Search Results (118)

Human epidermal growth factor receptor 2 (HER2) remains the most recognized and clinically established molecular biomarker in gastric cancer; however, the regulatory mechanisms underlying its dysregulation are not fully understood. This study aimed to identify microRNAs associated with HER2 gene amplification, chromosome 17 centromere copy number increase (CNI), or alternative mechanisms driving HER2 protein overexpression. We analyzed 115 gastric cancer patients treated surgically at a single institution, with available material for immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and microRNA profiling. Among 11 candidate microRNAs, four demonstrated significant associations with HER2-related alterations. hsa-miR-128-3p expression was positively associated with HER2 gene amplification, while hsa-miR-145-5p expression showed an inverse relationship with centromere enumeration probe 17 (CEP17) signal count and correlated with membranous HER2 protein expression. hsa-miR-27b-5p expression was linked to CEP17 CNI, whereas hsa-miR-552-3p expression was associated with both increased HER2 amplification and CEP17 signal count. Importantly, hsa-miR-27b-5p upregulation independently predicted worse overall survival, whereas hsa-miR-128-3p upregulation independently predicted improved survival outcomes. These findings identify distinct microRNA signatures associated with HER2 pathway alterations and prognosis in gastric cancer, highlighting their potential as biomarkers and contributors to HER2-driven tumor biology. Full article

Background/Objectives: Nowadays, transcatheter aortic valve implantation (TAVI) is widespread in patients with severe aortic valve stenosis. New prosthesis designs are becoming available to address the shortcomings of their predecessors and improve clinical outcomes. Methods: Electronic databases were screened for studies comparing outcomes of TAVI with Portico and SAPIEN 3. In a random-effects meta-analysis the pooled incidence rates of procedural, clinical and functional outcomes, according to VARC-2 definitions, were assessed. Results: Thirteen observational studies and one multi-center randomized clinical trial enrolling 20,522 patients (Portico N = 3001 and SAPIEN 3 N = 17,521) were included in the analysis. The need for more than one prosthesis during initial implantation was significantly higher among Portico recipients compared to SAPIEN 3 recipients: (RR 2.72 [1.36, 5.45] p = 0.005). Pre- and post-dilatation were performed more frequently in the Portico group (RR 1.53 [1.12, 2.09], p = 0.008 and RR 4.21 [2.83, 6.26], p < 0.00001, respectively). Moderate-to-severe paravalvular leak (PVL) was significantly more common in the Portico arm (RR 3.27 [1.80, 5.91] p < 0.0001). In contrast, the mean gradient and rate of prosthesis–patient mismatch (PPM) was significantly lower in the Portico group (MD −31.58 [−37.02; −26.14] mmHg and RR 0.42 [0.32, 0.55], p < 0.00001). Recipients of Portico demonstrated over 60% higher risk of permanent pacemaker implantation (PPI) compared to SAPIEN 3 (RR 1.62 [1.25, 2.10], p = 0.0002). Other procedural and short-term clinical outcomes, including neurologic events, major vascular complications, life threatening or major bleeding, acute kidney injury, myocardial infarction and mortality did not differ between the devices. A difference in mortality was observed at the 1-year follow-up (RR 1.26 [1.06, 1.51], p = 0.01; I² = 5%). Conclusions: The evidence shows good short-term outcomes for both valves. Compared to SAPIEN 3, Portico was associated with a significantly higher rate of moderate-to-severe PVL and PPI, but a lower mean gradient and incidence of PPM. A significantly higher 1-year mortality was observed in the Portico group. Full article

Cardiac surgery carries substantial risk of early postoperative complications including postoperative atrial fibrillation (POAF, 30–50%), periprocedural myocardial infarction (PMI), acute kidney injury (AKI, 3.8–54.4%), bleeding (3–5%), stroke, and cognitive dysfunction. This narrative review synthesizes 30+ studies on circulating microRNAs (miRNAs) as perioperative biomarkers, identifying strongest evidence for cardiac-enriched miR-499 (AUC 0.93, sensitivity 85.7%, specificity 93.3%) and miR-133a (peaks 1–3 h post-declamping) in PMI diagnosis -outperforming troponins’ 6h kinetics. POAF prediction favors preoperative miR-483-5p (AUC 0.78), while AKI, bleeding (miR-223), and neurological injury show emerging but less validated candidates (miR-21, miR-210-3p). We critically analyze limitations across studies and outline clinical translation barriers (3–6 h assay times, heparin inhibition, lacking standardization) with solutions for point-of-care implementation. Full article

Women in mining face unique health and safety challenges due to anatomical and physiological differences, making the assessment and management of ergonomic risks in underground coal mines critical. This study examines the ergonomic experiences of female mineworkers through six focus-group discussions, each comprising eight participants, using a qualitative research design involving women actively engaged in core mining activities at three South African mines. Findings reveal that mining equipment and work environments often fail to accommodate the physiological needs of female workers, exposing them to a range of ergonomic hazards. Beyond physical risks, the study highlights organizational and systemic shortcomings, including inadequate implementation of existing policies and regulations. Poor hygiene in toilet facilities was also reported, with three out of eight participants taking medication for urinary tract infections, underscoring gaps in occupational health provision. The findings emphasize the urgent need for mine-specific ergonomic programs developed through participatory approaches, as part of a broader strategy to prevent musculoskeletal injuries and improve working conditions for female mineworkers. The establishment of the Women in Mining Forum further indicates that the industry is not yet fully prepared to support women in underground mining, highlighting the need for targeted interventions to create a safer, more inclusive work environment. Full article

In oncology, traditional H&P templates centered on a single chief complaint often fail to address the longitudinal care needs and emotional complexities of cancer patients, leaving learners unprepared for sensitive conversations such as breaking bad news or discussing treatment goals. To address this, we conducted a literature review of specialty-focused H&P tools in child psychiatry and gynecology and, drawing on our experiences as two first-year medical students in an outpatient oncology clinic, developed an oncology H&P template to guide novice clinicians. The guide incorporates structured prompts for rapport-building; detailed oncologic and family cancer history; functional independence assessments; treatment goals; emotional wellbeing; support networks; and responding to emotion. After initial pilot testing by the two developers under supervisor guidance, the template was distributed to five then ten additional students and disseminated via the ASCO online forum and Twitter. Feedback from ten oncologists and oncology trainees highlighted the template’s value in gathering review of systems, past treatment details, functional status, and cancer history. Our findings suggest that this oncology-tailored tool enhances interview flow, promotes comprehensive data collection, and supports empathetic patient engagement. Integration into routine oncology training is planned, with future adaptations for specific oncological subspecialties and potential use in other medical specialties. Full article

Background/Objectives: Rheumatic fever is preventable and can be treated successfully; however, a lack of understanding of the disease and barriers to timely healthcare can impact outcomes. Pacific people in Aotearoa New Zealand experience inequitable burdens, and a Pacific community group and health professional network are working together to co-design education initiatives. This descriptive, mixed-methods study aimed to (1) explore Pacific people’s awareness and understanding of rheumatic fever, (2) describe where Pacific people access health information. Methods: An online survey co-developed with Pacific community members was run from December 2024 to February 2025. Questions related to sore throats, rheumatic fever, medication adherence, long-term outcomes and where Pacific people access health information. Quantitative data was analyzed descriptively using SPSS version 28 and open-ended qualitative responses were analyzed using an inductive content analysis approach. Results: A total of 400 Pacific respondents were included: 34% were aged 16–24 years and 66% were female. Based on the analysis, 71% of Pacific participants knew that a sore throat should always be checked by a health professional and 65.3% had heard of rheumatic fever. Fever and sore throats were commonly identified as symptoms of rheumatic fever, with joint pain, body aches and chest pain mentioned less. Barriers to health services such as cost, long waiting times and cultural factors were discussed as reasons why many Pacific people often utilize social media and online forums for health information. Conclusions: This study highlights gaps in rheumatic fever knowledge and thus opportunities for health education initiatives for Pacific communities, potentially utilizing social media and online platforms. Full article

The challenge of accurately identifying the appropriate medical specialty based on patient symptoms leads to delays in diagnosis and treatment. This paper presents an AI model developed to classify medical specialties from symptom descriptions. The model, implemented with BERT, hosted via a Python-based Flask API v3, and integrated with an interactive frontend application, allows users to input symptoms textually or interactively select affected body parts and answer multiple choice questions. Following deployment, feedback data from doctors and residents was collected and utilized to enhance the model performance, supplemented by additional data from online medical forums. This study demonstrates significant improvements in finding the correct medical specialty, contributing to more efficient patient triage, reducing the time to diagnose and treat patients, and eliminating the presence of doctors in the initial process as they are often busy in emergency departments. The use of generative AI and large language models, notably BERT, is highlighted as a key factor in the model’s success. Full article

Objectives: miR-21-5p, miR-145-5p and miR-382-5p have been associated with angiogenesis, which plays a central role in tumor growth and metastasis formation. The aim of the study was to determine whether expression of these three potentially angiogenic miRNAs is related to the lymphatic spread capability of gastric adenocarcinoma and patient survival. Methods: Pathoclinical data of 123 patients who underwent elective gastric resection for adenocarcinoma between 1 August 2006 and 31 December 2013 were retrospectively retrieved. The major concerns were the total number of lymph nodes retrieved, the number of positive nodes, depth of the tumor invasion to the stomach wall, pTNM stage of the disease, Lauren histological tumor type, presence of a mucinous component in the cancer tissue, tumor location in the stomach and survival outcome. The cancer tissues of patients were examined for the expression levels of miR-21-5p, miR-145-5p and miR-382-5p. Results: Elevated hsa-miR-21-5p expression levels and downregulated hsa-miR-145-5p levels were observed in patients with a higher pT stage, lymph node metastasis and advanced pTNM stage. Additionally, hsa-miR-145-5p expression was lower in patients with cardia involvement and a Lauren intestinal-type carcinoma. hsa-miR-382-5p levels were higher in patients with non-mucinous gastric carcinoma. Both hsa-miR-145-5p and hsa-miR-21-5p were predictors of the presence of node metastasis, even when adjusted for pT status. hsa-miR-145-5p was significantly associated with improved survival. hsa-miR-145-5p was significantly associated with an increased probability of surviving 3 years, while increased hsa-miR-21 expression was significantly associated with reduced 3-year survival. All these associations were confirmed in multivariate models, which also included pT and M staging. Conclusions: The upregulation of miR-21-5p and downregulation of miR-145-5p are independent prognostic factors for lymph node metastasis and could serve as specific biomarkers of the lymphatic spread of gastric adenocarcinoma. miR-145-5p downregulation is an independent prognostic factor for overall survival. Full article

The implementation of the European (EU) Health Technology Assessment (HTA) Regulation 2021/2282 (EU HTAR) offers many opportunities, aimed at harmonizing HTA procedures and improving access to innovations; it also represents a significant challenge for the European healthcare system. Within the 2024 Health Policy Forum Italy meeting, different actors, stakeholders, and institutions had the opportunity to discuss major criticism and opportunities coming from the EU-HTA Regulation addressing future developments in the healthcare sector. Two groups, EU & Italy Pharmaceuticals and EU-Italy Medical Devices, worked distinctively on the EU HTAR by highlighting key issues that may pose challenges at both European and national levels, proposing potential solutions. The allocation of participants into two groups, according to their affiliation with either the pharmaceutical or the medical device sector, enhances the diversity of professional backgrounds and institutional perspectives, thereby fostering a more comprehensive and informed discussion. The recommendations highlighted by the two groups emphasize the need to promote cooperation among Member States, strengthen training for decision-makers, and develop a monitoring system to evaluate EU HTA’s impact. Full article

Background/Objectives: Patients with inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) exhibit complex clinical profiles due to autonomic dysfunction. While sinus node sparing (SNS) hybrid ablation is emerging as a promising therapy, there are no established guidelines worldwide for post-procedure patient management and care is mainly based on telemonitoring. In contrast, our hybrid cardiac rehabilitation (HCR) program integrates inpatient care and home-based telerehabilitation. We aim to evaluate the implementation of the HCR program, patient acceptance and adherence, and the effectiveness of the Malmö POTS scoring system in monitoring disease progression and rehabilitation outcomes. Methods: Patients underwent a personalized HCR program after SNS. The program included early mobilization, psychological support, respiratory therapy, and structured exercise. Clinical outcomes were assessed using symptom burden (Malmö POTS score), ECG parameters, exercise duration, perceived exertion, and rehabilitation adherence. Results: All patients completed the inpatient phase, and 87% completed the home-based phase. In the early postoperative period, pericarditis, anemia, and benign rhythm disturbances were mild and self-limiting. The Malmö POTS score decreased from 65.3 to 25.7. Lower perceived exertion early in the program correlated with clinical improvement. At the 2-month follow-up, 81% of patients no longer met the clinical criteria for IST/POTS without the use of medications. The program was evaluated as safe, feasible, and well-tolerated, with high patient satisfaction. Conclusions: A well-organized hybrid cardiac rehabilitation program after SNS is feasible, safe, and well-tolerated in IST/POTS patients. The Malmö POTS score may support outcome monitoring. The integration of individualized training and telemedicine represents a promising development for patients post-SNS ablation. While this study demonstrates feasibility and potential benefits, further controlled studies are needed to evaluate its impact on long-term recovery and symptom control. Full article

Background: Chronic inflammatory bowel disease significantly impacts patients’ everyday lives. Despite receiving regular medical care in gastroenterological or family medicine consultations, patients with inflammatory bowel disease (IBD) still experience a lack of information. To evaluate these deficits, we analyzed the main points of interest raised in an online consultation forum offered as a supplementary resource for patients. Methods: We analyzed 20 years of online consultation data at three time points, 2003 (launch of the forum), 2013, and 2024, and compared them against each other. A total of 681 patients participated in the consultations during these years. The clinical profiles of the participants included Crohn’s disease (CD, n = 209), ulcerative colitis (UC, n = 140), unclassified colitis (IBDU, n = 30), and individuals with no specified diagnosis (NSD, n = 303). Results: Patients with ulcerative colitis demonstrated interest in topics such as diet and nutrition, as well as treatment with biologics. Patients with Crohn’s disease expressed interest in diet, nutritional management, and treatment with biologics. Additionally, they showed interest in pain management, diagnostic imaging, and stress management. In the case of patients with unclassified colitis, a broad range of topics was addressed, with no single area emerging as particularly prominent. Patients with no specified diagnosis exhibited interest in diet and nutrition, laboratory diagnostics, and pain therapy. Conclusions: For patients with inflammatory bowel disease, online consultations represent a valuable complement to standard medical care. They provide additional support and contribute to enhancing patients’ confidence in managing their condition. A broad spectrum of disease-related topics was addressed during the consultations. Identified information gaps can be systematically discussed and subsequently reduced. Full article

As part of the substantial public discourse surrounding the distribution and use of mifepristone, which is used with misoprostol to facilitate drug-induced abortions, claims comparing the safety of this regimen to that of common pharmaceuticals have emerged and proliferated. Offered in forums ranging from social media to the Supreme Court, these claims have so gained public acceptance that they are now echoed without scrutiny and, at times, reference. Yet the simplistic slogan that “mifepristone is safer than Tylenol”, though easily disseminated, defies both an intuitive understanding of how we evaluate drug safety and our norms and regulations for doing so. Indeed, if such an assertion was attributable to the manufacturer, it would precipitate a reprimand by the FDA given the lack of specific, controlled, and head-to-head evidence rightly required for its support. To the extent that these claims persist, however, including among the outputs of medical societies, abortion centers, clinical researchers, and government officials, and to the extent that they aim to inform both individual and public decision-making, it is critical that the evidence offered for their support be thoroughly explored. Such examination reveals these claims to be wholly unfounded, offering deficient and disingenuous representations of safety for any of the drugs compared. Full article

Background: Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively. Methods: Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients. Results: In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (p < 0.001) and the renal arteries (p < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure. Conclusion: Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery. Full article

Coronary artery atherosclerosis is a common condition characterized by different symptomatology and incidences of risk factors. The disease manifestation may differ; therefore, proper diagnosis is essential. The preventive, diagnostic, and therapeutic arms are still developing to improve patient outcomes. Among diagnostic steps, the non-invasive tools for evaluating non-classical factors related to metabolomic profiles are gaining attention. The aim of this study was to investigate possible metabolic profiling differences between patients with chronic coronary artery disease (CAD) and a control group based on plasma sphingomyelin levels. The study group consisted of 23 patients (72% male, median age of 69 (63–72) years) presenting with chronic coronary syndrome and confirmed epicardial disease in coronary angiography and 15 patients (33% male, median age of 70 (64–72) years) with normal angiographic results. Clinical data were recorded, and blood samples were collected for standard biochemical laboratory assessment and metabolomic profiling. The plasma sphingomyelin levels were evaluated in patients with different degrees of coronary artery atherosclerosis involvement. In addition, the severity of the epicardial disease was estimated by the Gensini Score. The study subgroups did not differ in terms of age (p = 0.765) and co-morbidities, though the male sex was more common in the CAD group (p = 0.007). The analysis revealed significant differences regarding neutrophil count (p = 0.014), neutrophil-to-lymphocyte ratio (NLR) (p = 0.016), and high-density lipoprotein (HDL) (p = 0.003). Among different plasma sphingomyelin species, there was a significant difference in plasma SM42:1 level (16.2 (14.2–19.1) vs. 20.8 (18.9–21.7) (p = 0.044) between the CAD and control groups, respectively. The SM 42:1 plasma level was independent of the number of involved epicardial arteries (p = 0.109). However, Spearman correlations tests were performed between the SM 42:1 plasma level and the number of coronary arteries diagnosed with atherosclerosis disease (rho = −0.356, p = 0.014) and the severity of the disease measured by the Gensini Score (rho = −0.403, p = 0.006). There was no correlation between plasma sphingomyelin levels and NLR (Spearman’s rho = −0.135, p = 0.420), suggesting a lack of inflammatory associations. Further, sphingomyelins showed no relationship with coronary artery disease risk factors such as dyslipidemia and diabetes. Lower plasma SM 42:1 levels were revealed in the CAD group compared with the control group, indicating a possible significance of sphingomyelin 42:1 in coronary artery disease progression. Full article