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Abstract Background Patients with congenital heart disease (CHD) are more likely to experience ischemic and hemorrhagic stroke due to factors such as arrhythmias, residual shunts and related cardiovascular complications. However, guidelines for identifying CHD patients at the highest risk of stroke remain unclear. In this study, we aimed to evaluate the risk of developing stroke in patients with CHD. Methods A systematic literature search was performed on PubMed, Scopus, Cochrane, and Embase databases to retrieve studies that evaluated stroke risk in patients with CHD. Random effects model was used to pool the hazard ratios (HR) with 95% confidence intervals (CI). Subgroup analysis was conducted on age, type of stroke, type of study and region. Publication bias was assessed by Egger’s regression test. Statistical significance was set at p

Abstract This study explored the role of radioiodine therapy (RAI) in low-risk thyroid cancer patients and examined the disease-specific survival (DSS) rates in a large cohort of differentiated thyroid cancer patients (DTC). We obtained patient data from SEER database. Patients who underwent total thyroidectomy were included and categorized into three groups based on histology: classical papillary thyroid carcinoma (C-PTC), follicular type variant carcinoma (FV-PTC), and follicular thyroid cancer (FTC). Patients with distant metastasis, tumor size ≥ 200 mm, chemotherapy, or any type of radiation other than RAI were also excluded. A nomogram was developed and tested for discrimination and calibration. In total, 96,532 thyroid cancer cases were examined, including 59,460 C-PTC, 31,583 FV-PTC, and 5,489 FTC cases. Age > 65 years and male sex were correlated with lower survival rates across the subtypes. In addition, extrathyroidal extension had a worse survival effect in patients with FTC. DSS rates were compared between patients who received RAI and those who did not, with a 3% difference in C-PTC (94% vs. 91%, p

Abstract Background Infective endocarditis (IE) is a severe condition characterized by inflammation of the heart endocardium and valves, commonly caused by Gram-positive bacteria. Complications such as embolic phenomena and organ abscesses can arise, necessitating timely diagnosis and intervention. Case presentation We report the case of a 20-year-old female with a history of cerebral and splenic infarctions due to IE. The patient presented with left-sided flank pain, urinary burning, and fever. Examination revealed mitral and aortic valve involvement, splenomegaly, and neurological deficits. Despite initial antibiotic therapy, the patient developed a splenic abscess and drug-induced neutropenia. She required aortic valve replacement and was successfully managed with a multidisciplinary approach. Conclusion Multidisciplinary management, including timely surgical intervention and advanced imaging, is essential for favorable outcomes in IE patients. This case underscores the importance of early detection and tailored treatment strategies in managing severe complications associated with IE.

Background: Breast adenoid cystic carcinoma (BACC) is a rare subtype of breast cancer that accounts for less than 0.1 % of all cases. This study was designed to assess the efficacy of various treatment approaches for BACC and to create the first web-based tool to facilitate personalized treatment decisions. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five Machine Learning (ML) algorithms to predict the 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of ML models. We also performed a Kaplan-Meier (K-M) survival analysis. Results: This study included 1212 patients. The median age was 60 years, with most tumors being localized and less than 2 cm in size. The 5-year overall survival (OS) rates were highest for surgery + radiotherapy (RT) (94.9 %) and lowest for surgery + chemotherapy (CTX) + RT (80.1 %). Positive estrogen receptor (ER) status and younger age were associated with better survival outcomes. ML models identified key predictive features for survival, including age, nodal status, and ER status. Conclusion: Age, lymph node metastasis, and ER status are crucial prognostic indicators for BACC. Although postoperative RT enhances survival, the advantages of adjuvant CTX are uncertain, implying that it may be eschewed to avert adverse effects. Our online tool offers essential resources for prognostication and treatment optimization.

ABSTRACT Background Hürthle cell (HCC) and columnar cell variants (CCV) are rare subtypes of thyroid cancer. Aims This study used machine learning (ML) to evaluate treatment effectiveness and develop prognostic models. Methods Chi‐square tests, Kaplan–Meier curves, log‐rank tests, and Cox regression were used. Five ML algorithms constructed prognostic models predicting 5‐year survival, validated using the AUC of the ROC curve. Results Among 3690 patients, 3180 had CCV and 510 had HCC. ML models showed metastasis, surgery + RT, and age were significant factors for HCC, while the N component of TNM, metastasis, and tumor size were significant for CCV. Conclusion This study offers a comprehensive approach for treating and assessing prognosis in PTC variants. The ML models developed offer practical tools for personalized clinical decision‐making.

IntroductionThe clinicopathological characteristics and prognosis of placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) have not been well summarized. Consequently, we conducted the largest to date series of samples of both types and employed machine learning (ML) to assess treatment effectiveness and develop accurate prognostic models for patients with GTN. Gestational choriocarcinoma (GCC) was used as the control group to show the clinical features of PTSS and ETT.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database provided the data used for this study’s analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five ML algorithms to predict the 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of the ML models. We also investigated the role of multiple therapeutic options using the Kaplan-Meier survival analysis. ResultsThe study population comprised 725 patients. Among them, 139 patients had ETT, 107 had PSTT, and 479 had GCC. There were no significant differences in survival between the different tumor groups. Multivariate Cox regression analysis revealed that metastasis was a significant prognostic factor for GCC, while older age and radiotherapy were significant prognostic factors for PTSS and ETT. ML models revealed that the Gradient Boosting classifier accurately predicted the outcomes, followed by the random forest classifier, K-Nearest Neighbors, Logistic Regression, and multilayer perceptron models. The most significant contributing factors were tumor size, year of diagnosis, age, and race.DiscussionOur study provides a method for treatment and prognostic assessment of patients with GTN. The ML we developed can be used as a convenient individualized tool to facilitate clinical decision making.

Abstract Background Malignant Struma Ovarii (MSO) is a rare type of germ cell tumour which is diagnosed postoperatively on surgical pathology specimens by the presence of differentiated thyroid cancer in mature cystic teratomas in the ovaries. Treatment and follow-up procedures are not clearly established due to the paucity of MSO cases. Case 1 A 44-year-old multiparous female presented with an irregular period. Ultrasound showed a left ovarian lesion mostly a dermoid cyst, however, CT showed a 3.8 × 2.7 × 4 cm complex cystic lesion with thick septation and enhancing soft tissue component. Laparoscopic left salpingo-oophorectomy was performed and histopathology showed a follicular variant of papillary thyroid carcinoma arising in a mature cystic teratoma. Peritoneal cytology was positive for malignancy. A thyroid function test was normal before surgery. Total thyroidectomy was performed followed by radioactive (RAI) iodine therapy. Later, a total laparoscopic hysterectomy and right salpingo-oophorectomy were performed. There is no evidence of recurrent disease during the 26-months follow-up. Case 2 A 46-year-old single female presented with left lower abdominal pain that had persisted for 2 months. Imaging revealed an 8 × 9 × 9.5 cm left ovarian mass. Laparoscopic left salpingo-oophorectomy was performed and histopathology showed mature cystic teratoma with small papillary thyroid cancer. CT showed no evidence of metastatic disease. Later, the patient had a total thyroidectomy followed by radioactive (RAI) iodine therapy. She was started on thyroxine and later had total abdominal hysterectomy and right salpingo-oophorectomy. Conclusion MSO is a very rare tumour. Preoperative diagnosis is very difficult because of the nonspecific symptoms and the lack of specific features in imaging studies. Also, there is no consensus on the optimal treatment of women with MSO. Our two cases add to the limited number of MSO cases.

Background Primary axillary hyperhidrosis has limited noninvasive and effective treatment, and we present the use of sofpironium bromide as a promising treatment option. We aimed to assess the efficacy and safety of sofpironium in patients with primary hyperhidrosis.Methods We systematically searched the databases for Studies that assessed sofpironium bromide in patients with primary axillary hyperhidrosis. Methodological quality was determined using the Cochrane Risk of Bias Assessment tool and Newcastle-Ottowa scale.Results Five studies were included (752 patients). They used 5% sofpironium, except for one study that used 5%, 10%, and 15% sofpironium. Studies have shown a significant difference in the incidence of patients with an HDSS score of 1 or 2 ranging from 53.9% to 86.7% and reported a greater reduction in the mean change in the DLQI score in the sofpironium group. They also noted a more significant reduction in the total gravimetric weight of sweat in the sofpironium group. A 1.5 point or greater improvement in HDSM-Ax score ranged from 48.2% to 69.1%. Serious adverse events were not observed in the intervention group.Conclusion Sofpironium gel provides notable improvements in symptom severity, sweat reduction, and quality of life, with mostly mild localized adverse events.Hyperhidrosis is relatively common, affecting 4.8% of the US population and negatively affects physical, social, and psychological well-being.Sofpironium bromide is recently approved by the FDA for the treatment of primary axillary hyperhidrosisSofpironium bromide showed promising results in terms of safety and efficacy for treating hyperhidrosisWe systematically assessed the use of sofpironium gel reported in five studies (752 patients)Sofpironium gel provides notable improvements in symptom severity, sweat reduction and quality of life, with mostly mild localized adverse events.