Improved Survival In Patients Research Articles

Surgical treatment for hepatocellular carcinoma in era of multidisciplinary strategies.

Hepatocellular carcinoma (HCC) remains a significant global health challenge, with over 800,000 new cases diagnosed annually. This comprehensive review examines current surgical approaches and emerging multidisciplinary strategies in HCC treatment. While traditional surgical criteria, such as the Barcelona Clinic Liver Cancer (BCLC) staging system, have been relatively conservative, recent evidence from high-volume Asian centers supports more aggressive surgical approaches in carefully selected patients. The review discusses the evolution of selection criteria, including the new "Borderline Resectable HCC" classification system, which provides more explicit guidance for surgical decision-making. Technical innovations have significantly enhanced surgical precision, including three-dimensional simulation, intraoperative navigation systems, and the advancement of minimally invasive approaches. The review evaluates the ongoing debate between anatomical versus non-anatomical resection and examines the emerging role of robotic surgery. In liver transplantation, expanded criteria beyond the Milan criteria show promising outcomes, while the integration of novel biomarkers and imaging techniques improves patient selection. The role of preoperative and adjuvant therapies is increasingly important, with recent trials demonstrating the potential of immune checkpoint inhibitors combined with anti-VEGF agents in both settings. Despite these advances, postoperative recurrence remains a significant challenge. The review concludes that successful HCC treatment requires a personalized approach, integrating surgical expertise with emerging technologies and systemic therapies while considering individual patient factors and regional variations in practice patterns.

Examined lymph node counts affected the staging and survival in cervical cancer: a retrospective study using the SEER and Chinese cohort

Background The impact of examined lymph node (LN) count on survival in cervical cancer remains understudied, with no consensus on the optimal number required. Objectives We aimed to investigate the role of LN count in postoperative pathological evaluation for cervical cancer patients undergoing surgery. Methods Data from the US SEER database and a retrospective Chinese cohort were analyzed. Multivariable logistic and Cox regression models assessed LN positivity detection and overall survival (OS), respectively. Smoothing spline curves and Chow tests identified structural change points in hazard ratios and LN-positive ratios. Results Among 14,133 SEER and 2,811 Chinese cases, higher LN counts correlated with increased detection of positive LNs (OR: 1.040, 95% CI: 1.019–1.062) and improved OS (HR: 0.990, 95% CI: 0.984–0.996). Structural change points occurred at 20 LNs for LN-negative patients and 13 LNs for LN-positive patients (both P < 0.001). An elevated LN-positive ratio (positive/examined LNs) strongly predicted worse OS (HR: 4.208; 95% CI: 1.454–12.181). Conclusions An increased number of examined LNs significantly contributes to the detection of positive LNs and improved patient survival. For patients with claimed LN-negative and LN-positive disease, a minimum examination of 20 and 13 LNs, respectively, is recommended to ensure adequate LN evaluation. The LN positive ratio is a strong prognostic indicator in patients with LN-positive disease.

The Present State and Potential Applications of Artificial Intelligence in Cancer Diagnosis and Treatment.

An aberrant increase in cancer incidences has demanded extreme attention globally despite advancements in diagnostic and management strategies. The high mortality rate is concerning, and tumour heterogeneity at the genetic, phenotypic, and pathological levels exacerbates the problem. In this context, lack of early diagnostic techniques and therapeutic resistance to drugs, sole awareness among the public, coupled with the unavailability of these modern technologies in developing and low-income countries, negatively impact cancer management. One of the prime necessities of the world today is the enhancement of early detection of cancers. Several independent studies have shown that screening individuals for cancer can improve patient survival but are bogged down by risk classification and major problems in patient selection. Artificial intelligence (AI) has significantly advanced the field of oncology, addressing various medical challenges, particularly in cancer management. Leveraging extensive medical datasets and innovative computational technologies, AI, especially through deep learning (DL), has found applications across multiple facets of oncology research. These applications range from early cancer detection, diagnosis, classification, and grading, molecular characterization of tumours, prediction of patient outcomes and treatment responses, personalized treatment, and novel anti-cancer drug discovery. Over the past decade, AI/ML has emerged as a valuable tool in cancer prognosis, risk assessment, and treatment selection for cancer patients. Several patents have been and are being filed and granted. Some of those inventions were explored and are being explored in clinical settings as well. In this review, we will discuss the current status, recent advancements, clinical trials, challenges, and opportunities associated with AI/ML applications in cancer detection and management. We are optimistic about the potential of AI/ML in improving outcomes for cancer and the need for further research and development in this field.

Therapeutic efficacy of immune-oncology combination therapy in advanced renal cell carcinoma without prior nephrectomy.

Immuno-oncology (IO) combination therapies, including IO + IO or IO + vascular endothelial growth factor targeted therapies (VEGF-TT), have become the standard first-line treatment for advanced renal cell carcinoma (RCC). However, the optimal regimen for patients without prior nephrectomy remains unclear. Data from 99 patients with advanced RCC without nephrectomy, treated with VEGF-TT, IO + IO, or IO + VEGF-TT between May 2008 and May 2024, were retrospectively reviewed and analyzed. Patients were divided into VEGE-TT, IO + IO, and IO + VEGF-TT groups based on their first-line treatment, and survival and tumor response were compared. All patients included in this study were categorized as either intermediate or poor risk according to the International Metastatic RCC Database Consortium risk classification. Among the 99 included patients, 41 initiated first-line therapy with VEGF-TT, 36 with IO + IO, and 22 with IO + VEGF-TT. The objective response rates were 17.5% for VEGF-TT, 38.9% for IO + IO, and 61.9% for IO + VEGF-TT. Notably, the IO + VEGF-TT group showed the greatest shrinkage of target kidney lesions (p = 0.0042). In multivariate analyses, bone metastasis (hazard ratio (HR) = 1.812, 95% confidence interval (CI) 1.017-3.228, p = 0.0436) and the first-line regimen (VEGF-TT vs IO + VEGF-TT: HR = 0.129, 95% CI 0.045-0.369, p = 0.0001) were independent prognostic factors for progression-free survival. The first-line regimen (VEGF-TT vs IO + VEGF-TT: HR = 0.303, 95% CI 0.104-0.879, p = 0.0279) independently affected overall survival. IO combination therapy, especially IO + VEGF-TT, has demonstrated a higher anti-tumor response in patients with advanced RCC without nephrectomy and may also be highly effective against primary renal tumors. Therefore, further studies are needed to improve patient survival and validate efficacy of IO combination therapy.

Recent Developments in Nanotechnology and Immunotherapy for the Diagnosis and Treatment of Pancreatic Cancer.

Pancreatic cancer kills millions of people worldwide each year and is one of the most prevalent causes of mortality that requires prompt therapy. A large number of people who have pancreatic cancer are detected at an advanced stage, with incurable and drug-resistant tumors. Hence the overall survival rate of pancreatic cancer is less. The advance phase of this cancer is generated because of the expression of the cancer-causing gene, inactivation of the tumorsuppressing gene, and deregulation of molecules in different cellular signalling pathways. The prompt diagnosis through the biomarkers significantly evades the progress and accelerates the survival rates. The overexpression of Mesothelin, Urokinase plasminogen activator, IGFR, Epidermal growth factor receptor, Plectin-1, Mucin-1 and Zinc transporter 4 were recognized in the diagnosis of pancreatic cancer. Nanotechnology has led to the development of nanocarriersbased formulations (lipid, polymer, inorganic, carbon-based and advanced nanocarriers) that overcome the hurdles of conventional therapy, chemotherapy and radiotherapy, which causes toxicity to adjacent healthy tissues. Biocompatibility, toxicity and large-scale manufacturing are the hurdles associated with the nanocarriers-based approaches. Currently, Immunotherapy-based techniques have emerged as an efficient therapeutic alternative for the prevention of cancer. Immunological checkpoint targeting techniques have demonstrated significant efficacy in human cancers. Recent advancements in checkpoint inhibitors, adoptive T cell therapies, and cancer vaccines have shown potential in overcoming the immune evasion mechanisms of pancreatic cancer cells. Combining these immunotherapeutic approaches with nanocarriers holds great promise in enhancing the antitumor response and improving patient survival.

Role of respiratory secretion culture in the surgical outcome prediction of bacterial empyema.

Thoracic empyema is a serious infection. Video-assisted thoracoscopic surgery is a recommended treatment, and pleural fluid and tissue cultures are collected intraoperatively. The combination of a pleural peels tissue culture and a pleural fluid culture improves the positive culture rate. We aimed to investigate the role of respiratory secretion cultures to determine the optimal management for improving surgical outcome. The study analyzed 225 adult patients with phase II/III thoracic empyema who underwent thoracoscopic decortication. Respiratory secretion cultures were obtained and compared with pleural cultures. Key outcomes were culture positivity and pathogen consistency, with secondary outcomes including intensive care unit stay, hospital stay, and mortality. There were 225 empyema patients with either a positive pleural fluid culture or a positive pleural peel tissue culture. Of these, 76 patients had positive respiratory secretion culture findings during hospitalization. The most common pathogen species were Pseudomonas aeruginosa (44%) and Klebsiella pneumoniae (16%) in the respiratory secretion cultures and Streptococcus spp. (38%) and Klebsiella pneumoniae (12%) in the pleural cultures. There were 30 patients having a common pathogen in the respiratory secretion culture and in the pleural fluid/tissue culture. Poor outcome measures were found in these patients, including the longer use of antibiotics preoperatively [2.50 (1.00-6.00) days versus 5.00 (2.75-11.00) days, p = 0.006] and a higher mortality rate during hospitalization (40.0% versus 17.4%, p = 0.002). Respiratory secretion cultures are vital for predicting surgical outcomes in bacterial empyema, and prompt specimen collection can improve patient survival.

Spatial profiling of endoplasmic reticulum stress markers in tumor associated cells predicts patient outcomes in pancreatic cancer.

The impact of endoplasmic reticulum (ER) stress in tumor-associated cells, such as cancer associated fibroblasts (CAFs), immune cells and endothelial cells, on patient outcomes in clinical specimens have not been examined. For the first time, we characterized the expression and spatial locations of ER stress markers, BiP and CHOP, in tumor-associated cells and assessed their prognostic significance in a panel of pancreatic ductal adenocarcinoma (PDAC) patient samples. Multiplex immunofluorescence was performed on tumor microarrays and images were analyzed using HALO AI software. BiP and CHOP were upregulated in CAFs and endothelial cells in PDAC sections relative to non-neoplastic pancreas sections. High BiP expression in CAFs and endothelial cells was associated with greater vascular invasion and in immune cells was correlated with increased tumor size. High CHOP expression in immune cells correlated with poor patient survival. CAFs and immune cells were more likely to express BiP or CHOP when located close (< 20 μm) to tumor cells. High expression of CHOP in CAFs close to tumor cells correlated with improved patient survival. For the first time, this study demonstrated that ER stress occurs in CAFs and immune cells predominantly in proximity to tumor cells in PDAC patient tissue. The correlation of high ER stress in immune cells with poor patient survival highlights the importance of the TME and the use of spatial analysis for the identification of novel biomarkers.

Abstract TMP78: Beyond Recanalization: Predicting Poor Outcomes in Successful Vertebrobasilar Thrombectomy

Background: Successful recanalization following endovascular thrombectomy (EVT) in vertebrobasilar artery occlusions (VBAOs) does not uniformly translate into favorable functional outcomes. Identifying predictors of futile recanalization is critical for improving patient selection and treatment strategies. This study aimed to compare patients with good versus poor functional outcomes despite successful recanalization in VBAO and to establish predictive factors for futile recanalization. Methods: We retrospectively analyzed patients who achieved successful recanalization after EVT for VBAO from a prospectively maintained database between 2014-2024. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days; dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcomes. Demographic data, clinical characteristics, procedural variables, and imaging findings were compared between the groups using pairwise comparisons and multivariable logistic regression models to identify predictors of futile recanalization. Results: Among the 163 patients who qualified for final analysis, 73 (44.8%) had good functional outcomes, while 90 (55.2%) had poor outcomes despite successful recanalization. Age (72 years vs. 64 years, p=0.0014), baseline NIHSS score (22 vs. 14, p&lt;0.0001), and serum glucose levels (142 mg/dL vs. 124 mg/dL, p=0.0109) were significantly higher in patients with poor outcomes. In addition, intubation (57.1% vs. 25.4%, p&lt;0.001) and prior history of diabetes mellitus (34.4% vs. 17.8%, p=0.017) and coronary artery disease (33.3% vs. 16.4%, p=0.014) were more prevalent in the poor outcome group. Multivariable analysis confirmed that advanced age (OR 0.73, 95% CI: 0.57-0.93, p=0.012), higher serum glucose (OR 0.90, 95% CI: 0.82-0.99, p=0.025), NIHSS at 24-36 hours post-last known well (OR 0.61, 95% CI: 0.38-0.98, p=0.039), and mRS at discharge (OR 0.0001, 95% CI: 0.0002-0.064, p=0.005) were independent predictors of poor functional outcomes, indicating futile recanalization. A subgroup analysis of patients with complete recanalization (mTICI 2c/3) further validated these findings. Conclusion: Futile recanalization after EVT for VBAO is linked to older age, elevated serum glucose levels, higher NIHSS scores at 24-36 hours, and poor mRS at discharge. These factors should be carefully considered in clinical decision-making to improve patient selection for EVT in VBAO.

Chitosan and hyaluronic acid in colorectal cancer therapy: A review on EMT regulation, metastasis, and overcoming drug resistance.

Up to 90% of cancer-related fatalities could be attributed to metastasis. Therefore, understanding the mechanisms that facilitate tumor cell metastasis is beneficial for improving patient survival and results. EMT is considered the main process involved in the invasion and spread of CRC. Essential molecular components like Wnt, TGF-β, and PI3K/Akt play a role in controlling EMT in CRC, frequently triggered by various factors such as Snail, Twist, and ZEB1. These factors affect not only the spread of CRC but also determine the reaction to chemotherapy. The influence of non-coding RNAs, especially miRNAs and lncRNAs, on the regulation of EMT is clear in CRC. Exosomes, involved in cell-to-cell communication, can affect the TME and metastasis of CRC. Pharmacological substances and nanoparticles demonstrate promise as efficient modulators of EMT in CRC. Chitosan and HA are two major carbohydrate polymers with considerable potential in inhibiting CRC. Chitosan and HA can be employed to modify nanoparticles to enhance cargo transport for reducing CRC. Additionally, chitosan and HA-modified nanocarriers, which can be utilized as potential approaches in suppressing EMT and reversing drug resistance in CRC, can inhibit EMT and chemoresistance, crucial components in tumorigenesis.

Real-world outcomes of targeted therapies and local interventions in BRAF V600E–mutated metastatic colorectal cancer: A single-center retrospective study.

203 Background: Metastatic colorectal cancer (mCRC) patients with BRAF V600E mutations, especially those with microsatellite stable (MSS) tumors, have poor prognoses. Chemotherapy has limited efficacy in this subgroup, especially for second-line or subsequent-line treatments. Current research is increasingly focusing on the integration of targeted therapies and local interventions, but real-world evidence remains scarce, particularly from Asian cohorts. This study leverages real-world data to evaluate the impact of novel therapeutic combinations, including triplet and doublet targeted therapies, alongside local treatments in this high-risk patient population. Methods: This retrospective study includes MSS-type mCRC patients with BRAF V600E mutations treated at the Sixth Affiliated Hospital of Sun Yat-sen University between April 2014 and May 2024. Patients receiving targeted therapies were stratified into three groups: Triplet group (BRAF, EGFR, and MEK inhibitors, including Dabrafenib, Cetuximab and Trametinib), Doublet group (BRAF and EGFR inhibitors, including Dabrafenib and Cetuximab or Encorafenib and Cetuximab), and Doublet target-chemotherapy group (BRAF and EGFR inhibitors combined with chemotherapy, including Vemurafenib, Irinotecan, and Cetuximab). Primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS) and objective response rate (ORR). Results: Among 239 enrolled patients, 58 received targeted therapy and 68 underwent conventional chemotherapy as second-line treatment. 63.5% (80/126) of these patients underwent local interventions, including primary tumor resection, metastasectomy, CRS±HIPEC, and liver ablation. Targeted therapy demonstrated significantly improved mPFS compared to conventional chemotherapy (5.5 vs. 4.2 months, HR = 0.44; 95% CI: 0.29-0.68, p &lt; 0.001). OS did not differ significantly between the two treatment arms (12.7 vs. 12.1 months, HR = 0.80; 95% CI: 0.50-1.25, p = 0.330). In the triplet group, ORR, mPFS, and mOS were 21%, 5.8 months and 18.0 months, respectively, showing a trend towards enhanced efficacy compared to the other targeted therapy groups, albeit without statistical significance. Patients who received targeted therapy (n=35) or chemotherapy (n=45) in combination with local interventions demonstrated significantly prolonged OS compared to those without local therapy (mOS: 22.3 vs. 9.6 months; HR = 0.19; 95% CI: 0.09-0.42; p &lt; 0.001 and 14.3 vs. 10.9 months; HR = 0.53; 95% CI: 0.29-0.98; p = 0.042, respectively). Conclusions: Optimal treatment for BRAF V600E mCRC remains under investigation. This study suggests that combining targeted therapies with selective local interventions may significantly improve patient survival in this challenging subgroup, warranting further prospective evaluation.

Acneiform Eruption Secondary to Deucravacitinib: A Case Series and Review of the Literature.

Acneiform eruptions have been observed and reported in clinical trials for tyrosine kinase 2 (TYK2) inhibitors. However, data on their occurrence in real-world settings remain limited. This case series describes six patients, who developed acneiform eruptions following the initiation of deucravacitinib for chronic plaque psoriasis. Through this case series, we aim to shed further light into the clinical characteristics and potential risk factors for this side effect. Contrary to clinical trial data, we demonstrate high cessation rates of deucravacitinib following the development of acneiform eruption, due to the significant burden on quality of life. We highlight the need to identify risk factors to improve patient selection and allow adequate counselling or prophylactic treatments for these acneiform eruptions.

Cardiac resynchronization therapy in heart failure based on Strauss criteria for left bundle branch block.

The left bundle branch block (LBBB) is a strong predictor of response to cardiac resynchronization therapy (CRT). However, a significant number of patients do not respond to the treatment. The study sought to evaluate the impact of the stricter Strauss criteria for left bundle branch block (St-LBBB) on CRT response, hospitalizations, ventricular arrhythmia (VA) events and mortality. This study is a retrospective analysis of prospectively collected data on heart failure (HF) patients with LBBB admitted for CRT implantation. Patients were divided into two groups according to the fulfilment or not of St-LBBB criteria. The study included 82 patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy [46 (56%) with St-LBBB and 36 (44%) with non-St-LBBB]. Patients with St-LBBB showed higher CRT response rates compared with those with non-St-LBBB (P<0.01), while the group with NICM exhibited the greatest benefit (P<0.01). St-LBBB CRT responders displayed significantly lower rates of HF hospitalization (P<0.0001) compared with the non-St-LBBB group. According to Kaplan-Meier time curves, this was primarily evident in patients with NICM (P<0.0001). CRT responders displayed significantly fewer VA events (P<0.001) and lower mortality rates (P<0.0001) than non-responders. Kaplan-Meier estimates demonstrated a significantly lower incidence of VAs in NICM patients with St-LBBB (P=0.049) compared with ICM patients with St-LBBB (P=0.25). Lower mortality rates were observed in CRT responders than non-responders (P<0.0001), with the group of NICM with St-LBBB criteria exhibiting the greatest benefit (P=0.0238). Patients with NICM and St-LBBB present the greatest benefit concerning CRT response, HF hospitalizations, VA events and mortality. Although St-LBBB criteria seem to improve patient selection for CRT, more data are needed to elucidate the role of St-LBBB criteria in this setting.

Blood-based prognostic scores and early dynamics under immunotherapy to select patients with metastatic solid tumors for continuing immune check-point inhibition: a prospective longitudinal study.

Immune check-point inhibitors (ICI) were a major breakthrough in cancer care, but optimal patient selection remains elusive in most tumors. Overall 173 adult patients with metastatic solid tumors candidates to ICI in clinical trials at our Institution were prospectively recruited. Blood samples were collected at cycle 1 (C1D1) and 2 (C2D1) and until the occurrence of progressive disease (PD). C1D1 LIPI, RMH, PMHI, NLR, dNLR, PIPO and GRIm prognostic scores were calculated. The primary endpoint was identifying the best score to predict rapid PD (≤ 4months) with ICI using logistic regressions accounting for tumor type, and receiving operators characteristics (ROC) with area under curve (AUC), accompanied by an extensive comparison of the score performances in the prediction of overall survival (OS), progression-free survival (PFS), overall response rates (ORR) and durable clinical benefit (DCB). Secondary objectives included describing study cohort outcomes and studying the association between the selected score at C1D1, C2D1 and its dynamics with OS and PFS. C1D1 LIPI was the best predictor of rapid PD, OS and PFS, regardless of cancer type, compared to other scores. No score was associated to ORR and only RMH to DCB. Baseline LIPI detected three categories of patients with significantly different OS (p < 0.001) and PFS (p = 0.013). The same was observed at C2D1 for OS and PFS (both p = 0.020). Significant LIPI class shifts were observed in the overall population (p < 0.001), rapid progressors (p = 0.029) and non-rapid progressors (p = 0.009). Retaining a good LIPI or experiencing a shift towards a better prognostic class was associated to improved OS (p = 0.009) and PFS (p = 0.006). C2D1 LIPI, but not C1D1, remained significantly associated to rapid PD in multivariable analysis. LIPI may improve patient selection for ICI and guide treatment adjustments according to on-treatment dynamics in a pancancer context.

Multimodal Artificial Intelligence Model for Prediction of Abdominal Aortic Aneurysm Shrinkage After Endovascular Repair ( the ART in EVAR study).

The goal of the study described in this protocol is to build a multimodal artificial intelligence (AI) model to predict abdominal aortic aneurysm (AAA) shrinkage 1 year after endovascular aneurysm repair (EVAR). In this retrospective observational multicenter study, approximately 1000 patients will be enrolled from hospital records of 5 experienced vascular centers. Patients will be included if they underwent elective EVAR for infrarenal AAA with initial assisted technical success and had imaging available of the same modality preoperatively and at 1-year follow-up (CTA-CTA or US-US). Data collection will include baseline and vascular characteristics, medication use, procedural data, preoperative and postoperative imaging data, follow-up data, and complications. The cohort will be stratified into 3 groups of AAA remodeling based on the maximum AAA diameter difference between the preoperative and 1-year postoperative moment. Patients with a diameter reduction of ≥5 mm will be assigned to the AAA shrinkage group, cases with an increase of ≥5 mm will be assigned to the AAA growth group, and patients with a diameter increase or reduction of <5 mm will be assigned to the stable AAA group. Furthermore, an additional fourth group will include all patients who underwent an AAA-related reintervention within the first year after EVAR, because both the complication and the reintervention might have influenced the state of AAA remodeling at 1 year. The preoperative and postoperative CTA scans will be used for anatomical AAA analysis and biomechanical assessment through semi-automatic segmentation and finite element analysis. All collected clinical, biomechanical, and imaging data will be used to create an AI prediction model for AAA shrinkage. Explainable AI techniques will be used to identify the most descriptive input features in the model. Predicting factors resulting from the AI model will be compared with conventional univariate and multivariate logistic regression analyses to find the best model for the prediction of AAA shrinkage. The study is registered at www.clinicaltrials.gov under the registration number NCT06250998. This study aims to develop a robust and high-performance AI model for predicting AAA shrinkage one-year after EVAR, with great potential for optimizing both EVAR treatment and follow-up. The model can identify cases with an initially lower chance of early AAA shrinkage, in whom EVAR-treatment could be tailored by including additional preoperative coil embolization, active sac management and/or postoperative tranexamic acid therapy, which have shown to promote AAA shrinkage rate but are too complex and costly to perform in all patients. The model could aid in stratification of post-EVAR surveillance based on the patient's individual risk and possibly decrease follow-up for the 40-50% of patients who will experience AAA sac shrinkage. Overall, the AI prediction model is expected to improve patient survival and decrease the number of reinterventions after EVAR and associated healthcare costs.

Use of Double-Layer Carotid Stents is Associated with Improved Patient Survival and Lower Neurological Complications: A Single-Center Retrospective Observational Study

Background/Objectives: Dual-layer stents (DLS) with micromesh technology may offer better protection from plaque protrusion compared to single-layer stents (SLS), but little data are available. The aim of this study is to compare clinical outcomes of elective carotid artery stenting for asymptomatic and symptomatic patients treated for primary CAS with DLS or SLS in a high-volume center. Methods: This study is a single-center retrospective cohort study and included patients who underwent elective CAS between December 2006 and September 2023. The final analysis included patient baseline characteristics, postoperative complications and patient outcomes. Results: A total of 573 patients underwent elective carotid artery stenting in the study period. Most of the 573 patients undergoing CAS were male (62.5%), and the median age of patients at the time of CAS was 70 years. Of the 573 eligible patients, 43.5% (n = 249) were asymptomatic and 56.4% (n = 323) were symptomatic. Analyzing neurological complications, it was found that the only factor that had a statistically significant effect was the type of stent used. Patients who had a carotid stenting procedure using a single-layer carotid stent had statistically significantly more periprocedural neurological complications (8.3% (n = 35)) than the double-mesh stent group (2% (n = 3)), mostly due to more transient ischemic attacks in the single-layer stent group (4% (n = 17)) compared to the double-mesh group (0.7% (n = 1)). Conclusions: The use of carotid double-layer stents is associated with a low rate of periprocedural and postprocedural events.

Identification of Lipid Species Signatures in FOLFOXIRI-Resistant Colorectal Cancer Cells

Chronic drug treatment can alter the lipidome of cancer cells, potentially leading to significant biological changes, such as drug resistance or increased tumor aggressiveness. This study examines the lipidome profiles of four human colorectal cancer (CRC) cell lines, comparing treatment-naïve cells with the same cells after chronic exposure to a clinically used combination therapy (FOLFOXIRI: folinic acid, 5-fluorouracil, oxaliplatin, and irinotecan). Lipidomic profiling was obtained with untargeted liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS). For data deconvolution and to interpret the multifactorial dataset generated, Analysis of Variance Multiblock Orthogonal Partial Least Squares (AMOPLS) was used. Our results indicate specific shifts in triglycerides (TGs), sphingolipids, and phospholipids in CRC cells resistant to FOLFOXIRI. The overall shift in TGs, phosphatidylcholine, and cholesteryl ester species was notably linked to FOLFOXIRI resistance (-R) in SW620 cells, whereas an increased abundance of phospholipids, mainly hexosylceramide and sphingomyelin, was present in the signatures of HCT116-R, LS174T-R, and DLD1-R cells. These altered lipid species may serve as potential prognostic markers in CRC following chemotherapy. Furthermore, lipid-targeting therapies aimed at reprogramming the lipid profiles of drug-resistant cells could play a crucial role in restoring drug sensitivity and improving patient survival.

Radiomics-Based Prediction of Treatment Response to TRuC-T Cell Therapy in Patients with Mesothelioma: A Pilot Study

Background/Objectives: T cell receptor fusion constructs (TRuCs), a next generation engineered T cell therapy, hold great promise. To accelerate the clinical development of these therapies, improving patient selection is a crucial pathway forward. Methods: We retrospectively analyzed 23 mesothelioma patients (85 target tumors) treated in a phase 1/2 single arm clinical trial (NCT03907852). Five imaging sites were involved, the settings for the evaluations were Blinded Independent Central Reviews (BICRs) with double reads. The reproducibility of 3416 radiomics and delta-radiomics (Δradiomics) was assessed. The univariate analysis evaluated correlations at the target tumor level with (1) tumor diameter response; (2) tumor volume response, according to the Quantitative Imaging Biomarker Alliance; and (3) the mean standard uptake value (SUV) response, as defined by the positron emission tomography response criteria in solid tumors (PERCISTs). A random forest model predicted the response of the target pleural tumors. Results: Tumor anatomical distribution was 55.3%, 17.6%, 14.1%, and 10.6% in the pleura, lymph nodes, peritoneum, and soft tissues, respectively. Radiomics/Δradiomics reproducibility differed across tumor localizations. Radiomics were more reproducible than Δradiomics. In the univariate analysis, none of the radiomics/Δradiomics correlated with any response criteria. With an accuracy ranging from 0.75 to 0.9, three radiomics/Δradiomics were able to predict the response of target pleural tumors. Pivotal studies will require a sample size of 250 to 400 tumors. Conclusions: The prediction of responding target pleural tumors can be achieved using a machine learning-based radiomics/Δradiomics analysis. Tumor-specific reproducibility and the average values indicated that using tumor models to create an effective patient model would require combining several target tumor models.

Utility of left atrial strain in characterizing patients with reablated atrial fibrillation

Abstract Introduction and Objectives Atrial fibrillation (AF) is a highly prevalent condition, with projections indicating it will increase in the future. Various ablation techniques exist to try to eliminate the arrhythmia, but the problem of recurrences and the need for reinterventions are not uncommon. We need markers to predict which patients will benefit from these procedures and which will recur despite our efforts. Atrial strain techniques have emerged as a novel tool in assessing the function and degree of atrial fibrosis, which could improve patient selection and increase the success of procedures. Methods A retrospective analysis was conducted, including adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 59 healthy patients with no history of cardiovascular disease, labeled as "normal studies" by the examiner, served as the control group, and another group of 47 patients with recurrent AF with at least two ablation procedures were included. Various left atrial strain values (Reservoir, Conduit, and Pump) of each patient were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups. Results Patients with reablated AF showed significantly lower absolute strain values compared to normal patients in all three analyzed varieties (Reservoir, Conduit, and Pump) with p&amp;lt;0.01 for all comparisons. The mean strain in the control group was 41.80 for reservoir strain, -24.01 for conduit strain, and -17.07 for pump strain; while the mean in the AF group was 17.42, -11.72, and -6.33, respectively. Conclusions We found significant differences in left atrial strain values between normal patients and patients with reablated AF. These findings suggest that left atrial strain could be useful in selecting patients for AF ablation procedures, as those more prone to recurrence exhibit lower absolute strain values, indicating a higher degree of atrial fibrosis where anomalous circuits may establish and perpetuate the arrhythmia over time. Normal Vs Atrial fibrillation

Role of Traditional Chinese Medicine in Lung Cancer Management: A Review.

With the continuous advancements in modern medicine, significant progress has been made in the treatment of lung cancer. Current standard treatments, such as surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy, have notably improved patient survival. However, the adverse effects associated with these therapies limit their use and impact the overall treatment process. Traditional Chinese medicine (TCM) has shown holistic, multi-target, and multi-level therapeutic effects. Numerous studies have highlighted the importance of TCM's role in the comprehensive management of lung cancer, demonstrating its benefits in inhibiting tumor growth, reducing complications, mitigating side effects, and enhancing the efficacy of conventional treatments. Here, we review the main mechanisms of TCM in combating lung cancer, inducing cancer cell cycle arrest and apoptosis. These include inhibiting lung cancer cell growth and proliferation, inhibiting cancer cell invasion and metastasis, suppressing angiogenesis and epithelial-mesenchymal transition (EMT), and modulating antitumor inflammatory responses and immune evasion. This paper aims to summarize recent advancements in the application of TCM for lung cancer, emphasizing its unique advantages and distinctive features. In promoting the benefits of TCM, we seek to provide valuable insights for the integrated treatment of lung cancer.

CTCs Detection Methods In Vivo and In Vitro and Their Application in Tumor Immunotherapy.

Circulating tumor cells (CTCs) are tumor cells that detach from the primary tumor site and enter the bloodstream. They hold significant value for the early detection, diagnosis, and treatment of tumors. CTC detection methods can be classified into in vivo and in vitro techniques. Compared to traditional tumor detection methods, CTC detection causes less harm to the body and allows for earlier identification of malignant tumors, thereby enabling timely treatment and improving patient survival rates. In recent years, CTC detection has been widely used to assess the effectiveness of tumor immunotherapy. Dynamic monitoring of CTCs can help optimize clinical treatment strategies. This review summarizes the latest in vivo and in vitro detection methods for CTCs and discusses their applications in immunotherapy for various common tumors, aiming to provide better guidance and support for clinical practice.