Search Results (14)

Aim: This study aimed to evaluate the diagnostic performance of the Delta Neutrophil Index (DNI) and Neutrophil-to-Lymphocyte Ratio (NLR) in distinguishing malignant from benign primary brain tumors during the preoperative period. Methods: This retrospective cohort study was conducted at a tertiary university hospital. A total of 140 participants were included 60 patients with malignant glial tumors, 50 patients with benign brain tumors, and 30 healthy controls without inflammatory, infectious, or hematologic disease. Preoperative complete blood count results obtained within seven days before surgery were analyzed. Results: Patients with malignant tumors were significantly older than those in the benign and control groups (p < 0.001). DNI, NLR, PLR, MLR, and SII values were all significantly elevated in the malignant group (p < 0.001, for all comparisons). ROC analysis revealed high diagnostic accuracy for DNI (AUC = 0.847) and NLR (AUC = 0.850), with optimal cut-off values of 3.50 and 3.95, respectively. In multivariable logistic regression adjusted for age, DNI > 3.5 (OR = 20.67; 95% CI: 3.35–127.64; p = 0.001), NLR > 3.95 (OR = 21.17; 95% CI: 3.28–136.50; p = 0.001), and CRP (OR = 1.52; 95% CI: 1.20–1.93; p = 0.001) remained independent predictors of malignancy. The combined model including DNI and NLR achieved the highest diagnostic accuracy (AUC = 0.937; age-adjusted AUC = 0.943), with a sensitivity of 88.3% and a specificity of 86.0% after age adjustment. Conclusions: Both DNI and NLR demonstrated significant value in differentiating malignant from benign primary brain tumors prior to surgery, with DNI emerging as the most powerful independent predictor. The combined use of DNI and NLR substantially improved diagnostic accuracy, suggesting that simple hematologic indices may serve as practical, noninvasive adjunctive tools in the preoperative assessment of brain tumor malignancy. These markers may assist in surgical prioritization, patient counseling, and clinical decision-making, particularly in resource-limited settings. Full article

Background and Aims: Hypothermic oxygenated machine perfusion (HOPE) improves outcomes in orthotopic liver transplantation (OLT), but reliance on University of Wisconsin machine perfusion solution (UW-MPS) increases costs and logistical burden. Histidine-tryptophan-ketoglutarate (HTK) has potential as a single-solution alternative for HOPE. This study evaluated the safety and efficacy of HTK versus UW-MPS during HOPE. Methods: A retrospective, propensity score-matched cohort study including 46 patients who received donation after brain death (DBD) grafts that were preserved with HOPE at the Medical University of Vienna between May 2018 and October 2024 was conducted. A total of 23 patients received grafts perfused with HTK; another 23 patients transplanted with organs perfused with UW-MPS were matched based on recipient age and sodium model of end-stage liver disease score, donor age and sex, cold ischemia time, and perfusion time. Postoperative outcomes, perfusion parameters, and cost differences were assessed. Results: The HTK and UW-MPS cohorts demonstrated comparable perfusion dynamics and vascular resistance. While arterial pressure and flow were higher in the UW-MPS group, clinical outcomes—including early allograft dysfunction (47.8% each), ICU stay, and comprehensive complication index—were statistically similar. A trend toward fewer biliary complications (13.0% vs. 30.4%) and reduced hemodialysis requirement (17.4% vs. 30.4%) was observed in the HTK group. Use of HTK reduced perfusion-related costs by approximately EUR 560 per procedure. Conclusion: HTK is a viable alternative to UW-MPS during HOPE in OLT of DBD grafts, offering comparable short-term outcomes and relevant cost savings. Prospective studies are warranted to validate these findings and explore broader applications of single-solution perfusion strategies. Full article

Background/Objectives: We hypothesized that older recipients have a higher rate of kidney graft failure compared to younger recipients. Thus, we assessed 60-month kidney graft failure (KGF) among deceased donor recipients aged 65 years or older and compared it with that of younger recipients. Methods: A single-center, retrospective cohort study was conducted at Son Espases University Hospital in Palma, Spain, including all consecutive deceased donor kidney transplant recipients from 2011 to 2021. The primary outcome was 60-month KGF, analyzed using the cumulative incidence function (CIF). A multivariable semi-parametric Fine and Gray model was used to estimate the subhazard of KGF in older versus younger recipients, adjusting for variables associated with recipients aged 65 years or older, including KGF and overall survival. Results: The study included 618 recipients, with a median age (interquartile range) of 58 years (47–66 years); of these, 187 (30%) were aged 65 years or older, and 498 (81%) received grafts from donors after brain death. The 60-month CIF (95% confidence interval) of KGF for the entire cohort was 12% (9.1–15). Candidate variables for multivariable analysis included recipient sex, body mass index, donor age, presence of hypertension or diabetes, donor sex, length of hospital stay, cold ischemia time, donor type, multiple renal veins, and Clavien-Dindo grade ≥ 3 complications. After adjustment, KGF risk did not significantly differ between age groups (sHR: 0.75; 95% CI: 0.41–1.38; p = 0.36). Conclusions: Despite having worse baseline characteristics, receiving lower-quality grafts, and experiencing a higher incidence of postoperative complications, we observed comparable 60-month kidney graft survival in older recipients relative to younger ones. These findings support the viability of kidney transplantation in well-selected older patients. Full article

Background/Objectives: Previous magnetic resonance imaging (MRI) investigations reported brain alterations in anorexia nervosa restricting type (AN-R); however, the number of existing structural neuroimaging studies in the developmental age is limited. Here, we analyzed the volumetric brain differences between adolescent patients with AN-R and control peers, and possible correlations between brain volumes and clinical features. Methods: The sample comprised 47 adolescent females with AN-R (mean age: 15.0 years, SD = 1.4) who underwent structural MRI within one month of admission to a tertiary care university hospital, and 39 typically developing controls matched for sex and age. The patients were clinically characterized by standardized interviews/questionnaires. Using the voxel-based morphometry (VBM) technique, possible significant volumetric brain differences between the two groups were analyzed. Moreover, correlations between altered brain regions and clinical (i.e., body mass index (BMI) and disease duration) or psychopathological variables were investigated. Results: An overall reduction in gray matter (GM) volume with a concomitant increase in cerebrospinal fluid (CSF) is observed in AN-R patients; these alterations correlate with a lower BMI. The reduction in GM volume affects the frontal and parietal regions involved in the cognitive processes that underlie and sustain the AN-R clinical features. Conclusions: These results add to the current knowledge of the AN-R pathophysiology and pave the way for the development of brain imaging biomarkers for AN in the developmental age. Full article

Objective: We aimed to compare the forebrain length, corpus callosum sub-segment thickness, corpus callosum area, and corpus callosum index in the cerebral magnetic resonance imaging (MRI) of schizophrenia patients and healthy individuals. Materials and Methods: In this retrospective study, 137 schizophrenia patients who met the inclusion and exclusion criteria and were hospitalized in the Psychiatry Clinic of Mersin University Faculty of Medicine Hospital between January 2014 and January 2024 and 137 healthy individuals of the same age and gender without any mental disorders were included. The relationship between sociodemographic characteristics and disease-related variables obtained in the retrospective file review and the corpus callosum morphometric findings on brain MRI were analyzed with the SPSS 22 package program. p-values below 0.05 were considered statistically significant. Results: In the study, 274 individuals, including 137 schizophrenia patients (59 [43.1%] males; 78 [56.9%] females) and 137 healthy individuals (59 [43.1%] males; 78 [56.9%] females), were evaluated. There was no significant difference between the two groups in terms of age, gender, and mean age at the time of brain MRI. In brain MRI measurements, forebrain length, corpus callosum (CC) AP diameter, CC genu, body, splenium, rostrum and isthmus thicknesses, CC area, and CC index values were significantly lower in the patient group compared to healthy controls. It was also found that patients with multiple episodes in the patient group were diagnosed at an earlier age, had a longer duration of illness, had a history of more homicide and suicide attempts, had more hospitalizations, had a history of more psychotic disorders in their families, and had lower levels of functioning compared to patients with a single episode. Conclusions: Each of the corpus callosum subregion thickness, corpus callosum area, and corpus callosum index values shows a decrease in schizophrenia patients compared to healthy controls. These findings contribute to the understanding of the neurobiological basis of the disease and provide important evidence to elucidate its pathophysiology. The results need to be confirmed in studies with larger samples using a prospective study design in which clinical parameters related to the disease are also measured. Full article

Background/objectives: recent studies have suggested that components typical of the Mediterranean diet (MedDiet) are associated with depression and anxiety prevention. In this sense, the main objective of this study was to analyse the associations between adherence to the MedDiet and depression and anxiety symptoms and to examine whether this relationship is mediated by lean mass and the muscle strength index (MSI). Methods: a cross-sectional study (based on data obtained from the Nuts4Brain-Z study) was conducted from 2023–2024, involving 428 university students, aged 18–30 years, from a Spanish public university. Depression was assessed using the Beck Depression Inventory (BDI-II), and anxiety was assessed via the General Anxiety Disorder-7 (GAD-7) tool. Adherence to the MedDiet was assessed using the MEDAS questionnaire. Lean mass was assessed via bioimpedance, and MSI was measured via a dynamometer. ANCOVA models were used to test the mean differences in depression and anxiety scores using MEDAS categories (low adherence < 9 points vs high adherence ≥ 9 points). Serial multiple mediation models, adjusted for the main confounders, were used to explore the role of lean mass and MSI in the relationships between adherence to the MedDiet and depression and anxiety symptoms. Results: university students with high adherence to the MedDiet exhibited lower scores for depression and anxiety symptoms (p < 0.05) than did students with low adherence to the MedDiet. The mediation analysis preliminarily revealed that both lean mass and MSI acted as mediators of the relationships between adherence to the MedDiet and depression and anxiety. Conclusion:adherence to the MedDiet in university students per se does not appear to have a direct effect on depression and anxiety symptoms because these associations are partially (for depression) or entirely (for anxiety) explained by lean mass and MSI. Full article

Heart rate variability biofeedback (HRV BF) training aids adaptation to new climatic, geographical, and social environments. Neurophysiological changes during the HRV BF in individuals from tropical regions studying in the Arctic are not well understood. The aim of this study was to research electroencephalographic (EEG) changes during a single short-term HRV BF session in Indian and Russian students studying in the Russian Arctic. The Indian (n = 40) and Russian (n = 40) healthy students (age 19–21 years) at a medical university in Arkhangelsk (64°33′ N 40°32′ E) were studied. HRV and EEG parameters were measured at baseline (5 min) and during a short-term HRV BF session (5 min) to increase the total power (TP, ms²) of the HRV spectrum. The baseline heart rate and stress index levels were significantly higher in the Indian students. During the HRV BF sessions, the sympathetic activity decreased more significantly in Russian students, while the alpha EEG activity significantly increased across all brain regions in both groups. In Indian students, there was a notable increase in theta and beta1 EEG spectral power in the frontal, central, and temporal regions. HRV BF training in Indian students was associated with a more pronounced activation of brain systems compared with Russian students. Full article

Source activity was extracted from resting-state magnetoencephalography data of 103 subjects aged 18–60 years. The directionality of information flow was computed from the regional time courses using delay symbolic transfer entropy and phase entropy. The analysis yielded a dynamic source connectivity profile, disentangling the direction, strength, and time delay of the underlying causal interactions, producing independent time delays for cross-frequency amplitude-to-amplitude and phase-to-phase coupling. The computation of the dominant intrinsic coupling mode (DoCM) allowed me to estimate the probability distribution of the DoCM independently of phase and amplitude. The results support earlier observations of a posterior-to-anterior information flow for phase dynamics in {α₁, α₂, β, γ} and an opposite flow (anterior to posterior) in θ. Amplitude dynamics reveal posterior-to-anterior information flow in {α₁, α₂, γ}, a sensory-motor β-oriented pattern, and an anterior-to-posterior pattern in {δ, θ}. The DoCM between intra- and cross-frequency couplings (CFC) are reported here for the first time and independently for amplitude and phase; in both domains {δ, θ, α₁}, frequencies are the main contributors to DoCM. Finally, a novel brain age index (BAI) is introduced, defined as the ratio of the probability distribution of inter- over intra-frequency couplings. This ratio shows a universal age trajectory: a rapid rise from the end of adolescence, reaching a peak in adulthood, and declining slowly thereafter. The universal pattern is seen in the BAI of each frequency studied and for both amplitude and phase domains. No such universal age dependence was previously reported. Full article

Background: Stereotactic radiosurgery (SRS) is considered a promising treatment for brain metastases (BM) with better healing efficacy, relatively faster treatment time, and lower neurotoxicity, which can achieve local control rates above 70%. Although SRS improves the local control of BM, this may not translate into improvements in survival time. Thus, screening out the key factors influencing the treatment response to SRS, instead of the survival time following SRS, might be of more significance. This may assist doctors when making adjustments to treatment strategies for patients with BM. Methods: This is a retrospective review of 696 patients with BM who were treated with SRS at Huashan Hospital, Fudan University between June 2015 and February 2020. According to the patients’ treatment response to SRS, the patients were divided into an improved group (IG) and a progressive group (PG). The clinical data and magnetic resonance imaging (MRI) performed pre- and post-treatment were collected for the two groups. Five clinical variables (gender, age, Karnofsky performance status (KPS), primary tumor type, and extracranial lesion control) and seven radiological manifestations (location, number, volume, maximum diameter, edema index (EI), diffusion weighted imaging (DWI) sequence signal, and enhanced pattern) were selected and compared. A stepwise regression analysis was performed in order to obtain the best prediction effect of a group of variables and their regression coefficients, and finally to build an SRS treatment response scoring model based on the coefficients. The performance of the model was evaluated by calculating the AUC and performing the Hosmer–Lemeshow test. Results: A total of 323 patients were enrolled in the study based on the inclusion and exclusion criteria, including 209 patients in the IG and 114 patients in the PG. In the Chi-square test and t-test analysis, the significant p values of KPS, extracranial lesion control, volume, and EI were less than 0.05. Moreover, the cut-off values for volume and EI were 1801.145 mm³ and 3.835, respectively. The scoring model that was based on multivariate logistic regression coefficients performed better, achieving AUCs of 0.755 ± 0.062 and 0.780 ± 0.061 for the internal validation and validation cohorts, with p values of 0.168 and 0.073 for the Hosmer–Lemeshow test. Conclusions: KPS, extracranial lesion control, tumor volume, and EI had a certain correlation with the treatment response to SRS. Scoring models that are based on these variables can accurately predict the treatment response of patients with BM to SRS, thereby assisting doctors to make an appropriate first treatment strategy for patients with BM to a certain degree. Full article

Decision-making is one of the most crucial cognitive processes in daily life. An adaptable, rapid, and flexible decision requires integration between brain and body. Heart rate variability (HRV) indexes this brain–body connection and appears to be related to cognitive performance. However, its relationship with decision-making is poorly analyzed. This study investigates the relationship between HRV and the decision-making process, assessed through the Iowa Gambling Task (IGT). One hundred and thirty healthy university students (mean age = 23.35 ± 2.50) participated in the study. According to IGT performance, they were divided into high decision-makers (n = 79) and low decision-makers (n = 51). Heart rate variability was measured in the resting, reactivity (i.e., during IGT), and recovery phases. Higher vagally mediated HRV (vmHRV; indexed in frequency domain measures) was evidenced in good decision-makers in the resting, reactivity, and recovery phases. During the task, a higher vagal modulation after a first evaluation was highlighted in good decision-makers. In conclusion, HRV proves to be a valid index of inhibitory circuit functioning in the prefrontal cortex. The relationship with cognitive functions was also confirmed, considering the ability to inhibit disadvantageous responses and make better decisions. Full article

Identification of risk factors for cognitive impairment is crucial for providing proper care and treatment. The aim of the study was to investigate the relationship between sociodemographic and health-related factors and the severity of cognitive impairment in elderly patients. In this retrospective study, we assessed the medical documentation of 323 patients aged 60+ years hospitalized in a geriatric clinic of university hospital. The patients were classified into five groups of cognitive impairment severity based on the Mini Mental State Examination and Clock Drawing Test. Kruskal-Wallis and Chi square tests and multivariate ordinal logistic regression were used to assess relationships involved. Cognitive impairment was identified in 84.2% of subjects. The following factors were indicative for higher level of cognitive disorders: primary and vocational education, older age, presence of vascular brain injury, and inability of walking independently. On the other hand, the factors associated with lower severity of cognitive impairment were co-morbid anxiety disorders, ischemic heart disease, and a higher BMI index. Dementia is one of the leading causes of disability and mortality in the elderly. Enhancing knowledge about the risk factors that worsen cognition is particularly relevant for accelerating the diagnosis of dementia and improving patient care. Full article

Recently antibiotic exposure has been associated with worse outcomes in patients undergoing treatment with antibodies directed against programmed cell death protein-1 (PD-1). We reviewed data of 1264 patients enrolled at Melanoma Skin and Ocular Tissue Repositories at University of Iowa Hospitals and Clinic. Reviewed data included patient demographics, prior medical history, baseline hematologic and disease parameters and outcomes including progression-free survival (PFS) and overall survival (OS). Cox regression models were used to determine predictive markers. Overall, 169 patients with advanced cutaneous melanoma received anti-PD-1 based therapies. Median follow up was 18.46 (range 0.89 to 62.52) months. On multivariable analysis brain metastasis, higher absolute neutrophil count (ANC) and lower absolute lymphocyte count were associated with poorer PFS while brain and liver metastasis and lower albumin were associated with poorer OS. Prior antibiotics, radiation as well as age, gender, basal metabolic index (BMI), smoking status, BRAF mutation, line of therapy (first or latter), prior treatments (ipilimumab or BRAF inhibitors), hemoglobin, neutrophil-to-lymphocyte ratio, white blood cell, platelet and eosinophil counts were not associated with PFS or OS in multivariable analysis. Contrary to some prior studies BMI, radiation, and antibiotics were not associated with PFS or OS. Full article

Deep and subcortical white matter hyperintensity (DSWMH) lesions are a small-vessel disease of the brain. The aim of this cross-sectional study was to investigate the relationship between DSWMH lesions and periodontal status in Japanese adults who participated in a health check. We enrolled 444 consecutive participants (mean age, 54.5 years) who received both brain and oral health evaluation services at the Asahi University Hospital. Magnetic resonance imaging was used to detect DSWMH lesions. Periodontal status was assessed using the community periodontal index. Of the study participants, 215 (48.4%) had DSWMH lesions. Multivariate logistic regression showed that the presence of DSWMH lesions was significantly related to age ≥ 65 years (vs. < 65 years, odds ratio [OR] = 2.984, 95% confidence interval [CI] = 1.696–5.232), systolic blood pressure ≥ 140 mmHg (vs. < 140 mmHg, OR = 2.579, 95% CI = 1.252–5.314), the presence of ≥ 28 teeth (vs. < 28 teeth, OR = 0.635, 95% CI = 0.420–0.961), and probing pocket depth (PPD) ≥ 6 mm (vs. PPD < 6 mm, OR = 1.948, 95% CI = 1.132–3.354) after adjustment for confounding factors. Having PPD ≥ 6 mm may be a risk factor for DSWMH lesions in Japanese adults. Full article

Purpose: Despite numerous breakthrough therapies, inoperable lung cancer still places a heavy burden on patients who might not be candidates for chemotherapy. To identify potential candidates for the newly emerging immunotherapy-based treatment paradigms, we explored the clinical and biologic factors affecting treatment decisions. Methods: We retrospectively reviewed the records of patients diagnosed at our university-affiliated cancer centre between 1 January 2011 and 31 December 2013. Patient demographics, systemic treatment, and survival were examined. Results: During the 3-year study period, 683 patients fitting the inclusion criteria were identified. First-line therapy was administered in 49.5% of patients; only 22.4% received further lines of therapy. The main reasons for withholding therapy were poor performance status [ps (43.2%)], rapidly deteriorating ps (31.9%), patient refusal of therapy (20.9%), and associated comorbidities (4%). Older age, the presence of brain metastasis at diagnosis, and non-small-cell histology were also associated with therapeutic restraint. Oncology referrals were infrequent in patients who did not receive therapy (32.2%). Older patients and those with a poor ps experienced superior survival when treatment was administered (hazard ratio: 0.25; 95% confidence interval: 0.16 to 0.38; and hazard ratio: 0.44; 95% confidence interval: 0.23 to 0.87 respectively; p < 0.001). Conclusions: Advanced lung cancer still poses a therapeutic challenge, with a high proportion of patients being deemed unfit for therapy. This issue cannot be resolved until appropriate measures are taken to ensure the inclusion of older patients and those with a relatively poor ps in large clinical trials. Immunotherapy might be interesting in this setting, given that it appears to be more tolerable. Another consequential undertaking would be the deployment of strategies to reduce wait times during the diagnostic process for patients with a high index of suspicion for lung cancer. Full article