Senses and Sciences

Impact of Early Changes in Circulating Cell-Free DNA Load on Outcome in Metastatic Luminal Breast Cancer Patients

Sat, 27 Dec 2025 09:51:59 +0000

Abstract

Background: Circulating cell-free DNA (cfDNA) is a promising non-invasive biomarker that reflects tumor burden and treatment dynamics in metastatic breast cancer (MBC). However, the prognostic significance of early cfDNA changes in hormone receptor–positive, HER2-negative (luminal) subtypes remains insufficiently defined.

Methods: This prospective study included 50 patients with metastatic HR+/HER2– breast cancer treated at Alexandria University between January 2022 and December 2023. Plasma cfDNA levels were quantified at baseline and after 3–4 weeks of therapy using real-time PCR targeting the β-actin gene. Patients were classified based on early cfDNA kinetics (≥10% decrease vs. no decrease/increase). Progression-free survival (PFS), overall survival (OS), and objective response rates (ORR) were analyzed using Kaplan–Meier and Cox regression models.

Results: Median baseline cfDNA was 86.4 ng/mL (range 12–410). Early cfDNA decline occurred in 62% of patients and was associated with higher ORR (52% vs. 18%, p=0.021). Patients with early cfDNA decrease had significantly longer median PFS (14.2 vs. 6.3 months; HR 0.48, 95% CI 0.26–0.88, p=0.016). Multivariate analysis identified early cfDNA decrease (HR 0.42, p=0.009) and endocrine-based therapy (HR 0.55, p=0.041) as independent predictors of prolonged PFS. Median OS was not reached in patients with cfDNA decrease versus 16.5 months in those without (p=0.044).

Conclusions: Early reduction in cfDNA load within the first month of systemic therapy predicts improved outcomes in metastatic HR+/HER2– breast cancer. cfDNA dynamics represent a minimally invasive and practical biomarker that may complement radiologic assessment and support earlier treatment decision-making. Larger studies integrating molecular profiling are warranted to validate the clinical utility of cfDNA kinetics.

The Prognostic Value of Serial C-Reactive Protein Monitoring in Pediatric Febrile Neutropenia

khaled mohamed seddik — Sat, 27 Dec 2025 10:16:38 +0000

Background: In pediatric cancer patients, predicting the occurrence of sepsis and septic shock in the context of febrile neutropenia (FN) remains an important clinical challenge. While C-reactive protein (CRP) is one of the most widely used clinical biomarkers, further studies are needed to identify its utility in predicting clinical deterioration in this specific population. The aim was to assess the prognostic potential of initial (0h) and 24-hour (24h) CRP kinetics in predicting sepsis severity, ICU admission, and mortality in pediatric cancer patients presented with FN.

Methods: We performed a prospective observational study of 242 pediatric cancer patients presenting with FN. We analyzed CRP dynamics, Pediatric Sequential Organ Failure Assessment (pSOFA) scores, microbiological profiles, and clinical outcomes including sepsis progression, septic shock, admission to the ICU, and 28-day mortality.

Results: The cohort (median age 9.0 years) demonstrated that there was a meaningful increase in mean CRP from 89.4 mg/L at presentation to 116.4 mg/L at 24 hours (P < 0.05). Elevated CRP levels were strongly correlated with disease severity; patients requiring ICU admission (n=50) and those developing septic shock (n=51) exhibited significantly higher CRP levels at both time points. The 28-day mortality rate was 12.0% (n=29). Non-survivors demonstrated persistently elevated or rising CRP trends compared to survivors. Gram-positive bacteremia was associated with the highest CRP level.

Conclusion: Serial CRP monitoring provides critical prognostic data in pediatric FN. A rising CRP trajectory over the first 24 hours is a potent indicator of clinical deterioration, supporting its use in identifying high-risk patients requiring escalated care.

A pilot study using a visual art intervention to support the well-being of elderly people living in residential care home

Vincenza Ferrara, Enzo Grossi — Sat, 27 Dec 2025 10:38:47 +0000

As people age, interventions that promote emotional well-being and cognitive function become essential, especially for people with potential cognitive decline in residential healthcare facilities. Art-based interventions, particularly Visual Thinking Strategies (VTS), have solid evidence for promoting observation and listening skills, and activating specific neural areas for problem-solving and critical thinking. Furthermore, several studies have also shown that those involved in these activities reduce anxiety and stress in both educational and nursing settings. We therefore aimed to apply these activities to elderly people living in a nursing home to verify improvements in well-being, anxiety, and cognitive decline. This study piloted a 4-session program that used a facilitated, guided discussion of the VTS method, presenting images of artworks to assess the impact on measures of emotional well-being and self-esteem, and to obtain feedback from participants on their experience using the VTS Skill Grid and the PANAS questionnaire. The results indicated that VTS activities were well accepted by participants, and the impact recorded in terms of both cognitive experience and anxiety reduction was very positive. These findings suggest the possibility of using this method and other artistic practices to promote cognitive, relational, and emotional skills in people at risk of cognitive decline, loneliness, and depression.

Study of levator ani anatomy and function using dynamic 4D ultrasound after vaginal versus caesarean delivery in primiparous women.

Tue, 30 Dec 2025 14:47:46 +0000

Background: Childbirth is a central experience in women’s lives. Vaginal delivery is more physiological having superior outcome compared to caesarean section (CS). It is obvious that clinical assessment alone is insufficient to assess pelvic floor function and anatomy as it focuses on the description of surface anatomy which is unable to reveal true underlying abnormalities, therefore the role of pelvic floor ultrasound imaging is increasing in postnatal follow up visits. Non-invasive nature of pelvic floor ultrasound allows a comprehensive pelvic floor assessment, enabling a new dimension in obstetric quality control and secondary prevention of pelvic floor dysfunctions. This study was conducted to assess pelvic floor function using four dimensional (4D) dynamic ultrasound in a cohort of women after vaginal versus caesarean delivery and the ultimate objective was to predict the impact of vaginal delivery on pelvic floor function and also to study the potential of 4D ultrasound in assessment of pelvic floor dysfunction. Methods: This study was a cross-sectional study conducted on 120 primiparous women 2-3 months after delivery. Women were recruited after counselling from urogynaecology, family planning clinic and ultrasound unit in El-Shatby Maternity Hospital, after approval of the local Ethical Committee and having an informed consent from patients included in the study. Results: We found no statistically significant differences between the primiparous after vaginal and caesarean delivery regarding levator ani anatomy and functions parameters at rest. During Valsalva, there was significant increase in levator ani hiatus anteroposterior, transverse diameter and levator ani hiatus area, yet they did not exceed upper limit normal range. Conclusions: There is no significant differences between vaginal versus caesarean delivery on levator ani functions at rest yet statistically significant differences in certain parameters at Valsalva without exceeding the normal range.