Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, necessitating the identification of reliable prognostic indicators to enhance treatment outcomes. Recent research has highlighted the triglyceride-glucose (TyG) index as a potential surrogate marker for insulin resistance, which may significantly influence the prognosis of patients undergoing immunotherapy combined with chemotherapy. In this context, the study by Yao et al demonstrates that a high TyG index correlates with improved overall survival and progression-free survival in advanced GC patients receiving sintilimab and chemotherapy. Specifically, patients in the high TyG group had a significantly longer median progression-free survival of 9.8 months [95% confidence interval (CI): 9.2-10.9] compared to 8.0 months (95%CI: 7.5-8.5) in the low TyG group (hazard ratio = 0.58, 95%CI: 0.43-0.79, P < 0.001). Similarly, the median overall survival was significantly longer in the high TyG group at 23.1 months (95%CI: 21.2-NA) vs 16.5 months (95%CI: 13.9-18.3) in the low TyG group (hazard ratio = 0.30, 95%CI: 0.21-0.42, P < 0.001). These findings underscore the strong prognostic potential of the TyG index in guiding treatment strategies for advanced GC. These findings underscore the need for further investigation into the TyG index's role as a prognostic tool and its underlying mechanisms in influencing treatment efficacy. We advocate for additional multicenter studies to validate these results and explore the TyG index's applicability across diverse patient populations, ultimately aiming to refine treatment strategies and improve patient outcomes in advanced GC.

The outcomes of varicocele repair (VR) for severe oligozooasthenoteratozoospermia (OAT) have not been widely examined.

Assessment of outcomes of VR after severe OAT, employing scoping review of published guidelines, and systematic review of literature. The Newcastle-Ottawa scale appraised the quality of included studies. Findings from both reviews were used to identify knowledge gaps and ways to enhance the evidence base.

No published guidelines exist specifically on VR for severe OAT. Of 731 articles retrieved, 15 were included, indicating a scarcity of studies appraising the topic. Most included studies exhibited high risk of bias and low-level evidence. Studies focused on basic sperm parameters; fewer examined hormonal/testicular volume changes, or pregnancy/live births. Studies suggested some post-VR sperm parameters improvements but mostly no changes in hormone levels/testicular volume. We identified four knowledge gaps: methodological issues; narrow scope of research and measurement aspects; lack of genetic considerations; and scarce economic/cost-effectiveness appraisals. We propose some precautions, remedies, and research questions to enhance the thin evidence base.

VR for severe OAT has potential to improve sperm parameters. Scarcity of studies, high risk of bias, low-level evidence, and other limitations mitigate against drawing solid conclusions. Future research is required.

In response to the insightful comments made by Dr. Abid et al. on our article "Investigation of Vitamin D Levels in Men with Suspected Infertility", we address several key points concerning the generalizability and methodology of our study. Dr. Abid et al.'s critique primarily focused on the single-center nature of our research, regional variations in ultraviolet (UV) exposure, dietary factors affecting vitamin D levels, and the sample size of our study. We discuss the inherent value and controlled environment of single-center studies while acknowledging the need for multi-center validation. Additionally, we explain our consideration of sun exposure and dietary intake in our analysis, and recognize the importance of larger, more diverse studies to strengthen our findings. Our response aims to clarify these aspects and emphasize the significance of vitamin D in male infertility, encouraging further research in this field.

Engineered biomaterials are materials specifically designed to interact with biological systems for biomedical applications. This paper offers the comprehensive analysis of global clinical trial trends involving such materials. We surveyed 834 studies in the ClinicalTrials.gov database and explored biomaterial types, their initiation points, and durations in clinical trials. Predominantly, synthetic and natural polymers, particularly silicone and collagen, are used. Trials, focusing on ophthalmology, dentistry, and vascular medicine, are primarily conducted in the United States, Canada, and Italy. These trials encompass a broad demographic, and trials enrolled fewer than 100 participants. The study duration varied ranging from 0.5 to 4.5 years. These biomaterials are mainly bioresorbable or bioinert, with the integration of cells in biomaterials remaining an underexplored area. Our findings shed light on current practices and future potentials of engineered biomaterials in clinical research, offering insights for advancing this dynamic field globally.

The comparative effectiveness of transrectal and transperineal prostate biopsy in detecting clinically significant prostate cancer is not well understood. We conducted a randomized clinical trial to determine whether transperineal biopsy improves the detection of clinically significant prostate cancer.

Of the 840 men randomized, 93% were White, 44% had a previous biopsy, with a median age of 66 years and median PSA density of 0.14. Of these, 384 underwent transrectal and 398 underwent transperineal prostate biopsy. Prebiopsy prostate MRI was performed in 96% of men. Grade Group ≥ 2 prostate cancer was classified as clinically significant. Odds ratios were calculated using logistic regression to evaluate the effect of biopsy procedures on cancer detection rates.

The detection rates of clinically significant prostate cancer were 47.1% and 43.2% (odds ratio 1.17; 95% CI, 0.88-1.55) for transrectal and transperineal biopsy, respectively. Age, PSA density, clinical stage and Prostate Imaging Reporting and Data System score were associated with the diagnosis of clinically significant cancer, whereas history of previous biopsy, anterior tumors, and biopsy procedure (transrectal or transperineal) were not. Clinically significant cancer detection rates in biopsy-naïve men undergoing MRI-targeted transrectal or transperineal biopsy were 59% and 62%, respectively. The overall cancer detection rates following transrectal and transperineal biopsy were 72.1% and 70.4%, respectively.

There was no significant difference noted in the detection of clinically significant prostate cancer following transrectal or transperineal prostate biopsy. Urologists may utilize either biopsy procedure that best suits their patients' needs and practice setting.

Second-generation tyrosine kinase inhibitors (2GTKI) are more effective in inducing rapid molecular responses than imatinib when used first-line in patients with chronic myeloid leukemia in chronic phase (CML-CP). However, failure of first line-2GTKI (1L-2GTKI) still occurs and there is no consensus regarding subsequent management. We retrospectively analyzed the outcome of 106 CML-CP patients treated with 1L-2GTKI and with a median follow-up of 91 months. 45 patients (42.4%) switched to an alternative TKI, 28 for intolerance (26.4%) and 17 (16%) for resistance. Most patients who remained on 1L-2GTKI achieved deep molecular responses (DMR) and 15 (14.1%) are in treatment-free remission (TFR). Intolerant patients also obtained DMR, although most required multiple TKI changes and were slower to respond, particularly if treated with 2L-imatinib. Inferior outcomes were observed in resistant patients, who failed alternative 2L-2GTKI and required 3/4GTKI and/or allogeneic hematopoietic stem cell transplant (alloSCT). 7yr-OS was significantly lower for these individuals (66.1%) than for intolerant patients and those who remained on 1L-2GTKI (100% and 97.9%, respectively; p = 0.001). It is apparent that failure of 1L-2GTKI is a challenging problem in modern CML therapy. Intolerance can be effectively managed by switching to an alternative 2GTKI, but resistance requires early consideration of 3/4GTKI.

Immunosuppressors (IS) such as Dexamethasone (DXM), Tocilizumab, and high-dose methylprednisolone boli (HDMB), are used in COVID-19-related acute respiratory distress syndrome (ARDS). This study aimed to determine whether COVID-19 ARDS-related combined IS therapy was associated with an increased incidence of ICU-acquired pneumonia (IAP).

We retrospectively analyzed COVID-19-ARDS admitted to ICU from March 2020 to April 2022. Patients' and IAP characteristics were analyzed according to five IS regimens: No IS, DXM alone, DXM+HDMB, DXM+tocilizumab, and DXM+tocilizumab+HDMB. To investigate the role of IS on IAP incidence, we performed a multivariate logistic regression and built a propensity score. Ultimately, we used a conditional logistic regression after pairing on the propensity score.

The study included 496 COVID-19-ARDS. Regarding the IS therapy, 12.7% received no IS, 43% DXM alone, 21.6% DXM+HDMB, 15.5% DXM+tocilizumab and 5.4% DXM+tocilizumab+HDMB. 37% presented at least one IAP, and the IAP incidence was higher with DXM+HDMB (66.4%) compared to no IS (P<0.0001), DXM (P<0.0001) and DXM+tocilizumab (P<0.0001). HDMB and probabilistic antibiotherapy at admission were independent IAP predictors after adjustment on the propensity score (respectively OR:2.44; P<0.0001 and OR:2.85; P<0.001).

In critically ill COVID-19, HDMB significantly increases the risk of IAP whereas DXM alone, nor in combination with tocilizumab, did not.

Personalized medicine (PM), as a rapidly growing research area, provides treatments, practices, and interventions being adapted to an individual patient based on his own risk of disease. This study aims to analyze the productivity of countries, institutions, and authors in this field, to determine the existing research trends worldwide, and to forecast future research activity for specific countries.

Documents published between 2000 and 2020 were retrieved from the Web of Science (WoS) database. Bibliometric analysis was performed to assess the outputs, correlation analysis was applied to analyze the relationship between Gross Domestic Product per capita (GDP-PP) and the number of publications, and an extrapolation method was used for predicting the future productivity trends for certain countries.

A total of 7,772 documents were published globally on PM between 2000 and 2020. The most productive country, journal, and institution are the USA, Personalized Medicine, and Harvard Medical School, respectively. The USA is also first in line in terms of total citations. Netherlands, Denmark, and the USA are listed at the top in terms of the total number of papers and citations, after adjusting for GDP-PP and population size. Also, as predictions suggest, the USA will maintain its predominant role in the PM field in the next 5 years.

Owing to its both interdisciplinary and multidisciplinary nature, PM bestows researchers' numerous sources to benefit and enables them a field that they can be productive of for the future. Therefore, this field is expected to progress and be the lead area in medicine in the upcoming years.