Search Results (81)

Background: Artificial Intelligence (AI) has emerged as a transformative tool in in vitro fertilization (IVF) as it has done in other sectors. In IVF, AI offers advancements in embryo selection, treatment personalization, and outcome prediction. It does so by leveraging deep learning and computer vision, as well as AI-driven platforms such as ERICA, iDAScore, and IVY where the goal is to address the limitations of traditional embryo assessment. Key amongst them are the issues of subjectivity, labor intensity, and limited predictive power. Despite rapid technological progress, the integration of AI into routine IVF practice faces key challenges. These are issues related to clinical validation, ethical dilemmas, and workflow adaptation. Rationale/Objectives: This review synthesizes current evidence to evaluate the role of AI in IVF, focusing on six critical dimensions: (1) the evolution of AI from traditional embryology to algorithmic assessment, (2) clinical validation and regulatory considerations, (3) limitations and ethical challenges, (4) pathways for clinical integration, (5) real-world applications and outcomes, and (6) future directions and policy recommendations. The objective is to provide a comprehensive roadmap for the responsible adoption of AI in reproductive medicine. Outcomes: AI demonstrates significant potential to improve the precision and efficiency of IVF. Studies report that AI models can achieve 10 to 25% higher accuracy in predicting embryo viability and implantation potential compared to traditional morphological assessment by embryologists. This enhanced predictive power supports more consistent embryo ranking, facilitates elective single-embryo transfer (eSET) strategies, and is associated with 30 to 50% reductions in embryologist workload per embryo cohort. Early adopters report promising trends. However, large-scale randomized controlled trials have yet to conclusively demonstrate a statistically significant increase in live birth rates per transfer compared to expert embryologist selection. The most immediate and evidenced value of AI lies in hybrid decision-making models. This is where it augments embryologists by providing data-driven, objective support, thereby standardizing workflows and reducing subjectivity. Wider Implications: The sustainable integration of AI into IVF banks on three key aspects: robust evidence generation, interdisciplinary collaboration, and global standardization. To foster these, policymakers ought to establish regulatory frameworks for transparency and bias mitigation. On their part, clinicians need training to interpret AI outputs critically. Ethically, safeguarding patient trust and equity is non-negotiable. Future innovations, mainly AI-enhanced genomics and real-time monitoring, could further personalize care. However, their success depends on addressing current limitations. By balancing innovation with ethical vigilance, AI holds the potential to revolutionize IVF while upholding the highest standards of patient care. Full article

Background: Head and neck cancer patients frequently encounter nutritional deterioration, culminating in poor clinical and treatment-related outcomes and reduced quality of life. This systematic review and meta-analysis aim to examine the effects of non-invasive nutritional interventions on nutritional status and clinical, biochemical, and patient-reported outcomes. Methods: A comprehensive literature search across five databases (PubMed, CINAHL, ProQuest, Medline, and Scopus) was carried out to identify potentially relevant randomized control trials published in English between 2019 and 2024. Screening, extraction of data, and quality check were carried out separately by two reviewers. The Joanna Briggs Critical Appraisal tools assessed the quality of the included studies and evidence certainty was appraised using the GRADE framework. Depending on the amount of heterogeneity present, a random or fixed-effects model was used to conduct the meta-analysis. Results: Eleven studies were included, involving 1000 participants. Pooled estimates showed significant effects on weight (SMD = 0.171, 95%CI: 0.008, 0.335, p = 0.04), serum albumin (SMD = 0.539, 95%CI: 0.150, 0.927, p= 0.007), and patient-generated subjective global assessment score (SMD = −0.518, 95%CI: −0.931, −0.106, p = 0.014) in the intervention group compared to controls. Bias concerns were observed in some studies, largely stemming from inadequate blinding and deviations from intention-to-treat analysis. Evidence certainty ranged from moderate to very low. Conclusions: Non-invasive, patient-directed nutritional interventions may lead to clinically meaningful benefits in patients with head and neck cancer receiving chemoradiotherapy, particularly for the maintenance of body weight and nutritional status. However, robust, adequately powered trials with standardized reporting of intervention components and outcome measures are needed in the future to strengthen the evidence base for clinical application. Full article

Background: Malnutrition is a significant national health problem in countries with low and intermediate incomes and was announced in the United Nations’ 2030 Agenda for Sustainable Development Goals. Chemotherapy may have adverse effects on nutritional health issues and quality of life experience, particularly in patients with gastrointestinal (GIT) cancer. Our research’s objective was to determine the beneficial effects of oral nutrition supplements on nutritional status assessed by maintenance of whole-body composition and patient-generated subjective global assessment (PG-SGA) in all GIT cancer patients treated with chemotherapy medications. Methods: Among the patients, the nutrition support (NS) group (n = 75) received 500 kcal daily of a balanced oral nutrition supplement formula for 12 weeks, while the control (C) group (n = 75) did not. Anthropometric measures, whole-body composition, nutritional status biomarkers, and the PG-SGA questionnaire were assessed. Additionally, this study analyzed whole-body composition, skeletal mass, fat mass, laboratory data, the complete lipid profile, albumin, total protein, adverse effects, and therapy delays. Results: After 12 weeks, the NS group showed a significant increase in body weight, with a mean difference of 1.27 ± 3.39, while the C group showed a mean difference of only 0.15 ± 0.42. Moreover, fat mass increased in the NS group, showing a mean difference of 0.55 ± 3.69, while the C group showed a fat mass loss with a mean difference of −0.21 ± 2.93. The fat mass index (FMI) indicated statistical significance between the two groups. There was a statistically significant difference in the lean mass index between the two groups, favoring a steady increase in the NS group. The NS group showed improvements in the PG-SGA and nutritional biochemical markers, such as albumin. The initial findings from our study include data from a total of 150 patients, including 75 patients in the NS group and 75 patients in the C group. These results are consistent with earlier research. Conclusions: Early oral nutrition supplements for GIT cancer may enhance nutritional outcomes and reduce the delay of disease-related therapy. Additionally, they may help maintain body composition. Full article

Background: Acquired brain injury (ABI) often produces heterogeneous cognitive and emotional outcomes that are not fully explained by conventional neuropsychological testing. Diffusion tensor imaging (DTI) tractography may capture patient-specific patterns of white matter connectivity and thereby complement clinical assessment. Methods: We conducted an exploratory case series of nine patients in the subacute phase of ABI (traumatic brain injury or subarachnoid hemorrhage). Each underwent a brief cognitive-emotional battery and 1.5 T DTI with deterministic tractography of major association tracts and the corpus callosum. Tract lateralization was quantified using the Structural Asymmetry Index (SAI), and individual profiles were compared with neuropsychological and emotional data. Results: Six patients met criteria for clinically significant anxiety, and four for depression, often dissociated from global cognitive screening. Tractography revealed heterogeneous asymmetry patterns, most often in the superior longitudinal fasciculus, uncinate fasciculus, and cingulum. In several cases, structural asymmetries diverged from neuropsychological findings, suggesting dissociations between behavioral testing and connectivity-based measures. Conclusions: Within-subject tract asymmetry analysis provided preliminary, potentially clinically relevant information not captured by tests alone. These findings indicate that individualized tractography could enrich the interpretation of cognitive and emotional profiles and help guide hypothesis generation for connectivity-informed neurorehabilitation. Full article

Background/Objectives: Colorectal cancer (CRC) has high prevalence and mortality, with a high frequency of malnutrition during chemotherapy (60–70%). Malnutrition reduces treatment tolerance, quality of life, and survival. The Patient-Generated Subjective Global Assessment (PG-SGA) is effective in detecting it, but its use is not systematic. This study aims to analyze the prevalence and degrees of malnutrition in CRC patients undergoing active chemotherapy, using the PG-SGA, and to propose its systematic implementation in oncology care protocols. Methods: Observational, cross-sectional, and descriptive study in patients with stage III–IV CRC receiving FOLFOX, XELOX, or irinotecan regimens. Nutritional status was assessed with PG-SGA and body composition by bioimpedance. Results: The study includes 91 patients. A total of 45.05% of patients required intensive nutritional intervention, 39.56% needed dietary and pharmacological measures, 10.99% required health education, and only 4.4% did not require intervention. FOLFOX was significantly associated with taste alterations (p < 0.001), nausea (p = 0.020), unpleasant odors, and eating problems; XELOX with diarrhea (p = 0.009) and xerostomia (p = 0.038). Irinotecan was related to poorer functional capacity (p = 0.042). Oxaliplatin was linked to loss of appetite (p = 0.034) and unpleasant odors (p = 0.035). Older age correlated with a greater need for intensive interventions. Conclusions: The study shows a high nutritional risk in oncology patients, particularly in those with colorectal cancer undergoing FOLFOX treatment, associated with symptoms that impair intake and functional capacity. The systematic implementation of nutritional screening from the onset of treatment, using tools such as the PG-SGA and GLIM criteria, is essential for early detection and individualized management, improving therapy tolerance, clinical outcomes, and quality of life. Full article

Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This review explored the types of nutrition impact symptoms following curative-intent treatment for upper gastrointestinal (UGI) cancers and assessed their impact on nutrition status. Methods: A systematic search of four electronic databases identified studies involving adults treated with curative intent for UGI cancers. Included studies reported both nutrition impact symptoms and nutrition outcomes using validated tools. Study quality was assessed, and results were synthesised narratively. Results: Eleven studies (n = 953 participants), predominantly from the Asia–Pacific region, met the inclusion criteria. Participants were mostly male (68%), with surgery as the primary treatment (91%). Most studies (n = 10) used validated assessment tools to identify nutrition impact symptoms. Reflux was the most commonly reported symptom (n = eight studies), followed by abdominal pain and diarrhoea. Nutrition status was assessed using various validated tools: Patient-Generated Subjective Global Assessment (n = six studies, 55%), Mini Nutritional Assessment (n = two studies, 18%), and Global Leadership Initiative on Malnutrition as well as Subjective Global Assessment and Prognostic Nutritional Index (both n = one study, 9%). Malnutrition prevalence was up to 87% one year post-treatment. Conclusions: Nutrition impact symptoms are common and persistent after curative-intent treatment for UGI cancers. Future research should incorporate validated assessment tools and extend follow-up beyond 12 months. Integrating long-term, tailored dietetic support to identify and manage symptoms post-treatment is vital to improve outcomes for patients. Full article

Background: Treatment compliant with the Global Initiative for Asthma (GINA) can promote more effective disease control. Single-inhaler triple therapy (SITT) is one method that is used to optimize therapy in this context, but TRIPLE therapy is still employed by physicians to a limited extent. Objective: This study aimed to describe the factors influencing challenges in optimizing asthma therapy. Methods: A 19-question survey, created via the CATI system, was distributed among pulmonologists, allergologists, general practitioners, and internal medicine specialists in Poland, Greece, Sweden, Slovenia, and Austria. Results: Statistically significant percentage differences in the use of TRIPLE therapy in the context of asthma management were observed among countries as well as between pulmonologists, allergists, and other specialists. Overuse of oral corticosteroids (OCSs) to treat nonsevere and severe asthma in the absence of an approach that focuses on optimizing inhalation therapy among asthma patients receiving TRIPLE therapy was observed in different countries as well as among physicians with different specialties. Twenty elements associated with the challenges involved in diagnosing and managing difficult-to-treat and severe asthma were identified. Six clinical categories for the optimization of asthma therapy via SITT were highlighted. The degree of therapeutic underestimation observed among severe asthma patients was assessed by comparing actual treatment with the recommendations of the GINA 2023 guidelines. Conclusions: Physicians of various specialties in Europe are subject to therapeutic inertia in terms of their compliance with the GINA 2023 guidelines. Full article

Background/Objectives: T1-weighted magnetic resonance imaging (MRI) and the Montreal Cognitive Assessment are standard, efficient, and swift clinical and research tools used when interrogating cognitively impairing (CI) conditions, such as Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD). However, the associations between gross cognitive impairment (CI) as compared to domain-specific functioning and underlying neuroanatomical correlates have not been investigated among individuals with early-onset Mild Cognitive Impairment (MCI) or Alzheimer’s disease (EOAD), who can benefit greatly from early diagnosis and intervention strategies. Methods: We analyzed T1-weighted MRIs and Montreal Cognitive Assessment (MoCA) scores from the ADNI database in individuals < 65 years old who were either cognitively normal (CN) or had MCI or EOAD. Gray matter volume (GMV) was estimated in voxel-based morphometry (VBM) and ROI-parcellation general linear models examining associations with individual MoCA scores after adjusting for demographic covariates. Results: Results from 120 subjects (44 CN, 62 MCI, and 14 EOAD), identified significant global but also individually distinct domain-specific topographical signatures spanning the temporal, parietal, limbic, occipital, frontal lobes, and cingulate gyri. Conclusions: The results highlight neural correlates of cognitive functioning in a sample of young patients representative of the AD continuum, in addition to studying the structural MRI and functional cognitive difference. Full article

Background and Objectives: Left atrial function is commonly assessed using speckle-tracking echocardiography, focusing on global strain averaged from the 4-chamber and 2-chamber views. However, regional variations in atrial strain remain underexplored. This study aimed to evaluate regional left atrial deformation in healthy subjects. Materials and Methods: A total of 22 healthy subjects underwent echocardiographic examinations during routine check-ups in 2023–2024. Images were retrieved and analyzed offline. Left atrial reservoir strain was calculated from four-chamber, two-chamber, and three-chamber views. A comprehensive map of 3-plane strain was generated for each patient, with detailed analysis of regional strain differences. Regional and average longitudinal displacement were also assessed. Results: There was no significant difference between triplane and biplane left atrial reservoir strain (34.4 ± 7.7% vs. 34.7 ± 6.8%, p = 0.9). Strain in the segments near the mitral annulus was significantly higher than in the mid-atrial segments. Mid-atrial strain was, in turn, higher than in the superior segments. Regional longitudinal displacement showed a gradient from the mitral annulus toward the superior part of the atrium, correlating well with the strain results. Additionally, strain in the inferior and septal walls was higher than in the lateral wall. Conclusions: Left atrial strain varies significantly across different regions. Strain is highest near the mitral annulus and lowest in the superior wall. Longitudinal displacement may serve as an additional tool for assessing left atrial function, showing a strong correlation with strain measurements. Biplane and triplane strain assessment yielded comparable results. Full article

Background and Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by joint inflammation and pain. Metabolomics approaches, which are high-throughput profiling of small molecule metabolites in plasma or serum in RA patients, have so far provided biomarker discovery in the literature for clinical subgroups, risk factors, and predictors of treatment response using classical statistical approaches or machine learning models. Despite these recent developments, an explainable artificial intelligence (XAI)-based methodology has not been used to identify RA metabolomic biomarkers and distinguish patients with RA. This study constructed a XAI-based EBM model using global plasma metabolomics profiling to identify metabolites predictive of RA patients and to develop a classification model that can distinguish RA patients from healthy controls. Materials and Methods: Global plasma metabolomics data were analysed from RA patients (49 samples) and healthy individuals (10 samples). SMOTE technique was used for class imbalance in data preprocessing. EBM, LightGBM, and AdaBoost algorithms were applied to generate a discriminatory model between RA and controls. Comprehensive performance metrics were calculated, and the interpretability of the optimal model was assessed using global and local feature descriptions. Results: A total of 59 samples were analysed, 49 from RA patients, and 10 from healthy subjects. The EBM generated better results than LightGBM and AdaBoost by attaining an AUC of 0.901 (95% CI: 0.847–0.955) with 87.8% sensitivity which helps prevent false negative early RA diagnosis. The primary biomarkers EBM-based XAI identified were N-acetyleucine, pyruvic acid, and glycerol-3-phosphate. EBM global explanation analysis indicated that elevated pyruvic acid levels were significantly correlated with RA, whereas N-acetyleucine exhibited a nonlinear relationship, implying possible protective effects at specific concentrations. Conclusions: This study underscores the promise of XAI and evidence-based medicine methodology in developing biomarkers for RA through metabolomics. The discovered metabolites offer significant insights into RA pathophysiology and may function as diagnostic biomarkers or therapeutic targets. Incorporating EBM methodologies integrated with XAI improves model transparency and increases the therapeutic applicability of predictive models for RA diagnosis/management. Furthermore, the transparent structure of the EBM model empowers clinicians to understand and verify the reasoning behind each prediction, thereby fostering trust in AI-assisted decision-making and facilitating the integration of metabolomic insights into routine clinical practice. Full article

(1) Background: Implantable port catheters are vital for cancer treatment, but complications such as infections and mechanical failures pose challenges. Lymphoma and leukemia patients’ unique cellular abnormalities may influence these risks. This study aimed to determine whether the underlying disease or varying degrees of cytopenia increase the risk of unplanned early port removal. (2) Methods: We conducted a single institution retrospective study that included 368 patients with lymphoma or leukemia who received implantable venous access ports between January 2015 and December 2022. Propensity score matching was employed to compare patients with and without early removals. (3) Results: Univariate analysis revealed statistically significant differences between early and non-early port removal for cancer, hemoglobin, and PG-SGA scores. Cox proportional hazard analysis demonstrated that leukemia patients exhibited a 4.5 times higher risk for unplanned early catheter removal than lymphoma patients did (HR 4.589, 95% CI 1.377–15.299, p = 0.013), while patients with normal nutrition, based on the PS-SGA, demonstrated a 75% lower risk of unplanned early catheter removal than those with any degree of malnutrition did (HR 0.258, 95% CI 0.116–0575, p < 0.001). Unplanned early catheter removal negatively impacted patient survival. (4) Conclusions: The type of cancer, rather than individual cytopenias, is an independent factor influencing clinical outcomes in lymphoma and leukemia patients. Full article

Aims: This phase II study aimed to evaluate the impact of early nutritional intervention on the nutritional status and survival of locally advanced non-small cell lung cancer (LANSCLC) patients undergoing concurrent chemoradiotherapy (CCRT). Methods: LANSCLC patients treated with CCRT were enrolled in the study group and received early nutritional intervention, including individualized nutrition counseling and oral nutritional supplements, from the initiation of CCRT to 2 weeks after its completion. The primary endpoint was the incidence of weight loss ≥5% during the CCRT. For comparison with the study group, a matched control group was retrieved from previous trials by the 1:1 propensity score matching method. Results: Sixty-seven patients were enrolled in the study group with a median follow-up of 52.4 months. Compared with the control group, the study group exhibited a lower incidence of weight loss ≥5% (p = 0.032), higher body mass index (p = 0.034) and prealbumin levels (p = 0.014) at the end of CCRT, as well as lower patient-generated subjective global assessments scores at the end of CCRT (p < 0.001) and 6 months after CCRT (p = 0.007). The study group also had a lower incidence of grade 2+ radiation pneumonitis (p = 0.023) and longer progression-free survival (13.5 vs. 11.3 months, p = 0.032). Patients who responded well to oral nutritional supplements had a higher Firmicutes/Bacteroidetes ratio at baseline (p = 0.036). Conclusions: Early nutritional intervention in LANSCLC patients undergoing CCRT improved nutritional status and reduced radiation pneumonitis. Gut microbiota was associated with the response to oral nutritional supplements. Full article

In patients with gastric, gastroesophageal junction or esophageal adenocarcinoma (GOC), peri-operative multimodal therapies have improved survival; however, prognosis remains underwhelming. Pre-operative nutritional decline and weight are linked with poorer patient outcomes. This study retrospectively analyzed the impact of peri-operative nutritional status (as assessed by patient-generated subjective global assessment, PG-SGA), and weight loss on the survival of patients undergoing curative surgery for GOC (2013 to 2022). Of the 148 patients who underwent surgery, PG-SGA and weight data were available for 107 (72%) and 121 (82%), respectively. At presentation, 44% (n = 47) of patients were well nourished, dropping to 17% (n = 18) post-operatively. Lower post-operative nutritional status correlated to worse overall survival (OS) (p < 0.001). Patients who stayed well nourished or improved their nutritional status had better survival outcomes (HR: 2.7; 95%CI: 1.2–6.1; p = 0.01). Significant weight loss (>10%) was ubiquitously observed in 54% (n = 64) of patients, and this group had shorter OS (HR: 2.2; 95%CI: 1.2–4.1; p = 0.009). In conclusion, both nutritional decline and weight loss negatively impacted survival. Maintenance of nutritional status over the peri-operative period resulted in better outcomes. This study highlights the need for improved nutritional support during curative treatment in GOC. Full article

Background. Sleep disturbances are frequent in patients with substance use disorders (SUDs) and are associated with craving and addiction relapses, leading to increased clinical severity and detrimental outcomes. Daridorexant, a selective dual orexin receptor antagonist, has been approved for persistent insomnia disorder (ID), but specific insights on patients with SUDs are lacking. Methods. This observational, retrospective study investigated the effects of a three-month treatment with daridorexant (50 mg/day) in 41 outpatients with comorbid IDs and SUDs. Improvement in subjective sleep measures, assessed with the Insomnia Severity Index (ISI) and subjective total sleep time, was the primary outcome measure. Changes in anxiety and depression symptoms, quality of life, clinical global severity, and craving were also investigated through the following: Hamilton Anxiety and Depression Rating Scale; Five-item World Health Organization Well-Being Index; Clinical Global Impression Severity Scale; Visual Analog Scale for Craving. Results. All sleep outcomes significantly improved throughout treatment, which was generally safe and well tolerated, with mild and transient drowsiness and sluggishness reported in 21.1% of patients. Similar improvements were observed in psychopathology, quality of life, and craving, and positive correlations were found among ISI scores and anxiety/depression symptoms and craving. An abstinence rate (i.e., absence of any substance use, regardless of the amount, throughout treatment) of 65.8% was also detected at the endpoint. Conclusions. These preliminary findings suggest that daridorexant might represent a promising tool for treating insomnia in patients with SUDs. Identifying interventions effectively targeting insomnia with a good safety/tolerability profile in SUDs is crucial to achieve remission and full functional recovery. Full article

Background/Objectives: Cancer, a leading cause of mortality globally and in Brazil, is influenced by environmental and behavioral factors, often linked to nutritional deficiencies such as low body mass index and muscle wasting, exacerbating prognostic outcomes and mortality rates. Timely nutritional interventions during chemotherapy are pivotal, necessitating continuous nutritional assessment for effective patient care management. This study aimed to assess the nutritional status of non-metastatic cancer patients undergoing chemotherapy and identify factors influencing their nutritional status. Patient evaluation involved sociodemographic data, clinical profiles, anthropometric measurements, blood biochemical analyses, and nutritional status classification employing the Patient-Generated Subjective Global Assessment (PG-SGA) criteria. Statistical analysis was performed using R software. Results: Suspected malnutrition was identified in 5.81% of patients, with a significant association observed with gender, indicating a higher prevalence among men. Cancer stages II and III, along with a positive family history, correlated with heightened risk of malnutrition. Patients with suspected malnutrition exhibited older age, lower weight, body mass index (BMI), and reduced circumferences, underscoring the necessity of comprehensive nutritional assessment for optimized patient management during treatment. Conclusions: This study underscores a notable prevalence of malnutrition, particularly among patients with lower weight and BMI, affirming the reliability of PG-SGA criteria. Full article