Role of periodontal treatment in pregnancy gingivitis and adverse outcomes: a systematic review and meta-analysis

BACKGROUND

Pregnancy gingivitis is a common oral health issue that affects both maternal and fetal health. This study aims to evaluate the effectiveness of periodontal treatment in preventing pregnancy gingivitis, preterm birth, and low birth weight through a systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive literature search was performed across CINAHL, Scopus, Cochrane, and PubMed/Medline databases from 2000 to the present. Study selection and data extraction were independently carried out by two reviewers. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using RevMan 5.4 and R software.

RESULTS

A total of 13 studies were included. The meta-analysis indicated that periodontal treatment might have a potential effect on preventing pregnancy gingivitis, but this was not statistically significant (OR = 0.85, 95% CI [0.68, 1.06], I2 = 51%). Subgroup analysis revealed that periodontal treatment significantly reduced the rates of preterm birth and low birth weight in lower-quality studies, but no significant effects were observed in higher-quality studies. Sensitivity analysis and publication bias tests confirmed the stability and reliability of the results.

CONCLUSION

While lower-quality studies suggest that periodontal treatment may positively impact pregnancy gingivitis, preterm birth, and low birth weight, these effects were not supported by higher-quality evidence. Further well-designed RCTs are needed to confirm these findings and ensure their reliability. Periodontal treatment could potentially be considered as part of prenatal care to improve maternal oral health and pregnancy outcomes.

Associations between preoperative thyroid parameters, aggressive clinicopathological features and risk of recurrence in differentiated thyroid cancer

OBJECTIVE

The study aimed (1) to investigate the association between aggressive clinicopathological characteristics and the American Thyroid Association (ATA) recurrence risk classification in differentiated thyroid cancer (DTC) patients, and (2) to investigate the prognostic value of preoperative thyroid parameters.

METHODS

A total of 3833 patients histologically confirmed DTC were recruited. Preoperative clinical and postoperative pathologic data were retrospectively collected. Participants were stratified into low recurrence risk and intermediate-to-high recurrence risk groups based on the ATA risk stratification system.

RESULTS

The study cohort had a mean age of 48.87 ± 8.08 years, and 1,465 (76.82%) were female. Male (OR = 1.37, p = .024), aged 52 years and older (OR = 2.01, p < .001), larger tumor size (OR = 3.71, p = 0.011), nerve invasion (OR = 6.69, p = .004), margin involvement (OR = 5.46, p < .001), multifocality (OR = 3.71, p < .001), and bilaterality (OR = 3.95, p < .001) were identified as risk factors for a higher ATA recurrence risk classification, in addition to established factors such as lymph node metastasis and angioinvasion, after adjusting for potential confounding variables. Higher preoperative levels of free triiodothyronine (FT3), FT3 to free thyroxine (FT3/FT4), and lower thyroid feedback quantile-based index (TFQI) levels were associated with a higher ATA recurrence risk classification. The comprehensive predictive model incorporating these variables demonstrated excellent discrimination (AUC = 0.836). Furthermore, higher FT3/FT4 levels and lower TFQI levels were associated with higher risk of lymph node metastases and angioinvasion.

CONCLUSIONS

Factors such as male sex, older age, multifocality, bilaterality, margin involvement, nerve invasion, larger tumor size, and preoperative thyroid parameters serve as complementary predictors for higher ATA recurrence risk in DTC, in addition to conventional risk factors. These insights contribute to a more nuanced understanding and optimization of current risk stratification methodologies.

Effects of transumbilical single-port laparoscopy versus multi-port laparoscopy for adnexal mass during pregnancy: a retrospective cohort study

OBJECTIVES

To compare the effects of transumbilical single-port laparoscopic surgery (TSPLS) and multi-port laparoscopic surgery (MPLS) for adnexal mass during pregnancy.

METHODS

A retrospective analysis was performed on patients with adnexal mass during pregnancy admitted to our hospital between January 2015 and June 2023. The patients were divided into a TPLS group and a MPLS group according to surgical methods. Demographic characteristics, operative outcomes, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Childbirth attitudes questionnaire (CAQ) were compared between the two groups.

RESULTS

A total of 55 patients were included (TSPLS = 25; and MPLS = 30). The demographic characteristics of the patients between the two groups were not significantly different. The operation time in the TSPLS group was shorter than that in the MPLS group, but operative blood loss, length of hospital stay, and postoperative complications were comparable between the two groups. There were no significant difference observed in the preoperative SAS, SDS or CAS scores between the two groups, however, lower postoperative SAS (TSPLS 42.48 ± 4.57 vs. MPLS 45.90 ± 4.89), SDS (TSPLS 38.93 ± 3.70 vs. MPLS 42.12 ± 4.35) or CAS (TSPLS 34.04 ± 4.64 vs. MPLS 37.67 ± 4.79) scores were observed in the TSPLS group (p < 0.05).

CONCLUSIONS

Compared with MPLS, TSPLS has shorter surgical time, reduces pregnancy and delivery pressure for pregnant women with adnexal mass.

Age, creatinine, and ejection fraction score is a risk factor for acute kidney injury after surgical aortic valve replacement

BACKGROUND

The incidence of acute kidney injury (AKI) increases after surgical aortic valve replacement (SAVR). This study aimed to characterize the risk factors of AKI after SAVR.

METHODS AND RESULTS

We conducted a retrospective registry study based on data from 299 consecutive patients undergoing SAVR. At 48 h after SAVR, 41 patients developed AKI. There was a significantly higher prevalence of older age, higher body mass index (BMI), and diabetes mellitus in the AKI group. Previous use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) and β-blocker, intake and output volumes within 24 h, mechanical ventilation time, length of intensive care unit and hospital stay, baseline creatinine, baseline, 24 h, and 48 h estimated glomerular filtration rate were strongly associated with the incidence of AKI. BMI >24, history of hypertension, use of ACEI/ARB and β-blocker, and mechanical ventilation time were associated with AKI. Univariate logistic regression indicated that overweight, hypertension, use of ACEI/ARB and β-blocker, and mechanical ventilation time were associated with AKI. Notably, the ACEF score was an independent predictor of AKI. The receiver operating characteristic curve was employed to assess the ACEF score for predicting AKI and the best cutoff was 1.1. After dividing ACEF into quartiles, each one-unit increment in ACEF led to a 2.27-fold risk in the incidence of AKI among patients.

CONCLUSIONS

AKI is a generalizable phenomenon occurring frequently after SAVR. The ACEF score is an independent predictor of AKI among patients undergoing SAVR.

'At the heart of the community' - a Somali woman's experience of 'alignment' of support to escape social isolation in pregnancy and early motherhood

PURPOSE

Stresses in pregnancy and early motherhood can affect women's health and wellbeing, and babies' development. Migrant women face compounding stressors from the intersection of gender, race, social class, migration, and language. We explored one Somali woman's experience of pregnancy and the transition to motherhood, following migration to an urban environment in the Global North, aiming to understand resilience in this specific socio-cultural context.

METHODS

This case study used interpretative phenomenological analysis of a single two-hour semi-structured interview with a Somali woman in the UK to explore how this experience may have relevance for communities and practitioners in the Global North.

RESULTS

We identified two overarching themes in this woman's experience: "vicious" and "virtuous" circles, attempting to make sense of her experience of isolation and lack of wellbeing, and subsequent confidence, engagement, and community-building.

CONCLUSIONS

An experience of "alignment" in social relationships appeared to make possible the shift from "vicious" to "virtuous" circle, which enabled escape from social isolation. This account of transformation-from social isolation to community contribution-underlines the role of community organizations facilitating positive social networks and peer support during pregnancy and early motherhood.

Characterization of metabolism associated with outcomes in severe acute pancreatitis: Insights from serum metabolomic analysis

Severe Acute Pancreatitis (SAP) is characterized by an abrupt onset of pancreatic inflammation, which may induce damage to other organs, and is associated with significant morbidity and mortality. Despite the considerable disease burden, specific treatments to stop progression or prevent occurrence are limited. Currently, there is a paucity of comprehensive studies that thoroughly explore metabolic dysregulation in SAP, particularly those that emphasize changes in outcomes. Nuclear magnetic resonance (NMR) based metabolomics coupled with multivariate analysis was applied to serum samples of 20 survivors and 30 non-survivors of SAP to identify metabolic changes linked to different outcomes. The discriminant analysis of serum samples of SAP survivors and non-survivors revealed isoleucine, leucine, valine, arginine, lactate, and 3-hydroxybutyrate as significant metabolites elevated in the non-survivors. These identified metabolites had shown a significant positive correlation with clinical severity scores in the Pearson correlation analysis. Pathway analysis revealed disruptions in amino acid metabolism, driven by protein catabolism to fulfill the patient's energy requirements. This study highlights the importance of metabolomics in unraveling the molecular and physiological mechanisms underlying SAP. These findings offer valuable insights for clinicians to develop treatment strategies that target metabolic pathways in SAP, potentially for improving patient outcomes.

Neuropathological links between T2DM and LOAD: systematic review and meta-analysis

Recent decades have described parallel neuropathological mechanisms increasing the risk for developing late-onset Alzheimer's dementia (LOAD) in type 2 diabetes mellitus (T2DM); however, still little is known of the role of diabetic encephalopathy and brain atrophy in LOAD. The aim of this systematic review is to provide a comprehensive view on diabetic encephalopathy/cerebral atrophy, taking into account neuroimaging data, neuropathology, metabolic and endocrine mechanisms, amyloid formation, brain perfusion impairments, neuroimmunology, and inflammasome activation. Key switches were identified, to further meta-analyze genomic candidate loci and epigenetic modifications. For the qualitative meta-analysis of genomic bases extracted, human linkage studies were examined; for epigenetic mechanisms, data from both human and animal studies are described. For the systematic review of pathophysiological mechanisms, 1,259 publications were evaluated and 93 gene loci extracted for candidate risk linkages. Sixty-six publications were evaluated for genomic association and descriptions of epigenomic modifications. Overall accumulated results highlight the insulin signaling system, vascular markers, inflammation and inflammasome pathways, amylin interactions, and glycosylation mechanisms. The protocol was registered with PROSPERO (ID: CRD42023440535).

Deciphering the roles of neddylation modification in hepatocellular carcinoma: Molecular mechanisms and targeted therapeutics

Hepatocellular carcinoma (HCC) is the most prevalent type of malignant liver tumor with high morbidity and mortality and severely threatens human health and life quality. Thus, it is of great significance to investigate the molecular mechanism underlying the pathogenesis of HCC and seek biomarkers for early diagnosis. Neddylation, one of the most conserved post-translational modification types in eukaryotes, plays vital roles in the progression of HCC. During the process of neddylation, NEDD8 is covalently conjugated to its substrate proteins, thereby modulating multiple necessary biological processes. Currently, increasing evidence shows that the aberrant activation of neddylation is positively correlated with the occurrence and development of tumors and the poor clinical prognosis of HCC patients. Based on the current investigations, neddylation modification has been reported to target both the cullins and non-cullin substrates and subsequently affect HCC progression, including the virus infection, malignant transformation, tumor cell proliferation, migration and invasion ability, and tumor microenvironment. Therefore, inhibitors targeting the neddylation cascade have been developed and entered clinical trials, indicating satisfactory anti-HCC treatment effects. This review aims to summarize the latest progress in the molecular mechanism of pathologically aberrant neddylation in HCC, as well as the advances of neddylation-targeted inhibitors as potential drugs for HCC treatment.

Marked Increase in Thyrotropin Receptor Antibodies With the Development of Pretibial Myxedema After Total Thyroidectomy

A recent study revealed that the complex of thyrotropin receptors (TSHRs) and human leukocyte antigen (HLA) class II molecules within the thyroid gland, rather than TSHR alone, induces anti-TSHR autoantibody production by disrupting self-tolerance in Graves disease (GD). However, this complex has not yet been identified outside the thyroid gland. Complete removal of the thyroid gland typically reduces autoantibody titers by eliminating the antigen source. We present the case of a 51-year-old woman with GD and Graves ophthalmopathy who exhibited a marked increase in anti-TSHR autoantibodies concurrent with the development of pretibial myxedema (PTM) despite having undergone a total thyroidectomy. Immunohistological analysis of PTM tissues revealed the coexpression of TSHR and HLA class II molecules, forming a complex similar to that previously identified in the thyroid gland. These findings suggest that TSHR complexed with HLA class II molecules in PTM tissues may contribute to autoantibody production in this patient after total thyroidectomy, although the involvement of potential residual thyroid tissue cannot be entirely excluded. This case suggests that autoantibodies can be induced outside the thyroid gland and provides novel insights into the pathogenesis and progression of GD and related disorders.

Exploring preventive and treatment strategies for oral cancer: Modulation of signaling pathways and microbiota by probiotics

The evidence suggests that the microbiome plays a crucial role in cancer development. The oral cavity has many microorganisms that can influence oral cancer progression. Understanding the mechanisms and signaling pathways of the oral, gum, and teeth microbiome in tumor progression can lead to new treatment strategies. Probiotics, which are friendly microorganisms, have shown potential as anti-cancer agents. These positive characteristics of probiotic strains make them suitable for cancer prevention or treatment. The oral-gut microbiome axis supports health and homeostasis, and imbalances in the oral microbiome can disrupt immune signaling pathways, epithelial barriers, cell cycles, apoptosis, genomic stability, angiogenesis, and metabolic processes. Changes in the oral microbiome in oral cancer may suggest using probiotics-based treatments for their direct or indirect positive roles in cancer development, progression, and metastasis, specifically oral squamous cell carcinoma (OSCC). Here, reported relationships between probiotics, oral microbiota, and oral cancer are summarized.

Disorders of gut-brain interaction are a new challenge of our increasingly complex society, with worldwide repercussions

The term disorders of gut-brain interaction (DGBIs) encompasses gastrointestinal disorders that globally affect more than one third of all people. The Rome IV criteria replaced the former term “functional gastrointestinal disorders.“ DGBIs can seriously challenge health and quality of life (QoL). A traditional but outdated approach differentiated “organic” vs “functional“ disorders, seen by some as real vs psychiatric or undefined ones. This traditional distinction did not help patients whose health and QoL are seriously affected. DGBIs include motility disturbance; visceral hypersensitivity; altered mucosal and immune function; altered central nervous system processing, and more. Several DGBIs affect both children and adolescents. DGBIs are characterized by clusters of symptoms. Their pathophysiology relates to combinations of altered motility, visceral sensitivity, mucosal immune function, and more. Routine investigations find no structural abnormality that would easily explain the symptoms. Symptom-based criteria were developed to better understand patients where no mechanistic explanation was available for clinical practice and inclusion into clinical trials. To understand DGBIs and to find ways to treat them, these rigid mechanistic views fall short.

Infections, genetics, and Alzheimer's disease: Exploring the pathogenic factors for innovative therapies

Alzheimer's disease (AD) is a progressive neurodegenerative condition that creates a significant global health challenge and profoundly affects patients and their families. Recent research has highlighted the critical role of microorganisms, particularly viral infections, in the pathogenesis of AD. The involvement of viral infections in AD pathogenesis is predominantly attributed to their ability to induce neuroinflammation and amyloid beta (Aβ) deposition in the brain. The extant research exploring the relationship between viruses and AD has focused largely on Herpesviridae family. Traces of Herpesviruses, such as Herpes Simplex Virus-1 and Epstein Barr Virus, have been found in the brains of patients with AD. These viruses are thought to contribute to the disease progression by triggering chronic inflammatory responses in the brain. They can remain dormant in the brain, and become reactivated due to stress, a secondary viral infection, or immune-senescence in older adults. This review focuses on the association between Herpesviridae and bacterial infections with AD. We explore the genetic factors that might regulate viral illness and discuss clinical trials investigating antiviral and anti-inflammatory agents as possible therapeutic strategies to mitigate cognitive decline in patients with AD. In summary, understanding the interplay between infections, genetic factors, and AD pathogenesis may pave the way for novel therapeutic approaches, facilitating better management and possibly even prevent this debilitating disease.

Internal Versus External Fixation of the Anterior Ring in Unstable Pelvic Fractures Was Associated With Discharge to Home

OBJECTIVE

To determine whether anterior internal or definitive external fixation combined with posterior internal fixation of unstable pelvic fractures was associated with frequency of discharge to home.

METHODS

DESIGN

Retrospective cohort study.

SETTING

Two Level 1 trauma centers and one academic tertiary referral center.

PATIENT SELECTION CRITERIA

Patients aged 16 years or older with unstable OTA/AO 61B/C pelvis fractures treated with operative fixation of the anterior and posterior pelvic ring by three fellowship-trained orthopaedic trauma surgeons from October 2020 to November 2022.

OUTCOME MEASURES AND COMPARISONS

The primary outcome was the adjusted odds of discharge to home with internal fixation compared with definitive external fixation of the anterior pelvic ring on multivariable analysis considering patient, injury, and treatment characteristics. Secondary outcomes included bivariable associations between anterior fixation type and intensive care unit (ICU) days, ventilator days, hospital length of stay, and hospital charges.

RESULTS

Seventy-nine patients (65%) who were treated with internal fixation presented with higher mean Glasgow Coma Scale scores (13.5 ± 3.6 vs. 10.5 ± 5.4, P < 0.01) than 43 patients treated with definitive external fixation but were otherwise similar regarding age [mean 48.1 ± 19.9 vs. 41.2 ± 15.8, range (16-96) versus (19-77), P = 0.07], sex (36.7% vs. 44.2% female, P = 0.42193), mean body mass index (28.4 ± 6.2 vs. 28.7 ± 7.4 kg/m 2 , P = 0.93), any medical comorbidities (50.6% vs. 44.2%, P = 0.62), substance use (13.9% vs. 27.9%, P = 0.09884), insurance type ( P = 0.97), mean Injury Severity Score (24.8 ± 12.0 vs. 29.5 ± 14.0, range 5-57 vs. 10-57, P = 0.14), pelvis fracture pattern ( P = 0.12187), and preinjury living environment ( P = 0.67695). On multivariable analysis, patients treated with internal fixation were more frequently discharged to home (53.2% vs. 27.9%, odds ratio 3.39, 95% confidence interval 1.29-9.84, P = 0.0198). Patients treated with anterior internal fixation also experienced fewer mean ICU days (6.0 ± 8.8 vs. 9.8 ± 16.3, P = 0.0213), ventilator days (3.5 ± 8.2 vs. 6.9 ± 15.9, P < 0.0081), and hospital days (18.7 ± 16.2 vs. 31.2 ± 26.7, P < 0.01) and incurred less hospital charges ($278,563.29±$261,602.35 vs. $580,625.98±$503,067.98, P < 0.01).

CONCLUSIONS

Patients who received anterior and posterior internal fixation of their unstable pelvis fractures were more likely to discharge to home than patients treated with anterior definitive external fixation and posterior internal fixation. Anterior internal fixation was also associated with fewer ICU, ventilator, and hospital days, as well as less hospital charges.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

18F-FDG PET/CT for Surveillance in Salivary Gland Cancers: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the diagnostic accuracy of 18F-FDG-PET/CT compared to conventional imaging modalities (CIM) to detect recurrence of primary salivary gland cancers (SGCs).

DATA SOURCES

Review performed on December 26, 2024, using Embase, CINHAL, MEDLINE, and PubMed.

REVIEW METHODS

Two blinded reviewers selected studies reporting diagnostic accuracy of PET/CT in identifying locoregional recurrence and/or metastasis in patients with SGCs. The analysis was performed adhering to PRISMA guidelines using R 4.3.3. Pooled analysis with 95% confidence intervals (CI) were analyzed.

RESULTS

A total of 12 studies were retained from the systematic review, including 264 patients evaluated in the meta-analysis. For local recurrence, there was a pooled sensitivity of 0.86 (95% CI 0.73-0.93) and a pooled specificity of 0.95 (95% CI 0.92-0.97) for PET/CT, and a pooled sensitivity of 0.89 (95% CI 0.80-0.94) and a pooled specificity of 0.91 (95% CI 0.79-0.97) for CIM (p = 0.90). For regional metastasis, there was a pooled sensitivity of 0.90 (95% CI 0.73-0.97) and a pooled specificity of 0.96 (95% CI 0.92-0.98) for PET/CT, and a pooled sensitivity of 0.80 (95% CI 0.62-0.91) and a pooled specificity of 0.95 (0.90-0.98) for CIM (p = 0.26). For distant metastasis, there was a pooled sensitivity of 0.96 (95% CI 0.90-0.99) and a pooled specificity of 0.95 (95% CI 0.85-0.98) for PET/CT, and a pooled sensitivity of 0.80 (95% CI 0.71-0.86) and a pooled specificity of 0.97 (95% CI 0.87-0.99) for CIM (p = 0.018).

CONCLUSIONS

18F-FDG-PET/CT imaging is accurate for the detection of SGC recurrence, particularly for the detection of regional and distant metastases.

LEVEL OF EVIDENCE

NA Laryngoscope, 135:1884-1898, 2025.

Psychological risk factors for problematic social network use: An overview of systematic reviews and meta-analyses

Problematic Social Network Use (PSNU) is a widespread and harmful public health issue. Therefore, it is unsurprising that the literature has focused on identifying possible risk factors contributing to this behavior. However, most identified factors were found to be shared with other problematic online behaviors. Therefore, the present overview aims to identify the psychological risk factors consistently associated with PSNU and evaluate whether the emerging risk factors were shared across Internet Gaming Disorder, Problematic Pornography Use, and Compulsive Online Shopping. A systematic search of four databases was conducted to identify systematic reviews/meta-analyses investigating the relationship between PSNU and psychological risk factors. Then, a bibliometric analysis was performed to examine whether the identified factors were shared across other problematic online behaviors. Thirty-five systematic reviews/meta-analyses were included, examining general and behavior-specific predisposing factors. General predisposing factors associated with PSNU included insecure attachment, high neuroticism, low conscientiousness, low self-esteem, depression, anxiety, stress, social anxiety, loneliness, and fear of missing out. Behavior-specific factors, though less frequently studied, highlighted the role of unmet psychological needs, Preference for Online Social Interaction, and motives related to emotion regulation and socialization. The bibliometric analysis revealed that many risk factors for PSNSU are shared with other problematic online behaviors. However, certain specificities emerged, including distinct motivations driving these behaviors. Findings suggest that PSNU shares a spectrum of risk factors with other problematic online behaviors, yet specific etiological and motivational differences remain. Overall, the findings underscore integrating shared and specific risk factors to improve tailored prevention and intervention strategies.

Premalignant lesions of the oral cavity: a narrative review of factors and mechanisms of transformation into cancer

Oral squamous cell carcinoma (OSCC) is the most common type of head and neck cancer. The development and progression of OSCC are closely linked to various aetiological factors. Early signs of OSCC may manifest as oral lesions, genetic abnormalities, and chronic inflammation. Lesions with dysplastic features have a high risk of malignant transformation into OSCC. Moreover, dysplastic lesions are characteristic of many oral potentially malignant disorders (OPMDs). Currently, there is no unified standard of treatment for OPMD patients, due to the variability in risk factors and mechanisms of transformation. Therefore, it is essential to detect and manage OPMDs at an early stage in order to prevent their malignant transformation into OSCC. This necessitates analysing OPMD mechanisms to identify objective markers for predicting the risk of malignant transformation. The aim of this review was to describe the process of OPMD transformation into OSCC under the influence of environmental, immune, microbiome, and molecular factors.

Determining the optimal radiation dose for locally advanced esophageal cancer: A pooled analysis of reconstructed individual patient data from randomized clinical trials

BACKGROUND

The optimal radiation dose of definitive concurrent chemoradiotherapy (dCCRT) for esophageal cancer (EC) has always been a concern in radiation oncology and has remained controversial for several decades, we performed a meta-analysis based on individual patient data (IPD) to explore the optimal dose.

METHODS

Randomized clinical trials (RCTs) comparing high-dose radiotherapy (HD-RT,≥59.4 Gy) with standard-dose radiotherapy (SD-RT, 50 Gy/50.4 Gy) were identified. Graphical reconstructive algorithms were employed to extract time-to-event outcomes from Kaplan-Meier curves presented in the original RCTs. Using reconstructed individual patient data, summary overall survival (OS), progression-free survival (PFS) and locoregional progression-free survival (LRPFS) for HD-RT versus SD-RT were recalculated. Hazard Ratios (HRs) of OS, PFS and LRPFS reported were also pooled by the fixed or random effects model.

RESULTS

Six RCTs, including 1722 patients, were included. IPD for OS, PFS, and LRPFS were from 1287, 462, and 722 patients, respectively. Overall, HD-RT had no significant benefits in 3-year OS (RR = 1.00, P = 0.990), 3-year progression-free survival (PFS) (RR = 0.96, P = 0.320) and 3-year locoregional progression-free survival (LRPFS) (RR = 0.88, P = 0.204), compared with SD-RT. Consistent with above results, the pooled HRs of OS, PFS and LRPFS for HD-RT versus SD-RT were 0.99 (P = 0.854), 0.94 (P = 0.628) and 0.91 (P = 0.410), respectively. However, HD-RT had higher grade ≥ 3 treatment-related adverse effects (TRAEs) (OR = 1.26, P = 0.025). Subgroup analyses were also performed based on the RT techniques, histology, size of the RT target, dose-escalation mode, and stage editions. We found that dose escalation, even in subgroups, did not benefit long-term survival but resulted in a higher incidence of grade ≥ 3 TRAEs.

CONCLUSION

The results provide robust evidence that corroborates current guidelines and supports the clinical practice of employing SD-RT. Additionally, it provides implications for the feasibility of further research into novel drug combinations (e.g., immunotherapy) rather than radiation dose escalation.

The Impact of Psychological Prehabilitation on Surgical Outcomes: A Meta-analysis and Meta-regression

OBJECTIVE

To investigate the efficacy of psychological prehabilitation in improving surgical outcomes.

BACKGROUND

Prehabilitation aims to improve surgical outcomes through prevention. While most prehabilitation protocols have focused on improving patient knowledge and physical function, mental health has started to receive greater attention due to its effects on postoperative recovery, including persistent opioid use. However, the efficacy of psychological prehabilitation remains unclear due to the heterogeneity of psychological modalities, intervention characteristics, and surgical contexts.

METHODS

A systematic review, meta-analysis, and meta-regression of randomized controlled trials from 2004 to 2024 were conducted per "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines to assess the effect of psychotherapy on 4 postoperative outcomes: length of stay (LOS), pain, anxiety, and depression. Randomized controlled trials were retrieved from MEDLINE, EMBASE, CENTRAL, and Google Scholar databases (March 2024). Studies with >50 adult surgical patients were included. Random effect meta-analyses estimated pooled effect sizes, with meta-regression analyzing intervention and surgery types.

RESULTS

Twenty articles comprising 2376 patients were included. Psychological prehabilitation interventions included cognitive behavioral therapy (70%), supportive psychotherapy (25%), and acceptance and commitment therapy (5%). Pooled analysis revealed greater reductions in LOS [mean difference (MD) = -1.62 days; 95% CI: -2.899, -0.349; P = 0.012], pain (MD = -3.52; 95% CI: -2.642, -4.401; P < 0.001), anxiety (standard MD = -1.51; 95% CI: -0.634, -2.385; P < 0.001), and depression (standard MD = -1.48; 95% CI: -0.578, -2.382; P = 0.001). Psychotherapy modality and surgery type showed no significant effects, except for anxiety.

CONCLUSIONS

Psychological prehabilitation reduces LOS, pain, anxiety, and depression after surgery. Further studies are necessary to compare different types, durations, and delivery methods of psychotherapy for specific postoperative outcomes of interest.

Current Understanding of Optimal Prevention of Helicobacter pylori-Induced Cancer

Gastric cancer is the fifth most common cancer and the fifth most common cause of cancer-related death globally. The key to improving outcomes lies in effective prevention and early detection, which are critical for successful curative interventions. Helicobacter pylori is the strongest known risk factor for gastric cancer, and eradication of this pathogen is critical for reducing cancer risk. By synthesizing current evidence and exploring the advanced therapeutic approaches, this review provides a comprehensive overview of best practices for mitigating gastric cancer through targeted bacterial intervention.

Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5-year follow-up study

INTRODUCTION

Levator ani muscle avulsion is a risk factor for inferior outcomes after native tissue pelvic organ prolapse repair. In a previously published study, we found no such association 1 year after the Manchester procedure (anterior repair combined with cardinal and uterosacral ligament suspension and perineal repair). The aim of the present study was to compare women with and without levator ani muscle avulsions in terms of patient-reported and anatomical outcomes, and failure rates in the same cohort after 5 years.

MATERIAL AND METHODS

Five-year prospective cohort study of 143 women operated on for anterior and/or mid-compartment pelvic organ prolapse with the Manchester procedure between October 2014 and January 2017, Clinical Trial study number NCT02246387. Levator ani muscle avulsions (uni- or bilateral) were diagnosed at inclusion by transperineal ultrasound. Primary outcome at 5-year follow-up was subjective bulge symptoms (question 3, Pelvic Floor Distress Inventory-20). Secondary outcomes were total score from the same questionnaire, sexual distress (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12), subjective cure, Pelvic Organ Prolapse Quantification scale measurements, defining optimal outcomes as anterior compartment stage <0-1 and mid-compartment point C ≤-5, and new surgical or conservative prolapse treatment.

RESULTS

Among 143 women followed up after 5 years, the avulsion rate was 52.4%. Both groups showed similar reductions in bulge symptoms, pelvic floor symptoms, and anatomical anterior- and mid-compartment measurements. Sexual distress improvement was significantly greater for women with avulsion (Mean change difference: -3.4 (-6.4 to -0.5)). Multivariate regression revealed no significant effect of avulsion on symptom scores, cure rates, or need for new prolapse treatment. Women with avulsion had half the odds of obtaining an optimal anterior compartment outcome compared to those without avulsion (adjusted odds ratio: 0.5 (0.2-0.9)).

CONCLUSIONS

Although women with levator ani muscle avulsion had lower odds of achieving an optimal anterior compartment outcome, the overall anatomical changes from preoperative to 5 years were similar in both groups. Importantly, avulsion did not impact symptom improvement, patient-reported outcomes, or the need for further treatment. These findings support the Manchester procedure as an effective and durable surgical option for women with POP, regardless of avulsion status.

Obsessive-compulsive symptom trajectories from pregnancy through the postpartum: examining longitudinal course and risk factors during the COVID-19 pandemic

PURPOSE

The peripartum is a time of increased risk for the development or worsening of obsessive-compulsive (OC) symptoms. Existing evidence suggests that OC symptoms commonly surge immediately postpartum followed by a gradual recovery. Yet how societal conditions, such as a widespread public health crisis, may affect this pattern remains unknown. Increased OC symptom prevalence in the general population during the COVID-19 pandemic coupled with the pre-existing vulnerability of peripartum women suggests they may have been at particularly high risk for sustained symptoms. Thus, the aim of the current study was to examine trajectories in OC symptoms, particularly contamination concerns, in women who gave birth during the COVID-19 pandemic, and to look at risk and resiliency factors that may influence symptom course METHODS: A sample of 164 US pregnant women were recruited during the COVID-19 pandemic. They reported OC symptoms at 3 timepoints: April/May, 2020, July, 2020, and February, 2022. We used a growth mixture modeling approach to examine OC symptom trajectories from pregnancy through the postpartum across these timepoints, comparing the goodness of fit of models with 1-5 trajectory classes for overall OC symptoms and for contamination-related OC symptoms.

RESULTS

For total OC symptoms, two classes of trajectories were identified: recovering (29.27%) versus stable low (70.73%) symptoms; for contamination symptoms alone, a subset of total symptoms, three trajectories were identified: recovering (8.54%), stable low symptoms (68.29%), and stable high symptoms (23.17%). Peripartum stress, but not sociodemographic or obstetric factors, predicted class membership.

CONCLUSIONS

These findings suggest that peripartum OC symptoms, particularly related to contamination, may persist beyond the postpartum period in some women, particularly for women exposed to elevated stress in pregnancy and the postpartum.

Association between the Hospital Anxiety and Depression Scale and Swallowing Function in Dysphagic Patients in Japan

OBJECTIVE

Dysphagia affects 2.3 %-16 % of the general population and increases with age. It can lead to malnutrition, weight loss, aspiration pneumonia, and emotional symptoms such as anxiety and depression. Mental health disorders impact appetite and muscle mass, further worsening dysphagia. Additionally, cultural and economic factors influence anxiety and depression, which can either result from or contribute to dysphagia. Studies on the relationship between anxiety, depression, and swallowing function using FEES are limited in Asian populations. The Hospital Anxiety and Depression Scale (HADS) is a useful tool for assessing mood disorders. Therefore, in this study, we aimed to investigate the associations among anxiety, depression, and swallowing function in Japanese patients with dysphagia using HADS.

METHODS

Data on age; sex; HADS; Eating Assessment Tool-10 (EAT-10); Functional Oral Intake Scale (FOIS); tongue pressure; Hyodo score, a scoring system for evaluating the swallowing function determined by flexible endoscopic evaluation of swallowing (FEES); and videofluoroscopic dysphagia scale (VDS), assessed by videofluoroscopic swallowing study, were collected and analyzed from medical records. Hyodo score consists of four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) glottal closure reflex or cough reflex induced by touching the epiglottis or arytenoid; (3) swallowing reflex induced by colored water; and (4) extent of pharyngeal clearance after colored water is swallowed. The Mann-Whitney U test, Fisher's exact test, and multiple logistic regression analyses were used to estimate associations between HADS and swallowing function.

RESULTS

No significant relationships were observed between the EAT-10, FOIS, and VDS with HADS scores. Patients with depression were associated with a significantly higher percentage of anorexia complaints (p = 0.047). Lower tongue pressure was observed in patients with depression than in patients without depression (p = 0.002). Patients with anxiety had better swallowing function, as assessed by the Hyodo score (p = 0.047). Fluid clearance, a component of the Hyodo score, was significantly better in patients with anxiety (p = 0.03) even after propensity score matching adjusted for the effects of age, sex, and fluid clearance.

CONCLUSION

In patients with anxiety, swallowing function assessed by FEES was favorable, whereas a higher proportion of patients with depression reported decreased appetite, and lower tongue pressure. This discrepancy between subjective dysphagia and FEES findings suggests that patients with anxiety may underestimate their swallowing function.

Mothers' Ideas About Causes of Autism Spectrum Disorder (ASD): Differences Over Time and by Household Experience with ASD

To understand trends in mothers' causal ideas about autism spectrum disorder (ASD) that may be important in targeting education efforts for parents and healthcare providers, as these may be associated with healthcare choices. Data from the Study to Explore Early Development (SEED) was used to examine the causal ideas mothers had, sociodemographic characteristics associated with causal ideas, and whether reported ideas differed over time. SEED included 8307 mothers of pre-school children, with and without ASD, who completed a maternal phone interview between 2007 and 2020. Less than half of mothers (39.3%) offered a causal idea. The most frequently offered causal ideas were genetics, vaccines, environment, parent lifestyle issues, pre/peri-pregnancy maternal medical issues, labor/delivery experiences, and child diet. Some aspects of sociodemographic characteristics, particularly ethno-cultural background, were significantly associated with reporting several causal ideas. Odds of reporting vaccines decreased over time while odds of reporting genetics, parent lifestyle, maternal medical, or labor/delivery issues increased over time. There were significant differences in odds of reporting several causal ideas between those with and those without a child with ASD in the household. Causal ideas reported were consistent with prior research but important differences between those with and those without household ASD as well as significant time trends for certain causes were noted. Implications for public health communication and future research are discussed.

Metatranscriptomic analysis of colonic mucosal samples exploring the functional role of active microbial consortia in complicated diverticulitis

In this study, we investigated complicated diverticulitis, an inflammatory condition associated with abscesses, fistulas, intestinal obstructions, perforations, and primarily affects adults over the age of 60. Although the exact etiology remains unclear, the gut microbiome has been suggested as a contributing factor. Previous studies have used 16S rRNA gene analysis from patient fecal samples, which is limited to identifying the bacterial communities present. Herein, we employed shotgun metatranscriptomics on 40 patient-matched samples of diseased and adjacent normal colonic mucosal tissues from 20 patients with complicated diverticulitis to gain a more comprehensive understanding of active microbial taxa and gene expression patterns that may be involved in this disease state. Our findings revealed distinct beta diversity and a conglomerate of pathogenic microbiota in the diseased tissues, including Staphylococcus cohnii, Corynebacterium jeikeium, Kineococcus, Talaromyces rugulosus, Campylobacteraceae, and Ottowia, among others. The adjacent normal tissues were a stark contrast, harboring anti-inflammatory taxa such as Streptococcus salivarius and housekeeping genes and pathways such as the ABC-2 type transport system ATP-binding protein. These results align with previous amplicon sequencing studies and provide novel functional insights that may be crucial for understanding the etiology of complicated diverticulitis.IMPORTANCEComplicated diverticulitis is a virulent condition with no clear cause other than the association with colonic diverticulosis. We assessed the microbial gene expression in complicated diverticulitis patients using colonic tissue samples, revealing microbes in the diseased tissue known to exacerbate the diverticular condition and to live in extreme places, and microbes in patients' normal tissue known to maintain normal bodily functions. This functional information is therefore important for understanding what microbial taxa are present and what they are doing. It is possible clinicians could someday harness this information to more effectively treat complicated diverticulitis symptoms. For example, clinicians may suggest dietary changes and prescribe probiotics to increase beneficial bacteria. Clinicians may also prescribe targeted antibiotics or consider the emerging treatment option of fecal transplants in complicated diverticulitis patients. While not curing complicated diverticulitis, each potential treatment option mentioned addresses balancing out dysbiosis of the gut microbiome, therefore alleviating associated symptoms.

Association between Perceived Dysphagia Symptoms and Swallowing Physiology in Parkinson's Disease

BACKGROUND

Swallowing disorders are prevalent in Parkinson's disease (PD). Swallowing assessment often relies on patient-reported outcome measures (PROMs). Although PROMs and physiologic swallowing measures correlate with disease severity, the relationship between PROMs and physiologic swallowing impairments is unclear.

OBJECTIVES

Our aim was to (1) delineate the relationship between perceived swallowing symptoms and physiologic swallowing impairments; and (2) determine the relationship between swallowing-related quality of life (QoL) and physiologic impairments.

METHODS

A total of 31 individuals with PD (mean age = 64.8, standard deviation = 9.4) and dysphagia were recruited. PROMs included the Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Survey (SWAL-QOL) to measure perceived swallowing-related symptoms and QoL, respectively. Participants underwent a Modified Barium Swallow Study (MBSS) to obtain physiologic swallowing measures, including the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scale (PAS). Multiple linear regression analyses assessed the associations between PROMs and physiologic measures, controlling for disease duration.

RESULTS

Perceived swallowing difficulties indicated mild to moderate symptoms (SSQ: 20-871.5), and perceived swallowing-related QoL showed moderate to no impact (SWAL-QOL: 52.5%-100%). Swallowing components oral residue (97%) and delayed pharyngeal swallow (97%) were the most frequently impaired on the MBSImP. Furthermore, 45.2% of participants showed airway invasion (PAS ≥3) in at least one swallow trial. Regression analysis showed significant associations between MBSImP pharyngeal total score with SSQ (P < 0.001, R2 = 0.49) and SWAL-QOL (P = 0.014, R2 = 0.36).

CONCLUSIONS

These findings suggest that PROMs may not fully capture all aspects of physiological swallowing impairments. Relying solely on PROMs may overlook critical swallowing deficits not perceived by the patient, highlighting the need for objective swallowing assessments in PD.

Clinical characteristics and survival of breast cancer patients with extramammary malignancies in a single Asian center over the past 23 years

BACKGROUND

The rise of multiple primary malignant neoplasms (MPMNs) necessitates exploration. MPMNs represent 18% of U.S. cancers. Breast cancer is the predominant malignancy among female Americans. However, most studies on breast cancer with MPMNs are confined to case reports with small sample sizes. Hence, this article scrutinizes 280 patients diagnosed with breast cancer and extramammary primary malignancies via long-term follow-up.

METHODS

We reviewed 280 breast cancer cases with extramammary primary malignancies from January 2000 to December 2022 at our institute, excluding those diagnosed with stage IV breast cancer. The double primary malignant neoplasms (DPMNs) were used as focal points and segregated into the first primary breast cancer (FPBC) and second primary breast cancer (SPBC) subgroups. With a median follow-up period of 107 months (8.9 years), we examined the characteristics of these diseases in various patients.

RESULTS

Concerning breast cancer patients with extramammary primary malignancies, DPMNs were predominant, comprising 77.1% (216/280). Among these DPNMs, gynecology, thyroid, and lung were the primary site of extramammary tumors, predominantly. Nearly all (93.9%) of FPBC patients exhibited metachronous cancer whereas 55.9% of SPBC patients experienced this. The median interval between the onset of breast cancer and extramammary malignancy in metachronous FPBC and metachronous SPBC patients was 60 months and 48 months, respectively. Over time, both metachronous FPBC and metachronous SPBC patients demonstrated a diminishing prevalence of second tumors. The distinction lay in that in the metachronous FPBC group, second tumors ceased to occur after 300 months, whereas in the metachronous SPBC group, their emergence persisted. Synchronous cancer, negative ER/PR status, and advanced extramammary malignancy stage portend poor prognosis among patients with DPMNs.

CONCLUSIONS

Careful monitoring of MPMNs necessitates precise guidelines, differing amongst FPBC and SPBC patients. Synchronous cancer, ER/PR-negative, and advanced extramammary malignancy stage indicate poor prognosis in DPMNs patients.

Effects of continuous theta burst stimulation on patients with obsessive‒compulsive disorder (OCD): A systematic review and meta-analysis of randomized sham controlled trials

Despite standard pharmacological and behavioral therapies, a significant proportion of patients with obsessive‒compulsive disorder (OCD) have a suboptimal or no response. Continuous theta burst stimulation (cTBS) is a novel variant of traditional transcranial magnetic stimulation (TMS) that has shown promising results in a wide array of behavioral disorders. To integrate the evidence of its role in OCD, we conducted a systematic review and meta-analysis of pertinent randomized controlled trials (RCTs). We conducted a comprehensive literature search from inception until June 2024 on PubMed, Google Scholar, PsycINFO, Embase, and clinical trial registries. Six RCTs were identified and included in our study. Data regarding obsessive‒compulsive symptoms, depression, and anxiety were extracted and analyzed via a random effects model. We found no significant differences between the active and sham groups regarding the change in obsessive‒compulsive symptoms, neither immediately posttreatment (p = 0.98) nor at follow-up (p = 0.83). Similarly, neither group was superior in alleviating concomitant anxiety and depression. Owing to the limited number of studies and their variability in terms of brain targets and the total number of pulses administered, we cannot definitively conclude the effectiveness of cTBS in patients with OCD. However, our research highlights it as a potentially safe treatment option with no serious side effects. Future investigators should aim to optimize intervention protocols and utilize neuronavigation techniques for accurate delivery of pulses to targeted brain loci. High-powered trials with sufficient sample sizes are needed to gain deeper insight into the effects of cTBS on primary and secondary clinical manifestations of OCD.

Good clinical practice recommendations for the diagnosis and treatment of functional dyspepsia: An expert review from the Asociación Mexicana de Gastroenterología

INTRODUCTION AND AIMS

Functional dyspepsia (FD) is a highly prevalent condition characterized by upper gastrointestinal symptoms with no apparent organic cause. It is a complex and multifactorial disease that frequently overlaps with other disorders of gut-brain interaction. It is recurrent, has a variable therapeutic response, and affects patient quality of life. Our aim was to formulate good practice recommendations for the management of FD through a consensus review of the disease, updating and complementing the 2017 consensus on dyspepsia from the Asociación Mexicana de Gastroenterología (AMG).

METHODS

Sixteen experts summoned by the AMG carried out a literature review (2017-2024) and formulated good clinical practice recommendations for the diagnosis and treatment of FD. They were discussed until reaching a consensus, and the most recent evidence on the theme was evaluated, utilizing the GRADE system.

RESULTS

Twenty-three good clinical practice recommendations for the management of FD were developed that addressed the following aspects: (1) definition, pathophysiology, and epidemiology; (2) diagnosis; (3) nonpharmacologic treatment; (4) Helicobacter pylori eradication; (5) antisecretory and anti-acid therapy; and (6) prokinetics and neuromodulators.

CONCLUSIONS

FD is one of the most frequent gastrointestinal conditions seen in daily practice. We present good clinical practice recommendations for the specific management of this disorder, taking into account the most recent advances that complement and update the consensus on dyspepsia published by the AMG in 2017.

Examination of the correlation between functionality, cognition and swallowing skills in patients with acute stroke

This study aims to identify factors linked to swallowing abilities in acute stroke patients, including lesion location, cognitive level, clinical features, stroke risk factors, and functionality. A total of 97 patients who were hospitalized in the neurology clinic and diagnosed with stroke and whose duration of after stroke did not exceed 7 days were included. Acute stroke patients aged between 45 and 90 years, 58 males and 39 females, were grouped according to lesion type, affected side, and stroke risk factors. Turkish MMASA (TR-MMASA) was used to evaluate the swallowing ability of the patients. Additionally, Standardized Mini Mental Test (SMMT) and Modified Rankin Scale (MRS) were applied to evaluate cognition level and functionality, respectively. No significant relationship was found between TR-MMASA results and time spent after stroke (0-7 days), lesion type, affected side, and risk factors for stroke (p > 0.05). A moderately significant correlation was found between MRS and TR-MMASA (r=-0.312, p < 0.05) while a highly significant correlation was found between SMMT and TR-MMASA (r=-0.352, p < 0.05). Decreases in functionality and cognitive level are considered to be strong predictors of detecting dysphagia. To detect complications at the earliest stage, rapid dysphagia screening tests that screen for pre-swallowing skills should be included in routine assessments in stroke patients with low cognitive level and functionality. Further referrals can be provided by evaluating the patient's level of cognition, functionality, and pre-swallowing skills together at the first presentation to the hospital.

Advances in the treatment of hepatocellular carcinoma: An overview of the current and evolving therapeutic landscape for clinicians

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the third leading cause of cancer-related death worldwide. Contemporary advances in systemic and locoregional therapies have led to changes in peer-reviewed guidelines regarding systemic therapy as well as the possibility of downstaging disease that may enable some patients with advanced disease to ultimately undergo partial hepatectomy or transplantation with curative intent. This review focuses on all modalities of therapy for HCC, guided by modern-day practice-changing randomized data where available. The surgical management of HCC, including resection and transplantation, both of which have evolving criteria for what is considered biologically resectable and transplantable, as well as locoregional therapy (i.e., therapeutic embolization, ablation, radiation, and hepatic arterial infusion), are discussed. Historical and modern-day practice-changing trials evaluating immunotherapy with targeted therapies for advanced disease, as well as adjuvant systemic therapy, are also summarized. In addition, this article examines the critical dimension of toxicities and patient-oriented considerations to ensure a comprehensive and balanced discourse on treatment implications.

A Novel Surgical Approach for Vaginal Laxity: Tightening the Vagina from the Cervix to the Hymen; ''Elçi Technique''

BACKGROUND

Vaginal looseness is a common problem in women. However, many procedures are based on the principle of narrowing the distal 1/3 of the vagina. We aimed to describe a new technique for tightening the vagina from top to bottom.

METHODS

Forty-four parous women complaining of wide vaginas were operated on according to three supportive levels of the vagina: Level I is sutured by uterosacral and cardinal ligament attachments to the proximal 2-3 cm of the vagina. Level II restraint is supported by the vesicovaginal and rectovaginal fascia. The level III segment is the region 2-3 cm above the hymeneal ring and is reinforced with the perineal membrane. The circumferential submucosal 30 mm polyglactin sutures were passed through and tied at each level. Postoperative pain was assessed with visual analog scale (VAS) 24 h later. Anatomical results were evaluated via comparisons with preoperative values of the genital hiatus (GH), total vaginal length (TVL), and proximal/mid/distal vaginal width at the 6-month visit. The functional results were compared with the preoperative values of the Female Sexual Function Index (FSFI-6). Additionally, patients' overall satisfaction was assessed with the Patient Global Impression of Improvement (PGI-I) questionnaire.

RESULTS

The patients' median age was 49 years (29-66 years). The mean duration of surgery was 38 min (31-56 min). The estimated blood loss was 35 ml (25-35 ml). No intraoperative complications were recorded. The mean VAS score was 2.7 (1.6-4.8). All patients stayed in the hospital for 1 night. A significant decrease in the dimensions of the vagina was noted (p < .05). There was no marked change in TVL (p = 0.53). When the preoperative total mean FSFI-6 score was 23.63 ± 6.84, it significantly increased to 27.11 ± 6.12, (p < .001). Thirty-seven of the 44 women (84%) responded "very much better" or "much better" on the PGI-I scale.

CONCLUSIONS

These findings support that Elçi technique is reliable for the treatment of vaginal laxity. It maintains normative dimensions of the vagina, with high FSFI-6 scores and patient satisfaction rates.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Association between herpes simplex virus type 1 and the risk of Alzheimer's disease: a retrospective case-control study

OBJECTIVE

A growing body of evidence points to a role for herpesviruses in the development of Alzheimer's disease (AD) and a reduced risk of AD among patients receiving antiherpetic medications. We investigated the association between herpes simplex virus type 1 (HSV-1) and AD using real-world data (RWD) from USA.

DESIGN

In a matched case-control study, patients with AD aged ≥50 years diagnosed between 2006 and 2021 were identified from the IQVIA PharMetrics Plus claims database. Controls were matched in a 1:1 ratio with subjects with AD on age, sex, region, database entry year and healthcare visit numbers.

RESULTS

The study included 344 628 AD case-control pairs. History of HSV-1 diagnosis was present in 1507 (0.44%) patients with AD compared with 823 (0.24%) controls. HSV-1 diagnosis was found to be associated with AD (adjusted OR 1.80; 95% CI 1.65 to 1.96). Patients with HSV-1 who used antiherpetics were less likely to develop AD compared with those who did not use antiherpetics (adjusted HR 0.83, 95% CI 0.74 to 0.92).

CONCLUSIONS

Findings from this large RWD study implicate HSV-1 in the development of AD and highlight antiherpetic therapies as potentially protective for AD and related dementia.

Why some embrace and others hesitate? A behavioral analysis of insomnia sufferers’ engagement with acupuncture treatment

BACKGROUND

Acupuncture is emerging as a promising treatment for insomnia. However, the determinants driving patients’ decisions to pursue or adopt this treatment modality remain underexplored.

AIM

To identify the key factors shaping the willingness of patients with insomnia to seek and engage in acupuncture from a patient-centered perspective.

METHODS

A semi-structured focus group design was used, with a research framework integrating the capability, opportunity, motivation-behavior model, and theoretical domains framework. The results were mapped onto constructs of a behavioral wheel derived from the capability, opportunity, motivation-behavior/theoretical domains framework matrix. Data analyses employed abductive thematic analysis.

RESULTS

Data saturation was achieved after ten focus group sessions, involving a total of 45 participants. Key facilitators for patients with insomnia seeking acupuncture included: (1) Cultural beliefs in ethnic medicine; (2) Concerns about the adverse effects of, and dependence on, hypnotics; (3) Expectations of improvement in comorbid symptoms; (4) Desire for more communication with the clinician; and (5) Incentives from peers and online key opinion leaders. Barriers were: (1) Limited knowledge of acupuncture indications; (2) Accessibility burden; (3) Needle-phobia; and (4) Safety concerns. Additionally, prior acupuncture experiences, family/friend attitudes, and treatment costs (reimbursement rate in health insurance) served as both facilitators and barriers.

CONCLUSION

The interrelated facilitators and barriers underscore that the decision to use acupuncture for insomnia is a complex issue involving efficacy/safety, culture, economics, information dissemination, and communication factors. Expanding patient education on acupuncture, increasing media exposure, and improving governmental oversight of this process are essential. Investing in high-quality acupuncture services in public hospital nighttime clinics and community health centers is expected to address accessibility challenges. Acupuncturists need to improve doctor-patient communication, including guiding patients to set treatment expectations that are grounded in reality to enhance service quality. For patients with significant needle-phobia, cognitive manipulation or hypnosis techniques may be employed to improve treatment compliance.

Sedentary Behavior and Cardiac Events and Mortality After Hospitalization for Acute Coronary Syndrome Symptoms: A Prospective Study

BACKGROUND

Patients hospitalized with symptoms of acute coronary syndrome remain at high risk for adverse events postdischarge, highlighting a need for modifiable therapeutic targets. The role of sedentary behavior in this risk and the potential benefits of replacing sedentary time with other activities remain unclear. This study examined the association between sedentary behavior and 1-year cardiac events/mortality among patients evaluated for acute coronary syndrome and estimated risk reductions from substituting alternative activities for sedentary time.

METHODS

Patients presenting to the emergency department of a New York City hospital with acute coronary syndrome symptoms were enrolled from 2016 to 2020. Sedentary behavior, light-intensity physical activity, moderate-to-vigorous physical activity, and sleep were measured via a wrist-mounted accelerometer worn for 30 days postdischarge. Cardiac events and all-cause mortality were ascertained 1 year postdischarge via participant contact, electronic health records, and the Social Security Death Index. Participants were categorized into tertiles of sedentary time, with tertile 1 representing the lowest sedentary time and tertile 3 the highest. Cox proportional hazards regression models were used to evaluate associations.

RESULTS

Of 609 participants (mean age, 62 years; 52% male, 58% Hispanic), 8.2% experienced a cardiac event or died within 1 year. Mean sedentary time was 13.6 h/d (SD, 1.8). Sedentary time was associated with increased risk of cardiac events/mortality (tertile 2: hazard ratio [HR], 0.95 [95% CI, 0.37-2.40]; tertile 3: HR, 2.58 [95% CI, 1.11-6.03]; Ptrend=0.011). In isotemporal substitution analyses, replacing 30 minutes of sedentary time (referent) with sleep (HR, 0.86 [95% CI, 0.78-0.95]), light-intensity physical activity (HR, 0.49 [95% CI, 0.32-0.75]), or moderate-to-vigorous physical activity (HR, 0.39 [95% CI, 0.16-0.96]) was associated with lower cardiac event/mortality risk.

CONCLUSIONS

Sedentary behavior was associated with increased risk of 1-year cardiac events/mortality among patients evaluated for acute coronary syndrome. Replacing sedentary behavior with sleep, light-intensity physical activity, or moderate-to-vigorous physical activity was associated with lower risk. These findings highlight reducing sedentary behavior as a potential strategy to improve posthospitalization outcomes.

Alcohol consumption and esophageal cancer risk: unveiling DLEU2 as a key immune modulator through Mendelian randomization and transcriptomic analysis

Esophageal cancer (EC) is a leading cause of cancer-related mortality globally, with alcohol consumption being a significant risk factor. However, the genetic and molecular mechanisms linking alcohol intake to EC remain unclear. This study utilized Mendelian randomization analysis to establish a causal relationship between alcohol consumption and EC (OR: 4.11 [95% CI 1.83-9.23]). Transcriptomic analysis identified 83 differentially expressed genes (log₂ fold change > 1, false discovery rate [FDR] < 0.05), among which DLEU2 was uniquely transcribed into a long non-coding RNA (lncRNA). Pan-cancer analysis revealed its association with the tumor immune microenvironment and cancer progression. Single-cell RNA sequencing localized DLEU2 expression predominantly to T cells, particularly exhausted subpopulations, and pseudo-temporal analysis demonstrated increased DLEU2 expression during late T cell differentiation stages, co-expressing immune suppression markers, with consistent expression patterns observed across multiple patient-derived samples. Additionally, cell communication analysis suggested that DLEU2 modulates TNF signaling through TNFRSF1A/B pathways, contributing to immune evasion and poor prognosis. These findings position DLEU2 as a pivotal regulator of the immune landscape in EC and a potential prognostic biomarker and therapeutic target.

A shared inflammatory signature across severe malaria syndromes manifested by transcriptomic, proteomic and metabolomic analyses

Factors governing the clinical trajectory of Plasmodium falciparum infection remain an important area of investigation. Here we present transcriptomic, proteomic and metabolomic analyses comparing clinical subtypes of severe Plasmodium falciparum malaria to matched controls with uncomplicated disease in 79 children from Mali. MMP8, IL1R2, and ARG1 transcription is higher across cerebral malaria, severe malarial anemia, and concurrent cerebral malaria and severe malarial anemia, indicating a shared inflammatory signature. Tissue inhibitor of metalloproteinases 1 is the most upregulated protein in cerebral malaria, which along with elevated MMP8 and MMP9 transcription, underscores the importance of the metalloproteinase pathway in central nervous system pathophysiology. L-arginine metabolites are decreased in cerebral malaria, which coupled with increased ARG1 transcription suggests a putative mechanism impairing cerebral vasodilation. Using multi-omics approaches, we thus describe the inflammatory cascade in severe malaria syndromes, and identify potential therapeutic targets and biological markers.

Characterisation of non-cirrhotic MAFLD-related hepatocellular carcinoma: a retrospective cohort study

Background

Hepatocellular carcinoma (HCC) is a major global health issue, in which the underlying liver disease aetiology has shifted towards non-viral causes, particularly metabolic (dysfunction)-associated fatty liver disease (MAFLD). While traditionally associated with cirrhosis, a subset of HCC cases arises in patients with MAFLD but without cirrhosis, whose characteristics remain poorly understood.

Objectives

The study aims to explore the clinical, tumour and genetic characteristics of non-cirrhotic MAFLD-related HCC when compared to those that develop in the context of cirrhosis.

Design

A multi-centre, retrospective study of 89 MAFLD-related HCC patients enrolled between 2009 and 2023 was performed.

Methods

We conducted a study of well-defined MAFLD-related HCC patients to explore their MAFLD-related clinical and genetic associations. Statistical analysis was undertaken to compare the underlying cirrhosis and non-cirrhosis groups for HCC features, adjusting for relevant confounders.

Results

Patients with HCC arising in cases of MAFLD without cirrhosis exhibited a lower body mass index, higher triglyceride levels and increased smoking prevalence compared to their counterparts with cirrhosis. Despite arising in the absence of cirrhosis, these patients had more aggressive tumour features, including larger tumour size, multifocality and portal vein thrombosis. Logistic regression confirmed non-cirrhosis status to be an independent predictor of larger tumour size and increased lesion number.

Conclusion

Non-cirrhotic MAFLD-related HCC presents with distinct clinical and tumour characteristics, suggesting the existence of unique disease drivers that are yet to be discovered.

Multifocality of papillary thyroid carcinoma with low risk of recurrence: Prevalence, predictive markers, prognostic significance and initial surgical treatment

BACKGROUND AND OBJECTIVE

The impact of multifocality on the prognosis of patients with papillary thyroid cancer is relevant when considering the choice of initial surgical treatment by hemithyroidectomy or total thyroidectomy. The aim of the study is to determine the prevalence of multifocality in our setting, its predictive markers and the rates of persistence, recurrence and mortality associated with papillary thyroid cancer with a low risk of recurrence in order to infer the most appropriate initial surgical treatment.

PATIENTS AND METHOD

Retrospective observational cross-sectional study of 85 total thyroidectomies.

RESULTS

Prevalences: unifocal carcinoma: 68.2%; multifocal: 31.8%. Predictive markers of multifocality: multinodular ultrasound pattern (OR:17.069, 95% CI:2.989-97.454) and non-incidental finding (OR:7.569, 95% CI:2.363-24.242). In 66.6% of multifocal cases there was bilateral involvement, all of them had a bilateral multinodular ultrasound pattern. Multifocal cases received postoperative radioiodine more frequently (p < 0.001). During the follow-up of 95.5 ± 32.2 months there was one case of persistence and one of recurrence, both in the multifocal group (p:ns), at 12 and 71 months of follow-up. There was no mortality.

CONCLUSIONS

This is the first study in our country to estimate the prevalence of multifocality in papillary carcinoma with a low risk of recurrence and to show an excellent prognosis, with no differences compared to unifocal cases, considering that all cases have been treated with total thyroidectomy, but multifocal cases with radioiodine more frequently. Hemithyroidectomy could offer a similar prognosis to total thyroidectomy in cases with an ultrasound pattern of a single or unilateral multinodular nodule, but not in cases of bilateral multinodular thyroid.

Metabolic dysfunction-associated steatotic liver disease and pregnancy

Metabolic dysfunction-associated steatotic liver disease (MASLD) is rising among reproductive-aged individuals and in pregnancy. MASLD in pregnancy does increase such risks as gestational diabetes, preeclampsia, and preterm birth. Although routine screening for MASLD has not been established in pregnancy, individuals with metabolic comorbidities, such as type 2 diabetes mellitus, should be evaluated by liver imaging and liver panel. Preconception counseling should address potential risks as well as need for optimized metabolic health before and during pregnancy. Fibrosis assessment should ideally be completed before pregnancy, to identify cases of cirrhosis that may warrant additional preconception management, such as variceal screening, as well as comanagement with maternal-fetal medicine specialists. In patients with MASLD, aspirin is advised at 12 weeks of gestational age to lower preeclampsia risk. In the absence of cirrhosis, no additional blood test monitoring is needed. In the general population, breastfeeding has beneficial effects on metabolic health in birthing parents and offspring and thus should be encouraged in the setting of MASLD, including access to enhanced lactation support. Research needs include evaluation of the long-term risks of MASLD in pregnancy on metabolic health in birthing parents and infants, as well as safety data for MASLD-directed therapies during pregnancy and lactation.

Clinical practice recommendations on the use of neuromodulators in gastroenterology: AMG (Asociación Mexicana de Gastroenterología) - AMNM (Asociación Mexicana de Neurogastroenterología y Motilidad) expert joint review

Disorders of gut-brain interaction (DGBI) are characterized by alterations in both central and peripheral gut-brain axis (GBA)-related stimuli, and include esophageal, gastroduodenal, intestinal and anorectal disorders. Despite the fact that several pathophysiologic mechanisms are involved, the mainstay of treatment is neuromodulators, a heterogeneous group of drugs that act on pathways related to central and peripheral pain processing. This expert review by both the AMG (Asociación Mexicana de Gastroenterología) and AMNM (Asociación Mexicana de Neurogastroenterología y Motilidad) summarizes a series of updated clinical recommendations based on an exhaustive review of the literature, regarding the use of neuromodulators for DGBI, and is grouped into six sections: pharmacologic principles, definition, classification, mechanism of action, indications and use in each DGBI subtype, up/downscaling strategies, combination therapy, adverse events, joint use along with psychiatry in the case of comorbidities, and non-pharmacologic neuromodulation. Furthermore, drug selection process tips and dose personalization according to individual groups and sensitivities are provided, and special cases with DGBI-psychiatric comorbidity, as well as overlap with another DGBI, are considered.

Is two-dimensional oblique parasagittal ultrasound imaging valid for levator ani muscle assessment?

OBJECTIVE

To evaluate the validity of two-dimensional (2D) oblique parasagittal ultrasound imaging to assess levator ani muscle avulsion.

METHODS

This was a cross-sectional prospective study of women attending a tertiary urogynecological service between February 2021 and August 2022. All women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) assessment and four-dimensional transperineal ultrasound. 2D oblique parasagittal ultrasound imaging was performed by rotating the transducer 10-20° from the midline to line up the main transducer axis with the fiber direction of the puborectalis muscle, followed by a full parasagittal sweep of the hiatus at rest. Postprocessing of archived ultrasound volume data was performed at a later date, blinded to all other data. Findings were compared with levator ani assessment results obtained previously using three-dimensional tomographic ultrasound imaging (TUI). Diagnosis of levator ani avulsion on TUI and oblique parasagittal imaging was analyzed for associations with pelvic organ prolapse (POP).

RESULTS

The datasets of 484 women were analyzed. Mean age was 58 (range, 16-94) years, mean body mass index was 30 (range, 17-65) kg/m2 and mean parity was 2.6 (range, 0-8). POP symptoms were reported by 278 (57%) women. Clinically and sonographically significant POP was found in 385 (80%) and 350 (72%) women, respectively. Levator ani avulsion was diagnosed in 77 (16%) women on TUI and in 90 (18.6%) women on oblique parasagittal ultrasound imaging, with fair agreement between the two methods (Cohen's kappa of 0.365). There were significant associations between levator ani avulsion on 2D ultrasound imaging and POP diagnosis on clinical examination (odds ratio (OR), 2.88 (95% CI, 1.34-6.18); P = 0.005) and on ultrasound (OR, 2.92 (95% CI, 1.53-5.55); P = 0.001), but these associations were much stronger for TUI (P < 0.001 for both).

CONCLUSION

There was limited agreement between tomographic and oblique parasagittal ultrasound diagnosis of levator ani muscle avulsion. The latter technique has some validity for levator ani assessment but is clearly less valid than TUI. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A network meta-analysis of different interventional treatment strategies for unresectable hepatocellular carcinoma

BACKGROUND

The optimal clinical management of unresectable hepatocellular carcinoma (uHCC) is challenging for clinicians. Bayesian network meta-analysis was conducted to compare the efficacy and safety of different interventional strategies for uHCC.

METHODS

A systematic search was conducted in PubMed, Embase, the Cochrane Library, Web of Science, and CNKI databases. Bayesian network meta-analysis was applied to evaluate the disease control rate (DCR), 1-year survival rate and 2-year survival rate, as well as the incidence of serious adverse events associated with seven interventional strategies. Odds ratios (ORs) were estimated using pairwise and network meta-analysis with random effects. Treatment rankings utilized surface under the cumulative ranking curve (SUCRA), whereas heterogeneity was examined via I-square and meta-regression.

RESULTS

A total of 40 randomized controlled studies were included. Compared with transarterial chemoembolization (TACE) alone, all of the combination treatments, including TACE with radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), percutaneous ethanol injection (PEI), and radiotherapy (RT), significantly improved the DCR. TACE combined with RFA was observed to be superior to hepatic arterial infusion chemotherapy (HAIC) (OR: 1.91; 95% CI: 1.03-3.81) and TACE (OR: 3.85; 95% CI: 2.66-5.69), with the highest probability (SUCRA 0.836). TACE combined with HIFU ranks highest 1-year survival (SUCRA 0.919) and 2-year survival (SUCRA 0.925) rates, and also exhibited a better 1-year survival rate than HAIC (OR: 2.99; 95% CI: 1.09-9.03). Compared with TACE alone, HAIC exhibited a greater DCR (OR: 2.02; 95% CI: 1.15-3.40) and a potential advantage in 2-year survival (OR: 1.95; 95% CI: 1.02-3.78). No significant differences in serious adverse events were observed across treatments.

CONCLUSIONS

Compared with TACE alone, combined treatments for uHCC patients demonstrates better efficacy and survival. Moreover, compared with TACE and HAIC, TACE combined with RFA provides better efficacy, whereas TACE combined with HIFU offers the highest 1-year survival rate. HAIC alone outperforms TACE in DCR and 2-year survival rate.

Efficacy of Cerebroplacental Doppler Ratio in Predicting Adverse Fetal Outcomes in Cases of Fetal Growth Restriction Multicenter Study

INTRODUCTION

Fetal growth restriction (FGR) is a significant cause of perinatal morbidity and mortality. Differentiating FGR from small-for-gestational-age fetuses is critical for risk assessment. This study investigates the cerebroplacental ratio (CPR) as a noninvasive predictor of adverse fetal outcomes, particularly neonatal intensive care unit (NICU) admissions, intrauterine fetal death (IUFD), and birth weight variability.

METHODS

This prospective, multicentre study included 60 pregnant women (gestational age 28-34 weeks) divided into normal and abnormal CPR groups. Doppler ultrasonography assessed umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices. Statistical analysis included receiver operating characteristic (ROC) curves for CPR, UA, and MCA indices to predict adverse outcomes.

RESULTS

Abnormal CPR correlated with increased NICU admissions (46.7%), IUFD (10%), and lower birth weight (mean: 2138 g). Elevated UA PI and reduced MCA PI were observed in the abnormal CPR group. Sensitivity and specificity analyses identified CPR (cutoff: 1.1) as a modestly accurate predictor of adverse outcomes.

DISCUSSION

CPR effectively stratifies risk in high-risk pregnancies but requires further validation. Abnormal Doppler findings highlight placental insufficiency and compromised cerebral perfusion. These findings could refine FGR management strategies.

Radiotherapy, tyrosine kinase inhibitors, immune checkpoint inhibitors combined with hepatic arterial infusion chemotherapy of RALOX versus FOLFOX for hepatocellular carcinoma with portal vein tumor thrombus: a propensity score-matching cohort study

BACKGROUND

This retrospective study aimed to evaluate the safety and effectiveness of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin (RALOX-HAIC) combined with radiotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors in patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).

METHODS

A propensity score-matching (PSM) cohort study was conducted. The tumor response, treatment-related adverse events, survival outcomes were compared. Univariate and multivariate analyses were conducted to explore the risk factors of overall survival (OS).

RESULTS

Twenty-one pairs of patients were evaluated after PSM. No statistical differences were found in the tumor response, objective response rate, disease control rate, PVTT response, surgical resection rate, metastasis, and mortality between the two groups before and after PSM. Compared with the FOLFOX-HAIC group, the incidences of abdominal pain and fever was lower in the RALOX-HAIC group (P = 0.028, P = 0.029). These differences still had statistical significance after PSM (P = 0.013, P = 0.014). No statistical differences were found in OS and progression-free survival (PFS) between the two groups before and after PSM (Before [OS: hazard ratio(HR) = 1.138; 95%CI 0.569-2.276, P = 0.715; PFS: HR = 0.549; 95%CI 0.195-1.548, P = 0.257; After [OS: HR = 0.998; 95%CI 0.438-2.274, P = 0.995; PFS: HR = 0.792; 95%CI 0.359-1.748, P = 0.564]). The prealbumin < 170 mg/L before therapy was an independent risk factor for OS (HR = 2.234; 95%CI 1.051-4.751; P = 0.037).

CONCLUSIONS

The RALOX-HAIC combined radiotherapy, TKI, and ICI may provide similar survival advantages with fewer treatment-related abdominal pain and fever compared to FOLFOX-HAIC for HCC patients with PVTT. The prealbumin < 170 mg/L before therapy is an independent risk factor for OS.

Female levator ani muscle damage assessment in supine and upright position

There is damage in the pelvic floor only visible in upright imaging. This damage have not been yet studied. The aim of this research is to assess the difference in levator ani muscle (LAM) damage in supine and upright position by means of MRI scans. Sixty-four patients with minimum stage 2 prolapse of the anterior vaginal wall or uterus, without previous pelvic organ prolapse (POP) surgery were scanned in a MR scanner in supine and upright position. Damage to the pubococcygeus muscle (PCM) and the iliococcygeal muscle (ICM) was scored as none, minor or major. For PCM, a previously established protocol was used. For ICM, a protocol for damage assessment was established and validated in this study, by determining the interclass correlation coefficient (ICC). The new ICM assessment protocol was established with ICC values of 0.68 (0.57-0.77) for supine and 0.81 (0.74-0.86) for upright assessment. 6.3% major ICM damage was found in supine vs. 51.6% in upright position with a significant difference of p < 0.001 for the sign-test. There was an underestimation of ICM damage in 59% of the cases in supine position. PCM damage scoring was not feasible on upright MRI's and therefore only assessed on supine scans. In our POP population we found 53.1% of the women with major damage to either the PCM or ICM and 32.8% with major damage in both, leading to a total of 85.9% of women with major damage to at least one structure. There is a significant difference in LAM damage assessment between supine and upright position. Supine imaging leads to a severe underestimation of ICM damage while for the PCM supine damage assessment remains superior.

Negative association between body roundness index and constipation: insights from NHANES

BACKGROUNDS

The relationship between body roundness index (BRI), a metric that distinguishes heterogeneity in fat distribution, and constipation is unclear. This study is the first to investigate the association between BRI and constipation based on the National Health and Nutrition Examination Survey (NHANES) in the United States, providing a new perspective on the mechanisms of obesity-related gastrointestinal dysfunction.

METHODS

This cross-sectional study utilized data from the NHANES conducted between 2005 and 2010. Constipation was diagnosed based on the Bristol Stool Form Scale (BSFS). Weighted logistic regression models were employed to assess the association between BRI and constipation prevalence. Restricted cubic splines (RCS) and piecewise linear regression models were applied to evaluate non-linear relationships between BRI and constipation. Propensity score matching (PSM) was implemented to match constipated and non-constipated populations with similar baseline characteristics. Subsequent analyses were conducted to investigate the correlation between BRI and constipation.

RESULTS

A total of 12,732 eligible participants were included. A negative correlation was observed between BRI and constipation prevalence, with an adjusted odds ratio (OR) of 0.87 (95% CI: 0.80, 0.95) after controlling for all covariates. When BRI was categorized into quartiles (Q1-Q4), both Q3 and Q4 groups exhibited significantly reduced constipation risk compared to Q1 (OR = 0.72, 95% CI: 0.54-0.97; OR = 0.63, 95% CI: 0.46-0.87). The RCS regression model revealed a linear inverse association between BRI and constipation risk (nonlinearity test P = 0.083). Subgroup analyses identified significant interaction effects of BRI with age, alcohol consumption status, and hypertension on constipation risk (interaction P < 0.05). Post PSM, constipation patients demonstrated higher BRI levels than non-constipation counterparts (P = 0.013).

CONCLUSION

An inverse association was observed between BRI and constipation risk in U.S. adults, suggesting that lower BRI levels may correlate with raised constipation incidence. This underscores the critical importance of maintaining optimal BRI levels for constipation prevention. Further research is warranted to elucidate the underlying mechanisms governing this association.

EASL Clinical Practice Guidelines on the management of hepatitis B virus infection

The updated EASL Clinical Practice Guidelines on the management of hepatitis B virus (HBV) infection provide comprehensive, evidence-based recommendations for its management. Spanning ten thematic sections, the guidelines address diagnostics, treatment goals, treatment indications, therapeutic options, hepatocellular carcinoma surveillance, management of special populations, HBV reactivation prophylaxis, post-transplant care, HBV prevention strategies, and finally address open questions and future research directions. Chronic HBV remains a global health challenge, with over 250 million individuals affected and significant mortality due to cirrhosis and hepatocellular carcinoma. These guidelines emphasise the importance of early diagnosis, risk stratification based on viral and host factors, and tailored antiviral therapy. Attention is given to simplified algorithms, vaccination, and screening to support global HBV elimination targets. The guidelines also discuss emerging biomarkers and evolving definitions of functional and partial cure. Developed through literature review, expert consensus, and a Delphi process, the guidelines aim to equip healthcare providers across disciplines with practical tools to optimise HBV care and outcomes worldwide.

Poor prognosis of early-stage acral melanoma with a history of trauma: a multicenter analysis of 468 patients

BACKGROUND

Previous studies have suggested that trauma may be a risk factor for the development and prognosis of acral melanoma (AM).

METHODS

This population-based retrospective cohort study included patients with AM and a confirmed history of trauma who received treatment at 5 melanoma treatment centers in China. Factors associated with recurrence and survival were analyzed using univariate and multivariate Cox regression analyses.

RESULTS

Totally 468 AM cases were included in this study, with 101 patients in the trauma group and 367 in the non-trauma group. The trauma group had more patients with ulceration (P = .027), mitotic rate ≥ 1 (P = .036), and Clark level IV-V (P = .009) than the non-trauma group. Among stage I-II postoperative AM patients, the median recurrence-free survival (RFS) was 33.3 months (95% CI: 18.8-47.8) and 115.6 months (95% CI: 96.3-135.0) in the trauma and non-trauma groups, respectively (P < .001). Similarly, the median overall survival (OS) was 64.6 (95% CI: 54.8-74.4) and not reached (95% CI: NR), respectively (P = .002). Comparatively, no significant differences were observed in RFS or OS between the trauma and non-trauma groups in patients with stage III and IV AM. Multifactorial analysis showed that trauma was an independent risk factor for RFS and OS only in patients with stage I-II AM patients.

CONCLUSIONS

Postoperative stage I-II patients in the trauma group had significantly worse RFS and OS compared to those in the non-trauma group.

EASL Clinical Practice Guidelines on the management of autoimmune hepatitis

Autoimmune hepatitis (AIH) is a chronic liver disease of unknown aetiology which may affect any patient irrespective of age, sex, and ethnicity. At baseline, the clinical spectrum of the disease varies largely from asymptomatic cases to acute liver failure with massive hepatocyte necrosis. The aim of these EASL guidelines is to provide updated guidance on the diagnosis and management of AIH both in adults and children. Updated guidance on the management of patients with variants and specific forms of AIH is also provided, as is detailed guidance on the management of AIH-associated cirrhosis, including surveillance for portal hypertension and hepatocellular carcinoma, as well as liver transplantation in decompensated cirrhosis.

Peripartum fetal Doppler sonography and perinatal outcome: a systematic review and meta-analysis

OBJECTIVE

Systematically review and critically appraise the literature on the association between peripartum fetal Doppler sonography findings, i.e., acquired upon admission for spontaneous or induced labor, and perinatal outcome in term (37-42w) pregnancies.

METHODS

Medline, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov databases were systematically searched from inception to 05/2024. Studies conducted in unselected populations of term (37-42w) pregnancies, admitted for spontaneous or induced labor, reporting the association between fetal Doppler findings and perinatal outcome, were eligible for inclusion. Study eligibility was assessed independently by two reviewers. Methodological quality was assessed using the Quality In Prognosis Studies (QUIPS)-tool. Effect estimates were pooled using random-effects meta-analyses. Summary Odds Ratios (ORs) and Mean Differences (MDs) are reported with 95% confidence intervals.

RESULTS

Thirty-seven studies, reporting on 11.505 women and neonates, were included. Fourteen studies reported on findings from the umbilical artery (UA), four on the middle cerebral artery (MCA), five on the umbilical vein (UV), and nine on the cerebroplacental ratio (CPR). An abnormal UA Doppler and CPR increased the odds of fetal distress (FD) during labor (UA: OR 3.67 [1.14, 11.78], I2 = 72% - CPR: OR 3.19 [2.68, 3.80], I2 = 0%) and subsequent operative delivery (ODFD) (UA: OR 3.65 [1.66, 8.04], I2 = 81% - CPR: OR 2.48 [1.66, 3.70], I2 = 57%). Likewise, the presence of UV pulsations was strongly associated with both outcomes (FD: OR 28.78 [11.21, 73.87], I2 = 0% - ODFD: OR 303.36 [11.11, 8279.82], I2 = 0%). Regarding neonatal outcome, an Apgar-score < 7 at 5 min and NICU admission occurred more frequently if Doppler findings were abnormal in the UA (Apgar: OR 3.65 [1.82, 7.34], I2 = 0% - NICU: OR 3.92 [2.36, 6.51], I2 = 0%), or in case of an abnormal CPR (Apgar: OR 3.64 [2.03, 6.54], I2 = 0% - NICU: OR 2.71 [1.15, 6.38], I2 = 0%). Neonatal birthweight was also lower in the presence of an abnormal UA or CPR result, with a MD of -630.61g ([-1234.29, -26.93], I2 = 80%) and -146.52g ([-285.03, -8.01], I2 = 0%) respectively. Most studies (70.3%) were at high risk of bias on one or more domains; only 11 studies had an overall low risk of bias score.

CONCLUSION

Doppler sonography in the peripartum period allows for the identification of fetuses at risk of adverse birth outcomes. Further research on optimal thresholds to define at-risk cases and subsequent management strategies is needed.

PROSPERO REGISTRATION NUMBER

CRD42023413264.