Severe trauma remains a major global cause of death and disability, particularly among individuals younger than 45 years. Emergency departments are the main gateway to trauma care, where rapid risk stratification guides resuscitation, surgical decision-making, intensive care admission, and resource allocation. Conventional tools, including the Revised Trauma Score, Glasgow Coma Scale, Injury Severity Score, and Trauma and Injury Severity Score, standardize early assessment but rely largely on static variables and may not capture dynamic physiological changes during resuscitation. Dynamic biomarkers offer additional biological information. Glial fibrillary acidic protein, S100B, neuron-specific enolase, serum lactate, and lactate clearance may reflect neuronal injury, tissue hypoperfusion, metabolic stress, and how effectively resuscitation is restoring perfusion. Artificial intelligence and machine-learning models can integrate vital signs, laboratory findings, imaging data, biomarkers, and demographic variables to generate individualized predictions of mortality, clinical deterioration, intensive care requirements, and complications. Recent studies suggest that some machine-learning models may outperform conventional scoring systems; however, limitations involving data heterogeneity, algorithmic bias, interpretability, external validation, privacy, and clinical workflow integration remain. This narrative review synthesizes current evidence on conventional trauma scoring systems, dynamic biomarkers, and artificial intelligence-based prediction models for early risk stratification of severe trauma in emergency departments. It also examines the potential of multimodal frameworks that combine physiological, anatomical, molecular, and computational information. Although integrated prediction systems may improve accuracy and clinical decision-making, prospective multicenter validation and evidence of real-world clinical benefit are required before routine implementation.
Xiabing Sun,1,* Jie Han,1,* Jianjian Ni,2 Yujie Shen11Emergency and Critical Care Medicine, The Second People’s Hospital of Xiaoshan District, Hangzhou, Zhejiang, 311241, People’s Republic of China; 2Pediatric Department, Yaqian Town Community Health Service Center, Hangzhou, Zhejiang, 311209, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yujie Shen, Emergency and Critical Care Medicine, The Second People’s Hospital of Xiaoshan District, No. 1118 Dongling North Road, Guali Town, Xiaoshan District, Hangzhou, Zhejiang, 311241, People’s Republic of China, Email shyj82779843@hotmail.comAbstract: Severe trauma remains a major global cause of death and disability, particularly among individuals younger than 45 years. Emergency departments are the main gateway to trauma care, where rapid risk stratification guides resuscitation, surgical decision-making, intensive care admission, and resource allocation. Conventional tools, including the Revised Trauma Score, Glasgow Coma Scale, Injury Severity Score, and Trauma and Injury Severity Score, standardize early assessment but rely largely on static variables and may not capture dynamic physiological changes during resuscitation. Dynamic biomarkers offer additional biological information. Glial fibrillary acidic protein, S100B, neuron-specific enolase, serum lactate, and lactate clearance may reflect neuronal injury, tissue hypoperfusion, metabolic stress, and how effectively resuscitation is restoring perfusion. Artificial intelligence and machine-learning models can integrate vital signs, laboratory findings, imaging data, biomarkers, and demographic variables to generate individualized predictions of mortality, clinical deterioration, intensive care requirements, and complications. Recent studies suggest that some machine-learning models may outperform conventional scoring systems; however, limitations involving data heterogeneity, algorithmic bias, interpretability, external validation, privacy, and clinical workflow integration remain. This narrative review synthesizes current evidence on conventional trauma scoring systems, dynamic biomarkers, and artificial intelligence-based prediction models for early risk stratification of severe trauma in emergency departments. It also examines the potential of multimodal frameworks that combine physiological, anatomical, molecular, and computational information. Although integrated prediction systems may improve accuracy and clinical decision-making, prospective multicenter validation and evidence of real-world clinical benefit are required before routine implementation.Keywords: severe trauma, risk stratification, trauma scoring systems, artificial intelligence, machine learning
Background and Objective:C-reactive protein (CRP), the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MLR) are routinely available inflammatory markers of uncertain relative prognostic value after stroke. This study aimed to investigate the associations of baseline CRP, NLR, and MLR with 12-month mortality and recurrence in patients with stroke. Methods:This single-center prospective cohort study enrolled hospitalized patients with stroke. Univariable analyses were performed to compare baseline characteristics according to 12-month mortality and recurrence status. Multivariable logistic regression models were constructed to evaluate the independent associations of CRP, NLR, and MLR with 12-month mortality and recurrence after adjustment for clinically relevant covariates. Results:A total of 2937 patients were included in the baseline analysis. Among them, 2166 were included in the 12-month mortality analysis, and 237 died during follow-up. In the multivariable logistic regression model, higher CRP was independently associated with an increased risk of 12-month mortality (OR = 1.01, 95% CI: 1.01-1.02, P < 0.001). NLR showed a borderline association with mortality (OR = 1.06, 95% CI: 1.00-1.13, P = 0.064), whereas MLR was not independently associated with mortality. A total of 2018 patients were included in the 12-month recurrence analysis, among whom 614 experienced recurrent events. In the multivariable model, higher CRP was independently associated with an increased risk of recurrence (OR = 1.01, 95% CI: 1.00-1.02, P = 0.025), whereas NLR and MLR was not independently associated with recurrence. Conclusion:Baseline CRP was independently associated with 12-month mortality and, more weakly, with recurrence. The mortality association was substantially stronger, and CRP should be regarded primarily as a marker of long-term mortality risk. NLR and MLR showed no independent association with either endpoint. CRP, combined with key clinical indicators, may assist long-term risk stratification after ischaemic stroke.
Yu Zhao,1,2,* Yutong Wang,3,* Shengyuan Wang41Department of Neurology, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China; 2Department of Neurology, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China; 3Faculty of Medicine, Semmelweis University, Budapest, Hungary; 4Department of Neurology, Chongqing General Hospital, Chongqing University, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shengyuan Wang, Department of Neurology, Chongqing General Hospital, Chongqing University, 118 Xingguang Avenue, Liangjiang New Area, Chongqing, 400013, People’s Republic of China, Tel/Fax +86-23-63390106, Email wang371756040@yeah.netBackground and Objective: C-reactive protein (CRP), the neutrophil-to-lymphocyte ratio (NLR) and the monocyte-to-lymphocyte ratio (MLR) are routinely available inflammatory markers of uncertain relative prognostic value after stroke. This study aimed to investigate the associations of baseline CRP, NLR, and MLR with 12-month mortality and recurrence in patients with stroke.Methods: This single-center prospective cohort study enrolled hospitalized patients with stroke. Univariable analyses were performed to compare baseline characteristics according to 12-month mortality and recurrence status. Multivariable logistic regression models were constructed to evaluate the independent associations of CRP, NLR, and MLR with 12-month mortality and recurrence after adjustment for clinically relevant covariates.Results: A total of 2937 patients were included in the baseline analysis. Among them, 2166 were included in the 12-month mortality analysis, and 237 died during follow-up. In the multivariable logistic regression model, higher CRP was independently associated with an increased risk of 12-month mortality (OR = 1.01, 95% CI: 1.01– 1.02, P < 0.001). NLR showed a borderline association with mortality (OR = 1.06, 95% CI: 1.00– 1.13, P = 0.064), whereas MLR was not independently associated with mortality. A total of 2018 patients were included in the 12-month recurrence analysis, among whom 614 experienced recurrent events. In the multivariable model, higher CRP was independently associated with an increased risk of recurrence (OR = 1.01, 95% CI: 1.00– 1.02, P = 0.025), whereas NLR and MLR was not independently associated with recurrence.Conclusion: Baseline CRP was independently associated with 12-month mortality and, more weakly, with recurrence. The mortality association was substantially stronger, and CRP should be regarded primarily as a marker of long-term mortality risk. NLR and MLR showed no independent association with either endpoint. CRP, combined with key clinical indicators, may assist long-term risk stratification after ischaemic stroke.Keywords: stroke, C-reactive protein, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, prognosis
In the first-in-human (FIH) study, the intravenous (IV) administration represents a critical juncture where preclinical data meet human physiology, characterized by immediate systemic exposure and an extremely narrow margin for safety. The current management measures for these trials are fragmented and lack a systematic framework. This narrative review, informed by a structured synthesis of peer-reviewed literature, regulatory guidance documents, and systematic institutional experience from multiple IV FIH trials conducted between 2020 and 2025, summarizes the key risk factors for FIH-IV trials, including pharmacological uncertainties, formulation-related toxicity, infusion rate sensitivity, and participant heterogeneity. It further evaluates preventive strategies such as determination of starting dose, personnel management and ensuring operational readiness, standardization of medication preparation and administration, comprehensive safety monitoring, and emergency response coordination and infrastructure. The primary aim is to propose a conceptual, stratified risk management framework that categorizes trials into low-, moderate-, and high-risk levels based on drug-related, procedural, and participant-specific variables. Corresponding management strategies are then applied to each level: standardized for low risk, enhanced for moderate risk, and advanced for high risk. This structured approach optimizes safety assurance in high-risk trials while avoiding the overutilization of resources in low-risk settings. The proposed framework is intended as a conceptual supplement to existing regulatory guidelines (eg, ICH E6(R3), EMA FIH guideline) and requires prospective multicenter validation before broad implementation.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for type 2 diabetes, obesity, and broader cardiometabolic, cardiorenal, and metabolic liver disease indications, creating new challenges for perioperative medication safety. This review summarizes current evidence on GLP-1RA-associated delayed gastric emptying and proposes a structured pharmacist-led framework for individualized perioperative risk management. GLP-1RAs may increase the likelihood of residual gastric contents during anesthesia or procedural sedation despite adherence to standard fasting recommendations. Perioperative outcome studies have not consistently shown an increased risk of aspiration pneumonia; however, these findings should be interpreted in light of the low incidence of aspiration-related events, the predominance of retrospective study designs, residual confounding, and heterogeneous definitions of residual gastric contents. We review mechanisms of delayed gastric emptying, treatment- and patient-related risk modifiers, perioperative clinical evidence, areas of agreement and divergence among major guidance statements, gastric ultrasonography as a selective risk-mitigation tool, and medication-safety issues beyond aspiration, including oral drug absorption and postoperative resumption. Because perioperative GLP-1RA decisions require accurate medication history, last-dose verification, symptom assessment, evaluation of glycemic consequences of drug interruption, coordination with anesthesia and surgical teams, and safe postoperative restart planning, pharmacists are well positioned to support this process. The proposed pharmacist-led pathway provides a structured approach to GLP-1RA medication verification, gastrointestinal symptom screening, risk phenotyping, multidisciplinary escalation, day-of-surgery reassessment, postoperative restart planning, patient education, and documentation. Perioperative GLP-1RA management should not rely on routine discontinuation alone, but should integrate treatment phase, dose escalation, gastrointestinal symptoms, comorbid motility disorders, procedural urgency, anesthetic risk, oral medication considerations, and the metabolic consequences of withholding therapy. This pathway represents a structured implementation framework informed by current evidence and guidance; prospective evaluation in real-world perioperative settings is needed.
Introduction:Postoperative cognitive dysfunction (POCD) is a common condition that greatly threatens patients' quality of life. While mechanical bowel preparation (MBP) enhances surgical visibility, its effect on postoperative complication rates remains debated. This study aims to evaluate the effect of MBP on POCD in patients undergoing colorectal surgery and to investigate its association with tau protein, brain-derived neurotrophic factor (BDNF) and lipopolysaccharide-binding protein (LBP) levels. Methods:This is a single-center randomized controlled trial. 80 eligible ASA-PS II-III colorectal surgery patients were randomized into his pilot study, which was designed as a randomized controlled trial. Cognitive function was assessed preoperatively (T1), postoperatively on day 15 (T2), and on day 90 (T3) using the Montreal Cognitive Assessment (MoCA). Blood samples were collected simultaneously from the patients for biomarker analysis. A decline of > 1 standard deviation from baseline on the MoCA was defined as POCD. Results:The incidence of POCD was significantly lower in patients without MBP compared to those with MBP (7.5% vs. 55%). At T3, BDNF levels were significantly higher in Group I than in Group II (p < 0.001). LBP levels were significantly higher in Group II than in Group I at T3 (p = 0.001). In patients with POCD, tau protein levels were significantly higher at T2 and T3 (p = 0.007; p = 0.012), while BDNF levels were significantly lower at T3 (p < 0.001). Conclusion:MBP was associated with a higher incidence of POCD in patients undergoing colorectal surgery; however, these preliminary findings require confirmation in larger trials.
Ayşe Ülgey,1 Gamze Talih,1 Tutkun Talih,2 Elif Funda Sener,3 Saliha Ozsoy,4 Oğuz Kaan Şimşek,1 Ersin Sönmez,1 Halime Dana31Department of Anaesthesiology and Reanimation, Erciyes University Faculty of Medicine, Kayseri, 38039, Turkey; 2Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, 38039, Turkey; 3Department of Medical Biology and Genome and Stem Cell Center (GENKOK), Erciyes University Faculty of Medicine, Kayseri, 38039, Turkey; 4Department of Psychiatry, Erciyes University, Faculty of Medicine, Kayseri, 38039, TurkeyCorrespondence: Gamze Talih, Department of Anaesthesiology and Reanimation, Erciyes University Faculty of Medicine, Köşk Mah. Prof. Dr. Turhan Feyzioğlu Cad. No: 42, Melikgazi/Kayseri, 38039, Turkey, Tel +905447604780, Email gamzetalih@gmail.comIntroduction: Postoperative cognitive dysfunction (POCD) is a common condition that greatly threatens patients’ quality of life. While mechanical bowel preparation (MBP) enhances surgical visibility, its effect on postoperative complication rates remains debated. This study aims to evaluate the effect of MBP on POCD in patients undergoing colorectal surgery and to investigate its association with tau protein, brain-derived neurotrophic factor (BDNF) and lipopolysaccharide-binding protein (LBP) levels.Methods: This is a single-center randomized controlled trial. 80 eligible ASA–PS II–III colorectal surgery patients were randomized into his pilot study, which was designed as a randomized controlled trial. Cognitive function was assessed preoperatively (T1), postoperatively on day 15 (T2), and on day 90 (T3) using the Montreal Cognitive Assessment (MoCA). Blood samples were collected simultaneously from the patients for biomarker analysis. A decline of > 1 standard deviation from baseline on the MoCA was defined as POCD.Results: The incidence of POCD was significantly lower in patients without MBP compared to those with MBP (7.5% vs. 55%). At T3, BDNF levels were significantly higher in Group I than in Group II (p < 0.001). LBP levels were significantly higher in Group II than in Group I at T3 (p = 0.001). In patients with POCD, tau protein levels were significantly higher at T2 and T3 (p = 0.007; p = 0.012), while BDNF levels were significantly lower at T3 (p < 0.001).Conclusion: MBP was associated with a higher incidence of POCD in patients undergoing colorectal surgery; however, these preliminary findings require confirmation in larger trials.Keywords: biomarker, colorectal surgery, mechanical bowel preparation, MoCA test, postoperative cognitive dysfunction
Purpose:Diabetic foot ulcers represent a major clinical challenge due to delayed healing and high risk of complications. Medicinal encircling therapy, a traditional external treatment, has been widely used as an adjunctive intervention in clinical practice. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of medicinal encircling therapy combined with conventional treatment for diabetic foot ulcers. Material and Methods:A comprehensive literature search was conducted across major English and Chinese databases from inception to November 1, 2025. Randomized controlled trials comparing medicinal encircling therapy plus conventional care versus conventional care alone were included. Primary and secondary outcomes related to ulcer healing, symptom improvement, inflammatory markers, pain, and adverse events were synthesized using risk ratios or mean differences with corresponding 95% confidence intervals. This systematic review was prospectively registered with PROSPERO (CRD420261299230). Results:Fifteen randomized controlled trials were included, all of which were published in Chinese. The pooled results showed that adjunctive medicinal encircling therapy significantly improved complete ulcer healing rate compared with conventional treatment alone (RR = 1.78, 95% CI 1.39-2.28). Overall clinical response and several secondary outcomes generally favored the intervention, although heterogeneity was observed for some outcomes. No serious treatment-related adverse events were reported. Conclusion:These findings suggest that medicinal encircling therapy may be a promising adjunctive treatment for diabetic foot ulcers; however, the certainty and generalizability of the evidence are limited by methodological shortcomings, incomplete safety reporting, and the inclusion of Chinese-language studies only. Further high-quality, multicenter randomized controlled trials are warranted.
Background:CYP2C19 loss-of-function alleles are highly prevalent in Asian populations and may reduce the effectiveness of clopidogrel. This study aimed to evaluate the efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy in patients with symptomatic severe intracranial atherosclerotic stenosis undergoing neurovascular endovascular treatment (EVT). Methods:This prospective non-randomized controlled study enrolled 175 patients who underwent neurovascular intervention. Patients in the genotype-guided group (n=100) received individualized antiplatelet therapy according to CYP2C19 genotyping results, whereas patients in the conventional therapy group (n=75) received routine dual antiplatelet therapy with aspirin and clopidogrel. Safety events, 90-day neurological outcomes, and the cumulative incidence of ischemic events within one year were compared between groups. Results:The incidence of bleeding events did not differ significantly between the genotype-guided group and the conventional therapy group (1.0% vs 4.0%, P>0.05). At 90 days, a significantly higher proportion of patients achieved a favorable functional outcome (modified Rankin Scale score 0-1) in the genotype-guided group than in the conventional therapy group (84.0% vs 65.3%, P=0.004). At one year, the proportion of patients experiencing at least one ischemic event was significantly lower in the genotype-guided group than in the conventional therapy group (12.0% vs 26.7%, P=0.013). Multivariable Cox regression analysis demonstrated that patients in the conventional therapy group had a significantly higher risk of ischemic events during follow-up than those in the genotype-guided therapy group (HR: 2.723, 95% CI: 1.259-5.888, P = 0.011). Interaction analysis suggested that treatment effects differed according to device type, with a numerically greater benefit observed in the stent subgroup, although this finding should be considered exploratory. Conclusion:CYP2C19 genotype-guided antiplatelet therapy following neurovascular EVT was associated with improved neurological outcomes and a lower incidence of ischemic events without increasing bleeding risk. However, because ticagrelor exposure differed between treatment groups, the independent contribution of pharmacogenetic testing requires further confirmation in larger randomized studies.
Chemotherapy is a cornerstone of comprehensive breast cancer treatment. However, its non-specific cytotoxic effects frequently involve the gastrointestinal tract, leading to a spectrum of digestive adverse reactions, including chemotherapy-induced nausea and vomiting (CINV), anorexia, diarrhea, and constipation. These symptoms not only compromise patients' quality of life but may also impair treatment adherence. In severe cases, they can necessitate dose reduction or treatment discontinuation. This review systematically examines the epidemiology, pathophysiology, and classification of gastrointestinal adverse reactions associated with breast cancer chemotherapy, with a focus on CINV management strategies. These strategies include pharmacological prophylaxis, individualized risk assessment, non-pharmacological interventions, and the use of standardized assessment tools. Based on the available evidence, we discuss the transition from an experience-based nursing model to a predictive one. We also emphasize the importance of patient education, psychological support, and family involvement, and highlight specific considerations for breast cancer patients. This review provides a systematic, evidence‑based reference for the clinical care of CINV in breast cancer to optimize gastrointestinal symptom management and improve treatment outcomes and quality of life for these patients.
The landscape of breast cancer treatment has been fundamentally transformed by the emergence of immune checkpoint inhibitors (ICIs), representing a paradigm shift from traditional cytotoxic approaches to precision immunotherapy. This comprehensive review examines the current state and future directions of ICIs in breast cancer, with particular emphasis on triple-negative breast cancer (TNBC) where these therapies have shown the most promise. We explore the mechanistic foundations of checkpoint inhibition targeting CTLA-4, PD-1, and PD-L1 pathways, examine resistance mechanisms and predictive biomarkers, and discuss emerging targets including LAG-3, TIM-3, and TIGIT. The integration of ICIs with conventional therapies has yielded encouraging clinical outcomes, leading to the first FDA approvals for immunotherapy in breast cancer. However, significant challenges remain in identifying optimal patient populations, overcoming resistance mechanisms, and developing robust predictive biomarkers. This review synthesizes current evidence from recent clinical trials and provides insights into future therapeutic strategies that promise to enhance the efficacy of immune checkpoint blockade in breast cancer treatment.
Objective:This study aimed to determine the median effective dose (ED50) of esketamine in combination with remifentanil for anesthesia induction during painless colonoscopy, utilizing the sequential dosing method. Methods:This study adopted a sequential design.Patients scheduled for painless colonoscopy at the Endoscopy Center of Northern Jiangsu People's Hospital in April 2023 were screened for inclusion in this study. The inclusion criteria encompassed male and female participants aged 18 to 60 years, with a body mass index (BMI) between 18 and 30 kg/m2 and classified as American Society of Anesthesiologists (ASA) physical status I or II. Participants undergoing colonoscopy as the sole procedure, without severe communication barriers, were included. Exclusion criteria included patients undergoing additional diagnostic or therapeutic procedures besides colonoscopy and those with a history of oral sedative or analgesic use exceeding one month. Data were analyzed using SPSS 20.0. Normally and non-normally distributed data were expressed as mean ± standard deviation and median (interquartile range), respectively. ED50, ED95 and 95% CI were determined by Probit regression. Correlation and logistic regression analyses were performed, and the sample size was verified by power analysis (α=0.05).For anesthesia induction, the remifentanil dose was fixed at 0.3 μg/kg, while the esketamine dose was adjusted sequentially. The initial dose of esketamine was 0.1 mg/kg and was incrementally increased by a ratio of 1:1.2 for each subsequent dose administered. Successful induction of anesthesia was defined as a positive response, while unsuccessful induction was classified as a negative response. An "inflection point" was defined as the dose transition from a negative response (unsuccessful anesthesia induction) to a positive response (successful anesthesia induction) within the sequential dosing framework. The sample size was determined by identifying at least seven such inflection points, where each inflection point involved two consecutive participants: one demonstrating a negative response at a given dose, immediately followed by another demonstrating a positive response at the next dose. Data from these inflection points were aggregated for the final analysis. Results:A total of 23 study participants were included in this study, with the following distribution: 13 males and 10 females. 13 participants were classified as Grade I, and 10 were classified as Grade II. The ED50 of esketamine combined with remifentanil for anesthesia induction in painless colonoscopy was 0.209 mg/kg, with a 95% confidence interval (CI) of 0.178 to 0.248 mg/kg. The dose required for 95% efficacy (ED95) was 0.259 mg/kg, with a 95% CI of 0.231 to 0.478 mg/kg. Conclusion:The ED50 and ED95 of esketamine combined with remifentanil for anesthesia induction in painless colonoscopy were 0.209 mg/kg (95% CI: 0.178-0.248 mg/kg) and 0.259 mg/kg (95% CI: 0.231-0.478 mg/kg), respectively. This anesthetic regimen shows promising safety and efficacy profiles and may serve as a viable option for clinical application in painless colonoscopy procedures.
Triple-negative breast cancer (TNBC) is clinically heterogeneous, and selected patients experience rare complications, unusual responses, or biomarker-discordant treatment trajectories that are not fully represented in aggregate trial evidence. This review aims to synthesize published case-report evidence on clinical outcomes and treatment-related complications in TNBC, with an emphasis on host vulnerability, tumor biology, biomarker-guided treatment, and therapy-associated toxicity. A descriptive review of PubMed-indexed case reports was performed for records published from January 1, 2020, to December 31, 2025. Two reviewers independently screened records, extracted data, and appraised the reporting quality using the CARE domains. Results were synthesized narratively without meta-analysis. Seventy-one records were screened, and 24 case reports were included. All patients were female, with a median age of 45 years (range 28-87 years). The cases consisted of 11 with metastatic or advanced disease, 10 with early or localized disease, 1 with a local recurrence, and 2 with unclear disease settings. Actionable or resistance-informative biomarker signals were described in 12 cases, and biomarker-matched therapy was reported in 11. Immunotherapy was used in 9 cases. Serious or clinically significant complications were reported in 10 cases, including two fatal treatment-related events. Favorable outcomes were reported in 17 cases, but these selected reports cannot be used to estimate response rates, survival, or the incidence of toxicity. TNBC case reports provide clinically instructive, hypothesis-generating evidence on rare toxicities, biomarker-guided treatment decisions, and individualized risk assessment.
Background:Heart failure (HF) represents a significant global health challenge. Individuals with HF commonly experience psychological issues, including depression and anxiety, which negatively affect quality of life (QoL) and clinical outcomes. While telehealth has been identified as a promising approach for chronic disease management, its effectiveness in enhancing psychological outcomes in HF remains unclear. Objective:To evaluate the effectiveness of telehealth interventions in improving psychological outcomes among individuals with HF. Methods:A systematic review and meta-analysis were conducted across six electronic databases (PubMed, Scopus, EBSCOhost, Springer Nature, Taylor & Francis, and Sage Journals). Methodological quality was evaluated with the JBI and RoB 2 tools. Pooled effects were reported as standardized mean differences (SMD) or mean differences (MD), applying fixed- or random-effects models based on heterogeneity (I2). Subgroup analyses were conducted by delivery model, intervention duration, and measurement tool. Publication bias was examined using funnel plots, Egger's test, and Begg's test. Results:26 RCTs were included, with 17 (n = 4,796) entered the meta-analysis. Telehealth showed no significant effect on QoL (SMD=-0.31; p=0.25; I2=98%) or depression (SMD= -0.65; p=0.07; I2= 96%), but were associated with a significant reduction in anxiety (SMD= -0.91; p=0.009; I2 = 94%). Subgroup analyses indicated that mobile applications significantly improved QoL (SMD= -0.92; p=0.01), while phone-call support significantly reduced depression (SMD= -1.28; p=0.02). Significant reductions in depression were also observed when using HADS (p=0.006) and BDI (p=0.010), and with follow-up >6 months (p=0.03). Conclusion:Telehealth interventions significantly reduced anxiety among individuals with HF but demonstrated limited effects on depression and QoL. The presence of very high heterogeneity across all outcomes reduces the certainty of these findings and necessitates cautious interpretation. The effectiveness of telehealth as a psychological intervention may depend on specific design and implementation factors.
Purpose: Obstructive sleep apnea (OSA) is an independent risk factor for gastric insufflation during the induction of general anesthesia. We aimed to compare the impact of oropharyngeal airway-assisted face-mask ventilation and transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation in patients with high-risk OSA. Patients and Methods: Patients at high risk for OSA scheduled for elective major abdominal surgery under general anesthesia were randomized 1:1 to either Group T (THRIVE throughout induction) or Group M (face-mask preoxygenation followed by oropharyngeal airway-assisted pressure-controlled ventilation). Gastric antrum ultrasonography was performed at baseline (T-1), after preoxygenation (T-2), and post-intubation (T-4) to assess changes of antral cross-sectional area (CSAa). Arterial blood gases were analyzed at T-1, T-2, after induction during ventilation/apnea (T-3), and T-4. Adverse events and patient comfort were recorded. The primary outcome was the incidence of gastric insufflation at T-4. Secondary outcomes included CSAa percentage change, oxygenation and arterial blood gas variables, adverse events, and patient comfort. Results: Of 100 randomized patients, 94 completed the study (47 per group). Group T demonstrated a significantly lower incidence of gastric insufflation post-intubation compared to Group M (23.4% vs 44.7%; P = 0.030) and a smaller median percentage increase in antral cross-sectional area (7.62% vs 13.24%; P = 0.070). THRIVE provided superior preoxygenation (higher PaO2 at T-2, P < 0.001). During apnea (T-3-T-4), Group T maintained adequate oxygenation (SpO(2) > 92%) without mechanical ventilation but developed mild hypercapnia, which was expected to improve following continued mechanical ventilation after intubation. Adverse event rates were non-significant (P = 1.000). Patient comfort scores were significantly higher in Group T (P < 0.001). Conclusion: In patients at high risk for OSA, THRIVE reduces the incidence of gastric insufflation during induction compared with oropharyngeal airway-assisted face-mask ventilation. THRIVE improves preoxygenation and patient comfort. Oxygenation was maintained during apnea, with a transient increase in PaCO2 observed after intubation.
Background:To evaluate the clinical utility of blood-based inflammatory and metabolic biomarkers in assessing symptom burden and quality of life among older adults with cancer. Methods:This review synthesizes current evidence regarding the clinical utility and underlying pathophysiological mechanisms of blood-based biomarkers, focusing particularly on the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and modified Glasgow prognostic score (mGPS). Results:Elevated inflammatory markers, such as NLR and SII, independently correlate with increased frailty and functional decline. Concurrently, nutritional-metabolic markers, including hypoalbuminemia and a high mGPS, are strongly associated with anorexia and cancer cachexia. These composite indicators effectively capture the synergistic effects of "inflammaging", neuroinflammation, and tumor-driven metabolic reprogramming. Conclusion:Objective, cost-effective, and dynamically measurable inflammatory and metabolic biomarkers represent promising adjunctive tools for early symptom screening. The integration of these markers into comprehensive geriatric assessments may enhance risk stratification and symptom management. However, current evidence is constrained by study heterogeneity, retrospective designs, a lack of standardized cutoffs, and insufficient prospective validation in older cancer populations. Therefore, these biomarkers should be regarded as complementary to traditional assessments rather than definitive standalone tools.
This perspective presents a new conceptual framework for the comprehensive care of patients with keratoconus. Keratoconus is an ectatic degeneration of the cornea associated with progressive vision loss and diminished quality of life. Until recently, treatment consisted of optical correction in early stages and corneal transplantation in later stages, neither of which impacted the progressive nature of the disease. The development of corneal cross-linking-a minimally-invasive procedure that stabilizes the disease process and prevents progressive ectasia and vision loss-has significantly altered the therapeutic approach to keratoconus. Until recently, the procedure required removal of the corneal epithelium, but a newly FDA-approved epithelium-on oxygen-enriched option may simplify the process with a favorable benefit-to-risk balance. The FDA indication for this new epithelium-on treatment option also does not require disease progression, further facilitating earlier intervention. Interventional keratoconus management is a novel paradigm characterized by early diagnosis enhanced by new and emerging technology, and early proactive intervention to prevent vision loss and quality of life. Some technologies like epithelium-on oxygen-enriched cross-linking are FDA-approved, while others such as pharmaceutical treatments and customized cross-linking are in development. A decentralized coordinated effort from all eyecare providers, including optometrists, comprehensive ophthalmologists, and corneal surgeons may be necessary for identification of early cases and timely referral for early interventional cross-linking treatment. This approach facilitates preservation of vision and quality of life for patients with keratoconus; it also may reduce the economic burden of keratoconus for health systems and society by reducing the long-term costs of care as well as lost productivity and disability. Development and implementation of a viable community-based, patient-centered, interventional keratoconus care pathway will likely require expanded awareness and education regarding keratoconus and its treatment, as well as creating recommendations and guidelines for healthcare systems and providers to streamline screening, referral, and treatment processes. Given that evidence is emerging and clinical practices are evolving for this novel technology, the paper represents a modern perspective based on a synthesis of available evidence, rather than a traditional consensus guideline.
Chemotherapy-induced cardiotoxicity (CIC) is a major limitation of modern anticancer therapy, particularly with anthracyclines and targeted agents, and contributes to long-term cardiovascular complications in cancer survivors. Extracellular vesicles (EVs) are nanoscale lipid-bilayer particles that mediate intercellular communication through the transfer of proteins, nucleic acids, and lipids. Emerging evidence indicates that EVs play a dual role in CIC. On one hand, EVs released from tumor cells or stressed cardiomyocytes can propagate cardiotoxic signals by modulating pathways related to oxidative stress, mitochondrial dysfunction, apoptosis, and inflammatory responses. On the other hand, EV-associated molecular cargo, including specific microRNAs and proteins, shows promise as minimally invasive biomarkers for early detection and monitoring of cardiac injury during chemotherapy. In addition, EVs derived from stem or progenitor cells, as well as engineered EVs with modified cargo or surface ligands, have demonstrated cardioprotective potential by attenuating oxidative damage, suppressing apoptosis, and modulating immune and inflammatory signaling in the injured myocardium. Despite these advances, several barriers hinder clinical translation, including vesicle heterogeneity, limited targeting specificity, challenges in standardized isolation and characterization, and insufficient safety and efficacy validation. This review summarizes the mechanistic roles of EVs in the development of CIC, highlights their emerging value as diagnostic biomarkers and therapeutic carriers, and discusses current technical challenges and future directions for translating EVbased strategies into clinical cardio-oncology practice.
Background: The semaglutide once-weekly injection (Sema-OWI) is widely accepted for managing type-2 diabetes mellitus (T2DM) patients, particularly those seeking weight loss. However, hypoglycemia is continually challenging healthcare practitioners, and the underlying factors have yet to be conclusively reported. The study aimed to investigate the underlying characteristics of T2DM patients undergoing sema-OWI treatment. Methods: A matched case-control study design was employed with a 1:4 (case:control) ratio. Univariable conditional logistic regression was used for the preliminary analysis of the association between patient characteristics and the occurrence of hypoglycemia using a matched odds ratio (mOR). Then, multivariable conditional logistic regression was performed using the predictors, with adjusted mOR (mORadj), including body mass index (BMI) and glycosylated hemoglobin (HbA1C), adjusted for the significant confounders identified in the univariable conditional logistic regression. Results: Forty-five cases diagnosed with the hypoglycemic event and 180 controls were recruited according to a 1:4 (case:control) ratio. According to univariable conditional logistic regression, Patients treated with sema-OWI for 4-6 months (mOR = 0.052; p<0.001) and more than 6 months (mOR = 0.045; p = 0.001) were least likely to experience hypoglycemia. Obese patients (mOR = 0.110; p = 0.041) and those with an HbA1C level >9 (mOR = 0.254; p < 0.001) were also least likely to experience hypoglycemia. According to multivariable conditional logistic regression analysis, the model was adjusted for the number of T2DM medications and Sema-OWI duration, confirming that obesity and higher HbA1C levels (>9) were associated with a lower likelihood of hypoglycemia. On the other hand, the above results establish that the normal body mass index and lower HbA1C levels (<7) were associated with a higher likelihood of hypoglycemia. Conclusion: Patients with T2DM treated with sema-OWI require careful monitoring, particularly during the first 3 months. Normal BMI and HbA1C levels <7 are considered risk factors for hypoglycemia.
