Individualized Treatment Strategies Research Articles

Ischemic Stroke in a Child with Sickle Cell Anemia, Patent Foramen Ovale and Moya-Moya Syndrome: The Challenges of Implementing a Secondary Prevention Strategy

Strokes, traditionally regarded as conditions affecting adults, can also occur in the pediatric population, where their rarity often delays diagnosis. This report describes the case of a seven-year-old boy with sickle cell anemia who was admitted with left-sided motor deficits. The patient had been febrile and recumbent the previous day. Laboratory tests revealed severe anemia (hemoglobin 6.7 g/dL). During hospitalization, a transthoracic echocardiogram identified a patent foramen ovale (PFO) with left-to-right atrial flow and dilation of the left heart chambers. Brain imaging revealed lesions in the vascular border zones, while cerebral angiography confirmed severe stenosis in the internal carotid artery and a Moyamoya pattern. Following an etiological investigation, the symptoms were attributed to an ischemic stroke. Empirical antimicrobial therapy, blood transfusions, and antiplatelet therapy were initiated. Two potential mechanisms for the stroke were identified: PFO and Moya-Moya syndrome (MMS). The coexistence of these rare conditions in a pediatric patient presented unique diagnostic and therapeutic challenges. MMS was considered the primary cause of the stroke due to characteristic imaging findings and the patient’s history of sickle cell anemia. This case highlights the complexities of managing pediatric strokes with dual pathologies and the importance of a multidisciplinary approach. It advances clinical understanding by demonstrating how PFO complicates secondary prevention in MMS and emphasizes the need for individualized treatment strategies and long-term follow-up to optimize outcomes.

Diabetes-inducing effects of bronchial asthma.

The relationship between diabetes mellitus (DM) and asthma is complex and can impact disease trajectories. To explore the bidirectional influences between the two conditions on clinical outcomes and disease control. We systematically reviewed the literature on the relationship between DM and asthma, focusing on their impacts, mechanisms, and therapeutic implications. Various studies were assessed, which investigated the effect of glycemic control on asthma outcomes, lung function, and exacerbations. The study highlighted the role of specific diabetes medications in managing asthma. The results showed that poor glycemic control in diabetes can exacerbate asthma, increase hospitalizations, and reduce lung function. Conversely, severe asthma, especially in obese individuals, can complicate diabetes management and make glycemic control more difficult. The diabetes-associated mechanisms, such as inflammation, microangiopathy, and oxidative stress, can exacerbate asthma and decrease lung function. Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations. The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes. Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes, while asthma severity, especially in obese individuals, complicates diabetes control. However, the current research has limitations, and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.

Establishment and internal validation of a model to predict the efficacy of Adalimumab in Crohn’s disease

Background: Clinically, the ability to distinguish which Crohn’s disease patients can benefit from Adalimumab is limited. Aims: This study aimed to develop a model for predicting clinical remission probability for Crohn’s disease patients with Adalimumab at 12 weeks. The model assists clinicians in identifying which Crohn’s disease patients are likely to benefit from Adalimumab treatment before starting therapy, thus optimizing individualized treatment strategies. Methods: Demographic and clinical characteristics of Crohn’s disease patients were utilized to develop a model for clinical remission probability. LASSO regression was used to select predictive factors, and predictions were made using a logistic regression model. The model was internally validated using the bootstrap method (resampling 1000 times). Results: 68 patients with Crohn’s disease were enrolled in this study. Clinical remission was observed in 55.9% at 12 weeks. Three variables were selected through the least absolute shrinkage and selection operator regression method, including Adalimumab-positive cell count, disease duration, and neutrophil count of Crohn’s disease patients. A predictive model was constructed by multivariate logistic regression (Adalimumab-positive cell count (OR, 1.143; 95%CI, 1.056–1.261), disease duration (OR, 0.967; 95%CI, 0.937–0.986), and neutrophil count (×109/L) (OR, 1.274; 95%CI,1.014–1.734)). The predictive model yielded an area under the curve of 0.866 (95%CI, 0.776–0.956), and in the internal validation, the area under the curve was 0.870 (95%CI, 0.770–0.940). Conclusions: This model provides a convenient tool to assess the likelihood of patient remission prior to Adalimumab treatment, thereby supporting the development of personalized treatment plans.

Risk factors associated with the failure of local methotrexate combined with minimally invasive surgery for late cesarean scar pregnancy

BackgroundThis study aimed to investigate the risk factors related to the failure of initial combined local methotrexate (MTX) treatment and minimally invasive surgery for late cesarean scar pregnancy (CSP).MethodsThis retrospective case-control study was conducted between January 2016 and December 2023, involving patients with late CSP (≥ 8 weeks) who received local MTX injection combined with either hysteroscopic or laparoscopic surgery. Cesarean scar pregnancy was classified as type I, II, or III based on the direction of growth of the gestational sac and the residual myometrial thickness as assessed by ultrasound. Binary logistic regression analysis was utilized to identify the risk factors associated with the failure of the initial combined treatment.ResultsOverall, 574 patients with late CSP were included in our study. Among them, 29 patients (5.1%) experienced treatment failure with the initial local MTX combined with minimally invasive surgery, while 545 patients (94.9%) achieved successful treatment outcomes. In the univariate analysis, several potential risk factors associated with the initial combined treatment failure were identified, including baseline serum β-human chorionic gonadotropin (β-hCG) levels, type of CSP, time interval between MTX and surgery, and positive fetal heart activity before surgery. Subsequent binary logistic regression analysis revealed the following independent risk factors linked to the failure of the initial combined treatment: baseline serum β-hCG levels exceeding 94,000 IU/L [odds ratio (OR) 3.060, 95% confidence interval (CI) 1.387–6.749, P = 0.006], type III CSP (OR 3.574, 95% CI 1.147–11.135, P = 0.028), a time interval greater than seven days between MTX and surgery (OR 3.847, 95% CI 1.725–8.581, P = 0.001), and the presence of a fetal heartbeat before surgery (OR 4.405, 95% CI 1.014–19.128, P = 0.048).ConclusionThe findings indicate that higher baseline serum β-hCG levels, an extended time interval between MTX and surgery, type III CSP and a positive preoperative fetal heartbeat are significant risk factors for the failure of initial local MTX combined with minimally invasive surgery in patients with late CSP. Individualized treatment strategies are recommended for these high-risk patients with late CSP.

Effects of antidepressants on body weight in patients treated in a naturalistic setting in Oman

BackgroundThe rising use of antidepressants is critical for managing mental health disorders, but weight gain is a concerning side effect, particularly with certain classes like TCAs and SSRIs. This study aims to investigate weight changes in Omani patients prescribed paroxetine, fluoxetine, mirtazapine, or venlafaxine.MethodA cross-sectional study conducted from January to June 2023 at Sultan Qaboos University Hospital recruited adults with mental disorders on these medications. Weight measurements were taken at baseline and follow-up, with clinically significant weight gain defined as a ≥ 7% increase.ResultsA total of 135 participants were analyzed, showing a mean weight gain of 5.54 kg, with 60.7% experiencing significant weight gain. Mirtazapine and paroxetine exhibited the highest average weight increases (7.51 kg and 8.05 kg, respectively) compared to fluoxetine (0.69 kg) and venlafaxine (4.32 kg). No significant demographic factors influenced weight changes (p = 0.213).ConclusionThe study highlights significant weight gain among Omani patients on antidepressants, particularly mirtazapine and paroxetine. This underscores the importance of monitoring weight in clinical practice and necessitates further investigations into individualized treatment strategies to manage both mental health and weight-related concerns.

Mechanisms of inflammatory microenvironment formation in cardiometabolic diseases: molecular and cellular perspectives

Cardiometabolic diseases (CMD) are leading causes of death and disability worldwide, with complex pathophysiological mechanisms in which inflammation plays a crucial role. This review aims to elucidate the molecular and cellular mechanisms within the inflammatory microenvironment of atherosclerosis, hypertension and diabetic cardiomyopathy. In atherosclerosis, oxidized low-density lipoprotein (ox-LDL) and pro-inflammatory cytokines such as Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) activate immune cells contributing to foam cell formation and arterial wall thickening. Hypertension involves the activation of the renin-angiotensin system (RAS) alongside oxidative stress-induced endothelial dysfunction and local inflammation mediated by T cells. In diabetic cardiomyopathy, a high-glucose environment leads to the accumulation of advanced glycation end products (AGEs), activating the Receptor for Advanced Glycation Endproducts (RAGE) and triggering inflammatory responses that further damage cardiac and microvascular function. In summary, the inflammatory mechanisms in different types of metabolic cardiovascular diseases are complex and diverse; understanding these mechanisms deeply will aid in developing more effective individualized treatment strategies.

Unraveling the potential mechanism and prognostic value of pentose phosphate pathway in hepatocellular carcinoma: a comprehensive analysis integrating bulk transcriptomics and single-cell sequencing data.

Hepatocellular carcinoma (HCC) remains a malignant and life-threatening tumor with an extremely poor prognosis, posing a significant global health challenge. Despite the continuous emergence of novel therapeutic agents, patients exhibit substantial heterogeneity in their responses to anti-tumor drugs and overall prognosis. The pentose phosphate pathway (PPP) is highly activated in various tumor cells and plays a pivotal role in tumor metabolic reprogramming. This study aimed to construct a model based on PPP-related Genes for risk assessment and prognosis prediction in HCC patients. We integrated RNA-seq and microarray data from TCGA, GEO, and ICGC databases, along with single-cell RNA sequencing (scRNA-seq) data obtained from HCC patients via GEO. Based on the "Seurat" R package, we identified distinct gene clusters related to the PPP within the scRNA-seq data. Using a penalized Cox regression model with least absolute shrinkage and selection operator (LASSO) penalties, we constructed a risk prognosis model. The validity of our risk prognosis model was further confirmed in external cohorts. Additionally, we developed a nomogram capable of accurately predicting overall survival in HCC patients. Furthermore, we explored the predictive potential of our risk model within the immune microenvironment and assessed its relevance to biological function, particularly in the context of immunotherapy. Subsequently, we performed in vitro functional validation of the key genes (ATAD2 and SPP1) in our model. A ten-gene signature associated with the PPP was formulated to enhance the prediction of HCC prognosis and anti-tumor treatment response. Following this, the ROC curve, nomogram, and calibration curve outcomes corroborated the model's robust clinical predictive capability. Functional enrichment analysis unveiled the engagement of the immune system and notable variances in the immune infiltration landscape across the high and low-risk groups. Additionally, tumor mutation frequencies were observed to be elevated in the high-risk group. Based on our analyses, the IC50 values of most identified anticancer agents demonstrated a correlation with the RiskScore. Additionally, the high-risk and low-risk groups exhibited differential sensitivity to various drugs. Cytological experiments revealed that silencing ATAD2 or SPP1 suppresses malignant phenotypes, including viability and migration, in liver cancer cells. In this study, a novel gene signature related to the PPP was developed, demonstrating favorable predictive performance. This signature holds significant guiding value for assessing the prognosis of HCC patients and directing individualized treatment strategies.

COMPARISION BETWEEN EARLY AND DELAYED CHOLECYSTECTOMY IN ACUTE BILIARY PANCREATITIS

Background: Acute biliary pancreatitis is a common surgical emergency requiring inpatient conservative management. Cholecystectomy is critical in preventing recurrent episodes and minimizing additional biliary complications. However, the optimal timing for cholecystectomy remains a matter of ongoing debate. Early laparoscopic cholecystectomy has been suggested to improve outcomes, but further evidence is required to validate its benefits compared to delayed surgery in patients with mild to moderate acute biliary pancreatitis. Objective: This study aimed to compare the outcomes of early versus delayed laparoscopic cholecystectomy for acute biliary pancreatitis in a tertiary care hospital setting. Methods: A randomized controlled trial was conducted in the General Surgery Department of Fauji Foundation Hospital, Rawalpindi, from July 2024 to December 2024. A total of 100 patients, aged 20–60 years, with mild to moderate acute biliary pancreatitis (ASA grades I or II), were enrolled and randomized into two groups. Group A (early cholecystectomy) underwent surgery within 7 days of symptom onset, whereas Group B (delayed cholecystectomy) underwent surgery between 8 days and 6 weeks after symptom onset. Cholecystectomy was performed following a standardized laparoscopic technique. Data were analyzed using SPSS version 17, with Chi-square tests applied to compare outcomes such as intraoperative bleeding, postoperative fever, severe abdominal pain, and atelectasis. A p-value ≤0.05 was considered statistically significant. Results: The mean age of patients in the early cholecystectomy group was 43.94 ± 11.26 years, while it was 46.38 ± 9.23 years in the delayed group. Females predominated in both groups (72% in early and 70% in delayed groups). Intraoperative bleeding occurred in 20% of early cholecystectomy patients compared to 34% in the delayed group (p=0.115). Postoperative severe abdominal pain was significantly lower in the early group (18% vs. 36%; p=0.043), as was postoperative fever (22% vs. 48%; p=0.006). Atelectasis occurred in 12% of early group patients and 22% of delayed group patients, with a statistically significant difference between the groups (p=0.183). Conclusion: Early laparoscopic cholecystectomy significantly reduces postoperative complications such as severe abdominal pain and fever in patients with acute biliary pancreatitis. The findings particularly highlight the benefits for patients with elevated BMI and advanced age, advocating for individualized treatment strategies. Future studies with larger sample sizes and longer follow-up periods are recommended to confirm these results and optimize management protocols.

Induction Radiochemotherapy for Esophageal Cancer: Long-Term Outcomes from a Single-Center Study

Background/Objectives: The management of esophageal cancer (EC) remains a significant clinical challenge, particularly in optimizing therapeutic strategies for different stages and subgroups. This study assessed the impact of preoperative radiochemotherapy (CRT) on clinical staging and identified subgroups for whom definitive CRT (dCRT) may provide a favorable alternative to surgery. Methods: Sixty-one patients with esophageal adenocarcinoma or squamous cell carcinoma were enrolled. Pre-treatment staging included computed tomography, gastroscopy with biopsy, and comprehensive laboratory evaluations. Patients received preoperative CRT following the CROSS or dCRT protocols based on tumor stage. Surgical approaches included staged esophagectomy or single-stage Ivor Lewis procedures. Four patients declined surgery and were treated with dCRT. Postoperative outcomes were evaluated using pTNM classification. Follow-up included imaging and endoscopic surveillance. Statistical analyses assessed changes in staging and factors influencing treatment outcomes. Results: CRT significantly reduced T stage across the entire cohort (p = 0.0002), with complete pathological response (pT0N0M0) observed in 54.5% of patients following induction CRT (p = 0.0001). Male patients demonstrated a significant reduction in T stage (p = 0.0008), while a similar trend in females was not significant (p = 0.068). Among patients declining surgery, dCRT demonstrated acceptable oncologic control over a mean follow-up of 4 ± 0.79 years. Conclusions: Preoperative CRT effectively downstages EC and achieves high rates of response, especially in male patients. Therefore, dCRT may be a viable alternative in selected patients, emphasizing the need for individualized treatment strategies to optimize outcomes. These findings underscore the importance of refining multimodal approaches in EC care.

Four Decades of Treatment for Actinic Cheilitis: Outcomes, Challenges, and the Introduction of a New Clinical Index.

To evaluate the clinical outcomes of surgical and non-surgical treatments for actinic cheilitis (AC) over a four-decade period and to introduce a novel Clinical Index for the Treatment and Control of Actinic Cheilitis (CITC-AC) for improved patient stratification and management. A retrospective cohort study analyzed 151 patients diagnosed with AC treated at a university clinic between 1980 and 2020. Sociodemographic, clinical, and histopathological data were collected. Treatments were categorized as sun protection (SP), topical corticosteroids (TC), surgical removal (SR), and vermilionectomy. Therapeutic outcomes, recurrence rates, and malignant transformation were assessed. The CITC-AC was developed to guide clinical decision-making based on stratified risk. A total of 87% of patients achieved therapeutic resolution. Recurrence was observed in 13%, and malignant transformation occurred in 7% of cases. Surgical treatments, particularly vermilionectomy, demonstrated superior outcomes with no recurrence or malignancy. Non-surgical treatments, including the novel use of Omcion-A Orabase, achieved favorable outcomes but exhibited higher recurrence rates. The CITC-AC provided a structured framework for stratifying patients by severity and risk, aiding in the selection of appropriate interventions and follow-up schedules. This study highlights the importance of individualized treatment strategies and consistent follow-up in AC management. While surgical interventions remain the gold standard for advanced cases, non-surgical treatments are effective for early-stage lesions. The CITC-AC offers a practical tool for optimizing patient care and reducing progression to squamous cell carcinoma (SCC). Prospective studies are needed to validate its applicability across diverse clinical settings.

Machine learning Nomogram for Predicting endometrial lesions after tamoxifen therapy in breast Cancer patients

Objective Endometrial lesions are a frequent complication following breast cancer, and current diagnostic tools have limitations. This study aims to develop a machine learning-based nomogram model for predicting the early detection of endometrial lesions in patients. The model is designed to assess risk and facilitate individualized treatment strategies for premenopausal breast cancer patients. Method A retrospective study was conducted on 224 patients who underwent diagnostic curettage post-tamoxifen (TAM) therapy between November 2012 and November 2023. These patients exhibited signs of endometrial abnormalities or symptoms such as colporrhagia. Clinical data were collected and analyzed using R software (version 4.3.2) to identify factors influencing the occurrence of endometrial lesions and evaluate their predictive values. Three machine learning methods were employed to develop a risk prediction model, and their performances were compared. The best-performing model was selected to construct a nomogram of endometrial lesions. Internal validation was conducted using the bootstrap method, and the model’s accuracy and fit were assessed using the concordance index (C-index) and calibration curves. Results Independent risk factors for endometrial lesions included ultrasound characteristics, duration of TAM therapy, presence of colporrhagia, and endometrial thickness (P < 0.05). Among the machine learning methods compared, the LASSO regression integrated with a multifactorial logistic regression model demonstrated strong performance, with a concordance index (C-index) of 0.874 and effective calibration (mean absolute error of conformity: 0.014). This model achieved an accuracy of 0.853 and a precision of 0.917, with a training set AUC of 0.874 (95% CI: 0.794–0.831) and a test set AUC of 0.891 (95% CI: 0.777-1.000), closely aligning the predicted risk with the actual observed risk. Conclusion The developed prediction model is effective in evaluating endometrial lesions in premenopausal breast cancer patients. This model offers a theoretical foundation for improving clinical predictions and devising tailored treatment strategies for this patient group.

Etiology of Antisocial Personality Disorder: A Review of Brain Function and Childhood Experiences

Antisocial Personality Disorder (ASPD) is a psychological disorder in which an individual engages exclusively or significantly in the deliberate violating of, scamming, as well as violence against other people for their gain. This review aims to provide a comprehensive account of the recent developments regarding biological, neurocognitive, and neuropsychological factors and environmental risks related to ASPD. Neuroimaging studies have been conducted to assess brain function using voxel-based morphometry (VBM) and imaging of functional magnetic resonance (fMRI) to determine structural and functional changes that occur. Previous studies have recognized marked grey matter volume (GMV) disruptions in the prefrontal cortex, temporal lobes, parietal regions, and aberrant functional connectivity profiles — particularly between attention and default mode networks. Of the environmental factor, childhood trauma is crucial for leading to necessary support of ASPD phenotype with emotional or physical abuse during infancy, significantly contributing to risk-prediction capacity—the systematic review methodology involved six critical evaluations of the study on neurobiology and childhood ASPD risk factors. Consistent neuroimaging data on brain structure (grey matter volume reductions) and functional connectivity and the critical role of early life experiences in susceptibility to this disorder are shown throughout. In conclusion, ASPD's etiology is multifactorial, involving a complex interaction of biological and environmental factors. Understanding the neurological underpinnings and developmental experiences leading to ASPD can inform more targeted interventions and treatment strategies for at-risk individuals, highlighting the need for early detection and therapeutic approaches to address brain function deficits and childhood adversities.

POLYCYSTIC OVARY SYNDROME (PCOS): DIAGNOSIS, PATHOPHYSIOLOGY AND CONTEMPORARY THERAPEUTIC APPROACHES

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Elektronische Zeitschriftbibliotek Logo Bielefeld Academic Search Engine Logo Erfolgreich durch internationale Zusammenarbeit GYNECOLOGY Cite as: Archiv EuroMedica. 2024. 14; 6. DOI 10.35630/2024/14/6.606 Received 15 November 2024; Accepted 13 December 2024; Published 16 December 2024 POLYCYSTIC OVARY SYNDROME (PCOS): DIAGNOSIS, PATHOPHYSIOLOGY AND CONTEMPORARY THERAPEUTIC APPROACHES Jakub Początek orcid id logo, Szczepan Pośpiech, Jakub Prosowski orcid id logo, Michał Piotrowski orcid id logo, Piotr Serwicki email orcid id logo Medical University of Silesia, Katowice, Poland download article (pdf) piooreser@gmail.com ABSTRACT Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder impacting reproductive-aged women, manifesting through hormonal imbalances, metabolic irregularities, and reproductive health issues. It is one of the leading causes of infertility, also contributing significantly to various metabolic and psychological conditions. Effective management of PCOS depends on early and accurate diagnosis, a comprehensive understanding of it’s underlying mechanisms, and the application of individualized treatment strategies. Aim of the Study: This study seeks to consolidate existing knowledge on PCOS, outline diagnostic criteria, examine pathophysiological mechanisms, and evaluate both conventional and modern therapeutic approaches. This study aims to promote improved health outcomes and care strategies for women with PCOS by examining recent research findings. Materials and Methods: A systematic review of scientific literature was conducted through PubMed, Google Scholar, and other databases, focusing on diagnostic advancements, insights into pathophysiology, and innovative therapeutic methods for PCOS. Only studies published from 2019 onwards were included to ensure the use of the most recent data and developments in the field. Results: Although research has advanced, PCOS remains a complex condition with significant diagnostic and therapeutic challenges. Recent studies propose innovative diagnostic and treatment approaches that offer clinicians alternative options for cases that do not respond to standard management methods. Conclusions: PCOS continues to present a significant challenge in women’s health. Ongoing research into diagnostic techniques and treatment options enriches current guidelines, facilitates the creation of standardized protocols, and supports more timely and effective management strategies tailored to individual needs.

Differentiation between Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura: A comparison of key laboratory findings between 2010 and 2021

Objective: This article aims to analyze and compare the clinical and laboratory findings related to Thrombotic Microangiopathies (TMAs), specifically Hemolytic Uremic Syndrome (HUS) and Thrombotic Thrombocytopenic Purpura (TTP), to support diagnostic and therapeutic decisions. The study also explores critical biochemical and hematological markers to differentiate these diseases. Methodology: A systematic literature review was conducted using articles from PubMed, Scielo, and Google Scholar, focusing on studies published from 2010 to mid-2021, covering a ten-year period. The review included research on clinical presentations, laboratory findings, and the molecular mechanisms underlying HUS and TTP. Results: The analysis revealed significant overlaps in clinical manifestations, such as anemia, thrombocytopenia, and renal dysfunction, but distinct differences in their pathophysiologies. HUS is associated with complement system dysfunction and Shiga toxin-mediated damage, while TTP is linked to ADAMTS13 enzyme deficiency. Laboratory markers such as lactate dehydrogenase, bilirubin, and platelet count were identified as crucial for differentiating the two conditions. Unique Contribution to Theory, Policy, and Practice: Underscoring the critical clinical and laboratory distinctions between HUS and TTP, this study provides a comprehensive framework for achieving precise diagnoses and developing individualized treatment strategies. Enhancing diagnostic accuracy is paramount to mitigating treatment delays, minimizing complications, and improving patient outcomes. Moreover, this review highlights the imperative need for standardizing diagnostic protocols for TMAs and advocates for further research to address existing knowledge gaps in this field.

Prognostic Factors, Predictive Modeling, and Treatment Patterns in Breast Cancer Patients with Bone Metastasis Receiving First-Line Chemotherapy: A Population-Based Study.

The prognostic factors and a nomogram applicable to breast cancer (BC) patients with bone metastasis (BM) who received first-line chemotherapy have not been extensively studied. This study aimed to identify prognostic factors and construct a prognostic nomogram to predict overall survival (OS) in this population. Data for BC patients with BM undergoing first-line chemotherapy were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016. A total of 2996 BC patients with BM undergoing first-line chemotherapy were included. Age, tumor size, race, tumor grade, breast cancer subtype, brain metastasis, liver metastasis, lung metastasis, surgical intervention, and marital status were identified as independent prognostic factors in the training cohort. Patients were randomly assigned into a training cohort (n = 2100) and an internal validation cohort (n = 896). Prognostic variables were identified using univariate and multivariate Cox Proportional Hazards (Cox) regression analysis. A nomogram was constructed and validated in both cohorts. The discrimination and accuracy of the nomogram were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). The areas under the curves (AUCs) for 1-, 2- and 3-year OS were 0.803 (95% confidence interval (CI): 0.752-0.854), 0.785 (95% CI: 0.756-0.814), and 0.767 (95% CI: 0.701-0.803), respectively, in the training cohort, and 0.793 (95% CI: 0.756-0.830), 0.791 (95% CI: 0.761-0.821), and 0.756 (95% CI: 0.719-0.793), respectively, in the validation cohort. The nomogram demonstrated excellent discrimination, calibration, and clinical utility. This study developed and validated a robust survival prediction model for breast cancer patients with bone metastasis receiving first-line chemotherapy. The nomogram demonstrates strong predictive performance and can aid clinicians in formulating individualized treatment strategies, thereby improving patient outcomes.

Gouty arthritis patients’ diagnostic, biochemical, and hematological characteristics study: a single-center retrospective study

ObjectiveThis study aims to investigate the diagnostic, biochemical, and hematological characteristics of patients with gouty arthritis and analyze their correlations with baseline characteristics to guide clinical practice, develop personalized treatment strategies, and improve patient outcomes.MethodsA single-center retrospective analysis was conducted on 8,344 patients with acute gouty arthritis admitted to our hospital between January 2014 and December 2023. Baseline characteristics and laboratory data, including uric acid, blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), C-reactive protein (CRP), white blood cell count, neutrophil count, lymphocyte count, monocyte count, fibrinogen, and serum albumin, were collected. General linear and Pearson correlation analyses were performed to identify significant relationships.ResultsSignificant correlations were observed between baseline characteristics (age, body mass index (BMI), smoking, and drinking status) and uric acid levels. High uric acid levels were positively correlated with inflammatory markers (hs-CRP, white blood cell count, and neutrophil count) and metabolic indicators (triglycerides, LDL-C, and creatinine) but negatively correlated with HDL-C. Notable differences in blood and biochemical indicators were identified across age, gender, and BMI groups.ConclusionThis study highlights key laboratory characteristics of gouty arthritis, emphasizing the need for individualized treatment strategies. Comprehensive interventions focusing on managing inflammation and metabolic disturbances in patients with elevated uric acid levels are critical for optimizing prognosis and improving quality of life.

Roving pen: minimally invasive mitral surgery.

Minimally invasive mitral valve surgery (MIMVS) is revolutionizing the field of cardiothoracic surgery by offering patients less invasive alternatives to conventional sternotomy. This article reviews recent research and studies on the outcomes, challenges, and considerations surrounding MIMVS. Comparative studies reveal that while MIMVS offers advantages such as shorter hospital stays and reduced recovery times, it shows no significant differences in mortality or long-term quality-of-life outcomes compared to traditional methods. Techniques like mini-thoracotomy and artificial chordae have demonstrated safety and efficacy, although specific challenges such as higher rates of recurrent mitral regurgitation and the need for extensive postoperative monitoring persist. The learning curve for MIMVS emphasizes the importance of surgical expertise, with improved outcomes observed after mastering the procedure. Furthermore, complex degenerative mitral regurgitation presents unique challenges but can be effectively managed with tailored approaches. Patient selection, surgeon experience, and individualized treatment strategies are pivotal factors in achieving optimal results. While promising, the overall benefits of MIMVS require further exploration through large-scale randomized trials focusing on patient-reported outcomes and long-term success.

Effect of antipsychotic on mismatch negativity amplitude and evoked theta power in drug-naïve patients with schizophrenia

BackgroundRecurrent observations have indicated the presence of deficits in mismatch negativity (MMN) among schizophrenia. There is evidence suggesting a correlation between increased dopaminergic activity and reduced MMN amplitude, but there is no consensus on whether antipsychotic medications can improve MMN deficit in schizophrenia.MethodsWe conducted clinical assessments, cognitive function tests, and EEG data collection and analysis on 31 drug-naïve patients with schizophrenia. Comprehensive evaluation tools such as PANSS and MCCB. MMN amplitude was analyzed by event-related potential (ERP) approaches, evoked theta power was analyzed by event-related spectral perturbation (ERSP) approaches.ResultsOur findings indicate that antipsychotic treatment significantly improved clinical symptoms, as evidenced by reductions in PANSS positive, negative, general symptoms, and total scores (all p < 0.001). Cognitive function improvements were observed in language learning, working memory, and overall MCCB scores (p < 0.05), although other cognitive domains showed no significant changes. However, no significant improvements were noted in MMN amplitude and evoke theta power after four weeks of antipsychotic treatment (p > 0.05).ConclusionThese results suggest that while antipsychotic medications effectively alleviate clinical symptoms, their impact on MMN amplitude and evoke theta power deficit is limited in the short term. Moreover, the amelioration of cognitive impairment in individuals with schizophrenia is not readily discernible, and it cannot be discounted that the enhancement observed in language acquisition and working memory may be attributed to a learning effect. These findings underscore the complexity of the neurobiological mechanisms involved and highlight the need for further research to optimize individualized treatment strategies for schizophrenia.Trial RegistrationChiCTR2000038961, October 10, 2020.

Cardiac effects and comorbidities of neurological diseases.

Neurological disorders encompass a complex and heterogeneous spectrum of diseases affecting the brain, spinal cord, and peripheral nervous system, each presenting unique challenges that extend well beyond primary neurological symptoms. These disorders profoundly impact cardiovascular health, prompting an intensified exploration into the intricate interconnections between the neurological and cardiovascular systems. This review synthesizes current insights and research on cardiovascular comorbidities associated with major neurological conditions, including stroke, epilepsy, Parkinson's disease, multiple sclerosis, and Alzheimer's disease. The cardiovascular sequelae of these neurological disorders are multifactorial. For instance, strokes not only predispose individuals to arrhythmia and heart failure but also exacerbate preexisting cardiovascular risk factors. Similarly, epilepsy is associated with autonomic dysregulation and an elevated risk of sudden cardiac death, underscoring the necessity for vigilant cardiac monitoring in affected individuals. Parkinson's disease manifests with orthostatic hypotension and cardiac sympathetic denervation, significantly contributing to morbidity. Additionally, multiple sclerosis and Alzheimer's disease exhibit cardiovascular autonomic dysfunction and heightened cardiovascular risk, underscoring the need for proactive management strategies. Mechanistically, these conditions disrupt autonomic nervous system regulation, induce chronic inflammation, and may share genetic susceptibilities, each contributing to cardiovascular pathology. Effective management of these complexities requires an integrative approach that includes risk factor modification, pharmacotherapy, lifestyle interventions, and comprehensive patient education. Future research directions include identifying novel therapeutic targets, conducting large-scale clinical trials, and investigating genetic biomarkers to individualize treatment strategies. By addressing the multifaceted interactions between neurological disorders and cardiovascular health, healthcare providers can optimize patient care, reducing cardiovascular morbidity and mortality in this vulnerable population.

Surgical Management of Pediatric Obstructive Sleep Apnea: Efficacy, Outcomes, and Alternatives-A Systematic Review.

Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder. OSA affects approximately 2 million Italians, although only 3% receive a diagnosis and correct treatment. This review aims to provide an overview to guide clinical decision making, ensuring that patients receive the most appropriate treatment for their specific condition. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered at PROSPERO under the ID CRD42024593760. A search on PubMed, Scopus, and Web of Science was performed to find papers that matched the topic, using the following Boolean keywords: ("obstructive sleep apnea" OR "OSA" OR "sleep apnea, obstructive") AND ("surgery" OR "surgical" OR "surgical techniques" OR "surgical treatment" OR "operative" OR "surgical procedures") AND ("treatment" OR "therapy" OR "management"). The electronic database search found 20337 publications. After the screening and eligibility phase, 15 papers were chosen for the qualitative analysis. Adenotonsillectomy (AT) significantly improves secondary outcomes like behavioral issues and quality of life, compared to watchful waiting with supportive care (WWSC). Alternative approaches such as tonsillotomy and adenopharyngoplasty (APP) offer promising results, with less postoperative discomfort and lower complication rates. However, further large-scale studies are needed to refine surgical techniques, assess long-term outcomes, and optimize individualized treatment strategies for OSA.