Search Results (25,779)

Spigelian hernia (SH) is an infrequent aponeurotic defect in Spiegel’s semilunar line. The literature on pediatric SH is scarce. A comprehensive review of the previous literature was conducted. Eligible studies were identified by searching primary medical bibliography databases, and a pooled analysis of published case-level data was performed. Medians and interquartile ranges were used to describe the quantitative variables and proportions for categorical variables. The Kruskal–Wallis, Mann–Whitney U, and Fisher’s exact tests were used to compare group variables. Spearman’s and Pearson’s correlation analyses were used to assess the degree of correlation between variables, while Cramér’s V was applied to evaluate the degree of association among the variables. A p-value < 0.05 (two-tailed) was considered statistically significant. Our search identified 82 publications reporting on 123 patients (106 male, 86.2%), with an age range of 0–21 years. Forty-seven patients (38.2%) had a left-sided SH, fifty-six (45.5%) had a right-sided SH, and thirteen (10.6%) had a bilateral SH. Traumatic SH, mostly from bicycle injuries, accounted for 45 cases (36.6%), while 41 (33.3%) were associated with undescended testis (UDT). In this series of published cases, hernia incarceration/strangulation (I/S) was reported in 15 patients (12.2%), who were significantly younger (p = 0.02). Surgical correction was performed in 95 cases (77.2%), 14 of them laparoscopically, with a 35.7% conversion rate. Eight cases (6.5%) were managed conservatively. Overall, outcomes were favorable. SH is an infrequent pediatric condition that, based on the synthesized literature, predominantly affects males. The published cases suggest two main clinical phenotypes: a congenital form, often linked to ipsilateral UDT, and an acquired form, typically resulting from trauma. Analysis of the reported data indicates a higher risk of incarceration in early childhood. Surgical treatment is the most frequently reported approach with generally favorable outcomes, whereas the evidence for conservative management remains limited. This comprehensive review highlights the dual nature of pediatric SH and underscores the need for a high index of suspicion in relevant clinical scenarios. Full article

Background/Objectives: All-inside ACL reconstruction has emerged as a minimally invasive alternative to conventional techniques, with potential advantages in graft configuration and reduced surgical trauma. This study aimed to compare the clinical outcomes of all-inside and full tibial tunnel ACL reconstruction, focusing on graft diameter, postoperative stability, and functional recovery. We hypothesized that the all-inside technique would allow for thicker grafts and yield superior postoperative knee stability and functional outcomes, with postoperative anterior laxity as a major outcome of interest. Methods: This retrospective comparative study reviewed patients who underwent ACL reconstruction between January 2020 and February 2024. From January 2020 to September 2022, a four-strand hamstring autograft with full tibial tunnel technique (FT-4) was used, while from September 2022, a six-strand hamstring autograft with the all-inside technique (AI-6) was adopted to enable thicker grafts and optimize fixation. Among a total of 103 patients, 1:1 propensity score matching (PSM) was performed based on age, sex, BMI, laterality, ALL reconstruction, meniscal lesion, and preoperative anterior laxity (SSD). Graft diameter and clinical outcomes, including knee stability and functional scores, were compared between the matched groups. Results: After PSM, two comparable groups of 29 patients each were established. Graft diameter was significantly larger in the AI-6 group (9.5 ± 0.7 mm) compared to the FT-4 group (7.8 ± 0.8 mm, p < 0.001), while other baseline characteristics remained well balanced between the groups. At the final follow-up, both groups exhibited significant improvements in anterior laxity, functional scores, and pivot shift grades (all p < 0.001). The AI-6 group demonstrated superior outcomes with a significantly higher Lysholm score (82.2 ± 6.7 vs. 75.6 ± 8.9, p = 0.002), lower WOMAC score (8.0 ± 4.3 vs. 12.9 ± 10.5, p = 0.023), and reduced anterior laxity (1.6 ± 1.1 mm vs. 2.5 ± 1.4 mm, p = 0.005) compared to the FT-4 group, whereas no significant differences were observed in the IKDC, Tegner, Korean knee score, or pivot shift test results. A simple linear regression revealed a significant negative correlation between graft diameter and postoperative anterior laxity (B = −0.398, p = 0.048). Conclusions: The present study demonstrated that the use of a six-strand hamstring graft configuration in the AI-6 technique resulted in significantly thicker grafts and was associated with reduced postoperative anterior knee laxity compared to the FT-4 technique. While interpretation of these findings requires caution in light of MCID thresholds, the AI-6 group showed favorable outcomes in anterior laxity and selected functional scores, such as the Lysholm and WOMAC. This technique may offer practical clinical value, particularly in populations prone to smaller graft diameters, as it facilitates adequate graft thickness through multifold preparation, with the all-inside approach accommodating the inherent graft shortening. Full article

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is now widely acknowledged as belonging to the broader category of metabolic disorders, being closely associated with obesity, insulin resistance, and chronic systemic inflammation. Recent evidence indicates that in MASLD, alterations in the gut–liver axis—particularly increased intestinal permeability may serve as a crucial mechanistic link between metabolic dysfunction and hepatic steatosis. Zonulin, a physiological modulator of intestinal tight junctions, has been suggested as an indicator of compromised barrier integrity; however, its specific role in MASLD remains to be fully elucidated. Materials and Methods: We conducted a prospective observational study including 52 adult patients diagnosed with MASLD. Hepatic steatosis was evaluated using the SteatoTest (FibroMax panel), while fecal zonulin levels were measured by ELISA at baseline. Clinical, anthropometric, and metabolic parameters were assessed. We used ROC curve analysis to explore zonulin’s predictive value for moderate-to-severe steatosis (≥S2). Results: Elevated fecal zonulin (>107 ng/mL) occurred in 26.9% of participants. In a binary logistic model with SteatoTest ≥ S2 as outcome, zonulin was independently associated with clinically significant steatosis (OR per 1 ng/mL = 1.017; 95% CI 1.002–1.032; p = 0.029). Discrimination for ≥S2 was AUC = 0.680 (95% CI 0.535–0.825; p = 0.015). The Youden-optimal cut-off was 57.0 ng/mL (sensitivity 68.2%, specificity 63.3%) versus 40.9%/83.3% at the manufacturer’s 107 ng/mL threshold. Conclusions: Fecal zonulin shows modest discriminatory ability for steatosis and is best used as an adjunct to non-invasive assessment; cohort-specific calibration (57.0 ng/mL) outperformed the generic 107 ng/mL threshold. Full article

Background/Objectives: Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy with a strong clinical impact on patients affected by the disease and a challenging diagnosis. Methods: This comprehensive narrative review evaluates the role of [18F]fluorodesoxyglucose ([18F]FDG) positron emission tomography (PET)-based radiomics and machine learning (ML) analyses in the assessment of CS. Results: The value of [18F]FDG PET-based radiomics and ML has been investigated for the clinical settings of diagnosis and prognosis of patients affected by CS. Even though different radiomics features and ML models have proved their clinical role in these settings in different cohorts, the clear superiority and added value of one of them across different studies has not been demonstrated. In particular, textural analysis and ML showed high diagnostic value for the diagnosis of CS in some papers, but had controversial results in other works, and may potentially provide prognostic information and predict adverse clinical events. When comparing these analyses with the classic semiquantitative evaluation, a conclusion about which method best suits the final objective cannot be drawn with the available references. Different methodological issues are present when comparing different papers, such as image segmentation and feature extraction differences that are more evident. Furthermore, the intrinsic limitations of radiomics analysis and ML need to be overcome with future research developed in multicentric settings with protocol harmonization. Conclusions: [18F]FDG PET-based radiomics and ML show preliminary promising results for CS evaluation, but remain investigational tools since the current evidence is insufficient for clinical adoption due to methodological heterogeneity, small sample sizes, and lack of standardization. Full article

Candida albicans and Candida glabrata are key fungal pathogens linked to candidiasis, with rising concerns due to antifungal resistance and biofilm abilities. However, data from Latin America remains limited. This study assessed biofilm formation and antifungal susceptibility of vaginal Candida isolates from Ecuadorian women. Biofilm formation at 24 and 48 h was evaluated using biomass and CFU assays and the biofilm formation index. Antifungal resistance in planktonic cells and patient microbiota profiles were also analyzed. Biofilm assessment showed 57.14% of isolates were high biofilm formers, 33.33% intermediate, 4.76% low, and 4.76% non-formers. Planktonic susceptibility testing included fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, flucytosine, and amphotericin B. Micafungin showed the lowest MBEC90 value among tested antifungals, with an average MIC of 0.15 µg/mL, MBIC90 of 1.26 µg/mL, and MBEC90 of 1.86 µg/mL. Fluconazole followed with MIC, MBIC90, and MBEC90 values of 4.19, 63.33, and 66.59 µg/mL. Flucytosine had the highest values (MIC = 11.36 µg/mL; MBIC90 = 244.71 µg/mL; MBEC90 = 245.33 µg/mL). Both micafungin and flucytosine produced similar reductions in viable biofilm cells (1.44 log CFU), while fluconazole induced a slightly lower reduction of 1.39 log CFU. Findings suggest echinocandins may be effective against biofilm-forming Candida in this Ecuadorian population subset. Full article

Recent years have provided numerous reports on the mechanisms of action of psychiatric medications (antidepressants, antipsychotics, mood stabilizers, and antidementia drugs) that directly inhibit the growth of cancer cells, as well as on their indirect effects on the psyche and immune system, and their supportive effects on chemotherapeutic agents. The mechanisms of the anticancer activity of psychiatric drugs include inhibition of dopamine and N-methyl-D-aspartate receptors that work via signaling pathways (PI3K/AKT/mTOR/NF-κB, ERK, Wnt/ß-catenin, and bcl2), metabolic pathways (ornithine decarboxylase, intracellular cholesterol transport, lysosomal enzymes, and glycolysis), autophagy, Ca²⁺-dependent signaling cascades, and various other proteins (actin-related protein complex, sirtuin 1, p21, p53, etc.). The anticancer potential of psychiatric drugs seems to be extremely broad, and the most extensive anticancer literature has been reported on antidepressants (fluoxetine, amitriptyline, imipramine, mirtazapine, and St John’s Wort) and antipsychotics (chlorpromazine, pimozide, thioridazine, and trifluoperazine). Among mood stabilizers, lithium and valproates have the largest body of literature. Among antidementia drugs, memantine has documented anticancer effects, while there is limited evidence for galantamine. Of the new psychiatric substances, the antipsychotic drug brexpiprazole and the antidepressant vortioxetine have a very interesting body of literature regarding glioblastoma, based on in vitro and in vivo animal survival studies. Their use in brain tumors and metastases is particularly compelling, as these substances readily cross the blood–brain barrier (BBB). Moreover, the synergistic effect of psychiatric drugs with traditional cancer treatment seems to be extremely important in the fight against chemo- and radio-resistance of tumors. Although there are some studies describing the possible carcinogenic effects of psychiatric drugs in animals, the anticancer effect seems to be extremely significant, especially in combination treatment with radio/chemotherapy. The emerging evidence supporting the anticancer properties of psychiatric drugs presents an exciting frontier in oncology. The anticancer properties of psychiatric drugs may prove particularly useful in the period between chemotherapy and radiotherapy sessions to maintain the tumor-inhibitory effect. While further research is necessary to elucidate the mechanisms, clinical implications, dose-dependence of the effect, and clear guidelines for the use of psychiatric medications in cancer therapy, the potential for these commonly prescribed medications to contribute to cancer treatment enhances their value in the management of patients facing the dual challenges of mental health and cancer. Full article

Background: Serum markers are commonly used to diagnose bone and joint infections; however, their accuracy for diagnosing pyogenic spondylitis remains unproven. This study aimed to validate the diagnostic accuracy of inflammatory, nutritional, and immunological serum markers for spinal infections and identify the most effective combinations. Methods: The retrospective cohort study analyzed 656 patients who visited the hospital for spinal diseases between 1 January 2004 and 31 March 2021; a total of 76 were diagnosed with pyogenic spondylitis. Blood samples were analyzed for serum albumin (Alb), total protein (TP), globulin (Glb), C-reactive protein (CRP), platelet count, white blood cell count, neutrophil count, lymphocyte count, and monocyte count. Combination markers, including albumin–globulin ratio (AGR), CRP–albumin ratio (CAR), CRP–AGR (CAGR), neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR), were also evaluated. Receiver operating characteristic curves were used to determine each marker’s diagnostic performance. Furthermore, multivariate analysis was performed to examine the odds ratios. Results: Patients with pyogenic spondylitis showed significantly different levels in Alb (p < 0.0001), Glb (p < 0.0001), CRP (p < 0.0001), platelet count (p < 0.0001), WBC count (p < 0.0006), neutrophil count (p = 0.0019), lymphocyte count (p = 0.0085), AGR (p < 0.0001), CAR (p < 0.0001), CAGR (p < 0.0001), NLR (p < 0.0001), and PLR (p < 0.0001). CRP (AUC = 0.80) showed good diagnostic accuracy, while combination markers CAR (AUC = 0.82) and CAGR (AUC = 0.83) had the highest areas under the curve (AUC). Multivariate analysis indicated that decreased age and the presence of comorbidities (including chronic kidney disease, chronic liver disease, malignancy, or diabetes), were independent predictors of early pyogenic spondylitis (OR_age = 0.93, OR_comorbidities = 16.98, p_age = 0.0005, and p_comorbidities = 0.0001). In patients with low-inflammatory pyogenic spondylitis, significant differences were observed in TP (p = 0.0293), Glb (p = 0.0012), CRP (p = 0.0023), platelet count (p = 0.0108), AGR (p = 0.0044), CAR (p = 0.0006), CAGR (p = 0.0004), PLR (p = 0.0192), and NLR (p = 0.0027), with CAGR showing the highest AUC (AUC = 0.70) among them. Conclusions: Serum combination markers (AGR, CAGR, CAR, PLR, and NLR) showed diagnostic value for pyogenic spondylitis, with CAGR achieving the highest accuracy. In low-inflammatory pyogenic spondylitis patients (CRP ≤ 1.0 mg/dL), these markers may aid diagnosis. Full article

Background and Objectives: Ureteral kinking may hinder endoscopic access and reduce the success of ureteroscopic lithotripsy (URSL). This study evaluated whether kinking can be predicted preoperatively using non-contrast computed tomography (CT) by introducing a novel metric—Maximum Horizontal Ureteral Displacement (HUDmax)—and assessed its predictive value for procedural success. Materials and Methods: Data from 1261 patients who underwent URSL for a single ureteral stone were retrospectively analyzed. Patients were categorized into two groups based on whether the stone could be reached using a semirigid ureteroscope. Propensity score matching (1:2) was performed based on stone size and location, resulting in two matched cohorts: Group 1—Semirigid Inaccessible (SRI, n = 72), and Group 2—Semirigid Accessible (SRA, n = 144). Stone characteristics, ureteral wall thickness (UWT), and HUDmax were evaluated. Correlations between HUDmax and surgical parameters were analyzed, and the predictive value of HUDmax was assessed using receiver operating characteristic (ROC) analysis. Results: The SRI group showed significantly higher HUDmax values (median 2.36 mm vs. 1.2 mm, p < 0.0001). Semirigid access failure necessitated conversion to flexible ureteroscopy in all SRI cases, compared to 15% in the SRA group (p < 0.0001). Stone-free rates were significantly lower in the SRI group (45% vs. 82%, p < 0.0001), and the use of a double-J stent or nephrostomy placement was more frequent. Operative times were also longer in the SRI group (55 vs. 42 min, p < 0.0001). HUDmax correlated positively with operative time (r = 0.258, p = 0.005) but not with stone size, density, UWT, or hydronephrosis. ROC analysis showed HUDmax strongly predicted semirigid access failure (AUC: 0.805; cutoff: 1.58 mm), and moderately predicted stone-free status (AUC: 0.697; cutoff: 1.68 mm). Conclusions: Severe ureteral kinking constitutes a significant anatomical obstacle to the success of semirigid URSL. This study is the first to demonstrate that clinically relevant kinking can be predicted preoperatively using a non-contrast imaging modality, via the novel HUDmax parameter. Full article

Objectives: Few studies have reported in vivo measurements of electron density (ED) and effective atomic number (Z_eff) in normal brain tissue. To address this gap, dual-energy computed tomography (DECT)-derived ED and Z_eff maps were used to characterize normal-appearing adult brain tissues, evaluate age-related changes, and investigate correlations with myelin partial volume (V_my) from synthetic magnetic resonance imaging (MRI). Materials and Methods: Thirty patients were retrospectively analyzed. The conventional computed tomography (CT) value (CT_conv), ED, Z_eff, and V_my were measured in the normal-appearing gray matter (GM) and white matter (WM) regions of interest. V_my and DECT-derived parameters were compared between WM and GM. Correlations between V_my and DECT parameters and between age and DECT parameters were analyzed. Results: V_my was significantly greater in WM than in GM, whereas CT_conv, ED, and Z_eff were significantly lower in WM than in GM (all p < 0.001). Z_eff exhibited a stronger negative correlation with V_my (ρ = −0.756) than CT_conv (ρ = −0.705) or ED (ρ = −0.491). ED exhibited weak to moderate negative correlations with age in nine of the 14 regions. In contrast, Z_eff exhibited weak to moderate positive correlations with age in nine of the 14 regions. CT_conv exhibited negligible to insignificant correlations with age: Conclusions: This study revealed distinct GM–WM differences in ED and Z_eff along with opposing age-related changes in these quantities. Therefore, myelin may have substantially contributed to the lower Z_eff observed in WM, which underlies the GM–WM contrast observed on non-contrast-enhanced CT. Full article

Background/Objectives: Cervicodorsal lipodystrophy, commonly referred to as “buffalo hump,” has traditionally been associated with Human Immunodeficiency Virus (HIV)-related antiretroviral therapy. However, similar deformities may also occur independently of HIV treatment. This study aimed to investigate non HIV-associated buffalo hump as a potential clinical marker of underlying metabolic or endocrine disorders. Methods: We retrospectively reviewed 12 HIV-negative patients who presented with cervicodorsal lipodystrophy between 2012 and 2022. Patient demographics, laboratory values, and imaging findings were analyzed. All patients underwent surgical resection of a hypertrophic fat pad. Exploratory statistical analyses were performed using Mann–Whitney U and Fisher’s exact tests and Spearman’s correlation analysis. Results: These 12 patients had a mean age of 56.92 ± 16.69 years and a mean Body Mass Index (BMI) of 30.15 ± 4.59 kg/m². Hypertension and diabetes were each present in 66.7% of patients, and hyperlipidemia in 75%. Three patients were newly diagnosed with metabolic disease. No significant differences were found between newly diagnosed and previously diagnosed patients in age (45.67 ± 21.46 vs. 60.67 ± 14.31 years, p = 0.194) or BMI (32.44 ± 2.39 vs. 29.39 ± 4.99 kg/m², p = 0.145). Group differences in hypertension, diabetes, hyperlipidemia, or liver dysfunction were also not significant (all p > 0.49). No correlation was observed between age and BMI (ρ = −0.158, p = 0.624). Conclusions: Although the small sample size precludes definitive conclusions, the prevalence of obesity, hypertension, and diabetes in this cohort was notably higher than reported in Korean population-based surveys. These findings suggest that non HIV-associated buffalo hump may serve as an externally visible marker of systemic metabolic burden. Metabolic screening should be considered even in the absence of overt systemic disease. Full article

Background: Functional X-ray imaging of the cervical spine in flexion and extension remains a fundamental, objective method for mobility assessment. However, there remains no consensus on how to perform the measurements or which indicators are most useful in clinical practice. Methods: This study included 288 participants (197 female and 91 male); these included patients without CDD signs or with first-degree cervical spine CDD according to the Kellgren–Lawrence criteria. Cobb angle C2–C7, HDI, ROM, CIF, and CIE were measured. Results: The most significant correlations were observed for HDI, and the strongest correlations were between CIF measurements. The greatest mobility was noted for the centrally located segments of the cervical spine, particularly at the C4–C5 level. Conclusions: HDI appears to be the most reliable parameter for characterizing the mobility of the cervical spine. It is precise and has the highest number of correlations with other measurements, but it is very time-consuming. Cobb angle C2–C7 combines ease of performance with good diagnostic value. Full article

Background/Objectives: Rhabdomyolysis is a potentially life-threatening condition characterized by acute skeletal muscle breakdown. In addition to well-described external triggers, a genetic contribution is increasingly recognized. We aimed to (I) review the genetic diagnostic approach of rhabdomyolysis, (II) evaluate the clinical characteristics indicative of a genetic susceptibility with the ‘RHABDO’ acronym, and (III) assess the predictive value of the presence RHABDO features for identifying genetic variants. Methods: In this retrospective two-center study, 122 patients underwent genetic testing for rhabdomyolysis since the introduction of whole exome sequencing (WES) in 2013. The presence of RHABDO features was compared between those with (likely) pathogenic variants and those with benign or no identified variants or variants of uncertain significance. Results: The testing methods included panel-based WES (82%), Sanger sequencing (49%), and full WES (24%), of which 52 patients (43%) underwent multiple methods. A (likely) pathogenic variant was identified in 13 patients (11%), in all of whom ≥2 RHABDO features were present. The positive predictive value for ≥2 features was 14%, while the negative predictive value was 100%. Conclusions: These results highlight the relevance of WES in further elucidating the genetic basis of rhabdomyolysis and demonstrated that RHABDO is a valuable tool for selecting patients who should undergo genetic testing. Full article

Background/Objectives: Immune checkpoint inhibitors targeting the PD-1/PD-L1 axis have become a standard in the treatment of all stages of non-small lung cancer. Beyond tumor-intrinsic biomarkers like PD-L1 expression, evidence points to the role of patient-related factors, such as body mass index, sarcopenia, and cachexia. These body composition parameters may reflect metabolic reserve or even immune competence and could help stratify outcomes in patients treated with PD-1 and PD-L1. This systematic review aims to evaluate the impact of body composition—specifically BMI, pretreatment weight loss, sarcopenia, and cachexia—on clinical outcomes such as progression-free and overall survival in NSCLC patients treated with immune checkpoint inhibitors. Methods: A systematic literature search was conducted across multiple databases including PubMed, Google Scholar, and Science Direct. We included full-text original research articles (1 January 2020–1 May 2025) reporting clinical outcomes of NSCLC patients treated with PD-1 or PD-L1 inhibitors, in relation to body composition factors (BMI, pretreatment weight loss, sarcopenia, cachexia). Eligible studies involved adults (>18 years) and included observational cohorts or controlled trials; animal or in vitro studies were excluded. Data extraction and risk of bias assessments were performed independently by two reviewers, with discrepancies being resolved through a third one. Results: From 12,358 records identified, 21 studies met the inclusion criteria. Most were retrospective cohorts assessing the impact of pre-treatment weight loss, cachexia, and sarcopenia on ICI outcomes in NSCLC. These factors consistently predicted poorer survival and response, while BMI alone showed limited prognostic value. Considerable heterogeneity in body composition definitions and outcome reporting was observed. Conclusions: Body composition—particularly weight loss, cachexia, and sarcopenia—significantly impacts survival and response in NSCLC patients treated with ICIs. These factors reflect immune–metabolic dysfunction that may impair treatment efficacy. BMI alone is insufficient; routine assessment of muscle mass and cachexia could improve risk stratification. Full article

Background and Objectives: Postoperative physical recovery, particularly the acquisition of independent ambulation, is a critical milestone in rehabilitation following living donor liver transplantation (LDLT). Although liver function markers are conventionally used to assess hepatic physiology, emerging evidence has suggested their potential role as prognostic indicators of physical performance. Materials and Methods: This study investigated the association between liver function parameters at the initiation of postoperative physical therapy (total bilirubin [T-Bil], aspartate aminotransferase [AST], and alanine aminotransferase [ALT]) and the independent walking ability of 63 patients who underwent LDLT. A logistic regression model was constructed using these variables, and a receiver-operating characteristic (ROC) curve analysis was performed to evaluate its discriminative performance. Predicted probabilities of each patient were calculated, and the optimal cutoff value was determined based on the Youden Index. Results: The multivariate logistic regression model demonstrated a statistically significant association between liver function markers and the ambulation status of a cohort of 63 patients. The ROC curve analysis yielded an area under the ROC curve (AUC) of 0.8416 (95% confidence interval [CI]: 0.715–0.968), indicating strong predictive performance. The optimal cutoff value was 0.865, with sensitivity and specificity of 74.1% and 88.9%, respectively. The bootstrap CI for sensitivity at this threshold ranged from 0.6111 to 0.8519. The Hosmer–Lemeshow test indicated good model fit (p = 0.363), and the correct classification rate was 87.3%. Conclusions: Liver function test results may be indicators of hepatic dysfunction as well as functional biomarkers that could predict ambulatory outcomes following LDLT. This predictive model may enhance early clinical decision-making regarding rehabilitation and discharge planning. Future prospective studies should be performed to validate the generalizability of these results to broader clinical contexts. Full article

Background: Young-onset colorectal cancer (YO-CRC) has emerged as a distinct clinical entity, often presenting at advanced stages. Despite the increasing incidence, the molecular and clinical underpinnings of YO-CRC remain underexplored. This study aims to characterize the clinical and molecular features of YO-CRC and to evaluate their impact on OS. Methods: We reviewed 110 patients diagnosed with YO-CRC at our institution who underwent next-generation sequencing. Demographic, clinical, and molecular data, including age, gender, race, tumor location, cancer stage, and mutation status (KRAS, NRAS, BRAF, POLE, ERBB-2/HER2, microsatellite status), were collected by reviewing electronic medical records. For OS analysis, we focused on patients diagnosed with de novo stage IV. Cox proportional hazards regression and Kaplan–Meier survival analysis were utilized to assess the association of these factors with OS, with statistical significance determined by a p-value threshold of <0.05. Results: Among 110 patients, n = 44 (40%) presented with local disease (stage 1–3), while n = 66 (60%) presented with de novo metastatic disease at the time of diagnosis. The median age at diagnosis was 44.5 years. The cohort consisted of 64% males and 36% females, with 84% of patients identified as White. Most tumors were left-sided (77%), including the distal colon/sigmoid (44%) and rectum (33%). KRAS and BRAF mutations were present in 36% and 5.5%, respectively. ERBB-2/HER2 amplification and microsatellite instability were observed in 4.5% and 6.4%, respectively. Tumor mutation burden (TMB) was <10 in 57% of patients, with 14% having TMB > 20. CNV analysis revealed that 14% of patients had copy gains, 12% had concurrent gains/losses, and 31% had copy losses. Among 66 patients with de novo metastatic disease, 44% had died by the time of analysis, with a median overall survival (OS) of 43.6 months (95% CI, 28.7—not reached). KRAS mutations were found to be significantly associated with worse survival outcomes. Cox regression analysis reveals the prognostic significance of KRAS status, with a hazard ratio (HR) of 3.52 (95% CI: 1.59–7.76, p = 0.002), indicating a significantly higher risk of death for KRAS-mutant YO-CRC patients. Conclusions: Patients with YO-CRC are more likely to present with de novo metastatic disease and left-sided tumors with distinct molecular characteristics. KRAS mutations are a key prognostic factor in YO-CRC, highlighting the need for therapeutic interventions to improve outcomes in this high-risk group. Full article