Background and Objectives: The associations between operative-day timing and outcomes after laparoscopic gastrectomy remain uncertain. This study evaluated surgical start time, daily case order, and inter-case interval in relation to short-term outcomes in patients with gastric cancer. Materials and Methods: This retrospective cohort study included 394 patients who underwent curative-intent laparoscopic gastrectomy at two tertiary centers between January 2016 and January 2026. Surgical start time was classified as morning (<12:00) or afternoon (≥12:00), and case order as first, second, or third. Among patients with available inter-case interval data, intervals were categorized as ≤30 or >30 min. Primary outcomes were 30-day postoperative complications and anastomotic leakage. Multivariable logistic regression was used to assess factors associated with postoperative complications. Results: Of the 394 procedures, 319 were performed in the morning and 75 in the afternoon. Afternoon procedures had higher unadjusted rates of conversion to open surgery (9.3% vs. 3.1%), postoperative complications (6.7% vs. 1.9%), and anastomotic leakage (5.3% vs. 0.9%). Across first, second, and third cases, complication rates were 1.5%, 3.7%, and 14.3%, respectively, and leakage rates were 0.8%, 2.8%, and 9.5%. Among 130 patients with interval data, leakage occurred in 7.6% after intervals > 30 min and in 0% after intervals ≤ 30 min. In the reported multivariable model, third versus first case order was associated with complications (odds ratio, 17.74; 95% confidence interval, 1.17–269.66). Conclusions: Later case order may be associated with postoperative complications; however, the limited number of postoperative events and wide confidence interval warrant cautious interpretation. These exploratory findings require validation before recommendations regarding surgical scheduling can be made.
Background and Objectives: This study aimed to evaluate whether intra-amniotic infection is associated with severe histological fetal inflammatory response in pregnant women with spontaneous preterm delivery. Materials and Methods: This retrospective study included patients diagnosed with preterm labor, cervical insufficiency, or preterm pre-labor rupture of membranes between 20 and 33 weeks of gestation. Patients underwent amniotic fluid tests via transabdominal amniocentesis to detect intra-amniotic infection (positive amniotic fluid culture in combination with a high IL-6 level and/or a low glucose level and/or a high white blood cell count) between April 2014 and March 2022. Severe histological fetal inflammatory response (≥stage 2 and/or grade 2) was assessed via placental pathology. Multivariate regression analysis was performed to identify risk factors for severe histological fetal inflammatory response. Results: Of the 155 patients, 14.8% (23/155) were diagnosed with intra-amniotic infection. The incidence of severe histological fetal inflammatory response was significantly higher in the intra-amniotic infection group than in the non-intra-amniotic infection group (52.2% vs. 9.1%, p < 0.001). Univariate analysis has revealed that IAI (OR 10.9, 95% CI, 3.97–30), fever (OR 5, 95% CI, 1.25–20.4), and CRP ≥1.24 mg/dL (OR 3.5, 95% CI, 1.4–8.6) were significantly associated with severe histological fetal inflammatory response. Multivariate logistic regression revealed that intra-amniotic infection remained significantly associated with severe fetal inflammatory response even after adjustment for fever and elevated CRP (OR 9.1, 95% CI 2.4–34.2). Conclusions: Intra-amniotic infection in pregnant women with threatened spontaneous preterm delivery was identified as a significant risk factor for severe fetal inflammatory response, which may contribute to adverse neonatal outcomes in preterm infants. Amniotic fluid testing for intra-amniotic infection may aid in predicting fetal inflammatory response antenatally.
Background and Objectives: Diffuse midline glioma (DMG), H3 K27-altered, occurs in children and adults, but age-group differences and their prognostic significance remain uncertain. We examined clinicopathologic and molecular features and survival in H3 K27M-mutant DMG across age groups. Materials and Methods: This retrospective single-center study included 53 patients (18 children and 35 adults). Histologic features, treatment, targeted sequencing results (28 tumors), and overall survival (OS) were analyzed. Results: Thalamic tumors predominated in adults (77.1%) and brainstem tumors in children (66.7%; p < 0.001). Median Ki-67 labeling index (LI) was higher in children (39% vs. 20%; p = 0.032); the estimated age-group difference remained similar after adjustment for location. Treatment regimens differed by age, but no significant age-group differences were found in other histologic features or the genomic alterations examined. At the data cutoff, 48 patients (90.6%) had died. Median OS was 20.3 months, without a significant difference between children and adults (15.2 vs. 21.7 months; p = 0.124). Higher Ki-67 LI remained associated with shorter OS after adjustment for age group, brainstem involvement, necrosis, and upfront radiotherapy (hazard ratio (HR) 1.37 per 10-percentage-point increment; 95% confidence interval (CI), 1.16–1.63; p < 0.001). Necrosis was also independently associated with shorter OS (HR 2.54; 95% CI, 1.29–5.00; p = 0.007). TP53 alteration was associated with shorter OS in univariable analysis but not after adjustment. Conclusions: Age groups differed in anatomical distribution and proliferative activity, but age was not independently associated with OS. Ki-67 LI and necrosis may provide accessible prognostic information, whereas the association of TP53 alteration with outcome requires validation.
Background and Objectives: Sentinel lymph node biopsy (SLNB) is the standard procedure for regional nodal staging in patients with clinically localized cutaneous melanoma. However, most patients undergoing SLNB have negative sentinel lymph nodes, highlighting the need for predictive tools to optimize selection. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram estimates the probability of sentinel lymph node metastasis using clinicopathological variables. This study evaluated the discrimination, calibration, and net benefit of the MSKCC nomogram in a Romanian cohort of patients with cutaneous melanoma. Materials and Methods: We conducted a retrospective, single-center cohort study including 117 patients with primary cutaneous melanoma who underwent SLNB between 2020 and 2025. The predicted probability of sentinel lymph-node (SLN) metastasis was calculated using the official MSKCC nomogram, and histopathological SLN status served as the reference standard. Discrimination was evaluated using receiver operating characteristic analysis, and threshold-based classification was assessed at predicted risks of 5%, 10%, and the exploratory Receiver Operating Characteristic (ROC) curve-derived threshold of 19%. Calibration was assessed using the observed-to-expected ratio and the calibration intercept and slope, and net benefit was evaluated by decision curve analysis. Results: Patients with positive sentinel lymph nodes had higher MSKCC-predicted risks than patients with negative nodes (median 20.0% vs. 10.0%; p = 0.0004). The MSKCC score was associated with SLN positivity (OR 1.065 per 1-percentage-point increase; 95% CI 1.026–1.106; p = 0.0011). The model showed moderate discrimination (AUC = 0.714; 95% CI 0.614–0.814). At the 5% threshold, 24 patients (20.5%) were classified below the threshold, and no SLN-positive case was observed in this subgroup; however, the subgroup was small. Higher thresholds classified more patients below the biopsy threshold but reduced sensitivity. The nomogram underestimated the observed risk (mean predicted 15.6% vs. observed 26.5%; observed-to-expected ratio 1.70, 95% CI 1.15–2.41; calibration slope 0.89). Compared with SLNB for all patients, nomogram-based selection yielded a net reduction of 20.5 biopsies per 100 patients at the 5% threshold but no net benefit at the 10% threshold. Conclusions: In this cohort, the MSKCC nomogram showed moderate discrimination for SLN positivity but underestimated the absolute risk of SLN metastasis. It may be useful as an additional tool in selected or borderline cases, but it should be applied with caution and should not replace established clinicopathological criteria and guideline-based SLNB recommendations. Validation in larger multicenter cohorts, including recalibration, is required before any risk threshold can be recommended.
Background and Objectives: Eco-anxiety is a growing psychological response to climate change, but individual vulnerability factors remain poorly understood. Affective temperaments may contribute to differences in eco-anxiety. Materials and Methods: This cross-sectional online study involved 209 Italian adults recruited between May and December 2024. Participants completed the Hogg Eco-Anxiety Scale and the short version TEMPS-A. Gender differences were assessed using independent-sample t-tests, and multiple linear regression analyses were performed to examine the associations between affective temperaments and eco-anxiety dimensions. Results: Regression models explained 16–22% of variance. Anxious temperament was the most consistent correlate, associating with affective symptoms, rumination, behavioural symptoms, and personal-impact anxiety. Cyclothymic temperament was associated with behavioural symptoms and personal-impact anxiety, but not rumination after correction for multiple testing. Other temperaments showed no significant associations. Females reported higher anxious temperament and personal-impact anxiety. After adjustment for age and gender, associations with personal-impact anxiety did not survive correction for multiple testing. Conclusions: Findings suggest that individual differences in eco-anxiety are associated with affective temperament, although the cross-sectional design and partial overlap between measures call for caution. Considering temperament may improve understanding of psychological responses to climate change and inform future preventive and support strategies.
