Medicina-Lithuania最新文献

{"title":"Anti-Platelet Therapy with Cangrelor in Cardiogenic Shock Patients: A Systematic Review and Single-Arm Meta-Analysis.","authors":"Jacopo D'Andria Ursoleo, Luca Baldetti, Marina Pieri, Pasquale Nardelli, Savino Altizio, Silvia Ajello, Anna Mara Scandroglio","doi":"10.3390/medicina60122092","DOIUrl":"https://doi.org/10.3390/medicina60122092","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Percutaneous coronary intervention (PCI) is a proven therapy for acute myocardial infarction (AMI) cardiogenic shock (CS). Dual anti-platelet therapy (i.e., aspirin plus an oral P2Y12 inhibitor) is recommended in patients treated with PCI. However, CS patients present severe hemodynamic instability, deranged hemostatic balance, and the need for invasive mechanical circulatory support (MCS) alongside invasive procedures, resulting in an increased risk of both bleeding and thrombotic complications, leaving uncertainty about the best anti-thrombotic treatment. Recently, the parenteral short-acting P2Y12 inhibitor has been increasingly used in the acute cardiac care setting, mainly in light of its favourable pharmacokinetic profile and organ-independent metabolism. <i>Materials and Methods:</i> In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review and single-arm meta-analysis of the safety and efficacy outcomes (i.e., rates of major bleeding, occurrence of stent/any thrombosis, and hospital survival) of all existing original studies reporting on the intravenous administration of cangrelor in AMI-CS patients. <i>Results:</i> Ten studies (678 patients with CS) published between 2017 and 2023 were included in the present review: nine were observational and one had a randomized design. Percutaneous revascularization was performed in >80% of patients across the studies. Moreover, 26% of patients were treated with temporary MCS, and in all studies, concomitant systemic anticoagulation was performed. Cangrelor was administered intravenously at the dosage of 4 mcg/kg/min in 57% of patients, 0.75 mcg/kg/min in 37% of patients, and <0.75 mcg/kg/min in 6%. The pooled rate of major bleeding was 17% (11-23%, confidence interval [CI]), and the pooled rate of stent thrombosis and any thrombosis were 1% (0.3-2.3% CI) and 3% (0.4-7% CI), respectively. Pooled hospital survival was 66% (59-73% CI). <i>Conclusions:</i> Cangrelor administration in AMI-CS patients was feasible and safe with a low rate of thromboembolic complications. Haemorrhagic complications were more frequent than thrombotic events. Nevertheless, to date, the optimal dosage of cangrelor in this clinical context still remains not universally recognized.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11678342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C Virus Infection in Hemodialysis Patients in the Era of Direct-Acting Antiviral Treatment: Observational Study and Narrative Review.","authors":"Ioana Adela Ratiu, Adelina Mihaescu, Nicu Olariu, Cristian Adrian Ratiu, Bako Gabriel Cristian, Anamaria Ratiu, Mirela Indries, Simona Fratila, Danut Dejeu, Alin Teusdea, Mariana Ganea, Corina Moisa, Luciana Marc","doi":"10.3390/medicina60122093","DOIUrl":"https://doi.org/10.3390/medicina60122093","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Hepatitis C virus (HCV) infection is a major global public health concern, particularly in hemodialysis (HD) patients. This study aims to evaluate the demographic, clinical, and laboratory characteristics of HCV-positive patients undergoing HD and assess the long-term impact of direct-acting antivirals (DAAs) on patient outcomes. Moreover, a narrative review aims to summarize the current knowledge regarding HCV treatment in HD patients. The search in the PubMed, Google Scholar, and Scopus databases identified 48 studies relevant to our topic, 18 regarding clinical history and 29 related to HCV treatment. <i>Methods</i>: A retrospective analysis was performed on 165 HD patients from Bihor County HD centers, Romania, between 2014 and 2024. The cohort was divided into two groups: 54 patients who tested positive for HCV and 111 controls who were HCV-negative. Data collected from GPs included demographic information, comorbidities, laboratory parameters, and psychological assessments. Outcomes were evaluated at over 5 years after DAA treatment. A literature review was conducted using PubMed and Google Scholar to identify relevant studies on HCV in HD patients from 1989 to 2024. <i>Results:</i> Laboratory results showed similar parameters across groups, except for lower serum cholesterol levels in the HCV-positive DAA-treated group vs. HCV-positive non-treated ones (155.607 mg% vs. 170.174 mg%, <i>p</i> = 0.040) and increased ALT levels when comparing the same groups (29.107 vs. 22.261, <i>p</i> = 0.027), whereas comorbidities did not differ significantly. The incidence of malignancies was significantly higher among HCV-positive compared to HCV-negative patients (20.3% vs. 8.1%, <i>p</i> = 0.023), mainly among those treated with DAAs, highlighted by the multivariate analysis. Cardiovascular disease remains the leading cause of mortality regardless of HCV status or the use of antiviral therapy. Psychological assessments revealed more severe depression in HCV-positive patients compared to their HCV-negative counterparts. <i>Conclusions:</i> HCV infection in the hemodialysis population typically follows a subclinical course. At over five years after DAA therapy, the results indicate a stabilization of the liver function and the absence of major complications. However, the incidence of malignancies remains high in HCV-positive patients.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11678887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Postoperative Complications of Lobectomy for Non-Small Cell Lung Cancer: An Exploratory Analysis of Premedication and Clinical Variables.","authors":"Markéta Kepičová, Lubomír Tulinský, Adéla Kondé, Paula Dzurňáková, Peter Ihnát, Dávid Adamica, Čestmír Neoral, Lubomír Martínek","doi":"10.3390/medicina60122088","DOIUrl":"https://doi.org/10.3390/medicina60122088","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Postoperative pneumonia and complications significantly impact outcomes in thoracic surgery, particularly for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). This study evaluates whether preoperative premedication influences the risk of postoperative pneumonia and overall complications. <i>Materials and Methods</i>: This retrospective study included 346 patients who underwent lobectomy for NSCLC at the University Hospital Ostrava between 2015 and 2021. Data on demographic variables, tumour staging, surgical approach, and premedication (anticholinergics, benzodiazepines, antihistamines, and analgesics) were analysed. Postoperative outcomes included pneumonia and complications classified by the modified Clavien-Dindo system. <i>Results</i>: Premedication was not significantly associated with postoperative pneumonia (10.7%) or overall complications (26.0%). Tumour size was the only factor significantly associated with complications, with larger tumours increasing the odds (OR: 1.16, <i>p</i> = 0.032). Other factors, including age, ASA classification, BMI, and surgical approach, did not demonstrate significant associations with postoperative outcomes. <i>Conclusions</i>: Premedication does not appear to significantly influence the risk of postoperative pneumonia or overall complications in patients undergoing lobectomy for NSCLC. Similarly, other clinical variables, such as age, ASA classification, BMI, and surgical approach, also did not show significant associations with these outcomes. These findings suggest that premedication can be individualised without increasing postoperative risks. However, tumour size emerged as a significant factor associated with complications, highlighting the need for careful preoperative assessment and planning, particularly in patients with larger tumours.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11678637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HALP Score in Predicting Response to Treatment in Patients with Early-Stage Gastric Cancer: A Multi-Centred Retrospective Cohort Study.","authors":"Tolga Köşeci, Mustafa Seyyar, Yasemin Aydınalp Camadan, Halil Çelik, Burak Mete, Hakan Demirhindi, Kadir Eser, Serdar Ata, Ali Alper Solmaz, Timuçin Çil","doi":"10.3390/medicina60122087","DOIUrl":"https://doi.org/10.3390/medicina60122087","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The HALP (Haemoglobin, Albumin, Lymphocyte and Platelet) score is used to predict the prognosis of different types of cancer. This study aimed to investigate the role of the HALP score in predicting pathological response in early-stage gastric cancer patients. <i>Materials and Methods</i>: This retrospective cohort study was conducted on 118 patients diagnosed with early-stage gastric cancer and subjected to perioperative (FLOT) treatment between 2018 and 2023. The role of the HALP score in predicting the pathological response to perioperative treatment in patients was investigated. <i>Results</i>: The mean age of the 118 patients included in the study was 61.3 ± 11.1 (min = 23; max = 86). In the ROC analysis, the optimum cut-off value for the HALP score in pathological response classification was found to be 28.9 (AUC = 0.710, sensitivity = 56.7%, specificity = 80%, PPV = 86.79%, NPV = 46.15%). The pathological response rate was 69% in all patients, 87% in patients with a HALP score ≥ 28.9, and 52% in patients with a HALP score < 28.9 (<i>p</i> < 0.001). The probability of pathological response is 6.5 times higher in patients with a HALP score ≥ 28.9. In the Fagan nomogram, when the HALP score was ≥28.9, our pathological response probability estimate (post-test response probability) was found to increase to 64.8% (Positive Likelihood Ratio = 3, Negative Likelihood Ratio = 0.53). In patients with HALP scores ≥ 28.9 and <28.9, progression rates were 16.7% and 47.8%, respectively (<i>p</i> < 0.001), and median survival times were 45.4 and 30.6 months (<i>p</i> < 0.001). <i>Conclusions</i>: The HALP score is a useful and easily accessible score for determining pathological responses in patients with locally advanced gastric cancer.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11678702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends.","authors":"Marko Ostojic, Pier Francesco Indelli, Bruno Lovrekovic, Jerome Volcarenghi, Doria Juric, Hassan Tarek Hakam, Mikhail Salzmann, Nikolai Ramadanov, Aleksandra Królikowska, Roland Becker, Robert Prill","doi":"10.3390/medicina60122090","DOIUrl":"10.3390/medicina60122090","url":null,"abstract":"<p><p>Anterior cruciate ligament (ACL) injuries are common in sports and often require surgical intervention, e.g., ACL reconstruction (ACLR), aimed at restoring knee stability and enabling a return to pre-injury activity levels. The choice of graft is crucial, impacting biomechanical properties, clinical outcomes, and complication rates, and is especially important in revision surgeries after graft failure. Over the past 30 years, trends in graft selection have evolved towards more individualized approaches, considering factors such as patient activity level, prior injuries, and tissue availability. In Europe, autografts like hamstring tendon (HT), bone-patellar tendon-bone (BTB), and quadriceps tendon (QT) are preferred, with the increasing use of QT grafts. This review synthesizes the current literature on graft selection and its influence on ACLR outcomes.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11678177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teenage Patients with Class II Subdivision Treated with Aligners and Elastics: A Retrospective Study.","authors":"Vincenzo Quinzi, Andrea Conigliaro, Eda Fani, Lucia Memè, Fabiana Fiasca, Nicolò Carugo, Giuseppe Marzo","doi":"10.3390/medicina60122089","DOIUrl":"https://doi.org/10.3390/medicina60122089","url":null,"abstract":"<p><p><i>Background and Objectives</i>: This study aimed to evaluate the outcomes of Class II subdivision teenage patients treated with Invisalign^® clear aligners (CAs) and elastics. <i>Materials and Methods</i>: A total of 23 individuals aged 14.3 ± 2.5 years were enrolled in this study. The participants were divided into Group 1 (mandibular midline deviation) and Group 2 (maxillary midline deviation). The midline deviation from the facial midline; anteroposterior discrepancy; overjet (OJ), overbite (OB), and Peer Assessment Rating (PAR) scores; upper incisor and lower incisor (L1) positions; and angulation were measured at the beginning (T0) and end (T1) of the orthodontic treatment. <i>Results</i>: Group 1 showed significant higher variations in OJ (-2.3 ± 2.3 vs. -0.6 ± 0.8, <i>p</i> < 0.001), OB (-2.1 ± 2.3 vs. -1.1 ± 1.4, <i>p</i> < 0.001), PAR score (-32.0 ± 11.7 vs. -27.3 ± 13.1, <i>p</i> < 0.001), L1-to-mandibular-plane angle (-3.6 ± 7.0 vs. -1.3 ± 3.2, <i>p</i> < 0.001), and interincisal angle (10.07 ± 8.7 vs. 5.9 ± 5.3, <i>p</i> = 0.007). The midline deviation was the only measurement with higher variation in Group 2. The average distance between the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar was 0.3 ± 0.5 mm. <i>Conclusions</i>: A total of 21 patients achieved bilateral Class I (91% success rate) and demonstrated great improvement (72-96%) in PAR scores. Regardless of the etiology of malocclusion, the orthodontic correction of the Class II subdivision with CAs showed high accuracy and predictable results.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11678840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Invasive Cardiac and Vascular Monitoring in Systemic Sclerosis: Impact of Therapy on Subclinical Dysfunction.","authors":"Ștefania Lucia Magda, Ana Maria Gheorghiu, Raluca Ileana Mincu, Andrea Olivia Ciobanu, Tudor Constantinescu, Elisa Cristina Popa, Carina Mihai, Dragoș Vinereanu","doi":"10.3390/medicina60122080","DOIUrl":"https://doi.org/10.3390/medicina60122080","url":null,"abstract":"<p><p><i>Background and objectives</i>: Systemic sclerosis (SSc) causes myocardial and microvascular impairment, with subclinical dysfunction and eventually permanent cardio-vascular damage. The long-term influence of SSc therapies on subclinical cardiovascular dysfunction is insufficiently investigated. We aimed to assess 2D and 4D cardiac ultrasound parameters of heart function in patients with different forms of SSc versus controls and to determine the evolution of cardiac function and arterial stiffness parameters under therapy. <i>Materials and methods</i>: A total of 60 subjects with SSc were studied at baseline; 30 SSc patients were compared to 30 matched controls. A total of 52 SSc subjects were reassessed after 1 year and 30 after 2 years of treatment. Cardiac function was evaluated through 2D standard echocardiography, tissue Doppler, speckle tracking and 4D auto LV quantification echo. Arterial stiffness was determined via the cardio-ankle vascular index and ankle brachial index. <i>Results</i>: At baseline, the standard echo parameters were normal. The 4D and myocardial work parameters, although in normal limits, were significantly altered in the SSc group vs. controls (4D ejection fraction 54.5 ± 8.5% in SSc vs. 63.8 ± 3.1% in controls; 4D longitudinal strain -14.2 ± 2.4% in SSc vs. -22.0 ± 2.7% in controls; global constructive work 2124.2 ± 449.5 mmHg% in SSc vs. 3102.8 ± 337.5 mmHg% in controls, for all <i>p</i> ≤ 0.02). Both at 1 year and 2 years of treatment, all echo and arterial stiffness parameters were similar to baseline, with no correlation to treatment type. <i>Conclusions</i>: SSc determines subclinical systolic dysfunction. Non-invasive assessment methods do not detect a functional cardiovascular decline in patients on classical therapy. Complex cardiac follow-up should be implemented in cases at risk for complications.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11678526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Diagnosis of Parotid Gland Follicular Lymphoma Arising in Warthin Tumor: Case Report and Literature Review.","authors":"Ido Vaknin, Irit Allon, Shirley Zafrir-Haver, Alex Abramson","doi":"10.3390/medicina60122086","DOIUrl":"https://doi.org/10.3390/medicina60122086","url":null,"abstract":"<p><p><i>Introduction</i>: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. <i>Clinical report</i>: A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 × 2.7 × 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. <i>Conclusions</i>: Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the \"wait and see\" approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11679321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Efficacy of Staging Laparoscopy Compared to CT and PET-CT in Gastric Cancer: A Retrospective Cohort Analysis.","authors":"Cem Batuhan Ofluoğlu, Isa Caner Aydın, Fırat Mülküt, Orhan Uzun, Aziz Serkan Senger, Selçuk Gülmez, Uğur Duman, Erdal Polat, Mustafa Duman","doi":"10.3390/medicina60122079","DOIUrl":"https://doi.org/10.3390/medicina60122079","url":null,"abstract":"<p><p><i>Background and Objectives</i>: This study aimed to assess the diagnostic accuracy and prognostic significance of staging laparoscopy (SL) compared to computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) in gastric cancer staging. We evaluated the ability of SL to detect occult peritoneal metastases and influence of SL on survival outcomes across cancer stages and treatment approaches. <i>Materials and Methods</i>: In this retrospective cohort study, 95 patients with gastric cancer underwent preoperative assessment using CT, PET-CT, and SL between 2018 and 2024. Diagnostic performance metrics were calculated for SL, CT, and PET/CT across the local, locally advanced, and metastatic stages. Survival outcomes were analyzed using Kaplan-Meier curves, and comparisons were made using log-rank tests. A multivariable Cox proportional hazards model incorporating interaction terms was used to determine the independent prognostic factors affecting survival, focusing on SL findings and cytology results. <i>Results</i>: The cohort comprised 75 males (78.9%) and 20 females (21.1%), with a mean age of 57.4 ± 10.1 years. The tumor location distribution was predominant in the corpus (31.1%) and cardia. Tumor staging revealed that 48.1% were classified as T3 and 28.8% as T4, respectively. Diagnostic accuracy analysis showed that SL outperformed CT and PET-CT in detecting peritoneal metastasis across all stages. Specifically, SL demonstrated a sensitivity and specificity of 85% and 95% for local disease, 92% and 80% for locally advanced disease, and 95% and 99% for metastatic disease, significantly exceeding those of CT and PET-CT. Patients with SL findings had a median overall survival (OS) of 30 months compared with 20 months for those assessed only with CT and PET-CT (<i>p</i> < 0.05). The stage-specific median OS for SL patients was 40 months in the local, 25 months in the locally advanced (<i>p</i> < 0.05), and 15 months in the metastatic disease (<i>p</i> < 0.01) groups, indicating significant survival benefits. Multivariable Cox regression identified SL findings as an independent factor associated with reduced mortality risk (HR: 0.70, 95% CI: 0.50-0.90, <i>p</i> < 0.01), while positive cytology findings predicted poorer survival (HR: 1.80, 95% CI: 1.25-2.60, <i>p</i> < 0.01). Interaction terms revealed that SL yielded greater survival benefits in patients with metastatic disease (hazard ratio [HR]: 0.60, <i>p</i> < 0.01) and those undergoing systemic therapy (HR: 0.75, <i>p</i> = 0.04). <i>Conclusions</i>: SL provides superior diagnostic accuracy and prognostic information for advanced gastric cancer staging compared with CT and PET-CT. By accurately detecting peritoneal metastasis, SL aids in optimizing treatment plans, particularly in advanced stages, thus potentially improving patient outcomes.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11677282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends and Identification of Suicide Mortality Risk Areas in Brazil (2000-2022): Are We Dealing with an Underestimated Epidemic?","authors":"Danilo de Gois Souza, Lucas Almeida Andrade, José Augusto Passos Góes, Luís Ricardo Santos de Melo, Matheus Santos Melo, Caíque Jordan Nunes Ribeiro, José Marcos de Jesus Santos, Emerson Lucas Silva Camargo, Álvaro Francisco Lopes de Sousa, Liliane Moretti Carneiro, Regina Claudia da Silva Souza, Márcio Bezerra Santos, Shirley Veronica Melo Almeida Lima, Carla Aparecida Arena Ventura, Allan Dantas Dos Santos","doi":"10.3390/medicina60122083","DOIUrl":"https://doi.org/10.3390/medicina60122083","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Suicide is a pressing public health issue globally, including in Brazil, where it ranks among the leading causes of mortality. This study aimed to analyze the spatial, temporal, and spatiotemporal distribution of suicide mortality in Brazil from 2000 to 2022. <i>Materials and Methods</i>: Using secondary data from the Mortality Information System of Brazil's 5570 municipalities, an ecological study of time series was conducted. Segmented linear regression (Joinpoint 4.6 version) was used to calculate temporal trends, while Moran's indices were employed to analyze spatial autocorrelations. Retrospective scanning was utilized to investigate spatiotemporal clusters, and choropleth maps were developed to visualize high-risk areas. <i>Results</i>: The analysis revealed the occurrence of 240,843 suicides in Brazil, with higher percentages in the southeast, south, and northeast regions. The south, central-west, and southeast regions exhibited the highest mortality rates, predominantly among white, single men, aged 20 to 59, with 1 to 11 years of schooling. Intentional self-harm by hanging, strangulation, and suffocation was the main cause. The general trend of mortality due to suicide in Brazil was increasing (AAPC: 2.9; CI 95%: 2.6 to 3.0), with emphasis on the age groups from 10 to 19 years (AAPC: 3.7; CI 95%: 2.9 to 4.5) and 20-39 years old (AAPC: 2.9; CI 95%: 2.3 to 3.5). The brutal and smoothed rates revealed areas of high mortality in the south, north, and central-west regions. <i>Conclusions</i>: The findings of this study highlight the need to direct resources and efforts to the south and midwest regions of Brazil, where suicide rates are the highest. Additionally, implementing targeted prevention programs for young men, who are the most affected, is essential to reduce suicide mortality in these areas.</p>","PeriodicalId":49830,"journal":{"name":"Medicina-Lithuania","volume":"60 12","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11677106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}