Individualized Treatment Strategies Research Articles

A Systematic Review of Comparative Effectiveness of Interventions for Low Anterior Resection Syndrome: Impacts on Bowel Function and Quality of Life.

Low anterior resection syndrome (LARS) is a common complication following sphincter-preserving surgical resection for rectal cancer, characterized by symptoms such as fecal incontinence, urgency, and altered bowel habits, which significantly affect patients' quality of life. This cluster of symptoms not only limits their day-to-day physical activity but also has a debilitating effect on their emotional and mental well-being, undermining their integration and overall psychological health. This systematic review aimed to evaluate the effectiveness of invasive and non-invasive interventions for LARS, including pelvic floor rehabilitation, transanal irrigation, and various surgical options such as sacral neuromodulation and stoma formation, either as part of primary surgery or as a definitive treatment option for refractory cases. We systematically searched relevant databases for studies published in the last decade, focusing on adult patients diagnosed with LARS post-low anterior resection (LAR), with outcomes assessed through bowel function and quality of life metrics. The review identified six studies that met our eligibility criteria; a pooled cohort of 794 patients was identified, with sample sizes ranging from 37 to 430 participants. Our analysis revealed that pelvic floor rehabilitation significantly improves bowel function and quality of life in patients with LARS; yet, the optimal management approach remains unclear due to variability in patient responses. These findings highlight the inherent complexity and heterogeneity of LARS management, underscoring the necessity for multifaceted and individualized treatment strategies. Although pelvic floor rehabilitation shows promise, especially among motivated patients, its long-term sustainability remains uncertain. Surgical options are typically reserved for severe cases and carry significant risks and psychological impacts. For patients identified as being at high risk for LARS, treatment options must be considered and discussed at an earlier phase of their care. Our review concludes with the need for a tailored, patient-centered approach to managing LARS, highlighting the importance of ongoing research to fill existing evidence gaps. There is a need for translational research across various treatment modalities, comparing their effects, cost-effectiveness, implementation strategies, and the consequent effects on patients' quality of life and mental health.

Comparative Analysis of Digital Transcriptomics Between Pre- and Post-Treatment Samples of Patients with Locally Advanced Cervical Cancer: A Preliminary Study

Cervical cancer remains a leading cause of cancer-related deaths in women worldwide, with limited treatment options for advanced stages and therapy-resistant cases. Despite advances in treatment, the variability in the patient response to standard therapies underscores the need for molecular biomarkers to guide personalized treatment strategies. This study aimed to explore the transcriptomic changes associated with the therapeutic response in locally advanced cervical cancer, focusing on 770 immune-related genes. We employed a digital multiplexed gene expression analysis, comparing gene expression profiles between matching pre- and post-treatment samples. The results revealed the significant upregulation of C7 and EGR2 in the post-treatment samples, suggesting that enhanced immune activity is a key factor in therapeutic success. Conversely, IL17RB, S100A7, and SAA1 were upregulated in the pre-treatment samples, potentially indicating resistance mechanisms. Pathway enrichment analysis highlighted that the immune response and apoptosis pathways are crucial to post-treatment changes. These findings suggest that C7, EGR2, and IL17RB may serve as biomarkers for predicting therapeutic outcomes and could inform the development of more effective, individualized treatment strategies for cervical cancer. This study provides new insights into the molecular mechanisms underlying treatment response and resistance.

Prognostic value of diffuse high-risk plaque in patients with acute myocardial infarction: a three-vessel optical coherence tomography study

Abstract Background Existing evidence has identified that high-risk plaque (HRP) characterized by a thin-cap fibroatheroma and/or a minimal lumen area ≤ 3.5 mm² were indicative of future cardiovascular events. Diffuse coronary artery disease also contributes to the poor prognosis. Purpose The present study aims to assess the prognostic value of diffuse HRP in patients with acute myocardial infarction (AMI) by using three-vessel optical coherence tomography (OCT). Methods A total of 674 patients with AMI who underwent OCT examination of three major epicardial arteries between January 2017 and December 2018 were consecutively studied. Among 2843 nonculprit lesions detected by OCT, 1375 (48.4%) HRPs were identified and divided into diffuse HRP group (lesion length >20mm, n=443) and focal HRP group (lesion length ≤20mm, n=932). Patients were followed up for a median period of 5 years. Major adverse cardiovascular event (MACE) was defined as the composite of cardiac death, nonculprit lesion-related nonfatal myocardial infarction, and unplanned coronary revascularization. Results The average age of all enrolled patients is 56.7±11.4 years, with 74.9% of male. As compared with focal HRP group, diffuse HRP group had longer lesion length [25.8(23.0,30.8) mm vs. 13.2(9.8,16.1) mm, P<0.001], longer lipid length [18.6(12.3,24.9) mm vs. 7.0(4.5,10.5) mm, P<0.001], and thinner minimal fibrous cap thickness [73.3(53.3,106.7) μm vs. 93.3(60.0,130.0) μm, P<0.001], whereas mean lipid arc was comparable between the two groups. The prevalence of nonculprit plaque rupture (14.2% vs. 7.8%, P<0.001) was significantly higher in diffuse HRP group than that in the focal HRP group. Nonculprit lesions in diffuse HRP group had higher incidence of macrophage accumulation, microvessels, cholesterol crystals, calcification, and layered plaque phenotype than those in focal HRP group (all P<0.001). The incidence of nonculprit lesion-related MACE was 4.7% in diffuse HRP group and 1.7% in focal HRP group [HR: 3.155, 95% confidence interval: 1.579 to 6.301, P=0.002]. Conclusions In patients with AMI, diffuse HRP at nonculprit segment has higher levels of plaque vulnerability and is predictive of future adverse cardiovascular events. Further studies are warranted to investigate the individual treatment strategy of diffuse and focal HRP.Figure 1.Nonculprit plaque vulnerabilityFigure 2.MACE

Identification and validation of a prognostic model based on three TLS-Related genes in oral squamous cell carcinoma

BackgroundThe tertiary lymphoid structures (TLSs) have an immunomodulatory function and have a positive impact on the survival outcomes of patients with oral squamous cell carcinoma (OSCC). However, there is a lack of standard approaches for quantifying TLSs and prognostic models using TLS-related genes (TLSRGs). These limitations limit the widespread use of TLSs in clinical practice.MethodsA convolutional neural network was used to automatically detect and quantify TLSs in HE-stained whole slide images. By employing bioinformatics and diverse statistical methods, this research created a prognostic model using TCGA cohorts and explored the connection between this model and immune infiltration. The expression levels of three TLSRGs in clinical specimens were detected by immunohistochemistry. To facilitate the assessment of individual prognostic outcomes, we further constructed a nomogram based on the risk score and other clinical factors.ResultsTLSs were found to be an independent predictor of both overall survival (OS) and disease-free survival in OSCC patients. A larger proportion of the TLS area represented a better prognosis. After analysis, we identified 69 differentially expressed TLSRGs and selected three pivotal TLSRGs to construct the risk score model. This model emerged as a standalone predictor for OS and exhibited close associations with CD4 + T cells, CD8 + T cells, and macrophages. Immunohistochemistry revealed high expression levels of CCR7 and CXCR5 in TLS + OSCC samples, while CD86 was highly expressed in TLS- OSCC samples. The nomogram demonstrates excellent predictive ability for overall survival in OSCC patients.ConclusionsThis is the first prognostic nomogram based on TLSRGs, that can effectively predict survival outcomes and contribute to individual treatment strategies for OSCC patients.

A novel classification of congenital cervicothoracic scoliosis: identification of coronal subtypes and their prognostic significance.

To propose a novel classification system for stratifying coronal curve patterns in congenital cervicothoracic scoliosis with hemivertebrae (CTS-HV). Type A: regional cervicothoracic deformity only disturbing the balance of head-neck-shoulder complex; Type B: cervicothoracic deformity with significant trunk tilt to the convex side; Type C: cervicothoracic deformity with a significant compensatory thoracic curve. The reliability and reproducibility were assessed via the Kappa test. The differences among different subtypes in deformity parameters and bony structures were compared to identify the causative factors predisposing to different subtypes. 98 patients were classified into Type A (47 cases), Type B (31 cases), and Type C (20 cases). The Kappa test showed excellent reliability (Kappa value = 0.847) and reproducibility (Kappa value = 0.881). The proportions of Klippel-Feil syndrome in Types B (71.0%) and C (85.0%) were significantly higher than in Type A (46.8%; all P < 0.05). Type A (66.0%) and Type B (71.0%) predominantly had their hemivertebra (HV) at T3 or T4, while Type C (75%) mostly had HV at T1 or T2. Type B exhibited the most severe trunk tilt, head shift, neck tilt, head tilt, and coronal balance distance (all P < 0.05). Type C had the lowest T1 tilt and first rib angle despite the greatest cervicothoracic Cobb angle (all P < 0.05). This novel reliable classification allows a better understanding of structural diversity and different coronal compensatory mechanisms for the natural progression of CTS-HV. It can contribute to determining the individualized treatment strategy and standardizing academic communication for this rare clinical entity.

Ai-driven Predictive Analytics, Healthcare Outcomes, Cost Reduction, Machine Learning, Patient Monitoring

Integrated with predictive analytics and machine learning, AI has exceeded the traditional approaches of health care contexts by focusing on patient outcomes and costs. This paper aims to discuss the adoption of integrated AI in healthcare systems, categorizing these by how AI predictive models help improve patient health by proactively estimating the course of their illness and its potential impact, prioritizing patient readmissions, and developing effective individualized treatment strategies. The research also identifies more important savings realised through avoiding redundant tests, better utilisation of resources, and shorter hospitalisations. In the current study, the authors present concrete findings for AI-driven Predictive Analytics based on realistic scenarios and quantitative data of health care systems. It also points to the fact that healthcare organisations adopting the use of AI technology have gained an objective that reduced their operations costs by 25% and improved patient outcomes whereby the readmission rates were reduced by between 15% and 20%. Furthermore, there is an evaluation of the ethical considerations of applying AI in healthcare, especially on the subject of patient’s information security. To the best of our knowledge, this study is the first to systematically review AI applications in healthcare and provide detailed suggestions for better understanding the general impact of AI in healthcare to enhance patient outcomes and manage costs. With advancement in artificial intelligence technology, there is a growing importance of how the technology can transform the health care industry.

The effect of antidiabetic drugs on bone metabolism: a concise review.

Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia, which derives from either insufficient insulin production [type 1 diabetes mellitus (T1DM)] or both impaired insulin sensitivity along with inadequate insulin production [type 2 diabetes mellitus (T2DM)] and affects millions of people worldwide. In addition to the adverse effects of DM on classical target organs and tissues, skeletal health can also be adversely affected. There is considerable evidence linking DM with osteoporosis. The fracture risk in patients with DM differs upon the type of diabetes, and it appears to be related to the type of anti-diabetic treatment. Antidiabetic drugs may have various effects on bone health. Most of them have neutral or even favorable effects on bone metabolism with the exception of thiazolidinediones (TZDs). Some studies suggest that TZDs may have negative impact on bone health by decreasing bone formation and increasing the fracture risk. There are also limited studies linking the use of canagliflozin, a Sodium-glucose contransporter-2 inhibitor (SGLT2i), with increased fracture risk. On the other hand, therapies that are based on incretin effect, like Dipeptidyl peptidase-4 inhibitors (DPP-4i) and Glucagon-like peptide-1 receptor agonizts (GLP-1RAs) might have positive effects on bone health by promoting bone formation. Herein we review the impact of antidiabetic drugs on bone health, highlighting the potential benefits and risks associated with these medications in an attempt to contribute to the development of personalized treatment strategies for individuals with DM.

The Role of Hearing Difficulty: Cognitive-Communication and Speech-in-Noise Deficits in Adults Following Mild Traumatic Brain Injury

Purpose: Mild traumatic brain injury (TBI) has a high rate of occurrence across the lifespan. Following mild TBI (mTBI), perceived deficits in cognitive communication and hearing may be noted. This study aimed to determine if adults with a history of mTBI and hearing difficulty perceived greater degrees of cognitive-communication difficulty and performed poorer on a speech-in-noise task when compared to participants with mTBI and controls without reported hearing difficulty. Method: Adults aged 19–77 years with and without a history of mTBI were analyzed. Participants were divided into three groups: control ( n = 49), mTBI ( n = 22), and mTBI with hearing difficulty (mTBI-HD, n = 26). Perception of hearing difficulty was based on a score of ≥ 20 on the Hearing Handicap Inventory or a score ≥ 2 on the Adult Auditory Performance Scale. Self-perceived cognitive communication was measured using the Cognitive Difficulties Scale (CDS) and the La Trobe Communication Questionnaire (LCQ). Speech-in-noise performance was measured using the low-cue speech recognition threshold (SRT) from the Listening in Spatialized Noise–Sentences (LiSN-S) test. Results: Adults in the mTBI-HD group reported significantly greater degrees of cognitive-communication difficulties (higher CDS and LCQ scores) and exhibited significantly poorer speech-in-noise performance on the low-cue LiSN-S condition when compared to the control and mTBI groups. Results also revealed significant correlations between the LiSN-S low-cue SRT and perceived cognitive communication on the CDS. Conclusions: Results of the current study indicate that adults with a history of mTBI and hearing difficulty experience greater subjective cognitive-communication difficulties and perform more poorly on difficult speech-in-noise tasks than adults who do not experience self-perceived hearing difficulties. The results of this study support the consideration of hearing and cognitive-communication difficulties when determining appropriate speech, language, and hearing assessment, treatment, and intervention strategies for individuals following mTBI.

Emerging Role of Natriuretic Peptides in Diabetes Care: A Brief Review of Pertinent Recent Literature

Diabetes markedly increases susceptibility to adverse cardiovascular events, including heart failure (HF), leading to heightened morbidity and mortality rates. Elevated levels of natriuretic peptides (NPs), notably B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP), correlate with cardiac structural and functional abnormalities, aiding in risk stratification and treatment strategies in individuals with diabetes. This article reviews the intricate relationship between diabetes and HF, emphasizing the role of NPs in risk assessment and guiding therapeutic strategies, particularly in individuals with type 2 diabetes mellitus (T2DM). We also explore the analytical and clinical considerations in the use of natriuretic peptide testing and the challenges and prospects of natriuretic-peptide-guided therapy in managing cardiovascular risk in patients with diabetes. We conclude with some reflections on future prospects for NPs.

Juvenile idiopathic arthritis management: insights into the utilization of intra-articular corticosteroid injections

ABSTRACT Background Juvenile idiopathic arthritis (JIA) is a common chronic rheumatic disease in children, requiring careful management to reduce both short- and long-term morbidity. In this study, our objective was to assess the clinical features of patients diagnosed with JIA who received intra-articular corticosteroid injections (IACI). Methods In this retrospective study, we evaluated the clinical and laboratory characteristics of 225 JIA patients monitored from January 2012 to October 2023 at a tertiary care center. We focused on patients who underwent intra-articular corticosteroid injections (IACI) as part of their treatment. Triamcinolone hexacetonide (TH) was used due to its demonstrated safety and efficacy. Results Our analysis revealed that IACI, particularly utilizing TH, was a widely employed and effective adjunct therapy, contributing to rapid symptom relief and local disease control. Patients receiving IACI exhibited earlier symptom onset, younger age at diagnosis, longer follow-up durations, and higher cumulative treatment burden (p < 0.001, p < 0.001, p < 0.01, p < 0.001 respectively). Despite inconclusive acute-phase reactants, a higher frequency of ANA positivity and elevated initial lymphocyte counts were associated with increased IACI use (p < 0.001, p < 0.001 respectively). Importantly, on a joint basis, a high percentage of arthritis remission following IACI underscores its efficacy and favorable safety profile. Conclusions Notably, the high percentage of arthritis remission achieved with intra-articular corticosteroid injections (IACI) on a joint-specific basis highlights its efficacy and favorable safety profile. A lymphocyte count exceeding 5000/mm3 at the time of diagnosis may serve as an early indicator for considering intra-articular steroid administration. These findings emphasize the need for nuanced and individualized treatment strategies in JIA management to optimize outcomes for affected children.

Component-resolved diagnostics of fruit and vegetable allergy: precise identification and individualized treatment strategies

Vegetable and fruit allergies are common types of food allergies worldwide, most of them are triggered by primary sensitization to pollen. Most allergens in vegetables and fruits belong to a few cross-reactive proteins such as PR-10 proteins, profilins, and nsLTPs. The presence of these allergens in various plants can lead to widespread cross-reactive allergic responses. Component-resolved diagnostics (CRD) can improve diagnostic accuracy by precisely identifying specific allergenic proteins, aiding physicians in making more accurate treatment and management decisions, and reducing unnecessary food avoidance. This article, based on the "Molecular Allergology User's Guide 2.0 (MAUG 2.0)" issued by the European Academy of Allergy and Clinical Immunology (EAACI), analyzes the primary mechanisms, relevant allergens, and diagnostic and clinical management strategies for vegetable and fruit allergies. By detailing and analyzing these allergenic components, this article may help the healthcare professionals to deep the understandings of vegetable and fruit allergies, offer new perspectives and practical guideline for the research and treatment of these allergies, and promot the development of precise diagnostics and personalized treatment strategies.

Drug Metabolizing Enzymes: An Exclusive Guide into Latest Research in Pharmaco-genetic Dynamics in Arab Countries.

Drug metabolizing enzymes play a crucial role in the pharmacokinetics and pharmacodynamics of therapeutic drugs, influencing their efficacy and safety. This review explores the impact of genetic polymorphisms in drug-metabolizing genes on drug response within Arab populations. We examine the genetic diversity specific to Arab countries, focusing on the variations in key drug-metabolizing enzymes such as CYP450, GST, and UGT families. The review highlights recent research on polymorphisms in these genes and their implications for drug metabolism, including variations in allele frequencies and their effects on therapeutic outcomes. Additionally, the paper discusses how these genetic variations contribute to the variability in drug response and adverse drug reactions among individuals in Arab populations. By synthesizing current findings, this review aims to provide a comprehensive understanding of the pharmacogenetic landscape in Arab countries and offer insights into personalized medicine approaches tailored to genetic profiles. The findings underscore the importance of incorporating pharmacogenetic data into clinical practice to enhance drug efficacy and minimize adverse effects, ultimately paving the way for more effective and individualized treatment strategies in the region.

Case Report: Spontaneous cornual Pregnancy at 7 Weeks: A Gynecological challenge

Introduction and Importance Cornual pregnancy (CP) is a rare and dangerous type of ectopic pregnancy, occurring in 2% to 4% of cases. Due to its atypical location in the uterine horn, it poses a high risk for severe complications, such as rupture of the uterus, and life-threatening bleeding, particularly when diagnosis is delayed. Case Presentation We report the case of a 35-year-old female patient presenting with severe pelvic pain and vaginal bleeding, with 12 weeks of amenorrhea. Clinical evaluation revealed elevated β-HCG levels and transvaginal ultrasound showed a 7-week unruptured right cornual pregnancy. Surgical management involved a mini-laparotomy, which confirmed the diagnosis and a cornuostomy along with a right salpingectomy was performed. The patient’s postoperative course was uneventful, and follow-up confirmed complete recovery. Clinical Discussion Cornual pregnancies, though rare, carry a significant risk of serious complications and maternal death due to delayed diagnosis. Risk factors encompass a history of miscarriage, elective abortion, sexually transmitted infections, and smoking, all contributing to abnormal implantation. Early diagnosis is challenging but crucial, with ultrasound being key for detection. Management depends on gestational age, patient stability, and future reproductive plans, with methotrexate or surgical intervention being standard options. Conclusion Cornual pregnancy, despite its rarity, demands prompt and accurate diagnosis to prevent catastrophic outcomes. This case underscores the need for individualized treatment strategies and highlights the importance of early intervention. Ongoing research is vital to improving diagnostic approaches and therapeutic outcomes.

On placental and lactational transfer of IgG-based therapeutic proteins - Current understanding and knowledge gaps from a clinical pharmacology perspective.

Maternal medication use may expose the developing fetus through placental transfer or the infant through lactational transfer. Because pregnant and lactating individuals have been historically excluded from early drug development trials, there is often limited to no human data available to inform pharmacokinetics (PK) and safety in these populations at the time of drug approval. We describe the known mechanisms of placental or lactational transfer of IgG-based therapeutic proteins and use clinical examples to highlight the potential for fetal or infant exposure during pregnancy and lactation. Placental transfer of IgG-based therapeutic proteins may result in systemic exposure to the developing fetus. A lactational transfer may be associated with local gastrointestinal (GI) exposure in the infant and may also result in systemic exposure, although data are very limited as proteins have shown instability in the GI tract. Understanding of PK and pharmacodynamic (PD) effects of IgG-based therapeutic proteins in infants exposed in utero as well as the potential exposure through human milk and its clinical implications is critical for developing treatment strategies for pregnant or lactating individuals. We share the current knowledge gaps and considerations for future evaluations to inform PK, PD, and the safety of IgG-based therapeutic proteins for safe use during pregnancy and lactation. With the increasing use of IgG-based therapeutic proteins in treating chronic diseases during pregnancy and lactation, there is a need to improve the quantity and quality of data to inform the safe use in pregnant and lactating individuals.

Uncommon Presentation Of A Giant Retroperitoneal Liposarcoma: A Peculiar Case Study

Introduction: Soft tissue sarcomas constitute less than 1% of all neoplasms, with approximately one-third of malignant tumors in the retroperitoneum being sarcomas. Among these, liposarcoma emerges as the most prevalent type. Retroperitoneal liposarcomas with intraperitoneal extension and extension into the inguinal canal are relatively uncommon, presenting a challenge for treatment due to their local aggressiveness and clinical nonspecificity. The clinical difficulty in managing these cases is exacerbated by patients often seeking medical attention late in the disease progression. The slow development and the scarcity of symptoms in the early stages contribute to delayed reporting. Consequently, these tumors are recognized for their capacity to reach enormous sizes before being diagnosed and addressed. Case Report: We present a case involving a 52-year-old man who underwent surgical resection for a massive, well-differentiated retroperitoneal liposarcoma. This tumor exhibited intraperitoneal extension and weighed a substantial 6.8 kilograms. Discussion: Retroperitoneal liposarcomas (RPS) frequently manifest as large, locally advanced lesions. The occurrence of RPS with intraperitoneal extension and extension into the inguinal canal is relatively uncommon. The clinical presentation is often delayed, attributed to the expansive nature of the retroperitoneal space. Evaluating these tumors necessitates a comprehensive, multimodal approach. Given that most RPS are characterized as low-grade, distant metastasis is infrequent, and the primary challenge lies in achieving effective local control and preventing recurrence. The preferred treatment involves radical resection of these tumors, incorporating en bloc resection of involved structures. In certain cases, the strategic use of neoadjuvant and adjuvant therapies, tailored to specific tumor histologies, may enhance local control and overall survival. Conclusion: Effectively managing retroperitoneal liposarcomas necessitates a multidisciplinary approach, ideally conducted at high-volume centers that specialize in the treatment of patients facing these intricate malignancies. Existing data indicate that radical resection stands as the primary opportunity for a cure. In select cases, chemotherapy and radiation therapy may offer a survival benefit, underlining the importance of individualized treatment strategies based on the specific characteristics of the tumor and the patient

Lamotrigine vs levetiracetam in female patients of childbearing age with juvenile absence epilepsy: A Bayesian reanalysis.

Women of childbearing age with juvenile absence epilepsy (JAE) face treatment challenges due to limited access to safe and effective anti-seizure medications (ASMs). In a previous study we compared the effectiveness of levetiracetam (LEV) and lamotrigine (LTG) in women with idiopathic generalized epilepsy (IGE), highlighting a superiority of LEV in juvenile myoclonic epilepsy. In this study, we specifically reanalyzed, through a Bayesian approach and by expanding the previously published cohort, the comparative effectiveness of these ASMs as initial monotherapy in JAE. We conducted a multicenter, retrospective, comparative effectiveness study on women of childbearing age diagnosed with JAE and prescribed LEV or LTG as the initial ASM. Inverse probability treatment weighting (IPTW) Bayesian Cox proportional hazard models were employed to evaluate treatment failure (TF) due to ineffectiveness and ASM retention. The patients' center of provenance and year of prescription were considered as random effect factors. Posterior probabilities and relative log-risk distribution were computed, and the distribution of posterior draws was analyzed to assess the evidence supporting LTG superiority over LEV. Of 123 patients, those treated with LTG (n = 67) demonstrated lower TF and higher ASM retention than those treated with LEV (n = 56), with the IPTW-weighted Bayesian Cox proportional hazards model showing a 99.2% posterior probability of LTG being superior on TF and a 99.5% probability on ASM retention. Additional analyses on ≥50% and ≥75% seizure reduction through IPTW-weighted Bayesian logistic regression largely confirmed these findings, whereas the two ASMs did not show evident differences in terms of seizure freedom. The two ASMs showed comparable safety profiles, with only a minority of patients discontinuing treatment due to side effects. Bayesian reanalysis supports LTG as first-line monotherapy for JAE in women of childbearing age, emphasizing the importance of individualized treatment strategies in women with IGE. This study underscores the value of Bayesian methods in refining clinical research and treatment decisions.

Impact of Age on Prescribing Patterns of Cardiovascular Medications in Older Japanese Patients with Non-Dialysis-Dependent Chronic Kidney Disease: A Cross-Sectional Study.

Older patients with chronic kidney disease (CKD) are more likely to be excluded from clinical trials. This exclusion affects the quality of cardiovascular disease (CVD) prevention in this population. Baseline data from the Fukuoka Kidney Disease Registry (FKR) cohort, which included 4476 adult patients with CKD stages G1-G5, were cross-sectionally analyzed to compare the use of recommended drugs for preventing CVD in each age group. Different prescribing patterns were observed according to age for the cardiovascular drug classes. Older patients with CKD were less likely to receive renin-angiotensin system (RAS) inhibitors and were more likely to receive calcium channel blockers. The proportion of anticoagulation prescriptions for patients with CKD and atrial fibrillation decreased in the older age group (≥ 75 years). However, the proportion of antiplatelet therapy in patients with ischemic CVD increased linearly with age, even in the very old group aged ≥ 85 years. These findings suggest a severe cardiovascular burden in patients with CKD. Notably, RAS inhibitor use was avoided in the older group despite a severe cardiovascular burden, such as a high prevalence of CVD history and massive albuminuria ＞300 mg/g creatinine. This finding indicates that an older age independently contributed to the non-use of RAS inhibitors, even after adjusting for other covariates. This study suggests that age is a potential barrier to the treatment of patients with CKD and highlights the need to establish individualized treatment strategies for cardiovascular protection in this population.

Development and Validation of an Early Recurrence Predictive Model for Intrahepatic Cholangiocarcinoma Based on a Systematic Review and Meta-Analysis of 17 Cohorts

BackgroundIntrahepatic cholangiocarcinoma (ICC) is a rare malignant tumor with a high incidence of recurrence after surgery. This study aims to identify the early recurrence (ER) risk factors in ICC and develop an ER predictive model for ICC. MethodA computerized search was performed in Embase, Web of Science, Cochrane Library, and PubMed to identify studies focusing on the risk factors associated with ER in ICC. Based on the results of the meta-analysis, an ER predictive model was developed and validated using an external cohort of patients diagnosed with ICC through postoperative pathological examinations who received curative-intent surgery at West China Hospital of Sichuan University. ResultsA total of 4,534 ICC patients from 17 studies were included in the meta-analysis. The results indicated that gender, preoperative serum level of CA199, CEA, tumor size, tumor number, differentiation, macrovascular invasion, microvascular invasion, perineural invasion, lymph node metastasis, and AJCC T stage were ER risk factors for ICC. All risk factors were scored according to their weightings, and a risk predictive model was established. The area under the curve of the validation cohort was 0.902, indicating high predictive accuracy. Additionally, the calibration curve demonstrated that the predicted ER rate aligned well with the actual ER rate in the validation cohort. ConclusionThe predictive model accurately assesses the risk of ER in ICC patients undergoing surgical resection, providing valuable prognostic insights and guiding the tailoring of individualized treatment strategies to improve patient outcomes.

Classification of Neoadjuvant Therapy Response in Patients With Colorectal Liver Metastases Using Contrast-Enhanced Ultrasound—With Histological Pathology as the Gold Standard

ObjectiveTo evaluate the response to neoadjuvant therapy in patients with colorectal liver metastases (CRLMs) using ultrasound(US) and contrast-enhanced ultrasound(CEUS), with correction to the tumor regression grade (TRG) of pathological results. MethodsThis study included patients with resectable CRLMs admitted from February to December 2022. After at least 4 cycles neoadjuvant therapy, all the patients received US and CEUS examinations within two weeks before hepatectomy. CEUS clips were postprocessed with color parameter imaging (CPI) and microflow imaging (MFI) analysis. Logistic regression analyses were used to develop an evaluation Nomogram. Ultrasound-based model was constructed to discriminate between the response (TRG1/2/3) and nonresponse (TRG4/5) groups at the lesion level. The model's predictive ability was evaluated using the C index and calibration curve, with decision curve analysis assessing the Nomogram's added value. ResultsThe study analyzed 105 CRLM lesions (the lesion with the highest diameter analyzed for each patient), with 43.8% showing a response to therapy. Univariate analysis identified calcification on US (p = 0.039), CEUS enhancement degree (p < 0.001), CEUS enhancement pattern (p<0.001), CEUS washout type (p < 0.001), CEUS necrosis (p < 0.001), CPI feeding artery (p = 0.003) and MFI pattern (p < 0.001) were significantly associated with TRG. The multivariate analysis showed CEUS enhancement pattern (p = 0.026), CEUS washout type (p = 0.018) and CEUS necrosis (p = 0.005) were independently associated with the neoadjuvant therapy response. A Nomogram with the three independent predictors was developed, with an AUC of 0.898. ConclusionThe ultrasound-based model provided accurate evaluation of pathological tumor response to preoperative chemotherapy in patients with CRLM, and may help to decide the individualized treatment strategy.

IMPACT OF LESION COMPLEXITY ON PCI SUCCESS IN LAD DISEASE: A RETROSPECTIVE STUDY

Coronary artery disease (CAD) involving the left anterior descending (LAD) artery is a major cause of morbidity and mortality globally. The prognosis of patients with coronary artery disease depends on the extent of at-risk myocardium. LAD comparatively supplies a large percentage of the left ventricle compared to RCA or LCX. The principal indication of percutaneous coronary intervention is to improve the quality of life in patients with angina refractory to medications. There are many advancements in PCI techniques for better management of challenging lesions due to physiological, anatomical, or functional difficulties. Some of the complex lesions include ostial lesions, bifurcating lesions, calcified lesions, and chronic total occlusions. However, as lesion complexity plays a significant role in procedural success and long-term outcomes, complex lesions are often associated with increased rates of restenosis, adverse events, and procedural challenges Objective: This study aims to evaluate the impact of lesion complexity on PCI success in patients with LAD disease. Methods: This retrospective cohort study was conducted from January 1, 2021, to December 31, 2023, at a tertiary cardiovascular center. A total of 216 participants who had PCI to LAD lesions done were included. Lesion complexity was assessed using the SYNTAX score and categorised into low, intermediate, and high complexity groups. The primary outcome was restenosis at 12 months, defined as ≥50% luminal narrowing in patients requiring repeat angiography due to any indication. Secondary outcomes included procedural success, major adverse cardiac events (MACE), and rates of stent thrombosis. Data were analysed using SPSS version 24.0, with statistical significance set at p &lt; 0.05. Results: Among the 216 participants, 72% were male, and the mean age was 61.4 ± 9.8 years. Restenosis occurred in 13.9% of participants, with higher rates observed in patients with high-complexity lesions (24.5%) compared to low-complexity lesions (7.7%) (p = 0.02). Procedural success was achieved in 92.6% of cases, though it decreased with increasing lesion complexity (97.8% for low, 93.4% for intermediate, and 85.7% for high-complexity groups). MACE occurred in 4.6% of participants, with stent thrombosis noted in 2.7%. Conclusion: Lesion complexity significantly influences PCI success and restenosis rates in LAD disease. Patients with higher complexity lesions experience worse outcomes, necessitating individualised treatment strategies to optimise procedural success.