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Ključne besede: vitamin D, pomanjkanje, preskrbljenost, Slovenija
Objavljeno v DiRROS: 24.11.2025; Ogledov: 143; Prenosov: 83
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Ključne besede: vitamin D, dietary intake, serum 25-hydroxy-vitamin D, vitamin D deficiency, systematic reviews, Slovenia
Objavljeno v DiRROS: 24.11.2025; Ogledov: 161; Prenosov: 74
Celotno besedilo (1,08 MB)
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Objavljeno v DiRROS: 24.11.2025; Ogledov: 154; Prenosov: 77
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Povzetek: A considerable proportion of metastatic melanoma (mM) patients do not respond to immune checkpoint inhibitors (ICIs). There is a great need to develop noninvasive biomarkers to detect patients, who do not respond to ICIs early during the course of treatment. The aim of this study was to evaluate the role of early [18F]2fluoro- 2-deoxy-D-glucose PET/CT (18F-FDG PET/CT) at week four (W4) and other possible prognostic biomarkers of survival in mM patients receiving ICIs. Patients and methods. In this prospective noninterventional clinical study, mM patients receiving ICIs regularly underwent 18F-FDG PET/CT: at baseline, at W4 after ICI initiation, at week sixteen and every 16 weeks thereafter. The tumor response to ICIs at W4 was assessed via modified European Organisation for Research and Treatment of Cancer (EORTC) criteria. Patients with progressive metabolic disease (PMD) were classified into the no clinical benefit group (no-CB), and those with other response types were classified into the clinical benefit group (CB). The primary end point was survival analysis on the basis of the W4 18F-FDG PET/CT response. The secondary endpoints were survival analysis on the basis of LDH, the number of metastatic localizations, and immune-related adverse events (irAEs). Kaplan-Meier analysis and univariate Cox regression analysis were used to assess the impact on survival. Results. Overall, 71 patients were included. The median follow-up was 37.1 months (95% CI = 30.1–38.0). Three (4%) patients had only baseline scans due to rapid disease progression and death prior to W4 18F-FDG-PET/CT. Fifty-one (72%) patients were classified into the CB group, and 17 (24%) were classified into the no-CB group. There was a statistically significant difference in median overall survival (OS) between the CB group (median OS not reached [NR]; 95% CI = 17.8 months – NR) and the no-CB group (median OS 6.2 months; 95% CI = 4.6 months – NR; p = 0.003). Univariate Cox analysis showed HR of 0.4 (95% CI = 0.18 – 0.72; p = 0.004). median OS was also significantly longer in the group with normal serum LDH levels and the group with irAEs and cutaneous irAEs. Conclusions. Evaluation of mM patients with early 18F-FDG-PET/CT at W4, who were treated with ICIs, could serve as prognostic imaging biomarkers. Other recognized prognostic biomarkers were the serum LDH level and occurrence of cutaneous irAEs.
Ključne besede: melanoma, prognostic biomarkers, survival, immunotherapy
Objavljeno v DiRROS: 21.11.2025; Ogledov: 165; Prenosov: 63
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Povzetek: In recent decades, which have brought about dramatic changes in medicine, the relationship of trust between patients and doctors has come under severe pressure. In parallel with the increasing needs and complexity of patients who demand more individual time from their physicians (including the explanatory duty required by law), the administrative burden of the latter is increasing. The performance metrics of individual physicians has either already been introduced or is planned to be introduced, forcing physicians into the “production line” of healthcare services. Although physicians represent a small percentage of all employees in the healthcare enterprise, generally less than 10 %, they are the main target of performance metrics in healthcare. The administrative burden and metrics approach are enhanced by the corporatization of healthcare systems, both in private as well as public healthcare organizations. Patients and physicians are no longer the main figures in medical decision making, as many other individuals and entities have since joined, described as “strangers at the bedside” in a book by Professor David Rothman. They include bioethicists, lawyers, court rulings, economists, psychologists, civil society, and activists. The introduction of artificial intelligence into healthcare and its role in medical decision making will be assessed in the near and distant future. Patients do not want to be part of a healthcare production line. They want a human touch from their physician, whom they trust to fight for and protect their best interests, their health, and their lives. Patients need this trustful relationship at least as much as medications and healthcare services. Physicians want and need the same. A trustful relationship between patient and physician has been the core value of medicine for thousands of years, and should be protected and consolidated for the future. Our duty as physicians is the fight to sustain it in the challenging times ahead.
Ključne besede: moral injury, trust, physicians, physician - patient relationship
Objavljeno v DiRROS: 21.11.2025; Ogledov: 158; Prenosov: 79
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