 2020 were included. Multivariate Cox regression analysis identified prognostic factors. CT-based body composition parameters were acquired from baseline abdominal CT images at the level of the third lumbar vertebra. A prognostic score (Myo-ALBI) was developed based on the presence of preoperative myosteatosis and the ALBI grade, and its prognostic value was evaluated. Of 446 patients, 63% were male, and the mean age was 62.4 years. Preoperative myosteatosis was present in 41.5% of patients. The BCLC stages were mostly B (67.9%). Multivariate analysis shows that preoperative myosteatosis, ALBI grade 2, and ALBI grade 3 were independent prognostic factors. The Myo-ALBI grade was incorporated into a prognostic model, including alpha-fetoprotein and up-to-seven criteria, to generate a nomogram. The C-index of the nomogram based on the Myo-ALBI grade (0.743) was significantly higher than the non-Myo-ALBI nomogram (0.677), the up-to-seven criteria (0.653), the ALBI grade (0.616), and the Child-Pugh class (0.573) (all p < 0.05). The t-ROC curve for the nomogram was consistently superior to the other models throughout the observation period in all patients and the BCLC-B subgroup. The combination of preoperative CT-derived myosteatosis and ALBI grade enhances prognostication for patients with unresectable HCC undergoing TACE. The Myo-ALBI nomogram constructed in this study could support individualized prognosis prediction, assisting in treatment decision-making for HCC patients.

Evaluating the Impact of Age and G8 Assessment on Definitive Treatment Strategies in Elderly Patients with Local Advanced Esophageal Carcinoma.

While chemoradiotherapy (CRT) is commonly employed as a curative approach for esophageal cancer, administering standard CRT to elderly patients often presents challenges in practical settings. The objective of this study was to compare treatment tolerance and survival outcomes between younger and elderly patients (aged ≥65 years) diagnosed with locally advanced esophageal cancer receiving curative-intent treatment. Additionally, it aims to assess the impact of the Geriatric 8 Health Status Screening Tool (G8 score) on treatment decisions in elderly patients. Ninety-seven patients treated with neoadjuvant or definitive CRT for locally advanced esophageal cancer were retrospectively evaluated at two centers from 2013 to 2023. We divided the patients by age (&lt;65 and ≥65 years) and assessed their demographic, clinical, and treatment data, including pre- and post-treatment G8 scores. Radiotherapy (RT) was administered at a median dose of 50.4 Gy (45-66 Gy). Planned concurrent chemotherapy was completed in 73 (75.3%) of the patients. In the comparative study of 97 esophageal cancer patients, 48 geriatric (aged ≥65 years) and 49 younger individuals were followed up for a median of 20 and 21 months respectively. No significant statistical differences were noted between the groups concerning baseline and treatment characteristics. Surgical intervention rates were comparable, with 22.9% of geriatric and 36.7% of young patients undergoing surgery (p=0.184). There were no significant differences in pathological complete response, local recurrence, distant metastasis, progression, or death rates. The median progression-free survival (PFS) for geriatric and younger patients was 31 months (95% CI, 13.6-48.4) and 19 months (95% CI, 0-39.4), respectively (p=0.832). The median overall survival (OS) was 38 months (95% CI, 23.8-52.2) in geriatric patients, while it was not reached in younger patients (p=0.745). There was no significant difference between the two groups. The pretreatment and posttreatment G8 values of the geriatric patients were 9.25 (6-13.5) and 9.5 (6-14), respectively. Patients with increased G8 scores were found to have significantly higher PFS (median 85 mo vs. 11 mo, p=0.001) and OS (median 85 mo vs. 14 mo, p=0.001) compared to those with unchanged or decreased G8 scores. Age alone should not be the determining factor in the treatment decision of elderly patients diagnosed with locally advanced esophageal cancer. Moreover, CRT could be safely performed even in patients with low G8 scores, and although the G8 score may not directly influence treatment decision, its enhancement during the treatment process holds significant prognostic value.