Search Results (209)

Objective: In the eighth edition of the American Joint Committee on Cancer tumor–node–metastasis staging system, gross extrathyroidal extension (ETE) into the strap muscles is classified as T3b when identified during surgery. In clinical practice, this invasion is primarily assessed intraoperatively by the surgeon and documented in the operative report, forming the basis of the final T3b staging. Because this evaluation is inherently subjective, its diagnostic accuracy remains uncertain. This study evaluated the accuracy of intraoperative gross ETE assessment and whether misclassification affects recurrence outcomes. Methods: In total, 4987 patients who underwent thyroidectomy at Seoul St. Mary’s Hospital during 2017–2022 were analyzed. Patients were categorized by concordance between intraoperative findings and final pathology: confirmed gross ETE (Group A), intraoperative overestimation (Group B), and intraoperative underestimation (Group C). Clinical characteristics, recurrence rates, and predictors of inaccurate assessment were compared. Results: Of the cohort, 179 patients (3.6%) were judged intraoperatively to have gross ETE, classified as Group A (141 patients), Group B (38), and Group C (33). Recurrence rates were not significantly different among groups (6.4%, 2.6%, and 3.0% in Groups A, B, and C, respectively). Other than lymphatic invasion and tumor size, baseline characteristics were comparable among groups. Multivariate analysis identified age (odds ratio [OR]: 0.961; 95% confidence interval [CI]: 0.932–0.990; p = 0.009), tumor location (OR: 0.182; 95% CI: 0.056–0.591; p = 0.005), and lymphatic invasion (OR: 0.292; 95% CI: 0.118–0.719; p = 0.007) as independent predictors of inaccurate intraoperative evaluation. Conclusions: Among 179 patients suspected of gross ETE intraoperatively, 21.2% showed no muscle invasion on pathology. Although recurrence rates were similar across groups, recurrence-free survival tended to be lower in Group A relative to Group B, indicating the potential prognostic relevance of accurate intraoperative T3b identification. Long-term follow-up is needed to confirm this trend. Full article

Universal newborn hearing screening (UNHS) has become widely adopted worldwide as a standard of care for the early detection of congenital hearing loss. The Egyptian UNHS program started as a presidential initiative by the Ministry of Health in November 2019. The program was initiated in 1346 primary health care units (PHCUs) located throughout the 26 governorates. A retrospective study was conducted to assess the performance of the Egyptian Program during the period from November 2019 to July 2023. Quality measures recommended by the Joint Committee on Infant Hearing including coverage rate, rate of referral to a second screening, follow up rate of attendance of second screening, referral for diagnosis rate, and follow up rate of attendance of diagnostic assessment, were analyzed. Over a period of 3 years and 9 months, more than five and half million infants underwent a first screening. The coverage rate was initially 39% and increased to reach 82% in 2023. The rate of referral to a second screen was 7.2% in 2019 and reached 5.2% in 2023. The follow-up rate of attendance of a second screening improved throughout the study period, from 75.5% to 92.1% but did not reach the benchmark of 95%. The rate of referrals for diagnosis was less than 1.7% and rate of attendance of a diagnostic assessment was initially 20% and improved to more than 65% in 2023. The very low rate of attendance of diagnostic assessment in 2020 and 2021 was attributed to the effects of the COVID pandemic. Full article

Background: Staging systems are essential for guiding treatment and predicting outcomes in cancer patients. For pancreatic neuroendocrine tumors, the American Joint Committee on Cancer (AJCC) Tumor, Lymph Node, and Metastasis (TNM) system is the current standard. However, its predictive accuracy is limited, as survival curves often overlap, particularly between Stage I and Stage II. Improved methods of patient stratification are therefore needed. Methods: We applied the Ensemble Algorithm for Clustering Cancer Data (EACCD) that involves calculating dissimilarities, ensemble learning, and hierarchical clustering. Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Models were developed with AJCC TNM variables (T, N, M) and expanded by including patient age. Results: The AJCC TNM system achieved a C-index of 0.6656 (95% CI: 0.6473–0.6839), with survival curves showing poor separation. In contrast, the EACCD model using TNM variables produced four prognostic groups with refined and clear separation, yielding a comparable C-index of 0.6685 (95% CI: 0.6518–0.6852). When age was added, EACCD identified five groups with even stronger stratification and a higher C-index of 0.7015 (95% CI: 0.6852–0.7178). Conclusions: EACCD provides a refined prognostic framework for pancreatic neuroendocrine tumors, outperforming the AJCC TNM system by offering clearer survival stratification, comparable or higher C-index values, and integration of additional clinical factors. Full article

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin malignancy in the world, representing approximately 20% of all skin cancers. Immunosuppression is a well-established risk factor, contributing not only to the development of new cSCC lesions but also to more aggressive disease and increased mortality. Despite the National Comprehensive Cancer Network (NCCN) and the American Joint Committee on Cancer (AJCC) 8th edition updates recognizing immunosuppression as a risk factor for cSCC, standardized management protocols for these high-risk patients remain limited. As a result, treatment of this already high-risk group remains a significant challenge and highlights the need for dedicated research and attention to improve outcomes in this patient population. This review explores the current knowledge regarding cSCC in IS patients, outlines key gaps in the knowledge, and highlights recent clinical trials to further guide the evaluation and management of these patients. Full article

Background/Objectives: Merkel cell carcinoma (MCC) is an uncommon but aggressive skin malignancy with a rising incidence. Limited data exist on the survival of MCC patients in Canada. This study analyzes the survival of patients diagnosed with MCC in Canada between 2000 and 2018 compared to those reported by the American Joint Committee on Cancer (AJCC) 8th edition. Risk factors included in the database were sex, age, and immunosuppression. Methods: We conducted a multicenter retrospective cohort study including patients diagnosed with stage I–IV MCC aged ≥18 from 10 Canadian university centers and three provinces. We evaluated differences in survival compared to the cohort included in the AJCC 8th edition. Results: Among 899 patients diagnosed with MCC in Canada, 327 (36.4%) had stage I, 195 (21.7%) had stage II, 305 (33.9%) had stage III, and 72 (8.0%) had stage IV at presentation. When examining risk factors, 61.1% (549) were male, 10.2% (92) were immunosuppressed, and age at diagnosis was 75 years (±11). The five-year overall survival for patients diagnosed in Canada at stage I was 56.8%, stage IIA 54.0%, stage IIB 28.0%, stage IIIA 52.7%, stage IIIB 40.2%, and stage IV 13.9%. Conclusions: Survival from MCC is low in Canada across all stages. Compared to the AJCC 8th edition, patients diagnosed with MCC in Canada have similar survival rates, except for patients diagnosed with stage IIIB, who have lower survival rates in the AJCC 8th edition. Further research is needed to improve the survival of this rare malignancy. Full article

Background/Objectives: To develop an automated American Joint Committee on Cancer (AJCC) staging system for radical prostatectomy pathology reports using large language model-based information extraction and knowledge graph validation. Methods: Pathology reports from 152 radical prostatectomy patients were used. Five additional parameters (Prostate-specific antigen (PSA) level, metastasis stage (M-stage), extraprostatic extension, seminal vesicle invasion, and perineural invasion) were extracted using GPT-4.1 with zero-shot prompting. A knowledge graph was constructed to model pathological relationships and implement rule-based AJCC staging with consistency validation. Information extraction performance was evaluated using a local open-source large language model (LLM) (Mistral-Small-3.2-24B-Instruct) across 16 parameters. The LLM-extracted information was integrated into the knowledge graph for automated AJCC staging classification and data consistency validation. The developed system was further validated using pathology reports from 88 radical prostatectomy patients in The Cancer Genome Atlas (TCGA) dataset. Results: Information extraction achieved an accuracy of 0.973 and an F1-score of 0.986 on the internal dataset, and 0.938 and 0.968, respectively, on external validation. AJCC staging classification showed macro-averaged F1-scores of 0.930 and 0.833 for the internal and external datasets, respectively. Knowledge graph-based validation detected data inconsistencies in 5 of 150 cases (3.3%). Conclusions: This study demonstrates the feasibility of automated AJCC staging through the integration of large language model information extraction and knowledge graph-based validation. The resulting system enables privacy-protected clinical decision support for cancer staging applications with extensibility to broader oncologic domains. Full article

Background: Cancer staging, guided by anatomical and clinicopathologic factors, is essential for determining treatment strategies and patient prognosis. The current gold standard for prostate cancer is the American Joint Committee on Cancer (AJCC) Tumor, Lymph Node, and Metastasis (TNM) Staging System 9th Version (2024). This system incorporates five prognostic variables: tumor (T), spread to lymph nodes (N), metastasis (M), prostate-specific antigen (PSA) levels (P), and Grade Group/Gleason score (G). While effective, further refinement of prognostic systems may improve prediction of patient outcomes and support more individualized treatment. Methods: We applied the Ensemble Algorithm for Clustering Cancer Data (EACCD), an unsupervised machine learning approach. EACCD involves three steps: calculating initial dissimilarities, performing ensemble learning, and conducting hierarchical clustering. We first developed an EACCD model using the five AJCC variables (T, N, M, P, G). The model was then expanded to include two additional factors, age (A) and race (R). Prostate cancer patient data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program from the National Cancer Institute. Results: The EACCD algorithm effectively stratified patients into distinct prognostic groups, each with well-separated survival curves. The five-variable model achieved a concordance index (C-index) of 0.8293 (95% CI: 0.8245–0.8341), while the seven-variable model, including age and race, improved performance to 0.8504 (95% CI: 0.8461–0.8547). Both outperformed the AJCC TNM system, which had a C-index of 0.7676 (95% CI: 0.7622–0.7731). Conclusions: EACCD provides a refined prognostic framework for primary localized prostate cancer, demonstrating superior accuracy over the AJCC staging system. With further validation in independent cohorts, EACCD could enhance risk stratification and support precision oncology. Full article

Objectives: Human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) represent biologically distinct subtypes. However, the role of tobacco exposure in the pathogenesis of each remains incompletely understood. This study aimed to evaluate the prognostic implications of smoking in patients with HPV-positive OPSCC, with stratification based on the eighth edition of the American Joint Committee on Cancer (AJCC-8) staging system. Methods: We retrospectively analyzed all OPSCC cases managed at our institution between January 2011 and January 2024. Smoking history was dichotomized into <10 and ≥10 pack-years. Survival outcomes—including overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS)—were calculated using the Kaplan–Meier method. Log-rank testing and multivariable Cox proportional hazards modeling were used to assess prognostic factors and identify risk groups. An interaction analysis was also conducted to determine whether smoking alters the survival benefit conferred by HPV positivity. Results: Of the 329 patients included, 181 (55%) had a history of smoking, while 148 (45%) had never smoked. Among all patients, 211 (64.1%) were HPV-positive. HPV-positive cases exhibited superior 3- and 5-year OS, DSS, and PFS compared with HPV-negative tumors (p < 0.001). Within the HPV-positive cohort, never-smokers had the most favorable survival outcomes. Notably, interaction modeling demonstrated that the survival benefit of HPV positivity was markedly diminished among smokers, with hazard ratios approaching unity. Conclusions: Tobacco use negates the survival advantage typically associated with HPV-positive OPSCC. These findings highlight the critical need to account for smoking history in treatment planning and when considering eligibility for de-intensification strategies in HPV-related diseases. Full article

Background/Objectives: Musculoskeletal disorders causing chronic pain are increasingly prevalent due to factors such as injury, overuse, and aging, leading to interest in porcine collagen injections as a potential therapeutic and conservative option. Despite promising results, evidence-based information on this treatment is scarce. To address this gap, the authors conducted an eDelphi consensus among expert Italian physicians in musculoskeletal pain to gather their perspectives on collagen injections. Methods: A Steering Committee and a Panel of 23 physicians developed the statements list (36) including the modalities, safety, and efficacy of intra- and extra-articular collagen injections. Panelists rated their agreement with each statement on a 5-point Likert scale (5 means “Strong Agreement”). Consensus was defined as when at least 75% of the panelists voted with a score of ≥4/5 after two rounds of votes. The weighted average (WA) was calculated for each statement. As control, we elaborated a Hypothetical Parametric Distribution (HPD WA equal to 3.00), where the percent of panelists is equally distributed along each Likert Scale Value (LSV). The maximum WA for 75% of the consensus is established at 3.75. Indeed, the combination of 75% having WA > 3.75 was defined as “Strong Agreement”. While, if the consensus was under 75%, the WA vs. HPD comparison was performed using the Wilcoxon Test. Significant differences among the distribution of LSVs judged the statement as “Low Level of Agreement”. Disagreement was evaluated when the WA was under the PHD. Results: The consensus was reached “Strong Agreement” after twin rounds in 29 out of 36 (8.55%). In 5 out of 36 statements (13.89%), the panelists reached the “Low Level of Agreement” by statistical tests. In the remaining two statements, there was a “Consensus of Disagreement”. All panelists unanimously agreed on crucial points, such as contraindications, non-contraindication based solely on comorbidity, and the importance of monitoring collagen’s effectiveness. Unanimous agreement was reached on recommending ultrasound guidance and associating collagen injections with therapeutic exercise and physical modalities. Substantial consensus (concordance > 90%) supported collagen injections for osteoarthritis, chondropathy, and degenerative tendinopathies, emphasizing intra- and peri-articular treatment, even simultaneously. However, areas with limited evidence, such as the combination of collagen with other injectable drugs, treatment of myofascial syndrome, and injection frequency, showed disagreement. The potential of intra-tendinous porcine collagen injections for tendon regeneration yielded mixed results. Conclusions: Clinicians experts in musculoskeletal pain agree on using collagen injections to treat pain originating from joints (e.g., osteoarthritis) and periarticular (e.g., tendinopathies). Full article

Background/Objectives: Unlike other thoracic malignancies, seeding malignant cells along surgical tracts is a known complication of invasive diagnostic or therapeutic procedures for pleural mesothelioma (PM). We report the tract dissemination rate and risk factors in 308 consecutive patients treated over 9 years in a single institution who underwent pleurectomy decortication (PD). Methods: Clinical and outcome data were reviewed. Fisher’s exact test, Kaplan–Meier estimators, and log-rank tests were used to identify significant risk factors for surgical tract dissemination and to compare overall survival. Results: There were 233 males (75.6%), 187 right-sided operations (61%), 190 (61.7%) epithelioid histology cases, and the median age was 69 (29–84). During the study, malignant cell dissemination in resected surgical tracts was diagnosed in 69 (22.4%) patients. The dissemination rates in epithelioid, biphasic, and sarcomatoid tumors were 24.7%, 20.4%, and 0%, respectively. Disseminated malignant surgical tract was associated with advanced nodal status (p = 0.001), advanced staging by the American Joint Committee on Cancer (AJCC 8th edition, p = 0.03), female sex (0.02), side of surgery (p = 0.03), and the number of video-assisted thoracoscopic surgery (VATS) ports (p = 0.003). In epithelioid mesothelioma, the median survival from diagnosis was 19.7 months in patients with tract seeding versus 36.3 months in patients without seeding (hazard ratio, 1.9; p = 0.001). Conclusions: Procedure tract dissemination occurs in almost every fourth patient with pleural mesothelioma and is associated with shorter overall survival in the epithelioid subtype. Full article

Background/Objectives: Seaweeds have recently gained global attention as sustainable and health-promoting food sources. However, seaweeds contain iodine. While iodine is a beneficial micronutrient, its excessive intake can pose health risks. Therefore, ensuring iodine safety has emerged as a critical priority. The present study aims to determine the total iodine content in five major edible seaweeds, namely laver (Porphyra spp.), sea mustard (Undaria pinnatifida), sea tangle (Saccharina japonica), green laver (Enteromorpha spp.), and hijiki (Hizikia fusiforme), collected from 12 coastal regions in South Korea during 2020–2024. Methods: A total of 348 samples were analyzed using inductively coupled plasma mass spectrometry following microwave-assisted digestion. A risk assessment was performed based on the estimated daily intake and hazard index (HI) using both the Korean Ministry of Food and Drug Safety (MFDS), EFSA (European Food Safety Authority), and the Joint FAO/WHO Expert Committee on Food Additives (JECFA) reference values. Results: The iodine content varied widely among the different species, with sea tangles exhibiting the highest levels (mean 2432 mg/kg dry weight). The HI values were all below 1.0, based on MFDS standards, indicating a low potential health risk. However, sea tangle exhibited values exceeding 1.0 based on the EFSA and JECFA standards. Conclusions: These findings highlight the need for species-specific iodine intake guidelines and safety regulations to ensure consumer protection and facilitate global seaweed trade. The present study provides a scientific basis for balancing the nutritional benefits of seaweed with the potential risks of overconsumption, contributing to the development of national dietary guidelines and providing evidence-based data for navigating international regulatory landscapes. Full article

Background and Objectives: Tennis involves repetitive high-velocity movements, rapid directional changes, and challenging environmental conditions, exposing players to injury risk. However, injury surveillance data for North African youth players are lacking. This study aimed to determine the frequency, characteristics, and management of tennis-related injuries among competitive Tunisian youth players. Materials and Methods: A cross-sectional study was conducted among players aged 5–18 years from tennis clubs (October 2023–November 2024). Data were collected using researcher-administered questionnaires, incorporating the Oslo Sports Trauma Research Center Overuse Injury Questionnaire and a sport-specialization assessment, following International Olympic Committee guidelines. Results: Among 256 players, 53.5% (n = 137) reported 366 injuries. Lower limbs were most affected (58.5%), followed by upper limbs (32.8%); knees (23.2%), ankles (17.5%), and wrists (10.1%). Muscle/tendon (36.9%), superficial tissue (28.1%), and ligament/joint capsule injuries (27.6%) predominated. Most injuries occurred during practice (74.9%) and hot weather (93.4%). Severe injuries represented 24%, while 29.5% were minor without time loss. Subsequent injuries occurred in 54.6% of injured players, with significantly higher rates in those with incomplete rehabilitation (p < 0.001). Conclusions: The high frequency of recurrent injuries and limited rehabilitation highlight critical gaps in injury management, emphasizing the need for targeted neuromuscular training, accessible rehabilitation, and standardized return-to-play protocols. Full article

Background/Objectives: The Wolf Motor Function Test (WMFT) is a standardised assessment tool used to evaluate upper limb (UL) performance in individuals with acquired brain injury (ABI). It consists of 15 timed movement tasks, two strength measures, and a functional ability scale that assesses the quality of movement from 0 to 5. This study aimed to translate and culturally adapt the WMFT for Spanish-speaking individuals with ABI. Methods: The translation and cultural adaptation process followed established guidelines and involved researchers from the Rey Juan Carlos University (URJC) and from the Investigación en Terapia Ocupacional (InTeO) group. A joint committee of experts from both research groups unified two previous versions into the final Spanish version of the WMFT. The pilot study included 60 ABI survivors, who were evaluated for the clarity and usability of the adapted test. Descriptive statistical analysis was conducted to evaluate participant characteristics and test performance, with the results summarised for both the less-affected and most-affected UL. Results: The final version of the tool features inclusive language and a unified administration procedure. In the pilot study, execution times were longer when using the most-affected UL, particularly for tasks involving object manipulation, while grip strength was lower. Conclusions: The Spanish version of the WMFT is a suitable tool for evaluating UL function in ABI survivors and shows promising clinical and research implications. Full article

Background/Objectives: Gallbladder cancer (GBC) is a lethal malignancy curable only by surgical resection in early stages (Tis, T1, T2). Significant controversy exists regarding the optimal extent of surgery. This review summarizes recent trends and evidence on surgical strategies for Tis, T1, and T2 GBC to guide practice and research. Methods: This narrative review synthesizes recent literature on surgical management of Tis, T1a, T1b, and T2 GBC based on American Joint Committee on Cancer (AJCC) 8th edition staging. It examines simple vs. extended cholecystectomy (simple cholecystectomy (SC) vs. extended/radical cholecystectomy (EC/RC)), the role of lymphadenectomy (LND) and hepatectomy, and minimally invasive surgery (MIS). Results: Simple cholecystectomy is curative for Tis/T1a GBC. For T1b, regional LND is essential for staging/potential benefit, especially examining ≥5–6 nodes. Tumor size is critical; SC alone may suffice for T1b < 1 cm (low lymph node metastasis (LNM) risk), while EC/RC with LND is indicated for ≥1 cm (higher LNM risk). Routine hepatectomy for T1b lacks survival support. For T2 GBC, mandatory regional LND (≥6 nodes) is required for both T2a and T2b substages due to high LNM rates; T2b has higher LNM than T2a. Routine hepatectomy for T2 is debated; evidence suggests no routine benefit for T2a beyond LND, with conflicting findings for T2b. R0 resection is paramount. MIS is feasible for early stages in experienced hands. Conclusions: Management of early GBC is moving towards risk stratification. SC is standard for Tis/T1a. Adequate regional LND is crucial for T1b (especially ≥1 cm) and mandatory for T2 GBC. Routine hepatectomy, particularly for T2b, remains controversial. Tailored surgery prioritizes R0 resection and comprehensive LND, necessitating further standardized research. Full article

The Amazon faces significant challenges related to mercury contamination, including naturally elevated concentrations and gold mining activities. Due to mercury’s toxicity and the importance of fish as a protein source for local populations, assessing mercury levels in regional fish is crucial. However, there are gaps in knowledge regarding mercury concentrations in many areas of the Amazon basin. This study aims to synthesize the existing literature on mercury concentrations in fish and the exposure of urban and traditional social groups through fish consumption. A systematic review (1990–2022) was conducted for six fish genera (Cichla spp., Hoplias spp. and Plagioscion spp., Leporinus spp., Semaprochilodus spp., and Schizodon spp.) in the Web of Science (Clarivate Analytics) and Scopus (Elsevier) databases. The database consisted of a total of 46 studies and 455 reports. The distribution of studies in the region was not homogeneous. The most studied regions were the Madeira River sub-basin, while the Paru–Jari basin had no studies. Risk deterministic and probabilistic assessments based on Joint FAO/WHO Expert Committee on Food Additives (JECFA, 2007) guidelines showed high risk exposure, especially for traditional communities. Carnivorous fish from lakes and hydroelectric reservoirs, as well as fish from black-water ecosystems, exhibited higher mercury concentrations. In the Amazon region, even if mercury levels in fish muscle do not exceed regulatory limits, the high fish consumption can still elevate health risks for local populations. Monitoring mercury levels across a broader range of fish species, including both carnivorous and non-carnivorous species, especially in communities heavily reliant on fish for their diet, will enable a more accurate risk assessment and provide an opportunity to recommend fish species with lower mercury exposure risk for human consumption. The present study emphasizes the need to protect regions that already exhibit higher levels of mercury—such as lakes, hydroelectric reservoirs, and black-water ecosystems—to ensure food safety and safeguard public health. Full article