Roosevelt Hospital

Metastatic pancreatic ductal adenocarcinoma (mPDAC) is one of the most aggressive malignancies with a very poor prognosis. Currently, there is no standardized therapeutic approach for third-line systemic treatment. The aim of this retrospective/prospective study was to evaluate survival outcomes in patients treated in the third-line setting and to analyze the impact of nutritional and inflammatory biomarkers on overall survival (OS) and progression-free survival (PFS). The analysis retrospectively and prospectively included 95 patients with mPDAC treated with third-line systemic therapy. Data were collected from the Slovak Pancreas Registry. Data were collected from 13 hospitals. Baseline chemotherapy regimens, ECOG, nutritional, and inflammatory parameters were recorded and used to calculate prognostic scores (PNI, CRP, NLR, SII, SIRI, GPS). Their association with OS and PFS was analyzed using the log-rank test and Kaplan-Meier survival analysis. The most frequently used regimen was FOLFOX/CAPOX (56 patients), followed by nanoliposomal irinotecan (nal-IRI, 24 patients) and capecitabine (11 patients). The median OS was 5.55 months and the median PFS was 3.29 months. A PNI > 40.5 was significantly associated with longer OS (6.34 vs. 3.32 months, p=0.001) and PFS (3.71 vs. 2.76 months, p=0.009). Lower GPS scores were significantly associated with improved OS (p=0.006) and PFS (p=0.027). Other inflammatory markers (NLR, SIRI, SII, CRP) did not show a statistically significant impact on OS or PFS. Third-line systemic therapy may offer clinical benefit in selected mPDAC patients, particularly in those with favorable nutritional-inflammatory profiles. The Prognostic Nutritional Index (PNI) and Glasgow Prognostic Score (GPS) appear to be potentially useful tools for identifying candidates suitable for further systemic treatment. However, further prospective studies are needed to confirm these findings.

Background: Hyaluronic acid (HA) hydrogels are the most widely used injectable fillers for facial rejuvenation. A new generation of HA fillers crosslinked with poly(ethylene glycol) diglycidyl ether (PEGDE) has been developed to enhance cohesiveness, tissue integration, stability, and longevity while minimizing swelling and immunogenicity. Owing to their distinct viscoelastic properties, PEGDE-crosslinked HA fillers may require product-specific selection and adapted injection techniques. Objective: The objective of this study is to provide practical, expert-based recommendations for the safe and effective use of PEGDE-crosslinked HA hydrogels in facial aesthetic treatments. Methods: A multidisciplinary panel of nine Italian experts in aesthetic medicine, each with more than 15 years of experience using HA fillers, developed consensus recommendations based on clinical practice and available evidence. A pre-meeting questionnaire informed structured discussions during a face-to-face meeting held in Paris in January 2024. The nominal group technique was applied, with consensus defined as agreement by at least 80% of panel members. Results: Consensus was reached on product selection, injection planes, delivery devices, techniques, and typical treatment volumes for PEGDE-HA hydrogels across multiple facial regions, including the forehead, temples, midface, nasolabial folds, chin, jawline, and lips. Recommended injection techniques included microbolus, macrobolus, and retrograde linear threading, with placement ranging from superficial subcutaneous to supraperiosteal planes depending on the anatomical area and clinical indication. Typical injection volumes generally ranged from 0.1 to 0.5 mL per side. Optional ultrasound mapping was considered beneficial in selected high-risk or superficial procedures to improve anatomical safety. Conclusions: These expert consensus recommendations provide practical guidance for clinicians using PEGDE-crosslinked HA hydrogels in facial rejuvenation. Tailoring product characteristics to injection depth, technique, and regional anatomy may help optimize clinical outcomes and procedural safety. Future research priorities include prospective comparative studies with other crosslinking technologies, standardized reporting of adverse events, long-term outcome registries, and further evaluation of ultrasound-guided injection strategies.

Prostate cancer is a preventable and detectable disease, which implies a strong public health commitment. Therefore, it is necessary to understand the current situation of prostate cancer in Central America and the Caribbean compared to the rest of the world, since the incidence of the disease can vary due to factors such as race and genetic inheritance. The educational, social, and cultural factors are the biggest problem in cancer prevention in Central America and the Caribbean.

Introduction: In Guatemala the prevalence is estimated at 18-20 cases per 100,000 inhabitants “DERRAME Code” initiative was created by our group for a better identification and management of acute Stroke patients, given the common colloquial name by which our regional population identifies the term stroke, making this name equivalent to STROKE CODE. For mainly pre-hospital management purposes. This initiative was initiated a decade ago including population and paramedical personnel training and continuing with medical training with internal medicine residents at public medical school hospital. In Guatemala the mnemonic DERRAME originates from: D ificultad para hablar (Difficulty speaking), E ntiende poco (Poor understanding), R ápido Inicio (Rapid onset), D esviación facial (Deviated face), A lteración visual (Altered vision), M edico cuerpo débil (One side motor symptoms), E mergencia (Emergency). This initiative was temporaly suspended during the COVID- 19 pandemic and formally reinitiated January this year. Objective: To improve the early pre-hospital identification and early arrival to a qualified hospital within the 4.5-hour time window, for thrombolytic treatment Methodology: Analytical, prospective, cross-sectional study from January to July 2025. The trainees were given a pretest- and a post-training test. The test included 10 questions for paramedics regarding prehospital approach and management and 20 questions for medicine resident physicians regarding hospital management in acute stroke patients. Then, analyzed data obtained from thrombolyzed patients. Results: 1. 153 paramedics and 50 resident physicians were trained during first semester 2025. 2. The knowledge of acute stroke management by paramedics and internal medicine residents improved by more than 90%. 3. The number of thrombolyzed patients in our hospital increased during this period by 60% compared to four prior semesters (2023 and 2024). There was only one intraparenchymal hemorrhage associated to the thrombolytic procedure in this period with no other complications documented. Conclusions: 1. Training of paramedic personnel and emergency medical personnel showed a significant improvement in early and effective acute care in stroke patients with an increased number of thrombolyzed patients with minimal side effects 2. This initiative is currently in the process of involving a significant increase of public hospitals, aiming to improve the acute stroke care in Guatemala.

This case report describes mandibular distraction osteogenesis (DO) in a six-year-old patient with first and second branchial arch syndrome and obstructive sleep apnea, in whom 3D surgical planning was combined with ultrasonography (US) for postoperative monitoring. The aim was to illustrate how patient-specific 3D modeling and a structured ultrasonography protocol can support safe mandibular advancement while limiting radiation exposure in a pediatric patient with complex craniofacial deformity. Preoperatively, a 3D-printed model of the mandible, generated from a cone beam computed tomography (CBCT) scan, was used to guide precise osteotomy planning and vector orientation. The surgical procedure was conducted using a Risdon approach and piezoelectric tools to ensure minimal trauma. Postoperative monitoring incorporated serial panoramic radiography and US at predefined time points to assess gap size, callus formation, and vascularity during distraction and consolidation. US identified early callus formation, progressive cortical bridging, and preserved callus vascularity, and, together with radiographic findings, guided the timing of distraction termination and distractor removal at 16 weeks. This case adds to the limited literature on pediatric mandibular DO by demonstrating the feasibility of integrating patient-specific 3D virtual planning with US-based follow-up to improve the safety, precision, and radiation-conscious management of DO in pediatric patients with complex craniofacial deformities.

SERPINA1 Z and PNPLA3 G alleles are the most potent genetic risk modifiers in chronic liver disease (CLD) progression. We aimed to test the impact of concomitant carriage of these variants on the progression of CLDs of various aetiology. The cirrhosis cohort included 1583 individuals with CLD, evaluated as candidates for liver transplantation (LTx), with alcoholic-related liver disease (ALD), metabolic dysfunction-associated (MASLD), viral (VIR), autoimmune/cholestatic (AIH-CHOL), and metabolic conditions (MET). This cohort was compared to a control population of 3483 healthy individuals. The frequency of SERPINA1 MZ heterozygotes was significantly higher (p < 0.0001) in the entire cirrhosis group (84/1583; 5.3%) than in controls (89/3483; 2.6%), OR 2.57 (95% CI 1.92–3.44). The frequency of SERPINA1 MZ heterozygotes was significantly higher in the subgroups with ALD and MASLD (37/557; 6.4% and 23/208; 11.1%, respectively, p < 0.0001); the frequency in the subgroups VIR, AIH-CHOL and MET did not differ from controls. The frequency of the PNPLA3 G allele was significantly higher (p < 0.0001) in the entire cirrhosis group (880/1,583; 55.6%) than in controls (1418/3402; 41.6%); OR 1.48 (95% CI 1.36–1.99). The G allele frequency was significantly higher only in ALD, MASLD and VIR subgroups (392/577, 67.9%; 133/208, 63.9% and 139/264, 52.7%; p < 0.0001, 0.0001 and 0.0005, respectively). The frequency of the PNPLA3 G allele was the same in cirrhotic patients carrying SERPINA1 MM and MZ genotypes (824/1483, 55.6% vs 50/84, 59.2%, N.S.). SERPINA1 MZ heterozygotes with ALD and MASLD were significantly younger (56.9 vs 60 years, p = 0.046) and had a higher MELD score (17 vs 15 points, p = 0.0003) at waitlisting, whereas the PNPLA3 genotype had no impact on the age and MELD score at waitlisting. We conclude that both variant alleles increase the risk of liver cirrhosis in ALD and MASLD; however, SERPINA1 MZ heterozygotes have more progressive chronic liver disease and need LT at a younger age.

BackgroundAround 20% of patients undergoing assisted reproductive technology are at risk of hypo-response to ovarian stimulation. The aim of this study was to describe the real-world use of follitropin delta for ovarian stimulation in these patients, as defined by POSEIDON groups 3 and 4 [an anti-Müllerian hormone (AMH) level of <1.2 ng/ml].Materials and methodsThis study was a post-hoc analysis of participants from DELTA, a multi-centre, prospective, observational study conducted in normal care settings in fertility clinics at 14 active sites in France. A subset of 35 patients at risk of hypo-response to ovarian stimulation (mean AMH 0.7 ± 0.29 ng/ml) and treated with follitropin delta were included. Patients were followed for 10–11 weeks after the first fresh or frozen embryo transfer in case of subsequent pregnancy, and data on real-world follitropin delta use collected.ResultsMost patients (92.9%) had undergone their first IVF or ICSI. The prescribed daily dose was usually based on the approved algorithm (N = 26; 74.3%) with a mean daily dose of 14.2 ± 4.1 mcg, resulting in a mean total dose of 187.7 ± 135.6 mcg. The mean duration of ovarian stimulation was 11.6 ± 6.7 days with no premature discontinuations, while the mean number of oocytes retrieved among patients that started stimulation was 6.3 ± 4.3. A fresh transfer was performed for 21 patients (84.0%), with a mean of 1.04 ± 0.98 embryos transferred per patient. Seven patients (20.0%) achieved an ongoing pregnancy (28% per transfer). No adverse drug reactions were reported.ConclusionsThe results describe the real-world use of follitropin delta and demonstrate its suitability for POSEIDON group 3 and 4 patients. These data complement clinical trial outcomes, supporting clinician decision-making and improving IVF/ICSI outcomes.

Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) are blood biomarkers that able to aid in the assessment of mild traumatic brain injury (mTBI) patients and reduce computed tomography (CT) overuse. The aim of this study was to evaluate the predictive performance of individual biomarkers and their combination (i.e. mTBI assay) in detecting clinically significant intracranial injuries in mTBI. Furthermore, the influence of older age on the predictive performance of individual biomarkers and their combination was investigated. This prospective multicenter study was conducted in 12 European healthcare centers. Adults with suspected mTBI presenting to the emergency department (ED) of each participating healthcare center within 12 h of head trauma were enrolled. GFAP and UCH-L1 were determined in blood samples collected from each participant. Head CT was considered as reference standard for the presence of intracranial injury. The mTBI assay yielded the highest sensitivity [95.5%, 95% confidence interval (CI): 89.9-98.5] and the highest negative predictive value (NPV) value (97.3%, 95% CI: 93.9-98.9) for the exclusion of intracranial lesions in mTBI. The sensitivities and NPVs of individual biomarkers were lower compared with the mTBI assay. In adults over 65 years, the individual biomarkers and the mTBI assay displayed the weakest diagnostic performances. After optimizing cutoff values for the mTBI assay for older adults, the following diagnostic accuracy measures were obtained: sensitivity 87.7%, 95% CI: 77.2-94.5 and NPV: 94.4%, 95% CI: 89.6-97.0 ( P < 0.001). The mTBI assay yielded high sensitivity and NPV for the exclusion of significant intracranial injuries in mTBI patients presenting to the ED within 12 h from injury, performing better than individual biomarkers. A significant age-dependent influence on the predictive performances of the individual biomarkers and the mTBI assay was demonstrated.