Optimal Treatment Strategy Research Articles

Decoding medina 0.0.1 bifurcation: Are all codes equal? Results from a multicentric registry

ObjectivesThis study aimed to detail the technical management of Medina 0.0.1 lesions, assess their outcomes, and identify predictors of Major Adverse Cardiovascular Events (MACE). BackgroundMedina 0.0.1 bifurcations are rare and under-researched, with their optimal treatment strategy still debated and poorly described in daily practice. MethodsA multicenter international registry enrolled 273 patients (277 lesions) undergoing PCI for de novo Medina 0,0,1 lesions (2017–2022). Data were systematically collected, and clinical follow-up was performed. The primary endpoint was 3-year MACE (cardiovascular death, myocardial infarction, and target vessel revascularization). Target lesion revascularization and stent thrombosis were secondary endpoints. ResultsMedian follow-up was 1180 days. Most cases were treated with planned one-stent PCI (84.1 %), mainly inverted provisional and ostial stenting (53.6 % and 45.9 %, respectively). The incidence of MACE and TLR was 16.9 % and 13.4 %, respectively. Univariate analysis identified dyslipidemia, diabetes, prior PCI, and left main bifurcation as predictors of MACE. Proximal optimization technique significantly reduced 3-year MACE (HR 0.28, 95 % CI 0.10–0.80, p = 0.03). Multivariate analysis identified diabetes as the only independent predictor of 3-year MACE (adjusted HR 2.35, 95 % CI 1.23–4.49, p = 0.01). No significant difference in 3-year MACE was found between inverted provisional and ostial stenting (17.2 % vs. 12.1 %). ConclusionMedina 0.0.1 bifurcations show high levels of MACE and TLR in the long-term. Diabetes emerged as the only independent 3-year MACE predictor. While current recommendations are widely adhered to in left main bifurcation angioplasty, they are less frequently applied in smaller bifurcations and acute settings.

Exosomal signaling in gynecologic cancer development: The role of cancer-associated fibroblasts.

Gynecologic cancer, a prevalent and debilitating disease affecting women worldwide, is characterized by the uncontrolled proliferation of cells in the reproductive organs. The complex etiology of gynecologic cancer encompasses multiple subtypes, including cervical, ovarian, uterine, vaginal, and vulvar cancers. Despite optimal treatment strategies, which typically involve cytoreductive surgery and platinum-based chemotherapy, gynecologic cancer frequently exhibits recalcitrant relapse and poor prognosis. Recent studies have underscored the significance of the tumor microenvironment in ovarian carcinogenesis, particularly with regards to the discovery of aberrant genomic, transcriptomic, and proteomic profiles. Within this context, cancer-associated fibroblasts (CAFs) emerge as a crucial component of the stromal cell population, playing a pivotal role in oncogenesis and cancer progression. CAF-derived exosomes, small extracellular vesicles capable of conveying biological information between cells, have been implicated in a range of tumor-related processes, including tumorigenesis, cell proliferation, metastasis, drug resistance, and immune responses. Furthermore, aberrant expression of CAF-derived exosomal noncoding RNAs and proteins has been found to strongly correlate with clinical and pathological characteristics of gynecologic cancer patients. Our review provides a novel perspective on the role of CAF-derived exosomes in gynecologic cancer, highlighting their potential as diagnostic biomarkers and therapeutic targets.

What is the optimal treatment strategy of salvage line treatment after progression on anti-epidermal growth factor receptor monoclonal antibody in patients with tissue RAS/BRAF wild-type metastatic colorectal cancer?

138 Background: Trifluridine/tipiracil (FTD/TPI) plus bevacizumab (BEV) and anti-epidermal growth factor receptor (EGFR) monoclonal antibody (mAb) re-challenge are treatment options for tissue RAS/BRAF wild-type (WT) metastatic colorectal cancer (mCRC) in salvage line, although the optimal treatment sequence of salvage line remains unclear. Methods: RAS/BRAF WT mCRC patients refractory to anti-EGFR mAb were retrospectively enrolled at a single cancer institute from November 2017 to April 2024. We compared responses, progression-free survival (PFS), and overall survival (OS) between Group A (anti-EGFR mAb re-challenge given first) and B (FTD/TPI plus BEV given first). We compared responses between Group C (treated with anti-EGFR mAb re-challenge at any line) and D (treated with FTD/TPI plus BEV at any line). We explored the clinical factors related to the treatment efficacy using multivariate analysis. Results: A total of 89 patients (median age, 63 years) were included. The cohort included 74 patients with a primary lesion in the left-sided colon, while 15 patients had a primary lesion in the right-sided colon. The response rate (RR) was 3.4%. The disease control rate (DCR) was 52.8%. The median PFS (mPFS) and OS (mOS) were 3.5 months (95% confidence interval [CI], 2.8-4.2) and 12.8 months (95% CI, 8.8-15.7) respectively. Two of 18 patients (11.1%) in Group A and 1 of 71 patients (1.4%) in Group B achieved partial response (PR). The RR of Group C was significantly higher than Group D (9.6% vs 1.2%; p = 0.031). Both PFS and OS showed no significant difference between Group A and B (mPFS: 3.3 vs 3.9 months; hazard ratio [HR], 1.08; 95% CI, 0.63-1.84; p = 0.79) (mOS: 12.8 vs 15.0 months; HR, 0.90; 95% CI, 0.49-1.65; p = 0.72). Multivariate analysis identified that primary tumor resection was associated with PFS (HR, 0.44; 95% CI, 0.25–0.80; p = 0.0068) and primary tumor resection (HR, 0.34; 95% CI, 0.18–0.65; p = 0.0010) and serum CA19-9 level (HR, 1.75; 95% CI, 1.02-3.00; p = 0.043) were associated with OS. Conclusions: No significant survival difference was observed between patients administered anti-EGFR mAb re-challenge first and those administered FTD/TPI plus BEV first, whereas the RR of anti-EGFR mAb re-challenge is significantly higher than that of FTD/TPI plus BEV.

Updated results of ALTER-H006: A phase II study of benmelstobart (PD-L1 inhibitor) plus anlotinib as adjuvant therapy in hepatocellular carcinoma (HCC) with high risk of recurrence after radical resection.

601 Background: Although radical resection offers one of the most favorable prognosis for hepatocellular carcinoma (HCC), the rate of postoperative recurrence remains high, which is the primary cause of mortality in HCC patients. The optimal adjuvant treatment strategy for patients is still under active investigation. Herein we evaluated the efficacy and safety of the anti-angiogenic tyrosine kinase inhibitor, anlotinib, plus benmelstobart, a novel programmed death-ligand 1 (PD-L1) inhibitor as an adjuvant treatment for HCC with high risk of recurrence after radical resection. Methods: This study enrolled patients diagnosed with HCC confirmed through histological or cytological examination, whose age was 18-75, with ECOG 0-1, Child-Pugh class A, 4~8 weeks after R0 resection with any of the following high-risk factors for recurrence: a) tumor nodules ≥4; b) portal vein tumor thrombus (PVTT): vp1 or vp2; c) hepatic vein tumor thrombus (HVTT): vv1 or vv2. Enrolled patients received anlotinib (12 mg, p.o., qd, d1-14, q3w) plus benmelstobart (1200 mg, i.v., d1, q3w) until disease recurrence or unacceptable toxicity or up to 18 cycles (~1 year), whichever occurred first. Tumor assessment was performed at the end of the second cycle and every four cycles thereafter, according to RECIST v1.1. The predefined sample size was 37. The primary endpoint was 1-year recurrence-free survival (RFS) rate. Secondary endpoints included RFS, 1-year overall survival (OS) rate, and safety. Results: As the cutoff date of September 13,2024, a total of 38 patients (pts) were enrolled and 35 pts included in per-protocol set analysis. The majority of the 38 pts were male (94.7%, n = 36), and the median age was 56.5 years (range: 33-75). 18 pts (47.3%) had CNLC Stage IIb and 20 (52.6%) had CNLC Stage IIIa HCC. Among them, 35 pts received at least once tumor assessment. According to RECIST 1.1, of the 35 pts, 18 had no recurrence, 15 experienced relapse, 1 dropped out and 1 discontinued due to serious adverse events. The 1-year RFS rate was 59.97% (95%CI: 39.12-79.68) and the primary median RFS was 16.89m(95%CI: 6.82-26.96). The 1-year OS rate was 91.47% (95%CI: 69.23-97.86). 34 of 38 pts (89.5%) experienced treatment-related adverse events (TRAEs). The most common grade 3 TRAEs occurred in 17 pts (44.7%) including hypertension (32%) and neutropenia(5.3%). No grade 4 or 5 TRAEs were observed. Conclusions: The present study indicated that anlotinib plus benmelstobart as adjuvant treatment for HCC with high risk of recurrence after radical resection exhibited promising efficacy and tolerable safety profile. The conclusion should be validated in more participants included subsequently. Clinical trial information: NCT05111366 .

Optimal preoperative treatment strategy for conversion surgery in unresectable locally advanced pancreatic cancer: A project study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

718 Background: Conversion surgery (CS) for unresectable locally advanced pancreatic cancer (UR-LAPC) has been widely accepted when feasible. However, optimal preoperative treatment strategies remain unclear. To determine the most effective preoperative approach for UR-LAPC in the current treatment landscape, we conducted a project study in the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Methods: We analyzed 465 UR-LAPC patients who underwent CS following chemotherapy with FOLFIRINOX (FFX), gemcitabine plus nab-paclitaxel (GnP), or modified regimens between 2015 and 2020 across 84 Japanese board-certified training institutions. Overall survival (OS) was the primary endpoint. We used the Kaplan-Meier method for estimating survival analyses, the Cox proportional hazards model for multivariate analyses, and Maximally Selected Rank Statistics to determine the optimal preoperative treatment duration. Results: Median OS was 43.8 months, with a 5-year survival rate of 37.2%. The optimal preoperative treatment duration was 6.1 months. Patients receiving >6 months of preoperative treatment (n=350) showed significantly better median OS and recurrence-free survival (RFS) compared to ≤6 months (n=115) (50.4 vs 29.7 months and 15.6 vs 9.1 months, respectively; both P<0.001 ). FFX-based regimens (n=116) showed better OS and RFS than GnP-based regimens (n=349) (65.0 vs 36.5 months and 19.3 vs 12.4 months, respectively; both P<0.01 ). Multivariate analysis identified preoperative treatment >6 months (HR 0.53, 95% CI 0.407-0.697, P<0.001 ) and initial FFX-based regimens (HR 0.63, 95% CI 0.464-0.843, P=0.002 ) as independent prognostic factors. Additional favorable factors included normal CA19-9 and CEA levels, PNI>45 before CS, adjuvant chemotherapy, R0 resection, and Evans grade III/IV. Conclusions: This large-scale retrospective study has demonstrated that preoperative treatment duration >6 months and the use of FFX-based regimens as initial treatment were associated with improved survival outcomes in UR-LAPC patients undergoing CS. These findings provide critical information for considering CS in UR-LAPC patients, especially in current clinical practice.

Clinical and Prognostic Implications of an Alternative Splicing-related Risk Model Based on TP53 Status in Breast Cancer

Background: Breast Cancer (BRCA) is one of the most common cancers worldwide. Abnormal Alternative Splicing (AS) is frequently observed in cancers. Understanding the intricate relationship between gene mutations and abnormal AS is vital for developing novel diagnostic and therapeutic strategies to effectively target cancer. Objective: This study aimed to focus on the analysis of transcriptomic splicing events in patients with Breast Cancer (BRCA), particularly those with mutations in the TP53 gene. Understanding the role of AS may be helpful in revealing potential predictive indicators for survival and treatment strategies. Methods: The splicing data were downloaded from the Cancer Genome Atlas (TCGA) breast cancer project, incorporating 972 patients in the study, classified according to TP53 mutation status. A comprehensive splicing profile of these breast tumors was outlined, and an interaction network of Alternative Splicing (AS) events and splicing factors was constructed. This allowed for the identification of specific AS events associated with TP53-mutant breast cancer. A prognostic risk model based on AS events was established, using univariate and multivariate Cox regression analyses. To understand the molecular heterogeneity, consensus clustering analyses of prognostic AS events were performed. We also investigated the association of AS patterns with the immune microenvironment and drug sensitivity. Results: A total of 4519 significant Alternative Splicing (AS) events were distributed among 2729 genes that were altered in TP53 mutant tumors. Based on the analysis of these events, a prognostic risk model was created involving ten AS events from ten genes (such as NKTR, CD46, VCAN, etc.). The survival analysis showed that patients with high-risk scores had significantly poorer overall survival (p< 0.001, HR=2.46, 95% CI 1.90-3.18) than those with low-risk scores. Furthermore, the study identified four molecular subtypes related to AS events (C1, C2, C3, and C4), which showed significant differences in immune cell infiltration, with C1 and C4 clusters having a higher degree of immune cell infiltration than C2 and C3. The chemosensitivity analysis revealed that these different AS clusters have different sensitivities to several anticancer drugs, such as docetaxel, paclitaxel, and doxorubicin, with C1 and C4 clusters being more sensitive than the other clusters. Conclusion: We have demonstrated differential transcriptomic splicing events between TP53 mutant and wild-type cases of breast cancer, establishing an effective prognostic risk model based on AS events. These findings provide new insights that may aid in understanding the biological behavior of breast cancer and potentially in optimizing treatment strategies for breast cancer.

Analysis of Prognostic Factors and Treatment Outcomes in Indirect Traumatic Optic Neuropathy: A Retrospective Review of 105 Patients

Purpose To identify risk factors for vision recovery in indirect traumatic optic neuropathy (TON) and to analyze the outcomes associated with surgical treatment for TON. Methods Between 2020 and 2023, a total of 105 patients diagnosed with traumatic optic neuropathy (TON) at Shanghai Ninth People’s Hospital and Shanghai Minhang Hospital were included in a retrospective study. These individuals underwent optic nerve decompression surgery as part of their treatment. To collect comprehensive data, both preoperative and postoperative information was gathered. For analytical purposes, only those patients who had a minimum of one month follow-up post-treatment were considered. The statistical analysis incorporated the use of median values, odds ratios (OR), and 95% confidence intervals (CI) to interpret the data. Any p-values less than 0.05 were deemed to indicate statistical significance, underlining the rigorous criteria set for this study. Results A total of 105 patients, with a mean age of 31.8 ± 14.9 years, met the inclusion criteria; 89.5% (94) were men, and 10.5% (11) were women. The median time to seek medical attention after injury was 4 days (range: 1 to 15 days). Prognostic factors associated with visual acuity (VA) improvement included a gradual VA loss pattern (OR: 2.22, 95% CI: 0.91–5.67, p = 0.045), while canal fractures (OR: 0.31, 95% CI: 0.095–0.933, p = 0.019) significantly correlated with poor VA outcomes. Conclusions This study suggested that surgical interventions benefit TON patients with low vision. Gradual VA loss, rather than sudden loss after injury, may be a potential prognostic factor for favorable VA outcomes, while canal fractures, as detected on computed tomography (CT) imaging—especially complex canal fractures, are associated with poor VA outcomes. In the future, more definitive prospective treatment trials are required to identify optimal treatment strategies for TON.

Post-intrathecal chemotherapy-related paraplegia syndrome in hematological cancer patients: A systematic review.

Intrathecal (IT) chemotherapy is essential in treating hematological malignancies, but it can lead to ascending paraplegia, a condition that currently lacks clear management guidelines. We conducted a systematic review, analyzing 1219 studies and 116 patients, adhering to PRISMA guidelines for individual patient data. The study, registered under PROSPERO (CRD42022362121), focused on the onset, diagnostic approaches, and therapeutic interventions associated with this complication, and management strategies to tackle the ascending paraplegia. Paraplegia typically manifests approximately 10 days after chemotherapy, irrespective of injection frequency. In 95% of cases, paralysis stabilizes around the umbilical region, although some patients progress to upper limb involvement and respiratory compromise. Despite various diagnostic methods, consistent inflammatory markers in blood or cerebrospinal fluid are lacking, with approximately 60% of patients showing normal magnetic resonance imaging results at presentation. Misdiagnoses often include transverse myelitis, Guillain-Barré syndrome, and autoimmune radiculitis. Common treatments such as corticosteroids and intravenous immunoglobulins show limited effectiveness. Our review delineates the clinical entity of ascending paraplegia following IT chemotherapy, aiming to increase clinician awareness and provide prognostic insight. We introduce the term post-IT paraplegia syndrome to facilitate accurate diagnosis and optimize treatment strategies for affected patients.

Examining the Efficacy, Safety, and Future Prospects of Tirofiban in Managing Myocardial Infarction among Diabetic Patients.

Myocardial infarction (MI) is a leading cause of death worldwide, particularly in patients with diabetes mellitus (DM). Tirofiban, a platelet GP IIb/IIIa receptor inhibitor, has shown promise as adjunctive therapy in the emergency management of MI in diabetic patients. However, a comprehensive understanding of its use, efficacy, safety, and limitations in this patient population is necessary to optimize treatment strategies and improve patient outcomes. This review article utilized a systematic approach to gather relevant research articles, clinical trials, and studies on the use of tirofiban in the therapy of MI in diabetic patients. Databases, such as PubMed and Google Scholar, were extensively searched using specific keywords related to tirofiban, MI, DM, STEMI, and antiplatelet therapy. The collected data were carefully examined, summarized, and analyzed to provide an extensive overview of using tirofiban in the management of MI in diabetic individuals. The analysis of the gathered literature revealed that tirofiban has demonstrated efficacy in improving clinical outcomes, reducing myocardial ischemia-reperfusion injury, and promoting early recovery of heart function in diabetic patients with MI undergoing percutaneous coronary intervention. The fast on- and off-rate and dose-dependent effect of the drug on platelet aggregation contribute to its effectiveness. However, caution should be exercised due to the potential risk of tirofiban-associated thrombocytopenia. Clinical trials and studies have provided evidence- based dosing guidelines, enabling the safe and effective administration of tirofiban in this patient population. Tirofiban, a platelet GP IIb/IIIa receptor inhibitor, shows promise as adjunctive therapy in the emergency management of MI in diabetic patients. It has demonstrated efficacy in improving clinical outcomes, reducing myocardial ischemia-reperfusion injury, and promoting early recovery of heart function. However, healthcare providers should be cautious regarding the potential risk of tirofiban-associated thrombocytopenia. Further research is needed to optimize dosing guidelines, evaluate long-term safety, and fully understand the benefits and limitations of tirofiban in this patient population. The comprehensive insights provided in this review aim to enhance treatment strategies and improve patient outcomes in the emergency management of MI in diabetic individuals.

Targeted therapy in TNBC: Exploring the role of antibody-drug conjugates with a focus on sacituzumab govitecan.

To underscore the prevalence and mortality of breast cancer and review advancements in metastatic TNBC management, with a particularly focus on the role of antibody-drug conjugates (ADCs), emphasizing the safety and therapeutic potential of Sacituzumab govitecan (SG) as a groundbreaking ADC. This review gathers scientific data from the past decade, sourced from PUBMED, ClinicalTrials.gov, and Google Scholar to retrieve relevant studies focused on SG in metastatic TNBC treatment. Breast cancer is the most common cancer in women, with TNBC being particularly aggressive and difficult to treat. Recent advancements, such as ADCs, have enhanced treatment options. The third-generation Trop-2-targeting ADC, SG, shows promise for metastatic TNBC. This review summarizes available scientific data on SG's safety, efficacy, and future potential. It also discusses ongoing clinical trials evaluating SG in various combinations, offering hope for improved therapeutic strategies in this high-risk group. ADCs hold great promise for transforming anti-tumor therapies over the next decade and SG has demonstrated substantial efficacy and a manageable safety profile in treating metastatic TNBC. Ongoing trials show that combining SG with immunotherapies enhances its potential, offering hope for better outcomes in patients with limited options. These findings highlight the need for further research to fully define SG's role in optimizing treatment strategies.

P-16 MANAGEMENT OF RECURRENT PARATHYROID CARCINOMA: A CASE REPORT OF MULTIDISCIPLINARY TREATMENT AND LONG-TERM SURVIVAL

Abstract Introduction Parathyroid carcinoma is a rare endocrine malignancy, accounting for a small fraction of primary hyperparathyroidism (PHPT) cases. Its rarity complicates diagnosis due to overlapping symptoms with benign conditions and challenges in pathological examination. Limited cases result in insufficient data on optimal treatment strategies and outcomes. Clinical Case A 49-year-old male with a history of symptomatic primary hyperparathyroidism (PHPT) four years earlier was referred due to recurring hypercalcemia. His initial imaging scans were unobtainable, however, he had a pathology report indicating that he had total thyroidectomy, left-sided cervical lymph node dissection (LND) and parathyroidectomy. A poorly differentiated thyroid carcinoma measuring 4.5x3.5 cm with positive surgical margins and cervical lymph node metastases (15/24) were reported. Additionally, three parathyroid glands were excised; with one reported to be a parathyroid adenoma with a Ki-67 index of 7-10%. The patient was asymptomatic for the following 4 years, except for a transient hypocalcemia early after surgery. However, recently, his symptoms of nausea, muscle weakness and fatigue returned due to recurrent PHPT. Two months before being referred to our center, he was assessed elsewhere (Serum Ca: 15.6 mg/dL, P: 1.9 mg/dL, creatinine: 1.2 g/dL, PTH: 1121 pg/mL), and given 5 mg intravenous zoledronic acid, followed by cinacalcet 30 mg daily. At the time of his presentation to our center, physical examination was unremarkable except surgical scars compatible with thyroidectomy and left-sided cervical LND, and a fixated left-sided supraclavicular lymph node of ∼2 cm. Upon presentation at our center, his labs showed Calcium: 12.07 mg/dL, phoshorus: 1.63 mg/dL, PTH: 1319 pg/mL, and imaging revealed multiple metastatic lymph nodes and lung metastases. A pathology re-evaluation confirmed parathyroid neoplasia, as the immunohistochemical evaluation of the specimens were positive for PTH but negative for thyroidal markers. Multidisciplinary treatment included cervical LND, surgical removal of lung and pleura metastases for reducing tumor load, followed by denosumab, and 16 cycles of paclitaxel and carboplatin, achieving stable disease. Sorafenib was then administered and continued for 18 months. The patient has an 8-year overall survival, with rather stable PTH levels (909-1626 pg/mL), with recent rapid PTH progression to 7897 pg/mL. Conclusion Management of parathyroid carcinoma requires a multidisciplinary approach, with a focus on meticulous metastatic assessment and calcium control. Surgical excision is advised for regional recurrences, while surgery for distant metastases is mainly palliative. Though rare, multikinase inhibitors may help manage hypercalcemia, but long-term survival data are lacking, warranting further research.

Influence factors of clinical effects on patients with early gastric cancer: A retrospective study.

Identifying factors that influence non-curative resection (NCR) is critical to optimize treatment strategies and improve patient outcomes in patients with early gastric cancer (EGC). To investigate the factors influencing the NCR of EGC and to evaluate the predictive value of these factors. The clinical data of 173 patients with EGC admitted between July 2020 and July 2023 were retrospectively collected. According to radical resection criteria, the patients were further divided into curative resection group (n = 143) and NCR group (n = 30). Clinical information was collected, including surgical method, tumor diameter, tumor site, ulcer formation, depth of invasion, pathological type, and lymph node metastasis. Logistic regression analysis was used to explore the factors affecting non-curable resection. Multivariate logistic regression analysis showed that ulcer formation [odds ratio (OR) = 3.53; 95% confidence interval (CI): 1.55-8.01, P = 0.003], pathological type (OR = 3.73; 95%CI: 1.60-8.74, P = 0.002), tumor diameter (OR = 3.15; 95%CI: 1.40-7.05, P = 0.005), tumor location (OR = 3.50; 95%CI: 1.16-10.58, P = 0.027), lymph node metastasis (OR = 4.40; 95%CI: 1.83-10.57, P = 0.001), and depth of penetration (OR = 3.75; 95%CI: 1.60-8.74, P = 0.002) were all risk factors for NCR in EGC patients. Predictive analysis showed varying area under the curve values for factors such as tumor diameter (0.636), tumor location (0.608), ulcer formation (0.652), infiltration depth (0.658), pathological type (0.656), and lymph node metastasis (0.674). The results suggest that factors such as tumor diameter, tumor location, ulcer formation, depth of invasion, pathological type, and lymph node metastasis increase the risk of NCR in EGC patients.

Machine Learning Model for Risk Stratification of Papillary Thyroid Carcinoma Based on Radiopathomics.

This study aims to develop a radiopathomics model based on preoperative ultrasoundand fine-needle aspiration cytology (FNAC) images to enable accurate, non-invasive preoperative risk stratification for patients with papillary thyroid carcinoma (PTC). The model seeks to enhance clinical decision-making by optimizing preoperative treatment strategies. A retrospective analysis was conducted on data from PTC patients who underwent thyroidectomy between October 2022 and May 2024 across six centers. Based on lymph node dissection outcomes, patients were categorized into high-risk and low-risk groups. Initially, a clinical predictive model was established based on the maximum diameter of the thyroid nodules. Radiomics features were extracted from preoperative two-dimensional ultrasound images, and pathomics features were extracted from 400x magnification H&E-stained tumor cell images from FNAC. The most predictive radiomics and pathomics features were identified through univariate analysis, Pearson correlation analysis and LASSO algorithm. The most valuable radiopathomics features were then selected by combining these predictive features. Finally, machine learningwith the XGBoost algorithm was employed to construct radiomics, pathomics, and radiopathomics models. The performance of the models was evaluated using the area under the curve (AUC), decision curve analysis, accuracy, specificity, sensitivity, positive predictive value, and negative predictive value. A total of 688 PTC patients were included, with 344 classified as intermediate/high-risk and 344 as low-risk. The multimodal radiopathomics model demonstrated excellent predictive performance, with AUCs of 0.886 (95% CI: 0.829-0.924) and 0.828 (95% CI: 0.751-0.879) in two external validation cohorts, significantly outperforming the clinical model (AUCs of 0.662 and 0.601), radiomics model (AUCs of 0.702 and 0.697), and pathomics model (AUCs of 0.741 and 0.712). The radiopathomics model exhibits significant advantages in accurately predicting preoperative risk stratification in PTC patients. Its application is expected to reduce unnecessary lymph node dissection surgeries, optimize treatment strategies, and improve therapeutic outcomes.

Bibliometric analysis of global research trends in vestibular neuritis (1980-2024).

Vestibular neuritis (VN) is a common cause of vertigo with significant impact on patients' quality of life. This study aimed to analyze global research trends in VN using bibliometric methods to identify key themes, influential authors, institutions, and countries contributing to the field. We conducted a comprehensive search of the Web of Science Core Collection database for publications related to VN from 1980 to 2024. Bibliometric data including publication year, keywords, citations, authors, journals, institutions, and countries were extracted and analyzed using VOSviewer software. A total of 624 publications were identified, showing a steady increase in VN research output, particularly after 2003. South Korea and the USA were the most prolific countries, while Acta Oto-Laryngologica and Otology & Neurotology were the leading journals in terms of publication count. Michael Strupp emerged as the most productive author. Keyword analysis revealed prominent research themes including diagnosis, treatment (vestibular rehabilitation, pharmacological interventions), pathophysiology, and the impact of VN on vestibular function. This bibliometric analysis provides a comprehensive overview of global VN research. The findings highlight the growing research interest in VN, with a focus on improving diagnostic accuracy, optimizing treatment strategies, and understanding the underlying mechanisms. This study can serve as a valuable resource for researchers, clinicians, and policymakers interested in the field of VN.

Optimizing healthcare big data performance through regional computing

The healthcare sector is experiencing a digital transformation propelled by the Internet of Medical Things (IOMT), real-time patient monitoring, robotic surgery, Electronic Health Records (EHR), medical imaging, and wearable technologies. This proliferation of digital tools generates vast quantities of healthcare data. Efficient and timely analysis of this data is critical for enhancing patient outcomes and optimizing care delivery. Real-time processing of Healthcare Big Data (HBD) offers significant potential for improved diagnostics, continuous monitoring, and effective surgical interventions. However, conventional cloud-based processing systems face challenges due to the sheer volume and time-sensitive nature of this data. The migration of large datasets to centralized cloud infrastructures often results in latency, which impedes real-time applications. Furthermore, network congestion exacerbates these challenges, delaying access to vital insights necessary for informed decision-making. Such limitations hinder healthcare professionals from fully leveraging the capabilities of emerging technologies and big data analytics. To mitigate these issues, this paper proposes a Regional Computing (RC) paradigm for the management of HBD. The RC framework establishes strategically positioned regional servers capable of regionally collecting, processing, and storing medical data, thereby reducing dependence on centralized cloud resources, especially during peak usage periods. This innovative approach effectively addresses the constraints of traditional cloud processing, facilitating real-time data analysis at the regional level. Ultimately, it empowers healthcare providers with the timely information required to deliver data-driven, personalized care and optimize treatment strategies.

Cerebellar metastasis from colorectal cancer: a case report

IntroductionColorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide, with adenocarcinoma as the most common subtype. While metastasis typically occurs in the liver, lungs, and peritoneal cavity, metastasis to the brain, particularly the cerebellum, is exceedingly rare.Case presentationThis report discusses the case of a 50-year-old woman diagnosed with mucinous adenocarcinoma of the descending colon. Over six years, the patient experienced multiple common metastatic sites, including the liver and lungs, before developing a rare cerebellar metastasis. Despite extensive treatment, including surgery and chemotherapy, the disease progressed, ultimately leading to the patient’s demise. This case represents the first documented cerebellar metastasis from CRC in Mexico.ConclusionThis case highlights the altered metastatic patterns in CRC due to advanced therapies that extend survival. Clinicians should remain vigilant for metastasis to uncommon sites, such as the cerebellum, especially in patients with prolonged survival. Further research is needed to understand the mechanisms underlying such metastatic behavior and optimize treatment strategies.

What is the optimal treatment strategy for ACL injuries in children and adolescents?

What is the optimal treatment strategy for ACL injuries in children and adolescents?

Expert perspectives on the clinical use of meropenem monotherapy in the management of various antibiotic-resistant pathogens in Indian settings

Background: To gather expert perspectives on the clinical use of meropenem monotherapy in managing multidrug-resistant (MDR), extensively drug-resistant (XDR), and pan-drug-resistant (PDR) pathogens in Indian settings. Methods: This cross-sectional study used a 20-item questionnaire to gather clinician opinions on prescription practices, clinical observations, and preferences regarding meropenem monotherapy. Descriptive statistics were employed to analyze the responses, presenting frequencies as percentages. Results: A total of 353 clinicians participated in this study, with 37% reporting a 6-10% prevalence of MDR, XDR, and PDR pathogens in their practice. Complicated intra-abdominal infections (cIAIs) were the most common conditions treated with meropenem, reported by 54.96% of respondents. The majority (91.5%) of the respondents preferred combination therapy for resistant infections, with tigecycline (54%) and colistin (33.43%) being common choices. Key pathogens included Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus. Most participants (58%) favored administering 1g of IV meropenem in 2 to 3 divided doses. Bloodstream infections, meningitis, and ventilator-associated pneumonia (VAP) were noted as primary indications for meropenem use. Additionally, 68% of participants stated meropenem was the most prescribed antibiotic for complicated urinary tract infections (cUTIs), while 77% indicated it as the preferred treatment for Gram-negative MDR pathogens. Conclusion: Meropenem remains a critical option for treating MDR, XDR, and PDR infections in India, particularly in combination with tigecycline or colistin. Clinicians preferred its use in cIAIs and VAP, especially in elderly patients. The findings highlight the importance of continuously monitoring resistance patterns to optimize treatment strategies.

Baseline (derived) neutrophil-lymphocyte ratio associated with survival in gastroesophageal junction or gastric cancer treated with ICIs

ObjectiveWe carried out the meta-analysis to determine the predictive value of baseline neutrophil to lymphocyte ratio (NLR) and derived neutrophil to lymphocyte ratio (dNLR) levels in patients with gastroesophageal junction or gastric cancer (GJGC) who underwent immune checkpoint inhibitor (ICI) treatment.MethodsEligible articles were obtained through PubMed, the Cochrane Library, EMBASE, and Google Scholar, until April 15, 2023. The clinical outcomes evaluated in this study encompassed overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR)ResultsA total of 24 articles with 2221 patients were included in this meta-analysis. The pooled results demonstrated that patients with high NLR levels had significantly poorer OS (HR: 1.860, 95% CI: 1.564-2.213, p < 0.001) and PFS (HR: 1.678, 95% CI: 1.354-2.079, p < 0.001), and lower ORR (OR: 0.754, 95% CI: 0.621-0.915, p = 0.004) and DCR (OR: 0.391, 95% CI: 0.262-0.582, p < 0.001). Besides, we also found that high dNLR levels were significantly associated with shorter OS (HR: 2.117, 95% CI: 1.590-2.820, p < 0.001) and PFS (HR: 1.803, 95% CI: 1.415-2.297, p < 0.001).ConclusionLow baseline (Derived) NLR has the potential to predict the good efficacy of ICIs and survival outcomes in patients with GJGC. (Derived) NLR could be useful in determining the optimal treatment strategies for these patients.

Antiphospholipid Syndrome: A Comprehensive Clinical Review

Background: Antiphospholipid syndrome (APS) is a rare systemic autoimmune disease characterized by persistent antiphospholipid antibodies (aPL) in combination with recurrent thrombosis in the veins and/or arteries, obstetric morbidity, and various non-thrombotic associated complications. APS can be primary, as an isolated condition, or secondary in the context of another autoimmune disease, especially systemic lupus erythematosus. This comprehensive clinical review aims to summarize the current understanding of APS pathogenesis, diagnostic approaches, and treatment strategies for this unique clinical entity. Methods: A comprehensive review of the existing literature on APS was conducted, focusing on pathophysiological mechanisms, current diagnostic criteria, and therapeutic approaches. Results: APS pathogenesis involves complex interactions between aPL, phospholipid-binding proteins, and the coagulation cascade. Apart from the cardinal features of thrombosis and APS-related obstetric morbidity, APS is associated with a wide spectrum of clinical manifestations. Diagnosis remains challenging due to overlapping symptoms with other conditions, and clinicians should maintain a high index of suspicion in order to set the diagnosis. The recently published 2023 ACR/EULAR criteria although not definitive for clinical decision-making, these criteria offer clinicians a valuable tool to aid in determining whether further investigation for APS is warranted. Continued refinement of these criteria through ongoing feedback and updates is anticipated. Treatment strategies center on anticoagulation, but individualized approaches are necessary. Conclusions: Early diagnosis and multidisciplinary management of APS are critical to reducing morbidity and improving outcomes. Moreover, familiarization with the 2023 ACR/EULAR criteria is encouraged, recognizing that ongoing feedback and updates will contribute to their ongoing refinement and improvement. While VKAs remain the mainstay of treatment for most APS patients further research is needed to optimize treatment strategies and deepen our understanding of APS’s underlying disease mechanisms.