Accreditation
SINTA 2Nationally Accredited Journal
Vol. 10 No. 10 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Articles
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Does Germline BRCA1/2 Status Modify the Effect of Neoadjuvant Pembrolizumab on Pathological Complete Response in Early-Stage Triple-Negative Breast Cancer? A Systematic Review and Meta-analysis of Treatment-Biomarker Interactions
Views: 34Downloads: 31Background: Germline BRCA1/2 pathogenic variants are associated with chemotherapy response, but higher response among pembrolizumab-treated carriers does not establish a treatment-predictive interaction.
Objective: To determine whether germline BRCA1/2 status modifies the effect of neoadjuvant pembrolizumab on pathological complete response in early-stage triple-negative breast cancer, estimated as a within-study treatment-by-biomarker interaction on the ratio-of-odds-ratios scale.
Methods: Accessible bibliographic, registry, and citation sources were searched from inception through the final accessible-source update for comparative cohorts of neoadjuvant pembrolizumab plus chemotherapy versus chemotherapy alone reporting pathological complete response (pCR) by germline BRCA1/2 status. One author approved screening, extraction, ROBINS-I, and ICEMAN judgements. Treatment-by-biomarker interactions were expressed as ratios of odds ratios (RORs) and pooled by restricted-maximum-likelihood random effects with Hartung-Knapp inference.
Results: Three retrospective cohorts (655 participants) were included; two (415 participants) provided complete interaction cells. Study RORs were 3.65 (95% CI 0.52-25.62) and 2.76 (0.39-19.39). The pooled ROR was 3.17 (0.54-18.51; p=0.076), with tau-squared=0 and I-squared=0%. The third cohort remained qualitative because noncarrier cells were irreconcilable. Risk of bias was serious, interaction credibility was low, and certainty was very low.
Conclusion: The direction of effect is compatible with greater relative pembrolizumab-associated pCR improvement among carriers, but the evidence does not establish a predictive interaction. Prospective adjusted interaction analyses are required.
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Segmental Open Mandibular Fracture with Type 2 Diabetes Mellitus Managed by Intraoral Open Reduction, Internal Fixation and 101 Days of Arch Bar Retention: A Case Report with a Structured Care-Gap Analysis
Views: 43Downloads: 50Background: Mandibular fracture is the maxillofacial injury most often treated operatively, and road traffic collision is its dominant cause. Published series report fixation technique and union; far fewer report the perioperative variables that govern outcome when a metabolic comorbidity is present.
Objective: To present the staged intraoral repair of a segmental open mandibular fracture in an adult with type 2 diabetes mellitus and, through a structured audit of the record, to identify the measurable perioperative determinants of outcome that were not documented during care.
Case presentation: A 51-year-old man was struck by a car while riding a motorcycle and sustained a multiple open mandibular fracture of the symphysis, right parasymphysis and a segmental right body, with an anterior open bite, an interincisal opening of 24 mm, right mandibular crepitus and an avulsed right mandibular canine. He had treated hypertension and type 2 diabetes mellitus. Computed tomography with three-dimensional reconstruction defined the pattern and excluded condylar and intracranial injury. On the eighth day after injury, intraoral open reduction with four plates was combined with Erich arch bar maxillomandibular fixation. Rigid intermaxillary fixation was released at 21 days and the mandibular arch bar retained for 101 days. At day 116 mouth opening was unrestricted and mastication pain-free, with no infection, dehiscence, malunion or plate exposure. Structured review of the record showed that four determinants of outcome were never documented: any glycaemic measurement, inferior alveolar nerve sensation, the disposition of the avulsed canine and the retained dental roots, and a closing interincisal measurement.
Conclusion: A staged intraoral repair restored occlusion and function in a diabetic adult with a segmental open mandibular fracture. The favourable result was achieved despite four recording gaps, each fixable at no cost, that would have converted a good outcome into a demonstrated one.
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Excess Adiposity Predicts In-Hospital Mortality but Not SCORTEN in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Three-Year Retrospective Cohort at Dr. Moewardi General Hospital, Surakarta
Views: 29Downloads: 12Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare drug-induced reactions in which in-hospital death occurs in 12–49% of cases, yet the reference prognostic instrument, SCORTEN, contains no anthropometric variable. Whether body mass index (BMI) carries independent prognostic information is unknown.
Objective: To determine whether body mass index carries independent prognostic information — for in-hospital mortality and for the SCORTEN severity score — in adults admitted with Stevens–Johnson syndrome and toxic epidermal necrolysis.
Methods: This retrospective observational analytic study used total sampling of the ICD-10 L51.1/L51.2 admission register at Dr. Moewardi General Hospital, Surakarta, from January 2022 to December 2024. Forty-three adults were classified by Asia-Pacific BMI thresholds and analysed against SCORTEN, diagnostic class and in-hospital mortality using exact, Firth-penalised and interval-valued methods, with STROBE reporting.
Results: Eight patients died (18.6%; 95% CI 9.7–32.6). BMI was not associated with SCORTEN (Spearman ρ = 0.163; 95% CI −0.14 to 0.44; p = 0.296), and all 3,280 exhaustively enumerated reconstructions of the incompletely reported score distribution reproduced a non-significant coefficient (ρ 0.061–0.287); the minimum detectable |ρ| was 0.42, so this null is uninformative rather than negative (BF01 = 3.10). Mortality rose across the ordered BMI strata from 0% to 36.4% (Cochran–Armitage z = 2.053; p = 0.040, exact permutation p = 0.056), and at the Asia-Pacific overweight threshold reached 35.3% versus 7.7% (odds ratio 6.55; 95% CI 1.14–37.75; Fisher exact p = 0.042; Firth-penalised odds ratio 5.54, 95% CI 1.20–34.09; number needed to harm 3.6; E-value 8.65; fragility index 1).
Conclusion: Excess adiposity is associated with in-hospital death in Indonesian patients with epidermal necrolysis through a channel SCORTEN does not capture. The estimate is imprecise and requires prospective multicentre confirmation.
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Visual Recovery to 6/6 After Plasma Exchange Begun 29 Days Into a Corticosteroid-Refractory Aquaporin-4-IgG-Positive Optic Neuritis Attack: A Case Report
Views: 37Downloads: 24Background: Optic neuritis in aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD) is severe and frequently corticosteroid-refractory. Plasma exchange is recommended within days of onset, and the evidence that later treatment still helps is thin. Whether an attack first treated a month after onset can still recover fully is unresolved.
Objective: To describe the visual and structural recovery that followed therapeutic plasma exchange begun 29 days after onset — far outside the recommended window — in a corticosteroid-refractory aquaporin-4-IgG-positive optic neuritis attack, and to audit the record against the quantified determinants of outcome.
Case presentation: A 34-year-old woman with systemic lupus erythematosus, antiphospholipid syndrome and AQP4-IgG seropositivity documented one month earlier presented 24 days after the onset of painful visual loss in the right eye. Best-corrected visual acuity was 3/60 and the Ishihara score 0 of 25. No relative afferent pupillary defect was demonstrable in the affected eye, because the fellow eye, atrophic since an attack 11 years earlier, showed the defect instead. A full Optic Neuritis Treatment Trial course of intravenous methylprednisolone, from day 24 to day 27, produced no measurable change. Plasma exchange was started on day 29; acuity reached 6/60 on day 33 and 6/6 on day 35, and the Ishihara score rose to 5 of 25 by day 40 without any procedure-related adverse event. At day 53 the peripapillary retinal nerve fibre layer measured 91 micrometres in the treated eye against 41 in the fellow eye.
Conclusion: Complete recovery of high-contrast acuity followed plasma exchange begun 29 days after onset, far outside the recommended window, while colour vision recovered only partially. A chronically damaged fellow eye can abolish the relative afferent pupillary defect in an acutely inflamed eye, and the attack occurred on azathioprine in a patient already known to be seropositive.
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Acute Changes in Cartilage Oligomeric Matrix Protein and CTX-II Following Endurance Running in Adults: A Systematic Review and Meta-analysis
Views: 13Downloads: 11Background: Acute running-related changes in cartilage oligomeric matrix protein (COMP) and the C-terminal cross-linked telopeptide of type II collagen (CTX-II) should not be interpreted automatically as structural cartilage injury. This review evaluated the magnitude and consistency of these biomarker responses after endurance running.
Objective: To quantify the magnitude and consistency of the immediate post-run change in serum cartilage oligomeric matrix protein (COMP), and to summarize the corresponding CTX-II responses, in adults following endurance running.
Methods: The protocol was registered in PROSPERO (CRD420261485170). PubMed/MEDLINE, CENTRAL, ClinicalTrials.gov, WHO ICTRP, OpenAlex, Crossref, and citation networks were searched for adult running studies reporting pre- and post-exercise COMP or CTX-II. The primary effect was the log ratio of immediate post-run to pre-run serum COMP. Random-effects models used restricted maximum likelihood with Hartung-Knapp inference.
Results: The search identified 221 unique reports; seven reports met the criteria for qualitative synthesis, and four compatible healthy-adult COMP estimates involving 57 participants entered the meta-analysis. The pooled post/pre ratio was 1.132 (95% CI 0.794–1.613), with τ²=0.0365, I²=89.0%, and a 95% prediction interval of 0.560–2.286 at ρ=0.50. Three estimates increased and one decreased after running. CTX-II and recovery findings were too heterogeneous for pooling. Certainty was very low.
Conclusion: Serum COMP may change acutely after endurance running, but the direction and magnitude are inconsistent. These short-term surrogate responses do not establish cartilage damage, protection, or long-term clinical harm.
