Annals of medicine最新文献

{"title":"Risk-based triage strategy by extended HPV genotyping for women with ASC-US cytology.","authors":"Xuan Rao, Yue-Han Wang, Rui-Zhe Chen, Qian-Qian Wu, Xiao-Fei Zhang, Yun-Feng Fu, Xin-Yu Wang, Xiao Li","doi":"10.1080/07853890.2025.2451183","DOIUrl":"10.1080/07853890.2025.2451183","url":null,"abstract":"<p><strong>Objective: </strong>We attempted to evaluate the immediate high-grade squamous intraepithelial lesion-cervical intraepithelial neoplasia grade 2/3 or worse (HSIL-CIN2+/3+, hereafter referred to as CIN2+/3+) risk of specific human papillomavirus (HPV) genotype and form the precise risk-based triage strategy for atypical squamous cells of undetermined significance (ASC-US) women.</p><p><strong>Methods: </strong>The clinical data of ASC-US women who underwent HPV genotyping testing and colposcopy were retrospectively reviewed. The distribution and CIN2+/3+ risks of specific HPV genotype were assessed by three approaches. The risk-based triage strategy was further established, and its efficacy in detecting CIN2+/3+ was estimated.</p><p><strong>Results: </strong>Totally, 5553 ASC-US women including 3648 HPV-positive and 1905 HPV-negative were analysed. CIN2+/3+ were 662/319 cases, including 639/306 HPV-positive and 23/13 HPV-negative women. HPV16, HPV52, HPV58 and HPV18 were always among the top 5 ranking genotypes, no matter in HPV-positive women or in HPV-positive CIN2+/3+ cases. HPV16 and HPV33 carried the highest risk, while HPV73 and 26 carried the least risk for CIN2+/3+. Based on the immediate CIN2+/3+ risk of specific HPV genotype, 18 HPVs were divided into three risk-stratified groups. Only women infected with HPVs included in group A were necessary for immediate colposcopy. Compared with conventional strategy, this new risk-based strategy not only had higher specificity (CIN2+: <i>p</i> = .00; CIN3+: <i>p</i> = .01) and positive predictive value (CIN2+: <i>p</i> = .00; CIN3+: <i>p</i> = .03) for detecting CIN2+/3+, but also needed fewer colposcopies to identify each CIN2+/3+.</p><p><strong>Conclusions: </strong>A new triage strategy for ASC-US women was successfully constructed based on CIN2+/3+ risks of 14 high-risk and 4 intermediate-risk HPVs, which could significantly reduce unnecessary colposcopies.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2451183"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017764","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":"Risk factors for delayed gastric emptying after pancreatoduodenectomy: a 10-year retrospective study.","authors":"Carlos Jiménez-Romero, Agustín de Juan Lerma, Alberto Marcacuzco Quinto, Oscar Caso Maestro, Laura Alonso Murillo, Paula Rioja Conde, Iago Justo Alonso","doi":"10.1080/07853890.2025.2453076","DOIUrl":"10.1080/07853890.2025.2453076","url":null,"abstract":"<p><strong>Background: </strong>Delayed gastric emptying (DGE) is a frequent complication of pancreatoduodenectomy (PD) and is associated with prolonged hospital stay, readmission, increased hospital costs and decreased quality of life. However, the pathophysiology of DGE remains unclear.</p><p><strong>Methods: </strong>This is a retrospective study of patients who underwent PD for pancreatic or periampullary tumours. All these patients were operated between January 2012 and February 2023. The patients were divided into four groups according to the development of DGE after PD: No DGE, DGE grade A, DGE grade B and DGE grade C. The groups were compared in terms of outcomes and complications. We also analysed the preoperative and perioperative risk factors for DGE development.</p><p><strong>Results: </strong>Between January 2012 and February 2023, a total of 250 patients underwent PD. These patients were divided into four groups: No DGE (<i>n</i> = 152); DGE grade A (<i>n</i> = 42); DGE grade B (<i>n</i> = 45); and DGE grade C (<i>n</i> = 11). The incidence of the postoperative pancreatic fistulas (POPFs) grade B/C was significantly higher in the DGE grade C group (<i>p</i> < .001), and the rates of post-pancreatectomy haemorrhage (<i>p</i> = .004) and reoperation (<i>p</i> < .001) were significantly higher in the DGE grade B/C groups. A significantly higher rate of grade III-IV Clavien-Dindo complications (<i>p</i> < .001), longer intensive care unit (<i>p</i> < .001) and longer hospital stays (<i>p</i> < .001) were observed in the DGE grade C group; and 90-day mortality (<i>p</i> < .001) and morbidity (<i>p</i> < .001) were significantly higher in the DGE grade B/C groups. Multivariate analysis demonstrated that the POPF grade B/C was a risk factor of DGE grade B/C (OR: 9.147; 95%CI: 4.125-20.281; <i>p</i> < .001).</p><p><strong>Conclusions: </strong>POPF B/C is a risk factor for grade B/C DGE. Prevention of surgical complications and early treatment could contribute to the decreased incidence of DGE.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2453076"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017803","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":"Global burden and trends of the <i>Clostridioides difficile</i> infection-associated diseases from 1990 to 2021: an observational trend study.","authors":"Jun Xia, Tan Liu, Rui Wan, Jing Zhang, Quanzhu Fu","doi":"10.1080/07853890.2025.2451762","DOIUrl":"10.1080/07853890.2025.2451762","url":null,"abstract":"<p><strong>Background: </strong>This study was aimed to explore the global burden and trends of Clostridioides difficile infections (CDI) associated diseases.</p><p><strong>Methods: </strong>Data for this study were obtained from the Global Burden of Disease Study 2021. The burden of CDI was assessed using the age-standardized rates of disability-adjusted life years (ASR-DALYs) and deaths (ASDRs). Trends in the burden of CDI were presented using average annual percentage changes (AAPCs).</p><p><strong>Results: </strong>The ASR-DALYs for CDI increased from 1.83 (95% UI: 1.53-2.18) per 100,000 in 1990 to 3.46 (95% UI: 3.04-3.96) per 100,000 in 2021, with an AAPC of 2.03% (95% CI: 1.67-2.4%). The ASDRs for CDI rose from 0.10 (95% UI: 0.08-0.11) per 100,000 in 1990 to 0.19 (95% UI: 0.16-0.23) per 100,000 in 2021, with an AAPC of 2.26% (95% CI: 1.74-2.79%). In 2021, higher burdens of ASR-DALYs (10.7 per 100,000) and ASDRs (0.53 per 100,000) were observed in high socio-demographic index (SDI) areas, and among age group over 70 years (31.62/100,000 for ASR-DALYs and 2.45/100,000 for ASDRs). During the COVID-19 pandemic, the global ASR-DALYs and ASDRs slightly decreased. However, in regions with low SDI, low-middle and middle SDI, those rates slightly increased.</p><p><strong>Conclusion: </strong>The global burden of CDI has significantly increased, particularly in regions with high SDI and among individuals aged 70 years and above. During the COVID-19 pandemic period from 2020 to 2021, the burden of CDI further increased in regions with low, low-middle, and middle SDI. These findings underscore the need for increased attention and intervention, especially in specific countries and populations.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2451762"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026020","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":"The methyl-CpG binding domain 2 regulates peptidylarginine deiminase 4 expression and promotes neutrophil extracellular trap formation via the Janus kinase 2 signaling pathway in experimental severe asthma.","authors":"Biao Peng, Mu-Yun Yan, Yun-Rong Chen, Fei Sun, Xu-Dong Xiang, Da Liu","doi":"10.1080/07853890.2025.2458207","DOIUrl":"10.1080/07853890.2025.2458207","url":null,"abstract":"<p><strong>Objective: </strong>The prognosis for severe asthma is poor, and the current treatment options are limited. The methyl-CpG binding domain protein 2 (MBD2) participates in neutrophil-mediated severe asthma through epigenetic regulation. Neutrophil extracellular traps (NETs) play a critical role in the pathogenesis of severe asthma. This study aims to detect if MBD2 can reduce NETs formation and the potential mechanism in severe asthma.</p><p><strong>Methods: </strong>A severe asthma model was established in C57BL/6 wild-type mice exposure to house dust mite (HDM), ovalbumin (OVA), and lipopolysaccharide (LPS). Enzyme-linked immunosorbent assay was used to measure the concentrations of IL-4, IL-17A, and IFN-γ in lung tissues. Flow cytometry was employed to determine the percentages of Th2, Th17, and Treg cells in lung tissues. Quantitative real-time polymerase chain reaction was utilized to assess the mRNA expression levels of MBD2, JAK2, and PAD4. Western blotting and immunofluorescence were conducted to detect the protein of MBD2, JAK2, PAD4, and CitH3. HL-60 cells were differentiated into neutrophil-like cells by culturing in a medium containing dimethyl sulfoxide and then stimulated with LPS. KCC-07, Ruxolitinib, and Cl-amidine were used to inhibit the expressions of MBD2, JAK2, and PAD4, respectively.</p><p><strong>Results: </strong>Severe asthma mice were characterized by pulmonary neutrophilic inflammation and increased formation of neutrophil extracellular traps (NETs). The expression of MBD2, JAK2, and PAD4 was elevated in severe asthma mice. Inhibiting the expression of MBD2, JAK2, and PAD4 reduced NETs formation and decreased airway inflammation scores, total cell counts and neutrophil counts in BALF, and percentage of Th2 and Th17 cell in lung tissues, whereas increasing Treg cell counts. In both severe asthma mice and HL-60-differentiated neutrophil-like cells <i>in vitro</i>, inhibiting MBD2 reduced the mRNA and protein expression of JAK2 and PAD4, and inhibiting JAK2 reduced the expression of PAD4 mRNA and protein.</p><p><strong>Conclusion: </strong>MBD2 regulates PAD4 expression through the JAK2 signaling pathway to promote NETs formation in mice with severe asthma. Further bench-based and bedside-based studies targeting the MBD2, PAD4, and JAK2 signaling pathways will help open new avenues for drug development of severe asthma.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2458207"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049089","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":"Diagnostic ability for common skin diseases among general practitioners working in community health service centers in Shanghai, China: a cross-sectional study.","authors":"Lei Zhang, Guanghui Wang, Haiying Chen, Xiaoqing Gu, Minjie Jia, Ying Yu, Xiaoxiao Cao, Ruiping Wang","doi":"10.1080/07853890.2024.2442066","DOIUrl":"10.1080/07853890.2024.2442066","url":null,"abstract":"<p><strong>Objective: </strong>Primary care general practitioners (GPs) play a crucial role in common skin diseases (CSDs) diagnosis and treatment for community residents. This study investigates their clinical diagnostic ability for CSDs and influencing factors among GPs in Shanghai.</p><p><strong>Methods: </strong>In 2023, we recruited 5745 GPs in Shanghai, and online survey was conducted among 5745 GPs with written informed consents. Images of ten CSDs was used to evaluate the diagnostic ability among GPs, logistic regression (LR) analysis was applied to explore influencing factors in GPs with a good skin diseases diagnostic ability.</p><p><strong>Results: </strong>The 5745 GPs included 1740 male (30.3%), the age ranged from 25 to 60 years with an average of age of 40.8 years. The total score for GSDs diagnostic ability ranged from 2 to 10, with a median of 7.5. In this study, GPs who have achieved ≥ 9 scores were identified as GPs with good diagnostic ability, with a prevalence of 26.7%. LR analysis indicated that GPs with 11 to 15 and over 15 years of work experience had a higher prevalence of good diagnostic ability compared with those with <5 years, the OR was 1.23 (95% CI: 1.02-1.48) and 1.25 (95% CI: 1.05-1.49) respectively. GPs with advanced studies [OR = 1.61, 95% CI:1.33-1.95] and work experience [OR = 1.39, 95% CI:1.20-1.61] in dermatology had a higher prevalence of good diagnostic ability.</p><p><strong>Conclusion: </strong>The diagnostic ability for CSDs was good among GPs in Shanghai. GPs with more years of work, advanced studies and work experience in dermatology have better diagnostic abilities CSDs.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2442066"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840534","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":"The expression and clinical significance of serum exosomal-long non-coding RNA DLEU1 in patients with cervical cancer.","authors":"Yu Chen, Facai Cui, Xiaoyu Wu, Weifeng Zhao, Qingxin Xia","doi":"10.1080/07853890.2024.2442537","DOIUrl":"10.1080/07853890.2024.2442537","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence has demonstrated that the long non-coding RNA (lncRNA) lymphocytic leukaemia deletion gene 1 (DLEU1) is abnormally overexpressed in many cancer types, including cervical cancer (CC). However, the potential clinical significance of DLEU1 in serum exosomes of patients with CC remains unclear.</p><p><strong>Methods: </strong>The expression of serum exosomal DLEU1 was detected by quantitative real-time polymerase chain reaction (qRT-PCR). A receiver operating characteristic (ROC) curve was plotted to evaluate the clinical diagnostic efficacy of DLEU1. The Kaplan-Meier survival curve and Cox proportional hazards model were used to assess the effect of DLEU1 on postoperative recurrence, metastasis and prognosis among patients with CC.</p><p><strong>Results: </strong>Our research showed that DLEU1 expression in the serum exosomes of patients with CC was significantly upregulated compared to that in patients with cervical intraepithelial neoplasia (CIN) and healthy controls (HCs) (both <i>p</i> < .001). DLEU1 relative expression was significantly correlated with tumour size, cervical invasion depth, pathological grade, International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis among patients with CC (<i>p</i> < .01 all). The combined detection of DLEU1, carbohydrate antigen 125 (CA-125) and squamous cell carcinoma (SCC) exhibited significantly higher diagnostic efficiency (<i>p</i> < .01). Furthermore, the overall survival (OS) and disease-free survival (DFS) of CC patients in the high DLEU1 expression group were markedly lower than those in the low DLEU1 expression group (both <i>p</i> < .01). Cox univariate and multivariate regression analyses indicated that DLEU1 was an independent risk factor for postoperative recurrence and metastasis in CC patients.</p><p><strong>Conclusions: </strong>Our findings suggest that serum exosome DLEU1 has certain clinical value for diagnosing, monitoring recurrence and metastasis, and evaluating CC prognosis.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2442537"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840540","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":"Identification of a postoperative survival scoring index for adult liver transplantation.","authors":"Shuai Wang, Xiaohong Lin, Yefu Li, Zhonghao Xie, Ming Zhang, Yicheng Liang, Chuchen Zhu, Yuqi Dong, Ping Zeng, Xiaoshun He, Weiqiang Ju, Maogen Chen","doi":"10.1080/07853890.2025.2458212","DOIUrl":"10.1080/07853890.2025.2458212","url":null,"abstract":"<p><strong>Background: </strong>In addition to surgical technology, successful liver transplantation (LT) depends on perioperative management, which needs an effective prognostic index. Therefore, a simplified and sensitive postoperative index for adult LT should be developed.</p><p><strong>Methods: </strong>In total, 906 patients who underwent LT were included in this cross-sectional study. Univariate analysis was used to identify the independent risk factors for recipient survival. Multivariate logistic and stepwise regression analyses were used to construct and simplify the model design. Area under the curve (AUC) and Kaplan-Meier's (K-M) analysis demonstrated superiority of the new index. The postoperative survival score (POSS) index was further simplified via restricted cubic spline (RCS) analysis. Finally, the interpretation of the long-term mortality and subgroup analyses extended the application of the POSS index.</p><p><strong>Results: </strong>Finally, a total of five factors (donor sex, recipient body mass index (BMI), total bilirubin (Tbil), international normalized ratio (INR) and total operative time) were identified as independent risk parameters and included in our POSS index. The AUCs of the original and simplified POSS indices were 0.764 and 0.723, respectively. Patients with high scores had poor short-term survival. Our index also functioned well in predicting long-term mortality, and it was more effective for patients with hepatitis B cirrhosis or hepatocellular carcinoma (HCC).</p><p><strong>Conclusions: </strong>We constructed a simplified and effective postoperative survival scoring index to predict short-term complications and survival in adult LT patients.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2458212"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190470","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":"An overview of downhill esophageal varices: a challenge for medical practice.","authors":"Donghong Wang, Zhibin Ma","doi":"10.1080/07853890.2025.2462452","DOIUrl":"10.1080/07853890.2025.2462452","url":null,"abstract":"<p><strong>Objectives: </strong>Unlike the commonly seen uphill esophageal varices in clinical practice, downhill esophageal varices are caused by obstruction of the superior vena cava and azygous venous system. The predominant causes of downhill esophageal varices are hemodialysis in end-stage renal disease patients and mediastinal malignancies. The cornerstone of the treatment for downhill esophageal varices is to address the underlying primary causes. Without this, patients may suffer from recurrent bleeding, and the bleeding can be fatal.</p><p><strong>Methods: </strong>This review is primarily summarized through previous case reports. Meanwhile, it emphasizes the significance of case reports.</p><p><strong>Results: </strong>Clinicians should be conscious that esophageal varices are not necessarily caused by liver cirrhosis or non-cirrhotic portal hypertension.</p><p><strong>Conclusions: </strong>Specifically, when varices are only observed in the upper and middle esophagus, and the patient presents with evidence of superior vena cava obstruction, clinicians should be particularly vigilant for downhill esophageal varices. Moreover, a thorough investigation and definitive treatment of the underlying primary causes should be implemented.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2462452"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191618","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":"Examined lymph node counts affected the staging and survival in cervical cancer: a retrospective study using the SEER and Chinese cohort.","authors":"Tao Guo, Yuxi Zhao, Jia Zeng, Jian Li, Enyu Tang, Lingying Wu","doi":"10.1080/07853890.2025.2459821","DOIUrl":"10.1080/07853890.2025.2459821","url":null,"abstract":"<p><strong>Background: </strong>The impact of examined lymph node (LN) count on survival in cervical cancer remains understudied, with no consensus on the optimal number required.</p><p><strong>Objectives: </strong>We aimed to investigate the role of LN count in postoperative pathological evaluation for cervical cancer patients undergoing surgery.</p><p><strong>Methods: </strong>Data from the US SEER database and a retrospective Chinese cohort were analyzed. Multivariable logistic and Cox regression models assessed LN positivity detection and overall survival (OS), respectively. Smoothing spline curves and Chow tests identified structural change points in hazard ratios and LN-positive ratios.</p><p><strong>Results: </strong>Among 14,133 SEER and 2,811 Chinese cases, higher LN counts correlated with increased detection of positive LNs (OR: 1.040, 95% CI: 1.019-1.062) and improved OS (HR: 0.990, 95% CI: 0.984-0.996). Structural change points occurred at 20 LNs for LN-negative patients and 13 LNs for LN-positive patients (both P < 0.001). An elevated LN-positive ratio (positive/examined LNs) strongly predicted worse OS (HR: 4.208; 95% CI: 1.454-12.181).</p><p><strong>Conclusions: </strong>An increased number of examined LNs significantly contributes to the detection of positive LNs and improved patient survival. For patients with claimed LN-negative and LN-positive disease, a minimum examination of 20 and 13 LNs, respectively, is recommended to ensure adequate LN evaluation. The LN positive ratio is a strong prognostic indicator in patients with LN-positive disease.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2459821"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082554","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":"Utilizing vaginal natural orifice to facilitate bowel manipulation during totally intracorporeal ileal conduit construction: a retrospective cohort study.","authors":"Kaipeng Jia, Shiwang Huang, Zhun Wang, Yuda Lin, Yiduo Bai, Chong Shen, Zhe Zhang, Zhouliang Wu, Yunkai Qie, Hailong Hu","doi":"10.1080/07853890.2025.2453827","DOIUrl":"10.1080/07853890.2025.2453827","url":null,"abstract":"<p><strong>Objective: </strong>To explore the feasibility and efficacy of the modified technique of totally intracorporeal ileal conduit (IC) construction <i>via</i> vaginal approach following robot-assisted radical cystectomy (RARC) in females.</p><p><strong>Methods: </strong>By comparing the perioperative outcomes of the modified technique with extracorporeal urinary diversion (ECUD), 31 females treated for bladder cancer with RARC and IC from May 2020 to December 2023 were retrospectively analyzed and divided into two groups: the ECUD group (10 patients) and the modified intracorporeal urinary diversion (MICUD group) (21 patients). The modified technique involved performing transvaginal natural orifice specimen extraction surgery (TV-NOSES) after RARC; followed by the transvaginal placement of an Endo-GIA stapler to manipulate the bowel for intracorporeal IC construction.</p><p><strong>Results: </strong>Both groups' surgeries were successfully completed by the same surgeon and team. Patients in the MICUD group had shorter total operative time, lower postoperative pain scores, quicker recovery, and shorter hospital stays. The learning curve of the MICUD showed two phases: a learning phase (cases 1-7) and a proficiency phase (cases 8-21). The incidence of postoperative complications between the two groups was similar. The mean follow-up times were 29.3 months (ECUD group) and 22.6 months (MICUD group). In the MICUD group, there was one case of local tumor recurrence, two cases of distant metastasis, including one death from progression; in the ECUD group, one patient had distant metastasis and died from progression.</p><p><strong>Conclusion: </strong>RARC with MICUD represents a safe, feasible and easy-to-learn minimally invasive surgical approach. Patients experience less trauma and faster recoveries.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2453827"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018033","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}