Aging is a persistent topic of interest,with skin aging as its most visible manifestation,characterized by a reduction in intact collagen and elastic fibers in the dermis.Hyaluronic acid,a vital component of the extra...Aging is a persistent topic of interest,with skin aging as its most visible manifestation,characterized by a reduction in intact collagen and elastic fibers in the dermis.Hyaluronic acid,a vital component of the extracellular matrix present in the skin,has become a mainstream method for skin rejuvenation through injections.However,the rapid degradation of pure hyaluronic acid,combined with insufficient maintenance duration and often limited therapeutic effects,presents significant challenges for injectable treatments.Additionally,low patient compliance due to discomfort from needles penetrating the dermal layer further complicates its use.In this review,we summarize and compare existing interventions for skin aging,focusing on strategies to prolong the degradation cycle of hyaluronic acid,including variations in cross-linking modalities and injection techniques.We conclude that the injection of cross-linked modified hyaluronic acid via microneedles represents a promising approach to extend the degradation cycle,offering valuable insights for current therapeutic strategies.展开更多
Objective Traditional Chinese medicine(TCM)incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine,Chinese patent medicine,and non-pharmacological methods s...Objective Traditional Chinese medicine(TCM)incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine,Chinese patent medicine,and non-pharmacological methods such as acupuncture and tuina.Even though TCM is used daily by more than 70,000 healthcare facilities and over 700,000 clinical practitioners in China,there is a poor understanding of the extent to which TCM diagnostic methods are used,how different treatment modalities are deployed in general,and what major factors may affect the integration of TCM and Western medicine.This study aimed to fill this void in the literature.Methods In the 2021 National Healthcare Improvement Evaluation Survey,we included three questions gauging the perception and practices of TCM amongst physicians working in TCM-related facilities,investigating the frequency of their deployment of TCM diagnostic methods,and predominant TCM treatment methods.Our empirical analysis included descriptive statistics,intergroup chi-square analysis,and binary logistic regression to examine the association between different types of facilities and individual characteristics and TCM utilization patterns.Results A total of 7618 clinical physicians comprised our study sample.Among them,84.27%have integrated TCM and Western medicine in their clinical practice,and 80.77%of TCM practitioners used the 4 diagnostic methods as a tool in their clinical practice.Chinese herbal medicine was the most widely utilized modality by Chinese TCM physicians(used by 88.49%of respondents),compared with the Chinese patent medicine and non-pharmacological TCM methods,which were used by 73.14%,and 69.39%,respectively.Herbal tea as an out-of-pocket health-maintenance intervention is also a notable practice,recommended by 29.43%of physicians.Significant variations exist across certain institutions,departments,and individual practitioners.Conclusion Given that most of the surveyed physicians integrated TCM with Western medicine in their clinical practices,the practice of“pure TCM”appears to be obsolete in China’s tertiary healthcare institutions.Notably,remarkable variation exists in the use of different TCM modalities across institutions and among individuals,which might be related to and thus limited by the practitioners’experience.Future research focusing on the efficacy and safety of TCM interventions for specific diseases,the development of standardized clinical guidelines,and the enhancement of TCM education and training are called for to optimize TCM-Western medicine integration.展开更多
Acute aortic dissection is a serious condition in elderly patients and may become fatal rapidly if left undiagnosed and untreated. As pointed out by Welch et al1chest radiography is a screening test for this condition...Acute aortic dissection is a serious condition in elderly patients and may become fatal rapidly if left undiagnosed and untreated. As pointed out by Welch et al1chest radiography is a screening test for this condition by detecting these signs such as widening mediastinum,blurring of the aortic knob, left apical cap, etc.展开更多
Cases of obesity are increasing in recentyears,especially in the cities.The mecha-nism ot obesity is the excessive accumulationof fat chiefly in the subcutaneous tissue dueto unnecessary intake of food calories thattr...Cases of obesity are increasing in recentyears,especially in the cities.The mecha-nism ot obesity is the excessive accumulationof fat chiefly in the subcutaneous tissue dueto unnecessary intake of food calories thattransform into fat.The author adopted va-rious modalities for the treatment of 215cases of obesity with good results as re-ported in the following.展开更多
Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities fo...Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X<sup>2</sup> test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.展开更多
Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various...Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.展开更多
Diabetes mellitus is a powerful risk factor of coronary artery disease(CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD...Diabetes mellitus is a powerful risk factor of coronary artery disease(CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterolfor primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome(ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.展开更多
Animals communicate information within their environments via visual, chemical, auditory, and/or tactile modalities. The use of each modalityis generally linked to particular brain regions, but it is not yet known whe...Animals communicate information within their environments via visual, chemical, auditory, and/or tactile modalities. The use of each modalityis generally linked to particular brain regions, but it is not yet known whether the cellular morphology of neurons in these regions has evolved in association with the relative use of a modality.We investigated relationships between the behavioral use of communication modalities and neural morphologies in six lizard species. Two of these species （Anolis carol# nensis and Leiocephalus carinatus） primarily use visual signals to communicate with conspecifics and detect potential prey, and two （Aspidoscelis gularis and Scincella lateralis） communicate and forage primarily using chemical signals. Two other species （Hemidactylus turcicus and Sceloporus olivaceus） use both visual and chemical signals. For each species, we performed beha- vioral observations and quantified rates of visual and chemical behaviors. We then cryosectioned brain tissues from 9-10 males of each species and measured the soma size and density of neurons in two brain regions associated with visual behaviors （the lat- eral geniculate nucleus and the nucleus rotundus） and one region associated with chemical behaviors （the nucleus sphericus）. With analyses conducted in a phylogenetic context, we found that species that performed higher rates of visual displays had a denser lateral geniculate nucleus, and species that used a higher proportion of chemical displays had larger somas in the nucleus sphericus. These relationships suggest that neural morphologies in the brain have evolved convergently in species with similar communication behaviors .展开更多
Epigastric pain is a common symptomusually induced by improper diet(disharmonious temperature effects dam-aging the Spleen and Stomach),emotionalfrustration that stirs up perverted flow ofLiver-qi to disrupt the Stoma...Epigastric pain is a common symptomusually induced by improper diet(disharmonious temperature effects dam-aging the Spleen and Stomach),emotionalfrustration that stirs up perverted flow ofLiver-qi to disrupt the Stomach,or defi-ciency and stagnation of cold in the Spleenand Stomach.Therefore,epigastric pain in-volves the Stomach,the Spleen,and the Liv-er.For treatment,the individual patientsshould be discriminated with respect to thespecific nature of the pain and accom-panying symptoms,and whether the case isone of exuberance or deficiency.展开更多
Thymomas are rare and usually slowly growing tumors, originating from the epithelial layer of the thymus. Prognosis depends on the extent of invasion of adjacent tissues whereby multimodality treatment including surge...Thymomas are rare and usually slowly growing tumors, originating from the epithelial layer of the thymus. Prognosis depends on the extent of invasion of adjacent tissues whereby multimodality treatment including surgery with or without adjuvant chemoradiotherapy is the preferred approach for locally advanced thymomas. For metastatic thymomas, only few chemotherapeutic options are available. We report 2 cases of patients with metastatic thymic malignancies with a dramatic response on pemetrexed treatment. The choice for this antifolate therapy is based upon a small series. Because metastatic thymic neoplasm is a rare disease, large randomised trials are not feasible. Case reports on the treatment of these malignancies are very important and can provide readers with the opportunity to deal with rare dis- eases.展开更多
The recognition of dairy cow behavior is essential for enhancing health management,reproductive efficiency,production performance,and animal welfare.This paper addresses the challenge of modality loss in multimodal da...The recognition of dairy cow behavior is essential for enhancing health management,reproductive efficiency,production performance,and animal welfare.This paper addresses the challenge of modality loss in multimodal dairy cow behavior recognition algorithms,which can be caused by sensor or video signal disturbances arising from interference,harsh environmental conditions,extreme weather,network fluctuations,and other complexities inherent in farm environments.This study introduces a modality mapping completion network that maps incomplete sensor and video data to improve multimodal dairy cow behavior recognition under conditions of modality loss.By mapping incomplete sensor or video data,the method applies a multimodal behavior recognition algorithm to identify five specific behaviors:drinking,feeding,lying,standing,and walking.The results indicate that,under various comprehensive missing coefficients(λ),the method achieves an average accuracy of 97.87%±0.15%,an average precision of 95.19%±0.4%,and an average F1 score of 94.685%±0.375%,with an overall accuracy of 94.67%±0.37%.This approach enhances the robustness and applicability of cow behavior recognition based on multimodal data in situations of modality loss,resolving practical issues in the development of digital twins for cow behavior and providing comprehensive support for the intelligent and precise management of farms.展开更多
The burgeoning field of proximity-inducing modalities has revolutionized antiviral agent development by harnessing the power of molecular proximity to regulate protein-protein or protein-RNA interactions.This review d...The burgeoning field of proximity-inducing modalities has revolutionized antiviral agent development by harnessing the power of molecular proximity to regulate protein-protein or protein-RNA interactions.This review delves into the innovative strategies and breakthroughs in designing antiviral compounds that leverage induced spatial association,a concept with profound implications for both therapeutic applications and fundamental research.We highlight the role of bifunctional molecules in modulating cellular processes to combat viral infections,underscoring their potential within the proximity induction framework.The review encompasses a comprehensive analysis of current applications and future prospects of proximity-inducing molecules in antiviral research,emphasizing their promise for advancing antiviral therapies and infection control strategies.展开更多
BACKGROUND Sarcopenia is prevalent among patients with end-stage liver disease(ESLD)and is associated with adverse outcomes both before and after liver transplantation(LT).Accurate assessment of muscle mass is essenti...BACKGROUND Sarcopenia is prevalent among patients with end-stage liver disease(ESLD)and is associated with adverse outcomes both before and after liver transplantation(LT).Accurate assessment of muscle mass is essential for effective risk stratification and optimization of transplant outcomes.AIM To identify imaging modalities used to assess sarcopenia in ESLD patients awaiting LT,and evaluate the clinical utility of each technique in predicting waitlist mortality,length of hospital stay,and post-transplant survival.METHODS A systematic search was conducted in PubMed,MEDLINE,EMBASE,and Scopus for studies published between May 2015 and May 2025.Eligible studies included original research evaluating sarcopenia using imaging techniques in ESLD patients listed for LT.Due to heterogeneity in study design,diagnostic criteria,and outcomes,data were synthesized qualitatively.RESULTS A total of 17 studies met the inclusion criteria,encompassing modalities such as computed tomography(CT),magnetic resonance imaging,dual-energy X-ray absorptiometry,and ultrasound.CT at the third lumbar vertebra level was most frequently used,exhibiting consistent prognostic values for pre-and post-transplant outcomes.However,considerable variability in cutoff values and sarcopenia definitions was observed.Emerging evidence also supports the prognostic relevance of muscle quality indicators,including muscle attenuation and fat infiltration.CONCLUSION CT and magnetic resonance imaging are the most robust imaging methods for sarcopenia diagnosis in patients with ESLD.Standardized diagnostic criteria incorporating muscle quality metrics are essential for improving prognostic accuracy and guiding clinical decision making in LT candidates.Such integration would also support the development of unified frameworks for sarcopenia assessment in transplantation practice.展开更多
Accurate brain tumour segmentation is critical for diagnosis and treatment planning, yet challenging due to tumour complexity. Manual segmentation is time-consuming and variable, necessitating automated methods. Deep ...Accurate brain tumour segmentation is critical for diagnosis and treatment planning, yet challenging due to tumour complexity. Manual segmentation is time-consuming and variable, necessitating automated methods. Deep learning, particularly 3D U-Net architectures, has revolutionised medical image analysis by leveraging volumetric data to capture spatial context, enhancing segmentation accuracy. This paper reviews brain tumour segmentation methods, emphasising 3D U-Net advancements. We analyse contributions from the Brain Tumour Segmentation (BraTS) challenges (2014-2023), highlighting key improvements and persistent challenges, including tumour heterogeneity, limited annotated data, varied imaging protocols, computational constraints, and model generalisation. Unlike previous reviews, we synthesise these challenges, proposing targeted research directions: enhancing model robustness through domain adaptation and multi-institutional data sharing, developing lightweight architectures for clinical deployment, integrating multi-modal and clinical data, and incorporating explainability techniques to build clinician trust. By addressing these challenges, we aim to guide future research toward developing more robust, generalisable, and clinically applicable segmentation models, ultimately improving patient outcomes in neuro-oncology.展开更多
BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdia...BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdiagnosed or diagnosed in advanced stages,where little can be done to salvage functional vision.The literature suggests that a lack of knowledge is one of the reasons for its grave consequences.Assessment of awareness is the first step in planning management.Several studies have been conducted in the Indian community,but data from healthcare providers,who play a significant role in educating the masses directly or indirectly,are limited.AIM To identify awareness,knowledge,and attitudes about glaucoma among healthcare workers in a tertiary center in India.METHODS This cross-sectional study was conducted at a tertiary care institute in Eastern India.Data were collected from 423 participants by systematic stratified sampling after Institutional Ethics Committee approval via a pretested,self-designed,semistructured,validated questionnaire.Statistical analyses were performed using the Statistical Package for Social Sciences Software v22.0.Continuous variables are expressed as the means±SD for parametric values and medians with interquartile ranges for nonparametric values.The associations between the variables were studied via multivariate linear and logistic regression.P<0.05 was considered statistically significant.RESULTS Most respondents were 20–30 years old(n=345,81.6%).The knowledge regarding glaucoma was good,and almost 56.3%of the participants gained knowledge from their medical training.The majority were aware that it has a familial predisposition and is secondary to high intraocular pressure,leading to irreversible peripheral vision loss.Only 42%knew about the life-long requirements of treatment.The resident group scored highest on knowledgeand attitude-based questions,whereas the faculty group scored highest on practice-based questions.Although 62%of the nursing staff had good attitude scores,their knowledge and practice scores were lower.The occupation group response difference was statistically significant(P<0.05)for all the knowledge-based questions.CONCLUSION Although the majority of healthcare providers are aware of glaucoma,there is a dearth of knowledge about treatment modalities.Education via seminars and media can improve their knowledge,attitudes,and practices.展开更多
To the Editor:Hepatocellular carcinoma(HCC)represents the fifth most com-mon malignancy and the third cancer-related cause of death worldwide[1].Among several treatment modalities for HCC,liver transplantation(LT)is a...To the Editor:Hepatocellular carcinoma(HCC)represents the fifth most com-mon malignancy and the third cancer-related cause of death worldwide[1].Among several treatment modalities for HCC,liver transplantation(LT)is a preferred option for selected patients[2,3],which removes the tumor and targets the underlying liver disease simultaneously.To minimize the incidence of tumor recurrence,the Milan criteria and subsequently a series of expanded criteria such as UCSF and Hangzhou criteria were introduced[4-6].How-ever,tumor recurrence,which was partially ascribed to the im-paired function of antitumor immune responses following LT,still remains a pivotal obscure that hinders long-term survival[7,8].The human liver is characterized by a dual blood supply,with 80%of blood from the portal vein carrying bacterial endotoxin from the gastrointestinal tract.Liver is thus constantly exposed to a large load of intestinal antigens.展开更多
Bruxism, characterized by involuntary clenching or grinding of teeth, affects approximately 10% - 20% of adults globally and has significant implications for dental and systemic health. Emerging AI-driven diagnostic t...Bruxism, characterized by involuntary clenching or grinding of teeth, affects approximately 10% - 20% of adults globally and has significant implications for dental and systemic health. Emerging AI-driven diagnostic tools have demonstrated a 25% improvement in identifying nocturnal bruxism compared to conventional methods. This study explores the etiology, pathogenesis, and treatment modalities of bruxism, integrating cutting-edge advancements like neuromodulation and personalized medicine. Furthermore, socioeconomic factors and access disparities are analyzed to propose comprehensive strategies for improving patient outcomes. Current management strategies include behavioral therapies, orthodontic appliances, pharmacological interventions, physical therapy, and, in severe cases, surgical options. Emerging technologies, such as artificial intelligence, personalized medicine, and neuromodulation, are highlighted as promising advancements in bruxism diagnosis and treatment. Additionally, the study underscores the socioeconomic and ethical dimensions of bruxism care, advocating for interdisciplinary collaboration, patient education, and equitable access to innovative treatments. This research aims to contribute to improved understanding and management of bruxism, enhancing patient outcomes and quality of life.展开更多
基金financial support from several corporate sponsors.Contributions were made by the National Natural Science Foundation of China(Grant No.32071332)Shenzhen Science and Technology Innovation Project(Grant No.JCYJ20210324095802006)+2 种基金Ningbo Bureau of Science and Technology(Grant No.2023Z187)TransEasy Medical Tech.Co.,Ltd.(Grant No.2021114)Shenzhen University MedTech Innovation Fund(2023YG027).
文摘Aging is a persistent topic of interest,with skin aging as its most visible manifestation,characterized by a reduction in intact collagen and elastic fibers in the dermis.Hyaluronic acid,a vital component of the extracellular matrix present in the skin,has become a mainstream method for skin rejuvenation through injections.However,the rapid degradation of pure hyaluronic acid,combined with insufficient maintenance duration and often limited therapeutic effects,presents significant challenges for injectable treatments.Additionally,low patient compliance due to discomfort from needles penetrating the dermal layer further complicates its use.In this review,we summarize and compare existing interventions for skin aging,focusing on strategies to prolong the degradation cycle of hyaluronic acid,including variations in cross-linking modalities and injection techniques.We conclude that the injection of cross-linked modified hyaluronic acid via microneedles represents a promising approach to extend the degradation cycle,offering valuable insights for current therapeutic strategies.
基金The Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences——A Strategic Study on Healthy China Development and Health System Reform(2021-I2M-1-046).
文摘Objective Traditional Chinese medicine(TCM)incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine,Chinese patent medicine,and non-pharmacological methods such as acupuncture and tuina.Even though TCM is used daily by more than 70,000 healthcare facilities and over 700,000 clinical practitioners in China,there is a poor understanding of the extent to which TCM diagnostic methods are used,how different treatment modalities are deployed in general,and what major factors may affect the integration of TCM and Western medicine.This study aimed to fill this void in the literature.Methods In the 2021 National Healthcare Improvement Evaluation Survey,we included three questions gauging the perception and practices of TCM amongst physicians working in TCM-related facilities,investigating the frequency of their deployment of TCM diagnostic methods,and predominant TCM treatment methods.Our empirical analysis included descriptive statistics,intergroup chi-square analysis,and binary logistic regression to examine the association between different types of facilities and individual characteristics and TCM utilization patterns.Results A total of 7618 clinical physicians comprised our study sample.Among them,84.27%have integrated TCM and Western medicine in their clinical practice,and 80.77%of TCM practitioners used the 4 diagnostic methods as a tool in their clinical practice.Chinese herbal medicine was the most widely utilized modality by Chinese TCM physicians(used by 88.49%of respondents),compared with the Chinese patent medicine and non-pharmacological TCM methods,which were used by 73.14%,and 69.39%,respectively.Herbal tea as an out-of-pocket health-maintenance intervention is also a notable practice,recommended by 29.43%of physicians.Significant variations exist across certain institutions,departments,and individual practitioners.Conclusion Given that most of the surveyed physicians integrated TCM with Western medicine in their clinical practices,the practice of“pure TCM”appears to be obsolete in China’s tertiary healthcare institutions.Notably,remarkable variation exists in the use of different TCM modalities across institutions and among individuals,which might be related to and thus limited by the practitioners’experience.Future research focusing on the efficacy and safety of TCM interventions for specific diseases,the development of standardized clinical guidelines,and the enhancement of TCM education and training are called for to optimize TCM-Western medicine integration.
文摘Acute aortic dissection is a serious condition in elderly patients and may become fatal rapidly if left undiagnosed and untreated. As pointed out by Welch et al1chest radiography is a screening test for this condition by detecting these signs such as widening mediastinum,blurring of the aortic knob, left apical cap, etc.
文摘Cases of obesity are increasing in recentyears,especially in the cities.The mecha-nism ot obesity is the excessive accumulationof fat chiefly in the subcutaneous tissue dueto unnecessary intake of food calories thattransform into fat.The author adopted va-rious modalities for the treatment of 215cases of obesity with good results as re-ported in the following.
文摘Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X<sup>2</sup> test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.
基金the grants from National S&T Major Project(2017ZX10203205)the Medical Science and Technology Project of Zhejiang Province(2014KYA082)+1 种基金the Fundamental Research Funds for the Central Universities(2018FZA7002)the Shulan Talent Foundation.
文摘Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.
文摘Diabetes mellitus is a powerful risk factor of coronary artery disease(CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterolfor primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome(ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.
基金We thank the members of the Johnson Lab at Trinity University for assistance in the field and labor- atory - particularly Bonnie Kircher, Alisa Dill, Michelle Ob- emdorf, Adam Silva, Taren Blackmon, Jordan Bush, McKen- zie Quinn, EUee Cook, Grayam Sailor-Tynes, and Collin Shinkle. We also thank David Ribble, Troy Murphy, Jimmy Roberts, Kevin McIntyre, and three reviewers for comments on an earlier version of this work, and Kevin McIntyre and Kimberly Phillips for statistical advice. This work was funded by a Sigma Xi GIAR （to C.D.R.）, a Trinity University Mind Science Foundation grant （to C.D.R.）, Trinity University＇s HHMI and Biology Summer Undergraduate Research Fel- lowships （to C.D.R.）, Texas Ecolab, and the National Science Foundation （IOS 1257021 to M.A.J.）. All procedures were approved by Trinity University＇s Animal Research Committee （protocol # 050213_MAJ2）.
文摘Animals communicate information within their environments via visual, chemical, auditory, and/or tactile modalities. The use of each modalityis generally linked to particular brain regions, but it is not yet known whether the cellular morphology of neurons in these regions has evolved in association with the relative use of a modality.We investigated relationships between the behavioral use of communication modalities and neural morphologies in six lizard species. Two of these species （Anolis carol# nensis and Leiocephalus carinatus） primarily use visual signals to communicate with conspecifics and detect potential prey, and two （Aspidoscelis gularis and Scincella lateralis） communicate and forage primarily using chemical signals. Two other species （Hemidactylus turcicus and Sceloporus olivaceus） use both visual and chemical signals. For each species, we performed beha- vioral observations and quantified rates of visual and chemical behaviors. We then cryosectioned brain tissues from 9-10 males of each species and measured the soma size and density of neurons in two brain regions associated with visual behaviors （the lat- eral geniculate nucleus and the nucleus rotundus） and one region associated with chemical behaviors （the nucleus sphericus）. With analyses conducted in a phylogenetic context, we found that species that performed higher rates of visual displays had a denser lateral geniculate nucleus, and species that used a higher proportion of chemical displays had larger somas in the nucleus sphericus. These relationships suggest that neural morphologies in the brain have evolved convergently in species with similar communication behaviors .
文摘Epigastric pain is a common symptomusually induced by improper diet(disharmonious temperature effects dam-aging the Spleen and Stomach),emotionalfrustration that stirs up perverted flow ofLiver-qi to disrupt the Stomach,or defi-ciency and stagnation of cold in the Spleenand Stomach.Therefore,epigastric pain in-volves the Stomach,the Spleen,and the Liv-er.For treatment,the individual patientsshould be discriminated with respect to thespecific nature of the pain and accom-panying symptoms,and whether the case isone of exuberance or deficiency.
文摘Thymomas are rare and usually slowly growing tumors, originating from the epithelial layer of the thymus. Prognosis depends on the extent of invasion of adjacent tissues whereby multimodality treatment including surgery with or without adjuvant chemoradiotherapy is the preferred approach for locally advanced thymomas. For metastatic thymomas, only few chemotherapeutic options are available. We report 2 cases of patients with metastatic thymic malignancies with a dramatic response on pemetrexed treatment. The choice for this antifolate therapy is based upon a small series. Because metastatic thymic neoplasm is a rare disease, large randomised trials are not feasible. Case reports on the treatment of these malignancies are very important and can provide readers with the opportunity to deal with rare dis- eases.
基金supported by the National Key Research and Development Program of China(Grand No.2023YFD2000700)“Supported by the earmarked fund for CARS(CARS-36)”the Key Research and Development Program of Heilongjiang Province of China(Grant No.2022ZX01A24).
文摘The recognition of dairy cow behavior is essential for enhancing health management,reproductive efficiency,production performance,and animal welfare.This paper addresses the challenge of modality loss in multimodal dairy cow behavior recognition algorithms,which can be caused by sensor or video signal disturbances arising from interference,harsh environmental conditions,extreme weather,network fluctuations,and other complexities inherent in farm environments.This study introduces a modality mapping completion network that maps incomplete sensor and video data to improve multimodal dairy cow behavior recognition under conditions of modality loss.By mapping incomplete sensor or video data,the method applies a multimodal behavior recognition algorithm to identify five specific behaviors:drinking,feeding,lying,standing,and walking.The results indicate that,under various comprehensive missing coefficients(λ),the method achieves an average accuracy of 97.87%±0.15%,an average precision of 95.19%±0.4%,and an average F1 score of 94.685%±0.375%,with an overall accuracy of 94.67%±0.37%.This approach enhances the robustness and applicability of cow behavior recognition based on multimodal data in situations of modality loss,resolving practical issues in the development of digital twins for cow behavior and providing comprehensive support for the intelligent and precise management of farms.
基金supported by the Key Research and Development Program,Ministry of Science and Technology of China(2023YFC2606500)the Shandong Laboratory Program(SYS202205)+1 种基金the China Postdoctoral Science Foundation(2024M761823)supported by the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health&Welfare,Republic of Korea(HI22C2067 to Meehyein Kim)。
文摘The burgeoning field of proximity-inducing modalities has revolutionized antiviral agent development by harnessing the power of molecular proximity to regulate protein-protein or protein-RNA interactions.This review delves into the innovative strategies and breakthroughs in designing antiviral compounds that leverage induced spatial association,a concept with profound implications for both therapeutic applications and fundamental research.We highlight the role of bifunctional molecules in modulating cellular processes to combat viral infections,underscoring their potential within the proximity induction framework.The review encompasses a comprehensive analysis of current applications and future prospects of proximity-inducing molecules in antiviral research,emphasizing their promise for advancing antiviral therapies and infection control strategies.
文摘BACKGROUND Sarcopenia is prevalent among patients with end-stage liver disease(ESLD)and is associated with adverse outcomes both before and after liver transplantation(LT).Accurate assessment of muscle mass is essential for effective risk stratification and optimization of transplant outcomes.AIM To identify imaging modalities used to assess sarcopenia in ESLD patients awaiting LT,and evaluate the clinical utility of each technique in predicting waitlist mortality,length of hospital stay,and post-transplant survival.METHODS A systematic search was conducted in PubMed,MEDLINE,EMBASE,and Scopus for studies published between May 2015 and May 2025.Eligible studies included original research evaluating sarcopenia using imaging techniques in ESLD patients listed for LT.Due to heterogeneity in study design,diagnostic criteria,and outcomes,data were synthesized qualitatively.RESULTS A total of 17 studies met the inclusion criteria,encompassing modalities such as computed tomography(CT),magnetic resonance imaging,dual-energy X-ray absorptiometry,and ultrasound.CT at the third lumbar vertebra level was most frequently used,exhibiting consistent prognostic values for pre-and post-transplant outcomes.However,considerable variability in cutoff values and sarcopenia definitions was observed.Emerging evidence also supports the prognostic relevance of muscle quality indicators,including muscle attenuation and fat infiltration.CONCLUSION CT and magnetic resonance imaging are the most robust imaging methods for sarcopenia diagnosis in patients with ESLD.Standardized diagnostic criteria incorporating muscle quality metrics are essential for improving prognostic accuracy and guiding clinical decision making in LT candidates.Such integration would also support the development of unified frameworks for sarcopenia assessment in transplantation practice.
文摘Accurate brain tumour segmentation is critical for diagnosis and treatment planning, yet challenging due to tumour complexity. Manual segmentation is time-consuming and variable, necessitating automated methods. Deep learning, particularly 3D U-Net architectures, has revolutionised medical image analysis by leveraging volumetric data to capture spatial context, enhancing segmentation accuracy. This paper reviews brain tumour segmentation methods, emphasising 3D U-Net advancements. We analyse contributions from the Brain Tumour Segmentation (BraTS) challenges (2014-2023), highlighting key improvements and persistent challenges, including tumour heterogeneity, limited annotated data, varied imaging protocols, computational constraints, and model generalisation. Unlike previous reviews, we synthesise these challenges, proposing targeted research directions: enhancing model robustness through domain adaptation and multi-institutional data sharing, developing lightweight architectures for clinical deployment, integrating multi-modal and clinical data, and incorporating explainability techniques to build clinician trust. By addressing these challenges, we aim to guide future research toward developing more robust, generalisable, and clinically applicable segmentation models, ultimately improving patient outcomes in neuro-oncology.
文摘BACKGROUND Glaucoma is the leading cause of irreversible blindness worldwide,with 60.5 million affected individuals,of whom 11 million are from India.Due to its asymptomatic nature,the disease largely remains underdiagnosed or diagnosed in advanced stages,where little can be done to salvage functional vision.The literature suggests that a lack of knowledge is one of the reasons for its grave consequences.Assessment of awareness is the first step in planning management.Several studies have been conducted in the Indian community,but data from healthcare providers,who play a significant role in educating the masses directly or indirectly,are limited.AIM To identify awareness,knowledge,and attitudes about glaucoma among healthcare workers in a tertiary center in India.METHODS This cross-sectional study was conducted at a tertiary care institute in Eastern India.Data were collected from 423 participants by systematic stratified sampling after Institutional Ethics Committee approval via a pretested,self-designed,semistructured,validated questionnaire.Statistical analyses were performed using the Statistical Package for Social Sciences Software v22.0.Continuous variables are expressed as the means±SD for parametric values and medians with interquartile ranges for nonparametric values.The associations between the variables were studied via multivariate linear and logistic regression.P<0.05 was considered statistically significant.RESULTS Most respondents were 20–30 years old(n=345,81.6%).The knowledge regarding glaucoma was good,and almost 56.3%of the participants gained knowledge from their medical training.The majority were aware that it has a familial predisposition and is secondary to high intraocular pressure,leading to irreversible peripheral vision loss.Only 42%knew about the life-long requirements of treatment.The resident group scored highest on knowledgeand attitude-based questions,whereas the faculty group scored highest on practice-based questions.Although 62%of the nursing staff had good attitude scores,their knowledge and practice scores were lower.The occupation group response difference was statistically significant(P<0.05)for all the knowledge-based questions.CONCLUSION Although the majority of healthcare providers are aware of glaucoma,there is a dearth of knowledge about treatment modalities.Education via seminars and media can improve their knowledge,attitudes,and practices.
基金supported by grants from the National Natural Science Foundation of China(82300742)Zhejiang Provincial Natural Science Foundation of China(LQ22H160052).
文摘To the Editor:Hepatocellular carcinoma(HCC)represents the fifth most com-mon malignancy and the third cancer-related cause of death worldwide[1].Among several treatment modalities for HCC,liver transplantation(LT)is a preferred option for selected patients[2,3],which removes the tumor and targets the underlying liver disease simultaneously.To minimize the incidence of tumor recurrence,the Milan criteria and subsequently a series of expanded criteria such as UCSF and Hangzhou criteria were introduced[4-6].How-ever,tumor recurrence,which was partially ascribed to the im-paired function of antitumor immune responses following LT,still remains a pivotal obscure that hinders long-term survival[7,8].The human liver is characterized by a dual blood supply,with 80%of blood from the portal vein carrying bacterial endotoxin from the gastrointestinal tract.Liver is thus constantly exposed to a large load of intestinal antigens.
文摘Bruxism, characterized by involuntary clenching or grinding of teeth, affects approximately 10% - 20% of adults globally and has significant implications for dental and systemic health. Emerging AI-driven diagnostic tools have demonstrated a 25% improvement in identifying nocturnal bruxism compared to conventional methods. This study explores the etiology, pathogenesis, and treatment modalities of bruxism, integrating cutting-edge advancements like neuromodulation and personalized medicine. Furthermore, socioeconomic factors and access disparities are analyzed to propose comprehensive strategies for improving patient outcomes. Current management strategies include behavioral therapies, orthodontic appliances, pharmacological interventions, physical therapy, and, in severe cases, surgical options. Emerging technologies, such as artificial intelligence, personalized medicine, and neuromodulation, are highlighted as promising advancements in bruxism diagnosis and treatment. Additionally, the study underscores the socioeconomic and ethical dimensions of bruxism care, advocating for interdisciplinary collaboration, patient education, and equitable access to innovative treatments. This research aims to contribute to improved understanding and management of bruxism, enhancing patient outcomes and quality of life.
