Patients Group Research Articles

Impact of different CEBPA mutations on therapeutic outcome in acute myeloid leukemia.

Biallelic mutations of the CEBPA gene (CEBPAbi) are generally associated with favorable prognosis in patients with acute myeloid leukemia (AML). Monoallelic mutations of the CEBPA gene in carboxy-terminal DNA-binding region (CEBPAsmbZIP) and amino-terminal transactivation domains (CEBPAsmTAD) indicate distinct clinical characteristics and therapeutic outcomes. However, further investigation is required to fully understand these differences. In this retrospective study, we enrolled 77 AML patients with CEBPA mutations, including 53 with CEBPAbi, 12 with CEBPAsmbZIP and 12 with CEBPAsmTAD. The clinical characteristics of the three CEBPAmut groups presented significant differences in age, FAB classification, hemoglobin level and platelet count at diagnosis. The CEBPAsmTAD group exhibited shorter 2-year overall survival (OS) and relapse-free survival (RFS) compared to the CEBPAbi group and CEBPAsmbZIP group in AML patients. The most common co-mutations observed in CEBPAmut AML patients were TET2 and GATA2, which had no effect on prognosis. 2-year RFS of 27 CEBPAmut AML patients who underwent allo-HSCT was better than those who did not. MRD3 positive was identified as an influencing factor for 2-year OS and RFS. Allo-HSCT was found to improve the prognosis of CEPBAmut AML patients with positive MRD3 and adverse co-mutations.

Identifying Survival Subtypes of Esophageal Squamous Cell Carcinoma Patients: An Application of Deep Learning in Gene Expression Data Analysis

Background: Esophageal squamous cell carcinoma (ESCC) is one of the most lethal types of cancer. Late diagnosis significantly decreases patient survival rates. Objectives: The study aimed to identify survival groups for patients with ESCC and find predictive biomarkers of time-to-death from ESCC using state-of-the-art deep learning (DL) and machine learning algorithms. Methods: Expression profiles of 60 ESCC patients, along with their demographic and clinical variables, were downloaded from the GEO dataset. A DL autoencoder model was employed to extract lncRNA features. The univariate Cox proportional hazard (Cox-PH) model was used to select significant extracted features related to patient survival. Hierarchical clustering (HC) identified risk groups, followed by a decision trees algorithm which was used to identify lncRNA profiles. We used Python.3.7 and R.4.0.1 software. Results: Inputs of the autoencoder were 8,900 long noncoding RNAs (lncRNAs), of which 1000 features were extracted. Out of the features, 42 lncRNAs were significantly related to time-to-death using the Cox-PH model and used as input for clustering of patients into high and low-risk groups (P-value of log-rank test = 0.022). These groups were then labeled for supervised HC. The C5.0 algorithm achieved an overall accuracy of 0.929 on the test set and identified four hub lncRNAs associated with time-to-death. Conclusions: Novel discovered lncRNAs lnc-FAM84A-1, LINC01866, lnc-KCNE4-2 and lnc-NUDT12-4 implicated in the pathogenesis of death from ESCC. Our findings represent a significant advancement in understanding the role of lncRNAs on ESCC prognosis. Further research is necessary to confirm the potential and clinical application of these lncRNAs.

A real world analysis of secondary BRAF variations after targeted therapy resistance in driver gene positive NSCLC

Secondary BRAF variations have been identified as a mechanism of resistance to tyrosine kinase inhibitors (TKIs) in patients with driver gene-positive NSCLC. Nevertheless, there is still a lack of consensus regarding the characteristics and subsequent treatment strategies for these patients. We retrospectively reviewed the medical records of patients with driver gene-positive NSCLC who received TKIs therapy at Zhejiang Cancer Hospital between May 2016 and December 2023. The clinical and genetic characteristics of these patients were assessed, along with the impact of various treatment strategies on survival. This study enrolled 27 patients with advanced NSCLC, in whom BRAF variations occurred at a median time of 28 months after the initiation of targeted therapy. The multivariate accelerated failure time (AFT) model revealed that, compared to chemotherapy-based regimens group, the combined targeted therapy group (p < 0.001) and the combined local treatment group for oligo-progression (p < 0.001) significantly extended patient survival. In contrast, continuing the original signaling pathway's targeted monotherapy was associated with shorter survival (p = 0.034). The median global OS for each treatment group was as follows: chemotherapy-based regimens group, 45 months; combined targeted therapy group, 59 months; combined local treatment group for patients with oligo-progression, 46 months; and targeted monotherapy group, 36 months. Study results indicate that the combination targeted therapy group (including TKIs, BRAF inhibitors, and/or MEK inhibitors) and the localized treatment group are more effective than traditional chemotherapy-based regimens in improving survival. Additionally, continuing targeted monotherapy along the original signaling pathway proves less effective than chemotherapy-based regimens.

Potential of BMI as a screening indicator for extracranial-intracranial bypass surgery in patients with symptomatic artery occlusion: a post-hoc analysis of the CMOSS trial.

To investigate the association between BMI and the incidence of ischemic stroke in patients with symptomatic artery occlusion, and further to evaluate the utility of BMI as a screening tool for identifying candidates for extracranial-intracranial bypass surgery. The authors analyzed the relationship between BMI and the occurrence of ipsilateral ischemic stroke (IIS) among patients receiving only medical management in the Carotid or Middle cerebral artery Occlusion Surgery Study (CMOSS). Additionally, the authors compared the primary endpoint of CMOSS-stroke or death within 30 days, or IIS after 30 days up to 2 years-among patients with varying BMIs who underwent either surgery or medical treatment. Of the 165 patients who treated medically only, 16 (9.7%) suffered an IIS within 2 years. BMI was independently associated with the incidence of IIS (hazard ratio: 1.16 per kg/m 2 ; 95% CI: 1.06-1.27). The optimal BMI cutoff for predicting IIS was 24.5kg/m 2 . Patients with BMI ≥24.5kg/m 2 experienced a higher incidence of IIS compared to those with BMI <24.5kg/m 2 (17.4 vs. 0.0%, P <0.01). The incidence of the CMOSS primary endpoint was significantly different between the surgical and medical groups for patients with BMI ≥24.5kg/m 2 (5.3 vs. 19.8%, P <0.01) and those with BMI <24.5kg/m 2 (10.6 vs. 1.4%; P =0.02). Surgical intervention was independently associated with a reduced rate of the CMOSS primary endpoint in patients with BMI ≥24.5kg/m 2 . Data from the CMOSS trial indicate that patients with BMI ≥24.5kg/m 2 are at a higher risk of IIS when treated medically only and appear to derive greater benefit from bypass surgery compared to those with lower BMIs. Given the small sample size and the inherent limitations of retrospective analyses, further large-scale, prospective studies are necessary to confirm these findings.

Incidence of Posterior Capsule Rupture During Phacoemulsification Cataract Surgery Among Patients Treated With Intravitreal Bevacizumab Injections.

To assess whether intravitreal bevacizumab injections increase the risk of posterior capsular rupture during phacoemulsification cataract surgery in diabetic patients. A retrospective study that included diabetic patients who underwent phacoemulsification cataract surgery at King Hussein Medical Center of the Jordanian Royal Medical Services during a one-year period from January 2023 until January 2024. Patients were categorized into four groups. The first group did not receive an intravitreal bevacizumab injection; the second group received only one injection; the third group received two injections; and the fourth group received three or more injections. Results from the four groups were compared with a control group for patients who underwent phacoemulsification surgery and were not known to have diabetes mellitus and did not receive previous intravitreal injections. All injections were received within a period of one year before the time of phacoemulsification surgery. Inclusion criteria for the study groups included diabetic patients with a history of diabetes of more than 10 years with the presence of diabetic retinopathy. Exclusion criteria included patients who received intravitreal injections other than bevacizumab, previous intraocular surgery or trauma, and the presence of ocular pathology that led to an increased risk of posterior capsular rupture. The incidence of posterior capsular rupture was compared among these groups. A p-value was used to assess statistical significance and was considered to be statistically significant if ≤0.05. The number of patients in the control group (group 0) was 1440 patients with a mean age of 64.9, and in the study groups were 1306 patients. Group 1 included 244 patients (18.7%) with a mean age of 62.4 years, compared to 306 patients (23.4%) in group 2 with a mean age of 66.1 years, 352 patients (27%) in group 3 with a mean age of 64.2 years, and 404 patients (30.9%) in group 4 with a mean age of 63.1 years. Posterior capsular rupture occurred more significantly in patients with group 4. It occurred in 21 patients, representing 5.2% of them, compared to four patients (1.6%) of group 1, six patients (2%) of group 2, and eight patients (2.3%) of group 3, while in the control group, the number of patients with posterior capsular rupture was 20 (1.4%). Intravitreal bevacizumab in diabetic patients is considered a risk factor for posterior capsular rupture in phacoemulsification cataract surgery in patients receiving more than three injections.

Endoscopic Resection of Stage T1 Colorectal Adenocarcinoma Followed by Surgical Intervention: a Single-center Retrospective Study

BackgroundDomestic and international guidelines recommend endoscopic resection for stage T1 colorectal adenocarcinoma with indications. However, completion surgery remains imperative for patients exhibiting high-risk factors subsequent to endoscopic procedures.ObjectiveTo investigate the evidence, pathological features, and surgical outcomes of completion surgery in patients with T1 colorectal adenocarcinoma following endoscopic resection.MethodsWe retrospectively collect data on the clinical features and treatment outcomes of patients with stage T1 colorectal adenocarcinoma who underwent endoscopic resection followed by surgical resection and those who initially completed surgical intervention at Peking University International Hospital between January 2019 and October 2022, with the aim of assessing the necessity and feasibility of surgical intervention.ResultsSeventeen patients (Group A) with high-risk factors following endoscopic procedure, especially with deep submucosal invasion and vascular or lymphatic invasion, experienced further surgical resection. The median interval between endoscopic resection and completion surgery was 23.71 days ± 15.89. Sixteen patients (Group B) underwent radical resection without any prior interventions. The surgical approach involves integration of laparoscopy and colonoscopy for precise localization and quantitative diagnosis, followed by radical surgery. The two groups demonstrated significant differences statistically with reference to tumor diameter (1.65 cm ± 0.77 vs 3.36 cm ± 1.39, P = 0.000) and the attainment of standard lymph node count (cases of detected lymph nodes larger than or equal to 12, 5 vs 12, P = 0.015). Postoperative complications and hospital stay manifested no significant disparity statistically in two groups. Patients who underwent completion surgery had no inferior outcomes compared with those who underwent direct surgery in terms of 5-year disease-free survival (Log rank test: P = 0.083, Breslow test: P = 0.089). The two groups also exhibited no significant differences statistically in the context of overall survival (Log rank test: P = 0.652, Breslow test: P = 0.758).ConclusionCompletion surgery is a safe and feasible treatment option for T1 colorectal adenocarcinoma patients with high-risk factors, particularly those with deep submucosal invasion and vascular or lymphatic invasion following endoscopic treatment. Furthermore, subsequent treatment should be chosen based on a comprehensive analysis of the patient’s history of abdominal surgery, willingness, and pathological features.

A scoring system based on inflammatory and nutritional indicators to predict the long-term survival of patients with non-metastatic nasopharyngeal carcinoma

To develop a simple scoring system based on baseline inflammatory and nutritional markers to predict the long-term prognosis of patients with nasopharyngeal carcinoma (NPC). Conducted a retrospective analysis of clinical data from 1024 newly diagnosed non-metastatic NPC patients. A total of 15 pre-treatment inflammatory and nutritional markers were collected as candidate variables. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff points for each parameter. Survival analysis was performed using Kaplan–Meier method and Cox regression analysis. Besides, the Inflammation Nutrition Risk Score (INRS) was calculated for each patient by assigning each independent prognostic factor a score of 1. Multivariate Cox regression analysis showed that serum albumin (ALB), systemic immune-inflammation index, and monocyte count (M) were independent prognostic factors for OS (P < 0.05). Survival analysis showed that higher INRS was associated with a worsened prognosis. Patients in the high-risk group had shorter OS than in the low-risk group. In the training group, the 3-, 5-, and 8-years OS rates for the low-risk group versus high-risk group were 92.5% versus 87.8%, 87.4% versus 75.1%, and 84.6% versus 62.2%, respectively (P < 0.05). In the validation group, the 3-, 5-, and 8-years OS rates for the low-risk group vs. high-risk group were 95.0% versus 86.4%, 92.1% versus 82.2%, and 89.5% versus 74.3%, respectively (P < 0.05). Further subgroup analysis showed a significant difference in the OS between the high-risk group and low-risk group in patients with locally advanced disease (P < 0.05). The ROC curve demonstrated that INRS had a similar predictive value for long-term survival in NPC patients compared to TNM staging and serum EBV-DNA levels. Pretreatment ALB, M, and SIRI are independent prognostic factors for long-term survival in patients with NPC. INRS constructed based on these three factors can serve as a long-term prognostic indicator for NPC.

Performance of cut-offs of the ASAS Health Index to discriminate between treatment groups in patients with axial spondyloarthritis in the TICOSPA trial

ObjectiveTo test trial and longitudinal known group discrimination of thresholds of meaning for improvement and health states of the ASAS Health Index (ASAS HI) in patients with active axSpA treated in a randomized study. MethodsData from baseline and week 48 from the tight-controlled, treat-to-target trial TICOSPA study were used. The performance of different thresholds to assess change or health states of the ASAS HI were evaluated between arms and against changes in patients’ relevant outcomes and various external responder criteria. Analyses were performed by comparing the mean values t-tests or proportion of responders of continuous and dichotomous external criteria respectively. Trial discrimination of the ASAS HI thresholds were assessed by odds ratios and Phi coefficient in a large number of potential ASAS HI thresholds. Differences in health states in relevant external outcomes between ASAS HI responders and non-responders was assessed by comparing the best performing improvement and state thresholds by using t-tests and chi-square, as appropriate. Missing data on outcomes was handled by non-responder imputation (NRI). ResultsAll 160 patients had available ASAS HI data. Trial discrimination was larger for absolute ASAS HI change of ≥2.0, ≥2.5, and ≥3.0 points followed by ASAS HI 20 % improvement. Odds ratio ranged between 1.27 and 1.75 for absolute and between 1.0 and 1.64 for relative improvement outcomes. Longitudinal discrimination of ASAS HI improvement ≥30 % or ≥ 3.0 points had a larger reduction in patient global and disease activity and reached more often remission compared to patients with no significant improvement in global functioning. Patients who achieved ASAS HI ≤ 5.0 compared with patients who did not achieve such states were more likely to have ASAS partial remission, ASDAS inactive disease or ASDAS low activity at week 48. ConclusionsThe data-driven thresholds of the ASAS HI identified in a longitudinal observational setting perform well in the context of a randomized trial.

Efficacy and safety of Shen Que (RN8) moxibustion on reproductive outcomes in unexpected poor ovarian responders: a randomized controlled trial

BackgroundManaging infertility patients with poor ovarian response (POR) to ovarian stimulation remains unmet clinically. Besides economic burdens, patients with POR have a poor prognosis during in vitro fertilization and embryo transfer (IVF-ET). In this study, we assessed the efficacy and safety of Shen Que (RN8) moxibustion on reproductive outcomes in POSEIDON patients (Group 2a).MethodsWomen eligible for IVF were invited to participate in this randomized, open-label, superiority trial at an academic fertility center from January 2022 to December 2023. One hundred patients ≤ 44 years old equally divided between Shen Que moxibustion (SQM) and control groups were randomized. These patients must meet the POSEIDON criteria, Group 2a, which requires antral follicle count (AFC) ≥ 5 or anti-müllerian hormone (AMH) ≥ 1.2ng/ml, and a previous unexpected POR (< 4 oocytes). Twelve moxibustion sessions were conducted in the SQM group prior to oocyte retrieval, while only IVF treatment was performed in the control group. The primary outcome was the number of oocytes retrieved.ResultsAs compared with the IVF treatment alone, the SQM + IVF treatment significantly increased the number of retrieved oocytes (4.7 vs. 5.8, p = 0.012), mature oocytes (3.0 vs. 5.0, p = 0.008), and available embryos (2.0 vs. 4.0, p = 0.014) in unexpected poor ovarian responders aged more than 35 years. In the SQM group, the cumulative live birth rate was 27.3% (9/33) in comparison to 13.3% (4/30) in the control group, whereas no statistical significance was detected (p = 0.172). During the study, no significant adverse effects were observed.ConclusionsWomen with unexpected POR who meet POSEIDON Group 2a can benefit from Shen Que (RN8) moxibustion treatment.Trial registrationClinicalTrials.gov, NCT05653557.

Comparative Study between Continuous and Interrupted Suturing in Laparoscopic Pyeloplasty

Background: Ureteropelvic junction obstruction (UPJO) is a common cause of symptomatic ureteral obstruction. Dismembered pyeloplasty is the most commonly employed procedure for the repair of UPJO. Both interrupted and continuous suturing is being practiced in laparoscopy. As satisfactory anastomosis determines the success of dismembered pyeloplasty and recovery of renal function, the success rate and the complications associated with the suturing technique need to be evaluated. Objective: To compare the outcome between continuous and interrupted suturing in laparoscopic pyeloplasty. Methods: This hospital-based, quasi-experimental study was done in the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka and the National Institute of Kidney Diseases &amp; Urology (NIKDU), Dhaka from July 2022- June 2023. A total of 60 patients were purposively selected for the study. According to the suture method for ureteropelvic anastomosis, patients were divided into two groups: 30 patients (group A) underwent surgery with the continuous suture method, and 30 patients (group B) underwent surgery with the interrupted suture method. Data on suturing time, post-operative drain output, post-operative hospital stay and post-operative complications were collected. Patients were followed up at 01, 03 and 06 months. At 06 months, a DTPA renogram with split GFR was done to evaluate the patients. Results: The mean ages were 30.0 (±8.3) years for Group A and 33.9 (±9.3) years for Group B, with males comprising 56.7% and 63.3% of each group, respectively. Group B had significantly higher mean suturing time, post-operative drain output, and hospital stay compared to Group A (p&lt;0.001). No significant differences in GFR were noted between the groups (p&gt;0.05). Post-operative complications were observed in 10.0% of Group A and 23.3% of Group B (p=0.166). Conclusion: Continuous suturing technique for pyeloplasty is found to have a lower mean suturing time, mean drain output and post-operative hospital stay.

Should routine pulmonary function tests be performed in patients with left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery?

BackgroundIt is controversial whether pulmonary function testing should be performed routinely in cardiac surgery patients. The aim of our study was to focus on patients who have congestive heart failure, caused by left ventricular dysfunction or left-sided heart valve disease, and study the prognostic value of performing preoperative pulmonary function testing on their postoperative outcomes.MethodsThis is a retrospective propensity score matched study that included 366 patients with congestive heart failure who underwent cardiac surgery and had preoperative pulmonary function test. The patients were divided into two groups: Group 1 who had a normal or mild reduction in pulmonary function tests and group 2 who had moderate to severe reduction in pulmonary function tests. The postoperative outcomes, including pulmonary complications, were compared between the two groups.ResultsPulmonary function tests were normal or mildly reduced in 190 patients (group 1) and moderately to severely reduced in 176 patients (group 2). Propensity matching identified 111 matched pairs in each group with balanced preoperative and operative characteristics. Compared to group 1, Group 2 had longer duration of mechanical ventilation [12 (7.5–16) vs. 9 (6.5–13) hours, p < 0.001], higher postoperative Creatinine [111 (90–142) vs. 105 (81–128) µmol/dl, p = 0.02] and higher hospital mortality (6.31% vs. 0%, p = 0.02).ConclusionRoutine Pulmonary Function Testing should be performed in patients with Left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery since moderate to severe reduction in those patients was associated with longer duration of mechanical ventilation and higher hospital mortality.

Serum Anti-SARS-CoV-2 IgG in Chronic Hepatitis B Virus Positive Patients

Background: Advanced age and comorbidities such as diabetes mellitus, hypertension, chronic obstructive pulmonary disease or cardiovascular diseases are proven risk factors in COVID-19. In COVID-19, pre-existing liver illnesses could be a substantial risk factor for hospitalization and severity. Infection with the hepatitis B virus (HBV) is one of the most significant and common health disorders. Objective: To estimate serum anti-SARS-CoV-2 IgG in chronic Hepatitis B virus positive patients. Methodology: This cross-sectional analytical study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, during the period of January 2021 to December 2021. A total of 63 subjects were selected from Hepatology Department of DMCH and BSMMU as per selection criteria. Among them, 23 were chronic HBV positive patients (3 with COVID-19 and 20 without COVID-19) (group A) and the rest 40 were non HBV cases (20 with COVID-19 and 20 without COVID-19) (group B). Blood sample was collected for the measurement of anti-SARS-CoV-2 IgG. Biochemical analysis was performed by chemiluminescent microparticle immunoassay (CMIA) in the Department of Biochemistry, BSMMU, Dhaka. Result: In this study, the mean age of group A was 47.26 ± 11.24 years and group B was 44.53 ± 10.17 years. Males were predominant in both the groups. In group A, male was 65.2% &amp; female was 34.8% and in group B, male was 60% &amp; female was 40%. The median value of serum anti-SARS-CoV-2 IgG level was 1110.70 in group A and 417.85 in group B (p&gt;0.05). The study showed frequency of positivity of serum anti-SARS-CoV-2 IgG level in COVID-19 positive cases was 95.7% and in COVID-19 negative cases it was 90%. In this study, the median value of serum anti-SARS-CoV-2 IgG level significantly higher in COVID-19 positive (1063.20) than in COVID-19 negative (119.00) in non-HBV cases. Conclusion: Serum anti-SARS-CoV-2 IgG level was non-significantly higher in chronic HBV positive patients than non-HBV patients. J Com Med Col Teachers Asso Jan 2024; 28(1): 19-23

Circulating monocytes decrease significantly following disease-directed therapy and may reflect disease expansion in Langerhans Cell Histiocytosis.

We aimed to examine the association between relative monocytosis and the recurrence of pulmonary Langerhans Cell Histiocytosis. Clinical, laboratory, radiographic and treatment data for 86 patients with a histopathological diagnosis of Langerhans Cell Histiocytosis over a 20-year duration. Parameters such as biological sex, age at diagnosis, time to diagnosis, molecular diagnostic data and imaging were collected. Treatment responses were assessed predominantly through radiography, with RECIST 1.1 criteria applied to MRI or CT scans and PERCIST utilized for serial PET imaging. Investigators also assessed peripheral blood absolute monocyte count at various time points, including initial diagnosis and the most recently available value. While peripheral blood absolute monocyte count between the earliest assessed timepoint and latest value did not differ, the mean value on progression (0.94K/µL), however, was significantly higher than that following re-institution of therapy (0.31, p = 0.000794. Our observation of relative monocytosis on LCH disease progression may be related to an increase in circulating LCH on disease progression or from increased monocyte production for later differentiation into mature dendritic cells that participate in MHC Class 1 upregulation. This trend is especially evident in pulmonary LCH which is incited by tissue trauma and irritation by environmental factors. The phenomena observed in our study parallel other non-LCH cohorts, specifically in published findings from our own group in patients with Rosai Dorfman and Erdheim Chester Disease. To further elucidate the molecular underpinnings of LCH and explore the etiology of this monocyte trend, expanded integrated genomic-transcriptomic sequencing analyses to evaluate the molecular character of LCH and ultimately clarify the origin of this monocyte trend are in progress. These studies are poised to offer invaluable insight to the molecular mechanisms underlying LCH, specifically as they pertain to monocyte signaling and differentiation.

Mismatch Between Pelvic Incidence and Lumbar Lordosis After Personalized Interbody Fusion: The Importance of Preoperative Planning and Alignment in Degenerative Spine Diseases.

Emerging data have highlighted the significance of planning and aligning total and segmental lumbar lordosis with pelvic morphology when performing short-segment fusion with the goal of reducing the risk of adjacent segment disease while also decreasing spine-related disability. This study evaluates the impact of personalized interbody implants in restoring pelvic incidence-lumbar lordosis (PI-LL) mismatch compared with a similar study using stock interbody implants. This multicenter retrospective analysis assessed radiographic pre- and postoperative spinopelvic alignment (PI-LL) in patients who underwent 1- or 2-level lumbar fusions with personalized interbody implants for degenerative (nondeformity) indications. The aim was to assess the incidence of malalignment (PI-LL ≥ 10°) both before and after fusion surgery and to determine the rate of alignment preservation and/or correction in this population. There were 135 patients included in this study. Of 83 patients who were aligned preoperatively, alignment was preserved in 76 (91.6%) and worsened in 7 (8.4%). Among the 52 preoperatively malaligned patients, alignment was restored in 23 (44.2%), and 29 (55.8%) were not fully corrected. Among patients who were preoperatively aligned, there was no statistically significant difference in either the "preserved" or "worsened" groups between stock devices and personalized interbody devices. In contrast, among patients who were preoperatively malaligned, there was a statistically significant increase in the "restored" group (P = 0.046) and a statistically significant decrease in the "worsened" groups in patients with personalized interbodies compared with historical stock device data (P < 0.05). Compared with a historical cohort with stock implants, personalized interbody implants in short-segment fusions have shown a statistically significant improvement in restoring patients to normative PI-LL. Using 3-dimensional preoperative planning combined with personalized implants provides an important tool for planning and achieving improvement in spinopelvic parameters.

The Enzen Trial: Analysis of EVAR Endoprosthesis Zenith and Endurant for Infrarenal Aortoiliac Aneurysms Regarding Outcomes, Endoleaks, and Reinterventions.

The main objective of this paper is to analyze the outcomes regarding endoleaks, reinterventions, and death related to aneurysm complications in patients submitted to endovascular repair (EVAR) for abdominal aortoiliac aneurysm (AAA) using Endurant II (Medtronic) and Zenith Flex (Cook) endografts. This was a prospective, consecutive cohort study of patients with AAA who underwent EVAR between January 2019 and December 2022. Two groups of patients were evaluated: Group Endurant (patients submitted to EVAR with the use of Endurant II) and Group Zenith (patients submitted to EVAR with the use of Zenith Flex). A total of 156 patients were evaluated. Group Zenith (67 patients, 42.9%) and Group Endurant (89 patients, 57.1%). The perioperative mortality was 5.1%, eight patients (six patients Group Zenith, and two patients Group Endurant, p=0.054). There were 28 patients (17.9%) submitted to urgent repair of the aneurysm (expansion or rupture), with no differences among the groups. There were 36 cases (23.1%) of later endoleak, with a higher incidence in Zenith group (23 patients, 34.3%) than Endurant group (13 patients, 14.6%, p=0.002), most of them Type II endoleak (21 patients, 13.4%). There were 12 cases of Type I endoleak, also with a higher prevalence in Zenith group (13.4%) than Endurant group (3.4%, p=0.002). Moreover, regarding limb graft occlusion (LGO), there were nine patients (5.8%), with a higher prevalence in Zenith group (9%) than Endurant group (3.4%, p=0.045). The overall survival in a Kaplan-Meier at 720 days was 82.3% in the Zenith group and 89.1% in the Endurant group, with no statistical significance among the groups (p=0.09). The freedom from reintervention rates in a Kaplan-Meier at 720 days was 82.8% in the Zenith group and 93.2% in the Endurant group (p=0.001). In this present study, Zenith endograft had higher rates of endoleaks, aneurysms related mortality, LGO and reinterventions than patients submitted to Endurant II endografts. The linear regression analysis showed that the presence of endoleaks, type of endograft device (Zenith graft) and limb graft occlusion were related to higher reintervention rates. In this present study, Zenith endograft had higher rates of endoleaks, aneurysms related mortality, limb graft occlusions and reinterventions than patients submitted to Endurant II endografts. The main impact and the innovation that this article provides is an opportunity to evaluate and choose the best endograft suitable for the patient with AAA during EVAR.

A Non-Invasive Technique to Unveil Renal Implications in Anderson-Fabry Disease.

Anderson-Fabry disease (AFD) is a rare genetic disorder characterized by a deficiency of α-galactosidase A activity and the accumulation of glycosphingolipids in tissues, which leads to multiorgan damage. Cardiovascular magnetic resonance (CMR) and the T1 mapping technique are essential tools for the assessment of AFD cardiac involvement. Moreover, the T1 mapping technique has proved to be a successful non-invasive method for the early detection of patients most at risk for kidney disease. We evaluated the application of MRI in patients with AFD to assess renal involvement. We conducted a retrospective analysis of 19 patients (Group A) with histologically proven AFD who underwent routine CMR examinations for the evaluation of cardiac involvement, selecting specific sequences that also showed the left kidney, compared to a control population (Group B, 19 patients) without kidney disease. A Spearman's rank-order correlation was run to assess the relationship between the T1 mapping values of the heart and kidney in Group A and between the kidneys of Groups A and B. There was a positive correlation between the heart and kidney T1 values in Group A (rho = 0.32). More interestingly, we observed a negative correlation between the kidney values of both groups (Group A mean 1284 ± 137 ms, Group B mean 1073 ± 57 ms, rho = -0.38), which is probably related to the presence of microvascular damage and infiltrates in the kidneys of AFD patients. To our knowledge, these results are the first to highlight the key value of T1 mapping in assessing pathological changes and aiding in the non-invasive diagnosis of renal involvement in AFD.

Study the Effect of Type and Duration of Treatment on Some Hematological and Biochemical Variables of Lymphoma Patients in Al-Muthanna Province, Iraq

The term "malignant lymphoma" describes primary cancers of the lymphoreticular system, almost all of which begin as lymphocytes. This study aimed to assess the impact of therapy type and duration on several hematological and biochemical parameters in lymphoma patients. The study was conducted from July 2023 to October 2023. This study examined one hundred samples in total, fifty sample as control group and fifty sample as patients group. The age range of the participants was between 5 and 77 years old. Some hematological and biochemical tests were analyzed in the current study. The study showed a significant increase (P&lt;0.05) according to type and duration of therapy in patient groups. The study indicated a significant decrease (P&lt;0.05) in red blood cells(RBC), hemoglobin (Hb), lymphocyte and basophils compared with control groups, but indicated a significant increase (P&lt;0.05) in white blood cells (WBC), neutrophils and platelets compared with control groups. Also, the study showed a significant increase (P&lt;0.05) in urea, creatinine, alanine aminotransferase(ALT) and aspartate transaminase (AST) compared with control groups.

Characterization of a Romanian Pediatric Population with Eosinophilic Esophagitis.

Background/objectives: An increase in the incidence of eosinophilic esophagitis (EoE) in children has been reported worldwide in the last decade. We conducted a study in a tertiary pediatric gastroenterology unit aimed at analyzing the clinical manifestations, biochemical markers, and endoscopic features of children with EoE in comparison to patients with non-eosinophilic esophagitis. Methods: This is a prospective analysis involving children with symptoms related to esophageal dysfunction, who had esophagogastroduodenoscopies with esophageal biopsies between January 2021 and April 2024 at "Dr. Victor Gomoiu" Clinical Children's Hospital, in Bucharest, Romania. For the analysis, patients were considered in either Group 1, classified as EoE, or in Group 2, classified as reflux esophagitis. Results: Among the total of 72 patients diagnosed with esophagitis, 17 patients (Group 1-study group) were classified as EoE and 55 were classified as reflux esophagitis (Group 2-control group). The sex ratio analysis showed a male predominance in the study group (71% vs. 32%, p = 0.002). The main symptoms were regurgitation, eructation, and nausea. Dysphagia was present in two (11.76%) patients from Group 1. Eosinophilia was more prevalent in the EoE group than in the individuals with gastroesophageal reflux disease (GERD) (10 (58.85%) vs. 10 (18.18%, p = 0.001)), as well as the total IgE (11 (64.70%) vs. 6 (10.9%, p = 0.001)). Conclusions: Pediatric gastroenterologists need to be aware of EoE atypical presentation and perform adequate biopsies, mainly in children with refractory GERD-like symptoms, dysphagia, and food bolus impaction. Further analyses in terms of prognosis and treatment response should be addressed in longitudinal studies.

Relationship between the white blood cell count and some lipid profile parameters in cancer patients with myocardial infarction

Hokkaido University (Tsumita T, 2022) researchers found that endothelial cells accumulate low-density lipoproteins (LDL) in tumor blood vessels. At the same time, the endothelium carries out neutrophil chemotaxis, which perform an immunosuppressive function contributing to cancer progression.Aim. To search for the relationship between the white blood cell (WBC) count and some lipid profile parameters in cancer patients with myocardial infarction (MI).Material and methods. We examined 319 patients who were treated at Dzhanelidze Research Institute of Emergency Medicine in 2018-2023, which were divided into three groups: MI in combination with an active cancer — 132 patients (Group I), MI+cancer in history — 58 patients (Group II), MI without cancer — 129 patients (Group III). Following laboratory data used in routine practice were assessed: WBC count, relative neutrophil count, total cholesterol, low-density lipoproteins.Results. Cancer patients with MI are characterized by higher WBC and neutrophil count than in other samples However, the total cholesterol level was significantly lower in this sample, and the LDL level was not significantly different. Patients with MI and previous cancer occupied an intermediate position between groups I and III in terms of studied parameters.Conclusion. In general, data on the role of cholesterol levels in cancer patients are contradictory. In particular, some studies have shown that elevated cholesterol levels are a potential risk factor for cancer. In our study, as in a number of others, no significant associations were identified between elevated cholesterol levels and the presence of cancer. Our study is a step towards understanding the connection between the cholesterol concentration and the immune response in cancer patients with MI.

Polyautoimmunity and multiple autoimmune syndrome in patients with neuromyelitis optica spectrum disorder

BackgroundThe coexistence of neuromyelitis optica spectrum disorders (NMOSD) with other autoimmune diseases (AID) has been increasingly reported. The prevalence and significance of this association are not fully understood. ObjectivesThis study aimed to compare the clinical and laboratory characteristics in NMOSD patients with and without AID. MethodsRetrospective cross-sectional observational study was conducted involving adults meeting NMOSD criteria followed in a neuroimmunology clinic at a tertiary center. Descriptive analysis of clinical/paraclinical/treatment/outcome data collected from the medical records was compared between NMOSD patients with AID (polyautoimmunity) and those without AID. ResultsFrom a cohort of 46 NMOSD patients, 16 (34.8 %) patients, mostly women around 40 years of age, presented with polyautoimmunity: 10 anti-AQP4 positive, 4 anti-MOG positive, and 2 seronegative. Five different organ -specific AID, and six systemic AID were identified in the polyautoimmunity patients group, in addition to 6 cases of multiple autoimmune syndrome. The AID manifestation preceded NMOSD in 10 (62.5 %) patients, with a median interval of 7 years. The NMOSD with polyautoimmunity and NMOSD without AID groups had similar initial clinical manifestations with optic neuritis and/or myelitis being most frequent. Inflammatory CSF, namely elevated proteins, was more common in the polyautoimmunity group (13.0 % in NMOSD vs. 31.3 % in NMOSD+AID, p = 0.003). After a 10±6 years follow-up period, more patients with polyautoimmunity had a relapsing disease (75.0 % in NMOSD vs. 46.7 % in NMOSD+AID, p = 0.012) but no difference in the functional outcome evaluated by the EDSS score was identified. ConclusionsPolyautoimmunity was common in AQP4 positive NMOSD patients leading to a significantly higher risk of disease recorrence. The presence of polyautoimmunity and multiple autoimmune syndrome in NMOSD patients suggests the existence of common susceptibility factors or pathophysiological mechanisms, emphasizing the importance of a multidisciplinary approach to those patients.