Long-term Prognosis Research Articles

Current strategies for predicting post-hepatectomy liver failure and a new ultrasound-based nomogram

Liver cancer is associated with a few factors, such as viruses and alcohol consumption, and hepatectomy is an important treatment for patients with liver cancer. However, post-hepatectomy liver failure (PHLF) is the most serious complication and has a high mortality rate. Effective prediction of PHLF allows for the adjustment of clinical treatment strategies and is critical to the long-term prognosis of patients. Many factors have been associated with the development of PHLF, so there is an increasing interest in the development of predictive models for PHLF, such as nomograms that integrate intra-operative factors, imaging and biochemical characteristics of the patient. Ultrasound, as a simple and important examination method, plays an important role in predicting PHLF, especially the Nomogram established based on ultrasound measurements of liver stiffness and spleen area provides a more convenient way to predict the occurrence of PHLF.

Surgical Approach and Recurrence Risk in Struma Ovarii: A Retrospective and Systematic Analysis.

Struma ovarii (SO) represents a rare subset of ovarian germ cell tumors, with approximately 5% transforming into malignant SO (MSO). This study retrospectively analyzed clinical data from 23 SO patients treated at the Cancer Hospital of the Chinese Academy of Medical Sciences between January 2013 and December 2023, including 17 benign SO (BSO) and 6 MSO cases. Additionally, a systematic review of 164 cases of MSO confined to the ovary, reported in the literature from 1946 to 2024, was conducted. Data on pathological type, treatment, and prognosis were extracted, and univariate and multivariate Cox regression analyses were performed to identify risk factors for recurrence in stage I MSO. The median age at diagnosis was higher for BSO compared to MSO (58 vs. 42.5 years), with 70.6% of patients being postmenopausal. BSO commonly presented with abdominal distension or mass, with more than half having ascites, while MSO patients were asymptomatic and lacked ascites. Cox regression analyses revealed that ovarian cystectomy was adversely associated with recurrence risk in stage I MSO, likely due to surgically induced capsular rent and potential tumor spillage. Significantly lower recurrence risks were observed in patients who underwent unilateral or bilateral salpingo-oophorectomy (HR = 0.36, P = 0.019; HR = 0.19, P = 0.004, respectively). This study highlights the importance of the surgical approach in the management of stage I MSO. A thorough preoperative discussion of the benefits and risks of different surgical approaches is recommended for patients desiring fertility preservation. Postoperative adjuvant therapy has not been shown to have a significant impact on prognosis. For the treatment of recurrent MSO, selecting appropriate surgical and adjuvant therapeutic strategies is essential to improve the long-term prognosis of MSO patients.

The Effect and Long-term Prognosis of Different Suturing Methods for Meniscus Repair Under Knee Arthroscopy.

This study aims to evaluate the efficacy and long-term prognosis of all-inside and outside-in suturing methods for meniscus repair under knee arthroscopy. A retrospective analysis was conducted on 120 patients with meniscus injuries who underwent surgical treatment at Yuhuan People's Hospital, Department of Joint Surgery, from January 2019 to March 2021. Based on the suturing method, patients were assigned into two groups: Group A (64 cases, all-inside suturing) and Group B (56 cases, outside-in suturing). Surgical indicators and adverse events were recorded for both cohorts. The variances in proprioception before and after surgery, International Knee Documentation Committee (IKDC) scores, Lysholm scores, knee range of motion (ROM), and Visual Analogue Scale (VAS) pain scores were compared between the two groups. Group A had significantly shorter operative time, postoperative immobilization, and hospital stay compared to Group B (p < 0.05). The overall incidence of adverse events was 12.50% in Group A and 16.07% in Group B, with no significant difference between the groups (p > 0.05). There were no substantial differences in preoperative knee proprioception difference values, IKDC scores, Lysholm scores, VAS scores, and knee ROM between the two groups (p > 0.05). At three months postoperatively, Group A exhibited lower proprioception difference values at 15°C, 45°C, and 75°C angles compared to Group B (p < 0.05). Additionally, at three months and three years postoperatively, Group A showed higher IKDC scores, Lysholm scores, and ROM and lower VAS scores compared to Group B (p < 0.05). Compared to the outside-in suturing approach, the all-inside suturing method for treating meniscus damage is more effective. It attenuates operative time, postoperative immobilization time, and hospital stay, ameliorates knee proprioception, promotes knee function recovery, alleviates pain, and is safe and reliable.

MRD Detection in B-Cell Non-Hodgkin Lymphomas Using Ig Gene Rearrangements and Chromosomal Translocations as Targets for Real-Time Quantitative PCR and ddPCR.

Minimal residual disease (MRD) diagnostics is of high clinical relevance in patients with indolent B-cell non-Hodgkin lymphomas (B-NHL), B-cell chronic lymphocytic leukemia (CLL), and multiple myeloma and serves as a surrogate parameter to evaluate treatment effectiveness and long-term prognosis. Real-time quantitative PCR (RQ-PCR) targeting circulating lymphoma cells is still the gold standard for MRD detection in indolent B-NHL and currently the most sensitive and the most broadly applied method in follicular lymphoma (FL) and mantle cell lymphoma (MCL). Alternatively, droplet digital PCR (ddPCR) can be used for MRD monitoring in multiple myeloma, mantle cell lymphoma, CLL, and FL with comparable sensitivity, accuracy, and reproducibility.The most broadly applicable MRD target in B-NHL is the junctional regions of the rearranged immunoglobulin heavy (IGH) and light chain genes. Complete and incomplete IGH and additionally IG kappa light chain rearrangements can be used as targets for MRD. Next-generation sequencing (NGS) of IG-rearrangements (IG-NGS) as new sequencing-based technology can overcome the limitation of PCR-based approaches and has a potential for higher sensitivity. Chromosomal translocations like the t(14;18)(q32;q21) translocation associated with IGH::BCL2 fusion in FL and t(11;14)(q13;q32) translocation in MCL leading to the IGH::CCND1 fusion can be used as MRD target in selected lymphoma subtypes. In patients with CLL, both flow-cytometry and RQ-PCR are equally suited for MRD assessment as long as a sensitivity of 10-4 is achieved.MRD diagnostics targeting the IG loci is complex and requires extensive knowledge and experience because the junctional regions of each clonal rearranged gene have to be identified before the patient-specific PCR assays can be designed for MRD monitoring. In addition, the presence and load of somatic hypermutation within the rearranged IGH gene occurring during B-cell development of germinal center and post-germinal center B-cell lymphomas may hamper appropriate primer binding leading to false-negative results. The translocations mentioned above have the advantage that consensus forward primers and probes, both placed in the breakpoint regions of chromosome 18 in FL and chromosome 11 in MCL, can be used in combination with a reverse primer placed in the IGH joining region of chromosome 14. PCR-based methods using allele-specific primers can reach a high sensitivity of up to 10-5. This chapter provides all relevant background information and technical aspects for the complete laboratory process from detection of the clonal IG gene rearrangements and the chromosomal translocations at diagnosis to the actual MRD measurements in clinical follow-up samples of B-NHL. However, it should be noted that MRD diagnostics for clinical treatment protocols has to be accompanied by regular international quality control rounds to ensure the reproducibility and reliability of the MRD results. This is available by the EuroMRD network ( https://euromrd.org ), a subgroup of ESHLO ( https://eslho.org ).

The value of assessing deep disease healing by probe-based confocal laser endomicroscopy and histology for long-term prognosis of ulcerative colitis.

The benefits of deep disease healing need evaluation by long-term clinical research in different populations. Confocal laser endomicroscopy (CLE) is a superior method for evaluating deep disease healing. This prospective study enrolled ulcerative colitis (UC) patients in clinical remission who underwent colonoscopy, CLE, and histological assessment. Patients were monitored for relapse by patient-reported outcomes and colonoscopy evaluation of mucosal healing. The ability of different methods of mucosal healing to predict long-term disease recurrence was assessed using Kaplan-Meier estimation and Cox proportional hazard regression. Forty-two patients in clinical remission were assessed by colonoscopy. Those with Mayo endoscopic subscores (MES)≤1 were enrolled. The 48-month recurrence rates in present healing group, assessed by CLE (colonic barrier assessment and ENHANCE index) and by histological examination (Geboes scale), were 20.0%, 26.7%, and 11.1%, respectively, and were significantly lower than absent healing group (P<0.05). Univariate Cox proportional risk regression analysis in absent of healing disease, determined by the ENHANCE index and Geboes scale, indicated an increased risk of recurrent events, with hazard ratios (HR) of 3.87 (95% CI: 1.18, 12.62) and 8.20 (95% CI: 1.06, 63.30), respectively. Multivariate Cox proportional hazard regression analysis adjusted for the extent of inflammation (E3 or not) showed a significant difference only for the ENHANCE index, with an HR of 3.53 (95% CI: 1.03, 12.10), P=0.045. Deep disease healing has a lower recurrence rate. The colonic barrier healing assessment, ENHANCE index, and histological Geboes scale have superior long-term prognostic value for UC patients.

Cornea Endothelial Cell Loss Before and After Explantation of Artisan and Artiflex Iris-Fixated Phakic Intraocular Lenses

PurposeTo investigate the risk factors for corneal endothelial cell density (ECD) loss of two types of iris-fixated phakic intraocular lenses (pIOL) and indicate the cutoff values for preventing irreversible ECD loss after explantation. DesignThe retrospective, comparative, clinical cohort study MethodsTotal 114 eyes of 61 patients were included in this study. Fifty-five eyes with Artisan pIOL and 59 eyes with Artiflex pIOL had undergone explantation of pIOLs due to continuous ECD loss. Correlation analysis was performed to assess the ocular parameters associated with ECD loss. Receiver operating characteristic (ROC) curve was performed to set cutoff values of ocular parameters to prevent ECD loss after explantation. ResultThe mean ECD before explantation was 1637 cells/mm2 in Artisan group and 1769 cells/mm2 in Artiflex group. The distance of cornea endothelium to IOL center and edges were all significantly higher in Artisan group (p <0.05). The risk factor of decreased ECD in Artisan group were small anterior chamber angle (ACA), and distance of nasal edge of IOL to endothelium and iris fixation to nasal limbus distance, and differences of fixation length. In Artiflex group, ACA, distance of nasal edge of IOL to endothelium, both limbus to IOL fixation length, fixation length, iris pigmentation grading were the risk factors. At 1 year after the pIOL removal, the population demonstrating ΔECD >10% were significantly higher in Artisan group than Artiflex group (p <0.05). In ROC curve analysis, the cutoff value of preoperative ECD to prevent significant post-explantation ECD loss was 1683.5 cells/mm2 in Artisan group and 1648 cells/mm2 in Artiflex group. ConclusionThis study examined the existing explantation guidelines for these lenses. In analyzing the longterm prognosis of cornea ECD with Iris-fixated phakic intraocular lens, it is important to identify the relevant anatomical factors. Small ACA, and short distances from IOL to endothelium and from limbus to iris fixation especially in the nasaSSSl region were significant risk factors to continuous ECD loss in both lenses. To minimize irreversible ECD loss after explantation, it is important to determine the optimal period of explantation by observing both ECD and structural changes.

Outcomes of cardiac resynchronization therapy (CRT) in cardiac sarcoidosis patients with a range of ejection fractions.

In cardiac sarcoidosis (CS) patients, the benefit of cardiac resynchronization therapy (CRT) remains unclear. We sought to assess the short-term and long-term effects of CRT in CS patients with a range of left ventricular (LV) ejection fractions (LVEFs). Consecutive CS patients with heart failure with reduced ejection fraction (HFrEF; LVEF≤40%), mildly reduced ejection fraction (HFmrEF; LVEF 41%-49%) and preserved ejection fraction (HFpEF; LVEF≥50) treated with CRT under the care of a tertiary UK centre between 2008 and 2023 were reviewed. CRT response was defined by >5% improvement in serial LVEF. The primary endpoint was a composite of all-cause mortality, cardiac transplantation or unplanned hospitalization for decompensated heart failure. The secondary endpoint included ventricular arrhythmic events. Of the 100 patients enrolled (age 58±10years; 71% male), 63 had HFrEF, 17 had HFmrEF and 20 had HFpEF. After short-term follow-up (9.8±5.4months), HFrEF patients demonstrated significant LVEF response (P<0.01). On Kaplan-Meier analysis (follow-up 38±32months), HFrEF non-responders had significantly worse event-free survival compared with HFrEF responders for the primary (P<0.001) and secondary (P=0.001) endpoints. Despite short-term LV function improvement, CRT responders still had worse event-free survival compared with HFmrEF/HFpEF patients for the primary endpoint (P<0.001). On multivariable Cox analysis, age [hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.01-1.10, P=0.008] and HFrEF CRT non-response (HR 12.33, 95% CI 2.45-61.87, P=0.002) were associated with the primary endpoint. In CS patients with HFrEF, CRT response is associated with a better long-term prognosis than non-response. However, HFrEF CRT responders still have worse long-term prognosis than HFmrEF/HFpEF patients.

Long-term prognosis and treatment modalities of hepatic epithelioid hemangioendothelioma: a retrospective study of 228 patients

BackgroundHepatic epithelioid hemangioendothelioma (EHE) is an extremely rare tumour. The aim of this study was to investigate the long-term prognosis and its relationship with treatment modalities.MethodsFrom March 2014 to June 2024, a total of 234 patients with histologically confirmed hepatic EHE were treated or followed up regularly by our team. The patients’ clinical data at the time of diagnosis and initial treatment modalities were retrospectively collected. Kaplan–Meier curves were constructed to determine overall survival (OS). To explore prognostic factors and treatment outcomes, univariable and multivariable Cox proportional hazard models were developed.ResultsA total of 228 patients were ultimately included. The median age of the cohort was 41 years. For all patients, the OS of 1-, 3- and 5-year were 96.2%, 87.9% and 84.9%, respectively. For patients who underwent liver transplantation (LT), the OS of 1- and 3-year were 62.5% and 25%, respectively. No difference was found in the OS between patients who received surgical therapy and those who did not (1-year: 100% vs. 96.9%; 3-year: 90.1% vs. 91.5%; 5-year: 87.2% vs. 88.2%; P = 0.891). In the multivariable analysis, age ≥ 60 years [HR (95% CI): 4.207 (1.266–13.973), P = 0.019], the size of the largest lesion > 10 cm [HR (95% CI): 12.140 (1.419–103.872), P = 0.023] and LT [HR (95% CI): 5.502 (1.343–22.536), P = 0.018] were poor prognostic factors.ConclusionsCompared with nonsurgical therapy, surgical therapy has no advantage in terms of long-term survival. The role of LT in the management of hepatic EHE should be reevaluated. Age ≥ 60 years and the size of the largest lesion > 10 cm are poor prognostic factors.

Diffusion tensor imaging in cerebral small vessel disease applications: opportunities and challenges.

Cerebral small vessel disease (CSVD) is a syndrome of pathology, imaging, and clinical manifestations caused primarily by a variety of functional or structural lesions in the small blood vessels of the brain. CSVD contributes to approximately 45% of dementia and 25% of ischemic strokes worldwide and is one of the most important causes of disability. The disease progresses insidiously, and patients often have no typical symptoms in the early stages, but have an increased risk of stroke, death, and poor long-term prognosis. Therefore, early diagnosis of CSVD is particularly important. Neuroimaging is the most important diagnostic tool used for CSVD. Therefore, it is important to explore the imaging mechanisms of CSVD for its early diagnosis and precise treatment. In this article, we review the principles and analysis methods of DTI, analyze the latest DTI studies on CSVD, clarify the disease-lesion mapping relationships between cerebral white matter (WM) microstructural damage and CSVD, explore the pathogenic mechanisms and preclinical imaging features of CSVD, and summarize the latest research directions of CSVD and research methods to provide a comprehensive and objective imaging basis for the diagnosis and treatment of CSVD.

Risk factor control and adherence to recommended Lifestyle among US hypertension patients

BackgroundAlthough hypertension is a significant public health challenge globally, only a few studies have assessed the effectiveness of risk factor control and adherence to recommended lifestyle among United States hypertension patients.MethodsIn this study, a detailed, stratified analysis of the 1999–2018 National Health and Nutrition Examination Survey was conducted to assess the adequacy of risk factor control and conformity to recommended lifestyle among United States patients with hypertension. Logistic regression analysis was used to identify influencing factors associated with not acheving risk factors and lifestyle targets.ResultsA total of 21,770 participants (mean age, 62 ± 15 years) were enrolled in this study. About one in five (20%) participants achieved the recommended body mass index goal, 40% achieved the low-density lipoprotein cholesterol goal, and 30% achieved the recommended waist circumference. Most patients (80%) achieved the recommended smoking goal, 58% met the recommended alcohol consumption, and 19% achieved the recommended physical activity goal. Multivariate analysis demonstrated that age, gender, race, education, metabolic syndrome, and diabetes mellitus were independent predictors of not achieving risk factors and lifestyle targets.ConclusionsControlling risk factors and adherence to recommended lifestyles are not ideal for hypertension patients. Therefore, further research should assess how to improve the compliance rate and take targeted measures based on influencing factors for long-term prognosis.

EARLY SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION ON LEFT VENTRICULAR EJECTION FRACTION IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

Early intervention in patients with ST-elevation myocardial infarction (STEMI) is crucial for preserving left ventricular function and improving patient outcomes. Primary percutaneous coronary intervention (PPCI) has become the standard of care, and the timing of intervention significantly influences recovery and long-term prognosis. Objective: This study aimed to evaluate the impact of early successful primary percutaneous coronary intervention (PPCI) on left ventricular ejection fraction (LVEF) in patients presenting with STEMI. Methods: A prospective cohort study was conducted on 116 STEMI patients undergoing PPCI at a tertiary care hospital. The patients were categorized into two cohorts: early presenters (n=67) who received PPCI within 6 hours of symptom onset and late presenters (n=49) who received PPCI after 6 hours. Baseline characteristics, procedural outcomes, Thrombolysis in Myocardial Infarction (TIMI) flow grades, and LVEF measurements were assessed at presentation and two months post-PPCI using transthoracic echocardiography. The primary outcome was the change in LVEF from baseline to follow-up, and the secondary outcome was the distribution of TIMI flow grades achieved during PPCI. Statistical analysis was performed using appropriate tests to compare outcomes between the two groups. Results: Early presenters demonstrated significantly better outcomes compared to late presenters. At presentation, the mean LVEF in the early group was higher (45.67 ± 1.73%) compared to the late group (36.94 ± 1.25%) (p = 0.0001). At the two-month follow-up, the LVEF improved significantly in both groups, with early presenters achieving an LVEF of 56.24 ± 1.73%, which was notably higher than the LVEF of late presenters (45.12 ± 1.42%) (p = 0.0001). In terms of coronary reperfusion, 62.7% of early presenters achieved TIMI grade 3 flow compared to 26.5% of late presenters (p = 0.0001), indicating better coronary artery perfusion in the early intervention group. Conclusion: Early successful PPCI in STEMI patients is associated with superior recovery of left ventricular function and improved coronary reperfusion compared to delayed intervention. Patients who received PPCI within 6 hours of symptom onset demonstrated significantly higher LVEF at follow-up and achieved better TIMI flow grades, highlighting the critical importance of minimizing treatment delays in STEMI management.

Small particle drug-eluting beads-transarterial chemoembolization combined with targeted therapy in the clinical treatment of unresectable liver cancer.

Liver cancer is a highly malignant tumor with significant clinical impact. Chemotherapy alone often yields suboptimal outcomes in both the short and long term, characterized by high rates of local recurrence and distant metastasis, leading to a poor long-term prognosis. To evaluate the clinical efficacy of small particle drug-eluting beads-transarterial chemoembolization (DEB-TACE) combined with targeted therapy for the treatment of unresectable liver cancer. We analyzed clinical data from 74 patients with unresectable liver cancer admitted between January 2019 and December 2020. Based on the different treatment regimens administered, patients were divided into the control (36 patients receiving sorafenib alone) and joint (38 patients receiving small particle DEB-TACE combined with sorafenib) groups. We compared liver function indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB)] and serum tumor markers [alpha fetoprotein (AFP)] before and after treatment in both groups. Short-term efficacy measures [complete response (CR), partial response, progression disease, stable disease, objective response rate (ORR), and disease control rate (DCR)] were assessed post-treatment. Long-term follow-up evaluated median overall survival (OS), progression-free survival (PFS), and adverse reaction rates between the two groups. One month post-treatment, the joint group demonstrated significantly higher rates of CR, ORR, and DCR compared to the control group (P < 0.05). Three days after treatment, the joint group showed elevated levels of ALT, AST, and TBIL but reduced levels of ALB and AFP compared to the control group (P < 0.05). The median OS was 18 months for the control group and 25 months for the joint group, while the median PFS was 15 months for the control group and 22 months for the joint group, with significant differences observed (log-rank: χ 2 = 7.824, 6.861, respectively; P = 0.005, 0.009, respectively). The incidence of adverse reactions was not significantly different between the groups (P > 0.05). The combination of small particle DEB-TACE and sorafenib significantly improves both short- and long-term outcomes in the treatment of unresectable liver cancer while preserving liver function.

Strain rate during isovolumic relaxation as a prognostic biomarker for long-term cardiovascular morbidity and mortality: an exploratory study on a general population.

Left ventricular (LV) strain rate (SR) during early relaxation correlates with LV filling pressures and has been assessed as a prognostic biomarker in several cardiac diseases. Conversely, even though LV SR during isovolumic relaxation (SRIVR)is more strongly related to invasive measurements of LV diastolic function, to date, studies on the role of SRIVR in the long-term prognosis assessment are lacking. Thus, the goal of this study was to assess the potential additive prognostic value of SRIVR on top of conventional cardiovascular risk factors in a general population. 657 subjects (mean age 51.6y; 47.6% males) were included in this study and, besides clinical and standard echocardiographic assessment, tissue Doppler imaging (TDI)-based SR was measured during IVR (SRIVR), early diastole (SRe), and atrial contraction (SRa) in the mid-segment of the inferior, inferolateral, lateral, and septal wall of the LV. During the follow-up period (median 12.1years), the total number of major adverse cardiac events was 85 (13.4%). Overall, after adjustment for known cardiovascular risk factors and important echocardiographic indices in a multivariable-adjusted Cox regression model, SRIVR of the inferolateral wall (SRIVRinflat) remained an independent predictor of fatal and nonfatal cardiac events (HR: 1.49, p = 0.016), along with GLS (HR: 1.35, p = 0.027), age (HR: 1.09, p < 0.001), and male sex (HR: 2.06, p = 0.037). None of SRIVR measured in the other myocardial walls were associated with cardiac outcome. SRIVRinflat predicted adverse outcome in the general population, on top of conventional cardiovascular factors. However, its incremental value as a prognosticator remained limited.

Progression of Mast Cell Activation Syndrome to Systemic Mastocytosis

Abstract Introduction/Objective Mast cell activation syndrome (MCAS) is characterized by the abnormal release of mast cell mediators, leading to symptoms such as flushing, abdominal pain, and allergic reactions. In some cases, MCAS progresses to systemic mastocytosis (SM), a mast cell disorder marked by organ infiltration and dysfunction. However, predictors of MCAS progression to SM remain poorly understood, and long-term prognosis data are limited. Methods/Case Report We conducted a retrospective study of patients diagnosed with MCAS at Penn Medicine from January 1, 2019, through December 30, 2021. The primary endpoint was progression to SM, defined by World Health Organization criteria, with a secondary endpoint set for September 24, 2023. Results (if a Case Study enter NA) We identified 47 patients with MCAS (Table 1). Of these, 11 patients (23.4%) progressed to SM. Notably, all five patients with c-KIT mutations progressed to SM (100%, 5/5), while six out of 22 patients without c-KIT mutations also progressed (27.2%). Additionally, baseline serum tryptase levels were identified as a significant predictor of progression at two years. Conclusion The relative risk of progression varied depending on the subtype of MCAS, with higher rates observed in those with KIT D816V presence. Compared to the incidence of SM in the general population, our findings suggest a higher risk of progression from MCAS to SM, even without a c-KIT mutation. Identification of prognostic factors, such as specific genetic mutations and baseline serum tryptase levels, may aid in risk stratification and early intervention strategies for individuals with MCAS. HaT mutation testing should be considered in future studies on this topic. Our findings have important implications for the clinical management and understanding of MCAS progression to SM. Additionally, our data imply the importance of recognizing MCAS in the early phase and proper monitoring, considering the low rate of MCAS diagnosis. Patients with MCAS may need annual monitoring, including serum tryptase levels, to detect progression to SM and related complications. Early detection and intervention may improve outcomes and quality of life for individuals with MCAS.

Comparison of microvascular decompression and percutaneous balloon compression efficacy in patients with V2 idiopathic trigeminal neuralgia.

This study aims to compare the efficacy and long-term prognosis of microvascular decompression (MVD) versus percutaneous balloon compression (PBC) in patients with idiopathic V2 (maxillary branch) trigeminal neuralgia. We retrospectively analyzed the clinical information and follow-up data of patients who underwent surgical treatment for V2 idiopathic trigeminal neuralgia from January 2020 to January 2023. A total of 58 patients were included in the MVD group and 99 in the PBC group. All surgeries were performed by two physicians at the same center, with follow-up conducted by a separate, trained researcher. We compared the initial versus 12-month postoperative pain relief rates (scored using the BNI), surgical complications, and described pain relief rates after long-term follow-up in both groups using Kaplan-Meier analysis. The study included a total of 157 patients (MVD 58, PBC 99). The median age of patients in the MVD group was lower than that in the PBC group (58 [51-65] vs. 63 [58-69], p = 0.002). There was no significant difference between the two groups in terms of pain relief rates initially after surgery and at 12 months (p = 0.521, p = 0.713). However, the MVD group had significantly better outcomes regarding postoperative facial numbness (p < 0.0001), masticatory weakness (p = 0.0017), and other complications (p = 0.04). Kaplan-Meier analysis showed that MVD provided a longer duration of pain relief than PBC (p = 0.0323), with most recurrences in both groups occurring within 1-2 years after surgery. There were no significant differences in significant pain relief rates between the two groups initially after surgery and at 12 months. However, the MVD group showed a clear advantage over PBC regarding postoperative facial numbness, masticatory weakness, and other complications; moreover, Kaplan-Meier analysis revealed that MVD offers a longer duration of pain relief for patients.

Population-based long-term prognosis analysis of subcutaneous gastrointestinal stromal tumors.

Subcutaneous gastrointestinal stromal tumors (scGISTs) are extremely rare tumors, and the analysis of their long-term prognosis remains unreported. Therefore, our objective is to analyze the long-term prognosis of patients with scGISTs using the Surveillance, Epidemiology, and End Results database. Patients diagnosed with GISTs between 2000 and 2019 were included in the study. To handle missing data, multiple imputation techniques were employed. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate overall survival (OS) and cancer-specific survival (CSS), and subgroup analyses were conducted for various variables. A total of 12,882 patients were enrolled, with 12,636 diagnosed with GISTs and 246 with scGISTs. In comparison to GISTs patients, scGISTs patients exhibited inferior OS [hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.45-1.98, P < 0.001] and CSS (HR 2.16, 95% CI 1.78-2.61, P < 0.001). Across various subgroups, including age, sex, surgical intervention, marital status, and chemotherapy, scGISTs patients consistently demonstrated significantly poorer OS and CSS outcomes compared to GISTs patients (P < 0.05). The 1-, 3-, and 5-year OS rates for scGISTs patients were 78.4%, 60.3%, and 49.3%, respectively, with corresponding CSS rates of 83.3%, 67.8%, and 57.4%. Notably, scGISTs patients who received surgical treatment had significantly higher 5-year OS rates (62.1% vs 30.9%, P < 0.001) and CSS rates (67.8% vs 40.0%, P < 0.001) compared to those who did not undergo surgery. Multivariate Cox regression analysis identified age, surgical status, and mitotic rate as risk factors influencing OS in scGISTs patients, while surgical status and mitotic rate were identified as risk factors affecting CSS. Compared to GISTs patients, scGIST patients exhibit a less favorable prognosis; nonetheless, surgical intervention has been demonstrated to enhance their prognosis.

Long-term functional outcome of limb-sparing surgery for paediatric bone sarcoma around the knee.

Surgical limb sparing for knee-bearing paediatric bone sarcoma is considered to have a clinically significant influence on postoperative function due to complications and leg-length discrepancies. However, researchers have not fully evaluated the long-term postoperative functional outcomes. Therefore, in this study, we aimed to elucidate the risk factors and long-term functional prognosis associated with paediatric limb-sparing surgery. We reviewed 40 patients aged under 14 years who underwent limb-sparing surgery for knee bone sarcoma (15 cases in the proximal tibia and 25 in the distal femur) between January 2000 and December 2013, and were followed up for a minimum of five years. A total of 35 patients underwent reconstruction using artificial materials, and five underwent biological reconstruction. We evaluated the patients' postoperative complications, survival rate of reconstruction material, and limb, limb function, and leg-length discrepancy at the final follow-up, as well as the risk factors for each. Complications were observed in 55% (22/40) of patients. The limb survival and reconstruction material rates at five and ten years were 95% and 91%, and 88% and 66%, respectively. Infection was the only risk factor in both survivals (p < 0.001, p = 0.019). In the 35 patients with limb preservation, the median International Society of Limb Salvage (ISOLS) score at the final follow-up was 80 (47% to 97%). Younger age (p = 0.027) and complications (p = 0.005) were poor prognostic factors. A negative correlation was found between age and leg-length discrepancy (R = -0.426; p = 0.011). The ISOLS scores were significantly lower in patients with a leg-length discrepancy of more than 5 cm (p = 0.005). Young age and complications were linked to an unfavourable functional prognosis. Leg-length correction was insufficient, especially in very young children, resulting in decreased function of the affected limb. Limb-sparing surgery for these children remains a considerable challenge.

The short-term and long-term prognosis of discharged COVID-19 patients in Guangdong during the first wave of pandemic

COVID-19 survivors concerning about the rehabilitation and sustained sequelae of Coronavirus Disease 2019 (COVID-19) infection. We aimed to investigate the sequelae of patients’ psychological and physical condition and its related factors in the early and late stages. This longitudinal study tracked 281 COVID-19 patients discharged from hospitals in Guangdong, China, for one year. Assessments occurred at 2,4,12,24 and 48 weeks post-discharge. We define 2 weeks, 4 weeks, and 12 weeks as early stage, and 24 weeks and 48 weeks as late stage. Psychological health was measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and Pittsburgh Sleep Quality Index (PSQI) scales. Physical health was assessed through laboratory tests, chest computed tomography (CT) scans, and pulmonary function tests. Data were analyzed using multivariate regression models to evaluate the influence of demographic and clinical variables on health outcomes. COVID-19 survivors exhibited psychological and physical sequelae in both the early and late stages. Compared to the early stage, the proportions of patients with depression (early stage 14.6%, late stage 4.6%), anxiety (early stage 8.9%, late stage 5.3%), PTSD(early stage 3.6%, late stage 0.7%), abnormal liver function (early stage 24.6%, late stage 11.0%), abnormal cardiac function (early stage 10.0%, late stage 7.8%), abnormal renal function (early stage 20.6%, late stage 11.0%) and abnormal pulmonary function (early stage 40.9%, late stage 13.5%) were significantly reduced in the late stage. Factors such as gender, age, severity of COVID-19, hospitalization duration, and various comorbidities were significantly associated with these sequelae. We noticed that psychological and physical sequelae occurred to COVID-19 survivors in short and long stages, and these would gradually decrease as time went on. Male gender, age > 50 years old, severe clinical condition, longer hospitalization time and comorbidity history were related factors that significantly affected the rehabilitation of COVID-19 patients.

Analysis of the outcomes in treatment of ulcerative colitis with acupuncture and moxibustion

To clarify the key outcomes of acupuncture-moxibustion treatment of ulcerative colitis. The clinical randomized controlled trials (RCTs) for ulcerative colitis treated with acupuncture and moxibustion were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, from the inception of each database to March 20th, 2023. The basic information of literature, intervention measures and outcome indexes were collected. The selection of primary and secondary outcomes, the use frequency of each index and the combination of them in utility were analyzed; and index domains of acupuncture and moxibustion for ulcerative colitis were summarized. A total of 215 RCTs were included and 54 outcomes were involved, classified into 6 categories, i.e. TCM syndromes, symptoms/physical signs, physical and chemical tests, quality of life, long-term prognosis and safety events. The top 3 outcomes with high use frequency were clinical effect evaluation, adverse reactions of acupuncture and moxibustion and the score of main symptoms. Only 3 articles clearly reported the primary outcome and the secondary ones, 180 articles used two types of outcomes simultaneously, 3 articles clearly described the time points of the observation indexes, and 126 articles determined the sources of the evaluation criteria of therapeutic effect, with 57 criteria involved. At present, the outcomes have not been standardized in RCTs of acupuncture and moxibustion for ulcerative colitis. It needs to clarify the primary one and the secondary ones. The criteria have not been unified for the evaluation of therapeutic effects and there is less consideration on the quality of life in patients, the follow-up visit and safety events. The attention should be paid to develop the outcome set, in which, the endoscopic score is taken as the objective, and the improvements in the symptoms/physical signs and the biochemical examination as the supplementary.

Long-Term Functional Outcomes of Retinal Detachment Due to Acute Retinal Necrosis: A Case Series.

Objectives: To evaluate the long-term anatomical and functional prognosis of patients with retinal detachment (RD) secondary to acute retinal necrosis (ARN) treated with pars plana vitrectomy (PPV). Methods: This retrospective case series included 21 eyes from 21 patients with RD secondary to ARN. The study analyzed vitreous or aqueous biopsy results, the impact of antiviral therapy, time to retinal detachment, changes in visual acuity (VA), and anatomical and surgical outcomes. All cases underwent 23-gauge PPV with silicone oil tamponade, and an episcleral encircling band was used in 11 cases. All patients received systemic antiviral therapy at diagnosis. Results: Retinal reattachment was achieved in 91% of cases during follow-up, with an average follow-up period of 39.5 ± 36.8 months. The average time from ARN diagnosis to RD onset was 33.3 ± 27.5 days. VZV was detected in 10 eyes through PCR analysis. Significant differences in visual prognosis were found between macula-off and macula-on RD (p = 0.048). Eyes with optic nerve head inflammation had worse final VA (p = 0.010). No significant difference was observed between preoperative VA and VA at the end of follow-up (p = 0.665). Conclusions: VZV was the primary virus associated with ARN-related RD. Early involvement of the macula and optic nerve in retinitis negatively impacted the final visual prognosis.