Search Results (1,292)

Purpose: The objective of this study was to evaluate the synergistic effect of combining an immune checkpoint inhibitor (ICI) with radiotherapy (RT) on murine fibrosarcoma and to conduct a narrative review of clinical studies on soft tissue sarcoma (STS). Materials and Methods: Forty male C3H mice (aged 5 weeks) were injected intramuscularly with 2 × 10⁵ FSaII cells into the right thigh and randomly assigned to four groups: (1) control; (2) RT; (3) InVivoMab™ (CD279) (mouse anti-PD-1 antibody) (ICI group); and (4) combined treatment with InVivoMab™ (CD279) and RT (combination group). On day −1, ICI was administered intraperitoneally. On day 0, RT (10 Gy, single fraction) was delivered locally to the tumors in the right hind limb. Subsequently, ICI was injected twice weekly (a total of 8 times). On day 26, all mice were euthanized, and the results were analyzed. In addition, a narrative review was conducted to identify clinical evidence. Results: On day 26, mean gross tumor volumes were 3578.13 ± 407.32 mm³ in the control group, 1995.72 ± 970.46 mm³ in the RT group, 2729.96 ± 286.47 mm³ in the ICI group, and 1007.92 ± 197.36 mm³ in the combination group. Gross tumor growth delay was most pronounced in the combination group. Moreover, the TUNEL assay demonstrated a significant increase in apoptosis in the combination group. Analysis of the underlying immune system revealed significantly higher expression of CD4+, CD8+, and IFN-γ in the combination group. The literature search identified only 12 case reports and 3 prospective studies involving patients with STS treated with the combined treatment of ICI and RT, suggesting potential synergism with acceptable toxicity. Conclusions: The current study demonstrated a synergistic effect of combining an ICI with RT in murine fibrosarcoma. There was limited data in the clinical setting. Further investigations are warranted to determine the optimal combination strategy of ICI and RT for STS. Full article

Objective: This study evaluated the association of the uric acid/albumin ratio (UAR) and platelet indices—mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR)—in predicting hypervascularization in placenta accreta spectrum (PAS) and compared clinical and perinatal characteristics among PAS, placenta previa, and healthy pregnancies. Methods: This retrospective study included 229 pregnant women managed and delivered at a tertiary hospital (PAS, n = 76; previa, n = 77; healthy controls, n = 76) between January 2023 and January 2025. Hypervascularization was staged using the ultrasonographic PAS scoring system: PAS0 (placenta previa without hypervascularization), PAS1 (abnormal placental findings without hypervascularization), PAS2 (uterovesical hypervascularization), and PAS3 (extensive vascularity to the parametrial area). The final diagnosis and severity of PAS were confirmed intraoperatively according to the FIGO clinical classification criteria. Platelet indices and UAR were obtained from preoperative blood tests. Results: Compared with placenta previa (PAS0) and control groups, PAS1–3 cases had higher gravidity, parity, previous cesarean history, postpartum hemorrhage, hysterectomy, and transfusion rates (all p < 0.001). In the high hypervascularization subgroup (PAS2–3, n = 38), MPV (median 10.3 fL) and PDW (11.6%) were significantly lower than in low/absent hypervascularization cases (PAS0–1) (p = 0.001, p = 0.001, respectively). UAR showed no significant difference (p = 0.891). Conclusions: Lower MPV and PDW were associated with hypervascularization in PAS and may serve as non-invasive adjunctive markers for risk stratification. Their predictive performance was modest, and UAR had no diagnostic value, likely due to physiological changes in pregnancy. Further prospective, multicenter research is needed to validate these findings. Full article

Background: The role of diaphragmatic function in transient tachypnea of the newborn (TTN) remains poorly understood. This study aimed to compare diaphragmatic ultrasound parameters between neonates with TTN requiring non-invasive ventilation (NIV) and healthy neonates. Secondary objectives include the relationships between these parameters and gestational age (GA), birth weight (BW), and the evaluation of inter-operator reproducibility. Methods: This prospective observational pilot study involved neonates with GA ≥ 34 weeks with clinical and ultrasound diagnosis of TTN treated with NIV. An equal number of healthy neonates served as controls. Diaphragmatic and lung ultrasound were performed on day 1 (T0) and day 2 (T1) of life. Measurements included end-inspiratory and end-expiratory diaphragmatic thickness (DTi and DTe, respectively), diaphragmatic excursion (DE), and Lung Ultrasound Score (LUS). Inter-operator reproducibility was tested in 31 neonates (62 scans in total). Results: Forty neonates were enrolled (20 TTN, 20 controls). DE was significantly higher in controls compared with TTN neonates (4.6 ± 0.9 mm vs. 5.4 ± 1.3 mm, p = 0.03) and increased from T0 to T1 in the control group (4.6 ± 1.1 mm vs. 5.4 ± 1.3 mm, p = 0.04), while no significant variation was observed in TTN cases. A negative correlation, approaching significance, was found between DE and LUS at T1 (p = 0.05). DTi and DTe increased linearly with GA and BW (p < 0.001). Bland–Altman analysis showed low bias and acceptable limits of agreement between measurements. Conclusions: The underlying pulmonary disease may influence diaphragmatic function in neonates with TTN. The integration of lung and diaphragmatic ultrasound could be useful for monitoring disease progression and follow-up. Full article

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, and fatal neurological disorder caused by persistent measles virus infection. Reliable prognostic biomarkers remain limited. Systemic inflammation has been implicated in the pathogenesis of neuroinfectious diseases, and hematology-derived indices are increasingly recognized as accessible markers of inflammatory burden. This retrospective case–control study was conducted at İnönü University Faculty of Medicine, Malatya, Türkiye, between 2010 and 2025, including 40 pediatric patients with SSPE and 40 age- and sex-matched healthy controls. Demographic and laboratory data were retrieved from institutional records, and disease severity was classified according to Jabbour stages. Compared with controls, patients with SSPE had significantly higher pan-immune inflammation value (PIV: 710.5 [320–1050] vs. 280.0 [150–460], p < 0.001), systemic immune-inflammation index (SII: 640.0 [310–1240] vs. 410.0 [210–720], p = 0.02), and neutrophil-to-lymphocyte ratio (NLR: 2.1 [1.2–3.8] vs. 1.6 [1.0–2.5], p = 0.03), along with lower lymphocyte counts (p = 0.04). Elevated PIVs were strongly associated with advanced Jabbour stages, impaired ambulation, and a higher case-fatality ratio (35%). Multivariate regression identified PIV as an independent predictor of death (OR: 3.25, 95% CI: 1.45–7.28, p = 0.004), and receiver operating characteristic analysis demonstrated superior discriminative accuracy of PIV (AUC = 0.87) compared with other indices. These findings suggest that PIV, a simple and inexpensive biomarker derived from routine blood tests, may provide useful prognostic information in SSPE and aid early risk stratification. Further multicenter, prospective studies are warranted to validate its clinical utility. Full article

Pre-eclampsia affects several physiological systems, often changing the course of pregnancy and manifesting with both maternal and foetal adversities, with a higher burden in rural Sub-Saharan African settings. This study presents maternal and foetal adverse outcomes associated with pre-eclampsia at a rural tertiary hospital in the Eastern Cape Province of South Africa. A prospective analytical case-control study was conducted with 250 pregnant women planned for delivery at the study setting’s labour unit. Pregnant women with pre-eclampsia were considered cases, whereas pregnant women without pre-eclampsia were considered controls. Cases were enrolled first, followed by a matched pair of controls based on their gravidity. A consecutive sampling technique was used to recruit eligible cases and controls. Data was collected using a self-designed questionnaire followed by descriptive and inferential analysis. Adverse foetal outcomes associated with pre-eclampsia were low birth weight [Adjusted odds ratio (AOR) = 2.1, p = 0.006] and foetal distress (AOR = 2.5, p < 0.001). Maternal outcomes associated with pre-eclampsia were haemolysis, elevated liver enzymes, and low platelets syndrome (AOR = 42.7, p < 0.001), as well as preterm delivery (AOR = 3.0, p = 0.001). Early antenatal visits, continuous monitoring of pre-eclamptic pregnant women, and implementation of preventive and curative measures to reduce the possibilities of this condition and its adverse outcomes are needed. Full article

Background/Objectives: Endovascular aneurysm repair (EVAR) is the standard treatment for abdominal aortic aneurysms, but the risk of endoleak compromises its effectiveness. Type IA endoleak, stemming from an inadequate proximal seal, is the most critical complication associated with the highest risk of rupture. Current preoperative planning relies on static anatomical measurements from computed tomography angiography that fail to predict seal failure due to dynamic biomechanical forces. This study aimed to retrospectively validate the predictive accuracy of a novel physics-informed digital twin and artificial intelligence (AI) model for predicting type IA endoleak risk compared to conventional static planning methods. Methods: This was a retrospective, single-center proof-of-concept validation study involving 15 patients who underwent elective EVAR (5 with confirmed type IA endoleak and 10 without type IA endoleak). A patient-specific digital twin was created for each case to simulate stent-graft deployment and capture the dynamic biomechanical interaction with the aortic wall. A logistic regression AI model processed over 16,000 biomechanical measurements to generate a single, objective metric of the endoleak risk index (ERI). The predictive performance of the ERI (using a cutoff of 0.80) was assessed and compared against a 1:3 propensity score-matched conventional control group (n = 45) who received traditional anatomical-based planning. Results: The mean ERI was significantly higher in the endoleak-positive group (0.85 ± 0.10) compared to the endoleak-negative group (0.39 ± 0.11) (p = 0.011). The digital twin/AI model demonstrated superior predictive capability, achieving an overall accuracy of 80% (95% CI: 51.9–95.7) and an area under the curve (AUC) of 0.85 (95% CI: 0.58–0.99). Crucially, the model achieved a sensitivity of 100% and a negative predictive value (NPV) of 100%, correctly identifying all high-risk cases and ruling out endoleak in all low-risk cases. In stark contrast, the matched conventional planning group achieved an overall accuracy of only 51.1% and an AUC of 0.54. Conclusion: This physics-informed digital twin and AI framework successfully validated its capability to accurately and objectively predict the risk of type IA endoleak following EVAR. The derived ERI offers a significant quantitative advantage over traditional static anatomical measurements, establishing it as a highly reliable safety tool (100% NPV) for ruling out endoleak risk. This technology represents a critical advancement toward personalized EVAR planning, enabling surgeons to proactively identify high-risk anatomies and adjust treatment strategies to minimize post-procedural complications. Further large-scale, multicenter prospective trials are necessary to confirm these findings and support clinical adoption. Full article

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a medical condition characterized by extreme fatigue lasting at least 6 months. Based upon case reports, patients infected with Babesia or Bartonella spp. have reported a history of chronic fatigue and concurrent neurological symptoms. In this study, 50 study participants reporting fatigue lasting from six months to 19 years and one or more neurological symptoms were selected. PCR assays were used to amplify Babesia and Bartonella spp. DNA from blood and enrichment blood cultures. Using targeted qPCR amplification and DNA sequencing, infection with Babesia spp., Bartonella spp. or both genera was confirmed in 10, 11, and 2 individuals, respectively. Of 50 participants, 12 (24%, 95% CI: 12–36%) were infected with a Babesia species, while Bartonella species infection was documented in 13/50 individuals (26%, 95% CI: 13.8–38.2%). This study provides documentation supporting a potential role for Babesia and Bartonella infection in patients with presentations consistent with ME/CFS. Prospective case–control studies, using highly sensitive direct pathogen detection techniques, are needed to determine whether or the extent to which infection with members of these two genera contributes to or causes ME/CFS. Full article

Background: Nylon-based removable partial dentures, such as Valplast^® (Valplast International Corp, Westbury NY, USA), have been proposed as a valuable alternative to acrylic resin prostheses, particularly following oral surgical extractions and in patients with suspected methacrylate hypersensitivity. This review aimed to evaluate the clinical indications guiding the use of nylon-based prostheses after oral surgical extractions and to investigate their prevalence in patients with documented acrylic allergies. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in six databases (PubMed, Scopus, Embase, Google Scholar, LILACS, and Cochrane Library) for studies published between 2015 and 2025. Eligible studies were critically appraised using the Joanna Briggs Institute (IBI) tools. Results: Nine studies met the inclusion criteria, all of which were low-level evidence (six case reports and three case series), comprising a total of 11 patients (mean age 43 years). Nylon-based prostheses were used in both maxillary and mandibular arches, with rehabilitation motivated by esthetic and functional reasons. Outcomes were generally favorable, with patients reporting satisfaction in terms of comfort, function, and esthetics. Conclusions: Current evidence supporting the use of nylon-based removable partial dentures remains extremely limited and is based exclusively on case reports and small case series. While this type of prostheses represents a viable post-surgical rehabilitation option, primarily chosen for esthetic and functional benefits, evidence on their use in patients with documented acrylic hypersensitivity remains lacking. The low quality and limited number of studies highlight the need for prospective, controlled, and long-term research to clarify the role of nylon prostheses in post-surgical oral rehabilitation and to define their effectiveness in patients with material allergies. Full article

Background and Objectives: Osteoarthritis (OA) is a common cause of chronic pain. In refractory cases, cooled radiofrequency (CRF) of the genicular nerves is indicated. However, recent studies suggest that traditional targets may be insufficient, proposing the inclusion of the recurrent fibular nerve and the infrapatellar branch of the saphenous nerve. This study reports a prospective four-case series evaluating short-term outcomes of CRF at five revised targets in elderly Brazilian patients. Case Report: The study (CAAE No.: 55647722.5.0000.5142) included four patients (three women, one man; mean age 73.8 years) with moderate to severe refractory knee pain underwent diagnostic nerve block followed by ultrasound-guided CRF. After 30 days, three patients reported pain reduction, including two who experienced substantial improvement. One patient maintained severe pain. Improvements in physical performance, knee flexion, and extension were observed in patients who responded clinically, while individuals with coexisting myofascial pain showed limited functional gains. One patient experienced mild transient pruritus. In this prospective case series, CRF applied to five revised targets appeared feasible and well tolerated, with short-term improvement in pain and function in some patients. These preliminary descriptive findings support further investigation in larger controlled studies. Full article

Objective: This study aimed to apply the Random Forest machine learning model using oxidative stress biomarkers to classify breast cancer status and assess sentinel lymph node (SLN) metastasis, a pathology of high incidence and mortality that represents a major public health challenge. Methods: The breast cancer classification cohort included 188 women with infiltrating ductal carcinoma and 78 healthy volunteers. For SLN metastasis assessment, a subset of 29 women with metastases and 57 controls (n = 86) was used. Data preprocessing and the SMOTE technique were applied to balance the classes in the metastasis set, achieving a perfect balance of 171 examples (57 per class). Random Forest model with a leave-one-out validation strategy was employed and oxidative stress biomarkers (e.g., lipid peroxidation, total antioxidant capacity, superoxide dismutase, catalase, glutathione peroxidase) were used. Results: The model achieved high accuracy (0.996) in classifying breast cancer, representing a substantial improvement over current screening methods such as mammography. In contrast, its performance in detecting SLN metastases was more limited (accuracy = 0.854), likely reflecting the inherent complexity and heterogeneity of the metastatic process. Moreover, these estimates derive from a retrospective case–control cohort and should not be viewed as a substitute for, or a direct comparison with, population-based mammography screening, which would require dedicated prospective validation. Conclusions: The findings underscore the model’s robust performance in distinguishing women with breast cancer from healthy volunteers, but highlight significant gaps in its ability to diagnose metastatic disease. Future research should integrate additional biomarkers, longitudinal data, and explainable artificial intelligence (XAI) methods to improve clinical interpretability and accuracy in metastasis prediction, moving towards precision medicine. Full article

Background and Objectives: Anastomotic leakage (AL) is a major complication following sphincter-preserving surgeries for left-sided colorectal cancer. In this study, we aimed to evaluate the association between circular stapler diameter and the risk of AL. As a secondary objective, we investigated whether preoperative serum protein levels were associated with leakage development. Materials and Methods: We conducted a retrospective case–control study including 99 patients who underwent elective colorectal surgery with stapled anastomosis for left-sided colorectal cancer between January 2020 and May 2024. A total of 99 patients were included (60.6% male), with a mean age of 66.1 ± 10.7 years. The patients were categorized into small (≤29 mm) and large (≥30 mm) stapler groups. Demographic, clinical, and laboratory variables were collected. Anastomotic leakage was defined as an International Study Group of Rectal Cancer (ISREC) Grade B or C leak requiring intervention. Univariate analyses and multivariate logistic regression analyses were performed, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). A STROBE-compliant flow diagram was prepared. Results: Anastomotic leakage occurred in 10 patients (10.1%), and leakage rates were not significantly different between stapler-size groups (≤29 mm: 10.9% vs. ≥30 mm: 7.5%, p = 0.365). In multivariate analysis, stapler size was not independently associated with leakage (OR 1.68, 95% CI 0.40–6.97, p = 0.480). Lower preoperative serum protein levels were identified as the only independent predictor of leakage (OR 0.28, 95% CI 0.10–0.74, p = 0.011). Postoperative hospital stay was significantly longer for patients with leakage (median 17 vs. 7 days, p < 0.001). Conclusions: We found no significant associations between circular stapler diameter and anastomotic leakage in left-sided colorectal cancer surgery. Conversely, low serum protein levels were independently associated with increased leakage risk, highlighting the importance of preoperative nutritional assessment. Given the retrospective design, small number of leakage cases, and unmeasured confounders, these findings should be interpreted with caution. Further multicenter, prospective studies should be conducted to clarify the influence of stapler size and patient-related factors on anastomotic outcomes. Full article

Background/Objectives: Idiopathic intracranial hypertension (IIH) is an uncommon but clinically important cause of elevated intracranial pressure in children. Conventional MRI findings such as perioptic subarachnoid space (SAS) distension and posterior globe flattening are helpful but may lack sensitivity or specificity in certain cases. Diffusion tensor imaging (DTI), which quantifies white matter microstructure through metrics such as fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD), offers additional diagnostic potential, yet its role in pediatric IIH remains insufficiently defined. Methods: This retrospective case–control study included 26 pediatric patients with IIH and 26 age- and sex-matched controls who underwent brain MRI with DTI between 2010 and 2025. DTI parameters were measured in major white matter tracts, and conventional MRI findings associated with raised intracranial pressure were recorded. Associations between DTI metrics and conventional imaging markers were analyzed using standardized statistical tests. Results: Children with IIH demonstrated significantly reduced FA and increased MD and RD values in several key white matter regions, particularly within the optic radiation, splenium of the corpus callosum, and posterior limb of the internal capsule. FA values showed a negative correlation with perioptic SAS width, while RD and MD were positively correlated with posterior globe flattening and empty sella grade. Receiver operating characteristic analysis identified FA in the optic radiation as the strongest discriminator between IIH and controls (AUC = 0.83). Inter-observer reliability for FA measurements was excellent (ICC = 0.91). Conclusions: Pediatric IIH appears to be associated with pressure-related microstructural alterations in white matter, detectable through DTI. Among the diffusion metrics, FA demonstrated the strongest diagnostic potential and may serve as a complementary tool to conventional MRI. Validation in larger, prospective pediatric cohorts is required to establish its clinical utility. Full article

Background/Objectives: Non-ablative fractional lasers are widely used for scar remodeling, yet treatment parameters are often selected empirically, and thermal thresholds for consistent outcomes remain undefined. This study explored whether forward-looking infrared (FLIR) thermography can estimate laser-induced surface temperature changes during 1550 nm Er:Glass laser therapy and examined the association between post-treatment temperature elevation and early clinical improvement. Methods: A retrospective analysis was conducted on patients treated with fractional Er:Glass laser for post-surgical or traumatic scars. Skin temperature was recorded using FLIR C5 imaging at baseline (T₀), after topical anesthesia (T₁), and immediately post-treatment (T₂). The temperature change (ΔT₂) was calculated as T₂ − T₀. Clinical outcomes were assessed one month after treatment using standardized digital photographs and Vancouver Scar Scale (VSS) scores. Safety data were collected from post-procedure observations and patient reports. Results: Mean surface temperature increased from 32.4 ± 0.9 °C at T₀ to 33.7 ± 0.7 °C at T₂ (ΔT₂ = +1.3 ± 0.6 °C, p < 0.001). Hypertrophic scars showed higher ΔT₂ values than linear scars (p = 0.02). A moderate temperature elevation was modestly associated with early VSS improvement (r = 0.42, p = 0.003). Representative cases with ΔT₂ values around 1.5–2.5 °C exhibited favorable short-term changes in texture and pigmentation. No adverse events were observed during follow-up. Conclusions: Real-time FLIR thermography may provide a non-invasive method to indirectly assess surface thermal response during non-ablative fractional treatment. A moderate temperature increase may be associated with an exploratory thermal response range linked to early clinical improvement, but the findings are preliminary. Further prospective, controlled studies with standardized treatment parameters and longer follow-up are required to clarify whether ΔT₂ has clinical relevance as a physiologic parameter for temperature-based assessment in scar management. Full article

Lipid-based nanomedicines are already widely used in antitumor therapy and gene delivery. However, their complex structural features demand advanced mesoscopic structural characterization tools for effective research and development (R&D) and quality control. Synchrotron small-angle X-ray scattering (SAXS) is a powerful, non-invasive technique for probing nanoscale membrane organizations, monitoring in situ dynamic membrane assembly, and exploring the interactions of components in lipid-based drug delivery systems, including liposomes, lipoplexes, lipid nanoparticles (LNPs), and lyotropic liquid crystals (LLCs). Recent advances in high-flux synchrotron facilities, high-frequency detectors, and automated SAXS data processing pipelines permit a detailed structural characterization of lamellarity, bilayer spacing, internal phases, core–shell morphology, as well as “pump-probe” dynamic process studies for lipid nanomedicines. Though major challenges remain in sample polydispersity and model fitting, the advances in time-resolved synchrotron SAXS, high-throughput automation, and artificial intelligence (AI)-assisted modeling are rapidly reducing this barrier. This review summarizes SAXS methodology and introduces representative case studies in the field of lipid nanomedicines. The performance of BioSAXS beamline BL19U2 in the Shanghai synchrotron radiation facility (SSRF) and prospects of AI-guided drug screening at BL19U2 are highlighted to advance intelligent R&D and quality control for lipid nanomedicines. Full article

Canine epilepsy often resists conventional antiepileptic drugs (AEDs), which affects their quality of life. Cannabidiol (CBD) has anticonvulsant properties; however, evidence of its use in canine epilepsy is limited and contradictory. This prospective pilot study aimed to investigate the potential advantages, safety profile, and effects of CBD on quality of life when used as an adjunctive therapy in cases of drug-resistant epilepsy in canines. Thirteen dogs with refractory epilepsy, all on 2–6 concurrent AEDs, were enrolled. A single-arm pretest–post-test design was used. CBD was titrated from 0.5 mg/kg BID 2.5 mg/kg q12h. The primary outcome was the change in seizure frequency. Secondary outcomes included changes in seizure severity, seizure cluster, hematological and biochemical parameters, and owner-reported quality of life (QoL). Significant overall seizure frequency reduction (p = 0.02) with the median decreased from 11 (IQR 9–22) during the pre-intervention period to 5 (IQR 2–13) at the post-intervention follow-up. Notably, 61.5% of the dogs achieved a ≥50% reduction in seizure frequency. The number of seizure clusters was significantly decreased (p = 0.001). Most hematological/renal parameters remained stable; however, Alkaline Phosphatase (ALP) levels significantly increased (p < 0.001). The owners reported positive CBD perceptions and an improved quality of life. CBD shows the potential for refractory canine epilepsy, especially in clusters. Increased hepatic enzyme levels necessitate rigorous monitoring, particularly with the concurrent use of AEDs. This groundbreaking study explored the application of CBD in managing canine epilepsy, utilizing a “start-low, go-slow” strategy to minimize adverse effects while effectively controlling seizures. Our findings underscore the necessity of customizing CBD dosages for individual needs and highlight the critical importance of monitoring liver function. This study challenged the traditional one-size-fits-all dosing approach. It provides the first evidence and practical framework for the use of CBD to treat canine epilepsy in Asia, detailing the pioneering approach and the initial findings from this cohort. Full article