Search Results (49)

Background: Neuroendocrine tumors (NETs) remain a problematic area in endocrine oncology due to their non-specific symptoms and lack of reliable biomarkers. Visfatin/eNAMPT’s involvement in tumorigenesis has been described in several malignancies. In NETs, NAMPT inhibition was explored as a potential therapeutic option; however, serum visfatin and its role as a biomarker have not been studied. Objectives: We aimed to measure serum visfatin concentrations in NETs and evaluate visfatin’s potential as a diagnostic biomarker. Methods: We conducted a single-center, cross-sectional study of 77 patients with NETs (33 pancreatic and 44 small intestinal) and 29 controls. Patient demographics, tumor characteristics, and clinical data were analyzed, and serum visfatin levels were measured using ELISA. Statistical analyses were performed in Python, including Mann–Whitney U and Kruskal–Wallis tests, Spearman’s correlation, multiple linear regression, and ROC curve analysis. Results: Serum visfatin was higher in NETs compared to controls (median [IQR]: 6.94 [2.11–236.17] vs. 1.59 [1.1–9.24] ng/mL, p = 0.004). ROC curves showed moderate diagnostic performance (AUC = 0.68), with concentrations above 2.11 ng/mL achieving 75.3% sensitivity and 58.6% specificity. In NETs, visfatin did not differ based on WHO grade (G1/G2, p = 0.31), primary site (pancreas/small intestine, p = 0.95), sex (p = 0.89), age (p = 0.13), and when stratified by primary site and grade (p = 0.18). Multiple linear regression confirmed no association between visfatin and the study variables (R-squared = 0.036, all p > 0.2). Conclusions: This is the first study examining serum visfatin as a diagnostic biomarker in NETs. Visfatin concentrations show moderate discriminatory ability between NETs and controls, independent of tumor and clinical characteristics. Further research should involve larger cohorts and comparisons to established biomarkers. Full article

Objective: The American Urological Association recommends ablation as an alternative treatment option for T1a RCC smaller than 3 cm. Our objective is to describe our technique and evaluate the outcomes of radiofrequency ablation (RFA) for biopsy-proven T1a RCC measuring 3–4 cm, compared to outcomes for tumors <3 cm. Materials and Methods: A single-center, retrospective review included patients with solitary, de novo, biopsy-proven T1a RCC who underwent RFA between January 2001 and December 2020. Using propensity score matching, patients with 3–4 cm lesions (Group A) were matched with patients with lesions less than 3 cm (Group B) based on the pathology, grade, duration of follow-up, another primary malignancy, age, and sex. Survival outcomes were estimated using the Kaplan and Meier product-limit estimator, and both groups were compared. Results: A total of 122 patients were included in the matched analyses. Eight patients were missing data on disease recurrence, leaving 114 patients with data on RFS and DFS (55 patients in Group A and 59 patients in Group B). The median tumor size in groups A and B was 3.3 cm and 2.2 cm, respectively. There was no statistically significant difference in the complication rate (p = 0.11) and local recurrence at the ablation site (p = 0.15). There was no statistically significant difference in overall survival (p = 0.93), recurrence-free survival (p = 0.45), or disease-free survival (p = 0.37). The metastasis-free survival and cancer-specific survival were 100% in both groups. Conclusions: RFA is a highly effective modality for the treatment of 3–4 cm T1a RCC, with long-term favorable oncologic and survival outcomes. Full article

Background and Objectives: Peripheral facial paralysis (PFP) is a condition with diverse etiologies, requiring multidisciplinary management. This study aimed to describe the sociodemographic, clinical, and functional characteristics of patients with PFP treated at the Rehabilitation Service of the University Hospital of Burgos and to evaluate factors associated with the initial degree of impairment. Materials and Methods: A descriptive, cross-sectional study was conducted on 45 patients referred to the Rehabilitation Service from July 2018 to July 2023. Inclusion criteria included first-time rehabilitation visits for PFP during the study period with signed informed consent. Patients with prior PFP on the affected side or severe comorbidities, such as stroke, were excluded. Data were collected from medical records and initial evaluations. The Sunnybrook Facial Grading System (SFGS) was used to assess impairment. Results: Idiopathic paralysis was the most common etiology, with a predominance in men (60.9%) and middle-aged or older adults. Otorhinolaryngology was the leading referral service, though primary care referrals were underrepresented. Delays in initiating rehabilitation were identified, especially in complex cases like acoustic neurinoma. The ANOVA test revealed no significant differences in functional assessments based on age, sex, or etiology, likely due to the limited sample size. Conclusions: The study highlights the predominance of idiopathic etiology in PFP and the importance of otorhinolaryngology in referrals. Greater awareness in primary care and early identification are crucial. Future studies with larger samples are needed to evaluate predictors of impairment and optimize rehabilitation strategies. Full article

Background: Skeletal age estimation plays a fundamental role in orthopedic treatments. Since the most reliable methods are based on ionizing radiation, this study aimed to use machine learning techniques to explore a skeletal age assessment method not based on additional radiographies. Methods: Patients aged between 6 and 16 years old whose clinical records included orthopantomography, radiographs of the second phalanx of the third finger, and biometric data were enrolled for the study. The radiographs were analyzed to estimate the maturation degree of the left lower first premolars, the midpalatal suture, and the second phalanx of the third finger. Both an explicative data analysis and a multivariate analysis were performed. Results: The sample comprised 111 subjects. The multivariate analysis revealed an explanatory role for sex (p < 0.01) and chronological age (p < 0.01). The ordinal tool showed how the use of height (p = 0.02) and weight (p = 0.03) was explicative of skeletal age against a loss of statistical significance corresponding to the use of body mass index (p = 0.6). The median palatine suture (p = 0.01) was explicative. Conclusions: The combined evaluation of weight, height, sex, chronological age, and grade of maturation of the midpalate suture provides an explicative tool for assessing skeletal age without additional radiographic exams, besides a routine orthopantomography. Full article

Background: The global increase in the population older than 80 years has led to a paradigm shift centered in the hospital environment, with the inclusion of domiciliary oral health actions improving quality of life. This review evaluates the effects of domiciliary dental care and oral health promotion in nursing homes of older adults. Methods: Seven databases were searched without date restrictions from 15 September to 21 November 2024. A manual search was also performed in the reference lists of the included articles. This research included studies evaluating older adults aged ≥80 years, regardless of sex, who received domiciliary dental care associated or not with oral health promotion, evaluating periodontal condition, dental caries, and the dental and denture plaque index. Regarding data collection and analysis, a risk of bias assessment was performed using RoB 2.0 and RoB 1.0, according to the study design. The level of evidence was assessed using the GRADE tool. Results: Of the 2415 studies found, 5 met the eligibility criteria. After quality assessment, one randomized clinical trial presented a moderate risk of bias, and one presented a low risk. Also, two non-randomized studies presented a high risk and one a low risk. The certainty of evidence was classified as low for all outcomes assessed. One study demonstrated a reduction in the caries level of participants. Regarding periodontal and gingival conditions, although the occurrence of deep pockets (greater than 3.5 mm) decreased over time, there was no significant difference between the control and intervention groups. The level of dental and denture plaque showed a slight reduction. Conclusion: There is limited evidence that domiciliary dental care in nursing homes for older adults can lead to a reduction in caries levels and that oral health programs can reduce dental and denture plaque in evaluations conducted over periods of up to two years. Although the results show a limited magnitude, this does not diminish the importance of promoting domiciliary oral health care. Full article

Background/Objectives: Utilizing a significative sample, this study aimed to analyze body composition components in different age groups and to develop age-specific normative tables for individuals in southern Brazil. Methods: This observational, descriptive, and cross-sectional study evaluated 8556 individuals of both sexes (54% females) aged 18–49. The hypotheses of the present study are related to declining fat-free mass (FFM), lean mass (LM), and skeletal muscle mass (SMM) and increasing fat mass (FM) and body fat percentage (BFP) during the aging process. Data were collected through bioelectrical impedance analysis (BIA) and stratified by age (18–29, 30–39, and 40–49 years), sex, and body mass index (BMI) classifications (normal weight, overweight, grade I, and grade II obesity). Following the comparison, body composition components were presented in the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles. Results: This study’s main findings indicated that FM and BFP increased with age in both sexes. Among overweight and obese individuals, elevated BFP was particularly high in obese females aged 40–49 years and in normal and overweight males. FFM, LM, and SMM were generally lower in the 40–49-year-old group, although obese females over 40 presented higher FFM and LM values. In contrast, males presented lower FFM and LM values but higher values among individuals with higher BMI. SMM was lower in overweight individuals over 40, likely reflecting muscle mass loss associated with aging. Conclusions: Based on these results, lifestyle interventions that combine nutrition and physical exercise may be recommended to mitigate these effects of aging. Full article

Background: Although extensive resection improves the prognosis of gliomas, it risks impairing critical brain functions. Photodynamic therapy (PDT) utilizing talaporfin sodium (TS) targets tumor cells upon light activation. Despite its approval in Japan, TS application remains restricted, and factors influencing its efficacy are unclear. We aimed to identify TS efficacy determinants to optimize treatment outcomes. Methods: Data from 171 patients with grade 4 glioma who underwent surgery and PDT at Tokyo Women’s Medical University Hospital between January 2017 and March 2024 were retrospectively analyzed. Clinical variables evaluated included age, sex, genotype, Karnofsky Performance Status (KPS), serum albumin (Alb) levels, MIB-1 expression levels, and medication history. TS concentrations in tumor tissues were quantitatively assessed in 82 patients (41 primary, 41 recurrent). Survival outcomes were analyzed. RNA-seq was performed on the three highest and three lowest TS concentration samples with significant TS concentration variations to investigate corresponding gene expression changes. Results: Multivariate analysis identified KPS (hazard ratio [95% confidence interval]: 0.96 [0.93–0.99], p = 0.01) and Alb (3.68 [1.05–13.76], p = 0.047) as independent prognostic factors. In recurrent cases, higher TS concentrations were significantly associated with improved survival (p = 0.0454). RNA-seq analysis indicated decreased expression of ACTB and PDPN genes in samples with lower TS concentrations, suggesting potential resistance mechanisms. Conclusions: TS concentration is a critical determinant of PDT efficacy, especially in recurrent glioma, highlighting its prognostic significance. Alb may affect treatment outcomes by mediating TS binding. RNA-seq findings imply that low TS concentrations may suppress immune and stress response-related genes, potentially diminishing PDT sensitivity. Full article

Objective: To evaluate the psychometric properties of the Shortened Version of the Token Test (SVTT), the Peabody Picture Vocabulary Test (PPVT-III), and the Rey–Osterrieth Complex Figure (ROCF) using an item response theory (IRT) framework and to establish normative data for Waranka children and adolescents based on their ability scores. Methods: A total of 436 healthy people aged between 6 and 17 participated in this study. The factor structure was evaluated using confirmatory factor analysis (CFA) and the difficulty and discrimination parameters using IRT through the two-parameter logistic model for the SVTT and PPTV-III, while for the ROCF, the graded response model was used. The ordinal alpha and McDonald’s omega were used for reliability. Results: For most items, a low ability was enough to achieve the highest scores for the ROCF and SVTT. For the PPVT-III, the items aligned sequentially based on the difficulty, and a low level of ability was enough to achieve the highest score for the first 40 items. The ROCF, SVTT, and PPVT-III demonstrated adequate reliability. The ROCF copy and immediate recall scores were influenced by the mean parents’ years of education (MPE) and quadratic age interaction. The SVTT performance was affected by the quadratic age and sex interaction, and the PPVT-III by the interaction effect of the MPE and quadratic age. Conclusions: This is the first study to analyze the psychometric properties of the ROCF, SVTT, and PPVT-III through IRT models that are accurate and relevant for the validity of the obtained data and generate normative data in the under-represented nation of Ecuador for clinical and research purposes. Full article

Soft tissue sarcomas are defined as relatively rare, wide-ranging mesenchymal tumors that present several forms of aggressive behavior. In order to improve the therapeutic result and thus the patient's prognosis, reliable diagnostic and evaluation tools are needed, capable of establishing the evolutive pattern of each patient. Materials and Methods. An analytical observational study was conducted in the period 2016–2023 in the Orthopedics Department of the Bucharest University Emergency Hospital, on patients diagnosed with soft tissue sarcoma. Data such as sex, age, site, size, depth, histotype, grade and margin status, vessel or bone involvement, adenopathies, adjuvant therapy, clinical findings, etc., were analyzed. Diagnosis included immunohistochemistry after macroscopic pathological findings were carefully reviewed by a dedicated pathologist. A molecular study was performed to increase the accuracy of diagnosis, prognosis and clinical management of selected sarcomas. Results. In adult soft tissue sarcomas, histotype has been reported to be a significant predictor of overall survival. In terms of survival rate, vascular invasion appears to be a significant pathological factor for progression in extremity STS. Even though the local control of the disease has improved, the development of systemic metastases seems to be largely influenced by the biological characteristics of the tumor. Conclusions. Significant prognostic factors for the likelihood of a lower survival and death rate are tumor size, tumor depth, histology type, and vascular invasion. The results of the study support and complement the literature data, thus improving the understanding of the prognosis of soft tissue sarcomas. Full article

Background/Objectives: High-grade gliomas are the most common primary malignant brain tumors in adults. These neoplasms remain predominantly incurable due to the genetic diversity within each tumor, leading to varied responses to specific drug therapies. With the advent of new targeted and immune therapies, which have demonstrated promising outcomes in clinical trials, there is a growing need for image-based techniques to enable early prediction of treatment response. This study aimed to evaluate the potential of radiomics and artificial intelligence implementation in predicting progression-free survival (PFS) in patients with highest-grade glioma (CNS WHO 4) undergoing a standard treatment plan. Methods: In this retrospective study, prediction models were developed in a cohort of 51 patients with pathologically confirmed highest-grade glioma (CNS WHO 4) from the authors’ institution and the repository of the Cancer Imaging Archive (TCIA). Only patients with confirmed recurrence after complete tumor resection with adjuvant radiotherapy and chemotherapy with temozolomide were included. For each patient, 109 radiomic features of the tumor were obtained from a preoperative magnetic resonance imaging (MRI) examination. Four clinical features were added manually—sex, weight, age at the time of diagnosis, and the lobe of the brain where the tumor was located. The data label was the time to recurrence, which was determined based on follow-up MRI scans. Artificial intelligence algorithms were built to predict PFS in the training set (n = 75%) and then validate it in the test set (n = 25%). The performance of each model in both the training and test datasets was assessed using mean absolute percentage error (MAPE). Results: In the test set, the random forest model showed the highest predictive performance with 1-MAPE = 92.27% and a C-index of 0.9544. The decision tree, gradient booster, and artificial neural network models showed slightly lower effectiveness with 1-MAPE of 88.31%, 80.21%, and 91.29%, respectively. Conclusions: Four of the six models built gave satisfactory results. These results show that artificial intelligence models combined with radiomic features could be useful for predicting the progression-free survival of high-grade glioma patients. This could be beneficial for risk stratification of patients, enhancing the potential for personalized treatment plans and improving overall survival. Further investigation is necessary with an expanded sample size and external multicenter validation. Full article

Background: Chondrosarcomas (CS) are a rare and heterogenic group of primary malignant bone tumors. In the literature, data on prognostic factors in chondrosarcomas are scarce, and most studies are limited by a short follow-up. The aim of this retrospective study was therefore to determine factors associated with the survival and local recurrence of chondrosarcomas and to compare the results with previous studies. Methods: We retrospectively evaluated 77 patients who were treated for chondrosarcoma of the extremities or pelvis at our tertiary sarcoma center between 1998 and 2007. Patient-related data (age, sex, etc.), tumor characteristics (localization, grading, presence of metastases, etc.), and treatment-related data (previous surgical treatment, type of local treatment, surgical margins, etc.) were evaluated and analyzed for possible correlation with patients’ outcomes. A statistical analysis was performed, including multivariate analysis. Results: The mean survival in our patients was 207 months, which resulted in a five-year survival rate of 76%. Negative prognostic factors for survival were histopathological grading, a patient aged over 70 years, and metastatic disease. The quality of the resection (clear or contaminated margins) negatively influenced both the development of local recurrence and survival too, at least in the univariate analysis. In contrast, factors such as tumor localization (extremities vs. pelvis), pathological fractures, or an initial inadequate resection elsewhere had no significant effect on survival. Conclusions: In accordance with results in the literature, the survival of patients with chondrosarcomas is mainly influenced by factors such as tumor grading, age, and metastases. However, complete resection remains paramount for the outcome in patients with chondrosarcoma—a primary malignant bone tumor with limited alternative treatment options. Full article

The aim of our study is to evaluate the relationship between sociodemographic and clinical characteristics of individuals with Colorectal Cancer (CRC), tumour-intrinsic characteristics and treatment received with health-related quality of life (HRQoL). Methods: Cross-sectional analysis of data from 805 survivors from the MCC study was conducted. HRQoL was assessed through a general and specific questionnaire, SF-12 and FCSI (Colorectal Symptom Index). Statistical analyses were performed with linear regression with adjustment for sociodemographic variables, stage at diagnosis and histological grade. Results: Participants had survived a median of 7.9 years from diagnosis (IQR 7.1–8.5 years). Age at diagnosis, sex and area showed a clear association with HRQoL in both physical and mental dimensions of the SF-12 questionnaire. A direct association between CRC recurrence was also found in the PCS-12 and MCS-12 dimensions and radical surgery in the PCS-12. Regarding the scores in FCSI questionnaire, statistically significant differences were observed by sex, age and area, with older women being the most impaired (p < 0.001). Conclusions: Age, sex and area was associated with lower scores of HRQoL among CRC survivors. Knowing the determinants related to HRQoL would allow us to lay the groundwork to develop strategies that help reduce morbidity and mortality, relapses and increase HRQoL. Full article

Background: Our purpose is to evaluate the long-term oncologic efficacy and survival rates of MRI-guided cryoablation for patients with biopsy-proven cT1a renal cell carcinoma (RCC). Materials and Methods: We retrospectively reviewed our renal ablation database between January 2007 and June 2021 and only included patients with solitary-biopsy-proven cT1a RCC (≤4 cm) who underwent MRI-guided cryoablation. We excluded patients with genetic syndromes, bilateral RCC, recurrent RCC or benign lesions, those without pathologically proven RCC lesions and patients who underwent radiofrequency ablation or CT-guided cryoablation. For each patient, we collected the following: age, sex, lesion size, right- or left-sided, pathology, ablation zone tumor recurrence, development of new tumor in the kidney other than ablation zone, development of metastatic disease, patient alive or not, date and cause of death. We used the Kaplan and Meier product limit estimator to estimate the survival outcomes. Results: Twenty-nine patients (median age 70 years) met our inclusion criteria. Twenty-nine MRI-guided cryoablation procedures were performed for twenty-nine tumor lesions with a median size of 2.2 cm. A Clavien–Dindo grade III complication developed in one patient (3.4%). Clear cell RCC was the most reported histology (n = 19). The median follow up was 4.5 years. No tumor recurrence or metastatic disease developed in any of the patients. Two patients developed new renal lesions separate from the ablation zone. The 5- and 10-year OS were 72% and 55.6%, respectively. The 5- and 10-year DFS were 90.5% and the 5-year and 10-year LRFS, MFS and CSS were all 100%. Conclusions: MRI-guided cryoablation is a safe treatment with a low complication rate. Long-term follow-up data revealed long-standing oncologic control. Full article

Background: Previous studies demonstrate an association between metabolic factors and Helicobacter pylori-related gastric cancer. However, the association of gastric atrophy or intestinal metaplasia (IM) with these factors remains unknown. Methods: Data on 1603 Helicobacter pylori-positive patients who underwent esophagogastroduodenoscopy between 2001 and 2021 were evaluated. The outcome measures were endoscopic atrophy, IM grade, and the incidence of endoscopically diagnosed and pathologically confirmed gastric neoplasms. Clinical factors associated with these findings were also determined. Results: Advanced age; successful Helicobacter pylori eradication; and comorbidities including diabetes mellitus (DM), hypertension, dyslipidemia, and fib4 index were significantly associated with endoscopic gastric atrophy grade. Male sex; advanced age; and comorbidities including DM, hypertension, dyslipidemia, hyperuricemia, fatty liver, aortic calcification, and fib4 index were also significantly associated with endoscopic IM grade, whereas advanced age, successful Helicobacter pylori eradication, DM, fatty liver, and fib4 index were significantly associated with the incidence of gastric neoplasms. Conclusion: Several metabolic disorders, including DM, hypertension, dyslipidemia, hyperuricemia, and fatty liver disease, are risk factors for advanced-grade gastric atrophy, intestinal metaplasia, and gastric neoplasms. Risk stratification according to these factors, particularly those with metabolic disorders, would affect EGD surveillance for Helicobacter pylori-positive patients. Full article

In the expanding landscape of immune checkpoint inhibitors (CPI) in high-risk (HR) non-muscle-invasive bladder cancer (NMIBC), the role of programmed death ligand 1 (PD-L1) as prognostic and predictive is increasingly significant. However, data evaluating its variability and susceptibility to Bacillus Calmette–Guérin (BCG) therapy in HR NMIBC patients is scarce. This retrospective study analyzed 126 HR NMIBC tissue samples from 63 patients (38× BCG-treated, 25× BCG-naïve) at two time points to assess PD-L1 expression using the ‘combined positivity score’ (CPS) with the 22C3 DAKO antibody method and correlated it with clinicopathological parameters. A CPS > 10 defined PD-L1 positivity. The impact of initial PD-L1 status and its change over time on time-to-recurrence, progression-free survival, and overall survival (TTR, PFS, OS) was analyzed using Kaplan–Meier and Cox proportional hazard models. BCG treatment significantly increased PD-L1 expression (5.31 vs. 0.22, p = 0.0423), with PD-L1 positive cases rising post-treatment in the BCG group and remaining unchanged in BCG-naïve patients. Multivariate analysis including T-stage, CIS, grading, tumor size, multifocality, age, and sex revealed a significant correlation between PD-L1 status change to positivity and improved TTR (p = 0.03). Our findings demonstrate a potential modulation of the PD-L1 status by an intravesical BCG therapy. However, its prognostic value appears limited. Full article