Abstract:

Background: Lymphadenectomy is fundamental part of surgical strategy in patients with gastric cancer. Lymph node (LN) status is a key point in assessment of prognosis in gastric cancer. The LN ratio (LNR) - number of positive LNs / number of sampled LNs, offers a new approach for predicting survival. The aim of the study was to find factors affecting LN yield and the impact of LNR on 5-year survival. Methods: Prospective multicentre quality assurance study. Only LN-positive patients were included in the LNR calculations. Results: 4946 patients from 149 hospitals were enrolled. The inclusion criteria were met by 1884 patients. Patients were divided into two groups: Group 1 (<16 LN) 456 patients and Group 2 (≥16 LN) 1428 patients. The multivariate analysis found G2 (OR 1.98; 95%CI 1.11-3.54), G3 (OR 2.15; 95%CI 1.212-3.829), UICC-stage II (OR 1.44; 95%CI 1.01-2.06) and III (OR 1.71; 95%CI 1.14-2.57), age <70 (OR 1.818 95%CI 1.19-2.78) and female gender ( OR 1.37; 95%CI 1.00-1.86) as independent factors of ≥16 LN yield. Patients with a LNR≥0.4 have a lower probability of survival (p=0.039 and <0.001) than patients with LNR=0.1. Patients with UICC-II have a lower probability of survival than UICC-I (p=0.023). Age 70-80 (p=0.045) and >80 years (p=0.003) were negative prognostic factors for long-term survival. Conclusion: Long-term survival is directly related to adequate lymphadenectomy. LNR could be superior to pN-stage for estimating survival, and adds remarkable nuances in prognosis compared to UICC-stage. LNR also appears valid, even in the case of insufficient LN yield.

Abstract: Background/Objectives: Computer-assisted mandibular reconstruction requires sophisticated technical expertise alongside surgical knowledge. This study aims to establish and validate an efficient collaborative protocol between oral and maxillofacial surgeons and bioengineers for virtual surgical planning in mandibular reconstruction. Methods: We developed a structured protocol with four sequential phases: (1) generation of 3D models from CT data, (2) virtual resection planning, (3) reconstruction design, and (4) surgical guide fabrication. Protocol efficiency was assessed through seven simulation trials measuring planning duration and required revisions. Clinical validation was performed in four mandibular reconstruction cases. Accuracy was evaluated by comparing virtual surgical plans to postoperative outcomes using 3-matic software analysis. Results: Protocol implementation showed consistent efficiency across simulations with mean planning duration of 2.86 working days (SD = 1.35). Only two of seven simulations required design revisions. Clinical application in four cases (three ameloblastomas, one odontogenic myxoma) demonstrated high precision with mean virtual-to-actual discrepancy of 0.90 mm (SD = 0.34). Successful reconstructions were achieved across varying defect spans (29-53 mm) using both bicortical DCIA flaps and monocortical iliac block bone grafts. The collaborative workflow resulted in optimized surgical guide design, reduced planning iterations, and improved surgical precision. Conclusions: The established surgeon-bioengineer collaborative protocol enhances the efficiency and accuracy of computer-assisted mandibular reconstruction while making advanced surgical planning techniques more accessible. While initial results are promising, future studies with larger patient cohorts and extended follow-up periods are needed to fully validate the protocol's long-term benefits and broader applicability.

Abstract: Background: We aimed to evaluate the long-term outcomes, treatment-related toxicity, and factors affecting postoperative prostate cancer patients treated with intensi-ty-modulated radiation therapy and image-guided radiation therapy (IMRT-IGRT) using TomoTherapy as salvage radiotherapy (SRT). Methods: We included 71 consecutive patients who underwent SRT after radical prostatectomy between 2011 and 2023. Treatment outcomes, including the progression-free rate (PFR) and overall survival, were calculated using Kaplan–Meier curves. Associations between treatment outcomes and factors were analyzed using the Cox proportional hazards regression analysis. Results: The median follow-up time after SRT was 60 (range, 1–148) months. The 5-year and 10-year PFR were 69.05% and 54.73%, respectively. In multivariate analysis, PSA maximum after surgery (mas PSA) >0.7 ng/mL was significantly associated with worse PFR (p 0.7 ng/mL, providing critical insights into prognostication. SRT for prostate cancer with IMRT and IGRT using TomoTherapy showed similar treatment outcomes and low toxicity rates compared with those of previous studies.

Abstract: In foals, Rhodococcus equi infections are typically linked to a range of non-pulmonary conditions, with hemolytic anemia being an uncommon complication. The authors are aware of only one case report involving immune-mediated hemolytic anemia in foals infected with Rhodococcus equi, highlighting the need for further research. This report aims to describe the clinical presentation, progression, outcome, and pathological findings of 4-month-old Holstein foal with Rhodococcus equi infection concurrently with presummed immune-mediated hemolytic anemia. Due to severe sepsis and worsening clinical condition, the foal was euthanized and necropsy was performed.

Abstract:

Background/Objectives: This study examines the academic discourse surrounding Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM) for first responders using Latent Dirichlet Allocation (LDA) topic modeling. Its aim is to uncover latent topical structures within the literature and critically evaluate underlying assumptions to identify gaps and limitations. Method: A corpus of 214 research article abstracts related to CISD/M was gathered from the Web of Science Core Collection. After preprocessing, we used Orange Data Mining software’s LDA tool to analyze the corpus. Models ranging from 2 to 10 topics were tested for log perplexity and topic coherence, with LDAvis visualizations guiding interpretation and labeling. A four-topic model offered the best balance of detail and interpretability. Results: Four topics emerged: (1) Critical Incident Stress Management in medical and emergency settings, (2) Psychological and group-based interventions for PTSD and trauma, (3) Peer support and experiences of emergency and military personnel, and (4) Mental health interventions for first responders. Key gaps included limited focus on cumulative trauma, insufficient longitudinal research, and variability in procedural adherence affecting outcomes. Conclusions: The findings highlight the need for CISD/M protocols to move beyond event-specific interventions and address cumulative stressors. Recommendations include incorporating holistic, proactive mental health strategies and conducting longitudinal studies to evaluate long-term effectiveness. These insights can help refine CISD/M approaches and enhance their impact on first responders working in high-stress environments.

Abstract: The link between cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated fatty liver disease (MAFLD)/metabolic dys-function-associated steatotic liver disease (MASLD) is well-established at both epidemi-ological and pathophysiological level. Among the common pathophysiological mechanisms involved in the development and progression of both diseases, oxidative stress and inflammation, insulin resistance, lipid metabolism deterioration, gut dysbiosis along with genetic factors have been rec-ognized to play a pivotal role. Pharmacologic interventions with drugs targeting common modifiable cardiometabolic risk factors, such as T2DM, dyslipidemia, and hypertension is a reasonable strategy to prevent CVD development and progression of MASLD. Recently, a novel drug for MASH, resmetirom, has shown positive effects regarding CVD risk, opening new opportunities for the therapeutic approach of NAFLD/MAFLD/MASLD and CVD. This review provides current knowledge on the epidemiologic association of NAFLD/MAFLD/MASLD to CVD morbidity and mortality and enlightens the possible underlying pathophysiologic mechanisms linking NAFLD/MAFLD/MASLD with CVD. It also highlights potential common therapeutic interventions with cardiometabolic drugs such as anti-hypertensive drugs, hypolipidemic agents, glucose-lowering medications, salicylic acid and the thyroid hormone receptor-beta agonist that may improve outcomes of NAFLD/MAFLD/MASLD.

Abstract: Objectives This study aimed to evaluate the outcomes of the Subcrestally Placed Implants (SPI) with Internal Platform Switching (IPS) design in single molar replacements utilizing the matching abutment technique. The investigation focused on achieving biological stability and esthetics while proposing a schematic model to seek the relationship between the biological stability of peri-implant soft tissue and crestal bone. Materials and Methods Twenty cases of SPI with IPS design were evaluated. Panoramic radiographs were employed to assess changes in crestal bone levels at the mesial and distal sides over an average follow-up period of 3.4 years, providing a practical method for routine monitoring. CBCT scans, acquired at least one year after surgery, were comprehensively analyzed to determine the dimensions of peri-implant soft tissue in a three-dimensional context. Parameters assessed included: Placement depth (PD), both central (cPD) and peripheral (pPD). Soft tissue thickness (STT), both central (cSTT) and peripheral (pSTT). Transitional Zone (TZ) length at the mesial, distal, buccal, and lingual aspects. To evaluate the health of peri-implant soft tissue, the following clinical assessments were performed: IPPP (Implant Paper Point Probe) Bleeding on Probing (BOP) Visual Assessment for redness and swelling Results 1. Panoramic Analysis Panoramic radiographs revealed stable crestal bone levels with minimal changes, with mean pPD change observed to be less than 0.1 mm over an average follow-up period of 3.3 years. 2. CBCT Analysis o The average central placement depth (cPD) was 1.4 mm, and the peripheral placement depth (pPD) was 2.7 mm. o The average central soft tissue thickness (cSTT) was 0.3 mm, and the peripheral soft tissue thickness (pSTT) was 0.6 mm. o The average Transitional Zone (TZ) length was 4.3 mm. 3. Clinical Observations o Depth of Probing: Probing depths were consistently less than 1 mm in all cases, demonstrating minimal pocket formation and stable peri-implant conditions. o Bleeding on Probing (BOP): No bleeding was observed in any case, suggesting an absence of inflammation around the implants. o Visual Signs of Inflammation: No swelling, redness, or other visual indicators of inflammation were detected, reflecting healthy peri-implant soft tissue in all cases. Conclusions The findings of this study demonstrated that subcrestally placed implants (SPI) with an internal platform switching (IPS) design, utilizing the matching abutment technique, provide stable outcomes, particularly in terms of crestal bone levels and peri-implant soft tissue dimensions. This stability is likely attributed to the biological and structural integrity at the soft tissue-implant restoration interface (Transitional Zone). The study investigated the three-dimensional topography of peri-implant soft tissue, emphasizing its relationship with implant restoration, crestal bone changes, and clinical outcomes. Further histological research is necessary to validate the unique characteristics and mechanical properties of these zones, offering deeper insights into their contribution to long-term implant success and enhanced esthetics.

Abstract:

Background/Objectives: Rifaximin is commonly used for patients with hepatic encephalopathy (HE); however, there is little data on the effects of its long-term (>1 year) administration in Jap-anese patients with cirrhosis. Therefore, we examined the effects and safety of three-year rifaxi-min treatment on HE in Japan. Methods: A total of 190 patients with cirrhosis who were contin-uously administered rifaximin for more than one year developed overt or covert HE, which was diagnosed by a physician. Laboratory data were collected at baseline, 3, 6, 12, 18, 24, 30, and 36 months following rifaximin administration. We examined the cumulative OHE incidences, overall survival rates, and hepatic functional reserves following rifaximin treatment. The occur-rence of adverse events was also assessed. Results: Ammonia levels improved significantly after 3 months of rifaximin administration, which continued for three years. Serum albumin and pro-thrombin activity also significantly improved after three years of rifaximin administration. Cumulative overt HE incidences were 12.1%, 19.7%, and 24.9% at 1, 2, and 3 years, respectively. The survival rates following rifaximin treatment were 100%, 88.9%, and 77.8% at 1, 2, and 3 years, respectively. In contrast, renal function and electrolytes did not change following rifaximin ad-ministration. Only three (1.6%) patients discontinued RFX therapy because of severe diarrhea after a year of RFX administration. No other serious adverse events were observed. Conclusion: Long-term rifaximin treatment (three years) is effective and safe for patients with HE and im-proves the hepatic function reserve and overall survival.

Abstract: Background: During the last few years, significant pathophysiological differences between heart failure (HF) patients with “normal” ejection fraction (EF) (50% to 64%) and those with supra-normal EF (≥65%) have been highlighted. However, these distinct EF phenotypes have been poorly investigated in elderly patients aged ≥70 yrs. Methods: All patients aged ≥70 yrs discharged from our Institution with a first diagnosis of HF with preserved EF (HFpEF) be-tween January 2020 and March 2021 entered the study. All patients underwent clinical evalua-tion, blood tests and transthoracic echocardiography. The primary endpoint was “all-cause mortality”, while the secondary one was the composite of “all-cause mortality or rehospitali-zation for all causes” over a mid-term follow-up. Results: A total of 200 HFpEF patients (86.4±6.6 yrs, 70% females) were retrospectively evaluated. The “normal” EF group (n=99) and the “supra-normal” EF one (n=101) were separately analyzed. Compared to patients with “normal” EF, those with “supra-normal” EF were older, with greater comorbidity burden and moderate-to-severe frailty status. During a mean follow-up of 3.6±0.3 yrs, 79 patients died and 73 were re-hospitalized. On multivariate Cox regression analysis, age (HR 1.09, 95% CI 1.03-1.16, p = 0.002), EF (HR 1.08, 95% CI 1.03-1.14, p = 0.004), tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio (HR 0.14, 95% CI 0.03-0.61, p = 0.009) and infectious disease (HR 7.23, 95% CI 2.41-21.6, p < 0.001) were independently as-sociated with all-cause mortality in the whole study population. EF (HR 1.04, 95% CI 1.01-1.07, p = 0.02) also predicted the secondary endpoint. EF ≥65% was the best cut-off to predict both endpoints. Conclusions: “Supra-normal” EF (≥65%) at hospital admission is independently associated with all-cause mortality and rehospitalization for all causes in elderly HFpEF pa-tients over a mid-term follow-up.

Abstract:

Alzheimer's disease (AD) is a neurodegenerative condition that has no definitive treatment and its early diagnosis can help to prevent or slow down its progress. Neuroimaging in particular, structural magnetic resonance imaging (sMRI) and the progress of artificial intelligence (AI) have significant attention in AD detection. In this study, 398 participants were used from the ADNI and OASIS global database of sMRI including 98 individuals with AD, 102 with early mild cognitive impairment (EMCI), 98 with late mild cognitive impairment (LMCI), and 100 normal controls (NC). The proposed model achieved high area under the curve (AUC) values and an accuracy of 99.7%, which is very remarkable for all four classes: NC vs. AD: AUC = [0.985], EMCI vs. NC: AUC = [0.961], LMCI vs. NC: AUC = [0.951], LMCI vs. AD: AUC = [0.989], and EMCI vs. LMCI: AUC = [1.000]. The results reveal that this model incorporates DenseNet169, transfer learning, and class decomposition to classify AD stages, particularly in differentiating EMCI from LMCI. Overall, this model performs well with high accuracy and area under the curve for AD diagnostics at early stages.