Open vs robotic-assisted pancreaticoduodenectomy, cost-effectiveness and long-term oncologic outcomes: a systematic review and meta-analysis.

BACKGROUND: Whipple pancreaticoduodenectomy (PD) is a complex gastrointestinal surgery that is performed increasingly via minimally invasive approach through robotic platforms. We sought to provide a comparative review of available data regarding robot-assisted vs open PD in terms of cost-effectiveness, overall survival, and other perioperative and long-term oncologic outcomes. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, PubMed, Scopus, and Web of Science databases were searched from 1980 to April 2024 using designated keywords. English-language studies comparing costs and oncologic outcomes of robotic vs open PDs were considered for inclusion. Reviews, abstracts, case reports, letters to the editor, and non-English articles were excluded. RESULTS: A total of 1733 studies were initially identified throughout the literature search. After the removal of duplicates, title and abstract screening identified 16 studies that were included in the review. No statistically significant differences were detected in terms of short-term complications (95% CI, 0.805-1.096; P = .42), mortality (95% CI, 0.599-1.123; P = .21), and readmission (95% CI, 0.959-1.211; P = .20) among patients undergoing open vs robotic PD. Robotic PDs was associated with a slightly better overall survival (95% CI, 1.020-1.233) and higher costs (95% CI, 0.134-1.139; P = .013). Mean length of stay (LOS) was higher in the open PD group (95% CI, -0.353 to 0.189; P < .001). CONCLUSION: Robotic-assisted PD had a slightly shorter LOS and improved overall survival. There were no differences in short-term complications, mortality, or readmission. The use of cohort studies and residual potential selection bias necessitate randomized controlled trials to define the benefit of robotic PD.

Screening tools to address social determinants of health in the United States: A systematic review.

The Centers for Medicare & Medicaid Services have mandated that hospitals implement measures to screen social determinants of health (SDoH). We sought to report on available SDoH screening tools. PubMed, Scopus, Web of Science, as well as the grey literature were searched (1980 to November 2023). The included studies were US-based, written in English, and examined a screening tool to assess SDoH. Thirty studies were included in the analytic cohort. The number of questions in any given SDoH assessment tool varied considerably and ranged from 5 to 50 (mean: 16.6). A total of 19 SDoH domains were examined. Housing (n = 23, 92%) and safety/violence (n = 21, 84%) were the domains assessed most frequently. Food/nutrition (n = 17, 68%), income/financial (n = 16, 64%), transportation (n = 15, 60%), family/social support (n = 14, 56%), utilities (n = 13, 52%), and education/literacy (n = 13, 52%) were also commonly included domains in most screening tools. Eighteen studies proposed specific interventions to address SDoH. SDoH screening tools are critical to identify various social needs and vulnerabilities to help develop interventions to address patient needs. Moreover, there is marked heterogeneity of SDoH screening tools, as well as the significant variability in the SDoH domains assessed by currently available screening tools.

Molecular Mechanisms of Cachexia: A Review.

Cachexia is a condition characterized by substantial loss of body weight resulting from the depletion of skeletal muscle and adipose tissue. A considerable fraction of patients with advanced cancer, particularly those who have been diagnosed with pancreatic or gastric cancer, lung cancer, prostate cancer, colon cancer, breast cancer, or leukemias, are impacted by this condition. This syndrome manifests at all stages of cancer and is associated with an unfavorable prognosis. It heightens the susceptibility to surgical complications, chemotherapy toxicity, functional impairments, breathing difficulties, and fatigue. The early detection of patients with cancer cachexia has the potential to enhance both their quality of life and overall survival rates. Regarding this matter, blood biomarkers, although helpful, possess certain limitations and do not exhibit universal application. Additionally, the available treatment options for cachexia are currently limited, and there is a lack of comprehensive understanding of the underlying molecular pathways associated with this condition. Thus, this review aims to provide an overview of molecular mechanisms associated with cachexia and potential therapeutic targets for the development of effective treatments for this devastating condition.

Study of the Relative Frequency of Spontaneous Pneumothorax Recurrence with Two Policy Therapies: A Clinical Trial.

Background: Spontaneous pneumothorax is a potentially fatal condition with a high risk of recurrence. The purpose of this study is to compare two different approaches to SP management. In the first group, patients underwent only chemical pleurodesis; in the second group, CT-scan, VATS, and then chemical pleurodesis was performed. Materials and Methods: This study is a non-randomized clinical trial conducted on 65 patients admitted to Al-Zahra Hospital in Isfahan with a primary complaint of sudden dyspnea and a definitive diagnosis of spontaneous pneumothorax. Two studies compared the main outcomes of recurrence within six months and the time until recurrence. Results: Age, sex, and BMI were matched between the two study groups. The side of the pneumothorax, smoking history, and pulmonary disease history did not differ significantly (P > 0.05). Pneumothorax recurrence did not differ significantly between the two groups (P: 0.477). Conclusion: This study demonstrated no distinction between VATS and chemical pleurodesis when using only chemical pleurodesis. However, because numerous studies have suggested that one of these techniques may be beneficial for patients with SP, it is recommended to conduct additional randomized controlled trials (RCTs) with a more detailed plan and more comparable procedures, although it appears that meta-analysis design may be effective given the abundance of available RCT studies.

Evaluation of the relationship between serum levels of 25-hydroxyvitamin D and prognostic factors in breast cancer.

<b> Introduction:</b> Breast cancer is the most frequent invasive malignancy in women worldwide. There is a modifiable risk factor (such as serum vitamin D level) for this cancer. We decided to conduct this study since the influence of serum vitamin D levels on breast cancer is still controversial. </br></br> <b> Methods and materials:</b> In this analytical cross-sectional study, 103 patients who were diagnosed with breast cancer were included. Patients' demographic, clinical and pathological features were all recorded. After the laboratory provided the serum vitamin D level, it was included in the checklist. Serum vitamin D level was categorized into 3 groups: <10 ng/ml, 1030 ng/ml and >30 ng/ml. The chi-square test was used to assess the relationship between vitamin D levels and clinicopathological features of the patients in SPSS software. The results were considered statistically significant at P-value < 0.05. </br></br> <b> Results:</b> The mean age of the patients was 47.97 8.8 years. The mean serum vitamin D level was 28.72 19.9 ng and it was divided into three groups: 1) deficient (10 ng), which included 20 (19.4%) patients, 2) insufficient (10-30 ng), which included 48 (46.6%) patients, and 3) normal (>30 ng), which included 35 (34%) patients. Low vitamin D level (<320 ng/ml) was mainly detected in premenopausal cases (P-value = 0.001) with poor prognosis high grade of the disease (P-value = 0.001), positive nodal involvement (P-value = 0.025) and positive Ki-67 (P = 0.021). Furthermore, patients with lower serum vitamin D levels interact in fewer outdoor activities (P-value = 0.007), sleep less during the day (P-value = 0.001) and sleep later at night (P-value = 0.009). </br></br> <b>Conclusion:</b> Decreased serum 25(OH) D levels were linked with a higher histological grade of the tumor and lymph node involvement. Low serum 25(OH) D levels were also related to prognostic factors such as high Ki67 expression and the presence of negative hormone receptors (ER and PR). Our data support negative correlations between vitamin D levels and the risk of breast cancer with poor prognostic characteristics, based on observational research.