Whether [18F]FDG PET/CT radiomic features provide information on tumor proliferation beyond conventional PET parameters remains uncertain. We investigated their associations with Ki-67 in untreated primary breast carcinoma using a predefined panel of technically reproducible features. This retrospective, single-center study included 42 women and 19 radiomic features previously selected based on interobserver reproducibility and redundancy, independently of Ki-67. Associations with continuous Ki-67 were evaluated using Spearman correlations, permutation tests, bootstrap confidence intervals, and false discovery rate (FDR) correction, alongside four conventional PET parameters. Five radiomic features showed significant associations with Ki-67 after FDR correction. The strongest association was observed for firstorder_90Percentile (ρ = 0.556; 95% CI, 0.279–0.745; q = 0.002), comparable to that of SUVmax (ρ = 0.565). However, none of these five associations remained significant after adjustment for metabolic tumor volume (MTV), SUVmax, or both, followed by FDR correction. Excluding six small lesions attenuated the correlations for both SUVmax (ρ = 0.440) and firstorder_90Percentile (ρ = 0.427). Although several radiomic features were associated with Ki-67, an independent contribution beyond conventional PET parameters was not demonstrated. These findings require confirmation in independent cohorts.
Background/Objective: In order to address the current knowledge gap with regard to serum calcium-to-magnesium ratio (Ca/Mg) in patients with adrenal incidentalomas, we aimed to analyze Ca/Mg in menopausal women diagnosed with these tumors versus (tumor-free) controls across DXA categories. Methods. This is a retrospective, real-world, cross-sectional study in 474 menopausal women admitted at a single tertiary center of endocrinology. Results. Tumor group (N=111) had osteoporosis/osteopenia/normal DXA prevalence: 17.1%, 36.9% and 46%, respectively, control group: 13.8%, 45.5%, and 40.8%. Ca/Mg ratio was similar between DXA sub-groups in each group. Tumor group: Ca/Mg corelated with age (r=0.288, p=0.047), P1NP (r= -0.459, p=0.011), osteocalcin (r= -0.37, p=0.026) and CrossLaps (r= -0.446, p=0.006) in subjects with normal DXA (N=51), while in those osteoporotic (N=19), with glycated hemoglobin A1c (r=0.596, p=0.025). Control group (N=363): Ca/Mg corelated with age (N=165, r=0.178, p=0.034), fasting glycemia (r=0.253, p=0.003), glycated hemoglobin A1c (r=0.22, p=0.045), osteocalcin (r= -0.196, p=0.03), and CrossLaps (r= -0.193, p=0.034) in osteopenic subjects (N=165) and with P1NP (r= -0.249, p=0.027) in normal DXA (N=148). Conclusion. Osteopenic subjects (regardless tumor diagnosis) showed a direct age-Ca/Mg association, while the ratio was correlated with the bone turnover biomarkers distinctively across DXA sub-groups. Additionally, the ratio might reflect a more severe glucose profile.
Brain tumors may present themselves initially under the appearance of depression, anxiety, psychosis, apathy, personality change, or cognitive decline, and psychiatric comorbidity remains frequent throughout the course of the neuro-oncological disease. In this Perspective, we argue that psychiatric expertise should be embedded in neuro-oncology care from the patient's first presentation through survivorship and palliation. We draw on the literature and on two cases from our liaison psychiatry service, in which older adults referred for depressive symptoms were found to have intracranial tumors and continued to need psychotropic treatment after successful surgery. We compare how DSM-5-TR and ICD-11 classify psychiatric syndromes secondary to brain disease and propose a four-domain etiological formulation that separates direct tumor effects, treatment-related and endocrine effects, psychological reactions, and pre-existing vulnerability. This article also presents the most relevant red flags that should prompt neuroimaging, the distinction between apathy and depression, the burden of depression, distress, suicide risk, and postoperative delirium, and the psychiatric effects of corticosteroids, antiseizure medications, dopamine agonists, and cranial irradiation. We also address practical psychopharmacology, electroconvulsive therapy, decision-making capacity, cognitive rehabilitation, and mood assessment in aphasia, while highlighting the scarcity of controlled evidence in this population. Finally, a phase-based, multidisciplinary model of care is proposed, and an outline of research priorities is presented.
Acute myocardial infarction (AMI) is a multifactorial condition and a leading cause of morbidity and mortality worldwide. This study aimed to assess the distribution of clinical and demographic characteristics among AMI patients and compare these findings with data from the RO-STEMI program for the Romanian population. We performed a case-control analysis of 138 patients presenting with chest pain at the Emergency Department of “Dr. Carol Davila” Central Military Emergency University Hospital between November 2021 and April 2022. The AMI group (n = 69) included patients with STEMI-specific ECG changes and elevated cardiac biomarkers, while the control group (n = 69) was represented by patients with chest pain but normal ECG and biomarkers. Men with AMI were 8.66 years younger than women, exceeding the 6.51-year difference reported by RO-STEMI. Hypertension and dyslipidemia were strongly associated with AMI (OR = 8.20 and OR = 7.36, p < 0.0001). During the pandemic, early presentation (<6 h) decreased by 15%, while arrivals within 6–12 h increased by 19.02%. Primary percutaneous coronary intervention was performed in 81.16% of cases versus 12.94% previously. Killip class and reduced left ventricular ejection fraction correlated with mortality and hospitalization duration. These findings indicate significant changes in AMI onset age, treatment strategies, and presentation delays compared to pre-pandemic data.
Background: COVID-19, declared a Public Health Emergency of International Concern, affected hospital operations by increasing the number of patients presenting to hospitals, the necessity to control infections, and the shortage of staff. Through our study, we evaluated the quality and quantity of care and how these changes affected patient experience and outcomes, and we identified actionable methods in order to prepare for the future. Methods: We analyzed data between 2020 and the first half of 2023 from a Romanian tertiary military hospital using patient-reported experience surveys and operational indicators (readmissions, postoperative complications). Associations were assessed using Pearson and Spearman correlation coefficients. We then benchmarked against an ideal surge-ready hospital using a 0-1 Composite Risk Index (CRI) that integrates occupancy, adverse-event density, flow reliability, and readmissions. Results: Overall satisfaction was strongly influenced by satisfaction with medical care (p < 0.001). Higher overall satisfaction was associated with fewer readmissions. Benchmarking showed the highest risk in the ICU, intermediate in Surgery and Internal Medicine, moderate in the ED, and the lowest in the Ambulatory. Satisfaction was highest in the initial period of the COVID-19 pandemic, dropped in 2022, and showed partial recovery at the end of this period. Conclusions: Quality of care is a critical measure of hospital performance, especially in the context of the COVID-19 pandemic. Patient feedback revealed areas of good practice and also the limits of the system, influenced by the burden of multisystem disease and limited resources. Post-COVID-19 disability outcomes are strongly influenced by the quality and continuity of care. Systematic use of patient- reported outcomes, standardized evaluation, and adaptive rehabilitation is essential to preserve the quality of care and reduce long- term functional impairment.
Background and purpose: Colorectal cancer is one of the most prevalent cancers globally, representing a significant public health challenge. Treatment methods include surgery, chemotherapy, and targeted therapies, selected based on disease stage and patient status. Common cancer treatments, such as chemotherapy and radiation therapy, often induce considerable side effects, including fatigue, nausea, hair loss, and blood disorders, which can impact patients' quality of life. Consequently, researchers are focusing on developing novel drugs and targeted therapies aimed at reducing side effects while enhancing treatment efficacy. Innovative therapies, including bacterial and oncolytic viruses, can specifically target cancer cells while sparing healthy tissues. The present study aims to compare the cytotoxic effects of Lactobacillus casei extract with Newcastle disease virus on human colorectal cancer. Materials and methods: Human colorectal cancer cells were cultured and treated with various concentrations of Lactobacillus casei extract and Newcastle disease virus to determine the IC50. Cell viability and apoptosis rates were then assessed using MTT assay and acridine orange/propidium iodide staining. Statistical significance was set at P<0.05 for all evaluations. Results: The results demonstrated that both Lactobacillus casei extract and Newcastle disease virus significantly reduced cell viability and increased apoptosis in a concentration- and time-dependent manner. Caspase-8 and -9 activity measurements indicated that Newcastle disease virus and Lactobacillus casei extract activated both the mitochondrial and extrinsic apoptotic pathways. Conclusion: Based on the findings, it appears that bacterial and oncolytic viruses could be considered as complementary therapeutic options alongside chemotherapy and radiotherapy, following clinical trials.
Knee osteoarthritis (KOA) is a chronic, degenerative disease that affects not only the bone and cartilage but also all periarticular soft tissues. Transcriptomic investigations in osteoarthritis have recently advanced due to the introduction of RNA sequencing, which has been used to elucidate significant molecular differences between groups of patients with KOA. A total of 29 patients with knee pain were selected and divided into two groups. Group 1 comprised 26 patients, who were diagnosed with stage four KOA according to the Kellgren and Lawrence (KL) classification and were scheduled for total knee arthroplasty. Group 2 consisted of three patients who constituted the control group. The main objective of this study is to analyze gene expression in suprapatellar synovial tissue using the RT-PCR technique in patients with knee osteoarthritis. The promising results of gene expression analysis highlight the complex transcriptomic profile of synovial tissue in patients with stage IV KL KOA who required TKA after conservative treatments failed. The analysis of the expression of four genes indicates that compensatory mechanisms are either insufficient or exhausted due to the chronic proinflammatory status. Pro-inflammatory transcription factors (JUN, MYC) and feedback regulators (DUSP1, NFKBIA) require extensive clinical trials for the use of disease-modifying drugs.
Many patients, usually over 60 years old, presenting presenile dementia associated with marked gait disorders, impaired balance, urinary incontinence, have been shown to have enlarged ventricles associated with relatively small cortical atrophy. Intracranial pressure monitoring indicates normal values, or subject to only minor peaks, usually at night. Because some of these patients improve markedly after ventricular shunting procedures it has been suggested that their neurological dysfunction may be caused by a pressure effect on the brain from the increased internal surface of the ventricles. Many of these patients do benefit from surgery, and a lot of them have a history of subarachnoid hemorrhage, traumatic brain injury or meningitis which might have impaired the CSF absorption.
Chronic pancreatitis is characterised by progressive and irreversible damage of the pancreatic parenchyma and ductal system, which leads to chronic pain, loss of endocrine and exocrine functions. Clinically, pancreatic exocrine insufficiency becomes apparent only after 90% of the parenchima has been lost. Despite the simple definition, diagnosing chronic pancreatitis remains a challenge, especially for early stage disease. Because pancreatic function tests can be normal until late stages and have significant limitations, there is an incresing interest in the role of imaging techniques for the diagnosis of chronic pancreatitis. In this article we review the utility and accuracy of different imaging methods in the diagnosis of chronic pancreatitis, focusing on the role of advanced imaging (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography and endoscopic ultrasound).
Autoimmune cholangitis defines a spectrum of cholestatic liver diseases that are characterized by inflammation of bile ducts and a reasonable response to immunosuppressive therapy. The two most common diseases associated with this term in the literature are: an overlap syndrome of primary biliary cirrhosis and autoimmune hepatitis and a form of hyper IgG4 syndrome (currently associated with autoimmune pancreatitis). Liver biopsy is mandatory for the diagnosis. There are, whatsoever, in clinical practice, many cases that do not meet current diagnostic criteria but that have a good response to corticosteroid treatment.
