Filipa Abreu Martins

Palliative radiotherapy is a well-established treatment for symptomatic bone metastases, but patients with a vital prognosis of under 3 months may not experience benefit, making accurate prognostic estimation essential for treatment selection. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of PubMed, Scopus, and Web of Science identified studies evaluating prognostic models in patients receiving bone metastases palliative radiotherapy. The risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Nineteen studies were included, most retrospective and heterogeneous, with mixed primary tumour histology. A broad range of prognostic approaches was identified, including established scores, newly developed prognostic tools, validated models, and individual prognostic factors. Performance status was the strongest prognostic variable. Models found were heterogeneous, and most studies had a high or unclear risk of bias. This PRISMA review highlights that prognostic models may support patient selection for palliative radiotherapy, but given the heterogeneity of patients and clinical settings, their use requires robust external validation and should be adequate to the local context, clinician experience, and patient characteristics.

MicroRNAs (miRNAs) have emerged as crucial regulators of gene expression and have been implicated in various physiological and pathological processes, including cardiovascular diseases. The clinical presentation, diagnostic criteria, and proposed pathophysiological mechanisms of Takotsubo Syndrome (TTS) are discussed, with an emphasis on the emerging evidence implicating miRNAs in its etiology and progression. A systematic review following the PRISMA guidelines was performed on the evidence regarding the interplay between miRNAs and TTS. A search of the Pubmed, Web of Science, and Scopus databases was conducted and resulted in 584 articles. Of these, 14 full-text articles were eligible for inclusion in the qualitative analysis. The reviewed studies suggest that multiple miRNAs are involved in the processes associated with TTS pathophysiology, including acute and chronic myocardial inflammation, oxidative stress, apoptosis, microvascular dysfunction, hypertrophy, and, ultimately, maladaptive cardiac remodelling. This review provides an overview of the current understanding of miRNAs in cardiovascular pathophysiology, with a specific focus on their potential roles in TTS. To the best of our knowledge, this is the first systematic exploration of the miRNAs involved in TTS and its modulation as potential biomarkers or therapeutic targets.