Immunotherapy-induced microsatellite instability status shift in recurrent perihilar cholangiocarcinoma: A case report

Immunotherapy revolutionized the treatment of biliary tract tumors and tumors with high microsatellite instability (MSI-H). This paper reports a 52-year-old woman with recurrent perihilar cholangiocarcinoma. The tumor was initially microsatellite stable (MSS) and proficient mismatch repair (pMMR) but shifted to MSI-H and deficient mismatch repair (dMMR) after combined immunotherapy. Following laparoscopic radical resection for jaundice, stage IV recurrence was diagnosed. Genetic testing revealed the MSS status. Subsequent treatment with camrelizumab and lenvatinib led to a partial response. Ovarian metastases, removed due to abdominal symptoms, exhibited dMMR and MSI-H. The mismatch in MSI status between the primary tumor and metastases suggests tumor heterogeneity and the influence of spatial or temporal factors. This shift can have important clinical significance since MSI-H is associated with significant responses to immune checkpoint inhibitors. MSI-H should be systematically tested in tumors and metastases to personalize treatments. MSI heterogeneity is not only rare but potentially has implications for treatment personalization and prognosis in patients with cholangiocarcinoma. This case highlights the dynamic changes in tumor characteristics during immunotherapy.

Glucose deprivation induces cisplatin resistance through upregulation of SLC7A11 (xCT) expression in endometrial cancer cells

Cisplatin resistance poses a substantial barrier to the successful treatment of advanced endometrial cancer. Glucose deprivation in the tumor microenvironment, resulting from inadequate vascularization and rapid proliferation of cancer cells, may promote chemoresistance by modifying cellular metabolism and survival pathways. This study aimed to elucidate how glucose deprivation induces cisplatin resistance in endometrial cancer cells, focusing on the role of solute carrier family 7 member 11 (SLC7A11, xCT). The endometrial cancer cell lines HEC-1A and AN3CA were cultured under glucose-deprived and glucose-supplemented conditions. Cisplatin half-maximal inhibitory concentration (IC50) values, SLC7A11 expression, and reactive oxygen species (ROS) levels were assessed using cell proliferation assays, real-time PCR, Western blotting, and fluorescence assays. SLC7A11 was inhibited using small interfering RNA (siRNA) knockdown and the selective inhibitor HG106. Cisplatin-resistant cell lines were generated to evaluate the effect of SLC7A11 inhibition. Glucose deprivation significantly decreased cisplatin sensitivity and increased cisplatin IC50 values (P < 0.05). This reduction in sensitivity was accompanied by upregulation of SLC7A11 expression and decreased ROS levels (P < 0.05). Inhibition of SLC7A11, either by siRNA or HG106, increased cisplatin sensitivity and ROS production, even in cisplatin-resistant cells (P < 0.05). This effect was reversible with the antioxidant N-acetylcysteine. These findings demonstrate that glucose deprivation induces cisplatin resistance in endometrial cancer cells by upregulating SLC7A11, leading to reduced ROS levels and enhanced cell survival. Targeting SLC7A11 restores cisplatin sensitivity by elevating ROS production, even in cisplatin-resistant cells. The findings suggest that SLC7A11 is a promising therapeutic target for overcoming chemoresistance in endometrial cancer, potentially improving treatment outcomes and patient survival.

Current updates regarding biogenesis, functions and dysregulation of microRNAs in cancer: Innovative approaches for detection using CRISPR/Cas13‑based platforms (Review)

MicroRNAs (miRNAs) are short non‑coding RNAs, which perform a key role in cellular differentiation and development. Most human diseases, particularly cancer, are linked to miRNA functional dysregulation implicated in the expression of tumor‑suppressive or oncogenic targets. Cancer hallmarks such as continued proliferative signaling, dodging growth suppressors, invasion and metastasis, triggering angiogenesis, and avoiding cell death have all been demonstrated to be affected by dysregulated miRNAs. Thus, for the treatment of different cancer types, the detection and quantification of this type of RNA is significant. The classical and current methods of RNA detection, including northern blotting, reverse transcription‑quantitative PCR, rolling circle amplification and next‑generation sequencing, may be effective but differ in efficiency and accuracy. Furthermore, these approaches are expensive, and require special instrumentation and expertise. Thus, researchers are constantly looking for more innovative approaches for miRNA detection, which can be advantageous in all aspects. In this regard, an RNA manipulation tool known as the CRISPR and CRISPR‑associated sequence 13 (CRISPR/Cas13) system has been found to be more advantageous in miRNA detection. The Cas13‑based miRNA detection approach is cost effective and requires no special instrumentation or expertise. However, more research and validation are required to confirm the growing body of CRISPR/Cas13‑based research that has identified miRNAs as possible cancer biomarkers for diagnosis and prognosis, and as targets for treatment. In the present review, current updates regarding miRNA biogenesis, structural and functional aspects, and miRNA dysregulation during cancer are described. In addition, novel approaches using the CRISPR/Cas13 system as a next‑generation tool for miRNA detection are discussed. Furthermore, challenges and prospects of CRISPR/Cas13‑based miRNA detection approaches are described.

PErioperative respiratory care aNd outcomes for patients underGoing hIgh risk abdomiNal surgery (PENGUIN): a randomised international internal pilot trial

Background

Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO2) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.

Methods

Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80-100% perioperative FiO2 to prevent surgical site infection (SSI) versus 21-35% FiO2. This 12-month internal pilot assessed feasibility of hospital site opening, patient recruitment, intervention adherence, patient follow-up and safety. Patients were randomised in a 1:1:1:1 ratio to the four intervention group combinations and followed up for 30 days.

Results

We recruited 927 patients from seven hospitals in India and South Africa over 12 months from November 2020. There were 907 adults (97.8%) and 20 children aged ten or over (2.2%): 89/927 (9.6%) patients died. Site opening reached 70% of our target (7/10) hospitals, and patient recruitment 107% (927/870). 917/927 (99%) patients in the mouthwash arm, and 840/927 (91%) patients in the oxygen arm received the allocated intervention. Lower adherence to the oxygen intervention related mainly to clinically necessary FiO2 increases in the 21-35% FiO2 arm. 30-day follow-up was completed appropriately for 924/927 (99%) patients. and was performed by a masked assessor for all patients. There were no reported safety events.

Conclusion

This pilot showed the feasibility and safety of a major phase III trial in post-operative infection prevention in LMICs.

Trial registration

ClinicalTrials.gov NCT04256798.

Exosome-based approaches in cancer along with unlocking new insights into regeneration of cancer-prone tissues

Most eukaryotic cells secrete extracellular vesicles called exosomes, which are involved in intercellular communication. Exosomes play a role in tumor development and metastasis by transporting bioactive chemicals from cancerous cells to other cells in local and distant microenvironments. However, the potential of exosomes can be used by engineering them and considering different therapeutic approaches to overcome tumors. Exosomes are a promising drug delivery approach that can help decrease side effects from traditional treatments like radiation and chemotherapy by acting as targeted agents at the tumor site. The present review provides an overview of exosomes and various aspects of the role of exosomes in cancer development, which include these items: exosomes in cancer diagnosis, exosomes and drug delivery, exosomes and drug resistance, exosomal microRNAs and exosomes in tumor microenvironment, etc. Cancer stem cells release exosomes that nurture tumors, promoting unwanted growth and regeneration, and these types of exosomes should be inhibited. Ironically, exosomes from other cells, such as hepatocytes or mesenchymal stem cells (MSCs), are vital for healing organs like the liver and repairing gastric ulcers. Without proper treatment, this healing process can backfire, potentially leading to disease progression or even cancer. What can be found from various studies about the role of exosomes in the field of cancer is that exosomes act like a double-edged sword; on the other hand, natural exosomes in the body may play an important role in the process and progression of cancer, but by engineering exosomes, they can be directed towards target therapy and targeted delivery of drugs to tumor cells. By examining the role and application of exosomes in various mechanisms of cancer, it is possible to help treat this disease more efficiently and quickly in preclinical and clinical research.

An Australian regional hospital's oesophagectomy experience: A 10-year case series from Tasmania

Introduction

Oesophagectomy is recommended as part of curative treatment for oesophageal cancer but is associated with substantial morbidity. Centralization has been recommended to improve outcomes, but this has not been widely applied in Australia. This study aimed to audit a regional hospital's experience over ten years and compare it to outcomes from national and international centres to support the view that oesophagectomy can be performed safely in select regional centres in Australia.

Methods

Patients undergoing oesophagectomy at a single regional hospital in North-East Tasmania, Australia between January 2014 and December 2023 were retrospectively identified. Preoperative patient and tumour characteristics, and outcomes (mortality, anastomotic leak, length of stay, respiratory complications, long-term complications and survival) were compared to other centres.

Results

65 patients were identified. 53 % were male, mean age was 65.2 years, 29.2 % had respiratory disease and 18.5 % were current smokers. The anastomotic leak rate was 7.7 %. 25 % developed pneumonia postoperatively. Average ICU length of stay was 4.6 days, median acute inpatient length of stay was 15 days. There was one in-hospital mortality and one 30-day mortality. 2 patients (3 %) required diaphragmatic hernia repair; 12 patients (18.5 %) required endoscopic dilatation of anastomotic strictures. The 5-year survival rate was 66 %. Our results compare favourably to published rates of anastomotic leak (10-15 %), inpatient stay (15 days), pneumonia (20-30 %), 30-day mortality (1-4 %) and anastomotic stricture (20 %).

Conclusions

Oesophagectomies can be safely performed in regional centres in Australia that routinely undertake a higher volume of cases per year, provided services required to manage complications are readily available.

Visible-light-driven rhodamine 6G mediated in situ poly-ferrocene strategy for highly sensitive quantification of esophageal cancer biomarkers

Esophageal cancer (EC) is one of the most prevalent malignant tumors globally, and the core strategy to improve the survival prospects of EC patients is to identify high-risk lesions and subsequently administer efficacious treatments. Among numerous biomarkers, microRNAs have the potential to facilitate rapid cancer screening and prevention. Therefore, a highly sensitive detection method based on photoinduced electron transfer atom transfer radical polymerization (PET-ATRP) signal amplification strategy was designed, aiming to accurately detect the potential markers of EC. The biosensor employs an indium tin oxide (ITO) electrode as a carrier, immobilizes probe 1 on the electrode surface by silanization, and achieves effective capture of tRNA with a stable sandwich structure to introduce -SH group. Subsequently, an ATRP initiator was introduced to the electrode surface by forming disulfide bonds, which resulted in the growth of poly-ferrocene under the catalysis of rhodamine 6G (R6G) and blue light irradiation. The R6G-mediated PET-ATRP signal amplification strategy offers significant advantages of simplicity, rapidity and cost-effectiveness while enhancing the sensitivity of the biosensor to tRNA with a limit of detection of 0.12 fM. Moreover, the biosensor exhibits excellent selectivity and anti-interference ability in real samples, which has significant potential for the timely prevention and diagnosis of EC.

Obesity-associated reduction of miR-150-5p in extracellular vesicles promotes ventilator-induced lung injury by modulating the lysosomal degradation of VE-cadherin

Obese patient has a high risk of ventilator-induced lung injury (VILI) but its underlying mechanisms remain elusive. This study was designed to explore the role of circulating plasma extracellular vesicles (EVs) on the progression of VILI in the context of obesity. After high tidal volume mechanical ventilation, mice treated with plasma EVs from obese patients developed more severe lung damage than mice treated with plasma EVs from normal controls. miRNA sequencing of plasma EVs from obese patients revealed a significant downregulation of miR-150-5p compared to the others. miR-150-5p was found to target on XBP1s which subsequently regulated RAB7 as verified through dual-luciferase assays. This pathway promoted lysosomal degradation of vascular endothelial (VE)-cadherin, leading to an increased endothelial permeability. Obese mice showed an enhanced XBP1s/RAB7 expression, reduced VE-cadherin levels, and aggravated endothelial barrier damage and all of which intensified VILI. Administration of miR-150-5p agomir in obese mice mitigated VILI. Thus, this study highlights the low levels of miR-150-5p in EVs from obese patients modulated VILI severity via the XBP1s/RAB7 axis and the lysosomal degradation of VE-cadherin.

Human Vocal Fold Tissue Modifications Related to Laryngopharyngeal Reflux Disease: A Systematic Review

BACKGROUND

The vocal fold tissue modifications and related dysphonia caused by laryngopharyngeal reflux disease (LPRD) remain a controversial topic in laryngology. Investigation of human vocal fold tissue exposed to reflux content can provide valuable insights. This systematic review aimed to summarize the current knowledge about LPRD-induced human vocal fold tissue modifications to better understand LPRD pathophysiology and LPRD-related voice disorders.

METHODS

A PubMed, Embase, and Web of Science database search was carried out by two investigators for studies investigating human laryngeal mucosa injuries and histological modifications related to LPRD refluxate, and their potential mechanistic associations with voice quality impairments according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements.

RESULTS

Of 389 retrieved articles, 24 experimental studies met the inclusion criteria. Studies demonstrate that laryngeal, particularly vocal fold, biopsies of patients with suspected LPRD reveal a substantial number of histological and functional alterations, including inflammatory cell infiltration, cell junction proteolysis, intercellular space dilatation, pepsin-induced cell DNA damage, and increases in oxidative stress mediators and tissue injuries. Functional impairment of defensive mechanisms through downregulation of carbonic anhydrases (CA III) and protective mucins (MUC2, MUC4, and MUC5AC) can consist of favoring factor of tissue injuries. Emerging studies reported evidence of tissue remodeling through matrix metalloproteinase activation and metabolic alterations included increased Glut-1 and sphingosine pathway activation, potentially linking LPRD to leukoplakia development. No studies addressed the potential effects of elastase, bile salts, trypsin, and lipases in non-acidic (weakly acidic or alkaline) gaseous environment.

CONCLUSION

This systematic review demonstrates that LPRD and pepsin induce cellular alterations in vocal fold and laryngeal tissues, highlighting potential pathogenic mechanisms and identifying biomarkers that may guide future diagnostic and therapeutic strategies.

A safety and effectiveness evaluation of refluxstop in the treatment of acid reflux comparing large and small hiatal hernia groups: results from 99 patients in Switzerland with up to 4-years follow-up

BACKGROUND

Standard-of-care surgical treatments for gastroesophageal reflux disease (GERD), with large hiatal hernia (HH), result in a reoperation rate of up to 50% at 5 years. RefluxStop, acting as a mechanical stop without encircling the food passageway, offers a novel approach to treat large HH patients. This study assesses the safety and efficacy of RefluxStop surgery comparing large and small HH groups followed for up to 4 years.

METHODS

Two cohorts were retrospectively analyzed in a combined investigator-initiated study evaluating safety outcomes of RefluxStop in severe GERD subjects, comparing concomitant small (≤3 cm) and large HH (4-10 cm) in Switzerland. Primary outcomes were procedure-related adverse events (AEs/ADEs). The secondary outcome was improvement in GERD-HRQL score.

RESULTS

Ninety-nine subjects underwent the RefluxStop surgical procedure, whereof 50 subjects had small (≤3 cm) and 49 subjects had large HH (4-10 cm). One surgeon at each site operated on both small and large hernia patients. No significant difference in AEs between patients with small and large HH was shown. At 1-year follow-up, subjects in both groups experienced statistically significant improvements in median (IQR) GERD-HRQL score of 93.8% (81.8%; 98.7%) for those with large HH and 85.7% (76.5%; 92.3%) for those with small HH.

CONCLUSION

RefluxStop surgery for GERD effectively treats patients with large HH that currently have no optimal treatment options, while showing significantly improved results for up to 4 years. Furthermore, RefluxStop provides equally favorable results and a robust low risk profile for subjects with either concomitant small (n = 49) and large (n = 50) HH.

NOVEMBER, A Phase 2 Trial of a 9-Day Course of Whole Breast Radiation Therapy With a Simultaneous Lumpectomy Boost for Early-Stage Breast Cancer

PURPOSE/OBJECTIVES

A phase 2 prospective noninferiority trial evaluating a novel 9 fraction course of whole breast radiation and simultaneous lumpectomy boost.

MATERIALS AND METHODS

Tis and T1-3N0 patients enrolled to receive 3420 cGy radiation to the breast with 3960 cGy to the lumpectomy cavity. The primary endpoint was averaged photographic cosmetic scores at 24 months with a hypothesis of >70% good to excellent cosmetic breast scoring 24 months after completing radiation, assuming a baseline excellent/good cosmetic scoring of 80% with an 80% power, α = 0.1.

RESULTS

From 2018 to 2020, with institutional review board approval, 103 patients were enrolled. Patients had mostly invasive ductal carcinoma (75%), tumor size ≤ 2cm (88%), negative margins (92%), no lympho-vascular invasion (80%), and estrogen receptor positive (85%). Patients had a mean age of 59.5 years (33-82). With a mean follow-up of 51 months, there were no local recurrences and 1 patient with both regional (axilla) and distant (brain) recurrence. Twenty-four-month post-radiation therapy (RT) cosmetic photos were 68% excellent/good, and 32% fair/poor. The null hypothesis was not rejected with one-sided 95% exact binomial confidence interval of 59.1% (59.1%-100%). There were no reported late ≥grade 3 radiation toxicity events and only 4 patients with late grade 2 events. Patient-reported outcomes utilizing the Breast-Q survey revealed breast satisfaction in 85% of women.

CONCLUSIONS

We demonstrate an effective novel 9 fraction whole breast + lumpectomy boost radiation schedule. This trial uses one of the shortest published radiation schedules for a lumpectomy boost. Although we did not meet our prespecified cosmetic endpoint, no significant cosmetic change from baseline was seen in 80% of patients. We demonstrate excellent local control, and patient-reported satisfaction with low RT-related toxicity. We hope to move this concept forward in a randomized trial against the 5-day United Kingdom (UK) Fast Forward regimen, inclusive of a simultaneous lumpectomy cavity boost.

Circulating Inflammation Biomarkers and the Risk of Esophageal Adenocarcinoma: A Nested Case-Control Study in the Department of Defense Serum Repository

BACKGROUND

We previously identified associations of esophageal adenocarcinoma risk with four inflammation-related candidate biomarkers: TNF receptor 2 (TNFR2), IL17A, VEGFR3, and resistin.

METHODS

We aimed to replicate these candidates and discover novel associations with additional proteins. We conducted a nested case-control study of men with prediagnostic biospecimens stored at the US Department of Defense Serum Repository, including 203 incident esophageal adenocarcinoma cases. Controls were matched to cases in a ∼2:1 ratio by date of birth, race, service branch, and blood draw date. Multiplex immunoassays (Olink/Proseek panels) measured 254 proteins detected in ≥10% of all samples. Multivariable-adjusted conditional logistic regression models calculated associations between biomarker quantiles and esophageal adenocarcinoma. P values (<0.05) were used to indicate the statistical significance of candidates, and FDR was applied to the additional proteins. ORs from the current analysis and those from previous studies were combined for the candidate markers using fixed-effects meta-analysis.

RESULTS

Among the four candidates, the highest category of TNFR2 was associated with significantly increased esophageal adenocarcinoma risk (ORQ4 vs. Q1 = 1.87; 95% confidence interval: 1.02-3.42). In the meta-analysis, associations with esophageal adenocarcinoma were positive for TNFR2 (meta-analyzed ORhighest-vs.-lowest = 2.04; 1.12-2.95) and inverse for IL17A (meta-analyzed ORhighest-vs.-lowest = 0.53; 0.26-0.80). Of the additional 250 proteins, 45 were associated with esophageal adenocarcinoma risk and 6 (monocyte chemotactic protein 3, IL6, TNFR1, hepatocyte growth factor, TFF3, and FURIN) remained significant after FDR correction.

CONCLUSIONS

We confirmed associations of TNFR2 and IL17A with esophageal adenocarcinoma risk. Additionally, our study expands the range of proteins associated with esophageal adenocarcinoma development.

IMPACT

This is the largest assessment to discover novel associations of inflammation-related proteins with esophageal adenocarcinoma to date.

Molecular Hydrogen Therapy: Mechanisms, Delivery Methods, Preventive, and Therapeutic Application

Molecular hydrogen (H2), recognized as the smallest gas molecule, is capable of permeating cellular membranes and diffusing throughout the body. Due to its high bioavailability, H2 is considered a therapeutic gas for the treatment of various diseases. The therapeutic efficacy of hydrogen is contingent upon factors such as the administration method, duration of contact with diseased tissue, and concentration at targeted sites. H2 can be administered exogenously and is also produced endogenously within the intestinal tract. A comprehensive understanding of its delivery mechanisms and modes of action is crucial for advancing hydrogen medicine. This review highlights H₂'s mechanisms of action, summarizes its administration methods, and explores advancements in treating intestinal diseases (e.g., inflammatory bowel disease, intestinal ischemia-reperfusion, colorectal cancer). Additionally, its applications in managing other diseases are discussed. Finally, the challenges associated with its clinical application and potential solutions are explored. We propose that current delivery challenges faced by H2 can be effectively addressed through the use of nanoplatforms; furthermore, interactions between hydrogen and gut microbiota may provide insights into its mechanisms for treating intestinal diseases. Future research should explore the synergistic effects of H2 in conjunction with conventional therapies and develop personalized treatment plans to achieve precision medicine.

Long-term health-related quality of life among adolescent and young adult breast cancer survivors

PURPOSE

As the prognosis for adolescents and young adults (AYAs) with breast cancer has improved, long-term health-related quality of life (HRQoL) has become increasingly important. This study aimed to analyze the long-term HRQoL of AYA breast cancer survivors compared to an age-matched normative population and to identify factors associated with HRQoL.

METHODS

Secondary analyses were conducted using data from the SURVAYA study. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) was used to assess HRQoL. The Mann-Whitney U test was used to compare HRQoL scores of AYA breast cancer survivors with those of the normative population (n = 409). Linear regression models were constructed to identify patient and treatment characteristics associated with HRQoL.

RESULTS

A total of 944 female AYA breast cancer survivors were included, with a median age of 36.0 years and a median follow-up of 12.2 years. AYA breast cancer survivors scored significantly lower on five functional scales: physical, role, emotional, cognitive, and social, and higher on five symptom scales: fatigue, pain, dyspnea, insomnia, and financial impact compared to the normative population. Being in a relationship, having a positive body image, and adaptive coping were positively associated with HRQoL, while older age, chemotherapy, unemployment, and maladaptive coping were negatively associated.

CONCLUSION

AYA breast cancer survivors experience significantly compromised long-term HRQoL compared to an age-matched normative population. These results highlight the need for tailored follow-up care and long-term support, as well as the importance of shared decision-making about the benefits and risks of treatments before initiation.

Survival Outcome of Thoraco-Laparoscopic McKeown Esophagectomy Versus Endoscopic Submucosal Dissection for Early-Stage Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

OBJECTIVE

To evaluate thoraco-laparoscopic McKeown esophagectomy (TLME) versus endoscopic submucosal dissection (ESD) for clinical-T1N0 esophageal squamous cell carcinoma (ESCC) depending on invasion depth.

BACKGROUND

Early-stage ESCC has been widely treated by endoscopic resection. While ESD is safer than esophagectomy perioperatively, its survival benefits for clinical-T1N0M0 ESCC, especially high-risk T1b tumors, are unclear.

METHODS

A retrospective study was conducted on clinical-T1N0 ESCC patients at the First Affiliated Hospital of Zhengzhou University comparing TLME (cT1a, n = 352; cT1b, n = 205) with ESD (cT1a, n = 499; cT1b, n = 62). Overall survival (OS), disease-specific survival (DSS), relapse-free survival (RFS), and metastasis-free survival (MFS) were analyzed depending on invasion depth after propensity score matching to account for selection bias.

RESULTS

ESD group had better OS (hazard ratio: 0.54, p = 0.029) but worse RFS (hazard ratio: 6.83, p < 0.001) than TLME group in general terms. T1a cancers showed no difference in DSS and MFS between groups. T1b subgroup with ESD had lower DSS (hazard ratio: 5.65, p = 0.036) and MFS (hazard ratio: 3.54, p = 0.069). R1-resection in ESD group linked to poorer OS (hazard ratio: 5.89, p = 0.006) and DSS (hazard ratio: 3.67, p = 0.006).

CONCLUSION

ESD can be safe in the treatment of clinical-T1aN0 ESCC. However, concerning oncologic curability, TLME should be recommended for patients with clinical-T1bN0 ESCC in terms of favorable DSS, RFS, and MFS.

Discrepancies in the Reporting of Hiatal Hernia Size: A Review

BackgroundIn the current literature there is a paucity of both standardized diagnostic criteria and accurate methods for determining hernia size. The aim of this review is to describe the most common methods for reporting hiatal hernia size.MethodsLiterature search using PubMed and Embase databases was performed. After exclusion and screening, 67 articles were analyzed and data were collected on hernia type and subtype, diagnostic method, size reporting method, and the author's definition of hernia size (measurement protocol).ResultsAuthors publishing on hiatal hernia size employed 8 different methods for diagnosing hiatal hernias and reported data using 7 distinct measurement types. Within individual diagnostic methods there was a further lack of standardization of measurement protocols.ConclusionOur review underscores the critical need for standardized reporting methods in the assessment and reporting of hiatal hernia size. Moving forward, collaboration is essential to establish and adopt standardized guidelines for reporting hiatal hernia size, ultimately improving patient care and outcomes.

A Novel Multi-Modal Population-Graph Based Framework for Patients of Esophageal Squamous Cell Cancer Prognostic Risk Prediction

Prognostic risk prediction is pivotal for clinicians to appraise the patient's esophageal squamous cell cancer (ESCC) progression status precisely and tailor individualized therapy treatment plans. Currently, CT-based multi-modal prognostic risk prediction methods have gradually attracted the attention of researchers for their universality, which is also able to be applied in scenarios of preoperative prognostic risk assessment in the early stages of cancer. However, much of the current work focuses only on CT images of the primary tumor, ignoring the important role that CT images of lymph nodes play in prognostic risk prediction. Additionally, it is important to consider and explore the inter-patient feature similarity in prognosis when developing models. To solve these problems, we proposed a novel multi-modal population-graph based framework leveraging CT images including primary tumor and lymph nodes combined with clinical, hematology, and radiomics data for ESCC prognostic risk prediction. A patient population graph was constructed to excavate the homogeneity and heterogeneity of inter-patient feature embedding. Moreover, a novel node-level multi-task joint loss was proposed for graph model optimization through a supervised-based task and an unsupervised-based task. Sufficient experimental results show that our model achieved state-of-the-art performance compared with other baseline models as well as the gold standard on discriminative ability, risk stratification, and clinical utility.

Safety and Early Clinical Outcomes Following Repair of Very Large Hiatus Hernia in Octogenarians

BACKGROUND

Very large hiatus hernias are often symptomatic, impact quality of life, and are increasingly encountered in aging populations. Laparoscopic repair offers excellent clinical outcomes. However, surgeons can be reluctant to offer surgery to the elderly due to concerns about morbidity and mortality. To determine safety, we evaluated outcomes following repair of very large hiatus hernias in patients aged 80 years and older and compared them to younger patients.

METHODS

Data were extracted from a prospective database. Patients who underwent operative repair of a very large hiatus hernia (> 50% intrathoracic stomach) between 2000 and 2023 were included and categorized into groups based on age: young (< 70 years), older (70-79 years), and octogenarian (≥ 80 years). Perioperative and early postoperative clinical outcomes were determined and compared.

RESULTS

1353 patients underwent surgery (< 70 years: 733 [54.2%], 70-79 years: 451 [33.3%], and ≥ 80 years: 169 [12.5%]). Rates of total intrathoracic stomach were commonest in octogenarians (11.6% vs. 20.4% vs. 32.5% and p < 0.001). Young and older patients were more likely to undergo elective surgery for heartburn (56.6% vs. 44.4% vs. 29.0% and p < 0.001), whereas octogenarians more likely underwent emergency surgery for gastric volvulus (5.4% vs. 6.6% vs. 14.5% and p = 0.019). Conversion to open surgery (1.1% vs. 1.1% vs. 5.0% and p = 0.002) and length of stay (2.69 vs. 3.19 vs. 4.62 days and p < 0.001) were greater in the octogenarian group. Major complications (4.2% vs. 5.1% vs. 8.1% and p = 0.120) and return to theater rates (2.6% vs. 2.9% vs. 2.7% and p = 0.925) were similar. Thirty-day mortality rates were low for all groups but highest in octogenarians (0.3% vs. 0.4% vs. 1.8% and p = 0.048). Adverse outcomes were more likely with emergency presentations, which were more common in octogenarians.

CONCLUSION

Despite a higher rate of emergency surgery in octogenarians-major complications and overall mortality rates are still acceptably low. Repair of very large symptomatic hiatus hernia should not be withheld from patients aged over 80 who are otherwise fit.

Experience With an Innovative Surgical Treatment Option for Gastroesophageal Reflux Disease: Results of 28 Patients in a Retrospective Analysis

Introduction: Standard-of-care gastroesophageal reflux disease (GERD) procedures are associated with adverse events (AEs) (i.e., dysphagia, gas-bloating). RefluxStop has been developed to circumvent these outcomes. This study presents the results of 28 patients managed with RefluxStop in Germany. Methods: Between July 2021 and November 2023, 28 patients with GERD underwent RefluxStop surgery, a novel laparoscopic antireflux procedure. Retrospective chart analysis with patient-informed consent was conducted to determine clinical outcomes, such as GERD Health-Related Quality of Life (GERD-HRQL) score, proton pump inhibitors (PPI) use, symptomatology, patient satisfaction, and perioperative AEs. Results: Baseline characteristics (n = 28): age 47 ± 13.1 years; 67.9% female; body mass index (BMI) 27.3 ± 4.1 kg/m2; 93% PPI use for 5.6 ± 2.7 years; and hiatal hernia in 100% of cases of mean (standard deviation [SD]) size 3.4 (0.8) cm, whereof 35.7% were large hiatal hernia (4-6 cm). At a mean (SD) follow-up of 14.1 (4.7) months, patients experienced 88.6% improvement in median (IQR) total GERD-HRQL score from a baseline of 35 (7.7) to 4 (4.2) at follow-up (P < .05). Preoperative dysphagia (35.7%) resolved completely in all patients (P < .001). The mean (SD) GERD-HRQL heartburn subdomain decreased by 90.6% from a baseline of 18.1 (6.1) to 1.7 (1.2) at follow-up and all patients (100%) had scores <5. Similarly, the mean (SD) regurgitation subdomain decreased from a baseline of 13.2 (4.7) to 2 (1.6) at follow-up and all patients (100%) had scores <5. Patient satisfaction was achieved in 96.4% of patients with no PPI use required in 93% of patients (P < .001); only one patient required PPIs for persistent GERD symptoms. No cases of reoperation or esophageal dilatation were performed. Minor intraoperative AEs occurred in seven patients (i.e., neck emphysema). Conclusion: RefluxStop provides excellent safety and effectiveness outcomes for GERD treatment. Dysphagia completely resolved (0%) with 88.6% improvement in median GERD-HRQL score and satisfaction achieved in 96.4% of patients. These promising results reproduced the outcomes noted in the RefluxStop CE trial in real-world settings.

Improving patient access to symptomatic treatment through self-serving nausea stations at Peace Arch Hospital emergency department

BACKGROUND

Nausea is a common complaint among patients waiting at the emergency department (ED). Previous research indicates that isopropyl alcohol (IPA) can provide symptomatic relief for nausea. However, the number of studies investigating this effect is limited, especially in ED settings. This study investigates the effect of IPA administration on patients presenting with nausea to the ED. We aim to provide symptomatic relief to 20% of these patients.

METHODS

In the Peach Arch Hospital (PAH) ED, patients who reported feeling nauseous were provided with a single IPA swab, instructional materials and feedback surveys. Patients inhaled IPA at a self-serving booth and completed a standardised survey immediately after. Patients were included in the study if they presented with nausea and excluded if they were under the age of 18, were pregnant, were allergic to alcohol, had cognitive impairment and/or were taking disulfiram. Multiple plan-do-study-act cycles were implemented to refine this study, including changes in feedback collection, instructional materials and presentation of IPA swabs.

RESULTS

The total number of surveys completed over the 25-week period was 41 (n=41). These surveys showed that IPA inhalation is effective in improving nausea symptoms in the ED, with 53% of survey respondents suggesting 'great improvement' or 'good improvement'. 88% of respondents felt there was improvement in symptoms. There were very limited participants (12%) who reported that IPA administration showed 'no improvement'.

CONCLUSIONS

Self-serving nausea treatment stations may be an effective strategy in alleviating symptoms for patients awaiting to be seen by a physician while in the ED. These stations can enhance patient care through rapid treatment, optimise resources by reducing workload on nursing staff, and empower patients to manage their own symptoms.

Association of immediate symmetrizing oncoplastic surgery with patient-reported outcomes in patients with breast cancer - A retrospective cohort study

INTRODUCTION

Oncoplastic breast surgery (OPS) with immediate symmetrization is commonly performed. However, its impact on patient-reported outcomes (PROs) remains uncertain.

METHODS

Patients with stage 0-III breast cancer who underwent OPS (including oncoplastic breast conserving surgery, or nipple- or skin-sparing mastectomy) at a Swiss university hospital between 01/2013-12/2023 who completed a postoperative BREAST-Q questionnaire were identified from a prospectively maintained database. A generalized linear model was used to detect differences in PROs between those who underwent unilateral versus immediate symmetrizing surgery.

RESULTS

Of 441 eligible patients, 333 (75.5 ​%) underwent unilateral OPS, while 108 (24.5 ​%) underwent bilateral OPS. Median time to PRO assessment was 35.1 months (Q1-Q3 13.4-49.5). No differences in PROs were identified between patients who underwent unilateral versus bilateral OPS. Short-term surgical morbidity was more common in patients who underwent symmetrizing surgery, which negatively impacted PROs.

CONCLUSION

The present study did not demonstrate any impact of immediate symmetrization on PROs.

Application of machine learning models to identify predictors of good outcome after laparoscopic fundoplication

BACKGROUND

Laparoscopic fundoplication remains the gold standard treatment for gastroesophageal reflux disease. However, 10% to 20% of patients experience new, persistent, or recurrent symptoms warranting further treatment. Potential predictors for the best outcome after laparoscopic fundoplication were tested using a mature prospectively maintained database.

METHODS

Data from 894 consecutive patients who underwent primary laparoscopic fundoplication from 1998 to 2015 were examined using regression and machine learning (ML) models. Preoperative factors were assessed for influence on postoperative outcomes: heartburn, dysphagia, and satisfaction scores at a median follow-up of 5 years.

RESULTS

The accuracy in predicting heartburn score (range, 0-10) assessed using the root mean squared error (RMSE) was similar to a negative binomial regression model (RMSE = 2.39) and the least absolute shrinkage support operator ML model (RMSE = 2.34). The multivariate analysis using only patients with complete data (n = 221) generated a lower error than using mean imputation for patients with missing values. The most predictive variables were male sex for heartburn (β = -1.48 [95% CI, -2.37 to -0.6; P =.001) and dysphagia (β = -4.70 [95% CI, -8.02 to -1.39; P =.006) and percentage of esophageal peristalsis for satisfaction (β = 0.63 [95% CI, 0.16-1.10]; P =.009) and dysphagia (β = -1.85 [95% CI, -3.43 to -0.27]; P =.02).

CONCLUSION

Although male sex and degree of intact peristalsis are significant predictors for outcomes after laparoscopic fundoplication, prediction of individual patient outcome was relatively poor, and ML prediction models provided only marginal improvement in accuracy. Clinical acumen and a discussion with patients to set realistic postoperative expectations cannot be replaced by regression models or standard ML prediction algorithms at the present time.

Durability of esophageal acid exposure normalization after Nissen fundoplication and its association with symptoms

BACKGROUND

Nissen fundoplication provides durable symptomatic control over time in patients with gastroesophageal reflux disease (GERD). Studies have also demonstrated a high rate of distal esophageal acid exposure normalization up to 1 year after surgery. However, data on the durability of acid exposure normalization after surgery are limited. This study aimed to assess esophageal acid exposure over time and determine factors associated with its durability in patients with an intact Nissen fundoplication.

METHODS

Patients who underwent primary Nissen fundoplication at our institution with an endoscopically intact fundoplication and no herniation were selected. Those who completed esophageal pH monitoring at 1 and 4 years after surgery were included. One-year pH monitoring was performed at a mean (SD) of 17.7 (10) months, and the 4-year test at 49.0 (26) months after surgery. The degree of esophageal acid exposure was compared before and at 1 and 4 years after surgery. A subgroup of patients with acid normalization at 1 year was divided into durable and waning normalization groups based on the 4-year pH-monitoring result and compared. Normalization of esophageal acid exposure was defined as a DeMeester score of <14.7.

RESULTS

The final study population comprised 71 patients (78.9% females) with a mean (SD) age of 59.5 (14). At 1-year follow-up after surgery, there was improvement in the Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score (28.9 [18] to 13.7 [9]; P <.0001). There was improvement in DeMeester score (35.8 [27] to 4.3 [5.1]; P <.0001), with a 94.4% acid exposure normalization rate. From 1 to 4 years, GERD-HRQL score improvement was comparable (13.7 [9] to 12.0 [12]; P =.889]. Freedom from antisecretory medications was similar (82.6%-81.8%; P =.911). DeMeester score was also comparable (4.3 [5.1] to 7.3 [10.5]; P =.234), with similar normalization rate (94.4% vs 91.5%; P =.724). Of the 67 patients with acid exposure-normalization at 1 year, 91% had durable normalization at 4 years. Those with durable pH-normalization were similar in age, sex, BMI, and preoperative GERD-HRQL score to those with waning normalization (P >.05). GERD-HRQL scores and antisecretory medication use were comparable at both 1 and 4 years between groups (P >.05). The remaining 9% with waning pH-normalization had higher preoperative DeMeester scores (65.9 [34] vs 32.7 [24]; P =.014). They were also less likely to have >80% intact peristaltic contractions (33.0% vs 73.0%; P =.047) and had lower percentage complete bolus clearance on preoperative high-resolution manometry (34 [43] vs 75.5 [29]; P =.021).

CONCLUSION

Nissen fundoplication provides durable symptomatic and objective reflux control in patients with an intact repair. Only 9% of patients had waning acid exposure normalization over time with no impact on symptoms or medication use. Waning acid exposure-normalization was associated with poor esophageal body function.

Incisional hernia incidence following laparoscopic versus open abdominal surgery: an updated systematic review and meta-analysis of randomized controlled trials

PURPOSE

Incisional hernias (IH) are a frequent complication following open surgery (OP). While laparoscopic (LAP) surgery is designed to enhance patient recovery through smaller incisions, contemporary quantitative evidence supporting its efficacy in reducing IH rates (IHR) is sparse. This study aims to provide an overview of IHR following OP and LAP abdominal operations.

METHODS

We searched for randomized controlled trials (RCTs) studies in PubMed, Cochrane, and Embase from inception until May 2024 comparing OP approach to LAP and reported IH incidence as a postoperative complication. Exclusion criteria included studies involving patients aged ≤ 18 years, those lacking a control group, or those with a follow-up period of less than 12 months. Studies were stratified by procedure type and by fully laparoscopic (T-LAP) versus laparoscopic-assisted (LAP-A) approaches. Statistical analyses were performed using RStudio software. To address potential clinical and methodological heterogeneity across studies, we applied the restricted maximum-likelihood estimator and random-effects models for outcome analysis.

RESULTS

8.754 studies were screened, and 72 studies were reviewed. From the initial screening, 28 studies involving 6,113 patients were included, of which 3,337 (54.6%) underwent LAP. Analysis revealed a significantly lower incidence of IH among patients who received LAP (RR 0.51; 95% CI 0.33-0.79). Subgroup analysis by surgery type indicated that bariatric (RR 0.20; 95% CI 0.068-0.578) and fundoplication procedures (RR 0.1; 95%CI 0.018-0.545) were associated with a substantial reduction in IHR. Moreover, totally-laparoscopic (T-LAP) procedures showed a significant reduction in IHR (RR 0.26;95%CI 0.14-0.5), while LAP-A procedures failed to show the same benefit.

CONCLUSION

LAP surgery is associated with reduced IHR in abdominal operations, with the benefit being particularly notable amongst LAP-A, bariatric, and fundoplication procedures. These findings underscore the advantages of LAP in specific surgical contexts, emphasizing its potential to minimize postoperative complications such as IH. Further research focusing on comparing IHR on open versus LAP approaches is warranted.

STUDY REGISTRATION

A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024551280).

Clinical manifestations of SARS-CoV-2 Omicron infection is associated with the stage of liver cirrhosis

BACKGROUND & AIM

The impact of Omicron variants on cirrhosis was largely unknown. Herein, we aimed to evaluate the impact of SARS-CoV-2 omicron variants infection on the clinical course and mortality of patients with liver cirrhosis.

METHODS

Between 26 December 2022, and 27 January 2023, eighty-two hospitalized patients with cirrhosis and confirmed SARS-CoV-2 infection were enrolled. The clinical and pulmonary CT imaging features were retrospectively collected. A gender and age-matched cohort of 51 non-cirrhotic patients with COVID-19 were also included.

RESULTS

Our results indicated the symptom heterogeneity in patients with cirrhosis infected with omicron variants. Patients with more severe liver disease tended to have less severe respiratory symptoms and less pulmonary lesions. SARS-CoV-2 omicron did not cause obvious perturbation of liver function or cirrhosis decompensation. In comparison with hospitalized COVID-19 patients without liver cirrhosis, cirrhotic patients showed more severe pulmonary lesions and higher levels of inflammatory cytokine IL-6, but no significant increase in mortality. Multivariate analysis identified lung lesions proportion, MELD ≥ 15 score, and APTT as independent predictors for 28-day-mortality in these patients.

CONCLUSION

SARS-CoV-2 omicron variants caused a more severe inflammatory response in cirrhotic patients than in non-cirrhotic patients, but no further deterioration of liver function. Instead, patients with advanced stage of liver cirrhosis showed milder respiratory symptoms and pulmonary lesions. These results underscore the intricate relationship between Omicron infection and cirrhosis, highlighting the necessity for personalized clinical approaches in managing this specific patient group.

Is preoperative smoking status a predictor of postoperative outcomes after esophagectomy for squamous cell carcinoma in a high-volume centre?

BACKGROUND

Smoking is a major risk factor for esophageal squamous cell carcinoma (ESCC) and is linked to increased postoperative morbidity. However, its impact on long-term survival remains unclear. This study evaluated the influence of preoperative smoking status on postoperative complications and survival following esophagectomy for ESCC in a high-volume center.

METHODS

Patients who underwent surgery for ESCC between 1996 and 2019 were retrospectively categorized as smokers (S-group) or non-smokers (NS-group). A subgroup analysis was performed to compare active and former smokers. Primary outcomes included major postoperative complications (Clavien-Dindo ≥ III), pulmonary complications, and postoperative mortality at 30 and 90 days. Long-term outcomes included overall survival (OS) and recurrence-free survival (RFS).

RESULTS

Among 694 patients, 97 (14%) were in the NS-group and 597 (86%) in the S-group. Smokers had significantly higher major morbidity rates (37% vs 23%, P = .002), including major pulmonary complications (29% vs 21%, P = .03). Active smoking was associated with increased 30-day mortality (P = .006) and higher rates of acute respiratory distress syndrome (P = .012) compared to former smokers. OS and RFS did not differ significantly between groups. The absence of post-operative smoking data limits long-term outcome interpretation.

CONCLUSION

Smoking was associated with increased perioperative morbidity, particularly pulmonary complications, but its effect on long-term survival remains uncertain. Structured smoking cessation programs should be integrated into perioperative care. Future studies should incorporate postoperative smoking status to better assess its impact on survival.

LH Induces Murine Hair Loss through TRPC-Medicated Cell Aging Responses: Implications for Female Pattern Hair Loss Pathogenesis

Menopause-related hormonal imbalances, particularly the decline in estrogen and the rise in luteinizing hormone (LH), are implicated in female pattern hair loss (FPHL). This study investigated LH's role in FPHL, as its precise function has remained unclear. Our results found that a significant association between elevated LH levels and FPHL. The binding of LH to LH receptor (LHR), activates downstream transient receptor potential canonical channels (TRPCs), which potentially mediate excess Ca2+ signals to initiate cell aging responses. We revealed that LH causes reactive oxygen species (ROS) accumulation, Ca2+ elevation and senescence in vibrissa follicles (VFs) and cell damage via DNA damage response (DDR), senescence, and senescence-associated secretory phenotype (SASP) activation in dermal papilla cells (DPCs). Hair loss in mice was due to LH-induced hair follicle (HF) damage and aging. The involvement of TRPCs in LH-induced pathogenesis was examined by treatment with TRPC inhibitors. Similarly, the balding area of FPHL showed higher levels of LHR compared to the non-balding area, while the expression of DDR-related genes, SASP-related genes and TRPCs were upregulated in scalp biopsies. Overall, we identified the impacts of LH/LHR signaling on the pathogenesis of FPHL, including TRPC-mediated cell aging responses in HFs.

Validation of the cancer-specific utility measure EORTC QLU-C10D using evidence from four lung cancer trials covering six country value sets

The Quality of Life (QoL) Utility measure, QLU-C10D, is derived of the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire, QLQ-C30. Based on the cancer-specific nature, the QLU-C10D is expected to be sensitive and responsive in lung cancer patients.This retrospective analysis used data from four international lung cancer multi-center trials (NCT00656136, NCT00949650, NCT01085136, NCT01523587). Clinical validity was assessed in comparison to a generic standard utility instrument, the EuroQoL Group´s EQ-5D-3L. Utilities of six country value sets (Australia, Canada, Italy, the Netherlands, Poland, UK) were calculated at baseline and end of treatment for both measures. Country value set pairs of both measures (k) were compared in terms of Relative Efficiency (RE) and difference in Effect Sizes (dES) in 1) sensitivity to detect differences between performance status groups and 2) responsiveness to changes at each trial sample. Analysis of the four trials (N1 = 496, N2 = 290, N3 = 202, N4 = 770) with the six country value sets of each utility measure showed ad 1) Sensitivity indices favored the QLU-C10D (k = 18, p ≤ 0.019; RE > 1.10; dES > 0.03), and ad 2) Responsiveness indices of changes within clinically known groups (k = 78), largely favored QLU-C10D (k = 74, p ≤ .024; RE > 1.01; dES > 0.02), in comparison with the generic utility instrument. In summary, 96% of the comparative indices favored the QLU-C10D. In summary, this study confirms the clinical validity of the QLU-C10D in lung cancer patients. The QLU-C10D produced homogenous results across six country value sets and detected differences/changes in alignment with clinical expectations. In most comparisons the QLU-C10D was more sensitive or responsive compared to the EQ-5D-3L.

Temporal trends in cross-country inequalities of early-onset pancreatic cancer: a comprehensive analysis for the global burden of disease study 2021

By 2040, pancreatic cancer is expected to become the second leading cause of cancer-related deaths in the U.S., with early-onset pancreatic cancer (EOPC) cases rising among adolescents and young adults. This study uses the global burden of disease (GBD) 2021 dataset to examine global, regional, and national EOPC trends and predicts the burden through 2050. The analysis covers EOPC burden from 1990 to 2021, focusing on age-standardized prevalence rate (ASPR), incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years rate (ASDR). Annual percentage change (APC) and average annual percentage change (AAPC) were calculated via joinpoint regression. Clustering and frontier analysis based on the sociodemographic index (SDI) assessed the link between development levels and health outcomes. We used WHO-recommended health equity methods to quantify EOPC burden disparities and applied a Bayesian age-period-cohort (BAPC) model to project trends. In 2021, EOPC cases rose to 42,254, a 73% increase from 1990, while deaths reached 26,996, up 57%. Although ASIR, ASMR, and ASDR declined, ASPR rose (EAPC = 0.1). Central and Eastern Europe had the highest EOPC burden, with the fastest growth in Australasia (EAPC = 2.78) and Western Sub-Saharan Africa (EAPC = 2.25). Males had about double the burden of females, though female prevalence increased. The widening gap in health burden between low- and high-SDI regions is especially concerning. While EOPC currently affects high-SDI countries the most, there is a clear trend over time showing a gradual shift of EOPC burden towards low-SDI countries. By 2050, ASIR, ASPR, ASMR, and ASDR are projected to stabilize, with cases increasing until 2036, then decreasing. High-SDI countries bear a disproportionately high EOPC burden, with significant diagnostic and management challenges, particularly in Central and Eastern Europe. Rising global EOPC prevalence highlights the need to identify burden differences and risk factors across countries to develop targeted prevention and control strategies.

Validation of the Cancer-Specific Preference-Based Measure EORTC QLU-C10D against the Generic Instruments EQ-5D-5L and SF-6Dv2 in a Prospectively Collected Sample of Patients with Cancer in Austria and France

BACKGROUND

The Quality of Life Utility - Core 10 Dimensions (QLU-C10D) is a disease-specific preference-based measure (PBM) designed to obtain health state utility values from patients with cancer. Previously, satisfactory psychometric properties were established from retrospective trial analyses using clinical anchors. This study aimed to validate the QLU-C10D against two generic PBMs in a prospective sample of Austrian and French patients with cancer using patient-reported anchors.

METHODS

Patients completed the European Organisation of Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire - Core 30 (QLQ-C30), EQ-5D-5L and Short Form 36 (SF-36) at study baseline (any time during anti-cancer treatment) plus a follow-up assessment 3-6 months later. Sociodemographic and clinical characteristics were assessed. QLU-C10D and SF-6Dv2 utilities were calculated from QLQ-C30 and SF-36 data, respectively. German, French and UK value sets were applied for all three PBMs. Floor and ceiling effects were assessed. Known-group validity (independent t-test) and responsiveness (paired t-tests) were assessed respectively by ability to detect health status differences and changes over time according to patient-rated overall quality of life/health perception assessed by the QLQ-C30 Global Health Status scale, the EQ-5D-5L VAS and the SF-36 General Health scale.

RESULTS

A total of 465 patients were included in the analysis. QLU-C10D index scores (intra-class correlation) and domains (Pearson) were correlated with EQ-5D-5L and Short-Form Six Dimensions (SF-6Dv2) conceptual counterparts. Correlation coefficients for the index scores of QLU-C10D and the generic PBMs ranged from 0.63 to 0.81. The QLU-C10D detected statistically significant differences between groups at baseline in 100% of tests performed (n = 27). For changes over time, QLU-C10D detected expected effects in 68% of cases (n = 29). In comparison with the generic PBMs, QLU-C10D detected differences and changes with a higher statistical efficiency in 76% of cases (77 of 102).

CONCLUSIONS

The QLU-C10D is a fit-for-purpose ready-to-use PBM to estimate health state utilities of patients with cancer. This study adds to evidence that QLU-C10D has appropriate psychometric properties and appears to have higher statistical efficiency than generic PBMs in cancer.

Clinical efficacy of peroral endoscopic myotomy treatment performed in patients diagnosed with achalasia

OBJECTIVE

Achalasia is a movement disorder of the esophagus that continues with chest pain, dysphagia, weight loss, regurgitation of undigested foods, recurrent aspiration and night cough.

METHODS

Weight loss, presence of dysphagia, presence of retrosternal pain and regurgitation were recorded before POEM treatment and preoperative Eckardt Score was calculated and recorded. Patients were recorded at the 6th month after POEM treatment recording weight loss, dysphagia presence, retrosternal pain and regurgitation presence and calculating postoperative Eckardt score.

RESULTS

The change between the postoperative and preoperative values of the patients was calculated as ∆ value. As a result of the examination, no significant difference was found between the values ∆weight loss, ∆dysphagia, ∆retrosternal pain, ∆regurgitation and ∆Eckardt score and gender variable (respectively, p=0.112; p=0.412; p=0.619; p=0.171; p=0.092). Postoperative weight loss, dysphagia, retrosternal pain, regurgitation and Eckardt score values were found to be lower than preoperative values. (respectively, p<0.001;p<0.001; p<0.001; p<0.001; p<0.001).

CONCLUSION

Peroral endoscopic myotomy treatment is an effective treatment method with its being more reliable, lower complication risk, being less invasive and with postprocedural and clinical results.

Does Patient Sex Influence the Symptom Pattern for Patients With Gastro-Oesophageal Reflux Disease and the Response of Symptoms to Fundoplication?

BACKGROUND

Several studies show that female patients experience lower satisfaction after anti-reflux surgery. We hypothesised that there is a pattern of symptoms common to female patients presenting with GORD and that it is these symptoms in particular that lead to inferior outcomes. We also hypothesised that these symptoms would respond differently to the different types of fundoplication.

METHODS

Pre-operative and post-operative questionnaires for all patients undergoing laparoscopic fundoplication were analysed. Pre-operative symptoms, improvement of symptoms, patient demographics and type of fundoplication were assessed.

RESULTS

The study evaluated 328 patients, 156 females and 172 males. Eighty-seven females (55.8%) and 135 males (78.5%) underwent a Nissen Fundoplication (p < 0.001) with the rest undergoing a posterior 270° (partial) fundoplication. Females reported most symptoms more frequently than males, and a predominantly female pattern of symptoms was identified. Bloating (p ≤ 0.001), asthma (p = 0.045), constipation (p = 0.010) and diarrhoea (p = 0.023) were significantly more associated with being female. At 18 months post-surgery, outcomes for patients presenting with 'female-pattern' symptoms were not improved by undertaking partial fundoplication when compared to Nissen fundoplication. The only symptom that was affected by the type of fundoplication was dysphagia, with a significant number of patients experiencing worsening of dysphagia after a Nissen fundoplication (p < 0.01).

CONCLUSION

There are certain symptoms that affect female patients who present with GORD more commonly than male patients, and this may contribute to lower satisfaction outcomes. Partial fundoplication does not appear to offer a significant advantage in improving these symptoms.

Optimal adaptive cancer therapy based on evolutionary game theory

Cancer development is a dynamic and continuously evolving process, with the emergence of drug-resistant cancer cells being one of the primary reasons for the failure of traditional treatments. Adaptive therapy, as an emerging cancer treatment strategy, is increasingly being applied in oncology. In this study, we incorporate pharmacokinetics into a cancer evolutionary game theory model and propose an optimal control problem constrained by maximum drug concentration and maximum tumor burden. Firstly, we demonstrate the existence of an optimal control for this problem. Secondly, using Pontryagin's minimum principle, we formulated the structure of the optimal control to design an optimal adaptive therapy strategy. Finally, through numerical simulations, we compare the optimal adaptive therapy strategy with other adaptive therapies and traditional treatments, and further develop personalized treatment plans for different patient groups. The results demonstrate that the optimized adaptive treatment strategy effectively preserves a high survival rate of healthy cells during treatment. By maintaining drug-sensitive and drug-resistant cell populations in a state of low-level competition, this approach prevents the proliferation of drug-resistant cells, reduces the tumor burden on patients, and extends overall survival.

Challenges in studying neuroanatomy in sub-Saharan Africa: The case of Cameroon

Introduction

Quality education is key in addressing the skilled neurological workforce gap in Africa. However, many medics are scared of the neurological sciences because of the challenges faced in medical schools in studying the neurosciences. Understanding its state and educational challenges is crucial for fostering interest in neurosurgery and related specialities on the continent.

Research question

What are the current state, challenges, and solutions to improve neuroanatomy education in Cameroon, Africa in miniature?

Materials and methods

A cross-sectional study using an 11-item electronic survey was conducted among medical students from all nine medical schools in Cameroon. Data were analysed using descriptive statistics and independent t-tests, with significance set at p < 0.05.

Results

Among 220 respondents, 40.1 % and 35.0 % respectively, reported cranial nerves/brainstem and neurovascular anatomy to be the most challenging, with a mean comprehension score of 5.83/10. Faculty predominantly relied on PowerPoint lectures (83.2 %), while most students supplemented learning with YouTube videos (77.7 %). 63.9 % of the respondents perceived classroom teaching alone to limit their understanding of neuroanatomy, and 85.8 % of students reported the time allocated for neuroanatomy teaching to be inadequate. The usage of cadaver dissection (69.5 %), and neurosimulation practicals (66.4 %) were the most recommended tools by students to improve neuroanatomy teaching.

Discussion and conclusion

Challenges in neuroanatomy education in Cameroon are perceived to arise from insufficient hands-on learning, time constraints, and limited access to specialised faculty. These suggest interactive teaching, increased curriculum time, and diverse resources as potential improvements, though further research is needed to assess their effectiveness and ultimately improve understanding, fostering a stronger neurological workforce.

Ten-year review of oesophagectomy in a regional New Zealand hospital: making the case for a low-volume centre

BACKGROUND

Oesophageal cancer is a highly aggressive malignancy with poor survival rates. The treatment approach is multimodal, employing endoscopy and chemoradiotherapy; however, surgical resection remains a mainstay of management. Centres with high volumes of resections are associated with improved outcomes, but an optimal number for annual caseload is not defined. International benchmarks for morbidity and mortality have been established by the Oesophageal Complications Consensus Group (ECCG) using data from high-volume centres. This study compared data from a New Zealand low-volume centre against these.

METHODS

This retrospective study included all patients undergoing oesophagectomy at Tauranga Hospital between 2014 and 2023, with primary analysis comparing mortality and complications to the ECCG benchmarks. Secondary analysis stratified data by age, ethnicity, comorbidity, and preoperative treatment.

RESULTS

Sixty-one patients underwent oesophagectomy, with a 30-day mortality of 0% and a 90-day mortality of 1.6%, both below the ECCG benchmarks. However, complication rates were higher, with anastomotic leak (16.4%) and Clavien-Dindo ≥3B complications (26.2%) exceeding the benchmark rates. There were no significant differences in outcomes stratified by demographic or clinical subgroups.

CONCLUSION

This study finds better mortality outcomes and poorer morbidity outcomes than the benchmark. These results suggest that low-volume centres which concurrently perform similar complex oncological resections and have access to dedicated Intensive Care, interventional radiology, and endoscopy may have comparable results to high-volume centres. If similar centres achieve good outcomes, consideration must be given to keeping regional oesophagectomy services to reduce inequities and improve access to healthcare.

Exploring take-home opioid stewardship (ETHOS) in UK postoperative patients

Background

Surgery is one of the most common indications for a patient's first opioid prescription, with some patients progressing to unintended long-term use. There is no current data from the United Kingdom on how much patients use of the opioid medication dispensed at discharge from hospital. This study investigates discharge opioid prescribing and usage following common surgical procedures.

Methods

This cohort study was conducted at the Oxford University Hospitals NHS Foundation Trust and involved 20 of the most commonly performed adult surgical procedures. At least 20 patients per procedure were surveyed using a standardised telephone questionnaire 6-8 days after discharge to establish the amount of used and unused opioids. Opioid doses were converted to oral morphine equivalent (OME) for analysis.

Results

The amount of opioid given to patients after all types of surgery far exceeded requirement, with often large variations in prescribing practices for the same procedures, most notably in trauma and orthopaedics.For the cohort of 426 patients, a total of 55 080 mg OME was dispensed on discharge, with only 34.4% actually used by patients, leaving a total of 36 108.5 mg OME unused in the community, risking inappropriate opioid use, overdose, or diversion.

Conclusions

Opioid overprescribing is common after surgery and represents waste, expense, and risk to patients. There is a clear need to develop a procedure-specific evidence-base for discharge opioid prescribing, adopting an "enough but not too much" approach to ensure that patients have adequate analgesia to facilitate functional surgical recovery, but not more than is needed.

Effectiveness of anterior gastropexy with mesh reinforcement in reducing the recurrence of giant hiatal hernia

BACKGROUND

The number of patients with giant hiatal hernias requiring surgery is increasing. However, there have been some concerns regarding the possible high recurrence rates. Additional gastropexy has been suggested to reduce recurrence rates. This study aimed to examine whether additional gastropexy is effective in patients with giant hiatal hernias.

METHODS

We enrolled 77 patients with giant hiatal hernias who underwent laparoscopic hiatal hernia repair between June 2011 and December 2022. The patients were divided into two groups according to the presence or absence of gastropexy, the surgical outcomes and recurrence of hiatal hernia between the groups were compared.

RESULTS

The gastropexy group included 52 patients (68%). Although the operating time was longer in the gastropexy than in the non- gastropexy group (P < 0.01), there were no differences in the pre- and post- operative complications between the two groups. Surgery with gastropexy significantly improved symptoms, such as heartburn, reflux, chest pain, and vomiting, as well as the pathology of hiatal hernia, cardiac loosening, and esophagitis. The rates of recurrence of hiatal hernia and esophagitis were significantly lower in the gastropexy than in the non- gastropexy group (P < 0.01 and P = 0.04, respectively).

CONCLUSIONS

Laparoscopic anterior gastropexy is safe and effective for preventing the recurrence of giant hiatal hernias.

Outcomes of Focal Therapy for Localized Prostate Cancer: A Systematic Review and Meta-analysis of Prospective Studies

BACKGROUND AND OBJECTIVE

Focal therapies (FTs) for localized prostate cancer (PCa) are recommended only within prospective registries or clinical trials. In this systematic review and meta-analysis, we aimed to synthesize data from prospective trials evaluating the efficacy and safety of FTs in patients with clinically localized PCa.

METHODS

Systematic searches of the PubMed, Scopus, and Web of Science databases identified prospective studies reporting oncological outcomes of FTs in treatment-naïve, clinically localized PCa patients. The primary endpoint was biopsy-proven clinically significant PCa (csPCa; International Society of Urological Pathology grade group ≥2) recurrence-free survival (csPCa RFS). The secondary endpoints included RFS, radical/systemic treatment-free survival, and adverse event (AE) rates.

KEY FINDINGS AND LIMITATIONS

Fifty studies including 4615 patients treated with FTs were analyzed; of these 50 studies, 19 were on predominantly intermediate-risk (n = 2800), 16 on mixed low-/intermediate-risk (n = 990), and 15 on low-risk (n = 825) patients. Estimates of 12- and 24-mo csPCa RFS rates were 86% (95% confidence interval [CI] 82-89%) and 81% (95% CI: 74-86%), respectively. In the intermediate-risk subgroup, the 12-mo csPCa RFS rate was 79% (95% CI: 74-83%). Five-year radical and systemic treatment-free survival was 82% (95% CI: 75-88%). The pooled incidence of grade ≥3 AEs was 3% (95% CI: 2-5%). Pad-requiring urinary incontinence increased by 3% (95% CI: 0-6%), with 11% of patients developing new erectile dysfunction (95% CI: 4-18%). The median follow-up of 21 mo (interquartile range 12-34) and the use of surrogate endpoints constitute the major limitations.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The primarily short-term data from prospective studies of FT in clinically localized PCa demonstrate moderate to high cancer control with a favorable safety profile.

Utilizing Artificial Intelligence for Predicting Postoperative Complications in Breast Reduction Surgery: A Comprehensive Retrospective Analysis of Predictive Features and Outcomes

BACKGROUND

Breast reduction is a common procedure with growing rates in the United States of America, aimed at alleviating the physical and psychological burdens of macromastia. Despite high success rates, it carries a risk of complications, with incidence rates ranging from 6.2% to 43%.

OBJECTIVES

The authors developed a machine learning model using gradient-boosting decision trees to predict severe breast reduction complications up to 30 days following surgery requiring inpatient care.

METHODS

This retrospective study included 322 cases of breast reduction surgery performed at the Tel Aviv Medical Center from 2017 to 2024. Model performance was evaluated using 5-fold cross-validation, and key metrics such as area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were reported. An interpretability tool was also created to visualize complication risks based on clinical features.

RESULTS

Severe complications occurred in 7.4% of cases. Key predictive factors included specimen weight, SN-N distance, and liposuction volume. The model achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.83, with an accuracy of 0.93 and a negative predictive value (NPV) of 0.95. The interpretability tool clearly visualized complication risks, aiding preoperative counseling.

CONCLUSIONS

This is the first study to use artificial intelligence (AI) to predict severe complications in breast reduction surgery. In this study, the AI model, with an AUC-ROC of 0.83 and NPV of 0.95, offers a reliable tool for surgical planning and patient education. Further validation across diverse populations is recommended to confirm its clinical utility.

LEVEL OF EVIDENCE: 4 (RISK)

Molecular and Functional Recovery of Esophageal Barrier Integrity After Laparoscopic Anti-reflux Surgery

BACKGROUND

Patients undergoing laparoscopic anti-reflux surgery (LARS) often experience improved quality of life and reduced gastroesophageal reflux disease (GERD) symptoms. This study aimed to assess the impact of LARS on epithelial remodeling and repair in the esophageal mucosa.

METHODS

Upper gastrointestinal (GI) endoscopy was performed once on healthy controls (HC) and twice on GERD patients before and approximately 6 month after surgery, with esophageal biopsies collected. The expressions of E-cadherin (ECAD), Occludin (OCLN), Claudin 1 (CLDN1), Claudin 4 (CLDN4), Zonula Occludens -1 (ZO-1), and ZO-2 were analyzed in the biopsies, and dilated intercellular spaces (DIS) were examined under light microscopy.

RESULTS

The study included 22 GERD patients who were underwent for LARS, and 20 HCs. All patients had pathological reflux episodes. In the Post-LARS group, TEER increased significantly compared to Pre-LARS and HC (p < 0.05), while mucosal permeability decreased (p < 0.05). A significant negative correlation was found between TEER and permeability (p = 0.0002). DIS remained dilated in both Pre- and Post-LARS patients compared to HC (p < 0.05). Gene expression analysis revealed significant increases in ZO-1, OCLN, and ZO-2 Post-LARS (p < 0.05).

CONCLUSION

LARS improves mucosal integrity by enhancing TEER and reducing permeability in GERD patients, although DIS remains unchanged. The upregulation of tight junction genes such as ZO-1 and OCLN Post-LARS suggests that surgical intervention may support epithelial barrier restoration. DIS remains dilated after LARS; this might be reason that it is not an early marker in GERD pathogenesis. These findings enhance our understanding of GERD nature and may inform future target therapeutic strategies.

Optimizing timing for elective surgery in cancer patients following COVID-19 infection; a post-pandemic analysis

INTRODUCTION

The COVID-19 pandemic introduced challenges including delaying elective surgery. For cancer patients, reducing delays is preferred to prevent unfavorable outcomes. there is a lack of consensus regarding the optimal timing of elective surgery following a SARS-CoV-2. This study aimed to find the optimal time to elective surgery to minimize 30-day postoperative morbidity and mortality.

METHODS

This is a retrospective chart review of all adult patients who underwent elective surgery with a confirmed preoperative COVID-19 diagnosis between September 2020 and April 2023. Patients' elective surgeries delays were examined to determine the optimal time to surgery in terms of postoperative complications. Analysis was controlled for age, ASA score, comorbidities, and smoking status.

RESULTS

358 records examined, 94.7% had delayed surgery and 5.3% had cancelled surgery. The optimal time to surgery was ≥ 17 days to minimize postoperative pulmonary complications [OR: 0.299, p = 0.048], other postoperative complications [OR: 0.459, p = 0.01], and a decrease in length of hospital stay. In multivariate analysis, the only significant predictors for postoperative complications were time to surgery; surgery ≥ 17 days after diagnosis had better postoperative outcomes [p < 0.001], and COVID-19 symptoms status [p = 0.019].

CONCLUSION

The best time to surgery in this cohort is at least 17 days (or a range of 2-3 weeks) for optimal results. Further research is needed to investigate the effect of such delays on oncological outcomes in this cohort.

Small Balloon Dilation Versus Bougie Dilation Versus Large Balloon Dilation for the Treatment of Benign Esophageal Strictures in Adult Patients

RATIONALE AND OBJECTIVES

The optimal treatment for benign esophageal strictures (BES) is still unknown, small balloon dilation (6-24mm in diameter) and bougie dilator dilation (5-17mm in diameter) are usually used clinically, while large balloon dilation (25-30mm in diameter) is rarely used due to the potential risk of esophageal rupture and massive bleeding. According to the different choices of treatment, we grouped the patients into three groups and compared their safety and effectiveness to explore the optimal treatment of BES.

MATERIALS AND METHODS

Between July 2016 and March 2024, 104 consecutive patients with BES who underwent dilation of small balloon (Group S, n=30), bougie dilator (Group B, n=38) or large balloon (Group L, n=36) were retrospectively evaluated. Data were collected to analyze the technical success, safety and clinical outcome of the dilations as evaluated by dysphagia score, complications and recurrence.

RESULTS

Technically success rates of Group S, Group B and Group L were 97.0%, 96.7% and 89.9%, respectively (P=0.0507). Recurrence of stricture and esophageal rupture were the reasons for technical failures in balloon and bougie dilation. Esophageal ruptures occurred in 11 dilations as follows: 4 (3.0%) in the Group S, 2 (1.7%) in the Group B and 5 (7.2%) in the Group L (P=0.1184). Among them, two patients with type III rupture had temporary removable esophageal stent placed, and rupture healed after stents removal. Two patients with type II rupture had the rupture clamped with titanium clips. A total of 55/104 patients (52.9%) were cured with no dysphagia after the end of follow-up as follows: 12 (40.0%) in the Group S, 18 (47.4%) in the Group B and 25 (69.4%) in the Group L (P=0.0385). Less No. of dilation sessions and shorter duration of treatment were required in the Group L than in the Group S or the Group B (P<0.05). Total hospitalization cost was higher in the Group S than in the Group B or the Group L (P<0.05).

CONCLUSION

Both balloon dilation and bougie dilation are safe and effective for patients with benign esophageal strictures. Large balloon dilation seems to be preferable to small balloon dilation and bougie dilation regardless of the condition of adult BES, as they are associated with higher clinical effectiveness, less required dilation, and reduced duration of treatment.

Nanopore-based consensus sequencing enables accurate multimodal tumor cell-free DNA profiling

Shallow genome-wide cell-free DNA sequencing holds great promise for noninvasive cancer monitoring by providing reliable copy number alteration (CNA) and fragmentomic profiles. Single-nucleotide variations (SNVs) are, however, much harder to identify with low sequencing depth due to sequencing errors. Here, we present Nanopore Rolling Circle Amplification (RCA)-enhanced Consensus Sequencing (NanoRCS), which leverages RCA and consensus calling based on genome-wide long-read nanopore sequencing to enable simultaneous multimodal tumor fraction (TF) estimation through SNVs, CNAs, and fragmentomics. The efficacy of NanoRCS is tested on 18 cancer patient samples and seven healthy controls, demonstrating its ability to reliably detect TFs as low as 0.24%. In vitro experiments confirm that SNV measurements are essential for detecting TFs below 3%. NanoRCS provides an opportunity for cost-effective and rapid sample processing, which aligns well with clinical needs, particularly in settings where quick and accurate cancer monitoring is essential for personalized treatment strategies.

Innovative laparoscopic 'Tunnel' approach in managing hiatal hernia with gastroesophageal reflux disease: a retrospective study

BACKGROUND

Hiatal hernia (HH) is a major cause of gastroesophageal reflux disease (GERD), and laparoscopic repair combined with anti-reflux surgery is a common treatment. However, postoperative complications such as vagus nerve injury remain a concern. This study introduces a novel Laparoscopic "Tunnel" Approach aiming to minimize damage to the vagus nerve and preserve perigastric vessels.

METHODS

Clinical data were consecutively collected from patients who underwent laparoscopic "tunnel" approach for the treatment of hiatal hernia combined with gastroesophageal reflux disease at the First Affiliated Hospital of Ningbo University between June 2023 and June 2024. Data collected included age, gender, BMI, DeMeester score, surgical time, and postoperative symptoms. Follow-ups were conducted at 1, 3, and 6 months postoperatively.

RESULTS

The average age was 54 ± 9 years, BMI was 25.56 ± 4.32 kg/m2, DeMeester score was 118.05 ± 17.71, and GERD-Q score was 13 ± 2. The average surgical time was 115 ± 15 min. Postoperatively, symptoms significantly improved, with an average GERD-Q score of 5 ± 1 at 6 months. At 1 month, dysphagia was observed in 14 patients, belching in 19, abdominal distension in 5, nausea in 16, and diarrhea in 8. By 6 months, only 2 patients exhibited belching, with no other symptoms persisting. No cases of vomiting or gallstones were reported.

CONCLUSIONS

The Laparoscopic "Tunnel" Approach may effectively minimizes vagus nerve injury and preserves perigastric vessels, resulting in improved postoperative outcomes and quality of life. This method shows potential for wider application in treating HH and GERD. However, since this study was retrospective and lacked a control group, further studies are needed to verify our conclusions.

Postoperative obstruction of recurrent esophageal hiatal hernia: A case report

RATIONALE

Surgical repair is considered the optimal treatment for hiatal hernia (HH); however, postoperative complications, such as obstruction, can occur, which may complicate recovery. This case report details a patient who experienced postoperative obstruction following laparoscopic adhesiolysis combined with transabdominal HH repair and Nissen fundoplication for recurrent esophageal HH.

PATIENT CONCERNS

A 64-year-old female presented with a 3-year history of worsening shortness of breath during physical activity. She also reported upper abdominal pain, postprandial vomiting, and difficulty swallowing, all of which significantly compromised her quality of life. The patient had a 5-year history of diabetes, with no notable family or genetic history. Three years prior, she underwent laparoscopic HH repair at a local hospital, but specific details of that surgery were not available.

DIAGNOSES

HH was confirmed through computed tomography scans of the chest and upper abdomen, as well as serial examinations of the upper digestive tract.

INTERVENTION

On March 9, 2023, the patient underwent laparoscopic abdominal adhesion release, transabdominal HH repair, and Nissen fundoplication. Postoperatively, she received parenteral nutrition, acid inhibition, and symptomatic treatment for deswelling to alleviate abdominal pain and vomiting. However, the patient was unable to tolerate oral intake due to obstruction.

OUTCOMES

A contrast study revealed high obstruction at the distal esophagus, specifically at the junction of the stomach and esophagus, likely at the cardia. Subsequently, on April 6, 2023, the patient underwent a second laparoscopic exploration and adhesiolysis under general anesthesia. Postoperatively, the patient recovered well and was discharged on April 14, 2023. During the 12-month follow-up on April 30, 2024, she reported returning to normal daily activities with no complaints of discomfort.

LESSONS

This case highlights that laparoscopic adhesiolysis combined with transabdominal HH repair and Nissen fundoplication can effectively address recurrent esophageal HH along with postoperative obstruction. The findings provide important insights for the individualization of surgical procedures for patients with HH.

Exogenous acetate mitigates later enhanced allergic airway inflammation in a menopausal mouse model

Introduction

Asthma, an inflammatory lung disease, disproportionately affects women in adulthood and is associated with a decline in estrogen levels during the menstrual cycle and menopause. To study asthma symptoms during menopause, we used a mouse model of postmenopausal asthma via ovariectomy (OVx). Similar to human menopause, we previously discovered that re-exposure of allergic OVx mice to allergen exacerbates lung inflammation. Surprisingly, we found that probiotic treatment alleviates this inflammatory exacerbation and produces acetate as one of its metabolites. Here, we investigate whether exogenous acetate alone can inhibit the exacerbation of experimental asthma in menopause.

Methods

Mice received acetate administration before and during sensitization. After challenge and OVx the mice were subjected to a second challenge to test whether acetate protected against airway inflammation after menopause induction.

Results

Acetate administration reduced all lung T2 inflammatory responses, as well as the serum immunoglobulin (IgE) level. Early acetate treatment led to an increase in regulatory T cells, even 3 weeks after cessation of the treatment, suggesting that the increase in Treg percentage is associated with the reduction of type 2 inflammation in the airways after menopause induction, indicating its potential role in this process. Given the significant role of the lung-gut axis in asthma and the association of asthma and menopause with intestinal dysfunctions, this finding is particularly relevant; we also analyzed several markers of intestinal integrity. Compared with sham-operated mice, rechallenged allergic menopausal mice had a reduction in the intestinal epithelial genes, MUC2 and OCLN, and preventive supplementation with acetate returned their expression to normal. No change was found in menopausal mice without allergic inflammation.

Conclusion

In conclusion, treatment with acetate prior to estrogen level decline protects sensitized and challenged mice against later airway T2 inflammation and may restore gut homeostasis.

Bacterial Volatile Organic Compounds as Potential Caries and Periodontitis Disease Biomarkers

Oral diseases represent a significant global health and economic burden, necessitating the development of effective diagnostic tools. This study investigates the volatile organic compound (VOC) profiles of bacteria associated with dental caries and periodontal disease to explore their potential as diagnostic biomarkers. Four microbial strains-Streptococcus mutans (700610), Streptococcus sanguis (NCO 2863), Porphyromonas gingivalis (ATCC 33277), and Fusobacterium nucleatum (PK1594)-were cultured (N = 24), alongside intraoral samples (N = 60), from individuals with common oral diseases. Headspace VOCs were analyzed using gas chromatography-mass spectrometry (GC-MS), and statistical analyses were conducted by applying non-parametric Wilcoxon and Kruskal-Wallis tests. VOC identification was performed using the NIST14 database. Strain-specific VOC signatures were identified, with P. gingivalis and F. nucleatum exhibiting distinct profiles from each other and from Streptococcus strains. Comparative analysis of disease cohorts revealed statistically significant differences at multiple retention times between caries, gingivitis, and periodontitis. These findings suggest that VOC profiling enables differentiation between bacterial strains and disease phenotypes, supporting their potential application as diagnostic biomarkers for oral diseases. This study establishes a foundational framework for VOC-based diagnostic methodologies in dental pathology.

Effect of Prehabilitation Interventions in People Affected by Bladder Cancer on Long-Term Physical, Clinical, and Patient-Reported Outcome Measures: A Systematic Review

PURPOSE

To understand the effect of prehabilitation interventions on ≥30 days post-treatment outcomes including physical functioning, clinical, and patient-reported outcomes in people affected by bladder cancer.

METHODS

This systematic review included all randomized, quasi-randomized, or single-arm studies in patients affected by bladder cancer (irrespective of stage or treatment modality) that compared prehabilitation intervention(s) with standard care. A range of key terms related to bladder cancer and prehabilitation were developed to search the four electronic databases. Articles were assessed according to predetermined inclusion and exclusion criteria. A methodological quality assessment was performed.

RESULTS

Of the 932 studies identified, 14 studies were included and represented 1,034 participants. The interventions included multimodality prehabilitation (n = 5), exercise-only programs (n = 3), nutrition-focused interventions (n = 2), educational support (n = 3), and smoking/alcohol cessation counseling (n = 1). All of the studies were conducted in patients treated by surgery, therefore clinical and research gaps exist in the prehabilitation interventions among patients treated by intravesical therapy (ie, BCG) or radiotherapy. The key findings highlighted that multimodal program mainly showed improvements in physical function outcomes. Exercise-only interventions demonstrated some benefits in physical function. Nutrition-only interventions did not show any statistically significant improvements. Education programs showed improvements in patient-reported outcomes. Smoking and alcohol cessation counseling achieved notable abstinence rates, which were associated with fewer postoperative complications.

CONCLUSION

This review suggests that prehabilitation interventions may benefit patients with bladder cancer, particularly exercise and education programs, which showed improvements in physical function and patient-reported outcomes. However, the evidence remains inconclusive, with no clear impact on clinical outcomes such as complications or hospital stay. More robust studies are needed to determine the most effective prehabilitation strategies for patients with bladder cancer.