Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atheroscle...Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.展开更多
In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent...In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent complication,it poses severe risks to both maternal and fetal health.Due to its infrequent occurrence in clinical practice,this review is based on an analysis of individual case reports over the past 55 years.While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis,it is unique in that it has a sufficiently large sample size with statistically significant results.Our discussion focuses on the diagnostic challenges associated with this condition,which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels.We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.展开更多
Currently, pharmaceutical preparations are serious contributors to liver disease; hepatotoxicity ranking as the most frequent cause for acute liver failure and post-commercialization regulatory decisions. The diagnosi...Currently, pharmaceutical preparations are serious contributors to liver disease; hepatotoxicity ranking as the most frequent cause for acute liver failure and post-commercialization regulatory decisions. The diagnosis of hepatotoxicity remains a difficult task because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug’s hepatotoxic potential, the exclusion of alternative causes of liver damage and the ability to detect the presence of subtle data that favors a toxic etiology. This process is time-consuming and the final result is frequently inaccurate. Diagnostic algorithms may add consistency to the diagnostic process by translating the suspicion into a quantitative score. Such scales are useful since they provide a framework that emphasizes the features that merit attention in cases of suspected hepatic adverse reaction as well. Current efforts in collecting bona fide cases of drug-induced hepatotoxicity will make refinements of existing scales feasible. It is now relatively easy to accommodate relevant data within the scoring system and to delete low-impact items. Efforts should also be directed toward the development of an abridged instrument for use in evaluating suspected drug-induced hepatotoxicity at the very beginning of the diagnosis and treatment process when clinical decisions need to be made. The instrument chosen would enable a confident diagnosis to be made on admission of the patient and treatment to be fine-tuned as further information is collected.展开更多
Diabetes is a highly prevalent disease that was initially simplified into three major types:Type 1,type 2 and gestational diabetes.With the global rise in incidence of acute pancreatitis(AP),a lesser-known type of dia...Diabetes is a highly prevalent disease that was initially simplified into three major types:Type 1,type 2 and gestational diabetes.With the global rise in incidence of acute pancreatitis(AP),a lesser-known type of diabetes referred to as diabetes of the exocrine pancreas(DEP)is becoming more recognized.However,there is a poor understanding of the inherent relationship between diabetes and AP.There is established data about certain diseases affecting the exocrine function of the pancreas which can lead to diabetes.More specifically,there are well established guidelines for diagnosis and management of DEP caused be chronic pancreatitis.Conversely,the sequelae of AP leading to diabetes has limited recognition and data.The purpose of this review is to provide a comprehensive summary of the prevalence,epidemiology,pathophysiology and future research aims of APrelated diabetes.In addition,we propose a screening and diagnostic algorithm to aid clinicians in providing better care for their patients.展开更多
Dynamic light scattering(DLS)is a promising technique for early cataract detection and for studying cataractogenesis.A novel probabilistic analysis tool,the sparse Bayesian learning(SBL)algorithm,is described for reco...Dynamic light scattering(DLS)is a promising technique for early cataract detection and for studying cataractogenesis.A novel probabilistic analysis tool,the sparse Bayesian learning(SBL)algorithm,is described for reconstructing the most-probable size distribution ofα-crystallin and their aggregates in an ocular lens from the DLS data.The performance of the algorithm is evaluated by analyzing simulated correlation data from known distributions and DLS data from the ocular lenses of a fetal calf,a Rhesus monkey,and a man,so as to establish the required efficiency of the SBL algorithm for clinical studies.展开更多
Early diagnosis of cancer can significantly improve treatment and survival outcomes.Imaging and tissue biopsy are the gold standard diagnostic approaches but are costly,invasive,and often unable to detect early-stage ...Early diagnosis of cancer can significantly improve treatment and survival outcomes.Imaging and tissue biopsy are the gold standard diagnostic approaches but are costly,invasive,and often unable to detect early-stage tumors.The past decade has marked an acceleration in the discovery and development of liquid biopsy tests for aiding in the detection of various types of tumor markers in non-tissue samples,such as blood.Liquid biopsy markers include circulating tumor cells,as well as tumor cell fragments,nucleic acids,and proteins.Liquid biopsy may be useful in screening patients considered to be at high risk of developing cancer,for refining diagnosis when combined with other test results,and for early detection of recurrence.Advances in big data analytics,informatics,and artificial intelligence will make it possible to combine patient history,clinical data,and liquid biopsy marker profiles to achieve more accurate and earlier diagnosis.In this review,we summarize the current use of liquid biopsy in cancer care,including the development of multi-analyte panels to improve diagnostic accuracy and detect several cancer types in a single assay.We highlight recent advances for potential future applications of liquid biopsy to aid in the diagnosis of early-stage lung cancer.We also discuss the opportunities and challenges of integrating liquid biopsy into current algorithms for cancer screening and diagnosis.展开更多
文摘Myocardial infarction with nonobstructive coronary arteries is a unique presentation of acute coronary syndrome occurring in patients without significant coronary artery disease.Its pathophysiology involves atherosclerotic and nonatherosclerotic mechanisms such as plaque erosion,coronary microvascular dysfunction,vasospasm,spontaneous coronary artery dissection,autoimmune and inflammatory diseases,and myocardial oxygen supply-demand imbalance.A systematic approach to diagnosis is needed due to the diverse range of underlying causes.Cardiac troponins confirm the myocardial injury and coronary angiography rules out significant obstruction.Cardiac magnetic resonance imaging differentiates ischemic from nonischemic causes,and additional investigations,such as intravascular ultrasound,optical coherence tomography,and provocative testing,play a role in identifying the etiology to guide management strategies.Atherosclerotic cases require antiplatelet therapy and statins,vasospastic cases respond to calcium channel blockers,spontaneous coronary artery dissection is typically managed conservatively,and coronary microvascular dysfunction may require vasodilators.Lifestyle modifications and cardiac rehabilitation are essential for improving outcomes.The prognosis of patients experiencing recurrent events despite treatment is uncertain,but long-term outcomes depend on the etiology,highlighting the need for personalized management.Future research should focus on refining diagnostic protocols and identifying optimal therapeutic strategies.Randomized controlled trials are necessary to establish evidence-based treatments for different subtypes of myocardial infarction with nonobstructive coronary arteries.
文摘In this manuscript,we provide critical commentary on the systematic review by Augustin et al,which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy.Although this is an infrequent complication,it poses severe risks to both maternal and fetal health.Due to its infrequent occurrence in clinical practice,this review is based on an analysis of individual case reports over the past 55 years.While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis,it is unique in that it has a sufficiently large sample size with statistically significant results.Our discussion focuses on the diagnostic challenges associated with this condition,which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels.We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.
基金Supported partly by research grants from the Agencia Espaoladel Medicamento from the Fondo de Investigación Sanitaria(FIS 04-1688 and FIS 04-1759)
文摘Currently, pharmaceutical preparations are serious contributors to liver disease; hepatotoxicity ranking as the most frequent cause for acute liver failure and post-commercialization regulatory decisions. The diagnosis of hepatotoxicity remains a difficult task because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug’s hepatotoxic potential, the exclusion of alternative causes of liver damage and the ability to detect the presence of subtle data that favors a toxic etiology. This process is time-consuming and the final result is frequently inaccurate. Diagnostic algorithms may add consistency to the diagnostic process by translating the suspicion into a quantitative score. Such scales are useful since they provide a framework that emphasizes the features that merit attention in cases of suspected hepatic adverse reaction as well. Current efforts in collecting bona fide cases of drug-induced hepatotoxicity will make refinements of existing scales feasible. It is now relatively easy to accommodate relevant data within the scoring system and to delete low-impact items. Efforts should also be directed toward the development of an abridged instrument for use in evaluating suspected drug-induced hepatotoxicity at the very beginning of the diagnosis and treatment process when clinical decisions need to be made. The instrument chosen would enable a confident diagnosis to be made on admission of the patient and treatment to be fine-tuned as further information is collected.
文摘Diabetes is a highly prevalent disease that was initially simplified into three major types:Type 1,type 2 and gestational diabetes.With the global rise in incidence of acute pancreatitis(AP),a lesser-known type of diabetes referred to as diabetes of the exocrine pancreas(DEP)is becoming more recognized.However,there is a poor understanding of the inherent relationship between diabetes and AP.There is established data about certain diseases affecting the exocrine function of the pancreas which can lead to diabetes.More specifically,there are well established guidelines for diagnosis and management of DEP caused be chronic pancreatitis.Conversely,the sequelae of AP leading to diabetes has limited recognition and data.The purpose of this review is to provide a comprehensive summary of the prevalence,epidemiology,pathophysiology and future research aims of APrelated diabetes.In addition,we propose a screening and diagnostic algorithm to aid clinicians in providing better care for their patients.
基金the National Science Council of the Republic of China under the Contract No.NSC-97-2112-M-006-006.
文摘Dynamic light scattering(DLS)is a promising technique for early cataract detection and for studying cataractogenesis.A novel probabilistic analysis tool,the sparse Bayesian learning(SBL)algorithm,is described for reconstructing the most-probable size distribution ofα-crystallin and their aggregates in an ocular lens from the DLS data.The performance of the algorithm is evaluated by analyzing simulated correlation data from known distributions and DLS data from the ocular lenses of a fetal calf,a Rhesus monkey,and a man,so as to establish the required efficiency of the SBL algorithm for clinical studies.
文摘Early diagnosis of cancer can significantly improve treatment and survival outcomes.Imaging and tissue biopsy are the gold standard diagnostic approaches but are costly,invasive,and often unable to detect early-stage tumors.The past decade has marked an acceleration in the discovery and development of liquid biopsy tests for aiding in the detection of various types of tumor markers in non-tissue samples,such as blood.Liquid biopsy markers include circulating tumor cells,as well as tumor cell fragments,nucleic acids,and proteins.Liquid biopsy may be useful in screening patients considered to be at high risk of developing cancer,for refining diagnosis when combined with other test results,and for early detection of recurrence.Advances in big data analytics,informatics,and artificial intelligence will make it possible to combine patient history,clinical data,and liquid biopsy marker profiles to achieve more accurate and earlier diagnosis.In this review,we summarize the current use of liquid biopsy in cancer care,including the development of multi-analyte panels to improve diagnostic accuracy and detect several cancer types in a single assay.We highlight recent advances for potential future applications of liquid biopsy to aid in the diagnosis of early-stage lung cancer.We also discuss the opportunities and challenges of integrating liquid biopsy into current algorithms for cancer screening and diagnosis.
