The objective of this study is to determine the auditory gain, quality of life, audiological benefits, in bone-anchored hearing device users (BAHA). It is a retrospective and concurrent evaluation of thirty patients f...The objective of this study is to determine the auditory gain, quality of life, audiological benefits, in bone-anchored hearing device users (BAHA). It is a retrospective and concurrent evaluation of thirty patients fitted unilaterally and seven fitted bilaterally for at least six months. Patients were assessed with audiometric testing and application of Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB). Regarding sound-field pure audiometry results, we found a statistically significant gain in all frequencies using the bone-anchored device. APHAB scores showed statistically significant subjective audiological gains in all subscales except for the aversiveness subscale. GBI mean scores for all items in both groups were all above 3, suggesting quality of life improvement in conductive and mixed hearing loss patients. BP100 users showed a greater clinical gain in the APHAB global score and subscales compared with Divino users. In conclusion the BAHA provides significant auditory gain, subjective audiological benefits and improves quality of life in all BAHA users. This study shows a significant clinical and statistical benefit of BAHA measured by audiometric testing and by the APHAB and GBI questionnaires.展开更多
Aging is a physiological and complex process produced by accumulative age-dependent cellular damage,which significantly impacts brain regions like the hippocampus,an essential region involved in memory and learning.A ...Aging is a physiological and complex process produced by accumulative age-dependent cellular damage,which significantly impacts brain regions like the hippocampus,an essential region involved in memory and learning.A crucial factor contributing to this decline is the dysfunction of mitochondria,particularly those located at synapses.Synaptic mitochondria are specialized organelles that produce the energy required for synaptic transmission but are also important for calcium homeostasis at these sites.In contrast,non-synaptic mitochondria primarily involve cellular metabolism and long-term energy supply.Both pools of mitochondria differ in their form,proteome,functionality,and cellular role.The proper functioning of synaptic mitochondria depends on processes such as mitochondrial dynamics,transport,and quality control.However,synaptic mitochondria are particularly vulnerable to age-associated damage,characterized by oxidative stress,impaired energy production,and calcium dysregulation.These changes compromise synaptic transmission,reducing synaptic activity and cognitive decline during aging.In the context of neurodegenerative diseases such as Alzheimer’s,Parkinson’s,and Huntington’s,the decline of synaptic mitochondrial function is even more pronounced.These diseases are marked by pathological protein accumulation,disrupted mitochondrial dynamics,and heightened oxidative stress,accelerating synaptic dysfunction and neuronal loss.Due to their specialized role and location,synaptic mitochondria are among the first organelles to exhibit dysfunction,underscoring their critical role in disease progression.This review delves into the main differences at structural and functional levels between synaptic and non-synaptic mitochondria,emphasizing the vulnerability of synaptic mitochondria to the aging process and neurodegeneration.These approaches highlight the potential of targeting synaptic mitochondria to mitigate age-associated cognitive impairment and synaptic degeneration.This review emphasizes the distinct vulnerabilities of hippocampal synaptic mitochondria,highlighting their essential role in sustaining brain function throughout life and their promise as therapeutic targets for safeguarding the cognitive capacities of people of advanced age.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
Impairments on body function,activities of daily living(ADL)and cognition are common after stroke.Eccentric resistance training(ERT)may be implemented to improve them.The primary objectives were to evaluate whether ER...Impairments on body function,activities of daily living(ADL)and cognition are common after stroke.Eccentric resistance training(ERT)may be implemented to improve them.The primary objectives were to evaluate whether ERT improves body function,ADL and cognition after stroke.The secondary objectives were to evaluate whether ERT improves strength,gait,quality of life,and self-perceived health.Seven electronic databases were searched:Cochrane Central Register of Controlled Trials,Cochrane Stroke Group Trials Register,PubMed,Epistemonikos,Embase,SPORTDiscus,and WHO International Clinical Trials Registry Platform.Last search was run in December 2023,including studies since 2012.Selection criteria were studies with stroke participants of both sexes,aged 18 or more,with an intervention based on ERT.Accepted languages were English,Spanish or French.First search was done in pairs.Authors removed duplicate studies and those which did not meet inclusion criteria through title and abstracts.Finally,all authors,independently,screened the final search results and extracted data.Of 68 records identified,15 were eligible and 6 were finally included(with moderate risk of bias),analyzing 159 participants.Body function(4 interventions,n=84),gait(4 interventions,n=115)and strength(3 interventions,n?78)showed significantly better results when ERT was performed.Meta-analysis could not be done because of the few studies and their heterogeneity.This review provided low-moderate quality evidence suggesting that ERT might be effective at improving body function,strength,and gait after stroke.Besides,no harm was documented,and it was well-accepted.展开更多
BACKGROUND Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all ...BACKGROUND Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all age groups,but its prevalence increases with age.Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context,res-pectively.Surgical valve replacement(or mitral valve repair)is the standard of care for treating heart valve disease.However,the replacement of a prosthetic heart valve can lead to complications,either in the peri-procedural phase or in the long-term follow-up period.CASE SUMMARY We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy.She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology.A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs.Furthermore,a possible microthrombotic lesion was suspected.Therefore,systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.CONCLUSION This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.展开更多
BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ trans...BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ transplantation.AIM To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.METHODS A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses.This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents(prophylactic or therapeutic)aimed at preventing antimicrobial resistance.The search strategy involved analyzing multiple databases,including PubMed/MEDLINE,Web of Science,Embase,Scopus,and SciELO,as well as examining gray literature sources on Google Scholar.A comprehensive electronic database search was conducted from the databases’inception until May 2024,with no language restrictions.RESULTS After the final phase of the eligibility assessment,this systematic review ultimate-ly included 7 articles.A total of 2318 patients were studied.The most studied microorganisms were cytomegalovirus,although vancomycinresistant enterococci,Clostridioides difficile,and multidrug-resistant Enterobacterales were also analyzed.The antimicrobials used in the interventions were mainly maribavir,valganciclovir,gancic-lovir,and colistin-neomycin.Of concern,all clinical trials showed significant proportions of resistant microorga-nisms after the interventions,with no statistically significant differences between the groups(mean resistance 13.47%vs 14.39%),except for two studies that demonstrated greater efficacy of maribavir and valganciclovir(mean resistance 22.2%vs 41.1%in the control group;P<0.05).The total reported deaths in three clinical trials were 75,and there were 24 graft rejections in two studies.CONCLUSION All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions.More high-quality randomized clinical trials are needed to corroborate these results.展开更多
BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hi...BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.展开更多
BACKGROUND Despite advances in the treatment of ulcerative colitis(UC),some patients remain refractory to the currently available treatments.Dual biologic therapy(DBT)has emerged as a promising strategy for these pati...BACKGROUND Despite advances in the treatment of ulcerative colitis(UC),some patients remain refractory to the currently available treatments.Dual biologic therapy(DBT)has emerged as a promising strategy for these patients.CASE SUMMARY A patient with extensive UC presented with steroid dependence and contraindications(past medical history included breast cancer and previous myocardial infarction)to treatment with tumor necrosis factor and Janus kinase inhibitors.DBT ofα4β7 integrin antagonist(vedolizumab)and interleukin 23p19 inhibitor(mirikizumab)resulted in a sustained clinical and biochemical remission.No adverse events were recorded during the follow-up.CONCLUSION This case highlighted the challenge of managing refractory UC,especially in frail patients.展开更多
BACKGROUND Severe alcoholic hepatitis(SAH)carries a 90-day mortality rate approaching 50%.Management includes corticosteroids,nutritional support,and early liver transplantation in selected cases.However,the mid-term ...BACKGROUND Severe alcoholic hepatitis(SAH)carries a 90-day mortality rate approaching 50%.Management includes corticosteroids,nutritional support,and early liver transplantation in selected cases.However,the mid-term impact of available therapies remains unclear.This systematic review provides a critical evaluation of treatments for SAH,specifically focusing on survival or mortality at 90 days as an essential window that captures short-and mid-term outcomes.The 90-day window is clinically significant,as it reflects the remission of systemic inflam-mation,early liver recovery,and minimizes confounding long-term behaviors such as alcohol relapse.AIM To review the effect of different treatments for SAH on survival and mortality at 90 days.METHODS A systematic search of PubMed and EMBASE(last updated March 2025)was performed without language restrictions,focusing on studies published in the last decade.Study selection and data extraction were performed independently by at least two reviewers.Risk of bias was assessed using RoB 2.0 and Risk-of Bias in Non-Randomized Studies of Interventions tools.Due to heterogeneity in study designs and interventions,a meta-analysis was not feasible.A qualitative synthesis was conducted using narrative summaries and evidence tables.RESULTS Searches in the databases yielded 645 citations in PubMed and 1516 in EMBASE.Of these 2161 studies,618 were duplicates and therefore removed.A total of eight studies were included in qualitative synthesis.Among the included publications,six were randomized control trials(RCT)and two were retrospective cohort studies.These studies evaluated 90-day mortality or survival in SAH patients treated with corticosteroids(n=2),pentoxifylline(n=1),anakinra plus zinc(n=2),granulocyte colony-stimulating factor(n=1),amoxicillin-clavulanate(n=1),fecal microbiota transplantation(n=1)or extracorporeal liver assist device(n=1).While most studies were conducted in Western countries,two had a global scope.CONCLUSION Steroids remain the first-line therapy for SAH despite reports of them not having any 90-day survival benefit.These results highlight the need for multicenter,biomarker-guided RCTs evaluating emerging treatments to improve mid-term survival in SAH.展开更多
BACKGROUND Cancer incidence remains a global challenge.The World Health Organization reported 19976499 new cases in 2022,including 1551060 in Latin America and the Caribbean.While chemotherapy advances have improved s...BACKGROUND Cancer incidence remains a global challenge.The World Health Organization reported 19976499 new cases in 2022,including 1551060 in Latin America and the Caribbean.While chemotherapy advances have improved survival,these treatments carry significant risks,particularly cardiovascular complications impacting morbidity and mortality.Early cardiotoxicity detection enables targeted interventions,guiding clinical decisions on treatment adjustments to mitigate damage and preserve function.Cardiac imaging and biomarkers assess cardiotoxicity before,during,and after therapy.Despite their importance,the lack of a structured multidisciplinary program hinders early detection and management in high-risk patients.AIM To evaluate the use of diagnostic tools for monitoring cardiotoxicity in cancer patients receiving high-risk chemotherapy at the National University Hospital of Colombia.METHODS This observational,retrospective cohort study included patients aged≥18 with cancer treated with potentially cardiotoxic chemotherapy at the National University Hospital of Colombia(2016-2019).Data from medical records included demographics,comorbidities,biomarkers,and echocardiographic parameters.Cardiotoxicity was defined by reduced left ventricular ejection fraction(LVEF)using Simpson’s method and biomarker abnormalities.Statistical analysis included descriptive methods to compare pre-and post-chemotherapy use of biomarkers and echocardiographic parameters.RESULTS From a total of 195 patients analyzed,8.7%(n=17)developed cardiotoxicity,predominantly mild(58.8%,n=10).Affected patients were mostly male(64.7%,n=11)with a mean age of 51.88±15.9 years.The median LVEF declined from 62%[interquartile range(IQR):58%–66%]at baseline to 46%(IQR:34%–56%)post-treatment.STRAIN longitudinal values also significantly decreased,from-18.38±4.62%at baseline to-14.22±4.93%posttreatment.Troponin was measured in 58.8%(n=10)of cardiotoxicity cases,while ProBNP was less frequently used(17.6%,n=3).CONCLUSION This study highlights the utility of echocardiography and biomarkers in assessing cardiotoxicity in oncology patients,emphasizing the need for standardized protocols to optimize early diagnosis and management.However,the retrospective nature of the study and the insufficient use of biomarkers may limit the generalizability of the findings.展开更多
This article evaluates the transformative potential of large language models(LLMs)as patient education tools for managing inflammatory bowel disease.The discussion highlights their ability to deliver nuanced and perso...This article evaluates the transformative potential of large language models(LLMs)as patient education tools for managing inflammatory bowel disease.The discussion highlights their ability to deliver nuanced and personalized infor-mation,addressing limitations in traditional educational materials.Key consider-ations include the necessity for domain-specific fine-tuning to enhance accuracy,the adoption of robust evaluation metrics beyond readability,and the integration of LLMs with clinical decision support systems to improve real-time patient education.Ethical and accessibility challenges,such as algorithmic bias,data privacy,and digital literacy,are also examined.Recommendations emphasize the importance of interdisciplinary collaboration to optimize LLM integration,en-suring equitable access and improved patient outcomes.By advancing LLM technology,healthcare can empower patients with accurate and personalized information,enhancing engagement and disease management.展开更多
BACKGROUND Colorectal cancer is the third most common malignancy globally,with the liver being the predominant site of metastatic disease.AIM To evaluate safety,feasibility,and outcomes of robotic liver resection(RLR)...BACKGROUND Colorectal cancer is the third most common malignancy globally,with the liver being the predominant site of metastatic disease.AIM To evaluate safety,feasibility,and outcomes of robotic liver resection(RLR)versus laparoscopic liver resection(LLR)and open liver resection(OLR)for colorectal metastasis(CRLM).METHODS This study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Systematic searches in PubMed,EMBASE,Scopus,and Cochrane Library identified comparative and noncomparative reviews evaluating RLR versus LLR or OLR for CRLM.Two independent reviewers screened studies using predefined PICO(Population,Intervention,Comparator,Outcome)criteria,with data extraction focusing on conversion rates,operative outcomes,morbidity,mortality,and survival.Methodological quality was assessed via Assessment of Multiple Systematic Reviews 2.Pooled analyses were performed for comparative data;noncomparative studies were narratively synthesized.RESULTS Pooled evidence from two comparative systematic reviews(9792 patients)demonstrated that RLR offers distinct advantages over LLR and OLR,including significantly lower conversion rates(4.7%–6.7%vs 10.4%–12.4%,P<0.001)and reduced intraoperative blood loss(190.8–266.8 mL vs 283.9–294.3 mL,P<0.001)despite longer operating times(mean 304.1 vs 191.8 min).Perioperative safety and oncologic outcomes(R0 resection>82%;5-year overall survival:53.1%–60.8%)were comparable across approaches.Three additional noncomparative reviews(n=274)highlighted the technical practicability of RLR in complex cases(zero conversions in small cohorts,median 399.5 min for simultaneous resections).However,these findings were not included in pooled analyses due to the lack of comparator groups.Noncomparative data(n=274)revealed higher upfront costs for RLR due to prolonged operating times(median 399.5 min)and the need for expensive equipment;however,no formal cost comparisons were available.CONCLUSION RLR is a safe and feasible alternative to LLR and OLR for CRLM,demonstrating superior technical performance and comparable short-term outcomes.展开更多
With gastric cancer ranking among the most prevalent and deadly malignancies worldwide,early detection and individualized prognosis remain essential for improving patient outcomes.This letter discusses recent advancem...With gastric cancer ranking among the most prevalent and deadly malignancies worldwide,early detection and individualized prognosis remain essential for improving patient outcomes.This letter discusses recent advancements in arti-ficial intelligence(AI)-driven predictive tools for gastric cancer,emphasizing a computed tomography-based radiomic model that achieved a predictive accuracy of area under the curve of 0.893 for treatment response in advanced cases undergoing neoadjuvant immunochemotherapy.AI offers promising avenues for predictive accuracy and personalized treatment planning in gastric oncology.Additionally,this letter highlights the comparison of these AI tools with tra-ditional methodologies,demonstrating their potential to streamline clinical workflows and address existing gaps in risk stratification and early detection.Furthermore,this letter addresses the ethical considerations and the need for robust clinical-AI collaboration to achieve reliable,transparent,and unbiased outcomes.Strengthening cross-disciplinary efforts will be vital for the responsible and effective deployment of AI in this critical area of oncology.展开更多
Purpose:This paper focuses on scientific journals’policies on open access and open science.The subject has gained increasing relevance,driven by the need for more-democratic access to knowledge and improved research ...Purpose:This paper focuses on scientific journals’policies on open access and open science.The subject has gained increasing relevance,driven by the need for more-democratic access to knowledge and improved research visibility,which require eliminating the financial,legal,and technical barriers that restrict access to scientific output.Design/methodology/approach:This paper uses the findings of FECYT’s 2023 Assessment of the Editorial and Scientific Quality of Spanish Scientific Journals,with 254 participating journals,as its case study.Open science indicators assess the transparency of policies on content access,reuse,openness,and reproducibility.Nonparametric tests analyse the relationship between the indicators and the dimensions of publisher type and subject area.Findings:High compliance rates are found for indicators related to publication licences and intellectual property rights.Only 37%of the journals examined post their editorial policy on Sherpa Romeo.Ninety-four percent publish open access.However,open peer review is rarely applied(0.38%of the journals).Journals in Communication,Information and Scientific Documentation,Fine Arts,Education Science,and Biomedical Sciences have high compliance percentages.Most journals(83%)are institutional,with universities and associations generally exhibiting better results.Research limitations:This study is based on specific indicators that do not cover all the factors that influence the transition toward open science;for example,editorial culture and technological infrastructure are not envisaged.Furthermore,differences in open science implementation are identified between disciplinary areas and between publisher types,but the underlying causes of these differences are not thoroughly investigated.Future research could address these points for a fuller understanding.Practical implications:This study highlights the need for journals to improve transparency by adopting open peer review and clear policies.These changes enhance accessibility and credibility,fostering inclusive knowledge dissemination.Institutions and policymakers should support these efforts to boost research impact.Originality/value:This study offers insights into open science practices in Spanish journals,a growing academic topic.Its originality lies in examining open science indicators across disciplines and publishers.By identifying strengths and gaps,the study helps journals enhance transparency.展开更多
BACKGROUND Approval of teduglutide is an important addition to the limited treatment options for short bowel syndrome(SBS).However,real-world evidence on teduglutide therapy for SBS in Latin America is scarce.AIM To i...BACKGROUND Approval of teduglutide is an important addition to the limited treatment options for short bowel syndrome(SBS).However,real-world evidence on teduglutide therapy for SBS in Latin America is scarce.AIM To investigate the effectiveness and safety of teduglutide in clinical practice in Argentina with a 24-week follow-up.METHODS This non-interventional multicentre cohort study included consecutive patients(aged≥1 years)with SBS who were dependent on parenteral support(PS)and received≥1 dose of teduglutide according to currently approved indications.RESULTS The study population(n=45)included 21 adult and 24 pediatric patients.The proportion of adult and pediatric patients who showed clinical response(defined as a≥20%reduction in weekly PS volume)after 24 weeks of treatment was 90.4%[95%confidence interval(CI):69.6%-98.8%]and 83.3%(95%CI:62.6%-95.2%),respectively.Overall,12 patients(26.6%;95%CI:14.6-41.9)were weaned from PS support at the 24-week assessment,6(28.5%;95%CI:11.5-52.1)in the adult cohort,and 6(25%;95%CI:9.7-46.7)in the pediatric cohort.Only baseline PS requirement was inversely associated with weaning from PS(P=0.025).The most frequently reported treatmentemergent adverse events(TEAEs)were mild to moderate abdominal pain and abdominal distension(16.6%;and 9.5%,respectively).None of the reported TEAEs led to treatment discontinuation.CONCLUSION This prospective real-world study demonstrated the effectiveness and safety of teduglutide in adult and pediatric patients with SBS in Argentina.The clinical response observed in both adults and pediatric patients was greater than that reported in phase 3 trials and was consistent with the results of other real-world studies.展开更多
Acute-on-chronic liver failure(ACLF) is increasingly recognized as a complex syndrome that is reversiblein many cases. It is characterized by an acute deterioration of liver function in the background of a pre-existin...Acute-on-chronic liver failure(ACLF) is increasingly recognized as a complex syndrome that is reversiblein many cases. It is characterized by an acute deterioration of liver function in the background of a pre-existing chronic liver disease often associated with a high short-term mortality rate. Organ failure(OF) is always associated, and plays a key role in determining the course, and the outcome of the disease. The definition of ACLF remains controversial due to its overall ambiguity, with several disparate criteria among various associations dedicated to the study of liver diseases. Although the precise pathogenesis needs to be clarified, it appears that an altered host response to injury might be a contributing factor caused by immune dysfunction, ultimately leading to a pro-inflammatory status, and eventually to OF. The PIRO concept(Predisposition, Insult, Response and Organ Failure) has been proposed to better approach the underlying mechanisms. It is accepted that ACLF is a different and specific form of liver failure, where a precipitating event is always involved, even though it cannot always be ascertained. According to several studies, infections and active alcoholism often trigger ACLF. Viral hepatitis, gastrointestinal haemorrhage, or drug induced liver injury, which can also provoke the syndrome. This review mainly focuses on the physiopathology and prognostic aspects. We believe these features are essential to further understanding and providing the rationale for improveddisease management strategies.展开更多
Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic ...Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging mo-dalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.展开更多
The extensive use of imaging techniques in differential diagnosis of abdominal conditions and screening of hepatocellular carcinoma in patients with chronic hepatic diseases,has led to an important increase in identif...The extensive use of imaging techniques in differential diagnosis of abdominal conditions and screening of hepatocellular carcinoma in patients with chronic hepatic diseases,has led to an important increase in identification of focal liver lesions.The development of contrastenhanced ultrasound(CEUS) opens a new window in the diagnosis and follow-up of these lesions.This technique offers obvious advantages over the computed tomography and magnetic resonance,without a decrease in its sensitivity and specificity.The new second generation contrast agents,due to their intravascular distribution,allow a continuous evaluation of the enhancement pattern,which is crucial in characterization of liver lesions.The dual blood supply in the liver shows three different phases,namely arterial,portal and late phases.The enhancement during portal and late phases can give important information about the lesion's behavior.Each liver lesion has a different enhancement pattern that makes possible an accurate approach to their diagnosis.The role of emerging techniques as a contrastenhanced three-dimensional US is also discussed.In this article,the advantages,indications and technique employed during CEUS and the different enhancement patterns of most benign and malignant focal liver lesions are discussed.展开更多
AIM:To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae.METHODS:Under controlled circumstances,and approved by European and Spanish laws,a Compassionat...AIM:To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae.METHODS:Under controlled circumstances,and approved by European and Spanish laws,a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae.Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae,and presented symptomatic recurrence.The intervention consisted of limited surgery(with closure of the internal opening),followed by local implant of stem cells in the fistula-tract wall.Autologous expanded adipose-derived stem cells were the main cell type selected for implant.The first evaluation was performed on the 8th postoperative week;outcome was classified as response or partial response.Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved.RESULTS:Ten patients(8 male)with highly recurrent and complex fistulae were treated(mean age:49years,range:28-76 years).Seven cases were nonCrohn’s fistulae,and three were Crohn’s-associated fistulae.Previous surgical attempts ranged from 3to 12.Two patients presented with preoperative incontinence(Wexner scores of 12 and 13 points).After the intervention,six patients showed clinical response on the 8th postoperative week,with a complete cessation of suppuration from the fistula.Three patients presented a partial response,with an evident decrease in suppuration.A year later,six patients(60%)remained healed,with complete reepithelization of the external opening.Postoperative Wexner Scores were 0 in six cases.The two patients with previous incontinence improved their scores from12 to 8 points and from 13 to 5 points.No adverse reactions or complications related to stem-cell therapy were reported during the study period.CONCLUSION:Stem cells are safe and useful for treating anal fistulae.Healing can be achieved in severe cases,sparing fecal incontinence risk,and improving previous scoring.展开更多
There is evidence supporting the hypothesis that inflammation participates in providing conditions that lead to cancer.An unresolved inflammation due to any failure in the precise control of the immune response can co...There is evidence supporting the hypothesis that inflammation participates in providing conditions that lead to cancer.An unresolved inflammation due to any failure in the precise control of the immune response can continue to perturb the cellular microenvironment, thereby leading to alterations in cancer-related genes and posttranslational modification in crucial cellular proteins involved in the cell cycle,DNA repair and apoptosis.In addition,there are data indicating that inflammatory cells and immunomodulatory mediators present in the tumor microenvironment influence tumor progression and metastasis.Historically,tumor-infiltrating leukocytes have been considered to be manifestations of an intrinsic defence mechanism against developing tumors.However,increasing evidence indicates that leukocyte infiltration can promote tumor phenotypes, such as angiogenesis,growth and invasion.This may be due to inflammatory cells that probably can influence cancer promotion by secreting cytokines,growth factors,chemokines and proteases,which stimulate proliferation and invasiveness of cancer cells.Conse-quently,events and molecules implicated in this cross talk between the tumor microenvironment and inflam- matory process may emerge as attractive targets in anticancer therapeutic interventions with significant clinical impact.展开更多
文摘The objective of this study is to determine the auditory gain, quality of life, audiological benefits, in bone-anchored hearing device users (BAHA). It is a retrospective and concurrent evaluation of thirty patients fitted unilaterally and seven fitted bilaterally for at least six months. Patients were assessed with audiometric testing and application of Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB). Regarding sound-field pure audiometry results, we found a statistically significant gain in all frequencies using the bone-anchored device. APHAB scores showed statistically significant subjective audiological gains in all subscales except for the aversiveness subscale. GBI mean scores for all items in both groups were all above 3, suggesting quality of life improvement in conductive and mixed hearing loss patients. BP100 users showed a greater clinical gain in the APHAB global score and subscales compared with Divino users. In conclusion the BAHA provides significant auditory gain, subjective audiological benefits and improves quality of life in all BAHA users. This study shows a significant clinical and statistical benefit of BAHA measured by audiometric testing and by the APHAB and GBI questionnaires.
基金supported by ANID FONDECYT No.1221178Centro Ciencia&Vida,FB210008,Financiamiento Basal para Centros Científicos y Tecnológicos de Excelencia de ANID to CTR.
文摘Aging is a physiological and complex process produced by accumulative age-dependent cellular damage,which significantly impacts brain regions like the hippocampus,an essential region involved in memory and learning.A crucial factor contributing to this decline is the dysfunction of mitochondria,particularly those located at synapses.Synaptic mitochondria are specialized organelles that produce the energy required for synaptic transmission but are also important for calcium homeostasis at these sites.In contrast,non-synaptic mitochondria primarily involve cellular metabolism and long-term energy supply.Both pools of mitochondria differ in their form,proteome,functionality,and cellular role.The proper functioning of synaptic mitochondria depends on processes such as mitochondrial dynamics,transport,and quality control.However,synaptic mitochondria are particularly vulnerable to age-associated damage,characterized by oxidative stress,impaired energy production,and calcium dysregulation.These changes compromise synaptic transmission,reducing synaptic activity and cognitive decline during aging.In the context of neurodegenerative diseases such as Alzheimer’s,Parkinson’s,and Huntington’s,the decline of synaptic mitochondrial function is even more pronounced.These diseases are marked by pathological protein accumulation,disrupted mitochondrial dynamics,and heightened oxidative stress,accelerating synaptic dysfunction and neuronal loss.Due to their specialized role and location,synaptic mitochondria are among the first organelles to exhibit dysfunction,underscoring their critical role in disease progression.This review delves into the main differences at structural and functional levels between synaptic and non-synaptic mitochondria,emphasizing the vulnerability of synaptic mitochondria to the aging process and neurodegeneration.These approaches highlight the potential of targeting synaptic mitochondria to mitigate age-associated cognitive impairment and synaptic degeneration.This review emphasizes the distinct vulnerabilities of hippocampal synaptic mitochondria,highlighting their essential role in sustaining brain function throughout life and their promise as therapeutic targets for safeguarding the cognitive capacities of people of advanced age.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘Impairments on body function,activities of daily living(ADL)and cognition are common after stroke.Eccentric resistance training(ERT)may be implemented to improve them.The primary objectives were to evaluate whether ERT improves body function,ADL and cognition after stroke.The secondary objectives were to evaluate whether ERT improves strength,gait,quality of life,and self-perceived health.Seven electronic databases were searched:Cochrane Central Register of Controlled Trials,Cochrane Stroke Group Trials Register,PubMed,Epistemonikos,Embase,SPORTDiscus,and WHO International Clinical Trials Registry Platform.Last search was run in December 2023,including studies since 2012.Selection criteria were studies with stroke participants of both sexes,aged 18 or more,with an intervention based on ERT.Accepted languages were English,Spanish or French.First search was done in pairs.Authors removed duplicate studies and those which did not meet inclusion criteria through title and abstracts.Finally,all authors,independently,screened the final search results and extracted data.Of 68 records identified,15 were eligible and 6 were finally included(with moderate risk of bias),analyzing 159 participants.Body function(4 interventions,n=84),gait(4 interventions,n=115)and strength(3 interventions,n?78)showed significantly better results when ERT was performed.Meta-analysis could not be done because of the few studies and their heterogeneity.This review provided low-moderate quality evidence suggesting that ERT might be effective at improving body function,strength,and gait after stroke.Besides,no harm was documented,and it was well-accepted.
文摘BACKGROUND Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all age groups,but its prevalence increases with age.Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context,res-pectively.Surgical valve replacement(or mitral valve repair)is the standard of care for treating heart valve disease.However,the replacement of a prosthetic heart valve can lead to complications,either in the peri-procedural phase or in the long-term follow-up period.CASE SUMMARY We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy.She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology.A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs.Furthermore,a possible microthrombotic lesion was suspected.Therefore,systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.CONCLUSION This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.
文摘BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ transplantation.AIM To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.METHODS A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses.This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents(prophylactic or therapeutic)aimed at preventing antimicrobial resistance.The search strategy involved analyzing multiple databases,including PubMed/MEDLINE,Web of Science,Embase,Scopus,and SciELO,as well as examining gray literature sources on Google Scholar.A comprehensive electronic database search was conducted from the databases’inception until May 2024,with no language restrictions.RESULTS After the final phase of the eligibility assessment,this systematic review ultimate-ly included 7 articles.A total of 2318 patients were studied.The most studied microorganisms were cytomegalovirus,although vancomycinresistant enterococci,Clostridioides difficile,and multidrug-resistant Enterobacterales were also analyzed.The antimicrobials used in the interventions were mainly maribavir,valganciclovir,gancic-lovir,and colistin-neomycin.Of concern,all clinical trials showed significant proportions of resistant microorga-nisms after the interventions,with no statistically significant differences between the groups(mean resistance 13.47%vs 14.39%),except for two studies that demonstrated greater efficacy of maribavir and valganciclovir(mean resistance 22.2%vs 41.1%in the control group;P<0.05).The total reported deaths in three clinical trials were 75,and there were 24 graft rejections in two studies.CONCLUSION All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions.More high-quality randomized clinical trials are needed to corroborate these results.
文摘BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.
文摘BACKGROUND Despite advances in the treatment of ulcerative colitis(UC),some patients remain refractory to the currently available treatments.Dual biologic therapy(DBT)has emerged as a promising strategy for these patients.CASE SUMMARY A patient with extensive UC presented with steroid dependence and contraindications(past medical history included breast cancer and previous myocardial infarction)to treatment with tumor necrosis factor and Janus kinase inhibitors.DBT ofα4β7 integrin antagonist(vedolizumab)and interleukin 23p19 inhibitor(mirikizumab)resulted in a sustained clinical and biochemical remission.No adverse events were recorded during the follow-up.CONCLUSION This case highlighted the challenge of managing refractory UC,especially in frail patients.
基金Supported by Hepatology Training Grant from the Spanish Association for The Study of Liver(AEEH-Asociación Española para el Estudio del Hígado)in 2023,No.G28551570(to Quiñones-Calvo M).
文摘BACKGROUND Severe alcoholic hepatitis(SAH)carries a 90-day mortality rate approaching 50%.Management includes corticosteroids,nutritional support,and early liver transplantation in selected cases.However,the mid-term impact of available therapies remains unclear.This systematic review provides a critical evaluation of treatments for SAH,specifically focusing on survival or mortality at 90 days as an essential window that captures short-and mid-term outcomes.The 90-day window is clinically significant,as it reflects the remission of systemic inflam-mation,early liver recovery,and minimizes confounding long-term behaviors such as alcohol relapse.AIM To review the effect of different treatments for SAH on survival and mortality at 90 days.METHODS A systematic search of PubMed and EMBASE(last updated March 2025)was performed without language restrictions,focusing on studies published in the last decade.Study selection and data extraction were performed independently by at least two reviewers.Risk of bias was assessed using RoB 2.0 and Risk-of Bias in Non-Randomized Studies of Interventions tools.Due to heterogeneity in study designs and interventions,a meta-analysis was not feasible.A qualitative synthesis was conducted using narrative summaries and evidence tables.RESULTS Searches in the databases yielded 645 citations in PubMed and 1516 in EMBASE.Of these 2161 studies,618 were duplicates and therefore removed.A total of eight studies were included in qualitative synthesis.Among the included publications,six were randomized control trials(RCT)and two were retrospective cohort studies.These studies evaluated 90-day mortality or survival in SAH patients treated with corticosteroids(n=2),pentoxifylline(n=1),anakinra plus zinc(n=2),granulocyte colony-stimulating factor(n=1),amoxicillin-clavulanate(n=1),fecal microbiota transplantation(n=1)or extracorporeal liver assist device(n=1).While most studies were conducted in Western countries,two had a global scope.CONCLUSION Steroids remain the first-line therapy for SAH despite reports of them not having any 90-day survival benefit.These results highlight the need for multicenter,biomarker-guided RCTs evaluating emerging treatments to improve mid-term survival in SAH.
文摘BACKGROUND Cancer incidence remains a global challenge.The World Health Organization reported 19976499 new cases in 2022,including 1551060 in Latin America and the Caribbean.While chemotherapy advances have improved survival,these treatments carry significant risks,particularly cardiovascular complications impacting morbidity and mortality.Early cardiotoxicity detection enables targeted interventions,guiding clinical decisions on treatment adjustments to mitigate damage and preserve function.Cardiac imaging and biomarkers assess cardiotoxicity before,during,and after therapy.Despite their importance,the lack of a structured multidisciplinary program hinders early detection and management in high-risk patients.AIM To evaluate the use of diagnostic tools for monitoring cardiotoxicity in cancer patients receiving high-risk chemotherapy at the National University Hospital of Colombia.METHODS This observational,retrospective cohort study included patients aged≥18 with cancer treated with potentially cardiotoxic chemotherapy at the National University Hospital of Colombia(2016-2019).Data from medical records included demographics,comorbidities,biomarkers,and echocardiographic parameters.Cardiotoxicity was defined by reduced left ventricular ejection fraction(LVEF)using Simpson’s method and biomarker abnormalities.Statistical analysis included descriptive methods to compare pre-and post-chemotherapy use of biomarkers and echocardiographic parameters.RESULTS From a total of 195 patients analyzed,8.7%(n=17)developed cardiotoxicity,predominantly mild(58.8%,n=10).Affected patients were mostly male(64.7%,n=11)with a mean age of 51.88±15.9 years.The median LVEF declined from 62%[interquartile range(IQR):58%–66%]at baseline to 46%(IQR:34%–56%)post-treatment.STRAIN longitudinal values also significantly decreased,from-18.38±4.62%at baseline to-14.22±4.93%posttreatment.Troponin was measured in 58.8%(n=10)of cardiotoxicity cases,while ProBNP was less frequently used(17.6%,n=3).CONCLUSION This study highlights the utility of echocardiography and biomarkers in assessing cardiotoxicity in oncology patients,emphasizing the need for standardized protocols to optimize early diagnosis and management.However,the retrospective nature of the study and the insufficient use of biomarkers may limit the generalizability of the findings.
文摘This article evaluates the transformative potential of large language models(LLMs)as patient education tools for managing inflammatory bowel disease.The discussion highlights their ability to deliver nuanced and personalized infor-mation,addressing limitations in traditional educational materials.Key consider-ations include the necessity for domain-specific fine-tuning to enhance accuracy,the adoption of robust evaluation metrics beyond readability,and the integration of LLMs with clinical decision support systems to improve real-time patient education.Ethical and accessibility challenges,such as algorithmic bias,data privacy,and digital literacy,are also examined.Recommendations emphasize the importance of interdisciplinary collaboration to optimize LLM integration,en-suring equitable access and improved patient outcomes.By advancing LLM technology,healthcare can empower patients with accurate and personalized information,enhancing engagement and disease management.
文摘BACKGROUND Colorectal cancer is the third most common malignancy globally,with the liver being the predominant site of metastatic disease.AIM To evaluate safety,feasibility,and outcomes of robotic liver resection(RLR)versus laparoscopic liver resection(LLR)and open liver resection(OLR)for colorectal metastasis(CRLM).METHODS This study followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Systematic searches in PubMed,EMBASE,Scopus,and Cochrane Library identified comparative and noncomparative reviews evaluating RLR versus LLR or OLR for CRLM.Two independent reviewers screened studies using predefined PICO(Population,Intervention,Comparator,Outcome)criteria,with data extraction focusing on conversion rates,operative outcomes,morbidity,mortality,and survival.Methodological quality was assessed via Assessment of Multiple Systematic Reviews 2.Pooled analyses were performed for comparative data;noncomparative studies were narratively synthesized.RESULTS Pooled evidence from two comparative systematic reviews(9792 patients)demonstrated that RLR offers distinct advantages over LLR and OLR,including significantly lower conversion rates(4.7%–6.7%vs 10.4%–12.4%,P<0.001)and reduced intraoperative blood loss(190.8–266.8 mL vs 283.9–294.3 mL,P<0.001)despite longer operating times(mean 304.1 vs 191.8 min).Perioperative safety and oncologic outcomes(R0 resection>82%;5-year overall survival:53.1%–60.8%)were comparable across approaches.Three additional noncomparative reviews(n=274)highlighted the technical practicability of RLR in complex cases(zero conversions in small cohorts,median 399.5 min for simultaneous resections).However,these findings were not included in pooled analyses due to the lack of comparator groups.Noncomparative data(n=274)revealed higher upfront costs for RLR due to prolonged operating times(median 399.5 min)and the need for expensive equipment;however,no formal cost comparisons were available.CONCLUSION RLR is a safe and feasible alternative to LLR and OLR for CRLM,demonstrating superior technical performance and comparable short-term outcomes.
文摘With gastric cancer ranking among the most prevalent and deadly malignancies worldwide,early detection and individualized prognosis remain essential for improving patient outcomes.This letter discusses recent advancements in arti-ficial intelligence(AI)-driven predictive tools for gastric cancer,emphasizing a computed tomography-based radiomic model that achieved a predictive accuracy of area under the curve of 0.893 for treatment response in advanced cases undergoing neoadjuvant immunochemotherapy.AI offers promising avenues for predictive accuracy and personalized treatment planning in gastric oncology.Additionally,this letter highlights the comparison of these AI tools with tra-ditional methodologies,demonstrating their potential to streamline clinical workflows and address existing gaps in risk stratification and early detection.Furthermore,this letter addresses the ethical considerations and the need for robust clinical-AI collaboration to achieve reliable,transparent,and unbiased outcomes.Strengthening cross-disciplinary efforts will be vital for the responsible and effective deployment of AI in this critical area of oncology.
基金funding from the Spanish Ministry of Science, Innovation and Universities for project PID2023-149340OB-I00, “Ciencia abierta y ciencia ciudadana para una sociedad más sostenible e inclusiva: aportaciones del Sistema Universitario Espanol”
文摘Purpose:This paper focuses on scientific journals’policies on open access and open science.The subject has gained increasing relevance,driven by the need for more-democratic access to knowledge and improved research visibility,which require eliminating the financial,legal,and technical barriers that restrict access to scientific output.Design/methodology/approach:This paper uses the findings of FECYT’s 2023 Assessment of the Editorial and Scientific Quality of Spanish Scientific Journals,with 254 participating journals,as its case study.Open science indicators assess the transparency of policies on content access,reuse,openness,and reproducibility.Nonparametric tests analyse the relationship between the indicators and the dimensions of publisher type and subject area.Findings:High compliance rates are found for indicators related to publication licences and intellectual property rights.Only 37%of the journals examined post their editorial policy on Sherpa Romeo.Ninety-four percent publish open access.However,open peer review is rarely applied(0.38%of the journals).Journals in Communication,Information and Scientific Documentation,Fine Arts,Education Science,and Biomedical Sciences have high compliance percentages.Most journals(83%)are institutional,with universities and associations generally exhibiting better results.Research limitations:This study is based on specific indicators that do not cover all the factors that influence the transition toward open science;for example,editorial culture and technological infrastructure are not envisaged.Furthermore,differences in open science implementation are identified between disciplinary areas and between publisher types,but the underlying causes of these differences are not thoroughly investigated.Future research could address these points for a fuller understanding.Practical implications:This study highlights the need for journals to improve transparency by adopting open peer review and clear policies.These changes enhance accessibility and credibility,fostering inclusive knowledge dissemination.Institutions and policymakers should support these efforts to boost research impact.Originality/value:This study offers insights into open science practices in Spanish journals,a growing academic topic.Its originality lies in examining open science indicators across disciplines and publishers.By identifying strengths and gaps,the study helps journals enhance transparency.
基金Supported by Takeda Argentina SA,No.TAK-633-4003.
文摘BACKGROUND Approval of teduglutide is an important addition to the limited treatment options for short bowel syndrome(SBS).However,real-world evidence on teduglutide therapy for SBS in Latin America is scarce.AIM To investigate the effectiveness and safety of teduglutide in clinical practice in Argentina with a 24-week follow-up.METHODS This non-interventional multicentre cohort study included consecutive patients(aged≥1 years)with SBS who were dependent on parenteral support(PS)and received≥1 dose of teduglutide according to currently approved indications.RESULTS The study population(n=45)included 21 adult and 24 pediatric patients.The proportion of adult and pediatric patients who showed clinical response(defined as a≥20%reduction in weekly PS volume)after 24 weeks of treatment was 90.4%[95%confidence interval(CI):69.6%-98.8%]and 83.3%(95%CI:62.6%-95.2%),respectively.Overall,12 patients(26.6%;95%CI:14.6-41.9)were weaned from PS support at the 24-week assessment,6(28.5%;95%CI:11.5-52.1)in the adult cohort,and 6(25%;95%CI:9.7-46.7)in the pediatric cohort.Only baseline PS requirement was inversely associated with weaning from PS(P=0.025).The most frequently reported treatmentemergent adverse events(TEAEs)were mild to moderate abdominal pain and abdominal distension(16.6%;and 9.5%,respectively).None of the reported TEAEs led to treatment discontinuation.CONCLUSION This prospective real-world study demonstrated the effectiveness and safety of teduglutide in adult and pediatric patients with SBS in Argentina.The clinical response observed in both adults and pediatric patients was greater than that reported in phase 3 trials and was consistent with the results of other real-world studies.
文摘Acute-on-chronic liver failure(ACLF) is increasingly recognized as a complex syndrome that is reversiblein many cases. It is characterized by an acute deterioration of liver function in the background of a pre-existing chronic liver disease often associated with a high short-term mortality rate. Organ failure(OF) is always associated, and plays a key role in determining the course, and the outcome of the disease. The definition of ACLF remains controversial due to its overall ambiguity, with several disparate criteria among various associations dedicated to the study of liver diseases. Although the precise pathogenesis needs to be clarified, it appears that an altered host response to injury might be a contributing factor caused by immune dysfunction, ultimately leading to a pro-inflammatory status, and eventually to OF. The PIRO concept(Predisposition, Insult, Response and Organ Failure) has been proposed to better approach the underlying mechanisms. It is accepted that ACLF is a different and specific form of liver failure, where a precipitating event is always involved, even though it cannot always be ascertained. According to several studies, infections and active alcoholism often trigger ACLF. Viral hepatitis, gastrointestinal haemorrhage, or drug induced liver injury, which can also provoke the syndrome. This review mainly focuses on the physiopathology and prognostic aspects. We believe these features are essential to further understanding and providing the rationale for improveddisease management strategies.
文摘Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging mo-dalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature.
文摘The extensive use of imaging techniques in differential diagnosis of abdominal conditions and screening of hepatocellular carcinoma in patients with chronic hepatic diseases,has led to an important increase in identification of focal liver lesions.The development of contrastenhanced ultrasound(CEUS) opens a new window in the diagnosis and follow-up of these lesions.This technique offers obvious advantages over the computed tomography and magnetic resonance,without a decrease in its sensitivity and specificity.The new second generation contrast agents,due to their intravascular distribution,allow a continuous evaluation of the enhancement pattern,which is crucial in characterization of liver lesions.The dual blood supply in the liver shows three different phases,namely arterial,portal and late phases.The enhancement during portal and late phases can give important information about the lesion's behavior.Each liver lesion has a different enhancement pattern that makes possible an accurate approach to their diagnosis.The role of emerging techniques as a contrastenhanced three-dimensional US is also discussed.In this article,the advantages,indications and technique employed during CEUS and the different enhancement patterns of most benign and malignant focal liver lesions are discussed.
文摘AIM:To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae.METHODS:Under controlled circumstances,and approved by European and Spanish laws,a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae.Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae,and presented symptomatic recurrence.The intervention consisted of limited surgery(with closure of the internal opening),followed by local implant of stem cells in the fistula-tract wall.Autologous expanded adipose-derived stem cells were the main cell type selected for implant.The first evaluation was performed on the 8th postoperative week;outcome was classified as response or partial response.Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved.RESULTS:Ten patients(8 male)with highly recurrent and complex fistulae were treated(mean age:49years,range:28-76 years).Seven cases were nonCrohn’s fistulae,and three were Crohn’s-associated fistulae.Previous surgical attempts ranged from 3to 12.Two patients presented with preoperative incontinence(Wexner scores of 12 and 13 points).After the intervention,six patients showed clinical response on the 8th postoperative week,with a complete cessation of suppuration from the fistula.Three patients presented a partial response,with an evident decrease in suppuration.A year later,six patients(60%)remained healed,with complete reepithelization of the external opening.Postoperative Wexner Scores were 0 in six cases.The two patients with previous incontinence improved their scores from12 to 8 points and from 13 to 5 points.No adverse reactions or complications related to stem-cell therapy were reported during the study period.CONCLUSION:Stem cells are safe and useful for treating anal fistulae.Healing can be achieved in severe cases,sparing fecal incontinence risk,and improving previous scoring.
文摘There is evidence supporting the hypothesis that inflammation participates in providing conditions that lead to cancer.An unresolved inflammation due to any failure in the precise control of the immune response can continue to perturb the cellular microenvironment, thereby leading to alterations in cancer-related genes and posttranslational modification in crucial cellular proteins involved in the cell cycle,DNA repair and apoptosis.In addition,there are data indicating that inflammatory cells and immunomodulatory mediators present in the tumor microenvironment influence tumor progression and metastasis.Historically,tumor-infiltrating leukocytes have been considered to be manifestations of an intrinsic defence mechanism against developing tumors.However,increasing evidence indicates that leukocyte infiltration can promote tumor phenotypes, such as angiogenesis,growth and invasion.This may be due to inflammatory cells that probably can influence cancer promotion by secreting cytokines,growth factors,chemokines and proteases,which stimulate proliferation and invasiveness of cancer cells.Conse-quently,events and molecules implicated in this cross talk between the tumor microenvironment and inflam- matory process may emerge as attractive targets in anticancer therapeutic interventions with significant clinical impact.
