Improved Survival In Patients Research Articles

External Validation of the ISGPS Complexity Grading System for Minimally Invasive Pancreatoduodenectomy: Insights from the IGOMIPS registry.

To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD). Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise. Data from MIPD cases reported in the IGOMIPS registry (October 2019-February 2024) were analyzed, with severe postoperative complications as the primary outcome. Logistic regression was used to identify risk factors for complications. Of the 771 MIPD cases, 426 (55.3%) were analyzed. A pancreatic duct size ≤3mm was the only significant risk factor for severe complications (OR=2.22, P=0.0001). Most cases (n=255; 59.9%) were classified as grade C complexity, whereas 22 (5.1%) were classified as grade A. Severe postoperative complications increased with complexity (grade A, 31.8%; grade B, 36.3%; grade C, 48.6%; P=0.0091). For grade A complexity, the outcomes were consistent across surgeons and centers. Grade B outcomes were similar between grade B and C centers but superior to grade A centers. In grade C cases, outcomes were comparable between grade A and B centers, with improvements at grade C centers. Grade A ISGPS experience correlated strongly with mismatches between planned and performed procedures (grade A, 15.0%; grade B, 3.0%; grade C, 3.1%; P<0.0001), including total pancreatectomy (grade A, 11.5%; grade B, 1.2%; grade C, 3.1%; P=0.0005). The ISGPS complexity grading system effectively predicted MIPD outcomes, supporting better patient selection and alignment of complexity with surgical expertise.

The impact of Mayo Adhesion probability score on the success of extracorporeal shock wave lithotripsy for kidney stones.

Urolithiasis is a prevalent condition in urology, with extracorporeal shock wave lithotripsy (ESWL) serving as a common treatment for kidney stones under 2cm. The Mayo Adhesion Probability (MAP) score, calculated from perinephric fat characteristics, is traditionally used to assess surgical outcomes but has not been explored in the context of ESWL. This study aims to evaluate the effect of MAP score on the success rate of ESWL. This retrospective study included patients who underwent ESWL for kidney stones between January 2018 and June 2024 at a tertiary care center. Demographic data, stone characteristics, and MAP scores were obtained through CT imaging. ESWL success was defined as either complete stone clearance or a residual fragment less than 4mm at three months post-procedure. Logistic regression and ROC analysis were employed to identify predictors of treatment success and to determine the optimal MAP score cutoff. A total of 260 patients were analyzed, divided into two groups: MAP score < 3 (n = 154) and MAP score ≥ 3 (n = 106). Patients with a MAP score ≥ 3 had a significantly lower ESWL success rate (49.1%) compared to those with a MAP score < 3 (71.4%; p = 0.001). Multivariate analysis identified MAP score, BMI, and stone size as significant predictors of ESWL success. ROC analysis established a MAP score cutoff of 2, with 76.5% sensitivity and 64.3% specificity. The MAP score is an independent predictor of ESWL success in kidney stone treatment. Preoperative MAP evaluation may improve patient selection and optimize ESWL outcomes.

Right Ventricular Myocardial Infarctions.

Acute isolated right ventricular (RV) myocardial infarctions are relatively uncommon in clinical practice; more frequently, RV infarctions occur in association with inferior ST-segment elevation myocardial infarctions. Recent advances in diagnostic tools and methods have significantly improved our ability to detect RV infarctions in both scenarios. For this reason, it is critical for physicians to understand the pathophysiology, clinical presentation, and diagnostic criteria for RV infarctions to initiate treatment and optimize the outcomes of patients. About half of all patients with an inferior ST-segment elevation myocardial infarction develop RV infarction. In the acute setting, RV infarctions can lead to hemodynamic instability and frank shock, which are responsible for the high morbidity and mortality associated with these episodes. However, when treated properly, the prognosis of RV myocardial infarctions is quite excellent if the patient survives the acute hemodynamic compromise. In addition, RV infarctions are likely a misnomer since these events tend to represent ischemia and stunning of the RV myocardium that results in its short-term dysfunction, but the myocardium remains viable and recovers over time with no signs of an infarct if the patient survives the episode. In fact, patient outcomes in RV ischemia are dependent more on the involvement of the left ventricle than RV involvement, especially since a left ventricular infarct and dysfunction can be difficult to overcome in the long term. It is imperative to understand the various treatments available to target the hemodynamic changes and shock often seen in patients with acute RV ischemia and to implement these treatments accordingly to improve patient survival and prognosis.

Distinct Transcriptomic and Tumor Microenvironment Profiles in Sinonasal Mucosal Melanoma and Aggressive Cutaneous Melanomas.

Background/Objectives: Sinonasal mucosal melanoma (SNMM) is a rare and aggressive melanoma subtype with a notably poor prognosis compared to cutaneous melanoma (CM). Despite advances in molecular characterization, SNMM remains underexplored, posing a clinical challenge and highlighting the need for detailed molecular profiling. This study aimed to identify the molecular features of SNMM, elucidate its clinical behavior and prognostic implications, and provide insights for improved therapeutic strategies. Methods: This retrospective study analyzed 37 primary melanoma tumors diagnosed at the Hospital Clinic of Barcelona. Gene expression was examined using 1402 immuno-oncology-related probes through next-generation sequencing. Hierarchical clustering analysis (HCA), differentially expressed genes (DEGs), gene set enrichment analysis (GSEA), and the xCell algorithm were performed. The statistical methods comprised descriptive statistics, clinical variable associations, and survival analyses. Results: HCA revealed two primary clusters. Cluster A exclusively contained CM tumors (20/24), while cluster B included all SNMMs (13/13) and some CMs (4/24). Cluster B showed a higher average age at diagnosis (p = 0.018), higher mitotic index (p = 0.0478), fewer BRAF mutations (p = 0.0017), and poorer melanoma-specific survival (p = 0.0029). Cluster B showed 602 DEGs with cell cycle pathways enriched, immune pathways diminished, lower immune scores (p < 0.0001), and higher stromal scores (p = 0.0074). Conclusions: This study revealed distinct molecular characteristics and an altered tumor microenvironment in SNMMs and certain aggressive CMs. Identifying specific genes and pathways involved in cell cycle progression and immune evasion suggests potential prognostic markers, offering new avenues for enhancing treatment strategies and improving patient survival rates.

Ebola disease: bridging scientific discoveries and clinical application.

The west Africa Ebola disease epidemic (2014-16) marked a historic change of course for patient care during emerging infectious disease outbreaks. The epidemic response was a failure in many ways-a slow, cumbersome, and disjointed effort by a global architecture that was not fit for purpose for a rapidly spreading outbreak. In the most affected countries, health-care workers and other responders felt helpless-dealing with an overwhelming number of patients but with few, if any, tools at their disposal to provide high-quality care. These inadequacies, however, led to attention and innovation. The decade since then has seen remarkable achievements in clinical care for Ebola disease, including the approval of the first vaccines and treatments. In this paper, the first in a two-part Series, we reflect on this progress and provide expert summary of the modern landscape of Ebola disease, highlighting the priorities and ongoing activities aimed at further improving patient survival and wellbeing in the years ahead.

Improving Patient Selection in Clinical Trials: Should We Start Using the Pretrial eGFR Decline as Risk Enrichment Criterion?

Improving Patient Selection in Clinical Trials: Should We Start Using the Pretrial eGFR Decline as Risk Enrichment Criterion?

State of the art endocrine treatments for patients diagnosed with endometrial cancer in 2025.

Endometrial cancer (EC) is rising in incidence, particularly in younger, premenopausal women, due to increasing rates of obesity and delayed childbearing. This review evaluates current and emerging endocrine therapies, with a focus on fertility-preserving approaches for early-stage EC and treatment options for advanced or recurrent disease. Fertility-sparing endocrine therapies, such as medroxyprogesterone acetate, megestrol acetate, and levonorgestrel-releasing intrauterine devices, achieve high response rates but carry recurrence risks. Biomarkers, including progesterone receptor status and molecular subtyping, are improving patient selection and outcomes. In advanced EC, single-agent and combination endocrine therapies with agents like selective estrogen receptor modulators, selective estrogen receptor down-regulators (SERDs), and aromatase inhibitors show efficacy, especially in hormone receptor-positive disease. Newer agents, including next-generation SERDs and proteolysis-targeting chimeras, hold potential for treating resistant cases. Endocrine therapy offers a well tolerated alternative to chemotherapy in selected EC patients, particularly those with hormone-sensitive tumors. Advances in molecular profiling and the development of novel endocrine agents are refining treatment strategies, supporting endocrine therapy's continued role in managing EC across various stages.

A Review on Impact of Diet and Lifestyle Modifications on Treatment Outcomes in Multiple Myeloma

This study examines the safety, tolerability, and efficacy of anticancer drugs in the treatment of multiple myeloma, a malignancy of plasma cells characterized by overproduction of monoclonal proteins that damage bones and organs. The disease remains largely incurable despite advances in treatment, necessitating ongoing evaluation of therapeutic approaches. This review focuses on the role of key medications like bortezomib, lenalidomide, and daratumumab, highlighting their mechanisms, clinical efficacy, and associated adverse effects. Bortezomib, a proteasome inhibitor, has shown significant efficacy in both newly diagnosed and relapsed/refractory cases, particularly in combination regimens. However, it is associated with adverse effects such as peripheral neuropathy and hematologic and gastrointestinal toxicities, which require careful management. Strategies such as optimized dosing and subcutaneous administration have improved its safety profile. Future directions include enhancing therapeutic outcomes through personalized medicine, combination regimens, and mitigating resistance. This research underscores the critical need for tailored treatment strategies to improve patient survival and quality of life in multiple myeloma. Keywords: BiPN – Bortezomib-induced Peripheral Neuropathy, RRMM –Relapsed and Refractory Multiple Myeloma, NDMM –Newly Diagnosed Multiple Myeloma, PN –Peripheral Neuropathy.

Intraprocedural 3D-vena contracta area predicts survival after transcatheter edge-to-edge repair: results from MITRA-PRO registry.

The MITRA-PRO registry revealed residual mitral regurgitation (MR) to be an important predictor of survival following transcatheter edge-to-edge repair (TEER). Intraprocedural MR assessment using 3D-Vena Contracta Area (VCA) might be a feasible tool to guide mitral TEER procedures. The study aimed to assess the impact of residual MR assessed by 3D-VCA on 1-year mortality. 823 patients with residual MR quantification using 3D-VCA in the MITRA-PRO registry, were included in this study. 1-year mortality, NYHA classification and major adverse events were assessed 1-year after mitral TEER. Patients with trace residual MR after mitral TEER were allocated to the 3D-VCA < 0.1 cm2 group (27.8%), while a 3D-VCA ≥ 0.1 < 0.3 cm2 (55.4%) was considered as mild and a 3D-VCA ≥ 0.3 cm2 (16.8%) as relevant residual MR. One-year mortality was significantly lower in patients with non-relevant residual MR (3D-VCA < 0.1 cm2: 10.5%; ≥ 0.1 < 0.3 cm2: 16.0%; ≥ 0.3: 24.8%, p = 0.003). An increasing 3D-VCA post mitral TEER was associated with a higher 1-year mortality. At a 3D-VCA of 0.07 cm2 mortality increased significantly (1-year mortality 3D-VCA post mitral TEER ≥ 0.07 cm2: 16.5% vs. < 0.07 cm2: 7.8%; p = 0.005) indicating a 3D-VCA of 0.07 cm2 to be a cut-off value for survival in daily practice. Residual MR assessed by 3D-VCA after TEER is associated with 1-year mortality. Therefore, 3D-VCA is a valuable echocardiographic tool for intraprocedural MR assessment during mitral TEER and achieving a lower 3D-VCA improve patient survival. (German Clinical Trials Register: DRKS00012288). DRKS00012288.

Impact of Robotic Percutaneous Coronary Intervention (R-PCI) With and Without CCTA-Guidance on Clinical Outcomes and Hospital Economics: A Single Center Registry.

Several studies have confirmed the safety and efficacy of robotic assisted coronary interventions for simple and complex coronary lesions. However, in the real-world clinical setting the currently available evidence is still inconclusive with regard to clinical outcomes. In terms of financial sustainability, the emerging use of pre-PCI Coronary Computed Tomography Angiography (CCTA) may potentially impact the overall patient journey and related costs. However, the role of CCTA guidance in elective robotic-assisted revascularizations and its potential impact on hospital economics has never been investigated. Therefore, we aimed to assess the clinical impact of R-PCI according to procedural complexity and its potential financial sustainability when integrated with CCTA guidance. Major adverse cardiovascular events (MACE) at the latest clinical follow-up available have been prospectively evaluated in a single center cohort of 111 patients undergoing elective R-PCI (CorPath, Corindus GRX Robotic Drive, Boston, MA). The study population was subsequently divided into two groups according to either the median Syntax Score (SS = 14) as a surrogate of procedural complexity or the adoption of CCTA-guidance. Additionally, both periprocedural and in-hospital outcomes have been investigated in the overall cohort and in the subgroups. Overall, MACE occurred in 5.4% of the patients at a median follow-up of 309 days. Procedural complexity was associated with significantly longer procedural time and radiation exposure (SS ≥ 14: 94.5 ± 32.1 vs. 78.7 ± 25.5 min, p = 0.011, and 32.7 ± 30.9 vs. 22.5 ± 19.8 mSv, p = 0.010, respectively), but not with increased in-hospital and long-term clinical outcomes. Additionally, patients undergoing CCTA-guided R-PCI had a significantly higher rate of same-day-discharge (SDD-64.6% vs. 44.2% respectively, p = 0.034) than those without CCTA support. R-PCI appears safe and effective regardless the procedural complexity. Moreover, the integration of robotics and CCTA-guidance appears to have beneficial impact on hospital economics by optimizing resource utilization and improving patient selection for percutaneous revascularization.

P108 Immunotherapy of psoriasis in the context of underlying malignant disease: risk–benefit balance?

Abstract The recently established immunotherapeutic approaches to various malignant tumours have dramatically improved patient survival and tumour responses. Yet, they may result in a number of severe unwanted effects on various organs including the skin, which in fact makes up 20–30% of these side effects. Induction or exacerbation of psoriasis is frequent among these. Interdisciplinary care is needed to efficiently approach both tumour and organ-related side effects. This complex issue may be intensively discussed within local interdisciplinary clinical boards on chronic inflammatory diseases (ICB) and is addressed with this case report. A 67-year-old patient was diagnosed with multifocal metastasing small cell lung cancer (SCLS) of his left upper lung lobe and osseous, hepatic and soft tissue metastases. Radiochemotherapy was initiated with cumulative doses of 34 Gy and four cycles of carboplatin and etoposide as well as atezolizumab (anti-PD-L1), the latter continued for maintenance therapy. After 2 years of treatment, no pathologic lymphnodes nor organ metastases could be found with residual pneumonic condensation in his right lung. After 1 year of immune checkpoint inhibition (ICI) both psoriasis arthritis and skin psoriasis appeared with an initial PASI of 20 and a DLQI of 15 and above. The appropriate treatment within this tumour context was intensively discussed by the local ICB. Four injections of guselkumab were well tolerated, yet without any clinical effect. After 7 months of distinct improvement of both skin and joint symptoms upon bimekizumab, clinical effects waned and the therapy was changed another time to injections of adalimumab. This was well tolerated with slow improvement of skin and joint symptoms. The tumour parameters remained unchanged over time. This case demonstrates the induction of psoriasis and psoriasis arthritis by ICI, the critical risk-benefit balance of immunomodulation for psoriasis in the context of underlying malignant disease and the clinical benefit of interdisciplinary discussion within a board on chronic inflammatory diseases.

The relationship between composite lipid indices and baveno classification in patients with obstructive sleep apnoea

Obstructive Sleep Apnoea (OSA) is associated with the development of cardiovascular disease (CVD); however, the risk is only weekly related to OSA severity traditionally determined by the apnoea-hypopnoea index. The Baveno classification was developed to improve patient selection who would benefit from OSA treatment in terms of symptoms improvement and CVD risk reduction. However, it is unclear how the classification relates to biomarkers of CVD risk. Composite lipid indices were evaluated in various populations and showed good predictive value for incident CVD. One thousand two hundred and forty-two patients with OSA were included in the study. Composite lipid indices, including the atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP) and cardiometabolic index (CMI) were compared between different Baveno groups (A – minor symptoms, minor comorbidities, B – severe symptoms, minor comorbidities, C – minor symptoms, severe comorbidities, D – severe symptoms, severe comorbidities). All composite lipid indices were higher in group D versus groups A and C. Only LAP (86.93 /58.40–119.49/ vs. 75.73 /48.37–99.04/) and CMI (1.03 /0.69–1.42/ vs. 0.91 /0.63–1.12/) were significantly different between the minimally symptomatic groups (C vs. A), and solely LAP was significantly higher (110.69 /76.76–147.22/ vs. 82.32 /60.35–113.50/) when the highly symptomatic groups (D vs. B) were compared. The Baveno classification correlates with cardiovascular risk estimated with composite lipid indices. Composite lipid indices may help better stratifying cardiovascular risk in both minimally- and highly symptomatic patients.

Trends in Management of Malignant Bowel Obstructions: A Longitudinal Analysis of the National Inpatient Sample.

Malignant bowel obstructions (MBO) are complex, heterogeneous disease processes which can be managed with surgical or endoscopic interventions. Patients with MBO often have advanced metastatic disease and poor functional status, which makes it difficult for providers to determine the best treatment strategy. Patients with urgent or emergent admissions and a primary or secondary ICD-9/ICD-10 diagnosis of bowel obstruction with an additional diagnosis of disseminated cancer were identified from the National Inpatient Sample (2000-2017). Patients were stratified into operative and non-operative intervention groups. Multivariate regression determined factors associated with surgical treatment of MBO based on significant factors on univariate analysis. Trends in treatment over time were calculated using log-linear regression to determine the annual percent change (APC). Of 1118 patients, 18% underwent surgery and 7% underwent endoscopic intervention. From 2000 to 2017, a decreasing proportion of patients underwent surgery (APC -2.4, p = 0.023) with a commensurate increase in endoscopic interventions (APC 5.3, p = 0.042). There was also a decrease in the proportion of patients who died during hospitalization (APC -4.3, p = 0.029). Surgery was associated with longer mean lengths of stay (13 days vs. 7 days, p < 0.001) and higher rates of in-hospital mortality (13% vs. 6%, p = 0.001) compared to non-operative management. The proportion of patients receiving surgery for MBO is decreasing and that receiving endoscopic interventions is increasing. In-hospital mortality is also decreasing proportionately, suggesting an improvement in patient selection.

THE ANALYSIS STUDY OF DIAGNOSIS AND MANAGEMENT OF ACUTE CORONARY SYNDROME: A COMPREHENSIVE SYSTEMATIC REVIEW

Introduction: Acute coronary syndrome (ACS) represents a spectrum of conditions with significant morbidity and mortality rates worldwide. Optimal management of ACS is critical, involving a combination of pharmacological therapies, interventional procedures, and comprehensive rehabilitation programs. This systematic review evaluates various management strategies for ACS, focusing on their efficacy, safety, and clinical outcomes to guide improved patient care practices. Methods: This systematic review was conducted in adherence to PRISMA 2020 guidelines. A comprehensive literature search was performed in major databases, including PubMed, ScienceDirect, Embase, Cochrane Library, Web of Science, studies published from 2018 onwards that evaluated ACS management strategies. Inclusion criteria were original research articles providing insights into treatment methods such as medication regimens, surgical interventions, and supportive therapies. The studies were assessed for bias across parameters like temporal precedence, participant selection, confounding factor handling, and retention rates. Results: From an initial set of 1916 publications, eight studies met the inclusion criteria after thorough screening. These studies highlighted various ACS management approaches, revealing that pharmacological treatments combined with early revascularization strategies improved patient survival and reduced complication rates. Assessment of bias showed consistent rigor in administration protocols and outcome assessments across the majority of studies. However, participant retention and confounding factor management were areas where inconsistencies were observed. The overall findings suggest that a multidisciplinary approach encompassing medication, timely intervention, and structured rehabilitation yields the best patient outcomes. Conclusion: This systematic review underscores the importance of comprehensive, multidisciplinary management in ACS care. Effective treatment strategies should address timely diagnosis, therapeutic interventions, and follow-up plans that include patient education and rehabilitation. Further research is needed to refine management protocols and overcome challenges in confounding factor control and participant retention for future studies.

Safety and therapeutic potential of allogeneic adipose-derived stem cell spray transplantation in ischemic cardiomyopathy: a phase I clinical trial

BackgroundIschemic cardiomyopathy, characterized by coronary artery atherosclerosis, impairs the myocardial tissue. Coronary artery bypass grafting (CABG) is commonly used to revascularize affected areas and improve patient survival rates; however, it can fail to enhance cardiac function. Impaired capillary blood flow may obstruct functional recovery, prompting interest in treatments, such as angiogenic factor administration. Adipose-derived stem cells (ADSCs), which are known for immune evasion, have shown the potential to construct capillary networks and improve myocardial function. This clinical trial aimed to evaluate the safety and efficacy of ADSC spray therapy combined with CABG.MethodsThis single-center, randomized, double-blind study involved patients with ischemic cardiomyopathy who were scheduled for CABG and who had a left ventricular ejection fraction ≤ 40%. The participants were randomized to receive CABG as well as ADSC spray therapy or placebo. The primary endpoints were safety, changes in late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) volumes, and feasibility. The secondary endpoints included left ventricular function, exercise tolerance, and heart failure symptoms.ResultsSeven patients were enrolled; of them, six were randomized to receive ADSC therapy (n = 3) or placebo (n = 3). The procedure was successfully completed with minimal adverse events. One patient in the ADSC group developed pleural effusion that was resolved with drainage. The LGE-MRI volumes decreased in the ADSC group but remained unchanged in the placebo group. Improvements in left ventricular function and exercise tolerance were noted in the ADSC group, with heart failure symptoms improving to New York Heart Association class I. In contrast, the placebo group showed no significant changes, with one patient experiencing worsening symptoms.ConclusionsADSC spray therapy combined with CABG demonstrated safety and efficacy at enhancing cardiac function. ADSC likely contributes to capillary network reconstruction, thereby augmenting the benefits of CABG. Future phase II and III trials are warranted to confirm its therapeutic efficacy and long-term outcomes. This novel approach represents a significant advancement in the treatment of ischemic cardiomyopathy and offers a viable strategy for improving myocardial function and patient prognosis.Trial registration This study was registered with the Japan Registry of Clinical Trials (jRCT2053190103) and ClinicalTrials.gov (NCT04695522)Graphical

Clinical Outcomes for Postinfarct Ventricular Septal Defect Repair in a Large State-Wide Surgical Registry.

Ventricular septal defect (VSD) is a life-threatening complication occurring after delayed presentation of acute myocardial infarction (AMI). We assessed clinical characteristics based on mortality following surgical repair of post-AMI VSD and evaluated trends of mortality, mechanical circulatory support (MCS) device use, and surgical approach. We included all patients who had surgical VSD repair following AMI who were included in a regional quality collaborative from May 2008 through January 2020. The primary outcome was in-hospital mortality. A univariate logistic regression model was utilized for each clinical variable on in-hospital mortality, while a multivariable model was used on age and variables that showed significant association (p <0.05) in the univariable model. Of the 79 patients who received repair, 32 (41%) were ≥70 years, 49 (62%) were male, and 28 (35%) died. The preoperative mean ejection fraction was 35%. Cardiogenic shock (CS) was observed in 53% (alive vs dead: 39% vs 79%, p = 0.001), while 6% required cardiopulmonary resuscitation (alive vs dead: 2% vs 14%, p = 0.05). MCS devices including extracorporeal membrane oxygenation were used in 22% (alive vs dead: 4% vs 54%, p <0.001). Emergent surgery was performed in 37% (alive vs dead: 18% vs 71%, p <0.001),concomitant aortic valve replacement in 10% (alive vs dead: 11% vs 9%, p = 0.029), and delayed intervention (beyond 7 days) in 44% (alive vs dead: 57% vs 21%, p = 0.002). Intraoperatively, blood products were used in 49% (alive vs dead: 45% vs 57%, p = 0.005). Following repair, 22% suffered from renal failure (alive vs dead: 19% vs 48%, p = 0.021). Patients who experienced delayed intervention had higher survival rates probably related to survival bias. Patients who suffered in-hospital mortality were more likely to have CS and to require MCS. Improvement in patient selection by a "Heart Team" approach and new therapeutic options are needed as part of advanced care for mechanical complications of AMI.

HOOK3 Amplification in Bladder Urothelial Carcinoma: Insights from Gene Expression and Survival Analysis.

Bladder urothelial carcinoma (BUC) poses a significant health challenge, ranking as the fourth most common cancer among men in the United States, with a mortality rate of approximately 20%. Genetic abnormalities such as mutations in the telomerase reverse transcriptase (TERT) gene and loss of heterozygosity (LOH) on chromosome 9 are commonly observed in BUC; however, many genes involved remain unidentified. This study aimed to explore the role of HOOK3 in BUC and its impact on survival. Using data from The Cancer Genome Atlas (TCGA) and cBioPortal, we performed differential gene expression and survival analyses to compare the patients with and without HOOK3 amplification. Our findings revealed that 2.2% of genes were up-regulated and 5.3% down-regulated in the HOOK3-amplified group. These changes suggest that HOOK3 amplification is linked to distinct gene expression patterns, with a higher proportion of down-regulated genes. Pathway enrichment related to chromatin remodeling, ion transport, and mitochondrial function suggests that HOOK3 may promote genomic stability and transcriptional regulation, contributing to tumor suppression. The involvement of mitochondrial and ribosomal pathways in protein synthesis and chromosome segregation may also protect against chromosomal abnormalities and uncontrolled cell growth. HOOK3 amplification appears to correlate with improved patient survival. These results suggest a potential protective role of HOOK3 amplification in BUC. Further research is needed to explore the underlying mechanisms and their therapeutic potential for reducing BUC-related mortality.

CT-based radiomics analysis for prediction of pathological subtypes of lung adenocarcinoma

ObjectiveLung cancer is a leading cause of cancer-related deaths worldwide, and its early and accurate diagnosis is crucial for improving patient survival. This paper developed an artificial intelligence (AI) model based on machine learning combined with radiomics for predicting the pathologic type of ground glass nodules (GGN). It explored its potential and challenges in practical applications. MethodsA total of 179 GGN patients with postoperative pathologically confirmed lung adenocarcinoma from June 2022 to June 2024 were collected from a hospital, including 22 cases of atypical adenomatous hyperplasia (AAH), 61 cases of adenocarcinoma in situ (AIS), 55 cases of invasive adenocarcinoma (IAC), and 41 cases of minimally invasive adenocarcinoma (MIA). Two experienced radiologists outlined the imaging data's regions of interest (ROI). Radiomic features were extracted and selected through normalization, mutual information, Spearman correlation coefficient, recursive feature elimination, and LASSO regression. Different machine learning models were developed and the best model was determined based on classification accuracy. ResultsDifferent machine learning models were trained and tested, and a variety of deep learning models were selected for comparison, among which Random Forest had the highest accuracy of 83.3%, and the AUC value of 0.892(95%CI, 0.846-0.923) in recognizing lung adenocarcinoma types. The AUC values reached 0.92 and 0.94 respectively in diagnosing AIS and IAC. ConclusionRadiomics combined with machine learning models, such as Random Forest, outperform average physician diagnostic accuracy in identifying lung adenocarcinoma types. The model is valuable for early and precise lung adenocarcinoma diagnosis, enhancing clinical decision-making.

Next-Generation Cancer Phenomics: A Transformative Approach to Unraveling Lung Cancer Complexity and Advancing Precision Medicine.

Lung cancer remains one of the leading causes of cancer-related deaths globally, with its complexity driven by intricate and intertwined genetic, epigenetic, and environmental factors. Despite advances in genomics, transcriptomics, and proteomics, understanding the phenotypic diversity of lung cancer has lagged behind. Next-generation phenomics, which integrates high-throughput phenotypic data with multiomics approaches and digital technologies such as artificial intelligence (AI), offers a transformative strategy for unraveling the complexity of lung cancer. This approach leverages advanced imaging, single-cell technologies, and AI to capture dynamic phenotypic variations at cellular, tissue, and whole organism levels and in ways resolved in temporal and spatial contexts. By mapping the high-throughput and spatially and temporally resolved phenotypic profiles onto molecular alterations, next-generation phenomics provides deeper insights into the tumor microenvironment, cancer heterogeneity, and drug efficacy, safety, and resistance mechanisms. Furthermore, integrating phenotypic data with genomic and proteomic networks allows for the identification of novel biomarkers and therapeutic targets in ways informed by biological structure and function, fostering precision medicine in lung cancer treatment. This expert review examines and places into context the current advances in next-generation phenomics and its potential to redefine lung cancer diagnosis, prognosis, and therapy. It highlights the emerging role of AI and machine learning in analyzing complex phenotypic datasets, enabling personalized therapeutic interventions. Ultimately, next-generation phenomics holds the promise of bridging the gap between molecular alterations and clinical and population health outcomes, providing a holistic understanding of lung cancer biology that could revolutionize its management and improve patient survival rates.

Resistance mechanisms of non-small cell lung cancer and improvement of treatment effects through nanotechnology: a narrative review.

Lung cancer continues to be the leading cause of cancer-related deaths globally. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases. Although targeted therapies and immune checkpoint inhibitors have improved clinical outcomes for NSCLC patients, primary and acquired resistance remain significant obstacles to effective treatment. This review aims to elucidate the molecular mechanisms of NSCLC resistance and explore the potential of nanotechnology-based drug delivery systems in overcoming these resistance barriers. The research team conducted a comprehensive literature search in PubMed, Cochrane Library, Google Scholar, Embase, Web of Science, China National Knowledge Internet (CNKI), and Wanfang Database, covering the period from January 1st, 2007 to January 1st, 2024. This review summarizes the molecular mechanisms of NSCLC resistance, including target alterations, bypass signaling pathways, phenotypic transformations, and immunosuppressive mechanisms. It discusses the use of nanotechnology-based drug delivery systems (such as polymeric nanoparticles, liposomes, dendrimers, and inorganic nanoparticles) to overcome various resistance barriers. Additionally, it highlights the role of nanotechnology-based immunotherapeutic strategies in modulating tumor immunity. The review also explores methods for rationally designing combination nanomedicine strategies to address resistance issues at multiple levels, thereby enhancing the effectiveness of NSCLC treatment. A deep understanding of the mechanisms of NSCLC resistance and the innovative application of nanotechnology-based delivery strategies are crucial for improving patient survival. Rationally designing combination nanomedicine strategies that target multiple resistance mechanisms simultaneously holds promise for overcoming NSCLC resistance and enhancing treatment effectiveness. Further research is needed to investigate the clinical translation of emerging nanotechnologies, providing more effective treatment strategies for NSCLC patients.