Prognostic value of stress perfusion cardiac magnetic resonance imaging in Kawasaki disease with coronary artery aneurysms: A 10-year retrospective cohort study.

Minimally invasive treatment for high-risk gastrointestinal stromal tumor (GIST) remains controversial for the concerns including intra-operative rupture and tumor spillage. This study aimed to compare the long-term oncological outcomes in the high-risk GIST patients receiving laparoscopic and open surgery. We conducted a retrospective study on patients with high-risk GISTs of the stomach undergoing curative resection by laparoscopic or open approach from 2002 to 2024 at a single medical center. Propensity score matching was applied to adjust for tumor size and tumor location between these two groups at a 1:1 ratio. We evaluated the peri-operative and long-term oncological outcomes. There were 184 patients with high-risk GISTs of the stomach recruited. The clinical demographics including age and gender were similar between the laparoscopic and open groups. The mean tumor size was significantly larger in the open group (13.4 ± 7.4cm versus 5.7 ± 3.5cm, p < 0.001). After matching, 34 patients in each group were analyzed with comparable tumor sizes and locations. The laparoscopic group was associated with a shorter hospital stay (9.7 ± 2.3days versus 12.4 ± 4.0days, p = 0.013). Otherwise, the operation time, blood loss, and the ratio of receiving adjuvant target therapy were similar between groups. Kaplan-Meier RFS analysis showed no difference between the open and laparoscopic groups either in 10-year RFS (82.7% versus 73.6%, p = 0.739) or 10-year OS (90.0% versus 96.9%, p = 0.588). Multivariate analysis showed the surgical approach was not a significant risk factor affecting RFS or OS. Laparoscopic resection is a safe and feasible surgical approach in selected gastric high-risk GIST patients, providing comparable oncologic outcomes to open surgery with a shorter hospital stay.

Background Germline RET- p.C634Y heterozygous mutations are predominant in MEN2A, but homozygous cases and MEN2A-affected identical twins remain poorly characterized. Summary We report two MEN2A families—a homozygous female patient and heterozygous male twins, all with RET- p.C634Y mutations and classic MEN2A manifestations. A systematic review identified 18 homozygous cases from 10 families, involving exons 11, 14, and 15, containing nine types of mutations, presenting a female (55.6%) and moderate-risk mutation (61.1%) predominance. Overall, 83.3% of the 18 patients with homozygous mutations and 30.6% of the 49 patients with heterozygous mutations from the same generation had medullary thyroid carcinoma (MTC). The homozygous mutations had a higher penetrance rate of MTC ( P &amp;lt; 0.001) and rates of node-positive metastasis (8/15 vs. 1/15, P = 0.017). However, the comparison of the mean age at initial MTC diagnosis between patients with homozygous and heterozygous mutations [33.40 ± 17.97 (5–59) vs. 39.60 ± 12.94 (14–61) years], as well as in moderate-risk and high-risk patients with homozygous mutations [36.89 ± 16.21 (13–59) vs. 28.17 ± 20.72 (5–56) years], showed no significant differences (all P &amp;gt; 0.05). Additionally, the mean age at diagnosis and the incidence of pheochromocytoma did not differ significantly [(37.75 ± 18.43) vs. (39.5 ± 3.54); 27.8% vs. 13.3%; all P &amp;gt; 0.05]. Clustered data for identical twins diagnosed with MEN2 were also analyzed, including one with MEN2A and two with MEN2B. All three pairs of identical twins exhibited varying clinical presentations, expressivity of MEN2-related MTC and/or pheochromocytoma, and associated biomarker levels. Conclusions Homozygous MEN2A accelerates MTC onset and increases metastasis risk, but there is no evidence of association with the development of pheochromocytoma. Consanguineous marriage could increase homozygosity in offspring and the number of affected individuals. Expressivity and clinical progression can vary even with the same genetic backgrounds, and identical twins should also be subject to individual management.

To identify second primary malignancies (SPMs) death risk factors in prostate cancer (PCa) survivors and high-risk PCa patients for SPMs. With improved PCa survival, there's a growing need to study second SPMs in PCa survivors. PCa patients from 2004 to 2015 in the surveillance, epidemiology, and end results database were screened for SPM risk. The Fine and Gray competing risk model identified SPM mortality risk factors via univariate and multivariate analyses. A competing risk nomogram predicted 3-, 5-, and 10-year SPM mortality risk, stratifying patients by total scores for risk assessment. Model performance was assessed using the correlation index, receiver operating characteristic curve, calibration curve, and area under the curve. SPM-diagnosed PCa patients (2004-2015) were split into a 7:3 training (n = 31,435) and validation set (n = 13,472). The nomogram included 12 factors: age, chemotherapy, radiation, Gleason score, race, grade, marital status, tumor size, surgical site, surgery/radiation sequence, scope, and stage. C-index values were 0.70 (se: 0.001) and 0.684 (se: 0.002) in training and validation, respectively, indicating high discriminative power. The 3-, 5-, and 10-year area under the curves in training were 0.75 (95% confidence interval (CI): 0.72-0.77), 0.73 (95% CI: 0.72-0.75), and 0.72 (95% CI: 0.7-0.73), and in validation were 0.7 (95% CI: 0.65-0.74), 0.7 (95% CI: 0.67-0.73), and 0.71 (95% CI: 0.69-0.73), respectively, showing good predictive accuracy. The calibration curve confirmed model fit. A competing risk model predicts SPM mortality in PCa survivors, aiding high-risk patient identification and guiding survival-oriented treatment and follow-up strategies.

Accurate quantitative survival prediction in advanced non-small cell lung cancer (NSCLC) remains an unmet clinical need. While liquid biopsy is widely used, single circulating tumor DNA (ctDNA) shows limited predictive power. We developed an interpretable deep-learning model to quantitatively predict outcomes. We integrated data from 1373 advanced NSCLC patients profiled by two ultra-deep ctDNA sequencing assays (MSK-ACCESS and ctDx Lung). Features associated with overall survival (OS) were incorporated into a deep-learning network (DeepSurv), which estimates time-to-event survival probabilities. Model performance was evaluated by time-dependent area under the curve (AUC). SHapley Additive exPlanations (SHAP) were employed to interpret model output. A total of 1373 patients were analyzed, with 1012 using MSK-ACCESS (discovery) and 361 using ctDx Lung (validation). Among over 40 clinicopathological features, ctDNA status, cell-free DNA (cfDNA) concentration, age, blood-based TP53, EGFR, PIK3CA, ARID1A, STK11 and MET mutations significantly predicted OS. In ctDNA-positive patients, TP53/PIK3CA/ARID1A/STK11/MET-mutated patients had significantly inferior OS compared with wildtype patients (P < 0.001). Using above variables, DeepSurv was trained and tested in the MSK-ACCESS cohort (12-month AUC = 0.75), outperforming single cfDNA (AUC = 0.66) or ctDNA (AUC = 0.59), and externally validated in the ctDx Lung cohort. Compared with high-risk patients, DeepSurv-identified low-risk patients had significantly longer OS in both discovery (12-month OS 87.8% vs 53.8%, HR 0.32, P < 0.001) and validation cohorts (73.2% vs 48.4%, HR 0.42, P < 0.001). SHAP revealed TP53 and cfDNA concentration > 4.8ng/mL had the most important contributions. The interpretable DeepSurv model, integrating multimodal features, enables quantitative survival prediction and risk stratification in advanced NSCLC, facilitating personalized decision-making.

Background: In high-risk non-muscle-invasive bladder cancer (NMIBC), adjuvant therapies, such as intravesical Bacillus Calmette–Guérin (BCG) instillation, are widely employed; however, BCG treatment poses challenges due to potential adverse effects and ongoing supply limitations. This study aimed to evaluate treatment patterns, therapeutic efficacy, incidence of adverse events, and clinical predictors of recurrence and progression in patients with high-grade pT1 urothelial carcinoma (HG-T1 UC) of the bladder. Methods: This retrospective cohort study included 204 patients diagnosed with HG-pT1 UC who underwent transurethral resection of bladder tumor (TURBT) at Toho University Sakura Medical Center between 2010 and 2021. Clinical data encompassing treatment modalities (BCG or intravesical chemotherapy), complications, and oncological outcomes were collected. Recurrence-Free Survival (RFS), Progression-Free Survival, and Cancer-Specific Survival were analyzed using Kaplan–Meier analyses and multivariate regression models. Results: Maintenance BCG therapy was significantly associated with prolonged RFS compared to other treatments, including among ‘very high-risk’ patients. However, 52.4% of patients receiving BCG maintenance experienced adverse events, with dose reductions required in 59% of cases. Notably, recurrence rates did not significantly differ based on dose reduction or the total number of BCG instillations. Tumor multiplicity emerged as an independent risk factor for recurrence. Conclusions: Although maintenance BCG therapy remains essential for managing HG-T1 UC, especially in high-risk patients, treatment should be individualized due to concerns about tolerability and availability. The study results support the importance of personalized strategies based on risk stratification as outlined in clinical guidelines for preventing recurrence in NMIBC.

The Primary Care Assessment Tool (PCAT) is designed to assess a patient's experience with primary care across various core and ancillary domains, including First contact - Utilization, First contact - Access, Ongoing Care, Coordination, Comprehensiveness (services provided), Family-centeredness, Community Orientation, and Cultural Competence. This study examined the psychometric properties of the Adult Primary Care Assessment Tool Short Form (PCAT-S) in the Australian general practice setting. Data included 715 participants from the EQuIP-GP study, a cluster randomized controlled trial (RCT) conducted with adults aged 18-65 years with a chronic illness or aged over 65 years, from 34 general practices across Australia. For each subscale we assessed internal consistency using Cronbach's alpha. Factor structure of the PCAT-S instrument was assessed through confirmatory and exploratory factor analysis, using three samples with different methods for handling 'don't know/can't remember' responses. The findings were mixed. Specifically, the subscales related to First Contact - Utilization, Ongoing Care and Comprehensiveness, demonstrated satisfactory internal consistency. However, the remaining subscales showed weak internal consistency. Confirmatory factor analysis indicated potential model misspecification, while exploratory factor analysis generally supported the hypothesized factor structure, albeit with some observed deviations. The findings indicate the PCAT-S shows promise as an instrument to evaluate primary care experiences in Australia. However, the observed variability in internal consistency, along with issues identified in confirmatory and exploratory factor analyses, highlight the need for further validation and refinement in this population. Further research is required to address the identified limitations and enhance the tool's applicability within the Australian general practice context.

Arthroscopic ligament repair is a standard treatment for chronic ankle instability (CAI). In patients with risk factors for failure, isolated repair (ILR) may be insufficient and augmentation techniques have been proposed. This study compared ILR with suture tape-augmented repair (LR + STA), hypothesizing comparable outcomes in higher-risk patients. In this retrospective, indication-based cohort study, all patients who underwent arthroscopic treatment for CAI between 2019 and 2022 were included. Patients were allocated to two groups: Group A underwent ILR, and Group B underwent LR + STA due to pivoting-sport participation, generalized ligamentous laxity or poor-quality remnant ligament. Clinical evaluation was performed preoperatively and at 3, 6, 12 and 24 months using the Foot Function Index (FFI), visual analogue scale (VAS) and Foot and Ankle Ability Measure-Sports Subscale (FAAM-SS). Return to daily activities (RTD), work (RTW), sport (RTS) and complications were recorded at final follow-up. A total of 105 patients (mean age 30.8 ± 14.5 years) were included: 44 in Group A and 61 in Group B. Both groups demonstrated significant improvements in all clinical outcomes from baseline to final follow-up (p < 0.001). At 2 years, no significant between-group differences were observed in VAS (1.2 ± 1.7 vs. 0.7 ± 1.0; 95% confidence interval [CI]: -1.6; 0.6), FFI (9.7 ± 13.5 vs. 5.7 ± 7.6; 95% CI -12.7; 4.7) or FAAM-SS (86.6 ± 20.9 vs. 90.5 ± 12.9; 95% CI: -9.9; 17.5). No major complications or recurrences of instability occurred. RTS was significantly earlier in Group B (12 vs. 20 weeks, p < 0.001), while RTD and RTW showed no significant differences. Both isolated repair and suture tape-augmented repair achieved excellent outcomes with no significant differences at 2 years. Despite being performed in patients with higher functional demands or greater failure risk, suture tape-augmented repair demonstrated similar complication rates, no recurrence of instability and an earlier RTS. Level III, retrospective cohort study.

This retrospective study investigated risk factors and clinical outcomes of placenta accreta in pregnancies complicated by pernicious placenta previa (PPP). A total of 177 women diagnosed with PPP and treated at our institution between July 2020 and July 2025 were included. Clinical, imaging, and perinatal data were retrieved and analyzed. Placenta accreta spectrum was diagnosed based on prenatal ultrasonography, magnetic resonance imaging, intraoperative findings, and histopathological confirmation. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Among all patients, 56 had placenta accreta and 121 did not. Women with accreta had higher rates of 2 or more prior cesarean sections, shorter intervals since the last cesarean, and anterior placental implantation (all P < .01). Imaging indicators, including loss of the retroplacental clear space on ultrasound and bladder wall interruption on magnetic resonance imaging, were also independently associated with accreta. Multivariate analysis identified 5 independent predictors: ≥2 previous cesarean sections (odds ratio [OR] = 5.31), shorter interpregnancy interval (OR = 0.62), anterior placental location (OR = 3.90), loss of retroplacental clear space (OR = 3.16), and bladder wall interruption (OR = 4.91). Maternal and neonatal outcomes worsened with increasing placenta accreta spectrum severity, characterized by greater intraoperative blood loss, higher transfusion and hysterectomy rates, earlier delivery, and lower neonatal birth weight and Apgar scores. Early identification of high-risk PPP patients using clinical and imaging markers, coupled with multidisciplinary management, is essential to improve maternal and neonatal outcomes.

Background: Infective endocarditis (IE) is a severe and multifactorial condition historically linked to dental procedures. Current evidence shows that most cases arise from complex host–microbe interactions and biofilm colonization on damaged endothelium or intracardiac/prosthetic material, while the inappropriate use of antibiotics in dentistry promotes antimicrobial resistance. Objectives: To provide a narrative synthesis of contemporary evidence on (i) the relative contribution of dental procedures versus daily oral inflammatory burden to bacteremia and IE risk, (ii) the role of periodontal disease and the oral resistome in AMR, and (iii) the clinical and medico-legal implications of antibiotic prescribing and guideline adherence in dental practice. Materials and Methods: A narrative review was conducted using PubMed, Scopus, ResearchGate, and Google Scholar, complemented by manual screening of reference lists and relevant guideline documents. The search covered approximately the last decade (2015–2025) and included ESC 2023 and AHA 2021 guidance on IE prevention. Search terms combined concepts related to “infective endocarditis”, “antibiotic prophylaxis”, “dentistry/dental procedures”, “periodontitis/periodontal disease”, “bacteremia”, “biofilm”, “oral microbiome/oral resistome”, and “antimicrobial stewardship/antibiotic resistance”, using Boolean operators. Eligible sources included clinical studies, systematic reviews/meta-analyses, consensus statements and guidelines, and selected medico-legal literature relevant to dental decision-making and documentation. Editorials and non-peer-reviewed items without retrievable full text were not considered for evidence synthesis. Results: The reviewed evidence supports that spontaneous bacteremia associated with active periodontitis and daily oral activities may be more frequent than procedure-related bacteremia, suggesting that inflammation control and biofilm management represent a major preventive lever. Antibiotic prophylaxis should be reserved for a limited subset of high-risk cardiac patients as per contemporary ESC/AHA recommendations, whereas routine “defensive” prescribing in low-risk contexts provides minimal expected benefit and carries individual and societal harms (adverse events, microbiome disruption, AMR selection). Integrating periodontal care pathways with risk stratification and targeted antibiotic stewardship can improve patient safety and support public health. Conclusions: Dentistry plays a strategic preventive role in IE and AMR primarily through periodontal inflammation control, asepsis, and prudent antibiotic use. From a medico-legal standpoint, professional liability should be assessed on a process-based standard (risk assessment, adherence to updated guidelines, causal local treatment, informed consent, and traceable follow-up) rather than on outcome-driven hindsight.

The Inpatient Mental Health Pharmaceutical Assessment and Care Tool (IMPACT) was developed to assist pharmacy teams in identifying high risk patients for early intervention. Evaluation of the IMPACT tool is important to ensure its feasibility and effectiveness. This study reports the first evaluation of the IMPACT tool aiming to explore its acceptability by mental health inpatient pharmacy teams using an iterative qualitative approach. Between October 2024 and February 2025, pharmacy staff from five National Health Service (NHS) organisations retrospectively applied the IMPACT tool on patients that they had provided pharmaceutical care to, completed a reflection sheet, and attended an online focus group. Training was delivered to participants before initiating the study and the Theoretical Framework of Acceptability guided the content and analysis of the focus groups. Four focus groups and one dual interview were conducted with 12 pharmacists and 5 pharmacy technicians. The tool was viewed as self-explanatory and effective. Most participants were confident using the tool, though some pharmacy technicians reported difficulties due to clinical criteria (e.g., blood tests interpretation) that was not part of their usual duties. Following the first focus group, some changes were made such as clarifying or combining some risk-indicators. These changes were well-received by subsequent participants and recommendations and insights gained from all participants assisted in improving the tool. This study revealed that the IMPACT tool was acceptable by pharmacy team members and resulted in a refined version. Future work should further explore the tool's feasibility and impact using mixed methods approaches.

Left ventricular myocardial work (MW) has emerged as a valuable echocardiographic parameter for evaluating cardiac function and predicting clinical outcomes. Unlike conventional indices such as left ventricular ejection fraction and global longitudinal strain, MW integrates myocardial deformation with left ventricular pressure, providing a load-adjusted and physiologically meaningful assessment of myocardial performance. Growing evidence demonstrates that impaired MW is consistently associated with adverse outcomes, including heart failure hospitalization, mortality, and functional deterioration, across a wide spectrum of cardiovascular conditions such as ischemic heart disease, valvular heart disease, and cardiomyopathies. The noninvasive estimation of MW using commercially available echocardiographic software has enhanced its feasibility in routine clinical practice, enabling improved risk stratification and early identification of high-risk patients. This review summarizes current evidence supporting the prognostic value of MW, highlights its incremental role beyond conventional echocardiographic parameters, and discusses future perspectives for its integration into everyday clinical decision-making.

Background Some intracranial aneurysms (IAs) still develop in-stent stenosis (ISS) even after successful pipeline embolization device (PED) implantation. ISS increases the risk of retreatment and ischemic complications, thereby affecting the long-term prognosis of IA patients. This study aims to identify predictors for ISS after PED treatment of IAs, and develop a nomogram for assessing individual risk. Materials and Methods This analysis included unruptured IA patients treated with PEDs between April 2016 and October 2023 at three institutions. The patients were grouped into the training cohort and validation cohort according to the admission institution. Predictors were identified via least absolute shrinkage and selection operator analysis and multivariable regression analysis. A nomogram was then developed to predict ISS after PED implantation in the training cohort. The area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate the predictive accuracy and clinical value of the nomograms. Results A total of 1335 IA patients were included in this study (1049 in the training cohort and 286 in the validation cohort). A total of 139 (13.3%) and 41 (14.3%) patients developed ISS in the training cohort and validation cohort, respectively. A nomogram with five predictors (difference between the proximal and distal parent artery diameters, distal stent-to-vessel diameter ratio, overlapping devices, balloon angioplasty, and dissecting aneurysms) was developed via multivariate logistic regression analysis. AUCs of the nomogram in the training cohort and validation cohort were 0.836 (95%CI, 0.801–0.870) and 0.829 (95%CI, 0.770–0.888), respectively. Calibration curve and DCA analysis confirmed the utility and clinical applicability of this nomogram. Conclusion This nomogram showed high accuracy and clinical utility in predicting ISS after PED treatment, indicating that the nomogram can guide the identification of high-risk patients and the development of improved treatment strategies.

Background Conventional classification of surgical margins is inadequate for head and neck squamous cell carcinoma (HNSCC) treated with neoadjuvant immunochemotherapy (NICT), as it fails to capture the complex biological changes in the tumor microenvironment. This study aimed to develop a novel definition of a negative margin. Methods We conducted a retrospective analysis of treatment-naïve, HPV-negative HNSCC patients who completed NICT followed by surgery. Surgical margins underwent multi-modal assessment, including histopathology (tertiary lymphoid structures), tumor burden (Pan-CK, Ki-67), molecular profiling (driver mutations, PD-L1 RNA), and immune contexture (CD8+/FoxP3+ ratio, Granzyme B). A Margin Risk Index (MRIx) was developed by weighting these domains based on their prognostic impact for locoregional control (LRC) and distant metastasis-free survival (DMFS). The MRIx was externally validated in an independent cohort. Results The study included a training cohort of 144 patients and an independent validation cohort of 100 patients. The MRIx integrated four domains into a continuous score, stratifying patients into low, intermediate, and high-risk categories. The MRIx significantly outperformed traditional margin assessment, with superior discrimination for both LRC (C-index=0.72) and DMFS (C-index=0.75). External validation confirmed its prognostic power, demonstrating significant risk stratification (log-rank p&amp;lt;0.001 for both LRC and DMFS) and an independent hazard ratio for high-risk patients (HR = 2.95 for LRC; HR = 3.22 for DMFS, both p&amp;lt;0.001). Conclusion The proposed MRIx provides a biologically-grounded tool that redefines margin status following NICT. It accurately identifies patients at high risk of recurrence who may benefit from treatment intensification and those with low-risk margins suitable for de-escalation, enabling personalized adjuvant therapy.

BACKGROUND The global rise in the elderly population has amplified the urgency to address age-related nutritional risks, as malnutrition among older hospitalized patients contributes to poor clinical outcomes and shows the need for targeted nutritional interventions. This study aimed to assess the clinical nutrition management of elderly hospitalized patients. MATERIAL AND METHODS A total of 227 hospitalized patients who received nutrition consultations in the Department of Geriatrics at Peking University People's Hospital from May 2017 to September 2020 were included in this study. We conducted a retrospective review of their medical records, collecting basic clinical information, nutritional status, consultation times and recommendations, compliance with clinical advice, and changes in blood biochemical indicators. RESULTS Among 227 patients, 160 (68.75% male and 73.49% female) were at nutritional risk. Those with type 2 diabetes, pulmonary infections, gastrointestinal diseases, chronic kidney disease, and anemia had a higher incidence of nutritional risk (* P<0.05). Of these, 204 adhered to the nutritionists' intervention plan, with the highest implementation rate for health education (98.73%) and the lowest for oral nutritional supplements (ONS) at 83.87%. Noncompliance included 69% failing to take oral supplements and 22% refusing tube feeding. Patients following nutritional advice had significantly shorter hospital stays (P=0.03, P=0.00). After the intervention, total protein and albumin improved, with low-risk patients showing higher levels in total enteral nutrition (* P<0.05). No significant differences were found in high-risk patients (P>0.05). CONCLUSIONS Effective clinical nutrition management for elderly patients requires enhanced dietary supply practices, standardized consultation implementation, and the active involvement of patients' families in nutritional planning, ultimately improving overall healthcare outcomes.

Lactylation, a recently identified post-translational modification mediated by lactate, plays a critical role in regulating metabolic and immune processes in tumors. However, its function in neuroblastoma, particularly its association with tumor progression and immune modulation, remains unclear. We conducted immunohistochemical analyses on neuroblastoma tissue samples to evaluate lactylation levels and their clinical relevance. Single-cell RNA sequencing data and the AUCell algorithm were utilized to identify lactylation-related genes (LRGs) and map their expression within the tumor microenvironment. A seven-gene LRGs-based prognostic model was constructed using Cox regression and Least absolute shrinkage and selection operator (LASSO) analysis and validated in independent datasets. Bioinformatics analyses were performed to assess the associations between LRGs and clinical characteristics, biological pathways, immune infiltration, and therapeutic response. Functional assays further investigated the role of KLHL32, a key gene identified in the model. Our study revealed significantly elevated lactylation levels in neuroblastoma tumor tissues, which were associated with advanced disease stages and poor prognoses. We identified 407 LRGs and developed a seven-gene prognostic model that effectively stratified patients by risk, showing robust predictive performance in both internal and external validations. High-risk patients exhibited increased activation of tumor-promoting pathways, including glycolysis and PI3K/AKT signaling, alongside reduced immune cell infiltration, indicative of an immunosuppressive tumor microenvironment. Among the LRGs, KLHL32 emerged as a key tumor suppressor, inhibiting neuroblastoma cell proliferation, migration, and invasion, while enhancing NK cell-mediated cytotoxicity and anti-GD2 immunotherapies response. KLHL32 overexpression suppressed lactate production by downregulating the PI3K/AKT pathway, reducing protein lactylation levels, and promoting anti-tumor immunity. Our findings establish lactylation as a critical determinant of neuroblastoma progression and prognosis. The seven-gene lactylation-related prognostic model provides a novel tool for patient stratification and therapeutic decision-making. Additionally, KLHL32 represents a promising target for enhancing immunotherapy efficacy by modulating metabolic and immune pathways, offering new opportunities for precision treatment in high-risk neuroblastoma patients.

Abstract Background: The treatment and prognosis of melanoma have historically been based on histologic stage and Breslow depth; however, due to the increase in surveillance, melanomas are being identified at an earlier stage and lower Breslow depth. Advances in genetic testing, such as Decision Dx ® , mean that melanoma diagnostic decisions and prognosis can now be directed by genetics. The purpose of this project was to assess the influence of a Decision Dx ® high-grade (Class 2A/B) classification on the treatment of melanoma patients at a regional medical center, particularly those not deemed high risk by conventional classification methods, including Breslow depth and Clark level. Materials and Methods: Melanomas that were diagnosed as Decision Dx ® class 2A/B (high risk) at a single institution between 2019 and 2020 were retrospectively evaluated. Patients were stratified by recurrence and sentinel lymph node (SLN) positivity. Results: A total of 97 Decision Dx ® high-risk patients were evaluated, in whom the average Breslow depth was 2.38 (0.45–7.5 mm), and three most common histologic stages were pT2a (19%), pT2b (18%), and pT4b (22%). Overall, 65% had oncology follow-up, 37% received immunotherapy, and 91% were alive. Recurrence was noted in 22% of the patients ( n = 22); there was no significant difference in Breslow depth between those with and without recurrence. Significantly more of those with recurrence had Stage T3a ( P = 0.0390; no recurrence 0%), oncology follow-up (95%; P = 0.0030), and immunotherapy (86%, P = 0.0001) but no difference in survival ( P = 0.3161). Analysis of the patients with SLN biopsy (SLNBx) positivity showed that they were younger (mean: 63.3 years; P = 0.0040); however, no significant differences were found in histologic variables. Oncology follow-up was higher in the patients who were SLNBx positive (90%; P = 0.0126) as was immunotherapy ( P = 0.0001); however, due to the Decision Dx ® high-risk classification, 60% of the SLNBx-negative patients received oncology follow-up. Overall, recurrence and survival rates were not significantly different between cohorts. Conclusion: Although there were no significant differences in survival/recurrence, some patients would not have received additional follow-up based on the initial pathology who eventually developed recurrence. These data emphasize that genetic analysis can change management decisions and allow for more intensive surveillance, and that Decision Dx ® can play an integral role in defining melanoma behavior along with histologic characterization. Larger studies to substantiate these results are warranted.

Simultaneous versus Staged Bilateral Oxford Unicompartmental Knee Arthroplasty in the Era of Diagnosis-related Group: Influence on Outcome and Costs of Care

Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative to open craniotomy for patients deemed unsuitable for surgery due to deep-seated or eloquent lesion location, age, frailty, or comorbidities. However, its use in newly diagnosed deep-seated low-grade glioma (nLGG) has not been elucidated. We aimed to evaluate the safety and efficacy of LITT for deep-seated nLGG compared with a similar surgical cohort. We retrospectively reviewed patients with unifocal, deep-seated nLGG treated with either LITT or surgical resection between 2013 and 2024. Demographic, perioperative, and follow-up data were compared between groups. Kaplan-Meier assessed progression-free and overall survival outcomes. To address baseline tumor volume differences, a subset analysis was performed using a greedy nearest-neighbor algorithm to generate a 1:1 matched cohort based on tumor volume. A total of 15 patients in the study group (median age 46 [IQR: 34-53] years, 40.0% men) were compared with 51 patients (median age 38 [IQR: 29-54] years, 43.1% men) in the control group. There were no significant differences in in-hospital complications (P = .999), 30-day complications (P = .999), or complications between 30 days and 3 months (P = .713), new postoperative motor or speech deficits (0.999) between groups. Postoperative adjuvant chemotherapy (23.1% vs 46.9%, P = .217) and radiation (23.1% vs 44.7%, P = .210) rates did not differ significantly. Among high-risk patients, time to adjuvant chemotherapy (64.7 vs 77.7 days) and radiation (36.0 vs 53.6 days) was earlier in the LITT group, although not statistically significant. Kaplan-Meier analysis showed no statistically significant differences in progression-free survival or overall survival between groups. On matched pair analysis, there remained to be no statistically significant differences in outcomes observed between LITT and craniotomy groups. This pilot study is the first to suggest that LITT is a safe treatment option for patients with deep-seated nLGG, offering comparable outcomes with surgical resection.

To identify clinical and imaging factors associated with vision-threatening proliferative diabetic retinopathy (VT-PDR) in the fellow eye of patients undergoing vitrectomy for VT-PDR in one eye. This retrospective cohort study included patients with type 2 diabetes mellitus who underwent vitrectomy for VT-PDR-defined as moderate-to-severe vitreous haemorrhage, tractional retinal detachment involving or threatening the macula, or extensive neovascularization-between January 2017 and December 2022. Clinical and imaging data including diabetic retinopathy severity scale (DRSS), presence of predominantly peripheral lesions (PPL), and VT-PDR subtype in the operated eye, were evaluated. Cox proportional hazards model was used as the primary analysis, supported by Kaplan-Meier survival analysis, multivariate logistic regression, and sensitivity analyses. Among 152 patients (mean age 50.1 ± 9.8 years), 96 patients (63.2%) developed VT-PDR in the fellow eye during a mean follow-up of 39.3 ± 23.4 months. Cox regression identified younger age (HR 0.822 per 5-year increase, 95% CI 0.726-0.930, p = 0.002), higher DRSS in the fellow eye (HR 1.033 per point, 95% CI 1.003-1.064, p = 0.029), and PPL (HR 1.819, 95% CI 1.095-3.022, p = 0.021) as independent predictors of progression. Kaplan-Meier curves confirmed significantly shorter time to VT-PDR events in eyes with these risk factors (all p < 0.05). Younger age, advanced DRSS, and PPL are independent risk factors for fellow-eye VT-PDR. Early identification of these risk factors may help guide close monitoring and timely intervention to prevent vision loss in the fellow eye. WHAT IS KNOWN : Patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) in one eye remain at risk for vision-threatening PDR (VT-PDR) in the fellow eye. Prior studies have mainly assessed systemic factors or DR severity, with limited evaluation of widefield imaging features. Younger age, higher diabetic retinopathy severity scale (DRSS) scores, and predominantly peripheral lesions (PPL) on widefield imaging independently predict fellow-eye VT-PDR progression. Integrating systemic, clinical, and imaging factors enables improved risk stratification and highlights the need for closer surveillance in high-risk patients.