Annals of Medicine and Surgery最新文献

{"title":"Complex sclerosing lesions of the breast mimicking carcinoma: diagnostic pitfalls and the decisive role of immunohistochemistry.","authors":"Shuo Zhang, Jiaxing Wang, Lei Han, Yanshou Zhang","doi":"10.1097/MS9.0000000000005712","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005712","url":null,"abstract":"<p><strong>Background: </strong>Complex sclerosing lesion (CSL) of the breast is a benign proliferative condition that frequently mimics invasive carcinoma on imaging and in limited biopsy specimens. Radiologic-pathologic discordance may result in diagnostic uncertainty and potentially unnecessary surgical intervention. Accurate pathological assessment, particularly evaluation of myoepithelial cell preservation, is therefore critical to appropriate clinical decision-making.</p><p><strong>Methods: </strong>A retrospective analysis of three female patients diagnosed with CSL at a single medical institution was conducted, along with a focused review of the literature. Clinical presentation, multimodal imaging findings, core-needle biopsy results, histopathological features, immunohistochemical profiles, diagnostic challenges, and subsequent management strategies were systematically evaluated.</p><p><strong>Results: </strong>All three lesions demonstrated imaging features highly suspicious for malignancy on ultrasound, mammography, and magnetic resonance imaging. Core-needle biopsy yielded inconclusive or misleading results, including atypical ductal proliferation and suspected invasive carcinoma, prompting surgical excision. Final pathological examination confirmed CSLs in two patients and breast secretory carcinoma in one patient. Immunohistochemical analysis - particularly the assessment of myoepithelial markers such as p63 and calponin - played a decisive role in distinguishing benign CSL from invasive disease. No recurrence or disease progression was observed during follow-up.</p><p><strong>Conclusions: </strong>CSLs represent a well-recognized diagnostic pitfall in breast practice due to their close resemblance to carcinoma on imaging and in limited biopsy samples. Comprehensive histopathological evaluation, supported by appropriate immunohistochemistry, is essential to establish an accurate diagnosis, guide surgical decision-making, and avoid overtreatment.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6498-6503"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of FundoRing versus standard one-anastomosis gastric bypass: up to 3-year results of a randomized controlled trial.","authors":"Oral Ospanov, Galymjan Duysenov, Bakhtiyar Yelembayev, Galymzhan Yeleuov, Zhanbolat Dildbekov","doi":"10.1097/MS9.0000000000005625","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005625","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The FundoRing modification of one-anastomosis gastric bypass (OAGB) has demonstrated superior clinical outcomes compared with standard OAGB in patients with metabolic syndrome. However, the cost-effectiveness of this innovative technique remains unclear. This study aimed to perform a cost-effectiveness analysis of FundoRing versus standard OAGB using the incremental cost-effectiveness ratio (ICER) and the cost-effectiveness plane.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cost-effectiveness analysis was conducted alongside a randomized controlled trial including 1000 patients (&lt;i&gt;n&lt;/i&gt; = 500 FundoRing, &lt;i&gt;n&lt;/i&gt; = 500 standard OAGB) with metabolic syndrome and up to 3 years of follow-up (median: 28 months, IQR: 22-34 months). Effectiveness was measured as the proportion of patients who achieved a target BMI of &lt;30 kg/m&lt;sup&gt;2&lt;/sup&gt; at their last follow-up visit. Direct medical costs, including surgical intervention, hospitalization, postoperative follow-up, and management of late complications, were calculated from the healthcare-system perspective. Costs were converted from the Kazakhstani tenge (KZT) to US dollars (USD) using the 2025 exchange rate (521.59 KZT/USD). The willingness-to-pay (WTP) threshold was used as a contextual benchmark, with the understanding that the primary conclusion on cost-effectiveness relies on the dominance finding. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in costs divided by the difference in effectiveness. A probabilistic sensitivity analysis with 5000 bootstrap iterations was performed to construct the cost-effectiveness plane.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At the last follow-up (median 28 months), the FundoRing group demonstrated significantly higher effectiveness (94.2% vs. 86.7% achieving BMI &lt;30 kg/m&lt;sup&gt;2&lt;/sup&gt;; &lt;i&gt;P&lt;/i&gt; = 0.002) and significantly lower total costs per patient (5928.10 USD vs. 6758.00 USD, difference -829.90 USD, 95% CI: -1184.2 to -475.6). The cost savings in the FundoRing group were primarily driven by a reduced incidence of late complications such as dumping syndrome (13.7% vs. 36.5%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), marginal ulcers (0.2% vs. 2.9%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and bile reflux esophagitis (0.2% vs. 8.1%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001). The ICER was -11 065 USD per patient achieving the target BMI. On the cost-effectiveness plane, 100% of the bootstrap iterations fell in the southeast quadrant, indicating that FundoRing is a dominant strategy (lower costs and higher effectiveness).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;FundoRing modification of OAGB is a more cost-effective strategy than standard OAGB within the studied population and single-center setting. The reduction in late postoperative complications generates substantial healthcare savings while achieving superior clinical outcomes. These findings provide economic evidence to support the use of the FundoRing technique in bariatric surgery. Multi-center studies are needed to confirm generalizabi","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6404-6412"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic solid papillary neoplasm with high-grade malignant transformation and multiple hepatic metastases in an elderly male: a case report.","authors":"Kuang-Ting Liu, Yueh-Ching Chang, Yu-Chieh Lin, Junn-Liang Chang","doi":"10.1097/MS9.0000000000005529","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005529","url":null,"abstract":"<p><strong>Introduction and clinical importance: </strong>Solid pseudopapillary neoplasms (SPNs) are rare pancreatic tumors that predominantly affect young women and generally exhibit low malignant potential. High-grade malignant transformation with distant metastasis is uncommon, particularly in elderly males.</p><p><strong>Case presentation: </strong>A 66-year-old male with hepatitis B virus-related cirrhosis presented with obstructive jaundice, abdominal pain, and significant weight loss. Contrast-enhanced computed tomography revealed a large pancreatic head mass with multiple hepatic lesions. Histopathological examination demonstrated mixed solid and pseudopapillary architecture with marked nuclear atypia, high mitotic activity, and extensive necrosis. Immunohistochemical analysis showed nuclear β-catenin positivity and expression of CD56 and CD99, with negative neuroendocrine markers, and a proliferative Ki-67 labeling index of approximately 60% in the hot spot together, these findings confirmed SPN with high-grade malignant transformation and hepatic metastases.</p><p><strong>Clinical discussion: </strong>This case represents an aggressive and atypical presentation of an SPN. Advanced disease, extensive metastases, and underlying liver cirrhosis significantly limited therapeutic options; only palliative management was feasible.</p><p><strong>Conclusion: </strong>High-grade metastatic SPNs may exhibit aggressive clinical behavior and a poor prognosis. Elderly male sex may represent a potential adverse prognostic factor for aggressive SPN variants. Early recognition and accurate diagnosis are essential, particularly in atypical populations with significant comorbidities.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6773-6780"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-model comparison and nomogram development for predicting in-hospital mortality in Trauma patients based on NLR and other indicators.","authors":"Kang Chao, Fan Jiawei, Xu Tairui, Ma Youyun, Zhang Bo","doi":"10.1097/MS9.0000000000005715","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005715","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to systematically compare the predictive performance of logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost) for predicting in-hospital mortality among trauma patients, evaluate the prognostic value of key indicators, including the neutrophil-to-lymphocyte ratio (NLR), and develop a visual clinical nomogram.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 318 severe trauma patients [Injury Severity Score (ISS) ≥ 16] admitted between January 2022 and October 2024 as the derivation cohort; an independent temporal validation cohort of 161 patients admitted between January 2025 and May 2026 from the same institution was also included. LR, RF, and XGBoost models were trained and evaluated for AUC, sensitivity, specificity, and calibration. LASSO regression was used for variable selection, and a multivariable LR model was constructed to develop a nomogram.</p><p><strong>Results: </strong>On the internal test set, RF achieved the highest AUC (0.919) with a sensitivity of 0.963. LR had the highest specificity (0.868), with a calibration plot indicating good agreement. In the temporal validation cohort, LR demonstrated robust performance with an AUC of 0.906. Multivariable LR identified age [odds ratios (OR) = 1.071], ISS (OR = 1.234), and shock index (OR = 3.963) as independent risk factors, while NLR was a paradoxical protective factor (OR = 0.872). Variable importance analysis ranked NLR as the top contributor. A nomogram incorporating these variables demonstrated favorable discrimination and clinical utility, supported by DCA.</p><p><strong>Conclusion: </strong>The developed nomogram integrates key predictors into a visual tool for rapid mortality risk assessment in trauma patients, thereby facilitating early risk stratification and optimized resource allocation. The RF model is superior for identifying high-risk patients (high sensitivity), whereas the LR model excels at ruling out low-risk patients (high specificity) and demonstrates better probability calibration. NLR is a significant predictor of early post-traumatic mortality, although its direction of effect warrants further investigation.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6504-6513"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cumulative obesity exposure and hepato-pancreato-biliary cancer risk following different weight-loss interventions: retrospective cohort study.","authors":"Ivan Kukeev, Yuval Arnon, Elchanan Quint, Sofyan Abu Freih, Anton Osyntsov, Oleg Dukhno","doi":"10.1097/MS9.0000000000005470","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005470","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a time-dependent carcinogenic exposure associated with an increased risk of hepatopancreatobiliary (HPB) cancers. Although weight-loss interventions improve metabolic status, the comparative oncologic impact and the role of cumulative obesity duration remain unclear.</p><p><strong>Objectives: </strong>To compare HPB cancer incidence across lifestyle-based, pharmacologic, and surgical weight-loss strategies and to assess whether differences in cumulative obesity exposure before and after weight reduction may influence cancer risk.</p><p><strong>Setting: </strong>A retrospective cohort study at a tertiary university hospital in Israel.</p><p><strong>Methods: </strong>We analyzed 1131 adults who achieved weight loss between 2010 and 2024 through lifestyle modification, weight-loss medications, or bariatric surgery. For each patient, the duration of obesity before and after weight loss, the magnitude of BMI reduction, and follow-up intervals were recorded. HPB cancers - including hepatocellular carcinoma, pancreatic ductal adenocarcinoma, cholangiocarcinoma, and gallbladder carcinoma - were identified through national registry linkage. Group differences were evaluated using analysis of variance, Kruskal-Wallis, χ² tests, and unadjusted risk ratios and odds ratios.</p><p><strong>Results: </strong>Twenty-seven HPB cancers were identified. Incidence did not differ significantly among lifestyle (2.05%), medication-induced (3.24%), and surgery-induced (1.05%) groups (<i>P</i> = 0.334). Bariatric surgery had the lowest numerical incidence, whereas pharmacologic therapy had higher numerical rates; however, these differences were not statistically significant and should be interpreted cautiously. Obesity duration before weight loss differed significantly across groups (<i>P</i> < 0.001), and post-weight-loss duration showed a borderline difference (<i>P</i> = 0.050). BMI reduction was similar across interventions.</p><p><strong>Conclusions: </strong>Although no statistically significant differences in HPB cancer incidence were observed among weight-loss strategies, exploratory numerical differences were noted, with the lowest crude incidence in the bariatric surgery group. Given the limited number of events, these findings should be interpreted cautiously and viewed as hypothesis-generating only. Further adequately powered prospective studies are required before any clinical inference can be made.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6304-6311"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonographic changes following pyeloplasty in children with ureteropelvic junction obstruction: a prospective observational before-after cohort study.","authors":"Farnoush Izadfar, Reza Abbasioun, Ahmad Mohammadipour, Sara Saadat, Mostafa Abrishami, Sayed Morteza Fayez, Mohammad Mahdi Alvandi Fard, Khashayar Atqiaee","doi":"10.1097/MS9.0000000000005679","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005679","url":null,"abstract":"<p><strong>Background/objective: </strong>Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly in pediatric patients. Although nuclear scintigraphy is traditionally considered the standard for postoperative follow-up, the associated radiation exposure, invasiveness, and cost have prompted interest in noninvasive options. This study evaluated postoperative ultrasonographic changes as a first-line surveillance tool for children undergoing pyeloplasty.</p><p><strong>Methods: </strong>This prospective observational before-after cohort study (March 2023-March 2024) evaluated 50 children (38 girls, 12 boys) treated for primary congenital UPJO. All underwent open pyeloplasty by two experienced surgeons, with Double-J stents removed at 4 weeks. Preoperative and 3-month postoperative evaluations compared sonographic parameters [anteroposterior pelvic diameter (APD), cortical thickness, renal length, hydronephrosis severity], diethylenetriamine pentaacetic acid renal scintigraphy, and biochemical markers. Surgical success was defined as clinical improvement alongside stable or improved sonography without the need for reintervention.</p><p><strong>Results: </strong>Postoperatively, significant reductions were observed in APD, hydronephrosis grade, serum creatinine, BUN, and random urine creatinine (all <i>P</i> < 0.001). Conversely, cortical thickness and renal length significantly increased bilaterally (all <i>P</i> < 0.001). Differential renal function was effectively preserved, with no significant postoperative changes (right: <i>P</i> = 0.209; left: <i>P</i> = 0.189). Additionally, patient age demonstrated significant positive correlations with multiple postoperative sonographic and biochemical parameters.</p><p><strong>Conclusion: </strong>Ultrasonography is a safe, reliable, and practical first-line surveillance tool for post-pyeloplasty follow-up. Nuclear renography can be selectively reserved for patients showing clinical deterioration or a lack of sonographic improvement.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6454-6459"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of parasitic fibroid in unscarred abdomen mimicking pedunculated uterine fibroid: a case report.","authors":"Lokendra Bata, Sumana Thapa, Suman Gurung, Samiksha Regmi, Sandip Paudel","doi":"10.1097/MS9.0000000000005707","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005707","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Parasitic leiomyomas are a type of extra-uterine fibroid that develop outside the uterus and thus receive their blood supply from surrounding structures. While most cases are iatrogenic, spontaneous occurrences are rare and often pose diagnostic challenges due to atypical locations.</p><p><strong>Case presentation: </strong>We report the case of a 28-year-old woman, para 2, with no prior abdominal or pelvic surgery, who presented with a 5-year history of intermittent lower abdominal pain. Ultrasound suggested a pedunculated mass arising from the uterine fundus, mimicking an ovarian endometrioma. During laparotomy, a 4.5 × 4.5 cm mass was identified at the mesenteric border near the sigmoid colon. The uterus and adnexa were normal. The mass was completely excised, and histopathology confirmed a benign leiomyoma. The patient recovered uneventfully.</p><p><strong>Clinical discussion: </strong>Spontaneous parasitic leiomyomas are rare and can mimic adnexal or pedunculated uterine masses. Also, the symptoms of the disease may be vague, which makes preoperative diagnosis challenging. Surgical excision is both diagnostic and curative, with excellent outcomes.</p><p><strong>Conclusion: </strong>This case demonstrates a rare spontaneous parasitic leiomyoma arising from the mesentery. Clinicians should consider this entity in the differential diagnosis of extra-uterine masses, even in patients with no history of surgery. Complete excision provides definitive treatment with minimal risk of recurrence.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6907-6911"},"PeriodicalIF":1.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple hepatic cyst is not always simple - a case report of cystobiliary communication requiring hepatic resection.","authors":"Chin-Yee Mah, Chang-Kuo Wei, Chun-Hung Lin, Shih-Pin Lin, Yu-Ting Chiu, Wen-Yao Yin, Cheng-Hung Lee","doi":"10.1097/MS9.0000000000005656","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005656","url":null,"abstract":"<p><strong>Background: </strong>Simple hepatic cysts are common and usually asymptomatic, but rarely may communicate with the intrahepatic biliary tree; unroofing alone can then result in postoperative bile leakage if this communication is not recognized.</p><p><strong>Case presentation: </strong>We report a 74-year-old woman with multiple hepatic cysts, the largest measuring 11 cm and causing extrinsic gastric compression. Preoperative computed tomography (CT) suggested a simple cyst without evidence of biliary communication, and laparoscopic unroofing was planned. Needle decompression, however, yielded bile-like fluid indicating unsuspected cystobiliary communication; the procedure was therefore converted to laparoscopic left lateral sectionectomy. Her postoperative course was uneventful, without bile leakage.</p><p><strong>Conclusion: </strong>In conclusion, a preoperatively \"simple\" hepatic cyst may harbor unsuspected cystobiliary communication that CT alone can miss. Intraoperative vigilance and willingness to convert to formal resection are essential when this complication is encountered.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6856-6859"},"PeriodicalIF":1.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of long-term beta-blockers post-stemi: a meta-analytic review.","authors":"Iqra Maryam, Sagreeka Raj, Sheela Bai, Fnu Muskan, Sanjana Devi, Fnu Geeta, Ghazi Uddin Ahmed, Areeba Pervaiz, Deepika Deepika, Sayed Jawad","doi":"10.1097/MS9.0000000000004665","DOIUrl":"https://doi.org/10.1097/MS9.0000000000004665","url":null,"abstract":"<p><strong>Aims: </strong>This meta-analysis assessed the long-term impact of beta-blocker therapy on all-cause mortality and cardiovascular outcomes in patients with ST-elevation myocardial infarction (STEMI) who continued beta-blocker use for a minimum of 1 year after hospital discharge.</p><p><strong>Methods: </strong>Electronic databases were searched through September 2024 to identify studies comparing long-term outcomes in patients treated with beta-blockers versus those untreated. A random-effects model was used to estimate Hazard Ratios (HRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 21 studies involving 270 566 patients were included. In pooled analyses, extended beta-blocker was associated with significantly lower all-cause mortality in STEMI patients [HR: 0.74 (0.66, 0.83); <i>P</i> < 0.0001] and showing non-significant trend toward reducing cardiac death [HR: 0.77 (0.56, 1.04); <i>P</i> = 0.09], an effect observed predominantly in observational studies. However, in randomized controlled trials (<i>N</i> = 3), no significant benefit was demonstrated (all-cause mortality: <i>P</i> = 0.67; cardiac death: <i>P</i> = 0.62). No meaningful differences were found for major adverse cardiovascular events [HR: 0.90 (0.76, 1.07); <i>P</i> = 0.22], myocardial infarction, hospitalization for heart failure, or revascularization.</p><p><strong>Conclusion: </strong>Long-term beta-blocker use is associated with a significant reduction in all-cause mortality among STEMI patients, though this benefit was not seen in RCTs. Effects on other cardiovascular outcomes remain uncertain, highlighting the need for further large-scale trials.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6514-6521"},"PeriodicalIF":1.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the potential of mRNA vaccines in combatting communicable and non-communicable diseases in low-income and lower-middle-income countries.","authors":"Faida Paison, Queen Ntumurize, Gustave Munyurangabo, Sifa Nayihiki, Yue Jingze, Secret Atukunda, Rosine Ikuzwe Shabe, Janvier Habumugisha, Fortunate Ayebare, Fabrice Kayitare, Betty Amikoro, Willy Mazimpaka, Jean de Dieu Niyoyita, Biyun Su","doi":"10.1097/MS9.0000000000005664","DOIUrl":"https://doi.org/10.1097/MS9.0000000000005664","url":null,"abstract":"<p><p>The global health landscape is increasingly dominated by a double burden of communicable diseases (CDs) and non-communicable diseases (NCDs), with low-income and lower-middle-income countries (LMICs) being disproportionately affected due to geographic, demographic, and socioeconomic vulnerabilities. While infectious diseases like HIV/AIDS, tuberculosis, malaria, and diarrheal illnesses continue to cause high mortality rates, particularly in LMICs, NCDs such as cardiovascular disease, cancer, diabetes, and chronic pulmonary conditions are rising rapidly due to demographic shifts and lifestyle changes. This dual burden not only contributes to high morbidity and mortality but also results in significant economic losses due to treatment costs and reduced productivity. World Health Organization projections suggest that by 2050, NCDs will account for 70% of all deaths in LMICs. This study aimed to explore recent literature on the impact of communicable diseases and NCDs in these regions and assess the potential role of mRNA vaccine technology in addressing this growing crisis. The findings indicate that mRNA vaccines have emerged as a transformative innovation in the field of vaccinology, offering rapid, adaptable platforms for addressing both infectious diseases and virus-induced cancers. The study highlights that mRNA vaccines could play a pivotal role in personalized and efficient disease management. However, barriers such as vaccine stability, cold-chain storage requirements, and delivery logistics hinder their implementation in resource-limited settings. This study emphasizes the need for targeted strategies to overcome these challenges and extend the benefits of mRNA vaccines to developing nations.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"88 10","pages":"6696-6707"},"PeriodicalIF":1.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}